WESTERN NEVADA COLLEGE
NURSING 276
ADVANCED CLINICAL NURSING II THEORY
Nursing 276 – Spring - 2010
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WESTERN NEVADA COLLEGE
ADVANCED CLINICAL NURSING II -- THEORY
NURSING 276
Credits: 3
Prerequisite(s):
Successful completion of the second year nursing
program fall semester
_________________
Faculty
Michael Malay, RN, MS,
Cedar 216
malaym@wnc.edu
445-4404 (office)
762-5465 (cell)
Sherry Neil-Urban, PhD, RN
Cedar 215
Neilurba@wnc.edu
445-4279 (office)
787-7714 (home)
233-6885 (cell)
I. COURSE DESCRIPTION
Assists students to gain knowledge of nursing care for the patient experiencing
primary threats to physiological integrity due to complex multisystem disruption.
The student will apply the nursing process to address needs in the
psycho/social/cultural and spiritual domains which emerge with primary threats to
physiological integrity. Related legal and ethical issues are applied throughout
the course.
II. COURSE OBJECTIVES
Upon completion of this course the student will be able to:
A. Comprehend and apply college level written material.
B. Integrate theory necessary to perform complex nursing interventions to meet
the bio/psycho/social/cultural/spiritual needs of patients in acute care
settings.
C. Integrate pathophysiology, pharmacology and nutritional therapies to analyze
effective care for patients experiencing complex alterations in health.
D. Expand upon the nursing management and evaluation of persons with
complex alterations using the nursing process and Maslow’s Heirarchy of
Needs as a guiding framework.
Nursing 276 – Spring - 2010
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E. Describe the role of prevention, health promotion and health maintenance as
they related to complex health alterations.
F. Apply concepts of cultural awareness and cultural sensitivity to the care of
patients from a wide variety of backgrounds and cultures.
G. Define diagnostic criteria for a variety of complex alterations in health.
H. Depict the relationship of various therapeutic modalities on patient recovery
for a number of disease states.
I. Analyze legal and ethical implications for persons experiencing multi-system
dysfunction.
J. Apply critical thinking to provide cost effective, quality care for clients/patients.
K. Utilize technology in accessing and in presenting information.
L. Explore advances and trends in clinical nursing related to selected content
areas.
III. CONTENT OUTLINE
I. Assessment, diagnosis, treatment, and evaluation of Nursing care for
persons with complex alterations in health related to:
A. Cardiovascular dysfunction
1. Acute myocardial infarction
2. Heart Failure
3. Valvular Dysfunctions
4. Cardiomyopathies
5. Coronary Artery Disease
6. Cardiac surgery
7. Pharmacologic management
8. Cardiac dysrhythmias
9. Cardiac rehabilitation
10. Cardiac infections
B. Respiratory Dysfunction
1. Acute Respiratory Failure
2. Adult Respiratory Distress Syndrome
3. Management of the patient requiring ventilatory support
4. Weaning and pulmonary rehabilitation
5. Home oxygen therapy
C. Peripheral Vascular Dysfunction
1. Hypertensive emergencies
2. Acute Arterial Occlusions
3. Vascular surgery
4. Thrombolytic and Anticoagulant therapy
D. Neurologic dysfunction
1. Increased intracranial pressure
2. Unconscious patient
3. Spinal cord injuries (acute management)
4. Brain death (ethical and legal issues)
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A. Gastrointestinal dysfunction
1. Acute gastrointestinal infection (including peritonitis)
2. Acute gastrointestinal hemorrhage (upper and lower)
3. Acute and chronic hepatic and pancreatic dysfunction
4. Management of the complicated abdominal surgical
client/patient
including wound and fistula care
F. Alteration in skin integrity (Burns)
1. Classification
2. Emergency management
3. Systemic effects
4. Acute care
5. Rehabilitation issues
II. Restoration of health for complex patients in complex clinical settings.
A. Principles and priorities of emergency nursing
B. Nursing Assessment and interventions in the following:
1. Blunt and Penetrating Trauma
2. Acute Abdomen
3. Problems with temperature regulation
4. Poisoning
5. Toxic ingestions
6. Multiple Trauma
7. Ethical and legal considerations
C. Critical Care
1. Organized multi-system assessment
2. Overview of advanced monitoring concepts
3. Management of patients with multi-organ dysfunction
syndromes
4. Legal and Ethical considerations in critical care
5. Family and patient psycho-emotional support
D. Endocrine dysfunction
5. Pituitary disorders
6. Adrenal disorders
7. Thyroid disorders
8. Management of endocrine emergencies
E. Renal dysfunction
1. Acute glomerulonephritis
2. Genitourinary malignancies
3. Acute and chronic renal failure and dialysis
4. Surgical Management of the client/patient with genitourinary
surgery
IV. TEACHING AND LEARNING STRATEGIES
Nursing 276 – Spring - 2010
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1.
2.
3.
4.
5.
6.
Lecture
Textbooks
Assigned readings
Tickets to class
Hand-outs
Self-directed inquiry
Nursing 276 – Spring - 2010
7. Written assignments
8. Discussion
5
V. REQUIRED TEXTS
ECG interpretation made incredibly easy. current edition Lippencott, Williams
and WIlkins
Gahart, B. & Nazareno, A. Intravenous medications. current edition. St. Louis,
Mosby.
Jones, S. (2008 ) ECG Success: Exercises in ECG Interpretation.
Philedelphia: FA Davis.
Lewis S., Heitkemper, M., & Dirksen, S. , O’Brian, P., Bucher, L. (2007).
Medical-surgical nursing: Assessment and management of clinical problems. 7th
ed. St. Louis. Mosby.
Preusser, B. (2009). Critical thinking cases in nursing. (4th ed.). St. Lewis:
Mosby.
Recommended
Doenges et al…..
Porter, W. (Ed.). (>1998). Porter's pocket guide to critical care (>5th ed.). Bend,
Oregon: Porter and Associates.
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VI. METHODS OF EVALUATION IN N276 THEORY
GRADING:
Grading of all examinations, and written assignments (tickets and paper) are
done on a point basis. A letter grade and percentile is computed from the
number of points earned for each examination against the number of points
possible. The overall theory course grade is based on the average of the three
exams and the tickets to class score.
3 examinations
70%
Tickets
10%
Pathophysiology Paper
20%
______________________________________
Total
100%
Exams
There are three exams. Each exam has approximately 100 questions. Some
mathematical computation is required for the exams. The exams are primarily
multiple-choice. Occasionally there is a short answer or essay portion of the
exam. You will be given 3 hours to complete each exam.
Each student MUST EARN a 75% average on unit exams. Students who do not
earn a 75% average on unit exams will not be allowed to continue in the
program. (As noted in your student handbook). Students who are having
difficulty will be counseled by the faculty and be given opportunities to go over
exams. A letter will be kept on file to document your status and that you were
counseled.
Tickets to class
Prior to each class session you will complete that week’s “ticket to class.” The
ticket to class will be handed in at the beginning of class and will be corrected
that day. Remember, turning in your tickets to class constitutes 10 percent of
your grade. Please write (or better - print) clearly.
b) CASE STUDY: Pathophysiology Paper with Discharge planning
This case study (pathophysiology/discharge planning) paper should be
completed on your first or possibly second medical-surgical or ICU patient. This
patient should have a minimum of three medical/surgical diagnoses (comorbidities). The criteria for the paper are as follows:
Nursing 276 – Spring - 2010
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1.
2.
3.
4.
5.
6.
The paper should be 7-8 pages, 12 point font, typed, double spaced
with a title page and references using APA format.
You must complete it and submit it to “TURN IT IN. COM” Your work
must be original. Your faculty will review the originality score from
Turn-it-in.
You should incorporate language you could use to explain the
pathophysiology to the patient and their family.
You will also turn in a hard copy to your clinical instructor.
You must use 7-8 references with at least 3 of these references
coming from the research literature.
The paper will include the pathophysiology for the 3 or more comorbidities and should describe the interaction between the comorbidities.
For the purposes of organizing your paper you may wish to give your patient an
alias “Peter or John, or Mary” or whatever. Your paper should be organized as a
case study in which you are describing the symptoms of the individual and then
include the following information:
a.
b.
c.
d.
e.
f.
g.
h.
Common clinical manifestations of each disease and how your
patient demonstrated these symptoms or did not.
Diagnostics performed to determine what is going on with the
patient.
When were these diseases initially diagnosed (if you have this
information)
How are these diseases interrelated? (This is critical to your
paper)
Actual labs for your patient and how these labs were expected
for his/her condition or not expected. What labs are relevant
but were perhaps in the “normal range”
Medications your patient is taking and how these compare with
common (expected) medications for these disease processes.
Potential complications of these disease processes
What patient teaching and discharge planning, and referrals
could you provide for this patient that would make hospital
readmission less likely. In a narrative format, please indicate
the discharge planning issues this patient and patients with
these disorders will have and how these issues should be
addressed. Also include what referrals you might make for this
patient. And, finally indicate what you would teach your patient,
be specific please and provide teaching detail. The question
your discharge section should answer is:
What should be done for the patient, or by the patient, to
help him/her stay out of the hospital and help him/her live as
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well as possible. And, how shall I properly teach this patient
so that he/she is cooperative in his/her care.
7.
A score of 75% Required (If your paper does not achieve 75% you
will be required to re-submit until it does!) We want you to be
successful and for this paper not to become the basis of your failure.
8.
This Case Study (Pathophysiology/ Discharge Planning paper) is due
for the first group of Med-Surg (N277) students on Monday morning,
March 1, 2010 at 6:30 AM in clinicals.
For the second group of Med-Surg students the paper is due on
Monday, April 26, 2010 at 10:30 AM in Edda, Sherry or Mike’s
office. It may be possible to email to your clinical instructor if you
cannot make it to campus.
THE ATTACHED WRITING RUBRIC WILL BE USED TO SCORE YOUR
PAPER.
One full letter grade will be deducted for each day you are late.
(Extraordinary circumstances will be taken into consideration.)
Employment
Students are advised not to work the night prior to a theory examination or
the day of the examination.
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Content Overview Nursing 276
(You will note the corresponding laboratory relating theory to practice. )
Week
UNIT I
1
2
3
Topic
Cardiac
Cardiac
Respiratory
Laboratory Activities:
Cardiac Rhythms, Film
Cardiac Rhythms with SIM MAN, more rhythm strips
Respiratory – O2 delivery, tracheal suction,
trach cleaning, chest tubes, ABGs
Respiratory – Tracheal suctioning, and cleaning,
chest tubes. O2 delivery, ABG’s
4
PVD – HTN
UNIT II
5
6
7
8
EXAM – Unit I
Digestive System
Burns
Neuro – Spinal
Hepatic/Pancreatic
Nutrition Jeopardy (for total nutrition content)
Burn Care case studies, Fluid administration
Transplant Lab/ Neuro Assessment
UNIT III
9
10
11
12
EXAM – Unit II
Critical Care/ER
Renal Failure
EXAM – Unit III
Endocrine
ER Simulation
Understanding Dialysis/ Lab Interpretation
Orient for 284 clinicals
*** NOTE - LABS GO FROM 9:00 until 12:00 or from 1:00 until 4:00 PM
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Alterations in Cardiovascular Health
Week 1
Required Reading:
Lewis et al:
Chapter 31 Cardiovascular System (REVIEW)
Chapter 32 Hypertension (review now – read in
depth for week 4)
Chapter 33 Coronary Artery Disease
Chapter 34 Congestive Heart Failure / Cardiac
Surgery
Chapter 35 Arrythmias
Chapter 36 Valvular Disease
Chapter 37 Vascular Disorders (REVIEW)
CLASSROOM LEARNING ACTIVITIES (Cardiac):
1.
Ticket to Class:
Complete case study 16 in the Cardiovascular disorders section of the
Preusser text (page 79).
2.
Small group activity:
Cardiac rhythm strip analysis
Note * lab time for this week will be devoted to Atrial dysrythmias
Theory Objectives
The student will complete the following:
1. Review diagnostic tests including laboratory studies for cardiovascular
disorders including:
C. Isoenzymes
D. Biomarkers
E. Troponin levels
2. Explain health promotion for the client with cardiac disease, including:
A. Dietary modification
B. Activity
C. Behavioral changes
3. Review/ discuss the pharmacological agents currently utilized in the
management of cardiovascular disease:
A. Diuretics
B. Antiarrythmics
C. Antihypertensives
D. Vasodilators
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E. Cardiotonics
F. Calcium channel blockers
4. Describe the pathophysiology, clinical behaviors, management, and nursing
care to promote health in the following coronary diseases:
A. Coronary atherosclerosis
B. Angina pectoris
C. Myocardial Infarction
5. Explain normal cardiac impulse generation and propagation and relate
associated waveforms.
6. Express medical and nursing interventions to promote health for the
client/patient experiencing the following dysrhythmias:
A. Bradycardias
B. Tachycardias
C. Junctional Rhythms
D. A-V Blocks
E. Premature ventricular contractions
7. Predict the pre-operative management of cardiac surgical clients
8.
Discuss measures to promote recovery for the post-operative cardiac
surgical client/patient in terms of the following:
A. Oxygenation
B. Cardiac output & shock management
C. Fluid & electrolyte management
D. Pain Control
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Alterations in Cardiovascular Health
Week 2
Required Reading:
Lewis et al:
Chapter 31 Cardiovascular System (REVIEW)
Chapter 32 Hypertension (review now – read in
depth for week 4)
Chapter 33 Coronary Artery Disease
Chapter 34 Congestive Heart Failure / Cardiac
Surgery
Chapter 35 Arrythmias
Chapter 36 Valvular Disease
Chapter 37 Vascular Disorders (REVIEW)
CLASSROOM LEARNING ACTIVITIES (Cardiac):
Ticket to Class:
Complete assigned EKG’s from Jones’ ECG Success book:
11.1, 11.2, 11.4, 11.6, 11.7, 11.9, 11.13, 11.14, 11.18,
11.19, 11.23, 11.29, 11.33, 11.35, 11.36, 11.37, 11.38,
11.40, 11.41, 11.43, 11.44, 11.45, 11.48, 11.51, 11.59,
11.65, 11.67, 11.70, 11.71, 11.74, 12.1, 12.4, 12.27, 12.29,
12.35, 12.36, 12.61
(Lab time this week will be devoted to Ventricular dysrythmias)
1. Examine health concerns related to congestive heart failure and pulmonary
edema in terms of the following:
A. Physiological stimuli and behaviors
B. Pharmacological interventions
C. Related nursing interventions
2. Identify the electrocardiographic pattern and treatment indicated for the
following life-threatening dysrhythmias:
A. Ventricular standstill
B. Ventricular Tachycardia
C. Ventricular Fibrillation
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3 Compare the difference between cardioversion and defibrillation, including
indications for each.
4.
Anticipate nursing measures utilized to prepare patients for :
A. External pacing
B. Internal pacing
C. Temporary pacing
5. Plan the post-procedure interventions to promote adjustment for the
client/patient being paced.
7. Predict the emergency care for the person experiencing an acute myocardial
infarction.
8. Explain the major complications experienced by persons with acute
myocardial infarction.
9. Outline the nursing management of the coronary client/patient in relation to
the following :
E. Coronary Care Unit
F. Psycho-emotional health
G. Definitive care unit
H. Rehabilitation and client family teaching issues
I.
10. Discuss the nurses role in the care of individuals and families with prolonged
inherited Q-T syndrome.
11. Describe the pathophysiology associated with specific cardiomyopathies.
12. Explain the pathophysiology and treatment for pericarditis aand pericardial
effusions.
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Problems Related to Oxygenation
Week Three
Required Reading:
Lewis et al
Chapter 25
Chapter 27
Chapter 28
Chapter 66
Chapter 64
Respiratory System (review)
Chest Surgery / Lower Respiratory Disfunction.
Obstructive Pulmonary Disease
Respiratory Failure
Critical Care (focus on respiratory
support/ventilation)
Ticket to Class: Complete the following ECG rhythms from Jones’ ECG
Success:
11.11 11.12, 11.16 11.17, 11.21 11.22, 11.24, 11.26, 11.27, 11.39,
11.42, 11.46, 11.49, 11.50, 11.52, 11.54, 11.55, 11.56, 11.61, 11.63,
11.68, 11.73, 12.3, 12.8, 12.12, 12.22, 12.25, 12.31, 12.42, 12.45,
12.51, 12.63, 12.65, 12.66, 12.75.
Theory Objectives
The student will be able to do the following:
1. Explain oxygen and carbon dioxide exchange.
2. Interpret via case study diagnostic behaviors utilized for assessment of
respiratory function.
3. Review pharmacologic agents used to promote airflow.
4. Describe clinical behaviors and interventions to promote recovery for the
client/patient with acute respiratory failure including emergency management.
5. Prioritize interventions for the client requiring ventilatory support including:
A. Negative pressure ventilation
B. Positive pressure ventilation
C. Nasal Bipap
D. Ventilatory modes
E. Physiological and psycho-emotional stimuli related to ventilatory
support
6. Compare and contrast ventilatory weaning techniques:
A. Intermittent Mandatory Ventilation (IMV)
B. Traditional Weaning
7. Discuss therapeutic interventions for the person with Adult Respiratory
Distress Syndrome.
8. Describe methods of pulmonary rehabilitation.
9. Discuss home oxygen therapy in relation to the following contextual stimuli
C. Risks versus benefits
D. Safety issues
E. Family impact
10. Investigate various nutritional therapies (including tube-feeds) specific to the
client/patient with major respiratory compromise.
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Compromised Peripheral Tissue Perfusion
Week Four
Required reading:
Lewis
Chapter 32
Chapter 37
Hypertension
Vascular Disorders
Ticket to Class:
Please complete case study 2 in the cardiovascular section in the
Preusser text. (p.5)
Theory Objectives
The student will complete the following:
1. Explain the pathophysiology of hypertensive vascular disease.
2. Describe therapeutic interventions for the client/patient experiencing acute
and chronic hypertensive disease (make sure to include nutritional therapies).
3. Describe therapeutic measures for the patient with rheumatic fever and
endocarditis and the patient with valvular diseases.
4. Examine pharmacologic agents utilized to promote adaptation for
hypertensive client/patients including:
A. Diuretics
B. Ace Inhibitors
C. Vasodilators
D. Beta blockers and Calcium Channel blockers
E. Ganglionic blockers
F. Angiotensin II blockers
4. Predict nursing interventions ensure recovery in hypertensive emergencies.
5. Discuss the various classifications of aneurysms including clinical behaviors
and management.
6. Review diagnostic tests utilized to identify adaptive disorders of the vascular
system including arterial insufficiency and occlusion.
7. Compare and contrast the actions of major anticoagulant and thrombolytic
agents including related nursing measures of:
A. Coumadin
B. Heparin
C. Thrombolytics
D. Platelet inhibitors
8. Identify common clinical behaviors associated with acute arterial occlusion
and discuss related nursing measures (pre-and post-intervention).
Nursing 276 – Spring - 2010
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Alterations in Gastrointestinal Function
HEPATIC/BILIARY DYSFUNCTION
WEEK 5
Required Reading:
Lewis: Chapter 42 Liver, Biliary Tract, and Pancreas
Ticket to Class:
(page 237)
Case Study 46 in the Gastrointestinal section of Presser
Theory Objectives
At the completion of this unit, the student will be able to
1. Explain the pathophysiology of hepatic cirrhosis and relate how this guides
nursing care.
2. Explain the pathophysiology, clinical results, and related management of
client/patients with the following:
A. Portal hypertension
B. Esophageal varices
C. Ascites
3. Describe the clinical behaviors of the client/patient with hepatic failure,
including:
A. Encephalopathies
B. Coagulopathies
C. Metabolic and nutritional considerations
D. Fluid balance
4. Review and interpret laboratory and test results associated with hepatic
disorders including:
A. Liver biopsy
B. Bilirubins
C. Serum transaminase studies
D. Protein, Albumin, Corrected Calcium
E. Coagulation studies
F. Serum ammonia
5.
Discuss the causes, pathophysiology, potential complications, and related
nursing and medical interventions for clients/patients with pancreatic
cancer.
6.
Discuss the causes, pathophysiology, potential complications, and related
nursing and medical interventions for client/patients with Hepatitis A, B, C,
D, Non-A, Non-B, Non-C etc.
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Alterations in Gastrointestinal Function
WEEK 6
Required Reading:
Lewis:
Chapter 38
Chapter 40
Chapter 41
GI System (Review)
Upper GI Problems
Lower GI Problems
Ticket to Class:
Please complete case study 48 in the gastrointestinal section (page 249) in the
Preusser text.
Theory Objectives
At the completion of this unit, the student will be able to
1.
Classify gastrointestinal disorders in terms of the following:
 Bleeding
 Perforation
 Obstruction
 Inflammation
 Neoplasm
2.
Examine medical and nursing interventions to promote adaptation for
client/patients with colon cancer.
Identify the behaviors and nursing interventions associated with gastric
cancer and complications of gastric surgery.
Describe the nursing and medical management of client/patients with
gastrointestinal bleeding and acute abdominal infection.
Compare and contrast behaviors and associated management of the
client/patient with Crohn’s disease, ulcerative colitis, diverticulitis, and
diverticulosis (make sure to include nutritional management).
3.
4.
5.
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Selected Neurological Problems
Week 7
Required Reading:
Lewis
Chapter 54 Neurologic System (Review)
Chapter 55 Intracranial Problems (Review)
Chapter 57 Chronic Neurological Problems
Chapter 59 Peripheral Nerve and Spinal Cord Problems
Ticket to Class:
Please complete case study 70 in the neurologic disorders chapter
(page 359) in the Preusser text.
Theory Objectives
The student will complete the following:
1. Restate the clinical behaviors associated with increased intracranial pressure
and identify the appropriate nursing interventions used to deal with increased
ICP.
2. Examine medical and nursing interventions for traumatic brain injuries.
3. Explain health maintenance for the patient with a decreased level of
consciousness in relation to the following:
A. Airway management
B. Management of skin integrity
C. Immobility
D. Fluid and nutritional status
E. Maintaining bowel and bladder function
F. Managing environmental stimuli .
G. Psychoemotional management .
8. Compare and contrast the clinical behaviors associated with different types of
spinal
cord injury in terms of the following:
H. Location (cervical, thoracic, lumbar)
I. Mechanism (subluxation, flexion, extension, compression, rotation)
5. Discuss medical and nursing interventions indicated in acute Spinal Cord
Injury (SCI)
6. Anticipate problems encountered during the rehabilitation of spinal cord
injured clients including:
A. autonomic dysreflexia
B. skin integretiy
C. nutritional status
D. elimination status
E. sexuality/reproduction
F. body image/self-esteem
7. Identify behaviors associated with brain death and debate issues related to
organ donation including the following:
A. Ethical and legal issues
B. Donor and recipient care
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Compromised Skin Integrity and Burns
Week 8
Required Reading:
Lewis
Chapter 22
Chapter 23
Chapter 24
Integumentary System (Review)
Integumentary Problems
Patient with Burns
Ticket to Class:
Please complete case study 134 in the multiple system disorders chapter
(page 629) in the Preusser text.
Theory Objectives
The student will complete the following:
1. Define and describe soft tissue injuries and their respective care.
2. Compare and contrast assessment techniques for determining burn extent
and severity.
3. Calculate fluid requirements and nutritional needs for the acutely burned
adult and child.
4. Debate open and closed wound management and indications for each.
5. Predict the emergency management for the person experiencing the
following types of burns:
A. Opthalmic
B. Chemical
C. Thermal
D. Inhalation
5. Discuss systemic physiologic behaviors associated with moderate to
severe burn injury, including:
A. Pulmonary
B. Cardiovascular
C. Immune
D. Gastrointestinal
E. Renal
6. Explore pain management for the person with burns.
7. Anticipate psycho-emotional issues related to severe burn injury.
8. Debate societal costs related to burn rehabilitation.
9. Predict the nursing and medical interventions used to prevent scaring,
contractures, and promoting the best cosmetic result of burn rehabilitation
clients/patients.
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Endocrine Dysfunction
Week Nine
Required reading:
Lewis
Chapter 46
Chapter 48
Endocrine System (Review)
Endocrine Problems
Ticket to Class:
Please complete case study 79 in the endocrine disorders chapter (page
401) in the Preusser text.
Theory Objectives
The student will complete the following:
1. Review the inter-relationships of various endocrine glands.
2. Review the clinical behaviors associated with hyper-and hypothyroidism.
3. Identify measures to promote health in the person experiencing acute thyroid
crisis and myxedema coma.
4. Discuss the use and predicted clinical response of the following theraputic
modalities in the management of thyroid disorders:
A. Pharmacologic agents
B. Surgery
C. Radiation
D. Nutritional therapies
5. Discuss the behaviors (signs and symptoms) and associated management of
the client/patient with pituitary dysfunction.
6. Differentiate between primary adrenocortical insufficiency and secondary
adrenocortical insufficiency.
7. Describe clinical behaviors and management for clients/patients with adrenal
tumors.
8. Compare and contrast Addisonian Crisis with Cushing’s Syndrome.
9. Discuss nursing interventions to promote recovery after endocrine surgery.
10. Predict nursing education needs for persons experiencing endocrine
dysfunction including:
A. Medication management
B. Fluids and electrolytes
C. Stimulus management
D. Safety issues
E. Immune response
F. Lab values
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Emergency/Critical Care
Week 10
Required Reading:
Lewis
Lewis
Chapter 64
Chapter 67
Critical Care
Emergency Care
Ticket to Class:
Please complete case study 139 from the emergency situations chapter
(page 651) in the Preusser text.
Theory Objectives
The student will complete the following:
1. Review psycho-emotional behaviors associated with persons and families in
crisis.
2. Discuss principles of emergency management related to the following:
A. Airway
B. Breathing
C. Circulation and C-spine control
D. Disability
E. Exposure
3. Via case study, prioritize client/patient management in the emergency setting .
4. Identify the clinical behaviors and related management associated with the
following disorders of thermal regulation:
A. Hypothermia and frostbite
B. Heat stroke and heat exhaustion
5. Discuss the promotion of health for the person with toxic ingestions including:
A. Inhaled agents
B. Corrosives
C. Non-corrosives
D. Overdoses
E. Food poisoning
F. Street Drugs
G. Acute poisonings including snake and insect bites
7. Predict injuries associated with blunt and penetrating abdominal trauma.
8. Prioritize emergency management for the person experiencing multiple
trauma.
9. Review the management of the client/patient with musculoskeletal trauma
including crush injuries.
10.Discuss methods to perform an organized multi-system assessment on
complex clients/patients.
11. Identify advanced monitoring techniques utilized in critical care and discuss
the significance of each.
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12. Explore the nurses role in the care of patients, and also the management of
events, surrounding mass casualties and weapons of mass destruction:
specifically nuclear, biologic and chemical exposures.
13. Explore management of client/patients with multi-organ dysfunction
syndromes.
14. Identify appropriate therapeutic interventions in the critical care setting.
14. Via case study, debate legal and ethical considerations related to critical care
including:
A. Ordinary versus extraordinary care
B. Euthanasia versus terminal weaning
C. Advanced directives and family conflicts
D. Rights and legal minority ; the child
15. Investigate the nurses role as an advocate for nutritional management of
patients with multiple system problems.
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Alterations in Renal Function
Week 11
Required reading:
Lewis
Chapter 43 Urinary System (Review)
Chapter 44 Renal and Urologic Problems
Chapter 45 Acute and Chronic Renal Failure
Ticket to Class:
Please complete case study 56 in the genitourinary disorders chapter (page
289) in the Preusser text.
Theory Objectives
The student will complete the following:
1. Predict the clinical behaviors and nursing management for persons with the
following:
A. Acute Glomerulonephritis
B. Chronic Glomerulonephritis
C. Nephrotic syndrome
D. Wilm’s tumor
E. Polycystic renal disease
2. Discuss urinary diversion procedures and indications for each.
3. Compare and contrast the clinical behaviors and related management for
persons experiencing the following:
A. Renal failure
B. Genitourinary inflammatory processes
C. Genitourinary cancers
4. Anticipate the differences in clinical behaviors and management for the
person in acute renal failure from the person in chronic renal failure including:
A. Dietary requirements
B. Psycho-emotional support
C. Client and family education
D. Fluid and electrolyte requirements
5. Explore principles of dialysis, complications (sepsis, anemia, fistula/graft
failure) and related nursing management in :
A. Hemodialysis
B. Continuous Ambulatory Peritoneal Dialysis (CAPD)
C. Post -dialysis care
6. Anticipate issues related to asepsis and their application in the care of the
dialysis client.
7. Explain the multi-systemic effects of uremia.
8. Debate issues related to renal transplant including:
A. Indications
B. Ethical issues and economic impact
C. Clinical behaviors associated with organ rejection
Nursing 276 – Spring - 2010
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