NUR 215 - University of Phoenix
NUR 215
NURSING MANAGEMENT OF THE MEDICAL-SURGICAL CLIENT II
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Program Council
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Copyright
Copyright ( 2003 by the University of Phoenix. All rights reserved.
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Edited in accordance with University of Phoenix® editorial standards and practices. (Template U3).
Table of Contents
Click on any one of the headings within the Table of Contents to move to that section within the UniModuleTM. Similarly, click on any one of the Table of Contents hyperlinks within the body of the UniModuleTM to bring you back to this page. Please note that the UniModuleTM must be in Print Layout View to view the Table of Contents hyperlinks.
Overview 1
Faculty Overview 4
Student Materials 6
Faculty Materials 7
Workshop One 8
Clinical Activity Meeting One 10
Workshop One Faculty Notes 12
Workshop Two 15
Clinical Activity Meeting Two 17
Workshop Two Faculty Notes 18
Workshop Three 20
Clinical Activity Meeting Three 21
Workshop Three Faculty Notes 22
Workshop Four 24
Clinical Activity Meeting Four 26
Workshop Four Faculty Notes 27
Workshop Five 29
Clinical Activity Meeting Five 30
Workshop Five Faculty Notes 31
University of Phoenix Material 33
Peer and Self Evaluation Form 33
Requirements for Grading Formal Written Care Plan 34
University of Phoenix Faculty Material 35
Arizona State Board of Nursing Summary of NCLEX® Board Meeting, October 3, 2002 35
Problem Based Learning Using In-class Group Case Studies 39
Faculty Grading Form for In-Class Case Studies 41
Case Studies 42
Workshop One – Case Studies 43
Workshop Two - Case Studies 45
Workshop Three - Case Studies 47
Workshop Four - Case Studies 49
Workshop Five - Case Studies 51
Clinical Conferencing 52
In-Class Group Case Study Form 53
Overview
COURSE DESCRIPTION
THIS COURSE CONTINUES TO BUILD ON THE CONCEPTS AND CONDITIONS INTRODUCED IN THE PREVIOUS COURSE. STUDENTS WILL ADD THE FOCUS OF GASTROINTESTINAL, NEUROLOGICAL, MUSCULOSKELETAL AND GENITOURINARY CONDITIONS TO THE CARE MANAGEMENT OF COMPLEX ADULT CLIENTS. THE NURSE’S ROLE IN THE ASSESSING, PLANNING, IMPLEMENTING, AND EVALUATING INTERVENTIONS BASED ON DATA ANALYSIS IS EMPHASIZED. PRECEPTORED CLINICAL EXPERIENCES ALLOW STUDENTS TO DEMONSTRATE AND APPLY THEORY TO PRACTICE.
TOPICS AND OBJECTIVES
Nursing Process and the Care of the Client with Endocrine Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in endocrine health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in endocrine health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in endocrine health patterns.
• Utilize therapeutic communication with clients experiencing alterations in endocrine health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in endocrine health patterns.
Nursing Process and the Care of the Client with a Musculoskeletal Disorder
• Apply the pathophysiological changes to client care for individuals experiencing alterations in musculoskeletal health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in musculoskeletal health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in musculoskeletal patterns.
• Utilize therapeutic communication with clients experiencing alterations in musculoskeletal health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in musculoskeletal health patterns.
Nursing Process and the Care of the Client with Immunologic Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in health patterns related to the immune system.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in health patterns related to the immune system.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in health patterns related to the immune system.
• Utilize therapeutic communication with clients experiencing alterations in health patterns related to the immune system.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in health patterns related to the immune system.
Nursing Process and the Care of the Client with Neurologic Disorders – Part I and II
• Apply the pathophysiological changes to client care for individuals experiencing alterations in neurologic health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in neurologic health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in neurologic health patterns.
• Utilize therapeutic communication with clients experiencing alterations in neurologic health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in neurologic health patterns.
Nursing Process and the Care of the Client with Eye or Ear Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in health patterns related to eye or ear disorders.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in health patterns related to eye or ear disorders.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in health patterns related to eye or ear disorders.
• Utilize therapeutic communication with clients experiencing alterations in health patterns related to eye or ear disorders.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in health patterns related to eye or ear disorders.
Nursing Process and the Care of the Client with Integumentary Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in integumentary health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in integumentary health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in integumentary health patterns.
• Utilize therapeutic communication with clients experiencing alterations in integumentary health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in integumentary health patterns.
DELIVERY METHODS
THIS MODULE CONTAINS ASSIGNMENTS AND INFORMATION FOR MULTIPLE COURSE DELIVERY METHODS.
• [pic] ALL DELIVERY METHODS
These assignments are applicable for all delivery methods.
• [pic] CLASSROOM
Students meet face to face with the instructor and their classmates.
• [pic] ONLINE
Students meet via computer with the instructor and their classmates. This course is not currently offered in this modality.
• [pic] FlexNet®
Classroom and Online delivery methods are combined. This course is not currently offered in this modality.
• [pic] DIRECTED STUDY
Student works one-to-one with the instructor. This course is not currently offered in this modality.
In all cases, refer to the syllabus distributed by your instructor for a comprehensive listing of the assignment descriptions and due dates.
ASSIGNMENTS DUE
• [pic] CLASSROOM
All assignments are to be completed prior to the workshop in which they appear.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not offered Direct Study, Flex-Net, or Online at this time.
Faculty Overview
MODULE REVISION HISTORY
REFER TO THE TABLE BELOW TO DETERMINE IF MODULE CHANGES MADE SINCE YOU CREATED YOUR SYLLABUS ARE SIGNIFICANT ENOUGH TO REQUIRE A NEW SYLLABUS.
|MODULE CODE |REVISION(S) DETAIL |
|nur215u1 |Original UniModule™ |
UNIMODULE™ FORMAT
THE FACULTY NOTES FOR EACH WORKSHOP ARE ORGANIZED INTO PREVIEW, CONTENT, AND SUMMARY SECTIONS. NOTE THAT ALL WORKSHOPS MUST RUN FOR A FULL FOUR HOURS.
Preview
This is a brief overview of the content of the workshop.
Content
The Topics are designed to guide the workshop content. Avoid repackaging the information from the reading assignments into a lecture.
The Discussion Questions are designed to prompt activities and bring the content to life. Once these questions have been introduced, facilitate the discussion and/or activity toward the related Learning Objectives for the workshop. The Faculty Resource Guide at , provides suggestions on specific activities and other resources. Check back frequently as this resource is constantly changing.
The Integrating Questions are designed to help students build a thorough understanding of the relevance, relationships, and application of the content in the real world. To ensure that students can relate course theories to the workplace, illustrate with examples drawn from your professional experiences and the experiences of the students.
The Discussion Questions and the Integrating Questions will be addressed through the case studies, therefore you will not see Discussion Questions or Integrating Questions in the module.
Summary
In this section the key points for the workshop are summarized and the next workshop is previewed. If appropriate for the delivery method, the Learning Team assignments are also discussed.
TEACHING GUIDELINES
• [pic] [pic] DIRECTED STUDY AND ONLINE
A Weekly Summary is due at the end of each workshop. This summary should be used to evaluate the individual student’s learning during the workshop. It is left to your discretion to set guidelines for the Weekly Summary. This course is not currently offered in a Directed Study or Online format.
• [pic] FlexNet®
The FlexNet® delivery method combines the Classroom and Online workshop formats. Please consult with your campus for specific instructions. This course is not currently offer in a Flex-Net format.
WEIGHTING OF ASSIGNMENTS
THE FOLLOWING ARE THE SUGGESTED WEIGHTINGS OF ASSIGNMENTS FOR THIS COURSE. STUDENTS DO NOT RECEIVE THIS INFORMATION; HOWEVER, YOU ARE RESPONSIBLE FOR COMMUNICATING YOUR PERFORMANCE CRITERIA TO YOUR STUDENTS IN THE SYLLABUS.
• [pic] CLASSROOM
|ASSIGNMENTS |Percent |
|Individual (100%) | |
|Peer Review of Case Study in Small Group Classroom Activity (All Workshops) |5 |
|Faculty Review of Case Study in Small Group Classroom Activity (All Workshops) |15 |
|Classroom Discussion and Activity (All Workshops) |5 |
|Weekly Practice NCLEX Questions (All Workshops) Must score at least 90% each week to get credit |20 |
|Clinical Conference Online (All Workshops) |10 |
|Formal Written Care Plan (Workshop Four) |25 |
|Final NCLEX Questions – paper and pencil in class (Workshop 5) |20 |
| | |
|Clinical Activities | |
|Midpoint Clinical Evaluation (Workshop Three) No points awarded. |Pass/Fail |
|Final Clinical Evaluation (Workshop Five) This is pass/fail. You must pass the clinical component to pass the|Pass/Fail |
|course. | |
|Total |100 |
•
Student Materials
BOOKS, SOFTWARE, OR OTHER COURSE MATERIALS
LEMONE, P., & BURKE, K. M. (2000). MEDICAL SURGICAL NURSING: CRITICAL THINKING IN CLIENT CARE [UNIVERSITY OF PHOENIX SPECIAL COVER EDITION]. BOSTON: PEARSON CUSTOM PUBLISHING.
Pagana, K. D., & Pagana, T. J. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis, MO: Mosby.
ELECTRONIC RESOURCES
SELECTED READINGS:
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CourseCompass Web site:
UNIVERSITY OF PHOENIX MATERIALS
(NOTE: THIS MATERIAL IS FOUND IN THE BACK OF THE UNIMODULE™.)
“Peer and Self Evaluation Form” (All Workshops)
“Requirements for Formal Written Care Plan” (Workshop Four)
Faculty Materials
BOOKS, SOFTWARE, OR OTHER COURSE MATERIALS
NONE
ELECTRONIC RESOURCES
CourseCompass faculty log in page
UNIVERSITY OF PHOENIX FACULTY MATERIALS
(NOTE: THIS MATERIAL IS FOUND IN THE BACK OF THE UNIMODULE™.)
“Arizona State Board of Nursing Summary of NCLEX Board Meeting, October 3, 2002” (Workshop One)
“Problem Based Learning Using In-class Group Case Studies” (All Workshops)
“Faculty Grading Form for In-Class Case Studies” (All Workshops)
“Case Studies” (All Workshops)
“Workshop One – Case Studies” (Workshop One)
“Workshop Two – Case Studies” (Workshop Two)
“Workshop Three – Case Studies” (Workshop Three)
“Workshop Four – Case Studies” (Workshop Four)
“Workshop Five – Case Studies” (Workshop Five)
“Clinical Conferencing” (All Workshops)
“In-Class Group Case Study Form” (All Workshops)
Workshop One
Nursing Process and the Care of the Client with Endocrine Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in endocrine health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in endocrine health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in endocrine health patterns.
• Utilize therapeutic communication with clients experiencing alterations in endocrine health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in endocrine health patterns.
ASSIGNMENTS
• [pic] CLASSROOM
1. Review from Medical Surgical Nursing: Critical Thinking in Client Care
a. Assessing Clients with Endocrine Disorders, pp. 672-682
b. Fluid and Electrolytes, pp. 112-126
2. Read from Medical Surgical Nursing: Critical Thinking in Client Care
a. Diabetes, pp. 716-764
b. Thyroid, Parathyroid, pp. 683-702
c. Osteoporosis, pp.1527-1536
d. Adrenal, pp. 702-712
e. Pituitary, pp. 713-715
3. In-class case studies will be analyzed in groups to help you apply what you are reading. Please bring both textbooks for this course to class. Please review the “Peer and Self Evaluation Form” found in University of Phoenix Materials located at the back of this module. You will use this form to evaluation your contribution and that of your group members after completing the in-class case studies each week.
4. Practice NCLEX questions will be posted in CourseCompass each week. You will have unlimited opportunities to pass these with a score of 90% or better. You must do so each week to pass this course. The final NCLEX questions in Workshop Five will be answered in a test in class.
5. Bring LPN to BSN Program Student Clinical Handbook to class.
6. The CourseCompass web site for this course is the same one used for NUR 214. The URL can be found under “Student Materials” in this module.
These assignments are due in Workshop One.
• [pic] ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Clinical Activity Meeting One
ASSIGNMENTS
• [pic] [pic] CLASSROOM AND ONLINE
Learning Team
There is no learning team hour requirement for this clinical course. Instead, students will be placed in clinical agencies for clinical rotation to fulfill course requirements and objectives.
Clinical Agency Requirements:
Students will:
• Be assigned to a specific agency, preceptor, and unit as determined by faculty, College Campus Chair, and/or designee of the agency.
• Contact Clinical Preceptor* and arrange a meeting to discuss clinical hours for the entire course. Clinical hours must mirror the preceptors' work schedule. Students are not allowed to clock clinical hours without being with their preceptor, nor while they are working as staff for the agency.
• Arrange for orientation of unit and/or agency, based on agency policy.
• Select a patient from the assigned unit the day before the clinical rotation. The patient needs primary and secondary diagnoses that match the workshop content for the week.
• Fill out the Preparatory Client Care Plan on each patient. This form is found in the back of the LPN to BSN Program Student Clinical Handbook. The care plan will be reviewed by the Clinical Preceptor prior to starting the clinical hours for the day. The plan will also be reviewed by the Clinical Site Faculty (CSF)** weekly.
• Arrive at the unit on time for report and prepared to care for your patient.
• Fulfill clinical hours as scheduled by faculty preceptor. Approximately 10 to 12 hours per week are required to complete the 45 clinical hours for this course.
• Perform clinical skills as opportunities arise with preceptor's observation and approval. Preceptor should sign-off on the clinical skill observed.
• Participate in the online Clinical Conferencing weekly with the classroom faculty and Clinical Site Faculty.
• Evaluate the preceptor and clinical agency after the last workshop. Forms for this purpose are located in the LPN to BSN Program Student Clinical Handbook.
• Maintain an accurate clinical log of time spent in the agency and in clinical experience. The log will be discussed in the Clinical Conferencing and signed off by the Clinical Preceptor and Clinical Site Faculty. The log is located in the back of the LPN to BSN Program Student Clinical Handbook.
Clinical Conferencing
Clinical Conferencing will be conducted weekly online through an asynchronous chat within CourseCompass. Students will be responsible to join the conference to discuss the week’s clinical rotation, patient/client outcomes, accomplishments, and challenges. Participation in Clinical Conferencing will require approximately 1 to 2 hours per week. Attendance will be taken.
After you have logged in to CourseCompass click on “Discussion Board”. There will be a link for each week’s Clinical Conference. Click on that link and add your comment. Click on the “Submit” button to submit your comment.
*Clinical Preceptor – An RN who works for the agency where clinicals are held and is there to supervise the student throughout the clinical experience.
** Clinical Site Faculty (CSF) – A contracted employee of the University of Phoenix who supervises the Clinical Preceptor and works with the student periodically. This individual will be responsible for reviewing the student’s Preparatory Client Care Plan and ensuring appropriate progression in the clinical component of the course.
Workshop One Faculty Notes
Time: 4 hours
Preview (1 hour)
• [pic] CLASSROOM
Facilitate introductions and a course overview discussion.
• [pic] [pic] CLASSROOM AND ONLINE
This course is not currently offered in this format.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not currently offered in this format.
• Content (2 hours, 30 minutes) (refer to Faculty Resource Guide at )
Please read “Problem Based Learning Using In-class Group Case Studies” contained in the University of Phoenix Faculty Materials prior to preparing for your class.
NOTE TO FACULTY: Please read the article “Arizona State Board of Nursing Summary of NCLEX( Board Meeting, October 3, 2002” found in the University of Phoenix Faculty Material at the end of the module.
1. Nursing Process and the Care of the Client with Endocrine Disorder
Note to faculty: the following information should be covered as part of the case studies, not in lecture format.
a. Diabetes
1) Pathophysiology of type I & II (type I will be covered more in the pediatrics course)
a) Type I
b) Type II
1) Hyperinsulinemia
2) Insulin resistance
2) Complications with associated pathophysiology – the text fragments this into different chapters. Need to relate these complications/target organ damage to the disease for the student.
a) Retinopathy
b) Nephropathy
c) Neuropathy
d) Ketoacidosis
e) Coronary artery disease/atherosclerosis/peripheral vascular disease
a. Thyroid gland disorders
1) Normal physiology
a) Thyroid hormone production
b) Relationship to anterior pituitary gland
c) Relationship of hormone production and lab tests used to assess function
2) Hypothyroidism
a) Pathophysiology of hormone function
b) Abnormality in laboratory tests – T4, TSH
c) Relate symptoms with pathophysiology
d) Multisystem effects
e) Nurses will often encounter as secondary diagnosis – not why patient having contact with health care system.
3) Hyperthyroidism
a) Pathophysiology of hormone function
b) Abnormality in laboratory tests – T3, T4, TSH
c) Relate symptoms with pathophysiology
b. Parathyroid gland disorders
1) Physiology of gland – calcium regulation
2) Hyperparathyroidism – relationship to osteoporosis, which text lists as musculoskeletal disorder. Students should learn this as an endocrine disorder.
3) Laboratory tests used to diagnose
c. Adrenal gland disorders
1) Physiology of adrenal gland
a) Cortex
b) Medulla
2) Pathophysiology of hyper and hypo function
3) Electrolyte disturbance
d. Pituitary gland disorders – these are rare and you may not want to spend much time on them. A case study on diabetes insipidus is included.
1) Anterior gland – growth hormone, prolactin, ACTH
2) Posterior – ADH
a) SIADH – pathophysiology
b) Symptoms
c) Lab abnormalities
1. Discussion Questions and Integrating Questions will be integrated into the case study.
Summary (30 minutes)
• [pic] CLASSROOM
1. Review key points and preview the next workshop.
2. Remind students to submit any assignments that are due.
3. Remind students about necessary clinical paperwork from the LPN to BSN Program Clinical Handbook.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Workshop Two
Nursing Process and the Care of the Client with a Musculoskeletal Disorder
• Apply the pathophysiological changes to client care for individuals experiencing alterations in musculoskeletal health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in musculoskeletal health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in musculoskeletal patterns.
• Utilize therapeutic communication with clients experiencing alterations in musculoskeletal health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in musculoskeletal health patterns.
Nursing Process and the Care of the Client with Immunologic Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in health patterns related to the immune system.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in health patterns related to the immune system.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in health patterns related to the immune system.
• Utilize therapeutic communication with clients experiencing alterations in health patterns related to the immune system.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in health patterns related to the immune system.
ASSIGNMENTS
• [pic] CLASSROOM
1. Review from Medical Surgical Nursing: Critical Thinking in Client Care
a. Immune System, pp. 219-238
b. Assessing Clients with Musculoskeletal Disorders, pp. 1510-1526
2. Read from Medical Surgical Nursing: Critical Thinking in Client Care
a. Paget’s Disease, pp. 1541-1545
b. Osteomyelitis, pp. 1545-1556
c. Low Back Pain, pp. 1561-1564
d. Bone Tumors, pp. 1564-1569
e. Musculoskeletal Trauma, pp. 1572-1616
f. Degenerative Joint Disease, 1617-1632
g. Altered Immunity, pp. 238-309
h. Rheumatoid Arthritis, pp. 1639-1661
3. Read the two articles on traction found on the Selected Readings Page.
4. In-class case studies will be analyzed in groups to help you apply what you are reading. Please bring both textbooks for this course to class. Please review the “Peer and Self Evaluation Form” found in University of Phoenix Materials located at the back of this module. You will use this form to evaluation your contribution and that of your group members after completing the in-class case studies each week.
5. Practice NCLEX questions will be posted in CourseCompass each week. You will have unlimited opportunities to pass these with a score of 90% or better. You must do so each week to pass this course. The final NCLEX questions in Workshop Five will be answered in a test in class.
These assignments are due in Workshop Two.
• [pic] ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Clinical Activity Meeting Two
ASSIGNMENTS
LEARNING TEAM
There is no learning team hour requirement for this clinical course. Instead, students will be placed in clinical agencies for clinical rotation to fulfill course requirements and objectives.
Clinical Agency Requirements:
Students will:
• Be assigned to a specific agency, preceptor, and unit as determined by faculty, College Campus Chair, and/or designee of the agency.
• Contact Clinical Preceptor* and arrange a meeting to discuss clinical hours for the entire course. Clinical hours must mirror the preceptors' work schedule. Students are not allowed to clock clinical hours without being with their preceptor, nor while they are working as staff for the agency.
• Arrange for orientation of unit and/or agency, based on agency policy.
• Select a patient from the assigned unit the day before the clinical rotation. The patient needs primary and secondary diagnoses that match the workshop content for the week.
• Fill out the Preparatory Client Care Plan on each patient. This form is found in the back of the LPN to BSN Program Student Clinical Handbook. The care plan will be reviewed by the Clinical Preceptor prior to starting the clinical hours for the day. The plan will also be reviewed by the Clinical Site Faculty (CSF)** weekly.
• Arrive at the unit on time for report and prepared to care for your patient.
• Fulfill clinical hours as scheduled by faculty preceptor. Approximately 10 to 12 hours per week are required to complete the 45 clinical hours for this course.
• Perform clinical skills as opportunities arise with preceptor's observation and approval. Preceptor should sign-off on the clinical skill observed.
• Participate in the online Clinical Conferencing weekly with the classroom faculty and Clinical Site Faculty.
• Evaluate the preceptor and clinical agency after the last workshop. Forms for this purpose are located in the LPN to BSN Program Student Clinical Handbook.
• Maintain an accurate clinical log of time spent in the agency and in clinical experience. The log will be discussed in the Clinical Conferencing and signed off by the Clinical Preceptor and Clinical Site Faculty. The log is located in the back of the LPN to BSN Program Student Clinical Handbook.
Clinical Conferencing
Clinical Conferencing will be conducted weekly online through an asynchronous chat within CourseCompass. Students will be responsible to join the conference to discuss the week’s clinical rotation, patient/client outcomes, accomplishments, and challenges. Participation in Clinical Conferencing will require approximately 1 to 2 hours per week. Attendance will be taken.
After you have logged in to CourseCompass click on “Discussion Board”. There will be a link for each week’s Clinical Conference. Click on that link and add your comment. Click on the “Submit” button to submit your comment.
* Clinical Preceptor – An RN who works for the agency where clinicals are held and is there to supervise the student throughout the clinical experience.
** Clinical Site Faculty (CSF) – A contracted employee of the University of Phoenix who supervises the Clinical Preceptor and works with the student periodically. This individual will be responsible for reviewing the student’s Preparatory Client Care Plan and ensuring appropriate progression in the clinical component of the course.
Workshop Two Faculty Notes
Time: 4 hours
Preview (30 minutes)
• [pic] CLASSROOM
Present Workshop Overview
• [pic] [pic] CLASSROOM
• Content (3 hours) (refer to Faculty Resource Guide at )
1. Nursing Process and the Care of the Client with Musculoskeletal Disorders
Note to faculty: the following information should be covered as part of the case studies, not in lecture format.
a. Back pain
1) Mechanical (musculoskeletal strain) vs radicular (pinched nerve) – these are covered in two areas of the text and should be correlated in the student’s mind.
a) Compare and contrast pathophysiology of both
b) Compare and contrast symptoms, nursing interventions, and surgical and non-surgical medical treatment.
b. Bone tumors
1) Pain control
2) Nursing diagnosis and interventions – body image disturbance, grief, impaired physical mobility
c. Osteomyelitis
1) Pathophysiology of process in bone or soft tissue
2) Long-term IV antibiotics and problems to other organ systems caused by that
d. Degenerative joint disease (osteoarthritis)
1) Pathophysiology – compare and contrast to that of RA
a) Joints most commonly effected
b) Not systemic illness, but caused by wear and tear
2) Surgical procedures and post-op nursing care
3) Chronic pain – nursing care and non-pharmacologic treatment measures
e. Crystal induced arthritis (gout used for case study)
1) Pathophysiology – how crystals precipitate in joint and cause inflammation
2) Treatment for acute attack
3) Treatment for prevention of acute attack
f. Musculoskeletal trauma
1) Fractures
a) Physiology of bone healing
b) Treatment – casting and traction – Traction is a topic covered on the NCLEX exam. Be sure the students have read the articles on the Selected Readings Page and understand the basic concepts behind the various kinds of traction.
c) Nursing care of the immobilized patient
2. Nursing Process and the Care of the Client with Immunologic Disorders
a. Rheumatoid arthritis
1) Pathophysiology
a) Compare and contrast with DJD
b) Systemic illness – autoimmune disease
1) Briefly review immune system
2) Compare and contrast normal immune response with autoimmune response
3) Intra-articular and extra-articular manifestations
c) Step-wise medical treatment
1) Non-steroidal anti-inflammatory drugs (NSAIDs)
2) Steroids
3) DMARDs (disease modifying anti-rheumatid drugs)
a) Classes of drugs used
b) Serious side effects and the nurses role in identifying
b. Acquired immunodeficiency syndrome (AIDS)
1) Pathophysiology
a) Compare and contrast a virus with retrovirus
b) Part of immune system effected by retrovirus
2) Multi-system involvement
a) Lymphadenopathy
b) AIDS dementia
c) Secondary infectious disease
3. Discussion Questions and Integrating Questions will be integrated into the case study.
Summary (30 minutes)
• [pic] CLASSROOM
1. Review key points and preview the next workshop.
2. Remind students to submit any assignments that are due.
3. Remind students to complete the Preparatory Client Care Plan prior to reporting to the clinical agency.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Workshop Three
Nursing Process and the Care of the Client with Neurologic Disorders – Part I
• Apply the pathophysiological changes to client care for individuals experiencing alterations in neurologic health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in neurologic health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in neurologic health patterns.
• Utilize therapeutic communication with clients experiencing alterations in neurologic health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in neurologic health patterns.
ASSIGNMENTS
• [pic] CLASSROOM
1. Review from Medical Surgical Nursing: Critical Thinking in Client Care
a. Assessing Clients with Neurologic Disorders, pp. 1674-1697
2. Read from Medical Surgical Nursing: Critical Thinking in Client Care
a. Intracranial Disorders, pp. 1698-1719
b. Seizure Disorder, pp. 1719-1727
c. Headaches, pp. 1727-1734
d. Craniocerebral Trauma, pp. 1734-1743
e. Intracranial Infections, Inflammation, and Neoplasms, pp. 1743-1761
f. Cerebral blood flow disorder, pp. 1763-1787
3. In-class case studies will be analyzed in groups to help you apply what you are reading. Please bring both textbooks for this course to class. Please review the “Peer and Self Evaluation Form” found in University of Phoenix Materials located at the back of this module. You will use this form to evaluation your contribution and that of your group members after completing the in-class case studies each week.
4. Practice NCLEX questions will be posted in CourseCompass each week. You will have unlimited opportunities to pass these with a score of 90% or better. You must do so each week to pass this course. The final NCLEX questions in Workshop Five will be answered in a test in class.
These assignments are due in Workshop Three.
• [pic] ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Clinical Activity Meeting Three
ASSIGNMENTS
LEARNING TEAM
There is no learning team hour requirement for this clinical course. Instead, students will be placed in clinical agencies for clinical rotation to fulfill course requirements and objectives.
Clinical Agency Requirements:
Students will:
• Be assigned to a specific agency, preceptor, and unit as determined by faculty, College Campus Chair, and/or designee of the agency.
• Contact Clinical Preceptor* and arrange a meeting to discuss clinical hours for the entire course. Clinical hours must mirror the preceptors' work schedule. Students are not allowed to clock clinical hours without being with their preceptor, nor while they are working as staff for the agency.
• Arrange for orientation of unit and/or agency, based on agency policy.
• Select a patient from the assigned unit the day before the clinical rotation. The patient needs primary and secondary diagnoses that match the workshop content for the week.
• Fill out the Preparatory Client Care Plan on each patient. This form is found in the back of the LPN to BSN Program Student Clinical Handbook. The care plan will be reviewed by the Clinical Preceptor prior to starting the clinical hours for the day. The plan will also be reviewed by the Clinical Site Faculty (CSF)** weekly.
• Arrive at the unit on time for report and prepared to care for your patient.
• Fulfill clinical hours as scheduled by faculty preceptor. Approximately 10 to 12 hours per week are required to complete the 45 clinical hours for this course.
• Perform clinical skills as opportunities arise with preceptor's observation and approval. Preceptor should sign-off on the clinical skill observed.
• Participate in the online Clinical Conferencing weekly with the classroom faculty and Clinical Site Faculty.
• Evaluate the preceptor and clinical agency after the last workshop. Forms for this purpose are located in the LPN to BSN Program Student Clinical Handbook.
• Maintain an accurate clinical log of time spent in the agency and in clinical experience. The log will be discussed in the Clinical Conferencing and signed off by the Clinical Preceptor and Clinical Site Faculty. The log is located in the back of the LPN to BSN Program Student Clinical Handbook.
Clinical Conferencing
Clinical Conferencing will be conducted weekly online through CourseCompass. Students will be responsible to join the conference to discuss the week’s clinical rotation, patient/client outcomes, accomplishments, and challenges. Participation in Clinical Conferencing will require approximately 1 to 2 hours per week. Attendance will be taken.
After you have logged in to CourseCompass click on “Discussion Board”. There will be a link for each week’s Clinical Conference. Click on that link and add your comment. Click on the “Submit” button to submit your comment.
* Clinical Preceptor – An RN who works for the agency where clinicals are held and is there to supervise the student throughout the clinical experience.
** Clinical Site Faculty (CSF) – A contracted employee of the University of Phoenix who supervises the Clinical Preceptor and works with the student periodically. This individual will be responsible for reviewing the student’s Preparatory Client Care Plan and ensuring appropriate progression in the clinical component of the course.
Workshop Three Faculty Notes
Time: 4 hours
Preview (30 minutes)
• [pic] CLASSROOM
Present Workshop Overview
• [pic] CLASSROOM
• Content (3 hours) (refer to Faculty Resource Guide at )
1. Nursing Process and the Care of the Client with Neurologic Disorders – Part I
Note to faculty: the following information should be covered as part of the case studies, not in lecture format.
a. Increased intracranial pressure (ICP)– Compare and contrast how this can occur, the various structures that can increase in size and put pressure on vital tissues.
1) Normal pressure hydrocephalus
a) Pathophysiology – increased cerebral spinal fluid (CSF)
b) Post-op nursing management post-shunt placement – assessment
2) Closed head injury, increased
a) Pathophysiology – compare and contrast causes following head trauma
b) Nursing management of a patient with diminishing level of consciousness (LOC)
3) Brain tumor
a) Pathophysiology – space occupying lesion
b) Location of tumor will cause symptoms
b. Seizures
1) Pathophysiology of seizure following head injury
2) Nursing management of acute seizure
c. Intracranial infections (bacterial meningitis used in case study)
1) Pathophysiology
2) Assessing neurological function – what to look for
d. Headaches
1) Compare and contrast various types of headaches
2) Pathophysiology of migraine headaches (used in case study)
3) Pain management
e. Cerebral blood flow disorders
1) The patient having a carotid endarterectomy
a) Pathophysiology of plaque formation
b) Role of hypercholesterolemia and diabetes in promoting atherosclerosis
c) Special needs of the diabetic facing surgery
2) Stroke/cerebral vascular accident (CVA)
a) Pathophysiology - differentiate TIA from hemorrhagic stroke and thrombotic stroke
b) Role of hypertension in CVA
c) Nursing management of manifestations of stroke
d) Nursing management of complications of stroke
2. Discussion Questions and Integrating Questions will be integrated into the case study.
Summary (30 minutes)
• [pic] CLASSROOM
1. Review key points and preview the next workshop.
2. Remind students to submit any assignments that are due.
3. Remind students to complete the Preparatory Client Care Plan prior to reporting to the clinical agency.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Workshop Four
Nursing Process and the Care of the Client with Neurologic Disorders – Part II
• Apply the pathophysiological changes to client care for individuals experiencing alterations in neurologic health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in neurologic health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in neurologic health patterns.
• Utilize therapeutic communication with clients experiencing alterations in neurologic health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in neurologic health patterns.
Nursing Process and the Care of the Client with Eye or Ear Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in health patterns related to eye or ear disorders.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in health patterns related to eye or ear disorders.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in health patterns related to eye or ear disorders.
• Utilize therapeutic communication with clients experiencing alterations in health patterns related to eye or ear disorders.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in health patterns related to eye or ear disorders.
ASSIGNMENTS
• [pic] CLASSROOM
1. Review from Medical Surgical Nursing: Critical Thinking in Client Care
a. Assessing Clients with Eye or Ear Disorders, 1876-1896
2. Read from Medical Surgical Nursing: Critical Thinking in Client Care
a. Spinal Cord Disorders, pp. 1787-1816
b. Degenerative Neurologic, Neuromuscular, and Cranial Nerve Disorders, pp. 1817-1853
c. Cranial Nerve Disorders, pp. 1864-1868
d. PNS Disorders, pp. 1853-1864
e. Eyes, pp. 1907-1928
f. Ear, pp. 1938-1947
3. Formal Written Care Plan due. See “Requirements for Formal Written Care Plan” in University of Phoenix Materials.
4. In-class case studies will be analyzed in groups to help you apply what you are reading. Please bring both textbooks for this course to class. Please review the “Peer and Self Evaluation Form” found in University of Phoenix Materials located at the back of this module. You will use this form to evaluation your contribution and that of your group members after completing the in-class case studies each week.
5. Practice NCLEX questions will be posted in CourseCompass each week. You will have unlimited opportunities to pass these with a score of 90% or better. You must do so each week to pass this course. The final NCLEX questions in Workshop Five will be answered in a test in class.
These assignments are due in Workshop Four.
• [pic] ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Clinical Activity Meeting Four
ASSIGNMENTS
LEARNING TEAM
There is no learning team hour requirement for this clinical course. Instead, students will be placed in clinical agencies for clinical rotation to fulfill course requirements and objectives.
Clinical Agency Requirements:
Students will:
• Be assigned to a specific agency, preceptor, and unit as determined by faculty, College Campus Chair, and/or designee of the agency.
• Contact Clinical Preceptor* and arrange a meeting to discuss clinical hours for the entire course. Clinical hours must mirror the preceptors' work schedule. Students are not allowed to clock clinical hours without being with their preceptor, nor while they are working as staff for the agency.
• Arrange for orientation of unit and/or agency, based on agency policy.
• Select a patient from the assigned unit the day before the clinical rotation. The patient needs primary and secondary diagnoses that match the workshop content for the week.
• Fill out the Preparatory Client Care Plan on each patient. This form is found in the back of the LPN to BSN Program Student Clinical Handbook. The care plan will be reviewed by the Clinical Preceptor prior to starting the clinical hours for the day. The plan will also be reviewed by the Clinical Site Faculty (CSF)** weekly.
• Arrive at the unit on time for report and prepared to care for your patient.
• Fulfill clinical hours as scheduled by faculty preceptor. Approximately 10 to 12 hours per week are required to complete the 45 clinical hours for this course.
• Perform clinical skills as opportunities arise with preceptor's observation and approval. Preceptor should sign-off on the clinical skill observed.
• Participate in the online Clinical Conferencing weekly with the classroom faculty and Clinical Site Faculty.
• Evaluate the preceptor and clinical agency after the last workshop. Forms for this purpose are located in the LPN to BSN Program Student Clinical Handbook.
• Maintain an accurate clinical log of time spent in the agency and in clinical experience. The log will be discussed in the Clinical Conferencing and signed off by the Clinical Preceptor and Clinical Site Faculty. The log is located in the back of the LPN to BSN Program Student Clinical Handbook.
Clinical Conferencing
Clinical Conferencing will be conducted weekly online through CourseCompass. Students will be responsible to join the conference to discuss the week’s clinical rotation, patient/client outcomes, accomplishments, and challenges. Participation in Clinical Conferencing will require approximately 1 to 2 hours per week. Attendance will be taken.
After you have logged in to CourseCompass click on “Discussion Board”. There will be a link for each week’s Clinical Conference. Click on that link and add your comment. Click on the “Submit” button to submit your comment.
* Clinical Preceptor – An RN who works for the agency where clinicals are held and is there to supervise the student throughout the clinical experience.
** Clinical Site Faculty (CSF) – A contracted employee of the University of Phoenix who supervises the Clinical Preceptor and works with the student periodically. This individual will be responsible for reviewing the student’s Preparatory Client Care Plan and ensuring appropriate progression in the clinical component of the course.
Workshop Four Faculty Notes
Time: 4 hours
Preview (30 minutes)
• [pic] CLASSROOM
Present Workshop Overview.
• [pic] CLASSROOM
• Content (3 hours) (refer to Faculty Resource Guide at )
1. Nursing Process and the Care of the Client with Neurological Disorders – Part II
Note to faculty: the following information should be covered as part of the case studies, not in lecture format.
a. Spinal cord injury
1) Manifestations related to level of injury
a) C3-4 spinal cord injury
b) T10 fracture
2) Stabilization and immobilization – review traction used for cervical fractures
3) Spinal shock – nursing implications
b. Alzheimer’s disease
1) Pathophysiology
2) Assessing mental status
3) Nursing care
4) Caregiver support
c. Multiple sclerosis – be sure to discuss traction used in case study
1) Pathophysiology
2) Nursing management of disease manifestations
d. Parkinson’s disease
1) Pathophysiology
2) Assessing functional status
3) Caregiver support
e. Vertigo – be sure to discuss traction used in case study
1) Pathophysiology – differentiate benign positional vertigo with Ménière’s disease
2) Nursing management of fall potential – disease caused or caused by side effect of medication used to treat the problem (somnolence)
f. Guillain-Barré syndrome
1) Pathophysiology
2) Ongoing nursing assessment
2. Nursing Process and the Care of the Client with Eye or Ear Disorders
a. Acute angle-closure glaucoma
1) Pathophysiology – differentiate open-angle and angle-closure glaucoma
2) Nursing care of acute episode
3) Surgical and post-op management
3. Discussion Questions and Integrating Questions will be integrated into the case study.
Summary (30 minutes)
• [pic] CLASSROOM
1. Review key points and preview the next workshop.
2. Remind students to submit any assignments that are due.
3. Remind students to complete the Preparatory Client Care Plan prior to reporting to the clinical agency.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Workshop Five
Nursing Process and the Care of the Client with Integumentary Disorders
• Apply the pathophysiological changes to client care for individuals experiencing alterations in integumentary health patterns.
• Develop a collaborative plan of care utilizing the nursing process for individuals experiencing alterations in integumentary health patterns.
• Identify the major pharmaceutical treatment modalities utilized in treating individuals experiencing alterations in integumentary health patterns.
• Utilize therapeutic communication with clients experiencing alterations in integumentary health patterns.
• Formulate a teaching plan that addresses the needs of the client experiencing alterations in integumentary health patterns.
ASSIGNMENTS
• [pic] CLASSROOM
1. Review from Medical Surgical Nursing: Critical Thinking in Client Care
a. Assessing Clients with Skin Disorders, 554-567
2. Read from Medical Surgical Nursing: Critical Thinking in Client Care
a. Pruritus, Dry Skin and Psoriasis, pp. 568-575
b. Fungus, Parasites, and Viral, pp. pp. 578-589
c. Malignant Melanoma and Trauma, pp. 611-633
d. Burns, pp. 638-669
3. NCLEX in-class paper and pencil exam covering content from all Workshops.
4. In-class case studies will be analyzed in groups to help you apply what you are reading. Please bring both textbooks for this course to class. Please review the “Peer and Self Evaluation Form” found in University of Phoenix Materials located at the back of this module. You will use this form to evaluation your contribution and that of your group members after completing the in-class case studies each week.
5. Practice NCLEX questions will be posted in CourseCompass each week. You will have unlimited opportunities to pass these with a score of 90% or better. You must do so each week to pass this course. The final NCLEX questions in Workshop Five will be answered in a test in class.
These assignments are due in Workshop Five.
• [pic] ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
Clinical Activity Meeting Five
ASSIGNMENTS
LEARNING TEAM
There is no learning team hour requirement for this clinical course. Instead, students will be placed in clinical agencies for clinical rotation to fulfill course requirements and objectives.
Clinical Agency Requirements:
Students will:
• Be assigned to a specific agency, preceptor, and unit as determined by faculty, College Campus Chair, and/or designee of the agency.
• Contact Clinical Preceptor* and arrange a meeting to discuss clinical hours for the entire course. Clinical hours must mirror the preceptors' work schedule. Students are not allowed to clock clinical hours without being with their preceptor, nor while they are working as staff for the agency.
• Arrange for orientation of unit and/or agency, based on agency policy.
• Select a patient from the assigned unit the day before the clinical rotation. The patient needs primary and secondary diagnoses that match the workshop content for the week.
• Fill out the Preparatory Client Care Plan on each patient. This form is found in the back of the LPN to BSN Program Student Clinical Handbook. The care plan will be reviewed by the Clinical Preceptor prior to starting the clinical hours for the day. The plan will also be reviewed by the Clinical Site Faculty (CSF)** weekly.
• Arrive at the unit on time for report and prepared to care for your patient.
• Fulfill clinical hours as scheduled by faculty preceptor. Approximately 10 to 12 hours per week are required to complete the 45 clinical hours for this course.
• Perform clinical skills as opportunities arise with preceptor's observation and approval. Preceptor should sign-off on the clinical skill observed.
• Participate in the online Clinical Conferencing weekly with the classroom faculty and Clinical Site Faculty.
• Evaluate the preceptor and clinical agency after the last workshop. Forms for this purpose are located in the LPN to BSN Program Student Clinical Handbook.
• Maintain an accurate clinical log of time spent in the agency and in clinical experience. The log will be discussed in the Clinical Conferencing and signed off by the Clinical Preceptor and Clinical Site Faculty. The log is located in the back of the LPN to BSN Program Student Clinical Handbook.
Clinical Conferencing
Clinical Conferencing will be conducted weekly online through CourseCompass. Students will be responsible to join the conference to discuss the week’s clinical rotation, patient/client outcomes, accomplishments, and challenges. Participation in Clinical Conferencing will require approximately 1 to 2 hours per week. Attendance will be taken.
After you have logged in to CourseCompass click on “Discussion Board”. There will be a link for each week’s Clinical Conference. Click on that link and add your comment. Click on the “Submit” button to submit your comment.
* Clinical Preceptor – An RN who works for the agency where clinicals are held and is there to supervise the student throughout the clinical experience.
** Clinical Site Faculty (CSF) – A contracted employee of the University of Phoenix who supervises the Clinical Preceptor and works with the student periodically. This individual will be responsible for reviewing the student’s Preparatory Client Care Plan and ensuring appropriate progression in the clinical component of the course.
Workshop Five Faculty Notes
Time: 4 hours
Preview (1 hour)
• [pic] CLASSROOM
Present Workshop Overview
• [pic] CLASSROOM
• Content (2 hours, 30 minutes) (refer to Faculty Resource Guide at )
Note to faculty: the following information should be covered as part of the case studies, not in lecture format.
1. Nursing Process and the Care of the Client with Integumentary Disorders
a. Primary skin lesions
1) Examples from each category that may be encountered as secondary problems for patients
2) Documentation strategies
b. Secondary skin lesions
1) Examples from each category that may be encountered as secondary problems for patients
2) Documentation strategies
c. Skin problems that immobilization causes and nursing diagnoses and interventions
d. Case studies
1) Psoriasis
a) Pathophysiology
b) Body disturbance issues related to
c) Lab abnormalities – high alkaline phosphatase due to rapid turnover of skin
2) Burns
a) Burn classification according to depth of tissue involved
b) Severity of burns
1) Rule of 9’s
2) Lund and Browder burn assessment method
c) Multisystem involvement and nursing assessment
1) Fluids
2) Respiratory status
3) Skin care
4) Pain control
5) Nutrition support
6) Mobility
7) Psychological support
8) Family support
d) Treatment options
1) Debridement
2) Surgical procedures
3) Malignant melanoma
a) Pathophysiology
b) Surgical treatment
c) Emotional support
4) AIDS and opportunistic infections
a) Pathophysiology of tinea, Kaposi’s sarcoma, thrush
b) Immune status in HIV
c) Nursing diagnosis and interventions
d) Comfort measures with tinea infections and thrush
2. Discussion Questions and Integrating Questions will be integrated into the case study.
Summary (30 minutes)
• [pic] CLASSROOM
1. Remind students to submit any assignments that are due.
2. Remind students to complete the Preparatory Client Care Plan prior to reporting to the clinical agency.
• [pic] [pic] DIRECTED STUDY AND ONLINE
This course is not currently offered in this format.
• [pic] DIRECTED STUDY
This course is not currently offered in this format.
University of Phoenix Material
Peer and Self Evaluation Form
Please submit this peer and self-evaluation form to the faculty member at the end of each class to evaluate participation in the group case studies.
Directions:
1. This is a confidential evaluation. I will not share the results with your group members.
1. Write the name of each group member in the left-hand column. Be sure to include yourself.
2. In the right-hand column, assign a percent of the total effort that was contributed by that person. The numbers should total 100.
For example, if there were four in your group and all four group members contributed equally, indicate a maximum of 25% for each.
If your group was highly dysfunctional, it might well look like this:
• Mary: 0%
• Tony: 80%
• Jill: 10%
• Susan: 10%
TOTAL = 100%
What percent of the total effort for the weekly group case studies was contributed by each group member, including you?
|Name (include your own!) |Percent contribution to group effort |
| Course Workshop | |
| | |
| | |
| | |
| | |
| | |
|TOTAL |100% |
University of Phoenix Material
Requirements for Grading Formal Written Care Plan
Nursing diagnoses stated in appropriate format 6
One short-term goal with measurable outcomes
for each diagnosis 6
Minimum of four interventions with rationale
for each therapeutic intervention (ie: 4
interventions under assessment, 4 under
therapeutic interventions, 4 under
education and AT LEAST 2 under referral) 13
Total points 25
University of Phoenix Faculty Material
Arizona State Board of Nursing Summary of NCLEX® Board Meeting, October 3, 2002
Background
The Arizona State Board of Nursing noted that Arizona NCLEX-RN first time pass rates declined below the national average in 2001. This is the first time in the past 9 years that the state first time pass rate dipped below the national rate. In past years, the Arizona first time pass rate was well above the national average. In 2001, several programs posted pass rates below 70%, while some programs increased their pass rates or maintained rates above 90%. The Board expressed concern about the issue and requested that all Arizona nursing programs attend a special Board meeting on October 3, 2002. Before the meeting, the programs were requested to submit a document addressing the following:
1. Five reasons for a lower than 90% pass rate in your program
2. Five strategies your program will implement to increase the pass rate to 90% or higher.
3. A profile of the successful NCLEX candidate.
4. A profile of the unsuccessful candidate.
If a program had attained a 90% pass rate, the questions were modified to address strategies that the program utilized to attain and sustain the pass rate. All but one program sent a written report. All programs delivered an oral report at the meeting.
Overview
It was noted during the introduction of the topic by the Board Consultant that no program achieved a 90% pass rate consistently for the past 9 years. It was also noted that during 2001, over half the programs in the state participated in multi-system curriculum change. Data from National Council of State Boards of Nursing was presented showing that English as a Second Language (ESL) and ethnicity affected pass rates. ESL candidates also took longer per item to test, had lowered pass rates, and answered more items. The ethnic group with the highest pass rate was whites. All other ethnic groups had pass rate at 10% or more below the white group. During the initial part of the session, Dr. Casey Marks, Director of Testing for the National Council of State Boards of Nursing, was present via teleconferencing to answer questions. Dr. Marks informed the group that the Exam committee was studying the issue of the test time allotted to candidates to see if a modification was needed. Dr. Marks also encouraged programs to continue to refine the curriculum to meet the evolving health care needs of clients.
Reasons for decreased pass rate
Academic Preparation
Many programs noted that students are not academically prepared for the rigors of a nursing program. Some programs noted that passing prerequisite courses is not an adequate measure of student competence in the subject area. One program noted that some students who passed college algebra tested at “less then junior high” level in math on standardized testing. It was noted that the math department in the particular college did not require that students to actually calculate the correct answer to the problem, but gave them credit for attempting the problem. Other programs noted that many students passed college level English courses had very low reading comprehension skills. Some programs were able to correlate poor reading comprehension skills to NCLEX failure.
Curriculum
Several programs that experienced curricular change noted that they lost sight of NCLEX in the change and did not map the curriculum content to the NCLEX test plan. Faculty involved in constant curricular changes and revisions were noted to have little attention to give to students. Content on the test plan was dropped, inadvertently, by some of these programs.
Student Support
Nearly all programs cited student stress and lack of support as a factor. Many students had to work long hours during the program. Interestingly, many programs did not cite the working itself as a significant factor, but the amount of support the student received from family and friends as crucial. Stressors for students were financial, relationships, and multiple roles they were expected to fulfill.
Faculty
All programs reported difficulty recruiting and retaining qualified faculty. It was noted by several programs that masters nursing education does not prepare graduates for teaching. Many programs have hired faculty prepared as practitioners who lack curricular and teaching theory and practice. The quality and experience of the faculty was cited as crucial to program success. Many programs also reported that faculty were reluctant to fail a student clinically due to a multiplicity of factors which may include lack of knowledge of legal issues, lack of support of administration, too much hassle, and insecurity.
Academic Rigor
Many programs noted that lack of academic rigor contributed to lower pass rates. The tendency to offer extra credit for projects, rounding up of grades, few objective tests, test questions at an inappropriate level and not expecting students to read the materials were a few examples cited. A few programs reported that overly detailed study guides to teacher-made test might have encouraged students to study only for the test. Grade inflation, both within the nursing program and across campuses was also identified as a factor that contributed to over-confidence of the student and undermined reliance on pre-requisite courses to ensure a knowledge base.
Teacher-made Test
Testing of students may not have been at the appropriate level for some programs. Several programs reported what when they examined course tests, many questions were at a knowledge and comprehension level rather than application and analysis level, which is the level of the majority of the NCLEX RN questions.
Student Attitude
Student attitude was also reported to affect pass rates. All programs agreed that many students major in nursing because it is relatively high paying job in an uncertain economy. Some students are motivated to study only what will be on the test and are not active participants in learning. Some programs reported that students are overconfident when it comes to taking NCLEX.
Timing of NCLEX
Time elapsed from graduation to testing was cited as a factor for several programs, although one large program did not find it significant.
Strategies to increase NCLEX pass rates
Admissions
Admission testing was cited as one strategy utilized to ensure students have the abilities to succeed in a nursing program. The most frequently cited test was the Nursing Entrance Test (NET). Cut-off scores were cited as crucial for several programs in selecting likely candidates for admission. Two programs suggested tying the NET reading comprehension score to the level of nursing textbooks used.
Testing and Grading
Many programs are seriously examining teacher-made tests and constructing test questions and exam plans that are similar to NCLEX. Almost all programs reported utilizing measures that ensure that students meet the minimum passing score on the objective tests. Comprehensive end-of-course exams that were eliminated by some programs in the past are again being given. Programs reported eliminating extra credit assignments, points for attendance, grading of clinical performance, and other measure thought to inflate grades. Several programs are instituting policies where grades are not “rounded up”.
Standardized Testing
Many programs utilize standardized tests of nursing content (HESI, ERI) and NCLEX predictor exams. Programs report utilizing standardized tests in a variety of ways. Some used it to inform students of their strengths and weaknesses and for faculty to refine teaching, while others tie the score to the class grade, progression, or graduation.
Student Support
Early identification of students at risk for failure is used as a strategy by some programs. These programs were also quick to point out that there are occasional surprises where students that appeared very strong in the program failed NCLEX. Some programs are actively engaged in providing services to students such as financial help in the form of scholarships, partnering with health care institutions to offer externships, tutoring, and counseling services. Most programs also offer an NCLEX review course for their graduates. One program offers NCLEX study groups during the curriculum. Another program institutes an NCLEX success program from the first day the student enters the program. Many programs offer support to the unsuccessful NCLEX candidate.
Faculty Support
One large program has instituted a workshop for new faculty to orient them to clinical teaching and curriculum. Other programs are looking for ways to build strong clinical and didactic faculty. Faculty members are often sent to test construction and curriculum workshops. Many programs are searching for ways to allow faculty more time to prepare for classes and institute innovative teaching. Other activities include mentoring new clinical instructors and developing methods where clinical instructors can connect clinical experience to didactic content.
Curriculum
Many programs are actively engaged in mapping curriculum content to the NCLEX test plan. Stabilizing the curriculum to allow the flexibility to “fine tune” but not completely overhaul the total program, is a reported strategy of programs that participated in multi-system curriculum change.
Profile of NCLEX candidate
There was not agreement on the overall characteristics of the candidate who passes NCLEX on the first try. Some common characteristics of successful candidates were:
• Had a reading comprehension level similar to or higher than the level of the nursing textbooks.
• Had a high level of support from family/friends
• Had high grades in nursing clinical courses
• Motivated, self-directed learner
• Took NCLEX within 5 months of completing the program
• Was predicted to pass NCLEX at 85% or better via standardized testing
• Took an NCLEX review course
• Speaks English in the home
Some characteristics of unsuccessful first time candidates were identified as:
• Lower grade in some clinical courses
• May be ethnic minority
• Studied to pass the course test only
• Lack of social support
• Delay in taking test (not all report this as significant)
• Reading comprehension level below the level of nursing textbooks
• May have multiple repeats of prerequisite courses (not all programs found this)
• Failed NCLEX-PN
Board Decision
On November 6, 2002 the Arizona Board of Nursing received the above report and determined the following:
1. The goal of every program should be a 90% pass rate.
3. The Education Committee will recommend specific action items for programs.
4. The Education Committee will provide a report to the Board at the January meeting.
The Education Committee recommended:
1. That 90% be retained as an ideal minimum pass rate for programs.
2. That programs submit a progress report on their implementation of the actions proposed at this meeting in 18 months
Taken From: Arizona State Board of Nursing summary of NCLEX board meeting, October 3, 2002 (2003, February/March/April). Arizona State Board of Nursing Newsletter, 4(1), p.1,3.
University of Phoenix Faculty Material
Problem Based Learning Using In-class Group Case Studies
Students need the opportunity to apply what they are learning by reading the text. Therefore, it is recommended that faculty use the in-class case studies included in this module instead of lecturing to the students. The purpose of these case studies is to help the students learn the pathophysiology of the disease process and apply the nursing process to a specific patient scenario. Hopefully, CourseCompass will provide adequate anatomy, physiology, and pathophysiology review for the students. It is envisioned that you will spend most of the class time doing case studies with students in groups, pausing to emphasize pathophysiology of the disease process being discussed (in a “lecturette” PowerPoint® format) and how that alone can be a driving force for the nursing process, the nursing process itself, and other gaps. When the groups present the case studies to the other students, additional discussion should ensue.
Divide the class into groups of 3 or 4 students. Eight case studies will be provided for Workshops One through Four and four for Workshop Five. If you need additional case studies, please create them. Have one student take notes. Provide the case study to each group with the following list of content to be covered:
For each:
1. Briefly, what is the pathophysiology of the disease?
5. How will pathophysiology drive nursing care for this disease entity?
6. How are the patient’s signs and symptoms explained from a pathophysiologic viewpoint?
7. Two nursing diagnoses stated in appropriate format and prioritized
8. One short-term goal with measurable outcomes for each diagnosis
9. Four interventions with rationale for each
e. Assessment
f. Therapeutic intervention
g. Education
h. Referral
i. Teaching
The students should be given 30 minutes for this entire process. When everyone has completed their nursing care plans, the groups should informally present their case study and plan to the group, asking for feedback. The faculty’s role as facilitator is to ask probing questions, explain any concepts that the students do not understand, and fill in any gaps. It is recommended that faculty prepare a “lecturette” on pathophysiology of the disease processes or at least graphics on a PowerPoint® to help teach the basic concepts of the disease process. Graphics of all the pictures & tables in the text can be found in CourseCompass by going to Control Panel ( Course Documents (PowerPoints. Download the file “PowerPoints” to your hard drive. This file contains only the graphics from the text numbered just as in the text. Within CourseCompass under each week, an outline can be found containing recommended content and graphics for each “lecturette” needed to accompany each case study. Follow the path: CourseCompass (Control Panel (Course Documents (for specific week) (Faculty teaching materials
“Threads” will appear throughout NUR 214 and 215. While you will not spend direct class time covering these topics, they will appear in the case studies and on the NCLEX exam. These “threads” include:
1. Growth and development
10. Cultural awareness
11. Self-care
12. Pain management
13. Therapeutic communication
14. Surgical therapies
15. Cancer care
University of Phoenix Faculty Material
Faculty Grading Form for In-Class Case Studies
The students will receive three points each week for participating in the case studies. Your evaluation should reflect your observations of the students during the group process, as well as incorporate their peer evaluation forms. In addition, you may want to recommend that a different student from the group present the case study each time. This is a very subjective process and equivalent to class participation points.
University of Phoenix Faculty Material
Case Studies
The eight case studies for Workshops One through Four and four case studies for Workshop Five are listed here. The chart below is the suggested format for students to fill out during class. Due to time constraints, you may want to go through this entire process during Workshop One, but then focus on specific aspects of the nursing process in the remaining workshops. The purpose of these case studies is to learn about the disease entities as well as plan nursing care. Since these case studies will not appear in the student modules, you will need to bring copies of them to class. Recommended answers for each case study can be found in CourseCompass by week under Course Documents, Faculty Teaching Materials.
Students will do “Peer and Self-Evaluations” each week after the case studies are complete. The form can be found in University of Phoenix Materials. Hopefully, this will help you pinpoint students who are not participating during the in-class case studies. As faculty, you will rate each student’s participation at the end of each workshop. The guidelines for doing so can also be found in University of Phoenix materials, “Faculty Grading Form for In-Class Group Case Studies”.
A larger version of the form below can be found in University of Phoenix Materials.
In-Class Group Case Study Form
|Nursing dx: |Nursing dx: |
| | |
|Short-term goal: |Measurable outcome: |Short-term goal: |Measurable outcome: |
| | | | |
| | | | |
|* Interventions: |* Rationales: |Interventions: |Rationales: |
|1. |1. |1. |1. |
|2. |2. |2. |2. |
|3. |3. |3. |3. |
|4. |4. |4. |4. |
|Opportunities for teaching (prevention, health maintenance, etc.) |
*Four interventions with rationale for each
• Assessment
• Therapeutic intervention
• Education
• Referral
University of Phoenix Faculty Material
Workshop One – Case Studies
WS 1 - Case Study I
65 year-old male with type II diabetes is admitted for right lower lobe pneumonia and blood sugars out of control. He has been taking glyburide 10 mg bid and his blood sugars have been 150-180 before breakfast and supper prior to the onset of the pneumonia. The day prior to admission, his fasting blood sugars were 350 with his before supper blood sugars around 450. His primary care provider initially placed him on Amoxicillin 500 mg tid two weeks ago for a sinus infection. However, he did not improve and a cough and fever developed. He is admitted to the medical floor for IV antibiotics and control of his blood sugars. He is started on NPH insulin 12 U q am and 6 U q pm with a sliding scale of regular insulin. For the past two days, he has required 4 units of regular insulin in the morning, at noon, and at dinner. Last night he had an insulin reaction at midnight.
WS 1 - Case Study II
A 72 year-old female with type II diabetes is admitted with increasing shortness of breath, edema, weight gain, and fatigue. Her admitting labs reveal a TSH of 62 (0.35 – 3.5 μU/ml) and her T4 is (4.5 – 11.5 μU/dl). Other labs are within normal limits. She is diagnosed with low output heart failure secondary to hypothyroidism. She is started on thyroid replacement and an ACE inhibitor.
WS 1 - Case Study III
A 26 year-old female is admitted to your medical unit in high output heart failure due to hyperthyroidism (Graves disease). Her BP is 160/100, pulse is 110, and respirations are 22. She is restless and complaining of feeling nervous. She has bibasilar crackles and 2+ edema. Her entire body seems to shake with each heartbeat. She is started on a beta-blocker (metoprolol) 50 mg bid, Lasix 40 mg qd, and KCL 20mEq qd.
WS 1 - Case Study IV
A 40 year-old woman is admitted for pain control following a minor fall while roller skating, which caused a compression fracture of T10. A DEXA bone density study reveals a T score of –3.0, consistent with a diagnosis of osteoporosis. Because of her age, a work-up was instituted to find the cause of her osteoporosis. Her serum calcium was 14 (9-11mg/dl) and her PTH intact (parathyroid hormone) was 59pg/ml (11-54pg/ml). A diagnosis of hyperparathyroidism was made. An ultrasound of the thyroid and parathyroid glands was completed and an adenoma assumed to be on a parathyroid gland was found. The patient was scheduled for surgical excision of the parathyroid adenoma the following day.
WS 1 - Case Study V
You are caring for a 35 year-old male in the ICU for observation after he was admitted following a MVA in which he sustained a head injury and chest trauma. On admission he was somnolent and confused. Twenty-four hours after admission he is unresponsive to verbal stimuli and develops severe hypotension. Stat blood work reveals sodium of 119 (135-145mEq/L) and potassium of 5.9 mEq/L (3.5 – 5.5 mEq/L). The patient’s wife arrives from an out-of-town business trip after being told of her husband’s accident. She informs the physician that the patient has Addison’s disease and has been taking fludrocortisone and cortisol, which he has been without for at least 2 days now.
Note to faculty: use this case study as a review of the adrenal glands and hormone production and nursing care of patients in shock. Addison’s disease is rare and the students may never see it.
WS 1 - Case Study VI
A 30 year-old woman with cystic fibrosis had a lung transplant 5 years ago and has done well. She has been on Prednisone 25 mg qd since the transplant and now has iatrogenic Cushing’s syndrome. She is admitted to your medical unit with intractable nausea and vomiting for two days secondary to a viral illness. She has been unable to keep her medications down for two days, as well. She is weak, light-headed, and dehydrated. Her labs reveal hypokalemia, mild hypernatremia, and a urine specific gravity of 1.030. She is 5’5” tall and weight 105 pounds, which is 5 pounds less than she weighs normally.
WS 1 - Case Study VII
A 30 year-old male is admitted to the ICU with new onset diabetes insipidus. He has been drinking large quantities of water and voiding frequently. His serum sodium is 150 mEq/L (135-145mEq/L), his blood glucose 100 mg/dl (70-110 mg/dl), and his urine specific gravity is 1.000. He is light headed when he stands. He has a 20-point drop in his systolic blood pressure from sitting to standing, his skin turgor is poor, and he mucous membranes are dry. He is started on desmopressin.
WS 1 - Case Study VIII
A 40 year-old obese woman is admitted for amputation of her right lower leg due to gangrene of her toes. She has severe peripheral arterial disease and poor eyesight due to her 20-year history of poorly controlled diabetes mellitus type II. She is 5’3” tall and weights 200 pounds. She has smoked 2 packs per day for 20 years. Because she is disabled, she is on a fixed income and cannot afford a variety of foods. She is on Glucophage 1 Gm bid, which she takes sporadically. She is concerned about how she is going to get around after her leg is amputated.
University of Phoenix Faculty Material
Workshop Two - Case Studies
WS 2 - Case Study I
A 56 year-old male is admitted with low back pain and a herniated intervertebral disk. He is scheduled for a laminectomy and diskectomy tomorrow under general anesthesia. He has been taking Percocet and a muscle relaxer for pain at home and they have not been controlling his pain, which he rates at 8 out of 10. He has COPD and continues to smoke 2 packs per day, which he has done for 25 years. He is employed as a construction worker and is concerned he will not be able to pay his bills while he is recuperating.
WS 2 - Case Study II
A 32 year-old male was referred to an orthopedic surgeon because of right hip pain unrelated to exercise. An X-ray revealed a bone tumor in the head of the femur and a biopsy revealed a chondrosarcoma. A bone scan showed no metastatic lesions. Surgery to remove the head of the femur and replace it with a total hip arthroplasty is scheduled for tomorrow. The patient has only had a week to comprehend that he has cancer and is very frightened. He rates his pain as 7 out of 10 with Percocet every 4 hours.
WS 2 - Case Study III
A 56 year-old divorced female is admitted for IV antibiotics for an osteomyelitis of her right foot and pain control. She had surgery for a bone spur one month ago and continued to have pain. An MRI indicated osteomyelitis and a culture from the bone confirmed the diagnosis. The patient is unable to bear weight on the foot and unable to use crutches or a walker due to shoulder problems. She has already lost her job as a retail clerk because of the ongoing pain. She is worried about paying her rent and other bills. She has adult children who live out-of-state who cannot help her financially.
WS 2 - Case Study IV
A 63 year-old male is admitted for right total knee arthroplasty for degenerative joint disease. He has severe DJD in both knees and eventually will need to have the other knee replaced as well. However, his orthopedic surgeon has opted to do only one during this admission due to the patient’s varicose veins in his left leg. The patient also has DJD in his hands and is concerned about being able to use a walker or cane post-op. The patient’s wife has Alzheimer’s disease and he must care for her. Her sister has come from out-of-state to care for her while he is hospitalized, but she cannot stay for more than a month.
WS 2 - Case Study V
A 45 year-old female owner of a fabric store is admitted due to thrombocytopenia. She has rheumatoid arthritis and was not responding to NSAIDs. She consulted a rheumatologist who started her on Penicillamine 2 weeks ago. She is admitted for platelet transfusion when she was found to have a platelet count of 18,000μL (150,000-400,000) during her follow-up visit with the rheumatologist. Her WBC was also low at 3000μL (4500 – 10,000μL). She has no signs of symptoms at this time. She is concerned about the staff at her store being able to keep things going without her.
WS 2 - Case Study VI
A 34 year-old single mother developed rheumatoid arthritis after delivery of her second child. Her arthritis did not respond to an adequate trial of NSAIDs and she has been on Prednisone 20 mg for the past month in order to have any quality of life and care for her 3 year-old and 8 month-old children. She is admitted for total joint replacement surgery on her right wrist, which is her dominant hand. She has ulnar deviation on both hands with synovitis of the MCP’s and PIP’s bilaterally. She is concerned about how she will care for her children post-operatively. Since she normally uses a cane in her right hand due to the arthritis in her knees, she is also concerned about being able to walk.
WS 2 - Case Study VII
An 82 year-old woman fell at home and fractured her left hip. She is placed in Buck’s traction. She is 5’2 inches tall and weighs 100 pounds. She has a history of osteoporosis. You notice that her skin is very thin and she has multiple small bruises on her hands and forearms. Her left lateral hip area that sustained the impact of the fall is quite ecchymotic and there is a small skin tear in that area. She lives alone and has no family nearby.
WS 2 - Case Study VIII
A 34 year-old male is admitted with bibasilar pneumonia. The chest X-ray was consistent with Pneumocystis pneumonia. His HIV antibody is positive and is confirmed with a positive Western blot. His CD4 count is 180/mm3. The patient is homosexual, but was unaware he had AIDS. He ended a short relationship two months ago and has just started an intimate relationship with another man. He is concerned that he has infected his new partner.
University of Phoenix Faculty Material
Workshop Three - Case Studies
WS 3 - Case Study I
A 58 year-old woman was admitted with normal pressure hydrocephalus for shunt placement, which was done earlier in the day. She works as a banker and had been having increasing difficulty with her memory and felt unsteady on her feet. She has returned from recovery and is groggy. She complains of a headache and pain in the incision site on her abdomen.
WS 3 - Case Study II
A 32 year-old male is admitted following an MVA during which he sustained a closed head injury. As he is being admitted to your ICU, he has a grand mal seizure. You are the only nurse in the room and you must respond.
WS 3 - Case Study III
A 45 year-old woman with migraine headaches is admitted to the medical floor. The purpose of the admission is to control her pain while she is taken off all of her headache medicines: Imitrex, Tegretol (used for prevention), metoprolol (used for prevention), and all OTC products. Many of these drugs cause rebound headaches, and her physician wants to see if eliminating all her medications will decrease the frequency of the headaches. She is currently getting headaches every day and takes 1-2 doses of Imitrex per day. The patient is very apprehensive about this as the pain is often 9 out of 10. For the first 48 hours she will have a PCA pump with Demerol for pain control. After that, the physician plans to control her pain with Percocet. Her expected hospital stay is 2 weeks.
WS 3 - Case Study IV
A 88 year-old male on Coumadin for atrial fibrillation and a prosthetic mitral valve lost his balance and fell backwards striking the back of his head. He sustained a small laceration but the paramedics were able to control the bleeding. He arrives in your ICU after being evaluated in the ER where the laceration was sutured. He is confused and somnolent, but able to move all extremities on command. Two hours later he is incontinent of urine and unresponsive to even painful stimuli. His family insists on full code status.
WS 3 - Case Study V
A 42 year-old woman is admitted with bacterial meningitis. She has a fever of 102 and a headache. She has been vomiting for several days and is dehydrated. She is admitted to ICU for antibiotic treatment. Her level of consciousness has fluctuated since she was admitted.
WS 3 - Case Study VI
A 50 year-old nursing instructor became depressed. She attributed it to menopause, but when she did not get better with hormone replacement therapy, she was treated with an antidepressant. No improvement in mood occurred. Six weeks later she fell on campus and could not get up. Her right arm and leg were weak. An MRI of her head revealed a brain tumor near the cerebellum. Surgery was done to remove the tumor. The biopsy done at that time revealed an astrocytoma. The patient has two teen-agers, 13 and 15 years of age, and a husband who has been a quadriplegic since an accident 15 years ago. She has provided total care for her husband since the accident. The patient’s prognosis is poor and she is not expected to live more than a couple of months. She is currently in your ICU immediately post-op craniotomy surgery.
WS 3 - Case Study VII
A 78 year-old man is brought into the ER with new onset right-side hemiplegia and expressive aphasia. His daughter stopped by to visit her father and found him in bed, incontinent of urine and stool. It was obvious he had been there for over 24 hours, unable to help himself. He is admitted to the medical unit for a work-up, physical, and speech therapy. He has a history of hypertension and hypercholesterolemia. He is currently taking Zestril 20mg qd and HCTZ 50 mg qd. His blood pressure is 162/100, his mucous membranes are dry, and his skin turgor is poor. He is unable to move his right arm or right leg. He seems to understand what you are saying, but cannot respond verbally. He becomes very frustrated when he tries to talk.
WS 3 - Case Study VIII
A 68 year-old woman with a history of diabetes and hypercholesterolemia is admitted for a right carotid endarterectomy. She has a history of hypertension and is taking atenolol 50mg qd and HCTZ 50 mg qd. She is also on Glucophage 1Gm bid and Zocor 20mg q hs. Her right carotid artery is 75% occluded and her left is 50% occluded. She is concerned about being started on insulin post-operatively to manage her blood sugars and is afraid she will not be able to “get off of it” post-op.
University of Phoenix Faculty Material
Workshop Four - Case Studies
WS 4 - Case Study I
A 28 year-old male is admitted to the ER following a diving accident at the lake. He has sustained a C3-4 spinal cord injury but is breathing on his own. As he arrives in the ICU, his BP drops, he becomes bradycardic and areflexic. His frantic parents arrive in your ICU asking many questions. They want to know the extent of his injuries and whether or not he will recover and be normal.
WS 4 - Case Study II
A 78 year-old osteoporotic woman fell in her kitchen and sustained a fracture of T10. The bone fragments are pressing on her spinal cord and she has little sensation or mobility in her legs. She is also incontinent of urine. She rates her pain at 9 out of 10. She is a widow and lives alone. She is concerned about ever being independent again. Surgery is planned for tomorrow to remove the bone fragments and relieve pressure on her spine.
WS 4 - Case Study III
A 65 year-old woman is admitted with a fractured right hip following a fall at home. She is generally healthy except she has middle stage Alzheimer’s disease. She is being prepped for ORIF of the hip and will return to the ortho floor post-op. Her daughter with whom she lives feels terrible that the fall couldn’t have been prevented and feels responsible. She tells you that her mother gets very confused at night and often wanders.
WS 4 - Case Study IV
A 43 year-old social worker with two children is admitted with a fractured right femur following an MVA. Other than multiple contusions, she is not seriously injured. She has a history of MS and ranges from ambulating with a cane to being confined to a wheelchair. Her left leg is placed in balanced suspension traction, which her spasticity makes difficult. The orthopedic surgeon plans to cast her in a few days when the swelling has diminished. She rates her pain as 6/10, but she is extremely fatigued. The stress of the accident has exacerbated her MS.
WS 4 - Case Study V
A 70 year-old male is admitted with sepsis due to a urinary tract infection caused by BPH and his inability to empty his bladder. He also has Parkinson’s disease and is currently taking levodopa. The sepsis has caused him to be confused, disoriented, and unable to care for himself. He has an indwelling Foley catheter. A TURP is planned after the infection clears.
WS 4 - Case Study VI
A 74 year-old Asian woman is admitted for hiatal hernia surgery. She is recovering well and tolerating a clear liquid diet 48 hours post-op. She suddenly develops a headache, nausea, vomiting, and pain in her right eye. She has a history of glaucoma and has been without her eye drops for several days. Acute angle-closure glaucoma is diagnosed and the patient scheduled for an emergency laser trabeculoplasty.
WS 4 - Case Study VII
A 72 year-old woman is admitted with a fractured left humerus sustained in a fall that was caused by an acute attack of vertigo. The patient became very dizzy, fell, and began to vomit. The fall caused a fracture in the surgical neck of her humerus. The patient tried to get up off the floor, but could not due to any body movement causing dizziness. Her husband summoned the paramedics who brought her to the ER. After being admitted to the medical unit, she is placed in skeletal traction. She was given meclizine 50 mg IM for the vertigo while in the ER which has made her very sleepy.
WS 4 - Case Study VIII
A 42 year-old female is admitted to the ICU in the acute stage of Guillain-Barré syndrome following a viral illness. The disease had progressed up both legs at this time, and she is very frightened.
University of Phoenix Faculty Material
Workshop Five - Case Studies
WS 5 - Case Study I
An 88 year-old woman is admitted from a nursing home with a fractured hip and is placed in Buck’s traction. She weighs 100 pounds and is 5’3” tall. During your initial assessment you note that her mucous membranes are dry and her skin turgor is poor. Psoriasis is active on her elbows, knees, and buttocks. You also discover a stage I decubitus over the sacrum and stage III ulcers on both heels. She has a history of hypertension, diabetes, and psoriasis. Her blood pressure is 100/60, pulse 92, temp 99. She takes HCTZ 50 mg qd and methotrexate 2.5mg, one tablet weekly for her psoriasis. She must remain on bedrest in traction for several days until she can be rehydrated and readied for surgery.
WS 5 - Case Study II
A 22 year-old male is admitted to the burn unit with second-degree burns over 60% of his body. His house caught fire while he and his family were sleeping. Everyone got out safely, but he was badly injured when he returned to the house to retrieve his dog. He was unable to find his pet. He suffered smoke inhalation and is in mild respiratory distress as he arrives.
WS 5 - Case Study III
A 35 year-old male is admitted for wide excision of a malignant melanoma on his upper back. Two days post-operatively, the patient complained of severe right knee pain that began suddenly. When you assessed the knee, it was red, quite warm, swollen, and the skin had a reddish purple tint (violaceous). The physician was notified and examined the patient. Acute gout was diagnosed and the patient was started on IV steroids since he remained nauseated and was not tolerating PO fluids well. Demerol was prescribed for pain.
WS 5 - Case Study IV
A 32 year-old male is admitted for dehydration. He has AIDS and his CD4 count is 100/mm3. He has multiple opportunistic infections; Kaposi’s sarcoma on his arms, legs, and trunk, severe tinea cruris in the groin, axilla, intertrial fold of the buttocks and perirectally, and severe oral thrush. His thrush is so severe that he has not been able to eat or tolerate fluids for several days. He has little weight to lose weighing in at 130 pounds at 6’2”. He knows he is going to die and is frightened. His partner of 10 years stays with him night and day.
University of Phoenix Faculty Material
Clinical Conferencing
The Clinical Conference will take place in CourseCompass. Within CourseCompass go to the Control Panel ( Discussion Board. Students will access Clinical Conferencing by clicking on the Discussion Board link on the left hand side of the CourseCompass page.
To set up a conference, click on the “Add Forum” button. Title this “Clinical Conference One” and copy and paste the following description:
The weekly clinical conference will take place as an asynchronous chat within CourseCompass as part of this course. You will be expected to respond to questions posted by your faculty and to your fellow learner’s responses. Clinical Conferencing will take two hours of your time each week.
Clinical Conferencing will be conducted weekly online through CourseCompass. Students will be responsible to join the conference to discuss the week’s clinical rotation, patient/client outcomes, accomplishments, and challenges. Participation in Clinical Conferencing will require approximately 1 to 2 hours per week. Attendance will be taken.
Click “Submit” and then “OK” on the screen that follows. This will take you back to the Discussion page. Repeat the above process, setting up Clinical Conferences Two, Three, etc. To comment on the particular conference, the students will click on what you have just created and add their comment.
University of Phoenix Faculty Material
In-Class Group Case Study Form
|Nursing dx: |Nursing dx: |
| | |
|Short-term goal: |Measurable outcome: |Short-term goal: |Measurable outcome: |
| | | | |
| | | | |
|Interventions* |Rationales* |Interventions |Rationales |
|1. |1. |1. |1. |
| |2. |2. |2. |
|2. | | | |
| |3. |3. |3. |
|3. | | | |
| |4. |4. |4. |
|4. | | | |
|Opportunities for teaching (prevention, health maintenance, etc. |
| |
*Four interventions with rationale for each
Assessment
Therapeutic intervention
Education
Referral
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