MIDDLESEX COUNTY VOCATIONAL AND TECHNICAL SCHOOLS
PRACTICAL NURSING PROGRAM
MEDICAL SURGICAL NURSING 2 SYLLABUS
including Clinical Pharmacology and Clinical Nutrition
Medical Surgical Nursing care incorporates the clinical concepts of the pharmacology and nutrition
courses. Application of medical surgical nursing is based upon a thorough comprehension of correct
anatomy and physiological characteristics in the human body, comprehension of the
pathophysiology of each disease process, pharmacological interventions (as well as indications,
incompatabilities, and side effects) appropriate to each disease, proper nutrition for the health care
condition and cultural implications of nursing care.
Objectives: By the end of this course, the student will be able to safely provide care for patients with
disorders in the following systems:
1. Neurological
a. Identify significant subjective and objective neurological data that should be obtained
from a patient during an assessment.
b. Discuss the Glasgow coma scale
c. List 5 signs & symptoms of increased intracranial pressure, why they occur, & what
nursing interventions that can decrease / prevent increase of the pressure.
d. Differentiate between trigeminal neuralgia & Bell’s palsy.
e. Discuss various neurological disturbances in motor & sensory-perceptual function.
f. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. 6 degenerative diseases
ii. Stroke
iii. Meningitis/ Encephalitis
iv. AIDS
v. Guillian-Barre` syndrome
vi. Intracranial tumors/ brain trauma/ spinal trauma
g. Compare & contrast stroke and traumatic brain injury
h. List 4 classifications of seizures, the characteristic clinical signs, aura and postictal
period.
i. Discuss patient teaching and home care planning for patients with Stroke/ MS/
Parkinson’s disease and myasthenia gravis
j. Review effects of vitamins on the neurological system.
k. Discuss nutritional support of the peri-surgical patient.
l. Identify the major drug classifications that affect the CNS.
m. Discuss the following medications for classification, effect, major side effects, toxicity
symptoms, nursing interventions and patient teaching:
i. Migraine medications
ii. Sedative / Hypnotics
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iii. Seizure medications
iv. Antiemetics/ antivertigo
v. Antidepressants
vi. AntiParkinson’s disease
vii. CNS stimulants
viii. Common anesthetics
ix. Analgesics
n. Compare and contrast drug addiction and drug tolerance.
o. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 16 and bring to class prior to the exam in this content.
2. Special senses
a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Refractory errors: astigmatism/ strabismus/ myopia/ hyperopia
ii. Inflammatory conditions
iii. Sjorgen syndrome/ ectropion/ entropion
iv. Corneal injuries
v. Cataracts/ diabetic retinopathy/ macular degeneration/ retinal detachment and
glaucoma
vi. Major ear inflammatory & infectious / noninfectious disorders
b. Identify teaching tips for communicating with hearing and vision impaired people
c. Discuss patient teaching and home care planning for people with eye/ ear disorders,
post- surgical recovery & hearing/ vision impairments
d. Differentiate between conductive & sensorineural hearing loss.
e. Describe specific administration techniques for eye, ear, and skin medications.
f. Discuss 3 medications each for eye, ear and skin problems for classification, effect,
major side effects, toxicity symptoms, nursing interventions and patient teaching:
g. Discuss the role of sodium, chocolate and aged food products on the special senses.
h. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 23 and bring to class prior to the exam in this content.
3. Respiratory
a. Identify signs & symptoms the patient is experiencing hypoxia.
b. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Disorders of the upper airway
ii. Disorders of the lower airway
iii. Emphysema/ chronic bronchitis/ asthma/ bronchiectasis.
c. Discuss nursing interventions for a laryngectomy patient.
d. Compare arterial oxygen tension and arterial oxygen saturation.
e. Discuss 5 interventions for patients with retained pulmonary secretions.
f. Differentiate between tuberculosis infection and tuberculosis disease.
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g. List four medications used to treat tuberculosis; discuss classification, side effects,
adverse effects and pertinent nursing interventions of each.
h. List 3 risk factors associated with pulmonary emboli.
i. List 5 assessments/ interventions related to care of the patient with closed-chest
drainage system.
j. Discuss patient teaching and home care planning for the patient with respiratory
disorders using room air and needing oxygen supplementation.
k. Identify major antihistamines used to treat breathing problems caused by allergens.
l. Compare antitussives and expectorants.
m. Discuss medications used to treat and prevent asthma attacks. Note “rescue meds”.
n. List 6 medications used as decongestants.
o. Discuss the effects and contraindications of nasal steroid usage.
p. Discuss the following medications for effect, major side effects, toxicity symptoms,
nursing interventions and patient teaching:
i. Penicillins
ii. Tetracyclines
iii. Aminoglycosides
iv. Fluorquinolones
v. Cephalosporins
vi. Sulfonamides
vii. Antitubercular
viii. Antiviral
ix. Amebicides
x. Antihelminths
q. Discuss the role of water, vitamin C and Zinc in the patient with respiratory issues.
r. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 11 and 12; bring to class prior to the exam in this content.
4. Cardiovascular
a. Describe 5 dysrhythmias.
b. Identify risk factors and the effects of aging on the peripheral vascular system.
c. Compare essential/ primary, secondary and malignant hypertension
d. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Angina pectoris/ myocardial infarction/ heart failure/ valvular heart disease
ii. Pulmonary edema
iii. Rheumatic heart disease/ pericarditis/ endocarditis
iv. Arterial aneurysm/ Buerger’s disease/ Raynaud’s disease
v. Thrombophlebitis/ varicose veins/ stasis ulcers
vi. Hypertension
e. Discuss the indications & contraindications of cardiac transplantation.
f. Discuss appropriate nursing diagnoses and patient education for each disorder.
g. Discuss the following medications for classification, effect, major side effects, toxicity
symptoms, nursing interventions and patient teaching:
i. Antianginal medications
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ii. Antilipidemics
iii. Dysrhthymic
iv. Cardiotonics
v. Hypertensive medications/ treatments (A2, B, C, D, E, F)
h. Discuss nutritional risk factors that contribute to the development of coronary heart
disease and hypertension.
i. Discuss the role of fats, sodium and water in heart disease.
j. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 15 and bring to class prior to the exam in this content.
5. Blood and Lymph
a. List the commonly used diagnostic tests which evaluate blood & lymph disorders;
what is the significance of the result
b. List 6 signs & symptoms associated with hypovolemic shock.
c. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Anemia
ii. Acute and chronic leukemia
iii. Coagulation disorders: thrombocytopenia/ hemophilia/ DIC
iv. Multiple myeloma/ malignant lymphoma/ Hodgkin’s lymphoma
d. Discuss care intervention for a patient with lymphedema.
e. Discuss appropriate nursing diagnoses and patient education for each disorder.
f. Discuss the role of iron and vitamins K & B12 in patients with blood disorders.
g. Discuss the following medications for classification, effect, major side effects, toxicity
symptoms, nursing interventions and patient teaching:
i. Anticoagulants/ antiplatelet aggregates/ thrombolytics
ii. Toxoids/ Vaccines (bacterial & viral)/ immune serums/ in vivo agents
h. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 19 and bring to class prior to the exam in this content.
6. Endocrine
a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Acromegaly/ gigantism/ dwarfism
ii. Diabetes insipidus/ syndrome of inappropriate antidiuretic hormone
iii. Hypothyroidism/ hyperthyroidism/ goiter/ thyroid cancer
iv. Hyperparathyroidism/ hypoparathyroidism
v. Cushing’s syndrome / Addison’s disease
vi. Diabetes mellitus – type 1 VS type 2
b. Differentiate symptoms between the following:
i. Diabetes insipidus & SIADH
ii. Hypothyroidism & hyperthyroidism
iii. Hyperparathyroidism & hypoparathyroidism
iv. Cushing’s syndrome & Addison’s disease
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c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
v. Hypoglycemia & hyperglycemia
Discuss diabetic ketoacidosis; hyperosmolar hyperglycemic nonketotic coma &
hypoglycemic reaction
Discuss the role of exercise, nutrition & medication in controlling diabetes mellitus.
Discuss short term and long term complications of diabetes mellitus.
Discuss the medication categories used to treat diabetes as follows:
i. Insulin: rapid acting, intermediate acting and long acting
ii. Oral hypoglycemics:
1. Metformin
2. Receptor agonists
3. Absorptive rate adjusters
4. Pancreatic beta cell stimulants
5. Appetite suppressants
Discuss 5 nursing interventions that increase self-care in the individual with diabetes’
ADL’s.
Discuss appropriate nursing diagnoses and patient education for each disorder.
Discuss the following medications for classification, effect, major side effects, toxicity
symptoms, nursing interventions and patient teaching:
i. Insulin: rapid, short, intermediate and long acting
ii. Sulfonylureas
iii. Metformin
iv. Avandia & Actos
v. Precose & Glyset
vi. Prandin & Starlix
vii. Byetta & Smylin
viii. Januvia
ix. Levothyroxine and liothyronine vs Propylthiouracil
x. Vasopressin
Discuss the ‘Somogyi’ effect.
Compare mineralcorticoids and glucocorticoids.
Describe one day’s meal plan for a diabetic patient needing 1800cal ADA diet.
Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 20 and bring to class prior to the exam in this content.
7. Gastrointestinal
a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Disorders of the mouth, esophagus, stomach and intestines
ii. Ulcerative colitis and Crohn’s disease
iii. Acute abdominal inflammations
iv. Hernias: external and hiatal
v. Intestinal obstructions: mechanical and nonmechanical
vi. Colorectal cancer
vii. Fecal incontinence
b. Discuss laboratory and diagnostic exams for the gastrointestinal system.
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c. Compare food intolerance to food allergy.
d. Identify various types of hospital diets, fluid consistencies and formulas for GT feeds.
e. Discuss nursing interventions for patients with gastric reflux, hiatal hernia & impaired
swallowing.
f. Compare high fiber and low fiber diets; determine which GI diseases benefit from use
of fiber.
g. Discuss pancreatic enzyme supplementation needs.
h. Discuss requirements for implementation of PO, enteral and parental feedings.
i. Identify common uses for antacids, histamine H-2 receptor antagonists & proton pump
inhibitors.
j. Compare and contrast anticholinergic, antidiarrheal and antispasmodic medication’s
effects on the GI tract.
k. Discuss the 5 types of laxatives, including action and side effects.
l. Discuss the purpose, action and effect of disulfiram.
m. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 18 and bring to class prior to the exam in this content.
8. Accessory organs
a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Cirrhosis of the liver, hepatitis, liver abscesses, cholecystitis, pancreatitis
ii. Liver cancer, pancreatic cancer
b. Discuss 6 types of viral hepatitis and modes of transmission.
c. Discuss cholecystitis and cholelithiasis treatments and dietary management.
d. Discuss indications for liver transplant, debate the ethics, discuss immunosuppressant
medications and dietary management.
9. Urinary
a. Identify the effects of aging on the urinary system’s function.
b. Discuss patient concerns of changes in body image, changes in family function and
altered sexuality related to renal dysfunctions.
c. Design culturally sensitive care plans incorporating community resources to increase
support for the patient with renal impairment.
d. Describe clinical conditions in which uricosuric therapy would be used.
e. Identify foods that cause calculi production in the tissue and kidneys.
f. Review Edmunds chapter 15.
10. Musculoskeletal
a. Describe the risk factors for primary and secondary osteoporosis and ways to reduce
them.
b. Discuss drug therapies in prevention and management of osteoporosis.
c. Compare and contrast osteomyelitis, osteoporosis and osteomalaccia.
d. Discuss types of malignant bone cancers; nursing interventions and psychosocial
impact for the patients.
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e. Discuss the pathophysiology, risk factors and treatment options for carpal tunnel
syndrome.
f. Discuss common disorders of the foot.
g. Discuss various fracture types; their symptoms; normal bone healing; complications of
fractures and develop nursing diagnoses for the fractures discussed.
h. Differentiate the need for casting, traction and fixation in fractured bones.
i. Develop a care plan for a patient with each stabilization method.
j. Discuss reasons for amputations; common types; psychosocial aspects to surgery; and
discuss nursing interventions.
k. Identify common sports related injuries and ways to prevent them.
l. Describe the pathophysiology of muscular dystrophy and myasthenia gravis.
m. Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 22 and bring to class prior to the exam in this content.
11. Reproductive
a. Review the etiology, pathophysiology, clinical manifestations, assessment, diagnostic
tests, medical management, nursing interventions, and prognosis for each of the
following:
i. Infections of the reproductive system
ii. Cancers of the reproductive tract
iii. Endometriosis
iv. Self examination for female breast and male testes & breast
b. Differentiate between cystocele, rectocele, hydrocele and varicocele.
c. Review patient education on prevention of sexually transmitted infections.
d. Discuss antiviral, antiretroviral and antifungal medications used in treatment of STIs.
Complete the Emunds Pharmacology PN review questions on www.evolve.com for
chapter 13 and bring to class prior to the exam in this content.
TOPICAL SCHEDULE
Class Number
Class 1
Topic
Care of a Pt with Neurological
Disorders
Class 2
Class 3
Class 4
Class 5
Class 6
Class 7
Continue with chapter 14
Continue with chapter 14
Continue with chapter 14
Continue with chapter 14
Continue with chapter 14
Disorders of the Eye and Ear
Class 8
Continue with chapter 13
Books/ chapters
Christensen: Ch.14; p. 650-718
Edmunds: Ch. 16 & 17;
CNS medications
Nix: Table 17-2, p. 341.
Nix: pp. 447-460
As above
As above
As above
As above
Christensen, Ch. 13, pp. 601649
Edmunds Ch. 23, p. 411
Nutrition
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Class 14
Class 15
Class 16
Class 17
Class 18
Care of a Pt with Respiratory
Disorders
Continue chapter 13
Continue chapter 13
Continue chapter 13
Care of a Pt with a
Cardiovascular Disorder
Continue chapter 8
Continue chapter 8
Continue chapter 8
Continue chapter 8
Blood and Lymph Disorders
Class 19
Class 20
Continue chapter 7
Endocrine Disorders
Class 21
Class 22
Class 23
Class 24
Continue chapter 11
Continue chapter 11
Disorders of the GI System
Continue chapter 5
Class 25
Class 26
Continue chapter 5
Accessory Organ Disorders
Class 27
Class 28
Continue chapter 6
Urinary Disorders
Class 29
Class 30
Class 31
Class 32
Class 33
Continue chapter 10
Continue chapter 10
Musculoskeletal Disorders
Continue chapter 4
Continue chapter 4
Class 34
Reproductive: Female
Class 35
Class 36
Class 37
Class 38
Class 39
Reproductive: Female
Reproductive: Male
ATI Testing MS2
Review
Final Exam
Class 9
Class 10
Class 11
Class 12
Class 13
Christensen: Ch. 9, pp. 373-433
Edmunds: Ch. 11, p. 136
Edmunds: Ch. 12, p.161
And Nutrition
As above
Christensen: Ch. 8, pp. 303-372
Edmunds: Ch. 15, p. 211
Nix: Ch. 19, pp. 379-397
As above
As above
As above
Christensen: Ch. 7, pp. 262-302
Edmunds: Ch. 20, p. 354; Ch.
22, p.400
Nix: p. 115&116; pp.140-144
Christensen: Ch. 11, pp. 484532
Edmunds: 19, p334+.
Nix: Ch. 20, pp. 400-424
Christensen: Ch. 5, pp 175 -230
Edmunds: Ch. 19, p 334
Nix: Ch. 18, pp. 352-370
Nix: Ch. 22, pp. 460-466
Christensen: Ch. 6, 231-261,
Nix 370-375
As above
Christensen: Ch. 10, pp. 434483
Edmunds: p. 328- 332
Nix: p 442-444
Christensen: Ch. 4, pp. 109-174
Edmunds: Ch. 18, p312
Nix: Ch. 16, pp. 311-327 &
burns: 466-468
Christensen: Ch. 12, pp. 533600.Nix: Folic acid, p.428.
Edmunds: Ch. 13, pp. 188-198
As above
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GRADING:
Grade Determinants: As per the student handbook, the lowest quiz grade in the course will be
dropped. The final must be completed prior to beginning the next course.
Unit Quizzes
40%
(Any project assigned will equal one quiz grade)
Final Exam
60%
Students must receive a total didactic grade of 75% to progress to the next course. Your
clinical grade will be averaged with your passing didactic grade to become your course
grade.
TEXTBOOKS:
Christensen, B. & Kockrow, E. (2011). Adult Health Nursing, 6th ed.
Elsevier Mosby, St. Loius, Mo.
Christensen, B. & Kockrow, E. (2011). Adult Health Nursing Workbook,
6th ed. Elsevier Mosby, St. Loius, Mo.
Edmunds, M.W. (2013). Introduction to Clinical Pharmacology, 7th ed.
Elsevier Mosby, St. Loius, Mo.
Edmunds, M.W. (2013). Introduction to Clinical Pharmacology Workbook, 7th ed. Elsevier
Mosby, St. Loius, Mo.
Nix, S. (2013). William’s Basic Nutrition and Diet Therapy, 14th. ed. Elsevier Mosby, St.
Loius, Mo.
EXPECTATIONS OF ALL STUDENTS:
1. Electronic copying and/ or taping of (during) the class are prohibited. Cell phone use is not
permitted in the class during the didactic portion. If used in class for other than instructor
approved reasons, the cell phone will be placed on the instructor’s desk for the remainder of
the class. Repeated offenses are frowned upon.
2. ATI testing will be completed prior to the final for the course. The benchmark has been set at
level 2 for the students in this course. If you achieve a level 3, you will be given one (1)
grade point higher on the final course grade (EX: 79 could become 80). If you do not achieve
the benchmark of 2, but get level 1, you will lose 1 point on your final course grade, and a
‘below level 1’ would lose 2 points on their final grade (Ex: 76 would become a 75.
HOWEVER, you cannot fail the course based upon your ATI score. A 75 would not become
74. ALSO, you cannot pass the course by achieving a level 3 adding 1 point to your grade.
EX 74 will not become 75 for the passing grade). Your ATI print out is an excellent guide to
show you where your weaknesses are located.
3. You must complete the Medical Surgical ATI student practice with a 90% or better as a class
requirement. Not achieving this/ doing the practice would result in an incomplete for the
course until it is satisfactorily submitted. You may take the practice test as many times as you
like; it is for your practice. You may hand in the practice at a 90% or better pass anytime
within the course. It is a requirement, NOT a grade.
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4. Your professional portfolio is to be handed in to the instructor no later than the second day of
class with proof of current health and nursing insurance. It is your responsibility to ensure the
required items are current for the entire semester. The completed professional portfolio must
be handed in to the instructor by the requested date at the end of the semester or the grades
for the class will be withheld until the criteria have been met.
5. Upon completion of the program and PRIOR to graduation, all senior students are required to
complete EXIT testing. Students are required to take and pass a (1) comprehensive exam, (2)
a pharmacology exit exam, and (3) a critical thinking exit exam.
6. To be eligible for graduation:
a. The comprehensive exam is scored as a percentage likelihood of passing the NCLEX.
The percentage of potential to pass needs to be 90% or greater, therefore, the
individual’s score at the top of the report sheet needs to be 68% or greater.
b. Pharmacology exam needs to be passed at the national level of 75. This number is
located at the bottom of the report. The individual score is not what we are
measuring.
c. Critical thinking needs to show improvement from the first exam taken at the
beginning of the program.
7. After you complete the above, all your courses and pay any outstanding tuition, your letter of
completion will be sent to the board of nursing to get your NCLEX testing process started.
GOOD LUCK IN MS2!!
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