ADN 253 NURSING PROCESS APPLIED TO ADVANCED CONCEPTSfaculty.riohondo.edu/cpage/ADN 253/2014 ADN 253 Syllabus Spring.pdf · Nursing Care of the Patient With Hematologic Disorders

RIO HONDO COLLEGE

HEALTH SCIENCE DIVISION

ADN 253

NURSING PROCESS APPLIED TO

ADVANCED CONCEPTS

PROFESSOR

Catherine Page R.N., M.S.N., W.O.C.N.

PROFESSOR

Pam Boyd R.N., M.S.N.

Spring 2014

“Caring is the essence of nursing”

Jean Watson

TABLE OF CONTENTS

Course Description and Objectives.......................................................................................….

Disability Statement……………………………………………………………………………

Instructor Communication.......................................................................................…………...

Lecture and Exam Schedule..................................................................................................….

ADN 253 Theory Reading Assignments..............................................................................…..

ADN 253 Reflective Journaling Assignments……………………..…………………………..

ADN 253 Journal Grading Rubric……………………………………………………………..

ADN 253 Mr. Sims Clinical Experience / Schedule…………………………………………..

Theory Content and Objectives, Clinical Objectives

Week 1 Assessment and Care of the Patient Who Requires Complex Care..............…..

Nursing Care of the Patient With Hematologic Disorders…………………….

Week 2 Nursing Care of the Patient With Hematologic Disorders / Central Lines….....

Nursing Care of the Patient With Dysfunction of the Immune System........….

Week 3 Nursing Care of the Patient a Diabetic Emergency......................................…..

Nursing Care of the Patient Requiring Complex Care R/T Respiratory

Function……………………………………………………………………

Week 4 Nursing Care of the Patient Requiring Complex Care R/T Cardiac

Function……………………………………………………………………

Week 5 Nursing Care of the Patient with Cancer………………………………………

Nursing Care of the Patient with Cancer Complications………………………

Week 6 Nursing Care of the Patient with Acute Renal Failure.......................................

Nursing Care of the Patient with a Cardiac/Respiratory Arrest.........................

Week 7 Nursing Care of the Patient in Shock..................................................………...

Nursing Care of the Patient with Multiple Organ Dysfunction Syndrome...….

Clinical Section………………………………………………………………………………..

ADN 253 Clinical Expectations...........................................................................................

ADN 253 Clinical Focus / Objectives……………………………………………………..

ADN 253 Clinical Objectives for the Operating Room Experience...........................……..

ADN 253 Clinical Objectives for the SCU/ ICU/ CCU Experience....................................

ADN 253 Clinical Objectives for the ER / ED Experience............................................….

ADN 253 Clinical Evaluation Process…………………………………………………….

ADN 253 Clinical Evaluation Tool.....................................................................................

ADN 253 Correlation/Concept Map Guidelines......................……………………......…..

ADN 253 Correlation/Concept Map Blank / Medication Sheet…….…...…………....…..

ADN 253 Correlation/Concept Map Example...........................……………………....…..

ADN 253 Three Patient Report/Care Form................................………….......….......…....

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RIO HONDO COLLEGE

HEALTH SCIENCE DIVISION

ASSOCIATE DEGREE NURSING PROGRAM

COURSE SYLLABUS

Welcome to All Entering Students

You are very important. If you have any questions about the class,

do not hesitate to see the instructors for clarification.

Course Title:

ADN 253: Nursing Process Applied to Advanced Concepts

Course Description:

This course focuses on the use of the nursing process in caring for patients requiring complex

nursing care in general medical/surgical settings. The course emphasizes generalized emergencies,

immunologic problems and oncologic problems. The course integrates all past nursing theory to

assist the student to apply advanced nursing concepts to patient care.

Course Student Learning Outcome:

The student will be able to apply knowledge, skills and attitudes necessary to provide care for

complex and multi-system health problem adults at an advanced level.

Course Objectives:

As a result of the course, the student will be able to:

Utilize the nursing process in caring for the patient who requires complex nursing care.

Utilize the nursing process in caring for the patient who has cancer and immunologic deficits.

ADN Program Philosophy Overview

The philosophy of the nursing program is in harmony with the mission, vision, and goals of

Rio Hondo College. The Associate Degree Nursing Program strives to be an exemplary nursing

program that provides opportunities for students from diverse backgrounds, ethnicities and

cultures to be educated, responsible and caring community members. Graduates are prepared

for licensure as registered nurses. The faculty recognizes the importance of also preparing

students to practice in a variety of settings as health care delivery evolves. Teaching/learning

strategies will embrace student centered competency-based instruction. In addition, the

program has established quality improvement measures to assure that educational competencies

have been met.

Course Unit / Hours:

Units: 5 units

Lecture: 36 hours of lecture

Clinical: 162 hours of clinical

Course Prerequisites:

Associate Degree Nursing 250, 251 and 252 (or equivalent) completed with a minimum grade of “C”.

1

Textbooks Required:

1. Associate Degree Nursing 253 Syllabus – 2014.

2. Associate Degree Nursing – Rio Hondo College Student Handbook.

3. Ignatavicius, D., Workman, L. Medical-Surgical Nursing Patient-Centered Collaborative Care.

7th

ed., 2013, Elsevier.

4. Zacharoff, K., Pujol, L., Corsini, E.; The PainEdu.org Manual: A Pocket Guide to Pain

Management, 4th

edition. Inflexxion, 2010. (Will be uploaded in blackboard)

5. Reference books-current- of your own choice: (several are available in the bookstore)

IV Drugs Laboratory Tests and Diagnostic Procedures

Drugs with Nursing Implications Nursing Review

Nursing Care Plans

Course Materials:

1. Journals: Articles are assigned in the syllabus or announced in class. Available in the nursing

section of libraries, the Internet and the Health Science Skills Center.

3. Audio-Visual Materials:

As assigned in the syllabus or announced in class. Available in the skills center.

4. Student Materials:

a. Required textbook and materials.

b. White uniform and white shoes.

c. Appropriate name pin / RHC NS name badge.

d. Stethoscope.

e. Bandage Scissors.

f. Appropriate watch (with second hand).

g. Scantrons for exams (PAR Score Scantrons).

h. Black ink pens.

Method of Instruction:

1. Lecture / Group discussion with class participation and interaction.

2. Skill demonstrations and activities.

3. Audio-visual materials.

4. Skill center activities.

5. Clinical assignments in an acute care facility with written concept maps.

6. Textbook assignments.

7. Internet / Blackboard assignments.

Course Evaluation:

1. Satisfactory completion of clinical objectives.

2. Satisfactory demonstration of nursing skills.

3. Written theory examinations and quizzes must be completed with a minimum cumulative

average of 75%.

4. Satisfactory completion of Journaling Assignments (on-line).

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Exams:

The student must earn 75% of possible total points on theory examinations/quizzes. If the total

points are over 75%, the points from the Journaling Assignment will be added for calculation of

the final grade. The final grade percentage must be over 75% of the total points to earn a passing

grade of “C”. If a student is unable to take a written exam or quiz at the scheduled time, makeup

exams or quizzes must be taken within one week and can only be awarded up to 75% of possible

points. The student is responsible to make these arrangements with the instructor.

Course Assignments:

5 Quizzes (20 points each) 100 35.7%

2 Exams (40 points each) 80 28.6%

Final Exam 75 26.8 %

Journaling Assignments 25 8.9%

TOTAL 100%

Clinical:

Clinical grades are Excellent, Satisfactory or Unsatisfactory. Students must achieve an excellent

or satisfactory clinical grade in order to achieve a course grade of C or above. A clinical grade of

unsatisfactory will result in a course grade of “F”.

Nursing Department Grading Scale:

The final grade for the course will be calculated from the total accumulated points.

Health Science Department Grading Standard:

A 90-100%

B 83-89%

C 75-82%

D 70-74%

F 69% and below

Classroom Behavior:

1. Attendance is encouraged at all sessions.

2. Absence in clinical will be assessed on an individual basis with make-up assignments required.

3. It is expected that all class members will arrive on time.

4. Cell phones and pagers will be turned off during the classroom session.

5. Students will be respectful of the instructors, peers and the classroom environment at all times.

6. No food or beverages (other than water) allowed in classroom. Please be responsible to

pick up your trash.

7. Successful students have indicated the importance of reading the material in the textbook

before the lecture is given. Students need to be prepared to discuss the content.

8. Students need to provide their own Parscore Scantron purchased in the campus bookstore for

each test and the final exam. Blank paper may be used for math calculations.

The instructor will provide calculators for the exams.

9. Lack of academic integrity will result in failure.

10. Tape recorders and laptop computers are permissible.

11. Community life in the classroom and clinical setting should be marked with professionalism

including mutual encouragement and consideration for others.

12. There will be no discrimination based on race, ethnicity, gender, age or disability.

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Skill Center / Simulation Lab Guidelines:

The Skills Lab and Simulation Lab are provided as a service for students in the Health Science

Department to supplement and promote student learning and success. The labs are generally

available during posted hours. The skills lab may be reserved for class activities or other events.

Services available include: computers, multimedia library, simulated hospital areas and internet

access. Guidelines for behavior in the skills lab include: no food or drinks, conversation kept low,

no children, no material may be removed from the skills center without permission. Priority for

all services in the labs are for Health Science coursework. The skills center is used by many

nursing students and can get crowded at times. Other computer stations are available in the

Campus Library and in the Business department. Study rooms are available in the library.

Disability Statement:

“Any student who feels s/he may need an accommodation based on the impact of a disability

should contact me privately to discuss your specific needs. Please contact Disabled Students

Programs and services to coordinate reasonable accommodations for students with documented

disabilities.” Please visit the Rio Hondo college DSPS website:

http://www.riohondo.edu/dsps/index.htm for further information.

Accommodations granted by Rio Hondo College for course testing does not guarantee

accommodation for NCLEX examination.

Communication with Instructors:

Catherine Page

Office: S206 562.463.3237: [email protected] or thru Blackboard e-mail

Pam Boyd

Office: S206 562.463.3228: [email protected] or thru Blackboard e-mail

CLINICAL

FACULTY

HOSPITAL CONTACT

INFORMATION

C. Page PIH Health - Downey 562-463-3237

C. Kelbert White Memorial Hospital 562-463-3421

J. Moreno Arcadia Methodist 562-463-3241

K. Brandt Kaiser Downey 562-463-3239

S. Tang Kaiser Baldwin Park 562-463-3229

D. Vallo PIH, Whittier 562-463-3421

K. Gottlieb Whittier Hospital 562-463-3238

V. Rodriguez Beverly Hospital 562-463-3421

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http://www.riohondo.edu/dsps/index.htm

RIO HONDO COLLEGE 2013

ADN 253 Lecture and Exam Schedule

WEEK

ONE

1-27-14

1-28-14

Assessment and Care for the Patient Requiring Complex Care

Case study: Diabetes / ABG / Fluid / Electrolytes

QUIZ 1 (20 points) Nursing Care of the Patient with Hematologic Disorders

Case study: Anemia / TRALI / DIC

WEEK

TWO

2-3-14

2-4-14

Nursing Care of the Patient with Hematologic Disorders / Central

lines

Case study: Neutropenia / Lymphoma / PICC

QUIZ 2 (20 points) Nursing Care of the Patient with Dysfunction of the Immune

System

Case study: Lupus / HIV / Allergies

WEEK

THREE

2-10- 14

2-11- 14

EXAM 1 (40 points) Nursing Care of the Patient with a Diabetic Emergency

Case study: DKA / Hypovolemic / Advanced DM Complications

Nursing Care of the Patient Requiring Complex Care R/T

Respiratory Function

Case study: Acute Respiratory Distress Syndrome on Ventilator

Journal entry #1

- due by 1800 Mon.

(5 points)

WEEK

FOUR

2-17-14

2-18-14

HOLIDAY

QUIZ 3 (20 points)

Nursing Care of the Patient Requiring Complex Care R/T

Cardiac Function

Case study: MI / Arrhythmias / Heart Failure

Journal entry #2

- due by 1800 Mon.

(5 points)

WEEK

FIVE

2-24-14

2-25-14

Nursing Care of the Patient with Cancer

Case study: Colon CA / Lung CA / Treatment – Chemo/Rad

QUIZ 4 (20 points)

Nursing Care of the Patient with Cancer Complications

Case study: Extravasation / Tumor Lysis Syndrome

Journal entry #3

- due by 1800 Mon.

(5 points)

WEEK

SIX

3-3-14

3-4-14

EXAM 2 (40 points)

Nursing Care of the Patient with Acute Renal Failure

Case Study: Heart Failure / Acute Renal Failure / Dialysis

Nursing Care of the Patient in Cardiac / Respiratory Arrest

Case study: Heart Failure / Arrhythmias / Code Blue

Journal entry #4

- due by 1800 Mon.

(5 points)

WEEK

SEVEN

3-10-14

3-11-14

Nursing Care of the Patient in Shock

Case Study: Hypovolemic / Cardiogenic / Septic

QUIZ 5 (20 points)

Nursing Care of the Patient with Multiple Organ Dysfunction

Syndrome

Case Study: Elderly / Urinary HAI / Sepsis

Journal entry #5

- due by 1800 Mon.

(5 points)

WEEK

EIGHT

3-17-14

3-18-14

Review

FINAL EXAM (75 points, Comprehensive)

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RIO HONDO COLLEGE

ADN 253 Theory Reading Assignments

Week 1

Assessment and Care of the Patient Requiring Complex Care

Ignatavicius: Review: Chapters 13, 14 and 15 (pp 165 – 238): Management of Patients

with Fluid, Electrolytes and Acid Base Disturbances

Evolve Resources: Fluid & Electrolytes tutorial- mandatory !

(http://evolve.elsevier.com/Iggy/ Chapter 13)

Nursing Care of the Patient with Hematologic Disorders Ignatavicius: Chapter 41 (pp 855 – 868); and, pp 869 – 879; pp 895 – 904.

Week 2

Nursing Care of the Patient with Hematologic Disorders Ignatavicius: Chapter 41 (pp 855 – 868); pp 880 – 894.

Hadaway, Lynn. Targeting therapy with central venous access devices. Nursing 2008,

June, 38 (6), 34-40.

Rogers, Barbara. “Looking at Lymphoma and Leukemia” Nursing 2005, 35(7) pp 56-63

Nursing Care of the Patient with Dysfunction of the Immune System

Ignatavicius: Chapter 19 (pp 302 – 317); Chapter 21 (pp 357 – 382);

Chapter 22 (pp 383 – 395); SLE (pp 343 – 347);

Review Chapter 25 (pp 434 – 450)

Durston, Shelba. Uncompromising immunocompromised patient care. Nursing Made

Incredibly Easy!, July/August 2007, 5 (4), 52-61.

Week 3

Nursing Care of the Patient with a Diabetic Emergency

Ignatavicius: Chapter 67 (pp 1410 – 1462): Care of the Patients with Diabetes Mellitus

Evolve Resources: The function of insulin: Animation


Nursing Care of the Patient Requiring Complex Care R/T Respiratory Function

Ignatavicius: Review Chapter 29 (pp 543 – 561): Assessment of the Respiratory System

Chapter 34: Care of Critically Ill Patients with Respiratory Problems

Parker, Laura. “Top10 care essentials for ventilator patients” American Nurse Today,

7 (3), March 2012, p 13-16.

Week 4

Nursing Care of the Patient Requiring Complex Care R/T Cardiac Function

Ignatavicius: Review Chapter 35 (pp 686 – 710): Assessment of Cardiovascular System

Evolve Resources: Animation: Heart Valves and Sounds


Review: Chapter 37: Heart Failure with pulmonary edema p. 744-758

Evolve: Chap 37: Animation: Congestive Heart Failure


Read: Chapter 36 (pp 711 – 743): Care of Patients with Dysrhythmias

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http://evolve.elsevier.com/Iggy/




Week 5


Ignatavicius: Chapter 24 (pp 408 – 433); Breast Cancer: pp 1591 – 1609;

Prostate Cancer: pp 1637 – 1642; Colon Cancer: pp 1245 – 1254;

Lung Cancer: pp 630 - 638

Zacharoff. Cancer Pain & End of Life Considerations: 105 - 111, Pharmacologic Options

for the Management of Pain: 133 - 162

Held-Warmkessel, J., ”Taming three high-risk chemotherapy complications”,

Nursing2011, 41 (11), 30-37.

Held-Warmkessel, J., “How to prevent and manage Tumor Lysis syndrome”,

Nursing2012, 40 (2), 26-31.

Week 6


Ignatavicius: Review: Chapter 68 (pp 1465 – 1488): Assessment of The Renal/Urinary

System

Read: Chapter 71 (pp 1537 – 1574): Care of Patients with Acute kidney Injury and

Chronic Kidney Disease.

Dirkes, Susan. “Acute Kidney Injury: Not just acute renal failure anymore?”

Critical Care Nurse , Feb 2011, 31 (1), p 37 – 50.

Nursing Care of the Patient in Cardiac/Respiratory Arrest

Ignatavicius: Chapter 36: Cardiac Arrest: p 719-742

Week 7


Ignatavicius: Chapter 39 (pp 808 – 827); Anaphylaxis (pp 387 – 391);

Cardiogenic Shock/Heart Failure (p 842)

Strickler, Jeff. Traumatic hypovolemic shock: Halt the downward spiral. Nursing 2010,

October 2010, 40 (10), 34-39.

Powers, Kelly, Burchell, P.. Sepsis alert: Avoiding the Shock. Nursing 2010,

April 2010, 40 (4), 34-38.

Nursing Care of the Patient with Multiple Organ Dysfunction Syndrome

Ignatavicius: Chapter 39 (pp 808-826): Shock and MultiOrgan dysfunction syndrome

Micheletti, Lorraine, “Multiple Organ Dysfunction Syndrome” Advance Healthcare

Network for Nurses, October 24, 2011

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RIO HONDO COLLEGE

Associate Degree Nursing 253

Reflective Journaling Assignment

Description and Purpose: Reflective Journaling is a cognitive process that involves a deliberate pause to examine and write about your

reflections on what you have learned and experienced in the clinical setting. It provides a format for you to

synthesize your knowledge, skills and experiences. It helps you to find significance and make connections in order

to critically think and apply concepts and skills you have learned. This is not a diary of your clinical activities.

Reflective Journaling is not just three or four sentences nor a daily log of activities.

Each Journal entry will be worth 5 (five) points (includes scores for format).

Instructions: Journaling will be due Monday by 6 pm on Blacboard, following clinical weeks 2, 3, 4, 5 and 6 (5 entries).

Due Dates: 2/10/2014, 2/17/2014, 2/24/2014, 3/3/2014, 3/10/2014

First:

You need to take time and reflect on what you have learned from the week’s experience. What

memories arose of prior learning or experiences that relate to your learning from this week.

Think about your thoughts and feelings regarding the new learning that has occurred for you.

Second:

A. Identify an essential incident from the week regarding one of the QSEN competencies:

- Patient-Centered Care

- Safety

- Evidence-Based Practice

- Teamwork and Collaboration

- Professionalism

- Quality Improvement

- Informatics.

(Each journal entry must address a different competency topic. Faculty is aware that only three

of the topics will be addressed.)

B. Describe the essential incident from the week addressing the following:

- Why this incident is essential to you.

- What your concerns and thoughts were at the time.

- Describe your feelings during and after the incident.

- What, if anything, you thought most demanding of the incident.

C. Answer the following questions about the essential incident.

a. What does this particular competency mean to you? How is this competency

addressed/clear or not addressed/unclear in this incident? What were the patient’s and

caregivers’ responses to the incident? Were these responses expected or not? (Explain)

b. Explain what you understand about the incident. Does all of the information you

gathered lead to a logical conclusion? Did you have enough relevant information to

support planning/interventions?

c. What did you do during the incident? How did you monitor progress in the incident?

Did you need to adjust or modify your interventions? Were you able to communicate

clearly to the team members, the patient, the family? (Explain) What therapeutic

nursing and/or communication skills did you perform?

e. Reconsider your previous actions and decisions during the incident. What would you

do differently to positively address the competency? What alternatives could you

consider? How will this reflection change your future nursing actions?

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RIO HONDO COLLEGE


Reflective Journal Grading Rubric

Parameters Zero

points

One

point

Two points Three points Four Points

-Grammatical

&/or Spelling

Errors-

Five points

-Grammar &

Spelling Correct-

Identifies

an essential

incident

Not

addressed.

Briefly

identified.

Briefly

identified

with one to

two details.

Clearly

identified with

several details.

Identified and

described in

enough detail to

explain the entire

incident.

Identified and

described in

enough detail to

explain the entire

incident.

Describes

the essential

incident

Not

addressed.

Briefly

described.

Briefly

described

with one to

two details.

Clearly

described with

several details.

Described with

enough detail to

explain why the

incident was

essential and

concerns at the

time

Described with

enough detail to

explain why the

incident was

essential and

concerns at the

time

Describes

the QSEN

competency

and how it

is reflected

in the

incident

Not

addressed

Briefly

described.

Briefly

described

with one to

two details.

Clearly

described with

several details.

Described with

enough detail to

explain an

understanding of

the competency

and how it is

reflected in the

incident.

Described with

enough detail to

explain an

understanding of

the competency

and how it is

reflected in the

incident.

What was

unclear

about the

incident

Not

addressed.

Briefly

identified.

Briefly

identified

with one to

two details.

Described what

was unclear

with several

details.

Described what

was unclear with

comparisons to the

situation/ patient’s

norms.

Described what

was unclear with

comparisons to the

situation/ patient’s

norms.

What was

understood

about the

incident

Not

addressed.

Briefly

identified.

Briefly

identified

with one to

two details.

Identified what

was understood

but no logical

conclusions

noted.

Identified what

was understood

with logical

conclusions and

plan/interventions

identified.

Identified what

was understood

with logical

conclusions and

plan/interventions

identified.

What did

the student

do during

the incident

Not

addressed.

Briefly

described.

Briefly

described

with one to

two details.

Clearly

describes what

they did / how

they reacted.

Describes what

they did / how

they reacted, how

they modified

their interventions

during the

incident.

Describes what

they did / how

they reacted, how

they modified their

interventions

during the

incident.

What would

the student

do

differently

after

reflection

Not

addressed.

Briefly

described.

Briefly

described

with one to

two details.

Describes what

they would do

differently with

no other

options noted.

Identifies their

actions during the

incident and what

they would do

differently. Also

other options they

would consider.

Identifies their

actions during the

incident and what

they would do

differently. Also

other options they

would consider.

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RIO HONDO COLLEGE


Mr. Sims Clinical Experience Guidelines / Schedule

1. Your clinical group will be assigned a 4 hour time frame with Mr. SIMS during your clinical days.

(See below)

2. You need to be prepared to participate in any scenario from this course (ADN 253).

3. You will “debrief” with Mrs. Boyd or Mr. Cordova about the scenario played out. Debriefing will

include a self-evaluation and discussion regarding your clinical reasoning and performance

– what you did well, what else could have been done, what you need to remediate about.

4. Learning Objectives:

a. Identify the primary problems for the patient after completing an appropriate assessment.

b. Implement patient safety measures.

c. Identify and demonstrate therapeutic communication with the patient’s family and health care

team members.

d. Prioritize and implement physician orders.

e. Identify and implement the 6 rights of medication administration.

Location: L406 (old library – fourth floor)

FACULTY HOSPITAL SIMULATION

Date and Time (fill-in)

C. Page PIH Health - Downey

C. Kelbert White Memorial Hospital

J. Moreno Arcadia Methodist

K. Brandt Kaiser Downey

S. Tang Kaiser Baldwin Park

D. Vallo PIH, Whittier

K. Gottlieb Whittier Hospital

V. Rodriguez Beverly Hospital

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Week 1

Assessment and Care of the Patient Requiring Complex Care

Theory Objectives

Monday, January 27, 2014

1. Describe crisis intervention. Describe nursing management of the patient and patient’s

family in crisis. Describe the interpersonal, intrapersonal and developmental implications

of complex illness on the patient’s family.

2. Identify the techniques and rationales for gathering data on patients with complex

medical/nursing problems.

3. Discuss legal implications applicable to emergency care and critical situations.

4. Define triage. Discuss pre-hospital and emergency department triage and assessment.

5. Describe a head-to-toe assessment on the patient with complex medical/nursing problems.

6. Describe expected variations in assessment and planning for the older adult client.

7. Recognize the significance of subtle changes in physical assessment data on the client with

complex medical/nursing problems.

8. Discuss the nurse’s role in performing diagnostic testing on the patient with complex problems.

9. Identify the significance, interpretation of signs/symptoms, and treatment for acid/base imbalance.

10. Describe the nursing diagnoses and care planning appropriate for the patient with complex

medical/nursing problems.

11. Describe the goals and desired outcomes for the patient requiring complex care: the patient will

maintain adequate physiological functions, complications will be detected early and treatments

will be initiated.

12. Compare and contrast fluid volume deficit and fluid volume excess in patients.

13. Understand common acid/base, electrolyte imbalances including signs, symptoms and

interventions.

Case Study: Diabetes / ABG / Fluid / Electrolytes

Nursing Care of the Patient with Hematologic Disorders

Theory Objectives

Tuesday, January 28, 2014

1. Describe the processes of hematopoiesis and in maintaining homeostasis.

2. Use the nursing process as a framework to care for patients with anemia and coagulation

disorders.

3. Identify therapies for red blood cell and platelet disorders, including the nursing implications for

the administration of blood components.

4. Identify the nursing assessment and interventions during blood component administration and

transfusion reactions.

(As entry into the classroom, you must answer correctly a question asked based on the reading.)

Case Study: Anemia / TRALI / DIC

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Week 2

Nursing Care of the Patient with Hematologic Disorders / Central Lines

Theory Objectives

Monday, February 3, 2014

1. Use the nursing process as a framework to care for patients with neutropenia, leukemia,

lymphoma or multiple myeloma.

2. Identify therapies for white blood cell disorders, including the nursing implications for the

administration of blood components.

3. Identify the appropriate uses for tunneled and nontunneled central venous catheters.

4. Describe the nursing care of the various central venous catheters/access devices including

assessment and appropriate dressings.


Case Study: Neutropenia / Lymphoma / PICC

Nursing Care of the Patient with Dysfunction of the Immune System

Theory Objectives

Tuesday, February 4, 2014

1. Compare the different types of primary immunodeficiency disorders and their causes, clinical

manifestation, management, potential complications and common treatment modalities.

2. Describe the nursing management of the patient with an immunodeficiency, including

hypersensitivities, with respect to clinical manifestation, management and teaching, potential

complications and common treatment modalities.

3. Describe the modes of transmission, the pathophysiology of and the physiology underlying the

clinical manifestation of HIV infection.

4. Use the nursing process as a framework for care of the patient with HIV / AIDS.

5. Use the nursing process as a framework for care of the patient with Systemic Lupus

Erythematosus.


Case Study: Lupus / HIV / Allergies

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Week 3

Nursing Care of the Patient with a Diabetic Emergency

Theory Objectives


1. Describe the pathophysiology and etiology for diabetic hypoglycemia.

2. Describe the pathophysiology of hyperglycemia/ketoacidosis.

3. Identify the assessment data for the patient experiencing hyperglycemia/ketoacidosis.

4. Describe the role of the nurse in diagnostic studies for hypoglycemia and

hyperglycemia/ketoacidosis.

5. Describe the nursing diagnosis for the patient with diabetes out of control.

6. Compare and contrast the medical and nursing interventions for the patient experiencing

hypoglycemia to the patient experiencing hyperglycemia/ketoacidosis.

Case Study: DKA / Hypovolemic / Advanced DM Complications

Nursing Care of the Patient Requiring Complex Care Related to Respiratory Function

Theory Objectives


1. Describe the assessment of the patient with atelectasis and pneumonia with the complication

of acute respiratory distress.

2. Compare and contrast the pathologies that lead to acute respiratory distress and respiratory

insufficiency or failure.

3. Describe the criteria used to define acute respiratory insufficiency and failure.

4. Describe the etiology and progression of Adult Respiratory Distress Syndrome.

5. Describe the use of mechanical ventilation for the patient experiencing respiratory distress.

Include the following: negative pressure, positive pressure (pressure cycled, time cycled,

volume cycled), features and settings of the ventilator: FIO2, tidal volume, respiratory rate,

sensitivity setting, types of ventilatory control (control, assist control, intermittent ventilation),

and positive end-expiratory pressure.

6. Describe the pathology of chronic obstructive pulmonary disease (COPD).

7. Describe the principles of water seal drainage for chest tubes including collection of fluids and

addition of suction to the system.

8. Identify and describe the nursing diagnoses and medical/nursing interventions for the patient with

a chest tube to water seal drainage.

Case Study: Acute Respiratory Distress Syndrome on Ventilator

14

Week 4

Nursing Care of the Patient Requiring Complex Care Related to Cardiac Function

Monday, February 17, 2014: Holiday

Theory Objectives


1. Describe the pathophysiology and the etiology of coronary artery disease including angina and

myocardial infarction.

2. Identify the assessment data that differentiate the patient with angina and myocardial infarction.

3. Describe the variation in assessment data and care for the older adult patient with acute

cardiovascular disease.

4. Develop a care plan for the patient with acute angina, myocardial infarction, heart failure and

hypertension.

5. Identify and describe the interventions appropriate for the patient with complications of an

acute myocardial infarction.

6. Describe the normal anatomy and physiology of the conduction system of the heart.

7. Identify and describe the normal ECG pattern on lead II.

8. Describe the etiology, pathophysiology, assessment data, nursing diagnoses and medical/nursing

interventions for the patient experiencing the following dysrhythmias:

a. sinus tachycardia

b. sinus bradycardia

c. atrial tachycardia, paroxysmal atrial tachycardia

d. premature ventricular contractions

e. atrial fluter and fibrillation

f. junctional rhythm

g. atrioventricular tachycardia

h. ventricular fibrillation

i. asystole

9. Describe the principles of pacemaker function and care of the patient with a pacemaker.

10. Discuss methods of hemodynamic monitoring including nursing interventions and potential

complications.

11. Describe the management of patients (including a teaching plan) with heart failure and

pulmonary edema.

Case Study: MI / Arrhythmias / Heart Failure

15

Week 5


Theory Objectives


1. Use the nursing process to describe the role of the registered nurse in prevention of cancer.

2. Discuss how the nursing care needs of the patient undergoing cancer surgery compare

and contrast to those for the patient undergoing any other type of surgery.

3. Compare and contrast the purposes and side effects of radiation therapy (internal and

external) and chemotherapy for cancer.

4. Prioritize care and educational needs for the patient receiving radiation therapy, chemotherapy,

bone marrow transplantation and other therapies in treating cancer.

5. Describe the special nursing needs of the patients receiving chemotherapy.

6. Discuss the uses of biologic response modifiers as supportive therapy in the treatment of cancer.

7. Explain how to troubleshoot the chest tube drainage system in a patient 1 day after a

thoracotomy for lung cancer.

8. Explain the role of the nurse in managing the patient with colorectal cancer.

9. Develop a plan of care for a patient with breast cancer.

10. Explain the role of hormonal therapy in treating prostate cancer.


Case Study: Colon CA / Lung CA / Treatment – Chemotherapy/Radiation

Nursing Care of the Patient with Cancer Complications

Theory Objectives


1. Identify the patients at risk for oncologic emergencies and the role of the nurse during these

emergencies.

2. Discuss the nursing process in caring for a patient experiencing: Tumor Lysis Syndrome,

Superior Vena Cava syndrome, Hypercalcemia, DIC or SIADH.

3. Describe pain and compare and contrast the theories of pain.

4. Describe the equa-analgesic chart and how it is used to assist health care personnel in

providing pain relief for patients with cancer.


Case Study: Extravasation / Tumor Lysis Syndrome

16

Week 6


Theory Objectives:

Monday, March 3, 2014

1. Describe the pathophysiology and etiology of acute and chronic renal failure.

2. Develop a nursing care plan for the patient with acute and chronic renal failure identifying

expected assessment data, nursing diagnoses and interventions including fluid and electrolyte

imbalances.

3. Describe the assessment data that characterizes the oliguric and anuric phases of acute renal

failure.

4. Describe the principles of hemodialysis and peritoneal dialysis.

5. Describe the plan of care for a patient on dialysis.

Case Study: Heart Failure / Acute Renal Failure / Dialysis

Nursing Care of the Patient in Cardiac/Respiratory Arrest

Theory Objectives:

Tuesday, March 4, 2014

1. Describe the etiology of cardiac and respiratory arrest.

2. Describe the pathologies that occur during a cardiac and respiratory arrest.

3. Describe the nursing roles and responsibilities during a code.

4. Describe the procedures for CPR (Cardio Pulmonary Resuscitation) based on the AHA

(American Heart Association) guidelines.

5. Identify the equipment and medication located on the crash cart.

6. Describe the medications, actions, indications and dosages, routes of administration

and side effects/nursing implications for giving medications administered in a code.

7. Describe the rationale for use, procedures and nursing implications for procedures used

to handle cardiac arrest.

8. Discuss the emotional issues for the patient’s family and the nursing staff.

Case Study: Heart Failure / Arrhythmias / Code Blue

17

Week 7


Theory Objectives

Monday, March 10, 2014

1. Describe the pathophysiology of hypovolemic, cardiogenic and distributive shock.

2. Identify the nursing responsibilities for the patient in hypovolemic, cardiogenic and

distributive shock.

3. Compare the clinical manifestations of the compensatory, progressive and irrereversible stages of

shock

4. Discuss the nursing assessment of the patient in cardiogenic shock.

5. Compare and contrast the patient in hypovolemic, cardiogenic and distributive shock.

6. Compare and contrast the patient experiencing neurogenic, anaphylactic and septic shock.

7. Compare and contrast the pathophysiology and clinical manifestations of the hyperdynamic and

hypodynamic phases of septic shock.

8. Compare and contrast the assessment findings of the elderly patient in hypovolemic, cardiogenic

or septic shock to the findings in the younger adult. Contrast the differences in treatment.

9. Identify the treatment modalities for the patient in shock. Include: IV solutions and rates:

medications: positioning; respiratory/oxygenation assistance; and surgical interventions.

10. Use the nursing process as a framework for the care of patients with hypovolemic, cardiogenic

or septic shock.

11. Identify the role of the registered nurse in the care of the patient in the community who has

recovered from shock or is at risk for developing shock.


Case Study: Hypovolemic / Cardiogenic / Septic

Nursing Care for the Patient with Multiple Organ Dysfunction Syndrome

Theory Objectives:

Tuesday, March 11, 2014

1. Describe the etiology and pathophysiology for the patient with multiple organ dysfunction

syndrome.

2. Identify the patients at risk for multiple organ dysfunction syndrome

3. Identify the nursing diagnoses for the patient with multiple organ dysfunction syndrome.

4. Compare and contrast the nursing/medical priorities for the patient experiencing shock and

multiple organ dysfunction syndrome including the signs, symptoms, laboratory findings and

nursing / medical interventions.

Case Study: Elderly / Urinary HAI / Sepsis

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RIO HONDO COLLEGE

Associate Degree Program

253 Clinical Section

ADN 253 Clinical Expectations

ADN 253 Clinical Focus / Objectives

ADN 253 Clinical Objectives for the Operating Room Experience

ADN 253 Clinical Objectives for the SCU/ICU/CCU Experience

ADN 253 Clinical Objectives for the ER/ED Experience

ADN 253 Clinical Evaluation Process

ADN 253 Clinical Evaluation Tool

ADN 253 Clinical Correlation and Concept Map Guidelines

ADN 253 Clinical Correlation and Concept Map Blank

ADN 253 Clinical Correlation and Concept Map Example

ADN 253 Medication Sheet

Three Patient Report / Care Form

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RIO HONDO COLLEGE

Associate Degree Nursing Program 253

Clinical Expectations

Time

ADN 253 is a 5 unit course. This includes 20 clinical hours each week. Students are expected to

arrive to each clinical period on time and stay for the entire clinical class. Tardiness will result in

an Unsatisfactory clinical evaluation for that week (see clinical evaluation form – member of the

profession). If a student is unable to attend a clinical session or portion there-of, it is expected

that the student will notify the clinical instructor prior to the beginning of the session.

Behavior

Students represent Rio Hondo College and are guests at the affiliating agency. It is expected that

students will be respectful of the facility, patients and staff at all times. It is also expected that

students will follow HIPPA guidelines at all times.

Experiences

Students may have alternate clinical experiences as allowed by each clinical facility. See Clinical

Objectives for alternate clinical experiences.

Preparation

Students are expected to meet RHC ADN program requirements prior to beginning each course.

This includes completed and updated physicals, lab work and American Heart Association BLS

CPR. If a student is noncompliant with the program guidelines, the student will not be allowed to

attend clinical until the student is in compliance. (See RHC ADN Student Handbook). The

student will receive an Unsatisfactory clinical evaluation for each week they are unable to

attend clinical for failure to meet clinical objectives.

Students are also expected to chose patients and prepare for patient care prior to clinical.

Assignments

Clinical paperwork related to patient care will be due at the end of the second clinical day.

Any assignment not submitted or submitted late will result in an Unsatisfactory clinical

evaluation for the week (see clinical evaluation form – member of the profession).

Clinical Make-up

It is expected that ALL clinical time missed will be made-up. The student is responsible to develop a

make-up assignment that meets the objectives for the time missed. Make-up assignments must be

approved by the clinical instructor before they are initiated, and completed by the date assigned by

the clinical instructor.

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Clinical Focus / Objectives

Week 1 Clinical Conference Focus

1. Discuss assessment of the patient with complex nursing problems.

2. Discuss the patient’s inter/intrapersonal stress response to complex illness including

assessment and interventions to decrease stress.

3. Discuss diagnostic tests used to assess the patient with complex nursing problems.

4. Discuss the care planning for the patient with complex nursing problems.

5. Discuss the effects of aging on the patient with complex nursing problems.

6. Discuss the rationale and nursing implications for administration of IV solutions.

Clinical Assignment

The student will be assigned to care for a patient(s) with complex nursing problems.

Clinical Objectives

The student will be able to:

1. Assess the patient with complex nursing problems.

2. Develop a care plan on the patient(s) based on the assessment data and theory related

to the medical and nursing diagnoses.

3. Use the nursing process to develop a care plan to assist the patient experiencing

disturbance of fluid and electrolyte balance.

Week 2 Clinical Conference Focus:

1. Discuss the assessment of the patient with hematologic disorders.

2. Discuss diagnostic studies for the patient with hematologic disorders.

3. Discuss the nursing plan of care for the patient with hematologic disorders.

4. Compare and contrast blood transfusion reactions.

5. Identify the nursing interventions for the patient with a central intravenous catheter.

6. Discuss the assessment of the immunologically suppressed patient including

diagnostic studies.

7. Identify the intra/interpersonal stress factors related to HIV disease.

8. Describe the nursing plan of care for the immunosuppressed patient.

Clinical Assignment:

1. The student will select, plan for and implement care for a minimum of two patients with

hematologic disorders and/or central IV lines.

2. The student will select, plan for and implement care for a minimum of two patients with

immunosuppression or HIV disease.

Clinical Objectives:


1. Accurately assess the patient with hematologic disorders.

2. Discuss the patient’s specific hematologic problems based on assessment data and

theoretical knowledge.

3. Develop a nursing plan of care for the patient with hematologic disorders.

4. Identify the patient at risk for developing a blood component transfusion reaction and the

appropriate nursing actions during a transfusion reaction.

5. Complete a central line dressing per Rio Hondo College and facility policy/procedure.

6. Identify and assess the immunologically suppressed patient or the patient with HIV

disease.

7. Develop a nursing plan of care for the patient based on assessment data and theoretical

knowledge related to medical and nursing diagnoses. Include in the plan of care, acute

care and follow-up care in the community setting.

8. Discuss specific patient problems based on assessment data and theoretical knowledge.

21


1. Discuss the care of the patient with acute diabetic emergencies: hypoglycemia and


2. Describe the assessment data in the early stages of hypoglycemia and


3. Discuss the assessment of the patient with respiratory function.

4. Discuss the care of the patient on mechanical ventilation and water seal chest drainage.

5. Discuss the care of the patient with adult respiratory distress syndrome.

Clinical Assignment

1. The student will be assigned to care for 1-3 patients with or at risk for diabetic

hypoglycemia or hyperglycemia/ketoacidosis.

2. The student will be assigned to care for patients with complex problems related to the

respiratory system.

Clinical Objectives


1. Assess the patient with complex problems related to diabetes.

2. Describe the use of the nursing process to care for patient with diabetes out of control.

3. Assess the patient with complex respiratory nursing problems.

4. Develop and implement a nursing plan of care based on the assessment data and

pathology for the patient with complex problems with emphasis on respiratory

dysfunction.


1. Discuss the care of the patient with disorders of cardiac function: angina pectoris,

myocardial infarction, heart failure and cardiogenic shock.

2. Discuss the significance of dysrhythmias to the cardiac patient.

3. Identify the priorities in caring for the patient with dysrhythmias.

Clinical Assignment

The student will be assigned to care for a patient(s) with complex problems related to the

cardiovascular system.

Clinical Objectives


1. Assess the patient with disorders of the cardiovascular system.

2. Develop a care plan for the patient based on the assessment data and theory related to

the medical and nursing diagnoses of the patient with cardiovascular problems.

22


1. Discuss the assessment of the patient with cancer including diagnostic studies.

2. Compare and contrast cancer treatment modalities your patient is undergoing.

3. Identify the intra/interpersonal stress factors related to cancer.

4. Discuss nursing interventions specific to medical/nursing problems related to cancer

and cancer care.

Clinical Assignment

The student will select, plan for and implement care for a minimum of two patients with

cancer or are dying.

Clinical Objectives


1. Complete a physical and psychosocial assessment of the patient with cancer.

2. Assess the patient’s response to cancer treatment.

3. Discuss specific patient problems based on assessment data and theoretical knowledge.

4. Develop and implement a nursing plan of care for the patient with cancer or who is

dying.

5. Discuss appropriate methods of pain relief for patients on the nursing units.


1. Discuss the assessment of the patient with acute problems related to renal function.

2. Discuss the use of the nursing process to care for the patient with acute renal failure.

3. Discuss the prioritization of care for the patient during cardiac/respiratory arrest.

4. Discuss the role and responsibility of the nurse in caring for a patient experiencing

cardiac/respiratory arrest.

Clinical Assignment

1. The student will be assigned to care for 1-3 patients with or at risk for acute renal failure.

2. The student will care for 1-3 patients at risk for or with a history of cardiac/respiratory

arrest.



1. Assess the patient with or at risk for acute and renal failure.

2. Develop a plan of care based on assessment data and medical/nursing problems for the

patient with or at risk for acute renal failure.

3. Describe the patient care needs for the patient receiving hemodialysis for renal failure.

4. Assess the patient with complex nursing/medical problems.

5. Identify the patient at risk for respiratory/cardiac arrest.

6. Develop a plan of care based on assessment data for the patient at risk for developing

cardiac/respiratory arrest.

23


1. Discuss the identification of the patient in shock.

2. Discuss the nursing plan of care, including assessment, diagnoses, intervention and

evaluation for the patient in shock (hypovolemic, distributive and cardiogenic).

3. Identify the patient at risk for multiple organ dysfunction syndrome.

4. Discuss the care of the patient experiencing multiple organ dysfunction syndrome.

Clinical Assignment:

The student will select, plan for and implement care or a minimum of two patients with

shock, at risk for shock or with a history of shock or at risk for multiple organ dysfunction

syndrome.



1. Identify the patient experiencing shock or at risk for shock.

2. Accurately assess the patient in shock or at risk for shock.

3. Discuss specific patient problems based on assessment data and the theoretical

knowledge.

4. Develop and implement a plan of care for the patient in shock or at risk for shock.

5. Identify the risk for a patient for multiple organ dysfunction syndrome.

6. Prioritize nursing care based on assessment data and theory for the patient at risk for or

experiencing multiple organ dysfunction syndrome.


1. Discuss assessment of the patient with complex nursing problems.

2. Discuss the patient’s inter/intrapersonal stress response to complex illness including

assessment and interventions to decrease stress.

3. Discuss diagnostic tests used to assess the patient with complex nursing problems.

4. Discuss the care planning for the patient with complex nursing problems.

5. Discuss the effects of aging on the patient with complex nursing problems.

6. Discuss the rationale and nursing implications for administration of IV solutions.

Clinical Assignment

The student will be assigned to care for a patient(s) with complex nursing problems.

Clinical Objectives



2. Develop a care plan on the patient(s) based on the assessment data and theory related

to the medical and nursing diagnoses.

Final clinical evaluation

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RIO HONDO COLLEGE


Operating Room Objectives

This course is designed to assist the student to use the nursing process to care for the patient with

complex nursing problems. Content includes care of the patient with cancer, immune system

disorders, acute cardiovascular problems, acute renal failure, acute respiratory failure, shock and

multisystem organ failure. Students are in the last semester of the program.

The student is assigned to participate in patient care in the Operating Room (OR) under the direct

supervision of the RN staff nurse. With the help of the staff nurse in the OR, the student will:


2. Identify the priority nursing and medical problems and prioritize care.

3. Carry out nursing interventions identified in the patient's plan of care including

procedures as described in the hospital manual. The student will NOT give

medications in the OR and they are not allowed to insert intravenous catheters.

4. Evaluate patient responses to interventions.

5. Describe the patient situation including pathology, anticipated outcomes (positive and

negative) and planned interventions to achieve positive outcomes.

6. Describe the roles of the registered nurse in the Operating Room.

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RIO HONDO COLLEGE


Intensive Care Unit / Coronary Care Unit Objectives

This course is designed to assist the student to use the nursing process to care for the patient with

complex nursing problems. Content includes care of the patient with cancer, immune system

disorders, acute cardiovascular problems, acute renal failure, acute respiratory failure, shock and

multisystem failure. Students are in the last semester of the program.

The student is assigned to participate in care in the Intensive Care Unit/Coronary Care Unit under the

direct supervision of the RN staff nurse. With the help of the staff nurse in the unit, the student will:


2. Develop nursing diagnoses, goals and outcomes for the patient with complex problems.

3. Intervene to carry out the care plan for the patient including procedures as described in the hospital

procedure manual. The student shall not give medications in the ICU/CCU and they are not allowed

to insert intravenous catheters.

4. Evaluate care of the patient with complex problems using goals and outcomes.

5. Describe the patient situation including pathology, nursing diagnoses and interventions in a narrative

format.

6. Describe the roles of the nurse in the ICU/CCU.

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RIO HONDO COLLEGE


Emergency Department Objectives

This course allows the second year associated degree nursing student to focus on the use of the nursing

process in caring for patients requiring complex care in general medical-surgical settings. The course

emphasizes generalized emergencies such as the patient who complains of chest pain, shortness of breath

or has a diabetic emergency. The course also presents content related to immune system problems and

problems of the cancer patient. The course integrates all past nursing theory and presents opportunity for

the student to use critical thinking skills in applying theory to patient care planning and decision making.

Rotation of the student through the emergency department would assist the student with assessment

skills, prioritizing and understanding the differences in carrying out the nursing process in this setting.

The student will rotate through the emergency department for one day. Under the supervision of the

emergency department RN staff, the student will be able to:

1. Assess the patient with focus on the presenting complaint.

2. Identify the priority nursing and medical problems and prioritize care.

3. Perform nursing interventions under the direct supervision of the RN staff. The student may perform

procedures such as NGT insertion and urinary catheterization. The student may not start IVs.

4. Describe the roles of the nurse and medical team members in the emergency department.

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RIO HONDO COLLEGE

Associate Degree Nursing Program

Clinical Evaluation Process

Revised 12/2013

Clinical Student Learning Outcome: The student will be able to utilize the nursing process in:

assessment; planner of care; provider of safe, skilled care; communicator and member of the profession

in both sections of the course for patients that have disorders related to advanced nursing care concepts.

STUDENT LEARNING OUTCOME PERFORMANCE STANDARD: The student will be able to

utilize the nursing process in four essential areas: Planner of Care, Provider of Safe Skilled Care,

Communicator/Client Teacher, Member of the Profession, for patients in a variety of health settings.

The purpose of the clinical evaluation process is to assist the student meet the student learning outcome.

1. The clinical evaluation process will allow the student to:

a. Receive a fair evaluation

b. Clarify performance expectations in a specific level of practice

c. Monitor progress leading to growth

d. Provide formal feedback

e. Promote open dialogue between student and faculty

f. Implement the nursing process in clinical judgment

g. Apply critical thinking standards to enhance clinical judgment

h. Utilize the Systems Developmental Stress Model in clinical judgment

2. The process of evaluation is as follows:

a. At clinical orientation to the course, the faculty will review the clinical evaluation process

and all applicable clinical tools with the student

b. Each clinical week the student will have a performance evaluation by:

i. Meeting all clinical objectives for that specific week at a satisfactory success rate

or better in each of the essential areas of nursing practice:

1. Planner of Care

2. Provider of Safe Skilled Care

3. Communicator/Client Teacher

4. Member of the Profession

ii. Earn a grade of satisfactory or greater on each Correlation/Concept Map (CCM). If

less than satisfactory is earned on any CCM, the student will be given an

opportunity of resubmitting the CCM 1 time within the clinical course for a

satisfactory grade.

c. Each week the student will complete the clinical evaluation tool of the course. He/she will

use the following grading scale and point system as follows:

i. E: Excellent – Significantly exceeds all objective criteria

ii. S: Satisfactory – Successfully meets the objective criteria

iii. NI: Needs Improvement – Needs to become more competent in meeting objective

criteria

iv. U: Unsatisfactory – Fails to meet objective criteria

3. Third Semester Rating for Grading Scale and Grading Criteria. The student will earn the

following clinical grade using the following criteria:

28

a.

i. The student will turn in the clinical evaluation tool with self-evaluation for faculty

grading and feedback.

ii. All additional paperwork will be turned in as specified in the course for faculty

grading and feedback.

iii. The faculty will return all paperwork and the clinical evaluation tool back to the

student after grading.

iv. Collaboratively the student and faculty will discuss the student’s weekly progress

b. If the faculty during any week determines the student has earned less than a satisfactory

grade, the faculty will develop a “Clinical Corrective Plan for Success.”

i. The Clinical Correction Plan for Success with be reviewed with the student

ii. Student and instructor will:

1. Revise the plan if necessary

2. Approve the plan by signing the document

c. The last week of the course the student and instructor will review all paperwork and

evaluation tools. A satisfactory course grade will be received by the student when the

student has met all clinical objectives with a score of satisfactory or better.

d. Thus the student learning outcome performance standard will be met.

The Eight Critical Thinking Standards Defined (Richard Paul)

These are the standards of critical thinking that are essential in passing clinical. A standard is the

cognitive ability used to measure the level of critical thinking.

1. Clarity: Understandable, the meaning can be grasped

2. Accuracy: Free from errors and distortions

3. Precision: Exact to the necessary level of detail

4. Relevance: Related to the matter at hand

5. Depth: Find complexities, interrelationships and causes

6. Breadth: All parts or points of view; getting it all

7. Logic: One idea accurately supports or leads to another

8. Significance: An important points of view; not trivial

E Excellent Demonstrates precisely, in depth and breadth, nursing theory,

in performing patient care related to the SLO, SDSM, critical

thinking standards and the nursing process to give nursing care

for multiple, complex patients.

S Satisfactory Independently utilizes the Systems Developmental Stress

Model, the Nursing Process and advanced nursing concepts to

safely care for patients with complex nursing problems related

to theory, the SLO, the SDSM, critical thinking standards and

the nursing process.

NI Needs

Improvement

Reflects uncertainty about theory and the use of SLO, SDSM,

critical thinking standards and the nursing process to patient

care.

U Unsatisfactory Actions are not reflective of theory, or the SLO, the SDSM,

critical thinking standards or the nursing process to patient

care.

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RIO HONDO COLLEGE


Clinical Course Evaluation Tool

Student Name: ____________________________________________ Date: ____________________________

Clinical Week: ___________________________ Clinical Focus ________________________

STUDENT LEARNING OUTCOME PERFORMANCE STANDARD: The student will be able to utilize the nursing

process in: assessment; planner of care; provider of safe, skilled care; communicator and member of the profession

in both sections of the course for patients that have disorders related to advanced nursing care concepts.

Grading:

1. The student independently utilizes the Systems Developmental Stress Model and the Nursing Process to deliver

safe care using advanced nursing concepts for those who are experiencing complex nursing care problems.

2. The student applies critical thinking standards in meeting clinical objectives.

3. Weeks are identified so that student progress can reach a satisfactory grade by the indicated week.

4. Grading will consist of four scoring options : E, S NI U.

5. Each essential area and all objectives must be passed with a satisfactory rating by completion of clinical rotation.

Refer to the “Clinical Evaluation Process” for grading.

Course Objectives:

I. Planner of Care: Student’s

evaluation

Faculty’s

evaluation

Weeks to be

Completed

Satisfactory

A. Preplanning: ----- -----

1. Appropriate choice of patient(s) 2-7

2. Theoretical preparation completed for safe care 2-7

3. Pathophysiology (Stressors) thoroughly described, understood

and presented in student’s words with reference

3-7

B. Assessment (Stressors) Correlation/Concept Map ----- -----

1. Assess patient in a relevant and complete manner

(Stressor: Biological, Interpersonal, Intrapersonal)

3-7

2. Identify and prioritize significant NANDA statements (Stress State)

and identify as Active or At Risk.

3-7

3. Identified each NANDA (Stress State) as a Biological,

Interpersonal or Intrapersonal Subsystem

4-7

4. Clustered all findings (Stress response) with accuracy and

precision under pertinent NANDA statements (Stress State)

4-7

5. Identified the expected and actual developmental stage 2-7

6. Medications presented precisely 2-7

7. All areas correlated with precision, depth & breadth 5-7

8. In depth questions asked 5-7

C. Care Plan(s) Development on Correlation/Concept Map: ----- -----

1. PES statement(s) accurate, and completed incorporating the

significance of the patient stressors

a. P statement is critical for the patient

b. E statement supports the presenting pathophysiology

c. S statement has essential signs/symptoms identified

3-7

2. Each nursing intervention accurately relates to the NANDA/Stress

State and includes appropriate medications with assessment for side

effects and expected labs

4-7

3. Each nursing intervention has a precise rationale 3-7

4. Desired outcomes (Adaptation) relevant 4-7

5. Desired outcomes presented with behavioral or measurable criteria 3-7

6. Outcomes (Adaptation) analyzed accurately including time frame 4-7

7. When outcome partially/not met, interventions/outcome revised 4-7

Comments (Instructor/Student): Planner of Care

30

II. Provider of Safe Skilled Care:

Student’s

evaluation

Faculty’s

evaluation

Weeks to be

Completed

Satisfactory

A. Implementation of the Plan of Care ----- -----

1. Implements care for one or multiple patients based on the

biological, inter/intrapersonal and developmental needs.

2-7

2. Initiates or delegates to others to provide a safe environment 2-7

3. Demonstrates increasing independence 5-7

4. Implementation of Care Utilizing Standard Precautions 2-7

5. Demonstrates accurate assessment techniques 3-7

6. Prepares for and performs skills accurately and precisely 3-7

7. Evaluates the significance of patient responses to interventions

accurately and in a timely manner

3-7

8. Responds logically to patient assessment findings / responses in a

timely manner

3-7

C. Medication ----- -----

1. Analyzes actions, indications, dosages, routes, side effects,

contraindications and nursing implications for prescribed

medications

2-7

2. Calculates, administers medication per institutional and program

procedures

2-7

3. Assesses patients for effects and potential side effects of

medications

2-7

Comments (Instructor/Student): Provider of Skilled Care

III. Communicator/Client Teacher:

1. Demonstrates advocacy for patients through use of appropriate

communication style

2-7

2. Utilizes principles of verbal and non verbal communication skills 4-7

3. Demonstrates an awareness of the rights and responsibilities of

assertive communication

4-7

4. Utilizes principles of assertive communication when appropriate 4-7

5. Demonstrates a variety of therapeutic communication skills 3-7

6. Evaluates the effectiveness of communication skills with peers,

staff, patients and instructor

4-7

7. Documents significant data in a timely manner 2-7

8. Reports significant data with precision and accuracy to the appropriate

care provider in a timely manner

2-7

9. Provides accurate health teaching for the patient and family

appropriate to the developmental, educational, and cultural

practices

4-7

Comments (Instructor/Student): Communicator/Client Teacher

31

IV. Member of the Profession

Student’s

evaluation

Faculty

evaluation

Weeks to be

Completed

Satisfactory

1. Functions in a legal/ethical manner maintaining professional

standards

2-7

2. Critically reflects upon own nursing behaviors 2-7

3. Assignments are turned in on time in correct format 2-7

4. Demonstrates increasing progress in quality, depth and breadth

of all aspects of care

4-7

5. Adheres to professional practice related to all program

procedures emphasizing; punctually, attendance, absence,

dress code and demeanor.

2-7

Comments (Instructor/Student): Member of Profession:

Student Additional Comments:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Instructor Additional Comments:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

__________________________________________________________________________________________________

WEEKLY Grading Section:

Weekly Clinical Grade: Excellent, Satisfactory, Needs Improvement, Unsatisfactory

Week’s Score/Grade: Student:____________/___________ Instructor: _______________/_____________

Student Signature: ___________________________________________

Instructor Signature: _________________________________________ Date: ___________________

FINAL Grading Section:

Course Clinical Grade: Excellent Satisfactory Unsatisfactory

Final Week’s Score/Grade: Student:____________/___________ Instructor: _______________/_____________

Student has Met / Not Met the SLO Performance Standard and Passed the Clinical section of ADN 253:

Student Signature: _____________________ Instructor Signature: _______________________ Date: _____________

32

RIO HONDO COLLEGE


Clinical Correlation / Concept Map Guidelines

A Clinical Reasoning Tool

Utilizing the Systems Developmental Stress Model Guidelines for Developing a Correlation & Concept Map.

1. Name, date and patient’s RN on top of form.

2. In the first section of the page:

a. Identify a patient by age, initials, allergies, code status, and problems (active and chronic

problems) (Stressors).

b. Briefly describe the pathophysiology of the patient active and chronic problems in the appropriate

areas.

c. Identify the patient’s expected and actual Psychosocial / Erikson’s stage with supporting data.

d. Identify the patient’s interdisciplinary care needs.

e. Identify the patient’s risk factors for admission.

f. Identify the patient’s pertinent lab values and diagnostic findings.

g. Identify two pertinent NANDA’s (PES), appropriate outcomes (adaptation) / interventions and

then evaluate the patient based on the outcomes with an analysis of the outcome and intervention

adjustment..

2. In the second section of the page

a. Identify your assessment findings, family / SO findings and learning needs.

b. Include your patient’s daily weight, vita signs, glucoscan and dietary intake information.

c. Include any other information about your patient that is not outlined by the grids.

3. Correlate pathophysiology, assessment findings, nursing care priorities, patient care outcomes,

and interdisciplinary care needs, (indicating relationships) in colored pen or pencil.

4. ON THE BACK of the map, identify the patient’s medications and pertinent information to the

patient in relationship to that medication.

Guidelines when discussing the correlation/concept map with your instructor.

You need to be ready to clearly and accurately explain the following:

1. Explain the significance of each nursing problems selected?

2. Justify your prioritization of the nursing problems.

3. Please explain the relevance of the findings.

4. Briefly discuss how rationales support each nursing intervention.

5. How will the nursing interventions aid in achieving the desired patient outcomes?

6. Discuss the impact of the patient stressors related to the plan of care.

7. Describe how the plan of care assisted the patient in meeting the desired outcomes.

33

Pt information: Initials Age Male / Female Room # Allergies Code status Advance Directive Primary language

Initial Patient C/O: Admitting Medical Diagnoses:

Brief patho:

(Correlate w/ Hx, Risk factors, labs, tests)

Pt chronic medical history/surgery and patho:

Expected / Actual Erickson stage with rationale

Interdisciplinary: PT / OT / ST / RT / NT Precautions:

Risk factors for admission

1. 2. 3.

Pertinent labs / Diagnostic tests & results

NANDA: (PES) 1. 2.

Outcomes: 1. 2.

Interventions: 1. 2.

Evaluation / Analysis of Outcomes: 1. 2.

Assessment:

Neuro: Mus/Skel:

Cardio: Skin:

Resp: Psych/Soc:

GI: Family/SO:

GU: Learning needs:

Location

Type / size

Assessment

Solution

Rate

Vital Signs Daily Weight:______________________ IV:

Date Time Pain Temp BP HR RR POx Intake Output

/10 %

/10 %

/10 %

/10 %

Additional Information:

Glucoscan results Date Time result / coverage

Diet:__________________________ Date Time % eaten / comments

34

Medications

Medication Route /Time Dose Action Nursing Concerns Labs Interaction / Side effects

Patient Response (Actual)

35

36

37

RIO HONDO COLLEGE


Three Patient Report / Care form

Pt #1 initials _______ Rm # ______

age______ M F nurse ________

Pt #2 initials _______ Rm # ______

age______ M F nurse ________

Pt #3 initials _______ Rm # ______

age______ M F nurse ________

Dx: ________________________

HX: DM CAD Renal HTN

CA Other: _______________

Dx: ________________________


CA Other: _______________

Dx: ________________________


CA Other: _______________

#1 NANDA #1 NANDA #1 NANDA

Focused Labs:

Focused Labs:

Focused Labs:

Diet:____________________________ Diet:____________________________ Diet:____________________________

Activity: Bedrest BRP BSC

Turn Q 2 hrs up ad lib P.T.





Tubes: NG placement G-tube

J-P Foley other___________





O2 at______ L via N/C Mask

Vent TV_____ Rate____ FiO2____

Type: Vol Cy Prs Cy Neg Prs

Mode: Cont V AC SIMV

Sigh_____ PEEP_________





Sigh_____ PEEP_________





Sigh_____ PEEP_________

SL IV Sol _________at ___ cc/hr

Central line TPN PPN Lipids





Dialysis shunt Peritoneal Dialysis Dialysis shunt Peritoneal Dialysis Dialysis shunt Peritoneal Dialysis

0730 Vital signs: BS_______

____________________ POx ____ %


____________________ POx ____ %


____________________ POx ____ %

0800 Complete H2T and chart

Neuro

Cardio

Resp

GI

GU

Skin


Neuro

Cardio

Resp

GI

GU

Skin


Neuro

Cardio

Resp

GI

GU

Skin

0800 – 1000 med prep: ALL_________

List med/rationale for this pt

*

*

*

*

*

0800 – 1000 med prep: ALL_________


*

*

*

*

*

0800 – 1000 med prep: ALL_________


*

*

*

*

*

1130 BS/cover 1130 BS/cover 1130 BS/cover

1200 Vitals 1200 Vitals 1200 Vitals

1300 – 1400 meds

*

*

*

1300 – 1400 meds

*

*

*

1300 – 1400 meds

*

*

*

1600 Vitals 1600 Vitals 1600 Vitals

1700 BS/cover 1700 BS/cover 1700 BS/cover

1600 - 1800 meds

*

*

*

1600 - 1800 meds

*

*

*

1600 - 1800 meds

*

*

*

1800 I/O totals 1800 I/O totals 1800 I/O totals

38

Pt #1 Medication/dose/route/action/

SE and labs for this patient





Pt #1 Patient problems and nursing

process (Clinical Reasoning)





39