N211 Midterm

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Leon
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307968
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N211 Midterm
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2015-09-17 00:11:35
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N211 Midterm
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Midterm Study GUide
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  1. Introduction to key aspects of nursing - what is a nurse? What characteristics do they carry?
    • žNursing as a Profession:
    • Unique career
    • žDistinct advanced knowledge basež
    • Guided by systematic theoryž
    • Authority to provide a servicež
    • Guided by ethical standardsž
    • Has prescribed standards of practicež*Let’s read through the ANA Code Of Ethics for Nurses (Interpretive Statement) ž

    • RN vs LVN:
    • žRN has more education
    • žDifferences in scope of practice from LVN
    • žLVNs function under the direction of a RN
    • Professional practice embodies critical thinking and clinical judgment decisions

    • žComponents of Professional RN Practice:
    • ž“3 As”
    • ¡Autonomy¡Accountability¡Advocacyž
    • Leadership
    • ¡RN actively involved in supervising, delegating, evaluating othersž
    • Utilize critical thinking, clinical judgment, expertise when providing and evaluating carež
  2. Describe the main difference between the Medical Model vs. Nursing Model
    • 1) Medical Model:
    • Narrow focus on anatomy, physiology, pathophysiology
    • Considers problems with organs and body systems
    • Focus on treating disease and trauma
    • Consults with nursing for planning ADLs 

    • Medical Care Focus:
    • Diagnosis of disease processes and conditions
    • What body parts are diseased or broken?
    •   Uses a body systems approach
    •   Example- Neurological, Cardiac, Pulmonary, Gastrointestinal, Genitourinary
    • Not as “holistic” in approach as nursing   

    • 2) Nursing Model:
    • Broad holistic, mind, spirit, body
    • Considers how human lives are affected by illness
    • Focus on maximum function and independence
    • Consults with medicine for treatment of disease or trauma 
    • Nursing Care Focus Assesses patients’ response to their illness and care
    • How is the patient meeting their basic needs and facing their illness?
    • How are they adapting to medical treatment?
    • Nursing uses a basic needs, holistic approach Look at the whole person
  3. Describe an overview of the Roy Adaptation Model (RAM)
    • • Components of RAM
    • a. Key concepts
    • 1. Person
    • 2. Health
    • 3. Environment
    • 4. Nursing
    • 5. Adaptation
    • b. Definitions
    • 1. Adaptation
    • • RAM defines ADAPTATION as a positive response to changes in one’s internal and external environment
    • • The body adapts in order to maintain the INTEGRITY of the body
    • • Promotes and maintains “wholeness” and balance of our physical and emotional being
    • Goals of Adaptations
    • • Survival/Safety
    • • Growth
    • • Reproduction
    • • Mastery
    • • Individual and environmental change

    • • Adaptive behaviors / Maladaptive (Ineffective) behaviors
    • • Survival/Safety
    • • Growth
    • • Reproduction
    • • Mastery
    • • Individual and environmental change

    • Examples:
    • Mrs. Lopez eats a bag of chocolate MM’s. Her blood sugar rises to 240.
    • Her pancreas responses by releasing more insulin into the blood stream to move the glucose into the cells. The blood sugar returns to 90 within two hours. (normal BS is 75-125)

    Mr. Davis has had an amputation of his right leg due to gangrene infection. When performing the dressing change, he refuses to look at the wound site.

    • Mr. Jackson has a blood pressure of 210 / 95 in the doctor’s office. He is started on BP medications and given teaching on a low sodium diet. Within two months, his repeat BP is 168 / 80.
    • Ms. K is preparing to give herself an insulin injection. Her hands are shaking and she bursts out crying. “ I will never be able to do this.”
    • Mr. P complains of pain 8/10 and requests pain medication. You administer Morphine IM. In 30 minutes he reports a pain level of 2/10 and is resting comfortably.
    • Modes
    • • Physiological
    • • Basic Needs Approach
    • • Basics to survival
    • • Physiological activity of all cells, tissues, organs of human body




    • Oxygenation
    • Fluid and electrolyte
    • Nutrition
    • Elimination
    • Activity and Rest
    • Protection
    • Neurosensory
    • Endocrine


    • Psychosocial
    • • Self-Concept - "Psychic Integrity"
    • • Focus on psychological wellness, spirituality, body image
    • • The image, belief, and feeling one has for oneself
    • • Every aspect of adult life is affected by ones self concept
    • • Most important of psychosocial modes
    • • How do people cope when they feel positively about themselves vs feeling low on self concept?

    • Details
    • Physical Self
    • • Body Sensation
    • o How one physically feels
    • o “I feel ____.”
    • • Body Image
    • o How is illness affecting body image
    • o Changes in appearance: loss of limb, breast, ostomies, alopecia
    • o Grooming / Posture
    • o Comments about appearance:
    • “I must look awful.”

    • Personal Self
    • • Focuses on how one feels physically, self respect, body image, and spiritual sense
    • • How does this client view themselves and the kind of person they are? Goals? Aspirations?
    • • Personal characteristics/attributes?
    • o “I am usually a really strong person.”
    • • How is their illness impacting them?
    • o Are they showing signs of anxiety? Fear? Sadness?
    • • Do they feel that they are getting better? Worse?
    • • Are their spiritual needs being met ?

    • Nursing Concerns
    • Body Image Disturbance
    • Grieving
    • Anxiety
    • Powerlessness (loss of control)
    • Guilt
    • Low Self Esteem
    • Hopelessness
    • What types of behaviors would you see of
    • these?


    • Role Function - Social Integrity
    • • Focus on roles one occupies in home and society
    • Details
    • A ROLE is a functioning unit of society
    • Roles come with a set of “expectations” based on societal-cultural norms
    • Roles change according to ones “developmental stage”
    • Fulfills social obligations and one’s achievement of life goals


    • Types of Roles
    • Primary Role
    • • Age / Sex / Developmental Stage
    • • Example: “21 yo male in young adults transitional period”
    • Secondary Roles
    • • Permanent roles people take on:
    • o Chronic Disease
    • o Wife, husband
    • o Mother, father
    • o Occupation
    • What does the patient do for each of these roles that is adaptive? Effective? How do they feel about the role?
    • Ex: Does a diabetic check their blood sugar? Abide by their ADA diet?
    • Tertiary Roles (temporary )
    • • focus on acute illness assessment and how the patient is managing and adapting to this illness and hospitalization
    • • How are they participating in their care?



    • Secondary Role Example:
    • Hypertension (chronic condition – diagnosed 3 years ago)
    • Subjective: (pt statements)
    • What does the patient say about their blood pressure state?
    • What is their knowledge about HTN?
    • What do they say they do to manage their BP everyday?
    • Assess and document any feeling they express about having
    • hypertension
    • Objective: (what you observe)
    • Document your patient assessment/observations and data from the
    • chart, or from what you are observing, that pertains to their HTN
    • Example: Blood pressure on admission. Is their current hospitalization as a result of poorly controlled BP? BP trends since admission.
    • Assess your observations of how well they are participating in managing their HTN while in the hospital. Example: How they are following their diet in the hospital???
    • Do their actions/behaviors/words show you adaptive or maladaptive
    • behaviors to control this chronic condition? (compliance?)

    Tertiary Role: Acute illness an current hospitalization

    • Subjective:
    • Assess and document statements the patient makes regarding this acute illness or being in the hospital
    • Assess for what concerns they have about this illness
    • How is this illness affecting their life, job, family obligations?
    • How do they feel about being sick and in the hospital?
    • Assess knowledge level regarding their illness and plan of care

    • Objective:
    • Assess and document patient participation in their care
    • Assess and document how they respond to instruction
    • Do they ask for help?
    • Are they eager or ready to learn?
    • Assess and document observed patient behaviors regarding their illness and being in the hospital

    • Interdependence
    • • Focus of close relationships and support systems
    • Details
    • Focus on the close relationships of people
    • Reflects on the person’s willingness and ability to give and receive love, respect, value, time, and commitment
    • A “balance between giving and receiving”
    • • “Reciprocity”
    • Balance between appropriate
    • “independence and dependence” in a relationship


    • Overview of the Nursing Process
    • Define the Nursing Process
    • What is the Nursing Process?
    • Systematic
    • Integrates both the art and
    • the science of nursing
    • Uses critical thinking
    • Plans
    • Implements
    • Evaluates


    • Discuss the benefits of utilizing the Nursing Process
    • • Promotes HOLISTIC CARE
    • • Promote, maintain or restore HEALTH AND WELL-BEING
    • • Prevents DISEASE AND ILLNESS
    • • Restores HEALTH
    • • Empowers CLIENTS TO CARE FOR THEMSELVES, AND TAKE CONTROL OF THEIR HEALTH GOALS

    ***Provides "quality care" through nursing planning and interventions that are client centered and evidenced based researched and proven!

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