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School of Nursing
Course Information: Fall 2025 Term
HH/NURS 4526 6.00 Acute and Complex Health Challenges
Prerequisite/Co-requisite(s): Open to students in BScN programs. Prerequisite for 4-year Direct
Entry: HH/NURS 3517 3.00, HH/NURS 3511 6.00. Prerequisites for 2nd Entry BScN students:
HH/NURS 3511 6.00. Prerequisite for Post-RN IEN BScN students: HH/NURS 3515 3.00,
HH/NURS 2547 6.00. Course Credit. Equivalent: HH/NURS 4130 6.00. Notes: Students need to
pass both practicum & classroom components in order to pass the course & are responsible for
providing their own transportation to & from the practicum sites. A minimum grade of 5.00 (C+) is
required for this course. Enrolled students who failed to achieve the minimum grade of 5.00 (C+)
in course prerequisites will be ineligible to proceed/withdrawn from this course.
Brief Description
Integrates theoretical and practicum components of client-centred nursing care with clients
experiencing acute & complex health challenges. Through classroom, laboratory/simulation &
practicum experiences, students expand their knowledge of the registered nurse role in providing safe,
competent & evidence-informed care. Interprofessional collaboration & coordination of care &
decision-making are integral when working with clients with unpredictable, complex, & multiple
health needs.
Course Learning Outcomes
Upon completion of this course, students will be able to:
1. Utilize knowledge from nursing and other disciplines to guide nursing care of clients with
complex health challenges.(Relates to Program Goal #2)
2. Demonstrate therapeutic communication and critical-reflective practices to support care for
various clients in acute settings.(Relates to Program Goal #4)
3. Compare effective interprofessional practices used within the health care team to support
improved client outcomes. (Relates to Program Goal # 5)
4. Utilize evidence to inform decision-making and prioritization during management of complex client
care situations. (Relates to Program Goal #3 and 4)
5. Analyze the different ways in which culturally relevant nursing care that honours human dignity
and respects diversity can be incorporated into planning care with clients. (Relates to Program
Goal #8)
6. Evaluate approaches for the safe & efficient nursing management of clients with increasingly
complex health issues.(Relates to Program Goal #3 and 4)
7. Identify appropriate client education & health promotion that addresses complex health needs
across the lifespan.(Relates to Program Goal #9)
Revised May 2025 for Fall term 2025 by Brenda Orazietti & Sandra Peniston
Introduction
Instructor Information
Course Director & Course Lead: Section B: Brenda Orazietti BScN, MEd, MScN, CCNE, CCSNE
Associate Professor, Teaching Stream
Lecture: Tuesday 1430-1730 Classroom: RS 137
Clinical Days either Thursday or Friday 12 hr day
brendao@yorku.ca cell 416-435-3740
Appointments available before or after class, or by face time/whats up/zoom
Office HNES 3rd floor, room 308
Course Director: Section A: Sandra M. Peniston MN-NP PhD(c)
Associate Professor Teaching Stream
Lecture: Thursday 0830-1130 Classroom: SLH-A
Clinical Days either Monday or Tuesday 12 hr day
sskerrat@yorku.ca
Appointments available before or after class, or by zoom
Office HNES 3rd floor, room 331
Course Director: Section Julie Neilson-Berec
Winter Term 2026
Course Director : Section Melanie Dauncey
Winter Term 2026
Office Hours: By appointment, in office or on-line. Please email request for an appointment to
Course Director.
E-mail correspondence: E-mails will be reviewed and responded to on weekdays from 0900 to
1700. Every effort will be made to respond to email inquiries within 48 hours during available
times, as above.
Course Delivery
Course content will be delivered on campus, in person, apart from two asynchronous online
classes. Please see the weekly schedule.
Course Organization
The course is organized in a weekly format, corresponding with the 12 weeks of the semester, as
per the weekly outline. Course content will be presented in class. Students are strongly
encouraged to engage with the required readings before this time to maximize meaningful
learning. Supplementary learning materials will be posted to e-class as required.
Expanded Course Description
Students enact family/client-centred care with individuals and families, experiencing health
challenges in home and acute care settings. Family theories and models of care are an essential
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component of this course. The unique contribution of nursing in home health care is studied.
Family theories in nursing and other disciplines inform the construction and interpretation of
family/centred approaches to care. The course is visionary in that it reflects societal trends that
call for healthcare practitioners to focus on the experiences of human beings and to respect their
values and choices about health and quality of life. Practicum experiences provide opportunities
for students to refine their clinical decision-making and practice skills as well as gain confidence
as theory-guided, evidence-informed practitioners. The practicum experience will occur in either
acute medical/surgical areas or home settings. This course requires students to examine
critically the health care cultures in which they provide care.
Teaching & Learning Approaches
Approaches to learning include dialogue, critical reflection, writing and self-directed learning,
both on-line and in the classroom. Through dialogue and reflection in an open, non-judgmental
space, students are supported to discover meaningful insights into the linkages among values,
beliefs, language, and actions in professional practice. An essential element in the success of each
class is student preparation and participation. Sharing, analyzing, developing, and critiquing
ideas with peers will expand your understanding of theory and enhance your skills in critical
thinking and collaboration. The corresponding practicum provides opportunities for supervised
nursing care of individuals and families in acute care or community settings, such as homes,
rehabilitation, and complex continuing care. Students are to apply and integrate theoretical
knowledge in practice.
Course Website
The eClass course management system will be used as an extension of this course outline, and for
course content, extra learning materials (i.e., assignment rubrics), and communication. Students are
required to check the course eClass site on a very regular basis. Students should use their York U email
for course communication. For more information, see How do I access my eClass Course?.
Links to CNO Entry-to-Practice (ETP) Competencies (2020)
Roles
ETP Competencies
Clinician
1.1-1.17,1.20-1.27
Professional
2.1-2.14
Communicator 3.2-3.8
Collaborator
4.1-4.5
Coordinator
5.1-5.3,5.5,5.7-5.9
Leader
6.3,6.4,6.7,6.8
Advocate
7.1,7.27.6,7.7,7.9,7.12,7.13,7.14
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Educator
Scholar
8.1-8.5
9.1-9.4
Links to NCLEX-RN Categories and Sub-Categories
•
•
•
•
Safe and Effective Care Environment
o Management of Care
o Safety and Infection Control
Health Promotion and Maintenance
Psychological Integrity
Physiological Integrity
o Basic Care and Comfort
o Pharmacology and Parenteral Therapies
o Reduction of Risk Potential
o Physiological Adaptation
Course Text/Readings
The following text(s) are required for this course (available at the York University Bookstore,
or online).
1. Tyerman, J., Cobbett, S., Harding, M.M., Kwong, J., Roberts, D., Hagler D., and Reinisch, C. (2023)
Lewis’s Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems
(5th ed.). Elsevier
ISBN: 9780323791564
2. Hockenberry, M. J., & Wilson, D. (2022). Wong's Essentials of Pediatric Nursing (11th ed.).
Mosby/Elsevier.
College of Nurses of Ontario. (Revised 2018). Competencies for entry-level registered nurse
practice. Retrieved from https://www.cno.org/globalassets/docs/reg/41037-entry-to-practicecompetencies-2020.pdf
Registered Nurses’ Association of Ontario. (2015). Person and family-centred care. Retrieved from
http://rnao.ca/bpg/guidelines/person-and-family-centred-care
Supplemental Readings: As provided via EClass
Elsevier Adaptive Quizzing (EAQ)
All students will have access to this resource. Information regarding the use of this technology will be
shared on eClass and in class. Students are encouraged to create their own quizzes as a study tool.
Evaluation/Evidence of Learning
The learning evidences for this course are designed to evaluate your knowledge and
application of essential concepts that support safe, competent nursing practice.
Clinical Judgement Model
This course incorporates the NCSBN’s Clinical Judgment Measurement Model to guide
student learning and evaluation. The model emphasizes six steps: recognize cues, analyze
cues, prioritize hypothesis, generate solutions, take action and evaluate outcomes. These
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terms will appear in lecture slides, be highlighted by faculty in class and be applied in clinical
practice. Examinations will also reflect this model to support your development in thinking
like a nurse.
Description of Course Evaluation
1. In-Class Participation – 5% (Weeks 1-12): Questions will be presented to students
during class. Answers must be handwritten. Students must be present and submit correct
responses to earn the mark. Five out of the twelve classes will offer opportunities to
receive participation grades. One mark will be awarded per class.
2. Test #1 – 30% (Week 6): The Test #1 will focus on material covered in class, assigned
readings, and additional resources posted on eClass (from Weeks 1-5 inclusive). The
test will consist of NCLEX-style multiple-choice, alternate format, and short answer
questions.
3. Test #2 – 25% (Week 10): The Test #2 will focus on material covered in class,
assigned readings, and additional resources posted on eClass (from Weeks 6-9
inclusive). The test will consist of NCLEX-style multiple-choice, alternate format, and
short answer questions.
4. HESI-Pass/Fail:THE HESI-RN Exam 1 is the first attempt in writing a computerized
NCLEX-RN style exam with question formats and an exam blueprint matching the latest
NCLEX-RN test plan. The HESI-RN Exams will assist students in identifying their strengths
and areas for improvement. A maximum of 4 hours will be provided for completion of this
exam, review of rationales, and completion of the NGN questions. A score of 900 or higher
is correlated with a high probability of passing the NCLEX-RN. Upon completion of the
exam, individualized remediation resources will be provided to address knowledge
deficits. NOTE: The exam will take place TBD. No switches will be permitted. Taking the
exam, regardless of the score achieved, will constitute a pass for the assignment in this
course.
5. Final Exam – 40% (During Exam Period): This exam will consist of multiple- choice,
alternate format questions. Content tested will cover course content from the entire
semester and be drawn from your text, additional readings, materials posted on the
course website, classroom and practicum.
Due Dates
The final grade for the course* will be based on the following items, weighted as indicated:
Week
1-12
Due & Return
Date
Assignment Name
In-Class Participation
Percentage of
Course Grade
5%
5
Oct 21 (Brenda) Exam #1
(relates to Course Objective #1, 2, 5, 6)
30%
Oct 9 (Sandra)
Nov 18 (Brenda) Exam #2
10
25%
Nov 13 (Sandra) (relates to Course Objective #1, 2, 5,
HESI
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Sat Nov 1? TBD 6)
Pass/Fail
0830-1300
Final Cumulative Exam
Exam Period
(relates to Course Objective #1, 2, 5,
40%
6)
* As per Faculty of Health and School of Nursing program policies, a student’s final course
grade is not necessarily confined to a compilation of marks earned on individual course
components. Final course grades may be adjusted to conform to Program or Faculty grades
distribution profiles.
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** The last date to drop a course without receiving a grade is November 8, 2023. Note that the
late drop option of the Withdrawn from Course (W) Policy does not apply to: Practica learning
placements/courses. Students must contact the undergraduate program coordinator or
director in advance of any deadlines, in order to exercise any course removal or withdrawal
options.
For all clinical courses: Student must successfully pass both in-class and clinical components
to achieve a passing grade/credit for this course.
Clinical Course Component Information:
All students must review the College of Nurses of Ontario’s requirements of ‘Requisite Skills and
Abilities’ for Registered Nurse practice.
Clinical Placements are scheduled for 12 hrs/week for the duration of the course, in
medical-surgical health care environments; the first clinical day is scheduled on-site in the
Nursing Simulation Centre and is equivalent to 12 clinical hours. Total hours requirement:
144.
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Participation in NSC On-Campus Clinical Day
In the NSC, students will practice a variety of nursing skills and assessments in simulated
and/or situational contexts. Under the guidance of CCDs and NSC staff, students will
develop their competency in interacting with clients with complex health care issues. The
purpose of the on- site clinical experience in the NSC is to assist students in transferring
theoretical concepts of health challenges taught in previous courses to practice in the NSC
setting. The NSC student experience provides a simulated learning environment that assists
students’ preparedness for the off-site clinical experience. Students are expected to be
punctual, professional, prepared, and bring their stethoscope and watch with second hand.
Students must wear a uniform. This mandatory on-campus day serves as the first clinical
day. You will write the medication calculation quiz during the on-campus clinical day.
Practicum Competencies: Students will:
1.
2.
3.
4.
5.
Utilize the nursing process for the safe, effective, competent, ethical, compassionate
theory and evidence-informed care based on multiple clients’ individual needs. (Relates
to Program Goals #2, 3 and 4)
Prioritize multiple clients’ needs and supports adapting a plan of care for complex
health challenges. (Relates to Program Goals #5)
Use effective verbal and written communication strategies to convey accurate and
timely client assessments and information about the care provided. ( Relates to
Program Goals #5)
Analyze and interpret best evidence and appropriate data to continually inform plans of
care. (Relates to Program Goals #2, 3 and 4)
Demonstrate consistent professional accountability and behaviours in providing safe,
equitable care for diverse clients. (Relates to Program Goals #1 and 8)
Practicum Components:
Students are required to attend all clinical placement dates throughout the term with their
clinical group – this will consist of 12 hours or 1 shift per week. In the case of illness, it is the
student’s responsibility to contact their CCD and the placement unit no later than 0630 on the
day of placement. Missed clinical days/hours due to extenuating circumstances must be
made up. Repeated absences from clinical will jeopardize a student’s success in the course.
Practicum During or Post COVID-19
It is important to note that for those students who have been exposed or who are working parttime in an at-risk environment during the Pandemic, clinical placement agencies may ask for a
self-isolation period prior to entering that clinical placement. As well, students may not be able to
work or continue to work anywhere while attending clinical practice placements. Students must
be prepared to adhere to these expectations while in the course.
IMPORTANT: Please ensure familiarity with the following York-Senate documents:
Professional Appearance and Dress Code
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Students Professional Behavior Policy
Involuntary Withdrawal in a Practicum Course
School of Nursing Social Media Policy
Undergraduate Leave of Absence Policy
Medications approved for student administration in 4526 practicum:
Course
NURS
4526
Term/Year
F/4
Medication Administration
• Oral, topical, drops (eyes, ears), suppository
administration
• NG/J/G tube
• Injections: IM, SUBCUT, ID, Inhalation
• IV medications (exceptions Potassium, Push
medications, Insulin, Narcotics, Chemotherapy,
Heparin)
Notes
All routes as long as there is
not a contradictory agency
policy.
Associate Course Fees
In the course On Campus Clinical session you will receive the following:
Parenteral Kit, IV tubing Kit, Suction catheter kit, clean gloves, Hand Sanitizer, 27G and 21 G injection
needle, 18G blunt fill needle, practi-powder vial, practi-diluent vial, Humulin N, Humulin R
vials.
$43.00
The annual Canadian Nursing Student Association Fee of 11.00 is charged in this fall
course.
$11.00
Used in this course is the Software Elsevier: RN Exit Exam 120.00
Total
ACF: $174.00
Description of Practicum Evaluation:
1. Medication Calculation Quiz - Week 1 (Pass/Fail): A medication calculation quiz will be
administered in Week 1 during the NSC clinical practicum day. Students will be provided with
one rewrite option. If a student is unable to achieve 90% after the second attempt, formal
remediation in the NSC is required. Students must achieve 90% on the final/third rewrite test.
Successful completion of the quiz and/or remediation is required prior to administering
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medications in the practicum setting. Only a simple function calculator is required, students
are not permitted to use cell phones as calculators.
2. Learning Plan (Pass/Fail): Learning plans allow students to integrate their learning needs
with program outcomes. Learning plans enable students to make choices and decisions that
individualize learning and promote self-direction. Learning plans are explicit, written
agreements between students and faculty that outline the learner’s objectives,
resources/strategies, evidence of achievement, target date and criteria for evaluation. Plans
can be modified or renegotiated as circumstances dictate. Your learning plan should reflect
your personal learning objectives that link to course goals and development of professional
self.
Students should develop learning objectives that:
•
•
•
•
Target clinical skills specific to a particular site or population (e.g.,
assessment, intervention methods, etc.; not just 1 skill e.g., Insert a foley catheter)
Target those skill sets transferable to many clinical settings (e.g., documentation, time
management, etc.)
Target Inter-professional practice skills
Target developing competencies reflecting CNO entry to practice standards
Use the template to create your learning plan (eClass), submit to your CCD as per due date.
A minimum of four (4) learning goals that reflect the course goals is required with two (2)
learning evidences per goal. Your CCD will evaluate your learning plan, assign a pass/fail and
provide feedback as necessary. Your learning plan is a “living document” and may require some
minor changes. Any revisions made to the learning plan will need to be done in consultation with
your CCD and an updated copy will need to be given to your CCD. Students must achieve a
passing standard for success in practicum.
3. Clinical Portfolio - On-going (Pass/Fail)
A clinical portfolio is your collection of evidences of progress towards or attainment of your
learning goals during your nursing practicum. It provides the evidence of clinical competence on
which a passing clinical grade depends. Use the following guide to develop your clinical portfolio
or as directed by your CCD on organization of content and additional components:
Include the following sections:
❖ CPP: this should be a photocopy of your permit in a protective cover
❖ Learning plan: your learning plan should be first
❖ Clinical evaluations: includes previous evaluations and current. Helps your current CCD to
guide your learning and build on your strengths and weaknesses
❖ Learning goals: each learning goal should have a separate tab with the evidences of how the
goal was met.
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❖ Research: research evidence to meet learning plan goals; it is expected a one-page synopsis
summarizing the key points of the research is included and not just the copies of the research
paper.
❖ Client research: this tab contains information related to your client assignments, for example
client’s diagnostic information/care map, medication information, patient teaching
information, etc.
❖ NOTE: No patient identifying information should be included in your portfolio.
❖ Orientation material: any specific information for current specific practice area.
❖ Miscellaneous: this may include information from post conference presentations, material
from presentations/conferences attended.
❖ Portfolio must be available to your CCD upon request and will be evaluated during
midterm and final evaluation.
4. Midterm and Final Evaluations (Pass/Fail)
The evaluation template can be found on the eClass course site.
Students must complete their midterm self-evaluations by Week 5 and submit to their CCD. CCDs
will then complete their comments and review with students individually during week 6 clinical
day.
Students must complete their final self-evaluations by Week 11 and submit to their CCD. CCDs
will then complete their comments and review with students individually during the final day of
placement.
Requirements to Demonstrate Competence for each Clinical Component.
Week Due & Return
Assignment Name
Date
1
Participation in NSC On-site Clinical Day
(mandatory)
1
Medication Calculation Quiz (relates to Course
Objective #2, 6) 90 %
2-4
Learning Plan (relates to Course Objective #1-6)
Percentage of
Course Grade
Pass/Fail
Pass/Fail
Pass/Fail
5-6
11-12
Mid-term Self-Evaluation & portfolio to date (as
per CCD) (relates to Course Objective #1-6)
Final Self-Evaluation & Final portfolio (as per CCD)
(relates to Course Objective #1-6)
Pass/Fail
Pass/Fail
Grading, Assignment Submission, Lateness Penalties and Missed Tests
Grading: The grading scheme for the course conforms to the 9-point grading system used in
undergraduate programs at York (e.g., A+ = 9, A = 8, B+ - 7, B = 6, C+ = 5, etc.). Assignments
and tests* will bear either a letter grade designation or a corresponding number grade (e.g.
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A+= 90 to 100, A = 80 to 90, B+ = 75 to 79, etc.) For a full description of York grading system
see the York University Undergraduate Calendar.
Assignment Submission: Proper academic performance depends on students doing their work
not only well, but on time. Accordingly, assignments for this course must be received on the due
date specified for the assignment.
Lateness Penalty: Assignments received later than the due date, without negotiated extensions,
will be penalized. Any assignment that is not submitted by the date and time specified, OR any
assignment for which an extension is granted that is not handed in by the negotiated date and
time, to the location specified, is subject to the following penalty(s):
For 1 day late (any time up to 24 hours after date/time due), the penalty is 5% deducted from the
grade for the assignment (e.g., mark of 75% would be reduced to 70%)
For each subsequent day late (each 24-hour period), the reduction increases daily:
• for 2 days late, deduct 15% (e.g., mark of 75% would be reduced to 60%)
• for 3 days late, deduct 30%
• for 4 days late, deduct 50%
• for 5 or more days late, deduct 100% (assignment is given zero [0])
Exceptions to the lateness penalty for valid reasons such as illness, compassionate grounds, etc.,
may be entertained by the Course Director. Generally, 24-hour notice for extension requests is
required. Assignments submitted later than five calendar days without negotiation will not be
accepted.
Missed Tests: Students with extenuating circumstances for missing a course test, such as
illness, compassionate grounds, etc., may request accommodation from the Course Director.
Such requests should be submitted prior to the test date or as soon as a student knows that they
cannot attend. A make-up date will be scheduled at the Course Director’s discretion and shared
when notification is received from a student regarding a missed test.
Process for Missed Midterm Tests/Exams
1. If a student is experiencing an extenuating circumstance, they must contact the Course
Director to request a make-up test. Normally requests must be communicated within 72hours following a missed test.
2. If the student misses the scheduled make-up test, the weight of the missed test during
the term will be automatically added to the final exam. This is the current practice
within Faculty of Health.
Process for Missed Final Exams
1.
If a student is experiencing an extenuating circumstance, they must contact the Course
Director to request a make-up for their final exam.
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2.
The request should include:
a. Course code, section, and name
b. Completed Deferred Standing Document
c. A copy of their York University exam schedule
d. Medical note for absence must be included with all the above
3.
Students can find the Deferred Standing Agreement (DSA) to request extended time.
See Deferred Standing (Final Exams and Assignments) for more information.
4.
If the student misses the scheduled make-up for the final exam the student must
Petition to the Faculty of Health. See Academic Petitions for more information.
Additional Information
No Use of Generative AI Permitted
The use of generative AI tools in the preparation or completion of homework, assignments,
tests, exams or any other form of assessment in this course is prohibited. Using such tools for
any part of an assessment may be treated as a breach of cheating as outlined in York
University’s Senate-approved Academic Conduct Policy and Procedures.
In this course, every element of each course assessment must be fully prepared by the student
themselves. The use of generative AI is not permitted, and its use may be treated as a breach of
academic honesty. For more information, please refer to York University’s Senate-approved
Academic Conduct Policy and Procedures.
Important Course Information for Students
All students are expected to familiarize themselves with the academic policies, procedures and
guidelines available on the Senate Committee on Academic Standards, Curriculum & Pedagogy
webpage including the Senate Policy on Academic Honesty and the Academic Integrity and
Student Professional Behaviour Policy (BScN).
Accessibility Services: Student Accessibility Services provides academic accommodations and
supports for students with temporary and permanent disability including physical, sensory,
medial, learning, and mental health disabilities. Students who had an Individualized Education
Plan (IEP) in high school are eligible for support. Please note that registering with disabilities
services and discussing your needs with your professors is necessary to avoid any impediment to
receiving the necessary academic accommodations to meet your needs.
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Ethics Review Process: York students are subject to the York University Policy for the Ethics
Review Process for Research Involving Human Participants. Ethics approval must be obtained
prior to the starting any research activities involving human participants, including research
conducted by students in a graduate or undergraduate course, for an undergraduate thesis or
project, or for a Major Research Paper, Thesis or Dissertation. If you are in doubt as to whether
this requirement applies to you, contact your Course Director immediately.
Religious Accommodation: York University is committed to respecting the religious beliefs and
practices of all members of the community, and making accommodations for observances of
special significance to adherents. Should any of the dates specified in your course syllabus pose
such a conflict for you, contact the Course Director within 14 days of the date for which
accommodation is sought. Other procedures are outlined in the York University policy, guidelines
and procedures on Academic Accommodation for Students’ Religious Observances. Please note
that to arrange an alternative date or time for an examination scheduled in the formal
examination periods (December and April/May), students must complete an Religious
Accommodation Agreement.
Academic Skills Support: York University Libraries and the Learning Commons provide students
with academic support for their course assignments and research requirements. The Libraries
offer an array of supports, services, workshops, resources and people available to help ensure
continued success during a student’s academic career.
Centre for Human Rights, Equity, and Inclusion: The Centre for Human Rights, Equity and
Inclusion facilitates confidential processes to discuss allegations of discrimination and
harassment by York Community members. There are also robust training opportunities and
workshops available to the community year-round.
Counselling, Health and Well Being: Student Counselling, Health & Well Being supports students
in realizing and developing their personal potential in order to maximally benefit from their
university experience and manage the challenges of university life. Services include: peer-led
workshops, certificate training programs, support groups, same-day and appointment-based
counselling, short-term therapy, and more.
For other information, please see the current Supplemental Calendar.
These course materials are designed for use as part of the (enter course code) course at York University and
are the property of the instructor unless otherwise stated. Third party copyrighted materials (such as book
chapters, journal articles, music, videos, etc.) have either been licensed for use in this course or fall under an
exception or limitation in Canadian Copyright law. Copying this material for distribution (e.g., uploading
material to a commercial third-party website) may lead to a violation of Copyright law.
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Learning Objectives
Readings
1) Class 1: Foundations of Assessment
Introduction to the course
Adult & Pediatric ABCD Assessments
Article: Tanner, C. (2006). Thinking like a nurse: A research-based model
of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204211. https://www.mccc.edu/nursing/documents/Thinking_Like_A_Nurse_
Tanner.pdf
1. Outline the course requirements, assignments,
and due dates.
2. Describe the processes involved in clinical
decision making and judgment using the
Clinical Judgement Measurement Model.
3. Discuss the primary and secondary survey
assessments in adults.
4. Discuss the primary survey in pediatrics using
the Pediatric Assessment Triangle.
5. Recognize abnormalities in physical
assessment, including paediatric red flags.
6. Compare and contrast the differences in adult
and paediatric assessment.
Class 2: Perioperative Care: live zoom class
1. Perioperative Care: focus on preoperative & postoperative care
2. Blood Component Therapy: Focus on
RBC Transfusions
1. Describe the purpose & components of a
preoperative nuro9sing assessment.
Clinical Judgement Measurement Model
https://www.atitesting.com/docs/default-source/default-documentlibrary/clinical-judgment-guide-rev-final_july-2020.pdfillustrated
Lewis 2023 Chapter 71: pp.1776-1780
Table 71.3 (Primary Survey) & 71.4 (Secondary Survey)
Pediatric Assessment Triangle
https://www.health.ny.gov/professionals/ems/pdf/pediatricreferencecard04.pdf (Page 1 only)
Review:
Physical Assessment of Adult (NURS 1543) and Child (NURS 2546/ 2543
Lewis 2023 Chapter 20: Preoperative Care pp.374-387 *Older adult
considerations pp 388 Older Adult Considerations pp. 388
Lewis 2023 Chapter 22: Discharge from the Post anaesthesia Care Unit
pp. 421-423 *Older Adult Considerations pp. 424
Lewis 2023 Chapter 33: Blood transfusions: pp.742-746; Table 33.32
(focus on Packed Red Blood Cells & Blood transfusion reactions)
HH/NURS 4526 6.00 Acute and Complex Health Challenges
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2. Examine the nursing role in the physical,
psychological, and educational preparation of
the patient undergoing surgery.
3. Prioritize nursing responsibilities related to
day-of-surgery preparation for the surgical
patient.
4. Apply knowledge of special considerations in
the preoperative preparation for the older-adult
surgical patient
5. Differentiate between general and regional or
local anaesthesia.
6. Describe the initial nursing assessment and
management after transfer from the PACU to
the general care unit.
7. Explain the etiology and nursing assessment
and management of potential problems during
the postoperative period.
8. Describe the nursing management of
transfusing blood and blood products.
Class 3: Airway/Breathing Challenges (ABCD)
1) Arterial Blood Gas Interpretations
2) Acute Management of Airway and
Breathing Challenges in the Adult
1. Describe the interpretation, causes clinical
manifestations & management of acid – base
imbalances, with a focus on arterial blood gas
interpretation.
2. Discuss nursing management of acute adult
respiratory conditions including COPD
exacerbation, pneumothorax, flail chest, and
pleural effusion/pleurisy.
Lewis 2023 Chapter 28: Arterial Blood Gases p.548; Oximetry p.549
Table 28.1 (Normal Blood Gas Values)
Table 28.2 (Signs/Symptoms of Inadequate Oxygenation)
Table 28.3 (Critical Values)
Lewis 2023 Chapter 30:
Lower Respiratory Conditions: Pneumothorax, Flail Chest, Chest Tubes &
Pleural Drainage pp. 610-616; Table 30.17; Table 30.18
Restrictive Respiratory Disorders: Pleural Effusions, Pleurisy,
Thoracentesis, Atelectasis p. 618 - 621
Lewis 2023 Chapter 31
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3. Describe the purpose of chest tubes and the
methods of their action, including nursing
responsibilities in the care of a patient with a
chest tube.
4. Describe respiratory distress versus failure,
including the causes, clinical manifestations &
nursing management.
Obstructive Lung Disease: Acute Exacerbation of COPD & Acute
Respiratory Failure pp.654-655
Lewis 2023 Chapter 70
Respiratory Failure & Acute Respiratory Distress
Acute Respiratory Failure pp. 1753-1764
*Age related Considerations pp. 1764
Class 4: Airway/Breathing Challenges (ABCD)
1) Acute Management of Airway and
Breathing Challenges in the Pediatric
Patient
2) Arterial Blood Pressure Monitoring
3) Endotracheal tubes & Mechanical
Ventilation (introduction only)
1. Discuss the pediatric clinical manifestation
and nursing managing of pediatric acute
pediatric conditions including respiratory
failure, epiglottitis, croup, bronchiolitis and
status asthmaticus
2. Review the indications for arterial blood
pressure monitoring.
3. Describe the types of artificial airways the
nursing management of a patient with an
artificial airway.
4. Describe the different types of mechanical
ventilation, settings, modes, complications,
troubleshooting of alarms, weaning and the
overall nursing management of a mechanically
ventilated patient.
Lewis 2023 Chapter 68
Arterial Blood Pressure Monitoring pp.1709 - 1710 Figures 68.7, 68.8 &
Table 68.5
Artificial Airways Endotracheal Tube pp. 1713-1717
Mechanical Ventilation: settings, modes, complications, troubleshooting,
alarms, weaning, chronic ventilator patient pp. 1717-1722
Wong 2022 Chapter 21
Epiglottitis p. 634
Bronchiolitis p. 638
Croup p. 634-637, 606
Status Asthmaticus p. 658
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Class 5: Circulatory Challenges (ABCD)
1) Basics of ECGs
2) Sinus and Atrial Rhythm
1. Review conduction system,
electrocardiographic monitoring, types of
monitoring.
2. Describe the systematic approach to assessing
a cardiac rhythm.
3. Identify the clinical characteristics of ECG
patterns including normal sinus rhythm, sinus
bradycardia, sinus tachycardia, atrial flutter
and atrial fibrillation, clinical significance &
management.
4. Describe the nursing management of patient
requiring continuous ECG monitoring.
Lewis 2023 Chapter 38: Nursing Management: Dysrhythmias pp.849-858
• Normal sinus rhythm, Sinus Bradycardia, Sinus Tachycardia, Atrial
Flutter, Atrial Fibrillation
Jarvis S, Saman S (2018) Cardiac system 1: anatomy and physiology.
Nursing Times [online]; 114: 2, 34-37.
310118-Cardiac-system-1-anatomy-and-physiology.pdf
Class 6: Midterm Exam (30%)
Class 7: Circulatory Challenges (ABCD)
1) Ventricular Rhythms
2) Defibrillation and cardioversion
3) Transcutaneous pacing
Lewis Chapter 38: Nursing Management: Dysrhythmias pp 860-866
• Premature Ventricular Contractions, Ventricular Tachycardia,
Ventricular Fibrillation, Asystole, Defibrillation, Synchronized
Cardioversion, Transcutaneous pacing
1. Identify the characteristics of ECG patterns:
PVCs, VT, VF, asystole, clinical significance
& management.
2. Differentiate between defibrillation &
cardioversion, identifying indications for use
and management.
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3. Describe the indicators and nursing
management of a patient with transcutaneous
pacemakers
Class 8: Circulatory Challenges (ABCD)
1) Coronary Artery Disease (CAD),
Chronic Stable Angina, Acute Coronary
Syndrome
2) Pediatric challenges – Focus on
Kawasaki’s disease
1. Describe the purpose & significance of and
nursing responsibilities related to diagnostic
studies of the cardiovascular system.
2. Identify risk factors for CAD and the nursing
role in health promotion
3. Differentiate the clinical manifestations,
complications & management of the patient
experiencing chronic stable angina and acute
coronary syndrome.
4. Describe clinical manifestations & nursing
management of Kawasaki’s disease in
children.
Class 9: Disability [Neurological] Challenges
(ABCD)
1) Acute intracranial conditions (adult):
Stroke (focus on hemorrhagic stroke,
intracerebral & subarachnoid
hemorrhage); Head injury (intracranial
hemorrhage) /
Lewis 2023 Chapter 34: Cardiovascular System Diagnostic studies pp.
762-771
Lewis 2023 Chapter 36:
• CAD Risk Factors & Nursing Management: pp. 798-804; Table 36.2
Teaching Guide
• Chronic stable angina & Prinzmetal angina pp.804-808; Table 36.7
(PQRST Assessment of Angina); Table 36.8 (Factors Precipitating
Angina); Fig 36.7 (Common locations of pain); Table 36.9
(Comparison of Major Types of Anginas); Table 36.10 (Major
Treatment Elements of Chronic Stable Angina)
• Acute Coronary Syndrome pp. 811- 824. Unstable angina, Myocardial
infarction, Diagnostic Studies (ECG, serum markers, angiogram);
Interprofessional care - percutaneous intervention (angiogram, PTCA),
fibrinolytic therapy, coronary revascularization; Nursing Management;
Table 36.14 (Nursing Assessment ACS); Table 36.17, 36.18, 36.19
(Teaching Guides)
Wong 2022: Kawasaki Disease pp. 772-773
Lewis 2023 Chapter 59 :
• Increased Intracranial Pressure p.1455-1459 Clinical manifestations;
Table 59.3 (Interprofessional Care)
Nursing management/implementation: pp. 1462-1465
• Head Injury pp. 1465-1471.
Types; Table 59.6 (Types of skull fractures); Complications;
Diagnostic/Interprofessional Care; Nursing Management
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2) Acute intracranial conditions
(pediatric): Head Injury
1. Describe the common etiologies, clinical
manifestations & nursing/collaborative
management of the patient with increased
intracranial pressure.
2. Differentiate between the types of head injury
by mechanism of injury & clinical
manifestations & nursing/collaborative
management of the patient with a head injury.
3. Describe the acute nursing management and
interprofessional care of a patient with a
hemorrhagic stroke.
Lewis 2023 Chapter 60: Hemorrhagic Stroke p. 1488-1490 ; Diagnostics
(p.1491) ; Interprofessional care (p.1495-1496) ; Acute Interventions
(p.1500 -1504) ; Age-related considerations (p.1507)
Wong: Acute Head injury, Concussion pp. 895-896
Class 10:
Exam: 25%
Multisystem Challenges Self Study - Burns:
prerecorded / asynchronous class, self study
Lewis 2023 Chapter 27: pp. 518-541
1. Differentiate the types, classification, depth, of
various burns.
2. Outline the clinical manifestations &
management of the patient with various types
of burns.
Class 11: Multisystem Challenges: live zoom
1) Shock
2) Multiple Organ Dysfunction Syndrome
3) Code Blue
Lewis 2023 Chapter 69:
Shock pp.1729 - 1747
Sepsis and Multiple Organ Dysfunction Syndrome p1747-1749
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1. Describe the four main categories of shock:
cardiogenic, hypovolemic, distributive
[neurogenic, anaphylactic, septic], obstructive)
including causes, clinical manifestations &
nursing management.
2. Identify the stages of shock.
3. Describe the clinical manifestations & nursing
management of the patient with shock &
multiple organ dysfunction.
4. Discuss the role of a student nurse during a
code blue.
Class 12: Multisystem Challenges
1) Acute Complications of Diabetes
Mellitus: Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycemia State
(HHNS)
2) Pediatric: Sickle Cell Anemia (SCA)
Lewis 2023 Chapter 52
Diabetic Ketoacidosis pp.1293 – 1296
Hyperosmolar Hyperglycemia State pp.1296
Wong 2022: Sickle cell anemia pp. 788-796
1. Identify the clinical manifestations &
management of acute complications of
diabetes mellitus (HHNS, DKA).
2. Describe the types of episodic sickle cell
crises & the clinical manifestations of each.
3. Identify the nursing management for a child
with SCA, Exam review
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