Welcome Back!

As before, the notes are posted on individual pages along the right hand column.  These are the notes I have been taking while studying and are by no means made to replace any reading or following of the study guides (which help me tremendously). Good luck!

Nursing Process: Fundamentals

These are the nursing processes you should be aware of for Fundamentals. I am using the Mosby's Guide to Nursing Diagnosis, 4th edition.

Functional Assessment:

Readiness for Enhanced Self Health Management (pgs 146, 694-695)

NANDA-I Definition: A pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequalae that is sufficient for meeting health-related goals and can be strengthened.

Defining Characteristics:

• choices of daily living are appropriate for meeting goals
• describes reduction of risk factors
• expresses desire to manage illness
• expresses little difficulty with prescribed regimens
• no unexpected acceleration of illness symptoms

Client Outcomes- Client Wil:

• describe integration of therapeutic regimen into daily living
• demonstrate continued commitment to integration of therapeutic regimen into daily living routines

Nursing Interventions:

• acknowledge expertise of client and family
• review factors that contribute to the success of self care
• support all efforts to self manage therapies
• collaborate with client to identify strategies to maintain strengths and achieve success
• identify factors that may need to be improved
• educate
• help client maintain and/or seek support
• help client obtain health insurance and drug payment pans if necessary

Risk For Falls (353-359)

NANDA-I Definition: Increased susceptibility to falling that may cause physical harm

Risk Factors:

• Adults:
• age 65 or older
• history of falls
• fear of falling
• living alone
• lower limb prosthesis
• use of assistive devices (walker, cane)
• wheelchair use
• Children:
• less than 2 years of age
• bed located near window
• lack of automobile restraints
• lack of gate on stairs
• lack of window guard
• lack of parental supervision
• male gender when less than 1 year of age
• unattended infant on elevated surface
• Cognitive:
• diminished mental status
• Environment
• cluttered environment
• dimply lit room
• no anti-slip material in bath or shower
• restraints 
• throw rugs
• unfamiliar room
• weather conditions
• Medications:
• Angiotensin- Converting Enzyme (ACE) inhibitors
• alcohol use
• anti-anxiety agents
• antihypertensive agents
• diuretics
• hypnotics
• narcotics/opiates
• tranquilizers
• tricyclic antidepressants
• Physiological:
• anemias
• arthritis
• diarrhea
• decreased lower extremity strength
• difficulty with gait
• foot problems
• hearing difficulties
• impaired balance
• incontinence
• neoplasms
• neuropathy
• orthostatic hypotension
• post-op
• postprandial blood sugar changes
• acute illness
• proprioceptive deficits
• vascular disease
• visual difficulties 

Nursing Interventions:

• complete a fall-risk assessment for older patients (Henrich II model)
• screen pts for balance and mobility skills
• when sitting up dangle legs before standing to prevent orthostatic hypotension
• use "high-risk fall: arm band to alert staff
• evaluate meds
• place call light within reach and answer promptly
• lock wheels
• keep dim light in room at night
• assist with toiling promptly and keep path to bathroom clear
• avoid restraints
• be aware of acute change in mental status or chronic confusion
• place pt in room close to RN station
• refer to PT to improve strength, balance, flexibility, or insurance

Practice Exam Score vs. Real Exam Score

How do you know when you are ready to test?

Our brains tell us that a 75 indicates that we have a major knowledge deficit and need to continue studying but many people have reported getting 70's on practice exams and then A'cing real exams. So far I have very limited personal experience to share but I can tell you that going into the Transitions exam I had a 74 on the practice and made a B on the real thing. For Health Differences I made a 73 on Form A and a 75 on Form B even after doing all of the required reading. But alas, I made a C on the actual exam. I have been informed by the Director of Testing for Excelsior that the practice exams (as of 4/25/14) are not updated to reflect the credit-bearing exams. The practice exams for Health Differences were not a good indication of the real exam due to the high number of Select All That Apply questions and a shifted focus on certain areas of information.

I will keep updating as I go. For now, I am going to go nurse my disappointment from today's exams with some trashy reality TV :)

Update, 5/8/2014: I took the Health Safety exam today. From what the Excelsior testing person told me, some tests have been updated and some have not; some have SATA questions ad some do not. What that also means is that some practice exams correlate with their credit-bearing exam, and some do not. Excelsior is apparantly in the process of updating their practice exams but have not completed the process. I have an email from Excelsior explaining this. I got a 76 on the practice exam and got an A on the credit-bearing exam. This is in line with what many people have said about what to expect. I do not think that I got one of the updated exams and do not believe I would have gotten an A if it had been one of the updated exams. The last exam I took was Health Differences. i got a 74 on the practice exam and a C on the updated version of the credit-bearing exam.