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

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1 Stephen F. Austin State University DeWitt School of Nursing NURSING CARE OF CLIENTS WITH COMPLEX HEALTH NEEDS SYLLABUS Course Number: NUR 406 Section Number: Section(s): 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.

2 2 Faculty Contact Information: Name: Cynthia McCarley, DSN, RN Department: Nursing Office: Room 152 Phone: (936) 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 lowrd1@sfasu.edu Office: Room 180 Phone: (936) Office Hours: Thursday: 9:00 a.m. - 3:00 p.m. Friday: 9:00 a.m. - 3:00 p.m. Name: Department: Office: Room 172 Phone: (936) Laura Logan, MSN, RN Nursing loganlm1@sfasu.edu 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 ( Only) Department: Nursing wldonnell@sfasu.edu Office: Room 170 Phone: (936) Office Hours: Monday, 9 a.m. 3:00 p.m. Tuesday, 8:00 a.m. 12 noon Name: Christopher Ryan, MSN, RN ( Only) Department: Nursing ryanc@sfasu.edu Office: Room 124 Phone: (936) 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.

3 TEXTBOOKS & SUPPLIES Required Texts: NUR 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 Problems (7 th Ed.). Mosby. Baier, S. and Schomaker, M.K. (1985). Bed Number Ten. CRC Press, Inc. Aehlert, B (2011). ECGs Made Easy (4 rd 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.

4 4 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

5 Faculty Meetings 8:30 am College Meetings 10:00 am Dept. Mtgs 11:00 am 27 SON Retreat 9:00 am NUR pm 31 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/ HO- Nac Med Center 8:30-11 am HO- WHMC 11-3 pm Day (all 3rd Semester) 9-5 pm N-407 N pm Labor Day 8-12 pm 8-12 pm 8-12 pm N-407 Skills 1-4:30 pm N :30 pm CV Simulation Micro/Sim 8-5 pm 9-4 pm 8-5 pm A,B Practice 8-12 pm (Class) N-407

6 6 1-4 pm Orientation 2-5 pm Exam #1 1-4 pm A,B N- 407,408 A,B N-407 Exam #1 5-7 pm All students Skyview/Hod ge Orientation Group F: Burke N E,F,G Practice 8-12 pm 1-4 pm E,F N- 407,408 A,B,C,D E,F A,B,C,D A,B,C,D October 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 09/26 09/27 09/28 09/29 09/30 1 N C,D,H Practice 8-12 pm 1-4 pm C,D C,D N Exam # pm G,H A,B,C,D G,H A,B,C,D A,B,C,D N pm A,B A,B

7 7 N pm E,F A,B,C,D E,F A,B,C,D A,B,C,D N November 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 10/ pm C,D B1,2 C,D N Exam # pm G,H A,B,C,D G,H A,B,C,D A,B,C,D N pm A,B A,B N pm THANKSGIVING THANKSGIVING THANKSGIVING Exam # pm C,D

8 December 2010 NUR Sunday Monday Tuesday Wednesday Thursday Friday Saturday 11/28 11/29 11/ C,D 3rd Semester Make/Up N-407 Exam # Exam #3 N-407 HESI Review 1-4 pm E,F G,H G,H E,F A,B,C,D Processing HESI Exam Review Group B: Burke Final Simulation 8-5 pm Processing 1-3 pm Exam #5 & Final Exam 12-3 pm 14 Med/Surg Exit HESI Exam 2-4 pm HESI Exam 17 Pinning 7:00 pm 18 Commence. 9:00 am /01

9 9 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. 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

10 10 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, / (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 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.

11 CLASS ASSIGNMENTS NUR 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 questions/set 10 sets total (7.5 points) Medical/Surgical questions/set 10 sets total (7.5 points) Total 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 b. Pulmonary c. Cardiovascular d. GI e. Neuro f. Endocrine Total 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

12 12 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 = 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.

13 13 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

14 Unit 2 Problems of urinary function (RENAL FAILURE) NUR 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. Required Learning Activities 1. Lewis, Chapters 45, NCLEX Questions: 150 questions worth 6.75 points. 3. Patient Reviews: a. Rusty Jackson (CNC/fluid & electrolyte balance) due 9/16/10

15 UNIT 3 PROBLEMS OF OXYGENATION: VENTILATION (PULMONARY VASCULAR) NUR 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. Required Learning Activities Lewis, Chapters 26, 28, 66 (Artificial airways & mechanical ventilation: pages ), 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

16 Unit 4 PROBLEMS WITH OXYGENATION: PERFUSION (CARDIOVASCULAR) NUR 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 ) 3. Discuss the principles of hemodynamic monitoring and related collaborative care of critically ill patients. (page ) 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.

17 17 Required Learning Activities Lewis: Chapters 32-38, 66 (Hemodynamic monitoring & Circulatory assist devices: pages ), 67 (Shock: pages ). 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

18 18 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 ), 44 (pp ) NCLEX Questions: 100 questions worth 4.5 points. 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

19 19 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. Required Learning Activities Lewis, Chapters 56, 57, 58, and 61 (Spinal cord injuries: pages ). NCLEX Questions: 150 questions worth 6.75 points. 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

20 Unit 7 PROBLEMS RELATED TO REGULATORY MECHANISMS (ENDOCRINE) NUR Unit Objectives 1. Discuss Acute Thyrotoxocosis (page ) 2. Discuss issues related to SIADH and DI. (page ) 3. Discuss acute complications of diabetes mellitus- DKA and NKHN. (page ) 4. Describe gerontologic issues and management of the client with endocrine disorders. Required Learning Activity Lewis, Chapter 48 & 50. NCLEX Questions: 100 questions worth 4.5 points. 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

21 21 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. Required Learning Activity Lewis, Chapter 67 (pages Worksheets: a. The pathophysiology of MODS due 12/6/10

22 22 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. Required Learning Activities Lewis, Chapter 25.

23 UNIT 10 ORGAN DONATION AND TRANSPLANTATION NUR 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. Required Learning Activities Lewis, Chapter 14 (pages , ). Patient Reviews: a. Margie Thompson (CC/gastrointestinal) due 12/6/10

24 CLINICAL SYLLABUS NUR 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. Experience PURPOSE: The purpose of the 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. Hours Activity Hours Hospital orientations 6 Hospital experience 60 Learning labs 22 Micro simulations 6 simulations 8 Alternate 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.

25 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 NUR 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.

26 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 - 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. 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

27 27 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. performance will be evaluated using the clinical evaluation form found on line. Absence from 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.

28 28 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 Concept Map A written 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.

29 29 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) a. Label the connections 5. Place all suggested treatments in the map with connections to either signs/symptoms, vital signs, diagnostic test findings, or pathology. (Green) a. Label the connections 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.