NSE 13A/B Study Guide - Comprehensive Final Exam Guide - Trust Law, Canada, Substance Abuse

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20 Nov 2018
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NSE 13A/B
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Week 1 of NSE13 Chapter 1&3 Jarvis Textbook
Chapter 1
Assessment: Point of Entry in an Ongoing Process
- During the assessment phase of the nursing process, one can collect either subjective data or objective
data. Subjective data includes what the patient can describe about themselves and how they are feeling
while objective data includes information collected through inspection and observation during the
physical examination.
- Both subjective and objective data form the data base that leads to a clinical judgement or diagnosis
regarding health problems, risk factors and life processes.
Diagnostic Reasoning
- Adequate examiners are able to gather data effectively but treat all data as equally important which
makes the process long and ineffective.
- Diagnostic Reasoning involves:
o Attending to initial cues such as a signs/symptoms or lab data
o Formulating a diagnostic hypothesis, which is an explanation for a set of cues
o Gathering data related to the hypothesis
o Evaluate hypothesis with new collected data to make final diagnosis
- After collecting data develop list of signs, symptoms and patient health needs in no particular order
o Organize data that appear to be related and validate it to make sure they are accurate
o Fill in missing information by double checking yourself or by having someone more
experienced check it out for you
Critical Thinking and the Diagnostic Process
- The nursing process includes six phases:
o Assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
o Applying the process depends on level and time of experience
o Novice nurses - no experience and uses clear cut rules; proficient nurses have time and
experiences and is able to envision long-term goals; expert nurses arrive at a clinical
judgement in one leap due to intuition, which is the immediate recognition of patterns.
Expert nurses have high stakes so monitor vigilantly to prevent complications. They have
much more experience and are able to draw from it.
- Critical thinking is the means by which nurses learn to assess and modify, if indicated, before
acting.
- During your career, you will need to sort through vast amounts of data and information in order to
make a diagnosis; the steps of the nursing process are not used in isolation but in a
multidimensional thinking process.
- The process can be broken down into different parts:
o Identify assumptions: determine what is unique about the case and what you might be
taking for granted as there may be unique circumstances.
o Identify an organized comprehensive approach to assessment: approach depends on
patients priority needs and your personal/institutional preference.
o Validation: check the accuracy and reliability of the data.
o Distinguishing normal from abnormal: first stop in problem identification.
o Making inferences or hypotheses: interpret data to come to correct conclusions about
health.
o Clustering related clues: allows you to see relationships between data.
o Distinguishing relevant from irrelevant: examination produces a lot of data, therefore it is
important to consider which is relevant to making a diagnosis.
o Recognize inconsistences: with conflicting information between subjective and objective data,
it can lead to further investigation
o Identifying patterns: Awareness of patterns helps you fill in the whole picture and discover
missing pieces of information.
o Identifying missing information: allows you to fill in gaps and come to a correct diagnosis.
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o Promoting health: identify patient priority, assess risk factors in order to manage them
and prevent diseases and promote good health.
o Diagnosing actual/potential risk problems: using assessment data, it is important to
identify a diagnosis perhaps while referring to the NANDA, which includes actual
diagnosis (existing problems), risk diagnoses (potential problems) & wellness diagnosis
(promotion of health).
While medical diagnoses are used to determine the cause of a disease, nursing
diagnoses evaluate the response of the whole person for actual or potential health
problems.
o Setting priorities: acuity of illness, persons social/family context determines priorities of
problems:
First level priority problems: emergency, immediate (airway establishing,
breathing and cardiac circulations)
Second level priority: require intervention to prevent further deterioration (risk
of infections or change in mental status)
Third level priority: important to health but can be addressed after 1st/2nd
Collaborative: approach to treatment involves multiple disciplines to solve
physiological complications
o Determining specific interventions: aim to prevent, manage or resolve health problems
and must be clear who, when, how often it should be done.
o Evaluating and revising your thinking: compare actual outcomes and expected outcomes
and determine effectiveness of interventions.
o Determining a comprehensive plan: record revised plan of care and keep it up to date and
make sure it is accessible to multidisciplinary team.
Evidence Informed Assessment
- Evidence based practice include clinical trials or experimental research that will then support your
practice and your decisions and is strictly this form of evidence.
- Evidence informed practice, however, is tailored to the needs of the patient and is more inclusive
of what is actually considered evidence, such as other research or readings.
- EIP is more than the use of best-practice techniques to treat patients; it is a systematic approach
to practice that emphasizes the use of best evidence in combination with the clinicians experience,
as well as the patient preferences and values, to make decisions about care and treatment
- Clinical decision making depends on all four factors: the best and most appropriate evidence from
a critical review of research literature; the patients own context and preferences; the clinicians
experience and expertise; and finally, physical examination and assessment.
- Although assessment skills are important, when there is no clinical evidence to support its
significance, it can be omitted from the examination process.
- New protocols or guidelines can be established based on clinical evidence in order to make patient
care more effective and to manage staff time.
- Patients that have received care based on EIP face advantages, but to implement the research
findings into practice can take several years.
Expanding the Concept of Health
- Biomedical model: health is the absence of disease, which is caused by specific agents or
pathogens. The biomedical focus involves elimination of those pathogens through treatment, and a
person is considered healthy when they no long exhibit the signs and symptoms.
- Behavioural model: states that health care must extend past treatment and also include primary
and secondary preventions that change lifestyles and behaviours.
- Socioenvironmental model: incorporates sociological and environmental aspects.
- The Ottawa Charter for Health Promotion identifies peace, education, shelter, food, income, equity
and social justice as health, making several Canadians unhealthy due to their lack of these things.
- Through this, Canada has been able to identify social determinants of health include social,
economic and political conditions that shape the health of individuals.
o Economic determinant: the red wine study, where red wine is associated with greater
wealth and therefore better health, rather red wine just being healthy for you.
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