TEST IV NURSING PLANNING
Terms
undefined, object
copy deck
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what are the 4 components to the nursing process.
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establish diagnosis
develope outcome goals
plan interventions
document the nursing plan of care - the deal here is the establishing of priorities. in the real world, the pt might have 20 problems, so we ...
- try and come up with a plan to fix some of the major problmens
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we would use to establish priorities:
physiologicial importance
rank needs w/ pt and family
what else? -
use maslov's hiearchy of needs
basic needs safety, love, etc - goals have to be written well and are MEASURABLE.. if goals are well written, then...
- the evaluaion goes well too, but if its vague, you can't tell if you had met your goals.
- 3 things to remember writing goals:
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patient centered/driven
time frame
measurable
specific
short term: hous,days
lo
ng term: weeks, days after discharge -
Goals must be:
observable
singular
realistic for patient and nurse
what else? -
measurable: can tell when it has happened
reflects highest level of wellness - Clear, specific goals include:
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the subject
Action verb
condition
criteria
time lapse -
the VERB:
is an action verb
is measurable
what words do you not use? -
normal
acceptable
sufficient
adequate
improved
the verb must be objective -
The next part of defining the goal is the condition. say things like:
under what condition
provide clarity
condition with which the activiity must be performed
what else is ex of condition -
with use of walker
using diet plan left by dietican
not essential, but does help clarify -
the next part of the goal concept is CRITERIA
examples are:
time limit or time line
amount of activity
description of performance
how well it is to be done
examples? -
ambulate 10 feet
list 3 signs of infection - Criteria is the next part of the specified goal,after condition. what is criteria about?
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time limit or time line
amt of activity
description or performance
how well it is to be done
EX: ambulate 10 feet
list 3 signs of infection -
then the goal has to have a time line:
"by the end of the shift"
"by discharge"
lets look at this: -
subject = the patient
verb = will walk
condition = with use of cane
criteria = to the door and back to bed
time frame = by friday 11/01/06 -
here's something Karla read outloud
"the patient will know the 4 basic food groups by the end of the shift" is this good? -
How about this one
"Mr Brown will feel less pain by the end of the shift" -
3 domains for goals
cognitive
phychomotor
affective. which 2 will we be writting in ? -
congnitive and phychomotor
Psychomotor deals w/ developing motor skills
"will demonstrate"
"will correctly perform"
"will ambulate"
"will draw up medication" - what does affective domain have to do with?
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associated w/ changes in attitudes, feelings, or values
REAL hard to measure!
Novices shouldn't go here! - so b/c associative is difficult to measure, we will stick to cognitive and psycomotor domains. what are examples again of cognitive and phschomotor goals?
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"will explain"
"will state, will identify"
psychomotor is like
"will demonstrate"
"will perform"
"will ambulate" -
How about some AFFECTIVE domain words!!!
express
share
listen
communicate
relate. what is it hard for these words to do? - to measure
- "Pt will list risk factors for heart disease? good or bad? i think she said bad. flip has it better
- the pt. will list 4 risk factors for heart disease by friday
- how about "the patient will be turned every 2 hours. like it?
- how about "the pt will identify 4 signs of infection by discharge" Its good!
- "the patient will know 4 sources of protein by the end of the shift" better way?
- "the pt will list or identify 4 sources of protein by the end of the shift"
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stay away from vague verbs!
"knowledge deficit (disease process) r/t lack of exposure to information m/b questions about diabetes. better? -
Goal:
"the pt. will understand the disease process of diabetes by Friday 11/03/05. the original goal was too big, so make it more specific -
what about these goals:
risk for fluid volume deficit r/t NG tube. NPO status m/b NA
goal: client will maintain fluid vol. at a functional level as evidenced b adequate output (39 ml/hr)look at flip -
write a nursing diagnosis and a goal.
ND anxiety r/t long hospital stay m/b diarrhea and incontience
Goal: pt will learn about importance of fluid intake and his disease condition - So, as review, after defining the goal, we come up with the interventions. what is an intervention?
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actions done by the nurse to achieve the goals:
ASK:
will it be effective?
is it realistic for the pt?
is it realistic for the nurse? -
Interventions:
are nurse driven, detailed, should tell WHAT WHEN HOW
rank in order of importance
what else? -
detailed
should tell what when how
rank order of importance
which must be done first
involve the patient -
Independent:
a nurse can do w/out consultation or collaboration or orders! that is indepedent. an ex follows: - EX: input and output or teaching or checking a blood gas
- whats an example of interdependent intervention?
- nurse collaborates w/ other disicplines
- what is a dependent intervention?
- requires order from another health care provider
- action/interventions must be detailed so a float nurse or new nurse can follow up on the intervention and knows what the plan is. expand this
- any nurse should be able to read and plan and follow it, the nursing intervention