It is important to remember that the nursing process is not static but dynamic.

ID: 122698 • Letter: I

Question

It is important to remember that the nursing process is not static but dynamic. In other words, you do not perform a single step at a time beginning with assessment and ending with evaluation. Use the following scenario to discuss the dynamic nature of the nursing process: You enter a patient's room to find the patient ashen, short of breath, and complaining of chest pain. Your first actions include checking vital signs, measuring pulse oximetry, giving nitroglycerin, applying oxygen, and notifying the physician, Explain which steps of the nursing process you are performing. Using a physical problem you understand well (e.g., common cold, flu, or broken bone), list the common signs and symptoms, and identify whether they represent subjective or objective data. List any further explanation on the blank lines. Take the following nursing diagnoses and prioritize them according to Maslow's hierarchy of human needs, and group them using the hierarchy terms: ineffective airway clearance, spiritual distress, decreased cardiac output, readiness for enhanced power, ineffective breathing pattern, risk for injury, chronic low self-esteem, for loneliness, and readiness for enhanced spiritual well-being.

Explanation / Answer

52Ans.

The nursing process is a series of organized steps designed for nurses to provide excellent care. The below are the nursing process steps.

In this scenario checking vital signs, pulse oximetry, giving nitroglycerin, applying oxygen and notifying physician are the part of implementation of the care plan out of the nursing process steps.

53Ans:

Signs symptoms of commom cold

Flu symptoms can include:

Subjective data: Subjective data is gathered from the patient telling you something that you cannot use your five senses to measure.

Objective data: This is the information that we can gather using our 5 senses. It is either a measurement or an observation.

Subjective data

Objective data

Headache

Sneezing

Fatigue

Cough

Body aches

Fever

Nausea/Vomitings

Shortness of breath

Sore throat

54Ans:

Self fulfillment needs

1.Self actualization-(Achieving one’s full potential, including creative activities): Readiness for enhanced spiritual wellbeing, Spiritual distress

2.Esteen needs –( Prestige and feeling of accomplishment): Readiness for enhanced power, Chronic Low self esteem

Psychological needs

Basic Needs

5.Physiological needs-(Food water, warmth, rest): Ineffective breathing pattern, Ineffective airway clearance, Decreased cardiac output