initial assessment - Correct answer performed shortly after the patient is admitted to a
health care facility or service and is used to establish a complete database for problem
identification and care planning
focused assessment - Correct answer nurse gathers data about a specific problem that
has already been identified
emergency assessment - Correct answer when a patient has a physiologic or
psychological crisis it is used to identify life-threatening problems
time-lapsed assessment - Correct answer scheduled to compare a patient's current
status to the baseline data obtained earlier
patient-centered assessment method (PCAM) - Correct answer a tool health care
practitioners can use to assess patient complexity using the social determinants of
health
subjective data - Correct answer information perceived only by the affected person;
these data cannot be perceived or verified by another person
objective data - Correct answer observable and measurable data that can be seen,
heard, felt, or measured by someone other than the person experiencing them
nursing diagnosis - Correct answer actual or potential health problem that an
independent nursing intervention can prevent or resolve; defining characteristics are
present at risk factors
medical diagnosis - Correct answer statement about a specific disease process using
terminology from a well-developed classification system accepted by the medical
profession
collaborative problem - Correct answer actual or potential health problem that may
occur from complications of disease, diagnostic studies, or treatment regimen; the nurse
works together with other members of the health care team toward its resolution
, NANDA approved nursing diagnoses - Correct answer related to either sign/symptom
that support diagnosis, look at objective and subjective assessment secondary to an
explanation to why nursing diagnosis and related to occuring
long term goal - Correct answer resolution/improvement of your nursing diagnosis that
is measurable, patient-centered, and needs a time frame
short term goal - Correct answer helps patient achieve long term goal; must also be
measurable, patient-centered, and have a time frame
SMART - Correct answer specific, measurable, achievable, relevant, and time-bound
initial planning - Correct answer performed by the nurse with the admission nursing
history and the physical assessment
standardized planning - Correct answer prepared care plans that identify the nursing
diagnoses, outcomes, and related nursing interventions common to a specific
population or health problem
ongoing planning - Correct answer carried out by any nurse who interacts with the
patient to keep the plan up to date to facilitate the resolution of health problems,
manage risk factors, and promote function
discharge planning - Correct answer carried out by the nurse who has worked most
closely with the patient and family, possible in conjunction with a nurse or social worker
with a broad knowledge of existing community resources
patient-centered care - Correct answer providing care that is respectful of, and
responsive to, individual patient preferences, needs and values, and ensuring the
patient values guide all clinical decisions
nursing-initiated intervention - Correct answer an autonomous action based on
scientific rationale that a nurse executes to benefit the patient in a predictable way
related to the nursing diagnosis and projected outcomes
Physician-Initiated Interventions - Correct answer dependent on nursing actions,
involving carrying out physician-prescribed orders
collaborative interventions - Correct answer interdependent nursing actions performed
jointly by nurses and other members of the health care team
Nurse centered - Correct answer "nurse will" and needs a frequency
nursing intervention - Correct answer any treatment, based on clinical judgment and
knowledge, that a nurse performs to enhance patient outcomes; what the nurse will do
to help client achieve the LTG and STGs
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