BSN Program Nursing Practice II
Student Advance Preparation for Nursing Practice: Expectations
Topic
When Started
Standard
Presenting
Health Challenge
Praxis Week 1
Clinical Week 2
Students will come to clinical having completed a standardized
template on the patient’s admitting/priority health challenge(s)
as validated by the Instructor. The template is attached.
Concurrent
Health
Challenges
Decision Making
Worksheet
Praxis week 1
Clinical Week 2
Students will come to clinical with a page on which each of the
patient’s concurrent health challenges are defined only.
Praxis Week 1
Clinical Week 2
Students will come to clinical with Anticipated Foci listed in
pencil and an assessment plan outlined within the system
assessment boxes on the back of the worksheet.
Medications:
Drug Guide
Clinical Week
4/Two weeks
prior to
medication quiz
Medications:
Client Drug
Profile
Clinical Week 4
Two weeks prior
to medication
quiz.
1. For each of the medications your patient is receiving, flag
and review the Drug guide
2. Use the Drug Guide to prepare the Client Drug Profile Card
(see the next section).
3. Bring the flagged Drug Guide to each clinical day.
4. Have the Drug Guide with you for reference as you prepare
the medications e.g. for checking safe dose and other
important details etc.
Students will come to clinical with a client specific medication
profile e.g. index card, in words understood by most clients that
identifies:
Nursing Responsibilities
(Including
Major/Common Side
Drug Name Purpose/Action
Effects & Assessments)
1.
2.
3.
4.
5.
6.
Etc.
This information should be carried in the uniform pocket and
accessed as needed e.g. at the bedside.
Laboratory & Diagnostic Tests
Please note that students are NOT expected to come to clinical practice with evidence of having
researched and understood laboratory and diagnostic tests; this will be an expectation in Semester III
when pathophysiology courses have begun. In semester II, students are encouraged to be curious about
these tests and to consult with the instructor and staff about their use and the related nursing
responsibilities.
Sproule/Douglas/NPII/Student Clinical Prep
28/08/2010
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BSN Program Nursing Practice II
Knowledge Preparation on Presenting Health Challenges
Student Jeoffrey Nacar
Date 02/02/11
Health Challenge/Diagnosis: Diabetes Type 1 (Insulin dependent)
***Please note that this research is standardized for any client with this health challenge and as such, once
completed can be re-used with any other client with this specific health challenge. In future semesters, additional
knowledge including pathophysiology and diagnostic tests will be expected.
Description/Definition
(in your own words)
Clinical Manifestations
Collaborative Care
(Medical, Pharmacological, Surgical etc Treatments)
Disease related to
abnormal insulin
production, impaired
insulin utilization or
both.
Impending or actual
ketoacidosis
Sudden weight loss
Polyspsia (excessive
thirst)
Polyuria (frequent
urnination)
Polyphagia (excessive
hunger)
Pronounced changes in
visual acuity
Weakness
Fatigue
Fluid Retention
Nutritional Therapy:
Diet
Healthy eating education
Food composition education
Diagnostic:
Hx & Physical exam
Blood tests (Fasting blood glucose, post
prandial blood glucose, fasting lipid
profile, serum creatine)
Fudoscopic examination (dilated eye
exam)
Neurological examination (Monofilament
test for sensation to lower extremities)
ECG
BP
Monitoring of weight
Dental Exam
Podiatric Exam
Exercise Therapy
Drug Therapy:
Insulin therapy
Oral antihyperglycemic agents
Vascular Protection
Enteric coated ASA
ACE inhibitors
Lipid lowering therapy
Surgical
Pancreas Transplant
Home Care
Self Blood glucose monitoring
Client and family teaching
Follow up programs
Decreased ability to
breakdown and use
glucose within the
body.
Sproule/Douglas/NPII/Student Clinical Prep
28/08/2010
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BSN Program Nursing Practice II
Nursing Management
Nursing
Assessment
Safety
LOC
ABC
VS
Past health Hx
Meds
Foci: Nursing
Diagnosis
Nursing Implementation
Nursing Interventions & Rationales
1. Risk for Unstable
blood glucose level
1.1 Review blood glucose monitoring results on each contact w/ pt;
measures progress to achieving set blood glucose level goals,
positive feedback motivates pt to continue with health behaviour
for effective management
1.2Instruct the client to take oral hypoglycemic medications as
directed; There are many different types of drugs that act on
different sites of glucose metabolism. Some drugs act on secretion
of glucose by pancreas, some decrease insulin resistance, and
some decrease glucagon secretion to decrease production of
glucose
1.3 Instruct the client to prepare and administer insulin accurately;
Inconsistencies in technique of insulin preparation may lead to
elevated blood glucose levels.
2. Imbalanced Nutrition
2.1 Determine pt’s and significant other’s feelings & attitude
towards a prescribed diet; determines readiness to learn
2.2 Assist pt to accommodate food preferences in prescribed diet;
improve compliance to diet
2.3 Refer to pt to dietician or nutritionist; provide continuing
education
3. Foot care
3.1 Instruct pt to inspect inside of shoes and socks daily for foreign
objects; avoid injury not felt
3.2 Report signs of infection immediately to primary care provider;
prevention of amputation
3.3 Instruct pt to always wear protective footwear; prevents injury
to foot
Integumentary
Dry
Warm
Inelastic
Pigmented lesions
Ulcers (feet)
Loss of hair on toes
4 . Risk for ineffective
therapeutic regimen
management
4.1 increase fluid intake; dehydration causes many of the
symptoms
4.2 Ensure pt. adheres to dietary guidelines and medical regimen;
non-adherence is frequently a cause of hyperglycemia
4.3 Instruct pt to carry medical identification at all times; medical
personnel needs to be able to identify the pt as having diabetes to
provide appropriate care in case of an emergency
Respiratory
Breathing rate
Breathing depth
Breathing rhythm
5. Risk for peripheral
neurovascular
dysfunction
5.1Inspect skin for ulcers or tissue breakdown; provide timely
treatment and prevent infection and additional necrosis
5.2Encourage exercise as tolerated; increase peripheral circulation
5.3 Maintain adequate hydration; decrease blood viscosity
Symptoms:
Malaise
Weight loss
Thirst & hunger
Poor healing
Constipation or
diarrhea
Skin infections
Msk Weakness,
fatigue
Abd. Pain,
headache, blurred
vision
Depression,
irritability
Eyes
Vitreal
haemorrhages
Cataracts
Cardiovascular
Hypotension (BP)
Pulse
Peripheral pulses
CWMS (feet)
Neurological
Reflexes
Sproule/Douglas/NPII/Student Clinical Prep
28/08/2010
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BSN Program Nursing Practice II
Restlessness
Confusion
Stupor
Glasgow coma scale
Sensation (feet)
MSK
Muscle wasting
Strength
References: It is anticipated that the required textbook Medical-Surgical Nursing in Canada (Lewis et.al.,
2010) is used for this research. If other sources are used, please provide a brief list here.
Sproule/Douglas/NPII/Student Clinical Prep
28/08/2010
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