Nursing Documentation Flashcards
1
Q
Nursing process includes what?
A
ADPIE
2
Q
What is assessment?
A
Gather information. Collect data.
3
Q
What is diagnosis?
A
Nursing diagnosis. Interpret the information given.
4
Q
What is plan?
A
Set goals for the problem. Prioritize the outcomes of care.
5
Q
What is implement?
A
Reach the goals through nursing action.
6
Q
What is evaluate of nursing process?
A
Determine the outcome of the goals. Evaluate the patient’s compliance. Modify and assess.
7
Q
Define objective data.
A
Unbiased facts. Things you can observe. Example: VS, Bleeding, vomitting.
8
Q
Define subjective data.
A
Opinions or bias. Example: pain, history, emotions.
