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B R O O K D A L E C O M M U N I T Y C O L L E G E
Nursing Program
Science & Health Science Division
Syllabus
NURS 261
Nursing and Human Needs III
Fall 2017
1
Rev. 6.5.17
Nursing and Human Needs III
NURS 261
Table of Contents
Page
Course Overview ................................................................................................................................................................... 2
Textbooks ............................................................................................................................................................................ 2-3
Course Faculty ....................................................................................................................................................................... 3
Course Learning Outcomes .................................................................................................................................................... 4
Notification of Services for Students with Disabilities .......................................................................................................... 4
Grading Standard ................................................................................................................................................................... 5
Student Grade Worksheet .................................................................................................................................................... 7
Unit I Competencies (Mental Health) .................................................................................................................................. 8
Unit II Competencies (Cardio Vascular) ............................................................................................................................. 22
Unit III Competencies (Respiratory) .................................................................................................................................... 29
Unit IV Competencies (Endocrine) ...................................................................................................................................... 36
Unit IV Competencies (Shock & Burns, Hematologic Disorders) ...................................................................................... 40
Clinical Laboratory Guide ................................................................................................................................................... 42
Skills Designated for Observation Only ...................................................................................................................... 43
Clinical Interviewing Guide ......................................................................................................................................... 44
Guidelines for Chart Review ....................................................................................................................................... 49
Guide to Giving Change-of-Shift Report ..................................................................................................................... 51
Weekly Clinical Outcomes .......................................................................................................................................... 52
Clinical Evaluation ................................................................................................................................................ 95
You are responsible for keeping a copy of all nursing course syllabi.
In the event you need copies for transfer or validation purposes, it is your responsibility
to provide the relevant materials.
2
Rev. 6.5.17
CODE: NURS 261 TITLE: Nursing and Human Needs III
DIVISION: Science & Health Sciences DEPARTMENT: Nursing
COURSE DESCRIPTION: In Nursing III, the student uses the Human Needs Framework to care for individuals
with alterations in mental health, oxygenation, tissue perfusion and metabolism.
PRE-REQUISITES: NURS 162 and BIOL 213
CO-REQUISITES:
CREDITS: 8 LECTURE HOURS: 4 LAB/STUDIO HOURS: 12
Clinical/Field/Work Experience
Class (1:1) (4 hours/week x 15 weeks) 4.0
Clinical Lab (1:3) (10.5 hours/week x 13 weeks) 3.0
College Lab (1:3) (3 hours x 15 weeks) 1.0
Credits 8
REQUIRED TEXTBOOK & MATERIALS:
Doenges, M. E. & Moorhouse M. F. & Murr A. C. (current edition) Nurse’s Pocket Guide, Diagnoses,
Prioritized Interventions, and Rationales PA: F. A. Davis Company.
Kee, J. & Hayes, E. (2015). Pharmacology: A nursing process approach (7th ed.). St. Louis: Saunders.
Kee, J. & Hayes, E. (2015). Study Guide for Pharmacology: A nursing process approach (7th ed.)
Philadelphia, PA: W.B. Saunders Company.
London, M. L. (2011). Maternal and Child nursing Care (3rd ed.). Upper Saddle River, NJ. Prentice
Hall.
Smeltzer, S. C. & Bare, B. G. & Hinkle, J. & Cheever, K. H. (2014). Brunner & Suddarth’s Textbook Of
Medical Surgical Nursing (12th or 13th ed.). Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins.
Taylor C., L. (2008 or 2011). Fundamentals of Nursing (7th ed.) with Taylors Video Guide to Clinical
Nursing Skills, Student Set on CD ROM. Philadelphia, PA: Lippincott Williams and Wilkins.
Videbeck, S.. Psychiatric Mental Health Nursing (6 or 7ed.). Philadelphia, PA: Lippincott, Williams, &
Wilkins.
ATI, online software www.ATITesting.com (Part of student lab fees).
Nursing Constellation Plus. Powered by Skyscape. (Available in the bookstore)
This is a software program that integrates resources and tools you will need in clinical. You need a Mobile
Device with minimum system requirements: Palm OS 4 or higher, BlackBerry OS version 4.1 or higher,
Windows Mobile Pocket PC & Smartphone 5.0 or 6.0 or Windows Mobile Pocket PC 2003. All these devices
must accept a 2GB external memory card where the software program needs to be installed. The following
required books are included in the software: Deglin, J. H. & Vallerand, A. H. Davis’ Drug Guide for Nurses.
Philadelphia, PA: F.A. Davis; Schnell, Z., Van Leeuwen, A. & Krapnitz. Davis’s comprehensive handbook of
3
Rev. 6.5.17
laboratory and diagnostic tests with nursing implications. Philadelphia: F. A. Davis; Venes, D. & Thomas, C.
Taber’s Cyclopedic Medical Dictionary. Philadelphia, PA: F. A. Davis.
Recommended:
American Psychological Association. (current edition). Publication manual. Washington, D.C.:
American Psychological Association.
Schuster, P. (Current). Concept mapping: A critical-thinking approach to care planning. Philadelphia,
PA: F.A. Davis.
ADDITIONAL TIME REQUIREMENT:
College Nursing Skills Lab
Health Science Computer Lab
Lab time required is according to assignments and practice time varies according to individual learning needs.
ADDITIONAL SUPPORT:
Learning Assistant Pam Anania, Extension 2420 (available in the Nursing Lab MAS 136). Computer
software is also available in the Health Science Computer Lab (MAS 101-102).
NURSING 261 COURSE FACULTY
Full-time faculty: Office hours for individual faculty are posted on office doors (MAS 138E).
Phone E-mail
Diane Booker 732-224-1978 [email protected]
Linda Servidio 732-224-2649 [email protected]
The adjunct faculty may be reached by CANVAS email.
4
COURSE LEARNING OUTCOMES
Assess human needs across the lifespan using the Holistic Needs Assessment framework, focusing on
complex psychopathology, pathophysiology and incorporating basic sensitivity to cultural diversity.
Calculate and administer medications incorporating information from pharmacology, psychopathology,
pathophysiology, diagnostic tests and National Patient Safety Goals.
Analyze care using the Critical Thinking Model and the Nursing Process for patients with complex needs
emphasizing the prioritization of care.
Analyze therapeutic communication when interacting and collaborating patients, families, groups and
members of the health care team.
Participate in the coordination of care with other members of the health care team.
Incorporate time management skills and efficient use of resources when managing care for more than one
patient or for one patient with complex needs.
Recognize responsibility for participation in lifelong learning activities, including student and professional
organizations.
Apply knowledge from BIOL 213 and utilize information literacy to identify evidence-based nursing
practice.
DEPARTMENT POLICIES:
See current Nursing Student Handbook via Nursing webpage.
COLLEGE POLICIES:
For information regarding:
Brookdale’s Academic Integrity code
Student Conduct Code
Student Grade Appeal Process
Please refer to the STUDENT HANDBOOK AND BCC CATALOG.
NOTIFICATION OF SERVICES FOR STUDENTS WITH DISABILITIES:
Brookdale Community College offers reasonable accommodations and/or services to persons with disabilities.
Students with disabilities who wish to self-identify must contact the Disabilities Services Office at 732-224-
2730 (voice) or 732-842-4211 (TTY) to provide appropriate documentation of the disability, and request
specific accommodations or services. If a student qualifies, reasonable accommodations and/or services, which
are appropriate for the college level and are recommended in the documentation, can be approved.
5
GRADING STANDARD:
In addition to the Academic Progress policy in the Brookdale Nursing Student Handbook the following policies
apply to Nursing 261.
1. Upon completion of the units as indicated on the course calendar, students will be given a written test based
on the unit outcomes. Grades will be determined as follows:
A = 94 - 100
A- = 90 - 93
B+ = 87 - 89
B = 84 - 86
B- = 81 - 83
C+ = 78 - 80
C = 74 - 77
D = 65 - 73
F = 64 or below
2. The course grade will be derived as follows:
Unit I The Patient with an Alteration in Mental Health (4 weeks) 25%
Unit II
The Patient with an Alteration in Cardiovascular Circulatory System & Tissue
Perfusion (4 weeks)
25%
Unit III The Patient with an Alteration in Oxygenation (3 weeks) 20%
Unit IV* The Patient with an Alteration in Metabolism (2 weeks)
The Patient with Shock, Burns and Hematologic Disorders (1 week)
Final Comprehensive Examination is 80 questions. 30%
*Unit IV content will be tested on the Comprehensive Course Final Exam
3. Students are encouraged to take ATI-Learning Systems RN tests in the practice and assessment mode for
each unit.
4. Students are encouraged to participate in all discussion forums (required in the online sections).
5. If an examination is conducted in the classroom or computer lab, the examination will start promptly
according to the course calendar. If the student is late, no additional time will be given for the examination.
The examination will end at the posted times. Provision will be made for students with disabilities
according to College policy.
6. The clinical laboratory evaluation must reflect a pass grade in order to receive a passing grade in the course.
6
7. All students are required to meet examination schedule requirements as stated on the course calendar. Any
student who is unable to meet this schedule must speak personally to the instructor responsible for the
examination at least 1(one) week prior to the exam.
8. All College laboratory skills and all assignments must be completed by the due date as noted on the NURS
261 course calendar.
9. In order to pass this course, the student must:
a) Complete all College laboratory skills and all assignments;
b) Achieve a pass grade in clinical laboratory;
c) THE FOLLOWING APPLIES:
The quality of your participation also counts. Students must achieve at least 74 points on EACH
required online learning activity in order to achieve a passing grade for your online participation.
Failure to submit an assignment or unsatisfactory performance in online activities (total less than
74 points) will result in a course failure.
All activities must be submitted by the assigned due dates. If you anticipate missing the deadline for a
learning activity, you are responsible to contact faculty before the due date. If you do not contact
faculty or do not submit the required learning activity, you will be assigned a zero, as per the
Nursing Student Handbook.
Assuming you have earned 74 points on each online learning activity the average grade of your four unit
tests will be your course grade.
d) Achieve a course grade of 74% or above. Students who do not achieve a course grade of 74% will fail
the course.
7
NURSING 261
STUDENT GRADE WORKSHEET
Unit I
X 0.25 =
Unit II
X 0.25 =
Unit III
X 0.20 =
Final Course
Exam (includes
unit IV content)
X 0.30 =
Course Grade
8
Name of Unit: Unit I: Nursing Care of the Patient with Alterations in Mental Health
Method of Evaluation: Multiple Choice and Alternative Item Format Examination (40 questions)
Time to Achieve: 4 weeks
Learning Outcomes
Content Learning Experiences
General Considerations 1. Complete a holistic assessment
using the human needs framework for a mental health patient.
2. Plan care for the mental health patient incorporating the elements of critical thinking and the nursing process.
3. Implement care for the mental health patient integrating knowledge of both normal and physiologic changes as well as complex pathophysiology.
4. Accurately calculate dosage and
safely administer medication to a patient experiencing medication to a patient experiencing an alteration in mental health noting the therapeutic and adverse pharmacologic effects.
5. Utilize the principles of therapeutic
communication when interacting with a patient that has an alteration in mental health.
6. Recognize the need to effectively
interact with members of the health care team when caring for the mentally ill patient and significant others.
7. Utilize time management skills and
prioritizing care for more than one complex care patient with an alteration in mental health.
8. Identify legal and ethical issues
related to maintaining patient confidentiality that directly affect the delivery of safe professional
General Considerations A. Assessment B. Clinical judgment and
prioritization C. Medications D. Communication E. Collaboration F. Legal/Ethical Issues G. Etiology of Disorders:
(Chapter 3) Genetic Theories Biologic Theories Neurochemical Theories Psychodynamic Theories
Interpersonal theories Behavioral theories Cultural Considerations
H. Prior to beginning this unit the student will review:
the anatomy and physiology of the parasympathetic/sympathetic nervous system
central nervous system
therapeutic communication
defense mechanisms
normal anxiety
stress response
mental status exam
grief/loss
Assessment (chapter 8)
Required Text: Videbeck, S. Psychiatric mental health Nursing (6 or7th ed.), Philadelphia, Pa.: Lippincott Williams & Wilkins Kee, J.L. Hayes & McCuistion, E.R.Pharmacology A Nursing Process Approach (8th ed.) Philadelphia, PA: W. B. Saunders Company Study Guide For Pharmacology A Nursing Process Approach (8th ed.). Philadelphia, PA: W.B. Saunders Company
9
Learning Outcomes
Content Learning Experiences
nursing care to mental health patients.
9. Manage and evaluate nursing care responding to adverse effects of medication, ECT or any diagnostic tests.
10. Demonstrate responsibility for
professional and personal development in lifelong learning activities.
11. Utilize technology to obtain
evidence-based nursing practices and legal/ethical issues for a patient with an alteration in mental health.
Introduction to Mental Health
Nursing Week 1 (of 4)
I. J. Treatment Modalities
Crisis intervention
Behavior modification
Group/Family therapy
Psychopharmacology
Concepts
Assessment
Special Note: Key Terms in Each Chapter
o Laboratory Studies specific to disorders and medications
Week 1 (of 4)
Mental health/mental illness History of Mental Illness Examine personal beliefs Describe the range of
treatment settings Factors contributing to
mental illness Therapeutic Milieu Mental Status Assessments Barriers effecting successful
integration to the community Prejudice/stereotypes Diagnostic & Statistical
Manual of Mental Disorders
Required reading: Videbeck (6 7thed.): Chapter 3 Chapter 8
Videbeck Chapter 8 (very important) Week 1 (of 4) Required Reading: Videbeck: Ch. 1 & 4, Media Presentation on (Canvas) (14 minutes) Chapter Study guides
CANVAS Learning Resources
10
Learning Outcomes
Content Learning Experiences
Specific Considerations Nursing Care of the Experiencing Alterations in Mental Health 1. Assess the needs of the mental
health patient focusing on but not limited to: anxiety/panic disorders,
post-traumatic stress disorder/
mood disorders (depression & mania), the crisis of suicide, anger hostility, aggression, psychotic disorders (schizophrenia & drug induced psychosis), substance abuse, dual diagnosis, and delirium.
2. Monitor the influences that physiologic, emotional changes, developmental roles and the cultural values have on the mental health patient and significant others.
3. Collect data to plan nursing
interventions that will help the patient and significant others cope with the specific mental health disorder.
4. Respond to common clinical
problems associated with mental health disorders using the following therapeutic framework: listen, communicate, facilitate, and reward.
5. Assess the increased nutritional
needs which mental health disorders impose.
6. Develop teaching strategies to help
patients meet their nutritional needs including but not limited to the needs for the following supplements: vitamins B, A, C, D, E, and K.
Week 1 (of 4) Nursing Care of the Patient Experiencing Anxiety/Anxiety Disorders, And Stress – Related Illness/Panic/Panic Disorder, Post-traumatic Stress Disorder, Personality Disorders-Antisocial & Borderline
Anxiety/Anxiety Disorders, And Stress-Related Illness/Panic & Panic Disorder Specific Considerations Application of the Nursing Process:
History General Appearance &
Motor Behavior Mood & Affect Thought Processes &
Content Sensorium & Intellectual
Processes Judgment & Insight Self-Concept Roles & Relationships Physiologic & Self-Care
Concerns Data Analysis Outcome Identification Interventions
Self-Awareness Issues Points to Consider When Working with Clients with Anxiety & Stress-Related Illness Key Points & Terms
Week 1 (of 4) Nursing Care of the Patient Experiencing Anxiety/Anxiety Disorders, And Stress –Related Illness/Panic/Panic Disorder, Post-traumatic Stress Disorder, Personality Disorders-Antisocial & Borderline
Required Readings: Videbeck (6 or7th ed.): Chapter 2 , 13 (Focus on Post Tramatic Stress Disorder) Chapter 14 (Focus on Anxiety & Stress Related Disorders including Panic & Panic Disturbance) Chapter 18 (Focus on Anti-Social & Borderline Personality Disorder) Kee & Hayes Antiolytics Kee & Hayes Study Guide, Clinical Vignette Panic Disorder: (Videbeck) Critical Thinking questions: (Videbeck) Chapter Study Guide: (Vidbeck) CANVAS Learning Resources
11
Learning Outcomes
Content Learning Experiences
7. Design a teaching plan that addresses risk factors and early symptoms recognition of an impending crisis.
8. Plan nursing interventions to
prepare the mental health patient for diagnostic tests such as electroconvulsive therapy, laboratory, work, imaging studies etc.
9. Monitor the patient following
electroconvulsive treatments and report changes in the patient’s condition.
10. Plan therapeutic interventions that
will promote a healthy outcome for the patient threatened by psychological and physiologic complications.
11. Collaboratively review with health
care personnel assessment findings.
12. Apply principles of reality
orientation, safety, and anxiety reduction when caring for a patient following electroconvulsive therapy (ECT) and other diagnostic studies.
13. Plan interventions to assess the
progression/lack of progression of the treatment program.
14. Implement nursing interventions
appropriate for the patient experiencing an alteration in mental health and any physiologic concerns.
15. Plan nursing interventions to
stabilize the patient in crisis.
16. Plan interventions for patients with alterations in mental health or conditions that have accompanying complications including but not
Week 1 (of 4) Post-Traumatic Stress Disorder Specific Considerations Application of the Nursing Process:
Health History General Appearance &
Motor Behavior Mood & Affect Thought Process & Content Sensorium & Intellectual
Processes Judgment & Insight Self-Concept Roles & Relationships Physiologic Considerations Data Analysis Outcome Identification Interventions Self-Awareness Issues Points to Consider When
Working with Abused or Traumatized Clients
Specific Considerations
Intrusive thoughts
Flashbacks
Nightmares
Grief/Guilt facilitation
Suicide risk/homicidal behavior
Substance Abuse
Dissociation
Grounding techniques during a flashback
Hyperarousal
Hypervigilance
Irritability
Trauma
Week 1 (of 4)
Nursing Care of the Patient with Post Traumatic Stress Disorder Clinical Vignette Post Traumatic Stress Disorder Critical Thinking Questions: Videbeck Chapter Study Guide Videbeck Canvas Learning Resources
12
Learning Outcomes
Content Learning Experiences
limited to: diabetes, cardiac disease, endocrine, respiratory, neurological, respiratory or substance abuse problems.
17. Perform a focused assessment on
the assigned patient/s.
18. Assess the learning needs of the patient’s with an alteration in mental health to assist with self-care measures that promote wellness and relieve discomfort.
19. Observe and document signs of
progression/regression/crisis using SBAR.
20. Become aware of patients at risk
for homicide/suicide on the clinical unit.
21. Assess warning signs of impending
assault and compare with textbook behaviors.
22. Plan nursing interventions to assist
at risk patients including but not limited to: one-to-one observation; no-suicide contract, seclusion, restraint, and rapid tranquilization.
23. Safely calculate and administer
neuroleptic medications to the mental health patient monitoring for adverse and expected side effects of the prescribed medications using the 8 rights and 4 checks. Included but not limited to:
Anxiolytics
Antipsychotics
Adjunctive medications
Anticholinergic
Antihistamine
Dopamine agonist
Antidepressants
Mood stabilizers
Anticonvulsants
Pharmacological Management for
above disorders Antianxiety drugs/Anxiolytics
Benzodiazepines Non-benzodiazepines
Special Considerations (Pharmacology)
Dependence Tapering Safety Drowsiness Tolerance
Week 1 (of 4)
Personality Disorders
Antisocial
Borderline
Application of the Nursing Process : Antisocial/Borderline Personality Disorders
Assessment Mood & Affect Thought Process & Content Sensorium & Intellectual
Processes Judgment & Insight Self-Concept Roles & Relationships Data Analysis Outcome Identification Interventions
Special Considerations: Traits
Splitting/polarized thinking
Week 1 (of 4)
Nursing Care of the Patient with a Personality Disorder-Antisocial-Borderline Clinical Vignette: Antisocial Personality Disorder: (Videbeck) Clinical Vignette Borderline Personality Disorder: (Videbeck) Critical thinking questions: (Videbeck) Chapter Study Guide: (Videbeck) Canvas Learning Resources
13
Learning Outcomes
Content Learning Experiences
24. Explain trends in mental health care and discuss the need for related prevention programs ensuring cultural considerations.
25. Plan care that incorporates nursing interventions that will promote healthy outcomes for the patient with an alteration in mental health using evidenced based nursing practice.
26. Develop illness management
teaching plans for patients with mental health disorders.
27. Document and evaluate the patient
and family’s responses to nursing interventions. Proposes changes as needed.
28. Use the Diagnostic and Statistical
manual of Mental Illness (DSM IV) to identify characteristics of specific mental health disorders and compare them to patient symptomology.
29. Use of Erickson’s theory of
emotional development to plan care for patients with alterations in mental health.
30. Collectively review agency
protocols for safety.
31. Evaluate agency guidelines for handling a crisis by using universal protocols. Propose changes if necessary.
32. Evaluate protocols on the mental
health unit that ensure safety when implementing seclusion, restraint, and rapid-tranquilization.
33. Employ evidenced based practice
in planning care.
Safety
Impulse control
Suicidal/homicidal ideation
Manipulation
Decatastrophizing
Boundaries
Limit Setting
Delaying gratification
Time out Pharmacologic Management Key Points & Key Terms Week 2 (of 4) Nursing Care of the Patient with Anger, Hostility, Aggression-Legal & Ethical Issies Schizophrenia/psychosis Anger, Hostility, & Aggression Ethical/Legal Issues Special Considerations Onset and clinical course
Applying the Nursing Process Assessment’ Data Analysis Intervention
Legal Aspects
Seclusion Restraint Suicide/homicide contract Agency protocols Duty to warn Third Parties Chemical restraint Rights Confidentiality Least Restrictive
environment Privacy
Five Phase Aggression cycle
Triggering Escalation
Week 2 (of 4) Nursing Care of the Patient with Anger, Hostility, Aggression-Legal & Ethical Issues Schizophrenia/psychosis
Required reading: Videbeck (6th or 7th Ed.) Ch. 2, 9 & 10 & 16 Kee & Hayes Antipsychotic Medications Kee & Hayes Study Guide Chapter Study Guide: Videbeck Critical Thinking Questions: Videbeck Canvas Learning Resources Clinical Vignette: Seclusion
14
Learning Outcomes
Content Learning Experiences
34. Describe the barriers to prevention of mental illness and comprehensive treatment program.
35. Determine if affect, interest, and
energy levels are appropriate to accomplish ADL.
36. Assess warning signs of impending assault.
37. Monitor and reinforce all patient attempts to:
Reduce anxiety
Enhance coping
Maintain role-performance
Focus on problem-identification
Demonstrate health ways of dealing with the mental illness
Interpret and respond to messages objectively
Comply with prescribed facility and treatment regimens
Use coping strategies in a function adaptive manner
Eat adequate amounts of different food groups
Adjust to the prevailing emotional tone in response to circumstances
Concentrate on as specific stimulus
Refrain from gestures and attempts at self-harm
Make choices amongst alternatives
Refrain from behaviors that are intimidating or frightening to others
Contract for safety
Develop personal judgment and self-worth
Describe feelings without aggression
Use coping strategies in a functional adaptive manner
Maintain interest in life
Crisis Recovery Post-Crisis
Points to Consider When Working with Clients Who Are Angry, Hostile, or aggressive
Key Terms & Points
Self-Awareness Issues Pharmacological Management Benzodiazepines Anti-psychotics
Haloperidol (Haldol)
Risperidone (Rispiradol)
Ziprasidone (Geodon)
Lorazepam (Ativan) Laboratory Tests
Week 2 (of 4) Schizophrenia /Psychosis Special Considerations Key Points & Terms Application of the Nursing Process
Assessment History General Appearance, Motor
Behavior, & Speech Mood & Affect Thought Process & Content Sensorium & Intellectual
Processes/Judgment & Insight
Self-Concept Roles & Relationships Physiologic & Self-Care
Considerations Data Analysis Outcome Identification Interventions
Tarasoff Vs. Regents
(case law Duty to Warn) Week 2 ( of 4) Nursing Care of the Patient with Schizophrenia/Psychosis Critical Thinking Questions: (Videbeck) Chapter Study Guide: (Videbeck) Canvas Learning Resources
15
Learning Outcomes
Content Learning Experiences
Focus on non-chemical alternatives to deal with life situations
38. Collectively review and implement when appropriate the following National Patient Safety Goals: Hospital Settings:
Improve the accuracy of patient identification o Uses two patient identifiers
when providing care, treatment & services
Improve the effectiveness of communication among caregivers o For verbal or telephone orders
or for telephone reporting of critical test results, the individual giving the order or test result verifies the complete order or test result by having the person receiving the information record & “read-back” the telephone order or test result.
Improve the safety of using medications (8 rights and 4 checks) o The agency identifies a list of
look-alike/sound alike medications used and takes actions to prevent errors involving the interchange of these medications.
Reduce the risk of health care-associated infections o Comply with WHO (World
Health Organization) & CDC (Center for Disease Control) hand hygiene guidelines when providing services to high-risk population or administering physical care.
Community Based Care Self-Awareness Issues Points to Consider When
Working with Clients with Schizophrenia
Unusual speech patterns Positive & Negative Symptoms
Hallucinations
Delusions
Illusions
Safety
Suicide/homicide
Early Signs of relapse Sub-types
Catatonic
Paranoid Special Considerations:
Antipsychotic agents
Extrapyramidal effects/Other side effects: (serious)
Dystonic Neuroleptic Malignant
Syndrome Photosensitivity Agranulocytosis
Maintenance Therapy (Examples)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Aripiprazole (Ability)
Pharmacologic Management:
Pharmacologic Management for Extrapyramidal Side Effects
Laboratory Tests
Key Terms & Points
16
Learning Outcomes
Content Learning Experiences
o Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function related to a health care associated infection.
Accurately and completely reconcile medications across the continuum of care. o Identifies agency policy for
comparing the patient’s current medication with those ordered for the patient while under the care of the organization.
o Identifies agency policy for the communication & documentation to the next provider of service of a complete and reconciled list of medications when transferring or discharging the patient.
o Agency policy for providing a
complete list of reconciled medications directly to the patient and family, and the list is explained to the patient and/or family.
Reduce the risk of patient harm resulting from falls.
Encourage patient’s active in their own care as a patient safety strategy o Agency policy for identifying
ways in which patient and family can report concerns about safety & encourage them to do so.
Identify safety risks inherent in its patient population
Week 3 (of 4)
Mood Disorders: Depression/Mania Crisis of Suicide Application of the Nursing Process-Depression/Mania
Assessment History General Appearance &
Motor Behavior Mood & Affect Thought Process & Content Sensorium & Intellectual
Processes Judgment & Insight Self-Concept Roles & Relationships Physiologic & Self-Care
Considerations Data Analysis Outcome Identification Interventions
Special considerations
Suicide Risk
Points to Consider When Working with Clients with Mood Disorders
Self-Awareness Issues
Privacy Pharmacologic Management Antidepressants Tricyclics Monoamine oxidase inhibitors
Week 3 (of 4) Nursing Care of the Patient with Mood Disorders:
Depression
Mania
The Crisis of Suicide Required Readings: Videbeck (6 or 7th ed.) Ch. 2, 17 Kee & Hayes: Mood Stabilizers & Anti-depressants, Anticonvulsants, Kee & Hayes (7th ed.) Study Guide Clinical Vignette: Depression Clinical Vignette: Manic Episode Critical Thinking questions: Videbeck Chapter Study Guide: Videbeck. Canvas Learning Resources
17
Learning Outcomes
Content Learning Experiences
o Agency policy for identifying patients at risk for suicide.
Improve recognition and response to changes in a patient’s conditions
Selective serotonin reuptake inhibitors
Atypical antidepressants/other compounds Serotonin/norepinephrine reuptake inhibitors
Special Considerations
Hypertensive crisis-foods to Avoid when Taking MAOI’s
Anticholinergic effects
Impotence
Drug Alert: Serotonin syndrome
Drug Alert: Overdose of MAOI & Cyclic Antidepressants
MAOI Drug Interactions
Weight gain Electroconvulsive Treatment
Expected effects
Serious side effects
Medications prior to treatment (sequence)
Bipolar Disorder Special Considerations
Nutrition/Diet
Finger foods
Fluids (lithium)
Stable salt intake (lithium)
No fad diets (lithium) Laboratory Studies Renal (Lithium) Hepatic function (Anti-
convulsant agents) Pharmacologic Management
Mood-stabilizers
Anticonvulsants used as Mood Stabilizers
Symptoms and Interventions of Lithium Toxicity
18
Learning Outcomes
Content Learning Experiences
Nursing Care of the patient experience the Crisis of suicide Identify the client is crisis. Apply knowledge of patient psychopathology to crisis intervention Guide the patient to resources to recovery from crisis
Special Considerations Lithium Toxicity Symptoms Key Terms & Points & Terms Week 3 (of 4)
The Crisis of Suicide Special Considerations
Warning Signs
Suicidal Ideation
Risky Behaviors
Lethality Assessment
Drug Alert: Antidepressants & Suicide Risk
Myths and Facts about Suicide
Suicidal Ideation: Client Statements and Nurse Responses
Relate crisis theory to the care of the suicidal patient
Privacy
Key Terms & Points
Pharmacological Management Antidepressants
Week 3 (of 4) Nursing Care of the Patient experiencing the Crisis of Suicide Required reading: Videbeck (6th or 7th ed.) Ch. 17 Chapter Study guide: Videbeck Critical thinking Questions: Videbeck
Canvas Learning Resources
Week 4 (of 4)
19
Learning Outcomes
Content Learning Experiences
Nursing Care of the Patient that Abuses substances/dual diagnosis/delirium/Psychosocial Needs of the Critically Ill Assess patients for drug/alcohol dependencies, withdrawal, overdose, or toxicities. Collaborate on key diagnostic data to formulate comprehensive nursing diagnoses. Encourage the patient to participate in support groups (e.g. Alcoholics Anonymous & Narcotic Anonymous. Plan Care focusing on, but not limited to, priority therapeutic nursing interventions:
substance use prevention substance use treatment support system enhancement delirium management reality orientation surveillance: safety coping enhancement sleep enhancement nutrition management electrolyte monitoring neurologic monitoring symptom management for
patients experiencing
Investigate percentage of mental health admissions for acute care is related to substance use/abuse in the clinical agency. Compare & contrast the patient’s symptomatology with DSM criteria. Safely calculate and identify medications prescribed. State the rationale for use; observe for side effects. Evaluate effectiveness. Collaborate with dietary to select vitamin and nutritional supplements.
Week 4 (of 4) Nursing Care of the Patient who abuses substances, dual diagnosis, delirium, Psychosocial Needs of the Critically Ill Adult Substance Abuse Special Considerations
Alcoholism
Opioids
Cocaine
Inhalants
Cannabis
Amphetamines
Hallucinogenic
Benzodiazepines
Pattern of drug use
Physical evidence of drug usage
3 h’s How much How long How often
Defense mechanisms Denial Rationalization Projection Key Terms & Points Physiological consequences (according to substance addicted to, abused, or ingested as an overdose) Pharmacologic management (according to substance addicted to, abused, or ingested as an overdose) Common Drugs Used for Substance Abuse Treatment Emergency interventions for abused substances: overdose/delirium tremens/withdrawal/intoxication
Nursing Care of the Patient who abuses substances, dual diagnosis, delirium, Psychosocial Needs of the Critically Ill
Required Reading: Videbeck (6th or 7th ed.) Ch. 19 (Addiction), Ch. 24 (Delirium not Dementia) (Dementia is taught in Nursing 262)
Clinical Vignette: Detoxification Clinical Vignette: Alcoholism Videbeck Interactive Case Studies: Alcohol Dependence: Substance Use & Abuse Chapter Study Guide: Videbeck Critical thinking questions: Videbeck Canvas Learning Resources
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Learning Outcomes
Content Learning Experiences
Participate with team members to review community resources. Monitor and reinforce all client attempts to:
minimize substance abuse consequences
enhance personal judgment maintain role expectations establish effective aftercare verbalize acceptance of
responsibility for behavior practice non-chemical
alternatives to deal with difficult situations.
evaluate the patient’s response to a treatment plan and revise as needed
Psychosocial Needs of patients with a Critical Illness (Camtasia on Canvas) 39. Identify risk factors for developing
mental health problems in your patient hospitalized for a critical illness.
40. Collectively identify areas of assessment that would be a sign of risk:
Physiologic
Emotional
Relational
Spiritual
Dual Diagnosis/Substance Abuse
Points to Consider When working with Clients and Families with Substance Abuse
Self-Awareness Issues Key Points Support groups
Week 4 (of 4)
Cognitive Disorders-Delirium
Application of the Nursing Process: Delirium
Assessment History General Appearance &
Motor behavior Mood & Affect Thought Process & Content Sensorium & Intellectual
Processes Judgment & Insight Roles & Relationships Self-Concept Physiologic & Self-Care
Considerations Data Analysis Outcome Identification Interventions
Community-Based Care Special Considerations
Differentiation Delirium/Dementia
Most common causes
Drugs causing delirium
Week 4 (of 4)
Nursing Care of the Patient Experiencing Cognitive Disorders: Delirium Clinical Vignette: Delirium Canvas Learning Resources
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Learning Outcomes
Content Learning Experiences
Patient/Family education for Delirium
Confabulation
Safety
Stimuli reduction Pharmacological Management
Antipsychotic medication (only when absolutely needed)
Week 4 (of 4)
Individual and Family Considerations Related to Illness Risk populations Lack of support Poor medical prognosis Interference in goal
attainment/achievement (Erickson’s theory)
Week 4 (of 4) Nursing Care of the patient with psychosocial needs with critical illness Media Presentation-Canvas-Electronic Lecture: Psychosocial Needs of the Critically Ill Adult
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Name of Unit: Unit II: Nursing Care of the Patient with an Alteration in Cardiovascular, Circulatory
System and Tissue Perfusion
Method of Evaluation: Multiple Choice and Alternative Item Format Examination (40 questions)
Time to Achieve: 4 weeks (refer to course calendar)
Learning Outcomes
Content
Learning Experiences
General Considerations: At the completion of this unit the student will be able to: 1. Utilize the holistic needs
assessment framework to assess patients with a cardiac disorder.
2. Utilize the critical thinking
model and the nursing process to determine appropriate and priority nursing diagnoses for a cardiac patient.
3. Safely calculate, administer,
assess and evaluate the effectiveness of medications used to treat a patient with an alteration in tissue perfusion.
4. Use therapeutic communication
with patients having an alteration in tissue perfusion, family and health care members.
5. Coordinate care of a patient
with an alteration in tissue perfusion with other members of the health care team.
6. Incorporate time management
skills and prioritizing of care for more than one cardiac patient or a cardiac patient with complex needs.
7. Demonstrate responsibility for
professional and personal development in lifelong learning activities.
8. Utilize technology to obtain
evidence-based nursing
General Considerations A. Assessment B. Clinical judgment and
prioritizing C. Communication D. Collaboration E. Medications F. Legal/ethical issues
Prior to this unit the student will review: Cardiovascular Anatomy and Physiology Mechanisms that control hemodynamics, blood pressure, pre-load, after-load, & cardiac output Assessment of cardiovascular system
23
Learning Outcomes
Content
Learning Experiences
practices and legal/ethical issues for the cardiac patient.
Week One Nursing Care of the Patient with an Alteration in Myocardial Tissue Perfusion (Coronary Artery Disease, Myocardial Infarction) 9. Assess the physiological,
psychological, developmental, environmental and learning needs of the patient with an alteration in myocardial tissue perfusion.
10. Critically analyze hemodynamic
stability as it relates to the cardiac patient.
11. Analyze data to manage a
patient with cardiac disorder, coronary artery disease/myocardial infarction and provide care and analyze implications for a cardiac patient undergoing a diagnostic test.
12. Complete a risk factor profile
for a patient with coronary artery disease.
13. Collaborate with members of
the health team to plan and implement appropriate interventions for a patient with acute chest pain.
14. Safely calculate, administer
and assess patient for effectiveness of medications used to treat a patient with decreased myocardial perfusion.
15. Plan, implement and evaluate
nursing care for the patient with an alteration in myocardial perfusion.
Week One Specific Considerations
Normal and abnormal function and assessment of the cardiovascular system including normal hemodynamics.
Concepts of preload, afterload and contractility in relationship to cardiac output.
Oxygen supply and demand.
Diagnostic testing of the cardiovascular system.
Modifiable and non-modifiable risk factors.
Angina: Stable Non-stable Variant (prinzmetal’s)
Nursing care of patient with angina: Activity Medications Analgesics Oxygen Teaching Psychological/psychosocial considerations
Nursing care of patient with myocardial infarction: Dysrhythmia recognition Pain management Medications (including MONA) Monitoring enzymes EKG Bedside monitoring Activity Diet Rehabilitation Therapeutic Communication
Therapeutic effects, nursing implications and rationale for cardiac medications used to treat a patient with decreased myocardial perfusion.
Week One Required Readings: Brunner (12th ed.) Ch. 26 & 28 Brunner (13th ed.) Ch. 25 & 27 Kee and Hayes (7th ed.) Ch. 42, 45, 46 CANVAS Learning Resources ATI Learning Resources
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Learning Outcomes
Content
Learning Experiences
16. Describe and explain standing orders for a patient on a telemetry/cardiac care unit.
17. Plan and implement nursing
interventions for pre-post op patient experiencing heart surgery.
18. Detect warning signs and
implement therapeutic interventions for a patient experiencing decreased cardiac output.
19. Assess the critically ill patient
and relate findings to pathophysiology.
20. Utilize therapeutic
communication to support the critically ill cardiac patient and family members.
21. Identify community resources
available for patients and family members affected by cardiovascular disease.
Week Two Nursing care of a Patient with a Dysrhythmia/Pacemaker 22. Analyze an EKG rhythm strip in
relation to the patient’s pathophysiology and compare to textbook norms.
23. Assess the patient’s
hemodynamic response to the dysrhythmia and implement therapeutic interventions.
24. Formulate Nursing Diagnoses
and outcomes for a patient with a dysrhythmia.
25. Safely calculate, administer
and assess the patient for the effects of anti-dysrhythmic medications.
Nursing care for procedures performed to enhance myocardial perfusion.
Nursing care for post-open heart patients: Hemodynamic monitoring Arterial lines Monitoring for decreased output of all body systems Prioritized nursing actions Collaboration among disciplines Intra-aortic balloon pump Anxiety reduction, enhanced coping techniques Psychosocial impact on patient and family
Week Two
Electrophysiologic properties of a cardiac cell.
Cardiac conduction system and sequence of events.
12 Lead EKG monitoring: Resting Exercise Holter
Bedside monitoring
Electrophysiological studies
Dysrhythmias: Etiology Pathophysiology Characteristics on EKG Clinical significance Pharmacological management Emergency protocol
Nursing Management of Dysrhythmias:
Week Two Required Readings: Brunner (12th ed.) Ch. 27 & 32 Brunner (13th ed.) Ch. 26 & 31 CANVAS: Learning Resources Kee and Hayes (7th ed.) Ch. 42 43 & 44 CANVAS Learning Resources ATI Learning Resources
25
Learning Outcomes
Content
Learning Experiences
26. Compare and contrast different types of pacemakers, while analyzing a rhythm strip and correlating findings with specific pacemaker terminology.
27. Utilize therapeutic
communication while working with a patient with a dysrhythmia, including family and health care team members.
28. Evaluate and document the
effectiveness of interventions for a patient with a dysrhythmia.
29. Investigate the role of the
telemetry or ICU/CCU nurse. Nursing Care of the Patient with Hypertension 30. Analyze physiologic changes
associated with the development and progression of hypertension.
Cardiac precautions Monitoring of cardiac output Embolus precautions Anxiety reduction Coping enhancement
Non-surgical methods of dysrhythmia management: Vagal maneuvers Cardioversion CPR Defibrillation Catheter ablation Temporary pacing
Nursing care and learning needs for adults with permanent pacemakers and automatic internal cardio-defibrillators.
Nursing care for patients in cardiac arrest: Ethical issues Prioritized interventions Medications
Nursing diagnoses for patients with cardiac dsyrhythmias: Altered cardiac output Decreased tissue perfusion High risk for injury Activity intolerance Anxiety Ineffective coping
Explain rationale for therapeutic interventions to meet the needs of a patient with a cardiac dysrhythmia: Cardiac precautions Dysrhythmia monitoring Cardiac output monitoring Embolus precautions Anxiety reduction Coping enhancements Identification of learning needs
Pathophysiology of hypertension and effect on target organs.
Primary verses secondary hypertension.
26
Learning Outcomes
Content
Learning Experiences
31. Assess a patient for risk factors of hypertension.
32. Safely assess, administer and
evaluate the effect of medications used in the management of hypertension.
33. Design an individualized
teaching plan for a patient with hypertension.
Week Three Nursing Care of the Patient with Heart Failure 34. Assess the physiological,
environmental, psychosocial and learning needs of the patient with heart failure.
35. Correlate specific assessment
findings with compensatory responses of heart failure.
36. Analyze subjective and
objective data to formulate nursing diagnoses and desired outcomes for a patient with heart failure.
37. Safely calculate and administer
and observe effects of medications for patients with heart failure.
38. Design, implement and
evaluate a teaching plan of a patient and family affected by heart failure.
39. Recognize the physical,
spiritual and emotional needs of the patient and family, including anticipatory grieving.
40. Research and evaluate a
patient’s advanced directive
Gerontologic changes associated with aging process and relationship to blood pressure.
Nurse’s role in screening, assessment and patient teaching in hypertension.
Lifestyle modifications-identification of risk factors.
Medications used in the management of hypertension.
Week Three
Concepts of preload, afterload, contractility in relationship to cardiac output.
Pathophysiology of left and right sided heart failure.
Chronic verses acute heart failure including pulmonary edema.
Diagnostic tests for patients with heart failure: Purpose Significance Nursing care
Medications used in the management of heart failure: Dosage Therapeutic effects/side effects Scientific rationale Nursing implications
Nursing diagnoses for patients with heart failure: Impaired gas exchange Fluid volume excess Altered cardiac output Fatigue Activity intolerance Ineffective individual and family coping
Therapeutic interventions for patients with heart failure and rationale: Hypervolemia management Fluid and electrolyte management
Week Three Required Readings: Brunner (12th ed.) Ch. 29, 30 Brunner (13th ed.) Ch. 28, 29 Kee and Hayes (7th ed.) Ch. 42, 43 CANVAS Learning Resources ATI Learning Resources
27
Learning Outcomes
Content
Learning Experiences
and its impact on end-of-life care.
41. Investigate the clinical agency
policies regarding resuscitation. Nursing Care of the Patient with Cardiac Valve Disease/Inflammatory Disorders of the Heart 42. Assess the physiological,
psychosocial and learning needs of a patient with cardiac valve disease.
43. Formulate nursing diagnoses,
interventions and outcomes for patients with cardiac valve problems.
44. Differentiate between various
inflammatory disorders of the heart.
Fluid reduction Embolus precautions Medication management Nutrition counseling Self-care assistance Teaching Positioning Oxygen therapy Activity management Psychosocial interventions in response to chronic illness Family/patient impact of anticipatory grieving
Etiology, pathophysiology, clinical manifestations of: Mitral stenosis Mitral regurgitation Aortic stenosis Aortic regurgitation
Nursing interventions to prevent complications and promote wellness in patients with cardiac valve disease.
Surgical approaches and nursing interventions for a patient undergoing repair of a defective valve (including open heart surgery).
Etiology, pathophysiology, clinical manifestations and nursing implications for inflammatory heart disorders:
Endocarditis Pericarditis Rheumatic carditis
Cardiac tamponade Cardiomyopathies
Heart transplant Pre & post-operative nursing implications VAD Ethical issues and considerations
28
Learning Outcomes
Content
Learning Experiences
Week Four Nursing Care of the Patient with Alterations in Tissue Perfusion and Vascular Disorders: PVD 45. Complete a vascular
assessment identifying findings with consideration of age and cultural variations
46. Review patient’s charts for
relevant information related to alterations in perfusion.
47. Develop a plan of care and
implement therapeutic interventions for a patient with actual or potential altered tissue perfusion.
48. Safely calculate and administer anticoagulants and vasoactive medications.
Week Four
Pathophysiology, etiology, incidence, prevention and treatment of acute and chronic arterial and venous disease: Arterial insufficiency Venous insufficiency Acute occlusion Aneurysms Varicose veins Phlebitis Buerger’s disease Raynaud’s phenomenon Venous thrombosis
Diagnostic assessment and tests for tissue perfusion/vascular disorders
Nursing Diagnoses for patients with peripheral vascular disorders: Altered peripheral tissue perfusion Activity intolerance Risk for impaired tissue integrity Knowledge deficit
NIC interventions-explain and understand rationale: Circulatory care: arterial/venous insufficiency Embolus care and precautions Skin surveillance Wound care Pressure ulcer prevention and care Emotional support Energy management Foot care Pain management
Pre/post-operative care for surgical treatment of PVD or aneurysms
Medications used in PVD including nursing implications
Week Four Required Reading Brunner (12th ed.) Ch. 31 Brunner (13th ed.) Ch. 30 Kee & Hayes (7th ed.) Ch. 45 & 46 CANVAS Learning Resources ATI Learning Resources
29
Name of Unit: Unit III: Nursing Care of the Patient with an Alteration in Oxygenation
Method of Evaluation: Unit Exam (40 questions multiple choice/alternate items)
Time to Achieve: 3 weeks
Learning Outcomes
content
Learning Experience
Prior to this unit, the student will review the anatomy and physiology of the Respiratory System, Assessment of the Respiratory System, methods of oxygen administration and basic nursing interventions.
At the completion of this unit, the student will be able to:
General Considerations
1. Perform a holistic assessment, using the human needs framework and the Needs Assessment Guide, for patients across the life-span with a respiratory disorder.
2. Develop appropriate nursing diagnoses in the patient with a respiratory disorder.
3. Implement appropriate clinical judgment and prioritization, incorporating evidence based practice and incorporating patient’s active involvement when managing the patient’s airway or caring for a patient with respiratory disorder.
4. Use principle of therapeutic communication with patients having a respiratory alteration or the patient with an artificial airway who is unable to vocalize.
5. Collaborate with the health care team in the care of a patient with a respiratory disorder emphasizing management of activities of daily living and conservation of energy.
6. Accurately calculate dosage and safely administer respiratory medications, using the 8 rights and 4 checks & monitoring expected
General Considerations A. Assessment B. Clinical judgment and prioritizing C. Communication D. Collaboration E. Medications F. Legal/ethical issues
Note: Classes will include structure and concepts of Narrative pedagogy – all students are invited to actively participate in class and discussion forums sharing their experiences, thoughts and stories.
Prior to this unit the student will review: Brunner (12th ed.) Chapter 21 Brunner (13th ed.) Chapter 20 College Nursing Lab
Review lung and heart sounds on mannequin CANVAS Learning Resources ATI Learning Resources
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Learning Outcomes
content
Learning Experience
and adverse effects. (NPSG.01.01.01, Use at least two patient identifiers when providing care, treatment, and services).
7. Identify legal and ethical issues that directly impact patients with a respiratory alteration.
8. Manage care for 1-2 patients
requiring respiratory interventions, incorporating time management, efficient use of resources, to include reporting critical values and using Hand Off Communications e.g. SBAR and with consideration of the National Patient Safety Goals. (NPSG.02.03.01, Report critical results of tests and diagnostic procedures on a timely basis).
Week 1 Nursing care of the patient with upper respiratory problems 9. Compare and contrast the
pathophysiology, age related concerns, clinical manifestations, complementary and alternative therapies, and collaborative management/therapeutic interventions of respiratory disorders.
10. Research the patient’s chart to analyze lab and diagnostic tests specific to the respiratory system.
11. Discuss patient-teaching needs relative to diet, exercise, medication and management of alterations in oxygenation.
12. Provide care for patients having
upper respiratory disorders or related surgery with consideration of psychosocial and cultural concerns.
13. Use NANDA and therapeutic
nursing interventions to include
Week 1 A. Normal and abnormal
function and assessment of the Respiratory system including basic diagnostic tests.
B. Problems of the upper airway – (including pathophysiology)
Infection
Nose and sinuses
Pharynx and larynx
Nursing care in surgery and procedures.
Nasal trauma, deformities or obstruction
Nasal reconstruction and surgery-nursing care
Sleep apnea
Malignancies
Laryngeal cancer
Nursing care of the patient with laryngeal surgery
Nursing care of the patient with an artificial airway Oral and nasal airways Endotracheal tubes Tracheostomy/
Week 1 Required Readings Textbooks Brunner (12th ed.) Ch. 21, 22, 25 Brunner (13th ed.) Ch. 21 & 22 CANVAS Learning Resources ATI Learning Resources
31
Learning Outcomes
content
Learning Experience
teaching, to prioritize individualized care for a patient with an upper respiratory disorder.
14. Demonstrate appropriate
assessment and implementation of suctioning and/or trach/laryngectomy care.
15. Compare and contrast the collaborative interventions and treatments for patients with infectious, noninfectious and cancerous processes of the upper respiratory tract.
Week 2 Nursing care of the patient with an alteration in chest wall integrity/chest trauma. 16. Plan and implement care for a
patient with an alteration in chest wall integrity.
Nursing care of the patient with a chronic alteration in oxygenation or chronic airflow limitation (CAL) 17. Utilize critical thinking strategies to
plan and evaluate care for the patient with a chronic alteration in oxygenation with consideration to quality of life.
18. Discuss the nursing implications
related to managing respiratory medications via the inhalation route.
19. Assess the patient’s need for
respiratory treatments and oxygen therapy, and evaluate the response.
20. Identify available community
resources to promote wellness for patients and family members affected by a chronic alteration in oxygenation.
laryngectomy tubes
Therapeutic nursing interventions for respiratory disorders and monitoring.
Incentive Spirometry
Peak flow meters
Pulse Oximeters Suctioning
Oropharyngeal
Nasopharyngeal
Tracheostomy/
Laryngectomy tubes Week 2 C. Nursing care of the patient
with an alteration in chest wall integrity/chest trauma
Negative intrapleural pressure in the mechanics of ventilation
Compare and contrast the pathophysiology, clinical manifestations, collaborative care and nursing interventions for patients with:
Pneumothorax (open and closed)
Tension pneumothorax
Hemothorax
Pulmonary contusion
Rib fractures
Flail chest
D. Nursing care of the patient with a chronic alteration in oxygenation
Etiology, pathophysiology risk factors, life span considerations and clinical manifestations for patients with:
Chronic obstructive pulmonary Disease (emphysema/chronic bronchitis/asthma)
Interstitial lung disease: pulmonary fibrosis
Week 2 Required Reading Textbooks Brunner (12th ed.) Ch. 14 (p. 293-298) & Ch. 23 Brunner (13th ed.) Ch. 13 (Acid Base Disturbance) p. 267-272 & Ch. 23 Kee & Hayes (7th ed.) Ch. 29, 30, 31, 32, 41, 45 CANVAS Learning Resources ATI Learning Resources
32
Learning Outcomes
content
Learning Experience
21. Utilize the elements of reasoning to analyze strategies for smoking prevention and cessation.
Nursing care of the patient with respiratory failure and mechanical ventilation.
22. Identify risk factors, warning signs
for the development of respiratory failure and implement preventative interventions.
23. Use critical thinking strategies to assist in the care of a patient on a mechanical ventilator and collaborate with respiratory therapy to evaluate the patient’s response to ventilator settings/modes.
24. Use research based strategies to
prevent VAP in vented patients. (NPSG 07.03.01, Implement evidence-based practices to prevent health care-associated infections due to multidrug-resistant organisms in acute care hospitals).
25. Utilize time management skills and
efficient use of resources to provide safe nursing care to a
Diagnostic studies
Chest x-ray
Pulmonary function tests
Pulse oximetry
Arterial blood gas analysis
Sputum culture
Pharmacology
Bronchodilators Beta agonists Anticholinergics Antihistamines
Corticosteroids
Mycolytics
Leukotriene Inhibitors Learning needs, teaching strategies and discharge planning issues for a patient with a chronic alteration in oxygenation. E. Nursing care for the patient
with respiratory failure and mechanical ventilation
Concepts of ventilation and perfusion to differentiate the various causes of respiratory failure.
Etiology, pathophysiology, risk factors, clinical manifestations and collaborative care for patients with:
ARDS
Pulmonary embolus
Correlate clinical manifestations and ABG alterations with the pathophysiology of respiratory failure
Basic Knowledge of Ventilation settings, modalities, alarms: Assist control, etc
IMV, PEEP, pressure support, Rate, tidal volume, high and low pressure alarms.
33
Learning Outcomes
content
Learning Experience
patient with complex needs and identifying potential worsening in condition and seeking appropriate assistance.
Week 3 Nursing care of the patient with an alteration of acid base balance 26. Evaluate ABG results of a Patient
and correlate clinical assessment findings with the ABG results utilizing the ABG Assessment form.
27. Use NANDA and therapeutic nursing interventions to plan individualize nursing care for patients with acid base disorders.
Nursing care of the patient with problems of the lower airway
28. Compare and contrast the types of
lower respiratory infections and discuss the pathophysiology, risk factors, life span considerations, clinical manifestations and collaborative care.
29. Use critical thinking strategies to prepare a plan of care for the patient with a respiratory infection.
30. Accurately calculate, safely
administer, assess for side effects, and evaluate the effectiveness of medications for a patient with a respiratory disorder/infection.
Week 3 F. Nursing care of the patient
with an alteration of acid base balance:
Causes and effects of acid base imbalances
Homeostasis
Regulatory mechanisms
Knowledge of Compensation of acid base imbalances
Pathophysiology and expected management of:
Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis
Significance of arterial blood gas values in relation to respiratory function
Arterial blood gas interpretation
Nursing responsibilities for the collection of an ABG specimen.
G. Nursing care of the patient
with an problem of the lower airway
Infection
Bacterial pneumonia
Viral pneumonia
Tuberculosis
Screening
Diagnostic
Mode of transmission
Prophylaxis
Clinical manifestations
Therapeutic
Pharmacology
Antibiotics
Mucolytic/expectorants
Antitussives
Antitubercular drugs
Week 3 Required Readings
Textbooks Brunner (12th ed.), Chapter 23, 24, 25 Brunner (13th ed.) Chapter 21, 23, 24, 1 (p. 9-10) Key & Hayes, (7th ed.), Chapters 7, 23, 40, 41 CANVAS Learning Resources ATI Learning Resources
34
Learning Outcomes
content
Learning Experience
31. Utilize principles of infection control
to provide safe care for a patient with a respiratory infection. (NPSG.07.01.01, Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines).
32. Research agency protocols
concerning the management of tuberculosis.
33. Compare and contrast various
occupational lung diseases and their complications.
Nursing care of the patient with lung cancer 34. Compare and contrast the
pathophysiology and staging with various treatment modalities for the patient with lung cancer and plan nursing care appropriately.
35. Apply the Elements of Reasoning
to discuss ethical considerations when caring for a patient and family affected by terminal lung cancer.
36. Develop a plan of care using the
Hierarchy of Needs, and therapeutic communication & nursing interventions to prioritize care for a patient with lung cancer.
37. Develop a plan of care for a post
op patient having surgery affecting the respiratory tract. (NPSG 07.05.01 Implement evidence-based practices for preventing surgical site infections)
Nursing care of the patient with a pulmonary embolism
Acute respiratory distress syndrome
H. Nursing care of the patient with lung cancer
Risk factors, etiology, pathophysiology and staging of lung cancer.
Warning signs and clinical manifestations of lung cancer.
Diagnostic tests, and related nursing implications for lung cancer to include:
Lung scans
Biopsies
Thoractentesis
Treatment modalities and nursing responsibilities for patients with lung cancer to include:
Radiation therapy
Surgery (chest) Pneumonectomy Lobectomy Wedge resection Segmental resection
Community resources to assist with home management of patients with cancer.
I. Nursing care of the patient with a pulmonary embolism
35
Learning Outcomes
content
Learning Experience
38. Recognize the risk factors and assessments related to a pulmonary embolus and implement preventative strategies.
39. Accurately calculate, safely
administer, assess for side effects, and evaluate the effectiveness of medications of anticoagulants. (NPSG.03.05.01, Reduce the likelihood of patient harm associated with the use of anticoagulant therapy).
40. Analyze a patient’s coagulation
profile in relation to the laboratory norms for PT, PTT, INR (NPSG.03.05.01, Reduce the likelihood of patient harm associated with the use of anticoagulant therapy).
Effects of a pulmonary embolism on oxygenation and tissue perfusion.
Risk factors for the development of a pulmonary embolus and strategies for prevention.
Emergency care for patients with a pulmonary embolus.
Diagnostic test in relation to anticoagulant therapy: PT, PTT, INR.
Pharmacology: Review Anticoagulant medications
36
Name of Unit: Unit IV: Nursing Care of the Patient with an Alteration in the Endocrine System
Method of Evaluation: Tested on Comprehensive Course Final Exam
Time to Achieve: 2 weeks
Learning Outcomes
Content
Learning Experiences
General Considerations At the completion of this unit the student will be able to: 1. Perform a holistic assessment,
using the human needs framework and the Needs Assessment Guide, of patients across the life-span having alterations in endocrine function.
2. Develop appropriate nursing diagnoses in the patient with endocrine dysfunction.
3. Implement appropriate clinical judgments and prioritization incorporating evidenced based practice and patient’s active involvement when managing care for a patient with an endocrine disorder or related surgery (Incorporate National Patient [NPSG13].13.01.01).
4. Communicate effectively with patients having a metabolic alteration or the patient who is unable to vocalize due to disorder, diagnostic procedures or surgery.
5. Collaborate with the health care team in the care of a patient with an endocrine disorder emphasizing management of activities of daily living and conservation of energy.
6. Accurately calculate dosage and safely administer medications, using the 8 rights and 4 checks for endocrine disorders, monitoring expected and adverse effects. (NPSG.01.01.01)
General Considerations
Assessment
Clinical judgment and prioritizing
Communication
Collaboration
Medications
Legal/ethical issues
Note: Classes will include structure and concepts of Narrative pedagogy – all students are invited to actively participate in class and discussion forums sharing their experiences, thoughts and stories.
The student will utilize related readings and previously learned knowledge from Anatomy & Physiology text and from NURS 160, NURS 161, NURS 162.
Prior to this unit, the student will review the Anatomy and Physiology of the Endocrine system:
Structure and functions
Feedback systems
Hormones
37
Learning Outcomes
Content
Learning Experiences
7. Identify legal and ethical issues that directly impact patients with vascular or endocrine disorders.
8. Manage care for 1-2 patients needing therapeutic or caring interventions for endocrine disorders incorporating time management, efficient use of resources, to include reporting using SBAR and APIE, and documentation, with consideration of the National Patient Safety Goals. (NPSG.02.05.01)
Week 1 Patients with problems of Diabetes Mellitus (Pancreas) 9. Assess patients for risk factors,
signs and symptoms, and complications Diabetes Mellitus (DM) using the diabetic assessment.
10. Compare and contrast the manifestations, collaborative care, complementary and alternative therapies, and complications of DM.
11. Research patient charts and
analyze lab data with respect to DM.
12. Identify rationale for use and administers ant diabetic and oral hypoglycemic medications while monitoring therapeutic effect and any adverse effects.
13. Accurately calculate dosage and
safely administer prescribed medication such as sq insulin injections including mixing acceptable types and monitoring effects. (NPSG.01.01.01)
Week 1 Type I & Type 2 diabetes Acute and long-term complications of Type1 and Type 2 Cultural and age related considerations of diabetes
Acute
Hypoglycemia
Hyperglycemic
Diabetic ketoacidosis (DKA)
Hyperglycemic Hyperosmolar Syndrome (HHS)
Long Term
Macrovascular
Microvascular Lab and diagnostic tests used to diagnose and monitor self-management of DM to include:
FBS
GTT
HbA1C
Self monitoring of capillary blood glucose (SMBG)
Urine for ketones
Diet, insulin/medication and exercise in the management of DM.
Week 1 Readings – (required) Textbooks Brunner (12th ed.) Chapter 41 Brunner (13th ed.) Chapter 51 Kee & Hayes (7th ed.) Chapter 52 Kee & Hayes Workbook (7th ed.) Chapter 52 CANVAS Learning Resources ATI Learning Resources
38
Learning Outcomes
Content
Learning Experiences
14. Identify learning needs of a patient on a prescribed diabetic diet and assess knowledge of the prescribed diet by observing the selection of foods from a menu.
15. Develop a teaching plan with
selected peers for a newly diagnosed diabetic or on a diabetic with assessed learning needs.
16. Interact with the patient, family
members and health care team to assess and plan for the patient’s discharge.
17. Provide accurate information to
patients with DM to facilitate self-management of medications, diet planning, exercise, and foot care.
18. Use NANDA and therapeutic
nursing interventions to develop a plan of care for the diabetic patient to include considerations specific to age and culture.
Week 2 Specific considerations Concepts of nursing care for patients with endocrine problems
19. Compare and contrast the pathophysiology, clinical manifestations, and collaborative management/therapeutic interventions of endocrine disorders.
20. Discuss lab and diagnostic tests relative to the endocrine system.
21. Discuss patient-teaching needs relative to diet, exercise, medication and management of alterations in metabolism.
Types of insulin, onset, peak, duration of action and the administration via subcutaneous or IV injection or via pump administration, including nursing responsibilities.
Nursing implications for medications for DM to include:
glucagon
oral hypoglycemic agents
antidiabetics (comparing and contrasting various categories)
Sulfonylureas Biguanide Alpha-glucosidase
inhibitors Meglitinides Thiazolidinediones Combinations
Community agencies and support groups that are available to meet the needs of the diabetic patient
Week 2 Specific considerations
Endocrine pathophysiology
Labs and Diagnostics
T3, T4, TSH
Thyroid scan
Thyroid ultrasound
Thyroid biopsy
CT Scan
Vitamin D and Calcium levels
Hormone levels
Osmolality
Medications
Hormones
ACTH
ADH
Thyroid preparations
Antithyroid agents
Week 2
Required Readings:
TextBooks Brunner (12th ed.) Chapter 42 Brunner (13th ed.) Chapter 52
Kee & Hayes (7th ed.) Chapter 51
CANVAS Learning Resources ATI Learning Resources
39
Learning Outcomes
Content
Learning Experiences
Pituitary and Adrenal Gland Problems
22. Discuss considerations for patients having pituitary and adrenal disorders considering age related, psychosocial and cultural concerns.
23. Prepare a plan of care for the patient with pituitary or adrenal disorders focusing on but not limited to altered body image and/or physiological alterations.
24. Accurately calculate dosage and safely administer medications, monitoring expected and adverse effects for patients with pituitary or adrenal disorders. (NPSG.01.01.01)
Patients with problems of the Thyroid and Parathyroid glands
25. Develop a plan of care for patients
having thyroid and parathyroid disorders considering psychosocial needs, altered body image and/or physiological alterations and cultural and age related concerns.
26. Integrate principles of therapeutic communication to meet the communication needs of a patient with thyroid or parathyroid surgery who is unable to vocalize.
27. Accurately calculate dosage and
safely administer medications, monitoring expected and adverse effects for patients with thyroid or parathyroid disorders.
(NPSG.01.01.01)
Glucocorticoids
Calcium gluconate/carbonate
Disorders of the pituitary gland
Hyposecretion (anterior)
Hypersecretion (anterior) Acromegaly Gigantism
Hyposecretion (posterior) Diabetes Insipidus
Hypersecretion (posterior) SIADH
Disorders of the adrenal gland
Hypofunction Addison’s disease Addisonian crisis
(adrenal crisis)
Hyperfunction Cushing’s syndrome
(hypercortisolism)
Hyperaldosteronism
Adrenal Tumor Pheochromo-
cytoma Disorders of the thyroid gland
Hypothryroidism Iodine deficiency myxedema
Hyperthyroidism Thyroid storm
Disorders of the parathyroid glands
Hypoparathyroidism
Hyperparathyroidism
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Name of Unit: Unit IV: Nursing Care of the Patient with Shock and Burns, Hematology
Method of Evaluation: Tested on Comprehensive Course Final Exam
Time to Achieve: 1 week
Learning Outcomes
Content
Learning Experiences
Please note: Shock and Burns content will be tested on the final exam. Week 1 Nursing Care of the Patient in Shock 1. Differentiate Stages and
classifications of shock and Identify patients at risk.
2. Assess patients, formulate nursing diagnosis and respond with therapeutic interventions to early signs and symptoms of shock.
3. Safely calculate and administer medications for the patient in shock; evaluate expected and unexpected responses to medications.
Nursing Care of the Patient with Burns 4. Recognize the signs and
symptoms of burn injuries, evaluating the physiological and psychological effects and anticipate potential complications.
Week 1
Pathophysiology, stages and classifications of shock Hypovolemic Cardiogenic Distributive Obstructive
Assessment findings for different types of shock
Effects of shock on major body organs
Interventions for patients in various types of shock-prioritize Oxygen therapy IV therapy Respiratory monitoring Circulatory care Cerebral perfusion promotion Fluid/Electrolyte management Medications used in treatment of shock including nursing care
Nursing diagnoses for patients in shock Altered tissue perfusion Anxiety Decreased cardiac output Fluid volume deficit
Specific assessment findings of a patient with burns
Etiology of burn injuries
Risk factors, cultural considerations and prevention of burns
Classification of burns
Week 1 Required Reading: Shock Brunner (12th ed.) Ch. 15 Brunner (13th ed.) Ch. 14 Kee & Hayes (7th ed.) Ch. 59 CANVAS Learning Resources ATI Learning resources Required Reading: Burns Brunner (12th ed.) Ch. 57 Brunner (13th ed.) Ch. 62 Kee and Hayes (7th ed.) Ch. 59 CANVAS Learning Resources ATI Learning resources
41
Learning Outcomes
Content
Learning Experiences
5. Integrate cultural considerations; describe emergency care for the patient with burns.
6. Utilize therapeutic nursing
interventions, hierarchy of needs and NANDA to plan care for the patient with burns.
7. Safely administer and monitor
effects of pharmacologic agents used in patients with burns.
Blood Dyscrasias/Hematologic Disorders 8. Research patient’s charts with
blood dyscrasias, monitor and evaluate lab and diagnostic studies.
9. Develop and implement a plan of care for a patient with a hematologic problem.
Methods for estimating extent of burn injuries
Pathophysiology of burns
Systemic changes: Skin Vascular Cardiac Pulmonary GI Metabolic Immunological
Compensatory responses
Fluid and nutritional needs
Stages (phases) of burns
Patient and family teaching specific to managing burn injuries during all phases of care
Anemias
Polycythemia Vera
Coagulation disorders
Disseminated Intravascular Coagulopathy (DIC)
Thrombocytopenia
Non-Hodgkin’s Lymphoma
Lymphoma
Multiple Myeloma
Required Reading: Hematology Brunner (12th ed.) Ch. 33 Brunner (13th ed.) Ch. 33 (p. 899-909, 918, 921-922, 929) CANVAS Learning Resources ATI Learning resources
42
CLINICAL LAB GUIDE
43
Skills Designated for Observation Only
Students may observe staff but shall not perform any of the following techniques/activities:
a. Medications through or care of a central line
b. I.V. starts, venipuncture
c. Administration of blood or blood products (to include RhoGAM on obstetrics)
d. Telephone orders
e. Independent titration of IV narcotics, antiarrhythmics, antihypertensives or other flexible drug orders
f. Insertion of nasogastric tubes
g. IV pushes
h. Male catheterization (dependent on agency policy)
i. Peritoneal dialysis
j. Changing Ventilator settings
k. Finger stick blood glucose determinations
l. Patient controlled analgesia
m. Epidural analgesia
n. Techniques associated with arterial access lines
o. Mechanically assisted lifting devices
p. Signing narcotic waste
q. Witnessing a patient’s consent
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CLINICAL INTERVIEWING GUIDE
The following is a collection of hints to guide the therapeutic interview. Each strategy will be considered
separately and examples given with a discussion of the usefulness of the specific approach.
RULE # 1
There exists a hierarchy of questions and responses. They usually follow the schema:
description of the experience
feelings about the experience
thoughts the experience generated.
Any discussion of an experience without all three levels being addressed leaves gaps for both the patient’s
understanding and potential restructuring of the experience, as well as for the student’s grasp of the significance
of the experience.
EXAMPLE
Student: What happened, you look so upset?
Patient: My wife decided to leave me. (description of the experience)
Student: Tell me how that came about. (further descriptive exploration of the experience)
Student: Can you explain your feelings about her leaving? (requesting feelings about the experience)
Patient: I feel pretty guilty, and I guess a little angry with her. (feelings)
Student: What thoughts about this do you have…..?
Patient: Well, I think she has a good reason, I was gone a lot … and the other women … but then she had
some part in driving me to them … (thoughts)
DISCUSSION
The three “levels” of questions asked aid the patient in describing the event and clarifying his thoughts and
feelings. Had the student either skipped a level and simply asked, “How do you feel?” or offered an
expression of “sympathy” neither the patient nor student would have had the opportunity to gain insight into
the Gestalt of the experience or have firm confirmation that each knew about what the other was talking. The
patient might likely have answered, “I’m feeling pretty low.” Then the student is faced with the task of
assuming why and about what exactly the patient feels upset. She is back at the beginning and so is the
patient.
HINT: Remember: 1) situation, 2) feelings, and 3) thoughts.
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RULE # 2
It is not so much the stressful situation itself that the patient needs help in exploring, but the significance that
the situation has had for him/her.
EXAMPLE: Utilizing the previous example of the patient’s wife leaving
Student: What does this whole experience tell you about yourself?
Patient: I’m a failure. I failed as a husband. (It is the significance of the experience that has importance in
the nurse-patient relationship.)
DISCUSSION
Such an exploration is often lost when working with a patient. The significance is often concluded by the
student. For instance, the student initially may have assumed that the patient was depressed because he was
alone without a loving wife. However, appropriate questions indicate that in fact, the patient is feeling
depressed because he thinks he is a failure. This creates a different assessment of the patient’s need and has
implications for the direction of subsequent questions and interviews. For this patient, it is not the loneliness,
but the failure that is meaningful.
HINT: Always explore what significance an event has for a patient
RULE # 3
Never assume anything
EXAMPLE: (inappropriate)
Patient: I went home over the weekend.
Student: Oh, that’s terrific. Tell me about it.
OR
Patient: I’ve flunked out of college
Student: That must have been difficult for you. Let’s talk about it.
DISCUSSION
In both cases the student has assumed that the patient had a particular response to an event. These
assumptions may be completely out of phase with what the patient actually is experiencing. The patient may
have had a terrible time at home or may be pleased to be finally out of school as he only went because his
parents made him. Assumptions often can close patients from recognizing their feelings, but more crucial, is
that students proceed with interviews without a valid base.
EXAMPLE: (appropriate)
Patient: I went home this weekend.
Student: Tell me about it.
OR
Patient: I’ve just flunked out of college.
Student: What was that like for you?
DISCUSSION
Both of these responses allow the patients to being to share their perceptions, thoughts and feelings about the
events (Rule # 1). And, eventually pursue the significance of the event (Rule #2).
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RULE # 4
Make what is implicit, explicit.
EXAMPLE
Student: The student notices a patient following her around, but continually avoiding eye contact and never
asking to talk with her. The student thinks, “that patient probably wants to talk with me, but is
frightened to initiate contact.”
Student: (inappropriate) The student approaches the patient and says, “Would you like to play ping-pong?”
(Although the student with this response often feels she is filling the need of the patient for
contact, she has, in fact, missed the opportunity to model a clear statement of perception, the
chance to validate with her patient, and may have closed off verbal communication from the
patient about his needs at that particular time.
Student: (appropriate) The student approaches the patient and says, “I notice you’ve been watching me and
I thought that you perhaps wanted to talk but were a bit frightened to stop me. (The student shares
her observation and interpretation with the patient and allows him the opportunity to respond,
without biasing his response.)
Student: (appropriate) The student and the patient are having a dialogue and the student makes an obviously
wrong interpretation. The student says to the patient, “I guess that was the wrong idea, or that was
way off base …
OR
Student: (appropriate) The student and patient are engaged in therapeutic interviews and the student thinks
that the patient is agreeing with her only to avoid disagreeing, not because he really concurs with
what she’s saying. The student says to the patient, “It seems to me that you’re agreeing with me
only to avoid disagreeing.”
DISCUSSION
In each example the goal is to articulate and make explicit the implicit thoughts that the student and most
likely the patient are already having. This rule models for the patient the norm of clearly sharing what is
going on within and avoiding deception in the mutual partnership of the student-patient relationship. Here
exists the essence of consensual validation.
HINT: Make the implicit, explicit.
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RULE # 5
Use only open-ended questions rather than those that can be answered “yes” or “no”.
EXAMPLE: (inappropriate)
Student: Do you have brothers or sisters?
Patient: Yes.
OR
Student: Have you been to the hospital before?
Patient: Yes.
EXAMPLE: (appropriate)
Student: Tell me about your family.
Patient: Well, I have two brothers and one sister. My mother …
OR
Student: Tell me how you came to be hospitalized.
Patient: Well, I was here for six months in 1977 and have been doing all right until …
DISCUSSION
Questions that can be answered “yes” or “no” reveal little information and interfere with the total
communication process. They also communicate to the patient that the student is the director of the
interview and the patient only a passive responder.
HINT: Directive statements (tell me, talk about, share with me) are more helpful than those that begin with
“do”, “did”, “were”, and “was”.
RULE # 6
When the patient comments about people and things, always direct your questions to the patient’s relationship
with the people.
EXAMPLE: (inappropriate)
Patient: My brother and I bought a car together.
Student: Oh, what kind of car?
EXAMPLE: (more appropriate)
Patient: My brother and I bought a car together.
Student: Oh, tell me about your brother.
EXAMPLE: (most appropriate)
Patient: My brother and I bought a car together.
Student: Oh, tell me about you and your brother.
DISCUSSION
The first example is inappropriate in that the student only explores the inanimate object. It most likely will
not channel the interview into productive areas, or if it does, take precious time. The second example is more
appropriate because it at least asks the patient about his brother and focuses his perceptions on his brother.
This may give the student minimal familial data, but probably will serve only to encourage the patient to talk
about his brother rather than himself. The third example clearly directs the patient to talk about himself and
his relationship with his brother. It is these meaningful relationships that are fruitful for exploration by the
patient and student in an attempt to gain understanding and insight.
HINT: Remember the patient and his relationship to other people.
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RULE # 7
Never talk with the patient in generalities.
EXAMPLE: (inappropriate)
Patient: My mother never even liked me.
Student: How did she show that?
EXAMPLE: (appropriate)
Patient: My mother never even liked me.
Student: Tell me about one time your mother did something that told you she didn’t like you.
DISCUSSION
The first example asked the patient to speak generally about his perceptions of his mother’s feelings. Such a
question encourages a pervading view of a particular feeling. The following examples may help to clarify this
dynamic. “How do you feel about being a nursing student?” This question asks for a general conclusion.
Conversely, “How did you feel about being a nursing student on your first day of clinical? After your first exam?
When you told your parents you’d been accepted?” conjure different and distinct feelings. Each specific
question helps recall a particular database, which is by far more useful than response to a general question and
avoids encouraging the patient to merge and make consistent his recollections.
The second example demonstrates the specific approach. It is essential that such particular language be used
so that the patient has the chance to understand and eventually work through particular situations, thoughts,
and feelings.
HINT: Always be concerned with the particulars of time, place, and situation.
RULE # 8
Speak only for yourself; you cannot legitimately speak for anyone else.
EXAMPLE: (inappropriate)
Patient: None of you nurses care anything about me.
Student: That’s not true. We all care a great deal about what happens to you.
OR
Patient: Do you think my son understands why I can’t take care of him?
Student: Children are surprisingly resilient. I’m sure he’ll understand when he gets older.
EXAMPLE: (appropriate)
Patient: None of you nurses care anything about me.
Student: I can speak only for myself and I know that I care a great deal. What in particular happened that
gave you that idea?
OR
Patient: Do you think my son understands why I can’t take care of him?
Student: I don’t know. That’s a questions that neither one of us can answer. But the idea that he might not
understand seems to bother you. Let’s talk about that..
DISCUSSION
Students must model the process of not speaking for anyone but themselves. Students demand that patients
speak only for themselves and teach the necessity of this by complying with this norm. Additionally, one
never really knows how another feels or thinks, and speaking only for oneself prevents misinterpretation.
HINT: I feel and think; I perceive by others’ behavior what they feel and think. Developed by L. Servidio
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GUIDELINES FOR CHART REVIEW
1. Nursing History
preadmission meds
housing and family circumstances
health history
specific physical and psychosocial needs
how the patient came to be admitted to the hospital
2. Medical History and Physical
chief complaint
major admission diagnosis with initial problem list
detailed medical history
complete physical assessment
3. Consultations (medical specialists, dietary, therapists, psychiatrists, social service)
4. Progress Notes (may be physician notes only or multidisciplinary notes)
identifies major problems in problem-oriented language – recorded at least daily or when patient’s
condition changes
Correlate the physician assessments with your nursing assessments and validate findings (e.g., heart
murmur).
5. Diagnostic Tests
Research the chart for all tests that are pertinent to the patient’s diagnoses or treatment (e.g., Does the
patient on Digoxin have a Dig level ordered?).
Any pertinent tests not recorded in the chart?
Are diagnostic test abnormalities addressed in Progress Notes? Is there a plan to manage the
abnormality?
6. Operative Reports
Review the details of any operative or invasive procedure performed.
7. Medication Administration Orders
correlate with primary healthcare provider order
any errors (duplication, omission or inaccuracies?)
know how each medication relates to patient’s diagnosis
If you are not sure of rationale for a medication, look at Progress Notes or diagnostic tests for a clue.
Look for meds that need renewal.
Review sliding scale records of Insulin and Heparin.
What medications need to be reviewed (e.g., narcotics, antibiotics)?
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8. Primary Healthcare Provider Orders
Check orders for accuracy of Primary Healthcare Provider orders with medication record, IV flow
sheet, diagnostic tests.
Check for new orders over the course of the day.
Be sure standing orders have been implemented.
Check orders for accurate transcription.
9. Nurses’ Notes
Review Nurses’ Notes to ascertain patient’s response to illness and therapeutic interventions.
Identify problems that need immediate follow up.
Look for Nursing Care Plan and updated list of nursing diagnoses.
10. Patient Teaching Record
Validate content, teaching strategy and patient’s evidence of learning.
Evaluate written plans for the patient’s discharge.
11. Clinical Pathway
Locate the clinical care map or clinical pathway for your patient’s diagnosis.
Compare your patient’s health status to the expected outcomes
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GUIDE TO GIVING CHANGE-OF-SHIFT REPORTS
Name: Date: Criteria:
Organize data for shift report on work sheet __________
Known allergies __________
Present individual patient data (identify patient by name, age, room number, and attending physician)
__________
Special needs related to physical alterations __________
Primary diagnosis and procedures done to date __________
Secondary diagnosis with relevant history __________
Consultations __________
CPR status __________
Physician’s orders (include IV therapy, diet therapy, lab data, medication changes, and treatments)
__________
Current patient status (includes physical and behavioral responses to illness) __________
Lab data and diagnostic test results __________
Therapies or treatments administered __________
Plan of care (includes related assessments and patient’s response, e.g., trach care, dressing change, revisions, and long- and short-term goals)
__________
Discharge plans – communication with referral agencies, preparation of family members __________
Teaching plans, including charts, evidence of learning __________
Omit routine patient care activities __________
Omit subjective opinions and value judgments not related to individual patient care __________
Comments
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WEEKLY CLINICAL OUTCOMES
53
NURSING 261
WRITTEN CLINICAL ASSIGNMENTS
General Assignments for all clinical weeks
Student Assignment sheets on all assigned patients (follow guidelines in syllabus for Mental Health or Med-
Surg)
Pharmacology sheets and medication review in preconference whether or not meds are being administered
Unit I Mental Health – 4 weeks
Interpersonal Analysis (1)
Medication review in conference as if the student is administering the medication
Weekly nurses note following Mental Health Assessment charting Guide in syllabus.
Unit II Cardiac – 4 weeks
Concept Map (Faculty discretion regarding individual or group assignment-may be started early in Unit II
and must be complete by end of Unit III)
Unit III Respiratory – 3 weeks
One ABG Interpretation Sheet with critical analysis questions
Unit IV Endocrine – 2 weeks; Shock, Burns & Hematologic Disorders – 1 week
Assignment
1. Retrieve a nursing article on an Endocrine Disorder. Article must be current (within 5 years), must be from
the U.S. (not foreign) and peer reviewed article. May be started prior to Unit IV in order to make sure that
the assignment is completed by ALL STUDENTS by Clinical Week 13.
2. Write a 1-page typed paper to include a paragraph each on the following:
what were the major points of the article- strategies, content, etc
what does the article mean to you as a nursing student/nursing practice
what questions did the article make you think about
3. Use APA style
4. All students will present their paper in their clinical group
Flexible Clinical Assignment
Info Lit Journal Flexible assignment due one week after Critical Care/ER experience
Note:
All unit assignments are due no later than the Monday following the end of that particular unit, except where noted.
Please ensure comprehensive understanding of all medications your patient is receiving. Bring Mobile Device to clinical for reference
only.
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GUIDELINES FOR THE CRITICAL CARE EXPERIENCE - NURSING 261
Flexible Week
Preconference:
1. Assess the personal, environmental and illness-related stressors confronting the individual experiencing
trauma, surgery, or critical illness.
2. Identify the major concerns of family members of patients who are severely injured or critically ill.
3. Identify interventions to facilitate coping for the patient and family who are facing the stress of critical
illness, surgery or trauma.
4. Evaluate your own coping skills in the critical care environment. What does this experience tell you about
yourself and your professional goals?
Focus: Physiological and Psychosocial Aspects of Critical Illness (ICU, ER, Cath. Lab)
Clinical Outcomes:
1. Spend time – at least one hour or more – at the bedside of a critically ill person and evaluate the nurse’s role
relative to the following factors:
a. Presence: the number of times the nursing staff make contact with the patient to specifically attend to
psychological need versus physical needs.
b. Communication: 1. The number of verbal and nonverbal communications made to the patient of psychosocial
nature versus those of physical care nature.
2. Therapeutic communication techniques most frequently observed; nontherapeutic
communication techniques observed.
3. Remarks made by nurses to other staff members about the patient or the family, but not
intended to be heard by the patient.
c. Prevention of Sensory Deprivation: What type of sensory stimuli or information is made available to
the patient (orientation to time, place and person) and to prevent sensory deprivation? Use of eye
contact and therapeutic touch.
d. Prevention of Sensory Overload: level of noise in the environment (sensory overload) – alarms,
phones, ventilators, background conversations.
e. Families: manner in which information is delivered to family about the patient. Were cultural aspects
taken into consideration? Were families encouraged to interact or touch the patient? What type of
orientation/support regarding the critical care atmosphere was provided to families?
f. Delegation: of tasks to other members of health care team.
g. Prioritization: of nursing care encompassing the physiological and psychosocial aspects of the
critically ill person.
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Post Conference:
1. Evaluate your own coping skills in the critical care environment. What does this experience tell you about
yourself and your professional goals?
2. Debrief your impression of your patient’s psychosocial needs and the psychosocial nursing interventions
which you observed.
CRITICAL CARE JOURNAL ASSIGNMENT
1. Incorporates the physiological and psychosocial aspects of the patient in the specialty units
by addressing the specified clinical outcomes a. through g.
PLEASE UTILIZE THE a. through g. HEADINGS NOTED ABOVE IN YOUR
WRITTEN PAPER.
You MUST address ALL of these areas to get credit for the assignment.
2. Research a peer reviewed nursing article focused on the psychosocial aspects of critical
illness and you must integrate this information into the journal with proper APA citation
format.
3. Demonstrates reflective introspective thinking in a journal format writing.
Length of reflection must be 1 – 2 type written pages (no more than 2 pages)
WHAT IS A REFLECTION?
It is by definition a REFLECTION is an INTROSPECTION. Merriam-Webster defines
INTROSPECTION as “reflective looking inward: an examination of one’s own thoughts
and feelings”.
As you are writing, please look inward and examine your thoughts and feelings about your
experiences. Your writings should clearly explain and explore your thoughts and feelings.
E.g.: Imagine you are the patient and/or family member in a critical care area. How would
you think, what would your feelings be, what are your needs? What do you think you need
from hospital staff? As a student what is/was your reaction to the staff and their interaction
and communication skills with the patient/family? Would it be the same if you were the
patient or family? Most importantly, is this how you would behave or like your family or
yourself to be treated? What impact has this experience had on the kind of
PROFESSIONAL NURSE you want to be?
Learn to utilize Reflective expression in all your nursing assignments, not just this one!
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BROOKDALE COMMUNITY COLLEGE - NURSING 261
HEAD TO TOE ASSESSMENT
NEED NORMAL ABNORMALITIES
SENSATION/PERCEPTION Oriented to time, place, person, alert Confused, inappropriate speech, restlessness, disoriented, unresponsive to stimuli (verbal or painful), lethargic, combative
OXYGEN 1. Respiratory rate, depth & rhythm Respiratory pattern i.e., Cheyne Stokes, asymmetrical. Use of accessory muscles, nasal flaring, retractions (e.g., intercostal)
2. Lung sounds: anterior & posterior, predominately vesicular sounds; no cough or sputum
Sputum: describe amount, color and characteristics Breath sounds: describe area of rales, rhonchi, wheezes Cough: productive, nonproductive
3. Apical rate, rhythmS1 & S2 present Oxygen: type and rate of delivery
4. Peripheral pulses: equal bilaterally, carotid, brachial, radial, dorsalis, pedis present (posterior tibeal & popliteal when applicable)
Cardiac: S3, S4, murmur, irregular or rapid rhythm, PMI displaced Pulses weak, unequal or absent, asymmetrical Edema: pitting or non, location
Capillary refill (in ____ seconds) Extremities: asymmetrical in size, temp and/or color
NUTRITION Fluid intake: type, amount Feeding assistance needed - Thin, obese, cachetic
Diet: _____ % eaten
IV: location, appearance (without pain, redness or swelling) Type of line (size, peripheral or central) Type of solution infusing at ____ ml/hr (or gtts/min). Include additives Type of controller
N/G, gastrostomy tube: type, amount & rate of controller, placement checked Infiltration, redness, edema Decreased flow, occluded (stopped)
ELIMINATION Bowel sounds present Bowel sounds absent
Abdomen soft and non-tender Abdomen rigid, tender, distended, ascites
Last BM _____ (date), characteristics, normal pattern
Diarrhea, constipation, hemoccult positive
Urine: voiding clear, yellow, straw color. Without difficulty, amount per voiding
Urine: cloud, odorous, bloody, sediment present (describe), output < 30 ml/hr Foley present
SKIN Color, temp, turgor (elasticity) Pale, cyanosis, rubor, dusky, jaundiced
Diaphoretic, cool or cold, hot or clammy
Skin eruptions, breakdown, dressings, grains
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NEED NORMAL ABNORMALITIES
ACTIVITY, REST &
MOBILITY Strong, symmetrical movement of all extremities, ROM, gait
Weak, absent or asymmetrical extremity pain on movement, contractures
Level of self-care Presence of casts, splints, restraints
Diversional activity Unsteady gait or ataxia
COMFORT No objective or subjective (verbal or nonverbal) indications of pain
Describe characteristics of pain
Describe comfort measures, including any medications
PSYCHOSOCIAL Verbal & nonverbal behaviors bonding, cultural bonding, cultural factors
Knowledge deficit
Developmental level Pacing, tearful, detached, inappropriate
Patient teaching Non-communicative
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Interpersonal Analysis
Purpose: To help you analyze interpersonal responses during the clinical interview/assessment, reflect upon
your own performance and formulate recommendations for future interactions where needed~~~~~
Directions: Please answer the following questions after completing a nurse-patient interaction.
1. What were your feelings and myths prior to and during this interaction? Did they influence the outcome of
the interaction? Give details……
2. What did you learn about the patient that you did not know before? Ensure completeness in
description……
3. What particular communications skills did you use most often? Which communication techniques were you
most comfortable utilizing? Examples…..
Therapeutic:
Non-therapeutic:
Make recommendations for future interactions: What would you have done or done differently? If
anything please give details?
4. List any defense mechanisms identified: (be aware of when defenses were utilized and the purpose as
you assess it and the outcome as you attempt to use therapeutic communication to achieve a positive
outcome. What was your response; how did you handle this time in the interview; reflect, seek
clarity etc….)
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NURSING 261
Nursing and Human Needs III
Unit 1
WEEKLY CLINICAL OUTCOMES
Unit I
Week 1
Introduction into Mental Health Nursing
Foundations of Psychiatric Nursing
Treatment Settings & Therapeutic Programs
Mental Health Assessment
Unit I
Week 1
Nursing Care of the patient with:
Anxiety, Anxiety disorders/Stress/Related Illness-Panic,
Panic Disorder/Post Traumatic Stress Disorder
Personality Disorders
o Antisocial
o Borderline
Unit I
Week 2
Nursing Care of the patient with:
Aggression, Anger, Hostility
Legal & Ethical Issues
The Patient Experiencing Schizophrenia and Other Psychotic
Disorders
Unit I
Week 3
Nursing Care of the patient with:
The Patient Experiencing Mood/Affective Disorders
The Patient who is experiencing the crisis of Suicide
Unit I
Week 4
Nursing Care of the patient with:
Substance Use/Related Disorder/Delirium/Dual Diagnosis
Psychosocial Needs of the Critically Ill Adult
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61
BROOKDALE COMMUNITY - NURS 261
Mental Health Assessment Charting Guide
Mood/Affect Appropriate Inappropriate, labile, apathetic, dramatic, fearful, angry, anxious, ambivalent, euphoric
Motor Behavior Purposeful Psychomotor retardation/agitation, waxy flexibility, restless/facial grimacing/gestures, passive.
Thought Process Content/Speech
Congruent Logical
Flight of ideas, loose associations, delusions, mute, suicidal ideation, obsessions
Speech Articulate Slurred, rapid, monotone, slowed
Sensorium
Oriented X3 Able to concentrate Accurate perceptions Can explain current problem Able to process information
Disoriented Distracted Hallucinations
Judgment/Insight
Interprets environment accurately, can identify strengths and weaknesses Ability to analyze a problem objectively Can delay gratification
Lack of reasonable care for oneself, risky behaviors (placing oneself in unsafe situations), impulsive, irrational Insight poor, places blame on others
Appearance Appropriate Grooming poor, inappropriate dress, body odor
Comfort No objective or subjective (verbal or nonverbal) indications of pain No medical problems
Describe characteristics of pain Describe comfort measures, including any medications, medical problems, physical impairments or disabilities, self-care deficits
Coping Skill Adaptive to internal and external stressors; use of adaptive coping mechanisms and techniques
Maladaptive (overuse of defense mechanisms)
Roles and Relationships
Aware of abilities and responsibilities, engages in rewarding activity congruent with societal standards
Roles and relationships are a significant source of stress
Discharge Planning
Medications/plans Patient teaching needed. What, when, how? Who should be included?
Note: When describing abnormalities, use behavioral terms and record observations!!!!!
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NURSING 261 CLINICAL OUTCOMES
Clinical Week 1
Focus: Foundations of Psychiatric – Mental Health Nursing
Clinical Learning Outcomes:
1. Identify how the DSM-IV multi-axial system facilitates patient assessment in a mental health
setting.
2. Compare and contrast the DSM-IV and NANDA.
3. Discuss Neurologic theories & how they relate to success in treatment of mental illness.
Preconference:
1. Define a diagnostic system and evaluate the purposes, advantages, and disadvantages.
2. Review the five axes that make up the DSM-IV.
Post Conference:
1. Evaluate effectiveness of the DSM-IV as a diagnostic tool.
2. Propose hypothetical changes.
3. Identify one neurotransmitter that influences any mental disorder (Chapter 2) Videbeck.
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Clinical Learning Outcomes
Assessment: Chapter 8
Outcomes:
1. Identify the categories used to assess the patient’s mental health status.
2. Formulate questions to obtain information in each category.
3. Describe the patient’s functioning in terms of self-concept, roles, and relationships.
4. Recognize key physiologic functions that frequently are impaired in people with mental health
disorders.
5. Obtain and organize psychosocial assessment data to use as a basis for planning Nursing care.
6. Examine one’s own feelings and any discomfort discussing suicide, homicide, or self-harm behaviors
with a patient.
Pre-Conference:
Review the above outcomes.
Post Conference:
Debrief discussion questions.
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NURSING 261 CLINICAL OUTCOMES
Unit I – Clinical Week I
FOCUS: NURSING CARE OF THE PATIENT EXPERIENCING: STRESS
Anxiety/Panic Attack/ Disorders
Post-Traumatic Stress Disorder
Dissociative Disorders/Somatoform Disorders
Clinical Learning Outcomes:
1. Assess patient needs and diagnostic information to develop a comprehensive list of nursing diagnoses.
2. Identify DSM-IV criteria that support diagnoses.
3. Safely calculate and identify anti-anxiety medications prescribed. State the rationale for use: observe for
side effects, evaluate effectiveness
4. Participate with members of the team and review community resources to develop a discharge plan focused
on prevention, aftercare, and evaluation.
5. Monitor and reinforce all patient attempts to:
reduce anxiety
enhance coping
maintain role performance
focus on problem identification
demonstrate healthy ways of dealing with stress
interpret and respond to messages objectively
6. Evaluate and document the patient’s responses to nursing interventions and treatment plan.
Preconference:
1. Review outcomes.
2. Review the levels of anxiety.
3. Discuss the psychopathology of anxiety-related, somatoform and dissociative disorders.
4. Review defense mechanisms that are often utilized by patients as they attempt to decrease anxiety.
5. Discuss common pharmacological management that one may expect for a patient with an anxiety-
related, somatoform and dissociative disorder.
Post Conference:
1. Discuss specific communication strategies used with the anxious patient.
2. Debrief learning activities.
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NURSING 261 CLINICAL OUTCOMES
Unit I – Clinical Week I
Focus: Nursing Care of the Patient Experiencing a Personality Disorder
Clinical Learning Outcomes:
1. Assess patient needs and the diagnostic information necessary to formulate comprehensive nursing
diagnoses.
2. Participate with members of the health team and review community resources to develop a discharge plan
focused on prevention, aftercare and evaluation.
3. Monitor and reinforce all patients’ attempts to:
refrain from self-inflicted injury, impulsive and compulsive behaviors
adapt and trust in non-family caregivers
restrain from assaultive, combative, destructive and/or manipulative behaviors toward others
adapt and trust in non-family caregivers
4. Evaluate and document the patient’s responses to nursing interventions and treatment plan.
Preconference:
1. Discuss the psychopathology involved in understanding personality disorders.
2. Identify the action, side effects and reasons for any prescribed medications.
3. Outline the steps in limit setting.
4. Describe the intensity of therapy required for a patient and perspective on prognosis.
Post Conference:
1. Debrief learning activities.
2. Report on prescribed medications and effectiveness.
3. Evaluate the therapeutic environment and propose changes, if needed.
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NURSING 261 CLINICAL OUTCOMES
Unit I - Clinical Week 2
FOCUS: ANGER, HOSTILITY AND AGGRESSION
Clinical Learning Outcomes:
1. Assess patient needs and diagnostic information necessary to formulate a comprehensive list of nursing
diagnoses.
2. Assess patient’s response to boundaries and touch in the clinical setting/therapeutic milieu.
3. Interpret signals and cues that would help you identify a patient’s level of comfort:
body language
eye contact
silence
4. Compare and contrast the patient’s symptomatology and behavior with DSM-IV criteria.
5. Safely calculate and identify medications prescribed. State the rationale for use; observe for side effects;
evaluate effectiveness.
6. Participate with members of the team and review community resources to develop a discharge plan focused
on prevention, after care, and education.
7. Reinforce and monitor all patient attempts to:
develop personal judgment of self-worth
restrain assaultive, combative or destructive behavior toward others
contract for safety
describe feelings without aggression
comply with treatment recommendations
refrain from behaviors that are intimidating or frightening to others
8. Evaluate and document the patient’s response to nursing interventions and treatment plan.
Preconference:
1. Review outcomes.
2. Discuss the psychopathology involved in aggressive behavior.
3. Identify common therapeutic modalities utilized for the aggressive patient.
4. Share specific communication techniques.
5. Define the term proxemics and relate the zones of personal space to safety.
Post Conference:
1. Debrief the effectiveness of the prescribed treatment plan.
2. Debrief learning activities.
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NURSING 261 CLINICAL OUTCOMES
Unit 1 - Clinical Week 2
Focus: Nursing Care of the Patient Experiencing Psychosis, Schizophrenia, and Chronic Mental Illness
Clinical Learning Outcomes:
1. Assess patient needs and diagnostic information necessary to formulate comprehensive nursing diagnoses.
2. Compare and contrast the patient’s symptomatology with the DSM-IV criteria.
3. Safely calculate and identify antipsychotic medications prescribed and the rationale for use. Observe for
side effects; evaluation effectiveness.
4. Participate with the team and review community resources to develop a discharge plan focused on
prevention, after care and education.
5. Monitor and reinforce all patient attempts to:
achieve control over distorted thoughts
maintain social supports
promote personal safety
comply with prescribed treatment regimens
meet developmental tasks
receive, interpret and express messages appropriately
use coping strategies in a functional adaptive manner
eat adequate amounts of different food groups
6. Evaluate and document the patient’s responses to nursing interventions and treatment plan.
Preconference:
1. Review outcomes.
2. Review the psychopathology involved in the above disorders.
3. Discuss the psychodynamics of the delusional/hallucinatory process.
4. Role play specific communications that are appropriate when interacting with a patient that is
delusional or hallucinating.
Post Conference:
1. Share specific examples of schizophrenic behavior: delusions/hallucinations.
2. Share specific examples of extrapyramidal (EPS) reactions to the antipsychotic medications.
3. Debrief learning activities.
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Unit 1 – Clinical Week 3
Focus: Nursing Care of the Patient Experiencing Affective/Mood Disorders
Clinical Learning Outcomes:
1. Assess patient needs and diagnostic information necessary to formulate comprehensive nursing diagnoses.
2. Apply principles of reality orientation, safety and anxiety reduction when caring for a patient following
electroconvulsive therapy (ECT).
3. Compare and contrast the patient’s symptomatology with the DSM-IV criteria.
4. Safely calculate and identify anti-depressant and mood stabilizers prescribed. State the rationale for use.
Observe for side effects; evaluate effectiveness.
5. Participate with members of the team and review community resources to develop a discharge plan focused
on prevention, after care and education.
6. Monitor and reinforce all patient attempts to:
maintain interest in life events
sustain social support
promote personal safety
comply with prescribed treatment regimens
maintain role performance
concentrate on specific stimulus
adjust to the prevailing emotional tone in responses to circumstances
7. Evaluate and document the patient responses to nursing interventions and treatment plan.
Preconference:
1. Review Outcomes.
2. Review psychopathology of the disease process.
3. Identify specific communication strategies effective with depressed and/or manic patients.
4. Collectively identify key elements needed for an effective teaching plan for patients receiving
lithium and/or MAOI pharmacological agents.
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Post Conference:
1. Debrief learning activities.
2. Identify the rational and implications for nursing care behind statements such as:
When working with severely depressed patients, the nurse must often take directive actions.
It is not useful for the nurse to maintain a cheerful, happy-go-lucky attitude or try to talk a depressed
patient out of feeling sad.
The nurse has the responsibility to respond to the positive part of the ambivalence experienced by a
suicidal patient.
The manic patient is extremely sensitive to environmental stimuli and the nurse must keep such stimuli
to a minimum.
Both the manic and depressed patient’s well-being are at risk.
The risk of suicide increases as the depressed patient’s mood improves.
Consistency in approach among team members is critical in caring for a manic/depressed patient.
The manic patient’s judgment is frequently impaired.
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NURSING 261 CLINICAL OUTCOMES
Unit 1 – Clinical Week 3
FOCUS: NURSING CARE OF THE PATIENT WHO IS EXPERIENCING THE CRISIS OF SUICIDE
Clinical Learning Outcomes:
1. Assess patient needs and collect diagnostic information necessary to formulate comprehensive nursing
diagnoses.
2. Collectively review agency tools used to assess lethality and evaluate agency guidelines for handling a
suicidal crisis. Use universal protocols outlined in class. Propose changes if necessary.
3. Monitor and reinforce all patient attempts to:
identify personal health threats
refrain from gestures and attempts at killing self
make choices amongst alternatives
encourage social support
4. Evaluate and document the patient’s responses to nursing interventions and treatment plan.
Preconference:
1. Share thoughts on potential hazards in the environment.
2. Discuss the role of support groups for survivors.
Post-conference:
1. Share thoughts on potential hazards in the environment.
2. Discuss the role of support groups for survivors.
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NURSING 261 CLINICAL OUTCOMES
Unit I – Clinical Week 4
Focus: Nursing Care of the Patient with a Substance Related Disorder/Delirium/Dual
Diagnosis/Psychosocial Needs of the Critically Ill Patient
Clinical Learning Outcomes:
1. Assess patient needs and diagnostic information to formulate comprehensive nursing diagnoses.
2. Investigate what percentage of mental health admissions for acute care is related to substance use/abuse in
your clinical agency.
3. Compare and contrast the patient’s symptomatology with DSM-IV criteria.
4. Safely calculate and identify medications prescribed. State the rationale for use. Observe the side effects;
evaluate effectiveness.
5. Collaborate with dietary to select vitamin and nutritional supplements.
6. Participate with members of the team and review community resources to develop a discharge plan focused
on prevention, after care and education.
7. Monitor and reinforce all patient attempts to:
minimize substance abuse consequences
enhance personal judgment of self worth
maintain role expectations
establish an effective aftercare plan
verbalize acceptance of responsibility for his or her own behavior
practice non-chemical alternatives to deal with difficult situations
8. Evaluate and document the patient’s responses to nursing interventions and treatment plan.
Preconference:
1. Discuss the psychopathology and pathophysiology involved in the disorder.
2. Review supportive therapies: self help, group, family
3. Discuss how the following symptoms may be related to substance abuse:
change in school or work attendance
alteration in personal appearance
sudden mood or attitude change
withdrawal from family contacts
Post Conference:
1. Debrief learning activities.
2. Discuss key nursing interventions for the following:
potential for injury due to convulsions/delirium tremens/illusions
anxiety
alteration in nutrition: less than body requirements
fluid volume/electrolyte deficit
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NURS 261 CLINICAL OUTCOMES
Unit I – Clinical Week 4
Focus: Individual and Family Considerations Related to Illness – Psychiatric Theory Applied to the
Adult Patient.
Clinical Outcomes:
1. Identify risk factors for Mental Health problems in your patient hospitalized for a critical illness.
2. Determine if affect, interest, concentration and energy level are appropriate to accomplish ADL
and maintain safety.
3. Monitor appetite, grooming, hygiene, ability to accomplish daily tasks and compliance with
therapeutic regimens.
4. Using Benner’s Domains of Nursing Practice, correlate the following with the role of the medical
surgical nurse:
Effective management of rapidly changing situations
Administering and monitoring therapeutic interventions
Assessing the quality of health care
Preconference:
1. Review defense mechanisms that are often utilized by patients as they attempt to decrease anxiety.
2. Review clinical outcomes.
Post Conference:
1. Discuss strategies for assisting the patient to decrease anxiety in the acute care setting.
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NURSING 261
UNIT II
CARDIAC
WEEKLY CLINICAL OUTCOMES
Unit II
Week 5
Nursing Care of the Patient with:
Coronary Artery Disease
Myocardial Infarction
Unit II
Week 6
Nursing Care of the Patient with:
Cardiac Dysrhythmias
Pacemakers
Hypertension
Discharge Planning Needs
Unit II
Week 7
Nursing Care of the Patient with:
CHF/Cardiomyopathy
Valve Disorders
End of Life Issues
Unit II
Week 8
Nursing Care of the Patient with:
Alterations in Tissue Perfusion
Vascular Disorders
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NURSING 261
CLINICAL WEEK 5
Focus:
Cardiovascular Assessment
Nursing Care of the Patient with:
Coronary Artery Disease
Myocardial Infarction
GENERAL CONSIDERATIONS:
1. Utilize the holistic needs assessment framework to assess patients with a cardiac disorder.
2. Utilize the critical thinking model and the nursing process to determine appropriate and priority nursing
diagnoses for a cardiac patient.
3. Safely calculate, administer, assess and evaluate the effectiveness of medications used to treat a patient with
an alteration in tissue perfusion.
4. Use therapeutic communication with patients having an alteration in tissue perfusion including family and
health care members.
5. Coordinate patient centered care of a patient with an alteration in tissue perfusion with other members of the
health care team.
6. Incorporate time management skills and prioritizing of care for more than one cardiac patient or a cardiac
patient with complex needs.
7. Demonstrate responsibility for professional and personal development in lifelong learning activities.
8. Utilize technology to obtain evidence-based nursing practices and legal/ethical issues for the cardiac patient.
Clinical Outcomes
1. Assess the physiological, psychosocial, cultural, developmental, environmental and learning needs of the
patient with an alteration in myocardial tissue perfusion.
2. Critically analyze hemodynamic stability as it relates to the cardiac patient.
3. Analyze data to manage a patient with cardiac disorder, coronary artery disease/myocardial infarction and
provide care and analyze implications for a cardiac patient undergoing a diagnostic test.
4. Complete a risk factor profile for a patient with coronary artery disease.
5. Collaborate with members of the health team to plan and implement appropriate interventions for a patient
with acute chest pain.
6. Safely calculate, administer and assess patient for effectiveness of medications used to treat a patient with
decreased myocardial perfusion.
7. Plan, implement and evaluate nursing care for the patient with an alteration in myocardial perfusion.
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8. Describe and explain standing orders for a patient on a telemetry/cardiac care unit.
9. Plan and implement nursing interventions for pre-post op patient experiencing heart surgery.
10. Detect warning signs and implement therapeutic interventions for a patient experiencing decreased cardiac
output.
11. Assess the critically ill patient and relate findings to pathophysiology.
12. Utilize therapeutic communication to support the critically ill cardiac patient and family members.
13. Identify community resources available for patients and family members affected by cardiovascular disease.
Preconference:
1. Review clinical competencies.
2. Compare and contrast the pathophysiologic concepts of myocardial ischemia (angina) and infarction.
3. Review critical assessments and emergency interventions for a patient with chest pain.
4. Explore the nursing diagnosis of altered myocardial tissue perfusion and discuss related nursing
interventions.
Post Conference:
1. Discuss risk factors and related learning needs for patients with coronary artery disease.
2. Integrate developmental and psychosocial needs when describing an individualized care plan for your
patient with an MI.
3. Debrief experiences with teaching your patient with CAD/MI and evaluate patient learning outcomes.
4. Analyze the effects of assigned medications on your patient’s myocardial oxygenation.
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NURSING 261
CLINICAL WEEK 6
Focus:
Nursing Care of the Patient with:
Cardiac Dysrhythmias
Pacemakers
Hypertension
Clinical Outcomes:
1. Analyze an EKG rhythm strip in relation to the patient’s pathophysiology and compare to textbook norms.
2. Assess the patient’s hemodynamic response to the dysrhythmia and implement therapeutic interventions.
3. Formulate Nursing Diagnoses and outcomes for a patient with a dysrhythmia.
4. Safely calculate, administer and assess the patient for the effects of anti-dysrhythmic medications.
5. Compare and contrast different types of pacemakers, while analyzing a rhythm strip and correlating
findings with specific pacemaker terminology.
6. Utilize therapeutic communication while working with a patient with a dysrhythmia, including family and
health care team members.
7. Evaluate and document the effectiveness of interventions for a patient with a dysrhythmia.
8. Investigate the role of the telemetry or ICU/CCU nurse.
9. Analyze physiologic changes associated with the development and progression of hypertension.
10. Assess a patient for risk factors of hypertension.
11. Safely assess, administer and evaluate the effect of medications used in the management of hypertension.
12. Design an individualized teaching plan for a patient with hypertension, taking under consideration socio-
economic, cultural, educational, and co-morbidities.
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NURSING 261
CLINICAL WEEK 7
Focus:
Nursing Care of the Patient with:
Heart Failure
Cardiac Valve Disease
End of Life Issues
Clinical Outcomes:
1. Assess the physiological, environmental, psychosocial and learning needs of the patient with
heart failure.
2. Correlate specific assessment findings with compensatory responses of heart failure.
3. Analyze subjective and objective data to formulate nursing diagnoses and desired outcomes
for a patient with heart failure.
4. Safely calculate and administer and observe effects of medications for patients with heart
failure.
5. Design, implement and evaluate a teaching plan of a patient and family affected by heart
failure.
6. Recognize the physical, spiritual, cultural and emotional needs of the patient and family,
including anticipatory grieving.
7. Research and evaluate a patient’s advanced directive and its impact on end-of-life care.
8. Investigate the clinical agency policies regarding resuscitation.
9. Assess the physiological, psychosocial, cultural and learning needs of a patient with cardiac
valve disease.
10. Formulate nursing diagnoses, interventions and outcomes for patients with cardiac valve
problems.
11. Differentiate between various inflammatory disorders of the heart.
Preconference:
1. Review clinical competencies.
2. Analyze the concepts of preload, afterload and contractility when exploring the nursing
diagnosis of decreased cardiac output.
3. Correlate assessment findings of heart failure with the compensatory responses to decreased
cardiac output.
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4. Explain the hemodynamic effects of assigned medications and identify expected outcomes
and critical assessments.
5. Identify nursing interventions and learning needs for a patient with chronic heart failure.
6. Discuss pre and post-operative nursing care for the patient undergoing surgery for cardiac
valve disease.
7. Discuss the relationship between cardiac valve disease and heart failure.
8. Explore your own attitudes, feelings, values and expectations about death.
9. Discuss the impact of cultural and spiritual diversity on the patient and family’s perception
of death.
10. Apply legal/ethical principles when discussing complex issues in end-of-life care.
11. Describe the influence of professional codes of ethics and patient self-determination
(advanced directives) on the patient’s end-of-life quality.
12. Explore the ANA position statement regarding the nurse’s role in end-of-life issues.
13. Discuss signs and symptoms of cardiac tamponade
Post Conference:
1. Share experiences with cardiovascular assessment.
2. Consider physical assessment findings, developmental, psychosocial and cultural factors to
individualize the care plan for your heart failure patient.
3. Evaluate the use of learning materials in the teaching and discharge planning for the patient
with heart failure.
4. Analyze quality of life for your patient with chronic heart failure and identify interventions to
enhance optimal wellness.
5. Debrief your experiences and emotional reactions when caring for a dying patient.
6. Discuss the process involved in determining your patient’s “code status.” Include patient’s
advanced directives, communication with patient and/or family members, and agency
policies regarding resuscitation.
7. Discuss signs and symptoms of pulmonary edema, including emergency management.
8. Assess the family’s response to the death of a loved one and evaluate caring interventions to
support their progression through the grieving process.
9. Differentiate between artificial and biological values.
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NURSING 261
CLINICAL WEEK 8
Focus:
Nursing Care of the Patient with:
Alterations in Tissue Perfusion
Vascular Disorders
Clinical Outcomes:
1. Complete a vascular assessment identifying findings with consideration of age and cultural
variations
2. Review patient’s charts for relevant information related to alterations in perfusion.
3. Develop a plan of care and implement therapeutic interventions for a patient with actual or
potential altered tissue perfusion.
4. Safely calculate and administer anticoagulants and vasoactive medications.
Preconference:
1. Review clinical competencies.
2. Explain the pathophysiology of Peripheral Vascular Disease (PVD).
3. Discuss the plan of care for actual or potential altered tissue perfusion.
4. Identify the classification, action and side effects of prescribed drugs to be administered.
Post Conference:
1. Discuss the evaluation of plans of care for patients with altered tissue perfusion.
2. Review and practice calculations related to drug administration.
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NURSING 261
UNIT III RESPIRATORY
WEEKLY CLINICAL OUTCOMES
Unit III Week 9 Respiratory Assessment
Nursing Care of the Patient with:
An Upper Airway Alteration
Head and Neck Cancer
Artificial Airways/Tracheostomy
Unit III Week 10
Nursing Management of the Patient with:
Chest Wall Disorders
Chronic Airflow Limitation (CAL)/COPD
Respiratory Failure
Acute Respiratory Distress Syndrome
Mechanical Ventilation
Unit III Week 11 Nursing Care of the Patient with:
An Alteration in Acid Base Balance
Pneumonia
Tuberculosis
Occupational Lung Disease
Lung Cancer
Chest Surgery and Chest Tube Management
Pulmonary Embolism
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NURSING 261
CLINICAL WEEK 9
Focus:
Respiratory Assessment
Nursing Care of the Patient with:
Upper Airway Alteration
Head and Neck Cancer
Artificial Airways/Tracheostomy
Clinical Outcomes:
General Considerations
1. Perform a holistic assessment, using the human needs framework and the Needs Assessment Guide, for
patients across the life-span with a respiratory disorder.
2. Develop appropriate nursing diagnoses in the patient with a respiratory disorder.
3. Implement appropriate clinical judgment and prioritization, incorporating evidence based practice and
incorporating patient’s active involvement when managing the patient’s airway or caring for a patient with a
respiratory disorder.
4. Use principles of therapeutic communication with a patient having a respiratory alteration or the patient
with an artificial airway who is unable to vocalize.
5. Collaborate with the health care team in the care of a patient with a respiratory disorder emphasizing
management of activities of daily living and conservation of energy.
6. Accurately calculate dosage and safely administer respiratory medications, using the 8 rights and 4 checks
& monitoring expected and adverse effects. (NPSG 01.01.01)
7. Identify legal and ethical issues that directly impact patients with a respiratory alteration.
8. Manage care for 1-2 patients requiring respiratory interventions, incorporating time management, efficient
use of resources, to include reporting critical values using Hand off communications eg. SBAR and
documentation, with consideration of the National Patient Safety Goals. (NPSG 02.03.01)
Specific Considerations
Nursing Care for Patients with Upper Respiratory Problems
9. Compare and contrast the pathophysiology, age related concerns, clinical manifestations, complementary
and alternative therapies, and collaborative management/therapeutic interventions of respiratory disorders.
10. Research the patient’s chart to analyze lab and diagnostic tests specific to the respiratory system.
11. Discuss patient-teaching needs relative to diet, exercise, medication and management of alterations in
oxygenation.
12. Provide care for patients having upper respiratory disorders or related surgery with consideration of
psychosocial and cultural concerns.
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13. Use NANDA and therapeutic nursing interventions to include teaching, to prioritize individualized care for
a patient with an upper respiratory disorder.
14. Demonstrate appropriate assessment and implementation of suctioning and/or trach/laryngectomy care.
15. Compare and contrast the collaborative interventions and treatments for patients with infectious,
noninfectious and cancerous processes of the upper respiratory tract.
Preconference:
1. Review clinical outcomes.
2. Identify critical respiratory assessment data.
3. Discuss risk factors and Nursing Diagnoses for patient with cancer of larynx and upper airway alterations.
4. Discuss therapeutic Nursing Interventions and Outcomes of the care plan for a patient with an upper
respiratory alteration or cancer of the larynx.
5. Review the critical elements of tracheostomy care and suctioning.
6. Discuss the risk factors for aspiration and explain the critical nursing interventions for prevention.
Post Conference:
1. Discuss effectiveness of a nursing care plan and selected therapeutic nursing interventions in the plan of
care.
2. Explore nursing diagnoses Impaired Gas Exchange, Altered Tissue Perfusion, Anxiety and Impaired Verbal
Communication.
3. Share your strategies for meeting the communication needs of patients with artificial airways.
4. Evaluate the expectations of nursing interventions to prevent infection and protect the patient from
aspiration.
5. Share your experiences in implementing therapeutic nursing interventions for a patient with an upper
respiratory infection.
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NURSING 261
CLINICAL WEEK 10
Focus:
Nursing Management of the Patient with:
Chest Wall Disorders
COPD
Respiratory Failure
Mechanical Ventilation
Clinical Outcomes:
1. Plan and implement care for a patient with an alteration in chest wall integrity.
2. Utilize critical thinking strategies to plan and evaluate care for the patient with a chronic alteration in
oxygenation with consideration to quality of life.
3. Discuss the nursing implications related to managing respiratory medications via the inhalation route.
4. Assess the patient’s need for respiratory treatments and oxygen therapy, and evaluate the response.
5. Identify available community resources to promote wellness for patients and family members affected by a
chronic alteration in oxygenation.
6. Utilize the elements of reasoning to analyze strategies for smoking prevention and cessation.
7. Identify risk factors, warning signs for the development of respiratory failure and implement preventative
interventions.
8. Use critical thinking strategies to assist in the care of a patient on a mechanical ventilator and collaborate
with respiratory therapy to evaluate the patient’s response to ventilator settings/modes.
9. Use research based strategies to prevent Ventilator Acquired Pneumonia in vented patients. (NPSG
07.03.01)
10. Utilize time management skills and efficient use of resources to provide safe nursing care to a patient with
complex needs and identifying potential worsening in condition and seeking appropriate assistance.
(NPSG.16.01.01)
Preconference
1. Review clinical outcomes.
2. Explore your own feelings about working with patients who are critically ill.
3. Explain the pathophysiology that occurs with an alteration in chest wall integrity.
4. Identify expected outcomes and therapeutic nursing interventions for a patient with an alteration in chest
wall integrity.
5. Explain the early warning signs of respiratory failure and explore the nursing diagnoses of impaired gas
exchange.
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6. Identify expected outcomes and therapeutic nursing interventions to meet the physiologic, psychosocial and
learning needs for a patient with chronic airflow limitation.
7. Review the critical elements of tracheostomy care and suctioning.
8. Utilize knowledge of ventilator settings and alarms to identify safety precautions when caring for a patient
on a mechanical ventilator.
9. Explore the nursing diagnoses of impaired gas exchange and impaired verbal communication.
Post Conference:
1. Discuss assessment findings for a patient with an alteration in chest wall integrity.
2. Evaluate the effectiveness of nursing interventions to prevent complications in the patient with a chest wall
integrity problem.
3. Synthesize assessment data for your patient with chronic airflow limitation, and share your nursing
interventions and patient outcomes.
4. Analyze the quality of life for your patient with chronic respiratory disease, and explore caring
interventions and teaching strategies to enhance wellness.
5. Share your strategies for meeting the communication needs of patients with artificial airways.
6. Explain how the specific type of ventilator modalities and settings facilitated your patient’s oxygenation
needs.
7. Discuss ethical implications for patients on life support, and evaluate the patient’s degree of comfort.
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NURSING 261
CLINICAL WEEK 11
Focus:
Nursing Care of the Patient with:
An Alteration in Acid Base Balance
Infectious diseases
Pneumonia
Tuberculosis
Occupational Lung Disease
Lung Cancer
Chest Surgery and Chest Tube Management
Pulmonary Embolism
Clinical Outcomes:
1. Evaluate ABG results of a patient and correlate clinical assessment findings with the ABG results utilizing
the ABG Assessment form.
2. Use NANDA and therapeutic nursing interventions to plan individualize nursing care for patients with acid
base disorders.
3. Compare and contrast the types of lower respiratory infections and discuss the pathophysiology, risk factors,
life span considerations, clinical manifestations and collaborative care.
4. Use critical thinking strategies to prepare a plan of care for the patient with a respiratory infection.
5. Accurately calculate, safely administer, assess for side effects, and evaluate the effectiveness of medications
for a patient with a respiratory disorder/infection.
6. Utilize principles of infection control to provide safe care for a patient with respiratory infection.
(NPSG.07.01.01)
7. Research agency protocols concerning the management of tuberculosis.
8. Compare and contrast various occupational lung diseases and their complications.
9. Compare and contrast the pathophysiology and staging with various treatment modalities for the patient
with lung cancer and plan nursing care appropriately.
10. Apply the Elements of Reasoning to discuss ethical considerations when caring for a patient and family
affected by terminal lung cancer.
11. Develop a plan of care using the Hierarchy of Needs, NANDA and therapeutic communication & nursing
interventions to prioritize care for a patient with lung cancer. (NPSG 07.05.01)
12. Develop a plan of care for a post op patient having surgery affecting the respiratory tract.
13. Recognize the risk factors and assessments related to a pulmonary embolus and implement preventative
strategies.
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14. Accurately calculate, safely administer, assess for side effects and evaluate the effectiveness of
anticoagulants. (NPSG.03.05.01)
15. Analyze a patient’s coagulation profile in relation to the laboratory norms for PT, PTT, INR
(NPSG.03.05.01)
Preconference:
1. Review clinical outcomes.
2. Review normal ABG results and nursing implications.
3. Relate assessment data and lab/diagnostic data to formulate appropriate nursing diagnoses.
4. Discuss therapeutic nursing interventions and patient outcomes.
5. Explain the pathophysiology involved in pneumonia and tuberculosis.
6. Discuss categories, action and side effects of related pharmacologic agents.
7. Discuss the nursing care related to medical and surgical management of patients with lung cancer.
8. Discuss critical assessment parameters for a patient with an alteration in oxygenation.
9. Analyze the implications of assigned medications relative to the patient’s pathophysiology.
10. Differentiate the purpose of the three chambers of a closed chest drainage system.
11. Describe assessment findings that indicate proper functioning of a closed drainage system.
Post Conference:
1. Discuss assessment findings, lab values and diagnostic findings for lung cancer and explain the relationship
of abnormal findings to pathophysiology.
2. Compare and contrast the ABG results of patients relating findings to clinical condition.
3. Discuss ethical decision making with regard to management of terminal lung cancer.
4. Discuss effectiveness of a nursing care plan with selected therapeutic nursing interventions in plans of care.
5. Explore the Nursing Diagnoses of Ineffective Airway Clearance, Impaired Gas Exchange, Pain, and Grief.
6. Discuss factors that influenced your patient’s oxygenation needs and relate these to the pathophysiology.
7. Evaluate the effectiveness of nursing interventions to prevent complications in the patient with a chest tube.
8. Discuss the significance of laboratory test results in relation to the management of a patient on
anticoagulants.
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Clinical Week 11 (cont.)
Patient Initials: Room: Date: Diagnosis:
ACID-BASE (ARTERIAL BLOOD GAS) ASSESSMENT FORM
Date of ABG
Normal Value (agency ranges)
Patient’s Value Imbalance
(If so, name it)
pH
PaCO2
HCO3
PaO2
Name the patient’s acid-base imbalance:
Critical thinking:
Is there compensation? Explain.
What physical assessment data support this finding?
Why do you believe this imbalance occurred?
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NURSING 261
UNIT IV
ALTERATION IN METABOMISM
FOCUS OF CLINICAL OUTCOMES
Unit IV Week 12 Nursing Care of the Patient with Diabetes Mellitus
Type 1
Type 2
Complications
Unit IV Week 13 Nursing Care of the Patient with an Alteration in
other Endocrine Disorders
Pituitary
Thyroid
Parathyroid
Adrenal Glands
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NURSING 261
CLINICAL WEEK 12
Focus: Nursing Care of the Patient with Diabetes Mellitus
Clinical Outcomes:
1. Assess patients for risk factors, signs and symptoms, and complications Diabetes Mellitus (DM) using the
diabetic assessment.
2. Compare and contrast the manifestations, collaborative care, complementary and alternative therapies, and
complications of diabetes mellitus.
3. Research patient charts and analyze lab data with respect to DM.
4. Identify rationale for use and safely administers antidiabetic medications while monitoring therapeutic effect
and any adverse effects.
5. Accurately calculate dosage and safely administer prescribed medication such as sq insulin injections
including mixing acceptable types and monitoring effects (NPSG.01.01.01).
6. Identify learning needs of a patient on a prescribed diabetic diet and assess knowledge of the prescribed diet
by observing the selection of foods from a menu.
7. Develop a teaching plan with selected peers for a newly diagnosed diabetic or on a diabetic with assessed
learning needs.
8. Interact with the patient, family members and health care team to assess and plan for the patient’s discharge.
9. Provide accurate information to patients with DM to facilitate self-management of medications, diet
planning, exercise, and foot care.
10. Use NANDA and therapeutic nursing interventions to develop a plan of care for the diabetic patient to
include considerations specific to age and culture.
Preconference:
1. Review clinical outcomes.
2. Review the action, onset, peak and duration of diabetic medications.
3. Discuss dietary guidelines of the prescribed diabetic diet.
4. Discuss the plan of care including teaching interventions for the diabetic patient.
Post Conference:
1. Evaluate the plan of care and teaching plan for the diabetic patient.
2. Compare and contrast the assessment findings of Type 1 and Type 2 Diabetes Mellitus of assigned patients.
3. Discuss diabetic assessment.
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NURSING 261
CLINICAL WEEK 13
FOCUS: NURSING CARE OF THE PATIENT WITH AN ALTERATION IN METABOLISM
Clinical Outcomes:
1. Perform a holistic assessment, using the human needs framework and the Needs Assessment Guide, of
patients across the life-span having endocrine dysfunction or tissue perfusion problems.
2. Develop appropriate nursing diagnoses in the patient with endocrine dysfunction or tissue perfusion
problems.
3. Implement appropriate clinical judgment and prioritization incorporating evidenced based practice and
patient’s active involvement when managing care for a patient with an endocrine disorder or tissue
perfusion disorder or related surgery {incorporate National Patient Safety Goal (NPSG.13.01.01)}.
4. Communicate effectively with patients having a metabolic alteration or the patient who is unable to vocalize
due to disorder, diagnostic procedures or surgery.
5. Collaborate with the health care team in the care of a patient with an endocrine disorder emphasizing
management of activities of daily living and conservation of energy.
6. Accurately calculate dosage and safely administer medications, using the 8 rights and 4 checks for
endocrine or tissue perfusion disorders, monitoring expected and adverse effects. (NPSG.01.01.01)
7. Identify legal and ethical issues that directly impact patients with endocrine disorders.
8. Manage care for 1-2 patients needing therapeutic or caring interventions for endocrine disorders
incorporating time management, efficient use of resources, to include reporting using SBAR and
documentation, with consideration of the National Patient Safety Goals. (NPSG.02.05.01).
Specific Considerations
Concepts of Nursing Care for patients with Endocrine Problems
9. Compare and contrast the pathophysiology, clinical manifestations, and collaborative
management/therapeutic interventions of endocrine disorders.
10. Discuss lab and diagnostic tests relative to the endocrine system.
11. Discuss patient-teaching needs relative to diet, exercise, medication and management of alterations in
metabolism.
Pituitary and Adrenal Gland Problems
12. Discuss considerations for patients having pituitary and adrenal disorders considering age related,
psychosocial and cultural concerns.
13. Prepare a plan of care for the patient with pituitary or adrenal disorders focusing on but not limited to
altered body image and /or physiological alterations.
91
14. Accurately calculate dosage and safely administer medications, monitoring expected and adverse effects for
patients with pituitary or adrenal disorders (NPSG.01.01.01).
Patients with problems of the Thyroid and Parathyroid glands
15. Develop a plan of care for patients having thyroid and parathyroid disorders considering psychosocial
needs, altered body image and /or physiological alterations and cultural and age related concerns.
16. Integrate principles of therapeutic communication to meet the communication needs of a patient with
thyroid of parathyroid surgery who is unable to vocalize.
17. Accurately calculate dosage and safely administer medications, monitoring expected and adverse effects for
patients with thyroid or parathyroid disorders (NPSG.01.01.01).
Preconference:
1. Review clinical outcomes.
2. Describe the systemic effects of replacement and pharmacologic use of corticosteroid therapy.
3. Discuss the plan of care for patients with an alteration in metabolism.
Post Conference:
1. Discuss evaluations of plans of care for patients with alterations in metabolism.
2. Discuss diagnostic test results.
3. Explore quality of life for chronic endocrine disorders.
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NURSING 261
UNIT IV (con’t)
SHOCK AND BURNS
WEEKLY CLINICAL OUTCOMES
Unit IV Week 14 Nursing Care of the Patient with Shock
Nursing Care of the Patient with Burns
Nursing Care of the Patient with Hematologic
Disorders
93
NURSING 261
Unit IV – CLINICAL WEEK 14
FOCUS:
NURSING CARE OF THE PATIENT EXPERIENCING SHOCK
NURSING CARE OF THE PATIENT WITH BURNS
NURSING CARE OF THE PATIENT WITH HEMATOLOGIC DISORDERS
Clinical Outcomes:
1. Differentiate Stages and classifications of shock and Identify patients at risk.
2. Assess patients, formulate nursing diagnosis and respond with therapeutic interventions to early signs and
symptoms of shock.
3. Safely calculate and administer medications for the patient in shock; evaluate expected and unexpected
responses to medications.
4. Recognize the signs and symptoms of burn injuries, evaluating the physiological and psychological effects
and anticipate potential complications.
5. Integrate cultural considerations; describe emergency care for the patient with burns.
6. Utilize therapeutic nursing interventions, hierarchy of needs and NANDA to plan care for the patient with
burns.
7. Safely administer and monitor effects of pharmacologic agents used in patients with burns.
Preconference:
1. Review clinical competencies.
2. Identify critical assessment data and risk factors for patients with shock or burns.
3. Explore Nursing Diagnoses: Impaired Gas Exchange, Altered Tissue Perfusion, Fluid Volume Deficit and
Altered Body Image.
4. Discuss therapeutic nursing interventions and patient outcomes for patients with shock or burns.
5. Explore the physiologic and psychosocial effects associated with burns.
6. Compare and contrast bleeding disorders
7. Differentiate Hodgkin’s disease from Non-Hodgkin’s lymphomas.
8. Identify the classification, action and side effects of prescribed drugs to be administered.
9. Discuss the plan of care for the patient with a hematologic disorder.
94
10. Discuss the concepts of oxygenation, safety and infection protection for a patient with hematologic
disorders.
Post Conference:
1. Identify the psychosocial impact of a patient whose condition is deteriorating.
2. Discuss evaluation of therapeutic nursing interventions in relation to patient outcomes.
3. Discuss the multi-system effects of a burn.
4. Evaluate planned teaching.
5. Discuss fluid and nutritional needs of a burn patient.
6. Discuss the evaluation of plans of care for patients with hematologic disorders.
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CLINICAL EVALUATION
96
Brookdale Community College
Clinical Grading Policy
1. All clinical learning outcomes must be achieved by the conclusion of the semester at the assigned performance level, in order to receive credit in all courses with a clinical component. The course specific performance levels are represented by the shaded areas on the Clinical Evaluation Tool. Failure to meet all clinical learning outcomes at the assigned performance level by the end of the semester will result in a clinical failure and a grade of F in the course.
2. Students will be held accountable for all previously learned clinical learning outcomes.
3. Clinical faculty may refer students for remediation of any clinical performance that does not meet the expected performance level. This affords students the opportunity for remediation.
4. Students will complete weekly clinical reflections on their clinical performance on the Clinical Progress
Notes and faculty will add written feedback. Students receiving a “Not Satisfactory “ (N) rating in one or more clinical competencies on the weekly Clinical Progress Notes will identify a remediation plan and meet with faculty to discuss plans for improvement. Students are expected to follow the steps in the remediation plan so they can move toward successful achievement of the clinical learning outcomes by the end of the semester.
5. The mid-term clinical evaluation will be completed by the student and discussed with the faculty. At that
time the clinical faculty will make comments on the student’s self-evaluation with a plan for remediation.
6. The final clinical evaluation will be completed by the clinical faculty. The student and the clinical faculty will meet at the conclusion of the term to discuss the evaluation. The signature of the student indicates that the student has had the opportunity to read and discuss the evaluation. The student’s signature does not indicate agreement with the content of the evaluation.
7. Any student demonstrating unsafe behavior or violation of legal/ethical parameters may be dismissed at
any time from the nursing program. If a student is deemed to be unsafe, the student will be excluded from clinical laboratory, may not self-drop, and will receive a grade of F (failure). This is applicable at any time during the term. Behaviors which may result in dismissal include, but are not limited to:
a. clinical performance that is deemed by the faculty to jeopardize patient safety
b. performing acts beyond the scope of nursing student practice
c. unauthorized use or distribution of equipment or drugs
d. falsification or alteration of agency documents
e. patient abuse, neglect or abandonment
f. felonious acts
g. violation of legal / ethical principles
h. violation of the Fitness for Duty policy
i. unprofessional behavior
Clinical Evaluation Tool
Student’s Name Clinical Agency
Semester Faculty
Brookdale Community College Nursing Program NURS 261
The BCC Clinical Evaluation tool is used to document your clinical progress using the following levels of performance that describe your ability to meet the clinical learning outcomes in your respective courses. For each clinical experience, these levels evaluate the way you behave, your ability to perform safe practice, the level of faculty direction you require, and your ability to apply theoretical knowledge. Examples of behaviors are listed under each level. All clinical learning outcomes must be achieved by the conclusion of the semester at the assigned performance level, in order to pass the clinical component in a nursing course. The performance levels are represented by the shaded areas on the course specific Clinical Evaluation Tool. Failure to meet all clinical learning outcomes at the assigned performance level by the end of the semester will result in a clinical failure and a grade of F in the course.
Levels of Performance
SATISFACTORY (S) ASSISTED (A) NOT SATISFACTORY (N) UNSAFE (U)*
Performance is safe and accurate with minimal or no faculty direction.
Performance is safe, but requires frequent faculty direction and/or cues.
Requires continuous faculty direction to perform at a safe level.
Unsafe behaviors that may result in immediate dismissal include but are not limited to:
Clinical performance that is deemed by the faculty to jeopardize patient safety.
Performing acts beyond the scope of nursing practice.
Unauthorized use or distribution of equipment or drugs.
Falsification or alteration of agency documents.
Patient abuse, neglect, or abandonment.
Felonious acts
Violation of legal / ethical principles
Violation of the Fitness for Duty policy.
Applies knowledge appropriate to course level with minimal or no faculty direction.
Demonstrates gaps in understanding and requires frequent faculty direction to apply knowledge.
Unable to apply knowledge and requires continuous faculty direction to apply knowledge.
Demonstrates dexterity, coordination and efficiency.
Uncoordinated and inefficient, but improves with faculty guidance.
Uncoordinated and inefficient and does not improve with practice. Requires continuous faculty direction.
Organizes care and completes assignment in an appropriate time frame with minimal or no faculty direction.
Some disorganization is evident and requires frequent faculty direction to manage time.
Disorganized, expends excessive energy and does not complete care in a safe time frame. Requires continuous faculty direction.
*Any student demonstrating unsafe behavior or violation of legal/ethical parameters may be dismissed at any time from the nursing program. If a student is deemed to be unsafe, the student will be excluded from clinical laboratory, may not self drop and will be assigned a course grade of F. This is applicable at any time during the term.
Rev. spring 2011
Clinical Evaluation Tool
Below are the clinical learning outcomes. By the end of the semester, students must meet all the clinical learning outcomes at the course specific expected level of performance (as indicated by the shaded areas).
Student Mid term
Evaluation Levels of
Performance
NURS 261
Faculty Final Evaluation Levels of
Performance
S A N Unsafe S A N Unsafe
I. As a PROVIDER OF CARE, the student will be able to:
Assessment
1.1 Use a needs assessment framework to accurately obtain pertinent current information and history from the medical record, patient interview and health team members
1.2 Complete an accurate and thorough physical assessment in a timely manner
1.3 Integrate multiple dimensions of patient centered care, including psychosocial, cultural, spiritual and developmental needs, values and preferences
1.4 Identify patient’s actual and potential health problems, including risk factors, strengths, values and preferences
1.5 Collect information about diagnostic tests appropriate to the patient’s pathophysiology
1.6 Utilize critical thinking to validate accuracy of data and identify missing information
1.7 Distinguish normal from abnormal assessment findings
1.8 Accurately interpret abnormal assessment findings and diagnostic test results in relation to pathophysiology
1.9 Recognize changes in patient status and levels of comfort, and report in a timely manner
1.10 Initiate appropriate re-assessment as patient’s condition warrants
1.11 Identify patient’s learning needs related to health promotion and discharge planning
Nursing Diagnosis/Planning
1.12 Utilize critical thinking to identify and prioritize appropriate physiologic and psychosocial nursing diagnoses, with consideration of the patient’s cultural, spiritual and developmental needs
1.13 Apply an understanding of the patient’s situation to select accurate nursing diagnoses, including the correct etiology and manifestations
1.14 Identify short and long term patient outcomes that are measureable and realistic for patient’s diagnosis
1.15 Collaborate with the patient and/or significant other to develop a plan for shared decision making to achieve patient outcomes
1.16 Develop a plan to meet the patient’s learning needs related to health promotion and discharge planning, with consideration of patient and family expertise
Clinical Evaluation Tool
Student Mid term
Evaluation Levels of
Performance
NURS 261
Faculty Final Evaluation Levels of
Performance
S A N Unsafe S A N Unsafe
Implementation
1.17 Incorporate knowledge of pharmacology, nutrition, developmental theory, sociocultural considerations, and legal/ethical principles to minimize harm to patients and providers
1.18 Utilize critical thinking and evidence based practice to identify the appropriate rationale for nursing care, based on an understanding of patient’s pathophysiology
1.19 Maintain proficiency in previously learned skills
1.20 Complete college lab preparation for new skills and verbalize underlying principles
1.21 Utilize appropriate precautions related to infection control
1.22 Safely utilize equipment and communicate concerns related to environmental hazards
1.23 Implement skills according to evidence based standards, policies and current National Patient Safety Goals
1.24 Implement a teaching plan that empowers and involves the patient/family in wellness promotion
1.25 Provide patient centered care with sensitivity and respect toward diverse patients across the life span
1.26 Implement therapeutic caring goal directed communication with awareness of interpersonal factors that impact communication
1.27 Focus on the patient and maintain privacy when providing care
1.28 Document patient information in an objective, accurate and thorough manner
1.29 Apply technology and information management tools to communicate, manage knowledge, mitigate error and support decision making
1.30 Verbalize understanding of all medications including classification, actions, rationale for the specific patient, side effects, interactions, assessments, nursing implications and patient teaching
1.31 Correctly determine safe dose and calculate correct medication dose accurately
1.32 Administer medications according to nursing standards agency protocol and patient safety goals, including accurate and timely documentation
Evaluation
1.33 Utilize critical thinking and evidence-based practice to modify interventions based on patient’s response to care
1.34 Demonstrate accountability and follow-through on the plan of care in relation to patient centered outcomes
II. As a MANAGER OF CARE, the student will be able to:
Clinical Evaluation Tool
Student Mid term
Evaluation Levels of
Performance
NURS 261
Faculty Final Evaluation Levels of
Performance
S A N Unsafe S A N Unsafe
2.1 Establish appropriate priorities when providing care to one patient or groups of patients
2.2 Complete assignments within the allotted time frame
2.3 Provide care in an efficient cost effective manner
2.4 Use an organized format to report accurate and relevant patient information to members of the health care team
2.5 Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect and shared decision making to achieve quality patient care
2.6 Identify circumstances where patient advocacy is needed and implement strategies to involve patients and families in their care
2.7 Contribute to continuity across the health care continuum through involvement in discharge planning
2.8 Research and utilize evidence based resources to meet patient’s needs
III. As a MEMBER OF THE PROFESSION, the student will be able to:
3.1 Initiate requests for help when appropriate to the situation
3.2 Use reflection to identify strengths and weaknesses and develop a plan for improvement
3.3 Exhibit reflective thinking when participating in group clinical conferences
3.4 Integrate unit specific quality improvement initiatives into the patient’s plan of care
3.5 Maintain patient confidentiality and adhere to HIPAA regulations
3.6 Practice within the legal and ethical parameters of the profession according to the ANA code of ethics, ANA Standards of Practice and the NJ Nurse Practice Act
3.7 Show initiative by seeking opportunities for learning
3.8 Exhibit honesty and accountability for one’s behavior
3.9 Utilize evidence based resources to prepare for clinical laboratory
3.10 Demonstrate punctuality and adhere to the attendance policy
3.11 Submit assignments within the established time frame
3.12 Demonstrate thorough and accurate preparation of assignments
3.13 Demonstrate appropriate professional behavior with patients, faculty, staff, and peers
Clinical Evaluation Tool
Brookdale Community College
Nursing 261
MID-TERM STUDENT SELF-EVALUATION SUMMARY
Identification of Strengths
Areas for Development
Plan for Improvement
Faculty Comments
Student Signature ____________________
Faculty Signature ____________________
Date __________
Brookdale Community College
Nursing 261
FINAL CLINICAL EVALUATION SUMMARY
Identification of Student’s Strengths
Areas for Development
Plan for Improvement
Student Comments
Student Signature ____________________ Pass______
Faculty Signature ____________________ Fail_______
Date __________
