Syllabus Handout for

Winter 2012

Adult Nursing IVNURS 2140 7A

INSTRUCTORS: Diana Blum, RN, MSNTeresa Champion, RN, MSN

Welcome to Metropolitan Community College

Metropolitan Community CollegeCourse Syllabus – 2012 Winter

COURSE IDENTIFICATION

Title: Adult Nursing IVPrefix/Section: NURS 2140 7ACredit Hours: 5 credit hours, 3.5 hour lecture a week, 8 hours clinical per week. Begins/Ends/No-Class Days: Tuesday, December 4, 2012 to Tuesday, February 26, 2013Meeting Day/Time: Tuesdays, 8:00 noon to 11:30 p.m.

Clinical, see clinical schedule for clinical timesNo Class: Holiday Break, December 24, 2012 to January 4, 2013Last Day to Withdraw Tuesday, February 12, 2013Class Location: SOC-Mahoney Bldg, RM 510Lab Location: SOC-Mahoney Bldg, RM 505Course Web Address: http://www.mccneb.edu/academics/alliedhealth/index.asp

CONTACT INFORMATION

Instructor Name: Diana Blum, RN, MSNOffice Telephone: 402-738-4651Email Address: dblum3@mccneb.edu Website: faculty@mccneb.edu/dblum3

Instructor Name: Teresa Champion, RN, MSNOffice Telephone: 402-738-4648Email Address: tmchampion@mccneb.edu

Office Location: SOC-Mahoney Bldg, RM 513Facsimile: 402-738-4552Office Hours: Posted outside of room SOC-Mahoney, RM 513Academic Program Area: Health CareersTutoring: Alice Ludwig, RN – SOC-Mahoney bldg, RM 513

COURSE INFORMATION

Course DescriptionAdult Nursing IV is a continuation and advancement of pathophysiological

manifestations treatment modalities, and nursing interventions through utilization of the critical thinking process and subsequent safe decision outcomes.

Course PrerequisitesNURS 2520, NURS 2410.

Course Objectives1. Demonstrate an advanced understanding of each pathophysiological

manifestation, treatment modality, and advanced physiological realms through case studies, discussion, lecture, and examinations by obtainment of 76% or higher grades.

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2. Demonstrate advancement toward critical thinking skills with subsequent safe decision outcomes.

3. Demonstrate mastery of medication math calculations by obtainment of 100% on exam (with total 3 attempts).

4. Demonstrate an understanding of pathophysiological modalities through safe, competent care and the utilization of the nursing process.

5. Integrate knowledge from research as influences current and/or future practice.

Clinical ObjectivesRefer to “NURS 2140 Clinical Evaluation” attached to this syllabus.

Required & Supplemental Materials:Required textbooks:

1. Nursing Diagnosis Handbook: A Guide to Planning Care: 9th ed Ackley ISBN: 9780232071503

2. Laboratory and diagnostic tests, 8th ed, Corbett ISBN: 0132373327

3. Davis’s Drug Guide for Nurses, 13th ED 2013, Vallerand, FA Davis ISBN:9780803628373

4. Math for Nurses: Stassi, M; Kaplan publishing, 2nd ed ISBN: 9781607140474

5. Mosby’s Dictionary of Medicine, Nursing and Health Professions. Mosby 2007, 8th ed ISBN: 978032304975

6. Pearson package #0133158217 Ball ped, olds maternity, Osborn med/surg, Kozier ISBN: 9780133158212

7. Pearson package #013313475X Osborn + MNL

8. 2013 Intravenous Medications. Gahart, B. Mosby ISBN: 9780323084819

9. Flip and See ECG, Cohn 4th ed Mosby 2012 ISBN: 9780323084529

10. Pearson package 0133095940 Kozier + MNL 9th edition text with 9th ed MNL

My Nursing Lab has weekly assignments due. When you log in, look for a clock on the calendar.

ASSESSMENT OF STUDENT WORK

Methods of Instruction: Classroom – A variety of teaching strategies may be used in presenting theory content, such as: case study, discussion, exams, guest speakers, lecture-discussion, concept mapping, role-play, and questioning. Instructional strategies to be used may include: handouts, videos, and PowerPoints.

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Instructional guides – will be used to stress important points for each lecture. The guides may be in various forms which may include critical thinking scenarios, questions, prioritizing, and concept mapping, for example.

Methods of Assessing Student Progress:Student progress is evaluated using a variety of methods including written examinations/quizzes, clinical observation of client care, written process recordings, nursing care plans, charting, assessment of skills in clinical settings.

Selected Testing/Assessment Methods:Examinations/quizzes include multiple choice and more than 1 answer type questions. Written assignments include written nursing careplans or concept maps, and other written assignments appropriate to the clinical setting or classroom. Faculty observation of student completion of skills are primary methods of evaluating students in the clinical practicum setting. Evaluation: Final course grades are based on the following letter scale: 93-100 = A 84-92 = B 78-83 = C 70-77 = D Below 70 = F

student’s course grade will be determined as follows:

My nursing Lab

Exam # 1 Biliary/diabetes 25 points 10 pointsExam # 2 Renal 25 points 10 pointsExam # 3 ACS 25 points 10 pointsExam # 4 Telemetry 50 points 10 pointsExam # 5 Vascular 25 points 10 pointsExam # 6 Shock and Burn 25 points 10 pointsExam # 7 Acid/Base 50 points 10 pointsExam # 8 Respiratory 25 points 10 pointsExam # 9 Hematology 25 points 10 pointsComprehensive Final 100 points

Unit exams are equivalent to 70% of the grade. My Nursing Lab is equivalent to 10% of the grade. The final exam is worth 20% of the grade.

There will be no rounding of grades, i.e., a 75.7 = 75%. A final course grade of 78% is required to continue in the program.

Clinical will be graded on a satisfactory/unsatisfactory basis. Refer to clinical evaluation attached to this syllabus. Students must obtain satisfactory on all assignments, and skills performances to obtain a satisfactory evaluation for the clinical component. Students must pass the math exam with a 100% before they can pass medications on the unit. Students are allowed three attempts to pass the math exam with a 100%. Failure to pass the exam after three attempts will result in failure of the course.

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To satisfactorily complete a nursing course, the student must receive a “C” (78%) or above in the theory course and a pass in the corresponding clinical component. Failure by a student in either theory or clinical will necessitate repeating the entire course (both theory and clinical components).

Make-up Test Procedures:If it is necessary to be absent during an assigned test period, the student must make up the exam prior to the next scheduled class date. Failure to do so will result in a zero for the exam. The student may miss one exam without penalty, as long as the test is made up within the specified time period.  If the student misses more than one exam, the exam may be made up, but the maximum score allowed is 80% for the second missed exam, 50% for all others missed . The final examination must be taken on the scheduled date and at the scheduled time.

Students may not enter the classroom after the testing has begun. If the student is not in the classroom when tests are being distributed the student must follow the provision for make up test procedures.

When necessary to make up an examination, it will be placed in the testing center. It is the student’s responsibility to make an appointment and take the test within the specified period of time.

Exceptions to these guidelines may be considered, but only if the student consults with the instructor in advance.

Late Assignments:Assignments are expected to be completed and turned in by the dates stipulated on the course calendar and the individual instructor due dates. It is the responsibility of the student to notify the clinical/course instructor of any delay in meeting the stated/written deadlines. Habitual lateness in handing in assigned work can contribute to course failure.

Maintenance of Student Records:Examination reviews will be held following all student completion and/or grading of scheduled exams. Courteous and respectful behavior is expected of every student present to facilitate the learning experience afforded by the review. Students may request to review the exams individually, by appointment. Appointments must be made individually with faculty of the course. Course faculty will keep all exams/quizzes.Every effort will be made to return all tests and written assignments in a timely manner for review.

ASSESSMENT OF STUDENT LEARNING PROGRAM:Metropolitan Community College is committed to continuous improvement of teaching and learning. You may be asked to help us to accomplish this objective. For example, you may be asked to respond to surveys or questionnaires. In other cases, tests or assignments you are required to do for this course may be shared with faculty and used for assessment purposes.

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INSTRUCTOR’S EXPECTATIONS OF STUDENTS

Methods of Learning:Students are expected to participate in all theory and clinical sessions. Assigned readings are to be completed prior to attending the class/clinical session scheduled for the specific topic. Written assignments, theory, and clinical assignments must be completed by specified dates. Due dates for written theory assignments and some clinical assignments will be on the class schedule. Due dates for written clinical assignments will be given with clinical information if not on class schedule. Assignments not handed in by the due date will receive a zero, and will not be accepted.

Pre-clinical lab preparation is a must. Students are expected to come to the clinical practicum setting prepared to give care to their clients. Being prepared includes such things as looking up medications, knowing the diagnosis of the clients, being prepared to do procedures/treatments, having data related to prior laboratory and previous assessments completed before clinical, and having a written plan of care. Faculty will provide students with clinical expectations the day of orientation to the clinical facility. Students not prepared for clinical assignment, will be sent home and will be subject to the clinical attendance policy per the Nursing Program Policy/Procedure Student Manual.

Class Attendance:Promptness: This is of high importance for success in this class. If a student should miss a class for any reason he/she is expected to cover, on his/her own, the material he/she missed. All work must be made up to the satisfaction of the instructor involved. For absences on days when exams/quizzes are given, refer to section related to “makeup test procedure”. It is the student’s responsibility to notify the Instructor immediately if the student is unable to attend class. If a student demonstrates unprofessional behavior in the classroom, the student will be asked to leave. Frequent tardiness and early departures from class can contribute to course failure. Students who attend no class meetings up to and including the Section Census Date published in the Class Schedule at www.mccneb.edu/schedule/ may be disenrolled from the class. There is no appeal for this disenrollment.

Clinical Attendance:Refer to Attendance Policy in the Nursing Policy/Procedure Student Manual

WX: After the first class meeting and through the Census Date, the instructor will disenroll (WX) students who have never attended. The Census Date is listed under the Important Dates for the course in the official Class Schedule at http://www.mccneb.edu/schedule/.

FX is a final grade given to a student who stops attending a class (participating in a class if it's an online class), does not return, and fails.

COMMUNICATION EXPECTATIONS:When you communicate with others in this course, you must follow the Student Code of Conduct (http://www.mccneb.edu/catalog/studentinformation.asp), which calls for responsible and cooperative behavior. Please think critically, ask questions, and challenge ideas, but also show respect for the opinions of others, respond to them politely, and maintain the confidentiality of thoughts expressed in the class. You may also wish to review information at http://www.albion.com/netiquette/.

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RECORDING IN THE CLASSROOM:Students may not video or audio record class sessions without the instructor’s knowledge and permission. If recording of class sessions is authorized as a reasonable accommodation under Americans with Disabilities Act (ADA), the instructor must have the appropriate documentation from College Disability Support Services. Permitted recordings are to be used only for the individual student’s educational review of the class session and may not be reproduced, posted, sold or distributed to others. Students who violate this policy are subject to disciplinary procedures as outlined in the Student Conduct Code.

ACADEMIC HONESTY STATEMENT:Students are reminded that materials they use as sources for classwork may be subject to copyright protection. Additional information about copyright is provided on the library website at http://www.mccneb.edu/library or by your instructor. In response to incidents of student dishonesty (cheating, plagiarism, illegal peer-to-peer file sharing, etc.), the College imposes specific actions that may include receiving a failing grade on a test, failure in the course, suspension from the College, or dismissal from the College. Disciplinary procedures are available in the Advising/Counseling Centers or at http://www.mccneb.edu/procedures/V-4_Student_Conduct_and_Discipline.pdf.

STUDENT WITHDRAWAL:If you cannot participate in and complete this course, you should officially withdraw through WebAdvisor at http://webadvisor.mccneb.edu or by calling Central Registration at 402-457-5231 or 1-800-228-9553. Failure to officially withdraw will result in either an attendance-related failure (FX) or failing (F) grade. The last date to withdraw is noted in the CLASS IDENTIFICATION section of this syllabus.

LEARNING SUPPORT

MCC's Academic Resource Centers, Math Centers, and Writing Centers offer friendly, supportive learning environments that can help students achieve educational success. Staff members in these centers provide free drop-in assistance with basic computing, reading, math, and writing skills. Self-paced, computer-assisted instructional support in reading, vocabulary, typing, English as a Second Language, and online course orientation is also available.

Detailed information about the Academic Resource, Math, and Writing Centers is in the Student Handbook, College Catalog, and online at http://www.mccneb.edu/arc/.

ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES:Metropolitan Community College will provide reasonable accommodations for persons with documented qualifying disabilities. It is the student’s responsibility to request accommodations from Disability Support Services (DSS) located in each Student Services Office. After students have arranged for accommodations with DSS, the student and instructor should privately discuss these accommodations. For further information, please contact DSS or visit http://www.mccneb.edu/dss/.

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TECHNOLOGY SUPPORT

For assistance with student email, passwords, and most other MCC technology, contact the Help Desk at 457-2900 or mcchelpdesk@mccneb.edu.

TECHNOLOGY RESOURCES:By using the information technology systems at MCC (including the computer systems and phones), you acknowledge and consent to the conditions of use as set forth in the Metropolitan Community College Procedures Memorandum on Acceptable Use of Information Technology and Resources. It is your responsibility as a student to be familiar with these procedures. The full text of the Procedures Memorandum may be found at the following website: http://www.mccneb.edu/procedures/X-15_Technology_Resources_Use.pdf.

[Other pertinent college policies are posted on the CDS website www.mccneb.edu/cds; it is suggested, but not required, that they be attached to your syllabus.]

REQUIRED ATTACHMENTS

1. SCHEDULE OF ASSIGNMENTS

2. IMPORTANT DATES Note: You may want to include a link Metro’s Academic Calendar at http://www.mccneb.edu/academics/calendar.asp?Theme=2 )

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NURS 2140 Clinical Component

Location:Assignments to clinical facility in the acute care setting.

Clinical focus:Hierarchy of needs, the nursing process, communication, safety, advancement of clinical skills, advancement of assessment skills, along with advancement of the understanding of pathophysiology to include medications, labs, diagnostic tests, and other significant data.

Preceptor Experience: Students may be assigned clinical experience with an RN preceptor. Refer to following page for specifics.

Clinical Methods of Instruction:A variety of teaching strategies applicable to the clinical experience will be utilized such as patient care, case study, demonstration, return demonstration, discussions group and/or individual, individual supervision, pre/post conferences, journaling, and concept mapping.

Emphasis in Clinical Experience: Safety is the emphasis in all areas of patient care to include but not limited to; medication administration and physiological cares.

Assessment of Clinical Student Progress:The instructor will assess knowledge base through observation, discussion, and questioning during patient care. Pre and post conferences will be utilized to assess knowledge base through discussion. The written patient care plan, pre-lab data and ongoing patient care data will be assessed. Medication administration safety will also be an important area of patient care that will include verbal questioning and direct observation as to action, therapeutic response, side effects, and proper administration.

Assessment Methods:The student will be evaluated daily/weekly. The student must achieve a satisfactory for each objective by the end of the clinical components. If the student does not achieve a satisfactory for each objective by the end of the clinical experience this indicates that the objectives was not met and therefore constitutes a clinical failure. Pre-lab requirements must be completed before the clinical experience. Pre-lab forms and clinical forms must be completed and submitted weekly. Students are responsible for completion of all assignments. The student must successfully complete clinical to pass the course. The student will participate in self-evaluation during the quarter.

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NURS 2140Class Schedule

Please Note for Exams: Expect incorporation of delegating, prioritizing and pharmacology questions throughout all exams. Exam questions may be obtained from all sources (textbook, study guides, lecture, powerpoints, videos, concept maps, and handouts).

Please Note for Lectures: Concept mapping may be utilized in the classroom. The class schedule is used as a guide and may need to be adjusted per Instructor discretion.

WEEK1 Dec. 4 Introduction to class. Diabetes Lecture/Renal Lecture.

2 Dec. 11 Diabetes Exam. Take home due. ACS Lecture.

3 Dec. 18 ACS Exam/Tele Lecture.

4 Jan. 8 Tele Exam/Vascular lecture

5 Jan. 15 Vascular Exam/Shock & Burn Lecture

6 Jan. 22 Shock & Burn Take Home. Exam/F/E

7 Jan. 29 F/E/Acid Base

8 Feb. 5 Exam on F/E. Respiratory Lecture.

9 Feb. 12 Respiratory Exam/Hematology Lecture

10 Feb. 19 Heme Exam/Review for Final

11 Feb. 26 Comprehensive Final

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Introduction: Key elements to implement throughout Advanced Nursing IV

1. Explore the elements of critical thinking and its application to theory and clinical realms.

2. Explore the process of prioritizing patient care.

UNIT I – Critical Thinking, Prioritizing Patient Care, Diabetes, and Biliary Disorders.

Objectives:1. Differentiate pathophysiology, clinical manifestations of diabetic ketoacidosis (DKA) and

hyperosmolar hyperglycemic state (HHS).2. Identify treatment modalities for DKA and HHS.3. Review types of insulin, onset/duration, and precautions.4. Identify differences in insulin absorption as to site of injection for subcutaneous administration.5. Define significant Lab results for diabetes management.6. Identify new treatment and research in diabetes realm.7. Identify the role of diabetes educators/nurses to include importance of patient teaching in the

following areas:- Insulin, oral agents- Activity/exercise- Nutrition- Importance of monitoring blood glucose- Body systems affected- Preventive/delay of complications- Importance of follow-up appointments with healthcare professionals.

8. Identify biliary disorders including signs and symptoms, labs, nursing interventions, and treatment modalities.

9. Identify pathophysiology of acute and chronic cholecystitis, clinical manifestations, and surgical and nonsurgical management.

Required Reading:

Osborn, Watson, Wraa : p. 114-117 Chapter 53 Diabetes Chapter 46 Biliary Disorders

Supplemental Resources:PowerpointsHandoutsReference Textbooks

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UNIT II – Renal Disorders, Dialysis, and Basic Concepts

Objectives:1. Identify pathophysiology; clinical manifestations and interventions for the following renal

disorders:A. Congenital disorders: Polycystic Kidney Disease (PKD)B. Obstructive Disorders: Hydronephrosis, Hydroureter, Urethral Stricture.C. Infectious Disorders: Pyelonephritis, Renal Abscess, Renal TuberculosisD. Immunologic Renal Disorders: Acute Glomerulonephritis, Rapid Progressive

Glomerulorephritis, Chronic Glomerulonephritis, Nephrotic Syndrome, Immunologic Interstitial Disorder

E. Degenerative Disorders: Nephrosclerosis, Renovascular Disease, Diabetic Nephropathy.

F. Tumors: Cysts and Benign2. Identify pathophysiology, clinical manifestations, and interventions for:

A. Acute Renal Failure (ARF)B. Chronic Renal Failure (CRF)

3. Identify patients at risk for ARF and CRF.4. Compare and contrast hemodialysis and peritoneal dialysis as renal replacement therapy.5. Define Hemodialysis nursing care and post-dialysis care.6. Identify type of vascular access for hemodialysis.

Required Reading:

Osborn, Watson, Wraa: Chapter 44 and 47

Supplemental Resources:PowerpointsHandoutsReference textbooks

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UNIT III – Acute Coronary Syndromes

Objectives:1. Identify coronary artery anatomy and significance of location of arterial blockage.2. Identify cardiac output, stroke volume, and heart rate significance.3. Identify normal and abnormal parameters for cardiac output, stroke volume, and heart rate.4. Differentiate between unstable angina and acute myocardial infarction.5. Identify significant cardiac profiles.6. Identify fibrinolytic therapy indications, contraindications, and nursing interventions.7. Identify indicators for pre and post management for cardiac catheterization, angioplasty, and

stent insertion.8. Identify hemodynamic monitoring as diagnostic tools including nursing management.9. Identify use of Intra-Aortic Balloon Pump to include indications for, management of, and

identification of complications.10. Identify indicators for coronary artery-bypass graft (CABG) to include pre and post-operative

management and nursing interventions.11. Identify nursing interventions for patient with cardiomyopathy. 12. Identify nursing interventions for patient with congestive heart failure.13. Identify valvular disorders treatment modalities, and management.14. Review pericarditis and endocarditis, treatment modalities and management.15. Review significance of the following cardiac medication to include nursing responsibilities and

patient teachingA. AnticoagulantsB. NitratesC. Beta BlockersD. Calcium Channel BlockersE. AntiarrythmicsF. MorphineG. Vasopressors

16. Identify cardiogenic IV medications per pump.17. Calculate drip rates, safe administration, and titration of IV cardiac medications.18. Identify cardiac transplant criteria and nursing interventions of the transplant patients.19. Identify medical and/or nursing research that may affect change of practice in the future.

Required Reading:

Osborn, Watson, Wraa: Review Chapter 24, 37, 40, 41, and 42

Supplemental Resources:PowerpointsHandoutsReference Textbooks

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UNIT IV – Cardiac Pacers, Radiofrequency Catheter Ablation, Cardioversion, ECG Interpretationand Introduction to Advanced Cardiac Life Support Protocol

Objectives:1. Identify indications for pacemakers.2. Define temporary pacing, permanent pacing and implantable cardioverter/defibrillator (ICD).3. Identify modes of pacing.4. Identify use of automatic defibrillator units that are available outside health care facilities.5. Define continuous electrocardiographic monitoring (ECG)6. Identify ECG complexes, segments, intervals, and rates.7. Identify between ECG complexes and artifact.8. Perform ECG rhythm strips.9. Identify normal rhythms and dysrhythmias.10. Identify importance of airway management in emergency cardiac care.11. Identify correct dysrhythmia terminology.12. Identify cardiac emergency medication including mechanism of action, indications

contraindications, and safe administration.13. Identify dysrhythmias that are indications for defibrillation.14. Identify dysrhythmias that are indications for cardioversion.15. Define cardioversion and medical/nursing interventions.16. Identify Advanced Cardiac Life Support protocol as supported by the American Heart

Association.17. Given critical thinking and challenges, in relation to patient assessment of data, identify correct

and safe nursing intervention in emergency cardiac care.18. Define introduction to 12 lead ECG analysis.19. Identify the purpose of radiofrequency catheter ablation.20. Identify teaching for patients with permanent pacemakers or ICDs.21. Identify the patient and family need to express feelings of anxiety and fear.22. Identify coping mechanisms with possible lifestyle changes associated with patient’s condition.

Required Reading:

1 Osborn, Watson, Wraa: Chapters 38 and 39

Supplemental Resources:PowerpointsHandoutsACLS materials by the American Heart AssociationReference Textbooks

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UNIT V – Vascular Problems, Stroke, Aneurysms, andHypertensive Crisis

Objectives:1. Review peripheral arterial disease (PAD) and use of the ankle-brachial index (ABI) as a

diagnostic tool.2. Identify nonsurgical and surgical interventions for management of PAD and approximate

nursing interventions.3. Identify chronic versus acute peripheral arterial occlusion and proper interventions.4. Identify aneurysms of central arteries and peripheral arteries.5. Identify nonsurgical and surgical interventions in aneurysm treatment and nursing interventions.6. Identify venous thromboembolism (VTE) pathophysiology treatment modalities, and nursing

interventions.7. Identify hypertensive crisis signs and symptoms, and treatment.8. Identify types of strokes, clinical manifestations, assessment tools, surgical, nonsurgical

interventions and nursing interventions.

Required Reading:

Osborn, Watson, Wraa: Chapter 21, 30, and 43

Supplemental Resources:PowerpointsHandoutsReference Textbooks

Metropolitan Community College 14

UNIT VI – Types of Shocks and Burns

Objectives:1. Define pathophysiology of shock, including classifications.2. Identify physiologic events during shock if progresses.3. Identify etiology of shock including hypovolemic, cardiogenic, distributive, and obstructive

shock.4. Identify clinical manifestations treatment modalities, and nursing interventions for each type of

shock.5. Identify he potential for multiple organs dysfunction syndrome (MOBS)6. Define intervention activities for shock prevention.7. Identify clinical manifestations of depth of burn injuries: superficial, partial thickness, and full

thickness and treatment modalities.8. Define mportance of assessment skills and gathering of important data in determining

treatment in the emergent phase of burns.9. Identify burn etiology and significance of in treatment.10. Identify vascular changes resulting from burn injuries including fluid shifts, electrolyte changes,

gastrointestinal involvement, cardiac, pulmonary, skin, metabolic changes, and immunologic changes.

11. Identify prioritization of treatment of burns from emergent phase, acute phase, and rehabilitative phase of burn injury.

12. Compare and contrast the Browder-Lund chart and Rule of Nines chart in calculating total body surface area (TBSA) in a burn injury.

13. Apply the Parkland Formula together with the TBSA in establishing correct fluid replacement in the emergent phase.

14. Identify airway management in burn injury.15. Identify compensatory responses to burn injury.16. Evaluate laboratory profiles during the emergent phase of burn injury.17. Identify the role of burn centers.18. Identify surgical management in burn injury.19. Identify pain management in burn injury and treatments.20. Define prevention of infection interventions21. Identify wound care management to include debridement, dressings, and types of grafts.22. Compare and contrast type of grafts available.23. Identify nutrition requirements in burn injury.24. Identify nursing interventions for prevention of complications such as patient position, range of

motion, ambulation, pressure dressings and post-op cares utilized to prevent complications of burns.

25. Identify research in the burn realm that may affect future burn interventions.26. Identify current/future therapies in the treatment of burn patients.

Required Reading:

Osborn, Watson, Wraa: Chapter 61 and 68

Supplemental Resources:Powerpoints, Handouts, Reference textbooks and Lab textbook.

Metropolitan Community College 15

UNIT VII – Fluid and ElectrolytesAcid/Base Balance

Objectives:1. Discuss the nurse’s role in understanding fluid and electrolytes as needed for safe IV therapy.2. Examine the importance of maintaining homeostasis.3. Review Extracellular Fluid (ECF), Intracellular Fluid (ICF), and interstitial fluid dynamics.4. Examine solute and solvent in relation to osmotic pressure and importance of maintaining

homeostasis.5. Identify the major electrolytes, their functions and location.6. Describe the following abnormalities of fluid and electrolyte balance, and evaluate how each

abnormality affects homeostasis:A. HypovolemiaB. HypervolemiaC. HyponatremiaD. HypernatremiaE. HypokalemiaF. HyperkalemiaG. HypocalcemiaH. HypercalcemiaI. HypermagnesemiaJ. HypomagnesemiaK. HyperphosphatemiaL. HypophosphatemiaM. HyperchloremiaN. Hypochloremia

7. Discuss differences between isotonic, hypertonic, and hypotonic IV solutions and their actions. in osmosis, indications for, and contraindications in various pathophysiological conditions.

8. Identify normal acid-base balance.9. Examine the following abnormalities in acid-base balance.

A. Respiratory acidosisB. Respiratory alkalosisC. Metabolic acidosisD. Metabolic alkalosisE. Compensation

10. Identify the body’s regulatory mechanism for acid-base balance (buffer systems)11. Examine hormonal regulation of fluid and electrolyte balance.

Required Reading:

Osborn, Watson, Wraa: Chapter 18, 19, and 22

Supplemental Resources:PowerpointsHandoutsLab textbook and Reference Textbooks

Metropolitan Community College 16

UNIT VIII – Acute Respiratory Problems

Objectives:1. Identify patients at risk for pulmonary embolism (PE).2. Identify clinical manifestations of pulmonary embolism.3. Identify diagnostic tools for determination of pulmonary embolus.4. Identify treatment of pulmonary embolism to include oxygenation, nonsurgical management,

surgical management, and nursing interventions.5. Identify intervention for prevention of pulmonary embolism.6. Identify patient education necessary for management of pulmonary embolism.7. Identify pathophysiology and causes of acute respiratory failure.8. Identify interventions for acute respiratory failure.9. Define pathophysiology and causes of acute respiratory distress syndrome (ARDS)10. Identify clinical manifestations, diagnostic assessment, and interventions for patient with ARDS.11. Identify the patient who requires intubation and mechanical ventilation.12. Identify procedure for endotracheal intubation including indications for, verifying tube

placement, and nursing care.13. Define goals of mechanical ventilation, including types of, controls and settings, and care of the patient to prevent complications.14. Define the weaning process from the ventilator to extubation.15. Identify severe acute respiratory syndrome (SARS) as a new respiratory infection including

clinical manifestations, interventions, and isolation of patient.16. Identify pathophysiology, clinical manifestations, diagnostic tests, and interventions for the

following:A. TuberculosisB. Lung abscessC. AspirationD. Pulmonary empyemaE. Cystic fibrosisF. Pulmonary hypertentionG. Pulmonary edemaH. Pleurisy

Required Reading:

Osborn, Watson, Wraa: Chapter 33, 34, 35, and 36

Supplemental Resources:PowerpointsHandoutsReference textbooks

Metropolitan Community College 17

UNIT IX – Hematological Dysfunction

Objectives:1. Identify red blood cell disorders, clinical manifestations and interventions to include:

anemia and the common types of:A. Sickle CellB. Glucose-6-Phosphate Dehydrogenase (G6PD)C. Autoimmune HemolyticD. Iron deficiencyE. Vitamin B12 DeficiencyF. Folic Acid DeficiencyG. AplasticH. Anemia

2. Identify Polycythemia Vera, clinical manifestations and interventions.3. Identify white blood cell disorders, clinical manifestations, and interventions to include:

A. LeukemiaB. Malignant LymphomaC. Hodgkin’s LymphomaD. Non-Hodgkin’s LymphomaE. Multiple Myeloma

4. Identify coagulation disorders, clinical manifestations, and interventions to include:A. Autoimmune Thrombocytopenic PurpuraB. Thrombotic Thrombocytopenic PurpuraC. HemophiliaD. Disseminated Intravascular Coagulation (DIC)

Required Reading:

Osborn, Watson, Wraa: Chapter 22, 62, and 63

Supplemental Resources:PowerpointsHandoutsLab textbookReference textbooks

Metropolitan Community College 18

2012/13 Winter Quarter Important DatesClasses Begin...........................................................................................................Nov 28 W***Census Date/Tenth Day*....................................................................................Dec 11 TuHoliday Recess/College Closed...........................................................................Dec 24-Jan 1Holiday Recess ends for Staff.....................................................................................Jan 2 W Holiday Recess ends Faculty Report/classes Resume................................................Jan 5 Sa Current Student (greater than 50 hours) Spring 2013 (12/SP) Registration begins. . .Jan 3 ThCurrent Student (less than 50 hours) Spring 2013 (12/SP) Registration begins.........Jan 9 WGeneral Spring 2013 (12/SP) Registration begins.....................................................Jan 16 WMartin Luther King Recess/College closed................................................................Jan 21 MFall Quarter Term Incomplete “I” Grades Due.........................................................Feb 12 TuNo Classes.....................................................................................................Feb 23-24 Sa-Su Classes end..............................................................................................................Feb 26 TuWinter grades due and posted by 11:59 p.m.............................................................Feb 28 ThStudent Withdrawal Deadline to “drop” a class without receiving a grade. Varies by Class**Student Withdrawal Deadline to “drop” a class with a refund varies ** See Refund Policy****

* Tenth Day is the date on which your enrollment level is checked. **To view the last day to withdraw “drop” a class to prevent receiving a grade, go to the class schedule found on line at http://www.mccneb.edu/schedule/classschedule.asp . Then, find the course section and click on the Important Dates link on the same line as the course title. Dates for each course section are automatically calculated based on the start and end dates and the number of sessions for a course. A student must withdraw by this date to avoid an “F” grade.

Note: Schedule changes may have implications for students on Financial Aid. Check with the Financial Aid Office prior to any schedule changes at 402-457-2330. The Census Date*** is the date on which Financial Aid Student’s enrollment is checked to determine the type and amount of authorized funds for the quarter. Payment is based on enrollment as of that date.

****REFUND POLICY for Credit Courses

A student is responsible for withdrawing “dropping” from a course(s) if unable to attend. Non-attendance or non-payment does not relieve a student from the obligation to pay.

An official schedule change that reduces or terminates a student’s academic credit load may entitle the student to a refund. Go to “My Services” and click “Student Accounts”, then “Tuition Modeler” to see the refund percentage received through midnight of the same day you “drop” withdraw from a class.

To withdraw “drop” from a course in My Way, go to “My Services”, click “Registration”. Then click “Register and Drop Sections”. Find the class you wish to drop and check the box under the word Drop and click Submit. You have successfully dropped the class if the message at the bottom of the screen states “the following request(s) have been processed”.

Metropolitan Community College 19

Metropolitan Community College 20

METROPOLITAN COMMUNITY COLLEGENURSING PROGRAM

NURS 2140 CLINICAL EVALUATIONCharting By Exception: If objective criteria is satisfactory, the area will be blank. Scale for rating clinical performance: U=Unsatisfactory NI=Needs Improvement NO=No OpportunityNA = Not Applicable

Name: Clinical site: Quarter

OBJECTIVE I: Maintain standards of ethical, professional and legal behavior while functioning as a safe and competent member of the interdisciplinary team .

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Instructor Comments

a. Functions within the Scope of Practice and in accordance with educational level. 1. Protects confidential information.b. Independently records data on graphic sheet/client’s care record/flow sheet, I & O sheets. c. Maintains safe environment at all times. 1. Uses side-rails appropriately.

2. Call light is within reach. 3. Practices appropriate body mechanics consistently.

d. Adheres to institutional policies regarding standard precautions and security.

1. Hand-washing.2. Utilizing barrier protectors.3. Cleaning client area.4. Handling linen correctly.

e. Administers medications utilizing safe practices.

OBJECTIVE II: Demonstrate responsibility and accountability for nursing practice with an awareness of the need for continued personal learning and self-development.

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Instructor Comments

a. Demonstrate accountability for own actions.

1. Keeps busy and takes initiative.b. Identifies own strengths and limitations with guidance from instructor.c. Reports promptly and participates in conferences.d. Successfully completes all written assignments on time and with appropriate minimum score when applicable.

1. Completes daily pre-lab documents as assigned.

2. Completes math exam with 100% (only three attempts per policy).e. Demonstrates reliable clinical attendance.

1. Notifies clinical instructor in timely manner when unable to attend clinical.f. Maintains good personal hygiene.g. Adheres to acceptable clinical dress.

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OBJECTIVE III: Display caring behaviors in the delivery of nursing care to clients

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Instructor Comments

a. Accommodates differences of race, culture.

b. Demonstrates a respectful attitude towards others.

c. Uses appropriate title and tone of voice.

d. Spends time with client beyond the time spent providing physical care.

e. Provides privacy for the client when appropriate.

f. Able to recognize measures to support psycho-social integrity.

g. Accepts client’s communications without judging.

h. Demonstrates an awareness of client’s religious needs.

i. Demonstrates a positive attitude through one’s behavior.

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OBJECTIVE IV: Utilize knowledge from nursing and related disciplines when applying the nursing process in the provision of nursing care to clients.

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Instructor Comments

a. Assesses the basic human needs 1. Collects data from appropriate

sources, i.e, chart, Kardex, client, significant others, nursing staff. 2. Demonstrates critical thinking skills through data collection and subsequent problem solving. 3. Performs basic physical assessment, progressing to mastery of advanced assessment skills. a. Submits assessment data weekly and as part of each care plan. b. Defines diagnostic tests and relates to client’s condition. c. Successfully completes wkly head to toe assessments on assigned client(s) in clinical area. d. Participates in the development of the nursing diagnosis.

1. Reviews assessment data.

2. Identifies the problem (s) for the client.

3. Expresses the problems in the form of a nursing diagnosis with guidance from the clinical instructor.e. Develops a plan of care based on the nursing diagnosis with guid- ance from the clinical instructor. 1. Establishes goals

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OBJECTIVE IV continued Utilize knowledge from nursing and related disciplines when applying the nursing process in the provision of nursing care to clients.

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Instructor Comments

2. Evaluate goals.3. Identifies nursinginterventions related toestablished goals.4. Documents appropriaterationale and source for eachnursing intervention.

f. Implements the plan of care in a thorough manner under the supervision of the clinical instructor.1. Initiates basic care

without direct supervision of the clinical instructor.

g. Participates in the evaluation of care.1. Observes and describes

changes in client’s status.2. Establish new goals as

needed.h. Successfully completes two concept maps with four nursing diagnoses on each NCP per quarter.

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OBJECTIVE V: Manage the nursing care of clients with selected health needs in structured settings in collaboration with the interdisciplinary team.

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Instructor Comments

a. Discusses plan of care with appropriate nursing staff.

b. Informs appropriate staff member if client assignment requires nursing action above level of responsibility.

c. Utilizes an organized plan of care.

d. Follows instructions provided by instructors or appropriate health team member.

e. Directs questions or problems regarding nursing care to the instructor.

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OBJECTIVE VI: Employ effective communication to establish relationships with clients and the interdisciplinary team.

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Instructor Comments

a. Introduces self and initiates conversation with client.

b. Notes client’s verbal and nonverbal communication.

c. Explains procedures before beginning.d. Reports client concerns and pertinent

observations to appropriate health team member and instructor in a timely manner.

e. Gives a concise and comprehensive report to appropriate health team member at the end of clinical hours.

f. Completes wkly reflective journaling.g. Communicates effectively with all clients,

families and health care team members at all times.

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OBJECTIVE VII: Utilize the teaching-learning process to assist clients to reach a higher level of health.

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Instructor Comments

a. Instructs client on health promotion measures.b. Identifies learning readiness.c. Identifies assessing for appropriate learning

style for patient.d. Instructs patient on identified needs.e. Assesses learning and technique used to

achieve goal.f. Completes documentation of teaching and

evaluation of learning by the patient.

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OBJECTIVE VIII: Follow the hierarchy of needs when providing nursing care to clients in collaboration with the interdisciplinary team.

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Instructor Comments

a. Meets the physiologic needs of the client.1. Feeds client when indicated.2. Positions client to enhance pulmonary

functions.3. Maintains recommended level of oral

intake.4. Provides range of motion exercises.

b. Meets the safety needs of the client.1. Demonstrate safe and competent nursing

practice.2. Identifies factors related to client’s

current condition which may put them at risk for complications.

Charting By Exception: If objective criteria is satisfactory, the area will be blank. Scale for rating clinical performance: U=Unsatisfactory NI=Needs Improvement NO=No OpportunityNA = Not Applicable

EVALUATION: The student will receive a satisfactory, unsatisfactory, needs improvement, no opportunity or not applicable based on the quality of clinical performance as outlined in the course syllabus. The instructor will rate the student’s performance weekly. The student must achieve a satisfactory for each objective by the end of the clinical course. If the student does not achieve a satisfactory for each objective by the end of the quarter the grade will be an unsatisfactory for that objective. An unsatisfactory in any one objective at the end of the quarter indicates that the objective has not been met and therefore constitutes a clinical failure. (Any unsatisfactory must all be followed by a satisfactory.) The student must successfully pass clinical to pass the course. The student will participate in self-evaluation during the quarter.

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SUMMARY OF ABSENCES/TARDIESWeek 1 2 3 4 5 6 7 8 9 10 11

Hours of absence.

Number of tardies.

Total of absences and tardies

ACKNOWLEDGEMENT OF INSTRUCTOR’S NOTATIONSWeek 1 2 3 4 5 6 7 8 9 10 11

Instructor’s initials

Student’s initials

NOTE: Student’s initials indicate that she/he has reviewed instructor’s notations for the previous week of clinical practice.

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Instructor’s signature: Date:

Student’s signature:

Student’s Comments:

Date:

FINAL QUARTER EVALUATION

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