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FIRELANDS REGIONAL MEDICAL CENTER SCHOOL OF NURSING Sandusky, Ohio

COURSE OUTLINE

MEDICAL SURGICAL NURSING ADVANCED CONCEPTS

Fast LANE LPN to RN Program

January 2009

TIME ALLOTMENT:

84 16 64 164 8

Theory Hours Lab Hours Clinical Hours Total Hours Credit Hours

PLACEMENT:

Second Level Winter/Spring Semester

TEACHING PERSONNEL:

Joli B. Reising, MSN, MEd, RN, CNS, Course Coordinator Erin E. Nesbit, BSN, RN

COURSE OBJECTIVES: At the conclusion of the course, the student will be able to: 1. Formulate written care maps to demonstrate the pathophysiological alterations in adult patients with medical -surgical problems. (3,5,6)* 2. Select physical assessment priorities based on individual client needs. (1,2,6)* 3. Provide quality, patient-centered care in an organized, safe manner. (1,2,4,5,6)* 4. Utilize therapeutic communication and interpersonal skills in the interactions with clients, families, and members of the health team. (2,3,4,6)* 5. Develop a comprehensive health education plan based on the nursing process. (1,2,3,4,5,6)* 6. Generate holistic, patient-centered plans of care utilizing the nursing process. (1,4,5)* 7. Classify the achievement of clinical competencies through weekly self-evaluation. (1,2,3,7)* COURSE OVERVIEW: This course focuses on assessment and nursing care of the adult client with endocrine, gastrointestinal, renal, integumentary, neurological, musculoskeletal, respiratory, hematologic, liver, immune, reproductive, sensory disorders and cancer. Theory presented addresses patient and family education needs, community resources, diet therapy, pharmacotherapy and gerontological considerations. The course builds upon medical surgical concepts learned in LPN e ducation. Students use critical thinking and the nursing process in the care of adult clients in a variety of clinical settings. The course is offered in the spring semester. This course is taken in the second level. Prerequisite: Nursing Access

* Second Level Objectives

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TEXTBOOKS: REQUIRED: th Assessment Technologies Institute; LLC. (2007). Pharmacology for nursing (5 ed.). Overland Park, KS: ATI. th Assessment Technologies Institute; LLC. (2007). Adult medical-surgical nursing RN edition (8 ed.). Overland Park, KS: ATI. Doenges, M., Moorhouse, M., & Murr, A. (2008). Nurse's pocket guide: Diagnoses, interventions, and rationales (11th ed). Philadelphia: Davis. Hodgson, B. & Kizior, R. (2009). Saunders nursing drug handbook 2009. St. Louis: Saunders. th Lewis, S., Heitkemper, M., Dirksen, S., O'Brien, P., & Bucher, L. (2007). Medical-surgical nursing assessment and management of clinical problems (7 ed.). St. Louis: Mosby. th Pickar, G. (2007). Dosage calculations (8 ed.). Albany, NY: Delmar. RECOMMENDED: Malarkey, L. & McMorrow, M. (2005). Nursing guide to laboratory and diagnostic tests. St. Louis: Saunders.

TEACHING METHODS: Assigned readings Lecture In-class exercises Group discussion Presentations Guest Speakers Power Point, Videos, Smart Board Demonstrations and psychomotor practice Critical thinking exercises Clinical experiences Clinical conferences Written clinical assignments

METHODS OF STUDENT EVALUATION: Quizzes Unit Tests Comprehensive Final Examination Comprehensive Diabetic Interview and Health Teaching Project Weekly and Final Evaluation of Clinical Performance Tool Observation of Clinical Performance Care Plans and Care Maps Written Clinical Reports Presentations Student/Instructor Conferences

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REFERENCES: Adams, M., Holland, L., & Bostwick, P. (2008). Pharmacology for nurses, a pathophysiologic approach. (2 ed.). New Jersey: Pearson Prentice Hall. th Black, J., & Hawkes, J. (2005). Medical surgical nursing: Clinical management for positive outcomes (7 ed.). St. Louis: Elsevier Saunders. th Dudek, S. (2006). Nutrition essentials for nursing practice (5 ed.). New York: LWW. Ebersole, P., Hess, P., Touhy, T., & Jett, K. (2005). Gerontological nursing & healthy aging. (2nd ed.). St. Louis: Mosby. th Gulanick, M. & Myers, J. (2007). Nursing care plans; Nursing diagnosis and intervention. (6 ed.). St. Louis: Mosby. rd Huether, S. & McCance, K. (2004). Understanding pathophysiology (3 ed.). St. Louis: Mosby. th Ignatavicius, D. & Workman, M. (2006). Medical surgical nursing critical thinking for collaborative care (5 ed.). Philadelphia: Saunders. th Jarvis, C. (2004). Physical examination & health assessment (4 ed.). St. Louis: Saunders. LeMone, P., & Burke, K. (2008). Medical-surgical nursing critical thinking in client care. (4th ed.). New Jersey: Pearson Prentice Hall. Lilley, L., Harrington, S. & Snyder, J. (2005). Pharmacology and the nursing process (4th ed.). St. Louis: Mosby. th Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K.( 2008). Brunner & Suddarth's textbook of medical-surgical nursing. (11 ed.). New York: LWW. th Smith, S., Duell, D. & Martin, B. (2008). Clinical nursing skills: Basic to advanced skills (7 ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Swearingen, P. (2007). Manual of medical-surgical nursing care; Nursing interventions and collaborative management. (6th ed). St. Louis: Mosby.

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PERIODICALS: Advance for Nurse Practitioners American Journal of Nursing AORN Journal Diabetes Forecast Geriatric Nursing hivplus Nurse Practitioner Nursing Nursing Research Orthopedic Nursing Patient Care RN

WEB: Several Internet resources are available at the end of each chapter in Lewis's Medical Surgical textbook plus additional resources are at the website for the text at http://evolve.elsevier.com/Lewis/medsurg.

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COURSE OUTLINE UNIT OBJECTIVES CONTENT INTRODUCTION AND OVERVIEW OF COURSE (2 hours) A. B. C. D. Welcome Overview Course Outline Course Calendar Review Course Orientation Document 1. Assignments 2. Quizzes/tests 3. Grading Scale 4. Attendance 5. Classroom 6. Clinical Review Student Handbook Sections 1. Plagiarism Statement 2. Attendance Policy and Student Accountability flowchart 3. Academic Policies 4. Testing Policies 5. Confidentiality 6. Course Document Receipt Signed Current CPR, Health Insurance, and Liability Verification Clinical Schedule 1. Evaluation of Clinical Performance Tool 2. Nursing Process Study 3. Criteria for Satisfactory NCP 4. Criteria for Care Map 5. Diabetic Patient Education 6. Evidence Based Nursing Practice Presentation FRMC Student Orientation 1. FRMC Vision Statement 2. Electrical, Fire, Back Safety 3. Infection Control 4. Emergency Codes 5. Hazardous Materials 6. Security, Parking, Smoking, Lost & Found, Personal Phone Calls 7. Confidentiality, Guest Relations 8. Variance Reporting 9. Student Orientation Form Signed

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RELATED LEARNING EXPERIENCES

Verbalize expectations and requirements for successful completion of the course.

Handouts: Course Orientation Course Outline Student Accountability Flow Sheet Student Code of Conduct Policy Firelands Regional Medical Center (FRMC) - Student Orientation Guidelines for Administration of Medications Nursing Students Clinical Experience Policy Guidelines for Comprehensive Care Flow Sheet

E.

F. G.

Handouts: Course Calendar and clinical schedule Evaluation of Clinical Performance Tool Nursing Process Study Guidelines for satisfactory Care Map and Care Plan Diabetic Education Project EB Nursing Practice Presentation Guidelines FRMC Orientation Packet and checklist

H.

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES CONTENT FRMC Documentation 1. Meditech Orientation 2. Meditech Competency J. FRMC Medication Administration 1. Guidelines 2. MAR 3. The 6 Rights 4. IV Medication Guidelines K. Competency Guidelines 1. Ng Insertion 2. Urinary Catheter Insertion 3. Blood Glucose testing 4. Sterile Asepsis, Surgical Wet-to-Dry Dressing 5. Trach Care 6. IV Calculations 7. Braden Scale 8. Venous Thromboembolism Risk Assessment 9. Falls Risk Assessment, etc. L. Surgery Orientation ­ Dress/Scrub/lab coats I. RELATED LEARNING EXPERIENCES

Video: Reducing Medication Errors Drug Abbreviation Handout, "Do Not Use"

Nursing Skills Lab: Review of Competencies ATI DVD ­ Basic Nursing Skills Intranet Nursing Competencies

Tour of the Surgery Department

UNIT I - PERIOPERATIVE NURSING (4 hours) A. B. Perioperative Nursing Review Surgical Procedures 1. Types of Surgery 2. Degree of Risk 3. Extent 4. Purpose 5. Anatomical Site 6. Timing or Physical Setting Special Considerations for the Patient having Surgery 1. The Psychological Response 2. Informed Consent 3. Do-Not-Resuscitate Orders 4. The Sociological Response Read: Lewis Ch. 18 (Preop) pg 343-358 Ch. 19 (Intraop) pg 359-375 Ch. 20 (Postop) pg 376-396 Ch. 10 (Pain) pg 125-150 Ch. 67 (Shock) pg 1772-1794 Review corresponding ATI material

Describe the preoperative phase as a component of the surgical experience. (1,2,3)* Identify the common purposes and settings of surgeries. (1,4)*

C.

Clinical Assignment: Care of a Surgical Patient: Preop, Periop and Postop Video: This Is Perioperative Nursing

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES Discuss the components of the preoperative patient assessment and identification of surgical risks. (2)* D. CONTENT Nursing Management 1. Assessment a. Subjective Data b. Objective Data c. Surgical Risk 2. Nursing Diagnosis 3. Expected Patient Outcomes 4. Interventions a. Patient/Family Education b. Promoting Psychological Comfort c. Use of Medications d. Minimizing the Potential for Respiratory Complication e. Minimizing the Potential for Deep Vein Thrombosis f. Minimizing the Potential for Postoperative Wound Infection g. Promoting Rest and Sleep h. Final Preparations for Surgery i. Preoperative Checklist 5. Evaluation 6. Documentation Intraoperative Phase Intraoperative Patient Care Team 1. Primary Surgeon and Assistants 2. Scrub Nurse 3. Circulating Nurse 4. Anesthesiologist 5. Other Infection Control 1. Basic Rules of Surgical Asepsis 2. Infection Control Practices for Operating Room Personnel 3. Surgical Attire 4. Standard Precautions 5. Surgical Scrub 6. Patient Skin Preparation

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RELATED LEARNING EXPERIENCES Handouts: DNR Orders, Informed Consent

Describe the nursing role in the physical, psychological, and educational preparation of the surgical patient. (1,3,6)* Identify the purposes and types of preoperative medications. (3)*

Discuss final preparations for the preoperative patient. (1,2,6)*

Handouts: Preop Checklist; Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery

Describe the roles of each member of the surgical health care team. (1,2,3)*

E. F.

Discuss the three different areas of the surgery department and the proper attire for each. (3)* Discuss the significance of aseptic technique. (3)*

G.

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES Differentiate between general, regional and local anesthesia. (1,2)* Discuss nursing interventions to minimize intraoperative risks. (2,3,4,6,7)* I. CONTENT Anesthesia 1. Preoperative Medication 2. Types of Anesthesia 3. Monitoring the Patient 4. Anesthesia Complications Other Considerations 1. Latex Allergy 2. Gerontological Considerations 3. Herbal Medications Immediate Postanesthesia Care Nursing Management 1. Assessment a. Respiratory b. Cardiovascular status c. Thermoregulation d. Fluid and electrolyte imbalance e. Gastrointestinal disturbances f. Neurological/psychological status g. Urinary status h. Integumentary Pain Management 1. Etiology 2. Pain Assessment 3. Collaborative Care Management a. Pharmacological approaches b. Nonpharmacological approaches 4. Nursing Management Shock 1. Classification of Shock 2. Stages of Shock 3. Collaborative Care Management 4. Nursing Care Management RELATED LEARNING EXPERIENCES Handout: JCAHO Sentinel Event Alert Issue 32 ­ Preventing & Managing the Impact of Anesthesia Awareness Case Study: Malignant Hyperthermia

H.

Describe the intraoperative and postoperative phase as a component of the surgical experience. (1,2)* Discuss postoperative patient assessment. (1,3)* Discuss the patient's risk factors for potential postoperative complication. (1,3)* Describe nursing interventions to prevent or treat postoperative complications. (2,3,4,7)*

J. K.

Handouts: Routine Post-op Care, Immediate Post-op Assessment

L. Describe pharmacological and nonpharmacological approaches for pain management. (1,2,3,7)*

Handout: Acute Pain Management In Adults: Operative Procedures, Pain Scales, "The Pain Experience" Case Study: pg 148. On-Q Pain Buster Review Handout: Multisystem effects of shock

Explain early and late pathophysiological changes that occur with shock. (1,2)* M. Compare the collaborative care, drug therapy, and nursing management of patients with the manifestations of shock. (1)*

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT II - ALTERATIONS IN FLUIDS AND ELECTROLYTES (4 hours) Compare the causes, effects, and care of the client with fluid volume deficit and fluid volume excess. (1,2,3,7)* Identify information and physical examination data essential to the assessment of fluid, and electrolyte status. (1,2,4)* Recognize normal values, as well as values representing a deficit or excess, of electrolytes in the blood. (1,2)* Use the nursing process as a framework to provide individualized care to clients with fluid and electrolyte disorders. (2,3,7)* Provide teaching about diet and medications used to treat or prevent electrolyte disorders. (1,2,3,4,5,6,7)* Describe the steps in preparing an IV bag for administration and hanging a secondary IV. (1,5)* Calculate IV infusion time and volume. (5)* A. Fluid Volume Disorders 1. Overview of Fluid Balance in the Body 2. Patient assessment of fluid and electrolytes 3. The Patient with Fluid Volume Deficit 4. The Patient with Fluid Volume Excess B. Electrolyte Disorders 1. Sodium Imbalances 2. Potassium Imbalances 3. Calcium Imbalances 4. Phosphorus Imbalances 5. Magnesium Imbalances C. Collaborative Care Management D. Nursing Care Management E. IV Therapy 1. IV solutions, equipment, and calculations a. Solution components, strength, and additives b. Monitoring IVs c. Primary and Secondary IVs 2. Administering Intravenous Therapy a. Changing IV solution and tubing b. Monitoring IV site and infusion c. Changing an IV dressing d. Capping primary line for intermittent use 3. Regulating IV flow rate a. Electronically regulated IVs b. Manually regulated IVs c. Calculating flow rates Read: Lewis Ch. 17 (Fluid/Elec) pg 314-341 Pikar (Math) Ch. 15 pg 355-402 Review corresponding ATI material RELATED LEARNING EXPERIENCES

Clinical Assignment: Care of a Patient with a Fluid and Electrolyte Disorders Handout: Fluid and Electrolytes Chart

Handout: IV Medication Calculations IV Handouts IV fluid demonstration Nursing Skills Lab: Case Studies

Clinical Assignment: Care of the Patient receiving IV fluid therapy.

UNIT I & II TEST

*Course Objectives

9

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT III- ENDOCRINE DYSFUNCTION (10 hours) Explain the normal physiology of insulin and the hormonal regulation of blood glucose levels. (1)* Identify information and physical examination data essential to the assessment of patients with diabetes mellitus. (1,2)* Contrast Type 1 and Type 2 diabetes; the differences in DKA and HNKC; and hyperglycemia and hypoglycemia. (1,2)* A. Overview of diabetes mellitus (DM) B. Pathophysiology 1. Type 1 diabetes mellitus a. Manifestations b. Diabetic ketoacidosis (DKA) 2. Type 2 diabetes mellitus a. Manifestations b. Hyperosmolar nonketotic coma (HNKC) 3. Complications of diabetes mellitus a. Alterations in blood glucose levels 1) Hyperglycemia 2) Hypoglycemia b. Alterations in the vascular system 1) Microvascular 2) Macrovascular C. Collaborative Management 1. Laboratory and diagnostic tests a. Tests to monitor diabetes management b. Monitoring blood glucose 1) Urine testing for ketones and glucose 2) Self-monitoring of blood glucose 2. Pharmacology a. Insulin b. Oral antidiabetic agents 3. Medical nutrition therapy 4. Exercise Management 5. Acute complication a. Treatment of hypoglycemia (insulin reaction) b. Treatment of diabetic ketoacidosis c. Treatment of hyperosmolar nonketotic coma (HNKC) 6. Management of Pressure ulcers D. Review of the endocrine system anatomy and physiology E. Assessment of endocrine function 1. The physical assessment interview

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RELATED LEARNING EXPERIENCES

Read:

Lewis Ch. 48 (Assessment) pg 1234-1252 Ch. 49 (Diabetes) pg 1253-1289 Ch. 50 (Endocrine) pg 1290-1322 Review corresponding ATI material

Clinical Assignment: Care of the client with diabetes. Handouts: FRMC Diabetic Flow Sheet FRMC Diabetic Flow Sheet Guidelines FRMC Hypoglycemic Reactions ­ Protocol FRMC Hypoglycemia Card Various Diabetic Patient Education pamphlets and booklets, BMI calculator, etc

Identify the laboratory and diagnostic tests used to diagnose and monitor self-management of diabetes mellitus. (1)* Perform capillary blood glucose monitoring. (2,3,)* Describe the role of nutrition in the management of diabetes. (1,2,7)* Perform a physical and psychosocial assessment of a diabetic patient. (1,2,4,)* Explain the collaborative care and nursing management of the patient with acute and chronic complications of diabetes. (2,4,7)* Implement a health teaching project for a selected diabetic patient. (1,2,3,4,5,6,7)*

Nursing Skills Lab: Blood Glucose Monitoring & practice with Diabetes Conversation Maps, Case senerios with hypo/hyperglycemia. Guest Lecturer: Dietician - Counting Carbs Written Assignment : Develop an 1800 calorie diabetic diet plan for 1-day Written Assignment: Diabetic Client Interview, Assessment, Correlation and Teaching Project; Utilize Foot-Screening Monofilament

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES Describe techniques for physical assessment of endocrine function. (1,2)* CONTENT 2. The physical assessment 3. Variations in assessment findings for the older adult F. Disorders of the thyroid gland 1. The client with hyperthyroidism a. Pathophysiology and Manifestations 1) Graves' disease 2) Toxic nodular goiter 3) Thyroid crisis 4) Excess TSH stimulation 5) Thyroiditis b. Collaborative Care Management c. Nursing Care Management 2. The client with hypothyroidism a. Pathophysiology 1) Iodine deficiency 2) Hashimoto's thyroiditis 3) Myxedema coma b. Collaborative Care Management c. Nursing Care Management G. Disorders of the parathyroid gland 1. The client with hyperparathyroidism 2. The client with hypoparathyroidism H. Disorders of the adrenal gland 1. The client with adrenal cortex hyperfunction 2. The client with adrenal cortex hypofunction a. Addison's disease b. Addisonian crisis 3. The client with hyperfunction of the adrenal medulla: pheochromocytoma I. Disorders of the pituitary gland 1. The client with a disorder of the anterior pituitary a. Giantism b. Acromegaly 2. The client with a disorder of the posterior pituitary a. Syndrome of inappropriate ADH secretion (SIADH) b. Diabetes insipidus RELATED LEARNING EXPERIENCES Clinical Assignment: Care of the client with an endocrine disorder.

Discuss the nursing implications for medications prescribed for the client with a disorder of the thyroid gland. (3)* Contrast the pathophysiology of hypothyroidism and hyperthyroidism, and hypo/ hyperparathyroidism. (1)* Summarize the nursing implications for medications prescribed for the patient with hypothyroidism. (3)*

Handout: Overview chart on endocrine system and pictorial memory aids.

Describe the clinical manifestations, collaborative care and nursing management of the various endocrine disorders.

Case Study: Adrenal Crisis

Contrast the pathophysiology and etiology of adrenal gland hypofunction and hyperfunction. (1)*

Contrast the pathophysiology and etiology of hypopituitarism with hyperpituitarism. (1)*

UNIT III TEST

*Course Objectives

11

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT IV - URINARY, RENAL & HTN NURSING (6 hours) A. Review of anatomy and physiology B. Assessment of urinary function 1. The health assessment interview 2. The physical assessment 3. Variations in assessment findings for the older adult 4. Diagnostic studies C. The client with an infectious & inflammatory disorder 1. Pyelonephritis 2. UTI 3. Cystitis 4. Urethritis D. The client with obstructive disorders 1. Bladder Cancer 2. Ureteral Tumors 3. Urinary Calculi 4. Urinary Reflux E. The client with voiding disorders 1. Urinary Retention 2. Urinary Incontinence 3. Neurogenic Bladder F. The client with immunologic kidney disorders G. The client with renal trauma H. The client with renal cancer I. The client with a vascular disorder of the kidney J. The client with acute renal failure 1. Collaborative care management 2. Nursing care management K. The client with chronic renal failure 1. Collaborative care management 2. Nursing care management L. The client on dialysis. M. The client wit h a transplant N. Care of the Client with Hypertension RELATED LEARNING EXPERIENCES

Describe the functions of the urinary and renal system. (1)* Differentiate normal from common abnormal findings of a physical assessment of the urinary and renal system. (2)* Identify laboratory and diagnostic tests used to diagnose disorders affecting the urinary and renal systems. (1,2,)* Contrast the manifestations of common disorders of the urinary tract and kidney. (1,2)* Use the nursing process as a framework for providing individualized care to clients with disorders of the urinary tract and kidney. (2,3,4,7)* Identify specific dietary modifications prescribed for clients with renal disorders. (1)*

Read:

Lewis Ch. 45 (Assessment) pg 1136-1153 Ch. 46 (Renal) pg 1154-1196 Ch. 47 (Acute/Chronic) pg 1197-1232 Ch. 33 (HTN) pg 761-783 Review corresponding ATI material

Clinical Assignment: Care of the patient with a urinary or renal disorder.

Handout: Tips for Coping with Bladder Control Loss Sample visuals for urethral stents

Discuss the nursing implications for a client undergoing dialysis or transplantation. (2,3,7)* Describe the pathophysiology, etiology, incidence, and prevention of hypertension. (1)* Use the nursing process as a framework for providing individualized care to clients with hypertension. (2,3,4,7)*

Guest Lecturer: Life Banc

Guest Lecturer: Laura L. Manzey, PharmD - Hypertensive Drugs UNIT IV TEST

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT V - MUSCULOSKELETAL NURSING (7 hours) A. B. C. D. E. Review of Anatomy and Physiology Musculoskeletal Assessment Review Variations in the older adult. Diagnostic tests Nursing management of the client with musculoskeletal trauma and orthopedic surgery 1. Sprains and strains 2. Dislocation and subluxation 3. Repetitive strain injury 4. Carpal tunnel syndrome 5. Rotator cuff injury 6. Meniscus injury 7. Fractures 8. Amputation F. Nursing management of the client with musculoskeletal surgery G. Nursing management of the client with joint surgery H. Nursing management of the client with 1. Osteomyelitis 2. Bone cancer 3. Low back pain I. Metabolic bone diseases 1. Osteomalacia 2. Osteoporosis 3. Paget's disease J. Arthritis and connective tissue disorders 1. Osteoarthritis and Rheumatoid arthritis 2. Spondyloarthropathies 3. Psoriatic Arthritis 4. Reactive arthritis (Reiter's syndrome) 5. Lyme disease 6. Systemic lupus erythematosus 7. Systemic sclerosis (scleroderma) 8. Polymyositis & Dermatomyositis 9. Sjorgrens 10. Fibromyalgia syndrome, Chronic Fatigue syndrome

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RELATED LEARNING EXPERIENCES

Contrast the structure and function of the different tissues that compose the musculoskeletal system. (1)* Relate components of the nursing assessment of the musculoskeletal system. (2)* Correlate the diagnostic tests indicated for the person with a musculoskeletal problem. (1)* Explain the nursing role in the management of musculoskeletal trauma, surgery, and prevention of complications. (3,6,7)* Identify preoperative and postoperative management of the patient having joint replacement surgery. (1,2,6)* Describe the nursing and collaborative care management of persons with osteomalacia, osteoporosis and Paget's disease. (1,2,6)* Relate the pathophysiology and clinical manifestations of degenerative disease of the spine with the medical, surgical, and nursing management of persons who have degenerative disease of the spine. (1,2,)* Contrast the etiology/epidemiology, pathophysiology, and clinical manifestations of rheumatoid arthritis and osteoarthritis. (1,2)* Describe the medical, surgical, and nursing management of persons who have various arthritis and connective tissue disorders. (1,2,3,4,6,7)*

Read:

Lewis Ch. 62 (Assessment) pg 1614-1628 Ch. 63 (Trauma/Surgery) pg 1629-1667 Ch. 64 (Problems) pg 1668-1692 Ch. 65 (Arthritis) pg 1693-1731 Review corresponding ATI material

Clinical Assignment: Care of the patient with a musculoskeletal disorder. Observation of surgical repair of a client with an orthopedic disorder. In class viewing of X-rays and review of surgical equipment

In class Risk Factors for Osteoporosis

Video: Arthoscopic ACL Repair

Various bone and joint models for viewing.

UNIT V TEST

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT VI - RESPIRATORY NURSING (6 hours) Describe the respiratory system's primary function of gas exchange. (1)* Identify subjective and objective data to obtain a complete respiratory assessment. (2)* Describe diagnostic tests and related nursing care commonly used to evaluate respiratory conditions. (2,3,4,6,7)* Compare the etiology, pathophysiology, clinical manifestations, and management of the patient with rhinitis, sinusitis, and influenza. (1,2,3,4,6,7)* Describe the nursing care of the patient after nasal surgery. (1,2,3,4,6,7)* Contrast the nursing care of the patient after a partial laryngectomy and after a total laryngectomy with radical neck dissection. (1,2,3,4,6,7)* Describe incidence, preventive measures, and treatment of infections of the respiratory tract. (1)* Describe incidence, prevention, and therapy for lung cancer. (1)* Explain the pathophysiology of asthma, chronic bronchitis and pulmonary emphysema. (1)* Discuss clinical manifestations and treatment of respiratory failure. (1,2)* A. Review of Respiratory Anatomy and Physiology B. Assessment Review of Respiratory Status 1. Health assessment interview 2. Physical assessment 3. Variations in the older adult C. Diagnostic Tests D. Infections, Obstruction, Trauma and Carcinoma of the Nose and Sinuses 1. Rhinitis 2. Sinusitis 3. Influenza 4. Polyps 5. Nursing Management of the Patient Undergoing Surgery E. Sleep Apnea F. Carcinoma of the Oropharynx and Larynx G. Infectious Diseases of the Respiratory Tract 1. Acute Bronchitis 2. Pneumonia 3. Tuberculosis 4. Lung Abscess H. Environmental Lung Diseases I. Cancer of the Lung J. Chest Trauma K. Nursing Management of the Patient with Thoracic Surgery 1. Preoperative Care 2. Postoperative Care 3. Maintaining Chest Tube L. Interstitial Lung Disorders M. Pulmonary Embolism N. Obstructive Pulmonary Disease 1. Asthma 2. Chronic Bronchitis 3. Emphysema O. Respiratory Failure Read: Lewis Ch. 26 (Assessment) pg 509-532 Ch. 27 (Upper Airway) pg 533-559 Ch. 28 (Lower Airway) pg 560-606 Ch. 29 (Obstructive) pg 607-663 Review corresponding ATI material RELATED LEARNING EXPERIENCES

Clinical Assignment: Care for a Patient with a Respiratory Disorder

Review of reading a TB Skin Test In class review of ABG interpretation, review of suctioning, care of chest tubes, various trach tubes and trach care Nursing Skills Lab: Trach care and suctioning, Chest tube monitoring

Video: COPD Use of Inhalers and Peak Flow Meter

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT VII - NURSING CARE OF THE CLIENT WITH HEMATOLOGIC DISORDERS (4 hours) A. B. C. D. E. Review of the hematologic system Assessment of the hematologic system Variations in the older adult Diagnostic tests Red blood cell disorders 1. Overview of red blood cells 2. The client with anemia 3. The client with polycythemia F. Platelet and coagulation disorders 1. Overview of platelets and hemostasis 2. The client with thrombocytopenia a. Immune thrombocytopenia purpura (ITP) b. Thrombotic thrombocytopenia purpura (TTP) c. Heparin-induced (HITTS) d. Acquired thrombocytopenia 3. The client with disseminated intravascular coagulation G. Lymphoproliferative disorders 1. Overview of white blood cells 2. Overview of lymphoid tissues 3. The client with neutropenia 4. The client with myelodysplastic syndrome 5. The client with leukemia a. Pathophysiology and manifestations (1) Acute myelogenous leukemia (AML) (2) Chronic myelogenous leukemia (CML) (3) Acute lymphocytic leukemia (ALL) (4) Chronic lymphocytic leukemia (CLL) (5) Hairy cell leukemia b. Collaborative care management c. Nursing care management 6. The client with malignant lymphoma, Hodgkin's disease versus Non-Hodgkin's lymphoma 7. The client with multiple myeloma RELATED LEARNING EXPERIENCES

Describe the physiology of the hematologic system. (1)* Relate physiology and assessment of the hematologic, peripheral vascular, and lymphatic systems to commonly occurring hematologic disorders. (1,2)* Identify laboratory and diagnostic tests used to diagnose hematologic disorders. (1,2)* Discuss nursing implications for medications prescribed for the client with hematologic disorders. (1,2,3,5)* Discuss nursing implications for bone marrow transplantation, chemotherapy, and radiation for the client with a hematologic disorder. (1,2,3,5)* Compare and contrast bleeding disorders. (1)* Describe the major types of leukemia and the most common treatment modalities and nursing interventions. (1,2,3,4,5,6)*

Read:

Lewis Ch. 30 (Assessment) pg 665-683 Ch. 31 (Hematologic) pg 684-737 Review corresponding ATI material

Clinical Assignment: Care of a patient with a hematologic disorder

In-class viewing of Jamshidi® bone marrow biopsy and aspiration tray

DVD Series: RBC, WBC, and Platelets

Differentiate between Hodgkin's disease and nonHodgkin's lymphoma. (1)* Use the nursing process as a framework for providing individualized care to clients with hematologic disorders. (1,2,3,4,5,6)*

UNIT VI & VII TEST

*Course Objectives

15

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT VIII - CANCER AND IMMUNE NURSING (8 hours) A. Oncology overview 1. Terminology 2. Epidemiology 3. Pathophysiology a. Carcinogens b. Carcinogenesis c. Inability of immune to recognize cancer cells d. Genetics and cancer e. Benign versus malignant B. Care of the Client with Cancer 1. Prevention, screening, early detection 2. Nursing Assessment a. Risk factors ­ Noncontrollable and Controllable b. Clinical manifestations 3. Collaborative care a. Laboratory and diagnostic tests 1) Diagnosis and classification 2) Grading and staging 3) Tumor markers 4) Oncologic imaging 5) Direct visualization 6) Laboratory tests b. Surgery c. Radiation d. Chemotherapy 1) Classes of chemotherapeutic drugs 2) Summary of effects of chemotherapeutic drugs 3) Preparation and administration 4) Management of clients receiving chemotherapy e. Biologic therapy f. Bone marrow and stem cell transplantation g. Gene therapy 4. Nursing interventions for oncologic emergencies 5. Pain management 6. Complementary and alternative therapies RELATED LEARNING EXPERIENCES

Discuss the theories of carcinogenesis, known carcinogens, and risk factors for cancer. (1)* Compare the mechanisms and characteristics of normal cells with those of malignant cells. (1)* Describe the effects of cancer on the body. (1,2)*

Read:

Lewis Ch. 16 (Cancer) pg 271-313 Ch. 8 (Alternative) pg 94-109 (optional) Ch. 11 (End-of-life) pg 151-164 Ch. 14 (Immune) pg 213-242 Ch. 15 (HIV) pg 243-270 Review corresponding ATI material

Describe the role of the nurse in the prevention and detection of cancer. (1,2)*

Clinical Assignment: Care of a client with a diagnosis of cancer. Care of a client with an immune system disorder. Handouts: Men & Women Screening information Where to Find Help Chemotherapy and radiation information ABCD Danger Signs of Skin Cancer Tour of Cancer Center

Describe the laboratory and diagnostic tests used to diagnose cancer. (1)*

Discuss the use of surgery, radiation therapy, biotherapy, and bone marrow transplantation in the treatment of cancer. (1,2,3)* Discuss the role of chemotherapy in cancer treatment. (1,2,3)* Use the nursing process as a framework for providing individualized care to the client with cancer. (2,3,5,6)* Describe the nursing interventions required for oncologic emergencies. (2,3,4,5,6)* Explain pharmacologic and nonpharmacologic method of pain management. (3,6)*

Speaker: Nurse specialist in Oncology

*Course Objectives

16

COURSE OUTLINE UNIT OBJECTIVES Describe theories of loss, grief, and dying. (1)* Use the nursing process as a framework for providing individualized care to clients and their families experiencing loss, grief, or dying. (1,2,3,4,5,6)* Discuss some legal and ethical issues related to loss, grief, and dying. (4)* Discuss the components and functions of the immune system and the immune response. (1)* Describe the assessment of a client's immune status. (2,4)* Compare natural and acquired immunity and active and passive immunity. (1)* Describe the four types of hypersensitivity reactions. (1)* Identify laboratory and diagnostic tests used to diagnose and monitor immune response. (1,2,)* List the modes and variables involved in the transmission of HIV. (1)* Explain the characteristics of opportunistic diseases associated with AIDS. (1)* Use the nursing process as a framework to provide individualized care to clients with altered immune responses, and HIV infection. (1,2,3,4,5,6)* CONTENT C. Nursing Care of Clients Experiencing End-of-Life Issues 1. Physical manifestations at end-of-life 2. Psychosocial manifestations 3. Grief responses 4. Legal and ethical issues 5. Palliative care and Hospice 6. Care for the care-givers D. Overview of the immune system 1. Normal immune response 2. Altered immune response 3. Assessing the client's immune system 4. The client with a hypersensitivity reaction a. Type I Anaphylactic Reactions b. Type II Cytotoxic & Cytolytic Reactions c. Type III Immune-Complex Reactions d. Type IV Delayed Hypersensitivity Reactions 5. Human Leukocyte Antigen System 6. The client with autoimmune disorders 7. The client with immunodeficient disorders 8. Organ transplantation E. The client with HIV infection 1. Risk factors and transmission 2. Opportunistic infections e. Pneumocystis carinii pneumonia (PCP) f. Cryptococcal meningitis' g. Cytomegalovirus retinitis (CMV) h. Mycobacterium avium Complex (MAC) i. Other infections 3. Secondary cancers a. Kaposi's sarcoma (KS) b. Lymphomas c. Cervical cancer 4. AIDS dementia complex and neurologic effects 5. Collaborative care management 6. Nursing care management

17

RELATED LEARNING EXPERIENCES Booklet: FRMC Choices Living Well at the End of Life Tour: Hospice Clinical Assignment: Care of a client receiving Hospice care.

Speakers: Organ Donation Debates ­ End of Life issues and Organ Donation

Handouts for HIV/AIDS

"Philadelphia Story"

UNIT VIII TEST

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT IX - GASTROINTESTINAL, LIVER, BILIARY, AND PANCREATIC NURSING (8 hours) A. Review of anatomy and physiology B. Assessment review of digestion and nutritional status 1. The health assessment interview 2. The physical assessment 3. Variations in assessment findings for the older adult C. Diagnostic Tests D. Nutritional disorders 1. The client with malnutrition 2. The client with obesity 3. The client with nausea and vomiting E. Disorders of the mouth 1. The client with infection and inflammation of mouth 2. The client with oral cancer F. Disorders of the esophagus 1. The client with gastroesophageal reflux 2. The client with a hiatal hernia 3. The client with esophageal cancer 4. The client with esophageal diverticula 5. The client with esophageal strictures 6. The client with achalasia G. Disorders of the stomach and upper GI 1. The client with gastritis 2. The client with upper GI bleeding 3. The client with ulcers of the stomach and duodenum 4. The client with cancer of the stomach H. Disorders of intestinal motility 1. The client with diarrhea 2. The client with fecal incontinence 3. The client with constipation 4. The client with abdominal pain 5. The client with irritable bowel syndrome I. Acute inflammatory and infectious disorders 1. The client with appendicitis 2. The client with peritonitis 3. The client with gastroenteritis

18

RELATED LEARNING EXPERIENCES

Explain the normal anatomy and physiology of the digestive system and its accessory organs. (1)* Identify physical examination data essential to the assessment of gastrointestinal status. (2)* Identify laboratory and diagnostic tests used to diagnose problems of the GI system . (2)* Discuss the multiple etiologies, complications, and collaborative care approaches to the management of obesity and undernutrition. (1,2,6)* Describe the etiology, clinical manifestations, and treatment of common oral, esophageal and stomach disorders. (1,2)* Describe the etiology, clinical manifestations, complications, collaborative care, and nursing management of carcinoma of the oral cavity and esophagus. (1,2,3,7)* Use the nursing process to assess needs, plan and implement individualized care for the client with a gastric disorder. (6)* Relate the effects and manifestations of bowel disorders to normal physiology and assessment findings. (1,2)*

Read: Lewis Ch. 39 (Assessment) pg 926-947 Ch. 40 (Nutrition) pg 948-970 Ch. 41 (Obesity) pg 971-989 Ch. 42 (Upper GI) pg 990-1034 Ch. 43 (Lower GI) pg 1035-1086 Ch. 44 (Liver, Biliary, Pancreas) pg 1087-1134 Review corresponding ATI material Clinical Assignment: Care of a client with a GI disorder. In Class Viewing of X-ray, EGD, and Colonoscopy Studies Video: Laparoscopic Placement of Gastrostomy Feeding Tubes Video: Heartburn Sufferers: Stop Taking Chances

Describe the collaborative care and nursing management of acute appendicitis, peritonitis and gastroenteritis. (1,2,3,5)*

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES Compare and contrast ulcerative colitis and Crohn's disease. (1)* Identify laboratory and diagnostic tests used to diagnose disorders of the small and large bowel. (1)* Use the nursing process as a framework for providing individualized care to clients with disorders of the lower GI tract. (1,2,3,4,5,6)* Differentiate between diverticulosis and diverticulitis. (1)* J. CONTENT Inflammatory bowel disease 1. The client with ulcerative colitis 2. The client with Crohn's disease K. Neoplastic disorders 1. The client with polyps 2. The client with colorectal cancer L. Structural and obstructive disorders 1. The client with a hernia 2. The client with intestinal obstruction a. Small bowel obstruction b. Large bowel obstruction 3. The client with diverticular disease a. Diverticulosis b. Diverticulitis M. Anorectal disorders 1. The client with hemorrhoids 2. The client with anorectal lesion N. Liver Disorders 1. The client with jaundice 2. The client with hepatitis 3. The client with cirrhosis 4. The client with cancer of the liver O. Disorders of the Biliary Tract 1. The client with cholelithiasis and cholecystitis 2. The client with cancer of the gallbladder P. Exocrine pancreas disorders 1. The client with pancreatitis a. Acute pancreatitis b. Chronic pancreatitis 2. The client with pancreatic cancer UNIT IX TEST RELATED LEARNING EXPERIENCES

Video: Nursing Management of Patients with Colon Cancer

Discuss laboratory and diagnostic tests, including client preparation, used to diagnose disorders of the liver, biliary or pancreatic systems. (1,2)* Discuss nursing implications for dietary and pharmacologic interventions related to the liver, biliary or pancreatic systems. (1,2,3,4,5,6)* Use the nursing process as a framework for providing individualized care to clients with disorders of the liver, biliary tract or pancreatic system. (1,2,3,4,5,6)*

Handout: Hepatitis Chart

Video: Lap-Chole

*Course Objectives

19

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT X - NEUROLOGICAL NURSING (7 hours) A. Review of Neurologic Anatomy and Physiology B. Assessment review of neurological status 1. The health assessment interview 2. The physical assessment 3. Variations in assessment findings for the older adult C. Diagnostic Tests D. Management of Increased Intracranial Pressure E. Management of Head Injuries F. Brain Tumors G. Nursing management of the patient undergoing cranial surgery H. Inflammatory conditions of the brain 1. Meningitis ­ Bacterial and viral 2. Encephalitis 3. Rabies 4. Brain Abscess I. Nursing Management of Stroke J. Headache K. Seizure Disorders L. Management of Clients with Degenerative Disorders 1. Multiple Sclerosis 2. Parkinson's Disease 3. Myasthenia Gravis 4. Restless Legs Syndrome 5. Amyotrophic Lateral Sclerosis 6. Huntington's 7. Alzheimer's and Related Dementias (Creutzfeldt-Jakob Disease) M. Management of Clients with Peripheral Nervous System Disorders 1. Disorders of cranial nerves (Trigeminal Neuralgia & Bell's Palsy) 2. Polyneuropathies (Guillian-Barre Syndrome, Botulism, Tetanus) 3. Spinal cord injuries (Post polio Syndrome) RELATED LEARNING EXPERIENCES

Describe the techniques used in the physical assessment of the nervous system. (2)* Describe diagnostic procedures used to evaluate neurological disease. (1,2,)* Describe the collaborative and nursing management of the patient with increased intracranial pressure, head injuries, or undergoing cranial surgery. (1,2,3,4,7)* Differentiate between bacterial and viral meningitis. (1)* Explain the differences between ischemic and hemorrhagic stroke. (1)* Describe the acute nursing management of the patient with a stroke. (1,2,3,4,5)* Describe the etiology, clinical manifestations, diagnostic studies, collaborative care and nursing management of seizure disorders, and the various neurodegenerative disorders. (1,2,3,4,6)*

Read:

Lewis Ch. 56 (Assessment) pg 1441-1466 Ch. 57 (Acute) pg 1467-1501 Ch. 58 (Stroke) pg 1502-1526 Ch. 59 (Chronic) pg 1527-1560 Ch. 60 (Alzheimer) pg 1561-1579 Ch. 61 (Spinal) pg 1580-1613 Review corresponding ATI material

Clinical Assignment: Care for a client with a neurological disorder

Review Head CT scans for Ischemic versus Hemorrhage Stroke Review NIH Stroke Scale and Glasgow Coma Scale

Class Assignment: Student Presentations of clients with neurological disorders.

Compare and contrast different etiologies of dementia. (1)* Correlate the clinical manifestations of spinal cord injury with the level of disruption and rehabilitation potential. (1,2)*

Video: Living with Alzheimer's Disease

UNIT X TEST

*Course Objectives

20

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT XI - SENSORY NURSING (2 hours) Describe the structure and function of the eye and ear. (1,4)* Identify the normal physiological and anatomic ocular changes that occur with aging. (1)* Identify the subjective and objective data that should be obtained when assessing the eye and ear. (1,2,4,5)* Discuss the nursing interventions and patient teaching associated with common diagnostic tests. (1,2,3,4,5)* Discuss the etiologies of the common forms of visual impairment. (1)* Discuss the collaborative management of glaucoma. (1,2,3,4,5,6)* Compare the preoperative and postoperative care of patients undergoing surgery for cataracts and retinal detachment. (1,2,4)* Discuss behavioral cues to detect loss of hearing and balance. (1,2,4)* Compare the etiologies and assessment features of conductive and sensorineural hearing loss. (1,2)* Relate the signs and symptoms of Menière's disease and its underlying pathology. (1,2,4)* A. B. C. D. E. Review Anatomy and Physiology of the Eye and Ear Assessment Review of the Eye and Ear Variations in the Older Adult Diagnostic Studies Visual Problems 1. Correctable Refractive Errors a. Myopia b. Hyperopia c. Astigmatism d. Aphakia 2. Uncorrectable Visual Impairment 3. Collaborative care management 4. Nursing management of visual impairment F. Problems with the eyes 1. Eye trauma and injury 2. Infections and inflammation 3. Glaucoma 4. Cataracts 5. Retinal detachment 6. Eye tumors 7. Collaborative care management 8. Nursing management G. Hearing problems 1. Etiology/Epidemiology 2. Pathophysiology 3. Collaborative care management 4. Nursing management H. Problems with the Ear 1. Trauma of the ear 2. Infections of the ear 3. Acoustic neuroma 4. Menière's disease 5. Collaborative care management 6. Nursing management Read: Lewis Ch. 21 (Assessment) pg 398-415 Ch. 22 (Visual/Auditory) pg 416-448 Review corresponding ATI material RELATED LEARNING EXPERIENCES

Clinical Assignment: Care of the client with sensory disorders

In class view of altered vision posters. Review eye drop medication administration.

*Course Objectives

21

COURSE OUTLINE UNIT OBJECTIVES CONTENT UNIT XII - REPRODUCTIVE NURSING (4 hours) Describe the structures and functions of the male and female reproductive systems. (1,2)* Discuss assessment, diagnostic and laboratory tests used in identifying reproductive tract problems and related nursing interventions. (1,2,3,4,5)* Analyze the patient's risk factor profile for developing breast cancer. (2)* Identify the differences between benign breast conditions and breast cancer. (1,2)* Discuss the advantages and disadvantages of surgery, chemotherapy, radiotherapy, and hormonal therapy in the treatment of breast cancer. (2,4)* Discuss the etiologies of various disorders of menstruation. (1,2)* Discuss the collaborative management of common infectious diseases of the female reproductive tract. (2,4)* Compare nursing interventions indicated for the patient undergoing radiation therapy and chemotherapy for cancer of the female reproductive tract. (2,3)* Compare the preoperative and postoperative care provided to women undergoing structural repair of a cystocele or rectocele versus the care provided for hysterectomy. (1,2,3,4,5)* G. Describe the process of infectious diseases specific *Course Objectives F. A. B. C. D. E. Review Anatomy and Physiology of Reproductive System Assessment of Reproductive System Male and Female Physiological Changes with Aging Diagnostic Tests Management of clients with Breast Disorders 1. Benign breast disorders a. Mastalgia b. Breast infections c. Fibrocystic changes d. Male breast problems 2. Malignant Conditions of the Breast a. Etiology and risk factors b. Epidemiology c. Pathophysiology d. Collaborative care management e. Nursing care management Management of Women with Reproductive Problems 1. Disorders of menstruation 2. Conditions of the vulva, vagina and cervix a. Infections b. Pelvic inflammatory disease (PID) c. Endometriosis 3. Benign and malignant neoplasms of the female reproductive tract a. Leiomyomas b. Polyps c. Benign ovarian tumors d. Cervical cancer e. Endometrial cancer f. Ovarian cancer 4. Problems with Pelvic Support Management of Men with Reproductive Problems 1. Problems of the testes and related structures

22

RELATED LEARNING EXPERIENCES

Read:

Lewis Ch. 51 (Assessment) pg 1323-1342 Ch. 52 (Breast) pg 1343-1365 Ch. 54 (Female) pg 1381-1413 Ch. 55 (Male) pg 1414-1439 Ch. 53 (STD) pg 1366-1380 Review corresponding ATI material

Clinical Assignment: Care of a woman with a reproductive problem Class Assignment: Student Presentations of clients with reproductive disorders. Handout: Breast Self-Examination Nursing Skills Lab: Location and identification of lumps on breast model

Clinical Assignment: Care of a male patient with reproductive problem

COURSE OUTLINE UNIT OBJECTIVES to men's reproductive health. (1,4)* Demonstrate the correct technique for performance of testicular self-examination. (4)* Identify teaching strategies that promote the monthly practice of testicular self-examination. (1,5)* Identify teaching needs of the patient with impotence. (2,4)* Define sexually transmitted diseases (STD's) (1,4)* Describe the transmission, prevention, and control of STD's. (1,4)* CONTENT Problems of the prostate a. Prostatitis b. Benign prostatic hypertrophy (BPH) c. Cancer of the prostate Problems of the Penis RELATED LEARNING EXPERIENCES Handout: Testicular self-exam Testosterone questionnaire Nursing Skills Lab: Location and identification of lumps on testicle model

2.

3. H.

Management of Persons with Sexually Transmitted Diseases 1. Gonorrhea 2. Syphilis 3. Herpes genitalis 4. Chlamydial infection 5. Chancroid 6. Condylomata acuminata (genital warts) 7. Trichomoniasis 8. Other sexually transmitted diseases

Handout: STD Chart

ATI Test: Medical Surgical

FINAL EXAMINATION (2 HOURS)

*Course Objectives

23

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