Textbooks
1.
Required
2.
Cox et al., Clinical Applications
of Nursing Diagnosis, 5th Edition, Publisher:
Required
3.
Lewis, et al., Medical-Surgical Nursing,
7th Edition, Publisher: Mosby.
Required
4.
Lewis, et al., Medical-Surgical Nursing – Study Guide, 7th
Edition, Publisher: Mosby.
Recommended
5.
Lilley, Harrington & Snyder, Pharmacology and the Nursing Process,
4th Edition, Publisher:
Mosby.
Required
6.
Luz Martinez de Castillo, S., Strategies, Techniques & Approaches
to Thinking, 2nd. Edition,
Publisher: Saunders.
Required
7.
Pagana, K. & Pagana, T., Mosby’s Manual of Diagnostic and
Laboratory Tests, 2nd. Edition,
Publisher: Mosby.
Required
8.
Potter, P. & Perry, A., Fundamentals of Nursing, 6th
Edition, Publisher: Mosby.
Highly Recommended
9.
Perry, A. & Potter, P., Clinical Nursing Skills & Techniques,
5th Edition, Publisher:
Mosby.
Highly Recommended
10.
Elsevier/Saunders.
Required
11.
ATI, Nursing Care of Children, RN Edition, Review Module.
Recommended (distributed in previous classes, not
available at the bookstore)
12.
ATI, Maternal-Newborn Nursing, RN Edition, Review Module.
Recommended (distributed in previous classes, not available at the
bookstore)
13.
ATI, Adult Medical-Surgical Nursing, RN Edition, Review Module.
Recommended (distributed in previous classes, not available at the
bookstore)
|
Nursing Complex Health Alterations II Course Outcome Summary
|
Information
|
Course Number |
10-543-113 |
|
Credits |
3 |
|
Instructional Area |
Nursing |
|
Instructional Level |
Associate Degree |
Description
|
Complex Health Alterations II prepares the learner to expand knowledge and skills from previous courses in caring for clients with alterations in the immune, neuro-sensory, musculoskeletal, gastrointestinal, hepatobiliary, renal/urinary and the reproductive systems. The learner will also focus on management of care for clients with high-risk perinatal conditions, high-risk newborns and the ill child. Synthesis and application of previously learned concepts will be evident in the management of clients with critical/life threatening situations. |
Prerequisites
|
1. |
Pre: Nursing Complex Health Alterations I |
|
2. |
Pre: Nursing Advanced Skills |
|
3. |
Pre: Nursing Mental Health and Community Concepts |
|
4. |
Pre: Nursing Intermediate Clinical Practice |
|
5. |
Pre: Microbiology |
Competencies
|
1. |
Evaluate nursing care for clients with alterations in the immune systems Performance Standards You will demonstrate your competence:
Your performance will be successful when: a. response incorporates
lifespan considerations when into the nursing process for clients with
alterations in the immune system b. response incorporates
lifespan considerations when describing the pathophysiology, etiology, and
clinical manifestations of alterations in the immune system c. response incorporates
lifespan considerations when identifying available agency and community
resources to promote care for clients with alterations in the immune system d. response incorporates
lifespan considerations when explaining procedures used to screen, diagnose,
and treat clients with alterations in the immune system e. response incorporates
lifespan considerations when planning nutritional interventions for clients
to promote/maintain health with alterations in the immune system f. response incorporates
lifespan considerations when integrating pharmacological therapy in the care
of clients with alterations in the immune system g. response incorporates
lifespan considerations when selecting teaching/learning topics to promote
self care for the client with an immune system alteration Learning objectives What you will learn as you master the competency: a. Describe the effects of the following variables on function of their immune system; age, gender, nutrition, psychoneuroimmunology, concurrent illness, cancer, medications, radiation b. Compare the different types of primary immunodeficiency disorders addressing causes, clinical manifestations, management, possible complications, and available treatments c. Describe the pathophysiology of HIV infection d. Describe the management of patients with HIV infection and AIDS e. Explain the physiologic events involved with allergic reactions f. Describe the management of patients with allergic disorders including measures to prevent and manage anaphylaxis g. Discuss the different allergic disorders according to type h. Explain the processes of inflammation and degradation in the development of rheumatic diseases i. Describe the assessment and diagnostic findings that may be evidenced by patients with a suspected diagnosis of rheumatic disease j. Describe the systemic effects of a connective tissue disease k. Apply the nursing process as a framework for the care of the patient with an immunodeficiency , HIV, allergic disorders, and a rheumatic disease, such as connective tissue disease or osteoarthritis |
|
2. |
Evaluate nursing care for clients with alterations in the neuro-sensory system (including CVA's) Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with neuro-sensory system alterations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the neuro-sensory system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the neuro-sensory
system c. response
incorporates lifespan considerations when explaining procedures used to screen,
diagnose, and treat clients with alterations in the neuro-sensory system d. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
neuro-sensory system e. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the neuro-sensory
system f. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the neuro-sensory system g. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with an neuro-sensory system alteration Learning objectives What you will learn as you master the competency: a. Describe the significance of physical assessment to the diagnosis of neurologic dysfunction b. Describe changes in neurologic functions associated with aging and their impact on neurologic assessment findings c. Describe diagnostic tests used for assessment of suspected neurologic disorders and the related nursing implications d. Describe the special nursing needs of patients with varied neurologic dysfunction e. Use the nursing process as a framework for care of the patient with altered level of consciousness f. Identify the early and late clinical manifestations of increased intracranial pressure g. Identify the various types and causes of seizures h. Use the nursing process to develop a plan of care for the patient experiencing seizures i. Identify the needs of the patient experiencing headaches j. Describe the incidence and social impact of cerebrovascular disorders k. Identify the risk factors for cerebrovascular disorders and related measures for prevention l. Compare the various types of cerebrovascular disorders: their causes, clinical manifestations, and medical management m. Use the nursing process as a framework for care of a patient in the acute stage of an ischemic stroke, recovering from an ischemic stroke, with a cerebral aneurysm, with a head injury, with a spinal cord injury n. Differentiate among patients with head injuries according to mechanism of injury, clinical signs and symptoms, diagnostic tests, and treatment options o. Identify the population at risk for spinal cord injury p. Describe three clinical feature of the patient with neurogenic shock q. Discuss the pathophysiology of autonomic dysreflexia and describe the appropriate nursing interventions r. Discuss clinical features of ocular disorders, diagnostic assessment and examinations, medical or surgical management, and patient care s. Identify methods to assess hearing and ways to communicate effectively with hearing impaired persons |
|
3. |
Evaluate nursing care for clients with alterations in the musculo-skeletal system Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with musculo-skeletal system alterations (format may be oral, written, or graphic)
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the musculoskeletal system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the musculoskeletal
system c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients with alterations in the musculoskeletal
system d. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the
musculoskeletal system e. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the musculoskeletal system f. response
incorporates lifespan considerations when selecting teaching/ learning topics
to promote self-care for the client with a musculoskeletal system alteration g. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
musculoskeletal system Learning objectives What you will learn as you master the competency: a. Describe the significance of physical assessment to the diagnosis of musculoskeletal function b. Compare the nursing needs of the patient undergoing total hip replacement with those of the patient undergoing total knee replacement c. Use the nursing process as a framework for care of the patient undergoing orthopedic surgery d. Use the nursing process as a framework for care of the patient with low back pain e. Explain the pathophysiology, pathogenesis, prevention and management of osteoporosis h. Describe the rehabilitative needs of patients with contusions, strains, sprains, and fractures i. Use the nursing process as a framework for care of the elderly patient with fracture of the hip j. Use the nursing process as a framework for care of the patient with a bone tumor, with an amputation |
|
4. |
Evaluate nursing care for clients with alterations in the upper gastrointestinal tract Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with upper gastrointestinal tract alterations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the gastrointestinal and hepatobiliary system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the gastrointestinal
and hepatobiliary system c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients with alterations in the gastrointestinal
and hepatobiliary system d. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
gastrointestinal and hepatobiliary system e. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the
gastrointestinal and hepatobiliary system f. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the gastrointestinal and
hepatobiliary system g. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with an gastrointestinal and
hepatobiliary system alteration Learning objectives What you will learn as you master the competency: a. Use assessment parameters appropriate for determining the status of upper gastrointestinal function b. Describe the appropriate preparation, teaching, and follow-up care for patients who are undergoing diagnostic testing of the upper gastrointestinal tract c. Use the nursing process as a framework for care of patients with conditions of the upper gastrointestinal tract d. Discuss purposes and nursing management of the patient who has a nasogastric, nasoenteric tube, or a gastrostomy tube e. Identify the purposes and nursing management of parenteral nutrition f. Compare the etiology, clinical manifestations, and management of acute gastritis, chronic gastritis, and peptic ulcer g. Use the nursing process as a framework for care of patients with peptic ulcer disease or gastric cancer h. Describe the dietary, pharmalogical, and surgical treatment of peptic ulcer i. Use the nursing process as a framework for care of patients undergoing gastric surgery j. Describe the home health care needs of the patient who has had gastric surgery |
|
5. |
Evaluate nursing care for clients with alterations in the lower gastrointestinal tract Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with lower gastrointestinal tract alterations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the gastrointestinal and hepatobiliary system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the gastrointestinal
and hepatobiliary system c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients with alterations in the gastrointestinal
and hepatobiliary system d. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
gastrointestinal and hepatobiliary system e. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the
gastrointestinal and hepatobiliary system f. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the gastrointestinal and
hepatobiliary system g. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with an gastrointestinal and
hepatobiliary system alteration Learning objectives What you will learn as you master the competency: a. Use assessment parameters appropriate for determining the status of lower gastrointestinal function b. Describe the appropriate preparation, teaching, and follow-up care for patients who are undergoing diagnostic testing of the lower gastrointestinal tract c. Identify the health care teaching needs of patients with constipation or diarrhea d. Compare conditions of malabsorption with regard to their pathophysiology, clinical manifestations, and management e. Use the nursing process as a framework for care of patients with diverticulitis, inflammatory bowel disease f. Compare regional enteritis and ulcerative colitis with regard to their pathophysiology, clinical manifestatons, diagnostic evaluation, and medical, surgical, and nursing management g. Describe the responsibilities of the nurse in meeting the needs of the patient with an ostomy h. Describe the various types of intestinal obstructions and their management i. Use the nursing process as a framework of care of the patient with cancer of the colon or rectum j. Use the nursing process as a framework for care of the patient with an anorectal condition |
|
6. |
Evaluate nursing care clients with alterations in the hepatobiliary system Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with hepatobiliary system alterations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the gastrointestinal and hepatobiliary system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the gastrointestinal
and hepatobiliary system c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients with alterations in the gastrointestinal
and hepatobiliary system d. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
gastrointestinal and hepatobiliary system e. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the
gastrointestinal and hepatobiliary system f. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the gastrointestinal and
hepatobiliary system g. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with an gastrointestinal and
hepatobiliary system alteration Learning objectives What you will learn as you master the competency: a. Identify the metabolic functions of the liver and the alterations in these functions that occur with liver disease b. Explain liver function tests and the clinical manifestations of liver dysfunction in relation to pathophysiologic alterations of the liver c. Relate jaundice, portal hypertension, ascites, varices, nutritional deficiencies, and hepatic coma to pathophysiologic alterations of the liver d. Describe the medical, surgical, and nursing management of patients with esophageal varices e. Compare the various types of hepatitis and their causes, prevention, clinical manifestations, management, prognosis, and home health care needs f. Use the nursing process as a framework for care of the patient with cirrhosis of the liver g. Compare the nonsurgical and surgical management of patients with cancer of the liver h. Describe the postoperative nursing care of the patient undergoing liver transplant i. Describe medical, surgical, and nursing management of patients with cholelithiasis j. Differentiate between acute and chronic pancreatitis k. Use the nursing process as a framework for care of patients with pancreatitis l. Describe the nutritional and metabolic effects of conditions and treatment of the patient with alterations of the pancreas |
|
7. |
Evaluate nursing care for clients with alterations in the renal/urinary system Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with renal/urinary system alterations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the renal/urinary system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the renal/urinary
system c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients with alterations in the renal/urinary
system d. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
renal/urinary system e. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the renal/urinary
system f. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the renal/urinary system g. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with an renal/urinary system alteration Learning objectives What you will learn as you master the competency: a. Identify the assessment parameters used of determining the status of upper and lower urinary tract function b. Describe the diagnostic studies used to determine upper and lower urinary tract function c. Initiate education and prepation for patients undergoing assessment of the urinary system d. Discuss the role of the kidney in regulating fluid and electrolyte balance, acid-base balance, and blood pressure e. Compare and contrast urinary retention and urinary incontinence in terms of their clinical manifestations, complications, and medical and nursing management f. Outline the principles of management of a patient with an indwelling urinary catheter or an ostomy g. Compare and contrast hemodialysis and peritoneal dialysis in terms of underlying principles, procedures, complications, and nursing considerations h. Use the nursing
process as a framework for care of patients undergoing kidney surgery |
|
8. |
Evaluate nursing care for clients with critical/life threatening situations (burns, shock, etc.) Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with critical/life threatening situations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
experiencing critical/life threatening situations b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of clients experiencing critical/life
threatening situations c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients experiencing critical/life threatening
situations d. response
incorporates lifespan considerations when planning nutritional interventions
for clients experiencing critical/life threatening situations e. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients experiencing critical/life threatening situations f. response
incorporates lifespan considerations when implementing the teaching/learning
process to promote informed decisions for the client and significant others g. response
incorporates lifespan considerations when proposing caring interventions to
provide for psychosocial needs of the client experiencing critical/life
threatening situations and their significant others h. response
incorporates lifespan considerations when exploring collaborative aspects of
caring for clients with critical/life threatening situations Learning objectives What you will learn as you master the competency: a. Describe shock and its underlying pathophysiology and organ damage that may occur with shock b. Compare hypovolemic, cardiogenic, and circulatory shock in terms of causes, pathophysiologic effects, and medical and nursing management c. Describe indications for varying types of fluid replacement d. Identify vasoactive medications used in treating shock, and describe nursing implications associated with their use e. Discuss the importance of nutritional support in all forms of shock f. Discuss the role of the nurse in psychosocial support of both the patient experiencing shock and the family g. Discuss the syndrome of multiple organ dysfunction h. Discuss the classification system used for burn injuries i. Describe the three phases of burn care and the priorities of care for each phase j. Describe the goals of burn wound care and management and the nurse's role in each k. Use the nursing process as a framework for care of the patient during the three phases of burn care l. Describe the concept of emerging infectious diseases and factors that lead to the development of these diseases m. List potential biological warfare agents and describe recommended precautions n. Develop a plan of care for a patient experiencing short- or long-term psychological effects after a disaster o. Identify the differences among the various chemical and bioterrorism agents used in terrorist events, their effects, and the decontamination and treatment procedures that are necessary |
|
9. |
Evaluate nursing care for clients with alterations in the reproductive system Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of patients with reproductive system alterations
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for clients
with alterations in the reproductive system b. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of alterations in the reproductive
system c. response
incorporates lifespan considerations when explaining procedures used to
screen, diagnose, and treat clients with alterations in the reproductive
system d. response
incorporates lifespan considerations when identifying available agency and
community resources to promote care for clients with alterations in the
reproductive system e. response
incorporates lifespan considerations when planning nutritional interventions
for clients to promote/maintain health with alterations in the reproductive
system f. response
incorporates lifespan considerations when integrating pharmacological therapy
in the care of clients with alterations in the reproductive system g. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with an reproductive system alteration Learning objectives What you will learn as you master the competency: a. Identify the diagnostic examinations and tests used to determine alteration in female reproductive function and describe the nurse's role before, during, and after these examinations and procedures b. Compare the various types of vaginal infections and the signs, symptoms, and treatments of each c. Use the nursing process as a framework for care of the patient with a vaginal infection, with a vulvovaginal infection d. Describe medical and nursing management for the patient with toxic shock syndrome e. Discuss the signs, symptoms, management, and nursing care implications of malignant disorders of the female reproductive tract. f. Use the nursing process as a framework for care of the patient undergoing a hysterectomy g. Describe the diagnostic tests used to detect breast disorders h. Use the nursing process as a framework for care of the patient with breast cancer i. Compare the therapeutic effectiveness of chemotherapy, surgery, and radiation therapy in treating breast cancer j. Discuss nursing assessment of the male reproductive system and identify diagnostic tests that complement assessment k. Discuss the causes and management of male sexual dysfunction l. Use the nursing process as a framework for care of patients undergoing different types of prostatectomy m. Describe the nursing management of patients with testicular cancer n. Describe the various conditions affecting the penis, including pathophysiology, clinical manifestations, and management |
|
10. |
Evaluate nursing care for the high-risk perinatal client Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of high risk perinatal clients
Your performance will be successful when: a. response
incorporates lifespan considerations into the nursing process for high risk
perinatal clients b. response
incorporates lifespan considerations when demonstrating provision of
psychosocial support for high risk perinatal client and family c. response
incorporates lifespan considerations when describing the pathophysiology,
etiology, and clinical manifestations of high risk perinatal conditions d. response
explains procedures used to screen, diagnose, and treat high risk perinatal
conditions e. response
identifies available agency and community resources to promote care for
clients with high risk perinatal conditions f. response
plans nutritional interventions for clients to promote/maintain health for
clients with high risk perinatal conditions g. response
integrates pharmacological therapy in the care of clients with high risk
perinatal conditions h. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote self care for the client with high risk perinatal conditions Learning objectives What you will learn as you master the competency: a. Discuss care management for the pregnant woman with metabolic disorders b. Discuss care management for the pregnant woman with pregestational or gestational diabetes c. Explain the effects on and the management of pregnant women with human immunodeficiency virus (HIV.) d. Discuss the care of pregnant women who use, abuse, or are dependent on alcohol or illicit or prescription drugs e. Describe the pathophysiology of preeclampsia and eclampsia f. Describe HELLP syndrome, including appropriate nursing actions g. Explain the effects of hyperemesis gravidarum on maternal and fetal well-being h. Compare and contrast placenta previa and abruptio placentae in relation to signs and symptoms, complications, and management i. Discuss the diagnosis
and management of disseminated intravascular coagulation (DIC) j. Differentiate signs and symptoms; effects on pregnancy, fetus, and newborn; management of maternal infections during pregnancy k. Explain the basic principles of care for a pregnant woman having abdominal surgery |
|
11. |
Evaluate nursing care for a high-risk newborn Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of high risk newborn clients
Your performance will be successful when: a. response
utilizes the nursing process for high risk newborn clients b. response
incorporates lifespan considerations when demonstrating provision of
psychosocial support for the family of the high risk newborn c. response
describes the pathophysiology, etiology, and clinical manifestations of high
risk newborn conditions d. response
explains procedures used to screen, diagnose, and treat high risk newborn
conditions e. response
identifies available agency and community resources to promote care for
clients with high risk newborn conditions f. response
plans nutritional interventions for clients to promote/maintain health for
clients with high risk newborn conditions g. response
integrates pharmacological therapy in the care of clients with high risk
newborn conditions h. response
incorporates lifespan considerations when selecting teaching/learning topics
to promote care for the family with high risk newborn conditions Learning objectives What you will learn as you master the competency: a. Discuss respiratory distress syndrome and the approach to treatment b. Describe nursing interventions for nutritional care of the preterm infant c. List the signs and symptoms of perinatal asphyxia and meconium aspiration syndrome d. Plan developmentally appropriate care e. Examine the needs of parents of high risk infants f. Summarize assessment and care of the newborn with soft tissue, skeletal, and nervous system injuries due to birth trauma g. Describe the asssessment of a newborn for infection h. Assess the effects of maternal use of alcohol, heroin, methadone, marijuana, cocaine, and smoking tobacco on the fetus and newborn i. Describe assessment, prevention, and management of hyperbilirubinemia j. Compare Rh and ABO incompatibility k. Describe each congenital disorder presented in the text and identify the priority of nursing care for each |
|
12. |
Evaluate nursing care for the ill child Performance Standards You will demonstrate your competence: o by responding to a case study or scenario of an acute or chronically ill child Your performance will be successful when: a. response
shows developmentally appropriate modification of nursing measures of the
acutely or chronically ill child b. response
incorporates lifespan considerations when identifying interventions that
minimize stress of illness and hospitalization for children and families c. response
incorporates effects of illness and hospitalization on the child and family Learning objectives What you will learn as you master the competency: a. Identify the stressors of illness and hospitalization for children during each developmental stage b. Outline nursing interventions that prevent or minimize stress to support the ill child, the child's parents and siblings during a child's illness and hospitalization c. Describe safe methods of administering oral, parenteral, rectal, optic, otic, and nasal medications to children d. Identify the scope of and changing trends in care of children with special needs e. Identify the major reactions of and effects on the family with a child with special needs f. Recognize the impact of the illness or disability on the developmental stages of childhood g. Outline nursing interventions that support the family at the time of death h. Formulate general guidelines for preparing children for procedures, including surgery i. Implement play in therapeutic procedures j. List general strategies for enhancing compliance in children and families
|
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
OVERVIEW
|
INCLUDES: |
|
1.
Course Description and Policies 2. Course Objectives |
|
|
Spring 2008
A. Lecture – Students are responsible for the material given in Lecture. Excessive absences, as determined by the lead instructor, will warrant individual attention.
B. Discussion Session – Students are required to submit a two- to three-page summary of Discussion Objectives and the completed Critical Thinking Exercise if absent. Additional make-up will be assigned at discretion of the instructor.
Please note and take advantage of the teacher consultation hours. They will be posted at the front desk.
C. The student is responsible for knowing his/her own academic status. It is the students' responsibility to contact a Nursing Complex Health Alterations 2 course instructor, the ADN Coordinator or the program advisor if she/he is in jeopardy of failing the course.
Note: To avoid disturbing others in Lecture and Discussion
Session, please turn off pagers, watch alarms, and cell phones.
NOTE:
|
If there is any reason that would interfere with your ability to complete the requirements of this course or to participate in the activities described in this syllabus, please contact the Dean of Health, Human and Protective Services. Reasonable requests for appropriate academic adjustments and reasonable modifications to policies and practices will be granted. Requests must be received prior to the third class section. |
COURSE POLICIES (Cont’d)
Grading PoliciesThis course must be completed satisfactorily in
order to progress in the Nursing Program.
Satisfactory completion includes the following: Requirements: 1.
Maintain an 80% average in
unit exams and final exam. Achieve an
80% average on Sr. Mentor paper, Nursing Practice Paper & Discussion
Sessions. 2.
Satisfactory in Discussion Sessions.
Participate actively in every Discussion Session. Instructor may require bib cards if
preparation for discussion appears weak.
A speech or presentation may be assigned for non-participation. 3.
Senior 4.
Nursing practice paper. Scholarly paper related to a topic covered
in the course. The Nursing process is
emphasized. See guidelines. Students must achieve 80% on the Nursing Practice
paper. If a student does not achieve
an 80% on the Nursing Practice paper, there will be one opportunity to redo
the paper at the Instructor’s discretion.
Any revised assignment cannot achieve a grade higher than 80%. 5.
Course evaluations completed and turned
in. Points earned for late assignments will be reduced
by 5% per calendar day. Reminder: In your portfolios, continue to save copies
of each required paper that you submit for the remainder of your courses. |
EXAMS Most unit exams will be held on Tuesdays. Note: Exams must ordinarily be taken on the day and time
scheduled unless prior
arrangements have been made with
instructor. If prior
arrangements are not made with the instructor, the student may
forfeit the option of taking the exam at an alternate time. The student will ordinarily be permitted to
take no more than one exam at an
alternate time. Any exam taken at an
alternate time will be based on a 95% maximum. The make-up exam must
also be completed before the next scheduled exam. ** Students are expected to
make an appointment with the lead instructor to discuss any exams below 80%. ATI- Policy Statement The ATI Comprehensive Assessment and Review Program (CARP) prepares students for the NCLEX by systematically strengthening their knowledge base throughout their nursing education. The program is designed to increase pass rates on the NCLEX and to lower program attrition rates by early identification of students at risk. CARP includes review material and assessments directed toward orientation/assessment, content mastery aligned with each course and NCLEX preparation the final semester. Scoring: Practice tests – you will get 1 point for turning it in by the due date established **The lead instructor reserves the right
to make any changes in the syllabus and calendar at any time. |
Nursing Practice Paper Guidelines
Topic – One of the nursing topics covered in
the units of study in this course. Topic must be approved by instructor
by the end of week 4.
Organization – Four to six pages which includes the
introduction stating what the paper will cover, the body, and the conclusion
summarizing the major points of the paper.
The topic should be narrow enough to develop in some depth within four
to six pages.
Format –
Three professional sources – must be utilized other than
required reading, and not including dictionaries, manuals or
handbooks. Two sources must be nursing
journals. Avoid sources more than five years old. Pamphlets, books, and magazines written for
lay people may be used but are not included as one of the three required
professionals sources. Only one on-line source may be used. One professional
source should be a research article.
An interview with a professional who is a specialist in the practice
area may be used as one professional source. Include copy of each article,
interview and/or on-line source.
The
paper will be evaluated according to the following criteria:
Introduction 10
Conclusion 20
Emphasis on nursing care and nursing
process 60
Professional writing style
(grammar, sentence structure, spelling,
paragraph structure,
incorporate resource materials
throughout paper, APA format) 10
Total 100 Points
Due – Week
Nine of course.
|
Criteria |
Points
Possible |
Points
Earned |
|
Introduction |
10 |
|
|
Conclusion |
20 |
|
|
Nursing
Care/Nursing Process: |
60 total |
|
|
Assessment |
15 |
|
|
Diagnosis |
10 |
|
|
Plan |
15 |
|
|
Implement |
10 |
|
|
Evaluation |
10 |
|
|
Incorporate
resource materials throughout paper, including at least one research
article Professional
writing style: *grammar, sentence structure,
spelling, paragraph structure, incorporate resource materials throughout paper, including
at least one research article, APA format |
10 |
|
|
Total |
100 |
|
Nursing Practice Paper
Grading Criteria
**Please Submit with paper
Topic needs to be approved by instructor by week 4 and paper is due at
the on or before week nine on Tuesday at the beginning of class
All students will be expected to prepare for and participate in each Discussion Session according to provided guidelines. Sources of information that the students bring to the Discussion must be credible. Articles must be from nursing journals. Sources of information from the internet should be from websites such as nursing journal websites, university health sites, etc.
Each student will be given two points for participation for each Discussion Session if the following criteria are met:
1. The critical thinking exercise must be completed prior to each Discussion Session.
2. The student participates verbally during each Discussion Session.
The points for Discussion Session will be added to the theory portion of the grade.
Students may be asked to do additional assignments related to the assigned topic for the unit if the student does not evidence preparation.
|
|
Course: Nursing Complex Health Alterations 2 - Fall
2008 Due:
Week 6
|
1.
From
what I expected, this class ranks as follows: q
Excellent. I’m really learning a lot q
O.K. It meets my expectations q
It
is not as good as I expected 2.
The
book and course materials are: q
Helpful
and easy to understand q
Average q
Hard
to understand 3.
The
information taught in this course is: q
q
Not
sure right now q
A
waste of my time 4.
The
class is moving at a pace which I would describe as: q
Well
paced q
Too
fast for me q
Too
slow for me 5.
This
class is: q
Interesting q
Okay q
Boring 6.
The
instructor’s explanations are: q
Clear
and easy to follow q
Sometimes
hard to understand q
Very
difficult to understand |
7.
The
instructor: q
Listens
and connects effectively with students q
Usually
listens to students q
Does
not listen or care about student concerns 8. The tests and projects for this course
are: q
Appropriate
learning opportunities q
Sometimes
hard to understand q
A
waste of my time Student Self-Evaluation I
have been attending class regularly
Yes q No
q I
actively participate in class discussions
Yes q No
q I
am putting forth a reasonable amount of effort for this class Yes q No
q I
utilize all the learning opportunities provided in this course: Yes q No
q See reverse side
for additional comments. |
Suggestions I would
make to improve this class:
Thank you for taking the time to complete this
evaluation. Your responses on this evaluation
are confidential.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
THE ILL CHILD
Learning Activities – Unit I
Lecture: Ill Child
Required
Chapter 4: Health Promotion for the Developing Child
Read pgs. 61-63: Assessment of Development
Chapter 33: Physical Assessment of the Child
Chapter 35: The Ill Child in the Hospital and Other Care Settings
Chapter 36: The Child with a Chronic Condition or Terminal Illness
Chapter 37: Principles and Procedures for Nursing Care of Children
Chapter 38: Medicating Infants and Children
Review content related to this unit topic from previous courses.
Recommended Video: Administering Medications to Children
|
Complex Health Alterations 2 DISCUSSION SESSION Unit 1: The Ill Child |
Objectives:
1. Discuss the care of the ill child in
the hospital setting.
2. Complete and be prepared to discuss the
critical thinking exercise from the syllabus for this unit.
3. Visit the website www.kidshealth.org. Click on “Kids Site”. Click on topics from
“Kids Health Problems” focusing on chronic illness. Be prepared to report the following:
a. A summary of the topic’s key
points
b. A personal reaction to the
ideas presented in the topic
c. A description of how the
professional nurse could use the information presented to enhance and improve
the health care he or she provides to a child with an illness requiring
hospitalization.
ADMINISTERING
AN INJECTION TO A CHILD
General
Principles
|
Nursing
Action Find out how the child copes with painful procedures. Use an approach based on the child’s development level. |
Rationale This promotes individualization of care. |
|
Infant
(Birth to 12 Months) |
|
|
Nursing
Action |
Rationale |
|
Spend time with the infant prior to giving an injection. This supports the development of a sense of
trust. |
|
|
For the older infant, state what you are going to do and proceed with
the injection. Provide something to look at or a toy to hold during the injection. Provide physical comfort after the injection. |
This age child cannot understand explanations but should not be
injected without warning. The infant is often distractible. Physical comforting is more effective than verbal. |
|
EXAMPLE: Brian M., six months old, is to receive his third DPT
immunization. His mother is very
anxious and upset because she cannot stand to see her baby experience pain. The nurse explains the immunization procedure to Mrs. M., and asks if
she’d like to leave the room. Mrs. M.
decides to stay, so the nurse suggests that the mother stand close to her
baby’s head and talk to him so he’ll be distracted from the sight of the 5/8”
needle and syringe. Another nurse
helps restrain Brian while the injection is being administered in the right vastus lateralis muscle. The nurse picks up Brian and immediately hands him to Mrs. M., so she
can hold and cuddle him. This is an
important way to help Mrs. M. deal with her feelings of helplessness as well
as comfort Brian. |
|
|
Toddler
(1-2 years) |
|
|
Nursing
Action |
Rationale |
|
State what you are going to do and proceed with injection. Use simple words and short phrases. For example, say, “This will take only a
minute and then you can play.” Provide
something for the child to look at, hold, or play with during the injection. |
At this age, the child obeys simple commands and develops a sense of
time beginning at about 18 months of age.
The toddler often can be distracted. |
|
Give a simple, honest reason for the injection. Use a firm, consistent approach, reward the toddler’s positive
behaviors, and ignore his negative ones.
Let the child take some part in the procedure, for example, he can
hold the Band-Aid.® Provide a Band-Aid for covering the injection site. |
Fantasies are prominent at this age. Rituals are important to toddlers, and they take pride in their
accomplishments. The toddler has an incomplete sense of body boundaries and fears body
contents may leak out. |
|
|
|
|
EXAMPLE: Shari P., two years old, has been receiving kanamycin sulfate 45 mm
every six hours intramuscularly for 48 hours.
She begins to cry loudly when the nurse enters the room and tells her
it is time for “the medicine in your leg.”
The nurse knows from the Kardex® that The nurse tells |
|
|
Preschooler
(3-6 years) |
|
|
Nursing
Action |
Rationale |
|
Tell the child what he will feel and what he can do to help himself,
for example, he can lie still. Let the child see and handle equipment before the nurse gives him the
injection. Tell the child that injections are never used as punishment and give
him a simple honest explanation. Allow youngster a choice when possible.
For example, ask in which leg he wants the injection. Foster the development of coping
mechanisms. Let the child play at giving injections, including handling a needle
under supervision. |
This age child remains egocentric and is a concrete thinker but also
can understand simple explanations and follow directions. Seeing and handling the equipment will help the child learn, and it
promotes coping. The preschooler is developing a conscience and may view an injection as
punishment for his actions, but he can understand a simple explanation. This age child seeks to master situations and takes pride in
accomplishments. Therapeutic play is an effective means of dealing with fantasies and
fears, especially those associated with painful and/or intrusive procedures. |
|
EXAMPLE: Tracy B. four years old, is to have a DPT injection. She does not remember her previous
immunization and is very frightened.
The nurse encourages |
|
|
School
Age (6-12 years) |
|
|
Nursing
Action Give a simple explanation of why the specific injection is needed. Let the child help select the injection site, if possible, and praise
the child for her cooperation. Provide time to sit and talk with the child. |
Rationale This age child has the ability to think in a logical manner and
comprehend relationships. Taking part in procedure supports the child’s developmental need to
master situations. This age group
thrives on praise. For children of this age, talking about their fears replaces play as a
method of dealing with anxiety. |
|
EXAMPLE: Barbara H., nine years old, had an open reduction of a fractured right
humerus the previous evening. She
received meperidine hydrochloride 30 mgm intramuscularly six hours earlier
for pain. She now is obviously in
pain, but denies it because she doesn’t want “another shot.” The nurse decides that medication should be
given and tells Barbara she is going to prepare it. The nurse also explains that when Barbara
is able to drink liquids, the medicine will be changed. After preparing the medication, the nurse describes to Barbara how she
will feel during the injection and what she can do to help. Mrs. H. is very calm and supportive while
Barbara chooses the site. The nurse
suggests that Barbara hold her mother’s hands and count how many seconds the
injection lasts. After the medication
is administered using a 1” needle, the nurse tells Barbara how much it helped
because she held so still. |
|
|
Adolescent
(13-18 years) |
|
|
Nursing
Action |
Rationale |
|
Provide as much information as the adolescent requests about
medication, but also tell her how injections will feel. Provide privacy and permit choice of injection site whenever possible. |
The adolescent is capable of logical, abstract thinking but may also
demonstrate egocentrism, especially when under stress. The adolescent experiences concern over body image and likes to feel in
control of a situation. |
|
EXAMPLE: Tony W., 15 years old, has injured his right foot on a rusty tin can
while swimming in a pond. He needs a
tetanus injection. The nurse explains
to him why a booster injection is necessary and answers his questions. She offers him a choice of sites and Tony
chooses the left deltoid. The nurse
describes the steps in the procedure and tells him what he will feel Although he is visibly anxious, Tony tries
to control his fear. The nurse
comments that no one likes to get a shot, and he might want to look to the
other side of the room. After the injection, the nurse tells Tony that he did very well. She describes the local reaction he might
have from the injection, and she also tells him what he can do at home to
minimize his discomfort. |
|
Critical Thinking Exercises – The
Ill Child
GROUP DISCUSSIONS
1. 6
months old Justin is admitted to the hospital with a diagnosis of pneumonia. This admission order includes weight, measure
I & O and chest x-ray. The baby
scale is in the maintenance department for repair. How will you accurately weigh Justin,
accurately measure his output and safely transport him to radiology?
2. 3-1/2
year old Christine slammed her finger in a car door. It is now infected. The physician has ordered daily warm soapy
water soaks. Christine cries every time
the bandage is removed and resists putting her hand in the basin of water. What methods can you use to gain Christine’s
cooperation?
3. 2-1/2
year old Lisa has been potty trained for about 6 months. She has hematuria and is admitted to the
hospital with a diagnosis of severe urinary tract infection. The doctor orders a urinalysis and I &
O. Lisa’s mother states that Lisa cries
whenever she voids. Although she sits on
the toilet at home, Lisa cries and refuses to sit on the toilet in the
hospital. How will you collect the
specimen? What methods will you use to
encourage fluid intake?
4. 6
year old Michael is admitted to the hospital with a diagnosis of
pneumonia. The last time the nurse gave
him his medicine, he spit it out stating that it tasted awful. How will you encourage Michael’s cooperation
in taking his medicine?
5. 16
year old Ryan was involved in motor vehicle accident 1 month after receiving
his driver’s license. He sustained a
fractured femur requiring traction. He
has not had a BM for 4 days and complains of abdominal pain. His physician ordered a fleet enema that will
require Ryan to use a bedpan. Ryan tells
you that he is expecting a visit from his girlfriend in 30 minutes. How will you deal with this situation?
6. 18
month old Megan is admitted to the hospital for further surgery on a cleft
lip. Hospital policy states that a 2
year old must be in a crib. Upon
admission, Megan’s mother tells you that Megan is a real “climber”. After surgery Megan pulls at her IV and
attempts to scratch the delicate stitches above her lip. How will you provide for Megan’s safety and
prevent her from pulling at her IV and stitches?
7. 4
year old Mary is admitted to the hospital with severe pneumonia. Upon admission, she is to receive a stat
injection of an antibiotic and be placed in a croup tent. Her mother tells you that Mary has never been
away from home and is terrified of coming to the hospital. How will you handle this situation?
8. 9
year old Jason complains of a severe headache and stiff neck. He also has a high fever. His doctor suspects meningitis and admits
Jason to the hospital. An admission
order written by the physician is, “prepare child for spinal tap to be done
when I arrive in one hour”. How will
you prepare Jason for this procedure?
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE MUSCULOSKELETAL SYSTEM
Learning Activities – Unit II
Musculoskeletal System
Required
Lewis:
Chapter 62: Nursing
Assessment Musculoskeletal System (Review)
Chapter 64: Nursing Management
Musculoskeletal Problems
Read: pgs:
1668-1686
Review: pgs:
1686-1691
Chapter
65: Nursing Management Arthritis and Connective Tissue Diseases
Review: pgs. 1693-1711
Read: pgs. 1711-1730
Read:
Chapter 48:
The Child with Cancer
pgs. 1353-1356 Osteosarcoma,
Chapter
50: The Child with a Musculoskeletal
Alteration
pgs.
1437-1438 Muscular Dystrophies
Review pediatric content on this topic from previous
courses.
DISCUSSION SESSION
Unit II: Musculoskeletal
Objectives:
1. Discuss the care of the patient with
alterations in the musculoskeletal system.
2. From the ATI Adult Medical-Surgical RN
Review Module: Review Chapters in the
unit: Nursing Care of Clients with
Musculoskeletal Disorders. Complete
and be prepared to discuss the application exercises found at the end of each
chapter.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE NEUROSENSORY SYSTEM
Learning Activities – Unit
Required
Lewis:
Chapter 21: Nursing Assessment Visual and Auditory Systems
Chapter 56: Nursing Assessment Nervous System
Chapter 57: Nursing Management Acute Intracranial Problems
Chapter 59: Nursing Management Chronic Neurologic Problems
pgs. 1555-1559 Myasthenia Gravis, Amyotrophic Lateral Sclerosis and
Huntington’s Disease (except restless legs syndrome)
Chapter 61: Nursing Management Peripheral Nerve and Spinal Cord Problems
Chapter 38: The Child with Cancer
pgs. 1522-1527 Meningitis, Guillain-Barre Syndrome and Encephalitis
Chapter 52: The Child with a Neurologic Alteration
pgs. 1338-1348 Brain Tumors
Chapter 55: The Child with a Sensory Alteration
Discussion Session
Unit 3: Neurosensory
Objectives:
1. Discuss the nursing care of the patient with alterations in the neurosensory system.
2. From the ATI Adult Medical – Surgical RN Review Module: Review chapters in the Unit: Nursing Care of Clients with Neurosensory Disorders. Complete and be prepared to discuss the application exercises found at the end of each chapter.
3. Visit the website:
1) The
National Institute of Neurologic Disorders and Stroke at www.ninds.nih.gov, go to Disorder Quick
Links and click on “stroke,” “traumatic brain injury,” “myasthenia gravis,”
“multiple sclerosis,” “
Guidelines for
Required Senior
Revisit
your “senior mentor” in the community after the Neurosensory Unit is presented
and assess his/her neurosensory status.
Relate your findings to his/her health history, medications he/she is
taking, his/her activity, and resources.
Summarize the information you obtain and identify specific interventions
you would recommend.
Include
a copy of original assessments, list medication. Write brief synopsis of changes since initial
assessments, i.e. changes in condition(s), meds, ADLs.
Guidelines
for the Assessments:
1. Assess your “senior
mentor’s” vision. From your textbook
utilize table 21-2, “Health History Visual System”. Assess for risk factors for glaucoma and
cataracts. To assess your “senior
mentor’s” vision take the eye chart provided with you to your visit and check
your “senior mentor’s” near vision.
2. Assess your “senior mentor’s” hearing. From your textbook utilize the table 21-8 “Health
History Auditory System”. Assess for
risk factors for hearing loss.
3. Assess your “senior mentor’s” cranial nerve function. Refer to table 56-3 “Cranial Nerves” and
table 56-7 “Normal Physical Assessment of the Nervous System” in your text.
Summarize in a two-three page typed paper using
(Include any charts, forms you used with your documented findings.)
1. Findings
of sensorineural and cranial nerve function assessments 10
2. Results of
vision screening 10
3. Results of
hearing screening 10
4. Identify
changes in medications, health history, activity, resources since previous
visits 10
5.
Relationship of findings to meds, health history, activity, resources 10
6. Risk
factors 10
7. Interventions 10
8. Grammar,
spelling, typing, format 10
Total 80
Due on or before Tuesday of week
5.
**You are expected to dress professionally on your visit(s). (No jeans, t-shirts with slogans, etc.), dressing as you might for a clinical assignment. This includes wearing your nametag.
Criteria |
Points Possible |
Points Earned |
Findings of sensorineural and cranial nerve function assessments |
10
|
|
Results of vision
screening
|
10
|
|
Results of hearing
screening
|
10
|
|
Identify changes in
medications, health history, activity, resources since previous visits
|
10
|
|
Relationship of findings to medications, health history, activity, resources |
10
|
|
Risk factors
|
10
|
|
Interventions |
10
|
|
Grammar, spelling, typing, APA format |
10
|
|
Total Points |
80
|
|
Due on or before Tuesday of week
5.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE UPPER GASTROINTESTINAL TRACT
Learning Activities – Unit IV
Lecture – Gastrointestinal Tract
Required
Lewis:
Chapter 39: Nursing
Assessment Gastrointestinal System (Review)
Chapter 40: Nursing
Management Nutritional Problems
Review
pgs. 948-960
Read pgs. 960-970
Chapter 41: Obesity
Chapter 42:
Nursing Management Upper Gastrointestinal Problems
Review
pgs. 990-995
Read
pgs. 995-1003
Review pgs. 1003-1009
Read
pgs. 1009-1033
Mc Kinney, et
al:
Chapter 37:
Principles and Procedures for Nursing Care of Children
Read pgs. 953-957
Chapter 43: The Child with a Gastrointestinal Alteration
Read pgs. 1099-1120
Read pgs. 1120-1123
Nursing Care Plan of the Infant with
Gastroesophageal Reflux in the
Community Setting
Read pgs. 1126-1128
Chapter 53: The Child with a Psychosocial Disorder
Read pgs.1550-1558
Review in
Lilley Text:
Chapter 49: Acid Controlling
Agents
Chapter 51: Antiemetic and
Antinausea Agents
Chapter 53: Nutritional Supplements
Critical Thinking Exercise
– Gastrointestinal Intubation
1. Develop a patient teaching guide for a patient for home administration of an enteral feeding. Each student may choose a patient profile (age, socioeconomic status, financial status) that the student wants to use.
2. You are interviewing Mr. S. in a clinic during a routine, annual check up. He complains of burning pain just below the xiphoid process.
a. Describe further nursing assessments.
3. The physician orders upper GI studies for this patient, related to a possible diagnosis of peptic ulcer disease. Mr. S. asks what these tests are for: helicobacter pylori, gastric analysis, and swallow studies. Provide the answers including preparation for these tests.
4. What diet instructions does Mr. S. need?
5. Mr. S. receives prescriptions for Prilosec, Zantac, and Maalox. He asks, “Why do I need to take so many medications? Don’t they all do the same thing?” Provide the answers.
6. What further instructions does Mr. S. need for self-management?
7. Mr. S. is admitted to the Emergency Room with hematemesis. Describe your immediate assessment.
8. You are to start an IV on Mr. S. What size needle will you use? Why?
9. You receive an order for nasogastric lavage. Describe the patient teaching needed for Mr. S.
10. Mr. S. is transferred to the Medical unit. Describe the data provided in the report to the receiving nurse
11. The nasogastric tube is to be on low intermittent suction. Mr. S. complains of nausea. Describe your nursing assessments and nursing actions.
12. Describe your role as a nurse advocate for Mr. S. who is to receive a blood transfusion.
13. As Mr. S. recovers, he is anticipating discharge. Describe the patient teaching Mr. S. needs to prepare for home maintenance, medications, and dietary changes.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH ALTERATIONS 2
ALTERATIONS IN
THE
Learning Activities – Unit V
Lecture: Lower Gastrointestinal
Tract
Required
Lewis:
Chapter 38:
Management of Patients with Intestinal & Rectal Disorders
Chapter 43: Nursing Management Lower Gastrointestinal Problems
Read
pgs. 1051-1086
Mc Kinney et
al:
Chapter 43: The Child with a Gastrointestinal Alteration
Read pgs. 1120-1148
Review in Lilley text:
Chapter 50; Antidiarrheals and Laxatives
Discussion
Session
Unit 5: Lower Gastrointestinal Tract
Objectives:
1. Discuss the care of the patient with alterations in the
lower gastrointestinal system.
2. From the ATI Adult Medical-Surgical RN Review Module: Review Chapters in the section: Nursing Care of Clients with Intestinal Disorders. Complete and be prepared to discuss the
application exercises found at the end of each chapter.
3. Visit the website of Crohn’s and Colitis Foundation of
America at www.ccfa.org.
Visit the website of the United Ostomy Associations of
America at www.uoa.org. Click on “About UOAA.” Click on “Ostomy Info”.
Choose a topic from either of these websites and be
prepared to report the following:
a.
A summary of the topic’s key points
b.
A personal reaction to the ideas presented in the topic
c.
A description of how the professional nurse could use the information
presented to enhance and improve the health care he or she provides to a
patient.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE HEPATOBILIARY SYSTEM
Learning Activities – Unit VI
Lecture: Alterations in the
Hepatobiliary System
Required
Lewis:
Chapter 44: Nursing Management Liver, Pancreas, and
Biliary Tract Problems
Mc Kinney et
al:
Chapter 43 The Child with a Gastrointestinal Alteration
Read pgs. 1148-1155 Hepatic Disorders
Discussion Session
Unit 6: Hepatobiliary System
Objectives:
1. Discuss
the care of the patient with alterations in the hepatobiliary system.
2. Complete
and be prepared to discuss the critical thinking exercise in the syllabus for
this unit.
C NURSING COMPLEX HEALTH ALTERATIONS 2
BILARY CONDITIONS
CASE
STUDY – CIRRHOSIS OF THE LIVER
M.N.
is a 54-year-old client admitted to a medical nursing unit with a diagnosis of
hepatic encephalopathy secondary to Laennec’s cirrhosis. Admission assessment shows that he has a
grossly distended abdomen, bilateral 4 + ankle edema, jaundiced sclera and
skin, and multiple bruises. M.N. has
difficulty answering the nurse’s questions, easily becoming distracted and
preoccupied with scratching his arms and legs vigorously. Several times, he closes his eyes and dozes
briefly, awaking with a start and asking where he is.
1.
Identify the data which support the clinical diagnosis.
2.
Discuss why M.N. has ascites and peripheral edema.
3.
Based on the above data, formulate relevant nursing diagnoses for M.N.
Laboratory data for M.N. show increased serum
bilirubin, decreased total proteins and serum albumin, prolonged prothrombin
time, hypokalemia, and increased serum ammonia levels. The physician orders a 500 mg sodium/15 gm
protein diet; neomycin sulfate (Neobiotic) 20 gm P.O., Q.I.D.; diphenhydramine
(Benadryl) 50 mg P.O., H.S. prn; vitamin K (AquaMEPHYTON) 2 mg I.M., three
times per week; potassium chloride 20 mEq, P.O., T.I.D.; spironolactone
(Aldactone) 50 mg P.O. Bid, and one unit of salt-poor albumin to be infused
daily for three days.
4.
Why was spironolactone (Aldactone) ordered? Neomycin sulfate (Neobiotic)? Vitamin K (AquaMEPHYTON)?
5.
What is the purpose of also administering furosemide (Lasix)? Potassium chloride (Kaochlor)?
6.
Discuss the rationale for administering salt-poor albumin to M.N.
7.
Discuss why diphenhydramine (Benadryl) is the preferred sedative for
M.N.
8.
What should the nurse do to assess M.N.’s mental status?
9.
What purpose does his diet have in treating the hepatic
encephalopathy?
10.
M.N. is on a fluid restriction of 1500 cc per day. This includes the parenteral volume of fluids
for administering the salt-poor albumin as well as the albumin itself, which is
250 cc. Devise a schedule for M.N.’s
fluid intake which includes all his medications.
11.
What does the nurse monitor for in M.N. to determine if his therapeutic
regimen is achieving the desired outcomes?
12.
What other medication would you anticipate will be ordered for this
patient to decrease the NH+3 levels?
NURSING COMPLEX HEALTH ALTERATIONS 2
BILARY CONDITIONS
CASE
STUDY – CHOLELITHIASIS
K.M.
is a 43-year-old client admitted with a diagnosis of cholelithiasis. She is married and has four children ranging
in age from 3 to 20 years of age. K.M.
tells the nurse that she has had right upper quadrant abdominal pain for
several weeks and nausea for the last two days.
Since yesterday, K.M. has noticed that her urine is dark brown and
frothy and her stool is pale yellow. With
some embarrassment, K.M. admits to having trouble with “gas.” She also says that she has been bothered with
itching and tries not to scratch because her “skin is getting rubbed raw.” K.M. states that she gains weight easily and
always has had difficulty losing weight after having a baby. She is currently 25 pounds overweight. The nurse notes that K.M.’s skin and sclera
have a yellow cast. There are several
superficial scratches on her arms and bruises on her legs and left arm. All laboratory studies are within normal
limits except for serum potassium, which is 3.2 mEq/L, and the prothrombin
time, which is 22 seconds.
1.
Identify the data which support the clinical diagnosis of
cholelithiasis.
2.
The nurse needs to assess the pain episodes more thoroughly. What additional data should be collected?
3.
Why does K.M. have changes in her urine and stool? Itching?
Jaundice? Bruising?
K.M.’s ultrasound of the gallbladder is positive for
gallstones. Further tests show that
there is no sign of a tumor obstructing the biliary tract. K.M. is scheduled for a cholecystectomy and
exploration of the common bile duct the next morning. Medications include: meperidine hydrochloride (Demerol) 75-100 mg
I.M. for pain every 3 to 4 hours; cholestyramine (Questran) 6 gm P.O., Q.I.D.;
diphenhydramine (Benadryl) 50 mg P.O. every 3 to 4 hours prn; phytonadione
(AquaMEPHYTON) 10 mg I.M. stat; and potassium chloride (Kaochlor) 20 mEq P.O.,
pc and H.S.
4.
What are the purposes for these specific orders? What side effects should the nurse monitor
for in K.M.?
5.
What information should the nurse reinforce with K.M. about the
upcoming surgery?
K.M. returns from surgery with the intravenous
infusion, an NG tube to low intermittent suction, an abdominal dressing
covering the incision, which has a Penrose drain, and a T-tube connected to a
closed, drainable collection bag. The
postoperative orders include: D5W with
20 mEq potassium chloride at 125 cc per hour; meperidine 75-100 mg I.M. every 4
hours prn for pain; and prochloperazine (Compazine) 10 mg I.M. every 4 hours
prn for nausea.
6.
What observations does the nurse make relative to the T-tube? The abdominal dressing?
7.
That evening, K.M. becomes nauseated and vomits. What should the nurse do prior to
administering any prochlorperazine?
There also is an order to empty and measure the
T-tube drainage every four hours.
Beginning the first postoperative day, the drainage is to be instilled
via the NG tube and the tube clamped for 30 minutes.
8.
What is the rationale for this intervention?
NURSING COMPLEX HEALTH ALTERATIONS 2
BILARY
CONDITIONS
CASE STUDY – HEPATITIS
D.R. is a 28-year-old female client who is admitted to a medical nursing unit. Admission assessment data include that D.R. works as a charge nurse on that same unit. She returned three weeks ago from her honeymoon at a resort area in a Central American country. Prior to leaving on vacation, D.R. had been caring for several oncology clients who were receiving intravenous chemotherapy and blood transfusions. D.R. has lost ten pounds since returning from vacation and states that she is always tired and has no energy. D.R. denies any jaundice, but laughs and says, “I really tanned easily!” Her appetite, which usually is good, is depressed and she finds it difficult to eat without feeling full and becoming nauseated. Frequent headaches have become a problem and her husband says that she is moody and becomes easily upset. Laboratory result indicate that D.R. has hepatitis A although hepatitis B has not been completely ruled out.
1.
Formulate relevant nursing diagnoses for D.R. based
upon the above data.
2.
What precautions should the nurse take when caring for
D.R.? What instructions should be given
to D.R. and her husband?
3.
D.R. continues to have difficulty eating. Plan a diet for her that will help D.R. to
boost her oral nutrition.
4.
What medication(s) may be helpful to D.R. in improving
her appetite? Which classes of drugs are
contraindicated in this client? Why?
5. D.R. begins to improve and is scheduled for dismissal. Design a teaching/learning plan for her concerning diet, activity, hygiene, family cooking arrangements, and sexual activity. Include specific information regarding transmission of hepatitis A to family members and friends.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE RENAL/URINARY SYSTEM
Learning Activities – Unit
Lecture: Renal/Urinary Tract
Required
Lewis::
Chapter 45: Nursing Assessment Urinary System (Review)
Chapter 46: Nursing Management Renal and Urologic
Problems
Read pgs. 1164-1195
Chapter 47: Nursing Management Acute Renal Failure and
Chronic Kidney Disease
McKinney et al:
Chapter 44: The Child with a
Genitourinary Alteration
Chapter 48: The Child with
Cancer
Read pgs. 1356-1357
Review in Lilley text:
p. 337 Paragraph beginning “When using cholinergic –
blocking agents for urinary tract disorders…”
p. 625-627 Sulfonamides
p. 737-738 Anti-gout agents.
Discussion
Session
Unit
7: Renal/Urinary System
Objectives:
1. Discuss the care of the patient with alterations in the renal/urinary system.
2. Complete and be prepared to discuss the Case scenarios from the syllabus for this unit.
3. Visit the website of the National Kidney Foundation at www.kidney.org.
Visit the website: www.nkdep.nih.gov/index.htm. Click on “Health Professionals.”
Choose one topic from both websites and be prepared to report the following:
a. A summary of the topic’s key points
b. A personal reaction to the ideas presented in the topic.
c. A description of how the professional nurse could use the information to enhance and improve the health care he or she provides.
Critical
Thinking Exercise – Renal/Urinary System
CASE SCENARIOS
Complex Health Alterations 2
1. Discuss the following concepts: glomerular filtration, tubular reabsorption,
regulation of fluids and electrolytes by the kidneys, regulation of hydrogen
ion balance by the kidneys, regulation of blood pressure by the kidneys.
2. J.W. is a 46
year-old male oil executive who presents in the emergency room after
experiencing sharp severe pain in the left lumbar region radiating around his
left side toward his left testicle. He
is diagnosed based on his symptoms as having a kidney stone. What other symptoms (besides the pain) would
you expect would be present? What
diagnostic tests would you expect to be performed? What nursing diagnoses would be
appropriate? What nursing interventions
should be performed?
Describe the medical management of the patient with renal calculi. If medical management is unsuccessful, what
other options are there? What are this
patient’s discharge instructions likely to be?
Be specific.
3. Develop a Nursing History form for renal functioning. Describe any special considerations that should be included when performing a nursing history to assess urinary functioning for the following patients:
a. Infants and young children.
b. Older adults.
c. People with limited or no bladder control.
4. Outline the pathophysiologic changes associated with glomerulonephritis as if you were teaching a patient about the disease. Include information about causes and expected outcomes. Identify appropriate Nursing Diagnoses, goals and interventions.
5.
CASE SCENARIOS
Complex Health Alterations 2
6. The client had a radical cystectomy
with formulation of an
7. You are caring for a 74-year-old man who is 1 day post coronary artery bypass surgery. His urine output is about 15 ml/hr. He has a long history of hypertension (controlled) and his usual pressure still ranges from 180 to 190 over 90 to 100 mm Hg. His blood pressure since surgery ranges from 120 to 130 over 70 to 76 mm Hg. His serum sodium is 145 mEq/L and potassium is 49 mEq/L. His skin turgor is poor and his mucous membranes dry. What is your priority assessment and action? What other assessments should you make? Identify the classifications of ARF and describe them. What are the differences between ARF and CRF?
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE IMMUNE SYSTEM
Learning Activities – Unit VIII
Lecture: Alterations in the Immune
System
Required
Lewis:
Chapter 14 Genetics, Altered Immune Responses, and
Transplantation
Review pgs. 213-234
Read pgs. 235-241
Chapter 15 Infection and Human Immunodeficiency Virus
Infection (Review)
Chapter 16 Cancer
Read pgs. 289-311
Chapter 65 Nursing Management Arthritis and Connective
Tissue Diseases
Chapter 41: The Child with an Immunological
Alteration
Chapter
50: The Child with a Musculoskeletal
Alteration
Read
pgs. 1432-1437 Juvenile Rheumatoid
Arthritis
Review in Lilley text:
p.581-88; Antihistamines, Decongestants.
Discussion Session
Unit 8: Immune System
Objectives:
1. Discuss the care of the patient with alterations in the immune system.
2. From the ATI Adult Medical – Surgical RN Review Module: Review Chapters “HIV/AID,” “Rheumatoid Arthritis,” “Systemic Lupus Erythematosus (SLE).” Complete and be prepared to discuss the application exercises found at the end of each chapter.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
ALTERATIONS IN
THE REPRODUCTIVE SYSTEM
Learning Activities – Unit IX
Lecture: Alterations in the
Reproductive System
Required
Lewis:
Chapter 51: Nursing
Assessment Reproductive System (Review)
Chapter 52: Nursing Management Breast Disorders (Read)
Chapter 53: Nursing Management Sexually Transmitted
Diseases (Read)
Chapter 54: Nursing Management Female Reproductive
Problems (Read)
Chapter 55: Nursing Management Male Reproductive Problems
(Read)
McKinney
et al:
Chapter
26: The Pregnant Woman with Complications
Read
pgs. 661-662
Chapter
31: Women’s Health Care
Read
pgs. 788-792
Chapter
40: The Child with an Infectious Disease
Read pgs. 1040-43
Chapter
44: The Child with a Genitourinary Alteration
Read
pgs 1168-71
Review in Lilley text:
pp. 546-553 Estrogens, Progestins
and Contraceptive Agents
pp. 568-74 Androgens
Discussion Session
Unit 9:
Alterations in the
Reproductive System
Objectives:
1. Discuss the care of the patient with
alterations in the reproductive system.
2. From ATI Adult Medical Surgical RN
Review Module: Review chapters in the
unit Nursing Care of Clients with Reproductive Disorders. (Skip Chapter “Hormone Replacement
Therapy”) Complete and be prepared to
discuss the application exercises found at the end of each chapter.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
HIGH RISK
PERINATAL
and
HIGH RISK
NEWBORN
Learning Activities – Unit X
Lecture: High Risk Perinatal and
High Risk Newborn
Required
McKinney et al:
Chapter 26: The Pregnant Woman with Complications
Chapter 27: The Woman with an Intrapartum Complication
Chapter 28: The Woman with a Postpartum Complication
Chapter 29: The High-Risk Newborn: Problems Related to
Gestational Age and
Development
Chapter 30 The
High-Risk Newborn: Acquired and Congenital Conditions
Discussion Session
Discussion Session
Unit 10: Pregnancy at Risk/Newborn at Risk
Objectives:
1. Discuss the care of the patient with a
high risk pregnancy.
2. Discuss the newborn at risk.
3, From ATI Maternal Newborn RN Review
Module: Review Chapters “Complications
of Pregnancy” and “Assessment and Management of Newborn Complications” Complete
and be prepared to discuss the application exercises found at the end of each
chapter.
ASSOCIATE
DEGREE NURSING PROGRAM
COMPLEX HEALTH
ALTERATIONS 2
PATIENTS IN
CRITICAL/
SITUATIONS
Learning Activities – Unit XI
Lecture: Clients in Critical/Life
Threatening Situations
Required
Lewis:
Chapter 25: Nursing Management Burns
Chapter 66: Nursing
Management Critical Care
Read pgs. 1733-1738
Chapter 67: Nursing
Management Shock, Systemic Inflammatory Response
Syndrome (SIRS), and Multiple Organ Dysfunction Syndrome (MODS)
Chapter 69: Nursing Management Emergency and Disaster Nursing
Chapter 34: Emergency Care of the Child
.
Discussion Session
Unit 11: Critical/Life Threatening Situations
Objectives:
1. Discuss the care of the patient in
critical/life threatening situations
2. From the ATI Adult Medical Surgical RN
Review Module: Review chapters in the
Unit: Emergency Care and Triage,
and the chapter “Burns.” Complete and be
prepared to discuss the application exercises found at the end of each chapter.
3. Visit the website www.ACLS.net. View the first three categories listed on the left of the screen. Try
each of the interactive quizzes.
Visit the website: www.who.int/en/. Click on Health Topics. Choose a topic and click on Fact Sheet. Click Back on the toolbar twice to get
to the home page. Click on Features or one of the topics on the bottom of
the screen, such as Disease Outbreaks, and Emergencies and Disasters.
Choose a topic from either of these websites and be
prepared to report the following:
a. A summary of the topic’s key points
b. A personal reaction to the ideas presented in the topic
c. A description of how the professional nurse could use the
information presented to enhance and
improve the health care he or she provides to a patient.
