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62 Cards in this Set

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This process involves use of the mind in forming conclusions, making decision, drawing inferences, and reflecitng: 1. assessment 2. critical thinking 3. thinking independently 4. intellectual humility
2-critical thinking is an active organized, cognitive process used to carefully examine one's thinking and the thinking of others. It involves use of the mind in forming conclusions, making decisions, drawing inferences, and reflecting.
The nurse identifies ways he can improve his own performance. He reflects on his nursing experiences. This is an example of the core critical thinking skill: 1. inference 2. explanation 3. analysis 4. self-regulation
4-there are core critical thinking skills that when applied to nursing, are useful in showing the complex nature of clinical decision making. Self-regulation involves self-examination and self-correction. the nurse reflects on his experiences and identifies ways he can improve his own performance.
During the day the nurse spends time instructing the client on how to self-administer insulin. After discussing the techniques & demonstrating an injection, the nurse has the client try it. After 2 attempts, the client obviously does not understend how to preopare a dose. when the nurse returns to the med room, he discusses the sitiuation w/the charge nurse, reviewing his approach w/the client & asking for her suggestions on his technique. this is an example of: 1. reflection 2. risk-taking 3. client assessment 4. care plan evaluation
1-an important aspect of critical thinking is reflection. the process of purposefully thinking back or recalling a situation to discover its purpose or meaning. as a nurse, it helps to think back on a client situation, to make sense of the experience and to thus gain insight as to the meaning of the situation
An expeirienced surgical nurse enters a surgical client's room & suspect the client is experiencing a surgical complication. the nurse begins an assessment of VS, the client's wound and the IV line status & an analysis of how the client feels to gather information and verify whether the_______ was correct & a problem really exists: 1. knowledge 2. intuition 3. reflection 4. risk-taking
2-intuition is the direct understanding of particulars in a situation w/o conscious deliberation. it is an innner sensing that something is so. it occurs when an experienced nurse walks into a client's room, looks @ the client's appearance w/o the benfit of a thorough assessment, and senses that the client is about to derteriorate physically
A nurse uses an institutions procedure manual to confirm how to insert a foley cathetar. the level of critical thinking the nurse uses is: 1. commitment 2. complex critical thinking 3. scientific method 4. basic critical thinking
4-at the basic level of critical thinking a learner trusts that experts have the right answers for every problem. thinking is concrete and based on a st of rules or principles. for example, a nurse uses an intstiutions procedure manual to confirm how to insert a foley catherter.
A client has a nursing diagnosis of anxiety and deficien knowledge concerning his impending surgery. the nurse decides that the clients anxiety must be addressed first in order for the client to be receptive to any formal instruction about surgery. this decision is considered a part of: 1. assessment 2. planning 3. intervention 4. evaluation
2-it is during planning when care priorties are established that the nurse determines the need to first address the client's anxiety.
A client had hip surgers 24 hours ago. when the nurse begins shift, she refers to the written plan of care, noting that the client has a drainage device collecting wound drainage. the physicians order requires that he be notified when drainage in the device exceeds 100 mL for the day. when the nurse enters the room the nurse looks at the device and carfefully notes the amount of drainage currently in the device. this is an example of: 1. assessment 2. planning 3. intervention 4. evaluation
4-evaluation is the process that the nurse uses to determine client response to care and the drainage is monitored.
The nurse asks a client how she feels about her impending surgery for breast cancer. before the descussion, the nurse reviewed the description in his textbook of loss and grief in adddtion to therapeutic communication principle. the critical thinking component involeved in the nurse and review of literature is: 1. experience 2. problem-solving 3. knowledge application 4. clinical decision making
3-the first component of critical thinking is a nurse's specific knowledge base. this varies according to a nurse's educational experience, including basic nursing education, continuing education courses, and additional college degrees. in addition, it includes the itiative a nurse shows in reading the nursing literature so as to remain current in nursing science.
A 72 yof has been a client on the med. unit for about 4 days when she was first admitted she was A&O. for the last 24 hours, she became acutely confused and repeatedly attempted to get out of bed. the nursing staff has discussed the use of restraints; however one nurse insists that the use of orientation and meaningul diversion should be tried. this is an example of the critical thinking attitude: 1. integrity 2. risk taking 3. thinking independtly 4. responsibility & authority
3-a criticla thinker does not customarily accecpt another person's ideas w/out question. tho think independetly one questions others' ways of interpreting knowledge and looks for rational and logical answers to problems.
The nurse does not take shortcuts (eg. failing to identify a client) when administering meds. this is an example of the critical thinking attitude: 1. responsibility & accountability 2. thinking independently 3. fairness 4. discipline
1-when caring for clients, a nurse has a responsibility to correctly perform nursing care activities based upon standards of practice. standards of practice are the minimum level of performance accepted to ensure high-quality care. for example, the nurse does not take shortcuts when administering meds.
What are the basic competencies essential to nursing practice?
Technical Interpersonal Ethical/Legal Cognitive
What is the basic competency: Tecnical
it includes manual desterity, eye-hand coordination, trouble-shooting equipment, problems, equipment to client needs
What is the basic competency: Interpersonal?
ability to affirm worth of clients, significant others and (collegues) while interratcting; bringe out the best in others: communicate knowledge effectively; work on a team
What is the basic competence: Ethical/Legal?
trustworthy, accountable; client advocate, mediate ethical conflics. practice within the permeters of the nursing code of ethics and safety.
What is the basic competency Cognitive?
has scientific rationale for care; selects actions that will result in the optimal outcomes; uses critical outcomes; uses critical thinking to problem solve.
What are the attitudes noted in a critical thinker?
confidence independent thinker fairness responsiblity/accountablity risk taker discipline perserverance creative/curiousity integrity humility-know your limitations
What is the nursing process?
assessment diagnosis planning implemnetation evaluation -purpose: to diagnose and treat human responses to actual or potential health problems
What is problem solving?
-involves evaluating the solution over time to be sure that it is still effective.
What is scientific method?
-one approach to reasoning that is used in nursing, medicine and a variety of other disciplines -an approach to seeking the truth or verifying that a set of facts agrees with reality
Decision Making
an end point of critical thinking that hopefully leads to problem resolution
diagnostic reasoning
process of determining a client's health status after the nurse signs meaning to the behaviors physical signs and symptoms presented by the client
inference
process of drawing conclusions from related pieces of evidence
clinical decision-making process
requires careful reasoning so that the options for the best client outcomes are chosen on the basis of the client's condition and the priority of the problem
intuition
the direct understanding of particulars in a situation without conscious deliberation
reflection
the process of purposefully thinking back or recalling a situation to discover its purpose/meaning
Critical thinking
-an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others -it involves use of the mind in forming conclusions, making decisions, drawing inferences and reflecting -process of analyzing and understadning how and why one reaches a certain conclusion
Complications associated with common medical problems:
-angina -asthma/chronic obstructive pulmonary disease (COPD) -hypertension -myocardial infarction (MI) -diabetes mellitus (DM) -fractures -renal failure -pneumonia -pulmonary embolus (PE)
Pulmonary Embolus (PE)
dyspnea heart failure hypoxemias shock
Pneumonia
respiratory failure sepsis
Renal Failure
-acid base inbalance -anemia -congestive heart failure (CHF) -electrolyte imbalance -fluid overload -hyperkalemia -hypertension -uremic percarditis -edema
Fratctures
-bleeding -compromised circulation -edema -embolus -fracture displacement -infection -nerve damage from compression -poor bone alignment -skin breakdown @ pressure pts -shock -swelling -thrombus
Diabetes Mellitus
-compromised circulation -delayed wound healing -diabetic retnopathy -hyperglycemia -hypertension -hypoglycemia -increased risk for infection -renal failure
Myocardial Infarction (MI)
-acid base imbalance -cardiac arrest -cardiac tamponade -cerebal vasuclar accident (CVE) -COPD -dysrhthmias -electolyet imbalance -extension of infarction -hypoxemia -pericarditis -pulmonary emboli (PE) -thrombi
Hypertension
-cerebovascular accident (CVA) -hypertensive crisis -tranisent ischemic attacks (TIA) -renal failure
Asthma/Chronic Obstructive Pulmonary Disease (COPD)
-acid base imbalance -cardiac failure -electrolyte imbalance -hypoexmia -infection -status asthmaticus -repiratory failure
Angina
-CHF -dysrhythmias -MI -Pulmonary Edema -shock (cardiogenic/hypovelemic)
Clinical decision making requires the nurse to: 1. improve a client's health 2. establish and weigh criteria in deciding the best choice of therapy for a client 3. follow the physicians orders for client care 4. standardize for the client
2-establish and weigh criteria in deciding the best choice of therapy for a client
Which of the following is not one of the five steps of the nursing process? 1. planning 2. evaluation 3. hypothesis testing 4. assessment
3-hypothesis testing
Gathering, verifying and communicating data about the client to establish a database is an example of which component of the nursing process?
Assessment
Completing nursing actions necesary for accomplishing a care plan is an example of which component of the nursing process?
Evaluation
What are some potential complications seen in common treatment and diagnostic procedures:
-anesthesia/invasive procedures/surgery -cardiac catherterization -central lines -chest tubes -foley catheter -IV therapy -medications -nasogastric suciton -pacemakers
Pacemakers
-ectopic complexes -hematoma -infection -loss of capture -oversensing -stimulation of the chest wall or daphram -undersensing
Nasogatric Suction
-aspiration -electolyte imbalance -tube malfunction
Medications
-allergic/adverse reactions -drug interactions -exaggerated effects -overdose -side effects -toxicity
IV Therapy
-air embolus -bleeding -fluid overload -infection -inflitration -sepsis
Foley Catherter
-infection -sepsis
Chest Tubes
-ateletasis -bleeding -chest tube blockage -hemothorax -infection -pneumothorax -sepsis
Central Lines
-air embolus -infection -sepsis -thrombus
Cardiac Catherization
-bleeding -dysrhythmias -embolus -thrombus
Anesthesia, Ivasive Procedures, Surgery
-atelectasis -bleeding -embolus -fluid & electolyte imbalance -hypovolemia -paralytic illeaus -incisional complications: infection, dehiscence, evisceration -respiratory depression -sepsis -shock -thrombus -urinary retention
What are critical thinking attitudes?
confidence thinking indepentdently fairness responsibility & authority risk taking discipline perserverance creativity curiosity integrity humility
Confidence: application in practice:
Learn how to indroduce yourself to a client. Speak w/conviction when you begin a treatment or procedure. Do not lead a client to think that you are uncertain of being able to perform care safely. Alwasy be prepared before performing a nursing activity.
Thinking Independently: application in practice:
REad the nursing literature, especially when there are different views ont eh same subject. Talk w/collegues and share ideas about nursing interventions.
Fairness: application in practice:
Listen to both sides in any discussion. If aclient or family member complains about a collegue, listen to the story and then speak w/the collegue as well. Weigh all facts.
Responsibilty & authority: application in practice:
Ask for help if you are uncertain about an aspect of client care. Report any problems immediately. Follow standars of practice in your care.
Risk Taking: application in practice:
If your knowledge causes you to question a physician's order, do so. Be willing to recommend alternative approaches to nursing care when collegues are having little success w/clients.
Discipline: application in practice:
Be thorough in whatever you do. Use known scientific & practice-based criteria for activities such as assessment and evaluation. Take time to be thorough, and manage your time effectively.
Preserverance: application in practice:
Be wary of an easy answer. If colleagues give you information about a client, and some fact seems to be missing, go clarify information or talk to the client directly. If problems of the same type continue to occur on a nursing division, bring colleagues together, look for a pattern, and find a solution.
Creativity: application in practice:
Look for different approaches if interventions are not working. A client may need a different positioning technique or a different instructional approach that will suit his/her unique needs.
Curiosity: application in practice:
Always ask why. A clinical sign or symptom can indicate a variety of problems. Explore and learn more about the client so as to make appropriate clinical judgments.
Integrity: application in practice:
Recognize when your opinions may conflict wthose of a client; review your position, and decide how best to proceed to reach mutually beneficial outcomes. Do not compromise nursing standards or honesty in delivering nursing care.
Humility: application in practice:
Recognize when you need more information to make a decision. When you are newly assigned to a clinical division and you are unfamiliar w/the clients, ask to be oriented to the area. Ask RNs regularly assigned to the area for assistance. Read the professional journals regularly to keep updated on new approaches to care.