Study Guide
Nursing 02 - Exam #1

1. Explain the components of a teaching plan: Cognitive domain, psychomotor domain, and Affective domain. Include in your explanation how the presenter would evaluate each.

Cognitive :( Includes all intellectual behaviors and requires thinking. In the hierarchy of cognitive behavior the simplest behavior is acquiring knowledge whereas the most complex is evaluation cognitive learning includes the following: knowledge, comprehension, application, analysis, synthesis, evaluation) DISCUSSION: 1. involves nurse and one client or nurse with several clients. 2. Promotes active participation and focuses on topics of interest of client. 3. Allows peer support. 4. Enhances application and analysis of new information. LECTURE: 1. is more format method of instruction because it is teacher controlled. 2. Helps learner acquire new knowledge and gain comprehension. QUESTION AND ANSWER SESSION: 1. addresses client’s specific concerns. 2. Assists client in applying knowledge. ROLE PLAY, DISCOVERY: 1. allows client to actively apply knowledge in controlled situation. 2. Promotes synthesis of information and problem solving. INDEPENDENT PROFECT (COMPUTER ASSISTED INSTRUCTION), FIELD EXPERIENCE: 1. allows client to assume responsibility for completing learning activities at own pace. 2. Promotes analysis, synthesis, and evaluation of new information and skills. Affective :( deals with expression of feelings and acceptance of attitudes, opinions, or values. Values clarification is an example of affective learning. The simplest behavior in the hierarchy is receiving, and the most compels is characterizing. Affective learning includes the following receiving, responding, valuing, organizing, characterizing) ROLE PLAY: 1. allows expression of values, feelings, and attitudes. DISCUSSION: 1. allows client to receive support from others in group. 2. helps client learn from others experiences. 3. Promotes responding, valuing, and organization. DISCUSSION (ONE ON ONE): 1. allows discussion of personal, sensitive topics of interest or concern. Psychomotor: (involves acquiring skills that require the integration of mental and muscular activity, such as the ability to walk or to use an eating utensil. The simplest behavior in the hierarchy is perception whereas the most complex is organization. Psychomotor learning includes the following: perception, set, guided response, mechanism complex overt response, adaptation, organization. ) DEMONSTRATION: 1. provides presentation of procedures or skills by nurse. 2. Permits client to incorporate modeling of nurse’s behavior. 3. Allows nurse to control questioning during demonstration. PRACTICE: 1. gives client opputunity to perform skills using equipment in a controlled setting. 2. Provides repetition. RETURN DEMONSTRATION: 1. permits client to perform skill as nurse observes. 2. provides excellent source of feedback and reinforcement. INDEPENDENT PROFECTS, GAMES: 1. requires teaching method that promotes adaptation and origination of psychomotor learning. 2. Permits learner to use new skills.

Cognitive is learning that involves only data and facts. It involves things like problem solving and decision making. One example would be educating the client on the side effects and actions of the medications they’re taking. Psychomotor involves using motor skills. An example of this would be teaching a patient how to give themselves an injection. Lastly is the affective domain. This involves changing the patient’s attitudes or judgment about something. An example of affective teaching would be getting a patient to accept their chronic illness. The three main components of a teaching plan are learning outcomes, content, and strategies. These would all change depending on the domain of teaching. If you were teaching in the cognitive domain, you would probably want to provide charts or visuals to help them learn the information. If you were teaching in the psychomotor domain you would want to demonstrate and have them demonstrate that they can perform the action. If you were teaching in the affective domain, you would want to listen to them a lot more and find out their feelings on the issue before educating them.

2. Describe the elements of a community assessment.

The community has 3 components: structure or locale, the people, and the social systems. To develop=op a complete community assessment you need to take a careful look at each of the 3 components to begin to identify needs for health policy, health programs, and needed healthy services. When assessing the structure or locale, travels around the neighborhood or community and observe its design. The location of services and the locations where residents meet. Obtain the demographics of the population by accessing statistics on the community form a local public health department or public library. Acquire information about existing social systems. Such as schools or health care facilities, by visiting various sites and learning about there services. Once you have a good understanding of the community, perform all individual client assessments against that background. For example, when assessing a clients home for safety consider the following, does the client have secure locks on doors? Are window secure and intact? Is lighting along walkways and entryways operation? As you conduct the client assessment know the level of community violence and the available resources when help is necessary. Always assess an individual in the context of the community. The assessment of health care needs of individuals, families, and communities, development and implementation of public health policies and improved access to care. Assessment includes systematic data collection on the population monitoring of the population health status and accessing available information about the health of the community.

Assess medical needs of community, economic needs, social needs. Look at building and location, social structure, and personal factors. For buildings you want to check the level of repair needed, what types of buildings if the community is residential or mostly apartments or single family homes. For social you want to investigate the social structure of the community. Look for schools, churches, other areas where people congregate. Look for groups of homeless. See what kind of options they have in the community. Is there a hospital close by, are there medical offices or a clinic, are there pharmacies or stores that sell medications? For personal factors you want to see what kinds of factors affect people in the community. It could be something environmental like a high level of pollution.

3. Discuss the factors to consider when providing health education.

Educational efforts need to take into consideration client’s psychosocial, spiritual, and cultural values, as well as the desire to actively participate in the educational process.

The first thing you want to consider are things that would impair their education. First would be if someone has an altered level of consciousness. They could have a mental illness or alzheimers or some other form of dementia. Then you want to assess if they speak the same language as you. You may have to get an interpreter to help you as you don’t want to rely on the family to translate. The family might not tell the patient things they think would hurt them. Then you want to assess their eyesight. They may have poor eyesight, or need glasses and might not be able to read something. Then you want to assess their hearing. If you’re explaining something to them and they can’t hear you, it won’t work. If they can’t hear you very well, then you want to turn facing them so they can see your mouth movements when you talk. Otherwise, you may want to provide written materials or find a sign language interpreter. Lastly you would want to assess their developmental age. If someone has heart problems, you wouldn’t explain it the same way to a 4 year old and a 40 year old.

Then you would want to consider things outside of the other person that could affect the education. You would want to make sure you educate them in a place that has no distractions, like the patient’s room. You would probably want to close the door, turn off the tv, and make sure the lighting is at a good level. You may or may not want other people in there when you provide the education. It could be about a subject they don’t want the visitor to know about so you may want to ask the visitor to step out. On the other hand if the person has a hard time following the education you may want to have someone else in there. If the person is confused or can’t learn a skill, then you would want to teach a significant other or family member the skill instead.


4. Describe the physiological, cognitive and psychosocial changes of the aged. Include pharmacological aspects and multiple health problems.

See concept map pg 198 nursing

5. Discuss the assessment needed for the elderly patient.

It is important to remember that the elderly may face a health problem with fear and anxiety. Health care workers may be perceived as helpful but institutions are viewed negatively. The nurse must communicate a sense of concern and care use simple statements, appropriate eye contact and direct touch and gentle humor. These will help relax the elder patient. Before beginning the assessment attend to primary needs. Ensure that the patient is in no pain and does not have to urinate. Make sure all assistive devices are in place. I.e. hearing aids glasses…etc. Take time and interview the patient alone unless they request their caregiver in the room. Go over all previous med history in there record.
The focus of the assessment is to determine appropriate interventions to maintain and enhance the functional abilities of the older adult. The assessment is interdisciplinary and at a minimum includes the med history, physical exam, functional abilities, and social resources. It often includes an entire team but primarily a nurse, physician and social worker.
Elements include assessment of mood, ADLs, IADLs, mental status, and a social environmental assessment. Focus on the older adult remaining as functionally independent as possible.

6. Discuss the nursing diagnoses appropriate for the elderly patient.

CV SYSTEM: activity intolerance decreased CO, fatigue. RESPIRATORY SYSTEM: impaired gas exchange, ineffective airway clearance, ineffective breathing pattern, risk for aspiration, and risk for infection. INTEGUMENTARY SYSTEM: impaired skin integrity. URINARY SYSTEM: deficient fluid volume, impaired urinary elimination. MUSCULOSKELETAL SYSTEM: impaired physical mobility, chronic pain, and risk for injury, self care deficit, and sedentary lifestyle. REPRODUCTIVE SYSTEM: disturbed body image, ineffective sexuality patterns, sexual dysfunction. GI SYSTEM: constipation, imbalanced nutrition, impaired oral mucosa membrane. NERVOUS SYSTEM: disturbed thought process, disturbed sensory perception, hyperthermia, hypothermia, insomnia. SENSES: disturbed body image, impaired verbal communication, social isolation. IMMUNE SYSTEM: risk for infection.

7. Discuss the roles of the community health nurse. Potter page 38-41

CAREGIVER: focus on individualized care and maintain a healthy community. CASEMANAGER: the ability to establish an appropriate plan of care based on assessment of clients and families ant to coordinate needed resources and services for the client’s well being across a continuum of care. Assume the case management of multiple clients and families. COLLABORATOR: Being able to work with a team to better the heath of a client. EDUCATOR: Determine the needs of the community and then host educational meetings. COUNSELOR: help clients identify health problems and work to fix these problems. CLIENT ADVOCATE: advocate for client provide health care choices that best suit there need. CHANGE AGENT: identifying and implementing new and more effective approaches to problems. Act as a mediator for community or client problems. EPIDEMIOLOGIST: responsible for community surveillance for risk factors.

Care giver-apply nursing process in a critical approach to ensure appropriate, individualized nursing care for specific client and their families. Individualized care within the context of client’s community.

Case manager- establishes appropriate plan of care based on assessment of clients and families and coordinated needed resources and services for the client’s well-being across a continuum of care.

Change agent-empowers individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency.

Client Advocate- provides the information necessary for client to make informed decisions in choosing and using services appropriately. Defend and support client’s decision.

Collaborator- work with other health care disciplines

Counselor- helps clients identify and clarify health problems and choose appropriate courses of action to solve those problems.

Educator-

Epidemiologist- protects the community’s level of health, develop sensitivity to changes in the health status of the community, and help identify the cause of these changes

8. Discuss the principles of appropriate delegation. Potter, pg309-310

* Assess the knowledge and skills of the delegate: determine what the person knows and what he or she is able to do by asking open ended questions.
* Match tasks to delegate’s skills: Know what skills the delegates are able to perform or have performed before. Be there to assist if delegate is uncomfortable with task or needs assistance.
* communicate clearly: never give instructions through another staff member. Be clear on exactly what you want.
*listen attentively: Find out if after you have delegated a responsibility if the AP understands or has any questions. Or If the AP has prior obligations for another nurse.
*provide feedback: give feedback regarding performance.

Right task-one that is delegable for a specific client, such as tasks that are repetitive, require little supervision, have predictable results, and minimal potential risks.

Right circumstances- appropriate client setting, available resources, and other relevant factor considered. If the circumstances have not been assessed or are deemed too complicated, the nurse takes the responsibility and doesn’t delegate.

Right person- the right person is delegating the right task to the right person to be performed on the right person.

Right direction and communication- a clear, concise description of the task is conveyed, including its objectives, limits, expectations, and when to report concerns or assessment findings. Very specific, clear directions are essential for delegation to work well.

Right Supervision- appropriate monitoring, evaluation, intervention, as needed, and feedback. The nurse remains accountable for the tasks that were delegated and for making clinical judgment.

9. Discuss the attributes of a nurse manager.

* assist staff in establishing annual goals for the unit and systems needed to accomplish goals
* monitor professional nursing standards of practice on the unit
* develop an ongoing staff envelopment plan, including one for new employees.
*recruit new employees (interview and hire)
*conduct routine staff evaluations
* establish self as a role model for positive customer service.
* submit staffing schedules for the unit
* Conduct regular client rounds and problem solve client or family complaints.
* establish and implement a unit quality improvement plan.
* review and recommend new equipment for the unit
* conduct regular staff meetings
* make rounds with physicians.
* establish and support staff and interdisciplinary committees.

Effective communicator, assertiveness, honesty, and accuracy

Skill and competency- Critical thinking, communication, managing resources, enhancing employee performance, building and managing teams, managing conflicts, and managing time

In addition, see Box 21-3 Potter, page 304

10. Discuss the interventions for the elderly patient with visual impairment; hearing impairment.

For hearing problems talk facing the patient, Speak loudly and clearly, lower tones are more commonly easier to hear, Use visual cues or write things down. Provide hearing aids when needed. For vision problems: Speak when you enter the room to let them know you are there as to not startle them, Move into their best space of vision. Some elderly patients have central vision and some have better peripheral vision. Keep room well lit it is easier to see in a brightly lit room. Provide glasses when needed.

11. Discuss the home safety strategies for the aged.

Constant evaluations to determine if the patient is properly caring for self or that all of their needs are being satisfied by their home health care provider. The older adult needs an environment safe from crime and needs to feel safe and have a sense of belonging in their community. If needed homes can be made wheelchair accessible, lighting can be increased and adjusted, safety devices can be installed in bathrooms and kitchens. Alarms and assistive listening devices can be used.

12. Discuss the strategies to enhance and maintain long term memory.

Use of memory helps to maintain it “use it or lose it” crossword puzzles, sudoku, or any other memory jogging game or puzzle. Any type of mental stimuli such as conversation or social interaction help to keep the mind young and working.