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  • 1. KENTUCKY CHRISTIAN UNIVERSITY School of Nursing NURS 306: Adult Nursing Spring 2006
  • 2. KENTUCKY CHRISTIAN UNIVERSITY SCHOOL OF NURSING NURS 306: ADULT NURSING TABLE OF CONTENTS Accommodations 7 NURS 306 Assignments 6 13-18 Bibliography 11 Calendar 13-18 Course Description and Outcomes 4 Course Requirements & Due Dates 6 Course Schedule 13-18 Faculty 3 Grading Policy 6-10 Statement of Academic Guidelines 9-10 Textbooks 5 Unit 1 Genetics & Altered Immune Response 19 HIV Infection 20 Visual Problems 23 Auditory Problems 25 Unit 2 Nutritional Problems 28 Upper GI Problems: Oral & Esophageal 30 Upper GI Problems: Gastric & Intestinal 32 Lower Gastrointestinal Problems 33 Lower Gastrointestinal Problems, Part 2 36 Liver, Biliary-Tract, & Pancreas Problems 38 Unit 3 Renal & Urologic Problems 40 Renal & Urologic Problems, Part 2 42 Acute Renal Failure & Chronic Kidney Disease 44 1
  • 3. Unit 4 Endocrine System 58 Endocrine Problems 60 Diabetes Mellitus 62 Unit 5 Increased ICP & Head Injury 46 Other Acute Intracranial Problems 48 Stroke 50 Other Chronic Neurologic Problems 51 Alzheimer’s Disease & Dementia 53 Peripheral Nerve Problems 55 Spinal Cord Problems 57 Unit 6 Musculoskeletal Trauma 64 Orthopedic Surgery 67 Musculoskeletal Problems 68 Arthritis & Connective Tissue Diseases 68 NURS 306: Assignment Information Due Dates 6 Christian Service Opportunities 88 Family Cultural Assessment Tool 76 Family Wellness Promotion Project 74 Guidelines for Study Guides 72 Reminder 80 Clinical Evaluation Tool 82 2
  • 4. Kentucky Christian University SCHOOL OF NURSING NURS 306: Adult Nursing Syllabus Course Credit: 7 semester hours of credit. 5 hours of theory per week. 6 hours of clinical per week Term: Spring 2006 Lecture: Monday, Wednesday 1415-1645 Clinical: Monday, Wednesday 0700-1300 Faculty: Abigail Beck MSN, RN Office Phone: 474-3105 KCU Box: 2048 Email: abeck@kcu.edu Office Hours: Hours available by appointment. Please arrange appointments through Administrative Assistant (474-3255). 3
  • 5. Matthew 9:35-38 Jesus went through all the towns and villages, teaching in their synagogues, preaching the good news of the kingdom and healing every disease and sickness. When he saw the crowds he had compassion on them…then he said to his disciples, “The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field.” Catalog Description NURS 306: Adult Nursing (7) This course offers continued focus on the nursing process and caring relationship with ill adults and their families. Environmental and family influences that affect the individual’s health care behaviors are also examined. Emphasis is placed on caring and a wellness oriented approach in the nursing care of adults experiencing disorders of gastrointestinal, renal, neurological, musculoskeletal, and endocrine function. Opportunity is provided for the application of nursing concepts and skills in multiple settings. Prerequisites: NURS 301, 303, 305. (5 hours of class per week and 6 hours of clinical per week.) Course Outcomes: Upon successful completion of this course, the student should be able to: 1. Applying Watson’s carative factors, provide nursing care for adult clients and their families in a variety of settings focusing on communication, self-awareness, trust, and patience. 2. Using the nursing process, design primary, secondary, and tertiary prevention activities within families employing evidence based health care information. 3. Demonstrate non-discriminatory competent nursing care for adults and their families experiencing health alterations related to gastrointestinal, renal, neurological, musculoskeletal, and endocrine disorders. 4. Manage the nursing care of ill adults and their families based on a caring relationship while interacting with other professionals and non-professionals. 5. Engage in service learning activities that promote professional development or scholarly activities. 4
  • 6. Required Textbooks: American Psychological Association. (2001). Publication manual of the American Psychological Association (5th ed.). Washington, DC: Author. Kentucky Christian College. (2004). School of nursing handbook. Grayson, KY: Author. Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby. O'Brien, M. E. (2003). Spirituality in nursing: Standing on holy ground (2nd ed.). Sudbury, MA: Jones and Bartlett. Companion Website: http://evolve.elsevier.com/Lewis ***Students are required to have computer access and a KCU email account. Faculty members will be utilizing KCU email as a communication tool, and students are expected to check email frequently. Optional Textbooks: Ackley, B., & Ladwig, G. (2004). Nursing diagnosis handbook: A guide to planning care (6th ed.). St. Louis: Mosby. Carpenito-Moyet, L. (2004). Nursing diagnosis: Application to clinical practice (10th ed.). Philadelphia: Lippincott Williams & Wilkins. Como, D. (Ed.). (2002). Mosby's medical, nursing, & allied health dictionary (6th ed.). St. Louis: Mosby, Inc. Dirksen, S., Heitkemper, M., & Lewis, S. (2004). Clinical companion to medical-surgical nursing (3rd ed.). St. Louis: Mosby. Fischbach, F. (2004). A manual of laboratory and diagnostic tests (7th ed.). Philadelphia: Lippincott Williams & Wilkins. O’Brien, P. (2004) Study guide for medical-surgical nursing: Assessment and management of clinical problems, 6th ed. St. Louis: Mosby. Olsen, J.L., & Giangrasso, A.P. (2004). Medical dosage calculations (8th ed.). Upper Saddle River, NJ: Prentice-Hall, Inc. Silvestri, L.A. (2002). Comprehensive review for NCLEX-RN (2nd ed.). Philadelphia: W.B. Saunders Company. Skidmore-Roth, L. (2004). Mosby’s 2004 nursing drug reference. St. Louis: Mosby, Inc. Watson, J. (1999). Nursing human science and human care: A theory of nursing. Sudbury, MA: Jones and Bartlett. 5
  • 7. NURS 306 Course Requirements and Due Dates Theory A journey begins with a single step. ~ Tao Item Due Date Points Possible Points earned by student: Quiz Wednesday, Feb. 1 50 Exam #1 Wednesday, Feb. 22 100 Exam #2 Wednesday, March 8 100 Exam #3 Wednesday, April 12 100 Exam #4 Wednesday, April 19 100 Family Wellness Monday, March 20 100 Promotion Project Paper Study Guide Throughout semester. 50 (total) Total 600 Clinical Mark 10:43 Whoever wants to be great must become a servant. Item Requirement/Possible Points Earned by student: Clinical Evaluation Tool Satisfactory Rating (minimum of 4 on 1-5 rating) Clinical Performance Minimum of 73% Competency Final Clinical Paperwork Repeat until 100% obtained. Date completed: Final Evaluation All requirements met. Grading Scale 93 – 100 A 90 – 92 A- 88 – 89 B+ 83 – 87 B 80 – 82 B- 78 – 79 C+ 73 – 77 C 70 – 72 C- 68 – 69 D+ 63 – 67 D 60 – 62 D- 59 and below E 6
  • 8. If it is to be…it is up to me (with God’s help). Evaluation and Grading Policy Please refer to 2005-2006 KCU Catalog for Grading Policies. Evaluation consists of a theoretical component and a clinical component. A minimum grade of "C" in theory and clinical must be obtained to receive credit for NURS 306. It is the firm belief of the instructor that the student is to collect points and the instructor is to record what is earned. Discussion of earned grades will only occur during appointments made through the Administrative Assistant. This is to protect the privacy of the student and to allow ample time for discussion without sacrificing class time. If possible, submit topic of discussion via email prior to scheduling an appointment as this will provide an opportunity to clarify information. Theory • Exam Average  Students must achieve an average score of 73% on quizzes and exams for the theory component. If the exam average is below 73%, students will automatically receive an “E” grade for NURS 306.  Grades will be posted when all exams are graded and evaluated. This will be completed in a timely manner. Please do not contact the instructor to find out your grade before the posting. Passwords will be utilized for posting. If you suspect that others may identify your password, feel free to contact the instructor to change it.  Feedback will be provided to you via KCU mail. Please include your mailbox # on all assignments. • ATI Medical-Surgical Content Mastery  The purpose of the ATI Content Mastery Exam is to assist students in identifying weak areas in knowledge in preparation for the comprehensive final exam, and, ultimately NCLEX-RN.  Students who score at the 70th percentile or above on ATI #1 may choose to receive either a 5% bonus added to their final course grade or a 2.5% bonus added to their exam average.  Students who score below the 70th percentile on ATI #1 will be required to remediate and take ATI #2. Students who score at the 70th percentile or above on ATI #2 may choose to receive a 2.5% bonus added to their final course grade or a 1% bonus added to their exam average.  Students who score below the 70th percentile on ATI #2 will be required to remediate and achieve a passing score (85%) on the non-proctored ATI by the final exam (TBD). Students may take the non-proctored ATI only once every 24 hours. Students who do not achieve a passing score by the final exam will automatically receive an “E” grade for NURS 306. • Attendance A tardy will be documented when a student arrives late, leaves early, or leaves during class/lab and returns. Three (3) tardies will be documented as an absence. See KCU Attendance Policy for further information about attendance. 7
  • 9. Romans 6:13 Give yourselves to God….Surrender your whole being to him to be used for righteous purposes. Clinical • Clinical activities are critical to successful completion of this course. Students are required to wear their lab coat and name tag when using the campus laboratory for any activities and to sign in and out. Students are required to wear the appropriate clinical or community uniform for all clinical activities, as designated by the SoN Handbook and faculty. • Clinical schedules are designed to provide optimal faculty to student ratios in coordination with the availability of clinical facilities. Faculty members are unable to evaluate student achievement of objectives if the student is not present. Therefore, attendance as scheduled is mandatory. Clinical make-up for excused absences is arranged at the discretion of the clinical faculty member. • A student's performance may be considered unsatisfactory (and student may be dismissed from the clinical area) for any of the following behaviors in clinical or campus laboratory: 1. Unsafe clinical performance - any action which places the client in physical or emotional jeopardy. 2. Unsatisfactory performance of technical skills in clinical experience or campus laboratory. 3. Absence or tardiness. 4. Lack of preparation – Satisfactory completion of clinical portfolio, history, nursing care plan, and medication cards for assigned client(s) is due at the beginning of each clinical assignment. • Students are required to validate competency of essential skills in campus laboratory and/or clinical experiences. Failure to attain a passing grade (73%) on validation of clinical performance competency final will result in an unsatisfactory clinical appraisal and an “E” grade for NURS 306. Clinical Portfolio Students are required to have a clinical portfolio for each clinical course. The portfolio will provide evidence that the student has met clinical and course objectives. The clinical portfolio is cumulative – assignments should remain in the portfolio for the duration of the course. The contents of the clinical portfolio will be placed in the student’s professional portfolio at the completion of the course. • Guidelines:  Students are required to purchase a 3-ring binder (1”) and dividers. The student’s name should be placed on the outside of the binder.  Section 1 – Items necessary for verification prior to attending clinical: 1. Verification of immunizations. 2. Current Basic Life Support for Health Care Providers card must be renewed every two years. 3. Evidence of annual Tuberculosis (TB) testing or health assessment in positive reactors. 4. Evidence of current health insurance.  Section 2 – Clinical Evaluation Tool 8
  • 10.  Section 3 – Clinical Preparation Worksheets for each clinical week. Student will be required to complete Clinical Preparation Worksheets until 100% is obtained. II Peter 3:17 Don’t let the errors of evil people lead you down the wrong path and make you lose your balance. Statement of Academic Guidelines 1. Scholastic Dishonesty: All scholastic dishonesty, especially within the context of a Christian college, is unacceptable. Scholastic dishonesty includes cheating on exams, turning in reports and term papers as one's own when they are not, lying, stealing exams and other work, allowing other students to copy one's work in order to meet a graduation requirement for a course, and plagiarism. Plagiarism is defined as passing off as one's own the ideas of another. Copying and summarizing another's ideas in a written or oral report must be correctly attributed to the source. Any of these aforementioned offenses warrant academic discipline. First offences are subject to the discipline of the individual professor and are reported to the Vice President of Academic Affairs and the Vice President of Student Life. Offenses may be subject to review by the Student Appeals Committee and may be subject to severe penalties. Disciplinary measures may include re-doing the work, automatic failure of the course, probation, suspension, and/or expulsion. 2. Late Written Work: Required notes, papers, or projects are due at the time appointed by the professor. When it is not possible to submit such work on time, the student should consult the professor, who may grant an extension time not beyond one month after the last day of the semester. Students desiring an extension need to contact the faculty for approval prior to the due date. Late work will receive a 5% reduction in the grade for each day the work is late. Unexcused late work will not be accepted, and a grade of zero will be assigned. 3. Incomplete Grades: Students have one month after the end of the semester to change an incomplete grade to a letter grade, unless there are extenuating circumstances approved by the Vice President of Academic Affairs. It is the responsibility of the student to see that the necessary work is accomplished. An incomplete grade will automatically become an "E" grade at the end of the month. With the exception of an incomplete, a grade once recorded with the Registrar cannot be changed except for very unusual circumstances. 4. Attendance Policy: Regular and punctual class attendance is required for students to gain the greatest value from their educational experience. Therefore, students are expected to attend and participate in all class sessions for which they are registered. Deviations from this expectation must be reported by the student to the professor. KCU believes that students are responsible for their attendance. However, for governmental purposes, faculty must keep a record of attendance throughout the semester. See KCU Student Handbook for attendance policy. 9
  • 11. Danish proverb What you are in God’s gift to you; what you do with yourself is your gift to God. Statement Inviting Students with Disabilities to Identify Themselves and Discuss their Accommodation Needs Disabilities: KCU's obligation to provide reasonable accommodations to students with disabilities is triggered by the following sequence of steps: 1. Student's request for information: KCU provides information about availability of support services. 2. Student's request for accommodation and self-disclosure: KCU informs students of procedures and specifies need for current documentation that is three years or newer. 3. Student provides documentation: KCU evaluates documentation and determines adequacy of documentation or identifies any additional documentation need. 4. KCU determines that documentation supports requested, or alternative effective accommodation: Accommodation activity is now "triggered". 5. Student provides permission to notify faculty of the need for reasonable accommodations: Accommodation request is signed by student and disseminated to specified faculty. 10
  • 12. Bibliography American Nephrology Nurse’s Association Journal American Journal of Hospice and Palliative Care Geriatric Nursing Holistic Nursing Practice Journal of Christian Nursing – Quarterly Orthopaedic Nursing Urologic Nursing American Holistic Nurses Association – www.ahna.org Nurses Christian Fellowship – www.intervarsity.org/ncf Beare, P.G., & Meyers, J.L. (1998). Principles and practice of adult health nursing (3rd ed.). St. Louis: Mosby. Bourgeois, M.S. (2002). “Where is my wife and when amd I goin home?” The challenge of communicating with persons with dementia. Alzheimer’s Care Quality, Burke, M.M., & Walsh, M.B. (1997).Gerontologic nursing: Wholistic care of the older adult (2nd ed.). St. Louis: Mosby. Canobbio, M.M. (2000). Mosby’s handbook of client teaching (2nd ed.). St. Louis: Mosby. Chin, P.A., et al. (Eds.). (1998). Rehabilitation nursing practice. New York: McGraw-Hill. Denham, S.A. (2003). Familial research reveals new practice model. Holistic Nursing Practice, 17(3), 143-151. Friedman, M.M. (1998). Family nursing: Theory & practice (4th ed.). Upper Saddle River, NJ: Prentice Hall Health. Gahart, B.., & Nazareno, A.R. (2000). Intravenous medications: A handbook for nurses and allied health professionals (16th ed.) St. Louis: Mosby. Hartrick, G., Lindsey, A.E., & Hills, M. (1994). Family nursing assessment: Meeting the challenge of health promotion. Journal of Advanced Nursing, 20, 85-91. Karlowicz, K.A. (Ed.). (1995). Urologic nursing: Principles and practice. Philadelphia: Saunders. Katz, P.R., et al. (Eds.). (1999). Emerging systems in long-term care. New York: Springer Pub. Co. Lea, D.H., et al. (1998). Genetics in clinical practice: New directions for nursing and health care. Sudbury, MA: Jones and Bartlett. Luckmann, J., (1999). Transcultural communication in nursing. Albany, NY: Delmar. Meeker, M.H., & Rothrock, J.C. (1999). Alexander’s care of the client in surgery (11th ed.). St. Louis: Mosby. Metcalf, C. (2002). Crohn’s disease: An overview. Nursing Standard, 16(31), 45-52. Monahan, F.D., & Neighbors, M. (1998). Medical surgical nursing: Foundations for clinical practice (2nd ed.). Philadelphia: Saunders. Nettle, C., Pavelich, J., Jones, N., Beltz, C., Laboon, P., & Pifer, P. (1993). Family as client: Using Gordon’s health pattern typology. Journal of Community Health Nursing, 10(1), 53-61. Nolan, M.T., & Augustine, S.M. (1995). Transplantation nursing: Acute and long-term management. New York: McGraw-Hill. Phipps, W.J., et al. (Eds.). (1999). Medical surgical nursing: Concepts & clinical practice (6th ed.). St. Louis: Mosby. 11
  • 13. Ropka, M.E., & Williams, A.B. (1998). HIV nursing and symptom management. Sudbury, MA: Jones and Bartlett. Watson, J. (1999). Postmodern nursing and beyond. Edinburgh, Scotland, U.K.: Churchill- Livingstone: Harcourt-Brace. Watson, J. (1996). Watson's theory of transpersonal caring. In P. Hinton-Walker & B. Neuman (Eds), Blueprint for use of nursing models: Education, research, practice and administration (pp.141-184). New York: NLN Press. Watson, J. (1989). New dimensions of human caring theory. NSQ. Williams, S.R. (1998). Nutrition and diet therapy (8th ed.). St. Louis: Mosby. ***Students will also be asked to utilize on-line resources and other journal articles throughout the semester, as assigned on an on-going basis. 12
  • 14. Monday Tuesday Wednesday Thursday Friday KEY: P= Preparation T= Theory C= Clinical E= Evaluation Method 9 10 11 12 13 16 17 18 19 20  Clinical and  P: Read Chapters Theory Orientation 13 & 14.  NCLEX  Andragogy SoN Faculty/Staff Meeting 23 24 25 26 27  C: Skills  P: Read Chapters  C: Skills  P: Read Chapters Presentation 20 & 21 Presentation 20 & 21.  C: Sign up for  C: Sign up for check-offs check-offs  T: Genetics and  Guest Speaker: Altered Immune Dr. Campbell Response, HIV (Missions) KCU Faculty Meeting  T: Visual Systems 30 31  C/E: Skills Check-  P: Read Chapters off and Preparation 38 & 39 for Clinical (scheduling).  T: Auditory Systems  Guest: Gail Wise 13
  • 15. Monday Tuesday Wednesday Thursday Friday NURS 408 ATI Comp 1 1 2 3  C/E: Skills Check-  P: Read Chapter off and Preparation 40. for Clinical (scheduling).  E: Quiz on Genetics, Altered Immune Response, Committee Meetings HIV, and Visual and Auditory Systems.  T: Nutritional Problems (begin) 6 7 8 9 10  T: Nutritional  P: Read/Review  T: Upper  P: Read Chapter 41 Problems Chapter 40. Gastrointestinal  T: Upper Problems Gastrointestinal problems (Oral and Esophageal) Academic Council 13 14 15 16 17  T: Lower  P: Read/Review  T: Lower  P: Read Chapter Gastrointestinal Chapter 41 Gastrointestinal 42. Problems Problems SoN Faculty/Staff Meeting 20 21 22 23 24  T: Liver, Biliary  P: Read Chapters  E: Exam Upper &  P: Read/Review Tract, and Pancreas 43 & 44. Lower Chapter 44. Problems Gastrointestinal Problems, Liver, KCU Faculty Meeting Biliary Tract, and Refreshments & Pancreas Problems. Devotional by the  T: Renal and School of Nursing Urologic Problems. 14
  • 16. 27 28 T: Renal and Urologic  P: Read Chapter Problems 45. 15
  • 17. 16
  • 18. Monday Tuesday Wednesday Thursday Friday CSL Evaluation 1 2 3  T: Acute Renal NURS 408 ATI Comp 2 Failure and Chronic Renal Problems Committee Meetings 6 7 8 9 10 Academic Council 13 14 15 16 17  P: Read Chapters 54 & 55. 20 21 22 23 24  T: Increased Intracranial Pressure & Head Injury  T: Other Acute Intracranial  P: Read Chapter  Guest: Bridgett Problems 56.  P: Read/Review Jarvis Chapter 55. SoN Faculty/Staff Meeting  E: Family Wellness Promotion Project Paper 27 28 29 30 31  T: Stroke  P: Read Chapter  T: Chronic Ladies’ Day 57. Neurological Problems  P: Read Chapter 58. KCU Faculty Meeting 17
  • 19. 18
  • 20. Monday Tuesday Wednesday Thursday Friday ATI Critical Thinking Exit Test SECE Surveys 3 4 5 6 7  T: Alzheimer’s  P: Read Chapters  T: Neuro-  P: Read Chapter Disease and 58 & 59. degenerative and 59. Dimentia Peripheral Nerve Problems Committee Meetings 10 11 12 13 14  T: Spinal Cord  P: Read Chapter  T: Endocrine Problems 48. System Easter  E: Exam Neurological Break Disorders  P: Read Chapter 47. Academic Council 17 18 19 20 21  T: Diabetes  P: Read Chapters  E: Exam Mellitus 60 , 61, & 62. Health Care Job Fair Endocrine System and Diabetes  T: Musculoskeletal Trauma and Musculoskeletal Problems SoN Faculty/Staff Meeting 24 25 26 27 28  ATI  ATI  Clinical Final  Clinical Final Appointments Appointments KCU Faculty Meeting 19
  • 21. Monday Tuesday Wednesday Thursday Friday 1 2 3 4 5 Final Exam as per university schedule. Pinning Ceremony 8 9 10 11 12 15 16 17 You did it!!!! 18 19 Enjoy your summer!!! 22 23 24 25 26 20
  • 22. Genetics and Altered Immune Responses Theory Outcomes 1. Define common terms related to genetics and genetic disorders: autosome, carrier, heterozygous, homozygous, mutation, recessive, and sex-linked. 2. Compare and contrast the most common classifications of genetic disorders. 3. Differentiate among the four types of hypersensitivity reactions in terms of immunologic mechanisms and resulting alterations. 4. Identify the clinical manifestations and emergency treatment of a systemic anaphylactic reaction. 5. Describe the assessment and collaborative care of a client with chronic allergies. 6. Describe the etiologic factors, clinical manifestations, and treatment modalities of autoimmune diseases. 7. Identify the types and side effects of immunosuppressive therapy. Clinical Outcomes 1. Employ evidence based health care information in the nursing care of assigned clients and their families with altered immune responses. 2. Analyze environmental and family influences that affect assigned clients with genetic disorders. Learning Resources Medical-Surgical Nursing, Chapter 13. Key Terms anergy, p. 245 antigen, p. 239 autoimmunity, p. 254 cell-mediated immunity, p. 242 cytokines, p. 242 human leukocyte antigens, p. 249 humoral immunity, p. 242 hypersensitivity reaction, p. 245 immunocompetence, p. 245 immunodeficiency, p. 256 immunosuppressive therapy, p. 257 monoclonal antibodies, p. 259 Outline GENETICS Basic Principles of Genetics Inheritance Patterns Genetic Testing Genetic Therapy NURSING MANAGEMENT: GENETICS 21
  • 23. NORMAL IMMUNE RESPONSE Types of Immunity Antigens Lymphoid Organs Cells Involved in Immune Response Cytokines Comparison of Humoral and Cell-Mediated Immunity Gerontologic Considerations: Effects of Aging on the Immune System ALTERED IMMUNE RESPONSE Hypersensitivity Reactions ALLERGIC DISORDERS Assessment Diagnostic Studies Collaborative Cares NURSING MANAGEMENT: IMMUNOTHERAPY Latex Allergies NURSING AND COLLABORATIVE MANAGEMENT: LATEX ALLERGIES Multiple Chemical Sensitivities AUTOIMMUNITY Theories of Causation Autoimmune Diseases Apheresis HISTOCOMPATIBILITY Human Leukocyte Antigen System Human Leukocyte Antigen and Disease Associations Histocompatibility Studies IMMUNOSUPPRESSIVE THERAPY Calcineurin Inhibitors Sirolimus Mycophenolate Mofetil Polyclonal Antibodies (Antithymocyte Globulin and Antilymphocyte Globulin) Monoclonal Antibodies New Immunosuppressive Therapy Nursing Implementation Evaluation Human Immunodeficiency Virus (HIV) Infection Theory Outcomes 1. List the modes and variables involved in the transmission of the human immunodeficiency virus (HIV). 2. Outline HIV disease progression in the spectrum of untreated HIV infection. 3. List the diagnostic criteria for acquired immunodeficiency syndrome (AIDS). 4. Explain the methods of testing for HIV infection. 5. Discuss the collaborative management of HIV infection. 6. Explain the characteristics of opportunistic diseases associated with AIDS. 22
  • 24. 7. Discuss the long-term consequences of HIV infection and/or treatment of HIV infection. 8. Compare and contrast the methods of HIV prevention that eliminate risk and those that decrease risk. 9. Describe the nursing management of HIV-infected clients and HIV-at-risk clients. Clinical Outcomes 1. Applying Watson's carative factors, provide nursing care to assigned clients with HIV. 2. Analyze diagnostic study results of clients with HIV. Learning Resources Medical-Surgical Nursing, Chapter 14. Milestone, M. (Director). (n.d.). Positive – Life with HIV [Video recording]. United States: Bay Books Video. Key Terms acquired immunodeficiency syndrome (AIDS), p. 268 acute retroviral syndrome, p. 268 AIDS-dementia complex, p. 285 clades, p. 273 human immunodeficiency virus (HIV), p. 266 Kaposi’s sarcoma (KS), p. 284 non-nucleoside reverse transcriptase inhibitors, p. 273 nucleoside reverse transcriptase inhibitors, p. 273 nucleotide reverse transcriptase inhibitors, p. 273 opportunistic diseases, p. 267 oral hairy leukoplakia, p. 268 postexposure prophylaxis, p. 280 protease inhibitors, p. 273 retrovirus, p. 266 reverse transcriptase, p. 266 viral load, p. 264 viremia, p. 267 window period, p. 270 Outline HUMAN IMMUNODEFICIENCY VIRUS INFECTION Significance of Problem Transmission of HIV Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: HIV INFECTION 23
  • 25. Nursing Assessment Nursing Diagnoses Planning 24
  • 26. Visual Systems Theory Outcomes 1. Review the physiologic processes involved in normal vision. 2. Review the subjective and objective assessment of the visual system. 3. Differentiate normal findings from common abnormal findings of a physical assessment of the visual system. 4. Review age-related changes in the visual system and differences in assessment findings. 5. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the visual system. 6. Review the types of refractive errors and appropriate corrections. 7. Describe the etiology and collaborative care of extraocular disorders. 8. Explain the pathophysiology, clinical manifestations, nursing management, and collaborative care of the client with intraocular disorders. 9. Describe the nursing measures that promote the health of the eyes. 10. Explain the general preoperative and postoperative care of the client undergoing surgery of the eye. 11. Describe the action and uses of drug therapy used in treating problems of the eyes. 12. Explain the use, care, and client teaching related to assistive devices for eye problems. 13. Describe the common causes and assistive measures for uncorrectable visual impairment. 14. Describe the measures used to assist the client in adapting psychologically to decreased vision. Clinical Outcomes 1. Apply Watson's carative factors to provide nursing care to assigned clients and families with visual disorders. 2. Analyze results of diagnostic and laboratory studies for clients with visual disorders. 3. Demonstrate pre and postoperative teaching for clients undergoing surgery of the eye. 4. Demonstrate client teaching related to assistive devices for eye problems. Learning Resources Medical-Surgical Nursing, Chapters 20 & 21. Key Terms amblyopia, p. 439 aphakia, p. 441 aqueous humor, p. 416 astigmatism, p. 417, 441 blepharitis, p. 446 cataract, p. 449 chalazion, p. 446 conjunctiva, p. 418 conjunctivitis, p. 446 enucleation, p. 461 glaucoma, p. 456 hordeolum, p. 446 25
  • 27. hyperopia, p. 417, 441 intraocular lens, p. 443 keratitis, p. 447 keratoconus, p. 448 laser photocoagulation, p. 454 lens, p. 419 myopia, p. 441 presbyopia, p. 441 refractive error, p. 439 retinal detachment, p. 453 strabismus, p. 448 Outline NURSING MANAGEMENT: VISUAL IMPAIRMENT Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Gerontologic Considerations: Visual Impairment EYE TRAUMA EXTRAOCULAR DISORDERS INFLAMMATION AND INFECTION Hordeolum Chalazion Blepharitis Conjunctivitis Keratitis NURSING MANAGEMENT: INFLAMMATION AND INFECTION Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation INTRAOCULAR DISORDERS CATARACT Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: CATARACTS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation 26
  • 28. Evaluation Gerontologic Considerations: Cataracts RETINAL DETACHMENT Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care AGE-RELATED MACULAR DEGENERATION Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care GLAUCOMA Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: GLAUCOMA Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Gerontologic Considerations: Glaucoma INTRAOCULAR INFLAMMATION AND INFECTION ENUCLEATION OCULAR MANIFESTATIONS OF SYSTEMIC DISEASES Auditory Systems Theory Outcomes 1. Review the physiologic processes involved in normal hearing. 2. Review the subjective and objective assessment of the auditory system. 3. Differentiate normal findings from common abnormal findings of a physical assessment of the auditory system. 4. Review age-related changes in the auditory system and differences in assessment findings. 5. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the auditory system. 6. Describe the nursing measures that promote the health of the ears. 7. Explain the general preoperative and postoperative care of the client undergoing surgery of the ear. 8. Describe the action and uses of drug therapy used in treating problems of the ears. 9. Explain the pathophysiology, clinical manifestations, nursing management, and collaborative care of common ear problems. 27
  • 29. 10. Compare the causes, management, and rehabilitative potential of conductive and sensorineural hearing loss. 11. Explain the use, care, and client teaching related to assistive devices for ear problems. 12. Describe the common causes and assistive measures for uncorrectable deafness. 13. Describe the measures used to assist the client in adapting psychologically to decreased hearing. Clinical Outcomes 1. Applying Watson's carative factors, provide nursing care to assigned clients and families with auditory disorders. 2. Analyze results of diagnostic and laboratory studies for clients with auditory disorders. 3. Demonstrate pre and postoperative teaching for clients undergoing surgery of the ear. 4. Demonstrate client teaching related to assistive devices for ear problems. Learning Resources Medical-Surgical Nursing, Chapters 20 & 21. Key Terms acoustic neuroma, p. 468 external otitis, p. 462 labyrinthitis, p. 467 Ménière’s disease, p. 466 otosclerosis, p. 466 presbycusis, p. 471 Outline HEARING PROBLEMS EXTERNAL EAR AND CANAL TRAUMA EXTERNAL OTITIS Etiology Clinical Manifestations and Complications NURSING MANAGEMENT: EXTERNAL OTITIS CERUMEN AND FOREIGN BODIES IN THE EXTERNAL EAR CANAL MIDDLE EAR AND MASTOID ACUTE OTITIS MEDIA CHRONIC OTITIS MEDIA AND MASTOIDITIS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ACUTE OTITIS MEDIA Following Tympanoplasty CHRONIC OTITIS MEDIA WITH EFFUSION OTOSCLEROSIS 28
  • 30. Collaborative Care NURSING MANAGEMENT: OTOSCLEROSIS INNER EAR PROBLEMS MÉNIÈRE’S DISEASE NURSING AND COLLABORATIVE MANAGEMENT: MÉNIÈRE’S DISEASE HEARING LOSS AND DEAFNESS Types of Hearing Loss Clinical Manifestations NURSING AND COLLABORATIVE MANAGEMENT: HEARING LOSS AND DEAFNESS Gerontologic Considerations: Hearing Loss 29
  • 31. Nutritional Problems Theory Outcomes 1. Review the structures and functions of the organs of the gastrointestinal tract, liver, gallbladder, biliary tract, and pancreas. 2. Review the processes of ingestion, digestion, absorption, and elimination, biliary metabolism, bile production, and bile excretion. 3. Describe age-related changes in the gastrointestinal system and differences in assessment findings. 4. Review the subjective and objective assessment of the gastrointestinal system. 5. Differentiate normal from common abnormal findings of a physical assessment of the gastrointestinal system. 6. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the gastrointestinal system. 7. Review the essential components of a nutritionally sound diet and their importance to good health. 8. Describe the common etiologic factors, clinical manifestations, and management of malnutrition. 9. Explain the indications for use, complications, and nursing management of tube feedings. 10. Describe the types of feeding tubes and related nursing management. 11. Define the indications, complications, and nursing management related to the use of parenteral nutrition. 12. Discuss the etiologies, complications, and collaborative care of obesity. 13. Describe the nursing management related to conservative and surgical therapies for obesity. Clinical Outcomes 1. Analyze results of diagnostic and laboratory studies for clients with gastrointestinal problems. 2. Apply Watson's carative factors when caring for clients with gastrointestinal problems focusing on communication, self-awareness, trust, and patience. 1. Apply evidence based health care information when caring for clients and families experiencing nutritional problems. 2. Demonstrate the proper nursing care of clients with feeding tubes. Learning Resources Medical-Surgical Nursing, Chapters 38 & 39. Key Terms absorption, p. 948 anorexia nervosa, p. 999 bilirubin, p. 952 defecation, p. 951 boborygmi (Table 38-11), p.960 deglutition, p. 948 body mass index, p. 991 digestion, p. 948 bulimia nervosa, p. 999 endoscopy, p. 965 cheilosis (Table 38-11), p. 960 hematemesis (Table 38-11), p.960 30
  • 32. hepatocytes, p. 951 parenteral nutrition, p. 987 ingestion, p. 947 protein-calorie pyorrhea (Table 38-11), p. Kupffer cells, p. 951 960 kwashiorkor, p. 973 pyrosis (Table 38-11), p. 960 lipectomy, p. 995 steatorrhea (Table 38-11), p. 961 malabsorption syndrome, p. 973 tenesmus (Table 38-11), p. 961 malnutrition, p. 972 total parenteral nutrition, p. 987 melena (Table 38-11), p. 961 tube feeding, p. 982 marasmus, p. 973 undernutrition, p. 972 morbid obesity, p. 991 Valsalva maneuver, p. 951 nutrition, p. 969 villi, p. 948 obesity, p. 991 overnutrition, p. 972 Outline DIAGNOSTIC STUDIES OF THE GASTROINTESTINAL SYSTEM Radiologic Studies Endoscopy Liver Biopsy Liver Function Studies NUTRITIONAL PROBLEMS SPECIAL DIETS Vegetarian Diet MALNUTRITION Types of Malnutrition Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies NURSING MANAGEMENT: MALNUTRITION Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Gerontologic Considerations: Malnutrition TYPES OF SPECIALIZED NUTRITION SUPPORT Oral Feeding Tube Feeding Gerontologic Considerations: Enteral Nutrition Total Parenteral Nutrition NURSING MANAGEMENT: TOTAL PARENTERAL NUTRITION Home Nutrition Support OBESITY Etiology and Pathophysiology Diagnostic Studies 31
  • 33. Collaborative Conservative Care Collaborative Surgical Care NURSING MANAGEMENT: OBESE CLIENT Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Upper Gastrointestinal Problems: Oral & Esophageal Theory Outcomes 1. Describe the etiology, complications, collaborative care, and nursing management of nausea and vomiting. 2. Describe the etiology, clinical manifestations, and treatment of common oral inflammations and infections. 3. Describe the etiology, clinical manifestations, complications, collaborative care, and nursing management of oral cancer. 4. Explain the types, pathophysiology, clinical manifestations, complications, and collaborative care, including surgical therapy and nursing management, of gastroesophageal reflux disease and hiatal hernia. 5. Describe the pathophysiology, clinical manifestations, complications, and collaborative care of esophageal cancer, diverticula, achalasia, and esophageal strictures. Clinical Outcomes 1. Design preventive activities for assigned clients experiencing upper gastrointestinal problems. 2. Provide teaching employing evidence based health information for assigned clients experiencing upper gastrointestinal problems. Learning Resources Medical-Surgical Nursing, Chapter 40. Key Terms achalasia, p. 1019 gastroesophageal reflux disease, p. 1011 Barrett’s esophagus, p. 1012 hiatal hernia, p. 1015 dysphagia, p. 1009 leukoplakia, p. 1009 esophageal cancer, p. 1017 nausea, p. 1003 esophageal diverticula, p. 1019 vomiting, p. 1003 esophagitis, p. 1012 Outline NAUSEA AND VOMITING Etiology and Pathophysiology Clinical Manifestations Collaborative Care NURSING MANAGEMENT: NAUSEA AND VOMITING 32
  • 34. Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Gerontologic Considerations: Nausea and Vomiting ORAL INFLAMMATIONS AND INFECTIONS ORAL CANCER Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ORAL CANCER Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation ESOPHAGEAL DISORDERS GASTROESOPHAGEAL REFLUX DISEASE Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: GASTROESOPHAGEAL REFLUX DISEASE HIATAL HERNIA Types Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: HIATAL HERNIA Conservative Therapy Surgical Therapy Gerontologic Considerations: GERD and Hiatal Hernia ESOPHAGEAL CANCER Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ESOPHAGEAL CANCER Nursing Assessment Nursing Diagnoses 33
  • 35. Planning Nursing Implementation Evaluation OTHER ESOPHAGEAL DISORDERS Esophageal Diverticula Esophageal Strictures Achalasia Esophageal Varices Upper Gastrointestinal Problems: Gastric & Intestinal Theory Outcomes 1. Differentiate between acute and chronic gastritis, including the etiology, pathophysiology, collaborative care, and nursing management. 2. Explain the common etiology, clinical manifestations, collaborative care, and nursing management of upper gastrointestinal bleeding. 3. Compare and contrast gastric and duodenal ulcers, including etiology and pathophysiology, clinical manifestations, complications, collaborative care, and nursing management. 4. Identify the common types of food poisoning and the nursing responsibilities related to food poisoning. Clinical Outcomes 1. Design preventive activities for assigned clients experiencing upper gastrointestinal problems. 2. Provide teaching employing evidence based health information for assigned clients experiencing upper gastrointestinal problems. Learning Resources Medical-Surgical Nursing, Chapter 40. Key Terms gastric cancer, p. 1044 peptic ulcer disease, p. 1028 gastritis, p. 1020 physiologic stress ulcer, p. 1031 Mallory-Weiss tear, p. 1023 Outline DISORDERS OF THE STOMACH and UPPER SMALL INTESTINE GASTRITIS Types Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: GASTRITIS Acute Gastritis Chronic Gastritis 34
  • 36. UPPER GASTROINTESTINAL BLEEDING Etiology and Pathophysiology Emergency Assessment and Management Diagnostic Studies Collaborative Care NURSING MANAGEMENT: UPPER GASTROINTESTINAL BLEEDING Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation PEPTIC ULCER DISEASE Types Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care: Conservative Therapy NURSING MANAGEMENT: PEPTIC ULCER DISEASE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Collaborative Therapy: Surgical Therapy for Peptic Ulcer Disease NURSING MANAGEMENT: SURGICAL THERAPY FOR PEPTIC ULCER DISEASE Preoperative Care Postoperative Care Gerontologic Considerations: Peptic Ulcer Disease FOOD POISONING E. coli Poisoning Lower Gastrointestinal Problems Theory Outcomes 1. Explain the common etiologies, collaborative care, and nursing management of diarrhea, fecal incontinence, and constipation. 2. Describe common causes of acute abdominal pain and nursing management of the client following an exploratory laparotomy. 3. Describe the collaborative care and nursing management of acute appendicitis, peritonitis, and gastroenteritis. 4. Compare and contrast ulcerative colitis and Crohn’s disease, including pathophysiology, clinical manifestations, complications, collaborative care, and nursing management. 5. Differentiate between diverticulosis and diverticulitis, including clinical manifestations, collaborative care, and nursing management. 35
  • 37. Clinical Outcomes 1. Applying Watson's carative factors, provide nursing care to assigned clients and their families with lower gastrointestinal problems. 2. Manage the nursing care of clients with lower gastrointestinal problems. Learning Resources Medical-Surgical Nursing, Chapter 41. Key Terms appendicitis, p. 1064 irritable bowel syndrome, p. 1064 constipation, p. 1057 peritonitis, p. 1066 Crohn’s disease, p. 1076 ulcerative colitis, p. 1068 diarrhea, p. 1052 Valsalva maneuver, p. 1057 gastroenteritis, p. 1067 inflammatory bowel disease, p. 1067 Outline DIARRHEA Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ACUTE INFECTIOUS DIARRHEA Nursing Assessment Nursing Diagnoses Planning Nursing Implementation FECAL INCONTINENCE Etiology and Pathophysiology Diagnostic Studies and Collaborative Care NURSING MANAGEMENT: FECAL INCONTINENCE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation CONSTIPATION Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies and Collaborative Care NURSING MANAGEMENT: CONSTIPATION Nursing Assessment Nursing Diagnoses Planning 36
  • 38. Nursing Implementation ACUTE ABDOMINAL PAIN Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies and Collaborative Management NURSING MANAGEMENT: ACUTE ABDOMINAL PAIN Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation INFLAMMATORY DISORDERS APPENDICITIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies and Collaborative Care NURSING MANAGEMENT: APPENDICITIS PERITONITIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: PERITONITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation GASTROENTERITIS NURSING MANAGEMENT: GASTROENTERITIS INFLAMMATORY BOWEL DISEASE ULCERATIVE COLITIS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ULCERATIVE COLITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation CROHN’S DISEASE Etiology and Pathophysiology Clinical Manifestations 37
  • 39. Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: CROHN’S DISEASE Gerontologic Considerations: Inflammatory Bowel Disease DIVERTICULOSIS AND DIVERTICULITIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: DIVERTICULOSIS AND DIVERTICULITIS Lower Gastrointestinal Problems, Part 2 Theory Outcomes 1. Differentiate among mechanical, neurogenic, and vascular bowel obstructions, including causes, collaborative care, and nursing management. 2. Describe the clinical manifestations and collaborative management of colorectal cancer. 3. Explain the anatomic and physiologic changes and nursing management of the client with an ileostomy and colostomy. 4. Compare and contrast the types of hernias, including etiology and surgical and nursing management. 5. Describe the types, clinical manifestations, collaborative care, and nursing management of anorectal conditions. Clinical Outcomes 1. Applying Watson's carative factors, provide nursing care to assigned clients and their families with lower gastrointestinal problems. 2. Manage the nursing care of clients with lower gastrointestinal problems. Learning Resources Medical-Surgical Nursing, Chapter 41. Key Terms anal fissure, p. 1100 anal fistula, p. 1101 nontropical sprue, p. 1097 constipation, p. 1057 ostomy, p. 1087 diverticulum, p. 1093 paralytic (adynamic) ileus, p. 1078 fecal impaction, p. 1056 pilonidal sinus, p. 1101 fecal incontinence, p. 1055 pseudoobstruction, p. 1078 hemorrhoids, p. 1099 short bowel syndrome, p. 1098 hernia, p. 1095 steatorrhea, p. 1096 intestinal obstruction, p. 1078 lactase deficiency, p. 1098 Outline INTESTINAL OBSTRUCTION 38
  • 40. Types of Intestinal Obstruction Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: INTESTINAL OBSTRUCTION Nursing Assessment Nursing Diagnoses Planning Nursing Implementation COLORECTAL CANCER Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: COLORECTAL CANCER Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation OSTOMY SURGERY Types Surgical Therapy NURSING MANAGEMENT: OSTOMY SURGERY Preoperative Care Colostomy Care Ileostomy Care Adaptation to an Ostomy Sexual Dysfunction After Ostomy Surgery HERNIAS Types Clinical Manifestations NURSING AND COLLABORATIVE MANAGEMENT: HERNIAS ANORECTAL PROBLEMS HEMORRHOIDS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies and Collaborative Care NURSING MANAGEMENT: HEMORRHOIDS 39
  • 41. Liver, Biliary Tract, and Pancreas Problems Theory Outcomes 1. Define jaundice and describe signs and symptoms that may occur with the different types of jaundice. 2. Differentiate among the types of viral hepatitis, including etiology, pathophysiology, clinical manifestations, complications, and collaborative care. 3. Describe the nursing management of the client with viral hepatitis. 4. Explain the etiology, pathophysiology, clinical manifestations, complications, and collaborative care of the client with cirrhosis of the liver. 5. Describe the nursing management of the client with cirrhosis. 6. Describe the clinical manifestations and management of liver cancer. 7. Describe the pathophysiology, clinical manifestations, complications, and collaborative care of acute and chronic pancreatitis. 8. Describe the nursing management of the client with pancreatitis. 9. Explain the clinical manifestations and collaborative care of the client with pancreatic cancer. 10. Explain the pathophysiology, clinical manifestations, complications, and collaborative care, including surgical therapy, of gallbladder disorders. 11. Describe the nursing management of the client undergoing conservative or surgical treatment of cholecystitis and cholelithiasis. Clinical Outcomes 1. Demonstrate teaching for clients undergoing conservative or surgical treatment of cholecystitis. 2. Demonstrate teaching for clients undergoing conservative or surgical treatment of cholelithiasis Learning Resources Medical-Surgical Nursing, Chapter 42. Key Terms acute pancreatitis, p. 1133 ascites, p. 1118 fulminant viral hepatitis, p. 1109 asterixis, p. 1120 hepatic encephalopathy, p. 1120 cholecystitis, p. 1141 hepatitis, p. 1105 cholelithiasis, p. 1141 hepatorenal syndrome, p. 1120 chronic pancreatitis, p. 1138 jaundice, p. 1104 cirrhosis, p. 1116 paracentesis, p. 1121 esophageal varices, p. 1118 portal hypertension, p. 1118 fetor hepaticus, p. 1120 pseudocyst, p. 1134 fulminant hepatic failure, p. 1131 spider angiomas, p. 1117 Outline JAUNDICE Hemolytic Jaundice Hepatocellular Jaundice 40
  • 42. Obstructive Jaundice DISORDERS OF THE LIVER HEPATITIS Etiology Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: HEPATITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Control of Hepatitis in Health Care Personnel TOXIC AND DRUG-INDUCED HEPATITIS AUTOIMMUNE HEPATITIS CIRRHOSIS OF THE LIVER Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: CIRRHOSIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation FULMINANT HEPATIC FAILURE LIVER CANCER Clinical Manifestations and Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: LIVER CANCER LIVER TRANSPLANTATION DISORDERS OF THE PANCREAS ACUTE PANCREATITIS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ACUTE PANCREATITIS Nursing Assessment Nursing Diagnoses 41
  • 43. Planning Nursing Implementation Evaluation CHRONIC PANCREATITIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: CHRONIC PANCREATITIS PANCREATIC CANCER Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: PANCREATIC CANCER DISORDERS OF THE BILIARY TRACT CHOLELITHIASIS AND CHOLECYSTITIS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: GALLBLADDER DISEASE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Renal and Urologic Problems Theory Outcomes 1. Review the anatomic location and functions of the kidneys, ureters, bladder, and urethra. 2. Review the subjective and objective assessment of the urinary system. 3. Describe age-related changes in the urinary system and differences in assessment findings. 4. Differentiate normal from common abnormal findings of a physical assessment of the urinary system. 5. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the urinary system. 6. Describe the normal physical and chemical characteristics of urine. 7. Describe the pathophysiology, clinical manifestations, collaborative care, and drug therapy of cystitis, urethritis, and pyelonephritis. 8. Explain the nursing management of urinary tract infections. 9. Describe the immunologic mechanisms involved in glomerulonephritis. 42
  • 44. 10. Explain the clinical manifestations and nursing and collaborative management of acute poststreptococcal glomerulonephritis, Goodpasture syndrome, and chronic glomerulonephritis. 11. Describe the common causes, clinical manifestations, collaborative care, and nursing management of nephrotic syndrome. Clinical Outcomes 1. Analyze results of diagnostic studies related to the urinary system. 2. Demonstrate a caring relationship for assigned clients with urinary system problems. Learning Resources Medical-Surgical Nursing, Chapters 43 & 44. Key Terms costovertebral angle, p. 1161 interstitial cystitis, p. 1179 creatinine, p. 1166 intravenous pyelogram, p. 1167 cystitis, p. 1173 nephron, p. 1152 cystometrogram, p. 1170 nephrotic syndrome, p. 1183 cystoscopy, p. 1169 pyelonephritis, p. 1173 glomerular filtration rate, p. 1154 renal arteriogram, p. 1168 glomerulonephritis, p. 1180 renal biopsy, p. 1169 glomerulus, p. 1153 retrograde pyelogram, p. 1167 Goodpasture syndrome, p. 1182 stricture, p. 1189 hydronephrosis, p. 1184 urethritis, p. 1173 hydroureter, p. 1184 urinalysis, p. 1162 Outline DIAGNOSTIC STUDIES OF THE URINARY SYSTEM Urine Studies Radiologic Studies Endoscopy Urodynamics INFECTIOUS AND INFLAMMATORY DISORDERS OF THE URINARY SYSTEM URINARY TRACT INFECTION Classification Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care and Drug Therapy NURSING MANAGEMENT: URINARY TRACT INFECTION Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation ACUTE PYELONEPHRITIS 43
  • 45. Etiology and Pathophysiology Clinical Manifestations and Diagnostic Studies Collaborative Care and Drug Therapy NURSING MANAGEMENT: ACUTE PYELONEPHRITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation IMMUNOLOGIC DISORDERS OF THE KIDNEY GLOMERULONEPHRITIS Etiology and Pathophysiology Clinical Manifestations ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS Clinical Manifestations and Complications Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS NEPHROTIC SYNDROME Etiology and Clinical Manifestations Collaborative Care NURSING MANAGEMENT: NEPHROTIC SYNDROME RENAL DISEASE AND ACQUIRED IMMUNO-DEFICIENCY SYNDROME Renal and Urologic Problems, Part 2 Theory Outcomes 1. Compare and contrast the etiology, clinical manifestations, collaborative care, and nursing management of various types of urinary calculi. 2. Describe the common causes and management of bladder dysfunctions. 3. Differentiate among ureteral, suprapubic, nephrostomy, and urethral catheters with regard to indications for use and nursing responsibilities. 4. Explain the nursing management of the client undergoing nephrectomy or urinary diversion surgery. Clinical Outcomes 1. Demonstrate non-discriminatory competent nursing care for adults and their families experiencing renal and urologic problems. 2. Manage the nursing care of adults and their families experiencing renal and urologic problems based on a caring relationship. Learning Resources Medical-Surgical Nursing, Chapter 44. 44
  • 46. Key Terms calculus, p. 1186 renal artery stenosis, p. 1191 ileal conduit, p. 1203 renal vein thrombosis, p. 1191 lithotripsy, p. 1188 urinary incontinence, p. 1195 nephrolithiasis, p. 1185 urinary retention, p. 1195 nephrosclerosis, p. 1191 polycystic kidney disease, p. 1192 Outline URINARY TRACT CALCULI Etiology and Pathophysiology Types Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: RENAL CALCULI Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation URINARY INCONTINENCE AND RETENTION Diagnostic Studies Collaborative Care: Urinary Incontinence NURSING MANAGEMENT: URINARY INCONTINENCE Collaborative Care: Urinary Retention NURSING MANAGEMENT: URINARY RETENTION INSTRUMENTATION Urethral Catheterization Ureteral Catheters Suprapubic Catheters Nephrostomy Tubes Intermittent Catheterization SURGERY OF THE URINARY TRACT RENAL AND URETERAL SURGERY Preoperative Management Postoperative Management Laparoscopic Nephrectomy URINARY DIVERSION Incontinent Urinary Diversion Continent Urinary Diversions Orthotopic Bladder Substitution NURSING MANAGEMENT: URINARY DIVERSION 45
  • 47. Preoperative Management Postoperative Management 46
  • 48. Acute Renal Failure and Chronic Kidney Disease Theory Outcomes 1. Differentiate between acute renal failure and chronic kidney disease. 2. Differentiate among the causes of prerenal, intrarenal, and postrenal acute renal failure. 3. Describe the clinical course of reversible acute renal failure. 4. Explain the collaborative care and nursing management of a client with acute renal failure. 5. Describe the systemic manifestations of chronic kidney disease. 6. Explain the conservative collaborative care and the related nursing management of the client with chronic kidney disease. 7. Differentiate between peritoneal dialysis and hemodialysis in terms of purpose, indications, advantages and disadvantages, and nursing responsibilities. 8. Describe common vascular access sites used for hemodialysis. 9. Compare dialysis and renal transplantation as methods of treatment for end-stage renal disease. 10. Describe the nursing management of clients in the preoperative, intraoperative, and postoperative stages of kidney transplantation. 11. Discuss the potential long-term problems of the client with a kidney transplant. Clinical Outcomes 1. Manage the nursing care of adults and their families experiencing acute renal failure and chronic kidney disease while interacting with other professionals and non-professionals in a variety of settings. 2. Demonstrate nursing management of clients with acute renal failure and chronic kidney disease using evidence based health care information. Learning Resources Medical-Surgical Nursing, Chapter 45. Key Terms acute renal failure, p. 1210 dialysis, p. 1228 acute tubular necrosis, p. 1211 end-stage renal disease, p. 1217 arteriovenous grafts, p. 1232 hemodialysis, p. 1228 automated peritoneal dialysis, p. 1230 oliguria, p. 1212 azotemia, p. 1210 peritoneal dialysis, p. 1228 chronic kidney disease, p. 1217 renal osteodystrophy, p. 1220 continuous ambulatory peritoneal dialysis, p. uremia, pp. 1210, 1218 1230 continuous renal replacement therapy, p. 1236 Outline ACUTE RENAL FAILURE Etiology and Pathophysiology Clinical Course Collaborative Care 47
  • 49. NURSING MANAGEMENT: ACUTE RENAL FAILURE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Gerontologic Considerations: Acute Renal Failure CHRONIC KIDNEY DISEASE Clinical Manifestations Diagnostic Studies Collaborative Care: Conservative Therapy of Chronic Kidney Disease NURSING MANAGEMENT: CONSERVATIVE THERAPY OF CHRONIC KIDNEY DISEASE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation DIALYSIS General Principles of Dialysis PERITONEAL DIALYSIS Catheter Placement Dialysis Solutions and Cycles Peritoneal Dialysis Systems Complications of Peritoneal Dialysis Effectiveness of and Adaptation to Chronic Peritoneal Dialysis HEMODIALYSIS Vascular Access Sites Dialyzers Procedure Complications of Hemodialysis Effectiveness of and Adaptation to Hemodialysis KIDNEY TRANSPLANTATION Recipient Selection Histocompatibility Studies Donor Sources Surgical Procedure Kidney Transplant Recipient NURSING MANAGEMENT: KIDNEY TRANSPLANT RECIPIENT Preoperative Care Postoperative Care Immunosuppressive Therapy Complications of Transplantation Gerontologic Considerations: Chronic Kidney Disease 48
  • 50. Increased Intracranial Pressure & Head Injury Theory Outcomes 1. Review the structure and functions of neurons and neuroglia, nerve impulse transmission, cerebrum, brainstem, cerebellum, spinal cord, peripheral nerves, and cerebrospinal fluid. 2. Identify the major arteries supplying the brain and describe the functions of the 12 cranial nerves. 3. Compare the functions of the two divisions of the autonomic nervous system. 4. Describe age-related changes in the neurologic system and differences in assessment findings. 5. Review the subjective and objective assessment of the nervous system. 6. Differentiate normal from common abnormal findings of a physical assessment of the nervous system. 7. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the nervous system. 8. Identify the physiologic mechanisms that maintain normal intracranial pressure. 9. Identify the common etiologies, clinical manifestations, and collaborative care of the client with increased intracranial pressure. 10. Describe the collaborative and nursing management of the client with increased intracranial pressure. 11. Differentiate types of head injury by mechanism of injury and clinical manifestations. 12. Describe the collaborative care and nursing management of the client with a head injury. Clinical Outcomes 1. Analyze the results of diagnostic studies of the nervous system. 2. Employ evidence based health care information in the nursing care of assigned clients and their families with disorders of the nervous system. Learning Resources Medical-Surgical Nursing, Chapters 54 & 55. Nichols, M. (1991). Regarding Henry [Video recording]. United States: Paramount. Key Terms autonomic nervous system, p. 1473 head injury, p. 1505 blood-brain barrier, p. 1475 intracerebral hematoma, p. 1508 central nervous system, p. 1464 intracranial pressure, p. 1491 cerebral edema, p. 1493 lower motor neurons, p. 1468 cerebrospinal fluid, p.1470 meninges, p. 1476 coma, p. 1494 neuroglia, p. 1464 concussion, p. 1507 neurotransmitter, p. 1466 subdural contusion, p. 1507 hematoma, p. 1507 cranial nerves, p. 1473 peripheral nervous system, p. 1464 dermatome, p.1472 reflex, p. 1468 diffuse axonal injury, p. 1507 synapse, p. 1466 epidural hematoma, p. 1507 unconsciousness, p. 1495 Glasgow Coma Scale, p. 1500 49
  • 51. upper motor neurons, p. 1468 Outline DIAGNOSTIC STUDIES OF THE NERVOUS SYSTEM Cerebrospinal Fluid Analysis Radiologic Studies Electrographic Studies Combined Doppler and Ultrasound (Duplex) Studies INTRACRANIAL PRESSURE Regulation and Maintenance of Intracranial Pressure Cerebral Blood Flow INCREASED INTRACRANIAL PRESSURE Cerebral Edema Mechanisms of Increased Intracranial Pressure Clinical Manifestations Complications Diagnostic Studies Measurement of ICP Collaborative Care NURSING MANAGEMENT: INCREASED INTRACRANIAL PRESSURE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation HEAD INJURY Types of Head Injuries Pathophysiology Complications Diagnostic Studies and Collaborative Care NURSING MANAGEMENT: HEAD INJURY Nursing Assessment Nursing Diagnosed Planning Nursing Implementation Evaluation 50
  • 52. Other Acute Intracranial Problems Theory Outcomes 1. Compare the types, clinical manifestations, and collaborative care of brain tumors. 2. Discuss the nursing management of the client with a brain tumor. 3. Describe the nursing management of the client undergoing cranial surgery. 4. Compare the primary causes, collaborative care, and nursing management of meningitis, encephalitis, and brain abscess. Clinical Outcomes 1. Using the nursing process, demonstrate a caring relationship with assigned clients and their families experiencing acute intracranial problems. 2. Manage the nursing care of clients and their families experiencing acute intracranial problems. Learning Resources Medical-Surgical Nursing, Chapter 55. Nova. (2002). Killer disease on campus – Meningitis [Video recording]. United States: WGBS Boston Video. Key Terms brain abscess, p. 1522 meningitis, p. 1518 encephalitis, p. 1521 nuchal rigidity, p. 1518 Outline BRAIN TUMORS Types Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: BRAIN TUMORS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation CRANIAL SURGERY Types NURSING MANAGEMENT: CRANIAL SURGERY Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation 51
  • 53. INFLAMMATORY CONDITIONS OF THE BRAIN BACTERIAL MENINGITIS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: BACTERIAL MENINGITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation VIRAL MENINGITIS ENCEPHALITIS Etiology and Pathophysiology Clinical Manifestations and Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: VIRAL ENCEPHALITIS BRAIN ABSCESS 52
  • 54. Stroke Theory Outcomes 1. Describe the incidence of and risk factors for stroke. 2. Explain the mechanisms that affect cerebral blood flow. 3. Compare and contrast the etiology and pathophysiology of ischemic and hemorrhagic strokes. 4. Correlate the clinical manifestations of stroke with the underlying pathophysiology. 5. Identify diagnostic study performed for clients with strokes. 6. Describe the collaborative care, drug therapy, and nutritional therapy for a client with a stroke. 7. Describe the acute nursing management of a client with a stroke. 8. Describe the rehabilitative nursing management of the client with a stroke. 9. Explain the psychosocial impact of a stroke on the client and family. Clinical Outcomes 1. Manage the acute nursing care of assigned clients who have experienced a stroke. 2. Manage the rehabilitative nursing care of assigned clients who have experienced a stroke. Learning Resources Medical-Surgical Nursing, Chapter 56. Key Terms aneurysm, p. 1529 ischemic strokes, p. 1528 aphasia, p. 1531 lacunar stroke, p. 1529 dysarthria, p. 1531 stroke, p. 1525 dysphasia, p. 1531 subarachnoid hemorrhage, p. 1529 embolic stroke, p. 1529 thrombotic stroke, p. 1528 hemorrhagic strokes, p. 1529 transient ischemic attack, p. 1527 intracerebral hemorrhage, p. 1529 Outline ETIOLOGY AND PATHOPHYSIOLOGY Risk Factors for Stroke Pathophysiology: Transient Ischemic Attack TYPES OF STROKE Ischemic Stroke Hemorrhagic Stroke Clinical Manifestations Diagnostic Studies and Collaborative Care NURSING MANAGEMENT: STROKE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Gerontologic Considerations: Stroke 53
  • 55. Chronic Neurological Problems Theory Outcomes 1. Describe the etiology, clinical manifestations, diagnostic studies, collaborative care, and nursing management of seizure disorder, multiple sclerosis, Parkinson’s disease, and myasthenia gravis. 2. Explain the potential impact of chronic neurologic disease on physical and psychologic well-being. 3. Outline the major goals of treatment for the client with a chronic, progressive neurologic disease. Clinical Outcomes 1. Apply Watson's carative factors when caring for clients with neurologic problems focusing on communication, self-awareness, trust, and patience. 2. Apply evidence based health care information when caring for clients and families experiencing neurologic problems. Learning Resources Medical-Surgical Nursing, Chapter 57. Littman, L. (Director). (1999). Freak city [Video recording]. United States: Showtime. Key Terms absence (petit mal) seizure, p. 1556 myasthenic crisis, p. 1574 atypical absence seizures, p. 1556 Parkinson’s disease, p. 1569 aura, p. 1550 partial seizure, p. 1556 epilepsy, p. 1555 seizure, p. 1555 generalized seizures, p. 1556 status epilepticus, p. 1557 multiple sclerosis, p. 1563 tonic-clonic seizure, p. 1556 myasthenia gravis, p. 1573 Outline CHRONIC NEUROLOGIC DISORDERS SEIZURE DISORDERS AND EPILEPSY Etiology and Pathophysiology Clinical Manifestation Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: SEIZURE DISORDERS AND EPILEPSY Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation MULTIPLE SCLEROSIS Etiology and Pathophysiology 54
  • 56. Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: MULTIPLE SCLEROSIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation PARKINSON’S DISEASE Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: PARKINSON’S DISEASE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation MYASTHENIA GRAVIS Etiology and Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: MYASTHENIA GRAVIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation 55
  • 57. Alzheimer’s Disease and Dementia Theory Outcomes 1. Describe the etiology, pathophysiology, clinical manifestations, diagnostic studies, and collaborative management of delirium. 2. Define dementia and describe its impact on society. 3. Compare and contrast different etiologies of dementia. 4. Describe the clinical manifestations, diagnostic studies, and collaborative management of dementia. 5. Describe the clinical manifestations, diagnostic studies, and collaborative management of Alzheimer’s disease. 6. Describe the nursing management of the client with Alzheimer’s disease. Clinical Outcomes 1. Design health promotion activities for assigned clients experiencing Alzheimer's Disease and dementia. 2. Provide teaching employing evidence based health information for assigned clients and their families experiencing Alzheimer's Disease and dementia. Learning Resources Medical-Surgical Nursing, Chapter 58. Iris [Video recording]. Key Terms Alzheimer’s disease, p. 1586 mild cognitive impairment, p. 1587 delirium, p. 1581 neuritic plaque, p. 1586 dementia, p. 1583 neurofibrillary tangles, p. 1586 familial Alzheimer’s disease, p. 1586 vascular dementia, p. 1584 Outline DELIRIUM Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies COLLABORATIVE AND NURSING MANAGEMENT: DELIRIUM DEMENTIA Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative and Nursing Management: Dementia ALZHEIMER’S DISEASE Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies 56
  • 58. Collaborative Care NURSING MANAGEMENT: ALZHEIMER’S DISEASE Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation 57
  • 59. Neurodegenerative and Peripheral Nerve Problems Theory Outcomes 1. Explain the etiology, clinical manifestations, collaborative care, and nursing management of trigeminal neuralgia and Bell’s palsy. 2. Explain the etiology, clinical manifestations, collaborative care, and nursing management of Guillain-Barré syndrome and tetanus. Clinical Outcomes 1. Demonstrate non-discriminatory competent nursing care for adults and their families experiencing peripheral nerve problems. 2. Manage the nursing care of adults and their families experiencing peripheral nerve and problems based on a caring relationship. Learning Resources Medical-Surgical Nursing, Chapters 58 & 59. Key Terms Bell’s palsy, p. 1605 tetraplegia, p. 1610 Guillain-Barré syndrome, p. 1606 trigeminal neuralgia, p. 1601 tetanus, p. 1609 Outline CRANIAL NERVE DISORDERS TRIGEMINAL NEURALGIA Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: TRIGEMINAL NEURALGIA Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation BELL’S PALSY Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: BELL’S PALSY Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation 58
  • 60. POLYNEUROPATHIES GUILLAIN-BARRÉ SYNDROME Etiology and Pathophysioloy Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: GUILLAIN-BARRÉ SYNDROME Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation TETANUS Etiology and Pathophysiology Clinical Manifestations Collaborative Care NURSING MANAGEMENT: TETANUS Nursing Implementation 59
  • 61. Spinal Cord Problems Theory Outcomes 1. Describe the classification of spinal cord injuries and associated clinical manifestations. 2. Describe the clinical manifestations, collaborative care, and nursing management of spinal cord shock. 3. Correlate the clinical manifestations of spinal cord injury with the level of disruption and rehabilitation potential. 4. Describe the nursing management of the major physical and psychologic problems of the client with a spinal cord injury. 5. Describe the effects of spinal cord injury on the older adult population. Clinical Outcomes 1. Demonstrate non-discriminatory competent nursing care for adults and their families experiencing spinal cord problems. 2. Manage the nursing care of adults and their families experiencing spinal cord problems based on a caring relationship. Learning Resources Medical-Surgical Nursing, Chapter 59. Steinberg, M., & Jimenez, M. (Directors). (1999). Waterdance [Video recording]. United States: Columbia Pictures. Key Terms anterior cord syndrome, p. 1612 neurosyphilis, p. 1610 autonomic dysreflexia, p. 1625 paraplegia, p. 1611 Brown-Séquard syndrome, p. 1612 poikilothermism, p. 1614 central cord syndrome, p. 1612 posterior cord syndrome, p. 1612 neurogenic bladder, p. 1626 spinal shock, p. 1611 neurogenic shock, p. 1611 Outline SPINAL CORD PROBLEMS SPINAL CORD TRAUMA Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: SPINAL CORD TRAUMA Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation Gerontologic Considerations: Spinal Cord Injury 60
  • 62. Endocrine System Theory Outcomes 1. Review the common characteristics and functions of hormones secreted by the pituitary, thyroid, parathyroid, and adrenal glands and the pancreas. 2. Describe the locations and roles of hormone receptors. 3. Review subjective and objective assessment of the endocrine system. 4. Describe age-related changes in the endocrine system and differences in assessment findings. 5. Differentiate normal from common abnormal findings in the assessment of the endocrine system. 6. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the endocrine system. 7. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the client with an imbalance of antidiuretic hormone secretion. 8. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the client with thyroid dysfunction. Clinical Outcomes 1. Analyze environmental and family influences that affect assigned clients with endocrine disorders. 2. Manage the nursing care of assigned clients with endocrine disorders from a wellness oriented approach. Learning Resources Medical-Surgical Nursing, Chapters 46 & 48. Key Terms aldosterone, p. 1255 insulin, p. 1255 antidiuretic hormone, p. 1253 islets of Langerhans, p. 1255 calcitonin, p. 1254 negative feedback, p. 1249 catecholamine, p. 1254 oxytocin, p. 1254 corticosteroid, p. 1255 parathyroid hormone, p. 1254 cortisol, p. 1255 target tissue, p. 1248 glucagon, p. 1255 thyroxine, p. 1254 growth hormone, p. 1253 triiodothyronine, p. 1254 hormone, p. 1248 tropic hormones, p. 1252 Outline DIAGNOSTIC STUDIES OF THE ENDOCRINE SYSTEM Laboratory Studies Radiologic Studies DISORDERS ASSOCIATED WITH ANTIDIURETIC HORMONE SECRETION DIABETES INSIPIDUS Etiology and Pathophysiology 61
  • 63. Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: DIABETES INSIPIDUS DISORDERS OF THE THYROID GLAND HYPERTHYROIDISM Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: HYPERTHYROIDISM Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation THYROID ENLARGEMENT THYROID NODULES THYROIDITIS HYPOTHYROIDISM Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: HYPOTHYROIDISM Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation 62
  • 64. Endocrine Problems Theory Outcomes 1. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the client with an imbalance of hormones produced by the adrenal cortex. 2. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of the client with an excess of hormones produced by the adrenal medulla. 3. Describe the side effects of corticosteroid therapy. 4. List common nursing assessments, interventions, rationales, and expected outcomes related to client teaching for management of chronic endocrine problems. Clinical Outcomes 1. Demonstrate a caring relationship in the nursing care of clients and their families with endocrine problems. 2. Manage the nursing care of assigned clients and their families emphasizing wellness promotion. Learning Resources Medical-Surgical Nursing, Chapter 48. Key Terms acromegaly, p. 1303 hypoparathyroidism, p. 1325 Addison’s disease, p. 1331 hypopituitarism, p. 1306 cretinism, p. 1319 hypothyroidism, p. 1319 Cushing syndrome, p. 1326 myxedema, p. 1320 diabetes insipidus, p. 1309 pheochromocytoma, p. 1335 exophthalmos, p. 1312 syndrome of inappropriate antidiuretic goiter, p. 1311 hormone, p. 1307 goitrogens, p. 1317 tetany, p. 1324 Graves’ disease, p. 1311 thyroiditis, p. 1318 hyperaldosteronism, p. 1334 thyrotoxic crisis, p. 1312 hyperparathyroidism, p. 1323 thyrotoxicosis, p. 1311 hyperthyroidism, p. 1311 Outline DISORDERS OF THE ADRENAL CORTEX CUSHING SYNDROME Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: CUSHING SYNDROME Nursing Assessment Nursing Diagnoses Planning Nursing Implementation 63
  • 65. Evaluation ADRENALCORTICAL INSUFFICIENCY Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: ADDISON’S DISEASE Nursing Implementation CORTICOSTEROID THERAPY Effects of Corticosteroid Therapy Complications Associated with Corticosteroid Therapy NURSING AND COLLABORATIVE MANAGEMENT: CORTICOSTEROID THERAPY 64
  • 66. Diabetes Mellitus Theory Outcomes 1. Describe the pathophysiology and clinical manifestations of diabetes mellitus. 2. Describe the differences between type 1 and type 2 diabetes mellitus. 3. Describe the collaborative care of the client with diabetes mellitus. 4. Describe the role of nutrition and exercise in the management of diabetes mellitus. 5. Describe the nursing management of a client with newly diagnosed diabetes mellitus. 6. Describe the nursing management of the client with diabetes mellitus in the ambulatory and home care settings. 7. Identify the pathophysiology and clinical manifestations of acute and chronic complications of diabetes mellitus. 8. Explain the collaborative care and nursing management of the client with acute and chronic complications of diabetes mellitus. Clinical Outcomes 1. Apply a wellness oriented approach in the nursing care of assigned clients and their families with diabetes mellitus. 2. Demonstrate collaborative nursing management of assigned clients in multiple settings with diabetes mellitus and chronic complications of diabetes mellitus. Learning Resources Medical-Surgical Nursing, Chapter 47. Key Terms angiopathy, p. 1296 insulin pump, p. 1276 diabetes mellitus, p. 1268 insulin resistance, p. 1271 diabetic ketoacidosis, p. 1271 insulin resistance syndrome, p. 1271 diabetic nephropathy, p. 1297 intensive insulin therapy, p. 1277 diabetic neuropathy, p. 1298 lipodystrophy, p. 1278 diabetic retinopathy, p. 1297 prediabetes, p. 1271 hyperosmolar hyperglycemic nonketotic syndrome, self-monitoring of blood glucose, p. p. 1293 1283 hypoglycemic unawareness, p. 1295 Somogyi effect, p. 1278 impaired fasting glucose, p. 1272 impaired glucose tolerance, p. 1271 Outline DIABETES MELLITUS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care Drug Therapy: Insulin Drug Therapy: Oral Agents 65
  • 67. Nutritional Therapy Exercise Monitoring Blood Glucose New Developments in Diabetic Therapy Culturally Competent Care: Diabetes Mellitus NURSING MANAGEMENT: DIABETES DIABETIC RETINOPATHY MELLITUS Etiology and Pathophysiology Nursing Assessment Collaborative Care Nursing Diagnoses NEPHROPATHY Planning NEUROPATHY Nursing Implementation Etiology and Pathophysiology Evaluation Classification COMPLICATIONS OF THE FOOT AND ACUTE COMPLICATIONS OF LOWER EXTREMITY DIABETES MELLITUS INTEGUMENTARY COMPLICATIONS DIABETIC KETOACIDOSIS INFECTION Etiology and Pathophysiology Gerontologic Considerations: Diabetes Clinical Manifestations Mellitus Collaborative Care HYPEROSMOLAR HYPERGLYCEMIC NONKETOTIC SYNDROME Collaborative Care NURSING MANAGEMENT: DIABETIC KETOACIDOSIS AND HYPEROSMOLAR HYPERGLYCEMIC NONKETOTIC SYNDROME HYPOGLYCEMIA NURSING AND COLLABORATIVE MANAGEMENT: HYPOGLYCEMIA CHRONIC COMPLICATIONS OF DIABETES MELLITUS ANGIOPATHY Macrovascular Complications Microvascular Complications 66
  • 68. Musculoskeletal Trauma Theory Outcomes 1. Review the gross anatomic and microscopic composition of bone, the classification system of joints and movements at synovial joints, the types and structure of muscle tissue, and the functions of cartilage, muscles, ligaments, tendons, fascia, and bursae. 2. Describe age-related changes in the musculoskeletal system and differences in assessment findings. 3. Review the subjective and objective assessment of the musculoskeletal system. 4. Differentiate normal from abnormal findings of a physical assessment of the musculoskeletal system. 5. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the musculoskeletal system. 6. Explain the etiology, pathophysiology, clinical manifestations, and collaborative care of soft tissue injuries, including strains, sprains, dislocations, subluxations, and muscle spasms. 7. Describe the sequential events involved in fracture healing. 8. Differentiate among closed reduction, cast immobilization, open reduction, and traction regarding purpose, complications, and nursing management. 9. Describe the neurovascular assessment of an injured extremity. 10. Explain common complications associated with fracture injury and fracture healing. 11. Describe the collaborative care and nursing management of clients with specific fractures. Clinical Outcomes 1. Manage the nursing care of adults and their families experiencing musculoskeletal disorders while interacting with other professionals and non-professionals in a variety of settings. 2. Demonstrate nursing management of clients with musculoskeletal disorders using evidence based health care information. 2. Demonstrate client teaching related to musculoskeletal trauma. Learning Resources Medical-Surgical Nursing, Chapters 60 & 61. crepitation (Table 60-6), p. 1644 Key Terms dislocation, p. 1652 abduction (Table 60-3), p. 1643 extension (Table 60-3), p. 1643 adduction (Table 60-3), p. 1643 fat embolism syndrome, p. 1672 ankylosis (Table 60-6), p. 1644 flexion (Table 60-3), p. 1643 arthrocentesis, p. 1648 fracture, p. 1656 arthroscopy, p. 1648 hip spica cast, p. 1663 atrophy (Table 60-6), p. 1644 isometric contractions, p. 1638 bursitis, p. 1656 isotonic contractions, p. 1638 carpal tunnel syndrome, p. 1654 kyphosis (Table 60-6), p. 1644 compartment syndrome, p. 1671 lordosis (Table 60-6), p. 1644 contracture (Table 60-6), p. 1644
  • 69. motor end plate, p. 1638 strain, p. 1651 neuromuscular junction, p. 1638 subluxation, p. 1652 repetitive strain injury, p. 1653 traction, p. 1664 scoliosis, p. 1644 x-ray, p. 1644 sprain, p. 1650 Outline DIAGNOSTIC STUDIES OF THE MUSCULOSKELETAL SYSTEM X-ray Magnetic Resonance Imaging Arthroscopy Arthrocentesis and Synovial Fluid Analysis Muscle Enzymes Serologic Studies SOFT TISSUE INJURIES SPRAINS AND STRAINS NURSING MANAGEMENT: SPRAINS AND STRAINS Nursing Implementation DISLOCATION AND SUBLUXATION NURSING AND COLLABORATIVE MANAGEMENT: DISLOCATION MUSCLE SPASMS FRACTURES Classification Clinical Manifestations Fracture Healing Collaborative Care NURSING MANAGEMENT: FRACTURES Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation COMPLICATIONS OF FRACTURES Infection Compartment Syndrome Venous Thrombosis Fat Embolism Syndrome TYPES OF FRACTURES COLLES’ FRACTURE FRACTURE OF THE HUMERUS FRACTURE OF THE PELVIS FRACTURE OF THE HIP Clinical Manifestations Collaborative Care NURSING MANAGEMENT: HIP FRACTURE
  • 70. Nursing Implementation Evaluation Gerontologic Considerations: Hip Fracture FEMORAL SHAFT FRACTURE FRACTURE OF THE TIBIA STABLE VERTEBRAL FRACTURES FACIAL FRACTURES Mandible Fracture NURSING MANAGEMENT: MANDIBULAR FRACTURE Nursing Implementation
  • 71. Orthopedic Surgery Theory Outcomes 1. Describe the nursing care of client’s with traction. 2. Describe the indications for and collaborative care and nursing management of amputation. 3. Identify the preoperative and postoperative management of the client having joint replacement surgery. Clinical Outcomes 1. Demonstrate pre and postoperative teaching for clients undergoing joint replacement. Learning Resources Medical-Surgical Nursing, Chapters 61 & 62. Key Terms arthroplasty, p. 1685 Complications of Joint Surgery debridement, p. 1685 Collaborative Care osteotomy, p. 1685 phantom limb sensation, p. 1682 synovectomy, p. 1684 Outline AMPUTATION Clinical Indications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: JOINT SURGERY NURSING MANAGEMENT: AMPUTATION Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation COMMON JOINT SURGICAL PROCEDURES Indications for Joint Surgery TYPES OF JOINT SURGERIES Synovectomy Osteotomy Debridement Arthroplasty Arthrodesis
  • 72. Musculoskeletal Problems Theory Outcomes 1. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of osteomyelitis. 2. Explain the etiology and nursing management of common foot disorders. 3. Describe the etiology, pathophysiology, clinical manifestations, and collaborative and nursing management of osteoporosis. Clinical Outcomes 1. Apply a wellness oriented approach in the nursing care of assigned clients and their families with musculoskeletal problems. 2. Demonstrate collaborative nursing management of assigned clients in multiple settings with musculoskeletal problems. Learning Resources Medical-Surgical Nursing, Chapter 62. Key Terms muscular dystrophy, p. 1698 osteomyelitis, p. 1692 osteoporosis, p. 1708 Outline OSTEOMYELITIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: OSTEOMYELITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation FOOT DISORDERS NURSING MANAGEMENT: FOOT DISORDERS Nursing Implementation Gerontologic Considerations: Foot Problems OSTEOPOROSIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: OSTEOPOROSIS 71
  • 73. Arthritis and Connective Tissue Diseases Theory Outcomes 1. Compare and contrast the sequence of events leading to joint destruction in osteoarthritis and rheumatoid arthritis. 2. Describe the clinical manifestations, collaborative care, and nursing management of osteoarthritis, rheumatoid arthritis, gout, and systemic lupus erythematosus. 3. Describe the drug therapy and related nursing management associated with arthritis and connective tissue diseases. 4. Compare and contrast the possible etiologies, clinical manifestations, and collaborative and nursing management of fibromyalgia syndrome and chronic fatigue syndrome. Clinical Outcomes 1. Employ evidence based health care information in the nursing care of assigned clients and their families with arthritis and connective tissue diseases. 2. Demonstrate collaborative nursing management of clients experiencing arthritis and connective tissue diseases. Learning Resources Medical-Surgical Nursing, Chapter 63. Key Terms chronic fatigue syndrome, p. 1751 fibromyalgia syndrome, p. 1749 gout, p. 1737 Lyme disease, p. 1736 osteoarthritis, p. 1715 Raynaud’s phenomenon, p. 1745 rheumatoid arthritis, p. 1724 systemic lupus erythematosus, p. 1739 Outline OSTEOARTHRITIS Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care NURSING MANAGEMENT: OSTEOARTHRITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation RHEUMATOID ARTHRITIS Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care 72
  • 74. NURSING MANAGEMENT: RHEUMATOID ARTHRITIS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Gerontologic Considerations: Arthritis GOUT Etiology and Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: GOUT SYSTEMIC LUPUS ERYTHEMATOSUS Etiology and Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: SYSTEMIC LUPUS ERYTHEMATOSUS Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation FIBROMYALGIA SYNDROME Etiology and Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Collaborative Care NURSING MANAGEMENT: FIBROMYALGIA SYNDROME CHRONIC FATIGUE SYNDROME Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies NURSING AND COLLABORATIVE MANAGEMENT: CHRONIC FATIGUE SYNDROME 73
  • 75. NURS 306: ADULT NURSING ASSIGNMENTS 74
  • 76. NURS 306: Adult Nursing Guidelines for Study Guides To assist in understanding client responses to medical-surgical conditions and nursing management of conditions, you will work with another classmate to write a Study Guide for two (2) selected chapters. Students are encouraged to collect study guides throughout the semester to aid in preparation for evaluations…and ultimately NCLEX. Study Guides are to include:  Brief Anatomy/Pathophysiology overview.  Assessment information and techniques.  Diagnostic Studies.  Nursing Management.  A brief case study (address impact of family).  5 NCLEX review questions related to covered information (answers provided on separate sheet). The assigned team must be prepared to present their study guides to the class on the assigned due date. Freedom is provided on format utilized. Include methods that help you to retain information. Have fun with this project!!! Usefulness is of utmost importance! Be advised: Your colleagues will be grading this project!!! Bonus points for creativity (at Course Leader’s discretion). 75
  • 77. Sign up for Study Guides Class Session Writers/Presenters Monday, January 23 Chapter 13 Chapter 14 Wednesday January 25 Chapter 20 Monday, January 30 Chapter 21 Wednesday, February Chapter 38 Monday, February 6 Chapter 39 Chapter 40 (pp.1003-1028) Wednesday, February 8 Chapter 40 (pp. 1028-1050) Monday, February 13 Chapter 41 Wednesday, February 15 **None** Monday, February 20 Chapter 42 Wednesday, February 22 Chapter 43 Monday, February 27 Chapter 44 Monday, March 20 Chapter 54 Wednesday, March 22 Chapter 55 Monday, March 27 Chapter 56 Wednesday, March 29 Chapter 57 Monday, April 3 Chapter 58 Wednesday, April 5 Chapter 59 Monday, April 10 **None** Wednesday, April 12 Chapter 48 Monday, April 17 Chapter 47 Wednesday, April 19 Chapter 60 Chapter 61 Chapter 62 76
  • 78. NURS 306: Adult Nursing Family Wellness Promotion Project Complete the Family Assessment Tool and Family Cultural Assessment Tool included in the syllabus to guide you in a family assessment. Drawing from assessment data, develop a family wellness plan (care plan) that prioritizes three (3) nursing diagnoses. Describe the kinds of interventions you consider necessary for this family. Utilize nursing interventions as well as other means of assistance (community resources) that you believe are necessary. Apply one nursing theory that you use as the framework for your family wellness promotion. The paper needs to conform to the nursing process, including proposed methods of evaluating identified nursing diagnoses and outcomes. The chosen family for this assignment must be approved by the faculty before completing the assignment. A written proposal briefly describing the family structure and rationale for selection must be submitted by March 6, 2005. Submit a 2,500-3,000 word paper utilizing at least 5 references, two of which must be from professional nursing journals. Papers must follow APA 5th edition formatting and be submitted in a report folder for grading on March 20, 2005. References for student use in project preparation: Medical-Surgical Nursing, Chapter 4. Family Assessment Tool (syllabus) Family Cultural Assessment Tool (syllabus) The following reference materials are on reserve in the KCU Young Library: Denham, S.A. (2003). Familial research reveals new practice model. Holistic Nursing Practice, 17(3), 143-151. Hartrick, G., Lindsey, A.E., & Hills, M. (1994). Family nursing assessment: Meeting the challenge of health promotion. Journal of Advanced Nursing, 20, 85-91. 77
  • 79. Family Wellness Promotion Project Guidelines Points Form 10 APA (5th ed.) style of writing and documentation required. Organization 10 Material organized in logical sequence. Content Selection of family. (10) Assessment of family physical, cognitive, psychosocial, attitudinal, cultural, and spiritual influences. (10) Family diagnoses (at least 3) with rationale from assessment data. (10) 60 Family outcome developed for each diagnosis. (10) Nursing interventions (at least 3 for each outcome) appropriate to achieve outcomes. (10) Evaluation plan consistent with assessing nursing diagnoses. (10) Sources 10 At least two citations must be from nursing journals. Grammar, spelling, and sentence construction 10 Total 100 78
  • 80. NURS 306: Adult Nursing Family Assessment Tool Identifying Data Family Composition - Who are the members of the family? o Social Roles  Describe the social roles of each member of the family (role within the family) o Geographic Location  Where is each member of the family located? Genogram Cultural Background o Cultural Heritage o Values o Gender Roles Religious Identification o Religious Background o Importance of Religious Practices in Family Culture Social Class Status Recreational/Leisure-time Activities Developmental Stage Stage of Family Development - Discuss the phase of family development – use a family theory (you’ll have to do some research). Conflicts - What conflicts are present within the family structure that affect the development of the family? Environmental Data Home - Describe the family home(s), the surrounding environment, and availability of sanitation. Neighborhood & Community - Describe the neighborhood and the surrounding community. Geographical Mobility - How is mobility viewed within the community? Association with Community - Describe the community ties and how the family utilizes community resources. Social Support - Describe the formal and informal social supports available to the family. Family Structure Communication Patterns - Analyze the communication patterns and describe functional & dysfunctional patterns. Power Structure - How is power balanced and utilized within the family? Role Structure - Analyze and describe the roles of each member of the family. Family Values - Analyze and discuss the family’s values – are they consistent with individual values within the family? Family Functions Affective - How does the family meet the affective needs (love, affection, respect, belonging, safety, etc.) of its members? Socialization - How does the family its function of socialization of family members? Health Care Family Stress & Coping Stressors - Describe the stressors affecting the family. Coping - How has the family coped with the stressors as a family unit? 79
  • 81. NURS 306: Adult Nursing Family Cultural Assessment Tool Social Orientation Ethnic / Racial Identity How does the family identify itself? Parents from same ethnic background? Core Values Ethics, and norms Standards of behavior Attitudes about time, work, money, education, beauty, strength, and change. Ethnic Group Affiliation Friends and associations: within or outside of ethnic group Social activity within and outside of ethnic group Family’s Religion What is religious affiliation? What is the level of activity with the religious affiliation? Acceptance by Community What extent is the family affected by discrimination? Communication Languages Spoken What is the preferred language within the family group? What language is preferred when speaking with strangers? Are there any family members who cannot speak English? Space Geographic Mobility Where has family lived? How long have they lived in the present country? Neighborhood Affiliation What are the characteristics of the neighborhood? Heterogeneous? Homogeneous? Time Place of birth and immigration history Birthplace? When and why did they immigrate? Family life transitions What are the customs and beliefs about: 80
  • 82. Birth, pregnancy, and childcare? Illness? Death and dying? Health care? Environmental Control Household appearance Cultural decorations? Dietary habits, dress Culturally traditional dress? Food? Health/Illness Belief Systems View of health and illness? Use of folk systems What practices are used? Are cultural practitioners used? Biological Variation Body type features, characteristics such as: Racially related body structure, skin color, hair texture, and other physical characteristics Enzymatic and genetic variations; electrocardiographic patterns; susceptibility to disease Nutritional preferences and deficiencies Psychological characteristics Adapted from Friedman (1998) and Transcultural Nursing (1997-2000). 81
  • 83. NURS 306: ADULT NURSING CLINICAL GUIDELINES 82
  • 84. NURS 306: Adult Nursing Clinical The purpose of the Adult Nursing Clinical experience is to provide the student with an opportunity to prove competent clinical practice for the client and family. This draws from clinical experience and knowledge gained from previous semesters as well as theory. It is the expectation of the clinical instructor(s) that the student will reflect excellence in practice and display behavior consistent with Christian principles. Evaluation by the clinical instructor will be completed on a weekly basis (unless otherwise indicated) through utilization of the Clinical Evaluation Tool. In cases in which the student performs an out rotation (with the exception of Open Heart Surgery) it is the responsibility of the student to have the supervising nurse complete the evaluation for review by the Clinical Instructor. It is the responsibility of the student to keep documentation of health insurance, certifications, and immunizations current. Otherwise, the student is not permitted to practice in the clinical environment and the student will receive a 0 rating on their Clinical Evaluation Tool. Documentation is to be provided to the Administrative Assistant for the KCU School of Nursing. This includes:  CURRENT AMERICAN HEART ASSOCIATION BASIC LIFE SUPPORT HEALTH CARE PROVIDER CARD.  CURRENT HEALTH INSURANCE DOCUMENTATION.  DOCUMENTATION OF NEGATIVE PPD OR NORMAL CHEST X-RAY IF APPLICABLE.  RECORD OF CURRENT AND COMPLETE IMMUNIZATIONS. To ensure competency, several evaluation methods exist for NURS 306. These include:  Clinical Evaluation Tool  Clinical Assignments  Clinical Performance Final If a student is detected to need remediation of a skill, the student will receive written notification. It is expected that the student will complete successful remediation of the skill will the CSL Supervisor prior to attending the next scheduled clinical day. It is the responsibility of the student to provide a completed Remediation Form to the Clinical Instructor. Matters for professionalism are taken very seriously. This concerns interaction with instructors, colleagues, clients, and other members of the multidisciplinary team. 83
  • 85. Ke ntucky Christian College School of Nursing NURS 306 Adult Nursing Clinical Evaluation Tool Directions for Use: • Student clinical performance is evaluated weekly with a 5-point scale. Criteria are based on program outcomes and leveled for progression throughout the curriculum. Score Descriptor Definition 5 Independent Student requires no verbal or physical cues. Care is consistently coordinated and efficient. Preparation is exemplary. Student requires occasional assistance with verbal cues. Care is 4 Self-directed progressively coordinated and efficient. High level of preparation consistently demonstrated. 3 Guided Student requires assistance with verbal or physical cues. Consistent high quality performance. Preparation is thorough. 2 Supervised Student requires frequent assistance with verbal or physical cues. Quality of performance is variable. Minimal level of preparation. 1 Dependent Consistently needs assistance or direct supervision. Poor or unsafe quality of performance. Unprepared. • Final clinical performance evaluation is satisfactory (S) or unsatisfactory (U) based on weekly evaluation and validation of clinical competency. Students must demonstrate progression throughout the clinical course and achieve a 73% on clinical final examination. Expectations for student performance are determined according to course and level of student. Students must achieve the required minimum satisfactory score in each program outcome in order to receive a satisfactory clinical performance evaluation. Course or Level Minimum Satisfactory Score Sophomore NURS 201: Introduction to Nursing and the Caring Process 2 NURS 206: Introduction to Adult Nursing 3 NURS 211: Clinical Practicum Junior NURS 301: Women and Childbearing Families 3 NURS 303: Nursing Care of Children NURS 306: Adult Nursing 4 NURS 311: Clinical Practicum Senior NURS 401: Mental Health Nursing 3 NURS 403: Community Health Nursing NURS 408: Clinical Integration Practicum 4 • Outcomes identified with ** are critical outcomes that must be demonstrated consistently for satisfactory performance. • Validation of essential skills competency is documented by student and clinical instructor. Students document each date that skill is performed. Clinical instructors validate competent performance with date and signature. 84
  • 86. NURS 306 Adult Nursing Name ____________________________________ Final Clinical Performance Appraisal: S / U Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Outcomes Final 1. A caring and competent provider, designer, and coordinator of nursing care who demonstrates integrity, biblical values, and non- discrimination in health promotion and illness management. Incorporates Watson’s caring behaviors in the provision of nursing care. Demonstrates biblical values in the provision of nursing care. Demonstrates professional responsibility in attendance, appearance, and submitting assignments. **Administers medications safely. **Provides for individual’s, family’s and community’s safety. Effectively utilizes principles of infection control. Seeks additional information, supervision, or other clinical assistance appropriately. Comments: 85
  • 87. NURS 306 Adult Nursing Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Outcomes Final 2. A critical thinker who employs the nursing process and provides evidence based health care information to individuals, families, and communities empowering them to make informed choices and decisions. **Incorporates the nursing process in the provision of nursing care. Adapts plan of care to meet individual needs of individuals, families, and communities. **Demonstrates competence in performance of physical assessment and interpretation of data. Initiates teaching appropriate to individuals, families, and communities. Incorporates principles of comfort in giving client care. Comments: 86
  • 88. NURS 306 Adult Nursing Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Outcomes Final 3. A caring and competent manager of nursing care in a variety of settings respecting the dignity and worth of each patient regardless of ethnic identity, race, gender, age, status, diagnosis, or ability to pay. **Maintains patient privacy and confidentiality of information. Assertively advocates on behalf of patients, families and communities. **Recognizes assessments outside normal limits and intervenes appropriately. Comments: 87
  • 89. NURS 306 Adult Nursing Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Outcomes Final 4. An effective communicator who uses leadership skills to collaborate and partner with patients, families, communities, and other health care providers to promote wellness and effect social change for a healthy environment. Collaborates effectively with agency care providers and peers in the provision of patient care. **Communicates effectively with individuals, families, and communities. **Documents care administered clearly, concisely, and accurately. Comments: 88
  • 90. NURS 306 Adult Nursing Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Outcomes Final 5. A professional practitioner and lifelong learner who understands health care systems and health care policy, encouraging legislation and policy consistent with the advancement of nursing care and health care. Demonstrates adequate preparation for clinical assignment. Participates in and prepares for pre- and post-clinical conferences. Utilizes nursing research in the care of individuals, families, and communities. Completes clinical out-rotations (specify): Comments: 89
  • 91. 90
  • 92. NURS 306 Adult Nursing Christian Service Matthew 7:16 You can tell what they are by what they do. Scripture to guide service: Matthew 25:35-36 “For I was hungry and you gave Me food; I was thirsty and you gave Me drink; I was a stranger and you took Me in; I was naked and you clothed Me; I was sick and you visited Me; I was in prison and you came to Me.” If you are seeking your degree under the current Kentucky Christian College catalogue, you will need to sign up for .5 units of Christian Service. You will need to: 1. Register for one course (.5 units) of Christian Service 2. Select one of the suggested service opportunities below, which are designed to correspond with this course. If you have an alternate suggestion, contact your Instructor with a written proposal. 3. Download a proposal form from the KCC web site. Complete the form and turn it in to the course leader for NURS 306. The Course Leader must have your proposal on file before you begin the service experience. Documentation of the experience is then provided to the Bible/Ministry Department. NOTE: A minimum of 10 hours per .5 credit hour unit of service is required. Here are some suggestions for Christian Service you might consider: • Organize a winter coat drive for adult indigents (work with an organization that specializes in services to this population). • Work at a soup kitchen. • Visit women living in a women’s shelter. • Work with a prison ministry (under the direction of an established minister). • Raise money to purchase/place books and Bibles in prison libraries. • Get involved with an adult education program that teaches adults to read. • Find a needy family and purchase one article of clothing (or one complete outfit) for each child before the start of the school year. • Collect personal hygiene items to donate to indigent persons. • Visit a senior center or women’s shelter or food kitchen and provide simple health screenings; i.e. blood pressures. 91

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