COURSE SYLLABUS
VNSG 1432 (4:4:0)
MEDICAL – SURGICAL
NURSING II
**********
VOCATIONAL NURSING
NURSING DEPARTMENT
HEALTH OCCUPATIONS DIVISION
LEVELLAND CAMPUS
SOUTH PLAINS COLLEGE
SUMMER 2012
Levelland
Campus
COURSE SYLLABUS
COURSE TITLE:
Medical – Surgical Nursing II, VNSG 1432
INSTRUCTOR:
Jennifer Ponto, R.N., B.S.N
OFFICE LOCATION AND PHONE/E-MAIL:
Room TA 204, 894-9611 ext. 2471, jponto@southplainscollege.edu
OFFICE HOURS:
By Appointment
SOUTH PLAINS COLLEGE IMPROVES EACH STUDENT’S LIFE
I.
GENERAL COURSE INFORMATION
A. COURSE DESCRIPTION (WECM):
Continuation of Medical-Surgical Nursing I with application of the nursing process to
the care of adults experiencing medical-surgical conditions in the health care illness
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 and incorporated in the
course.
B. LEARNING OUTCOMES (WECM):
The student will:
1. Explain the components of the health-illness continuum.
2. Assess prevalent medical-surgical conditions affecting the adult client.
3. Utilize the nursing process to assist in developing a plan of care for selected
medical-surgical conditions.
1
VNSG 1432
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.
SEE CHAPTER OBJECTIVES IN THE LEARNING OBJECTIVE FOR EACH CHAPTER
C. COURSE COMPETENCES:
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.
2
VNSG 1432
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, 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. & VaLlerard, 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.(2008). The Human Body in Health and Disease, 11th Edition.
Philadelphia, PA: Lippincott (Anatomy textbook).
5. Springhouse: Diagnostic Tests Made Incredibly Easy. (2009) Springhouse 2nd Edition.
6. Taber’s Medical Nursing Dictionary or Medical Dictionary of choice
7. White, L & Duncan, G. (2011). Foundations of Adult Health Nursing, 3rd Edition.
Albany, NY: Delmar Publisher.
8. Occasionally, the student will be required to utilize outside references.
9. PN Review Texts: Springhouse: NCLEX PN made incredibly easy.
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.
3
VNSG 1432
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. Also, please note specific information
regarding drug cards.
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. A
grade of 0 (zero) 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.
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 also required to complete the assigned drug cards prior to the first lecture hour. 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.
Please refer to the student handbook for the policy for failure to complete all written
assignments.
4
VNSG 1432
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 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 involved with case studies.
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 8 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 on the cover page of each
book used must be included with the case study turned in.
Internet resources are 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
5
VNSG 1432
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 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
VNSG 1432
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
7
VNSG 1432
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)
*2
*2
Describe the events leading to patients’ hospital admission. (use chart and critical thinking)
Explain the etiology of the type of diabetes your patient has. (use reference)
This involves explaining the cause, or how the disease “starts”.
Describe in detail, possible risk factors for developing this type of diabetes. (use reference)
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)
*1
*2
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.
7
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 admitting blood sugar, the highest and lowest and the blood sugar at patient discharge. PLEASE NOTE: If the patient has a
CBC, UA or metabolic panel etc, EACH portion must be described. 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 Test
Reason Test Performed
Expected Result
10
Patient Result
Significance to this Patient
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
11
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?
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.
12
Ethical Thinking-USE A DIFFERENT CASE FROM M/S I.
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. He 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
lover, 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
make an autonomous decision to end his life. Another nurse feels obligated to confiscate the
barbiturates and contact the MD.
13
Case #4
A 70 year old patient has amyotrophic lateral sclerosis (aka Lou Gehrig's disease). This has caused the
muscles of her body to become weak. She is totally dependent on the nursing staff for every need. It is
a terminal illness. 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 take her off the ventilator this evening, after she has said her "good byes"
to her family. Her family agrees 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. His first two strokes resulted in
hemiparesis. He has been in a nursing home since his first stroke and is totally dependent on others.
However, this stroke has resulted in a coma. He is unresponsive even to painful stimuli. His wife of
60 years 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
but the wife states shortly 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.
14
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:
Beginning with Unit D, 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 p70, 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
ASSIGNMENTS
A. Disease Causation/Prevention
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 11
L. Endocrine
Chapter 12
M. Reproductive
Chapter 13 & 14
N. Immune System
Chapter 16
O. Sensory
Chapter 11
P. Responding to Emergencies
Chapter 19
15
16