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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 1: CARE OF THE PATIENT WITH TRAUMATIC INJURIES PAGE 1 OF 3

CL A SS O BJ ECT IVES 1. C omp are and contrast, based on acquired know ledge, traum a/ insult at all le vels identified in relationship to professional p ractice. 2. L ist the le ading causes of traum atic injury and th e im pact on the patient, fam ily, and society. 3. List th e criteria for traum a classification. II . 4. Explain th e pro cess of prim ary assessm ent of th e scene of a traum a. 5. 6. D iscuss the use of a traum a score. III. Explain the proce ss of th e ER T raum a S urvey presented in class. 7. Identify clients at risk for septic sho ck and h ypovolem ic sho ck. 8. D iscuss the inte raction of blood vo lum e and size of th e capillary bed affecting m ean arterial pressure (M A P). 9. Com pare and contrast hyperdynamic and hyp odynamic ph ases of shock and their progression to M O D S and death . 10 . D e te rm ine the stages or ph ases of sho ck by analyzing signs and sym ptom s as w ell as physiological ch ange s. E. 11. E xplain the effe ct of traum a on the bod y system s. 12 . D iscuss and analyze th e effect of nursing outcom es and nursing interventions for th e patient in sho ck. 13. Prioritize and integrate nursing diagnose s base d on patients' needs into the plan of care. 14. D eterm ine the appropriate pharm acological and nutritional as w e ll as alte rnative strategies utilized by nursing. C. V. S pecific D isorders in th e Patient w ith Traum a A. B. M O D S (M ultisystem O rg an D y sfunc tio n Synd rom e) Types of Sh ock 1. 2. 3. 4. 1. 2. 3. 4. 5. 6. 7. 8. 9. H ypovolem ic Cardiogenic D istributive O bstructive h ypovolem ia cardiogenic shock d istributive shock (neura l/c hem ic al ind uc ed ) anaph ylaxis sepsis DIC capillary leak syndrom e h ypoxia acidosis h yperkalem ia D. C. B. IV . Patient A dvoca cy / Legal-Eth ica l Issue s / Careg iver A cc ounta bility A. Ro le of the N urse i.e., state/fede ral law s/policy proced ures; bereavem ent/loss/death U tilization of the N ursing Process as it Relates to Th is U nit in General A. A ssessm ent 1. 2. 3. 1. 2. 3. 1. 2. A B C's of Care S urveillance D ata Co llection Alteratio n in T issue Perfusio n A lteration in Fluid V olum e H em od ynam ics/Cardiac O utput Suggested N O C Ou tc om es/Sy stem O riented Suggested N IC Interventio ns/H em od yna m ic M o nito ring /Sy stem O riented Im plementa tion 1. 2. 3. N IC Ba sed Interventio n Prioritizing /O rg anizing C a re a nd A ctivities Collabo ra tive E ffo rts/C o m p lem enta ry T hera pies/D elega tion H ealth Prom otion: Ro le of the Professional N urse A. B. C. Prim ary (risk factors; educ ation) S econd ary (triage assessm ent in early detec tion) Tertiary (co ncepts of reh abilitation at onset of acute injury; D isease S ynd rom e/Post Traum atic S tre ss D iso rder) C. D. E. F. B. I. O verview of Traum a A. Cellular 1. 1. 2. 3. Review of A & P of hypoxia/acidosis Statistic al ana lysis ba sed on area/system Review A & P; M A P/C.O . Types Clinical Assignm ent W hen Practical C a se S tudie s H andouts Po w er Po int Pre se nta tio n Individual C L A SS C O N T E N T T E A C H IN G S TR AT E GY L ec ture/D isc ussio n

Fam ily Com m unity N ational Global

A nalysis / N ursing D iagnosis / N A N D A

Planning

Evaluation of O utcom es (N O C) Ach ievem ent

Pathoph ysiology/Epidem iology Etiology

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REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 1: CARE OF THE PATIENT WITH TRAUMATIC INJURIES PAGE 2 OF 3

C L A SS O BJ ECT IVES 10. h ypoth erm ia 11. tablets/toxins overdo se 12. card iac ta m p ona de 13. tension pneum othorax 14. pulm onary em bo lus D. Clinica l M anifestations/D iagnostic D ata 1. Fours stages of shock a. b. c. d. E. 1. initial nonprogressive progressive refracto ry C L A SS C O N T E N T T E A C H IN G S TR AT E GY

Collaborative M anagem ent of M O D S A ssessm ent a. b. c. d. e. f. 2. 3. h istory physical exam clinical m anifestations vital signs O 2 saturations A B G 's

V olum e re placem ent; Collo id fluid re placem ent; Crystallo id fluid replace m ent D rug therapy a. adrene rgics/va so constrictors

F.

N ursing M anag em ent in Ac corda nce to the N ursing Process 1. NANDA a. b. c. d. e. 2. N IC a. surveillance of cardio hem odynam ics 1) 2) 3) 4) b. c. d. e. f. 3. a. b. c. d. e. f. sh ock m anagem ent/cardiogenic vasogenic volum e p revention potential for M O D S potential for SI RS (S ystem ic Inflam m atory Re sponse Synd rom e) altera tions in tissue p erfusio n A lt C.O . JVD

fluid volum e m anag em ent drug th erapies (antibiotics/antibo dies/anticoagulants/clotting factors; bloo d produc ts) safety h ea lth teach ing h om e care m anag em ent infectio n free labs W N L O 2 sat >= to 85% CV P/M A P/PCW P/W N L patent airw ay urina ry output >300cc/h r.

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Care of th e Patient w ith Acute Traum a w ith Insult to M usculoskeletal, GI/AB D , Respira tory, C om p artm ent Synd ro m e i.e. M V A /G unshot W o und s A. B. Pathoph ysiology Clinica l M anifestations/D iagnostic D ata 1. 2. 3. Xray/U ltra sound s Peritoneal tap B ronchoscopy

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 1: CARE OF THE PATIENT WITH TRAUMATIC INJURIES PAGE 3 OF 3

C L A SS O BJ ECT IVES C. C L A SS C O N T E N T Collabo rative M anag em ent 1. 2. 3. 4. D. 1. Invasive hem od ynam ic m onitoring Intubation, ch est tubes, m ech anical ve ntilation, oxygen delive ry N G suction, peritoneal tap Stabiliza tio n o f fra ctures NANDA a. b. c. d. e. f. g. h. 2. N IC a. b. c. d. e. f. g. h. i. 3. a. b. c. d. e. surveillance energ y conserva tion pain m anag em ent blee ding precautions fluid m anag em ent oxygen delive ry know led ge: p ain/infectio n pre /p ost op nutritio n im m une status optim a l level of func tio n follow -up w ith rehab ilita tion infectio n contro l tissue p erfusio n nutrition H igh risk ineffective coping Post T ra um a tic Stress D isord er alterations in m obility tissue p erfusio n risk fo r J V D hem orrhage infectio n protectio n/c ontro l ene rgy m anag em ent T E A C H IN G S TR AT E GY

N ursing M anagem ent/Assessm ent/S ystem Approach

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REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 2: CARE OF THE PATIENT WITH COMPLEX ENDOCRINE DISORDERS PAGE 1 OF 2

C L A SS O BJ ECTIVES 1. D e scribe th e functio n of th e E ndo crine glands and th e production of h orm one s. 2. D e scrib e thre e le ve ls of prevention in relation to end ocrine disorders. 3. D iscuss the patho ph ysiolog y and clinical m anifestations of th yroid disorders. 4. I nte rp re t the re sults of laboratory data and diagnostic tests associated w ith th yroid disorders. 5. U tilize M aslow 's hie rarch y of needs to assess th e client w ith a th yroid diso rder. 6. Prioritize nursing care for a client following m e dical treatm ent or thyroide ctom y. 7. Prioritize nursing care for a client experiencing th yroid storm . 8. Prioritize nursing care for a client experiencing m yxedem a com a. B. 9. I dentify thre e nursing d iagnoses (N A N D A ) com m only associated w ith a client w ith hyperthyroidism or h ypothyroidism utilizing the nursing process. 10. Id entify three co rrespo nding nursing outcom e s (N O C) associate d w ith the diagnoses generated for th e client w ith hyp erthyroidism or h ypoth yroidism . 11. D iscuss ap propriate (N IC) based nursing interventio ns fo r th e clie nt with hyp erthyroid ism or h ypoth yroidism . 12 . D iffe re ntiate b etw een features se en in a client w ith hyperth yroidism vs. hypoth yroidism . D. 13 . D iscuss the thre e types of thyroiditis and the expected treatm ent. 2. 3. C o ntinue s on ne xt pa ge . . . C. V. 4. 3. 2. D. 2. 1. C. IV . A dvanced N ursing M anag em ent of th e C lient w ith H yperthyroidism and H ypothyroidism A. Assessm ent utilizing G o rd o n's F unc tiona l H ealth Pa tterns - key findings A nalysis / N ursing D iagnosis / N A N D A Planning 1. S uggested N O C outcom es (activity tolerance, anxiety tolerance and h ea lth m a intena nc e) S uggested N IC interventions N IC based interventions (activity m anag em ent, stress m anag em ent, and im proved he alth ed ucation) Prioritizing (M a slow ) / Org anizing c are a ctivities / co st issues (ch ronic condition and ongo ing ed ucation) Collabo ra tive effo rts / C om p lem enta ry thera pies / D elega tio n (H ealth care resources) Evaluation of outco m e (N O C) ach ievem ent Im plementa tion D. 2. 1. C. II I. S pecific D isorders of th e T h yroid G land A. B. Pathoph ysiolog y of hype rthyroidism and h ypothyroidism Clinical m anifestations of hyperth yroidism and h ypothyroidism 1. 2. 1. laborato ry da ta diagnostic tests m ed ical intervention: antithyroid drugs, rad ioa ctive iod ine treatm ents surgical intervention: thyroidectom y m ed ical intervention Collabo rative m anag em ent of hypo thyroidism II. H ealth Prom otio n A. B. C. Prim ary prevention (ed ucation re: risk factors) S econd ary prevention (ea rly detec tion) Tertiary prevention (prevention of com plications) I. C L A SS C O N T E N T Review th e Ana tom y & Physiology of the End ocrine Sy stem A. B. C. D. E. F. G. Pituitary Parath yroid Th yroid A dre nals Pancreas O varies Testes C a se studie s H andouts Lecture T E A C H IN G S TR AT E GY A ssigned Re ad ing

Collabo rative m anag em ent of hype rthyroidism

S pecific D isorders of th e Parathyroid G land A. B. Pathoph ysiolog y of hype rparathyroidism and h ypoparathyroidism Clinical m anifestations of hyperparathyroidism and h ypoparathyroidism 1. 2. assessm ent serum lab tests

Collabo rative m anag em ent (D iuretic and fluid the rapy, drug the rapy, surge ry) N ursing m anag em ent in acco rda nce w ith the nursing process 1. N A N D A : activity intolerance, altered th oug h t process, im balanced nutritiona l status) N O C: ac tivity tolera nc e, cognitive o rienta tion, ba la nc ed nutritional status N IC: energy m anagem ent, delusional m anagem ent, nutritional counseling

C ontinues on next pa g e . . .

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 2: CARE OF THE PATIENT WITH COMPLEX ENDOCRINE DISORDERS PAGE 2 OF 2

CL A SS O BJ ECT IVES 14. D iscuss the patho ph ysiolog y and clinical manife statio ns of Parath yroid disorders. 15 . D iffe re ntiate b etween features seen in clients w ith h yperparathyroidism vs. h ypoparath yroidism . 16 . I dentify thre e nursing d iagnoses (N A N D A ) com m only associated w ith a client w ith hyperparathyroidism or h ypoparathyroidism utilizing the nursing process. H. 17. Id entify three co rrespo nding nursing outcom e s (N O C) associate d w ith th e d iagnoses generated for th e patient w ith hyp erp arathyroidism or h ypoparath yroidism . 18 . D iscuss ap propriate (N IC) based nursing interventions for th e client w ith hyp erp arathyroid ism or h ypoparath yroidism . 19. D iscuss the patho ph ysiolog y and clinical m anifestations of Adrenal disorders. 2 0. D iffe re ntiate b etween features seen in clients w ith Cush ing's Syndrom e and Conn's Syndrom e. 2 1. D iffe re ntiate b etween features seen in clients w ith Cush ing's S yndrom e, Co nn's Syndrom e, and A ddison's Dise ase . 22. Prioritize nursing care for a client ex periencing A dd isonian Crisis. 23. Interpret the results of laboratory da ta & diagnostic tests associated w ith A drenal disorders. 24. I dentify th ree po ssible N A N D A , N O C, and N IC labels com m only associated w ith a client e xp erie ncing C ushing's Syndrom e. 25. I dentify th ree po ssible N A N D A , N O C, and N IC labels com m only associated w ith a client e xp erie ncing C onn's Syndrom e. 26. I dentify th ree po ssible N A N D A , N O C, and N IC labels com m only associated w ith a client e xp erie ncing A ddison's Disease. 6. 3. 4. 5. 2. G. C. D. E. F. VI. C L A SS C O N T E N T Specific D isord ers o f the A d rena l G la nd s A. B. Path oph ysiology of Cush ing's Syndrom e and Conn's Syndrom e Clinical ma nifesta tions of C ushing 's Synd rom e a nd Conn's Synd rom e 1. 2. assessm ent serum lab tests T E A C H IN G S TR AT E GY

Collabo rative m anag em ent (fluid balance , drug the rapy, surge ry) N ursing m anag em ent in acco rda nce w ith the nursing process Pathoph ysiolog y of Ad dison's D isease Clinical m anifestations of Add ison's D isease 1. 2. 3. assessm ent serum lab tests non-invasive tests

Collaborative m anagem ent (fluid balance, drug therapy, cardiac m onitoring) N ursing m anag em ent in acco rda nce w ith the nursing process 1. N A N D A : Activity intolerance, Altered body im age, Know ledge de ficit r/t disease process N O C: E nd ura nc e, Psyc hoso cia l ad justm ent, Inc reased know led ge base N IC : Energy m anag em ent, Im proved self-esteem , Te ach ing N A N D A : Fluid and electrolyte im balance, D enial, Know ledge de ficit r/t disease process N O C: F luid and electro lyte b ala nc e, A c cepta nc e, Inc reased know led ge base N IC : D rug the rapy, Co m pliance , Te ach ing

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 3: ETHICAL AND BIOETHICAL ISSUES IN NURSING AND HEALTH CARE

CL A SS O BJ ECT IVES 1. Identify basic concepts of hum an valuing essential for ethical decision m aking. 2. I dentify se le cte d e th ical th eories and principles basic to ethical decision m aking. III. 3. Identify current and future eth ical issues related to nursing p ractice. 4. A nalyze the re lationsh ip between the AN A Co de of Ethics and personal m orality/values in re lation to nursing p ractice. 5. A pply th e eth ical dec ision-m aking p roce ss to sp ecific issues e ncounte re d in nursing practice. 6. I dentify com m unity resources available to patients facing difficult ch oices. 7. D e ve lop a curiosity in th e stud y of eth ics by research ing available resources identified in SIM O N . V. A cc ounta bility A. B. C. V I. Personal Professional Patient Advocacy IV . Eth ical Term ino logy and Principals A. B. C. D. E. F. V eracity A utonom y Fidelity B eneficence N on-m aleficence Futility Th e State of A ffairs A. B. C. D. E. F. G. H. Public Re sponse Patient B ill of Righ ts Patient Self-D eterm ination A ct Advanced H ea lth D irectives Confidentiality Collaborative Pra ctic e Inc lud ing D elega tio n Legal Issues vs. E thic al Issues B ioethics and Com m on Ethical D ilem m as Presented in the Clinical Environm ent Linkage s: Connecting new content to prior learning. II . Eth ical Refo rm ation, A Process A. B. C. Value Form a tio n M oral D evelopm ent Th eo ry D evelopm ent W ritten E xa mina tio n D isc ussio n A udio/V isual Presentations I. C L A SS C O N T E N T Re view AN A Co de of Ethics and H istorical D evelopm ent T E A C H IN G S TR AT E GY Lecture

A pplication of the N ursing Process to Ethical D ilem m as Inco rporating N AN D A, NIC, N O C . A. NANDA 1. 2. 3. 4. 5. B. 1. 2. 3. 4. C. N IC 1. 2. 3. 4. 5. active listening anticipatory guidance conflict m ed ia tion learning fa cilita tio n patient rig hts protection decisional conflict fear coping , individual and fa m ily spiritual distress com m unity coping ineffective acc eptance of h ea lth status com m unity com petence fam ily/individua l coping spiritual w ell-being

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 4: CARE OF THE PATIENT WITH COMPLEX CARDIOVASCULAR DYSFUNCTION PAGE 1 OF 6: OVERVIEW

CL A SS O BJ ECT IVES 1. D e scribe th e functio ns of th e cardio vascular system and th e co ncepts invo lved in th e h em odyna m ic stability related to th e cardiovascular system . 2. D e scrib e thre e le ve ls of preventio n in relatio n to th e cardiovascular system . II I. 3. D iscuss die t modific ation used w ith th e patient w ith CA D . IV . 4. D e scrib e and discuss issues involved in relation to age, gend er, culture , socioe conom ic, religion and eth ics in relation to cardiovascular system . B. 5. D iscuss and diffe re ntiate between pathoph ysiology and clinical m anifestations of chest p ain/cardiovascular d isease. 6. D escribe and discuss client preparation, procedure and follow up care of patients h aving diagnostic assessm ents. d. 7. Identify defining character-istics use d for nursing diagnoses related to cardiovascular disease/prob lem s. b. 8. Identify N O C outco m es related to com plex cardiovascular problem s. 9. Id entify N IC interventions related to com plex cardio-vascular problem s. e. 10 . D iscuss ap propriate N IC based nursing interventions for pa tients w ith com p le x cardiac disease. 11. Prioritize care based on M aslow 's h ierarch y of needs for pa tients w ith cardiovascular disease. E. 12. D iscuss purpose and nursing responsibilities related to m ed ication, diet th erapy, the rape utic interventions, and discharge planning/education re late d to cardiovascular disease. C a rd iova scula r S ectio n C o ntinues on next pa g e . . . 2. 3. D. 1. c. d. 2. a. c. b. C. Com plex D isorders in Relation to Ch est Pain and Cardiovascular D isease A. A ssessm ent 1. 2. Pathoph ysiolog y related chest pain/ cardiovascular disease Clinical m anifestations of chest pain/cardiovascular disease a. b. Planning 1. Suggested N O C Ou tc om es a. Card ia c pum p effectiveness (extent to w hic h b lood is ejected from th e left ventricle per m inute to support system ic perfusion) S ufficient tissue perfusion (blood flow to m aintain organ/tissue perfusion) Adequa te c irc ula tory sta tus (C V P , w ed ge p ressure, blood pre ssure, blo od ga ses w ithin no rm a l ra ng e) Sta ble vita l sig ns sta tus (exp ec ted ra ng e H R , rhythm , B P, R, T, pulse O x) Possible N IC Interventions Acute C a rd ia c C are (lim it co m p lic ations betw een supply/dem and resulting from cardiac problem s) Circulato ry Ca re (drug therapy; tem po rary suppo rt w ith m ech anical devices/pum ps) H e m od yna m ic R eg ula tions - Op tim ize (heart ra te, preloa d/afterloa d, contractability, perfusion) S h ock M anagem ent - Cardiac, O bstructive (prom ote ad equate tissue p erfusio n for a pa tient w ith a severely com p ro m ised h eart) Pain M anag em ent (drug th erapy, trea tm ents) Im plementa tion N IC B ased Interventions (pain m a na gem ent, anxiety red uc tio n, ac ute c ard ia c ca re, h em odyna m ic regula to rs, ad equa te c irc ula to ry ca re, ventila tion assistance, shock m anagem ent, energy m anagem ent) Prioritize (M a slo w ) Org anizing C a re A c tivities Collabo ra tive E ffo rts / C om p lem enta ry T hera pies / D elega tion Gordan's functional he alth patterns Collabo rative data (lab data, diagnostic data, he m od ynam ics) Patient Ad voca cy / Le gal-Eth ical Issues / Caregiver A cc ounta bility II. H ealth Prom otio n A. B. C. Prim ary Preve ntion (education i.e. risk facto rs, diet) S econd ary Prevention (ea rly detec tion) Tertiary Prevention (ea rly recog nition of com plications) Post Conference D isc ussio n Po w erPo int Pre se nta tio n I. C L A SS C O N T E N T Review of the A & P of the Cardiovascular Syste m and the Concepts Involved in H em od yna m ic Sta bility Rela ted to this System (i.e. electro ph ysiology, corona ry arte ries, pre load, afterload, cardiac output). O verhead T ra nspare nc ie s T E A C H IN G S TR AT E GY Lecture

A nalysis / N ursing D iagnosis / N A N D A

Evaluation of N O C O utcom e A ch ievem ent

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 4: CARE OF THE PATIENT WITH COMPLEX CARDIOVASCULAR DYSFUNCTION PAGE 2 OF 6: ACUTE CORONARY SYNDROME

CL A SS O BJ ECTIVES 1. Explain th e path oph ysiology in acute coronary syndrom e. 2. D escribe considerations necessary w h en evaluating fem ale, elde rly, and th e culturally diverse in relation to acute corona ry syndrom e . C. 3. Interpret, com pare and co ntrast clinical m anifestations/ diagnostic data to diffe re ntiate between unstable angina, subendocardial M I, M I by location. 4. Prioritize the care of th e patient w ith acute coronary synd rom e. C a rd iova scula r S ectio n C o ntinues on next pa g e . . . 5. D escribe th e care of the patient after interventions for acute coronary syndrom e . 6. List possible N A N D A , N O C labels w ith coronary arte ry synd rom e. 7. L ist possib le nursing (N IC) interventions for pa tients w ith coronary arte ry syndrom e. 8. D evelop disch arge teach ing plans for pa tients adm itted w ith coronary syndrom e . E. D. I. C L A SS C O N T E N T U nstable Angina , Sub end o ca rd ia l M I, M yo ca rd ia l Infa rc tion A. B. Pathoph ysiology / Epidem iology (focus on coronary arteries) Clinical M anifestations (S &S , locatio n o f M I) D iagnostic D ata (lab values, EKG interpretation in depth, stress test, scans, cardiac cath eterization) Collabo rative M anag em ent (drug therapy, O 2, m onitor, throm bolysis, PT CA , PT CA w ith shunt, laser tx) N ursing M anag em ent in acco rda nce w ith the N ursing Process/N A N D A /N IC/N O C Teach ing/E d uc atio n (drug therapy, rest/activity, cardiac rehab. program s, psychosocial aspects) M ed ication H andout C orrela te m ed ic atio n with ca re o f th e pa tient w ith acute corona ry syndro m e . Lecture C o m p etenc ies I I, I II , V I , V I I Posters in the N ursing Lab A /V M aterials - Po w er Po int, Slid es, T ra nspare nc ie s T E A C H IN G S TR AT E GY H andouts prepared by D r. Flynn Com petencies, E K G Inte rpre ta tio n

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 4: CARE OF THE PATIENT WITH COMPLEX CARDIOVASCULAR DYSFUNCTION PAGE 3 OF 6: CARDIAC DYSRHYTHMIAS

CL A SS O BJ ECT IVES 1. D e scrib e and discuss path ophysiology involved in cardiac dysrh yth m ias (electrical / conduction) electroph ysiologic properties. 2. Correlate co m po nents of EKG w ith cardiac co nduction. 3. Interpret com m on cardiac dysrh yth m ias and cardiac heart blocks. 4. I dentify he modynamics associated w ith com m on rh yth m ias problem s and priorities for interventions. D. 5. C omp are and contrast classes of antidysrhythm ia drugs. 6. Explain the purp ose and types of pa ce m ake rs use d for clients w ith dysrhythm ias. 7. O utline proced ures and preca utions associated w ith cardiove rsion/de fibrillation. 8. Explain th e purpose of radio freque ncy catheter ablation. 9. D iscuss the purp ose of aneurysm ectom y. 10. D iscuss w hen open heart cardiac m assage w ould be used . 11. 12. Explain th e purpose of ICD . Identify priorities for pa tients ex periencing dysrh ythm ias. 13. D iscuss dysrhythm ias w ith a focus on the elde rly. 14 . D e ve lop a plan of care for patients w ith dysrhythm ias using N A N D A , N O C , and NIC. 15. D evelop disch arge/teach ing plans for pa tients adm itted w ith dysrhythm ias. C a rdiova scula r Section C ontinues o n next pa g e . . . V. IV. N ursing M anagem ent in A c cord anc e w ith N u rsing Process (N A N D A , N O C , N IC) H e alth Teach ing Related to M e dications, D iet Th erapy, Pacem akers, ICD . II I. Collabo rative M anag em ent A. B. C. D rug Th erapy Cardiac M onitoring N on-S urgical 1. 2. 3. 4. 5. 1. 2. 3. D rug Th erapy Tempora ry Pa cem a ker (no n-inva sive, inva sive) Cardioversion D efibrilla tion Radio Frequenc y C atheter A b la tio n A neurysm ectom y O pen Chest Cardiac M assage ICD (Inp lantable Cardiove rte r/D efibrillato r) M ed ication H andout Correlated w ith arh yth m ia problem s II. Clinica l M anifestations/D iagnostic D ata (C ardiac M o nito ring, Lab D ata, EKG , EPS ) H andouts (prepared by D r. Flynn) D ysrhythm ias Practice Strips A udiovisuals I. Pathoph ysiology/Epidem iology C L A SS C O N T E N T S tudents M U S T be certified in B LS T E A C H IN G S TR AT E GY Lecture C o m p e te nc ie s IV , V , V I I I, I X

S urgical

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 4: CARE OF THE PATIENT WITH COMPLEX CARDIOVASCULAR DYSFUNCTION PAGE 4 OF 6: CARDIAC PROBLEMS RELATED TO MECHANICAL FAILURE

CL A SS O BJ ECT IVES 1. E xplain the pathophysiology of h eart failure/acute pulm ona ry edem a. 2. List descriptions of h eart failure using Killip Classification o f H eart F ailure . 3. D escribe considerations necessary w h en evaluating a patient in relation to heart failure/ac ute pulm onary edem a. 4. D escribe special conside rations focusing on the elde rly. D. 5. Prioritize nursing care for patients experienc ing heart failure, acute pulm onary edem a. 6. List possible N A N D A , N O C labels and N IC interventions for pa tients w ith CH F/acute pulm onary edem a. 7. D e ve lop te aching /le arning plan for clients at risk for heart failure/acute pulm onary edem a. 8. Explain the pathophysiology of cardiom yopathy. B. 9. D escribe considerations necessary w h en evaluating a pa tient w ith cardiom yopathy. C. 10 . Comp are and contrast th e th ree diffe re nt typ es of cardiom yopathy and interventions re quire d. 2. 11. Prioritize nursing care for patients w ith cardiom yopathy. 12. List possible N A N D A , N O C labels and N IC interventions for pa tients w ith cardiom yopathy. C a rdiova scula r Section C ontinues o n next pa g e . . . E. I I. C ardio m yo path y A. Pathoph ysiology/Epidem iology 1. 2. 3. 1. 2. 3. 1. D ilated Cardio m yo path y H ypertro ph ic Cardio m yo path y Restrictive Cardio m yo path y ECH O Cardiac C atheteriza tio n Radionuclide Im aging M edical a. b. c. a. b. c. drug therapy diet therapy stress m anag em ent ex cision of hypertroph ied septum ca rdiom yo plasty h ea rt transplant E. C. B. I. C L A SS C O N T E N T Congestive H eart Failure/A cute Pulm onary Edem a A. Pathoph ysiology/Epidem iology 1. 2. 1. 2. 3. 4. 1. 2. 3. 4. 5. Left-S ided / Righ t-S ided H eart Failure A cute Pulm onary Edem a M ed ication H andout ECH O M VGA S tress EKG Cardiac C atheteriza tio n D rug Th erapy O2 V entilation A ssistance H em od ynam ic Regulations Ene rgy M anag em ent H andout on CH F T E A C H IN G S TR AT E GY C om p ete nc y I II

Clinica l M anifestations/D iagnostic D ata

Collabo rative M anag em ent

N ursing M anagem e nt in A cco rdance w ith N ursing Pro cess fo r th e Care of Patients w ith H eart F ailure U sing N A N D A /N O C /N IC Teach ing/E d uc atio n 1. 2. 3. 4. 5. 6. H ealth T ea ch ing A ctivity Sch edule D rug Th erapy D iet Therapy W h at to repo rt to hea lth ca re p rovid er S urgical interve ntions w h en necessary

Clinica l M anifestation/D iagnostic D ata

Collabo rative M anag em ent

S urgical

N ursing M ana gem ent in A ccordanc e w ith N ursing Process for Care o f th e Patient w ith C ardio m yo path y

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 4: CARE OF THE PATIENT WITH COMPLEX CARDIOVASCULAR DYSFUNCTION PAGE 5 OF 6: CARDIAC PROBLEMS RELATED TO SHOCK

CL A SS O BJ ECT IVES 1. Explain th e path oph ysiology in cardiogenic sh ock (direct pum p failure); obstructive shock (ind irect pum p failure). 2. D escribe the clinical m anifestatio ns asso ciated w ith th e com p ensatory me chanism s of sho ck. 3. Com pare and contrast cardio-genic shock vs obstructive shock (cardiac tam pona de). 4. Prioritize the care of patients w ith cardiog enic sho ck vs ob structive sho ck. 5. List possible N A N D A /N O C labels for patients w ith cardiogenic sho ck/ obstructive sho ck. C a rdiova scula r Section C ontinues o n next pa g e . . . 6. List possible nursing interventions (N IC) for pa tients w ith cardiog enic sho ck/obstructive sho ck. 7. D evelop a discharge teaching plan for a patie nt w ith a d iagnosis of sho ck. V. IV . N ursing M anag em ent in Ac corda nce w ith the N ursing Process U sing N AN D A/N O C/N IC Teach ing/Education for a Patient After Treatm ent for Sh ock B. II. II I. Clinica l M anifestations/D iagnostic D ata A udiovisuals Collabo rative M anag em ent A. M edical 1. 2. 3. 4. 1. 2. D rug Th erapy O 2 Therapy Intra-A ortic B alloon Pum p Intervention in cause of cardiogenic shock V alvular surgery Pericardiocentesis M ed ication H andout I. C L A SS C O N T E N T Pathoph ysiology/Epidem iology Related to Cardiogenic Sh ock/O bstruc tive Shoc k (C a rd ia c T am p ona de) C om p ete nc y I II T E A C H IN G S TR AT E GY Lecture

S urgical

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 4: CARE OF THE PATIENT WITH CARDIOVASCULAR DYSFUNCTION PAGE 6 OF 6: SURGICAL INTERVENTIONS

CL A SS O BJ ECT IVES 1. D escribe and discuss path oph ysiology involved in valvular disorders. B. 2. Com pare and co ntrast signs and sym ptom s com m on in each valvular diso rder. 3. D e scrib e various proced ures used to correct valvular problem s. 2. 4. Prioritize the care of patients w ith valvular disease interventions. 5. D escribe th e care of the patient after interventions for vascular dise ase . 6. D e ve lop a plan of care for patients before and after surgical inte rve ntions for valvular d isease. 7. D evelop a discharge teaching plan for patients w h o h ave unde rgo ne surgical interventions for vascular dise ase . 8. D escribe and discuss path oph ysiology involved in cardiovascular dise ase. 9. Com pare and co ntrast signs and sym pto m s co m m on in pa tients re quiring surg ical intervention for CA D . 10 . D iscuss the diffe re nces between surgica l interventions for pa tients w ith CA D . 11. D escribe th e interventions used in CA B G surge ry. 12. Prioritize the care of patients afte r surgical inte rvention for CA D . 13. D evelop a discharge teaching plan fo r pa tients w h o have had surgery for CA D . D. E. C. II. Corona ry Artery A. B. Pathoph ysiology/Epidem iology 1. 1. 1. Coronary A rteries Righ t-S id ed/L eft-Sid ed C ard ia c C atheteriza tio n CA B G Surgery a. b. c. saph eno us radial interna l m am m ary arte ry Clinica l M anifestations/D iagnostic D ata Collabo rative M anag em ent E. D. C. I. V alvular D iso rders A. Pathoph ysiology/Epidem iology (Tricuspid, Pulm onary, M itral, Aortic V alves) Clinica l M anifestations/D iagnostic D ata (in general and sp ec ific for ea ch va lve) Collabo rative M anag em ent 1. Reparative Proced ures a. b. c. a. b. c. d. B alloon valvuloplasty D irect or open com m issurotom y M itral valve reconstruction. Pro sthetic va lves X eno graft H om og raft Pulm o nary auto graph y H andout on S urgical Interventions C om p etenc ie s V I , V I I A udiovisuals C L A SS C O N T E N T T E A C H IN G S TR AT E GY Lecture

Replace m ent Proced ures

N ursing M anag em ent in Ac corda nce w ith N ursing Process U sing N A N D A /N O C/N IC Interventions Teach ing/D ischarge Plan for Patients H aving U ndergone V alvular S urgery

N ursing M anag em ent in Ac corda nce w ith N ursing Process using N A N D A /N O C/N IC Interventions Teach ing/E d uc atio n for Pa tients H a ving U nd erg one Su rg ery for CAD 2. 3. M inim ally Invasive D irect Coronary A rtery B ypass Transm yoca rd ia l La ser Reva sc ula riza tion

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 5: CARE OF THE PATIENT WITH COMPLEX RENAL, URINARY, AND PROSTATE DISORDERS PAGE 1 OF 2

C L A SS O BJ ECTIVES 1. D e scribe th e functio n of th e renal and urinary system s and function of the prostate gland. D e scrib e thre e le ve ls of pre vention in relation to renal, urinary and prostate disorders. D iscuss the patho ph ysiolog y and clinical m anifestations of renal failure . Interpret the results of laboratory da ta & diagnostic tests associated w ith re nal failure. D iscuss three treatm ent m o dalities used in th e collaborative m anagement of chronic re nal failure. D e scrib e the kidne y d onor selection process. V. 7. D iscuss th e drug therapy use d to prevent transplant re jection. D iscuss nursing re sponsibilities in caring for possible transplant cand ida tes. U se M aslow's hie rarc h y of needs to prio ritize assessm e nts in th e patient w ith CRF undergoing various treatm ent m odalities. S tate four nursing diagnoses (N A N D A ) com m only associated w ith a patient in end-stage renal disease. List four correspo nding nursing outcom es (N O C) associated w ith th e diagno ses generated fo r th e p atie nt in end-stage renal d isease. V I. 12 . D iscuss ap propriate N IC based nursing interventio ns fo r th e p atie nt unde rgoing d ialysis or renal transplant. D iscuss the nursing m anag em ent of the end-stage renal patient at h om e and the use of co m m unity resources. VII. 14. D iscuss the patho ph ysiolog y and clinical manife statio ns of com plex diso rd ers of th e urinary system : Ex B lad de r Tum ors. I. II. C L A SS C O N T E N T Review of th e Anatom y and Ph ysiology of th e Renal and U rinal System s H ealth Prom otio n A . Prim ary Preve ntion of Re nal Fa ilure, U rinary D isorde rs and Prosta te D iso rders B . S econd ary Prevention: Ea rly D etection of Re nal, U rinary, and Prostate D iso rders C. Tertiary Prevention: Patient Te ach ing Complex Disord ers of the Rena l System A. Path oph ysiology of C hronic R ena l F ailure (C R F) B . Clinical M anifestations of C h ronic Rena l Failure 1. Laborato ry da ta 2. D iagnostic tests C. Collaborative M ana gem ent of Ch ronic Rena l Failure D . M ed ical Intervention: Ph arm aco log ical, D ialysis & Renal Transplant E. S urgical Intervention: D ialysis Access and Renal Transplant F. N utritiona l S upport Patient A dvoca cy / Legal-Eth ica l Issue s / Careg iver A cc ounta bility A . U nequal Acce ss to Kidne y Transplant List B . H ealth Insurance S tatus A dva nc ed N ursing M ana gem ent of th e Patient w ith Ch ronic Rena l Failure A. Assessm ent A c cord ing to G ord o n's F unc tiona l H ealth Pa tterns ­ Key findings B . A nalysis/N ursing D iagnoses Associated w ith D ialysis and Renal Transplant: Ex ­ Exc ess fluid volum e, Interrupted fam ily process, Ine ffective coping C. Planning 1. Com m on N O C O utcom es: Ex ­ Fluid Balance 2. S uggested N ursing Interventions: Ex - Fluid M anagem ent, Fluid M onitoring D . Im plem entation: N IC B ased Actions A pplied to the Patient and Fa m ily of th e D ialysis/T ransplant Patient: Ex - Fluid M anag em ent 1. Prioritizing /O rg anizing C a re A c tivities 2. D elegation/C olla bora tive E fforts/ C om p lem enta ry T hera pies 3. Cost issues r/t he m od ialysis and transplant 4. D isch arge Planning a. H om eca re: Peritoneal d ia lysis and sym p tom & m ed ic ation m anag em ent b. Com m unity resourc es c. O utp atient ed uc atio n E. Evaluation of O utcom e Ach ievem ent: Ex - Fluid Balance Com plex D iso rders of th e U rina ry System : Ex - B lad der Tum ors A . Path oph ysiology of B lad der Tum ors B. Clinical M anifesta tio ns o f B la dd er C anc er 1. Laborato ry da ta 2. D iagnostic tests C. Collaborative M a na gem ent of B la dd er C anc er 1. M ed ical interventions 2. Surgical intervention 3. N utritiona l support Advanced Nursing M a na gem ent of the Pa tient w ith Urina ry D iversio n A . A ssessm ent Ac cording to Go rdo n's Functional H ea lth Patterns B . A nalysis/N ursing D iagnoses Associated w ith U rinary D iversion: Ex D eficient Know ledge r/t Ca re of Stom a, D isturbed B ody Im age r/t Presence of Stom a T E A C H IN G S TR AT E GY A ssigned Re ad ing Lecture C a se Stud y D isc ussio n Inve stigation of Com m unity R esourc es using th e Inte rne t

2.

3.

III.

4.

5.

IV .

6.

8.

9.

10 .

11.

13.

C o ntinue s on ne xt pa ge . . .

C ontinues on next pa g e . . .

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 5: CARE OF THE PATIENT WITH COMPLEX RENAL, URINARY, AND PROSTATE DISORDERS PAGE 2 OF 2

CL A SS O BJ ECT IVES 15. Interpret the results of laboratory tests & diagnostic tests associate d w ith B lad der Canc er. D iscuss tre atm e nt modalities used in th e co llabo rative m anag em ent of B lad der Canc er. U se M aslow's hie rarc h y of needs to prio ritize assessm e nts in th e patient w ith U rinary D iversions. List four nursing dia gnoses (N A N D A ) com m only associated w ith a pa tient w ith U rina ry D iversions. List four correspo nding nursing o utco m es (N O C ) asso ciated w ith a patient w ith U rinary D iversions. D iscuss appropriate nursing inte rve ntions (N I C ) associated w ith a pa tient w ith U rina ry D iversions. D iscuss the nursing m anag em ent of a pa tient w ith a urinary dive rsion at home and th e use of com m unity resources. D iscuss the patho ph ysiolog y and clinical m anifestations of patients w ith Prostate D isorders. Interpret the results of laboratory da ta and diagnostic tests associated w ith Prostate Ca ncers. D iscuss tre atm e nt modalities used in th e co llabo rative m anag em ent of Prostate Canc er. U se M aslow's hie rarc h y of needs to prio ritize assessm e nts in th e patient w ith Pro state Canc er. List four nursing dia gnoses (N A N D A ) com m only associated w ith a pa tient w ith Prosta te Canc er. List four correspo nding nursing o utco m es (N O C ) asso ciated w ith a patient w ith Pro state Canc er. D iscuss appropriate nursing inte rve ntions (N I C ) associated w ith a pa tient w ith Prosta te Canc er. D iscuss the nursing m anag em ent of the patient w ith Prosta te cancer at home and th e use of com m unity resources. C. C L A SS C O N T E N T Planning 1. Com m on N O C O utcom es: Ex - Know ledge of H ealth B eh aviors r/t S to m a Care 2. S uggested N ursing Interventions: Ex - Individual and fa m ily teach ing of stom a care and appliance m anag em ent Im plementa tion 1. N IC based actions applied to the patient & fam ily prioritizing and organizing c are a ctivities a. D elega tio n/C o lla bo ra tive E ffo rts/ C om p lim enta ry T hera pies b. Cost issues 2. D isch arge Planning 3. H om e Care: H om e H ealth Care and Com m unity Suppo rt; Resourc e: w w w .ricanc ercounc il.org Evaluation of O utcom e A ch ievem ent T E A C H IN G S TR AT E GY

16 .

D.

17 .

18 .

E.

19.

20.

V III. A dvanced Considerations of the Patient w ith D isorde rs of the Prosta te A . Path oph ysiology of Prostate Diso rders B . Clinical M anifestations of Prostate D iso rders 1. Laborato ry da ta 2. D iagnostic tests C. Collaborative M a na gem ent of Pro sta te C a nc er 1. M ed ical interventions 2. Surgical intervention IX. Advanced Nursing M a na gem ent of the Pa tient w ith Prosta te C a nc er A . A ssessm ent Ac cording to Go rdo n's Functional H ea lth Patterns B. Analysis/N ursing D ia gno ses: E x - A c ute Pa in r/t Inc isio n o r B la dd er S pasm s; Inco ntinence of U rine C. Planning 1. Comm on N O C Ou tc om es: E x - Pa in Level 2. S uggested N ursing Interventions D . Im plem entation - N IC B ased Actions A pplied to the Patient and Fam ily 1. Prioritizing a nd Org anizing C a re A c tivities 2. D elegation/C olla bora tive E fforts/ C om p lem enta ry thera pies 3. M anag em ent of Surgical Co m plications 4. Cost Issues 5. D isch arge Planning / Patient Te ach ing 6. H om e Care: Ex - Pain m ana gem ent & cath ete r ca re 7. Comm unity Reso urc es E. Evaluation of O utcom e Ach ievem ent: Ex .: - Com fo rt Level

21.

22.

23.

2 4.

2 5.

2 6.

27.

28.

29.

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 6: CARE OF THE PATIENT WITH COMPLEX RESPIRATORY DISORDERS PAGE 1 OF 2

CL A SS O BJ ECT IVES 1. D e scrib e clinical parameters for re sp iratory failure . 2. D escribe ventilation, perfusion, diffusio n, and sh unting and th e relationsh ip of pulm ona ry circulation to these processes. II. 3. C om p are and co ntrast th e ve ntilation-p erfusion ratios for re sp iratory failure of ventilator origin and re sp iratory failure of ox yge nation origin. 4. U se asse ssm e nt para meters for determ ining the characteristics and se ve rity of the major sym pto m s of th e respirato ry dysfunction. IV. 5. D e scrib e the rationale for m ana gem ent of adult respirato ry failure . 6. Explain the proble ms associated w ith O 2 therapy for pa tients w h ose respirato ry efforts are controlle d b y the ir hypoxic d rive. 2. 7. A nalyze changes in clinical m a nifestatio ns to determ ine th e e ffe ctive ne ss of therapy for patients receiving O 2. 3. 8. Prioritize the care for a client w ith a new trach eo stom y. 9. Explain the rationale for nutrition the rapy. 10. D escribe ho w to ch eck place m ent for an ET tub e. 11. D efine M O V and criteria for cuff care . 12 . E xplain em e rgency procedures for dislodge d tub e. 13 . D e scrib e the pathoph ysiology of A RD S . 14. Explain th e basic difference in ventilation types. 15. List critica l assessm ents fo r a patient on a ventilator. C o ntinue s on ne xt pa ge . . . C ontinues on next pa g e . . . B. C. V II . U tilization of N ursing Process A. A ssessm ent 1. Gordon's Functional H ea lth Patterns Collaborative D ata A nalysis/N ursing D iagno sis (N A N D A ) 1. 2. 3. Im paired ventilation related to respiratory m uscle fatigue D ysfunctional w ea ning respo nse Ine ffective airw ay clea rance related to trach ea l secretions B. VI. V. Care of Patient w ith A rtificial Airw ays A. B. Endotrach e al T ub es Trach eosto m y T ub es 1. 2. 3. 4. Types Cuff care/M inim al leak D islodged tube W eaning B. 2. 1. Complex Disorders o f the Resp ira tory System A. Path oph ysiology of A R F 1. D efine ventilatory failure a. b. acute ch ronic III. Patient A dvoca cy/Legal and Eth ica l Issue s/Careg iver A cc ounta bility C. B. H ealth Prom otio n A. Prim ary Pre vention of Resp ira tory D iseases 1. 1. 2. 3. 1. Sm oking c essa tio n S creening X -Ray CBC Patient ed uc atio n Second ary Prevention I. A natom y and Physiology A. B. C. D. E. Concepts Com pliance Tidel V olum e V entilation/Perfusion Ratio S h unting V ide os H andouts C L A SS C O N T E N T T E A C H IN G S TR AT E GY Pow er Point Pre se nta tio n

Tertiary Preventio n

Clinical param ete rs Clinical m anifestations a. a. b. c. d. Lab da ta and diagnostic tests Pharm acological O2 N utritio n Breathing exerc ises M edical m a na gem ent o f resp ira tory d iseases

Path oph ysiology of ARD S

Collaborative m ana gem ent of respirato ry diso rders

M ech anical Ventila tion A. Types 1. 2. 1. Pressure V olum e Stages

W eaning

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 6: CARE OF THE PATIENT WITH COMPLEX RESPIRATORY DISORDERS PAGE 2 OF 2

CL A SS O BJ ECT IVES 16. 17. S tate the four stages of w eaning. Care for th e patient on a m ech anical ventilation. E. D. C L A SS C O N T E N T S uggested N O C O utcom es - Respiratory status 1. 2. 3. 1. 2. 3. 4. F. G. gas exchange ventilation airw ay patency Infection co ntrol Re spiratory m onitoring V entilator assistance Electrolyte balance T E A C H IN G S TR AT E GY

Proposed N IC Interventions

Im plementa tion Evaluation of Ou tc om es

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 7: CARE OF THE PATIENT WITH COMPLEX NEUROLOGIC PROBLEMS PAGE 1 OF 2

CL A SS O BJ ECT IVES 1. D escribe a neurolog ic history and ph ysica l asse ssm ent. 2. Relate path oph ysio lo gy to th e clinical manife statio ns of inc reasing intracranial pressure (ICP). II. 3. D ifferentiate ea rly and late signs/sym ptom s of increasing IC P. 4. I dentify the purp ose of ICP m onitoring. 5. D iffe re ntiate the com m on types of traum atic brain injury (TB I). 6. D escribe th e psych oso cial and beh avioral m anifestations associate d w ith T BI . 7. Id entify the risk factors and com p lications of TBI in th e older adult. 8. D escribe the diagnostic tests use d for the neurologic patient. 9. D e scrib e com m on com plications of brain tum ors. 10 . Identify the diagnostic tests used for th e patient w ith ch anges in m e ntal status and T BI. 11. Prio ritize assessm e nts of th e patient w ith neurologic problem s using M aslow 's hierarch y of nee ds. 12. Identify appropriate N A N D A nursing diagno ses fo r th e critica lly ill patient w ith neurolog ic prob lem s. 13. List N O C labels for specific neurolog ic prob lem s. 14 . D e scrib e N I C inte rventions linked to N O C labels th at apply to th e critica lly ill patient w ith neurolog ic prob lem s. D. C. B. IV . U tilization of th e N ursing Pro cess as it Relates to Care of th e Critically Ill Patient w ith N eurologic Problem s A. N eurolog ic A ssessm ent 1. 2. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. C o ntinue s on ne xt pa ge . . . E. 6. 7. Gordon's Functional H ea lth Patterns Collaborative da ta, diagnostic tests D ecreased intracranial ad aptive capa city Ineffective tissue perfusion, cerebral Ine ffective breath ing pa ttern Risk for disuse syndrom e D isturbed tho ug ht processes D isturbed sensory perc ep tion Interrup ted fa m ily processes N eurolog ical status: Consciousness Tissue perfusion, cerebral Respira tory sta tus: V entila tio n Im m obility consequences: Physiological D istorted tho ug ht contro l B ody im age Fa m ily coping Cerebral ede m a m anag em ent M onitor neurolog ic status, IC P m onitoring A irw ay m anag em ent Exercise therapy: joint m obility D elusion m anag em ent Environm ental m anag em ent Fam ily process m aintenance III. Legal and Eth ical Issues A. B. Criteria for B rain D eath O rgan D onation and Referral to N EO B B. C. H ealth Prom otio n Stra tegies A. Prim a ry Preventio n of TB I 1. 2. 3. 4. 5. S afe m otor veh icles, use of sea t belts D ecrease in drinking and driving, M A D D H elm et use Safe pla yg round s Prevent/d ecrease vio lent behavio r W ritten E xa mina tio n Reading Assignm ents Self S tudy Case S tudies and C ritical Th inking E xerc ise s I. C L A SS C O N T E N T Know led ge B asic to Care of the N eurolog ic Patient A. B. A natom y and Physiology Concepts of ICP Regula tio n 1. 2. 3. M onro-Kellie hypoth esis Compensa ting m easures Cerebral perfusion pressure (CPP) Po w erp oint Pre se nta tio n and H andouts D isc ussio n T E A C H IN G S TR AT E GY Lecture

Second ary Prevention - E arliest D etectio n o f IIC P Tertiary Preventio n 1. 2. 3. Preventing co m plica tions of im m obility Reh abilitative plan o f care Refe rral to local ch apte r N H IF (N ationa l H ead Injury Foundation), Am erican B rain Tum or Association, N ational B rain Tum or Found ation, Am erica n Cancer S ociety

A nalysis/N ursing D iagno ses (N A N D A )

Planning - N O C O utcom e Labels

Im plem entation - N IC Interventions

Evaluation of O utcom e A ch ievem ent

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 7: CARE OF THE PATIENT WITH COMPLEX NEUROLOGIC PROBLEMS PAGE 2 OF 2

CL A SS O BJ ECT IVES 15. D iscuss th e nursing m anagem ent, utilizing nursing pro cess, of th e p atie nt expe rie ncing com plex neurolog ic prob lem s. 16 . D e ve lop a postope ra tive plan of care for a patient having a craniotom y. 17. D escribe collabo rative m anagem ent of th e critically ill neurologic patient. 3. V. C L A SS C O N T E N T S pecific N eurologic Problem s A. Traum atic B rain I njury 1. 2. Prim ary brain injury S econd ary brain injury a. b. c. d. e. a. b. c. d. e. 4. a. b. c. 5. 6. B. 1. 2. 3. Cla ssific ation of bra in injuries IIC P H em orrhage Loss o f autoregula tio n H e rnia tion B ed side neurolog ical assessm ent Re spiratory interventions Fluid m anag em ent Positioning D rug rela ted resp onsib ilities Clinical m anifestations Psychoso cial assessm ent Radiograph ic and oth er diagnostic tests T E A C H IN G S TR AT E GY

N ursing m a na gem ent o f pa tient w ith IIC P

Collabo rative m anag em ent

Re h abilitation and ho m e care m anag em ent H ealth ca re resourc es Classification o f tum ors Com plications of tum ors Collabo rative m anag em ent a. b. c. Radiation therapy and chem otherapy D rug therapy O perative proced ures and surgical m anag em ent 1) 2) post ope rative assessm ent preventing post operative com plications a) b) neurogenic pulm onary edem a a ltera tions in A D H secretio n

B rain T um ors

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 8: CARE OF THE PATIENT WITH PROBLEMS OF THE SPINAL CORD PAGE 1 OF 2

CL A SS O BJ ECT IVES N ursing M anagem ent of Patients w ith S pina l Cord Injury 1. D escribe th e m oto r and sensory assessm ent for th e patient w ith acute spina l cord injury (SCI). D escribe typical m edical com plications th at are e xp erie nced by patients with SCI. D e scrib e the pathoph ysiology of autonom ic dysreflexia. Recognize early signs/ sym ptom s of autonom ic dysreflexia. Prio ritize assessm e nts fo r th e patient w ith SCI using M aslow 's h ierarch y of nee ds. Identify appropriate N A N D A nursing diagnoses for the patient w ith proble ms of the spinal cord. List N O C labe ls for th e patient w ith SC I . D e scrib e N I C inte rventions linked to N O C labels for th e patient w ith SC I . Prio ritize th e nursing care of th e p atie nt with SC I . IV . 10 . D e ve lop a com m unity based teach ing plan for pa tients w ith SC I . III. I. C L A SS C O N T E N T A natom y and Physiology A. Spinal Colum n and Spina l N erves B. Autonom ic N ervous System H ealth Prom otio n Stra tegies A. Prim ary Pre vention of B a ck Pa in and D isc Injuries 1. Correct body m echanics 2. S afe w ork environm ent 3. Ex ercise, w eig ht co ntrol, sm o king c essa tion B . Prim ary Pre ve ntion o f S pina l Cord Injury 1. Safety m ea sures ind ic ated fo r T B I preventio n 2. Correct transfer and transport of accident victim s C. S econd ary Pre ve ntion o f B ack/D isc Injury 1. Patient ed uc atio n o f treatm ent regim en 2. M otor and sensory assessm ent D . Second ary Prevention of SC I 1. Frequent m otor and sensory assessm ent 2. M o nitor for earliest indications of increasing spinal cord edem a E. Tertiary Pre ve ntion o f B ack/D isc Injury 1. Physical therapy 2. Pain spe cialists F. Tertiary Preventio n o f SC I 1. Ea rly integration of reh abilitative plan to prevent com plications of im m obility 2. H ealth teach ing to re cognize and prevent autonom ic dysreflexia 3. Refe rral to N ationa l S pina l Cord Injury Association, Spina l Cord Injury H otline Legal and Ethical Issues/Patient Advocacy A . H igh inc idenc e of back pa in; co st of tim e lost from w ork, w ork com pensation and m ed ical/surgical trea tm ent B . Lifetim e cost of care for th e quadriplegic C. N eed for full-tim e caretaker or personal assistant for quadriplegic U tilization of the N ursing Process as it Re lates to C are of th e Patient w ith Spinal Cord Problem s A . A ssessm ent U sing Go rdo n's Functional H ea lth Patterns and Collaborative D ata B . A nalysis/N ursing D iagnoses for Intervertebral D isc D isease (N A N D A ) 1. A cute and ch ronic pain 2. D eficit knowledge 3. Risk for pe rioperative po sitioning injury 4. D isturbed sensory perc ep tion C. Planning - N O C O utcom e La bels for Intervertebral D isc D isease 1. Pain level 2. Knowled ge of treatm ent regim en 3. M uscle func tion 4. Risk co ntro l D . Im plem entation - N IC Labe ls for Intervertebral D isc D isease 1. Pain ma na gem ent, ana lg esic a dm inistra tio n 2. Teach ing disease process 3. Positioning; intrao perative 4. H ealth educ atio n E . A nalysis/N ursing D iagno ses fo r th e Patient w ith S C I (N A N D A ) 1. Risk for ine ffective breath ing pa ttern 2. Risk for autonom ic dysreflexia 3. Risk fo r im pa ired skin integrity 4. U rinary retentio n 5. Constip atio n 6. S elf care deficit 7. Sexual d ysfunc tio n 8. Risk for pow erlessness T E A C H IN G S TR AT E GY S pina l Cord Injury Lecture Po w erp oint Pre se nta tio n Case S tudies and C ritic al T hinking E x erc ise s Reading Assignm ents W ritten E xa mina tio n

II.

2.

3.

4.

5.

6.

7.

8.

9.

N ursing M anag em ent of th e Patient w ith Intervertebral D isc D isease 1. D e scrib e the pathoph ysiology of disc dise ase . Identify risk factors that contribute to back pain. Identify facto rs co ntributing to low back pain in the olde r adult. Ex plain w ays to prevent bac k pain. L ist N O C labe ls and NIC interventions for th e patient h aving a discectom y, lam inectom y, and/or spinal fusion.

2.

3.

4. 5.

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 8: CARE OF THE PATIENT WITH PROBLEMS OF THE SPINAL CORD PAGE 2 OF 2

C L A SS O BJ ECT IVES F. C L A SS C O N T E N T Planning - NO C Ou tc om e L ab els for the Pa tient w ith SC I 1. Respira tory sta tus: V entila tio n 2. N eurolo gic status: A utonom ic 3. Im m obility consequences: Physiological 4. U rinary elim ina tio n 5. Bow el elim ina tio n 6. S elf care: H ygiene, eating, toileting 7. S ex ual functioning 8. Participation: H ea lth care de cisions Im plementa tion - N IC L ab els for the Pa tient w ith SC I 1. Re spiratory m onitoring 2. D ysreflex ia m anag em ent 3. Pressure ulc er preventio n 4. U rinary ca theteriza tion 5. Constipation/im paction m anag em ent 6. S elf care assistance : B athing, fee ding, toileting 7. S ex ual counseling 8. S elf esteem enh ance m ent T E A C H IN G S TR AT E GY

G.

V.

VI.

Specific Problem s o f the Spina l C ord - Spina l C ord Injury (SC I) A. Path oph ysiology - M echa nism s and Forc es B. Classificatio n 1. D egree of injury a. co m plete b. incom plete C. Functional Levels 1. Paraplegia 2. Q uadriplegia 3. U pper m oto r neuron injury 4. Low er m oto r neuron injury D . Sh ock S ynd ro m es 1. S pinal sh ock, post-traum atic areflexia 2. N eurogenic E. A utonom ic D ysreflexia or H yperreflexia F. N ursing M anag em ent 1. A cute ph ase a. non-surgical b. h igh dose m eth ylprednisolone 2. Po st acute a. respiratory com plications b. venous th rom bosis c. GI h em orrhage d. decubitus ulce rs e. spasticity f. bla dd er retra ining , ca theteriza tio n g. bow el func tio n h . sexua l func tion G. Re h abilitation, H om e C are M anag em ent 1. Prevention of co m plica tions of im m obility 2. Prevention of respiratory com plications, secretion clearance 3. S pasticity control, antispasm od ic m ed ications 4. Pain, pa resthesia a nd hyp eresthesia c ontrol 5. M onitor for heterotroph ic ossification and syringom yelia N ursing M anagem ent of Specific Pro blem s o f the Spina l C ord Intervertebral D isc D isease A . Pathoph ysiology 1. A natom ical conside rations 2. Cause s of disc injury B. Clinical Presenta tio n C. D iagnostic T ests D . Collabo rative Trea tm ent E. Post O perative N ursing M anag em ent 1. Lam inectom y 2. Spinal fusion

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 9: CARE OF THE PATIENT WITH COMPLEX METABOLIC DISORDERS

C L A SS O BJ ECTIVES 1. D escribe th e path oph ysiolog y, e tiology, and management of D iabe tes M ellitus. 2. D iscuss the current trend s and future advances in diabetes m anagem ent. 3. Re late the clinical m anifestations o f diabetes m e llitus to th e associated path oph ysiologic alterations. 4. C om p are and co ntrast th e m anifestations and co llabo rative care of hyp og lycem ia , d iabetes ketoa cido sis (D KA ), and h yperosm olar nonketotic synd rom e (H H N S ). C. 5. I dentify clie nts at risk for hypoglycem ia. 6. Prioritize nursing interventions for th e patient w ith m ild to m od erate hypog lycem ia and m oderate to severe hypoglycem ia. 7. Prioritize interventions for clients w ith D K A and H H N S . 8. D iscuss the patho ph ysiolog y and etio lo gy of hypo functio ning of th e ad renal glands. 9. D e scrib e the pathoph ysiology of h yperadrenalism . 10 . S tate four nursing diagnoses (N A N D A ) asso ciated w ith a patient w ith a m etabolic diso rder. 11. List four correspo nding nursing outcom es (N O C) associated w ith th e diagno sis gene rate d for a patient w ith a m etabolic diso rder. 12. D iscuss N IC based interventions for a patient w ith a m etabolic diso rder. 13. U se the nursing process as a fram ew ork for providing individualized care in th e m a nagem e nt of a patient w ith a m etabolic diso rder. E. D. C. B. V. IV . Com plex D iso rders A. B. Pathoph ysiolog y of th e A drenal Gland Clinica l M anifestations - Lab D ata and D iagnostic T ests 1. 1. 2. Identify the m etabolic disease affected by acid/base im balance M edical intervention - pharm acologic Surgical inteventio n Collaborative M a na gem ent of an A d rena l D isord er III. Com plex D iso rders A. B. C. D. Path oph ysiology of D M , H ypoglycem ia and H H N S Clinica l M anifestations - Lab D ata and D iagnostic T ests Collaborative M anagem ent of D M , hypoglycem ia and H H N S M ed ical M anag em ent - Pha rm aco log ic, D iet, Exe rcise C. II. H ealth Prom otio n A. B. Prim ary Pre ve ntion o f D M , H ypoglycem ia and Adrena l D iso rders S econd ary Pre ve ntion - Early D ete ction o f D M and Adrena l D iso rders and Related Co m plications Tertiary Pre ventio n 1. Patient ed uc atio n V id e os C a se S tudie s H andouts I. C L A SS C O N T E N T Review of the A natom y and Physiology Pow erp oint Pre se nta tio n T E A C H IN G S TR AT E GY

A dva nc ed N ursing M ana gem ent of a Patient w ith M etabolic D iso rders A. Assessm ent A c co rd ing to G ord on's F unc tio na l H ealth Pa tterns - Key Findings A na lysis/N ursing D iagno se s A ssociate d w ith M etabolic D iso rders 1. 2. 1. 2. 1. 2. 3. 4. 5. 1. Ineffective m anagem ent of th erapeutic regim e related to D M Risk for fluid volum e deficit related to D KA Adh ere nc e behavio r Electrolyte and acid/base balance; fluid balance Electrolyte m anag em ent m onitoring M onitoring em ergenc y care Fluid m anag em ent Lab d ata interp reta tio n Teach ing Electrolyte s w ith in norm al lim its

Planning - Com m on N O C Ou tc om es

S uggested N ursing Interventions

Evaluation of O utcom e A ch ievem ent

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 10: CARE OF THE PATIENT WITH COMPLEX FLUID, ELECTROLYTE AND ACID-BASE DISORDERS

C L A SS O BJ ECTIVES T h e stude nt will be able to: 1. M ake clinical applicatio n of th e properties of fluid, solutions, ions acids, base s and buffers as th ey relate to reaction of w ater and electrolytes in th e bo dy. II. 2. Ex plain and pred ict th e m ovem ent of body fluids and electrolytes betw e en "co m partm e nts" in th e bo dy. 3. Explain and m ake clinical application of the w ays in w hich circulatory, respiratory, renal and endocrine system s interact to regulate ho m eo stasis of th e "internal environm ent". 4. Inco rporate lab values (A B G's, electrolytes, B U N , creat., album in and serum osm olarity) into patient p lan of care . 5. U tilize lab values as outcom e indicators and scale . 2. 6. Correlate assessm ent findings and p re dict the conse quences of disturb ance in the balance of w ater, electrolytes, and acid b ase . 7. Id entify etiolog ies and risk factors re lating to disturbance in fluid, electrolyte and acid base b alance. 8. Incorporate appropriate N IC/N O C into individualized plan of care . 3. c. IV . M anagem ent of D isorders in A cid-B ase Balance Through Clinical A pplication of the N ursing Process A. A cidosis vs. A lkalosis 1. S ubjective a. b. a. b. H ealth histo ry and presenta tion Functional im pact VS PE 1) 2) 3) 4) 1) 2) 3) 4) 5) 6) 7) 8) a. b. 4. a. b. c. 5. a. CN S N eurom uscular Respirato ry Integum entary A B G ;s E lectro lytes S erum osm olarity A lbum in B U N & Creat UA A nion gap H em oglobin/H em atocrit III. A cc ounta bility A. RN Role in M onitoring Response to Trea tm ent 1. 2. 3. 4. Fluid replace m ent N utritiona l support O 2 therapy Electrolyte replace m ent H ealth Prom otio n A. Identification of A t Risk Ind ivid ua ls fo r A ltera tio n in F luid , Electrolytes and A cid Base Balance 1. 2. 3. A cute disturbances in acid base balance Ch ronic conditions im pacting acid base balance Im pact of aging I. C L A SS C O N T E N T Physiological Influences on Fluid & Electrolyte and Acid-B ase Balance A. H om eostasis 1. 2. 3. 4. Th e cell Th e fluid Electrolytes Carbonic acid H and outs (3): T E A C H IN G S TR AT E GY Pow er Point Lecture Pre se nta tio n

Î

S yste m atic A pp roa ch to

Interpretation of AB G's

Ï

Conceptual Flow Ch art: Facto rs

Fluid & Electro lyte and Regulatory

Ð Core

Concept Grid

Concept M apping: Pure and M ixe d Re spiratory and M etabolic Acidosis and Alkalo sis Intera ctive, lecture c ase studie s

O bjective

Labs and D iagnostics (baseline & trend s)

D ifferential diagno sis and contributing facto rs M eta bolic , Resp ira to ry, or M ixed A cute vs. Ch ronic O ngoing assessm ent H ea lth teach ing M ed ical m anag em ent N O C ind ic ato rs and sc ales

Interve ntions (N ursing & C o lla bora tive)

Evaluation of Ou tc om es

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 11: CARE OF THE PATIENT WITH COMPLEX DISORDERS OF THE LIVER PAGE 1 OF 3

CL A SS O BJ ECT IVES 1. D escribe th e path oph ysiolog y and co m plica tions associated w ith cirrh osis of th e live r. Interpret laboratory test findings co m m only seen in clients w ith cirrh osis. D e scrib e thre e le ve ls of prevention in re lation to hepatic disorders. D iscuss the ob lig atio n to care for the clie nt with a lifestyle d isease. D e ve lop a com m unity-based teach ing plan for th e client w ith cirrh osis of th e live r. Form ulate a collaborative plan of care for th e client w ith seve re late-stage cirrh osis. Id entify em ergency interventions for the client w ith blee ding esophageal varicies. Identify the two m ost com m on c om p lications of liver transplantation. I. C L A SS C O N T E N T Care of th e Patient W ith Cirrh osis A . Review of Anatom y and Physiology B . M ajor Types of Cirrh osis 1. Laennec's Cirrh osis 2. Post N ecrotic 3. B iliary 4. Cardiac C. Com plications of Cirrh osis 1. Portal h yp ertension 2. Ascites 3. Bleeding eso pha geal va ric ies 4. Coagulation defects 5. J aundice 6. Portal System ic Enceph alopath y (PS E) w ith hepatic com a (stages) 7. H epatovenal Syndrom e D . Collaborative M ana gem ent of O th er Live r Diso rders 1. Liver transplant 2. Acute g ra ft rejection 3. H epatic absce ss 4. Fatty liver 5. H epatic traum a 6. Cancer of the liver E. Comm on Dia gno stic Pro ced ures 1. S erum electrolytes/album in 2. Paracentesis 3. Liver function tests 4. Esphagascope 5. A rteriogram 6. Liver biopsy (percutaneo us vs transvenous) 7. Coagulation pro file H ealth Prom otio n A. Prim ary Pre vention (alco h ol/drug-free environm ent) B. Second ary Prevention (liver traum a/ liver absce ss) C. Tertiary Preventio n (preve ntion o f com plications; fatty live r) Legal-Ethical Issues / Caregiver Accountability / Patient Advocacy S pecific D iso rders of th e Live r: A scites/Cirrh osis A . A ssessm ent 1. Gordon's Functional H ealth Patterns/key findings 2. Collaborative D ata a. h istory b. ph ysical assessm ent c. clinical m anifestations d. psych oso cial assessm ent e. lab assessm ent B . A nalysis / N A N D A 1. Excess fluid volum e 2. Po tential fo r hem o rrh age/PS E C. Planning 1. Suggested N O C Ou tc om es a. decrease in ascites/lytes N N L/B P N N L 2. Proposed N IC Interventions a. non-surgical m anag em ent b. diet therapy c. drug therapy T E A C H IN G S TR AT E GY A ssigned Re ad ing R eview of pertine nt no te s fro m N ursing II (N U RS 1020) Lecture D isc ussio n H andout w ith Pow er Point

2.

3.

4.

5.

6.

7.

8.

II.

III. IV .

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 11: CARE OF THE PATIENT WITH COMPLEX DISORDERS OF THE LIVER PAGE 2 OF 3

CL A SS O BJ ECT IVES C L A SS C O N T E N T d. paracentesis e. com fort m ea sures f. surgical LeV ee n sh unt Im plementa tion 1. N IC B ased Interventions a. breathing patterns b. fluid/electrolyte m anag em ent c. blee ding precautions d . surg ic al intervention e. Le V ee n sh unt f. paracentesis g. neurolog ic m onitoring h . know ledge deficit i. h om e care m anag em ent k. h ealth ca re resourc es l. diet/drug therapy m . alcohol abstinence Evaluation of N O C Ach ievem ent T E A C H IN G S TR AT E GY

D.

E. V.

S pecific D iso rders of th e Live r: Bleeding Esoph a geal V a ric ies A. Collaborative M a na gem ent of B leeding E so pha geal V a ric ies 1. Pathoph ysiology a. h istory risk factors b. co agulo path y c. D IC 2. Clinical M anifestations a. blee ding b. shock 3. Collabo rative M anag em ent a. fluid resusc ita tio n b. vasopressin/bloo d transfusions c. gastric intub ation d. esophageal e. balloon ta m pona de/S eng staken-B lakem ore f. T IPS /T IPS S g. shunts - portacaval/splenorenal 4. M ed ical Interventions a. h em od ynam ics m onitoring 5. surgical intervention B . A dvanced N ursing M anag em ent of th e Patient w ith B lee ding Esoph ageal V a ric ies 1. A ssessm ent 2. N A N D A Potential for H em orrhage a. fluid volum e deficit b. de creased cardiac output c. ineffective airw ay clearance d . altered tissue p erfusio n 3. N O C a. w ith 12 hours patient w ill be norm ovolem ic b. M A P >70 m m H g 4. N IC a. blee ding precautions b. blo od pro d uc t ad m inistra tion c. fluid/electrolyte m anag em ent d. h ypovolem ia/sho ck m anag em ent S pecific D iso rders of th e Live r: Portal-S ystem ic (PS E) w ith H epatic Com a A . Collabo rative M anag em ent 1. Pathoph ysiology a. blood/brain ba rrier pe rm eability

V I.

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 11: CARE OF THE PATIENT WITH COMPLEX DISORDERS OF THE LIVER PAGE 3 OF 3

CL A SS O BJ ECT IVES 2. C L A SS C O N T E N T Clinical M a nifesta tion a. late/am enorrhea, im potence 3. Collabo rative M anag em ent a. sexua l d ysfunc tion b. risk fo r infectio n c. fatigue 4. M ed ical Interventions a. am m onia levels 5. N utritio na l Interventio n a. diet therapy b. lacta lo se/neom y cin/o xazepa m /levod op c. increa se calories/low or no protein/low sodium A dvanced N ursing M anagem e nt of th e Patient w ith PS E 1. A ssessm ent a. baseline level of consciousness 2. N A N D A - Po tential fo r Po rtal S ystem ic Enceph alo path y a. J V D /J V E b. altered nutritio n c. im paired gas exchange d. altered th oug h process e. risk for injury 3. N IC a. neurolog ical m onitoring b. fluid/electrolyte m anag em ent c. cerebral ede m a m anag em ent d. h ypokalem ia e. nutrition m anag em ent f. h ypoglycem ia g. energy m anag em ent h . aspiration precautions 4. N O C a. return to optim al level of AD Ls b. 3-4 stools/day T E A C H IN G S TR AT E GY

B.

VII.

Liver Transplanta tio n A. Collaborative M a na gem ent - Rejection 1. Pathoph ysiology 2. Clinical M anifestations a. 10-14 days 3. M edical Interventio n a. m ethyl prednisolone/ALG 4. S urgical Interventions a. retra nsp la nta tion B . A dvanced N ursing M anag em ent of th e Patient 1. A ssessm ent / N A N D A a. acute g ra ft rejection b. infectio n c. h epatic com plications d. acute rena l failure e. fluid volum e ex cess f. fluid and electrolyte im balance g. hem orrhage h. anxiety/fear i. pow erlessness j. body im age disturbance o k. 2 im m uno suppressive agents 2. Im plementa tio n / N IC a. utilize concept m ap to evaluate early/late ph ases of hepatic fa ilure 3. Evaluation / N O C

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH BURNS PAGE 1 OF 4

CL A SS O BJ ECT IVES 1. Identify burn clie nts at risk for inhalation injury. 2. Com pare and contrast the clinical m anife stations of superficial, partial th ickness, and full thickness burn injuries. 3. Explain the expected clinical m anifestations of neural and h orm o nal co m pensatio n during th e em ergent pha se of burn injury. 4. Calculate the total body surface area involved in burn injury. 5. Prio ritize nursing care fo r th e patient during the em ergent pha se of burn injury. 6. U se laboratory data and clinical m a nifestatio ns to determ ine th e effectiveness of fluid resuscitation during the em ergent ph ase of burn injury. 7. U se the Parkland form ula to establish the co rrect rate and tim ing of fluid replace m ent (also th e Lund and B row der ch art). 8. Prio ritize nursing care fo r th e p atie nt during the acute ph ase of burn injury. 9. Explain the alte ration of nutritiona l ne eds fo r th e burn clie nt during the acute ph ase of burn injury. 10. E valuate w ound healing in th e p atie nt during the acute ph ase of burn injury. 11. Com pare and contrast pain m anage me nt strate gies for patients in th e em ergent and acute ph ases of burn injury. 12 . D e scrib e the characteristics of infected burn w ound s. C o ntinue s on ne xt pa ge . . . B. 7. 8. 9. V. U tilization of the N ursing Process: Em ergent Phase of Burn Injury (048 /Resuscitative Perio d ) A. A ssessm ent 1. 2. 3. 4. 5. 6. Gordon's Functional H ea lth Patterns co llaborative da ta h istory / ph ysical assessm ent clinical m anifestations laboratory/radiograph ic respirato ry a. b. c. d. e. direct airw ay injury carbon m ono xide poisoning therm al sm oke poisoning pulm onary fluid overloa d (esch arotom y)

o

C L A SS C O N T E N T I. Path oph ysiology of B urn I njury A. Integum entary Ch ang es Resulting from B urn I njury 1. 2. 3. 4. 5. 6. 7. 8. B. 1. 2. C. D. E. F. G. H. anatom ic functiona l tem pe rature/depth superficial th ickness partial th ickness superficial partial th ickness de ep partial th ickness full th ickness de ep full th ickness fluid shift fluid rem ob iliza tio n

T E A C H IN G S TR AT E GY Lecture Pow er Point Pre se nta tio n H andout S elf-A ssessm ent Q uestions w w w .w b sa unde rs.c om /sim o n Evidence-B ased Practice D iscussion: "W h at is th e be st d o nor site dre ssing? " Ignatavicius, 4

th

Vascular Chang es Resulting fro m B urn Injuries

Edition, p. 1579

Cardiac Func tion C h ang es Resulting from B urn I njury Pulm ona ry Ch ang es Resulting from B urn I njury GI Ch anges M etabolic Im m unologic Compensatory Resp onses 1. 2. inflam m ato ry SNS

II.

Etiology of B urn Injury A. B. D ry/M oist/C o nta ct/C hem ic al/E lectric al/R ad ia tion Incidence/Prevalence

III.

H ealth Prom otion A. B. C. Prim ary S econd ary Tertiary

IV.

Legal / Eth ical Issues

cardiovascular rena l/urinary integum entary a. b. TBSA Rule o f N ines

10. gastroinestinal A nalysis 1. Com m on N A N D A a. b. c. d. e. 2. de creased cardiac output fluid volum e deficit ineffective tissue p erfusion ineffective breathing patterns acute/ch ronic pain

Prim ary Collaborative Problem s

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH BURNS PAGE 2 OF 4

CL A SS O BJ ECT IVES 13. Explain the positioning and range o f m o tio n interventio ns fo r th e prevention of m obility problem s in the patient w ith burns. 14. Prio ritize nursing care fo r th e clie nt during the re h abilitation ph ase of burn injury. 15. D iscuss the potential psychosocial problem s associate d w ith burn injury. D. C. C L A SS C O N T E N T Planning (N O C) Expe cte d O utcom es for D ecreased Cardiac O utput, D eficient Fluid V olum e, and Ineffective T issue Perfusion 1. 2. 3. 4. 1. restored cardiac output VS WNL O 2 sat >93% pH W N L N on-surgical a. b. c. d. e. f. 2. fluid resuscitation volum e IV therapy plasm a exchange drug therapy fluid m onitoring fluid m anag em ent 1) S urgical a. b. E. 1. V I. esch arotom y fasciotom y 24 form ulas

o

T E A C H IN G S TR AT E GY

Im plementa tion (N IC )

N ursing Actions/R esp onsib ilities Evaluation of N O C

Potential for Pulm onary Edem a/A RD S A. Ine ffective B rea thing Patterns 1. 2. 3. 4. B. 1. 2. 3. 4. C. 1. A cute pain / ch ronic pain Anxiety red uc tio n Potential for acute respiratory distress Potential pulm onary edem a PaO 2 PaCO 2 arterial pH W N L free of com plications of ARD S/pulm onary edem a N on-S urgical M anag em ent a. b. c. d. e. f. g. h. 2. a. b. c. d. D. 1. 2. airw ay m aintenance pro m o tio n o f ventila tio n m onitoring gas exchange oxygen th erapy/ventilator/A RD S drug therapy positioning and dee p brea thing com plem entary and alternative therapy environm enta l m a nip ula tio n ch est tub es trach eostom y de bride m ent anesth esia

Planning N O C Expected O utc om es

N ursing Interventions

S urgical M anag em ent

Evaluation: N O C reporte d p ain is allevia ted /red uc ed A B G's W N L

o o

V II .

A dvanced N ursing Ca re in th e A cute Phase of B urn Injury (48 - 72 and beyond ) A. A ssessm ent 1. 2. 3. 4. neuroend ocrine im m unologic m usculoskeletal infectious ag ents

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH BURNS PAGE 3 OF 4

CL A SS O BJ ECT IVES B. NANDA 1. 2. 3. 4. 5. C. 1. 2. D. 1. im pa ired skin integrity risk for infectio n nutrition im pa ired m obility disturbed body im age no furthe r skin loss resto red skin integrity N on-surgical m anag em ent a. b. c. d. 2. a. b. E. m ech anical/enzym atic de bride m ent standard w ound dressings biologic dressings synthetic dressings surg ic al excisio n w ound covering C L A SS C O N T E N T T E A C H IN G S TR AT E GY

Planning/N O C

Im plementa tion

S urgical m anag em ent

Evaluation of N O C

VIII. Care of th e Burn Pa tient at H ig h R isk for Infection A. B. NANDA 1. 1. C. N IC 1. N on-surgical a. b. c. d. e. 2. D. IX. a. drug therapy isolation therapy enviro nm enta l m a nip ula tion second ary preventio n early d etection surg ic al excisio n Risk for infection Patient to rem ain free of infection by cross contam ination and not experience septicem ia NOC

S urgical m anag em ent

Evaluation

Care of th e Burn Pa tient w ith Im b a la nc ed N u trition: L ess T han B o d y Requirem ents A. NANDA 1. 2. B. 1. 2. 3. C. N IC 1. 2. 3. 4. 5. D. Calculation of patient's current daily m etabo lic needs and requirem ents H igh caloric/h igh protein Enteral feedings Positioning/RO M /am bulation/pressure dressings assist pa tients w ith bod y im a ge d isturb anc e/ d ec ision m aking/ind epend ent ac tivities Evaluation of N O C Im pa ired ph ysica l m obility D isturbed body im age E vidence of m aintenance of no rm a l bo dy w eigh t S erum alb. W N L Tissue he aling

NOC

C ontinues on next pa g e . . .

REVISED: 05/03

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH BURNS PAGE 4 OF 4

CL A SS O BJ ECT IVES X. C L A SS C O N T E N T A dva nc ed N ursing Care/C onc epts: Reh abilitative Ph ase of B urn I njury A. NANDA 1. 2. B. N IC 1. 2. 3. 4. 5. C. norm aliza tio n prom otion self aw areness enha ncem ent electrolyte m anag em ent skin surveillance skin ca re: topical treatm ents body im age se lf ca re T E A C H IN G S TR AT E GY

Evaluation (N O C )

REVISED: 05/03

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