UNIT 1: COURSE INTRODUCTION
Column I
Column II
Column III
Column IV
Theory Objectives
Suggested Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies/ skills)
1.
Relate Level 4 Student Learning
Outcomes (SLO) to the Program
Student Learning Outcomes.
Required reading
1. Bakersfield College Associate Degree
Nursing Student Handbook and all
addendums.
2.
Compare the attributes of Provider of
Care, Manager of Care and Member
of the Profession for the Level 4
Associate Degree Student Nurse to
those attributes in Levels 1 thru 3.
3.
4.
Differentiate the SLO’s in all the
junior Medical Surgical Nursing
Courses, Levels 1 through 3, from
those in this Level 4 course.
Explain course policies, expectations
and requirements as outlined in the
syllabus for both the theory and
clinical components of Nursing B28.
5. Verbalize the attendance policy, and
criteria for student evaluation in the
theory component of Nursing B28.
2. Nursing B28 Instructional Syllabus
and Clinical Manual.
1.
Recognize the roles of the Provider
of Care, Manager of Care, and
Member of the Profession for a Level
4 nursing student, and model the
specific behaviors.
2.
Relate course policies, expectations,
requirements, and evaluation criteria
as outlined in the Clinical Manual to
the theory component of Nursing
B28.
Internet Resources
1. Review the Associate Degree
Nursing Student Handbook and
Addendum (s) located at:
http://www2.bakersfieldcollege.edu/allied
health/studentpages/RNstudent.html
Read the Instructional Syllabus for
Nursing B28.
2. Nursing B28 Instructional Syllabus
and Clinical Manual.
3. Student Laboratory Rotation Matrix
4. Achieve 100% on math competency
exam.
3.
2.
Required reading
1. Bakersfield College Associate Degree
Nursing Student Handbook and all
addendums.
Verbalize the attendance policy, and
criteria for student evaluation in the
laboratory component of NURS B28.
4.
Interpret the student laboratory
rotation matrix.
5.
Discuss the advanced application of
the nursing process when caring for
patients who have critical and
complex medical conditions.
Internet Resources
1. Review the Associate Degree
Nursing Student Handbook and
Addendum (s) located at:
http://www2.bakersfieldcollege.edu/allied
health/studentpages/RNstudent.html
2.
Read the Instructional Syllabus for
Nursing B28.
Study Guide 1.1
Nursing Diagnostic Statements and
Comprehensive Plans of Care
UNIT 2 - PROFESSIONAL ISSUES AND NURSING PRACTICE
Module 2A Introduction to Critical Care Nursing
Column I
Theory Objectives
1. Recall the roles of the medical
surgical-nurse and define how
they relate to the Level 4
nursing student.
•
•
•
•
•
•
•
Provider of care
Manager of care
Member of profession
Team nursing
Primary care
Multidisciplinary
Case management
2. Define Critical Care Nursing
and describe the role of the
critical care nurse
3. Discuss the purposes and
functions of the professional
organizations that support
critical care practice.
•
•
•
ACCN
SCCM
ENA
4. Identify and describe
professional certifications.
•
•
ACLS
CCRN/CEN/MICN
5. Identify current trends and
issues.
Column II
Learning Activities
Required
Sole Chapter 1
Lecture/Discussion
• Discuss the role of the critical
care nurse.
• Explore the purpose of
professional organizations and
certifications.
• Current trends
Recommended
Study Guide 2A.1
Evolve website
Chapter 1 resources
http://evolve.elsevier.com/Sole
Internet resources
• American Association of
Critical-Care Nurses
http://www.aacn.org
• Emergency Nursing Association
http://www.ena.org
• Society of Critical Care
Medicine http://www.sccm.org
• The Joint Commission
http://www.jointcommission.org/
Column III
Clinical Objectives
1. Incorporate the roles of
Provider of Care,
Manager of Care, and
Member of Profession in
the medical surgical,
critical care, and
specialized
environments.
2. Differentiate the role
and scope of the critical
care nurse from the
medical surgical nurse.
Column IV
Clinical Activities
(expected competencies/skills)
• Consistently demonstrate
roles of Provider of Care,
Manager of Care, and
Member of Profession with
each critical and complex
medical surgical client.
o Develop comprehensive
individualized nursing
care plans using
evidenced based practice
o Deliver safe and
efficacious care
o Written process
o Team lead group of peers
o Lead a post conference
group
o Teaching presentation for
groups of peers
o Oral case presentation of
complex client
o Consistently maintain
o Maintain current skills
check list
• Discuss with a critical care
nurse the advanced
preparation required for
competent nursing practice in
the critical care environment.
UNIT 2 – PROFESSIONAL ISSUES AND NURSING PRACTICE
Module - 2B Caring and Comfort
Column I
Theory Objectives
Column II
Learning Activities
6. Evaluate the effects of the critical Required
care environment on the nurse,
Sole Chapter 2
patient, and family.
Discussion/Lecture
Critical Care Experience
• Critical Care Environment
• Critically Ill Patient
• Family of the critically ill
• The Critical Care Nurse
Recommended
Study Guide 2B.1
Column III
Clinical Objectives
3. Discuss the concerns
expressed by critically ill
patients.
Column IV
Clinical Activities
(expected competencies/skills)
• Demonstrate principles of
caring by responding to
clients expressions, both
verbal and nonverbal.
4. Discuss ways to identify
and meet the needs of
families of critically ill
patients.
•
Focus on the caring needs
of the critical care client
and their families.
5.
•
Encourage clients and
family expression of needs
by using appropriate
verbal, physical, and
interpersonal
communication skills.
Describe strategies a nurse
might utilize to
communicate with the
critically ill client.
UNIT 2 PROFESSIONAL ISSUES AND NURSING PRACTICE
Module 2C Critical Thinking
Column I
Theory Objectives
7. Describe the decision
making process, including
goal setting, prioritization
and delegation.
Column II
Suggested Learning Activities
Column III
Clinical Objectives
6. Relate critical thinking to the
Required
Huber Ch 25
nursing process, and
Handouts
evidenced based practice
• “Understanding Role of the
RN and IP” Title 16 Section 7. Explore the relationship
between critical thinking and
1443.4(4), p.4
problem solving.
• “RN as Supervisor”
• “Unlicensed Assistive
8. . Analyze data to establish
Personnel”
priorities and anticipate the
• “Unlicensed Assistive
care for increasingly
Personnel Acute Care”
complex clients/families.
Lecture/Discussion
9. Consistently demonstrate
• Role of the RN / IP
reflective reasoning,
analytic skill, sensitivity,
Media Clip
and knowledge of resources
ATI Fundamentals of Nursing
and possible solutions in
CH 6: Delegation Video
order to effectively make
Ch. 8: Priority Setting Video
decisions, problem solve,
organize, and prioritize, and
Recommended
delegate care for
Huber Ch 6, 7
individuals and/or groups of
clients.
Media Clip
ATI Fundamentals of Nursing
Ch. 2 Interdisciplinary Team:
Video
•
•
•
•
•
•
•
Column IV
Clinical Activities
(expected competencies/skills)
Apply concepts from prior learning.
Prioritize valid therapeutic nursing.
Use analytical approaches in care of the
complex medical-surgical client.
Seek and utilize appropriate resources.
Use the nursing process to develop
individualized nursing care in case
studies and critical thinking exercises.
Implement delegation into clinical
practice.
Indentify a problem noted in the clinical
setting and create a solution.
UNIT 2 – PROFESSIONAL ISSUES AND NURSING PRACTICE
Module 2D Leadership and Management
Column I
Theory Objectives
8. Discuss employment issues that
affect the new graduate nurse.
• Resume
• Interview
• Interim Permittee
• Role transition
Column II
Learning Activities
Column III
Clinical Objectives
10. Demonstrate Fiscal
Required
responsibility in the
Handouts
clinical setting.
• Resume examples
• Interim permittee functions
• “Understanding role of RN and IP” 11. Analyze specific
examples of role
Title 16 Section 1414 (8), p.8
transitions as a leader,
• NPA, Section 2725, Article 2,
manager, and follower.
Section 2732.1, p. 8
Lecture/Discussion
• Resume do’s and don’t
• How to ask for references
• Interview
• Phases of role transition
• Functions of the IP
•
Develop a resume
Recommended Assignments
Internet Resources
Information related to the BRN, Nurse Practice
Act or a professional nursing organization:
•
•
•
•
•
www.rn.ca.gov
www.ncsl.org
www.nursingworld.org
www.allnurses.com
www.nsna.org
12. Compare the strategies
used during a previous
transition: strengthening
internal resources,
negotiating a role,
growing with mentors or
learning necessary skills.
Column IV
Clinical Activities
(expected competencies/skills)
• Consistently demonstrate
fiscal responsibility in clinical
setting
•
Discuss level 4 roles in post
conference.
•
Explore potential mentors
•
Pair up with a partner and
Complete study guide 2D.1
UNIT 2 – PROFESSIONAL ISSUES AND NURSING PRACTICE
Module 2E Community Based Care
Column I
Theory Objectives
9. Describe advanced patient
assessment and triage.
• Role of the nurse
• Assessment of clients
• Principles of triage
10. Explain the
pathophysiology and apply
the nursing process to
traumatic injury
11. Analyze disaster planning,
and response to include
bioterrorism.
• Define Mass Casualty
• Definition of a disaster
• Disaster preparedness
• Identify disaster team
members: HEICS
• What constitutes
bioterrorism?
12. Analyze environmental
emergencies and
collaborative management
of:
• Hypothermia
• Heat-related
• Near drowning
Column II
Suggested Learning Activities
Required
1. Sole Chapter 19
2. Lemone 1305-1308
3. ATI Chapter 6: Communicable
Diseases, Disasters, and Bioterrorism
Lecture/Discussion
• Role of the emergency nurse
• Primary and secondary survey
assessments
• Principles of triage
• Types of disasters
• Definition of bioterrorism
• Environmental emergencies
ATI Community Health Nursing
Ch 6: Communicable Diseases,
Disasters, and Bioterrorism:
Complete Application Exercises &
NCLEX Connections
Recommended
Case Study 2E.1
Evolve Resources
Sole Chapter 19
http://evolve.elsevier.com/Sole
Internet Resources
Emergency Nurses Association:
http://www.ena.org/
CDC Mass Casualty Preparedness
http://www.bt.cdc.gov/masscasualties/
hypothermia:
http://www.sarbc.org/hypo2.html
Column III
Clinical Objectives
13. Identify the role of the
emergency department (ED)
nurse.
Column IV
Clinical Activities
(expected competencies/ skills)
• Observe and/or participate in
an emergency department
triage.
14. Differentiate between
emergency department triage
versus mass casualty triage
•
Participate in the assessment
and nursing care of a trauma
patient.
15. Discuss Hospital Emergency
Incident Command System
(HEICS).
•
Participate in hospital or
community based disaster
drill.
16. Identify the correct sequence of
priorities utilizing the A thru I
trauma assessment in treatment
of the client who has the multi
system trauma.
•
Identify predisposing factors
for both heat and cold-related
injuries.
•
Emphasize that prompt
recognition of infections of
bioterrorism is critical in the
preparedness of health care
professionals.
17. Discuss predisposing factors and
interventions for environmental
emergencies: heat exhaustion,
heatstroke, frostbite,
hypothermia, and neardrowning.
18. Discuss the nurse’s
responsibility for bioterrorism
preparedness.
UNIT 2 – PROFESSIONAL ISSUES AND NURSING PRACTICE
Module 2F Leadership-Ethical and Legal Issues
Column I
Theory Objectives
13. Recall ethical principles and
discuss how they relate to
critical care patients.
14. Identify legal and professional
obligations of critical care
nurses
• Duty to treat and
abandonment
• Medical malpractice
• Patient advocate
15. Identify and discuss selected
ethical and legal issues in
critical care nursing practice.
• informed consent
• decisions regarding lifesustaining treatment
• end of life issues
16. Identify the purposes and
needs for nurse licensure, the
significance of nurse practice
acts and implications of
regulatory agencies.
Column II
Suggested Learning Activities
Required Reading
Sole Chapter 3
Handouts
“Patient Advocate”
“Patient Abandonment”
Discussion/Lecture
Landmark legal cases
End-of Life Issues
• Patient self determination Act
• Advance Directives
• Living will
• Durable Power of Attorney for
Healthcare
• Purpose of licensure to practice as an RN
• Nurse Practice Act and its purpose
• Regulatory Agencies and how they
interact with nursing programs and
clinical agencies: BRN, NLN, JACHO
• Professional organizations for nursing
students and registered nurses
Media Clip
ATI Nurisng Leadership & Management
CH 3: Professional Responsibilities
Client Rights Video
Client Advocacy Video
Informed Consent Video
Advanced Directives (image)
Recommended
Study Guide 2F.1
Evolve Resources
Sole Chapter 3
http://evolve.elsevier.com/Sole
Internet resources
ANA Code of Ethics
http://www.nursingworld.org/ethics/ecode.htm
Column III
Clinical Objectives
19. Describe ethical dilemmas
encountered in your own
experience.
20. Analyze different
approaches to ethical
dilemmas and the
implication of each
approach.
21. Discuss the purpose of
obtaining licensure to
practice as a registered
nurse in the state of
California.
22. Describe the Nurse Practice
Act, how it can be obtained
and its purpose
23. Discuss the composition,
purpose of the BRN, its
relationship with the public,
with nursing programs and
registered nurses in
California
24. Describe the importance of
belonging to a professional
nursing organization for
nursing practice and
lifelong career
development.
Column IV
Clinical Activities
(expected competencies/skills)
• Identify and critique an
ethical dilemma observed in
the clinical setting.
•
Download a copy of an
application for licensure
from the BRN website and
bring to clinical
•
Discuss the components of
the application for a person
applying for licensure by
taking the NCLEX
examination
•
Discuss an implication of
the Nurse Practice Act in
relationship to clinical
practice.
Column I
Theory Objectives
17. Describe ethical and legal
concerns related to end-oflife (EOL) care.
18. Discuss cultural
considerations in EOL care.
19. Describe nursing
interventions to support the
patient and family during
the EOL stage.
20. Explain accepted guidelines
for discontinuation of life
support systems.
21. Describe the indications for
organ transplantation.
22. Discuss the collaborative
management necessary for
care of the organ transplant
patient.
• Organizations
• Organ matching
procedures
• Client waiting lists
• Client selection
23. Discuss policies that apply
to organ donation and
transplantation Discuss
rejection as the major
obstacle organ
transplantation.
24. Explain clinical
manifestations of rejection.
25. Discuss the purpose, action
and possible adverse effects
of immunosuppressant
UNIT 2- PROFESSIONAL ISSUES AND NURSING PRACTICE
Unit 2G End of Life Issues
Column II
Column III
Suggested Learning Activities
Clinical Objectives
Required
Sole Chapter 4
Handouts
• Organ Donor Process Card
• Hospital Organ Donor
Management
25. Discuss concepts of end-of-life
care, including palliative care;
communication and conflict
resolution; withholding or
withdrawing therapy; and
psychological support of the
patient, family members, and
health care providers.
Lecture/Discussion
Organ and tissue donation
26. Discuss components of
communicating with families
regarding organ donation and
Recommended
end-of-life issues.
Handout: Does my religion approve
organ donation?
27. Describe the components of
communicating with potential
Evolve Website
organ recipients.
Chapter 4 resources
Study Guide 2G.1
28. Summarize the procedure
followed for organ donation.
29. Specify ethical dilemmas related
to discontinuation of life support
systems.
Column IV
Clinical Activities
(expected
competencies/skills)
Explain accepted guidelines
for discontinuation of life
support systems.
Identify ethical dilemmas
related to discontinuation of
life support systems
During post conference
discuss legal and ethical
issues relating to organ
donation
Summarize post conference
summarize the procedure
followed for organ donation.
UNIT 3 BIOPSYCHOSOCIAL CONCEPTS RELATED TO HEALTH CARE
Unit 3A Communication/Conflict Resolution
Column I
Theory Objectives
1. Differentiate various
communication pathways:
• Organizational
• Persuasion
• Negotiation
2. Demonstrate an understanding
of the process of conflict
resolution in the leadership
role.
3. Analyze how assertiveness and
responsiveness may be helpful
to effective leadership
Column II
Suggested Learning Activities
Required
•
Huber pp. 407-427
•
Huber pp. 524-536
Media Clip
ATI Nursing Leadership &
Management
Conflict Mediation Video
Column III
Clinical Objectives
1. Evaluate leadership and
management implications of
communication.
2. Critique techniques for
becoming more assertive.
Column IV
Clinical Activities
(expected competencies/skills)
• Consistently apply techniques
of therapeutic communication
to clients and families in
crisis.
• Effectively communicate in
both written and oral formats:
• Oral case presentation
• Nursing process papers
• Journal
• Teaching presentation
• Utilize SBAR tool.
• Discuss and analyze
persuasion techniques and
negotiation strategies
observed in the clinical
setting in post conference.
• Implement assertive
techniques in clinical setting.
9
UNIT 3 BIOPSYCHOSOCIAL CONCEPTS RELATED TO HEALTH CARE
Module 3B Pain
Column I
Theory Objectives
4. Discuss methods/tools for
assessing pain and anxiety in the
critically ill client.
• FACES
• FLACC
• Ramsey
• MAAS
5. Analyze nursing interventions
for sedation and pain control and
continuous IV infusions for
sedation, pain, anxiety.
• Pharmacological agents
• Advantages and
disadvantages
• Safety considerations
• Nursing care priorities
Column II
Suggested Learning Activities
Column III
Clinical Objectives
Required Reading
1. Sole Chapter 5
2. Study Guide 3B.1
3. Ch. 41 Pain Management
Application Exercises
NCLEX Connections
3. Demonstrate problem solving
techniques to provide relief of
acute pain.
Lecture/Discussion
• Pain/anxiety assessment
• Anxiety and sedation tools
• Pharmacological
interventions
Recommended
Computer Assisted Instruction
Evolve website
Chapters 5 resources
http://evolve.elsevier.com/Sole/
5. Identify appropriate pain
management strategies that are
nonpharmacological.
Column IV
Clinical Activities
(expected competencies/skills)
•
Discuss continuous infusions
for sedation using patient
situations from clinical
experiences.
•
Formulate appropriate nursing
diagnoses for clients’
experiences acute pain.
•
Implement nursing care for a
client with acute pain
4. Complete a thorough and
complete pain assessment.
Media Clip
ATI Adult Medical Surgical
Nursing
Ch. 41 Pain Management
PCAVideo
Application Exercises
NCLEX Connections
SPRING 2011/Medical Surgical Nursing 4 / CMG /
10
UNIT 4 – PROBLEMS OF OXYGENATION
(MODULE 4A --- Pulmonary Disorders)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
1. Recall normal respiratory anatomy and
physiology, and previously acquired
knowledge of single use suctioning
techniques, chest drainage systems,
oxygen delivery systems and basic
ABG interpretation.
REQUIRED
1. Sole-Klein-Moseley
Ch. 14: Acute Respiratory Failure
Ch. 19: Maintaining effective breathing
(pp. 661 – 663), Thoracic
injuries (667 – 669)
2. Ch. 39: PPH (pp. 1352-1353)
2. Explain the components of an
advanced respiratory assessment as
they relate to caring for clients who
have selected critical and complex
medical conditions, including
mechanical ventilation and thoracic
surgeries.
3. Discuss etiologies, pathophysiologies,
clinical manifestations, and
complications for clients who have
selected critical and complex medical
conditions related to the respiratory
system, including:
Chest trauma
Acute respiratory failure
PPH
PE
ARDS
Thoracic surgeries
4. Explain the collaborative management,
as appropriate, including: diagnostic
and laboratory data, nutrition, nursing
diagnosis and interventions,
pharmacology, surgical /nonsurgical
treatments, safety, teaching /learning
needs, and health promotion for clients
who have selected critical and
complex medical conditions related to
the respiratory system, and who
require selected O2 delivery systems.
Media Clip
3.
ATI Adult Medical Surgical Nursing
Ch. 21: Oxygen & Mechanical
Ventilation
Mechanical Ventilation Video
Application Exercises
NCLEX Connections
4.
Media Clip
ATI Adult Medical Surgical Nursing
Ch18: Respiratory Diagnostic Procedures
Ch 28: Pulmonary Embolism
Ch 30: Acute Respiratory Failure
Application Exercises
NCLEX Connections
Allens Test Video
LECTURE / DISCUSSION
See disease specific lectures
STUDY GUIDES
4A.1: Simulated Learning Experiences:
Respiratory Assessment
4A.2: ABG Practice Problems
1. Demonstrate accountability for the
provision and evaluation of nursing
care that conforms to professional
standards and incorporates legal and
ethical responsibilities of the nurse,
especially the rights of the clients.
1. Function as a Level 4 Provider of
Care, Manager of Care, and Member
of the Profession when caring for a
client with critical and complex
medical conditions related to
respiratory system.
2. Function as a client advocate by
identifying and utilizing appropriate
resources.
2. Consistently utilize appropriate
resources for individual clients
3. Differentiate the elements of an
advanced pulmonary assessment.
Work of breathing
Compliance
Resistance
Subcutaneous creptius
Tactile fremitus
Resonance
Dullness
Flatness
Hyperresonance
Tympany
Whispered pectoriloquy
Bronchophony
Egophony
ABG
o Mixed disturbances
o Partial vs. full
compensation
ETCO2 Monitoring
CXR
Bronchoscopy
3. Participate as an interdisciplinary
healthcare team member.
4. Perform a systematic, comprehensive
physical exam, incorporating
advanced pulmonary assessment
techniques and diagnostic data on a
patient who has critical and complex
medical conditions while being
observed by the clinical instructor.
5. Demonstrate single use and inline
suctioning via an ETT and trach skills
lab and clinical area.
6. Demonstrate using the BVM device
via an ETT and tracheostomy tube.
7. Actively participate in a group
discussion in which a case study is
presented on a client with ARF.
8. Complete ABG Comprehensive Exam
RECOMMENDED
1. LeMone
Ch. 36: Respiratory assessment
Ch. 31: Interventions for Clients with
Oxygen Therapy or
Tracheostomy (pp1355-1365)
SPRING 2011/Medical Surgical Nursing 4 / CMG /
11
UNIT 4 – PROBLEMS OF OXYGENATION
(MODULE 4A --- Pulmonary Disorders)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
5. Explain respiratory changes associated
with aging, and summarize age
appropriate care, for clients who have
selected critical and complex medical
conditions.
RECOMMENDED (CONT)
4. Explain the collaborative
management, as appropriate,
including: diagnostic and laboratory
data, nutrition, nursing diagnosis and
interventions, pharmacology, surgical
and nonsurgical treatments, safety,
teaching and learning needs, and
health promotion for clients who have
selected critical and complex medical
conditions related to the respiratory
system, and who require selected
oxygen delivery systems.
6. Differentiate ABG results in terms of
full and partial compensation, and
mixed disturbances.
7. Classify acid-base imbalances
according to their underlying causes,
and relate their clinical significance.
COMPUTER ASSISTED
INSTRUCTION
Evolve website - Chapters 8 and 13
http://evolve.elsevier.com/Sole/
Lung sounds: AH Computer Lab
ABG II, Comprehensive Exam
Media Clip
ATI Adult Medical Surgical Nursing
Ch. 21: Oxygen & Mechanical
Ventilation
NC, Simple Mask, NRB Mask, Face
Tent, & Venturi Mask Images
Media Clip
ATI Adult Medical Surgical Nursing
Ch. 23: COPD: Image
Ch 24: Pneumonia Image
Ch. 28: Pulmonary Embolism (Image)
5. Explain respiratory changes associated
with aging, and summarize age
appropriate care, for clients who have
selected critical and complex medical
conditions.
9. Create and discuss a care plan in
which collaborative problems are
utilized for a client who has critical
and complex medical conditions
related to the respiratory system.
10. Perform a comprehensive physical
examination on a Gerontological
client and develop an age appropriate
plan of care.
11. Participate in a respiratory arrest
simulation scenario in skills
laboratory.
6. Differentiate ABG results in terms of
full and partial compensation, and
mixed disturbances.
7. Classify acid-base imbalances
according to their underlying causes,
and relate their clinical significance.
SPRING 2011/Medical Surgical Nursing 4 / CMG /
12
Unit 4 – PROBLEMS OF OXYGENATION
(MODULE 4B --- Mechanical Ventilation)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
REQUIRED
11. Interpret ABG results and relate them
to the underlying physiologic
processes when caring for patients
who have critical and complex
medical conditions, and anticipate the
appropriate medical and nursing
interventions.
6. Differentiate ABG results in terms of
full and partial compensation, and
mixed disturbances.
7. Classify acid-base imbalances
according to their underlying causes,
and relate their clinical significance.
READING
1. Sole-Klein-Moseley
Ch. 9
2. Instructional Syllabus Nursing 28
LECTURE / DISCUSSION
ARF and Mechanical Ventilation
STUDY GUIDES
4B.1: MV ABG Practice Questions
8. Differentiate selected types, modes,
and associated settings of mechanical
ventilation, and relate them to various
pathophysiological processes and
ABG results.
Types
o Negative pressure
o Positive pressure
Modes
o PC
o PRVC
o VC
o SIMV
o CPAP/PS
o T-tube
o NPPV
Settings
o Mode
o FiO2
o Vt
o Rate
o IE ratio
o PEEP
o Alarms
RECOMMENDED
Study Guides
4B.2: Ventilatory Discussion
4B.3: Acute Respiratory Failure
4B.4: Critical thinking exercises
1. COMPLETE COMPUTER
SIMULATED INSTRUCTION
View the Critical Care Nursing Video
Series: Mechanical Ventilation:
Concepts and Mechanical Ventilation:
Nursing Management.
12. Verify the mechanical ventilator
settings, and correlate them to the
patient’s condition and ABG results.
2. Practice inflating a cuff on the manikin
with an endotracheal tube and
correctly place the stethoscope where
a leak would be heard.
13. Recognize potential complications
associated with mechanical
ventilation.
3. Verify the ventilator settings on the
ventilator in both the skills laboratory
and in the clinical settings.
14. Explain the weaning criteria
associated with mechanical
ventilation.
4. Complete simulated learning
experience “Practicing Airway
Insertions” and “Assessing a
Ventilated Client”
15. Correlate hemodynamics responses
to effects of mechanical ventilation.
5. Discuss the weaning criteria with the
clinical instructor while in the clinical
setting, and relate either actual or
potential intolerance.
SPRING 2011/Medical Surgical Nursing 4 / CMG /
13
UNIT 5 – PROBLEMS OF CARDIAC OUTPUT AND TISSUE PERFUSION
(MODULE 5A --- Cardiovascular Disorders)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
1. Recall normal cardiac anatomy and
physiology, and previously
acquired knowledge of the key
elements of BLS, hypertension,
and shock.
2. Explain the components of an
advanced cardiac assessment.
REQUIRED
READING
1. Sole-Klein-Moseley
Ch. 11: Review Shock, pp. 265 – 287
Classifications pp 288- 302
Ch. 12: Cardiovascular Alterations
as they relate to caring for
clients who have selected critical
and complex medical conditions.
3.Discuss the etiologies, pathophysiology,
clinical manifestations, and
complications for clients who have
selected critical and complex medical
conditions related to the cardiovascular
system, including:
Hypertensive crisis
CAD
Angina
MI
ACS
Valvular heart disease
Aortic aneurysms
Pericardial effusion
Cardiac tamponade
Shock
Dysrhythmias
Cardiac emergencies
1. Integrate all previously learned
knowledge while caring for critical
and complex clients.
2. Incorporate the roles of a Level 4
Provider of Care, Manager of Care, and
Member of the Profession when caring
for patients who have critical and
complex medical conditions related to
the cardiovascular system (CV).
Ch 19: Cardiac tamponade, p. 667
2. LeMone
Ch 35: hypertensive crisis
(pp.1168- 1170)
3.
Media Clip
ATI Adult Medical Surgical Nursing
Ch. 34: Invasive Cardiac Procedures:
Stent Placement (Animation)
Bypass Graft Image
Ch 35: Myocardial Infarction Image
Ch 37: Valvular Heart Disease
Heart Blood Flow Image
Heart Valve Comparison Image
LECTURE / DISCUSSION
See disease specific lectures
3. Differentiate elements of an advanced
cardiac assessment, including:
Jugular venous distention
Pulsus alternans
Pulsus paradoxus
Hemodynamic readings
Diagnostic tests
o Electrocardiography
o Exercise tolerance test
o Chest X-ray
o Echocardiography
o Transcutaneous /esophageal
o Heart scans
o Cardiac cath /arteriography
o
Magnetic resonance imaging
o
Electrophysiology studies
4. Critique and organize data to establish
priorities when caring for patients who
have selected critical and complex
medical conditions related to the
CV system.
5. Anticipate and minimize complications
when caring for patients who have
critical and complex medical
conditions related to the CVsystem.
1. Apply concepts from previous learning.
2. Function as a Level 4 Provider of
Care, Manager of Care, and Member
of the Profession when caring for a
client with critical and complex
medical conditions related to CV
system.
3. Perform a systematic, comprehensive
physical exam, incorporating
advanced cardiac assessment
techniques and diagnostic data on a
patient who has critical and complex
medical conditions while being
observed by the clinical instructor.
4. Recognize changes in clients
conditions, and implement
appropriate action plans to minimize
client complications, including
notifying the RN preceptor and
clinical instructor.
5. Actively participate in a group
discussion in which a case study is
presented on a client who has a
critical and complex condition related
to CV system.
6. Create and discuss a care plan in
which collaborative problems are
utilized for a client who has critical
and complex medical conditions
related to the CV system.
SPRING 2011/Medical Surgical Nursing 4 / CMG /
14
Unit 5 – PROBLEMS OF CARDIAC OUTPUT AND TISSUE PERFUSION
(MODULE 5A --- Cardiovascular Disorders)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
6. Create individualized nursing care
plans for patients who have selected
critical and complex medical
conditions related to the CV system,
and revise the plan of care as needed to
optimize patient outcomes.
7. Implement a teaching plan for a client
and / or their family in the critical care
and telemetry rotations.
7. Incorporate collaborative problems
into care plans, as appropriate.
9. Observe one procedure of
interventional cardiology.
8. Evaluate learning needs of the patient
and / or their family, and design an
appropriate teaching plan for disease
prevention, health promotion, and self
care for clients who have selected
critical and complex medical
conditions related to the CV system.
10. Consistently utilize appropriate
resources for individual clients.
4. Explain the collaborative management,
as appropriate, including: diagnostic
and laboratory data, nutrition, nursing
diagnosis and interventions,
pharmacology, surgical and
nonsurgical treatments, safety,
teaching and learning needs, and
health promotion for clients who have
selected critical and complex medical
conditions related to the cardiovascular system.
5. Explain cardiovascular changes
associated with aging, and summarize
age appropriate care, for clients who
have selected critical and complex
medical conditions.
RECOMMENDED
1. Lemone
Ch 30 Review Cardiac assessment
STUDY GUIDE
Study Guide 5A.1
3.
Media Clip
ATI Adult Medical Surgical Nursing
Ch 35: Myocardial Infarction Image
Ch . 37: Heart Blood Flow Image
COMPUTER ASSISTED
INSTRUCTION
Evolve website
Chapters 11, 12, 19
http://evolve.elsevier.com/Sole/
Heart sounds: AH Computer Lab
9. Classify selected cardiac medications
used in critical care environments,
anticipate their desired and adverse
effects, and correlate them with
selected CV conditions.
10. Verify drug and intravenous solution
delivery rates for patients who have
selected critical and complex medical
conditions related to the CV system.
8. Complete Specialized Equipment and
Medication assignments.
11. Participate in a simulated learning
experience in which vasoactive
medications are calculated.
12. Demonstrate care and respect for the
patient’s uniqueness, developmental
level, sociocultural background,
spiritual beliefs, perceptions and
values.
12. Identify nursing interventions that are
culturally sensitive, and implement
professional care that is culturally
competent.
13. Participate in interdisciplinary rounds.
11. Describe how cultural perspectives
affect the critically and terminally ill
client and how these are addressed in
the critical care setting.
14. Complete required Simulation
Activities
12. Function as a client advocate when
caring for patients who have
selected critical and complex medical
conditions related to the
CV system.
15
UNIT 5 – PROBLEMS OF CARDIAC OUTPUT AND TISSUE PERFUSION
(MODULE 5B – Dysrhythmias)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
2. Explain components of an advanced
cardiac assessment:
as they relate to caring for
clients with selected
dysrhythmias.
6. Correlate the components of the
electrocardiogram (ECG) with the
cardiac conduction system.
7. Identify key features of normal sinus
rhythm and selected dysrhythmias.
8. Demonstrate a systematic approach
in interpreting selected rhythm strips.
Rhythmcity
Measurements
Waveforms and intervals
Rate calculation - atrial and
ventricular
9. Differentiate the pathophysiologic
mechanisms for selected
dysrhythmias and organize them in
terms of lethality, emergency
management (BLS and ACLS), and
pharmacological interventions.
10. Outline the hemodynamic
consequences and signs and
symptoms of selected dysrhythmias.
11. Summarize the nursing and medical
responsibilities of selected
dysrhythmias.
REQUIRED
READING
1. Sole-Klein-Moseley
Ch 7: Dysrhythmia Interpret & Mgt
Ch. 10: Code Management
Ch 12: CV Alterations, pp. 346 -348
LECTURE / DISCUSSION
Cardiac Monitoring and Waveform
Analysis
Rhythm Interpretation
Code Management
Cardioversion versus Defibrillation
Pacemakers
REQUIRED STUDY GUIDES
5B.4 Simulated Learning Experiences
Media Clip
ATI Adult Medical Surgical Nursing
Ch 32: Application Exercises & NCLEX
Connections
Ch 57: Cardiac Arrest,CPR, Defib
VT strip animation
13. Demonstrate proper ECG lead
placement
for leads I, II, III, and MCL 1.
1. Interpret and submit 8 different ECG
Tracings, utilizing a systematic
approach.
14. Measure the atrial and ventricular
rates by utilizing two methods.
2. Document approved interpretation,
and any related dysrhythmia event on
the clients record.
15. Interpret selected cardiac rhythms,
and incorporate into the plan of care.
3. Participate in a code blue in either the
simulation laboratory and / or the
clinical setting.
16. Attribute physiologic responses to
observed dysrhythmias.
17. Implement BLS and ACLS
algorhythms, as appropriate, under the
guidance of the clinical instructor and /
or RN preceptor.
4. COMPLETE COMPUTER
SIMULATED INSTRUCTION
Tissue perfusion management
Crisis management
ECG II: Basic Arrhythmia Recognition
ECG III: Advanced Recognition
RECOMMENDED STUDY GUIDES
5B.1: Cardiac Dysrhythmia and Code
Management
5B.2 Dysrhythmia interpretation
5B.3 Practice Rhythm Strips
Media Clip
ATI Adult Medical Surgical Nursing
Ch 32: ECG & Dysrhythmia Monitoring
Images: ECG strip
PAC
VT
AF
ECG Lead Placement
Ch. 33: Pacemaker Image
16
UNIT 5 – PROBLEMS OF CARDIAC OUTPUT AND TISSUE PERFUSION
(MODULE 5C --- Hemodynamic Monitoring)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
2. Explain the components of an
advanced cardiac assessment:
as they relate to caring for clients
who have invasive hemodynamic
monitoring.
12. Describe the components of a
hemodynamic monitoring system.
13. Describe the indications, normal
parameters, complications, and
nursing implications associated with
invasive monitoring of right atrial,
pulmonary artery, and intra-arterial
pressures.
14. Discuss common medications used in
the critical care area, and explain
their effects on hemodynamic
readings.
15. Explain the clinical relevance of
altered hemodynamic values.
REQUIRED
READING
1. Sole-Klein-Moseley
Ch 8: Hemodynamic Monitoring
Ch 12: Cardiovascular Alterations
Ch 19: Cardiac Tamponade, p.667
18. Identify the components of pressured
system.
19. Create a nursing care plan which
integrates and correlates advanced
cardiac data for a patient with
altered cardiovascular function.
2. Instructional Syllabus Nursing 28
LECTURE / DISCUSSION
Hemodynamic Monitoring
Media Clip
ATI Adult Medical Surgical Nursing
Ch 31: CV Diagnostic & Therapeutic
Procedures
Image Hemodynamic Monitoring
Image Cardiac Cath
RECOMMENDED STUDY GUIDES
5C.1
INTERNET RESOURCES
Skill Stat Learning ECG Simulator
http://www.skillstat.com/learn.htm
AACN - Dysrhythmia Monitoring:
http://www.aacn.org/WD/Practice/Docs/
Dysrhythmia_Monitoring_04-2008.pdf
AACN - Monitor Placement and Lead
selection Audit Tool
http://www.aacn.org/WD/Practice/Docs/E
lectrode_PlacementLead_Selection_Audit_Tool_04-2008.pdf
BLS Essential Facts Flash Cards Online
http://www.richacls.com/Home%20Page/
Providers%20Page/the_learing_center.hm
20. Critique and organize data to
establish priorities when caring for
patients with right atrial, pulmonary
artery, and intra- arterial pressure.
21. Relate physiologic conditions and
treatment modalities for a client with
invasive hemodynamic monitoring.
1. Perform a comprehensive cardio vascular assessment in either the
simulation laboratory, or the clinical
setting, on a patient who has invasive
hemodynamic monitoring.
2. Examine the equipment and describe
the placement of the transducers for
pressure monitoring
3. Identify normal and abnormal
arterial pressure tracings from
clients with altered cardiovascular
function.
4. Observe one procedure specific to the
cardiovascular system.
5. Participate in at least one simulated
learning experience utilizing
SimMan.
6. Actively participate in a group
discussion in which a case study is
presented on a client who has a
critical and complex condition, with
invasive hemodynamic monitoring.
7. COMPLETE COMPUTER
SIMULATED INSTRUCTION
Hemodynamic Monitoring
Hemodynamic Monitoring II
17
UNIT 6 – PROBLEMS OF HEMATOLOGICAL SYSTEM
(MODULE 6 --- Hematological Disorders)
Column I
Column II
Column III
Column IV
Theory Objectives
Learning Activities
Clinical Objectives
Clinical Activities
(Expected competencies / skills)
1. Recall normal hematologic anatomy
and physiology, and previously
acquired knowledge of blood
formation, blood and blood products,
hematopoietic cells, coagulation
factors, anemia and hematologic
disorders.
REQUIRED
READING
1. Sole-Klein-Moseley
Ch. 16: Hematological and Immune
Disorders
2. Explain the components of an
advanced hematologic assessment as
they relate to caring for clients who
have selected critical and complex
medical conditions.
LECTURE / DISCUSSION
See disease specific lectures
3. Discuss etiologies, pathophysiologies,
clinical manifestations, and
complications for clients who have
selected critical and complex medical
conditions related to the hematologic
system, including:
Anemia
DIC
Thrombocytopenia
4. Explain the collaborative management,
as appropriate, including: diagnostic
and laboratory data, nutrition, nursing
diagnosis and interventions,
pharmacology, surgical /nonsurgical
treatments, safety, teaching /learning
needs, and health promotion for clients
who have selected critical and
complex medical conditions related to
the hematologic system.
5. Relate hematologic changes associated
with aging, and summarize age
appropriate care, for clients who have
selected critical and complex medical
conditions.
2. Instructional Syllabus Nursing 28
RECOMMENDED
COMPUTER ASSISTED
INSTRUCTION
Evolve website – Chapter 16
http://evolve.elsevier.com/Sole/
RECOMMENDED STUDY GUIDES
6.1: DIC
1. Differentiate the elements of an
advanced hematologic assessment,
including:
Patient history
Genetic risks
Petechiae
Laboratory data
o Hemogram
o White and red blood
cell differential
o Coagulation studies
PTT/PT/INR
Fibrinogen / FDPs
D-dimer
Platelet
Bleeding time
1. Perform a systematic, comprehensive
physical exam, incorporating
advanced hematologic assessment
techniques and diagnostic data on a
patient who has critical and complex
medical conditions while being
observed by the clinical instructor.
2. Actively participate in a group
discussion in which a case study is
presented on a client with DIC,
thrombocytopenia and anemia.
3. Complete a study guide on DIC.
2. Identify laboratory tests used in
evaluating patients with anemia, DIC,
and thrombocytopenia.
3. Relate the clinical presentation and
laboratory findings in the patient with
anemia, DIC and thrombocytopenia.
4. Explain the relationship of anemia to
oxygen saturation (SpO2), cardiac
output, and oxygen transport.
5. Develop and evaluate a care plan for a
client with anemia, DIC, and
thrombocytopenia.
18
UNIT 7 --- PROBLEMS OF MOBILITY, SENSATION, AND COGNITION
Column I
Theory Objectives
1. Analyze nursing interventions for
sedation and pain control for
neuromuscular blockades and
continuous intravenous infusions
for sedation.
2. Differentiate between medically
induced coma and therapeutic
paralysis.
3. Analyze pharmacological agents
used to provide conscious sedation
and neuromuscular blockade.
Column II
Suggested Learning
Activities
Required Reading
Sole Chapter 5
LeMone pp. 63-64
Lecture/Discussion
• Neuromuscular Blockade
o Indications for NMB
o Common
pharmacological
agents
o Factors altering
blockade
o Methods to monitor
neuromuscular
function
• Conscious Sedation
Column III
Clinical Objectives
1. Discuss levels of sedation.
2. Identify appropriate anxiety and
pain management strategies for
the client receiving
neuromuscular blockade
Column IV
Clinical Activities
(expected competencies/skills)
• Recognize the rational and
mechanism of action underlying
the use of neuromuscular
blocking agents in the critical
care setting.
3. Describe evaluation of the
client receiving neuromuscular
blockade.
19
Column I
Theory Objectives
1.
Unit 8 – Problems of Neurological Function
Column II
Column III
Suggested Learning
Clinical Objectives
Activities
Recall normal neurological anatomy and
physiology and previously acquired
knowledge regarding problems of
neurological function.
Required
1. Sole Chapter 13
Explain the components of an advanced
neurological assessment as they relate to
caring for clients who have selected critical
and complex neurological conditions and
intracranial pressure monitoring.
3. ATI Nursing Care of
Children: Ch. 14 & 15
Application Exercises &
NCLEX Connections
1.
2. LeMone 1653-1655
2.
2.
3.
Discuss the etiologies, pathophysiology,
clinical manifestations, and complications
for clients who have selected critical and
complex medical conditions related to the
neurological system, including:
•
•
•
•
•
•
4.
5.
Traumatic brain injury
Spinal cord trauma
Guillian Barre
Cerebral aneurysms
Increased intracranial pressure
Neurogenic shock
Integrate all previously learned
knowledge while caring for critical
and complex clients.
Incorporate the roles of a Level 4
Provider of Care, Manager of Care,
and Member of the Profession when
caring for patients who have critical
and complex medical conditions
related to the neurological system.
Lecture/Discussion
See disease special lectures
3.
Differentiate the elements of an
advanced neurological assessment.
Evolve Website
Chapter 13 activities
4.
Critique and organize data to establish
priorities when caring for patients who
have selected critical and complex
medical conditions related to the
neurological system.
RECOMMENDED
Study Guide 8.1.A
Media Clip
ATI Nursing Care of Children
Ch 12: Meningitis
Brudzinski Sign Image
Kernig's Sign Image
Explain the collaborative management, as
appropriate, including: diagnostic and
laboratory data, nutrition, nursing
diagnosis and interventions, pharmacology,
surgical and nonsurgical treatments, safety,
teaching and learning needs, and health
promotion for clients who have selected
critical and complex medical conditions
related to the neurological system.
Ch. 13: Nerve with Myelin
Sheath Image
Explain neurological changes associated
with aging, and summarize age appropriate
care, for clients who have selected critical
and complex medical conditions.
Media Clip
ATI Medical Surgical Nursing
Ch. 17: SCI Images
5.
6.
Ch 14: Head Injury
Decorticate Posturing Image
Decerebrate Posturing Image
Ch 15: Brain Herniation Image
7.
Anticipate and minimize
complications when caring for patients
who have critical and complex
medical conditions related to the
neurological system.
Create individualized nursing care
plans for patients who have selected
critical and complex medical
conditions related to the neurological
system, and revise the plan of care as
needed to optimize patient outcomes.
Incorporate collaborative problems
into care plans, as appropriate.
Column IV
Clinical Activities
(expected competencies/skills)
1. Apply concepts from previous learning.
2. Function as a Level 4 Provider of
Care, Manager of Care, and Member
of the Profession when caring for a
client with critical and complex
medical conditions related to the
neurological system.
3. Perform a systematic, comprehensive
physical exam, incorporating
advanced neuro assessment
techniques and diagnostic data on a
patient who has critical and complex
medical conditions while being
observed by the clinical instructor.
4. Recognize changes in clients
conditions, and implement
appropriate action plans to minimize
client complications, including
notifying the RN preceptor and
clinical instructor.
5. Actively participate in a group
discussion in which a case study is
presented on a client who has a
critical and complex condition related to
neurological system.
6. Create and discuss a care plan in
which collaborative problems are
utilized for a client who has critical
and complex medical conditions
related to the neurological system.
and / or their family in the critical care and
telemetry rotations.
7. Consistently utilize appropriate
resources for individual clients.
20
8.
6.
7.
Describe the indications, normal
parameters, complications, and nursing
implications associated with intracranial
pressure monitoring.
Discuss common pharmacological agents
used for patients who have selected critical
and complex medical and surgical
conditions related to the neurological
system.
9.
Evaluate learning needs of patient and
/ or their family, and design an
appropriate teaching plan for disease
prevention, health promotion, and self
care, for clients who have selected
critical and complex medical
conditions related to the neuro system.
Classify selected medications used in
critical care environments, anticipate
their desired and adverse effects, and
correlate them with selected
neurological conditions.
8. Demonstrate care and respect for the patient’s
uniqueness, developmental level,
sociocultural background, spiritual beliefs,
perceptions and values.
9. Identify nursing interventions that are
culturally sensitive, and implement
professional care that is culturally
competent.
10. Participate in interdisciplinary rounds.
10. Verify drug and intravenous solution
delivery rates for patients who have
selected critical and complex medical
conditions related to the neuro system.
11. Describe how cultural perspectives
affect the critically and terminally ill
client, and how these are addressed in
the critical care setting.
12. Function as a client advocate when
caring for patients with who have
selected critical and complex medical
conditions related to the neurological
system.
13. Differentiate elements of an advanced
neurological assessment, related
intracranial pressure monitoring.
14. Create a nursing care plan which
integrates and correlates advanced
neurological data for a patient with
altered neurological function.
15. Critique and organize data to establish
priorities when caring for patients
with increased intracranial pressure
monitoring.
16. Relate physiologic conditions and
treatment modalities for a client with
intracranial pressure monitoring
21
Unit 9 – PROBLEMS OF REGULATION AND METABOLISM
Column I
Theory Objectives
1.
Recall anatomy and physiology of
the endocrine system including
regulation of electrolytes and
osmolality.
2. Discuss the etiologies,
pathophysiology, clinical
manifestations, and complications for
clients who have selected critical and
complex medical conditions related
to the neurological system, including:
• Diabetes insipidus (DI)
• Syndrome of inappropriate antidiuretic hormone (SIADH)
3. Explain the collaborative
management including: diagnostic
and laboratory data, nutrition, nursing
diagnosis and interventions,
pharmacology, surgical and
nonsurgical treatments, safety,
teaching and learning needs, and
health promotion for clients with DI
and SIADH.
4. Explain endocrine changes associated
with aging and summarize age
appropriate care for clients with DI
and SIADH.
Column II
Suggested Learning
Activities
Required Reading
Sole Chapter 642-648
Lecture/Discussion
• DI
• SIADH
Column III
Clinical Objectives
1. Integrate all previously learned
knowledge while caring for
critical and complex clients.
2. Incorporate the roles of a Level 4
Provider of Care, Manager of
Care, and Member of the
Profession when caring for
patients who have critical and
complex medical conditions related
to the neurological system.
3. Analyze clinical changes and
laboratory data to determine the
effectiveness of interventions for
critically ill clients with DI and
SIADH.
Column IV
Clinical Activities
(expected competencies/skills)
•
From the laboratory results of
a client with DI or SIADH,
identify the fluid, electrolyte,
and osmolality imbalances.
•
Develop a plan of care and
implement nursing care for a
client with DI or SIADH
•
Demonstrate assessment of
the client who is admitted
with a diagnosis of DI or
SIADH
•
Identify the appropriate fluid
therapy.
4. Utilize critical thinking skills to
develop, evaluate, and revise a plan
of care for a critically ill client
with DI and SIADH
5. Prioritize and implement health
teachings for the client with DI
and SIADH
6. Demonstrate patient advocacy
when caring for a client with DI
and SIADH
22
Unit 10 – PROBLEMS OF DISGESTION, NUTRITION, AND ELIMINATION
Column I
Theory Objectives
1. Recall normal gastrointestinal
anatomy and physiology and
previously acquired knowledge
regarding problems of digestion,
nutrition, and elimination.
2. Explain the components of an
advanced gastrointestinal assessment
as they relate to caring for clients who
have selected critical and complex
problems of digestion, nutrition, and
elimination.
Column II
Suggested Learning
Activities
Required
Reading
Sole Chapter 17
Evolve Website
Chapter 17 activities
3. Discuss the etiologies,
4. Explain the collaborative management,
as appropriate, including: diagnostic
and laboratory data, nutrition, nursing
diagnosis and interventions,
pharmacology, surgical and
nonsurgical treatments, safety, teaching
and learning needs, and health
promotion for clients who have selected
critical and complex medical conditions
related to digestion, nutrition, and
elimination.
1. Integrate all previously learned
knowledge while caring for critical
and complex clients.
Column IV
Clinical Activities
(expected competencies/skills)
1. Apply concepts from previous
learning.
2. Function as a Level 4 Provider
Lecture/Discussion
GI bleed
Hepatic failure
Hepatorenal failure
RECOMMENDED
pathophysiology, clinical
manifestations, and complications for
clients who have selected critical and
complex medical conditions related to
the gastrointestinal system, including:
• hepatic failure
• hepatorenal failure
• acute gastrointestinal bleeding
Column III
Clinical Objectives
Media Clip
ATI Medical Surgical Nursing
Ch 53: Esophageal
varices
Ch 54 SengstakenBlakemore Tube Image
Media Clip
ATI Nutriton for Nursing
Ch 9: Enternal Nutrition
Ch.10: TPN Video
2. Incorporate the roles of a Level 4
Provider of Care, Manager of Care,
and Member of the Profession when
caring for patients who have critical
and complex medical conditions
related to problems of digestion,
nutrition, and elimination.
3. Differentiate the elements of an
advanced gastrointestinal
assessment.
4. Critique and organize data to
establish priorities when caring for
patients who have selected critical
and complex medical conditions
related to the gastrointestinal system.
5. Anticipate and minimize
complications when caring for
patients who have critical and
complex medical conditions related
to problems of digestion, nutrition,
and elimination.
6. Create individualized nursing care
plans for patients who have selected
critical and complex medical
conditions related to the
gastrointestinal system, and revise
the plan of care as needed to
optimize patient outcomes.
of Care, Manager of Care, and
Member of the Profession when
caring for a client with critical
and complex medical condition
related to the GI system.
3. Perform a systematic,
comprehensive physical exam,
incorporating advanced GI
assessment techniques and
diagnostic data on a patient who
has critical and complex medical
conditions while being observed
by the clinical instructor.
4. Recognize changes in clients
conditions, and implement
appropriate action plans to
minimize client complications,
including notifying the RN
preceptor and clinical instructor.
5. Actively participate in a group
discussion in which a case study
is presented on a client who has
a critical and complex condition
related to GI system.
7. Incorporate collaborative problems
23
5. Explain digestion, nutrition, and
elimination changes associated with
aging, and summarize age appropriate
care, for clients who have selected
critical and complex medical
conditions.
6. Discuss common pharmacological
agents used for patients who have
selected critical and complex medical
and surgical conditions related to
digestion, nutrition, and elimination.
into care plans, as appropriate.
8. Evaluate learning needs of the
patient and / or their family, and
design an appropriate teaching plan
for disease prevention, health
promotion, and self care for clients
who have selected critical and
complex medical conditions related
to problems of digestion, nutrition,
and elimination.
6. Create and discuss a care plan in
which collaborative problems
are utilized for a client who has
critical and complex medical
conditions related to the GI
system and / or their family in
the critical care and telemetry
rotations.
7. Consistently utilize appropriate
9. Classify selected medications used in
critical care environments, anticipate
their desired and adverse effects, and
correlate them with selected
gastrointestinal conditions.
10. Verify drug and intravenous solution
delivery rates for patients who have
selected critical and complex
medical conditions related to the GI
system.
11. Describe how cultural perspectives
affect the critically and terminally ill
client, and how these are addressed
in the critical care setting.
resources for individual clients.
8. Demonstrate care and respect for
the patient’s uniqueness,
developmental level,
sociocultural background,
spiritual beliefs, perceptions and
values.
9. Identify nursing interventions
that are culturally sensitive, and
implement professional care that
is culturally competent.
10. Participate in interdisciplinary
rounds.
12. Function as a client advocate when
caring for patients with who have
selected critical and complex
medical conditions related to the GI
system.
13. Critique and organize data to establish
priorities when caring for patients
with problems of digestion, nutrition,
and elimination.
14. Relate physiologic conditions and
treatment modalities for a client with
problems of digestion, nutrition, and
24
elimination.
Unit 11 – Problems of Excretion
Column I
Theory Objectives
1. Recall normal renal anatomy and
physiology and previously
acquired knowledge regarding
problems of renal function.
Column II
Suggested Learning Activities
Required
Reading
Sole Chapter 13
LeMone pp 921-923
Kidney transplant
2. Explain the components of an
advanced renal assessment as
they relate to caring for clients
who have selected critical and
complex renal conditions and
dialysis.
3. Discuss the etiologies,
pathophysiology, clinical
manifestations, and
complications for clients who
have selected critical and
complex medical conditions
related to the renal system,
including:
• Acute renal failure
• Renal transplant
Lecture/Discussion
• Acute renal failure
• Dialysis
• Renal transplant
Column III
Clinical Objectives
1. Integrate all previously learned
knowledge while caring for
critical and complex clients.
2. Incorporate the roles of a Level 4
Provider of Care, Manager of
Care, and Member of the
Profession when caring for
patients who have critical and
complex medical conditions related
to the renal system.
Evolve Website
Chapter 13 activities
3. Differentiate the elements of an
RECOMMENDED
Study Guide 11.1
4. Critique and organize data to
Media Clip
ATI Medical Surgical Nursing
Ch. 65: Hemodialysis (Animation)
Ch. 70: Renal Calculi Image
advanced renal assessment.
establish priorities when caring
for patients who have selected
critical and complex medical
conditions related to the renal
system.
5. Anticipate and minimize
4. Explain the collaborative
management, as appropriate,
including: diagnostic and
laboratory data, nutrition,
nursing diagnosis and
interventions, pharmacology,
surgical and nonsurgical
treatments, safety, teaching and
learning needs, and health
promotion for clients who have
selected critical and complex
complications when caring for
patients who have critical and
complex medical conditions
related to the renal system.
6. Create individualized nursing
care plans for patients who have
selected critical and complex
medical conditions related to the
renal system, and revise the plan
of care as needed to optimize
Column IV
Clinical Activities
(expected competencies/skills)
1. Apply concepts from previous
learning.
2. Function as a Level 4
Provider of Care, Manager of
Care, and Member of the
Profession when caring for a
client with critical and
complex medical conditions
related to the renal system.
3. Perform a systematic,
comprehensive physical
exam, incorporating advanced
renal assessment techniques
and diagnostic data on a
patient who has critical and
complex medical conditions
while being observed by the
clinical instructor.
4. Recognize changes in clients
conditions, and implement
appropriate action plans to
minimize client
complications, including
notifying the RN preceptor
and clinical instructor.
5. Actively participate in a group
discussion in which a case
study is presented on a client
25
medical conditions related to the
renal system.
5. Explain renal changes associated
with aging, and summarize age
appropriate care, for clients who
have selected critical and
complex medical conditions.
6. Describe the indications,
complications, and nursing
implications associated with
dialysis.
7. Discuss common
pharmacological agents used for
patients who have selected
critical and complex medical and
surgical conditions related to the
renal system.
patient outcomes.
7. Incorporate collaborative
problems into care plans, as
appropriate.
8. Evaluate learning needs of the
patient and / or their family, and
design an appropriate teaching
plan for disease prevention,
health promotion, and self care
for clients who have selected
critical and complex medical
conditions related to the renal
system.
9. Classify selected medications
used in critical care
environments, anticipate their
desired and adverse effects, and
correlate them with selected
renal conditions.
10. Verify drug and intravenous
solution delivery rates for
patients who have selected
critical and complex medical
conditions related to the renal
system.
11. Describe how cultural
perspectives affect the critically
and terminally ill client, and how
these are addressed in the critical
care setting.
who has a critical and complex
condition related to renal system.
6. Create and discuss a care plan
in which collaborative
problems are utilized for a
client who has critical and
complex medical conditions
related to the renal system.
and/or their family in the
critical care and telemetry
rotations.
7. Consistently utilize
appropriate resources for
individual clients.
8. Demonstrate care and respect
for the patient’s uniqueness,
developmental level,
sociocultural background,
spiritual beliefs, perceptions
and values.
9. Identify nursing interventions
that are culturally sensitive,
and implement professional
care that is culturally
competent.
10. Participate in interdisciplinary
rounds.
12. Function as a client advocate
when caring for patients with
who have selected critical and
complex medical conditions
related to the renal system.
26
13. Differentiate elements of an
advanced renal assessment,
related dialysis.
14. Create a nursing care plan which
integrates and correlates
advanced renal data for a patient
with altered renal function.
15. Critique and organize data to
establish priorities when caring
for patients with dialysis.
16. Relate physiologic conditions
and treatment modalities for a
client with dialysis.
27
28
Unit 12 – Problems of Protection
Column I
Theory Objectives
1. Recall normal anatomy and
physiology of the skin (structure
and function).and previously
acquired knowledge regarding
problems of the skin.
2. Explain the components of an
advanced skin assessment as
they relate to caring for the burn
client.
3. Discuss the etiologies,
pathophysiology, clinical
manifestations, and
complications for clients who
have selected critical and
complex medical conditions
related to the renal system,
including:
• Burns
• MODS
4. Discuss types, causative agents
and burn classification by depth
and extent of injury.
Column II
Suggested Learning Activities
Required Reading
Sole Chapter 20; pp. 302-305
Lecture/Discussion
• Burns
• MODS
•
Evolve Website
Chapter 20 activities
RECOMMENDED
Study Guide 12.1
Media Clip
ATI Nursing Care of Children
Ch. 32: Percentage of Burns Image
Stages of Burns Image
Media Clip
ATI Medical Surgical Nursing
Ch. 87: Burn Staging Image
Online resources
American Burn Association
http://www.ameriburn.org/
Column III
Clinical Objectives
1. Integrate all previously learned
knowledge while caring for
critical and complex clients.
2. Function as a Level 4 Provider of
2. Incorporate the roles of a Level 4
Provider of Care, Manager of
Care, and Member of the
Profession when caring for
patients who have critical and
complex medical conditions
related to burns and MODS.
3. Differentiate the elements of an
advanced integumentary
assessment.
4. Critique and organize data to
establish priorities when caring
for the client with burns and
MODS.
5. Anticipate and minimize
complications when caring for
patients who have critical and
complex medical conditions
related to burns and MODS.
Care, Manager of Care, and
Member of the Profession when
caring for a client with critical
and complex medical conditions
related to problems of protection.
3. Perform a systematic,
comprehensive physical exam,
incorporating advanced renal
assessment techniques and
diagnostic data on a patient who
has critical and complex medical
conditions while being observed
by the clinical instructor.
4. Recognize changes in clients
conditions, and implement
appropriate action plans to
minimize client complications,
including notifying the RN
preceptor and clinical instructor.
5. Actively participate in a group
5. Calculate the total body surface
area involved in a burn injury
using the rule of nines.
Column IV
Clinical Activities
(expected competencies/skills)
1. Apply concepts from previous
learning.
6. Create individualized nursing
care plans for patients who have
selected critical and complex
medical conditions related to
burns and MODS, and revise the
plan of care as needed to
discussion in which a case study
is presented on a burn client or
client with MODS.
6. Create and discuss a care plan in
which collaborative problems are
29
optimize patient outcomes.
7. Incorporate collaborative
problems into care plans, as
appropriate.
6. Explain the collaborative
management, as appropriate,
including: diagnostic and
laboratory data, nutrition,
nursing diagnosis and
interventions, pharmacology,
surgical and nonsurgical
treatments, safety, teaching and
learning needs, and health
promotion for clients with burns
and clients with MODS.
7. Explain integumentary changes
associated with aging, and
summarize age appropriate care,
for clients who have selected
critical and complex medical
conditions.
8. Describe the indications,
complications, and nursing
implications associated with
fluid resuscitation of the burn
client
8. Evaluate learning needs of the
patient and / or their family, and
design an appropriate teaching
plan for disease prevention,
health promotion, and self care
for clients who have selected
critical and complex medical
conditions related to burns and
MODS.
utilized for a burn or MODS
client and/or their family in the
critical care and telemetry
rotations.
7. Consistently utilize appropriate
resources for individual clients.
8. Demonstrate care and respect for
the patient’s uniqueness,
developmental level,
sociocultural background,
spiritual beliefs, perceptions and
values.
9. Identify nursing interventions
9. Classify selected medications
used in critical care
environments, anticipate their
desired and adverse effects, and
correlate them with burn and
MODS clients.
that are culturally sensitive, and
implement professional care that
is culturally competent.
10. Participate in interdisciplinary
rounds.
10. Verify drug and intravenous
solution delivery rates for
patients who have selected
critical and complex medical
conditions related to burns and
MODS
11. Describe how cultural
9. Use the Parkland formula to
establish the correct rate and
timing of fluid replacement.
10. Discuss common
pharmacological agents used for
the burn client and the patient
perspectives affect the critically
and terminally ill client, and how
these are addressed in the critical
care setting.
12. Function as a client advocate
when caring for patients with
who have selected critical and
30
with MODS.
complex medical conditions
related to burns and MODS.
13. Differentiate elements of an
advanced Integumentary
assessment
14. Create a nursing care plan which
integrates and correlates
advanced renal data for a patient
with burns or MODS.
15. Critique and organize data to
establish priorities when caring
for clients with burns or MODS.
16. Relate physiologic conditions
and treatment modalities for a
client with burns or MODS.
31
32