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Course Syllabus

NURS 270: Advanced Clinical Nursing I Theory

Sherry Neil-Urban PhD, RNMichael Malay MS, RN

Fall 2013

WESTERN NEVADA COLLEGENURSING 270 ADVANCED CLINICAL NURSING I

CREDITS: PREREQUISITES:3 credits Lecture Successful completion of the(45 clock hours) first year of the program

I. COURSE DESCRIPTION:Offers clinical theory organized around the nursing process and its application to patient needs. Requires students to apply the principles of providing a safe care environment, while addressing health promotion and health maintenance needs for persons experiencing complex/acute alterations in health. Students will also apply concepts of community care, case management, health teaching and discharge planning.

Students must pass NURS 271 and achieve a theory grade of 75% or better in NURS 270 to obtain a grade of C or better in NURS 270. Failure to satisfactorily complete the required coursework for any of the Advanced Clinical Nursing I courses will necessitate that the student repeat the coursework series which includes NURS 270 and 271.

II. REQUIRED TEXTS:

Fluids & electrolytes made incredibly easy! (2010). (5th ed.) Springhouse, Pennsylvania: Springhouse Corporation. Read the sections on Fluids, electrolytes (Ch 1-10)

Gahart, B. & Nazareno, A. (2012) Intravenous medications. 28th edition. St. Louis: Missouri, Mosby.

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby.

Doenges, M., Moorhouse, M., Murr, A. (2010) The Nurses Pocket Guide : Diagnoses, Prioritized Interventions, and Rationales. Philadelphia: F.A Davis

ATI Review Modules

III. WNC online (Canvas) Course RequirementsThis course utilizes myWNC (Canvas) to provide handouts and communicate with students. The faculty will also communicate with you through your personal email. Students will need to have the skills necessary to use the internet and a basic understanding of how to download and print documents from the internet. You should also know how to use a word processor that will save in an .rtf or .doc or html format to type and submit papers via the web. Tutorial link and frequently asked questions and answers regarding this online platform are available at mywnc and in the canvas tutorial.

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IV. Disability Support Services

Any student needing to request accommodations for a specific disability, counseling and/or testing support to please meet with the DSS coordinator (445-3275) at your earliest convenience to ensure timely and appropriate accommodations. The DSS office is located in Bristlecone building, Room 103.

V. STUDENT LEARNING OUTCOMES:

Upon completion of the course the student will be able to apply the theoretical concepts, related pathophysiology and care practices to safely meet the multiple complex and acute needs of their patients.

Upon successful completion of the course the student will be able to :

1. Analyze specific problems of patients with complex/acute health alterations to address the patient’s physiological integrity needs.

2. Utilize therapeutic communication skills when interacting with patients and their families.

3. Integrate research findings that guide (or lead to) best practice and quality improvement. 4. Apply the nursing process with patients who are experiencing actual or potential problems

related to:a. respiratory system functionb. endocrine (diabetes) and auto-regulatory system function (Acid-base/fluid and electrolyte imbalance) c. hematological system functiond. Immune system function (hematological, immune, oncological)d. nervous system function e. circulatory perfusion (shock, fluid and electrolyte imbalances)f. pain

5. Explain the concepts for safely administering therapeutic intravenous nutritional supplements including total parenteral nutrition (TPN), blood, and intravenous therapy, on the health of patients in the acute care setting.

6. Describe the effects of diet on the management of selected complex/acute alterations in health.

7. Apply concepts of cultural awareness, cultural sensitivity and respect for persons when working with all populations in the healthcare environment.

8. Compare and contrast the nursing practice environment in community and home heath settings with that of acute care facilities.

9. Provide care and comfort to adult patients experiencing end of life issues.3

10. Explore the role and dimensions of case management in the provision of continuity of care for patients experiencing complex/acute alterations in their health.

11. Demonstrate professional accountability through identification of self-learning needs and ongoing professional development.

12. Apply ethical and legal principles which apply to patients, and their families, who are experiencing complex/acute alterations in their health.

Western Nevada College General Education Program Outcomes Linkage

1. Using college level reading skills, analyze and interpret nursing and medical Research

2. Understand and appreciate the many ethical dilemmas in health care provision and delineate a framework useful for ethical decision making.

3. Demonstrate professional level communication in their oral presentations

4. Employ appropriate technologies for this WebCT enhanced course and to produce word processed manuscripts.

5. Appreciate and value cultural diversity encountered in patient care

environments and the diverse and alternative health care philosophies and approaches employed.

VI. METHODS OF INSTRUCTION: Lecture, concept mapping, ATI modules, tickets to class, ATI practice tests, ATI Proctored Assessments, case study (patho) paper

VI. METHODS OF EVALUATION -- Students progressing from the first year of the nursing program are expected to apply content covered in the first year of the program.

Methods of Evaluation

1. Four computerized (or written scantron) unit examinations ----60%2. ATI Integrated testing (three Proctered Assessments) and practice tests ----10%3. Pain Symposium ---- 10% 4. Four tickets to class (see weekly unit objectives) ----5%5. One pathophysiology paper/case study ---- 15%

Each student must earn a 75% average on unit exams. Students who do not earn a 75% average on unit exams will not be allowed to continue in the nursing program and will receive the earned average of unit examinations as their grade for the course. Students with questions about this are referred to the WNC nursing student handbook and to the director of Nursing and Allied Health Programs. Grading of all exams and student work is done on a percentage basis.

1) EXAMS - 60% of the final grade is derived from exams.

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Four program exams will be given. Exams will be computerized, or on written scan tron. The non-comprehensive final exam will be proctored in the computer lab during finals week. The other three examinations will be proctored during the beginning of class in the computer lab in the Cedar building. There will be 50 – 70 questions per unit exam and 1 hour of class time will be allotted for these examinations. The computer labs – Cedar 331 A, C and D have been scheduled from 8AM until 9:30AM on exam days.

• Exam 1 09/17/13 Week 4• Exam 2 10/08/13 Week 7• Exam 3 11/05/13 Week 11• Exam 4 12/10/13 Finals Week

All exams must be taken on date scheduled. All exams are taken online in the WNC Computer lab (8-9:30 am of the exam day) unless other accommodations are made. If a written exam is used, only the answers on the scantron will count so be sure to mark the answer you want clearly on the scantron.

If your exam score is less than 80%, you have one week after grades are posted to further review the content and discuss concerns with the instructors.

Any students caught cheating on an exam, quiz, or assignment will receive a 0. No exceptions. Refer to criteria for exam taking.

2) ATI on-line exams and learning activities ---- 10% - Ten percent of your grade is based on your ATI Exam Scores (Proctored Assessments) and preparation for these proctored tests and remediation of these proctored tests. You will take Pharmacology (2010 Form B) and Medical-Surgical Proctored Assessment (2010 form B) and Nutrition Proctored Assessment (2010 Form B). These proctored assessments will be taken in a controlled environment in the computer lab. These proctored assessments are scheduled for September 13 Friday at 8:00AM (Pharmacology- Form B) and also on November 22nd from 8-12 (Medical-Surgical Nursing 2010 Form B, and Nutrition 2010 –Form B).

Preparation for taking the proctored Assessments: Half of your grade for ATI is based upon how much time you spend in preparation (taking the practice tests and reviewing the modules) BEFORE you take the proctored exam and half of your grade is based upon how much time you spend in remediation of your proctored exams. The table below is an expected time participation with remediation which corresponds to the score your receive on your proctored exam.

Before your test The proctored exam Depending on your score Remediation you must complete

Take the two practice in Pharmacology for the 2010 Form B Assessment

Pharmacology B - on Friday, September 13, 8-10AM

Less than 50% - Four, or more hours of remediation50%- Three, or more hours remediation63.3%- Two, or more hours of remediation81.7%- One or more hour of remediation

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Take the two practice tests in Nutrition

Nutrition- 2010 Form B on Friday, Nov. 22, 8-10AM.

Less than 51.7%- Four, or more hours of remediation

51.7%, Three, or more hours remediation

66.7%, Two, or more hours of remediation

81.7%, One or more hour of remediation

Take minimum of 6 practice tests in Medical Surgical Nursing (there are a total of 34 in all) It might be worth your while to do many more than six.

Adult Medical Surgical (2010-Form B) Friday, Nov. 22, 10AM-12 noon

Less than 55.6% - Four, or more hours of remediation

55.6% - Three, or more hours remediation

64.4%- Two, or more hours of remediation

73.3% - One or more hour of remediation

Practice tests can be found under the tutorials, and there are others under the practice tests tab.

After taking the practice tests you can go to the results section and you can remediate from there.

Obviously: The better you, do the less remediation you will need to complete.

Proctored tests must be remediated (also from the results section ) following the time guidelines above. If you do complete the practice tests and do the required remediation you may obtain the full 10% points for your final grade. If you do not complete the practice tests and do not complete the remediation as recommended, whole percentage points will be deducted from your final grade.

ATI practice tests are available to you to use as a study tool. You will be evaluated at the end of the course for how much time you spent in the practice tests and how many practice tests you took. ATI practice tests are available for you all semester to use at your discretion. We are planning to take questions directly from, or similar to, these practice tests so it would be helpful for you to “take” these practice tests on the topics we have been covering in class.

3) CASE STUDY: Pathophysiology Paper with Discharge Planning ---15% This case study (pathophysiology/discharge planning) paper should be completed on your second or possibly third medical-surgical patient. This patient should have a minimum of three medical/surgical diagnoses (co-morbidities). The criteria for the paper are as follows:

1. The paper should be 8-10 pages, 12 point font, typed, double spaced with a title page and references using APA format.

2. Your work must be original. 3. You should incorporate language you could use to explain the pathophysiology to the

patient and their family.

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4. Use a narrative style, do not include lists and tables , if you do need to use a table do so sparingly.

5. You will also turn in a hard copy to your clinical instructor on the morning of the last clinical day, or sooner.

6. You must use 7-8 references with at least 3 of these references coming from – and incorporating the research literature.

7. The paper will include the pathophysiology for the 3 or more co-morbidities and should describe the interaction between the co-morbidities.

RESEARCH: Research must be cited in the body of the paper. It must be original research. Not secondary resources. You should report the persons responsible for the study, the researchers, the sample size, the methodology, and the findings. The findings should pertain directly to your patient.

An Example: In one study, Cummings, Rivera, Olsen and Smity found that of the 858,741 traffic deaths that occurred in the United States in the period of 1982-2001, 366,606 or 53% were alcohol related. (p148, 2006). Additionally, a study in a level one trauma center found ….. (Rivara, Jurkovich, Gurney, Seguin, Filger, Ried, Raisy & Copass, 2007)

Another example: One study published by Usma Mehdi, MD and Robert D. Toto, MD of the University of Texas, Department of Nephrology, Their study of 1, 386 patients found that diabetes was the number one cause of chronic kidney disease which, in turn, leads to cardiovascular morbidity and mortality. (Mehdi, 2009)

In studies where the effectiveness of a treatment is presented, you need to indicate the method used to make their results and findings and how this treatment pertains to your patient. Make sure your sample size is large enough to be relevant and statistically significant. For the purposes of organizing your paper you MUST give your patient an alias “Peter or John, or Mary” or whatever name you choose. Your paper should be organized as a case study in which you are describing the symptoms of the individual and then include the following information:

a. Common clinical manifestations of each disease and how your patient demonstrated these symptoms or did not.

b. Diagnostics performed to determine what is going on with the patient. c. When were these diseases initially diagnosed (if you have this information) d. How are these diseases interrelated? (This is critical to your paper)e. Actual labs for your patient and how these labs were expected for his/her condition

or not expected. What labs are relevant but were perhaps in the “normal range”f. Medications your patient is taking and how these compare with common (expected)

medications for these disease processes. g. Potential complications of these disease processesh. What patient teaching and discharge planning, and referrals could you provide for

this patient that would make hospital readmission less likely. In a narrative format, please indicate the discharge planning issues this patient and patients with these disorders will have and how these issues should be addressed. Also include what referrals you might make for this patient. And, finally indicate what you would teach your patient, be specific please and provide teaching detail. The question your discharge section should answer is:

What should be done for the patient, or by the patient, to help him/her stay out of the hospital and help him/her live as well as possible. And, how shall I properly teach this patient so that he/she is cooperative in his/her care.

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This Case Study (Pathophysiology/ Discharge Planning paper) is due on the morning of your LAST CLINICAL DAY! THE ATTACHED WRITING RUBRIC WILL BE USED TO SCORE YOUR PAPER. One full letter grade will be deducted for each day you are late. (Extraordinary circumstances will be taken into consideration.)

4) COMMUNITY EDUCATOR – PAIN SYPOSIUM - 10% of course grade

This purpose of this assignment is:• to help you develop your abilities to work within a group• to practice your oral presentation skills, and written communication skills• to explore the current nursing literature and gain knowledge• to experiment with the role of educator

You and your group (total no more than 4) are working at a local hospital and you have been asked to participate in a symposium on aspects of pain and pain management for nurses. You will present some aspect of pain control, pain theory and pain assessment to a mixed group of nurses. SEE LIST OF TOPICS.

You are to provide an oral presentation no longer than 20 minutes along with any handouts, pamphlets, or written material that you believe would reinforce your teaching. Please be dressed in Business Professional clothing, points will be deducted for wearing jeans.

Please provide a reference sheet in APA format that identifies the professional resources that you used to prepare your presentation and hand-out materials.

Here are some things to keep in mind:• Be creative and keep things interesting – yet make your creativity relevant • Make your material appropriate to both the general public and professional nurses.• Use the basic principles of teaching/learning discussed in your texts.• Base your teaching materials in solid research and current literature.

Specifically here is the community educator assignment:a) Choose a group of 4 students.b) Choose a teaching topic on some aspect of pain management, assessment, or physiology from the list c) Submit a short written proposal (no later than September 10 th , 2013) regarding your topic, your group composition, and a plan for how each group member will contribute, and an outline of your teaching strategies. There must be evidence that all members of the group are actively participating in the presentation.

You will present your topic on Tuesday, October 15th Presentations will start at 8 AM and will go until 1:00 PM. Please make arrangements. Refreshments will be provided. This is a dress-up event!

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d) Your grade will be determined in the following manor:

A) application of teaching/learning principles (interesting?) 25%B) accurate and up-to-date information 25%C) effective use of teaching aids, handouts, etc. 25%D) reference sheet and use of current literature 25%

5) TICKETS TO CLASS – Mandatory

On four occasions , or more, you will be required to have completed an assignment in order to attend the scheduled class. Please note the syllabus and the assignment prior to each class. If you have not prepared your assignment (ticket), points will be deducted from your grade (up to a total of 4% of your grade). In addition, it is expected that you complete the required reading each week. These assignments are specifically selected to help you perform better on the exam and apply the critical material.

IN SUMMARY:Examinations 60% of gradeATI Testing and modules 10% of gradePain Symposium Teaching 10% of gradePatho (Case Study) paper 15% of gradeTickets to class 5% of grade

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TOPICAL OUTLINEWeek I Circulatory: IV Therapy Week 2 Circulatory: Fluid balance and electrolyte regulation Ticket (see weekly objectives)

also, select pain topic and group members this week

Week 3 Shock

Week 4 EXAM I Respiratory and Circulatory: Acid- base regulation - ABG’s (see weekly objectives)

Ticket: Analyze the ABG’s listed in your weekly objectives.

Week 5 Endocrine: Diabetes and pancreatic dysfunction

Week 6 Ethics and culture in Nursing Ticket Culture definitions (see weekly objectives)

Ethics definitions (see weekly objectives)

Week 7 EXAM II Community Health and Discharge Planning Home Health Care

Ticket See weekly objectives.

Week 8 PAIN SYMPOSIUM: MARLETTE HALL and plan to stay from 8- 1:00 PM on TUESDAY, October 15th (food will be provided)

PRESENTATIONS Advanced and terminal pain control & Nontraditional pain control methods. TOPICS : 1) Neural mechanisms of pain, 2) Gate theory of pain3) Catagories of pain, (somatic, visceral, etc) 4) Narcotics (include administration methods), 5) NSAIDS 6) Epidural pain relief (be sure to also focus on nursing considerations and role of nurse), 7) Back pain8) Pain assessment techniques across the lifespan,

Alternative pain relief: 9) Acupressure, 10) Guided imagery 11) Culture and the expressions of pain

Week 9 End of life issues HIV / AIDS

Week 10 Respiratory system and associated dysfunctions

Week 11 EXAM III Nervous system and associated dysfunctions

Week 12 Immune system and associated dysfunctions Week 13 Nutrition Day ---- you are expected to go through the practice tests in ATI regarding nutrition

Week 14 Hematopoetic System: Cellular dysfunction – Cancer

Week 15 Male Reproductive system and ear and eye concerns (HEENT)

Week 16 EXAM IV Tuesday, December 10, 2013 ---- 8AM during finals week

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Week 1 Meeting the patient’s/client’s physiological integrity related to parenteral (IV) therapies.

Readings - RequiredFluids & electrolytes made incredibly easy! (2010). (5th ed.) Springhouse, Pennsylvania: Springhouse Corporation. (review).


RecommendedTaylor, C., Lillis, C., & LeMone, P. (2010). Fundamentals of Nursing. The art & science of nursing care (7th ed.). Philadelphia: Lippincott. Find Intravenous Therapy in the index.

Weekly student learning outcomesAt the completion of this unit the student will be able to: I . Explain the functions of the various types of Intravenous equipment

(this objective also involves laboratory content).-in line filters-Tubing

_Drip factors-Blood tubing-Extension tubing

-Needles-Gauges-Types

_Butterfly-Over-the-needle cannula

-Through-the-needle cannula-Solutions

-isotonic-Hypertonic-Hypotonic-Blood and blood components

-Pumps and control devices

-Long term parenteral catheters

2. Using the nursing process, and using effective communication prepare the client for IV therapy-Psychological preparation-Site selection

-Vein dilation

3. Explain the nursing interventions utilized to reduce the risk of complications for the client undergoing IV therapy-Sterile equipment and principles of asepsis-Site preparation and maintenance-Schedule for tubing and solution changes and site rotation

-Use of personal protective equipment

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4. Discuss common clinical signs and behaviors associated with the following complications of IV therapy-infiltration-Phlebitis-Air embolus-Catheter embolism-Circulatory overload-Allergic reactions

5. Identify the nurse's role regarding appropriate precautions and safe administration of the following therapies.-Hyperalimentation-Fat emulsion therapy-Blood and blood components-Plasma substitutes

6. Analyze the nurse's role in providing care for a client with a central venous line, including: -- -insertion-Assessment of the site and client-Patency and site care-Phlebotomy from central lines-implications for home/community care-Alterations in body image-Complications

7. Describe the legal and ethical implications related to the administration of parenteral therapy in terms of the following:-Nurse practice act-Refusal of therapy-Patient assault and informed consent-Ordinary versus extra-ordinary care-Transfusion therapy and the right to privacy-Client injury

8. Compare and contrast the different types of central venous access catheters.

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Week 2 Alterations in fluid balance and electrolyte regulation

Required ReadingsFluids & electrolytes made incredibly easy! (2010). (5th ed.) Springhouse, Pennsylvania: Springhouse Corporation. Read the sections on Fluids, electrolytes (Ch 1-10)

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby. Chapter 17

Ticket to classMake a set of 3x5 flash cards for yourself on each on the electrolytes that we are studying. (#5) Make two cards for each electrolyte. On one side of the card write the electrolyte and the prefix hyper or hypo. On the other side of the card write out the clinical manifestations of the disorder and the typical nursing and medical management for the problem. This is also a good way to learn the ranges of the laboratory value.

Weekly student learning outcomesAt the completion of this unit the student will be able to:

1 . Compare and contrast management issues related to problems in fluid and electrolyte balance.

2. Analyze the pathophysiology related to:-Fluid volume deficit-Fluid volume overload

3. Analyze nursing and associated interventions for patients/ clients experiencing the following:-Dehydration-Water intoxication-Solute loading hypertonicity-Third space syndrome and - Interstitial fluid excess (edema)

4. Predict lab tests that may be ordered for each of the disorders in objective 3.

5. Discuss assessment findings and collaborative interventions indicated for the following: (3X5 Cards)

-hyper and hypokalemia-hyper and hyponatremia-hyper and hypocalcemia-hyper and hypomagnesemia

6. Describe the teaching needs for the client experiencing a fluid and electrolyte disturbance in the following areas:

-Diet-Medication, over the counter interactions, drug interactions

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WEEK 3 --- SHOCK

Required Readings• Review previous reading on fluids, acid-base regulation, transfusions, and IV

therapy.

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby. Chapter 67


1 . Explain the pathophysiology of shock and its effect on physiological integrity.2. Compare and contrast clinical behaviors across the lifespan and associated nursing interventions for

the following stages of shock:-Compensated -Uncompensated-Progressive -Irreversible

3. Predict major physiological stimuli responsible for the major types of shock and explain the pathophysiology related to each and treatment strategies for each:-Hypovolemic -Cardiogenic-Neurogenic -Septic -anaphylactic

4. Evaluate nursing and medical measures to prevent shock development. 5. Explain the promotion and maintenance of health for the client in shock in terms of the following:

-Medical therapy, -Diagnosis, -Independent nursing interventions

- intravenous and blood component therapy 6. Review the functions of the sympathetic and parasympathetic nervous systems and relate their role in the physiologic adaptation of shock states.7. Consider how cardiac function promotes (or detours) physiologic adaptation in shock states in regards

to:-Preload-Afterload-Contractility

8. Predict pharmacologic management for the client in shock, including:-Vasopressors -Vasodilators-inotropic agents -Chronotropic agents-Sympathomimetics

9. Explain advanced assessment techniques utilized for clients with shock and the significance of each:

-Central venous pressure-Pulmonary capillary wedge pressure-Systemic vascular resistance

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EXAM 1

Week 4 Acid/base regulation

ReadingsFluids & electrolytes made incredibly easy! (2010). (5th ed.) Springhouse, Pennsylvania: Springhouse Corporation. 33-44, 179-205. Read chapters related to acid/base.

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby. pp. 500-503

Ticket to classPlease attempt to interpret the following ABG's as either physiologic neutral, acidic or basic and state if you believe it to be caused by a respiratory or metabolic component.

Case 1 Case 2 Case 3 Case 4 Case 5pH 7.4 7.32 7.48 7.2 7.36PaO2 87 130 86 50 58PaCO2 40 32 40 82 68HCO3 24 18 30 23 29


I Explain the adaptive responses associated with each of the following in regards to the regulation of acid-base balance.

-Hydrogen ions-Buffer systems-Respiratory regulation-Renal regulation

2a. Compare and contrast the clinical signs and behaviors of the following acid-base dysfunctions and predict measures to restore health in each.-Respiratory acidosis-Respiratory alkalosis-Metabolic acidosis-Metabolic alkalosis-Mixed disorders (compensation)

2b. Modify the plan of care for clients with the disorders listed in objective 2a.

3. Describe how client teaching can be used to promote client health in acid base imbalances across the lifespan.

4. Discuss the use of client teaching to promote health related to acid-base disorders in the following areas: -Diet

-Medications-Drug interactions -OTC medications

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Week 5 : Endocrine: Diabetes and Pancreatic dysfunction

Readings:Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby.

Read Chapter 49 (Patient with diabetes mellitus)Read Located in chapter 44: (pancreatitis)


1. Review the etiology of Type I and Type 11 diabetes and explain the pathophysiology related to each.

2. Compare and contrast collaborative management of the client with Type I diabetes and Type 11 diabetes including developmental issues.

3. Interpret the following laboratory tests:-Fasting blood sugar-Glucose tolerance test-Two hour post-prandial-Glycosylated hemoglobin

4. Analyze the promotion of health for diabetics in relation to the following:-Client age -Diet-Exercise-Glucose and ketone monitoring-insulin administration-Oral hypoglycemic agents-Client teaching

5. Predict the signs and clinical behaviors of acute hyperglycemia and hypoglycemia and describe the emergency management for each.

6. Compare and contrast diabetic keto-acidosis and non-ketotic hyperosmotic diabetic coma (also known as hyperglycemic hyperosmolar non-ketotic coma).

7. Analyze the potential long-term complications of diabetes.

8. Explain the clinical signs and behaviors associated with pancreatitis and the related pathophysiology.

9. Compare and contrast the nursing and medical management for the client with acute and chronic pancreatitis.

10. Analyze the effect of pancreatitis on other physiologic systems.

11. Discuss the causes, pathophysiology, potential outcomes, and related nursing interventions for the client with pancreatic cancer.

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WEEK 6 Culture ---- Ethics

Readings - Required


(Chapter 2 – Culturally competent care )

Ticket to class:

1. Define the following cultural terms:-Ethnicity-Ethnocentrism-Minority-Stereotyping-Culturally competent care

. 2. Define the following ethical terms:-Autonomy-Paternalism-Nonmaleficence-Beneficence-Justice-Confidentiality-Fidelity

3. Define informed consent and identify the components necessary to assure informed consent.

Weekly student learning outcomes associated with the culture portion of the classAt the completion of this unit the student will be able to: 1. Outline diverse cultural beliefs regarding

i. Family roles in medical and personal decision makingii. Child rearing practicesiii. Death and dyingiv. Nutrition and dietv. Medication

2. Compare and contrast how cultural beliefs affect patient and family interventions and healthcare practices.

3. Delineate the seven steps to developing cultural competence.

4. Examine the current JCAHO guidelines regarding provision of culturally and linguistically appropriate healthcare.

5. Modify methods for working with patients when beliefs may conflict with effective healthcare interventions.

6. Explain what types of cultural information should be put into the patients multidisciplinary plan of care.

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Weekly student learning outcomes associated with the ethics portion of the classAt the completion of this unit the student will be able to:

1. Describe the ethical values of the nursing profession.

2. Apply ethics principles to the scenario offered.

3. Describe the differences between utilitarian ethical theory and deontologic ethical theory.

4. Engage in discussion on the impact and effects of cultural diversity on the health care experience. 5. Evaluate the roles of members of an Ethics Committee.

6. Analyze the processes of and functions of an Ethics Committee.

7. Participate, using role play, on a mock hospital ethics committee meeting, using a scenario based upon a complex ethical premise.

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Week 7 EXAM II

Promotion of client health in the community setting and continuity of careEmphasis on Discharge planning

ReadingsLewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby.

Community Based Nursing – Chapter 6,

Taylor, C., Lillis, C., & LeMone, P. (2010). Fundamentals of Nursing. The art & science of nursing care (7th ed.). Philadelphia: Lippincott.

Ticket to Class Identify the elements of a discharge plan for a hospitalized patient (outcome #10)

Weekly student learning outcomesAt the completion of this unit the student will be able to: I . Describe at least 3 community-based nursing roles.

2. Relate how the nursing process can be used to guide health promotion and disease prevention in:-Home settings-Community settings

3. Compare the 3 stages of disease prevention.

4. Relate understanding of the existence and purpose of the Healthy People 2020 project.

5. Debate factors that may affect continuity of care in the home setting.

6. Investigate the nursing orientation to practice of nursing care delivered outside of an acute care institution, that of a community health nurse, and that of a public health nurse. Make sure to develop a working definition of "community as client."

7. Describe the components of a home care visit.

8. Identify essential components of inter-agency referrals and the nurse's role in providing continuity of care.

9. Debate ethical issues related to efficient and cost-effective care versus extended client need.

10. Describe elements of an effective patient discharge.a. Identify components of a client discharge plan.b. Compare and contrast the role of care maps, critical paths, and

case management in the discharge planning process.c. Predict the collaborative input of other health care disciplines in the

discharge planning process.d. Identify community resources available for clients with the following

issues:-the uninsured client-immobilized or home-bound

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-elderly clients with pulmonary dysfunctionWEEK 8 Pain Symposium

Advanced pain control, Terminal pain control, nontraditional pain control methodsNOTE: 8AM – 1:00 PM on Tuesday, October 15th

Required ReadingsLewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby.

Weekly student learning outcomes: (any of the below may be selected for presentation)At the end of this unit the student will be able to use information literacy skills to integrate research findings that guide best practice decisions for patients experiencing pain.

The student will:1 . Identify the basic neural mechanisms of acute pain and the pathophysiology involved.

2. Explain the Gate control theory of Pain.

3. Discuss in depth types of pain: somatic, (nociceptive pain) visceral (internal organ), neuropathic pain, acute and chronic pain and what treatment modalities work best for each.

4. Describe pain assessment techniques that may be utilized across the life-span.

5. Present the pharmacologic action of narcotic medications (opiods) for pain control.

6. Present the group of medications we call NSAIDS (Non-steroidal anti-inflammatory drugs): their primary actions and side effect.

7. Present the various types of alternative pain control methods including; acupressure, relaxation techniques, herbals, humor and guided imagery. Please demonstrate at least one technique of your choice using the class audience as participants.

8. Present issues related to epidural medication administration, including: -nurse practice issues, -initiation, precautions, medication administration-Assessment-Evaluation-Termination

9. Present issues related to TENS unit use in pain control including:-Client teaching, initiation, testing, stimulus adjustment.

11. Present Interventional Therapies including: Nerve blocks, Neuroablative techniques and Neuroaugmentation.

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WEEK 9

1. End of life issues and ethics of nursing care for clients with complex adaptive dysfunction.

2. HIV/AIDS


Use Index to find topic.


1 Analyze ethical issues related to death and dying-Risk versus benefit-Extraordinary versus ordinary care-Treatment options and accessibility-"gag" rules and implications for the client-Non-traditional therapies

2. Compare and contrast the nurses' role in end of life care in the home setting, hospice, and in an acute care facility.

3. Examine all aspects of holistic nursing care for Persons with HIV or AIDS

4. Apply concepts of cultural awareness, cultural sensitivity and respect for persons when working with persons affected by HIV/AIDS

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Week 10 Alterations in the Respiratory system


Use Index to find topic.

Review and Read* Unit 5 - Problems of Oxygenation I VentilationChapter 26 - Respiratory System Chapter 28 - Lower Respiratory ProblemsChapter 27 -Upper Respiratory Probs Chapter 29 - Obstructive Pulmonary Diseases


1 Compare and contrast the nursing and medical management of clients experiencing

complications related to the following:-Pneumonia (across the lifespan)-Tuberculosis

2. Analyze the following types of lung cancer in terms of location, treatment and prognosis: -Small cell-Oat cell-Adenocarcinoma

3. Examine the causes, clinical behaviors, pathophysiology and treatment related to cancer of the throat.

4. Compare and contrast the nursing management of the client with a tracheotomy and a laryngectomy.5. Plan the client care for safely weaning the patient before discontinuing a tracheostomy.6. Develop a discharge plan for the client with a laryngectomy, including:

-Daily care-Emergency management for problems-Home set up-Nutritional needs-Referrals

7. Explain interventions utilized to promote physical and psychosocial health for the client experiencing head and neck surgery for malignancy.

8. Identify the presence of acute respiratory failure and determine safe emergency airway management. 9. Relate the physiology of the thorax to the mechanical set up of a chest drainage system and predict possible system complications 10. Compare and contrast a chest drainage system and Heimlich valve.11. Evaluate the nutritional needs of clients affected by the

following respiratory disorders:-Pneumonia-Lung cancers-Tuberculosis-The client with a tracheostomy and laryngectomy

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EXAM III -----Week 11

Alterations in the Nervous system


Use Index to find topic.Review chapter 56 (neurology system)Review chapter 58 (client with a stroke) BY TOPIC ONLYRead chapter 57 (intracranial problems)Read chapter 59 (ALS, and seizures)

Ticket to class: Please write a short synopsis of Myasthenia Gravis including treatment(s).

Weekly student learning outcomesAt the completion of this unit the student will be able to: I . Review basic pathophysiology, clinical behaviors, and treatment of seizures in adult and pediatric clients.2. Predict interventions for the client experiencing status epilepticus across the lifespan, including:

-Airway management-Client assessment-intravenous medications for seizures

3. Compare and contrast the clinical behaviors, pathophysiology, and nursing interventions utilized in caring for clients with the following:-Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease)-Guillain-Barre` syndrome

4. Identify the clinical incidence of brain tumors in clients across the lifespan5. Compare and contrast types of brain tumors in terms of prognosis.6. Analyze the effects of cerebral auto-regulation on intra-cranial pressure7. Predict nursing interventions to decrease intra-cranial pressure and identify the rationale for each.8. Anticipate multi-system nursing care needs of the unconscious client including nutritional support.9. Compare and contrast the pathophysiology, behaviors, and treatment for the client experiencing a

hemorrhagic versus a thrombotic or occlusive stroke.10. Identify types of traumatic brain injury.11. Compare and contrast each type of traumatic brain injury (TBI) in terms of: --- pathophysiology

-Clinical behaviors-interventions for the promotion of client health-Client rehabilitation

12. Explore legal and ethical issues related to declaration of brain death.13. Please review Myasthenia Gravis. Write a short synopsis of Myasthenia Gravis including

treatment modalities. You will be required to participate in class and share your knowledge about this topic.

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Week 12 EXAM III

Alterations in the Immune system


Review (altered immune responses – Chapter 14)Read: Chapter 65 (Selected Autoimmune diseases)


1 . Compare and contrast the three major types of immune response and discuss how the immune response develops and changes over time.

2. Review the four types of hypersensitivity reactions and predict the nursing interventions required for each.

3. Assess the clinical behaviors of a client experiencing a systemic anaphylactic reaction and predict emergency management.

4. Identify the five types of immunoglobulins and their physiological behaviors, predict indications for IVIGG (intravenous gammaglobulin) use and identify related client precautions.

5. Analyze the diagnosis, clinical behaviors, pathophysiology and treatment for clients experiencing the following autoimmune disorders:-Systemic lupus erythematosis (SLE)-Progressive systemic sclerosis (PSS)-Rheumatoid Arthritis

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WEEK 13 NUTRITION DAY

NUTRITION: ReadingsLewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I., (2011). Medical surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis: Mosby.

Review and Read* - Chapter 40 (7 th Ed and 8 th Ed)

This weeks ticket to class: The student will complete the 2 Nutrition practice tests on ATI and bring in Certificates of Completion to class.


1. Describe the essential components of a nutritionally sound diet and their importance to good health.

2. Describe the common etiologic factors, clinical manifestations, and management of malnutrition.

3. Describe the carbohydrates, fats and proteins, their specific functions in the human body and the recommended daily allowance of each.

4. Describe the role of fat in heart disease.

5. Be able to state the normal and abnormal triglycerides, and cholesterol levels.6. From a group of foods, select those dietary fats that are best in moderate

consumption, and those that are poor choices.7. Be able to read and interpret a food label.8. Analyze contemporary diet plans.9. Be able to define and recognize medically ordered diets such as: “soft,

mechanically soft, low-residue, and low-protein)10. Be able to make recommendations for the dietary management of specific

disease states (ie. Anemia, constipation, diarrhea, incontinence)11. Explain the various eating disorders.12. Determine the uses for the specific types of medical nutritional formulas (tube

feedings).13. The student will participate in a classroom discussion and determine nutritional values for foods that are

presented in class. The nutritional values are for: 1) calories 2) fat 3) carbohydrates, 4) protein, and 5) fiber This will be turned in to the instructor.

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WEEK 14 -- Cellular alterations resulting in cancer


Read Chapter 16 (Cancer)Read Chapter 30 (Hematologic Systems)Read Chapter 31 (Hematologic Problems)


1 . Review the nurse's role related to diagnostic testing for a client with cellular dysfunction.2. Analyze common laboratory tests performed on clients with cellular dysfunction.3. Predict the nursing and medical management for clients experiencing aplastic anemia.4. Discuss treatment goals for the following phases of chemotherapy:

-Induction -Maintenance -Consolidation5. Debate the safety issues related to chemotherapy administration for both client and nurse.6. Describe pathophysiology, treatment, and nursing care for the client with leukemia (ALL and AML)7. Explore nursing interventions to promote health for clients experiencing the following treatments for hemopoetic malignancies:

-Chemotherapy-Radiation (teletherapy) and brachytherapy-Bone marrow transplant

8. Identify and analyze safety and prioritization requirements when caring for a client receiving brachytherapy.9. Compare and contrast the treatment for polycythemia and thrombocytopenia.10. Identify clients at risk for disseminated intra-vascular coagulation (DIC) and describe nursing and medical interventions needed.11. Explain the pathophysiology, clinical signs, and behaviors associated with disseminated intra-vascular coagulation.12. Predict collaborative interventions employed in the acute management of hemophilia including:

-Developmental issues in the client with hemophilia-Nutritional support-intravenous hydration-Surgical management of hemophiliac clients-Reconstitution and administration of clotting factors (Factor VIII)

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WEEK 15 -- Alterations resulting in bone cancer, visual and auditory problems, and male reproductive problems


Review: Chapter 16 – CancerRead: Chapter 64 – Musculoskeletal from p. 1672 - p. 1676Read: Chapter 21 – Visual and auditory systemsRead: Chapter 22 – Visual and auditory problemsRead: Chapter 55 – Male reproductive problems


1. Describe the types, pathophysiology, clinical manifestations, and collaborative care of patients with bone cancer.

2. Describe the structures and functions of the visual and auditory systems.3. Describe the physiologic processes involved in normal vision and hearing.4. Identify the significant subjective and objective assessment data related to the visual and auditory

systems that should be obtained from the patient.5. Describe the types of refractive errors and appropriate corrections.6. Explain the pathophysiology, clinical manifestations, and nursing management and collaborative care of

the patient with selected extraocular and intraocular disorders.7. Explain the general care of the patient undergoing surgery of the eye or ear.8. Explain the pathophysiology, clinical manifestations, and nursing management and collaborative care of

the patient with selected ear disorders.9. Explain the use, care, and patient teaching related to assistive devices for eye and ear problems.10. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of

benign prostatic hyperplasia.11. Describe the pathophysiology, clinical manifestations, collaborative care, and management of prostate

cancer.12. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of

problems of the penis, scrotum, testes.13. Discuss the nursing management of problems related to male sexual functioning.

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N276: Grading Rubric for Case Study (Patho-Dischage Planning)

Domain Fundamentally Deficient

0

Seriously Flawed

4

Limited

8

Adequate

12

Strong

16

Outstanding

20

Total

Content Fails to present a case study

Shows little success in presenting a case study, essential material missing

Partially presents a case study, missing some material

Adequately presents a case study, presents all material but lacks richness

Strongly presents a case study, little if any material is missing, could be richer

Insightfully presents a case study, rich, deep, material fully addressed

Organization Co-morbidities are seriously disorganized and patient is not central character of Case Study

Co-morbidities lack organization and patient is not the central character in the case study

Co-morbidities may be unclear and poorly organized and patient may or may not be the central character.

Co-morbidities are fairly clear and adequately organized; logical connections are satisfactory and patient is the central character.

Co-morbidities are generally clear and well organized; connections are logical and patient is the central character.

Co-morbidities are very clear, well organized, and logically connected and patient is the central character.

Scholarly Writing with adequate research focus

Development and support of ideas is missing and there is no evidence of incorporating the research

Lacks development and support of ideas and there is no evidence of incorporating the research

Provides inadequate analysis, development and support of ideas; Little emphasis on research literature and not tied to this patient or the patho

Provides adequate support and development of ideas and some research literature is incorporated but poorly tied to the patho or patient

Provides strong development with reason, evidence and analysis with adequate articulation of some related research

Provides excellent development of ideas with reason, evidence and accurate analysis and clear articulation of key research

Discharge Plan is appropriate to the patient audience

Discharge plan lacks any sense of meaning for the patient

Discharge Plan Does not write toward the patient/family audience

Discharge plan target audience is unclear from writing

Demonstrates adequate sensitivity toward intended audience in the discharge plan

Clearly targeting the patient and family in the discharge plan

Demonstrates exceptional sensitivity to the patient and family in the discharge plan

Mechanics and APA format

Lacks meaning due to widespread severe mistakes in grammar, usage, and citation format

Meaning is impeded by many serious mistakes in grammar, usage. Citation format may be missing

Shows less than satisfactory control of language: contains significant mistakes in grammar, usage, may demonstrate serious errors in citation format

Shows satisfactory control of language and APA format: grammar, stylistic variety, citation format; some flaws may occur

Shows solid control of language and APA format: grammar, stylistic variety, citation format; minor flaws may occur

Shows superior control of language and APA format: grammar, stylistic variety, citation format; minor flaws may occur

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