It's especially important for healthcare professionals to have solid critical thinking skills. When you think critically, you analyze information to form judgments about it. The information may be gathered from your observations, personal experience, reasoning, or communication. In your profession, you may be required to gather and analyze information and evaluate results on a daily basis. If you're able to think critically and make good judgments based on the information you can gather, you'll have a positive impact on your patients' health.

Bloom's Learning Stages
Critical thinking occurs in several stages. Benjamin Bloom, a noted neuropsychologist, assigned names and descriptions to these stages in the 1950s. Although other psychologists have developed new theories about critical thinking since then, most theories are similar to Bloom's. In other theories, the stages may be named or ordered differently, but their descriptions remain relatively the same. Bloom's stages are:

• Knowledge. During this stage of critical thinking, you memorize information and repeat it word for word. At this point, you don't necessarily have to understand the information to memorize it. Some examples of things you may need to memorize are formulas in math class; people's names, addresses, and phone numbers; and simple instructions.
  
• Comprehension. In this stage, you're able to understand information enough to restate it in your own words. If you take effective notes during class, your notes should reflect your comprehension. You can accomplish this by drawing charts and diagrams, summarizing and paraphrasing information, describing how concepts are related, and explaining the material to someone else.
  
• Application. During this stage, you use the information you've memorized and comprehended to accomplish a task. Examples of application include using a mathematic formula to solve a problem, using a rule or principle to classify information, and successfully completing a project by following directions.
  
• Analysis. This stage involves taking information and breaking it into parts to understand how those parts are organized and related to one another. For example, when you read an article in a magazine, you first look at the different pieces of information presented. An author may provide several anecdotes to illustrate a single main point. Then, you analyze the different pieces of information by thinking about how they are related. How does each anecdote relate to the author's theme or main point? What message is the author trying to get across?
  
• Synthesis. In this stage, you put your analysis to use by developing a new idea. In a sense, you take parts of information and put them together in a different way to form a new concept. This stage of learning is more creative than the others. It includes building on the pieces of information contained in your notes and writing a paper or presentation, forming a plan for conducting a lab experiment, and writing a poem or short story.
  
• Evaluation. During the last stage in the critical thinking process, you evaluate information. This means you use other methods, such as comprehension and analysis, to determine whether or not information has value or relevance. Evaluation can include determining which conclusions are actually supported by facts and research, judging the value of a work of art or a piece of writing based on specific standards, and determining the value and relevance of information presented in a textbook, lecture, or class discussion.
  

Source: Student Success for Health Professionals, Lippincott Williams & Wilkins, 2007.

Cirrhosis is a chronic, progressive disease characterized by inflammation, fibrosis, and degeneration of liver parenchymal cells. There are four types of cirrhosis: Laennec's (micronodular), postnecrotic (macronodular), biliary, and idiopathic.

Common causes

• Unknown
• Alcohol use
• Viral hepatitis
• Cholecystitis

Key signs and symptoms

• Nausea and vomiting
• Anorexia
• Jaundice
• Pain in the right upper quadrant

Diagnosis

• Blood chemistry: increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactic dehydrogenase (LD), alkaline phosphatase, ammonia, bilirubin, and sulfobromophthalein tests; decreased albumin and total protein
  
• Liver biopsy: destruction of parenchymal cells
• CT scan: ascites

Treatment

• Transfusion therapy: platelets, packed red blood cells, fresh frozen plasma
• Diuretics
• Ammonia detoxicant
• Vitamins

Key nursing interventions

• Assess respiratory status, gastrointestinal bleeding, and fluid balance.
• Assess for bleeding.
• Monitor and record vital signs, I/O laboratory studies, hemodynamic variables, daily weight, and fecal occult blood.
  
• Observe for signs of behavioral or personality changes.
• Monitor ammonia levels.
• Provide information on AA, or make a referral to a treatment program.

Key complications

• Ascites
• Liver cancer
• Portal hypertension

Source: Straight A's in Medical-Surgical Nursing, 2nd edition, Lippincott Williams & Wilkins, 2008.

Worried about passing the NCLEX? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. ANSWERS BELOW.

1.	Which statement by the father of an 8-year-old boy with Duchenne's muscular dystrophy indicates that he has realistic expectations about the course of the disease?
	1.	"My son will gradually lose his ability to walk."
	2.	"Corticosteroids will help prevent muscle degeneration."
	3.	"Surgery will help my son walk."
	4.	"My son will have a normal lifespan."
2.	To help promote a normal life for a child with celiac disease, which intervention should his parents use?
	1.	Treat the child differently from other siblings.
	2.	Focus on restrictions that make him feel different.
	3.	Introduce the child to another peer with celiac disease.
	4.	Don't allow the child to express doubt in keeping with dietary restrictions.
3.	A nurse is assessing a toddler with hypothyroidism. Which signs should alert the nurse to the most serious complication of this condition?
	1.	Low hemoglobin and hematocrit
	2.	Cyanosis
	3.	Bone and muscle dystrophy
	4.	Mental retardation
4.	When evaluating the urinalysis report of a child with acute glomerulonephritis, the nurse should expect which result?
	1.	Proteinuria and decreased specific gravity
	2.	Bacteriuria and increased specific gravity
	3.	Hematuria and proteinuria
	4.	Bacteriuria and hematuria
5.	A 9-year-old child is admitted to the hospital with deep partial-thickness burns to 25% of his body. Which assessment finding is consistent with a deep partial-thickness burn?
	1.	Erythema and pain
	2.	Minimal damage to the epidermis
	3.	Necrosis through all layers of skin
	4.	Tissue necrosis through most of the dermis

• 16th International Conference on Cancer Nursing
  March 7-11, 2010, at the Westin Peachtree Plaza in Atlanta, Georgia.
  

Don't miss these substantive, peer-reviewed features from the October issue of Nursing2009. They'll help you learn about evidence-based practice.

• Overturning barriers to pain relief in older adults
  By Yvonne D'Arcy, CRNP, CNS, MS
  Older patients--and even some healthcare professionals--have mistaken beliefs that stand in the way of effective pain management. This article reviews the latest practice guidelines and research findings supporting best practices for pain control in older adults.
  
• Taking aim at ARDS
  By John J. Gallagher, RN, CCNS, CCRN, RRT, MSN
  This comprehensive discussion of acute respiratory distress syndrome will prepare you to manage the complex care a patient needs to survive.
  

Need an easy-to-understand patient handout on H1N1 to give to your patients? Click here for one you can download and print!

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1. 1 Duchenne's muscular dystrophy is a progressive muscular degenerative disorder in which children lose their ability to walk independently by age 12. Corticosteroids may slow muscle degeneration, but won't stop its progression. Surgery may be done to correct contractures but it doesn't change the course of the disease. Death occurs by early adulthood, usually from respiratory failure.
2. 3 Introducing the child to another child with celiac disease will let him know that he isn't alone. It will show him how other people live a normal life with similar restrictions. Treat the child no differently from other siblings, but stress appropriate limit setting. Instead of focusing on restrictions that make him feel different, the nurse should encourage the parents to focus on ways he can be normal. Allow the child with celiac disease to express his feelings about dietary restrictions.
3. 4 The most serious consequence of congenital hypothyroidism is delayed development of the central nervous system, which leads to severe mental retardation. The other choices occur but aren't the most serious consequences.
4. 3 Urinalysis during the acute phase of this disease characteristically shows hematuria, proteinuria, and increased specific gravity.
5. 4 A client with a deep partial-thickness burn will have tissue necrosis to the epidermis and dermis layers. Erythema and pain are characteristic of superficial injury. With deep burns, the nerve fibers are destroyed and the client won't feel pain in the affected area. Superficial burns are characteristic of slight epidermal damage. Necrosis through all skin layers is seen with full-thickness injuries.

Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2008.

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