LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 22A
Advanced Nursing Critical Care Life Span
COURSE SYLLABUS
for
ADULT THEORY CONTENT
Edited by:
Sigrid Sexton, RN, MSN, FNP
 2011 Long Beach City College Associate Degree Nursing
Program, Long Beach CA 90808
ADULT THEORY BEHAVIORAL OBJECTIVES
Theory Content: CARDIOVASCULAR DISORDERS ................................................................3.0
Heart Failure Worksheet ................................................................................................3.2
Heart Failure - Drug Worksheet ....................................................................................3.3
Hypertension Drug Worksheet ......................................................................................3.4
Hemodynamic Effects of Drugs ......................................................................................3.5
Sympathetic Drugs .........................................................................................................3.6
Theory Content: CARDIAC DYSRHYTHMIAS .........................................................................4.0
Cardiac Dysrhythmias Worksheet .................................................................................4.1
Dysrhythmia Practice Worksheets........................ ........................................................4.3
Theory Content: CARDIOPULMONARY ARREST ...................................................................5.0
Cardioversion vs. Defibrillation .....................................................................................5.2
Cardiac Dysrhythmias and Code Blue Drug Worksheet ..............................................5.3
Theory Content: ACUTE MI AND CARDIAC SURGERY ........................................................6.0
Complications of MI ........................................................................................................6.2
Comparison of MI and Pulmonary Embolism ...............................................................6.3
Myocardial Infarction Drug Worksheet .........................................................................6.4
Theory Content: RESPIRATORY FAILURE .............................................................................7.0
Verification of CD-ROM Completion Form ...................................................................7.1
Acute Respiratory Failure Worksheet ...........................................................................7.2
Acute Respiratory Disorders Drug Worksheet ..............................................................7.4
Classification of Respiratory Disorders... ......................................................................7.5
Theory Content: ACUTE RENAL FAILURE .............................................................................8.0
Renal Worksheet: Causes of Renal Failure ...................................................................8.2
Renal Worksheet: Phases of Acute Renal Failure ........................................................8.3
Theory Content: NEUROLOGICAL DISORDERS IN CRITICAL CARE ................................9.0
Worksheet: Medications for Critically Ill Neurological Patient ...................................9.2
Vocabulary: Neurological Health Deviations ................................................................9.3
Theory Content: Health Deviations: Cardiovascular Disorders
1. Independently review anatomy and physiology of the heart and systemic
circulation from previous nursing and biology classes.
2. Describe health deviations associated with the following cardiac compensatory
mechanisms: tachycardia, cardiac dilatation and cardiac hypertrophy.
3. Define and explain cardiac output, ejection fraction, Starling’s law of the heart,
stroke volume, cardiac contractility, and peripheral vascular resistance.
4. Define preload and afterload. List factors contributing to changes in preload and
afterload including medical and nursing actions. Include the collaborative role in
adjusting preload and afterload to maximize cardiac output in the patient with
heart failure. Complete the Hemodynamic Effect of Drugs worksheet on page 3.6
of the syllabus.
5. Describe causes of heart failure including valve disease, pericarditis, and
endocarditis. Describe the specific medical treatment for each cause of heart
failure.
6. Discuss the pathophysiology and stages of heart failure including effects on health
deviations. Describe theoretical frameworks used to describe heart failure
including right and left sided heart failure and systolic and diastolic failure.
7. Differentiate between clinical manifestations seen in early and late stages of heart
failure. Consider and describe the nurse’s response to each of these clinical
findings.
8. List non-cardiac causes of pulmonary edema. Consider the critical thinking
required to effectively collaborate with the healthcare team when many critical
illnesses have multiple causes.
9. Describe collaborative problems and team goals of treatment in the management
of the patient with heart failure.
10. Review the categories of drugs used in the treatment of heart failure as included
in the Heart Failure Drug Worksheet.
11. Discuss the hazards associated with potassium replacement therapy including
phlebitis, cardiac arrhythmias, and cardiac arrest and the nursing actions taken to
protect the patient against these hazards.
3.0
12. Describe diagnostic tests used in patients with heart failure including chest x-ray,
laboratory studies including BNP and arterial blood gases.
13. Describe the pulmonary artery catheter. Define and state the normal values for
pulmonary artery, central venous, and wedge pressures.
14. Describe the intra-aortic balloon pump (IABP) including indications, insertion,
actions and expected outcomes, and hazards of use. Describe the nurse’s role in
preventing hazards and optimizing the effectiveness of the balloon pump.
15. Prioritize common nursing diagnoses for the patient in acute and chronic heart
failure. Develop a teaching plan for a heart failure patient.
16. Describe the pathophysiology of shock states. Describe the hemodynamic
differences between cardiogenic shock and distributive (septic) shock. Describe
the collaborative role in caring for the patient in acute failure and the role of the
nurse in assuring patient safety.
17. Review pathophysiology, risk factors, complications, and dietary management of
hypertension. Describe the possible learning needs of a patient with hypertension.
18. Compare and analyze the differences between essential hypertension and
secondary hypertension according to pathology, etiology, incidence, and clinical
manifestations.
19. List health deviations that occur as a result of hypertension. Group these effects
according to target organ systems.
20. Describe the nursing care of the patient in hypertensive crisis including health
deviations, medical therapies, and the collaborative role of the nurse.
21. Identify how antihypertensive and cardiovascular drugs affect the elderly
differently.
22. Describe the clinical manifestations, complications, and medical and surgical
treatment of aortic aneurysm. Describe the priorities of nursing and collaborative
care during the immediate post-operative period.
23. Describe how cultural differences in diet and health seeking behaviors may affect
the nursing and medical management of heart failure and hypertension.
3.1
ASSIGNMENTS:
1. Texts:
2.
Brunner, 11th edition: pp. 781-790, 798, 813-820, 914-942, 944-969,
997-1001, 1021-1033, and as needed.
Urden, Stacy, & Lough, 5th ed., pp.151-170, 199-213, 241-244, 248-251,
and as needed.
Davis: as needed.
Dudek:5th ed., pp. 454-460 (nutrition in acute stress), 547-564 (heart
failure, hypertension), and as needed.
Complete the worksheets in the syllabus PRIOR to class.
Heart Failure Worksheet
Heart Failure Drug Worksheet
Hypertension Drug Worksheet
Hemodynamic Effects of Drugs
3.2
Heart Failure Worksheet
Place the following conditions into the following table:
Effects (these go in the top section of the table under either right or left heart
failure)
Systemic edema
Reabsorption of sodium and water
Pulmonary congestion
Increased preload
Engorgement of organs and tissues w/
Decreased renal and adrenal perfusion
edema
Increased blood volume
Poor perfusion of organs and tissues
Increased systemic venous pressure
Increased pulmonary venous pressure
Fluid seepage into alveoli
Symptoms (these go in the bottom section under either right or left heart failure)
Hemoptysis
Dependent edema
Sudden onset
Hepatomegaly, splenomegaly
Wheezing
Paroxysmal nocturnal dypsnea
Gradual onset
SOB, orthopnea
Cough
Ascites
Milder symptoms
Weight gain
Severe symptoms
RIGHT HEART FAILURE
Backward congestion:
LEFT HEART FAILURE
Backward congestion:
Forward failure:
Forward failure:
SYMPTOMS
3.3
HEART FAILURE - DRUG WORKSHEET
Category
Drugs affecting RAA system
Ace Inhibitors
Drugs
Actions and Uses
Captopril
Vasotec (enalapril)
Angiotensin Receptor
Blockers
Diuretics
Loop
Diovan (valsartan)
Thiazides
Hydrochlorothiazide
Aldosterone antagonist
Aldactone
Cardiac Glycoside
Digoxin
Beta Adrenergic Blockers
metoprolol (Toprol-XL)
Lasix
carvedilol (Coreg)
Direct Vasodilator
Phosphodiesterase
Inhibitors
Inotropic Drugs
Hydralazine
Isordil
Natrecor
Milrinone (Primacor)
Inamirinone (Inocor)
Dobutamine
3.4
Adverse Effects
Nursing Responsibilities
HYPERTENSION DRUG WORKSHEET
CLASS
ACTIONS
DRUGS
Diuretics
Thiazides
Hydrochlorothiazaide
Loop Diuretics
Lasix
Aldosterone blocker
Aldactone
Calcium Channel Blockers
amlodipine
nicardipine
nifedipine
Adrenergic Antagnoists:
Lisinopril
Beta-adrenergic blockers
Alpha1-adrenergic blockers
Alpha2-adrenergic agonists
Captopril
Apresoline
Direct Vasodilators
Nitroprusside
3.5
SIDE EFFECTS
NURSING
INTERVENTIONS
Drug Classification
HEMODYNAMIC EFFECT OF DRUGS
Effect on Heart Rate
Effect on Preload
Effect on Afterload
Digoxin
Dopamine
Dobutamine
Nitroglycerin
Nitroprusside
Levophed
Epinephrine
Calcium Channel Blockers
Beta Adrenergic Blockers
3.6
Effect on Cardiac
Contractility
THEORY CONTENT: HEALTH DEVIATION: CARDIAC DYSRHYTHMIAS
1. Independently review the electrical conduction system and mechanical response of the
heart.
2. Describe the following dysrhythmias according to physiology, origin of impulse, criteria
for identification, hazards, treatment and health deviations.. Complete the Cardiac
Dysrhythmia worksheet found on page 4.1.
sinus tachycardia (ST)
sinus bradycardia (SB)
premature atrial contraction (PAC)
premature ventricular contractions (PVC)
atrial fibrillation (A-Fib)
ventricular tachycardia (V-Tach)
ventricular fibrillation (V-Fib)
asystole
3. Identify dysrhythmias found on pages 4.3 to 4.5 of the syllabus.
4. Discuss the role of pacemakers in cardiac dysrhythmias. Describe the code system used
to designate pacemaker modes using a three letter system.
5. Discuss nursing assessments and care of the patient with a temporary or permanent
cardiac pacemaker. Include promotion of normalcy.
6. Describe the nursing assessments and care of a patient undergoing an electrophysiology
study (EPS). Describe radiofrequency catheter ablation including the goals of treatment.
7. Discuss the importance of communicating collaboratively with the physician and monitor
technician in adjusting care and monitoring needs for the patient with dysrhythmias.
REQUIRED ASSIGNMENTS:
Text:
Brunner, 11th edition, pp. 816, 823-856, 875-876, and as needed
Urden, Stacy & Lough, 5th edition, pp. 137-151, 624-680, 686-776 and as needed.
Syllabus:
Cardiac Dysrhythmias Worksheets
EKG recognition practice
RECOMMENDED ASSIGNMENTS:
Nursing Video Skill Series:
Video #215: "Reading ECG Rhythm Strips”:
CD-ROM:
"EKG Rhythm Strip Recognition Courseware", available at
http://itdc.lbcc.edu/cps/nursing/EKGwebsite/ekg.htm ; written by Sigrid Sexton, RN faculty.
4.0
CARDIAC DYSRHTHMIAS WORKSHEET
Dysrhythmia
Physiology and
Origin of Impulse
Monitor Pattern
Description
Sinus Bradycardia
Sinus Tachycardia
Supraventricular
Tachycardia
Premature Atrial
Contractions (PACs)
Atrial Fibrillation
Atrial Flutter
4.1
Prognosis/Treatment
CARDIAC DYSRHTHMIAS WORKSHEET
Dysrhythmia
Physiology and
Origin of Impulse
Monitor Pattern
Description
Premature Ventricular
Contraction
Ventricular
Tachycardia
Ventricular
Fibrillation
Ventricular Standstill
(Asystole)
4.2
Prognosis/Treatment
Long Beach City College
ADN 22A Critical Care
EKG Recognition practice
1.
2.
3.
4.
5.
6.
4.3
7.
8.
9.
10.
11.
4.4
12.
13.
14.
15.
16.
4.5
THEORY CONTENT: HEALTH DEVIATION: CARDIOPULMONARY ARREST
1. Describe the expected assessment findings of a patient with health deviations
pertaining to cardiopulmonary arrest and respiratory arrest.
2. Compare respiratory arrest and cardiac arrest as to etiology, assessment, wholly
compensatory nursing interventions and emergency measures.
3. Differentiate between Basic Cardiac Life Support (BCLS) and Advanced Cardiac
Life Support (ACLS).
4. Give the actions, doses, and routes of the following emergency drugs:
Amiodarone, calcium chloride, epinephrine, atropine sulfate, morphine sulfate,
oxygen, dopamine, and sodium bicarbonate.
5. Compare and analyze the differences between cardioversion and defibrillation
(see worksheet).
6. Describe the Automated External Defibrillator (AED) and its use in pre-hospital
cardiac care and in-hospital transport of patients.
7. Describe the Automated Implantable Cardiac Defibrillator (AICD) and the
psychological stressors associated with its use. Discuss how the AICD may affect
sexual intimacy.
8. Discuss the physical and emotional care of the patient who has been resuscitated
and the educative/supportive role for the family.
9. Discuss the medical and legal considerations concerning cardiopulmonary
resuscitation and end of life care in the ICU.
10. Identify priorities of care for the patient with bradycardia, tachycardia, PEA,
ventricular fibrillation, ventricular tachycardia, and asystole. Identify medical and
nursing responsibilities.
11. Discuss the role of collaborative management during a Code Blue and during endof- life care in the ICU.
REQUIRED ASSIGNMENTS
Text:
Brunner, 11th edition: pp. 969-972, and as needed.
Urden, Stacy & Lough, 5th edition: pp.109-117, 131-150, and as needed.
5.0
Syllabus:
Cardioversion/ Defibrillation worksheet.
ACLS algorithms
Code Blue Drug Worksheet
Library Article:
Impact of a Multifaceted Intervention on Nurses and Physicians Attitudes
and Behaviors Towards Family Presence During Resuscitation.
Criticalcare Nurse. February 2007; 27 (1)
Tomas, K. Rapid Response Team; Challenges, Solutions, Benefits.
Critical Care Nurse. (2007). 27 (1)
Web Site:
http://www.madsci.com/manu/indxacls.htm
5.1
CARDIOVERSION
DEFIBRILLATION
Differences
1. Definition - use of electrical shock to
convert non-lethal atrial and ventricular
tachyarrhythmias.
Refers to a high voltage shock delivered
through the chest wall in order to stop the
chaotic electrical activity of lethal ventricular
arrhythmias.
2. Usually a non-emergency, elective situation. ALWAYS an emergency situation.
3. Used to convert atrial flutter, atrial
Attempts to convert ventricular fibrillation and
fibrillation, or ventricular tachycardia with a ventricular tachycardia to sinus rhythm.
pulse.
4. Patient is usually alert, so the consent, IV,
pre-medication, and crash cart are ready.
Patient is usually unconscious;
Exception: early ventricular tachycardia.
5. Synchronized - electrical impulse must
NOT synchronized - if switch is ON machine
NOT hit the T wave. So the synchronization will wait for QRS - which may not exist.
button is depressed so that it will
synchronize with the R waves.
6. 25 - 100-watt seconds Is increased on
successive tries.
Usually start with minimum of 200-watt
seconds, maximum of 360 watt-seconds.
7. Digitalis preparations are often held for
several days.
Unable to wait in order to allow digitalis levels
to go down.
Similarities






Both stop the electrical activity of the heart by depolarizing the heart muscle.
Same paddle placement –
o Standard placement - To the right of the upper sternum below the clavicle
and just to the left of the left nipple in anterior-axillary line.
o Alternative placement - anteriorly over the left precordium and posteriorly
behind the heart.
Adhesive disposable paddles in elective situations and after the initial shock in
emergency situations.
If paddles are used, conductive pads are used with paddles to facilitate the flow of
electricity and to prevent burns.
Oxygen is turned off.
All personnel stand away from bed when the "all clear" command is called.
5.2
THEORY CONTENT: HEALTH DEVIATION: ACUTE MYOCARDIAL
INFARCTION AND CARDIAC SURGERY
1. Independently review Cardiovascular Health Deviations from ADN 12A and
Biology courses with emphasis on:
Cardiac Anatomy and Physiology
Coronary Circulation
Cardiac Conduction System
Pathophysiology of Coronary Artery Disease (CAD)
2. Discuss the health deviations as it relates to the pathophysiology of coronary
insufficiency including ischemia, injury, and infarction.
3. Compare and contrast the clinical manifestations, medical therapies, and nursing
care cardiovascular patients with angina, Acute Coronary Syndrome (ACS), and
Myocardial Infarction (MI).
4. Define the implications of intramural, subendocardial, and transmural MI’s.
Describe the implications of a ST elevation MI (STEMI) vs. a non-STEMI.
5. Identify and discuss briefly the stages of healing, and complications that occur
after myocardial infarction.
6. Identify and analyze the complications of an MI according to incidence and
severity, clinical manifestations/ assessments, nursing intervention. Complete the
worksheet prior to class.
7. Discuss the specifics of drug and diet therapy, emotional and sexual adjustments,
the role cultural diversity plays, progressive activity, and the functions of the
nurse in the educative/ supportive role for the client who has had an acute
myocardial infarction. Use worksheets provided in the syllabus.
8. Complete the drug worksheet and identify how the drugs on the worksheet affect
the elderly differently.
9. Discuss the following medical/ surgical measures for angina and acute MI clients:
Thrombolytic therapy, Percutaneous Coronary Angioplasty (PTCA), and
Intracoronary stents.
10. Name and describe the incisions used for cardiovascular by-pass surgery and how
this affects the nursing care of a cardiac surgery client. Include pain management.
11. Briefly discuss the functions of a cardio-pulmonary bypass using the heart-lung
machine and the implications for post-op nursing care.
12. Identify the pre-op care and promotion of normalcy of the cardiac surgery clients.
6.0
13. Compare and contrast the incisions, procedures, and recovery for a patient
undergoing a CABG vs. a Minimally Invasive Direct Coronary Artery Bypass
(MID-CAB).
14. Identify the common post-op complications and how these affect the self-care
requisites of valve replacement coronary artery by-pass surgery. Include health
deviations associated with these complications.
15. Discuss the effect of cardiac dysfunction including myocardial infarction and
cardiac surgery on the client’s intimacy and sexuality.
ASSIGNMENTS Prior to class, complete the following required reading and
worksheets in syllabus.
1. Texts: Brunner, 11th edition: pp. 791-813, 858-911 and as needed.
Urden, Stacy & Lough, 5th edition, pp.174-198, 227-241 and as needed.
Dudek, 5th edition pp. 525-546 (nutrition for patients with cardiovascular
disorders) and as needed.
Davis Drug Handbook and Carpenito. as needed.
2.
Required Articles:
Massive Pulmonary Embolism. Critical Care Nursing. February 2007;
27(1): 39-50
Unstable Angina: Is your Care up to Snuff. RN, February 2005, 22-27.
3. Complete the following worksheets in the syllabus: Complications of MI,
Comparison of MI and PE, and MI drug worksheets
4.
Recommended viewing in Learning Center:
Video: Cardio-Vascular Nursing Principles of Hemodynamic Monitoring.
6.1
COMPLICATIONS OF MI
COLLABORATIVE
PROBLEMS
1. Arrhythmias
SEVERITY/
INCIDENCE
2. CHF
3. Cardiogenic Shock
4. Thromboembolic
Episodes
Pulmonary Emboli
Mural Thrombi
Leg, Pelvic Thrombi
5. Cardiac Rupture/
Tamponade
6. Ventricular Aneurysm
7. Pericarditis
8. Extension of MI/
Another MI
6.2
ASSESSMENT
NSG DIAG./
NSG.INTERV.
Worksheet:
Comparison of Myocardial Infarction and Pulmonary Embolism
Acute MI
Pulmonary Embolism
Onset of Pain
Location of Pain
Quality of Pain
Pain Induced by…
Duration, Frequency of
Pain
Response to
Nitroglycerin
Anxiety
Diaphoresis, pale skin
Hypoxia
Nausea
Dypsnea
Fever
Leukocytosis
Cardiac Enzymes
12 Lead EKG
Rhythm Strip
D-dimer (lab test)
V/Q Lung Scan
CT Scan
Arteriogram
6.3
MYOCARDIAL INFARCTION DRUG WORKSHEET
Class Specific Action
CORONARY artery vasodilators
Nitrates/Nitrites
Short Acting
Long Acting
VASODILATORS
Afterload reducers.
MYOCARDIAL workload reducers
Beta Blockers
Condition Used for
Coronary Artery Spasms.
Angina
Nitroglycerine
ASHD
Post MI
Nitropaste
Isordil
Cardiogenic Shock
Heart failure
HTN Crisis
Nitroprusside
(Nipride)
Angina Post MI
Inderal
Corgard
Verapamil
Cardizen
Procardia
Calcium Channel Blockers
VASOPRESSORS/ Inotropes
Drugs
Cardiogenic shock
Severe CHF
ANTIARRHYTHMIC
Arrhythmias
ANTILIPEMICS
Atherosclerosis
THROMBOLYTICS
Recent MI or
MI in progress
Dopamine
Dobutamine
Lidocaine
Quinidine
Questram
Clorfilrate
Niacin
Lopid
Streptokinase
Urokinase
tPA (Tissue Plasma
Antigen)
6.4
Side/Toxic Effect
Nsg.Interventions/
Educ. Supportive
THEORY CONTENT: HEALTH DEVIATION: ACUTE RESPIRATORY FAILURE
1. Independently review the anatomy and physiology of respiration from nursing
prerequisite courses.
2. Prior to class complete the Acute Respiratory Failure Worksheet. Define each of the
following terms and be prepared to discuss the effect of acute respiratory disorders on
these factors:
a. stimulus for breathing
b. distribution
c. ventilation
d. respiration
e. perfusion
f. diffusion
g. shunting
h. compliance
i. surfactant production
j. cardiac output
3. Identify the disorders that interfere with the mechanics of respiration and categorize them
according to the areas affected using the Classification of Respiratory Disorders
worksheet.
4. Review the following diagnostic tests commonly used to assess the patient with a
respiratory health deviation. Be prepared to interpret ABGs identifying acid/base
imbalances and the presence of compensation.
a. Arterial blood gasses
b. Pulse oximetry
c. Pulmonary function testing
d. Chest X-ray
e. Mixed venous saturation
f. Bronchoscopy
5. Identify the clinical manifestations of respiratory failure in early and later stages. Discuss
nursing and collaborative interventions for respiratory failure.
6. Discuss the nutritional needs and management of the client in respiratory failure. Include
needs related to increased work of breathing and the effect of excessive dietary
carbohydrates.
7. Discuss etiology, pathophysiology, preventive measures, clinical manifestations, and
medical and nursing management associated with the following respiratory illnesses:
a. Adult Respiratory Distress Syndrome
b. Chronic Obstructive Pulmonary Disease (emphysema, chronic bronchitis)
7.0
c.
d.
e.
f.
g.
h.
i.
j.
Asthma
Cor Pulmonale
Ventilator Associated Pneumonia (VAP)
Oxygen toxicity
Pulmonary Embolism
Pulmonary Edema, including non-cardiac causes
Pleuritis and pleural effusion
Pneumothorax
8. Identify common nursing diagnoses, potential complications and interventions for the
client with the respiratory diseases listed above.
9. Complete the respiratory drug worksheet provided in your syllabus.
REQUIRED ASSIGNMENTS:
Text:
Urden, Stacy & Lough, 5th edition: pp. 255-322 and as needed
Brunner: 11th edition, pp. 522-586, 624-680, 686-776, and as needed
Davis: as needed
Dudek:5th ed, pp. 464-466, and as needed
Syllabus:
Acute Respiratory Failure Worksheets
Classification of Respiratory Disorders Worksheet
Library Articles: Six steps to ABG Analysis, Nursing 2007, March, Vol.2, #2, pages 48-52.
CD-Rom:
ABGs
Web Sites:
http://www.rnceus.com/abgs/abgmethod.html
RECOMMENDED ASSIGNMENTS:
Videos:
Mechanical Ventilation
Acid/Base Balance: Ups and downs of pH.
Metabolic alkalosis and acidosis.
Respiratory alkalosis and acidosis.
Assessing Breath Sounds.
7.1
Long Beach City College
Associate Degree Nursing Program
ADN 22A
Verification of CD-ROM completion
To be signed by a Learning Center representative.
The student, _________________, has completed the CD-ROM, ABG’s.
Signed__________________________
7.2
ACUTE RESPIRATORY FAILURE WORKSHEETS
I. Define the steps involved in the pathophysiology of respiration and list the disorders that
interfere with each step.
DEFINITION
DISORDERS
stimulus for breathing
distribution
ventilation
hypoventilation
hyperventilation
respiration
perfusion
diffusion
shunting
surfactant production
Cardiac Output
II. Define these parameters related to respiratory failure and give their normal values.
DEFINITION
NORMAL VALUES
tidal volume
minute ventilation
vital capacity
compliance (peak inspiratory pressure)
SVO2 (mixed venous oxygen saturation)
pulse oximetry
7.3
III. Complete the following chart of expected blood gas findings and indicate whether these
values are elevated or lowered in the conditions below.
ABG'S
NORMAL
VALUE
METABOLIC METABOLIC RESP.
ACIDOSIS
ALKALOSIS ACIDOSIS
RESPIRTORY
ALKALOSIS
PH
PCO2
PO2 (room
air)
HCO3
base excess
O2
saturation
IV. Practice ABGs.
pH
#1
7.10
#2
7.48
#3
7.42
#4
7.10
#5
7.27
#6
7.50
#7
7.47
#8
7.30
PCO2
47
30
26
90
65
28
40
37
PO2
58
107
88
80
57
55
67
85
HCO3
14
23
16
24
30
25
29
15
Base
excess:
-15
7
7
+2
1
1
6
-15
O2 sat:
79%
98%
97%
90%
85%
90%
94%
98%
Interpretation
7.4
ACUTE RESPIRATORY DISORDERS – DRUG WORKSHEET
Class –Actions
Beta-Adrenergic Agonists
Conditions Used For
Drugs
Maxair (pirbuterol)
Proventil (albuterol)
Serevent (salmeterol)
Anticholinergics
Atrovent (ipratropium)
Spiriva (tiotropium)
Methylxanthines
Theo-Dur (theophylline)
Corticosteroids
Beconase
(beclomethasone)
Prednisone
Solumedrol
Leukotriene Modifiers
Accolate (zafirlukast)
Singulair (montelukast)
Mast Cell Stabilizers
Intal (cromolyn)
7.5
Side/Toxic Effects
Nursing Responsibilities/
Interventions
CLASSIFICATION OF RESPIRATORY DISORDERS
Place the following conditions into the correct category:
Pulmonary emboli
Foreign body obstruction
Pneumothorax
Myasthenia Gravis crisis
Pneumonia
Obesity
Botulism
Shock
Cystic fibrosis
Asthma
Pulmonary edema
Sepsis
Tumor
Trauma
Flail chest
Hyperthermia
MI
Bronchitis
Nonpulmonary Disorders:
Pleura and chest wall pathology:
Respiratory muscle and nerve pathology:
Increased oxygen consumption:
Inadequate cardiac output:
Pulmonary Disorders:
Airway Obstruction:
Parenchymal Diseases:
Vascular diseases:
7.6
Pulmonary fibrosis
ARDS
Polio
Emphysema
Thoracic wall surgery
Scoliosis
Cardiomyopathy
Heart Failure
THEORY CONTENT: HEALTH DEVIATION: ACUTE RENAL FAILURE
10. Independently review the anatomy and physiology of the kidneys from nursing
prerequisite courses.
11. Discuss the following functions of the kidneys as it pertains to preventing health
deviations:
a. Regulation of water and electrolytes
b. Regulation of blood pressure
c. Regulation of acid-base
d. Regulation of erythropoiesis
e. Regulation of calcium and phosphate
12. Define and describe the common health deviations resulting from acute renal failure,
acute tubular necrosis and nephrotic syndrome.
13. Describe, differentiate and discuss the etiology/ risk factors, pathophysiology,
assessment, nursing interventions and management of the patient in acute renal failure in
terms of the categories of prerenal, intrarenal and postrenal failure. Use “Causes of Acute
Renal Failure” worksheet, page 8.2.
14. Describe and discuss the purpose/ rationale, normal values, and nursing responsibilities
for the following tests:
a. Serum BUN
f. Renal Angiography
b. Serum Creatinine
g. Renal Biopsy
c. Serum Osmolarity
h. Renal Ultrasound
d. Creatinine Clearance
i. KUB
e. 24 hour urine
15. Identify and differentiate between the three phases of (Oliguric, Diuretic, and Recovery)
of acute renal failure in terms of
a. Pathophysiology
b. Clinical manifestations/ assessment
c. Fluid, electrolytes, and metabolic changes
d. Management and nursing interventions
16. List the nursing interventions associated with each of the three nursing agencies (wholly
compensatory, partially compensatory, and educative supportive) for the patient
progressing through the phases of acute renal failure.
17. Describe the educative/ supportive nursing interventions pertaining to the dietary
restrictions for the acute renal patient in each of the three phases of acute renal failure.
8.0
18. Explain the action, effects, and rationale for the following medications that may be
prescribed for the acute renal failure patient:
a. Sodium Bicarbonate
b. Glucose and Insulin
c. Kayexalate
19. Describe the common causes, pathophysiology, treatment and possible complications of
rhabdomyolysis.
20. Describe the following in regards to acute glomerulonephritis:
a. Etiology
b. Pathophysiology
c. Clinical manifestations
21. Identify the possible complications of peritoneal dialysis and hemodialysis. Describe the
collaborative management of these complications.
REQUIRED ASSIGNMENTS:
Text:
Urden, Stacy & Lough, Priorities in Critical Care Nursing, 5th edition, Chapters 19
and 20.
Brunner and Suddarth’s Textbook of Medical Surgical Nursing, 12th Edition,
Chapters 43, 44, and 45.
Dudek: 5th edition: Nutrition Essentials for Nursing Practice, Chapter 20: Nutrition
for Patients with Renal Disorders
Davis: as needed
Syllabus:
Causes of Renal Failure, page 8.2
8.1
RENAL WORKSHEET
Causes of Acute Renal Failure
Type of Failure
Etiology/
Predisposing
Factors
Pathophysiology
Prerenal
Intrarenal
Postrenal
8.2
Assessments
Nursing
Interventions/
Medical
Management
RENAL WORKSHEET
Phases of Acute Renal Failure
Phase
Pathophysiological
Changes
Results of
Pathophysiologic
Changes
Oliguric
Diuretic
Recovery
8.3
Nursing
Interventions
Medical
Management
Educative
Supportive Role
THEORY CONTENT: NEUROLOGICAL HEALTH DEVIATIONS IN CRITICAL
CARE
1. Independently review anatomy and physiology, assessments, health deviations, and
diagnostic tests related to the nervous system from ADN 12B and previous courses.
2. Define intracranial pressure (ICP) and identify the pathophysiologic process,
common causes, signs and symptoms, health deviations, and medical and nursing
management of increased intracranial pressure using the Increased Intracranial
Worksheets. Define Cerebral Perfusion Pressure (CPP) and discuss its significance
in monitoring the patient with a high ICP.
3. Describe the various types of ICP monitors and drains. Describe the health
deviations, risks and nursing responsibilities associated with these devices.
4. Discuss health deviations found in patients with head trauma including concussion,
diffuse axonal injury, cerebral contusion, and basilar skull fracture. Describe
nursing and medical management of each type of injury.
5. Review the various types of cerebral bleeds including intracerebral hemorrhage,
subdural hematoma, epidural hemorrhage, and subarachnoid hemorrhage. Describe
the causes, clinical manifestations, and nursing role in the treatment of each type of
cerebral bleed.
6. Describe the causes, pathophysiology, and common complications of subarachnoid
hemorrhage.
7. Complete the Neurological Medications Worksheet.
8. Describe the potential complication of brain herniation, including predisposing
factors and the nurse’s role in prevention.
9. Describe the pituitary complications associated with brain injury.
10. Describe emergency and critical care treatment of patients with Cerebrovascular
Accident (CVA) including interventional procedures and the use of thrombolytic
medications.
11. Describe the criteria used to determine brain death. Discuss special considerations
in the care of the brain dead patient in preparation for organ donation. Describe the
educative/supportive role of the nurse in the care of the family of the brain dead
patient.
12. Describe the special problems and nursing management of the unconscious patient.
Be prepared to discuss applicable nursing diagnoses.
9.0
ASSIGNMENTS:
Text:
Brunner and Suddarth: 12th edition, pp. 1828-1856, 1895-1948.
Lippincott Nurse’s Drug Guide, as needed.
Urden, Stacy & Lough, 5th edition.
Syllabus:
Worksheet: Neurological Medications
Worksheet: Vocabulary: Neurologic Health Deviations
9.1
Worksheet: Medications for the Critically Ill Neurological Patient
Drug
Action/Indication
Route/Dose
Dilantin
Phenobarbital
Mannitol
Solu-Medrol
3% Normal Saline
9.2
Nursing
Considerations
VOCABULARY: NEUROLOGICAL HEALTH DEVIATIONS
Doll’s Eyes
Nystagmus
Nuchal Rigidity
Deep Tendon Reflexes
Craniotomy
Burr Holes, Bone Flap
Vertigo
Hydrocephalus
Decorticate Posturing
Decerebrate Posturing
Kernig’s Sign
Brudzinski’s Sign
Halo Sign
Periorbital Edema
Papilledema
Battle’s sign
Racoon eyes
Cushing’s Triad
Babinski’s Reflex
Plantar Reflex
Dermatomes
Ipsilateral
Contralateral
9.3