Study Guide for Fundamentals of Nursing The Art and Science of Nursing Care

CHAPTER 17 DOCUMENTING, REPORTING, CONFERRING, AND USING INFORMATICS 95

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APPLYING YOUR KNOWLEDGE

CRITICAL THINKING QUESTIONS

1.Consider the following patient: A 79-year-old

woman with Alzheimer’s disease is admitted

to a long-term care unit. She has a history of

falls and has fractured her left hip in the past.

She no longer recognizes her daughter, who

was taking care of her. The daughter states she

can no longer handle her mother’s condition.

The daughter insists that the nurses restrain

her mother physically to prevent falls.

Think about the information the team

will need to provide safe, quality care for this

patient. What types of data should the

admitting nurse record, and what system of

documentation is most likely to bring the

information to the attention of everyone

who needs it?

2.How would you go about scheduling a consul-

tation for a male amputee who needs physical

therapy? Write a brief summary of the

patient’s condition and how you would pre-

sent his case to the referred agency.

3.Make an appointment to interview the risk

manager of a healthcare system. Find out how

important the documentation of patient care

is to the patient, nurse, and health agency

when legal questions arise. How can this

knowledge help to safeguard your practice?

REFLECTIVE PRACTICE USING CRITICAL

THINKING SKILLS

Use the following expanded scenario from

Chapter 17 in your textbook to answer the

questions below.

Scenario:Philippe Baron, age 52, is being dis-

charged from the outpatient surgery department

after undergoing a colonoscopy for removal of

three polyps. Upon admittance, Mr. Baron

stated that he was allergic to a pain medication

but couldn’t remember the name of it. The

RN phoned the doctor’s office to check his

medical record. His attending gave an order

via phone for a PRN analgesic that worked in

the past. He will be going home with his wife,

who is a nurse, and they require discharge

teaching.

1. What should be the focus of discharge teach-
   ing for Mr. Baron and his wife?


2. What would be a successful outcome for this
   patient?


3. What intellectual, technical, interpersonal,
   and/or ethical/legal competencies are most
   likely to bring about the desired outcome?


4. What resources might be helpful for
   Ms. Baron?

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