NURS7610
Syllabus
1
Masters Degree Program
Nurse Practitioner Concentration
Neonatal Option
NURS 7610: Alterations in Health III
Fall 2012
COURSE NUMBER:
NURS 7610
COURSE TITLE:
Alterations in Health III: Chronic Illness & Specialty Care:
Neonatal
CREDITS HOURS:
6 credits (Classroom 2 credits; Clinical 4 credits)
CONTACT HOURS:
45 classroom hours, 240 clinical hours
COURSE PLACEMENT: Level IV
Fall Semester, 2012
COURSE DAYS/TIME:
Meets Wednesdays, 3-5 p.m.
CORUSE LOCATION:
Whitby 7B
COURSE FACULTY
Marlene D. Wuethrich, RN, MS, CNP-Neonatal
Phone:
(763) 494-3435 (home)
Email:
wueth001@comcast.net
COURSE DESCRIPTION:
This course focuses on clinical management related to secondary prevention but focusing on
tertiary care. Emphasis is placed on complex and chronic alterations of health of the target
population in the contexts of the family and health systems. Clinical component of this
course expands advanced practice skills and evidenced based interventions. Students will
evaluation patient outcomes and their affect/implications for policy, fiscal and organizational
change will be described and analyzed in the student’s capstone project.
PREREQUISITES:
NURS 6100, 6110, 6140, 6160, 6260, 6310, 6200, 6360, 7410,
7510
COURSE LEARNING OBJECTIVES/OUTCOMES:
1. Demonstrates comprehensive, collaborative management of the focus population,
comparing and contracting alternative approaches to therapy with multifaceted
alterations in health. (Phenomena of Nursing; “Creative and Critical Thinking” and
“Discipline-Based Competence;” NONPF CC 1, 4, 8; Essentials I, IV)
Master’s Degree Program
Department of Nursing
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2. Analyzes selected quality evaluation methods in relationship to advanced nursing
practice & tertiary care settings of neonates. (Critical Thinking; “Effective
Communication in a Variety of Modes;” NONPF CC 3, 7, 8; Essentials II, III)
3. Applies case management processes to clinical practice and outcomes, health care
systems coordination and integration, fiscal management and reimbursement
patterns. (Communication; “Leadership and Collaboration” and Effective
Communication in a Variety of Modes;” NONPF 2, 5, 7; Essentials II, VII)
4. Analyzes legal and professional standards as they apply to care of the focus
population. (Systems; “Ethics and Social Justice,” “Diversity and Global
Perspectives,” and “Effective Communication in a Variety of Modes;” NONPF CC
1, 5, 6; Essentials I, V, VI, VII)
5. Evaluates the implications of selected health care policies for advanced practice
nurses and the health care system. (Role; “Leadership and Collaboration” and
“Purposeful Lifelong Learning;” NONPF CC 2, 9; Essentials IX)
6. Integrates ethical, legal, social and cultural perspectives into the advanced practice
nursing role. (Therapeutic Interventions; “Discipline-Based Competence;” NONPF
CC 9, Essential IX)
Please note: Department of Nursing curricular threads are identified in italics, University
goals of a liberal arts education are identified in quotes, professional standards in regular font
(Please refer to Appendix A).
TEACHING-LEARNING ACTIVITIES
Teaching-learning activities in NURS 7610 include (a) discussion-based classes about facultyassigned readings, (b) individual presentations, (c) experiential learning and practicum
experiences, and (d) tests and papers.
FACULTY EXPECTATIONS
As faculty members, our responsibility is to ensure that you receive the best possible education and
learning experiences. Therefore, students can expect from faculty members that we…
 Appreciate the diversity of our campus and respect the rights of each member.
 Show human concern for each of those with whom we work and study while presenting a
positive attitude and professional demeanor.
 Be on time for class and return from scheduled breaks.
 Respond to e-mail messages and voice mail messages within 24-48 hours, except on
weekends and holidays.
 Treat the students with courtesy. Refrain from any behaviors that may distract others.
Minimize distraction and interruptions. This includes limiting private conversations, and
keeping phones and pagers in a vibrate mode.
 Understand that this class is a dynamic one, where disagreements may occur. Respect
diverse opinions and listen politely when others are speaking.
 Give everyone a chance to contribute and value hearing all voices.
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Department of Nursing
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 Come prepared for the class and having thought about how the day's teaching-learning
will unfold.
STUDENT EXPECTATIONS
To create an optimal respectful learning environment for everyone, your faculty members
expect you to…
 Appreciate the diversity of our campus and respect the rights of each member.
 Show human concern for each of those with whom you work and study while presenting a
positive attitude and professional demeanor.
 Be on time for class and return from scheduled breaks.
 Treat the faculty members and fellow students with courtesy. Refrain from any behaviors
that may distract others. Minimize distraction and interruptions. This includes limiting
private conversations, and keeping phones and pagers in a vibrate mode.
 Understand that this class is a dynamic one, where disagreements may occur. Respect
diverse opinions and listen politely when others are speaking.
 Give everyone a chance to contribute and value hearing all voices.
 Accept the challenge of doctorate level studying, thinking, and learning. Anticipate that
the level and quantity of work in this course may exceed your prior experiences.
 Come to class prepared, having read the assignment beforehand and having thought about
how you can participate in that day's discussion.
COURSE SCHEDULE AND TOPICAL OUTLINE
DATE
9/5/2012
9/26/2012
TOPIC
Introduction
Chronicity
BPD
Seizures
Neuro Drugs
Bleeds
10/3/2012
10/10/2012
Shunts and Hydrocephalus
Renal
10/17/2012
Conference
10/24/2012
10/31/2012
11/7/2012
11/14/2012
11/21/2012
11/28/2012
12/5/2012
12/12/2012
12/20/2012
Conference
9/12/2012
9/19/2012
Mid Term Test
Res. Ventilation Management
Chronicity presentation
Chronicity presentation
Chronicitiy presentation
Chronicity presentation
Class Case
Class Case
Professional Pot Pourri
Master’s Degree Program
Department of Nursing
READINGS & ASSIGNMENTS
See topic outline
See topic outline
See topic outline
See topic outline
1st Alteration in Health due
See topic outline
See topic outline
Inclusivity paper due
Children’s St. Paul
2nd Alteration in Health due
Cumulative Pharmacology test due
Role Synthesis paper due
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COURSE ASSIGNMENTS AND GRADING
Assignments, assigned points and due dates will be reviewed during out first class session.
Rubrics are used to evaluate course assignments and also to address the integrating concepts
related to each course assignment.
ASSIGNMENT
CLASSROOM
Inclusivity Paper
Acute to Chronic Evidence
Based Practice Paper
Neuro/Renal/BPD Exam
Role Synthesis Paper
Cumulative Pharm Test
CLINICAL
Alteration in Health
Assessment #1
Alteration in Health
Assessment #2
OBJECTIVES
POINTS
%
DUE
DATE
3,6, Appendix A
2,3, Appendix B
10
35
10
35
10/10/12
11/7-11/28
1
4,5, Appendix C
1
10
20
10
10
15
10
10/24/2012
12/20/2012
12/5/2012
1, Appendix D
7.5
10
9/26/2012
1, Appendix D
7.5
10
11/7/2012
100 pt.
100%
ASSIGNMENTS:
Students are responsible for completing all course assignments and learning activities. Course
assignments are due at the beginning of class on the scheduled due date. Please submit
written assignments by using the Desire2Learn (D2L) course site. Assignments and papers
will be returned at the next class session. Late assignments will not be accepted unless you
notify Marlene Wuethrich by email or voice mail prior to when the assignment is due. Thank
you!
Grading Policy:
NURS 7610 must be taken for a grade and must be satisfactorily completed with a minimum
grade of B (87% of the total possible points). Each course assignment must be completed
with a minimum grade of C (78%) of total possible points. Assignments may be resubmitted
once if not completed satisfactorily the first time (if evaluation of assignment is <78%
possible points). Resubmitted assignments receive a maximum of 78% of total possible
points for that assignment. If you have questions about how to complete a particular
assignment, please contact Marlene Wuethrich.
Grading Scale:
Grades in NURS 7610 are determined as follows:
A 96-100%
A- 93-95%
Master’s Degree Program
Department of Nursing
B+ 90-92%
C+ 81-83%
B 87-89% Passing C 78-80%
B- 84-86%
C- 75-77%
D+ 72-74%
D 69-71%
F 68% and below
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Incomplete Grades:
A grade of incomplete is given only when unusual circumstances deem it appropriate.
Ordinarily, such circumstances would involve matters that are not wholly within your control,
such as illness. If you wish to receive an incomplete grade you must complete a Petition for
Incomplete Grade form (available online) no later than the last day of the term in which course
requirements are due. You must be making satisfactory progress in the course and you must have
completed 75% of the course at the time the petition is filed. Incompletes are awarded at the
faculty’s discretion. If granted, the normal deadline for completion of the work is no more than 8
weeks after the last day of classes in the term in which the course is offered. The course faculty
may establish a due date after the normal deadline if you request it and special circumstances
warrant it. The faculty will submit an alternate grade that will automatically be recorded if you
do not complete the requirements for the course by the deadline. If you complete the course
requirements in the time allotted, the faculty must submit the final grade by the deadline.
Extensions to the due date originally agreed to by you and your course faculty must be approved
by the academic dean.
COURSE POLICIES
Additional policies related to this course may be found in the Master’s Degree Program Student
Policies located in the online Nursing Student Handbook.
Academic Integrity:
Please refer to the “Academic Integrity Policy” in the Graduate Academic Catalog.
Accommodations:
St. Catherine University is committed to equal access for all and recognizes that disability is
an aspect of diversity. The University’s goal is to create learning environments that are
usable, equitable, inclusive, and welcoming. If there are aspects of the instruction or design of
this course that result in barriers to the learning environment, accurate assessment, or your
achievement, please contact me and the Resources for Disabilities office as soon as possible.
Access Consultants can be reached in the O’Neill Center at 651.690.6563 to discuss academic
adjustments or accommodations
Attendance:
The most significant learning activity is attendance and active participation in all class sessions.
Taking initiative in learning is a hallmark of advanced nursing practice. This requires preparation
for all class sessions, the belief that you have a unique and valuable perspective to offer to class
discussions, and the willingness to enter into to our class discussions. Therefore, attendance and
active participation and engagement in class discussions and learning activities will be noted.
Regular class attendance is expected and is defined by the format of the course. For online
courses, attendance means following the communication requirements and due dates on the
syllabus. For in-class learning, attendance means that (a) you arrive at class on time and stay
for the duration of the class; and (b) whether present or not, you are responsible for in-class
content. For hybrid courses, you must follow both the online and in-class attendance
requirements. Failure to attend, for any reason, may be taken into account in the evaluation of
your work. First day attendance (for in-class) or first week online communication (for online
learning) is required.
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If you will be late or absent for a class session, please e-mail or call Marlene Wuethrich prior
to class (wueth001@comcast.net or 769-494-3435). Failure to regularly attend class sessions
will result in implementation of the Performance Issue Algorithm/Guided Improvement Plan
described in the Master’s Degree Program Student Policies.
Course Communication:
Please check your St. Kate’s e-mail and D2L regularly for messages and updates related to the
course--at least every 2-3 days. E-mail messages and voice mail messages will be responded to
within 24 hours, except on weekends and holidays. You are encouraged to discuss optimal
means of communication with course faculty. In the event of severe weather on a planned class
day or learning event, please monitor e-mail and D2L closely for alternative assignments or
plans. Grades will be posted in the online gradebook on our D2L course site.
Evaluation:
Evaluation is an essential component of this course. Informal and formal evaluations will be
conducted during the course and evaluative data will be used by faculty to improve the course
and ensure that learning is being facilitated through teaching-learning activities and course
assignments. Online course and faculty evaluations are completed at the end of this course.
Information about how to complete these online evaluations will be sent by a staff member in
the Department of Nursing, usually before the final class session. Final course evaluations
are confidential; only aggregated data are reported to faculty.
Inclusivity:1
Nurses are called to promote human dignity. In order to be aware of the ever changing
environment in nursing and health care, an open dialogue must be able to occur in a nonthreatening environment in which students and faculty can engage in discussions that are
taking place, challenge comments that are made, and evaluate aspects of the structural
environment that support injustice. Bringing attention to expressions of cultural bias is a way
to model against stereotyping. At any time, a moment of consideration can be called. This can
and should be called by anyone, student or faculty, in order to facilitate needed conversation
around sensitive issues. These moments are times for all of us to learn how to become more
sensitive in our language and actions. Such dialogues may pertain to stereotypes related to
“race,” sex, religion, gender identity, sexual preference, weight, economic status, and
anything that can impact the dignity of persons, including equitable treatment of patients and
students. These moments of consideration should be freely addressed in the classroom and are
an essential aspect of learning in this course.
PROFESSIONAL STANDARDS, WRITING AND TECHNOLOGY REQUIREMENTS
Faculty in the Department of Nursing use professional nursing standards in the development,
implementation, and evaluation of curricula, as well as to promote and evaluate student
learning.
In the Nurse Practitioner Concentration of the Master’s Degree Program, professional
standards include:
 Code of Ethics for Nurses with Interpretive Statements (ANA, 2001)
1
This statement is based on a statement written by NURS 6790 student, Maria Kludt (Spring 2009).
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 Code of Ethics for Registered Nurses (Canadian Nurses Association, 2008[Canadian])
 International Council of Nurses Code of Ethics for Nurses (ICN, 2006 [All])
 Core Competencies for Interprofessional Collaborative Practice (Interprofessional







Education Collaborative Expert Panel, 2011)
The Essentials of Master’s Education in Nursing (AACN, 2010 [Draft: 2.17.10])
NLNAC Accreditation Standards and Criteria: Master’s Degree Programs (NLNAC, 2008)
National Task Force Criteria for Nurse Practitioner Programs (NTF, 2012)
Nurse Practitioner Core Competencies (NONPF, 2012)
Nursing: Scope and Standards of Practice, 2nd Edition (ANA, 2010)
Nursing’s Social Policy Statement: The Essence of the Profession (ANA, 2010)
Quality and Safety Education for Nurses: Graduate Competencies (QSEN, 2011)
Writing and Technology Requirements:
The ability to write, use technology, and communicate effectively is essential in advanced
nursing roles. Professional nursing standards and competencies for advanced nursing practice
specifically address these skills. Courses in the Master’s Degree Program in Nursing are
designed to provide opportunities for you to learn and develop writing abilities and skills in
using technology.
In NURS 7610, written assignments will be evaluated by faculty for (a) the logical flow of
ideas and organization of content; (b) spelling, grammar, and punctuation; and (c) the use of
American Psychological Association style (APA, 2010). If specific concerns are identified,
you will be encouraged to seek assistance with your professional writing skills, including the
use of APA style.
CONGRUENCE WITH THE ST. CATHERINE UNIVERSITY MISSION
NURS 7610 advances the “Goals of a Liberal Arts Education” at St. Catherine University by
challenging you to learn strategies to enhance neonatal health promotion through a focus on
awareness and response to the range of factors that affect neonatal health, family support,
socioeconomic environment, culture, policy, and broader social justice issues. There is a
growing emphasis on a global perspective, even while you learn about your potential roles
within the U.S. health system. Critical and creative inquiry is specifically addressed in the
Health Maintenance Protocol assignments, where you will analyze multiple protocols (from
local or international health care systems), review the research, and develop your own
recommended protocol. Discipline-based competence is introduced and developed in this
course. Effective communication (oral, written, and electronic) is incorporated throughout the
course, as it is essential for obtaining an accurate history, identifying family strengths and
needs, and jointly developing and promoting a plan for health. This will be practiced through
written maternal/newborn assessments, student presentations, and use of the electronic
medical record where possible. Each of the “Goals of a Liberal Arts Education” is related to
one or more of the course objectives and consistent with the teaching and learning activities
used in this course. …
TEXTBOOKS AND COURSE MATERIALS
Required texts for this course include:
Course Packet for NURS 7610
Master’s Degree Program
Department of Nursing
NURS7610
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Avery, G.B. (2005). Neonatology: Pathophysiology and management of the newborn.
Philadelphia: J.B. Lippincott.
Goldsmith, J.P.& Karotkin, E.H. (2010). Assisted ventilation of the neonate (5th ed.)
W.B. Saunders.
Moore, K.L. (2008). Before we are born: Essentials of human embryology (7th ed.)
Philadelphia: W.B. Saunders.
Tortora, G.J. & Derrickson, B. (2009). Principles of Anatomy and Physiology, (12th ed.)
Wiley and Sons, Inc. Hoboken, NJ.
Yaffe, S.J. & Arenda, J.V. (2011) Neonatal and Pediatric Pharmacology: Therapeutic
principles in practice. (4th ed.) Lippincott, Williams & Wilkins, Philadelphia, PA.
Journal articles as listed in course packet.
St. Catherine University Liberal Arts Goals:
Leadership and Collaboration: The ability to lead and influence for ethical and responsible action
and for systemic change; the ability to work well with others, especially in joint intellectual effort.
Ethics and Social Justice: The ability to apply ethical standards to judge individual and collective
actions; the development of attitudes and behaviors that reflect integrity, honesty, compassion, and
justice in one’s personal and professional life.
Diversity and Global Perspectives: The ability to understand and analyze the impact of diversity and
systems of power and privilege on the individual and society; the ability to decipher and honor
multiple and global perspectives in creating mutual understanding; the ability to imagine and take
action towards justice.
Critical and Creative Inquiry: The ability to gather, analyze and critically evaluate information to
develop reasonable arguments, sound judgments, and effective solutions. This ability is founded on a
broad knowledge of the achievements of human creativity and of the variety of disciplinary
approaches for exploring truths.
Discipline-Based Competence**: The ability to demonstrate in-depth knowledge, values and skills in
at least one major field of study and to relate disciplinary approaches to those of other fields.
Effective Communication in a Variety of Modes: The ability to read, write, speak and listen
effectively; the ability to present information in a clear and engaging manner.
Purposeful Life-long Learning: The ability to continue personal and professional development based
on ongoing self-assessment, feedback from others, and new learning.
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Essentials of Master’s Education in Nursing
(American Association of Colleges of Nursing, 2011)
Essential I.
Background for Practice from Sciences and Humanities
Essential II.
Organizational and Systems Leadership
Essential III.
Quality Improvement and Safety
Essential IV.
Translating and Integrating Scholarship into Practice
Essential V.
Informatics and Healthcare Technologies
Essential VI.
Health Policy and Advocacy
Essential VII.
Outcomes
Interprofessional Collaboration for Improving Patient and Population Health
Essential VIII. Clinical Prevention and Population Health for Improving Health
Essential IX.
Master’s-Level Nursing Practice
Nurse Practitioner Core Competencies
(National Organization for Nurse Practitioner Faculties, 2012)
Scientific Foundation Competencies
1. Critically analyzes data and evidence for improving advanced nursing practice.
2. Integrates knowledge from the humanities and sciences within the context of nursing science.
3. Translates research and other forms of knowledge to improve practice processes and outcomes.
4. Develops new practice approaches based on the integration of research, theory, and practice
knowledge
Leadership Competencies
1. Assumes complex and advanced leadership roles to initiate and guide change.
2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community,
integrated health care teams, and policy makers) to improve health care.
3. Demonstrates leadership that uses critical and reflective thinking.
4. Advocates for improved access, quality and cost effective health care.
5. Advances practice through the development and implementation of innovations incorporating
principles of change.
6. Communicates practice knowledge effectively both orally and in writing.
7. Participates in professional organizations and activities that influence advanced practice nursing
and/or health outcomes of a population focus.
Quality Competencies
1. Uses best available evidence to continuously improve quality of clinical practice.
2. Evaluates the relationships among access, cost, quality, and safety and their influence on health
care.
3. Evaluates how organizational structure, care processes, financing, marketing and policy decisions
impact the quality of health care.
4. Applies skills in peer review to promote a culture of excellence.
5. Anticipates variations in practice and is proactive in implementing interventions to ensure quality.
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Practice Inquiry Competencies
1. Provides leadership in the translation of new knowledge into practice.
2. Generates knowledge from clinical practice to improve practice and patient outcomes.
3. Applies clinical investigative skills to improve health outcomes.
4. Leads practice inquiry, individually or in partnership with others.
5. Disseminates evidence from inquiry to diverse audiences using multiple modalities.
6. Analyzes clinical guidelines for individualized application into practice.
Technology and Information Literacy Competencies
1. Integrates appropriate technologies for knowledge management to improve health care.
2. Translates technical and scientific health information appropriate for various users’ needs.
2a). Assesses the patient’s and caregiver’s educational needs to provide effective, personalized
health care.
2b). Coaches the patient and caregiver for positive behavioral change.
3. Demonstrates information literacy skills in complex decision making.
4. Contributes to the design of clinical information systems that promote safe, quality and cost effective
care.
5. Uses technology systems that capture data on variables for the evaluation of nursing care.
Policy Competencies
1. Demonstrates an understanding of the interdependence of policy and practice.
2. Advocates for ethical policies that promote access, equity, quality, and cost.
3. Analyzes ethical, legal, and social factors influencing policy development.
4. Contributes in the development of health policy.
5. Analyzes the implications of health policy across disciplines.
6. Evaluates the impact of globalization on health care policy development.
Health Delivery System Competencies
1. Applies knowledge of organizational practices and complex systems to improve health care
delivery.
2. Effects health care change using broad based skills including negotiating, consensus-building, and
partnering.
3. Minimizes risk to patients and providers at the individual and systems level.
4. Facilitates the development of health care systems that address the needs of culturally diverse
populations, providers, and other stakeholders.
5. Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the
environment.
6. Analyzes organizational structure, functions and resources to improve the delivery of care.
7. Collaborates in planning for transitions across the continuum of care.
Ethics Competencies
1. Integrates ethical principles in decision making.
2. Evaluates the ethical consequences of decisions.
3. Applies ethically sound solutions to complex issues related to individuals, populations and
systems of care.
Independent Practice Competencies
1. Functions as a licensed independent practitioner.
2. Demonstrates the highest level of accountability for professional practice.
3. Practices independently managing previously diagnosed and undiagnosed patients.
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3a). Provides the full spectrum of health care services to include health promotion, disease
prevention, health protection, anticipatory guidance, counseling, disease management,
palliative, and end of life care.
3b). Uses advanced health assessment skills to differentiate between normal, variations of
normal and abnormal findings.
3c). Employs screening and diagnostic strategies in the development of diagnoses
3d). Prescribes medications within scope of practice
3e). Manages the health/illness status of patients and families over time.
4. Provides patient-centered care recognizing cultural diversity and the patient or designee as a full
partner in decision-making.
4a). Works to establish a relationship with the patient characterized by mutual respect, empathy,
and collaboration.
4b). Creates a climate of patient-centered care to include confidentiality, privacy, comfort,
emotional support, mutual trust, and respect.
4c). Incorporates the patient’s cultural and spiritual preferences, values, and beliefs into health
care.
4d). Preserves the patient’s control over decision making by negotiating a mutually acceptable
plan of care.
Reference
National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies.
Retrieved from
http://www.nonpf.com/associations/10789/files/NPCoreCompetenciesFinal2012.pdf
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Department of Nursing
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APPENDIX A
St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III - Neonatal
INCLUSIVITY APPROACH TO HEALTH CARE DELIVERY
PURPOSE: To identify health care delivery strategies in a specific group.
Develop GROUP specific strategies for perinatal/neonatal tertiary health care delivery which:
-
Focus on one specific group, i.e., teens, blacks, American Indians, Hmong, poor.
-
Are based on the group’s value and belief systems.
-
Identifies current means of health care delivery that favor this group’s participation.
-
Identifies current means of health care delivery that hinders this group’s participation.
-
Takes into account all costs of strategy implementation vs. non-implementation.
-
Can be evaluated for effectiveness by pre-designated outcome criteria.
Paper should be no longer than 10 typed pages (including bibliography).
Submit paper with bibliography to faculty by October 10/2012.
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Department of Nursing
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APPENDIX B
St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III - Neonatal
ACUTE TO CHRONIC ALTERATION IN HEALTH
BEST EVIDENCE BASED PRACTICE
Purpose: Develop an explicit strategy for an approach to a common acute NICU Alteration in
Health with the goal of preventing or minimizing the corresponding chronic alteration in
health potential. Identify the impact of the chronic health problem of the neonate, on the
family and community. Describe services available and the adequacy of the services for the
newborn infant and family’s specific need. Describe a role for the NNP in providing
assessment, direct care and case management for the neonate/infant with the identified Acute
to Chronic Alteration in Health.
Instructions
1)
Identify an Alteration in health in the neonate that commonly results in a chronic
alteration in health.
2)
Describe the Alteration in health: overview of epidemiology, pathology, morbidity
(chronicity) and mortality.
3)
Develop (from evaluation of the research/literature) a best evidence critical pathway
for the management of the acute alteration in health.
a) Includes subjective and objective data to be collected for the specific alteration in
health.
b) Includes laboratory/diagnostic test that may be ordered.
c) includes treatment and evaluation of treatment.
d) Reflects joint efforts of all health professionals involved.
e) Includes measurable evaluation of treatment (outcomes)f) identify when acute becomes chronic.
4)
Describe the family, environmental/community services needed/available to manage
the chronic alteration of health (resulting from your identified acute alteration and
promote function/growth and development outside of the tertiary care setting.
Include: Physical, physiologic parameters of newborn/infant environment, caregivers,
caregiving, economics, psychological, developmental.
5)
Identify the role of the NNP in providing assessment, direct care, and case
management for the newborn/infant when acute becomes chronic.
6)
Visit at least one community facility for the newborn/infant with the selected chronic
alteration in health to assess adequacy of services for meeting specific needs of the
newborn/infant and his family. If unable to visit a facility, what is available online.
Master’s Degree Program
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Syllabus
7.
Identify sources of reference materials for the chronic alteration.
8.
Submit in writing.
9
Present in class.
14
*This cannot be a pathway from your case management paper, but can cover any other NICU
topic that has potential to become chronic.
*Reference Articles:
 Tobin, C.R. et.al. (1998). A Neonatal Care Map Based on Gestational Age. Neonatal
Network, 41- 51.
 Jennings, B, M and Loan, L.A. (2001) Misconceptions Among Nurses About EvidenceBased Practice Journal of Nursing Scholarship [Second Quarter],121-189.
 Campbell, M.A. (2006). Development of a clinical pathway for Near-Term and
Convalescing Premature Infants in A Level II Nursery. Advances in neonatal Care, 16(3),
150-164
 Stokowski, L.A. (2007) Family Centered Care MAP. Advances in Neonatal Care. 7(6)
280
 Askin Fraser, Debbie (2006) Evidence-Based Practice: How much, How Strong, How
Fast? Neonatal Network, 25(3).
 Smith, J.R. and Donze, A. (2009). Clinical Practice guidelines: What Are They? Where
Are They? How Good Are They? Neonatal Network, 28(5)
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Department of Nursing
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APPENDIX C
St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III--Neonatal
ROLE SYNTHESIS PROJECT
PURPOSE:
This experience is a culmination activity of the advanced practice neonatal clinical and role
content of the master’s program. The student will develop in depth knowledge of an
organizational structure, functional role and client population by spending 2-3 clinical days
with experienced advanced practice nurses.
INSTRUCTIONS:
1. Identify an area of interest in advanced nursing practice.
2. In consultation with neonatal faculty, contract with experienced advanced practice nurses
to spend 2-3 days exploring an area of interest.
3. Use the following objectives for the experience” :
a. What is the mission of the organization, facility, institution? How does the advanced
practice nurse’s position fit into the mission? With whom or with what other agencies
does the nurse interact?
b. What are the prioritized responsibilities of the position? Does the invested authority
of the position match the level of responsibility? Do the responsibilities reflect the
NPs scope of practice?
c. What is the formal and informal reporting structure for the advanced practice nurse?
Does it appear to be constraining to effective practice?
d. What are the opportunities for creative practice? What are the procedures for
implementing change?
e. What role does evidence based practice research play in the position? Is there any
community service aspect? Is there formal or informal teaching? Is there any formal
or informal consultation? What are opportunities for publishing and presentations?
What are continuing education opportunities?
f. What is the level of client/family intervention? Is the position involved with primary,
secondary, or tertiary care? Is this Autonomous practice?
g. How are the NPs services recovered?
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h. How is NP practice assured to be safe and effective?
4. Describe the agency(ies), the nurse(s) role, the objectives, the degree to which the
objectives were met and your analysis of the objectives in a 5-10 page paper which
includes documentation from agency sources or other appropriate references.
5. Summarize this experience by designing a one-page personal conceptual diagram of your
ideal advanced practice NP role. Include a schematic of the system of interactions with
client, families, other professionals, community, etc. Indicate lines of responsibility and
accountability. Incorporate theorists and authors whose works have been meaningful to
you during the program. Accompany your schematic with a brief explanation of its
meaning and a list of references.
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
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APPENDIX D
St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III-- Neonatal
APPLIED CLINICAL
Purpose: Supervised experience in applying the knowledge, theory, and techniques learned
in NNP didactic courses to the clinical setting focusing on neonates with complex or chronic
problems.
Requirements: Minimum of 24 hours per week clinical experience.
At the completion of the clinical, the student, acting in a semi-independent manner, will
be able to:
1. Participate as a professional member of the health team in identifying the neonate at risk
for complex or chronic alteration in health.
a. Accurately collect and record a thorough history of mother and baby
b. Perform a newborn physical exam and gestational age assessment
c. Distinguish between normal and abnormal findings
d. Select, analyze, and interpret appropriate laboratory and radiological tests
2. Participate in planning and implementing care for infants with selected complex or
chronic neonatal problems and their families in the NICU.
a. Present case on rounds with identified plan of care
b. Support care plan with current data and theoretical knowledge
c. Evaluate infants response to care and review changes with other health team members
d. Participate in the development of discharge plans and summary of patient’s course in
NICU.
e. Accurately and effectively document plans and patient’s response to care
3. Identify need for and perform technical and specialized skills according to national or
local standards, protocols and procedures and current scientific data.
a. Arterial blood gases
b. Insertion of peripheral IV’s and purcutaneous central IV’s
c. Intubation
d. Umbilical catheterization
e. Lumbar puncture
f. Needle aspiration of pneumothorax
g. Placement of chest tubes
h. Cardiopulmonary resuscitation
4. Participation as the lead member of the NICU delivery room/transport team.
5. Display appropriate assessment of family, intervention, and education.
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
6. Display appropriate consultation, cooperation, and effective communication with other
health team members.
7. Evaluate NNP role in NICU and define own philosophy of practice.
8. Identify areas of advanced nursing practice that have the potential to create ethical
dilemmas.
9. Evaluate the research component of advanced practice nursing in the NICU.
Master’s Degree Program
Department of Nursing
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NURS7610
Syllabus
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St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III-- Neonatal
GUIDELINES FOR CLINICAL EXPERIENCE
Each Neonatal Nurse Practitioner student will spend a minimum of 24 hours per week at a
Level III NSY where a preceptor will supervise and guide the student’s activities. The
College of St. Catherine faculty will make 1 site visit during the sessions, approximately one
half day long, to observe the student’s interactions and assess and guide the student’s clinical
progress. The following is a list of suggested activities for the clinical experience.
Prior to the first week of clinical, if the clinical site has changed, it is recommended that the
student arrange a 2-3 hour observation, a “get acquainted” period in the NICU. This would
include a brief discussion with the preceptor about the way the NICU functions, a tour of the
NICU and L & D area, introduction to staff and examination of recording systems.
Week 1
Preceptor should select 3-4 patients for you that are complex. Attend
NICU working rounds, pay particular attention to the presentation on the
patients you will be managing. Compile a case history and do a physical
exam on all your patients. Select, analyze, and interpret appropriate lab or
radiological data. Make an assessment and develop a plan of care. Check
your work with your preceptor and then institute the plan.
Week 2
Continue 1st week process. Present your patients in rounds on a daily
basis (if clinical hours allow). Observe and/or practice technical
specialized skills within the unit under preceptor’s guidance/observation.
(Any skill observed once may be performed.)
Week 3
Continue 1st and 2nd week process. The student should attend deliveries,
act as practitioner in the delivery room. Admit patients when possible and
build case loads to follow through discharge.
Week 4
Continue 1st and 2nd week process including interactions with family predelivery (if possible), introduction to NICU, support and planning of care.
Week 5
Continue previous process. If outside transport are possible, attempt to
gain this experience. One acute alteration in health assessment due.
Week 6-7
Case load should consist of complex patients (i.e., 2-3 complex, 1 mild or
uncomplicated patients). Previous process should be continued on this
level. Clinical evaluations and site visits will begin. Objectives of
clinical should be met by the student in a semi-independent manner. If
not, reasons for not meeting objectives should be noted by student,
preceptor, and faculty.
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Department of Nursing
NURS7610
Syllabus
Week 8-11
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One acute alteration in health assessment due. Patients should be picked
up as admits where possible. Student should collect data, assess and plan
for patient through entire hospital stay including discharge planning. Any
specialized technical interventions needed should be performed by student
under preceptor’s observations. (TOTAL PATIENT CARE) Attend
deliveries as practitioner with preceptor. Try working off shifts for
different role on off-hours.
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
21
St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III-- Neonatal
ALTERATIONS IN HEALTH ASSESSMENTS
Purpose:
1. Provide an opportunity for the student to demonstrate application of didactic material on
care of the high-risk neonate in the clinical setting.
2.
Develop skills of data collection and case management assessment on four infants with a specific disease
entity.
Method:
1. Choose two complex infants presenting in the clinical setting. Collect histories, conduct
the physical exam and formulate assessments. Plan of care will be suggested by the
student and carried out in consultation with the preceptor.
2.
3.
4.
The complete SOAP format is to be submitted along with pharmacology emphasis assignment and this form
containing preceptor comments to your advisor.
Preceptor comments should reflect evaluation criteria as to student skill development. Please include
specific strengths and weaknesses and suggestions for improvement.
Submit the 2 acute disease assessments and preceptor evaluation forms based on time frame given in
guidelines for clinical experience to Marlene Wuethrich.
Evaluation Criteria
A. Completeness of Database
1.
Subjective data from mother, family,
or chart is relevant and pertinent for
positive and negative findings
a. Family for Newborn past health/social
history included to indicate chronic or
ongoing problems, status of usual health,
previous experience with illness.
b.
History of the present pregnancy and/
or newborn’s illness.
c.
2.
Preceptor Comments and Points
Maternal or Newborn presenting symptoms
or concerns are identified; and
qualified sufficiently to indicate importance;
the “real” concern is determined. What is the
identified potential risk for the infant?
Objective data is descriptive and clarifies
or supports subjective data.
a. Performs physical exam systematically
according to age, condition, and with
emphasis on presenting concern.
b.
Includes each organ system to
appropriate depth.
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Department of Nursing
NURS7610
Syllabus
c.
22
Performs gestation age exam.
d. Includes appropriate laboratory/
radiological data.
3.
4.
Assessment statement includes:
a. A descriptive summary of physical
findings, gestational age/pertinent
history and lab or radiological data.
b.
A judgment of the known specific
condition, degree of severity, probable
etiology, or reasonable probabilities,
i.e., “rule outs” which reflects standardized
knowledge base required by practice
specialty.
c.
An indication of family’s ability
to cope, understand, and implement
care.
Plan is appropriate and reflects current
practice standards/protocols.
a. Includes short and long term plans
Based on potential patient outcomes
b.
Included means for evaluation of
plan based on patient outcome.
c.
Areas for ethics, research, or
educational consideration are identified.
____________________________________
Preceptor Signature
___________________
Date
____________________________________
Student Signature
___________________
Date
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
23
The College of St. Catherine
Master of Arts in Nursing
NURS 7610: Alterations in Health III-- Neonatal
APPLIED CLINICAL
GUIDELINES FOR PHARMACOLOGY EMPHASIS
(Incorporated into complete H & P)
Purpose: To provide an opportunity to focus on essential pharmacologic data necessary to
provide safe drug therapy.
Assignment: The student:
1. Selects patient with problems where drugs are a part of the treatment plan.
2. Explains the rationale for the use of each drug including
a. Action (for what condition(s) is it used? How does it act? What changes should it bring
about?)
b. Contraindications for its use, if any
3. States the dosage prescribed including
a. Frequency given in a 24 hour period.
b. Route by which it is given (oral, I.M., etc.).
c. Any special instructions for giving the medication.
4. Lists most frequently encountered untoward (side) effects. (Suggest consulting with preceptor
for his/her experience with the drug.)
5. Explains the rationale for making any change in medications or their dosage.
6. Identifies possible deleterious drug interactions.
7. Incorporates this information, where appropriate, in the parent-teaching plan.
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
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St. Catherine University
Master of Arts in Nursing
Nursing 7610: Alterations in Health III--Neonatal
Newborn Assessment
I. History
A. Sex
B. Age at assessment/birthdate
C. Birth weight
D. Gestational age
E. Race
F. Prenatal summary
Grav____Para T____P____A____L____/History (past preg.)
Maternal Blood Type____Rh____Rubella____VDRL____HbAg____
D. LMP____EDC____
Prenatal complications
History of:
a. ISO immunizations
b. Toxemia
c. Oligo/Polyhydramnios
d. Premature labor
e. Vaginal bleeding
f. Fetal assessment testing
g. Medications
h. Substance use
I. Allergies
j. Acute/chronic illness
k. Surgery
l. Hospitalizations
m. Injuries
Ultrasounds Date_______Reason_____________________________________
Results_______________________________________________
a. Pre-pregnant weight
b. Height
c. Weight gain
d. Exercise pattern
G. Labor and delivery summary
Amniotic fluid - amount & color
Anesthesia
Fetal distress
Onset
Membranes Rupture Date__________ Time__________
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
25
Hours prior to delivery_________________
Length: First Stage
Second Stage
Third Stage
Monitoring / Results
Delivery
Presentation
Method
Episiotomy
Blood loss
Apgar scores
Resuscitation at birth
H. Medications - vitamin K, eye drops
II. Summary of Hospital Course to Date (Newborn)
III.
Physical Assessment
A. General appearance
1. Color and breathing
2. Alertness
3. Gross anomalies
4. Quality of cry
5. Distress / no distress
6. Amount of vernix
B. Measurements
1. OFC and percentile rank
2. Length and percentile rank
3. Weight and percentile rank
4. Temperature
5. Fontanels
C. Orientation of infant
1. Infant state (deep sleep/alert/crying)
2. Consolability
3. Infant interactive attractiveness
4. Infant need for stimulation
5. Self-quieting activities
D. Skin
1. Color
2. Lesions, stains, tumors, and/or hemangiomas, tags
3. Skin trauma, i.e., injuries secondary to delivery or forceps application
4. Congenital anomalies
5. Nails
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
6. Temperature
7. Turgor
8. Rashes
E. Head
1. Hair- color, distribution, and texture
2. Shape
3. Presence and amount of overriding sutures
4. Fontanels
a. Quality (flat, full, bulging, depressed, etc.)
b. Quality (length and width in centimeters)
5. Scalp
6. Visual adenopathy
7. Cephalohematoma
8. Caput Succedaneum
9. Cranial or facial asymmetry
10. Control and position
F. Face
1. Proportion
2. Symmetry
3. Lesions, stains, and/or skin trauma
4. Features
5. Edema
6. Temporal pulses
G. Eyes
1. Color, position, and spacing
2. Lids, lashes, and brows
3. Hemorrhages
4. Cataracts
5. Pupil reflex
6. Discharge and quality
7. Movements
8. Conjunctiva or sclera
9. Retinal red reflex bilaterally
10. Markings
11. Lacrimal apparatus
H. Ears
1. General appearance - anomalies
2. Position/alignment with palpebral fissures
3. External canal
4. Tympanic membrane color
5. Pinna
I. Nose
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Department of Nursing
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NURS7610
Syllabus
1.
2.
3.
4.
Position
Discharge (quality/quantity)
Nasal flaring
Patency
J. Mouth
1. Tongue and lips
a. size
b. color
c. rooting reflex
d. sucking reflex
2. Buccal mucosa
3. Palate
4. Retention cysts
5. Teeth
6. Pharynx
a. Uvula
b. Gag reflex
K. Neck
1. Visual adenopathy
2. Shape
3. Posture
4. Masses
5. Carotid pulses
6. Lymph nodes
7. Range of motion
8. Strength - head lag
L. Chest
1. Shape and symmetry of wall
2. Breast position - tissue mass
3. Respiratory rate
4. Character of respirations
5. Breath sounds
6. Clavicles - intact
M. Heart
1. Visual pulsations
2. Thrills
3. Rate
4. Rhythm
5. Heart sounds
a. First heart sound
b. Second heart sound
c. Murmurs
Master’s Degree Program
Department of Nursing
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NURS7610
Syllabus
N. Abdomen
1. Shape, size
2. Symmetry
3. Visual peristaltic waves
4. Umbilical cord and vessels
5. Hernia
6. Bowel sounds
7. Bruits
8. Muscle tone
9. Masses
10. Defects
11. Liver
12. Spleen
O. Genitalia
1. External male organs
a. Penis and uretheral orifice
b. Scrotal sac, testes, ruga, hydrocele hernias
2. External female organs
a. Clitoris
b. Labia
c. Vaginal orifice
d. Vaginal discharge
3. Voiding
4. Edema
5. Visual adnopathy
6. Lesions
7. Femoral pulses
P. Anus
1. Patency
2. Fissures
3. Tonicity
Q. Spine and extremities
1. Range of motion, symmetry, and alignment
2. Defects and abnormalities
3. Integrity of vertebral bodies
4. Edema
5. Number of digits
6. Appearance of palmar creases
7. Length and proportion
8. Position
9. Temperature of skin
10. Peripheral pulses
11. Ortolani’s sign
Master’s Degree Program
Department of Nursing
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NURS7610
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29
12. Barlow’s maneuver
13. Muscle tone and strength
a. DTR (deep tendon reflexes)
b. Clonus
c. Tremors
R. Neurological reflexes (refer to Gestational Age Form)
S. Gestational age (refer to attached forms)
T. Laboratory data
U. Social / Psychological Data: i.e., support, housing, insurance, culture, etc.
V. Current problems or concerns by system; i.e. #HCM (FEN), #Resp, #Metabolic, #Renal,
#GI, etc.
W. Assessment
X. Plan
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
30
St. Catherine University
Master of Arts in Nursing
NURS 7610: Alterations in Health III-- Neonatal
CLINICAL EVALUATION OF STUDENT: DONE BY STUDENT AND PRECEPTOR
Directions: Please rate your/student’s ability to meet the course objectives using the rating scale
below. Complete and have student submit to faculty, please.
1=Below Objectives (please explain) 2=At Objectives 3=Above Objectives 4=Not
observed
STUDENT
PRECEPTOR
Rating/Comments
Course Objectives
Rating/Comments
(infants with multifaceted health problems)
______________________________________________________________________________
__
1. Accurately collects and records a
thorough history of mom and baby.
2. Performs a newborn physical and
gestational age assessment.
3. Distinguishes between normal and
abnormal finding.
4. Selects, analyzes and interprets
appropriate lab and radiological
tests.
5. Identifies specific conditions, probable
etiology or reasonable probabilities i.e.
“Rule Outs”, “differential diagnosis.”
6. Participates in planning and
implementing care for neonates with
selected neonatal problems and their
families in the NICU.
a) Presents case on rounds with
identified plan of care
b) Supports care plan with current
data and theoretical knowledge
c) Evaluates infant’s response to
care and reviews changes with
other health team members
d) Participates in the development of
discharge plans and summary of
patient’s course in NICU
e) Accurately and effectively documents
plan and patient’s response to care
Includes long range and discharge planning
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
31
STUDENT
PRECEPTOR
Rating Comments
Course Objectives
Rating Comments
_______________________________________________________________________
6. Performs technical and specialized
skills according to protocol and
scientific data.
a) Arterial blood gases
b) IVs (peripheral-central)
c) Intubation
d) Umbilical catheterization
e) Lumbar puncture
f) Needle aspiration of pneumothorax
g) Placement of chest tubes
h) Cardiopulmonary resuscitation
i) Bladder taps
j) P.I.C. lines
7. Participates as the lead member of
the NICU delivery room/transport
team.
8. Display appropriate assessment of
family, intervention, and education.
9. Display consultation, cooperation and
effective communication with other
health team members.
10. Evaluate NNP role in NICU and
defines own philosophy of practice.
11. Identifies ethical considerations of
practice in the NICU.
12. Identifies relevance of nursing research
in the NICU.
Signature___________________
Signature_________________
Date______
Master’s Degree Program
Department of Nursing
Date_______
NURS7610
Syllabus
21
Master of Arts in Nursing
NURS 7610: Alterations in Health III-- Neonatal
INTRODUCTION TO COURSE
I. Objectives:
The student will:
1. Analyze the tertiary care environment’s impact on the target population.
2. Analyze theoretical concepts basic to advanced nursing practice in tertiary care setting.
3. Identify approaches to ethical dilemmas as they relate to advanced nursing practice in the
neonatal ICU.
II. Learning Experiences
Readings
Lecture
Discussion
III. Required Readings
1. ANA Code for nurses with interpretive statements.
2. Barthel, J. (1985, November). Jimmy. McCall’s, 109-161.
3. Johnaon, P.J. (2002) The History of the Neonatal Nurse Practitioner: Reflections From
Under the Looking Glass, Neonatal Network, 21(5), 51-59.
4. Juretschke, L. (2001) “Ethical dilemmas and the Nurse Practitioner in the NICU.”
Neonatal Network, 20(1).
5. Avery, G.B. (2005). Neonatology: Pathophysiology and management of the newborn.
Philadelphia: J.B. Lippincott.
6. Catlin, A. et al (2008). Conscientious Objection: A potential Neonatal Nursing
Response to Care Orders that Cause Suffering at the End of Life. Study of a Concept.
Neonatal Network. 27(2).
7. Groopman. J. (2011) A Child in Time. The New Yorker 87(33).; 26-35.
8. Matthews, A.L. & O’Conner-Von, S. (2008). Administration of Comfort Medication at
End of Life in neonates: Effects of Weight. Neonatal Network. 27(4).
9. NaNN Board of Directors (2012). Palliative Care for Newborns and Infants. Advances
in Neonatal Care 10(6) 287-293.
10. Kirkby, S., Greenspam, J.S. Kornhauser, M. Schneiderman, R. (2007). Clinical
Outcomes and Cost of Moderately Preterm Infants. Advances in Neonatal Care 7(2)
80-82.
11. Badr. L/K. Bahian, A.J., sossi, B., Hala, T., Nirvot, H. (2007). The Chasm in Neonatal
Outcomes in Relation to Time of Birth in Lebanon. Neonatal Network. 26(2).
12. Little, G.A., & Goodman, D.C. (2003). Growth in Neonatal Intensive Care: When is
Enough Enough? Advances in Neonatal Care, 3(4), 162-165.
13. NAANP Council, NANN Board of Directors (2012). Standards for Maintaining the
Competence of Neonatal Nurse Practitioners. Advances in Neonatal Care. 10(6).
282-286.
14.1Staebler,S. (2011) Regionalized systems of Perinatal Care. Advances in Neonatal
Care. 11(1) 37-42.
15. Witt, C.L. (2009). Neonatal Nurse Practitioners: A Value to Nursing. Advances in Neonatal Care.
9(3).
16. Honeyfield, M.E. (2009). Neonatal Nurse Practitioners, Past, Present, and Future. Advances in
Neonatal Care. 9(3).
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
22
St. Catherine University
Master of Arts Program in Nursing
NURS 7610: Alterations in Health III--Neonatal
Multifaceted Health Issues: Chronic Alterations in Health
I.
Objectives: The student will:
A. Understand the potential effect of neonatal chronic illness on function of family.
B. Describe the pathogenesis of common chronic alteration of health in the newborn.
C. Identify the clinical presentation and diagnostic data of common chronic alterations of
health in the newborn.
D. Describe the advanced nursing practice management of the neonate with a chronic
alteration in health.
E. Describe interventions that might reduce the incidence or severity of common chronic
alteration of health in the newborn/infant.
F. Utilize a family theory approach to dealing with neonate with a chronic alteration in
health.
II.
Learning Experience:
A. Readings/Discussion
B. Lecture/Discussion
C. Chronicity Project
III.
Required Readings:
NICHD Neonatal Research Network. Extremely Preterm Birth Outcome Data [online 2001].
http://www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/epbo_case.cfm
Avery, G.B. (2005). Neonatology: Pathophysiology and Management of the Newborn,
Philadelphia: J.B. Lippincott. Chapters 30, 59, 60.
Fredericks, D.W., Williams, L.W. (1998). New Definition of Mental Retardation for the
American Association of Mental Retardation. Images, 30(1), 57.
Goldsmith, J.P., Karotkin, E.H., & Baker, S. (2008). Assisted Ventilation of the Neonate,
Philadelphia: W.B. Saunders, Chapter 28.
McMurray, J.L.; Wilson Jones, M.; Khan, J.H. (2002). Cerebral Palsy and the NICU
Graduate. Neonatal Network.
Mitchell, S. (1999). Caring for the Visually Impaired Infant, The Nann Pages
Neonatal Network. pp. 41-46.
Kairamkonda, V.R. et al(2008). Lung function measurements in prematurely born
preschool children with and without chronic lung disease. Journal of
Perinatology. 28.
Godfrey, A. (2010). ‘Blue Babies’ Lost: Managing Adult Congenital Heart
Disease. Advance for NPs & PAs 1(1). 27.
Catlin, A. (2008). Extremely Long Hospitalizations of Newborns in the United
States. Advances in Neonatal Care. 8(2).
Vasquez, E.P.; Pitts, K.;Nilson, M.M. (2008) A Model Program: Neonatal Nurse
Practitioners Providing Community Health Care for High-Risk Infants.
Neonatal Network. 27(3).
Bull, M.J. & the committee on Genetics (2011) Clinical Report-Health supervision for
Children with Down Syndrome. Pediatrics 128(2) 393-406.
Master’s Degree Program
Department of Nursing
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Boos, V.D., et al (2010) The Comprehensive Care Rounds. Advances in Neonatal
Care. 10(6). 301-306.
Nawak, U.S. et al (2008) Differences in Short-Term Neonatal Outcomes Between
Discordant Twins. Advances in Neonatal Care. 8(6) 334.340.
Atun-Einy, d. & Sher, A. (2008) Measuring developmentally appropriate practice in neonatal
intensive care units. Journal of Perinatology. 28.
Discenza, D. (2009) NICU Patient’s Top Ten Worries at Discharge. Neonatal Network. 28(3)..
202-203.
Doucete, J. & Pintelli, J. (2004). The Effects of Family Resources, Coping and Strains on
Family Adjustment 18 to 24 Months after the NICU experience. Advances in
Neonatal Care. 4(2), 920104.
Hanrahan, K. et al. (2007). Neonatal Back Transport: Perspectives from Parents of MedicaidInsured Infants and Providers. Neonatal Network, 25(5).
Velma, R.P., Sridhar, S. & Spitzer, A.R. (2003). Continuing Care of NICU Graduates,
Clinical Pediatrics, 299---315.
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
24
The College of St. Catherine
Master of Arts in Nursing
Nursing 710: Alterations in Health III-- Neonatal
ALTERATIONS IN CEREBRAL PERFUSION
I. Objectives:
The student will:
1. Describe normal developmental anatomy and physiology of the human neurological
system.
2. Describe environmental, anatomical, physiological and gestational processes that can have
an effect on the neonate’s neurological system.
3. Identify the assessment criteria and techniques used to identify and diagnose common
alterations in cerebral perfusion in the neonate.
4. Demonstrate the management of the neonate with a selected alteration in cerebral
perfusion.
5. Develop an approach to hospital care (including ethical implications) for the family
experiencing a neonate with an alteration in cerebral perfusion.
6. Identify post discharge follow-up necessary for the neonate who has experienced an
alteration in cerebral perfusion.
II. Learning Experiences
A. Required Readings
Avery, G. (2005). Neonatology: Pathophysiology and management of the newborn.
Philadelphia: J.B. Lippincott, chapters 50-51.
Barker, S. (2007). Subdural and primary subarachnoid hemorrhages: a case study. Neonatal
Network, 26(3). 143-151.
Barr, L.L. (1999). Neonatal Cranial Ultrasound. Radiologic Clinics of North America. 37(6).
Brand, C.M. (2006). Examining the newborn with an open spinal dysraphism Advances in
Neonatal Care. 4. pp 181-196.
Brand, C.M.. (2007) Examination of the newborn with closed spinal dysraphism, Advanced in
Neonatal Care, 7, pp30-40.
Bulas, D.I. Vezina, G.L. (1999). Preterm Anoxic Injury: Radiologic Evaluation. Radiologic
Clinics of North America. 37(6).
Goldsmith, J. & Karotkin, E. (2010). Assisted Ventilation of the Neonate. Philadelphia:
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
25
W.B. Saunders, chapter 28.
Griffin, H.C., Fitch, C.L. & Griffin, L.W. (2004). The Causal Pathway Mode and Cerebral
Palsy. Neonatal Network. 23(6). 3-47.
Kirby, C.L. (2002). Posthemorrhagic Hydrocephalus: A Complication of Intraventricular
Hemorrhage. Neonatal Network. 21(1).
Lavery, S.V. & Randall, K.S. (2008) Cerebral Monitoring of the Term Infant. Neonatal Network
25(5).
Moore, K. (2008). Essentials of Human Embryology. Philadelphia: W.B. Saunders, chapter 16.
Nehring, W.M. & Faux, S.A. (2006). Transitional and Health Issues of Adults with Neural Tube
Defects. Journal of Nursing Scholarship. Fall Quarter. Pp 63-70.
Owens, R. (2005). Intravenricular Hemorrhage in the Premature Neonate. Neonatal Network,
24(3), 55-68
Purdy Isabell, B. & Wiley Dorothy J. (2003). “Magnetic Resonance Imaging and the Neonate”.
Neonatal Network. (22(1). 9-16.
Stokowski, L. (2006). Bedside Cerebral function Monitoring. Advances in Neonatal Care.
Wilson, J. (2000). “Neonatal nurses’ Role in Folic Acid Education.” Central Lines. 16, (4),
Reid, J. (2007) Neonatal subgaleal hemorrhage Neonatal Network, 26.
Ambalavanam, N., et al (2006) Predicting outcomes of neonates diagnosed with hypoxemicischemic encephalopathy. Pediatrics, 118.
Boylas, M.M. (2009). Recognition of caugal regression syndrome. Advances in Neonatal Care.,
9(2), 61-69.
Zywicke, H.A., & Rozelle, C.J. (2011). Sacral Dimples. Pediatrics in Review , 32(3), 109-113.
Shankaran, S. (2010). Neonatal encephalopathy: Treatment with Hypothermia. NeoReviews
11(2), 85-91.
Merritt, L. (2009). Recognizing Craniosynostosis. Neonatal Network, 28(6) 369-375.
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
26
NEUROLOGIC PROBLEMS OF THE NEWBORN
Definition of Terms
White matter: Inner layer of the cerebrum and cerebellum. The fiber tracts of the neuron cells.
Gray matter: The outer layer in the cerebrum and cerebellum. Contains neuron cell bodies.
Subepidemyal area: Beneath or inside ependyma, contains the germinal matrix.
Ependyma: Lining of the ventricles and the central canal of the spinal cord.
Parenchyma: The essential parts of an organ which are concerned with its function Vs
Its framework (the white or gray matter of the brain.)
Ventricles: Cavities in the brain containing CSF.
Germinal matrix: Area in the developing brain that produces glial cells and neurons.
Neurons: Excitable and conductile cells of the brain.
Glia cells: Connective, supportive and nutritive elements of the nervous system.
Foraman of monro: Opening between the 3rd and lateral ventricles of the brain.
Meninges: The three membranes covering the brain: Dura = external
Arachnoid = middle
Pia mater = internal
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
27
Factors Identified with Pathogenesis of Intraventricular Hemorrhage
Factors
Proposed Mechanism or Action
Prematurity
Presence of the subependymal germinal
matrix. Poorly supported, thin walled
vessels. Impaired auto regulation of
cerebral blood flow.
Impaired autoregulation of cerebral
blood flow
Present in premature and sick, asphyxiated
newborns, results in pressure passive
cerebral blood flow.
Asphyxia, hypoxia, hypercarbia
acidosis
Impaired autoregulation of cerebral blood
flow, vasodilation of cerebral vessels,
venous congestion, endothelial damage
Contributory arterial hypertension
In the presence of impaired autoregulation,
increased cerebral vasculature pressure,
hyperperfusion
Hypotension
In the presence of impaired autoregulation,
decreased cerebral blood flow, hypoxic
ischemia, hyperperfusion with restoration
of blood pressure
Elevated central venous pressure
Impeded venous return, obstruction of
major venous sinuses, and elevated venous
pressure
Hypercarbia
Dilation of cerebral vessels, increased
blood flow
Rapid volume expansion
With impaired autoregulation, increased
Cerebral blood flow, hyperperfusion
Assisted ventilation, high positive
inspiratory pressure, prolonged inspiratory
duration, continuous positive airway
pressure
Associated hypoxia, hypercarbia.
Increased intrathoracic pressure
cerebral venous return impeded, stasis,
cerebral venous congestive
Increased cerebral venous pressure
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
Rapid infusion of hypertonic
sodium bicarbonate or glucose
28
Hyperosmodality, fluid shift from
intracellular to intravascular space leading
to increased vascular volume; cerebral
vessel hyperperfusion. Abrupt increase
in PCO2 after bicarbonate if neonate not
adequately ventilated
Hyperosmodality
Hypernatremia
Pneumothorax
Increased mean systolic blood pressure
after pneumothorax transmitted to pressure
passive cerebral vessels. Impeded venous
return to the heart
Early patent ductus arteriosus
ligation following aortogram
Increased blood pressure following
ligation transmitted to cerebral vessels,
increased blood pressure related to
aortogram
Muscle relaxants during positive
pressure ventilation
Increased mean intrathoracic pressure or
increased arterial blood pressure
secondary to muscle relaxants transmitted
to cerebral vessels
Master’s Degree Program
Department of Nursing
NURS7610
Syllabus
29
Saint Catherine University
Master of Arts in Nursing Department
Nursing 7610: Alterations in Health III-- Neonatal
Chronic Alterations in Respiratory Function
I. Objectives: The student will:
1. Describe environmental, anatomical, and pathophysiological processes that can have a
chronic effect on the neonate’s respiratory system.
2. Identify the assessment criteria and techniques used to identify and diagnose common
chronic alterations in respiratory function in the neonate.
3. Describe the management of the neonate with a selected alteration in chronic respiratory
function.
4. Develop an approach to hospital care (including ethical implications) for the family experiencing
a neonate with a chronic alteration in respiratory status.
5. Identify post discharge follow-up necessary for the neonate who is experiencing a
chronic alteration in respiratory function.
II. Learning Experiences
A. Required Readings:
Ambalavanan, N., Carlo, W. (2006). Ventilatory strategies in the prevention and management
of bronchopumonary dysplasia. Seminars in Perinatology. 30.
Baveja, R. & Christou, H. (2006) Pharmacological strategies in the prevention & management
of bronchopulmonary dysplasia. Seminars in Perinatology. 30.
Biniwale, M.A. & Ehrenkranz, R.A. (2006). The Role of nutrition in the presentation and
management of bronchopulmonary dysplasia. Seminars in Perinatology.
Avery, G. (2005). Neonatology: Pathophysiology and Management of the Newborn.
Philadelphia: J.B. Lippincott, Chapter 30.
Goldsmith, J.P. & Karotkin, E.H. (2003). Assisted Ventilation of the Neonate. Chapter 21.
Mentso, A.M. (2004). Vitamin A and bronchopulmonary dysplasia: Research, issues, and
clinical practice. Neonatal Network, 23(4), 19-22.
B. Lecture / Discussion
Master’s Degree Program
Department of Nursing