pharm 4 and 5
Terms
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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
- planning
- 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
- NIC
- 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
- evaluation
- 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
- s-specific,m-measureable,a-attainable,r-realistic,t-timely/timeframme
- 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
- implementation
- 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
- assessment
- 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
- evaluation
- 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
- cognitive,affective,psychomotor
- 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
- compliance
- 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
- assessment
- 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
- ethnography
- 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