Quarter Three: Chapter One and Two Review

Exam Information

  • Topical outline will be provided before the exam.
  • Insight into exam question format and study methods will be given.

Study Resources

  • Illustrated book (N+ study guide with practice questions and online access).
  • Sylvestri book (practice questions and online access).
  • FA Davis questions.
  • Use a variety of resources to prepare for different question styles.

Course Content Overview

  • First four chapters: Review of fundamentals (from previous courses like Fund. 1 &2, Professional Awareness, Pharmacology).
  • Chapter six (Fluid and Electrolytes): More advanced, "real medicine" type questions.
  • Exam 1 is usually the easiest because it covers familiar content.
  • Focus on applying information rather than memorizing, application-based questions.

Chapter 1: Critical Thinking, Clinical Judgment, and the Nursing Process

  • Importance of Critical Thinking:

    • Prioritization.
    • Providing the best patient care.
    • Early recognition of signs and symptoms.

  • Identifying Subtle Clues:

    • Clues often appear before a patient's condition severely declines.
      • Anorexia
      • Slight decrease in BP
      • Clammy skin
      • Low blood sugar
      • Altered mental status

  • Textbook:

    • Davis textbook is the primary resource.
    • ATI med-surg and pharmacology books may be referenced occasionally.

  • Critical Thinking:

    • Only 23% of new graduates are prepared to practice safely due to lack of application skills.

  • NCLEX Prioritization of Critical Thinking:

    • NCLEX includes case studies and various NGN questions.
    • Focus on critical thinking to prepare for real-world scenarios.
    • Making quick, independent decisions.

  • Failure to Rescue:

    • Failure to act promptly when a patient shows signs of decline.
    • Leads to patient's severe deterioration, hospitalization, or death.
    • Be able to recognize signs and symptoms early on and give the best outcome.

  • Cognitive Skills:

    • Using cognitive skills to increase the probability of a good outcome.
    • Understanding what is going on and why.

  • Applying Knowledge:

    • Using knowledge to make better decisions.

  • WHAT'S UP Mnemonic:

    • Assessment tool for gathering patient information.
    • What: What happened?
    • Where: Where is the pain?
    • How: How does it feel? (Sharp, dull, stabbing)
    • Aggravating/Alleviating: What makes it worse or better?
    • Timing: When did it start? How long?
    • Severity: Rate the pain (0-10 scale, faces scale for nonverbal patients).
    • Useful other data: Did you take anything? Have you had this pain before?
    • Patient perception: What do you think is happening? Why do you think this started?
    • Not just limited to pain, can be applied to weakness.

  • Prioritization:

    • Prioritizing can be important in nursing.

  • Clinical Judgment:

    • Outcome of critical thinking and decision-making.
    • Requires critical thinking attitudes, skills, and knowledge.
    • Understanding, not just memorizing.

  • Understanding Pathophysiology:

    • Understanding helps determine actions.
    • Understanding the pathophysiology guides action based on disease process or symptom.
    • Actions/interventions, symptoms, patient's diagnosis, and priorities are key aspects.

  • Example: Myocardial Infarction (MI)

    • MI: Ischemia of the heart muscle.
      • Chest pain
      • Lack of oxygen to the cardiac muscle. *What can you do?
        • Administer oxygen.
        • Administer nitroglycerin.
        • Sit patient up.
    • Nitroglycerin: Vasodilator, opens arteries for blood flow.
    • Questions will vary, so memorization isn't enough.

  • Critical Thinking Attitudes:

    • Intellectual Humility: Being aware of what you don't know and willing to learn.
    • Intellectual Autonomy: Observing actions of others, identifying what is safe/unsafe, and speaking up.
    • Intellectual Integrity: Valuing the truth and speaking up respectfully.

  • CUS for Communication:

    • Systematic way to share concerns with providers.
      • C: I am concerned about…
      • U: I am uncomfortable because…
      • S: This is a safety issue because… *Example provider wrote discharge orders for a patient going home alone with history of falls & forgetful. How can you use the CUSS method to communicate with your provider in this scenario?
        • I'm concerned that the patient would be home alone.
        • Makes you uncomfortable because She doesn't have assistance
        • Safety concern.
    • If provider doesn't listen, escalate to supervisor, social worker, or case manager.

  • Nursing Process:

    • ADPIE: Assessing, Diagnosing, Planning, Implementing, Evaluating.

  • Clinical Judgment:

    • Mirrors the nursing process.
    • Identify and analyze cues (gather data).
    • Prioritize hypotheses (identify problems).
    • Generating solutions (plan of care).
    • Take action (implement the plan).
    • Evaluate outcomes.
    • Process is iterative.

  • Applying the Nursing Process:

    • Being able to see a phrase and say, oh this is an assessment or that is an outcome or this is an intervention.

  • Nursing Diagnosis:

    • Identifies risks.
    • Different from medical diagnosis.
    • Guides nursing actions.

  • Nursing Diagnosis Example:

    • Patient admitted with myocardial infarction (MI).
    • Nursing diagnoses: Pain, risk for impaired oxygenation/gas exchange.

  • ATI Book:

    • Nursing process steps: Pose a question, gather evidence, analyze evidence, apply evidence, assess results.

  • Stay Vigilant:

    • Being attentive and alert.
    • Anticipating potential issues and planning accordingly.
    • Knowing when to intervene quickly.

  • Communication with Healthcare Team:

    • SBAR: Situation, Background, Assessment, Recommendation.

  • Example: Patient with Chest Pain:

    • Situation: Patient admitted for chest pain, pain increasing (3/10 to 8/10).
    • Background: Vital signs, objective findings (pain scale), subjective findings, lab results (cardiac enzymes).
    • What can you anticipate?
    • Recommendation: Request orders (EKG, troponin level, nitroglycerin, CBC).
    • Repeating orders to confirm: Do not be afraid to clarify if needed.

  • Active Listening:

    • Blocking out distractions.
    • Giving the speaker (patient) full attention.
    • Taking notes and verifying understanding.

  • Prioritizing Patient Care:

    • Patient-centered and using Maslow's hierarchy of needs.
    • Life-threatening conditions take priority.

  • Maslow's Hierarchy of Needs:

    • Physiological needs (bottom): Oxygen, nutrition, fluids, body temperature, elimination, shelter, sexual needs.
    • Safety and security: Physical and psychological safety.
    • Love and belonging: Family and friends.
    • Self-esteem.
    • Self-actualization (top): Requires all other needs to be met.

Collaboration with Healthcare Team

  • Team Members Include:

    • Supervisors, charge nurses, fellow nurses, managers, providers (doctors, NPs, PAs), case managers, social workers, dietary staff, housekeeping.
    • Maximize outcomes for patients.

  • Patient-Centric Care:

    • Involving patients in the team.
    • Advocating for patient preferences.

Chapter 2: Evidence Based Practice

  • Current evidence should not be more than five years old.

    • What is Evidence-Based Practice?

    • A systematic process using reliable, research-based information.

    • Improves the care and optimizes patients' outcomes.

    • Based from a resource that i reliable.

    • Evidence-Based Practice Components:

    • Analyzing current evidence.

    • Making patient care decisions.

    • Decision-Making Factors to Conside:

    • Ensure quality of care.

    • Addressing problems and solving them.

    • Considering patient's preferences.

    • Cost-effectiveness: This is used more as a priority when it is not a priority in health care settings.

    • Appropriateness for the clinical setting.

    • Benefits of Evidence-Based Practice:

    • It's the gold standard for care.

    • Provides the best care possible.

    • Measurable outcomes.

    • LPN's Role:

    • Use data from credible resources.

    • Know which sources provide reliable data.

    • Apply evidence-based practice when providing care.

    • Data Collection:

    • Using data from different source of evidence as long as they are evidence based.

    • Analyzing Evidence:

    • Looking at the best evidence to obtain and worse type.

    • Seven Levels of Evidence:

    • Level 1: Systematic review (strongest).

    • Level 2: Randomized controlled trial.

    • Level 3: Quasi experimental study.

    • Level 4: Case control and cohort study.

    • Level 5: Qualitative and descriptive studies.

    • Level 6: Qualitative for a single descriptive study.

    • Level 7: Expert opinion (weakest).

    • Systematic Review:

    • Looking at a bunch of trails.

    • Analysis of various controlled trials.

    • LPN Responsibilities:

    • Participating in quality improvement activities.

    • Gold Standard:

    • The goals is to maximize patient outcome.