Category: Nursing

Shadow health Comprehensive Health History Assignment – NR 509 Week 1

Transcript

Brian Foster Chest Pain Shadow Health Assessment

All Lines (103)
Interview Questions (85)
Statements (3)
Exam Actions (15)

 Height: 170 cm

 Weight: 90 kg

 BMI: 31

 Random blood glucose: 238

 Temperature: 101.1 F

 Blood pressure: 142/82

 Respiratory rate: 19

 O2 sat: 99%

 Heart rate: 86

Hallo M. Tina, my name is pam and i will taking care of you today

Hey.

how are you doing today?

Not so great… My foot really hurts right now.

im sorry to hear that can you tell me more about it

I appreciate you telling me that.

what brings you to the clinic today?

I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me! shadow health Comprehensive Health History Assignment – NR 509 Week 1

tell me about your more about the pain

It’s throbbing and like, sharp if I try to put weight on it.

how long have you been experiencing the pain?

Well, I got the scrape a week ago, but the scrape and the pain got a lot worse in the last few days.

did you see any doctor?

To be honest, I haven’t been to a doctor for just a check-up in. . . at least two years. But I did see a doctor at the ER about my foot.

were you given any medication? (Clarified to Did the ER prescribe anything?.)

Yes, they wrote me a prescription for some pain pills. (Clarified to if the ER prescribed me any medications.) shadow health Comprehensive Health History Assignment – NR 509 Week 1

what type of pain pills

It’s called tramadol.

how many mg

I just take the regular kind I think — 200 mg. It’s not extra strength or anything. [AUDIO COMING SOON]

how often do you take it

I don’t take anything now, but I used to be on the pill.

how many pills of tramadol do you take

I take two at a time.

how often do you take it

I don’t take anything now, but I used to be on the pill.

on a scale of 1-10 how much is your pain (Clarified to On a scale of 0-10 how would you rate the pain in your right foot?.)

I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet. (Clarified to how I would rate my foot pain on a scale.)

have you noticed any drainage

Yeah, there’s definitely pus.

is the pus has any color

Yeah, there’s definitely pus.

are you allergic to any medication

Yeah, I’m allergic to penicillin.

do you have food allergies

Nope, no food allergies that I know of.

do you have any environmental allergies

No, unless cats count.

tell me about the cat allergy

Whenever I’m around cats, I start sneezing, my eyes get itchy. . . and my asthma starts to act up. shadow health Comprehensive Health History Assignment – NR 509 Week 1

do you take anything for the allergies

I don’t take anything, unless my inhaler counts.

do you have any other medical conditions

Um, the only things I know I’m diagnosed with are diabetes. And asthma.

do you take anything for diabetes

I don’t take anything for my diabetes anymore.

how do you control your diabetes

I just watch what I eat and try to stay away from sweets.

do you take any asthma medication

I just use my inhaler.

what is the name of your inhaler

It’s just a regular Proventil inhaler.

how many mg

I just take the regular kind I think — 200 mg. It’s not extra strength or anything. [AUDIO COMING SOON]

how many cg is your inhaler (Clarified to How many times did you use your inhaler?.)

Question

03/08/20 3:59 PM PDT

At my cousin’s? I did two puffs, and then I had to do another one a little later. . . that’s been happening sometimes lately. (Clarified to how many times I used my inhaler.)

do you have any medical history

shadow health Comprehensive Health History Assignment – NR 509 Week 1

Yeah. . . I have asthma and diabetes.

does your family have any medical history

My mom has some issues, and I think some of my grandparents did, too.

what kind of issues does you mother have

Mom has high cholesterol and blood pressure, I think. She seems to be doing okay though.

any other medical history in the family (Clarified to What health problems run in your family?.)

My mom has some issues, and I think some of my grandparents did, too. (Clarified to what health problems run in my family.)

does you father have any medical issues

Well, he passed away. But he had a couple things . . . Type 2 diabetes, like me, and high cholesterol and blood pressure.

do you smoke?

No. I think it’s gross.

do you drink alcohol

I do sometimes, yeah, when I go out with my friends.

how many drinks do you have when you drink

Just a few. I’m not a big drinker.

do you take any illegal drugs

Well, I used to smoke pot. . . but I don’t do that anymore.

do your friends smoke pot

Yeah, a couple of my friends smoke when we go out. I don’t like being around smokers, though.

what do you plan to stop smoking with your friends

I’m pretty optimistic about the future actually. In a couple of months I’ll have my degree, and I’ll probably get my own place again. I’m planning on trying for one of the accounting jobs in our regional office, too. If that works out, I would like to start dating again… maybe I’ll find someone I want to marry, start a family with?

do you have shortness of breath

No, my breathing is fine right now.

are you in pain

Yeah, my foot’s really bothering me.

what makes it worse

I’d say the pain is at its worst when I have to put any weight on my foot. . . otherwise, it’s when the pain pills wear off.

can i take a look on your foot (Clarified to May I take a look at your foot now?.)

Ok. (Clarified to permission to examine my foot.)

tell me if you fill the pork (No matching questions found.)

tell me if you fill the prick (No matching questions found.)

how often do you take the pain medication

I’ve been taking the Tramadol morning, noon, and night. [AUDIO COMING SOON]

how old are you

I’m 28.

let me listen to you lungs (No matching questions found.)

Question

03/08/xx  4:11 PM PDT

do you have any problem with your eyes

Question

03/08/xx 4:12 PM PDT

I’ve actually been noticing problems lately. When I’m reading or studying I’ll notice that things start to get kind of blurry.

have you seen an eye doctor

Question

03/08/xx 4:12 PM PDT

I have a couple times as a kid, by the school nurse. Not recently though.

do you wear glasses

Question

03/08/xx 4:12 PM PDT

I don’t wear glasses–or contacts.

do you have any chest pain

Question

03/08/xx 4:13 PM PDT

No, my chest feels tight when I have breathing problems, but it doesn’t hurt.

have you seen a heart doctor

Question

03/08/xx 4:13 PM PDT

No, my heart’s always been fine.

how is your abdomen

Question

03/08xx 4:14 PM PDT

My stomach feels fine.

have you heard any problems with elimination (Clarified to Do you have difficulty moving your bowels?.)

Question

03/08/xx 4:14 PM PDT

No. No problems like that. (Clarified to if I have trouble moving my bowels.)

any pain on urination

Question

03/08/xx 4:14 PM PDT

It doesn’t hurt or feel different when I pee.

do you check blood sugar (Clarified to Do you check your sugars often?.)

Question

03/08/xx 4:15 PM PDT

I don’t check it very often, honestly. . . I think the last time was about a month ago. (Clarified to if I check my blood sugar often.)

i see bs is 238 (No matching questions found.)

Question

03/08/xx 4:15 PM PDT

your blood sugar is elevated

Question

03/08/xx 4:15 PM PDT

They checked it last week at the ER, and they said it was high, but I don’t remember what the number was. I wasn’t thinking about my blood glucose; I was worried about my foot!

 Measured wound: 2 cm x 1.5 cm, 2.5 mm deep

Exam Action

03/08/xx 4:16 PM PDT

let me take look of your foot (Clarified to Can I look at your foot?.)

Question

03/08/xx 4:16 PM PDT

Sure. (Clarified to if I can show you my foot.)

i see it is open , let me know if you feel pain (No matching questions found.)

Question

03/08/xx 4:17 PM PDT

 Swabbed wound and sent to lab for C & S

Exam Action

03/08/xx 4:17 PM PDT

 Cleansed and irrigated wound with normal saline and applied dry sterile dressing.

Exam Action

03/08/xx 4:17 PM PDT

i will take a look of your pupils is that okay (No matching questions found.)

Question

03/08xxx 4:18 PM PDT

you need to keep your foot off the ground

Educate

03/08/xx 4:19 PM PDT

Sure, I think I understand what you mean.

how long does the pain last

Question

03/08/xx 4:20 PM PDT

For the last couple of days, the pain is pretty much constant.

do you have any cough

Question

03/08/xx 4:26 PM PDT

I don’t have a cough, no.

any chills

Question

03/08/xx 4:26 PM PDT

I got some chills last night, before my fever really kicked in.

ear ache

Question

03/08/xx 4:27 PM PDT

No.

when was your last menstrual period

Question

03/08/xx 4:28 PM PDT

I don’t keep track very well because it’s kind of all over the map, but my last one was probably three weeks ago.

is it heavy bleeding or normal (No matching questions found.)

Question

03/08/xx 4:29 PM PDT

describe the bleeding to me (No matching questions found.)

Question

03/08/xx 4:29 PM PDT

are they regular (No matching questions found.)

Question

03/08/xx 4:30 PM PDT

do you have regular period

Question

03/08/xx 4:30 PM PDT

It’s not regular. Sometimes it’s every month, but sometimes it’s more like every two months. I don’t write it down or anything. I probably get…six periods a year.

do you have any other concerns

Question

03/08/xx 4:32 PM PDT

Um, the only things I know I’m diagnosed with are diabetes. And asthma.

have you been taking any OTC medication (Clarified to Do you take over the counter medications a lot?.)

Question

03/08/xx 4:35 PM PDT

No, I only take Advil when my cramps get bad, and sometimes Tylenol for headaches. Lately I’ve been taking Advil for my foot, too. (Clarified to if I take over the counter medication a lot.)

how many mg of tylenol

Question

03/08/xx 4:35 PM PDT

I take the extra-strength acetaminophen, the gel kind, 500 mg. It’s what we usually have around the house. [AUDIO COMING SOON]

how often do you take tylenol

Question

03/08/xx 4:36 PM PDT

I maybe take it once a week. Or less.

you mentioned you take advil how many mg? (Clarified to Can you tell me the dosage of the ibuprofen?.)

Question

03/08/xx 4:36 PM PDT

I just take the regular kind I think — 200 mg. It’s not extra strength or anything. [AUDIO COMING SOON] (Clarified to how many milligrams of ibuprofen I take.)

have you notice any weight gain in last month

Question

03/08/xx 4:37 PM PDT

Usually my weight’s pretty stable, but I’ve actually lost a little weight recently.

it is important to check your blood sugar often and record it

Educate

03/08/xx 4:44 PM PDT

OK, I understand.

try to not weight on your right foot while walking

Question

03/08/xx 4:45 PM PDT

No, I can’t. I can’t put any weight on it without like, shooting pain.

make sure you clean the wound with normal saline and cover it with clean dressing

Question

03/08/xx 4:46 PM PDT

Since it happened, I’ve been washing it with soap and water, and if it seemed irritated, I would put some peroxide on there and then rinse it off.

you want to keep it as clean as possible (No matching questions found.)

Question

03/08/xx 4:46 PM PDT

report any drainage or any foul smell

Question

03/08/xx 4:47 PM PDT

Um, no, not that I know of… That sounds gross.

notify the clinic if you have a any chills

Question

03/08/xx 4:47 PM PDT

I got some chills last night, before my fever really kicked in.

always wear shoes when you are walking (Clarified to Are you able to wear shoes normally?.)

Question

03/08/xx 4:48 PM PDT

My sneakers are too tight, so I’ve been wearing flip-flops at home, or slip-ons. (Clarified to if I can wear shoes.)

inspect you feet daily since you are diabetic (No matching questions found.)

Question

03/08/xx 4:48 PM PDT

protect your feet from cold

Question

03/08/ 4:49 PM PDT

Not really.

you need to also wear comfortable shoes (No matching questions found.)

Question

03/08/20 4:50 PM PDT

do you have problem sleeping

I usually sleep pretty well, but the last couple nights the pain has made it hard to get good sleep.

 Measured wound: 2 cm x 1.5 cm, 2.5 mm deep

 Swabbed wound and sent to lab for C & S

 Cleansed and irrigated wound with normal saline and applied dry sterile dressing.

 

Subjective Data Collection: 45 of 104 (43.3%)

Hover To Reveal…

Hover over the 
Patient Data
 items below to reveal important information, including 
Pro Tips
 and 
Example Questions
.

Found:

Indicates an item that you found.

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Available:

Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint

Finding:

Established chief complaint

Finding:

Reports pain

(Found)

Pro Tip: Beginning your conversation with your patient by asking an open-ended question is a best practice for gauging your patient’s general condition.

Example Question:

How severe is the pain?

Finding:

Reports open foot wound

(Found)

Pro Tip: If a patient mentions pain, it’s important to determine what specifically is causing her pain.

Example Question:

What’s causing your pain?

History of Present Illness

Finding:

Asked for details about the pain

Finding:

Describes the pain as throbbing

(Found)

Pro Tip: Determining how your patient describes the characteristics of the pain can be important data to support the cause of the pain.

Example Question:

Can you please describe the pain?

Finding:

Describes the pain as sharp when she attempts to stand

(Found)

Pro Tip: Determining how your patient describes the characteristics of the pain can be important data to support the cause of the pain.

Example Question:

What is the pain like when you stand on your foot?

Finding:

Initial injury occurred 1 week ago

(Found)

Pro Tip: Discovering how long ago the pain began is the first step in understanding whether the pain is chronic or acute.

Example Question:

When did the pain start?

Finding:

Pain has increased in the past 2 days

(Found)

Pro Tip: Finding out how the patient’s pain has changed will give you insight into the acceleration of infection.

Example Question:

How has the pain changed over time?

Finding:

Reports feeling pain radiating into ankle

(Available)

Pro Tip: Asking about where else the patient’s pain radiates can help determine the progression of infection.

Example Question:

Does the pain radiate anywhere else?

Finding:

Pain prevents bearing weight on foot

(Found)

Pro Tip: Determining if your patient can bear weight on an injury is important to determine their risk for falls while in your care.

Example Question:

Can you bear weight on your foot?

Finding:

Asked to rate pain on a scale

Finding:

Rates present pain at a 7 out of 10

(Found)

Pro Tip: Asking your patient to rate her pain on a scale of 0 to 10 is important to gauge how it ebbs and flows while she is in your care.

Example Question:

Can you rate the pain on a scale of 0 to 10?

Finding:

Clarified location of wound

Finding:

Confirmed that right foot is injured

(Available)

Pro Tip: Confirming which extremity an injury is located is a best practice for your patient’s safety.

Example Question:

Which foot is in pain?

Finding:

Confirmed that wound is on the plantar surface of her foot

(Available)

Pro Tip: Confirming where a wound is located ensures you are aware of your patient’s biggest complaint.

Example Question:

Where is the wound?

Finding:

Determined details of the injury

Finding:

Scraped foot on a cement step

(Available)

Pro Tip: Discovering how an injury happened helps to assess your patient’s risk factors for injury.

Example Question:

How did your injury happen? shadow health Comprehensive Health History Assignment – NR 509 Week 1

Finding:

Reports mild ankle injury

(Available)

Pro Tip: Discovering additional injuries can reveal more information about the circumstances that caused the presenting injury.

Example Question:

Did you injure anything besides your foot?

Finding:

Was not drinking at the time of the injury

(Available)

Pro Tip: Finding out if alcohol is involved in an injury can give you insight into a patient’s potential substance abuse, and can uncover aggravating factors.

Example Question:

Did you have any alcoholic drinks before your injury?

Finding:

Was not wearing shoes at the time of injury

(Available)

Pro Tip: Asking about clothing, footwear, and other protective elements being worn at the time of injury helps you discover the totality of the circumstances.

Example Question:

Were you wearing shoes when you fell?

Finding:

Asked about the assessment of the injury at the ER

Finding:

Went to the ER after sustaining the injury

(Available)

Pro Tip: Finding out how long ago a patient sought care helps you understand the evolution of symptoms.

Example Question:

When did you go to the ER?

Finding:

Decided to go because she suspected an ankle sprain

(Available)

Pro Tip: Asking why a patient sought care gives you more information about the initial injury and symptoms. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Example Question:

Why did you go to the ER?

Finding:

Received an x-ray

(Available)

Pro Tip: Determining what procedures were done by other healthcare providers gives insight into the symptoms at the onset.

Example Question:

Did they xray your foot at the ER?

Finding:

X-ray showed no broken bones

(Available)

Pro Tip: Confirming the results of the x-ray gives you a subjective report of the seriousness of the initial injury.

Example Question:

What did the x-ray show?

Finding:

Received a prescription for pain pills

(Found)

Pro Tip: Finding out if the patient has been prescribed medications is an important piece of data for your own care plan.

Example Question:

Did you receive any pain medications at the ER?

Finding:

Asked about drainage from the foot wound

Finding:

Reports that the wound bled a little after sustaining the injury

(Available)

Pro Tip: Asking about bleeding helps you determine the characteristics of a wound.

Example Question:

Did your foot bleed?

Finding:

Reports seeing pus draining from wound

(Found)

Pro Tip: Asking about discharge helps you determine the characteristics of a wound.

Example Question:

shadow health Comprehensive Health History Assignment – NR 509 Week 1

Did you notice any discharge from the wound?

Finding:

Began noticing pus 2 days ago

(Available)

Pro Tip: Pinpointing exactly when the patient noticed the arrival of pus gives you an important data point for when an active infection began.

Example Question:

When did you first notice the pus?

Finding:

Followed up about character of drainage from the foot wound

Finding:

Describes pus as white or yellow in color

(Available)

Pro Tip: The color of discharge from a wound can provide insight into its severity and characteristics. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Example Question:

What color is the drainage from your wound?

Finding:

Reports no odor from the wound

(Found)

Pro Tip: The odor of discharge from a wound can provide insight into its severity and characteristics.

Example Question:

Does the wound have an odor?

Finding:

Asked about home treatment of foot wound

Finding:

Describes wound care regimen of cleaning and bandaging

(Found)

Pro Tip: Listening to a patient’s wound care routine provides insight into the history of the wound, as well as the patient’s health literacy.

Example Question:

How did you treat your foot at home?

Finding:

Cleaned wound twice a day

(Available)

Pro Tip: Asking specifically how often a patient cleaned a wound will let you know if an infection spread through improper hygiene, or for other reasons such as uncontrolled blood sugar.

Example Question:

How often did you clean the wound?

Finding:

Cleaned wound with hydrogen peroxide

(Found)

Pro Tip: Determining what products a patient used to clean a wound provides insight into the history of the wound, as well as the patient’s health literacy.

Example Question:

What did you use to clean the wound?

Finding:

Changed bandage twice a day

(Available)

Pro Tip: Asking specifically how often a patient changed a bandage will let you know if an infection spread through improper hygiene, or for other reasons such as uncontrolled blood sugar.

Example Question:

How often do you change your bandage?

Finding:

Applied neosporin

(Available)

Pro Tip: Determining what products a patient used to sterilize or treat a wound establishes home care routines and health literacy.

Example Question:

Did you use any ointment on the wound?

Finding:

Asked about other foot wound symptoms

Finding:

Reports swelling around foot wound

(Available)

Pro Tip: Asking about the presence of swelling helps you gather information about your patient’s complaint, as well as potential related illnesses.

Example Question:

Is there swelling around the wound?

Finding:

Noticed swelling getting worse in the past 2 days

(Available)

Pro Tip: Finding out how long swelling appeared will help you understand the timeline for the infection’s progression.

Example Question:

How long have you noticed swelling around the wound? shadow health Comprehensive Health History Assignment – NR 509 Week 1

Finding:

Reports redness around the wound

(Available)

Pro Tip: Asking about redness will help you understand the timeline for the infection’s progression.

Example Question:

Did you notice any redness around the wound?

Finding:

Reports that the wound feels warm

(Available)

Pro Tip: Asking about warmth will help you understand the timeline for the infection’s progression.

Example Question:

Does the wound feel warm?

Finding:

Explored impact of patient’s foot injury on activities of daily living

Finding:

Pain affects ability to walk

(Available)

Pro Tip: Learning the impact of your patient’s wound on daily activities helps inform your plan for care.

Example Question:

Does your injury impact your ability to walk?

Finding:

Pain affects job performance

(Available)

Pro Tip: Learning how severely the wound has interfered with an essential aspect of daily life, and can uncover a source of stress for the patient.

Example Question:

Does your foot pain affect your work?

Finding:

Pain prevented her from attending class

(Available)

Pro Tip: For patients who are also students, you can find out what schoolwork they are missing, and help them make accommodations so they don’t fall behind.

Example Question:

Has your injury prevented you from going to class?

Finding:

Asked about recent fever

Finding:

Reports a fever last night

(Found)

Pro Tip: The presence or absence of fever can indicate if an infection is approaching sepsis, a life-threatening condition. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Example Question:

Are you feeling feverish right now?

Medical History: Medication

Finding:

Asked about use of pain medication

Finding:

Has been taking prescription pain medication

(Found)

Pro Tip: Discovering how a patient has been medicating for pain is a crucial element of understanding and treating her condition or injury.

Example Question:

Have you taken any prescription pain medications? shadow health Comprehensive Health History Assignment – NR 509 Week 1

Finding:

Medication is Tramadol

(Found)

Pro Tip: The differences between prescription and over-the-counter pain medications can be vast, and asking about the type of pain medication your patient has been using will help you fully understand her home treatment habits.

Example Question:

What is the name of the pain medication?

Finding:

Asked about pain medication frequency

Finding:

Has been taking pain medication for 2 days

(Available)

Pro Tip: Discovering how long your patient has been taking pain medication is a crucial part of the history of her condition or injury.

Example Question:

How many days have you needed pain medication?

Finding:

Takes dose 3 times a day

(Found)

Pro Tip: The frequency with which your patient takes pain medication can indicate the severity of her condition or injury.

Example Question:

How many times a day do you take pain medication?

Finding:

Last dose was this morning

(Available)

Pro Tip: Confirming the patient’s most recent dose sheds insight into her current pain level, and lets you know what substances may be in her system.

Example Question:

When was your last dose of pain medication?

Finding:

Asked about pain medication dose

Finding:

Dosage is 50 milligrams

(Available)

Pro Tip: Determining the exact dose of pain medication your patient takes helps determine the severity of her condition or injury and will factor in to your care plan. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Example Question:

What is the dose of the pain medication?

Finding:

Takes 2 pills each time

 

Education & Empathy 
: 2 of 11 (18.2%)

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A 
Model Statement
 is provided as an example of an appropriate response to each opportunity.

Opportunities marked as 
Not Encountered
 are opportunities that were not elicited in the interview

Opportunities marked as 
Not Followed Up
 are missed opportunities that were present in the interview, but where no statements were made

Opportunities marked as 
Followed Up
 were followed up by students, and include the dialogue between student and patient

 1 Expression of pain

Followed Up

 Description: 
Tina expresses frustration about her level of pain.

how are you doing today?

Question

03:45 PM PDT

Not so great… My foot really hurts right now.

im sorry to hear that can you tell me more about it

Empathize

03:46 PM PDT

I appreciate you telling me that.

 Model Statement: 
“I’m sorry to hear that your pain is returning. We want you to be in as little pain as possible. Together we can figure out the best way to reduce your pain quickly.”

 2 Impact of injury on daily life

Not Encountered

 3 Gaps in health literacy around diabetic diet

Not Followed Up

 4 Lack of treatment with diabetes medication

Not Followed Up

 5 Lack of blood glucose monitoring

Followed Up shadow health Comprehensive Health History Assignment – NR 509 Week 1

 Description: 
Tina reveals that she does not check her blood sugar.

do you check blood sugar (Clarified to: Do you check your sugars often?)

Question

04:15 PM PDT

I don’t check it very often, honestly. . . I think the last time was about a month ago. (Clarified to: if I check my blood sugar often)

your blood sugar is elevated

Question

04:15 PM PDT

They checked it last week at the ER, and they said it was high, but I don’t remember what the number was. I wasn’t thinking about my blood glucose; I was worried about my foot!

let me take look of your foot (Clarified to: Can I look at your foot?)

Question

04:16 PM PDT

Sure. (Clarified to: if I can show you my foot)

you need to keep your foot off the ground

Educate

04:19 PM PDT

Sure, I think I understand what you mean.

 Model Statement: 
“I understand how it can feel like a frustrating chore to check your sugar every day. But it is important to keeping your diabetes under control. When you monitor your sugar, it helps you understand what foods, activities, and times of day contribute to you feeling your best. And keeping your sugar down will help your foot wound heal quickly, too. If you would like, I can help you find a monitor that is as painless as possible. I can also teach you more about what the numbers mean.

 

 

Documentation / Electronic Health Record

Document: Provider Notes

Document: Provider Notes

Student Documentation

Model Documentation

Identifying Data & Reliability

Tina is a 28 year old female with chief complaint of right foot wound

shadow health Comprehensive Health History Assignment – NR 509 Week 1

Return to Canvas to complete your SOAP note for this assignment shadow health Comprehensive Health History Assignment – NR 509 Week 1

General Survey

patient has wound to the bottom of the foot, complains of pain when she bears weight

Return to Canvas to complete your SOAP note for this assignment

Chief Complaint

right foot pain

Return to Canvas to complete your SOAP note for this assignment

 

 

 

Information Processing

Each relevant diagnosis is scored on a four-point scale:

Priority (1 point):
 the correct priority of the diagnosis was chosen

Evidence (up to 2 points):
 the strength of the patient cue(s) selected as evidence for the identified diagnosis

Required Evidence:
 selecting at least one cue that 
directly indicates
 the presence of a problem or risk is worth 2 points

Supporting Evidence:
 selecting at least one cue that is a 
contributing factor
 or 
cause
 of a problem or risk, without the presence of Required Evidence, is worth 1 point

Planning (1 point):
 the plan proposed to address the diagnosis includes at least one correct component

Relevant Diagnoses

 1. Acute pain of the foot

2 of 4 points

Priority 
1 / 1

Student Response:
 
 High

Correct Priority:
 High

 Priority Pro Tip: 
Managing acute pain is an immediate high priority, because other health concerns cannot be effectively addressed while a patient experiences severe pain.

Evidence 
0 / 2

Relevant

(None provided)

Irrelevant

“Measured wound: 2 cm x 1.5 cm, 2.5 mm deep”

 Evidence Pro Tip: 
Tina reports intense pain and rates her pain on a numerical scale. She also reports characteristics of the pain, including its duration of one week; this timespan defines her pain as acute.

Planning 
1 / 1

Relevant

Educate – Medication:
 Educate the patient on medications used for pain relief.

Educate – Medication:
 Educate the patient on non-pharmaceutical methods to reduce pain intensity.

Irrelevant

Assess – Integumentary:
 Assess wound parameters (size, depth).

Intervene – Labs:
 Obtain a wound culture.

Intervene – Labs:
 Obtain blood for culture x2 (blood from two sites).

Intervene – Labs:
 Order a complete blood count test (CBC).

Intervene – Prescribe:
 Prescribe antibiotics.

 Planning Pro Tip: 
Intervene to reduce the pain by prescribing an appropriate analgesic and educating the patient on its effective use and potential side effects. Provide the patient with options for non-pharmacological pain relief, such as RICE (rest, ice, compression, elevation). shadow health Comprehensive Health History Assignment – NR 509 Week 1

 2. Local infection of skin and subcutaneous tissue of the foot

2 of 4 points

Priority 
1 / 1

Student Response:
 
 High

Correct Priority:
 High

 Priority Pro Tip: 
Treating this infection is a high priority, as failure to treat the infection may lead to it spreading to surrounding tissues or systemically. Treating the infection can prevent adverse events such as osteomyelitis and bacteremia.

Evidence 
0 / 2

Relevant

(None provided)

Irrelevant

“Measured wound: 2 cm x 1.5 cm, 2.5 mm deep”

 Evidence Pro Tip: 
Tina presents with an open wound on the plantar surface of the foot. The wound is red, swollen, warm, and produces purulent discharge. Tina reports that the appearance and level of discomfort have worsened with time- all of these factors support a diagnosis of acute infection.

Planning 
1 / 1

Relevant

Intervene – Other:
 Clean wound and cover with sterile dressing.

Educate – Health Maintenance:
 Educate the patient on wound care procedure.

Irrelevant

(None provided)

 Planning Pro Tip: 
Assess the wound directly and obtain a culture so that the infectious organism may be identified, then clean and re-dress the wound. Regional lymph nodes may be swollen. Because the infection is the root cause of Tina’s other acute issues, prescribing an anti-infective will begin to resolve the issues; after receiving culture results, the specific anti-infective given may be changed. Ensure that Tina understands how to treat the wound, use the anti-infective effectively, and to report symptoms of a worsening infection. Foot care is especially important for diabetics, so you should help Tina better understand diabetes’ impact on wound healing and the need to proactively monitor her foot health.

 3. Uncontrolled type 2 diabetes mellitus

2 of 4 points

Priority 
1 / 1

Student Response:
 
 High

Correct Priority:
 High

 Priority Pro Tip: 
Tina’s uncontrolled diabetes will delay her wound healing and places her at risk for end organ damage. The need to provide better glucose control for Tina makes this a high priority.

Evidence 
0 / 2

Relevant

(None provided)

Irrelevant

“Measured wound: 2 cm x 1.5 cm, 2.5 mm deep”

 Evidence Pro Tip: 
Tina’s current blood glucose level supports a diagnosis of uncontrolled type 2 DM. Tina reports symptoms consistent with poor control such as polyuria, polydipsia, and nocturia.

Planning 
1 / 1

Relevant

Educate – Health Maintenance:
Educate the patient on self-monitoring of blood glucose level procedure and its role in treating diabetes. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Educate – Health Maintenance:
 Educate the patient on the impact of diet, exercise, and weight loss on glycemic control.

Irrelevant

Educate – Health Maintenance:
 Educate the patient on the role of lifestyle changes, including diet and exercise, in improving health outcomes.

 Planning Pro Tip: 
Assess for impacts of Tina’s uncontrolled diabetes including diminished peripheral pulses, peripheral and sensory neuropathy, and retinopathy, and order labs to check for renal function and abnormal lipid levels. Establish a baseline fasting glucose level and educate Tina on the need to monitor her blood glucose and be aware of symptoms of hyperglycemia. Provide better control by prescribing a first-line drug for glucose control. As Tina’s diabetes is uncontrolled, educate her on appropriate diet, monitoring, and treatment regimens.

 4. Asthma

2 of 4 points

Priority 
1 / 1

Student Response:
  Low

Correct Priority:
 Low

 Priority Pro Tip: 
Although Tina requires education to better manage her asthma, she does not report active respiratory complaints, making this a lower priority diagnosis. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Evidence 
0 / 2

Relevant

(None provided)

Irrelevant

“Measured wound: 2 cm x 1.5 cm, 2.5 mm deep”

 Evidence Pro Tip: 
Tina reports a personal history of asthma, including past hospitalizations for asthma attacks, as well as her use of an albuterol inhaler. Her sibling’s asthma is of interest, given the strong genetic and environmental factors in the development of asthma.

Planning 
1 / 1

Relevant

Assess – Respiratory:
 Assess lung sounds with auscultation.

Assess – Respiratory:
Assess pulmonary function using spirometry. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Assess – Respiratory:
 Assess respirations (rate, rhythm, depth, quality).

Educate – Health Maintenance:
 Educate the patient on avoiding triggers of asthma.

Educate – Health Maintenance:
 Educate the patient on enacting her asthma action plan including proper use of rescue inhaler.

Irrelevant

Assess – Respiratory:
 Assess for reduced forced expiratory volume using spirometry.

 Planning Pro Tip: 
Because Tina does not report treatment for maintenance of her asthma, instead relying on a rescue inhaler for sporadic attacks, educate her on developing and enacting a proactive plan to manage the disease. Though Tina does not report an active respiratory complaint, it is valuable to assess for abnormal findings that she may not report. shadow health Comprehensive Health History Assignment – NR 509 Week 1

Patterns of recovery following percutaneous coronary interventions NURS 513 CRITIQUE RESEARCH PAPER

Kingdom of Saudi Arabia

Ministry of Education

University of Hail

College of Nursing

المملكة العربية السعودية

وزارة التعليم

جامـعـة حـائل

كلية التمريض

Advanced Research in Nursing (NURS 513)

GUIDELINES TO CRITIQUE RESEARCH PAPER

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Instruction to students:

Use these guidelines to critique your selected research article to be included in your research proposal.

Ask yourself questions about the purpose of each component of the research paper and then critique.

Review the abstract and read the study from beginning to end. Then read it again, critically.

After reading and comprehending the content of the study. You need to identify each step of the research process concisely.

Prepare your report of critique with appropriate headings.

First, for any type of research paper, your critique should include some basic information:

Name(s) of the author(s)

Title of article

Title of journal, volume number, date, month and page numbers

Statement of the problem or issue discussed

The study Purpose, approach or methods, hypothesis, and major conclusions.

 

The title
:
Ensure that it indicate what the research is about.

Does the title clearly indicate research problem ?

Is it too long or too short?

Are the variables stated clearly and are there any relationship between them?

Does the title indicate the type of study conducted—descriptive, correlational, quasi-experimental, or experimental?

Keywords
: Key words helps you to identify main areas of focus , must include 3-5 key words .

Does the keywords are written in alphabetic order?

Identify the number of key words and its appropriateness.

The abstract:
Check carefully whether it includes the problem, assumptions, method of solution, summary of results and maximum in 250 words. The abstract should clearly state the objective, results and the conclusion of the work. Patterns of recovery following percutaneous coronary interventions NURS 513 CRITIQUE RESEARCH PAPER

Does it explain the purpose of the research?

What is the research problem, objectives, research design, sample size sample technique and description about tool and results ?

What conclusions were reached?

Identify the number of words in abstract.

The aim:
While reading you must ensure that the aim is clearly stated focusing on one idea

Do the research study have a clear idea of what the study tried to achieve?

Is the aim clearly stated focusing on one main idea?

Does it convey the main purpose of the study?

The introduction
:
Read the introduction and you are to critique whether it orientate the background and purpose of the study clearly .

Is the purpose of the study made clear in the introduction ?

Is the topic of the integration important for nursing?

Did the reviewers use adequate efforts to identify relevant studies?

Is the background of the research relevant to the research question? Patterns of recovery following percutaneous coronary interventions NURS 513 CRITIQUE RESEARCH PAPER

The literature review: 
At this point, you may look for relevant previous studies in the research paper.

Is the literature review focuses on the problem/ research question?

Is the literature review is broad?

Are the references current (number and percentage of sources in the last 5 and 10 years)?

Are the studies described, critically appraised, and synthesized in the own words?

Are the studies from referred journals?

Examine the study
framework or theoretical perspective
. – 1. Is the framework based on tentative, substantive, or scientific theory? Provide a rationale for your answer.

2.Does the framework identify, define, and describe the relationships among the concepts of interest?

Research objectives, questions, or hypotheses:

Are the objectives, research questions, or hypotheses expressed clearly?

Are the objectives, research questions, or hypotheses logically linked to the research purpose, concepts and relationships ?

Are hypotheses stated to direct the conduct of quasi-experimental and experimental research?

Variables :

Are the variables are identified in the framework?

Are the variables clearly defined (conceptually and operationally)

Design : 1.
Review to determine the type of study design. When critically appraising the
designs of descriptive and correlational studies
, you need to address the following questions:

Is the study design descriptive or correlational?

Does the study design address the study purpose and/or objectives or questions?

Was the sample appropriate for the study?

Is the design used in the study the most appropriate design to obtain the needed data?

When critically appraising the
design of a quasi-experimental or experimental study
, you need to address the following questions:

Is the study design quasi-experimental or experimental?

Identify the specific type of quasi-experimental or experimental design used in the study.

Review the sampling criteria, sample size, assignment of subjects to groups, and study setting.

Was the study intervention described in detail? Patterns of recovery following percutaneous coronary interventions NURS 513 CRITIQUE RESEARCH PAPER

Is the treatment appropriate for examining the study purpose and hypotheses?

Whether the study dependent variables measured with reliable and valid measurement methods?

Is the design used in the study the most appropriate design to obtain the needed data? b. Does the design provide a means to examine all the objectives, questions, or hypotheses?

Does the study framework explain the links between the treatment (independent variable) and the proposed outcomes (dependent variables)?

Were the treatment and comparison group assignments appropriate for the purpose of the study?

Sample, population, and setting
:

Is the sampling method adequate to produce a representative sample?

Were the sampling criteria (inclusion and exclusion) appropriate for the type of study conducted ?

Was a power analysis conducted to determine sample size?

Was the attrition rate projected in determining the final sample size?

Are the rights of human subjects protected ?

Is the setting used in the study typical of clinical settings

Do the measurement methods selected for the study adequately measure the study variables?

Measurement approaches used in the study:

Are the instruments clearly described?

Are techniques to complete and score the instruments provided?

Are the validity and reliability of the instruments described ?

If the instrument was developed for the study, is the instrument development process described

Observation
(1) Is what is to be observed clearly identified and defined? (2) Is interrater reliability described? (3) Are the techniques for recording observations described .
Interviews
(1) Do the interview questions address concerns expressed in the research problem? (2) Are the interview questions relevant for the research purpose and objectives, questions, or hypotheses?
Physiological measures
(1) Are the physiological measures or instruments clearly described? If appropriate, are the brand names of the instruments identified? (2) Are the accuracy, precision, and error of the physiological instruments discussed? (3) Are the physiological measures appropriate for the research purpose and objectives, questions, or hypotheses? (4) Are the methods for recording data from the physiological measures clearly described?(5) Is the recording of data consistent?

Data collection
:

Is the data collection process conducted in a consistent manner?

Are the data collection methods ethical?

Do the data collected address the research objectives, questions, or hypotheses?

Did any adverse events occur during data collection, and were these appropriately managed?

Data analysis :

Are data analysis procedures appropriate for the type of data collected?

Are data analysis procedures clearly described?

Did the researcher address any problem with missing data, and explain how this problem was managed?

Do the data analysis techniques address the study purpose and the research objectives, questions, or hypotheses?

Are the results presented in an understandable way by narrative, tables, or figures or a combination of methods (APA)? Patterns of recovery following percutaneous coronary interventions NURS 513 CRITIQUE RESEARCH PAPER

Interpretation of findings
:

Are findings discussed in relation to each objective, question, or hypothesis?

Are various explanations for significant and nonsignificant findings examined?

Are the findings clinically important ?

Are the findings linked to the study framework ?

Are the findings consistent with the findings of previous studies in this area?

Conclusion
/
implications /

suggestions /limitations :

What conclusions did the researchers identify based on their interpretation of the study findings?

Do the conclusions fit the findings from this study and previous studies?

Did the researcher generalize the findings appropriately?

What were the implications of the findings for nursing practice?

Were quality suggestions made for future research ?

What study limitations did the researcher identify?

References :
References must be in alphabetic in the list of references. The reference in the text should be such as (Authors last name, Year). The complete details of the references will appear in the list of references.

For journal papers, books and conferences papers use the following formats:

 

Author A, Author B, and Author C (1994). Article Title. Journal Name, 1(5): 1–3.

Book title, 1st ed., Vol. 2 of Series Title. Publisher Name, Publisher address, Chap. 1, pp. 1– 3. See also URL

Home Page

.

Article title. In Collection Title, A. Editor, ed., 3rd ed., Vol. 2 of Series title. Publisher Name, Publisher address, May, Chapter 1, pp. 1–3. See also URL

Home Page

.

Article title. In Proceedings Title, A. Editor and B. Editor, eds., Vol. 1 of Series name, Organization Name, Publisher Name, pp. 1–3. Paper number 1234.

Masters thesis A (2003). Thesis Title. MS Thesis, University of Higher Education, Cambridge, MA, May. See also URL

Home Page

.

Miscellanies (2003). Miscellaneous Title. On the WWW, May. URL

Home Page

.

PhD thesis A (2003). Thesis Title. PhD Thesis, University of Higher Education, Cambridge, MA, May. See also URL

Home Page

.  Patterns of recovery following percutaneous coronary interventions NURS 513 CRITIQUE RESEARCH PAPER

———————————————————————————————————–

Study Guide for Final Exam

Health promotion and maintenance –

stages,

Primary prevention includes health promotion, wellness education programs, immunizations, hearing protection in occupational settings, training to develop good body mechanics, and health screening for prostate, breast, and colon cancer. Final Nursing Exam Study Guide

Secondary prevention is provided in the home, health care facility, or skilled nursing facility.

Tertiary prevention aims to help patients achieve as high a level of functioning as possible.

The HPM describes the multidimensional nature of people as they interact within their environment to pursue health (Pender, 1996; Pender et al., 2015). The model focuses on the following three areas: (1) individual characteristics and experiences; (2) behavior-specific knowledge and affect; and (3) behavioral outcomes, in which the patient commits to or changes a behavior.

Nursing incorporates health promotion activities, wellness education, and illness prevention activities rather than simply treating illness.

Health promotion activities help maintain or enhance health.

Wellness education teaches patients how to care for themselves.

Illness prevention activities protect against health threats and thus maintain an optimal level of health.

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health disparities,

health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage”

People in marginalized groups are more likely to have poor health outcomes and die at an earlier age

Social determinants of health to explain the complexity of these interactions (McGovern et al., 2014). According to the World Health Organization (2013), social determinants of health are “the conditions in which people are born, grow, live, work and age…shaped by the distribution of money, power and resources at global, national, and local levels.” Income and wealth, family and household structure, social support, education, occupation, discrimination,

Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by: Final Nursing Exam Study Guide

vulnerable populations

Immigrants

Poor and homeless

Abused

Substance abusers

Mentally ill

Older adults

Healthy People 2020 & WHO (purpose, definitions)

Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services

Occurs in community settings

Involves acute & chronic care

Enhances individuals’ capacity for self-care

Promotes autonomy in decision making

Uses critical thinking skills

Reduces costs for the patient by providing care near homes

Requires knowledge of family theory, communication, group dynamics, and cultural diversity

Multilevel intervention –

Tier III – intensive intervention

Tier II – targeted small group instruction

Tier I – core intrustional program

Maslow’s hierarchy of needs and prioritization

Management of care – key components of nursing, cultural influences

Team nursing developed in response to the severe nursing shortage following World War II.

Total patient care delivery was the original care delivery model developed during Florence Nightingale’s time. This model disappeared in the 1930s and became popular again during the 1970s and 1980s, when the number of RNs increased.

The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and professional relationships among staff members. The model became more popular in the 1970s and early 1980s as hospitals began to employ more RNs. Primary nursing supports a philosophy regarding nurse and patient relationships.

Case management is a care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Final Nursing Exam Study Guide

Theorists (Erikson) – normal development and assessment findings (health risks for each stage)

Stage 1:
Trust versus mistrust

(birth to 1 year)

An infant’s successful resolution of this stage requires a consistent caregiver who is available to meet his needs. From this basic trust in parents, an infant is able to trust in himself, in others, and in the world (Hockenberry and Wilson, 2015). The formation of trust results in faith and optimism.

Stage 2:
Autonomy versus shame and doubt

(1 to 3 years)

A toddler develops his or her autonomy by making choices. Choices typical for the toddler age-group include activities related to relationships, desires, and playthings.

A toddler who successfully masters this stage achieves self-control and willpower.

Stage 3:
Initiative versus guilt

(3 to 6 years)

Fantasy and imagination allow them to further explore their environment. Also at this time they are developing their superego, or conscience. Conflicts often occur between a child’s desire to explore and the limits placed on his or her behavior. These conflicts sometimes lead to feelings of frustration and guilt.

Successful resolution of this stage results in direction and purpose. Teaching a child impulse control and cooperative behaviors helps a family avoid the risks of altered growth and development.

Stage 4:
Industry versus inferiority

(6 to 11 years)

They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or if skills are too difficult, they develop a sense of inadequacy and inferiority. Children at this age need to be able to experience real achievement to develop a sense of competency. Erikson believed that an adult’s attitudes toward work are traced to successful achievement of this task

Stage 5:
Identify versus role confusion

(puberty)

This stage, in which identity development begins with the goal of achieving some perspective or direction, answers the question, “Who am I?” Acquiring a sense of identity is essential for making adult decisions such as choice of a vocation or marriage partner. Each adolescent moves in his or her unique way into society as an interdependent member. There are also new social demands, opportunities, and conflicts that relate to the emergent identity and separation from family. Erikson held that successful mastery of this stage resulted in devotion and fidelity to others and to their own ideals (Hockenberry and Wilson, 2015). Elkind (1967) identified a notion of perceived invulnerability in adolescents that contributes to risk-taking behaviors.

Stage 6:
Intimacy versus isolation

(young adult)

Erikson portrayed intimacy as finding the self and then losing it in another (Santrock, 2012a). If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment

Stage 7:
Generative versus self-absorption & stagnation
(middle age)

Middle-age adults achieve success in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement. Achieving generativity results in caring for others as a basic strength. Inability to play a role in the development of the next generation results in stagnation

Stage 8:
Integrity versus despair

(old age)         

Older adults often engage in a retrospective appraisal of their lives. They interpret their lives as a meaningful whole or experience regret because of goals not achieved (Berger, 2011). Because the aging process creates physical and social losses, some adults also suffer loss of status and function (e.g., through retirement or illness). These external struggles are met with internal struggles such as the search for meaning in life. Meeting these challenges creates the potential for growth and the basic strength of wisdom (Figure 11-1).

Normal physical assessment changes throughout lifespan (review of concepts from HA class)

Develop a plan of care – nursing process Final Nursing Exam Study Guide

ADPIE

Collect data.

Cluster cues, make inferences, and identify patterns and problem areas.

Critically anticipate.

Be sure to have supporting cues before making an inference.

Knowing how to probe and frame questions is a skill that grows with experience.

Selection and labeling of nursing diagnoses

A
nursing diagnosis
is a clinical judgment about individual,
family, or community responses to actual and potential health problems or life processes that the nurse is licensed and competent to treat. What makes the nursing diagnostic process unique from medical diagnoses is having patients involved, when possible, in the process.

Selection of a nursing diagnosis provides the basis for choosing nursing interventions. Accurate diagnosis of patient problems ensures the selection of more effective and efficient nursing interventions.

Nursing diagnoses are listed according to the North American Nursing Diagnosis Association (NANDA). Selecting the correct nursing diagnosis on the basis of an assessment involves diagnostic expertise.

Assessment of patient’s health status:

Patient, family, and health care resources constitute database.

Nurse clarifies inconsistent or unclear information.

Critical thinking guides and directs line of questioning and examination to reveal detailed and relevant database.

n
actual nursing diagnosis
describes human responses to health conditions or life processes that exist in an individual, family, or community. Final Nursing Exam Study Guide

A
risk nursing diagnosis
describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community.

A
health promotion nursing diagnosis
is a clinical judgment of a person’s, family’s, or community’s motivation, desire, and readiness to enhance well-being and actualize human health potential as expressed in their readiness to focus on specific health behaviors such as nutrition and exercise.

Relationship of critical thinking and evaluation

Interpretation:
Be orderly in data collection. Look for patterns to categorize data (e.g., nursing diagnoses [see Chapter 17]). Clarify any data you are uncertain about.

Analysis:
Be open-minded as you look at information about a patient. Do not make careless assumptions. Do the data reveal what you believe is true, or are there other options?

Inference:
Look at the meaning and significance of findings. Are there relationships between findings? Do the data about the patient help you see that a problem exists?

Evaluation:
Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior.

Explanation:
Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients.

Self-regulation:
Reflect on your experiences. Identify ways that you can improve your own performance. What will make you believe that you have been successful?

Level 1 is Basic: At the basic level, nurses think concretely on the basis of a set of rules or principles, following a step-by-step process without deviation from the plan. Following a procedure step by step without adjusting to a patient’s unique needs is an example of basic critical thinking.

Level 2 is Complex: Complex critical thinking analyzes and examines choices independently. Nurses learn to think beyond and synthesize knowledge. In complex critical thinking, a nurse learns that alternative and perhaps conflicting solutions exist.

Level 3 is Commitment: Commitment is the third level of critical thinking. Nurses anticipate needs and make choices without assistance from others.

Abuse and neglect

Cultural considerations, complementary and alternative therapies (invasive vs. non-invasive options)

Complementary therapies are therapies used in addition to or together with conventional treatment recommended by a person’s health care provider. As the name implies, complementary therapies complement conventional treatments. Many of them such as therapeutic touch contain diagnostic and therapeutic methods that require special training. Others such as guided imagery and breathwork are easily learned and applied. Complementary therapies also include relaxation; exercise; massage; reflexology; prayer; biofeedback; hypnotherapy; creative therapies, including art, music, or dance therapy; meditation; chiropractic therapy; and herbs/supplements (Lindquist et al., 2014). Another term that is used to describe interventions used in this fashion, particularly by licensed health care providers, is integrative therapies. Final Nursing Exam Study Guide

Alternative therapies sometimes include the same interventions as complementary therapies; but they become the primary treatment (Table 33-1). For example, a person with chronic pain uses yoga to encourage flexibility and relaxation at the same time that nonsteroidal antiinflammatory or opioid medications are prescribed. Both sets of interventions are based on conventional pathophysiology and anatomy while acknowledging the mind-body connection that contributes to the physiological pain response.

Several therapies are always considered alternative because they are based on completely different philosophies and life systems than those used by allopathic medicine. These are identified by the NIH/NCCIH as whole medical systems and include practices such as traditional Chinese medicine (TCM), Ayurveda, and naturopathy

Nursing presence and caring

Providing presence is a person-to-person encounter conveying a closeness and sense of caring. Presence involves “being there” and “being with.” “Being there” is not only a physical presence; it also includes communication and understanding. Nursing presence is the connectedness between the nurse and the patient

Triage

Routine screening to promote health and wellness

To determine eligibility for:

Health insurance

Military service

A new job

To admit a patient to a hospital or long-term care facility

 

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The nursing profession

Nursing as a profession

Historical influences

Florence Nightengale:

First practicing epidemiologist

Organized first school of nursing

Improved sanitation in battlefield hospitals

Her practices remain a basic part of nursing today

The growth of nursing in the United States:

Clara Barton founded the American Red Cross.

Dorothea Lynde Dix – was the supervisor of female nurses in the Union Army.

Mother Bickerdyke – organized ambulance service, supervised nurses, and searched for abandoned, wounded soldiers on the battlefield.

Harriet Tubman – Tubman was a prominent female in the Underground Railroad movement to free slaves.

Mary Mahoney – was the first professionally educated African-American. She may be one of the first proponents of better relationships between cultures and races and respect for individuals regardless of background, race, color, or religion.

Isabel Hampton Robb – helped found the American Nurses Association in 1911. She was an influential author with the following titles:

Nursing: Its Principles and Practice for Hospital and Private Use; Nursing Ethics;
and
Educational Standards for Nurses
. She was one of the original founders of the
American Journal of Nursing. Final Nursing Exam Study Guide

Lillian Wald and Mary Brewster: Henry Street Settlement –

In 1893, nursing expanded in the community owing to the influence of Lillian Wald and Mary Brewster. Nurses working in the settlement they established were some of the first to demonstrate autonomy in practice because they frequently encountered situations that required quick and innovative problem solving and critical thinking without the supervision or direction of a health care provider.

1906: Mary Adelaide Nutting, first professor of nursing at Columbia University

Another important development in nursing history occurred when the Rockefeller Foundation approached Nutting, along with Lillian Wald and Annie Goodrich, to study nursing education. Their study, conducted in 1920 and published in 1923, concluded that nursing education needed financial support and should be centered in university schools of nursing.

Contemporary influences

Nursing practice

Professional organizations

The American Nurses Association (ANA) (2010) develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.

The Joint Commission (TJC) (2014) requires accredited hospitals to have written nursing policies and procedures.

NANDA

Nursing theories

Grand

Broad in scope, complex, require specification

Middle-range

More limited in scope and less abstract

Descriptive

Describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena.

Prescriptive

Address nursing interventions for a phenomenon, and predict the consequence of a specific nursing intervention.

Nightengale

Nightingale was one of the first to develop a nursing theory (1860) that is still in use today. Her concept of the environment was the focus of nursing care, and her suggestion that nurses need not know all about the disease process differentiated nursing from medicine. The focus of nursing is on caring through the environment and helping the patient deal with the symptoms and changes in function related to an illness.

Nightingale did not view nursing as limited to the administration of medications and treatments, but rather, it is oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. Through observation and data collection, she linked the patient’s health status with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War. Nightingale’s “descriptive theory” provides nurses with a way to think about patients and their environment.

Peplau

Peplau’s theory focuses on interpersonal relations between the nurse, the patient, and the patient’s family and developing the nurse-patient relationship. The patient is an individual with a need, and nursing is an interpersonal and therapeutic process. In developing a nurse-patient relationship, the nurse can serve as a resource person, counselor, and surrogate.

The patient gains from this relationship by using available services to meet needs, and the nurse helps the patient reduce anxiety related to health care problems.

Peplau’s theory is unique: The collaborative nurse-patient relationship creates a “maturing force” through which interpersonal effectiveness meets the patient’s needs.

Henderson

Henderson defines nursing as “assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death, and that the individual would perform unaided if he or she had the necessary strength, will, or knowledge.” Henderson organized the theory into 14 basic needs of the whole person and includes phenomena from the following domains of the patient: physiological, psychological, sociocultural, spiritual, and developmental. Final Nursing Exam Study Guide

Framing nursing care around the needs of the individual allows you to use Henderson’s theory for a variety of patients across the life span and in multiple settings along the health care continuum.

Based on 14 activities, the belief that the nurse should assist the patient with meeting needs until they are able to do so independently

Orem

Orem defines self-care as a learned, goal-oriented activity directed toward the self in the interest of maintaining life, health, development, and well-being. Nursing care is necessary when the patient is unable to fulfill biological, psychological, developmental, or societal needs. The nurse assesses and determines why a patient is unable to meet these needs, identifies goals to assist the patient, intervenes to help the patient perform self-care, and evaluates how much self-care the patient is able to perform.

According to Orem’s theory, the goal of nursing is to enhance the patient’s ability to independently meet these needs.

Leninger

Leininger’s background in anthropology informed her theory. Human caring varies among cultures in its expressions, processes, and patterns. Societal structure factors such as the patient’s religion, politics, culture, and traditions are significant forces affecting care and influencing the patient’s health and illness patterns.

The major concept of Leininger’s theory is cultural diversity, and the goal of nursing care is to provide the patient with culturally specific nursing care. To provide care to patients of unique cultures, the nurse safely integrates the patient’s cultural traditions, values, and beliefs into the plan of care. Leininger’s theory recognizes the importance of culture and its influence on everything that involves the patient and providers of nursing care.

In addition, symptom expression differs among cultures.

Neuman model

In the Neuman model, the patient is the individual, group, family, or community. The system is composed of five concepts that interact: physiological, psychological, sociocultural, developmental, and spiritual. These concepts interact with both internal and external environmental factors and all levels of prevention (primary, secondary, and tertiary) to achieve optimal wellness. Neuman considers any internal and external factors as stressors that affect the patient’s stability and any or all of the five system concepts.

When you apply the Neuman systems model, you assess the stressor and the patient’s response to the stressor, identify nursing diagnoses, plan patient-centered care, implement interventions, evaluate the patient’s response, and determine whether the stressor is resolved.

Based on the theory that focuses on wellness and prevention of disease

Roy

According to Roy’s model, the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness. The need for nursing care occurs when the patient cannot adapt to internal and external environmental demands. All individuals must adapt to the following demands: meeting basic physiological needs, developing a positive self-concept, performing social roles, and achieving a balance between dependence and independence.

The nurse determines which demands are causing problems for a patient and assesses how well the patient is adapting to them. Nurses direct care at helping the patient adapt to changes.

A nurse is caring for a patient who recently lost a limb in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following? – Roy

Watson

In Watson’s theory, nursing is concerned with promoting and restoring health and preventing illness. Watson designed the model around the caring process—assisting patients in attaining or maintaining health or dying peacefully. This caring process requires the nurse to be knowledgeable about human behavior and human responses to actual or potential health problems. The nurse also needs to know individual patient needs, how to respond to others, and strengths and limitations of the patient and family and those of the nurse. In addition, the nurse comforts and offers compassion and empathy to patients and their families.

King –

Based on the belief that nurses should work with patients to develop goals for care

Benner and wrubel

With Benner and Wrubel’s theory, caring is central to nursing and creates possibilities for coping, enables possibilities for connecting with and concern for others, and allows for giving and receiving help. Caring means that persons, events, projects, and things matter to people. It presents a connection and represents a wide range of involvement. This theory sees personal concern as an inherent feature of nursing practice. In caring for one’s patients, nurses help patients recover by noticing interventions that are successful and that guide future caregiving. Final Nursing Exam Study Guide

Legal principles

Risk management

For nursing

Statutory for nursing practice

Statutory laws include the Nurse Practice Act found in all states. The Nurse Practice Act describes and defines the legal boundaries of nursing practice in each state. The Nurse Practice Act of each state defines the scope of nursing practice and expanded nursing roles, sets education requirements for nurses, and distinguishes between nursing and medical practice.

Criminal laws are meant to prevent harm to society and to provide punishment for crimes. These are categorized as felonies or misdemeanors.

A felony is a serious offense that results in significant harm to another person or society

A misdemeanor is a crime that, although injurious, does not inflict serious harm

Civil laws protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur

Regulatory law, also known as administrative law, defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing.

Common law results from judicial decisions concerning individual cases. Most of these revolve around negligence and malpractice.

The American Nurses Association (ANA) (2010) develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.

In a malpractice lawsuit, a nurse’s actual conduct is compared to nursing standards of care to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances.

The Joint Commission (TJC) (2014) requires accredited hospitals to have written nursing policies and procedures.

Patient Protection and Affordable Care Act (PPACA)

PPACA created a new Patient’s Bill of Rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick.

The Patient Self-Determination Act (PSDA) enacted in 1991 requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.

DNRs and Living Wills – Advanced directives

Uniform Anatomical Gift Act

An individual who is at least 18 years of age has the right to make an organ donation.

HIPPA – privacy law

Health Information Technology Act (HITECH)

HITECH expands the principles extended under the HIPAA, especially when a security breach of personal health information (PHI) occurs.

Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action.

The Uniform Determination of Death Act of 1980 states that health care providers can use the cardiopulmonary definition or the whole brain definition to determine death

An autopsy or postmortem examination may be requested by the patient or patient’s family.

The Oregon Death With Dignity Act (1994) was the first statute that permitted physician-assisted suicide

A tort is a civil wrong made against a person or property

Assault
is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur.

Battery
is any intentional offensive touching without consent or lawful justification.

The tort of
false imprisonment
occurs with unjustified restraint of a person without a legal reason

Defamation of character
is the publication of false statements that result in damage to a person’s reputation.

Slander
occurs when one speaks falsely about another.

Libel
is the written defamation of character.

Negligence
is conduct that falls below the generally accepted standard of care of a reasonably prudent person. Final Nursing Exam Study Guide

Malpractice
is one type of negligence and often referred to as professional negligence.

The nurse (defendant) owed a duty of care to the patient (plaintiff).

The nurse did not carry out or breached that duty.

The patient was injured and the nurse’s failure to carry out the duty caused the injury.

Key elements of consent:

The patient receives an explanation of the procedure or treatment.

The patient receives the names and qualifications of people performing and assisting in the procedure.

The patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort.

The patient receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing.

The patient knows that he or she has the right to refuse the procedure/treatment without discontinuing other supportive care.

The patient knows that he or she may refuse the procedure/treatment even after the procedure has begun.

Abortion laws:

In Roe vs. Wade, court ruled that during the first trimester, a woman could end her pregnancy without state regulation because the risk of natural mortality from abortion is less than with normal childbirth.

During the second trimester, the state has an interest in protecting maternal health, and the state enforces regulations regarding the person performing the abortion and the abortion facility.

By the third trimester, when the fetus becomes viable, the state’s interest is to protect the fetus; thus, the state prohibits abortion except when necessary to save the mother.

Ethics

Nursing Codes

Ethics and philosophy

Terms and meaning for nursing

Respect for patient
autonomy
refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence.

Beneficence – positive action for others

The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest

nonmaleficence
is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good, but an equal commitment to do no harm.

Justice
refers to fairness. It is used most often in discussions about access to health care resources, including the just distribution of resources

Fidelity –
agreement to keep promises

patient
autonomy
refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence

Deontology:
proposes a system of ethics that is perhaps most familiar to health care practitioners. Deontology defines actions as right or wrong based on their “right-making characteristics,” such as fidelity to promises, truthfulness, and justice. Deontology depends on a mutual understanding of justice, autonomy, and goodness. But it still leaves room for confusion to surface. Final Nursing Exam Study Guide

Utilitarianism:
A utilitarian system of ethics proposes that the value of something is determined by its usefulness. This philosophy is also known as
consequentialism
because its main emphasis is on the outcome or consequence of an action. A third term associated with this philosophy is
teleology,
from the Greek word
telos,
meaning “end,” or the study of ends or final causes. The greatest good for the greatest number of people is the guiding principle for determining right action in this system.

Feminist Ethics:
Feminist ethics critiques conventional ethics such as deontology and utilitarianism. It looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal, or in which a point of view has become ignored or invisible. Writers with a feminist perspective tend to concentrate more on practical solutions than on theory. Feminist ethicists propose that the natural human urge to be influenced by relationships is a positive value.

Ethics of Care:
The ethics of care and feminist ethics are closely related. Both promote a philosophy that focuses on understanding relationships, especially personal narratives. An early proponent of the ethics of care used the term
the one-caring
to identify the individual who provides care, and
the

cared-for
to refer to the patient or patients. In adopting this language, the author hoped to emphasize the role of feelings.

Casuistry
, or case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an “intimate understanding of particular situations.” This approach to ethical discourse depends on finding consensus more than an appeal to philosophical principle. As a strategy for solving dilemmas, consensus building promotes respect and agreement rather than a particular philosophy or moral system itself.

EBP

Critical thinking

Nursing process -ADPIE

Informatics and documentation

Source records

A separate section for each discipline

Charting by exception (CBE)

Focuses on documenting deviations

Case management plan and critical pathways

Incorporate a multidisciplinary approach to care

Variances

The source-oriented record is organized according to discipline. Each discipline charts in its defined section of the chart. The problem-oriented record is organized around a patient problem list. All disciplines chart on shared notes that are referenced to the identified problem. Final Nursing Exam Study Guide

An occurrence report is a formal record of an unusual occurrence or accident. This is an agency report and is not part of the patient’s chart. An occurrence report is filed in many circumstances. Examples of reportable events include falls or other patient injury, loss of patient belongings, or administration of the wrong medicine.

Communication

o   1. Intrapersonal

o   B. Occurs within an individual

o   2. Interpersonal

o   A. One-to-one interaction between two people

o   3. Transpersonal

o   D. Interaction within a person’s spiritual domain

o   4. Small group

o   E. Interactions with a small number of people

o   5. Public

o   C. Interaction with an audience

o   1. Referent

o   D. Motivates one to communicate with another

o   2. Sender and receiver

o   A. One who encodes and one who decodes the message

o   3. Message

o   G. Content of the message

o   4. Channels

o   E. Means of conveying and receiving messages

o   5. Feedback

o   C. Message the receiver returns

o   6. Interpersonal variables

o   F. Factors that influence communication

o   7. Environment

o   B. The setting for sender-receiver interactions

Preinteraction phase
:
occurs before meeting the       patient

Orientation phase
: when the nurse and the patient             meet and get to know each other

Working phase
: when the nurse and the patient work together to solve problems and accomplish goals

Termination phase
: occurs at the end of a relationship Final Nursing Exam Study Guide

S—This posture (sitting) conveys the message
that you are there to listen and are interested in what the patient is saying.

O—Observe an open posture (i.e., keep arms and legs uncrossed).
This posture suggests that the you are “open” to what the patient says. A “closed” position conveys a defensive attitude, possibly provoking a similar response in the patient.

L—Lean toward the patient. This posture conveys
that you are involved and interested in the interaction.

E—Establish and maintain intermittent eye contact.
This behavior conveys your involvement in and willingness to listen to what the patient is saying. Absence of eye contact or shifting the eyes gives the message that you are not interested in what the patient is saying.

R—Relax. It is important to communicate a sense of being relaxed and comfortable
with the patient. Restlessness communicates to the patient lack of interest and a feeling of discomfort.

Patients education

Affective learning deals with expression of feelings and development of values, attitudes, and beliefs. Affective learning includes the following:

Psychomotor learning involves acquiring motor skills that require coordination and the integration of mental and physical movements such as the ability to walk or use an eating utensil. Psychomotor learning includes the following:

Cognitive learning requires thinking and encompasses the acquisition of knowledge and intellectual skills. The revised taxonomy of six cognitive behaviors is hierarchical and increases in complexity as in the following list:

Health Assessment

Stress and coping

Exercise and activity

Patient Safety and quality

Final Nursing Exam Study Guide