What's the difference between the practice of nursing and medicine?

Medicine purpose and goals are to eliminate or correct disease or pathophysiology

Nursing purpose and goals are to focus on the human response to the disease state of pathophysiology. For example: fear, bosy image, pain, grieveing.  The purpose is to identify HOW the patient will respond to and deal with cancer (or disease)

ANA: established in 1911

Purpose: to improve qulity of nursing care

Actvities: 1) establish standards for nursing practice

2) develope educational standards 3) Establish code of ethics 4) Oversee credentialing system 5) Influence legislations affecting health care

Publication: AMerican Journal of Nursing.

NLN

Establishes in 1952

Purpose: to identify the nursing needs in society and foster programs designed ot meet those needs

Activities: Accredit Nursing schools 2) Offer testing services 3) NCLEX-RN for State Boards of Nursing  4) Achievements tests for use in nursing schools.

What is the structure of the Concept Based Cirriculum?

Threads and Concepts.

What are some examples of threads?

Threads

Threads: compnents integral to the provision of nursing care. ie: 1) caring 2) communication 3) evidenced- based practice 4) health promotion 5) life span 6) nursing process 7) pharmacology 8) safety 9) skills 10) Teaching

Concepts:

1) Bio-physical: cellular reg, cognition, metabolism, nutrition, oxygenation, perfusion.... 2) Life Phases: aging, child health, child bearing, end of life,  neonatal adaptation  3) Professional Practice: advocacy, delegation, ethics, health law, leadership, management, professionalism, community based care 4) Psychosocial Concepts: affective communication, culture, family adaptation, personal interaction, psychosocial integrity, spirituality

1) What is NANDA?

2) What are the 9 patterns of human response?

1) North American Nursing Diagnosis Association.

2) exchanging, valuing, perceiving, communicationg, choosing, knowing, relating, moving feeling.

A clinical judgement about individual, family, or community reponse to actual or potential health processes (NANDA)

This provides a basis for selection of interventions (or actions) to achieve outcomes for which the nurse is responsible.

1) Diagnosis: problem or lable: client's response to actual, possible, and risk health problems.

2) Etiology (related to: RT) related cause or contributor to the problem . ALways w/in domain of nursing practice and condition that will repsond to nursing intervention.

3) Signs and Symptoms (As Evidenced By:  AEB) defining characteristics or clinical manifestations.

Give an example of how you'd formulate a Nursing Diagnosis:

Patient comes back from surgery and is in pain.

Lable: acute Pain

RT: disruption of tissue integrity,

AEB: facial grimaces, and report of pain of 7 on pain scale 0-10

What is the  purpose for Outcome Identification?

What are the activities for Outcome Identification?

What are goals of Outcome Identification?

Purpose: to assist in planning client care that is individualized, realistic, measurable, and which promotes patient participation and involvement of support people.

Activities: 1) priority setting (Maslow's Hierarchy)

2) Setting goals/outcomes

Goals: overall direction or end result of care.; may be long or short term.

What are Expected Outcomes when it comes to Outcome identification?

Expected outcomes are measurable steps to achieve goals of treatment.

THey must be specific, patirnt focused, have a TIMEFRAME, measurable criteria for determining success or failure , mutally acceptable to client and nurse.

Outcome identification:

A GOAL is the overall direction of a individualized aim or intent Can be LONG TERM or SHORT TERM: EX: Client ventilation and oxygenation will be adequate to allow a functional lifestyle and completion of DLA (daily life activities)

EXPECTED OUTCOMES: (can be little baby steps to get to goal) 1. client will maintian clear breath sounds during hospitalization. 2) client will demonstrate how to do pursed lip breathing techniques w/in 48 hours. TIME FRAME IMPORTANT

What are the the purposed and activites regarding PLANNING nursing care?

Planning:

A) Puropse: to direct patient care, promote continuity , focus documentation and allow for delegation.

B) Activities: 1) Planning nursing interventions (choosing actions)

2) writing the nursing care plan.

PLANNING Is the crux of what we do. It distiguises us form LPNs.

Documentation of planning process is called the care plan.

1) What should be done?

2) How should it be done?

3) When should it be done?
4) Who will do it?

5) How long or how often should it be done?

Describe PLANNING. How whould you formulate it? It's a nursing care PLAN. Nurses do the planing.

(planning nursing care chpt 18 pg. 262 in text)

Interventions, Date, Action verbs (like a command sentence) and qualifiers like: how when where time frame amount...

Example:

2/25/10: inspect wound during each dressing change. bb

2/25/10: Measure urine output hourly bb

2/25/10: record resiratory rate and pulse before, during and after ambulation.

IMPLEMENATION

Purpose: to fullfill patient needs which result in health promotion, prevention of illness, ilnness management an or health restoration

Activities: 1) reassess 2) Set Priorities 3) Perform Nursing actions

4) record Nursing actions

1) Nursing Initiated: independent, doesn't require physicians order, (also known as nursing orders)

2) Physician Initiatied: physician's orders.

3) Collaborative: initiate

PLANNING

purpose: to direct patient care, promote continuity, focus documentation and allow for delegation

Activities: 1) planning nursing interventions

2) writing the nursing care plan.

Purpose: to determine a client's progress or lack thereof toward achievement of expected outcomes.

Activities: 1) review patient goals/outcomes

2) collect data

3) determine the goal/outcome attainment

4) revise/modify nursing care plan

Reassess and collect data on: appropriateness and effectiveness of nursing diagnosis, priorities, expected outcomes, nursing actions, development of new problems, need for referral to other resources.

Determine goal achievements: evaluate outcomes, patient's condition and movement toward short term goals

Modify care plan

the active support of patients to obtain the highest quality of health care.

called: "Ethic of Practice"

1) provide support, encouragement and assistance

2) Review complaints and concerns

3) Help facilitate quality of care

4) Empower clients to take responsibility for their own health matters

5) Promote good customer service

1) assessment

2) planning

3) Implementation that requires judgement

4) evaluation

1) right task- can task be delegated?

2) right circumstances- safe place? safety equipment close? good vitals?

3) right person- right delegator? right delegatee? :-)

4) right direction and communication?- is task being delegated specifically explained and made clear w/ expected outcomes?

5) right supervision- there needs to be appropriate monitoring so questions can be asked and assistance can be given.

What are some safety risks for older adults?

What are some for children?

Older adults: falls & other injuries, nervous system changes, sensory changes, genitourinary changes, car accidents.

Children: injuries are leading cause of death and disability

1) Improve the accuracy of patient ID

2) Improve effectiveness of caregiver communication

3) Reduce risk of health care associated infections

4) Reduce risk of patient harm resulting from a fall

5) Encourage patient's active involvement in tehir own care

6) ID safety risks inherent in your patient population

7) Improve the safety of using medications.

1) level of consciousness/mental status

2) history of falls

3) ambulation/elimination status

4) vision status

5) gait/balance

6) systolic BP

7) medications

8) predisposing diseases

1) patient will remain free from injury

2) patient will identify and avoid risks within their home enviornment.

What are the 2 purposes of restraints (as defined by JCAHO)

1) Behavioral restraint- to control agressive or violent behavior or behavior dangerous to self or others.

2) Non- behavioral restraint- to control a patient's inability to respond to direct requests/follow specific instructions or a patient's direct attempto remove vital tubes, catheters and lines.

1) What are some pulse rhythm pattern descriptions?

2) What are the 3 pulse characteristics we are to remember?

1)

regularly irregular beat: but it has a pattern

irregularly irregular beats- totally random beats

2)

normal pulse 2+

Bounding pulse 3+

thready or weak pulse 1+

1) If you're taking an Apical pulse?  How long should you listen?

2) What are some factors that affect the pulse?

1) For a full minute.

2) drugs, postural changes (orthostasis), age, ANS, fever, emotions, poor oxygenation

1) 12-20 breaths/minute for adults

Tachypnea is more than 20/min

Bradypnea is slower than 12/min

1) What is the purpose of passive Rang of Motion (ROM)?

2) What are contractures?

1) improve or maintian joint funciton, prevent contractures, improve muscle tone and strength, increase client comfort.

2) Contracutres are shortening of the muscle or a "frozen joint". Muscles of flexion shorten and become tight. Muscles of flexion are stronger than muscles of extension.

Contractures are 100% preventable if patient recieves ROM.

1) social practices

2) personal preferences

3) body image

4) socioeconomic staus

5) Health beliefs and motivation

6) cultural variables

7) physical condition