Foundations of Clinical Nursing Practice
Test 1
actual nursing diagnosis - ANS-describes human responses to health conditions or life
processes that exist in an individual, family, or community--acute pain
Acute Inflammation - ANS-*heals in 2-3 wks
*no residual damage
*neutrophils predominant
(Subacute is basically the same but last longer i.e. endocarditis)
Acute/Transient Pain - ANS--Is protective, has an identifiable cause, is of short duration,
and has limited tissue damage and emotional response.
-It eventually resolves, with or without treatment, after an injured area heals.
-Because acute pain has a predictable ending (healing) and an identifiable cause,
health team members are usually willing to treat it aggressively.
-Unrelieved acute pain can progress to chronic pain.
Aims to Improve Quality of Care - ANS-- Safe: avoid injuries
- Effective: provide care based on scientific knowledge
- Patient centered: patient values guide all decisions
- Timely: reduce wait and delays
- Efficient: avoid waste of equipment, supplies, ideas, and energy
- Equitable: care does not vary in quality (gender, ethnicity, geographic -location,
socioeconomic status)
Cancer pain - ANS-can be acute and/or chronic, sometimes nociceptive and/or
neuropathic; usually due to tumor progression and its related pathological process,
invasive procedures, toxicities or treatments, infection , and physical limitation--at actual
site or referred
Chain of Infection - ANS-Infection occurs in a cycle that depends on the presence of:
Infectious agent or pathogen, Reservoir or source for pathogen growth, portal of exit
from the reservoir, mode of transmission, portal of entry to a host, susceptible host
Chronic Inflammation - ANS-*lasts for weeks, months or years
*persistence = injured tissues
*predominant cells are lymphs, macrophages
, *debilitation leads to decreased immunity
(i.e. rheumatoid arthritis, TB)
Chronic/Episodic - ANS-pain that occurs sporadically over an extended duration of time,
may last for hours, days, or weeks (migraine headaches)
Chronic/Persistent Pain (Non-Cancer Pain) - ANS--Is not protective and serves no
purpose, lasts longer than 6 months and is constant or recurring with a mild-to-severe
intensity.
-Does not always have an identifiable cause, and leads to great personal suffering.
-Chronic pain is a major cause of psychological and physical disability, leading to
problems such as job loss, inability to perform simple daily activities, sexual dysfunction,
and social isolation.
client-centered goal - ANS-specific and measurable behavior or response that reflects a
client's highest possible level of wellness and independence in function
clinical criteria - ANS-objective or subjective signs and symptoms, clusters of signs and
symptoms, or risk factors that lead to a diagnostic conclusion
collaborative intervention - ANS-interdependent, therapies that require the combined
knowledge, skill, and expertise of multiple health care professionals
collaborative problem - ANS-an actual potential physiological complication that nurses
monitor to detect the onset of changes in a client's status
data analysis - ANS-involves recognizing patterns or trends in the clustered data,
comparing them with standards, and then coming to a reasoned conclusion about the
client's responses to a health problem.
database - ANS-built during assessment, concerns the client's perceived needs, health
problems, and responses to these problems
defining criteria - ANS-the clinical criteria or assessment findings that support an actual
nursing diagnosis
dependent nursing intervention - ANS-physician initiated, actions that require an order
from a physician or another health care professional