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Fundamentals of Nursing
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Part 4

📝 Nursing Planning & Implementation (Simple Cheat Sheet)

🎯 Goal Setting

  • Always in collaboration with the patient
  • Prescribe appropriate nursing interventions for each diagnosis.

🧠 Clinical Judgment in Planning

Uses 6 components (Fig. 18.2 p.259):

  • Attitudes – Open-minded, confident, responsible.
  • Standards – Nursing guidelines, policies, ethics.
  • Knowledge – What you know from school, books, and research.
  • Clinical decision-making – Putting it all together for safe patient care.
  • Environment – Available resources, setting, hospital vs. community.
  • Experience – Past patient encounters.

⏱ Priority Setting

Review priorities each time you see the patient.

Priorities can change quickly—reassess every time you see the patient.

  • High Priority → ABCs (Airway, Breathing, Circulation) + Maslow’s basic needs.
  • Intermediate Priority → Non-emergent, not life-threatening (e.g., infection risk).
  • Low Priority → Long-term, not urgent, affects overall well-being (e.g., patient education, patient asking “Can i get some ice cream”).

🎯 Outcomes Identification

  • Short-term goal → Example: Wound ulcer → signs of healing within a few days.
  • Long-term goal → Example: Patient ready for discharge.

✅ Expected Outcomes (SMART Goals)

  • Specific
  • Measurable
  • Attainable
  • Realistic
  • Timed

📑 Tools in Care Planning

  • Care plans in community → Focus on home/family environment.
  • Hand-off report → Passing essential info between nurses.
  • Concept maps → Flowcharts to visualize patient’s condition.
  • Critical pathways → Standardized plan for common conditions (ex: postop recovery).

🛤️ Critical Pathways (Clinical Pathways / Care Maps)

  • Definition: Standardized, multidisciplinary care plans designed for specific common conditions or procedures (e.g., hip replacement, pneumonia, stroke). Outlines the essential steps in patient care and keep everyone (nurses, doctors, therapists) on the same timeline toward recovery.

🔑 Key Features

  • It’s standardized → all patients with that condition generally follow the same pathway.
  • Show expected progress day by day (ex: Day 1 = mobility exercises, Day 2 = diet advancement).
  • Improve coordination, efficiency, and quality of care.
  • Help reduce unnecessary variations in treatment.

✅ Example

For a patient after hip replacement surgery:

  • Day 1: Pain control, deep breathing exercises, begin assisted walking.
  • Day 2: Increase walking distance, start physical therapy.
  • Day 3–4: Advance diet, review discharge planning.

⚡ In short:

Critical pathways = step-by-step timelines for care → ensure patients with the same condition receive consistent, efficient, and safe treatment.

💉 Implementation

  • Direct care interventions → What you do with the patient in front of him (meds, wound care, teaching).
  • Indirect care interventions → What you do for the patient when you are not in front of him (documentation, calling other services).

🏥 Collaboration & Interventions

  • Nurses can call Nutrition, PT, RT, etc. for referrals.

Types of Interventions

  1. Independent → Nurse-initiated(e.g., turning patient, teaching).
  2. Dependent → Health care provider-initiated(e.g., give meds ordered by MD).
  3. Interdependent → Collaboration with team (PT, OT, dietitian). Other providers.

👉 Student care plans must always have scientific rationale.

📞 Consulting with Providers

  • Use ISBAR before calling:
    • Identify → Who you are/patient details.
    • Situation → What’s happening now.
    • Background → Relevant history.
    • Assessment → What you think is going on.
    • Recommendation → What you need (orders, tests, etc.).
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🩺 Examples

🩺 Example 1: Post-op Patient with Low O₂

I: This is Nurse Smith on 4B. I’m calling about Mr. Johnson, 65, post-op day 1 hip replacement.

S: His oxygen saturation dropped to 86% on room air.

B: He has a history of COPD and hypertension. Normally sat is >94%.

A: Lung sounds diminished bilaterally; he’s using accessory muscles to breathe.

R: I recommend starting supplemental oxygen and would like an order for ABGs.

🤒 Example 2: Patient with Chest Pain

I: This is Nurse Lopez from ER. I’m calling about Mrs. Martinez, 58.

S: She’s reporting sudden chest pain, 8/10, radiating to her left arm.

B: History of hypertension and high cholesterol; no known allergies.

A: BP 160/100, HR 110, ECG shows ST elevation.

R: I recommend initiating MONA protocol and need orders for cardiology consult.

⚡ Tip: ISBAR keeps your call clear, structured, and efficient → doctors know exactly what’s happening and what you need.

🩺 Standard Interventions (Simple)

Purpose

  • Help nurses act faster and more appropriately.
  • Make it easier to share patient care information with the whole team.

Types

  • Clinical practice guidelines & protocols → Evidence-based “how to” guides.
  • Care bundles → Small set of best practices done together for better outcomes.
  • Standing orders → Pre-approved instructions nurses can follow without waiting for a provider.
  • NIC (Nursing Interventions Classification) → Standard list of nursing actions.
  • Standards of practice → Rules and expectations for safe, professional care.
  • QSEN (Quality & Safety Education for Nurses) → Focus on safety, quality, and patient-centered care.

⚙️ Implementation Skills

Key Point

Nurses must know when to use each skill and have the knowledge + ability to perform them.

🧠 Cognitive Skills

  • Using critical thinking and knowledge.
  • Example: Choosing the best intervention based on patient data.

🗣 Interpersonal / Communication Skills

  • Building trust and rapport with patients & team.
  • Example: Explaining a procedure clearly or calming an anxious patient.

✋ Psychomotor Skills

  • Hands-on skills that combine knowledge + physical ability.
  • Example: Giving an injection, inserting an IV, changing a dressing.

👉 Easy memory trick: “Think – Talk – Do”

  • Think = Cognitive
  • Talk = Interpersonal
  • Do = Psychomotor

👩‍⚕️ Examples of Direct Care Interventions

Direct care = nursing actions done directly with the patient to meet physical & emotional needs.

🏠 Activities of Daily Living (ADLs)

Everyday tasks: bathing, eating, dressing, toileting, walking.

🛒 Instrumental ADLs (IADLs)

Shopping, cooking, cleaning, caring for pets, managing money/meds. Support independence in the community.

💉 Physical Care Techniques

(e.g., wound care, IV therapy, medication administration) Safe, skilled procedures .

🚨 Lifesaving Measures

(CPR, controlling bleeding, mental health crisis support) Emergency support when patient’s life/health is threatened.

🗣 Counseling

Helping patients cope, set goals, and make decisions.

📚 Teaching

Educating patients/families about health, treatment, and self-care.

⚠️ Controlling for Adverse Reactions

Watching for and managing side effects (e.g., from meds or treatments).

🛡 Preventive Interventions

Actions to prevent illness/complications (e.g., vaccines, fall prevention, screenings).

🗂 Examples of Indirect Care

Nursing actions done away from the patient, but still for the patient’s benefit.

👉 Quick way to remember: Indirect = “Behind the Scenes Care”

📢 Communicating Nursing Interventions

  • Sharing info with the health care team.
  • Can be written (charting, reports) or oral (handoffs, phone calls).

👥 Delegating, Supervising & Evaluating

  • Assigning tasks to other staff.
  • Making sure work is done safely & correctly.
  • Providing feedback and follow-up.

✅ Evaluation

  • Check if interventions worked.
  • Change Care Plan if necessary.
  • Easier if you use past experience and apply to current situation.
  • Early detection = first line of defense.