NR 304 EXAM 1 STUDY GUIDE VERSION 1
Chapter 1
Evidenced based
1) research information
**.org websites, no wikipedia
2) Practiced
3) Patient’s prefer evidence based
**EBP: the use of evidence with the clinician’s experience
**Barriers: nurse lack of research skills in evaluating the quality of
research studies
**Best way for nurse to access research studies that incorporate EBP
decision making in the practice would be to teach the nurse how to
conduct electronic
searches for research
studies
Assessment is the
collection of data about the individual's health state
**Focused or problem-centered history —> when pt. is in an
outpatient clinic and has a cold/ flu like Sx
Subjective data (i.e., what the person says about himself or herself during history
taking)
Objective data (i.e., what you as the health professional observe by inspecting,
percussing, palpating, and auscultating during the physical examination).
**Database: subjective + objective + laboratory studies
1
, ** Pt. with chronic medical problem calls for a complete health data
base because of the nurse’s primary responsibility for monitoring
the pts. health
Diagnostic reasoning – process of analyzing health data and drawing conclusions
to identify diagnoses
Hypodeductive model:
- Formulate diagnostic hypothesis
- Attend to initially available cues
- Gather data relative to hypotheses
- Evaluate each hypothesis with new data collected to arrive at
final diagnosis
- **develops appropriate nursing interventions for a pt. relies on the
appropriateness of the nursing diagnosis
- ** diagnostic hypothesis is formulated using diagnostic reasoning
•** First-level priority problems are those that are emergent, life threatening,
and immediate, such as establishing an airway or supporting breathing. ABCs plus V
**Individual with SOB and respiratory distress
• **Second-level priority problems are those that are next in urgency—those
requiring your prompt intervention to forestall further deterioration (e.g., mental
status change, acute pain, acute urinary elimination problems, untreated medical
problems, **Abnormal laboratory values on pts.’ chart, risks of infection, or
risk to safety or security
• **Third-level priority problems are those that are important to the patient's
health but can be addressed after more urgent health problems are addressed.
Interventions to treat these problems are more long term, and the response to
treatment is expected to take more time.
• Collaborative problems: the approach to treatment involves multiple
disciplines. Collaborative problems are certain physiologic conditions in which
nurses have the primary responsibility to diagnose the onset and monitor the
changes in status
**Validate data by asking a coworker to listen to breath sounds
**Nurse gives medication but pt. is still in pain after 45 minutes, the nurse should
consider consulting with the pain management team to evaluate the effectiveness
of the pain medication regimen.
Critical thinking principles
Sequential steps novice to expert
- incorporation of experience provides foundation for development of
clinical practice
Multidimensional thinking approach to interpret data, use an organized,
systematic assessment format
Nonjudgmental find accuracy and reliability, check and collaborate
accuracy and reliability of data
Cluster data information to support evidence
- **helps nurse see relationships among the data
2
, Patient outcomes - measurable goals
Evaluation methods: validations of results or adjustment to care planning
- Continuously evaluate plan for care
Comprehensive of plan of care:
- evaluate and update plan
- record advised plan
- always changing
- communicate revised plans
- Be aware that this is legal document, accurate recording, insurance
reimbursement, and research
Types of data
Complete total health - health history and full examination
Episodic or problem centered database - mini database
Follow up
- **use this when pt. comes in weekly and changed medication 2
months prior
Emergency data base = rapid collection
- **Simultaneously ask history questions while performing the
examination and initiating life saving measures
Holistic model of health
- **mind body, spirit are interdependent and function as whole
- **prevention in describing health is essential because it places the
emphasis on the link between health and personal behavior
Frequency of assessment
• interval of assessment varies with illness and wellness needs
• Assessment through life cycle
• age specified charts
• Focus major risk factors: lifestyle, health needs and problems
Holistic model of health care: must include culture
Cost containment principle —> increase acuity, shorter stays, and earlier
discharges
**Novice nurse: use set of rules
**Proficient nurse: understands a pt. situation as a whole rather tan a list
of tasks and recognizes the long-term goals for the pt.
**Expert nurse: use intuition
Health promotion model: the focus of the health professional includes:
**helping consumer choose a healthier lifestyle
Chapter 2
Health: balance of person is complex, interrelated
Illness: Loss of person’s balance of health
Linguistic standards:
First & landmark standard
- language barriers does not stop care
Effective care - positive outcomes and satisfaction for patient
Respectful care - consider values, preferences, and expressed needs
of pt.
3
Chapter 1
Evidenced based
1) research information
**.org websites, no wikipedia
2) Practiced
3) Patient’s prefer evidence based
**EBP: the use of evidence with the clinician’s experience
**Barriers: nurse lack of research skills in evaluating the quality of
research studies
**Best way for nurse to access research studies that incorporate EBP
decision making in the practice would be to teach the nurse how to
conduct electronic
searches for research
studies
Assessment is the
collection of data about the individual's health state
**Focused or problem-centered history —> when pt. is in an
outpatient clinic and has a cold/ flu like Sx
Subjective data (i.e., what the person says about himself or herself during history
taking)
Objective data (i.e., what you as the health professional observe by inspecting,
percussing, palpating, and auscultating during the physical examination).
**Database: subjective + objective + laboratory studies
1
, ** Pt. with chronic medical problem calls for a complete health data
base because of the nurse’s primary responsibility for monitoring
the pts. health
Diagnostic reasoning – process of analyzing health data and drawing conclusions
to identify diagnoses
Hypodeductive model:
- Formulate diagnostic hypothesis
- Attend to initially available cues
- Gather data relative to hypotheses
- Evaluate each hypothesis with new data collected to arrive at
final diagnosis
- **develops appropriate nursing interventions for a pt. relies on the
appropriateness of the nursing diagnosis
- ** diagnostic hypothesis is formulated using diagnostic reasoning
•** First-level priority problems are those that are emergent, life threatening,
and immediate, such as establishing an airway or supporting breathing. ABCs plus V
**Individual with SOB and respiratory distress
• **Second-level priority problems are those that are next in urgency—those
requiring your prompt intervention to forestall further deterioration (e.g., mental
status change, acute pain, acute urinary elimination problems, untreated medical
problems, **Abnormal laboratory values on pts.’ chart, risks of infection, or
risk to safety or security
• **Third-level priority problems are those that are important to the patient's
health but can be addressed after more urgent health problems are addressed.
Interventions to treat these problems are more long term, and the response to
treatment is expected to take more time.
• Collaborative problems: the approach to treatment involves multiple
disciplines. Collaborative problems are certain physiologic conditions in which
nurses have the primary responsibility to diagnose the onset and monitor the
changes in status
**Validate data by asking a coworker to listen to breath sounds
**Nurse gives medication but pt. is still in pain after 45 minutes, the nurse should
consider consulting with the pain management team to evaluate the effectiveness
of the pain medication regimen.
Critical thinking principles
Sequential steps novice to expert
- incorporation of experience provides foundation for development of
clinical practice
Multidimensional thinking approach to interpret data, use an organized,
systematic assessment format
Nonjudgmental find accuracy and reliability, check and collaborate
accuracy and reliability of data
Cluster data information to support evidence
- **helps nurse see relationships among the data
2
, Patient outcomes - measurable goals
Evaluation methods: validations of results or adjustment to care planning
- Continuously evaluate plan for care
Comprehensive of plan of care:
- evaluate and update plan
- record advised plan
- always changing
- communicate revised plans
- Be aware that this is legal document, accurate recording, insurance
reimbursement, and research
Types of data
Complete total health - health history and full examination
Episodic or problem centered database - mini database
Follow up
- **use this when pt. comes in weekly and changed medication 2
months prior
Emergency data base = rapid collection
- **Simultaneously ask history questions while performing the
examination and initiating life saving measures
Holistic model of health
- **mind body, spirit are interdependent and function as whole
- **prevention in describing health is essential because it places the
emphasis on the link between health and personal behavior
Frequency of assessment
• interval of assessment varies with illness and wellness needs
• Assessment through life cycle
• age specified charts
• Focus major risk factors: lifestyle, health needs and problems
Holistic model of health care: must include culture
Cost containment principle —> increase acuity, shorter stays, and earlier
discharges
**Novice nurse: use set of rules
**Proficient nurse: understands a pt. situation as a whole rather tan a list
of tasks and recognizes the long-term goals for the pt.
**Expert nurse: use intuition
Health promotion model: the focus of the health professional includes:
**helping consumer choose a healthier lifestyle
Chapter 2
Health: balance of person is complex, interrelated
Illness: Loss of person’s balance of health
Linguistic standards:
First & landmark standard
- language barriers does not stop care
Effective care - positive outcomes and satisfaction for patient
Respectful care - consider values, preferences, and expressed needs
of pt.
3
