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NUR 240 > NUR 240 Exam 2 > Flashcards

NUR 240 Exam 2 Flashcards

1
Q

What is a litigation

A

Process of bringing and trying a lawsuit (suing someone)

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2
Q

What is the plaintiff

A

The person suing

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3
Q

What is the defendant

A

The person being accused of a crime

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4
Q

What is public law

A

Government is directly involved (wearing a seatbelt)

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5
Q

What is private law

A

Civil law; regulates relationships between people (breaking a contract)

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6
Q

What is criminal law

A

Concerns state and federal criminal statutes; defines criminal actions (Murder, theft, etc)

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7
Q

What is constitutional law

A

Serve as guides to legislative bodies; right to bear arms, civil rights -federal- state (workers comp, car accidents)

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8
Q

What is statutory law

A

Enacted by a legislative body; nurse practice acts (each state)

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9
Q

What is administrative law

A

Empowered by executive officers; (president-fed level/governor/mayor-state/local levels…state board of nursing- law enforcement)

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10
Q

What is common law

A

Judiciary system reconciles controversies (court-made law- malpractice laws- prevent one set of rules for one person and another set of rules for another person)

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11
Q

In what ways is nursing regulated by law

A

Nurse practice acts
Credentialing - accreditation, licensure, certification

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12
Q

What are some reasons why a nurse’s license may be suspended or revoked

A
  • drug or alcohol abuse
  • fraud
  • deceptive practice
  • ## criminal acts
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13
Q

What are some reasons why a nurse’s license may be suspended or revoked

A
  • drug or alcohol abuse
  • fraud
  • deceptive practice
  • criminal acts
  • previous disciplinary actions
  • negligence
  • physical or mental impairments including age
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14
Q

What is considered a crime

A

Wrong against a person or the person’s property as well as the public
- Misdemeanor - punishable by fines or less than 1 year imprisonment
- felony - punishable by imprisonment for more than 1 year

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15
Q

What is considered a tort

A

A wrong committed by a person against another person or that person’s property; tried in civil court
- intentional
- unintentional

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16
Q

What are some examples of intentional torts

A
  • Assault and battery
  • Defamation of character
  • Invasion of privacy
  • False imprisonment
  • Fraud
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17
Q

What are some examples of unintentional torts

A
  • negligence
  • malpractice
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18
Q

what rights are given to the patients under HIPPA

A
  • To see their health record
  • To update their health record
  • To request correction of mistakes
  • To get a list of the disclosures that have been sent out by the hospital
  • To request a restriction on certain disclosures
  • To choose how to receive health information
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19
Q

What are the categories of malpractice claims

A
  • Failure to follow standards of care
  • Failure to use equipment in responsible manner
  • Failure to assess and monitor
  • Failure to communicate
  • Failure to document
  • Failure to act as a patient advocate
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20
Q

What are the four elements of liability

A
  • duty
  • breach of duty
  • causation
  • damages
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21
Q

What is included under OSHA regulations

A
  • use of electrical equipment
  • use of isolation techniques
  • use of radiation
  • use of chemicals
    (ensures a safe working environment)
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22
Q

Is the incident report considered part of the medical record

A

No

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23
Q

What are the functions of the skin

A
  • protection
  • body temperature regulation
  • psychosocial (self esteem)
  • sensation
  • vitamin D production
  • immunologic
  • absorption
  • elimination
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24
Q

What are the causes of skin alterations

A
  • Very thin or very obese
  • Fluid loss
  • Excessive moisture
  • Jaundice
  • Diseases (psoriasis, eczema, etc)
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25
Q

What types of wounds exist

A
  • intentional or unintentional
  • open or closed
  • acute or chronic
  • partial thickness, full thickness, or complex
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26
Q

What is a wound

A

Break/disruption in the normal integrity of the skin

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27
Q

What are the principles of wound healing

A
  • intact skin
  • hand hygiene
  • systematic body response to trauma
  • adequate blood supply
  • no foreign material in the wound
  • extent of the damage
  • nutrition
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28
Q

What are the phases of wound healing

A
  • hemostasis
  • inflammatory
  • proliferation
  • maturation
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29
Q

What is hemostasis

A
  • occurs immediately after injury
  • blood vessels constrict; blood begins to clot
  • exudate (blood and plasma) is formed causing swelling and pain
  • increased perfusion leads to redness and warmth
  • platelets initiate other cells to progress the healing process
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30
Q

What is the inflammatory phase

A
  • after hemostasis (lasts2-3 days)
  • WBC (leukocytes and macrophages) migrate to the wound
  • leukocytes first, macrophages about 24 hours after and remain for a while (ingest debris then release growth factors to attract fibroblasts to fill in the wound
  • generalized body response: general malaise
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31
Q

What is the proliferation phase

A
  • lasts several weeks
  • fibroblasts build new tissue to fill wound space
  • capillaries grow across the wound
  • highly vascular, granular tissue forms the foundation of scar tissue development
  • A thin layer of epithelial cells form across the wound
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32
Q

What is the maturation phase

A
  • Final stage of healing; begins about 3 weeks after the injury, possibly continuing for months or years
  • Collagen is remodeled
  • New collagen tissue is deposited
  • Scar becomes a flat, thin, white line
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33
Q

What are some local factors affecting wound healing

A
  • pressure
  • deccication (dehydration)
  • maceration (overhydration)
  • trauma
  • edema
  • infection
  • excessive bleeding
  • necrosis
  • presence of biofilm (layer of microorganisms)
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34
Q

What are some systemic factors affecting wound healing

A
  • Age (children and healthy adults heal faster)
  • circulation
  • nutrition
  • etiology (cause of the wound)
  • health status
  • immunosuppression
  • medication use
  • adherence to treatment plan
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35
Q

What are some wound complications

A
  • infection
  • hemorrhage
  • dehiscence or evisceration
  • fistula formation
  • abcess formation
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36
Q

What is a hemorrhage and what do you do about it

A
  • hemostasis not reached
  • bleeding
  • always check post OP wounds and mark drainage on the dressing
  • if saturating the dressing and not getting better, notify the doctor and surgeon immediately
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37
Q

What is a fistula

A

a tract from one epithelial cell to another usually due to an abcess
- name by origin and end organ (rectovaginal, endocutaneous)

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38
Q

What is an abcess

A

A collection of infectious material
- usually leads to the formation of a fistula to get rid of the material

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39
Q

What is dehiscence

A

Separation of wound layers

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40
Q

What is evisceration

A

complete wound separation with internal organs protruding
- usually in the abdomen
- Caused by infection, increased internal pressure, coughing and sneezing (special pillows to hug when you cough or sneeze)

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41
Q

Psychological effects on wound healing

A
  • pain
  • anxiety
  • fear
  • impact on ADLs
  • Change on body image
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42
Q

Factors affecting pressure injury development

A
  • mobility
  • aging skin
  • chronic illnesses
  • malnutrition
  • incontinence
  • mental status
  • spinal cord and brain injuries
  • neuromuscular disorders
  • external pressure
  • friction or shearing
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43
Q

Stages of pressure injuries

A

stage 1
stage 2
stage 3
stage 4
unstageable
deep tissue pressure injury

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44
Q

What are the characteristics of a stage 1 pressure injury

A

intact skin; non-blanchable erythema (redness)

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45
Q

What are the characteristics of a stage 2 pressure injury

A

partial thickness skin loss with exposed dermis; red, moist base

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46
Q

What are the characteristics of a stage 3 pressure injury

A

full-thickness skin loss, no bone exposed

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47
Q

What are the characteristics of a stage 4 pressure injury

A

full-thickness skin loss; bone exposed

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48
Q

What are the characteristics of an unstageable pressure injury

A

full-thickness skin loss; obscured (cannot see the base of the wound)

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49
Q

What are the characteristics of a deep tissue pressure injury

A

persistent nonblanchable deep red, maroon, or purple discoloration

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50
Q

What are you looking at when measuring a pressure injury

A
  • size (length and width)
  • depth (from the deepest point)
  • presence of tunneling or fistulas (describe based on a clock)
  • percentage of red, white/yellow, and black tissue
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51
Q

How do you clean a pressure injury wound

A
  • clean with each dressing change
  • use 0.9% normal saline solution to irrigate/clean
  • dry using gauze
  • report drainage or necrotic tissue
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52
Q

What terms are used to assess wound drainage

A
  • serous (clear, watery)
  • sanguinous (bloody; dark is old blood bright is new blood)
  • serosanguinous (mixture of both)
  • purulent (yellow, green; infection, WBC, dead tissue debris)
  • scant, moderate, copious (amount)
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53
Q

What characteristics of a wound would indicate an infection

A
  • swollen
  • deep red color
  • hot when palpated
  • increased drainage
  • purulent drainage
  • foul odor
  • dehisscense
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54
Q

What are some types of wound dressings

A
  • nonadherent
  • gauze dressings
  • transparent dressings
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55
Q

What are the different types of drainage systems

A
  • open system (penrose)
  • closed system (Jackson-Pratt, hemovac)
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56
Q

What is a Penrose drain

A
  • open drain system
  • comes from the surgical incision to the outside of the body to drain fluid in order to avoid edema
  • needs surgery to remove
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57
Q

What is a Jackson-Pratt drain

A
  • closed drain system
  • uses negative pressure to remove drainage
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58
Q

What is the Braden scale

A
  • determines the risk of developing a pressure injury
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59
Q

What is CHA

A

Complimentary health approaches
- service animals
- guided imagery
- massage therapy
- supplements

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60
Q

What is allopathic medicine

A

Traditional medical care

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61
Q

What is holism

A

Connection and interactions between parts of the whole

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62
Q

What is Ayurveda

A

To integrate and balance the body, mind, and spirit
- treatments that include herbs, metals, minerals, and other materials; diet and exercise; and lifestyle recommendations

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63
Q

What is the process of micturation

A
  • urinating
  • detruser muscle contracts,
  • internal sphincter relaxes
  • urine enters the posterior urethra
  • perineum and external sphincter relax
  • muscle of abdominal wall contracts slightly
  • diaphragm lowers
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64
Q

What are some factors affecting micturesis

A
  • developmental factors
  • food and fluid intake
  • psychological factors
  • activity and muscle tone
  • pathologic conditions
  • medications
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65
Q

Diseases associated with renal problems

A
  • Congenital urinary tract abnormalities
  • Polycystic kidney disease
  • Urinary tract infection
  • Urinary calculi
  • Hypertension
  • Diabetes mellitus
  • Gout
  • Connective tissue disorders
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66
Q

what medications can affect urination

A
  • Diuretics: prevent reabsorption of water and certain electrolytes in tubules
  • Cholinergics: stimulate contraction of detrusor muscle, producing urination
  • analgesics and traquilizers: suppress CNS, diminish effectiveness of neural reflex
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67
Q

What medications affect urine color

A
  • Anticoagulants: red urine/hematuria- blood in urine
  • Diuretics: pale yellow urine
  • Pyridium: orange to orange-red urine
  • The antidepressant amitriptyline or B-complex vitamins: green or blue-green urine
  • Levodopa: brown or black urine
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68
Q

What are some different urine specimens

A
  • Routine urinalysis
  • Clean-catch or midstream specimens
  • Sterile specimens from indwelling catheter
  • Urine specimen from a urinary diversion
  • 24-hour urine specimens
  • Point-of-care urine testing
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69
Q

Which patients are at risk of a UTI

A
  • Sexually active women
  • Women who use diaphragms for contraception
  • Postmenopausal women
  • Individuals with indwelling urinary catheter
  • Individuals with diabetes mellitus
  • Older adults
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70
Q

What are some reasons to catheterize a patient

A
  • Relieving urinary retention
  • Prolonged patient immobilization
  • Obtaining a sterile urine specimen when patient is unable to void voluntarily
  • Accurate measurement of urinary output in critically ill patients
  • Assisting in healing open sacral or perineal wounds in incontinent patients
  • Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations.
  • Providing improved comfort for end-of-life care
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71
Q

What are the different types of urinary incontinence

A
  • transient
  • overflow/chronic retention
  • functional
  • reflex
  • stress
  • mixed
  • total
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72
Q

What is transient incontinence

A

appears suddenly and lasts 6 months or less

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73
Q

What is overflow/chronic incontinence

A

overdistention and overflow of bladder

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74
Q

What is functional incontinence

A

caused by factors outside the urinary tract

75
Q

What is reflex incontinence

A

emptying of the bladder without sensation of need to void

76
Q

What is stress incontinence

A

involuntary loss of urine related to an increase in intra-abdominal pressure

77
Q

What is mixed incontinence

A

urine loss with features of two or more types of incontinence

78
Q

What is total incontinence

A

continuous, unpredictable loss of urine

79
Q

What is a suprapubic catheter

A
  • surgically implanted catheter through the abdominal wall
  • done because of spinal cord injury or prostate cancer
  • less chance of fecal contamination
  • doesn’t interfere with sexual activity
80
Q

What is an ileal conduit

A
  • Part of the small bowel connected to the ureters so that urine can leave the body in the case that the bladder has been removed
  • urostomy
  • mucus is a normal finding
81
Q

What are some variables that affect bowel elimination

A
  • Developmental considerations
  • Daily patterns
  • Food and fluid
  • Activity and muscle tone
  • Lifestyle
  • Psychological variables
  • Pathologic conditions
  • Medications
  • Diagnostic studies
  • Surgery and anesthesia
82
Q

Which foods are constipating foods

A
  • cheese
  • lean meat
  • eggs
  • pasta
83
Q

What are some foods with peristaltic effects

A
  • fruits
  • vegetables
  • bran
  • chocolate
  • alcohol
  • coffee
84
Q

What are some gas producing foods

A
  • onions
  • cabbage
  • beans
  • cauliflower
85
Q

Which medications effect stool

A
  • Aspirin, anticoagulants: pink to red to black stool
  • Iron salts: black stool
  • Bismuth subsalicylate used to treat diarrhea can also cause black stools.
  • Antacids: white discoloration or speckling in stool
  • Antibiotics: green-gray color
86
Q

What are some types of endoscopy

A
  • Esophagogastroduodenoscopy
  • Colonoscopy
  • Sigmoidoscopy
  • Wireless capsule endoscopy
87
Q

What are some indirect visualization techniques

A
  • Upper gastrointestinal (UGI)
  • Small bowel series
  • Barium enema
  • Abdominal ultrasound
  • Magnetic resonance imaging (MRI)
  • Abdominal CT scan
88
Q

Which patients are at risk for constipation

A
  • Patients on bedrest taking constipating medicines
  • Patients with reduced fluids or bulk in their diet
  • Patients who are depressed
  • Patients with central nervous system disease or local lesions that cause pain while defecating
89
Q

How do you prevent food poisoning

A
  • Never buy food with damaged packaging.
  • Take items requiring refrigeration home immediately.
  • Wash hands and surfaces often.
  • Use separate cutting boards for foods.
  • Thoroughly wash all fruits and vegetables before eating.
  • Do not wash meat, poultry, or eggs to prevent spreading microorganisms to sink and other kitchen surfaces.
  • Never use raw eggs in any form.
  • Do not eat seafood raw or if it has an unpleasant odor
  • Use a food thermometer to ensure cooking food to safe internal temperature.
  • Keep food hot after cooking; maintain safe temperature of 140°F or above.
  • Give only pasteurized fruit juices to small children
90
Q

What are some methods of emptying the colon

A
  • Enemas
  • Rectal suppositories
  • Oral intestinal lavage
  • Digital removal of stool
91
Q

What are the different types of bowel ostomies

A
  • Sigmoid colostomy
  • Descending colostomy
  • Transverse colostomy
  • Ascending colostomy
  • Ileostomy
92
Q

What are the energy supplying nutrients

A

Carbohydrates
Lipids
Proteins

93
Q

Which nutrients regulate body processes

A

Vitamins
Minerals
Water

94
Q

What is the basal metabolic rate

A

The energy required to sustain metabolic activities of cells and tissues

95
Q

What is the primary source of heat in the body

A

Metabolism

96
Q

What is the BMR in men vs. women

A

Men: 1 cal/kg/hr
Women: 0.9 cal/kg/hr

97
Q

What are some factors that can raise BMR

A
  • Growth
  • infections
  • fever
  • emotional tension
  • extreme environmental temperatures
  • elevated levels of certain hormones
98
Q

What are some factors that can lower BMR

A
  • Aging
  • prolonged fasting
  • sleep
99
Q

How do you calculate BMI

A

Weight (kg)/ (Height (m) x Height (m))
[ weight divided by height squared] [kg per meter squared]

100
Q

What are the BMI categories

A

Underweight < 18.5
Normal (ideal) weight 18.5- 24.9
Overweight 25- 29.9
Obesity 30+

Waist circumference:
men: > 40 inches
women: >35 inches

101
Q

What are carbohydrates

A

Organic compounds composed of carbon, hydrogen, and oxygen

Sugars and starches

Most abundant and cheapest source of calories

102
Q

What are proteins

A

Made of amino acids

Required for the formation of all body structures

Complete and incomplete based on amino acid composition

103
Q

What is considered a complete or incomplete protein

A

Complete: animal proteins
Incomplete: plant proteins

104
Q

What is the recommended protein intake for an adult

A

0.8 g/kg of body weight
10% to 35% of total calorie intake

105
Q

What are fats

A

Composed of carbon, hydrogen, and oxygen

Insoluble in water and blood

Saturated and unsaturated

106
Q

What is the difference between saturated and unsaturated fats

A

Saturated: solid at room temp (most animal fats)
Unsaturated: liquid at room temp (most vegetable fats)

107
Q

What types of food are consistent of trans fats

A

manufactured, partially hydrogenated oils
liquid at room temp
more stable = longer shelf life

108
Q

Where are fats digested

A

Starts in mouth but mostly in the small intestine

109
Q

What is the recommended saturated and trans fat intake for an adult

A

Saturated: <10% of calories/day
Trans: as little as possible (or none)/day

110
Q

What are vitamins

A

Organic compounds needed by the body in small amounts
- Most are active in the form of coenzymes.
- Needed for metabolism of carbohydrates, protein, and fat
- Classified as water soluble or fat soluble
- Absorbed through the intestinal wall directly into
bloodstream

111
Q

What are minerals

A

Inorganic elements found in all body fluids and tissues
- Some function to provide structure in the body,
- others help regulate body processes
- Contained in the ash that remains after digestion
- Macrominerals
- Microminerals

112
Q

Which minerals are considered macrominerals

A
  • calcium
  • phosphorus (phosphates)
  • sulfur (sulfate)
  • sodium
  • chloride
  • potassium
  • magnesium
113
Q

Which minerals are considered microminerals

A
  • iron
  • zinc
  • manganese
  • chromium
  • copper
  • molybdenum
  • selenium
  • fluoride
  • iodine
114
Q

What percentage of the adult body weight consists of water

A

50-60%

2/3 of that water is inside cells

1/3 of that water is in extracellular fluid and plasma

115
Q

What are some physiologic/physical factors affecting food habits

A
  • stage of development
  • state of health
  • medications
116
Q

What are some sociocultural/psychosocial factors affecting food habits

A
  • Economics
  • culture
  • religion
  • tradition
  • education
  • politics
  • social status
  • food ideology
117
Q

What are some age related considerations causing differences in nutritional needs

A

Growth (infancy, adolescence, pregnancy, and lactation increase nutritional needs)

Activity increases nutritional needs.

Age-related changes in metabolism and body composition

Nutritional needs level off in adulthood because of decrease in BMR.

118
Q

What are some risk factors of poor nutritional status

A
  • Developmental factors
  • Gender
  • State of health
  • Alcohol abuse
  • Medications
  • Megadoses of nutrient supplements
119
Q

What are some potential complications of TPN

A
  • Insertion problems
  • Infection and sepsis
  • Metabolic alterations
  • Fluid, electrolyte, and acid–base imbalances
  • Phlebitis
  • Hyperlipidemia
  • Liver and gallbladder disease
120
Q

What are the nursing responsibilities when it comes to the nursing diagnosis

A

Recognize infection risks
Identify human responses
Anticipate possible complications
Initiate urgent interventions

121
Q

What are the different types of diagnoses

A

Nursing diagnosis
medical diagnosis
collaborative problems

122
Q

What is a nursing diagnosis

A

Patient problems that nurses can treat independently

123
Q

What is a medical diagnosis

A

Problems for which the physician directs the primary treatment

124
Q

What are collaborative problems

A

Managed by using physician-prescribed and nursing-prescribed interventions

125
Q

What are the four steps of data interpretation and analysis

A
  • Recognizing significant data: Comparing data to standards
  • Recognizing patterns or clusters
  • Identifying strengths, problems, and potential
    complications
  • Reaching conclusions
126
Q

What are the four possible conclusions that can be reached after analyzing data

A

No problem
Possible problem
Actual or potential nursing diagnosis
Clinical problem other than nursing diagnosis

127
Q

What does etiology mean

A

The cause of a disease or condition

128
Q

What are the steps to forming the nursing diagnosis

A
  1. identify the problem
  2. etiology of the problem
  3. defining characteristics of the problem

[problem] related to [etiology] as evidenced by [symptoms or characteristics]

Ex. [shortness of breath] r/t [smoking] AEB [use of accessory muscles and SPO2 of 88]

129
Q

What are the three types of nursing diagnoses

A

problem-focused [problem etiology and evidence]
Risk [problem and etiology]
Health promotion

130
Q

What are the goals of the outcome intervention/planning step of the nursing process

A

Establish priorities
Identify expected patient outcomes
Select evidence-based nursing interventions
Communicate the care plan

131
Q

What are the three elements of comprehensive planning

A

Initial
Ongoing
Discharge

132
Q

What does the initial planning step entail

A
  • Developed by the nurse who performs the nursing history
    and physical assessment
  • Addresses each problem listed in the nursing diagnoses
  • Identifies appropriate patient goals and related nursing care
133
Q

What does the ongoing planning step entail

A
  • Carried out by any nurse who interacts with patient
  • Keeps the plan up to date, manages risk factors, promotes
    function
  • States nursing diagnoses more clearly
  • Develops new diagnoses
  • Makes outcomes more realistic and develops new outcomes
    as needed
  • Identifies nursing interventions to accomplish patient goals
134
Q

What does the discharge planning step entail

A
  • Carried out by the nurse who worked most closely with the
    patient (usually a discharge planner)
  • Begins when the patient is admitted for treatment
  • Uses teaching and counseling skills effectively to ensure that
    home care behaviors are performed competently
135
Q

Nursing diagnosis priorities

A

High priority: greatest threat to patient well-being

Medium priority: nonthreatening diagnoses

Low priority: diagnoses not specifically related to current health problem

136
Q

What are the steps in Maslow’s hierarchy of needs

A

Physiologic needs
Safety needs
Love and belonging needs
Self-esteem needs
Self-actualization needs

137
Q

What are the six aims of quality care established by the Institute of Medicine (IOM)

A
  1. Safe: avoiding injury
  2. Effective: avoiding overuse and underuse
  3. Patient-centered: responding to patient preferences, needs,
    and values
  4. Timely: reducing waits and delays
  5. Efficient: avoiding waste
  6. Equitable: providing care that does not vary in quality to all
    recipients
138
Q

What are the three categories of outcomes

A

Cognitive (learning, education)
Psychomotor (new physical abilities)
Affective (self esteem)

139
Q

What are the parts of a measurable outcome

A

Subject: The patient will…
Verb: walk, brush teeth…
Conditions: 20 ft., twice a day…
Performance criteria: SBA, without assistance…
Target time: short term or long term

Ex. The patient will walk 20ft SBA by the end of the week

140
Q

What are the three types of nursing interventions

A
  1. Nurse-initiated: actions performed by a nurse without a
    physician’s order
  2. Physician-initiated: actions initiated by a physician in
    response to a medical diagnosis but carried out by a nurse
    under doctor’s orders
  3. Collaborative: treatments initiated by other providers and
    carried out by a nurse
141
Q

What is a procedure

A

A set of how-to action steps

142
Q

What is standard of care

A

A description of the acceptable level of patient care

143
Q

What is an algorithm

A

A set of steps used to make a decision

144
Q

What is a clinical practice guideline

A

A statement outlining appropriate practice for clinical condition or procedure

145
Q

What are some reasons for noncompliance

A
  • Lack of family support
  • Lack of understanding about the benefits
  • Low value attached to outcomes
  • Adverse physical or emotional effects of treatment
  • Inability to afford treatment
  • Limited access to treatment
146
Q

What are the five rights of delegation

A
  • Right task
  • Right circumstances
  • Right person
  • Right directions and communication
  • Right supervision and evaluation
147
Q

What are SMART goals

A

S: specific
M: measurable
A: achievable
R: realistic
T: timely

148
Q

What are the five elements of evaluation

A
  1. Identifying evaluative criteria and standards
  2. Collecting data to determine if criteria and standards are
    met
  3. Interpreting and summarizing findings
  4. Documenting judgment
  5. Terminating, continuing, or modifying the plan
149
Q

What is evaluative criteria

A

Measurable qualities, attributes, or characteristics that specify skills, knowledge, or health status

150
Q

What are standards when talking about evaluation

A

Levels of performance accepted and expected by the nursing staff

151
Q

What are some variables that affect outcome achievement

A

Patient: gives up and refuses
Nurse: suffering from burnout
Health care system: inadequate staffing

152
Q

What are some examples of an evaluative statement

A

Decide how well a goal was met along with data to support the statement
- met
- partially met
- not met

153
Q

What are the six Quality and Safety Education for Nurses (QSEN) competencies

A
  1. Patient-centered care
  2. Teamwork and collaboration
  3. Evidence-based practice
  4. Quality improvement
  5. Safety
  6. Informatics
154
Q

What are the different types of problem solving

A
  • Trial-and-error problem solving
  • Scientific problem solving
  • Intuitive problem solving
  • Critical thinking: intuitive, logical, or both
155
Q

What are the five steps of the nursing process

A

ADPIE
1. Assessing
2. Diagnosing
3. Planning
4. Implementing
5. Evaluating

156
Q

What does the diagnosis step of the nursing process entail

A

Analyzing patient data to identify patient strengths and problems

157
Q

What does the planning step of the nursing process entail

A

Specifying patient outcomes and related nursing interventions

158
Q

What does the implementation step of the nursing process entail

A

Carrying out the care plan

159
Q

What does the evaluation step of the nursing process entail

A

Measuring extent to which patient achieved outcomes

160
Q

What does the assessing step of the nursing process entail

A

Collecting, validating, and communicating patient data

161
Q

What are the characteristics of the nursing process

A
  • Systematic: part of an ordered sequence of activities
  • Dynamic: great interaction and overlapping among the five
    steps (ADPIE)
  • Interpersonal: human being is always at the heart of nursing
  • Outcome oriented: nurses and patients work together to
    identify outcomes
  • Universally applicable: a framework for all nursing activities
162
Q

What are the steps of concept mapping

A
  1. Collect patient problems and concerns on a list.
  2. Connect and analyze the relationships.
  3. Create a diagram.
  4. Keep in mind key concepts: the nursing process, holism,
    safety, and advocacy
163
Q

What is concept mapping

A

An instructional strategy that requires learners to identify, graphically display, and link key concepts.

164
Q

What are the types of reflective practice

A

Reflective in action
Reflective on action
Reflective for action

165
Q

What does “reflective in action” mean

A

Happens in the here and now of the activity and is also known as “thinking on your feet”

166
Q

What does “reflective on action” mean

A

Occurs after the fact and involves thinking through a situation that has occurred in the past

167
Q

What does “reflective for action” mean

A

Helps the person to think about how future actions might change as a result of the reflection

168
Q

What are the two clinical judgement models that we need to know for this class

A
  1. Tanner’s clinical judgement model
  2. Nursing process
169
Q

What is Tanner’s clinical judgement theory

A

Research-based model
- noticing: initial grasp and perceptions of the situation
- interpreting: attributing meaning to the data
- responding: deciding on an action & monitoring outcomes
- reflecting: in-action and on-action

170
Q

What are the four Clinical Decision-Making Theories, Models, and Frameworks

A
  1. Humanistic–Intuitive Approach
  2. Information-Processing Model
  3. Cognitive Continuum Theory
  4. Rest Framework
171
Q

What is the Humanistic-Intuitive approach

A

Believes that clinical judgment and decision-making models move from facts and rules to dynamic decision making with clinical experience

172
Q

What is the Information-Processing Model

A

Informs decision making and mirrors the way we think of a computer processor

173
Q

What is the Cognitive Continuum Theory

A

Integrates both intuitive and analytical cognitive characteristics

174
Q

What is the rest framework

A

Includes four components of moral reasoning and captures the cognitive processes that precede moral action

175
Q

What are the five types of nursing assessments

A
  1. Initial comprehensive
  2. Focused
  3. Emergency
  4. Time-lapsed
  5. Assessment of communities and special populations
176
Q

What does an initial comprehensive assessment entail

A

Performed shortly after admittance to hospital

Performed to establish a complete database for problem identification and care planning

Performed by the nurse to collect data on all aspects of patient’s health

177
Q

What does a focused assessment entail

A

May be performed during initial assessment or as routine ongoing data collection

Performed to gather data about a specific problem already identified, or to identify new or overlooked problems

Performed by the nurse to collect data about the specific problem

178
Q

What does an emergency assessment entail

A

Performed when a physiologic or psychological crisis presents

Performed to identify life-threatening problems

Performed by the nurse to gather data about a life-threatening problem

179
Q

What does a time-lapsed assessment entail

A

Performed to compare a patient’s current status to baseline data obtained earlier

Performed to reassess health status and make necessary revisions in care plan

Performed by the nurse to collect data about current health status of patient

180
Q

What is the difference between medical and medical assessments

A

Medical assessments target data pointing to pathologic conditions

Nursing assessments focus on the patient’s response to health problems

181
Q

What is objective data

A

Observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing them

182
Q

What is subjective data

A

Information perceived only by the affected person

183
Q

What are some sources of data

A
  • Patient
  • Family and significant others
  • Patient record
  • Medical history, physical examination, progress notes
  • Consultations
  • Reports of laboratory and other diagnostic studies
  • Reports of therapies by other health care professionals
  • Nursing and other health care literature
184
Q

What are the four phases of the nursing interview

A
  1. Preparatory phase: get report, look at EMR
  2. Introduction: purpose of interview, their opinion, why they sought care
  3. Working phase: ask questions, gather data
  4. Termination: conclude the interview, update chart

NUR 240 (4 decks)

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