Term
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Definition
| The series of 5 steps the nurse takes in planning and giving nursing care |
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Term
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| When given the responsibility of helping persons maintain, regain or improve their health, nurses must be able to think critically to problem solve and find the best solution to help meet the patient't unmet needs. This process is called:_____ |
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Definition
| Nursing requires developing attitudes of a _____. |
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| science and scientific method |
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Definition
| Critical thinking is based on principles of ____. |
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| Critical thinking entails purposeful, goal-directed thinking, and aims to make _____ based on evidence (facts) rather than conjecture (guesswork). |
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| Systematic collection of data reltating to patients and their problems. First step in the nursing process. May be viewed as the most important step. |
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| A statement of the potential or acutal problem in the patient's health status that the nurse is licensed and competent to treat; the second step in the nursing process |
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Definition
| Setting goals; identify patients goals; determine the outcome criteria which indicates the goal has been met; design nurisng interventions required to prevent, reduce or eliminate the patient's health problems; third step in the nursing process |
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Definition
| Component of the Nursing Process in which the actions necessary for accomplishing nursing care plan are initiated and completed; fourth step in the nursing process |
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| Assessing the effectiveness of the plan and modifying if necessary; last step of the nursing process; this phase identifies whether, or to what degree the patient's goals were met. |
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Definition
| The patient is a human with _____ and dignity. |
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Definition
| What needs are to be met by each patient, and when they are not problems arise requiring intervention |
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Definition
| The patients have a right to _____ and nursing care. |
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Definition
| What type of relationship is important that the nurse-pt must have during the nursing process |
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Term
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Definition
| The deliberate and _____ collection of data to determine the patient's current health status is involved in the assessment phase of the nursing process. |
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Definition
| Observations or measurements made by the data collector. |
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Definition
| The patients perception about their health problems |
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Definition
| The primary source of assessment data |
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Definition
| The secondary source of assessment data |
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Term
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Definition
| process by which you obtain data from patients or significant others |
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Term
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Definition
| process by which you fill out a health history form: head to toe |
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Definition
| You must also perform a physical exam and view laboratory and _____ tests when collecting data on your patients |
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Definition
| When interviewing you must prepare the environment to eliminate distractions, provide for _____ and use therapeutic communciation techniques |
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Definition
| questions that promps patients to describe a situation in more than one or two words. |
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Definition
| the practice of giving positive comments, which indicates that you have heard the patient. |
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Definition
| Questions that take information from patient's story and allows patient to more fully describe and identify problem areas. |
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Definition
| A _____ includes obtaining vital signs: T,P,R, B/P, SpO2, evaluating all body parts using inspection, palpation, percussion and auscultation. |
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Definition
| Observing patient's body, mood, and nonverbal behavior (ex: facial expression) |
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Definition
| Using hands and sense of touch to detect tenderness, temperature, texture, vibration, pulsations, masses and other changes in body integrity. |
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Definition
| Involves tapping of various body organs and structures to produce vibration and sound. |
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Definition
| Involves the process of listening to sounds produced by the body by using a stethoscope. |
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Term
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Definition
| to group data is to _____. |
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Term
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Definition
| First, group like data, determine which of Maslow's needs are involved, compare data with normal standards, then finally draw a conclusion. This process is called:_____ |
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Term
| first part of Nursing Diagnosis |
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Definition
| Statement of the patient's problem using NANDA terminology or Diagnostic Label. |
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Term
| second part of Nursing Diagnosis |
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Definition
| Statement of the etiology or factors contributing to patient's problem. |
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Term
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Definition
| The two parts of the nursing diagnosis is connected by: _____ |
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Term
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Definition
| What should address the patient's behavior and be identified in the first part of the nursing diagnosis statement. |
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Definition
| Outcome criteria should be: Specific, Measureable, Appropriate, Realistic, Timely |
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| goals that require a longer period of time to achieve, possibly after discharge; Only need 1 of these types of goal. |
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Definition
| Goals that are usually achieved during hospitalization. Need one of these goals for each nursing diagnosis. |
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Term
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Definition
| actions that are designed to achieve established patient goals. Need 5 for each nursing diagnosis |
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Term
| physician-initiated or dependent nursing intervention |
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Definition
| nurse responds to the physicians written orders |
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Term
| nurse-initiated or independent nursing intervention |
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Definition
| autonomous action based on scientific rationale; actions that the nurse is licensed to perform; require no supervision or direction from others. |
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Term
| collaborative interventions |
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Definition
| therapies that require the knowledge, skill, and expertise of multiple health care professionals. |
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Term
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Definition
| Nurses often care for patients on the basis of _____, convenience, or the standard. "It has always been done this way" |
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Term
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Definition
| enhances clinical performance and enables nurses to help pts and families achieve the best outcome. |
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Term
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Definition
| Final product of the planning phase and will usually be completed by the RN admitting patient to unit. |
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Term
| written nursing care plan |
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Definition
| The purpose of the _____ is to provide direction for individualized patient care; to provide for continuity of care; to provide direction about what needs to be recorded on patient's chart; and to serve as a guide for assigning staff. |
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Term
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Definition
| The evaluation phase is a _____ process, which means you reassess the patient everyday to see if goals are being met. |
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Term
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Definition
| The evaluation phase is a _____ process, which means you reassess the patient at the end of the hospital stay before being discharged to see if goals have been met. |
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Term
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Definition
| this type of statment must include a time frame and include the words as evidenced by (AEB) |
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Term
True or False:
Conducting a client interview is part of the Planning phase of the nursing process. |
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Definition
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Term
True or False:
Placing a "Protocol for Oxytocin Induction" in Mrs. Friedreich's care plan is part of the Planning phase of the nursing process. |
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Definition
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True or False:
Discussing with the client whether a goal should be included on the care plan is part of the Planning phase of the nursing process. |
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Definition
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True or False:
Changing the bed linens is part of the Planning phase of the nursing process. |
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Definition
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Term
True or False:
Writing a nursing order, "Intake and Output q8h" is part of the Planning phase of the nursing process. |
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Definition
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True or False:
Measureing a client's output is part of the Planning phase of the nursing process. |
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Definition
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True or False:
Choosing nursing orders from a computer menu is part of the Planning phase of the nursing process. |
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Definition
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True or False:
Checking to see if the nursing unit has standards of care for preeclampsia patients is part of the Planning phase of the nursing process. |
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Definition
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Term
True or False:
Writing a nursing diagnosis is part of the Planning phase of the nursing process. |
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Definition
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Term
True or False:
Deciding which of the client's problems need to be written on the care plan is part of the Planning phase of the nursing process. |
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Definition
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Term
Goal or Intervention:
Will verbalize anxieties about his surgery by 12/16. |
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Definition
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Term
Goal or Intervention:
Will rate pain as less than 3 on a scale of 1 to 10. |
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Definition
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Term
Goal or Intervention:
Keep head of bed level to 45 degrees. |
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Definition
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Goal or Intervention:
Turn patient every 2 hours. |
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Definition
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Term
Goal or Intervention:
Force fluids up to 250 cc per hour. |
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Definition
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Goal or Intervention:
Circulation to left foot will be improved, as evidenced by pink color, warm skin. |
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Definition
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Term
Goal or Intervention:
Infection will be prevented, as evidenced by temperature < 100.1 |
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Definition
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Term
Goal or Intervention:
Take temperature hourly if elevated. |
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Definition
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Term
Goal or Intervention:
Will list foods allowed on low-fat diet by 12/16. |
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Definition
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Term
| Maslow's Hierarchy of Human Needs (pyramid) |
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Definition
| What are the following when grouped together: physiological, safety, love/belonging, esteem, self-actualization? |
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Term
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Definition
| What level on the Maslow's Hierarchy do these belong to: mortality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts. |
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Term
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Definition
| What level on the Maslow's Hierarchy do these belong to: self-esteem, confidence, achievement, respect of others, respect by others |
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Term
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Definition
| What level on the Maslow's Hierarchy do these belong to: friendship, family, sexual intimacy |
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Term
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Definition
| What level on the Maslow's Hierarchy do these belong to: security of body, of employment, of resources, of morality, of the family, of health, of property |
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Term
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Definition
| What level on the Maslow's Hierarchy do these belong to: oxygen, fluid, nutrition, temperature, elimination, shelter, rest and sex - Most basic human needs have the highest priority and are necessary for survival. |
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Term
| Steps of the Nursing Process |
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Definition
| Whar are the following: Assessment, Nursing Diagnosis, Planning, Implementation, Evaluation |
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Term
| Format of the Nursing Diagnosis |
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Definition
First part is the problem - Use NANDA terms to define.
Second part is the etiology - cause of the problem |
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Term
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Fluid volume deficit related to prolonged vomiting and diarrhea. |
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Term
| Safety and Security Stage |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Potential for injury related to disorientation. |
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Term
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Alteration in family processes related to effects of hospitalization of mother. |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Powerlessness related to immbolitiy. |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Spiritual distress related to discrepancy between spiritual beliefs and prescribed treatment. |
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Term
| Safety and Security Stage |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Potential for violence, self injury related to hallucinations. |
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Term
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Ineffective breathing pattern related to side effects of anesthesia. |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Potential alteration in parenting related to separation from children during hospitalization. |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Potential ineffective coping related to potential role changes as a result of surgery. |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Disturbance in self concept related to prolonged disability. |
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Definition
| What stage of Maslow's Hierarchy does this pertain to: Sleep pattern disturbance related to excessive noise. |
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Term
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Definition
| This stage involves the setting of appropriate goals and the nursing care required to meet the goal. A goal should be specific, measurable, achievable, realistic, and time oriente. Goals can be short term or long term so there must be an indication of when the goal should be achieved. What stage of the nursing process is this? |
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Term
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Definition
| This stage is crucial to the whole nursing process and involves collection of data from a variey of sources and is structured according to the nursing model being used. What stage of the nursing process is this? |
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Term
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Definition
| This stage involves delivering the plan of care using evidence-based nursing interventions to achieve the goals. What stage of the nursing process is this? |
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Term
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Definition
| This stage involves identifying the patients nursing problems/needs, both actual and potential which will require nursing intervention. What stage of the nursing process is this? |
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Term
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Definition
| This stage is when the nurse reviews the care plan to see whether the goals have been met or partially met and whether the care that was planned was appropriate and effective. If the goal has not been fully or partially achieved, re-assessment may be necessary and the nursing process begins again. What stage of the nursing process is this? |
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Term
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Definition
| North American Nursing Diagnosis Association |
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