Welcome

to

01/18/23 RADIX ACADEMY 1

 Nursing Process

Masud Rana
RN, MSN(NIANER)

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Nursing Process
 Specific to the nursing profession
 A framework for critical thinking
 It’s purpose is to:

“Diagnose and treat human responses to

actual or potential health problems”

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Nursing Process
 Organized framework to guide practice
 Problem solving method - client focused
 Systematic- sequential steps
 Goal oriented- outcome criteria
 Dynamic-always changing, flexible
 Utilizes critical thinking processes

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Scientific Method of problem solving
 ID problem
 Collect data
 Form hypothesis
 Plan of action
 Hypothesis testing
 Interpret results
 Evaluate findings
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 Advantages of Nursing Process
 Provides individualized  Develops a clear and
care efficient plan of care
 Client is an active  Provides personal
participant satisfaction as you see
 Promotes continuity of client achieve goals
care  Professional growth as
 Provides more effective you evaluate
communication among effectiveness of your
nurses and healthcare interventions
professionals
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5 Steps in the Nursing Process
 Assessment
 Nursing
Diagnosis
 Planning
 Implementing
 Evaluating
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Assessment
 First step of the Nursing Process
 Gather Information/Collect Data
 Primary Source - Client / Family
 Secondary Source - physical exam, nursing
history, team members, lab reports, diagnostic
tests…..
 Subjective -from the client (symptom)
• “I have a headache”
 Objective - observable data (sign)
• Blood Pressure 130/80
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Assessment-collecting data
 Nursing Interview (history)
 Health Assessment -Review of Systems
 Physical Exam
 Inspection
 Palpation
 Percussion
 Auscultation

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Assessment-collecting data
 Make sure information is complete &
accurate
 Validate prn
 Interpret and analyze data
Compare to “standard norms”
 Organize and cluster data

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Example of Assessment
 Obtain info from nursing assessment,
history and physical (H&P) etc…...

 Client diagnosed with hypertension

 B/P 160/90
 2 Gm Na diet and antihypertensive
medications were prescribed
 Client statement “ I really don’t watch my
salt” “ It’s hard RADIX
01/18/23 to do and I just don’t get it”11
ACADEMY
Nursing Diagnosis
 Second step of the Nursing Process

 Interpret & analyze clustered data

 Identify client’s problems and strengths

 Formulate Nursing Diagnosis (NANDA : North

American Nursing Diagnosis Association)-
Statement of how the client is RESPONDING to
an actual or potential problem that requires
nursing intervention
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 Nsg Dx vs MD Dx
 Within the scope of  Within the scope of
nursing practice medical practice
 Identify responses  Focuses on curing
to health and illness pathology
 Can change from  Stays the same as
day to day long as the disease
is present

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Formulating a Nursing Diagnosis
 Composed of 3 parts:
 Problem statement- the client’s response
to a problem
 Etiology- what’s causing/contributing to
the client’s problem
 Defining Characteristics- what’s the
evidence of the problem

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Nursing Diagnosis
 Problem( Diagnostic Label)-based on your
assessment of client…(gathered
information), pick a problem from the
NANDA list...
 Etiology- determine what the problem is
caused by or related to (R/T)...
 Defining characteristics- then state as
evidenced by (AEB) the specific facts the
problem is based on...
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Example of Nursing Dx
 Ineffective therapeutic regimen
management
R/T difficulty maintaining lifestyle changes
and lack of knowledge
AEB B/P= 160/90, dietary sodium
restrictions not being observed, and client
statements of “ I don’t watch my salt” “It’s
hard to do and I just don’t get it”.

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Types of Nursing Diagnoses
 Actual
Imbalanced nutrition; less than body requirements
RT chronic diarrhea, nausea, and pain AEB height
5’5” weight 105 lbs.
 Risk
Risk for falls RT altered gait and generalized
weakness
 Wellness
Family coping: potential for growth RT
unexpected birth ofRADIX
01/18/23 twins.
ACADEMY 17
 Planning
Third step of the Nursing Process
 This is when the nurse organizes a nursing care
plan based on the nursing diagnoses.
 Nurse and client formulate goals to help the
client with their problems
 Expected outcomes are identified
 Interventions (nursing orders) are selected to aid
the client reach these goals.

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 Planning – Begin by
prioritizing client problems
 Prioritize list of
client’s nursing
diagnoses using
Maslow
 Rank as high,
intermediate or low
 Client specific
 Priorities can change
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Maslow’s Hierarchy of
Needs

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Planning
Developing a goal and outcome statement
 Goal and outcome EXAMPLE
statements are client  Goal:
focused. Client will achieve
 Worded positively therapeutic management
 Measurable, specific of disease process….
observable, time-limited,  Outcome Statement:
and realistic AEB B/P readings of
 Goal = broad statement 110-120 / 70-80 and client
 Expected outcome = statement of
objective criterion for understanding importance
measurement of goal of dietary sodium
restrictions by day of
discharge.
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Planning- Types of goals
 Short term goals
 Long term goals
 Cognitive goals
 Psychomotor goals
 Affective goals
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Goals are patient-centered and
SMART
Specific
Measurable
Attainable
Relevant
Time Bound
Pt will walk 50 ft.
Pt will eat 75% of meal
Pt will maintain HR<100
Pt will state pain level is acceptable 6 (0-10)

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Planning-select interventions
 Interventions are selected and written.
 The nurse uses clinical judgment and
professional knowledge to select
appropriate interventions that will aid the
client in reaching their goal.
 Interventions should be examined for
feasibility and acceptability to the client
 Interventions should be written clearly and
specifically.
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Interventions – 3 types
 Independent ( Nurse initiated )- any
action the nurse can initiate without direct
supervision
 Dependent ( Physician initiated )-nursing
actions requiring MD orders
 Collaborative- nursing actions performed
jointly with other health care team members

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Implemention
 The fourth step in the Nursing Process
 This is the “Doing” step
 Carrying out nursing interventions (orders)
selected during the planning step
 This includes monitoring, teaching, further
assessing, reviewing NCP, incorporating
physicians orders and monitoring cost
effectiveness of interventions
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 Implementing- “Doing”
 Teach potential
 Monitor VS q4h
complications of
 Maintain prescribed diet hypertension to instill
(2 Gm Na) importance of
 Teach client amount of maintaining Na
sodium restriction, foods restrictions
high in sodium, use of  Assess for cultural
nutrition labels, food factors affecting
preparation and sodium dietary regime
substitutes
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Implementing – “Doing”
 Teach the client-  Teach client importance
hypertension can’t be of life style changes:
cured but it can be (weight reduction,
controlled. smoking cessation,
 Remind the client to increasing activity)
continue medication  Stress the importance of
even though no S/S ongoing follow-up care
are present. even though the patient
feels well.
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Evaluation- To determine
effectiveness of NCP
 Final step of the Nursing Process but
also done concurrently throughout client care
 A comparison of client behavior and/or response
to the established outcome criteria
 Continuous review of the nursing care plan
 Examines if nursing interventions are working
 Determines changes needed to help client reach
stated goals.

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Evaluation
 Outcome criteria met? Problem resolved!
 Outcome criteria not fully met? Continue
plan of care- ongoing.
 Outcome criteria unobtainable- review each
previous step of NCP and determine if
modification of the NCP is needed.
 Were the nsg interventions
appropriate/effective?

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Evaluation
Factors that impede goal attainment:

 Incomplete database
 Unrealistic client outcomes
 Nonspecific nsg interventions
 Inadequate time for clients to achieve
outcomes.

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 Checkpoint
Identify which stage of the nursing process
is being described below:

 The nurse writes nursing interventions

 A goal is agreed upon
 The nurse performs a physical assessment
 A revision is made to the NCP
 The nurse administers antibiotic medication
 A statement is written that outlines the clients
response to a potential health problem
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S and O Data Quiz
 RR 22/min, even unlabored
 “I can only walk 3 blocks before my legs start to
hurt”
 Pain rated 3 on a scale of 0-10
 Skin pink, warm and dry
 Urine output 300mL/8 hr
 “My wife doesn’t come to visit very often”
 Dressing clean, dry and intact.
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Quiz
Nursing diagnoses are aimed at identifying
client problems that are treatable by
_______.
 A.The physician
 B.The nurse
 C.Invasive techniques
 D.Complementary strategies
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 Important to Know
 Father of Medicine: Hippocrates
 Father of Public Health : Cholera (by john
snow in London; 1848-1854)
Father of Epidemiology/Modern
Epidemiology/ The greatest doctor: John Snow
 Germ Theory : Louis Pasteur
 Small Pox Vaccine : Edward Jenner (1796)

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 Community
 A group of people
 A defined geographical area
 Common cultures, values, beliefs,
norms, interests

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 Comprehensive Health Care
A package of activities of community medicine
that includes-
1.Curative – treatment of common ailments
2.Preventive – e.g Immunization
3.Promotive – e.g. Health education
4.Rehabilitative

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Health
 Health is a state of complete physical, mental,
and social well-being and not merely an
absence of disease or infirmity, so that each
citizen can lead a socially and economically
productive life. - (WHO)

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 Dimension Health
Four Major Dimension:
1. Physical
2. Mental
3. Social, and
4. Spiritual

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 Health Indicators

 Health indicators are the tools with which we

measure the health status of a community

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 Health Indicators
 Health indicators are the tools with which we
measure the health status of a community

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Types of Health indicators
1. Mortality indicators
2. Morbidity indicators
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Indicators of social & mental health
8. Environmental indicators
9. Socio-economic indicators
10. Health policy indicators
11. Indicators of quality of life, and
12. Other indicators
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Mortality indicators
 Crude death rate
 Life expectancy at birth
 Infant mortality rate
 Child mortality rate
 Under 5 proportionate mortality rate
 Adult Mortality rate
 Maternal Mortality rate
 Diseases specific mortality rate
 Proportional mortality rate
 Case fatality rate
 Years of potential life lost (YPLL)

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Mortality indicators
 Crude death rate
 Life expectancy at birth
 Infant mortality rate
 Child mortality rate
 Under 5 proportionate mortality rate
 Adult Mortality rate
 Maternal Mortality rate
 Diseases specific mortality rate
 Proportional mortality rate
 Case fatality rate
 Years of potential life lost (YPLL)

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Morbidity Indicators
 Incidence & Prevalence rate
 Notification rate
 Attendance rate at out-patient departments,
health centers
 Admission, readmission and discharge rate
 Duration of hospital stay
 Spells of sickness or absence from work or
school

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Health Care (service) delivery
indicators
 Doctor-population ratio
 Doctor – Nurse ratio
 Population- Bed ratio
 Population per health centre/ sub-centre
 Population per traditional birth attendant

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RADIX ACADEMY
 Drugs to avoid in Pg
SAFE Moms Take Really Good Care

S- Sulfonamides (e.g. Sulfadiazine)

A- Aminoglycocides (e.g. gentamycin, amikacin, tobramycin,
neomycin, streptomycin)
F- Fluroquinolones (e.g. ciprofloxacine, gemifloxacin,
levofloxacin, moxifloxacine, ofloxacin)
E- Erythromycin
M- Metronidazole
T- Tetracyclin
R- Ribavirin (antiviral to Rx HCV)
G- Griseofulvin (antifungal to Rx skin infection e.g. itch,
wring worm)
C- Chloramphenicol/Clindamycin/Clarithromycin
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Primary Health Care
 The concept of ‘primary health care’ came
into existence at the Alma-Ata conference,
in 1978.

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8 Components/Elements of PHC

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Principles of PHC

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Prevention

 Prevention is the action taken to intercept or

oppose the ‘cause’ and thereby the disease
process.

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Levels of prevention

Four levels of prevention:

1.Primordial prevention
2.Primary prevention
3.Secondary prevention
4.Tertiary prevention

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 Thank You

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