NURS 3833 VC01 Adult Health I Summer 2014 COURSE DESCRIPTION: This course integrates knowledge and skills learned previously with disease processes affecting adults today. The student will learn disease processes that occur in the adult client with a focus on systems. The clinical focuses on providing care for adults in need of hospital care and rehabilitation. Patient teaching in the clinical setting will take on importance, as well as, higher levels of critical thinking and evidence based practice. This syllabus may be revised during the course of the semester to meet the needs of the students and faculty. Clinical, class time may be adjusted because of instructor, school, or facility needs CREDIT: 8 Credit hours (4 hrs class/wk, 2 hrs lab/wk, 16 hrs clinical/wk) PROGRAM LEVEL II REQUIRED TEXTBOOKS: Pellico, L.H. (2013). Focus on Adult Health: Medical-Surgical Nursing. Lippincott, Williams & Wilkins, Wolters Kluwer Health Kee, J.L., Hayes, E.R., & McCuistion, L.E. (2012). Pharmacology: A nursing process approach. 7th ed. St Louis: Sanders. Wilkinson, J.M. & Treas, L.S. (2011). Fundamentals of Nursing. 2nd ed. Philadelphia: F.A. Davis DocuCare, Student Stand Alone, Six-Month Access ISBN 9781451182477 Optional recommended textbooks: Jarvis, C. Health Assessment (or similar text used in your WBU Assessment course) Doenges, M. (2010). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care, 3rd Edition. Philadelphia: Davis (or similar text used in your WBU Fundamental’s course) Pellico, L.H. (2013). Focus on Adult Health: Medical-Surgical Nursing. (Workbook) Van Leeuwen, A. (2009). Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications, 3rd Edition. Philadelphia: Davis. (or similar text used in your WBU Fundamental’s course). Skidmore-Roth, L. (2010). Mosby’s Nursing Drug Reference. 23rd ed. St. Louis: Mosby. (or similar text used in your WBU Fundamental’s course). Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 1 Taber’s Cyclopedic Medical Dictionary 21st ed Course Coordinator: TBA Course Faculty: Dr. Richard P. Diaz DNP, FNP-BC, FPMHNP-BC Doctor of Nursing Practice Family Nurse Practitioner Family Psychiatric Mental Health Nurse Practitioner Richard.diaz@wayland.wbu.edu Cell Number : 210-324-3619 Lab Coordinator: Terri Dutton, MSN, RN (Cell 210-204-7872; Office 210-486-5806) / Clinical Faculty: Dr. Carlo Piraino Carlo.piraino@wayland.wbu.edu Clinical Site is North East Methodist Hospital 8811 Village Drive, San Antonio, TX 78217 June 12-15: Thursday 3-11pm Fri, Sat & Sun 7am-7pm July 10-13: Thursday 3-11pm Fri, Sat & Sun 7am-7pm July 31-Aug 3: Thursday 3-11pm Fri, Sat & Sun 7am-7pm COURSE OBJECTIVES: At the end of the course, the student will be able to: 1. Define the role of the BSN as member of the profession and member of health care team in care of the client in the medicalsurgical setting. 2. Identify signs and symptoms of disease processes that affect the adult client. 3. Utilize the nursing process in developing a plan of care for a client in the medical-surgical setting in collaboration with the client and the interdisciplinary health care team utilizing evidence-based practice. 4. Identify signs and symptoms associated with disease processes. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 2 5. 6. 7. 8. Describe principles of teaching for a client in the medical-surgical setting. Understand the pathophysiology of the disease processes of clients in the medical-surgical setting. List the ethical and legal principles necessary for quality care of the client in the medical-surgical setting. Describe the factors that contribute to the development of disease processes in the client in the medical-surgical setting. EVALUATION AND GRADING: A point system is used to determine the grade in Adult Health I. A = 90-100 Exams (blueprints may be provided) B = 80-89 C = 75-79 D = 70-74 F = 69 and below ATI Practice Med Surg Module Tests and Focused Reviews ATI RN Adult Med Surg Online Practice A ATI RN Adult Med Surg Online Practice B Final Exam ATI Med Surg Comprehensive Exam Discussion Board Medication Calculation Tests/quizzes 40% 5% 5% 5% 20% 10% 5% 10% 100.00% Last day to withdraw with a “W”: 18 July 2014 Last day to withdraw for the term with WP or WF: 25 July 2014 Testing/ Quizzes/Exam Test and exam dates and content will be published in the course calendar. A blueprint may be prepared by the faculty and distributed to the student prior to the test or exam. The blueprint will provide the student with the subject content and the number of questions. Testing Test Chapters will be published in the course calendar for the students at the beginning of each term. Test dates are found within the Student Calendar. Exam blueprints may be provided by the instructor prior to each exam. The Online Students will continue to use Proctor Secure as the secure mode for testing or a Live Proctor at the Clinical site. The Online Students will continue to use Proctor Secure as the secure mode Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 3 for testing or Live Proctor for make-up Exams. Students are required to follow the mandates as identified by Proctor Secure as this is a security camera that videos the student during testing which is then sent to the Dean of Nursing if questionable behaviors are videoed. Refer to the Student Calendar for testing dates. The Exams will only be offered one time. (Tuesday’s Between 8:15 PM CST and 9:45 PM CST ONLY ) Student is to follow the Student Calendar for the dates when the various Unit Exams and Final Exam will be administered. If the Student does not log onto the Final Online Exam at date/time being administered, the Student may place him/herself in a situation whereby he/she will have to arrange to make an additional trip to San Antonio to take a paper-pencil make-up Final Exam which will have to be taken prior to the current academic Quarter closing out. Again the Final Makeup Exam will not be the same Exam as the Online Final and will be similar question profile as the Unit Makeup Exams (10 to 20 Questions in length and will be questions that may require answers of: Listing, Short answer, Matching, Multiple Choice / Multiple Selection. Due to multiple occurrences whereby Students in the past have not been taking exam(s) when the exam(s) have been assigned, it was decided that the above was the best option to deter students from negating academic responsibilities. Online Students are permitted to have only 1 make-up exam occurrence; thereafter, the Exam Grade assigned will be 0 (ZERO) for missed online Exams (this also includes the Final Exam). It is your responsibility to ensure your Remote Secure Proctor Device is functioning appropriately. It is also your responsibility as an Adult Learner to view your Student Calendar as well as check your Blackboard Course Announcements at least twice a day, once in the early morning and then prior to you going to bed at night in case there have been changes. The Face-to-Face Students may have either a computer-generated or a paper-version of the Unit Exam and will utilize the appropriate Scantron Sheet to complete the Unit Exam if the Exam is the paper-version. Refer to the Student Calendar for specific times which the Exams will be open if the Exam is administered as a computer-generated Exam (online students). The Face-to-Face Student Calendar will be provided to the Students in class on the first day. The on-line Student Calendar will be posted on the Blackboard Course Site. In the event a faculty must change a test date, they will notify the students as soon as possible. If the student must miss an exam, they must notify the faculty that they will not be present for the exam and schedule a date for the make-up exam within one week of the date of the exam. Make-up Exams (Face-to-Face Students) For Face to Face Students, occasionally a student will miss a test that is scheduled for a class. A student should contact his/her instructor to arrange for the Make-up Exam. Test must be completed within one week from date of missed exam. The Make-up Test may not follow the Test Blue-Print, but will be over content covered for the specific chapters covered for the Unit of Content. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 4 Missed exam. If the student must miss an exam, he or she must notify the faculty as soon as possible with good cause provided before the scheduled test/exam. A date for the make-up test must be arranged with Tammi Sanders (sanderst@wbu.edu), make up shall be within one week of the missed test or the student will receive a zero. The make-up Scantron answers are the official submission of answers and the only answers that will be accepted. Medication Calculation Medication calculation quizzes and/or tests will be administered during the course and will count towards the final course grade. Dosage Calculations and Pharmacology Made Easy Modules (all sections) prior to the first Medication Calculation Test/Quiz. Logging into ATI, the Student will click onto the Tutorial Section and will scroll down until finding: Dosage Calculation 2.0. You will want to complete the Dosage Calculation 2.0 first. You will note that there are 3 different selections: Dimensional Analysis; Desired over Have; and Ratio and Proportion. The Student is allowed to select the module here that he/she is comfortable with in performing calculations. Once the Student has selected - then be sure that you successfully complete ALL COMPONENTS THAT FALL UNDER: Safe Dosage (COMPLETE ALL) Medication Administration (COMPLETE ALL) Oral Medications (COMPLETE ALL) Injectable Medications (COMPLETE ALL) Powdered Medications (COMPLETE ALL) Parenteral (IV) Medications (COMPLETE ALL) Dosages by Weight (COMPLETE ALL) Pediatric Medications (COMPLETE ALL) Critical Care Medications (COMPLETE ALL) Case Studies and Finals (COMPLETE ALL) Then the Student will also want to review and successfully complete the Module “Pharmacology Made Easy.” Again you will want to successfully complete (with Post-Test Grades of 100 for each module) ALL COMPONENTS THAT FALL UNDER: Introduction to pharmacology (COMPLETE ALL) The Neurological System (Part 1) (COMPLETE ALL) The Neurological System (Part 2) (COMPLETE ALL) Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 5 The Musculoskeletal System (COMPLETE ALL) The Respiratory System (COMPLETE ALL) The Cardiovascular System(COMPLETE ALL) The Hematologic System (COMPLETE ALL) The Gastrointestinal System (COMPLETE ALL) The Reproductive and Genitourinary System (COMPLETE ALL) The Endocrine System (COMPLETE ALL) The Immune System (COMPLETE ALL) Pain and Inflammation (COMPLETE ALL) Infection (COMPLETE ALL) ATI: Complete ATI transcript must be uploaded for each assignment. Wayland Baptist University has partnered with Assessment Technologies Institute (ATI) to aide students in their nursing studies and prepares them to take the NCLEX. In order for you to become familiar with this site it is required that you complete the tutorial available at the following link: http://www.sa.wbu.edu/bsn/bsn_general.htm . Scroll to the bottom of the page and click on: Please click here for WBU San Antonio- ATI student training Video links. Complete all for training video. Earphones or Ear Buds need to be brought to each theory and clinical class if you are enrolled in the Face-to-Face Course. Online Students Earphones or Ear buds need to be part of your Nursing Uniform as you will use these to perform ATI Focused Reviews during PostConference Clinical Times. ATI Targeted/ Practice Tests with Focused Reviews Targeted Medical-Surgical 2010 Respiratory Targeted Medical-Surgical 2010 Renal and Urinary Targeted Medical-Surgical 2010 Immune Targeted Medical-Surgical 2010 Fluid, Electrolyte and Acid-Base Targeted Medical-Surgical 2010 Endocrine Targeted Medical-Surgical 2010 Cardiovascular Targeted Medical-Surgical 2010 Neurological -Musculoskeletal Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 6 Targeted Medical-Surgical 2010 Gastrointestinal Targeted Medical-Surgical 2010 Preoperative RN Comprehensive Online Practice 2010 A RN Comprehensive Online Practice 2010 B Focused Review of Each Target Practice Test is based upon Student’s Score In order to receive Credit for the % Grade achieved, the student is also required to complete the following minimum remediation time for EACH PRACTICE / TARGET TEST. Failure to complete the Focused Review will result in the Student being assigned a ZERO (0) for that particular Targeted / Practice Test. These exams must be initiated after the start of the course and only the first score obtained after this date will be considered for the grading matrix. For a % score of 80-99 a minimum of 1 hour of Focus Review For a % score of 70-79 a minimum of 2 hours of Focus Review For a % score of <70 a minimum of 3 hours of Focus Review Discussion Participation Grading Rubric Criteria (12 total points) 0 Nonperformance 1 Basic 2 Proficient Applies relevant course concepts, theories, or materials correctly. (3 points) Does not explain relevant course concepts, theories, or materials. Explains relevant course concepts, theories, or materials. Applies relevant course concepts, theories, or materials correctly. Diaz 05/01/2014 (revised) 3 Distinguishe d Analyzes course concepts, theories, or materials correctly, using examples or supporting evidence. NURS 3833 Adult Health I Page 7 Collaborates with fellow learners, relating the discussion to relevant course concepts. (3 points) Does not collaborate with fellow learners. Collaborates with fellow learners without relating discussion to the relevant course concepts. Collaborates with fellow learners, relating the discussion to relevant course concepts. Applies relevant professional, personal, or other realworld experiences. (3 points) Does not contribute professional, personal, or other realworld experiences. Contributes professional, personal, or other realworld experiences, but lacks relevance. Applies relevant professional, personal, or other realworld experiences. Supports position with applicable knowledge. (3 points) Does not establish relevant position. Establishes relevant position. Supports position with applicable knowledge. (Website, reading material) Collaborates with fellow learners, relating the discussion to relevant course concepts and extending the dialogue. Applies relevant professional, personal, or other realworld experiences to extend the dialogue. Validates position with applicable knowledge. Participation Guidelines Actively participate in discussions. To do this you should create a substantive post for each of the discussion topics. Each post should demonstrate your achievement of the participation criteria. In addition, you should also respond to the posts of at least two of your fellow learners for each discussion question—unless the discussion instructions state otherwise. These responses to other learners should also be substantive posts that contribute to the conversation by asking questions, respectfully debating positions, and presenting supporting information relevant to the topic. Also, respond to any follow-up questions the instructor directs to you in the discussion area. Post in a timely manner in this online class. Main discussion posts are due by 2359 each Wednesday of the assigned week. Timely posting allows time for your peers to respond. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 8 Points-to-Grade Conversion The points you earn on this discussion activity will be converted to a percentage grade according to the chart below and will be used to determine your final course grade. 0 points 1 point 2 points 3 points 4 points 5 points 6 points 7 points 8 points 9 points 10 points 11 points 12 points = = = = = = = = = = = = = 0% 23% 46% 69% 71% 75% 79% 81% 85% 89% 90% 95% 100% = = = = = = = = = = = = = F F F F C C C B B B A A A Class Attendance 1. The student must attend the class(es) for which he/she is enrolled. 2. A student enrolled at Wayland Baptist University should make every effort to attend all class meetings. All absences must be explained to the satisfaction of the instructor, who will decide whether the omitted work may be made up. 3. A student who misses twenty-five percent (25%) (2.5) or more of the regularly scheduled class meetings will receive a grade of F for that class. 4. When a student reaches a number of absences considered by the instructor to be excessive, the instructor will so advise the student and file an Unsatisfactory Progress Report at the San Antonio Campus. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 9 5. The instructor may count three tardies as one absence in classroom Policy on Academic Integrity. Standards of academic honesty are expected. Academic dishonesty includes, but is not limited to, cheating, plagiarism, counterfeit work, unauthorized reuse of work, theft, and collusion, see student handbook. Students who violate academic integrity policies are subject to discipline, penalties, failure in the course, or dismissal from Wayland Baptist University. Cell Phone Policy. Respect for faculty and fellow students are necessary for teaching and learning in the classroom and clinical settings. You are required to silence cell phones, silence other mobile devices, and remove Bluetooth devices prior to entering any classrooms and clinical settings. No cell phones are permitted during tests/exams. Failure to follow this policy can affect your class participation (including, you may be requested to leave the class room), clinical or final course grade. Students shall contact faculty only during regular business hours, and shall only contact clinical faculty no earlier than 0600 hours regarding clinical attendance. Policy Regarding Due Dates for Written Assignments: Written work will be submitted on the announced due date and time, unless prior arrangements were made with the faculty. Failure to notify will result in a grade of zero for that assignment. Unless otherwise specified, hard copies of the assignments are due to faculty on assigned dates at the beginning of the class or clinical period. Students are responsible for contacting the course faculty if there is any difficulty in understanding the course materials or completing the course assignments. Up to 10% shall be deducted for late assignments, and reduced 10% each day, late or incomplete care plans may result in clinical failure. (Currently there is no written work for this course that is graded) Student Responsibilities: Students are adult learners and responsible for self-directed study to complete this course. Check postings on blackboard each week, learn to use blackboard postings provided by professors, as they are intended to increase your professional nursing knowledge bank. Learn to become a resource broker, speak professionally and use citations, it is part of professional nursing. Assignments and presentation have due dates and points shall be reduced if not punctual. The profession of nursing requires punctuality in documentation and attendance. It also requires reliability as fellow staff and administration rely on you to come to work prepared. Patients rely on you to know the current state of their health and current professional standards. Citations and references are to be used and documented using the professional citation of nursing, APA (6th edition) format. Research and writing competency is an expectation in professional nursing, therefore, effective writing and proficiency in research is required in this course. ENGL 1301 and RSWR 3345 are required prior to this course and provide preparation for the writing level required in this course. Consult Purdue’s OWL website or WBU’s Saturday clinic for writing assistance in APA citation. Research and writing competencies are expected, source selection shall be nursing peer reviewed, format, citations, organization, grammar and mechanics can impact your grade on written assignments. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 10 Group process is an essential part of professional nursing, therefore, group projects will be required in various nursing courses. Just as various shifts are responsible for patient care and nurses rely on each other and other professionals to accomplish total care, you will rely on each other and work together for a particular project. The grade earned goes to the entire group, therefore, it is crucial that students work together, review the grading rubric, and review the work together before presentation, project or paper submission. Disability Statement: Wayland Baptist University adheres to a policy of providing equal opportunity to students with disabilities. Disability is defined by the University as any condition that falls under the purview of the Rehabilitation Act of 1973. Wayland will strive to achieve optimum opportunity for participation in the University experience for all students, regardless of their circumstance. The University encourages any student who has a disability, as defined by the Rehabilitation Act of 1973, to inform the University of any Special Requirements or needs by reporting these to the Dean of Students or the Vice President for Academic and Student Services. The University will strive to meet these needs in accordance with applicable federal guidelines and Christian ethical considerations. Student Conduct: (This is a statement of conduct standards. It is enforced in conjunction with the Discipline Policy and Substance Abuse Policy found elsewhere in this handbook.) Wayland proudly adheres to high standards of intellectual, moral, ethical, and spiritual values. Convinced that self-discipline is more desirable than outside force and that the truly educated person must pursue what is right under all circumstances, Wayland entrusts each student with the solemn obligation of preserving these standards. However, in the light of revelation, reason, and the custom of the Christian community from which Wayland has sprung, certain practices are evaluated: 1. Personal integrity in keeping with New Testament standards is expected of all students. 2. Respect for the property, knowledge, and rights of other people must prevail. 3. The use or possession of alcoholic beverages and/or illegal drugs is forbidden. 4. Gambling, hazing, and the on-campus possession of firearms or deadly weapons are prohibited. BB Guns and Paint Ball Guns are also prohibited. 5. The use of tobacco by students is discouraged, though permitted in certain designated areas of the campus. In consideration of the rights of others and the requirements of safety, such areas are designated. 6. No head gear will be allowed in the classroom setting 7. No inappropriate clothing will be worn in the classroom setting The authority of the University is exercised over all student groups or organizations bearing the name of the university, or any student enterprises to the extent necessary to safeguard the good name and well being of Wayland. Specifically, each student is expected to conduct himself in such a manner as to uphold, not detract from, the good name of Wayland Baptist University. If one feels that he/she cannot subscribe to the moral and social practices of the University, he/she will find greater acceptance elsewhere. Standards of Professional Nursing Practice (BON 213.27, 217.11, 217.12) Please refer to the Board of Nursing at www.BON.state.tx.us for any additional information regarding the Texas Nurse Practice Act. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 11 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Knows rationale for side effects of medications and treatments, and correctly administers same. 217.00 (1)(c). Documents nursing care accurately and completely, including signs and symptoms, nursing care rendered, medication administration. Contacts health care team concerning significant events in patient health. 217.11 (1) (d). Implements a safe environment for patients and/or others. 217.11 (1) (b). Respects client confidentiality. 217.11 (1)(e). Accepts assignments commensurate with educational level, preparation, experience and knowledge. 217.11(1)(t). Obtains instruction and supervision as necessary when implementing nursing procedures and practices. 217.11(1)(h). Notifies the appropriate supervisor when leaving an assignment. 217.11 (1) (I). Recognizes and maintains professional boundaries of the nurse/patient relationship. 217.11 (1)(J). Clarifies orders, treatments, that the nurse has reason to believe are inaccurate, non-effective or contraindicated. 217.11 (1)(N). Able to distinguish right from wrong. 213.27 (b)(2)(A). Able to think and act rationally 213.27(b)(2)(B). Able to keep promises and honor obligations 213.27(b)(2)(C). Accountable for own behavior 213.27(b)(2)(D). Able to promptly and fully self-disclose facts, circumstances, events, errors and omissions when these disclosures will enhance health status of patients or protect patients from unnecessary risk or harm. 213.27(b)(2)(G). Please refer to the Board of Nursing at www.BON.state.tx.us for any additional information regarding the Texas Nurse Practice Act. Securexam Remote Proctor System Guidelines for Online Exams As recommended by Softwaresecure Objective: This policy outlines proctoring and examination security expectations for students when online examinations are given in a course. Standards: Examinations are important mechanisms for evaluation of student learning. The College of Nursing programs adhere to standards of academic integrity as articulated by the College of Nursing Honor Code and Wayland Baptist University Student Conduct Code. Cheating on examinations is contrary to both academic integrity standards and to ethical standards and constitutes reason for academic withdrawal and/or expulsion from the College or University. Review the Student Conduct Policy in the student handbook, available online at http://www.sa.wbu.edu/ Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 12 Some courses in the College of Nursing use the Securexam Remote Proctor System. Securexam Remote Proctor contains a web‐camera, microphone and fingerprint reader. These devices identify the student and capture video and audio throughout the exam and upload it to SSI’s secure servers. This video will be used for the purpose of establishing if any suspicious activity occurred during the test. The video feed provides a 360 degree view of the exam environment and all video records are subject to review by faculty. The Remote Proctor system must be purchased through the WBU bookstore. The fee includes all charges for use of the Remote Proctor system for (1) year from date of purchase. Renewal service fees are charged every year after initial purchase. Process: The Remote Proctor system will be used with online examinations as instructed by course faculty members. Students are required to take online examinations using a Windows or Mac based computer that meets the minimum requirements as outlined in the instructions on the Software Secure installation page (http://www.remoteproctor.com/install). o Students are required to register their devices and establish identity following the procedures outlined in the Remote Proctor instructions. o Students are responsible for self‐testing the functionality of their units well in advance of all Remote Proctored exams in their courses, so that any troubleshooting that is required can be accomplished. A practice quiz for this purpose can be found in the course. Test Environment Requirements: The online testing environment should mimic the ‘in class’ testing environment, and must conform to the following: fully lighted room for the examination o No other people in the room o No pets in the room o No communicating with others by any means (with the exception of contact with the faculty member in an emergency) o No leaving the room o Clean desk or table with nothing except computer and remote proctor system on the desktop or tabletop including removal of all books, papers, notebooks or other materials, unless specifically permitted in written guidelines for a particular examination Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 13 o o o o No writing visible on desk or on walls No music, videos, or TV playing No use of headphones No use of cell phone for any reason other than to contact support or your Instructor o All other computer monitors must be powered off o o o o o the Remote Proctor device correctly situated: Within an arm’s reach at all times during an exam On the opposite side of the keyboard as the computer mouse (if using one) Parallel to the keyboard (not behind the screen, etc.) Nothing covering the base or prism Lighting must be “daylight” quality and overhead is preferred if at all possible. If overhead is not possible, the source should not be behind the student. All exam videos can/will be reviewed by the course faculty and the Program director. If a red or yellow violation is detected, you will receive a zero on your exam or assignment. Contact information for Product Technical Support: Technical support is available by phone 24/7 for students from Software Secure at 1‐866‐811‐0719 or by clicking the following link for the online: http://clientportal.softwaresecure.com/support/ where students will be able to either (1) search the Knowledge Base (KB) to find the answer to their question; or, (2) open a web‐ticket which will be promptly answered by Software Secure Technical Support. Diaz 05/01/2014 (revised) NURS 3833 Adult Health I Page 14