Nursing: Aging
28-NSTN-192
University of Cincinnati Raymond Walters College
Associate Degree Program in Nursing
Winter 2009
Credit hours: 8
Classroom credits: 5
Laboratory credits: 3
Clinical Laboratory hours: 63
College Laboratory hours: 27
Course Description
The learning experiences for students in Nursing: Aging will focus on health problems
common to the older adult. Emphasis will be placed on the promotion of well being and
optimal level of functioning. Ways to communicate with and care for adults having cognitive
and physiological impairments will be addressed in a holistic manner. Students will be
encouraged to develop in the areas of self-awareness and critical thinking. Advocacy and
strategies to support older adults with chronicity will be emphasized. The learning
experiences for students will assist them in the promotion of a healthy life style for this
population.
As is the case with all six of the courses with lecture and clinical components in the Nursing
Program sequence, Nursing: Aging only partially contributes to the BoK requirement of
Social and Ethical Issues within the University’s General Education Program. Once a student
has completed the entire six-course sequence, then, the BoK requirement is considered
satisfied.
Prerequisites: Nursing: Health and Wellness
Corequisites: ENG 102 English II
BIO 202 Anatomy and Physiology II
BIO
Pharmacology
Course Objectives
Member Within the Discipline of Nursing
The learner will:
1. Demonstrate professional behavior as a beginning provider of care, manager of care,
and member of the discipline of nursing.
2. Practice within the legal and ethical framework of the discipline of nursing in the longterm care setting.
3. Apply previously learned knowledge from required and co-requisite courses.
4. Explain the concept of evidence-based nursing practice.
5. Discuss legal and ethical issues relating to older adults and long-term care.
Manager of Care
6. Examine the concepts of accountability, advocacy, collaboration and delegation as
applied to managing care of the older adult.
7. discuss financial and community resources available for the comprehensive care of
older adults.
8. Discuss legislation and government regulations which impact the care of older adults.
Winter, 2009
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Provider of Care
9. Apply the nursing process in the care of the older adult.
10. Incorporate principles of learning in teaching plans for the older adults.
11. Demonstrate caring behavior in clinical practice with older adult.
12. Apply therapeutic communication skills with older adults.
13. Demonstrate cultural sensitivity when providing care to older adults.
14. Discuss losses and client coping associated with aging.
15. Demonstrate competence and safety in nursing procedures.
16. Identify changes in nutritional needs of the older adult.
17. Discuss the risk for and prevention of injury to the older adult.
18. Discuss pathophysiological changes associated with selected health problems of older
adults.
19. Apply principles of pharmacology and safety when administering medications.
20. State pharmacotherapeutics of selected pharmacological agents used to treat older
adults.
21. Apply developmental theories in the plan of care for the older adult coping with
changes associated with aging.
Course Requirements:
Completion of assigned independent learning activities
Participation in classroom learning activities
Satisfactory clinical performance
Satisfactory completion of laboratory guides
Written assignments
Oral assignments
Method for Grade Determination:
In order to pass the course and progress in the curriculum the student must:
 receive at least 75% in Testing* and
 achieve a “Satisfactory” on all the objectives on the Clinical Performance Evaluation
and
 complete all course requirements
*See the grade calculation sheet for specific details.
Clinical absence may cause the student to be unable to meet the objectives of this course.
This will result in failure of the course. When meeting course requirements a student who
requires repeated attempts to achieve satisfactory status on written, oral or laboratory
assignments may receive a failing grade in the course
Grading Scale:
A =
A- =
B+ =
B =
B- =
93.00-100.00
90.00-92.99
86.00-89.99
83.00-85.99
80.00-82.99
C+ =
C =
D =
F =
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78.00-79.99
75.00-77.99
68.00-74.99
Below 68
During the numerical calculation of grades, there will be no rounding of raw scores,
percentages or final grades.
The student is required to read and be familiar with all information presented in the Student
Handbook and the University of Cincinnati Student Code of Conduct
(www.uc.edu/conduct/Code_of_Conduct.html). Instances of cheating or plagiarism have
caused some students to fail a nursing course and/or be dismissed from the nursing program.
Nursing students are also required by the Ohio Board of Nursing to adhere to the rules of
conduct in the Ohio Administrative Code. The Policy on Cheating and Plagiarism and the
ANA Code of Ethics are strictly enforced. This information is included in the Student
Handbook. (posted on Blackboard under My organizations, RWC Nursing Department)
The student needing assistance in accordance with the American Disabilities Act must selfidentify each quarter to the course faculty and follow Raymond Walters College procedures.
The Nursing program requires a minimum of one week notice prior to the student taking a
test in Disability Services.
Unforeseen circumstances may require changes within the course. All changes will be
announced or posted. The student is responsible for checking Blackboard for course
announcements and postings.
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Required Texts for
Nursing: Aging
Winter, 2009
Arnold, E. & Boggs, K. (2007). Interpersonal relationships (5th ed.). Philadelphia:
Saunders.
Berman, A.J. (2008). Clinical handbook for fundamentals of nursing: Concepts, procedure
and practice (8th ed.). Upper Saddle River, NJ: Prentice-Hall.
Berman, A., Snyder, S.J., Kozier, B, & Erb, G. (2008). Kozier & Erb’s fundamentals of
nursing: Concepts, process, and practice (8th ed.). Upper Saddle River, NJ: PrenticeHall.
Carpenito-Moyet, L.J. (2008). Nursing diagnosis: Application to clinical practice (12th ed.).
Philadelphia: Lippincott, Williams & Wilkins.
Deglin, J.L & Vallerand, A.J. (2009). Davis’s drug guide for nurses (11th ed.). Philadelphia:
F. A. Davis.
Ignatavicius, D.D. & Workman, M.L. (2006). Medical-surgical nursing: Critical thinking for
collaborative care (5th ed.). St. Louis: Saunders.
Ignatavicius, D.D. & Workman, M.L. (2006). Clinical companion for medical-surgical nursing:
Critical thinking for collaborative care (5th ed.). St. Louis: Saunders.
Kee, J. & Marshall, S. (2009). Clinical calculations (6th ed.). St. Louis: Elsevier.
Kee Lefever, J. (2009). Handbook of laboratory diagnostic tests with nursing implications (6th
ed.). Stanford, CT: Prentice-Hall.
Linton, A.D., & Lach, H.W. (2007). Matteson & McConnell’s gerontological nursing:
Concepts and practice (3rd ed.). St. Louis: Saunders.
Peckenpaugh, N.J. (2007). Nutrition essentials and diet therapy (10th ed.). Philadelphia:
Saunders.
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Medical Dictionary of students’ choice. Suggestions:
1. Stedman’s Medical Dictionary, 5th ed.
2. Tabers Cyclopedic Medical Dictionary, 20th ed.
NCLEX Review Book/CD – recommend it be organized by body systems and include CD with
questions and rationale.
Publication Manual of the American Psychological Association (5th ed.) (2001). American
Psychological Association: Washington, DC.
Optional:
Ignatavicius, D.D. & Workman, M.L. (2006). Critical thinking study guide: Medical-surgical
nursing (5th ed.). St. Louis: Saunders.
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Nursing: Aging
Unit Objectives
The learner will:
1. Discuss the origin and development of the field of gerontologic nursing.
2. Describe the current and projected demographics of the U.S. population with an
emphasis on the older adult population in the next three decades.
3. Apply theories of aging to current clinical practice.
4. Identify the legal responsibilities of the nurse in relation to advance directives.
5. Identify own values regarding ethical issues affecting aging adults.
6. Demonstrate critical thinking in the process of analyzing ethical issues facing older
adults.
7. Identify gerontological resources available to the nurse which will contribute to
professional development and enhance nursing practice.
8. Identify examples of evidence based practice in the long term care setting.
9. Maintain a professional image in appearance and behavior.
10. Work effectively with peers in class and the clinical settings.
CONTENT OUTLINE
I. Gerontological Nursing
A. Historical Development
1. Definition of terms
a. geriatric
b. gerontology
c. gerontic nursing
2. Evolution of the discipline
3. Leaders in the field
B. Standards of Practice
1. 1969 - ANA Committee developed Standards of Practice for Geriatric Nursing
2. 1976 - Revised and changed to Standards of Gerontological Nursing Practice
3. 1987 - Revised Standards and Scope of Gerontological Nursing Practice
C. Professional Accountability
1. Related to care given
2. Adherence to Standards of Practice
3. Accurate documentation
D. Evidence Based Practice
1. Defined
2. Process of development
3. Significance to nursing
E. Certification
1. Definition: demonstrates a level of expertise in the area of gerontological nursing
2. Criteria/qualifications
3. Levels
a. Gerontological Nurse
b. Gerontological Nurse Practitioner (GNP)
c. Clinical Specialist in Gerontology
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F.
G.
H.
I.
J.
Gerontological Nursing Organizations
1. National Gerontological Nursing Association
2. Association impacting gerontological nursing
a. American Society on Aging (ASA)
b. Association for Gerontology in Higher Education (AGHE)
Gerontological Research
1. Important for the development of a sound knowledge base which guides nursing
practice
2. Concerns for gerontological nurses
a. learn and communication with nurse researchers
b. support research efforts
c. keep abreast of new findings
3. Areas for future research
a. health promotion and maintenance
b. early detection of disease and illness
c. quality of life issues
Gerontological Nursing Literature
1. Journal of Gerontological Nursing
2. Geriatric Nursing
The Elderly and the Frail Elderly
1. Demographics
2. Characteristics of elderly and frail elderly
3. Transitional stages of aging
4. Factors contributing to frail health
5. Myths and Stereotypes
Theories of Aging (Review Adult Human Development)
II. Legal and Ethical Issues
A.
B.
C.
D.
E.
Confidentiality
1. Part of Nurses’ Ethical Code (ANA, 1985)
Patient Self-Determination Act of 1990
1. Became effective December 1, 1991
2. Clients are to be given information about the extent of their rights under current
law regarding refusing or accepting treatment
Informed Consent
1. Process by which individuals are provided with information that enables them to
make a decision about treatment or intervention
2. Older adults may be at risk regarding informed consent
Advance Directives
1. Living Will
2. Durable Power of Attorney for Health Care
3. Do Not Resuscitate (DNR) Order/Allow Natural Death (AND)
Pharmacological Issues
1. Plan management
2. Inappropriate medication
3. Alcoholism
4. Substance abuse
5. Chemical Restraints
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F.
G.
H.
I.
Medical and Surgical Interventions
1. Economic trends
2. Allocation of resources
Violation of rights
1. Crime
2. Abuse and neglect
3. Abandonment
Violation of Client Rights
1. Crime
2. Abuse and neglect
3. Abandonment
Monitoring Boards and Organizations
1. Ohio Regulatory Boards
2. Standards of Practice violations
3. Ethics Committees
UNIT II: MANAGER OF CARE
Unit Objectives
The learner will:
1. Discuss legislation affecting long-term care residents and care agencies.
2. Demonstrate accountability for own actions as a nursing student.
3. Participate in the process of interdisciplinary care planning for the aging adult.
4. Identify the role of the nurse as an advocate for aging adults.
5. Organize care for the aging adult within the long-term care setting.
6. Identify tasks that may be delegated to other health care workers.
7. Describe examples of advocacy behaviors promoting the rights of older adults.
8. Discuss resources available for aging adults and their families.
9. Discuss the impact of agency culture on the quality of care of older adults.
CONTENT OUTLINE
I. Legislation Affecting Nursing Homes
A. Omnibus Reconciliation Act of 1987 (OBRA)
1. Provision of Service Requirements
a. resident assessment/Minimum Data Set (MDS)
b. minimal staffing levels
c. required nurse aide training
d. professional social worker in home with 120 or more beds
e. assurance of resident rights
f.
addresses unnecessary use of physical and chemical restraints
2. Survey and Certification
a. new types of surveys established
b. standard annual survey
c. if necessary, homes may be subjected to more detailed survey
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3. Enforcement Mechanisms
a. corrective measures can be applied to address deficiencies
b. sanctions applied based on severity of risk to residents
II. Accountability
A. Structural organization of long term care setting
B. Student preparation for clinical experience
III. Advocacy
A. Role of the nurse as advocate for aging adults.
B. Adherence to ANA Code of Nurses, Code of Ethics
C. Patient Bill of Rights for Long Term Care
1. Copies must be given to all residents on admission
2. Are to be posted in facility
3. Ombudsman for each nursing home through Pro-Seniors
D. Association for the Advancement of Retired Persons (AARP)
1. Advocate for older adults
2. Resources in many areas provided
E. Agency culture and nurse advocate role
1. Indicators of agency culture
2. Informal norms of nursing staff behavior
IV. Interdisciplinary Care Planning
A. Collaboration with Health Team
1. Delegation of tasks
B. Documentation of Written Plan (MDS)
1. Functional patterns
2. Completed by many disciplines
C. Systematic Measurement of Health Outcomes
1. Care planning times dictated by law
2. Patient outcomes measured and documented
D. Reimbursement/Documentation
1. Health Care Financing Administration (HCFA) administers Medicare, Medicaid
2. Reimbursement based on thorough documentation
V. Health Insurance for Older Adults
A. Medicare: government health insurance for persons over the age of 65
1. Traditional
a. Part A
b. Part B
c. Part C
d. Part D
B. Medicaid: assistance program for poor, uninsured
C. Ohio programs which also help low income elderly
1. Passport
2. Elderly Services Program (ESP)
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D.
Supplemental Insurance
1. Gap insurance for what is not covered by Medicare
2. Long-term care insurance
VI. Resources
A. Community
1. National Eldercare Locator
2. Senior Information and Referral Service (phone directories)
3. Area Agency on Aging
4. Senior Centers
5. Mobile Meals
6. Friendly Visitors
7. Telephone Reassurance
8. Lifeline
9. Energy Assistance
10. Homemaker Services
B.
Evolving Health Care Delivery Systems
1. Community-Based Long-Term Care
2. Case Management
3. In-Home Health Services
4. Continuous Care Centers
5. Adult Day Care
UNIT III: PROVIDER OF CARE
Nursing Concepts: Nursing Process; Caring Theory; Communication; Cultural and Spiritual
Concepts
The learner will:
1. Complete a functional health assessment of an older adult.
2. Develop nursing diagnoses based on assessment data.
3. Develop a basic level plan of care using the nursing process.
4. Implement and evaluate the basic plan of care.
5. Apply caring theory in nursing practice with older resident.
6. Recognize personal biases and prejudices related to aging.
7. Communicate effectively with older adults.
8. Describe cultural beliefs and practices related to aging.
9. Identify various cultural beliefs related to health and healing among older adults.
10. Develop an awareness of spirituality and its impact upon health and healing.
11. Identify the cultural influences on health seeking behaviors of older adults.
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CONTENT OUTLINE
I. Nursing Process
A. Assessment
B. Diagnosis
C. Planning
1. Setting Priorities
2. Establishing outcomes
a. Nursing Outcome Classification (NOC)
3. Determining nursing interventions
a. Nursing Intervention Classification (NIC)
4. Documenting the plan of care
D. Implementation
1. Assessing and reassessing
2. Setting daily priorities
3. Performing nursing interventions
4. Charting
5. Accountability through documentation and reporting
E. Evaluation
1. Evaluating outcome achievement
2. Identifying variables affecting outcome achievement
3. Deciding whether to continue, modify, or terminate the plan
4. Continuing, modifying or terminating the plan
II. Application of Caring Theory
A. Dimensions of Caring with Older Adults
1. Application of Caring Processes with older adults
2. Other themes
a. genuine appreciation/authentic respect for older adults
b. self-awareness - own issues and experiences with aging and the aged.
B. Challenges to caring for older adults
1. Interrelationship between physical and psychosocial aspects of aging
2. Effects of disease and disability on functional status
a. decreased efficiency of homoeostatic mechanisms
b. lack of standards for health and illness norms
c. altered presentation of and response to specific diseases
d. tailoring the nursing assessment to the older person
III. Unique aspects of communication with older adults
A. Physical/cognitive Impairments
1. Sensory impairments
2. Sensory overload
3. Internal distractions - physical conditions
4. Effects of medications or pathologic conditions
IV. Culture and older adults
A. Cultural attitudes toward aging
1. Major groups in the U.S.
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B.
Practices regarding care of older adults of different cultures
1. Ageism.
2. Death rituals
V. Spirituality among older adults
A. Assessment of spiritual needs
B. Role of spirituality in health/illness
1. Attitudes toward illness
C. Nursing diagnosis: Spiritual Distress
1. Definition
2. Related factors
3. Defining characteristics
4. Goal setting/outcome criteria
5. Interventions
PROMOTION OF WELL BEING: Healthy Lifestyle, Teaching and Learning, Nutrition, Growth
and Development, Losses and Aging
Unit Objectives
The learner will:
1. Assess learning needs of older adults based on functional health assessment.
2. Implement incidental health teaching with older adults.
3. Assist individuals and families to cope with transitions in living.
4. Promote nutritional adaptations in fostering a healthy lifestyle for older adults.
5. Discuss the effects of alterations in fluid volume.
6. Discuss selected therapeutic diets.
7. Promote the use of adaptive equipment and restructured living environments.
8. Promote the practice of complimentary healing methods to maintain a healthy lifestyle.
9. Develop an understanding of the losses associated with aging.
10. Identify coping strategies used by individuals when dealing with losses associated with
aging.
11. Demonstrate elements of effective oral presentation.
CONTENT OUTLINE
I. Nutritional Needs of Older Adults
A. Correlations with illness
1. Taste changes
2. Supplements
B. Assistive Devices and Modifications for eating
1. Problems with teeth and dentures
2. Dysphagia
3. Tube feeding
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C.
Body Fluids and Hydration
1. Definition, Risk Factors, Incidence
a. fluid volume deficit: Dehydration/Hypovolemia
b. fluid volume excess: Hypervolemia
2. Pathophysiology
3. Clinical Manifestations
4. Diagnostic Analysis
a. osmolarity 270-300 mOsm/L
5. Nursing Implications related to Major Treatment Modalities
a. assessment
b. therapeutic diet examples
c. pharmacologic therapy
d. procedures
e. client teaching
II. Teaching the Older Learner
A. Learning modifications required due to aging process.
B. Resources and supports to promote learning.
III. Loss and the Aging Process
A. Types of loss
1. Loss of relationships
2. Loss of roles
3. Loss of health
B. Self awareness of losses experienced
1. Responses to loss
2. Healthy grief responses
C. Coping strategies used by older adults and families
D. Sadness and depression among older adults
1. Meaning of sadness as an emotion
2. Depression - differentiate from sadness
3. Types of grief
IV. Maintenance of Healthy Lifestyle/Complementary Therapy
A. Music/Dance activities
B. Reminiscence
C. Life review
D. Tai Chi
E. Pet Therapy
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PREVENTION OF ILLNESS
Unit Objectives
The learner will:
1. Identify risk factors for injury to the older adult
2. Discuss risk assessment and nursing interventions for prevention of injury to clients in
long term facilities.
3. Identify and discuss the different isolation techniques.
4. Identity teaching needed to promote residents’ safety in the long term care setting.
5. Incorporate into practice principles related to personal and client safety.
CONTENT OUTLINE
I. Safety Issues in Long Term Care
A. Falls
1. Risk assessment
2. Prevention
B. Effect of Cognitive Impairment
1. Wandering and monitoring devices
2. Potential risk with objects clients use
C. Effect of Sensory Impairment
1. Vision, hearing, smell changes
2. Risk of unsafe mobility, medication errors, diminished response to danger, i.e.,
gas leak, smoke, spoiled food
D. Driving Issues
1. Increased sensitivity to glare, slowed response to changes in illumination
2. Slowed reaction time
E. Drug and Alcohol Use
1. Improved assessment of alcoholism among older adults
2. Patient education on side effects of medication taken
F. Environmental Hazards
1. Floor coverings
2. Stairs and lighting
3. Furniture
4. Storage of supplies and equipment
5. Storage of medication and toxic substances
6. Fire prevention, safety, control and evacuation in LTC settings
G. Infection control
1. Types of isolation precautions
a. airborne
b. droplet
c. contact
2. Isolation attire
3. Disposal of infected materials
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RESTORATION OF HEALTH
PHARMACOLOGY
Unit Objectives
The learner will:
1. Accurately calculate medication dosages.
2. Recognize aging changes which impact the pharmacological effects of selected
medications
3. Discuss common over the counter (OTC) medications used by the healthy older adult.
4. Describe therapeutic and adverse effects of common OTC medications.
5. Discuss prescribed medications commonly used by the healthy older adult.
6. Safely administer medications to older adults.
7. Demonstrate safe administration of an IM and a SC injection.
8. Define “polypharmacy” and how it applies to the older adult.
9. Describe the pharmacology of selected medications and medication categories taught
during this course.
10. Identify laboratory tests significant for metabolism of medications.
CONTENT OUTLINE
I.
Introduction
A. Changes associated with aging
B. Polypharmacy
C. Overview of safe medication administration
D. Laboratory tests significant for medication administration
1. Serum creatinine, creatinine clearance
2. Glomerular Filtration Rate (GFR), Blood Urea Nitrogen (BUN)
RESTORATION OF HEALTH
HEALTH PROBLEMS
Unit Objectives
The learner will:
1. Apply the nursing process in the care of older individuals and families.
2. Identify nutritional and fluid modifications needed by older adults with illness.
3. Relate pathophysiological changes of selected health problems to the care needs of the
older adult.
4. Teach strategies for maintaining and improving health.
CONTENT OUTLINE
I. Immobility in Older Adults
A. Effects of immobility on body systems
1. Cardiovascular
2. Pulmonary
3. Gastrointestinal
4. Genitourinary
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B.
C.
Nursing assessment of immobility
Nursing interventions to decrease complications of immobility
II.Genitourinary - Urinary Tract Infections/Urinary Incontinence
A. Definition, Risk Factors, Incidence
B. Pathophysiology
C. Types of Urinary Incontinence
D. Clinical Manifestations
E. Diagnostic Analysis
1. Urine analysis
2. Culture and sensitivity
3. Radiographic
a. ultrasound
b. cystogram
c. intravenous pyelogram (IVP)
F. Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
3. Pharmacologic Therapy (Appendix D)
a. urinary cholinergics
b. urinary analgesics
4. Procedures
5. Client Teaching
III. Pressure Ulcers
A. Definition, Risk Factors, Incidence
B. Pathophysiology
C. Clinical Manifestations
D. Diagnostic Analysis
1. Culture and sensitivity of wounds (C&S)
E. Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
3. Pharmacologic Therapy
4. Procedures
5. Client Teaching
IV. Neurologic Disorders
A. Definition, Risk Factors, Incidence
1. Dementia/Alzheimer’s Disease
2. Cerebral Vascular Accident (CVA)
a. Transient Ischemic Attack (TIA)
b. Reversible Ischemic Neurologic Deficit (RIND)
B. Pathophysiology
C. Clinical Manifestations
D. Diagnostic Analysis
1. Computed Tomography Scan (CT scan)
2. Magnetic Resonance Imaging (MRI)
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E.
3. Position Emmision Tomography (PET)
4. Doppler ultrasound
5. Prothrombin Time (PT); Partial Thromboplastin Time (PTT)
6. International Normalized Ratio (INR)
Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
3. Pharmacologic Therapy (Appendix D)
a. anticoagulants
4. Procedures
5. Client Teaching
V. Respiratory
A. Definition, Risk Factors, Incidence
1. Chronic Airflow Limitation
a. asthma
b. chronic bronchitis
c. emphysema
2. Pneumonia
B. Pathophysiology
C. Clinical Manifestations
D. Diagnostic Analysis
1. Chest X-ray
2. Pulmonary Function Studies
3. Complete Blood Counts
E. Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
3. Pharmacologic Therapy (see Appendix D)
a. antibiotics
b. bronchodilators
c. corticosteriods
4. Procedures
5. Client Teaching
VI. Endocrine - Diabetes
A. Definition, Risk Factors, Incidence
1. Type I - Insulin Dependent Diabetes Mellitus
2. Type II - Non-Insulin Dependent Diabetes Mellitus
B. Pathophysiology
C. Clinical Manifestations
D. Diagnostic Analysis
1. Blood Glucose
2. Glycosylated hemoglobin A1C
3. Glucose Tolerance
4. Post-Prandial Glucose
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E.
F.
Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
a. carbohydrate counting
b. exchange system
3. Pharmacologic Therapy (see Appendix D)
a. insulins
1. types
2. complications
b. oral hypoglycemics
c. hyperglycemics
4. Procedures
5. Client Teaching
Complications.
1. Life Threatening: Hypoglycemia, Diabetic Ketoacidosis (DKA)
2. Microvascular: Retinopathy, Neuropathy, Nephropathy, Infections, and Erectile
Dysfunction
3. Macrovascular: Coronary Artery Disease (CAD), Peripheral Vascular Disease
(PVD), Pulmonary Embolus (PE), and Cerebral Vascular Accident (CVA)
VII. Endocrine - Thyroid Disorders
A. Definition, Risk Factors, Incidences
1. Thyroid Disorders
a. hyperthyroidism
b. hypothyroidism
B. Pathophysiology
C. Clinical Manifestations
D. Diagnostic Analysis
E. Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
3. Pharmacologic Therapy (Appendix D)
a. thyroid medications
b. antithyroid medications
4. Procedures
5. Client Teaching
VIII. Cardiovascular
A. Definition, Risk Factors, Incidence
1. Congestive Heart Failure
2. Hypertension
3. Coronary Artery Disease (CAD)
4. Peripheral Vascular Disease (PVD)
B. Pathophysiology
C. Clinical Manifestations
D. Diagnostic Analysis
1. Electrocardiogram (ECG)
2. Stress Test
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E.
3. Cardiac Catheterization
4. Abnormal Heart Sounds
5. Lab Values
a. lipid studies
b. Brain Natriuretic Peptide (BNP)
c. C-Reactive Protein (CRP)
d. cardiac markers
6. Echocardiogram
7. Multigated Angiography (MUGA)/Thalium
Nursing Implications Related to Major Treatment Modalities
1. Assessment
2. Diet Therapy
a. sodium restricted diet
b. low cholesterol diet
3. Pharmacologic Therapy (Appendix D)
a. antianginals
b. glycosides
c. antihypertensives
d. diuretics
e. anticoagulants
f. thrombolytic enzymes
g. antilipemic drugs
4. Procedures
5. Client Teaching
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Appendix A
The following assessments will be taught in this course:
1.
2.
3.
4.
5.
6.
Alzheimers Assessment
Blood Glucose Monitoring
Heart Sounds, abnormal
Kidney Function Tests
Lung Sounds, abnormal
Urine testing
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Appendix B
The following nursing skills and procedures will be taught in this course:
1. Hygiene
 Catheter Care
2. Tube feedings
 G-Tube
3. Elimination
 Bedpan/urinal/attends
 Intake and Output
 Ostomy care
 Enema
4. Medication Administration
 Oral
 Parenteral (subQ, IM)
 Topical medications: eye, ear, nose, skin, rectal, vaginal
5. Sterile Technique
 Wound care (dressings, irrigation)
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Appendix C: Laboratory Guides
The student will satisfactorily meet the objectives of the following laboratory guides:
Laboratory Guide
COLLEGE LABS
A
Ethics, Values, Standards of Care, Accountability
B
Enema, Measuring Intake and Output and Urinary Elimination
C
Sterile Technique: Surgical Asepsis, Wound Care, and Pressure Ulcers
D
Nutritional Supplements, Tube Feedings, and Bowel Elimination
E
Oral and Topical Medications
F
Intramuscular and Subcutaneous Medications
G
Potential Complications for the Client With Diabetes, Self-Monitoring of
Blood Glucose and Administering Insulin
AGENCY LABS
#1
Orientation to Facility, I&O, Safety, Isolation and Client Introduction
#2
Nursing Home Legislation, Interdisciplinary Care
#3
Hygiene, Assessment, Vital Signs, Nursing Process, Immobility
#4
Nursing Process
#5
Caring, Loss, Spirituality, Communication
#6
Medications
#7
Abnormal Heart Sounds
#8
Adventitious Lung Sounds
#9
Pharmacology and the Older Adult
#10
Resources in the Community
#11
Client Presentation
#12
Termination and the Older Adult
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Appendix D: Medications
The nursing implications related to the following medications will be taught in this course.
A.
B.
Antibiotics
1. penicillins
a. amoxicillin (Amoxil)
b. ampicillin (Amcil)
c. methicillin (Staphcillin)
2. cephalosporins
a. cefazolin (Ancef) - 1st generation
b. cefaclor (Ceclor) - 2nd generation
c. cefoperazone (Cefobid) - 3rd generation
3. macrolides
a. erythromycin (Ilasone)
4. aminoglycosides
a. amikacin (Amikan)
b. gentamycin (Garamycin)
c. tobramycin (Nebcin)
5. lincomycin
a. clindamycin (Cleocin)
b. lincomycin (Lincocin)
6. tetracyclines
a. demeclocycline (Declomycin)
b. doxycycline (Vibramycin)
c. minocycline (Minocin)
7. quinolones
a. ciprofloxacin (Cipro)
b. norfloxacin (Noroxin)
c. enoxacin (Penetrex)
8. miscellaneous
a. aztreonam (Azactam)
b. imipenam - cilastin (Primaxin)
c. metronidazole (Flagyl)
d. trimethoprim/sulfamethoxazole (Bactrim)
e. vancomycin (Vancocin)
Bronchodilators
1. sympathomimetics
a. epinephrine (Epdedrine, Ethylonorephine)
b. albuterol (Proventil)
c. metaproterenol (Alupent, Metaprel)
2. Anticholinergics
a. ipratropium bromide (Atrovent)
3. Methylxanthines
a. aminophylline
b. theophylline
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C.
D.
E.
F.
G.
H.
I.
J.
Corticosteroids
1. hydrocortisone
2. prednisone
3. dexamethasone
4. fluticasone (Flovent)
Mucolytics
Antidiabetic and Hypoglycemic Agents
1. Insulins
a. short acting
b. intermediate acting
c. long acting
2. Oral Hypoglycemics
3. Hyperglycemic Agents
a. Glucagon
Thyroid hormones and suppressants
1. Thyroid medications
a. levothyroxine sodium (Levoyx) T4
b. liothyronine sodium (Cytomel) T3
c. calcitonin
2. Antithyroid medications
a. popylthiouracil (Propyl - thyracel)
b. methimazole
c. iodine preparations
1. Lugol’s solution
2. Saturated solution of potassium iodine
d. Radioactive Iodine
1. Sodium iodine (I131)
Urinary cholinergics
1. Direct acting Cholinergic Agonists
2. bethanechol chloride (Urechloline)
Urinary Analgesics
1. phenazopyridine (Pyridium)
Antianginals
1. Nitrates
a. erythritol tetranitrate (Cardilate)
b. isosorbide dinitrate (Indur-Monolet)
c. nitroglycerine (Nitro-Bid)
2. non-nitrates (beta-adrenergic blockers)
a. nadolol (Corgard)
b. propranolol (Inderal)
3. calcium antagonists
a. diltiazem (Cardizem)
b. nifedipine (Procardia)
c. verapamil (Calan/Isoptin)
Glycosides
1. digoxin
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K.
L.
M.
N.
Human B-type natriuretic peptides
1. milrinone (Primacor)
2. nesiritide (Natrecor)
Antihypertensives
1. Calcium channel blockers
a. dilitazem (Cardizem SR)
b. nicardipine (Cardene)
c. verapamil (Calan/Isoptin)
2. Angiotensin-converting Enzyme (ACE) Inhibitors
a. captopril (Capoten)
b. enalapril (Vasotec)
c. lisinopril (Prinivil, Zestril)
3. Adrenergic Blockers
a. alpha-adrenergic blockers
1. prazosin (Minipress)
2. terazosin (Hytrin)
b. Beta-adrenergic blockers
1. pindolol (Visken)
2. propanolol (Inderol)
3. timolol (Timoptic)
c. Centrally acting adrenergic blockers
1. clonidine (Catapres)
4. Angiotensin II Receptor Agonists
a. losartan (Cozaar)
5. Aldosterone Receptor Antagonists
a. eplerenone
6. Peripheral Vasodilator
a. diazoxide (Hyperstat)
b. sodium nitroprusside (Nipride)
c. hydralazine (Apresoline)
Diuretics
1. osmotic diuretics
a. mannitol (Osmitral)
b. urea (Carbamide)
2. potassium-sparing diuretics
a. spironolactone (Aldactone)
b. triamterene (Dyrenium)
3. loop diuretics
a. bumetanide (Bumex)
b. ethacrynic acid (Edecrin)
c. furosemide (Lasix)
Anticoagulants
1. Antiplatelet Drugs
a. ASA
b. ticlopidine (Ticlid)
c. dipyridamole (Persantine)
d. clopidogrel (Plavix)
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O.
P.
2. Injectable anticoagulants
a. enoxaparin (Lovenox)
b. heparin sodium (Liqualmin)
c. dalteparin (Fragmin)
3. Oral anticoagulants
a. warfarin potassium
b. warfarin sodium (Coumadin)
c. dicumarol
4. Antidotes for Anticoagulants
a. protamine sulfate
b. vitamin K
5. Thrombolytic Enzymes
a. streptokinase (Kabikinase)
b. urokinase (Abbokinase)
c. alteplase (Activase)
Antilipidemic Drugs
1. Bile Sequestering
a. cholestryamine (Questan)
2. Fibric Acid Derivatives
a. gemfibrozil (Lopid)
3. Cholesterol synthesis inhibitor
a. lovastatin (Mevacor)
Alzheimer’s Disease Medications
1. Cholinesterase Inhibitors
a. donepezil (Aricept)
b. rivastigmine (Exelon)
c. galantamine (Razadyne)
2. NMDA Receptor Antagonist
a. memantine (Namenda)
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