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321 Learning Objectives - Lecture
Fundamentals of Nursing (NRS 130 )
Long Island University
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NUR1220Preview text
1 Week 1 & 2(05/19/2020)
1. Describe the six overlapping and interdependent phases of the nursing process.
a. Analysis i. Assessment (Data gathering stage) 1. Get information from all sources ii. Diagnosis
- Identify patients health needs based on assessment a. Analyze, synthesize & cluster data iii. Planning outcomes (Outcome Planning – can be after diagnosis)
- Client involved
- Client centered outcomes you want to achieve a. These outcome will drive your interventions (decide your goals)
- Planning interventions
- List the things you want to do to achieve the outcomes (goals) iv. Implementation
- Carry out or delegate your previously planned interventions v. Evaluation
- Decide if outcomes have been achieved and modify plan as needed
2. Explain how critical thinking is used in the nursing process.
a. Involves interpretation and analysis of the problem, reasoning to find a solution, applying and evaluation of outcomes. b. Nursing process is a problem solving, critical thinking process
2 i. It makes use of many critical thinking skills at a time – is the building block of critical thinking c. Each phase of the nursing process combination of critical thinking and nursing knowledge d. Levels of critical thinking according to Kataoka-Yahiro and Saylor’s model i. Basic
- Nurses follow whatever instructions experts or manuals tell them ii. Commitment
- The nurse anticipates when to make decisions without assistance from others iii. Complex
- The nurse begins to analyze the situation independently and does not just follow the experts
3. Describe and differentiate among initial, ongoing, comprehensive, focused and special needs assessments. a. Initial b. Ongoing i. Collected during rounding or whole administering patient care ii. Includes quick screenings to rule out or follow up on patient problems. c. Comprehensive d. Focused i. Begins with a patients presenting situation & specific problematic areas 1. i. incisional pain or limited post op recovery.
4
- Identify an undesirable human response to an existing problem or concerns of a patient. b. Risk Diagnosis i. Diagnosis that applies when there is an increased potential or a client is at risk for a problem or complication to develop. c. Wellness Diagnosis i. Health Promotion Diagnosis/positive diagnosis ii. Identify the desire or motivation to improve health status through a positive behavioral change.
6. Describe a framework for prioritizing nursing diagnosis.
a. Maslow's Hierarchy i. Work from the base of the pyramid to address those needs first (physiological) 1. Work your way up to address the next highest needs if the lower level is not in an immediate danger. a. i. if the client is in physical danger but physiological needs are well, their safety has to be addressed. 2. ABC – airway, breathing & Circulation a. Ensure the client ALWAYS has an open airway b. Ensure they are able to breathe c. Ensure proper circulation 3. Address acute events before chronic events a. Clients with chronic conditions have had time to physiologically adapt to their conditions
5 4. When address needs – try least invasive methods first before doing something invasive – introducing foreign objects into the body 5. Disaster situations a. Address those who are critically injured but have the highest chance of survival b. Expectant patients i. Provide comfort measures as they are most likely to die ii. Resources must be reserved for those patients who are most likely to survive.
7. List guidelines for writing an outcome statement
SMART a. S pecific - Must be patient-centered i. Reflect patients specific behaviors ii. Each goal/outcome must be separate
- Allows for better modification iii. Each goal must be written separately and address only 1 behavior
- Allows for modification b. M easurable i. Describe quality, frequency, length or weight ii. Observe or measure if a change takes place
- Reflected in physiological findings, patients knowledge, perceptions and behavior
7 WEEK 2 (05/26/2020)
1. Identify when interventions are dependent, independent or collaborative.
a. Dependent nursing interventions i. Require an order from a provider 1. Administering meds, inserting IV or catheter, preparing for diagnostic tests, a. Must know the types of precautions and observations to take to safely deliver care b. Independent i. Do not require a providers orders – carried out independently by the nurse to address a nursing diagnosis 1. Repositioning patient to prevent pressure injury 2. Initiate positioning early mobility protocols, offering counseling and coping strategies, instructing of side effects of medications c. Collaborative interventions/Interdependent i. Require combined knowledge, skill and expertise of multiple providers ii. Done after review of all necessary interventions and determine of collaboration is necessary
- Determine if appropriate
2. Identify correct nursing interventions for patient problems.
8 3. Describe what nurses do in the implementation phase of the nursing process.
a. Strong clinical reasoning & decision making skills are needed to accurately identify appropriate nursing interventions for a patients diagnosis b. Consider complexity of interventions c. Be aware of a patients changing condition – adjust intervention based on ongoing evaluation i. Exercise judgment while delivering each intervention d. Show confidence when performing an intervention e. Reassess patient i. Confirm interventions are still appropriate 1. A new problem may be found-requiring modifications to the care plan, or no longer appropriate-problem may have resolved f. Review & revise existing care plan i. If assessment data changes, entire care plan must be updated to reflect changes 1. Update interventions and evaluation measures g. Manage Time h. Gather equipment if needed i. Make sure it's working before going to patients room ii. Put in a convenient location to provide easy access during procedure iii. Have extra supplies available
- Do not use unless needed i. Determine what parts of the patients care can and cannot be delegated to a UAP or assistance is needed from another nurse j. Make sure environment is safe for patients with sensory deficits, those at risk for falls
10 i. wound care nurse ii. nutritionists
- identify foods that promote wound healing c. Patient who have trouble getting food i. Social work ii. nutritionists
6. Delegate care using the “five rights” of delegation.
a. Right Person i. Make sure the UAP is authorized by the facility and state to perform a task and it falls w/in their license ii. “Are they allowed to do this task?” b. Right Task i. Ensure the UAP is competent ii. “Are they competent to do this?” c. Right Circumstances i. Make sure the patient an tolerate the task being performed by the person ii. “Can this person tolerate the task being performed by the UAP?” “Will they need an assessment afterward?” d. Right Communication i. Communicate clearly with the person who is perform the task ii. “Did I clearly explain what I needed done?” Did I specify a time frame and what should be reported back?” e. Right Supervision i. Make sure the task is performed properly
11 ii. “Have I followed up with the care?” “At what level should I supervise the task or how much involvement should I have?”
7. Give examples for evaluating nursing interventions.
a. After explaining the correct hand washing techniques to a patient and the reason why they should washing their hands for a minimum of 15 seconds - Patient is able to demonstrate correct hand washing techniques b. After demonstrating to patient how to correctly use crutches - Patient is able to ambulate with cane/crutches without assistance
8. Explain how the nursing process and critical thinking work together in full-spectrum nursing. a. Critical thinking involves recognizing problems as soon as possible, gathering all the information efficiently and evaluating all possible outcomes and solutions b. The nursing process involves ADPIE, the framework in which a nurse uses to helps them think through how they will treat the patient and what to address first i. Another framework to consider with ADPIE is ABC’s 1. First check for an open airway 2. Second, make sure the patient is breathing a. Observe for labored breathing, bradypnea, etc. 3. Circulation a. Are they actively bleeding?
13 Week 4 (06/09/2020) - Hygiene
1. Explain how personal hygiene relates to health and well-being
a. Personal hygiene influences a person’s personal comfort (cleanses skin, reduces body odors, improves self-image), promotes normal structure and function of tissues (stimulates circulation, promotes range of motion).
2. Identify factors influencing personal hygiene practices.
a. Culture, personal values, social practices, body image, Health beliefs and motivation, functional ability, religious practices and available resources (money, SES) *Don’t assume everyone has the same hygiene practices – practices differ from person to person *As long as an activity is safe, do what the patient wants
3. Discuss the nurse’s role in determining a patient’s self-care ability.
a. It is the nurse’s role to assess the patient before performing hygiene care i. Assess patients ability to perform ADL’s ii. Use of limbs iii. Ability to ambulate b. The nurse individualizes care according to preferences, culture, beliefs, functional ability, etc. c. The nurse also assesses range of motion, learning needs, condition of skin (i. pressure ulcer), allows to auscultate lungs during self care, assess tolerance to activity level, ability to perform self care, i. touch and clean feet, hold toothbrush, etc.
14 d. Provides an opportunity to develop a therapeutic nurse-patient relationship – helps to develop trust
4. Identify concepts pertaining to cultural diversity
a. Hygiene practices differ according to culture. i. Other cultures may bathe more or less frequently depending on socioeconomic background and/or cultural groups b. Sensitivity to body odors may also differ between cultural groups
5. Identify when it is appropriate to delegate hygiene activities to the NAP.
a. Hygiene care can be delegated to a NAP when a patient is stable and does not need further assessment *Only the nurse can assess a patient and determine interventions appropriate for the patient. b. Denture care, shampooing and shaving, oral hygiene (nurse is responsible for assessing gag reflex), making an occupied bed (nurse informed NAP activity of restrictions, loosened equipment or wound drainage, when to obtain help from other caregivers, using special precautions, making an unoccupied bed
6. Discuss routine assessments made by the nurse when providing hygiene care.
a. Assess ROM b. Activity tolerance c. condition of skin and mucous membranes d. cultural practices related to hygiene
16 ii. can cause fatigue f. Bag bath/travel bath i. packet that contains several soft, nonwoven cotton cloths premoistened in a solution of no-rinse cleaner and emollient ii. reduces bath time and helps to increase patient comfort g. Chlorhexidine gluconate (CHG) bath i. antimicrobial agent – used to reduce incidence of HAI on skin, invasive lines and catheters
8. Apply the nursing process to common hygiene related problems.
a. design a patient-centered care approach to meet individuals needs that are congruent on patient’s usual practices i. minimize some agency-based constraints on care routines if possible b. Work with family and caregivers to determine/identify triggers that may trigger anxiety or reduce cooperation i. may vary from person to person ii. can include new staff, full bladder, time of day or too much environmental noise iii. involve the patient whenever possible in hygiene care plan and maintain prehospital routines c. communicate patient’s preferences related to hygiene and ADL’s with all agency caregivers d. promotes patient comfort, reduces anxiety and improvise patient satisfaction
9. Identify how culture can affect the nursing needs of patients and their families.
a. Ask the patient what feels most comfortable during a bath
17 i. this question may reveal normal cultural practices or what makes them comfortable
- i. a nurse doing a partial bed bath and family performing a complete bed bath or perineal care or person of the same sex performing perineal care b. get an understanding of a patients concerns re: a bath and offer explanations that would help them to accept interventions
10. Describe nursing strategies that promote delivery of culturally competent care to patients and families.
19 i. blood ii. skin iii. mucous membrane iv. respiratory tract v. GI and GU tract vi. transplacental
d. mode of transmission
i. practicing infection control techniques interrupts mode of transmission 1. even more effective for infections transmitted by more than one route 2. major route of transmission in health care settings - unwashed hands of healthcare workers and equipment used in the environment ii. direct transmission
- providers hands
- person to person/physical contact a. touching, kissing, sexual contact iii. indirect transmission
- susceptible host w/ contaminated agent
- contact w/ fomite a. soiled dressings b. soiled linen c. needles e. portal of entry
20 i. blood ii. skin iii. mucous membrane iv. respiratory tract v. GI and GU tract vi. transplacental
f. susceptible host
i. susceptibility depends on degree of resistance to pathogens ii. infection does not result until an individual becomes susceptible to the strength and numbers of microorganisms iii. susceptibility affected by...
- age a. very old and very young more susceptible to infections
- those with poor/decreased nutritional status
- presence of chronic disease i. i. DM, multiple illnesses,
- trauma & smoking i. burn victims ii. those under prolonged stress
- those w/ depressed immune systems i. HIV ii. Multiple Sclerosis iii. on steroid medications
321 Learning Objectives - Lecture
Course: Fundamentals of Nursing (NRS 130 )
University: Long Island University
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