Behavioral Objectives



|Behavioral Objectives |Content Outline |Clinical Objectives |Learning opportunities |

|Apply the terms listed in the content |Application of terms |Take client's history using structured and|Readings: |

|column appropriate to the client situations. |Anasarca |unstructured data collection tools to |Lewis 8th ed (2011) |

| |Azotemia |obtain physical, psychosocial, spiritual, | |

| |Debridement |cultural, familial, occupational, |Adams 3rd (2011) |

| |Eschar |environmental information, risk factors, | |

| |Graft |and client resources. |McKinney 3rd (2009) |

| |Interstitial edema | | |

| |Osmolality |Perform assessment to identify health | |

| |Wilm’s tumor |needs and monitor for change in health | |

| | |status. | |

|Compare and contrast the normal anatomy and |Anatomy & Physiology | |VCR: |

|physiology of the renal and integumentary systems to |Integumentary system |Validate, report, and document assessment |#M099 |

|the pathophysiology resulting in the loss of |Renal system |data using assessment tools. |Gerontology: Meeting Oxygenation and Fluid and |

|homeostasis. |Developmental considerations | |Electrolyte Needs. |

| |Infant |Identify complex multi-system health care | |

| |Child |problems of clients. | |

| |Adolescent | | |

| |Adult |Formulate nursing diagnoses based upon | |

| |Older adult |analysis of health data. | |

| |Pathophysiology of integumentary and renal system | | |

|Analyze factors included in the assessment of the |Assessment |Perform health screening. | |

|client experiencing fluid/electrolyte shifts |Interview | | |

|secondary to problems of the integumentary system and|Chief complaint |Analyze and interpret health data of | |

|the renal system, including the developmental and |History of present illness |clients. | |

|cultural considerations. |Prior medical history | | |

| |Medication history (prescription/ |Incorporate multiple determinants of | |

| |non-prescription) |health in clinical care when providing | |

| |Family/social/occupational history |care for individuals and families. | |

| |Knowledge of health maintenance | | |

| |Identify risk factors for disorders – fluid & electrolyte | | |

| |Physical exam of integumentary system | | |

| |Airway | | |

| |Level of consciousness | | |

| |Estimation of percentage of burned skin (age specific) | | |

| |Depth of burn | | |

| |Vital signs | | |

| |Physical exam of renal system | | |

| |Edema | | |

| |Weight | | |

| |Urine (amount, characteristics) | | |

| |Vital signs | | |

| |Hemodynamic parameters | | |

| |Skin | | |

| |Level of consciousness | | |

| |Nausea, vomiting, diarrhea | | |

| |Diagnostic tests | | |

| |Radiology | | |

| |Chest x-ray | | |

| |Flat plate of abdomen | | |

| |Skeletal | | |

| |Laboratory studies | | |

| |Renal function tests | | |

| |Blood urea nitrogen (BUN) | | |

| |Creatinine | | |

| |Electrolytes | | |

| |Serum calcium | | |

| |Serum phosphorous | | |

| |Serum magnesium | | |

| |Complete blood count (CBC) | | |

| |Serum protein/albumin | | |

| |24-hour urine | | |

| |creatinine | | |

| |protein | | |

| |Electrocardiogram (EKG) | | |

| |Arterial blood gases | | |

| |Renal biopsy | | |

| | | | |

| | | | |

| |Cultural influences | | |

| |Hereditary | | |

| |Environmental | | |

| |Health beliefs/practices | | |

| |Developmental | | |

| |Age specific assessment data | | |

| |Vital signs | | |

| |Fluid /electrolytes | | |

| |Nutritional | | |

| |Behavioral/emotional response to health care providers | | |

|Differentiate between the etiology, pathophysiology, |Disorders of integumentary and renal systems | | |

|and clinical manifestations of selected problems of |Burns | | |

|the integumentary and renal systems. |Nephrotic syndrome | | |

| |Renal failure | | |

| |Acute | | |

| |Chronic | | |

|Discuss analysis, planning, implementation and |Selected nursing diagnoses/implementation/ evaluation | |Will complete analysis of client with chronic renal |

|evaluation for the nursing management of clients with|Fluid and electrolyte imbalance | |failure on dialysis. |

|fluid/electrolyte shifts secondary to integumentary |Independent interventions | | |

|and renal disorders. |Review physical assessment | | |

| |Intake & output | | |

| |Weight | | |

| |Age related hydration status | | |

| |Intake & output | | |

| |Weight | | |

| |Age related hydration status | | |

| |Monitor pertinent diagnostic tests | | |

| |Maintain integrity of edematous skin | | |

| |Maintain bed rest | | |

| |Vital signs | | |

| |Maintain body temperature | | |

| |Positioning | | |

| |Collaborative interventions | | |

| |Administer replacement fluid | | |

| |Oral replacement solutions | | |

| |Intravenous therapy | | |

| |Parkland / Baxter Formula | | |

| |Administer medications and monitor for desired/adverse/side effects | | |

| | | | |

| |Biologic response modifiers | | |

| |Corticosteroids | | |

| |Immunosuppressive | | |

| |Ion exchange resins | | |

| |Antibiotics | | |

| |Diuretics | | |

| |Topical Sulfonamides | | |

| |Sodium bicarbonate | | |

| |Anti-hypertensives | | |

| |Dialysis | | |

| |Hemodialysis | | |

| |Peritoneal dialysis | | |

| |Recognition of complications | | |

| |a. Acute Tubular Necrosis (ATN) | | |

| |b. Burn shock | | |

| |c. Heart failure/pulmonary edema | | |

| |d. Hypovolemic shock | | |

| |e. Hypocalcemia | | |

| |f. Hyperphosphatemia | | |

| |g. Hyperkalemia | | |

| |h. Impaired skin integrity | | |

| |i. Thromboembolism | | |

| |j. Peptic ulcer disease (PUD) | | |

| |k. Pericarditis | | |

| |l. Seizures | | |

| |m. Renal osteodystrophy | | |

| |n. Infection | | |

| |o. Peritonitis | | |

| |The client will have improved fluid and electrolyte balance as | | |

| |evidenced by: | | |

| |Clear sensorium | | |

| |Vital signs | | |

| |Improved laboratory studies | | |

| |Intake & output (age specific) | | |

| |Weight | | |

| |Decreased edema | | |

| |Peripheral pulses | | |

| |Patent dialysis accesses | | |

| |Impaired gas exchange | | |

| |Independent interventions | | |

| |Emergent | | |

| |Extinguish the flames | | |

| |Assess breathing | | |

| |Maintain patent airway | | |

| |Administer 100% humidified O2 | | |

| |Obtain pertinent history regarding burn incident | | |

| |Assess nasal hairs, sputum, breath sounds | | |

| |Assess color | | |

| |Assess for restlessness, confusion, decreased sensorium | | |

| |Pulmonary toileting | | |

| |Hospital/burn center | | |

| |Continuous assessment of respiratory status | | |

| |Pulse oximeter/arterial blood gases | | |

| |Prepare to intubate | | |

| |Positioning | | |

| |Collaborative | | |

| |Respiratory therapy | | |

| |Oxygen support | | |

| |Mechanical ventilation | | |

| |Escharotomy | | |

| |Recognition of complication | | |

| |Carbon monoxide poisoning | | |

| |Respiratory failure | | |

| |The client will exhibit improved gas exchange as evidenced by: | | |

| |Breathing pattern | | |

| |Level of consciousness | | |

| |ABG’s/pulse oximeter | | |

| |Vital signs | | |

| |Color | | |

| |Cough/sputum | | |

| |Impaired skin integrity | | |

| |Independent interventions | | |

| |Assess tissue perfusion | | |

| |Assess depth and extent of burn | | |

| |Positioning | | |

| |To decrease edema | | |

| |To maintain function | | |

| |Maintain body temperature | | |

| |Prevent infection | | |

| |Environmental controls, isolation | | |

| |Sepsis | | |

| |Monitor pertinent labs (CBC, wound C&S) | | |

| |Monitor nutritional status | | |

| |Collaborative interventions | | |

| |Wound cleansing | | |

| |Wound covering/dressings | | |

| |Debridement | | |

| |Mechanical | | |

| |Surgical | | |

| |Enzymatic | | |

| |Administration of medications and monitor for desired | | |

| |effects/adverse effects/side effects | | |

| |Antibiotics | | |

| |Topical antibiotics | | |

| |Systemic antibiotics | | |

| |Narcotic analgesics | | |

| |Tetanus toxoid | | |

| |Biologic dressings | | |

| |Temporary grafts | | |

| |Permanent autografts | | |

| |Graft site | | |

| |Donor site | | |

| |Collaborate with physical therapy | | |

| |Escharotomy | | |

| |Recognition of complications | | |

| |Failure to heal | | |

| |Infection | | |

| |Inadequate nutrition | | |

| |Compartment syndrome | | |

| |Scarring | | |

| |Contractures | | |

| |The client will have improved skin integrity as evidenced by: | | |

| |Absence of infection | | |

| |Donor site clean and reepithelializing | | |

| |Lab work | | |

| |Healed wounds that are soft and smooth | | |

| |Full range of motion of extremities | | |

| |Participate in activities of daily living | | |

| |Altered health maintenance: knowledge deficit | | |

| |Client teaching | | |

| |Assess readiness to learn, ability, knowledge | | |

| |Avoid aggravating factors | | |

| |Promotion of alleviating factors | | |

| |Reportable signs/symptoms | | |

| |Wound care | | |

| |Dialysis access device care | | |

| |Medication teaching | | |

| |Rest/activity | | |

| |Range of motion (ROM) | | |

| |Compression device | | |

| |Splints | | |

| |Life style modifications | | |

| |Nutritional | | |

| |High protein | | |

| |Low protein | | |

| |Community Resources | | |

| |Dialysis centers | | |

| |National Kidney Foundation | | |

| |Home Health | | |

| |Department of Public Health | | |

| |Alcoholics Anonymous | | |

| |Burn support groups | | |

| |The client will have improved health maintenance as evidenced by: | | |

| |Stating rationale for different aspects of treatment | | |

| |Identifying reportable signs and symptoms | | |

| |Describing the purpose, correct administration and side effects of | | |

| |medications | | |

| |Increasing activity as tolerated | | |

| | | | |

| |Achieving optimum level of nutrition through prescribed diet | | |

| |Utilizing community resources | | |

| |Ineffective Individual coping: anxiety, fear, powerlessness, | | |

| |dependence | | |

| |Independent interventions | | |

| |Establish trust and rapport | | |

| |Therapeutic communication | | |

| |Assess for coping abilities and previous coping strategies | | |

| | | | |

| |Assist client in setting achievable short term goals | | |

| |Client in development of appropriate problem solving strategies | | |

| |Encourage client/significant other to discuss sexual concerns | | |

| |Collaborate with occupational therapist/refer for job training | | |

| |Assess spiritual needs and collaborate with spiritual leader | | |

| |Encourage family participation in client care, refer to social | | |

| |services | | |

| |The client will have individual effective coping as evidenced by: | | |

| |Verbalizes reaction to the disorder, treatment, and losses | | |

| |Identifies coping strategies | | |

| |Verbalizes realistic view of problems | | |

| |Cooperates with health care providers | | |

| |Participates in decision making | | |

| |Resolves grief over losses | | |

| |Displays hopeful attitude towards future | | |

| |Discussing sexual concerns | | |

| |Discussing spiritual concerns | | |

| |Utilizes community resources | | |

| |Body image disturbance | | |

| |Independent interventions | | |

| |Establish trust and rapport | | |

| |Therapeutic communication | | |

| |Provide reliable information | | |

| |Provide privacy and safe environment | | |

| |Encourage family to participate in care | | |

| |Encourage independence | | |

| |Arrange for continued schooling | | |

| |Prepare significant others/peers for altered appearance | | |

| |Provide opportunity to share with people going through similar | | |

| |experiences | | |

| |Use role playing | | |

| |Discuss sexuality concerns | | |

| |Assess meaning of loss for the client/family | | |

| |The client will acknowledge change in body image as evidenced by: | | |

| |Verbalizing feelings to nurse/significant other | | |

| |Accepts physical appearance | | |

| |Demonstrates interest in resources | | |

| |Uses cosmetics, wigs, and prosthesis to achieve acceptable | | |

| |appearances | | |

| |Socializes with others | | |

| |Seeks and achieves return to role in family, school, or community as| | |

| |a contributing member | | |

N:Spirng\ RNSG 2414 Unit III – Fluid & Electrolyte Reviewed 06/11

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