Nursing Process

1. Welcome
to
12/16/2022 RADIX ACADEMY 1

2. Nursing Process
Masud Rana
RN, MSN(NIANER)
12/16/2022 2
RADIX ACADEMY

3. Nursing Process
 Specific to the nursing profession
 A framework for critical thinking
 It’s purpose is to:
“Diagnose and treat human responses to
actual or potential health problems”
12/16/2022 3
RADIX ACADEMY

4. Nursing Process
 Organized framework to guide practice
 Problem solving method - client focused
 Systematic- sequential steps
 Goal oriented- outcome criteria
 Dynamic-always changing, flexible
 Utilizes critical thinking processes
12/16/2022 4
RADIX ACADEMY

5. Scientific Method of problem solving
 ID problem
 Collect data
 Form hypothesis
 Plan of action
 Hypothesis testing
 Interpret results
 Evaluate findings
12/16/2022 5
RADIX ACADEMY

6. Advantages of Nursing Process
 Provides individualized
care
 Client is an active
participant
 Promotes continuity of
care
 Provides more effective
communication among
nurses and healthcare
professionals
 Develops a clear and
efficient plan of care
 Provides personal
satisfaction as you see
client achieve goals
 Professional growth as
you evaluate
effectiveness of your
interventions
12/16/2022 6
RADIX ACADEMY

7. 5 Steps in the Nursing Process
 Assessment
 Nursing
Diagnosis
 Planning
 Implementing
 Evaluating
12/16/2022 7
RADIX ACADEMY

8. Assessment
 First step of the Nursing Process
 Gather Information/Collect Data
 Primary Source - Client / Family
 Secondary Source - physical exam, nursing
history, team members, lab reports, diagnostic
tests…..
 Subjective -from the client (symptom)
• “I have a headache”
 Objective - observable data (sign)
• Blood Pressure 130/80
12/16/2022 8
RADIX ACADEMY

9. Assessment-collecting data
 Nursing Interview (history)
 Health Assessment -Review of Systems
 Physical Exam
 Inspection
 Palpation
 Percussion
 Auscultation
12/16/2022 9
RADIX ACADEMY

10. Assessment-collecting data
 Make sure information is complete &
accurate
 Validate prn
 Interpret and analyze data
Compare to “standard norms”
 Organize and cluster data
12/16/2022 10
RADIX ACADEMY

11. Example of Assessment
 Obtain info from nursing assessment,
history and physical (H&P) etc…...
 Client diagnosed with hypertension
 B/P 160/90
 2 Gm Na diet and antihypertensive
medications were prescribed
 Client statement “ I really don’t watch my
salt” “ It’s hard to do and I just don’t get it”
12/16/2022 11
RADIX ACADEMY

12. Nursing Diagnosis
 Second step of the Nursing Process
 Interpret & analyze clustered data
 Identify client’s problems and strengths
 Formulate Nursing Diagnosis (NANDA :
North American Nursing Diagnosis
Association)-Statement of how the client is
RESPONDING to an actual or potential
problem that requires nursing intervention
12/16/2022 12
RADIX ACADEMY

13. Nsg Dx vs MD Dx
 Within the scope of
nursing practice
 Identify responses
to health and illness
 Can change from
day to day
 Within the scope of
medical practice
 Focuses on curing
pathology
 Stays the same as
long as the disease
is present
12/16/2022 13
RADIX ACADEMY

14. Formulating a Nursing Diagnosis
 Composed of 3 parts:
 Problem statement- the client’s response
to a problem
 Etiology- what’s causing/contributing to the
client’s problem
 Defining Characteristics- what’s the
evidence of the problem
12/16/2022 14
RADIX ACADEMY

15. Nursing Diagnosis
 Problem( Diagnostic Label)-based on your
assessment of client…(gathered
information), pick a problem from the
NANDA list...
 Etiology- determine what the problem is
caused by or related to (R/T)...
 Defining characteristics- then state as
evidenced by (AEB) the specific facts the
problem is based on...
12/16/2022 15
RADIX ACADEMY

16. Example of Nursing Dx
 Ineffective therapeutic regimen
management
R/T difficulty maintaining lifestyle changes
and lack of knowledge
AEB B/P= 160/90, dietary sodium
restrictions not being observed, and client
statements of “ I don’t watch my salt” “It’s
hard to do and I just don’t get it”.
12/16/2022 16
RADIX ACADEMY

17. Types of Nursing Diagnoses
 Actual
Imbalanced nutrition; less than body requirements
RT chronic diarrhea, nausea, and pain AEB height
5’5” weight 105 lbs.
 Risk
Risk for falls RT altered gait and generalized
weakness
 Wellness
Family coping: potential for growth RT
unexpected birth of twins.
12/16/2022 17
RADIX ACADEMY

18. Planning
Third step of the Nursing Process
 This is when the nurse organizes a nursing care
plan based on the nursing diagnoses.
 Nurse and client formulate goals to help the
client with their problems
 Expected outcomes are identified
 Interventions (nursing orders) are selected to aid
the client reach these goals.
12/16/2022 18
RADIX ACADEMY

19. Planning – Begin by
prioritizing client problems
 Prioritize list of
client’s nursing
diagnoses using
Maslow
 Rank as high,
intermediate or low
 Client specific
 Priorities can change
12/16/2022 19
RADIX ACADEMY

20. Maslow’s Hierarchy of
Needs
12/16/2022 20
RADIX ACADEMY

21. Planning
Developing a goal and outcome statement
 Goal and outcome
statements are client
focused.
 Worded positively
 Measurable, specific
observable, time-limited,
and realistic
 Goal = broad statement
 Expected outcome =
objective criterion for
measurement of goal
EXAMPLE
 Goal:
Client will achieve
therapeutic management
of disease process….
 Outcome Statement:
AEB B/P readings of
110-120 / 70-80 and client
statement of
understanding importance
of dietary sodium
restrictions by day of
discharge.
12/16/2022 21
RADIX ACADEMY

22. Planning- Types of goals
 Short term goals
 Long term goals
 Cognitive goals
 Psychomotor goals
 Affective goals
12/16/2022 22
RADIX ACADEMY

23. Goals are patient-centered and
SMART
Specific
Measurable
Attainable
Relevant
Time Bound
Pt will walk 50 ft.
Pt will eat 75% of meal
Pt will maintain HR<100
Pt will state pain level is acceptable 6 (0-10)
12/16/2022 23
RADIX ACADEMY

24. Planning-select interventions
 Interventions are selected and written.
 The nurse uses clinical judgment and
professional knowledge to select
appropriate interventions that will aid the
client in reaching their goal.
 Interventions should be examined for
feasibility and acceptability to the client
 Interventions should be written clearly and
specifically.
12/16/2022 24
RADIX ACADEMY

25. Interventions – 3 types
 Independent ( Nurse initiated )- any
action the nurse can initiate without direct
supervision
 Dependent ( Physician initiated )-nursing
actions requiring MD orders
 Collaborative- nursing actions performed
jointly with other health care team members
12/16/2022 25
RADIX ACADEMY

26. Implemention
 The fourth step in the Nursing Process
 This is the “Doing” step
 Carrying out nursing interventions (orders)
selected during the planning step
 This includes monitoring, teaching, further
assessing, reviewing NCP, incorporating
physicians orders and monitoring cost
effectiveness of interventions
12/16/2022 26
RADIX ACADEMY

27. Implementing- “Doing”
 Monitor VS q4h
 Maintain prescribed diet
(2 Gm Na)
 Teach client amount of
sodium restriction, foods
high in sodium, use of
nutrition labels, food
preparation and sodium
substitutes
 Teach potential
complications of
hypertension to instill
importance of
maintaining Na
restrictions
 Assess for cultural
factors affecting
dietary regime
12/16/2022 27
RADIX ACADEMY

28. Implementing – “Doing”
 Teach the client-
hypertension can’t be
cured but it can be
controlled.
 Remind the client to
continue medication
even though no S/S
are present.
 Teach client importance
of life style changes:
(weight reduction,
smoking cessation,
increasing activity)
 Stress the importance of
ongoing follow-up care
even though the patient
feels well.
12/16/2022 28
RADIX ACADEMY

29. Evaluation- To determine
effectiveness of NCP
 Final step of the Nursing Process but
also done concurrently throughout client care
 A comparison of client behavior and/or response
to the established outcome criteria
 Continuous review of the nursing care plan
 Examines if nursing interventions are working
 Determines changes needed to help client reach
stated goals.
12/16/2022 29
RADIX ACADEMY

30. Evaluation
 Outcome criteria met? Problem resolved!
 Outcome criteria not fully met? Continue
plan of care- ongoing.
 Outcome criteria unobtainable- review each
previous step of NCP and determine if
modification of the NCP is needed.
 Were the nsg interventions
appropriate/effective?
12/16/2022 30
RADIX ACADEMY

31. Evaluation
Factors that impede goal attainment:
 Incomplete database
 Unrealistic client outcomes
 Nonspecific nsg interventions
 Inadequate time for clients to achieve
outcomes.
12/16/2022 31
RADIX ACADEMY

32. Checkpoint
Identify which stage of the nursing process
is being described below:
 The nurse writes nursing interventions
 A goal is agreed upon
 The nurse performs a physical assessment
 A revision is made to the NCP
 The nurse administers antibiotic medication
 A statement is written that outlines the clients
response to a potential health problem
12/16/2022 32
RADIX ACADEMY

33. S and O Data Quiz
 RR 22/min, even unlabored
 “I can only walk 3 blocks before my legs start to
hurt”
 Pain rated 3 on a scale of 0-10
 Skin pink, warm and dry
 Urine output 300mL/8 hr
 “My wife doesn’t come to visit very often”
 Dressing clean, dry and intact.
12/16/2022 33
RADIX ACADEMY

34. Quiz
Nursing diagnoses are aimed at identifying
client problems that are treatable by
_______.
 A.The physician
 B.The nurse
 C.Invasive techniques
 D.Complementary strategies
12/16/2022 34
RADIX ACADEMY

35. Important to Know
 Father of Medicine: Hippocrates
 Father of Public Health : Cholera (by john
snow in London; 1848-1854)
Father of Epidemiology/Modern
Epidemiology/ The greatest doctor: John Snow
 Germ Theory : Louis Pasteur
 Small Pox Vaccine : Edward Jenner (1796)
12/16/2022 35
RADIX ACADEMY

36. Community
 A group of people
 A defined geographical area
 Common cultures, values, beliefs,
norms, interests
12/16/2022 36
RADIX ACADEMY

37. Comprehensive Health Care
A package of activities of community medicine
that includes-
1. Curative – treatment of common ailments
2. Preventive – e.g Immunization
3. Promotive – e.g. Health education
4. Rehabilitative
12/16/2022 37
RADIX ACADEMY

38. Health
 Health is a state of complete physical, mental,
and social well-being and not merely an
absence of disease or infirmity, so that each
citizen can lead a socially and economically
productive life. - (WHO)
12/16/2022 38
RADIX ACADEMY

39. Dimension Health
Four Major Dimension:
1. Physical
2. Mental
3. Social, and
4. Spiritual
12/16/2022 39
RADIX ACADEMY

40. Health Indicators
 Health indicators are the tools with which we
measure the health status of a community
12/16/2022 40
RADIX ACADEMY

41. Health Indicators
 Health indicators are the tools with which we
measure the health status of a community
12/16/2022 41
RADIX ACADEMY

42. Types of Health indicators
1. Mortality indicators
2. Morbidity indicators
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Indicators of social & mental health
8. Environmental indicators
9. Socio-economic indicators
10. Health policy indicators
11. Indicators of quality of life, and
12. Other indicators
12/16/2022 42
RADIX ACADEMY

43. Mortality indicators
 Crude death rate
 Life expectancy at birth
 Infant mortality rate
 Child mortality rate
 Under 5 proportionate mortality rate
 Adult Mortality rate
 Maternal Mortality rate
 Diseases specific mortality rate
 Proportional mortality rate
 Case fatality rate
 Years of potential life lost (YPLL)
12/16/2022 43
RADIX ACADEMY

44. Mortality indicators
 Crude death rate
 Life expectancy at birth
 Infant mortality rate
 Child mortality rate
 Under 5 proportionate mortality rate
 Adult Mortality rate
 Maternal Mortality rate
 Diseases specific mortality rate
 Proportional mortality rate
 Case fatality rate
 Years of potential life lost (YPLL)
12/16/2022 44
RADIX ACADEMY

45. Morbidity Indicators
 Incidence & Prevalence rate
 Notification rate
 Attendance rate at out-patient departments,
health centers
 Admission, readmission and discharge rate
 Duration of hospital stay
 Spells of sickness or absence from work or
school
12/16/2022 45
RADIX ACADEMY

46. Health Care (service) delivery
indicators
 Doctor-population ratio
 Doctor – Nurse ratio
 Population- Bed ratio
 Population per health centre/ sub-centre
 Population per traditional birth attendant
12/16/2022 46
RADIX ACADEMY

47. Drugs to avoid in Pg
SAFE Moms Take Really Good Care
S- Sulfonamides (e.g. Sulfadiazine)
A- Aminoglycocides (e.g. gentamycin, amikacin, tobramycin,
neomycin, streptomycin)
F- Fluroquinolones (e.g. ciprofloxacine, gemifloxacin,
levofloxacin, moxifloxacine, ofloxacin)
E- Erythromycin
M- Metronidazole
T- Tetracyclin
R- Ribavirin (antiviral to Rx HCV)
G- Griseofulvin (antifungal to Rx skin infection e.g. itch,
wring worm)
C- Chloramphenicol/Clindamycin/Clarithromycin
12/16/2022 47
RADIX ACADEMY

48. Primary Health Care
 The concept of ‘primary health care’ came
into existence at the Alma-Ata conference,
in 1978.
12/16/2022 48
RADIX ACADEMY

49. 8 Components/Elements of PHC
12/16/2022 49
RADIX ACADEMY

50. Principles of PHC
12/16/2022 50
RADIX ACADEMY

51. Prevention
 Prevention is the action taken to intercept or
oppose the ‘cause’ and thereby the disease
process.
12/16/2022 51
RADIX ACADEMY

52. Levels of prevention
Four levels of prevention:
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
12/16/2022 52
RADIX ACADEMY

53. 12/16/2022 53
RADIX ACADEMY

54. 12/16/2022 54
RADIX ACADEMY

55. Thank You
12/16/2022 55
RADIX ACADEMY