NURSING 270 - Western Nevada Web viewFirst year care-plan ... You should also know how to use a word...

Course Syllabus

NURS 270: Advanced Clinical Nursing I Theory

Sherry Neil-Urban PhDMichael Malay MS CEN

Edda Gibson MS, APN, CCRN

Fall 2012

WESTERN NEVADA COLLEGENURSING 270 ADVANCED CLINICAL NURSING I

CREDITS: PREREQUISITES:3 credits Lecture Successful completion of the(45 clock hours) first year of the program

I. COURSE DESCRIPTION:Offers clinical theory organized around the nursing process and its application to patient needs. Requires students to apply the principles of providing a safe care environment, while addressing health promotion and health maintenance needs for persons experiencing complex/acute alterations in health. Students will also apply concepts of community care, case management, health teaching and discharge planning.

Students must pass NURS 271 and achieve a theory grade of 75% or better in NURS 270 to obtain a grade of C or better in NURS 270. Failure to satisfactorily complete the required coursework for any of the Advanced Clinical Nursing I courses will necessitate that the student repeat the coursework series which includes NURS 270 and 271.

II. REQUIRED TEXTS

Fluids and Electrolytes Made Incredibly Easy (2005) 3rd Ed. Philedelphia: Lippencott Williams and Wilkins

Gahart, B. & Nazareno, A. (2012) Intravenous medications. 28th edition. St. Louis: Missouri, Mosby.

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis: Mosby.

First year care-plan text book.

III. WNC online (Moodle) Course RequirementsThis course utilizes myWNC (Moodle) to provide handouts and communicate with students. The faculty will also communicate with you through your personal email. Students will need to

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have the skills necessary to use the internet and a basic understanding of how to download and print documents from the internet. You should also know how to use a word processor that will save in an .rtf or .doc or html format to type and submit papers via the web. Tutorial link and frequently asked questions and answers regarding this online platform are available at http://www.wnc.edu/wnconline/

IV. Disability Support Services

Any student needing to request accommodations for a specific disability, counseling and/or testing support to please meet with the DSS coordinator (445-3275) at your earliest convenience to ensure timely and appropriate accommodations. The DSS office is located in Bristlecone building, Room 103.

V. STUDENT LEARNING OUTCOMES:

Upon completion of the course the student will be able to apply the theoretical concepts, related pathophysiology and care practices to safely meet the multiple complex and acute needs of their patients.

Upons successful completion of the course the student will be able to :

1. Analyze specific problems of patients with complex/acute health alterations to address the patient’s physiological integrity needs.

2. Utilize therapeutic communication skills when interacting with patients and their families.

3. Integrate research findings that guide (or lead to) best practice and quality improvement. 4. Apply the nursing process with patients who are experiencing actual or potential

problems related to:a. respiratory system functionb. endocrine (diabetes) and auto-regulatory system function (Acid-base/fluid and electrolyte imbalance) c. hematological system functiond. Immune system function (hematological, immune, oncological)d. nervous system function e. circulatory perfusion (shock, fluid and electrolyte imbalances)f. pain

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http://www.wnc.edu/wnconline/

5. Explain the concepts for safely administering therapeutic intravenous nutritional supplements including total parenteral nutrition (TPN), blood, and intravenous therapy, on the health of patients in the acute care setting.

6. Describe the effects of diet on the management of selected complex/acute alterations in health.

7. Apply concepts of cultural awareness, cultural sensitivity and respect for persons when working with all populations in the healthcare environment.

8. Explore the nursing practice environment in community and home heath settings with that of acute care facilities.

9. Provide care and comfort to adult patients experiencing end of life issues.

10. Explore the role and dimensions of case management in the provision of continuity of care for clients experiencing complex/acute alterations in their health.

11. Demonstrate professional accountability through identification of self-learning needs and ongoing professional development.

12. Explain and define ethical and legal principles which apply to patients, and their families, who are experiencing complex/acute alterations in their health.

Western Nevada College General Education Program Outcomes Linkage

1. Using college level reading skills, analyze and interpret nursing and medical Research

2. Understand and appreciate the many ethical dilemmas in health care provision and delineate a framework useful for ethical decision making.

3. Demonstrate professional level communication in their oral presentations

4. Employ appropriate technologies for this WebCT enhanced course and to produce word processed manuscripts.

5. Appreciate and value cultural diversity encountered in patient care environments and the diverse and alternative health care philosophies and approaches employed.

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VI. METHODS OF EVALUATION -- N270 Advanced Clinical Nursing 1 Theory

Students progressing from the first year of the nursing program and transfer students are expected to apply content covered in the first year of the program.

. Methods of Evaluation1. Four computerized (or written scantron) examinations2. Kaplan Integrated testing3. Pain Symposium4. Nutrition Day Assignment 5. Four tickets to class (see weekly unit objectives)

Each student must earn a 75% average on unit exams. Students who do not earn a 75% average on unit exams will not be allowed to continue in the nursing program and will receive the earned average of unit examinations as their grade for the course. Students with questions about this are referred to the WNC nursing student handbook and to the director of Nursing and Allied Health Programs. Grading of all exams and student work is done on a percentage basis.

1) EXAMS - 75% of the final grade is derived from exams.

4 exams will be given. Exams will be computerized. The non-comprehensive final exam will be proctored in the computer lab during finals week. The other three examinations will be proctored during the beginning of class. There will be 50 – 70 questions per unit exam and 1 hour of class time will be allotted for these examinations. We have scheduled the computer lab Cedar 331 A, C and D from 8AM until 9:30AM for those students who require extra time to take examinations.

• Exam 1 09/20/11 Week 4• Exam 2 10/11/11 Week 7• Exam 3 11/08/11 Week 11• Exam 4 12/13/11 Finals Week

All exams must be taken on date scheduled. All exams are taken online in the WNC Computer lab (8-9:30 am of the exam day) unless other accommodations are made. If a written exam is used, only the answers on the scantron will count so be sure to mark the answer you want clearly on the scantron.

If your exam score is less than 80%, you have one week after grades are posted to further review the content and discuss concerns with the instructors.

Kaplan Fundamentals focus test are available throughout the semester with remediation available for all questions. Specific content TBA. and is available for you all semester to use at your discretion. We are planning to take questions directly from, or similar to, these practice tests so it would be helpful for you to “take” these practice tests.

Any students caught cheating on an exam, quiz, or assignment will receive a 0. No exceptions. Refer to criteria for exam taking.

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2) Kaplan on-line exams ---- 10% - Ten percent of your grade is based on your Kaplan Exam Scores. You will take MSI and Nutrition Exams in a controlled environment in the computer lab.

These exams are scheduled for October 17th from 8-10 AM – MS1and also on November 28th from 8-10 AM- Nutrition.

Exams scores above 70% in Kaplan will count for full credit. Students who achieve less than 70% are expected to remediate for each exam below 70% for one hour. Your faculty will look at your remediation efforts during finals week.

3) COMMUNITY EDUCATOR – PAIN SYPOSIUM - 15% of course grade

This purpose of this assignment is:• to help you develop your abilities to work within a group• to practice your oral presentation skills, and written communication skills• to explore the current nursing literature and gain knowledge• to experiment with the role of educator

You and your group (total no more than 4) are working at a local hospital and you have been asked to participate in a symposium on aspects of pain and pain management for nurses. You will present some aspect of pain control, pain theory and pain assessment to a mixed group of nurses. SEE LIST OF TOPICS.

You are to provide an oral presentation no longer than 20 minutes along with any handouts, pamphlets, or written material that you believe would reinforce your teaching. Please be dressed in Business Professional clothing, points will be deducted for wearing jeans.

Please provide a reference sheet in APA format that identifies the professional resources that you used to prepare your presentation and hand-out materials.

Here are some things to keep in mind:• Be creative and keep things interesting – yet make your creativity relevant • Make your material appropriate to both the general public and professional nurses.• Use the basic principles of teaching/learning discussed in your texts.• Base your teaching materials in solid research and current literature.

Specifically here is the community educator assignment:a) Choose a group of 4 students.b) Choose a teaching topic on some aspect of pain management, assessment, or physiology from the list c) Submit a short written proposal (no later than September 13 th , 2011) regarding your topic, your group composition, and a plan for how each group member will contribute, and an outline of your teaching strategies.

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You will present your topic on Tuesday, October 18th Presentations will start at 8 AM and will go until 1:00 PM. Please make arrangements. Refreshments will be provided. This is a dress-up event!

d) Your grade will be determined in the following manor:

A) application of teaching/learning principles (interesting?) 25%B) accurate and up-to-date information 25%C) effective use of teaching aids, handouts, etc. 25%D) reference sheet and use of current literature 25%

TICKETS TO CLASS –

On four occasions , or more, you will be required to have completed an assignment in order to attend the scheduled class. Please note the syllabus and the assignment prior to each class. If you have not prepared your assignment (ticket), points will be deducted from your grade (up to a total of 6% of your grade). In addition, it is expected that you complete the required reading each week. These assignments are specifically selected to help you perform better on the exam and apply the critical material.

IN SUMMARY:EXAMS 75% of gradeKaplan 10% of gradePain Symposium Teaching 15% of grade

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TOPICAL OUTLINEWeek I IV Therapy Week 2 Fluid balance and electrolyte regulation Ticket (see weekly objectives)

also, select pain topic and group members this week

Week 3 Shock

Week 4 EXAM I Acid- base regulation - ABG’s (see weekly objectives)

Ticket: Analyze the ABG’s listed in your weekly objectives.

Week 5 Diabetes and pancreatic dysfunction

Week 6 Ethics and culture in Nursing Ticket Culture definitions (see weekly objectives)

Ethics definitions (see weekly objectives)

Week 7 EXAM II Community Health and Discharge Planning Home Health Care

Ticket See weekly objectives.

Week 8 PAIN SYMPOSIUM: MARLETTE HALL and plan to stay from 8- 1:00 PM on TUESDAY, October 18th (food will be provided)

PRESENTATIONS Advanced and terminal pain control & Nontraditional pain control methods. TOPICS : 1) Neural mechanisms of pain, 2) Gate theory of pain3) Catagories of pain, (somatic, visceral, etc) 4) Narcotics (include administration methods), 5) NSAIDS 6) Epidural pain relief (be sure to also focus on nursing considerations and role of nurse), 7) Back pain8) Pain assessment techniques across the lifespan,

Alternative pain relief: 9) Acupressure, 10) Guided imagery 11) Culture and the expressions of pain

Week 9 End of life issues HIV / AIDSWeek 10 Respiratory system and associated dysfunctions

Week 11 EXAM III Nervous system and associated dysfunctions

Week 12 Immune system and associated dysfunctions Week 13 Nutrition Day ---- you are expected to participate and bring food or beverage.

Week 14 Cellular dysfunction – CancerWeek 15 Male Reproductive system and ear and eye concerns

Week 16 EXAM IV Tuesday, December 13, 2011 ---- 8AM during finals week

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Week 1 Meeting the patient’s/client’s physiological integrity related to parenteral (IV) therapies.

Readings - RequiredFluids & electrolytes made incredibly easy! (2012). 3rd edition. Springhouse, Pennsylvania: Springhouse Corporation. (review).

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find IV therapy in your book.

RecommendedTaylor, C., Lillis, C., & LeMone, P. (2008). Fundamentals of Nursing. The art & science of nursing care (3rd ed.). Philadelphia: Lippincott. Find Intravenous Therapy in your index.

Weekly student learning outcomesAt the completion of this unit the student will be able to: I . Explain the functions of the various types of Intravenous equipment

(this objective also involves laboratory content).-in line filters-Tubing

_Drip factors-Blood tubing-Extension tubing

-Needles-Gauges-Types

_Butterfly-Over-the-needle cannula

-Through-the-needle cannula-Solutions

-isotonic-Hypertonic-Hypotonic-Blood and blood components

-Pumps and control devices

-Long term parenteral catheters

2. Using the nursing process, and using effective communication prepare the client for IV therapy-Psychological preparation-Site selection

-Vein dilation

3. Explain the nursing interventions utilized to reduce the risk of complications for the client undergoing IV therapy-Sterile equipment and principles of asepsis-Site preparation and maintenance

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-Schedule for tubing and solution changes and site rotation -Use of personal protective equipment

4. Discuss common clinical signs and behaviors associated with the following complications of IV therapy-infiltration-Phlebitis-Air embolus-Catheter embolism-Circulatory overload-Allergic reactions

5. Identify the nurse's role regarding appropriate precautions and safe administration of the following therapies across the lifespan.-Hyperalimentation-Fat emulsion therapy-Administration of blood and blood components-Plasma substitutes

6. Analyze the nurse's role in providing care for a client with a central venous line, including: -insertion-Assessment of the site and client-Patency and site care-Phlebotomy from central lines-implications for home/community care-Alterations in body image-Complications

7. Describe the legal and ethical implications related to the administration of parenteral therapy:-Nurse practice act-Refusal of therapy-Patient assault and informed consent-Ordinary versus extra-ordinary care-Transfusion therapy and the right to privacy-Client injury

8. Compare and contrast the different types of central venous access catheters.

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Week 2 Alterations in fluid balance and electrolyte regulation

Required ReadingsFluids & electrolytes made incredibly easy! (2012). Springhouse, Pennsylvania: Springhouse Corporation. Read the sections on Fluids, electrolytes (Ch 1-10)

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic: Fluid and Electrolyte and Acid-Base Imbalances..

Ticket to classMake a set of 3x5 flash cards for yourself on each on the electrolytes that we are studying. (#5) Make two cards for each electrolyte. On one side of the card write the electrolyte and the prefix hyper or hypo. On the other side of the card write out the clinical manifestations of the disorder and the typical nursing and medical management for the problem. This is also a good way to learn the ranges of the laboratory value.

Weekly student learning outcomesAt the completion of this unit the student will be able to:

1 . Compare and contrast management issues related to problems in fluid and electrolyte balance.

2. Analyze the pathophysiology related to:-Fluid volume deficit-Fluid volume overload

3. Analyze nursing and associated interventions for clients, across the lifespan, experiencing the following:-Dehydration-Water intoxication-Solute loading hypertonicity-Third space syndrome AND - Interstitial fluid excess (edema)

4. Predict lab tests that may be ordered for each of the disorders in objective 3.

5. Discuss assessment findings and collaborative interventions indicated for the following: (3X5 Cards)

-hyper and hypokalemia-hyper and hyponatremia-hyper and hypocalcemia-hyper and hypomagnesemia

6. Describe the teaching needs for the client experiencing a fluid and electrolyte disturbance in the following areas:

-Diet-Medication, over the counter interactions, drug interactions

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WEEK 3 --- SHOCK

Required Readings• Review previous reading on fluids, acid-base regulation, transfusions, and IV

therapy.

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topics: Shock, systemic inflammatory response syndrome, multiple organ dysfunction syndrome.


1 . Explain the pathophysiology of shock and its effect on physiological integrity.2. Compare and contrast clinical behaviors across the lifespan and associated nursing

interventions for the following stages of shock:-Compensated -Uncompensated-Progressive -Irreversible

3. Predict major physiological stimuli responsible for the major types of shock and explain the pathophysiology related to each and treatment strategies for each:-Hypovolemic -Cardiogenic-Neurogenic -Septic -anaphylactic

4. Evaluate nursing and medical measures to prevent shock development. 5. Explain the promotion and maintenance of health for the client in shock in terms of the following:

-Medical therapy, -Diagnosis, -Independent nursing interventions

- intravenous and blood component therapy6. Review the functions of the sympathetic and parasympathetic nervous systems and relate their role in the physiologic adaptation of shock states.7. Consider how cardiac function promotes (or detours) physiologic adaptation in shock states in

regards to:-Preload-Afterload-Contractility

8. Predict pharmocologic management for the client in shock, including:-Vasopressors -Vasodilators-inotropic agents -Chronotropic agents-Sympathomimetics

9. Explain advanced assessment techniques utilized for clients with shock and the significance of each:

-Central venous pressure-Pulmonary capillary wedge pressure-Systemic vascular resistance

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Week 4 Acid/base regulation

ReadingsFluids & electrolytes made incredibly easy! (2005). Springhouse, Pennsylvania: Springhouse Corporation. 33-44, 179-205. Read chapters related to acid/base.

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topics: Fluid and Electrolyte and Acid-Base Imbalances

Ticket to classPlease attempt to interpret the following ABG's as either physiologic neutral, acidic or basic and state if you believe it to be caused by a respiratory or metabolic component.

Case 1 Case 2 Case 3 Case 4 Case 5pH 7.4 7.32 7.48 7.2 7.36PaO2 87 130 86 50 58PaCO2 40 32 40 82 68HCO3 24 18 30 23 29


I Explain the adaptive responses associated with each of the following inregards to the regulation of acid-base balance.-Hydrogen ions-Buffer systems-Respiratory regulation-Renal regulation

2a. Compare and contrast the clinical signs and behaviors of the following acid-base dysfunctions and predict measures to restore health in each.-Respiratory acidosis-Respiratory alkalosis-Metabolic acidosis-Metabolic alkalosis-Mixed disorders (compensation)

2b. Describe the nursing management of clients with the disorders listed in objective 2a.

3. Describe how client teaching can be used to promote client health in acid base imbalances across the lifespan.

4. Discuss the use of client teaching to promote health related to acid-base disorders in the following areas:

-Diet-Medications-Drug interactions -OTC medications

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Week 5 : Diabetes and Pancreatic dysfunction

Readings:Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic.

Read Chapter 49 (Patient with diabetes mellitus)Read Located in chapter 44: (pancreatitis)


1 Review the etiology of Type I and Type 11 diabetes and explain the pathophysiology related to each.

2. Compare and contrast collaborative management of the client with Type I diabetes and Type 11 diabetes including developmental issues.

3. Interpret the following laboratory tests:-Fasting blood sugar-Glucose tolerance test-Two hour post-prandial-Glycosylated hemoglobin

4. Analyze the promotion of health for diabetics in relation to the following:-Client age -Diet-Exercise-Glucose and ketone monitoring-insulin administration-Oral hypoglycemic agents-Client teaching

5. Predict the signs and clinical behaviors of acute hyperglycemia and hypoglycemia and describe the emergency management for each.

6. Compare and contrast diabetic keto-acidosis and non-ketotic hyperosmotic diabetic coma (also known as hyperglycemic hyperosmolar non-ketotic coma).

7. Describe the potential long-term complications of diabetes.

8. Explain the clinical signs and behaviors associated with pancreatitis and the related pathophysiology.

9. Compare and contrast the nursing and medical management for the client with acute and chronic pancreatitis.

10. Analyze the effect of pancreatitis on other physiologic systems.

11. Discuss the causes, pathophysiology, potential outcomes, and related nursing interventions for the client with pancreatic cancer.

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WEEK 6 Culture Ethics

Readings - Required

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic.

(Chapter 2 – Culturally competent care )

Ticket to class:

1. Define the following cultural terms:-Ethnicity-Ethnocentrism-Minority-Stereotyping-Culturally competent care

. 2. Define the following ethical terms:-Autonomy-Paternalism-Nonmaleficence-Beneficence-Justice-Confidentiality-Fidelity

3. Define informed consent and identify the components necessary to assure informed consent.

Weekly student learning outcomes associated with the culture portion of the classAt the completion of this unit the student will be able to: 1. Outline diverse cultural beliefs regarding

i. Family roles in medical and personal decision makingii. Child rearing practicesiii. Death and dyingiv. Nutrition and dietv. Medication

2. Compare and contrast how cultural beliefs affect patient and family interventions and healthcare practices.

3. Delineate the seven steps to developing cultural competence.

4. Describe the current JCAHO guidelines regarding provision of culturally and linguistically appropriate healthcare.

5. List methods for working with patients when beliefs may conflict with effective healthcare interventions.

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6. State what types of cultural information should be put into the patients multidisciplinary plan of care.

Weekly student learning outcomes associated with the ethics portion of the classAt the completion of this unit the student will be able to:

1. Describe the ethical values of the nursing profession.

2. Be able to apply ethics principles to the scenario offered.

3. Describe the differences between utilitarian ethical theory and deontologic ethical theory.

4. Engage in discussion on the impact and effects of cultural diversity on the health care experience. 5. Evaluate the roles of members of an Ethics Committee.

6. Analyze the processes of and functions of an Ethics Committee.

7. Participate, using role play, on a mock hospital ethics committee meeting, using a scenario based upon a complex ethical premise.

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Week 7 EXAM II

Promotion of client health in the community setting and continuity of careEmphasis on Discharge planning

Readings

Lewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic.

Community Based Nursing – Chapter 6,

Taylor, C., Lillis, C., LeMone,P. (2008). Fundamentals of Nursing: The Art & Science of Nursing Care (6th

ed.). Lippincott & Wilkins, Philadelphia.

Ticket to Class Identify the elements of a discharge plan for a hospitalized patient (outcome #10)

Weekly student learning outcomesAt the completion of this unit the student will be able to: I . Describe at least 3 community-based nursing roles.

2. Relate how the nursing process can be used to guide health promotion and disease prevention in:-Home settings-Community settings

3. Identify and define the 3 stages of disease prevention.

4. Relate understanding of the existence and purpose of the Healthy People 2020 project.

5. Debate factors that may affect continuity of care in the home setting.

6. Investigate the nursing orientation to practice of nursing care delivered outside of an acute care institution, that of a community health nurse, and that of a public health nurse. Make sure to develop a working definition of "community as client."

7. Describe the components of a home care visit.

8. Identify essential components of inter-agency referrals and the nurse's role in providing continuity of care.

9. Debate ethical issues related to efficient and cost-effective care versus extended client need.

10. Describe elements of an effective patient discharge.a. Identify components of a client discharge plan.

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b. Relate how discharge plans are modified based on client development.

c. Compare and contrast the role of care maps, critical paths, and case management in the discharge planning process.

d. Predict the collaborative input of other health care disciplines in the discharge planning process.

e. Identify community resources available for clients with the following issues:

-the uninsured client-elderly-immobilized or home-bound-clients with pulmonary dysfunction

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WEEK 8 Pain Symposium

Advanced pain control, Terminal pain control, nontraditional pain control methodsNOTE: 8AM – 1:00 PM on Tuesday, October 18th

Required ReadingsLewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic.

Weekly student learning outcomes: (any of the below may be selected for presentation)At the end of this unit the student will be able to use information literacy skills to integrate research findings that guide best practice decisions for patients experiencing pain.

The student will:1 . Identify the basic neural mechanisms of acute pain.

2. Explain the Gate control theory of Pain.

3. Discuss in depth the pathophysiology of pain (neural mechanisms of pain)

4. Describe pain assessment techniques that may be utilized across the life-span.

5. Review the pharmocologic action of narcotic agonists and other pain control adjuncts.

6. Compare and contrast the concepts of analgesia and anesthesia in terms of-identification of each-Pathophysiology-Related client behaviors-nursing concerns

7. Explore the various types of alternative pain control methods including; Acupressure, Relaxation techniques, herbals, humor and guided imagery.

8. Examine in depth issues related to epidural medication administration, including: -nurse practice issues, -initiation, precautions, medication administration-Assessment-Evaluation-Termination

9. Examine issues related to TENS unit use in pain control including:-Client teaching, initiation, testing, stimulus adjustment.

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WEEK 9

1. End of life issues and ethics of nursing care for clients with complex adaptive dysfunction.

2. HIV/AIDS

ReadingsLewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic.


1 Analyze ethical issues related to death and dying-Risk versus benefit-Extraordinary versus ordinary care-Treatment options and accessibility-"gag" rules and implications for the client-Non-traditional therapies

2. Compare and contrast the nurses' role in end of life care in the home setting, hospice, and in an acute care facility.

2. Explore all aspects of holistic nursing care for Persons with HIV or AIDS

3. Apply concepts of cultural awareness, cultural sensivity and respect for persons when working with persons affected by HIV/AIDS

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Week 10 Alterations in the Respiratory system


Review and Read* Unit 5 - Problems of Oxygenation I VentilationChapter 26 - Respiratory System Chapter 28 - Lower Respiratory ProblemsChapter 27 -Upper Respiratory Probs Chapter 29 - Obstructive Pulmonary Diseases


1 Compare and contrast the nursing and medical management of clients experiencing

complications related to the following:-Pneumonia (across the lifespan)-Tuberculosis

2. Analyze the following types of lung cancer in terms of location, treatment and prognosis: -Small cell-Oat cell-Adenocarcinoma

3. Examine the causes, clinical behaviors, pathophysiology and treatment related to cancer of the throat.

4. Compare and contrast the nursing management of the client with a tracheotomy and a laryngectomy.

5. Plan the client care for safely weaning the patient before discontinuing a tracheostomy.6. Develop a discharge plan for the client with a laryngectomy, including:

-Daily care-Emergency management for problems-Home set up-Nutritional needs-Referrals

7. Explain interventions utilized to promote physical and psychosocial health for the client experiencing head and neck surgery for malignancy.

8. Identify the presence of acute respiratory failure and determine safe emergency airway management.

9. Relate the physiology of the thorax to the mechanical set up of a chest drainage system and predict possible system complications 10. Compare and contrast a chest drainage system and Heimlich valve.11. Evaluate the nutritional needs of clients affected by the

following respiratory disorders:-Pneumonia-Lung cancers-Tuberculosis-The client with a tracheostomy and laryngectomy

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EXAM III -----Week 11

Alterations in the Nervous system


Review chapter 56 (neurology system)Review chapter 58 (client with a stroke) BY TOPIC ONLYRead chapter 57 (intracranial problems)Read chapter 59 (ALS, and seizures)

Weekly student learning outcomesAt the completion of this unit the student will be able to: I . Review basic pathophysiology, clinical behaviors, and treatment of seizures in adult and pediatric

clients.2. Predict interventions for the client experiencing status epilepticus across the lifespan, including:

-Airway management-Client assessment-intravenous medications for seizures

3. Compare and contrast the clinical behaviors, pathophysiology, and nursing interventions utilized in caring for clients with the following:-Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease)-Guillain-Barre` syndrome

4. Identify the clinical incidence of brain tumors in clients across the lifespan5. Compare and contrast types of brain tumors in terms of prognosis.6. Analyze the effects of cerebral auto-regulation on intra-cranial pressure7. Predict nursing interventions to decrease intra-cranial pressure and identify the rationale for each.8. Anticipate multi-system nursing care needs of the unconscious client including nutritional support.9. Compare and contrast the pathophysiology, behaviors, and treatment for the client experiencing a

hemorrhagic versus a thrombotic or occlusive stroke.10. Identify types of traumatic brain injury.11. Compare and contrast each type of traumatic brain injury (TBI) in terms of: --- pathophysiology

-Clinical behaviors-interventions for the promotion of client health-Client rehabilitation

12. Explore legal and ethical issues related to declaration of brain death.

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Week 12 EXAM III

Alterations in the Immune system


Review (altered immune responses – Chapter 14)Read: Chapter 65 (Selected Autoimmune diseases)


1 . Compare and contrast the three major types of immune response and discuss how the immune response develops and changes over time.

2. Review the four types of hypersensitivity reactions and predict the nursing interventions required for each.

3. Assess the clinical behaviors of a client experiencing a systemic anaphylactic reaction and predict emergency management.

4. Identify the five types of immunoglobulins and their physiological behaviors, predict indications for IVIGG (intravenous gammaglobulin) use and identify related client precautions.

5. Analyze the diagnosis, clinical behaviors, pathophysiology and treatment for clients experiencing the following autoimmune disorders:-Systemic lupus erythematosis (SLE)-Progressive systemic sclerosis (PSS)-Rheumatoid Arthritis

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WEEK 13 NUTRITION DAY

NUTRITION: ReadingsLewis, S., Heitkemper, M., & Dirksen, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Lewis, Missouri: Mosby, Inc. Use Index to find topic.

Review and Read* - Chapter 40 (7 th Ed and 8 th Ed)

This weeks ticket to class: 8. The student will prepare a dish and create the nutritional values (sheet will be

provided) for that dish and display this information with the food item. 9. We will eat and enjoy and determine the 1) total calories and the 2) total fat in the

meal we are eating (sheet will be provided). This will be turned in to the instructors


1. Describe the essential components of a nutritionally sound diet and their importance to good health.

2. Describe the common etiologic factors, clinical manifestations, and management of malnutrition.

3. Describe the carbohydrates, fats and proteins, their specific functions in the human body and the recommended daily allowance of each.

4. Describe the role of fat in heart disease.

5. Be able to state the normal and abnormal triglycerides, and cholesterol levels.6. From a group of foods, select those dietary fats that are best in moderate

consumption, and those that are poor choices.7. Be able to read and interpret a food label.8. Analyze contemporary diet plans.9. Be able to define and recognize medically ordered diets such as: “soft,

mechanically soft, low-residue, and low-protein)10. Be able to make recommendations for the dietary management of specific

disease states (ie. Anemia, constipation, diarrhea, incontinence)11. Explain the various eating disorders.12. Determine the uses for the specific types of medical nutritional formulas (tube

feedings).13. Determine the nutritional values of the food item that was prepared for the class. 14. Tabulate the calories and the fat calories consumed in the meal eaten.

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WEEK 14 -- Cellular alterations resulting in cancer


Read Chapter 16 (Cancer)Read Chapter 30 (Hematologic Systems)Read Chapter 31 (Hematologic Problems)


1 . Review the nurse's role related to diagnostic testing for a client with cellular dysfunction.2. Analyze common laboratory tests performed on clients with cellular dysfunction.3. Predict the nursing and medical management for clients experiencing aplastic anemia.4. Discuss treatment goals for the following phases of chemotherapy:

-Induction -Maintenance -Consolidation5. Debate the safety issues related to chemotherapy administration for both client and nurse.6. Describe pathophysiology, treatment, and nursing care for the client with leukemia (ALL and AML)7. Explore nursing interventions to promote health for clients experiencing the following treatments for hemopoetic malignancies:

-Chemotherapy-Radiation (teletherapy) and brachytherapy-Bone marrow transplant

8. Identify and analyze safety and prioritization requirements when caring for a client receiving brachytherapy.9. Compare and contrast the treatment for polycythemia and thrombocytopenia.10. Identify clients at risk for disseminated intra-vascular coagulation (DIC) and describe nursing and medical interventions needed.11. Explain the pathophysiology, clinical signs, and behaviors associated with disseminated intra-vascular coagulation.12. Predict collaborative interventions employed in the acute management of hemophilia including:

-Developmental issues in the client with hemophilia-Nutritional support-intravenous hydration-Surgical management of hemophiliac clients-Reconstitution and administration of clotting factors (Factor VIII)

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WEEK 15 -- Alterations resulting in bone cancer, visual and auditory problems, and male reproductive problems

ReadingsLewis, S., Heitkemper, M., & Dirkson, S. (2011). Medical-surgical nursing: Assessment and management of clinical problems (7th ed.). St. Lewis, Missouri: Mosby, Inc.

Review: Chapter 16 – CancerRead: Chapter 64 – Musculoskeletal from p. 1672 - p. 1676Read: Chapter 21 – Visual and auditory systemsRead: Chapter 22 – Visual and auditory problemsRead: Chapter 55 – Male reproductive problems


1. Describe the types, pathophysiology, clinical manifestations, and collaborative care of patients with bone cancer.

2. Describe the structures and functions of the visual and auditory systems.3. Describe the physiologic processes involved in normal vision and hearing.4. Identify the significant subjective and objective assessment data related to the visual and auditory

systems that should be obtained from the patient.5. Describe the types of refractive errors and appropriate corrections.6. Explain the pathophysiology, clinical manifestations, and nursing management and collaborative

care of the patient with selected extraocular and intraocular disorders.7. Explain the general care of the patient undergoing surgery of the eye or ear.8. Explain the pathophysiology, clinical manifestations, and nursing management and collaborative

care of the patient with selected ear disorders.9. Explain the use, care, and patient teaching related to assistive devices for eye and ear problems.10. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing

management of benign prostatic hyperplasia.11. Describe the pathophysiology, clinical manifestations, collaborative care, and management of

prostate cancer.12. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing

management of problems of the penis, scrotum, testes.13. Discuss the nursing management of problems related to male sexual functioning.

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NURSING 270 - Western Nevada Web viewFirst year care-plan ... You should also know how to use a word...

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