Clinical thoughts
This subjective evaluation is 'what the patient says it is', and although we may always want to have none of it, that is not always a reasonable or achievable goal.
What is pain?
Sometimes a goal of being pain free is not possible, so your goal may be to have manageable pain that the patient can tolerate.
Can you think of an example of when you may not want to give analgesia to get to a goal of zero pain?
Babinski response, waving, sucking, hand grasping, smiling and speaking in sentences are examples of this
What are important age specific developmental milestones for children?
I will select the answer/s that describe INAPPROPRIATE actions, assessments findings, or actions suggested
When the questions asks for something like the identification of a 'need for additional teaching', 'does not demonstrate understanding' or which items are 'not to be included in the plan of care'.
The nursing diagnoses' of:
'Patient will use IS 10 times per hour until discharge'
'Wound drainage will improve within 3 days'
do NOT meet the criteria for this.
What is a SMART goal?
Any patient goal questions should include all components of a SAMRT goal.
When is discharge? - not time specific
How did we define parameters to quantify the wound drainage? - Not measurable
Pt has COPD, Pneumonia and is on oxygen, morbid obesity, dementia, and is very weak because they have been in bed for 3 weeks due to this illness.
True or False question:
When trying to get this patient out of bed, an appropriate nursing diagnosis would be:
"Risk for falls related to resp compromise"
False.
Be sure that the problem (fall risk) is related to the thing that would impact their ability to safely ambulate.
This patient is at risk for falls because of the muscle weakness and prolonged immobilization/bedrest.
Weight loss, night sweats and rust-colored or blood-tinged sputum are classic signs of this disease.
What are the classic signs of tuberculosis?
Yellow/Green sputum are signs of bacterial infection, but the rust (old blood) for TB is caused by damage to the lung tissue.
These interventions will reduce one of the major risks for someone with Parkinson's disease.
What are aspiration precautions?
Sit patient upright when eating
Chin tuck before swallowing
Thicken thin liquids
Small bites and allow extra time for swallowing
When a test answer has multiple components, for example, describing multiple assessment findings, risk factors, or interventions, and all but one of them are completely appropriate for the question situation...
Is this answer correct?
The answer is incorrect.
If a great looking answer has one part that is wrong, then that option is not the correct answer.
The first presentation presentation of this disorder can be delayed by doing regular strength building exercises that help improve stability.
What is Osteoporosis?
The first presentation is often a pathological fracture, so weight bearing exercises help stimulates bone building, and the increased core strength reduces the risk of having a fall that could cause a fracture.
This body response to infection that causes increased HR, increased resp rate, increased temp, localized swelling, and decreased blood pressure, also causes this change in blood glucose.
What is the inflammatory response, and an increase in blood glucose level?
Think fight or flight response: One of your body responses is to release stores glucose to supply your cells that have an increased workload, so that you can maintain tissue perfusion.
An open wound that extends though the dermis could be described in either of these terms.
What are Stage 2, or full- thickness?
Stage 1: Closed: Skin intact but remains red and non-blanchable after 30 minutes.
Stage 2: Partial thickness: Epidermis is disrupted but the dermal layer of the skin is intact.
Stage 3: Full thickness: All layers of skin are breached and the subcutaneous tissues are visible.
Stage 4: Full thickness: The would extends down to muscle and bone.
Memory loss, decreasing intelligence, and the development of incontinence in old age are not examples of this.
What are NOT expected findings in an old adult.
Be aware of the difference between age related changes and normal aging. Just because a condition is more common in the elderly, does not make it normal.
When I see an answer indicating something like:
...will never develop a complication
...if you do this you will be fine
...If you comply with treatment you WILL have a good outcome
What is a wrong answer?
Even when we do all things possible, we can not guarantee an outcome for a patient, we are always striving to reduce risks and optimize outcomes, but despite best efforts we do not always have a good outcome. Look for answers that express an absolute.
A person with this condition will not be helped by taking oral hypoglycemic medications.
What is type 1 diabetes?
Type 1 use insulin from the outset, and although people with type 2 may also progress to using insulin, they were able to use other treatments at the onset of the disease.
Because she has been on antibiotics for weeks, this pt is at risk for developing this infectious diarrhea that requires contact precautions, and I need to ensure that all hand sanitizer is removed from the patient room so that everyone must wash with soap and water instead.
What is C. Diff?
Certain antibiotics can cause an imbalance in the gastrointestinal bacteria that will allow C. Diff to flourish.
These are three potential manifestations of gastrointestinal bleeding
What are black tarry stools, coffee ground emesis, and hematemesis?
Coffee ground emesis and black tarry stools may be more chronic, and frank red vomit is very acute, but all indicate bleeding in the GI tract
Older people tend to reduce their fluid intake below the recommended 2000 mls , particularly in the evening because they don't want to experience this urinary problem.
What is nocturia?
If asked about the BEST way to evaluate a patients understanding of a clinical condition, any answer option describing this will be best.
What is purposeful demonstration?
Although describing the steps of a procedure (like self-administering insulin, or changing a dressing) are good, if there is an option where the patient shows you how they do that procedure is going to be a better answer.
A patient who is confused
What are considered restraints and requires a provider order?
This patient has increased blood glucose and the doctor orders a test for diabetes that does not require the patient to be fasting
What is A1C testing?
I will assess this with my stethoscope at the 4th intercostal space to the left border of the sternum.
What is the tricuspid valve?
This tertiary prevention is important for a person who has had poorly controlled diabetes for many years and has developed peripheral neuropathy and poor circulation.
What are regular foot examinations to assess for wounds that the patient may not realize are there?
This acronym for the nursing process can sometimes help you hone in on what the question is asking you to evaluate.
What is ADPIE: For some questions, you can analyze the question to determine if you are being asked to assess the pt, diagnose their needs, plan care/goal setting, deliver care, or evaluate the outcome. You can then ensure that your answer addresses the component of the nursing process that the question is asking about.
This occurs when blood and nerve supply to a body area (most commonly the extremities) is restricted resulting in compromised tissue perfusion, and can be caused by internal bleeding or external pressure.
What is compartment syndrome?
Remember, the internal bleeding within a closed compartment causes pressure that compromised neurovascular function, and the same can happen if the pt has a tight dressing or cast. It may not have been tight when applied, but if swelling occurs after application, we can constrict blood vessels and nerve function.
IV fluids may be needed in addition to encouraging oral fluids for this patient because of these assessment findings.
What are fever, vasodilation, and hypotension.
Fever increases the speed of your insensible fluid loss though the skin, breath, and sweating.
When we vasodilate, our blood pressure drops and we need to ensure adequate fluids because of that vasodilation to ensure that the BP is sufficient to maintain tissue perfusion.