NUR 310 FINAL Exam Study Guide Complete

NUR 310 FINAL Exam Study Guide Complete Critical Thinking, Clinical Reasoning, and the Nursing Process 1. Define the concept of critical thinking, clinical reasoning, and the nursing process • Critical thinking: An intentional higher-level reasoning process that is intellectually delineated by ones worldview, knowledge, and experience with skills, attitudes, and standards as a guide for rational judgment and action • Clinical Reasoning: Mental process analyzing all the elements of a clinical situation and making a decision based on that analysis; way of thinking • Nursing process: The traditional critical thinking competency that allows nurses to make clinical judgments (thinking strategies) and take actions based on reason; It is a cognitive process that uses thinking strategies; It is a systematic method of planning and providing care to clients 2. Discuss the attitudes and skills needed to develop critical thinking and clinical reasoning • Critical analysis: Application of a set of questions to a particular situation to discard unimportant ideas • Socratic questioning: Technique to search for inconsistencies, examine multiple points of view, separate the known from beliefs • Inductive reasoning: Builds from specific ideas or actions to make conclusions about a general idea • Deductive reasoning: Looking at a general idea as a whole and then considering more specific actions or ideas 3. Describe the phases of the nursing process and how they interrelate • ADPIE ⟶ Key points: systematic, collaborative, client-centered, outcome oriented, individualized, cyclic, dynamic, requires critical thinking, universally applicable ⟶ Purpose: identify client’s health status and actual or potential health care problems or needs, establish plans to meet needs, deliver specific interventions 4. Identify the purpose of each phase of the nursing process • Assessment: collect data, organize data, validate data, document data ⟶ Communication: determine impairments or barriers; verbal vs. nonverbal • Diagnosis: analyze data, identify health problems/risks/strengths, formulate diagnostic statements • Planning: prioritize problems, formulate goals/desired outcomes, select nursing interventions, write nursing interventions • Implementation: reassessing the client, determining the nurse’s need for assistance, implementing the nursing interventions, supervising the delegated care, documenting nursing activities • Evaluation: collecting data related to desired outcomes, comparing data with desired outcomes, relating nursing activities to outcomes, drawing conclusions about problem status, continuing/modifying/terminating nursing care plan 5. Identify the four major activities associated with the assessing phase • Collecting data: gathering information about a client’s health status • Validating data: verifying data to make sure it is accurate and factual • Organizing data: categorizing data systematically using a specified format • Documentation: accurately and factually recording and reporting data 6. Differentiate objective and subjective data and primary and secondary data • Objective data: signs; detectible by an observer, can be measured or tested against an acceptable standard, obtained through observation or physical examination • Subjective data: symptoms; apparent to and can be described only by the person affected; includes sensations, feelings, values, beliefs, attitudes, and perception of personal health status and life situations • Primary data: information from the client; objective or subjective • Secondary data: information from family, friends, or the health team about the client 7. Identify three methods of data collection and give examples of how each is useful • Observing • Interviewing • Examining 8. Differentiate various types of nursing diagnoses and how they differ from medical diagnoses • Actual Nursing diagnosis/problem: problem exists & is present at time of nursing assessment; based on presence of associated signs and symptoms • Risk Nursing diagnosis/problem: Problem does not exist; potential problem based on presence of risk factors that is likely to develop unless nurse intervenes • Possible Nursing diagnosis/problem: Evidence is incomplete or unclear; insufficient data to support or refute problem or etiology • Wellness or Health Nursing diagnosis/problem: Desire to attain a higher level of wellness; a readiness for enhancement 9. Identify the basic steps in the diagnostic process • Interpreting & analyzing data: comparing data with standards, clustering of clues • Determining client’s strengths, risks, and problems: resources and abilities to cope, problems that support tentative, actual, possible diagnosis • Formulating nursing diagnoses/problems: problem, etiology, joined by the words, “related to” 10. Identify activities that occur in the planning process • Individualize care that maximizes outcome achievement • Set priorities • Facilitate communication among nursing personnel and colleagues • Promote continuity of high-quality, cost-effective care • Coordinate care • Evaluate patient response to nursing care • Create a record used for evaluation, research, reimbursement, and legal reasons • Promote nurse’s professional development 11. Identify factors that the nurse must consider when setting priorities • Urgency of the health problem ⟶ High priority: airway, breathing, circulation ⟶ Medium priority: health threatening ⟶ Low priority: developmental needs, not specifically related to a current health problem • Maslow’s Hierarchy of Human Needs • Patient preference • Anticipation of future problems 12. Identify guidelines for writing goals/desired outcomes • Action, condition, and time element 13. Describe the process of selecting and choosing nursing interventions • SMART ⟶ Specific ⟶ Measurable ⟶ Attainable ⟶ Realistic ⟶ Time-oriented • Six factors: ⟶ Characteristics of nursing diagnosis ⟶ Goals and expected outcomes ⟶ Evidence base for interventions ⟶ Feasibility of the intervention ⟶ Acceptability to the patient 14. Discuss the five activities of the implementing phase ⟶ Nurse’s competency and knowledge • Reassessing the client: is the intervention still needed or a different set needed? • Determining the nurses need for assistance: inability to implement the nursing activity safely, assistance will reduce stress on the client, nurse lacks knowledge or skills to implement a particular nursing activity • Perform the interventions: base actions on scientific knowledge, holistic, client participation, clearly understands interventions, adapt activities to individual client, respect dignity, implement safe care, provide teaching/support/comfort 15. Describe five components of the evaluation process • Collaboration • Judge whether goals/outcomes were achieved ⟶ Collecting data, re-assessment • Compare data with outcomes ⟶ Actual client response ⟶ Was goal met, partially met, not met? • Relate actions to outcomes ⟶ Do the nursing activities have any relation to the outcomes? • Decision about the problem status ⟶ Were problems reduced/prevented, resolved, or does problem still exist? • Review, re-evaluate, modify, terminate, document 16. List the measures used to maintain the confidentiality and security of protected health information • Displaying information on a public screen • Sending confidential e-mail messages via public networks • Sharing printers among units with differing functions • Discarding copies of patient information in trash cans •Holding conversations that can be overheard • Faxing confidential information to unauthorized persons •Sending confidential messages overheard on pagers 17. Discuss guidelines for effective recording that meets legal and ethical standards • Completeness: include care that is omitted because of client’s condition, refusal • Appropriateness: record only information that pertains to the client’s health and care; end each thought or sentence with a period • Conciseness: no extra details, client’s name omitted • Legal prudence: usually viewed by juries and attorneys in court as a legal document; altering a chart is a criminal offense; don’t chart what someone else heard, felt, said, or smelled unless the information is critical • Confidentiality 18. Compare and contrast different documentation methods • Source-oriented Problem-oriented medical records PIE • Focus charting • Charting by exception • Computerized records: HER • The case management model 19. Discuss appropriate documentation of findings in the medical record • “ate all of breakfast” NO • Coffee 240 mL, 1 Egg, & 1 Slice of Toast YES • "bed soaked” NO • Bed wet from bladder incontinence YES • a large amount of blood” NO • Profuse bleeding from abdominal wound YES Communication: 1. Define and describe the components of the communication process • Channel: visual, auditory, kinesthetic • Message: verbal, nonverbal • Source: encoder • Receiver: decoder • Feedback 2. Describe factors influencing the communication process • Development: it is helpful to understand the process of language development and the stages of intellectual and psychosocial development; this helps you communicate effectively with patients and family of all age ranges • Gender: men and women often have differing communication styles and may give different interpretations to the same conversation • Values and perceptions: Communication is influenced by the way people value themselves, one another, and the purpose of any human interaction 3. State why communication is important among health professionals • Promotes understanding and establishes constructive relationships 4. Compare and contrast therapeutic techniques that facilitate communication and focus on client concerns • Silence: sitting quietly, waiting until client can pull thoughts together • Providing leads: “Would you link to talk about...?” “And then what?” • Open-ended questions: who, what, when, where, why • Clarifying: restating, reflecting, paraphrasing, exploring • Offering self: “I will stay with you until your daughter arrives” • Sequencing: “Tell me about what happened first” • Direct: “Rate your pain on a scale of zero to ten” 5. Describe how each type of ineffective communication hinders communication • Asking irrelevant questions • Stereotyping • False reassurance • Changing the topic • Challenging • Being defensive • Arguing 6. Describe the three phases of the helping relationship • Offering personal opinions • Giving advice • Minimizing feelings • Asking why questions • Asking questions excessively (probing) • Judging • Cliches • Orientation: the tone and guidelines are established; agreement or contract is made • Working: the nurse works together with the patient to meet the patient’s physical and psychosocial needs; nurse helps to perform ADL’s • Termination: conclusion of initial agreement is acknowledged (patient discharge) 7. Describe the following disruptive behaviors and how they affect the health care environment and client safety • Incivility: rude dialogue or actions (sarcasm, eye-rolling) • Lateral Violence: abusive words or actions of peers (gossiping, exclusion of information, threats of harm, actual harm) • Bullying: offensive, abusive, intimidating, insulting behavior or abuse of power 8. Differentiate the major characteristics of assertive and non-assertive communication • Assertive communication: promotes client safety by minimizing miscommunication with colleagues; honest, direct, and appropriate; open to ideas; respects rights of others • Non-assertive communication: passive communication; allowing one’s own rights to be violated by others; meeting the demands and requests of others without regard to own feelings and needs ⟶ Aggressive communication: can be blaming and delivered in a rushed manner 9. Describe and apply standardized communication techniques • SBAR ⟶ Situation ⟶ Background ⟶ Assessment ⟶ Recommendation • Closed loop: Sender initiates message - receiver accepts message, provides feedback confirmation - sender verifies message was received (repeat) • Handoff: the transfer of information (along with authority and responsibility) during transitions in care ⟶ Shift changes ⟶ Client transfers ⟶ Transfer of responsibility between and among nursing assistants, nurses, NP’s, and physicians Safety: 1. Discuss factors that affect people’s ability to protect themselves from injury across the lifespan • Lifestyle • Social behavior • Environment • Mobility • Sensory perception • Knowledge • Ability to communicate • Physical and psychosocial health state 2. Identify common safety risks and their potential impact on client and the healthcare setting • Falls: most common cause of traumatic brain injury (TBI) 3. Describe health-teaching interventions to promote safety at each developmental stage • Infants: educate parents on safety risks and interventions • Toddlers: fall risk assessment and parent education • Children: reduce high-risk behavior, attentive adult supervision • Adolescents: drugs, alcohol, or sexual activity education • Older adults: fall assessment, cognitive performance evaluation 4. Plan strategies to maintain safety in the home and healthcare setting across the lifespan • Falls ⟶ Keep stairways clear and uncluttered ⟶ Keep stairways and walkways well-lit ⟶ Apply non-slip adhesive strips to bottom surface of tub or shower ⟶ Eliminate scatter rugs or ensure rugs are secure ⟶ Use handheld device when reaching for inaccessible items 5. Discuss the use and legal implications of restraints • Restraints used with invalid, incomplete orders are considered “False imprisonment” • Never applied for staff convenience or as a client punishment 6. Discuss implementation of seizure precautions • Oxygen tubing, apparatus, and suction available • 2-3 side rails up and padded • Loosened clothing • Privacy provided • Harmful objects and clutter out of the way 7. Discuss the National Patient Safety Goals (NPSGs) • Patient identification • Improve communication • Medication safety • Clinical alarm safety • Health care associated infections • Patient in side-lying position • Bed in lowest position • Reduce falls • Pressure ulcers • Protocol to prevent wrong site, wrong procedure, wrong person surgery Infection Control & Asepsis: 1. Explain the chain of infection • Infectious agent • Reservoir: natural habitat for the microorganism • Portal of exit/entry • Means of transmission ⟶ Contact transmission: direct, vector (living creature), fomite (inanimate object) ⟶ Droplet transmission: sneezing, coughing, talking ⟶ Airborne transmission: sneezing, coughing • Portals of entry • Susceptible host 2. List the stages of an infection • Incubation period: interval between the pathogen’s invasion and the appearance of symptoms • Prodromal stage: most dangerous stage; vague, nonspecific symptoms; patient unaware of being contagious, infection spreads • Full stage: presence of infection-specific signs and symptoms; localized or systemic • Convalescent period: return to healthy state; recovery 3. Identify individuals at risk of developing infections • Compromised host: individual more likely than others to acquire an infection ⟶ Variables: age, clients receiving immunosuppression treatment, clients with immune deficiency conditions ⟶ Factors: skin integrity, integrity and number of WBC’s, age, sex, race, heredity, immunizations, level of fatigue, nutritional and general health status, stress level, use of invasive or indwelling devices • Etiology: number of microorganisms present, virulence and potency, ability to enter the body, susceptibility of the host, abili