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Terms in this set (30)
________ _________ are interprofessional care plans that specify care and desired outcomes during a specific time period for clients with a particular diagnosis or health condition. The clinical pathway is like a road map the patient and healthcare team should follow. Clients are expected to meet specific goals within a defined period of time. For example, a patient might be expected to be able to ambulate within his room on day 2 postoperatively. As the client progresses along the road, the client should receive specific care and accomplish specific goals. If the client's progress differs from the planned path, a variance has occurred. A negative variance occurs when specific goals are not met. A nurse should identify when a negative variance has occurred and work with the interprofessional team to create a plan to address the issue.
What are the five rights of delegation?
Right supervision and evaluation
Right directions and communication
ability to focus your thinking to get the results you need in various situations, has been described as knowing how to learn, be creative, generate ideas, make decisions, and solve problems.
Critical thinking is not memorizing a list of facts or the steps of a procedure. Instead, it is the ability to make judgments and solve problems by making sense of information. Learning and using critical thinking is a continual process that occurs inside and outside of the clinical setting.
using critical thinking to examine and analyze patient care issues.
It involves understanding the medical and nursing implications of a patient's situation when making decisions regarding patient care. You use clinical reasoning when you identify a change in a patient's status, take into account the context and concerns of the patient and caregiver, and decide what to do about it.
involves analyzing patient's situations and data, applying nursing knowledge, and using critical thinking skills (problem-solving, decision making, idea generating) to create an appropriate plan of care.
A new nurse assess a client's lungs, heart sounds, bowel sounds, and takes vitals. The blood pressure is 184/101. The nurse recognizes that this is a high blood pressure and decides to review the client's previous vital sign history, medication record, and current lab values to determine what action to take. Based on these findings, the nurse realizes that the previous shift appropriately held the client's Furosemide (lasix) due to a potassium level of 2.8. The nurses reviews the most current potassium level and determines that it is still low at 2.9. However, since the blood pressure is elevated, the nurse determines that a new medication order is necessary and contacts the patient's provider for an order that will not further decrease the potassium but will help the client rid the body of the extra fluid that is increasing the blood pressure.
What activities did the nurse engage to solve this problem satisfactorily?
Critical thinking allowed the new nurse to identify the problems with the patient. Clinical reasoning allowed the nurse to compile all the problems, analyze the data (lab values, vital signs, medication record) and problem-solve to identify that a new medication order was necessary for this client.
An example of "patient-centered care"
Engage the client in an active partnership that promotes health, well-being, and self-care management
_______ ________ are differences in the incidence, prevalence, mortality rate, and burden of diseases that exist among specific population groups in the United States because of social, economic, or environmental disadvantages.
Determinants of health
are factors that influence the health of individuals and groups, and help explain why some people experience poorer health than others. They involve where people are born, grew up, live, work, and their current age as factors that determine their health status, behavior, and care they receive.
What are the leading determinants of a client's health?
Social and Physical Environment
Where people are born, grow up, live, work and age, and their behaviors impact the type of care they receive.
When communicating with a client who speaks a language that the nurse does not understand, it is important to FIRST attempt to:
Use a trained medical interpreter
What is the first step a nurse should take to reduce health disparities and provide culturally competent care for patients?
The first and most important step is to assess self beliefs, backgrounds, and values so any negative views can be identified and dealt with. Nurses need to treat all patients with dignity and identify the patient's needs rather than basing care on stereotypes
Which situation would require the nurse to obtain a focused assessment? Select all that apply
A patient reports new symptoms during rounds
A previously identified problem requires reassessment
In what order should the abdomen be assessed?
Inspect, auscultate, percuss, palpate
The patient health history and physical examination provide the nurse with information to primarily:
Identify nursing diagnoses and collaborative problems
take a rapid history and examination while maintaining vital functions
Take a detailed health history and assessment of all body systems. Usually done on admission
This type of assessment is used to evaluate the status of previously identified problems and monitor for s/s of new problems. It involves an abbreviated health history and physical exam. It can be done when a specific problem (like post op pneumonia) is identified. The client's clinical s/s should alert you to the appropriate focused assessment you should do. For example: abdominal pain indicates the need for a focused abdominal assessment. Some problems will require a focused assessment of more than one body system. A complain of headache may indicate the need to do a focused assessment of the head, neck, neurologic, and musculoskeletal system.
A client requests his ordered morphine sulfate pain medication to relieve post-operative pain 8/10 on day one following total hip replacement surgery. The nurse assesses the surgical site, takes the client's vital signs, lung and heart sounds, and reviews the MAR for potential medication interactions. Knowing the side effects of morphine sulfate include depressed respiratory and GI systems, what other focused assessment should the nurse plan to perform prior to administering the medication?
AND ask about the patient's normal bowel evacuation (frequency, consistency, history of constipation/diarrhea). This information should then be used to evaluate whether the morphine is causing constipation and if so, the nurse might consider requesting an order for a stool softener. In fact, the sheer combination of bedrest, post op, and morphine sulfate medication should cause the nurse to use clinical reasoning skills to request and order for a stool softener as a prophylactic measure (unless contraindicated). The nurse should also plan to monitor the client's hydration status and encourage fluid intake to facilitate stool evacuation.
A 60 year old female notices a chronic cough and becomes frightened that she may have lung cancer. She stops smoking cigarettes. 4 months later she still has the cough and visits the nurse practitioner. She has not smoked in 4 months and is determined to have lung cancer but to be a viable candidate for surgery because she has not smoked in 4 months. What stage of change (Transtheoretical model) is this client in?
A client tells the nurse that she enjoys talking with other people and sharing experiences but often falls asleep when reading. Which teaching strategy would be MOST effective with this client?
A client with a chronic cough is advised to stop cigarette smoking but he refuses and says, "cigarettes keep me calm." What stage of change in TRANSTHEORETICAL MODEL of change is this patient in?
What adult learning principle is applied in this scenario:
The nurse has a client with a temporary colostomy that states she is not ready to look at the stoma. The nurse works together with the client to create a schedule for her to learn colostomy care that meets her need for control and prepares her for self-care.
self-concept and motivation to learn
key aspects of motivational interviewing
Help the patient recognize the gap between where he is and where he hopes to be
Adjust to, rather than oppose, patient resistance
Gently pursuade with the understanding that change is up to the patient
Focus on the patient's strengths to support the hope needed to make changes
Express empathy through reflective listening
Listen rather than tell
This term refers any knowing, intentional, or negligent act that harms or causes risk of harm to a vulnerable adult
emotional harm caused by threatening, frightening, isolating, intimidating, humiliating, or insulting a person
The majority of referrals made to APS (adult protection services) are for _________
An important nursing action to help a chronically ill older adult is to:
treat the patient as a competent manager of the disease
An appropriate care referral for an older adult who lives with an employed daughter but needs help with activities of daily living is:
adult day care
The nurse is interviewing and older adult client and begins to suspect that elder abuse may be occurring. When elder mistreatment is suspected, what should be done?
It is best to interview and examine the elderly client suspected of abuse in PRIVATE.
After obtaining consent, take photographs to document physical findings of suspected abuse or neglect
Screen for possible elder mistreatment, including domestic violence
Conduct a thorough history and head to toe phisical assessment, document findings, and include any statements made by the client or accompanying adult
Identify, collect, and preserve physical evidence
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