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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. Com pare and contrast, based on acquired know ledge, traum a/ insult at all levels identified in relationsh ip to professional practice. 2. List th e leading causes of traum atic injury and th e im pact on th e patient, fam ily, and society. 3. List th e criteria for traum a classification. II. 4. Explain th e process of prim ary assessm ent at th e scene of a traum a. 5. 6. D iscuss th e use of a traum a score. III. Explain th e process of th e ER T raum a S urvey. 7. D iscuss quality of life issues for patients w ith traum atic injuries. 8. Identify clients at risk for septic sh ock and h ypovolem ic sh ock. B. 9. D iscuss th e interaction of blood volum e and size of th e capillary bed affecting m ean arterial pressure (M A P). 10. Com pare and contrast h yperdynam ic and h ypodynam ic ph ases of sh ock and th eir progression to M O D S and death . 11. Recognize th e stages of sh ock by analyzing signs and sym ptom s as w ell as physiological ch anges. 12. Explain th e effect of traum a on th e body system s. (N K/PC C ) D. 1. 2. 3. 4. C. IV. C. D. E. F. B. I. O verview of Traum a A. Cellular 1. 1. 2. 3.

C LA S S C O N TEN T

T EA C H IN G S T R AT EGY A ssigned Reading Lecture H andouts Case studies Pow er Point Presentation Linkages: connecting new content to prior learning

Review of A & P of h ypoxia/acidosis S tatistical analysis based on area/system Review A & P; M A P/C.O . Types

Individual

Fam ily Com m unity N ational Global

H ealth Prom otion: Role of the Professional N urse A. B. C. Prim ary (risk factors; education) S econdary (triage assessm ent in early detection) Tertiary (concepts of reh abilitation at onset of acute injury; D isease S yndrom e/Post T raum atic S tress D isorder) Role Playing Patient Advocacy / Legal-Ethical Issues / Caregiver A ccountability A. Role of th e N urse i.e., state/federal law s/policy procedures; bereavem ent/loss/death D iscussion U tilization of th e N ursing Process as it Relates to T h 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 Collection A lteration in T issue Perfusion A lteration in Fluid V olum e H em odynam ics/Cardiac O utput S uggested N O C O utcom es/S ystem O riented S uggested N IC Interventions/H em odynam ic M onitoring/S ystem O riented Im plem entation N IC B ased Intervention Prioritizing/O rganizing Care and A ctivities Collaborative Efforts/Com plem entary T h erapies/D elegation Collaborative M anagem ent a. b. c. d. e. f. g. h. i. E. surgical services m edical services institutional support ph ysical th erapy occupational th erapy disch arge planning h om e care com m unity services reh abilitation Internet & Library Resources Clinical S im ulation Revisiting, Review , Repetition Concept M apping

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

Planning

13. D iscuss and analyze th e effect of nursing outcom es and nursing interventions for th e patient in sh ock. 14. Identify 3 possible N A N D A /N O C/ N IC labels com m only associated w ith traum atic injuries. 15. D escribe collaborative m anagem ent of patients w ith traum atic injuries. V.

Evaluation of O utcom es (N O C) A ch ievem ent

S pecific D isorders in th e Patient w ith T raum a A. B. M O D S (M ultisystem O rgan D ysfunction S yndrom e) Types of S h ock 1. 2. 3. 4. H ypovolem ic Cardiogenic D istributive O bstructive

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLAS S O B J EC T IV ES C. C LA S S C O N T EN T Path oph ysiology/Epidem iology Etiology 1. 2. 3. 4. 5. 6. 7. 8. 9. h ypovolem ia cardiogenic sh ock distributive sh ock (neural/ch em ical induced) anaph ylaxis sepsis D IC capillary leak syndrom e h ypoxia acidosis h yperkalem ia T EA C H IN G S TR A T EGY

10. h ypoth erm ia 11. tablets/toxins overdose 12. cardiac tam ponade 13. tension pneum oth orax 14. pulm onary em bolus D. Clinical M anifestations/D iagnostic D ata 1. Fours stages of shock a. b. c. d. E. 1. initial nonprogressive progressive refractory

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

V olum e replacem ent; Colloid fluid replacem ent; Crystalloid fluid replacem ent D rug th erapy a. adrenergics/vasoconstrictors

F.

N ursing M anagem ent in Accordance to th e N ursing Process 1. NANDA a. b. c. d. e. 2. N IC a. surveillance of cardio h em 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 prevention potential for M O D S potential for S IRS (S ystem ic Inflam m atory Response S yndrom e) alterations in tissue perfusion A lt C.O . JVD

fluid volum e m anagem ent drug th erapies (antibiotics/antibodies/anticoagulants/clotting factors; blood products) safety h ealth teach ing h om e care m anagem ent infection free labs W N L O 2 sat >= to 85% CV P/M A P/PCW P/W N L patent airw ay urinary output >300cc/hr.

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLAS S O B J EC T IV ES V I. C LA S S C O N T EN T Care of th e Patient w ith A cute T raum a w ith Insult to M usculoskeletal, GI/A B D , Respiratory, Com partm ent S yndrom e i.e. M V A /G unsh ot W ounds A. B. Path oph ysiology Clinical M anifestations/D iagnostic D ata 1. 2. 3. C. 1. 2. 3. 4. D. 1. X ray/U ltrasounds Peritoneal tap B ronch oscopy Invasive h em odynam ic m onitoring Intubation, ch est tubes, m echanical ventilation, oxygen delivery N G suction, peritoneal tap S tabilization of fractures 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 energy conservation pain m anagem ent bleeding precautions fluid m anagem ent oxygen delivery know ledge: pain/infection pre/post op nutrition im m une status optim al level of function follow -up w ith reh abilitation infection control tissue perfusion nutrition H igh risk ineffective coping Post T raum atic S tress D isorder alterations in m obility tissue perfusion risk for J V D h em orrh age infection protection/control energy m anagem ent T EA C H IN G S TR A T EGY

Collaborative M anagem ent

N ursing M anagem ent/Assessm ent/S ystem A pproach

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

C LA S S O B J EC T IV ES 1. D escribe th e function of th e endocrine glands and the production of h orm ones. 2. D escribe th ree levels of prevention in relation to endocrine disorders. 3. D iscuss th e pathoph ysiology and clinical m anifestations of thyroid disorders. 4. Interpret th e results of laboratory data and diagnostic tests associated w ith th yroid disorders. 5. U tilize M aslow 's h ierarch y of needs to assess th e client w ith a th yroid disorder. 6. Prioritize nursing care for a client follow ing m edical treatm ent or th yroidectom 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. 9. Identify th ree nursing diagnoses (N A N D A ) com m only associated w ith a client w ith h yperth yroidism or h ypoth yroidism utilizing th e nursing process. 10. Identify th ree corresponding nursing outcom es (N O C) associated w ith th e diagnoses generated for th e client w ith h yperth yroidism or h ypoth yroidism . 11. D iscuss appropriate (N IC) based nursing interventions for th e client w ith h yperth yroidism or h ypoth yroidism . 12. D ifferentiate betw een features seen in a client w ith h yperth yroidism vs. h ypoth yroidism . 13. D iscuss th e pathoph ysiology and clinical m anifestations of parathyroid disorders. 14. D ifferentiate betw een features seen in clients w ith h yperparath yroidism vs. h ypoparath yroidism . C ontinues on next pa ge . . . C ontinues on next pa ge . . . C. V I. S pecific D isorders of th e Parathyroid G land A. B. Path oph ysiology of H yperparath yroidism and H ypoparath yroidism Clinical M anifestations of H yperparathyroidism and H ypoparath yroidism 1. 2. assessm ent serum lab tests E. 4. 2. 3. D. B. C. V. A dvanced N ursing M anagem ent of th e Client w ith H yperthyroidism and H ypoth yroidism A. A ssessm ent utilizing G ordon's Functional H ealth Patterns - key findings A nalysis / N ursing D iagnosis / N AN D A Planning 1. 2. 1. S uggested N O C outcom es (activity tolerance, anxiety tolerance and h ealth m aintenance) S uggested N IC interventions N IC based interventions (activity m anagem ent, stress m anagem ent, and im proved h ealth education) Prioritizing (M aslow ) / O rganizing care activities / cost issues (ch ronic condition and ongoing education) Collaborative efforts / Com plem entary th erapies / D elegation (H ealth care resources) Collaborative m anagem ent (m edical services, surgical services, nutritional support, speech therapy, disch arge planning, h om e care, com m unity services) Evaluation of O utcom e (N O C) A ch ievem ent Im plem entation D. C. III. IV. Patient Advocacy/Legal-Eth ical Issues/Caregiver A ccountability Revisiting, Review , Repetition S pecific D isorders of th e T h yroid G land A. B. Path oph ysiology of h yperthyroidism and hypoth yroidism Clinical m anifestations of h yperth yroidism and h ypoth yroidism 1. 2. 1. 2. 1. laboratory data diagnostic tests D iscussion Internet & Library Resources m edical intervention: antith yroid drugs, radioactive iodine treatm ents surgical intervention: thyroidectom y m edical intervention Collaborative m anagem ent of h ypoth yroidism Clinical Sim ulation Role Playing II. H ealth Prom otion A. B. C. Prim ary prevention (education re: risk factors) S econdary prevention (early detection) Tertiary prevention (prevention of com plications) Concept M apping Linkages: connecting new content to prior learning I. C LA S S C O N T EN T Review the A natom y & Ph ysiology of th e Endocrine S ystem A. B. C. D. E. F. G. Pituitary Parath yroid Thyroid A drenals Pancreas O varies Testes Pow er Point Presentation Case studies H andouts Lecture TEA C H IN G S T R AT EGY A ssigned Reading

Collaborative m anagem ent of h yperthyroidism

Collaborative M anagem ent (D iuretic and fluid th erapy, drug th erapy, surgery)

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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

C LA S S O B J EC T IV ES 15. Identify th ree nursing diagnoses (N A N D A ) com m only associated w ith a client w ith h yperpara-thyroidism or h ypoparath yroidism utilizing th e nursing process. 3. 16. Identify th ree corresponding nursing outcom es (N O C) associated w ith th e diagnoses generated for th e patient w ith h yperparath yroidism or h ypoparath yroidism . 17. D iscuss appropriate (N IC) based nursing interventions for th e client w ith h yperparathyroidism or h ypoparath yroidism . 18. D iscuss th e pathoph ysiology and clinical m anifestations of A drenal disorders. G. 19. D ifferentiate betw een features seen in clients w ith Cush ing's S yndrom e and Conn's S yndrom e. 20. D ifferentiate betw een features seen in clients w ith Cush ing's S yndrom e, Conn's S yndrom e, and A ddison's D isease. 21. Prioritize nursing care for a client experiencing Addisonian Crisis. 6. 22. Interpret th e results of labora-tory data & diagnostic tests associated w ith A drenal disorders. 23. Identify th ree possible N A N D A , N O C, and N IC labels com m only associated w ith a client experiencing Cush ing's S yndrom e. 24. Identify th ree possible N A N D A , N O C, and N IC labels com m only associated w ith a client experiencing Conn's S yndrom e. 25. Identify th ree possible N A N D A , N O C, and N IC labels com m only associated w ith a client experiencing Addison's D isease. 26. S um m arize nursing responsibilities for patients w ith com plex endocrine disorders. 3. 4. 5. H. C. D. E. F. V II. S pecific D isorders of th e A drenal G lands A. B. Path oph ysiology of Cush ing's Syndrom e and Conn's S yndrom e Clinical m anifestations of Cushing's S yndrom e and Conn's S yndrom e 1. 2. assessm ent serum lab tests 2. D. C LA S S C O N T EN T N ursing m anagem ent in accordance w ith th e nursing process 1. N A N D A : activity intolerance, altered th ough t process, im balanced nutritional status) N O C: activity tolerance, cognitive orientation, balanced nutritional status N IC: energy m anagem ent, delusional m anagem ent, nutritional counseling T EA C H IN G S T R AT EGY

Collaborative m anagem ent (fluid balance, drug therapy, surgery) N ursing m anagem ent in accordance w ith th e nursing process Path oph ysiology of A ddison's D isease Clinical m anifestations of A ddison'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 anagem ent in accordance w ith th e nursing process 1. 2. N A N D A : A ctivity intolerance, Altered body im age, Know ledge deficit r/t disease process N O C: Endurance, Psych osocial adjustm ent, Increased know ledge base N IC: Energy m anagem ent, Im proved self-esteem , T eaching N A N D A : Fluid and electrolyte im balance, D enial, Know ledge deficit r/t disease process N O C: Fluid and electrolyte balance, A cceptance, Increased know ledge base N IC: D rug th erapy, Com pliance, Teach ing

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. Identify basic concepts of h um an valuing essential for eth ical decision m aking. 2. Identify selected eth ical th eories and principles basic to eth ical decision m aking. III. 3. Identify current and future eth ical issues related to nursing practice. 4. A nalyze th e relationsh ip betw een th e A N A Code of Eth ics and personal m orality/values in relation to nursing practice. 5. A pply th e eth ical decision-m aking process to specific issues encountered in nursing practice. IV. 6. Identify com m unity resources available to patients facing difficult ch oices. 7. U tilize internet resources and inform ation tech nology to enh ance understanding of com plex eth ical issues. 8. D escribe patient's righ ts as th ey pertain to paper and com puterized h ealth inform ation. V I. 9. S um m arize nursing responsibilities for patients w ith eth ical and bioeth ical issues. V. A ccountability A. B. C. Personal Professional Patient A dvocacy II. I.

C LA S S C O N T EN T Review A N A Code of Eth ics and H istorical D evelopm ent Eth ical Reform ation, A Process A. B. C. V alue Form ation M oral D evelopm ent Theory D evelopm ent

T EA C H IN G S T R A T EGY Lecture Pow er Point Presentations D iscussion Case S tudies

Patient Advocacy/Legal& Ethical Issues/Caregiver A ccountability A. B. C. D. E. F. G. H. I. J. Public Response Patient B ill of Righ ts Patient S elf-D eterm ination Act A dvanced H ealth D irectives Confidentiality Collaborative Practice Including D elegation Legal Issues vs. Eth ical Issues B ioeth ics and Com m on Eth ical D ilem m as Presented in the Clinical Environm ent Eth ics Com m ittee Religious O rganizations Library Resources Internet Resources H andouts

Eth ical Term inology and Principals A. B. C. D. E. F. V eracity A utonom y Fidelity B eneficence N on-m aleficence Futility

A pplication of th e N ursing Process to Eth ical D ilem m as Incorporating N A N D A , N IC, N O C. A. N AN D A 1. 2. 3. 4. 5. B. 1. 2. 3. 4. C. N IC 1. 2. 3. 4. 5. active listening anticipatory guidance conflict m ediation learning facilitation patient righ ts protection decisional conflict fear coping, individual and fam ily spiritual distress com m unity coping ineffective acceptance of h ealth status com m unity com petence fam ily/individual 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

CLA S S O B J EC T IV ES 1. D escribe th e functions of th e cardiovascular system and th e concepts involved in th e h em odynam ic stability related to th e cardiovascular system . D escribe th ree levels of prevention in relation to th e cardiovascular system . D iscuss diet m odification used w ith th e patient w ith CA D . D escribe and discuss issues involved in relation to age, gender, culture, socioeconom ic, religion and eth ics in relation to cardiovascular system . III. IV. I. C LA S S C O N T EN T Review of th e A & P of th e Cardiovascular S ystem and the Concepts Involved in H em odynam ic S tability Related to th is S ystem (i.e. electrophysiology, coronary arteries, preload, afterload, cardiac output). II. H ealth Prom otion A. B. C. Prim ary Prevention (education i.e. risk factors, diet) S econdary Prevention (early detection) Tertiary Prevention (early recognition of com plications) Pow er Point Presentation 3. Patient Advocacy / Legal-Ethical Issues /Caregiver A ccountability Linkages: connecting new content Com plex D isorders in Relation to Ch est Pain and Cardiovascular D isease A. A ssessm ent 1. 2. Path oph ysiology related ch est pain/ cardiovascular disease Clinical m anifestations of ch est pain/cardiovascular disease a. b. 5. D iscuss and differentiate betw een path oph ysiology and clinical m anifestations of ch est pain/cardiovascular disease. D escribe and discuss client preparation, procedure and follow -up care of patients having diagnostic assessm ents. Identify defining ch aracteristics used for nursing diagnoses related to cardiovascular disease/problem s. Identify N O C outcom es related to com plex cardiovascular problem s. 2. B. C. Planning 1. S uggested N O C O utcom es a. Cardiac pum p effectiveness (extent to w h ich blood is ejected from th e left ventricle per m inute to support system ic perfusion) b. c. 7. d. S ufficient tissue perfusion (blood flow to m aintain organ/tissue perfusion) A dequate circulatory status (CV P, w edge pressure, blood pressure, blood gases w ith in norm al range) S table vital signs status (expected range H R, rh ythm , B P, R, T, pulse O x) Possible N IC Interventions a. b. 9. Identify N IC interventions related to com plex cardiovascular problem s. c. d. A cute Cardiac Care (lim it com plications betw een supply/dem and resulting from cardiac problem s) Circulatory Care (drug therapy; tem porary support w ith m ech anical devices/pum ps) H em odynam ic Regulations - O ptim ize (h eart rate, preload/afterload, contractability, perfusion) 10. D iscuss appropriate N IC based nursing interventions for patients w ith com plex cardiac disease. 11. Prioritize care based on M aslow 's h ierarch y of needs for patients w ith cardiovascular disease. 12. D iscuss purpose and nursing responsibilities related to m edication, diet th erapy, th erapeutic interventions, and disch arge planning/ education related to cardiovascular disease. S h ock M anagem ent - Cardiac, O bstructive (prom ote adequate tissue perfusion for a patient w ith a severely com prom ised h eart) e. D. 1. Pain M anagem ent (drug th erapy, treatm ents) Im plem entation N IC B ased Interventions (pain m anagem ent, anxiety reduction, acute cardiac care, h em odynam ic regulators, adequate circulatory care, ventilation assistance, sh ock m anagem ent, energy m anagem ent) 2. 3. 4. Prioritize (M aslow ) O rganizing Care A ctivities Collaborative Efforts / Com plem entary T h erapies / D elegation Collaborative M anagem ent (cardiology services, surgical services, m edical services, respiratory th erapy, nutritional support, disch arge planning, com m unity services, cardiac reh abilitation, h om e care) E. Evaluation of N O C O utcom e A ch ievem ent Internet & Library Resources D iscussion Clinical Sim ulation Gordan's functional h ealth patterns Collaborative data (lab data, diagnostic data, h em odynam ics) Role Playing Revisiting, Review , Repetition Concept M apping to prior learning Case studies Lecture H andouts T EA C H IN G S T R A T EGY A ssigned Reading

2.

4.

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

6.

8.

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

C LAS S O B J EC TIV ES 1. Explain th e path oph ysiology in acute coronary syndrom e. 2. D escribe considerations necessary w h en evaluating fem ale, elderly, and th e culturally diverse in relation to acute coronary syndrom e. 3. Interpret, com pare and contrast clinical m anifestations/ diagnostic data to differentiate betw een unstable angina, subendocardial M I, M I by location. E. 4. Prioritize the care of th e patient w ith acute coronary syndrom e. 5. D escribe th e care of th e patient after interventions for acute coronary syndrom e. 6. List possible N A N D A, N O C labels w ith coronary artery syndrom e. 7. List possible nursing (N IC) interventions for patients w ith coronary artery syndrom e. 8. D evelop disch arge teach ing plans for patients adm itted w ith coronary syndrom e. D. C. I. C LA S S C O N T EN T U nstable A ngina, S ubendocardial M I, M yocardial Infarction A. B. Path oph ysiology / Epidem iology (focus on coronary arteries) Clinical M anifestations (S & S , location of M I) D iagnostic D ata (lab values, EKG interpretation in depth, stress test, scans, cardiac cath eterization) Collaborative M anagem ent (drug th erapy, O 2, m onitor, th rom bolysis, PT CA , PT CA w ith stent, laser tx) N ursing M anagem ent in accordance w ith th e N ursing Process/N A N D A /N IC/N O C Teach ing/Education (drug th erapy, rest/activity, cardiac reh ab. program s, psych osocial aspects) C a rdiova scula r U nit C ontinues on next pa ge . . . T EA C H IN G S T R A T EGY

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NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. D escribe and discuss path oph ysiology involved in cardiac dysrh yth m ias (electrical/conduction) electrophysiologic properties. II. 2. Correlate com ponents of EKG w ith cardiac conduction. III. 3. Interpret com m on cardiac dysrh yth m ias and cardiac h eart blocks. 4. Identify h em odynam ics associated w ith com m on arrh yth m ia problem s and priorities for interventions. 5. Com pare and contrast classes of antidysrh yth m ia drugs. 6. Explain th e purpose and types of pacem akers used for clients w ith dysrh yth m ias. IV. 7. O utline procedures and precautions associated w ith cardioversion/ defibrillation. 8. Explain th e purpose of radio frequency cath eter ablation. 9. D iscuss th e purpose of aneurysm ectom y. 10. D iscuss w h en open h eart cardiac m assage w ould be used. 11. Explain th e purpose of ICD . 12. Identify priorities for patients experiencing dysrh yth m ias. 13. D iscuss dysrh yth m ias w ith a focus on the elderly. 14. D evelop a plan of care for patients w ith dysrh yth m ias using N A N D A , N O C, and N IC. 15. D evelop disch arge/teach ing plans for patients adm itted w ith dysrh yth m ias. V. H ealth Teach ing Related to M edications, D iet T h erapy, Pacem akers, ICD . N ursing M anagem ent in Accordance w ith N ursing Process (N A N D A, N O C, N IC) D. Collaborative M anagem 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 Tem porary Pacem aker (non-invasive, invasive) Cardioversion D efibrillation Radio Frequency Cath eter Ablation A neurysm ectom y O pen Ch est Cardiac M assage ICD (Inplantable Cardioverter/D efibrillator) Clinical M anifestations/D iagnostic D ata (Cardiac M onitoring, Lab D ata, EKG , EPS ) I. Path oph ysiology/Epidem iology C LA S S C O N T EN T S tudents M U S T be certified in B LS T EA C H IN G S T R A T EGY

S urgical

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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

CLA S S O B J EC T IV ES 1. Explain th e path oph ysiology of h eart failure/acute pulm onary edem a. 2. List descriptions of h eart failure using Killip Classification of H eart Failure. 3. D escribe considerations necessary w h en evaluating a patient in relation to h eart failure/acute pulm onary edem a. 4. D escribe special considerations focusing on th e elderly. D. 5. Prioritize nursing care for patients experiencing heart failure, acute pulm onary edem a. 6. List possible N A N D A , N O C labels and N IC interventions for patients w ith CH F/acute pulm onary edem a. 7. D evelop teach ing/learning plan for clients at risk for h eart failure/ acute pulm onary edem a. 8. Explain th e path oph ysiology of cardiom yopath y. B. 9. D escribe considerations necessary w h en evaluating a patient w ith cardiom yopath y. C. 10. Com pare and contrast th e th ree different types of cardiom yopath y and interventions required. 11. Prioritize nursing care for patients w ith cardiom yopath y and related surgical interventions. 12. List possible N A N D A , N O C labels and N IC interventions for patients w ith cardiom yopath y. C a rdiova scula r U nit C ontinues on next pa ge . . . E. 2. II. Cardiom yopath y A. Path oph ysiology/Epidem iology 1. 2. 3. 1. 2. 3. 1. D ilated Cardiom yopath y H ypertroph ic Cardiom yopath y Restrictive Cardiom yopath y ECH O Cardiac Cath eterization Radionuclide Im aging M edical a. b. c. a. b. c. drug th erapy diet th erapy stress m anagem ent excision of h ypertroph ied septum cardiom yoplasty h eart transplant E. C. B. I. C LA SS C O N T EN T Congestive H eart Failure/A cute Pulm onary Edem a A. Path oph ysiology/Epidem iology 1. 2. 1. 2. 3. 4. 1. 2. 3. 4. 5. Left-S ided / Righ t-Sided H eart Failure A cute Pulm onary Edem a ECH O M V GA S tress EKG Cardiac Cath eterization D rug Th erapy O2 V entilation A ssistance H em odynam ic Regulations Energy M anagem ent T EA C H IN G S T R A T EGY

Clinical M anifestations/D iagnostic D ata

Collaborative M anagem ent

N ursing M anagem ent in Accordance w ith N ursing Process for th e Care of Patients w ith H eart Failure U sing N A N D A /N O C/N IC Teach ing/Education 1. 2. 3. 4. 5. 6. H ealth T each ing A ctivity S ch edule D rug Th erapy D iet Th erapy W hat to report to h ealth care provider S urgical interventions w h en necessary

Clinical M anifestation/D iagnostic D ata

Collaborative M anagem ent

S urgical

N ursing M anagem ent in Accordance w ith N ursing Process for Care of th e Patient w ith Cardiom yopath y

REVISED: 08/09

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

CLA S S O B J EC T IV ES 1. Explain th e path oph ysiology in cardiogenic sh ock (direct pum p failure); obstructive sh ock (indirect pum p failure). 2. D escribe th e clinical m anifestations associated w ith th e com pensatory m ech anism s of sh ock. 3. Com pare and contrast cardiogenic sh ock vs obstructive sh ock (cardiac tam ponade). 4. Prioritize th e care of patients w ith cardiogenic sh ock vs obstructive sh ock. 5. List possible N A N D A /N O C labels for patients w ith cardiogenic sh ock/ obstructive sh ock. 6. List possible nursing interventions (N IC) for patients w ith cardiogenic sh ock/obstructive sh ock. 7. D evelop a disch arge teach ing plan for a patient w ith a diagnosis of sh ock. C a rdiova scula r U nit C ontinues on next pa ge . . . V. Teach ing/Education for a Patient A fter T reatm ent for S h ock IV. N ursing M anagem ent in Accordance w ith th e N ursing Process U sing N A N D A /N O C/N IC B. II. III. Clinical M anifestations/D iagnostic D ata Collaborative M anagem ent A. M edical 1. 2. 3. 4. 1. 2. D rug Th erapy O 2 Th erapy Intra-A ortic B alloon Pum p Intervention in cause of cardiogenic shock V alvular surgery Pericardiocentesis I. C LA SS C O N T EN T Path oph ysiology/Epidem iology Related to Cardiogenic S hock/O bstructive S h ock (Cardiac T am ponade) T EA C H IN G S T R A T EGY

S urgical

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. D escribe and discuss path oph ysiology involved in valvular disorders. 2. Com pare and contrast signs and sym ptom s com m on in each valvular disorder. 3. D escribe various procedures used to correct valvular problem s. 4. Prioritize th e care of patients w ith valvular disease interventions. 5. D escribe th e care of th e patient after interventions for vascular disease. 6. D evelop a plan of care for patients before and after surgical interventions for valvular disease. II. 7. D evelop a disch arge teach ing plan for patients w h o h ave undergone surgical interventions for vascular disease. C. 8. D escribe and discuss path oph ysiology involved in cardiovascular disease. 9. Com pare and contrast signs and sym ptom s com m on in patients requiring surgical intervention for CA D . 10. D iscuss th e differences betw een surgical interventions for patients w ith CA D . 11. D escribe th e interventions used in CA B G surgery. 12. Prioritize th e care of patients after surgical intervention for CA D . 13. D evelop a disch arge teach ing plan for patients w h o h ave h ad surgery for CAD . E. D. B. Coronary A rtery A. Path oph ysiology/Epidem iology 1. 1. 1. Coronary A rteries Right-S ided/Left-S ided Cardiac Catheterization CA B G S urgery a. b. c. saph enous radial internal m am m ary artery Clinical M anifestations/D iagnostic D ata Collaborative M anagem ent D. E. 2. C. I. V alvular D isorders A. B. Path oph ysiology/Epidem iology (Tricuspid, Pulm onary, M itral, A ortic V alves) Clinical M anifestations/D iagnostic D ata (in general and specific for each valve) Collaborative M anagem ent 1. Reparative Procedures a. b. c. a. b. c. d. B alloon valvuloplasty D irect or open com m issurotom y M itral valve reconstruction. Prosth etic valves X enograft H om ograft Pulm onary autograph y C LA SS C O N T EN T T EA C H IN G S T R A T EGY

Replacem ent Procedures

N ursing M anagem ent in Accordance w ith N ursing Process U sing N AN D A /N O C/N IC Interventions Teach ing/D isch arge Plan for Patients H aving U ndergone V alvular S urgery

N ursing M anagem ent in Accordance w ith N ursing Process using N AN D A /N O C/N IC Interventions Teach ing/Education for Patients H aving U ndergone S urgery for CA D 2. 3. M inim ally Invasive D irect Coronary A rtery B ypass Transm yocardial Laser Revascularization

REVISED: 08/09

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 LA S S O B J EC T IV ES 1. D escribe th e function of th e renal and urinary system s and function of th e prostate gland. D escribe th ree levels of prevention in relation to renal, urinary and prostate disorders. D iscuss th e pathoph ysiology and clinical m anifestations of renal failure. Interpret th e results of laboratory data & diagnostic tests associated w ith renal failure. D iscuss th ree treatm ent m odalities used in th e collaborative m anagem ent of ch ronic renal failure. D escribe th e kidney donor selection process. V. 7. D iscuss th e drug th erapy used to prevent transplant rejection. D iscuss nursing responsibilities in caring for possible transplant candidates. U se M aslow 's h ierarch y of needs w h en assessing th e patient w ith CRF undergoing various treatm ent m odalities. I. II. C LA S S C O N T EN T Review of th e A natom y and Ph ysiology of th e Renal and U rinal S ystem s H ealth Prom otion A . Prim ary Prevention of Renal Failure, U rinary D isorders and Prostate D isorders B . S econdary Prevention: Early D etection of Renal, U rinary, and Prostate D isorders C. Tertiary Prevention: Patient T each ing Com plex D isorders of th e Renal S ystem A . Path oph ysiology of Ch ronic Renal Failure (CRF) B . Clinical M anifestations of Ch ronic Renal Failure 1. Laboratory data 2. D iagnostic tests C. Collaborative M anagem ent of Ch ronic Renal Failure D . M edical Intervention: Ph arm acological, D ialysis & Renal T ransplant E. S urgical Intervention: D ialysis A ccess and Renal T ransplant F. N utritional S upport Patient Advocacy / Legal-Ethical Issues / Caregiver A ccountability A . U nequal A ccess to Kidney T ransplant List B . H ealth Insurance S tatus A dvanced N ursing M anagem ent of th e Patient w ith Ch ronic Renal Failure A . A ssessm ent A ccording to G ordon's Functional H ealth Patterns ­ Key findings B . A nalysis/N ursing D iagnoses A ssociated w ith D ialysis and Renal Transplant: Ex ­ Excess fluid volum e, Interrupted fam ily process, Ineffective coping C. Planning 1. Com m on N O C O utcom es: Ex ­ Fluid B alance 2. S uggested N ursing Interventions: Ex - Fluid M anagem ent, Fluid M onitoring D . Im plem entation: N IC B ased A ctions A pplied to th e Patient and Fam ily of th e D ialysis/T ransplant Patient: Ex - Fluid M anagem ent 1. Prioritizing/O rganizing Care A ctivities 2. D elegation/Collaborative Efforts/ Com plem entary T h erapies 3. Cost issues r/t h em odialysis and transplant 4. Collaborative M anagem ent - D isch arge Planning a. H om ecare: Peritoneal dialysis, sym ptom & m edication m anagem ent, nutritional needs b. Com m unity resources and support groups c. O utpatient education E. Evaluation of O utcom e Ach ievem ent: Ex - Fluid B alance Com plex D isorders of th e U rinary System : Ex - B ladder T um ors A . Path oph ysiology of B ladder T um ors B . Clinical M anifestations of B ladder Cancer 1. Laboratory data 2. D iagnostic tests C. Collaborative M anagem ent of B ladder Cancer 1. M edical interventions 2. S urgical intervention 3. N utritional support A dvanced N ursing M anagem ent of th e Patient w ith U rinary D iversion A . A ssessm ent A ccording to G ordon's Functional H ealth Patterns B . A nalysis/N ursing D iagnoses A ssociated w ith U rinary D iversion: Ex D eficient Know ledge r/t Care of S tom a, D isturbed B ody Im age r/t Presence of S tom a TEA C H IN G S T R AT EGY A ssigned Reading Lecture H andouts Case studies Pow er Point Presentation Linkages: connecting new content to prior learning Concept M apping Revisiting, Review , Repetition Role Playing Clinical Sim ulation D iscussion Internet & Library Resources

2.

3.

III.

4.

5.

IV.

6.

8.

9.

10. S tate four nursing diagnoses (N A N D A ) com m only associated w ith a patient in end-stage renal disease. 11. List four corresponding nursing outcom es (N O C) associated w ith th e diagnoses generated for th e patient in end-stage renal disease. V I. 12. D iscuss appropriate N IC based nursing interventions for th e patient undergoing dialysis or renal transplant. 13. D iscuss th e nursing m anagem ent of th e end-stage renal patient at h om e and th e use of com m unity resources. V II. 14. D iscuss th e pathoph ysiology and clinical m anifestations of com plex disorders of th e urinary system : Ex B ladder T um ors. 15. Interpret th e results of laboratory tests and diagnostic tests associated w ith B ladder Cancer. 16. D iscuss treatm ent m odalities used in th e collaborative m anagem ent of B ladder Cancer. C ontinues on next pa ge . . .

C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

C LA S S O B J EC T IV ES 17. U se M aslow 's h ierarch y of needs w h en assessing th e patient w ith U rinary D iversions. 18. List four nursing diagnoses (N A N D A ) com m only associated w ith a patient w ith U rinary D iversions. 19. List four corresponding nursing outcom es (N O C) associated w ith a patient w ith U rinary D iversions. 20. D iscuss appropriate nursing interventions (N IC) associated w ith a patient w ith U rinary D iversions. 21. D iscuss th e nursing m anagem ent of a patient w ith a urinary diversion at h om e and th e use of com m unity resources. 22. D iscuss th e pathoph ysiology and clinical m anifestations of patients w ith Prostate D isorders. 23. Interpret th e results of laboratory data and diagnostic tests associated w ith Prostate Cancers. 24. D iscuss treatm ent m odalities used in th e collaborative m anagem ent of Prostate Cancer. 25. U se M aslow 's h ierarch y of needs to prioritize assessm ents in the patient w ith Prostate Cancer. 26. List four nursing diagnoses (N A N D A ) com m only associated w ith a patient w ith Prostate Cancer. 27. List four corresponding nursing outcom es (N O C) associated w ith a patient w ith Prostate Cancer. 28. D iscuss appropriate nursing interventions (N IC) associated w ith a patient w ith Prostate Cancer. 29. D iscuss th e nursing m anagem ent of th e patient w ith Prostate cancer at h om e and th e use of com m unity resources. C. C LA S S C O N T EN T Planning 1. Com m on N O C O utcom es: Ex - Know ledge of H ealth B eh aviors r/t S tom a Care 2. S uggested N ursing Interventions: Ex - Individual and fam ily teach ing of stom a care and appliance m anagem ent Im plem entation 1. N IC based actions applied to th e patient & fam ily prioritizing and organizing care activities a. D elegation/Collaborative Efforts/ Com plim entary T herapies b. Cost issues 2. D isch arge Planning 3. H om e Care: H om e H ealth Care and Com m unity Support; Resource: w w w .ricancercouncil.org Evaluation of O utcom e Ach ievem ent T EA C H IN G S TR A T EGY

D.

E.

V III. Advanced Considerations of th e Patient w ith D isorders of th e Prostate A . Path oph ysiology of Prostate D isorders B . Clinical M anifestations of Prostate D isorders 1. Laboratory data 2. D iagnostic tests C. Collaborative M anagem ent of Prostate Cancer 1. M edical interventions 2. S urgical intervention IX . A dvanced N ursing M anagem ent of th e Patient w ith Prostate Cancer A . A ssessm ent A ccording to G ordon's Functional H ealth Patterns B . A nalysis/N ursing D iagnoses: Ex - A cute Pain r/t Incision or B ladder S pasm s; Incontinence of U rine C. Planning 1. Com m on N O C O utcom es: Ex - Pain Level 2. S uggested N ursing Interventions D . Im plem entation - N IC B ased Actions A pplied to th e Patient and Fam ily 1. Prioritizing and O rganizing Care A ctivities 2. D elegation/Collaborative Efforts/ Com plem entary th erapies 3. M anagem ent of S urgical Com plications 4. Cost Issues 5. D isch arge Planning / Patient T each ing 6. H om e Care: Ex - Pain m anagem ent & cath eter care 7. Com m unity Resources E. Evaluation of O utcom e Ach ievem ent: Ex.: - Com fort Level

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. D escribe clinical param eters for respiratory failure. 2. D escribe ventilation, perfusion, diffusion, and sh unting and th e relationsh ip of pulm onary circulation to th ese processes. II. 3. Com pare and contrast th e ventilation-perfusion ratios for respiratory failure of ventilator origin and respiratory failure of oxygenation origin. 4. D iscuss th e pathoph ysiology and clinical m anifestations of respiratory failure. III. 5. D escribe th e rationale for m anagem ent of adult respiratory failure. 6. Explain th e problem s associated w ith O 2 th erapy for patients w hose respiratory efforts are controlled by th eir h ypoxic drive. 7. A nalyze ch anges in clinical m anifestations to determ ine th e effectiveness of th erapy for patients receiving O 2. 8. Prioritize th e care for a client w ith a new trach eostom y. 3. 9. Explain th e rationale for nutrition th erapy. 10. D escribe h ow to check placem ent for an ET tube. 11. D efine M ode O f V entilation and criteria for cuff care. 12. Explain em ergency procedures for dislodged tube. 13. D escribe th e path oph ysiology of clinical m anifestations of A RD S . 14. Explain th e basic difference in ventilation types. B. V I. V. Care of Patient w ith A rtificial Airw ays A. B. Endotrach eal T ubes Trach eostom y T ubes 1. 2. 3. 4. Types Cuff care/M inim al leak D islodged tube W eaning 2. (N K/PC C ) B. 2. 1. IV. Com plex D isorders of th e Respiratory System A. Path oph ysiology of A RF 1. D efine ventilatory failure a. b. acute ch ronic Internet & Library Resources D iscussion Clinical Sim ulation Patient Advocacy/Legal and Eth ical Issues/Caregiver A ccountability Role Playing C. B. H ealth Prom otion A. Prim ary Prevention of Respiratory D iseases 1. 1. 2. 3. 1. S m oking cessation Linkages: connecting new content to prior learning Concept M apping Revisiting, Review , Repetition S creening X -Ray CB C Patient education S econdary Prevention Pow er Point Presentation I. A natom y and Ph ysiology A. B. C. D. E. Concepts Com pliance Tidel V olum e V entilation/Perfusion Ratio S h unting Case studies H andouts Lecture C LA S S C O N T EN T T EA C H IN G S T R A T EGY A ssigned Reading

Tertiary Prevention

Clinical param eters Clinical m anifestations a. a. b. c. d. Lab data and diagnostic tests Ph arm acological O2 N utrition B reath ing exercises M edical m anagem ent of respiratory diseases

Path oph ysiology of A RD S

Collaborative m anagem ent of respiratory disorders (m edical services, respiratory th erapy, nutritional support, ph ysical th erapy, occupational th erapy, speech th erapy, discharge planning, h om e care, com m unity services)

M ech anical V entilation A. Types 1. 2. 1. Pressure V olum e S tages

W eaning

C ontinues on next pa ge . . . C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 15. List possible N A N D A , N O C labels and N IC interventions for patients on m echanical ventilation. B. 16. Explain four stages of w eaning. 17. Care for th e patient on m ech anical ventilation. D. 18. D eterm ine th e appropriate patient care strategies for patients on m ech anical ventilation. E. C. V II. C LA S S C O N T EN T U tilization of N ursing Process A. A ssessm ent 1. Gordon's Functional H ealth Patterns Collaborative D ata A nalysis/N ursing D iagnosis (N A N D A) 1. 2. 3. 1. 2. 3. 1. 2. 3. 4. F. G. Im paired ventilation related to respiratory m uscle fatigue D ysfunctional w eaning response Ineffective airw ay clearance related to tracheal secretions gas exch ange ventilation airw ay patency Infection control Respiratory m onitoring V entilator assistance Electrolyte balance T EA C H IN G S T R A T EGY

S uggested N O C O utcom es - Respiratory status

Proposed N IC Interventions

Im plem entation Evaluation of O utcom es

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. D escribe a neurologic h istory and ph ysical assessm ent. 2. Relate path oph ysiology to th e clinical m anifestations of increasing intracranial pressure (ICP). 3. D ifferentiate early and late signs/ sym ptom s of increasing ICP. 4. Identify th e purpose of ICP m onitoring. 5. D ifferentiate th e com m on types of traum atic brain injury (TB I). 6. D escribe th e psych osocial and beh avioral m anifestations associated w ith TB I. 7. Identify th e risk factors and com plications of TB I in th e older adult. 8. D escribe th e diagnostic tests used for th e neurologic patient. IV. 9. D escribe com m on com plications of brain tum ors. 10. Identify th e diagnostic tests used for th e patient w ith ch anges in m ental status and TB I. 11. Prioritize assessm ents of th e patient w ith neurologic problem s using M aslow 's h ierarch y of needs. 12. Identify appropriate N A N D A nursing diagnoses for th e critically ill patient w ith neurologic problem s. 13. List N O C labels for specific neurologic problem s. 14. D escribe N IC interventions linked to N O C labels th at apply to the critically ill patient w ith neurologic problem s. 15. D iscuss th e nursing m anagem ent, utilizing nursing process, of th e patient experiencing com plex neurologic problem s. 16. D evelop a postoperative plan of care for a patient h aving a craniotom y. 17. D escribe collaborative m anagem ent of the critically ill neurologic patient. C ontinues on next pa ge . . . E. D. C. B. U tilization of th e N ursing Process as it Relates to Care of th e Critically Ill Patient w ith N eurologic Problem s A. N eurologic A ssessm ent 1. 2. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6. 7. 8. Gordon's Functional H ealth Patterns Collaborative data, diagnostic tests D ecreased intracranial adaptive capacity Ineffective tissue perfusion, cerebral Ineffective breath ing pattern Risk for disuse syndrom e D isturbed th ough t processes D isturbed sensory perception Interrupted fam ily processes N eurological status: Consciousness Tissue perfusion, cerebral Respiratory status: V entilation Im m obility consequences: Ph ysiological D istorted th ough t control B ody im age Fam ily coping Cerebral edem a m anagem ent M onitor neurologic status, ICP m onitoring A irw ay m anagem ent Exercise th erapy: joint m obility D elusion m anagem ent Environm ental m anagem ent Fam ily process m aintenance Collaborative m anagem ent (neurological services, m edical services, respiratory th erapy, ph ysical therapy, occupational th erapy, speech th erapy, nutritional support, disch arge planning, rehab, h om e care, social services, com m unity support groups) Evaluation of O utcom e Ach ievem ent III. Legal and Eth ical Issues A. B. Criteria for B rain D eath O rgan D onation and Referral to N EO B Internet & Library Resources B. C. II. I. C LA S S C O N T EN T Know ledge B asic to Care of th e N eurologic Patient A. B. A natom y and Ph ysiology Concepts of ICP Regulation 1. 2. 3. M onro-Kellie h ypoth esis Com pensating m easures Cerebral perfusion pressure (CPP) Case studies H ealth Prom otion S trategies A. Prim ary Prevention of T B I 1. 2. 3. 4. 5. S afe m otor veh icles, use of seat belts D ecrease in drinking and driving, M A D D H elm et use S afe playgrounds Prevent/decrease violent beh avior Concept M apping Revisiting, Review , Repetition Role Playing Clinical Sim ulation D iscussion Linkages: connecting new content to prior learning Pow er Point Presentation H andouts Lecture T EA C H IN G S T R A T EGY A ssigned Reading

S econdary Prevention - Earliest D etection of IICP Tertiary Prevention 1. 2. 3. Preventing com plications of im m obility Reh abilitative plan of care Referral to local ch apter N H IF (N ational H ead Injury Foundation), A m erican B rain T um or Association, N ational B rain Tum or Foundation, A m erican Cancer S ociety

A nalysis/N ursing D iagnoses (N A N D A )

Planning - N O C O utcom e Labels

Im plem entation - N IC Interventions

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES V. C LA S S C O N T EN T S pecific N eurologic Problem s A. Traum atic B rain Injury 1. 2. Prim ary brain injury S econdary brain injury a. b. c. d. e. 3. a. b. c. d. e. 4. a. b. c. 5. 6. B. 1. 2. 3. Classification of brain injuries IICP H em orrh age Loss of autoregulation H erniation B edside neurological assessm ent Respiratory interventions Fluid m anagem ent Positioning D rug related responsibilities Clinical m anifestations Psychosocial assessm ent Radiograph ic and oth er diagnostic tests T EA C H IN G S TR A T EGY

N ursing m anagem ent of patient w ith IICP

Collaborative m anagem ent

Reh abilitation and hom e care m anagem ent H ealth care resources Classification of tum ors Com plications of tum ors Collaborative m anagem ent a. b. c. Radiation therapy and ch em oth erapy D rug th erapy O perative procedures and surgical m anagem ent 1) 2) post operative assessm ent preventing post operative com plications a) b) neurogenic pulm onary edem a alterations in A D H secretion

B rain Tum ors

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES N ursing M anagem ent of Patients w ith Spinal Cord Injury 1. D escribe th e m otor and sensory assessm ent for th e patient w ith acute spinal cord injury (S CI). D escribe typical m edical com plications th at are experienced by patients w ith S CI. D escribe th e path oph ysiology of autonom ic dysreflexia. Recognize early signs/ sym ptom s of autonom ic dysreflexia. Prioritize assessm ents for th e patient w ith S CI using M aslow 's h ierarch y of needs. Identify appropriate N A N D A nursing diagnoses for th e patient w ith problem s of th e spinal cord. List N O C labels for th e patient w ith S CI. D escribe N IC interventions linked to N O C labels for th e patient w ith S CI. Prioritize th e nursing care of th e patient w ith S CI. IV. 10. D evelop a com m unity based teaching plan for patients w ith S CI. N ursing M anagem ent of th e Patient w ith Intervertebral D isc D isease 1. D escribe th e path oph ysiology of disc disease. Identify risk factors th at contribute to back pain. Identify factors contributing to low back pain in th e older adult. Explain w ays to prevent back pain. List N A N D A /N O C labels and N IC interventions for th e patient h aving a discectom y, lam inectom y, and/or spinal fusion. III. I. C LA S S C O N T EN T A natom y and Ph ysiology A . S pinal Colum n and S pinal N erves B . A utonom ic N ervous S ystem H ealth Prom otion S trategies A . Prim ary Prevention of B ack Pain and D isc Injuries 1. Correct body m echanics 2. S afe w ork environm ent 3. Exercise, w eigh t control, sm oking cessation B . Prim ary Prevention of S pinal Cord Injury 1. S afety m easures indicated for T B I prevention 2. Correct transfer and transport of accident victim s C. S econdary Prevention of B ack/D isc Injury 1. Patient education of treatm ent regim en 2. M otor and sensory assessm ent D . S econdary Prevention of S CI 1. Frequent m otor and sensory assessm ent 2. M onitor for earliest indications of increasing spinal cord edem a E. Tertiary Prevention of B ack/D isc Injury 1. Ph ysical th erapy 2. Pain specialists F. Tertiary Prevention of S CI 1. Early integration of rehabilitative plan to prevent com plications of im m obility 2. H ealth teach ing to recognize and prevent autonom ic dysreflexia 3. Referral to N ational Spinal Cord Injury A ssociation, S pinal Cord Injury H otline Legal and Eth ical Issues/Patient A dvocacy A . H igh incidence of back pain; cost of tim e lost from w ork, w ork com pensation and m edical/surgical treatm 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 th e N ursing Process as it Relates to Care of th e Patient w ith Spinal Cord Problem s A . A ssessm ent U sing G ordon's Functional H ealth 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 know ledge 3. Risk for perioperative positioning injury 4. D isturbed sensory perception C. Planning - N O C O utcom e Labels for Intervertebral D isc D isease 1. Pain level 2. Know ledge of treatm ent regim en 3. M uscle function 4. Risk control D . Im plem entation - N IC Labels for Intervertebral D isc D isease 1. Pain m anagem ent, analgesic adm inistration 2. Teach ing disease process 3. Positioning; intraoperative 4. H ealth education E. A nalysis/N ursing D iagnoses for th e Patient w ith S CI (N A N D A ) 1. Risk for ineffective breath ing pattern 2. Risk for autonom ic dysreflexia 3. Risk for im paired skin integrity 4. U rinary retention 5. Constipation 6. S elf care deficit 7. S exual dysfunction 8. Risk for pow erlessness T EA C H IN G S T R A T EGY A ssigned Reading Lecture H andouts Case studies Pow er Point Presentation Linkages: connecting new content to prior learning Concept M apping Revisiting, Review , Repetition Role Playing Clinical S im ulation D iscussion Internet & Library Resources

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C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLAS S O B J EC T IV ES F. C LA S S C O N T EN T Planning - N O C O utcom e Labels for th e Patient w ith S CI 1. Respiratory status: V entilation 2. N eurologic status: A utonom ic 3. Im m obility consequences: Ph ysiological 4. U rinary elim ination 5. B ow el elim ination 6. S elf care: H ygiene, eating, toileting 7. S exual functioning 8. Participation: H ealth care decisions Im plem entation - N IC Labels for th e Patient w ith S CI 1. Respiratory m onitoring 2. D ysreflexia m anagem ent 3. Pressure ulcer prevention 4. U rinary cath eterization 5. Constipation/im paction m anagem ent 6. S elf care assistance: B ath ing, feeding, toileting 7. S exual counseling 8. S elf esteem enh ancem ent T EA C H IN G S T R A T EGY

G.

V.

V I.

S pecific Problem s of the S pinal Cord - S pinal Cord Injury (S CI) A . Path oph ysiology - M ech anism s and Forces B . Classification 1. D egree of injury a. com plete b. incom plete C. Functional Levels 1. Paraplegia 2. Q uadriplegia 3. U pper m otor neuron injury 4. Low er m otor neuron injury D . S h ock S yndrom 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 anagem ent 1. A cute ph ase a. non-surgical b. h igh dose m eth ylprednisolone 2. Post acute a. respiratory com plications b. venous th rom bosis c. GI h em orrh age d. decubitus ulcers e. spasticity f. bladder retraining, cath eterization g. bow el function h . sexual function G. Reh abilitation, H om e Care M anagem ent 1. Prevention of com plications of im m obility 2. Prevention of respiratory com plications, secretion clearance 3. S pasticity control, antispasm odic m edications 4. Pain, paresth esia and h yperesth esia control 5. M onitor for h eterotroph ic ossification and syringom yelia N ursing M anagem ent of S pecific Problem s of th e S pinal Cord Intervertebral D isc D isease A . Path oph ysiology 1. A natom ical considerations 2. Causes of disc injury B . Clinical Presentation C. D iagnostic T ests D . Collaborative M anagem ent (surgical services, neurological services, m edical services, genitourinary services, ph ysical th erapy, occupational th erapy, respiratory therapy, nutritional support, social services, rehab., disch arge planning, h om e care, com m unity resources) E. Post O perative N ursing M anagem ent 1. Lam inectom y 2. S pinal fusion

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

Unit 9: Care Of The Patient With Complex Metabolic Disorders

C LA S S O B J EC T IV ES 1. D escribe th e path oph ysiology, etiology, and m anagem ent of D iabetes M ellitus. 2. D iscuss th e current trends and future advances in diabetes m anagem ent. 3. Relate th e clinical m anifestations of diabetes m ellitus to th e associated path oph ysiologic alterations. 4. Com pare and contrast th e m anifestations and collaborative care of h ypoglycem ia, diabetes ketoacidosis (D KA ), and h yperosm olar nonketotic syndrom e (H H N S ). 5. Identify clients at risk for h ypoglycem ia. 6. Prioritize nursing interventions for th e patient w ith m ild to m oderate h ypoglycem ia and m oderate to severe h ypoglycem ia. 7. Prioritize interventions for clients w ith D KA and H H N S . E. 8. D iscuss th e pathoph ysiology, etiology, and m anagem ent for h ypofunctioning of th e adrenal glands. 9. D escribe th e path oph ysiology and m anagem ent of h yperadrenalism . 10. S tate four nursing diagnoses (N A N D A ) associated w ith a patient w ith a m etabolic disorder. 11. List four corresponding nursing outcom es (N O C) associated w ith th e diagnosis generated for a patient w ith a m etabolic disorder. 12. D iscuss N IC based interventions for a patient w ith a m etabolic disorder. 13. U se th e nursing process as a fram ew ork for providing individualized care in th e m anagem ent of a patient w ith a m etabolic disorder. V I. V. Com plex D isorders A. B. C. D. 1. D. C. B. IV. C. II. H ealth Prom otion A. B. I.

C LA S S C O N T EN T Review of the A natom y and Ph ysiology

TEA C H IN G S T R AT EGY A ssigned Reading Lecture H andouts Case studies Pow er Point Presentation

Prim ary Prevention of D M , H ypoglycem ia and A drenal D isorders S econdary Prevention - Early D etection of D M and A drenal D isorders and Related Com plications Tertiary Prevention 1. Patient education

III. Patient A dvocacy/Legal-Ethical Issues/Caregiver A ccountability Linkages: connecting new content Advanced N ursing M anagem ent of a Patient w ith M etabolic D isorders A. A ssessm ent A ccording to G ordon's Functional H ealth Patterns - Key Findings A nalysis/N ursing D iagnoses A ssociated w ith M etabolic D isorders 1. 2. 1. 2. 1. 2. 3. 4. 5. 6. Ineffective m anagem ent of th erapeutic regim e related to D M Risk for fluid volum e deficit Role Playing Clinical Sim ulation D iscussion Internet & Library Resources A dherence beh avior Electrolyte and acid/base balance; fluid balance Electrolyte m anagem ent m onitoring M onitoring em ergency care Fluid m anagem ent Lab data interpretation Teach ing Collaborative m anagem ent (m edical services, surgical services, nutritional support, disch arge planning, h om e care, com m unity services) Evaluation of O utcom e A ch ievem ent Electrolytes w ith in norm al lim its Revisiting, Review , Repetition Concept M apping to prior learning

Planning - Com m on N O C O utcom es

S uggested N ursing Interventions

Path oph ysiology of D M , H ypoglycem ia and H H N S Clinical 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 edical M anagem ent - Pharm acologic, D iet, Exercise

Com plex D isorders A. B. C. Path oph ysiology of th e A drenal G land Clinical M anifestations - Lab D ata and D iagnostic T ests 1. 1. 2. Identify th e m etabolic disease affected by acid/base im balance M edical intervention - pharm acologic S urgical intervention Collaborative M anagem ent of an A drenal D isorder

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

C LA S S O B J EC T IV ES 1. D iscuss th e properties of fluid, solutions, ions acids, bases and buffers and their relationsh ip to th e h um an body. 2. A nalyze the m ovem ent of body fluids and electrolytes betw een "com partm ents" in th e body. 3. Explain and m ake clinical application of th e w ays in w h ich circulatory, respiratory, renal and endocrine system s interact to regulate h om eostasis of th e "internal environm ent". 4. Incorporate lab values (A B G's, electrolytes, B U N , creat., album in and serum osm olarity) into patient plan of care. 5. Correlate assessm ent findings and predict th e consequences of disturbance in th e balance of w ater, electrolytes, and acid base. 6. Identify etiologies and risk factors relating to disturbance in fluid, electrolyte and acid base balance. 7. Incorporate appropriate N AN D A / N IC/N O C labels into individualized plans of care. c. 2. IV. III. A ccountability A. II. H ealth Prom otion A. I.

C LA S S C O N T EN T Ph ysiological Influences on Fluid & Electrolyte and A cid-B ase B alance A. H om eostasis 1. 2. 3. 4. Th e cell Th e fluid Electrolytes Carbonic acid

TEA C H IN G S T R AT EGY A ssigned Reading Lecture H andouts Case studies

Identification of A t Risk Individuals for A lteration in Fluid, Electrolytes and A cid B ase B alance 1. 2. 3. A cute disturbances in acid base balance Ch ronic conditions im pacting acid base balance Im pact of aging

Pow er Point Presentation Linkages: connecting new content to prior learning Concept M apping

RN Role in M onitoring Response to T reatm ent 1. 2. 3. 4. Fluid replacem ent N utritional support O 2 th erapy Electrolyte replacem ent

Revisiting, Review , Repetition Role Playing Clinical Sim ulation D iscussion Internet & Library Resources

M anagem ent of D isorders in A cid-B ase B alance Th rough Clinical A pplication of th e N ursing Process A. A cidosis vs. A lkalosis 1. S ubjective a. b. a. b. H ealth h istory and presentation Functional im pact VS PE 1) 2) 3) 4) 1) 2) 3) 4) 5) 6) 7) 8) 3. a. b. 4. a. b. c. 5. a. CN S N eurom uscular Respiratory Integum entary A B G ;s Electrolytes S erum osm olarity A lbum in B U N & Creat UA A nion gap H em oglobin/H em atocrit

O bjective

Labs and D iagnostics (baseline & trends)

D ifferential diagnosis and contributing factors M etabolic, Respiratory, or M ixed A cute vs. Ch ronic O ngoing assessm ent H ealth teach ing M edical m anagem ent N O C indicators and scales

Interventions (N ursing & Collaborative)

Evaluation of O utcom es

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 1. D escribe th e path oph ysiology and com plications associated w ith cirrh osis of the liver. Interpret laboratory test findings com m only seen in clients w ith cirrh osis. D escribe th ree levels of prevention in relation to hepatic disorders. D iscuss th e obligation to care for th e client w ith a lifestyle disease. D evelop a com m unity-based teach ing plan for th e client w ith cirrh osis of the liver. Form ulate a collaborative plan of care for the client w ith severe late-stage cirrh osis. Identify em ergency interventions for th e client w ith bleeding esoph ageal varicies. Identify th e tw o m ost com m on com plications of liver transplantation. I. C LA S S C O N T EN T Care of th e Patient W ith Cirrh osis A . Review of A natom y and Ph ysiology 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 Cirrhosis 1. Portal h ypertension 2. A scites 3. B leeding esoph ageal varicies 4. Coagulation defects 5. J aundice 6. Portal S ystem ic Encephalopath y (PS E) w ith h epatic com a (stages) 7. H epatovenal S yndrom e D . Collaborative M anagem ent of O th er Liver D isorders 1. Liver transplant 2. A cute graft rejection 3. H epatic abscess 4. Fatty liver 5. H epatic traum a 6. Cancer of the liver E. Com m on D iagnostic Procedures 1. S erum electrolytes/album in 2. Paracentesis 3. Liver function tests 4. Esph agascope 5. A rteriogram 6. Liver biopsy (percutaneous vs transvenous) 7. Coagulation profile H ealth Prom otion A . Prim ary Prevention (alcohol/drug-free environm ent) B . S econdary Prevention (liver traum a/ liver abscess) C. Tertiary Prevention (prevention of com plications; fatty liver) Legal-Ethical Issues / Caregiver A ccountability / Patient A dvocacy S pecific D isorders of th e Liver: 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 osocial assessm ent e. lab assessm ent B . A nalysis / N A N D A 1. Excess fluid volum e 2. Potential for h em orrh age/PSE C. Planning 1. S uggested N O C O utcom es a. decrease in ascites/lytes N N L/B P N N L 2. Proposed N IC Interventions a. non-surgical m anagem ent b. diet th erapy c. drug th erapy d. paracentesis e. com fort m easures f. surgical LeV een shunt T EA C H IN G S T R A T EGY A ssigned Reading Lecture H andouts Case studies Pow er Point Presentation Linkages: connecting new content to prior learning Concept M apping Revisiting, Review , Repetition Role Playing Clinical Sim ulation D iscussion Internet & Library Resources

2.

3.

4.

5.

6.

7.

8.

II.

III. IV.

C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES D. C LA S S C O N T EN T Im plem entation 1. N IC B ased Interventions a. breath ing patterns b. fluid/electrolyte m anagem ent c. bleeding precautions d. surgical intervention e. LeV een sh unt f. paracentesis g. neurologic m onitoring h . know ledge deficit i. h om e care m anagem ent k. h ealth care resources l. diet/drug th erapy m . alcoh ol abstinence 2. Collaborative M anagem ent (m edical services, surgical services, nutritional support, discharge planning, social services, h om e care, com m unity services) Evaluation of N O C A ch ievem ent T EA C H IN G S T R A T EGY

E. V.

S pecific D isorders of th e Liver: B leeding Esoph ageal V aricies A . Collaborative M anagem ent of B leeding Esoph ageal V aricies 1. Path oph ysiology a. h istory risk factors b. coagulopath y c. D IC 2. Clinical M anifestations a. bleeding b. sh ock 3. Collaborative M anagem ent a. fluid resuscitation b. vasopressin/blood transfusions c. gastric intubation d. esoph ageal e. balloon tam ponade/S engstaken-B lakem ore f. TIPS /T IPS S g. sh unts - portacaval/splenorenal 4. M edical Interventions a. h em odynam ics m onitoring 5. surgical intervention B . A dvanced N ursing M anagem ent of th e Patient w ith B leeding Esoph ageal V aricies 1. A ssessm ent 2. N A N D A Potential for H em orrh age a. fluid volum e deficit b. decreased cardiac output c. ineffective airw ay clearance d. altered tissue perfusion 3. N O C a. w ith 12 h ours patient w ill be norm ovolem ic b. M A P >70 m m H g 4. N IC a. bleeding precautions b. blood product adm inistration c. fluid/electrolyte m anagem ent d. h ypovolem ia/shock m anagem ent S pecific D isorders of th e Liver: Portal-S ystem ic (PS E) w ith H epatic Com a A . Collaborative M anagem ent 1. Path oph ysiology a. blood/brain barrier perm eability 2. Clinical M anifestation a. late/am enorrh ea, im potence

V I.

C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

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

CLA S S O B J EC T IV ES 3. C LA S S C O N T EN T Collaborative M anagem ent a. sexual dysfunction b. risk for infection c. fatigue 4. M edical Interventions a. am m onia levels 5. N utritional Intervention a. diet th erapy b. lactalose/neom ycin/oxazepam /levodop c. increase calories/low or no protein/low sodium A dvanced N ursing M anagem ent of th e Patient w ith PSE 1. A ssessm ent a. baseline level of consciousness 2. N A N D A - Potential for Portal S ystem ic Enceph alopath y a. J V D /J V E b. altered nutrition c. im paired gas exch ange d. altered th ough process e. risk for injury 3. N IC a. neurological m onitoring b. fluid/electrolyte m anagem ent c. cerebral edem a m anagem ent d. h ypokalem ia e. nutrition m anagem ent f. h ypoglycem ia g. energy m anagem ent h . aspiration precautions 4. N O C a. return to optim al level of A D Ls b. 3-4 stools/day T EA C H IN G S T R A T EGY

B.

V II.

Liver Transplantation A . Collaborative M anagem ent - Rejection 1. Path oph ysiology 2. Clinical M anifestations a. 10-14 days 3. M edical Intervention a. m eth yl prednisolone/ALG 4. S urgical Interventions a. retransplantation B . A dvanced N ursing M anagem ent of th e Patient 1. A ssessm ent / N A N D A a. acute graft rejection b. infection c. h epatic com plications d. acute renal failure e. fluid volum e excess f. fluid and electrolyte im balance g. h em orrh age h . anxiety/fear i. pow erlessness j. body im age disturbance o k. 2 im m unosuppressive agents 2. Im plem entation / N IC a. utilize concept m ap to evaluate early/late ph ases of h epatic failure 3. Evaluation / N O C

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH COMPLEX BURN INJURIES PAGE 1 OF 4

CLA S S O B J EC T IV ES 1. Identify burn clients at risk for inh alation injury. 2. Com pare and contrast th e clinical m anifestations of superficial, partial th ickness, and full th ickness burn injuries. 3. Explain th e expected clinical m anifestations of neural and h orm onal com pensation during th e em ergent ph ase of burn injury. 4. Calculate th e total body surface area involved in burn injury. 5. Prioritize nursing care for th e patient during th e em ergent ph ase of burn injury. 6. U se laboratory data and clinical m anifestations to determ ine th e effectiveness of fluid resuscitation during th e em ergent ph ase of burn injury. 7. U se th e Parkland form ula to establish the correct rate and tim ing of fluid replacem ent (also th e Lund & Brow der ch art). 8. Prioritize nursing care for th e patient during th e acute ph ase of burn injury. 9. Explain th e alteration of nutritional needs for th e burn patient during th e acute ph ase of burn injury. 10. Evaluate w ound h ealing in th e patient during th e acute ph ase of burn injury. 11. Com pare and contrast pain m anagem ent strategies for patients in the em ergent and acute ph ases of burn injury. 7. 12. D escribe th e ch aracteristics of infected burn w ounds. 13. Explain th e positioning and range of m otion interventions for the prevention of m obility problem s in the patient w ith burns. 14. Prioritize nursing care for th e client during th e reh abilitation ph ase of burn injury. 15. D iscuss th e potential psych osocial problem s associated w ith burn injury. C ontinues on next pa ge . . . 8. 9. V. U tilization of th e N ursing Process: Em ergent Ph ase of B urn Injury (0-48 /Resuscitative Period) A. A ssessm ent 1. 2. 3. 4. 5. 6. Gordon's Functional H ealth Patterns collaborative data h istory / ph ysical assessm ent clinical m anifestations laboratory/radiograph ic respiratory a. b. c. d. e. direct airw ay injury carbon m onoxide poisoning th erm al sm oke poisoning pulm onary fluid overload (esch arotom y)

o

C LA S S C O N T EN T I. Path oph ysiology of B urn Injury A. Integum entary Ch anges Resulting from B urn Injury 1. 2. 3. 4. 5. 6. 7. 8. B. 1. 2. C. D. E. F. G. H. anatom ic functional tem perature/depth superficial thickness partial th ickness superficial partial th ickness deep partial th ickness full th ickness deep full th ickness

T EA C H IN G S T R A T EGY A ssigned Reading Lecture H andouts Case studies Pow er Point Presentation Linkages: connecting new content to prior learning Concept M apping Revisiting, Review , Repetition Role Playing Clinical Sim ulation D iscussion

V ascular Ch anges Resulting from B urn Injuries fluid sh ift fluid rem obilization

Cardiac Function Ch anges Resulting from B urn Injury Pulm onary Ch anges Resulting from B urn Injury GI Ch anges M etabolic Im m unologic Com pensatory Responses 1. 2. inflam m atory SNS

II.

Etiology of B urn Injury A. B. D ry/M oist/Contact/Ch em ical/Electrical/Radiation Incidence/Prevalence Internet & Library Resources

III.

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

IV.

Legal / Eth ical Issues

cardiovascular renal/urinary integum entary a. b. TB S A Rule of N ines

10. gastroinestinal

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH COMPLEX BURN INJURIES PAGE 2 OF 4

CLA S S O B J EC T IV ES B. A nalysis 1. Com m on N A N D A a. b. c. d. e. 2. C. decreased cardiac output fluid volum e deficit ineffective tissue perfusion ineffective breathing patterns acute/ch ronic pain C LA S S C O N T EN T T EA C H IN G S T R A T EGY

Prim ary Collaborative Problem s

Planning (N O C) Expected O utcom es for D ecreased Cardiac O utput, D eficient Fluid V olum e, and Ineffective T issue Perfusion 1. 2. 3. 4. 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 th erapy plasm a exch ange drug th erapy fluid m onitoring fluid m anagem ent 1) S urgical a. b. 3. esch arotom y fasciotom y 24 form ulas

o

D.

Im plem entation (N IC) 1.

Collaborative M anagem ent (m edical services, surgical services, nutritional support, ph ysical th erapy, occupational th erapy, speech th erapy, respiratory th erapy, pain m anagem ent, disch arge planning, reh ab., h om e care, social services, com m unity resources)

E.

N ursing A ctions/Responsibilities 1. Evaluation of N O C

V I.

Potential for Pulm onary Edem a/A RD S A. Ineffective B reath ing Patterns 1. 2. 3. 4. B. 1. 2. 3. 4. C. 1. A cute pain / ch ronic pain A nxiety reduction Potential for acute respiratory distress Potential pulm onary edem a PaO 2 PaCO 2 arterial pH W N L free of com plications of A RD S/pulm onary edem a N on-S urgical M anagem ent a. b. c. d. e. f. g. h. 2. a. b. c. d. airw ay m aintenance prom otion of ventilation m onitoring gas exch ange oxygen th erapy/ventilator/A RD S drug th erapy positioning and deep breath ing com plem entary and alternative th erapy environm ental m anipulation ch est tubes trach eostom y debridem ent anesth esia

Planning N O C Expected O utcom es

N ursing Interventions

S urgical M anagem ent

C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH COMPLEX BURN INJURIES PAGE 3 OF 4

CLA S S O B J EC T IV ES D. Evaluation: N O C 1. 2. V II. reported pain is alleviated/reduced A B G's W N L

o o

C LA S S C O N T EN T

T EA C H IN G S T R A T EGY

A dvanced N ursing Care in th e A cute Ph ase of B urn Injury (48 - 72 and beyond) A. A ssessm ent 1. 2. 3. 4. B. 1. 2. 3. 4. 5. C. 1. 2. D. 1. neuroendocrine im m unologic m usculoskeletal infectious agents im paired skin integrity risk for infection nutrition im paired m obility disturbed body im age no furth er skin loss restored skin integrity N on-surgical m anagem ent a. b. c. d. 2. a. b. E. m ech anical/enzym atic debridem ent standard w ound dressings biologic dressings synth etic dressings surgical excision w ound covering

N AN D A

Planning/N O C

Im plem entation

S urgical m anagem ent

Evaluation of N O C

V III. Care of th e B urn Patient at H igh Risk for Infection A. B. N AN D A 1. 1. C. N IC 1. N on-surgical a. b. c. d. e. 2. D. a. drug th erapy isolation th erapy environm ental m anipulation secondary prevention early detection surgical excision Risk for infection Patient to rem ain free of infection by cross contam ination and not experience septicem ia NOC

S urgical m anagem ent

Evaluation

C ontinues on next pa ge . . .

REVISED: 08/09

NURSING IV - COURSE OUTLINE MEDICAL /SURGICAL COMPONENT

UNIT 12: CARE OF THE PATIENT WITH COMPLEX BURN INJURIES PAGE 4 OF 4

CLA S S O B J EC T IV ES IX . C LA S S C O N T EN T Care of th e B urn Patient w ith Im balanced N utrition: Less Th an B ody Requirem ents A. N AN D A 1. 2. B. 1. 2. 3. C. N IC 1. 2. 3. 4. 5. D. X. Calculation of patient's current daily m etabolic needs and requirem ents H igh caloric/h igh protein Enteral feedings Positioning/RO M /am bulation/pressure dressings assist patients w ith body im age disturbance/ decision m aking/independent activities Evaluation of N O C Im paired ph ysical m obility D isturbed body im age Evidence of m aintenance of norm al body w eigh t S erum alb. W N L Tissue h ealing T EA C H IN G S T R A T EGY

NOC

A dvanced N ursing Care/Concepts: Rehabilitative Ph ase of B urn Injury A. N AN D A 1. 2. B. N IC 1. 2. 3. 4. 5. C. norm alization prom otion self aw areness enh ancem ent electrolyte m anagem ent skin surveillance skin care: topical treatm ents body im age self care

Evaluation (N O C)

REVISED: 08/09

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