JohnO-1610-1
Terms
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- John
- O
- Differentiate the three levels of illness prevention and apply each to clinical situations
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PRIMARY - avoid or delay illness/injury occurrence.
Ex - seat belts
SECONDARY - early detection
Ex - Pap smear
TERTIARY - rehabilitation; goal is to return to best possible function and prevent severe disabilities. - Sensory-Security =
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This is the sum of the processes utilized to attain and maintain optimal health in adapting to the changing environment.
- What are the eight core components of the nursing program?
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1- Professional Behaviors
2- Communication
3- Assessment
4- Clinical Decision Making
5- Caring Interventions
6- Teaching and Learning
7- Collaboration
8- Managing Care - Self-Concept =
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the sum of the processes by which the individual maintains physical, personal, and interpersonal self in relation to the environment.
- List the Steps of the EVALUATION stage
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1 - Determine goal/outcome
2 - Assess pt. for that expected behavior
3 - Compare goal with exact pt. response
4 - Judge degree to which the goal has been reached -
Oxygenation-Circulation =
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sum of the processes by which oxygen is delivered to, utilized by and removed from the body cells. It enables body function and is affected by environmental factors.
- Define Values
- Concepts, ideas, behaviors, and significant themes that give meaning to a person's life.
- Nutrition-Metabolic =
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This is the sum of the processes through which requirements for growth are supplied, utilized and eliminated to maintain the internal environment.
- List three things to do after the Nursing Dx
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* Goals need to be set
* Nurse and patient set goals
* Include patient - Health State of Individual (Page 4, Figure 1-3). Areas to consider...
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Genetic
Cognitive
Age
Sex
Environment/Lifestyle
Geographic Location
Culture
Religion
Standard of Living
Health Belief/Practices
Previous Health Experience
Support Systems (formal and informal)
- What is the most effective medical aseptic practice?
- HANDWASHING
- Define Morals
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standards of rights and wrongs that are often based on religious belief.
- List the three Degrees of Attainment
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1 - Met
2 - Partially met
3 - Not met - What is an advance directive?
- written document that allows the patient to make legal decisions about treatment
- List five steps of the IMPLEMENTATION process?
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1 - Reassess the patient
2 - Review and revise care plan
3 - Organize (equipment/personnel)
4 - Prepare (environment/patient and family)
5 - Anticipate and prevent complications - False Imprisonment
- Pertinently, holding someone against thier will
- Questions to consider during the PLANNING stage
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1 - What problems need immediate attention?
2 - What problems have simple solutions?
3 - What problems must be referred?
4 - What problems must be recorded on the POC? - Define Gross Negligence
- intentional failure to perform a duty in reckless disregard of consequences to the patient.
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What is a "Standing Order"?
What is "Protocol"? -
Standing Order - dictates a situation and prescribes a standardized intervention.
Protocol - a written plan specifying the procedures to be followed during an assessment or when providing treatment for a specific condition. - Define Laws
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rules of conduct that protect the social (society) fabric.
- Objective data are obvious, measurable; can be seen, heard, and manipulated. By contrast SUBJECTIVE data tends to be more _________, __________, or ____________.
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Subtle
Covered
Hidden - Define Criminal Negligence
- Flagrant and reckless disregard for the safety of others and/or disregard to possible injury.
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The 5 assesments
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1.communication skills
2.observation skills
3.assesment skills- BP, T,R,P, AUSCULTION,PALPATION
4.knowing cues vs inference
5.validate impressions
- What are three components of the Nursing Assessment?
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1 - Data collection
2 - Data validation
3 - Data documentation
"If you didn't chart it, you didn't do it." - List 5 roles of the nurse.
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Provider
Teacher
Manager
Member of Profession
Advocate - Nursing Dx vs. Doctor Dx
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Doctor Dx -
1 - Identifies disease
2 - Treatment of disease
3 - Cure of disease
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1 - Nurse states patient's actual or potential response to disease/disorder
2 - Develop plan of care to adapt to changes from health problems - During PLANNING the nurse does what?
- Sets goals; considers desired outcome and identifies appropriate nursing actions
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During ASSESSMENT one
____________ patient _________. -
Identifies
Problems -
"The nursing process is..."
(three things) -
Systematic
Organized
Comprehensive (thorough, ongoing, plans may change to adapt to changing needs) - What occurs during the INTERVENTION/IMPLEMENTATION stage of the Nursing Process?
- Perform the identified nursing actions.
- Purpose of 5 step nursing process.
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1 - Establish patient's BASE data
2 - Identify patient's health care needs
3 - Determine priorities of care, goals and expected outcomes
4 - Establishing a nursing care plan - During the EVALUATION stage what happens?
- Determine if the goals has been met and if anticipated outcomes have been achieved.
- List 4 aspects of critical thinking
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Active
Organized
Cognitive
Process - Planning includes (6)
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1-Goal Setting/Patient priorities
2-Selecting interventions to achieve patient goals
3-Documenting care plan
4-Consultation with healthcare team
5-Modification of care
6-Recording info about the patient - (During) ASSESSMENT (we evaluate what?)
- Evaluate patient's condition
- OBJECTIVE data is informatin that is __________ and ___________.
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Measurable
Observable - During DIAGNOSE we IDENTIFY what?
- Patient's problem
- Define "Optimal Health"
- the best level of attainable well-being for a given individual.
- Nursing Diagnosis/Problem Diagnostic Statement
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1 - Problem
2 - Etiology
Think Maslow when Prioritizing...
1 - Look for most life threatening
2 - Then problems that interfere normal function/quality of life
3 - Then patient preferences - Three characteristics of the Nursing Dx...
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1 - Clear picture of patient problems
2 - Patient response to illness
3 - Distinguishes nurses role vs. doctor's role - What is "Holistic Health"?
- Health approach that considers the body, mind, and spirit to be interrelated.
- List three types of nursing orders (interventions)
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1-Interdependent = carried out by nurse in collaboration with another healthcare professional (protocol)
2-Dependent = Based on written order of another professional
3-Independent = You are able to perform as covered by licensure and law - Four advantages of Nursing Dx
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1-Efficient care
2 - Actions within standards of nursing practice
3 - Individualized patient care
4 - Goal directed care - Nursing Dx
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- Acutal Nursing Diagnosis
* Three Part Statement
* Contains P E S
* Uses
- Risk Nursing Diagnosis
* Two part
* contains P E
* Uses - Define "illness"
- A separation from health.
- List limitations of Nursing Dx (2)
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1 - May become "wordy"
2 - May label patient incorrectly - Interventions must be related to the nursing ______?
- Goal
- Patient Goals and Outcome Criteria
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- are long or short term
- have measurable verbs
- must be specific in content and time
- must be attainable/realistic
- are the "P"
- Include behavior, criteria, time, and condition -
Define "Health"
- Condition that allows for the pursuit and enjoyment of desired cultural values; absence of symptoms; level of wellness; not merely the absence of disease or infirmity.
- List the component parts of the three, two, and one part Diagnostic Statement.
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P E S
P E
P - State the Diagnostic Statement formula
- P r/t E aeb S/S