Chapter 16: Outcome Identification and Planning

The nurse, in collaboration with the pt's family, is assigning priorities related to the care of the pt. The nurse explains that when setting priorities it is important to look at the urgency of specific problems. What provides the best framework for prioritizing pt problems? A. Maslows hierarchy of needs B. family member statements C. nursing skill D. availability of hospital resources

A.

Which statement correctly describes a nurse-initiated intervention? A. nurse-initiated interventions are actions performed to diagnoses medical problem B. nurse-initiated interventions are derived from a nursing diagnosis C. nurse-initiated interventions require a physicians order D. nurse-initiated interventions are actions deemed to have a low risk of harm to the pt

B.

Nurse-initiated intervention

actions performed by a nurse without a physician's order

Types of institutionalized plans of care

computerized, concept maps, change of shift reports, multidisciplinary, and student care plans

Clinical outcomes

describe the expected status of health issues at certain points in time after treatment is complete. They address whether the problems are resolved or to what degree they are improved

Goals of outcome identification and planning step

establish priorities, identify and write expected pt outcomes, select evidence based nursing interventions, and communicate the care plan

Common errors in writing pt outcomes

expressing outcome as nursing intervention, using verbs that are not observable or measurable, including more than one pt behavior or manifestation in short-term outcomes, writing vague outcomes

A formal care plan allows the nurse to:

individuals care that maximizes outcome achievement, set priories, facilitate communication, promote high quality cost effective care, evaluate pt response to nursing care, create a record used for evolution and research, and promoting the nurses professional development

3 elements of comprehensive planning

initial, ongoing, and discharge

Short term outcomes

may be accomplished in a specified period of time

Long-term outcomes

require a longer period to be achieved and may be used as discharge goals

IOM's Six Aims to be Met by Health Care Systems Regarding Quality of Care

safe:avoiding injury, effective: avoiding over and underuse, pt centered: responding to pt preferences needs and values, timely: reducing waits and delays. efficient: avoiding wasting, and equitable: providing care that does not vary in quality to all recipients

Collaborative interventions

treatments initiated by other provers and carried out by a nurse

The nurse is writing outcomes that are measurable for a pt. What verbs will the nurse use in order to write these outcomes? (select all that apply) A. verbalize B. define C. feet D. know E. hear

A and B Rationale: the verb should indicate the action to be performed. examples include define, prepare, identity, list, design, verbalize, describe, choose, explain, select, apply, and demonstrate.

The nurse is caring for a 48 year-old-male pt with a new colostomy. Which pt goal for Mr. Connor is written correctly? A. Mr. Connor will be able to care for stoma and cope with psychological loss by 29MAR2015 B. Explain to Mr. Connor the proper care of the stoma by 29MAR2015 C. Mr. Connor will demonstrate proper care of stoma by 29MAR2015 D. Mr. Connor will know how to care for his stoma by 29MAR2015

C.

The nurse recognizes that identifying outcomes/goals must include: A. involvement of the nurse manager and other staff nurses B. input from the physician C. involvement of the pt and family D. input from the interdisciplinary team

C. Rationale: the more involved the pt and the family, the greater the probability the goals will be achieved.

Functional outcomes

describe the person's ability to function in relation to the desired usual activities

Affective outcome

describes changes in pt values, beliefs, and attitudes

Psychomotor outcomes

describes pt's achievements of new skills (teaching a new skill, learning to walk after spinal injury)

Which of the following is a correctly written nursing intervention? (select all that apply) A. provide opportunities for the pt to express concerns and verbalize feelings B. reposition the pt from the side to side every hour around the clock C. know the signs and symptoms of infection D. provide 5 to 6 small meals daily E. understand the side effects of furosemide

A, B, and D Rationale: nursing interventions are nurse centered, action Oriente, and describe specifically what the nurse is doing (how, when, where, how often, how long, or how much). providing 5-6 small meals, and providing opportunities for expression of concerns are correctly written interventions. Understand and know are vague and are not action oriented. It is unclear who is to perform these actions. Medication side effects and signs/symptoms of infection represent content that the nurse should know and teach to pt's.

What is true of nursing responsibilities with regard to a physician-initiated intervention (physician's order)? A. nurses do carry out interventions in response to a physicians order B. nurses are responsible for reminding physicians to implement orders C. nurses are not legally responsible for these interventions D. nurses do not carry out physician-initiated interventions

A. Rationale: a physician initiated intervention is initiated in response to a medical diagnosis, but carried out by a nurse in response to a medical diagnosis, but carried out by a nurse to a doctors order. Both the physician and nurses are legally responsible for these interventions.

The nursing student asks the nurse for guidance in selecting nursing interventions for the client's plan of care. Which response by the nurse would be inappropriate? A. nursing interventions are pretty much the same for pts that have the same medical diagnosis B. nursing intervention should be consistent with standards of nursing care and research findings C. nursing interventions are selected based on the etiology in the nursing diagnosis and must be compatible with other therapists planned for the pt D. the pt's developmental level, values, beliefs, and cultural and psychosocial background should be considered when selecting nursing interventions

A. Rationale: nursing interventions should be based on the etiology in the nursing diagnosis, be compatible with other planned therapies, be consistent with standards of care and research and individualized for the pt.

The nursing student asks the nurse about nurse-initiated and phsyican-initiated interventions. Which of the following is a nurse-initiated intervention? A. teach pt how to splint abdominal incision when coughing and deep breathing B. administer a 1000ml soap suds enema C. administer morphine sulfate 2mg IV push every 3 hours as needed for pain D. adminstier oxygen 4 L/min per nasal cannula

A. Rationale: nursing related interventions, like teaching do not require a physicians order, giving all of these other mediations does require their order

An older adult female has been admitted to the hospital for the treatment of exacerbation of COPD. Which statement constitutes a long-term outcome? A. the pt will return home able to conduct her activities of daily living (ADLs) without experiencing shortness of breath B. the pt will express an understanding of strategies for managing fatigue and shortness of breath C. the pt will demonstrate the correct use of her metered dose inhaler (MDI) D. the pt will ambulate 100 ft without supplementary oxygen or mobility aids

A. Rationale: resumption of ADLs in the home setting is a characteristic of a long term outcome. Explaining energy conservation techniques, mobilizing in the hospital, and demonstrating correct medication administration are short-term outcomes that may be accomplished prior to discharge.

The nurse is prioritizing the pt's nursing diagnoses. Which nursing diagnosis has priority? A. ineffective airway clearance related to retention of secretions B. disturbed sleep pattern related to abdominal incision pain C. self care deficit bathing related to joint inflammation D. constipation related to decreased fluid intake and decreased mobility

A. Rationale: this diagnosis poses the greatest threat to the pts wellbeing and should be addressed by the nurse first. The priority is to airway, breathing, and circulation before any other body system

A nurse writes down the following outcome for a depressed client: "By 6/9/12, the client will state three positive benefits of receiving counseling." This is an example of which of the following types of outcomes? A. affective B. cognitive C. realistic D. psychomotor

A. affective Rationale: affective outcomes describe changes in pt values, beliefs, and attitudes. Psychomotor outcome describe the pt's achievement of new skills. Cognitive outcomes describe increases in pt knowledge or intellectual behaviors. Realistic is not a temp to define outcomes, even though outcomes should be realistic.

A pt is unconscious and unable to provide input into outcome identification. With which group of individuals should the nurse consult for the formulation of goals and measurable outcomes? A. pharmacists B. family C. physical therapists D. occupational therapists

B. family Rationale: the family is aware of the pt's past experiences and accomplishments. Thus, the nurse should allow for the involvement of support people, particularly family.

Although each care plan is individualized, there are certain risks and health problems that pts undergoing similar medical or surgical treatment have in common. What name is given to this type of care plan? A. initial B. standardized C. ongoing D. discharge

B. standardized Rationale: standardized care plans identify the nursing diagnosis, outcomes, and related nursing interventions common to a specific population or health problem

Consider the following statement, "The pt ambulated with the assistance of a cane without incident during his PT session." Which part of the outcome criteria does the portion in italics represent? A. criteria B. verb (action) C. condition D. Who

B. verb (action) Rationale: the action is one of the essential pieces of nursing outcome criteria statement

A nurse administers an antihypertensive med according to the standardized plan of care for a pt admitted with uncontrolled hypertension. Which assessment info indicates the expected pt outcome has been met within the first 24 hours? A. pt is drowsy after lunch B. pt reports no headache C. pt is normal tensive D. pts lipids are within range

C.

A nurse is using a standardized plan of care for a pt. Which action would be most important for the nurse to do? A. expect to modify the plan significantly B. include the rationale for the interventions C. individualize the plan to the pt D. identity the appropriate nursing diagnoses

C.

The expected outcome for a pt with a new diagnosis of diabetes mellitus is: "pt will describe appropriate actions when implementing the prescribed medication routine." Which statement by the pt indicates the outcome expectation has been met? A. I will take my meds between meals for maximum effect. B. I will take insulin until my blood sugar levels are normal C. I will test my glucose level before meals and use sliding scale insulin. D. I will mix insulin glargine with insulin lisper at bedtime.

C.

The nurse has identified the following outcomes for the pt: The pt will have a soft formed stool. Which error has the nurse made in writing the outcome? A. the nurse has admitted defining characteristics B. the nurse has not made any error in writing the outcome C. the nurse has omitted the time frame D. the outcome should initiate what the nurse would do

C. Rationale: outcomes are client centered, use action verbs, identify measurable criteria, and include a time fame for when the outcome should be achieved

When planning nursing interventions, the nurse must review the etiology of the problem statement. The etiology: A. identities the unhealthy response preventing desired change B. identifies pt strengths C. identifies factors causing undesirable response and preventing desired change D. suggests pt goals to promote desired change

C. Rationale: the cause of the pt health problem is referred to as etiology. The problem statement of the nursing diagnosis suggests the pt goals, and cause of the problem (etiology) suggests the nursing interventions. Identifying the unhealthy response preventing desired interventions. Identifying the unhealthy response preventing desired change would occur during the evaluation phase of the nursing process. Pt strengths are identified during the nursing diagnosis phase.

In planning the care of a client who has been diagnosed with asthma, the nurse has written the following outcome: "Client will know how to self-administer his prescribed bronchodilators using a nebulizer by 09/09/2016." Why is this outcome inadequate? A. the outcome isn't related to an independent nursing action B. the outcome doesn't specify the conditions in which it will be achieved C. the outcome isn't observable or measurable D. the statement expresses a pt outcome as a nursing intervention

C. Rationale: the verb here is know and is not directly observable or measurable. The very demonstrate would be more appropriate. Educating a pt on how to use his/her nebulizer is an independent nursing action. This outcome is not expressed as a nursing intervention and conditions are not likely necessary for this outcome.

Which of the outcomes is sufficiently measurable? A. pt will progress form clear fluid diet to full fluid diet without experiencing nausea B. increase pt's diet from clear fluids by 12/15/2016 C. pt will tolerate a full fluid diet with no reports of nausea by 12/15/2016 D. pt will maintain adequate intake with no reports of nausea by 12/15/2016

C. Rationale: a fully measurable outcome should include a subject, verb, conditions, performance criteria, and target time.

A nurse is giving postoperative care to a pt after knee arthroplasty. What is a possible short-term goal for this pt? A. to prevent repeat surgery in the pt B. to maintain a healthy and active lifestyle C. to help the pt return to activities of daily life D. to ambulate the pt to a bedside chair

D. Rationale: all of the other goals listed would be long term

A nurse designs a care plan to improve walking mobility in an older adult client. When encouraged to implement the new strategies for ambulation the client refuses to try and tells the nurse, "I find it easier to use a wheelchair." What action by the nurse may have led to failure to meet the outcome? A. beginning the plan without family to help B. failing to update the written plan of care C. choosing actions that do not solve the problem D. developing the plan without pt input

D. Rationale: common problems with planning nursing care include failure to involve the pt in the planning process, insufficient data collection, use of broadly stated outcomes, stating nursing orders that do not resolve the problem, and failure to update the plan of care.

Which of the following is categorizes as a psychomotor outcome? A. within one week of attending class, the pt will have cut out smoking from 20 to 10 cigarettes per day B. the pt's skin will remain smooth, moist, and without breakdown or ulceration C. the pt will verbalize understanding of need to continue to take medications as prescribed D. within 2 days of education, the pt's wife will demonstrate dressing change

D. Rationale: psychomotor outcomes describe the pt's achievement of new skills. Cognitive describe an increase in the pt's knowledge and affective outcomes describe changes in pt beliefs, beliefs, and standards

After the health history and admission assessment are completed the nurse establishes a care plan for the patient. What is the rationale for documenting and planning the patients' care? A. it provides the pt with info about treatments B. it creates a teaching log for families C. it verifies staffing D. it helps deliver holistic, goal-oriented, individualized care

D. Rationale: the record provides a mans of communication among members of the healthcare team and facilitates delivering holistic, goal-oriented, individualized care.

A nurse is caring for a client admitted with a DVT is individualizing a prepared plan of care that identifies nursing diagnoses, outcomes, and related nursing interventions common to this condition. What type of tool is the nurse using? A. guidelines B. an order set C. an algorithm D. a standardized care plan

D. a standardized care plan Rationale: these are prepared plans of care that identify nursing diagnoses, outcomes, and related nursing interventions common to a specific population or health problems

A pt was admitted 2 days ago with sepsis. The nurse update the pt's care plan based on improvements in this condition. This is an example of which type of planning? A. initial planning B. discharge planning C. outcome planing D. ongoing planning

D. ongoing planning Rationale: ongoing planning is carried out by a nurse who interacted with the pt and the chief purpose is to keep the plan up to data. initial is developed by the nurse who performs the history and physical assessment, discharge planning prepares the pt for discharge from the healthcare setting.

Physician-initiated intervention

actions initiated by a physician in response to a medical diagnosis but carried out by a nurse under doctor's orders

Ongoing planning

carried out by any nurse who interacts with the pt, keeps plan up to date, states nursing diagnosis more clearly, develops new diagnoses, makes outcomes more realistic and develops new outcome if needed, and identifies nursing interventions to accomplish the pt goals

Discharge planning

carried out by the nurse who worked most closely with the pt, begins when pt is admitted for treatment, and uses teaching and counseling skills to ensure that home care behaviors are performed competently

Cognitive outcomes

describes increases in pt knowledge or intellectual behaviors (teaching the pt in some way and measure how they learned it)

Initial planning

developed by the nurse who performs the history and physical assessment, addresses each problem listed in the nursing diagnosis, and identifies appropriate pt goals and related nursing care

Quality-of-life outcome

focus on key factors that affect someone's ability to enjoy life and achieve personal goals

Actions Performed in Nurse-Initiated Interventions (Alfaro 2002)

monitor health status, reduce risks, resolve/prevent/manage problem, facilitate independence or assist with ADLs, and promote optimum physical, psychological, and spiritual well-being

Example of a measurable outcome

observer for status changes indicating status changes by assessing and observing changing in breath sounds in 3 days

Parts of a measurable outcome

subject, verb, conditions, performance criteria, target time

What should we consider when developing care plans?

the long and short term