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NUR 101A > Think Like a Nurse 1 > Flashcards

Think Like a Nurse 1 Flashcards

1
Q

What does it mean to use a trauma-informed and inclusive lens?

A
  • Reframe perspective
  • Reduce retraumatization
  • Value lived experiences
  • See the whole person
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2
Q

Critical thinking

A

A combination of reasoned thinking, openness to alternatives, an ability to reflect, and a desire to see truth

An active, organized cognitive process used to carefully examine ones thinking and the thinking of others

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3
Q

Nursing Process

A

A systematic problem-solving process that is foundational in all nursing actions

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4
Q

Situational factors that influence critical thinking ability

A
  • Anxiety, stress fatigue
  • Awareness of risks involved
  • Knowledge of related factors
  • Awareness of related factors
  • Positive reinforcement
    -Evaluative or judgmental styles
  • Presence of motivating factors
  • Time limitations
  • Environmental distractions
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5
Q

Nursing Process

A

Assessment, Diagnosis & analysis, Planning, Implementation, Evaluation

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6
Q

What does ADPIE stand for?

A

A= Assessment
D= Diagnosis
P= Planning
I= Implementation
E=Evaluation

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7
Q

What is the critical thinking process for assessment?

A
  • Consider the situation
  • Collect information
  • Process that information
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8
Q

What is the critical thinking process for diagnosis?

A

Identify Issues

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9
Q

What is the critical thinking process for planning?

A

Establish Goals

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10
Q

What is the critical thinking process for implementation?

A

Take action

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11
Q

What is the critical thinking process for evaluation?

A
  • Evaluate the outcomes
  • Adjust goals and actions according to outcomes
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12
Q

What does an assessment mean?

A

Systematic and continuous collection, validation, and communication (i.e. documentation) of patient data - utilizes knowledge, critical thinking skills, noticing skills, and reflection skills

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13
Q

Which part of the nursing process involves these skills?

  • Identifying assumptions
  • Identifying an organized approach to assessment
  • Checking accuracy and reliability
  • Distinguishing relevant from irrelevant
  • Distinguishing normal from abnormal and identifying signs and symptoms
  • Clustering related information
  • Recognizing inconsistencies
  • Identifying patterns
  • Identifying missing information
  • Drawing valid conclusions based on evidence
A

Assessment

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14
Q

What are some types of assessment data?

A
  • Pain 6/10
  • Red, raised papules on the lower right leg
  • Vital signs at 0800 noted on patient chart
  • Bilateral lower lungs clear to auscultation
  • Stomach pain
  • Stomach tenderness
  • Periorbital bruising bilaterally
  • Caregiver states patient is anxious
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15
Q

What are some data collection methods?

A
  • Observation
  • Interview
  • Physical examination
  • Inspection
  • Auscultation
  • Palpation
  • Percussion
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16
Q

What is the purpose of an interview during an assessment?

A
  • Purposeful structured communication
  • Components of health history
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17
Q

What does it mean to get ready for an interview?

A

Prepare yourself, the space and the patient

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18
Q

What is the orientation phase of an interview?

A

Introductions, the purpose of the interview, establish trust and confidence, establish role you will play, take note of cultural, spiritual, and comfort needs and how they may influence patient participation

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19
Q

What is the working phase of an interview?

A
  • Asking pertinent questions and gathering information, using observation skills
  • Closed (closed-ended) questions
  • Open-ended questions
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20
Q

What is the termination phase of an interview?

A
  • Ending the interview process
  • What will happen next for the patient
  • Thank the patient for participating
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21
Q

What is the purpose of a physical examination during an assessment?

A

Data gathered regarding the patient’s health status
- Comprehensive
- Focused
- Shift
- Etc

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22
Q

How do you make sense of the data collected from an assessment?

A
  • Comparing findings with expected norms
  • Validating data findings
  • Reassessing data that does not make sense
  • Clustering sets of data that support a particular judgment
  • Recognizing trends and patterns
  • Documentation
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23
Q

What are nursing diagnoses focused on?

A

Patient needs and responses

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24
Q

What does nursing diagnosis mean as a NOUN?

A
  • A word or phrase identifying specific patient problems, needs, or risks
  • The means of describing health problems that can be improved, prevented, or resolved by independent nursing interventions
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25
Q

What does nursing diagnosis mean as a VERB?

A

The process of identifying a specific patient problem/need

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26
Q

What are the three types of nursing diagnoses?

A
  • Problem-focused
  • Risk
  • Health promotion
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27
Q

What is a collaborative nursing diagnosis?

A

a health issue that requires both nursing and medical intervention

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28
Q

What is a problem-focused nursing diagnosis?

A

a nursing diagnosis that focuses on a current issue or condition that’s present in a patient at the time of assessment

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29
Q

What is a collaborative nursing diagnosis also known as?

A

A collaborative problem

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30
Q

What is a problem-focused nursing diagnosis also known as?

A

An actual diagnosis

31
Q

What is a risk nursing diagnosis?

A

a clinical judgment that identifies a patient’s vulnerability to developing a health issue in the future

32
Q

What is a health promotion nursing diagnosis?

A

a clinical judgment about a person’s motivation and desire to improve their health and well-being

33
Q

What is a health promotion nursing diagnosis also known as?

A

A wellness diagnosis

34
Q

What does NANDA stand for?

A

North American Nursing Diagnosis Association

35
Q

What is the purpose of the North American Nursing Diagnosis Association (NANDA)?

A

Provides a basis of selecting nursing interventions to address a patient’s needs - a common language for identifying problems, providing a basis for evidence-based nursing practice

36
Q

What does NIC stand for?

A

Nursing Intervention Classification

37
Q

What is the purpose of Nursing Intervention Classification (NIC)?

A

Describes the nursing treatments that nurses perform to improve patient outcomes

38
Q

What does NOC stand for?

A

Nursing Outcome Classification

39
Q

What is the purpose of Nursing Outcome Classification (NOC)?

A

Describes the changes in a patient’s health status based on the nursing interventions performed

40
Q

True or False: Significant data should begin to raise red flags

A

True

41
Q

How do you analyze data to identify a nursing diagnosis?

A
  • Compare data to standards (normal vs. abnormal)
  • Patterns or clusters of data
  • Patient strengths or problem areas
  • Potential problems (problems the patient is likely to encounter)
42
Q

What does the PES in nursing diagnosis PES statement mean?

A
  • Problem
  • Etiology
  • Signs & Symptoms
43
Q

What does problem mean in a nursing diagnostic PES statement?

A

Describes the actual or possible health and problem

44
Q

What always comes first in a nursing diagnosis PES statement?

A

Problem

45
Q

What does etiology mean in a nursing diagnostic PES statement?

A

Describes the factors believed to be causing or contributing to the problem

46
Q

What do signs & symptoms mean in a nursing diagnostic PES statement?

A

Supportive data (for actual problems only)

47
Q

What always follows the problem in a nursing diagnostic PES statement?

A

Etiology

48
Q

What is always last in a nursing diagnostic PES statement?

A

Signs and Symptoms

49
Q

How would you quote signs & symptoms on a nursing diagnostic PES statement?

A

“As evidenced by”
“As manifested by (AEB/AMB)

50
Q

True or False: “At risk” diagnoses are always two-part statements

A

True

51
Q

Why are “at risk” diagnoses always two-part statements?

A

Because the problems do not actually exist, or there is not enough data to support the problem

52
Q

True or False: You use PES when writing an “at risk” diagnosis statement

A

False

We use only the P and the E:
(P) “Risk for ____”
(E) “…R/T _____ “ (associated risk factors)

53
Q

What questions should you ask yourself when the diagnosis is unclear?

A
  • What are my concerns about the patient?
  • Can I/am I doing something about it?
  • Can the overall risk be reduced, or problem solved by a nursing intervention?
  • Am I sure I have the right problem identified?
54
Q

True or False: You should use a medical diagnosis when writing a nursing diagnosis (“pneumonia”, “fracture”)

A

False

55
Q

True or False: You should relate the problem to an unchangeable situation when writing a nursing diagnosis (“quadriplegia”, “houselessness”)

A

False

56
Q

True or False: You should not confuse the etiology or signs/symptoms for the problem (“limping” vs “impaired mobility”)

A

True

57
Q

True or False: Specificity does not matter when writing a nursing diagnosis (“as evidenced by medication intolerance”)

A

False

58
Q

True or False: It is okay to combine two nursing diagnoses when writing a nursing diagnosis

A

False

59
Q

True or False: Using judgmental/value-laden language is not allowed when writing a nursing diagnosis (“will not comply with…” , “bad hygiene”)

A

True

60
Q

True or False: It is okay to make assumptions when writing a nursing diagnosis (“will not be able to step up three stairs…” , “will become hostile if…”

A

False

61
Q

True or False: You can write a legally inadvisable statement when writing a nursing diagnosis (“AEB night shift nurse’s assessment”)

A

False

62
Q

True or False: Anything outside your nursing scope such as identifying a new medical diagnosis based on lab interpretation, etc is prohibited when writing a nursing diagnosis

A

True

63
Q

True or False: It is okay to copy and paste another nurse’s statement when writing a nursing diagnosis

A

False

64
Q

What does a chief complaint mean?

A

a brief statement that describes the main reason a patient is seeking medical care

65
Q

What are close-ended questions?

A

questions that limit the possible answers that respondents can choose from

66
Q

What is a comprehensive assessment?

A

a variety of systems and tools that evaluate a person or a student’s understanding

67
Q

What does diagnostic reasoning mean?

A

a cognitive process that involves interpreting patient data, forming a hypothesis, and narrowing down a list of diagnoses to determine a treatment plan

68
Q

What does evidence-based knowledge mean?

A

information or advice that is supported by scientific research

69
Q

What is the purpose of evidence-based knowledge?

A

to make informed decisions in healthcare

70
Q

What are open-ended questions?

A

questions that allow patients to discuss their concerns freely

71
Q

What is an ongoing assessment?

A

a head-to-toe evaluation of a patient’s physical and mental status that’s performed at least once per shift in acute care settings like hospitals

72
Q

What is the purpose of an ongoing assessment?

A

to verify that treatment is working and to monitor changes in a patient’s condition

73
Q

What does ROS stand for?

A

Review of systems

74
Q

What is a review of systems (ROS)?

A

a list of questions used in nursing to identify a patient’s symptoms

NUR 101A (22 decks)

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