1 Stephen F. Austin State University DeWitt School of Nursing NURSING PRACTICE PRACTICUM SYLLABUS Course Number: NUR 423 Section Number(s): 001-006 Section(s): 010-016 Fall 2010 Course Instructors Cindi McCarley, DSN, RN Laura Logan, MSN, RN Regina Low, 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. THE STUDENT IS RESPONSIBLE FOR ALL INFORMATION IN THIS SYLLABUS. This syllabus is provided for information purposes only.
Faculty Contact Information Name: Cindi McCarley, DSN, RN Department: Nursing Email: cmccarley@sfasu.edu Phone: (936) 468-7717 Office: Room 152 Office Hours: Thursday, 9:00 a.m. 4:00 p.m. Friday, 9:00 a.m. 4:00 p.m. NUR 423 2 Name: Department: Email: Phone: (936) 468-7723 Office: Room 172 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: Regina Low, MSN, RN Department: Nursing Email: lowrd1@sfasu.edu Phone: (936) 468-7724 Office: Room 180 Office Hours: Thursday, 9:00 a.m. 4:00 p.m. Friday, 9:00 a.m. 4:00 p.m. Class Meeting Time and Place: Refer to Course Calendar for specific dates. Textbooks & Materials Required Texts All textbooks from prior nursing courses. Urden, L., Stacy, K., & Lough, M. (2010). Critical Care Nursing: Diagnosis and Management (6 th Ed.). Mosby. (This book included in 4 th semester packaged books.) 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.). (This book included in 4 th semester packaged books.) American Heart Association. (2005). ACLS Provider Manual Silvestri, L. A. (2008). Comprehensive Review for the NCLEX-RN Examination. Sanders.
3 Patient Reviews by Elsevier (On-line). May be purchased from the Campus bookstores. SUGGESTED TEXTS: Any pocket sized critical care reference. Course Description Practical application of the theoretical base of nursing and leadership skills. This course allows the student to further refine their nursing and critical thinking skills and develop their research-based practice while caring for the acutely ill patient in a critical care setting. Number of Credit Hours 6 credit hours (3 lecture/9 hours of clinical practicum) Course Prerequisites and Co-requisites Prerequisites: NUR 414, NUR 417, NUR 324 Co-requisites: NUR 415, NUR 416 Program Learning Outcomes/ Terminal Objectives The graduate will: 1. Apply knowledge of the physical, social and behavioral sciences in the provision of nursing care based on theory, research, 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 individuals, families, communities, and society as a whole while respecting individual and cultural diversity. 4. Demonstrate effective leadership that fosters independent thinking and collaborative communication in the management of nursing care. 5. Assume responsibility and accountability for 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/Course Objectives The student will: 1. Relate concepts and principles from the arts, humanities, sciences, and nursing as a source for making nursing practice decisions with clients. 2. Assume responsibility and accountability for evaluation of the effectiveness of one's own nursing practice.
4 3. Evaluate research for applicability of findings to nursing practice of clients with complex health problems. 4. Incorporate moral, ethical, and legal issues affecting nursing practice into caring for clients with complex health problems. 5. Describe the pathophysiologic and psychosocial processes and related assessment findings associated with a variety of complex acute and chronic disease processes. 6. Develops individual plans of care for patients with a variety of acute and chronic complex health problems. 7. Identifies medical and appropriate nursing interventions (with rationales) utilized for patients with a variety of acute and chronic complex health problems. 8. List evaluation criteria for each of the medical and nursing interventions used to treat patients with acute and chronic complex health problems. 9. Modifies the plan of care for patients with acute and chronic complex health problems as necessary, based on continuous evaluation of the patient's response to nursing and medical interventions. Course Requirements Computerized exams including comprehensive final, quizzes, NCLEX review questions, patient reviews, weekly clinical performance, clinical check-offs, in-class activities, and simulations are used to determine the student s level of performance. Refer to Course Calendar for specific assignment due dates. Course Calendar (Begins on next page.)
5 August 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Faculty Meetings 8:30 am College Meetings 10:00 am Dept. Mtgs 11:00 am 27 SON Retreat 9:00 am 28 29 30 2-5 pm 31 8-10 am Introduction 09/01 09/02 09/03 09/04
6 September 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 08/29 08/30 08/31 1 2 3 4 HO- Nac Med Center 8:30-11 am 9-3 pm 9-4 pm HO- WHMC 11-12 pm Orientation 1-3 pm 5 6 7 8 9 10 11 Labor Day Ch 18-20 Skills 1-5 pm CV Simulation/ Micro Sims 8-5 pm 12 13 14 15 16 17 18 Ch 21-22 ROTC 19 20 21 22 23 24 25 Kaplan Lunch 12:00 pm Exam #1 8-10 am Orientation Skills Check offs B1,2 A1,2 Sim 9-3 pm C1,2 A1,2 B1,2 C1,2 A1,2 26 27 28 29 30 Exam #1 CH 18-22 B1,2 A 1,2 Sim 9-3 pm C1,2 A1,2 B1,2 C1,2
7 October 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 09/26 09/27 09/28 09/29 09/30 1 A1,2 2 KAPLAN Review 3 KAPLAN Review 4 5 Plan Fair Project 6 B1,2 C1,2 7 A1,2 B1,2 8 A1,2 9 10 11 12 Exam # 2 8-10 am Post Conference: Group C 1,2 13 C1.2 B 1,2 Sim 9-3 pm 416 Fair 14 B1,2 C1,2 416 Fair 15 B1,2 416 Fair 16 416 Fair 17 416 Fair 18 19 Ch 23 26 Community Directory Project Due 20 C1,2 B 1,2 Sim 9-3 pm A1,2 21 B1,2 C1,2 A1,2 22 B1,2 A1,2 23 ACLS 24 ACLS 25 26 Exam # 2 Ch 23-26 27 C1,2 A1,2 28 B1,2 C1,2 A1,2 29 B1,2 30
November 2010 NUR 423 8 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 10/31 1 2 3 4 5 6 Post Conf: A 1,2 A1,2 C1,2 Sim 9-3 pm B1,2 C1,2 A1,2 B1,2 C1,2 7 8 9 10 11 12 13 Exam # 3 10-12 am 1-4 pm Ch 27,28, 31,32, &33 Case Studies & Movie Discussion Due C1,2 Sim 9-3 pm A1,2 B1,2 C1,2 A1,2 B1,2 C1,2 14 15 16 17 18 19 20 Comp. Exit HESI Exam Exam # 3 Ch 27,28, 31,32,&33 A1,2 B1,2 C1,2 A1,2 C1,2 21 22 23 24 25 26 27 THANKSGIVING THANKSGIVING THANKSGIVING 12-2 PM Post Conf. B 1,2 28 29 30 Exam #4 10-12 am, 1-4 pm
9 December 2010 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 11/28 11/29 11/30 1 Disaster Simulation 9-11 & 12-4 2 4th Semester Make/Up 3 Final Simulation 8-5 pm 4 Kaplan Review 5 Kaplan Review 6 7 HESI 10:30-12:30 Reflection 1:30-4:30 The End 8 9 Comprehensive Exit HESI Retake 10 11 12 13 Exam #5 & Final Exam 3-7 pm 14 15 16 17 Pinning 7:00 pm 18 Commencement 9:00 am 19 20 21 22 23 24 25 26 27 28 29 30 31 01/01 Grading Policy Didactic Points Exam I (Unit 1and Learning Lab) 70 (14%) Exam 2 (Cardiovascular) 70 (14%) Exam 3 (Pulmonary) 70 (14%) Exam 4 (Renal, Neuro) 70 (14%) Exam 5 (Endocrine, MODS, Burns, Transplants+clicker average) 70 (14%) Final Exam (HESI Critical Care Exam) 70 (14%) ACLS (Grade on first test taken) 10 (2 %) Patient Reviews 20 (4 %) Summer Questions 30 (6 %) Course Questions 20 (4 %) Total 500 (100%)
10 It is necessary to obtain a WEIGHTED MEAN TEST SCORE OF 75 in the class exam grades to pass this course. This weighted mean test score does not include the ACLS test. A weighted mean test score below 75 or a class average below 75 constitutes failure of Nursing 423 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 423. (Nursing Policy No. 25) 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 423. 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 words or ideas of another person as if they were your own. Examples of plagiarism are (1) submitting an assignment as if it were one's own work when, in fact, it is at least partly the work of another; (2) submitting a work that has been purchased or otherwise obtained from an Internet source or another source; and (3) incorporating the words or ideas of an author into one's paper without giving the author due credit. Please read the complete policy at http://www.sfasu.edu/policies/academic_integrity.asp 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 from the end of the semester in which they receive 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 purpose 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.
11 Students with Disabilities To obtain disability related accommodations, alternate formats and/or auxiliary aids, students with disabilities must contact the Office of Disability Services (ODS), Human Services Building, and Room 325, 468-3004 / 468-1004 (TDD) as early as possible in the semester. Once verified, ODS will notify the course instructor and outline the accommodation and/or auxiliary aids to be provided. Failure to request services in a timely manner may delay your accommodations. For additional information, go to http://www.sfasu.edu/disabilityservices/. UNIT OBJECTIVES UNIT 1 ETHICAL AND LEGAL PRINCIPLES, END OF LIFE ISSUES AFFECTING DECISION-MAKING, GERINTALOGIC AND NUTRITION OVERVIEW 1. Discuss the ethical principles of autonomy, beneficence, nonmaleficence, veracity, and fidelity as they relate to the critical care patient. 2. Describe what constitutes an ethical dilemma. 3. List the steps for making ethical decisions. 4. Identify legal and professional obligations of critical care nursing. 5. Describe theories of liability. 6. Define and describe the components of malpractice. 7. Relate critical care practices and risk management strategies. 8. Discuss specific legal concerns; including informed consent, Durable Power of Attorney, do-not-resuscitate issue, staffing issues, and application of life support measures. 9. Discuss end of life issues: Comfort care, communication and decision making, withdrawing or withholding treatment, palliative care, symptom management, withdrawal of mechanical ventilation, family care, and organ donation. UNIT 2 NURSING CARE OF THE PATIENT EXPERIENCING COMPLEX ACUTE AND CHRONIC CARDIOVASCULAR ALTERATIONS 1. Identify and briefly describe the physiology of the normal anatomical structures of the heart and blood vessels. 2. Trace the normal sequence of depolarization through the cardiac conduction system. 3. Identify the determinants of cardiac output. 4. Describe the nervous system control of the heart and blood vessels. 5. Perform a thorough bedside examination of the cardiovascular system differentiating between normal and abnormal findings and state the significance of all abnormal findings. 6. Define hemodynamic monitoring and differentiate between CVP, PAP, PCWP, SVR, PVR, CO, and CI. 7. Differentiate between the normal and abnormal values of the hemodynamic parameters above and explain the clinical significance of the abnormal values.
12 8. Apply the nursing process to the client with a pulmonary artery catheter in place. 9. Describe the pathophysiologic and psychosocial processes and related assessment findings for the following cardiovascular disorders: congestive heart failure, myocardial infarction, coronary artery disease, endocarditis, cardiac tamponade, cardiac infective disorders, valvular heart disease, cardiomyopathy, carotid artery disease, hypertensive crisis, myocarditis, pericarditis, and the various types of shock. 10. Develop appropriate nursing diagnosis and collaborative problems with appropriated goals for the patients with the cardiovascular disorders outlined in objective 9. 11. Identify medical and appropriate nursing interventions (with rationales) utilized for patients with each of the above cardiovascular. 12. List evaluation criteria for each of the medical and nursing interventions used to treat patients with cardiovascular disorders. 13. Summarize the nursing assessments and interventions pertinent to the patient undergoing cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), atherectomy, stent, laser therapy and intra-aortic balloon pump therapy (IAABP). 14. Describe the role of the critical care nurse during and after the administration of thrombolytic therapy. 15. Describe the immediate postoperative medical and nursing management of the adult cardiovascular surgical patient. 16. Discuss the prevention, identification and management of pacemaker malfunction. 17. Identify the major nursing implications related to the administration of antidysrhythmic and vasoactive drug therapy. 18. Discuss nutritional considerations for the client with cardiovascular alterations. 19. Describe gerontologic issues and management of the client with cardiovascular alterations. UNIT 3 NURSING CARE OF CLIENTS EXPERIENCING COMPLEX ACUTE/CHRONIC PULMONARY ALTERATIONS 1. Perform a thorough bedside examination of the pulmonary system differentiating between normal and abnormal findings and state the significance of all abnormal findings. 2. Analyze arterial blood gases and state -the probable physiological cause of the disorder. 3. Describe appropriate nursing and medical interventions to correct the underlying causes of abnormal arterial blood gases. 4. Describe the pathophysiologic and psychosocial processes and related assessment findings for the following pulmonary disorders: acute respiratory failure, pulmonary edema, Adult respiratory distress syndrome (ARDS), atelectasis, pneumonia, pulmonary hypertension, cor-pulmonale, pulmonary embolus, pneumothorax and thoracic injuries. 5. Develop appropriate nursing diagnosis and collaborative problem statements with goals for patients with the following respiratory disorders: acute respiratory, failure,
13 pulmonary edema, adult respiratory distress syndrome (ARDS), atelectasis, pneumonia, pulmonary hypertension, cor- pulmonale, pulmonary embolus, pneumothorax and thoracic injuries. 6. Identify appropriate medical and nursing interventions (with rationales) utilized with each of the following pulmonary disorders: acute respiratory failure, pulmonary edema, adult respiratory distress syndrome (ARDS), atelectasis, pneumonia, pulmonary hypertension, cor-pulmonale, pulmonary embolus, pneumothorax and thoracic injuries. 7. List evaluation criteria for each of the medical and nursing interventions used to treat patients with pulmonary system disorders. 8. Discuss nutritional considerations for the client with pulmonary alterations. 9. Describe gerontologic issues and management of the client with pulmonary alterations. UNIT 4 NURSING CARE OF CLIENTS EXPERIENCING COMPLEX ACUTE/CHRONIC RENAL ALTERATIONS 1. 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. 2. Explain pertinent laboratory assessment data as it relates to fluid volume status, electrolyte balance, and the function of the renal system. 3. 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. 4. 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. 5. 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. 6. List evaluation criteria for each of the medical and nursing interventions used to treat patients with renal system disorders. 7. Compare and contrast hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. 8. Utilize the nursing process in the care of the patient receiving hemodialysis, peritoneal dialysis and continuous renal replacement therapy. 9. Discuss nutritional considerations for the client with renal alterations. 10. Describe gerontologic issues and management of the client with renal alterations.
14 UNIT 5 NURSING CARE OF CLIENTS EXPERIENCING COMPLEX ACUTE/CHRONIC NEUROLOGICAL ALTERATIONS 1. Perform a thorough bedside examination of the neurological system differentiating between normal and abnormal findings and state the significance of all abnormal findings. 2. Discuss the acceptable and unacceptable methods of applying noxious stimuli during the neurological exam. 3. Explain neurological changes associated with increased intracranial pressure and related assessment findings. 4. Describe nursing and medical interventions commonly used to treat increased intracranial pressure. 5. Describe various pressure monitoring systems commonly used to assess intracranial pressure. 6. Describe the pathophysiologic and psychosocial processes and related assessment findings for the following neurological disorders: central nervous system tumors, cerebrovascular accident, cerebral aneurysm, arteriovenous malformation, intracerebral hemorrhage, head injuries, spinal cord injuries, autonomic dysreflexia and Guillain-Barre. 7. Develop appropriate nursing diagnosis and collaborative problem statements with goals for patients with the following neurological disorders: central nervous system tumors, cerebrovascular accident, cerebral aneurysm, arteriovenous malformation, intracerebral hemorrhage, head injuries, spinal cord injuries, autonomic dysreflexia, Guillain-Barre and myasthenia gravis. 8. Identify appropriate medical and nursing interventions (with rationales) utilized for patients with each of the following neurological disorders: central nervous system tumors, cerebrovascular accident, cerebral aneurysm, arteriovenous malformation, intracerebral hemorrhage, head injuries, spinal cord injuries, autonomic dysreflexia and Guillain-Barre. 9. List evaluation criteria for each of the medical and nursing interventions used to treat patients with neurological system disorders. 10. Differentiate between the different types of brain injuries, the related assessment findings and interventions needed for each type of injury. 11. Describe the mechanisms of injury associated with spinal cord injuries. 12. Describe the levels of injury of the spinal cord and associated functional injuries. 13. Discuss nutritional considerations for the client with neurological alterations. 14. Describe gerontologic issues and management of the client with neurological alterations. UNIT 6 NURSING CARE OF CLIENTS EXPERIENCING COMPLEX ACUTE/CHRONIC GASTROINTESTINAL ALTERATIONS. 1. Describe the pathophysiologic and psychosocial processes and related assessment findings for clients with gastrointestinal disorders.
15 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. UNIT 7 NURSING CARE OF CLIENTS EXPERIENCING COMPLEX ACUTE/CHRONIC ENDOCRINE ALTERATIONS. 1. Describe the pathophysiologic and psychosocial processes and related assessment findings for clients with endocrine disorders. 2. Develop appropriate nursing diagnosis and collaborative problem statements with goals for patients with endocrine disorders. 3. Identify appropriate medical and nursing interventions (with rationales) utilized for patients with endocrine disorders. 4. List evaluation criteria for each of the medical and nursing interventions used to treat patients with endocrine disorders. 5. Discuss nutritional considerations for the client with endocrine disorders. 6. Describe gerontologic issues and management of the client with endocrine disorders. UNIT 8 NURSING CARE OF THE CLIENT EXPERIENCING SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN DYSFUNTION SYNDROME 1. Describe the pathophysiologic and psychosocial processes and related assessment findings for clients with systemic inflammatory response syndrome and multiple organ dysfunction syndrome (MODS). 2. Develop appropriate nursing diagnosis and collaborative problem statements with goals for patients with systemic inflammatory response syndrome and multiple organ dysfunction syndrome (SIRS). 3. Identify appropriate medical and nursing interventions (with rationales) utilized for patients with SIRS and MODS. 4. List evaluation criteria for each of the medical and nursing interventions used to treat patients with SIRS and MODS.
16 UNIT 9 NURSING CARE OF CLIENTS EXPERIENCING MAJOR THERMAL INJURIES 1. Differentiate full-thickness and partial-thickness burn injuries using the recommended classification criteria. 2. List the American Burn Association's criteria for determining burn injuries that should be referred to a regional burn center. 3. Describe emergency management of thermal, chemical, electrical, and inhalation injury. 4. Describe the pathophysiologic and psychosocial processes and related assessment findings associated in the resuscitation, acute, and rehabilitation phases of burn injuries. 5. Develop appropriate nursing diagnosis and collaborative problem statements with goals for patients in the resuscitation, acute, and rehabilitation phases of burn injuries. 6. Identify appropriate medical and nursing interventions (with rationales) utilized for patients in the resuscitation, acute, and rehabilitation phases of burn injuries. 7. List evaluation criteria for each of the medical and nursing interventions used to treat patients in the resuscitation, acute, and rehabilitation phases of burn injuries. UNIT 10 ORGAN DONATION AND TRANSPLANTATION 1. Discuss how brain death is determined and the sources of organ donors. 2. Explain the pathophysiology of transplant rejection. 3. Discuss specific organ transplants. 4. Discuss nursing and medical management of the immediate post-op transplant patient. All students are responsible for the Policies and Procedures of the School of Nursing. These can be found online at: http//www.nursing.sfasu.edu.