fall semester 2012 - napavalley.edu

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NURSING IN HEALTH ALTERATIONS I

NURS 142

FALL SEMESTER 2012

ASSOCIATE DEGREE PROGRAM IN NURSING NURS 142 – NURSING IN HEALTH ALTERATIONS I

TABLE OF CONTENTS

Course Information

Course Description .............................................................................................. 1

Program Outcomes ............................................................................................. 4

Course Objectives .............................................................................................. 5

Calendar.............................................................................................................. 6

Health Promotion/Alterations

I. Immune/HIV ............................................................................................. 8

II. Cardiovascular ....................................................................................... 17

III. Musculoskeletal ..................................................................................... 21

IV. Endocrine/Metabolic Diabetes .............................................................. 26

Bibliography .................................................................................................................. 31

Clinical Evaluation Tool ................................................................................................. 32

Guidelines for Patient/Family Teaching Assignment ..................................................... 39

Process Recording Guidelines & Forms ........................................................................ 41

Nursing Care Plan Guidelines & Prep Forms ................................................................ 44

Seminars

1. HIV and Aids Client ................................................................................ 54

2. Comparison of the Effects of Chronicity Across the Lifespan ................. 55

3. Pediatric Health Promotion & Group Teach Project................................ 56

4. Care Planning for a Patient with Diabetes .............................................. 57

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Napa Valley College

Associate Degree Program in Nursing

COURSE NUMBER AND TITLE: NURS 142 Nursing in Health Alterations I

COURSE DESCRIPTION: Introduces theory and practice to provide care to adults and children with selected stable alterations in health. The nurse functions at the beginning level in the roles of provider and manger of care.

PREREQUISITES: Completion of program admission requirements as identified

in the college catalog and the Admission Information and

Application packet. NURS 141

NUMBER OF HOURS: Credit: 4 Units

Class: 8 hours/week

Clinical/Lab: 12 hours/week (Scheduled days, hours and

clinical settings may vary)

TEACHING METHODS: This class will be taught using lecture, small group

discussion, audiovisuals, reading, demonstrations, study

guides and case studies.

FACULTY CONTACT: Jan Whitmer

[email protected]

707-253-3144

EVALUATION: 1. 100% of grade: Unit tests and quizzes

2. To successfully complete this course, the student must

achieve a cumulative average of 75% on tests. In

addition, the student must turn in required assessments

and satisfactory nursing care plans weekly within the

stated time frame, and receive a satisfactory summative

clinical performance evaluation. Students must pass

seminars by showing evidence of preparation,

attendance, and participation.

SUPPLIES: Scantron Test Sheets #F-288-PAR-L

1 Stethoscope, 1 Bandage Scissor, 1 Kelly Clamp, 1 Pen light, 1 wrist watch with second hand

mailto:[email protected]

ADN HANDBOOK: Students are responsible for adhering to the program policies and

procedures found in the ADN Program Handbook. All questions related to the policies should be directed to the relevant faculty. Students sign a form acknowledging that he/she will abide by the handbook. The signed form is placed in the student’s file.

REQUIRED TEXT: E-BOOK OR PAPER: 2012-2014 ADN Student Handbook Syllabus, NURS 142 Fall 2012

Ackley, B. J., & Ladwig, G. B. (2011) Nursing Diagnosis Handbook: A Guide To Planning Care. (9th ed.). St. Louis: Mosby.

Ball, J.W., & Bindler, R. C. (2012). Principles of Pediatric Nursing: Caring For Children (5th ed.). New Jersey: Prentice-Hall

Castillo, S. (2010). Strategies, Techniques And Approaches To

Thinking. (4th ed.). Philadelphia: W.B. Saunders. Ebersole, O., & Hess, P. (2010). Geriatric Nursing & Healthy Aging.

(3rd ed.). St. Louis: Mosby Elkin, M. K., Perry, A. G., & Potter, P. A.(2012). Nursing Interventions And Clinical Skills. (5th ed.) St. Louis: Mosby.

Purnell, L.D., (2009). Guide To Culturally Competent Health Care. (2nd ed.). Philadelphia: F. A. Davis.

Hogstel, M. O., & Curry, L. C. (2005). Practical Guide To Health

Assessment Throughout The Lifespan. (4th. ed.) Philadelphia: F. A. Davis.

Lewis, S. M., Hertkemper, M., & Dirksen, S. R.(2011). Medical-

Surgical Nursing Assessment & Management Of Clinical Problems. (8th ed.) St. Louis: Mosby.

Ogden, S. J. . Calculation Of Drug Dosages. (9th ed.)St. Louis:

Mosby(2012)

Potter, P. A., & Perry, A. G.(2013). Fundamentals Of Nursing: (8th ed.). St. Louis: Mosby.

Mosby’s Nursing Video Skills 3.0, DVDs

Nursing Skills Online, course to accompany Fundamentals of Nursing

HESI RN Practice Tests and HESI Case Studies

DRUG REFERENCE OPTIONAL TEXTS: Deglin, J. H., & Vallerand, A. H. (2011). Davis drug guide for nurses.

(12th ed.). Philadelphia: F.A. Davis. Karch, A. M.. Lippincott’s nursing drug guide. Philadelphia: J. B.

Lippincott. Skidmore-Roth. Mosby’s nursing drug reference.. St. Louis: Mosby. LABORATORY AND

DIAGNOSTIC OPTIONAL TEXTS: Kee, J. (2010) Laboratory and diagnostic tests with nursing implications. (8th ed.). New Jersey: Prentice Hall.

Van Leeuwen, A.M.& Poelhuis-Leth (2010) Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications. (4th ed.). Philadelphia: F.A . Davis.

MISCELLANEOUS OPTIONAL TEXTS: Mosby,s medical, nursing, & allied health dictionary. 7th ed. (2006). St.Louis: Mosby. Myers, E. (2006). RNotes. (2nd ed.) Philadelphia: F.A. Davis. Thomas, C. L. (Ed.). . Taber’s cyclopedic medical

dictionary..Philadelphia: F. A. Davis.

NAPA VALLEY COLLEGE ASSOCIATE DEGREE PROGRAM IN NURSING

PROGRAM OUTCOMES At the completion of the program, the graduate will: I. Use the nursing process in various settings to assist individuals and groups to promote, maintain

and restore health. II. Integrate ethical and legal guidelines from the Nurse Practice Act, ANA Code of Ethics,, and

Nurse Practice Standards. III. Collaborate with individuals, families, groups, and the health care team using therapeutic

communication. IV. Evaluate theory and evidence-based knowledge to guide nursing practice. V. Integrate leadership and management principles in the nursing care of individuals or groups with

alterations in health. VI. Demonstrate consistent commitment to professional growth and self-development

Napa Valley College Associate Degree Program in Nursing

Course Learning Outcomes

NURS 142 – Nursing in Health Alterations I

I. Use the nursing process to promote health and provide safe care for clients with health alterations.

II. Conform to legal and ethical principles of safe practice in the nurse-client relationship.

III. Apply basic principles of effective and therapeutic communication including use of informatics.

IV. Use relevant evidence based practice to guide basic client care.

V. Provide client centered care in a safe and organized manner incorporating quality improvement

goals.

VI. Use professional attitudes and values for self-development.


NURS 142 Fall Semester 2012

Calendar subject to change

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Week Monday Tuesday Wednesday Thursday Friday

1

11/12 Veterans Day Holiday

11/13 0650-1300 Clinical

11/14 0650-1300 Clinical Care plan due

11/15 08-10 Unit I Immune/HIV 10-12 Seminar HIV

11/16

2

11/19 13-14 Unit I HIV 14-17 Unit II Cardiovascular

11/20 0650-1300 Clinical

11/21 0650-1300 Clinical Care Plan due

11/22 Thanksgiving Holiday

11/23

3

11/26 13-15 Unit II Cardio 15-17 Musculoskeletal

11/27 0650-1300 Clinical

11/28 0650-1300 Clinical

Care plan due

11/29 08-09 Exam 1 Unit I & II 0900-1000 Unit III Musculoskeletal 10-12 Seminar Arthritis-Effects of Chronicity

11/30

4

12/3 13-17 Unit III Musculoskeletal

12/4 0650-1300 Clinical

12/5 0650-1300 Clinical

12/6 08-09 Exam 2 Unit III Musculoskeletal 09-10 Unit IV Diabetes 10-12 Ped Health Promotion Presentations

12/7

Teach/Learn for client with

chronic alteration due.

Process Recording due


NURS 142 Fall Semester 2012

Calendar subject to change

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Week Monday Tuesday Wednesday Thursday Friday

5

12/10 13-17 Unit IV Diabetes

12/11 0650-1300 Clinical

12/12 0650-1300 Last clinical day

12/13 08-10 Unit IV Diabetes 10-12 Seminar Care Planning Diabetes

12/14

6

12/17 13-1400 Exam 3 Unit IV 14-1500 Course Evaluations

12/18

12/19 12/20 12/21

Have a safe and happy winter break! See you in the spring.

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Unit I– Alterations in the Immune System: HIV

Related activities - Assignments

REQUIRED ACTIVITIES: Review:

Normal structure and function of the immune system.

Compare pediatric and adult immune systems.

NURS 141 – assessment and health promotion of the immune system.

Read:

Lewis, S. M., Heitkemper, M. M., & Dirksen, S. R. (2011). Medical-Surgical Nursing: Assessment And Management Of Clinical Problems. (8th ed.). St. Louis: Mosby. Ch 14, pp. 211-217; Ch 15, pp. 241-257.

Ball, J. & Bindler, R. (2012). Pediatric Nursing: Caring For Children. (5th ed.) New Jersey: Prentice Hall. pp.652-662.

Complete: (Select One Option to be completed)

Opportunity 1: Collect up to date newspaper articles or other recent resources with current content or issues related to HIV/AIDS. Think globally as HIV affects men, women and children in communities, cultures and countries throughout the world. New information will be shared in class and added to a bulletin board. Each student should share one new item of new information.

Opportunity 2: Collect any literature or visual statement expressed through the arts such as a poem, an essay, a novel, personal statement, drawing, photo, brochure, or cartoon, that especially has moved you in appreciation of the complexities of the impact of HIV/AIDs on the individual, families, nurses, the workplace, the community, or the global society.

Resources: Companion Elsevier CD and Evolve Online Website

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Unit I– Alterations in the Immune System: HIV

Theory objectives Content outline Lab/clinical objectives

The student will (be able to) The student will (be able to)

1. Describe how alterations in the

immune system can lead to HIV.

2. Describe the classification of

HIV/AIDs and the spectrum of infection.

3. Identify factors that place

children and adults at risk for HIV.

4. Describe rationale for

assessment findings of all body systems when a patient has HIV.

A) Immunity

1) Humoral immunity (a) B lymphocytes

2) Cell mediated immunity (a) Lt-lymphocytes

3) Factors effecting immunity (a) Pediatrics (b) Adults

4) Altered immune response (a) Hypersensitivity (b) Anaphylaxis

B) Epidemiology

1) Global impact/pandemic 2) Statistics 3) Race, ethnicity 4) Sex 5) Populations

C) Transmission of HIV

1) Sexual intercourse with infected partner (a) Anal (b) Vaginal (c) Oral

2) Blood, blood products and body secretions

3) Perinatal 4) IV drug use

D) Classification of HIV/AIDS

1) Acute retroviral syndrome (a) Seroconversion

2) Early infection 3) Early symptomatic disease 4) AIDS

(a) Opportunistic disease (b) CD+4 Lymphocytes < 200

E) Timeline/spectrum of infection

F) Pathophysiology

1) Viremia 2) Viral load 3) Replication of virus

(a) Reverse transcription (b) Protease

4) CD 4+ Lymphocytes 5) Viral replication 6) Variables of transmission

(a) Viral load (b) Amount of exposure (c) Frequency of exposure

1. Care for patients having diagnostic tests using correct protocols. 2. Apply the nursing process while planning and caring for a patient with HIV. a. Collect a nursing history and physical assessment and r record significant findings present b. Develop and individualize a nursing care plan for a patient with HIV. c. Set priorities for action using Maslow d. Implement effective nursing interventions with rationale for patients with HIV. e. Outline a teaching plan for a patient with HIV. f. Evaluate the expected outcomes of the nursing interventions and revise the nursing care plan. 3. Prevent infection transmission when caring for patients with HIV. 4. Maintain a relationship with patients that allows expression of concerns. 5. Teach patients about safe sex. 6. Teach IV drug user about safe IV drug use. 7. Identify local agencies

that provide services to persons with HIV/AIDS.

8. Practice within the legal boundaries of nursing.

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5. Describe the variations in

assessment findings and disease progress; in infants, children, adolescents, and women.

6. Explain the nursing care before

during and after diagnostic tests of the immune system.

(d) Duration of exposure (e) Virulence of organism (f) Immune function

G) Assessment findings in HIV/AIDS by system 1) VS

(a) Fever, night sweats 2) Musculoskeletal

(a) Fatigue 3) Gastrointestinal

(a) Persistent diarrhea (b) Weight loss

4) Integumentary (a) Bruising, bleeding (b) Oral thrush (c) Rashes, spots (d) Swollen glands

5) Respiratory (a) Cough (b) Shortness of breath

6) Cardiovascular 7) Nervous/sensory

(a) Headache (b) Dementia

8) Renal/urinary 9) Endocrine/metabolic 10) Reproductive 11) Psychosocial

(a) Stages (i) Diagnosed, emotional crisis (ii) Stabilization (adjustment,

refocusing) (iii) Deterioration (iv) Terminal stage

H) Variation in assessment findings of pediatric

patient and women. 1) Pediatrics 2) Women 3) Disease progression

I) Diagnoses/Diagnostic tests

1) Testing 2) Counseling 3) Diagnostic tests

(a) ELISA (b) Western blot (c) PCR (polymerase chain reaction) (d) P24 antigen (e) Reversal of CD4: CD8 ratio (f) Other

4) Diagnosis of HIV: Infection in children J) Education of prevention

1) Sexual 2) Blood products, blood & body secretions

9. Apply ethical principles related to the care of HIV/AIDS patients and their families. 10. Develop a discharge plan

for a client with HIV

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7. Identify education and

prevention measures to prevent the transmission of HIV/AIDS.

8. Explain the medical care of

clients with HIV. 9. Explain the rationale for

nursing interventions related to medications commonly used for HIV/AIDS.

10. Formulate outcome criteria

based on identified nursing diagnoses.

11. Prioritize nursing diagnoses

based on Maslow.

3) Perinatal, mother to baby 4) IV drug use

K) Clinical management

1) Baseline and following assessments 2) Collaborative care 3) Early intervention 4) Disease progression in children

L) Drug therapy

1) Guidelines (a) CD4+ counts (b) Disease progression (c) Combination therapy

2) Antiretroviral agents (a) Nucleocide reverse transcription

inhibitors (NRI) (b) Non-nucleocide reverse

transcription inhibitors (NNRI) (c) Protease inhibitors (PI) (d) High aggressive Anti Retroviral

treatment 3) Adherence 4) Prophylaxis

M) Nursing Diagnoses

1) Impaired gas exchange 2) Altered comfort: Fatigue 3) Altered nutrition: Less than body

requirements 4) Risk for impaired skin, mucous

membranes 5) At risk for infection 6) Altered sexual patterns 7) Risk for infection transmission 8) Altered family processes 9) P.C.: Electrolyte imbalance 10) P.C.: Sepsis 11) P.C.: Opportunistic infections 12) Grief related to actual or

perceived/antisocial isolation 13) Social isolation 14) Spiritual distress 15) Caregiver role strain 16) Anxiety 17) Powerlessness 18) Fear 19) Body image disturbance 20) Noncompliance (specific)

N) Factors to consider when planning care

1) Beliefs, values, attitudes related: (a) Diversity (b) Sexuality (c) Sexual orientation (d) Drug use

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12. Explain influencing factors to

consider when planning care of patients throughout their lifespan with HIV.

13. Describe methods to allay

fears about caring for patients who are HIV positive.

14. Describe with rationale nursing

care planning, interventions of patients with HIV.

15. Explain the rationale for

nutritional requirements of a patient with HIV.

16. Describe how fluid and electrolyte imbalances can affect a patient with HIV. 17. Evaluate the patient’s response to nursing interventions using stated outcome criteria. 18. Explain some of the legal and ethical issues related to the care of patients with HIV/AIDS.

(e) Poverty (f) Oppression, bias discrimination

(i) Homophobia (ii) Persons living with HIV/AIDS

2) Education and prevention 3) Discrimination 4) Growth and development 5) Culture 6) Environmental Control

O) Planning

1) Health promotion 2) Potential alterations 3) Alterations

P) Interventions

1) Communication 2) Acute interventions

(a) Promote health – limited disability (b) Mange problems caused by

HIV/AIDS 3) Assess, treat infections 4) Assess, prevent complications 5) Provide physical and emotional support

(a) Hospital care (b) Home care/ambulatory care (c) Terminal care (d) Complimentary therapies (e) Community resources referrals

6) Assistance with adherence

Q) Legal/ethical issues 1) Ethical

(a) Patients rights (i) Confidentiality vs.disclosure (ii) Autonomy (iii) Death with dignity

(b) Nurse rights (i) ANA statement regarding risk

vs. responsibility in providing nursing care

(ii) Loyal employee vs. patient advocate

(iii) Test counseling (iv) Advocacy

(c) Ethical dilemmas (i) Refusal to care for AIDS patients (ii) Other dilemmas

(d) Legal (i) Reporting (ii) HIV testing (voluntary vs.

mandatory) (iii) Confidentiality (iv) Discrimination (v) Patients with disabilities act

(e) Current legislation

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(f) Political issues (i) Needle exchange (ii) Others

(g) Poverty (h) Prisoners

R) Awareness and recognition 1) Impact of nurses in HIV/AIDS care 2) Nurses Association in AIDS Care

(ANAC) 3) AIDS memorial quilt 4) World AIDS Day 5) Newest trends and advances

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CLINICAL FEATURES OF HIV INFECTION IN INFANCY AND CHILDHOOD

MAJOR CLINICAL PRESENTATIONS:

Failure to Thrive (FTT)

Wasting Syndrome

Diarrhea – Chronic or Recurrent

Small for Gestational Age (SGA)

Fever of Unknown Origin (FUO) MINOR SIGNS

Salivary Gland Enlargement: Parotitis

Hepatosplenomegaly

Oral Thrush – Persistent or Recurrent

Thrombocytopenia

Developmental Delay: Loss of Milestones

Encephalopathy

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Position Statement on

Risk Versus Responsibility in Providing Nursing Care

SUMMARY: The American Nurses Association (ANA) believes that nurses are obligated to care for clients in a non-discriminatory manner, with respect for all human persons, yet recognizes that there may be limits to the personal risk of harm the nurse can be expected to accept as an ethical duty. Nurses are challenged to thoughtfully analyze the balance of responsibility and risk in particular situations in order to preserve the ethical mandates of the profession. Background: The first plank of the Code for Nurses with Interpretive Statements (code for Nurses) states “The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” This central axiom of respect for persons directs the profession. Nursing creates a special relationship between nurse and client, with special duties for the nurse. The nurse is not at liberty to abandon those in need of nursing cares. According to the Code for Nurses, nurses may morally refuse to participate in care, but only on the grounds of either client advocacy or moral objection to a specific type of intervention. In those situations, the nurse is obligated to provide for the client’s safety and assure that alternate sources of nursing care are available. Nursing is resolute in its position that care should be delivered without prejudice, and it makes no allowance for use of the client’s personal attributes, socioeconomic or health status as grounds for discrimination. It is the nature of health problems such as hepatitis-B or C, tuberculosis, HIV/AIDS, cytomegalovirus and other infectious processes which may present the nurse with questions regarding when personal risk outweighs responsibility for care of the client. For assistance in resolving the question of risk versus responsibility, nurses must turn to the field of ethics for guidance. In ethics, the differentiation between benefiting another as a moral duty and benefiting another as a moral option is found in four fundamental criteria. As applied to nursing, a moral obligation exists for the nurse if all four of the following criteria are present: 1. The client is at significant risk of harm, loss, or damage if the nurse does not assist. 2. The nurse’s intervention or care is directly relevant to preventing harm. 3. The nurse’s care will probably prevent harm, loss, or damage to the client 4. The benefit the client will gain outweighs any harm the nurse might incur and does not present more than an acceptable risk to the nurse

American Nurses Association 600 Maryland Avenue, SW

Suite 100 West Washington, DC 20024-2571

(202) 651-7000

The general principle of practice is that nurses are morally obligated to care for all clients. However, in certain cases the risks of harm may outweigh a nurse’s responsibility to care for a given client. For

ANA AMERICAN NURSES

ASSOCIATION

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example, a nurse who is immunosupressed may be justified in refusing to care for clients with certain infectious processes. Risk, therefore, must be assessed by each individual nurse. Accepting personal risk which exceeds the limits of duty is not morally obligatory; it is a moral option. The nurse in the above example is not morally obligated to care for such clients o the grounds that the fourth criterion has not been met. For the nurse to make an informed assessment of the risk, acquisition of current knowledge pertaining to the given situation is required. Nurses need to base their assessment on objective and scientifically sound information. Purely personal perception, bias or fears of risk are not adequate justification for refusing to care for clients. Conversely, on those occasions when the nurse has the potential for exposing the client to risks related to the nurse’s personal health problems, the nurse has the responsibility to assess the risk and has the moral obligation to care for or refuse to care for clients based on this assessment. In addition to the issue of personal risk to the nurse or the client, it is incumbent upon the hospital or agency administration to provide adequate safeguards such as risk-reducing supplies and equipment, to enforce protective procedures that minimize risks, to educate staff concerning risks, and to cooperate with research into actual and potential risks. Nurses must also proactively assess potential practice environments to consider the nature of the work and its inherent risks. Historically, nurses have given care to those in need, even at risk to their own health, life or limb. Indeed the suggested Code of 1926 proclaims that “the most precious possession of the profession is the ideal of service, extending even to the sacrifice of life itself...” Nursing history is replete with examples of nurses who have knowingly incurred great risk in order to care for those in need of nursing or to contribute to the advancement of health science. Contemporary nurses, too, knowingly place themselves at risk when giving care on the battlefield, in places of poverty and poor sanitation at home or abroad, in situations of natural disaster, and in dealing with persons with communicable or infectious diseases. Nursing is caring profession, oriented toward client advocacy. Because of nursing’s long history of standing ready to assist the sick and the vulnerable in society, society has come to rely on nursing and to expect that is will rise to health demands of virtually any occasion. In a sense, this reciprocity is crucial to the profession. All must know that care will be given when needed and that it will not be arbitrarily, prejudicially, or capriciously denied Yet there may be limits to the moral obligation of the individual nurse to benefit clients when placed at personal risk. Beneficence stands as a moral duty in those situations where the four criteria can be met. When not all of the criteria can be met, the individual nurse must evaluate the situation according to the criteria and choose whether or not to exceed the requirement of duty.

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UNIT II – ALTERATIONS IN THE CARDIOVASCULAR SYSTEM

RELATED ACTIVITIES – ASSIGNMENTS

REVIEW:

NURS 141 Syllabus: - Cardiovascular System

Fundamentals Structure and function of the cardiovascular system, factors affecting blood flow, capillary exchange, and venous return.

READ:

Lewis, S. M., Heitkemper, M.M., & Dirksen, S. R. (2011). Medical-surgical nursing: assessment & management of clinical problems. (8th ed.). St. Louis: Mosby. Ch. 32, 38.

Ball, J. & Bindler, R. (2012). Pediatric nursing: Caring for children. (5th ed.). New Jersey: Prentice Hall. pp-632-634; 635-636.

Complete:

“The patient with peripheral arterial disease.” In Castillo, S. (2010). Strategies and approaches to thinking. (4th ed.)


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Unit II – Alterations in the Cardiovascular System

THEORY OBJECTIVES CONTENT OUTLINE LAB/CLINICAL OBJECTIVES

The student will be able to: The student will be able to:

1. Describe how the

cardiovascular system functions and how alterations can lead to illness throughout the lifespan.

2. Identify factors that place a

person at risk for alterations in the cardiovascular system.

3. Describe the nursing care

before, during and after diagnostic tests of the cardiovascular system.


assessment findings of a client with an alteration in the cardiovascular system.

5. Compare the clinical

manifestations of alterations in arterial and venous disorders.

6. Identify signs that would alert

the nurse to potential problems with alterations in the cardiovascular system.

7. Describe how fluid and

electrolyte imbalances can effect a patient with alterations in the cardiovascular system.

8. Describe the medical/surgical

management of a client with alterations in the cardiovascular system.


based on an assessment of a client with alteration in the cardiovascular system.

10. Formulate outcome criteria

A) The vascular system

1) Components 2) Function

(a) Blood pressure (b) Blood flow

(i) Velocity (ii) Resistance

(c) Capillary exchange (d) Venous return

3) Risk factors (a) Age (b) Sex (c) Ethnicity (d) Smoking (e) Occupation (f) Nutritional status (g) Diabetes (h) Sedentary lifestyle (i) Obesity (j) Medication (k) Stress (l) Familial history

4) Diagnostic tests (a) BP (b) Doppler ultrasonography (c) Ultrasonic duplex scanning (d) Computed tomography (e) MRI (f) Plethysmography (g) Exercise testing (h) I.V. ultrasonography (i) Contrast angiography (j) Contrast venography (k) Vascular angioscopy

5) Assessment findings (a) Pain

(i) Location (ii) Influence of elevation (iii) Quality/characteristics (iv) Predisposing factors

(b) Skin (c) Pulses (d) Edema (e) Muscle mass (f) Capillary refill

6) Arterial disorders (a) Etiology

(i) Atheroscerolsis (ii) Inflammation (iii) Trauma (iv) Thrombosis

1. Prepare a patient

undergoing diagnostic testing of the cardiovascular system.

2. Evaluate the results of lab

and diagnostic tests of the cardiovascular system.

3. Apply theory to the nursing

care of patients with alterations in the cardiovascular system.

4. Assess a patient to identify

risk factors for cardiovascular alterations,

5. Use the nursing process to

care for a patient with an alteration in their cardiovascular system to promote and maintain health.

6. Relate therapies, drugs, and

lab data to a patient with alteration in the cardiovascular system.

7. Perform wound irrigation and

wet to dry dressings using sterile technique.

8. Develop a teaching plan for

a patient with an alteration in the cardiovascular system.

9. Safely administer blood and

blood products. 10. Perform an assessment of

the cardiovascular system according to guidelines given to you.

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based on identified nursing diagnosis of a patient with alterations in the cardiovascular system.

11. Describe with rationale the

nursing care planning, interventions, and evaluation of patients with alterations in the cardiovascular system.

12. Describe the action/use and

the implications for nursing of the following drug classification: anticoagulants.

13. Describe the three

components of the normal clotting mechanisms.


nutritional requirements of a patient with alteration in the cardiovascular system.

(v) Embolism (vi) Vasospasm

(b) Chronic occlusive disease (c) Acute arterial occlusion

(i) Pain (ii) Paresthesia (iii) Pallor (iv) Pulselessness (v) Paralysis

(d) Arterial ulcers (e) Buergers disease (f) Raynauds syndrome (g) Complications

(i) Ischemic ulcers (ii) Gangrene

7) Venous disorders (a) Etiology

(i) Acute venous insufficiency (ii) Chronic venous insufficiency (iii) Venous stasis ulceration (iv) Varicose veins

(b) Clinical signs 8) Medical/surgical management

(a) Exercise (b) Smoking cessation (c) Weight reduction (d) Diet management of fat &

cholesterol intake (e) Angioplasty (f) Peripheral arthrectomy (g) Stents (h) Thrombolytic therapy (i) Arterial bypass (j) Amputation (k) Support devices (l) Sclerotherapy (m) Venous stripping & ligation (n) Debridement

9) Nursing diagnoses (a) Altered tissue perfusion: peripheral (b) Impaired mobility (c) Impaired skin integrity (d) Altered comfort (e) Body image disturbance (f) Activity intolerance (g) High risk for infection

10) Nursing management (a) Outcomes (b) Interventions (c) Teaching (d) Moist heat (e) Positioning of extremity

11. Analyze assessment data to determine nursing diagnosis.

12. Develop patient outcomes

consistent with nursing diagnoses.

13. Select correct interventions

for patients with alterations in the cardiovascular system.

14. Document pertinent nursing

assessment, planning, and evaluation.

15. Use outcome criteria to

evaluate actual patient and family outcomes of care.

16. Provide for correct use of

resources to assist patient and family.

17. Contribute to discussions

and decisions that affect the health of patients.

18. Act as an advocate for the

patient and/or family to achieve outcomes.

19. Use the nursing process to

care for a patient with a CV alteration.

20. Evaluate each drug safety

based on planned measurable outcome.

21. Calculate drug dosage for

continuous Heparin IV med.

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(f) Monitor CSM (g) TEDS/pneumatic boots (h) Interpret clotting studies (i) Administer anticoagulants

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Unit III – Alterations in the Musculoskeletal System

Related activities - Assignments

REQUIRED ACTIVITIES: Review:

Normal structure and function of the musculoskeletal system.

Pediatric differences in the musculoskeletal system.

NURS 141 – assessment and health promotion of the musculoskeletal system.

Read:

Lewis, S. M., Heitkemper, M. M., & Dirksen, S. R. (2011). Medical-Surgical nursing: assessment and management of clinical problems. (8th ed.). St. Louis: Mosby. Ch 62, 63, 64, and pp.1641-1667.

Ball, J. & Bindler, R. (2012). Pediatric nursing: caring for children. (5th ed.) New Jersey: Prentice Hall. Chapter 29.

Hogstel, M. O., & Curry, L. C. (2005). Practical guide to health assessment throughout the lifespan. (4th ed.) Philadelphia: F. A. Davis. Chapter 17.

Attend & participate:

Seminar – Comparison of the effects of chronicity across the lifespan/arthritis

Complete:

“The patient with a hip fracture”, “The patient with a fractured tibia” in: Castillo, S. (2010). Strategies, techniques, and approaches to thinking. (4th ed.) Philadelphia: Saunders.


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1. Explain those factors that

influence the health of the Musculoskeletal system.

2. Compare acute and chronic

alterations in the Musculoskeletal system as to age, gender, occupation, social and economic level.


adults and children at risk for alterations in the Musculoskeletal system.


assessment findings of all body systems when a child or adult has an alteration in the Musculoskeletal system.

A) Normal structure and function

1) Tissues 2) Bones 3) Muscles 4) Joints

B) Influencing factors

1) Age (a) Infant, child, adolescent (b) Pregnant female (c) Aging adult

2) Environment 3) Diet 4) Genetics 5) Familial history 6) Cultural

C) Risk factors 1) History 2) Sex 3) Medications 4) Age 5) Medical conditions

(a) Metabolic alterations (b) Gastrectomy (c) Renal tubular necrosis (d) Hypothyrodism

6) Diet

D) Assessment 1) History and Interview

(a) Chief complaint (b) Behaviors related to movement (c) Functional assessment (d) Self care behaviors (e) Additional questions

2) Physical examination 3) General

(a) Posture (b) Gait (c) Use of assistive devices

4) Vital signs 5) Inspection and palpation 6) Range of motion 7) Neurovascular assessment – CSM

E) Diagnostic tests

1) Blood (a) Calcium (b) Alkaline phosphatase (c) Erythrocyte sedimentation rate

1. Explain those factors that

influence the health of the Musculoskeletal system.

2. Compare acute and chronic

alterations in the Musculoskeletal system as to age, gender, occupation, social and economic level.


adults and children at risk for alterations in the Musculoskeletal system.


assessment findings of all body systems when a child or adult has an alteration in the Musculoskeletal system.

23




5. Explain the nursing care

before, during and after diagnostic tests of the Musculoskeletal system.

6. Describe how alterations in the

musculokeletal system can lead to illness.

7. Compare differences of

rheumatoid arthritis, osteoarthritis, and juvenile rheumatoid arthritis.

(ESR) (d) Rheumatoid factor (RF) (e) ANA

2) Visualizations (a) X-ray (b) CT (c) MRI (d) Myelography (e) Bone scan (f) Biopsy (g) Arthroscopy

3) Procedures (a) Joint aspiration (b) Arthrocentesis (c) Electromyography

F) Alterations

1) Soft tissue injury (a) Strains, sprains (b) Dislocations, subluxations (c) Rotator cuff tears (d) Ligament injuries (e) Meniscus injuries (f) Repetitive motion injuries

2) Herniated disc 3) Bone infections 4) Degenerative changes 5) Osteoporosis 6) Gout 7) Arthritis

(a) Osteoarthritis (b) Rheumatoid arthritis (c) Juvenile rheumatoid arthritis

8) Curvature of the spine (a) Scoliosis (b) Kyphosis (c) Lordosis

9) Trauma (a) Fractures

(i) Open (ii) Closed (iii) Classification

(1) By pattern (2) By type (3) By point of reference (4) By location

(iv) Complications with fractures 10) Muscular dystrophy

G) Medical management

1) Medications 2) Nutrition

5. Explain the nursing care

before, during and after diagnostic tests of the Musculoskeletal system.

6. Describe how alterations in

the musculokeletal system can lead to illness.

7. Compare differences of

rheumatoid arthritis, osteoarthritis, and juvenile rheumatoid arthritis.

24




8. Explain the medical and

surgical care of children and adults with alterations in the musculoskeletal system.

9. Describe how fluid, electrolyte

and acid-base imbalances can affect a patient with an alteration in the musculoskeletal system.

10. Explain the action/use and the

implications for nursing of medications commonly used in the care of patients with alterations in musculoskeletal system.


nutritional requirements of a patient with an alteration in musculoskeletal system.


based on Maslow.

3) Immobilization 4) Rest and exercise 5) Heat and cold 6) Closed reduction

(a) Casts (b) Splints (c) Traction

(i) Uses (ii) Types

(d) Complications 7) Assistive devices 8) Special beds and frames

H) Surgical Management

1) Osteotomy 2) Arthrodesis 3) Open reduction internal fixation (ORIF) 4) Total hip, knee replacement 5) Amputations

I) Fluids and electrolytes

1) Calcium 2) Phosphorus 3) Potassium 4) Hydration

J) Pharmacological Therapy

1) Muscle relaxants 2) Pain medications 3) Antibiotics 4) Calcium supplements 5) Estrogen therapy 6) Salicylates 7) NSAID 8) Corticosteroids 9) SERMs 10) Immunosuppressives 11) Cytotoxics

K) Nutrition 1) Protein 2) Vitamins 3) Calcium 4) Fluids 5) Fiber 6) Weight management

L) Nursing diagnoses 1) Altered nutrition: less than body

requirements 2) Alteration in comfort 3) Infection, risk for

8. Explain the medical and

surgical care of children and adults with alterations in the musculoskeletal system.

9. Describe how fluid,

electrolyte and acid-base imbalances can affect a patient with an alteration in the musculoskeletal system.

10. Explain the action/use and

the implications for nursing of medications commonly used in the care of patients with alterations in musculoskeletal system.


nutritional requirements of a patient with an alteration in musculoskeletal system.


based on Maslow.

25




13. Describe with rationale nursing

care planning, interventions, and evaluation of patients with an alteration in the musculoskeletal system.

14. Evaluate the patient’s

response to nursing interventions using stated outcome criteria.

15. Explain guidelines and

outcomes for patient and family teaching for discharge planning and community care.

16. Describe some legal and

ethical issues related to patients with alterations of the musculoskeletal system.

4) Mobility, impaired physical 5) Health maintenance, altered 6) Risk for fluid and electrolyte imbalance 7) Risk for alteration in sensation 8) Risk for alteration in elimination

M) Nursing care planning

1) Outcomes (a) Identify daily dietary

requirements/restrictions (b) VS within acceptable range (c) Adequate circulation, evidenced by

color, sensation, movement (d) Mobilize self from sitting to

ambulation with assistive devices (e) Report decrease in pain 30” after

medicated Normal elimination pattern

(f) Verbalize understanding of the disease process

N) Nursing interventions

1) Teach (a) Pain scale (b) Diet (c) Medications (d) Assistive devices

O) Discharge plan

1) Assess community resources 2) Teach activities allowed 3) Coordinate home care: nursing, physical

therapy, occupational therapy 4) Teach signs and symptoms to report 5) Teach purpose, side effects, dosage,

time for medications

P) Legal and ethical issues 1) Pain control, management 2) Use of cadaver bones, ligaments

13. Describe with rationale

nursing care planning, interventions, and evaluation of patients with an alteration in the musculoskeletal system.

14. Evaluate the patient’s

response to nursing interventions using stated outcome criteria.

15. Explain guidelines and

outcomes for patient and family teaching for discharge planning and community care.

16. Describe some legal and

ethical issues related to patients with alterations of the musculoskeletal system.

26

Unit IV – Alterations in the Endocrine/Metabolic System: Diabetes Mellitus

Related Activities – Assignments

Review

Related units from NURS 141 Syllabus

Stress and the Environment, structure and Function of the Endocrine System, Nutrition Fluid & Electrolytes.

Insulin administration techniques

Identify sites used for insulin injections Read

Lewis, S.M., Heikemper, M.M., & Dirksen, S.R. (2011). Medical-surgical nursing: assessment & management of clinical problems. (8th ed.). St. Louis: Mosby, Chapters 48 & 49. Chapter 17 pp. 321-324.

Ball, J. & Bindler, R. (2008). Pediatric nursing: caring for children. (4th ed.) New Jersey: Prentice Hall. Chapter 29, pp 1005-1020.

Complete

Castillo, S. (2010). Strategies, techniques, and approaches to thinking. (4th ed.) Philadelphia: Saunders. “The patient with diabetes mellitus.”


27

Unit IV – Health Alterations in the Endocrine/Metabolic System: Diabetes

Theory Objectives Content Outline Lab/Clinical Objectives

The student will (be able to): The student will (be able to):

1. Explain factors that promote the

normal regulation of blood glucose in health.

2. Explain factors that influence

glucose regulation. 3. Define and describe diabetes. 4. Compare the etiology and

characteristics of the types of diabetes mellitus.

5. Identify environmental factors

that indicate patients at risk for altered glucose regulation.

6. Describe how alterations in

glucose regulation can lead to illness.

7. Describe common diagnostic

manifestations that suggest an alteration in glucose regulation.

8. Relate the pathological changes

in diabetes to the resulting assessment findings in patients with health alteration of diabetes mellitus.

9. Describe the nursing care for

A) Normal regulation of blood glucose

1) Regulatory hormones (a) Insulin (b) Glucagon (c) Somatostatin

2) Requirements for synthesis and release of insulin and glucagon (a) Nutrition (b) Healthy pancreas-islet cells

3) Normal K+ levels

B) Factors that influence glucose regulation 1) Stress 2) Medications 3) Exercise 4) Counter-regulatory hormones

C) Diabetes 1) Definition 2) Types

(a) Type I – (b) Type 2 – (c) (d) Gestational

3) Risk factors (a) Age (b) Genetics (c) Familial history (d) Ethnicity (e) Obesity (f) Hypertension (g) Hyperlipidemia (h) Women with baby > 9#

4) Alterations (a) Effects on glucose regulation (b) Effects on fat metabolism (c) Effects on protein metabolism (d) Diagnostic manifestations (e) Polyuria (f) Polydipsia (g) Polyphagia (h) Weight loss (i) Blurred vision (j) Weakness, fatigue, dizziness (k) Infections

D) Diagnostic Tests

1) FBS 2) Random blood glucose 3) 2-hour post-prandial 4) Glucose tolerance test 5) C-peptide 6) Glycosylated hemoglobin

1. Assess patients for presence

of risk factors for altered glucose regulation.

2. Select data that indicates an alteration in glucose metabolism and document findings.

3. Identify abnormal lab values that indicate alteration in glucose regulation.

4. Prepare patients for

diagnostic tests according to agency protocol.

28




patients requiring diagnostic tests.

10. Describe common chronic

conditions that suggest complications related to diabetes mellitus.

11. Compare the pathophysiology,

manifestations, and treatment of the acute complications of hyperglycemia in Type 1 and Type 2 Diabetes.

12. Predict the assessment findings

in patients with alterations in glucose regulation and give the rationale for each.

13. Identify nursing diagnoses and

outcomes for patients with diabetes.

7) Expected blood glucose levels in diabetic control

8) Urinalysis

E) Chronic complications 1) Macroangiopathy

(a) Heart disease (b) Cerebral vascular disease (c) Hypertension (d) Peripheral vascular disease (e) Infection

2) Microangiopathy (a) Diabetic retinopathy (b) Dermopathy (c) Nephropathy

3) Neuropathy (a) Mononeuropathy (b) Polyneuropthy

4) Autonomic neuropathy (a) Cardiovascular (b) Gastrointestinal (c) Genitourinary (d) Sexual dysfunctions

F) Diabetic Ketoacidosis (DKA) /

Hyperosmolar Hyperglycemic Syndrome (HHS) 1) Pathophysiology 2) Causes 3) Signs & symptoms 4) Treatment

G) Nursing Assessment 1) History interview

(a) Family history (b) Cultural health beliefs (c) Growth and development (d) Ethnicity (e) General condition

2) Medications 3) Physical assessment of systems: 4) Learning Needs

H) Nursing Diagnoses

1) Fluid volume deficit 2) Alteration in nutrition 3) Alteration in health maintenance 4) Tissue perfusion, altered (specify) 5) Altered sexuality patterns 6) Impaired skin integrity 7) PC: DKA OR HHS 8) PC: alteration in acid/base balance 9) PC: hypoglycemia 10) Potential for injury/infection 11) Self-esteem disturbance

5. Perform C.S.B.G according to

competency protocol. 6. Document results of C.S.B.G.

in proper format with 100% accuracy.

7. Analyze assessment data to

determine need for immediate intervention.

8. Perform a nursing history

and physical on a patient with diabetes.

9. Analyze assessment data

and determine nursing diagnosis and need for intervention.

10. Write nursing diagnoses

based on assessment of a patient with diabetes mellitus.

29




14. Describe the rationale for

interventions that maintain or restore health for patients with diabetes.

15. Formulate the expected

outcomes from the use of oral hypoglycemic agents (OHA’s), insulin, and glucagon.

16. Describe the causes,

assessment findings, and nursing management of hypoglycemic disorders.

12) Non-compliance related to anger, grief, denial, insufficient access to resources

13) Risk for ineffective management of therapeutic regime

14) Impaired social interactions

I) Therapeutic Management 1) Nutrition

(a) Dietary basics – Food pyramid (b) Nutritional assessment (c) Weight management (d) Special diets (e) Timing of meals

2) Exercise (a) Effects on glucose regulation (b) Frequency (c) Duration

3) Self-monitoring blood glucose 4) Medications

(a) Oral hypoglycemic agents (i) First generation

sulfonylureas (ii) Second generation

sulfonylureas (iii) Biguanides (iv) Alpha-glucosidase inhibitor (v) Mechanism of action (vi) Onset, peak, duration (vii) Side effects

(b) Insulin (i) Types by onset, peak and

duration (ii) Rapid acting (iii) Short acting (iv) Intermediate acting (v) Long acting (vi) Mixed – 70/30 (vii) Routes of administration (viii) Site selection (ix) Control regimes

(c) Glucagon (i) Indications (ii) Dosage (iii) Route

J) Hypoglycemia

1) Causes (a) Delay or omission of meal (b) Insulin overdose (c) Excessive exercise (d) Improper timing of insulin and

food (e) Hypoglycemic unawareness (f) Somogyi effect

11. Assess patient’s knowledge

of nutritional self-management.

12. Select nursing patient

interventions for a patient with diabetes.

13. Give OHA’s accurately. 14. Assess effectiveness of

OHA’s in relation to blood sugars.

15. Assess patients for possible

adverse effects of OHA’s. 16. Select correct insulin and

syringe when giving insulin. 17. Administer the correct type

and dose of insulin by the correct route with 100% accuracy.

18. Calculate correct dosage of

insulin in relation to blood sugars.

19. Evaluate patients for possible

adverse effects of insulin therapy.

20. Analyze assessment data to

determine need for immediate intervention.

30




17. Describe the perioperative

management of the patient with diabetes.

18. Describe learning needs of the

patient with an alteration in glucose regulation.

19. Evaluate the health behaviors of

a patient with diabetes. 20. Identify community resources

available for the patient with diabetes.

(g) Medications 2) Assessment

(a) Adrenergic responses (b) Neuroglycopenic responses (c) Reactions and nursing

management

K) Perioperative management 1) Blood glucose monitoring 2) Indications for holding insulin and/or

OHA’s 3) IVs 4) Wound healing 5) Infection risk 6) Determine risk factor management

related to chronic complications

L) Learning Needs – SURVIVE 1) Simple pathophysiology 2) Understand relationship between

food, stress, medicine, exercise and blood glucose level

3) Regular exercise 4) Variety of meal plans 5) Insulin and /or OHA’s 6) Value of normalizing blood glucose 7) Educate entire family

(a) Emergency plans (b) Sick day management (c) Supplies (d) Signs and symptoms of acute

complications (e) Routine foot care (f) Self-monitoring blood glucose (g) Ketone testing (h) Medication administration

M) Community Resources

1) ADA 2) Support groups 3) Nutritionist

21. Implement a teaching plan for

a patient with diabetes mellitus based on assessment of learning needs.

22. Write a nursing care plan for

a patient with diabetes mellitus.

31

Napa Valley College


CLINICAL EVALUATION TOOL

Course: NURS 142 Nursing in Health Alterations I

Semester: 1

Student:

CLINICAL EVALUATION

Clinical performance is evaluated by the clinical instructor and is based on the course objectives derived from the

program outcomes. The student also evaluates clinical performance using the same performance objectives.

Students are also responsible for formulating goals for each clinical week. Clinical evaluation tools are used to

document student progress in meeting clinical objectives for each course. These clinical evaluation tools are found in

each course syllabus. The clinical evaluation tool includes formative and summative evaluation. The evaluation is to

be in writing, discussed with the student, and signed by both the instructor and the student. It is then maintained in the

student’s folder during the program and used to review progress throughout the program.

Formative evaluations:

Formative evaluation monitors progress and provides direction for learning throughout the course. It provides

feedback to the student and shall include strengths and positive accomplishments as well as weaknesses and

performance that need to be improved. Faculty informs the student regarding progress in meeting clinical objectives,

identifies additional learning, and makes recommendations for ways to improve and meet written objectives.

Formative evaluations may occur at the halfway point in the clinical course.

In the formative evaluation, performance is rated as follows:

S Satisfactory Satisfactory is defined as consistent performance of the objectives

according to criteria or guidelines given. When errors are made they are

recognized and corrected.

NI Needs Improvement Needs Improvement is defined as performance that impedes progress

toward meeting clinical objectives and must be improved to satisfactory at

the summative evaluation.

NO Not Observed Not Observed behavior is defined as a behavior that should have occurred

but was not observed and indicates an area to be given attention.

NA Not Applicable A behavior rated as not applicable means it was not expected of the student.

U Unsatisfactory Unsatisfactory is defined as inconsistent performance, does not meet criteria

for performance, errors were made and not recognized or expected

behavior was not performed at all.

Clinical Review Policy

Regular conferences with students will be held to review clinical performance. When deficiencies in performance

occur – for example: when a student is not meeting clinical objectives or is demonstrating unsafe behavior – it will be

discussed with the student as soon as possible, with documentation of the identified behavior(s) and a recommended

plan for change. The plan will include the actions required to achieve satisfactory performance (ex: required lab

practice).

32

Summative evaluations:

Summative evaluation occurs at the end of the course to determine if the clinical objectives have been achieved and

establishes the grade for clinical practice.

The criteria for evaluation will be rated as follows:

S Satisfactory Satisfactory is defined as meeting all clinical objectives and consistent safe

practice.

U Unsatisfactory Unsatisfactory is defined as not meeting all clinical objectives consistently or

unsafe practice.

An unsatisfactory rating in any one or more evaluation criteria will result in failure in the course.

In addition to receiving a satisfactory evaluation in clinical, a student must achieve a 75% or better in theory.

Clinical Skills Performance

Students are expected to maintain a satisfactory level of performance in all previously learned clinical skills from one semester to another. The student is responsible to assess and remediate any skill deficiencies in the nursing skills lab.

Faculty may assign a student to perform these skills without advance notice and the student is expected to perform

these skills satisfactorily.

Safe Nursing Practice

The nursing faculty has the responsibility to determine whether practice is safe or whether it is unsafe and

unprofessional. They also have an obligation to protect the patient and society against harm. Therefore, if necessary,

faculty can send students away from clinical area and recommend suspension of students from clinical for unsafe,

unprofessional, dishonest and/or disruptive conduct.

Unsafe Nursing Practice

The major areas of concern for safe practice are:

1. Medical asepsis is the prevention of transfer or organisms.

2. Physical jeopardy is any action or inaction that threatens a patient’s physical health.

3. Emotional jeopardy is any action or inaction that threatens a patient’s emotional health.

Name: _____________________________________________

33

NURS 142

Napa Valley College


NURS 142 Nursing in Health Alterations I Student

Formative

Instructor

Formative Summative Comments

Formative/Summative Evaluation Tool

S NI U NO

NA

S NI U NO

NA

S U

I) Use the nursing process to promote health and provide care for clients with health alterations.

A) Assessment

1) Collects data from the individual, health-care team members, and community agency

2) Uses assigned format for data collection

3) Completes an assessment of all body systems

4) Identifies alterations in health in selected areas

5) Identifies health risks in selected areas

6) Identifies need for health teaching in selected areas

7) Identifies environmental, community, diversity, and developmental influences

B) Nursing Diagnosis

1) Formulates nursing diagnosis based on assessment findings

2) Uses correct classification list for nursing diagnosis

3) Relates nursing diagnoses to assessment data

C) Planning

1) Identifies individual outcomes that are realistic, measurable, and specific

2) Plans care in cooperation with client, community agency staff, and instructor

3) Prioritizes nursing diagnoses using assigned method

Name: _____________________________________________

34

Date: Date: Date:


Formative

Instructor



S NI U NO

NA

S NI U NO

NA

S U

D) Implementation

1) Uses standard precautions and infection transmission control measures

2) Performs planned nursing interventions

3) Provides safety and comfort

4) Maintains sterile technique with all sterile procedures

5) Calculates, measures, administers, and records medications accurately

6) Prepares clients correctly for tests and procedures

E) Evaluation

1) Describes individual responses to nursing care on basis of outcome criteria

2) Validates findings with instructor/agency staff

3) Revises care plan in relation to evaluation

II) Conform to legal and ethical principles of safe practice in the nurse client relationship.

A) Uses school and agency policies and procedures to guide action

B) Validates ethical and legal concerns with instructor

C) Discusses a legal or ethical issue encountered while providing client care

D) Seeks supervision/assistance as required to give safe nursing care

E) Maintains appearance according to nursing program uniform code

F) Accepts responsibility for outcome of own actions

G) Identifies values and beliefs that may influence individual care

Name: _____________________________________________

35

Date: Date: Date:


Formative

Instructor



S NI U NO

NA

S NI U NO

NA

S U

III) Apply basic principles of effective and therapeutic communication including the use of informatics.

A) Maintains a therapeutic nurse-client relationship

B) Uses interview techniques to obtain data from the client, and support systems

C) Uses effective techniques of communication to convey information

D) Maintains individual-centered conversation during nursing cares

E) Demonstrates non-judgmental behavior towards clients

F) Follows written and verbal information and directions correctly

G) Uses correct medical terminology and approved abbreviations

H) Documents client data and nursing care using correct format

I) Communicates accurate information about individual care and medications

IV) Uses relevant evidence based practice to guide basic client care

A) Identifies effects of selected health alterations

B) Explains clients’ alteration in health

C) Uses knowledge of health risks in assessing health status

D) Relates assessment data to diagnosis

E) Uses knowledge to support nursing interventions

F) Explains actions and side effects of medications

G) Uses verifiable evidence based information to solve problems

Name: _____________________________________________

36

Date: Date Date:


Formative

Instructor



S NI U NO

NA

S NI U NO

NA

S U

V) Provide client centered care in a safe and organized manner incorporating quality improvement goals.

A) Functions as a member of the health care team

B) Completes assigned care within the allotted time

C) Prioritizes individual care based on model provided

D) Demonstrates efficiency of skills in providing care

E) Validates individual care decisions with instructor

VI) Use professional attitudes and values for self-development

A) Demonstrates constructive use of clinical time

B) Uses constructive criticism to improve nursing practice

C) Informs instructor about own learning needs

D) Participates in a constructive manner in clinical conferences

E) Finds learning experiences to increase competency and knowledge

F) Accepts responsibility for assignments

G) Independently seeks information in the clinical setting

H) Uses a variety of learning resources

I) Participates in self-evaluation

37

Napa Valley College


NURS 142 – Nursing in Health Alterations I Semester 1 Formative Evaluation

Week (s)__________________________________ Student Comments and Goals: Please address how you are meeting clinical objectives. Instructor Comments: Date____________ *Student Instructor Summative Evalulation

Week (s)__________________________________ Student Comments and Goals: Please identify how you have met the 6 clinical objectives Instructor Comments: Date____________ *Student Instructor *My signature does not mean I agree or disagree, only that I have read this form.

38

NAPA VALLEY COLLEGE ASSOCIATE DEGREE PROGRAM IN NURSING

N142 – HEALTH ALTERATIONS I Guidelines for Patient and Family Teaching Assignment 1. Keep this teaching plan simple. 2. Select an appropriate patient or family in need of teaching and get approval from your clinical instructor. (You

need to do this on first clinical day or early on second day in order to be able to plan and implement your teach).

3. Use the form provided in N142 syllabus to:

a. Assess the patient/family’s learning needs (use only the area/areas appropriate to your teach)

b. Write the nursing diagnoses.

c. Note any barriers to learning. 4. Complete column on outcomes

a. Use appropriate terms for learning objectives, (See Potter & Perry “Fundamentals in Nursing)

5. Complete column on plan.

a. Teaching method to be used (e.g., discussion, video, pamphlets, demonstration)

b. Describe the content to be taught. 6. Implement your teaching plan. 7. Evaluate. Ask patient/family to do return demonstration, to verbalize or even to read back to you the content

taught. Be honest in your evaluation. This is a learning process for you, as well as your patient! 8. Be prepared to discuss experience in seminar.

39


Patient and Family Teaching and Discharge Planning – Worksheet

Student: Date:

Patient Initials: Diagnosis:

Room: Surgery/Treatment:

Health Alteration:

In Planning for your patient’s discharge anticipate the following:

1. Medication, purpose, schedule:

2. Ways to minimize pain:

3. Diet:

4. Activity:

5. Wound care/treatments:

6. Resources available:

7. When to notify doctor (Sx):

Nursing Diagnosis:

Outcomes( Patient knowledge/skills)

Plan (How are you going to teach and what methods will you use) Evaluation

Information given to:

40

PROCESS RECORDING

A Process recording is an exercise to help you analyze and improve your therapeutic communication skills. It is a written recording of a portion of what goes on between the nurse and the patient. It is the actual experience and words of the nurse and the patient and any other persons that are involved. The report includes anything that occurs, what is said or done as well as the observed effects. The process recording will help you learn to: Identify own verbal and nonverbal behaviors Interpret patient verbal and nonverbal behaviors Identify facilitators or blocks to communication Relate nursing actions to identified patient behavior Analyze own behavior within a therapeutic relationship Use format for recording interactions

Guidelines for writing the process recording

1. Write a short introduction telling a little about the patient and the situation being recorded. Include the

patient’s age, gender, and medical diagnosis. 2. Write the interaction as soon as possible after it takes place. Include the verbal and nonverbal

behaviors of yourself and the patient. (Include at least 5 verbal responses each) 3. Use the format given you. There are five columns: one for the patient’s responses, one for the

nurses responses, one to identify the principles of communication, one that applied the principles/techniques that were used, and one for analysis of the interaction.

41

Napa Valley College


Introduction (context of the interaction):

Process Recording of Conversation What the Patient Said and Did (include verbal and nonverbal

responses)

What I Thought and Felt (as you listened and before you

spoke)

What I Said and Did (include verbal and noverbal

responses)

Principles/Techniques Used

(reflection, clarifying, probing …)

Analysis (therapeutic or

nontherapeutic and why)

42


Process Recording of Conversation What the Patient Said and Did (include verbal and nonverbal

responses)

What I Thought and Felt (as you listened and before you

spoke)

What I Said and Did (include verbal and noverbal

responses)

Principles/Techniques Used

(reflection, clarifying, probing …)

Analysis (therapeutic or

nontherapeutic and why)

43


NURS 142

Nursing Care Plan Guidelines

1) Patient Data Base Forms: Use patient initials only on any papers. Fill in all the identified areas. Review

the patient’s chart. Read the medical history, doctor’s orders, physical assessment, nursing admission notes, progress notes, and laboratory and diagnostic test results. Introduce yourself and ask the patient for permission to conduct an informational interview. Conduct an interview for information. You may not do any physical assessments or nursing interventions with a patient when gathering data when your clinical instructor is not present in the hospital.

2) Physical Assessment Forms: Assess all identified areas. You will fill in this information during your

clinical days.

3) Lab Values Form: List and analyze only the abnormal lab values

4) Medication Assignment Forms: List all prescribed medications for the assigned patient

5) Nursing Care Plan Forms: Gather information from your textbooks and other resources about the patient’s health alterations, medical diagnosis, signs and symptoms, and medications. a) Write 3 nursing diagnoses, 1 must be psychosocial, and 2 must be physiological.

i) You may use actual, possible, risk, high risk, syndrome or wellness diagnoses. ii) Prioritize your nursing diagnoses according to Maslow’s Hierarchy of Needs

b) Document what the patient identifies as their long-term goal c) Identify patient-centered expected outcomes (goals). Outcomes should be realistic, clear, concise,

measurable and dated. They should be understood and measurable by any member of the health care team.

d) The evaluation is a statement from you about your assessment of whether the patient has achieved the actual outcome or goals that you identified. Did your nursing interventions lead to the outcomes or goals you expected? You will document your evaluation after you implement your plan of care.

e) Implementation includes the nursing interventions, actions, and teaching that you have researched and believe will help you reach your client’s goal or expected outcomes. Interventions are activities that you perform to restore, maintain or promote health.

f) State the rationale that explains and justifies your choice of the selected nursing interventions. The rationale states how the intervention achieves the outcome. Include the title and page numbers of the resource you used.

6) Mini-Prep: Required on the second patient when you have more than one patient assigned. It consists of:

a) Patient Data Base forms - Patient initials, diagnosis, pathophysiology, current treatments and orders. b) Physical Assessment form - Assess all identified areas c) Nursing Care Plan Form – Identify 3 nursing diagnoses d) Medication Assignment Forms – List only meds you will be administering


Patient Data Base

44

Student Name______________________________________________ Clinical date(s)____________________

Pt. Initials ________ Age______ Sex______ Rm #_________Dr._________________ Adm. Date_____________ Allergies___________________________________________________________________________________________________ Current Medical Diagnosis_____________________________________________________________________________________ Surgical Procedure/ Date _____________________________________________________________________________________ Admission Height__________ Weight__________

Socioeconomic/Health history:

Religion______________________ Ethnic identity____________________ Primary language____________________________ Cultural practices____________________________________________________________________________________________ __________________________________________________________________________________________________________ Educational level___________________ Occupation______________________________________________ FT__ PT__ Retired__ Living arrangements: Alone___Spouse___ Parent____ Other:_________________________________________________________ Institution (name & describe)____________________________________________________________________________ Insurance: Yes____ No____ Health patterns at home: ADL’s: Independent___ Needs help with:__________________________________________________________________ Diet: ________________ # of Meals a day____ Snacks (describe)___________________________________________ Sleep pattern ____________________________________ Aids to sleep_______________________________________ Elimination pattern: Voiding_______________________________________________________________ BM__________________________________ Use of laxatives/enemas: Yes__ No__ Alcohol use: No__ Yes ___ Type___________________ Daily amount_________________________________________ Smoking: No__ Yes __ Quit/ When? ________________ Type& Amount_______________________________________ Recreational drugs: No__ Yes ___ Type & Amount__________________________________________________________ List community resources used_________________________________________________________________________________ __________________________________________________________________________________________________________ Relevant family history: Hypertension ___ Diabetes___ Heart disease____ Stroke____ Cancer___ Other__________________ Advanced Directive: Living Will: Yes ___ No___ Developmental Stage (Erickson): _______________________________________________________________________________ Justify with examples of stage:________________________________________________________________________________ __________________________________________________________________________________________________________ Nursing considerations for stage ______________________________________________________________________________ __________________________________________________________________________________________________________

Pertinent medical/surgical or OB/GYN history: ___________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

Medications, herbs & OTCs used at home:

Medication & Dose Frequency Reason for taking


Patient Data Base

45

Patient Data Base

Pathophysiology of current medical diagnosis (explain how the medical diagnosis changes the patient’s normal

physiology)__________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

Symptoms on admission: ____________________________________________________________________________________

___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Admission Vital Signs:T._____ P.______ R. ____ B.P. _______Pain: location___________________ Scale 0/10_____

What does the client state as reason for admission: _________________________________________________________

________________________________________________________________________________________________

Current functional health status:(What can the client do now ? )

___________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Most recent V.S.: T_____ P______ R_____ BP_______ Pain: Location________________________ Scale 0/10_____ Last 24hr. Intake_________ Output ___________ Most recent weight__________ Date of last BM___________

Current Primary Care Provider (MD) Orders:

Activity: Fall risk: low__ med__ high__Assist devices:

Vital signs: I&O: Blood Glucose

I.V. site: _______________________ Saline (peripheral) lock: No __ Yes__ Flush frequency__________ Intravenous solution(s):_____________________________ rate: ________ml/hr _______gtts/min rate:________ml/hr _______gtts/min

Diet: Tube feedings: method_____________ formula____________________ rate______

Oxygen:___________L/min method____________________ TCDB: __________ IS__________ Respiratory treatments/procedures:

Tubes, Drainage devices, Catheters: _______________________________________________________________________________

Dressings:

Restraints:

Other:

Scheduled diagnostic tests:

Code Status: Full______ DNR_______ Other____________ Living Will________ DPA_____

Current Teach/Learn needs: ____________________________________________________________________________________

____________________________________________________________________________________________________________

Possible discharge needs: _____________________________________________________________________________________

____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________


NUR 141/142 Physical Assessment

46

Describe assessments that are not within normal limits

Neuro

/Sensory

LOC

Speech/Pupils

Motor Response

Communication

Vision/Hearing Restraints

Pain

Alert Oriented Disoriented Lethargic Unresponsive Clear Slurred Aphasia Nonverbal PERRL Other (L)____ (R)____ Follows instruction/spontaneous movement Other ______________________________________________ Movement/Strength of U.E. Rt_________ Lt_________ L.E. Rt_________ Lt_________ Grasps ideas and questions Other_________________________________________________ WNL Wears glasses Blind WNL Hearing aid R L Deaf NA Type _____________ None Yes Location:________________ Intensity (0-10)________ Radiates_______________ Relieved by:______________________________________________________________________ Other observations:__________________________________________________________________________ Plan: _________________________________________________________________________________________ _________________________________________________________________________________________

Card

iovascula

r Pulses

Heart sounds

Edema

Telemetry

Rhythm: Regular Irregular R Radial L Radial R Pedal L Pedal Present Present Absent Absent Strength________________ B.P._____________ Pulse Rate_________ Apical rate_______________

none Pitting Non-pitting Location ________________________________________________ Telemetry Rhythm (if applicable) _______________________________________________________________ Other observations:__________________________________________________________________________ Plan: _________________________________________________________________________________________ _________________________________________________________________________________________

Respirato

ry Effort

Breath sounds

Cough/Sputum

Rate____ Respirations even, regular, unlabored SPO2 ___ room air SPO2 ___ via _____@__L/min Clear Diminished Crackles Rhonchi Wheezes Absent Location of adventitious sounds:________________________________________________________________ None Nonproductive Productive Sputum (describe)_________________________________ Other observations:__________________________________________________________________________ Plan: _________________________________________________________________________________________ _________________________________________________________________________________________

Gastr

oin

testinal Diet/swallowing

Comfort

Abdomen

Bowel sounds

Tubes

Elimination

Diet type ________________, _____%taken NPO Dysphagia ____________ Enteral feeding____ml/hr Tolerates diet well Nausea Emesis (describe) _________________________________________ Soft Hard Firm Distended Tender Active in all quads Hypoactive Hyperactive Absent State location:________________________ None N/G Salem Other: _________ Ostomy (type)_________ Describe drainage: _________ BM this shift (describe) _______________________ Constipation Diarrhea Other observations:__________________________________________________________________________ Plan: _________________________________________________________________________________________ _________________________________________________________________________________________


NUR 141/142 Physical Assessment

47

Ren

al/U

rinar

y Voiding/pattern Diversion

Urine

Without complaints Dysuria Incontinent Condom Indwelling urinary catheter Suprapubic Amount:_____________ Color: ______________ Clarity:______________ Sediment:_______________________ Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________ __________________________________________________________________________________________

Mus

cuos

kele

tal Movement

ROM

Assist devices

Activity

Feed/Bath

Turn/Oral

Strength/movement equal Flaccid/weak: Rt___ Lt____ Tolerates activity well Other____________ Full active Passive Restricted___________________ Immobile_____________________________ Contractures ______________________________________ Hip precautions None Cane Crutches Walker W/C CPM Venodyne/SCD/Pneumonatic boots Ambulates by self Ambulates with assist Up in chair Other:_________________________________

No assistance required Fed with assistance Fed by staff Partial bath Complete bath

Turn with partial assist Turn with max. assist Oral care with assist Oral care by staff

Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________ __________________________________________________________________________________________

Inte

gum

enta

ry Appearance

Incision

Dressing

Warm Dry Skin color appropriate Cool Diaphoretic Pale Flushed Cyanotic Jaundiced Intact Redness/Rash Lesion/Wound (describe)_______________________________ _____________________________________________________________________________ None Approximated Clean Dry Staples in place Reddened Open Swollen None Yes/Location__________________________________________________________ Dry Drainage(describe)_____________________________________________________ Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________ __________________________________________________________________________________________

Rep

rodu

ctiv

e Complete on all patients

Birth control method______________ Last menses___________ Last PAP smear _____________ None Itching Bleeding Discharge (describe)_____________________ Pain Breast lumps Pregnant SBE STE Last mammogram___________ Last testicular exam_________ Rectal__________ Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________ __________________________________________________________________________________________

En

do

crin

e/M

etab

olic

Temperature ______________ Height__________ Weight_______________ Blood glucose________________ Polyuria Polydipsia Polyphagia Heat intolerance Cold intolerance Nervousness Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________ __________________________________________________________________________________________

Psy

chos

ocia

l Emotional status

Support/Coping

Care participation Code status

Calm Anxious Depressed Irritable Frightened Aggressive Other:__________________ Coping/support systems adequate Family/friends visit Visit by chaplain Sacraments of the sick Support system:______________________________________________________________________________ Active Passive Non-compliant Non-responsive Full Code No Code Limited Code_________________________ Concerns related to hospitalization:________________________________________________________________ Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________ __________________________________________________________________________________________

Ris

k I.D

. Precautions

Siderails/Safety

Skin breakdown Falls Patient checked q1hr Restraints Type ______________________________ Respiratory Contact Neutropenic All down Top rails up Top & bottom up Bed in low position Call bell within reach Brake on Other observations:__________________________________________________________________________ Plan: _____________________________________________________________________________________


Lab and Diagnostic Studies

48

Name of Test

Normal Range

Patient Values Date Date Date

Significance/Trend of Lab Test Nursing Actions

Review all lab values, normal & abnormal, as they apply to your client’s plan of care. Indicate relationships between medical diagnosis, lab test results, medications, and treatments.

Napa Valley College Associate Degree Program in Nursing N 142 – Medication Assignment Form

49

Name: _______________________________________________________ Date of Care: __________________ Patient’s Initials_____________ Room Number _________

Allergy Reaction Allergy Reaction

Medication Teaching Which medication? What did you teach and how did you adapt your teaching style to meet individual need or special considerations? Patient response:

Date

Ordered Medication

Trade Name Generic Name Dose Route Frequency Safe Range Age Related Considerations

Times given

1) Class 2) Action 3) Side Effects 4) Why administered

Nursing Implications Expected Outcome Evaluation

Date Ordered

Medication Trade Name Generic Name Dose Route Frequency Safe Range Age Related Considerations

Times given



Date Ordered


Times given



Napa Valley College Associate Degree Program in Nursing N 142 – Medication Assignment Form

50

N 141 Medication Assignment Form

Name: _______________________________________________________ Date of Care: __________________ Patient’s Initials_____________ Room Number _________

Date Ordered


Times given



Date Ordered


Times given



Date Ordered


Times given



Date Ordered


Times given



Date Ordered


Times given



51


Nursing Care Plan

Student’s Name: ______________________________________________________________ Date: ________________________ Client’s initials: ____________

Prioritize your nursing diagnoses based on Maslow’s Hierarchy of Needs and give your rationale.

1. __________________________________________________________________________________________________________________________

2. __________________________________________________________________________________________________________________________

3. __________________________________________________________________________________________________________________________

What does your client identify as their long-term goal? ______________________________________________________________________________________

Nursing Diagnosis Relate to: (causes)

Evidenced by: (S & S)

Expected Outcomes

(Goals)

(Singular, measurable and realistic, dated)

Evaluation (Actual

Outcomes)

(Did nursing interventions lead to expected outcomes?)

Implementation

(Nursing interventions, actions, teaching, medical

treatments)

Rationale

(Scientific principles Evidence based - include source and

page numbers)

Refer to: Potter & Perry 8th edition: Fundamentals of Nursing

52

Nursing Diagnosis Relate to: (causes)

Evidenced by: (S & S)

Expected Outcomes

(Goals)

(Singular, measurable and realistic, dated)

Evaluation (Actual

Outcomes)

(Did nursing interventions lead to expected outcomes?)

Implementation

(Nursing interventions, actions, teaching, medical

treatments)

Rationale

(Scientific principles Evidence Based - include source and

page numbers)

53

SEMINARS

54

NURS 142 HIV and AIDS

Seminar Application of Critical Thinking Skills

Goal: By applying essential elements of critical thinking, this seminar is designed to guide students as they analyze and interpret articles about HIV and AIDS. Seminar Preparation:

In groups of 2 or 3 review an on-line article about the HIV+ and AIDS client.

Come to class ready to discuss the following questions with your small group. 1. What is the author’s purpose for writing this article? 2. What are the most significant ideas or concepts in this article? 3. What are the implications embedded in the article? 4. What inconsistencies or questions did you discover after reading this article?

Class Participation:

In your small group, take 20 - 30 minutes to discuss the answers to the above questions about the article your group chose to review.

Take 20 minutes to prepare a summary about your findings.

Each group will have 10 minutes to present the information from the article to your seminar group.

Decide, as a group, how best to present your findings. Be creative….remember there are other ways of presenting information besides lecture!

Use the time remaining to give your peers feedback and ask questions.

55


NURS 142 Seminar

Arthritis - Comparison of the Effects of Chronicity Across the Lifespan

Objectives: 1. Describe the characteristics of Rheumatoid Arthritis, Osteoarthritis, Juvenile Idiopathic

Arthritis. 2. Compare the similarities and differences of RA, osteoarthritis, and JIA. 3. Determine how the nursing assessment, diagnoses, goals, and interventions would differ

between the three types of arthritis. 4. Describe how the nursing care plans would be modified on the basis of age specific

concerns. Instructions: Using your texts as resources

1. In groups of 3-4 a. Define the assigned arthritis condition and list defining characteristics, including

diagnostic tests b. Identify the effects of the health alteration on the developmental stage of

individuals affected c. Develop an age-specific plan of care for a patient with the assigned health

alteration d. Identify drugs of choice for treatment and give rationale.

2. Present your plan to the class 3. As a class, identify common characteristics of all three health alterations. 4. As a class identify differences in treatment modalities and rationale.

Resources: Lewis, S. L., M., & Dirksen, S. R. (2011). Medical-Surgical nursing: assessment and management of clinical problems. (8th ed.). St. Louis: Mosby. Ball, J., & Bindler, R. (2012). Principles of Pediatric Nursing: Caring for Children. (5th ed.). New Jersey. Pearson.

56

Pediatric Health Promotion

Seminar & Group Teach Project N 142

Goal: Understand the characteristics, clinical manifestations, treatment, and nursing management of selected infectious and communicable childhood diseases. This seminar will help prepare you for your daycare experience next semester. Seminar Preparation:

1. Read: Ball, J.W., & Binder, R.C.(2012). Principles of Pediatric Nursing Caring for Children (5th ed.) Chapter 16

2. Brainstorm with seminar group ways of presenting information. 3. In teams of 3-4 have one student from each clinical group randomly select one of the

following topics. 4. Spend the remaining time working in small groups planning the teaching project.

Teach/Learn Guidelines: Develop a 10 minute teach using handouts, posters, and visual aids – be creative. Presentations should include, but are not limited to, the following key concepts: • The causative agent • Any preventive measures • Clinical manifestations • Treatment measures • Prognosis • Nursing Diagnosis

Due Date: This information will be presented to the entire class. See calendar. FYI – Yes, this content will be on your next exam. So read, listen and pay attention!

Childhood

immunizations

Chickenpox Fifth disease & Roseola

Influenza Type B

Measles (Rubeola & Rubella)

Mumps Pertussis Hepatitis B

Impetigo

Scabies & Lice Ringworm Streptocccus

57


NURS 142

Seminar – Care Planning for a Patient with Diabetes

Objectives:

1. Identify factors that place a person at risk for diabetes. 2. Describe assessment findings for a patient with diabetes 3. Explain diagnostic tests used for diabetes 4. Select and prioritize possible nursing diagnoses for a person with diabetes 5. Identify outcomes for a patient with diabetes 6. Formulate a plan of care to achieve desired outcomes for a person with diabetes 7. Explain the rationale for chosen interventions

Preparation:

Answer the questions in Castillo’s “Strategies, techniques, and approaches to thinking” : Sections “Diabetes Mellitus”, “Insulin Therapy”, and “The Patient with Diabetes”

Instructions:

In groups of four, review your conclusions regarding each of the section questions. (30 minutes)

Designated spokespersons for each group will share findings with the remaining groups. (30 minutes)

As a class, determine priorities of diagnoses and interventions and state rationale for choices.