Nursing 2128 Medical-Surgical Nursing III Syllabus

North Arkansas College

Nursing 2128

Medical-Surgical Nursing III

Syllabus

2017

I

TABLE OF CONTENTS

Syllabus Acknowledgment ............................................................................................................... ii Calendar ........................................................................................................................................ 1-4 Course Title ...................................................................................................................................... 5 Course Number ................................................................................................................................ 5 Credit Hours ..................................................................................................................................... 5 Weekly Course Schedule ............................................................................................................... 1-4 Course Instructor, Office & Hours, Phone & E-mail ......................................................................... 7 Course Description ........................................................................................................................... 5 Audience for the Course .................................................................................................................. 5 General Course Goals ......................................................................................................................... Course Outcomes/Objectives/Competencies ......................................................................... 5-6, 38

Gen Ed Outcomes (If Applicable)................................................................................................. Assessment Procedures ............................................................................................................. 9

Required Textbooks ......................................................................................................................... 8 Supplemental/Suggested Books ...................................................................................................... 8 Supplies .............................................................................................................................................. Available Nursing Resources ............................................................................................................ 8 Other Available Resources ................................................................................................................. Instructional/Teaching Method ....................................................................................................... 8 Outline of Course Requirements ..................................................................................................... 9 Course Evaluation Procedures ......................................................................................................... 9

Method of Evaluation ................................................................................................................ 9 Weight of each Method ............................................................................................................ 9 Minimum Performance Level on each Criteria ......................................................................... 9 Detailed Outline of what a student must do to earn each grade ....................................... 9, 11

Attendance Policy ............................................................................................................................ 8 Excessive Absences .................................................................................................................... 8 Consequences of Absences ....................................................................................................... 8 How to Make Up Missed Work ................................................................................................. 8

Tardiness Policy ................................................................................................................................ 8 Academic Dishonesty ....................................................................................................................... 8

Procedure Instructor will Follow if He/She Suspects Dishonesty ............................................. 8 Consequences if Dishonesty is Verified ..................................................................................... 8

Provision for Changing the Syllabus (If Applicable) ......................................................................... 9 Lab Requirements (If Appropriate) .................................................................................................. 8 Safety Rules (If Applicable) .............................................................................................................. 8 Statement of Student Responsibilities ............................................................................................. 9 ADA Statement ................................................................................................................................ 9

II

SYLLABUS ACKNOWLEDGMENT

COURSE: NURS 2128 Medical Surgical Nursing III

SEMESTER: Spring 2017

I acknowledge by signing below that I have received the syllabus for the course indicated above. I have reviewed the syllabus and understand the objective of this course. I understand how my performance will be evaluated and how my final grade will be determined. I am aware of my instructor’s office hours, and I know how to contact them for help with and/or clarification of course contents or procedures.

(Student Signature)

(Printed Name) (Date)

1

1

Monday Tuesday Wednesday Thursday Friday

January 9 January 10 January 11 January 12 January 13

Skills Lab 0830-1230

Cardiovascular Ch. 33

Watch ECHO

0830-1230

Cardiovascular Ch. 35, 38

A104

0830-1220 (A104) Cardiovascular

Ch. 36


MLK Holiday No classes

0830-1500

Respiratory Modalities Skills Lab

12-3

0830-1220 (A104) Unit 1 Exam Ch. 33,35,36,38 ---------------------------------------

Respiratory Ch. 28, 32

NCLEX Questions Due


Clinical

Clinical

0830-1220 (A104) Hematology Ch. 39 & 40

January 30 January 31 February 1 February 2 February 3

Clinical

Clinical

0830-1220 (A104) Unit 2 Exam Ch. 28,32,39,40 ---------------------------------------

Neuro Ch. 41-45

NCLEX Questions Due

February 6 February 7 February 8 February 9 February 10

Clinical

Clinical

0830-1220 (A104) Calculation Exam

--------------------------------------- Neuro cont.

2


Clinical

Clinical

0830-1220 (A104) Neuro presentations

Calculations Exam Retake


Clinical

Clinical

0830-1220 (A104) Unit 3 Exam Ch. 41-45

---------------------------------------------- Ch. 34 Dysrhythmias

NCLEX Questions Due

February 27 February 28 March 1 March 2 March 3

Clinical

Clinical

0830-1220 (A104) Emergency Care, Disaster Preparedness Ch. 8, 9, 10

NCLEX Questions Due Calculation Exam Final Retake

March 6 March 7 March 8 March 9 March 10

ACLS

0830-1700

ACLS

0830-1700

0830-1220 (HESC) Myocardial Ischemia Simulation

NCLEX Questions Due


Clinical

& Multidisciplinary

Simulation

Clinical

& Multidisciplinary

Simulation

0830-1220 (A104) Unit 4 Exam Ch. 8, 9, 10, 34

---------------------------------------------- Urinary Ch. 65, 72

3

April 3 April 4 April 5 April 6 April 7

Preceptor Clinical

0830-1220 (A104) Unit 5 Exam Ch. 65, 66, 67,

68, & 72 ------------------------------------

Abuse, Crisis, Suicide ATI Ch. 17,27,28

NCLEX Questions Due


Preceptor Clinical

0830-1220 (A104) Anger, Family &

Community, and Sexual Assault

ATI Ch. 29-31 NCLEX Questions Due


Preceptor Clinical

0830-1220 (A104) Unit 6 Exam

Comprehensive ATI Mental Health

On-Line Module: Eyes/Ears, Ch. 46-48

NCLEX Questions Due


Spring Break


Preceptor Clinical Starts (60 hours)

0830-1220 (A104) Renal Ch. 66-68

4


Finish Preceptor Clinical

Hurst Review

Hurst Review

Hurst Review

TBA ATI Med/Surg Predictor

Exam (2) ATI Comprehensive

Predictor Practice Exams Due

May 1 May 2 May 3 May 4 May 5

Med/Surg III FINAL

PINNING TONIGHT Graduation: May 7th

5

NURSING 2128

Course Title: Nursing 2128-- Medical Surgical Nursing III

Course Description:

NURS 2128 Medical-Surgical Nursing III (8) 4L, 12LL

Medical-Surgical Nursing III is a 16 week course that is a continuation of Medical-Surgical Nursing II. Student Learning Outcomes are expanded upon in this course with emphasis on core competencies of managing care in emergent and acute care patients, clinical decision making, informatics, collaboration, teaching/learning, professional behavior, and legal/ethical aspects of care. Theory and clinical experiences are related to the course content. Pre-requisites: NURS 2114 and NURS 2021.

Credit and Time Allotment: Eight semester hours

Four hours of lecture/ week

Twelve hours of clinical/ week

Placement: Second level (2nd year, 2nd semester)

Course Outcomes:

At the end of the course, the student will be able to:

1. Formulate effective therapeutic communication techniques to establish and maintain therapeutic

nurse-patient relationships with patients, families and significant others, small groups of patients,

and colleagues. (Measured by observation in clinical setting and written critical thinking

assignments). [Human Flourishing]

2. Use the Nursing Process to assess, plan, implement, evaluate and prioritize basic care for critically

ill adult clients. (Measured by exams and written clinical assignments).[Nursing Judgment/Practice]

3. Support and value cultural competence while meeting the multicultural needs of critical care

patients and their families. (Measured by written clinical assignments, clinical evaluation, and

exams). [Human Flourishing]

4. Employ clinical decision making to critically think, analyze clinical problems, and strategically

plan appropriate patient centered solutions consistent with associate degree nursing practice roles.

(Measured by case scenarios, exams, clinical assignments).[Human Flourishing and Spirit of

Inquiry]

5. Use management and leadership skills to provide care for individuals, groups, and communities in

collaboration with other health care providers to ensure continuous and holistic care. (Measure by

exams, clinical instructor evaluation, and case studies).[Nursing Judgment/Practice]

6. Examine evidence- based practice to support therapies such as ventilation, defibrillation, dialysis,

and cardiac monitors in order to identify the benefits and /or complications relating to patient care

management. (Measured by exams and critical care written assignment).[Nursing

Judgment/Practice]

6

7. Formulate a patient centered teaching plan to assist patients and families about their plan of care,

medical diagnosis, medication, and treatment regimen. (Measured by exams, written clinical

assignments, and clinical evaluation) [Professional Identity]

8. Apply legal, ethical, and safety considerations while providing care to their patients and families.

(Measured by exams, simulation, clinical instructor evaluation, and clinical written

assignments)[Professional Identity and Nursing Judgment/Practice]

9. Assist patient with self-management in developing and attaining realistic goals. (Measured by

exams, clinical evaluation and written critical thinking assignments.)[Professional Identity]

10. Identify safety concerns both real and potential to initiate quality improvement through procedural

processes. (Measured by clinical written assignment, journaling, simulation, and exams)[Nursing

Judgment/Practice]

11. Inventory the use of informatics and technological advances to correspond with and support

clinical decision-making as it applies to the critically ill patients. (Measured by exams and clinical

observation)[Professional Identity and Spirit of Inquiry]

12. Evaluate the management of care in organizing delegation activities. (Measured with group

activities and clinical assignments).[Nursing Judgment/Practice]

7

Medical -Surgical III Instructors

Amy Gipson, MSN, RN, CNE

Office number: A100 A

Office phone: 870-391-3169

Email: [email protected]

Available to students at the following time: Monday: Clinical Tuesday: Clinical Office Hours: Monday: 8:30 am- 1:00 pm Wednesday: 9 am – 2:00 Thursday: 8:30 am- 3 pm Friday: By appointment

Carrie Geier RN BSN MSEd

Office number: M173

Office phone: 870-391-3455

Email: [email protected]

Available to students at the following time: Monday: Clinical Tuesday: Clinical Office Hours: Monday: 8 am – 2:30 pm Wednesday: 8 am – 2 pm Thursday: 8:30 am – 3 pm Friday: By appointment

8

Major Learning Facilitation Activities: Teacher: Lecture Audiovisual presentations Simulation activities Demonstrations Portal utilization Discussion Internet websites of interest Learner: Discussion Group presentations Clinical experience Portal utilization Nursing Skills laboratory Role Play Concept Mapping and Case Studies General Policies: The Medical Surgical Nursing III course adheres to all policies in the Registered Nursing Program Handbook and the Northark Student Handbook. You are responsible for knowing the information in the Registered Nursing Program Handbook for this course. Absenteeism, Lab requirements, and Safety Rules: Refer to your Registered Nursing Program Handbook. Make-Up Exams:

1. All exams should be taken at the scheduled time. 2. The student MUST notify the instructor prior to the exam if the student is unable to take the exam

at the scheduled time. A missed examination is considered a class absence. 3. Arrangements must be made by the student as soon as possible. 4. Student may make-up ONE test only per semester at the instructor’s discretion. 5. Failure to comply with the stated requirements omits the privilege of taking a make-up test and a

zero will be given for the test not taken. 6. An alternative exam may be administered

Academic Dishonesty: Refer to the Northark Student Handbook and the Registered Nursing Program Handbook. Required Textbooks:

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative

Care, 8 th ed., St. Louis, MO: Elsevier-Saunders.

Syllabus for Nursing 2128-- Medical- Surgical Nursing III 2017

Registered Nursing Program Handbook

ATI Med/Surgical, Mental Health and Pharmacology

9

Grading: The course grade is determined as follows: 6 Unit Exams and a comprehensive ATI---------------------70% Comprehensive Final--------------------------------------------20% Assignments-------------------------------------------------------10% Students must have a passing average on unit exams and final before the written assignment score is added. If a student has less than a passing average (79%) on unit tests and the final the student will not progress in the program. Students must pass the clinical component of the course in order to progress in the program. If the student fails the clinical component with an unsatisfactory summative evaluation, the theory grade drops to a “D” and the student cannot progress. Students are encouraged to review unit exams within 1 week after the test was given. Grading Scale: A------------------------------ 91-100 B-------------------------------84-90 C-------------------------------79-83 D-------------------------------70-78 F-------------------------------69 & below Student Responsibilities:

1. The student is expected to attend class, laboratory sessions, and clinical. 2. The student is expected to be prepared for classroom, laboratory activities, and clinical. 3. The student is expected to complete all written assignments as directed by the instructor. 4. The student is expected to meet course outcomes.

ADA statement: North Arkansas College complies with Section 504 of the Rehabilitation Act of 1973

and the Americans with Disabilities Act of 1990. Students with disabilities who need special

accommodations should make their requests in the following way: (1) talk to the instructor after class or

during office hours about their disability or special need related to classroom work; and/or (2) contact

Special Services in Room M154 and ask to speak to Kim Brecklein. Final Note: All information contained this document is subject to change in the event of extenuating circumstances. Students will be notified via Portal and/or verbally if changes are made.

10

Course Assignments

11

Course Assignments

Course Assignments are weighted as 10% of the course grade. The following assignments related

to NCLEX questions are worth 5 points each. The neuro presentation is also included in the

assignment and is worth 25 points.

Below is a list of assignments. Adaptive Quizzing must be completed at a Mastery level 2, and on ATI

assessments, you must receive at least 90% to receive credit. All Assignments must be completed by

8:30 am on the morning they are due. Late assignments will not be accepted. In addition, ATI exams

that are not assignments will be opened for extra practice.

January 19– Adaptive Quizzing Evolve: Cardiovascular System

February 2– Adaptive Quizzing Evolve: Respiratory

February 23- Adaptive Quizzing Evolve: Neuromusculoskeletal System

March 2- ATI Targeted Medical Surgical 2013: Cardiovascular

March 9- ATI RN Medical Surgical Practice 2016 A

April 6- Adaptive Quizzing Evolve: Urinary and Reproductive

April 13- Mental Health ATI Practice Test B 2016

April 20- ATI RN Adult Medical Surgical Online Practice 2016 B

April 27- 2 ATI Comprehensive Predictor Practice Exams 2016 A & B

12

NEURO PRESENTATIONS Neurological disorders are to be presented in class. You may choose from the following disorders for your presentations. You may work in groups of 2-3 people. All topics must be presented. Huntington’s

Multiple Sclerosis

Myasthenia Gravis

Guillian Barre

Alzheimer’s

Parkinson’s

Meningitis

Creutzfeldt-Jakob

Peripheral Neuropathy

Muscular dystrophy

ALS

Spinal Cord Injury- Focus on discharge planning

You will have 20 minutes for your presentation. Please refer to the grading rubric for required content. Guest speakers are not permitted due to time constraints. Be creative! All groups should include a case scenario. You may act out the scenario or walk through it with the class. However, you must apply all of the required information into your content at some point. You may want to do a concept map in class with the students. Be prepared to answer questions from the audience. You can develop a game or another way to get your classmates involved. You may choose any method as long as learning occurs and your presentation follows the rubric. Develop a handout regarding the disease process you are covering for fellow classmates. Please keep it to ONE page. This is to be used as a study guide.

13

Grading Rubric for Neuro Presentation

5 Points 4 Points 3 Points 2 Points 1 Point

Textbooks and peer

reviewed journals

Referenced at least 1

textbook and 2 peer

reviewed journals (APA)


textbook and 1 journal

(APA Format)


textbook and 2 journal

but did not use APA

Referenced at least

textbook or journal used

may or may not have

used APA format

Did not reference

textbook or journal

Describes disorder

and nursing

interventions,

education, and

safety

Described in detail all four

aspects including

rationales

Described at least 3

aspects including

rationales


aspects and did not

include rationales


aspects with or w/o

rationales

Described 1 aspect with

or w/o rationales

Identify treatments,

both

pharmacological

and non-pharm

Identified treatments

including pharm, S/A,

dose as well as detailed

information on non-

pharm treatment


including pharm and non-

pharmacological

treatments, but did not

give specific information

on one of the two


both pharm and non-

pharm, but only gave

some of the details about

each such as S/A but not a

dose

Identified both pharm

and non-pharm

treatments but gave

minimal details about

both

Identified either pharm

or no pharm

treatments, but not

both

Use creativity, and

incorporate case

scenario

Did not just stand and

talk, but utilized other

teaching strategies, like

skits, role play, games and

had at least 1 case

scenario

Was creative using skits,

role play, games etc., but

did not have a case

scenario

Stood and talked using a

power point and had at

least 1 case scenario

Only talked about

subjects without any

audio/visuals, skits, role

play, etc. Did have at

least 1 case scenario

Talked without any

Audio/visuals, skits,

role play, games, and

did not have a case

scenario

Evidence of

teamwork and

involvement of

classmates

Work was divided equally

and all had parts. Class

was involved and

participated a lot in

teaching

Work was obviously not

equally divided among

members, but the class

did participate a lot in

teaching

Work was divided equally.

Class was minimally

involved in teaching

Work was not equally

divided and class

participated minimally

Work was not equally

divided and there was

almost no participation

from class

14

Learning Modules

15

Cardiovascular Assessment,

Unit 1 Course Outcomes: 2, 4, 11, 12

Objectives Content Learner Activities

After completion of this chapter, the learner should be able to

1) Review the anatomy and physiology of the CV (cardiovascular) system.

2) Evaluate cardiac action potential and its role in the electrical stimulus in the heart.

3) Define terms: depolarization, repolarization, refractory period, stroke volume, cardiac output/ index, preload, afterload, contractility, ejection fraction, diastole, systole, systemic vascular resistance (SVR), ACS

4) List factors controlling heart rate

5) Critically think to apply factors effecting stroke volume to example

6) Teach patients about evidence-based ways to decrease their risk for CV health problems.

7) Explain nursing implications related to CV changes that affect perfusion in older adults.

8) Describe the focused physical assessment for patients with cardiovascular problems.

9) Distinguish between the various types of diagnostic evaluations and the associated nursing implications

I. Anatomic and Physiologic Overview

II. Function of the heart: Conduction system

A. Physiology of Cardiac Conduction

III. Control of Heart Rate A. Medications B. Physiological responses

IV. Control of Stroke Volume

A. Medications B. Physiological responses

V. Special considerations A. Gerontologic Considerations B. Genetic/ Gender Differences in

Cardiac Structure/ Function

VI. Assessment VII. Diagnostic Assessment

Ignatavivius, M. and

Workman, L. (2016) Medical-

Surgical Nursing: Patient-

Centered Collaborative Care,

8th ed., St. Louis, MO:

Elsevier-Saunders.

Read Ch. 33

Diagram of Heart/ Conduction

of Heart

PowerPoint presentation

Audio/Visual

Adaptive Quizzing: Evolve

Class activity –

- critical thinking exercises

- video - case scenarios

16

Care of Patients with Cardiac Problems

Unit 1 Course Outcomes: 1-12

Objectives Course Content Learner Activities


1.) Evaluate valvular disorders of the heart and describe the pathophysiology, clinical manifestations, and management of patients with mitral and aortic disorders.

2.) Design a patient centered teaching plan for

patients with structural cardiac disorders using evidence based approach.

3.) Analyze the pathophysiology, clinical

manifestations, and management of patients with cardiomyopathies.

4.) Examine quality improvement strategies to

improve safety concerns of acutely ill patients with structural, infectious, and inflammatory cardiac disorders.

5.) Evaluate the pathophysiology, clinical

manifestations, and management of patients with infections of the heart.

6.) Describe the rationale for prophylactic antibiotic

therapy for patients with mitral valve prolapse, valvular heart disease, rheumatic endocarditis, infective endocarditis, and myocarditis.

7.) Formulate a plan of care to manage patients with disorders in structural, infectious, and inflammatory cardiac disorders.

I. Pathophysiology, clinical manifestations, assessment/ diagnostic findings, medical management, nursing management of:

a. Mitral Valve Prolapse b. Mitral Regurgitation c. Mitral Stenosis d. Aortic Regurgitation e. Aortic Stenosis f. Valvular heart disorders

II. Pathophysiology, clinical manifestations,

Assessment and Diagnostic Findings, Medical Management, Nursing process with Cardiomyopathy

a. Dilated b. Hypertrophic c. Restricted d. Arrhythmogenic right ventricular e. Unclassified

III. Pathophysiology, clinical manifestations,

assessment/ diagnostic findings, medical management, nursing management related to infectious diseases of the heart:

a. Rheumatic endocarditis b. Infective endocarditis c. Myocarditis d. Pericarditis

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-Saunders. Read Ch. 35 Power Point Audio/Visuals NCLEX review questions Critical thinking exercises Class activities:

- Concept mapping - Group discussion - Case studies - Lab simulation

17

Care of Patients with Cardiac Problems: Heart Failure


Objectives Course content Learner Activities


1.) Diagram the management of care for patients with heart failure.

2.) Formulate a comprehensive teaching plan for patients with heart failure.

3.) Analyze laboratory finding related to patients

with heart disease.

4.) Differentiate between left sided and right sided heart failure.

5.) Explore medications used with patients who

have heart disease.

6.) Differentiate manifestations and nursing interventions among patients who have thromboembolism, pulmonary edema, pericardial effusion, cardiac tamponade, and cardiogenic shock.

7.) Examine gerontologic considerations among patients with heart disease.

8.) Inventory medical management and nursing

interventions for patients experiencing pericardial effusion, cardiac tamponade.

I. Pathophysiology, clinical

manifestations, assessment/diagnostic findings, medical management, nursing management of:

a. Heart failure b. Cardiac tamponade c. Thromboembolism d. Pericardial effusion e. Cardiogenic shock

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-Saunders. Read ch. 38 PowerPoint presentation Audio/Visuals NCLEX review questions Class activities:

- Concept mapping - Group discussion - Case studies

18

Assessment and Management of Patients with Vascular Disorders and Hypertension

Unit 1 Course objectives: 1-12


After completion of this chapter, the learner should be able to:

1.) Describe the pathophysiology as it relates to the vascular system.

2.) Differentiate pathological vascular differences in the geriatric client in relation to prevalent vascular disorders seen in this population.

3.) Using the nursing process, compare the management of care and assessment with venous disorders and arterial disorders.

4.) Formulate a patient centered teaching plan, utilizing evidence based practice, related to vascular disorders.

5.) Propose measures to increase safety and quality improvement in patients with an occlusive arterial or venous diagnosis

6.) Inventory differences the nurse might find in a culturally diverse population when assessing and teaching clients with vascular disorders

7.) Devise a plan of care that critically analyzes anticoagulant therapy

8.) Evaluate signs, symptoms, and management of various arterial disease processes- (aneurysms, dissecting aorta, arterial embolism/thrombosis, Raynaud’s phenomenon)

9.) Identify signs, symptoms, and management of various venous disorders (deep vein thrombosis, venous thrombosis, venous stasis, varicose veins, thrombophlebitis)

10.) Evaluate current trends involving risk factors affecting HTN

11.) Diagram various classifications of hypertension as well as follow up and management considerations.

12.) Evaluate organ systems at risk for damage with a dx HTN.

I. Anatomic and Physiologic

Overview

II. Gerontologic considerations

regarding patho of vascular

system

III. Assessment

A. Health History

B. Clinical Manifestations

C. Diagnostic Evaluation

IV. Review patho, risk factors,

prevention, clinical

manifestations, medical

management, nursing process

related to:

a. Arterial insufficiencies

b. Thromboangitis obliterans

(Beurger’s Disease)

c. Various Aneurysms

d. Arterial Embolism/

Thrombosis

e. Reynaud’s

f. Venous Disorders

g. Lymphatic Disorders

V. Hypertension

A. Types, risks, patho,

assessment, clinical s/s, &

treatments






Elsevier-Saunders.

Read ch 36


Audio/Visuals

NCLEX review questions

Class activities:

- Concept mapping - Group discussion - Case studies - Heparin orders - Review Healthy

People 2020 Objectives

19

Care of Patients with Acute Coronary Syndromes


Objective Course Content Learner Activities


1.) Relate coronary atherosclerosis to Angina, Myocardial Infarction, and Sudden Cardiac Death

2.) Assess multicultural considerations that effect a client’s risk factors

3.) Evaluate the causes of Coronary Artery Disease (CAD) and patient centered teaching regarding modifiable risk factors using evidence based research.

4.) Critically appraise the differences between the various types and treatments of atherosclerosis and angina

5.) Compare/ contrast various pharmacologic interventions and safety considerations with regards to atherosclerosis, angina, and myocardial infarction

6.) Formulate a plan of care using the nursing process in a patient with coronary atherosclerosis and angina.

7.) Differentiate nursing interventions (pre/ post) for various cardiac surgical interventions (i.e. PTCA, Stent placement, Atherectomy, CABG)

8.) Analyze significant EKG findings from an MI

9.) Manage and identify collaborative team members associated with the care of the client with atherosclerosis, angina, and acute coronary syndrome

10.) Examine pharmacological treatment for patients with Coronary Artery disease

I. Coronary Atherosclerosis A. Pathophysiology B. Clinical

manifestations C. Assessment D. Risk factors E. Medical

Management F. Nursing

interventions II. Angina

A. Pathophysiology B. Clinical



interventions III. Acute Coronary

Syndrome/MI A. Pathophysiology B. Clinical



interventions

Ignatavivius, M. and Workman, L.

(2016) Medical-Surgical Nursing:

Patient-Centered Collaborative Care,

8th ed., St. Louis, MO: Elsevier-

Saunders.

Read ch. 38

Power Point

Staging

Audio/Visual


Class Activities

- 12- lead key hand outs - Videos: Angina,

pharmacology of an MI, Cardiac rehab

- Case vignette on MI

20

Care of Patients with Respiratory Problems Requiring Oxygen, Tracheostomy, and the Critically Ill


Outcomes Content Learner Activities

Upon completion of this chapter, the learner should be able to:

1.) Test the nursing process as a framework for care

of the client with pneumonia.

2.) Prepare a teaching plan to incorporate safety with regards to patients who have tracheostomies.

3.) Relate cultural and societal influences r/t

smoking and air pollution to lung disorders.

4.) Utilize clinical decision making when assessing the need for respiratory intubation.

5.) Examine diagnostic values regarding patients in

respiratory distress.

6.) Using the nursing process, compare the different types of chest trauma.

7.) Relate the therapeutic management techniques

of acute respiratory distress syndrome to the underlying pathophysiology of the syndrome.

8.) Evaluate risk factors and safety concerns

appropriate for prevention and management of pulmonary embolism.

9.) Inventory the complications and nursing

management of chest trauma and their clinical manifestations.

I. Atelectasis II. Respiratory Infections

A. Pneumonia B. Pulmonary Tuberculosis C. Lung Abscess D. Empyema E. Pleurisy F. Pleural Effusion III. Respiratory Failure IV. Acute Respiratory Distress Syndrome V. Pulmonary Disorders

A. Pulmonary Hypertension B. Cor Pulmonale C. Pulmonary Embolism VI. Other pulmonary disorders A. Pneumoconiosis B. Lung cancer C. Trauma 1. Blunt 2. Penetrating 3. Pneumothorax 4. Cardiac Tamponade 5. Subcutaneous Emphysema

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-Saunders. Read Ch. 28 & 32 **ATI skill module “Oxygen Therapy” located under Tutorials. View all of the modules and take the pre and post tests. Power point Audio Visual NCLEX review questions Staging Class activity

- critical thinking exercises - discussion questions - concept Mapping

21

Respiratory Care Modalities Unit 2 Outcomes: 1-12

Outcomes Content Learner Activities


1.) Analyze the nursing management for clients receiving oxygen therapy, BiPAP, CPAP.

2.) Evaluate the nursing management and

collaboration, with other healthcare members, of a client with an endotracheal tube and for a client with a tracheostomy.

3.) Demonstrate tracheostomy care and suctioning.

4.) Discuss best practice and quality care for clients receiving mechanical ventilation.

5.) Examine legal/ethical and cultural considerations

regarding extubation of clients with irreversible brain injuries.

6.) Critically think to analyze the principle of chest

drainage and the nursing responsibilities using clinical decision making related to the care of the client with a chest tube.

7.) Explore evidence based practice to support care

of client with acute pulmonary complications.

8.) Describe the nursing care for a client with an endotracheal tube and for a client with a tracheostomy.

9.) Demonstrate tracheostomy care and suctioning.

10.) Identify safety measures while managing chest

drainage systems.

I. Noninvasive Therapies A. Oxygen 1. Types of administration 2. safety 3. client education B. BiPAP; CPAP II. Airway management A. Endotracheal intubation B. Tracheostomy C. Mechanical Ventilation 1. Types of vents 2. Assessment 3. Weaning III. Thoracic Surgery

A. Preoperative Nursing Care B. Postoperative Nursing Care C. Care of Chest Drainage

Systems

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-Saunders. Read Ch. 30 & 32: Power Point ATI Skills Modules:

- Airway management - Oxygen Therapy - Closed Chest Drainage

NCLEX review questions Class activity

- critical thinking exercises - discussion questions - concept mapping - group teaching

Lab – tracheostomy care, cleaning , and

suctioning – care of chest tubes – care of client on a ventilator - oxygen delivery devices

22

Hematology

Unit 2 Course outcomes: 1-12



1.) Compare underlying pathophysiology of various anemias. 2.) Formulate a teaching plan using evidence based research,

including diet, for a client with iron deficiency anemia. 3.) Using informatics, examine guidelines for medication regimen

for a patients with various types of anemias. 4.) Design a care plan for a patient with a coagulation disorder. 5.) Assess lab values of various hematologic disorders including

Leukemia, Hodgkin’s disease, and various bleeding disorders. 6.) Analyze the clotting cascade and integrate various clotting

disorders, anticoagulants, as well as blood components. 7.) Identify proper transfusion techniques, potential safety risks,

and possible reactions for various types of blood components. 8.) Debate the legal/ethical and safety aspects of refusing blood

products.

9.) Compare cultural differences regarding blood disorders.

I. Anatomic / Physiologic Overview II. Assessment of the hematologic system

III. Management of Hematologic Disorders including:

a. Clinical Manifestations, Assessment/ Diagnostic Findings, Complications

b. Medical/ Nursing Management IV. Hypoproliferative Anemias

a. Iron Deficiency b. Renal Disease c. Aplastic d. Megaloblastic e. Myelodysplastic Syndrome

V. Hemolytic Anemias VI. Polycythemias

a. Polycythemia Vera b. Secondary Polycythemia

VII. Leukopenia/ Neutropenia VIII. Lymphomas

a. Hodgkin’s Disease b. Non- Hodgkin’s c. Multiple Myeloma

IX. Bleeding Disorders a. Thrombocytopenia b. ITP c. Platelet Defects d. Hemophilia

X. Acquired Coag Disorders a. Liver Disease b. Vit. K Deficiency c. Disseminated Intravascular

Coagulation (DIC) XI. Therapies for Blood Disorders XII. Procuring Blood/ Blood Products XIII. Transfusion Complications

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8 th ed., St. Louis, MO: Elsevier-Saunders. Read Ch. 39 & 40 **ATI Skills Module located under tutorials “Administering blood Products” Complete all modules, pre and post tests PowerPoint presentation

Case scenarios within ATI modules

Audio/Visuals NCLEX questions Class activities:


23

Patients with Neurological Problems

Unit 3 course Outcomes: 1, 2, 4-12



1.) Recall the structures and functions of the central and peripheral nervous system.

2.) Justify the significance of physical assessment to the diagnosis of neurologic dysfunction.

3.) Inventory safety concerns as it relates to the changes in neurologic function associated with aging.

4.) Differentiate between the technological advances in imaging and other diagnostic tools related to the neurologic system.

5.) Examine the multiple needs of the client with altered level of consciousness using the framework of the nursing process.

6.) Evaluate the management of care re: the early and late clinical manifestations of increased intracranial pressure.

7.) Distinguish between collaborative healthcare team members involved with patients with altered cerebral function.

8.) Compare the various types of seizures re: assessments and acute and long term treatments, as well as safety measures.

9.) Organize teaching plan for patient with seizures.

10.) Manage pre and post-operative care for a patient having intracranial surgery.

11.) Explore legal and ethical issues regarding end of life care for individuals with neurological dysfunctions.

I. Anatomic and physiologic Overview II. Neurologic Examination A. Health History B. Clinical Manifestations C. Physical Exam D. Diagnostics III. Altered Level of Consciousness A. Pathophysiology B. Manifestations C. Assessment and Diagnostics D. Medical and Nursing

Management

IV. Increased Intracranial Pressure A. Pathophysiology B. Manifestations C. Assessment and Diagnostics D. Medical and Nursing Management V. Intracranial Surgery VI. Seizures A. Types of seizures B. Epilepsy C. Nursing Care VII. Legal & Ethical Issues Regarding End-of-Life

Ignatavivius, M. and Workman,

L. (2016) Medical-Surgical

Nursing: Patient-Centered

Collaborative Care, 8th ed., St.

Louis, MO: Elsevier-Saunders.

Read ch. 41-45


Staging


Audio/Visuals

Class activities:


24


Unit 3 Course Objectives: 1-12



1.) Assess and differentiate between various types of cerebrovascular disorders.

2.) Identify the risk factors for cerebrovascular disorders and related measure for prevention using evidence based practice.

3.) Justify the criteria for t-PA administration and initiation of therapy.

4.) Relate the principles of nursing management to the care of a client in the acute stage of an ischemic and hemorrhagic strokes.

5.) Use the nursing process as a framework for care of a client with a cerebral aneurysm.

6.) Examine essential elements for family teaching and preparation for home care of the stroke client.

7.) Differentiate among clients with head injuries according to mechanism of injury, clinical sign and symptoms, diagnostic testing, and treatment options.

8.) Use the nursing process as a framework for care of clients with brain injury.

9.) Identify and educate the population at risk for spinal cord injury.

10.) Manage three clinical features of the client with neurogenic shock.

11.) Diagram the pathophysiology of autonomic dysreflexia and describe the appropriate nursing interventions.

12.) Use the nursing process as a framework for safety and care of client with spinal cord injury.

13.) Discuss legal/ethical considerations regarding traumatic brain and spinal cord injuries.

I. Pathophysiology, manifestations, assessment and diagnostics, prevention, medical and nursing management of the following: A. Ischemic B. Hemorrhagic Stroke

C. Head Injuries D. Spinal Cord Injury II. Brain Injury A. concussion B. contusion C. Intracranial hemorrhage



Patient-Centered Collaborative

Care, 8th ed., St. Louis, MO:

Elsevier-Saunders.

Read ch. 41-45

Power Point

Audio/Visuals


NIHSS (stroke scale)

Class Activity


- Discussion

25





1.) Differentiate using clinical reasoning, the infectious disorders of the nervous system according to causes, manifestations, medical care, and nursing management.

2.) Analyze the pathophysiology, clinical manifestations and medical and nursing management of autoimmune disorders utilizing evidence based guidelines.

3.) Select collaborative team members and their responsibilities when treating oncologic disorders.

4.) Differentiate between brain and spinal cord tumors; their classification, clinical manifestations, diagnosis and medical and nursing management.

5.) Inventory safety and quality considerations involving clients receiving chemotherapy.

6.) Use the nursing process as a framework for care of clients with cerebral metastasis or inoperable brain tumors, and degenerative neurologic disorders.

7.) Identify resources for clients and families with oncologic and degenerative neurologic disorders.

8.) Debate legal ethical issues related to end of life care, euthanasia, and genetic testing.

9.) Formulate a teaching plan using therapeutic communication which discusses a specific neurological disorder.

10.) Examine multicultural aspects of dealing with degenerative neurological disorders.

I. Infectious Neurologic Disorders

A. Meningitis B. Brain Abscesses C. Herpes Simplex D. Fungal Encephalitis E. Creutzfeldt-Jakob II. Autoimmune Disorders

A. Multiple Sclerosis

B. Myasthenia Gravis

C. Guillain-Barre

D. Bell’s Palsy

III. Oncologic Disorders of the Brain and Spinal Cord B. Assessment, Clinical

Manifestations, Management,

Diagnostics, Treatments

Iv. Degenerative Disorders

A. Parkinson’s B. Huntington’s C. Alzheimer’s D. ALS E. MD F. Degenerative Disc H. Herniated Disc





Elsevier-Saunders.

Read ch. 41-45

Power Point

Audio/Visuals


Class Activity


- Discussion

- Skits

Class presentations of a

neurological disorder and

teaching plan

26

Dysrhythmias and Conduction Problems


Objectives Content Learner Activities After completion of this chapter, the learner should be able to

1. Evaluate electrocardiogram and justify clinical decisions based on appraisal.

2. Differentiate between the various cardiac dysrhythmias in order to manage client care.

3. Diagram the dysrhythmias, collaborative team members, and possible treatments.

4. Compare and contrast the different modalities of treatment for cardiac dysrhythmias.

5. Formulate a patient centered teaching plan using that enforces evidence based care for the client with Atrial fibrillation.

6. Test the nursing process related to management of the client with a cardiac dysrhythmia.

7. Design safety measures to ensure quality improvement during management of a client experiencing cardiac arrest.

8. Examine technological advances used to treat life threatening cardiac dysrhythmias.

9. Plan pre and post-operative care for the client undergoing Pacemaker placement, ICD insertion, and cardiac conduction surgery.

10. Debate legal/ethical and safety considerations regarding patients

with implanted devices.

11. Construct conversations using therapeutic communication with the family of the client in cardiac arrest.

12. Using the nursing process, prioritize the plan of care for a patient

experiencing various cardiac dysrhythmias.

I. Dysrhythmias

A. Electrocardiogram

B. Atrial dysrhythmias

C. Junctional dysrhythmias

D. Ventricular Dysrhythmias

E. Conduction Abnormalities

II. Management of Dysrhythmias

A. Cardioversion

B. Defibrillation

C. Pacemaker therapy

D. Implantable Cardioverter

Defibrillator (ICD)

E. Cardiac Conduction

Surgery

F. ACLS protocols

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-

Saunders. Read Chapter 34

PowerPoint presentation Audio/Visuals NCLEX review questions Cardiac dysrhythmia strips Class activities:

- Concept mapping - Group discussion - Case studies - Identify dysrhythmia strip - Lab simulation Acute MI

and ACLS Certification

**Practice ACLS Algorithms: There are 3 megacode simulators. Please complete all of them

http://acls-algorithms.com/acls-megacode-simulator/acls-simulator

27

Emergency Nursing




1.) Plan and implement best practices to maintain staff and patient safety in the ED

2.) Triage patients in the ED to prioritize the order of care delivery

3.) Prioritize resuscitation interventions based on the primary survey of the injured patient

4.) Prevent or reduce common risk factors in the ED that contribute to adverse events in older adults

5.) Employ therapeutic communication in providing support for families after the death of a loved one

6.) Formulate a plan of care using evidence based practice related to environmental emergencies.

7.) Identify the types of disasters

8.) Apply principles of triage to prioritize care delivery in a disaster situation

9.) Identify the roles of the nurse in emergency preparedness and response plan

10.) Identify the type of patient’s to recommend for hospital discharge in a disaster situation

I. Safety in the ED

II. Emergency Nursing Principles

III. Providing care for patient and family

during when death occurs in the ED

IV. Trauma Centers and Systems

V. Primary and Secondary Survey and Resuscitation Interventions

VI. Heat and Cold Related Emergencies

VII. Pre-hospital and Hospital Care of Bites and Stings

VIII. Prioritize nursing care for a near-drowning victim

IX. Types of disasters

X. Mass Casualty Triage

XI. Roles of the nurse in a disaster

XII. Event Resolution and Debriefing

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-Saunders. Read Ch. 8, 9, 10 PowerPoint presentation Audio/Visuals NCLEX review questions Learner activities

Concept mapping

Group discussion

28

Management of Patients with Urinary Disorders and Male Reproductive Processes

Unit 5 Course Outcomes: 1, 2, 4-12



1. Interpret factors contributing to urinary tract infections

and

2. Formulate an evidenced based teaching plan for a

client with a urinary tract infection.

3. Compare and contrast pyelonephritis,

glomerulonephritis, and nephritic syndrome: causes,

pathophysiology, manifestations, management, and

nursing care.

4. Explore types and care of urinary diversions in the

frame of the nursing process.

5. Examine legal/ethical issues related to urinary

diversions.

6. Discuss nursing assessment of the male reproductive

system and identify diagnostic test that complement

assessment.

7. Evaluate Evidenced based treatments and causes of

male sexual dysfunction.

8. Use the nursing process as a framework for care of

clients undergoing a prostatectomy.

9. Identify clinical manifestations, medical and nursing

management of a client with prostate cancer.

I. Disorders of the Urinary Tract

A. Lower UTI

B. Upper UTI 1. Pyelonephritis 2. Glomerulonephritis 3. Nephrotic Syndrome 4. Urolithiasis II. Urinary Diversions A. Ileal Conduit B. Nephrostomy C. Uterostomy D. Koch Pouch III. Assessment of Male Reproductive system

IV. Disorders of Male Sexual Dysfunction A. Erectile Dysfunction B. Infections C. Conditions of the Prostate D. Conditions affecting the testes, penis and adjacent structures 1. Cryptorchidism 2. Testicular Cancer 3. Penile Cancer

V. Surgical interventions and Nursing Care

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th ed., St. Louis, MO: Elsevier-Saunders.

Read Chapter 66, 67, 72


Audio/Visuals


Class activities

- teaching plan for UTI

- critical thinking

exercises

29

Management of Patients with Renal Disorders



Upon completion of this chapter the learner should be able to:

1.) Inventory possible fluid and electrolyte disturbances seen in

clients with renal dysfunction.

2.) Differentiate between acute and chronic renal failure.

3.) Use the nursing process as a framework for the care of clients

with acute and chronic renal failure.

4.) Compare and contrast types of renal replacement therapies

including hemodialysis, peritoneal dialysis, and kidney

transplantation.

5.) Examine responsibilities of the different team members

involved in caring for clients with kidney disease.

6.) Identify best practice when caring for a client undergoing

kidney transplant.

7.) Debate ethical dilemmas arising from the treatments of

dialysis and kidney transplants.

8.) Use the nursing process framework for care of clients

undergoing kidney surgery.

9.) Formulate a comprehensive teaching plan for clients with

kidney disease.

I. Fluid and Electrolyte

A. Review F/E disturbances commonly seen with renal disorders.

II. Renal Failure

A. Chronic

B. Acute

III. Dialysis

A. Types of dialysis

IV. Kidney Transplant

A. Preoperative Management

B. Postoperative Management

V. Kidney Surgery Pre/Post op

VI. Other Health Disorders R/T

Kidney Failure

A. Anemia

B. Pruritus

C. Sleep Disorders

D. Amyloidosis






Elsevier-Saunders.

Read Chapter 66, 68



Evidence Based Article

Class activities:


- 24 hour diet plan for

chronic renal failure

client

30

Care of Patients Related to Adult Abuse, Delirium, Dementia, Alcohol Abuse, and Psych Emergencies




1). Identify substances of abuse and assessment of a patient

abusing certain addictive substances

2) ) Discuss the care of the patient in alcohol and substance

abuse withdrawal

3). Evaluate the medications used to treat patients in alcohol

and substance abuse withdrawal

4). Explore the nurse’s role in psychiatric incidents and

emergencies.

Characteristics of patients with:

I. Substances of abuse

A. assessment findings related to

substances of abuse

B. assessment of the patient in

alcohol withdrawal

C. nursing care of the patient in

alcohol withdrawal

Ii. Psychiatric incidents and

emergencies

A. Crisis and anger management

B. Suicide

C. Anger

D. Family and community violence

E. Sexual Assault





Elsevier-Saunders.

ATI Read Chapters 17, 27-31

31

Assessment and Management of Patients with Eye and Vision Disorders

Unit 7 Course outcomes: 1-12



1.) Distinguish between diagnostic tests for assessment of vision and evaluation of visual and hearing disabilities.

2.) Using the nursing process, examine the clinical features of ocular disorders, diagnostic assessment and examinations, medical or surgical management, and client care.

3.) Describe therapeutic effects, safety, and infection control when using ophthalmic medications.

4.) Formulate a teaching plan for a client discharged after ocular surgery using therapeutic techniques.

5.) Differentiate collaborative team members associated with ocular disorders.

6.) Evaluate the manifestations that may be exhibited by a person

with a hearing disorder and communicative techniques.

7.) Differentiate problems of the external and middle ear and the

clinical manifestations, diagnosis, and management.

8.) Compare and contrast innovative technologies available to the

hearing impaired.

I. Pathophysiology, assessment, diagnostics, treatments, nursing management of: A. Low Vision and Blindness D. Glaucoma E. Cataracts F. Macular Degeneration G. Conjunctivitis H. Enucleation I. Diabetic Retinopathy II. Hearing Loss nursing management and treatments C. Gerontologic Considerations III. Conditions of the External Ear A. Cerumen impaction B. External Otitis IV. Conditions of the Middle Ear A. Perforation of Tympanic

Membrane B. Otitis Media V. Conditions of the Inner Ear A. Meniere’s Disease B. Vertigo C. Ototoxicity

Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8 th ed., St. Louis, MO: Elsevier-Saunders.

Read Chapter 46-48

On line module


- critical thinking

exercises

- Case scenarios

32

Labs and

Simulations

33

Respiratory Modalities Skills Lab

Learning Objectives:

1. Demonstrate tracheostomy care and suctioning.

2. Discuss the care of a client with a chest drainage system.

3. Teach another student how to assess a chest drainage system.

4. Discuss different methods of oxygen delivery.

5. Discuss best practice and quality care for clients receiving mechanical ventilation.

Student Preparation:

Complete all of the following ATI Skills Videos including pre and post-test and practice challenges.

-Airway Management

- Oxygen Therapy

- Closed Chest Drainage

Read in your book about chest drainage devices pages 577-580

Read in your book about intubation, extubation, and care of a client receiving mechanical ventilation

pages 615-622

Watch this video describing the basics of ventilators. Also found at

https://www.youtube.com/watch?v=gk_Qf-JAL84

Complete answers to questions and bring as a ticket to the skills lab.

1. What is BiPAP? Which clients might need BiPAP?

2. What are 2 priority problems for a client receiving mechanical ventilation?

3. What are potential complications the nurse is monitoring for clients on a ventilator?



34

Medical Surgical Nursing III

Respiratory Simulation

Case Study:

The following scenario will be accomplished using a high fidelity manikin with a variety of situations that will arise. Each simulation will be performed by two students. Student 1 will need to perform assessment and interventions accordingly after receiving report from the evening shift nurse. Student 2 will act in the role of evaluator, observing the simulation and being available to student 1 for advice. Mr. Watkins was admitted yesterday and diagnosed with Community Acquired Pneumonia (CAP); a

pneumothorax was seen on x-ray and placement of a 32 french chest tube was done in the ED. He has a

history of COPD for the past 8 years and was recently diagnosed with type 2 diabetes. He continues to smoke

1 pack of cigarettes a day. He lives alone in a rural home. His wife passed away last year, he has a daughter

and son who check on him regularly.

Mr. Watkins is in the ICU and you are the oncoming nurse caring for him today. The night nurse reports he

slept fairly well and did not ask for pain medication. He is on oxygen to be titrated to keep his oxygen

saturations above 91%. The night nurse did report increasing the O2 around 6 am from 2L to 4L due to a drop

in his saturation and she has not been back in to check his status or look at the 0600 ABGs. Lab work and vital

signs are on the patient’s chart at his bedside.

Simulation Objectives:

Demonstrates a focused respiratory assessment using proper auscultation technique

Implements appropriate interventions based on assessment findings

Recognizes the need to reassess for changes in patient status after interventions and make new changes accordingly

Interprets ABGs and recognizes trends

Demonstrates effective teamwork when collaborating with multiple disciplines

Implements therapeutic communication

Recognizes safety issues at the patient’s bedside

Demonstrate effective communication with peers

Prep for simulation: Watch ATI videos: ONLY 2 VIDEOS Oxygen Therapy Closed Chest Drainage Assignment before simulation: (this is your “ticket to simulation”, you will not be permitted to participate without completion)

Read article: Chest-tube care: The more you know, the easier it gets /Answer questions at the end of the article and bring answers to simulation (found on portal under simulation)

Complete respiratory worksheet and bring answers to simulation Case Study: Work through the case study prior to simulation

35

Respiratory Worksheet

1. What can happen if we give patients with lung disease large amounts of oxygen? (I’m not

looking for respiratory drive shut down)

2. What is respiratory acidosis? Explain, and give me an example of ABGs.

3. What are the signs of too much CO2 (respiratory acidosis)?

4. What other diseases might mimic respiratory acidosis?

5. What laboratory data might be helpful in coming up with a nursing diagnosis?

36

6. What assessment data would you want to perform to differentiate between the

respiratory acidosis and other potential disorders?

7. If you suspected respiratory acidosis, what would nursing interventions would you

perform? And give rationales.

8. What is the rationale for using BIPAP on a patient with respiratory acidosis? Why not

CPAP? Support your answer.

9. What other medical interventions might you anticipate in a patient with respiratory

acidosis? Support your answers.

10. Other information? (optional)

37

Lab Simulation

Myocardial Ischemia

Case Summary:

This case presents a patient in the Emergency Department, who is complaining of chest pain. The student will

be expected to follow the protocol for the treatment of chest pain suggestive of ischemia. The patient complains

of increasing angina and has an abnormal ECG. Students will identify ECG rhythm and treat according to

ACLS protocol. Students will delegate assignments in the event of cardiac arrest and use therapeutic

communication with family members at the bedside. Furthermore, students will collaborate with other

members of the healthcare team.

Learning Objectives:

Identifies primary nursing diagnosis

Implements patient safety measures

Evaluates patient assessment information including vital signs

Implements therapeutic communication

Implements direct communication to multidisciplinary team members

Demonstrates effective teamwork

Prioritizes and implements physician orders appropriately

Prepare for simulation by completing the following:

1. Recall ACLS protocol

2. Review ECG rhythms

3. Know the signs and symptoms of myocardial ischemia

4. Understand the roles of the multidisciplinary team in the event of cardiac arrest

5. Review medications that are commonly used for patients with ischemia and/or cardiac arrest

Please see portal for ticket to simulation.

38

Clinical Assignments

39

Clinical Objectives:

Throughout the 2128 clinical rotation, the nursing student will:

1. Examine the psychosocial aspects and community resources of caring for the critically ill patient and

his/her family. (Measured by clinical assignment and/or reflective journaling) [Professional Identity]

2. Correctly assess and document changes in patient status including level of consciousness. (Measured by

clinical assignment and critical care assignment)[Nursing Judgment/Practice]

3. Describe use of and safe nursing responsibilities related to monitoring equipment (i.e.- ventilators,

telemetry, defibrillators, CVP and arterial lines, IV pumps, chest tubes, oxygen delivery) (Measured by

critical care written assignment, and/or post conference discussion) [Nursing Judgment/Practice]

4. Explain nursing responsibilities for intubation and extubation, and care of a patient on a ventilator.

(Measured by critical care written assignment, and/or post conference discussion) [Nursing

Judgment/Practice]

5. Apply clinical reasoning skills to make evidence based decisions in identifying nursing priority

problems and implementing nursing interventions recognized through assessment skills. (clinical

assignment, preceptor assignment, simulation, and clinical evaluation) [Spirit of Inquiry]

6. Compare and contrast basic ABG's and ECG's and discuss appropriate interventions. (Measured by

clinical assignment, and post conference discussion) [Nursing Judgment/Practice]

7. Analyze nursing responsibilities for pre/ post heart catheterization. (Measured by clinical assignment

and/or post conference discussion) [Spirit of Inquiry]

8. Formulate a patient centered teaching plan to manage the care of a patient going home post heart cath

and/or pacemaker insertion. (Measured by written clinical assignment and/ or post conference

discussion)[Professional Identity]

9. Inventory patient centered care responsibilities of a pre/ post dialysis patient including safe and effective

clinical decision making regarding medication. (Measured by written clinical assignment and/ or post

conference discussion) [Nursing Judgment/Practice and Spirit of Inquiry]

10. Demonstrate therapeutic communication while advocating for a patient. (Preceptor

assignment)[Human Flourishing]

11. Demonstrate respect while providing care for patients with ethical, spiritual and cultural differences

(Measured by reflective journaling and preceptor assignment) [Human Flourishing]

12. Demonstrate accountability, professional communication, organization, prioritization, safe care and

appropriate delegation in transitioning to a graduate RN. (Measured by reflective journaling, preceptor

assignment, and clinical evaluation)[Nursing Judgment/Practice]

13. Identify quality improvement strategies including the use of informatics that are used to provide safe

care. (Measured by reflective journaling and preceptor assignment)[Nursing Judgement]

14. Provide patient education including learning preferences and evaluation of patient learning (clinical

assignment and preceptor assignment) [Professional Identity]

40

Clinical Assignments

Each clinical area has specific objectives and related assignments that guide the student through that

clinical experience. Clinical assignments are designed to maximize learning. Prepare in advance of each

clinical day by noting on the schedule which area you are assigned. Plan what assignment and objectives

should be completed and print all necessary documents before arriving. Consult your clinical instructor

if you are unsure. Some assignments will be completed while you are in the clinical setting while others

will be completed and turned in at the time your clinical instructor requests. Late assignments will be

reflected on your clinical evaluation.

Reflective Journaling

A reflective journal is meant for the writer to be able to think back about an experience learn about the meaning

of the experience. As nursing students, journaling can help you learn about yourself, a disease process, discover

holistic approach to nursing, how to really find value and demonstrate care to a patient or their family, discover

mistakes and make corrections. Journaling will teach you how to internalize your learning and make it real.

Guidelines:

You may either handwrite or type the entry.

Ideas about entries:

Describe an experience, observed behavior or perception of the experience during this

clinical day.

Express your feelings or maybe the feeling of others involved in the experience (e.g.

staff, patient, patient’s family)

Do you feel inadequate or better prepared to make decisions, plan care, and evaluate

patient care after today’s encounter? What can you do to improve?

Any skills you feel you need to improve or develop?

41

Critical Care Assignment

Use the MS III clinical objectives to guide your experience in the Critical Care Unit.

1. Consider the psychosocial aspects of caring for the critically ill patient and his /her family. List 2

priority psychosocial nursing problems with at least 3 nursing interventions for each.

2. Explain how to evaluate the level of consciousness of a critically ill patient. List 2 nursing priorities for

a patient with a neurological deficit or decreased LOC.

3. Describe the use of and nursing responsibilities associated with using monitoring equipment (Swan

Ganz catheter, CVP and arterial lines)

4. Interpret 1 set of ABGs with treatment. (To include with written assignment)

5. Interpret 3 patient ECG strips with treatment. (To include with written assignment.)

6. Complete a rapid reasoning case study on one client.

42

CARDIAC REHAB ASSIGNMENT

Objectives:

1. Complete a teaching plan for a cardiac rehab client.

2. Assess patients before, during, and after exercise consider trends in data and report significant

changes.

3. Identify priority problems with clients with a cardiac disorder.

4. Provide education to a client with a cardiac disorder.

During the rotation, the student will complete the following in writing

1. What are some goals or objectives of a cardiac rehab program?

2. What are the criteria for admission to a rehab program?

3. Describe the progression in a cardiac rehab program.

4. When is a client discharged from a rehab program?

5. Prepare a teaching plan on attached concept map for a cardiac rehab client. Consider issues such as,

emotional support, home exercise, diet, smoking, medications, sex, heart disease, and compliance.

CARDIAC CATH LAB/ Post Heart Catheter ASSIGNMENT

Objectives:

1. Complete a discharge teaching plan for a patient post heart catheter.

2. Analyze nursing responsibilities for pre and post heart catheter.

3. Use clinical reasoning to identify nursing priority problems before, during and after a heart

catheter procedure.

1. Evaluate nursing responsibilities for pre- op prior to heart cath. Be sure to include: important

considerations for patient history, current medication, known allergies.

2. Prioritize nursing interventions post heart cath.

3. Design a discharge teaching plan using the attached concept map for a post cardiac catheter client

4. Describe the nursing care of a client in cath lab.

5. Discuss personnel involved in the cath lab. What are their roles in relation to the patient?

44

EMERGENCY DEPARTMENT and EMT Objectives:

1. Inquire about how patients are triaged.

2. Assess patients noting changes in status, trends in data, and report significant changes

immediately.

3. Identify priority problems and priority nursing actions.

4. Interpret ABG, ECG and lab results.

5. Examine how care is safely delegated.

6. Use SBAR to communicate with other members of the healthcare team.

Assignment

1. Complete a rapid reasoning case study on one patient. For the EMT rotation adapt the rapid reasoning

tool as much as possible.

2. Describe the legal implications of ED nursing care: child abuse, blood ETOH, DOA's, poison control,

treatment of minors, psychiatric emergencies, physical restraint, and reporting incidents to law

enforcement.

45

RAPID Reasoning Case Study-STUDENT I. Data Collection History of Present Problem:

Personal/Social History:

What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?

RELEVANT Data from Present Problem: Clinical Significance:

RELEVANT Data from Social History: Clinical Significance:

What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?

(Which medications treat which conditions? Draw lines to connect)

PMH: Home Meds:

Lab/diagnostic Results:

What lab results are RELEVANT that must be recognized as clinically significant to the nurse?

RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable:

What lab results are RELEVANT that must be recognized as clinically significant to the nurse?

Basic Metabolic Panel (BMP) Current High/Low/WNL? Most Recent:

Sodium (135-145 mEq/L)

Potassium (3.5-5.0 mEq/L)

Glucose (70-110 mg/dL)

Creatinine (0.6-1.2 mg/dL)

Misc. Chemistries:

Complete Blood Count (CBC) Current High/Low/WNL? Most Recent:

WBC (4.5-11.0 mm 3)

Hgb (12-16 g/dL)

Platelets(150-450x 103/µl)

Neutrophil % (42-72)

46

RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable:

II. Patient Care Begins:

What VS data is RELEVANT that must be recognized as clinically significant?

RELEVANT VS Data: Clinical Significance:

What assessment data is RELEVANT that must be recognized as clinically significant?

RELEVANT Assessment Data: Clinical Significance:

III. Clinical Reasoning Begins… 1. What is the primary problem that your patient is most likely presenting with?

Current VS: WILDA Pain Scale (5th VS)

T: Words:

P: Intensity:

R: Location:

BP: Duration:

O2 sat: Aggreviate:

Alleviate:

Current Assessment:

GENERAL

APPEARANCE: Resting comfortably, appears in no acute distress

RESP: Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort

CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong,

equal with palpation at radial/pedal/post-tibial landmarks

NEURO: Alert & oriented to person, place, time, and situation (x4)

GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants

GU: Voiding without difficulty, urine clear/yellow

SKIN: Skin integrity intact

47

2. What is the underlying cause/pathophysiology of this concern?

3. What nursing priority(s) captures the “essence” of your patient’s current status and will guide your plan of care? (if

more than one-list in order of PRIORITY)

4. What interventions will you initiate based on this priority?

Nursing Interventions: Rationale: Expected Outcome:

5. What body system(s) will you most thoroughly assess based on the primary problem or nursing care priority?

6. What is the worst possible/most likely complication to anticipate based on the primary problem?

7. What nursing assessments will identify this complication EARLY if it develops?

8. What nursing interventions will you initiate if this complication develops?

Medical Management: Rationale for Treatment & Expected Outcomes Care Provider Orders: Rationale: Expected Outcome:

48

PRIORITY Setting: Which Orders Do You Implement First and Why? Care Provider Orders: Order of Priority: Rationale:

Medication Dosage Calculation: Medication/Dose:

Mechanism of Action: Volume/time frame to

Safely Administer:

Nursing Assessment/Considerations:

Normal Range: (high/low/avg?)

Hourly rate IVPB:

IV Push Rate Every

15-30 Seconds?

9. What educational/discharge priorities will you identify once this patient is admitted to the unit?

Caring & the “Art” of Nursing 10. What is the patient likely experiencing/feeling right now in this situation?

11. What can I do to engage myself with this patient’s experience, and show that he/she matters to me as a person?

It is now the end of your shift. Effective and concise handoffs are essential to excellent care and if not done well can

adversely impact the care of this patient. You have done an excellent job to this point, now finish strong and give the

following SBAR report to the nurse who will be caring for this patient:

Situation:

Background:

Assessment:

Recommendation:

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CHARGE NURSE ROTATION WRITTEN ASSIGNMENT

Objectives:

1. Identify how the charge nurse uses informatics to provide safe care.

2. Collaborate with members of the interdisciplinary team to improve client outcomes.

3. Identify quality improvement strategies that are being used to improve client outcomes.

1. Define responsibilities of the charge nurse.

2. Identify the knowledge and skills needed by the charge nurse to function effectively.

3. Describe how a charge nurse organizes his/her time, prioritizes, and delegates either assignments or

patient care.

TEAM LEADING ROTATION WRITTEN ASSIGNMENT

Objectives:

1. Gather report on all clients assigned to fellow students.

2. Determine priorities for each client using assessment findings as well as data from chart.

3. Collaborate with other team members including fellow student regarding changes in status or

new orders.

4. Promote time management and organization in helping fellow students plan nursing care.

1. Complete attached active questioning form and discuss with your instructor soon after report.

2. Complete a reflective journal. Include what you did well, and what you would like to improve or

change.

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Active Questioning

After assessing your patient answer these questions and discuss with your clinical instructor.

Patient 1 Patient 2 Patient 3 Patient 4 Patient 5

What are you on alert for today?

What are the priority assessments to make?

What complications may occur?

What interventions will prevent complications?

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Objectives:

1. Demonstrate the ability to apply the nursing process when caring for patients with multiple health

alterations.

2. Actively participate with patients, families and healthcare team members in accordance with the legal

and ethical standard of the nursing profession.

3. Use communication techniques to function collaboratively with the health care team caring for ESRD

patients.

4. Analyze at least one ESRD patient’s assessment of systems, psychosocial and medication needs.

5. Describe the management, supervision and delegation responsibilities of the RN at a dialysis center.

6. Demonstrate responsibility for continued personal and professional development.

Assignment

At the completion of the experience, submit a paper to your INSTRUCTOR that includes:

a. The value to you in having had this experience.

b. The value to other patients you will have in the future.

d. Your observations about the nursing assessment of a fistula vs a graft or a catheter

e. A summary of what you have observed about the impact of hemodialysis on ADLs’

A Concept Map including one patient’s diagnoses and Medications received

The Medication Sheet attached listing 5 drugs you have seen administered during your site visit

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiv1-2yuMXLAhVssYMKHZKiAU0QjRwIBw&url=https://wjjgibson.wordpress.com/2012/10/02/dialysis-progress/&bvm=bv.116954456,d.amc&psig=AFQjCNGYODA5dsZboV1o54zjSr5kGseYsQ&ust=1458225742348989

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Respiratory Therapy- Senior Level

Objectives:

1. Determine nursing responsibilities of a patient on a ventilator, intubation, and extubation.

2. Interpret ABG results and compare results to client’s physical assessment.

3. Discuss how to safely monitor respiratory equipment such as ventilators.

Assignment

1. Auscultate at least 3 client breath sounds using appropriate assessment techniques.

Discuss and document your findings with the R.T.

2. Review radiology films/reports of a patient for treatment of COPD/pneumonia, asthma,

and/or flu. What did you find? Any differences?

3. Observe at least one ventilator client. Notice settings. Answer below questions describing

difference (if ventilator was not observed, describe each statement and differences)

4. What classification of ventilator is being used (positive pressure, negative pressure)?

5. What is the ventilator mode (assist-control, intermittent, synchronized – see your med-

surg text book)?

6. What is the tidal volume set at, why is this important?

7. What is the FiO2 setting, why is this important?

8. What is the sensitivity setting, why is this important?

9. What is the sigh setting, why is this important?

10. What is the PEEP, why is this important?

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Registered Nursing Program

Clinical Warning Form

Definitions & Procedures

S = Satisfactory

Students meet minimum requirements for the program outcomes.

N = Needs Improvement

Students did not meet minimum requirements for 1 or more core competency for that program outcome. If an

N is received then the student and instructor are expected to:

1. Discuss the issue during the clinical rotation.

2. The instructor will document the discussion on the clinical formative evaluation tool.

3. The instructor will fill out the clinical warning form.

4. The student will formulate a simple remediation plan to be presented to the clinical instructor and course

coordinator. (if applicable)

5. If after remediation, the student receives another N, the process will be repeated once more.

6. If the student receives 3 N’s in the same program outcome category, such as Human Flourishing, on separate

occasions during a course clinical rotation then they will receive a U for that clinical rotation and will be

dismissed from the program.

U= Unsatisfactory (3 N’s)

Student did not demonstrate essential skills for patient safety, professional behavior etc. as stated on page 37 in

the RN Handbook. If the student participates in any of the reasons for dismissal as listed under “Unsafe Clinical Practice”

if the RN Handbook they will receive a U on the clinical formative evaluation tool.

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North Arkansas College Department of Nursing Clinical Warning Form

Student Name__________________________________ Clinical Rotation___________________ The above student has received a “Needs Improvement” evaluation from the clinical instructor. The following area(s) was/were designated as not meeting the minimal requirement.

(circle)

Human Flourishing Communication, Patient Centered Care, Cultural Diversity

Nursing Judgment/Practice Safety/Quality Improvement, Evidence Based Practice,

Managing Care, Collaboration/Teamwork

Spirit of Inquiry Clinical Decision Making, Clinical Reasoning Professional Identity Professional Behavior, Teaching-Learning, Informatics, Legal-Ethical Specific area needing improvement – _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Student’s plan for remediation – _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I acknowledge that I have read and understand the above clinical evaluation. Student____________________________________________________ Date_______________ Instructor__________________________________________________ Date_______________ Course Coordinator_________________________________________ Date_______________ INC 10-24-12 *Copy given to student, copy to instructor and/or course coordinator, original in student file.

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North Arkansas College Department of Nursing RN Program

Formative Evaluation Tool

Student Name____________________________________________ Clinical Rotation_______________________________________________ S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not Applicable

Fill in Clinical Dates HERE

Hu

man

Flo

uri

shin

g

Communication Uses effective therapeutic communication skills with patients, health care team, faculty and others

Actively participates in pre/post conferences Documents appropriately in either writing or in the electronic health record

Patient Centered Care Assess/plan for patient-family spiritual needs Respects the individual’s personal spirituality Assists the patient to meet their spiritual outcomes Demonstrates compassion for others

Cultural Diversity Respects & values diverse cultures Provides culturally competent care

Nu

rsin

g Ju

dgm

en

t/P

ract

ice

Safety/Quality Improvement Uses standard precautions, hand hygiene and sterile technique Administers medications using the 6 rights Able to verbalize action, side effects, adverse reactions of medications Recognizes and intervenes for high risk patients Provides for a safe environment for self, others and patients Recognizes their role in a disaster preparedness “Identifies” quality improvement measurements

Evidence Based Practice Utilizes the nursing process to provide patient care Uses correct assessment techniques Identifies appropriate nursing diagnosis Plans patient care using current trends in health care Performs appropriate nursing interventions Evaluates patient outcomes and revises care as needed

Managing Care Prioritizes patient care Provides timely patient care Demonstrates organizational skills Completes assignments on time

Collaboration/Teamwork Identifies members of the health care team (lower level) Compares the roles of the health care team (medium) Plans patient care with the health care team (higher level) Provides assistance to other health care team members Functions as a team member by demonstrating cooperativeness & displaying mutual respect

Semester____________________

Course______________________

Revised 4-12 10-24-12

56

Pro

fess

ion

al Id

en

tity

Professional Behaviors Professional appearance (uniform and hygiene) Preparedness (comes to clinical with stethoscope, name tag, pen, etc.) Demonstrates positive attitude Role model for others Notifies clinical instructor of absence/tardiness per policy Does not show pattern of tardiness/absenteeism Accepts criticism and corrects mistakes willingly Is self-motivated and directed Complies with agency and program policy

Teaching and Learning Utilizes evidence-based teaching interventions Demonstrates mutual goal-setting Identifies resources (physical, emotional, spiritual, etc.) Promotes self-determination of patient and self

Informatics Utilizes technology to provide safe patient care Access appropriate resources to support positive patient outcomes

Legal/Ethical Practices with in the identified role of a student nurse Maintains confidentiality (HIPAA)

Clinical Instructor Initial HERE

Instructor Comments: Instructor Signature:__________________________________________ Date:___________________ Student Comments: I acknowledge that I have read and understand the above clinical evaluation.

Student Signature:___________________________________________ Date:_____________________

Fill in Clinical Dates HERE Sp

irit

of

Inq

uir

y

Clinical Decision Making Makes clinical judgments to ensure safe care Uses evidence-based information to evaluate patient outcomes Identifies problems, issues, and risks to promote health and safety Seeks out learning opportunities Explores alternatives to achieve patient goals

Clinical Reasoning Questions underlying assumptions Offers new insight to improve quality of care

57

North Arkansas College Department of Nursing RN Program

Summative Evaluation Tool

Student Name_____________________________________ Clinical Rotation____________________________________________ S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not Applicable

Hu

man

Flo

uri

shin

g

Communication S, N, U,

NA Instructor Comments

Uses effective therapeutic communication skills with patients, health care team, faculty and others Actively participates in pre/post conferences Documents appropriately in either writing or in the electronic health record

Patient Centered Care

Assess/plan for patient-family spiritual needs Respects the individual’s personal spirituality Assists the patient to meet their spiritual outcomes Demonstrates compassion for others

Cultural Diversity

Respects & values diverse cultures Provides culturally competent care

Nu

rsin

g Ju

dgm

en

t/P

ract

ice

Safety/Quality Improvement

Uses standard precautions, hand hygiene and sterile technique Administers medications using the 6 rights Able to verbalize action, side effects, adverse reactions of medications Recognizes and intervenes for high risk patients Provides for a safe environment for self, others and patients Recognizes their role in a disaster preparedness “Identifies” quality improvement measurements

Evidence Based Practice

Utilizes the nursing process to provide patient care Uses correct assessment techniques Identifies appropriate nursing diagnosis Plans patient care using current trends in health care Performs appropriate nursing interventions Evaluates patient outcomes and revises care as needed

Managing Care

Prioritizes patient care Provides timely patient care Demonstrates organizational skills Completes assignments on time

Collaboration/Teamwork

Identifies members of the health care team (lower level) Compares the roles of the health care team (medium) Plans patient care with the health care team (higher level) Provides assistance to other health care team members Functions as a team member by demonstrating cooperativeness & displaying mutual respect

Semester____________________

Course______________________

Revised 10-12 10-24-12

58

Sp

irit

of

Inq

uir

y

Clinical Decision Making

Makes clinical judgments to ensure safe care. Uses evidence-based information to evaluate patient outcomes. Identifies problems, issues, and risks to promote health and safety. Seeks out learning opportunities Explores alternatives to achieve patient goals

Clinical Reasoning

Questions underlying assumptions Offers new insight to improve quality of care

Pro

fess

ion

al Id

en

tity

Professional Behaviors

Professional appearance (uniform and hygiene) Preparedness (comes to clinical with stethoscope, name tag, pen, etc.) Demonstrates positive attitude Role model for others Notifies clinical instructor of absence/tardiness per policy Does not show pattern of tardiness/absenteeism Accepts criticism and corrects mistakes willingly Is self-motivated and directed Complies with agency and program policy.

Teaching and Learning

Utilizes evidence-based teaching interventions Demonstrates mutual goal-setting Identifies resources (physical, emotional, spiritual, etc.) Promotes self-determination of patient and self

Informatics

Utilizes technology to provide safe patient care Access appropriate resources to support positive patient outcomes

Legal/Ethical

Practices with in the identified role of a student nurse Maintains confidentiality (HIPAA)

PASS FAIL Student Comments: I acknowledge that I have read and understand the above clinical evaluation. Student Signature:__________________________________________ Date:_____________________ Instructor Signature:________________________________________ Date:_____________________

Nursing 2128 Medical-Surgical Nursing III Syllabus

Documents

Transcript of Nursing 2128 Medical-Surgical Nursing III Syllabus