Transcript Critical Thinking and Ethical Decision Making

Enthusiasm
Stagnation
Frustration
Apathy
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#7 in class
#18, 28, 38 in textbook
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Problems
Critical thinking application
Brain storming
Critical Thinking Indicators
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Include three aspects of critical thinking
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Behaviors demonstrating
Knowledge & intellectual skills
Affective or emotional behaviors
Critical Thinking in Action
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Chart 3-1 (pp.26) details some
questions to help the nurse analyze a
patient care situation and determine a
course of action
Knowledge & Intellectual
Skills
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Nursing process and decision-making
skills
judges the value of information
Evaluation
評鑑
From lower to high level
Simple as baseline
builds a pattern from diverse elements
Synthesis
綜合
Analysis separates information into part for better understandin
分析
applying knowledge to a new situation
Application
應用
understanding information
理解
Comprehension
recall of data
Knowledge
知識
(Bloom,1956)
Learn from your mistakes
and strengths to improve
your own style
Build your fundamental knowledge
Understand your fundamental knowledge
DO2 vs. VO2
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MI, CV disoders
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A patient who arrives in the emergency
department complaining of squeezing substernal
pain that radiates to the left shoulder and jaw also
complains of nausea, diphoresis, and shortness of
breath. What should the nurse do?
A)
B)
C)
D)
Complete the patient’s registration information, perform
an EKG, gain IV access, and take vital signs
Alert the cardiac catheterization team, administer oxygen,
attach a cardiac monitor, and notify the physician
Gain IV access, give sublingual nitroglycerin, and alert the
cardiac catheterization team
Administer oxygen, attach a cardiac monitor, take vial
signs, and administer sublingual nitroglycerin
Sodium  →→ Hypertension
Tx Hypertension→→ Sodium, but Potassium
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The nurse is caring for a patient
receiving spironolactone to treat
hypertension. Which instruction should
the nurse give the patient?
Choose foods high in potassium
B) Take potassium supplements each day
C) Discontinue sodium restrictions
D) Avoid salt substitutes
A)
Medication Treatment
Table 32-4, pp. 1026-1029
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Diuretic and related drugs
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Thiazide diuretics
Loop diuretics
Potassium-sparing diuretics
Aldosterone receptor blockers
Adrenergic inhibitors-central-acting adrenergic
antaginists
Calcium channel-blocking agents
ACE inhibitors
Angiotensin II receptor antagonists
Beta-Adrenergic blockers
Alpha-adrenergic blockers
Vasodilators
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The nurse is caring for a 28-year-old
nonsmoker with a deficiency in the
enzyme antitrypsin. To what deficiency
does this predispose the young patient?
Pulmonary edema
B) Development of lobular emphysema
C) Cystic fibrosis
D) Empyema
A)
Changes in Alveolar
Structure with Emphysema
The bronchioles, alveolar ducts, and alveoli are destroyed,
and the air spaces within the lobule are enlarged
Changes occur in the lobule,
preserving the peripheral portions of the acinus
Laboratory Assessment
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Status if arterial blood gas values for
abnormal oxygenation, ventilation, and
acid-base status
Sputum samples
Hemoglobin and hematocrit blood tests
Serum alpha1-antitrypsin levels drawn
Chest x-ray
Pulmonary function test
Risk Factors for COPD
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Tobacco smoke causes 80-90% of
COPD cases!
Passive smoking
Occupational exposure
Ambient air pollution
Genetic abnormalities
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Alpha1-antitrypsin deficiency
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A patient diagnosed with multiple sclerosis
has decreased vital lung capacity. The
nurse is aware that vital capacity measures:
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The volume of air inhaled and exhaled with
each breath
The volume of air in the lungs after a maximum
inspiration
The maximum volume of air inhaled after
normal expiration
The maximum volume of air exhaled from the
point of maximum inspiration
Lung Capacities
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Total Lung Capacity (TLC) = RV+IRV+TV+ERV
Vital Capacity (VC) =IRV+TV+ERV=TLC-RV
Functional Residual Capacity (FRC) = RV+ERV
Inspiratory Capacity (IC) = TV+IRV
Pulmonary Function Tests
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The most accurate measures for
asthma are pulmonary function tests
using spirometry including
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Forced vital capacity (FVC)
Forced expiratory volume in the first
second (FEV1)
Peak expiratory rate flow (PERF)
Chest x-ray to rule out other causes
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A 10-year-old girl is having an asthma attack
on the school grounds at recess. Which the
following is the preferred treatment to
alleviate her airflow obstruction?
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B)
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Corticosteroids
Anticholinergics
Beta-adrenergics
Peak flow monitoring device
Medications Used for
Asthma
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Quick-relief medications, see Table 24-2,
pp.693
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Beta2-adrenergic agonists
Anticholinergics
Long-acting medications, see Table 244, pp.713
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Corticosteroids
Long-acting beta2-adrenergic agonists
Leukotriene modifiers
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Auscultation of the lung fields provides the
nurse with information on the type of
breath sound the patient is exhibiting. While
listening over the manubrium, the nurse
auscultates loud expiratory sounds that lst
longer than inspiratory sounds. The nurse
will document her findings as:
A)
B)
C)
D)
Vesicular breath sounds
Bronchovesicular breath sounds
Bronchial breath sounds
Tracheal breath sounds
Assessment of Breath Sounds
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Normal breath sounds (see Table 21-5,
pp.575)
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Bronchial
Bronchovesicular
Vesicular
Abnormal (adventitious) breath sounds (see
Table 21-6, pp. 575)
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Crackles
Wheezes
Rhonchus
Friction rubs
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Changes in the cardiac structure and
function occur in the heart of an older adult.
Which of the following is a normal change
expected in the aging heart?
A) Increase
Deceased
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left ventricular ejection time
Deceased connective tissue in the SA and AV
Increase
nodes and bundle branches
Thickeing
rigidity
Thinning and flaccidity
of cardiac valves
Widening of the aorta
Enthusiasm
Stagnation
Frustration
Apathy
Teaching vs. Learning
Assess, Learn, Evaluate
We always teach you,
not evaluate you
Critical Thinking Indicators
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Include three aspects of critical thinking
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Behaviors demonstrating
Knowledge & intellectual skills
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Affective or emotional behaviors
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Ways to Exercise Your Brain
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Pre-reading
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Add notes from textbook into handout
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Review anatomy & pathophysiology from your previous lectures
or textbook
Power-points
Assign reading, especially emphasizing in class
Practice questions from CD, NCLEX, or learning
resource center
Group study review (Sharing)
Ask questions immediately after reading
After exam
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ALWAYS clarify the concepts which you have missed