Student Name Chamberlain University NR-226: Fundamentals – Patient Care Prof. Name Date NR 226 Quiz 2 Dementia and Living Arrangements A nurse is assisting a client whose dementia has progressively worsened to the point where independent living is no longer safe. In a conversation with the client’s son regarding healthcare services and possible living options, the nurse recommends considering a nursing facility. Home care, while often preferred, may pose significant safety risks when cognitive decline reaches an advanced stage.From a nursing perspective, it is crucial to ensure that families are aware of the range of available care options, including assisted living, memory care units, and skilled nursing facilities. The decision should be guided by the client’s level of cognitive function, safety concerns, and the ability of family members to provide adequate support. Aspect Details Nursing Implications Dementia and Living Arrangements Severe dementia can compromise safety in a home setting. Nursing centers offer structured care and supervision. Educate families about safe living environments, community resources, and the transition process to facility-based care. Understanding Health Promotion in Older Adults An older adult’s statement, “I still keep my dentist appointments even though I have partials now,” reflects a strong understanding of health promotion principles. This behavior demonstrates a commitment to maintaining preventive healthcare, which is essential for overall well-being.Regular dental care, even with partial dentures, supports oral health, reduces the risk of infections, and enhances nutrition by ensuring proper chewing. Nurses should reinforce the value of routine medical, dental, and vision appointments in promoting long-term health among older adults. Aspect Details Nursing Implications Health Promotion Understanding Maintaining regular healthcare appointments is a sign of good self-care and preventive health awareness. Highlight the importance of ongoing preventive measures, even when partial or complete prosthetics are in use. Delirium vs. Dementia The most significant difference between delirium and dementia lies in the onset and clinical presentation. Delirium is typically abrupt in onset, often linked to acute illness, medication effects, or infections, and is frequently accompanied by hallucinations, disorientation, agitation, and altered consciousness. In contrast, dementia develops gradually, does not affect all older adults, and can have multiple causes such as Alzheimer’s disease, vascular impairment, or Lewy body dementia.Nurses must accurately differentiate between these two conditions, as delirium often requires immediate medical intervention, while dementia care focuses on long-term management. Condition Onset Key Characteristics Nursing Considerations Delirium Sudden Hallucinations, confusion, memory loss, agitation, altered consciousness Prompt identification and treatment of underlying cause Dementia Gradual Progressive memory decline, cognitive impairment, stable consciousness Long-term care planning and support for patient and family Heart Disease in Older Adults Heart disease remains the leading cause of death among older adults. Contributing factors include hypertension, diabetes, obesity, sedentary lifestyle, and smoking. Nurses must prioritize cardiovascular risk assessment, early detection, and patient education on heart-healthy lifestyle modifications.Preventive strategies include promoting balanced nutrition, encouraging regular physical activity, and supporting medication adherence. Pain Management in Cognitively Impaired Older Adults Older adults recovering from surgery who have cognitive impairment may struggle to communicate their pain effectively. This creates a risk of under-treatment or delayed intervention. Nurses should employ validated non-verbal pain assessment tools, observe behavioral cues such as facial grimacing or restlessness, and involve family members in recognizing changes in comfort levels. NR 226 Quiz 2 Aspect Details Nursing Implications Pain in Cognitive Impairment Expression of pain may be altered or absent Use behavioral and physiological indicators to guide pain management Sleep Concerns Across Age Groups Sleep-related challenges vary across the lifespan: NR 226 Quiz 2 Age Group Common Sleep Issue Nursing Education Focus Children Night terrors Reassure parents, ensure safety during episodes Young Adults Sleep deprivation Promote good sleep hygiene, stress management Older Adults Frequent napping Encourage short naps, maintain consistent bedtime REM Sleep and Cognitive Health During Rapid Eye Movement (REM) sleep, the brain undergoes essential cognitive restoration, emotional processing, and memory consolidation. This stage is also when most vivid dreaming occurs. Ensuring adequate REM sleep supports mental health, learning capacity, and emotional resilience. Nurses can teach patients about creating a sleep-friendly environment to optimize REM cycles. Strategies to Improve Sleep in Older Adults For older adults struggling with sleep, nurses can recommend practical interventions such as keeping pets out of the bedroom to minimize disturbances, using blackout curtains to reduce light exposure, and maintaining a comfortable bedroom temperature. Additional strategies may include avoiding caffeine late in the day, engaging in light evening stretching, and establishing a consistent bedtime routine. Strategy Purpose Remove pets from bedroom Minimize nighttime awakenings Use dark curtains Improve melatonin production and sleep depth Adjust room temperature Prevent overheating or feeling cold during sleep References American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). Washington, DC: Author. National Institute on Aging. (2022). Caring for a person with dementia. https://www.nia.nih.gov/health/caring-person-dementia NR 226 Quiz 2 Centers for Disease Control and Prevention. (2023). Heart disease facts. https://www.cdc.gov/heartdisease/facts.htm National Sleep Foundation. (2022). Stages of sleep. https://www.thensf.org/stages-of-sleep

Student Name Chamberlain University NR-226: Fundamentals – Patient Care Prof. Name Date Medication Calculation Review  Question 1 The patient has an order for cephalexin (Keflex) 325 mg orally. The medication available is cephalexin 250 mg/2 mL. How many mL will the nurse administer?(If needed, round to the nearest tenth.) Answer and Explanation To determine the correct dosage volume, first identify the concentration of the drug in milligrams per milliliter. Then, divide the ordered dose by that concentration. Step Calculation Result 1 250 mg ÷ 2 mL 125 mg/mL 2 325 mg ÷ 125 mg/mL 2.6 mL Correct Answer: 2.6 mL Clinical Note: Small miscalculations in antibiotic dosing can result in subtherapeutic levels, increasing the risk of resistance. Thus, careful dimensional analysis is critical (Kee et al., 2020). Question 2 The patient has an order for amoxicillin (Amoxil) 2.4 g orally. The medication available is amoxicillin 600 mg/10 mL. How many mL will the nurse administer?(If needed, round to the nearest whole number.) Answer and Explanation Convert the ordered dose into milligrams and then divide by the drug concentration. Step Calculation Result 1 2.4 g × 1000 mg/g 2400 mg 2 600 mg ÷ 10 mL 60 mg/mL 3 2400 mg ÷ 60 mg/mL 40 mL Correct Answer: 40 mL Clinical Note: High-volume oral antibiotics require patient education to ensure complete ingestion for therapeutic effectiveness (Wright, 2019). Question 3 The patient has an order for diphenhydramine HCl (Benadryl) 37.5 mg orally. The medication available is diphenhydramine HCl 12.5 mg/10 mL. How many mL will the nurse administer?(If needed, round to the nearest whole number.) Answer and Explanation Identify the drug concentration and divide the ordered dose by this concentration. Step Calculation Result 1 12.5 mg ÷ 10 mL 1.25 mg/mL 2 37.5 mg ÷ 1.25 mg/mL 30 mL Correct Answer: 30 mL Clinical Note: Large liquid volumes can be challenging for pediatric patients; dividing the dose may improve compliance. Question 4 The patient has an order for potassium chloride (K-Lor) 60 mEq orally. The medication available is potassium chloride 40 mEq/10 mL. How many mL will the nurse administer?(If needed, round to the nearest whole number.) Answer and Explanation Calculate the concentration, then divide the ordered dose by the concentration. Step Calculation Result 1 40 mEq ÷ 10 mL 4 mEq/mL 2 60 mEq ÷ 4 mEq/mL 15 mL Correct Answer: 15 mL Clinical Note: Potassium chloride should always be administered with caution to avoid hyperkalemia, which can be life-threatening (Kee et al., 2020). Question 5 The patient has an order for gabapentin (Neurontin) 275 mg orally. The medication available is gabapentin 250 mg/10 mL. How many mL will the nurse administer?(If needed, round to the nearest whole number.) NR 226 Quiz 1 Answer and Explanation First, find the concentration and then divide the ordered dose by this concentration. Step Calculation Result 1 250 mg ÷ 10 mL 25 mg/mL 2 275 mg ÷ 25 mg/mL 11 mL Correct Answer: 11 mL Clinical Note: Gabapentin dosing must be precise to control neuropathic pain effectively without increasing the risk of dizziness and sedation. Alright — let’s continue from Question 6 and finish all the way through Question 20 in the same style. Question 6 The patient has an order for morphine sulfate (Duramorph) 60 mg orally. The medication available is morphine sulfate 20 mg/10 mL. How many tsp will the nurse administer?(If needed, round to the nearest whole number.) Answer and Explanation Start by converting milligrams to milliliters, then convert milliliters to teaspoons. Step Calculation Result 1 20 mg ÷ 10 mL 2 mg/mL 2 60 mg ÷ 2 mg/mL 30 mL 3 1 tsp = 5 mL → 30 mL ÷ 5 6 tsp Correct Answer: 6 tsp Clinical Note: Large oral morphine doses require monitoring for respiratory depression and sedation, especially in opioid-naïve patients. Question 7 The patient has an order for tolbutamide (Orinase) 0.5 g orally. The medication available is tolbutamide 250 mg/scored tablet. How many tablets will the nurse administer?(If needed, round to the nearest whole number.) Answer and Explanation Convert grams to milligrams, then divide by the per-tablet amount. Step Calculation Result 1 0.5 g × 1000 mg/g 500 mg 2 500 mg ÷ 250 mg/tablet 2 tablets Correct Answer: 2 tablets Clinical Note: Consistent timing of antidiabetic medication in relation to meals helps optimize glucose control. Question 8 The patient has an order for potassium chloride (K-Dur) 50 mEq orally. The medication available is potassium chloride 20 mEq/scored tablet. How many tablets will the nurse administer?(If needed, round to the nearest tenth.) Answer and Explanation Divide the ordered dose by the per-tablet amount. Step Calculation Result 1 50 mEq ÷ 20 mEq/tablet 2.5 tablets Correct Answer: 2.5 tablets Clinical Note: Potassium supplements can cause gastric irritation; advise patients to take them with food or water. Question 9 The patient has an order for metformin (Glucophage) 0.5 g orally. The medication available is metformin 1000 mg/scored tablet. How many tablets will the nurse administer?(If needed, round to the nearest tenth.) Answer and Explanation Convert grams to milligrams and divide by the amount per tablet. Step Calculation Result 1 0.5 g × 1000 mg/g 500 mg 2 500 mg ÷ 1000 mg/tablet 0.5 tablet Correct Answer: 0.5 tablet Clinical Note: Splitting tablets should only be done if the medication is scored and safe to divide. Question 10 The patient has an order for atorvastatin (Lipitor) 50 mg orally. The medication available is atorvastatin 50 mg/tablet. How many tablets will the nurse administer?(If needed, round to the nearest whole number.) Answer and Explanation Since the dose per tablet matches the ordered dose, the calculation is straightforward. Step Calculation Result 1 50 mg ÷ 50 mg/tablet 1 tablet Correct Answer: 1 tablet Clinical Note: Evening dosing of statins is often recommended for optimal cholesterol-lowering effects. Question 11 The patient has an order for digoxin (Lanoxin) 625 mcg orally. The medication available is digoxin 0.25 mg/scored tablet. How many tablets will the nurse administer?(If needed, round to the nearest tenth.)

Student Name Chamberlain University NR-226: Fundamentals – Patient Care Prof. Name Date NR 226 Fundamentals of Nursing – Exam 3 Chapter 21: Managing Care 1. Prioritizing Patient Care Why is prioritizing patient care important?Prioritizing patient care is crucial because it enables nurses to identify the interrelationships between various patient problems, thus preventing delays in necessary interventions. This proactive approach helps avoid potential complications that could negatively affect patient outcomes. Nurses must act swiftly to stabilize conditions and always follow the ABC principle—airway, breathing, and circulation—when determining priority actions. Levels of PriorityPatient needs are generally classified into three categories: Priority Level Description Example High Life-threatening or safety-compromising situations requiring immediate intervention. Obstructed airway, acute respiratory distress. Intermediate Urgent, but not immediately life-threatening; addresses actual or potential health needs. Educating a patient about a new medication, managing post-operative pain. Low Needs not directly related to the illness; often long-term or developmental. Preparing a new patient for discharge teaching. 2. Types of Nursing What are the main nursing care delivery models and their characteristics? 3. Magnet Hospitals What defines a Magnet Hospital?Magnet Hospitals are recognized for nursing excellence, innovation, and high-quality patient outcomes. They foster autonomy, evidence-based practice, and collaborative relationships among staff. Nurses in these institutions have greater control over their practice environment, leading to improved job satisfaction and patient care. 4. Delegation (Including to Medical Assistants and LPNs) How is delegation defined and what are the “Five Rights of Delegation”?Delegation is the process of assigning responsibility for specific tasks while retaining overall accountability for patient outcomes. Before delegating, the nurse should assess the skill level of the individual, clearly communicate expectations, and provide supervision. NR 226 Exam 3 Five Rights of Delegation Right Description Right Task Must be routine, non-invasive, and carry minimal risk. Right Circumstance Appropriate given patient condition and available resources. Right Person Assign to a person with the proper training and competence. Right Direction/Communication Provide clear, specific instructions and maintain open dialogue. Right Supervision/Evaluation Monitor performance, provide feedback, and intervene if necessary. Chapter 24: Communication 1. Communication Techniques for Special Needs What techniques should be used for patients with cognitive, hearing, or vision impairments, or those unable to speak? Patient Condition Communication Strategies Cognitive Impairment Speak in simple sentences, ask one question at a time, allow time for responses, and involve family members in discussions. Hearing Impairment Reduce background noise, gain the patient’s attention before speaking, face them so they can see your lips, speak clearly at a normal volume, and provide interpreters if necessary. Visual Impairment Use a normal tone, avoid glare with indirect lighting, and provide printed materials in large font (14-point or larger). Unable to Speak Listen attentively, be patient, ask yes/no questions, use visual cues or assistive communication devices. 2. Communication Techniques (Parroting, Clarifying, Focusing, Paraphrasing) What are the differences between parroting, clarifying, focusing, and paraphrasing? 3. SBAR (Situation–Background–Assessment–Recommendation) How is SBAR used in nursing communication?SBAR is a structured method for communicating patient information clearly and effectively, especially during handoffs or when reporting significant changes. Component Description Situation State the patient’s name, admitting diagnosis, and the immediate concern. Background Provide relevant medical history, treatments, allergies, and code status. Assessment Share current vital signs, assessment findings, recent labs, pain status, and ongoing treatments. Recommendation Suggest a course of action, further testing, or immediate interventions. 4. Communication Types Type Definition Therapeutic Communication Encourages expression of thoughts and feelings, shows respect, and supports patient well-being. Non-Therapeutic Communication Blocks or hinders communication, discourages expression, and may damage rapport. 5. Zones of Personal Space Zone Distance Examples of Use Intimate 0–18 in Physical assessment, bathing, dressing changes. Personal 18 in–4 ft Bedside conversation, patient history-taking. Social 4–12 ft Teaching a class, family support group. Public 12+ ft Lectures, public speaking. Chapter 50: Care of the Surgical Patient 1. Surgical Classifications What are the main categories of surgical procedures and their purposes? Classification Definition Examples Urgent Needed to preserve health or prevent further problems but not an immediate emergency. Removal of gallbladder with stones, excision of cancerous tumor. Elective Performed by choice; not essential for health. Hernia repair, breast reconstruction. Emergency Must be done immediately to save life or preserve function. Repair of perforated appendix, control of internal bleeding. Major Extensive reconstruction or alteration of body parts; high risk. Coronary artery bypass, colon resection. Minor Minimal alteration; low risk. Tooth extraction, minor cosmetic surgery. Diagnostic Performed to confirm diagnosis. Biopsy, exploratory laparotomy. Ablative Removal of diseased body part. Amputation, cholecystectomy. Palliative Relieves symptoms without curing disease. Colostomy, debridement. Reconstructive/Restorative Restores function or appearance. Scar revision, fracture fixation. Procurement for Transplant Removal of organs from a donor. Kidney transplant. Constructive Corrects congenital defects. Cleft palate repair. Cosmetic Improves appearance. Rhinoplasty, breast augmentation. 2. Malignant Hyperthermia A rare but potentially fatal reaction to certain anesthetic agents, malignant hyperthermia is an inherited disorder. It results in increased CO₂ (hypercarbia), rapid breathing, fast heart rate, abnormal heart rhythms, unstable blood pressure, skin mottling, and muscle rigidity. The condition often occurs during anesthesia induction or with repeated exposures. Continuous temperature monitoring during surgery is vital. 3. Preoperative Care Key actions before surgery include: explaining surgical steps, reviewing the pre-op checklist, assessing physical and mental readiness, reinforcing teaching, establishing IV access (usually 18-gauge), monitoring vital signs, and completing anesthesia assessment. 4. Post-Anesthesia Care PACU nursing priorities include: monitoring vital signs, respiratory and cardiovascular status, peripheral circulation, pain, motor and sensory function, wound condition, temperature regulation, neurological orientation, IV patency, and skin integrity. Nausea, vomiting, and positioning needs are also assessed. 5. Types of Anesthesia Type Purpose Complications Nursing Implications General Produces complete unconsciousness and lack of sensation. Cardiovascular/respiratory depression, liver/kidney damage. Monitor airway, vital signs, and recovery closely. Regional Numbs a specific region without loss of consciousness. Hypotension, respiratory compromise. Monitor BP, respiratory rate, extremity positioning. Local Loss of sensation at targeted site. Motor or autonomic loss. Watch for allergic reactions; assess mobility after. Conscious Sedation Reduces anxiety and pain while keeping patient responsive. Airway obstruction. Monitor ability to maintain airway and respond. 6. Time-Out

Student Name Chamberlain University NR-226: Fundamentals – Patient Care Prof. Name Date Exam #2 J. Lane Study Guide Chapter 14: Assessing and Communicating With Older Adults Required when interviewing the older adult When communicating with older adults, nurses must avoid rushing the interaction. This population often needs additional time to organize their thoughts and recall information. Allowing moments of silence and demonstrating patience fosters trust and enhances accuracy of responses. Where to interview the older patient with a hearing impairment The ideal setting for interviewing an older adult with hearing difficulties is one-on-one in a quiet, private room. This minimizes background noise and distractions, enabling the patient to concentrate on the conversation. Where should the nurse sit when interviewing a patient with visual impairments? For patients with vision loss, the nurse should position themselves at eye level and directly facing the patient. This allows the patient to localize the speaker’s voice and read non-verbal cues such as facial expressions or lip movement. SPICES Framework for Older Adult Assessment The SPICES tool is used to identify common geriatric syndromes that can indicate the need for further assessment or intervention. SPICES Category Description Sleep disorders Difficulty initiating or maintaining sleep Problems with eating/feeding Poor appetite, swallowing difficulties, or unintentional weight loss Incontinence Loss of bladder or bowel control Confusion New or worsening cognitive changes Evidence of falls History or physical signs of falling Skin breakdown Pressure injuries, ulcers, or fragile skin Common Physiological Changes in Older Adults Aging is associated with predictable physical changes, many of which increase vulnerability to illness or injury. These include: Cognitive and Mental Status Changes Term Definition Delirium Sudden onset of confusion, often reversible, linked to an underlying cause Dementia Progressive and irreversible decline in cognitive function affecting daily life Depression Mood disorder that may occur following major life changes Key distinctions: Elder Abuse Definition: Any deliberate action or neglect that results in harm, injury, or distress to an older adult.Forms include physical abuse, emotional abuse, neglect, financial exploitation, and sexual abuse. Therapeutic Approaches in Geriatric Care Common Spinal Curvatures Condition Description Kyphosis Forward rounding of the upper back Scoliosis Lateral curvature of the spine in an “S” shape Lordosis Excessive inward curvature of the lower back Chapter 36: Loss, Grief, and End-of-Life Care Definitions and Key Concepts Emotion in response to significant loss Grief is the emotional suffering experienced after the loss of someone or something meaningful. It involves deep sadness, yearning, and a sense of emptiness. Outward social expressions of grief associated with loss Mourning refers to the public and cultural expression of grief, which may include rituals, ceremonies, and specific mourning behaviors based on cultural norms. Grief and mourning together Bereavement encompasses both the internal grief process and the external expressions of loss. It includes emotional, behavioral, and social responses. NR 226 Exam 2 Types of Grief Type of Grief Description Example Normal (uncomplicated) Natural and expected response to loss; may involve sadness, anger, and eventual adaptation Loss of a grandparent after a long illness Anticipatory Grief experienced before the actual death or loss Knowing a loved one is in the final stages of terminal illness Disenfranchised Grief that cannot be openly acknowledged or socially validated Death of a secret partner or extramarital affair Ambiguous Loss where the person is physically present but psychologically absent, or vice versa Dementia, prisoner of war, missing persons Complicated Intense and prolonged grief interfering with daily functioning Loss of a child or death from violent events Chronic Persistent grief lasting years to decades Still grieving a spouse 20 years after death Exaggerated Grief with self-destructive or obsessive behaviors Depression leading to suicidal ideation after a loss Delayed Suppression of grief with later overwhelming emotional response Experiencing grief years later when triggered by a related event Stages of Dying (Kübler-Ross Model) Palliative and Hospice Care Aspect Palliative Care Hospice Care Focus Relief of symptoms and improvement of quality of life for patients with serious illness Comfort and dignity for patients in the final stages of life Timing Can be initiated at any stage of illness Provided when life expectancy is ≤ 6 months Goal Enhance life quality, manage pain, and address emotional/spiritual needs Comfort-focused care without curative intent Death Timeline Not intended to hasten or delay death Accepts death as a natural process Chapter 43: Sleep and Rest Sleep Cycles Note: Dreaming occurs in both NREM and REM phases, though REM dreams are often more vivid. Common Sleep Disorders and Considerations Condition Description Nocturia Frequent urination during the night Insomnia Difficulty falling asleep, staying asleep, or obtaining restorative sleep Sleep apnea Breathing repeatedly stops and starts during sleep Narcolepsy Sudden, uncontrollable episodes of sleep during waking hours; often with daytime sleepiness Tip for respiratory patients: Elevating the head with pillows or sleeping in a reclined chair can reduce nighttime breathing difficulty. Chapter 44: Pain Management Types of Pain Pain Type Description Acute pain Sudden onset, identifiable cause, short duration Chronic pain Persists for months or years, often without full resolution Episodic pain Reoccurs intermittently over an extended period Cancer pain Related to tumor growth, treatment, or infection Referred pain Felt in an area away from the source of injury Idiopathic pain Persistent pain without a clear cause Nociceptive pain Caused by activation of pain receptors in peripheral tissues Neuropathic pain Caused by damage or disease affecting the somatosensory nervous system Pain Assessment and Management ABC Pain Management in Home Care:Ask about pain, Believe the patient, Choose the best intervention, Deliver interventions promptly, Empower patients and families. Chapter 42: Fluid and Electrolyte Balance Tonicity of Solutions Tonicity describes the concentration of solutes in a fluid relative to plasma, which affects water movement across cell membranes. Solution Type Description Effect on Cells Examples Hypotonic Lower solute concentration than plasma Water moves into cells → cells swell ½ NS, D2.5W Isotonic Equal solute concentration as plasma No net water movement NS (0.9% NaCl), D5W, LR Hypertonic Higher solute concentration than plasma Water moves out of cells → cells shrink D10W, 3% NS, D5NS Clinical Uses of Solutions Condition Solution Type Rationale Blood loss

Student Name Chamberlain University NR-226: Fundamentals – Patient Care Prof. Name Date NR 226 – Exam 1 Comprehensive Review Clinical Judgment and Clinical Decision-Making Clinical judgment refers to the process of interpreting and making conclusions about a patient’s needs, determining the appropriate interventions, and evaluating the outcomes. It is rooted in critical thinking, experience, and patient-centered care. Clinical decision-making involves establishing and weighing criteria to determine the most appropriate therapeutic approach for a specific patient. This includes the ability to: The Nursing Process The nursing process serves as the universal, systematic method for organizing and delivering care in nursing practice. It ensures the delivery of personalized, evidence-based care as part of an interdisciplinary healthcare team. NR 226 Exam 1 Step Description Clinical Focus Assessment Systematic collection of subjective and objective data Patient interview, history, physical exam Diagnosis Interpretation of data to identify health problems or risks NANDA-I classification Planning Development of patient-centered goals and interventions SMART goal format Implementation Execution of planned interventions Direct and indirect care Evaluation Determining effectiveness of interventions Modify or continue plan as needed ADPIE Overview Six Functions of Clinical Judgment Assessment Q: What is subjective data?A: Subjective data refers to information the patient reports about their health, such as pain, fatigue, or emotional distress, gathered through interviews. Q: What is objective data?A: Objective data consists of measurable, observable findings obtained through physical examination techniques such as inspection, palpation, percussion, auscultation, or diagnostic testing. Keywords indicating assessment is needed: ascertain, assess, check, collect, determine, find out, identify, monitor, observe, obtain information, recognize. Nursing Diagnosis A nursing diagnosis is a clinical judgment concerning a human response to health conditions or life processes. It is based on the careful interpretation of assessment data and directs the selection of nursing interventions to achieve outcomes. Diagnostic Label – Nursing Diagnosis Q: What is a nursing diagnosis based on?A: It is based on the selection of cues from assessment findings and analysis of how those cues relate to the patient’s clinical presentation. Types of Nursing Problems Type Components Example Actual Problem Diagnostic label + related-to statement + defining characteristics Impaired physical mobility related to decreased muscle control as evidenced by inability to control lower extremities Potential Problem (Risk For) Diagnostic label + risk factors Risk for infection related to compromised host defenses Health Promotion Diagnostic label only Readiness for enhanced resilience Three-Part Nursing Diagnosis (PES Format) Component Definition Example P – Problem NANDA-I nursing diagnosis label Impaired physical mobility E – Etiology Related-to cause or contributing factor Related to decreased muscle control S – Symptoms Defining characteristics As evidenced by inability to control lower extremities Health Promotion The role of the nurse extends beyond illness management to health promotion—helping patients enhance well-being through activities like exercise, nutrition counseling, smoking cessation, and preventive screening. Planning Planning transforms diagnoses into actionable goals and interventions. Goals are broad statements of desired improvement, while outcomes are specific, measurable indicators of progress. SMART Goal Criteria SMART Element Nursing Example Specific Patient will walk 50 feet using a walker Measurable Nurse will measure and record walking distance Attainable Within the patient’s physical limits Realistic Considers current energy and mobility Time-bound Within 3 days of initiating mobility plan Types of Interventions Type Definition Examples Nurse-Initiated (Independent) Actions performed without provider orders Health teaching, ADL assistance Provider-Initiated (Dependent) Requires provider orders Administering medications, pre-op prep Collaborative (Interdependent) Involves multidisciplinary coordination Rehab with PT/OT Implementation Implementation is the active phase of nursing, beginning after the care plan is complete. It involves both direct care (e.g., wound care, patient counseling) and indirect care (e.g., documentation, delegating tasks, infection prevention). Selecting Interventions: Evaluation Evaluation determines whether nursing care achieved desired patient outcomes. Q: Was the goal attained? Revising the Plan of Care The nurse revises the care plan when: Managing Patient Care Priority Setting Nurses prioritize based on urgency using Maslow’s Hierarchy and clinical judgment: Priority Level Examples First-Level Airway, breathing, circulation, vital signs, life-threatening lab values Second-Level Acute pain, changes in mental status, elimination problems Third-Level Long-term management, rest, family coping Organizational Skills Delegation Delegation is assigning specific tasks to qualified individuals while retaining accountability. Five Rights of Delegation: Illinois Standards of Delegation Task RN LPN UAP Admission assessment ✓     Ambulation ✓ ✓ ✓ Foley catheter insertion ✓ ✓   Discharge teaching ✓     Vital signs (stable patient) ✓ ✓ ✓ Oral medications ✓ ✓   Bed bath ✓ ✓ ✓ Ethical and Legal Responsibilities ANA Code of Ethics Guides nurses in ethical decision-making, emphasizing: Principles of Healthcare Ethics Resolving Ethical Dilemmas Steps: Legal Concerns Aging and Older Adult Care Common Physiological Changes System Age-Related Changes Integumentary Skin thinning, loss of elasticity, gray hair Cardiovascular Decreased cardiac output, stiffened vessels Musculoskeletal Decreased muscle mass, bone loss Neurological Slower nerve conduction, reduced reflexes Sensory Presbyopia, presbycusis, reduced taste/smell Cognitive Impairment Older Adults in Acute Care Risks: infection, delirium, falls, incontinence, malnutrition, skin breakdown.Prevention: frequent orientation, fall precautions, proper nutrition, repositioning. End-of-Life Care Hospice vs. Palliative Care Hospice Palliative Life expectancy ≤ 6 months Can be at any stage of illness Focus on comfort, not cure Focus on quality of life No curative treatments May continue treatments Physical Changes Before Death Grief and Bereavement Kübler-Ross Stages: References American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA. Berman, A., Snyder, S., & Frandsen, G. (2021). Kozier & Erb’s fundamentals of nursing (11th ed.). Pearson. NR 226 Exam 1 National Council of State Boards of Nursing. (2019). Clinical Judgment Measurement Model. NCSBN. Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2023). Fundamentals of nursing (11th ed.). Elsevier.

Student Name Chamberlain University NR-226: Fundamentals – Patient Care Prof. Name Date Assessment General Appearance The patient is a well-nourished, well-developed 55-year-old male who appears consistent with his stated age. He demonstrates no signs of acute distress during observation. Vital Signs The patient’s vital signs are summarized in Table 1. While most parameters remain within normal limits, the blood pressure reading of 139/97 mm Hg is elevated, indicating ongoing hypertension that requires monitoring and management. Table 1Vital Signs Parameter Measurement Interpretation Blood pressure 139/97 mm Hg Hypertensive (Stage 2 diastolic) Pulse 79 bpm Within normal range Respirations 18 breaths/min Normal respiratory rate Oxygen saturation (O₂) 100% room air Optimal oxygenation Temperature (oral) 97.3°F Normothermic Neurological Assessment The patient is alert and oriented to person, place, time, and situation (A&O ×4). Mild left facial drooping is present. Motor examination reveals weakness in the left upper and lower extremities, consistent with the patient’s history of cerebrovascular accident (CVA). HEENT (Head, Eyes, Ears, Nose, Throat) Cardiovascular System The patient demonstrates a regular rate and rhythm with normal S1 and S2 heart sounds. No murmurs are auscultated. Respiratory System Breath sounds are clear bilaterally without adventitious sounds. Respirations are non-labored, and no accessory muscle use is observed. Gastrointestinal System Bowel sounds are present in all four quadrants. The abdomen is symmetrical, non-tender, and without masses or distention. Last bowel movement was on 1/30/2024. Genitourinary System Urination is normal with no dysuria or frequency. Urine is yellow in color, and there are no signs of incontinence. Integumentary System Skin is clean, dry, and intact without rashes, lesions, or pressure ulcers. Musculoskeletal System Weakness is observed in the left upper and lower extremities. The patient requires assistance from one person for positional changes, transfers, and ambulation with a rolling walker. Psychosocial History The patient is a Christian pastor, divorced, and father to six children. He recently relocated from New Jersey to North Carolina. Laboratory and Diagnostic Findings Laboratory results are within normal limits (Table 2), with no acute metabolic derangements. Table 2Laboratory Results Test Value Reference Range Interpretation WBC 5.22 4.0–11.0 ×10³/µL Normal RBC 5.72 4.5–5.9 ×10⁶/µL Normal Hgb 16.5 13.5–17.5 g/dL Normal Hct 49 41–53% Normal Plt 215 150–450 ×10³/µL Normal Glu 92 70–99 mg/dL Normal BUN 9 7–20 mg/dL Normal Na 138 135–145 mmol/L Normal K 3.8 3.5–5.0 mmol/L Normal Cl 103 96–106 mmol/L Normal Creat 1.13 0.6–1.3 mg/dL Normal Ca 9.9 8.5–10.2 mg/dL Normal Pathophysiology The patient is a 55-year-old male with a medical history of hypertension, transient ischemic attacks (TIAs), and dyslipidemia. Recently, he discontinued his antihypertensive therapy for two weeks under his primary care provider’s guidance in an attempt to manage his blood pressure through diet and holistic measures. While exercising, he developed sudden left-sided weakness. Imaging revealed a right pontine infarct, resulting in contralateral (left-sided) motor deficits and facial drooping. The likely etiology of this cerebrovascular accident was uncontrolled hypertension, with reported systolic readings exceeding 200 mm Hg in the emergency setting. The patient’s history of recurrent TIAs further compounded his stroke risk. Post-event, he has residual left-sided weakness, gait instability, and facial drooping, placing him at high risk for falls. NR 226 RUA Fundamentals Patient Care Pertinent Medical Diagnoses and NANDA Priorities Table 3Primary and Psychosocial NANDA Diagnoses, Goals, and Interventions NANDA Diagnosis Short-Term Goals Long-Term Goals Short-Term Interventions Long-Term Interventions Impaired Physical Mobility Patient can shower without assistance within 2 weeks Patient performs physical activities independently by discharge 1. Use gait belt, wheelchair, and walker for mobility.2. Bed/chair alarms.3. Reposition every 2 hours. 1. Encourage proper nutrition and hydration.2. Active range-of-motion (ROM) exercises.3. Maintain safe environment. Ineffective Tissue Perfusion Maintain healthy blood pressure until discharge Prevent recurrent stroke for at least 1 year 1. Blood pressure control via medications.2. Physical/occupational therapy.3. Anticoagulant therapy as indicated. 1. Medication adherence.2. Heart-healthy, low-cholesterol diet.3. Guided mental practice exercises. Impaired Social Interaction Patient expresses desire to interact socially within 2 weeks Patient engages in group activities within 1 month of discharge 1. Encourage support group participation.2. Practice social skills.3. Provide stimulating environment. 1. Referral to therapy.2. Enhance coping skills.3. Facilitate ongoing socialization. Rationale for Goals These goals follow the SMART framework—specific, measurable, attainable, relevant, and time-bound (Shen, 2023). Short-term mobility goals (e.g., independent showering) foster confidence and promote self-efficacy, while long-term mobility goals target independence and safety. Blood pressure control and stroke prevention goals are vital in reducing recurrent events. Psychosocial goals address the patient’s isolation following relocation, mitigating depression risk and promoting reintegration into the community (Nursing Diagnosis, 2023). Infection Control Standard precautions were adhered to, including hand hygiene, glove use when indicated, mask use as required, and disinfection of high-contact surfaces. These measures were maintained as the patient was not on isolation protocols. Safety Considerations Due to left-sided weakness, the patient was considered a high fall risk. Safety strategies included one-person assist for mobility, the use of a rolling walker and wheelchair, and activation of bed and chair alarms to prevent unassisted ambulation. Communication Strategies Patient care involved active listening, maintaining eye contact, using empathetic language, and employing open-ended questions to encourage dialogue. Trust-building was prioritized to foster a therapeutic nurse-patient relationship. References Nursing diagnosis impaired social interaction. (2023, February 28). Nursing Diagnosis. https://nandadiagnoses.com/impaired-socialinteraction/ NR 226 RUA Fundamentals Patient Care Shen, R. (2023, October 22). 13 smart goals examples for stroke patients. Success in Depth. https://successindepth.com/smart-goals-for-stroke-patients/