COURSE SYLLABUS
VNSG 1429 (4:4:0)
MEDICAL – SURGICAL
NURSING I
**********
VOCATIONAL NURSING
NURSING DEPARTMENT
HEALTH OCCUPATIONS DIVISION
LEVELLAND CAMPUS
SOUTH PLAINS COLLEGE
SPRING 2012
Levelland
Campus
COURSE SYLLABUS
COURSE TITLE:
Medical – Surgical Nursing I, VNSG 1429
INSTRUCTOR:
Jennifer Ponto, R.N., B.S.N
OFFICE LOCATION AND PHONE/E-MAIL:
Room TA 204, 806 716 2471, jponto@southplainscollege.edu
OFFICE HOURS:
By Appointment
SOUTH PLAINS COLLEGE IMPROVES EACH STUDENT’S LIFE
I.
GENERAL COURSE INFORMATION
A. COURSE DESCRIPTION (WECM):
Application of the nursing process to the care of adult patients experiencing
medical-surgical conditions in the health care continuum. A variety of health care
settings are utilized. This course covers physiology and basic pathophysiology,
causes of illness, communicable disease and disease transmission and prevention.
The role of the vocational nurse in preventative health measures, health promotion,
referral to community health resources, patient/family education, therapeutic and
rehabilitative aspects will be presented. Discussion/projects for ethical issues and
critical thinking are incorporated in the course.
B. LEARNING OUTCOMES (WECM):
The student will:
1. Identify the components of the health illness continuum.
2. Identify prevalent medical-surgical conditions affecting the adult.
3. Utilize the nursing process to assist in developing a plan of care for selected
medical-surgical conditions.
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Specific goals/objectives of this course -- the student will be able to:
1. Compare and contrast normal physiology of the body systems with that of a
pathological state.
2. Recognize causes of disease and illness, to include microorganisms and
communicable diseases, physical agents, chemical agents, cellular abnormalities,
trauma, genetic transmission, and participation in high-risk activities.
3. Demonstrate appropriate nursing care during the diagnostic and assessment phase of
patient care.
4. Set appropriate nursing goals for patients with common medical and surgical
conditions, with consideration of the patient's physical, social and psychological
needs.
5. Demonstrate appropriate nursing interventions and recognize appropriate medical
treatment for patients with medical and surgical conditions, with an emphasis on
patient safety and comfort.
6. Recognize expected patient outcomes for patients with medical and surgical
conditions and initiate appropriate action if expected outcome is not achieved.
7. Demonstrate appropriate use of referrals to community resources.
8. Demonstrate appropriate preventative/health promotion activities in patient/family
education.
9. Demonstrate appropriate activities to promote the rehabilitative process.
10. Demonstrate critical thinking ability.
11. Discuss appropriate interventions and resolutions for ethical dilemmas.
12. Demonstrate ability to safely provide advanced nursing skills.
SEE CHAPTER OBJECTIVES IN THE TEXTBOOKS FOR EACH CHAPTER
C. COURSE COMPETENCIES:
Grading Scale:
A
(100-93)
B
( 92-83)
C
( 82-77)
Below 77 is failing
D. ACADEMIC INTEGRITY:
Please refer to SPC Catalog and Vocational Nursing Student Handbook.
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E. SCANS AND FOUNDATION SKILLS:
C1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19
F1, 2, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
F. VERIFICATION OF WORKPLACE COMPETENCIES:
No external learning experiences provided. Successful completion of the NEAC
Competency statements at the level specified by the course (Level Objectives) will allow
the student to continue to advance within the program. Upon successful completion of
the program, students will be eligible to take the state board exam (NCLEX) for
vocational nurse licensure
II.
SPECIFIC COURSE/INSTRUCTOR REQUIREMENTS
A. MANDATORY TEXTBOOKS:
1. Clayton, B. & Stock Y. (2010). Basic Pharmacology for Nurses, 15th Edition. St.
Louis, MO: Mosby
2. Deglin, J.P. & Vallerand, A. (2011). Davis' Drug Guide for Nurses, 12th Edition
Philadelphia, PA: F.A. Davis
3. Elkin, M. and Perry, A. (2012) Nursing Interventions and Clinical Skills, 5th
Edition St. Louis, MO: Mosby
4. Memmler, Ruth. (2009). The Human Body in Health and Disease, 11th Edition.
Philadelphia, PA: Lippincott (Anatomy textbook)
5. Springhouse, Diagnostic Tests made Incredibly Easy. (2009) Springhouse.
6. Taber’s Medical Nursing Dictionary or a Medical/ Nursing Dictionary of choice.
7. White, L (2011) Foundations of Adult Health Nursing. 3rd Edition Delmar.
8. Occasionally, the student will be required to utilize outside references.
B. ATTENDANCE POLICY
Contact hours: 64. See SPC catalogue and Vocational Nursing Student Handbook.
Students are expected to attend all classes, arrive on time, and to remain for the entire
class period. Attendance will be taken at the beginning of class: a student not present
will be marked absent in the attendance record. Students absent more than 8 hours will
be removed from the course. Three (3) tardies count as one (1) hours' absence.
C. ASSIGNMENT POLICY:
All class assignments are to be turned in by 8:00 a.m. on the due date announced or the
paper will be considered late. Ten (10) points will be deducted from the paper for each
day turned in late. Failure to complete assignments will result in a grade of
INCOMPLETE. Please refer to the Student Handbook for vocational nursing.
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D. GRADING POLICY/METHODS OF EVALUATION:
Unit Exams
Reading Quiz
Written assignments
Ethical Decision Making Activities
Final Examination
70%
10%
20%
E. SPECIAL REQUIREMENTS:
There will be an exam after the completion of each assigned unit. No make-up exams
will be given. If an exam is missed, a grade of zero (0) will be given. One exam grade
will be dropped.
Students are expected to read the assigned chapters prior to lecture time. A reading quiz
may be given prior to the first lecture hour of each unit. Quizzes cannot be made up, a
grade of 0 will be given if the student misses the quiz.
III.
COURSE OUTLINE
A. REQUIRED READINGS:
Texts as stated above, Chapters as assigned. See drug list for individual unit
assignments. It is required that each chapter be read prior to the first lecture hour for the
chapter. The student is responsible for completing the learning objectives and learning
the key terms at the beginning of the chapter.
B. ETHICAL DECISION MAKING ACTIVITY:
The student will select a case study from the medical-surgical syllabus and complete the
ethical decision making activity in the chapter. This paper will need to be turned in on a
date announced in class for the semester. See grading criteria. Late papers will have 10
points deducted for each class day late.
C. CASE STUDIES:
One medical, one surgical, and one insulin dependent diabetic case study is to be
completed during the medical/surgical rotation. The due dates will be given in class. The
grade will lowered by 10 points each class day the paper is later than 8:00 a.m. on the
due date. This paper is part of the clinical grade. Each case study has a different format
for completion. See instructions and grading criteria. The case study may be typed or
neatly handwritten using black or blue ink. The student will utilize information from a
selected patient's medical record, with confidentiality assured. The student will be
expected to utilize appropriate bibliography materials. Critical thinking should be
4
involved with case studies. Students must submit the sections indicated with a * for the
rough draft on the assigned date. Students must attend conference to discuss the rough
draft with the faculty member.
D. BIBLIOGRAPHY:
The student will be required to utilize three references, besides the assigned texts,
dictionary or review book. If periodicals are used, they should be no older than 5 years;
if books are used, the reference should be no older than 10 years. Each reference must
be used in the text of the paper. Passages from books and periodicals used in the paper
must be identified by source. (APPROPRIATE HEALTH CARE PROFESSIONAL
REFERENCES MUST BE USED.)




A photocopy of the first page of each article utilized, or the cover page of each
book used must be turned in with the case study .
Web sites not acceptable, except for journal article retrieval. In this
case, a copy of the first page of the article must be included with the case study.
A bibliography sheet must be attached to the paper. Each article or book used in
the case study must be referenced on the bibliography sheet.
The items on the bibliography sheet must be alphabetized and numbered.
E. SURGICAL CASE STUDY
F. INSULIN DEPENDENT DIABETIC
G. MEDICAL CASE STUDY
H. MEDICAL SURGICAL LECTURE OUTLINE
I. ETHICAL DECISION MAKING
J. MEDICAL – SURGICAL NURSING ASSIGNED READINGS
IV.
ACCOMMODATION
Students with disabilities, including but not limited to physical, psychiatric, or learning disabilities,
who wish to request accommodations in this class should notify the Special Services Office. In
accordance with federal law, a student requesting accommodations must provide acceptable
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documentation of his/her disability to the Special Services Coordinator. For more information, call
or visit the Special Services Office in the Student Services Building, 894-9611 ext. 2529, 2530.
6
Surgical Case Study
The patient selected for the case study should be a patient the student has cared for at least 1 day.
The student should care for the patient before, during and after surgery. The patient must have
general anesthesia. SELECTION OF A PATIENT FOR A CASE STUDY MUST BE APPROVED
BY THE INSTRUCTOR PRIOR TO SUBMISSION OF THE PAPER. Suggested reference:
Alexander’s Care of the Patient in Surgery, available at the reserve desk SPC library and TTUHSC
library, Lubbock. On the paper, indicate patient initials, age, gender, physician initials, date of
admission, and patient’s approximate educational level.
Grading criteria:
Possible Points
* 1 Define the disease process requiring surgery. (Use reference)
*14 A. Discuss risk factors (which people are most likely to get this disease).
B. Discuss etiology (how disease starts) and pathophysiology (how disease progresses)
C. Discuss possible complications for each disease (Use reference for these sections)
*10 Discuss the preoperative nursing assessment (Use reference)
5 What particular needs will this patient have based on assessment findings? (Examples: severe
anxiety, missing limbs, inability to communicate, loose teeth, inability to move joints etc)
*10 Labs and Diagnostics
A.
Complete this section p. 10 of syllabus
B.
Describe the relevance of each test for this patient having surgery
*10 Discuss how this patient’s health history or family history could affect surgical or anesthetic
outcomes. (Use knowledge of disease process, risk factors, patient/family history
and utilize critical thinking.) May utilize well explained concept map, or written format.
(Use reference) Examples: hypertension, diabetes, asthma, bleeding disorders etc, etc.
*10 Describe patient and family teaching for pre-operative patients. (Use reference)
5 Describe the operative procedure (From patient’s chart or use reference)
5 Describe what you observed during the case, focusing on team work, communication and
sterile technique. Then, (using a reference), correlate what you observed regarding the
responsibilities of the scrub nurse/tech and the RN/circulator.
10 Anesthesia
A: List all anesthesia medications. Describe the intended effects and potential adverse
reactions (use reference)
B: Describe what you observed during the anesthesia
10 Immediate post op care:
A:
Prioritize and discuss post-operative interventions in the PACU (Use reference)
B:
Describe this patient’s needs in the PACU, and what you observed
*5 Discuss post-operative complications and relevant preventative measures (Use reference)
5 References, spelling, grammar, neatness
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Diabetes
The patient selected for this case study must be a hospitalized patient with Type I or II diabetes.
Indicate what type your patient has. Do not use a patient with gestational diabetes. SELECTION
OF A PATIENT FOR A CASE STUDY MUST BE APPROVED BY THE INSTRUCTOR PRIOR
TO SUBMISSION OF THE PAPER.
On the paper, indicate the patient’s initials, age, gender, physician initials, date of admission, and
the patient’s approximate educational level.
Grading Criteria
Possible Points
*1
Define the type of diabetes your patient has. (use reference)
*1
Describe the events leading to patients’ hospital admission. (use chart and critical thinking)
*2
Explain the etiology of the type of diabetes your patient has. (use reference)
This involves explaining the cause, or how the disease “starts”.
*2
Describe in detail, possible risk factors for developing this type of diabetes. (use reference)
*2
Which risk factors for developing diabetes does your patient have? (use critical thinking)
*5
Describe the pathophysiology of this disease (how the disease progresses) (use reference)
*20
Describe, in detail, the possible complications of diabetes. (use reference)
*10
Describe, in detail, the complications your patient has. (use critical thinking)
*10
Using a well explained concept map (or in written format) show the correlation between the
patient’s diabetes, any complications patient already has, and the other medical diagnoses the
patient is experiencing. (use reference and critical thinking)
40
Make a 3 – 5 page pamphlet, or another type of visual aid to help your patient understand the
type of diabetes they have, and how to avoid complications. This MUST be original, written by the
student. Correlate to the patient’s educational level. Be very specific and include information on
blood sugar emergencies, how to deal with sick days, diet teaching, foot care, skin care and infection
prevention. Mention ALL possible long term complications and how to avoid them. This will be
graded on: accuracy 25 points, use of critical thinking 10 points, and presentation 5 points.
2
Discuss the patients highest and lowest blood sugars, explaining what action was necessary.
Discuss the patient’s kidney function test, and the correlation to diabetes.
5
Reference, spelling, grammar, neatness
Areas indicated with * must be submitted with the rough draft.
8
Medical Case Study
The hospitalized patient selected for the medical case study should have 2 or more significant
diseases in different body systems. The student must care for this patient for 1 to 2 days.
SELECTION OF A PATIENT FOR THE MEDICAL CASE STUDY MUST BE APPROVED
BY THE INSTRUCTOR PRIOR TO SUBMISSION OF THE PAPER.
On the paper, indicate the patient’s initials, age, gender, physician initials, date of admission and
approximate educational level. Suggested reference: Pathophysiology text on reserve at SPC
library.
Grading Criteria
Possible Points
*30 Use references
1
a) Define of EACH disease.
5
b) For EACH disease, discuss etiology (What causes the disease to start)
4
c) For EACH disease, discuss risk factors (Which patients are most likely
to develop this disease)
10
d) Discuss how EACH disease progresses (pathophysiology)
10
e) Discuss possible complications for each disease
5
A) Describe POSSIBLE signs and symptoms of EACH disease. (use reference)
B) Describe the patient’s signs and symptoms of EACH disease. Be sure to indicate which
symptoms correlate to which disease. (critical thinking)
*10
Use a well described concept map or written format to discuss how these diseases are related
to each other. HINTS: Did any of the patients diseases cause another? Is there any relation
between treatment for 1 disease and development of another? Do any of the risk factors
pertain to more than 1 disease? (Use reference AND critical thinking)
10
Describe the medical intervention for EACH disease. What does the physician do or
prescribe for each disease? BE SPECIFIC. Reference.
*20
Use priority order and describe nursing interventions for EACH disease, including patient
and family teaching. Discuss preventative measures. Use reference. This section needs
specifics and details.
5
Medication list—list medications prescribed, the intended effects for each, the most serious
and most common adverse reactions. Reference.
*15
Diagnostic and laboratory tests—use the lab info. Page
5
References, spelling, grammar, neatness
Sections indicated with a * must be turned in with the rough draft.
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Diagnostics and Laboratory Results
The purpose of this section is to help the student learn the relevance of diagnostic tests. The student will research each laboratory and
diagnostic test performed for the patient. If tests are repeated, describe only 1 test, preferably the most abnormal. If the patient is diabetic, list
the patient’s highest and lowest and the interventions performed. PLEASE NOTE: If the patient has a CBC, UA or metabolic panel etc, EACH
separate test must be described. For example on CBC, discuss the WBC, platelet count, etc. Even if the patient’s lab value is normal, be sure to
indicate what the significance is to the patient. Please feel free to make as many copies of this sheet that you need.
Diagnostic Tests
Reason Test Performed
Expected Result
Patient Result
Significance to this Patient
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MEDICAL SURGICAL LECTURE OUTLINE
Disease
Etiology and Risk Factors
Pathophysiology
Progression and Complications
Signs and Symptoms
How Disease is Diagnosed
Medical/Nursing Interventions
Priority
Medical Interventions
Possible Surgical Interventions
Diet
Activity
Other
Prevention/Patient-Family Teaching
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ETHICAL DECISION MAKING
GRADING CRITERIA
Possible Points:
15
1) What is the issue or problem?
15
2) Why is this an issue?
20
3) What values are involved? (Example: veracity, benevolence, etc…)
25
4) What values are in conflict?
25
5) If you were discussing this situation with a colleague, what solutions would
you recommend and state your rationale.
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Ethical Thinking
Case #1
Mr. A has terminal cancer affecting his pelvic bones and lower spine. He has severe pain in his
lower back and pelvic area every time he tries to move, even in bed. As a result, the only
comfortable position for him is supine.
He has developed stage 1 decubitus ulcers on his sacrum and on the back of his heels. His
nutritional status is poor. Mr. A has also developed atelectasis in his lower lobes and is unable to
cough up his secretions.
Several nurses would like Mr. A to be turned every 2 hours to prevent further skin breakdown and
respiratory distress, which would most likely hasten his death. They feel a decubitus ulcer and
respiratory distress would cause pain and discomfort also. Other nurses feel, in view of his
diagnosed terminal cancer, that turning him would cause unnecessary pain and would not benefit the
patient.
Case #2
A 28 year old patient is 9 weeks pregnant with her first child. She develops fatigue, epistaxis and
numerous bruises over her body. A CBC and other tests reveal acute leukemia. Her physician has
advised an immediate abortion in order to begin chemotherapy.
Her physician believes that chemotherapy must begin immediately in order to save the mother's life.
The physician believes the mother would only live three to four months without chemotherapy and
that the fetus would not have reached viability at that stage. The proposed chemotherapy is highly
teratogenic.
Several nurses in the operating room are refusing to assist the surgeon, stating religious and moral
objection to the procedure. Other nurses feel the mother and the child would die without
intervention and feel the OR nurses are abandoning the patient.
Case #3
A 30 year old patient has contracted AIDS and has been told this is a terminal illness. He is
emaciated, has chronic diarrhea and frequent mouth and skin infections. His vision is severely
impaired due to cytomegalovirus infections. He lives in his own home with only home health
workers visiting. His former partner, family and friends have abandoned him. Despite his illness,
he is alert.
A visiting nurse discovers a cache of unprescribed barbiturates in his medicine cabinet, which
would likely be sufficient to cause a fatal overdose. One nurse believes he should be allowed to
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make an autonomous decision to end his life. Another nurse feels obligated to confiscate the
barbiturates and contact the MD.
Case #4
A 70 year old patient has a terminal illness, amyotrophic lateral sclerosis (aka Lou Gehrig's disease).
Over the past 3 years, this has caused the muscles of her body to become progressively weaker.
She is totally dependent on the nursing staff for every need. Her respiratory muscles have
eventually weakened to the point she has needed a tracheotomy and a ventilator for the past 2
months. If she is removed from the ventilator, she could not breathe on her own. She is alert and
able to communicate her needs by mouthing words and writing notes. For the past several days, she
has requested to be taken off the ventilator. She nods "yes" when she is asked if she realizes this
will cause her to die.
The physician has decided to follow her wishes and take her off the ventilator this evening, after she
has said her "good byes" to her family. Her family members, although saddened, agree with her
decision.
Several nurses feel they could not assist the physician with this, stating "it would be like assisting
suicide". Others feel the illness would eventually cause death and that this is allowing the patient to
determine her own destiny.
Case #5
An 80 year old patient has suffered his third stroke in several years, just after his 60th wedding
anniversary. His first two strokes resulted in hemiparesis. He has been in a nursing home since his
second stroke, unable to eat, walk or bathe independently. With the most recent stroke, he has been
unresponsive even to painful stimuli. His wife requests he is not to be resuscitated and that he is not
fed or hydrated artificially, either through tube feedings or intravenously. He does not have a living
will or a durable power of attorney. His wife states before his first stroke, he verbalized his wishes
not to be kept alive artificially.
Several nurses feel he should receive tube feedings and IV hydration and say they cannot "watch
someone starve to death". Others believe this patient is comatose and therefore would not be
suffering any discomfort associated with dehydration or starvation.
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MEDICAL-SURGICAL NURSING I
ASSIGNED READINGS
Assigned reading must be completed prior to first lecture hour. Be sure to look up key terms. Additional
readings as required by instructor. Reading assignments: (White) textbook unless otherwise specified.
STUDENTS PLEASE NOTE:
You will be responsible for reviewing the anatomy and physiology for the assigned system prior to the lecture.
Also you will need to review “Common Diagnostic Tests for _______Disorders” for each chapter. See
example p78, White. Details for these diagnostics can be found in your Springhouse Diagnostic Tests made
Incredibly Easy.
Pop quizzes are likely to cover reading assignments.
TOPIC
Reading Assignments TBA
Advanced Med Surg Skills
A. Disease Causation/Prevention
ASSIGNMENTS
Skills Text Book 29, 30, 31, 32, & 35
A&P chapters 5 & 17
B. Oncology
Chapter 3
C. Fluids and Electrolytes
(Skills Chapter 28)
D. Respiratory
Chapter 4
E. Cardiac
Chapter 5
F. Blood
Chapter 6
G. Gastrointestinal (esoph to rectum)
Chapter 7
H. Gastrointestinal (GB, pancreas, live)
Chapter 7
MS II
I. Renal
Chapter 8
J. Neuro
Chapter 10
K. Ortho
Chapter 9
L. Endocrine
Chapter 12
M. Reproductive
Chapter 13 & 14
N. Immune System
Chapter 16
15
O. Sensory
Chapter 11
P. Responding to Emergencies
Chapter 21and group projects
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ASSESSING YOUR PATIENT'S CHEST PAIN
When your patient complains of chest pain, you have to find out what type of chest pain he's having before you can help him. Once you learn the location, radiation, character,
onset, and duration of the pain, you can describe if appropriately to the patient's doctor and evaluate the seriousness of his complaint. This chart will tell you how.
TYPE
Angina
Myocardial
Infarction
Pericardial
Chest Pain
LOCATION AND RADIATION

Substernal or retrosternal pain
spreading across chest

May radiate to inside of either
or both arms, the neck, or jaw

Substernal or over precordium

May radiate throughout chest
and arms to jaw
CHARACTER, ONSET, AND DURATION

Squeezing, heavy-pressure pain

Sudden onset

Usually subsides within 10 minutes



Crushing, viselike pain
Sudden onset
More severe and prolonged than anginal
pain



Sharp, intermittent pain (accentuated by
swallowing, coughing, inspiration, or
supine position).
Severe, sudden onset
May occur intermittently over several days
Stabbing, knifelike pain (accentuated by
respirations)
Sudden onset
May last a few days




PRECIPITATING EVENTS
Physical exertion
Hot, humid weather
Eating
Intense emotion
May occur spontaneously, often
while resting, and be associated with
dizziness, perspiration, and nausea.
Physical exertion and emotional
stress may also precipitate a cardiac
event.
Upper respiratory infection
Myocardial infarction
Rheumatic fever
Pericarditis

Anxiety (associated with coughing)
Burning, knotlike pain (simulating angina)
Sudden onset
Usually subsides within 15 to 20 minutes
Aching pain or soreness
Often begins as dull ache, increasing in
intensity over a few days
Usually long-lasting


May occur spontaneously
Eating



Chest wall movement


Pulmonary
origin
(pleuritis,
pulmonary
embolism)


Esophageal
origin


Chest wall
pain


Substernal or left of sternum
May radiate to neck, arms,
back, or epigastrium
Inferior portion of the pleura
May radiate to costal margins
or upper abdomen
Substernal
May radiate around chest to
shoulders
Costochondral or sternocostal
junctions
Does not radiate

















METHOD OF RELIEF
Instruct patient to stop all
physical activity.
Administer nitrates sublingually,
as ordered.
Administer morphine, as
ordered.
Administer oxygen.



Instruct patient to bend forward
Administer analgesics
Administer oxygen, as needed.

Administer codeine for pain, as
ordered
Administer antibiotic for
infection, as ordered
Administer anticoagulant for
pulmonary embolism, as ordered
Administer antacids, as ordered
Instruct patient to sit up






Apply heat
Administer muscle relaxants, as
ordered
Doctor may inject a local
anesthetic for pain at affected
junction.
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Anxiety


Left chest (variable)
Does not radiate



Sharp, stabbing pain or vague discomfort
Sudden onset
May last less than a minute or for several
days


Fatigue (sometimes)
Intense emotion (sometimes)


Administer sedatives, as ordered
Instruct patient to lie down and
breath normally.
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