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  • 1. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 Course catalogue no : 7030NRS Course title : Introduction to Intensive Care, Coronary Care and Emergency Nursing Field of Education Code Program/s Graduate Certificate in Critical Care Nursing Graduate Certificate in Emergency Nursing School : Nursing Faculty : Nursing and Health Status of Course within program/s or Core course academic plan/s Credit point value 10 Prerequisites : Nil Year and semester : 2003 Semester 1 Course convenors Patricia Johnson (Critical Care) (07)55528849 email: P.Johnson@griffith.edu.au Anne Evans-Murray(Critical Care) (07)55718283 or page 404 email: anne_evans-murray@health.qld.gov.au Heather James (Emergency) Rm: 3.11 G05 (07) 55528910 email: h.james@griffith.edu.au Kim Forrester (Emergency) Flexible Learning and Access Services Contact Person for examinations: Ms. Diane Crawford e.mail: Diane.crawford@mailbox.gu.edu.au Teaching team members : Date course outline was last modified January 2003 OBJECTIVES: On successful completion of this subject the student will be able to: 1. Initiate assessment and prescribed treatment of patients presenting with cardiac and other emergencies 2. Explain the physiological processes underlying findings from the physical assessment of a critically ill patient presenting to an emergency department / critical care for example: respiratory and cardiac auscultation. 3. Describe the use of technologies in the assessment of critically ill patients / patient presenting to an emergency department / in critical care. 4. Demonstrate the ability to interpret life threatening arrhythmias and instigate emergency treatment. 5. Describe the complex physiological processes underlying findings from the technological assessment of a critically ill patient / patient presenting to an emergency department / critical care. 6. Explain the basic modes of ventilation relating to a ventilated patient in the emergency department / Intensive care unit. 7. Discuss the safety precautions relating to nursing management of a patient in the emergency department / critical care who is being administered inotropes. 8. Discuss the assessment and investigation procedures indicated for a patient presenting to the emergency department and coronary care with chest pain. 1
  • 2. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 BRIEF DESCRIPTION OF CONTENT: This course has a strong clinical focus, and is designed to expand students’ health assessment knowledge and skills applied to care of patients who present to an emergency department or are critically ill. It will include an extensive assessment component such as arterial blood gas analysis, chest radiography, cardiac electrophysiology, cardiac monitoring and respiratory assessment. Concepts such as management airway, modes of ventilation, and management of patients on inotropes will be addressed. Clinical decision-making techniques, including reflection in action and the use of the nursing process, will be discussed within the emergency / critical care context. RATIONALE FOR CONTENT: The content reflects the necessary knowledge base, both theoretical and practical required by registered nurses specialising in this field of nursing. The course utilises critical thinking processes to achieve the successfully integration of theoretical understanding in relation to clinical application. INTERRELATIONSHIP OF THE COURSE WITH OTHER COURSES AND THE PROGRAM: This course is one of four core courses within the Graduate Certificate of Critical Care Nursing. The other core courses are 7003NRS Critical Care Nursing Interventions 1, 7005NRS Critical Care Nursing Interventions 11, 7007NRS Critical Care Nursing Interventions 111. This course is also one of the four core courses within the Graduate Certificate of Emergency Nursing, which is a 40 credit point program. The other core courses are Emergency Nursing 1 - 7004NRS, Emergency Nursing 11 – 7006NRS, and Emergency Nursing 111 – 7008NRS. ORGANISATION AND TEACHING METHODS: This course is offered by the School of Nursing, Faculty of Nursing and Health in flexible mode – either as an on-campus or off campus distance mode. Students are to enroll in either internal or external mode. Internal Mode (On Campus Delivery): This course is offered by the School of Nursing, Faculty of Nursing and Health in flexible mode. This will consist of six (6) contact hours per week for seven (7) weeks. A variety of teaching and learning strategies will be used and will include lecture, tutorials, and self-directed learning exercises. Students will undertake weekly reading and will be required to participate in discussions generated by the content of the material. This course will be coordinated through the Faculty of Nursing and Health, School of Nursing and conducted at the Gold Coast Hospital – Staff Development Centre. This course is offered by the School of Nursing, Faculty of Nursing and Health in flexible mode – either as an on-campus or off campus distance mode. Students are to enroll in either internal or external mode. External (Off Campus – Distance Mode) Online - Web Based Delivery: The School of Nursing, Faculty of Nursing and Health also offers this course in distance mode. Students are to access the course content through the Griffith home page – Learning@GU. Convenor: Heather James – Emergency Nursing - web based delivery. FLEXIBLE LEARING: The course is delivered in distance mode (on line web), with the option of on campus (hospital campus), workshop/lecture sessions during the semester. Please Note: Unlike the internal on campus mode, the distance course is conducted over the duration of the semester’s 13 teaching weeks. The course is structured around self-directed learning modules and students may attend optional workshop/lecture days. These optional hospital campus contact days are designed to assist you with your understanding of the course content and to provide an interactive and collegial environment for the students. 2
  • 3. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 OPTIONAL WORKSHOP/LECTURE DAYS: Optional Workshop/Lecture days have been organised again this semester. Should you wish to attend would you please indicate your expression of interest to the convenor by the 28th April. These workshop/lecture days will be held at the Gold Coast Hospital Staff Development Centre, Nerang Street, Southport. May 22nd 2003: Times: 0900-1600hours The first day assists those students enrolled in Emergency Nursing 1 (8004NRS). It is a combined day with the Critical Care students and focuses on Environmental Issues eg. burns, envenomation, poisoning, substance abuse and toxicology; drowning and diving injuries. May 23rd, 2003: Times: 0900-1600hours: Emergency Students only: Fast Track for Advanced Life Support (ALS): Students must be studying this course – 7030NRS – Introduction to Intensive Care, Coronary Care and Emergency Nursing to be eligible to complete the ALS day). Students who successfully complete this ALS day will be awarded an ALS certificate and are eligible to be placed on the national database of the Australian College of Critical Care Nurses (A.C.C.C.N.) as ALS competent. Please Note: Distance students unable to attend these workshops / lecture days will not be disadvantaged in relation to content delivery, as all content is delivered via the online information. The ALS qualification cannot be achieved without attendance at the workshop/lecture days. Students undertaking the online delivery, and who wish to attend intermittent hospital campus (Gold Coast Hospital) lecture days may contact the course convenor for Critical Care – Ms Anne Evans- Murray on 07 55718283 to arrange this attendance (or Patricia Johnson). Seating preference is given to ‘internal – on campus’ students so please check prior to attending. External Mode - Online Web Based Delivery: Contact: Heather James – convenor for emergency nursing web based delivery This course is also an online (web based) delivery. Students unable to attend these workshops / lecture days will not be disadvantaged as all content is delivered via the online access. As well as online content delivery, students will receive other relevant information eg lecture notes (the same as those provided to internal students) in hard copy to assist with their study program. These will be sent out by FLAS. Students are expected to secure the prescribed text/s for this course. As well as the prescribed text, students should integrate other relevant reading material to assist in their learning process and strive to integrate evidence-based practice throughout all aspects of the program. 3
  • 4. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 STUDY CHART FOR EXTERNAL MODE - ONLINE WEB BASED DELIVERY: The following study timetable is provided as a guide only. Students may progress through the topics at their own pace and in any order they prefer. Semester 1, 2003 Week Module Topic 1 Module 1 – Reflective Reflective Practice 3rd March - Practice 7th March Module 2 - Respiratory Introduction to Respiratory Module Arterial Blood Gas Analysis 2 10th – 14th March Module 2 – Respiratory Modes of Ventilation Primary and secondary assessment (see note below) 3 17th – 21st March Module 2 – Respiratory Respiratory Assessment -Auscultation 4 24th – 28th March Module 2 – Respiratory Airway Management Interpretation of Chest Radiography 5 Module 3 – Cardiac Introduction to Cardiac Module 31st – 4th April Cardiac Physiology 6 Module 3 – Cardiac Cardiac Physiology 7th – 11th April 7 Module 3 – Cardiac Cardiac Assessment 14th – 18th April - Auscultation Pharmacokinetics Public Holiday: Good Friday – 18th April Mid Semester Break 21st – 25th April 8 Module 3 - Cardiac Pharmacology 28th – 2nd May -Inotropes -Vaughn William’s Classification 9 Module 3 – Cardiac Interpretation of Arrhythmias 5th – 9th May Clinical Workbook Submission Date – 9th May 10 Module 3 – Cardiac Advanced Interpretation of Arrhythmias 12th – 16th May Module 3 – Cardiac Advanced Interpretation of Arrhythmias 11 19th – 23rd May 12 Module 3 – Cardiac Cardiac Electrophysiology and Interpretation of 26th – 30th May Cardiac Axis 13 Module 3 – Cardiac Cardiac Investigations 2nd - - 6th June Myocardial Infarction Study Week 14 9th – 13th June Exam Week Examination time and venue to be advised 15 16th – 20th June Exam Week 16 23rd – 27th June 4
  • 5. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 Please Note: Information for primary and secondary assessment has not yet been added to the web site. This information will be made available later in the course. ADMINISTRATIVE ISSUES: Submission of Assignments: All written assignments must be submitted to FLAS, using the cover sheets provided in the distance package. Please refer to the FLAS information for further instruction related to assignment submission. It is the student’s responsibility to keep a copy of all assignments – both electronic and hard copy, in case of accidental loss. All assignments will be due by 4.00pm on the designated date unless an alternative date has been negotiated. Failure to submit all pieces of assessment will result in a failing grade for this Course. Referencing Assignments: Written submissions should be presented in accordance with the Faculty of Nursing and Health requirements. The Writing Guide 2002 will assist in academic writing expectations. The Assignment Writing Guide (2002) has been included in your distance package. Another useful resource for referencing is found at http://www.apa.org/journals/webref.html Extensions: If for medical reasons or for any other unforeseen circumstances, you are prevented from completing an assignment on time, you may apply for an extension. These applications should be made to the course convenor as early as possible, before the due date of submission. Please make a note of the extension date negotiated by the program convenor and include this information on your assignment. Please Note: Please make a note of the extension date negotiated by the course convenor and include this information on your assignment front cover. This is important information for the course convenor in relation to penalties for late submission. Penalties for Late Submission: Assessment items submitted after the due date without authorised extensions will be subject to penalty. Marks will normally be deducted at a rate of 10% of the assignment for every working day it is late. A weekend will be counted as one working day. A late submission will be awarded 0% after five working days. Policies: Students should consult the relevant sections of the Griffith University Assessment Policies, which are on the net at: http://www.gu.edu.au/ua/aa/ppm/tal/content/aad_asspol_fs.html and the School of Nursing Assessment Policy - http://www.gu.edu.au/school/nrs/ It is the student’s responsibility to familiarise themselves with these policy documents. Award of Grades: The Assessment Board will examine results recommended by the course convenor and determine final results for all students in the course according to the rules and regulations of the University. The following grades will be used in this course: High Distinction (HD), Distinction (D), Credit (C), Pass (P), Failure (F) and Fail, No Submission (FNS). Final grades are awarded by the assessment board on the basis of performance in consultation with 5
  • 6. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 the Course convenor, and in accordance with the rules and policies of the University. Students should become familiar with the University’s assessment rules published in the Handbook and with the Faculty’s assessment policies displayed on the noticeboard and accessed by the Internet http://www.gu.edu.au/school/nrs/ RESOURCES: Prescribed Text: Urden, L., Stacy, K., & Lough, M,.(2002). Thelan’s Critical Care Nursing. Mosby Year Book Inc. St. Louis. OR: Thelan, L.A., Davie, J.K., & Urden, L.D. (1998). Critical Care Nursing, Mosby, St Louis. Lecture Notes: Distance students will receive lecture notes in their FLAS package. These lecture notes are used for the on campus mode of delivery, and have been included in the distance package to assist students with their study programs. Students are expected to secure the prescribed text/s for this course. As well as the prescribed texts, the students should integrate other relevant reading material to assist in their learning process. Students should strive to integrate evidence based practice throughout the duration of the program. On Line Access: Students who are having difficulties accessing the online web content, should see the Learning@GU Information Pages and the course convenor. It is very important to ask for assistance if you are experiencing any problems with access. ASSESSMENT: Failure to submit all pieces of assessment will result in a failing grade for this Course. There are two pieces of assessment. 1. Clinical Workbook 40% 2. Written Examination 60 % Failure to submit all pieces of assessment will result in a failing grade for this Course. Assessment Item 1: 1. Clinical Workbook: Weighting: 40% Due Date: Week 9 – 9th May, 2003 or a date negotiated with the convenor.**See below** **Negotiated Assignment Submission Date**: Students may negotiate a submission date for their written assignments with the course convenor. Students who opt for a negotiated submission date which is later than the designated date - Week 9 – 7th May, may not receive feedback and grading for the assignment prior to the end of the teaching semester and exam period. 1. Clinical Workbook: The clinical workbook will require the student to use interpretative skills to analyse common problems that occur in a critical care / emergency environment. They will be expected to analyse clinical data such as electrocardiographs, rhythm strips, blood gas analysis etc. 6
  • 7. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 The clinical workbook will be forwarded by FLAS or you can access it online. 2. Written Examination (2 hours) Weighting: 60% Due Date: University Examination Weeks The date, time and venue will be advised by FLAS The examination will be 2 hours in duration and may include multiple choice, short and long answer questions. The examination will examine and challenge the knowledge you have gained throughout this course. Examinations for this course will be organised through Flexible Learning and Access Services (FLAS). Students must complete the appropriate forms and return them to FLAS by the designated dates. FLAS will notify students of the time and venue for this examination. If you do not receive information regarding the examination, please contact FLAS to make final arrangements for the exam. Examination information regarding forms etc should be included in the distance package you receive from FLAS. Failure to submit all pieces of assessment will result in a failing grade for this Course. Internal Mode Study Chart Information: The following information has been included to assist you to plan your study program more efficiently. This is the study chart used for the on-campus mode of delivery – over a seven week period. The content for both courses (internal and external mode) is the same. You will note however that the sequencing is different. Please feel free to study the content in any order you prefer. Overview of Subject Content Time: 9am to 4.00 pm Venue: Staff Development Centre, Gold Coast Hospital Note: The first day, Feb 13th will be held at Griffith University Wk Date Content 1 Feb 13 Introduction Reflective Practice and evidence based practice Information Technology Resources Library Tour – Griffith /Information Technology 2 Feb 20 Primary and Secondary Assessment Blood gas analysis Modes of Ventilation Airway Management 3 Feb 27 Cardiac auscultation Respiratory Assessment Respiratory Auscultation Respiratory Physiology 7
  • 8. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 Wk Date Content 4 Mar 6 Cardiac Physiology: Action Potential Cardiac Output Properties of cardiac muscle cell Cardiac Interpretation 5 Mar 13 Cardiac Interpretation cont. A.V. Blocks Life threatening arrhythmias and treatment Cardiac (12 lead ECG) Einthoven’s triangle, Axis interpretation / 12 lead ECG – MI 6 Mar 20 Basics of pharmacology Cardiac Pharmacology Vaughn Williams Classification Assessment of chest pain/CAD /Cardiac investigations 7 March 27 Basics of chest x-ray interpretation CT scans, chest x-ray interpretation Evaluation 9 April 10 Exam – 9 am to 11.15 Weekly Objectives: CONTENT WEEK 1 Introduction and Overview of Subject Content Reflective Practice Introduction and Information Technology Resources, Tour of Griffith University Library. WEEK 2 Acid base balance 1 Identify the three major mechanisms that regulate pH. 2 Critically analyse arterial blood gas results including uncompensated, partially compensated and completely compensated respiratory and metabolic acidosis and alkalosis. 3 Describe the concepts A - a gradient and base excess. 4 Relate the analysis to clinical scenarios. Modes of Ventilation 1. Differentiate between spontaneous and mechanical ventilation. 2. Explain the following: Peak inspiratory pressure - Peak flow rate Critically evaluate the following modes of ventilation: - SIMV/ A/C - PSV - PEEP - CPAP 3. Differentiate between pressure cycled, & volume cycled 8
  • 9. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 Airway Management 1. Discuss the concepts of airway management 2. Outline the complications that may be associated with airway management Required Reading Thelan p 703 -712 Thelan (2002) – 537 –542 600- 602 Primary and Secondary assessment 1. Discuss the concepts of primary and secondary assessment in the emergency Department. (Further objectives given out in class) WEEK 3 Respiratory Assessment Respiratory 1. Describe the essential aspects of the mechanisms of breathing. 2. Differentiate between the relationships of pressure gradients, airway resistance and air flow. 3. Define compliance and describe its impact on the work of breathing. 4. Explain the physiological effect of surfactant. 5. Identify features of the respiratory membrane that facilitates gas exchange. 6. Compare the diffusion of gases between alveoli and pulmonary capillary. 7. Examine the ventilation perfusion relationship and its significance. 8. Describe oxygen and carbon dioxide transport in the blood stream. 9. Outline the oxyhaemoglobin dissociation curve and its significance. 10. Describe the control of breathing. 11. Describe the respiratory auscultation and palpation procedure, outlining the normal and abnormal chest sounds. Required Reading Thelan p 601 – 624, 629 -639 Learning Aids: Video Assessing Breath Sounds (in Library) CD ROM assessing breath sounds. Thelan (2002) 519 -535 497 – 516 Cardiac assessment 1. Describe auscultation of the cardiovascular system. 2. Discuss the characteristics of the normal and abnormal heart sounds. 3. Relate the abnormal sounds to clinical conditions Required Reading Thelan p 365 – 371 Thelan (2002) 285 -294 WEEK 4 Cardiac 1. Explain the properties of the cardiac muscle cell including: - automaticity - rhythmicity - excitability - conductivity - refractoriness - contractility 2. Describe the normal conduction pathways. 9
  • 10. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 3. Describe the mechanical events in the cardiac cycle and its relationship to the chemical and electrical events. 4. Explain the determinants of cardiac output including Starling’s Law. 5. Differentiate between cardiac output and cardiac index. 6. Describe control of the heart and circulation including neural, hormone and autoregulation. Cardiac (Rhythm Strip interpretation) 1. Interpret normal sinus rhythm. 2. Interpret the following rhythms and arrhythmias: - supraventricular arrhythmias (atrial ectopics, atrial fibrillation, atrial flutter, atrial tachycardia, junctional rhythm, junctional ectopics). - ventricular arrhythmias (ectopics, idioventricular rhythm, accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, ventricular standstill, agonal rhythm). 3. Briefly describe appropriate treatment for the above rhythms. Required Reading Thelan p 344 – 354, 389 -427 Thelan (2002) 251 – 272 307 –321 323 –342 Learning Aids: Heart Sim Video: Cardiovascular Nursing = Physiologic anatomy (RC 674. C375 1993 V1) WEEK 5 Cardiac arrhythmia interpretation continued: Cardiac (12 lead ECG) 1. Define the following terms: - lead - lead axis - positive and negative electrode - unipolar lead - bipolar lead 2. Explain the significance of Einthoven’s triangle. 3. Differentiate between the orientation of frontal and horizontal plane leads. 4. Identify current placement of leads for a 12 Lead ECG. 5. Identify the normal ventricular complexes seen in a 12 lead ECG. 6. Recognise the changes that indicate injury, ischemia and infarction on a 12 Lead ECG. Required Reading Thelan p 389 - 403 Thelan (2002) 251 – 272 307 –321 323 –342 WEEK 6 Cardiac investigations and myocardial infarction 1. Differentiate between the causes of chest pain under the following categories: cardiac, pulmonary, musculoskeletal, gastrointestinal, psychosomatic on the basis of: - (p) precipitating factors - (q) quality - (r) region and radiation - (s) signs and symptoms - (t) time and response to treatment 2. Discuss the assessment of coronary artery disease, and its risk factors 3. Describe cardiac enzymes and their changes following MI. 10
  • 11. Course Convenors: Trish Johnson & Anne Evans-Murray / Heather James Semester 1, 2003 4. For the following cardiac investigations outline the information obtained and relevant nursing care: - Echocardiography - Radionuclite (sp.) Studies - Electrophysiologic Studies - Stress Testing & Cardiac Catheterisation Cardiac pharmacology 1. Discuss the concepts of basic pharmacodynamics 2. Review cardiac physiology – preload, afterload, contractility 3. Outline action potential and relate to cardiac drugs 4 . Describe the pharmacological action and use of inotropes. vasodilators and other cardiac drugs. 5. Briefly explain Vaughn William's classification of arrhythmias. Required Reading Thelan p. 427 -441 Thelan (2002) 344 –354 395 – 402 484 – 490 WEEK 7 Chest x-ray Assessment 1. Differentiate between the different presentations of diseases /disorders on chest x-rays 2. Correctly identify anatomical landmarks on a chest x-ray 3. Identify placement of the patients tubes on the chest x-ray including endotracheal tube, tracheostomy tube, nasogastric tube 4. Discuss the radiographic features of the following: • pneumothorax cardiac failure • adult respiratory distress syndrome surgical emphysema • pleural effusion atelectasis / collapse • emphysema 5. Demonstrate the assessment of the heart size on a chest x-ray Required Reading Thelan (1998) p 384 – 387 Thelan (2002) P 545 – 547 Tutorial Review Of the Subject 11