Flashcards in Unit III Exam 2 Deck (69)
What is a disciplin specific, reflective, reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns?
Determining essential information
Differentiate between truth & assumptions
Specific example to generalized conclusion
From generalized to specific conclusion
What level of anxiety is the best to learn something at?
Knowledge is relevant
When you are older
Assumes there is only one right answer
Best way is to memorize
When you are young
Collect data, analyze, formulate solutions, implement action & evaluate
Problem solving process
Approach that enables nurses to manage explosion of new literature & knowledge
Allows nurses to search for, assess & apply best practices to care
Evidenced based practice
Three main elements of evidenced based practice
Best evidence from well designed research studies
Pt's values & preferences
Which is the fastest growing subgroup of the late adulthood population?
85-99 years old
The old old
What is the current % of individuals older than 65 years old?
During as dement you suspect the pt may be depressed, your next action is to?
Administer the geriatric depression scale short form
What is thought to be the primary cause of aging?
Safety issues with the elderly
Side rails up
Bed lowest position
dangle @ bedside b4 standing
Shoes with non skid soles
When can restraints be used? What do the prevent?
Only as a last resort & by MD order
Helps with preventing falls, pulling out iv's
Turn non ambulatory pt's every?
Every 2 hours
Slow insidious progressive loss of cognitive function, chronic state
Usually transient condition characterized by difficult concentration, disorganized thinking, sensory misperceptions, acute state
Are adult day care centers acceptable?
What is the purpose of teaching?
Restoration of health
Adapting to altered Heath & function
Process of activities intended to produce learning
Dynamic interaction between teacher & student
Manipulated environment for intended response
Refers to rational thought
Teach from simple to complex
Difficult to measure learning in this domain
Learn skills that require integration of knowledge with muscular activity
Learning is self motivated, self initiated & evaluated
Uses both cognitive & affective domains
Name some factors that effect learning.
What domain of learning does learning take place?
What are key factors in cognitivism?
Developmental & individual readiness
Teaching older adults
Takes longer to process information
Subjective, non specific feeling of uneasiness, tension, apprehension or impending doom
Anxiety is not the same as stress
Symptoms of anxiety
Increase: B/P, heart rate
Wringing of hands
Nursing process components
Develop, revise nursing diagnosis terminology
Pt benefits of the nursing process
Helps to provide continuous care, pt centered
Nurse benefits of nursing process
Enhancing professional creative care, helps effectiveness in daily care
Helps collaborate with other team members & pts
Professional benefits of the nursing process
Define scope of nursing practice
Methods of data collection
Interview with pt, family
Pt's perception of his/her health problems
Involves feelings " my leg hurts"
Pt is only one who can provide this data
Observations or measurements made by data collector
Sources include physical exam, diagnostic results, pt records
Who is the primary & best source of data
Double check your data
Ensure accuracy of info
Data that is acquired through the 5 senses
Nurses judgement or interpretation of cues
A clinical judgement about individuals, family or community responses to actual or potential health or life processes
Types of nursing disgnoses
Steps in developing a nursing diagnosis
Identify problem (NANDA list)
Identify etiology (related to factors)
Identify the defining characteristics (signs & symptoms)
Actual nursing diagnosis
Statement comes from NANDA list
Risk nursing diagnosis
2 part statement
No signs & symptoms
Risk for falls r/t fatigue and altered gait
A clinical judgement about a individual, family or community in transition from a specific level of wellness to a higher level of wellness
Goal - cure disease
Nursing diagnosis goal
Treat human response not disease
Caring for mind, body, spirit
Physiological problems that nurses monitor & collaborate with medicine for co-treatment
Descriptive statements about what the pt's state will be after the nursing interventions are carried out
Criteria for writing expected outcomes
Specific (be able to measure)
Realistic for pt
What the pt will accomplish
Includes a time frame
The # 1 intervention is?
Types of nursing interventions
Independent- things done without MD order
Dependent-require MD order
Interdependent-standing orders, protocols
Use therapeutic communication
Perform routine nursing activities
Ongoing assessment of pt
Carrying out the proposed plan of care to resolve the problem
Determine the pt's response to the MI's & the extent to which the EO's have been achieved