RANGER COLLEGE
Syllabus
COURSE NUMBER AND TITLE: RNSG 2514 – Integrated Care of the Client with Complex Health
Care Needs
CREDIT HOURS: _5_
HRS/WK LEC: _5_
HRS/WKLAB:_0_
LEC/LAB/HRS/WK COMBINATION: _5_
Name of Instructor: Donna Webb RN MSN Barbara Rhine RN MSN Office Location: 100 Streckert
Office Hours: by appointment Office Phone: DW 325-372-1105 BR254-979-1726 College E-Mail:
dwebb@rangercollege.edu; brhine@rangercollege.edu
I. CATALOG DESCRIPTION
Application of a systematic problem-solving process and critical thinking skills to provide
comprehensive nursing care to diverse clients/families across the life span with complex health care
needs including, but not limited to, complex childhood/adolescent diseases, complicated perinatal
care, acute mental illness, complex perioperative care, serious adult health problems and health issues
related to aging. Emphasis on tertiary disease prevention, health maintenance/restoration and
collaboration with members of the multidisciplinary health care team. Topics include the role of the
nurse as client advocate and coordinator of care and applicable competencies in knowledge,
judgment, skills, and professional values within a legal/ethical framework. This course lends itself to
an integrated approach.
II. REQUIRED BACKGROUND/PREREQUISITES
Program Prerequisites:
PSYC 2301 Introduction to Psychology
ENGL 1301 Composition I
BIOL 2302 Anatomy and Physiology I
BIOL 2420 Microbiology and Clinical Pathology
COSC 1401 Computer Applications
Semester I Courses:
RNSG 1423 Introduction to Professional Nursing
RNSG 1460 Clinical-Nursing (RN training)
RNSG 1119 Nursing Skills I
BIOL 2402 Anatomy and Physiology II
PSYC 2314 Lifespan Growth and Development
Semester II Courses:
RNSG 2504 Care of Client with Common Health Needs
RNSG 1129 Nursing Skills II
RNSG 1461 Clinical-Nursing (RN training)
RNSG 1311 Nursing Pathophysiology
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III. TEXTBOOK (S); READINGS; MATERIALS
Gray Morris, D. (2009). Calculate with confidence. (5th ed.). St. Louis: Elsevier.
Hockenberry, M. Wilson, D. (2009). Wong’s Essentials of Pediatric Nursing. (8th ed.). St. Louis: Elsevier
Ignatavicius, D. & Workman, M. (2012). Medical surgical nursing: Critical thinking for collaborative
care. (6th ed.). St. Louis: Elsevier.
Jarvis, C. (2008). Pocket companion for physical examination and health assessment (5th ed). Mosby
Elsevier.
Lowdermilk, D., Perry, S. (2007). Maternity & Women’s Health Care. (9th ed.). St. Louis: Elsevier
Mosby (2009). Mosby’s nursing video skills: Basic, intermediate, and advanced skills. (3rd ed.). St.
Louis: Elsevier.
Pagana, K. & Pagana T. (2009). Mosby’s diagnostic and laboratory test reference.(9th ed.). St. Louis:
Elsevier.
Perry, A. & Potter, P. (2010). Clinical nursing skills and techniques. (7th ed.). St. Louis: Elsevier.
Skidmore-Roth, L. (2010). Mosby’s 2010 drug reference. (23rd ed.). St. Louis: Elsevier.
Swearingen, P. (2008). All-in-one care planning resource (2nd. ed.). St. Louis: Elsevier.
Varcarolis, E. (2006). Foundations of psychiatric mental health nursing: A clinical approach. (5th Ed). St.
Louis: Elsevier.
IV. METHODS OF INSTRUCTION
Lecture, discussion, audio-visual materials
V. COURSE OBJECTIVES AND LEARNING OUTCOMES
Course specific competencies and learning outcomes flow from Program Outcomes. Program outcomes are the
Differentiated Entry-Level Competencies (DELCs), defined and published by the Texas Board of Nursing. (DELCs) are
defined in four categories; 1) Provider of Patient Centered care, 2) Patient Safety Advocate, 3) Member of the Health
Care Team, and 3) Member of profession.
Integral to program and course outcomes are the QSEN Competencies. The QSEN competencies are integrated with
DELC competencies throughout the nursing curriculum; progressing from simple to complex.
Minimum safe entry-level nursing practice is assessed by the NCLEX-RN licensure exam. The National Council of State
Boards of Nursing (NCSBN https://www.ncsbn.org) maintains and revises the NCLEX-RN licensure exam. The
NCLEX-RN is revised every three years. Exam revisions are based on comprehensive research of new graduate nurse
activities. The NCLEX-RN test blueprint contains weighted assessment categories based on graduate nurse activities.
Nurse activities describe expectations, duties, and responsibilities
As Provider of Patient-Centered Care, the student will have the opportunity to:
Nurses provide safe, competent nursing care to individuals and families, which reflect values of caring, competence, confidence, and
commitment. Using problem solving and critical thinking skills, nurses assess, plan, implement and evaluate nursing care.
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Coordinators collaborate with other health care providers, coordinate care and delegate specific aspects of nursing care to others as
appropriate. Coordinators implement cost-effective nursing care. As advocates for individuals and families effectively manages human
and material resources.
1. Apply the Ranger College nursing framework in accordance with the patient’s physical,
spiritual, emotional and social needs throughout the life cycle in acute care settings.
2. Integrate theoretical and practical knowledge from nursing, physical and behavioral
sciences into the nursing care for clients with complex health care needs.
3. Integrate characteristics, concepts, and processes related to clients and families, including
anatomy and physiology; physical and psychosocial growth and development;
pathophysiology and psychopathology; ethical reasoning; and cultural and spiritual
beliefs and practices related to health, illness, birth, death and dying.
4. Correlate the nursing process in implementing and evaluating care for clients with
complex health care needs.
5. Incorporate rules and regulations of the NPA as they relate to the implementation and
evaluation of the nursing process, established theories, models and approaches that guide
nursing practice.
6. Relate aspects unique to the individual client, such as: age, culture, emotional and mental
development in implementing and evaluating care for clients with complex health care
needs. Integrate characteristics, concepts, processes related to families and mental health,
including family development; family communication patterns; and decision making
structures.
7. Identify political, economic and societal forces that affect the mental health of individuals
and families.
8. Explain how the client’s environment relates to principles and strategies of stress
management and crisis intervention.
9. Examine issues and trends in delivery of care for clients/families with mental disorders
and available community resources.
10. Implement and evaluate use of critical thinking and evidenced-based practice in delivery
of quality health care for clients with complex health care needs.
11. Approach acute care nursing problems utilizing a systematic problem-solving process.
12. Demonstrate the ability to utilize critical thinking skills to make safe and ethical clinical
decisions.
13. Apply therapeutic communication skills with diverse clients and families having complex
health care needs
14. Assess learning needs of clients to develop and implement teaching plans for clients with
complex healthcare needs with evaluation of client learning outcomes.
15. Utilize knowledge of societal trends to identify and communicate client care problems.
16. Demonstrate advanced critical care skills with minimal assistance.
As a Patient Safety Advocate, the student will have the opportunity to:
1. Demonstrate knowledge about the Texas Nursing Practice Act and Board Rules
2. Implement measures to promote a safe environment for patients and others
3. Obtain instruction, supervision or training as needed when implementing nursing procedures or practices
utilizing Evidence Based Research or Practice.
4. Know, recognize and maintain professional boundaries of the nurse-patient relationship
5. Comply with mandatory reporting requirements of the Texas Nursing Practice Act
6. Understand the concept of “scope of practice” and function within individual scope of practice
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7. Accept and/or make assignments that take into consideration patient safety and that are commensurate with
educational preparation and employing health care institutional policy
As a Member of the Healthcare Team, the student will have the opportunity to:
1. Collaborate with other health care providers and clients and their families to provide
care and education for clients with complex health care needs with consideration of
developmental needs.
2. Analyze the skills required by the associate degree nurse to coordinate care and make
referrals on the basis of identified patient needs and knowledge of available resources.
3. Collaborate in multidisciplinary planning to provide care for clients/families with
complex health care needs.
4. Develop and implement a plan of care for the diverse client/family across the life span
with complex health care needs in a variety of health care settings.
As Member of a Profession, the student will have the opportunity to:
1. Demonstrate accountability and responsibility for the quality of nursing care provided
for complex patients.
2. Relate behaviors of client advocacy to own professional practice.
3. Compare the concepts of boundaries, safety, and trust development as they relate to
providing nursing care for clients with complex health care needs, especially clients
with mental health disorders.
4. Examine the roles of various agencies and organizations that promote the quality of
care for clients with complex health care needs.
5. Demonstrate a working knowledge of the implications of the Nurse Practice Act.
6. Demonstrate the responsibility of the professional nurse to serve as a role model for
students, peers and members of the interdisciplinary healthcare team.
7. Assure quality of care through evaluation of the learning needs of self, peers or others.
VI. COURSE CALENDAR
Week
1
Content Outline
Readings/ Assignments
Human Needs: Protection
Inflammation and Immune Response
Arthritis
Connective Tissue Disease
Immune Deficiencies
Hypersensitivity
Autoimmunity
Ignatavicious Ch. 19, 20, 21, 22
2
Human Needs: Protection
 Cancer Development
 Leukemias
 Breast Cancer
Ignatavicious Ch. 23, 24,
Hockenberry Ch. 26
Loudermilk Ch. 11, 12
4




3
4
Colon Cancer
Liver Cancer
Pancreatic Cancer
Lung Cancer
Care of the Patient with Liver Problems
 Cirrhosis
 Hepatitis
 Liver Transplantation
 Esophageal Varices
 Portal Hypertension
 Hepatic Encephalopathy
Test 1 – Human Needs Protection, Liver
Problems
Ignatavicious Ch. 61,
Ignatavicious Ch. 63, 65, 66
Care of the Patient with Endocrine Problems
 Pancreas
 Pituitary
 Adrenal
 Thyroid
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Care of the Patient with Renal Problems
 Acute renal failure
 Chronic kidney disease
 Kidney transplant
 Nephrotic syndrome
 Acute glomerular nephritis
 Dialysis
 Nephrectomy
Ignatavicious Ch. 70, 71
Hockenberry Ch. 26
6
Care of the Patient with Respiratory and Cardiac
Problems
 Tracheostomy
 Cardiac inflammations and infections
 Valvular diseases
 Cardiomyopathy
 Thoracotomy
Raynaud’s and Buerger’s disease
Test 2- Problems of Respiratory, Renal,
Endocrine and Cardiac
Ignatavicious Ch. 30, 38, 32
Hockenberry Ch. 26
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Ignatavicious Ch. 52, 53, 54
Hockenberry Ch. 31
Care of the Patient with Musculoskeletal Problems
 Osteoporosis
 Bone Cancer
 Osteomyelitis
 Muscular Dystrophy
 Paget’s Disease
 Common Disorders of the Foot
 Amputations
 Fractures
 Cast/traction care
5
8
9
Care of the Patient with Neurological Problems
 Central Nervous System problems
 Parkinson’s
 Alzheimers
 Chronic problems of the brain
 Meningitis
 Dementia
 Headaches
 Seizures
 Encephalitis
 Huntington’s
 Guillian barre
 Myasthenia gravis
 Restless leg syndrome
 Trigeminal neuralgia
 Facial paralysis
 Thymectomy
 Cerebral palsy
 Spina bifida
Test 3 – Problems of Musculoskeletal and
Neurological
Ignatavicious Ch. 44, 46
Hockenberry Ch. 32
Loudermilk Ch. 29, 30, 31, 32, 33
Complications of Pregnancy
 Assessment risk factors
 Hypertensive disorders
 Antepartal hemorrhagic disorders
 Diabetes mellitus
 Gestational diabetes
 Hyperemesis
 Thyroid disorders
 Med-surg problems of pregnancy
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Labor and Birth Complications
 Preterm birth
 Dystocia
 Abnormal Labor Patterns
 Post-term pregnancy labor
Loudermilk Ch. 36
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Postpartum Complications
 Hemorrhage
 Hemorrhagic shock
 Coagulopathies
 Thrombo-embolytic disease
 Postpartum infections
Loudermilk Ch.37
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Newborn Complications
 Birth trauma
 Infants of diabetic mothers
 Neonatal infections
 Substance abuse
Loudermilk Ch. 38, 39
6


Hyperbilirubinemia
Congenital anomalies
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Nursing Care of the High Risk Newborn
 Pre-term infant
 Near-term and post maturity
 Respiratory distress syndrome
 Meconium aspiration
 Large and small for gestation age
 Grief and loss of a newborn
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15
Test 4 – Complications of Labor and Birth
Acute Psychiatric Disorders
 Mood Disorders
 Crisis and suicide interventions
 Bipolar disorders
 Child and Adolescent Mental Health Issues
 Older adult mental health issues
 Family violence and sexual assault
 Depression
 Schizophrenia
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Final Exam
Loudermilk Ch. 40, 41
Varcarolis Ch, 12, 13, 14, 18, 19, 20,
VII. COURSE/CLASSROOM POLICIES
1. Attendance/Lateness
It is imperative that students attend lecture, clinical, and laboratory experiences as scheduled. A week’s
worth of cumulative absences in any one course will result in faculty evaluation of the student’s ability to
meet course objectives and may result in failure of the course. Three tardies (over 5 minutes late for
lecture, campus laboratory, or clinical) will equal 1 hour of absence.
2. Class Participation
Students are expected to take an active role in the learning experience.
3. Missed Exams/Assignments/Make-Up Policy
A student not present to take an assigned nursing examination may receive a grade of zero for that
examination. A student may be allowed to make-up an examination under the following circumstance:
a. Absence is due to serious illness/hospitalization of the student or an *immediate
family member. Documentation by a health care provider will be required at the
time the student requests a make-up exam for the day they were ill.
b. Absence is due to a death in the *immediate family. Documentation will be
required.
c. An absence the faculty and/or Department Head deems as unavoidable.
*Immediate – family member living in the same household or outside household
totally dependent on the student for care such as a spouse, parent, child, sibling,
grandparent or grandchild.
To be eligible for a make-up exam in the above circumstances, the student must
notify their instructor prior to the absence, and must make arrangements within
48 hours after the absence for the retake. Faculty have the right to offer an
alternative form of the exam and/or to deduct up to 10 points from the exam
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grade.
Clinical/Skills Lab Absences During Exam Week: A student who is absent from clinical or
skills lab up to 48 hours preceding an assigned nursing examination must present documentation from a
health care provider at the time of the exam in order to be eligible to take the test. Students without this
documentation will not be allowed to take the exam and thus will receive a grade of “0”. The student must
see a health care provider on the day of the absence with the excuse dated accordingly. Documentation
(excuses) dated after the date of the clinical absence will not be accepted. Faculty has the right to offer an
alternate form of the exam and/or to deduct up to 10 points from the exam grade.
Online Testing: Exams in online courses are always considered an independent student activity – NOT a
group activity (unless otherwise indicated by your course instructor.) Students are expected to take exams
alone and not in a study group. This means that you cannot refer to your textbook or any other materials
while you are taking the exam. It is inappropriate to share answers with other students. It is inappropriate
to talk to other students while you are taking the test. Students who do not follow the honor code will be
subject to disciplinary action.
4. Lab and clinical safety/health
Learning Lab Center
The primary objective of the Ranger College Learning Lab Center is to promote excellence in
clinical learning through low to medium fidelity lab experiences learning/teaching for students and
faculty by providing an environment to evaluate basic and advanced skills/behaviors.
CLINICAL LAB POLICIES
• Students are never to discuss events or scenarios occurring during lab clinical simulation
experiences except during debriefing sessions. “What happens in clinical simulation during lab stays in
clinical simulation during lab…” There is zero tolerance for academic dishonesty.
• Students are to dress for lab as if attending clinical. Scrubs, name badges and uniform policies
are enforced.
• Faculty are responsible for supervising all students brought to the lab for training.
• Universal Precautions are to be followed at all times as are all safety guidelines used in the
clinical setting. Sharps and syringes are to be disposed of in appropriate containers. Anyone sustaining an
injury must report it immediately to their instructor.
• Equipment may not be removed from the lab for practice nor are the labs to be used for
practicing clinical skills unless supervised by faculty or staff.
• Students may be recorded during scenarios. Viewing of videos recorded during training are
only permitted with faculty members. The videos are the property of the nursing program and students
may not possess lab videos or recordings.
• Coats, backpacks and other personal belongings are not to be in the lab during clinical
simulation and should be secured as directed by the instructor.
• All electronic devices are forbidden during clinical experiences during lab. (Cell phones, pagers,
any type of recording device, etc.).
• After a simulation take your personal belongings with you (i.e. papers, pens, stethoscopes, pen
lights etc.).
• Food and drink are not permitted in the labs.
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• If you have a latex allergy, inform your instructor before beginning simulation.
• Makeup days may not be available for students absent the day of simulation.
Standard Precautions
The Center for Disease Control and Prevention (CDC) Recommended Standard Precautions are
outlined below. It is the student’s responsibility to maintain compliance with these recommendations in
all clinical settings.
Standard Precautions
Because the potential diseases in a patient’s blood and body fluids cannot be known, blood and
body fluid and substance precautions recommended by the CDC should be adhered to for all patients and
for all specimens submitted to the laboratory. These precautions, called “standard precautions,” should be
followed regardless of any lack of evidence of the patient’s infection status. Routinely use barrier
protection to prevent skin and mucous membrane contamination with:
a. secretions and excretions, except sweat, regardless of whether or not they contain
visible blood
b. body fluids of all patients and specimens
c. non-intact skin
d. mucous membranes
Hand Hygiene
a. Wash hands after touching blood, body fluids, secretions, excretions, and
contaminated items, whether or not gloves are worn and/or immediately prior to any
client interaction or nursing intervention. Perform hand hygiene immediately after
gloves are removed, between patient contacts and when otherwise indicated to avoid
transfer of microorganisms to other patients or environments. It may be necessary to
wash hands between tasks and procedures on the same patient to prevent cross
contamination of different body sites.
b. Use a plain (non-antimicrobial) soap for routine hand washing.
c. Use an antimicrobial agent or waterless antiseptic agent for specific circumstances
(e.g., control of outbreaks or hyperendemic infections) as defined by the infection
control program.
Gloves
Wear gloves (clean non-sterile gloves are adequate) when touching blood, body fluids,
secretions, excretions and contaminated items. Put on clean gloves just before touching
mucous membranes and non-intact skin. Change gloves between tasks and procedures
on the same patient after contact with material that may contain a high concentration of
microorganisms. Remove gloves promptly after use, before touching non-contaminated
items and environmental surfaces and before going to another patient. Perform hand
hygiene immediately to avoid transfer of microorganisms to other patients or
environments.
Mask, Eye Protection, Face Shield
Wear a mask and eye protection or a face shield to protect mucous membranes of the
eyes, nose and mouth during procedures and patient care activities that are likely to
generate splashes or sprays of blood, body fluids, secretions and excretions.
Gown
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Wear a gown (a clean nonsterile gown is adequate) to protect skin and prevent soiling of
clothing during procedures and patient care activities that are likely to generate splashes
or sprays of blood, body fluids, secretions or excretions or cause soiling of clothing.
Select a gown that is appropriate for the activity and amount of fluid likely to be
encountered. Remove a soiled gown as promptly as possible and wash hands to avoid
transfer of microorganisms to other patients or environments.
Patient Care Equipment
Handle used patient care equipment soiled with blood, body fluids, secretions and
excretions in a manner that prevents skin and mucous membrane exposures,
contamination of clothing and transfer of microorganisms to other patients and
environments. Ensure that reusable equipment is not used for the care of another
patient until it has been appropriately cleaned and reprocesses and single use items
are properly discarded.
Environmental Control
Ensure that the hospital has adequate procedures for the routine care, cleaning and
disinfection of environmental surfaces, beds, bed rails, bedside equipment and other
frequently touched surfaces and that these procedures are being followed.
Linen
Handle, transport, and process used linen soiled with blood, body fluids, secretions and
excretions in a manner that prevents skin and mucous membrane exposures and
contamination of clothing and avoids transfer of microorganisms to other patients and
environments.
Occupational Health and Blood-borne Pathogens
a. Take care to prevent injuries when using needles, scalpels and other sharp instruments or
devices; when handling sharp instruments after procedures; when cleaning used instruments and when
disposing of used needles. Never recap used needles or otherwise manipulate them with both hands or any
other technique that involves directing the point of a needle toward any part of the body; rather, use either
a one-handed scoop technique or a mechanical device designed for holding the needle sheath. Do not
remove used needles from disposable syringes by hand and do not bend, break or otherwise manipulate
used needles by hand. Place used disposable syringes and needles, scalpel blades and other sharp items in
appropriate puncture-resistant containers located as close as practical to the area in which the items were
used. Place reusable syringes and needles in a puncture resistant container for transport to the
reprocessing area.
b. Use mouthpieces, resuscitation bags or other ventilation devices as an alternative to
mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.
Patient Placement
Place a patient who contaminates the environment or who does not (or cannot be
expected to) assist in maintaining appropriate hygiene or environmental control in a
private room. If a private room is not available, consult with infection control
professionals regarding patient placement or other alternatives.
Student Occurrence
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Any student involved in a clinical occurrence (e.g. needle stick, patient or student fall/injury,
medication error, etc.) must adhere to the following protocol for reporting the occurrence:
1. Notify the nurse responsible for the patient immediately.
2. Notify the clinical instructor, preceptor and/or faculty member as quickly as possible
after the occurrence happens. The clinical instructor, preceptor & faculty will provide
information on appropriate actions to be taken.
3. Notify the charge nurse.
4. Be prepared with details necessary for filling out a report and to sign the report as a
witness or the person responsible for the occurrence.
5. Meet any Ranger College or facility policy regarding occurrences.
5. Academic Dishonesty
Nursing students are expected to maintain an environment of academic integrity.
Actions involving scholastic dishonesty violate the professional code of ethics and are
disruptive to the academic environment. Students
found guilty of scholastic dishonesty are subject to disciplinary action including dismissal
from the Associate Degree Nursing Program and Ranger College in accordance with outlined criteria.
Examples of scholastic dishonesty include, but are not limited to:
CHEATING: Copying from another student’s test. Possessing or using, during
a test, materials which are not authorized. Using, buying, stealing, transporting,
or soliciting a test, draft of a test, test facsimile, answer key, care plans, or other
written works.
PLAGIARISM: Using someone else’s work in your academic assignments
without appropriate acknowledgment.
COLLUSION: Collaborating with another person in preparing academic
assignments without authorization.
Procedures for discipline due to academic dishonesty have been adopted published Ranger College
Student Handbook.
6. Student Behavior Policy
Students are expected to observe the following guidelines for classroom behavior:
1. Neither children nor pets may be brought to classes or clinical agencies under
any circumstance. Children must not be left unattended in any area of the building.
2. All buildings housing the Associate Degree Nursing Program are nonsmoking
facilities.
3. No food or drinks are allowed in classrooms.
4. Students are expected to be seated by the designated starting time for classes.
5. A student deemed disruptive by a faculty member may be asked to leave the
classroom.
6. Cell phones must be turned off during class or lab. Pager/beepers, if used, must
be set on silence during class or lab. Messages received during lecture may be
returned during class breaks.
7. Respectful, formal communication skills are used in online forums.
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7. Available Support Services
Library facilities are available at the main Ranger campus, the Heartland Mall center, and the
Brownwood Public Library. Reference materials are also available via online as well.
8. ADA Statement:
Ranger College provides a variety of services for students with learning and/or physical disabilities.
The student is responsible for making the initial contact with the Ranger College Counselor. It is
advisable to make this contact before or immediately after the semester begins.
VIII. ASSESSMENT
Exam I
Exam II
Exam III
Exam IV
Comp. Final
20%
20%
20%
20%
20%
100%
*Note: RNSG 2514 and RNSG 2560 must be successfully completed simultaneously to receive credit
in either course and graduate.
IX. NON-DISCRIMINATION STATEMENT
Admission, employment, and program policies of Ranger College are non-discriminatory in regard to
race, creed, color, sex, age, disability, and national origin.
X. RECEIPT OF SYLLABUS FORM
ALL STUDENTS MUST COMPLETE THE FOLLOWING RECEIPT OF SYLLABUS FORM
AND RETURN IT TO THE INSTRUCTOR
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RECEIPT OF SYLLABUS FORM
Legibly print the following information:
Name: __________________________ Date: ___________________________
“I have received and understand the information in the syllabus for RNSG 1514 and I agree to
abide by the stated policies.”
Signature of Student: _____________________________
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