FNP LEC

• Planning


  The nurse develops a plan of care that prescribes interventions to attain expected outcomes
• 4 Main Purposes of the Plan of Care

  • Promotes communication among caregivers to promote continuity of care
  • Directs care and documentation
  • Creates a record that can later be used for evaluation, research & legal reasons
  • Provides documentation of health care needs for insurance reimbursement purposes
• Activities of the PLANNING PHASE

  • Attending to urgent priorities
  • Clarifying expected outcomes
  • Deciding which problems must be prescribed
  • Determining Individualized Nursing interventions
  • Making sure the plan is adequately recorded
• ACTIVITY OF THE PLANNING PHASE: Setting Priorities


  1. It serves the purpose of ordering the delivery of nursing care so that the more important or life threatening problems are treated before less critical problems are treated

  2. Choose a method of assigning priorities and use it consistently

  3. Maslow's Hierarchy of Needs can guide the selection of high-priority problems

  4. Problems usually present in a cluster - study the relationships among the problems to determine major priorities

  5. Assign high priority to problems that contribute to other problems
• Basic Principles: Attending to Urgent Priorities

  • Make sure that the patient has NO THREATS to their Airway, Breathing, Circulation
  • Maslow's Hierarchy of Needs can guide the selection of high-priority problems
• Outcome


  The desired result of nursing care; that which one hopes to achieve with the patient and which is designed to prevent, remedy or lessen the problem identified in the nursing diagnosis
• Outcome Identification


  The nurse identifies expected outcomes individualized to the patient
• Goals & Objectives vs Outcomes

  Goals & Objectives refer to the intent (what you intend to do), Outcomes refer to the results (what you expect the patient to be able to do)
• 3 Main Purposes of Expected Outcomes

  • They are the "measuring sticks" for the plan of care
  • They direct interventions
  • They are motivating factors
• Principle of Patient-Centered Outcomes


  • Outcomes describe the specific benefits you expect to see in the patient after care has been given
  • Short Term Outcomes describe early expected benefits, Long Term Outcomes describe benefits expected at a certain point in time
  • Problem Outcomes state what you expect to observe when problems are resolved, Intervention Outcomes state the benefit you expect after an intervention
• Components of Outcome Statements

  • Subject (who is expected to achieve the outcome)
  • Verb (what actions the person must take)
  • Condition (under what circumstances the person is to perform the actions)
  • Performance Criteria (how well the person is to perform the actions)
  • Target Time (by when the person is expected to perform the actions)
• Patient Behavior


  An observable activity the patient will demonstrate at some time in the future showing improvement in the problem area
• Conditions


  Specific aids that will help the patient perform a behavior at the level specified in the criteria
• Performance Criteria


  A stated level or standard for the patient behavior stated in the outcome, used to determine if the outcome was satisfactorily achieved
• Time Frame


  A time or date to clarify how long it would realistically take for the patient to reach the level of functioning stated in the criteria
• Types of Time Frames

  • Intermediate Outcomes (achievable fairly quickly)
  • Long Term or Final Outcomes (maximum level of functioning possible)
  • Discharge Outcomes (expected to achieve to be safely discharged)
  • Health Promotion/Wellness Outcomes
• 3 Basic Steps To Determining Which Problems Must Be Recorded

  1. Create a problem list

  2. Decide which problems must be managed to achieve overall outcomes

  3. Determine what documentation will guide how each problem will be managed
• It's the nurse's responsibility to make sure any problems, diagnoses, risk factors likely to impede progress toward outcome achievement are addressed on the patient record
• Implementation


  The nurse implements the interventions identified in the plan of care
• Oxygenation


  Necessary to sustain life. The cardiac and respiratory systems supply the oxygen demand of the body. Blood is oxygenated through the mechanisms of ventilation, perfusion and transport of respiratory gases.
• Neural and chemical regulators

  • Control the rate and depth of respiration in response to changing tissue oxygen demands
  • The cardiovascular system provides the transport system to distribute oxygen to cells and tissues of the body
• Factors influencing adequacy of circulation, ventilation, perfusion and transport of respiratory gases to the tissues

  • Physiological
  • Developmental
  • Lifestyle
  • Environmental
• Physiological factors


  Any condition affecting cardiopulmonary functioning directly affects the ability of the body to meet oxygen demands
• Developmental factors affecting oxygenation

  • Infants and toddlers
  • School-Age and Adolescents
  • Young and middle-age adults
  • Older adults
• Lifestyle factors


  Lifestyle modifications are difficult for patients because they often have to change an enjoyable habit such as cigarette smoking or eating certain foods
• Environmental factors


  The environment influences oxygenation. The incidence of pulmonary disease is higher in smoggy urban areas than in rural areas. A patient's workplace sometimes increases the risk for pulmonary disease
• Nursing interventions for promoting and maintaining adequate oxygenation

  • Positioning
  • Coughing techniques
  • Health education for disease prevention
  • Oxygen therapy
  • Lung inflation techniques
  • Chest physiotherapy
• Activity and exercise


  The coordinated efforts of the musculoskeletal and nervous systems maintain balance, posture and body alignment during lifting, bending, moving and performing activities of daily living (ADLs)
• Exercise


  Physical activity that conditions the body, improves health, and maintains fitness. Sometimes it is also a therapeutic measure
• An active lifestyle is important for maintaining and promoting health; it is also an essential treatment for chronic illnesses. Regular physical activity and exercise enhance functioning of all body systems, including cardiopulmonary functioning, musculoskeletal fitness, weight control and maintenance and psychological well-being
• Best program of physical activity

  • Combination of exercises that produces different physiological and psychological benefits
• Proper balance, posture and body alignment

  • Reduce the risk of injury to the musculoskeletal system
  • Facilitate body movements
  • Allow physical mobility without muscle strain and excessive use of muscle energy
• Exercise


  Physical activity that conditions the body, improves health, and maintains fitness
• Exercise is sometimes a therapeutic measure
• Activity tolerance


  The type and amount of exercise or activity that a person is able to perform
• Physiological, emotional and developmental factors influence a patient's activity tolerance
• An active lifestyle is important for maintaining and promoting health; it is also an essential treatment for chronic illnesses
• Regular physical activity and exercise enhance functioning of all body systems, including cardiopulmonary functioning, musculoskeletal fitness, weight control and maintenance and psychological well-being
• Categories of exercise


  • Isotonic
  • Isometric
  • Resistive isometric
• Isotonic exercises


  Cause muscle contraction and change in muscle length