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Philadelphia UniversityFaculty of Nursing

Second Semester 2013/2014

Course Syllabus

Course code: 0911216Course Title: Adult Nursing/ Clinical

Course prerequisite(s) and/or co requisite(s):

0911219/Co-request with adult theoryCourse Level: 2nd year

Credit hours: 3 credit hoursClinical day date: : Monday/Wednesday

8:00am-2:00pm

Name Office number and Location

Office Hours E-mail Address

Dr. Fadwa Alhalaiqa(Course coordinator) 509 3rd floor

Sunday- Tuesday 10-12md

[email protected]

Nisreen Almusallami

3rd floor

Academic Staff Specifics

Course Description: This course is designed to provide nursing students with the skills required to care competently and safely for a wide variety of patients in different specialty areas. Care of adult patients with specific and complex problems will be studied. Nursing process as a mean of maintaining physiological, psychological and socio cultural integrity is applied. Critical analysis of patient's data and responses to nursing interventions are emphasized, communication skills, critical thinking, decision making, psychomotor skills, teaching-learning principles, keeping updated with current literature, and moral principles are emphasized.

Course Objectives: Specify individual learning outcomes you expect students to achieve during the module, using appropriate action verbs (define, demonstrate, analyses, compute, explain design,… etc.) to begin each statement.

At the end of this module, student will be able to: Provide competent and safe nursing care to patients in the following areas: Medical ward, surgical ward,

Recovery room, O.R, burn unit, Orthopedic, Hemodialysis, Neurosurgery, ENT unit. Identify complications either potential or collaborative. Demonstrate teaching abilities. Implement basic concepts from allied sciences and nursing in assisting client to meet their needs. Demonstrate ability to function within a team.

mailto:[email protected]

Demonstrate responsibility for their nursing interventions. Apply ethical standards of the nursing profession in the care of adult clients. Organize time and resources in providing nursing care.

Course Components: Construct a continually modified nursing care plan based on the medical patients changing conditions:

cardiovascular, respiratory, gastro-intestinal tract, endocrine and metabolic disorders, and oncology. Perform physical assessment using auscultation, palpation, percussion and inspection. Assess and record vital signs. Assist the patient undergoing diagnostic procedures: ECG, paracentesis, thoracentesis, blood and urine

specimen. Provide nursing intervention according to the individualized patient's needs. Provide basic comfort measures: positioning and bed making, turning, lifting, ambulation, elimination,

hygienic measures, safe environment. Perform therapeutic procedures according to patient's needs: pressure ulcer care, gavages feeding,

suctioning: or pharyngeal, naso-gastric, oxygen therapy, tube irrigation, catheter care, rehabilitative measures and precaution: chest physiotherapy, exercises, positioning with rehabilitative devices.

Administer oral and parenteral medication following the five rights and principles of asepsis. Identify signs of medication toxicity. Provide special care for: cancer patients, AIDS patients, immobile patients, Prepare a balanced plan for fluid & nutritional intake. Record and or report essential data pertinent to patients and nursing intervention.

Text Book(s) and Supporting Materials:1- Title: Nursing proceduresAuthor(s): Baranoski et al 2006 Publisher: Lippincott Williamas and Willkins, 6thed.ISBN: 1-58255-281-92- Clincal Nursing skills and techniques, 5th edition. Perry Potter.3- Mosby’s Pharmacology for Nurses 4- Nursing diagnosis application to clinical practice. 14th edition, by Lynda Juall Carpenito. Publisher: Lippincott Williamas and Willkins. - In addition to the above, the students will be provided with handouts by the lecturer.

Teaching Methods:

1. Clinical experience in medical, surgical and therapeutic settings2. Skill laboratory3. Pre and post clinical conferences.4. Case study and care plans5. Case presentations and group discussions6. Practice with medication kardex systems.7. Participate in doctors or nurse rounds

Learning Outcomes: Knowledge and understanding

-Obtain a concise patient historyObtain and label routine specimen.Prepare a balanced plan for fluid & nutritional intake.Recognize the need to view client as a holistic beings

Cognitive skills (thinking and analysis).

- Interpret results of diagnostic procedures and laboratory findings- Work according to priorities.

Communication skills (personal and academic).- - Provide health teaching to patients and their families.

- Provide psychological care to patients and their families

Practical and subject specific skills (Transferable Skills).- Provide special care for patients with orthopedic problems, renal problems, neurosurgery, cancer patients or burn injury

Course EvaluationModes of Assessment:

Modes of Assessment:ScoreExpected Due Date1.Clinical Performance Evaluation: Two Evaluations/ semester (Mid Term and Final)

) See Appendix A(

30Done each 5 weeks

2. Daily Work sheet: 3 / Semester (See Appendix B)5To be assigned throughout the course

3. Case Presentation:(See Appendix C)

10

Lab quiz5Focused Nursing care plans(See Appendix D)10Total60

Final Assessment (40%)

Final clinical practicum (OSCE)30Final clinical written10Total100

Attendance Policy: (Example to be adopted & modified.)Absence from lectures and/or tutorials shall not exceed 15%. Students who exceed the 15% limit without a medical or emergency excuse acceptable to and approved by the Dean of the relevant college/faculty shall not be allowed to take the final examination and shall receive a mark of zero for the course. If the excuse is approved by the Dean, the student shall be considered to have withdrawn from the course.

Documentation and Academic Honesty (Example to be adopted & modified.)Submit your home work covered with a sheet containing your name, number, course title and number, and type and number of the home work (e.g. tutorial, assignment, and project).

Any completed homework must be handed in to my office (room IT…) by 15:00 on the due date. After the deadline “zero” will be awarded. You must keep a duplicate copy of your work because it may be needed while the original is being marked.

You should hand in with your assignments:1- A printed listing of your test programs (if any).

2- A brief report to explain your findings.3- Your solution of questions.

Protection by Copyright (Example to be adopted & modified.)1. Coursework, laboratory exercises, reports, and essays submitted for assessment must be your own work,

unless in the case of group projects a joint effort is expected and is indicated as such.2. Use of quotations or data from the work of others is entirely acceptable, and is often very valuable provided

that the source of the quotation or data is given. Failure to provide a source or put quotation marks around material that is taken from elsewhere gives the appearance that the comments are ostensibly your own. When quoting word-for-word from the work of another person quotation marks or indenting (setting the quotation in from the margin) must be used and the source of the quoted material must be acknowledged.

3. Sources of quotations used should be listed in full in a bibliography at the end of your piece of work.

Avoiding Plagiarism. (Example to be adopted & modified.)1. Unacknowledged direct copying from the work of another person, or the close paraphrasing of somebody

else's work, is called plagiarism and is a serious offence, equated with cheating in examinations. This applies to copying both from other students' work and from published sources such as books, reports or journal articles.

2. Paraphrasing, when the original statement is still identifiable and has no acknowledgement, is plagiarism. A close paraphrase of another person's work must have an acknowledgement to the source. It is not acceptable for you to put together unacknowledged passages from the same or from different sources linking these together with a few words or sentences of your own and changing a few words from the original text: this is regarded as over-dependence on other sources, which is a form of plagiarism.

3. Direct quotations from an earlier piece of your own work, if not attributed, suggest that your work is original, when in fact it is not. The direct copying of one's own writings qualifies as plagiarism if the fact that the work has been or is to be presented elsewhere is not acknowledged.

4. Plagiarism is a serious offence and will always result in imposition of a penalty. In deciding upon the penalty the Department will take into account factors such as the year of study, the extent and proportion of the work that has been plagiarized, and the apparent intent of the student. The penalties that can be imposed range from a minimum of a zero mark for the work (without allowing resubmission) through caution to disciplinary measures (such as suspension or expulsion).

Course policy1. Demonstration of safety criteria by the student enables her/ him pass in the course and prevents unsafe

practices that compromise patient’s life.2. According to the university regulations, absenteeism for 10% will result in an absenteeism warning

letter.3. Absenteeism of 15% of the course in the semester will not qualify the student to attend the final

examination on the basis of absenteeism failure notice. 4. Compulsory attendance for all the in-course and final assessment evaluations and examinations. The

examinations will not be postponed for the student without any emergency reasons or medical certificates.

5. Students who are not prepared for the clinical experience during any clinical days should meet the clinical instructor personally for the required.

6. Non-adherence to complete student uniform, attendance, punctuality and professional behaviors will affect the clinical evaluation and total grade.

7. Students who remain absent for the clinical days should meet the Course Co-ordinator. Those who are sick will produce a medical certificate certified by the UniversityHealthCenter or any MOH and submit it to the respective clinical instructors.

8. Complete all the learning experiences depending on the feasibility in the unit.

Clinical Guidelines

1. By the end of the semester each student should have two clinical evaluation

2. At the end of each clinical day, post conference will be conducted in order to discuss clinical focus topics.

3. Each student should be prepared for post conference topics.

4. Students will be assigned to discuss specific topics with his clinical instructors and colleagues.

5. Each student should use nursing process as a framework for patient care.

6. Each student should accurately obtain health history and physical exam findings using proper medical terminology for his assigned patient.

7. At the end of semester students should attend a final written and clinical exam. Objective Structural Clinical Examination (OSCE) will be used as an evaluation tool for the clinical practicum exam. This exam will be given at the end of the course, utilizing simulated environment for evaluation of knowledge, data gathering skills (history), technical skills (physical exam) and psychomotor skills. It includes a minimum of three (3) stations.

8. Each student should prepare and distribute the medication for his/her assigned patient under supervision of clinical instructor.

9. student are required to know the medication ordered for his/her patient why they were ordered, dosage, side effect, and are able to correctly calculate the doses.

10. When administering medication remember Five Rights of Medication Administration

11. A clinical lab with common psychomotor skills for this course will be conducted at the beginning of semester.

INSTRUCTIONS FOR STUDENTS

1. Student should be present in clinical area from 9:00am - 1:30pm and clinical attendance will be maintained by clinical instructors. The bus will leave at 8:00 am. Students who miss the transport will be responsible for their own transport arrangement.

2. All pocket articles, stethoscope, and clinical requirement formats should be carried by the students without fail.

3. Attend doctors and nurses’ rounds for your patients in the unit.

4. Identify the nursing procedures, demonstrate the procedures to the clinical instructor

5. Maintain the break timing (30 mins: 10:30 – 11:00 AM) appropriately.

6. Students should complete the total credits and be present for their contact hours for the entire Clinical course including the exam days (16 hours/week for 15 weeks).

7. Attendance starts on the orientation day until the last day of clinical posting and all the days of the examination.

8. Any problems during the posting should be informed to the Clinical Instructor and the Course Co-ordinator for smooth interactions.

9. Be present for the clinical evaluation and examination conducted during the posting.

10. Timely submission of weekly assignments and care plans.

11. Write one drug every week and submit at the end of each week to the Clinical Instructor.

12. Students are expected to complete one case presentation, and total of 4 daily work sheets in the clinical course and one Focused Care Plan.

13. Students are to strictly adhere to the presentation dates for CP; Work Sheets, and FCP. failing to which the student will be awarded zero score.

14. Students will be given a Warning Notice after 5% absenteeism.

15. Absenteeism of 15% in the clinical course in a semester will not qualify the student to attend the final examination on the basis of Absenteeism Failure Notice.

16. Be responsible and accountable for your professional action and safety practices. Refer Unsafe Practice Criteria.

17. Maintain professional nursing standards while providing care to the patients. 18. Adhere to the Jordanian Nursing and Midwifery Code of ethics and conduct.

UNSAFE PRACTICE CRITERIA

Unsafe practices that compromise patient’s life is defined as any action threatening or jeopardizes patient’s life.

1. Error in patient identification.2. Omission of any of the 5 rights of medication, lack of knowledge regarding action or effects of

medications and medication administration error. 3. Lack of aseptic technique while handling central lines, while taking care of immuno-compromised

patients, repeatedly contaminating lines, avoiding hand washing.4. Leaving patients unattended, e.g. unconscious patients, disabled patients, disoriented, neurological

conditions.5. Causing environmental hazards that jeopardize patient’s safety and excessive property damage such as

fire, lack of infection control, causing patient’s fall.6. Error in communicating significant information in documentation/ reporting.7. Unsafe handling of equipments, syringe pump, lifesaving equipments.8. Unsafe and improper handling of sharps and needles.9. Omission of major scientific steps in nursing procedures, e.g. not checking nasogastric tube placement

before each feeding, not checking pulse, BP, and blood sugar as required.10. Negligence or threatening patient’s life while on oxygen therapy, suctioning, vital signs etc. 11. Any other activity that is not listed above and evaluated or judged as unsafe by the Clinical Instructor’s.

ETHICS AND PROFESSIONALISM

During clinical postings while caring for patients the student nurses should maintain professional standards and appropriate behavior. Students are expected to adhere to the Jordanian Nursing and Midwifery Council code of ethics and nursing standards of care. These behaviors are evaluated during the ongoing clinical performance and exit examinations.

Examples of some of the behaviors to be seen in a student are:

1. Shows caring and empathy 2. Shows genuine concern and is helpful3. Shows confidence and competence4. Is reliable and dependable5. Is accountable and responsible 6. Uses critical thinking and problem solving 7. Accepts corrections and improves performance 8. Takes initiative and identifies limitations 9. Adhere to safety principles and hospital policies 10. Follows critical elements during the procedures 11. Builds rapport and healthy communication 12. Improves professional and interpersonal relationship 13. Pleasant general appearance and behavior14. Maintains attitude and professional etiquettes 15. Maintains discipline 16. Professional nursing standards of care 17. Maintains Code of dress 18. Adheres to Code of ethics (JNMC)

Jordanian Code for NursesJordanian Code for Nurses, first published in 1996, describes the primary goals, obligations, duties, and values of nursing profession. It shapes and defines the commitments that nurses make to patients and the public. The following are major principles:

The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

The nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature.

The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person.

The nurse assumes responsibility and accountability for individual nursing judgments and actions. The nurse maintains competence in nursing. The nurse exercises informed judgment, uses individual competence and qualifications as criteria in

seeking consultation, accepting responsibilities, and delegating nursing activities to others. The nurse participates in activities that contribute to the ongoing professional knowledge development. The nurse participates in the profession's efforts to implement and improve standards of nursing. The nurse participates in the profession's efforts to establish and maintain conditions of employment

conductive to high quality nursing care. The nurse participates in the profession's efforts to protect the public from misinformation and

misrepresentation and to maintain the integrity of nursing. The nurse collaborates with members of the health professions and other citizens in promoting

community and national efforts to meet the health needs of the public.

Course Academic Calendar

ORIENTATION SCHEDULE-SECTION Week 1; Day: 1 –– Monday

Date and time Topic 8:00-8:45amIntroduction to the clinical course and outline Dr. Fadwa8:45-10amNursing process Dr. Fadwa10:00-10:30am Break 10:30-11:45amPin-site care and dressing

Cast and traction Miss. Nisreen

11:45-1:15pmECG O2 therapy

Dr FadwaMiss NisreenDay: 2 – Wednesday

Date and time Topic 8:00-8:45amDrug calculation Dr Fadwa8:45-10amIV fluid (administration, calculation, monitoring and

management).NGT

Miss Nisreen

10:00-10:30am Break 10:30-11:45amCannula insertion: monitoring, complication and

management), samplingMiss Nisreen

11:45-1:15pmBlood extraction and transfusionDr FadwaWeek 2; Day: 3 Monday

Date and timeTopic8:00-9:00amInfection controlMiss Nisreen9:00-10amVideo show of assessment of : cardiac, respiratory10:00-10:30amBreak10:30-11:45amVideo show of assessment of: musculoskeletal and

neurology11:45am-12:10Lab quiz

Week and date Assignments and quizzes (2)27/10/2014Lab quiz(3)3/11/2014Hospital training and evaluation(4)10/11/20141st Daily work sheet(5) 17/11/2014Clinical performance evaluation(6)24/11/2014Med term examination(7)1/12/20142nd Daily work sheet(8)8/12/2014Hospital training and evaluation(9)15/12/2014Focused nursing care plan (draft)(10)22/12/2014Hospital training and evaluation(11)29/12/20143rd Daily work sheet(12)5/1/2015Focused nursing care plan (marked)(13)12/1/2015Clinical performance evaluation(14)19/1/2015Final clinical practicum (OSCE)(15)25/1/2015Final clinical written

Clinical Objectives

On the completion of the course, the nursing students will achieve the following objectives in the specialty areas (Ortho, Renal Unit, Surgical and Medical units):

1. Use nursing process as a framework in providing nursing care to patients with potential or actual health alterations in the selected body systems / organs

2. Demonstrate competency in performing focused health assessment to patients experiencing potential or actual health alterations with respected to selected body systems / organs (cardiovascular, neurological, orthopedic, immune, hematology, endocrine, respiratory and renal)

3. Identify health care needs (physiological, psychological, social and spiritual responses to acute or chronic health alterations) of patients experiencing potential or actual health alterations in the selected body systems / organs

4. Identify the learning needs of patients and families experiencing potential or actual health alterations in the selected body systems / organs

5. Integrate knowledge from nursing, medical, and psychosocial sciences to provide scientific-based nursing care to patients experiencing potential and actual health alterations in the selected body systems / organs and their families

6. Set appropriate health outcomes to evaluate the effectiveness of nursing care provided7. Show knowledge of medications used for health alterations in the selected body systems /

organs and ensure safe and accurate administration of these medications8. Show awareness of the clinical unit’s policies and regulations9. Demonstrate competency in performing nursing skills / procedures relevant to care of

patients experiencing potential or actual health alterations in the selected body systems / organs

10. Demonstrate effective communication skills when interacting with patients, families, peers, instructors, and other health care providers

11. Show collaboration skills with interdisciplinary health care teams in provision of health care

12. Use time effectively and efficiently in completing nursing care required and course-related assignments.

13. Practice within legal and ethical standards established by JNMC14. Show responsibility for one’s own actions and safe practice 15. Show information seeking behavior

Objectives of the clinical posting: Medical Ward

On completion of posting in medical ward the students will be able to:

1. Perform neurological and cardiovascular assessment for their assigned patients.

2. Use nursing process as a framework for comprehensive care of patient

3. Perform special nursing needs of patients with varied dysfunction.

4. Teach relevant aspects of rehabilitation to their patients.

5. Write a focused nursing care on a patient with cardiac or neurological disorder.

Skill checklist: Medical Ward

No Nursing skills Observe Assist Perform (Initials & Date)1 2 3

1. Assessment of Neurological system2. Assessment of Cardiovascular

system3. Tracheostomy care4. Nasogastric feeding5. Medication Administration

Oral medication Subcutaneous injection Intramuscular injection Intradermal injection

6. Focused Nursing care plan7. Home care of patients with Cardiac

disorder8. Home care of patients with

neurological disorder9. Special Procedures

Name of Clinical Instructor:

Signature with Initials: Date:

Objectives of the clinical posting: Surgical ward

On completion of posting in surgical ward the students will be able to:Preoperative Nursing

1. Perform Pre-operative health assessment of the patients to identify the health problems that increase surgical risk.

2. Identify the causes of preoperative anxiety and describe nursing measures to alleviate it.3. Prepare patient for surgery with legal and ethical considerations.4. Implement a pre-operative teaching plan designed to promote the patient’s self care during recovery

period that prevents post operative complications.5. Demonstrate preoperative nursing interventions like maintaining preoperative record, assisting in

administering pre-anesthetic medication and transporting patient to operating room. Post Operative Nursing

1. Perform essential nursing assessment and nursing interventions during the immediate post-anesthetic phase.

2. Demonstrate ongoing nursing assessment and interventions for the post operative clients.3. Identify early and late post operative complications and describe nursing interventions to prevent them.4. Demonstrate post operative dressing technique.5. Performs specialized procedures like dressing6. Identify patient education needs and develop education plan including discharge plan.7. Write a focused nursing care on a patient undergoing a major surgery

Skill checklist: Surgical wardNo Nursing skills Observe Assist Perform (Initials & Date)

1 2 31. Surgical hand washing2. Preparation of surgical bed3. Preoperative care4. Postoperative care5. Intramuscular injection6. Subcutaneous injection7. Surgical dressing8. Removal of sutures/clips9. Focused Nursing care plan10. Home care education11. Special Procedures



Objectives of the clinical posting: Orthopedic unit

On completion of posting in orthopedic unit the students will be able to:

1. Gather relevant history and perform assessment of musculoskeletal system on patients with orthopedic problems.

2. Plan and execute nursing care to patients with various types of traction ensuring the principles of effective traction.

3. Plan and implement nursing care to patients with internal and external fixators using nursing process as a framework.

4. Plan and implement nursing care to patients undergoing orthopedic surgery.5. Monitor for and prevent complication of immobility.6. Incorporate selected concepts of rehabilitation, such as exercise and nutrition while nursing patients with

musculoskeletal dysfunction.7. Educate patient on home care

Skill checklist: Orthopedic unit

No Nursing skills Observe Assist Perform (Initials & Date)1 2 3

1. Assessment of musculoskeletal system

2. Dressing of orthopedic woundsOpenPost-opWith external fixator

6. Assisting in application of skin traction

7. Assisting in application of cast and splint

8. Pre and post operative nursing care9. Care of patients with skin traction10. Care of patients with skeletal

traction11. Focused Nursing Care Plan12. Home care of patients 13. Special Procedures



Appendix AEvaluation criteria of clinical performance of the students

PHILADELPHIA UNIVERSITY

COLLEGE OF NURSINGADULT HEALTH NURSING /CLINICAL (0911216)

Evaluation criteria of clinical performance of the students

Guidelines Your clinical performance and behavior will be evaluated using the designed criteria below The evaluation is be based on the instructor daily observation of your behavior and performance in the

assigned clinical setting; a formal evaluation will be at the end of each 5 weeks Ensure understanding of each criterion before starting your clinical activities; ask your instructor to

clarify and ambiguous item Your behavior / performance will be evaluated using this Likert-type scaleStudents’ behavior will be assessed during each interaction throughout the course and feedback will be provided on an ongoing basis. Based upon patterns of observed behavior, using the four-point scale described below.

4 = ExcellentPerforms safely and accurately without supportive cues.Assumes responsibility of behavior with initiative and in aself-directed manner.Synthesizes appropriate data and knowledge.

3 = Very GoodPerforms safely and accurately with minimal supportive cuesAssumes responsibility of behavior; frequently takes initiative.Synthesizes appropriate data and knowledge with some assistance.

2 = SatisfactoryPerforms safely and accurately; requires frequent supportive cues.Assume responsibility of behavior; occasionally takes initiative.Synthesizes appropriate data and knowledge with frequentassistance.

1 = ProvisionalPerforms safely and accurately only with supervision.Assumes responsibility; lacks initiative.Synthesizes appropriate data and knowledge only with assistance.

Student Name: ID. No:1234

Criterion

Nursing process, Knowledge and Critical thinking (7) Collect relevant information about the assigned case using history-taking,

physical exam, diagnostic procedures and lab tests Identify physiological and psychosocial health responses of the patient and

family (nursing diagnoses) to health alterations experienced Prioritize nursing diagnoses Integrate knowledge of Basic sciences( Anatomy, Physiology) in practice Shows knowledge of action and side actions of medications used used in

the management of health alterations in the selected body systems/organs Interpret findings of common diagnostic procedures and lab tests Shows organized thought process

Communication, Ethics and Values (3) Demonstrate caring approach during patients’ care Displays respect to patients’ values and beliefs Collaborate with health care providers in providing care to the patients

Professionalism (6) Show knowledge of ethical standards established by JNMC Show knowledge of the clinical settings’ policy and regulations Shows organization of the activities of the clinical day using the time

effectively Accepts criticism positively Ensure safe practice Asks relevant questions

Intervention/ Nursing Care (6) Implement specific nursing interventions at the bedside. Nursing interventions are individualized based on patient’s current needs Provide patient teaching interventions based on identified needs. Nursing interventions are based on up to date knowledge. Rationales are scientifically correct. Evaluates patient response to the interventions

Professional behaviors in the clinical course (3) Punctual Complete uniform Show respect to instructors and peers

Name and Signature of the Clinical Instructor: Date:



Second Semester 2014

CLINICAL PERFORMANCE EVALUATION: STRENGTH AND WEAKNESS

Name of the student: ID No:

Unit: From / / To / /

Strengths:

Areas that need improvement:

Signature of the Student Name and Signature of the Clinical InstructorDate: Date:

Appendix B

The Daily worksheet

Philadelphia University

Faculty of Nursing

The Daily worksheet

Background Data: 7 POINTSStudent Name: ________________________ I. D. No: Date: ______________________________ Room/ Bed: Admission Date: ____________________Medical Diagnosis: Surgical Procedure: ____________________ Date of Surgery Diet: _____________________________ Activity Limitations: I. V. Therapy : ____________________________________________________________________

History (Chief complaints on admission, present illness, significant events, and focus of the care): 10 POINTS________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Significant Findings of Physical Assessment: (include normal and abnormal): 10 POINTS______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Medications: (Name, dose, frequency, route, classification, nursing consideration) 5 POINTS

Name Classification Action Side Effect Nursing Consideration

Laboratory tests: 5 POINTS

Name of test Results Interpretations

Diagnostic procedures: 3 POINTS

Name of Procedure Findings Interpretations

S: 8 POINTS _____________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________

O: 8 POINTS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D: 6 POINTS

1.

2.

3.

P: 8 POINTSGoal___________________________________________

Objective________________________________________

Goal ________________________________________________

Objective___________________________________________

Goal___________________________________________

Objective_________________________________________

Interventions: 15POINTSRationales:5POINTS

E:10 POINTS1. ______________________________________________

2._________________________________________________

3.______________________________________________________

Appendix CCASE PRESENTATION



Second Semester 2014

CASE PRESENTATION

CASE PRESENTATION – GUIDELINES

1) Each student will conduct one case presentation at patient bed side as per the schedule given.

2) Case presentation will be for 20 minutes duration and 5 minutes for group discussion.

3) Case presentation should be according to the given format/guidelines.

4) Evaluation criteria are attached with the guidelines.

Case presentation will be 10% of the in course assessment

Case Presentation Evaluation Criteria

The patient assigned for nursing case round presentation must be different from the patient assigned for focused nursing care plan. The case presentation will be evaluated according to the following criteria.

1. Background: 2% States patient profile States health history: Chief complain Health habits Past health history States significant abnormal physical examination findings States the significant diagnostic procedure

2. Assessment: 2.5% Assessment includes subjective data that establishes the nursing diagnosis. 0.5 Assessment includes objective data that establishes the nursing diagnosis. 0.5 Assessment data reflects patients’ current health problem. 0.5 knows all relevant laboratory and diagnostic tests and their rational. 0.5 knows all medications, actions, implications, and rational for taking. 0.5

3. Nursing Diagnosis 1.5% Nursing diagnoses are derived from subjective & objective data. 0.5 Nursing diagnoses are prioritized. 0.5 Nursing diagnoses are stated in appropriate terminology. 0.5

3. Planning: 2% States objectives that are measurable, observable, applicable, and reflect the stated nursing

diagnosis Objectives must include cognitive, affective, and psychomotor domain

4. Implementations: 5% Implement/evidence that specific nursing interventions at the bedside.1 Nursing interventions are individualized based on patient’s current needs1 Provide/Evidence that patient teaching interventions that are based on identified needs.1 Nursing interventions are based on up to date knowledge.1 Rationales are scientifically correct.1

5. Evaluation: 1%Evaluations patient response to your interventions and whether your goals were met.1

6. Documentation: 1% Documentation of interventions or patient response to interventions 1 (for example document giving pain

medications and patient response to after giving medication)

Evaluation sheet of Patient Case Presentation 10%Student name:-……… ……………………………………. Student NO:-………………………..

Items of EvaluationGradeallotted

Gradeacquired

Comments

Background: States patient profile States health history: Chief complain Health habits Past health history States significant abnormal physical examination findings States the significant diagnostic procedure

2

Assessment: subjective data objective data. Assessment data reflects patients’ current health problem knows all relevant laboratory and diagnostic tests and

their rational. Knows all medications, actions, implications, and rational

for taking.

2.5

Nursing Diagnosis Derived from subjective & objective data. prioritized. Stated in appropriate terminology.1.5

Planning: measurable, observable, applicable, and reflect the stated

nursing diagnosis cognitive, affective ,and psychomotor domain

2

Implementations: Implement/evidence that specific nursing interventions at

the bedside. Nursing interventions are individualized based on

patient’s current needs Provide/Evidence that patient teaching interventions that

are based on identified needs Based on up to date knowledge Rationales are scientifically correct

5

Evaluation: 1%1Documentation: 1% 1

Total score10

Instructor signature & date: ..............................................Guide lines for Health History

Use the following format to complete health history for all your assignments this semester.

1. Current health statusA. Admission chief complaints

B. History of the present illness.

2. Health Habits:A. Smoking: (include No. of cigarettes/ day)B. Alcohol: (include amount/ day)C. Legal and illegal drugs (include type, amount, rout and rational)D. Seat belt E. Regular Exercises (include type duration)F. Dietary practices (include preference, considerations, and restrictions)

3. Past health history:A. Parental and birth history.B. Problems in growth and development.C. Common childhood illnessD. Immunizations.F. Past hospitalizations.G. Serious accidents, injuries, illnesses, and treatments

4. Environmental factors:A. Income (include other income resources specifying source and amount)B. Marital status (if married include No. of children, their ages, sexes, and occupations)C. No. of people living in the same household.D. Primary care providers.E. Job satisfaction/ concernsF. Marital satisfaction/ concerns.

Guidelines for Review of Body Systems

Use the following format for review of body systems to complete all your assignments:

GENERAL:

[ ] Recent weight changes.[ ] Fever/ chills.[ ] Malaise/ general weakness.[ ] Mood changes

SKIN, HAIR, AND NAILS:

[ ] Rashes[ ] Lesions[ ] Itching[ ] Color change[ ] Dryness[ ] Brittle nails[ ] Cracking[ ] Others

HEAD:

[ ] Headache[ ] Seizure[ ] Fainting[ ] Head injuries[ ] Dizziness

EYES:[ ] Changes in vision[ ] Blindness[ ] Cataract[ ] Diplopia[ ] Redness[ ] Pain[ ] Photophobia[ ] Glasses (last exam date and results)[ ] Contact lenses (type)[ ] Glaucoma[ ] Drainage[ ] Infection[ ] others

EARS:

[ ] Difficulty in hearing/ deafness[ ] Tinnitus[ ] Vertigo[ ] Infection[ ] Discharge[ ] Others

NOSE AND SINUSES:

[ ] Nasal stuffiness

[ ] Frequent colds[ ] Hay fever[ ] Nose bleeds[ ] Sinus troubles/ infection

MOUTH, PHARYNX, AND NECK:

[ ] Bleeding from gums/ teeth[ ] Oral infection[ ] Dental problems[ ] Dentures (last exam, time and results)[ ] Hoarseness[ ] Swelling in neck[ ] Frequent sore throats[ ] Lumps in neck[ ] Dysphagia[ ] Stiffness in neck[ ] other

BREASTS:

[ ] Prurutus, pain, lumps[ ] Nipple discharge[ ] Dimpling of skin[ ] Enlargement (gynecosmastia)[ ] Performance of self breast exam[ ] Mammograms (date, results)[ ] Steroids[ ] others

LUNGS:

[ ] Shortness of breath[ ] Dyspnea on exertion[ ] Orthopnea[ ] Pain with respiration[ ] Cough[ ] Sputum (color, frequency, quantity)[ ] Hemopteysis[ ] Wheezing[ ] Cyanosis[ ] Pneumonia[ ] Bronchitis[ ] Emphysema[ ] Asthma[ ] TB test (results and date)[ ] TB exposure[ ] Chest X-ray (date and results)[ ] others

HEART:

[ ] Heart troubles[ ] High blood pressure[ ] Heart murmurs[ ] Paroxysmal nocturnal dyspnea[ ] Chest discomfort/ pain[ ] Palpitations[ ] Syncope[ ] Rheumatic fever[ ] Coronary Artery disease[ ] Heart attack[ ] ECG (results and dates)[ ] Other heart tests[ ] Others

PERIPHERAL VASCULAR:

[ ] Edema[ ] Swelling/ pain calves[ ] Pain/ ulcerations or discoloration of extremities[ ] Cramps[ ] Varicose veins[ ] Others

GASTROINTESTINAL:[ ] Nausea[ ] Vomiting[ ] Hematemesis[ ] Indigestion/ heart burn[ ] Abdominal pain[ ] Jaundice[ ] Hepatitis[ ] Melena[ ] Clay colored stools[ ] Incontinence of stool[ ] Diarrhea[ ] Change in bowel habit[ ] Constipation[ ] Hemorrhoids[ ] Excessive gas[ ] Hernia[ ] Ulcer[ ] Gall bladder stone/ colic[ ] Pancreatic disease[ ] Others

URINARY:[ ] Frequency[ ] Urgency[ ] Infection

[ ] Dysuria[ ] Nocturia[ ] Hematuria[ ] Stream site and force[ ] Hesitancy[ ] Incontinence (stress, urge, dribbling)[ ] Others

MALE GENITALIA:[ ] Discharge[ ] Genital lesions[ ] Testicular pain/ mass[ ] Syphilis positive serology[ ] Gonorrhea[ ] Sexual problems[ ] Others

FEMALE GENITALIA:[ ] Vaginal discharge[ ] Pruritis[ ] Genital lesions[ ] Painful intercourse[ ] Post menstrual bleeding[ ] Post coital bleeding[ ] Pap smear (results, dates)[ ] Other

ENDOCRINE:[ ] Heat and cold intolerance[ ] Thyroid problems[ ] Neck Surgery[ ] Diabetes

HEMATOPOIETIC:[ ] Abnormal bleeding/ bruising[ ] Anemia[ ] Transfusions[ ] Leukemia[ ] Blood type[ ] Others

SPINE AND EXTREMITIES: MUSCOLOSKELETAL[ ] Arthritis[ ] Joint stiffness[ ] Joint swelling[ ] Joint pain[ ] Muscle weakness[ ] Muscle cramps[ ] Backache[ ] Limited ROM[ ] Others

SPINE AND EXTREMITIES: NEUROLOGICAL[ ] Paresthesia/ numbness[ ] Paralysis[ ] Incoordination[ ] Disturbed balance[ ] Fainting (LOC)[ ] Blackouts[ ] Tics[ ] Tremors[ ] Spasms[ ] Others

PSYCHIATRIC (Problems in the following areas):[ ] Spouse[ ] Family[ ] Peers[ ] Insomnia[ ] Depression (interfering with ADL’s)[ ] Anxiety interfering with ADL’s)[ ] Mood swings[ ] Delusions[ ] Hallucinations[ ] Eating, sleeping, memory problems[ ] Others

Guidelines for Physical Assessments

Use the following format to conduct and record results of physical examination for all assignments:

1. GENERAL:Statement to include observed state of health, posture, appearance, body odors, manner, affect, signs of distress, speech, and level of awareness.

2. VITAL SIGNS:Temp, Pulse, BP, Resp, Height, and Weight.

3. NUTRITION:Nutritional problems :-Anorexia,Nausea, Chewing difficulty, Dysphagia,Polydepsia, Polyphagia Anthropometric measurements:-Weight:- ……….. Height:- ……………

Body mass index =Weight ( in kilograms) ----------------------------- = --------------------- = Height (in meters)2

Underweight □ Overweight □ Obesity □ Extreme obesity □

Describe diet Determine energy requirements as follows:Body weight in Kg X 35 KcalDetermine fluid requirements as follows:Body weight in Kg X 35 ccNote: Increase calories 7% and fluids 125cc for each 1 F increase in temp.

4. MENTAL STATUS:Record a statement about the observation of appearance, behavior, mood, thought process, thought content, perceptions, and cognitive functions.

5. SKIN:Note color, temp., texture, moisture, presence of lesions, mobility, turgor, and describe appearance of nails.

6. HEAD:Describe hair, scalp, skull, and results of cranial nerves testing.

7. EYES:Report visual acuity, appearance of eyebrows, eyelids, eyelashes, lacrimal apparatus, sclera, cornea, conjunctiva, corneal light reflection, Pupillary light response, extra occular muscle movement, accommodation, peripheral vision.

8. EARS: Record result of inspection, palpation of the outer ear, hearing acuity, whisper test

9. NOSE AND SINUSES:Report description of the external nose, nasal mucosa, septum, presence of tenderness, transillumination.

10. MOUTH AND PHARYNX:Record description of observation of lips, buccal mucosa, gums, teeth, roof of the mouth, tongue, pharynx, movement of uvula, gage reflex

11. NECK:Note palpation of lymph nodes, thyroid gland, and position of trachea, presence or absence of masses.

12. PERIPHERAL VASCULAR:Record peripheral pulses, capillary refill, edema, skin temp., and enlarged nodes in lower limbs.

13. THORAX AND LUNGS:Record results of inspection, palpation, and auscultation of lungs. Note diaphragmatic excursion.

14. HEART:Record results of inspection, palpation, and auscultation of the heart, note apical pulse, presence of extra heart sounds, or murmurs.

15. BREAST AND AXILLAE:Record results of inspection and palpation of breast and axilla.

16. ABDOMEN:Record result of inspection, palpation, percussion, and auscultation of abdomen. Note liver size, palpable organs, tenderness, and umbilical reflexes

17. INGUINAL AREA:Record results of inspection and palpation of inguinal area. Note presence or absence of hernias.

18. SPINE AND EXTREMITIES: MUSCULOSKELETALRecord results of inspection and palpation of all joints. Note test results of ROM and muscle strength of all extremities. Check for scoliosis.

19. SPINE AND EXTREMITIES: NEUROLOGICALRecord results for reflex tests, gait, balance, and coordination. Note sensation to pain, temp. light touch vibration. Note position discrimination.

Appendix D

FOCUSED NURSING CARE PLAN



FOCUSED NURSING CARE PLAN

Student Name: Student ID:

Clinical setting: Date:

I. Patient Demographic data: Name of the patient:

Age: Gender: Occupation: Religion: Education: Nationality: Income: Marital status:

II. Health Information

Medical diagnosis: Date of Admission:Name of Surgery: Date of Surgery:Post Operative Day: Allergy: Source of history: Referral:

III. Health History

a. Chief complaints (major complaints by the patient in their own words / reason for hospitalization)

Current Complaints:

b. History of Present illness:

c. Related Past History:

d. Family Health History:

e. Personal and social history

IV. Psychosocial Assessment: Patient’s perception of the illness

a. Nature and cause of the problem:

b. Therapeutic approaches attempted by patient:

c. Feelings / fears about the problem:

d. Effects of the problem on the patient’s life:

e. Expectations from the health care system:

V. Nutritional Assessment:

a. Height: b. Weight:c. Body mass index: d. Total calories required: e. Diet plan:

IV. Comprehensive Physical Assessment: Review of systems – Head to Toe.

Describe actual findings/ deviation from abnormal.

Vital Signs:

Temperature______C

Pulse_____bpm

Respiration______/min

Blood Pressure____________mm Hg

Oxygen saturation ____%

Pain (Visual analog scale):________________________________________

General Appearance:

Mental Status and Neurological assessment:

Skin:

Head, Eyes, ENT

Neck, Breast, Axilla and Lymph nodes

Respiratory:

Cardiovascular:

Gastrointestinal:

Genito-Urinary System:

Peripheral Vascular:

Musculoskeletal:

VI. Focused physical assessment: Describe actual findings of the current complaints/ problem of the affected systems:

InvestigationsResult

Normal valueInterpretation

Nursing ConsiderationBiochemistry Investigation

Hematology Investigation

Microbiology Investigation

a. Other investigations:

Date Investigation Result Interpretation

Radiological Investigation

Clinical Physiology Investigation

VI. ManagementSpecial therapy:

1.

2.

3.

VII. Medications:

S. NoName of the drugDosage ActionReason for Administration

Nursing Consideration

1.

2.

3.

4.

5.

VIII. Evidence Based Nursing Care Plan:

Relevant Assessment Data

Nursing Diagnosis Implementation with Rationale Evaluation

Relevant Assessment Data

Nursing Diagnosis Implementation with Rationale Evaluation



EVALUATION OF FOCUSED NURSING CARE PLAN

Name: ID. No:Patient Health Profile (33)

I Patient demographics and health information (2) 2II Health history (12)

Chief complaints Present illness Related past history Family health history Personal and social history Psycho-Social Assessment

222222

III Review of systems (subjective expression) (10) Physical Examination Problem focused review of systems

55

IV Management (4) Special therapy Medications

13

V Lab and diagnostics (5) 5Evidenced Based Nursing Process (27)

I Assessment (4)a. Collects relevant data which focuses on the problem identified from:

History Physical examination Lab and diagnostics Medical records

4

II Nursing Diagnosis (6)a. Identifies the correct diagnostic label 2b. States the related factor to the pathophysiological base 2c. Prioritizes nursing diagnosis in order of main concern 2IV Nursing Interventions (10)a. Incorporates on-going assessments 2b. Writes appropriate prevention orders 2c. Includes relevant health Promotive / educative orders 2d. Identifies accurate treatment orders 2e. States scientific rationale for all interventions 2V Evaluation (3)a. Evaluative statements are:

Specific Measurable Achievable Reliable Time bound

3

VII Reflection 2VIII References 2

Total Marks (60 marks, 10%)


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Activity Intolerance Fluid Volume, Excess Falls, Risk for

Activity Intolerance, Risk for Fluid Volume, Imbalanced, Risk for

Family Processes, Dysfunctional: Alcoholism

Airway Clearance, Ineffective Gas Exchange, Impaired Family Processes, Interrupted

Anxiety Grieving Family Processes, Readiness for Enhanced

Anxiety, Death Grieving, Complicated FatigueAttachment, Parent/infant Child, Risk for Impaired Grieving, Risk for Complicated Fear

Autonomic Dysretlexia Autonomic

Growth, Disproportionate, Risk for

Fluid Balance, Readiness for Enhanced

Dysreflexia, Risk for Blood Glucose Disturbed

Growth and Development, Delayed Fluid Volume, Deficient

Body temperature: Imbalanced , Health Behavior, Risk-Prone Fluid Volume, Deficient, Risk for

Risk for Bowel Incontinence Health Maintenance, Ineffective Parenting, Impaired

Effective Breast feeding Health-Seeking Behaviors (Specify)

Parenting, Readiness for Enhanced

Ineffective Breast feeding Home Maintenance, Impaired Hope,

Parenting, Risk for Impaired Peri-operative

Interrupted Breathing pattern Readiness for Enhanced Hopelessness

Positioning Injury, Risk for Personal

Cardiac Output , Decreased Human Dignity, Risk for Compromised Identity, Disturbed

Caregiver role strain Hyperthermia Poisoning, Risk for Caregiver Role strain, Risk for Hypothermia Post-Trauma Syndrome Comfort, readiness for enhanced

Immunization Status, Readiness for Enhanced Post-Trauma Syndrome, Risk for

Communication Impaired, Verbal Infant Behavior, Disorganized Power, Readiness for Enhanced

Communication ,Readiness enhanced

Infant Behavior: Disorganized, Risk for Powerlessness

Confusion Acute Infant Behavior: Organized~ Readiness for Enhanced Powerlessness, Risk for

Confusion, Acute, Risk for Infant Feeding Pattern, Ineffective Protection, Ineffective

Confusion Infection, Risk for Rape-Trauma Syndrome

Constipation Injury, Risk for Rape-Trauma Syndrome: Compound Reaction

Constipation, Perceived Insomnia Rape-Trauma Syndrome: Silent Reaction

Constipation, Risk for Intracranial Adaptive Capacity, Religiosity, Impaired

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Decreased

Contamination Knowledge, Deficient (Specify) Religiosity, Readiness for Enhanced

Contamination, Risk for Knowledge (Specify), Readiness for Enhanced Religiosity, Risk for Impaired

Coping: Community Ineffective Latex Allergy Response Relocation Stress Syndrome

RelocationCoping: Community, Readiness for Enhanced

Latex Allergy Response, Risk for Liver Function, Impaired, Stress Syndrome, Risk for Role

Coping, Defensive Loneliness, Risk for Conflict, Parental Coping: Family, Compromised Memory, Impaired Role Performance, IneffectiveCoping: Family, Disabled Mobility: Bed, Impaired Sedentary Lifestyle Coping: Family, Readiness for Enhanced Coping (Individual), Mobility: Physical, Impaired Self-Care, Readiness for

Enhanced Self-Readiness for Enhanced Coping, Ineffective Mobility: Wheelchair, Impaired Care Deficit: Bathing/Hygiene

Self-Care

Decisional Conflict Moral Distress Deficit: Dressing/Grooming Self-Care

Decision Making, Readiness for Enhanced Nausea Deficit: Feeding

Denial, Ineffective Neurovascular Dysfunction: Peripheral, Risk for Self-Care Deficit: Toileting Self

Dentition, Impaired Noncompliance (Specify) Concept, Readiness For Enhanced Self

Development: Delayed, Risk for

Nutrition, ln1balanced: Less than Body Requirements Esteem, Chronic Low Self-Esteem

Diversional Activity, Deficient Nutrition, Imbalanced: More than Body Requirements

Situational] Low Self-Esteem, Risk for

Diarrhea Nutrition, Readiness for Enhanced Situational Low Self-Mutilation

Disuse Syndrome, Risk for Oral Mucous Membrane, Impaired Self-Mutilation, Risk for

Environmental Interpretation Syndrome, Impaired Pain, Acute

Sensory Perception, Disturbed (Specify: Auditory, Gustatory, Kinesthetic, Olfactory Tactile, Visual)

Failure to Thrive, Adult Pain, Chronic Sexual Dysfunction SexualityEnergy Field, Disturbed Sleep, Readiness for Enhanced Pattern, Ineffective SkinSorrow, Chronic Social Interaction, Impaired Integrity, impaired Spiritual Distress Social Isolation Skin Integrity, Risk for ImpairedSpiritual Distress, Risk for Spontaneous Ventilation, Impaired

Spiritual Well-Being, Readiness for Enhanced Sleep Deprivation

Stress, Overload Sudden Infant Death Syndrome, Risk for Suffocation, Risk for

Suicide, Risk for Surgical Recovery, Delayed Swallowing, ImpairedTherapeutic Regimen. Management: Community,

Therapeutic Regimen Management, Effective

Therapeutic Regimen Management: Family Ineffective

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Ineffective

Therapeutic Regimen Management, Ineffective

Therapeutic Regimen Management, Readiness for

Enhanced

Thermoregulation, Ineffective

Thought Processes, Disturbed Tissue Integrity, Impaired

Tissue Perfusion, Ineffective (Specify: Cerebral, Cardiopulmonary, Gastrointestinal, Renal)

Tissue Perfusion, Ineffective, Peripheral Transfer Ability, Impaired Trauma, Risk for

Unilateral Neglect Urinary Elimination, Impaired Urinary Elimination, Readiness for Enhanced

Urinary Incontinence, Functional Urinary Incontinence, Overflow Urinary Incontinence, Reflex

Urinary Incontinence, Stress Urinary Incontinence, Total Urinary Incontinence, Urge

Urinary Incontinence, Risk for Urge Urinary Retention Ventilatory Weaning Response,

DysfunctionalViolence: Other-Directed, Risk for Violence: Self-Directed, Risk for Walking, Impaired

Wandering

Source: NANDA Nursing Diagnoses: Definitions and Classification, 2007-2008. Philadelphia: North

American Nursing Diagnosis Association. Used with permission

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Criteria of Final oral Exam

Student name: Diagnosis of the Case:

1234

Criterion

Nursing process, Knowledge and Critical thinking (14) Collect relevant information about the assigned case using history-taking,

physical exam, diagnostic procedures and lab tests Identify physiological and psychosocial health responses of the patient and

family (nursing diagnoses) to health alterations experienced Prioritize nursing diagnoses Integrate knowledge of Basic sciences( Anatomy, Physiology) in practice Shows knowledge of action and side actions of medications used used in

the management of health alterations in the selected body systems/organs Interpret findings of common diagnostic procedures and lab tests Shows organized thought process

Communication, Ethics and Values (3) Demonstrate caring approach during patients’ care Displays respect to patients’ values and beliefs Collaborate with health care providers in providing care to the patients

Intervention/ Nursing Care (10.5) Implement specific nursing interventions at the bedside. Nursing interventions are individualized based on patient’s current needs Provide patient teaching interventions based on identified needs. Nursing interventions are based on up to date knowledge. Rationales are scientifically correct. Evaluates patient response to the interventions Providing appropriate health education according to the patient needs

Professional behaviors during exam (2.5) Uniform Show respect to examinars

Student:

Examiner:

Date:

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