Course catalogue no : 7005 NRS Course title : Critical Care ...
Course catalogue no : 7005 NRS
Course title : Critical Care Nursing Interventions 11
Field of Education Code
Program/s Graduate Certificate in Critical Care Nursing
Convenor – Patricia Johnson
School : Nursing
Faculty : Nursing and Health
Status of Course within program/s or
Credit point value 10
Prerequisites : Nil
Year and semester : 2002 Semester 2
Course convenor Patricia Johnson
(07)55718283 or page 404
Teaching team members :
Date course outline was last modified June 2002
Students completing this course will:
1. Describe selected pathophysiological processes encountered by patients in the critical care
2. Describe the role the critical care nurse plays in implementing, monitoring and evaluating complex
therapies in the critical care environment.
3. Explain the use of selected technologies in management of critically ill patients.
4. Demonstrate an understanding of therapies utilised by other health care professionals in the critical
5. Critically evaluate research findings related to nursing care of the critically ill patient.
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 7030NRS Introduction to Intensive Care, Coronary Care and Emergency Nursing, 7003NRS
Critical Care Nursing Interventions 1, and 7007NRS Critical Care Nursing Interventions 111. This course will
further develop and extend the knowledge and skills that were the focus of Critical Care Nursing Interventions
This course will focus on multi-disciplinary, technologically dependent approaches to patient care and the role
the critical care nurse plays in implementing, monitoring and evaluating the efficacy of these approaches. Body
system support, organ replacement technologies, complex infusion therapies and invasive monitoring will be
discussed. Aspects of advanced practice, teaching, research or management in critical care will be explored.
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Overview of Course Content
Week Content Speaker
A. Evans-Murray /Trish Johnson
Advanced cardiac: SVT versus VT, BBB
Complications of M.I
Compulsory Attendance today
Advanced Life support:
Clinical skills workshop
Clotting and thrombolytic therapy
Treatment of M.I
Congestive Cardiac Failure
Dr. Nasser Essack
Management of spinal injuries
Burnout/ bullying / communication
Exam Review /Evaluation
September 5 Exam 9am A. Evans-Murray
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1. Discuss credentialling of the specialist critical care nurse.
Gerontological Alterations and Management of the Elderly Patient in Critical Care
1. State the clinical significance of age-related physiological changes (neurological, cardiac, gastro-
intestinal) and the expected nursing consideration or interventions used in caring for the elderly critical
2. Relate the age -related changes in hepatic function and accompanying pharmacolinetic changes to
the administration of various cardiovascular medications.
3. Describe the age-associated physiological changes that occur in the elderly. (neurological, cardiac,
1998- Thelan, 271 to 292
2002 – Thelan, 199- 209
1. Review the nutritional assessment of a critically ill patient and identify the altered parameters in the
critically ill individual.
2. Explain mechanisms for energy use in the critically ill including the hypermetabolic state.
3. Outline indications for parenteral and enteral nutrition for a critically ill patient.
4. Describe the nutritional solutions available.
5. Describe methods of evaluating nutritional support, nursing care and complications.
1998 - Thelan, 121 - 126.
2002 – Thelan, 93 – 100, 109 -117
WEEK 2 Advanced cardiac
1. Explain the pathology of pre-excitation of the ventricle. (Wolff-Parkinson-White and Torsades)
2. Describe the ECG changes associated with accessory pathway conduction.
3. Differentiate between the features and management of SVT and VT.
4. Identify ECG changes associated with selected disease processes. (ie. pericarditis, pulmonary
5. Describe the ECG pattern that is characteristic of right and left bundle branch block.
6. Discuss rate dependent bundle branch block
7. Compare the hemiblock patterns that may be seen in both fascicles of the left bundle branch.
8. Determine the electrical axis on the basis of given complexes in the six limb leads and state whether
they are normal or abnormal.
Pacemakers and Internal Defibrillators
1. Identify principles of cardiac pacing.
2. Outline the purpose and indications for cardiac pacemakers.
3. Differentiate between temporary and permanent pacemakers.
4. Describe the various types of pacemakers currently in use.
5. Describe the management of a patient receiving cardiac pacing.
6. Describe the nursing response associated with caring for patients with AICD, Automatic Implantable
7. Correctly interpret a 12-lead electrocardiography of paced rhythm (noting pacing spikes), capture,
intrinsic, beats, etc).
Morton, P. 1997 ECG / Pacemaker Critical Care Nurse Vol 17, No 1 February.
1998, Thelan, 529 - 541
2002, Thelan, 440 – 450, 322 – 323, 338 – 339,
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Evans-Murray A. (2001). Wolff- ParkinsonWhite (WPW) syndrome: what the critical care nurse needs to
consider when administering antiarrhythmics. Aust Critical Care 14 (1) :pp. 5-9.
1. Discuss current trends and indications for cardiac surgery.
2. Describe the effects of cardiopulmonary bypass.
3. Contrast the management of patients with valve replacement surgery to that of coronary artery
4. Outline assessment data in the post-operative period and implications for nursing management.
5. Identify specific complications and long term prognosis.
1998, Thelan. 541 -550
2002, Thelan 466 –484
Hudak p. 394 - 426
1. Identify the principles of invasive pressure monitoring.
2. Explain the physiological significance of monitoring haemodynamic parameters.
3. Interpret data from arterial, central venous and pulmonary artery pressures, cardiac output, cardiac
index, systemic and pulmonary vascular resistance readings and calculations including the
significance of abnormalities.
4. Identify the indications for, nursing care of and complications related to haemodynamic monitoring.
Thelan, 442 to 480
Hudak, 226 to 242
Flynn, 161 to 206
Advanced Life Support
1. Discuss ARC’s policies on resuscitation
2. Demonstrate the team leader’s role in a mega code
3. Identify life threatening arrhythmias
4. Review treatment of life-threatening arrhythmias
THE STUDENT WILL DEMONSTRATE SUCCESSFULLY THE TEAM LEADERS ROLE IN A MEGA-CODE.
• Advanced airway and ventilation maintenance
• Electrocadiographic monitoring
• Arrhythmia analysis
• Arrhythmia management (mechanical , chemical, electrical )
• Management of resuscitation equipment
• Occupational health and safety issues
• ARC advanced guidelines
• Team leader decision-making
Review life threatening arrhythmias from previous subject – Introduction to Critical Care
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1998, Thelan 406 -428
2002, Thelan 332 -342
1. Discuss the complications of myocardial infarction
2. Describe the medical and nursing treatment of myocardial infarction.
3. Briefly outline the clotting cascade and relate to thrombolytic therapy
4. Explain the use of thrombolytic therapy after myocardial infarction
5. Describe the nursing care of patients receiving thrombolytic therapy.
1998, Thelan, 490 to 501
2002, Thelan, 409 –414, 452 -465
1. Discuss the pathophysiology, clinical manifestations and treatment of the following cardiovascular
2. Describe the pathophysiology of congestive cardiac failure.
3. Discuss the treatment of congestive cardiac failure and recent research into pharmacological agents.
1998. Thelan, 502-510,
2002, Thelan, 418 –420, 414 - 418
Hudak, 340 to 342
Neuro 1: Management of Head Injuries
1. Describe autoregulation of intracranial pressure (including Munoe Kelly Doctrine).
2. Review the factors that alter intracranial pressure (ICP).
3. Describe the various methods to monitor ICP.
4. Explain the role of the nurse in the management of ICP monitors and CSF drainage systems.
5. Describe the nursing interventions to decrease ICP.
6. Describe the pharmacological management of increased ICP including the implications for nursing.
7. Explain the five critical areas of neurological assessment:
• Motor Movements
• Pupillary reaction and eye movement
• Respiratory patterns
• Vital signs
8. Differentiate between types of head injuries:
• Scalp/skull injuries
• Brain injuries
• Haematomas (subdural, epidural, intracerebral)
9. Describe the Babinski, Occulocephalic and Occulovestibular reflexes.
1. Discuss the presentation of meningitis
2. Outline the nursing and medical treatment of meningitis
3. Discuss the pathophysiology of Guillain Barre and Myasthenia gravis
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4. Outline the nursing and medical treatment of Guillain Barre and Myasthenia gravis
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Wong, F, (2000) Prevention of Secondary Brain Injury. Critical Care Nurse, Vol 20, No. 5, October pp. 18-27.
Arbour, R, (1998) Aggressive Management on Intracranial Dynamics Critical Care Nurse Vol 18, No. 3, June,
Smillova A, Walker E. (2000) Meningococcemia: A critical care emergency. Critical Care Nurse vol 20, N0. 5,
October. pp. 28-37
1998, Thelan, 763 to 774, 812 - 814
2002, Thelan, 671 – 692, 701 -714
Hudak: 665 to-670, 678 to 682
Hudak, 615 to 621, 624-627
Neuro 2: Management Of Spinal Injuries
1. Describe the pathophysiology, complications and treatment of spinal shock.
2. Describe the pathophysiology of spinal cord transactions.
3. Describe the medical treatment of spinal cord injuries, and autonomic dysreflexia.
4. Explain the nursing care of spinal cord injuries.
5. Explain the complications of spinal cord injuries.
1998, Thelan 1065 –1071
2002, Thelan 903- 909, 1037
Burnout / Communication / bullying
Objectives will be given out in class
Generic Skills Development
This course will develop skills of problem solving and decision making, analysis and critical evaluation,
information retrieval, teamwork, professional effectiveness, oral and written communication.
This course will have some print materials supplemented. Attendance is recommenced but not compulsory
with the exception of the Compulsory Attendance day.
Rationale for Content
This course will further develop and extend the knowledge and skills that were the focus of Critical Care
Nursing Interventions I. The skills and knowledge learnt in this course will enable students to practise in a
variety of critical care settings.
Organisation and Teaching Methods
This course comprises 42 contact hours over seven (7) weeks. A variety of teaching and learning strategies
will be used and will include lectures, tutorials, self-directed learning exercises and reflective sessions. On
some weeks the students will utilise tutorial time to deliver their presentations. 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.
Rationale for Teaching Methods
The teaching and assessment strategies in this program reflect the philosophies and strategies of other
graduate certificate level programs offered by the School of Nursing. That is, they are designed to advance
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students’ professional practice skills, promote lifelong learning strategies, encourage critique and debate,
improve oral and written skills and facilitate interdisciplinary collaborative relationships.
1. Assignment (2000 to 2500 words) Weighting 40%
Due: August 22nd
2. Examination Weighting 60 %
Date: Sep 5th
3. Pass the clinical assessment in the workshop / megacode (ACCCN curriculum)
*NB. All pieces of assessment must be passed to pass the course.
1. Evidence Based Practice Case Study.
You may choose any one of the topics in the course outline, eg. Cardiac and respiratory emergencies, elderly
patient, patient with a pacemaker, head injury etc. etc.
Identify and discuss current treatment modalities for this patient presentation, focusing on the critical care
nurses’ role in the provision of care for these patients in the Critical care environment.
Critique your clinical practice in relation to this patient admission
Below is a suggested format to assist you in developing your assignment. Please feel free to structure it in
whatever way you believe addresses the assignment requirements.
Brief Patient Overview:
You are to complete a case study for a patient you have cared for in the critical care environment
Clearly identify the topic you have chosen at the beginning of your assignment.
Include a brief overview of the patient’s presenting condition – using a biopsychosocial perspective.
Part B: (Main Focus of the Assignment)
Using Evidenced Based Practice concepts - discuss the patient’s presenting condition
Provide an overview of the presenting condition ie. The aetiology of the condition or injury.
Identify and discuss the latest treatment modalities (interventions) for this condition.
Include in your discussion, the assessment and ongoing management for this patient, focusing on the
critical care nurse’s role in caring for this patient.
Provide clear referenced rationales for all interventions included.
Include in your discussion any controversial issues you identified during your review of the literature for
Support all aspects of your paper with relevant and current references to the literature.
In the final section, you are to critique your own clinical practice (reflective practice) related to this
patient’s care. Consider both positive and negative aspects of your care and what aspects you would
change for future practice.
This final section (reflective practice) may be written in the first person
Please do not hesitate to contact the course convenor if you need assistance with this assignment.
Please attach the Marking Criteria sheet for this assessment included at the end of this outline.
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This will be a multi-choice and short answer written examination held at the end of the course on the date
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3. Clinical Assessment
The clinical skills stations and advanced life support lectures follow the set curriculum of the accredited Gold
Coast Hospital Advanced Life Support Course. This course is accredited through ACCCN Ltd.
The program reflects current guidelines and policies of the Australian Resuscitation Council (ARC) throughout
Rationale for Assessment
The two items address each of the objectives for the course in addition to promoting writing skills. In addition,
the compulsory clinical assessment underpins the development and assessment of the advanced clinical and
decision making skills required for this particular nursing specialty.
Texts and Supporting Materials
Thelan, L.A., & Urden, L.D., Lough, M., Stacy, K. (1998), Critical Care Nursing, St Louis. Mosby.
Urden,L.D,. Stacy, K,M, & Lough, M,E. (2002) Thelan’s Critical Care Nursing Diagnosis and management (4th
Ed) St. Louis: Mosby.
Hudak, C., Gallo, B., & Morton, P. (1998). Critical Care Nursing: A Holistic Approach (6th Ed). Philadelphia:
Required readings will be available to purchase from the Gold Coast Campus bookshop.
Scope of Course Evaluation
Student evaluation of the course will be undertaken informally throughout the semester by inviting students to
discuss with the convenor any concerns or issues they have with the content relevancy, teaching/learning
strategies, assessment items and/or guest lecturers. A formal student course evaluation will be undertaken at
the end of semester. In addition, relevant professional bodies (for example, the Australian College of Critical
Care Nurses) will be asked to provide feedback in relation to national developments.
Your attention is drawn to the following important policies and guidelines relating to assessment.
Submission of Assignment:
All written assignments must be submitted to the course convenor at the Staff Development Centre Gold
Coast Hospital. The assignment must have the attached an Assignment Cover Sheet (this sheet is included in
your Assignment Writing and Study Guide for you to photocopy). This sheet will be date stamped and filed as
proof of submission. You are also advised to keep a copy of all assignments in case of accidental loss.
All assignments will be due by 4.00pm on the designated date unless an alternative time is stipulated.
Written submissions should be presented in accordance with the Faculty of Nursing and Health Science's
Assignment Writing and Study Guide 1997 which specifies the appropriate format (section 6.1), or in
accordance with A Writing Guide for First Year Students. (2002). Written by Dr Chris Vose and Dr Wendy
Moyle, School of Nursing Griffith University.
It is the student’s responsibility to keep a copy of all assignments – both electronic and hard copy, in case of
If for medical reasons or for any other unforseen circumstances, you are prevented from completing an
assignment on time, you may apply for an extension on the appropriate form in the Assignment Writing Guide.
Such application should be made to the course convenor as early as possible, before the due date of
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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.
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 (a copy of which is displayed on the School notice board, level 3, Health Science Building).
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), and Failure (F), and Failure,
No Submission (FNS).
The course convenor/s can be contacted by any means detailed on the front page.
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Aspects missing/or inadequately covered
Misunderstanding of the subject matter
Little evidence of original thought on topic
Irrelevant and/or inappropriate to topic
Insufficient relevant or recommended
Uncritical acceptance of author's
Insufficient or incorrect referencing of
Arguments illogical or relies on
Concepts appear muddled and
Report rambles and lacks coherent
Inappropriate introduction and conclusion
Not in accordance with Divisional
Grammatical, spelling and punctuation
problems detract from making the
Paragraphs of inappropriate length for
MARKING CRITERIA FOR
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
0 1 2 3
All aspects of the question covered
Shows evidence that the topic is clearly
Demonstrates original and creative
Appropriate and relevant to assignment
Shows evidence that relevant literature
has been read
Good critical understanding of authors
Citations appropriate and adequate
(within the text and reference list)
Uses reasoned argument substantiated
Concepts and ideologies clearly
Report follows a logical order of
Appropriate introduction and conclusion
In accordance with Faculty
Sentences grammatical and easy to
follow with attention to spelling
Paragraphs chunk information into