Exam (elaborations) RNSG 1137/RNSG 1137 Final BP. Lone Star College

RNSG 1137 Final BP. Lone Star College. 1. Clinical Judgement. When to contact a provider:  When pt.’s status deteriorates or need for new orders 2. Clinical Judgement. Maslow’s Hierarchy of Needs:  (Top) Self-actualization: need for one to meet their full potential through development of their unique capabilities  Esteem & Self-respect  Belonging & affection (love)  Safety & security: physical and emotional protection  (Bottom) Physiologic needs: O2, water, food, rest, activity 3. Clinical Judgement. Secondary health promotion:  Primary: Prevention (Ex: diet/weight loss)  Secondary: Screening (Ex: BP, cholesterol, skin check, etc.)  Tertiary: Treatment (Ex: medication, surgery) 4. Clinical Judgement. Components of critical thinking:  Identify priorities  Gather, validate, compare, analyze pertinent data  Utilize logical thinking  Knowledge and intuitive thinking  Maintain flexible attitude  Utilize inductive and deductive reasoning  Formulate decisions  Demonstrate personal humility  Exhibit courage to seek new, innovative approaches to patient centered care  Inquisitive exploration, “think-out-of-the-box” 5. Clinical Judgement. Common areas of nursing advocacy:  End-of-life decisions  Technological advances  Health-care reimbursement  Access to health care  Transitions in health care  Provider- patient conflicts re: expectations and desired outcomes, withholding info or blatant lying to patients  Insurance auths/denials/delays in coverage  Medical errors  Patient info disclosure  Patient grievance and appeals  Cultural and ethnic diversity  Respect for patient diversity  Inadequate consents  Incompetent health-care providers  Complex social problems (Ex: AIDS, teenage pregnancy, violence, poverty, aging population) 6. Clinical Judgement. Urgent/emergent situation- priority nursing action:  Early identification of potential bleeding source  Prompt action to minimize blood loss  Restore tissue perfusion  Achieve hemodynamic stability  Admin IV fluids, o2, blood products, meds as ordered o S/S of hemorrhage/shock:  Rapid/shallow respirations  Crackles  Pulmonary edema  Alveolar collapse  Dysrhythmia  Tachycardia  Chest pain  MI  Acute kidney injury  Systolic BP 90 or decrease in systolic BP of 40mmHg from baseline 7. Clinical Judgement. Tanner’s clinical judgement model:  Noticing (context, background, relationship, expectations, initial grasp)  Interpreting (reasoning, patterns, analytic, intuitive, narrative)  Responding (action)  Reflection-in-action (nurse’s ability to read the patient, how he/she is responding to the intervention)  Reflection-on-action (what nurses gain from their experience)