LEARNING MODULES
NURSING 1020
NOTE: Some of the "Suggested" ATI modules may not be available.
Faculty may alter the assigned work as necessary.
Revised July, 2014
LEARNING MODULES
NURSING 1020
CONCEPT
NURSING SUCCESS
0.1
Test Strategies (Optional after class)
CONCEPT I
PERIOPERATIVE NURSING
1.1
Pre-operative Nursing
1.2
Intra-operative Nursing
1.3
Post-operative Nursing
1.4
IV Fluid and Blood Replacement Therapy
1.5
Fluids and Electrolytes
CONCEPT II
METABOLISM
2.1
Diabetes Mellitus
CONCEPT III
TISSUE PERFUSION
3.1
Hypertension
3.2
Peripheral Vascular Disease.
3.3
Anemia’s
3.4
Vascular disorders of the Brain / Stroke
CONCEPT IV
OXYGENATION
4.1
Respiratory Disorders
CONCEPT V
NUTRITION
5.1
Gastrointestinal Disorders
CONCEPT VI
ALTERED CELL GROWTH
6.1
Cancer
CONCEPT VII
COMMUNICATION
7.1
Concept Mapping
CONCEPT VIII
PYSCHOSOCIAL INTEGRITY
8.1
Introduction to Psychiatric Mental Health and Legal Guidelines
8.2
Cognitive Disorders
8.3
Loss and Grief
Rev'd: July, 2014
Page 2 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
(*Optional Module – to be scheduled after class)
LEARNING MODULE: 0.1
Concept:
Nursing Success
Content:
Critical Thinking - Test Taking Strategies
Overview:
In Nursing 1000, the basics of how to prepare for class and lecture were introduced. Time management strategies were
recommended, in addition to basic strategies to prepare for nursing examinations. Bloom’s Taxonomy, as an organized
system to assess learning comprehension, was presented. Taking the nursing examinations provided first-hand
experience. Throughout the semester, the material that was presented became increasingly more complex in order to
prepare for subsequent nursing courses. The purpose of this module is to provide additional strategies to help answer
more complex test questions written at the application and analysis level.
In Nursing 1020 and throughout the rest of the nursing curriculum, terms that were first introduced to in Fundamentals
such as critical thinking and prioritization will be expanded upon and become more meaningful. As was reviewed in
Nursing 1000, ‘critical thinking’ is the red flag to think before you act. See Something to Think About.
Another critical concept in Nursing 1020 that will be explored in more depth is the concept of prioritization. Nugent
(2007, p. 23) defines prioritization as “the process of identifying the preferential order of doing something”. Simply
interpreted, what should be done first? In Nursing 1000, Maslow’s Hierarchy of Needs was introduced. This model is
commonly used to assist nurses to set priorities and forms the basis of the decision making process.
Most of the questions that will be tested on in Nursing 1020 will be at the application and analysis level and will assess
critical thinking ability and the ability to prioritize. This module provides strategies to approach those questions.
The ATI Integrated Testing Program in Nursing 1020 will continue to be used. ATI is an invaluable tool that is
available 24/7. Please make use of all that it has to offer!
Individual Learning Objectives
After completing this module, the learner will be able to:
 Define critical thinking and the application to the nursing process
 Demonstrate the ability to Identify the cognitive level of a test question based on Bloom’s Taxonomy
 Identify strategies to alleviate test anxiety
 Implement strategies to determine highest priority in selecting an answer to a test question.
DEFINITION OF CRITICAL THINKING IN CLINICAL NURSING PRACTICE
Critical thinking in nursing practice is a discipline specific, reflective reasoning process that guides a nurse in
generating, implementing, and evaluating approaches for dealing with client care and professional concerns.
Application of critical thinking to nursing practice is demonstrated by the ability to:
A. Interpret: Recognize, classify, and describe the significance of data
1. Asks relevant questions/Explores ideas
2. Validates data
3. Recognizes issues and concerns
B. Analyze: Identify the intended and inferential meaning of, and relationships among, data
1. Interprets evidence
2. Considers viewpoints/Recognizes assumptions
3. Identifies missing information
C. Evaluate: Judge the credibility of information
1. Detects bias
2. Considers legal/ethical standards
3. Uses reflective skepticism
4. Examines alternatives
5. Judges worth of evidence
D. Infer: Derive reasonable conclusions from the evidence
1. Predicts consequences
2. Applies deductive/inductive reasoning
3. Supports conclusions with evidence
4. Sets priorities
5. Plans approaches
6. Modifies/individualizes interventions
7. Applies research in practice
E. Explain: Justify the results of reasoning activity based on cogent arguments
1. Determines outcome attainment
2. Revises plans
3. Identifies client’s perception of results
Page 3 of 34
Learning Resources
Required Readings:
Nugent, P. M., Vitale, B. A., Test success: Test-taking techniques for beginning nursing students (5th ed.). Chapters 2, 6, 10, 11 F.A. Davis:
Philadelphia.
ATI Assignment/s: If not previously done in N1000
Complete the ATI Tutorial: Getting Started /w ATI
Complete the ATI Assessment: Self-Assessment Inventory
Electronic Resources:
Bloom's Taxonomy: http://www.youtube.com/watch?v=v0JuFHNp5PI
Professor Nightingale (Good review) Test Taking3 Techniques
(3:29)
Active Learning Strategies:
Complete the following questions:
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1.
The nurse is caring for a client of another culture. Which of the following would be the priority intervention of the nurse that would
demonstrate an understanding of the need for cultural competence?
a. Avoid assuming that members of the same culture all share the same beliefs and values
b. Develop an understanding of your own cultural heritage, feelings, and experiences.
c. Become bilingual to communicate effectively with the population of clients served.
d. Develop an understanding of the religious beliefs of clients served by the nurse.
2.
The nurse is developing a teaching plan on cultural sensitivity for his colleagues who are caring for clients from other cultures. What
intervention might a client of another culture interpret as culturally insensitive?
a. The nurse makes sure that the Arab female client is covered during assessment.
b. The nurse avoids making direct eye contact with the male American Indian client.
c. The nurse does not encourage the Japanese-American client to express feelings openly.
d. The nurse hugs an Egyptian-American female client who has received bad news.
3.
A Mexican-American client is insistent that her family members stay with her in her hospital room while she is recovering from surgery. What
will be the priority action of the nurse?
a. Explain the policy of the hospital regarding visitors.
b. Ask the Spanish-speaking chaplain to assist in explaining why this is unacceptable.
c. Arrange for additional cots to accommodate family member’s overnight stay.
d. Notify the physician of the client’s anxiety and suggest a prescription.
4.
A nurse is caring for a lesbian client. What is a priority assessment question for this client?
a. “When did you last have a complete physical examination?”
b. “How much alcohol do you consume?”
c. “Do you smoke?”
d. “Do you use recreational drugs?”
5.
The nurse is providing discharge instructions regarding medications to an older adult client who has expressed concerns about paying the
hospital bills. What will the nurse emphasize based on best cultural practice?
a. The client should be prepared to show the nurse how he fills his daily pill planner at his next appointment.
b. The client should keep a daily diary of side effects being experienced from his medication, as well how he is coping.
c. The client must adhere to his medication regimen, unless the cost becomes prohibitive.
d. The client should ask his pharmacist for the generic version of his medication to keep costs at a minimum.
6.
The nurse is interacting for the first time with a new home health client. What information obtained by observation is considered part of
cultural assessment?
a. The client asks the nurse how to obtain assistance with his utility bills.
b. The client’s wife reports that the children are having difficulty in school.
c. The client tells the nurse that he or she would like to move into public housing.
d. The client’s wife corrects the husband's response to questions about his parents.
7. The client states, “I cannot receive blood transfusions, because it is against my beliefs. I am concerned about having this surgery.” What is the
nurse’s best response?
a. “You should allow the health care professionals to do whatever is needed to save your life.”
b. “If you are worried about contamination, the blood supply in this country is the safest in the world.”
c. “There really is nothing unacceptable about blood transfusion.”
d. “There are good alternatives to transfusions if you should lose an excessive amount of blood.”
8.
The client expresses distress over missing religious services while in the hospital. What is the nurse’s best action?
a. Tell the client that he or she shouldn’t worry about it right now.
b. Ask the client’s spouse or family member to pray with the client.
c. Ask the hospital’s professional chaplain to talk to the client and help you manage the client’s distress.
d. Encourage the client to reschedule procedures for another day.
9.
The nurse is caring for a client who was medicated for pain 1 hour ago. The client is stating that the medication is not working and she still
has pain. What is the first action that the nurse will take?
a. Assess the client to determine her pain score.
b. Believe the client’s report of pain.
c. Wait until it is time for the next pain medication dose.
d. Teach the client how to use guided imagery.
(continued)
Page 4 of 34
(LM Test Taking continued)
10.
When is the nurse correct in decreasing the dose of pain medication in a client with end-stage cancer?
a. The spouse is worried that the client may become addicted.
b. The client wants to remain alert during the visit of a longtime friend.
c. The client has lost considerable weight and does not want to eat.
d. The client is becoming combative at night.
11.
A client with arthritic pain is considering taking an herbal supplement to relieve arthritic pain. What teaching is most important for the nurse to
carry out with this client?
a. Inform any health care providers about the use of this supplement.
b. Practice imagery along with the herbal supplement.
c. Take only herbal supplements that are prescribed.
d. Take herbal supplement at the onset of pain.
12.
A client with cholecystitis has pain in the right shoulder area and asks, “What is happening to me? What did I do to my shoulder?” What is the
nurse’s best response?
a. “You are weak from staying in bed.”
b. “Does your other arm hurt too?”
c. “Sometimes pain from a certain organ is referred elsewhere in the body.”
d. “I am going to hold your medication until we can determine what is happening.”
13.
A nurse is assigned to care for the following four clients who have the potential for having pain. Which client is most likely not to be treated
adequately for this problem?
a. Middle-aged woman with a fractured arm
b. Client with expressive aphasia
c. Older adult client with arthritis
d. Client who has undergone an appendectomy
14.
The nurse observes tenting of the skin on the back of the older adult client’s hand. What is the nurse’s next action?
a. Notifying the physician
b. Examining dependent body areas
c. Assessing turgor on the client's forehead
d. Documenting the finding and monitoring the client
15.
The client is taking a medication that inhibits aldosterone secretion and release. The nurse assesses for what potential complication?
a. Dehydration
b. Hyperkalemia
c. Hyponatremia
d. Fluid volume excess
16.
Which assessment will the nurse use to determine the adequacy of circulation in a client whose blood osmolarity is 250 mOsm/L?
a. Measuring urine output
b. Measuring abdominal girth
c. Monitoring fluid intake
d. Comparing the radial pulse with the apical pulse
17.
Which statement made by the older adult client will alert the nurse to the possibility of fluid and electrolyte imbalances?
a. “My skin is always so dry, especially here in the Southwest.”
b. “I often use a glycerin suppository for constipation.”
c. “I don't drink liquids after 5 PM so I don't have to get up at night.”
d. “In addition to coffee, I drink at least one glass of water with each meal.”
18.
A client has been taught the need to restrict sodium. Which food selection indicates appropriate choices?
a. 1 cup of cottage cheese and a sliced chilled tomato
b. A grilled American cheese sandwich on two slices of white bread
c. A ham and cheddar cheese sandwich on two slices of whole wheat bread
d. A chicken leg, one slice of whole wheat bread with butter, and 1/2 cup of steamed carrots
19.
Which protein source will the nurse recommend for a client who needs to restrict dietary potassium intake?
a. Raw broccoli
b. Grilled salmon
c. Poached eggs
d. Baked chicken
20.
Which intervention will the nurse teach the client who has lymphedema in her right arm from a mastectomy?
a. “Exercise your arm and use it during tasks that occur at the level of your chest or higher.”
b. “Be sure to use sunscreen or protective clothing to reduce the risk of injuring this arm.”
c. “Reduce your salt intake to prevent excess water retention.”
d. “Do not expose your arm to temperature extremes.”
Page 5 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 1.1
Concept I:
Perioperative Nursing
Content:
Preoperative Period
Overview
The term perioperative refers to the preoperative, intraoperative, and postoperative phases of the surgical experience.
Although most surgeries are performed in acute care hospitals, many patients have surgery in ambulatory or outpatient
settings.
The preoperative phase of the surgical experience begins when the decision is made to do surgery, and ends with
the transfer of the patient to the surgical suite. During this phase the nurse plays a major role in assessing the physical
and psychosocial needs of the patient, in order to create a safe and efficient perioperative experience. Patient
teaching is critical during this phase to prevent complications and promote a speedy recovery.
Patients facing surgery experience some degree of fear and anxiety about many aspects of surgery: fear of
anesthesia, fear of surgical findings, and uncertainty of the surgical outcome. The purpose of this module is to
introduce you to the first phase of the perioperative experience.
Individual Learning Objectives
After completing this module, the learner will be able to:
 Describe the preoperative phase as a component of the surgical experience
 Differentiate among the various types and purposes of surgeries
 Identify the biopsychosocial responses of patients to surgery
 Explain the components and significance of the preoperative nursing assessment
 Explain lab values that may affect the patient’s response to anesthesia and surgery
 Identify preoperative nursing diagnoses
 Prioritize teaching needs for the patient in the pre-operative phase
 Discuss expected nursing interventions in the pre-operative phase
 Discuss the following medications, with emphasis on the nursing interventions:
ANTICHOLINERGICS:
- atropine sulfate
BENZODIAZEPINES:
- diazepam/Valium, midazolam/Versed
ANTIEMETICS:
- ondanestron (Zofran)
- dolasetron (Anzemet)
 Explain final preparations before the patient is transferred to the OR
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic Resources:
Introduction to Perioperative Nursing http://www.youtube.com/watch?v=gnPXRe46SXU
Required: Medication Safety in Perioperative Care http://www.youtube.com/watch?v=enMSkLAmRwQ
Suggested ATI Assignment:
Complete the ATI Assessment:
Targeted
Perioperative
(Continued)
Page 6 of 34
(LM
…preoperative Continued)
Active Learning Strategies
Case Study
Prepare prior to class and be ready to discuss in class:
A patient to whom you have been assigned is a 55 year old gentleman who fell on a wet floor at work and fractured his
right ankle. Surgery is required and will be started in 2 hours. He is 5’11” and weighs 225 pounds and has no pertinent
past medical history. He is worried about his dog and keeps asking who will care for the dog. He is very anxious and not
interested in pre-op teaching “because I only broke my ankle-no big deal”. He is allergic to strawberries, tape and fish.
Although the patient said he is a nonsmoker, on admission you found cigarettes in his pocket.
a. What diagnostic tests would you anticipate the doctor to order pre-operatively for this patient?
b. Are his allergies important to document and communicate with the other health team members? Why or why not?
c. If Mr. Sam said he became nauseated when riding in cars, what medication may the anesthesiologist order for
him? What is it administered? What are the side effects?
d. What should you do about the disparity between his statement that he is a non-smoker and the fact that you found
cigarettes in his clothing?
e. What is the pharmacologic action, main side effects and nursing interventions related to atropine and midazolam
(Versed)?
f. Prioritize three nursing diagnoses and related nursing interventions for this patient.
Page 7 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 1.2
Concept I:
Perioperative Nursing
Content:
Intraoperative Period
Overview
A patient’s recovery from the surgical experience requires skillful and knowledgeable nursing care before, during, and
after surgery. The intra-operative phase of the surgical experience begins when the patient is transferred to the operating
room table and ends when the patient is admitted to the post-anesthesia care unit (PACU). During this phase the patient
is at risk for multiple complications related to both the surgical procedure and the anesthesia. The nurse is the patient’s
main advocate and is responsible for monitoring the safety and well-being of the patient. Nursing management focuses
on the physical and psychosocial needs of the patient. Outcomes include: reducing anxiety, minimizing infection,
preventing hypothermia, maintaining fluid and electrolyte balance, and protecting the patient from electrical, chemical,
and physical hazards.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Describe the intra-operative phase of the surgical experience
 Describe the roles of each member of the surgical team
 Review the principles of surgical asepsis in the operating suite
 Compare and contrast the different types of anesthesia
 Describe the physiologic stress response to anesthesia and surgery
 Describe the components of an intra-operative nursing assessment
 Formulate priority nursing diagnoses for the intra-operative patient
 Identify patients at risk for development of intra-operative complications
 Identify desired patient outcomes for the intra-operative phase
 Discuss nursing interventions to minimize intra-operative risks
 Discuss the following medications that may be used during the intra-operative period including nursing
interventions and patient teaching:
BENZODIAZAPINE:
- midazolam (Versed)*
OPIOID ANTAGONIST:
- naloxone (Narcan)
ANTISPASMODIC:
- dantrolene (Dantrium) [used to treat Malignant Hyperthermia]
BENZODIAZAPINE ANTAGONIST
- flumazenil (Romazicon)
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Suggested ATI Assignment/s:
Complete the ATI Assessment: Targeted Perioperative
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Neuro (Pt 1 -Drug: Anesthesia)
Electronic Resources:
Malignant Hyperthermia Association: http://www.mhaus.org
Anesthesia YouTube: http://www.youtube.com/watch?v=xNauWbQ23uI
(Continued)
Page 8 of 34
(LM
Intra op… Continued)
Required Lab Assignments /Other Requirements:
Attend the Required Nursing Skills Lab (NSL): Wounds
Complete/or Review the ATI Skills Module prior to attending Lab: Surgical Asepsis
Required Work for all ATI Skills Modules: pre-test, LESSON*, step videos & post test
*Lesson = review: Overview, Terminology, Accepted Practice, Step Videos, Current Guidelines, EBA & Documentation
Minimum achievement/time requirements:
Achieve an 85% on post test
Spend 1 hour on “Lesson” time for each module
Bring transcript [Labeled: “Transcript”] to lab for verification of above. (These may or may not be collected.)
Active learning strategies
Prepare before class and be ready to discuss in class.
Case Study
Group 1
A 71 year old man is very anxious when you meet him in the holding area. He is going to have his right hip
repaired. He is 5”10”, weighs 128 pounds.
PMH: high blood pressure and diabetes.
FH: brother had cancer of the bladder and died two years ago.
a. What can the nurse do to relieve his anxiety?
b. What kind of anesthesia will he probably receive? Why?
c. What are the advantages and potential complications of this type of anesthesia?
d. What precautions should the circulating nurse take to prevent injury to this patient during surgery?
e. Identify and prioritize 3 nursing diagnoses for this patient and discuss nursing interventions.
Group 2
Identify each member of the operating team, their qualifications, roles and responsibilities during surgery.
Group 3
Explain the pathophysiology, clinical manifestations and medical and nursing management of malignant
hyperthermia. Discuss the important information related to any medications that may be administered.
Group 4
Who would be good candidates for spinal anesthesia?
Discuss the advantages and disadvantages of spinal anesthesia.
What are the nursing interventions when caring for a patient who received this type of anesthesia?
Page 9 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 1.3
Concept I:
Perioperative Nursing
Content:
Postoperative Period
Overview
The postoperative period begins when the patient is transferred from the operating room (OR) to the Post Anesthesia
Unit (PACU), and ends when the patient has fully recovered from surgery. It is the nurse’s responsibility, as the patient’s
main advocate, to protect the patient from potential, preventable complications.
Individual Learning Objectives:
After completing this module the learner will be able to:
 Describe the postoperative phase as a component of the surgical experience.
 Describe the nursing care of the patient in the immediate post-anesthesia phase
 Discuss patient risk factors for postoperative complications.
 Discuss common postoperative complications and the medical and nursing management to prevent and/or
treat these complications
 Describe gastrointestinal intubation: the purpose, types of tubes and related nursing care of the patient with a
gastrointestinal tube.
 Formulate postoperative nursing diagnoses.
 Describe factors that affect wound healing.
 Discuss the gerontologic considerations related to post-operative management. Discuss the following
medications:
SEROTONIN ANTAGONISTS:
- Ondansetron (Zofran,dolosetron/Anzemet)*
ANTIBIOTICS:
- Antifungals:miconazole (Monistat)
- Aminoglycosides
- Gentamicin (Garamycin)
- Cephalosporins:
1st Generation:cephalexin (Keflex)
2nd Generation:cefaclor (Ceclor)
3rd Generation:ceftriaxone (Rocephin)
FLUOROQUINOLONES: ciprofloxacin/ (Cipro)
PENICILLINS
- Penicillin G and Penicillin V
ANTIINFECTIVES
- vancomycin (Vancocin)
- dicloxacillin (Dynapen)
- zyvox (Lineozold)
NARCOTIC ANALGESICS:
- morphine sulfate (Morphine)
- hydromorphone (Dilaudid)
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic:
Post-op Nursing Care Plan: http://www.youtube.com/watch?v=5utnmbYV0IE
Nursing Simulation Scenario of wound dehiscence: http://www.youtube.com/watch?v=bRs-buBVtlg
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Infection; Pain & Inflammation
Complete the ATI Assessment: Targeted Perioperative
(Continued)
Page 10 of 34
… Continued)
(LM
Required Lab Assignments /Other Requirements:
Attend the Required Nursing Skills Lab (NSL): Wound Care - Advanced; & Foley Catheterization
Complete/or Review the ATI Skills Module prior to attending Lab: Wound Care, Urinary Catheter Care
Required Work for all ATI Skills Modules: pre-test, LESSON*, step videos & post test
*Lesson = review: Overview, Terminology, Accepted Practice, Step Videos, Current Guidelines, EBA & Documentation
Minimum achievement/time requirements:
Achieve an 85% on post test
Spend 1 hour on “Lesson” time for each module
Bring transcript [Labeled: “Transcript”] to lab for verification of above. (These may or may not be collected.)
Active learning strategies
Prepare before class and be ready to discuss in class.
Case Study 1
An 81-year-old woman, with a history of congestive heart failure and hypertension, has been transferred from the OR to
the PACU. She has undergone an exploratory laparotomy for adhesions. She received general anesthesia and one unit
of packed red blood cells during the operation. She has a Jackson-Pratt drain to bulb suction and a Foley catheter to
straight drainage. She has an IV of 5% dextrose in normal saline infused 100 ml/hr. Medication history includes eye
drops for glaucoma and anti-hypertensive meds, including a diuretic.
a. Identify, prioritize and give the rationale for each nursing interventions .for Mrs. Lap immediately after she is
transferred to the PACU from the OR.
b. Using a systems approach (e, g, respiratory, cardiac,) identify and describe common potential post-operative
problems and their medical and nursing management. Include the clinical manifestations, abnormal labs/
diagnostic tests, and the medical and nursing management. Asterisk those Mrs. Lap is most likely to encounter
and explain why.
Case Study 2
You are the staff nurse receiving a new patient admission from the PACU. What information should be included in this
report? Be specific.
a. What assessments would you make immediately after the patient is safely settled in the bed? She is
complaining of pain and has an order for Morphine 2 mg IVP. Describe this medication, its action, side effects
and priority nursing interventions. The patient is also ordered to receive ceftriaxone (Rocephin) IV stat. Why is
this medication ordered for the patient? What are the pharmacological actions, the side effects, and nursing
interventions? The patient will be discharged home tomorrow on cephalexin (Keflex). Using role playing,
demonstrate how and what you would teach the patient.
b. Discuss the variables that affect the surgical patient’s wound healing. Include pertinent lab values. Describe
first, second and third intention healing in this discussion. What dietary teaching prior to discharge would be
beneficial?
c.
Discuss gerontologic considerations that affect post-operative management.
What nursing interventions would be helpful in promoting the client’s well-being?
Many patients have same day surgery. How would their post-operative care vary from that of a hospitalized
surgery patient? How would you teach the patient to care for the surgical wound at home?
Page 11 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 1.4
Concept I:
Perioperative Nursing
Content:
Intravenous Fluid Therapy & Blood Replacement Therapy
Overview:
In Nursing 1000 you learned the importance of fluids and electrolytes in maintaining the homeostasis of the body. It is
vital for the nurse to be able to anticipate potential imbalances associated with certain disorders and medical therapies.
In this module you will learn the importance of recognizing the signs and symptoms of fluid imbalances and to intervene
appropriately. When the patient is unable to tolerate oral intake, IV route may be utilized as a means of providing
nutritional support, administering medications, and transfusion of blood and blood products.
Packed red blood cells, albumin, plasma and cryoprecipitate can be a life saving measure, but they are not without
risks. Nurses must have an understanding of the principles and practices of safe administration of IV fluid therapy and
blood replacement therapy. Nursing responsibilities include starting and monitoring IV infusions, assessing the IV site,
monitoring for complications and checking orders from the health care provider for the correct IV fluids and blood
products to be administered.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Explain the principles and procedures for administering IV therapy and blood products.
 Describe the various types of IV fluids and blood products and identify which patient situations in which they
would be utilized.
 Describe the composition and indications of common intravenous fluid solutions.
 Describe the different types of IV catheters that are used.
 Plan and implement nursing care to a patient that requires IV therapy.
 Identify measures used to prevent potential complications of IV therapy and blood replacement therapy.
 Calculate IV drop factors and infusion rates.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic Resources:
Introduction to IV therapy - http://www.youtube.com/watch?v=7QpX6NpQvdU
New IV pump demo (Alaris pump) http://youtu.be/Z8CltymxLyE
Articles:
Tolich, D., Blackmur, S., Stahorsky, K. and Wabeke, D. (2013). Blood management: Best practices transfusion
strategies. Nursing 2013, 43 (1), 41-47.
McCarron, K. (2013). Blood essentials. Nursing made incredibly easy, 3-4, 16-24.
Required Lab Assignments /Other Requirements:
Attend the Required Nursing Skills Lab (NSL): IV Lab
The student will be expected to demonstrate competency in setting up an IV, time taping and
calculating accurate drop factor for the safe administration of IV fluids.
Complete/or Review the ATI Skills Module prior to attending Lab: IV Therapy, Blood Administration
Required Work for all ATI Skills Modules: pre-test, LESSON*, step videos & post test
*Lesson = review: Overview, Terminology, Accepted Practice, Step Videos, Current Guidelines, EBA & Documentation
Minimum achievement/time requirements:
Achieve an 85% on post test
Spend 1 hour on “Lesson” time for each module
Bring transcript [Labeled: “Transcript”] to lab for verification of above. (These may or may not be collected.)
Page 12 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 1.5
Concept I:
Perioperative Nursing
Content:
Fluids and Electrolytes
Overview:
Fluid and electrolyte balance within the body is necessary for maintenance of the health and function of all body systems.
This balance is accomplished internally by a process known as physiologic homeostasis. Fluid volume imbalances and
electrolyte disturbances are routinely encountered in nursing practice. A fluid volume balance may occur alone or in
combination with an electrolyte disturbance. Nursing care involves prevention, early assessment, and treatment of
potential or actual alterations in fluid and electrolyte imbalances. If left untreated, any fluid or electrolyte imbalance may
cause death.
This module will discuss the basics of fluid management and will include dehydration, fluid volume deficit, and fluid
volume excess, In addition, major electrolyte imbalances will be presented.
Individual Learning Objectives
After completing this module the learner will be able to:
 Describe the role of the kidneys, lungs, and endocrine glands in regulating the body’s fluid composition and
volume.
 Identify the effects of aging on fluid and electrolyte regulation.
 Describe the location and functions of body fluids including the factors that affect variations in fluid
compartments.
 Compare and contrast dehydration, fluid volume deficit, and fluid volume excess.
 Explain the etiology and clinical manifestations, management, and nursing interventions for the following
imbalances.
- Sodium deficit (hyponatremia) and Sodium excess (hypernatremia)
- Calcium deficit (hypocalcemia) and Calcium excess (hypercalcemia)
- Magnesium deficit (hypomagnesemia) and Magnesium excess (hypermagnesemia)
- Phosphorus deficit (hypophosphatemia) and Phosphorus excess (hyperphosphatemia)
- Chloride deficit (hypochloremia) and Chloride excess (hyperchloremia)
 Identify significant lab values for the above electrolyte imbalances: include both normal and abnormal ranges.
 Discuss dietary modifications and medical management for the treatment of fluid and electrolyte imbalances.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Article:
Collins, M. and Claros, E. (2011). Recognizing the face of dehydration. Nursing 2011, 41 (8), 26-31.
Suggested ATI Assignment:
Complete the ATI Assessment:
Targeted
Fluid, Electrolyte, and Acid-Base
Required Lab Assignments [Previously Assigned See IV LM]
Complete/or Review the ATI Skills Module prior to attending Lab: IV Therapy
Page 13 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 2.1
Concept II:
Metabolism
Content:
Diabetes Mellitus
Overview:
Diabetes Mellitus is a metabolic disease that is characterized by hyperglycemia resulting from deficiencies in insulin
production, secretion or action. This results in abnormalities in the metabolism of carbohydrates, proteins, and fats from
insufficient action of insulin on the target tissues of skeletal muscle, adipose tissue and the liver.
Type I and Type II diabetes have a different etiology and epidemiology, the basis for treatment for both types of diabetes
is diet, exercise, pharmacology and education. The Standards for care, developed by the American Diabetes association
(ADA and the international World Health Organization (WHO), encompass evaluation, management and education.
The goal of diabetes treatment is to prevent long-term complication to the nerves, blood vessels and organs in the body.
No other disease demands so much from the patient’s knowledge and ability. This puts a tremendous responsibility on
the professional nurse for patient education.
Individual Learning Objectives
After completing this module the learner will be able to:
 Understand the basic physiology of the endocrine function of the pancreas.
 Contrast the epidemiologic and etiologic factors of Type 1 and Type 2 diabetes.
 Differentiate the pathophysiologic bases for Type 1 and Type 2 diabetes.
 Describe the common manifestations of Type 1 and Type 2 diabetes.
 Compare the comprehensive care of the patient with Type 1 and Type 2 diabetes including nutrition, exercise,
and education.
 Analyze the insulin regimens in Type 1 diabetes:
Insulins:
Rapid acting: insulin lispro (Humalog, Novalog)
Regular: regular (Humalin R, Novolin R)
Intermediate-acting NPH (Humulin N, Novolin N)
Long-acting insulin glargine (Lantus)
Mixtures:

70% NPH/30% regular Humulin 70/30, Novolin 70/30
75% intermediate insulin and 25% rapid-acting Humalog 75/25
Describe the oral agents used in the treatment of Type 2 diabetes in terms of mechanism of action, dosage
ranges, metabolic effects, side effects and contraindications.
Oral agents for Type 2:
Sulfonylureas
Glypizide (Glucatrol)
Glyburide (Diabeta, Micronase)
Biguanides
Metformin (Glucophage)
Alpha-Glucosidas Inhibitors
Acarbose (Precose)
Miglitol (Glyset)
Meglitinides
Nateglinid (Starlix)
Repaglinide (Prandin)
Thiazolidinediones
Proglitazone (Actos)
Combination oral agents
Metformin+glyburide, glucovance
Metformin + rosiglitazone, Avandamet
Metformin + glipizide, Metaglip
Metformin + pioglitazone, Actoplus
Rosiglitazone + glimepiride, Avandaryl
(Continued)
Page 14 of 34
(LM Diabetes Mellitus… Continued)






Discuss the acute complications of diabetes including hypoglycemia, diabetic ketoacidosis (DKA), and
hyperosmolar non-ketotic syndrome (HHNK) as a consequence of diabetes management; include causes,
signs and symptoms, treatment and prevention.
Describe the chronic complications of diabetes
Discuss the management of chronic complications.
Develop a teaching plan for an individual with Type 1 and Type II diabetes.
Discuss the surgical considerations for an individual with diabetes.
Discuss sick day management guidelines for the individual with diabetes. Discuss hypoglycemia on the basis
of causes, clinical manifestations and management.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Articles:
Funnell, M. (2009). Lessons from DAWN: implementing effective insulin therapy. Internet Journal of Advanced
Nursing Practice, 10 (2), 5. Retrieved from CINAHL with Full Text database.
Prentice, D., Ritchie, L., Crandall, J., Harwood, L., McAuslan, D., Lawrence-Murphy, J., et al. (2009).
Implementation of a diabetic foot management best practice guideline (BPG) in hemodialysis units.
Canadian Association of Nephrology Nurses and Technologists Journal, 19 (4), 20-24. Retrieved from
MEDLINE with Full Text database.
Electronic:
Diabetes Patient Education: Types of Insulin
(PostCare.com& PreOp.com)
http://www.youtube.com/watch?v=SA7yCKxzzr0
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Endocrine [Drugs for DM]
Complete the ATI Assessment: Targeted Endocrine
Complete the ATI Tutorial: Practice Test Endocrine
Required Lab Assignments /Other Requirements:
Complete the ATI Skills Module prior to attending Class: Diabetes Management
Required Work for all ATI Skills Modules: pre-test, LESSON*, step videos & post test
*Lesson = review: Overview, Terminology, Accepted Practice, Step Videos, Current Guidelines, EBA & Documentation
Minimum achievement/time requirements:
Achieve an 85% on post test
Spend 1 hour on “Lesson” time for each module
Bring transcript [Labeled: “Transcript”] to lab for verification of above. (These may or may not be collected.)
Active Learning Strategies: MS Workbook
Case Study:
Be prepared to work in groups on teaching situations for Type 1 or Type 2 diabetics:
1. A 42 year old female patient is newly diagnosed with type 2 diabetes mellitus. During the patient education, the patient
asks the nurse, “What should I do if I am sick and can’t eat, should I still take my medicine for the diabetes?”
a. What management strategies should the nurse provide the patient to deal with “sick days”?
2. A 26-year-old patient has Type I Diabetes. He was originally diagnosed at the age of 14, and currently manages his
disease with an intensive regimen of insulin injections. He is employed as a schoolteacher and soccer coach. He
presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is
using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but
today he is unable to even tolerate that, and comes to the clinic for evaluation of possible Diabetic Ketoacidosis (DKA).
a. Describe the pathophysiology of DKA and why it occurs in patients with Type I Diabetes Mellitus.
b. Based upon the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?
c. The physician orders a complete metabolic panel, and his blood glucose is 425. Other lab values include a
serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?
d. Explain why it is important for the patient to continue taking his insulin even though his oral intake is decreased.
Page 15 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 3.1
Concept III:
Tissue Perfusion
Content:
Hypertension
Overview
Hypertension is defined as blood pressure that is above an individual’s baseline blood pressure for a sustained period
of time. Hypertension is one of the most common medical disorders and the leading cause of cardiovascular disease.
It is known as the “silent killer” because quite often there are no noticeable symptoms.
Early diagnosis and management of hypertension is essential to decrease risk factors that contribute to complications
and increase the morbidity and mortality rates. Hypertension is defined for the individual by the Eighth Report of the
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8)
according to age and existing comorbidities.
A thorough health history and physical assessment by the nurse is essential. The focus of nursing interventions includes
teaching the patient and family about hypertension, associated risk factors, and the necessity of compliance with the
treatment plan. Health promotion includes modification of lifestyles, taking medication regularly and keeping regular
follow-up appointments with health care providers.
Individual Learning Objectives
After completing this module, the learner will be able to:
 Discuss the pathophysiology of hypertension.
 Identify gerontologic changes that contribute to the development of hypertension.
 Explain the difference between primary and secondary hypertension.
 Compare and contrast modifiable and non-modifiable risk factors.
 Identify the components of a health history and physical assessment for a patient with hypertension.
 Discuss the medical management of hypertension.
 Formulate a nursing care plan with prioritized nursing diagnoses for a patient with hypertension.
 Describe the complications of hypertension.
 Discuss the following classifications of medications:
THIAZIDE DIURETIC:
- hydrochlorothiazide (Hydrodiuril/HCTZ)
LOOP DIURETIC:
- furosemide (Lasix)
K-SPARING DIURETIC:
- spironolactone (Aldactone)
BETA ADRENERGIC BLOCKERS:
- propranolol (Inderal) and metoprolol (Lopressor)
CALCIUM CHANNEL BLOCKERS: Two types
Dihydropyridines:
-
nifedipine (Procardia)
diltiazem (Cardiazem)
Non-Dihydropyridines:
verapamil (Calan)
ACE INHIBITORS:
- lisinopril (Zestril)
ANGIOTENSIN RECEPTOR BLOCKERS
- losartan (Cozaar)
VASODILATORS
- nitroglycerin

Develop a teaching plan for an individual newly diagnosed with hypertension.
Include lifestyle modifications, and medication compliance.

Identify expected outcomes to determine if the patient complies with the treatment plan.
Continued)
Page 16 of 34
(LM: HTN… Continued)
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Articles:
Baldwin, S. (2011). Helping patients manage hypertension. Nursing 2011, (41) 8, 60-63.
Electronic:
Medication for high blood pressure (HBP #3) http://www.youtube.com/watch?v=9zTFVmUK1gk&feature=related
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Cardiovascular
Complete the ATI Assessment: Targeted Cardiovascular
Complete the ATI Tutorial: Practice Test Cardiovascular & Hematology
Active Learning Strategies
Prepare before class and be ready to discuss in class.
1. Difference between primary and secondary hypertension and definition and classification of hypertension.
2. You have been assigned to care for a patient on a medical-surgical unit with multiple health problems, including
postural hypotension. He is very knowledgeable about the physiologic workings of the human body and asks you
why postural hypotension occurs. What is the best explanation of postural hypotension that you can give?
3. You are admitting a patient with hypertension. Upon assessment, his blood pressure is 180/110. Discuss potential
complications that can occur with a sustained elevated blood pressure.
4. You are taking the blood pressure of a 40-year-old male who is in the primary care office for follow-up of his
hypertension. He states, “My friend just died the past week from a heart attack. I have high blood pressure and
really don’t take my medications like I should. I have a family, and I just don’t want to get sick or die. Why do I have
to take these pills every day? I feel OK. Yes, sometimes I get bad headaches, but if I lie down, they go away. Can’t
you do something so I don’t have to take these pills?” Develop a teaching plan for Mr. B. Focus your response to
this case study on ways to promote compliance.
5. Be prepared to present this content in class to your colleagues:
a. What are beta blockers?
b. How do they work?
c. What nursing implications are important to consider when administering beta blockers? (labs, diet, vital signs)
d. What are some adverse effects and contraindications to this class of drugs?
e. What are some common beta blockers?
6. Be prepared to answer the same questions above about the following classes of drugs: thiazide diuretics, ACE
inhibitors, ARBs, calcium channel blockers.
7. What is meant by Hypertensive Urgency and Emergency? What are the treatment goals?
8. What would you do if ……….
- You were preparing to give propranolol (Inderal) to your hypertensive patient and noted that the apical pulse
was 52. The blood pressure remains stable.
-
Your patient has orthostatic hypotensive effects of an anti-hypertensive drug.
-
Your patient is receiving a thiazide diuretic and the potassium level is 3.0.
9. List three nursing diagnoses for a patient with hypertension, in order of priority.
Page 17 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 3.2
Concept III:
Tissue Perfusion
Content:
Peripheral Vascular Disease
Overview
Peripheral vascular disease refers to an extensive classification of disorders that affect the flow of arterial and venous
blood to or from the extremities. Disruption of blood flow may be due to narrowing or obstruction of the walls of the
vessels. Clinical manifestations of peripheral vascular disease are dependent on a variety of factors that include the
vessel affected, extent of the damage, and duration of the problem.
A thorough health history and physical assessment by the nurse is critical. The focus of nursing interventions includes
identification of risk factors, lifestyle modifications and prevention of complications. Patient education involves
maintaining adequate circulation and compliance with the treatment plan. Peripheral vascular disease is strongly
associated with aging, and symptoms usually appear between the ages of 50 and 70.
Individual Learning Objectives
After completing this module, the learner will be able to:
 Explain the anatomy and physiology of the vascular system.
 Identify risk factors associated with the development of vascular disease.
 Differentiate between arterial and venous disorders.
 Discuss the collaborative management of arterial and venous disease.
 Formulate a nursing care plan for preoperative and postoperative nursing care for patients undergoing
vascular surgery.
 Develop teaching plan for patients with PVD.
 Create a nursing care plan for a patient undergoing an amputation related to peripheral vascular
complications.
 Discuss common pharmacological agents prescribed for the management of vascular disease:
ANTICOAGULANTS:
- *heparin (antidote - Protamine sulfate)
- *enoxaparin, (Lovenox /Arixtra)
- *warfarin (Coumadin) (antidote - Vitamin K)
ANTIPLATELETS:
- aspirin (ASA) (Acetylsalicylic Acid)
- clopidogrel (Plavix)
- ticlopidine (Ticlid)
- dipyridamole (Persantine)
- aspirin and dipyridamole (Aggrenox)
THROMBOLYTICS:
- plasminogen activator (TPA)
 Discuss home and community services for patients with PVD.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic:
YouTube-Stay in Circulation: Take Steps to Learn About P.A.D. http://www.youtube.com/watch?v=cdvKSuYc93A&feature=related
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Hematology [Drugs to Prevent/Dissolve Thrombi]
Complete the ATI Assessment: Targeted Cardiovascular
Complete the ATI Tutorial: Practice Test Cardiovascular & Hematology
(Continued)
Page 18 of 34
(LM PVD… Continued)
Active Learning Strategies
Prepare before class and be ready to discuss in class.
1. a. What is heparin?
How does it work?
What nursing implications are to be considered with the administration of this medication? (labs, diet)
When is it contraindicated?
How is it delivered?
b. Be prepared to answer the above questions regarding:
enoxaparin Lovenox) , aspirin (ASA) (Acetylsalicylic Acid), warfarin (Coumadin), clopidogrel (Plavix),
ticlopidine (Ticlid), dipyridmole (Persantine), and aspirin and dipyridamole (Aggrenox).
2. A nurse is caring for a patient with a deep vein thrombosis (DVT). Discuss potential medical management for
this patient. Include anticoagulant therapy.
3. You are caring for a patient receiving warfarin (Coumadin) therapy. What information should be incorporated
into the patient’s teaching plan?
4. A diagnosis of peripheral arterial occlusive disease has been made following a Doppler study. Discuss
nursing management of a patient experiencing peripheral arterial occlusive disease.
5. What is the test Ankle Brachial Index? How is it used in the management of PVD?
6. Discuss Buerger’s disease.
7. Discuss Raynaud’s disease
8. Each group member list ways to prevent leg ulcers and varicose veins.
9. Differentiate between arterial and venous leg ulcers. Include appearance and signs and symptoms.
10. Discuss the care management of a patient post-bypass graft of a limb. Two priority nursing diagnoses and
assessments.
11. Discuss the care of a patient with cellulitis. List two priority nursing diagnoses and major assessments.
Page 19 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 3.3
Concept III:
Tissue Perfusion
Content:
Hematologic Disorder: Anemia
Overview
This module will discuss a common health problem, anemia of the hematopoietic system that can affect adults.
Hematologic disorders are not age specific, and can affect the very young through the very old.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Explain the structure and function of the organs, tissues and cells of the hematologic system.
 Identify essential data that is part of a comprehensive hematologic assessment.
 Describe diagnostic tests used in assessment of hematologic function.
 Differentiate among the following types of anemia: iron deficiency, Vitamin B12 deficiency and folic acid
deficiency in terms of pathophysiology.
 Identify gerontologic considerations important to the assessment and treatment of anemia in older adults.
 Formulate a nursing care plan for clients with anemia.
 Discuss the pharmacologic agents used in the management of hematologic disorders:
Drugs to Treat Anemia
- ferrous sulfate (Feosol)
- cyanocobalamim (Vitamin B12)
- folic acid (Folate)
- thiamine
- niacin
ERYTHROPOIESIS-STIMULATING AGENTS
- epoetin alpha (Epogen, Procrit)
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic Resources:
What is Blood? (America's Blood.org) http://www.youtube.com/watch?v=CRh_dAzXuoU&feature=related
The role of red blood cells in anemia (American Society of Hematology): http://www.youtube.com/watch?v=_ZV5140OykE&feature=related
Articles:
Miller, J. (2010). CBC count. Nursing 2010, 40 (7), 52-55.
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Hematology [Drugs for Anemia & Hematopoiesis]
Complete the ATI Tutorial: Practice Test Cardiovascular & Hematology
Active Learning Strategies
Prepare before class and be ready to discuss in class.
1. Discuss the various types of blood cells in the bone marrow.
2. List the normal lab values for: HCT, Hgb, platelets, RBC, WBC, MCV, MCH, MCHC
3. Describe iron deficiency anemia, folic acid and Vitamin B12 deficiency and explain the signs and symptoms
that a client may present with.
4. Formulate a teaching plan for a patient who must take ferrous sulfate (Feosol) or epoetin alpha (Epogen).
Page 20 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 3.4
Concept VII: Tissue Perfusion
Content:
Vascular Problems of the Brain / Stroke
Overview:
This module will present the care of persons with specific vascular problems of the brain that result in a stroke. By simple
definition, a stroke is any disruption in the normal blood supply to the brain. The National Stroke Association uses the
term brain attack to describe stroke.
Stroke is the third leading cause of death in the U.S. accounting for 160,000 deaths each year. It is estimated that
780,000 people will have a stroke this year. Any interruption of normal blood supply to the brain is a medical emergency
that requires prompt recognition and management to reduce either permanent neurological dysfunction or death.
The nursing care of patients with stroke is often challenging and requires a multidisciplinary approach of the health care
team. It is essential to review the anatomy and physiology of the brain to have an understanding of this module.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Explain the etiology, epidemiology, and pathophysiology of stroke.
 Compare and contrast transient ischemic attack (TIA), hemorrhagic and ischemic stroke.
 Identify the major risk factors for ischemic and hemorrhagic stroke.
 Recognize clinical manifestations of stroke.
 Demonstrate knowledge about the collaborative care management of a patient who has had a stroke.
 Explain the actions, side effects, and nursing implications for the following medications prescribed for the
management of a stroke:
FIRST-GENERATION NSAIDS:
- acetylsalicylic acid (Aspirin) [Previously assigned: N1000]
ANTICOAGULANTS:
- heparin/Enoxaparin (Lovenox) * [Previously assigned: LM 3.2 PVD]
- warfarin/Coumadin * [Previously assigned: LM 3.2 PVD]
ANTIPLATELET:
- dipyridamole aspirin (Aggenox) * [Previously assigned: LM 3.2 PVD]
- clopidogrel (Plavix)
THROMBOLYTICS:
- tissue-type Plasminogen, alteplase (tPA)
 Formulate a teaching plan for stroke prevention in a high-risk population.
 Summarize prioritized nursing interventions for patients with a stroke.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Articles:
Rowat, A., Lawrence, M., Horsburgh, D., Legg, L., & Smith, L. N. (2009). Stroke research questions: a nursing
perspective. [Article]. British Journal of Nursing (BJN), 18(2), 100-105.
Electronic Resources:
Recognizing signs and symptoms of stroke:
http://www.youtube.com/watch?v=wH7k5CFp4hI
Suggested ATI Assignments:
Complete ATI Tutorial prior to attending Class: Pharmacology Made Easy: Hematology [Drug: Prevent/Dissolve Thrombi]
Complete the ATI Assessment: Targeted Neurosensory and Musculoskeletal
Complete the ATI Tutorial: Practice Test Neurosensory
(Continued)
(LM
… Continued)
Page 21 of 34
Active Learning Strategies
Prepare for class and be ready to discuss in class.
Case Study 1
A 74-year-old patient is admitted to the telemetry unit with the diagnosis of acute ischemic stroke. The patient was found
by her daughter after her daughter had gotten out of work and arrived at her mother’s home. The daughter stated her
mother was normal before she left for work. The time of onset for the stroke could not be safely determined. The patient
has right-sided paralysis and global aphasia. The patient has unilateral neglect of her right side and has right field
homonymous hemianopsia. The patient is drooling from the right side of her mouth and coughs periodically.
A CT of the head without contrast reveals no evidence of hemorrhage. The transesophageal echocardiogram reveals
moderate mitral valve insufficiency and embolism as a primary cause of the stroke. The patient is experiencing atrial
fibrillation with a controlled ventricular rate on the monitor. The patient is started on a weight-based heparin protocol.
The patient received digoxin to keep the ventricular rate of the atrial fibrillation controlled.

What principles of nursing management should the nurse provide the patient during the acute stage of the
ischemic stroke based on the assessment findings from the case study?
Case Study 2
A 71-year-old male patient is being discharged from the rehab unit 8 weeks after an ischemic stroke. The patient’s
spouse states that they used to enjoy going to golf outings with their friends, but the patient has not golfed since her
husband had the stroke. She states that she does not want to try to golf once her husband is discharged home because
he has to use a walker and can barely walk. She also states that her husband still has trouble speaking, and his shortterm memory is not very astute so it would be embarrassing to be on a golf outing with him. The patient’s spouse has
worn the same outfit to the rehab unit the past 3 days.
The rehab nurse has made arrangements with the social worker for a physical therapist, speech therapist, and
occupational therapist to provide three sessions of therapy at the patient’s home for the next 4 weeks, and then a
reevaluation will follow to determine if the patient will need further therapy. The patient is able to sit independently, stand
independently, and use a walker to ambulate 30 feet before resting. Deficits include slurred and hesitant speech as well
as short-term memory loss.

What educational topics should the nurse provide the family about home care for the patient after stroke?
Page 22 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 4.1
Concept IV:
Oxygenation
Content:
Respiratory Disorders
Overview
This module will present disorders of the upper and lower airway. The role of the nurse is critical in caring for patients with
any disorder that involves the respiratory system. Upper airway disorders include rhinosinusitis, pharyngeal infections, and
aspiration. Lower airway disorders include pneumonia, tuberculosis (TB) and chronic obstructive pulmonary disease (COPD).
When a patient is unable to maintain airway patency, respiratory suctioning may be required. In clinical settings nurses are
expected to have strong assessment and intervention skills to safely care for these patients.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Explain the structures and function of the upper and lower airway.
 Describe the etiology, pathophysiology, clinical manifestations of airway disorders.
 Describe a physical assessment and diagnostic evaluation for a patient with upper or lower respiratory disorders.
Upper airway:

Compare and contrast methods of suctioning and oral and pharyngeal airways.
Lower airway:






Differentiate between community-acquired and hospital-acquired pneumonia.
Identify incidence, preventive measures, and present challenges in the diagnosis and treatment of tuberculosis.
Formulate a teaching plan for a patient and family for medication compliance and home safety while undergoing treatment for
tuberculosis.
Explain the pathophysiology for chronic bronchitis and pulmonary emphysema (COPD).
Discuss collaborative management of common lower airway disorders, pneumonia, tuberculosis, and chronic obstructive
pulmonary disease (COPD).
Discuss the following pharmacologic agents:
Pneumonia:
ANTIBIOTICS - ANTI-infectives
levofloxacin (Levaquin)
ciprofloxacin (Cipro)
ceftriaxone (Rocephin) *
Tuberculosis:
ANTIMYCOBACTERIALS & ANTI- TUBERCULOSIS AGENTS:
isoniazid (Isotamine)
rifampin (Ritadin)
ethambutol (Myambutol)
pyrazinamide (Tebrazid)
COPD:
SYMPATHOMIMETICS - BETA2-ADRENERGIC AGONISTS (COPD):
albuterol (Proventil, Ventolin)
salmetrol (Serevent)
GLUCOCORTICOIDS/STEROIDAL
beclomethasone depropionate (Vanceril, Beclovent)
methylprednisolone (Solu-Medrol) or prednisone
fluticasone and salmeterol (Flovent, Advair)
ANTICHOLENERGIC
ipratropium (Atrovent)
tiotropium (Spiriva)
MAST CELL STABILIZERS
cromalyn sodium (Intal, NasalCrom)
LEUKITRIENE MODIFIERS
montelukast (Singulair)
zafirkulast (Accolade)
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic Resources:
Tracheostomy Suctioning: http://www.youtube.com/watch?v=UVuPzhOWxRs
Centers for Disease Control and Prevention: http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.html
Auscultation Assistant heart sounds and lung sounds: http://www.wilkes.med.ucla.edu/
Easy Auscultation  Lung sounds reference guide: http://www.easyauscultation.com/
Page 23 of 34
(Continued)
Respiratory … Continued)
(LM
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Respiratory
Complete the ATI Assessment: Targeted Respiratory
Complete the ATI Tutorial: Practice Test Respiratory
Skills Module: Airway management (review)
Active Learning Strategies:
Prepare before class and be ready to discuss in class.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Discuss the concepts of oxygenation/ventilation and perfusion in terms of definition and principles.
What is meant by pulmonary function testing, spirometry, forced expiratory volume in 1 second (FEV1)?
What is a bronchoscopy?
Discuss the various types of pneumonia: community or hospital acquired. What are the likely pathogens? What are the common
treatments?
Develop a teaching discharge plan for a patient with pneumonia.
What is meant by Tuberculosis? Discuss active versus dormant disease. What causes the disease?
How is TB diagnosed? What is meant by acid fast bacilli sputum test?
Who is at risk for TB? How is it treated? Discuss the various drug regimes. Why so many drugs?
Discuss the drugs for TB listed above: include actions, side effects, dosages, length of drug treatment and any contraindications.
Discuss the infectious control management of a patient in the hospital suspected of having tuberculosis.
Develop a discharge teaching plan for a patient with TB going home with family members.
What is meant by barrel-chested as it relates to emphysema? Include Anterior-Posterior diameters in your answer.
Why do patients with emphysema acquire clubbed fingers?
Patients with emphysema often retain carbon dioxide….explain this.
Hypoxic patients are often placed on oxygen. Patients with emphysema are often at risk for CO 2 narcosis with high flow oxygen
delivery systems. Can you explain this?
Case Study
Your patient is a 24 year of age male who was admitted to the surgical unit after a successful repair of an inguinal hernia. He is 5 feet 10
inches tall and weighs 120 kg. He has a neck circumference of 21 inches. The patient has morphine sulfate 2-4 mg SC every 3-4 hours
for pain, as ordered. He has no known drug allergies. The vital signs are as follows: BP 122/70, R 26, P 88, and T 98.6°F. The patient
complains of incision pain and rates it on the pain scale as 7 out of 10. His family is visiting at the bedside. One-half hour after
administering the pain medication, a family member enters the hallway and yells, “We need help in here! John is not breathing.” The
nurse finds John having periods of apnea lasting a few seconds followed by a short snorting gasp and then he begins breathing at a rate
of 12 breaths per minute. His lips are bluish in coloration and so are his nail beds. The patient is lying supine in the bed. He awakens as
the nurse enters, but is very lethargic and somnolent.
 Which assessment parameters are appropriate to determine the characteristics and severity of the symptoms that the patient is
exhibiting?
 Which nursing interventions should the nurse institute? Which intervention must be provided immediately?
 Explain the possible reasons for the patient’s sudden decline in the respiratory status.
Case Study
A 70 year of age male patient is admitted to the medical-surgical unit with acute community acquired pneumonia. He was diagnosed with
emphysema three years ago. The patient smoked cigarettes 1 pack per day for 55 years and quit three years ago. The patient has a
history of hypertension, and diabetes that is controlled with oral diabetic agents. The patient presents with confusion as to time and place.
The family stated that this is a new change for the patient.
The admission vital signs are as follows: BP 90/50, P 101, R 28, and T 101.5 °F. The pulse oximeter on room air is 85%. The CBC is:
WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. ABGs on room air are: pH 7.30, PaO 2 55, PaCO2 50, HCO3 25. Chest x-ray
results reveal right lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion in the right lower
lobe. Lung auscultation reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base. The
breath sounds in the rest of the lungs are slightly decreased.
The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above
the baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic and is
using accessory muscles. The patient coughs weakly, but he does not raise any sputum.
 What nursing assessment findings support the diagnosis of pneumonia?
 What diagnostic findings support the diagnosis of pneumonia?
 What nursing diagnoses should the nurse formulate for the patient?
 What goals should the nurse develop for the patient?
 What overall interventions should the nurse provide?
Page 24 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 5.1
Concept V:
Nutrition
Content:
Gastrointestinal Disorders
Overview:
Disorders of the gastrointestinal tract can severely impact many aspects of a patient’s health. This module will present
common disorders affecting digestion and elimination. The primary pathological disorders are gastritis, gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), diverticulitis, inflammatory bowel disease (IBD), colorectal
cancer (CRC), and bowel obstruction. There is a growing understanding of the effect of biophysical and social factors,
such as stress, age, eating habits and exercise on the gastrointestinal tract. Patient and family education is a major
factor in the prevention and early detection of these medical conditions. The nurse plays a critical role in providing and
maintaining nutritional support, avoiding complications and promoting an optimal level of wellness.
Colorectal cancer is the third most common cancer for both men and women in the United States. This module will also
nursing care of the patient with an ostomy will be discussed.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Explain the structures and function of the upper and lower gastrointestinal system.
 Describe the etiology, pathophysiology, clinical manifestations of gastrointestinal disorders.
 Describe a physical assessment and diagnostic evaluation for a patient with upper and lower gastrointestinal disorders.
Upper gastrointestinal disorders:





Discuss collaborative management of common upper gastrointestinal disorders, gastritis, GERD, and PUD.
Formulate a nursing care plan for clients with gastritis, GERD and PUD.
Describe the dietary management of patients with gastritis, GERD and PUD.
Identify the purpose of parenteral nutrition of the related nursing interventions.
Discuss the following medications used in the management of patients with common upper gastrointestinal disorders:
ANTIBIOTICS (helicobacter pylori):
amoxicillin (Amoxyl)
clarithromycin (Biaxin)
metronidazole (Flagyl)
PROTON PUMP INHIBITOR:
omeprazole (Prilosec)
pantoprazole (Protonix)
HISTAMINE 2 RECEPTOR BLOCKER:
famotidine (Pepcid)
Lower Gastrointestinal Disorders:




Discuss collaborative management of common upper lower gastrointestinal disorders: diverticulitis, inflammatory
bowel disease (IBD) and colorectal cancer (CRC) and obstructions.
Formulate a nursing care plan/concept map for clients with diverticulitis, inflammatory bowel disease (IBD) and
colorectal cancer (CRC) and obstructions.
Differentiate between the different types of ostomies and the nursing care for a patient with an ileostomy vs.
colostomy.
Discuss the following medications that may be used for clients with lower gastrointestinal disorders:
IMMUNOMODULATOR:
azathioprine (Imuran)
5-AMINOSALICYLIC ACID/ GI ANTI-INFLAMMATORY :
sulfasalazine (Azulfidine)
mesalamine (ASACOL)
CORTICOSTEROID:
methylprednisone (Solu-Medrol)*
ANTIINFECTIVE:
metronidazole (Flagyl)
INTESTINAL ANTIMICROBIAL:
neomycin (Mycifradin)
LAXATIVES:
Go-Litely
Psyllium (Metamucil)
senna (Senokot)
MONOCLONAL ANTIBODY
infliximab (Remicade)
(Continued)
Page 25 of 34
(LM
GI… Continued)
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic Resources:
Medicine Net - Peptic Ulcer:
http://www.medicinenet.com/peptic_ulcer/page2.htm
Cleveland Clinic <click> Gastroenterology: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/
Crohn’s and Colitis Foundation of America: www.ccfa.org
Ostomy bag change, Coloplast: http://www.youtube.com/watch?v=ikBcwqV-p-w&feature=related
United Ostomy Association of America, Inc.: www.uoa.org
Wound, Ostomy and Continence Nurses Society (WOCN): http://www.wocn.org/
National Institute of Diabetes and Digestive and Kidney Diseases; http://www.niddk.nih.gov/
Clearinghouse of information, look under Resources http://digestive.niddk.nih.gov/
Colon and Rectal Cancer (patient guides/SE): www.patientcenters.com/colon/news/side_effects.html
Having a colonoscopy (Midwest Gastroenterology): http://www.youtube.com/watch?v=1S8orvEqk0U&feature=related
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: GI
Complete the ATI Assessment: Targeted Gastrointestinal
Complete the ATI Tutorial: Practice Test GI
Required Lab Assignments / Other Requirements:
Complete the ATI Skills Module prior to attending Class: Enteral Tube Feedings
Required Work for all ATI Skills Modules: pre-test, LESSON*, step videos & post test
*Lesson = review: Overview, Terminology, Accepted Practice, Step Videos, Current Guidelines, EBA & Documentation
Minimum achievement/time requirements:
Achieve an 85% on post test
Spend 1 hour on “Lesson” time for each module
Bring transcript [Labeled: “Transcript”] to lab for verification of above. (These may or may not be collected.)
Active Learning Strategies
1. Compare and contrast ulcerative colitis and Crohn’s disease: pathology, clinical manifestations, complications and medical
and nursing management.
2. Discuss the following medications:
metronidazole (Flagyl)
methylprednisone (Medrol)
sulfasalazine (Asulfidine)
mesalamine/Asacol (Rowasa)
diphenoxylate with atropine (Lomotil)
3. Discuss colorectal cancer: prevalence, risk factors, diagnostic tests, and management. If surgery is indicated what is the
pre-op bowel prep and patient teaching. If 5-FU were administered, what are the main side effects and nursing
interventions?
4. Discuss the pathophysiology, clinical manifestations, diagnostic tests, medical and nursing management of diverticulosis
and diverticulitis.
Be prepared to discuss case studies in class.
Case study 1
A 50 year old man presents at the walk-in clinic with complaints of burning epigastric pain that occurs about two hours after
he eats. He consistently feels bloated and obtains little or no relief from over the counter antacids. His prior medical history
reveals high blood pressure, cigarette smoking, a stressful job and chronic use of ibuprofen for low back pain.
a. What further information does the nurse need to collect about his chief complaint?
b. What is the client’s most serious risk factor for peptic ulcer disease?
c. The client’s blood is drawn. What other diagnostic tests should be ordered?
d. The results of the urea breath test come back positive for Helicobacter pylori. What is a possible treatment plan?
e. Develop a teaching plan for this patient. Include possible medications, dietary and life style modifications.
Case Study 2
A patient has been ordered to receive total parenteral nutrition. Explain the nursing care of a patient receiving TPN. Include
prevention of complications in your discussion.
(Continued)
Page 26 of 34
(LM
GI… Continued)
Case Study 3
A female patient 84 years of age presents to the clinic for an annual checkup. The nurse updates the patient’s history by
asking her if she has had any gastrointestinal pain associated with meals, at rest, or with activity, or with having a bowel
movement. The nurse also asks the patient if she has had any unexplained weight loss or weight gain since her last annual
checkup. The nurse asks the patient if she has had any changes in her bowel habits or changes in the usual stool
characteristics. The patient stated she has had no problems.
a. What age-related considerations should the nurse utilize when performing the focused physical assessment for the GI
system?
b. The nurse is obtaining a health history related to dysfunction of the GI system. Discuss symptoms that the nurse
should focus on when obtaining patient data.
c. A nurse is giving pre-procedural teaching to a patient undergoing colonoscopy. Explain pertinent information
necessary for this patient.
Case Study 4
A 60 year old patient has undergone a bowel resection with a transverse colostomy for treatment of colon cancer. He lives
with his wife of 25 years who is very interested in learning how to help him manage care for the stoma and colostomy. He will
be discharged home on Cipro and Percocet.
 What is your priority assessment in preparing a teaching plan for this patient?
 Role play the discharge teaching for this client (diet, ostomy care, etc.)
Page 27 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 6.1
Concept VI:
Immunologic Disorders
Content:
Cancer
Overview
This module will introduce you to a basic understanding of the development and treatment modalities available to
those diagnosed with cancer. General terminology and treatment regimens will be discussed to prepare you for the
various types of cancer that will be presented in subsequent modules.
It has long been recognized that cancer has both afflicted and affected the human race as far back as history has
been recorded. According to the American Cancer Society the first description of cancer (tumors) dates back to 1600
B.C. Years later, Hippocrates called these tumors karkinos. In Latin they were called cancri meaning crab-like. This
reflected the fact that these tumors reached out to many parts of the body like the legs of a crab.
http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer
Today, there are few words in our language that evoke the anxiety, hopelessness, and dread that the word cancer
does. In reality however, despite the myths still surrounding the disease, there are more than 10 million cancer
survivors in the United States today. Prevention, early detection and treatment, and advanced treatment modalities
have contributed to higher cure rates and extended longevity of those diagnosed with cancer.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Recognize epidemiologic trends in the incidence of cancer.
 Identify causes that contribute to the development of cancer.
 Differentiate between primary and secondary prevention.
 Explain the pathophysiology of cancer, including the characteristics of malignant cells, growth of neoplasms,
and nature of metastases.
 Using the acronym CAUTION describe the common clinical manifestations of cancer.
 Explain the nurse’s role in the prevention and early detection of cancer.
 Compare and contrast the rationale for the major types of cancer therapy: surgery, chemotherapy and
radiation (internal and external).
 Discuss the following pharmacologic agents commonly used in the management of oncology disorders:
ALKALATING AGENTS:
- cyclophosphamide/Cytoxan
PLATINUM CONTAINING COMPOUNDS
- cisplatin/Platinol
ANTIMETABOLITES:
- 5-Fluorouracil/5FU
- methotrexate/Rheumatrix
- folinic acid/Leukovorin
ANTITUMOR ANTIBIOTICS:
- doxorubicin/Adriamycin
HORMONAL AGENTS:
- dexamethasone/Decadron
- leuprolide/Lupron
VINCA ALKALOIDS
- vincristine/Oncovin
(Continued)
Page 28 of 34
Cancer … Continued)
(LM
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Articles:
Gonzalez, T. (2013). Chemotherapy Extravasations: Prevention, Identification, Management, and Documentation.
Clinical Journal of Oncology Nursing, 17(1), 61-66. doi: 10.1188/13.CJON.61-66
Rchaidia, L. (2009). Cancer Patients’ Perceptions of the Good Nurse: a Literature Review. Nursing Ethics, 16(5),
528-542.
Suggested ATI Assignments:
Complete the ATI Tutorial prior to attending Class: Pharmacology Made Easy: Immune (Drug Therapy for Cancer)
Complete the ATI Assessment: Targeted Immune
Complete the ATI Tutorial: Practice Test Oncology
Electronic Resources:
Medline Plus: cancers: http://www.nlm.nih.gov/medlineplus/cancers.html
Cancer Symptoms, Signs and Prevention: http://www.cancersymptoms.org/
Cancer Journal for Clinicians: http://caonline.amcancersoc.org/
Chemotherapy Tutorial:
Midwest Cancer Centre:
http://www.youtube.com/watch?v=eJq4xvjd_MU&feature=related
Active Learning Strategies
Prepare before class and be ready to discuss in class.
Case Study
You are assigned to a clinical rotation in an outpatient chemotherapy center. You are working with a nurse who will
administer chemotherapy to a group of patients that day. One of your assigned patients is a 55-year-old male who
has been diagnosed with prostate cancer. He sleeps most of the time in the chair. His wife asks you and the coassigned nurse the following questions. How would you as the nurse respond?
a.
b.
c.
d.
What is the cause of cancer in general? Can cancer be inherited?
What is the pathophysiology of cancer?
What other treatment options are there for people with cancer?
Why do they keep changing the medication? It seems like every time we come back to the doctor after a
round of chemo has ended, they change what they give him.
e. Why is it necessary to have blood work done frequently while on chemotherapy?
f. How do they know if he is strong enough for the next round of chemotherapy? “I’m worried that he will get a
really bad infection.”
g. Could you explain what myelosuppression means? What does the doctor mean by neutropenic precaution?
What should I do to prevent complications?
h. Could you tell me how cisplatin and doxorubicin work? If the physician prescribes these medications for him,
what side effects should I be watching for?
i. What is radiation therapy? Are there different types of radiation? What are some of the common side effects
of radiation therapy?
Page 29 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 7.1
Concept VIII:
Communication
Content:
Concept Mapping
Overview:
In Nursing 1000, the nursing care plan was introduced, which is the basis for developing concept maps for patients.
A critical concept that will be to explored more in depth in Nursing 1020 is the concept of prioritization. Terms that
were first introduced in Fundamentals such as critical thinking and prioritization will be expanded upon and become
more meaningful during this course and throughout the rest of the nursing curriculum. Incorporating the basics
of nursing care plan development, prioritizing concepts and critical thinking will form the concepts needed for
concept mapping completions.
This module will introduce the student to a basic understanding of the planning, development and implementation
of concept mapping. It will also provide strategies to develop concept maps by prioritizing and utilizing critical
thinking strategies.
Individual Learning Objectives:
After completing this module, the learner will be able to:



Discuss the definitions/components of nursing care plans, critical thinking and prioritizing.
Discuss how nursing care plans, critical thinking and prioritizing are used in developing a concept map.
Develop a concept map on a medical/surgical patient.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Recommended Reading:
Schuster, P. (2011). Concept Mapping (3rd ed.). Philadelphia: F.A. Davis.
Electronic Resources: Simple nursing concept maps http://youtu.be/8sLrbwTPcME
Page 30 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 8.1
Concept VIII:
Psychosocial Integrity
Content:
Introduction to Psychiatric Mental Health and Legal Guidelines for Psychiatric Nursing
Overview
This module will introduce the student to the role of the psychiatric mental health nurse. Psychiatric/mental health nursing
focuses on providing care to individuals or groups whose primary problems relate to emotional and cognitive disequilibrium.
Topics that will be discussed in this introduction: include: the role of the psychiatric nurse in the inpatient setting, integrating
psychiatric mental health concepts into the delivery of nursing care, and the care of patients with primary physiological
needs. It is important to educate the student to be sensitive to issues of stigma in the psychiatric population, and to be more
aware of the resources available in the community for patients with mental health needs and their families. As nurses
caring for individuals throughout the lifespan, it is important to understand the concepts of mental health and illness and the
laws that govern this scope of nursing practice.
This module will also outline the legal issues that affect psychiatric mental health nursing. In this litigious society, it is
important for all nurses to be familiar with the mental health laws particular to the state in which the licensee practices.
Understanding standards of care, ethical mandates of the profession and knowledge of patient’s rights and laws assist the
nurse when confronted with such issues as voluntary/involuntary hospitalization, patient’s right to refuse treatment, restraint
and seclusion, when to breach a patient’s confidentiality and mandated reporter obligations. Laws and a variety of practices
are developed to ensure the protection of vulnerable persons. Nurses are “Mandated Reporters” which means that we are
required to report abuse/neglect of children, elders, and disabled adults. Unfortunately, many abuses are committedthrough neglect or with intention- by professional care providers. Again it is essential that each nurse be cognizant of the
laws, ethics, and standards of care governing their practice so they can avoid legal action and ensure that those in their
care receive competent, ethical treatment.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Discuss the role of the psychiatric nurse in the inpatient setting.
 Describe the population that is served in the psychiatric inpatient setting.
 Compare and contrast the roles of a nurse in the medical setting and psychiatric milieu.
 Explain the importance of monitoring patient safety in the psychiatric milieu.
 Describe a typical day on a psychiatric unit.
 Describe criteria for admission to a psychiatric unit.
 Discuss Mental Health Laws that regulate the care and treatment of the mentally ill. Include in your discussion Civil
Rights and Client Rights.
 Identify admission, commitment, and discharge procedures.
 Describe the role of the mandated reporter and the populations and conditions that might necessitate filing a report with
Department of Children and Families (DCF), Elder Abuse Hotline or Disabled Person Protection Commission (DPPC).
 Describe methods of protecting client confidentiality.
 Examine the ways that TORT law is applied within psychiatric settings.
 Discuss the importance of documentation of care in a psychiatric setting. Include in the discussion legal guidelines for
accurate documentation.
 Develop an awareness of the balance between the client’s rights and the rights of society with respect to the following
legal concepts relevant in nursing and psychiatric nursing: a) duty to intervene, b) confidentiality, c) duty to report.
 Describe criteria for admission to a psychiatric unit.
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Suggested Readings:
Videbeck, S.L. (2014) Psychatric Mental health nursing (6th ed.). Philadelphia: Wolters Kluwer/ Lippincot, Williams
and Wilkins.
Townsend, M. C. (2010) Nursing diagnoses in psychiatric nursing. (8th ed.). Philadelphia: F. A. Davis.
Electronic Resources:
National Alliance for the Mentally Ill:
http://www.nami.org
Mental Health America: (National Mental Health Association) http://www.nmha.org
Work of Hildegard Peplau
http://en.wikipedia.org/wiki/Hildegard_Peplau
Continued)
Page 31 of 34
(LM
Psych Intro /Legal … Continued)
Active Learning Strategies:
Be prepared to discuss the questions at the end of Videbeck's Chapter 1 and 9.
1. Discuss the questions at the end of Videbeck's Chapter 1 and 9
2. Bring in one current newspaper article to class featuring mental illness. We will discuss in class.
3. Complete “Critical Thinking and Chapter Review” pp.85-86. In Class: will separate into small groups and discuss
4. Discuss instances where you have observed persons with mental health issues being stigmatized.
5. Discuss possible ways that you can feel more comfortable working with a patient who has a psychiatric disorder
6. Visit the Evolve website for Chapter Review Answers & Rationales, Critical Thinking Answer Guidelines, and
additional resources related to this chapter.
7. Use the companion CD to prepare for tests and the NCLEX Examination with Test-Taking Strategies for psychiatric
mental health nursing and hundreds of Review Questions.
Page 32 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE: 8.2
Concept VIII:
Psychosocial Integrity
Content:
Cognitive Disorders
Overview:
Cognitive disorders are defined as the temporary or permanent loss of mental functioning in an individual who is usually
alert and oriented. Cognition is defines as the brain’s ability to process, retain and use information (Videbeck, p. 440).
These cognitive abilities are necessary to perform everyday tasks of decision making, problem solving, etc.
This module will present a variety of cognitive disorders with an emphasis on delirium and Alzheimer’s dementia. The
broad categories of dementia are by far the most common cognitive conditions that nurses encounter. It is the
responsibility of the nurse to extend therapeutic interventions not only to the patient affected by dementia, but also to
the family and caregivers.
Individual Learning Objectives:
After completing this module, the learner will be able to:
 Compare and contrast the clinical pictures of depression, dementia, and delirium.
 Describe the signs and symptoms occurring in the four stages of Alzheimer’s disease
 Discuss the basic physiological and psychotherapeutic interventions for the patient with delirium
 Describe the treatment strategies involved in the nursing management of the patient with cognitive disorders
within the realms of:
- Therapeutic communication
- Health promotion and maintenance
 Discuss basic pharmacology, indications, therapeutic effects, adverse effects and pt/family teaching of the
following medications:
CHOLINESTERASE INHIBITORS
Aricept/donepezil
Exelon/rivastigmine
Razadyne/galantamine (formerly Reminyl)
NMDA RECEPTOR ANTAGONISTS
Namenda/memantine
ANTIPSYCHOTICS (typical* and atypical**)
Risperdal/risperidone**
Haldol/haloperidol*
Seroquel/quetiapine**
Zyprexa/Olanzapine**
Learning Resources
Required Readings:
See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Suggested ATI Assignments:
Complete ATI Tutorial prior to attending Class: Pharmacology Made Easy: Neuro (Pt1 Drug: Alzheimer’s / Pt 2 Drug: Schizophrenia)
Complete the ATI Assessment: Targeted Neurosensory and Musculoskeletal
Complete the ATI Tutorial: Practice Test: Practice Test Gerontology; ; Neurosensory; Mental Health 1 , 2
Electronic:
Alzheimer's Association: www.alz.org
Active Learning Strategies:
Prepare before class and be ready to discuss in class.
1. Go to www.alz.org and look for 1 research article pertinent to Alzheimer’s prevention and treatment. Bring
article to class and be prepared to discuss in small groups.
2. Be prepared to discuss the questions at the end of Chapter 21.
Page 33 of 34
LABOURÉ COLLEGE
Nursing Division
Nursing 1020
LEARNING MODULE
8.3
Concept VIII: Psychosocial Integrity
Content:
Loss, Grief and Dying
Overview
This module provides the learner with an overview of loss, grief, and death. The factors that affect loss, grief, and
dying are discussed, including developmental considerations, family, socioeconomic factors, cultural influences, and
religious influences. This module presents a discussion of the nurse’s role in developing a therapeutic relationship
with the patient and patient’s support system (if available). The role of the Hospice movement in influencing present
day attitudes and philosophical perspectives on death and dying will be emphasized.
Individual Learning Objectives
After completing this module, the learner should be able to accomplish the following:
 Describe the grief process and the stages of grief.
 Discuss the behavioral outcomes that would indicate that bereavement has been successful.
 Identify components of normal bereavement and contrast this with dysfunctional grieving.
 Describe customs associated with grief in individuals of various cultures.
 Describe the concept of hospice care for people who are dying and their families.
 Describe various types of loss that engender the grieving response in individuals.
Learning Resources
Required Readings: See Nursing1020 “REQUIRED READING ASSIGNMENTS” Reference Sheet
Electronic:
American Association for Retired Persons: http://www.aarp.org/griefandloss/
Hospice Foundation of America: http://www.hospicefoundation.org
Active Learning Strategies
Be prepared to discuss the questions at the end of Chapter 12.
Group Discussion:
The class will be divided into small groups. The group will explore member’s responses to death.
- Did you experience the stages of dying outlined by Kübler-Ross?
- How were you affected by the death and what coping mechanisms did you use?
Page 34 of 34