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20 Cards in this Set

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Purpose of Nursing Diagnoses: (5)
-contribute to the professional status of the discipline
-provide a means for effective communication
-facilitate holistic client, family, & community focused care
-provide a means to individualize nursing care
-provide a potential avenue for theory development and nursing research
Types of nursing diagnoses: (5)
-diagnostic label
-definition
-defining characteristics
-risk factors
-related factors
Components of nursing diagnosis: (2)
-two part statement
--diagnostic label
-- etiology
-three part statement
-- diagnostic label
-- etiology
-- defining characteristics
Common errors in development of diagnoses:
Assessment
-incomplete data
-validation problems
-misinterpretation
Diagnosis
-inappropriate data clustering
-incorrect writing
Limitations of nursing daignosis:
-lack of consensus among nurses regarding the NANDA-approved nursing diagnosis list
-disagreement over specific label in the classification system
-perception that the list is confining, imcomplete, meducally oriented, and confusing
Barriers that affect the use of a nursing diagnosis:
-recognize that NANDA's ;anguage is young and ever-changing
-become familiar with the language to empower communication
-develop accurate diagnosis
-increase agency and medical staff support for the use of nursind diagnoses
-continue offering standardized content related to nursing diagnoses in educational programs
-provide opportunities for experienced nurses to review nursing diagnoses
Process of developing a nursing diagnosis:
-generate cues
-validate cues
-interpret cues
-cluster cues
-confer with approved list from NANDA international
-write the statement
What is nursing diagnosis?
-2nd step in the nursing process
-clinical judgement about individual, family, or community responses to actual or risk problems, wellness states, or syndromes
What is the NANDA nursing diagnosis taxonomy: (13)
health promotion, elimination/ exchange, perception/ cognition, role relationship, coping/stree tolerance, safety/protection, growth/development, nutrition, activity/rest, self-perception, sexuality, life priniciples, and comfort
Purpose if planning and outcome identification:
-provide quality nursing care
-imporve staff communication
-provide continuity in the delivery of indiviualized care to all clients
4 critical elements of planning include:
-establishing priorities
-setting goals and developing expected outcomes (outcome iD)
-planning nursing interventions (w/ collaboration & consultation as needed)
-documenting
Characteristics of Goals:
Global statements describing the intended or desired change
-short term or long term
Characteristics of Expected Outcomes:
-Specific statement that describe the methods through which the goal will be achieved
-constructed to be realistic, mutually desired by the client and nurse, and attainable within a defined time pd.
5 Components of Goals & Expected Outcomes:
1. Subject-who will preform the desired behavior (pt.)
2. Task statement- what will be done
3. Criteria- standards used to evaluate whether the behavior demonstrated indicated accomplishments of the goal
4. Conditions- provide clarity and assist the client in demonstrating the expected behavior
5.Time frame- when the desired behavior or taks is to be performed
Common problems in planning nursing care:
-improper writing format
-inappropriate time frames
-paternalistic approach
Strategies for Effective Care Planning:
-Clear communication
-Establishment of a realistic nursing care plan
-Individualize nursing diagnoses
Independent Nursing Intervention:
nursing action initiated by the nurse that do not require an order from another health care professional
ex: ADL, health education, counseling, etc
Interdependent nursing interventions:
actions that are implemented in a collaborative manner by the nure with other health care professionals
ex: physical therapist, dietician, social worker
Dependent nursing interventions:
actions that reuire an order from another health care professional
ex: administration of medication
5 Steps of Nursing Process:
1. Assessing-gather data
2 Analyzing-identify problem, formulate nursing diagnosis
3. Planning- write care plan to meet goals
4. Implementing- carry out plan
5. Evaluating- collect obj. data to determine the extend to which goals were achieved. revise plan as needed.