nursing test 2

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nursing test 2
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2011-02-19 10:12:13
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  1. NURSING PROCESS
    A SYSTEMATIC PROBLEM SOLVING APPROACH TOWARD GIVING INDIVIDUALIZED NURSING CARE
  2. NURSING PROCESS CHARACTERISTICS
    • FRAMEWORK FOR PROVIDING NURSING CARE
    • ORDERLY AND SYSTEMATIC
    • INTERDEPENDANT
    • PROVIDES SPECIFIC CARE
    • CLIENT CENTERED FOR CLIENTS STRENGTHS
    • APPROPRIATE THROUGHT THE LIFESPAN
    • CAN BE USED IN ALL SETTINGS
  3. 6 PHASES OF THE NURSING PROCESS
    • ASSESSMENT
    • DIAGNOSIS
    • OUTCOME IDENTIFICATION
    • PLANNING
    • EMPLEMENTATION
    • EVALUATION
  4. ASSESSMENT
    • THE EVALUATION OR APPRAISAL OF A CLIENTS HEALTH STATE
    • THE SYSTEMATIC COLLECTION OF SUBJECTIVE AND OBJECTIVE DATA
  5. PRIMARY SOURCE
    THE CLIENT IS THE PRIMARY SOURCE OF INFORMATION
  6. SECONDARY SOURCE
    FAMILY MEMBERS, SIGNIFIGANT OTHERS, OTHER HEALTHCARE PROFESSIONALS, HEALTH RECORDS AND LITERATURE REVIEW
  7. DIAGNOSIS
    • DIAGNOSING ACTUAL OR POTENTIAL HEALTH PROBLEMS
    • IDENTIFYING PROBLEMS
  8. NANDA
    NORTH AMERICAN NURSING DIAGNOSIS ASSOCIATION
  9. OUTCOME IDENTIFICATION
    DOCUMENTING MEASURABLE, REALISTIC, CLIENT FOCUSED GOALS
  10. PLANNING
    PREPARING A CLIENT PLAN OF CARE
  11. IMPLEMENTATION
    THE INITIATION OF THE PLAN
  12. EVALUATION
    DECIDING WEATHER OR NOT THE PLAN OF CARE WAS A SUCCESS OR FAILURE
  13. SYSTEMS THEORY
    ONE CONCEPTUAL FOUNDTION ON WHICH NURSING PROCESS IS BUILT, ILLUSTRATES HOW THE STEPS OF THE NURSING PROCESS INTERACT WITH EACH OTHER
  14. INPUT
    • THE INFORMATION THAT ENTERS A SYSTEM
    • DATA COLLECTED DURING THE ASSESMENT
  15. THROUGHPUT
    THE PROCESS BY WHICH A SYSTEM TRANSFORMS, CREATES AND ORGANIZES INPUT, RESULTS IN THE REORGANIZATION OF THE INPUT
  16. OUTPUT
    • THE END OF A PRODUCT SYSTEM
    • IT IS THE CLIENTS HEALTH STATUS
    • WHETHER THE CLIENTS HEALTH HAS BEEN MAINTAINED OR IMPROVED
  17. PROBLEM SOLVING PROCESS
    • TAKES PLACE IN THE CLINICAL SETTING AND INVOLVES CLIENTS WITH MULTIPLE PROBLEMS
    • UNFORSEEN FACTORS FREQUENTLY INTERVEEN
  18. DECISION MAKING PROCESS
    • IDENTIFYNG THE PROBLEM
    • DETERMINE THE ALTERNATIVES
    • SELECTING APPROPRIATE ALTERNATIVE
  19. TYPES OF ASSESMENT
    • INITIAL ASSESMENT
    • FOCUSED ASSESSMENT
    • TIME LAPSE REASSESSMENT
    • EMERGENCY ASSESSMENT
  20. INITIAL ASSESSMENT
    WHEN CLIENT ENTER A HEALTHCARE FACILITY OR IS SEEN FOR THE FIRST TIME
  21. FOCUSED ASSESSMENT
    COLLECTING INFORMATION ABOUT A PROBLEM THAT HAS ALLREADY BEEN IDENTIFIED
  22. TIME LAPSED REASSESSMENT
    FOR EVALUATING CHANGES IN THE CLIENTS HEALTH STATUS
  23. EMERGENCY ASSESSMENT
    IN LIFE THREATENING SITUATIONS WHEN PRESERVING LIFE IS THE TOP PRIOROTY
  24. ASSESSMENT SKILLS
    • OBSERVATION
    • VISION
    • SMELL
    • HEARING
    • TOUCH
    • INTERVIEWING
  25. 4 INTERVIEW PHASES
    • PREPATORY PHASE
    • INTRODUCTORY PHASE
    • MAINTENANCE PHASE
    • CONCLUDING PHASE
  26. PREPATORY PHASE
    • BEFORE YOU MEET CLIENT
    • READING CHART
    • REPORTS
  27. INTRODUCTORY PHASE
    • ALSO CALLED ORIENTATION PHASE
    • WHEN NURSE AND CLIENT MEET
    • ASKING QUESTIONS
    • GETTING AQUAINTED
  28. MAINTENANCE PHASE
    • WORKING PHASE
    • CLIENT AND NURSE WORKING TOWARD ACHIEVING A GOAL
  29. CONCLUDING PHASE
    • TERMINATION PHASE
    • TO ENSURE THAT THE TERMINATION WILL BE POSITIVE FOR BOTH
  30. DATA COLLECTION
    THE PROCESS OF COMPILING INFO ABOUT THE CLIENT
  31. PRIMARY SOURCE
    THE CLIENT IS THE PRIMARY SOURCE OF DATA
  32. SECONDARY SOURCES
    PROVIDE DATA THAT SUPLIMENT, CLARIFY AND VALIDATE INFORMATION FROM THE CLIENT
  33. 3 FRAMEWORKS FOR COLLECTION AND RECORDING OF ASSESSMENT DATA
    • FUNCTIONAL HEALTH PATTERNS MODEL
    • HEAD TO TOE MODEL
    • BODY SYSTEMS MODEL
  34. FUNCTIONAL HEALTH PATTERNS MODEL
    • CLIENTS STRENGTHS AND ASETS NOTED
    • FOCUSES ON NURSING DIAGNOSIS
  35. HEAD TO TOE MODEL
    SYSTEMATICALLY EXAMINING EVERY PART OF THE BODY FROM THE HEAD TO TOE
  36. BODY SYSTEMS MODEL
    FOCUSES ON MAJOR ANATOMIC SYSTEMS
  37. NURSING DIAGNOSIS
    • USED TO IDENTIFY PROBLEMS AND SYNTHASIZE INFORMATION GATHERED IN THE ASSESSMENT
    • DESCRIBES A HEALTH RISK THAT THE NURSE IS RESPONSIBLE FOR TREATING INDEPENDANTLY
  38. TAXONOMY
    CLASSIFICATION SYSTEM
  39. MEDICAL DIAGNOSIS
    • DESCRIBES A DISEASE OR PATHOLOGY OF SPECIFIC BODY SYSTEMS
    • FOCUSES ON TREATING THE UNDERLYING PATHOLOGY
  40. COLLABORATIVE HEALTH PROBLEMS
    REQUIRES A NURSE AND A DR.
  41. DIAGNOSTIC LABEL
    THE NAME OF THE NURSING DIAGNOSIS AS LISTED IN THE NANDA TAXONOMY
  42. DESCRIPTORS
    WORDS USED TO GIVE ADDITIONAL MEANING TO A NURSING DIAGNOSIS
  43. DEFINITION
    • NURSING DIAGNOSIS WOULD NOT BE
    • HYPOTHERMIA
    • YOU WOULD USE
    • BODY TEMP BELOW NORMAL RANGE
  44. CUES
    SUBJECTIVE AND OBJECTIVE INFO
  45. CLUSTERS
    FORMED FROM SEVERAL CUES WHICH IS THEN INTERPRETED AND VALIDATED
  46. ACTUAL NURSING DIAGNOSIS
    • THREE PART STATEMENT INCLUDES DIAGNOSTIC LABEL, RELATED FACTORS, DEFINING CHARICTERISTICS
    • ACUTE PAIN RELATED TO SURGICAL TRAUMA AND INFLIMATION AS EVIDENCED BY GRIMACING AND VERBAL REPORTS OF PAIN
  47. RISK NURSING DIAGNOSIS
    • TWO PART STATEMENT THAT INCLUDES DIAGNOSTIC LABELS AND RISK FACTORS
    • RISK FOR INFECTION RELATED TO SURGERY AND IMMUNOSUPPRESSION
  48. POSSIBLE NURSING DIAGNOSIS
    • TWO PART STATEMENT THAT INCLUDES DIAGNOSTIC LABEL, RISK FACTORS
    • POSSIBLE SELF ESTEEM DISTURBANCE RELATED TO UNKNOWN ETIOLOGY
  49. WELLNESS DIAGNOSIS
    • ONE PART STATEMENT THAT INCLUDES DIAGNOSTIC LABEL
    • READIENESS FOR ENHANCED SPIRITUAL WELLBEING
  50. SIGNIFIGANCE OF NURSING DIAGNOSIS
    PROVIDES A MEANS OF COMMUNICATING NURSING REQUIREMENTS FOR CLIENT CARE TO OTHER NURSES HEALTHCARE MEMBERS AND THE PUBLIC
  51. OUTCOME IDENTIFICATION
    • FORMULATION OF GOALS AND MEASURABLE OUTCOMES THAT PROVIDE THE BASIS FOR EVALUATING THE NURSING DIAGNOSIS
    • ESTABLISHING PRIORITIES
    • ESTABLISH CLIENT GOALS AND OUTCOME CRITERIA
  52. PRIORITY
    A CHOICE THAT COMES FIRST FROM OTHER POSSIBLE OPTIONS
  53. CLIENT OUTCOME
    WHAT THE CLIENTS STATE WILL BE AFTER INTERVENTIONS ARE EFFECTED
  54. PLANNING
    • PLAN OF CARE
    • PLAN NURSING INTERVENTIONS
    • PROMOTES CONTINUITY OF CARE
  55. CORRECT PLAN OF CARE DOCUMENTATION
    • AMBULATES 30 FT IN HALL BEFORE DISCHARGE
    • CLIENT WALKS IN HALL
    • SMALL SHIFTS IN BODY WEIGHT TO PROMOTE CIRCULATION AND PREVENT SKIN BREAKDOWN
    • CHANGE POSITION EVERY 2 HOURS
  56. 3 PO DRUG PHASES
    • PHARMACEUTIC PHASE
    • PHARMACOKINETIC PHASE
    • PHARMACODYNAMIC PHASE
  57. PHARMACEUTIC PHASE
    • IST PHASE OF DRUG ACTION
    • TABLET GOES THROUGH DISINTIGRATION AND DISSOLUTION
  58. PHARMACOKINETIC PHASE
    • 2ND PHASE
    • THE PROCESS OF DRUG MOVEMENT TO ACHIEVE AN ACTION
    • ABSORBTION DISTRIBUTION METABOLISM AND EXCRETION
  59. ABSORBTION
    MOVEMENT OF DRUG FROM THE GI TRACT TO THE BODY FLUIDS
  60. DISTRIBUTION
    THE DRUG BECOMES AVAILABLR TO THE BODY FLUIDS AND TISSUES
  61. METABOLISM
    • LIVER IS THE PRIMAR SITE
    • ALSO GI TRACT
  62. EXCRETION
    KIDNEYS ARE THE PRIMARY SITE
  63. PHARMACODYNAMIC PHASE
    THE STUDY OF DRUG CONCENTRATION AND ITS EFFECTS ON THE BODY
  64. THERAPUTIC RANGE
    • ESTIMATES THE MARGIN OF SAFETY
    • THE CLOSER TO 1 THE GREATER THE DANGER OF TOXICITY
  65. LOW THERAPUTIC RANGE
    HAVE A NARROW MARGIN OF SAFETY
  66. HIGH THERAPUTIC RANGE
    WIDE MARGIN OF SAFETY
  67. PEAK AND TROUGH
    WHEN THE BLOOD PLASMA CONCENTRATION OF A DRUG IS AT ITS HIGHEST AND LOWEST LEVELS
  68. LOADING DOSE
    • IMMEDIATE DRUG RESPONSE IS DESIRED
    • A LARGER INITIAL DOSE IS REQUIRED TO GET THE PATIENT INTO THE THERAPUTIC RANGE
  69. 1970 THE CONTROLED SUBSTANCE ACT
    • DESIGNED TO SOLVE DRUG ABUSE
    • PROMOTION OF DRUG EDUCATION AND RESEARCH INTO THE PREVENTION AND TREATMENT OF DRUG DEPENDANCE
    • STRENGTHENING OF ENFORCEMENT AUTHORITY
    • ESTABLISHED REHAB FACILITIES
    • DESIGNATION OF SCHEDULES OF DRUGS
  70. SCHEDULE 1
    • DRUGS WITH HIGH ABUSE POTENTIAL
    • NO MEDICAL USE
  71. SCHEDULE 2
    • HIGH POTENTIAL FOR ABUSE
    • HAS A MEDICAL USE
  72. SCHEDULE 3
    • MEDICALLY ACCEPTED DRUGS
    • POTENTIAL FOR ABUSE IS LOWER
    • MAY CAUSE DEPENDANCE
  73. SCHEDULE 4
    • MEDICALLY ACCEPTED DRUG
    • MAY CAUSE DEPENDANCE
  74. SCHEDULE 5
    • MEDICALLY ACCEPTED
    • LOW POTENTIAL OF DEPENDANCE

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