Nursing Practice: Critical Thinking, Clinical Judgment, and Nursing Diagnosis, Exams of Nursing

Download Nursing Practice: Critical Thinking, Clinical Judgment, and Nursing Diagnosis and more Exams Nursing in PDF only on Docsity!

PPNC Exam 2 Questions with Answers All Perfectly

Solved

1. factors that commonly affect urinary elimination: Renal diseases, liquid in- take, age, medications
2. urinary retention: inability to empty bladder partially or completely can be due to blockage, muscle issues, Habits, surgery, medications, trauma may result in urinary leakage
3. urinary retention test: bladder scan / ultrasound with PVR
4. urinary tract infection (UTI): infection in the urine Risk factors - catheter (catheter- associated uti - CAUTI) Symptoms - polyuria, painful urination, blood in urine, cloudy urine, confusion, fatigue decrease appetite, fever Most common HAI
5. UTI most commonly caused by: e.coli due to stool and wiping back to front
6. UTI test: Test: urinalysis and culture/sensitivity
7. transient urinary incontinence: reversible - caused by medical condition, anes- thesia, narcotics, etc

8. urinary incontinence: Not able to control pee, lack of bladder control
9. functional urinary incontinence: caused by Mobility concerns, environmental barriers, sensory and cognitive impairment
10. overflow urinary incontinence: Bladder so full it starts leaking, elevated PVR (post void residual - They went to bathroom and bladder scan, there is still a lot of urine there, didnt empty urine fully)
11. stress urinary incontinence: involuntary discharge of urine during coughing, straining, or sudden movements happens when walking, exercising, moving too quick, laughing - women who have had kids can have this
12. reflex urinary incontinence: caused by spinal cord injury
13. urine culture: identifies microorganism in a urine sample and the specific an- tibiotic that will treat it Needs to be as clean as possible Clean perineal area very well from labia majora to labia minora to middle Catch urine midstream by peeing then stopping and sliding cup under and peeing again
14. urine dipstick: test that measures glucose, ketones, protein, leukocytes and other substances in the urine

al

16. creatine clearance test: measure of kidney function that examines the rate of creatine excreted in the urine
17. renal ultrasound: assess the size, shape, and location of the kidneys and bladder
18. kidney function blood tests: checks BUN, creatinine, and BUN/creatinine ratio

• all indicators of kidney function

19. cues associated with altered urinary elimination: anesthesia, medication side effects, surgery, immobility, IV, supine position, palpate distended bladder
20. ways to promote normal urination: privacy, running water, hands in warm water, place urinal close by, assist if able to stand
21. important tests for CAUTI/UTI: Urinalysis and culture/sensitivity
22. CAUTI: catheter associated urinary tract infection
23. prevent UTI: proper hygiene of perineal area and catheter. (always clean clean to dirty)
24. fluid volume deficit: body fluids have decreased volume but norm Sodium and water intake less than output causing isotonic loss

25. causes of fluid volume deficit: Can be caused by increased GI or renal output, loss of blood or plasma, severely decreased oral intake of water and salt, massive sweating
26. fluid volume excess (FVE): Body fluids have increased volume, but normal osmolality Sodium and water intake greater than output, causing isotonic gain
27. causes of fluid volume excess: Can be caused by excessive administration of oral intake of salty foods in water or Na+ containing isotonic IV fluids, renal retention of Na+ and water
28. clinical dehydration: ECV deficit with hypernatremia Body fluids have decreased volume and are too concentrated Sodium and water intake less then output with loss of more water than salt
29. causes of clinical dehydration: Can be caused by increased GI or renal output, loss of blood or plasma, severely decreased oral intake of water and salt, massive sweating, poor or no water intake, fever causing

33. Respiratory Alkalosis: Deficient Carbonic Acid Caused by Alveolar Hyperven- tilation
34. Metabolic Acidosis: Excessive Metabolic Acids ex) ketoacidosis
35. Metabolic Alkalosis: Deficient Metabolic Acids
36. hypovolemic: low blood volume - not enough fluids
37. Hypervolemia: increased blood volume - too much fluids
38. what organs help with the acid-base balance: lungs and kidneys
39. normal PaCO2 levels: 35-45 mmHg
40. higher PaCO2 means: acidosis
41. lower PaCo2 means: alkalosis
42. factors that impact bowel elimination: Anesthesia, immobility, dehydration, diet, medications, personal habits, age
43. constipation: Infrequent bowel movements (fewer than 3 a week), hard, dry stools that are hard to pass
44. constipation causes: irregular bowel habits, ignoring urge to defecate, chronic illnesses, low-fiber diets, low fluid intake, stress, physical inactivity, medication, pregnant, aging, travel, neurological conditions, chromic bowel dysfunction

45. impaction: Unrelieved constipation and is unable to expel hardened feces re- tained in the rectum Suspect impaction when a continuous oozing of liquid stool occurs
46. diarrhea: an increase in the number of stools and the passage of liquid, un- formed feces, intetines cant absorob fluid and nutrients associated with disorders affecting digestion, absorption, and secretion in the GI tract Worry about dehydration, skin breakdown (feces is very acidic)
47. diarrhea causes: infection, food intolerances, surgical resections
48. diarrhea effects: weight loss impact on nutrition, dehydration, skin break down, acid-base imbalances, fluid-electrolyte imbalances
49. diarrhea interventions: treat underlying cause, dietary change, medication
50. small bowel: absorbs nutrients
51. large bowel: water and electrolyte and vitamins absorption, propel feces
52. bowel incontinence: inability to control the passage of feces and gas from the anus.
53. fecal management system: indwelling rectal catheter held in place

60. stool cultures: Looks for bacterial or parasitic causes of diarrhea
61. endoscopy: Use a lighted fiberoptic tube to gain direct visualization of the upper GI tract (upper endoscopy) or large intestine (colonoscopy). Remove any polyps and biopsies done
62. barium swallow: An x-ray film examination using an opaque contrast medium (barium, which is swallowed) to examine the structure and motility of the upper GI tract, including pharynx, esophagus, and stomach.
63. cues of altered bowel elimination: Constipation, Impaction, Diarrhea, Inconti- nence, Pain
64. interventions that promote normal bowel elimination: eating a high-fiber diet that includes whole grains and an adequate daily fluid intake take time for defecation
65. implementation: the "carrying out" of the specific, individualized, jointly agreed-on interventions in the plan of care. (the point at which you are actually giving nursing care) Reflects direct and indirect care Health care provider

initiated

66. Explain the relationship between critical thinking and clinical judgment in nursing practice: Nurses uses critical thinking in order to make clinical judgement and create appropriate solutions towards a patients goals/needs. Clinical judgments made by thinking critically and making sound decisions are at the core of professional nursing competence.
67. basic problem solving: Identify the issue, figure out why it happened, and determine course of action Obtain info that clarifies the nature of a problem, suggest possible solutions, and try the solution over time and evaluate the effect. Solution = action for a problem = return to a stable condition
68. diagnostic reasoning: This is a form of decision making - understand and think through clinical problems, gather info, analyze cues, understand evidence, know when enough info is sufficient to make diagnosis.
69. data assessment: Observe patterns and

and clinical judgment: Recognize and analyze cues during assessment to aid in clinical decision making Having an accurate and complete database about a patient allows you to make a clinical judgment in the form of a nursing diagnosis

79. objective data: Assessment data, vital signs diagnostic test results, lab result, height/weight, intake, output data, medications
80. subjective data: Patient responses, pain
81. observation interview technique: Observe a patient's verbal and nonverbal behaviors Observe level of functioning
82. direct closed-ended questions interview technique: utilizing direct questions to seek specific information
83. probing interview technique: encourage a full description without trying to control a story's direction ex) "Is there anything else you can tell me?" or "What else is bothering you?"
84. backchanneling interview technique: active listening prompts such as "all right," "go on," or "uh-huh.

Shows interest and encourages more details

85. Recognize, validate, and confirm cues collected during an assessment: - Validation of assessment data is the comparison of data with another source to determine data accuracy. Ex - Tonya observed an open inflamed area of the patient's surgical incision and then validated by measuring the patient's body temperature
86. NANDA-I diagnosis: nurse educators recognized that assessment data needed to be analyzed and clustered into patterns and interpreted before nurses could make accurate nursing diagnoses provides standard, formal diagnostic statements includes 244 diagnoses
87. NANDA-I diagnosis goals: Provide a precise definition of a patient's human responses to health problems and life processes. Develop, refine, and disseminate evidence-based terminology representing clinical judgments by professional nurses. Allow nurses to communicate (e.g., verbally and in writing) a plan of care among themselves and with other health care professionals and the public.

labels describing similar responses to health conditions." NANDA has 244 diagnoses, these statements are already made and provides standard formal diagnostic statements w specific characteristics and definitions ICNP has multiacial terminololy form 7 axes with words with definitions that you combine to create a nursing diagnosis

90. problem-focused diagnosis (NANDA-I): identify an undesirable human re- sponse to existing problems or concerns of a patient ex) acute pain, urinary retension
91. 3 parts to formulating a problem-focused diagnostic statement using NAN- DA-I system: diagnostic label - the name of a nursing diagnosis approved by NANDA-I, related factors - etiologies, circumstances, facts, or influences that have a relation- ship with the nursing diagnosis ex) lack of knowlege major defining characteristics - optional, for further clarify ex) Lack of Knowledge regarding postoperative care related to

inexperience with surgery as evidenced by frequent queries about postoperative routines

92. risk diagnosis (NANDA-I): apply when there is an increased potential or vulner- ability for a patient to develop a problem or complication ex) RIsk for Unstable blood pressure 93. 2 parts to formulating a risk diagnostic statement using NANDA-I system- : Diagnosis associated risk factor, "related to"
93. health promotion NANDA-I: identify the desire or motivation to improve health status through a positive behavioral change ex) readiness for enhanced relationship
94. data clusters: critically organizing all data elements about a patient into mean- ingful patterns Helps to begin to shape a more formal label or description ex) A patient who reports having no immediate family, who does not initiate conver- sation, and who just lost his vision shows a coping problem pattern.
95. establishing priorities: Priority setting is the ordering of nursing

100. descriptive vs prescriptive theories: Descriptive Theory -Describe a specific phenomenon -Identify circumstances in which the phenomenon occur Prescriptive Theory -Used to anticipate the outcomes of nursing interventions -Doing rather than describing, guides practice change and directs nursing actions toward an explicit goal
101. Practice-Level Theories: Situation-specific theories - narrow in scope and focus applies theory to the bedside
102. Grand Theories: Complex, broad and abstract concepts. Address the nursing paradigm
103. Middle Range Theories: Less abstract Expand on specific concepts of phenomenon - addresses a specific phenomenon and reflects practice
104. Discuss the purpose of Nursing theory.: -Used as a foundational framework for nursing care -Explain relationship to variables -Provide rationales for how and why nurses execute interventions

-Serve as predictors for patient behaviors and outcomes

105. Describe concepts of teaching and learning.: cognitive- understanding (ed- ucation) Affective-attitudes Psychomotor domain- motor skills
106. standardized intervention: allow nurses to deliver the most clinically effective care to improve patient outcomes captures patient care information that can be shared across disciplines and care