5 Nursing Care Plans and Test Taking Skills

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5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com CHOLECYSTECTOMY One of the most common reasons for cholecystectomy is cholecystitis caused by gallstones or cholelithiasis. In order to understand and create a nursing care plan for Cholecystectomy we should understand cholelithiasis first. So what is Cholelithiasis? • Formation of GALLSTONES in the biliary apparatus ** Obesity increases the risk for cholelithiasis. Note the mix gallstones with a prominent component of yellowish cholesterol seen here in an opened gallbladder removed at surgery. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com So what are the Predisposing factors? 4F’s “F” • Female • Fat • Forty • Fertile Check 1nurses.com for more Nursing Resources And the Pathophysiology? Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Gross appearance of gallbladder after sectioning longitudinally. Notice thickness of gallbladder wall, abundant stones Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  Which symptom best describes murphy’s sign =  On deep inspiration, pain is elicited and breathing stops Ok, so what’s our Assessment findings? • 1. Indigestion, belching and flatulence • 2. Fatty food intolerance • 3. Epigastric pain that radiates to the scapula or localized at the RUQ • 4. Mass at the RUQ • 5. Murphy’s sign • 6. Jaundice • 7. CHARCOT TRIAD Check 1nurses.com for more Nursing Resources And what are the Diagnostic procedures we can take? • 1. Ultrasonography- can detect the stones • 2. Abdominal X-ray • 3. Cholecystography • 4. WBC count increased • 5. ERCP: reveals inflamed gallbladder with gallstone Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com What’s ERCP?  Endoscopic Retrograde Cholangiopancreatography?  Examination where a flexible endoscope is inserted into the mouth and via the common bile duct and pancreatic duct to visualize the structures Check 1nurses.com for more Nursing Resources ERCP So what’s our Nursing Interventions?  1. Maintain NPO in the active phase  2. Maintain NGT decompression  3. Administer prescribed medications to relieve pain. Codeine and Morphine may cause spasm of the Sphincter  increased pain.  4. Instruct patient to AVOID HIGH- fat diet Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  5. Assist in surgical and non-surgical measures  6. Surgical procedures = CHOLECYSTECTOMY! And the Pharmacologic Therapy… 1. Analgesic 2. Ursodiol ** 3. ESWL  Ursodiol is a bile acid available as 300 mg capsules suitable for oral administration. ** Ursodiol, USP (ursodeoxycholic acid) is a naturally occurring bile acid found in small quantities in normal human bile and in the biles of certain other mammals.  to dissolve the gallstones Check 1nurses.com for more Nursing Resources Ok, why is the stool foul smelling? Greasy Stool = Steatorrhea Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Obstruction (Cholelithiasis) Bile Stasis Decreased Bile  Duodenum Decreased digestion of fats Undigested Fats Excrete: STEATORRHEA (greasy, foul smelling) Check 1nurses.com for more Nursing Resources How about Surgical Interventions? • Cholecystectomy  removal of the gall bladder • Choledocotomy  opening of the gallbladder to remove stones • Choledocostomy  CBD exploration • Laparoscopic Cholecystectomy • Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • • Check 1nurses.com for more Nursing Resources What’s Choledochostomy? If with CBD exploration: T – tube • Purpose: to drain the bile • Drainage: Brownish red for the first 24 hours (combination of bile and blood) Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com 300 – 500 mL of bile drainage for the first 24 hours Drainage bottle should be placed in bed at the level of incision; this is to drain the excess bile, not all the bile Check 1nurses.com for more Nursing Resources Here’s some Post-OP Nursing Interventions… • 1. Monitor for surgical complications • 2. Post-operative position after recovery from anesthesia- LOW / SEMI FOWLER’s • 3. Encourage early ambulation Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • 4. Administer medication before coughing and deep breathing exercises • 5. Advise client to splint the abdomen to prevent discomfort during coughing • 6. Administer analgesics, antiemetics, antacids • 7. Care of the biliary drainage or T-tube drainage • 8. Fat restriction is only limited to 4-6 weeks. Normal diet is resumed Now let’s go to the Nursing Care Plan Commonly associated with Cholecystectomy…  Click Here To Get NCP for Cholecystectomy Check 1nurses.com for more Free Nursing Care Plans Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com APPENDECTOMY Appendectomy is commonly done because of Appendicitis. Let’s talk about Appendicitis first! So what is Appendicitis? Infectious and inflammatory process of the appendix creating acute abdominal pain and nausea. Check 1nurses.com for more Nursing Resources And what are the Signs and Symptoms?  Vague epigastric or peri-umbilical pain which progress to right lower quadrant pain  Low-grade fever  Nausea  Vomiting  Loss of appetite  Local tenderness when pressure is applied  Pain gradually becomes localized in RLQ / Mc Burney’s point Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  Pain is initially intermittent then become steady and severe over a short period.  Rebound tenderness  Psoas sign  Rovsing’s sign  Obturator sign  Jarr sign Check 1nurses.com for more Nursing Resources McBurney's point is located one third of the distance along a line from the front of the right pelvic bone and the belly button. JARR SIGN  plantar flex of RIGHT foot  pain ILOPSOAS SIGN  supine L side lying flex backward of R foot  PAIN  Rebound tenderness (Blumberg sign)  Psoas sign (lateral position with right hip flexion)  Rovsing’s sign (right quadrant pain when the left is palpated)  Obturator sign (pain on external rotation of the right thigh) Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Check 1nurses.com for more Nursing Resources This is the normal appearance of the appendix against the background of the cecum. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Seen here is acute appendicitis with yellow to tan exudate and hyperemia, including the periappendiceal fat superiorly, rather than a smooth, glistening pale tan serosal surface. So what’s the pathophysiology? Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com So What’s the treatment? 1. Antibiotics 2. Appendectomy 3. General or spinal anesthetic with a low abdominal incision or by laparoscopy Check 1nurses.com for more Nursing Resources And your Goals for Management? NPO Bed rest Relieve pain Avoid factors that increase peristalsis, thereby rupture:  Heat application over the abdomen  Laxative  Enema Here’s a nursing care plan for Appendectomy  Click here to get the NCP for Appendectomy Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com GASTRECTOMY Removal of the stomach can be temporary or permanent. One of the primary causes for Gastrectomy is the presence of Gastric cancer caused by PUD or Peptic Ulcer Disease. So let’s learn more about Peptic Ulcer Disease, what is PUD? Commonly referred with respect to the location  if in the stomach, gastric ulcer and if in the duodenum, duodenal ulcer The precise cause is not known Check 1nurses.com for more Nursing Resources Now let’s compare Duodenal Ulcer VS Gastric Ulcer Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  Pain from a gastric ulcer often occurs when food is still in the stomach, shortly after eating.  Pain from a duodenal ulcer often occurs when the stomach is empty, several hours after eating, and may improve after eating. Pain also may wake you frequently in the middle of the night. Check 1nurses.com for more Nursing Resources And Here’s the Pathophysiology of PUD Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com So what are Gastric Ulcers? Gastric secretions and stomach emptying rate are usually normal Occurs more often in men, in unskilled laborers, and in lower socioeconomic groups; peak age 40 – 55 years (older age group) Caused by smoking, alcohol abuse, emotional tension, and drugs (salicylates, steroids) Check 1nurses.com for more Nursing Resources Now let’s check our Assessment findings : 1. The pain is NOT relived by eating. * Pain located in the upper left epigastrium, usually occurs 1 – 2 hours after meals, rarely at night.  A chronic complication seen in gastric ulcer is gastric cancer. 2. Weight loss, vomiting, bleeding episodes, epigastric tenderness, and pyrosis. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com 3. Complications associate with peptic ulcer: Bleeding, Perforation, Pyloric obstruction and intractable pain. Here’s the Lab Findings… Endoscopy reveals ulceration; BIOPSY is usually done to detect H. pylori infection and to rule out MALIGNANCY! Gastric analysis: normal gastric acidity in gastric ulcer (increased in duodenal ulcer) Upper GI series And our Nursing Interventions… 1. Administer medications as ordered. 2. Provide nursing care for the client with ulcer surgery. 3. Prepare the client for diagnostic procedure (barium swallow and EGD) 4. Provide client teaching and discharge planning concerning Checklists for Medication regimen  Take medications at prescribed times. Antacids are taken ONE hour AFTER meals.  Have antacids available at all times. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  Recognize situations that would increase the need for antacids.  Avoid ulcerogenic drugs (salicylates, steroids).  Know proper dosage, action, and side effects. Checklists for Proper Diet  1) Bland diet consisting of six small meals/ day.  2) Eat meals slowly.  3) Avoid acid-producing substances (caffeine, alcohol, highly seasoned foods, milk and creams).  4) Avoid stressful situations at mealtime.  5) Plan for rest periods after meals.  6) Avoid late bedtime snacks. Other things to consider: C. Avoidance of stress-producing situations D. Development of stress-reduction methods (relaxation techniques, exercises, biofeedback). Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com How about Duodenal Ulcers?  Characterized by gastric hyperacidity and a significant increased rate of gastric emptying  Occur more often in younger men; more women affected after menopause; peak age: 35 – 45 years (younger than gastric ulcer group)  Caused by smoking, alcohol abuse, psychologic stress An acute duodenal ulcer is seen in two views on upper endoscopy in the panels below. Our Assessment findings: Relieved by food. Usually not accompanied by nausea and vomiting Diagnostic tests: same as for gastric ulcer. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Nursing interventions: same as for gastric ulcers. Medical management: same as for gastric ulcers So what’s our Surgical Interventions?  Vagotomy  Antrectomy  Pyloroplasly  Vagotomy  Antrectomy  Pyloroplasly Removal of the antrum (distal half) of the stomach; often combined with bilateral excision of portions of vagus nerve trunks (vagectomy) in treatment of peptic ulcer. Vagotomy: severing of part of the vagus nerve innervating the stomach to decrease gastric acid secretion Antrectomy: removal of the antrum of the stomach to eliminate the gastric phase of digestion (contains the cells that secrete gastrin) Pyloroplaslty: enlargement of the pyloric sphincter with acceleration of gastric emptying Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Check 1nurses.com for more Nursing Resources Gastroduodenostomy (Billroth I) Gastrojejunostomy (Billroth II) Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Check 1nurses.com for more Nursing Resources Gastrectomy: Removal of 60% - 80% of the stomach Esophagojejunostomy (total gastrectomy): Removal of the entire stomach with a loop of jejunum anastomosed to the esophagus Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Check 1nurses.com for more Nursing Resources So here’s a summary of how to manage the patient in Surgery:  Pre – op Care Teach deep breathing exercises Provide nutritional support  TPN Inform about post-op measures and tubes to anticipate Nasogastric tube TPN until peristalsis returns Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  Post-op Care Promote patent airway and ventilation Semi-Fowler’s position Reinforce Deep Breathing and Coughing exercise, incentive spirometry Administer analgesic before activities Splint incision before patient coughs Encourage early ambulation Check 1nurses.com for more Nursing Resources Promote adequate nutrition NPO until peristalsis returns Measure NG drainage accurately Monitor for sign of leakage of anastomosis Small, frequent feedings Monitor for early satiety and regurgitation Eat less food at a slower pace Monitor weight regularly Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Prevent potential complications  Bleeding – first 24 hours, 4th to 7th day post-op due to non-healing Check 1nurses.com for more Nursing Resources BLEEDING Monitor NG drainage for blood Avoid unnecessary irrigation or repositioning of the NGT Monitor for signs of peritonitis: severe abdominal pain, rigidity fever  Dumping Syndrome  A group of unpleasant vasomotor and G.I. symptoms caused by rapid emptying of gastric content into the jejunum.  Abrupt emptying of stomach contents into the intestine Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com What’s the Pathophysiology of Dumping Syndrome? Check 1nurses.com for more Nursing Resources Here’s our Nursing Interventions for Dumping Syndrome Eat in a recumbent or semi  recumbent position Lie down after a meal Small, frequent feedings Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Moderate fat, high protein diet. Limit carbohydrates, no simple sugars Give fluids few hours after meals Avoid very hot and cold foods and beverages Now let’s check a Nursing Care Plan on Gastrectomy  CLICK HERE TO GO TO THE NCP for GASTRECTOMY Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com THYROIDECTOMY Another Topic that we would like to discuss for this report is Hyperthyroidism, One of the possible reasons for Thyroidectomy. Let’s Start… What is Hyperthyroidism? EXCESSIVE THYROID HORMONE SECRETIONS LEADING TO THYROTOXICOSIS And it can result to: HYPERMETABOLISM INCREASED SYMPATHETIC ACTIVITY What are the causes of Hyperthyroidism? GRAVE’S DISEASE TOXIC MULTINODULAR GOITER THYROID ADENOMA THYROIDITIS T3 THYROTOXICOSIS THYROID CARCINOMA Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com And what are the Clinical Manifestations of the patient? HALLMARK IS HEAT INTOLERANCE VISUAL CHANGES FATIGUE WEAKNESS PALPITATION CHEST PAIN Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com What are the Lab and Diagnostic Tests for Hyperthyroidism? T3,T4,TSH,T3 RESIN UPTAKE THYROID SCAN POSITION, SIZE AND FUNCTIONING OF THE GLAND Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com ULTRASOUND ECG Here are some possible Nursing Diagnosis for Hyperthyroidism IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS RELATED TO INADEQUATE INTAKE IN RELATION TO METABOLIC NEEDS HYPERTHERMIA RELATED TO INCREASED METABOLIC NEEDS POTENTIAL FOR HYPERTENSION AND CARDIAC FAILURE Check 1nurses.com for more Nursing Resources Nursing Management VITAL SIGNS, REST, QUIET AND COOL ENVIRONMENT And the Pharmacological therapy PTU METHIMAZOLE CARBIMAZOLE IODINE PREPARATIONS BETA BLOCKERS RADIOACTIVE IODINE Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com And the Surgical Intervention Partial or Total Thyroidectomy ! Watch out for these complications! HEMORRHAGE RESPIRATORY DISTRESS HYPOCALCEMIA & TETANY If Parathyroid glands are affected… Chvostek’s Sign Trosseau Sign LARYNGEAL NERVE DAMAGE And Our NCP for Thyroidectomy  CLICK HERE TO CHECK the NCP for Thyroidectomy Check 1nurses.com for more Free Nursing Care Plans Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com CESAREAN OPERATION CS Operation are done as an elective or as an optional operation, but most of the time it is required for a patient with Gestational Diabetes, Abruptio Placenta, Preeclampsia, and other High Risk Pregnancies. Let’s talk about Gestational Diabetes first before we go to the NCP for CS operations… So what is Gestational Diabetes? It is Diabetes Mellitus that begins during pregnancy as a result of changes in glucose metabolism and insulin resistance. And what are the data that are collected? - Glucose Challenge Test (GCT) at 24-48 hours,if GCT >140 mg/dl proceed to 3 hour oral glucose tolerance test (GTT) - If GTT positive, dietary controls initiated - If dietary controls fail to keep FBS <105 mg/dl, insulin therapy is initiated - Observe for glycosuria,ketonuria,polydipsia,polyphagia and polyuria. Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com - Monitor for excessive weight gain or excessive weight loss - Fetal growth is estimated serially with sonograms - Antepartum visits biweekly until 34 weeks, then weekly - Biophysical profile (BPP) at 34 weeks, then weekly - Daily fetal movement counts - Client’s understanding of findings of hyperinsulinism and ketoacidosis So What’s our Management? - Maintain euglycemia throughout pregnancy - Mother proceeds to term (>37 weeks) with reassuring fetal condition - Delivery of infant without morbidity or mortality And our Nursing Interventions should include… - Monitor Blood Sugar and Report Abnormalities - Reinforce Education of client regarding: Increased risk for genitourinary infections,dystocia,hydramnios, Cesarean birth Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Diet, glucose screening and insulin administration Treatment for hyperglycemia,hyperinsulinemia and recognize signs of ketoacidosis. - Most clients with GDM will return to normal glucose levels after childbirth - Clients with GDM are at greater risk for GDM in future pregnancies What’s our Evaluation Findings? - Client verbalizes understanding of treatment regime - Client verbalizes understanding of Potential Complications - Client is hospitalized if complications arise - Maternal/fetal morbidity and mortality are minimized For more information about GDM check http://www.diabetes.org Check 1nurses.com for more Nursing Resources And now here’s our Nursing Care Plan on CS Operations  Click Here to Check the NCP for CS operations Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Ultimate Test Taking Skills v.1.0 For Student Nurses, Registered Nurses, and other Professionals Do you know any of these Test Taking Skills? Conquer your exams, Period. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com INTRODUCTION Have you ever wanted to successfully pass your Nursing exams? Do you spend lots of time studying and yet you still get failing grades or low marks? Are you having a hard time analyzing and answering Nursing exams? If you answered Yes in any of these questions, you are in luck. This Report is for you. Taking Exams is stressful. What’s more stressful is waiting for the results and PASSING the tests. What you have here are PROVEN ways that most people doesn’t know or doesn’t utilize when taking exams. Utilize them and you’ll see results when you take your next exam* Good Luck and God Bless. To your success, 1nurses Team *Disclaimer: Taking exams is an individual endeavor, and each person has a different set of skills and knowledge. This report does not guarantee that you will fail or pass your tests. Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com DEVELOP CRITICAL THINKING SKILLS!!! According to Scriven & Paul from Criticalthinking.org, Critical Thinking is the cornerstone of one’s ability to function in today’s society. It has 2 components namely; - A set of skills to process and generate information and beliefs and - The Habit, based on intellectual commitment, of using those skills to guide behavior. Check 1nurses.com for more Nursing Resources So Where do you start? I strongly suggest that you follow these steps if possible but if not go to the sample test taking lessons in the next pages. 1. Outline your notes to each Disease – Create a Visual guide/Map of your own notes about the Topic you are studying 2. Pathophysiology of the Disease- CRITICAL- don’t even start your review without understanding what is the brief summary/overview of the disease 3. Signs/Symptoms (Including Laboratory Exams) – Remember to Highlight special S/Sx for each Disease Eg. RLQ pain for Appendicitis 4. Know the Different Nursing Diagnosis 5. Nursing Goals for the patient 6. Specific Implementation Plans 7. Patient Teaching Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Here’s some great TEST TAKING STRATEGIES If you have to GUESS think st 1 PHYSIOLOGICAL NEEDS A irway B reathing C irculation D isability nd 2 SAFETY rd 3 COMMUNICATION th 4 NURSING PROCESS Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com NEXT STEP ↓ Critical Thinking and the Nursing Process ASSESSMENT – Collect Data, communicate information about assessments ANALYSIS/NURSING DIAGNOSIS – Clustering and Interpreting Data, Identifying and communicating Nursing Diagnosis PLANNING – Identifying goals, projecting outcomes, setting priorities, identifying interventions. IMPLEMENTATION - Implementing Nursing Care EVALUATION – Identifying patient responses, comparing outcomes to goals, modifying plan of care. Check 1nurses.com for more Nursing Resources When we think of patients, we apply the Nursing Process, let’s apply it also when we take our tests… Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com When answering PRIORITIZATION Questions Remember Maslow’s Hierarchy of Needs! 1st Priority PHYSIOLOGICAL NEEDS Food Shelter Sleep Rest Air Exercise Sensory Stimulation Sex Proper Nutrition Vitamins Freedom from Disease/Pain Check 1nurses.com for more Nursing Resources 2nd Priority SAFETY/SECURITY NEEDS Personal Safety Job security Insurance Retirement Future Satisfaction Freedom from Illness and Pain Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com 3rd Priority LOVE/BELONGING NEEDS To be loved To receive affection To belong To be Accepted To have a place in a group To be a part of a team To have friends and Family To be understood 4th Priority SELF-ESTEEM NEEDS 5th Priority SELF ACTUALIZATION NEEDS Check 1nurses.com for more Nursing Resources • PYRAMID TO SUCCESS – Read the question and every option thoroughly and carefully! – Ask yourself “What is the question specifically asking?” – Be alert to key words, true and false response stems – Eliminate all the incorrect options! Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com  IDENTIFY the STEM of the QUESTION - It follows the case situation and asks something about the case situation - Read the stem carefully and specifically identify exactly what is being asked (Saunders) - Identify the topic of the question (GAPUZ) - Identify the critical elements in the question ( NCLEX ) - Identify the issue : o A drug (effect or side effect) - e.g. digoxin (Lanoxin o A treatment or procedure – e.g. glucose tolerance test, cardiac catheterization o A nursing problem- e.g alteration in comfort,potential for infection o A disorder/ complication – e.g. DM, HPN Choose the Correct Option • The options are all the answers and you must select one! • Read every option carefully, and if you must, reread the stem of the question to be sure! • Use the process of elimination! • Once you have eliminated two incorrect options, read the stem again to identify the question is asking then select the best one! Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Here’s an Example! • A client has received Atropine Sulfate IV during a surgical procedure. The nurse monitors a client for which of the ff effects of the medication in the immediate post op period? A. bradycardia B. Excessive salivation C. Diarrhea D. Urinary retention Check 1nurses.com for more Nursing Resources Issue of the Question • The issue is the problem that the question is being asked (NCLEX) • Assist you in eliminating the incorrect option (SAUNDERS) Check 1nurses.com for more Nursing Resources ANSWER D • Atro SO4 is anti cholinergic drug (all are increased except GIT, thus increases blood flow to the skeletal muscles, heart and brain) Anticholinergic Properties • Tachycardia (all VS are increased!) • Dilates pupil – to be more aware of surrounding Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • Dry mouth • Constipation • Urinary retention • Keywords • LOOK FOR IT! • THIS FOCUSES YOUR ATTENTION ON WHAT IS IMPORTANT AND THEY MAY APPEAR IN BOLD PRINT - EXAMPLE QUESTIONS – During the early period, which of the ff nursing procedure would be best? – Which of the ff nursing actions is vital? – Which of the ff nursing actions would be best initially? Check 1nurses.com for more Nursing Resources Common Key Words( SAUNDERS) • Early or late • Best • First • Initial • Immediately • Most likely/ Least likely Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • Most/least appropriate • On the day of • After several days • TRUE RESPONSE • A TRUE response stem requires an answer which is a true statement. • Examples: 1. Which of these interpretations is most justifiable? 2. The chief purpose of the drug is to: • Key words of true response • Most likely • Most helpful • Best • Best judgment • Initial • First • Chief • Immediate • FALSE RESPONSE Check 1nurses.com for more Nursing Resources Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • A FALSE response requires a false statement (negative or not true) • Ex. – Which of the ff nursing actions is inappropriate? – Which of the ff describes incorrect placement of the hands during CPR? – Which of the ff actions would place the client at risk? • Key words of FALSE Response • Except • Not • Least likely • Need for further instruction (NFI) • Need for further understanding/ education • Lowest priority • Incorrect • Unsafe / at risk Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • QUESTION • #1. A patient with Parkinsons disease will most likely exhibit: a. Fine hand tremors b. Intentional tremors c. Resting tremors d. Coarse hand tremors • Tremors • Rhythmic, purposeless, quivering movements of muscles • Causes: A. Fine hand tremor ( hyperthyroidism) B. Intentional tremors (alkalosis/ MS) C. Resting tremors ( Parkinsons) D. Coarse tremors ( Alcohol / DT) Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com QUESTION = Mr. Tan is an 80 y/o man who just had cataract surgery performed in his right eye. • As the nurse reviews the history of the patient, which finding will not be expected: A. Blurred vision B. Cloudy white pupil C. Eye pain at night D. Absent red reflex • Answer = C • Cataract is not characterized by pain. • The S/Sx of CATARACT: – Blurred vision – Photophobia-client complains of glare – Opaque or cloudy white pupil – Difficulty to identify colors – Indirect opthalmoscope-red reflex is distorted/absent – Patient does not experience pain Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Check 1nurses.com for more Nursing Resources • Answering questions that focus on Setting Priorities • Priority setting questions asks the test takers to identify either what comes first, is most important or gets the highest priority • Sample questions • What is the nurse’s initial response? • The nurse should give immediate consideration to which of the ff? • Which nursing action receives the highest priority? • What should the nurse do first? QUESTIONS THAT REQUIRE PRIORITIZING • IDENTIFY the KEY WORDS – Initial – Essential – Vital – Immediate – Highest – Best – Most – Priority – Use GUIDELINES in PRIORITIZING Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • Use Maslow’s Hierarchy of needs – when a question ask you to establish priorities for the patient – Physiological comes first! (air, water, food,shelter,sex,activity, comfort, sleep) – SAFETY ( ALWAYS THINK OF SAFETY! Avoiding harm, feeling secure) • Example of Maslow’s • The doctor orders the following for a patient with diabetes insipidus, which one should the nurse carry out first? – Administer IV fluids – Measure urine output – Check the urine specific gravity – Monitor the blood pressure – ABC’S Check 1nurses.com for more Nursing Resources • Remember the order of priority: – Airway – Breathing – Circulation Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Sample Question • A client undergoes a subtotal thyroidectomy. The nurse ensures that which priority item is at the client’s bedside on arrival from the operating room? a. An apnea monitor b. A blood transfusion warmer c. A suction unit and oxygen d. An ampule of vit. k • Answer = C • Following thyroidectomy, resp. distress can occur due to tetany, tissue swelling or hemorrhage. O2 and suction should be at the bedside for emergency purpose • Recall the anatomical location of the thyroid gland and its close proximity to trachea Using the Nursing Process • When a question asks you to prioritize nursing interventions, use the nursing process. • Indicates that assessment comes first! • Key words: • Initial nursing action • First nursing action • Most appropriate nursing action Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Example • A nurse in ambulatory care clinic takes a client’s blood pressure. The nurse measures the client’s BP in the left arm as 200/118mmHg. The first action of the nurse is to: a. Notify the physician b. Inquire about the presence of kidney disorders c. Check the blood pressure in the right arm Recheck the pressure in the same arm within 30 seconds Check 1nurses.com for more Nursing Resources • Assessment Key Words • Ascertain • Assess • Check • Determine • Find out • Identify • Monitor • Observe • Obtain info Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com – Other strategies • Global options Similar distractors Look for qualifiers – DO NOT SELECT! As well as ABSOLUTE TERMS – INCORRECT! QUALIFIERS • GENERALLY • USUALLY • TENDS TO • POSSIBLY • OR MAY ABSOLUTE TERMS • NEVER • ALWAYS • EVERY • ALL • NONE • MUST • ONLY Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Communication theory – Indicates that we should focus on feelings first! – Watch out for responses which are considered NON THERAPEUTIC: • Don’t worry, WHY, • Pay particular attention to therapeutic phrases such as: • it seems • It sounds • Tell me • A client with aldosteronism has developed renal failure and says to the nurse, “This means that I will die very soon.” The most appropriate nursing response is: a. What are you thinking about? b. You will do just fine. c. You sound discouraged today. d. I read that death is a beautiful experience • Assessment key words • Therapeutic • Being silent • Offering self for assistance Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com • Showing empathy • Restatement • Paraphrasing • Validation/clarification • Giving info • Non therapeutic • Giving advise • Showing approval • False reassurance • Devaluing client’s feelings • Being defensive • Placing your clients on hold • Summary • Knowledge on facts – go back to basics! • do everything by the book • Use the guidelines/ test taking strategies • Use some clinical experiences • PRAY! And Pray! GOOD LUCK & God Bless NURSES! From 1Nurses.com Team Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com Resources Test Taking Tips – site to improve your test taking skills and studies Test Taking Strategies – From Google Books by Judi Kesselman-Turkel, Franklynn Peterson Free Nclex Questions – Practice NCLEX Questions Nursing Lectures – Free Powerpoint, Downloadable Nursing Lectures Free Nursing Ceu – Free Nursing Continuing Education Units 1NURSES.COM – Your #1 Source Of Nursing Related Information Grab the latest and most updated #1 Nursing resource on the Web – http://1nurses.com

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5 Nursing Care Plans and Test Taking Skills

by 1nurses on Oct 05, 2009

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5 Nursing Care Plans and Test Taking Skills — Document Transcript