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PIMA COMMUNITY COLLEGE
                       NURSING DEPARTMENT



                           NRS 201
                   ...
PIMA COMMUNITY COLLEGE
                                                   NURSING DEPARTMENT

                            ...
PIMA COMMUNITY COLLEGE
                              ASSOCIATE DEGREE NURSING
                              NRS 201 --NURS...
PIMA COMMUNITY COLLEGE
                         ASSOCIATE DEGREE NURSING
                         NRS 201- NURSING PROCESS...
UNIT I: APPLYING THE NURSING PROCESS FOR CHILDREN IN
                       THE CONTEMPORARY AND DEVELOPING FAMILIES
OBJEC...
UNIT II: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH
                          CONGENITAL/DEVELOPMENTAL DISO...
UNIT III: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH
                     ALTERATIONS IN NUTRITION AND MEDT...
UNIT IV: APPLYING THE NURSING PROCESS IN CARING FOR
                 THE CHILD WITH ALTERATIONS IN THE RESPIRATORY SYSTEM
...
D.   Application of the nursing process for children with lower airway disorders: RSV / bronchiolitis
     1.      Overvie...
UNIT V: APPLYING THE NURSING PROCESS IN CARING FOR THE
               CHILD WITH ALTERATIONS IN THE CARDIOVASCULAR SYSTEM
...
UNIT VI: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD
                       WITH ALTERATIONS IN THE NEUROLOGICAL ...
a.   Drug therapy
             b.   Nursing strategies
5.   Evaluation
             a.   Complications of meningitis




 ...
UNIT VII: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD
                       WITH ALTERATIONS IN URINARY ELIMINAT...
APPENDIX A

                                       NRS 201 - PEDIATRICS
                                    CRITERIA FOR M...
1. Ineffective airway clearance r/t inflammation and secretions
                           a.m.b. RR 54, retractions/nasal...
PIMA COMMUNITY COLLEGE
                                      NURSING DEPARTMENT
                                   NRS 201...
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Transcript of "PIMA COMMUNITY COLLEGE NURSING DEPARTMENT NRS 201 NURSING ..."

  1. 1. PIMA COMMUNITY COLLEGE NURSING DEPARTMENT NRS 201 NURSING PROCESS III MODULE B: PEDIATRIC NURSING SYLLABUS Fall/2007 Reasonable accommodations, including materials in an alternative format, will be made for individuals with disabilities when a minimum of five working days advance notice is given. For the general public, please contact the PCC information line at 206-4500 (TTY 206-4530); for PCC students, contact the appropriate campus Disabled Student Resources Office. i
  2. 2. PIMA COMMUNITY COLLEGE NURSING DEPARTMENT MODULE B: PEDIATRICS POLICIES GOVERNING NRS 201 AND ALL NURSING COURSES ARE FOUND IN THE NURSING DEPARTMENT STUDENT POLICY HANDBOOK 2007 GRADING CRITERIA Theory: A. Unit Examinations: Exam I 50 points Exam II 50 points _________ Total 100 points B. Math Exam: 90% or above Clinical Laboratory: A. Mind Mapping ......................................................... S/U B. Clinical Laboratory Evaluation Tool--A total score of zero (0) or above is REQUIRED on this tool by the completion of EACH Module (A, B, and C), to receive a passing grade for Nursing 201. 2
  3. 3. PIMA COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING NRS 201 --NURSING PROCESS III MODULE B: PEDIATRICS REQUIRED TEXTBOOKS: I. McKinney, E.S. , James, S. R., Murray, S. S. & Ashwill, J. W. (2005). Maternal-Child nursing. 2nd ed.. ElSevier Saunders. St. Louis, Mo. 2. Nursing Department Student Policy Handbook, 2007 3. Kozier,B. Erb, G. Berman, A. & Snyder, S. (2004). Fundamentals of nursing (7th ed). Upper Saddle Hill, NJ: Pearson/Prentice Hall. 4.. Lehne, R. (2004). Pharmacology for Nursing Care. Saunders: Philadelphia. Optional books: 1. American Nurses Association. (2004). Nursing scope and standards of practice. ANA Washington DC. 2. Society of Pediatric Nurses /American Nurses Association. (2003). Scope and standards of pediatric nursing practice. ANA Washington DC. 3
  4. 4. PIMA COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING NRS 201- NURSING PROCESS III MODULE B: PEDIATRICS COURSE OUTLINE I. APPLYING THE NURSING PROCESS FOR CHILDREN IN THE CONTEMPORARY AND DEVELOPING FAMILIES. II. APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH CONGENITAL/DEVELOPMENTAL DISORDERS. III. APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN NUTRITION AND METABOLISM. IV. APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN THE RESPIRATORY SYSTEM. V. APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN THE CARDIOVASCULAR SYSTEM. VI. APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN THE NEUROLOGICAL SYSTEM. VII. APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN URINARY ELIMINATION. 4
  5. 5. UNIT I: APPLYING THE NURSING PROCESS FOR CHILDREN IN THE CONTEMPORARY AND DEVELOPING FAMILIES OBJECTIVES: By the end of this unit the student will be able to: 1. Define family as to role, structure, function, and types 2. Identify contemporary issues and their impact on changing patterns of family life. 3. Apply the nursing process in the assessment of children and families 4. Cite the recommended immunizations schedule for infant and children and indicate nursing implications. 5. Describe age-specific modifications in performing a physical assessment for children of various ages, including strategies to prepare child and promote cooperation during the exam. 6. Identify methods to obtain physical measurements of weight, height/length, vital signs, and head circumference in a child. 7. Specify techniques unique to pediatric client assessment and differences in physical assessment findings. 8. Describe factors to be considered in the approach to medicating children 9. Define methods used to compute and verify safe pediatric drug dosages 10. Select the usual needle and the recommended intramuscular injection sites for infants and children (using anatomical landmarks) 11. Cite adaptations employed in administering oral medications to children 12. Calculate accurately sample medication practice problems UNIT OUTLINE: A. Application of the nursing process for the family 1. Assessment – types of families, family life cycles, alternative family lifestyles 2. Nursing diagnosis – health maintenance and immunizations 3. Planning 4. Implementation 5. Evaluation – family compliance 5
  6. 6. UNIT II: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH CONGENITAL/DEVELOPMENTAL DISORDERS OBJECTIVES: By the end of this unit the student will be able to: 1. Assess infants and children for congenital skeletal defects 2. Describe the pathology, etiology, manifestations, diagnostic evaluation and therapeutic management of common congenital disorders. 3. State appropriate nursing diagnoses for the child with developmental disorders 4. Implement and evaluate appropriate nursing interventions for the child with congenital disorders. UNIT OUTLINE: A. Application of the nursing process for clients with congenital or skeletal defects 1. Anatomy and physiology review a. Structure and function 2. History 3. Physical assessment 4. Diagnostic assessment a. Radiographic examinations B. Overview of congenital/developmental disorders congenital hip displasia, clubfoot, scoliosis, cerebral palsy, cleft lip and palate 1. Assessment a. Subjective b. Clinical manifestations c. Diagnostic findings 2. Analysis a. Collaborative problems b. Nursing diagnoses 3. Planning and implementation a. Non-surgical interventions – casting/splints b. Surgical interventions 4. Evaluation 5. Client / family education and home care 6
  7. 7. UNIT III: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN NUTRITION AND MEDTOBOLISM OBJECTIVES: By the end of this unit the student will be able to: 1. Review anatomy and physiology of gastrointestinal tract 2. Discuss nutrition requirements in the growing child: infant, toddler, preschooler, school-age, and adolescent 3. Describe the role of the nurse in diagnostic procedures utilized to assess childhood gastrointestinal disturbances 4. Specify nursing adaptations to provide alternative methods of nutrition and elimination in the child including: nasogastric, gastrostomy, and parenteral nutrition 5. Describe the manifestations of and the nursing assessment for dehydration 6. Identify infusion sites selected for fluid therapy in pediatric patients 7. State modifications in restraint and needle protection for a pediatric patient 8. List safety measures instituted to avoid fluid overload in the pediatric patient 9. Compare and contrast the infusion pump and controller 10. List nursing responsibilities for the following activities: administration of IV medication, determining patency of infusion, delivery of medication, calculation of maintenance fluids UNIT OUTLINE A. Overview of nutritional requirements during childhood B. Application of the nursing process for children with selected alterations in nutrition and metabolism. 1. Overview of pyloric stenosis, gastroesophageal reflux, hirschsprung’s disease (aganglionic megacolon), intussesception 2. Assessment a. Subjective b. Clinical manifestations c. Diagnostic findings 3. Analysis a. Collaborative problems b. Nursing diagnosis 4. Planning and Implementation a. Non-surgical interventions b. Surgical interventions – pre-op and post-op care c. Medications d. Discharge teaching 5. Evaluation 6. Client / family education 7
  8. 8. UNIT IV: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN THE RESPIRATORY SYSTEM OBJECTIVES: By the end of this unit the student will be able to: 1. Distinguish the respiratory tract changes throughout childhood 2. Define: Stridor, retractions, oxygen hood, ultrasonic nebulization, percussion and postural drainage 3. Explain the pathophysiology of selected childhood infections/inflammatory respiratory alterations: croup, epiglottis, and bronchiolitis 4. Discuss interventions for these childhood respiratory alterations including: nursing assessment/management, diet, pharmacology, and respiratory therapy 5. Identify nursing assessment of clinical manifestations of airway obstruction and respiratory distress in the child 6. Identify common pharmacological agents used in treating respiratory disease in the child as to nursing actions and implications 7. Describe sudden infant death syndrome and identify characteristics/risk factors UNIT OUTLINE A. Overview of the respiratory system B. Application of the nursing process for children with obstructive respiratory disorders reactive airway disease (asthma), cystic fibrosis 1. Overview a. Definition and incidence b. Etiology and pathophysiology 2. Assessment of the respiratory system: anatomical differences in infant/child a. Inspection b. Palpation c. Percussion d. Auscultation 3. Analysis a. Collaborative problems b. Nursing diagnosis 4. Planning and implementation a. Monitoring for complications b. Oxygen therapy c. Medication therapy d. Hydration e. Psychosocial support f. Discharge planning and education 5. Evaluation C. Application of the nursing process for children with upper airway disorders: croup 1 Overview a. Definition and Incidence b. Etiology and Pathophysiology 2. Assessment a. History b. Physical assessment: clinical manifestations c. Diagnostic findings 3. Analysis a. Nursing diagnosis 4. Planning and Implementation a. Humidification and oxygen therapy b. Medication therapy c. Fluid therapy d. Psychosocial support e. Intubation/airway care 5. Evaluation 8
  9. 9. D. Application of the nursing process for children with lower airway disorders: RSV / bronchiolitis 1. Overview a. Definition and Incidence b. Etiology and Pathophysiology 2. Assessment a. History b. Physical assessment: clinical manifestations c. Diagnostic findings 3. Analysis a. Nursing Diagnosis 4. Planning and Implementation a. Medication therapy b. Hydration and nutritional management c. Oxygen therapy d. Prevention of nosocomial infection e. Teaching f. Monitor for complications g. Discharge planning 5. Evaluation 9
  10. 10. UNIT V: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN THE CARDIOVASCULAR SYSTEM OBJECTIVES: By the end of this unit the student will be able to: 1. Review the structure and function of the heart and circulatory system 2. Discuss the role of the nurse in assessment of a child to determine cardiovascular alterations 3. Identify and discuss diagnostic studies and procedures used to evaluate cardiovascular status 4. List factors contributing to congenital heart defects 5. Differentiate between the hemodynamics of cyanotic (R-L) and acyanotic (L-R) shunting 6. Discuss a pre- and post-operative nursing care plan for a child undergoing cardiac surgery 7. Delineate the pathophysiology and clinical manifestations of congestive heart failure as evidenced in the child 8. Categorize and identify mode of action, route(s) of administration, usual dosage, side effects and nursing implications for Digoxin UNIT OUTLINE A. Overview of cardiac function in children B. Application of the nursing process for children with congenital heart anomalies: acyanotic vs cyanotic defects ventricular/atrial septal defects, coarctation of the aorta, and tetralogy of fallot 1. Overview a. Defects: types b. Incidence c. Etiology d. Review of normal circulation e. Pathophysiology 2. Assessment of cardiac anomalies a. History b. Physical assessment c. Diagnostic assessment and nursing role 1) Cardiac catheterization 2) Echo cardiology 3) Other tests d. Psychosocial assessment 1) Family responses and adaptation 3. Analysis a. Collaborative problems b. Nursing diagnosis 4. Planning and Implementation a. Client goals b. Drug therapy, Digoxin, Diuretics, Potassium c. Nutritional therapy d. Nursing management 5. Evaluation 10
  11. 11. UNIT VI: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN THE NEUROLOGICAL SYSTEM OBJECTIVES: By the end of this unit the student will be able to: 1. Review cerebral structure and function 2. Define terms: ataxia, nuchal rigidity, Kernig’s sign, Brudzinski’s sign, ventriculoperitoneal shunt, and hydrocephalus 3. Define methods used to assess neurological status and indicate modification necessary in the infant and young child 4. Explain the pathophysiology of complex alterations related to neurological functioning in the child with: 5. Cerebral palsy 6. Meningitis 7. Seizure disorder 8. Explain diagnostic procedures, interventions and nursing management for a child with hydrocephalus and spina bifida 9. Discuss the psychosocial impact of the neurological problems of neural tube deficits and hydrocephalus on the child’s self-concept and body image 10. Identify the nursing role to promote family coping with long-term neurological problems 11. Identify the etiological agents, diagnostic and therapeutic management of meningitis 12. Summarize the nursing care of a child with meningitis UNIT OUTLINE A. Overview of neurological function in children B. Application of the nursing process for children with neurologic alterations 1. Overview of neurologic alterations: spina bifida a. Incidence b. Pathophysiology 2. Assessment a. Subjective b. Clinical manifestations 3. Analysis a. Collaborative problems b. Nursing diagnoses 4. Planning and Implementation a. Client goals b. Interventions c. Surgical procedures d. Education / home care 5. Evaluation a. Complications C. Application of the nursing process for children with infection of the central nervous system 1. Overview of meningitis a. Pathophysiology b. Etiology c. Incidence -- age-related prevention 2. Assessment a. History b. Physical assessment: clinical manifestations c. Diagnostic findings 1) Cerebral spinal fluid characteristics 2) Other laboratory testing 3. Analysis a. Collaborative problems b. Nursing diagnosis 4. Planning and implementation 11
  12. 12. a. Drug therapy b. Nursing strategies 5. Evaluation a. Complications of meningitis 12
  13. 13. UNIT VII: APPLYING THE NURSING PROCESS IN CARING FOR THE CHILD WITH ALTERATIONS IN URINARY ELIMINATION OBJECTIVES: By the end of this unit the student will be able to: 1. Review structure and function of the kidney 2. Diagnostic testing for renal disease 3. Define: suprapubic bladder aspiration, voiding cystourethrogram, vesicoureteral reflux, and hematuria 4. Describe the pathophysiology of nephrotic syndrome and relate changes to the manifestations, diagnostic testing and management 5. Describe the evolution of acute glomerulonephritis including etiology and resultant lab findings 6. Discuss the pathophysiology of ureteral reflux and subsequent development of hydronephrosis in the child 7. Describe the nursing care for a child with ureteral reflux and hydronephrosis 8. Identify anatomical and structural factors that predispose the child to urinary tract infections/hydronephrosis 9. List preventive actions you would teach child and parents relative to urinary infections 10. Discuss frequently used drugs in antibacterial therapy for urinary tract infections and nursing implications UNIT OUTLINE A. Overview of the renal / urologic system B. Application of the nursing process for children with selected alteration in urinary elimination 1. Overview of acquired conditions: nephrotic syndrome, acute glomerulonephritis (AGN) a. Classifications b. Definition and incidence c. Etiology and pathophysiology 2. Assessment a. Developmental considerations/approach b. Abdominal assessment 3. Analysis a. Nursing diagnosis 4. Planning and Implementation a. Monitoring for complications b. Diet therapy c. Activity d. Medications e. Discharge planning and home care 5. Evaluation C. Application of the nursing process for children with structural defect 1. Overview of structural defects hypospadias and vesicoureteral reflux a. Pathophysiology 2. Assessment a. Physical findings b. History c. Diagnostic findings 3. Analysis a. Nursing diagnosis 4. Planning an Implementation a. Preventative family education b. Pharmacological agents c. Complications d. Surgical management e. Discharge planning 5. Evaluation 13
  14. 14. APPENDIX A NRS 201 - PEDIATRICS CRITERIA FOR MIND MAPPING Concept mapping or "mind mapping" is an approach used to promote learning and critical thinking about patient problems and how to solve them. Mind maps are used in nursing to diagram teaching/learning strategies that provide opportunity to visualize and integrate theories with the nursing process. Focus should be on individualizing the standardized care plans that are currently available, while increasing learning through better organization and planning. The goal of this variety of care plan is to encourage your skills in organization, and your ability to “see the whole picture”. Hopefully, it will be more fun and a better learning tool for you than the traditional care plan. 1. Start by putting the client in the center of your mind map, to remind you the client is the center for all nursing interventions. Please include initials, age, medical diagnosis, and psychosocial information (who the child lives with, family members’ etc). 2. Next, select nursing diagnoses. Number your diagnosis in order of priority, making number one the most important diagnosis for that child. Include your goals for the diagnosis. You may decide to place these together in a square, circle, or any color that separates the diagnosis from the rest of the plan. 3. After that, list the nursing interventions for each of the nursing diagnosis. Interventions need to be specific and individualized, for example: “offer infant Similac with iron every 3 hours”. This is specific to the ordered diet for the baby. Include rationale for each intervention. 4. Lastly, include evaluations. Please make this specific to what your child did that day. For example, “infant nippled a total of 68cc of Similac with iron for my eight hour shift.” Tell us if interventions were effective. Mind maps will be presented in post-conference to your peers and graded (satisfactory or not satisfactory) by everyone. Use the mind map evaluation sheet in the syllabus as your guideline. Other things to include are medications, abnormal lab values, diagnostic tests, and discharge instructions. ♦ Include drug information for the drugs you administered (name, dose, therapeutic dose, and side effects). Please list all medications your child was receiving regardless if you administered the medication or not. EXAMPLE: (see diagram following page) Six-month-old Danny has a two-day history of cough, runny nose, and decreased appetite. He and his two-year-old brother live with their 21-year-old single mother who works full-time to support the family. Danny is admitted to TMC Pediatrics with a diagnosis of RSV/bronchiolitis. On admission he presents with a temperature of 100.9 ®, respiratory rate of 54, moderate subcostal retractions, and nasal flaring. He has crackles biterally on auscultation. His pulse oximeter on admission is 87% on room air. He is placed on 1/2 liter O2 per canula with improved sats to 94%. An IV is started @ 30 cc/hr and he is made NPO due to respiratory distress. His CBC is normal except an elevated lymphocyte count. His mother states, " I can't stay with him during the day because I have to work." "Who will I get to watch his brother so I can visit in the evening?" 14
  15. 15. 1. Ineffective airway clearance r/t inflammation and secretions a.m.b. RR 54, retractions/nasal flaring, crackles sats 87% on room air. GOAL: Infant will exhibit normal respiratory function • Respiratory assessment q 2 hours • Position for maximum ventilation, up in “Danny sling” • Oxygen to keep sats > 90% as ordered • Promote rest by grouping care, provide frequent rest periods during feeds OUTCOME: Infant in “Danny sling” between feeds, few scattered crackles with good aeration bilaterally, sats 92% on ½ L per N/C, RR 30’s when awake, nipples q 3 to 4 hours eagerly without distress. 5. Altered family process r/t 2. Risk for fluid volume deficit hospitalization of child a.m.b. r/t difficulty taking fluids mother stating; "Who will from increased resp effort watch his brother so I can visit" and single mother GOAL: Infant will exhibit adequate hydration GOAL: Family will receive Maintain IV as ordered adequate support Monitor I & O closely • Encourage mother to (maintenance = 7KG 30cc/hr) discuss feelings Assess hydration status q 2 • Keep mother informed of hours child’s condition OUTCOME: Infant NPO as • Social service consult ordered. Skin warm with 2-sec OUTCOME: Mother feels cap refill, strong periph pulses, sense of support from staff, moist mm. I = 240cc’s, O = 150 visits evenings from 6 PM to 8 cc’s for 8 hour shift. PM 4. Alt growth & development Baby D. 3. Risk for infection r/t r/t hospitalization and 6 months presence of infective social isolation a.m.b. RSV organism mother unable to visit Bronchiolitis Lives with brother (2y/o) GOAL: Infant will exhibit no signs GOAL: optimal bonding and mother (21y/o), of secondary infection between family members Mother works full-time • Maintain good handwashing • Encourage age-appropriate to support family. • Use sterile catheters when socialization (hold during suctioning feeds) OUTCOME: Diminishing • Meet infants needs readily symptoms of infection • Educate family about developmental needs OUTCOME: Infant held, cuddled during feeds. Mother interactive (good eye contact, talking to infant) during visits 15
  16. 16. PIMA COMMUNITY COLLEGE NURSING DEPARTMENT NRS 201 - NURSING PROCESS III MIND MAPPING EVALUATION CRITERIA TOPIC S U 1. Follows MIND MAPPING format as outlined and discusses case in postconference. 2. Provides complete client information including results of laboratory data and relationship to client problems. 3. Discusses pathophysiology of diagnosis using correct terminology including definition, client history, diagnostic data, signs and symptoms. 4. Prioritizes care needs on the mind map, with rationale. 5. States appropriate client-nursing diagnoses, which include actual, potential and collaborative problems. 6. Includes scientific rationale for each nursing intervention 7. Includes actual results and/or criteria of evaluation for nursing actions. Suggests revisions.. 8. Drug data is complete and addresses all information specific to needs of patient. 9. Includes useful individualized teaching/discharge plan and evaluation sheet. 16

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