NUR 215Nursing Management of the Medical-Surgical Client I.docx

NUR 215
Nursing Management of the Medical-Surgical Client II
Program Council
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design and development of all University of Phoenix curricula.
Council members include full-time and practitioner faculty
members who have extensive experience in this discipline.
Teams of full-time and practitioner faculty content experts are
assembled under the direction of these Councils to create
specific courses within the academic program.
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Edited in accordance with University of Phoenix® editorial

standards and practices. (Template U3).
Table of Contents
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1Overview
4Faculty Overview
6Student Materials
7Faculty Materials
8Workshop One
10Clinical Activity Meeting One
12Workshop One Faculty Notes
15Workshop Two
17Clinical Activity Meeting Two
18Workshop Two Faculty Notes
20Workshop Three
21Clinical Activity Meeting Three
22Workshop Three Faculty Notes
24Workshop Four
26Clinical Activity Meeting Four
27Workshop Four Faculty Notes
29Workshop Five
30Clinical Activity Meeting Five
31Workshop Five Faculty Notes
33University of Phoenix Material
33Peer and Self Evaluation Form
34Requirements for Grading Formal Written Care Plan
35University of Phoenix Faculty Material
35Arizona State Board of Nursing Summary of NCLEX® Board
Meeting, October 3, 2002

39Problem Based Learning Using In-class Group Case Studies
41Faculty Grading Form for In-Class Case Studies
42Case Studies
43Workshop One – Case Studies
45Workshop Two - Case Studies
47Workshop Three - Case Studies
49Workshop Four - Case Studies
51Workshop Five - Case Studies
52Clinical Conferencing
53In-Class Group Case Study Form
Overview
COURSE DESCRIPTION
This course continues to build on the concepts and conditions
introduced in the previous course. Students will add the focus of
gastrointestinal, neurological, musculoskeletal and
genitourinary conditions to the care management of complex
adult clients. The nurse’s role in the assessing, planning,
implementing, and evaluating interventions based on data
analysis is emphasized. Preceptored clinical experiences allow
students to demonstrate and apply theory to practice.
TOPICS AND OBJECTIVES
Nursing Process and the Care of the Client with Endocrine
Disorders
· Apply the pathophysiological changes to client care for
individuals experiencing alterations in endocrine health
patterns.
· Develop a collaborative plan of care utilizing the nursing
process for individuals experiencing alterations in endocrine
health patterns.

· Identify the major pharmaceutical treatment modalities
utilized in treating individuals experiencing alterations in
endocrine health patterns.
· Utilize therapeutic communication with clients experiencing
alterations in endocrine health patterns.
· Formulate a teaching plan that addresses the needs of the
client experiencing alterations in endocrine health patterns.
Nursing Process and the Care of the Client with a
Musculoskeletal Disorder
individuals experiencing alterations in musculoskeletal health
patterns.
process for individuals experiencing alterations in
musculoskeletal health patterns.
musculoskeletal patterns.
alterations in musculoskeletal health patterns.
client experiencing alterations in musculoskeletal health
patterns.
Nursing Process and the Care of the Client with Immunologic
Disorders

individuals experiencing alterations in health patterns related to
the immune system.
process for individuals experiencing alterations in health
patterns related to the immune system.
utilized in treating individuals experiencing alterations in health
alterations in health patterns related to the immune system.
client experiencing alterations in health patterns related to the
immune system.
Nursing Process and the Care of the Client with Neurologic
Disorders – Part I and II
individuals experiencing alterations in neurologic health
patterns.
process for individuals experiencing alterations in neurologic
health patterns.
neurologic health patterns.
alterations in neurologic health patterns.

client experiencing alterations in neurologic health patterns.
Nursing Process and the Care of the Client with Eye or Ear
Disorders
eye or ear disorders.
patterns related to eye or ear disorders.
alterations in health patterns related to eye or ear disorders.
client experiencing alterations in health patterns related to eye
or ear disorders.
Nursing Process and the Care of the Client with Integumentary
Disorders
individuals experiencing alterations in integumentary health
patterns.
integumentary health patterns.

alterations in integumentary health patterns.
client experiencing alterations in integumentary health patterns.
DELIVERY METHODS
This module contains assignments and information for multiple
course delivery methods.
ALL DELIVERY METHODS
These assignments are applicable for all delivery methods.
CLASSROOM
Students meet face to face with the instructor and their
classmates.
ONLINE
Students meet via computer with the instructor and their
classmates. This course is not currently offered in this
modality.
FlexNet®
Classroom and Online delivery methods are combined. This
course is not currently offered in this modality.

DIRECTED STUDY
Student works one-to-one with the instructor. This course is not
currently offered in this modality.
In all cases, refer to the syllabus distributed by your instructor
for a comprehensive listing of the assignment descriptions and
due dates.
ASSIGNMENTS DUE
CLASSROOM
All assignments are to be completed prior to the workshop in
which they appear.
DIRECTED STUDY AND ONLINE
This course is not offered Direct Study, Flex-Net, or Online at
this time.
Faculty Overview
MODULE REVISION HISTORY
Refer to the table below to determine if module changes made
since you created your syllabus are significant enough to
require a new syllabus.
MODULE CODE
REVISION(S) DETAIL
nur215u1
Original UniModule™
UNIMODULE™ FORMAT

The Faculty Notes for each workshop are organized into
Preview, Content, and Summary sections. Note that all
workshops must run for a full four hours.
Preview
This is a brief overview of the content of the workshop.
Content
The Topics are designed to guide the workshop content. Avoid
repackaging the information from the reading assignments into a
lecture.
The Discussion Questions are designed to prompt activities and
bring the content to life. Once these questions have been
introduced, facilitate the discussion and/or activity toward the
related Learning Objectives for the workshop. The Faculty
Resource Guide at http://ecampus.phoenix.edu, provides
suggestions on specific activities and other resources. Check
back frequently as this resource is constantly changing.
The Integrating Questions are designed to help students build a
thorough understanding of the relevance, relationships, and
application of the content in the real world. To ensure that
students can relate course theories to the workplace, illustrate
with examples drawn from your professional experiences and
the experiences of the students.
The Discussion Questions and the Integrating Questions will be
addressed through the case studies, therefore you will not see
Discussion Questions or Integrating Questions in the module.
Summary
In this section the key points for the workshop are summarized

and the next workshop is previewed. If appropriate for the
delivery method, the Learning Team assignments are also
discussed.
TEACHING GUIDELINES
A Weekly Summary is due at the end of each workshop. This
summary should be used to evaluate the individual student’s
learning during the workshop. It is left to your discretion to set
guidelines for the Weekly Summary. This course is not
currently offered in a Directed Study or Online format.
FlexNet®
The FlexNet® delivery method combines the Classroom and
Online workshop formats. Please consult with your campus for
specific instructions. This course is not currently offer in a
Flex-Net format.
WEIGHTING OF ASSIGNMENTS
The following are the suggested weightings of assignments for
this course. Students do not receive this information; however,
you are responsible for communicating your performance
criteria to your students in the syllabus.
CLASSROOM
ASSIGNMENTS
Percent
Individual (100%)
Peer Review of Case Study in Small Group Classroom Activity
(All Workshops)

5
Faculty Review of Case Study in Small Group Classroom
Activity (All Workshops)
15
Classroom Discussion and Activity (All Workshops)
5
Weekly Practice NCLEX Questions (All Workshops) Must score
at least 90% each week to get credit
20
Clinical Conference Online (All Workshops)
10
Formal Written Care Plan (Workshop Four)
25
Final NCLEX Questions – paper and pencil in class (Workshop
5)
20
Clinical Activities
Midpoint Clinical Evaluation (Workshop Three) No points
awarded.
Pass/Fail
Final Clinical Evaluation (Workshop Five) This is pass/fail.
You must pass the clinical component to pass the course.
Pass/Fail
Total
100
Student Materials
BOOKS, SOFTWARE, OR OTHER COURSE MATERIALS
Lemone, P., & Burke, K. M. (2000). Medical surgical nursing:
Critical thinking in client care [University of Phoenix Special
Cover Edition]. Boston: Pearson Custom Publishing.

Pagana, K. D., & Pagana, T. J. (2003). Mosby’s diagnostic and
laboratory test reference (6th ed.). St. Louis, MO: Mosby.
ELECTRONIC RESOURCES
Selected Readings:
http://www.apollolibrary.com/Library/err/goerr.aspx?s=1006&fr
mCourse=475&frmWeek=1
CourseCompass Web site:
http://students.pearsoned.com/
UNIVERSITY OF PHOENIX MATERIALS
(NOTE: This material is found in the back of the UniModule™.)
“Peer and Self Evaluation Form” (All Workshops)
“Requirements for Formal Written Care Plan” (Workshop Four)
Faculty Materials
BOOKS, SOFTWARE, OR OTHER COURSE MATERIALS
None
ELECTRONIC RESOURCES

http://www.coursecompass.com/ccindex.html?bbatt=Y
CourseCompass faculty log in page
UNIVERSITY OF PHOENIX FACULTY MATERIALS
(NOTE: This material is found in the back of the UniModule™.)
“Arizona State Board of Nursing Summary of NCLEX Board
Meeting, October 3, 2002” (Workshop One)
“Problem Based Learning Using In-class Group Case Studies”
(All Workshops)
“Faculty Grading Form for In-Class Case Studies” (All
Workshops)
“Case Studies” (All Workshops)
“Workshop One – Case Studies” (Workshop One)
“Workshop Two – Case Studies” (Workshop Two)
“Workshop Three – Case Studies” (Workshop Three)
“Workshop Four – Case Studies” (Workshop Four)
“Workshop Five – Case Studies” (Workshop Five)
“Clinical Conferencing” (All Workshops)
“In-Class Group Case Study Form” (All Workshops)
Workshop One
Nursing Process and the Care of the Client with Endocrine
Disorders

individuals experiencing alterations in endocrine health
patterns.
process for individuals experiencing alterations in endocrine
health patterns.
endocrine health patterns.
alterations in endocrine health patterns.
client experiencing alterations in endocrine health patterns.
ASSIGNMENTS
CLASSROOM
1. Review from Medical Surgical Nursing: Critical Thinking in
Client Care
a. Assessing Clients with Endocrine Disorders, pp. 672-682
b. Fluid and Electrolytes, pp. 112-126
2. Read from Medical Surgical Nursing: Critical Thinking in
Client Care
a. Diabetes, pp. 716-764
b. Thyroid, Parathyroid, pp. 683-702
c. Osteoporosis, pp.1527-1536
d. Adrenal, pp. 702-712

e. Pituitary, pp. 713-715
3. In-class case studies will be analyzed in groups to help you
apply what you are reading. Please bring both textbooks for
this course to class. Please review the “Peer and Self Evaluation
Form” found in University of Phoenix Materials located at the
back of this module. You will use this form to evaluation your
contribution and that of your group members after completing
the in-class case studies each week.
4. Practice NCLEX questions will be posted in CourseCompass
each week. You will have unlimited opportunities to pass these
with a score of 90% or better. You must do so each week to pass
this course. The final NCLEX questions in Workshop Five will
be answered in a test in class.
5. Bring LPN to BSN Program Student Clinical Handbook to
class.
6. The CourseCompass web site for this course is the same one
used for NUR 214. The URL can be found under “Student
Materials” in this module.
These assignments are due in Workshop One.
ONLINE
This course is not currently offered in this format.
DIRECTED STUDY
Clinical Activity Meeting One

ASSIGNMENTS
CLASSROOM AND ONLINE
Learning Team
There is no learning team hour requirement for this clinical
course. Instead, students will be placed in clinical agencies for
clinical rotation to fulfill course requirements and objectives.
Clinical Agency Requirements:
Students will:
· Be assigned to a specific agency, preceptor, and unit as
determined by faculty, College Campus Chair, and/or designee
of the agency.
· Contact Clinical Preceptor* and arrange a meeting to discuss
clinical hours for the entire course. Clinical hours must mirror
the preceptors' work schedule. Students are not allowed to clock
clinical hours without being with their preceptor, nor while they
are working as staff for the agency.
· Arrange for orientation of unit and/or agency, based on agency
policy.
· Select a patient from the assigned unit the day before the
clinical rotation. The patient needs primary and secondary
diagnoses that match the workshop content for the week.
· Fill out the Preparatory Client Care Plan on each patient. This
form is found in the back of the LPN to BSN Program Student
Clinical Handbook. The care plan will be reviewed by the
Clinical Preceptor prior to starting the clinical hours for the
day. The plan will also be reviewed by the Clinical Site Faculty
(CSF)** weekly.

· Arrive at the unit on time for report and prepared to care for
your patient.
· Fulfill clinical hours as scheduled by faculty preceptor.
Approximately 10 to 12 hours per week are required to complete
the 45 clinical hours for this course.
· Perform clinical skills as opportunities arise with preceptor's
observation and approval. Preceptor should sign-off on the
clinical skill observed.
· Participate in the online Clinical Conferencing weekly with
the classroom faculty and Clinical Site Faculty.
· Evaluate the preceptor and clinical agency after the last
workshop. Forms for this purpose are located in the LPN to
BSN Program Student Clinical Handbook.
· Maintain an accurate clinical log of time spent in the agency
and in clinical experience. The log will be discussed in the
Clinical Conferencing and signed off by the Clinical Preceptor
and Clinical Site Faculty. The log is located in the back of the
LPN to BSN Program Student Clinical Handbook.
Clinical Conferencing
Clinical Conferencing will be conducted weekly online through
an asynchronous chat within CourseCompass. Students will be
responsible to join the conference to discuss the week’s clinical
rotation, patient/client outcomes, accomplishments, and
challenges. Participation in Clinical Conferencing will require
approximately 1 to 2 hours per week. Attendance will be taken.
After you have logged in to CourseCompass click on
“Discussion Board”. There will be a link for each week’s
Clinical Conference. Click on that link and add your comment.
Click on the “Submit” button to submit your comment.

*Clinical Preceptor – An RN who works for the agency where
clinicals are held and is there to supervise the student
throughout the clinical experience.
** Clinical Site Faculty (CSF) – A contracted employee of the
University of Phoenix who supervises the Clinical Preceptor and
works with the student periodically. This individual will be
responsible for reviewing the student’s Preparatory Client Care
Plan and ensuring appropriate progression in the clinical
component of the course.
Workshop One Faculty Notes
Time: 4 hours
Preview (1 hour)
CLASSROOM
Facilitate introductions and a course overview discussion.
CLASSROOM AND ONLINE
Content (2 hours, 30 minutes) (refer to Faculty Resource Guide
at http://ecampus.phoenix.edu)
Please read “Problem Based Learning Using In-class Group
Case Studies” contained in the University of Phoenix Faculty
Materials prior to preparing for your class.

NOTE TO FACULTY: Please read the article “Arizona State
Board of Nursing Summary of NCLEX( Board Meeting, October
3, 2002” found in the University of Phoenix Faculty Material at
the end of the module.
1. Nursing Process and the Care of the Client with Endocrine
Disorder
Note to faculty: the following information should be covered as
part of the case studies, not in lecture format.
a. Diabetes
1) Pathophysiology of type I & II (type I will be covered more
in the pediatrics course)
a) Type I
b) Type II
(1) Hyperinsulinemia
(2) Insulin resistance
2) Complications with associated pathophysiology – the text
fragments this into different chapters. Need to relate these
complications/target organ damage to the disease for the
student.
a) Retinopathy
b) Nephropathy
c) Neuropathy

d) Ketoacidosis
e) Coronary artery disease/atherosclerosis/peripheral vascular
disease
b. Thyroid gland disorders
1) Normal physiology
a) Thyroid hormone production
b) Relationship to anterior pituitary gland
c) Relationship of hormone production and lab tests used to
assess function
2) Hypothyroidism
a) Pathophysiology of hormone function
b) Abnormality in laboratory tests – T4, TSH
c) Relate symptoms with pathophysiology
d) Multisystem effects
e) Nurses will often encounter as secondary diagnosis – not why
patient having contact with health care system.
3) Hyperthyroidism
a) Pathophysiology of hormone function
b) Abnormality in laboratory tests – T3, T4, TSH
c) Relate symptoms with pathophysiology

c. Parathyroid gland disorders
1) Physiology of gland – calcium regulation
2) Hyperparathyroidism – relationship to osteoporosis, which
text lists as musculoskeletal disorder. Students should learn this
as an endocrine disorder.
3) Laboratory tests used to diagnose
d. Adrenal gland disorders
1) Physiology of adrenal gland
a) Cortex
b) Medulla
2) Pathophysiology of hyper and hypo function
3) Electrolyte disturbance
e. Pituitary gland disorders – these are rare and you may not
want to spend much time on them. A case study on diabetes
insipidus is included.
1) Anterior gland – growth hormone, prolactin, ACTH
2) Posterior – ADH
a) SIADH – pathophysiology
b) Symptoms
c) Lab abnormalities

2. Discussion Questions and Integrating Questions will be
integrated into the case study.
Summary (30 minutes)
CLASSROOM
1. Review key points and preview the next workshop.
2. Remind students to submit any assignments that are due.
3. Remind students about necessary clinical paperwork from the
LPN to BSN Program Clinical Handbook.
DIRECTED STUDY
Workshop Two
Nursing Process and the Care of the Client with a
Musculoskeletal Disorder
individuals experiencing alterations in musculoskeletal health
patterns.
musculoskeletal health patterns.

musculoskeletal patterns.
alterations in musculoskeletal health patterns.
client experiencing alterations in musculoskeletal health
patterns.
Nursing Process and the Care of the Client with Immunologic
Disorders
the immune system.
alterations in health patterns related to the immune system.
client experiencing alterations in health patterns related to the
immune system.
ASSIGNMENTS
CLASSROOM

Client Care
a. Immune System, pp. 219-238
b. Assessing Clients with Musculoskeletal Disorders, pp. 1510-
1526
Client Care
a. Paget’s Disease, pp. 1541-1545
b. Osteomyelitis, pp. 1545-1556
c. Low Back Pain, pp. 1561-1564
d. Bone Tumors, pp. 1564-1569
e. Musculoskeletal Trauma, pp. 1572-1616
f. Degenerative Joint Disease, 1617-1632
g. Altered Immunity, pp. 238-309
h. Rheumatoid Arthritis, pp. 1639-1661
3. Read the two articles on traction found on the Selected
Readings Page.

These assignments are due in Workshop Two.
ONLINE
DIRECTED STUDY
Clinical Activity Meeting Two
ASSIGNMENTS
Learning Team
Students will:
of the agency.

policy.
(CSF)** weekly.
your patient.

an asynchronous chat within CourseCompass. Students will be
responsible to join the conference to discuss the week’s clinical
rotation, patient/client outcomes, accomplishments, and
challenges. Participation in Clinical Conferencing will require
approximately 1 to 2 hours per week. Attendance will be taken.
* Clinical Preceptor – An RN who works for the agency where
Workshop Two Faculty Notes
Time: 4 hours
Preview (30 minutes)
CLASSROOM

Present Workshop Overview
CLASSROOM
Content (3 hours) (refer to Faculty Resource Guide at
http://ecampus.phoenix.edu)
1. Nursing Process and the Care of the Client with
Musculoskeletal Disorders
a. Back pain
1) Mechanical (musculoskeletal strain) vs radicular (pinched
nerve) – these are covered in two areas of the text and should be
correlated in the student’s mind.
a) Compare and contrast pathophysiology of both
b) Compare and contrast symptoms, nursing interventions, and
surgical and non-surgical medical treatment.
b. Bone tumors
1) Pain control
2) Nursing diagnosis and interventions – body image
disturbance, grief, impaired physical mobility
c. Osteomyelitis
1) Pathophysiology of process in bone or soft tissue
2) Long-term IV antibiotics and problems to other organ

systems caused by that
d. Degenerative joint disease (osteoarthritis)
1) Pathophysiology – compare and contrast to that of RA
a) Joints most commonly effected
b) Not systemic illness, but caused by wear and tear
2) Surgical procedures and post-op nursing care
3) Chronic pain – nursing care and non-pharmacologic treatment
measures
e. Crystal induced arthritis (gout used for case study)
1) Pathophysiology – how crystals precipitate in joint and cause
inflammation
2) Treatment for acute attack
3) Treatment for prevention of acute attack
f. Musculoskeletal trauma
1) Fractures
a) Physiology of bone healing
b) Treatment – casting and traction – Traction is a topic covered
on the NCLEX exam. Be sure the students have read the articles
on the Selected Readings Page and understand the basic
concepts behind the various kinds of traction.
c) Nursing care of the immobilized patient

2. Nursing Process and the Care of the Client with Immunologic
Disorders
a. Rheumatoid arthritis
1) Pathophysiology
a) Compare and contrast with DJD
b) Systemic illness – autoimmune disease
(1) Briefly review immune system
(2) Compare and contrast normal immune response with
autoimmune response
(3) Intra-articular and extra-articular manifestations
c) Step-wise medical treatment
(1) Non-steroidal anti-inflammatory drugs (NSAIDs)
(2) Steroids
(3) DMARDs (disease modifying anti-rheumatid drugs)
(a) Classes of drugs used
(b) Serious side effects and the nurses role in identifying
b. Acquired immunodeficiency syndrome (AIDS)
1) Pathophysiology
a) Compare and contrast a virus with retrovirus

b) Part of immune system effected by retrovirus
2) Multi-system involvement
a) Lymphadenopathy
b) AIDS dementia
c) Secondary infectious disease
CLASSROOM
3. Remind students to complete the Preparatory Client Care Plan
prior to reporting to the clinical agency.
DIRECTED STUDY
Workshop Three

Disorders – Part I
patterns.
health patterns.
ASSIGNMENTS
CLASSROOM
Client Care
a. Assessing Clients with Neurologic Disorders, pp. 1674-1697
Client Care
a. Intracranial Disorders, pp. 1698-1719
b. Seizure Disorder, pp. 1719-1727
c. Headaches, pp. 1727-1734

d. Craniocerebral Trauma, pp. 1734-1743
e. Intracranial Infections, Inflammation, and Neoplasms, pp.
1743-1761
f. Cerebral blood flow disorder, pp. 1763-1787
These assignments are due in Workshop Three.
ONLINE
DIRECTED STUDY
Clinical Activity Meeting Three
ASSIGNMENTS

Learning Team
Students will:
of the agency.
policy.
(CSF)** weekly.
your patient.

CourseCompass. Students will be responsible to join the
conference to discuss the week’s clinical rotation, patient/client
outcomes, accomplishments, and challenges. Participation in
Clinical Conferencing will require approximately 1 to 2 hours
per week. Attendance will be taken.

Workshop Three Faculty Notes
Time: 4 hours
CLASSROOM
CLASSROOM
1. Nursing Process and the Care of the Client with Neurologic
Disorders – Part I
a. Increased intracranial pressure (ICP)– Compare and contrast
how this can occur, the various structures that can increase in
size and put pressure on vital tissues.
1) Normal pressure hydrocephalus
a) Pathophysiology – increased cerebral spinal fluid (CSF)

b) Post-op nursing management post-shunt placement –
assessment
2) Closed head injury, increased
a) Pathophysiology – compare and contrast causes following
head trauma
b) Nursing management of a patient with diminishing level of
consciousness (LOC)
3) Brain tumor
a) Pathophysiology – space occupying lesion
b) Location of tumor will cause symptoms
b. Seizures
1) Pathophysiology of seizure following head injury
2) Nursing management of acute seizure
c. Intracranial infections (bacterial meningitis used in case
study)
1) Pathophysiology
2) Assessing neurological function – what to look for
d. Headaches
1) Compare and contrast various types of headaches
2) Pathophysiology of migraine headaches (used in case study)

3) Pain management
e. Cerebral blood flow disorders
1) The patient having a carotid endarterectomy
a) Pathophysiology of plaque formation
b) Role of hypercholesterolemia and diabetes in promoting
atherosclerosis
c) Special needs of the diabetic facing surgery
2) Stroke/cerebral vascular accident (CVA)
a) Pathophysiology - differentiate TIA from hemorrhagic stroke
and thrombotic stroke
b) Role of hypertension in CVA
c) Nursing management of manifestations of stroke
d) Nursing management of complications of stroke
CLASSROOM

DIRECTED STUDY
Workshop Four
Disorders – Part II
patterns.
health patterns.
Nursing Process and the Care of the Client with Eye or Ear
Disorders

eye or ear disorders.
alterations in health patterns related to eye or ear disorders.
client experiencing alterations in health patterns related to eye
or ear disorders.
ASSIGNMENTS
CLASSROOM
Client Care
a. Assessing Clients with Eye or Ear Disorders, 1876-1896
Client Care
a. Spinal Cord Disorders, pp. 1787-1816
b. Degenerative Neurologic, Neuromuscular, and Cranial Nerve
Disorders, pp. 1817-1853
c. Cranial Nerve Disorders, pp. 1864-1868

d. PNS Disorders, pp. 1853-1864
e. Eyes, pp. 1907-1928
f. Ear, pp. 1938-1947
3. Formal Written Care Plan due. See “Requirements for Formal
Written Care Plan” in University of Phoenix Materials.
These assignments are due in Workshop Four.
ONLINE
DIRECTED STUDY
Clinical Activity Meeting Four

ASSIGNMENTS
Learning Team
Students will:
of the agency.
policy.
(CSF)** weekly.

your patient.

Workshop Four Faculty Notes
Time: 4 hours
CLASSROOM
Present Workshop Overview.
CLASSROOM
1. Nursing Process and the Care of the Client with Neurological
Disorders – Part II
a. Spinal cord injury
1) Manifestations related to level of injury
a) C3-4 spinal cord injury
b) T10 fracture

2) Stabilization and immobilization – review traction used for
cervical fractures
3) Spinal shock – nursing implications
b. Alzheimer’s disease
1) Pathophysiology
2) Assessing mental status
3) Nursing care
4) Caregiver support
c. Multiple sclerosis – be sure to discuss traction used in case
study
1) Pathophysiology
2) Nursing management of disease manifestations
d. Parkinson’s disease
1) Pathophysiology
2) Assessing functional status
3) Caregiver support
e. Vertigo – be sure to discuss traction used in case study
1) Pathophysiology – differentiate benign positional vertigo
with Ménière’s disease

2) Nursing management of fall potential – disease caused or
caused by side effect of medication used to treat the problem
(somnolence)
f. Guillain-Barré syndrome
1) Pathophysiology
2) Ongoing nursing assessment
2. Nursing Process and the Care of the Client with Eye or Ear
Disorders
a. Acute angle-closure glaucoma
1) Pathophysiology – differentiate open-angle and angle-closure
glaucoma
2) Nursing care of acute episode
3) Surgical and post-op management
CLASSROOM

DIRECTED STUDY
Workshop Five
Nursing Process and the Care of the Client with Integumentary
Disorders
individuals experiencing alterations in integumentary health
patterns.
alterations in integumentary health patterns.
client experiencing alterations in integumentary health patterns.
ASSIGNMENTS
CLASSROOM

Client Care
a. Assessing Clients with Skin Disorders, 554-567
Client Care
a. Pruritus, Dry Skin and Psoriasis, pp. 568-575
b. Fungus, Parasites, and Viral, pp. pp. 578-589
c. Malignant Melanoma and Trauma, pp. 611-633
d. Burns, pp. 638-669
3. NCLEX in-class paper and pencil exam covering content
from all Workshops.
These assignments are due in Workshop Five.
ONLINE

DIRECTED STUDY
Clinical Activity Meeting Five
ASSIGNMENTS
Learning Team
Students will:
of the agency.
policy.

(CSF)** weekly.
your patient.

Workshop Five Faculty Notes
Time: 4 hours
Preview (1 hour)
CLASSROOM
CLASSROOM
Content (2 hours, 30 minutes) (refer to Faculty Resource Guide
at http://ecampus.phoenix.edu)
1. Nursing Process and the Care of the Client with
Integumentary Disorders
a. Primary skin lesions

1) Examples from each category that may be encountered as
secondary problems for patients
2) Documentation strategies
b. Secondary skin lesions
1) Examples from each category that may be encountered as
secondary problems for patients
2) Documentation strategies
c. Skin problems that immobilization causes and nursing
diagnoses and interventions
d. Case studies
1) Psoriasis
a) Pathophysiology
b) Body disturbance issues related to
c) Lab abnormalities – high alkaline phosphatase due to rapid
turnover of skin
2) Burns
a) Burn classification according to depth of tissue involved
b) Severity of burns
(1) Rule of 9’s
(2) Lund and Browder burn assessment method

c) Multisystem involvement and nursing assessment
(1) Fluids
(2) Respiratory status
(3) Skin care
(4) Pain control
(5) Nutrition support
(6) Mobility
(7) Psychological support
(8) Family support
d) Treatment options
(1) Debridement
(2) Surgical procedures
3) Malignant melanoma
a) Pathophysiology
b) Surgical treatment
c) Emotional support
4) AIDS and opportunistic infections
a) Pathophysiology of tinea, Kaposi’s sarcoma, thrush

b) Immune status in HIV
c) Nursing diagnosis and interventions
d) Comfort measures with tinea infections and thrush
CLASSROOM
DIRECTED STUDY
University of Phoenix Material
Peer and Self Evaluation Form
Please submit this peer and self-evaluation form to the faculty
member at the end of each class to evaluate participation in the
group case studies.
Directions:

2. This is a confidential evaluation. I will not share the results
with your group members.
3. Write the name of each group member in the left-hand
column. Be sure to include yourself.
4. In the right-hand column, assign a percent of the total effort
that was contributed by that person. The numbers should total
100.
For example, if there were four in your group and all four group
members contributed equally, indicate a maximum of 25% for
each.
If your group was highly dysfunctional, it might well look like
this:
· Mary:
0%
· Tony:
80%
· Jill:
10%
· Susan:
10%
TOTAL =
100%
What percent of the total effort for the weekly group case
studies was contributed by each group member, including you?

PRIVATE
Name (include your own!)
Percent contribution to group effort
Course Workshop
TOTAL
100%
University of Phoenix Material
Requirements for Grading Formal Written Care Plan
Nursing diagnoses stated in appropriate format
6
One short-term goal with measurable outcomes
for each diagnosis
6

Minimum of four interventions with rationale
for each therapeutic intervention (ie: 4
interventions under assessment, 4 under
therapeutic interventions, 4 under
education and AT LEAST 2 under referral)
13
Total points
25
University of Phoenix Faculty Material
Arizona State Board of Nursing Summary of NCLEX® Board
Meeting, October 3, 2002
Background
The Arizona State Board of Nursing noted that Arizona
NCLEX-RN first time pass rates declined below the national
average in 2001. This is the first time in the past 9 years that
the state first time pass rate dipped below the national rate. In
past years, the Arizona first time pass rate was well above the
national average. In 2001, several programs posted pass rates
below 70%, while some programs increased their pass rates or
maintained rates above 90%. The Board expressed concern
about the issue and requested that all Arizona nursing programs
attend a special Board meeting on October 3, 2002. Before the
meeting, the programs were requested to submit a document

addressing the following:
1. Five reasons for a lower than 90% pass rate in your program
2. Five strategies your program will implement to increase the
pass rate to 90% or higher.
3. A profile of the successful NCLEX candidate.
4. A profile of the unsuccessful candidate.
If a program had attained a 90% pass rate, the questions were
modified to address strategies that the program utilized to attain
and sustain the pass rate. All but one program sent a written
report. All programs delivered an oral report at the meeting.
Overview
It was noted during the introduction of the topic by the Board
Consultant that no program achieved a 90% pass rate
consistently for the past 9 years. It was also noted that during
2001, over half the programs in the state participated in multi-
system curriculum change. Data from National Council of State
Boards of Nursing was presented showing that English as a
Second Language (ESL) and ethnicity affected pass rates. ESL
candidates also took longer per item to test, had lowered pass
rates, and answered more items. The ethnic group with the
highest pass rate was whites. All other ethnic groups had pass
rate at 10% or more below the white group. During the initial
part of the session, Dr. Casey Marks, Director of Testing for the
National Council of State Boards of Nursing, was present via
teleconferencing to answer questions. Dr. Marks informed the
group that the Exam committee was studying the issue of the
test time allotted to candidates to see if a modification was
needed. Dr. Marks also encouraged programs to continue to

refine the curriculum to meet the evolving health care needs of
clients.
Reasons for decreased pass rate
Academic Preparation
Many programs noted that students are not academically
prepared for the rigors of a nursing program. Some programs
noted that passing prerequisite courses is not an adequate
measure of student competence in the subject area. One
program noted that some students who passed college algebra
tested at “less then junior high” level in math on standardized
testing. It was noted that the math department in the particular
college did not require that students to actually calculate the
correct answer to the problem, but gave them credit for
attempting the problem. Other programs noted that many
students passed college level English courses had very low
reading comprehension skills. Some programs were able to
correlate poor reading comprehension skills to NCLEX failure.
Curriculum
Several programs that experienced curricular change noted that
they lost sight of NCLEX in the change and did not map the
curriculum content to the NCLEX test plan. Faculty involved in
constant curricular changes and revisions were noted to have
little attention to give to students. Content on the test plan was
dropped, inadvertently, by some of these programs.
Student Support

Nearly all programs cited student stress and lack of support as a
factor. Many students had to work long hours during the
program. Interestingly, many programs did not cite the working
itself as a significant factor, but the amount of support the
student received from family and friends as crucial. Stressors
for students were financial, relationships, and multiple roles
they were expected to fulfill.
Faculty
All programs reported difficulty recruiting and retaining
qualified faculty. It was noted by several programs that masters
nursing education does not prepare graduates for teaching.
Many programs have hired faculty prepared as practitioners who
lack curricular and teaching theory and practice. The quality
and experience of the faculty was cited as crucial to program
success. Many programs also reported that faculty were
reluctant to fail a student clinically due to a multiplicity of
factors which may include lack of knowledge of legal issues,
lack of support of administration, too much hassle, and
insecurity.
Academic Rigor
Many programs noted that lack of academic rigor contributed to
lower pass rates. The tendency to offer extra credit for
projects, rounding up of grades, few objective tests, test
questions at an inappropriate level and not expecting students to
read the materials were a few examples cited. A few programs
reported that overly detailed study guides to teacher-made test
might have encouraged students to study only for the test.
Grade inflation, both within the nursing program and across
campuses was also identified as a factor that contributed to
over-confidence of the student and undermined reliance on pre-
requisite courses to ensure a knowledge base.

Teacher-made Test
Testing of students may not have been at the appropriate level
for some programs. Several programs reported what when they
examined course tests, many questions were at a knowledge and
comprehension level rather than application and analysis level,
which is the level of the majority of the NCLEX RN questions.
Student Attitude
Student attitude was also reported to affect pass rates. All
programs agreed that many students major in nursing because it
is relatively high paying job in an uncertain economy. Some
students are motivated to study only what will be on the test and
are not active participants in learning. Some programs reported
that students are overconfident when it comes to taking NCLEX.
Timing of NCLEX
Time elapsed from graduation to testing was cited as a factor
for several programs, although one large program did not find it
significant.
Strategies to increase NCLEX pass rates
Admissions
Admission testing was cited as one strategy utilized to ensure
students have the abilities to succeed in a nursing program. The
most frequently cited test was the Nursing Entrance Test (NET).

Cut-off scores were cited as crucial for several programs in
selecting likely candidates for admission. Two programs
suggested tying the NET reading comprehension score to the
level of nursing textbooks used.
Testing and Grading
Many programs are seriously examining teacher-made tests and
constructing test questions and exam plans that are similar to
NCLEX. Almost all programs reported utilizing measures that
ensure that students meet the minimum passing score on the
objective tests. Comprehensive end-of-course exams that were
eliminated by some programs in the past are again being given.
Programs reported eliminating extra credit assignments, points
for attendance, grading of clinical performance, and other
measure thought to inflate grades. Several programs are
instituting policies where grades are not “rounded up”.
Standardized Testing
Many programs utilize standardized tests of nursing content
(HESI, ERI) and NCLEX predictor exams. Programs report
utilizing standardized tests in a variety of ways. Some used it
to inform students of their strengths and weaknesses and for
faculty to refine teaching, while others tie the score to the class
grade, progression, or graduation.
Student Support
Early identification of students at risk for failure is used as a
strategy by some programs. These programs were also quick to
point out that there are occasional surprises where students that
appeared very strong in the program failed NCLEX. Some

programs are actively engaged in providing services to students
such as financial help in the form of scholarships, partnering
with health care institutions to offer externships, tutoring, and
counseling services. Most programs also offer an NCLEX
review course for their graduates. One program offers NCLEX
study groups during the curriculum. Another program institutes
an NCLEX success program from the first day the student enters
the program. Many programs offer support to the unsuccessful
NCLEX candidate.
Faculty Support
One large program has instituted a workshop for new faculty to
orient them to clinical teaching and curriculum. Other
programs are looking for ways to build strong clinical and
didactic faculty. Faculty members are often sent to test
construction and curriculum workshops. Many programs are
searching for ways to allow faculty more time to prepare for
classes and institute innovative teaching. Other activities
include mentoring new clinical instructors and developing
methods where clinical instructors can connect clinical
experience to didactic content.
Curriculum
Many programs are actively engaged in mapping curriculum
content to the NCLEX test plan. Stabilizing the curriculum to
allow the flexibility to “fine tune” but not completely overhaul
the total program, is a reported strategy of programs that
participated in multi-system curriculum change.
Profile of NCLEX candidate

There was not agreement on the overall characteristics of the
candidate who passes NCLEX on the first try. Some common
characteristics of successful candidates were:
· Had a reading comprehension level similar to or higher than
the level of the nursing textbooks.
· Had a high level of support from family/friends
· Had high grades in nursing clinical courses
· Motivated, self-directed learner
· Took NCLEX within 5 months of completing the program
· Was predicted to pass NCLEX at 85% or better via
standardized testing
· Took an NCLEX review course
· Speaks English in the home
Some characteristics of unsuccessful first time candidates were
identified as:
· Lower grade in some clinical courses
· May be ethnic minority
· Studied to pass the course test only
· Lack of social support
· Delay in taking test (not all report this as significant)
· Reading comprehension level below the level of nursing

textbooks
· May have multiple repeats of prerequisite courses (not all
programs found this)
· Failed NCLEX-PN
Board Decision
On November 6, 2002 the Arizona Board of Nursing received
the above report and determined the following:
5. The goal of every program should be a 90% pass rate.
6. The Education Committee will recommend specific action
items for programs.
7. The Education Committee will provide a report to the Board
at the January meeting.
The Education Committee recommended:
8. That 90% be retained as an ideal minimum pass rate for
programs.
9. That programs submit a progress report on their
implementation of the actions proposed at this meeting in 18
months
Taken From: Arizona State Board of Nursing summary of
NCLEX board meeting, October 3, 2002 (2003,
February/March/April). Arizona State Board of Nursing
Newsletter, 4(1), p.1,3.

Problem Based Learning Using In-class Group Case Studies
Students need the opportunity to apply what they are learning
by reading the text. Therefore, it is recommended that faculty
use the in-class case studies included in this module instead of
lecturing to the students. The purpose of these case studies is
to help the students learn the pathophysiology of the disease
process and apply the nursing process to a specific patient
scenario. Hopefully, CourseCompass will provide adequate
anatomy, physiology, and pathophysiology review for the
students. It is envisioned that you will spend most of the class
time doing case studies with students in groups, pausing to
emphasize pathophysiology of the disease process being
discussed (in a “lecturette” PowerPoint® format) and how that
alone can be a driving force for the nursing process, the nursing
process itself, and other gaps. When the groups present the case
studies to the other students, additional discussion should
ensue.
Divide the class into groups of 3 or 4 students. Eight case
studies will be provided for Workshops One through Four and
four for Workshop Five. If you need additional case studies,
please create them. Have one student take notes. Provide the
case study to each group with the following list of content to be
covered:
For each:
10. Briefly, what is the pathophysiology of the disease?
11. How will pathophysiology drive nursing care for this
disease entity?
12. How are the patient’s signs and symptoms explained from a

pathophysiologic viewpoint?
13. Two nursing diagnoses stated in appropriate format and
prioritized
14. One short-term goal with measurable outcomes for each
diagnosis
15. Four interventions with rationale for each
a. Assessment
b. Therapeutic intervention
c. Education
d. Referral
e. Teaching
The students should be given 30 minutes for this entire process.
When everyone has completed their nursing care plans, the
groups should informally present their case study and plan to
the group, asking for feedback. The faculty’s role as facilitator
is to ask probing questions, explain any concepts that the
students do not understand, and fill in any gaps. It is
recommended that faculty prepare a “lecturette” on
pathophysiology of the disease processes or at least graphics on
a PowerPoint® to help teach the basic concepts of the disease
process. Graphics of all the pictures & tables in the text can be
found in CourseCompass by going to Control Panel ( Course
Documents (PowerPoints. Download the file “PowerPoints” to
your hard drive. This file contains only the graphics from the
text numbered just as in the text. Within CourseCompass under
each week, an outline can be found containing recommended
content and graphics for each “lecturette” needed to accompany

each case study. Follow the path: CourseCompass (Control
Panel (Course Documents (for specific week) (Faculty teaching
materials
“Threads” will appear throughout NUR 214 and 215. While you
will not spend direct class time covering these topics, they will
appear in the case studies and on the NCLEX exam. These
“threads” include:
16. Growth and development
17. Cultural awareness
18. Self-care
19. Pain management
20. Therapeutic communication
21. Surgical therapies
22. Cancer care
Faculty Grading Form for In-Class Case Studies
The students will receive three points each week for
participating in the case studies. Your evaluation should reflect
your observations of the students during the group process, as
well as incorporate their peer evaluation forms. In addition, you
may want to recommend that a different student from the group
present the case study each time. This is a very subjective
process and equivalent to class participation points.

Case Studies
The eight case studies for Workshops One through Four and
four case studies for Workshop Five are listed here. The chart
below is the suggested format for students to fill out during
class. Due to time constraints, you may want to go through this
entire process during Workshop One, but then focus on specific
aspects of the nursing process in the remaining workshops. The
purpose of these case studies is to learn about the disease
entities as well as plan nursing care. Since these case studies
will not appear in the student modules, you will need to bring
copies of them to class. Recommended answers for each case
study can be found in CourseCompass by week under Course
Documents, Faculty Teaching Materials.
Students will do “Peer and Self-Evaluations” each week after
the case studies are complete. The form can be found in
University of Phoenix Materials. Hopefully, this will help you
pinpoint students who are not participating during the in-class
case studies. As faculty, you will rate each student’s
participation at the end of each workshop. The guidelines for
doing so can also be found in University of Phoenix materials,
“Faculty Grading Form for In-Class Group Case Studies”.
A larger version of the form below can be found in University
of Phoenix Materials.
In-Class Group Case Study Form
Nursing dx:
Nursing dx:
Short-term goal:

Measurable outcome:
Short-term goal:
Measurable outcome:
* Interventions:
* Rationales:
Interventions:
Rationales:
1.
1.
1.
1.
2.
2.
2.
2.
3.
3.
3.
3.
4.
4.
4.
4.
Opportunities for teaching (prevention, health maintenance,
etc.)
*Four interventions with rationale for each
· Assessment
· Therapeutic intervention
· Education
· Referral

Workshop One – Case Studies
WS 1 - Case Study I
65 year-old male with type II diabetes is admitted for right
lower lobe pneumonia and blood sugars out of control. He has
been taking glyburide 10 mg bid and his blood sugars have been
150-180 before breakfast and supper prior to the onset of the
pneumonia. The day prior to admission, his fasting blood sugars
were 350 with his before supper blood sugars around 450. His
primary care provider initially placed him on Amoxicillin 500
mg tid two weeks ago for a sinus infection. However, he did
not improve and a cough and fever developed. He is admitted to
the medical floor for IV antibiotics and control of his blood
sugars. He is started on NPH insulin 12 U q am and 6 U q pm
with a sliding scale of regular insulin. For the past two days, he
has required 4 units of regular insulin in the morning, at noon,
and at dinner. Last night he had an insulin reaction at midnight.
WS 1 - Case Study II
A 72 year-old female with type II diabetes is admitted with
increasing shortness of breath, edema, weight gain, and fatigue.
Her admitting labs reveal a TSH of 62 (0.35 – 3.5 μU/ml) and
her T4 is (4.5 – 11.5 μU/dl). Other labs are within normal
limits. She is diagnosed with low output heart failure secondary
to hypothyroidism. She is started on thyroid replacement and an
ACE inhibitor.
WS 1 - Case Study III
A 26 year-old female is admitted to your medical unit in high
output heart failure due to hyperthyroidism (Graves disease).
Her BP is 160/100, pulse is 110, and respirations are 22. She is
restless and complaining of feeling nervous. She has bibasilar
crackles and 2+ edema. Her entire body seems to shake with
each heartbeat. She is started on a beta-blocker (metoprolol) 50

mg bid, Lasix 40 mg qd, and KCL 20mEq qd.
WS 1 - Case Study IV
A 40 year-old woman is admitted for pain control following a
minor fall while roller skating, which caused a compression
fracture of T10. A DEXA bone density study reveals a T score
of –3.0, consistent with a diagnosis of osteoporosis. Because of
her age, a work-up was instituted to find the cause of her
osteoporosis. Her serum calcium was 14 (9-11mg/dl) and her
PTH intact (parathyroid hormone) was 59pg/ml (11-54pg/ml). A
diagnosis of hyperparathyroidism was made. An ultrasound of
the thyroid and parathyroid glands was completed and an
adenoma assumed to be on a parathyroid gland was found. The
patient was scheduled for surgical excision of the parathyroid
adenoma the following day.
WS 1 - Case Study V
You are caring for a 35 year-old male in the ICU for
observation after he was admitted following a MVA in which he
sustained a head injury and chest trauma. On admission he was
somnolent and confused. Twenty-four hours after admission he
is unresponsive to verbal stimuli and develops severe
hypotension. Stat blood work reveals sodium of 119 (135-
145mEq/L) and potassium of 5.9 mEq/L (3.5 – 5.5 mEq/L). The
patient’s wife arrives from an out-of-town business trip after
being told of her husband’s accident. She informs the physician
that the patient has Addison’s disease and has been taking
fludrocortisone and cortisol, which he has been without for at
least 2 days now.
Note to faculty: use this case study as a review of the adrenal
glands and hormone production and nursing care of patients in
shock. Addison’s disease is rare and the students may never see
it.
WS 1 - Case Study VI

A 30 year-old woman with cystic fibrosis had a lung transplant
5 years ago and has done well. She has been on Prednisone 25
mg qd since the transplant and now has iatrogenic Cushing’s
syndrome. She is admitted to your medical unit with intractable
nausea and vomiting for two days secondary to a viral illness.
She has been unable to keep her medications down for two days,
as well. She is weak, light-headed, and dehydrated. Her labs
reveal hypokalemia, mild hypernatremia, and a urine specific
gravity of 1.030. She is 5’5” tall and weight 105 pounds, which
is 5 pounds less than she weighs normally.
WS 1 - Case Study VII
A 30 year-old male is admitted to the ICU with new onset
diabetes insipidus. He has been drinking large quantities of
water and voiding frequently. His serum sodium is 150 mEq/L
(135-145mEq/L), his blood glucose 100 mg/dl (70-110 mg/dl),
and his urine specific gravity is 1.000. He is light headed when
he stands. He has a 20-point drop in his systolic blood pressure
from sitting to standing, his skin turgor is poor, and he mucous
membranes are dry. He is started on desmopressin.
WS 1 - Case Study VIII
A 40 year-old obese woman is admitted for amputation of her
right lower leg due to gangrene of her toes. She has severe
peripheral arterial disease and poor eyesight due to her 20-year
history of poorly controlled diabetes mellitus type II. She is
5’3” tall and weights 200 pounds. She has smoked 2 packs per
day for 20 years. Because she is disabled, she is on a fixed
income and cannot afford a variety of foods. She is on
Glucophage 1 Gm bid, which she takes sporadically. She is
concerned about how she is going to get around after her leg is
amputated.
Workshop Two - Case Studies

WS 2 - Case Study I
A 56 year-old male is admitted with low back pain and a
herniated intervertebral disk. He is scheduled for a
laminectomy and diskectomy tomorrow under general
anesthesia. He has been taking Percocet and a muscle relaxer
for pain at home and they have not been controlling his pain,
which he rates at 8 out of 10. He has COPD and continues to
smoke 2 packs per day, which he has done for 25 years. He is
employed as a construction worker and is concerned he will not
be able to pay his bills while he is recuperating.
A 32 year-old male was referred to an orthopedic surgeon
because of right hip pain unrelated to exercise. An X-ray
revealed a bone tumor in the head of the femur and a biopsy
revealed a chondrosarcoma. A bone scan showed no metastatic
lesions. Surgery to remove the head of the femur and replace it
with a total hip arthroplasty is scheduled for tomorrow. The
patient has only had a week to comprehend that he has cancer
and is very frightened. He rates his pain as 7 out of 10 with
Percocet every 4 hours.
A 56 year-old divorced female is admitted for IV antibiotics for
an osteomyelitis of her right foot and pain control. She had
surgery for a bone spur one month ago and continued to have
pain. An MRI indicated osteomyelitis and a culture from the
bone confirmed the diagnosis. The patient is unable to bear
weight on the foot and unable to use crutches or a walker due to
shoulder problems. She has already lost her job as a retail clerk
because of the ongoing pain. She is worried about paying her
rent and other bills. She has adult children who live out-of-state
who cannot help her financially.

A 63 year-old male is admitted for right total knee arthroplasty
for degenerative joint disease. He has severe DJD in both knees
and eventually will need to have the other knee replaced as
well. However, his orthopedic surgeon has opted to do only one
during this admission due to the patient’s varicose veins in his
left leg. The patient also has DJD in his hands and is concerned
about being able to use a walker or cane post-op. The patient’s
wife has Alzheimer’s disease and he must care for her. Her
sister has come from out-of-state to care for her while he is
hospitalized, but she cannot stay for more than a month.
WS 2 - Case Study V
A 45 year-old female owner of a fabric store is admitted due to
thrombocytopenia. She has rheumatoid arthritis and was not
responding to NSAIDs. She consulted a rheumatologist who
started her on Penicillamine 2 weeks ago. She is admitted for
platelet transfusion when she was found to have a platelet count
of 18,000μL (150,000-400,000) during her follow-up visit with
the rheumatologist. Her WBC was also low at 3000μL (4500 –
10,000μL). She has no signs of symptoms at this time. She is
concerned about the staff at her store being able to keep things
going without her.
A 34 year-old single mother developed rheumatoid arthritis
after delivery of her second child. Her arthritis did not respond
to an adequate trial of NSAIDs and she has been on Prednisone
20 mg for the past month in order to have any quality of life and
care for her 3 year-old and 8 month-old children. She is
admitted for total joint replacement surgery on her right wrist,
which is her dominant hand. She has ulnar deviation on both
hands with synovitis of the MCP’s and PIP’s bilaterally. She is
concerned about how she will care for her children post-
operatively. Since she normally uses a cane in her right hand
due to the arthritis in her knees, she is also concerned about

being able to walk.
An 82 year-old woman fell at home and fractured her left hip.
She is placed in Buck’s traction. She is 5’2 inches tall and
weighs 100 pounds. She has a history of osteoporosis. You
notice that her skin is very thin and she has multiple small
bruises on her hands and forearms. Her left lateral hip area that
sustained the impact of the fall is quite ecchymotic and there is
a small skin tear in that area. She lives alone and has no family
nearby.
A 34 year-old male is admitted with bibasilar pneumonia. The
chest X-ray was consistent with Pneumocystis pneumonia. His
HIV antibody is positive and is confirmed with a positive
Western blot. His CD4 count is 180/mm3. The patient is
homosexual, but was unaware he had AIDS. He ended a short
relationship two months ago and has just started an intimate
relationship with another man. He is concerned that he has
infected his new partner.
Workshop Three - Case Studies
WS 3 - Case Study I
A 58 year-old woman was admitted with normal pressure
hydrocephalus for shunt placement, which was done earlier in
the day. She works as a banker and had been having increasing
difficulty with her memory and felt unsteady on her feet. She
has returned from recovery and is groggy. She complains of a
headache and pain in the incision site on her abdomen.
A 32 year-old male is admitted following an MVA during which

he sustained a closed head injury. As he is being admitted to
your ICU, he has a grand mal seizure. You are the only nurse in
the room and you must respond.
A 45 year-old woman with migraine headaches is admitted to
the medical floor. The purpose of the admission is to control her
pain while she is taken off all of her headache medicines:
Imitrex, Tegretol (used for prevention), metoprolol (used for
prevention), and all OTC products. Many of these drugs cause
rebound headaches, and her physician wants to see if
eliminating all her medications will decrease the frequency of
the headaches. She is currently getting headaches every day and
takes 1-2 doses of Imitrex per day. The patient is very
apprehensive about this as the pain is often 9 out of 10. For the
first 48 hours she will have a PCA pump with Demerol for pain
control. After that, the physician plans to control her pain with
Percocet. Her expected hospital stay is 2 weeks.
A 88 year-old male on Coumadin for atrial fibrillation and a
prosthetic mitral valve lost his balance and fell backwards
striking the back of his head. He sustained a small laceration
but the paramedics were able to control the bleeding. He arrives
in your ICU after being evaluated in the ER where the
laceration was sutured. He is confused and somnolent, but able
to move all extremities on command. Two hours later he is
incontinent of urine and unresponsive to even painful stimuli.
His family insists on full code status.
WS 3 - Case Study V
A 42 year-old woman is admitted with bacterial meningitis. She
has a fever of 102 and a headache. She has been vomiting for
several days and is dehydrated. She is admitted to ICU for
antibiotic treatment. Her level of consciousness has fluctuated
since she was admitted.

A 50 year-old nursing instructor became depressed. She
attributed it to menopause, but when she did not get better with
hormone replacement therapy, she was treated with an
antidepressant. No improvement in mood occurred. Six weeks
later she fell on campus and could not get up. Her right arm
and leg were weak. An MRI of her head revealed a brain tumor
near the cerebellum. Surgery was done to remove the tumor.
The biopsy done at that time revealed an astrocytoma. The
patient has two teen-agers, 13 and 15 years of age, and a
husband who has been a quadriplegic since an accident 15 years
ago. She has provided total care for her husband since the
accident. The patient’s prognosis is poor and she is not expected
to live more than a couple of months. She is currently in your
ICU immediately post-op craniotomy surgery.
A 78 year-old man is brought into the ER with new onset right-
side hemiplegia and expressive aphasia. His daughter stopped
by to visit her father and found him in bed, incontinent of urine
and stool. It was obvious he had been there for over 24 hours,
unable to help himself. He is admitted to the medical unit for a
work-up, physical, and speech therapy. He has a history of
hypertension and hypercholesterolemia. He is currently taking
Zestril 20mg qd and HCTZ 50 mg qd. His blood pressure is
162/100, his mucous membranes are dry, and his skin turgor is
poor. He is unable to move his right arm or right leg. He seems
to understand what you are saying, but cannot respond verbally.
He becomes very frustrated when he tries to talk.
A 68 year-old woman with a history of diabetes and
hypercholesterolemia is admitted for a right carotid
endarterectomy. She has a history of hypertension and is taking
atenolol 50mg qd and HCTZ 50 mg qd. She is also on

Glucophage 1Gm bid and Zocor 20mg q hs. Her right carotid
artery is 75% occluded and her left is 50% occluded. She is
concerned about being started on insulin post-operatively to
manage her blood sugars and is afraid she will not be able to
“get off of it” post-op.
Workshop Four - Case Studies
WS 4 - Case Study I
A 28 year-old male is admitted to the ER following a diving
accident at the lake. He has sustained a C3-4 spinal cord injury
but is breathing on his own. As he arrives in the ICU, his BP
drops, he becomes bradycardic and areflexic. His frantic parents
arrive in your ICU asking many questions. They want to know
the extent of his injuries and whether or not he will recover and
be normal.
A 78 year-old osteoporotic woman fell in her kitchen and
sustained a fracture of T10. The bone fragments are pressing on
her spinal cord and she has little sensation or mobility in her
legs. She is also incontinent of urine. She rates her pain at 9 out
of 10. She is a widow and lives alone. She is concerned about
ever being independent again. Surgery is planned for tomorrow
to remove the bone fragments and relieve pressure on her spine.
A 65 year-old woman is admitted with a fractured right hip
following a fall at home. She is generally healthy except she has
middle stage Alzheimer’s disease. She is being prepped for
ORIF of the hip and will return to the ortho floor post-op. Her
daughter with whom she lives feels terrible that the fall couldn’t
have been prevented and feels responsible. She tells you that
her mother gets very confused at night and often wanders.

A 43 year-old social worker with two children is admitted with
a fractured right femur following an MVA. Other than multiple
contusions, she is not seriously injured. She has a history of
MS and ranges from ambulating with a cane to being confined
to a wheelchair. Her left leg is placed in balanced suspension
traction, which her spasticity makes difficult. The orthopedic
surgeon plans to cast her in a few days when the swelling has
diminished. She rates her pain as 6/10, but she is extremely
fatigued. The stress of the accident has exacerbated her MS.
WS 4 - Case Study V
A 70 year-old male is admitted with sepsis due to a urinary tract
infection caused by BPH and his inability to empty his bladder.
He also has Parkinson’s disease and is currently taking
levodopa. The sepsis has caused him to be confused,
disoriented, and unable to care for himself. He has an
indwelling Foley catheter. A TURP is planned after the
infection clears.
A 74 year-old Asian woman is admitted for hiatal hernia
surgery. She is recovering well and tolerating a clear liquid
diet 48 hours post-op. She suddenly develops a headache,
nausea, vomiting, and pain in her right eye. She has a history of
glaucoma and has been without her eye drops for several days.
Acute angle-closure glaucoma is diagnosed and the patient
scheduled for an emergency laser trabeculoplasty.
A 72 year-old woman is admitted with a fractured left humerus
sustained in a fall that was caused by an acute attack of vertigo.
The patient became very dizzy, fell, and began to vomit. The
fall caused a fracture in the surgical neck of her humerus. The
patient tried to get up off the floor, but could not due to any

body movement causing dizziness. Her husband summoned the
paramedics who brought her to the ER. After being admitted to
the medical unit, she is placed in skeletal traction. She was
given meclizine 50 mg IM for the vertigo while in the ER which
has made her very sleepy.
A 42 year-old female is admitted to the ICU in the acute stage
of Guillain-Barré syndrome following a viral illness. The
disease had progressed up both legs at this time, and she is very
frightened.
Workshop Five - Case Studies
WS 5 - Case Study I
An 88 year-old woman is admitted from a nursing home with a
fractured hip and is placed in Buck’s traction. She weighs 100
pounds and is 5’3” tall. During your initial assessment you note
that her mucous membranes are dry and her skin turgor is poor.
Psoriasis is active on her elbows, knees, and buttocks. You also
discover a stage I decubitus over the sacrum and stage III ulcers
on both heels. She has a history of hypertension, diabetes, and
psoriasis. Her blood pressure is 100/60, pulse 92, temp 99. She
takes HCTZ 50 mg qd and methotrexate 2.5mg, one tablet
weekly for her psoriasis. She must remain on bedrest in
traction for several days until she can be rehydrated and readied
for surgery.
A 22 year-old male is admitted to the burn unit with second-
degree burns over 60% of his body. His house caught fire while
he and his family were sleeping. Everyone got out safely, but he
was badly injured when he returned to the house to retrieve his
dog. He was unable to find his pet. He suffered smoke

inhalation and is in mild respiratory distress as he arrives.
A 35 year-old male is admitted for wide excision of a malignant
melanoma on his upper back. Two days post-operatively, the
patient complained of severe right knee pain that began
suddenly. When you assessed the knee, it was red, quite warm,
swollen, and the skin had a reddish purple tint (violaceous).
The physician was notified and examined the patient. Acute
gout was diagnosed and the patient was started on IV steroids
since he remained nauseated and was not tolerating PO fluids
well. Demerol was prescribed for pain.
A 32 year-old male is admitted for dehydration. He has AIDS
and his CD4 count is 100/mm3. He has multiple opportunistic
infections; Kaposi’s sarcoma on his arms, legs, and trunk,
severe tinea cruris in the groin, axilla, intertrial fold of the
buttocks and perirectally, and severe oral thrush. His thrush is
so severe that he has not been able to eat or tolerate fluids for
several days. He has little weight to lose weighing in at 130
pounds at 6’2”. He knows he is going to die and is frightened.
His partner of 10 years stays with him night and day.
The Clinical Conference will take place in CourseCompass.
Within CourseCompass go to the Control Panel ( Discussion
Board. Students will access Clinical Conferencing by clicking
on the Discussion Board link on the left hand side of the
CourseCompass page.
To set up a conference, click on the “Add Forum” button. Title
this “Clinical Conference One” and copy and paste the

following description:
The weekly clinical conference will take place as an
asynchronous chat within CourseCompass as part of this course.
You will be expected to respond to questions posted by your
faculty and to your fellow learner’s responses. Clinical
Conferencing will take two hours of your time each week.
Click “Submit” and then “OK” on the screen that follows. This
will take you back to the Discussion page. Repeat the above
process, setting up Clinical Conferences Two, Three, etc. To
comment on the particular conference, the students will click on
what you have just created and add their comment.
In-Class Group Case Study Form
Nursing dx:
Nursing dx:
Short-term goal:
Measurable outcome:
Short-term goal:
Measurable outcome:
Interventions*
Rationales*

Interventions
Rationales
1.
1.
1.
1.
2.
2.
2.
2.
3.
3.
3.
3.
4.
4.
4.
4.
Opportunities for teaching (prevention, health maintenance, etc.
*Four interventions with rationale for each
Assessment
Therapeutic intervention
Education
Referral
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Curriculum Evaluation PowerPoint Rubric
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NUR 215Nursing Management of the Medical-Surgical Client I.docx

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