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NURS 251 Lecture 1 Exam Questions and Answers 2024/2025 100% Verified.
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NURS 251 Lecture 1 Exam Questions and Answers 2024/2025 100% Verified.
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NURS 251 Lecture 1Case Study: E.B. is a 54 year old female who presents to the clinic for complaints of difficulty
walking with lower back and wrist pain after falling on the ice. You assist the patient from the
waiting room to the exam room. While awaiting the provider to see the patient, you obtain vital
signs and perform a focused assessment. What 2 systems are your priority? - ANS
Musculoskeletal and neurologic
Goals of Health Assessment - ANS -critically think and use clinical judgement
-gather accurate information including subjective and objective data
-cluster related information as a way of interpreting information
-demonstrate a thorough head to toe nursing assessment or focused system assessment
critically think in all situations with _______ as a priority - ANS SAFETY
The Nursing Process (6 phases) - ANS 1. Assessment
2. Diagnosis
3. Outcome identification
4. Planning
5. Implementation
6. Evaluation
1. Assessment - ANS -ongoing process
-the first and ONGOING essential step requiring the nurse to collect and analyze information
about the whole individual
-collection of data
collection of data includes: - ANS subjective data (symptoms) + objective data (signs) +
patient's record, and laboratory studies from the database
subjective - ANS what the person says about himself/herself during history taking, also referred
to as SYMPTOMS
objective - ANS what you as the health professional observe by inspecting, percussing,
palpating, and auscultating during the physical exam; also referred to as SIGNS
importance of assessment - ANS -data used to make diagnoses, decisions, and treatments >
accurate information is ESSENTIAL
-involves critical thinking: think, recall knowledge, and recognize the difference or deviations
between normal and abnormal assessment findings
-development of evidence-based practice 1970s Dr. Cochrane
, ~systematic reviews of randomized clinical trials
novice - ANS starting out in an area of learning
-uses rules to guide performance
competency - ANS building on 2 to 3 years of clinical experience
-see actions in the context of patient goals or plans
proficient - ANS adding to time and experience
-understands the patient situation as a whole rather than individual parts - apply long term goals
expert - ANS attained mastery of an area of learning
-performs clinical judgement using intuitive analysis
priority problem list - ANS -first-level priority
-second-level priority
-third-level priority
-collaborative problems
first-level priority - ANS emergent, life threatening, and immediate (airway)
-AIRWAY AND BREATHING
second-level priority - ANS next in urgency, requiring attention so as to avoid further
deterioration
-ex: pain after surgery
third-level priority - ANS important to patient's health but can be addressed after more urgent
problems are addressed
collaborative problems - ANS approach to treatment involves multiple disciplines
what is the first step in the nursing process? - ANS assessment
subjective health assessment - ANS obtain health history (complete, focused,
episodic/emergency)
objective health assessment - ANS perform physical assessment
health history - ANS -complete (baseline)
-focused
-episodic or emergency
complete (baseline) - ANS total health history and full physical examination describing current
and past health state
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