What are the phases of the nursing process? (6) - ANSWER -Assessment
-Nursing Diagnosis
-Outcome identification
-Planning care
-Implementation
-Evaluation
What is Patient-Centered Care? - ANSWER Caring for the "Whole Patient"
Compassionate care that includes the patients' beliefs, values, preferences and
needs
-Include patient's support system (ex.family,hired care giver, etc)
-Centered to provide the outmost quality care
Attributes of Patient-Centered care (9) - ANSWER -Respect for patients' values,
preferences, and expressed needs
-Coordination and integration of care
-Information, communication, and education
-Physical comfort
-Emotional support and alleviation of fear and anxiety
-Involvement fo family and friends
-Transition and continuity
-Access to care
-Cultural and Spiritual self-awareness
What is the primary role of the nurse? - ANSWER To promote basic care and
comfort
What is comfort? - ANSWER Is a state of a physical well being, pleasure, and
absence of pain or stress
Risk factors for Discomfort - ANSWER Physical(Pain, Surgery, Medication reactions
Psychosocial (Stress, emotional stress, change of lifestly)
S/S of Discomfort - ANSWER -Physiological ( Pain, Dyspnea, itching)
-Emotional Stress (Physical stress cause physiological stress,emotional stress
causes physiological if unchecked, lead to chronic pain and anxiety.)
Assesment of discomfort - ANSWER -Physiological (If Pain is the source of
discomfort- Ask about pain level -describe pain
-Emotional ( If stress is the source of discomfort, ask the patient to describe feelings
and sources of emotional stress.)
, What are Maslow's hierachy of needs? - ANSWER 1. Physiological needs (Food,
Water, Rest)
2. Safety and Security needs
3. Love and Belonging Needs (Intimate Relationships, Friends)
4. Self esteem (Feeling of Accomplishment)
5. Self actualization (Achieving one's full potential)
What are the Basic Physiological Needs? (9) - ANSWER -Oxygen
-Water
-Food
-Tempernature regulation
-Elimination
-Rest
-Sex
-Physical Activity
-Blood flow (perfusion) is necessary to meet other basic needs
Which is the most appropiate nursing diagnosis for a patient who is constantly
exposed to loud noises associated with being in the intensive care unity?
1.Acute pain
2.Deliirium
3. Disturbed Sleep Pattern
4. Risk for anxiety - ANSWER 3. Disturbed Sleep Pattern is the most appropriate
because this can potentially lead to other health problems such as anxiety and
delirium
Comfort Assesment & Interventions - ANSWER Assesment (assess level of
comfort)
-Assess pain level
-Identify emotional status
-Determine the underlying cause
Interveventions to Prevent & Promote
-Maintain a proper pain level
-Address any emotional stress before it escalates
-Ensure the patient is well-rested by creating a restful environment (clean,quiet)
-Promote relaxation techniques
-Avoid caffeine,smoking, alcohol
Interventions for Maintenhance
-Identify comfort level
-Implement treatment based on the need
-Involve the interdisciplinary team(Social worker, case manager, counselor, etc.)
What role does pain Assesment play? - ANSWER Plays a role in the client's rest
and comfort needs and in the area of anxiety related to illness recovery. It's
considered the fifth (5th) vital sign.