1 STUDY GU IDE Davis Advantage for Unders tanding Medical -Surgical Nursing 7th Editio n By Linda S . Hopper, Paula D.; Williams, All Chapter's 1 - 57 (Davis Advantage for Understanding Medical-Surgical Nursing, 7e Linda Williams, Paula Hopper) Answers CHAPTER 1 CRITICAL THINKING, CLINICAL JUDGMENT, AND THE NURSING PROCESS to collect appropriate data, identify a patient problem, and determine the best possible plan of action. Clinical judgment is based on good critical thinking. Cue Definition: Significant or relevant data. Not all data are cues (relevant), but all cues are data. AUDIO CASE STUDY Jane Practices Clinical Judgment 1. Identify and analyze cues; prioritize hypotheses; generate solutions; take action; evaluate outcomes; repeat. 2. Jane was exhausted, failed a test, and was pulled in too many directions. She was also crying in her car and had poor study habits and not enough sleep. 3. Jane’s resources included a good friend, sick time from work, and wasted time between classes that she could better utilize. Your resources will be different, but they exist! 4. Critical thinking —the why : Jane uses critical thinking to determine why her current plan isn ’t working. She thinks honestly about her poor study habits, her time- management problems, and the impact this is having on her and her family. Clinical judgment —the do: Jane uses her thinking to develop and carry out a plan that uses her resources and provides more productive study time and more quality time with her kids. VOC ABULA RY Sample sentences will vary for the Vocabulary problems. Nursing process Definition: An organizing framework that links thinking with nursing actions. Steps include assessment/data collection, nursing diagnosis, planning, implementation, and evaluation. Critical thinking Definition: The use of those cognitive (knowledge) skills or strategies that increase the probability of a desirable outcome. Also involves reflection, problem-solving, and related thinking skills. Clinical judgment Definition: The observed outcome of critical thinking and decision making. A process that uses nursing knowledge Collabora tion Definition: Working together with the health team to improve patient outcomes. Intervention Definition: Taking action to carry out a plan. Evaluation Definition: Comparing the outcomes you expected with actual outcomes. Did the plan work? Were expected outcomes met? Vigilance Definition: The act of being attentive, alert, and watchful. CRITICAL THINKING AND CLINICAL JUDGMENT Critical thinking and clinical judgment both follow a similar format. Both follow steps from collecting data to determin- ing problems and outcomes, developing and taking actions, and evaluating outcomes. However, critical thinking helps you think about the problem: What is it? Why is it happen- ing? And clinical judgment leads you to do something to manage the problem. CUE RECOGNITION You will do many things for each individual, but the FIRST thing is listed below. 1. Sit the patient upright. 2. Call 911 while running across the street. 3. Elevate the feet off the bed by placing a pillow under the calves and allowing the feet to hang off the edge of the pillow. 4. Check blood glucose and have a glucose source ready. 5. Turn the patient to the side to prevent aspiration. 1 Could it be low Am I diabetic? blood sugar? Frontal area "Sick" feeling Hard Tylenol helps Hunger makes it worse Patient's perception Where is it? Quality Aggravating and alleviating factors Food helps Headache Useful other data Severity Timing Sometimes feel sick to stomach Mother is diabetic 7–8 on 0–10 scale Lasts 1 –2 hours once starts Before meals Early in the morning 2 Chapter 1 Answers CRITICAL THINKING This is just one possible way to complete a cognitive map. REVIEW QUESTIONS The correct answers are in boldface. 1. (2) Critical thinking can lead to better outcomes for the patient. (1, 3, 4) may be true but are not the best answer. 2. (4) is correct. The nurse who can admit to not knowing something is exhibiting intellectual humility. (1) shows expertise but not necessarily intellectual humility; (2) reporting an error shows intellectual integrity; (3) empathizing is positive but does is not evidence of humility. 3. (3, 4, 5, 1, 2) is the correct order. 4. (1) is the best definition. (2, 3, 4) do not define critical thinking but are examples of good thinking. 5. (4) is correct. Evaluation determines whether goals are achieved and interventions effective. (2) is the role of the physician. (1, 3) encompass data collection and imple- mentation, which are earlier steps in the nursing process. 6. (1) is correct. The licensed practical nurse/licensed voca- tional nurse (LPN/LVN) can collect data, which includes taking vital signs; data collection is the first step in the nursing process. (2, 3, 4) are all steps in the nursing process, for which the registered nurse is responsible; the LPN/LVN may assist the registered nurse with these. Nitroglycerin should not be administered without first knowing the patient ’s blood pressure. 7. (2) indicates that the patient is concerned about freedom from injury and harm. (1) relates to basic needs such as air, oxygen, and water. (3) relates to feeling loved. (4) is related to having positive self-esteem. 8. (3, 1, 2, 4) is the correct order according to Maslow. 9. (5, 2, 1, 4, 6, 3) is the correct order. 10. (3) shows the patient is actually taking action. (1, 2, 4) are all positive but do not show intent to take action. 11. (4) is the nurse ’s analysis of the situation. (1, 2) are data; (3) is a recommendation. 12. (1, 2, 3, 4) should be present. Since the data provides only hip replacement as the patient ’s problem, (5) the dietitian is not necessary. Answers AUDIO CASE STUDY Marie and Evidence-Based Practice 1. Thirdhand smoke is the dangerous toxins of smoke that linger on hair, clothing, furniture, and other surfaces in an area after a cigarette is put out. Marie learned that exposure to these toxins can be neurotoxic to children and can trigger asthma attacks in sensitive people. 2. Evidence-based practice is considered the gold standard of health care. 3. Step 1: Ask the burning question. Step 2: Search and collect the most relevant and best evidence available. Step 3: Think critically. Appraise the evidence for validity, relevance to the situation, and applicability. Step 4: Measure the outcomes before and after instituting the change. Step 5: Make it happen. Step 6: Evaluate the practice decision or change. 4. Combination therapy with a nicotine patch and nicotine lozenges worked best, although bupropion (Zyban) or varenicline (Chantix) and nicotine lozenges worked well, too. A Cochrane Review found that advice and support from nursing staff can increase patients ’ success in quit- ting smoking, especially in a hospital setting. VOC ABULA RY Sample sentences will vary for the Vocabulary problems. 1. Evidence-based practice: A systematic process that uses current evidence in making decisions about patient care. 2. Evidence-informed practice: Consideration of patient factors along with the use of evidence for shared decision making between the health-care provider and the patient. 3. Randomized controlled trials: True experimental studies in which as many factors as possible that could falsely change the results are controlled. 4. Research: Scientific study, investigation, or experimenta- tion to establish facts and analyze their significance. 5. Systematic review: A review of relevant research using guidelines. EVIDENCE-BASED PRACTICE 1. proof 2. context 3. quality 4. care 5. randomized 6. outcomes 7. gold 8. nursing 9. patient ’s 10. information CLINICAL JUDGMENT 1. By questioning the existing way of doing things to ensure that the patient receives the best care possible 2. A thorough search of the literature, with the assistance of the medical librarian, in the area of their burning ques- tion regarding music reducing preoperative anxiety. 3. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Database, Joanna Briggs Institute evidence-based resources, Cochrane Reviews, Medline/ PubMed 4. Measure patient outcomes before instituting the evidence-
based change in practice so comparisons can be made after implementation to determine if the inter- vention worked 5. Evaluate the results to determine whether the change made a significant difference and if it was valuable in terms of cost and time REVIEW QUESTIONS The correct answers are in boldface. 1. (3) is correct. Providing an explanation of why some- thing is done promotes the understanding for why it is important to be done and therefore will more likely be done. (1, 2, 4) only communicate the need to perform a task. They do not provide rationale for the task to pro- mote understanding of the importance of the task. 2. (3) is correct. Evidence-based nursing care that has been evaluated as appropriate for an agency provides the best and safest patient care. (1) Opinions may not be based on CHAPTER 2 EVIDENCE-BASED PRACTICE
