The document provides a clinical teaching plan for medical-surgical nursing practicum. It includes: - An introduction outlining the philosophy, objectives, and responsibilities of students and instructors. - A description of the 5-day clinical attachment focusing on general and specific learning objectives. - An evaluation plan and outline of student competencies expected at entry, intermediate, and terminal stages. - A calendar of daily activities and focus of learning during the attachment period. - Sample assessment forms for physical assessment and Gordon's Functional Health Patterns.

1. BY:
Habtemariam Mulugeta
College of Medicine and Health Sciences
School of Nursing & Midwifery
Department of Adult Health Nursing
Advanced Nursing Education & Curriculum Development
CLINICAL TEACHING PLAN
Preparedby:
Name: Habtemariam Mulugeta Abate
ID No: SRSG/398/12
DESSIE, ETHIOPIA
DECEMBER, 2020

2. I
ACKNOWLEDGEMENT
First, I would like to express my heartfelt gratitude to WU CMHS for giving me this chance
to enhance my knowledge and skill.
Secondly, I would like to thank my instructor Dr. Caridad Sanchez Olis for sharing me his
deep knowledge, experience and expertise.
Last but not least I would like to thank my family and friends in helping me in ideas and
material during my entire work.

3. 1
Clinical Teaching Plan
Course Code: ___________
Program: post basic Nursing
Degree program: BSc in Nursing
Course Title: Medical - Surgical Nursing Practicum
ETCTS: ______________
Attachment period: 5 days
1. Philosophy of the Program
1.1 respect for the equality, dignity and singularity of self and others as a divine, biological,
psychological, social, economic, cultural and cultural
1.2 Ensure that the people, families and communities receive healthy, skilled and proven health
services by encouraging, sustaining and restoring health; prevent disease while maintaining
physical, emotional and spiritual support throughout their lives.
1.3 Incorporate nursing research into the nursing profession through good practices in the
provision of treatment to people over the whole of life
1.4 As a pupil, clinician, and leader, recognize responsibility and accountability for the efficacy
and development of one's own nursing practice.
1.5 Skilled nursing competently in different fields, using cautious and critical thinking and
treatment of culturally diverse people, families and communities at all stages of growth
1.6 Using the care process to determine, diagnose, prepare, administer and evaluate the care
given to diverse culturally diverse people, families and communities.
1.7 Incorporating and communicating effectively in relationships with cultures, families,
societies and others in realistic decisions that encompass beliefs, ethical, moral, and legal
dimensions in the field of nursing.

4. 2
We considerethicalbehavior
 Students care for the patients trust the hospital
 Includes effective and productive use of intellectual and material human capital.
 Quality healthcare provides students to promote optimal results for patients.
We certainof that Competence
 Enable us caregivers to provide outstanding treatment for patients.
 Serve as an opportunity for continuous treatment of quality
 Need us to be both a professor and a student.
 Changes from beginner to expert as we ride.
We have confidence in that Caring
 Is conveyed by the language of our patients
 Ensure we all recognize individual differences with respect.
 Please reassure us that superior care is possible, though treatment is not always possible.
 Let us develop relationships to nurture patients, their families, our associates and our
communities.
Students' responsibility in the clinical environment
 Accept the hospital laws and rules
 To be timely for the instructors' time
 The teacher is told of no absence from clinical practice even though he has any personal
problems
 The clinical practice with all resources required for this clinical practice
 Each procedure to see and do in the ward should be active in the clinical field.
 Be ethical, caring for the patient, compassionate
 Peaceful ties with each employee
 You need to wear the GOUN

5. 3
Instructors' duty in the clinical environment
 Provide and support the student in the process with quality patient/client care;
 Focusing on clinical students;
 Improving and strengthening clinical knowledge and skills of students;
 Assist students to reach their learning goals and needs; define learning needs for each
prescribe and topics for further education;
 Contribute to the management skills of students and priority care;
 Encourage students to think critically and solve problems;
 evaluating the performance of students and clinical skills;
 Help socialize students in their professional environment;
 The students' level of clinical skill, knowledge and professionalism related to their level
of experience and knowledge can be assessed and provided with constructive feedback;
 Fosters the active participation of the student in all practices.
 Contact the hospital authority responsible for allowing students to accept
 Allocate every war to the students
Prerequisite: Human Anatomy, Human Physiology, Pharmacology for nurses, Fundamental
of Nursing and Fundamental of Nursing Practicum. And also, the students’ minimum grade is
(C) and the students attained all course that including in the curriculum and also the students
registered completely as well as having all lists in the roaster. Level of the student’s second
year post basic surgical nursing
2. Descriptionof Clinical Practice
Clinical practice is how students change theory to practice and to gain more know-how on the
aspect of the clinical field. It is also useful for students to know how to approach the patient and
take patient history, diagnosis, planning, intervention assessment as well as patient medical and
patient family history.

6. 4
In general, clinical practice assists students to learn evaluation, surveillance, assessment;
intervening in patients and the medical and surgical disorders of patients and providing patients
with quality care.
3. GeneralObjective
At the end of the clinical attachment the students will be able to: Understand the general practice
of clinical care within five days of practice
4. Specific Object
 Identification of the role of care in patient care
 Demonstrate practical theoretical knowledge
 Assume responsibility for one's own learning needs and the effectiveness of one's nursing
practice
 Demonstrate autonomy and accountability for the health care provided to patients and
families at the level of practice.
 Identify the nursing, nursing, monitoring and assessment system
5. Evaluation criteria
 Personality and attitude to the profession
 Performance in clinic
 Skills in health care
 Expertise in the art of nursing
Student’s Competencies
A. Entry Competencies
 Students are expected to start with the clinical exposure:
 Show better communication skills with employees
 Synthesized concept on anatomical physiological and chirurgical physiology foundations

7. 5
 Assess the effects and uses of common drugs.
 Exhibit the ability to perform basic care procedures
 Know the hospital rules and rules
 Exposure to the environment and ward
 Know the materials required for nursing, such as documentation format, equipment, etc.
 Students were assigned and guided by the general hospital situation
B. Intermediate Competencies
Within 5 days exposure to surgical ward the students will be able to:
1. Utilize nursing process (NANDA, GORDON, SOAPIE, ADPIE, FDAR)
 Formulate plans for health care
 Encourage security and comfort for ward patients
 Integrate surgical patient pharmacology
 Integrate health education into and out of patients
 Identification of diagnostic procedures and the current state of health
 The patient made bed
 history of implementation by golden functional approach from the patient
 Administering the patient's medication
2. Management of Resources
a. Organize workloads to make patient care more efficient.
b. Use adequate and available resources to help patients achieve results
c. Keep the patient environment safe and comfortable
3. Health Education
 Implements appropriate health education/teaching activities to client and family
 Document all rendered care to patients

8. 6
4. Ethics & Moral
 respect the rights of the patient
 Ensures privacy and confidentiality
5. Legal Responsibility
 document care rendered to patient
 adhere to practices related to informed consent and waiver for treatment refusal
6. Personal and Professional Development
 Projects a professional image as surgical ward nurse or clinical nurse
 perform functions according to international and local standards
7. Quality Improvement
 Participates in quality improvement activities such as
 infection control
 proper documentation
 risk management
 preventive measures for the identified health problems
8. Research
 share related research findings from journal to actual patient care
 update oneself with the latest trends and development in the care of surgical clients
 share fundamental nursing skill manual for the students and utilized it
9. Record Management
 document accurately relevant date gathered from the client on assessment & treatment
 . maintain accurate recordings and documentation of patient care

9. 7
 provide safe storage
10. Communication
C. Terminal Competencies
 Obtained a variety of ideas with the necessary learning experiences regarding the assigned
unit.
 Able to execute how to function as a nurse (professionalization) in a clinical context
including:
• Obtaining the necessary level of responsibility and commitment to patient care
• Developing a compassionate approach to patient care
• Working effectively in a health care team
• Obtaining nursing care, procedure, and communication skills
 Able to develop a successful approach to solving patient-based problems.
 Able to acquire Knowledge, Skills, and Attitudes in the evaluation and management of the
following (but not limited to) Core Problems in Nursing Practice such as: abdominal pain,
chest pain, dyspnea, cough, dysuria, joint pain, back pain, weight loss, altered mental status,
anemia, fluids/electrolytes/acid-base disorders, congestive heart failure, COPD, depression,
diabetes/obesity, dyslipidemia, hypertension, renal failure, thyroid/parathyroid disease,
claudicating/PVD, venous thromboembolism, common cancers, preventive care, smoking
cessation, substance abuse, etc.
 Generally mastering the nursing practical skill in the ward and fully adapted the nursing
procedure.

10. 8
Calendarof Activities (5 days)
DATELINE FOCUS OF LEARNING TEACHING, LEARNING
ACTIVITIES
Day 1
 Exposure the hospital environment
 Orientation about rule and regulation of the hospital
protocol
 Assign to each ward rooms
 Communicate the students with nursing staff
 description of the study program and the total schedule
date with each activity
 philosophy of the study program
 Review on the needed requirements and submission
date
 Observation of the necessary nursing document
format, and equipment
 Holding the necessary equipment for practice
 Discusses the hospital protocol with the hospital
nursing staff
 Observation each hospital patient follow protocol
 Know the patient numbers
per beds and divided by
number of students
 Communicate the students
with the patients their
responsibility in the wards
Day 2  continue patient care
 Start bed making
 Observe the patients what do by the doctors and by the
staff nursing during round
 Observe the medication administration, route, dose,
frequency, dilution etc. is done by the staff nurse
 Observe advanced procedure like enema care,
catheterization, suturing wound, suctioning, iv line secure,
 Moring rounds
 Start to show any nursing
procedure to the students
 Show the students how to take
physical assessment and
history taking by eleven
Gordon’s Functional Health
Pattern and medical history of

11. 9
CPR, oxygen administration, Nasogastric tube insertion,
lavage, gavage etc.
 Start to give oral care, position the patient, wound care,
foot care perineal care, frequently change the position of
the patient, ambulating patients, bathing, performing back
care performing hair washing and care for fingernails/
toenails etc.
 Start physical assessment head to toes by structural
approach, take history by eleven Gordon’s Functional
Health Pattern and medical history of the patient
 Start to interpret the laboratory investigation and report to
the physicians
 Observe fluid administration protocol is done by the staff
nurse
 Start to take vital sign, documents every activity in
registration format.
patient
Day 3  continue patient care
 Bed side presentation
 Drug administration
 Care for Nasal-gastric Tube by removing or insertion
 Administering Nasal-Gastric tube feeding
 Cleaning a wound and Applying a sterile dressing
 Supplying oxygen inhalation by nasal cannula method and
mask method: simple facemask
 enema care, catheterization, suturing wound, suctioning, iv
line secure
 full filling discharge form of patient, give per operative
 Drug administration,
laboratory result interpretation,
informed consent, discharge
plan fulfilling
 Iv line secure, oxygen
administration and other
advanced procedure
 Bed side teaching

12. 10
care for patient by counseling the patient, the patient’s
family and carry out the informed consent
 Suctioning the patient by Suctioning machine if
unconscious and have any secretion
 Bed side health education for the patients
 Bed side presentation
Day 4  continue patient care
 can perform administration of medication by all routes
according to doctor order
 Perform catheterization, gastric lavage, gavage
 Enema care, CPR and other advanced nursing procedure
 Pulse oximetry, ABG analysis, RBS testing etc.
 Take patient history in the form of structural approach,
eleven Gordon’s Functional Health Pattern and medical
history of the patient without assist other staff worker
nurses
 explanation of pharmacologic
interventions appropriate
dosage and route of
administration, mechanism of
action, contraindication and
nursing interventions
 Review KSA if performing
such procedures
 Indication of medication
administration, medication
adverse effect reporting system
 Administration of fluid
protocol
 instructor side question.
 Asses the skill performance of
the students on real patient at
bed side.
Day 5  Continue bedside care
 carry out advanced procedures
 nursing rounds
 present nursing care plan
 Present case seminar
 Submitting the nursing care
plan and case presentation
 Complete evaluation of bed

13. 11
 Mastering the most important nursing advanced
procedures
 Developing effective nursing skill procedures
side nursing care

14. 12
WOLLO UNIVERSITY
College of Comprehensive Nursing
SURGICAL WARD PHYSICAL ASSESSMENT
I. DEMOGRAPHIC DATA
i. Patient’s Name:_________________________________________________________
ii. Date & Time of Admission: _____________Sex: _________
iii. Name of primary information source:_______________________________
iv. Admitting medicaldiagnosis: ______________________________________
II. CHIEF COMPLAINTS (Specific reasons why the client consults/ admitted)
III. HISTORY OF PRESENT ILLNESS
a. Onset (When did the symptoms begin?)___________________________________________
b. Location (Where are the symptoms?)_____________________________________________
c. Duration (How long do the symptoms last?)________________________________________
d. Characteristics (Describe the characteristics of the symptom)__________________________
e. Aggravating and Alleviating Factors (What affects the symptoms?)______________________
f. Related symptoms (What other symptoms are present?)______________________________
g. Treatment (Describe self-treatment/prescribed tried before seeking care)________________
h. Severity (Describe the severity of the symptom)_____________________________________
IV. FAMILY HISTORY (Genogram)

15. 13
VITAL SIGNS
Vital Signs Actual Normal Values Significance
Pulse
Rate:
Quality:
Respiration
Rate:
Quality:
Temperature
Centigrade:
Site:
Blood Pressure
Systolic:
Diastolic:
Site:
Height:
Weight:
NOTE: (The questions below are referring for the patient’s condition.)
Immunization history:
BCG ____________________
DPT (3 doses) _____________
HEPA B (3 doses) __________
OPV (3doses) _____________
AMV ____________________
Specify if incomplete ___________
Where do you submit the patient for check –up? Private Clinic: ___ Government Clinic____
Traditional Healer: ___ Government Hospital___ Private Hospital___ Traditional healer____

16. 14

17. 15
Gordon’s Functional Health Patterns Assessment(Adult)
1. Health PerceptionHealth ManagementPattern
1 History
a. How has general health been?
b. Any colds in past year? When appropriate: absences from work?
c. Most important things you do to keep healthy? Think these things make a difference to health?
(Include family folk remedies when appropriate.) Use of cigarettes, alcohol, drugs? Breast self-
examination?
d. Accidents (home, work, driving)?
e. In past, been easy to find ways to follow suggestions from physicians or nurses?
f. When appropriate: what do you think caused this ill- ness? Actions taken when symptoms
perceived? Results of action?
g. When appropriate: things important to you in your health care? How can we be most helpful?
2. Examination—general health appearance
2. NUTRITIONAL-METABOLIC PATTERN
1. History
a. Typical daily food intake? (Describe.) Supplements (vitamins, type of snacks)?
b. Typical daily fluid intake? (Describe.)
c. Weight loss or gain? (Amount) Height loss or gain? (Amount)
d. Appetite?
e. Food or eating: Discomfort? Swallowing? Diet restrictions?
f. Heal well or poorly?
g. Skin problems: Lesions? Dryness?
h. Dental problems?
2. Examination
a. Skin: Bony prominences? Lesions? Color changes? Moistness?
b. Oral mucous membranes: Color? Moistness? Lesions?

18. 16
c. Teeth: General appearance and alignment? Dentures? Cavities? Missing teeth?
d. Actual weight, height. e. Temperature.
f. Intravenous feeding–parenteral feeding (specify)?
3. ELIMINATION PATTERN
1. History
a. Bowel elimination pattern? (Describe) Frequency? Character? Discomfort? Problem in
control? Laxatives?
b. Urinary elimination pattern? (Describe.) Frequency? Problem in control?
c. Excessive perspiration? Odor problems?
d. Body cavity drainage, suction, and so on? (Specify.)
2. Examination—when indicated: examine excreta or drain- age color and consistency.
4. ACTIVITY-EXERCISES PATTERNS
1. History
a. Sufficient energy for desired or required activities?
b. Exercise pattern? Type? Regularity?
c. Spare-time (leisure) activities? Child: play activities?
d. Perceived ability (code for level) for:
Feeding_________________________
Dressing_________________________
___
Cooking_______________
Bathing_________________________ Grooming________________________
___
Shopping_______________
Toileting________________________ General
mobility______________________
Bed
mobility________________
Home maintenance __________________

19. 17
FunctionalLevel Codes: Level 0: full self-care
• Level I: requires use of equipment or device
• Level II: requires assistance or supervision from another person
• Level III: requires assistance or supervision from another person and equipment or device
• Level IV: is dependent and does not participate
2. Examination
a. Demonstrated ability (code listed
above) for:
Feeding________________________
_
Dressing_______________________
_
Cooking___________________
____
Bathing________________________
_
Grooming______________________
__
Shopping__________________
___
Toileting________________________ General mobility___________________
b. Gait_____________________________ Posture__________________________ Absent body part? _______
(Specify)_________________________
c. Range of motion (joints) ___________________ Muscle____________________
Firmness_________________
d. Hand grip ___________________________ Can pick up a pencil?
________________________
e. Pulse (rate) _______________________ (rhythm) ______________________ Breath sounds
___________________
f. Respirations (rate) __________________ (rhythm) ______________________ Breath sounds
____________________
g. Blood pressure ______________________
h. General appearance (grooming, hygiene, and energy level)

20. 18
5. SLEEP-RESTSPATTERN
1. History
a. Generally rested and ready for daily activities after sleep?
b. Sleep onset problems? Aids? Dreams (nightmares)? Early awakening?
c. Rest-relaxation periods?
2. Examination
a. When appropriate: Observe sleep pattern.
6. COGNITIVE-PERCEPTUALPATTERN
1. History
a. Hearing difficulty? Hearing aid?
b. Vision? Wear glasses? Last checked? When last changed?
c. Any change in memory lately?
d. Important decision easy or difficult to make?
e. Easiest way for you to learn things? Any difficulty?
f. Any discomfort? Pain? When appropriate: How do you manage it?
2. Examination
a. Orientation.
b. Hears whisper?
c. Reads newsprint?
d. Grasps ideas and questions (abstract, concrete)?
e. Language spoken.
f. Vocabulary level. Attention span
7. SELF-PERCEPTION—SELF-CONCEPT PATTERN
1. History
a. How describes self? Most of the time, feel good (not so good) about self?
b. Changes in body or things you can’t do? Problem to you?

21. 19
c. Changes in way you feel about self or body (since ill- ness started)?
d. Things frequently make you angry? Annoyed? Fearful? Anxious?
e. Ever feel you lose hope?
2. Examination
a. Eye contact. Attention span (distraction)
b. Voice and speech pattern. Body posture
c. Nervous (5) or relaxed (1); rate from 1 to 5.
d. Assertive (5) or passive (1); rate from 1 to 5.
8. ROLES-RELATIONSHIPSPATTERN
1. History
a. Live alone? Family? Family structure (diagram)?
b. Any family problems you have difficulty handling (nu- clear or extended)?
c. Family or others depend on you for things? How managing?
d. When appropriate: How family or others feel about ill- ness or hospitalization?
e. When appropriate: Problems with children? Difficulty handling?
f. Belong to social groups? Close friends? Feel lonely (frequency)?
g. Things generally go well at work? (School?)
h. When appropriate: Income sufficient for needs?
i. Feel part of (or isolated in) neighborhood where living?
2. Examination
a. Interaction with family member(s) or others (if present).
9. SEXUALITY-REPRODUCTIVE PATTERN
1. History
a. When appropriate to age and situations: Sexual relationships satisfying? Changes? Problems?
b. When appropriate: Use of contraceptives? Problems?

22. 20
c. Female: When menstruation started? Last menstrual period? Menstrual problems? Para?
Gravida?
2. Examination
a. None unless problem identified or pelvic examination is part of full physical assessment.
10. COPING-STRESSTOLERANCEPATTERN
1. History
a. Any big changes in your life in the last year or two? Crisis?
b. Who’s most helpful in talking things over? Available to you now?
c. Tense or relaxed most of the time? When tense, what helps?
d. Use any medicines, drugs, alcohol?
e. When (if) have big problems (any problems) in your life, how do you handle them?
f. Most of the time is this (are these) way(s) successful?
2. Examination: None.
11. VALUES-BELIEFS PATTERN
1. History
a. Generally get things you want from life? Important plans for the future?
b. Religion important in life? When appropriate: Does this help when difficulties arise?
c. When appropriate: Will being here interfere with any religious practices?
2. Examination: None.
3. Other concerns
a. Any other things we haven’t talked about that you would like to mention?
b. Any questions?

23. 21
Discharge Plan
GeneralObjectives:
Specific Objectives:(at least3 objectives)
1.
2.
3.
X1. Medications:
Name of Drugs Dosage, Route &
Frequency
Indication Side Effects General
Considerations
Environment: (determine and instruct the environment in which the patient ideally be placed)
Treatments:(mention treatments specific to disease. Condition, where and when it be done)

24. 22
Health teachings (at least 5; be specific and must relate with the case)
Observable Signs and Symptoms: (Alerted S. O’s ofpossible signs/symptoms ofinfection)
Diet: (Enumerate diet specific to client disease condition; ifpossible, make diet plan for DM
patients)
Spirituality:
Prepared and submitted by: _________________________ ID Number_________ Date____________
(Student Name)
10 Student Evaluation form (adopted by WOU as mandate in the Harmonized curriculum)
11 PROCEDURE CHECKLISTS (any procedure to be demonstrated by the MSc for
facilitating skills to the under graduate). The succeeding skills will be done by the undergraduate
with the supervision of MSc (CI).
A. Routine nursing procedures.
Criteria Dat
e
C
I
si
g
Dat
e
C
I
si
g
Dat
e
C
I
si
g
Dat
e
C
I
si
g
Dat
e
C
I
si
g
Dat
e
C
I
si
g
Dat
e
C
I
si
g
Dat
e
C I sig
1. Vital signs
2. bed making
3. Patient assessment

25. 23
& appropriate
nursing interventions
4. Medication
administration
5. Promotion of
comfort & relaxation
6. Skin testing
7.Wound cleansing &
dressing
8.Chest tapping
/cupping
B. ADVANCED NURSING PROCEDURES
1.Enema
2. Catheterization
3.Preoperative
4.Postoperative
5. Nasogastric tube
insertion-feeding or
gavage
6. Oxygen
administration &
regulation
7. Setting/giving IV
infusion
8. Blood transfusion
9. intake/output

26. 24
computation &
recording
10. Specimen
collection
11. Catheter insertion
12. gastric
washing/lavage
13. Ambulating post
op clients
14. Bleeding control
(blood transfusion)
15. Pain Management
16. colostomy care
17. Activity and
exercise (airway
clearance, breathing
exercises, O2
inhalation
18. Care of the dying
19. OR technique and
principle, etc.
20. Care plans/s
indicating nursing
assessment,
diagnosis, planned
action, scientific

27. 25
basis, nursing
interventions and
evaluative measures
21. Health teaching
to the patients and
significant others in
terms of infection
prevention, follow-
up, medication
compliance, lifestyle
and dietary or
nutritional
modification.
22. Bedside
conference-with
presenting objectives,
chief complaints,
laboratory, &
significance to dse
process, treatment,
medication & nursing
management
Every procedure/’s done ask the instructor’s /staff’s signature.
One day delay without signature, the procedure/s is /are subject for NO mark/s, or
confiscation.
NO Instructor, /staff signature NO Mark/s given.
12 Physical assessment format (follow the Hospital form Gordon’s Functional Health
Pattern)

28. 26
13 Grading criteria (must use this as adopted in the curriculum) See below:
INSTRUCTOR FOLLOW–UP SHEET FOR SYUDENTS DURING PRACTICAL
ATTACHMENT
St. Name______________________________ ID_________ Class__ Year: __ Sem: __
Clinical teacher/mentor: _______________________
Site of attachment: ___________________________ Ward/Unit: _________
Clinical practice period from __________________________________
Criteria of evaluation day1 day2 day3 day4 day5
1. Professional Ethical Aspects (10%)
 Punctuality and attendance (3%)
 professional appearance (3.5%)
 professional discipline (3.5%)
2. Daily dairy report (15%)
 Readiness to present (3%)
 Completeness of report (3%)
 Explaining current patient condition
(3%)
 Develops a brief plan for each
assigned patient (3%)
 Completeness of patient daily progress
note (3%)
3. Ward Management (25%)
 Readiness to manage cleanliness of
ward and bedside
(5%)
 Communicates and work well with
colleagues and or team members

29. 27
(5%)
 Reports changes in patient status and
abnormal findings to the instructor
and assigned staff member
 (2%)
 Documents assessment findings,
interventions, skills, medication
administration and progress towards
patient outcomes according to agency
protocol (3%)
 Participates in admissions, transfers,
and discharges
(3%)
 Creating safety and maintaining
comfort (3%)
 Staff feedback (4%)
4. Bedside case discussion (15%)
 Pretest (3%)
 Participation (3%)
 prior preparation (3%)
 Actual patient assessment (3%)
 Benefit of patient/value added (3%)
5. Seminar Case presentation (15%)
 Pretest (3%)
 Organization of content (3%)
 Individual participation (3%)
 Utilization of reference (5%)
 Ability to accept feedback (1%)
6. Nursing Care plan (20%)
 Detailed assessment (10%)
 Collects relevant data for nursing
assessment (4%)

30. 28
 Identifies health needs and risk
factors of the clients and families
(4%)
 Interpret data accurately (2%)
 Proper nursing diagnosis (2%)
o Appropriate actual Nursing Diagnosis
(1%)
o Appropriate Potential nursing
diagnosis (1%)
 Clear and realistic planning (2%)
o Patient centered planning
(1%)
o Planning independent and
collaborative patient problem
(1%)
 Implementation
(4%)
 Evaluation with available resource
(2%)
Total (100%)
 NB: form I and form II should be submitted simultaneously to clinical coordinator
immediately with in the 1st week after completion of the supervision.
General comments about the student:
______________________________________________________________________________
______________________________________________________________________________
___________________________________________________
Student Name ___________________________________ ID no. _____________

31. 29
SEMINAR FORMAT PLAN
Case Conn’s syndrome
No Types of content Explanation
1 Introduction Conn’s syndrome Conn’s Syndrome also known as primary hyperaldosteronism
refers to the excess production of the hormone aldosterone from
the adrenal glands, resulting in low renin levels. This
abnormality is caused by hyperplasia or tumors. Many suffer
from fatigue, potassium deficiency and high blood pressure
which may cause poor vision, confusion or headaches.
Symptoms may also include: muscular aches and weakness,
muscle spasms, low back and flank pain from the kidneys,
trembling, tingling sensations, numbness and excessive
urination. Complications include cardiovascular disease such as
stroke, myocardial infarction, kidney failure and abnormal heart
rhythms.
2 Review of Anatomy & Physiology  The adrenal glands are located on both sides of
the body in the retroperitoneum, above and
slightly medial to the kidneys.
 In humans, the right adrenal gland is pyramidal
in shape, whereas the left is semilunar or crescent
shaped and somewhat larger.
 The adrenal glands measure approximately 3 cm
in width, 5.0 cm in length, and up to 1.0 cm in
thickness.
 Their combined weight in an adult human range
from 7 to 10 grams. The glands are yellowish in

32. 30
color.
 The adrenal glands are surrounded by a fatty
capsule and lie within the renal fascia, which also
surrounds the kidneys. A weak septum (wall) of
connective tissue separates the glands from the
kidneys.
 The adrenal glands are directly below the
diaphragm, and are attached to the crura of the
diaphragm by the renal fascia. Each adrenal gland
has two distinct parts, each with a unique
function, the outer adrenal cortex and the inner
medulla, both of which produce hormones.
 The adrenal cortex produces three main types of
steroid hormones: mineralocorticoids,
glucocorticoids, and androgens.
Mineralocorticoids (such as aldosterone)
produced in the zona glomerulosa help in the
regulation of blood pressure and electrolyte
balance.
 The glucocorticoids cortisol and cortisone are
synthesized in the zona fasciculata; their
functions include the regulation of metabolism
and immune system suppression. The innermost
layer of the cortex, the zona reticularis, produces
androgens that are converted to fully functional
sex hormones in the gonads and other target
organs.
 The production of steroid hormones is called

33. 31
steroidogenesis, and involves a number of
reactions and processes that take place in cortical
cells. The medulla produces the catecholamines,
which function to produce a rapid response
throughout the body in stress situations.

34. 32
3 Definition Conn’s syndrome Conn’s Syndrome is a disease of the adrenal glands that involves
an excessive production of aldosterone.
4 Specialty Endocrinology
5 Epidemiology 10% of people with high blood pressure, about 33% of cases are
due to an adrenal adenoma that produces aldosterone, and 66%
of cases are due to an enlargement of both adrenal glands.
6 Cause Enlargement of both adrenal glands, adrenal adenoma, adrenal
cancer, familial hyperaldosteronism
7 Pathophysiology hyperaldosteronism causes hypernatremia, hypokalemia, and
metabolic alkalosis. Primary hyperaldosteronism is caused by
aldosterone-producing adenomas, bilateral idiopathic adrenal
hyperplasia, aldosterone-producing adrenal carcinoma, and
familial aldosteronism. The increased amount of aldosterone
potentiates renal sodium reabsorption and water retention, and
potassium excretion. The increased sodium reabsorption by the
kidneys results in plasma volume expansion which is the

35. 33
primary initiating mechanism for hypertension. This may induce
tissue inflammation and heightened sympathetic drive, with
subsequent development of fibrosis in vital organs, such as
heart, kidneys, and vasculature. As a result, this may lead to the
development of chronic kidney disease, atrial fibrillation, stroke,
ischemic heart disease, and congestive heart failure. Besides the
elevation in sodium, patients often develop hypokalemia and
metabolic alkalosis. Nearly 1/5th of patients with Conn
syndrome have impairment in glucose tolerance which is due to
the inhibitory effects of hypokalemia on insulin secretion.
8 Signs /symptoms High blood pressure, poor vision, headaches, muscular
weakness, muscle spasms
9 Usual onset 30 to 50 years old

36. 34
10 Diagnosis  Blood test for aldosterone-to-renin ratio used for case
detection
 X-rays, CT scans, and an MRI to confirm the presence of
tumors
11 Differential Diagnosis Hypertension, Metabolic alkalosis, Renal artery stenosis,
Malignant hypertension, Preeclampsia, Licorice intake,
Gitelman syndrome, Barter syndrome, Adrenal carcinoma
12 Complication Stroke, myocardial infarction, kidney failure, abnormal heart
rhythms
13 Medical Management  Spironolactone: Drug information
 Dosing: Adult To reduce delay in onset of effect,
a loading dose of 2 or 3 times the daily dose may
be administered on the first day of therapy.
 Edema: Oral: 25-200 mg/day in 1-2 divided
doses
 Hypokalemia: Oral: 25-100 mg daily
 Hypertension (JNC 7): Oral: 25-50 mg/day in 1-2
divided doses
 Diagnosis of primary aldosteronism: Oral: Long
test: 400 mg daily for 3-4 weeks; short test: 400
mg daily for 4 days; maintenance until surgical
correction: 100-400 mg/day in 1-2 divided doses
 Heart failure, severe (NYHA class III-IV; with
ACE inhibitor and a loop diuretic ± digoxin):
12.5-25 mg/day; maximum daily dose: 50 mg. If
25 mg once daily not tolerated, reduce to 25 mg
every other day was the lowest maintenance dose
possible.

37. 35
 Note: If potassium >5 mEq/L or serum creatinine
>4 mg/dL, discontinue or interrupt therapy.
 Acne in women (unlabeled use): Oral: 25-200 mg
once daily
 Hirsutism in women (unlabeled use): Oral: 50-
200 mg/day in 1-2 divided doses (Koulouri,
2008; Martin, 2008)
 Eplerenone: Drug information
 Dosing: Adult
 Hypertension: Oral: Initial: 50 mg once daily;
may increase to 50 mg twice daily if response is
not adequate; may take up to 4 weeks for full
therapeutic response. Doses >100 mg/day are
associated with increased risk of hyperkalemia
and no greater therapeutic effect.
 Dose modification during concurrent use with
moderate CYP3A4 inhibitors: Initial: 25 mg once
daily
 Heart failure (post-MI): Oral: Initial: 25 mg once
daily; dosage goal: Titrate to 50 mg once daily
within 4 weeks, as tolerated
 Dosage adjustment per serum potassium
concentrations for HF (post-MI): <5 mEq/L:
 Increase dose from 25 mg every other day to 25
mg daily or
 Increase dose from 25 mg daily to 50 mg daily
 5-5.4 mEq/L: No adjustment needed
 5.5-5.9 mEq/L:

38. 36
 Decrease dose from 50 mg daily to 25 mg daily
or
 Decrease dose from 25 mg daily to 25 mg every
other day or
 Modify dose from 25 mg every other day to
withhold medication
 ≥6 mEq/L: Withhold medication until potassium
<5.5 mEq/L, then restart at 25 mg every other
day
14 Nursing Management Health Education about Low Salt Diet
15 Surgical management Laparoscopic surgical removal (adrenalectomy) may be curative
16 Prognosis Conn syndrome is associated with high morbidity and mortality
if it is left untreated. The primary cause of the morbidity is
linked to hypertension and hypokalemia, the latter is known to
cause cardiac arrhythmias that can be fatal.
Summary
The students get adequate skill from the clinical practice and will give quality
nursing care to the patient by using nursing care plan and have adaptation the
hospital protocol. Generally, give quality nursing care by using their knowledge
and have the student good relationship to the staff nurse, good participation in
the clinical practiceand case presentation.

39. 37
References
1) Brunner and Suddarth’s textbook of medical surgical nursing 14th edition. | Philadelphia:
Wolters Kluwer, [2018]
2) Mary DiGiulio and Donna Jackson Medical-Surgical Nursing Demystified 1st edition.
The McGraw-Hill Companies, Inc 2007
3) https://emedicine.medscape.com/article/127080-overview#showall