Assessment vs.

Implementation
The Assessment VS Implementation strategy will assist you to establish priorities which involve the assessment and implementation steps of the nursing process. As a nursing student you have been drilled so that you can recite the steps of the nursing process in your sleep assessment, analysis, planning, implementation, and evaluation. In nursing school, you did have some test questions about the nursing process, but you probably did not use the nursing process to assist you in selecting a correct answer on an exam. On the NCLEX-RN exam, you will be given a clinical situation and asked to establish priorities. The possible answer choices will include both the correct assessment and implementation for this clinical situation. How do you choose the correct answer when both the correct assessment and implementation are given? Think about these two steps of the nursing process. Assessment is the process of establishing a data profile about the client and his or her health problems. The nurse obtains subjective and objective data in a number of ways: talking to clients, observing clients and/or significant others, taking a health history, performing a physical examination, evaluating lab results, and collaborating with other members of the healthcare team. Once you collect the data you compare it to the clients baseline or normal values. On the NCLEX-RN exam, the clients baseline may not be given, but as a nursing student you have acquired a body of knowledge. On this exam you are expected to compare the client information you are given to the normal values learned from your nursing textbooks. Assessment is the first step of the nursing process and takes priority over all other steps. It is essential that you complete the assessment phase of the nursing process before you implement nursing activities. This is a common mistake made by NCLEX-RN exam takers: dont implement before you assess. For example, when performing CPR, if you dont access the airway before performing mouth to mouth resuscitation, your actions may be harmful! Implementation is the care you provide to your clients. Implementation includes: assisting in the performance of activities of daily living (ADL); counseling and educating the client and the clients family; giving care to clients; supervising and evaluating the work of other members of the health team. Nursing interventions may be independent, dependent, or interdependent. Independent interventions are within the scope of nursing practice, and do not require supervision by others. Instructing the client to turn, cough, and deep breathe after surgery is an example of an independent nursing intervention. Dependent interventions are based on the written orders of a physician. On the NCLEX-RN exam, you should assume that you have an order for all dependent interventions that are included in the answer choices. This may be a different way of thinking from the way you were taught in nursing school. Many students select an answer on a nursing school test (that is later counted wrong) because the intervention requires a physicians order. Everyone walks away from the test review muttering trick question. It is important for you to remember that there are no trick questions on the NCLEX-RN exam. You should base your answer on an understanding that you have a physicians order for any nursing intervention described. Interdependent interventions are shared with other members of the health team. For instance, nutrition education may be shared with the dietitian. Chest physiotherapy may be shared with a respiratory therapist.

Below are some examples of assessments and some implementations Remember that action does not always mean implementation!!! For example Make a thorough assessment of the circumstances is an assessment! It will give you data or information.

Examples of Implementations
Increase his consumption of foods containing simple sugars. Increase his activity level Hold his regular dose of insulin. Document the results Notify the physician that the client has become hypotensive Obtain an order to administer IV fluids Place the client in semi-Fowlers position Administer O2 at 4 liters Administer a second dose of nitroglycerine Instruct the client to cough and deep breathe. Elevate the head of the bed. Increase the rate of oxygen the client is receiving Give his NPH insulin later in the evening Continue with his medication regimen Serve his bedtime snack earlier in the evening Immobilize the affected limb with a splint and ask him not to move Institute measures to minimize crying. Perform postural drainage every two hours Cough and deep breathe every hour Give ice cream as tolerated Stop the infusion. Call the pharmacist Attach the ties of the restraint to the bed frame Perform range of motion to the restrained extremities once a shift. Teaching the client about the importance of taking lithium as prescribed Providing the client with a safe environment with few distractions Setting limits on the clients behavior Turn the client on his left side Change the suction from intermittent to continuous Continue the irrigation Administer the Lasix and Aldactone

Examples of assessments Check his blood glucose level every 34 hours. Check the pedal pulse and blanching sign in both legs. Take Blood pressure and pulse Check skin turgor Ask family about health history of the patient Check for breathlessness by placing an ear over the clients mouth and observing the chest Ask the client, Are you choking? Determine that all the weights and ropes from the traction apparatus are in line and hanging free Ask the client for more information about the location and characteristics of her pain Check his blood sugar during the night Check the Thomas splint and Pearson attachment to make sure they are appropriately positioned Listen for bowel sounds Take a pulse oximetry reading Monitor the EKG for abnormal results Observe the amount and characteristics of the returns Obtain a clean catch urine specimen from a client suspected of having a urinary tract infection Obtain a 24-hour diet recall from a client recently admitted with anorexia nervosa Observe a client newly diagnosed with diabetes mellitus practice injection techniques using an orange Check Serum electrolytes and digoxin level Check WBC and RBC count Have the test results repeated