Sherpath Ch 16: Intro to Nursing Process

Question 1

several key principles to nursing process

Answer 1

Critical thinking
Patient-centered care
Goal-oriented tasks
Evidence-based practice
Nursing intuition

Question 2

nursing process utilizes five sequential steps

Answer 2

assessment, analysis, planning, implementation, and evaluation

Question 3

assessment process

Answer 3

The nurse gathers subjective and objective patient data through observation, interviews, health history, physical assessment, the medical record, and diagnostic/laboratory reports.

Question 4

analysis process

Answer 4

The nurse analyzes, validates, and clusters patient data to identify actual or potential patient problems. Patient data clusters are stated in standardized nursing language as nursing diagnoses, providing clarity and universal understanding.

Question 5

planning process

Answer 5

The nurse prioritizes the nursing diagnoses and identifies goals that are realistic, measurable, and patient-focused, with specific outcomes.

Question 6

implementation process

Answer 6

The nurse initiates specific nursing interventions and treatments designed to help the patient achieve established goals and outcomes

Question 7

evaluation process

Answer 7

The nurse determines if the patient’s goals are met, examines the effectiveness of interventions, and decides whether the plan of care should be discontinued, continued, or revised.

Question 8

ICNP

Answer 8

International Classification for Nursing Practice
-a standardized nursing language system used for point-of-care documentation for patient data and clinical activity

Question 9

SMART acronym

Answer 9

Specific
Measurable
Attainable
Realistic
Timed
-goals and outcomes should be written according to SMART

Question 10

3 types of nursing interventions

Answer 10

-nurse-initiated interventions: independent nursing interventions or actions that do not require a health care provider’s prescription (e.g., patient positioning and patient teaching)

health care provider–initiated interventions: dependent nursing interventions that may require a prescription from a health care provider (e.g., medication administration or catheter insertion)

collaborative interventions: interdependent interventions that require the combined knowledge, skill, and expertise of multiple health care providers; tasks are coordinated with members of the health care team

Question 11

implementation involves

Answer 11

-performing nursing care
-documenting interventions

Question 12

steps for implementation

Answer 12

1. reassess the patient
2. review and revise the existing plan of care
3. organize resources and care delivery
4. anticipate and prevent complications
5. implement nursing interventions

Question 13

evaluation focuses on

Answer 13

patient responses to nursing interventions and goal or outcome achievement