stephen f. austin state university dewitt school of nursing … · 2010. 9. 2. · stephen f....

Stephen F. Austin State University

DeWitt School of Nursing

NURSING CARE OF CLIENTS WITH COMPLEX HEALTH NEEDS SYLLABUS

Course Number: NUR 406

Section Number: 001 - 007

Clinical Section(s): 010 - 016

Fall 2010

Course Instructors

Dr. Cindi McCarley, DSN, RN

Ms. Regina Low, MSN, RN

Ms. Laura Logan, MSN, RN

Ms. Wendy Donnell, MSN, RN

Christopher Ryan, MSN, RN

ALL INFORMATION IN THIS SYLLABUS IS SUBJECT TO THE WRITTEN

POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING, STEPHEN F.

AUSTIN STATE UNIVERSITY, NACOGDOCHES, TEXAS.

IN THE CASE OF COMMISSION, OMISSION, AMBIGUITY, VAGUENESS, OR

CONFLICT, THE POLICIES AND PROCEDURES OF THE SCHOOL OF NURSING

SHALL CONTROL.

EACH STUDENT SHALL BE RESPONSIBLE FOR ACTUAL AND/OR

CONSTRUCTIVE KNOWLEDGE OF THE POLICIES AND PROCEDURES OF THE

SCHOOL OF NURSING AND FOR COMPLIANCE THEREWITH.

EACH STUDENT IS RESPONSIBLE FOR ALL INFORMATION IN THIS SYLLABUS.

This syllabus is provided for informational purposes only.

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Faculty Contact Information:

Name: Cynthia McCarley, DSN, RN

Department: Nursing

Email: [email protected]

Office: Room 152

Phone: (936) 468-7717

Office Hours: Thursday: 10:00 a.m. - 12:00 noon; 1:00 p.m. - 4:00 p.m.

Friday: 10:00 a.m. - 12:00 noon; 1:00 p.m. - 4:00 p.m.

Name: Regina Low, MSN, RN Department: Nursing


Office: Room 180

Phone: (936) 468-7724

Office Hours: Thursday: 9:00 a.m. - 3:00 p.m.

Friday: 9:00 a.m. - 3:00 p.m.

Name: Laura Logan, MSN, RN Department: Nursing


Office: Room 172

Phone: (936) 468-7723

Office Hours: Tuesday: 8:30 a.m. - 11:30 a.m.

Wednesday: 8:30 a.m. - 3:30 p.m.

Name: Wendy Donnell, MSN, RN (Clinical Only) Department: Nursing


Office: Room 170

Phone: (936) 468-7727

Office Hours: Monday, 9 a.m. – 3:00 p.m.

Tuesday, 8:00 a.m. – 12 noon

Name: Christopher Ryan, MSN, RN (Clinical Only) Department: Nursing


Office: Room 124

Phone: (936) 468-7736

Office Hours: Monday, 1:00 p.m. – 4:00 p.m.

Wednesday, 8:30 a.m. – 3:30 p.m.

Please call in advance as times may vary due to committee obligations.

Class meeting times and places: Refer to Course Calendar for time and location.

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TEXTBOOKS & SUPPLIES

Required Texts:

All textbooks from prior nursing courses.

Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2007). Medical

Surgical Nursing: Assessment and Management of Clinical Problems (7th

Ed.). Mosby.

Baier, S. and Schomaker, M.K. (1985). Bed Number Ten. CRC Press, Inc.

Aehlert, B (2011). ECGs Made Easy (4rd

Ed.) Mosby (On line course resources available

for an additional fee.)

American Heart Association. (2005). ACLS Pocket Guide.

Silvestri, L. A. (2008). Comprehensive Review for the NCLEX-RN Examination.

Sanders.

Patient Reviews by Elsevier (On-line). May be purchased from any of the bookstores on

or near the SFA campus.

SUGGESTED TEXTS:

Any pocket sized critical care reference.

Course Description

This course builds upon concepts learned in MS I, previous, concurrent, and pre-requisite

courses. This course provides students with the opportunity to apply critical thinking, nursing

theory, research, and practice to clients of diverse spiritual, ethno cultural, and socioeconomic

backgrounds. Students will utilize the nursing process with clients experiencing acute/chronic

complex health problems in a variety of clinical settings. Emphasis is placed on the challenges if

meeting the needs of the acutely ill clients and a holistic manner and the nurse’s role in

addressing associated legal, ethical, and economic issues in conjunction with the

interdisciplinary health care team.

Number of Credit Hours

6 semester hours (3 hours didactic; 9 hours clinical practicum)

Prerequisites and Co-requisites

Prerequisites: NURS 330, NURS 331, NURS 332

Co-requisites: NURS 407, NURS 408

Program Learning Outcomes

Graduates of the program will:

1. Apply knowledge of the physical, social, and behavioral sciences in the provision of

nursing care based on theory and evidence based practice.

2. Deliver nursing care within established legal and ethical parameters in collaboration with

clients and members of the interdisciplinary health care team.

3. Provide holistic nursing care to clients while respecting individual and cultural diversity.

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4. Demonstrate effective leadership that fosters independent thinking, use of informatics, and

collaborative communication in the management of nursing care.

5. Assume responsibility and accountability for quality improvement and delivery of safe and

effective nursing care.

6. Serve as an advocate for clients and for the profession of nursing.

7. Demonstrate continuing competence, growth, and development in the profession of

nursing

General Education Core Curriculum Objectives/Outcomes

None

Student Learning Outcomes

The student will:

1. Relate concepts and principles of the arts, sciences, humanities, and nursing

2. assessment as sources for making nursing practice decisions.

3. Demonstrate responsibility and accountability using consistent behavior patterns and

4. professional communication.

5. Identify moral, ethical, economic, and legal issues affecting nursing assessment.

6. Utilize the nursing process when assessing clients of diverse developmental levels,

7. spiritual, socio-economic, and ethno-cultural backgrounds.

8. Develop principle elements of nursing assessment skills.

9. Distinguish normal from abnormal findings in the assessment of clients.

10. Document assessment findings clearly and succinctly.

11. Interact with interdisciplinary healthcare team members to integrate socio-economic,

12. spiritual, and ethno-cultural factors for holistic client assessment and care.

13. Relate research findings to history taking and assessment.

Course Requirements

See course calendar for specific assignment due dates.

Course Calendar

August 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday

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2

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4

5

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8

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10

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22

23

24

25

26

Faculty Meetings 8:30 am

College Meetings 10:00 am

Dept. Mtgs 11:00 am

27 SON Retreat 9:00 am

28

29

30

N-406 1-4 pm

31

N-408 Clinical Day (All 3rd Semester)

09/01

09/02

09/03

09/04

September 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday

08/29

08/30

08/31

1

HO- Nac Med Center 8:30-11 am

HO- WHMC 11-3 pm

N-407

1-5 pm

2

N-408 Clinical Day (all 3rd Semester) 9-5 pm

3

N-408 8-10 am

N-407 10-12 pm

4

5

6

Labor Day

7

N-406 8-12 pm

8

N-406 8-12 pm

9

N-406 8-12 pm

N-407 Skills 1-4:30 pm

10

N-408 8-10 am

N-407 1-4:30 pm

11

12

13

N-406 CV Simulation Micro/Sim 8-5 pm

14

N-406 9-4 pm

15

N-406 8-5 pm

16

N-406 A,B Clinical Practice 8-12 pm

N-406 (Class)

17

N-408 8-10 am

N-407 10-12 pm

N-406 Clinical

18

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1-4 pm

Orientation 2-5 pm

19

20

N-406 Exam #1 8-10 am

N-406 1-4 pm

21

N-406 A,B Clinical

N-407,408 E,F,G,H Clinical

22

N-406 A,B Clinical

N-407,408 E,F,G,H Clinical N-407 Exam #1 5-7 pm

23

N-408 Clinical All students Skyview/Hodge Orientation Group F: Burke

24

N-408 8-10 am

N-407 10-12 pm

25

26

27

N-406 E,F,G Clinical Practice 8-12 pm

N-406 1-4 pm

28

N-406 E,F Clinical

N-407,408 A,B,C,D Clinical

29

N-406 E,F Clinical


30


October 2010

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

09/26

09/27

09/28

09/29

09/30

1

N-408 8-10 am

N-407 10-12 pm

2

3

4

N-406 C,D,H Clinical Practice 8-12 pm

N-406 1-4 pm

5

N-406 C,D Clinical


6

N-406 C,D Clinical


7


8

N-408 8-10 am

N-407 10-12 pm

9

10

11

N-406 Exam # 2 8-10 am

N-406 1-4 pm

12

N-406 G,H Clinical


13

N-406 G,H Clinical


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15

N-408 8-10 am

N-407 10-12 pm

16

17

18

N-406 1-4 pm

19

N-406 A,B Clinical

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N-406 A,B Clinical

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N-407,408 E,F,G,H

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N-408 8-10 am

23

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Clinical

N-407 10-12 pm

24

25

N-406 1-4 pm

26

N-406 E,F Clinical


27

N-406 E,F Clinical


28


29

N-408 8-10 am

N-407 10-12 pm

30

31

November 2010

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

10/31

1

N-406 1-4 pm

2

N-406 C,D Clinical

N-408 B1,2 Clinical


3

N-406 C,D Clinical


4


5

N-408 8-10 am

N-407 10-12 pm

6

7

8

N-406 Exam # 3 8-10 am

N-406 1-4 pm

9

N-406 G,H Clinical


10

N-406 G,H Clinical


11


12

N-408 8-10 am

N-407 10-12 pm

13

14

15

N-406 1-4 pm

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N-406 A,B Clinical


17

N-406 A,B Clinical


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19

N-408 8-10 am

N-407 10-12 pm

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21

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N-406 1-4 pm

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24

THANKSGIVING

25

THANKSGIVING

26

THANKSGIVING

27

28

29

N-406 Exam # 4 8-10 am

N-406 1-4 pm

30

N-406 C,D Clinical


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December 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday

11/28

11/29

11/30

1

N-406 C,D Clinical


2

3rd Semester Clinical Make/Up

3

N-408 8-10 am

N-407 Exam #4 10-12 pm

4

5

6

N-408 Exam #3 8-10 am

N-407 HESI

Review

10-12 pm

N-406 1-4 pm

7

N-406 E,F Clinical

N-406 G,H Clinical

8

N-406 G,H Clinical

N-406 E,F Clinical

9

N-408 A,B,C,D Clinical Processing 8-10 am

N-408 HESI Exam Review 10-12 pm Group B: Burke

N-408 E,F,G,H Clinical Processing 1-3 pm

10

N-406 Final Simulation 8-5 pm

11

12

13

N-406 Exam #5 & Final Exam 12-3 pm

14

N-406 Med/Surg Exit HESI Exam 2-4 pm

15

16 N-408 HESI Exam 10-12 pm

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Pinning 7:00 pm

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Commence. 9:00 am

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01/01

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Grading Policy

Didactic Points

Exam I (Unit 1and Learning Lab) 65 (13%)

Exam 2 (Renal & Pulmonary) 65 (13%)

Exam 3 (Cardiovascular) 65 (13%)

Exam 4 (GI, Neuro) 65 (13%)

Exam 5 (Endocrine, MODs, Burns, Transplants + Clicker test average) 65 (13%)

Final Exam: HESI Critical Care Exam 75 (15%)

Patient Reviews 40 (8 %)

Summer Questions 15 (3 %)

Course Questions 45 (9 %)

Total 500 (100%)

It is necessary to obtain a WEIGHTED MEAN TEST SCORE OF 75 in the class exam

grades to pass this course. A weighted mean test score below 75 or a class average below 75

constitutes failure of Nursing 406 and will result in a grade of “F" on the transcript.

Clinical will be graded as a Pass/Fail. You must pass both the class and clinical in order to

pass Nursing 406 (Nursing Policy No. 25).

Medical/Surgical HESI Exam

The Medical/Surgical HESI Exam will be taken at the end of the semester. The student may

choose to replace their lowest course exam (exam 1-4 only) grade with the grade earned on the

Medical/Surgical HESI.

Attendance Policy

Attendance is not mandatory: however, all students are expected to attend classes regularly. Roll

will be taken during each class. Attendance is assessed and encouraged for the student to be

successful in Nursing 406.

Academic Integrity (A-9.1)

Academic integrity is a responsibility of all university faculty and students. Faculty members

promote academic integrity in multiple ways including instruction on the components of

academic honesty, as well as abiding by university policy on penalties for cheating and

plagiarism.

Definition of Academic Dishonesty

Academic dishonesty includes both cheating and plagiarism. Cheating includes, but is not

limited to (1) using, or attempting to use, unauthorized materials to aid in achieving a better

grade on a component of a class; (2) the falsification or invention of any information, including

citations, on an assigned exercise; and/or (3) helping, or attempting to help, another in an act of

cheating or plagiarism. Plagiarism is presenting the works or ideas of another person as if they

were your own. Examples of plagiarism are 1) submitting an assignment as if it were one’s own

work when in fact, it is at least partly the work of another; (2) submitting a work that has been

purchased or otherwise obtained from an Internet source or another source; and (3) incorporating

the words or ideas of an author into one’s paper without giving the author due credit.

Please read the complete policy at http://www.sfasu.edu/policies/academic_integrity.asp

http://www.sfasu.edu/policies/academic_integrity.asp

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Withheld Grades (Semester Grades Policy A-54)

Ordinarily, at the discretion of the instructor of record and with the approval of the academic

chair/director, a grade of WH will be assigned only if the student cannot complete the course

work because of unavoidable circumstances. Students must complete the work within one

calendar year form the end of the semester in which they received a WH, or the grade

automatically becomes an F. If students register for the same course in future terms the WH will

automatically become an F and will be counted as a repeated course for the purposes of

computing the grade point average.

The circumstances precipitating the request must have occurred after the last day in which a

student could withdraw from a course. Students requesting a WH must be passing the course

with a minimum projected grade of C.

Students with Disabilities To obtain disability related accommodations, alternate formats and/or auxiliary aids, students

with disabilities must contact the Office of Disability Services (ODS), Human Services Building,

and Room 325, 468-3004 / 468-1004 (TDD) as early as possible in the semester. Once verified,

ODS will notify the course instructor and outline the accommodation and/or auxiliary aids to be

provided. Failure to request services in a timely manner may delay your accommodations.

For additional information, go to http://www.sfasu.edu/disabilityservices/

Acceptable Student Behavior

Classroom behavior should not interfere with the instructor’s ability to conduct the class or the

ability of other students to learn from the instructional program (see the Student Conduct

Code, policy D-34.1). Unacceptable or disruptive behavior will not be tolerated. Students who

disrupt the learning environment may be asked to leave class and may be subject to judicial,

academic or other penalties. This prohibition applies to all instructional forums, including

electronic, classroom, labs, discussion groups, field trips, etc. The instructor shall have full

discretion over what behavior is appropriate/inappropriate in the classroom. Students who do not

attend class regularly or who perform poorly on class projects/exams may be referred to the

Early Alert Program. This program provides students with recommendations for resources or

other assistance that is available to help SFA students succeed.

http://www.sfasu.edu/disabilityservices/

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CLASS ASSIGNMENTS

1. Summer NCLEX Review Questions (15 points) (Due October 4, 2010):

1000 NCLEX style review questions (from any NCLEX Review Question computer program)

covering the following areas:

Content area # of Questions Question Sets_____ Points Received

Fundamentals 500 50 questions/set 10 sets total (7.5 points)

Medical/Surgical 500 50 questions/set 10 sets total (7.5 points)

Total 1000 20 question sets (15 points)

You must submit the minimum # of questions for each content area.

Submitted # of questions below the required minimum will result in 0 points for that

content area.

You may continue over the minimum amount of questions for a content area to obtain a

higher grade.

The highest grade received on a 50 question test will be the grade recorded for each

content area.

Please complete each content area in 50 question sections. For example, Fundamentals

will have 10 sets of 50 question sections.

2. Course NCLEX Question Review Assignment (45 points)

You are required to complete a minimum number of NCLEX style questions with each body

system we study. The number of questions required is found below. The designated number of

questions is the minimum required to obtain a grade on each assignment. The best grade earned

on at least a 50 question test is the grade you will receive.

Silvestri, L. A. (2008). Comprehensive Review for the NCLEX-RN Examination is

required for this assignment.

***** The questions are due the day of the test for each body system (Prior to taking the

test). No late assignments will be accepted.

Content area # of Questions Points Received

a. Renal 150 6.75

b. Pulmonary 200 9.0

c. Cardiovascular 300 13.5

d. GI 100 4.5

e. Neuro 150 6.75

f. Endocrine 100 4.5

Total 1000 45

3. Evolve RN Patient Reviews:

Students are required to complete the patient reviews assigned with each unit of study. These

reviews are designed to assist the student prepare for class each week. They will be due at the

beginning of the class.

You will turn in the printed score sheet you run when you complete the review. You will receive

full credit for the assignment if you attempted all the questions that accompany each

review. A grade of zero will be given if all the questions are not attempted. We are not using

the grade made on the reviews because they are designed to help the student review content and

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the rationales of the wrong answers are as helpful as the rationales of the correct answers.

Completing the reviews will give the student a better understanding of the disease process

discussed in lecture and will facilitate understanding of the lecture. Please complete these

assignments in the spirit they are intended (to assist the student understand the content, not as a

busy work assignment to be hurried through 30 minutes before class).

Please note the abbreviations used to identity the required reviews.

CC = Critical care reviews

AH = Adult health reviews

CNC = Clinical nursing concepts

The content area (example, cardiovascular) indicates where each review is under either the CC,

AH, or CNC labels.

4. Clicker tests. The Student is required to bring a clicker to class daily. Questions will be

inserted in each lecture. They will range from knowledge based questions that assesses the

students preparedness for class to critical thinking application questions that will prepare the

student for the exams. These tests will add up to one half of an exam grade.

5. Course Evaluations: Course evaluations may be completed on line towards the end of the

semester. Two points will be added to your final points (NOT an EXAM GRADE) if all

evaluations are completed prior to the Final Exam.

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Unit 1

ETHICAL AND LEGAL PRINCIPLES, END OF LIFE ISSUES, AND GERONTOLOGY

& NUTRITION OVERVIEW

Unit Objectives

1. Describe what constitutes an ethical dilemma.

2. Identify legal and professional obligations of critical care nursing.

3. Discuss specific legal scenarios including informed consent, Durable Power of

Attorney, DNR, Staffing issues, and application of life support measures.

4. Describe the physical and psychological manifestations at the end of life.

5. Explain the process of grief and bereavement at the end of life.

6. Examine cultural and spiritual issues related to end of life.

7. Describe the nursing management of dying patient.

8. Discuss the special needs of family in end of life care.

9. Describe the common etiologic factors, clinical manifestations and management of

malnutrition in the acutely ill patient.

10. Describe the needs of special populations of older acutely ill adults.

11. Describe nursing interventions to assist chronically and acutely ill older adults.

12. Describe common problems of older adults related to hospitalization and acute

illness.

Required Learning Activities

Lewis: Chapters 6, 11

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Unit 2

Problems of urinary function

(RENAL FAILURE) Unit Objectives

1. Explain the physiologic events involved in the formation and passage of urine from

glomerular filtration to voiding.

2. Describe age-related changes in the urinary system and differences in assessment

findings.

3. Perform a thorough bedside examination of a client's fluid volume status,

electrolyte balance and renal system differentiating between normal and abnormal

findings and state the significance of all abnormal findings.

4. Explain pertinent laboratory assessment data as it relates to fluid volume status,

electrolyte balance, and the function of the renal system.

5. Describe the pathophysiologic and psychosocial processes and related assessment

findings for the following renal systems disorders: select electrolyte imbalances,

fluid volume disorders, acute renal failure, chronic renal failure, and renal trauma.

6. Develop appropriate nursing diagnosis and collaborative problem statements with

goals for patients with the following renal system disorders: select electrolyte

imbalances, fluid volume disorders, acute renal failure, chronic renal failure, renal

trauma.

7. Identify appropriate medical and nursing interventions (with rationales) utilized

with each of the following renal system disorders: select electrolyte imbalances,

fluid volume disorders, acute renal failure, chronic renal failure, and renal trauma.

8. List evaluation criteria for each of the medical and nursing interventions used to

treat patients with renal system disorders.

9. Compare and contrast hemodialysis, peritoneal dialysis, and continuous renal

replacement therapy.

10. Utilize the nursing process in the care of the patient receiving hemodialysis,

peritoneal dialysis and continuous renal replacement therapy.

11. Discuss nutritional considerations for the client with renal alterations.

12. Describe gerontologic issues and management of the client with renal alterations.


1. Lewis, Chapters 45, 47

2. NCLEX Questions: 150 questions worth 6.75 points.

3. Patient Reviews:

a. Rusty Jackson (CNC/fluid & electrolyte balance) – due 9/16/10

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UNIT 3

PROBLEMS OF OXYGENATION: VENTILATION

(PULMONARY VASCULAR)

Unit Objectives

1. Discuss the nursing management of the patient who requires a tracheostomy.

2. Identify the steps involved in performing tracheotomy care and suctioning an

airway.

3. Discuss the nursing management of the patient with a laryngectomy.

4. Describe the methods used in voice restoration for the patient with temporary or

permanent loss of speech.

5. Describe the pathophysiology, types, clinical manifestations, and collaborative care

of pneumonia.

6. Explain the nursing management of the patient with pneumonia.

7. Describe the pathogenesis, classification, clinical manifestations, complications,

diagnostic abnormalities, and nursing and collaborative management of

tuberculosis.

8. Identify the causes, clinical manifestations, and nursing and collaborative

management of pulmonary fungal infections.

9. Compare and contrast extrapulmonary and intrapulmonary restrictive lung disorders

in terms of causes, clinical manifestations, and collaborative management.

10. Identify the mechanisms involved, clinical manifestations, and management of

pneumothorax, fractured ribs, and flail chest.

11. Describe the purpose, methods, and nursing responsibilities related to chest tubes.

12. Describe the pathophysiology, clinical manifestations and management of

pulmonary embolism, pulmonary hypertension, and cor pulmonale.

13. Compare the pathophysiology that result in hypoxemic and hypercapnic respiratory

failure.

14. Differentiate between early and late clinical manifestations of acute respiratory

failure.

15. Describe the nursing and collaborative management of the patient with hypoxemic

or hypercapnic respiratory failure.

16. Discuss the pathophysiology, clinical manifestations, nursing and collaborative

management of the patient with ARDS.

17. Identify complications that may result from acute respiratory failure or ARDS and

measures to prevent or reverse these complications.

18. Describe age-related changes in the respiratory system and differences in

assessment findings.


Lewis, Chapters 26, 28, 66 (Artificial airways & mechanical ventilation: pages 1751-1769), 68.

NCLEX Questions: 200 questions worth 9 points.

Patient Reviews:

William Bennett (CC/respiratory – due 9/27/10

Mr. Hannigan (AH/respiratory) –due 10/4/10

Timothy Smythe (CC/respiratory) due 10/4/10

Worksheets:

Pulmonary vascular disease overview – due 9/27/10

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Unit 4

PROBLEMS WITH OXYGENATION: PERFUSION

(CARDIOVASCULAR)

Unit Objectives

1. Discuss common assessment abnormalities of the cardiovascular system. (page 749)

2. Differentiate between the CV abnormalities in presentation in each gender. (page

744-751)

3. Discuss the principles of hemodynamic monitoring and related collaborative care of

critically ill patients. (page1738-1748)

4. Describe the purpose, indications, and function of circulatory assist devices and

related collaborative care.

5. Describe the precipitating factors, types, clinical manifestations, collaborative care,

and nursing management of angina pectoris.

6. Describe the clinical spectrum of acute coronary syndrome.

7. Describe the pathophysiology of myocardial infarction from the onset of injury

through the healing process.

8. Describe the clinical manifestations, complications, diagnostic study results, and

collaborative care of the patient with a myocardial infarction.

9. Identify commonly used drug therapy in treating patients with coronary artery

disease and acute coronary syndrome.

10. Describe the nursing management of the patient following a myocardial infarction.

11. Describe the precipitating factors, types, clinical presentation, and collaborative

care of the patient with or at risk for sudden cardiac death.

12. Compare the pathophysiology of systolic and diastolic ventricular failure.

13. Discuss the compensatory mechanisms involved in congestive heart failure.

14. Describe the nursing and collaborative management of the patient with acute

congestive heart failure and pulmonary edema.

15. Explain the etiologies of acquired valvular heat diseases.

16. Describe the pathophysiology and clinical manifestations and diagnostic studies for

the various types of valvular heart disease.

17. Describe the collaborative care and nursing management of the patient with

valvular heart disease.

18. Describe the pathophysiology, clinical manifestations, nursing and collaborative

management of patients with different types of cardiomyopathies.

19. Define shock.

20. Differentiate the two major classifications of shock: low blood flow and

maldistribution of blood flow.

21. Discuss the pathophysiology and clinical manifestations of the different types of

shock (cardiogenic and hypovolemic).

22. Compare the collaborative care, drug therapy, and nursing management of patients

with different types of shock (cardiogenic and hypovolemic).

23. Describe the management of patients with temporary and permanent pacemakers

and cardioverter-defibrillators.

24. Describe gerontologic issues and management of the client with cardiovascular

disorders.

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Lewis: Chapters 32-38, 66 (Hemodynamic monitoring & Circulatory assist devices: pages 1738-

1751), 67 (Shock: pages 1772-1794).

NCLEX Questions: 300 questions worth 13.5 points.

Patient Reviews:

Mr. Whiting (1) (CC/cardiovascular) – due 10/11/10

Mr. Cole (AAA) (AH/peripheral vascular) – due 10/18/10

Mr. Erickson (AH/cardiovascular) – due 11/1/10

Mr. Whiting (2) (CC/cardiovascular) - due 11/1/10

Worksheets:

Shock overview – due 10/18/10

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Unit 5

PROBLEMS OF INGESTION, DIGESTION, ABOSORPTION, AND ELIMINATION

(GASTROINTESTINAL)

Unit Objectives

1. Describe the pathophysiologic and psychosocial processes and related assessment

findings for clients with gastrointestinal disorders.

2. Develop appropriate nursing diagnosis and collaborative problem statements with

goals for patients with gastrointestinal disorders.

3. Identify appropriate medical and nursing interventions (with rationales) utilized for

patients with gastrointestinal disorders.

4. List evaluation criteria for each of the medical and nursing interventions used to

treat patients with gastrointestinal disorders.

5. Discuss nutritional considerations for the client with gastrointestinal disorders.

6. Describe gerontologic issues and management of the client with gastrointestinal

disorders.

Required Learning Activity

Lewis, Chapter 39, 41, 42 (pp 990-1000), 44 (pp 1101-1124)


Patient Reviews:

Mr. Stone (CC/gastrointestinal) – due 11/8/10

George White (CC/gastrointestinal) – due 11/8/22

Mrs. Barker (AH/gastrointestinal) – due 11/8/10

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Unit 6

PROBLEMS RELATED TO MOVEMENT AND COORDINATION

(NEUROLOGICAL)

Unit Objectives

1. Identify the physiologic mechanisms that maintain normal intracranial pressure

(ICP).

2. Identify the common etiologies, clinical manifestations, and collaborative care of

the patient with increased ICP.

3. Differentiate types of head injury by mechanism of injury and clinical

manifestations.

4. Discuss the collaborative care and nursing management of the patient with a head

injury.

5. Discuss the nursing management of the patient undergoing cranial surgery.

6. Describe the classification of spinal cord injuries and associated clinical

manifestations.

7. Describe the pathophysiology, clinical manifestations, collaborative care, and

nursing management of spinal cord injury.

8. Describe the nursing management of the major physical and psychological

problems of the patient with a spinal cord injury.

9. Compare and contrast the pathophysiology, clinical manifestations, collaborative

care, and nursing management of autonomic dysreflexia and of spinal cord.

10. Compare and contrast the etiology and pathophysiology of ischemic and

hemorrhagic strokes.

11. Correlate the clinical manifestations of stroke with the underlying pathophysiology.

12. Identify diagnostic studies performed for patients with strokes.

13. Describe the collaborative care, drug therapy, and nutritional therapy for a patient

with a stroke.

14. Describe the acute nursing management of the patient with a stroke.

15. Discuss the nursing diagnosis and collaborative care of patients with arteriovenous

malformations.

16. Discuss the care of the patient with Carotid Endarterectomy.

17. Describe gerontologic issues and management of the client with neurological

alterations.


Lewis, Chapters 56, 57, 58, and 61 (Spinal cord injuries: pages 1589-1609).


Patient Reviews:

Mr. Jim Brown (CC/neurological) – due 11/15/10

Mr. John Wright (CC/neurological) – due 11/15/10

Mrs. Thorne (CC/neurological) – due 11/22/10

Worksheets:

Pathophysiology of a brain injury – due 11/15/10

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Unit 7

PROBLEMS RELATED TO REGULATORY MECHANISMS

(ENDOCRINE)

Unit Objectives

1. Discuss Acute Thyrotoxocosis (page 1302-1305)

2. Discuss issues related to SIADH and DI. (page 1295-1297)

3. Discuss acute complications of diabetes mellitus- DKA and NKHN. (page 1278-

1281)

4. Describe gerontologic issues and management of the client with endocrine

disorders.


Lewis, Chapter 48 & 50.


Patient Reviews:

Mary Kelly (AH/endocrine) – due 11/29/10

Louise Miller (CC/endocrine) – due 11/29/10

Mrs. Wilson (CC/endocrine) – due 11/29/10

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UNIT 8

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN

DYSFUNCTION SYNDROME

Unit Objectives

1. Describe the pathophysiology, clinical manifestations, nursing and collaborative management

of patients experiencing system inflammatory response syndrome and multiple organ

dysfunction syndrome.


Lewis, Chapter 67 (pages 1794-1797.

2. Worksheets:

a. The pathophysiology of MODS – due 12/6/10

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Unit 9

NURSING CARE OF CLIENTS EXPERIENCING MAJOR THERMAL INJURIES

Unit Objectives

1. Describe the causes and prevention of burn injuries.

2. Describe the burn injury classification system.

3. Describe the relationship between the involved structures and the clinical

appearance of partial and full-thickness burns.

4. Identify the parameters used to determine the severity of burns.

5. Describe the pathophysiology, clinical manifestations, complications, and nursing

and colloborative management of the three burn phases.

6. Explain fluid and electrolyte shifts during the emergent and acute burn phases.

7. Describe the nutritional therapy of the burn patient during three burn phases.

8. List the American Burn Association's criteria for determining burn injuries that

should be referred to a regional burn center.

9. Describe emergency management of thermal, chemical, electrical, and inhalation

injury.

10. Identify appropriate medical and nursing interventions (with rationales) utilized for

patients in the resuscitation, acute, and rehabilitation phases of burn injuries.


Lewis, Chapter 25.

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UNIT 10

ORGAN DONATION AND TRANSPLANTATION

Unit Objectives

1. Discuss how brain death is determined and the sources of organ donors.

2. Describe the various kinds of organ transplants and the types of rejections following

transplantation.

3. Describe the nurses’ role and responsibility in preparing a patient for potential

organ donation.

4. Explain the pathophysiology of transplant rejection.

5. Identify the types and side effects of immunosuppressive therapy.


Lewis, Chapter 14 (pages 219-228, 235-242).

Patient Reviews:

a. Margie Thompson (CC/gastrointestinal) – due 12/6/10

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CLINICAL SYLLABUS

Clinical meeting time and place:

Nacogdoches Memorial Hospital

Lufkin Memorial Hospital,

Woodland Heights Hospital

See calendar for times and location.

Text and Materials:

Same as for the class.

Clinical Experience

PURPOSE: The purpose of the Clinical practicum is to provide the senior nursing student a 126

hour clinical practicum in order to utilize the nursing process as a framework for practice with

clients requiring intensive nursing care. In addition, the course is designed to facilitate and

improve proficiency in providing nursing interventions; organizational skills required to care for

acutely ill patients', communication skills utilized with clients, families and other health care

professionals to promote optimum well-being; and demonstration of responsibility and

accountability for self-direction, self-evaluation, and for nursing care provided for a group of

patients.

Clinical Hours

Activity Clinical Hours

Hospital orientations 6

Hospital experience 60

Learning labs 22

Micro simulations 6

Clinical simulations 8

Alternate Clinical Experiences 24

Total 126

"Bed Number Ten" (Due 10/4/10)

The student is required to read "Bed Number Ten" by Sue Baier. On completion of the book you

will submit a one to two page typed paper (APA style) explaining how you think that the reading

of this book will affect your clinical practice. This is a clinical assignment and will be graded

pass/fail.

Micro Sims

The student is required to complete 6 micro simulations this semester. They must be completed

by 9/20/10. This is a clinical assignment and will be graded pass/fail. A 75% must be obtained

on each simulation in order to pass. The student must continue to work the simulation until a

75% is achieved. Each student will record the grades obtained on a grade sheet and turn in on the

assigned date.

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The following micro simulations are required:

1. Jennifer Hoffman – complex case

2. Carl Shapiro – complex case

3. Stan Checketts – complex case

4. Doris Brown – complex case

5. Floyd Bennett – complex case

6. Vincent Brody – complex case

Clinical Simulations

1. Each student will complete 8 hours of simulation and skills practice this semester.

2. Each student will complete 2 complex simulations this semester.

More information will be provided at the beginning of the semester.

Hospital Orientations (9/1/10)

All students are required to attend Woodland Heights Medical Center and Nacogdoches Medical

Center hospital orientations and complete the online orientations for Nacogdoches Memorial and

Lufkin Memorial and the Nacogdoches Memorial Hospital restraint PowerPoint. The

Completion forms must be signed and turned in by 9/1/10.

Emergency Room/Cardiac Cath Lab

Each student will spend one 8 hour day divided between the emergency room and the cardiac

cath lab. This is in addition to the 60 hours spent in acute care areas. Assignments will be posted

on blackboard for this clinical experience. This will be a precepted clinical day. Ms. Donnell will

be the clinical instructor for this experience.

Cardiac/Pulmonary Rehabilitation

PRACTICUM/CLINICAL OBJECTIVES

1. Assess clients with complex health needs using inspection, palpation, percussion, and

auscultation, as well as advanced assessment equipment (i.e. hemodynamic monitoring,

cardiac monitors, arterial lines, etc.)

2. Establish nursing diagnosis for clients with complex health needs based on information

gained in client assessment.

3. Plan and implement appropriate nursing care for clients with complex health needs.

4. Evaluate nursing care of clients with complex health needs.

5. Modify the plan of care based on evaluation results.

6. Document care in organized clearly stated fashion on paper and electronically.

7. Formulate accurate and concise shift report.

8. Demonstrate understanding of proper use of simple to sophisticated client care equipment.

9. Administer medications according to the 8 rights.

10. Demonstrate understanding of medications, their interactions, and side effects.

11. Utilize national standards when delivering nursing care for clients with complex health

needs.

12. Identify legal and ethical issues that arise in the care of clients with complex health

needs.

13. Apply appropriate research findings to clinical practice.

14. Develop and implement client education based on learning needs assessment.

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15. Meet Learning Lab Objectives:

1. Explain the important electrocardiographic findings, clinical significance, and nursing

actions for each of the cardiac rhythms found in the following classes of

dysrhythmias: sinus, atrial, junctional, ventricular, and all heart blocks.

2. Describe the significance of arterial blood gas values and the oxyhemoglobin

dissociation curve in relation to respiratory function.

3. Interpret arterial blood gases, describing the pathophysiology, clinical manifestations,

and nursing and collaborative management.

4. Demonstrate sterile technique while caring for and changing dressings of various

types of central venous lines.

5. Demonstrate the appropriate techniques needed to:

a. access various central venous lines

b. draw blood from the lines

c. flush the lines to maintain patency

6. Describe nursing assessment and management of a client receiving oxygen therapy.

7. List the indications for, complications of, and nursing management of artificial

airways.

8. Differentiate the indications for and modes of mechanical ventilation.

9. Apply the nursing process to the client receiving mechanical ventilation including

assessment, planning, nursing diagnosis, intervention and evaluation.

10. Apply the nursing process to the client with chest tubes including assessment,

planning, nursing diagnosis, intervention and evaluation.

11. Demonstrate endotracheal, tracheal and nasopharyngeal suctioning using sterile

technique by both the closed in-line suction apparatus and the open technique.

12. Demonstrate care of the two cannula tracheotomy using sterile technique.

13. Demonstrate the calculations needed to administer the correct doses off all pertinent

critical care medications.

14. Discuss nursing care and interventions appropriate for blood product administration.

Learning Lab Topic Outline:

Pulmonary assessment and therapeutic modalities (O2, ABG analysis and interventions,

endotracheal intubation and ET tube management, ventilator care and management, chest tube

management)

Blood administration

Cardiac rhythm strip interpretation and treatment

Practice treating life threatening cardiac rhythms (putting it all together)

Critical care drug calculations

Evaluation - Clinical Component

Purpose: The purpose of the clinical evaluation process utilized in NUR 406 provides a method

of determining whether desired outcomes have been successfully achieved by the student and to

determine whether the student has sufficient knowledge for the established level of clinical

practice to enter professional nursing practice following completion of the course. Clinical

practicum evaluation will be focused on both the progress through the clinical practicum (in

learning and practicing new knowledge and skills) and on past learning knowledge and skills.

For example, a student performing endotracheal suctioning for the first time will not be

evaluated on his/her ability to successfully suction or his/her ability to remember the procedure

since first-time experiences are very anxiety provoking. However, the student will be evaluated

on past learning, e.g., knowledge of aseptic technique. Contamination of the catheter would only

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be evaluated as unsatisfactory if the student fails to acknowledge the need to acquire a new

catheter.

Method of evaluation: Daily summative clinical evaluations, final evaluations, counseling

conferences, clinical skills evaluation, nursing assessments and oral nursing processes and

clinical correlation maps.

Clinical performance will be evaluated using the clinical evaluation form found on line.

Absence from Clinical Policy: Attendance is mandatory for all clinical hours. To be an excused absence the student must be

excused directly by the clinical instructor. The only excused absence is one related to illness of

self, or death of immediate family member, or significant other. The student must bring a written

excuse by the health provider or an obituary notice.

Absence from the clinical area exceeding 10% will result in a clinical failure regardless of the

reasons (including excused absences). Refer to Policy # 21 in the student handbook.

A day at the end of the semester will be scheduled for clinical make up days. Any clinical

time missed will be made up regardless of reason for absence. If more than one clinical day

needs to be made up arrangements will be made.

Requirements for passing clinical:

To receive a satisfactory clinical grade, the nursing student must:

1. Adhere to the policies stated in the student handbook.

2. Obtain a ‘satisfactory’ on all criteria found on the clinical evaluation.

3. Give a satisfactory demonstration of all selected clinical skills.

4. Give satisfactory performance in all oral or written process recordings and complete all

prescribed remediation.

Students may not receive more than 2 clinical "F" days and receive a passing grade in the

course.

Post Conference: Post conference for the clinical practicum will be held at least once weekly.

Students are expected to organize their care so that they can attend post conference on time on

the clinical days as scheduled. The student will give an updated report on each assigned patient

to the Nurse before leaving -the floor. The report should include:

1. Client's name, room number, age, physician, date of admission, diagnosis, date and type of

surgical procedure.

2. Diet, scheduled snacks, and any assistance required in feeding, amount of diet taken during

the shift and tolerance, any special notations (i.e., NPO at midnight for tests or surgery (NG tube

to low suction, etc.).

3. Prescribed activity, activity during shift and tolerance.

4. Orders for intake and/or output and amounts for the shift; whether the patient has had a stool

during the shift.

5. Vital sign frequency and/or special instructions (i.e., neuro checks, CMS checks) and

pertinent changes in these parameters.

6. Amount, route and frequency of oxygen administration, special considerations such as

suctioning requirements.

7. Current treatments to be done by the oncoming shift and pertinent information related to the

treatments.

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8. Scheduled studies for the next two shifts. Scheduled studies completed on your shift and any

results.

9. General condition and special needs.

10. Specific changes over the last 12 hours.

11. Problems or potential difficulties.

12. Significant medications or IV therapy, i.e., reactions, blood administration, anticoagulant

therapy, sliding scale insulin, titrated drips, chemotherapy.

13. Pending discharges and/or transfer.

14. Any relevant information essential to proper care of the patient.

Medication Administration

The student will follow the institutions medication administration policies. The student must

access two patient identifiers for example by checking the clients arm band and asking the

client his/her name and birth date prior to all medication administration.

Students are to properly document medication administration following hospital policy. Students

are expected to know the indications for, dose, and side effects to observe for prior to

administration of any drug.

Should an error in medication occur, the instructor should be notified immediately and the

proper documentation forms initiated. The decision to give an F Day is left to the discretion

of the clinical instructor. The clinical instructor or the nurse must verify PO and SQ meds before student administration.

The nurse or clinical instructor must accompany the student during IV or IM medication

administration.

Students may administer narcotics only after a licensed nurse has verified the drug, dosage and

route and co-signed the narcotic record with the student. The nurse must be in attendance for the

student to administer any narcotic.

ALL MEDICATIONS INCLUDING THOSE REQUIRING CALCULATIONS

(INCLUDING TITRATED IV MEDICATIONS) MUST BE VERIFIED BY THE

INSTRUCTOR OR THE PATIENT’S PRIMARY NURSE PRIOR TO

ADMINISTRATION.

Critical care medications: the student is required to check the calculations of all continuous

IV medications that are hanging on their patients (dopamine, lidocaine, dobutamine,

inocor, heparin, morphine, ativan, propofol, etc.). These calculations will be written down

and checked by the instructor by 10:00 a.m. each clinical day.

The Clinical Concept Map

A written Clinical Concept Map will be given to the instructor at the beginning of each clinical

day for all ICU patients being cared for and IMC/Step-Down/Med Specialty Hospital patients at

the discretion of the instructor. There is no "right" way to draw the map. The purpose of the map

is to describe the relationships between the patient's problems, signs and symptoms, therapies,

and nursing diagnosis or problems. It will be evaluated on a pass/fail basis depending on the

completeness of the map as well as the student's ability to verbally explain the map. The map

will be reviewed with the instructor each day of clinical. Failure to complete the map or

adequately defend it will result in the student receiving an "F" day and being pulled off of patient

care activities for that day.

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Concept Map Guidelines

Map out the pathophysiology of the disease. (Orange)

a. Be very detailed.

b. Place one concept or step of the pathology in each box.

c. Label the connections

2. List all of the risk factors or potential causes of the disease. (One in each box) (Pink)

a. Connect to pathophysiology.

b. Label the connections

3. Place all of the signs/symptoms, lab values, vital signs, diagnostic test findings, etc. in the

map connected to the appropriate pathology. (Yellow)

a. Label the connections

4. Identify appropriate Nursing Diagnosis and connect to the signs/symptoms, etc. (Purple)


5. Place all suggested treatments in the map with connections to either signs/symptoms,

vital signs, diagnostic test findings, or pathology. (Green)


When discussing the plan of care with your instructor you need to be able to explain the

following:

a. Why was each nursing diagnosis selected?

b. What are the priority nursing diagnoses/problems?

c. What are the priority nursing actions?

d. What conclusions did you draw from lab and diagnostic tests?

1. Why were the tests ordered?

2. What do the tests indicate?

3. Is any nursing action needed?

e. How appropriate is the stated outcome for your patient?

f. How will the interventions aid in achieving the desired patient outcome?

g. Are the expected outcomes for your patient being achieved through nursing and medical

intervention?

1. Were the daily outcomes met?

2. Have the nursing interventions been effective?

3. Are revisions needed in the outcomes or nursing interventions?

4. What has been the therapeutic effect of medications and treatments for your patient?

5. Has your patient experienced any side effects? If so, is any nursing action needed.

Critical Thinking Exercises

Critical Thinking Exercises are found under the clinical folder on NUR 406 Blackboard.

Students should have several copies of each and they will be completed at the discretion of the

clinical faculty.

stephen f. austin state university dewitt school of nursing … · 2010. 9. 2. · stephen f....

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