Nursing Process and Clinical Judgment

<p>Observable and measurable data (A)</p> Signup and view all the answers

<p>To confirm data accuracy and credibility (C)</p> Signup and view all the answers

<p>The patient (A)</p> Signup and view all the answers

<p>Setting measurable goals and planning interventions (A)</p> Signup and view all the answers

<p>Collect data through observation and interviews (C)</p> Signup and view all the answers

<p>A patient with difficulty breathing (C)</p> Signup and view all the answers

<p>Airway, Breathing, Circulation, Disability, Exposure (B)</p> Signup and view all the answers

<p>Urgency of the problem (C)</p> Signup and view all the answers

<p>Assessing the patient's condition (C)</p> Signup and view all the answers

<p>Prioritize based on the severity of their conditions (A)</p> Signup and view all the answers

<p>To make decisions based on evidence and patient needs (A)</p> Signup and view all the answers

<p>By using a systematic approach like the ABCDE method (D)</p> Signup and view all the answers

<p>Consult with a more experienced nurse or healthcare professional (B)</p> Signup and view all the answers

<p>Repositioning a patient to prevent pressure ulcers (C)</p> Signup and view all the answers

<p>A standardized plan of care for patients with similar conditions (B)</p> Signup and view all the answers

The nursing process is a systematic, patient-centered approach that involves five steps: assessment, diagnosis, planning, implementation, and evaluation.

Assessment involves collecting data about the patient's health status, including subjective and objective information.

Diagnosis involves identifying and labeling patient problems based on the collected data.

Planning involves setting goals and creating interventions to address the identified problems.

Implementation involves carrying out the planned interventions to address patient needs.

Evaluation involves assessing the patient's progress and effectiveness of the interventions.

Subjective data are based on the patient's feelings, opinions, and experiences, while objective data are measurable and quantifiable.

Nurses prioritize care based on patient needs, the urgency of the situation, and available resources.

Methods of data collection include observation, interviews, physical assessment, and documentation review.

Validating data involves ensuring its accuracy and reliability.

Validating data involves comparing assessment findings with other healthcare professionals, medical records, and diagnostic tests.

The patient is the primary source of data because they provide firsthand information about their condition.

Interventions that address life-threatening conditions should be prioritized first, followed by interventions that provide comfort, then interventions that are easiest to perform.

The ABCDE approach prioritizes patient care by addressing airway, breathing, circulation, disability, and exposure in that order.

Factors to consider when prioritizing patient care include the urgency of the problem, future consequences, patient preference, and the nurse's workload.

The first step in prioritizing patient care is assessing the patient's condition to determine the urgency of their needs.

When multiple patients require immediate attention, nurses should prioritize based on the severity of their conditions.

Clinical judgment plays a crucial role in prioritizing nursing care by allowing nurses to make informed decisions based on evidence and patient needs.

Using a systematic approach like the ABCDE method ensures that the most critical interventions are performed first.

When unsure about a patient's priority needs, a nurse should consult with a more experienced nurse or healthcare professional.

Nursing care plans, critical pathways, and patient preferences are tools nurses use to plan care.

Nurses evaluate nursing interventions by comparing patient responses to desired outcomes, asking for feedback, reviewing records, observing actions, and monitoring vital signs and assessment findings.