Hi, this is Professor Hoffman, and as I mentioned in class for Topic 4, there's some revision over the learning objectives from what was originally posted. I talked about it a little bit in lab, but I just want to go over some of the content real quickly to help you focus your studies. So again, what we're looking at is out of Topic 4, Objective Number 6 now, I believe, and it's focusing on the diagnosis step. So again, the whole intent of or content of topic four is the nursing process. So we have the six stages, the assessment, diagnosis, outcomes identification, planning, implementation, evaluation.
So for the whole topic, looking at all the objectives, you should be getting a comfortable way or a comfort with what happens in very general terms or basic terms in each of these stages or steps. So start out with the assessment. Now we'll move on.
So our focus at this point for this subsection basically is the diagnosis step. Again the content for this is located in chapter 4.4 in the text. So you have that hyperlink in the reading guide.
So we want to spend some time there. So during the diagnosis phase there's a couple things that happen and It's reflected in the definitions from the American Nurses Association's Standards of Professional Practice. So, again, an important link to be forming in your minds is when we're talking about nursing process, we are also talking about the ANA Standards of Professional Practice. The nursing process is just a way of implementing those standards in a thought process or a structured approach to... looking at information and developing a plan of care for a patient.
So again, the diagnosis phase according to ANA, the registered nurse is going to analyze assessment data and determine if there are any actual or potential issues that they can assist the patient with or participate with the patient in in dealing with those issues. Then the other part of the diagnosis phase or diagnosis step is that the RN is going to prioritize these diagnoses. That's correct.
bring them all together, form the beginnings of a plan, or the structure from which a plan can be developed. So again, it's an analysis and then it involves a prioritization process. So as we go through this step by step, for the RN we're looking at analyzing the assessment data or cues. So that's all that subjective and objective information we collect during our ongoing assessment. So it can be everything from vital signs to things the patient's reporting to us as far as pain, emotions, lab work, all those sorts of things.
Our analysis phase involves looking for expected or unexpected. If we expect something, no big surprises. If something is unexpected, that's going to trigger that this might be a valuable cue or valuable piece of data.
In the same way, are the results normal or are they abnormal? Abnormalities are going to be, again, a trigger that there's something here we need to look at. And that gets into the third step of the analysis phase. Once we've identified this was expected or unexpected, so more likely unexpected, this is abnormal, it's not what we were looking for, we're going to make a determination, is it clinically relevant? Is it really having an impact on the individual or our patient or client?
And again, that can be an individual, it could be a group of people, it could be a community, it could be even at the national level when we're looking at major safety issues or health issues in epidemics. So is that abnormality, is it relevant to the issue that that client or patient is experiencing? So again, that becomes a function of the nurse, and particularly the RN. We'll look at some distinctions on the last slide.
So once we've analyzed that information and identified those abnormalities and those relevant pieces, we're going to start clustering them together see are they related to each other are the relationships we can draw on and from that we're going to identify a hypothesis that's going to group that relationship or that pattern into a description that we can communicate to others that has meaning so in your text there's a section a grayed out section that deals with this it's referring back to um Patient information that was given in 4.3 in the assessment phase, basically a case study. And for that patient, if you go back and look at that, it was an elderly female patient. And the cues that came up from that were that her blood pressure is elevated, so that was an abnormality in her respiratory rate is elevated. She has abnormal sounds in her lungs that you'll later identify as crackles, which means a fluid buildup. She has had a weight gain over recent days.
She has edema or swelling in her lower extremities, and it has gotten worse over the last several days. She's feeling short of breath. She has a medical diagnosis of a history of heart failure.
And when you look at her medication, she's taking a diuretic, which helps with eliminating excess fluid. So when we look at all those pieces of information, they're all relevant. They are all related.
They're all related to... maintaining a normal fluid balance. So that gives us an ability to develop a hypothesis that the issue, one of the issues that's facing this patient right now is that she is demonstrating or demonstrating the results of having too much fluid on board.
So we can use different terms for that hypothesis that she has excess fluid volume, she's hypervolemic, some different terms that you'll learn as you move on and start talking about. different clinical pictures with patients. So we've developed that hypothesis that this individual is dealing with excess fluid volume or hypervolemia, and then we can establish a nursing diagnosis or problem statement. And actually we're going to establish several for this individual.
When we're looking at developing a diagnosis or problem statement, what we're looking at is verbalizing a clinical judgment That's related to the individual, the client, the group's response to this hypothesis. So again, we can be talking at an individual level. We may be talking about issues that are involving the family or caregivers. We may be looking at more of a community issue.
But in this case, with this patient, we're looking at fluid volume or load. We're looking at what is her response, where can we respond. So one, with the shortness of breath, we may have a... problem statement of dyspnea or shortness of breath or difficulty breathing and from that we will then in the next stages determine some outcomes and we'll move on to that tips with with the idea of developing a plan that's going to help that shortness of breath or difficulty breathing be relieved we may have a problem statement again tied up into the very same thing of anxiety And that maybe ties the fact that she's short of breath and she's nervous. And so there's steps that we can take that are going to help with the anxiety on top with helping the other.
So again, as we look at the data and look at that hypothesis, that summary of what is going on, how all these cues are related under that hypothesis, we're going to be looking at how does this individual or our client or patient. how we define that, how are they responding to that, and again the responses are going to be numerous. So again just the idea that that nursing diagnosis or problem statement is a result of our clinic, it's a stating a clinical judgment. We've taken the data, we've identified the relationships, we've seen this overall picture that how they're all related, and now we're pulling apart different responses that we can introduce interventions for to help relieve. So again, in the diagnosis phase, that's where we're getting that.
The other steps then happen as we move forward. One thing I do want to point out, as you look through the nursing process, and we're going to talk about it in lecture content again a little bit later in the semester, is there are different levels of accountability and responsibilities in our standards of practice based on our licensure. So our Nurse Practice Act. uses language from the nursing process and, again, from the ANA standards of practice, professional practice.
And it delineates when we look at the RN's Nurse Practice Act, the LPN Nurse Practice Act, and the Advanced Practice RN's Nurse Practice Act. Each of those sections is really clear on where are the boundaries. Under the nursing process, in each of the groupings, the RN has the final responsibility or the ultimate responsibility.
So in the diagnosis phase, it's the RN's responsibility to analyze the data and to develop the diagnosis. The LPN does not have the legal authority to perform the official analysis. They are going to help in the assessment phase collect data, which the RNs then are going to use. But as that analysis is done, the LPN is responsible for understanding what is the thought process, what's going on, what is that cluster of information, as they help provide the care to meet those needs.
And then the LPN is also responsible for continuing to gather assessment data that can be brought back into the picture for just continued review. So again, when we're looking at responsibilities, the responsibility for doing the analysis and developing the diagnosis or problem statement is by law, by our Nurse Practice Act, by ANA standards, and RN function. The LPN's role is supportive to gather the data during the assessment phase that's going to be used in that.
to understand so they are asked to communicate to the lpn what's going on what the plan is the lpn needs to understand that because they're going to be involved in implementing some of the interventions later on and they're going to continue to write ongoing assessment so again those are some of the things we'll be picking up from the readings and they get comfortable with if you have any questions please reach out and i'll be open to any questions during class next week before we get into the this exam so