NURSING 2808 - TCOnline
RNSG 1441
CONCEPTS OF CLINICAL
DECISION MAKING
SYLLABUS
PREPARED BY FACULTY
DIVISION OF HEALTH SCIENCE
TEXARKANA COLLEGE
TEXARKANA, TEXAS
TC does not discriminate on the basis of race, color, national origin, sex, disability,
or age in its programs or activities. The following person has been designated to
handle inquiries regarding the nondiscrimination policies:
Human Resources Director, 2500 N. Robison Rd., Texarkana, TX, 75599
(903) 823-3017 human.resources@texarkanacollege.edu
REVISED May 2017
TABLE OF CONTENTS
Page
Course Description, End of Course Outcomes, Key Concepts and General Course Plan.... 3
Student Learning Outcomes....................................................................................……… 4
Course Requirements...........................................................................................……. 6
Methods of Instruction.........................................................................................……. 8
Required Textbooks.............................................................................................……. 8
Disability Act/Financial Aid/Security Information………………………………… 9
Methods of Evaluation.........................................................................................……. 10
ATI Resources and Policy…………………………………………………………….. 12
Testing Center Policies………………………………………………………...……….. 14
Institutional Effectiveness....................................................................................……. 15
Objectives for On-Campus Lab Days.......................................................................…… 16
Major Course Topics RNSG 1441......................................................................…….. 18
Application of the Nursing Process:
Focusing on Gastrointestinal Disorders ................................................……… 19
Focusing on Endocrine Disorders …………………………………………….. 23
Focusing on Eye-Ear-Nose-Throat Disorders .........................................…...….. 26
Focusing on Critical Care........………………........................…………. 35
Focusing on Integumentary Disorders ..........................................………….. 52
Focusing on Musculoskeletal Disorders.................................……....... 54
Focusing on Reproductive and Sexual Disorders........................................…… 63
COURSE SYLLABUS OUTLINE: Fall 2017
COURSE NAME: Common Concepts of Adult
Health
COURSE NUMBER: RNSG 1441
CREDIT HRS: 4 LECTURE: 3
LAB: 3 TOTAL CLOCK HOURS: 96
Course Title: Common Concepts of Adult Health
Course Level: Intermediate
Course Description: Integration of previous knowledge and skills into the continued development of the professional nurse as a provider of patient-centered care, patient safety advocate, member of the healthcare team, and member of the profession. Emphasis on clinical decision making for patients in medical-surgical settings experiencing health problems involving gastrointestinal disorders, endocrine and metabolic disorders, reproductive and sexual disorders, musculoskeletal disorders, eye-ear-nose-throat disorders and integumentary disorders. Discussion of knowledge, judgment, skills, and professional values within a legal/ethical framework.
End of Course Outcomes: Utilize critical thinking, a systematic problem solving process, as a framework for providing care for patients in structured health care settings experiencing health problems involving gastrointestinal disorders, endocrine and metabolic disorders, reproductive and sexual disorders, musculoskeletal disorders, eye-ear-nose-throat disorders and integumentary disorders; and integrate the roles of the professional nurse in the provision of care for patients and families.
Key Concepts and General Course Plan: This course is designed for second year nursing students. Content related to principles of management, current trends affecting health care delivery, and care of patients with gastrointestinal, endocrine and metabolic, reproductive and sexual, musculoskeletal, eye-ear-nose-throat, and integumentary disorders. The student has opportunity to begin to assume responsibility and accountability for the quality of nursing care provided at the graduate nurse level. Mental health concepts, pharmacology, nutrition, technical skills, cultural diversity, and standards of nursing practice are threaded throughout the course.
Prerequisites: BIOL 2301/2101, 2302/2102, 2320/2120; PSYC 2301, 2314; AHA/BLS-HCP
Basic Students: RNSG 1413/1360, 1431/1260, 1412/1261.
Transition Students: RNSG 1327, 1251, 1160.
Corequisites: ARTS 1301 or MUSI 1306, or DRAM 1310; RNSG 2360, 2213
Revised: October 2014 QSEN - Quality & Safety Education for Nurses
PSLO = I.E. Student Learning Outcomes (Program) QSEN-P = Patient-Centered Care
CO= Student Learning Outcomes (Course) QSEN-T = Teamwork and Collaboration
** = Critical Thinking/Communication Skills QSEN-E = Evidence-Based Practice
DEC = Differentiated Essential Competencies (A D N) QSEN-Q = Quality Improvement
DEC-M = Member of the Profession QSEN-S = Safety
DEC-P = Provider of Patient-Centered Care QSEN-I = Informatics
DEC-S= Patient Safety Advocate
DEC-T=Member of the Health Care Team
SOP = Texas Board of Nursing (BON) Standards of Practice (2007)
RNSG 1441 CONCEPTS OF CLINICAL DECISION MAKING
COURSE STUDENT LEARNING OUTCOMES
(Competencies to be measured)
Upon completion of this course, the student will be able to:
**1. Apply the principles of pharmacology, nutrition, fluids and electrolytes, communication, health promotion and health teaching. PSLO 1
DEC-M-B, DEC-P-A DEC-T-C SOP 1C, 1D, 1F QSEN - P
**2. Relate with assistance, selected principles and procedures of healthcare utilizing the nursing process. PSLO 2 DEC-P-D, E, G, H DEC-S-B DEC-T-A, B, C
SOP 1D, 1F, 1P QSEN - P
**3. Discuss the importance of evaluating the patient’s response to treatment and nursing care. PSLO 1 DEC-P-F, G SOP 3A, 5 QSEN - P
**4. Examine therapeutic communication skills to interact effectively with patients, family and other health care professionals, taking into consideration societal/cultural differences. PSLO 1, 3, 6 DEC-M-B, D DEC-P-A, B, C, H DEC-T-A, D, E, F
SOP 1L, 1P, 3A QSEN - T
**5. Verbalize and explain behaviors that suggest the patient’s and family’s inability to cope with deviations in health. PSLO 3, 6 DEC-P-B, D, E, G DEC-T-A, B, C, D SOP 1F QSEN – P, T
**6. State methods to assess situational and environmental factors that promote a safe physical and psychological patient care environment.
PSLO 2, 3 DEC-S-A,B,C,F DEC-T-B SOP 1E, 1K, 1M, 1N, 1O, 3A, 5 QSEN - S
**7. Identify delegation principles in nursing care according to the Texas Nurse Practice Act. PSLO 4 DEC-M-A, D DEC-P-D, E DEC-S-A, E, S DEC-T-B, F, G SOP 1S, 3B, 1H, 1T QSEN - T
**8. Examine and display professional behaviors that reflect a positive image of nursing. PSLO 5 DEC-M-A, B, C, D DEC-P-A, D DEC-S-A, B, E DEC-T-A, B SOP 1J, 1K, 1R QSEN -Q
**9. Describe legal and ethical principles, as well as, personal values in relationship to the practice of nursing.
PSLO 5 DEC-M-A,B,C,D DEC-P-A,B,D,E DEC-S-A,B,D,E,F DEC-T-A,B,F SOP 1A, 1G, 1J, 1L QSEN – P, Q
**10. Discuss emerging evidence-based practices in the delivery of healthcare. PSLO 5, 6 DEC-M-C, D DEC-P-A, B, C, E, H DEC-S-C DEC-T-A, B, C, E
SOP 1C, 1H, 1Q, 1R, 2, 3A QSEN - E
**11. Demonstrate professional activities that promote continuous learning and self- development. PSLO 5 DEC-M-A, B, C, D DEC-P-H DEC-S-A, E SOP 1A, 1R, QSEN - Q
COURSE REQUIREMENTS
1. Attendance:
Class Absences: No more than four (4) class days may be missed. Only one (1) lab day absence is allowed. In the event of a fifth absence, or 2nd lab day absence, the student will not allowed to continue in the course. Students who are up to 15 minutes late are tardy. Students more than 15 minutes late are absent. Three tardies equal one (1) absence. Leaving class early counts as a tardy or absence according to the time missed. Lab days are considered theory days and an absence from lab will be counted as a theory absence. It is the responsibility of each student to contact the course instructor regarding any theory absence. The student is responsible for content missed during a lab absence.
2. Inclement Weather Policy: Refer to the Health Science Student Handbook.
3. In order to meet Student Learning Outcomes in the Associate Degree Nursing Program, students may be required to attend local professional seminars. A nominal fee may be required for the seminar. If required, the dates will be announced in advance of the seminar. If the seminar is required in lieu of class/clinical, the student will be expected to attend the entire seminar.
4. Outside Readings:
Evidence-Based readings may be taken from nursing periodicals and other publications to supplement your textbook reading. If outside readings are required, they will be available in the College Library.
5. Computer Assignments:
Each student will complete designated computer assignments. Student must sign in on the Student-Log record in the computer lab.
6. Written Assignments:
All written assignments will be submitted to the student’s instructor.
7. Lab Skills:
During the semester, students are assigned clinical skills check-offs to be demonstrated on campus. If the skill demonstrations do not meet the outcomes outlined for the skill, the student will be given two (2) additional opportunities for demonstration of the competency. The highest grade possible for the 2nd attempt will be a 75% and 3rd attempt will be 50% of the points available for that skill. (See grade computation on page 10).
If the student is not successful by the 3rd attempt, the student will not be allowed to continue in the program and will not be allowed to continue in co-requisite or concurrent courses. Refer to the Texarkana College Student Handbook and the Health Science Student Handbook.
8. Standards of conduct as described in the current Health Science Division Student Handbook and Texarkana College Student Handbook will be followed. Disciplinary action is described in the handbooks. Students are responsible for reading and being familiar with these standards.
It is an expectation that students treat faculty, staff and fellow students with respect on campus and in the clinical setting. Incivility will not be tolerated in the Health Sciences Programs.
Should a student not comply with the above expectations, one warning will
be given. A repeat offense will result in the student being asked to leave
the classroom. Appropriate counseling and disciplinary action will follow.
METHODS OF INSTRUCTION
1. Lecture/Discussion
2. Media resources
3. Assigned and supplemental readings
4. Demonstrate/Return demonstration
5. Conference – individual and group
6. Objective testing
7. Self-evaluation
8. Reports and projects
9. Written assignments
10. Computer assignments
11. Study Guides
REQUIRED TEXTBOOKS
A D N Skills Kit (Must be purchased in the TC Bookstore). If you are a Basic student, you have the correct Skills Kit (Royal Blue). If you are a Transition or transfer student, you should have a Skills Kit (Red).
Leeuwen, A., Poelhuis, D., and Bladh, M. Davis’s Comprehensive Handbook of Laboratory Diagnostic Tests with Nursing Implications. (6th edition). Philadelphia: F.A. Davis, 2013.
Ignatavicius, D and Workman, M.L. Clinical Companion for Medical-Surgical Nursing: Patient-Centered Collaborative Care, (8th ed.). St. Louis: Elsevier, 2016.
Ignatavicius, D. and Workman, M.L. Clinical Decision Making Study Guide for Medical-Surgical Nursing: Patient-Centered Collaborative Care, (8th ed.), St. Louis: Elsevier, 2016
Ignatavicius, D. and Workman, M.L. Medical-Surgical Nursing: Patient-Centered Collaborative
Care, (8th ed.). St. Louis: Elsevier, 2016.
Durham, R. & Chapman, L. Maternal-newborn nursing: The critical components of nursing care, (2nd edition). Philadelphia: F.A. Davis Company, 2014.
Rudd, K. & Kocisko, D. Pediatric nursing: The critical components of nursing care, (1st edition). Philadelphia: F.A. Davis Company, 2014.
Nursing Drug Reference/Guide (most recent edition). Within 3 years.
Smith, S., Duell, D., and Martin, B. Clinical Nursing Skills: Basic to Advanced Skills, (8th ed.).
Upper Saddle River, NJ: Prentice Hall Health, 2012.
Texas Board of Nursing Website (2011). Nursing Practice Act. bon.state.tx.us
Taber’s Cyclopedic Medical Dictionary, (22nd edition). Philadelphia: F.A. Davis Company, 2013
Disability Act Statement
Texarkana College complies with all provisions of the Americans with Disabilities Act and makes reasonable accommodations upon request. Please contact the Director of Advisement at 903.823.3283, or go by the Recruitment, Advisement, and Retention Department located in the Administration building for personal assistance.
If you have an accommodation letter from their office indicating that you have a disability, which requires academic accommodations, please present it so we can discuss the accommodations that you might need for this class. It is best to request these changes at the beginning if not before the start of class so there is ample time to make the accommodations.
Financial Aid
Attention! Dropping this class may affect your funding in a negative way! You could owe money to the college and/or federal government. Please check with the Financial Aid office before making a decision.
Security
Please keep your vehicle locked whenever you are away from it. Make sure you don’t leave any valuables in plain sight (purse, phone, lap top). We want you to be safe. You must acquire a TC parking permit and display it in your vehicle. You must also have a TC student ID badge and keep it with you at all times.
Campus police EMERGENCY line: (903) 798-3330
METHODS OF EVALUATION
1. Student must display satisfactory performance in both on-campus laboratory and classroom (minimum of 75% or “C” required) to complete RNSG 1441. In order to progress, RNSG 1441 and 2360 must be passed concurrently.
2. Testing: A 50-item examination will be given at the conclusion of each Unit of Content, for seven (7) Unit Exams. Exam scores are available from your clinical instructor. A comprehensive Final Exam will be given, consisting of 100 items. All exams (except the Final Exam) are available for review in your instructor’s office for a period of one week following the date of the exam. It is your responsibility to make an appointment with your instructor to review the exam. Discussion or disclosing the exams to others constitutes a BREACH OF ETHICS. Refrain from discussing the contents of exams with anyone other than the faculty. Each unit exam will have two dosage calculation problems. ATI remediation activities will be required for unit exam grades < 75%.
If a student is absent on the day of a unit exam, a make-up exam will be given. The make-up exam will consist of 25 questions and must be completed by 4 p.m. the next day back to class. Each question will be worth 4 points. The student will be given 30 minutes to take the exam.
3. Final grade computation:
60% = 7 Unit Exams *
20% = 1 Final Exam *
10% = ATI Practice and Proctored Assessments with required Remediation (see
grading rubric)
10% = ATI quizzes, homework, and skills check-off that include, but are not
Limited to, NGT, central line, and tracheostomy skills.
Grade Range: A 90-100
B 81-89.99
C 75-80.99
D 65-74.99
F 0-64.99
4. Exam scores are recorded as the score earned and will not be rounded.
Example: 74.99 will be recorded as a 74.99 and will be a D. There will be no rounding of exam averages, course averages or other coursework in the Health Sciences ADN Program.
5. *Student must have a passing exam average (unit exams and final) of 75 or greater according to the course criteria in order to successfully complete the course. Once this is accomplished, the other grade categories will be averaged into the overall course grade. The overall course grade must also be a 75 or greater to pass the course and progress in the program.
6. If absent, there will be no opportunity to make-up grades earned during in-class activities or pop quizzes.
7. Successful completion of the ATI Dosage Calculation Proctored Exam with a passing grade of 84 is a requirement of the course. The Dosage Calculation Exam score is not included in the calculation of the course grade. It is a pass/Fail only. One hour will be allowed to take the exam. Should a passing grade on the first exam not be achieved, two retakes will be allowed. If a retake is required, the student must remediate prior to taking the exam the second time. Dosage Calculation retake exams will be administered during a scheduled date and time set by the faculty. A passing score of 84 must be achieved by the date announced or the student will not be allowed to attend clinical days. Should a passing grade on the third exam (second retake) not be achieved, the student will receive a grade of “D” in RNSG 1443 and will not be able to progress in the program. The student must withdraw from RNSG 2360 and RNSG 2213. Drug dosage and infusion calculations will be tested on each unit exam.
8. Progression in a Concurrent Course: (RNSG 1441, RNSG 2360, and RNSG 2213)
Students must register and enroll for all three (3) nursing courses. A student who is unsuccessful in RNSG 1441 or RNSG 2360 or RNSG 2213 may not progress in the concurrent courses.
Drop procedures follow college policy. If a nursing course is dropped, on or before the “Drop Date”, the concurrent nursing courses must also be dropped. Failure on the student’s part to drop the concurrent courses will result in a failing grade being recorded as the grade for that course. This may adversely affect the student’s GPA.
For example: If a student enrolled in RNSG 1441, 2360 and 2213 fails to meet course requirements for performance and/or attendance, or withdraws from RNSG 1441, he/she must withdraw from RNSG 2360 and RNSG 2213. The decision to withdraw must be made before the Drop Date. If the student fails clinical (RNSG 2360) after the drop date, either by attendance or grade, he/she will not be allowed to take the Final Exam in the concurrent theory courses. If the student fails theory, but has successfully passed Clinical, he/she will receive the passing clinical grade on his/her transcript, but must take both courses concurrently if the student is accepted for reentry. A student who is unsuccessful in any nursing course must reapply to the School of Nursing.
Students are expected to follow the printed Curriculum Agreement plan. If the student is withdrawing from a general education course listed on the curriculum agreement, the student must discuss this action with the course coordinator prior to withdrawal as progression in nursing courses may be affected.
ATI Resources for Student Success
Throughout the course, the student will be responsible to completing ATI assessments and modules as assigned by your instructor.
What is ATI?
• Assessment Technologies Institute® (ATI) offers an assessment driven review program designed to enhance student NCLEX-RN success.
• The comprehensive program offers multiple assessment and remediation activities. These include assessment indicator for academic success, critical thinking, and learning styles, online tutorials, online practice testing, and proctored testing over the major content areas in nursing. These ATI tools, in combination with the nursing program content, assist students to prepare more efficiently, as well as increase confidence and familiarity with nursing content.
• Data from student testing and remediation can be used for program’s quality improvement and outcome evaluation.
• ATI information and orientation resources can be accessed from your student home page. It is highly recommended that you spend time navigating through these orientation materials.
Some of the assessment and remediation tools used in ATI are:
• Modular Study: ATI provides online review modules that include written and video materials in all content areas. Students are encouraged to use these modules to supplement course work and instructors may assign these during the course and/or as part of active learning/remediation following assessments.
• Tutorials: ATI offers unique Tutorials that teach nursing students how to think like a nurse; how to take a nursing assessment and how to make sound clinical decisions. Nurse Logic is an excellent way to learn the basics of how nurses think and make decisions. Learning System offers practice tests in specific nursing content areas that allow students to apply the valuable learning tools from Nurse Logic. Features are embedded in the Tutorials that help students gain an understanding of the content, such as a Hint Button, a Talking Glossary, and a Critical Thinking Guide.
• Assessments: Standardized Assessments will help the student to identify what they know as well as areas requiring active learning/remediation. There are practice assessments available to the student and standardized proctored assessments that may be scheduled during courses.
• Active Learning/Remediation: Active Learning/Remediation is a process of reviewing content in an area that was not learned or not fully understood as demonstrated on an assessment. It is intended to help the student review important information to be successful in courses and on the NCLEX.. The student’s individual performance profile will contain a listing of the topics to review. The student can remediate, using the Focused Review that contains links to ATI books, media clips and active learning templates.
The instructor has online access to detailed information about the timing and duration of time spent in the assessment, focused reviews and tutorials. Students can provide documentation that required ATI work was completed using the “My Transcript” feature under “My Results” of the ATI Student Home Page or by submitting written Remediation Templates as required.
ATI Content Mastery Policy
ATI Content Mastery consists of Practice and Proctored Assessments that are 10% of the total course grade. The Grading Rubric for the Comprehensive Predictor ATI Assessment is as follows:
|STEP 1: Practice Assessment with Required Remediation |Points Earned |
|A. Complete Practice Assessment: | |
|Student will earn a total of 2 points upon completion of Practice Assessment(s) by the course assigned deadline. | |
|Student who does not complete the Practice Assessment by the course assigned deadline will receive 0 points and will still be | |
|expected to take the proctored exam on time. |______ points |
| |(2 points possible) |
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|B. Complete Remediation: | |
|Student will earn a total of 2 points upon completion of remediation by the course assigned deadline. | |
|For each topic missed, complete an active learning template and/or identify three critical points to remember. | |
|Student who does not complete 3 critical points for each topic missed will not receive credit for remediation completion and | |
|will receive 0 points for the assignment. | |
| |______ points |
| |(2 points possible) |
| | |
|STEP 2: Standardized Proctored Assessment/Comprehensive Predictor Assessment | |
|Complete Standardized Proctored Assessment/Comprehensive Predictor Assessment | |
|Use Table below to calculate points earned and remediation requirements | |
|Student will earn 1 to 4 points based upon the score of their Proctored Assessment | |
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| |______ points |
| |(4 points possible) |
|Your Passing Predictability Score: |
|Complete Required Remediation Plan After Proctored/Comprehensive Assessment | |
|Follow proficiency column that corresponds to your earned level in STEP 2:A. | |
|Student will earn 2 points upon completion of their remediation. | |
|Student who does not complete remediation by the assigned course deadline will receive 0 points. | |
|Student who does not complete 3 critical points for each topic missed will not receive credit for remediation completion and | |
|will receive 0 points for the assignment. | |
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| |(2 points possible) |
| Your Level: |Level 3 |Level 2 |Level 1 |Below Level 1 | |
|Points Earned: |2 points |2 points |2 points |2 points | |
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|Points possible = (2 + 2 + 4 +2 = 10) | |
| |____________ |
| |TOTAL POINTS |
Testing Center Policies
The Testing Center is located in the Palmer Memorial Library.
To Take a Test:
Students must arrive on time and present a TC picture ID.
The student must know:
1. Course Name (RNSG and section number of your class)
2. The Test or Exam Unit Number
Testing Center Hours: as posted
No exams will be started within one hour of the posted closing time.
Check with testing center for a schedule of any weekend openings each semester. The Testing center is not open on College Holidays.
Additional Information:
Students are not allowed to have food or drinks in the classroom, lab, or
Testing Center. The cost of damage to computer equipment can be
significant due to a minor mishap. Students may not bring a cellular phone or
pager to class or the Testing Center, without prior written approval from the Dean
of Students. If you leave the Testing Center for any reason during an exam, the exam will be over. You will not be allowed to come back and complete the exam.
**Please refer to the Texarkana College website for Testing Center hours and policies listed for the current semester.**
INSTITUTIONAL EFFECTIVENESS
The purpose of the Associate Degree Nursing Program at Texarkana College is to provide a curriculum that produces a graduate nurse who functions in the role of member of the profession, provider of patient-centered care, patient safety advocate, and member of the health care team. Attainment of the program outcomes by the graduate nurse demonstrates effectiveness.
PROGRAM STUDENT LEARNING OUTCOMES
ASSOCIATE DEGREE NURSING PROGRAM
TEXARKANA COLLEGE
The following program outcomes shape the curriculum and are the criteria for measurement of its success. As a member of the profession, provider of patient-centered care, patient safety advocate, and member of the health care team, for patients in structured acute and long-term settings, the graduate is *competent to:
1. Provide patient-centered nursing care using evidence based outcomes and the nursing process to accommodate society/cultural differences and communicate the same to other members of the healthcare team.
2. Respect the rights of patients to participate in decisions affecting their health by promoting patient-centered care and ensuring confidentiality.
3. Act as a patient safety advocate by establishing compassionate, caring and therapeutic relationships in a physically and psychologically safe environment.
4. Accept and make assignments and delegate tasks to other members of the healthcare team that take into consideration patient safety, organizational policies, scope of practice, and demonstrated abilities.
5. Demonstrate professional responsibility as an associate degree nurse by assuming responsibility and accountability for quality of nursing care, maintaining continued competence, adhering to ethical and legal standards and promoting a positive image of professional nursing.
6. Serve as an advocate for continuity of care and promote quality and access to healthcare for the patient and family.
*Competent is defined as the ability to do; proficient is defined as the ability to do well; and mastery is defined as the ability to do brilliantly at every occasion.
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OBJECTIVES FOR LAB DAYS
After participating in GASTRO-INTESTINAL LAB DAY, the student will be able to:
1. Provide alternative means of providing nutrients for patients with inability to swallow or an existing obstruction in UGI tract via Total Parenteral Nutrition.
2. Place a gastro-intestinal tube, perform placement assessments, and maintain decompression and tube patency.
3. Irrigation and removal of nasogastric tubes
4. Implement preparation for diagnostic procedures
After participating in the ENDOCRINE LAB DAY, the student will be able to:
1. Work with group members to plan and present a teaching topic from the Endocrine Teaching List.
2. Discuss nursing care related to relevant endocrine system disorders.
3. Discuss pharmacologic therapies used to treat endocrine disorders.
After participating in the EENT ON CAMPUS LAB DAY, the student will be able to:
1. Discuss care of visually impaired patient.
2. Discuss care of hearing impaired patient.
3. Manage patients with varying diagnoses of nasal/throat disorders.
4. Describe differences in refractive errors and chronic eye conditions and their management.
5. Assess a tracheostomy.
6. Demonstrate tracheostomy cleaning/care and proper suctioning technique.
After participating in CRITICAL CARE LAB DAY, the student will be able to:
1. Define the terms triage and list strategies for implementing triage.
2. State the chain of command and reporting requirements when a mass casualty incident occurs.
3. Demonstrate the steps of treating life-threatening conditions.
4. Describe the communication network necessary to ensure delivery and transmission of accurate information during or following a disaster.
5. List at least two ethical issues you might encounter during a mass casualty event.
6. Assess patient’s need for suctioning; perform suctioning techniques, auscultate breath sounds, and list signs and symptoms of early and late hypoxia.
7. Maintain a disposable water seal chest drainage system
8. Assist with the insertion and removal of a chest tube(s).
9. Assist with a percutaneous central vascular catheterization; infuse IV fluids through a central line, draw blood from a central line catheter, and changing an access cap and dressing.
10. Provide care for patients on ventilators and weaning mechanically ventilated patients.
11. Discuss, monitor and demonstrate administration of IV medications: Diuretics, Protonix, Corticosteroids, Normal Saline, and Heparin Flush.
After participating in the SKIN/BURNS LAB DAY, the student will be able to:
1. Assess burns including depth and degree.
2. Manage patients with varying degrees of burn injury.
3. Discuss fluid and electrolyte replacement therapy.
4. Describe sterile technique involved in care of a burn patient.
5. Verbalize treatment modalities for a burn patient.
6. Develop a plan of care for a burn patient.
After participating in MUSCULOSKELETAL LAB DAY, the student will be able to:
1. Identify nursing diagnoses that apply to care of patients with orthopedic conditions.
2. Assess circulation, motion and sensation in an injured limb.
3. Apply a variety of immobilizing modalities (sling, bandage, and brace).
4. Outline the nursing and teaching needs of a patient with a cast or in traction.
5. Develop a teaching plan for a patient undergoing joint replacement.
6. Position and exercise the patient with an amputation.
MAJOR COURSE TOPICS
I. Application of the Nursing Process Focusing on Gastrointestinal Disorders
II. Application of the Nursing Process Focusing on Endocrine Disorders
III. Application of the Nursing Process Focusing on Eye-Ear-Nose-Throat Disorders
IV. Application of the Nursing Process Focusing on Critical Care
V. Application of the Nursing Process Focusing on Integumentary Disorders
VI. Application of the Nursing Process Focusing on Musculoskeletal Disorders
VII. Application of the Nursing Process Focusing on Reproductive and Sexual
Disorders
RNSG 1441 UNIT I - Application of the Nursing Process Focusing on Gastrointestinal Function
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| |Required Reading Assignment: |Ignatavicius and Workman: | |
|Upon completion of this unit, the student will be able to: |Ignatavicius and Workman: |Collaborative Care Study | |
| |Chapter 52, pp. 1084-1097 (Does not include |Guide: | |
|1. Demonstrate knowledge of anatomy and |liver, gallbladder, or pancreas, diagnostic |Chapters 52-57, 60 | |
|physiology in formulating a care plan for |tests) | | |
|the patient with gastrointestinal |Chapters 53, 54, 55, 56, 57 |Recommended Media: | |
|disturbances. CO 1, 2, 3, 4 |pp. 1099-1191 | |DUE DATES FOR HOMEWORK ON COURSE |
| |TPN pp. 1245-1246 |ATI Skills Module: |CALENDAR |
|2. Assess characteristics of the common |Obesity pp. 1246-1252 |Nasogastric Intubation | |
|gastrointestinal system disturbances. | | | |
|CO 1, 2, 3 |Reference: |ATI Skills Module: | |
| |Smith, Duell, & Martin: |Ostomy Care |NG Skills Check-off |
| |Chapter 19, pp. 652-662 | | |
| |Chapter 20, pp. 689-693 | | |
| |Chapter 21, pp. 737-745 | |UNIT EXAM |
| |Chapter 23, pp. 846-855 | | |
| |Chapter 29, pp. 1128-1138 | | |
| | | | |
| | | | |
| | | | |
| |A/P review | | |
| |Stomatitis | | |
| |Oral cancers/tumors | | |
| |GERD | | |
| |Hiatal hernia | | |
| |Diverticula disease | | |
| |Gastritis | | |
| |Peptic Ulcer Disease | | |
| |(continued next page) | | |
RNSG 1441 UNIT I – CONTINUED
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|3. Formulate nursing diagnoses related to | | | |
|the patient with gastrointestinal |Gastric Cancer |Medcom Videos | |
|disturbances and design a plan of care for |Irritable Bowel Syndrome |A&P Review Digestive | |
|the patient using evidence-based practice. CO 2, 5, 10, |Herniation |Caring for the Stoma | |
| |Colorectal Cancer |Common Feeding Tubes/NGT | |
|4. Demonstrate the ability to take a health/ |Intestinal Obstruction |How the Body Ages: Part 3: GI/Skin | |
|illness history of patients with disturbances of the gastrointestinal|Polyps |Fluid/Electrolyte Balance: Electrolyte | |
|system, incorporating societal/cultural differences and apply the |Hemorrhoids |Imbalances | |
|nursing process using critical thinking. | | | |
|CO, 1, 2, 3, 4, 5, 11, |Acute Inflammatory Bowel Dx. | | |
| |-Appendicitis | | |
|5. Integrate the purpose of diagnostic |-Peritonitis |GI Skills Day | |
|measures and treatment modalities for |-Gastroenteritis | | |
|specific GI disturbances. CO 1, 2, 3 | | | |
| |Chronic Inflammatory Bowel Dx. | | |
|6. Administer medications safely to patients |-Ulcerative Colitis | | |
|with disturbances of the gastrointestinal |-Crohn’s Disease | | |
|system based on National Patient Safety Goals. CO 1, 3, 6, 7, 9, 11 | | | |
| |Malabsorption Syndrome | | |
| | | | |
|7. Perform technical skills following standards |Parasitic Infections | | |
|of nursing care applicable to patients with |-Escherichia Coli. | | |
|disturbances of the gastrointestinal | | | |
|system. CO 7, 8, 9, 10, 11 |Obesity | | |
| | | | |
| | | | |
RNSG 1441 UNIT I - CONTINUED
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|8. Integrate principles of nutrition and food/ | | | |
|fluid intake in the care of patients with a | |Homework | |
|disturbance of the GI system. CO 1, 2 | | | |
| | |1. ATI Learning System RN: | |
|9. Determine the relationship of psychosocial | |Medical-Surgical: Gastrointestinal | |
|concepts to common gastrointestinal disorders considering | |(student will receive highest grade earned | |
|cultural/ethnic and social diversity. CO 3, 4, 5, 6, 8, | |by the due date.) | |
| | | | |
| | |2. ATI Pharm Made Easy: The | |
|10. Integrate community resources in | |gastrointestinal system (student must spend| |
|promoting health, preventing disease, and | |at least an hour in the lesson to receive | |
|planning nursing care of the patient with a | |credit for score on post-test) | |
|disturbance of the gastrointestinal | | | |
|system. CO 1, 2, 10, 11 | |3. ATI Dosage calculation 2.0: Medication | |
| | |administration (Student will receive | |
| | |highest grade earned by the due date) | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
GI Assessment Guideline
HISTORY PHYSICAL EXAM
Appetite ? Good ? Fair ? Poor Oral Cavity
Recent Weight ? Loss ? Gain _______ lbs. Mucosa color: __________
? Nausea ? Vomiting Emesis color __________ ? Lesions
Difficulty: ? Swallowing ? Chewing ? Caries
? Dentures: ____ Upper ____ Lower ? Loose teeth
? Removable Bridge Bowel Sounds: ? Yes ? No
? Allergies ___________________________________ Describe __________________
___________________________________________ __________________________
? Food Intolerances ____________________________ __________________________
Type Diet ____________ % past 24 hrs. ___________ Abdomen: ? Soft ? Rigid ? Tender
Usual eating habits _____________________________ ? Distention
? Tube Feeding/Formula _______________________ ? Incision
? TPN: Rate ______________ ? Dressing
? Lipids: Rate ______________ ? Drainage ___________________
Bowel Routines: _______________________________ Wt. __________ Ht. ____________
? Change in bowel habits _______________________
? Diarrhea ? Constipation ? Ostomy
Last BM ______________________________________ PSYCHOSOCIAL ASSESSMENT
Stool description _______________________________
Medications that affect the GI tract _______________ ? Eating Disorders
______________________________________________ ? Alcohol use ? Nicotine use
Sleep Disturbances ___________________________ ? Drug abuse ? Stressors
Previous Illness: Describe _______________________ Comments: ______________________
______________________________________________ ________________________________
______________________________________________ ________________________________
Coping Skills: ? Effective
Chief Complaint/Symptom: (analyze) ______________ ?Ineffective
______________________________________________
______________________________________________
______________________________________________
______________________________________________
********************************************************************************************************
SIGNIFICANT
DIAGNOSTIC TESTS
H & H
WBC
Electrolytes: Na, K+, etc.
Fecal Analysis: Occult, O&P, Culture, Lipids
Albumin
Total Protein
RNSG 1441 UNIT II - Application of the Nursing Process Focusing on Endocrine Function
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|Upon completion of this unit, the student will be able |Required Reading Assignment: |Ignatavicius and Workman: | |
|to: |Ignatavicius and Workman: |Collaborative Care Study Guide | |
| |Chapters 61, 62, 63, 64 |Chapters 61, 62, 63, 64 | |
|1. Demonstrate knowledge of anatomy and | | |Endocrine Student Presentations|
|physiology in formulating a care plan for the patient | |Recommended Media: | |
|with an endocrine disorder. CO 1, 2, 3, 4, |Reference: |Medcom videos | |
| |Smith, Duell, & Martin: |A&P: The Endocrine System (w/video) |UNIT EXAM |
| |Chapter 18, pp. 616-Table 18-1 |Diabetes in Clinical Practice | |
|2. Assess characteristics of common |Chapter 20, pp. 701-704 | | |
|endocrine disorders. CO 1, 2, 3 | | | |
| | | | |
|3. Formulate nursing diagnoses related to the patient |Disorders of the Pituitary glands | | |
|with an endocrine |Hypo/Hyper | | |
|disorder and design a plan of care for the patient using|Diabetes Insipidus | | |
|evidence-based practice. CO 2, 5, 10 |SIADH | | |
| | | | |
|4. Demonstrate the ability to take a health/ illness|Disorders of the Adrenal glands | | |
|history of patients with disorders of the endocrine |Cushing’s Dx. |Diabetic Skills Day Presentations | |
|system, incorporating societal/cultural differences and |Addison’s Dx. | | |
|apply the nursing process using critical thinking. | | | |
|CO, 1, 2, 3, 4, 5, 11 |Disorders of the Thyroid gland | | |
| |Hypo/Hyper | | |
|5. Integrate the purpose of diagnostic |Thyroiditis | | |
|measures and treatment modalities for specific |Thyroid cancer | | |
|endocrine disorders. | | | |
|CO 1, 2, 3 |Disorders of the Parathyroid | | |
| |Hypo/Hyper | | |
| | | | |
| |Diabetes Mellitus | | |
RNSG 1441 UNIT II - CONTINUED
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| | | | |
|6. Administer medications safely to patients with | |Homework | |
|disturbances of the endocrine system based on National | | | |
|Patient Safety Goals. CO 1, 3, 6, 7, 9, 11 | |1. ATI Learning System RN: | |
| | |Medical-Surgical: Endocrine (Student will receive highest| |
|7. Perform technical skills following standards of | |grade earned by due date) | |
|nursing care applicable to patients with disorders of | | | |
|the endocrine system. CO 7, 8, 9, 10, 11 | |2. ATI Pharmacology Made Easy: Endocrine System (Student | |
| | |must spend at least an hour in the lesson to get credit | |
|8. Integrate principles of nutrition and food/fluid | |for score on post-test). | |
|intake in the care of patients with an endocrine system | | | |
|disorder. CO 1, 2 | |3. ATI Dosage Calculation 2.0: Safe Dosage (Student will | |
| | |receive highest grade earned by the due date) | |
|9. Determine the relationship of psychosocial | | | |
|concepts to common endocrine disorders considering | | | |
|cultural/ethnic and social diversity. CO 3, 4, 5, 6, 8 | | | |
| | | | |
|10. Integrate community resources in | | | |
|promoting health, preventing disease, and planning | | | |
|nursing care of the patient with an endocrine | | | |
|disorder. CO 1, 2, 10, 11 | | | |
| | | | |
ASSESSMENT of PATIENTS with ENDOCRINE DYSFUNCTION GUIDELINE
HISTORY PHYSICAL EXAM
Age ______ Sex ______ Mental Status Changes _______ Ask about and observe for abnormalities of skin:
_________________________________________
P _______ B/P ___________ T _________ R _________ _________________________________________
Hair texture, distribution ___________________
Chief Complaint __________________________________ Nails ____________________________________
_________________________________________________ Head Shape and Contour ___________________
Medications past/current ___________________________ Eyes ____________________________________
_________________________________________________ Mouth: Size ________ Symmetry _________
History of illnesses, hospitalizations, surgeries: _________ Teeth ___________________________________
_________________________________________________ Tongue: Size ________ Fasciculation’s _______
_________________________________________________ Neck: Size __________ Symmetry ___________
Have you experienced? Hyperpigmentation of neck__________________
Palpitations _______ Tremors _______ Fatigue _______ Enlarged Thyroid _____ Trachea midline_____
Weakness _______ Appetite/Wt. Changes ____________ Voice: Hoarse, husky ______________________
Polydipsia ______ Polyphagia ______ Polyuria _______ Speech clarity, pitch, volume ________________
Changes in Bowel or Urinary Function: Swallowing difficulty/pain __________________
Diarrhea _____________ Constipation ______________ Upper extremities: Size _____ Symmetry _____
Gravida ______ Para ______ TPAL ________________ Grip strength _______ Muscle strength _______
Abnormal Lactation _______________________________ Lower Extremities: Calluses ____ Corns _____
Menstrual irregularities ____________________________ Skin deformities ________ Pulses ____________
Describe any sexual difficulties ______________________ Strength _____________
_________________________________________________ Breasts enlarged in males ___________________
Psychosocial History and Lifestyle: Genitalia _________________________________
_________________________________________________ Heart murmurs auscultated _________________
Describe stress at home, work or in relationships: Normal growth and development ____________
_________________________________________________ Ht. ________ Wt. __________ BMI __________
Sleep patterns _________ Nicotine use ________________
Diet ____________________ Exercise _________________
**************************************************************************************************
Lab/Diagnostic Tests
T3, T4, TSH
TRH; FT3, FT4, T3, RIA, RAI
Total Serum Calcium, Serum Phosphorus
Urine Ca, Serum alkaline phosphatase
PTH Radioimmunoassay test
Urine specific gravity, BUN, Creatinine
Serum electrolytes, Urine tests for ketones, protein
FBS, Glucose Tolerance Test, Hgb. A1c
Cortisol Suppression Test, Serum ACTH
24-hour urine specimen for catecholamine or VMA
Plasma aldosterone, angiotensin II, renin
CTs, MRIs, X-rays
RNSG 1441 UNIT III - Application of the Nursing Process Focusing on Eye-Ear-Nose-Throat Disorders (Sensory Organs)
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|Upon completion of this Unit, the student |Required Reading Assignment: |Ignatavicius and Workman: | |
|will be able to: |Ignatavicius and Workman: |Collaborative Care Study Guide | |
| |Chapter 28 Tracheostomy pp. 522-529 |Chapters 28 (tracheostomy only) | |
| |Chapter 29 pp. 531-536 |Chapters 29, 31, 46-48 |Tracheostomy Skill Check-Off |
|1. Demonstrate knowledge of anatomy and |Chapter 31 pp. 640-644 | | |
|physiology in formulating a care plan for |Chapters 46, 47, 48 | | |
|the patient with disorders involving the sensory organs. CO 1, |pp. 966-1016 | |UNIT EXAM |
|2, 3, 4 | |Recommended Media: | |
| |Reference: |ATI Skills Module: Airway Management | |
|2. Assess characteristics of common |Smith, Duell &Martin | | |
|sensory system disturbances. |Chapter 11, pp. 295-297 |EENT Lab day | |
|CO 1, 2, 3 |Chapter 18, pp. 593-597 | | |
| |Chapter 30, pp. 1197-1212 | | |
|3. Formulate nursing diagnoses related to the patient with a | | | |
|sensory system | | | |
|disorder and design a plan of care for the patient using |Tracheostomy | | |
|evidence-based practice. |Non-Infectious Nose/Sinuses | | |
|CO 2, 5, 10 |Fractures, Epistaxis | | |
| |Trauma | | |
|4. Demonstrate the ability to take a health/ |Oropharyngeal Disorders | | |
|illness history of patients with disturbances of the sensory |Sleep Apnea/Obstruction | | |
|system, incorporating societal/cultural differences and apply the |Infectious Disorders of Nose/Sinuses | | |
|nursing process using critical thinking. |Rhinitis/Sinusitis | | |
|CO, 1, 2, 3, 4, 6, 11 |Disorders of Oral Pharynx/Tonsils | | |
| | | | |
|5. Integrate the purpose of diagnostic | | | |
|measures and treatment modalities for | | | |
|specific sensory system disorders. CO 1, 2, 3 | | | |
| | | | |
RNSG 1441 UNIT III - Application of the Nursing Process Focusing on Eye-Ear-Nose-Throat Disorders (Sensory Organs)
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| 6. Administer medications safely to patients |Conjunctival Disorders | | |
|with disturbances of the sensory |Corneal Disorders | | |
|system based on National Patient Safety Goals. CO 1, 3, 6, |Glaucoma |Homework | |
|7, 9, 11 |Retinal Disorders | | |
| |Macular Degeneration |1. Study guides (Syllabus): | |
|7. Perform technical skills following standards | |“Care of patients with eye and vision | |
|of nursing care applicable to patients with |Middle Ear Problems |problems” | |
|sensory system disorders. |Mastoiditis |and “care of patients with ear and hearing | |
|CO 7, 8, 9, 10, 11 |Inner Ear Problems |problems” | |
| |Tinnitus/Labyrinthitis/ Meniere’s | | |
|8. Integrate principles of nutrition and food/ |Hearing Loss |2. ATI Skills Module: | |
|fluid intake in the care of patients with a | |Airway management | |
|sensory system disorder. CO 1, 2 | |(Tracheal suctioning and tracheostomy care) | |
| | | | |
| | |3. ATI Dosage Calculation 2.0: Dosage by | |
|9. Determine the relationship of psychosocial | |weight (student will receive highest grade | |
|concepts to common sensory system disorders considering | |earned by due date) | |
|cultural/ethnic and social diveristy. CO 3, 4, 5, 6, 8 | | | |
| | | | |
| | | | |
|10. Integrate community resources in | | | |
|promoting health, preventing disease, and | | | |
|planning nursing care of the patient with a | | | |
|sensory system disorder. CO 1, 2, 10, 11 | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
|Drug Class |Action |Uses |Examples |
|Beta-adrenergic Blockers |Decreases IOP |Open-angle glaucoma |timolol (Timoptic) |
| |Reduces aqueous humor production |Ocular hypertension |levobunolol Hcl (Betagan) betaxolol Hcl |
| |Increases outflow of aqueous humor |Watch for systemic absorption symptoms (HR/BP) |(Betoptic-S) |
| |Does not affect pupil size | | |
|Carbonic Anhydrase Inhibitors |Decreases IOP |Closed-angle glaucoma |acetazolamide (Diamox) oral/IM/IV |
| |Reduces aqueous humor production |Narrow-angle glaucoma |brinzolamide (Axopt) |
| | | |dorzolamide (Trusopt) |
|Cholinergics |Cause contraction of the iris (miosis) and |Glaucoma |pilocarpine (Pilopine HS) |
| |ciliary body | |carbachol (Miostat) |
| |Decreases IOP | | |
| |Permits flow of aqueous humor to improve | | |
| |MiotiCs--constrictor | | |
|Adrenergics |Relaxes ciliary muscles and causes pupil |Glaucoma (to decrease IOP)—avoid with closed- |brimonidine (Alphagan P) |
|(Also called sympathomimetics) |dilation |angle glaucoma |phenylephrine (Neofrin) |
| |Increases outflow of aqueous humor | | |
| |MyDriatic—dilator | | |
| |Decreases IOP | | |
|Prostaglandin Agonists |Decrease IOP |Open-angle glaucoma |bimatoprost (Lumigan) |
| |Increase outflow of aqueous humor |Ocular hypertension |latanoprost (Xalatan) |
|Anti-cholinergics |Relaxes ciliary body and iris |To aid in exam of the back of the eye (fundus) |atropine sulfate(Isopto-atropine) |
| |Produces cycloplegia (paralysis |AVOID WITH GLAUCOMA |cyclopentolate (Cyclogyl) |
| |MyDriatic—dilator | |tropicamide (Mydriacyl) |
|Drug Class |Action |Uses |Examples |
|Cholinesterase Inhibitors |Prevent metabolism of acetylcholine within the |Glaucoma not controlled by other agents |echothiophate (Phospholine Iodide) |
| |eye | | |
| |Causes miosis (constriction) | | |
| |Decreases IOP | | |
|Local Anesthetics |Cause relaxation and numbing of eye muscles |Treatment and diagnostic purposes |Tetracaine |
| |(ciliary) | |Xylocaine |
|Antibiotics (optic) |Antibacterial action for eye infections |To treat bacterial infections of the eye/cornea |tobramycin optic (Tobrex) |
| | |Bacterial conjunctivitis |gentamycin optic (Genoptic) |
| | | |ocufloxacin (Ocufloxin) |
| | | |gatafloxacin (Zymar) |
|Antihistamines |Allergic reactions in the eye |Allergic conjunctivitis |azelastine (Optivar) |
| | | |olopatadine (Pataday) |
|Steroids |Decrease inflammation of the eye or external |Allergic conjunctivitis |dexamethasone (Diodex) |
| |structures |Bacterial conjunctivitis |prednisolone (Pred Forte) |
| | |Inflammatory eye conditions |May be in combination with other agent |
| | | |(tobradex) |
|Lubricants |To moisturize the eye |Keeps eye moist in the absence of tears |Artificial Tears |
| | | |Moisture drops |
| | | |Liquiflim |
|Ocular staining |Stains the eye temporarily |To aid in visualization of foreign body or |Fluorescein staining |
| | |superficial injury to the cornea | |
*How to instill eye meds—instruct patient to tilt head back, open the eye and look up; expose the lower conjunctival sac and instill drops or ointment; close eye gently to allow for distribution of medication over the eye. Gently apply pressure to the inner canthus of the eye to prevent systemic absorption by minimizing drainage into the nasolacrimal duct.
Clayton, B. and Willihnganz, M. Basic Pharmacology for Nurses. (16th ed.) Mosby (2013).
Study Guide
Care of Patients with Eye and Vision Problems
1. _____________________, an inflammation of the eyelid edges, occurs most often in the older adult and those with dry-eye syndrome. Patients usually have itchy, ___________, and burning eyes. _______________ is controlled with eyelid care using warm, moist compresses followed by gentle scrubbing with dilute baby shampoo. _____________, turning inward of the eyelid causing the lashes to rub against the eye, is also more common in the older adult. The patient usually reports, “Feeling something in my eye” and surgery can be done to correct the problem. __________, turning outward and sagging of the eyelid, often occurs with aging. This lid position leads to corneal drying and ulceration. Surgery can be done to correct this. _________, “sty”, is an infection of the sweat glands in the eyelid. This usually affects only one eyelid at a time without affecting vision. This condition is painful and is treated with warm compresses and antibacterial ointment. __________ is an inflammation of a sebaceous gland in the eyelid. There is painless swelling at the gland. Treatment includes warm compresses and ophthalmic ointment. If large, it may be surgically removed.
2. _____________________, dry-eye syndrome, is decreased tear production. The patient may complain of burning or itching eyes and ___________ (sensitivity to light). Restasis or artificial tears may be used to treat this. Surgery may be done to correct the problem causing it.
3._______________________ can occur due to increased pressure during sneezing, coughing, vomiting, hypertension, trauma, or blood clotting problems. It resolves within 14 days without treatment. ____________ is an inflammation or infection of the conjunctiva. Manifestations include edema, burning, blood-shot appearance, excessive tears, and itching. _______________ is treated with vasoconstrictor and corticosteroid eye drops. ___________ Conjunctivitis (“pink eye”) occurs with bacterial or viral infection and is ____________ transmitted from person to person. Infectious produces a discharge. __________ is a chronic, bilateral scarring form of conjunctivitis caused by Chlamydia trachomatis. It is the leading cause of preventable blindness in the world. It is treated with antibiotics.
4. Corneal problems lead to visual impairment. Corneal __________ is a scrape or scratch of the cornea which can become infected and lead to corneal ______________. Corneal ulceration is an emergency which can lead to permanent __________. There is usually pain, reduced vision, photophobia, and eye secretions. Purulent fluid may be present on the eyelids or eyelashes. Antibiotics, antifungals, and antivirals may be administered as eye drops, injected subconjunctivally, or injected IV. Steroids may also be used to reduce the inflammatory response in the eye. ___________, degeneration of the corneal tissue resulting in abnormal corneal shape, can occur with trauma or as part of an inherited disorder. _______________ (corneal transplant) may be done. If a deceased patient is a potential eye donor, follow these steps: raise the head of the bed 30 degrees, instill antibiotic eye drops, close the eyes and apply a small ice pack to the closed eyes, contact the family and physician to discuss eye donation.
5. _________ are opacities of the lens that distort the images projected onto the retina. They cause painless_______ loss of vision. Cataracts may be present at birth or develop over time. Teach people to reduce the risk for cataract by wearing sunglasses that limit __________ light exposure whenever in bright sunlight, wear protective eye, and head gear during sports and work. _________ is the only cure for cataracts. Precautions should be taken to prevent ______________ intraocular pressure after eye surgery.
6. __________ is a group of ocular disease resulting in increased intraocular pressure. Primary open-angle glaucoma, the most common form, usually affects both eyes and is ____________ in the early stages. Late manifestations of open-angle glaucoma include seeing ______ around lights, losing ___________ vision, and experiencing decreased visual acuity not correctable with eyeglasses. __________ shows elevated intraocular pressure. Blindness from glaucoma can be prevented by early __________, lifelong treatment, and a regimen of close monitoring and follow-up care. ________ are the mainstay of control for glaucoma. They do ___ improve lost vision but _______ more damage by decreasing IOP. Surgical procedures may be done if intraocular pressure remains high with medical treatment. _______________ glaucoma (also called closed- angle glaucoma, narrow-angle glaucoma, or acute glaucoma) is less common, has a ______ onset, and is an emergency. The manifestations of acute glaucoma include: sudden, severe _____ around the eyes that radiates over the face, headache or brow pain, nausea and vomiting, seeing colored halos around lights, sudden blurred vision, decreased light perception, reddened sclera and foggy cornea. Systemic _______ drugs may be given for angle-closure glaucoma as part of emergency treatment to rapidly reduce intraocular pressure. These agents include oral glycerin (Osmoglyn) and IV Mannitol (Osmitrol).
7. ___________________ (bleeding into the vitreous cavity) may result from aging, systemic diseases, or trauma or it may occur spontaneously. The main manifestation is reduced visual acuity. Vitreous hemorrhage may absorb slowly with no treatment. If the hemorrhage is still present several weeks to months later, a vitrectomy may be indicated.
8. _______ is inflammation of the iris, the ciliary body, or the choroid. The cause is unknown but often follows exposure to allergens, infectious agents, trauma, or systemic disease. Anterior uveitis is inflammation of the iris, ciliary body, or both. Manifestations include aching around the eye; tearing; blurred vision; photophobia; a small, irregular, nonreactive pupil; and a “bloodshot” appearance of the sclera. Posterior uveitis is the common term for retinitis (inflammation of the retina) and choriorretinitis (inflammation of both the choroid and the retina). The onset of posterior uveitis is slow and painless. There is gradual vision loss, and a pupil that is small, nonreactive and irregularly shaped. Treatment of uveitis includes resting the ciliary body with a cycloplegic drug to paralyze ciliary muscles and dilate the pupil. Steroids are used to reduce inflammation. Analgesics that contain neither aspirin nor opioids are prescribed for pain. Antibiotics may be given. Cool or warm compresses are applied for pain. Darkening the room and wearing sunglasses reduce the discomfort of ____________.
9. ______________ is the deterioration of the ______ (area of central vision) and can be atrophic (age-related) or exudative. Age-related has two types. The most common type is dry. Less common type is wet. Manifestations of dry macular degeneration involve mild blurring and distortion of central vision which progresses to loss of all _______ vision. Treatment of dry is avoid _______ and increase intake of dietary _______ and ____________ lutein and zeaxanthin. Exudative is also wet but can occur at any age. With exudative degeneration, there is a sudden decrease in vision. Laser therapy is the most common treatment of exudative.
10. There may be holes or tears in the retina. Retinal __________ can occur following a hole or tear in the retina. With retinal detachment, manifestations are usually sudden and ________ The patient may suddenly see bright flashes of light (_________) or floating dark spots in the affected eye. The patient may describe a sensation of a curtain being pulled over part of the visual field. Treatment of a hole or tear involves creating an inflammatory response that will bind the retina and choroid together around the break. This may be done through ________ (a freezing probe), ________________ (laser), or __________ (high frequency current). Surgical repair is usually needed for retinal detachment with the most common procedure being _____________. Retinitis ___________ is a condition in which retinal nerve cells degenerate and the pigmented cells of the retina grow and move into the sensory areas of the retina, causing further degeneration. The most common early manifestation of retinitis pigmentosa is _____ blindness. Over time, decreased visual acuity progresses to total __________. Ingestion of 15,000 IU of vitamin ___ slows the progression, but no current therapy prevents blindness.
11. The ability of the eye to focus images on the retina depends on the length of the eye front to back and the refractive power of the lens system. Refraction is the bending of light rays. Problems in either eye _______ or refraction can result in refractive errors. _______ is nearsightedness. __________, also called hypermetropia, is farsightedness. ___________ is the age-related problem in which the lens loses its elasticity and is less able to alter its shape to focus the eye for close work. ___________ occurs when the curve of the cornea is uneven. Eyeglasses or contact lenses are used to correct ___________ errors. A popular surgical alternative is laser in-situ keratomileusus (_____).
12. ______ is hemorrhage into the anterior chamber. This is treated by bedrest in semi-fowler’s position and avoidance of sudden head movement. The eye is protected with a patch or shield and cycloplegic drops may be used to rest the eye. A hyphema usually resolves in 5 – 7 days. __________ is bruising of the eye. _______________ (“black eye”) is a common contusion injury. ___ is applied immediately to limit edema. The color gradually disappears in 10 – 14 days. _______ body in the eye causes a feeling of something in the eye and blurred vision. The eye of any patient with suspected corneal abrasion is examined with fluorescein, followed by irrigation with NS. After the foreign body is removed, the eye may be patched. Lacerations of the eye most commonly involve the eyelids or cornea. ___ is applied to decrease bleeding and edema. Corneal lacerations are an emergency because eye contents may ________ through the laceration. Manifestations include severe eye pain, photophobia, tearing, decreased visual acuity, and inability to open the eyelid. If there is a penetrating object, it is removed only by ______________. Antibiotics are given to reduce the risk for infection. If scar alters vision, a corneal transplant may be needed later. If the eye contents have prolapsed through the laceration or if the injury is severe, ___________ (surgical eye removal) may be indicated.
13. Ocular ________, the most common malignant eye tumor in adults, is associated with exposure to _____ light. ________ can spread easily. The most common treatment is ____________ (surgical removal of the entire eyeball).
14. Reduced vision was covered in Foundations, but should be reviewed as needed.
Study Guide
Care of Patients with Ear and Hearing Problems
1. _________ is a localized external otitis caused by bacterial infection of a hair follicle. Manifestations include intense local___________, edema, erythema, and possibly a ________head. Treatment includes local and systemic ___________and local ____application. The lesion should not be squeezed due to the risk of ______of the infection. Incision and _________may be necessary.
2. _______ is the most common cause of an impacted ear canal. A canal can also become impacted as a result of_______ _______. Manifestations include a sense of ________ in the ear with or without _______ loss, ear pain or itching, dizziness, or ________from the ear. The object may be visible with direct__________. Treatment includes _____________ drops, __________, or manual extraction.
3. Otitis media is inflammation of the ______ear. This can be acute, chronic, or______. If otitis progresses or remains untreated, permanent __________ hearing loss may occur. Acute otitis media and chronic otitis media are also known as suppurative or ________otitis media. An _________agent causes inflammation of the middle ear. Acute has a ______onset and lasts 3 weeks or less. Chronic often follows repeated _____episodes. Treatment of _______usually involves surgical procedures. Pain with chronic is much ____severe than with acute. Otoscopic exam varies, depending on the _____of the condition. The eardrum is initially _________and the patient has only vague ear discomfort. As the condition progresses to the third stage, the eardrum becomes red, thickened, and bulging and the patient complains of severe____. If the eardrum (TM) spontaneously ruptures, there is a sudden _________in pain and pus or blood drains from the ear. ________antibiotics are used to treat suppurative otitis media. If the pain persists after antibiotic therapy and the eardrum continues to bulge, a ___________is performed.
4. _______is an infection of the mastoid air cells by untreated or inadequately treated otitis media. IV ________ are used to prevent the spread of infection. Since antibiotics do not easily penetrate, the infected mastoid________ removal of the infected tissue may be needed.
5. _______is a continuous ringing or noise perception in the ear. Symptoms range from mild ringing, which can go unnoticed during the day, to a loud roaring, which can interfere with_________. Therapy focuses on ways to __ _____the tinnitus with background sound during sleeping hours. Ear mold __________ can amplify sounds to drowned out the tinnitus during the day.
6. _______ is a disturbed sense of a person’s relationship to space. _______ is a real sense of whirling or turning in space. Manifestations of vertigo include______, vomiting, falling, _________, hearing loss, and________. Patients with vertigo should be taught to restrict ______motions, move slowly, and maintain adequate_________. Drugs used to reduce vertigo can cause__________. Teach patients to maintain a____, uncluttered environment to prevent accidents during attacks.
7. ____________is an infection of the labyrinth. Manifestations include ________ loss, tinnitus, nystagmus, vertigo, nausea, and________. Treatment includes systemic antibiotics. Patients should be advised to stay in ______in a darkened room until manifestations are reduced. Antiemetic and _______________drugs may relieve symptoms. ________loss on the affected side may be permanent.
8. Meniere’s disease has three features:_________, one-sided sensorineural_______ ____, and_______, occurring in incapacitating attacks that can last for several days. Pathology involves excess of _____________ _____that distorts the entire inner-canal system. At first, hearing loss is__________, but repeated attacks can result in _______hearing loss. Patients should be taught to move______, stop_______, and follow hydrops diet (which limits _______intake). Drug therapy includes antiemetics, antivertiginous drugs, mild_________, and _________acid. ___________therapy with gentamycin and steroids is another method of treatment, but some or all hearing in the treated ear is lost. _______ device may be used to displace fluid from the inner ear. Surgical treatment (resection of vestibular nerve or total______________) is a last resort because the _______ in the affected ear is often lost from the procedure.
9. Hearing loss may be__________, __________, or_________. Conductive hearing loss is caused by sound waves being blocked from contact with inner-ear nerve fibers because of ________l-ear or ______-ear disorders. _____________hearing loss is caused by damage of the inner-ear or auditory nerve. Mixed hearing loss is caused by a ___________of the problems causing conductive and sensorineural hearing loss. Disorders that cause __________hearing loss are often corrected with no or minimal permanent damage. _____________ hearing loss is often permanent. _______ ____are often used for conductive hearing loss. _________ _______ is often used for sensorineural loss.
|Upon completion of this unit, the student |Required Reading Assignment: |Ignatavicius and Workman: | |
|will be able to: |Ignatavicius and Workman: |Collaborative Care Study Guide | |
| |Chapter 8 pp. 105-119 |Chapters 8, 10, 11, 12, 13, 32, and 37 | |
|1. Demonstrate knowledge of anatomy and |Chapter 10 pp. 138-147 | | |
|physiology in formulating a care plan for |Chapter 11 pp. 148-173 (review F/E) |Recommended Computer Exercise: |Central Line Skill Check-off |
|care of the critically ill patient. |Chapter 12 pp. 174-185 |Recommended Media in the computer lab: | |
|CO 1, 2, 3, 4 |Chapter 13 pp. 193-196 | | |
| |Chapter 32 pp. 603-625 | |UNIT EXAM |
|2. Assess characteristics of common critical care disorders. CO |Chapter 37 pp. 739-755 |Recommended Media: | |
|1, 2, 3 |Chapter 30 pp. 577-579 (chest tube placement and care) |ATI Skills Module | |
| |Reference: | | |
| |Smith, Duell & Martin: | | |
| |Chapter 15, pp. 449-505 |Calculation of Select Critical Care IV Meds | |
|3. Formulate nursing diagnoses related to the patient with a |Chapter 26, pp. 992-1002 |(See Study Guide at end of this | |
|critical care illness and design a plan of care for the patient |Chapter 29 pp. 1131-1147 1160-1180 |Syllabus) | |
|using evidence-based practice. CO 2, 5, 10 |Chapter 33, p 1316-1323 & 1336-1345 | | |
| | | | |
| |Emergency/Triage/Mass Casualty |Medcom Videos | |
|4. Demonstrate the ability to take a health/ | |Airway Care: Tracheostomy Care, Tube Change | |
|illness history of patients with critical care disorders, |Central Lines/Implanted Ports |Suctioning: | |
|incorporating societal/cultural differences and apply the nursing | |Nasotracheal | |
|process using critical thinking. |Acid/Base Balance and Interventions |Monitoring for complications | |
|CO, 1, 2, 3, 4, 5, 11 | |Endotracheal | |
| |Pulmonary Emboli | | |
| |Acute Respiratory Failure | | |
| |Acute Respiratory Distress Syndrome | | |
| |Intubation and Ventilation | | |
| |Chest Trauma | | |
| | | | |
| |Shock Hypovolemic/Septic | | |
| | | | |
| |Critical Care Math | | |
RNSG 1441 UNIT IV- Application of the Nursing Process Focusing on Critical Care
RNSG 1441 UNIT IV- Application of the Nursing Process Focusing on Critical Care (CONTINUED)
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| | | | |
|5. Integrate the purpose of diagnostic | | | |
|measures and treatment modalities for | |Critical Care skills day | |
|specific critical care disorders. CO 1, 2, 3 | | | |
| | | | |
|6. Administer medications safely to patients | |Homework | |
|with critical care disorders based on National Patient Safety | | | |
|Goals. CO 1, 3, 6, 7, 9, 11 | |1. ATI Skills Module 2.0: Central venous | |
| | |access devices | |
|7. Perform technical skills following standards | | | |
|of nursing care applicable to patients with | |2. ATI Dosage Calculation 2.0: Critical Care | |
|critical care disorders. | |Medications (Student will receive highest | |
|CO 7, 8, 9, 10, 11 | |grade earned by due date) | |
| | | | |
|8. Integrate principles of nutrition and food/ | |3. Study guide (syllabus) “Mechanical | |
|fluid intake in the care of patients with a | |Ventilation” | |
|critical care illness. CO 1, 2 | | | |
| | | | |
|9. Determine the relationship of psychosocial | | | |
|concepts to common critical care illnesses considering | | | |
|cultural/ethnic and social diversity. CO 3, 4, 5, 6, 8 | | | |
| | | | |
|10. Integrate community resources in | | | |
|promoting health, preventing disease, and | | | |
|planning nursing care of the patient with a | | | |
|critical care illness. CO 1, 2, 10, 11 | | | |
| | | | |
| | | | |
| | | | |
| | | | |
I.V. PUSH DRUG CARD
HEPARIN
Drug Name (generic)
(brand)
Action:
Indication/usage:
Contraindications:
Usual dose:
Pediatric dose
Dilution:
Incompatibilities:
Rate of I.V. administration:
Side Effects:
Nursing Implications:
I.V. PUSH DRUG CARD
LASIX
Drug Name: (generic)
(brand)
Action:
Indications/usage:
Contraindications:
Usual dose:
Pediatric dose
Dilution:
Incompatibilities:
Rate of IV administration:
Side Effects:
Nursing Implications:
I.V. PUSH DRUG CARD
PROTONIX
Drug Name: (generic)
(brand)
Action:
Indications/usage:
Contraindications:
Usual dose:
Pediatric dose
Dilution:
Incompatibilities:
Rate of IV administration:
Side Effects:
Nursing Implications:
I.V. PUSH DRUG CARD
STEROIDS (Decadron or Solumedrol)
Drug Name: (generic)
(brand)
Action:
Indications/usage:
Contraindications:
Usual dose:
Pediatric dose
Dilution:
Incompatibilities:
Rate of IV administration:
Side Effects:
Nursing implications:
I.V. DRUG CARD
Drug Name (generic)
(brand)
Action:
Indication/usage:
Contraindications:
Usual dose:
Pediatric dose
Dilution:
Incompatibilities:
Rate of I.V. administration:
Side Effects:
Nursing Implications:
Mechanical Ventilation
1. The goals of mechanical ventilation are to improve ___ exchange and to decrease the work needed for an effective _______. A ventilator does not ____ lungs; it provides ventilation until the patient can resume the process of breathing.
2. Many types of ventilators are available. Most in use today are ________-________ ventilators. During ___________, pressure is generated that pushes air into the lung and expands the chest. In most cases, an ____________ (ET) tube or ____________ is required. Positive pressure ventilators are classified by the mechanism that ends ___________ and starts __________. Inspiration is terminated or cycled in three major ways: ________-cycled, ____-cycled, or ______-cycled.
3. Pressure-cycled ventilators push air into the lungs until a preset airway ________is reached. ________positive airway pressure (BiPAP) ventilators are a modern form of pressure-cycled ventilator in which the ventilator provides a ______ inspiratory pressure and an ____________ pressure similar to positive end-expiratory pressure (PEEP).
4. Time-cycled ventilators push air into the lungs until a preset _______ has elapsed.
5. Volume-cycled ventilator push air into the lungs until a preset _______ has been delivered. A constant tidal ________ is delivered regardless of the pressure needed to deliver the tidal volume.
6. Microprocessor ventilators are ________-managed positive-pressure ventilators. The computer allows ongoing __________ of ventilator functions. It often has components of volume-, time-, and pressure-cycled ventilators. This type of ventilator is more common in _____ care settings.
7. ____ of ventilation is the way in which the patient receives breaths from the ventilator.
8. ______-_______ (AC) is the mode used most often and is mainly a resting mode. The ventilator takes over the work of breathing for the patient. The tidal volume and rate are______. If the patient does not trigger ___________ breaths, the ventilator establishes a minimal ventilator pattern. It is programmed to respond to the patient’s ___________effort if the patient begins a breath. In this case, the ventilator delivers the preset tidal volume while allowing the patient to control the ____ of breathing. A disadvantage of this mode is that if the patient’s rate has an increase, the ventilator continues to deliver the preset volume and ________________ can result.
9. ____________________________________________ (SIMV) also has a preset tidal volume and rate, but the patient can breathe at his/her own rate and tidal volume between the ventilator breaths. This mode can be used as a main ventilator mode or as a _______ mode. If used for weaning, the number of mechanical breaths is gradually _________ and the patient gradually resumes ___________ breathing. The mandatory ventilator breaths are delivered when the patient is ready to_______.
10. ________________________________ (BiPAP) provides noninvasive pressure support ventilation by nasal mask or facemask.
11. Pressure support and continuous flow (flow-by) are modes often used for_______.
12. The _________prescribes the ventilator settings, the ventilator is set up by the ____________department, and the _____assists in connecting the patient to the ventilator. The nurse is also responsible for monitoring the _______ and the ventilator settings.
13. _____volume (VT or TV) is the volume of air the patient receives with each breath. The average amount of TV prescribed ranges between 7 and 10 mL/kg of body_______. This can be estimated by adding a 0 to the patient’s weight in_________.
14. ____, or breaths/min, is the number of ventilator breaths delivered per minute. The rate is usually set between 10 and 14 breaths/min.
15. __________________ (FiO2) is the oxygen level delivered to the patient. The FIO2 is determined by the ___values and the patient’s condition. Ventilators can provide ___(same as room air) to ____.The oxygen delivered is warmed to ____ temperature (98.6o F [37o C}) and humidified to ____ .
16. ___________ (inspiratory) pressure (PIP) indicates the pressure needed by the ventilator to deliver a set tidal volume at a given lung compliance. The PIP is the _______ pressure reached during inspiration. Monitoring PIP reflect changes in ___________ of the lungs and __________ in the ventilator. An upper pressure limit is set on the ventilator to prevent__________. When the limit is reached, the ____-pressure alarm sounds and the remaining volume is not given.
17. ___________________________________ (CPAP) applies positive airway pressure throughout the entire respiratory cycle for spontaneously breathing patients. ________ drugs are given cautiously or not at all when the patient is receiving CPAP so that respiratory effort is not suppressed. CPAP keeps the ______open during inspiration and prevents alveolar collapse during__________. The most common use of CPAP is_______. During CPAP, __ ventilator breaths are delivered. The ventilator just delivers ______ and provides monitoring and an ______ system. If no ________ is set, the patient is using the ventilator as a T-piece with alarms.
18. ____________________ (PEEP) is positive pressure exerted during the expiratory phase of ventilation. PEEP improves oxygenation by enhancing ___ ________ and preventing ___________. PEEP is often added when the partial pressure of arterial ______ remains low with and FiO2 of 50% - 70% or greater.
19. ____ is how fast each breath is delivered. If a patient is agitated or restless or has other signs of air hunger, the flow may be set too low. Increasing the flow should be tried before using chemical__________.
20. WHEN CARING FOR A VENTILATED PATIENT, BE CONCERNED WITH THE ___________ FIRST AND THE VENTILATOR SECOND.
21. Ventilator settings are prescribed by the _________, often in conjunction with the___________ _________.
22. Perform and ________ventilator checks according to facility standards.
23. Respond ________ to alarms. Assess the situation from the _______ back to the ventilator. Keep a ______________at the bedside. If unable to identify the problem causing the alarm, notify the ___________ __________stat. If patient is not ventilating well, __________from the ventilator and use the ___device until respiratory therapy solves the ventilator problem.
24. Nearly _____ body system is affected by mechanical ventilation.
25. Cardiac problems include ___________ and fluid _________.
26. Lung problems during mechanical ventilation include _________, __________, and acid-base __________ . Barotrauma is damage to the lungs by positive________. This can result in____________, subcutaneous_________, and_________________. Volutrauma is damage to the lungs by excess _______ delivered to one lung over the other. Blood gas abnormalities can be corrected by __________ changes and adjustment of fluid and ___________ imbalances.
27. GI and nutritional problems result from the ______of mechanical ventilation. Stress ______ can develop. Changes in chest and abdominal cavity pressure can lead to paralytic_____. ____________ is an extreme problem for the patients and is a major reason why they cannot be weaned from the ventilator.
28. _____________________________ (VAP) is always a threat for mechanically ventilated patients. Good ____hygiene is necessary to help prevent this. To prevent pneumonia, perform ____care every 2 hours and implement pulmonary hygiene, including chest physiotherapy, postural drainage, _______ and___________.
29. Muscle ______________and weakness can occur because of immobility. Range of motion _________and getting the patient out of bed helps prevent complications of immobility.
30. Ventilator dependence is the inability to ____off the ventilator. This problem can be psychological or physiologic, but more often is___________.
31. _______ is the process of going from ventilator dependence to spontaneous breathing. Table 34-5 lists various weaning techniques.
32. __________ is the removal of the endotracheal tube (ET). The ___________ therapist usually does extubation with the nurse assisting. The airway is_________, the ____is deflated, and the __is quickly removed at peak inspiration. The patient should be instructed to _____as soon as the tube is out. __________ is essential after extubation. It is common for the _______to be sore and the voice to be _______ for a few days after extubation. Teach the patient to sit in a ____________ position, take deep _______every half-hour, use a ___________________ (IS) every 2 hours, and limit________. _______is a late sign of a narrowed airway and requires immediate attention.
STEPS TO ANALYZE ARTERIAL BLOOD GASES
1. DETERMINE LEVEL OF HYPOXIA
NORMALS OF PA02 = 80-100
MILD HYPOXIA = 60 - 79
SEVERE = BELOW 40
2. DETERMINE ACID/BASE BALANCE
A. Check pH
Normal = 7.35 – 7.45
Below 7.35 = acidosis
Above 7.45 = alkalosis
B. Check PaC02
Normal = 35 – 45 mm Hg
Above 45 mm Hg = respiratory acidosis
Below 35 mm Hg = respiratory alkalosis
C. Check HC03
Normal = 22 – 26 mEq/L
Below 22 mEq/L = metabolic acidosis
Above 26 mEq/L = metabolic alkalosis
D. Try to determine Primary problem
Look at pH. Use 7.40 as the dividing place of
acidosis and alkalosis. If the pH is more acidotic
the primary problem is the one that is acidotic.
If the pH is more alkalotic the primary problem is
is the one that is alkalotic.
E. Determine compensation
Compensation – pH is normal; evidence of compensation
Partial compensation – pH is abnormal; evidence of compensation
STUDY GUIDE FOR SELECT CRITICAL CARE IV MEDS
DOSAGE CALCULATIONS
1. Review conversions, calculations, and abbreviations.
2. Review calculating flow rate per hour and drops per minute in Smith and Duell, p.1069.
Usually piggyback milliliters per hour have been figured by the Pharmacy.
3. Study figuring rates for administration of continuous IV heparin and select
critical care IV medications.
Continuous IV Heparin Administration
1. Heparin is usually ordered in Units per hour. Continuous IV heparin should be
given on a pump.
Order: 1600 Units Heparin per hour
2. Determine # of Units of heparin in the IV bag supplied and the volume of the
solution.
Ex. 20,000 Units Heparin in 500 ml. 0.9% NS
3. Set up the problem to determine number of ml. per hour to be given.
Units in solution: # of ml. of solution = Units ordered: (X) # of ml. to give
20,000 Units : 500 ml. = 1600 Units : X ml.
20,000 X = 80,000
X = 40 ml/hr
Select Critical Care IV Medication Calculations
1. Many of the IV medications ordered in a critical care area are ordered by mcg/min. or
mcg./kg./min.
Example: Order: Nipride 0.3 mcg/kg/min
2. If the order is by kg. then the weight of the patient by lbs. must be converted to kg.
Example: Patient’s weight = 138 lbs.
138 lbs. = 62.7 kg.
2.2
3. Multiply the kg. by the number of mcg. ordered.
62.7 kg x 0.3 mcg = 18.8 mcg per min (actual order for select patient per minute)
4. Determine the volume to be given per minute based on the mcg. you
determined in #3 and the concentration of the IV solution found on the bag.
Example: Solution supplied 100 mcg/ml
100mcg. : 1 ml = 18.8mcg. : X ml
100X = 18.8
X = 0.188 ml
5. These medications are usually on a pump. The rate must be figured based on
an hourly rate. Multiply the volume per minute by 60 to get the hourly rate.
Example: 0.188 ml x 60 min = 11.28 ml/hr.
RNSG 1441
Critical Care IV Medication Problems
Have on Hand: Dopamine 400 mg/250 mL D5W
1. How many mcg in 400 mg?
1000 mcg : 1 mg :: X mcg : 400 mg = 400,000 mcg
2. How many mcg does 1 mL of this solution contain?
400,000 mcg : 250 mL :: X mcg : 1mL = 1600 mcg/mL
I. Ordered: Dopamine 3 mcg/Kg/min. Patient weighs 100 pounds.
1. Change pounds to kg. 100/2.2 = 45.5 Kg
2. How many mcg are ordered to be infused each minute?
45.5 Kg x 3 mcg/Kg/min = 136.5 mcg/min
3. How many mL/min would need to infuse to deliver this dose?
1600 mcg : 1 mL :: 136.5 mcg : X mL = 0.085 mL/min
4. How many mL/hr would the IV pump be set?
0.085 mL/min x 60 minutes = 5.1 mL/hr
NOTE: Dopamine 1-5 mcg/Kg/min is administered to increase renal perfusion. The nurse would monitor urine
output to assess if medication is adequately doing the job.
Dopamine 5-10 mcg/Kg/min is administered to increase cardiac output. The nurse would monitor the
patient’s B/P to assess if medication is adequately doing the job.
Dopamine 10-20 mcg/Kg/min is given as a vasopressor to raise blood pressure. The nurse would monitor
the patient’s B/P to assess if medication is adequately doing the job.
II. Ordered: Dopamine 7 mcg/Kg/min. Patient weighs 198 pounds.
1. What is patient’s weight in Kg.
2. How many mcg are ordered to be infused each minute?
3. How many mL/min would need to infuse to deliver this dose?
4. How many mL/hr would the IV pump be set?
5. What would the nurse monitor to determine if this dose is effective?
III. Ordered: Titrate Dopamine to maintain systolic B/P at 90.
The patient weighs 198 pounds and current SBP is 90.
The rate on the IV pump infusing the dopamine is 32 mL/hr.
Is this a safe rate of flow?
IV. Ordered: Dobutamine 20 mcg/Kg/min. Patient weighs 220 pounds.
On Hand: Dobutamine 500 mg/250 mL D5W.
How many mL/hr would the IV pump be set?
V. Ordered: Nitroglycerin 5 mcg/min. Patient weighs 185 pounds.
On Hand: Nitroglycerin 25 mg/250 mL NS.
How many mL/hr would the IV pump be set?
VI. Ordered: Natrecor 0.01 mcg/Kg/min. Patient weighs 187 pounds.
On Hand: 1.5 mg/250 mL NS
How many mL/hr should the IV pump be set?
VII. Ordered: Amiodarone 0.5 mg/min. Patient weighs 198 pounds.
On Hand: Amiodarone 900 mg/500 mL D5W.
How many mL/hr should the IV pump be set?
TO ANSWER THE FOLLOWING heparin problems, PLEASE use the following Heparin Protocol.
Heparin Protocol (CHRISTUS St. Michael Health System Protocol)
1. Heparin 5000 units IV bolus initially, then 15 units/Kg/hour (rounded to nearest 100).
2. PTT in 6 hours.
3. If PTT less than 40, increase by 200 units/hr and give 3000 unit bolus.
4. If PTT greater than 80, hold heparin for 1 hour and then reduce by 200 units/hr.
5. Repeat PTT 6 hours after any dose changes.
6. After 2 consecutive PTTs are 40-80, do daily PTT.
The patient weighs 95 kg and is receiving heparin for treatment of a PE.
The heparin infusion is available as 20,000 units of heparin in 500 mL of D5W.
1. The patient’s PTT at 0800 is 30.
The patient’s heparin drip is infusing at 42.8 mL/hr.
Would you give a bolus? If yes, how many units?
How would you adjust the rate of infusion? (units/her and mL/hr).
When would the next PTT be done?
2. The patient’s PTT at 1430 is 92.
The patient’s heparin drip is infusing at 47.8 mL/hr.
Would you give a bolus? If yes, how many units?
How would you adjust the rate of infusion? (units/her and mL/hr).
When would the next PTT be done?
3. The patient’s PTT at 2100 is 60.
The patient’s heparin drip is infusing at 42.8 mL/hr.
Would you give a bolus? If yes, how many units?
How would you adjust the rate of infusion? (units/her and mL/hr).
When would the next PTT be done?
4. The patient’s PTT at 0330 is 70.
The patient’s heparin drip is infusing at 42.8 mL/hr.
Would you give a bolus? If yes, how many units?
How would you adjust the rate of infusion? (units/her and mL/hr).
When would the next PTT be done?
5. The patient’s PTT at 0800 is 94.
The patient’s heparin drip is infusing at 42.8 mL/hr.
Would you give a bolus? If yes, how many units?
How would you adjust the rate of infusion? (units/her and mL/hr).
When would the next PTT be done?
RNSG 1441 UNIT V- Application of the Nursing Process Focusing on Integumentary Function
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|Upon completion of this unit, the student |Required Reading Assignment: |Ignatavicius and Workman: | |
|will be able to: |Ignatavicius and Workman: |Collaborative Care Study Guide | |
| |Chapter 24 pp. 415-431 |Chapters 24-26 | |
|1. Demonstrate knowledge of anatomy and |Chapter 25 pp. 432-463 | |Burn Simulation Exercise |
|physiology in formulating a care plan for |Chapter 26 pp. 465-491 |Medcom Videos | |
|the patient with disorders of the integumentary system CO 1, |(Content on pressure ulcers, fungal, |A&P: The Integumentary System | |
|2, 3, 4 |and parasitic disorders are for |Cutaneous membranes | |
| |review only) |Integumentary system |UNIT EXAM |
| | |Accessory structure | |
|2. Assess characteristics of common integumentary disorders. CO | |Post-test | |
|1, 2, 3 | |Wound Care Part 3 | |
| | |Types of wounds | |
|3. Formulate nursing diagnoses related to the patient with an | | | |
|integumentary disorder and design a plan of care for the patient |Skin Assessment | | |
|using evidence-based practice. CO 2, 5, 10 |Minor skin irritations | | |
| |Common skin infections |Burns | |
|4. Demonstrate the ability to take a health/ |Psoriasis |nlm.medlineplus | |
|illness history of patients with disorders of the integumentary |Benign tumors |Health Topics | |
|system, incorporating societal/cultural differences and apply the |Skin cancer | | |
|nursing process using critical thinking. | | | |
|CO 1, 2, 3, 4, 5, 11 |Burns | | |
| | | | |
|5. Integrate the purpose of diagnostic | |Integumentary skills day | |
|measures and treatment modalities for | | | |
|specific integumentary disorders. CO 1, 2, 3 | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
RNSG 1441 UNIT V - Application of the Nursing Process Focusing on Integumentary Function (CONTINUED)
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| | | | |
|6. Administer medications safely to patients | |Homework | |
|with integumentary system disorders based on National Patient | | | |
|Safety Goals. CO 1, 3, 6, 7, 9, 11 | |1. ATI Learning System RN: Dermatologic | |
| | |(Student will receive the highest grade | |
|7. Perform technical skills following standards | |earned by the due date) | |
|of nursing care applicable to patients with | | | |
|integumentary system disorders. | |2. ATI Dosage Calculation 2.0: Injectable | |
|CO 7, 8, 9, 10, 11 | |Medications (Student will receive the highest| |
| | |grade earned by the due date) | |
|8. Integrate principles of nutrition and food/ | | | |
|fluid intake in the care of patients with an | | | |
|integumentary disorder. CO 1, 2 | | | |
| | | | |
| | | | |
|9. Determine the relationship of psychosocial | | | |
|concepts to common integumentary disorders considering | | | |
|cultural/ethnic and social diversity. CO 3, 4, 5, 6, 8 | | | |
| | | | |
| | | | |
|10. Integrate community resources in | | | |
|promoting health, preventing disease, and | | | |
|planning nursing care of the patient with an integumentary | | | |
|disorder. CO 1, 2, 10, 11 | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
RNSG 1441 UNIT VI - Application of the Nursing Process Focusing on Musculoskeletal Function
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|Upon completion of this unit, the student will be able to: |Required Reading Assignment: | | |
| |Ignatavicius and Workman: |Recommended Media: | |
|1. Demonstrate knowledge of anatomy and |Chapter 18 pp. 290-325 |Medcom Videos | |
|physiology in formulating a care plan for |Chapters 49, 50, 51 |A&P: The Muscular System | |
|the patient with disorders of the | | | |
|musculoskeletal system. CO 1, 2, 3, 4 | |A&P: The Skeletal System |MSK Learning Module |
| | | | |
| |Reference: | | |
|2. Assess characteristics of common musculoskeletal disorders. |Smith, Duell, & Martin: | |UNIT EXAM |
|CO 1, 2, 3 |Chapter 27 pp. 1004-1041 | | |
| | | | |
| |Osteoarthritis |MSK on-campus day | |
|3. Formulate nursing diagnoses related to the patient with a |Rheumatoid Arthritis | | |
|musculoskeletal disorder and design a plan of care for the patient| | | |
|using evidence-based practice. CO 2, 5, 10 |Osteoporosis | | |
| |Osteomyelitis | | |
| | | | |
|4. Demonstrate the ability to take a health/ |Fractures | | |
|illness history of patients with disturbances of the |Amputations | | |
|musculoskeletal system, incorporating societal/cultural | | | |
|differences and apply the nursing process using critical thinking.| | | |
|CO, 1, 2, 3, 4, 5, 11 | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
RNSG 1441 UNIT VI - Application of the Nursing Process Focusing on Musculoskeletal Function (CONTINUED)
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| | | | |
|5. Integrate the purpose of diagnostic | |Homework | |
|measures and treatment modalities for | | | |
|specific musculoskeletal disorders. CO 1, 2, 3 | |1. ATI Learning System RN: Musculoskeletal | |
| | |System (student will receive highest grade | |
|6. Administer medications safely to patients | |earned by the due date) | |
|with musculoskeletal disorders based on National Patient Safety | | | |
|Goals. CO 1, 3, 6, 7, 9, 11 | |2. ATI Pharmacology Made Easy: | |
| | |Musculoskeletal System (student must spend | |
|7. Perform technical skills following standards | |at least an hour in the lesson to get credit| |
|of nursing care applicable to patients with | |for post-test score) | |
|musculoskeletal disorders. | | | |
|CO 7, 8, 9, 10, 11 | |3. ATI Dosage Calculation 2.0: Powdered | |
|8. Integrate principles of nutrition and food/ | |Medications (Student will receive highest | |
|fluid intake in the care of patients with a | |grade earned by the due date) | |
|musculoskeletal disorder. CO 1, 2 | | | |
| | | | |
|9. Determine the relationship of psychosocial | | | |
|concepts to common musculoskeletal disorders considering | | | |
|cultural/ethnic and social diversity. CO 3, 4, 5, 6, 8 | | | |
| | | | |
|10. Integrate community resources in | | | |
|promoting health, preventing disease, and | | | |
|planning nursing care of the patient with a | | | |
|musculoskeletal disorder. CO 1, 2, 10, 11 | | | |
Musculoskeletal Learning Module
1. The nurse is caring for Brad, who has injured his knee playing soccer. He has just returned from surgery and has a dressing in place. Brad, who has been receiving PCA morphine, continues to complain of severe pain. He also is complaining of paresthesia in his leg. The nurse suspects Brad may have:
A. A postoperative infection.
B. Phlebitis.
C. Compartment syndrome.
D. Referred pain.
2. When caring for the patient in traction, the nurse should make sure the patient is in
A. A position of comfort.
B. Good body alignment.
C. The Semi-Fowler’s position.
D. The Fowler’s position.
3. The nurse is educating Mrs. Stone about her new diagnosis of osteoporosis. In addition to calcium intake, the nurse should emphasize that Mrs. Stone have adequate intake of :
A. Vitamin C.
B. Vitamin E.
C. Vitamin D.
D. Vitamin A.
4. When educating a group of patients about the different types of musculoskeletal disorders, the nurse may refer to which of the following as a “wear and tear” disease?
A. Rheumatoid arthritis.
B. Osteoarthritis.
C. Osteoporosis.
D. Osteomyelitis.
5. The nurse is caring for Maxine Wall, who has just has a total hip replacement. When educating Maxine about the complications related to total hip replacement, the nurse should emphasize that one of the common complications is:
A. Osteomyelitis
B. Fracture
C. Dislocation
D. Joint immobility
6. A 90-year-old woman is preparing for transfer to an extended care facility to continue recovery following repair of a fractured hip. She begins to cry and says, “When you’re young these things don’t happen. Why did I break my hip at this age?” Which response by the nurse indicates the best understanding of risk factors for the elderly?
A. “As you age you become less aware of your surroundings and careless about safety.”
B. “Nothing works as well when we are older.”
C. “There are no known specific reasons why hip fractures occur more often in your age group.”
D. “Your age and sex are factors in the loss of minerals from your bones, making them more
likely to break.”
7. An adult is admitted to the hospital. X-rays reveal a fractured tibia and a cast is applied. Of the following, which nursing action would be most important after the cast is in place?
A. Assessing for capillary refill.
B. Arranging for physical therapy.
C. Discussing cast care with the patient.
D. Helping the patient to ambulate.
8. What are the most common sites for osteoarthritis?
A. Hands, back, hips, and knees
B. Hands, elbows, and pelvis
C. Hands, back, and pelvis
D. Knees, hips, and back
9. While assessing a patient in skeletal traction, you observe the distal extremity to be pale with slow capillary refill and palpated a 1+ pulse. You initial action is to
A. Assess the patient every 15 minutes for changes.
B. Observe for ecchymosis or signs of infection.
C. Remove the traction
D. Notify the physician
10. A nurse must apply an elastic bandage to a patient’s ankle ad calf. The nurse should apply the bandage beginning at the patient’s
A. Knee
B. Lower thigh
C. Foot
D. Ankle
11. A nurse teaching is a patient about nonpharmacologic comfort measures to alleviate postoperative pain. Which patient statement indicates a need for further teaching?
A. “With patient-controlled analgesia, or PCA, I can control my pain by administering my own pain medication.”
B. “Music therapy can help me relax, so the pain won’t be so bad.”
C. “The transcutaneous electrical nerve stimulation, or TENS, unit uses an electrical stimulator to block painful stimuli.”
D. “Applying warm moist compresses to my incision can relax my abdominal muscles.”
12. A female patient is at risk for developing osteoporosis. Which action will reduce the patient’s risk?
A. Living a sedentary lifestyle to reduce the incidence of injury
B. Stopping estrogen therapy
C. Taking a 300-mg calcium supplement to meet dietary guidelines
D. Initiating weight-bearing exercise routines
13. A patient who has suffered a compound fracture is preparing for discharge to home. During the teaching session, the patient asks why he needs antibiotics for a broken bone. Which response by the nurse is most appropriate?
A. “You may discuss your prescriptions with your physician at your follow-up appointment.”
B. “The antibiotics will help the bone to heal.”
C. “Antibiotic therapy has been prescribed as a precaution because your bone was exposed to the environment at the time of your injury.”
D. “Of your temperature is normal for 48 hours, you may discontinue the medication.”
14. A patient is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the patient has a greenstick fracture of the arm. What does this mean?
A. The fracture line extends through the entire bone substance.
B. Bone fragments are separated at the fracture line.
C. One side of the bone is broken and the other side is bent.
D. The fracture results from an underlying bone disorder.
15. A nurse has given instructions to a patient returning home after knee arthroscopy. The nurse determines that the patient understands the instructions if the patient states that he or she will:
A. Resume regular exercise the following day.
B. Stay off the leg entirely for the rest of the day.
C. Report fever or site inflammation to the physician.
D. Refrain from eating food the remainder of the day.
16. A patient has a fiberglass (non-plaster) cast applied to the lower leg. The patient asks the nurse when he will be able to walk using the casted leg. The nurse replies that the patient will be able to bear weight on the casted leg:
A. In 48 hours
B. In 24 hours
C. In about 8 hours
D. Within 20 to 30 minutes of application
17. A patient with a hip fracture asks the nurse why Buck’s extension traction is being applied before surgery. The nurse’s response is based on the understanding that Buck’s extension traction primarily:
A. Allows bony healing to begin before surgery
B. Provides rigid immobilization of the fracture site
C. Lengthens the fractured leg to prevent severing of blood vessels
D. Provides comfort by reducing muscle spasms and provides fracture immobilization
18. A patient has sustained a closed fracture and has just had a cast applied to the affected arm. The patient is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. The nurse interprets that this pain may be caused by:
A. Infection under the case
B. The anxiety of the patient
C. Impaired tissue perfusion
D. The recent occurrence of the fracture
19. A nurse is caring for a patient being treated for fat embolus after multiple fractures. Which of the following data would the nurse evaluate as the most favorable indication of resolution of the fat embolus?
A. Minimal dyspnea
B. Clear chest radiograph
C. Oxygen saturation of 85%
D. Arterial oxygen level of 78 mm Hg
20. A nurse is caring for a patient with a diagnosis of gout. Which of the following laboratory values would the nurse expect to note in the patient?
A. Calcium level of 9.0 mg/dl
B. Uric acid level of 8.6 mg/dl
C. Potassium level of 4.1 mEq/L
D. Phosphorus level of 3.1 mg/dl
21. The home care nurse is visiting a patient who is in a body cast. The nurse is performing an assessment of the psychosocial adjustment of the patient in the cast. The nurse would most appropriately assess the:
A. Type of transportation available for follow-up care
B. Ability to perform activities of daily living
C. Need for sensory stimulation
D. Amount of home care support available
22. A patient who has been admitted for an above the knee amputation seems preoccupied and anxious the night before the operation. Which comment by the nurse would promote therapeutic communication?
A. “Would you like me to call a chaplain to talk with you about any concerns you may have about surgery?”
B. “Are you worried about your surgery tomorrow?”
C. “You seem worried about something. Would it help to talk about it?”
D. “It isn’t unusual to worry about surgery. If you’d like, I’ll ask the physician for something to help you sleep.”
23. A nurse caring for a patient who has had an above the knee amputation. The patient refuses to look at the stump. When the nurse attempts to speak with the patient about his surgery, he tells her that he doesn’t wish to discuss it. The patient refuses to allow his family to visit. The nursing diagnosis that best describes the patient’s problem is:
A. Hopelessness
B. Disturbed body image
C. Fear
D. Powerlessness
24. A nurse is evaluating a postoperative patient for infection. Which sign or symptom is most indicative of infection?
A. White blood cell (WBC) count of 8,000/ul
B. The presence of an indwelling urinary catheter
C. Rectal temperature of 100 degrees F
D. Red, warm, tender incision
25. Before preparing a patient for surgery, the nurse assists in developing a teaching plan. What is the primary purpose of preoperative teaching?
A. To determine whether the patient is psychologically ready for surgery
B. To explain the risks associated with the surgery and obtain informed consent
C. To reduce the risk of postoperative complications
D. To express concerns to the patient about the surgery
26. The physician orders morphine, 4 mg IV every hour, as needed to relieve pain. The nurse knows that morphine belongs to which schedule of opioids?
A. Schedule II
B. Schedule IV
C. Schedule I
D. Schedule III
27. After knee replacement surgery, a patient is being discharged with acetaminophen and codeine tablets, 30 mg, for pain. During discharge preparation, the nurse should include which instruction?
A. “Take the medication on an empty stomach.”
B. “Avoid driving a car while taking this medication.”
C. “Decrease your fluid intake to two glasses daily.”
D. “Report any fine motor tremors to your physician.”
28. A patient twists his right ankle while playing basketball and seeks care for ankle pain and swelling. After the nurse applies ice to the ankle for 30 minutes, which patient statement suggests that ice application has been effective?
A. “I need something stronger for pain relief.”
B. “My ankle feels very warm.”
C. “My ankle looks less swollen now.”
D. “My ankle appears redder now.”
29. The patient comes to the emergency department (ED) after accidentally puncturing his hand with an automatic nail gun. Which disorder is this patient primarily at risk for?
A. Osteoporosis
B. Osteomyelitis
C. Osteomalcia
D. Dupuytran’s contracture
30. The older patient has a fractured humerus. The physician is considering the use of electrical bone stimulation and asks the nurse to take a medical history on the patient. Which specific condition, which is a contraindication for this therapy, does the nurse ask the patient about?
A. Seizures
B. Cardiac pacemaker
C. Stroke
D. Peripheral nerve damage
RNSG1441 UNIT VII - Application of the Nursing Process Focusing on Reproductive and Sexual Disorders
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
|Upon completion of the Unit, the student will |Required Reading Assignment: |Recommended Study Guide: | |
|be able to: |Ignatavicius and Workman: |Ignatavicius and Workman: | |
| |Chapter 69, pp. 1449-1460 |Collaborative Care Study Guide | |
| |Chapter 70, pp. 1431-1481 |Problems with Reproduction Chapter 72, pp. | |
|1. Demonstrate knowledge of anatomy and |Chapter 71, pp. 1482-1498 |657-662 | |
|physiology in formulating a care plan for |Chapter 72, pp. 1499-1518 |Chapter 73, pp. 663-670 | |
|patients with reproductive disorders. |Chapter 73, pp. 1519-1529 |Chapter 74, pp. 673-680 |Reproductive Learning Module |
|CO 1, 2, 3, 4 |Chapter 74, pp. 1530-1545 |Chapter 75, pp. 681-689 | |
| | |Chapter 76, pp. 691-698 | |
| | | | |
|2. Assess characteristics of common reproductive and sexual |Breast Cancer | |UNIT EXAM |
|disorders. | | | |
|CO 1, 2, 3 |Inflammations and Infections Gynecologic Cancers of the |CDC website info: | |
| |ovaries/cervix/uterus | | |
|3. Formulate nursing diagnoses related to the patient with | | | |
|reproductive or sexual |Testicular Cancer | | |
|disorders and design a plan of care for the patient using |STD’s | | |
|evidence-based practice. CO 2, 5, 10 |Gonorrhea | | |
| |Syphilis | | |
|4. Demonstrate the ability to take a health/ |Chlamydia | | |
|illness history of patients with reproductive system and sexual |Trichomonas | | |
|disorders, incorporating societal/cultural differences and apply the |Herpes | | |
|nursing process using critical thinking. |PID | | |
|CO 1, 2, 3, 4, 5, 11 | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
RNSG 1441 UNIT VII - Application of the Nursing Process Focusing on Reproductive and Sexual Disorders (CONTINUED)
|OBJECTIVES |THEORETICAL CONTENT |LEARNING ACTIVITIES |EVALUATION |
| | | | |
|5. Integrate the purpose of diagnostic | |Homework | |
|measures and treatment modalities for | | | |
|specific reproductive and sexual disorders. CO 1, 2, 3 | |1. Online STD Practice Test (Moodle) | |
| | | | |
|6. Administer medications safely to patients | |2. ATI Pharmacology Made Easy: Reproductive | |
|with reproductive and sexual disorders based on National Patient | |and Genitourinary Systems (Student must | |
|Safety Goals. CO 1, 3, 6, 7, 9, 11 | |spend at least an hour in the lesson to | |
| | |receive credit for grade on post-test) | |
|7. Perform technical skills following standards | | | |
|of nursing care applicable to patients with | |3. ATI Dosage Calculation 2.0: Parenteral | |
|reproductive system and sexual disorders. | |Medications (Student will receive highest | |
|CO 7, 8, 9, 10, 11 | |grade earned by due date) | |
| | | | |
|8. Integrate principles of nutrition and food/ | | | |
|fluid intake in the care of patients with a | | | |
|reproductive system or sexual disorder. | | | |
|CO 1, 2 | | | |
| | | | |
| | | | |
|9. Determine the relationship of psychosocial | | | |
|concepts to common reproductive and | | | |
|sexual disorders considering cultural/ethnic and social diversity. CO| | | |
|3, 4, 5, 6, 8 | | | |
| | | | |
| | | | |
|10. Integrate community resources in | | | |
|promoting health, preventing disease, and | | | |
|planning nursing care of the patient with a | | | |
|reproductive system or sexual disorder. CO 1, 2, 10, 11 | | | |
Patient Teaching Guide: Breast and Testicular Self-Assessment
FOCUS: Teaching the patient about breast and testicular self-assessment techniques
OBJECTIVES: The student will
1. Establish an empathetic patient approach through understanding of the special
concerns of patients with reproductive disorders.
2. Teach the patient about breast and/or testicular self-assessment techniques.
3. Identify concerns and issues related to breast and/or testicular cancer.
4. Develop teaching plans for breast and testicular self-assessment.
CRITICAL THINKING AND EXPERIENTIAL EXERCISES:
Who should perform monthly breast self-examination (BSE)?
What principles of learning would be appropriate to include in a teaching plan for BSE?
Develop a teaching plan for BSE.
Include: Why BSE is important?
Who should perform monthly BE?
Resources?
Components of the examination:
Inspection
Palpation
Position
Sequence
Imaging Techniques:
Frequency
Cost
Time involved
Pain or discomfort
Where service is available
Risk to exposure to radiation
Develop a plan for teaching self-examination of the male genitalia.
Include: Why self-examination is important?
Who should perform self-examination?
How often should self-examination be performed?
Resources?
Technique?
Where to perform the procedure?
Components of the examination:
Inspection
Palpation
Procedure
Sequence
*Smith and Duell 8th ed. Pages 310-311
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