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pharm 4 and 5


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who is involved in planning process
patient, nurse, family, measureable individual goals are established
nursing actions
its a statement that describes nursing interventions applicable to any patient (eg promote adequate respiratory ventilation).Suggested by etiologies of problems identified and are used to implement plans
patient goals
goals established for the patient only, patients involvement is essential to promote cooperation and compliance with the therapeutic regimen and sense of control over the disease process and course of treatment
incorporates patients desires, needs and values,learning goals (objectives) should be mutual, realistiv, measureable, identify teaching methodologies and resource materials, plan for a setting conducive to learning
why id drug history taken into account during assesment
evaluate the pat need for med, obtain pat current/past use of med/OTC, prescribtion,herbal,street drugs, to identify problems related to drug therapy
changes in expectations
changes assessed in pat outcome at all times, expectations abt therapy is based on diff individuals
what are the 2 types of nursing diagnosis that applies to med prescribed?
knowledge deficit(actual/risk/possible related to med regimen and required pat education,what level of understanding does pat has about the med), noncompliance(actual/risk/possible, related to the patients value system, cognitive ability, cultural factors, economic resources)
objective data
obtained from pat documentation(lab reults,EKG,physical exam,H&P), vital signs,physical findings during inspection/palpation.percussion/auscaltation, recent findings from lab test and diagnostic procedures
nursing diagnosis
clinical judgement about an individual, family or community responses to actual or potential health problems or life issues
what are the 5 approved syndrome diagnosis
rape-trauma syndrome,disuse syndrome,post trauma syndrome,relocation stress syndrome,impaired environmental interpretation syndrome
independent nursing actions
nurse obtains all pat history,verifies drug order and trascribes it to kardex or computers, verifes all aspects of prescribtion before sending it to the pharmacy, formulates nursing diagnosis, reviews drug monograph to formulate diagnosis and goal statements, prepares prescribed med
piriority setting(planning)
maslow's hierachy of needs is used here
what the nursing process does
organised guide that helps the nurse provides good care to patient and avoid making misstakes, NP is predictable, improves safety, organises the nurse, comes automatically with experience
implementation of med
understand all info about pat,why med is ordered, know the med, how to admin/techniques,nursing measures needed before giving
differences bw patient and nursing goals
patient goals-learning abt med and how to use properly, nursing goals-needs equipment and procedures
adult (readiness to learn)
their learning is usually oriented towards what is necessary to maintain a personal lifestyle, they need to understand the need to learn something before they undertake the effort to learn it, assess what the patient already knows, make the content relevant to the individual, incorporate his or her beliefs into the overall plan
syndrome nursing diagnosis
cluster high risk signs and symptoms that are predictive of certain circumstances/events, the etiologic factors are in the diagnostic label
what nurses teach during process of patient education(implementation)
communication,responsiblity, expectations of therapy, changes in expectation, changes in therapy through cooperative goal setting
what are the 4 phases of planning
priority setting, development if measureable goal/outcome statements,formulation of nursing interventions, formulation of anticipated therapeutic outcomes that can be used to evaluate the patients status
bad salt choices for lunch/dinner
lunchmeat,cheese,tomato juice, canned vegetables, packaged gravies, pickles,bottled salad dressings
factors for priority ranking in health education
patients concerns and health belief system and priorities,urgency/time available for learning to take place,sequence that allows patient to move from simple to more complex concepts, review of overall needs of the individual
educational level
tailor the vocabulary and reading level to the patients level, medical terms may not be understood, can the patient read, written insructions left at the bedside may be misinterpreted or not read at all
critical care pathway
standardized care plan derived from 'best practice' patterns enabling the nurse to develop a treatment plan that sequences detailed clinical interventions to be performed over a projectede time for a specific case/disease
define nursing actions
specific and deliberate and are performed in a random manner
native american culture
that only the affected individual may reveal info
nursing implementation/intervention
actual process of carrying out the established plan of care, documentation of all care given, including patient education/response should be performed regularly
daily requirement of Na
eat less than 6g of Nacl per day(2,400mg of Na)
side effects to expect
symptoms that can be alleviated or prevented by actions of the nurse or patient will require immediate planning for patient education
planning with reference to prescribed med
identify therapeutic for each prescribed med, review specific info abt med(side effects/plan to prevent/alleviate/manage side effects, side effects to monitor, identify recommended dosage and route, schedule admin of med based on healh care providers orders, review med for drug-drug interaction/drug-food interaction, lab tests needed if serum tests is ordered, teach pat to keep written record of response to med, educate as needed on techniques of self admin(injections/topical patches/instillation of drops), side effects, report to physician, inform as needed on proper storage, how to refill med,insurance forms or shown insurance card for payment
ethnocentrism(leininger 1978)
the assumption that one's culture provides the right way, the best way, and the only way to live, the nurse must be knowledgeable about the beliefs of many cultures or be willing to research the subject as needed, a clients response and compliance with our teaching is often a product of their cultural beliefs
motivating the individual to learn
basic needs should be met before pat is able to focus on learning, nurse should recognise individuals health belief, individuaize/standardize teaching plan, teaching doesnt require a formal setting,explaining a procedure and its benefits is a method for teaching and produces mastery in the skills
health teaching
important nursing responsibility that carries legal implications for failure to provide and document education
factors affecting compliance
beliefs about seriousness of illness,perception of benefits of treatment, personal beliefs,values and attitudes including prior experience with health care, impact of proposed changes on lifestyle, acceptance or denial of illness, daily stress, comprehension and understanding of the health regimen, multiple prescribers, cost of treatment, support of significant others, amount of control over the situation, side effects, degree of inconvenience,annoyance, or impairment they produce, degree of positive response acheived,physical difficulties(swallowing med,identifyn colors), concerns about addiction
used for clinical documentation,communication of care across setting,integration of data,effectiveness research,productivity measurement,competency, evaluation, reimbursement,curricular design
6 rights of med admin
right drug,right time,rigth dose,right pt, right route, right documentation
safety measures for med admin
verify accuracy of med, compare info with specific drug to determine if dosage and drug seen correct
3 sources for assessment
primary(patient), secondary(relatives,lab/med reports, nursing notes etc), tertiary(literature search,nursing intervention,diagnostic tests,diets,physical therapy,pharmacological treatment etc)
expectations of therapy
before discharge reasonable responses to the planned therapy should be discussed,knowledge of signs and syptoms that may be altered by prescribed med, precautions for takn meds and directions should be made known to pat
readiness to learn
nurse can help by being enthusiastic about material to be learnt, is the learner motivated?
anticipated therapeutic/expected outcome statements
are developed to document the effectiveness of the care delivered
changes in therapy through cooperative goal setting
an attitude of shared input into goals encourages pat, pat shoud be taught to monitor parameters used to evaluate therapy,nurses should nurture a comfortable environment that encourages pat to keep record of essential data needed to evalutae prescribed therapy,contact he health provider for advice rather than alter med regimen or discontinue med.
nursing care plan
written or computerized document that evolves from the nursing planning process
cognitive domain
level at which basic knowledge is learned and stored,thinking process uses persons previous experiences/perceptions,prior knowledge/experience is the foundation,determine what patient already knows, new info is needed much later when smths uncertain
side effects to report
a colaborative problem in which the nurse has a responsibility to monitor the patient for adverse effects to the health care provider
spacing the content
spacing should be considered no matter the age being taught, people tend to remember what is learned first, schedule multiple short sessions as possible, providing material/onformation is not synonymous with learning, patients learning style should be assessed and spacing of contents tailored to the types of learning materials available to teach the content
independent actions
actions not prescibed by a health care provider that a nurse can provide by virtue of the education and licensure attained
what are the 2 nursing diagnosis that applies to all types of med prescribed
deficient knowledge(actual,risk,possible)related to med, noncompliance(actual,risk,possible) related to patients value system,cognitive ability,cultural factors,economic resources
low salt eating habits
take salt out of tables, add flavor with salt free herbs, read food labels, rinse caned vegetables, do not use salt substitute unless okay by MD
what is the nursing process
foundation for the clinical practice of nursing providing the framework for consistent nursing actions, using a problem-solving approoach rather than an intuitive approach
examples of organized learning
discharge teaching plan, discharge form, medication teaching form,
bad salt choices for breakfast
sausage,bacon,ham,flour tortilas,packaged muffins,pancakes,biscuits
research by kaluger and kaluger(1984)
readness or the abiity to engage in learning depends on motive,relevant preparatory training, and physiologic maturation
nursing plan
usually adapted to the health teaching process, assesment, nursing diagnosis, planning, implementatiom, evaluation
older adult(readiness to learn)
additional assesment(vision,hearing,and short-term memory) needs to be assessed before implementation of health teaching, concerns about cost, often evaluate the benefits of planned medical interventions and the overall impact of these on the quality of their life,
what affects the older adult patients readiness to learn
experienced loss, social isolation, physical(functional) loss, finiancial restraints, additional problems(new crisis might be overwhelming-timely important)
low-salt choices for lunch/dinner
fresh fish/chicken/turkey/meat, dry beans cooked without salt, tofu, vegetables, potatoes
possible NIC labels
deficit knowledge, NOC-knowledge:med, NIC-teaching:prescribed med. Noncompliance-NOC-compliance behavior, NIC-learning readiness enhanced or fininacila resource assiatance
new strategies to increase awareness
case mgmt guideline- used to induce behavioural change in patients. it accesses pat motvational knowledge of prescribed med,identifies pat who are more at risk for nonadherence so interventions can be initiated early in care, caregiver negotiates(not dictate) with client to implement positive actions
an ongoing process,care is evaluated against the established nursing diagnosis/goal statements, planned nursing actions,anticipated therapeutic outcomes,signs and symptoms of recurring illness, adverse effects of med, patients education
discharge info
summary record of pat unmet goals written and placed inpat chart,health care provider consulted concerning community-based agency, document potential collaborative problems that require continued monitoring and intervention
what does SMART stands for
holistic paradigm
recognises harmony between the body, mind and spirit, identifies disease as a direct result of an imbalance between these natural components
nursing orders
describe how specific actions will be implemented for an individual patient
baseline assessment
when patients first examined
learning styles
visual (see), auditory(hear),tactile(demonstrate)
dependent nursing actions
health care provider admits pat,states admitting diagnsis,orders med,constantly reviews pat data,mdify med orders,, but nurses collects and evaluates data for med prescribed
wellness nursing diagnosis
a clinical judgement about an individual, group or community in transition from a specific level of wellness to a higher level of wellness, has only a one part statement (potential for enhanced)
what the nursing process does
evaaluate outcomes of delivered therapy,provides scientific,transferable method for health care planners to assign nursing staff to patients and to determine cost of providing health care
differences bw a medical diagnosis and a nursing diagnosis
statement of the patients alterations in structure and function and results in a diagnosis that impairs normal physiologic function while a nursing diagnosis refers to the patients ability to function in activities of daily living (ADL) in relation to the impairment induced by the medical diagnosis, it identifies the individuals response to the illness. medical diagnosis doesnt change but nursing diagnosis does
what are the steps used in planning to give meds
determine therapeutic goal for med(what is med accomplishing),review specific info abt the med(SMART)-anticipated action,side effects,dosage,routr,frequency,contraindcations to med(allergy,pregnancy),drug interactions, anticipate special storage/admin procedures/techniques/equipment, develop a teachn plan for pat-med info and side effects,admin of med, what to report abt response to med
collaborative problem
statements worded with possible complications and are found on critical pathways or multidisciplinary plans eg hypokalemia
how does repetition enhances learning?
repetition enhances learning, plan for multiple practise sessions, its not always feasible in the short hospital stay, may need reinforcement at home, document in charting what has been learned and what hasn't
psychomotor domain
learning a new procedure/skill by demonstration-step-by-step with a return demonstration by the patient to determine mastery, its known as the doing domain
pediatric patient(readiness to learn)
consider psychosocial,cognitive,and language abilities, age influences the types and amount if self-care activities the child is capable of learning and executing independently, consider the parent in your teaching plan,consult a textbk in developmental theory when developing a teaching plan
communication (culture and thnic diversity)
communication is vitally important,verbal and nonverbal communication means diff things to diff cultures
nursing acxtions/interventions (planning)
statements list in a concise form exactly what the nurse would do to acheive each goal developed for each nursing dignosis
scientific biomedical paradigm
most familiar to health providers educated in the Us, basic belief is that all disease has a cause even when the causeative factors are unknown, scientific research can be directed toward finding a cure
pat goals
learn properly and how to use properly within a certain time
low salt choices for snacks and desserts
yoghurt, popcorn,fruit and vegetables, frozen juice bars
risk/high nursing diagnosis
clinical judgement that an individual, family or community is more susceptible to the problem than others in the same or similar solution, related to is added to the statement
albers herberg (1989)
described scientific, maicoreligious and holistic paradigms as three ways people explain life events
affective domain
conducts that expresses feelings,needs,beliefs,values, opinions, most intangible portion of learning process, view events from diff perspective based on feelings etc, watch for non verbal messages, nurses beliefs might be diff from patients but must be non judgemental
ng denial/anger/bargaining stages of grieving?
patient is usually neither prepared nor willing to accept the limitations imposed by the disease process
what affects learning?
affected by clients perception of health,clients values/clients need to know/life experiences/self-concept/impact of the illness on lifestyle/prior experiences with the illness
patients needs and adherence
pateints needs are often changing so learning objectives must be modified and plan of care adapted to these changing needs
measureable goal/outcome statements(planning)
long term goals/short term goals which starts with an action verb, followed by behavior to be performed by patient/family with time for attainment.
interdependent action
actions nurse implements cooperatively with other members of the healthcare team
actual nursing diagnosis
based on human responses to health conditions and life processes that exist in an individual, family or community, supported by related to and manifested by
nursing classification systems
nursing minimum data set, NIC, NOC
techniques in teaching the older adult
good lighting, decrease distractions(radio,tvs etc), use eye contact, speak in a clear tone without shouting, be calm, use tact and diplomacy when frustrations arises, instill confidence in the learners ability to surmount problems
low-salt choices for breakfast
fruit/fruit juice, bread/english muffin, hot cereal, shredder wheat
use of an interpreter in teaching
its essential when teaching an interpreter about his meds, even if they say they understand often they do not, does the interpreter understand medical terms, is the interpreter explaining to you what the client is aying, keep questions brief, look/talk directly to the client not the interpreter, supplement teaching with pictures and pantomine
principles of learning
focus the learning(pat to focus on material/task to be learned,conducive environment,repetition of new material,begin teaching with patients questions
bad salt choices for snacks/desserts
pies,canned and packaged puddings, pretzels, chips,crackers, nuts
interdependent nursing action
nurse performs baseline and subsequent assesment and consults other professional when in doubt collabratively,pharmacist reviews drug aspects and sends out drug to storage for pat,health care provider orders in the original order, nurse and pharm schedules med based on standardized order in faculty,nurse and phar reviews lab results and conveys to the provider
physiologic and emotional needs should be met before initiating teaching,consider language,culture and behavior, provide time to ask and answer questions, adapt plan to learners needs, verify degree of comprehension throughout the process, document the content, written materials provided and patient understanding of the content
focused assessment
process of collecting additional data specific to a patient or family that validates a suggested problem or nursing diagnosis
etiologic/contributing factors
clinical and personal situations that causes the problems or influences its development, the situations are-pathophysiology,treatment related,personal,environment,maturation
cultures amongst different cultures
american-uses eye contacts, native americans/asians-sees eye contact as rudeness/disrespect, african americans-prefers formal names used rather than first name esp. when addressing older members, chinese-are more formal than americans and husbands and wifes do not necessary have same last name
health risk of Na
its essential to the body, its a mineral that helps the body regulate fluid balance.Under certain conditions,excess sodium can cause the body to retain too much fluid.This could be harmful for people with conditions such as high BP or heart disease
dependent actions
performed by nurse based on physicians orders eg admin of med and treatment
an ongoing process that starts with the admission of the patient and continues until the patient is discharged, its the problem-identifying phase of the nurse process, it gathers info about the pat., the problem and any factors that may influence drug given
review expected outcomes and revise as needed, return demonstartion, checked off on kardex/patients chart, question and answer, entire plan revised, refer patient to another agency to assist with health teaching,
nursing diagnosis
nursing diagnosis statements are based on the assesment data that incorporate the 3 learning domains(cognitive,affective, and psychomotor).
what is the practice of nursing
its an art and science that uses a systemic approach to identify and solve the potential problems that individuals experience as they strive to maintain basic human function along the wellness continum
culture and ethnic diversity
ethnocentrism, scientific biomedical paradigm, magicoreligious paradigm, holistic paradigm
name the 5 parts of nursing process
assessment,diagnosis,outcome identification,planning,implementation,evaluation
what are the 3 domains of learning
defining xtics
manifestations or signs and symptoms that relate to a particular patient problem
info gathered during assessment
biographic data, database, patient history, evaluating physical findings,physical examinations,nursing history, medication history,defining xtics(symptoms, signs), side effects of meds. etc
how does organization fosters learning?
the objectives should state the purpose of the activities and the expected outcome.organize in outline form/checklist so that one nurse can begin the teachng and another nurse on another shift can continue on it, stardardized contents for consistency, allows for materials to be learned in increments, makes documentation easier, can be reviewed before discharge to see where clients knowledge needs to be reinforced
nursing goals
equipment needed, procedures required
how does learning affect a patient during resolution/acceptance stages of the grieving process?
the patient moves towards accepting responsibility and willingness to learn what is necesary to attain an optimal level of health
right to make their own choices, sucess is enhanced with an enthusiastic communicator,reinforcing positive accomplishments fosters sucessful acheivement
communication and responsibility
patient must perceive info as relevant before discharge for learning to take place, nurse should start with simple, attainable goals to build confidence, correlate teaching with patients perspective on the illness and ability to control signs and symptoms or course of the disease process
data collection,critical info that requires patient learning shouldn be identified,patients current level of knowledge, learning styles, motivating factors, readiness to learn, educational level, cultural/ethnic needs, stage in grieving process, developmental needs
nursing professional judgements
selection of correct supplies,verification of med order, collection of appropriate data/premedication assesment, admin of med by correct route at correct site, documentation of med admin,implementations of nursing actions,education of pat
how to teach an older patient
the client may process info more slowly, the nurse should slow the pace of the presentation, limit the length of the session, work with them to develop methods to help them retain the information, do not ask "do you understand" they may be embarrassed to admit they dont,provide info in small increments,allow for practise,review,practise,review and practise until sucess is acheived, create an encouraging environment with positive feedback to releive anxiety
technique used to study adherence, when pats not meeting expected outcomes,observations are made on how and what procedures are accomplished and what errors are being made,industries used this mtd to design workflow in production and its valuable for inproving pat outcomes, ethnographs visit the pat at home to see what the patient is doing wrong
community-based agency
pat are referred to them after discharge for the acheivement of long term care requirements, help pat understand all aspects of continuing therapy prescribed
subjective data
supplied by pat/family eg problems,histories,past medical history,family disease,social profile,review of complaints
eastern europe cultures beleifs
that family info shouldnt be shared outside the family
nursing challenge
increase in aherence of patients to their health care regimen, and to minimize hospital readmission and suffering from complications
magicoreligious paradigm
views the world and its inhabitants as being under the control of supernatural,mystical forces, believe evil spirits and gods,withcrafts,spells and other forces impose illness on a person, may beleive health can be a gift from God and illness a punishment, may beleive illnesses are natural and intended by God or unnatural and not a part of Gods plan
name the 5 types of nursing diagnosis
actual, risk/high,possible,wellness,syndrome
how to prevent damage
eat less salt
possible nursing diagnosis
suspected patient problems requiring additional data for confirmation, has 2 statements(diagnostisc label and suspected etiologic defining xtics)
name the types of nursing actions
dependent, interdependent, independent

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