L&E Chapter 002 Lo


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  • Compare and contrast critical thinking and nursing process. Give applications of critical thinking on clinical decision-making.
  • What are the clinical applications of critical thinking? What are the roles and responsibilities of the LVN/LPN in clinical decision-making?
  • What are the steps in the nursing process? How do you apply these steps in the nursing process in clinical decision-making? What are the standards and the ethical codes that guide clinical judgments?
  • State the principles in the form of a question and facilitate discussion on the potential clinical applications. Identify nursing strategies that make the most of the human potential. How does the nurse compensate for problems created by illness? What are ways and measures to constantly re-evaluate, self-correct, and strive to improve nursing actions?
  • A 52-year-old patient is admitted with complaints of colicky right upper quadrant abdominal pain. She has not eaten for the last 3 days, and has light-colored stools. She indicates that the pain was aggravated by meals. Vital signs: BP 140/90, HR 90, RR 20, T 100 ° F. Her abdomen is tender to touch. What are some nursing considerations? What are potential learning experiences for the nursing student? What procedures would require a nursing instructor to supervise?
  • Based on a patient’s primary clinical complaint, discuss how the nurse can: Collect data Verify data Look for gaps in the information Analyze data Examples: Patient complains of general weakness and fatigue Patient was admitted for painful urination Patient seeks medical consult on bouts of nausea and vomiting
  • Identify clinical situations that: Demonstrate how the attitudes and communication skills positively/negatively affected nursing care. How did the nurse realize these positive/negative influences? What were the appropriate nursing measures to address these positive/negative influences?
  • Discuss applications of the fundamental beliefs that are the bases of the nursing process. Recall Maslow’s Theory of Hierarchy of Needs. What are the applications of the theory in nursing care? Identify how the nurse can provide “high quality of care” in the practice settings.
  • Define “patient-centered approach.” Give examples of how nursing focuses on: Maintaining health Preventing disease Helping the sick and injured
  • What comprise the complete database? A complete database includes a thorough health history, physical assessment, psychosocial assessment, and cultural and spiritual assessment. Compare and contrast actual nursing diagnosis and risk nursing diagnosis. Define “planning,” “implementation,” and “evaluation.”
  • Compare and contrast data collection and assessment. Give examples of subjective and objective data. How does the nurse gather subjective and objective data?
  • Review assessment forms and discuss the types of data. Compare and contrast primary and secondary source. What is the medication reconciliation form? What are the advantages and disadvantages of the form?
  • Give specific examples of the various types of physical assessments. Describe specific nursing considerations when assessing the older adult and/or the pediatric patient.
  • Describe how the nurse can best utilize patient information. What do you find in the various sections of the medical record? History Physical examination Progress notes Diagnostic tests
  • What are the ethical and legal implications of LVN/LPN assessments and data collection?
  • Identify specific health conditions associated with abnormal laboratory findings.
  • Compare and contrast medical diagnosis and nursing diagnosis. What are the components of the actual nursing diagnosis? Give specific examples. Give a specific example of a three-part nursing diagnosis.
  • Give examples of actual and potential problems.
  • Discuss Maslow’s Hierarchy of Needs. Discuss specific examples of how to apply the theory in setting priorities. Give exemptions.
  • Why is it important to set a realistic, measurable, and time-referenced outcome statement? Give an example of a realistic, measurable, and time-referenced outcome statement.
  • A patient with a history of diabetes mellitus complains of moderate leg pains with increased ambulation. A possible nursing diagnosis would be: Give an example of a complete expected outcome.
  • List nursing interventions for a patient with complaints of moderate leg pains. What are independent nursing interventions? What are collaborative nursing interventions?
  • What are the differences in the scope of practice of the LVN/LPN and the RN? How do the nursing staff communicate the plan of care? What constitutes a complete shift report?
  • Discuss how the nurse evaluates the effectiveness of nursing interventions and achievement of expected outcomes. What are appropriate nursing actions to help achieve unmet expected outcomes? Give examples.
  • L&E Chapter 002 Lo

    1. 1. Lesson 2.1 Chapter 2 <ul><li>Critical Thinking and Nursing Process </li></ul>
    2. 2. Learning Objectives <ul><li>Theory </li></ul><ul><li>1. Explain what critical thinking is in your own words. </li></ul><ul><li>2. Describe how critical thinking affects clinical judgment. </li></ul><ul><li>3. Discuss why nurses in all programs must learn to think critically. </li></ul><ul><li>4. Clarify your role in nursing process according to your state’s nurse practice act. </li></ul><ul><li>5. Explain three fundamental beliefs about human life as the basis for nursing process. </li></ul><ul><li>6. Identify the source for LPN/LVN standards for nursing process. </li></ul><ul><li>Clinical Practice </li></ul><ul><li>1. Explain how factors that influence critical thinking are experienced by you during patient care. </li></ul><ul><li>2. Provide a clinical example of how nursing process is used in the care of medical-surgical patients. </li></ul><ul><li>3. Provide an example of each of the following techniques of physical examination: inspection and observation, olfaction, auscultation, and percussion. </li></ul><ul><li>4. Prepare a list for beginning-of-shift assessment for a specific patient. </li></ul><ul><li>5. Write an example of a patient goal that is realistic, measurable, and time referenced. </li></ul><ul><li>6. Differentiate between nursing orders and medical orders. </li></ul><ul><li>7. Explain the value of identifying the patient’s actual problems that lead to nursing diagnoses. </li></ul>
    3. 3. Critical Thinking <ul><li>A problem-solving method </li></ul><ul><li>Incorporates the scientific method </li></ul><ul><li>Always asks, “Is there a better way?” </li></ul><ul><li>A lifelong process </li></ul>
    4. 4. Critical Thinking and Clinical Judgment (Alfaro-Lefevre, 2004) <ul><li>Purposeful, informed, and outcome-focused </li></ul><ul><li>Requires careful identification of patient problems, issues, and risks </li></ul><ul><li>Makes accurate decisions about what is happening, what needs to be done, and prioritization of patient care </li></ul>
    5. 5. Critical Thinking and Clinical Judgment (Alfaro-Lefevre, 2004) <ul><li>Driven by patient, family, and community health care needs </li></ul><ul><li>Based on principles of nursing process and the scientific method </li></ul><ul><li>Uses logic, intuition, knowledge, skills, and experience of the LPN/LVN </li></ul><ul><li>Guided by standards and ethical codes </li></ul>
    6. 6. Critical Thinking and Clinical Judgment (Alfaro-Lefevre, 2004) <ul><li>Calls for strategies that make the most of human potential </li></ul><ul><li>Compensates for problems created by human nature </li></ul><ul><li>Means constantly reevaluating, self-correcting, and striving to improve (Hill and Howlett, 2005). </li></ul>
    7. 7. Consider the Following When Receiving Report <ul><li>Do I understand what is being said? </li></ul><ul><li>What will I be expected to do? </li></ul><ul><li>What are the priorities of nursing care? </li></ul><ul><li>What areas need further clarification? </li></ul><ul><li>What procedures will require instructor supervision? </li></ul>
    8. 8. Critical Thinking Is Based On Science and Scientific Principles <ul><li>Collecting data in an organized way </li></ul><ul><li>Verifying data in an organized way </li></ul><ul><li>Looking for gaps in information </li></ul><ul><li>Analyzing the data </li></ul>
    9. 9. Factors that Influence Critical Thinking and Nursing Care <ul><li>Attitude </li></ul><ul><li>Communication skills </li></ul>
    10. 10. Fundamental Beliefs: The Basis for Nursing Process <ul><li>Every person is endowed with worth and dignity. </li></ul><ul><li>Every person has basic needs. </li></ul><ul><li>Meeting one’s basic human needs may require assistance. </li></ul><ul><li>Every person has the right to high-quality service. </li></ul>
    11. 11. Fundamental Beliefs: The Basis for Nursing Process <ul><li>Patients and their families prefer a patient-centered approach. </li></ul><ul><li>The focus of nursing should be on maintaining health, preventing disease, and helping the sick and injured. </li></ul><ul><li>The nurse who engages in the nursing process will continue to work toward his/her own self-fulfillment. </li></ul>
    12. 12. The Nursing Process <ul><li>NCSBN and the LVN/LPN in medical-surgical nursing: </li></ul><ul><li>Assessment (data collection) </li></ul><ul><li>Nursing diagnosis </li></ul><ul><li>Planning </li></ul><ul><li>Implementation </li></ul><ul><li>Evaluation </li></ul>
    13. 13. Assessment (Data Collection) <ul><li>Data collection </li></ul><ul><li>Subjective data </li></ul><ul><li>Objective data </li></ul>
    14. 14. Sources of Information <ul><li>Review of admission forms </li></ul><ul><li>Interview: </li></ul><ul><ul><li>Primary source </li></ul></ul><ul><ul><li>Secondary source </li></ul></ul><ul><li>Medication reconciliation form </li></ul><ul><li>Physical assessments </li></ul>
    15. 15. Figure 2-3
    16. 16. Physical Assessments <ul><li>Inspection and observation </li></ul><ul><li>Olfaction </li></ul><ul><li>Palpation </li></ul><ul><li>Auscultation </li></ul><ul><li>Percussion </li></ul><ul><li>Practical daily assessment (data collection) </li></ul>
    17. 17. Chart Review <ul><li>History, physical examination, progress notes, and results of diagnostic tests </li></ul><ul><li>Medication profile sheets or medication administration record </li></ul><ul><li>Nursing documentation and patient chart information </li></ul>
    18. 18. Legal & Ethical Considerations 2-1: Protected Health Information <ul><li>Any protected health information that the student collects from a patient’s chart must be carefully guarded to avoid violating the confidentiality component of the HIPAA. </li></ul><ul><li>Information that is retained by the student for educational purposes must be devoid of identifying information. </li></ul><ul><li>Student preparation paperwork that contains protected health information must be destroyed following the policies and procedures of the facility. </li></ul>
    19. 19. Commonly Ordered Tests <ul><li>WBCs </li></ul><ul><li>RBCs </li></ul><ul><li>Hemoglobin </li></ul><ul><li>Hematocrit </li></ul><ul><li>Platelets </li></ul><ul><li>Glucose </li></ul><ul><li>Hemoglobin A 1C </li></ul><ul><li>Thyroid-stimulating hormone </li></ul>
    20. 20. Analysis and Nursing Diagnosis: Patient’s Response to Health Condition <ul><li>Based on available patient data </li></ul><ul><li>Nursing diagnosis and medical diagnosis </li></ul><ul><li>Complete nursing diagnosis includes: </li></ul><ul><ul><li>The problem (NANDA stem) </li></ul></ul><ul><ul><li>The etiology (related causes of the problem) </li></ul></ul><ul><ul><li>The signs and symptoms (evidence of the problem) </li></ul></ul>
    21. 21. Nursing Diagnosis: Actual or Potential Problems <ul><li>Actual problems are currently exhibited and include all three components of the diagnosis statement </li></ul><ul><li>Potential problems do not currently exhibit evidence, but the data demonstrate that these could occur </li></ul>
    22. 22. Planning <ul><li>Setting priorities of care: </li></ul><ul><ul><li>Maslow’s Hierarchy of Needs </li></ul></ul><ul><li>Goals and expected outcomes: </li></ul><ul><ul><li>Outcome statements are derived from the signs and symptoms included in the nursing diagnosis statement </li></ul></ul>
    23. 23. Figure 2-5
    24. 24. Characteristics of Outcome Statements <ul><li>Realistic </li></ul><ul><li>Measurable </li></ul><ul><li>Time-referenced </li></ul>
    25. 25. Writing Expected Outcomes <ul><li>Subject </li></ul><ul><li>Action verb </li></ul><ul><li>Conditions or modifiers </li></ul><ul><li>Criterion (standard) for desired performance </li></ul>
    26. 26. Nursing Interventions <ul><li>Nursing actions to achieve the goals and expected outcomes </li></ul><ul><li>Independent nursing interventions </li></ul>
    27. 27. Implementation <ul><li>LPN/LVN scope of practice </li></ul><ul><li>Staff communication regarding care </li></ul>
    28. 28. Evaluation <ul><li>Comparison of actual outcomes to the expected outcomes </li></ul><ul><li>Interdisciplinary (collaborative) care plan </li></ul>