chapter 17
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| Once a nurse assesses a client's conditon and identifyies appropriate nursing diagnosis | plan is developed for nursing care
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| Planning is a category of nursing that involves: | Client -centered goals and expected outcomes are established
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| Priorities are establised to help the nurse anticipate and sequence nursing interventions when a clent has multiple problems or alerations. Priorities are determented by the client's: | Urgency of problems
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| A client-centered goals is a specific and measurable behavior or response that reflects a client's | Highest possible level of wellness and independence in function
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| For client's to participate in goal settings, they should be | Alert and have some degree of independence
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| The nurse writes an expected outcome statement in measurable terms. An example is: | client will report pain accuity less than 4 on a scale of 0-10
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| As goals, outcomes and interventions are developed the nurse must | Be aware of and committed to acceptable standards of practice from nursingand other disciplines
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| When establishing realistic goals the nurse: | Knows the resources of the health care facility family and client
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| To initate an intervention the nurse must be completent in three areas, which include | knowledge, function, and specific skills
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| Collaborative interventions are therapries that require | Multiple health care professionals
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| Client-centered goals | is a specific and measurable behavior or response that reflects a client's higher possible level of wellness and independence in function
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| Callaboration | the nurse taps the best resources to individualize nursing interventions
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| Nurse initated interventions | are the independent response of the nurse to the clent's health care needs and nursing diagnosis.
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| Nursing care plan | is a guide for clinical care. It also serves as a document that communcates a client's nursing care to all member of the health care team
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| Physician initated interventions | are based on a physician's response to treat or mange a medical diagnosis.
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| planning | is a category of nursing behaviors in which clent -centerd goals and expected outcomes are establised and nursing interventions are selected
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| Scientific rationale | is the reason that, based on supporting literature, a specific nursing action was chosen
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| Short term goal | is an objective that is expected to be achieved within a short time frame, usually less than a week
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| Well-formulated, client centered goal should | Meet immediate client needs. Include preventative health care needs. Include rehabillitaion needs.
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| The following statement appears on the nursing care plan for an immunosuppressed client: The client will remain free frim infection throughout hospitalization. This statement is an example of a | Short -term goal
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| The following statements appear on a nursing care plan for a clentafter a mastectomy: Incision site approximated; absence of drainage or prolonge erythema at incison site; and clent remains afebrile. These statements are example of | Expected outcome
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| The planning step of the nursing process includes which of the following activities? | Setting goals and selecting interventions
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