NR 509 MIDTERM EXAM STUDY GUIDE
CHAPTER 1-17 (ALL CHAPTER INCLUDED)
Chapter 2
Clinical Decision Making ashley
Clinical decision making should be evidence based. The FNP should draw on a full
range of knowledge and experience, and read widely. Clinical decision making is
when the reading about diseases and abnormalities is most useful. By consulting
the clinical literature, you are embarking on evidence-based decision making and
clinical practice. There are five steps to generating a clinical hypotheses
1. Select the most specific and critical findings to support your
hypothesis
2. Match findings against all the conditions that can produce them.
3. Eliminate the diagnostic possibilities that fail to explain findings.
4. Weigh the competing possibilities and select the most likely
diagnosis
5. Give special attention to potentially life-threatening conditions
Once the hypothesis is made it should be tested, this may include further history
taking, testing or physical examination. The next step is to establish a working
diagnosis such as “bacterial meningitis, pneumococcal”. The final step is
developing a plan. The plan should make reference to diagnosis, treatment and
patient education. It is important to discuss your assessment with the patient
prior to finalizing the plan to ensure the patient is onboard.
Critical Thinking and Reasoning
Critical thinking- the mental process of actively and skillfully perception, analysis,
synthesis and evaluation of collected information through observation, experience
and communication that leads to a decision for action. The main critical thinking
skills in which nursing students should be exercised during their studies are critical
analysis, introductory and concluding justification, valid conclusion, distinguish
between facts and opinions, evaluation the credibility of information sources,
,clarification of concepts and recognition of conditions. Critical thinking is an
essential process for the safe, efficient and skillful nursing practice. The nursing
education programs should adopt attitudes that promote critical thinking and
mobilize the skills of critical reasoning.
Critical thinking is the disciplined, intellectual process of applying skillful
reasoning as a guide to belief or action. In nursing, critical thinking for clinical
decision-making is the ability to think in a systematic and logical manner with
openness to question and reflect on the reasoning process used to ensure safe
nursing practice and quality care. Critical thinking when developed in the
practitioner includes adherence to intellectual standards, proficiency in using
reasoning, a commitment to develop and maintain intellectual traits of the mind
and habits of thought and the competent use of thinking skills and abilities for
sound clinical judgments and safe decision-making.
Differential Diagnoses (obtained from book and week 1 review) - A list with
potential causes of patient specific problem/CC
-A chief complaint must be identified first.
-Includes all medical diseases that may possibly explain problem/ CC.
-The differential diagnosis list should begin with the most likely explanation or
etiology for the problem/CC. EX: C/O vomiting blood: 1. Peptic ulcer 2.Cirrhosis
with bleeding esophageal varices 3. Acute hemorrhagic gastritis
-Differential diagnostic procedures are used by clinicians to diagnose the specific
disease in a patient, or, at least, to eliminate any imminently life-threatening
conditions. The differential diagnosis list is similar to, but different from, the
problem list.
-The differential diagnosis includes all of the medical diseases that may possibly
explain the patient’s chief complaint or principal problem
-A differential diagnosis list is focused on providing an explanation for a specific
complaint.
-In order to develop a differential list versus a problem list, you must first identify
the chief complaint. Each differential diagnosis should offer an explanation or
etiology for the same chief complaint.
Pathological and Physiological Processes
,Pathologic Process- patient complaints often stem from a pathologic process
involving diseases of a body system or structure. Common Classified: congenital,
inflammatory or infectious, immunologic, neoplastic, metabolic, nutritional,
degenerative, vascular, traumatic, and toxic.
Example: Possible pathological causes of a headache include- sinus infection,
concussion from trauma, subarachnoid hemorrhage, or brain tumor.
Problem List
-After you complete the clinical record, it is good clinical practice to generate a
problem list that summarizes the patient’s problems that can be placed in the
front of the office or hospital chart.
-List the most active and serious problems first
and record their date of onset.
- Helps to individualize the patient’s care. On follow-up
visits, provides a quick summary of the patient’s clinical history
and a reminder to review the status of problems the patient may not mention.
-An accurate Problem List allows better population management of patients, by
using EHRs to track patients with specific problems, recall patients who are
behind on appointments, and follow up on specific issues.
-Allows other members of the health care team to learn about the patient’s health
status at a glance.
For example, in a patient who is vomiting blood and is known to have migraines
and to be diabetic, the problem list might read:
1. Hematemesis
2. Diabetes Mellitus
3. Migraine
4. Recent divorce
5. Poverty
Prioritization
Generate problem list with all problems noted, differential diagnoses should cover
all possible causes of chief complaint. Prioritize which complaints/problems are
highest priority (urgent) for this visit. (i.e., Tina has diabetes, htn, and a slew of
other issues, but utmost importance is her foot wound and ankle pain)
, ● Chapter 1
Basic and Advanced Interviewing Techniques
Basic maximize patient's comfort, avoid unnecessary changes in position, enhance
clinical efficiency, move head to toe, examine the patient from their right side
Active listening, empathic responses, guided questioning, nonverbal
communication, validation, reassurance, partnering, summarization, transitions,
empowering the patient
Active Listening- closely attending to what the patient is communicating,
connecting to the patient’s emotional state and using verbal and nonverbal skills to
encourage the patient to expand on his or her feelings and concerns.
Empathic Responses-the capacity to identify with the patient and feel the patient’s
pain as your own, then respond in a supportive manner.
Guided Questioning- show your sustained interest in the patient’s feelings and
deepest disclosures and allows the interviewer to facilitate full communication, in
the patient’s own words, without interruption.
Non-verbal- includes eye contact, facial expression, posture, head position and
movement such as shaking or nodding, interpersonal distance, and placement of
the arms or legs-crossed, neutral, or open.
Validation- helps to affirm the legitimacy of the patient’s emotional experience.
Reassurance- an appropriate way to help the patient feel that problems have been
fully understood and are being addressed.
Partnering- building rapport with patients, express your commitment to an ongoing
relationship.
Summarization- giving a capsule summary of the patient’s story during the course
of the interview to communicate that you have been listening carefully.
Transitions- inform your patient when you are changing directions during the
interview.
Empowering the Patient- empower the patient to ask questions, express their
concerns, and probe your recommendations in order to encourage them to adopt
your advice, make lifestyle changes, or take medications as prescribed.
CHAPTER 1-17 (ALL CHAPTER INCLUDED)
Chapter 2
Clinical Decision Making ashley
Clinical decision making should be evidence based. The FNP should draw on a full
range of knowledge and experience, and read widely. Clinical decision making is
when the reading about diseases and abnormalities is most useful. By consulting
the clinical literature, you are embarking on evidence-based decision making and
clinical practice. There are five steps to generating a clinical hypotheses
1. Select the most specific and critical findings to support your
hypothesis
2. Match findings against all the conditions that can produce them.
3. Eliminate the diagnostic possibilities that fail to explain findings.
4. Weigh the competing possibilities and select the most likely
diagnosis
5. Give special attention to potentially life-threatening conditions
Once the hypothesis is made it should be tested, this may include further history
taking, testing or physical examination. The next step is to establish a working
diagnosis such as “bacterial meningitis, pneumococcal”. The final step is
developing a plan. The plan should make reference to diagnosis, treatment and
patient education. It is important to discuss your assessment with the patient
prior to finalizing the plan to ensure the patient is onboard.
Critical Thinking and Reasoning
Critical thinking- the mental process of actively and skillfully perception, analysis,
synthesis and evaluation of collected information through observation, experience
and communication that leads to a decision for action. The main critical thinking
skills in which nursing students should be exercised during their studies are critical
analysis, introductory and concluding justification, valid conclusion, distinguish
between facts and opinions, evaluation the credibility of information sources,
,clarification of concepts and recognition of conditions. Critical thinking is an
essential process for the safe, efficient and skillful nursing practice. The nursing
education programs should adopt attitudes that promote critical thinking and
mobilize the skills of critical reasoning.
Critical thinking is the disciplined, intellectual process of applying skillful
reasoning as a guide to belief or action. In nursing, critical thinking for clinical
decision-making is the ability to think in a systematic and logical manner with
openness to question and reflect on the reasoning process used to ensure safe
nursing practice and quality care. Critical thinking when developed in the
practitioner includes adherence to intellectual standards, proficiency in using
reasoning, a commitment to develop and maintain intellectual traits of the mind
and habits of thought and the competent use of thinking skills and abilities for
sound clinical judgments and safe decision-making.
Differential Diagnoses (obtained from book and week 1 review) - A list with
potential causes of patient specific problem/CC
-A chief complaint must be identified first.
-Includes all medical diseases that may possibly explain problem/ CC.
-The differential diagnosis list should begin with the most likely explanation or
etiology for the problem/CC. EX: C/O vomiting blood: 1. Peptic ulcer 2.Cirrhosis
with bleeding esophageal varices 3. Acute hemorrhagic gastritis
-Differential diagnostic procedures are used by clinicians to diagnose the specific
disease in a patient, or, at least, to eliminate any imminently life-threatening
conditions. The differential diagnosis list is similar to, but different from, the
problem list.
-The differential diagnosis includes all of the medical diseases that may possibly
explain the patient’s chief complaint or principal problem
-A differential diagnosis list is focused on providing an explanation for a specific
complaint.
-In order to develop a differential list versus a problem list, you must first identify
the chief complaint. Each differential diagnosis should offer an explanation or
etiology for the same chief complaint.
Pathological and Physiological Processes
,Pathologic Process- patient complaints often stem from a pathologic process
involving diseases of a body system or structure. Common Classified: congenital,
inflammatory or infectious, immunologic, neoplastic, metabolic, nutritional,
degenerative, vascular, traumatic, and toxic.
Example: Possible pathological causes of a headache include- sinus infection,
concussion from trauma, subarachnoid hemorrhage, or brain tumor.
Problem List
-After you complete the clinical record, it is good clinical practice to generate a
problem list that summarizes the patient’s problems that can be placed in the
front of the office or hospital chart.
-List the most active and serious problems first
and record their date of onset.
- Helps to individualize the patient’s care. On follow-up
visits, provides a quick summary of the patient’s clinical history
and a reminder to review the status of problems the patient may not mention.
-An accurate Problem List allows better population management of patients, by
using EHRs to track patients with specific problems, recall patients who are
behind on appointments, and follow up on specific issues.
-Allows other members of the health care team to learn about the patient’s health
status at a glance.
For example, in a patient who is vomiting blood and is known to have migraines
and to be diabetic, the problem list might read:
1. Hematemesis
2. Diabetes Mellitus
3. Migraine
4. Recent divorce
5. Poverty
Prioritization
Generate problem list with all problems noted, differential diagnoses should cover
all possible causes of chief complaint. Prioritize which complaints/problems are
highest priority (urgent) for this visit. (i.e., Tina has diabetes, htn, and a slew of
other issues, but utmost importance is her foot wound and ankle pain)
, ● Chapter 1
Basic and Advanced Interviewing Techniques
Basic maximize patient's comfort, avoid unnecessary changes in position, enhance
clinical efficiency, move head to toe, examine the patient from their right side
Active listening, empathic responses, guided questioning, nonverbal
communication, validation, reassurance, partnering, summarization, transitions,
empowering the patient
Active Listening- closely attending to what the patient is communicating,
connecting to the patient’s emotional state and using verbal and nonverbal skills to
encourage the patient to expand on his or her feelings and concerns.
Empathic Responses-the capacity to identify with the patient and feel the patient’s
pain as your own, then respond in a supportive manner.
Guided Questioning- show your sustained interest in the patient’s feelings and
deepest disclosures and allows the interviewer to facilitate full communication, in
the patient’s own words, without interruption.
Non-verbal- includes eye contact, facial expression, posture, head position and
movement such as shaking or nodding, interpersonal distance, and placement of
the arms or legs-crossed, neutral, or open.
Validation- helps to affirm the legitimacy of the patient’s emotional experience.
Reassurance- an appropriate way to help the patient feel that problems have been
fully understood and are being addressed.
Partnering- building rapport with patients, express your commitment to an ongoing
relationship.
Summarization- giving a capsule summary of the patient’s story during the course
of the interview to communicate that you have been listening carefully.
Transitions- inform your patient when you are changing directions during the
interview.
Empowering the Patient- empower the patient to ask questions, express their
concerns, and probe your recommendations in order to encourage them to adopt
your advice, make lifestyle changes, or take medications as prescribed.
