Foundations Week 2 - Nursing Study Notes
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Questions and Answers

What is the primary purpose of standing orders in nursing?

  • To standardize routine therapies and monitoring guidelines (correct)
  • To eliminate the need for patient consent
  • To introduce new, experimental treatments
  • To provide individualized care for each patient

Which of the following is NOT a component to consider when planning nursing interventions?

  • Patient's financial status (correct)
  • Desired patient outcomes
  • Nurse's competency
  • Research-based knowledge for the intervention

Why is it important for nurses to recognize incorrect therapies?

  • It is crucial for patient safety and legal responsibility (correct)
  • It ensures legal immunity for the nurse
  • It leads to more efficient paperwork
  • It allows for creative freedom in treatment plans

What should a nurse do to enhance their clinical judgment?

<p>Consult peers and experienced nurses for guidance (A)</p> Signup and view all the answers

What is the nature of reassessing a patient in nursing care?

<p>A continuous process during each patient interaction (A)</p> Signup and view all the answers

What is a primary focus of direct care?

<p>Medication administration (D)</p> Signup and view all the answers

Which of the following represents the correct sequence of the RAPGTE nursing process?

<p>Recognize Cues, Analyze Cues, Prioritize Hypotheses (C)</p> Signup and view all the answers

Which of the following is NOT one of the '5 Rights' of delegation?

<p>The 'right' training (C)</p> Signup and view all the answers

When evaluating patient outcomes, what should be compared to determine the effectiveness of care?

<p>Achieved effects with goals and expected outcomes (B)</p> Signup and view all the answers

What is a key purpose of modifying a care plan in patient evaluation?

<p>To reassess and redefine diagnoses as needed (B)</p> Signup and view all the answers

What is the primary purpose of collecting assessment data from patients and secondary sources?

<p>To create a comprehensive database (C)</p> Signup and view all the answers

Which type of assessment is conducted during a nursing health history?

<p>Patient-centered interview (A)</p> Signup and view all the answers

What is an essential step after interpreting and validating assessment data?

<p>Collection of complete database (A)</p> Signup and view all the answers

When assessing a patient, why is it important to consider cultural background?

<p>To avoid misinterpretation of data (C)</p> Signup and view all the answers

What must a nurse identify to implement effective patient care?

<p>The greatest risk for safety (C)</p> Signup and view all the answers

In the nursing process, what is the significance of prioritizing problems?

<p>To address urgent and important issues first (D)</p> Signup and view all the answers

What approach should be used when writing goal and outcome statements?

<p>SMART approach (C)</p> Signup and view all the answers

What is an important aspect of recognizing cues during patient assessment?

<p>Recognizing potential complications (C)</p> Signup and view all the answers

What is the primary purpose of recognizing cues in the nursing process?

<p>To understand the patient's current problems (A)</p> Signup and view all the answers

Which step follows the 'Diagnosing' phase in Tanner's clinical judgment model?

<p>Planning interventions (D)</p> Signup and view all the answers

What is the priority classification for life-threatening conditions?

<p>High—Emergent (A)</p> Signup and view all the answers

What is the main focus during the 'Implementation' phase of the nursing process?

<p>Taking appropriate actions based on the plan (C)</p> Signup and view all the answers

Which of the following is NOT a component of the SMART acronym for creating patient-centered goals?

<p>Complex (C)</p> Signup and view all the answers

Which of the following best describes 'critical thinking' in nursing?

<p>Applying logic and reasoning to assess patient needs (D)</p> Signup and view all the answers

What should a nurse do before implementing physician-initiated interventions?

<p>Assess the patient's current condition. (B)</p> Signup and view all the answers

In the nursing process, what is the role of evaluating outcomes?

<p>To assess the effectiveness of interventions applied (D)</p> Signup and view all the answers

Which of the following best defines nurse-initiated interventions?

<p>Independent actions taken by a nurse. (B)</p> Signup and view all the answers

What should a nurse consider when analyzing cues during the assessment phase?

<p>Possible underlying pathophysiology of symptoms (B)</p> Signup and view all the answers

Which complication may indicate a deteriorating patient condition?

<p>Increased respiratory distress (A)</p> Signup and view all the answers

What is a critical component of problem-solving in nursing practice?

<p>Working collaboratively with other healthcare professionals (B)</p> Signup and view all the answers

In patient-centered care, what factors are crucial to understand?

<p>Patient's preferences, values, and expressed needs. (A)</p> Signup and view all the answers

Which statement best characterizes the nursing process as a competency?

<p>It is a systematic approach encompassing multiple phases. (A)</p> Signup and view all the answers

Which of the following is considered a low priority in patient care?

<p>Future well-being concerns (D)</p> Signup and view all the answers

What is the role of nursing standards in patient interventions?

<p>They define the level of clinical excellence required for care. (C)</p> Signup and view all the answers

Flashcards

Diagnostic reasoning

The ability to understand and interpret a patient's signs and symptoms, leading to accurate diagnosis and care.

Clinical decision making

The process of making informed judgments about a patient's care based on their individual needs and circumstances.

Nursing process

A systematic approach to patient care that involves a series of steps to identify and address patient problems.

Assessment

An important element of the nursing process that involves observing and gathering information about a patient's current state.

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Analyze Cues

The ability to critically analyze and interpret the information gathered during assessment, leading to a clear understanding of the patient's situation.

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Prioritize Hypotheses

The identification and ranking of potential patient problems based on their severity and urgency.

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Generate Solutions

Creating a plan of action to address the patient's identified problems and to achieve desired outcomes.

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Take Action

Implementing the planned interventions and strategies to address the patient's identified problems.

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Assessment Cues

Pieces of information collected during an assessment that provide insights into a patient's health status.

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Generate Solutions/Goals

The process of developing specific, measurable, achievable, realistic, and time-bound goals for a patient's care.

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Plan of Care

A planned course of action designed to address a patient's identified needs and concerns.

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Implement Interventions

Taking action to address a patient's needs and achieve the established goals, based on the plan of care.

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Establishing Priorities

Classifying patient needs based on urgency, with high priorities requiring immediate attention, intermediate needs requiring consideration, and low but important needs impacting patient's future well-being.

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Potential Complications

Determining potential problems a patient might face, considering current condition, lab results, medication effects, and underlying health conditions.

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SMART Goals

Patient-centered goals are specific, measurable, achievable, realistic, and time-bound, aiming to improve patient outcomes.

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Nurse-Initiated Intervention

Actions nurses initiate independently, such as assessing patients, educating them, and promoting comfort.

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Health Care Provider-Initiated Intervention

Actions needing a healthcare provider's order, like administering medications or performing specific procedures.

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Collaborative Intervention

Actions relying on collaboration between multiple healthcare professionals, such as planning a patient's discharge or managing complex care needs.

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High Priority

Immediately address life-threatening issues like airway, breathing, circulation, safety, and pain.

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Intermediate Priority

Addresses problems that are not immediately life-threatening but require attention to prevent further complications.

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What is 'Direct Care'?

The direct care provided to patients involves treatments performed through interactions with them, such as medication administration, IV insertion, and counseling.

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What is 'Indirect Care'?

Indirect care focuses on tasks performed away from the patient, but still for their benefit. These tasks include managing the environment, ensuring safety and infection control, documentation, and interdisciplinary collaboration.

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What are the '5 Rights' of Delegation?

This refers to the 'five rights' involved in the delegation of tasks: the right person, right task, right circumstances, right directions, and right supervision/evaluation.

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What does 'RAPGTE' stand for?

This stands for 'Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action & Evaluate Outcomes.' These steps make up the nursing process, a systematic approach to patient care.

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What is 'Evaluation' in Nursing?

Evaluation is a crucial step in patient care that involves examining the results of implemented interventions. It includes comparing outcomes to established goals, using self-reflection, and recognizing errors.

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What are standing orders?

Printed guidelines outlining routine treatments, monitoring, and procedures for patients with specific diagnoses or clinical problems. They streamline care by providing clear instructions and reducing the need for repeated verbal orders.

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What is the Nursing Interventions Classification (NIC)?

A structured system for classifying and documenting nursing interventions across various healthcare settings. It aims to promote consistency, communication, and comparison of nursing care outcomes.

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What are the steps involved in clinical judgment?

The nurse must carefully evaluate various possible consequences of potential actions and prioritize interventions based on the likelihood of success and risk to the patient. Consulting with experienced nurses or instructors is crucial for new nurses.

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How are patients reassessed?

Regularly assessing the patient's condition, including their response to treatment. It's a continuous process that extends beyond just the initial assessment and doesn't involve evaluation of care directly.

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What is essential when making clinical decisions?

It's crucial to allocate sufficient time to review patient information, carefully consider options before making a decision, and avoid rushing through assessments or interventions.

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Study Notes

Foundations Week 2 - Study Notes

  •  Course covers chapters 15, 16, 17, 18, 19, and 20
  •  Focus on Next GEN THIN THINKING principles in nursing, emphasizing needs, concepts, questions, and immediate patient needs.
  •  Key elements of THIN THINKING include: - Help quick! - ACT NOW! (Immediate actions) - Identify greatest safety risks - Nursing Process (Assess and Implement) - Understanding why the patient is there and next care level
  •  Key objectives include: - Describing clinical judgment in nursing practice - Explaining problem-solving importance in nursing practice - Discussing the nursing process's relationship to critical thinking
  •  Tanner's CJ Model & NCJMM are relevant to the nursing process (Assessment, Diagnosis/Analysis, Planning, Implementation, and Evaluation). Corresponding steps in the model include: - Assessment: Noticing, Recognizing Cues - Diagnosis/Analysis: Interpreting, Analyze Cues, Prioritize Hypotheses - Planning: Responding, Generating Solutions - Implementation: Responding, Take Action - Evaluation: Reflecting, Evaluate Outcomes
  •  Chapter 15 focuses on clinical decision-making, critical thinking, and the nursing process.
  •  Critical thinking involves recognizing patient problems, employing diagnostic reasoning, interpreting patient symptoms, and expert nurses' quick context-based decisions. Clinical decision-making is also crucial (page 213, 214).
  •  Chapter 16 focuses on assessment/cues, including: - Understanding pathophysiology, scope, attitude, and experience - Collecting data from patients and secondary sources (family members) - Recognizing cues (most important data) - Importance of health assessment returns (patient-centered interviews, physical examinations, periodic assessments, and lab/diagnostic data) - Diagnostic and laboratory data provide further explanation of alterations or problems
  •  Chapter 17 focuses on analyzing cues/prioritizing hypotheses. This includes reviewing relevant client data, recognizing cues, determining data meaning, recognizing actual and potential complications.
  •  Chapter 18 focuses on generating solutions and goals.
  •  Chapter 19 focuses on taking action; standard nursing interventions; the need for clinical excellence within scope of care, ANA standards, and QSEN competencies; types of interventions (nurse-initiated, health care provider initiated, collaborative).
  •  Taking action includes implementing physician-initiated or collaborative interventions, recognizing incorrect therapies, and legal responsibility for actions.
  •  Evaluation criteria include considering desired patient outcomes, research-based knowledge, intervention feasibility and acceptability, and nurse competency.
  •  Standing orders are preprinted orders for routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients (examples: labs, meds, diet, PT/OT, wound care).
  •  Nursing interventions' classification differentiates nursing practice, enhances communication across settings, and allows for outcome comparison.
  •  Critical judgment includes reviewing all possible nursing interventions, consequences of actions, and potential consequences probability.
  •  Reassessment is a continuous process for each patient interaction and revising the existing nursing care plan. This includes time management, equipment, personnel, environment, and patient-centered care.
  •  Direct care involves patient interactions, med administration, IV infusions, and counseling. Indirect care is performed away from patients (managing environments, documentation, and interdisciplinary collaboration).
  •  Delegation involves: - Considering patient stability, task appropriateness, supervisory capability, and planned monitoring. - Delegation steps include assessment, communication, ensuring supervision, and evaluation. - The 5 rights of delegation are person, task, circumstances, directions/communication, and supervision/evaluation.
  •  Delegation scope of practice differentiates nurses, LPN/LVN, and UAP tasks.
  •  Chapter 20 focuses on evaluation/evaluating outcomes; objectives include explaining the evaluation process, how evaluation leads to plan modifications, and the relationship among goals, outcomes, and evaluative measures.
  •  Evaluation involves examining results, comparing achieved effects with goals, observing, teaching, and demonstrating error recognition using self-reflection; discontinuing, modifying, reassessing, redefining concerns goals. Also, resolving actual health problems, potential problems, and maintaining health state.

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Related Documents

Foundations Week 2 Chapters 15-20 PDF

Description

This quiz focuses on key concepts from Week 2 of the Foundations course, covering chapters 15 to 20. Students will explore Next GEN THIN THINKING principles in nursing, emphasizing clinical judgment and problem-solving skills essential for patient care. Relevant models such as Tanner's CJ Model and NCJMM are also discussed.

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