Medical Surgical Nursing – Chapter 1: Critical Thinking and the Nursing Process

Appraisal or evaluation of a patient’s condition.

This is where the medical team work together; the nurse, physician, and other health care members.

Critical thinking
Use of knowledge and skills to make the best decisions possible in client care situations.

A group of facts or statistics

The judgment of anything.

Evidence-based practice
When nursing care is based on good, well-designed research studies. Nurses no longer massage a patients’ reddening bony prominences to prevnt pressure ulcers. Through research, we now know that this practice should be avoided because it can further harm the damaged tissue.

Intervention (actions)
One or more actions taken in order to modify an effect.

Nursing diagnosis
A standardized label placed on a patient’s problem to make it understandable to all nurses.

Nursing process
An orderly, logical approach to administering nursing care so that the patient’s needs for such care are met comprehensively and effectively.

Objective data
FACTUAL DATA obtained through physical examination and diagnostic tests; objective data are observable or knowable through the five senses.

Subjective data
Information that is given verbally by the patient.

Watchfulness: the condition of being watchful and alert, especially to danger

Why is critical thinking important in nursing?
Critical thinking involves reasoning, reflection, common sense, problem solving, analysis and inquiry. All these skills along with a nurse’s knowledge will help make the best decisions possible in patient care situations.

What attitudes and skills promote good critical thinking?
Intellectual Humility;
Intellectual Courage;
Intellectual Empathy;
Intellectual Integrity;
Intellectual Perseverance;
Faith in Reason; and
Intellectual Sense of Justice.

What occurs in each step of the nursing process?
Gather data;
Identify the problem;
Decide what outcome is desirable;
Plan what to do;
Implement the plan of care; and
Evaluate the plan of care.

What are objective and subjective data?
OBJECTIVE DATA (aka: “signs”) are pieces of factual information obtained through physical assessment and diagnostic tests that are observable through the five senses. Examples: 3-cm red lesion or respiratory rate 36/min

SUBJECTIVE DATA are pieces of data provided verbally by the patient. It is documented normally in quotes (ex: “I feel out of breath” or “I have a headache”)

What is the best way to document objective and subjective data?
When recording OBJECTIVE data, include exactly what you observed and avoid any interpretation or vague meanings. (ex: “Capillary refill in 2-seconds.” is better than “Capillary refill is good.”)

When recording SUBJECTIVE data use direct quotations as much as possible. Quotes accurately represent the patient’s view and are least open to interpretation.

How would you prioritize patient care based on Maslow’s hierarchy of human needs?
According to Maslow, humans must meet their most basic needs first, then they can move up the hierarchy to meet higher level needs. Therefore, physiological needs are the most basic. For example: a person is short of breath cannot attend to higher level needs because the physiological need for oxygen is not being met. Once physiological needs are met, the patent can concentrate on meeting safety and security needs. Love, belonging, and self-esteem needs are nest: self-actualization needs are generally the last priority when planning care.

Intellectual Humility
A nurse that does NOT “know it all” and is able to embrace to unknown and have the ability to say, “I’m not sure about that…I need more information.”

Intellectual Courage
Intellectual courage allows you to look at other points of view even when you do not agree with them at first. Perhaps you’re an 8-hour nurse and disagree with the argument that a 12-hour nurse…the ability to listen and perhaps even be convince of the argument made.

Intellectual Empathy
The ability to think, “If I were here in chronic pain such as this patient is, how would I feel” and respond appropriately.

Intellectual Integrity
A nurse with intellectual integrity would want the same level of proof applied to both herbal remedies that a patient is taking, as well as their prescribed medications, to best determine if the herbal remedies are safe and effective before using them.

Intellectual Perseverance
A nurse with intellectual perseverance does not give up. You notice side-effects of a new drug prescribed to a patient. The doctor says not to worry about it, but your concern continues. You do some research and share you proofs with you supervisor and pharmacist to discuss your concerns.

Faith in Reason
If a nurse has faith in reason, you believe in yoru heart that good thinking, and reason, will result in the best outcomes for your patients.

Intellectual Sense of Justice
Make sure the decisions you make are best for the patient and not for your, the nurse’s needs. For example: a coworker would rather administer medications around his/her break schedule rather than the medication schedule.

Maslow's Hierarchy of Human Need
Maslow’s Hierarchy of Human Need

WHATSUP: Guide to Symptom Assessment
W – Where it is?
H – How does it feel? Describe the quality.
A – Aggravating the alleviating factors. What makes it worse? What makes it better?
T – Timing. When did it start? How long does it last?
S – Severity. How bad is it? This can often be rated on a scale of 0 – 10
U – Useful other data. What other symptoms are present that might be related?
P – Patient’s perception of the problem. The patient often has an idea about what the problem is, or the cause, but may not believe that his or her thoughts are important to share unless specifically asked.

In which of the following ways is critical thinking useful to the nursing process?
a. It highlights the obvious solution to the problem?
b. It can lead to a better outcome for the patient.
c. It simplifies the process.
d. It helps the nurse arrive at a solution more quickly.
b. It can lead to a better outcome for the patient.

Critical thinking is use of cognitive skills or strategies that increase the probability of a desirable outcome.

Which nurse is exhibiting intellectual humility?
a. The nurse who is an expert at wounds care.
b. The nurse who reports an error to the supervisor.
c. The nurse who tries to empathize with the patient.
d. The nurse who asks a coworker about a new procedure.
d. The nurse who asks a coworker about a new procedure.

Asking a question shows humility. The nurse does not “know it all.”

Which of the following pieces of information is considered objective data?
a. The patient’s respiratory rate is 28,.
b. The patient states, “I fell short of breath.”
c. The patient is short of breath.
d. The patient is feeling panicky.
a. The patent’s respiratory rate is 28.

A respiratory rate of 28 is observable (measurable/fact). Selections b, c, and d are patient perceptions.

An LPN is collecting data on a newly admitted patient who has an ulcerated area on his left hip. It is 2-inches in diameter and 1-inch deep, with yellow exudate. Which of the following statements best documents the findings in the patient’s database?
d. Wound on left hip, 20inches in diameter, 1-inch deep, yellow exudate

Selections a, b, and c all include the nurse’s perceptions.

A 34-year old mother of three children is admitted to a respiratory unity with pneumonia. Based on Maslow’s hierarchy of needs, which of the following patient problems should the nurse address first?
a. Frontal headache from stress of hospital admission.
b. Anxiety related to concern about leving children.
c. Shortness of breath from newly diagnosed pneumonia.
d. efficient knowledge about treatment plan.
c. Shortness of breath from newly diagnosed pneumonia

Shortness of breath is a physiological need and should be addressed first.





According to the American Nurses Association, how is nursing defined? Pg. 78 “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and …

Actual nursing diagnosis Statement describing human responses that have been validated by the nurse. Assessment First step of the nursing process; the orderly collection of objective and subjective data on the patient’s health status. WE WILL WRITE A CUSTOM ESSAY …

What is the nursing process? Systematic, problem solving approach to providing nursing care in an organized, scientific matter Why is the nursing process used? To explore patient’s health status, identify actual or potential health care problems, determine desired outcomes, deliver …

Is a way of thinking and acting based on the scientific method: nursing process The nursing process is a way of thinking and acting based on: scientific method WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR …

Critical thinker Raises questions/problems and formulates them clearly and precisely ◦Gathers and assesses relevant information ◦Arrives at conclusions and solutions that are well-reasoned and tests them against relevant standards ◦Is open-minded and recognizes alternative views ◦Communicates effectively about solutions to …

Critical thinking Directed, purposeful mental activity by which ideas are created and evaluated, plans are constructed, and desired outcomes ate are decided Outcomes Result of actions WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR …

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