N211 Midterm Study Guide version 2

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N211 Midterm Study Guide version 2
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  1. What is nurse?
    • A person who focused on assisting individuals, families and community to attain, recover and maintain optimum health and function from birth to old age. (Taylor-Pg 5)
    • Nursing: is a blend of science and art.
    • Science: knowledge base
    • Art: skilled application of that knowledge to help others achieve maximum health and quality of life.  
    • Definition of nursing: nurse originated from the Latin word nutrix meaning “to nourish”
    • Nursing describe a person who nourish, fosters, and protects and who Is prepared to take care of sick, injured and aged people.
  2. Characteristics do they carry?
    Caring, loving, empathy, responsible, respectful, communication skills, interpersonal skill, critical thinking skills, etc.
  3. What is the scope of practice of a RN?
    • 3 As:           
    • Autonomy: independent judgement and self-governing within the scope of RN practice
    • Accountability: responsible            
    • Advocacy           

    • Leadership: delegating (CNA & LVN)
    • Utilize critical thinking, clinical judgment, expertise when providing & evaluating care
  4. Medical Model vs Nursing Model
    • Medical Model:Diagnosis of disease process & conditions 
    • What body parts are diseased or broken?
    • Uses body systems approach:
    • -Ex: Neurological, Cardiac, Pulmonary, Gastrointestinal, Genitourinary-Ex: chest pain -> call cardiologist
    • -Not as “holistic” in approach as nursing Narrow focus on anatomy, physiology, pathophysiology
    • Considers problems w/organs & body systems
    • Focus on treating daises & trauma
    • Consult with nursing for planning ADLs

    • Nursing model:Assess pt’s response to their illness & care -> how they view their illness
    • How is pt meeting their basic needs & facing their illness
    • How are they adapting to medical treatment -> effective or ineffective
    • Nursing uses a basic need, holistic approach. Look at the person as a “whole”
    • Focus on prevention
    • Provide comfort measure
    • Maintain safety, bringing resources to help pt, No need Dr order to provide hygiene, turn pt, educate pt
    • Broad holistic, mind, spirit, body
    • Focus on maximum function & independence
  5. Describe an overview of the Roy Adaptation Model (RAM)
    • Adaptation: Goal of nursing
    • Person: Adaptive system
    • Environment: Stimuli
    • Health: Outcome of adaptation
    • Nursing: Promoting adaptation and health    
    • Adaptation: responding positively to environmental changes. The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration 
    • Person: Bio-psycho-social being in constant interaction with a changing environment
    • Acquired mechanisms to adapt/ adaptive system described as a whole comprised of parts.  Functions as a unity for some purpose.  Includes people as individuals or in groups-families, organizations, communities, and society as a whole. 
    • Environment: Focal - internal or external and immediately confronting the person.  All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli 
    • Health: Inevitable dimension of person's life.  Represented by a health-illness continuum
    • A state and a process of being and becoming integrated and whole 
    • Nursing: promote adaptation in the four adaptive modes -> contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions
  6. Adaptation
    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
  7. Adaptive behaviors
    promote integrity of system, fall within our adaption levelGoals of Adaptive behaviors: Survival & safety Growth & reproduction Mastery Individual and environmental change
  8. Maladaptive (Ineffective) behaviors:
    failure of coping mechanisms à result in adaptation problems
  9. Modes:
    Biological Need à Physiological Mode Love and Security Need à Interdependence Mode Self Esteem Need à Self Concept Model Self Actualization Need à Role Function Mode
  10. Physiological:
    • Basic needs approach                                    
    • Basics to survival                                     Physiological activity of all cells, tissues, organs of human body
  11. 7 basic needs are:
    • O2
    • Fluid & electrolytes
    • Nutrition
    • Elimination
    • Activity & rest
    • Protection
    • Neurosensory
    • Endocrine
  12. Maslow's Hierarchy of Needs
    • self-actualization
    • esteem
    • love/belonging
    • safety
    • physiological
  13. Psychosocial:
    • Self concept: focus on psychological wellness, spirituality, body image (disturbance) How the person views themselves physically, self respect, body image and spiritual sense
    • Role function: focus on roles one occupies in home & society Expectation of society based on societal-cultural norms à obligations. Primary Role: Age, sex, developmental stage. Secondary Roles: (permanent roles) Chronic diseases, daughter, granddaughter, sister, student, girlfriend
    • Interdependence: focus of close relationships and support systems
  14. Self concept
    focus on psychological wellness, spirituality, body image (disturbance) How the person views themselves physically, self respect, body image and spiritual sense
  15. Role function
    • focus on roles one occupies in home & society Expectation of society based on societal-cultural norms à obligations
    • Primary & Secondary, & Tertriary
  16. Primary Role:
    Age, sex, developmental stage
  17. Secondary Roles
    (permanent roles) Chronic diseases, daughter, granddaughter, sister, student, girlfriend
  18. Tertiary Role
    • Acute care (temporary)
    • Reason for hospitalization
  19. Interdependence
    focus of close relationships and support systems
  20. What is nursing process?
    • Dynamic systematic way of critical thinking: Systematic
    • Integrates both the art and the science of nursing
    • Uses critical thinking
    • Plans
    • Implements
    • Evaluates
  21. Discuss the benefits of utilizing the Nursing Process:
    • Nursing process: ADPIE à apply to all NCLEX questions. (critical thinking)
    • Promotes holistic care à globally
    • Promote, maintain or restore health and well-being
    • Prevents disease and illness
    • Restores health
    • Empowers client to care of themselves and take control of their health goals.
    • Provides “quality care” though nursing planning and interventions that are client centered and evidenced based!
    • Researched and proven! -> EX: put TED hoses on pt that is post surgery to prevent blood clots. We know we need to do this b/c it’s evidence-based (been tested)
  22. Outline the steps of the Nursing Process:
    • Assessment: systematic, continuous collection & communication of data- Nursing database: nursing history + physical assessment - Get info from: PATIENT, family members, other health care team- Objective & Subjective data1st level of assessment: “Subjective and Objective Data” (behaviors, actions, words, findings) assess behaviors & basic needs2nd level of assessment: assess influencing stimuli (influencing factors) contributing factors, etiologyExamples of 2nd level assessment factors: factors affecting pt response to illness OR leading to illness Other illnesses or chronic conditions Culture / Traditions / Beliefs / Practices Cognitive and physical abilities Age & maturity Self-concept/self esteem/coping mechanisms Education/learning / knowledge deficits Economics/Access to care 
    • Identification (prob/maladaption): Write down assessment data- Cluster “like data”ex: how many pieces of data do I have that shows a problem w/ infection?- Evaluate dataex: what abnormal findings am I seeing?- Identify pt problems “concept”ex: pain/infection/anxiety/electrolytes/imbalance/mobility issues/actual or potential à these are basis for pt care plan
    • Diagnosis (nursing diagnosis): identifies nursing problems à ex) inadequate nutrition OR risk for skin breakdown related to……     
    • Planning: nursing care plans à prioritize problems using Maslow’s hierarchy of needs à Safety-ABCsUse SMART to plan:SpecificMeasureableAchievableRealisticTime Framed Ex: During the next 24 hour period, the pt’s fluid intake will total at least 2,000 mL à goals are PATIENT CENTERED!
    • Intervention: carry out nursing actions to achieve goal à must be Evidenced Based Practice!
    • Evaluation: assess whether the goal is met or not and make changes if necessary
  23. Describe how critical thinking is utilized in the Nursing Process
    • Critical thinking: “a systematic way to form and shape one’s thinking. It functions purposefully and exactingly. It is thought that is disciplined, comprehensive, based on intellectual standards and as well-reasoned.” Alfaro: defines critical thinking as “your ability to focus your thinking to get the results you need in various situations.”  
    • Purpose of thinking: identify purpose or goal
    • Adequacy of knowledge: knowledge you have is accurate, complete, factual, timely and relevant
    • Critique of judgment/decision: alternative judgment or decisions, weight each and reach a conclusion (Taylor, Pg 201-202)  
    • Critical thinking: includes reasoning both outside and inside of the clinical setting à (Taylor Pg 210-211)
    • Clinical reasoning: thinking about pt care issues (determining, preventing and managing pt problems.)
    • Clinical judgment: result (outcome) of critical thinking or clinical reasoning- the conclusion or decision you made
  24. Discuss key aspects of nursing and relate them to personal perceptions of what it means to be a      nurse (Taylor, Pg 195) (not sure)
    Provision of a caring relationship that facilitates health and healing Attention to the range of human experiences and responses to health and illness within the pt’s physical and social environments Integration of assessment data w. knowledge gained Advancement of professional nursing knowledge through scholarly inquiry Promote social justice Assurance of safe, quality and evidence-based practice
  25. Discuss the scope of practice of the Registered Nurse and be familiar with the governing bodies that      regulate and oversee nursing practice and education:
    • American Nurses Association - ANA Defines nursing as the diagnosis and treatment of human responses to actual and potential health problems Sets national standards of care for nursing practice à Nurse’s scope of practice National agency that defines the overall practice and standard of care for nurses Represents nurse’s interests at national and state levels, helps develop legislation and monitors allocation of resources Advocates for nursing 
    • Board of Registered Nursing – CA-BRN à 9 members (not all are nurses) Protect the public from unsafe nurses and nursing care; state licensure board; accreditation of nursing education in CA à will be coming to check our school’s curriculum  
    • National League of Nurses - NLN Establishes national standards for nursing education (schools) 
    • Accreditation Commission for Education in Nursing - ACEN National accreditation standards for nursing education à not just meet the basic requirements from BRN. à 25% of school & Cerrito is one of it.
    • National Council of State Boards – NCSB Board of directors evaluates the national passing standard for the NCLEX-RN Examination every three years to protect the public by ensuring minimal competence for entry-level RNs.
  26. American Nurses Association - ANA
    • Defines nursing as the diagnosis and treatment of human responses to actual and potential health problems
    • Sets national standards of care for nursing practice ->
    • Nurse’s scope of practice
    • National agency that defines the overall practice and standard of care for nurses
    • Represents nurse’s interests at national and state levels, helps develop legislation and monitors allocation of resources
    • Advocates for nursing
  27. Board of Registered Nursing – CA-BRN
    • 9 members (not all are nurses)
    • Protect the public from unsafe nurses and nursing care; state licensure board; accreditation of nursing education in CA -> will be coming to check our school’s curriculum
  28. National League of Nurses - NLN
    Establishes national standards for nursing education (schools)
  29. Accreditation Commission for Education in Nursing - ACEN
    National accreditation standards for nursing education -> not just meet the basic requirements from BRN. à 25% of school & Cerrito is one of it.
  30. National Council of State Boards – NCSB
    Board of directors evaluates the national passing standard for the NCLEX-RN Examination every three years to protect the public by ensuring minimal competence for entry-level RNs
  31. Compare independent versus dependent nursing actions TEST: Independent vs Dependent Functions:
    • Independent functions: covered in ANA, standard of care that do not require a Dr’s order Are within the domain of nursing (framework of nursing) Development of nursing care plans Patient education Health promotion and prevention à wellness à pt’s education General hygiene à skin assessment and care Safety measures & comfort measures Delegation and prioritization à leadership + management à LVNs & CNAs
    • Dependent functions: need a Dr’s order EX: RN cannot prescribe or dispense medications
    • Interdisciplinary Collaborative Care à bring in people that we think are resourceful à send in referral independently (do not need Dr’s order) EX: MD / PT/ ST/ OT/ Dietary / Discharge Planning / Case Management Social Worker / Psychologist / Hospice / etc.
  32. Independent functions NRSG
    • covered in ANA, standard of care that do not require a Dr’s order
    • Are within the domain of nursing (framework of nursing)
    • Development of nursing care plans
    • Patient education
    • Health promotion and prevention à wellness à pt’s education
    • General hygiene à skin assessment and care
    • Safety measures & comfort measures
    • Delegation and prioritization à leadership + management à LVNs & CNAs
  33. Dependent functions:
    need a Dr’s order EX: RN cannot prescribe or dispense medications
  34. Interdisciplinary Collaborative Care
    bring in people that we think are resourceful à send in referral independently (do not need Dr’s order) EX: MD / PT/ ST/ OT/ Dietary / Discharge Planning / Case Management Social Worker / Psychologist / Hospice / etc.
  35. Verbalize an understanding of the basic components of the Roy Adaptation Model
    • Adaptation: Goal of nursing
    • Person: Adaptive system
    • Environment: Stimuli
    • Health: Outcome of adaptation
    • Nursing: Promoting adaptation and health
  36. Evidenced based practice guidelines and use of core measures in healthcare.
    • EBP: Is interdisciplinary approach to clinical practice since 1992                         
    • -All practical decision made should be based on research                               
    • -Disregard theoretical & qualitative studies & consider quantitative studies          

    • National Patient Safety Goals (NPSG)
    • “The Joint Commission” :National Accreditation Agency, Sets National Standards for Safety and Quality Care, & Works with the Centers for Medicare and Medicaid
    • National Patient Safety Goals: focus on high risk incidents in the hospital setting ex) falls/infection control


    • QSEN Measures:
    • “The Institute of Medicine” The core competencies of RN à published within last 10 yrs Framework for QSEN nursing education standards
  37. National Patient Safety Goals (NPSG)
    •  “The Joint Commission”: National Accreditation Agency Sets National Standards for Safety and Quality Care Works with the Centers for Medicare and Medicaid
    • National Patient Safety Goals: focus on high risk incidents in the hospital setting ex) falls/infection control
  38. QSEN Measures:
    “The Institute of Medicine” The core competencies of RN à published within last 10 yrs Framework for QSEN nursing education standards

    • Patient Centered Care
    • Teamwork & Collaboration
    • Evidence Based Practice
    • Quality Improvement
    • Safety
    • Informatics
    • Professionalism
  39. What are the “Five Core Competencies?” (Taylor Pg 210)
    • Patient centered care
    • Teamwork and collaboration
    • Evidenced Based practice
    • Quality improvement
    • Informatics

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