Intro Stuff

Question 1

Parts of Diagnostic reasoning

Answer 1

Formulating hypotheses
Gathering data
Evaluating hypotheses AND data

Question 2

Parts of the Nursing Process

Answer 2

Assessment
Diagnosis (Nursing)
Planning
Implementation
Evaluation

Question 3

Priority Levels

Answer 3

First level
- Emergent, life-threatening/immediate

Second Level
- Urgent, prompt intervention

Third Level
- Important, addressed after more urgent problems

Collaborative problems
- Treatment involves multiple disciplines

Question 4

Communication skills

Answer 4

Unconditional positive regard
Empathy
Active listening

Question 5

Comminication techniques

Answer 5

Open ended questions (Gather narrative info)

Closed ended questions
(Gather specific, factual, and short info)

Question 6

10 Traps of interviewing

Answer 6

1. Providing false assurance or false reassurance
   
   2. Giving unwanted advice
   3. Using authority
   4. Using avoidance language
   5. Engaging in distancing
   6. Overusing professional jargon or casual language
   7. Using leading or biased questions
   8. Talking too much
   9. Interrupting
   10. Using “why” questions

Question 7

LOTTAARRPP

Answer 7

Location
Onset
Type
Timing
Aggravating
Alleviating
Radiating
Related symptoms
Personal perception
Precipitating event

Question 8

Examples of biographical data

Answer 8

Name
Address and phone number
Health card / Insurance information
Age and birth date
Birthplace
Gender
Marital status
Ethnocultural background
Occupation (usual and present)
Source of information

Question 9

A-G Asssessment

Answer 9

airway, breathing, circulation, disability, exposure, further information (including family and friends) and
goals

Question 10

Skills of physical examination

Answer 10

Inspection
palpation
Percussion
auscultation

Performed one at time, in the above order (EXCEPT for the abdominal assessment).

Question 11

4 Assessment tequniques

Answer 11

Inspection, palpation, percussion, and auscultation

Question 12

What are you looking for when inspecting a patient?

Answer 12

Assess for normal physical appearance and deviations. Colour, size, location, movement, texture, symmetry, odors, and sounds in each body system.

Question 13

What is auscultation

Answer 13

Listening for various lung, heart, and bowel sounds w/ stethascope

Question 14

What is an assessment for?

Answer 14

collection of data about an individual’s health state

Question 15

Cue

Answer 15

A cue is a piece of information, sign or symptom, or lab data.

Question 16

Hypothesis

Answer 16

tentative explanation for the presence of cues, and the basis for further investigation.

Question 17

Critical Thinking is developed how?

Answer 17

Experience

Question 18

DARP Charting

Answer 18

a way of interprofessional communication carried out in the patient’s chart or electronic health record

Data
Action
Response
Plan

Question 19

Purpose of the “health history” assessment?

Answer 19

To collect subjective data

combined with objective data from a health history assessment

Question 20

pneumonic to describe an individual’s pain

Answer 20

OPQRSTUV

Onset
Provocative or Palliating
Quality of pain
Region of body
Severity
Timing of any pain medications
Understanding of pain (causation)
Values

Question 21

ADL assessment

Answer 21

assess a patient’s self-care abilities in the area of bathing, dressing, toileting, eating, and walking

Question 22

IADLs

Answer 22

Instrumental activities of daily
go a step further to assess ability for independent living, such as housekeeping, shopping, cooking, doing laundry, using the phone, managing finances, nutrition, social relationships, self-concept, coping, and home environment.

Question 23

Before entering patient space…

Answer 23

Proper handwashing practice
-PPE (Gloves, masks, gowns, and protective eyewear)
-Transmission-based precautions (aware of signage indicating necessary precautions for each patient – contact

Question 24

Inspection

Answer 24

Concentrated watching, close/careful scrutiny
Compare patient’s right and left sides (symmetrical)
Ensure adequate patient exposure

Question 25

Palpation

Answer 25

Using sense of touch can confirm points noted during the inspection
Slow and systematic
Light versus deep palpation

Question 26

Percussion

Answer 26

Tapping skin with short, sharp strokes to assess underlying structures

Question 27

Auscultation

Answer 27

Listen directly over skin
Use sense of hearing for detecting sounds produced by heart, blood vessels, lungs, and abdomen, channelled through a stethoscope

Question 28

SOAP for organizing data

Answer 28

subjective data, objective data, assessment and plan.

Question 29

DARP

Answer 29

Data - subjective or objective information that supports the stated focus or describes the patients, status at the time of a significant event or intervention
Action – Completed or planned nursing intervention based on the nurses’ assessment of the patient’s status
Response – Description of the impact of the interventions on patient outcome
Plan – Nurses’ and/or patients’ plan to follow up on care provided or next steps to be taken.

Question 30

ISBARR

Answer 30

I = identify yourself and the patient
R = repeat back for clarity

Example from textbook:
S: this is Andrea, I’m the nurse taking care of Max Goodson in 6443. His condition has changed, and his most recent vital signs show a significant drop in BP.
B: Max is 40 years old with a history of alcoholism. He was admitted through the ED last night with abdominal pain and a suspected GI bleed. His BPs have been running in the 130’s/80’s. He just produced a large amount of liquid maroon stool and reported feeling dizzy. I rechecked his vitals, and his BP is 88/50 and HR is 104.
A: I’m worried his GI bleed is getting worse.
R: Will you order stat bloodwork and place an order to transfuse red blood cells if his hemoglobin is below 80 mmol/L? Also, can you please come and assess? I think we may need to insert a nasogastric tube and do lavage.