Nursing Health History Assessment Quiz
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Questions and Answers

What type of nursing diagnosis is 'readiness for enhanced communication' an example of?

  • A potential nursing diagnosis
  • A risk nursing diagnosis
  • A wellness nursing diagnosis (correct)
  • An actual nursing diagnosis

    • In the nursing diagnosis 'impaired physical mobility', the word 'impaired' is an example of:

  • A descriptor (correct)
  • A nursing diagnosis
  • A related factor
  • A risk factor

    • When assessing Mr. Fletcher, what is the first appropriate assessment technique for data collection?

  • Review his medical record
  • Review the literature on hypertension
  • Interview him (correct)
  • Consult with the health care team

    • Which of the following are defining characteristics for the nursing diagnosis 'impaired nutrition (more than body requirements)'?

    <p>Patient’s weight is 10 to 20% more than his ideal height and frame</p> Signup and view all the answers

    What would be considered a realistic short-term goal for Mr. Fletcher to achieve prior to the next visit?

    <p>To remove two foods that are high in cholesterol from his diet</p> Signup and view all the answers

    What step should the nurse take to avoid incorrect inferences and ensure that the data from Mr.Fletcher’s assessment are accurate?

    <p>Validate data with the patient</p> Signup and view all the answers

    When clustering Mr.Fletcher’s data, what should the nurse do?

    <p>Organize cues into patterns that enable the nurse to identify nursing diagnoses</p> Signup and view all the answers

    Which of the following statements BEST describes a nursing diagnosis?

    <p>A clinical judgement about individual, family, or community responses to actual and potential health problems or life processes</p> Signup and view all the answers

    Why would the nurse choose to use a standard formal nursing diagnostic statement for Mr.Fletcher?

    <p>To standardize and communicate patient problems and nursing interventions</p> Signup and view all the answers

    What is the first nursing intervention to correct when watching Mr. Fletcher take his own blood pressure?

    <p>Mr. Fletcher has wrapped the blood pressure cuff too loosely</p> Signup and view all the answers

    Which is an example of an expected outcome statement written for Mr. Fletcher in measurable terms?

    <p>Patient will take his blood pressure daily and report systolic pressures over 140 mm Hg</p> Signup and view all the answers

    What is required for a collaborative intervention to assess Mr. Fletcher for peripheral arterial disease?

    <p>Multidisciplinary team intervention</p> Signup and view all the answers

    If the primary nurse wants to help Mr. Fletcher assess his peripheral arterial disease, what might be a collaborative intervention?

    <p>Consulting with a vascular specialist to aid in diagnosing and managing the condition</p> Signup and view all the answers

    What should the primary nurse prioritize when completing an individualized written care plan for Mr. Fletcher?

    <p>Collaborating with the patient and family in the development of the plan</p> Signup and view all the answers

    Which of the following interventions is an example of a specific life-saving measure that the primary nurse may implement?

    <p>Recognizing the signs of stroke in a patient</p> Signup and view all the answers

    How would the nurse use to evaluate the long-term impacts of teaching Mr. Fletcher how to take an antilipemic medication?

    <p>Ensure that Mr. Fletcher is scheduled for blood work that includes a fasting lipid panel monthly</p> Signup and view all the answers

    What objective evaluative criteria would the nurse use to judge Mr. Fletcher’s response to the care provided?

    <p>Goals and expected outcomes outlined in the care plan</p> Signup and view all the answers

    If Mr. Fletcher remains hypertensive despite taking prescribed medication, what should be the primary nurse’s initial action?

    <p>Ask Mr. Fletcher whether he is taking other medications such as NSAID therapy</p> Signup and view all the answers

    According to Kuhn, scientific advances are most likely to happen when creative individuals do which of the following?

    <p>Approach a problem in a new way</p> Signup and view all the answers

    The central idea characterizing the McGill model for nursing is that it:

    <p>Focuses on health rather than on illness or treatment</p> Signup and view all the answers

    Building upon a psychoanalytic perspective, theorist Hildegard Peplau considered which of the following as fundamental aspects of nursing practice?

    <p>All of the above</p> Signup and view all the answers

    The distinctive contribution that Canadian theorist Evelyn Adam made to nursing’s thinking at the time was a conceptualization of the essence of nursing as:

    <p>A helping process</p> Signup and view all the answers

    The idea that nursing theorists drew specifically from systems theories was to consider the human being as:

    <p>A whole and component parts in intricate interaction with one another</p> Signup and view all the answers

    What best describes a theory in the context of nursing?

    <p>Provides a systematic view of explaining, predicting, and prescribing phenomena</p> Signup and view all the answers

    In the early enterprise of theorizing about nursing practice, who was primarily driving the process?

    <p>Nursing educators</p> Signup and view all the answers

    What were the four basic steps involved in the original form of the nursing process?

    <p>Assessment, planning, intervention, evaluation</p> Signup and view all the answers

    Which concepts formed the metaparadigm structure of nursing theories?

    <p>Person, environment, health, and nursing</p> Signup and view all the answers

    What was the main focus of attention for early nursing theorists?

    <p>How to organize and make sense of general nursing knowledge and apply this knowledge to an individual clinical case</p> Signup and view all the answers

    Which of the following would be considered an independent nursing intervention?

    <p>Complete a chest X-ray to look for signs of heart failure and Obtain an order for new antihypertensive medication from the nurse practitioner.</p> Signup and view all the answers

    What is the primary focus when a nurse asks Amil, 'How do you feel about yourself?'

    <p>Self-esteem</p> Signup and view all the answers

    Which question would be appropriate to assess Amil’s satisfaction and dissatisfaction associated with role responsibilities and relationships?

    <p>What are your responsibilities in your family?</p> Signup and view all the answers

    What action would help increase Amil’s self-awareness?

    <p>Establishing a trusting nurse–patient relationship that allows him to explore his thoughts and feelings</p> Signup and view all the answers

    Apart from physiological stability and pain control, what other nursing interventions are necessary when caring for a patient after a mastectomy?

    <p>Interventions to improve the patient’s self-concept</p> Signup and view all the answers

    Why are adolescents specifically mentioned as being at risk for body image disturbance?

    <p>Due to hormonal changes during puberty</p> Signup and view all the answers

    Which of the following is an accurate statement about body image?

    <p>Body image includes actual and perceived perceptions of one’s body.</p> Signup and view all the answers

    What age group is particularly vulnerable to stressors that can affect an individual’s identity because it is a time of great change?

    <p>Adolescents</p> Signup and view all the answers

    What is the possible outcome when a person does not maintain a clear, consistent, and continuous consciousness of personal identity?

    <p>Identity confusion</p> Signup and view all the answers

    The nurse is assessing a 16-year-old who has been diagnosed with a sexually transmitted infection. Which of the following may be associated with risk-taking behaviors such as unprotected sex?

    <p>Poor self-esteem</p> Signup and view all the answers

    What critical thinking component is involved when the nurse reviews the literature about COPD in older patients and therapeutic communication principles?

    <p>Knowledge application</p> Signup and view all the answers

    When developing a discharge plan for a patient with COPD, what should the nurse advise the patient to expect?

    <p>Develop respiratory infections easily</p> Signup and view all the answers

    In what order, from first step to last step, should the nurse explain the pursed-lip breathing technique to the patient?

    <p>Relax your neck and shoulder muscles, Breathe in normally through your nose for two counts, Pucker your lips as if you were going to whistle, Breathe out through pursed lips for four counts</p> Signup and view all the answers

    What might be causing the patient's inability to sleep, fatigue during the day, and trouble concentrating after her husband's death 6 months ago?

    <p>Depression</p> Signup and view all the answers

    The nurse sits down to speak with the patient, whose husband died 6 months ago. The patient reports that she is unable to sleep, feels very fatigued during the day, and is having trouble concentrating. The nurse asks her to clarify the type of trouble she is having, and the patient explains that she cannot concentrate or even solve simple problems. The nurse records the results of her assessment, describing the patient’s condition as ineffective coping. This conclusion reflects the nurse’s use of:

    <p>Inference</p> Signup and view all the answers

    Based on the primary/priority concern in the case study, which body system(s) should the nurse most thoroughly assess?

    <p>Cardiovascular system and respiratory system</p> Signup and view all the answers

    Given the arterial blood gas results, what should the nurse do first?

    <p>Assess the patient’s vital signs</p> Signup and view all the answers

    When the nurse uses an institution’s procedure manual to confirm how to insert an IV line, which level of critical thinking is being used?

    <p>Basic critical thinking</p> Signup and view all the answers

    As the nurse enters a patient’s room, she observes that the IV line is not infusing at the ordered rate. The nurse checks the flow regulator on the tubing, looks to see whether the patient is lying on the tubing, checks the connection between the tubing and the IV catheter, and then checks the condition of the site where the IV catheter enters the patient’s skin. She readjusts the flow rate and the infusion begins at the correct rate. This is an example of:

    <p>problem solving</p> Signup and view all the answers

    Assessment

    <p>What are the patient’s desired health outcomes?</p> Signup and view all the answers

    Nursing Diagnosis

    <p>What is the patient’s health-related concern?</p> Signup and view all the answers

    Planning

    <p>What actions will help the patient achieve their desired outcomes?</p> Signup and view all the answers

    Implementation

    <p>How can I help the patient achieve their desired outcomes?</p> Signup and view all the answers

    Evaluation

    <p>How will I know if the patient has achieved their desired outcomes?</p> Signup and view all the answers

    Inference

    <p>Observe patterns and formulate conclusions</p> Signup and view all the answers

    Evaluation

    <p>Select criteria to assess the effectiveness of nursing interventions</p> Signup and view all the answers

    Explanation

    <p>Defend your conclusions</p> Signup and view all the answers

    Self-regulation

    <p>Ask how you can improve your clinical performance</p> Signup and view all the answers

    OPen-Mindedness

    <p>Consider opposing points of view</p> Signup and view all the answers

    Natalie has found a qualitative article that has recommendations for how to implement a falls-preventions program. She would like to determine whether she can use these findings in her own practice. Which question will help her determine this?

    <p>What is the transferability of the findings?</p> Signup and view all the answers

    Since Natalie was looking for fall-prevention programs that have been evaluated, she could consider a knowledge synthesis project, with the assistance of a nurse researcher. Which type of knowledge synthesis project may be most applicable in addressing her PICO question regarding the effectiveness of falls-preventions programs in acute care?

    <p>Meta-analysis</p> Signup and view all the answers

    Why is evidence-informed decision making important to Natalie?

    <p>It entails the use of knowledge based on research studies and takes into account a nurse’s clinical experience and patient preferences.</p> Signup and view all the answers

    Natalie wanted to learn about the lived experiences and perspectives of older persons who have experienced multiple falls. What type of research would she conduct?

    <p>Qualitative research</p> Signup and view all the answers

    If Natalie was unable to find the answer to her practice question in the literature, she should consider:

    <p>Working with a researcher to conduct research to answer her practice question</p> Signup and view all the answers

    It is important that Natalie critically appraise or evaluate any of the literature she finds for quality. This ability is referred to as:

    <p>Research literacy</p> Signup and view all the answers

    Because Natalie was looking for interventions to prevent falls, she would frame her literature search question using:

    <p>PICO</p> Signup and view all the answers

    Why was Natalie using evidence-informed decision making to improve her practice and the practice of others in preventing falls? Because it:

    <p>Has been found to improve patient care</p> Signup and view all the answers

    define cue

    <p>information that a nurse obtains through the use of senses.</p> Signup and view all the answers

    define inference

    <p>one's judgment or interpretation of those cues.</p> Signup and view all the answers

    medical diagnosis

    <p>The identification of a disease condition on the basis of his specific evaluation of physical signs, symptoms, the patient's medical history and the results of diagnostic tests and procedures</p> Signup and view all the answers

    diagnostic reasoning

    <p>a process of using assessment data about a patient to logically explain a clinical judgement</p> Signup and view all the answers

    Match

    <p>Nursing process = a cognitive framework through which the nurse aims to identify, diagnose, and treat actual and potential health issues and challenges of patients from a holistic perspective. Nursing process step = assessment, analysis, planning, implementation, and evaluation. The steps are unified and continuously relate to each other. It guides clinical judgement, decision making and reflective nursing practice. assessment = the purpose is to gather client data and establish client database. it is to collect, verify, analyze, and communicate. Planning = involves the creation of a formal plan that prescribes strategies and alternatives to obtain the expected outcomes.</p> Signup and view all the answers

    Various sources of data.

    <p>Primary = ): Nurses should always ask patients if they want their family involved during their physical assessment because usually, they are able to tell when changes are occurred in the patients. They also make observations about the patients’ need that can affect the way care is delivered. Secondary = They provide information to patients frame of reference, so like illness conditions. This is relevant to literature and nurses experience, so like accepted common commonality some patients with similar physical and emotional responses. Tertiary = Example patients’ description of the presenting problem and medical history narratives of health experiences. 111 = 111</p> Signup and view all the answers

    Nursing diagnosis like goals, expected outcomes or both and specific nursing interventions. It quickly identifies the patient's clinical needs and situation.

    <p>Nursing care plan</p> Signup and view all the answers

    Identify three types of nursing diagnosis.

    <p>Risk diagnosis Health promotion diagnosis Wellness diagnosis</p> Signup and view all the answers

    types of nursing diagnosis

    <p>actual risk wellness and promotion</p> Signup and view all the answers

    diagnoses present a current client problem "state of health problems" "problems exists right now"

    <p>actual (problem focused)</p> Signup and view all the answers

    Example of what? Impaired Skin Integrity related to immobility as evidenced by redness and excoriated skin on right heel

    <p>actual</p> Signup and view all the answers

    Three components of Actual

    <p>Diagnostic label Related/risk factors clinical manifestations</p> Signup and view all the answers

    Diagnostic label related to the problem evidenced by the signs and symptoms

    <p>actual</p> Signup and view all the answers

    diagnoses are if a client does not have a diagnosis but data reveal a risk for its development. This allows the nurse to focus on reducing factors for a ____

    <p>risk diagnosis</p> Signup and view all the answers

    developing problem; high degree of probability but it has not happened yet

    <p>risk</p> Signup and view all the answers

    two components of risk diagnosis

    <p>diagnostic label related/risk factors</p> Signup and view all the answers

    example of what?

    <p>Risk for impaired skin integrity related to immobility</p> Signup and view all the answers

    Opportunities for enhancement of a healthy state (health promotion and disease prevention) or increase well being – Actualize health potential – May not reflect current health levels (they can be used in any state) • Ex. Opportunity to enhance skin integrity. • Ex. Readiness for enhanced..

    <p>wellness and health promotion</p> Signup and view all the answers

    exists to develop, refine, and promote terminology that accurately reflects nurses’ clinical judgements

    <p>NANDA international</p> Signup and view all the answers

    Focus on client’s actual or potential response to a health problem and Allows nurses to focus their care (assess, identify problems, prioritize problems, intervene)

    <p>Nursing diagnosis</p> Signup and view all the answers

    Diagnosis Purpose: Develop a client-centered plan of care which meets the unique needs of the client

    <p>True</p> Signup and view all the answers

    Use quotation marks for a client’s statement, do not paraphrase

    <p>subjective information</p> Signup and view all the answers

    Use proper terminology and measurements

    <p>objective information</p> Signup and view all the answers

    Are subjective or objective data that can be directly heard or observed by the nurse • Example: What the client says or what the nurse can see, hear, feel, smell, or measure.

    <p>Cues</p> Signup and view all the answers

    Are the nurse’s conclusions or interpretations of the cues • Example: A nurse observes the cues that an incision is red, hot and swollen; the nurse makes the inference that the incision is infected.

    <p>Inferences</p> Signup and view all the answers

    • Organize information into ‘clusters’ • Set of signs and symptoms you group together in a logical way – Recognize patterns and trends – Improves with knowledge and experience

    <p>Analysis</p> Signup and view all the answers

    To ensure accuracy, eliminate biases, misperceptions and errors in data collection

    <p>verification</p> Signup and view all the answers

    Example of Interview + Examination

    • Nursing Health History
    • Extensive data collection
    • Get the ‘whole’ picture of client’s health and well being
    • Data collected includes:

    <p>methods of data collection</p> Signup and view all the answers

    methods of data collection

    <p>interview examination diagnostic and lab data</p> Signup and view all the answers

    who is the primary source of data?

    <p>clients</p> Signup and view all the answers

    secondary source of data?

    <p>family or caregivers</p> Signup and view all the answers

    Clients’ perceptions about their health problems. • Only clients can give this

    <p>subjective symptoms</p> Signup and view all the answers

    Observations or measurements made by the data collector. Ex. Assessment of a client’s wound , description of client behaviour

    <p>objective signs</p> Signup and view all the answers

    to gather client data and establish a client database?

    <p>assessment</p> Signup and view all the answers

    steps for assessment?

    <p>collect verify analyze communicate</p> Signup and view all the answers

    Not necessarily linear: Cyclic and dynamic

    • For all client systems: Client, families, communities
    • Interpersonal and collaborative
    • Goal and problem-oriented
    • Permits creativity
    • Feedback and evaluation necessary

    <p>characteristics of the nursing process</p> Signup and view all the answers

    • A problem-solving approach to identifying, diagnosing, and treating the health issues of patients.
    • Systematic approach to delivering nursing care
    • Allows nurses to think critically

    <p>nursing process</p> Signup and view all the answers

    <p>Implementation = Occur by coordinating care delivery, providing health teaching and health promotion activities to the patient. While consulting with other health care providers. Within the scope of practice of the registered nurse. objective data = observations or measurements of a patient's health status. So, this is to inspect of the condition of a wound. Description of an observed behavior and measurement of blood pressure are examples of objective data. subjective data = Our patients verbal descriptions of their health concerns. They are obtained through the health history and the nurse’s questions. In the explanation the patient provides. Only patients provide subjective data. evaluation = the patient’s response to the selected interventions and determines whether the interventions were effective.</p> Signup and view all the answers

    Diagnostic level/related factors and risk factors and defining characteristics (signs and symptoms)

    <p>components of a nursing diagnosis statement</p> Signup and view all the answers

    in order: nursing phases, problem prioritization, establish client goals, and expected outcomes, identify interventions, select interventions, write the health care plan.

    <p>process of planning phases</p> Signup and view all the answers

    Ex: Acute pain related to injury of right arm as evidenced by client stating 10/10 pain, client moaning and guarding of arm

    <p>nursing diagnosis</p> Signup and view all the answers

    client's response to health issue ex. pain, self-care, impaired skin integrity

    <p>diagnostic label</p> Signup and view all the answers

    One or more probable causes of the health problem.

    <p>acute</p> Signup and view all the answers

    One or more factors putting the client at risk of getting the health problem

    <p>risk</p> Signup and view all the answers

    Are the cluster of signs and symptoms that indicate the presence of a particular diagnostic label.

    • For actual nursing diagnoses, subjective and objective data
    • For risk nursing diagnoses, there are no defining characteristics as the client is ‘at risk’
    • Example: As evidenced by moaning and facial grimacing

    <p>defining characteristics</p> Signup and view all the answers

    The ‘priority nursing diagnosis’ is the most pertinent for the client

    <p>True</p> Signup and view all the answers

    what priority? Physiological or psychological issues that affect safety, circulation or oxygenation or address basic human needs • Focus on first!

    <p>highest</p> Signup and view all the answers

    What priority?

    • Not necessarily linked to illness or prognosis • Related to client’s future well-being • Long term health care needs

    <p>lowest</p> Signup and view all the answers

    what is the focus of your intervention?

    <p>expected outcomes and goal</p> Signup and view all the answers

    goals of care are:

    <p>client centered short-term goal long-term goal</p> Signup and view all the answers

    Smart?

    <p>specific measurable attainable realistic time bound</p> Signup and view all the answers

    any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance client outcomes

    <p>nursing intervention</p> Signup and view all the answers

    Is an intervention performed through interaction with the client.

    <p>direct care</p> Signup and view all the answers

    Is an intervention performed away from, but on behalf of, the client, such as interdisciplinary collaboration

    <p>indirect care</p> Signup and view all the answers

    three types of nursing interventions?

    <p>nurse initiated physician initiated/independent collaborative</p> Signup and view all the answers

    Also called independent nursing interventions – Does not require orders or directives from other health care professionals – Grounded in evidence-informed decision making

    <p>nurse initiated</p> Signup and view all the answers

    lso called dependent nursing interventions – Requires orders or directives from physicians – Treating or managing a medical diagnosis Nurse needs to recognize and question errors

    <p>physician initiated</p> Signup and view all the answers

    Also known as interdependent – Require combined skill and knowledge of various health care providers – Examples: • Dietician, social worker, physiotherapy etc. Nurse needs to recognize and question errors

    <p>collaborative interventions</p> Signup and view all the answers

    Clinical Practice Guidelines and Protocols • Agency specific intervention, BPGs, – Medical directive or standing order • Pre-approved and signed orders by physician – Nursing Intervention Classification System • Common interventions for NANDA diagnoses

    <p>types of standard nursing interventions</p> Signup and view all the answers

    Involves the actual performance of planned interventions. Requires – Preparation by the nurse – Specific set of skills

    <p>implementation</p> Signup and view all the answers

    implementation: required skills

    <p>cognitive interpersonal psychomotor</p> Signup and view all the answers

    Involves assessing the patient's response to interventions and determining whether the interventions were effective

    <p>evaluation</p> Signup and view all the answers

    an important aspect of the nursing process because conclusions drawn from the _____ determine whether the nursing interventions should be terminated, continued, or changed.

    <p>evaluation</p> Signup and view all the answers

    types of evaluation?

    <p>ongoing intermittent terminal</p> Signup and view all the answers

    Is done while or immediately after implementing a nursing order; it enables the nurse to make on-the-spot modifications in an intervention.

    <p>ongoing evaluation</p> Signup and view all the answers

    • Performed at specific intervals (i.e. once a week), shows the extent of progress toward goal achievement and enables the nurse to correct any deficiencies and modify the care plan as needed.
    • Evaluations continues until the client achieves the health goals and/or is discharged home nursing care.

    <p>ongoing evaluation</p> Signup and view all the answers

    Indicates the client’s condition at the time of discharge. It includes the status of goal achievement and is an evaluation of the client’s self-care abilities with regard to follow-up care. Most agencies have a special discharge record for _______.

    <p>terminal evaluation</p> Signup and view all the answers

    1. identify goal
    2. collect data to determine if goal has been met
    3. interpret and summarize findings
    4. document
    5. terminate, continue or revise care plan

    <p>evaluation process</p> Signup and view all the answers

    A theory is best understood as a set of assumptions or propositions that becomes useful when it does which of the following?

    <p>A theory is best understood as a set of assumptions or propositions that becomes useful when it does which of the following? = Provides a systematic view of explaining, predicting, and prescribing phenomena The metaparadigm concepts that formed the structure of concepts that nursing theories were concerned about included: = The person, environment, health, and nursing The idea that nursing theorists drew specifically from systems theories was to consider the human being as = A whole and component parts in intricate interaction with one another Adolescents are at risk for body image disturbance. Which of the following is an accurate statement about body image? = Body image includes actual and perceived perceptions of one's body</p> Signup and view all the answers

    <p>What is the nurse assessing for when she or he asks the client, “How do you feel about yourself?” = self-esteem Which of the following questions would be appropriate to assess the client's satisfaction and dissatisfaction associated with role responsibilities and relationships? (Select all that apply) = What are your responsibilities in your family?/What are your relationships like with your relatives? A nurse uses an institution's procedure manual to confirm how to change a patient's nasogastric tubing. The level of critical thinking the nurse is using is = Basic critical thinking The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion, the nurse reviewed the description in his textbook of loss and grief in addition to therapeutic communication principles. The critical thinking component involved in the nurse's review of the literature is = Specific knowledge base</p> Signup and view all the answers

    A patient had hip surgery 24 hours ago. The nurse refers to the written plan of care, noting that the patient has a device collecting wound drainage. The physician is to be notified when the accumulation in the device exceeds 100 mL for the day. When the nurse enters the room, the nurse looks at the device and carefully notes the amount of drainage currently in the device. This is an example of

    <p>assessment</p> Signup and view all the answers

    The nurse completes a nursing health history with her client. In order to avoid incorrect inferences and ensure that the data are accurate, the nurse's next step is to:

    <p>validate data</p> Signup and view all the answers

    The nursing diagnosis readiness for enhanced communication is an example of:

    <p>a wellness nursing diagnosis</p> Signup and view all the answers

    <p>data clustering = organization of data to classify and focus on the correct problem. close ended questions = limits answers to one or two words. &quot;yes or no&quot; assessment = collection and verification of data subjective data = clients perception about themselves</p> Signup and view all the answers

    <p>assessment data = information that is descriptive, concise, and complete without inferences or interpretive statements. verification = comparison of data with another reliable source to confirm accuracy directive interview = organized conversation with a client to obtain information database = information about a clients needs, health problems, and responses to these problems.</p> Signup and view all the answers

    Organized knowledge about nursing to enable nurses to use it in a professional manner

    <p>nursing theory</p> Signup and view all the answers

    <p>nursing theory = Aims to describe, predict and explain the phenomenon of nursing and provides foundations of how we practice as nurses nursing theory allows to: = are representations of the beliefs depicted by the theory (also known as a conceptual framework) and often help to introduce the theory into practice what is a model? = View client situations from a certain perspective, organize data, provides a method to analyze and interpret information nursing metapradigm = a group of theories which represents how our profession functions</p> Signup and view all the answers

    types of theories

    <p>grand theory middle range prescriptive descriptive</p> Signup and view all the answers

    Broad in scope, provide structural framework to direct nursing science (aka more narrow range theories)

    <p>grand theory</p> Signup and view all the answers

    Explains, relate and sometimes predict why a phenomenon occurs (ex. Helps explain nursing client assessment)

    <p>descriptive</p> Signup and view all the answers

    More limited scope, address specific phenomenon and reflect nursing practice

    <p>middle range</p> Signup and view all the answers

    Address nursing interventions (treatment) and help predict the consequences of an interventions

    <p>prescriptive</p> Signup and view all the answers

    types of theoretical models

    <p>practices based needs interactionist systems</p> Signup and view all the answers

    environment conducive to healing: was characterized by a commitment to evidence-based care, holistic principles, patient advocacy, professionalism, infection control, and education.

    <p>florence nightingale practice base</p> Signup and view all the answers

    14 basic human needs

    <p>virginia henderson needs</p> Signup and view all the answers

    interpersonal relationship between client and nurse?

    <p>hildegard interactionist</p> Signup and view all the answers

    what points to the holistic view of care?

    <p>nursing metaparadigm</p> Signup and view all the answers

    four components of mental image

    <p>body image role performance personal identity self-esteem</p> Signup and view all the answers

    Develops partly from others attitudes and responses and partly form the individuals

    <p>self-esteem</p> Signup and view all the answers

    components of role performance

    <p>role conflict role strain role ambiguity role overload</p> Signup and view all the answers

    <p>role ambiguity = One person assumes two roles which are contradictory or mutually exclusive role conflict = Expectation are unclear and people do not know what to do or how to do it role strain = Frustration related to a role expected of the person that does not fit or feel right role overload = having more roles or responsibilities that is manageable.</p> Signup and view all the answers

    Conscious sense of individuality and uniqueness

    • Continually evolving

    <p>personal identity</p> Signup and view all the answers

    the degree to which a person identifies as male, female, or some combination

    <p>gender identity</p> Signup and view all the answers

    predominant gender preference’s of a person’s sexual attraction over time

    <p>sexual orientation</p> Signup and view all the answers

    How that person’s standard and performance compared to others and to one’s ideal self

    <p>self-esteem</p> Signup and view all the answers

    The process of purposefully thinking back or recalling a situation to discover its purpose or meaning. Reflection is necessary for self-evaluation and improvement of nursing practice.

    <p>reflection</p> Signup and view all the answers

    A process and as a set of skills; an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others

    <p>critical thinking</p> Signup and view all the answers

    critical thinking levels

    <p>basic complex commitment</p> Signup and view all the answers

    critical thinking components

    <p>specific knowledge base experience competencies attitudes standards</p> Signup and view all the answers

    <p>specific knowledge base = Education (sciences, theory, humanities, behavioural, nursing sciences) – Important to admit limitations in your knowledge experience = Clinical experiences (nursing school and professional employment) – Other work experiences general compentencies = Scientific Method, Problem Solving, Decision Making specific competencies = Diagnostic reasoning, clinical inference, and clinical decision making/ Determining health status of patient after you have gathered all important assessments (physical, social, psychological)</p> Signup and view all the answers

    determine how a critical thinker approaches a problem or a situation that requires some kind of decision-making. – For example, when a patient complains of anxiety before undergoing a diagnostic procedure, the curious nurse explores possible reasons for the patient’s concerns

    <p>attitudes</p> Signup and view all the answers

    What ‘attitudes’ are important for nurses to have? (Curiosity, independence, fair-mindedness, aware of self-limits, integrity, perseverance, confidence)

    <p>True</p> Signup and view all the answers

    is the integration of the most informative research evidence with evidence from expert clinical practice, client preferences, professional clinical judgment, and other sources to produce the best possible care for clients

    <p>evidence informed practice</p> Signup and view all the answers

    Information derived from research and scientific evaluation of practice

    <p>evidence</p> Signup and view all the answers

    defined by the CNA as “an ongoing process that incorporates evidence from research findings, clinical expertise, client preferences and other available resources to inform decisions that nurses make about clients”

    <p>evidence informed decision making</p> Signup and view all the answers

    types of evidence

    <p>research non research evidence patient focused evidence</p> Signup and view all the answers

    <p>nursing diagnosis = Clinical judgment about individual, family, or community responses to health care problems or life processes that is within the domain of nursing medical diagnosis = The identification of a disease condition on the basis of a specific evaluation of physical signs, symptoms, the patient's medical history, and the results of diagnostic tests and procedures. 111 = 111 222 = 222</p> Signup and view all the answers

    Study Notes

    Nursing Diagnosis Concepts

    • 'Readiness for enhanced communication' exemplifies a health promotion nursing diagnosis.
    • In 'impaired physical mobility', the term 'impaired' indicates a diminished function or capability.
    • Initial assessment techniques for data collection include observation and physical examination.

    Data Collection and Assessment

    • Defining characteristics for 'impaired nutrition (more than body requirements)' may include weight gain and excessive caloric intake.
    • A realistic short-term goal for Mr. Fletcher could be to reduce weight by a specific amount before the next visit.
    • To avoid incorrect inferences, the nurse should validate data through multiple sources.

    Cluster Data and Nursing Diagnosis

    • When clustering data, the nurse should identify patterns and correlations among Mr. Fletcher’s symptoms.
    • A nursing diagnosis is characterized as a clinical judgment about an individual’s response to health conditions.
    • A standard formal nursing diagnostic statement clarifies the focus of care and intervention.

    Nursing Interventions and Goals

    • The first nursing intervention while observing Mr. Fletcher taking his blood pressure should involve checking the device for proper use.
    • An expected outcome statement relevant to Mr. Fletcher may quantify measurable improvements in blood pressure levels.
    • Collaborative interventions for assessing peripheral arterial disease might include referring to a vascular specialist.

    Care Planning and Prioritizing Interventions

    • Prioritization in a written care plan should focus on immediate health concerns impacting Mr. Fletcher’s wellbeing.
    • Life-saving measures may include administering CPR or medications for acute health crises.
    • Long-term evaluation of teaching medication adherence could involve monitoring cholesterol levels over time.

    Critical Thinking in Nursing

    • Objective evaluative criteria could include vital signs, lab results, and the patient's self-reported outcomes.
    • If Mr. Fletcher remains hypertensive, the primary nurse should first assess compliance with medication regimens.

    Nursing Theories and Models

    • Scientific advancements occur when creative individuals challenge established norms and explore new ideas, according to Kuhn.
    • The McGill model of nursing emphasizes the collaboration between patients and nurses in achieving health.
    • Hildegard Peplau highlighted the therapeutic relationship and interpersonal processes in nursing practice.

    Nursing Process and Theorists

    • The essence of nursing according to Evelyn Adam involves relational understanding and the healing process.
    • Human beings are viewed through the lens of systems theories, considering environmental and relational factors.

    Knowledge Synthesis and Evidence-Based Practice

    • Knowledge synthesis projects are essential to identify effective fall-prevention programs in nursing practice.
    • Evidence-informed decision making is crucial for improving patient outcomes and implementing best practices.
    • Qualitative research may be conducted to explore the experiences of older adults who have suffered falls.

    Nursing Assessment and Diagnosis

    • Cue refers to observable data while inference is the interpretation of those cues.
    • Actual nursing diagnoses convey current issues, while risk diagnoses identify potential future problems.
    • Health promotion diagnoses focus on enhancing client wellness and addressing potential improvements.

    Nursing Process Steps

    • The original nursing process involves assessment, diagnosis, planning, implementation, and evaluation.
    • Each nursing diagnosis is structured to encompass a diagnostic label, related factors, and evidence-based signs and symptoms.

    Patient-Centric Assessment

    • Subjective data arise from the patient’s experience, while objective data consist of observable metrics recorded by the nurse.
    • Gathering thorough client data involves comprehensive health histories and physical examinations to establish a robust client database.

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    Description

    Test your knowledge about nursing health history assessments with these questions about data validation, interpretation, and clustering. Determine the correct steps to ensure accurate assessment data and proper nursing care.

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