Fundies Chap 18

Front 1

PLANNING involves setting priorities, identifying pt-centered go____, expected outcomes, and prescribing indiv____ nursing interventions.

Back 1

goals
individualized

Front 2

PRIORITY SETTING is the ordering of nursing diagnoses or pt problems using determi++++ of urgency and or importance to establish a preferential order of nursing actions.

Back 2

determinations

Front 3

Priorities help you to anticipate seq)))))) nursing interventions

Back 3

sequence

Front 4

Nurses also prioritize on the basis of ti____

Back 4

time

Front 5

Classify a pt's priorities as high, intermediate, or _____ importance

Back 5

low

Front 6

Intermediate priority nursing diagnoses involve nonemer_____ nonlife threatening needs of pt

Back 6

nonemergent

Front 7

Low- priority nursing diagnoses are not always directly related to a specific ill____ or diagnosis but affect pts future well being.

Back 7

illness

Front 8

The order of prior++++ changes as the pt's cond changes

Back 8

priorities

Front 9

also need to prioritize the specific interventions or strategies that you will use to help a pt achieve desired goals and out_____

Back 9

comes

Front 10

Critical thinking helps to prio_____

Back 10

prioritize

Front 11

Involve pts in prioritization whenever poss____

Back 11

possible

Front 12

Resolve any conflicting values concerning health care needs and with open communication and informing pt of all opt____

Back 12

options

Front 13

Ethical care is a part of priority set____
Open dialogue with the pt, fam, and other health care providers when ethical issues make priorities less cle____

Back 13

setting.
clear

Front 14

A MODEL FOR PRIORITY SETTING- Assess pt, Identify problems, Prioritize prob___, Identify desired outcomes, Identify interventions or Achieve outcomes, Deliver pt care, Evaluate interventions

Back 14

problems

Front 15

A MODEL FOR PRIORITY SETTING- FACTORS THAT AFFECT- Experience and expe++++ of nurse, pt acuity, availability of resources, interruptions from care providers, nurse-pt relationship, ward organization, priority setting strategies and frameworks, philosophies and models of care

Back 15

expertise

Front 16

PRIORITIES IN PRACTICE- Interruptions and availabitiy of resources; shifting of att_____

Back 16

attention

Front 17

CRITICAL THINKING IN SETTING GOALS AND EXPECTED OUTCOMES: Goals and expected outcomes are specific statements of pt behav or physicolog resp that you set to resolve a nursing dia_____ or collab prob.

Back 17

diagnosis

Front 18

Nursing actions based on clinical judgment and knowledge to enhance client outcomes.

Back 18

Nursing Interventions

Front 19

DURING PLANNING, you select goals and out++++ for each nursing diagnosis to provide a clear focus for the types of interventions needed for your pt.

Back 19

outcomes

Front 20

A GOAL is a broad statement that describes a desired ch+++++ in the pts condition or behavior.

Back 20

change

Front 21

AN EXPECTED OUTCOME is a measureable criterion to evaluate goal ach______

Back 21

achievement

Front 22

Sometimes several expected outcomes for a single go++++. SPECIFIC, SINGULAR, MEASURABLE, and TIME LIMITED

Back 22

goal

Front 23

CRITICAL THINKING AND PROCESS OF PLANNED CARE: EXPERIENCE; Previous PT care experience, Personalized exp in org______ activities

Back 23

organized

Front 24

A guide for clinical care to enhance the continuity of nursing.

Back 24

Nursing Care Plan

Front 25

CRITICAL THINKING AND PROCESS OF PLANNED CARE: ATTITUDES- Creativity, Responsibilaty, Perser______, and Discipline

Back 25

Perserverence

Front 26

CRITICAL THINKING AND PROCESS OF PLANNED CARE: STANDARDS- ANA Scope of Nursing Practice, Patient-centered goals and out______, intellectual standards, and agency policies and procedures

Back 26

outcomes

Front 27

CRITICAL THINKING AND PROCESS OF PLANNED CARE: STANDARDS- KNOWLEGE- Pt database and selected diagnoses; anatomy and phys; psych; pathophysi; normal growth and dev; comm resources; teaching; delegation principles; priority-set))))))

Back 27

setting

Front 28

A patient-centered goal reflects a pt's highest possible level of wellness and indepen++++ in function.

Back 28

independence

Front 29

Each patient-centered goal is time-li++++. Time frame depends on the nature of the prob, etiology, overall condition of the pt and tx set++++

Back 29

time-limited
setting

Front 30

A SHORT-TERM GOAL is an objective behav or response that you expect a pt to achieve in a short time, usually less than a We____

Back 30

week

Front 31

Always partner with pt when setting their individualized go+++ Mutual goal setting includes pt and fam when appropriate. For pts to participate in goal setting they must be alert and and have some deg of indep+++_+_ in completing ADLS. When setting goals, act as an advocate or support person.

Back 31

goals
independence

Front 32

An EXPECTED OUTCOME is a specific measu++++ change in a pt's status that you expect to occur in response to nursing care.

Back 32

measurable

Front 33

Usually develop several expected outcomes for each nursing diagnosis and goal because sometimes one nursing action is not enough to resolve a pt prob___.

Back 33

problem

Front 34

A list of step by step outcomes gives you practical guidance in planning interv_____

Back 34

interventions

Front 35

Always write expected outcomes seq____ with time frames

Back 35

sequentially

Front 36

Time frames give you progressive steps in which to move a pt toward rec_____and offer an order for nursing interventions. Set time limits for problem resolution.

Back 36

recovery

Front 37

A nursing-sensitive patient outcome is a measurable patient, fam, community, state, behav, or perception largely influenced by and sensitive to nursing inter____

Back 37

interventions

Front 38

Iowa NOC Nursing Out_____ Classification and linked to NANDA

Back 38

outcomes

Front 39

GUIDELINES FOR WRITING GOALS AND EXPECTED OUTCOMES Patient=Centered- Outcomes and go____ reflect pt behaviors and responses as a result of nursing interventions

Back 39

goals

Front 40

NURSING DIAG: Deficit Knowledge RELATED NOC: Knowledge of Tx Procedures OUTCOME INDICATORS: Description of steps in tx proc_____

Back 40

procedure

Front 41

NURSING DIAG: Deficit Knowledge NOC: Knowledge of DISEASE PROCESS; OUT)))))) INDICATORS: Effects of Disease

Back 41

Outcome

Front 42

NURSING DIAG: Activity Imbalance NOC: ACTIVITY TOLERANCE; OUTCOME INDICATORS: Pulse rate with acti)))))))

Back 42

activity

Front 43

SINGULAR GOAL OR OUTCOME- Precisely evaluate only goal or resp____

Back 43

response

Front 44

A goal contains only ____ behavior or response.

Back 44

one

Front 45

Goals= You need to be able to observe if change takes place in pt sta____

Back 45

status

Front 46

GOALS SHOULD BE OBSERVABLE, MEASUREABLE, TIME- LIM_____, and REALISTIC

Back 46

time-limited

Front 47

Learn to write goals and expected outcomes that set standards against which to measure the pts response to nursing ca_____

Back 47

care

Front 48

The time frame for each goal and expected outcome indicates when you expect the res_____ to occur.

Back 48

response

Front 49

MUTUAL FACTORS Mutually set goals and expected outcomes ensure that the pt and nurse agree on the direction and time lim____ of care.

Back 49

limits

Front 50

REALISTIC- Set goals and expected outcomes that a pt is able to reach based on your assess_____

Back 50

assessment

Front 51

CRITICAL THINKING IN PLANNING Nursing interventions are treat_____ or actions based on clinical knowledge and judgement that nurses perform to meet outcomes.

Back 51

treatments

Front 52

Choose interventions in planning and implement in IMPLE______ phase.

Back 52

implementation

Front 53

There are 3 types of interventions: nurse-iniated, phys____-initiated, and collaborative.

Back 53

physician

Front 54

Nurse- intiatied by ___

Back 54

RN

Front 55

Physician initiated interventions are dependent nursing interventions that require order from physican or other health prof_____ Based on physician's need to treat a medical diagnosis

Back 55

professional

Front 56

Advanced practice RNS who work under collaborative agreements with physicians or who are licensed indep by state are also able to write dep_____ interventions.

Back 56

dependent

Front 57

Each physician initiated intervention req know+++++ and skill.

Back 57

knowledge

Front 58

COLLABORATIVE INTERVENTIONS= conference of interdisciplinary team= require the combined skill of multiple health care prof______

Back 58

professionals

Front 59

Do not implement physician or collaborate without deciding if app______

Back 59

appropriate

Front 60

FACTORS OF INTERVENTIONS- characteristics of the nursing diag______

Back 60

diagnosis

Front 61

FACTORS OF INTERVENTIONS-goals and expected out_____

Back 61

comes

Front 62

FACTORS OF INTERVENTIONS-evidence ba____

Back 62

base

Front 63

FACTORS OF INTERVENTIONS- feasiblity of the inter____

Back 63

intervention

Front 64

FACTORS OF INTERVENTIONS-accep____ to the pt

Back 64

acceptability

Front 65

NBC Iowa dev a set of nursing inter_____ Domain is the highest level of the model. Then classes, then interventions

Back 65

interventions

Front 66

Interventions should alter the etiological or RELATED FACTOR or signs and symptoms associated with the diagno_____ label.

Back 66

diagnostic

Front 67

When an etiological factor cannot change, direct the interventions toward treating the sig___ and symptoms for a diagnosis.

Back 67

signs

Front 68

For potential or high risk diagnoses, direct interventions or altering or eliminating risk fac)))) for the diagnosis.

Back 68

factors

Front 69

EXPECTED OUTCOMES- State outcomes in terms used to evaluate the effect of an interv))))))

Back 69

intervention

Front 70

RESEARCH BASE- supportive research evidence and when not available use scient____ principles.

Back 70

scientific

Front 71

FEASIBILITY- A specific intervention has the potential to interact with other interv_____. Be knowledgeable about total plan of care. Are time and personal resources available?

Back 71

interventions

Front 72

ACCEPT to the PT- A tx plan needs to be acceptable to the pt and fam and match the pts goals, values, and cultures. Promote infor_____ choice.

Back 72

informed

Front 73

CAPABILITY OF THE NURSE- Be prepared to carry out. Have the necessary psychosocial and psychomotor skills to carrry out. Be able to function effec____ and efficiently.

Back 73

effectively

Front 74

EX of Intervention: Physical Comfort Promotion Many interventions: aromatherapy cutaneous stim_____, Ex of linked Nursing Diagnoses: acute pain and chronic pain.

Back 74

stimulation

Front 75

Plan of care may be nursing KARDEX, standardized care plans, or comput____ plans.

Back 75

computerized

Front 76

A nursing care plan diagnoses, goals, and/or expe___ outcomes, specific nursing interventions and evaluation.

Back 76

expected

Front 77

Interdisciplinary care plans for multiple prov____

Back 77

providers

Front 78

Nursing care plan enhances the continuity of ca____

Back 78

care

Front 79

The change of shift report is the standard prac___ used for off going nurses leaving a shift to commun info.

Back 79

practice

Front 80

Activities at change of shift called nursing hand____

Back 80

handoff

Front 81

STUDENT CARE PLANS- to learn problem solving techniques, nursing process, skills of written comm_____, and organizational skills needed for nursing care.

Back 81

communication

Front 82

Write a care plan for each nursing ___

Back 82

diagnosis

Front 83

SIX COLUMN PLAN= assess, diagn, intervent, planning, and evalu Expected out____ and rationales

Back 83

outcomes

Front 84

Keep handoff report pt centered and concise. Standardize and include pt and fam. Complexity of pts and high pt case ______

Back 84

load

Front 85

Each scientific ref that you use to support a rationale should include a ref)))_)

Back 85

reference

Front 86

Community Based Settings= More comprehensive comm, home, and fam))))) assessment. Design a plan to educate the fam/pt about the necessary care tech____ and precautions. 2 how to integrate care with fam activities 3. guide the pt/fam to assume a greater percentage of care over time

Back 86

family
techniques

Front 87

Critical care pathways are pt care management plans that provide multidis____ health care teams with activities and tasks to be put into place sequentially. Main purpose timely care specific pt.

Back 87

multidisciplinary

Front 88

Critical care pathways defines trans___ points and draws a cooordinated map of activities

Back 88

transition

Front 89

Consultation is a process by which you seek the exp____ of a specialist .

Back 89

expertise

Front 90

Consultation occurs when id a problem you cannot ))))))

Back 90

solve

Front 91

Ordering of nursing diagnoses or patient problems uses determinations of urgency and/or importance to establish a preferential order for nursing actions.
Helps nurses anticipate and sequence nursing interventions
Classification of priorities:
High—EmerG_____
Intermediate
Low—Affect patients’ future well-being

Back 91

EMERGENT

Front 92

The order of priorities CH________ as a patient’s condition changes.

Back 92

CHANGES

Front 93

Priority setting begins at a hol____ level when you identify and prioritize a patient’s main diagnoses or problems.

Back 93

HOLISTIC

Front 94

Patient-centered care requires you to know a patient’s pref______, values, and expressed needs.

Back 94

PREFERENCES

Front 95

Ethical care is a part of prio___ setting.

Back 95

PRIORITY

Front 96

NURSE PT RELATIONSHIP AFFECTED BY : EXPERTISE OF NURSE; ACCUTIY OF PT; AVAILABILITY OF RESOURCES; INTERRUTPION BY CARE PROV____; WARD ORGANIZATION; MODELS OF CARE: PRIORITY SETTING

Back 96

PROVIDERS

Front 97

ASSESS PROB
IDENTIFY PROB
PRIORITIZE PROB
IDENTIFY DESIRED OUT++++
IDENTIFY INTERVENTIONS
DELIVER PT CARE
EVALUATE

Back 97

OUTCOMES

Front 98

Goal
A broad statE+++++ that describes the desired change in a patient’s condition or behavior
An aim, intent, or end
Expected outcome
Measurable criteria to evaluate goal achievement

Back 98

STATEMENT

Front 99

GOALS: Always part++++ with patients when setting their individualized goals.

Back 99

PARTNER

Front 100

GOAL SETTING:For patients to participate in goal setting, they need to be aleR___ and must have some degree of independence in completing activities of daily living, problem solving, and decision making.

Back 100

ALERT

Front 101

Patients need to underST___ and see the value of nursing therapies, even though they are often totally dependent on you as the nurse.

Back 101

UNDERSTAND

Front 102

GOALS OR EXPECTED OUTCOMES: Are written sequE____, with time frames
Usually, several are developed for each nursing diagnosis and goal.

Back 102

SEQUENTIALLY

Front 103

GOALS OR EXPECTED OUTCOMES: An objective criterion for goal achievement
A specific, meas____ change in a patient’s status that you expect in response to nursing care
Direct nursing care

Back 103

MEASUREABLE

Front 104

A nursing-sensitive patient outcome is a measurable patient, family, or comm____ state, behavior, or perception largely influenced by and sensitive to nursing interventions.

Back 104

COMMUNITY

Front 105

The Iowa Intervention Project published the Nursing Outcomes Classification (NOC) and linked the out____to NANDA International nursing diagnoses.NOC outcomes provide a common nursing language for continuity of care and measuring the success of nursing interv____.

Back 105

OUTCOMES
INTERVENTIONS

Front 106

SEVEN GUIDELINES FOR WRITING GOALS: 1.PT-CENTERED
2. SINGULAR GOAL OR OUT____; 3. OBSERVABLE 4. MEASUREABLE; 5. TIME- LIM___6. MUTUAL FACTORS; 7. REALISTIC

Back 106

OUTCOME
TIME-LIMITED

Front 107

Nursing interventions are treaT____ or actions based on clinical judgment and knowledge that nurses perform to meet patient outcomes.

Back 107

TREATMENTS

Front 108

Nurses need to:
Know the scientific rationale for the intervention
Possess the necessary psychom____ and interpersonal skills Be able to function within a setting to use health care resources effectively

Back 108

PSYCHOMOTOR

Front 109

TYPES OF INTERVENTIONS: NURSE INITIATED; PHYSICIAN- INIT_____; AND COLLABORATIVE

Back 109

PHYSICIAN INITIATED

Front 110

Nurse initiated
Independent—Actions that a nurse initiates
Physician initiated
Dependent—Require an order from a physician or other health care professional
Collaborative
Inter________—Require combined knowledge, skill, and expertise of multiple health care professionals

Back 110

INTERDEPENDENT

Front 111

SIX FACTORS TO CONSIDER IN NURSING INTERVENTIONS: Characteristics of nursing diagnosis
Goals and expected outcomes
Evidence base for interventions
Feasibility of the interventions
Accept_____ to the patient
Nurse’s competency

Back 111

ACCEPTABILITY TO PT

Front 112

Nursing care plan = Nursing diagnoses, goals and expected outcomes, and nursing interventions, and a section for evaluation findings so any nurse is able to quickly identify a patient’s clinical needs and situation
Reduces the risk for incoM____, incorrect, or inaccurate care
Changes as the patient’s problems and status change
Interdisciplinary care plan = Contributions from all disciplines involved in patient care.

Back 112

INCOMPLETE

Front 113

Planning involves consultation with members of the health care team.
Consultation is a process by which you seek the expertise of a specialist such as your nursing instructor, a physician, or a clinical nurse educator to identify ways to handle problems in patient management or in planning and implementation of therapies.
Consultation occurs at any st__ in the nursing process, most often during planning and implementation.

Back 113

STEP

Front 114

A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes.
Interventions include direct and in_____ care measures aimed at individuals, families, and/or the community.

Back 114

INDIRECT

Front 115

Protocols and Standing Orders
STANDING ORDERS ARE: A preprinted document containing orders for the conduct of routine therapies, monit____- guidelines, and/or diagnostic procedures for specific patients with identified clinical
problems

Back 115

MONITORING

Front 116

Protocols and Standing Orders
Guidelines & Protocols
Systematically developed
set of statements that helps nurses, physicians, and other health care proviD_____ make decisions about appropriate health
care for specific clinical situations

Back 116

PROVIDERS

Front 117

IMPLEMENTATION PROCESS
Reassessing the patient
Reviewing and revis_____ the existent care plan
Organizing resources and care delivery
Anticipating and preventing complications

Back 117

REVISING

Front 118

Implementation Skills
Cognitive skills
Application of critical thinking in the nursing process
Interpersonal skills
Developing a trusting relationship, expressing a level of caring, and communicating clearly with a patient and his or her family
Psychomotor skills
Integr_____ of cognitive and motor activities

Back 118

INTEGRATION

Front 119

DIRECT CARE: Treatments performed through interacT_____ with patients
Examples:
-Medication administration
-Insertion of an intravenous (IV) infusion
-Counseling during a time of grief

Back 119

INTERACTIONS

Front 120

INDIRECT CARE:
Treatments performed away from the patient but on behalf of the
patient or group of patients
-Managing the patient’s environ______ (e.g., safety and infection control)
-Documentation
-Interdisciplinary collaboration

Back 120

ENVIRONMENT

Front 121

ACHIEVING PT GOALS
Nurses implement care to meet patient goals.
At times, multiple interv______ may be needed.
Priorities help nurses to anticipate and sequence nursing interventions.
Patient adherence means that patients and families invest time in carrying out required treatments.

Back 121

INTERVENTIONS

Front 122

CRITICAL THINKING AND EVALUATION
Evaluation is an ongoing process.
If outcomes are met, patient go____ are met.
Positive evaluations occur when nurses meet desired outcomes.
Positive evaluations lead nurses to conclude that interventions were successful.

Back 122

GOALS

Front 123

Standards for Evalu_____:
Resolve actual health problems
Prevent potential problems
Maintain a healthy state

Back 123

EVALUATION

Front 124

CRITERION BASED STANDARDS Criterion-based standards for evaluation are the
physiol+++++, emotional, and behavioral responses that are a patient’s goals and expected outcomes.

Back 124

PHYSIOLOGICAL

Front 125

Collaborate and Evaluate Effect______ of Interventions
Collaborate with the patient and family.
Use evaluative measures.
Interpret and summarize findings.
Document results.
Revise care plan.

Back 125

EFFECTIVENESS

Front 126

Revising a care plan:
Has the goal been met?
Does the patient agree?
Document the discont----- plan.

Back 126

DISCONTINUED

Front 127

PLANNING INVOLVES: IDENTIFYING PT-CENTERED GOALS AND EXPECTED OUT____ PRESCRIBING INDIVIDUALIZED NURSING INTERV____

Back 127

OUTCOMES
INTERVENTIONS

Front 128

HIGH PRIORITY- IF UNTREATED, RESULT IN HARM TO PT OR OTH____ EMERGENT

Back 128

OTHERS

Front 129

INTERMEDIATE PRIORITY- NONEMERG____, NONTHREATENING, NEEDS OF PT

Back 129

NONEMERGENT

Front 130

LOW PRIORITY- NOT ALWAYS DIRECTLY RELATED TO A SPECIFIC ILL____ OR PROGNOSIS

Back 130

ILLNESS

Front 131

INDEPENDENT NURSING INTERVENTIONS ARE NURSE-INIT----- INTERVENTIONS THAT DO NOT REQUIRE DIRECTIONS OR AN ORDER FROM ANOTHER HEALTH PROFESSIONAL

Back 131

INITIATED

Front 132

DEPENDENT NURSING INTERVENTIONS- ARE PHYSICIAN INITIATED INTERVENTIONS THAT REQUIRE ORDER FROM PHYS_____ OR OTHER HEALTH PROFESSIONAL

Back 132

PHYSICIAN

Front 133

NURSING CARE PLAN LISTS THE INTERV____ INTENDED TO ACHIEVE THE GOALS OF CARE. IT IDENTIFIES AND COORDINATES RESOURCES FOR DELIVERING CARE.

Back 133

INTERVENTIONS

Front 134

NURSING HANDOFF- NURSES COLLAB____ AND SHARE INFORMATION THAT ENSURES CONTINUITY OF CARE AND PREVENTS ERRORS AND DELAYS.

Back 134

COLLABORATE

Front 135

CRITICAL PATHWAYS ARE PT CARE AND MANAGEMENT PLANS THAT PROVIDE MULTIDISCIPLINARY HEALTH CARE TEAM ACTIVITES AND TASKS TO PUT INTO PRACTICE SEQ______. GOAL IS TO PROVIDE TIMELY CARE AT EACH PHASE OF PROCESS FOR SPECIFIC PT

Back 135

SEQUENTIALLY