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Diagnostic Reasoning

process of analyzing heath data and drawing conclusions to identify diagnoses.

1) attend to initial cues
2) formulate diagnostic hypothesis
3) gather data relative to tentative hypothesis
4) evaluate each hypothesis with new data collected -- > arriving at final diagnosis


Nursing process

1) assessment
2) diagnosis
3) outcome identification
4) planning
5) implementation
6) evaluation



Collect Data: review clinical record, health history, physical exam, functional assessment, risk assessment, review of literature, evidence-based assessment techniques, document relevant data



- Compare clinical findings with normal and abnormal variation and developmental events
- interpret data: identify clusters of clues, make hypotheses, test hypotheses, derive diagnoses
- validate diagnoses
- document diagnoses


outcome identification/planning

- identify expected outcomes, individualize to the person, culturally appropriate, realistic and measurable, include timeframe
- establish priorities
- develop outcomes
- identify interventions
- integrate evidence based trends and research
- document plan of care



- implement in safe and timely manner
- evidence-based interventions
- collaborate with colleagues
- use community resources
- coordinate care delivery
- provide health teaching and promotion
- document implementation and any modification



- progress toward outcomes
- conduct systematic, ongoing, criterion-based evaluation
- include patient and significant others
- use ongoing assessment to revise diagnoses, outcomes, plan
- disseminate results to patient and family


Critical Thinking Skills

1) identifying assumptions: make sure you are careful to not automatically see something as a fact if it isn't, don't take certain information for granted
2) identifying an organized and comprehensive approach: PRIORITIES
3) Validation: check accuracy and reliability of data collected. corroborate with family members, social worker
4) distinguishing normal from abnormal: learn this through experience and gained knowledge
5) making inferences: hypothesis. interpret data and make hypothesis.
6) clustering related cues: find relationships in data
7) distinguishing relevant from irrelevant: full health assessment then take what is actually important
8) recognizing inconsistencies: conflicintg information given versus your findings, etc.
9) identifying patterns: helps fill in the whole pictures and fills in missing information
10) identify missing information: gaps in data, need for more data prior to diagnosis
11) promoting health: identify risk factors,
12) diagnosising actual and potential (risk) problems: see nursing diagnoses
13) setting priorities: when there is more than one diagnosis.
14) identifying patient-centered expected outcomes: timeframe and specific results you are looking for
15) determining specific interventions: prevent, manage or resolve health problems
16) evaluating and correcting thinking: successful interventions, outcomes consistent with goals?
17) determining comprehensive plan: revised plan of care for future


nursing diagnoses

clinical judgements about a person's response to an actual or potential health state.
1) ACTUAL diagnoses: existing problems that are amenable to independent nursing interventions
2) RISK diagnoses: potential problems that an individual does not currently have but is particularly vulnerable to developing
3) WELLNESS diagnoses: focus on strengths and transitions to an individual's higher level of wellness.


types of priorities

1) first-level priorities: emergent, life-threatening, immediate
A airway problems
B breathing problems
C cardiac/circulation problems
V vital sign concerns
2) second-level priorities: next in urgency, prompt intervention to forestall further deterioration (mental status change, acute pain, risk of infection)
3) Third-level priorities: important to patient's health but can be addressed later (chronic low self esteem, dysfunctional family process)
**Collaborative problems--> approach to treatment involves many disciplines (exp: alcoholic)


setting priorities

1) make a list of current meds, medical problems, allergies, reasons for seeking care.
2) determine the relationships among the problems


4 types of data

1) complete (total health) database
complete health history and full physical exam
2) focused/problem-centered database
for a limited or short term problem
3) follow up database
check the status of any identified problems
4) emergency database
rapid collection of data about an individual's health state


holistic health

views the mind, body, and spirit as interdependent and functioning as a whole within the environment.
- includes culture and values, family and social roles, self-care behaviors, job-related stress, developmental tasks, and failures and frustrations.
* health promotion and disease prevention


culture and genetics

34% of total us population is emerging minority
- hispanics 24.3%, blacks 13.2%, asian/pacific islander 8.9% and american indian 0.8%
- largest growing pop is hispanic
- 2nd largest is asian, then blacks, american indians, alaska natives, and native hawaiians and islanders.
- median age in 2007 was 36.6, 1/4 younger than 18
- hispanic median age = 27, blacks 31, amican indian and alaskans = 30, hawaiin and islanders = 30 ==> all cose to 1/2 pop under 18
- white median ages are between 36 and 40


legal resident

granted lawful permanent residence



the conferring, by any means, of citizenship upon a person after birth



an alien who seeks temporary entry to the US for a specific purpose



an alien, allowed to the US for urgent humanitarian reasons or when their entry is significant to the public's benefit


permanent resident alien

alien admitted to the us as lawful permanent resident



presecution or a well-founded fear of persecution


unauthorized residents

not legal residents and foreign born


medical diagnosis

used to evaluate the cause and etiology of disease, focus is on the function or malfunction of a specific organ system


Title VI of the cycle rights act of 1964

a federal law that mandates that when people with limited engligh proficiency seek health care in health care settings such as hospitals, nursing homes, clinics, daycare centers, and mental health centers, services cannot be denied to them.



culture, ethnicity, religion and spirituality, socialization, time orientation (reflection towards past, present and future thinking)


culture vs. ethnicity

culture: socially transmuted behavioral patterns, arts, beliefs, knowledge, values, morals, customs, life ways and characteristics that influence a world view

ehtnicity: social group within a cultural and social system that shares common cultural and social heritage that include language, history, lifestyle, religion or all of these.


health disparity

the unusual and disproportionate frequency of a given health problem (e.g.. diabetes, hypertension, certain cancers) within a population when compared to other populations


cultural competence

your own personal heritage, the heritage of the nursing prof, heritage of the health care system, heritage of the patient


heritage consistency

concept that describes the degree to which one's lifestyle reflects his or her respective "whatever" culture
* determination of a person's cultural, ethnic, and religious background and socialization (being raised within a culture and acquiring characteristics of that group) experiences

- traditional - living within the norms of the traditional culture
- modern - acculturated to the norms of the dominant society

INDICATORS: childhood occurred in county of origin or ehtnic neighborhood, extended family supports the traditional activities, family home within ethnic community in which they belong, name not anglicized, social activities primarily within ethnic group, knowledge of language and cultural values


heath-related beliefs that may be effected by culture, ethnicity, heritage, religion

vaccinations, meditating, exercise/fitness, sleep habits, willingness to undergo physical exam, pilgrimage, truth about feelings, coping with stress, genetic screening and concealing, disabilities, caring for children


3 major views on causes of illness

1) biomedical/scientific: assumes cause and effect, views the body and a machine, life can be divided into parts, endorses germ theory

2) Naturalistic/holistic: forces of nature must be kept in balance, embraces idea of opposing categories or forces
- yin/yang - asians, health = all aspects of person are in perfect balance. Yin = cold, yang = hot - basis for chinese medicine
- hot/cold - hispanics, arab, black, asians. four humors of the body (blood, phlegm, black bile, yellow bile) regulate basic body function. uses cold, heat, dryness and wetness to treat.

3) Magicoreligious: super natural powers predominate in area of health and illness
- voodoo, witchcraft, faith healing