Nursing Process & Critical Thinking PDF

If a patient's condition worsens, what must the nurse do? Call the doctor. By calling the doctor you were doing what? notifying of a change in condition.. You're taking immediate action by calling the doctor right away. If you are applying the nursing process, um, you are using what? Exactly. So, n...

If a patient's condition worsens, what must the nurse do? Call the doctor. By calling the doctor you were doing what? notifying of a change in condition.. You're taking immediate action by calling the doctor right away. If you are applying the nursing process, um, you are using what? Exactly. So, nurse is using nursing process to apply critical thinking. When you are talking to a patient about their pain and you've assessed all of their pain, what's an important question to ask if they've had this pain before? worse? new?. What helped before? What has helped you in the past for this? Interpretation when we are doing our data collection, we want to be orderly in collecting data. as students, you will not be super organized in your data collection. But when you start practicing your head to toe, um you will get a systematic approach to your assessment. um and that will help you be orderly and um collecting your data. We also will be fine reasoning while looking for patterns to emerge when we are organizing our data. How do we organize our data or what is one way that we can organize that data? If we've gone in and assessed our data and we have a cough and we have low oxygen sats and they're on two liters of nasal cannulas and then we have information about their pain here. concept mapping. gathering data and clarifying using that concept map. When we are collecting and gathering our data, how do we organize it? We organize it one way: concept mapping. If you have a patient that um you just reviewed the record before you go in and see them, um, you see that they have a very low heart rate of um 42 beats per minute. Um, you go in and assess them, they're not in any distress. They have no shortness of breath. They're walking around their room just fine. What might be an action that you do for that patient? recheck their vitals, absolutely. What's another thing you could do as well before you recheck the pulse? Ask what? You could ask them if they're a good source. Check the other side, look at their flow sheet. Yeah, those are two great ways if they're with it and yeah, um and if not, then certainly you wanna check it. A lot of times you're doing that while you're checking their pulse again. Inference, what does inference mean if I'm looking at my assessment and I have a lot of data that kind of points me in one direction. I might make an inference that the patient has a problem with this. So, for example, if the patient is asking me a lot of questions and they're talking very fast and um they seem very anxious. um their pulse is high. I might make an inference that they're anxious, they have baseline anxiety or they're anxious about being here in the hospital or they're anxious about what's gonna happen. So I need to research that a little bit more, yes. I might infer that they have anxiety, but again, I wanna know why. Interpretation is the nurse using critical thinking with orderly data collection, finding patterns and categorizing and clarifying any uncertain data. When we are making critical decisions and clinical decisions for our patient and we're using deductive reasoning and maybe making inferences, what do we have to have to look at before we can do all of that? Flowsheet or it's also called the database of the patient database. We have to have that database that specific knowledge base to take that information from. Levels of critical thinking are basic when we are answering problems that are perceived as either right or wrong, a single solution usually resolves the problem. Early step in critical thinking for basic complexes, you're making more decisions independently. You're having to use creativity. um you're generating many ideas., you're thinking, abilities are beyond the expert opinion. You're looking at alternative solutions and considering different options in the complex. Components of critical thinking, judgment model, you should note those six components. 6 components: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. — This essentially represents a progression from initial observation to decision-making and evaluation of results. Assessment, Diagnosis, Planning, Implementation, Evaluation. Knowledge base is first needed for making clinical decisions using critical thinking. Responsibility and authority, we have to use that as nurses, so if you are um put on a new unit and you've never been there before. How can you act as a responsible nurse? ask questions, ask for an orientation to that unit. If you don't know how to do a procedure and the doctors just ordered you to do this procedure. What is your responsibility to do? Research it and we research that where, In the policy and procedure. Discipline is something that we need to best develop critical thinking. Do we have to practice discipline? Uh, reflection utilizes critical thinking when thinking back on the effectiveness of the interventions. Did it work? Did it not work? Why did it work? Why did it not work? On set maps help us synthesize or organize our relevant data. And it also helps us identify relationships between nursing diagnoses and synthesized data. When we are exchanging information either through a verbal report or electronic or written report, we have to document legally and confidentially only what is relevant to the patient's health care. Do I care that Mary has a boyfriend and a husband? I do if it means that I need to find out who is going to do the care of her um moveback changes when she gets home. It's only if it is going to relate to their nursing care somehow. or their care. If a nurse uses a previous shift assessment to plan, what action should happen? say your coworker is planning their care for their patient, but they used the night shifts assessment to plan. What should happen? If you're seeing it, you should go to who? Your supervisor and then the supervisor would step in. It would be appropriate for the supervisor to step in if they're utilizing a previous shifts assessment, because again, that's not up to date and it is not their assessment. During the assessment phase, which is the first phase of the nursing process, you collect data to complete a thorough draft. Go deeper. That baseline or we call that the database. Is the patient database. When a patient is hard of hearing and you go in to do an interview, what's one thing that you should do for the patient?. What are you gonna eliminate? Extra noises in the background. Shut the door, turn down the television next door. or their television. What are periodic assessments? Done every time. Periodic assessment, we're gonna do on like a routine type of assessment. They say I'm coming in to start my shift. I'm gonna start my assessment. But is my assessment gonna be ongoing every time I see my patient? Yes, so that would be a periodic assessment. Checking you with them every time we have contact. specific issue to it can be or or when we're going in, if we see that geez, they have some glue around their lips. And when I assess them before my first head to toe assessment, they had great pink mucus membranes, they had no blue tinge on their lips. I'm seeing a change, so I'm gonna now do a focus assessment based off of that. When we're assessing our patient, we're gonna be getting a health history and a physical examination. when we assess our patients. know what the acronym, ADPI is. A is assessment, D is diagnosis, P is planning, I is intervention and evaluation of how our implementation works. Do you know what subjective data is? It's what the patient says. When we are getting subjective data, what's one important piece of subjective data that we want to get from them? First thing we're gonna ask them after that, What are your expectations? Interview preparation will be reviewing the medical record for that. Um, maybe previous nurses notes or medical entries. If we're doing a focused assessment, we might do a quicker preparation for that. So we might only look at those sections that are affected by what they're calling out for as a problem. For problems specific approaches, we're focusing on that patient's current complaint of a problem or presenting situation instead of a complete full database, head to toe type assessment. What is objective data? what we measure what we see, what we hear. absolutely. What are leading questions? What do you think caused your tiredness? Were you doing anything that created this pain? Have them give you more of the story in those leading questions. If somebody isn't giving you good eye contact when you're talking with them, what could that be a cause of? A cultural issue. So again, confirming that, um what's another thing that when we are going through and asking patients' expectations, we also want to include not just their culture, but their spirituality, yes. And again, the easiest way to do that is do you have any spiritual things you want me to include in your care? When assessing pain, um what do you do if the patient states they have no pain, but their body says otherwise? What kind of questions might you ask them? close ended. Like what? So, like, if they're doing this and they ask them, are you having any pain and they say no. I see that Why are you holding your stomach? Why are you like that hunkered down?. So that will elicit more information, yes. What are nurses mandated to do? report. Report what? What type of abuse? maltreatment, child abuse. and endangerment, neglect, absolutely. If a minor wants to be an organ donor, what must happen in order for that to happen? consent from whoever is their guardian, legal person, parent. If a patient wishes to be a DNR, what must occur first before we don't give them CPR. You need to have a documented medical order from a physician stating your desire to not receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. You will need an order from your physician, as well as an advance directive. ​ ​ Patient consent: You must actively choose to have a DNR and understand its implications. ​  ​ Medical evaluation: A doctor will assess your health condition to determine if a DNR is appropriate. ​ ​ Legal documentation: The DNR order must be filled out on a standardized form and signed by your doctor. ​ ​ State variations: Specific requirements for a DNR order may vary depending on your location. ​ ​ Communication: Inform your family, other healthcare providers, and emergency responders about your DNR status. What would be an exception to a DNR order? Surgery, a lot of consents will say you are will code for this process. When we have licensure, so you as nurses are going to become licensed to practice as nurses, what does that do? Protect who? It protects the public, the patient. Good Samaritan laws, they do what? Protects individuals who voluntarily help someone in an emergency situation from being sued for unintentional harm, essentially encouraging people to assist others in need without fearing legal repercussions, as long as they act reasonably and in good faith; this means they can provide aid without expecting compensation and within the scope of their training. What does malpractice insurance do for us? If we get sued and we need legal representation for that. It doesn't protect us from doing wrongful things if we are a nurse and we are at a scene of an accident and we take somebody. We're still gonna be liable for acting, out of our scope of practice. Um, but at least with malpractice insurance, we have somebody to litigate it and try to prove what great things we did do. it does protect you in the event that you are doing everything you're supposed to be doing. What is slander? defamation? Slander in nursing is the act of making false or negative statements about a person or entity in a spoken manner. Slander is a type of defamation of character, which is when someone's reputation is harmed by false statements. What is liability? refers to the legal responsibility a nurse has to provide proper care to a patient, and if they fail to meet the standard of care and cause harm, they can be held legally accountable for any resulting injuries, essentially meaning they can be sued for negligence if their actions lead to patient harm; this includes situations like administering incorrect medication, failing to monitor a patient adequately, or not reporting critical changes in condition Malpractice lawsuit, it is typically required that the nurse had a duty of care, um in other words, they're following their nurse practice acts, following their regulations. If that duty was breached and physical harm occurred, then they are liable. Otherwise they're not. liable for malpractice. Malpractice would be if that duty was breached. They didn't follow those standards. When the doctor is having the patient sign informed consent, what must they do? Explain the So they're gonna go through and explain the whole consent, make sure that they understand what's gonna happen. Make sure that they understand everything that we just went over. It is the physician's responsibility to make sure that the patient understands the benefits in the risks of the procedure and the entire informed consent before they sign the consent. What are we not going to leave when we are hand documenting? spaces if somebody could write in there. So I just crossed it out, wrote error. Know what appropriate documentation is versus inappropriate. Auditing health records show us what If we audit records, we're gonna see if standards were met or not. Um, if they weren't met, it gives us an area for quality improvement. When we audit, we're determining, again, if those standards of care have been mapped. The term electronic health record (EHR) looks at what? from the beginning, the lineage of their health care. If we are looking at their electronic medical record (EMR), that is for the visit, one visit. Where would we find labs? In a flowsheet or results review tab. Vital signs would be in a flow. The nurse's notes, if there isn't a nurse's notes tab, a progress note tab. When we're giving verbal report, um, what should that report reflect? The same as what's in the chart. When a nurse is doing quality review, it is their job to audit medical records, to ensure what. standard documentation is done complete and accurately. When you are doing telephone orders or verbal orders, immediately write down the order verbatim, read it back to the prescriber for confirmation, document the date and time, and ensure the order is signed by the prescriber as soon as possible. Before using restraints, we first have to try everything else, and get an order.