9. Be able to determine the priority of given interventions based on patient’s subjective report of symptoms (ch 1 pg5)Make a complete list of medications, medical problems, allergies, and reason for seeking care. Determine relationships among problems: If problem a patient is rendered immobile due to pain, thentreating the pain is the priority. Setting PrioritiesAssign high priority to all first-level priority problems:Airway problems, Breathing problems, Cardiac. Circulation problems, and vital sign concerns (ex: High fever)Next assign priority to second-level priority problems:Mental status change (eg: confusion, decreased alertness)Untreated medical problems requiring immediate attention(eg:a diabetic who has not had insulin)Acute PainAcute urinary elimination problemsAbnormal laboratory valuesRisks of infection, safety, or security (for the patient or for others)Address third-level priority problems (later priorities):Health problems that do not fit into the above categories (ex: problems with lack of knowledge, activity, rest, family coping)10. Review the different types of data bases (complete, focused or episodic and emergency) and the situations that call for each type (Ch1 pg7-8)Complete Data base: A complete health history and full physical examination. It describes current and past health state and forms a baseline against which all future changes can be measured. Collected carried out in primary care settings; generally upon the first visit if the client is not presenting with a highpriority problem. Focused or Episodic Data Base: This is for a limited or short term problem. You collect a “mini” database, smaller in scope and more targeted than a complete database. It concerns one problem, one cue complex, or one body system. Can be collected anywhere. EX: A patient presents with a rash in anoutpatient clinic. The history and examination follow the direction of this presenting concern, such as whether the rash had an acute or chronic onset, wa associated with fever, and was localized or generalized. History and examination must include a clear description of the rash. Emergency Data Base: This calls for a rapid collection of data, often complied concurrently with lifesavingmeasures. Diagnosis must be swift and sure. For example, in a hospital ER, a person brought in with a suspected substance overdose. The first history questions are, “What did you take?,” and “When?” The person is questioned simultaneously while his or her airway, breathing, circulation, level of consciousness, and disability are being assessed. 11. Know how the nurse should proceed with data collection in a situation when the patient presents to the Emergency Department with multiple traumas A rapid collection of focused data on the issue at hand. See Q10- Emergency Database. 12. Review the importance in an emergency situation to assess history questions while performing the examination and initiating lifesaving measuresIn an emergency situation the focus of the health care professionals is to treat the patient but to also to collect an emergency history. This emergency database give health professionals relevant information onwhat the problem is and how best to begin treatment. 13. Know that physical development occurs in a cephalocaudal direction (head-to-toe)Development proceeds from the head downward. This is the cephalocaudal principle. It describes the direction of growth and development. The child gains control of the head first, then the arms, and then the legs. Infants develop control of the head and face movements within the first two months after birth.In the next few months, they are able to lift themselves up by using their arms. By 6 to 12 months of age,infants start to gain leg control and may be able to crawl, stand, or walk. Coordination of arms always precedes coordination of legs14. Be aware that the assessment of an aging adult may take more time than a younger person. It may take the aging adult a little longer to respond but general knowledge and mental abilities should not have declined in the absence of dementiaInterviews tend to take longer for older adults because they have a longer story to tell. They need more time to collect their thoughts, and they have a greater number of symptoms you must work through. Avoid trying to hurry them along. You may need to break up the interview into multiple visits collecting the most important data first. This information can also be collected from forms sent home with the patient if their vision and handwriting are adequate.15. Know the standards of practice in nursing (nursing process) and the six phases.Begin with AssessmentCollect data –both subjective & objectiveDiagnose actual problems and predict potential problemsIdentify risk factorsIdentify strengthsFormulate nursing diagnosesPlanning – OUTCOMES!Determine specific outcomesDecide what interventions would be most effectiveImplementationIntervene with specific nursing activitiesReassess and modify, if indicatedDetermine appropriateness of interventionsEvaluationHow are we doing as far as achieving desired outcomes?Do we need help?How can we do this better?Do we need to terminate or modify
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