nurs 101 ch 11-15

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  1. initiating urgent intervention
    you should not wait to make final diagnosis if there are signs and symptoms indicating the need for immediate treatment
  2. collecting, validating and communicating patient data
  3. analyze patient data to identify patient strengths and problems
  4. specifying patient outcomes and related  nursing interventions
  5. carrying out the plan of care
  6. measuring extent to which patient achieved outcomes
  7. characteristics of the nursing process
    • systemic
    • dynamic
    • outcome oriented
    • universally applicable
  8. problem solving and the nursing process
    • trial and error¬†
    • scientific problem solving
    • intuitive problem solving
    • critical thinking: intuitive, logical or both
  9. should you use clinical reasoning during assessment
  10. characteristics of nursing assessments
    • purposeful
    • prioritized
    • complete
    • systematic
    • accurate
    • relevant
    • recorded in a standard manner
  11. four types of nursing assessments
    • initial comprehensive
    • focused
    • emergency ABCD
    • time-lapse
  12. performed shortly after admittance to hospital
    performed to establish a complete database for problem identification and care planning
    first time admission
    initial comprehensive assessment
  13. may be performed during initial assessment or as a routine ongoing data collection
    performed to gather data about specific problem
    focused assessment- usually acute problem
  14. 1. performed to compare a patient's current status to baseline data obtained earlier
    2. reassess health status and make necessary revision
    3. performed to collect current status data
  15. characteristics of DATA
    • purposeful
    • complete
    • factual and accurate
    • relevant
  16. four phase of nursing interview
    • preparatory phase
    • introduction
    • working phase
    • termination
  17. when to verify data
    when there is a discrepancy between what the person is saying and what the nurse is observing. also when data lack objectivity
  18. 5 steps of data interpretation and analysis
    • 1. recognizing significant data: comparing data to standard
    • 2. recognizing patterns or cluster
    • 3. identifying strengths and problems
    • 4. identifying potential complications
    • 5. reaching conclusion
  19. PPMP alfaro
    predict, prevent, manage, promote
  20. types of nursing diagnoses
    • actual
    • risk
    • possible
    • wellness
    • syndrome
  21. four components of a diagnosis
    • label
    • definition
    • defining characteristics
    • related factor
  22. three elements of comprehensive planning
    • initial
    • ongoing
    • discharge
  23. IOM's six aims
    • safe
    • effective
    • efficient
    • patient-centered
    • timely
    • equitable
  24. alfaro's rule
    assess, reassess, revise, record
  25. four types of outcomes
    • cognitive
    • psychomotor
    • affective
    • physiologic
  26. evaluative criteria vs. standards
    criteria is measurable qualities, attributes or characteristics the specify skills, knowledge, or health status while standard is level of performance accepted and expected by the nursing staff
  27. variables affecting outcome achievement
    • patient-they give up
    • nurse-they burnout
    • health care system-inadequate staffing
Card Set:
nurs 101 ch 11-15
2016-09-24 23:51:08

nursing process
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