solutions 2024/2025
nursing process - ANSWER✓✓-is a systematic, rational method of
planning and providing nursing care.
nursing process - ANSWER✓✓-Its purpose is to identify a client's
health-care status and actual or potential health problems, to
establish plans to meet the identified needs, and to deliver specific
nursing interventions to address those needs.
nursing process - ANSWER✓✓-is cyclical; that is, its components
follow a logical sequence, but more than one component can be
involved at one time.
At the end of the first cycle - ANSWER✓✓-care may be terminated if
goals are achieved, or the cycle may continue with reassessment, or
the plan of care may be modified.
ASSESSING - ANSWER✓✓-✓ Collectdata✓ Organizedata ✓
Validatedata ✓ Documentdata
DIAGNOSING - ANSWER✓✓-✓ Analyzedata
✓ Identify health problems,
risks, and strengths
✓ Formulate diagnostic
statements
PLANNING - ANSWER✓✓-✓ Prioritize problems and diagnose
✓ Formulate goals and designed health outcome
✓ Selectnursingintervention
,✓ Writenursinginterventions
IMPLEMENTING - ANSWER✓✓-✓ Reassesstheclient
✓ Determine the nurse's need
for assistance
✓ Implement the nursing
interventions
✓ Supervisedelegatedcare
✓ Documentnursingactivities
EVALUATING - ANSWER✓✓-✓ Collect data related to outcome
✓ Complete data with outcomes
✓ Relate nursing actions to client goals / outcomes
✓ Draw conclusions about
problem status
✓ Continue, modify, or
terminate the client's care plan
Assessment - ANSWER✓✓-is the systematic and continuous
collection, organization, validation, and documentation of data
Assessment - PURPOSE - ANSWER✓✓-To establish a database about
the client's response to health concerns or illness and the ability to
manage health care needs
Database - ANSWER✓✓-is all the information about a client; it
includes the nursing health history, physical assessment, the
physician's history and physical examination, results of laboratory
and diagnostic tests, and material contributed by other health
personnel
ACTIVITIES - ANSWER✓✓-1. Establish a database
-Obtain a nursing health history
-Conduct a physical assessment
- Review client records
2. Nursing health history
3. Physical assessment
4. Client records
5. Nursing literature
6. Support persons
, 7. Health professionals
8. Update data as needed
9. Organize data
10. Validate data
11. Communicate / document data
a. Review nursing literature
b. Consult support persons
c. Consult health professionals
CRITICAL-THINKING ACTIVITIES - ANSWER✓✓-1. Making reliable
observation2. Distinguishing validate data from irrelevant data 3.
Distinguishing important from unimportant data 4. Validating data5.
Organizing data6. Categorizing data according to a framework7.
Recognizing assumption
Initial - ANSWER✓✓-Time performed: performed within specified
time
Initial - ANSWER✓✓-Purpose: establish a complete database
Initial - ANSWER✓✓-Example: nursing assessment admission
Problem-focused - ANSWER✓✓-Time performed: ongoing process
Problem-focused - ANSWER✓✓-Purpose: determine the status of a
specific problem intake and identified in an earlier assessment
Problem-focused - ANSWER✓✓-Example: hourly assessment of
client's fluid intake and urinary output earlier in an ICU
Emergency (triage) - ANSWER✓✓-Time performed: physiologic or
psychologic crisis if client
Emergency (triage) - ANSWER✓✓-Purpose: identify life-threatening
problems
Emergency (triage) - ANSWER✓✓-Example: rapid assessment of
airway, breathing status & circulation during a cardiac arrest