NUR 2227 Medical Surgical Nursing II

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COAHOMA COMMUNITY COLLEGE
ASSOCIATE DEGREE NURSING PROGRAM
NUR 2227 – MEDICAL SURGICAL NURSING II
SPRING 2015
COURSE COORDINATOR/INSTRUCTOR:
OFFICE LOCATION:
CHARLES R. SMITH MSN, RN
ALLIED HEALTH BUILDING # 105
OFFICE HOURS:
EMAIL: [email protected]
T-F 1ST 2 WEEKS – 11-12 & 4-5
T-F AFTER CLINICAL BEGINS 11-12 (BY APPOINTMENT)
PHONE: 662-621-4254
CLASS/CINICAL TIME: SEE TOPICAL OUTLINE
CO-INSTRUCTOR:
GLORIA MORRIS DNP, RN
OFFICE HOURS:
PHONE: 662-624-4252
OFFICE LOCATION:
ALLIED HEALTH BUILDING # 113
EMAIL: [email protected]
CO-INSTRUCTOR:
OFFICE LOCATION:
DR. J. BROWNLOW, RN
ALLEID HEALTH BUILDING RM 114
OFFICE HOURS: BY APPOINTMENT
EMAIL: [email protected]
PHONE: 662-621-4673
CLASS/CINICAL TIME: SEE TOPICAL OUTLINE
CO-INSTRUCTOR:
OFFICE LOCATION:
D. WILSON, MSN, RN
ALLEID HEALTH BUILDING RM 106
OFFICE HOURS: BY APPOINTMENT
EMAIL: [email protected]
PHONE: 662-621-4253
CLASS/CINICAL TIME: SEE TOPICAL OUTLINE
Course Description:
NUR 2227 MEDICAL-SURGICAL NURSING II – This course expands the content of NUR
1227 to include care of complex, acute inpatient clients. Refinement of critical thinking skills,
organization, and time management is developed by assignment of several clients. Emphasis is
placed on cultural and ethical differences, medication and IV therapy assessment, and
documentation of nursing care. Clinical experiences include medical surgical units, dialysis
units, ambulatory care, emergency rooms, and intensive care units. The nursing roles of Provider
of Care, Manager of Care and Member of the Profession focus on adults with complex, acute
health needs of multiple body systems. Emphasis is placed on knowledge, judgment, hands-on
skills and professional values within a legal/ethical framework. Pre-requisites: NUR 1117, NUR
1011, NUR 1113, NUR 1227, NUR 2114, NUR 2128. Co-requisites: NUR 2223. Credits: 7
credit hours/4 theory and 3 clinical (4 theory clock hours per week and 9 clinical clock hours per
week with lab hour ratio 1 to 3; 60 total theory clock hours/135 total clinical clock hours).
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Textbooks:
Required:
Sommer, S., Johnson, J., Roberts, K., Redding, S., Churchill, L., et al. (2013). RN Adult medical-
surgical nursing review module 9th ed. Overland Park, Kansas: Assessment Technologies
Institute®, LLC.
Manning, L., & Rayfield, S. (2014). Pharmacology made insanely easy 4th ed. Duluth, GA: CAN
Publishing, Inc.
Rayfield, S., & Manning, L. (2014). Nursing made insanely easy 7th ed. . Duluth, GA: I CAN Publishing
Inc.
Hinkle, J. L., Cheever, K. H. (2013). Brunner & Suddarth’s textbook of medical surgical
nursing (13th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.
Recommended:
Sparks, S. & Taylor, C. (2014). Nursing diagnosis references manual. (9th ed.). Philadelphia: Lippincott,
Williams & Wilkins.
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Graduate Competencies:
Upon completion of the Associate Degree Nursing Program at Coahoma Community
College, the graduate will be prepared for professional nursing practice role by:
Core Concepts
Role Specific Graduate Competencies
Nursing
Process/Clinical
Reasoning
Exercising clinical reasoning skills as the basis for carrying out the
nursing process to meet the physiological, psycho-social, and
cultural needs of the client.
Safe and Effective
Care Environment
Providing and directing safe client care to protect the client and
health care personnel from health and environmental hazards.
Health Promotion
Utilizing various strategies in implementing and evaluating
methods to assist clients in meeting their self-care needs to
promote health and prevent health disorders throughout the life
span.
Psychosocial Care
Demonstrating therapeutic communication, caring and
professionalism in interpersonal interactions with clients and
documentation of client care.
Pharmacological
Management
Providing pharmacological management to ensure a safe and
effective client care environment.
Evidence-Based
Practice
Managing client care to incorporate evidence-based practice for
the improvement of nursing care delivery and client safety.
Additional research required
Reduction of
Potential Risk
Reducing potential risk through reassessment and recognition of
changes in the client’s condition that requires intervention.
Leadership
Demonstrating leadership behaviors consistent with the roles and
responsibilities of the registered nurse.
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Student Learning Outcomes:
Upon completion of this course, the student should be able to do the following:
1. Exercise clinical reasoning skills using the nursing process to provide safe nursing care to
meet the physiological, psycho-social, and cultural needs of adult clients in the acute care
setting. .
2. Utilize various strategies to implement and evaluate the teaching-learning process to
assist clients in meeting their self- care needs for illness prevention and health promotion.
3. Demonstrate therapeutic communication, caring and professionalism in interpersonal
interactions with clients and their families.
4. Collaborate with the multidisciplinary health care team to ensure a safe and effective care
environment including pharmacological management.
.
5. Provide care to incorporate evidence-based practice interventions for clients in acute care
settings.
6. Adapt practice through reassessment and recognition of changes in the condition of
clients that require intervention.
7. Demonstrate accountability and ethical decision making in nursing actions based on
accepted standards of nursing practice.
8. Accept responsibility and accountability for self- assessment, learning, and role
development by engaging in self-evaluation and professional development activities and
exercise independent judgment by advocating for clients to ensure quality of care in a
variety of settings.
Attendance:
3.1 The Absentee Policy for the Associate Degree Nursing, Respiratory Care,
Polysomnography, and Practical Nursing programs is as follows:
Fall and Spring Courses
One semester hour course one absence
Two semester hour course two absences
Three semester hour course and higher three absences
Absences greater than those listed above result in the student being dropped from
the class.
3.2 Refer to specific program requirements regarding make up for time missed (class and
clinical).
3.3 Three tardies will be recorded as an absence. Three occurrences of leaving class
before
the class period is completed equals one absence.
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3.4 Class work and assignments missed due to absence: In order to make up class work
and
assignments missed due to being absent, the student must provide documentation to
support the reason for the absence immediately upon return to class. When a student is
allowed to make up class work and assignments the absence is still recorded. (see 3.1)
3.5 A student must call prior to the beginning of an assigned clinical activity as follows:
● One hour prior to an absence, other than an emergency
● 30 minutes prior to a tardy, other than an emergency
● In the event of an emergency, there must be proper documentation of that emergency,
and the student must call as soon as possible after becoming aware of the situation.
Absence from Class for School Sanctioned Activities
The nature of the educational programs at Coahoma Community College is such that it is
necessary for every student to attend class regularly. Instructors will keep accurate class
attendance records, and those records will become part of the student's official record.
Regular class attendance and punctuality are expected. All arrangements for completing
missed work are to be made with the instructor. It is the student’s responsibility to initiate
these arrangements. Excessive absences may result in loss of credit for the course
concerned as well as loss of grant refunds and/or financial aid eligibility. For more
information, see the Attendance Policy section in the College Catalog.
Make-up Policy:
Make-up-When a scheduled test is missed the students must upon return to class bring
documentation of the reason for the absence in order to make up. The make-up test will
be a
different test but cover the same content and will be according to the time scheduled by
the
instructor. The make-up test may be a paper and pencil test and include essay-type
questions.
Academic Dishonesty:
Cheating and plagiarism (the representation of someone else’s work as your own, usually
by directly copying or paraphrasing without a reference to the original source) will not be
tolerated. The penalty will be receiving a (0) for that assignment, without any possibility
of make-up work or alternative assignments. Additionally, according to the Student
Handbook, such acts will be considered a severe infraction and carry a possible sanction
of suspension in semester (s) length or expulsion. For a more in-depth explanation of
academic dishonesty, see the Student Handbook.
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5.2 Dishonesty in any form is absolutely forbidden. Areas that are considered
dishonest
include, but are not limited to:
• Giving or receiving examination or quiz answers
• Copying from another student
• Talking during examinations and quizzes
• Plagiarism in any form includes but is not limited to:
Taking other authors work and not crediting the author
Cut and paste
• Making statements not based in fact (lying, gossip, etc.)
• Failing to inform the instructor of a clinical mistake, e.g. medication error,
documentation, etc.
• Falsification of documentation, including but not limited to, date, time,
procedures, medication entered into the medical record improperly or with intent
to mislead
5.3 Students in violation of the honesty policy will be removed from the classroom,
laboratory, or clinical affiliate and referred to the Vice President for Health Sciences for
disciplinary action. Disciplinary action may be up to and including dismissal from the
healthcare programs. (see Coahoma Community College Student Handbook
Electronic Devices in Class
The use of cellular phones, pagers, CD players, radios, and similar devices is prohibited in
the classroom and laboratory facilities.
Classroom and Clinical Policies and Procedures
See http://www.coahomacc.edu/healthsciences/HealthP&P.pdf for classroom and
clinical policies sections I-XII and Appendix A.
Non-Discrimination/Disability Policy:
Coahoma Community College is an equal opportunity institution in accordance with civil
rights and does not discriminate on the basis of race, color, national origin, sex, disability,
age, or other factors prohibited by law in any of its educational programs, activities and
employment opportunities. The following person has been designated to handle inquiries
regarding the non-discrimination policies: Wanda G. Holmes, Director of Human
Resources/Coordinator for 504/ADA, Title IX Compliance Officer, Office #A100, Vivian
M. Presley Administration Building, 3240 Friars Point Road, Clarksdale, Mississippi
38614, Phone: (662)621-4853, Email: [email protected]
Instructional Techniques:
Lecture / Discussion Independent and Group Study – utilizing reading apprenticeship methodologies.
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Audio-visual Learning Aids – PowerPoint presentations, Computer media
Post-test Review Sessions
Case Studies – Class participation / discussion.
Handout materials via Blackboard – Assessment, Medication, and Concept mapping forms
Selected Web content – MedscapePlus online interactive tutorials.
Blackboard Assignments – Journaling, Handout completion, Discussion Group responses.
Methods of Evaluation:
Theory:
1.
2.
3.
6 Unit Tests
1 Comprehensive Final Exam
ATI Proctored Test - Medical – Surgical Nursing
Clinical Setting:
1. Observation - daily
2. Clinical Evaluation Tool – daily and final
3. Concept Map – daily
Grade Scale:
Grading Scale for Associate Degree Nursing Program
Grade
A-Excellent
B-Good
C-Average
D-Poor
F-Failure
I-Incomplete
W-Withdrawal
Z-Unassigned grade
CR: This grade will be
assigned when the
student successfully
completes programspecific requirements
for advancement to the
Associate Degree
Nursing program.
Scale
93-100
85-2
77-84
70-76
69 or Below
Quality Points
4.0
3.0
2.0
1.0
0.0
0.0
0.0
0.0
Associate Degree Nursing Program courses require a letter grade of “C”
(minimum 77%). Failure to attain these score will prevent the student from
progressing to the next scheduled semester.
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Course Grading System:
Unit Tests (6) 90%
Final Exam
10%
100%
Theory: Formative assessments will be conducted throughout the course at the instructor’s
discretion which will constitute the daily average. The daily average consists
of the average
of formative assessments given by the instructor. The points received for the daily average will
be added to the lowest unit test. The point system is as follows: A = 5 points, B = 3 points and C
= 1 point. Types of formative assessments include pre and post
lecture
quizzes,
class
assignments, and learning activities provided by the instructor.
Assessment Technologies Institute®, LLC (ATI) Resources: The Associate Degree Nursing
Program utilizes ATI resources to enhance learning and to provide a means for evaluation of
student comprehension of content and concepts presented in the nursing curriculum classes. An
orientation to utilization of ATI resources will be provided to the students at the beginning of the
semester. Resources include practice tests, proctored tests, and tutorials relevant to the content
and concepts taught within each class of the nursing curriculum.
Completion of Medical Surgical Nursing practice tests A and B is required for the student to be
allowed to take the Medical Surgical Nursing Proctored test at the end of the course. Students
will receive points added to the final exam based on the level achieved on the proctored exam.
The point system is as follows: Level 3 = 5 points, Level 2 = 3 points, and level 1 = 1 point. The
student is responsible for keeping a notebook containing printed information related to results on
practice tests, proctored test, tutorials, and focus review materials developed to address
deficiencies identified by practice and proctored tests. This notebook is to accompany the student
when meeting with their advisor for academic counseling. Academic counseling sessions will be
scheduled to occur weekly. It is the student’s responsibility to schedule additional counseling
sessions with their advisor as needed. Students who make 77 or less on a unit exam will be
expected to make an appointment with their advisor within one week.
Clinical Evaluation Tool: Each student will be evaluated daily on specific behaviors in the clinical area.
Behaviors will be scored (S) satisfactory or (U) unsatisfactory. Satisfactory is defined as actions that meet the
established standards of care and ensure client safety. Unsatisfactory is defined as any action or inaction which
does not meet the established standards of care and / or poses a threat to the client’s well being. Three (3) (U)
unsatisfactory behaviors or repeating an (U) unsatisfactory behavior will result in failure of the course.
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Course Grading Worksheet:
NUR 2227 – MEDICAL SURGICAL NURSING II
SPRING SEMESTER
Unit Tests
#1
Respiratory
15%
#2
Cardiovascular
15%
#3
F&E / Renal & Urological
15%
#4
Endocrine & Gastrointestinal
15%
#5
Neurological / Sensory
15%
#6
Lymphatic/ Immune/ Hematology/Oncology, Surgical,
Integumentary
15%
Comprehensive Final Exam
Daily class points achieved / available = _____%
90%
10%
Proctored ATI Medical Surgical Level achieved
Total
Summary:
100%
Unit Exams
____ __________
Comprehensive Final Exam
________________
TOTAL
______________
COURSE GRADE
_____ ____
_____________________
Instructor
I Concur ______
_____________
Date
_____________________
Student
___________
Date
I do not concur _____
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Unit Objectives:
Upon completion of the units of study, the student should be able to do the following:
Unit I: Respiratory
1. Relate the therapeutic management techniques of acute respiratory distress syndrome
to the underlying pathophysiology of the syndrome.
2. Describe risk factors and measures appropriate for prevention and management of
pulmonary embolism.
3. Describe the pathophysiology of asthma.
4. Discuss the medications used in asthma management.
5. Explain the roles of the lungs, kidneys, and chemical buffers in maintaining acid-base
balance.
6. Compare metabolic acidosis and alkalosis with regard to causes, clinical
manifestations, diagnosis, and management.
7. Compare respiratory acidosis and alkalosis with regard to causes, clinical
manifestations, diagnosis, and management.
8. Interpret arterial blood gas measurements.
9. Describe the nursing care for a patient with an endotracheal tube and for a patient
with a tracheostomy.
10. Demonstrate the procedure of tracheal suctioning.
11. Use the nursing process as a framework for care of patients who are mechanically
ventilated.
12. Explain the principles of chest drainage and the nursing responsibilities related to the
care of the patient with a chest drainage system.
13. Describe the complications of chest trauma and their clinical manifestations and
nursing management (Hemothorax / Pneumothorax).
Unit II: Cardiac
1. Analyze elements of an ECG rhythm strip; ventricular and atrial rate, ventricular and
atrial rhythm, QRS complex and shape, QRS duration, P wave and shape, PR interval,
and P: QRS ratio.
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2. Identify the ECG criteria, causes, and management of several dysrhythmias, including
conduction disturbances.
3. Use the nursing process as a framework for care of patients with dysrhythmias.
4. Describe the possible complications and nursing management of patients with
pacemakers and implantable cardiac devices (implantable cardioverter defibrillator).
5. Discuss the clinical indications, patient preparation, and other related nursing
implications for common tests ad procedures used to assess cardiovascular function
and diagnose cardiovascular diseases (Cardiac Catheterization).
6. Compare the various methods of hemodynamic monitoring (central venous pressure,
arterial pressure monitoring) with regard to indications for use, potential
complications, and nursing responsibilities.
7. Describe the pathophysiology, clinical manifestations, and treatment of coronary
atherosclerosis, angina pectoris, and myocardial infarction.
8. Use the nursing process as a framework for care of patients with angina pectoris,
acute coronary syndrome and myocardial infarction.
9. Describe the nursing care of a patient who has had a percutaneous coronary
interventional procedure or has undergone cardiac surgery for treatment of coronary
artery disease.
10. Describe the pathophysiology, clinical manifestations, and management of patients
with mitral and aortic valvular disorders.
11. Describe the pathophysiology, clinical manifestations, and management of patients
with aneurysms of the aorta.
12. Describe the management of patients with pulmonary edema
Unit III: Fluid & Electrolytes - Renal / Urological
1. Compare and contrast the pathophysiology, clinical manifestations, medical
management and nursing management for patients with renal disorders
(glomerulonephritis, Pyelonephritis, nephrotic syndrome, acute renal failure)
2. Identify potential causes of renal calculi and management of the patient with this
condition (Urolithiasis).
3. Describe shock and its underlying pathophysiology.
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4. Compare clinical findings of the compensatory, progressive, and irreversible stages of
shock.
5. Describe similarities and differences in shock due to hypovolemic, cardiogenic,
neurogenic, anaphylactic, and septic shock states.
6. Identify medical and nursing management priorities in treating patients in shock.
7. Identify vasoactive medications used in treating shock and describe nursing
implications associated with their use.
8. Discuss the role of nurses in psychosocial support of patient experiencing shock and
their families.
Unit IV: Endocrine / Gastrointestinal (GI)
1. Describe nursing management of patients with pheochromocytoma.
2. Differentiate between hyperglycemia with diabetic ketoacidosis (DKA) and
hyperosmolar Nonketonic syndrome and nursing management of patients with each
condition.
3. Describe the medical, surgical, and nursing management of patients with esophageal
varices.
4. Compare the various types of hepatitis and their causes, prevention, clinical
manifestations, management, and prognosis.
5. Use the nursing process as a framework for care of the patient with cirrhosis of the
liver.
6. Relate jaundice, portal hypertension, ascites, varices, nutritional deficiencies, and
hepatic coma to pathophysiologic alterations of the liver.
7. Differentiate between acute and chronic pancreatitis and describe nursing
management of patients with acute or chronic pancreatitis.
Unit V: Neuro-Sensory
1. Identify the early and late clinical manifestations of increased intracranial pressure.
2. Use the nursing process as a framework for care of the patient with increased
intracranial pressure.
3. Describe the nursing management of patients with (head) brain and spinal cord injury.
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4. Describe the mechanisms of injury, clinical signs and symptoms, diagnostic testing
and treatment options for patients with traumatic brain and spinal cord injuries.
5. Use the nursing process as a framework for care of patients with brain and spinal cord
injuries.
6. Discuss the pathophysiology of autonomic dysreflexia and describe the appropriate
nursing interventions.
7. Compare and contrast the pathophysiology, clinical manifestations, medical
management and nursing management for patients with diabetes insipidus and
syndrome of inappropriate antidiuretic hormone release (SIADH).
8. Describe the pathophysiology, clinical manifestations, and medical and nursing
management of myasthenia gravis and Guillain-Barré syndrome.
9. Use the nursing process as a framework for care of patients with multiple sclerosis
and Guillain- Barré syndrome.
10. Describe the pathophysiology, clinical manifestations, and medical and nursing
management of meningitis.
11. Describe the pathophysiology, clinical manifestations, and medical and nursing
management of retinal detachment and traumatic eye injury.
Unit VI: Lymph/Immune, Hematology, Oncology
1. Identify assessment parameters and nursing management of patients with oncologic
emergencies.
2. Describe the modes of transmission of HIV infection and prevention strategies.
3. Explain the pathophysiology associated with the clinical manifestation of human
immunodeficiency virus (HIV) and acquired immunodeficiency disorder (AIDS).
4. Describe the medical and nursing management of patients with HIV/AIDS.
5. Discuss the nursing interventions appropriate for patients with HIV/AIDS.
6. Use the nursing process as a framework for care of the patient with HIV/AIDS.
7. Identify the nursing implications for the administration of blood components.
13
Unit VII: Surgical Nursing
1. Describe the pathophysiology, clinical manifestations, and medical and nursing
management of malignant hyperthermia (MH).
2. Identify the indications, advantages, disadvantages, and nursing responsibilities
associated with providing care to a patient that has received IV conscious (moderate)
sedation.
3. Describe the responsibilities of the postanesthesia care unit (PACU) nurse in the
prevention of immediate postoperative complications.
4. Identify common postoperative problems and their management.
5. Describe the gerontology considerations related to post operative management.
6. Identify assessment parameters appropriate for the early detection of postoperative
complications.
Unit VIII: Integumentary & Resistant Infection Management
1. Describe the local and systemic effects of a major burn injury.
2. Compare and contrast the potential fluid and electrolyte alterations of the
emergent/resuscitative and acute phases of burn management.
3. Describe the goals of burn care and the nurse’s role in wound assessment, cleansing,
topical antibacterial therapy, and wound dressing.
4. Describe the nurse’s role in pain management, psychological support of the patient and
family, nutritional support, pulmonary care, and patient and family education.
5. Differentiate between colonization, infection, and disease with methicillin–resistant
Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), or
vancomycin-resistant Staphylococcus aureus (VRSA).
6. Describe the concept of emerging infectious diseases and factors that led to the
development of these diseases.
7. Use the nursing process as a framework for care of patients with infectious diseases.
Clinical Activities/Competencies:
Upon completion of this course, the student should be able to do the following:
1. Prepare for all facets of clinical day (skills, drugs, patho, etc.).
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2. Perform system-specific assessments; i.e., physiology, psychosocial, culture, spiritual.
3. Recognize deviation from client’s normal
4. Formulate appropriate nursing diagnosis, concepts, and desired outcomes using assessment.
5. Identify specific, measurable outcome criteria.
6. Develop interventions to obtain desired outcomes.
7. Implement priority nursing interventions.
8. Perform nursing procedures with supervision as needed.
9. Med protocol (preparation/administration/documentation.
10. Discuss appropriate principles of delegation, room assignment for specific client’s needs.
11. Notify instructor/nurse (trends/changes in client condition, complications with meds and/or
post procedure) and intervene as appropriate.
12. Evaluate progress toward desired outcomes.
13. Evaluate medications for desired outcomes, undesirable effects, interactions.
14. Assess if progress toward outcomes is being met; make changes as appropriate.
15. Seek guidance when appropriate.
16. Maintain client safety (fall prevention, bed position, call light infection control, equipment,
etc.).
17. Written communication/charting are complete, timely, and cosigned by end of shift.
18. Oral communication: use therapeutic communication techniques.
19. Non-verbal communication: Aware of importance of and impact of non-verbal behavior.
20. Give concise, accurate report at end of day using following SBAR before leaving.
21. Client teaching concise, accurate; includes health promotion and plan of care for transition.
22. Integrate standards of care, scope of practice and ethical practice into client care.
23. Coordinate /collaborate/advocate with interdisciplinary team.
24. Accept constructive criticism.
25. Maintain client/institutional confidentiality; i.e., HIPAA.
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26. Assertive in seeking learning experiences.
27. Respectful of all clients/personnel.
28. Report on time to unit/conferences and utilizes spare time constructively.
29. Follow dress code.
30. Paperwork turned in on time (Concept Map)
Clinical Expectations:
See Coahoma Community College Student handbook for health Science Programs Appendix A
Associate Degree Nursing Section 7: Clinical Practicum
http://www.coahomacc.edu/healthsciences/HealthP&P.pdf
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