NUR 122 NURSING II

INSTRUCTION Course Package

MCC Form EDU 0007 (rev. 10/07/11)

NUR 122

NURSING II

PRESENTED AND APPROVED: MAY 4, 2012

EFFECTIVE: FALL 2012-13


MCC Form EDU 0007 (rev. 10/07/11)

Prefix & Number NUR 122 Course Title: Nursing II

Purpose of this submission: New Change/Updated Retire

If this is a change, what is being changed?

(Check all that apply) NUR 122 course package is being submitted in order to complete the process for approved changes in the 4/6/12 meeting.

Update Prefix Course Description

Title Course Number

Format Change Credits

Prerequisite Competencies

Textbook/Reviewed Competencies-no changes needed

Does this course require additional fees? No Yes If so, please explain. Nursing Program Fee

Is there a similar course in the course bank? No Yes (Please identify)

Articulation: Is this course or an equivalent offered at other two and four-year universities in Arizona? No Yes (Identify the college, subject, prefix, number and title: Nursing Programs within the

Healing Community -. Yavapai, Central, AZ Western, Northern Pioneer, etc. ASU and UA – Elective Credit, NAU – NUR 208

Is this course identified as a Writing Across the Curriculum course? No Yes

Course Textbook, Course Textbook, Course Textbook, Course Textbook, Materials and EquipmentMaterials and EquipmentMaterials and EquipmentMaterials and Equipment----All Texts ordered for Nursing I NUR 121 Plus

Textbook(s) Current edition

Title Brunner & Suddarth’s Textbook of Medical Surgical Nursing 12th Edition.

Author(s) Smeltzer S. C., Bare, B.G., Hinkle, J. L. & Cheever, K. H.

Publisher Wolters Kluwer: Lippincott Williams and Wilkins

ISBN 13: 978-0-7817-5978-6 (already purchased in Nursing I)

Title Psychiatric Health Nursing, 6th Edition

Author(s) Mary C. Townsend

Publisher F.A. Davis

ISBN 9780803619173

Title Pathophysiology for the Health Professions, 4rd edition

Author(s) Gould, B.

Publisher Saunders Elsevier.

ISBN 13: 978-1-4377-0965-0


MCC Form EDU 0007 (rev. 10/07/11)

Required from previous semesters

Fundamentals of Nursing 6th Edition (2006)

Author(s) Taylor, C., Lillis, C., Lemone, P.


ISBN 9780781781572

Taylor’s Clinical Nursing Skills, 6th Edition

Author(s) Taylor, C., Lillis, C., Lemone, P., Lynn, P. & LeBon, M.


ISBN 13: 978-0-7817-6407-0

Pharmacology and the Nursing Process, 6th

Author (s) Lilley, L. and Aucker, R. (2007)

Publisher C.V. Mosby, St. Louis, MO

ISBN 13: 978-0-323-05544-4

Title Davis’s Drug Guide for Nurses 12th Edition

Author(s) Deglin, J. H., Vallerand, A. H.

Publisher F. A. Davis

ISBN 10-0-8036-2310-0

Taber’s Cyclopedic Medical Dictionary 21st Edition (2005)

Author(s)

Publisher F. A. Davis

ISBN 13-978-08036-2041


MCC Form EDU 0007 (rev. 10/07/11)

Title Nurses Quick Reference to Common Laboratory and Diagnostic Tests 5th Edition

Author(s) Fischbach, F. & Dunning III, M. B.

Publisher Lippincott, Williams & Wilkins

ISBN 0781735475

Title Clinical Calculations Made Easy

Author(s) Craig, G.

Publisher Lippincott, Williams & Wilkins

Software/ Equipment

Prep U Resources

Nurse Pack and computer capable of on-line access

ATI testing and resources

Computer capable of accessing course management system, ATI and text on

Course AssessmentsCourse AssessmentsCourse AssessmentsCourse Assessments

Description of Possible Course Assessments (Essays, multiple choice, etc.)

Multiple choice exams, care plan, process recording, concept maps, clinical performance.

Exams standardized for this course? Midterm Final Other (Please specify): Exams 1-4.

Are exams required by the department? No Yes

If Yes, please specify: Final and unit exams are the same on all campus sites.

Where can faculty members locate or access the required standardized exams for this course? (Contact Person and Location) Example: NCK – Academic Chair Office

Director of Nursing, Nursing Faculty.

Student Outcomes: Identify the general education goals for student Student Outcomes: Identify the general education goals for student Student Outcomes: Identify the general education goals for student Student Outcomes: Identify the general education goals for student learning that is a component of this course.learning that is a component of this course.learning that is a component of this course.learning that is a component of this course.

Check all that apply:Check all that apply:Check all that apply:Check all that apply:

MethoMethoMethoMethod of Assessmentd of Assessmentd of Assessmentd of Assessment

1. Communicate effectively. a. Read and comprehend at a college level. b. Write effectively in a college setting.

Multiple choice exams. Care plans, clinical documentation, concept maps.

2. Demonstrate effective quantitative reasoning and problem solving skills.

Dosage exams and clinical performance.

3. Demonstrate effective qualitative reasoning skills.

Multiple choice exams.

4. Apply effective methods of inquiry. a. Generate research paper by gathering information

from varied sources, analyzing data and organizing

Working with evidence based practice and utilizing nursing process which is nursing care plan and concept maps.


MCC Form EDU 0007 (rev. 10/07/11)

information into a coherent structure. b. Employ the scientific method.

5. Demonstrate sensitivity to diversity

a. Experience the creative products of humanity. b. Describe alternate historical, cultural, global

perspectives.

Cultural considerations in nursing care. Care plans and concept maps.

Office of Instruction Use only:

CIP Code:

ONET Code:

Minimum Qualifications:


MCC Form EDU 0007 (rev. 10/07/11)

COURSE INFORMATIONCOURSE INFORMATIONCOURSE INFORMATIONCOURSE INFORMATION

Initiator: Cynthia Huth, Linda Riesdorph, Marilyn Parker

Date of proposal to Curriculum Sub-Committee: 5/4/12

Effective Semester/Year Fall 2012 Spring Summer

Prefix & Number: NUR 122 Full Title: (100 character limit)

Nursing II

Short Title: (30 character limit)

Catalog Course Description: Within the framework of transitions, the focus is on nursing care to promote healthy transitions for individuals and families with chronic health conditions in well defined practice settings. Emphasis is on basic management concepts and continued development of critical thinking, clinical judgment and skills. Principles of pharmacology, culture, and nutrition are integrated throughout the course.

SUN Course Number:

Credit Hours: 8

Lecture Hours: 4 Lab Hours : 12

Prerequisite(s) NUR 121 Nursing I.

Co-requisite(s) NUR 227 Pharmacology, NUR 122 L Nursing II Laboratory

Intended Course GoalsIntended Course GoalsIntended Course GoalsIntended Course Goals By the end of the semester, students will be able to:By the end of the semester, students will be able to:By the end of the semester, students will be able to:By the end of the semester, students will be able to:

1. Accountability: Identify and apply ethical, professional and legal principles within his/her current scope of practice and for nursing practice. (Test Plan)

2. Caring: Demonstrate physical, emotional and spiritual components of caring behaviors for self and others.

3. Clinical Competence: Demonstrate use of evidence-based practice principles and nursing skills in well-defined practice settings to provide safe and effective therapeutic nursing interventions for self, and for individuals and families experiencing transitions. (Test Plan) (AZ Workplace Employability Skill)

4. Communication: Demonstrate effective communication skills in interactions with clients, families, peers, faculty and others. (AZ Workplace Employability Skill)

5. Critical Thinking: Begin to use theory, and evidence-based practice principles to formulate clinical judgments and enhance professional role development. (Test Plan) (AZ Workplace Employability Skill)

6. Culture: Recognize biological and cultural diversities that impact self and others’ experience with healthcare. (AZ Workplace Employability Skill)

7. Learning/Teaching: Identify own learning needs and styles and then apply learning principles for health promotion, restoration, maintenance and prevention for individuals and families across the life-span.

8. Leadership/Management: Implement basic management skills with individuals, families and other


MCC Form EDU 0007 (rev. 10/07/11)

members of the health care team. (AZ Workplace Employability Skill)


MCC Form EDU 0007 (rev. 10/07/11)

Course Competencies and ObjectivesCourse Competencies and ObjectivesCourse Competencies and ObjectivesCourse Competencies and Objectives

By the end of the By the end of the By the end of the By the end of the semester, students will be able to:semester, students will be able to:semester, students will be able to:semester, students will be able to: Competency 1 Correctly remove sutures and staples within a 5 minute time frame. (Test Plan) Objective 1.1 Confirm physician orders. Objective 1.2 Assess wound appearance (approximation, color of the wound and surrounding area, presence of drainage). Objective 1.3 Follow basic principles of surgical asepsis. Objective 1.4 Assess for the need for analgesic medication. Objective 1.5 Cleanse incision before suture/staple removal. Objective 1.6 Remove sutures/staples using proper technique. Objective 1.7 Document appropriate information.

Competency 2 Correctly perform a manual bladder irrigation within a 10 minute time frame. (Test Plan) Objective 2.1 Confirm physician order. Objective 2.2 Follow basic principles of surgical asepsis. Objective 2.3 Assess for bladder fullness, pain. Objective 2.4 Empty catheter bag prior to starting procedure noting amount, color and characteristics of urine. Objective 2.5 Clamp catheter below injection port. Objective 2.6 Irrigate bladder using correct technique. Objective 2.7 Document appropriate information.

Competency 3 Correctly insert and remove a nasogastric (NG) tube within a 10-15 time period. (Test Plan) Objective 3.1 Confirm physician’s order. Objective 3.2 Perform correct assessment (patency of nares, history of facial trauma, previous surgeries, abdomen). Objective 3.3 Correctly position client (high fowler’s or 45 degrees). Objective 3.4 Measure distance needed to insert tube. Objective 3.5 Insert tube using correct technique. Objective 3.6 Constantly monitor client for signs of distress (gasping, coughing, cyanosis). Objective 3.7 Correctly secure tube. Objective 3.8 Determine the correct placement after insertion. Objective 3.9 Prior to removal, perform abdominal assessment (presence of bowel sounds). Objective 3.10 Confirm correct placement of tube. Objective 3.11 Flush tube with air or water. Objective 3.12 Instruct client to take a deep breath and hold it prior to removal. Objective 3.13 Remove NG tube using correct technique. Objective 3.14 Offer oral hygiene. Objective 3.15 Document appropriately.

Competency 4 Irrigate a nasogastric (NG) tube correctly within a 15 minute time frame. (Test Plan) Objective 4.1 Confirm physician’s order. Objective 4.2 Perform correct assessment of the abdomen (presence of distention, bowel sounds). Objective 4.3 Correctly position client (30-45 degrees). Objective 4.4 Confirm tube placement. (Test Plan) Objective 4.5 Irrigate NG tube using correct technique. Objective 4.6 Reconnect tube to suction. Objective 4.7 Inject air into blue air vent. Objective 4.8 Identify client potential for aspiration. (Test Plan) Objective 4.9 Documents appropriately.

Competency 5 Correctly administer insulin within a 5 minute time limit.. Objective 5.1 Confirm physician’s order. Objective 5.2 Determine compatibility of insulins if mixing. Objective 5.3 Note blood glucose level prior to administration of insulin. Objective 5.4 Follow the 5 Rights of Medication Administration. Objective 5.5 Gently agitate insulin that is in suspension.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 5.6 Draw up insulin using proper technique Objective 5.7 Titrate dose of insulin based on ordered parameters. (Test Plan) Objective 5.8 Document appropriately.

Competency 6 Correctly perform oral and nasopharyngeal suctioning within a 10 minute time limit. Objective 6.1 Perform assessment as needed (lung sounds, respiratory status, history of nasal obstruction/injury). Objective 6.2 Correctly position client (semi-Fowler’s or lateral). Objective 6.3 Follow basic principles of surgical asepsis. Objective 6.4 Insert catheter without suction. Objective 6.5 Perform suction using correct technique. Objective 6.6 Pre-oxygenate and suction no more than 10-15 seconds. Objective 6.7 Allow 30 seconds to 1 minute interval between suction passes. Objective 6.8 Offer or perform oral hygiene. Objective 6.9 Document appropriate information.

Competency 7 Correctly perform a neurological assessment within a 5 minute time limit. (Test Plan) Objective 7.1 Assess mental status (impaired cognition) and speech. (Test Plan) Objective 7.2 Assess cranial nerve function. Objective 7.3 Assess sensory and motor functions. Objective 7.4 Assess reflexes.

Competency 8 Safely and correctly administer parenteral medications according to agency policies and procedures and evidence-based nursing standards. (Clinical Competence, Critical Thinking) (Test Plan) Objective 8.1 Withdraw medication from a vial correctly. Objective 8.2 Open an ampule and withdraw medication correctly. Objective 8.3 Draw up and mix medication from a vial and ampule correctly. Objective 8.4 Draw up and mix medication from a vial and/or ampule and Carpuject correctly. (Test Plan) Objective 8.5 Correctly read insulin orders and draw up NPH insulin. (Test Plan) Objective 8.6 Locate proper intramuscular (IM) and subcutaneous (SQ) injection sites. Objective 8.7 Correctly prepare and administer IM and SQ injections on patient care mannequins using the rights of medication administration. (Test Plan)

Competency 9 Correctly demonstrate intravenous insertion within a 15 minute time limit. (Test Plan) Objective 9.1 Observe standard precautions. Objective 9.2 Accurately calculate given IV flow rate by passing the flow rate quiz at 100%. Objective 9.3 Confirm physician order. Objective 9.4 Assess for conditions that would prevent use of an extremity. Objective 9.5 Maintain asepsis of equipment. Objective 9.6 Prime tubing prior to initiating. Objective 9.7 Cleanse site properly and utilize proper insertion technique. Objective 9.8 Release tourniquet, start flow and stabilize cannula while taping. Objective 9.9 Correctly calculate and regulate flow and accurately document. (Test Plan) Objective 9.10 Monitor use of infusion pump and maintain site. (Test Plan)

Competency 10 Correctly change intravenous solution within a 5 minute time limit. (Test Plan) Objective 10.1 Observe standard precautions and maintain asepsis of equipment and supplies. Objective 10.2 Follow 5 rights of medication administration. Objective 10.3 Close tubing clamp, spike new bag and reestablishe flow rate.

Competency 11 Correctly convert intravenous line to saline lock and appropriately flush it within a 5 minute time limit. (Test Plan) Objective 11.1 Observe standard precautions and maintain asepsis of equipment and supplies. Objective 11.2 Prepare saline lock. Objective 11.3 Assess IV site for inflammation, infection or infiltration. (Test Plan) Objective 11.4 Maintain stability of device throughout procedure and flush lock correctly. Objective 11.5 Accurately document procedure.

Competency 12 Correctly change IV site dressing within a 5 minute time limit. (Test Plan) Objective 12.1 Observe standard precautions and maintain asepsis of site and supplies. Objective 12.2 Assess site for inflammation, infection or infiltration. Objective 12.3 Stabilize cannula during procedure while cleansing site. Objective 12.4 Apply new dressing and label accordingly,.


MCC Form EDU 0007 (rev. 10/07/11)

Competency 13 Correctly discontinue an intravenous infusion within a 5 minute time limit. (Test Plan) Objective 13.1 Observe standard precautions. Objective 13.2 Assess IV site for inflammation, infection or infiltration. Objective 13.3 Remove catheter and confirm catheter is intact. Objective 13.4 Apply pressure for bleeding and documents accordingly.

Competency 14 Correctly demonstrates phlebotomy procedure within a 10 minute time limit. (Test Plan) Objective 14.1 Observe standard precautions. Objective 14.2 Confirm physician order. Objective 14.3 Assess for conditions that would prevent use of extremity. Objective 14.4 Maintain asepsis of supplies and chosen site and cleanses appropriately. Objective 14.5 Stabilize needle while in vein and remove tourniquet during draw of last tube. Objective 14.6 Release last blood tube before withdrawing needle and applies pressure. Objective 14.7 Properly prepare tube for lab and labels.

Competency 15 Correctly change a central line dressing within a 10 minute time limit. (Test Plan) Objective 15.1 Observe standard precautions. Objective 15.2 Properly assess central line site. Objective 15.3 Maintain asepsis of equipment and site. Objective 15.4 Cleanse site and labels dressing while preventing dislodgement of catheter. Objective 15.5 Document procedure correctly. Objective 15.6 Implement best practices or evidence-based guidelines to prevent central line associated bloodstream infections. (National Patient Safety Goal)

Competency 16 Change a central line cap and flush a central line correctly within a 10 minute time limit. (Test Plan) Objective 161 Observe standard precautions. Objective 16.2 Maintain asepsis of equipment and site. Objective 16.3 Confirm catheter is clamped and secure. Objective 16.4 Prepare flush correctly. Objective 16.5 Flush line correctly maintaining stability assuring catheter is clamped prior to inserting or removing syringes. (Test Plan) Objective 16.6 Document correctly.

Competency 17 Orient to Nursing II course. Objective 17.1 Participate in review of syllabus, written paper requirements (care plan, concept maps, process recording) and grading of same, schedule, test taking skills, classroom etiquette, attendance requirements, and exams and rules for taking same. (AZ Workplace Employability Skill) Objective 17.2 Review use of ANGEL, ATI, The Point, Prep U and course manual as critical thinking tools. Objective 17.3 Function competently within own scope of practice as a member of the health care team. (QSEN Competency-Teamwork and Collaboration) Objective 17.4 Initiate requests for help when appropriate to the situation. (QSEN Competency-Teamwork and Collaboration) Objective 17.5 Base individualized care plan on client values, clinical expertise and evidence. (QSEN Competency-Evidence Based Practice)

Competency 18 Apply the Healing Community Nursing Model and the concept of Transitions to the clinical nursing care of adults with chronic health problems in the present health care system. Objective 18.1 Review the definition of nursing and transitions as related to the Healing Community Nursing Model. Objective 18.2 Review critical points within chronic health-illness transitions and identify possible cultural and spiritual implications. Objective 18.3 Review healthy versus unhealthy outcomes in health-illness transitions. Objective 18.4 Describe concepts of health and wellness taking cultural differences and multidimensional aspects of health promotion into consideration. Objective 18.5 Describe factors causing significant changes in today’s health care delivery system and the impact on health care in general and the nursing profession. Objective 18.6 Describe several nursing care delivery models. Objective 18.7 Discuss changes in the health care system that have increased the need for medical-surgical nurses to practice in community-based settings. Objective 18.8 Compare community-based and acute care settings. Objective 18.9 Ascertain why cultural competence is necessary especially in community-based settings.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 18.10 Describe the acute care discharge process in relation to home care preparation and communicate care provided and needed at each transition in care. (QSEN Competency-Patient Centered Care) Objective 18.10a Assess need for supplies and equipment.(Test Plan) Objective 18.10b Explore resources including community and support systems available to assist client in achieving or maintaining independence. (Test Plan) Objective 18.10c Provide client with information on discharge procedures to home and community setting. (Test Plan) Objective 18.10d Identify specific documents to include when referring or transferring a client. (Complete and reconciled medication list) (Test Plan and National Patient safety Goal. Objective 18.10e Assure patient receives a complete and reconciled medication list and that list is explained when leaving the hospital. (National Patient Safety Goal) Objective 18.10f Assess need for home modifications. (Test Plan) Objective 18.10g Apply knowledge of client pathophysiology to home safety interventions. (Test Plan) Objective 18.10i Assess client understanding of and ability to manage self-care in the home environment. (Test Plan) Objective 18.11 Discuss how to prepare for and conduct a home health care visit. Objective 18.12 Define and recognize stages of chronic illness. Objective 18.13 Identify factors related to increasing incidence of chronic illness. Objective 18.14 Describe characteristics and implication of chronic conditions for individuals and their families.

Competency 19 Apply critical thinking, ethical decision making, nursing standards, evidence-based practice and the nursing process to the clinical nursing care of adults with chronic health problems in the present health care system. (Test Plan) (AZ Workplace Employability Skill) Objective 19.1 Describe the relationship between critical thinking characteristics and the nursing process. Objective 19.2 Review the nursing process. Objective 19.2a Implement expectations of a Nursing II student in regard to comprehensive health and risk assessments. (Test Plan) Objective 19.2a1 Effectively utilize the pain rating scale appropriate to age and elicit expectations of client family for relief of pain, discomfort or suffering. (QSEN Patient Centered Care)

Objective 19.2a2 Utilize effective communication and procedure in client interview to determine key components of history and to complete a comprehensive health assessment. Elicit client values, preferences and expressed needs. (QSEN-Patient Centered Care, Test Plan, AZ Workplace Employability Skill) Objective 19.2a3 Compare diagnostic testing results and current client data with previous test results and baseline data, evaluate results and if deviation from normal, intervene as needed. (Recognize trends and notify physician) (Test Plan, AZ Workplace Employability Skill) Objective 19.2a4 Recognize deviations from normal and report critical results of tests (lab) and diagnostic procedures on a timely basis. (National Patient Safety Goal, AZ Workplace Employability Skill) Objective 19.2a5 Assess fluid and electrolyte imbalances, monitor hydration status and manage care. (Test Plan) Objective 19.2a6 Assess emotional status via observation of general demeanor. Objective 19.2a7 Assess how the client views their problem to determine impact and significance on individual/family lifestyle. (Test Plan). Objective 19.2a8 Assess coping skills and ability to adapt to temporary/permanent role changes. (Test Plan) Objective 19.2a9 Correlate clinical assessment parameters and manifestations with pathophysiology. (Test Plan, AZ Workplace Employability Skill) Objective 19.2a10 Assess adaptation of client to health alteration, illness or disease. (Test Plan) Objective 19.2a11 Assess tube drainage during the time the client has an alteration in body system. (Test Plan) Objective 19.2a12 Perform a focused assessment and re-assessment of body system in alteration. (Test Plan) Objective 19.2a13 Monitor client output for changes from baseline. (Test Plan) Objective 19.2a14 Assess client area for sources of infection. (Test Plan) Objective 19.2a15 Assess client perception of health status. (Test Plan) Objective 19.2a16 Identify client and environmental deficits that may impede client safety and communicate observations or concerns to the appropriate person. (QSEN Safety) Objective 19.2a17 Identify the degree of sensory involvement and deficits that may impede client safety.(Test Plan) Objective 19.2a18Identify factors that influence accident/injury prevention. (Test Plan)


MCC Form EDU 0007 (rev. 10/07/11)

Objective 19.2a19 Identify factors including prescriptions for treatments that influence accident/injury prevention. ((Test Plan) Objective 19.2a20 Ascertain client/staff knowledge of safety needs and injury prevention. (Test Plan) Objective 19.2a21 Identify lifestyle practices and assist client to identify same that impact health and memory. (Test Plan) Objective 19.2a22 Assess stressors, including environmental, that affect client care. Objective 19.2a23 Identify client health oriented behaviors. (Test Plan) Objective 19.2a24 Assess food interactions and ability to eat. Test Plan) Objective 19.2a25 Assess client for medication interactions. (Test Plan) Objective 19.2a26 Assess need for consultation with other health care providers and initiate as needed. (Test Plan)

Objective 19.2b Implement expectations of a Nursing II student in regard to planning safe cost effective care. (Test Plan) Objective 19.2b1 Assess importance of culture and ethnicity when planning approaches to care. (Test Plan, AZ Workplace Employability Skill) Objective 19.2b2 Develop plan of care with client/significant other to meet client and significant other’s needs and value the active partnership; examine how effectiveness of health care can improve with active partnerships. (QSEN Patient Centered Care, AZ Workplace Employability Skill) Objective 19.2b3 Apply knowledge of related pathophysiology, nursing procedures and psychomotor skills when client is undergoing diagnostic testing and nursing assessment. (Test Plan) Objective 19.2b4 Identify interventions and safety devices to promote a safe physical environment. Objective 19.2b5 At beginning level, review plan of care to assure continuity across disciplines. (Test Plan) Objective 19.2b6 Consider client self-care needs before developing or revising care plan. (Test Plan) Objective 19.2c Implement expectations of a Nursing II student in regard to nursing therapeutics (Interventions). Objective 19.2c1 Report critical diagnostic values to physician and identify client data that needs to be reported immediately. (Test Plan, AZ Workplace Employability Skill)

Objective 19.2c2 Recognize need for referrals, make appropriate referrals and document action taken. (test plan) (Test Plan, AZ Workplace Employability Skill) Objective 19.2c3 Identify specific documents to include when referring a client. (Test Plan) Objective 19.2c4 Initiate and evaluate outcomes of consultations. (Test Plan, AZ Workplace Employability Skill) Objective 19.2c5 Provide for interdisciplinary team conferences. (AZ Workplace Employability Skill) Objective 19.2c6 Collaborate with other health care team members in other disciplines when providing care (physician, respiratory therapist). (Test Plan, AZ Workplace Employability Skill) Objective 19.2c7 Initiate, evaluate, update plan of care, care map, clinical pathway used to guide and evaluate care. (Test Plan, AZ Workplace Employability Skill) Objective 19.2c8 Use appropriate strategies to reduce reliance on memory. (QSEN Safety)

Objective 19.2c9 Apply knowledge of client pathophysiology to illness management and health screening. (Test Plan) Objective 19.2c10 Promote client progress from an alteration in body systems. (Test Plan) Objective 19.2c11 Act as a client advocate. (Test Plan) Objective 19.2c12 Maintain continuity of care between/among health care agencies. (Test Plan) Objective 19.2c13 Follow up on unresolved issues regarding client care. (Test Plan) Objective 19.2c14 Provide follow-up to the client following participation in health promotion. (Test Plan) Objective 19.2c15 Assist primary caregivers working with client to meet self-care goals. (Test Plan) Objective 19.2c16 Assess client progress from an alteration in body systems. (Test Plan). Objective 19.2c17 Provide support to client in coping with life changes. (Test Plan) Objective 19.2c18 Incorporate client cultural practices and beliefs when planning and providing care. (Test Plan, AZ Workplace Employability Skill)

Objective 19.2c19 Provide care in culture of safety to prevent errors and communicate concerns related to hazards to clients, families and the health care team. (Test Plan, AZ Workplace Employability Skill, QSEN Competency –Safety) Objective 19.2c20 Facilitate safe and appropriate use of equipment. Inspect equipment and if unsafe, participate in removal. (Test Plan) Objective 19.2c21 Place assistive devices within reach. Objective 19.2c22 Follow communication practices that minimize risks associated with handoffs among


MCC Form EDU 0007 (rev. 10/07/11)

providers and across transitions in care. (QSEN Safety, AZ Workplace Employability Skill) Objective 19.2c23 Use precautions to prevent injury and or complications associated with a procedure or diagnosis. (Test Plan)

Objective 19.2c24 Assure implementation of diet modifications. Objective 19.2c25 Monitor clients before, during and after procedure/surgery. (Test Plan)

Objective 19.2c26 Recognize trends and changes in client condition and intervene appropriately. (Test Plan, AZ Workplace Employability Skill) Objective 19.2c27 Verify appropriateness and accuracy of medication orders, including reconciling orders. (Test Plan) Objective 19.2c28 Research action of medications and assess for actual/potential side effects. (Test Plan) Objective 19.2c29 Consider actual/potential incompatibilities/interaction and notify primary health care provider of same. (Test Plan) Objective 19.2c30 Assess for and notify primary health care provider of side effects, adverse effects and contraindications, manage care and document same. (Test Plan, AZ Workplace Employability Skill)

Objective 19.2c31 Review pertinent data prior to medication administration. (Test Plan, AZ Workplace Employability Skill) Objective 19.2c32 Promote recovery of client from unexpected response to therapy. (Test Plan) Objective 19.2c33 Examine how the safety, quality and cost effectiveness of health care can be improved through the active involvement of clients, family and value active partnership with clients or designated surrogates in planning, implementation and evaluation of care. (QSEN Competency-Patient Centered Care) Objective 19.2c34 Describe examples of how technology and information management are related to the quality and safety of client care. (QSEN Cometency-Informatics) Objective 22.2d Implement expectations of a Nursing II student in regard to evaluation and revision of care plan as needed. (Test Plan)

Objective 19.2d1 Evaluate use of stress management techniques. Objective 19.2d2 Assess changes, note complications and appropriateness of therapy/treatment orders. (Test Plan) Objective 19.2d3 Evaluate results of consultations. (Test Plan, AZ Workplace Employability Skill) Objective 19.2d4 Apply knowledge of pathophysiology to monitoring for complications. (Test Plan, AZ Workplace Employability Skill) Objective 19.2d5 Evaluate responses to procedures and treatments. (Test Plan, AZ Workplace Employability Skill) Objective 19.2d6 Evaluate use of medications over time. (Test Plan) Objective 19.2d7 Evaluate therapeutic effects of medications. (Test Plan) Objective 19.2d8 Use clinical decision making/critical thinking when addressing expected effects/outcomes of medications. (Test Plan, AZ Workplace Employability Skill) Objective 19.2d9 Evaluate client understanding of health promotion behaviors/activities. (Test Plan) Objective 19.2d10 Evaluate client alternative or homeopathic health care practices outcomes. (Test Plan)

Objective 19.2d11 Evaluate client response to interventions to correct fluid and electrolyte balance. (Test Plan) Objective 19.3 Explain the importance of nursing codes and standards as guidelines for medical-surgical nursing care. (Test Plan, AZ Workplace Employability Skill) Objective 19.4 Seek examples of how technology and information management are related to quality and safety of nursing care. (QSEN Competency) Objective 19.5 Describe reliable sources for locating evidence reports and clinical practice guidelines. (Test Plan} Objective 19.6 Discuss the National Patient Safety Goals. (National Patient Safety Goals, AZ Workplace Employability Skill) Objective 19.7 Describe how facility standards and guidelines are used as aids in decision making. (AZ Workplace Employability Skill

Competency 20 Apply principles of health education and health promotion to the clinical nursing care of adults (ages 19-0ver 85 years) with chronic health problems in the present health care system. (Test Plan) Objective 20.1 Describe health education and the importance of the client’s adherence to the therapeutic regimen.

Objective 20.1a Educate client on home safety issues. (Test Plan) Objective 20.1b Access data for client via online data bases, journals. (Information Technology) (Test Plan, AZ Workplace Employability Skill) Objective 20.1c Assess readiness to learn, learning preferences and barriers to learning. (Test Plan)


MCC Form EDU 0007 (rev. 10/07/11)

Objective 20.1d Select appropriate teaching method. (Test Plan) Objective 20.1e Educate client regarding purpose and procedure of diagnostic testing.

Objective 20.1f Provide client with information on discharge procedures to home/community setting. Objective 20.1g Teach client principles of infection control and safe use of health care equipment. (Test Plan) Objective 20.1h Teach frequency of recommended diagnostic testing. Objective 20.1i Educate client on methods to prevent complications associated with activity, diagnosed illness or disease. (Test Plan) Objective 20.1j Educate client about medications, treatments and procedures. (Test Plan) Objective 20.1k Provide information to client on common side effects, adverse effects and potential interactions of medications and when to notify primary health provider. (Test Plan) Objective 20.l Provide information about healthy behaviors and heal promotion/maintenance recommendations. (Test Plan) Objective 20.1m Provide information for prevention of high risk behaviors. (Test Plan) Objective 20.1nAssess and teach client about health risks based on known population or community characteristics. (Test Plan) Objective 20.1o Educate client on actions to promote/maintain health and prevent disease. (Test Plan) Objective 20.1p Provide information about healthy behaviors, prevention of high risk behaviors and health promotion/maintenance recommendations. (Test Plan) Objective 20.1q Evaluate client understanding of information given. (Test Plan)

Objective 20.1r Educate client about home management of care and articulate long range plans. (Test Plan) Objective 20.1s Educate client about purpose and procedures of laboratory tests, treatments and nursing care procedures. (Test Plan) Objective 20.2 Review characteristics and components of effective therapeutic communication in client care. Objective 20.3 Identify the impact of personal and client commonalities and diversities on the caring relationship. Objective 20.4 Demonstrate therapeutic communication skills in client interactions. (AZ Workplace Employability Skill)

Objective 20.4a. Use therapeutic communication to provide support to client. (Test Plan) Objective 20.4b Allow time to communicate with client. (Test Plan)

Objective 20.5 Identify the phases of a therapeutic relationship. Objective 20.6 Review defense mechanisms and their impact as you relate them to clinical exemplars. Objective 20.6a Evaluate constructive use of defense mechanisms by client. (Test Plan)

Competency 21 Provide clinically competent nursing care to clients with altered patterns of bowel elimination and gastrointestinal (GI) function. (esophageal reflux disease (GERD), acute and chronic gastritis, diverticulitis, cirrhosis, hepatitis, cholelithiasis, cholecystitis) (AZ Workplace Employability Skill) Objective 21.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of altered bowel elimination and GI function. (Test Plan) Objective 21.1a.Describe the relationship of dental hygiene and dental problems to nutrition. Objective 21.1b.List and explain the types of impaired esophageal motility. Objective 21.1c.Differentiate the types of hiatal hernia. Objective 21.1d Correlate risk factors of chronic gastritis with cancer of the stomach. Objective 21.1e Explain the pathophysiology of appendicitis and how it could lead to peritonitis. Objective 21.1f Compare and contrast pathophysiology, clinical manifestations, diagnostic evaluation and medical/surgical and nursing management of clients with ulcerative colitis and Crohn’s disorders. Objective 21.1g Define hemorrhoids, anal fissure and anal abcess. Objective 21.1h Compare and contrast mechanical versus function colon obstructions. Objective 21.1i Discuss causative organisms of gastroenteritis and modes of infection. Objective 21.1j Compare and contrast the normal metabolic functions of the liver and alterations that occur in these functions with liver disease. Objective 21.1k Differentiate the three types of hepatic cirrhosis. Objective 21.1l Compare and contrast the normal metabolic functions of the gallbladder and alterations that occur with gallbladder dysfunction. Objective 21.2 Identify key physical assessment parameters and diagnostic test results for clients with altered bowel elimination and GI function. (impaired esophageal motility, GERD, cancer of stomach, malabsorptive syndrome, gallbladder disorders, cirrhosis, diverticulitis, inflammatory bowel disease, gastroenteritis, conditions due to parasitic organisms. Objective 21.2a Differentiate the key assessment parameters of the different types of hiatal hernia.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 21.2b Correlate liver function test results with liver pathophysiologic alterations. Objective 21.2c Relate jaundice, portal hypertension, ascites, varices, nutritional deficiencies and hepatic encephalopathy/coma to specific pathophysiological alterations of the liver. Objective 21.2d Identify variables that influence bowel function (diarrhea and constipation). Objective 21.2e Identify client potential for aspiration. (Test Plan) Objective 21.2f Identify client potential for skin breakdown due to nutritional status. (Test Plan) Objective 21.3 Formulate priority nursing diagnoses and plan expected outcomes for clients with altered bowel elimination and GI function by engaging client/significant other in active partnership in planning. Objective 21.3a. Formulate nursing diagnosis and appropriate outcomes for the client with altered bowel elimination including potential complications. Objective 21.3b Formulate priority nursing diagnosis and outcomes for clients with malabsorptive syndrome, inflammatory bowel disdorder, intestinal obstruction, ostomy, cirrhosis and hepatitis. Objective 21.3c Formulate nursing diagnosis and appropriate outcomes for client undergoing laparoscopic cholecystectomy or lithotripsy. Objective 21.4 Identify support interventions for clients during diagnostic testing and nursing care in order to meet psychosocial needs. (Test Plan) Objective 21.4a Describe the appropriate preparation, teaching and follow-up care for clients undergoing diagnostic testing of the GI tract. Objective 21.4b Include frequency of recommended diagnostic testing and dietary considerations in preventative care. Objective 21.5 Identify priority nursing therapeutics (interventions) Including evidence-based practice principles in the plan of care for clients with altered bowel elimination and GI function. (Test Plan) Objective 21.5a Differentiate between the different types of nasogastric/gastric feeding tubes and their placement prior to feeding. Objective 21.5b Explain the pre- and postoperative care of the client with gastrostomy. Objective 21.5c Utilize the nursing process as a framework for care and management of the client receiving an enteral feeding. Objective 21.5d Formulate nursing interventions which support dietary alterations and changes in life style. Objective 21.5e Describe surgical approaches utilized to treat chronic gastritis, peptic ulcer disease and cancer of stomach and resulting nursing care needed. Objective 21.5f Formulate interventions for client with malabsorptive syndrome. Objective 21.5g Describe the nursing management of clients who undergo surgical procedures to treat obesity. Objective 21.5h Compare and contrast nursing care needed for cholelaparotomy versus laparoscopic approaches to surgery including lithotripsy. Objective 21.5i Identify critical nursing interventions when client undergoes liver biopsy. Objective 21.5j Identify critical elements of nursing role in assisting with paracentesis procedure. Objective 21.5k Formulate priority interventions and goals for client with diverticulits. Objective 21.5l Rapidly prepare client for surgery. Objective 21.5m Describe the responsibilities of the nurse in meeting needs of a client with an iliostomy, Objective 21.5n Formulate plan of care for client experiencing gastroenteritis and conditions caused by parasitic organisms. Objective 21.5o Incorporate appropriate cultural and psychosocial interventions for clients with bowel disorders and ostomies. (AZ Workplace Employability Skill) Objective 21.5p Formulate nursing interventions to facilitate client acceptance of ostomy. (Test Plan) Objective 21.5q Develop a plan of care to meet the physiological and psychosocial integrity needs of clients with anorectal disorders. Objective 21.5r Identify supportive measures in meeting psychosocial integrity needs for clients with cirrhosis/hepatitis. Objective 21.5s Utilize principles of wound care in caring for post-surgical incision. (Test Plan) Objective 21.5t. Develop post-operative plan of care for client experiencing intestinal obstruction. Objective 21.5u Compare nursing care differences in conservative treatment versus surgery for anorectal disorders. Objective 21.5v Monitor and maintain devices and equipment used for surgical wound drainage. (Test Plan) Objective 21.6 Formulate teaching plans addressing activity and medications utilized for clients with altered bowel elimination and altered GI function. (Test Plan)


MCC Form EDU 0007 (rev. 10/07/11)

Objective 21.6a. Identify the health care learning needs of clients with constipation or diarrhea. Objective 21.6b. Prepare dietary teaching plan and use of medications for client with diverticulitis. Objective 21.6c Formulate teaching plan for medications that stop acute attacks of inflammatory bowel disorder quickly and addresses dietary management strategies that will assist in lowering inflammation of the bowel. Objective 21.6d Prepare client teaching plan for ostomy care. (Test Plan) Objective 21.6e Teach client hand washing as well as other methods to manage symptoms, prevent complications and spread of infection. Objective 21.6f Formulate teaching plan regarding dietary and fluid management of cirrhosis/hepatitis. Objective 21.6g Prepare teaching plan regarding hepatotoxic drugs to be able to administer safely and teach avoidance of alcohol when client experiences liver dysfunction. Objective 21.6h Formulate teaching plan regarding nutritional management of gallbladder disorders. Objective 21.6i Teach client purpose of T-Tube and nasogastric tube. Objective 21.7 Apply pharmacological management principles for clients with altered bowel elimination and GI function. Objective 21.7a Research usual dosage, side effects and nursing implications of medications commonly prescribed to treat GERD, hiatal hernia, etc. Objective 21.7b. Identify correct dose and nursing implications of combination therapies used to eradicate H. Pylori infection. Objective 21.7c. Identify potential complications of medications utilized to treat alterations in bowel elimination. Objective 21.7d Appropriately utilize pain reduction measures postoperatively. Objective 21.7e Review side effects and nursing implications of broad spectrum antibiotics. Objective 21.8 Identify priority nursing assessments in recognizing complications of altered patterns of bowel elimination and GI function while evaluating achievement of desired outcomes. (Test Plan) Objective 21.8a Identify complications of gastric surgery and their prevention and management. Objective 21,8b Recognize manifestations of dumping syndrome and utilize nursing therapeutics to prevent. Objective 21.8c Recognize signs and symptoms of shock. Objective 21.8d Recognize abnormal diagnostic values and complications of clients with inflammatory bowel disorder. Objective 21.8e Explain the reasons for development of varied complications of liver cirrhosis. Objective 21.8f Recognize complication of esophageal varices and seek emergency assistance.

Competency 22 Provide clinically competent nursing care to clients with altered patterns of oxygenation. Objective 22.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology for altered patterns of oxygenation. (atalectasis, upper respiratory infections and epistaxis: UTI, sinusitis, pharyngitis, tonsillitis, adenoiditis, peritonsillar abscess and laryngitis; influenza(s), lower respiratory tract problems: pneumonia, chronic bronchitis, COPD, bronchiectasis, asthma, tuberculosis, anthrax, fungal infections, occupational lung disease and sarcoidosis, pneumonia, COPD, tuberculosis. (Test Plan, AZ Workplace Employability Skill) Objective 22.1a Discuss causes of altered patterns of oxygenation while identifying pathophysiology related to a chronic condition. Objective 22.1b Identify pathophysiology related to impaired gas exchange and ineffective breathing pattern. Objective 22.1c Review the anatomy and physiology of the respiratory system prior to lecture. Objective 22.1d Review the functions of the upper and lower respiratory tracts prior to lecture. Objective 22.1e Explain the mechanics of ventilation and describe factors affecting respiration. Objective 22.1f Define and describe the assessment of inspiratory force. Objective 22.1g Explain the concept of lung compliance. Objective 22.1h Define the ventilation/perfusion ratio. Objective 22.1i Differentiate the varied types of pneumonic, COPD, tuberculosis. Objective 22.2 Identify physical assessment parameters and diagnostic test results for clients with altered patterns of oxygenation. (atalectasis, upper respiratory infections and epistaxis, influenza(s), pneumonia, chronic bronchitis, COPD, bronchiectasis, asthma, tuberculosis, anthrax, fungal infections, occupational lung disease and sarcoidosis. Objective 22.2a Identify clinical assessment parameters of the respiratory system and identify those which would reflect ineffective airway clearance (to determine characteristics and severity of major symptoms of respiratory dysfunction). Objective 22.2b Choose physical assessment equipment and techniques appropriate for the client. (Test Plan) Objective 22.2c Identify clinical assessment parameters of the respiratory system which would reflect impaired gas exchange and ineffective breathing pattern.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 22.2d Utilize effective communication techniques in client interview to determine key components of respiratory history and to complete a comprehensive health assessment. (AZ Workplace Employability Skill) Objective 22.2e Discriminate between normal and abnormal breath sounds. Objective 22.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients with altered patterns of oxygenation. Objective 22.3a Identify outcomes/evaluation criteria for clients with dyspnea, impaired gas exchange and ineffective breathing pattern. Objective 22.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 22.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients with altered patterns of oxygenation. (Test Plan) Objective 22.5a Identify appropriate nursing therapeutics for ineffective airway clearance. Objective 22.5b Identify the nurse’s role in treatments (nursing therapeutics) used to improve elimination of secretions. Objective 22.5c Formulate specific nursing interventions to prevent atalectasis. Objective 22.5d Identify the nurse’s role in treatments used to improve ventilation and remove secretions (pulmonary hygiene). (Test Plan) Objective 22.5e Identify laboratory values for arterial blood gases and recognize deviations from normal. Monitor serial results and notify primary health care provider as needed. (Test Plan) Objective 22.5f Monitor oxygenation via pulse oximetry to verify maintenance/improvement in O2 saturation. (Test Plan) Objective 22.5 g Perform suction as needed to clear secretions: oral, nasopharngeal and nasotracheal (pulmonary hygiene). (Test Plan) Objective 22.5 h Encourage slower deeper respirations to assist client in taking control. Objective 22.5i Identify nurse’s role in treatments and complementary therapies in management of upper respiratory infections, influenza(s), epistaxis and lower respiratory chronic conditions. Objective 22.5j Manage care of client with impaired oxygenation and appropriately administer oxygen. (Test Plan) Objective 22.5k Encourage client participation and provide information in appropriate behavior modification programs related to health and wellness such as stress management and smoking cessation. (Test Plan) Objective 22.6 Formulate teaching plans addressing activity and education utilized for clients with altered patterns of oxygenation. (Test Plan) Objective 22.6a Demonstrate/assist client in performing specific airway clearance techniques (pulmonary hygiene). (Test Plan) Objective 22.6b Educate client regarding rationale and importance of oxygen order and no smoking (safety). Objective 22.6c Provide information for prevention of high risk health behaviors such as smoking cessation. (Test Plan) Objective 22.6d Outline preventative health care teaching for clients with upper respiratory infections; educate client/staff regarding infection control measures. Objective 22.6e Assess and teach client health risks of respiratory conditions based on known population or community characteristics. (Test Plan) Objective 22.6f Teach clients the medications regimes of asthma and tuberculosis. (Test Plan) Objective 22.6g Teach client purpose of HEPA filtered respirator and appropriate masking for visitors and staff and when client is outside of room. Objective 22.6h Identify and teach appropriate clients the significance of the public health threat of tuberculosis as related to importance of screening and disease transmission. Objective 22.7 Apply pharmacological management principles for clients with altered patterns of oxygenation. Objective 22.7a Administer bronchodilators as ordered after evaluating appropriateness/accuracy of medication order for client. Educate client on self-administration. (Test Plan) Objective 22.7b Evaluate effectiveness of aerosol/nebulizer treatments. Objective 22.7c Identify medication common to respiratory system and nursing implications: allergic symptoms, actual/potential incompatibilities and managing side effects. Objective 22.7d Identify medications used in treatment of upper and lower respiratory infections and chronic conditions. Objective 22.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing altered patterns of oxygenation. (Test Plan)


MCC Form EDU 0007 (rev. 10/07/11)

Objective 22.8a Assess changes, note complication and appropriateness of therapy. Objective 22.8b Observe for respiratory distress and other notable complications and identify client data that needs to be reported immediately. (Test Plan) Objective 22.8c Educate client regarding bronchodilator medications and assess client technique for self-administration. Objective 22.8d Evaluate client use of stress management techniques.

Competency 23 Provide clinically competent nursing care to clients with nutritional and endocrine disorders. Objective 23.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered endocrine function: hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoparathyroidism, Addison’s Disease, Cushing’s Syndrome and diabetes. (Test Plan, AZ Workplace Employability Skill) Objective 23.1a Review the functions of the endocrine glands and the negative feedback system regarding their hormones as preparation for class. Objective 23.1b Review the anatomy and physiology of the endocrine system independently in preparation for class. Objective 23.1c Define common terminology associated with chronic endocrine disorders and nutritional deficits which are associated with hypothyroidism, hyperthyroidism, goiters, thyroid crisis, parathyroid disorders, adrenal disorders, pituitary disorders and diabetes mellitus. Objective 23.1d Differentiate pathophysiology and risk factors of Type I and Type II Diabetes. Objective 23.1e Distinguish between Type I and Type II Diabetes Classifications. Objective 23.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered endocrine function: hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoparathyroidism, Addison’s Disease, Cushing’s Syndrome and diabetes. Objective 23.2a Identify clinical assessment parameters of the endocrine system which would indicate risk for imbalanced nutrition less than body requirements. Objective 23.2a1 Apply knowledge of nutrition to assessing client weight. (Test Plan) Objective 23.2b Identify clinical assessment parameters of the endocrine system which would indicate risk for imbalanced nutrition more than body requirements, risk for unstable glucose levels. Objective 23.2c Identify clinical assessment parameters of the endocrine system which would indicate risk for falls. Objective 23.2c1 Assess and evaluate correct use of assistive devices. (Test Plan) Objective 23.2d Identify clinical assessment parameters of the endocrine system which would indicate risk for ineffective health maintenance, knowledge deficit. Objective 23.2e Identify the diagnostic tests used to determine alterations in function of each of the endocrine glands. Objective 23.2e1 Compare and contrast manifestations and diagnostic test results of hypothyroidism and hyperthyroidism. Objective 23.2e2 Perform glucose monitoring. (Test Plan) Objective 23.2f Identify signs and symptoms of client fluid and/or electrolyte imbalance. (Test Plan) Objective 23.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered endocrine function. Objective 23.3a Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing risk for imbalanced nutrition, less than body requirements; more than body requirements, risk for unstable blood glucose; risk for falls; risk for ineffective health maintenance and knowledge deficit. Objective 23.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 23.4a Note influence of cultural/religious factors impacting dietary practices, taking responsibility for own care and expressions of outcomes and incorporate cultural religious factors into care. (AZ Workplace Employability Skill) Objective 23.4b Evaluate client’s social situation for factors that influence diabetic treatment and education plan. Objective 23.4c Provide support to client in coping with life changes such as newly diagnosed diabetes. (Test Plan) Objective 23.4d Assist client with planning and implementing problem-solving strategies for areas of client’s concern regarding their health condition. Objective 23.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experience chronic altered endocrine function including hypothyroidism, hyperthyroidism, hypo-hyperparathyroidism, Addison’s and Cushings, Diabetes) (Test Plan) Objective 23.5a Consult dietitian to implement interdisciplinary team management in risk for altered nutrition, less than body requirements. (AZ Workplace Employability Skill) AZ Workplace Employability Skill


MCC Form EDU 0007 (rev. 10/07/11)

Objective 23.5b Formulate specific nursing interventions for the client requiring total or subtotal thyroidectomy. Objective 23.5c Apply knowledge of pathophysiology when caring for client experiencing a medical emergency as Addisonian Crisis or complication of diabetes. Objective 23.5d Recognize complications of diabetes and make appropriate decisions regarding treating of hypoglycemia and diabetic ketoacidosis. Identify data that needs to be reported immediately. (Test Plan) Objective 23.5e Develop and implement a plan of care based on the physiological and psychosocial integrity needs of client with diabetes undergoing surgery. Objective 23.5f Recognize long term complications of diabetes and make appropriate decisions regarding treatment. Objective 23.5g Manage client who has alteration in nutritional intake. (Test Plan) Objective 23.6 Formulate teaching plans addressing activity and educations utilized for clients experiencing chronic altered endocrine function. (Test Plan) Objective 23.6a Formulate a teaching plan for client on corticosteroid therapy. (Test Plan) Objective 23.6b Formulate teaching plan for client on insulin and include blood glucose testing and use of protective equipment when using devices such as syringes which can cause injury. (Test Plan) Objective 23.6c Promote compliance in the client with diabetes. Objective 23.6d Explain emergency interventions to the client. Objective 23.6e Teach sick day rules to the diabetic client. Objective 23.6f Prepare a diabetic teaching plan including lifestyle modifications, nutritional planning, exercise plan and anti-diabetic medication or insulin self management as well as self care activities to prevent long term complications. Take culture into consideration. (Test Plan) Objective 23.7 Apply pharmacological management principles for clients experiencing chronic altered endocrine function. Objective 23.7a Identify and teach pertinent information regarding medications used in treatment of hypothyroidism and hyperthyroidism. Include common side effects, adverse effects, potential interactions and when to call the primary health provider. (Test Plan) Objective 23.7b State the definition of insulin and explain its action. Objective 23.7c Identify the functions of insulin for the client with diabetes. Objective 23.7d Identify the correct procedure for administering insulin. Objective 23.7e Identify the functions of oral hypoglycemic for the client with diabetes. Objective 23.7f Identify oral hypoglycemic used in treatment of diabetes. Objective 23.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered endocrine function including hypothyroidism, hyperthyroidism, hypo-hyperparathyroidism, etc. (Test Plan) Objective 23.8a Consider client choices regarding meeting nutritional requirements when diagnosis of risk for impaired nutrition, less than body requirements. Objective 23.8b Evaluate the impact of disease/illness on nutritional requirements. (Test Plan)

Competency 24 Provide clinically competent nursing care to clients with altered cardiac and circulatory function. Objective 24.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered chronic cardiac and circulatory function: (congestive heart failure, cardiomyopathy, coronary artery disease, angina pectoris, atherosclerosis and cardiovascular disease). (Test Plan, AZ Workplace Employability Skill) Objective 24.1a Define selected cardiac terms. Objective 24.1b Review the conduction system of the heart. Objective 24.1c Relate the concepts of cardiac cycle and cardiac output. Objective 24.1d Define cardiac output and identify what factors influence it. Objective 24.1e Outline the determinants of cardiac output. Objective 24.1f Apply the concepts of preload, afterload and Starling’s Law to the care of client with chronic alteration in cardiac function and circulation. Objective 24.1g Discuss the concept of cardiac index. Objective 24.1h Differentiate between modifiable and non-modifiable risk factors. Objective 24.1i Differentiate right and left heart failure. Objective 24.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered chronic cardiac and circulatory function. (angina pectoris, myocardial infarction, cardiomyopathy, congestive heart failure; impaired tissue and cardiac tissue perfusion; pain related to decreased tissue perfusion; knowledge deficit of


MCC Form EDU 0007 (rev. 10/07/11)

cardiac issues; ineffective health maintenance; activity intolerance related to imbalanced oxygen supply and demand; and coping issues. (Test Plan-peripheral edema) Objective 24.2a Identify clinical assessment parameters of cardiac system which would reflect decreased cardiac output. (Test Plan) Objective 24.2b Incorporate assessment of functional health patterns and cardiac risk factors into the health history and physical assessment of client with chronic cardiovascular disease utilizing effective interview techniques. Objective 24.2c Differentiate the different types of angina, cardiomyopathy.. Objective 24.2d Recognize abnormal results of blood studies and follow reporting system. (Test Plan) Objective 24.2e Compare baseline results with progressive testing in congestive heart failure including serum electrolytes, urinalysis, BUN, Creatinine, blood gasses, ANF, ANH, BNP, etc. (Test Plan) Objective 24.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered cardiac and circulatory function. (angina pectoris, myocardial infarction cardiomyopathy, congestive heart failure, Objective 24.3a Identify outcome evaluation criteria for clients with decreased cardiac output, impaired tissue perfusion, pain related to decreased tissue perfusion; knowledge deficit of cardiac issues; ineffective health maintenance; activity intolerance related to imbalanced oxygen supply and demand; and coping issues. Objective 24.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 24.4a Discuss end of life care for client with chronic heart failure. Objective 24.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experiencing chronic altered cardiac and circulatory function. (angina pectoris, myocardial infarction, cardiomyopathy, congestive heart failure) (Test Plan) Objective 24.5a Identify the nurse’s role in treatment used to improve and maintain circulation for clients with decreased cardiac output. (Provide client with strategies.) (Test Plan) Objective 24.5b Determine VS, etc. to provide baseline for comparison to follow trends and evaluate response to interventions. Objective 24.5c Monitor intake and output and calculate 24 hour fluid balance. (Test Plan) Objective 24.5d Identify key nursing interventions in care of client undergoing cardiac catheterization both pre-and post-operatively (Assessing peripheral pulses, positioning client to prevent complications, monitoring for bleeding, assessing for dysrhythmia). (Test Plan) Objective 24.6 Formulate teaching plans addressing activity and education utilized for clients experiencing chronic altered cardiac and circulatory function. (Test Plan) Objective 24.6a Prepare teaching plan which outlines approaches to changing life style and dealing with modifiable risk factors. Objective 24.6b Discuss significant signs and symptoms and danger signs that require prompt reporting to healthcare provider. Objective 24.6c Instruct BP monitoring at home. Objective 24.6d Formulate teaching plan which address medication regimen usually ordered for client with myocardial infarction, cardiomyopathy and congestive heart failure. (Test Plan) Objective 24.7e Prepare teaching plan relative to cardiac rehabilitation program, risk factor modification, smoking cessation, exercise, hypertension control and principles of dietary management. Objective 24.7f Develop discharge plan including teaching for patient with cardiomyopathy. Objective 24.7 Apply pharmacological management principles for clients experiencing chronic altered cardiac and circulatory function. Objective 24.7a Identify common medications and pharmacological measures used in treating chronic alterations of cardiac function. Objective 24.7b Outline purpose, action, route, side effects and nursing implications of administering digitalis, nitrates, beta blockers, calcium channel blockers, anti-platelet and other related drugs to clients with angina pectoris and myocardial infarction. Objective 24.7c Evaluate therapeutic effects of pain medications. (Test Plan) Objective 24.7d Recognize signs of digitalis toxicity. Objective 24.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered cardiac and circulatory function. (angina pectoris, myocardial infarction, cardiomyopathy and congestive heart failure) (Test Plan) Objective 24.8a Recognize long term complications of myocardial infarction. (Test Plan)

Competency 25 Provide clinically competent nursing care to clients with alterations in peripheral circulation. (chronic


MCC Form EDU 0007 (rev. 10/07/11)

peripheral vascular, hematologic and lymphatic disorders) (Buerger’s and Raynaud’s Disease, disorders of venous circulation, thrombophlebitis, primary and secondary hypertension, anemia) (AZ Workplace Employability Skill) Objective 25.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered peripheral circulation. (Test Plan) Objective 25.1a Review the anatomy and physiology of the peripheral vascular circulatory system prior to lecture. Objective 25.1b Review factors affecting circulation. Objective 25.1c Review regulators of and factors affecting blood pressure. Objective 25.1d Discuss Virchow’s Triad associated with thrombophlebitis. Objective 25.1e Differentiate primary and secondary hypertension. Objective 25.1f Describe the process of hematopoiesis. Objective 25.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered peripheral circulation. Objective 25.2a Differentiate clinical manifestations of arterial insufficiency versus venous insufficiency. Objective 25.2b Recognize manifestations of thrombophlebitis. Objective 25.2c Appropriately classify blood pressure of adults. Objective 25.2d Identify clinical assessment parameters commonly ordered in secondary hypertension. Objective 25.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered peripheral circulation. Objective 25.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 25.4a Prepare client for diagnostic studies utilized with thrombophlebitis. Objective 25.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experience chronic altered peripheral circulation.(hypertension, thrombophlebitis, chronic venous insufficiency, varicose veins, hypertension, anemia.) (Test Plan) Objective 25.5a Identify prophylactic measures utilized for hospitalized clients at risk for thrombophlebitis and identify clients at risk. Objective 25.6 Formulate teaching plans addressing activity and education utilized for clients experiencing chronic altered peripheral circulation. (Test Plan) Objective 25.6a Formulate a teaching plan addressing smoking, diet, exercise and periodic screening for complications. Objective 25.6b Formulate teaching plan for client experiencing varicosities. Objective 25.6c Formulate teaching plan stressing lifestyle modifications for client experiencing hypertension. Objective 25.7 Apply pharmacological management principles for clients experiencing chronic altered peripheral circulation. Objective 25.7a Discuss action, purpose, side effects and nursing implications of administering anti-coagulant therapy; reduce the likelihood of harm associated with use of anticoagulant therapy. (National Patient Safety Goal) Objective 25.7b Correctly follow medication administration orders for antihypertensive medications. Objective 25.7c Discuss pharmacological guidelines followed in pharmacologic control of hypertension. Objective 25.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered peripheral circulation. (Test Plan) Objective 25.8a Recognize complications of thrombophlebitis and evaluate achievement of desired outcomes. (Test Plan)

Competency 26 Provide clinically competent nursing care to clients with altered sensory function. Objective 26.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered sensory function. (integumentary disorders, ocular disorders, ear disorders) (Test Plan, AZ Workplace Employability Skill) Objective 26.1a Identify and describe primary and secondary skin lesions and their pattern and distribution. Objective 26.1b Discuss the consequences of diabetes and HIV on the sensory organs. Objective 26.1c Review anatomy, physiology and functions of the external, middle and inner ear. Objective 26.1d Explore the role of the inner ear in balance and equilibrium. Objective 26.1eDifferentiate problems of the external ear from those of middle and inner ear. Objective 26.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered sensory function. (risk for or actual impaired skin integrity, risk for infection, pain due to impaired skin integrity, impaired sensory perception, risk for injury, ocular disorders, hearing disorders) (Test Plan) Objective 26.2a Recognize common skin eruptions and manifestations associated with systemic disease.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 26.2b Describe the components of physical assessment that are most useful when examining the skin, hair and nails. Objective 26.2c Discuss common skin tests and procedures used in diagnosing skin and related disorders. Objective 26.2d Identify deficits in hearing that may impede client safety. (Test Plan) Objective 26.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered sensory function. Focus is on risk for or altered skin integrity, risk for infection, risk for increased pain, risk for impaired sensory perception and risk for injury. Objective 26.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 26.4a Identify ways to communicate effectively with client with hearing disorder. Objective 26.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experiencing chronic altered sensory function. (Test Plan) Objective 26.5a Identify nurse’s role in treatment used to improve or maintain skin integrity (needed assessments and interventions.) Objective 26.5b Apply principles of infection control. (Test Plan) Objective 26.5c Describe the general management of client with abnormal skin condition. Objective 26.5d Use the nursing process as a framework for care of the client with psoriasis, pruritis, noninfectious, inflammatory dermatoses, secretory disorders, skin infections and blistering disorders. Objective 26.5e Describe the management and nursing care of client with skin cancer and benign tumors. Objective 26.5f Compare the nursing care needs of various types of dermatologic and plastic reconstructive surgeries. Objective 26.5g Use the nursing process as a framework for care of client undergoing facial reconstructive surgery. Objective 26.5h Compare the various types of surgical procedures used for managing middle ear disorders and appropriate nursing care. Objective 26.6 Formulate teaching plans addressing activity and education utilized for clients experiencing chronic altered sensory function. (Test Plan) Objective 26.6a Identify health education needs of the client with infections of the skin and parasitic skin diseases. Objective 26.6b Describe the teaching topics that need to be addressed for clients undergoing middle-ear and mastoid surgery. Objective 26.7 Apply pharmacological management principles for clients experiencing chronic altered sensory function. Objective 26.7a Administer analgesics as needed and comply with requirements governing controlled substances. Objective 26.7b Demonstrate installation of eye drops and ointments. Objective 26.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered sensory function. Focus is on risk for or altered skin integrity, risk for infection, risk for increased pain, risk for impaired sensory perception and risk for injury, (Test Plan)

Competency 27 Provide clinically competent nursing care to clients with alterations in sensory, cognition and perception. Objective 27.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered in cognition and perception. (headache, infectious disease (Creutazfeldt-Jakob), cranial nerve disorders (Trigeminal Neuralgia, Bell’s Palsy), degenerative neurological syndromes (Muscular Dystrophy, Post-Polio Syndrome, Amyotrophic Lateral Sclerosis, Huntington’s Disease), peripheral neuropathy, disorders of immune, origin, seizure, degenerative disk disease, trans-ischemic attack, stroke, ) (Test Plan, AZ Workplace Employability Skill) Objective 27.1a Review the anatomy and physiology of the nervous system defining overall function and including cranial nerves. Objective 27.1b Identify the antecedent events including risk factors leading to health/illness transitions due to alteration in neurological system related to changes in level of consciousness. Objective 27.1c Review Parkinson’s and Alzheimer’s Disease covered in Nursing I. Objective 27.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered cognition and perception function. (Test Plan) Objective 27.2a Identify clinical assessment parameters of neurological system which would reflect risk for injury, impaired memory, ineffective health maintenance, knowledge deficit, body image disturbance. Objective 27.2b Identify deficits that may impede client safety. (Test Plan) Objective 27.2c Assess client’s degree of sensory impairment. (Test Plan) Objective 27.2d Assess lifestyle practice that may impact memory, health. (Test Plan) Objective 27.2e Review health history data that is essential for assessment of the neurological system and varied levels of consciousness so assessment of client for abnormal neurological status can be completed.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 27.2f Correctly utilize and interpret the Glasgow Coma Rating Scale in client assessment. Objective 27.2g Correlate lab and diagnostic test results with assessment date related to nervous system disorders and compare diagnostic testing findings with pre-test results. (Test Plan) Objective 27.2h Recognize and cluster significant assessment data for clients experiencing health illness transition due to headache, infectious disease (Creutazfeldt-Jakob), cranial nerve disorders (Trigeminal Neuralgia, Bell’s Palsy), degenerative neurological syndromes (Muscular Dystrophy, Post-Polio Syndrome, Amyotrophic Lateral Sclerosis, Huntington’s Disease), peripheral neuropathy, disorders of immune origin (Multiple Sclerosis, Myasthenia Gravis), alterations in vertebral structure, TIA and stroke) Objective 27.2i Differentiate the different types of seizure activity by assessment and identify time, place and stimuli surrounding the appearance of symptoms. (Test Plan) Objective 27.2j Differentiate the different types of stroke and correlate with planned outcomes. Objective 27.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered cognition and perception. (unconscious client, headache, infectious disease (Creutazfeldt-Jakob), cranial nerve disorders (Trigeminal Neuralgia, Bell’s Palsy), degenerative neurological syndromes (Muscular Dystrophy, Post-Polio Syndrome, Amyotrophic Lateral Sclerosis, Huntington’s Disease), peripheral neuropathy, disorders of immune origin, altered vertebral structure, TIA and stroke) Objective 27.3a Perform thorough assessment regarding safety issues when planning for client care and or preparing for discharge from care. Objective 27.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 27.4a Implement nursing interventions which facilitate the improvement of coping measures and lessoning of fears for clients with seizure. Objective 27.4b Develop a plan of care based on psychosocial integrity needs of clients experiencing TIA/stroke. Objective 27.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experiencing chronic altered cognition and perception function. (headache, infectious disease (Creutazfeldt-Jakob), cranial nerve disorders (Trigeminal Neuralgia, Bell’s Palsy), degenerative neurological syndromes (Muscular Dystrophy, Post-Polio Syndrome, Amyotrophic Lateral Sclerosis, Huntington’s Disease), peripheral neuropathy, disorders of immune origin, altered vertebral structure, TIA and stroke) (Test Plan) Objective 27.5a Identify the nurse’s role in treatment of clients at risk for injury and maintain the client safe from injury. Objective 27.5b To evaluate source/degree of risk inherent in the individual situation, Identify factors that influence accident and injury prevention. Objective 27.5c Examine ethical issues that may arise in health care of client with dysfunction in cognition/perception. (Test Plan) Objective 27.5d identify areas in care of clients with dysfunction of cognition perception that would benefit from increased nursing research or evidence based practice principles. Objective 27.5e Recognize complications of neurological disorders. Objective 27.5f Identify the priority nursing interventions for the unconscious client. Objective 27.5g Identify key assessment parameters and nursing interventions during seizure activity. (Test Plan) Objective 27.5h Outline the nurse’s role in emergency treatment of TIA and stroke. Objective 27.6 Formulate teaching plans addressing activity and educations utilized for clients experiencing chronic altered cognition and perception function. (Test Plan) Objective 27.6a Identify individual needs and resources for safety education. (Test Plan) Objective 27.6b Design teaching plan regarding medications ordered for seizure disorder. (Test Plan) Objective 27.7 Apply pharmacological management principles for clients experiencing chronic altered cognition and perception function. Objective 27.7a Determine client’s response to and effect of medications. (Test Plan) Objective 27.7b Recognize the accepted pharmacological treatment parameters for clients with seizure disorders. Objective 27.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered cognition and perception function. (headache, infectious disease (Creutazfeldt-Jakob), cranial nerve disorders. (Test Plan)

Competency 28 Provide clinically competent perioperative nursing care. (AZ Workplace Employability Skill) Objective 28.1 Discuss general perioperative principles. Objective 28.1a Outline the classifications of surgical procedures. Objective 28.1b Compare and contrast differences and similarities between inpatient and outpatient surgery.


MCC Form EDU 0007 (rev. 10/07/11)

Objective 28.1c Review the three phases of perioperative nursing. Objective 28.1d Relate the principles of surgical asepsis. Objective 28.1e Describe the interdisciplinary approach to the client during surgery and explain the roles of surgical team members during the intra-operative phase of care. (Test Plan) Objective 28.1f Describe the variables that influence wound healing. (Test Plan) Objective 28.1g Compare various types of anesthesia with regard to uses as to advantages, disadvantages. Objective 28.2 Conduct a comprehensive preoperative assessment to identify surgical risk factors. (risk for infection, anxiety, pain). Objective 28.2a Identify health factors that affect the client preoperatively. Objective 28.2b Identify the surgical risk factors related to age-specific and condition-specific populations. Objective 28.2c Identify clinical assessment parameters of pain which would reflect pain related to decreased tissue perfusion. Objective 28.2d Recognize both verbal and nonverbal clues of anxiety. (Test Plan) Objective 28.2e Recognize abnormal values in the usual diagnostics completed prior to surgery. (Test Plan) Objective 28.2f Identify assessment parameters for the early detection of post-operative complications. Objective 28.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing surgery. Objective 28.4 Identify support interventions for clients during the perioperative experience in order to meet psychosocial needs. Objective 28.4a Identify the nurse’s role in interventions used to decrease anxiety episodes and improve client’s coping skills in stressful situations. Objective 28.4b Recognize the importance of individual cultural practices and tradition and their effect on the post-operative experience. (AZ Workplace Employability Skill) Objective 28.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experiencing surgery. Objective 28.5a Identify the nurse’s role in treatment used to improve and prevent pain issues related to decreased tissue perfusion. Objective 28.5b Identify preoperative nursing measures that decrease the risk for skin infection and other postoperative complications. Objective 28.5c Identify the immediate preoperative preparation measures of the client. (Test Plan) Objective 28.5d Outline nursing responsibilities as related to anesthesia and assess client response to recovery from local, regional or general anesthesia. (Test Plan) Objective 28.5e Identify adverse effects of surgery and anesthesia. Objective 28.5f Use the nursing process for optimizing client outcomes during the intra-operative period. Objective 28.5g Describe the responsibilities of the post-anesthesia unit nurse in the prevention of immediate post-operative complications. (Test Plan) Objective 28.5h Compare postoperative care of the ambulatory surgery client with that of the hospitalized surgery client. Objective 28.5i Utilize principles of pain management specific to the acute post-operative pain control and consider cultural differences. (Test Plan, AZ Workplace Employability Skill) Objective 28.5j Describe the gerontological considerations related to post-operative management. Objective 28.5k Identify common post-operative problems and their management. Objective 28.5l Demonstrate post-operative dressing techniques. Objective 28.5m Monitor client for signs of bleeding. (Test Plan) Objective 28.6 Develop a perioperative teaching plan designed to promote the client’s recovery from anesthesia and surgery, to prevent postoperative complications. (Test Plan) Objective 28.6a Incorporate effective communication skills while discharge teaching. (AZ Workplace Employability Skill) Objective 28.7 Apply pharmacological management principles for clients experiencing surgery. Objective 28.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing surgery. (Test Plan) Objective 28.9 Consider legal/ethical factors in perioperative nursing. (Test Plan) Objective 28.9a Consider legal/ethical factors as related to informed consent. (Test Plan) Objective 28.9b Describe the role of the nurse in ensuring client safety outcomes such as pre-procedure verification process, marking of procedure site and time-out during the perioperative experience. (National Patient Safety Goal) Objective 28.9c Verify that client comprehends and consents to care/procedures especially those requiring


MCC Form EDU 0007 (rev. 10/07/11)

informed consent. (Test Plan)

Competency 29 Provide clinically competent nursing care to clients with altered urinary elimination. (AZ Workplace Employability Skill) Objective 29.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered urinary elimination. (acute and chronic glomerulonephritis, nephrotic syndrome, renal failure, acute and chronic pyelonephritis, urolithiasis, nephrolithiasis) (Test Plan) Objective 29.1a Review the anatomy and physiology of the renal and urinary systems prior to class. Objective 29.1b Review the concepts of filtration, absorption and reabsorption; Renin-Angiotensin System. Objective 29.1c Review causative factors of urinary tract infection. Objective 29.1d Define ureterolithotomy, pyelolithotomy, nephrolithotomy and cystoscopy. Objective 29.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered urinary elimination. Objective 29.2a Identify questions to elicit subjective data from client concerning urinary elimination history. (Test Plan, AZ Workplace Employability Skill) Objective 29.2b Recognize abnormal diagnostics relative to urinary tract infections and chronic disorders. (Test Plan) Objective 29.2c Correctly obtain urine specimens. (Test Plan) Objective 29.2d Identify clinical manifestations of acute and chronic glomerulonephritis; acute and chronic pyelonephritis, uterolithiasis, nephrolithiasis, nephritic syndrome, renal failure. Objective 29.2e Assess for signs and symptoms of fluid volume excess. (Test Plan) Objective 29.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered urinary elimination. Objective 29.3a Formulate nursing diagnoses and nursing outcomes for client undergoing urinary tract surgery. Objective 29.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 29.4a Prepare client for cystoscopy. Objective 29.4b Consider psychosocial and cultural aspects when caring for client with urinary elimination disorder. Objective 29.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experience chronic altered urinary elimination. (Test Plan) Objective 29.5a Formulate a nursing care plan for client with chronic renal disease. (glomerulonephritis, pyelonephritis) Objective 29.5b Keep accurate intake and output and daily weight records. (Test Plan) Objective 29.5c Formulate a nursing care plan for client with urinary incontinence and urinary retention. Objective 29.5d Provide clinically correct catheter care. (Test Plan) Objective 29.5e Plan appropriate treatments for incontinent client. Objective 29.5f Formulate nursing interventions for client with urinary calculi. Objective 29.5g Develop a postoperative plan of nursing care for client undergoing kidney and urinary tract surgery. Objective 29.6 Formulate teaching plans addressing activity and educations utilized for clients experiencing chronic altered urinary elimination. (Test Plan) Objective 29.6a Formulate teaching plan for client with urinary calculi based on prevention of same. Objective 29.6b Develop a teaching plan for client undergoing kidney and urinary tract surgery. Objective 29.7 Apply pharmacological management principles for clients experiencing chronic altered urinary elimination. Objective 29.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered urinary elimination. (Test Plan) Objective 29.8a Identify assessment parameters appropriate for early detection of postoperative complications. (Test Plan)

Competency 30 Provide clinically competent nursing care to clients with altered immune function and cancer disorder. Objective 30.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered immune function and cancer disorder. (Hodgkin’s, Non-Hodgkin’s, Leukemia, bone tumors, brain tumor, oral cancer, laryngeal, thyroid, breast, lung, colorectal, malignant melanoma). (Test plan, AZ Workplace Employability Skill) Objective 30.1a Relate the principles of internal consistency, homeostasis, stress, and adaptation to the concept of the steady state. Objective 30.1b Identify the significance of the body’s compensatory mechanisms in promoting adaptation and


MCC Form EDU 0007 (rev. 10/07/11)

maintaining the steady state. Objective 30.1c Identify physiologic and psychosocial stressors including environmental that affect client care. (Test Plan) Objective 30.1d Review the inflammatory and reparative processes. Objective 30.1e Describe the body’s general immune responses, stages of the immune response and differentiate between cellular and humoral immune responses. (Test Plan) Objective 30.1f Describe the effects of selected variables on function of the immune system. Objective 30.1g Compare the different types of primary immunodeficiency disorders as to their causes, clinical manifestations, management, potential complications and common treatment modalities. Objective 30.1h Describe the modes of transmission, pathophysiology and physiology underlying the clinical manifestations of HIV infection. Objective 30.1i Compare the structure and function of the normal cell with the cancer cell. (Test Plan) Objective 30.1j Differentiate between benign and malignant tumors. Objective 30.1k Identify agents that have found to be carcinogenic. Objective 30.2 Identify physical assessment parameters and diagnostic test results in clients experiencing chronic altered immune function and cancer disorder to determine client’s status of immune function. Objective 30.2a Identify clinical assessment parameters for clients for risk for imbalanced nutrition less than body requirements. Objective 30.2b Determine all factors that can affect ingestion such as client’s ability to eat and/or digestion of nutrients. Objective 30.2c Assess for actual/specific drug/food interactions and disease effects that may be affecting appetite. Objective 30.2d Assess weight to establish baseline. (Test Plan) Objective 30.2e Assist in nutritional assessment and apply knowledge of mathematics to client nutrition. (Test Plan) Objective 30.2f Identify clinical assessment parameters which would reflect fluid volume deficit, pain, fatigue, impaired oral mucosa. Objective 30.2g Identify clinical assess parameter of integumentary system which would reflect risk for infection. Objective 30.2h Assess the health patterns of a client and determine their effects on maintenance of the steady state, maladaptive responses and use of measures that reduce stress. Objective 30.2iIdentify clinical assessment parameters of laryngeal, lung cancers. Objective 30.2j Assess client need for alternative and/or complementary therapy or for palliative care. (Test Plan) Objective 30.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing chronic altered immune function and cancer disorder. Objective 30.3a Identify outcome/evaluation criteria for client with immune system diseases with nutrition, less than body requirements. Objective 30.3b Identify client at risk for malnutrition. Objective 30.3c Prioritize nursing diagnoses and collaborative problems for client with AIDS, cancer, oral cancer. Objective 30.3d Outline key evaluation factors in achieving planned outcomes for client with bone tumor. Objective 30.4 Identify support interventions for clients during the diagnostic and nursing care stages in order to meet psychosocial needs. Objective 30.4a Ascertain client understanding of individual nutritional needs and consider client choices regarding meeting nutritional requirements. Objective 30.4b Assist in diagnostic procedures. Objective 30.4c Differentiate among the purposes of surgical procedures used on cancer treatment, diagnosis, prophylaxis, palliation and reconstruction. Objective 30.4d Describe the concept of Hospice in providing care for clients with advanced cancer. Objective 30.4e Formulate nursing interventions when client has disturbance in self image. Objective 30.4f Respect client palliative care choices. (Test Plan) Objective 30.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experiencing chronic altered immune function and cancer disorder. (laryngeal, lung) (Test Plan) Objective 30.5a Consult dietitian and implement interdisciplinary team management. (Test Plan) Objective 30.5b Provide for diet modifications as needed. (Test Plan) Objective 30.5c Review laboratory data relative to fluid deficit and recognize deviations from normal. (Test Plan) Objective 30.5d Discuss the nurse’s role in treatment plans and nursing management for clients with


MCC Form EDU 0007 (rev. 10/07/11)

immunodeficiency disorders. Use appropriate precautions. (Test Plan) Objective 30.5e Describe the nursing and treatment management of clients with HIV infection and AIDS. (Test Plan) Objective 30.5f Describe the roles of surgery, radiation therapy, chemotherapy, bone marrow transplantation and other therapies in treating cancer and evaluate client response. Objective 30.5f1 Implement interventions to address side/adverse effects of radiation therapy. (Test Plan) Objective 30.5f2 Ensure safe implementation of internal radiation therapy. (Test Plan) Objective 30.5g Use the nursing process as a framework for care of clients with cancer. Objective 30.5h Discuss the role of the nurse in assessment and management of common oncologic emergencies. Objective 30.5i Explore the role of the nurse as provider of care and counselor in health promotion, maintenance and adaptation. Objective 30.5j Incorporate alternative/complementary therapies into client plan of care and apply knowledge of pathophysiology to nonpharmacological comfort/palliative care interventions. (Test Plan) Objective 30.6 Formulate teaching plans addressing activity and educations utilized for clients experiencing chronic altered immune function and cancer disorder. (Test Plan) Objective 30.6a Identify essential teaching needs for client with immunodeficiency. Objective 30.6b Describe the significance of health education and preventive care in decreasing the incidence of cancer. Objective 30.6c Outline health teaching opportunities for clients with laryngeal tumors. Objective 30.7 Apply pharmacological management principles for clients experiencing chronic altered immune function and cancer disorder. Objective 30.7a Provide for pain relief and evaluate and document client’s response to pain and comply with requirements governing controlled substances. (Test Plan) Objective 30.7b Identify the nursing implications of administering the different types of chemotherapy. Objective 30.7c Describe the special nursing needs of clients receiving chemotherapy. Objective 30.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered immune function and cancer disorder. (Test Plan) Objective 30.8a Assess client for signs and symptoms of adverse effects of radiation therapy. (Test Plan) Objective 30.8b Evaluate outcomes of palliative care interventions. (Test Plan)

Competency 31 Provide clinically competent nursing care to clients with altered mobility due musculoskeletal dysfunction. Objective 31.1 Discuss the incidence, etiology, antecedent events including risk factors and pathophysiology of conditions that result from altered musculoskeletal dysfunction. (soft tissue injuries, fractures, osteoporosis, degenerative joint disease, osteomalacia, Paget’s Disease, osteomyelitis, rheumatoid arthritis, ankylosing spondylitis, connective tissue disorders-lupus, sclerderma, polymysitis, rheumatic disorders.-gout, fibromyalgia, Reiter’s Syndrome, Psoriatic, amputaion) (Test Plan, AZ Workplace Employability Skill) Objective 31.1a Review anatomy and physiology of the muscle-skeletal system as well as bone formation/maintenance/healing independently in preparation for class. Objective 31.1b Distinguish between dislocation and subluxation as related to complication of avascular necrosis. Objective 31.1c Explore emergency treatment of fractures including methods of fracture reduction. Objective 31.1d Explain the cardiovascular pathophysiology as related to amputation. Objective 31.1e List levels and approaches to amputation that may occur. Objective 31.2 Identify physical assessment parameters and diagnostic test results in clients experiencing altered musculoskeletal function and altered mobility (musculoskeletal trauma, bone mass loss, hip fracture post surgery, degenerative joint disease pre- and post-operatively, osteomyelitis, inflammatory disease processes, connective tissue disease rheumatic disease, amputation.) Objective 31.2a Identify clinical assessment parameters which would reflect risk for increased acute or chronic pain or risk for injury due to musculoskeletal injury or dysfunction. (Test Plan) Objective 31.2b Identify clinical assessment parameters which reflect impaired physical mobility and insufficient vascular perfusion. (Assess client’s ability to balance, transfer and use assistive devices.)(Test Plan) Objective 31.2c Identify clinical assessment parameters which reflect self-care deficit. Objective 31.2d Identify key elements of health history pertinent to the assessment of muscle-skeletal health. Objective 31.2e Recognize and demonstrate skill in significant physical assessment parameters of the muscle skeletal system. Objective 31.3 Formulate priority nursing diagnoses and plan for expected outcomes for clients experiencing altered


MCC Form EDU 0007 (rev. 10/07/11)

musculoskeletal function. (musculoskeletal trauma, bone mass loss, hip fracture post surgery, degenerative joint disease pre- and post-operatively, osteomyelitis, inflammatory disease processes, connective tissue disease rheumatic disease, amutation.) Objective 31.4 Identify support interventions for clients during the diagnostic and nursing care stages (Casts, splints, tractions, braces) in order to meet psychosocial needs. (Support to client with unexpected altered body image) (Test Plan) Objective 31.5 Identify priority nursing interventions including evidence-based practice principles in the plan of care for clients experience altered musculoskeletal function in order to prevent potential neurological complications. (Test Plan) Objective 31.5a Consult with physical/occupational therapist as indicated. (Test Plan, AZ Workplace Employability Skill) Objective 31.5b Identify priority nursing interventions utilized in post-operative arthroscopy client to promote positive outcomes. Objective 31.5c Research evidence-based practice principles applicable to fall prevention and prevention of osteoporosis with outcome of minimizing aging changes and maximizing musculoskeletal health. Objective 31.5d Clinically recognize the varied classifications of traction used to treat hip fracture. Objective 31.5e Formulate nursing interventions which address post-operative wound care, assessment parameters and interventions for complications and prevention of complications for client with amputation. Objective 31.5f Use precautions to prevent further injury when moving client with musculoskeletal condition. (Test Plan) Objective 31.5g Maintain correct adjustment of client traction device. (Test Plan) Objective 31.6 Formulate teaching plans addressing activity and educations utilized for clients experiencing chronic altered musculoskeletal function. (Test Plan) Objective 31.6a Formulate teaching strategies to prepare client to undergo both noninvasive and invasive medical diagnostic tests utilized in assessment of musculoskeletal system. Objective 31.6b Formulate a discharge teaching plan for client with cast, splint or braces. Objective 31.6c Formulate nutritional and physical activity teaching plans to address physiological and psychosocial integrity needs of client with significant loss of bone mass. Objective 31.6d Design an appropriate pre-operative teaching plan for client undergoing hip surgery. Objective 31.6e Formulate discharge teaching plan for post-operative hip repair client. Objective 31.6f Formulate a health promotion teaching plan addressing body mechanics, exercise, body weight, adequate support and medication regime. Objective 31.6g Formulate teaching plan addressing activity and medications utilized for clients with inflammatory, rheumatic and connective tissue disease processes. (Test Plan) Objective 31.6h Formulate teaching plan addressing nutrition, medication and hydration regime in gout and fibromyalgia. (Test Plan) Objective 31.7 Apply pharmacological management principles for clients experiencing chronic altered musculoskeletal function. Objective 31.7a Administer analgesics as needed. Notify physician if regimen inadequate. Objective 31.7b Address non-pharmacological pain management for client with inflammatory disease process. (Test Plan) Objective 31.7c Address varied methods of pain relief for phantom and chronic stump pain and consider cultural implications regarding pain. (Test Plan) Objective 31.8 Evaluate the effectiveness of nursing therapeutics and achievement of desired outcomes in clients experiencing chronic altered musculoskeletal function. (prevent complications from immobility) (Test Plan) Objective 31.8a Identify priority nursing assessments necessary to recognize early, late and systemic complications of fracture and other musculoskeletal traumas as well as complications of immobility when evaluating achievement of desired outcomes. (Test Plan) Objective 31.8b Identify priority nursing assessments necessary to recognize complications of connective tissue disease processes when evaluating achievement of desired outcomes. (Test Plan)

NUR 122 NURSING II

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