€¦ · Web viewCTH = Med-Surg @ Carson Tahoe HospitalPsy = Mental Health @ NNAMHS Lead Faculty Debi Ingraffia-Strong, email questions to [email protected] NURS 167: Plan

Course Syllabus

NURS 167: Medical Surgical Nursing I Clinical

Debi Ingraffia-Strong PhD(c), MSN, RNProfessor of Nursing

Lisa Dunkelberg MSN, RNNursing Instructor

Spring 2019

December 31, 2018 DI-S

NURS 167: MEDICAL-SURGICAL NURSING CLINCIAL

Number of credits: 1 Prerequisite: Must be an accepted into the nursing programCo requisite: NURS 165 and NURS 166 Must pass NURS 166 and NURS 167 in order to receive a grade of C or better in NURS 165.Transferability of Course within Nevada: General Elective

I. Course Description:

Provides opportunities for students to utilize knowledge from the bio/psycho/social sciences, humanities, nursing and current literature to provide safe, competent care of adult patients experiencing common alterations in body systems. The course utilizes the nursing process in order to achieve best practice outcomes in a medical/surgical setting. Particular emphasis is placed on concepts of holistic care, patient education and discharge planning.

II. Course Objectives:

The information in the parentheses after a course objective refers to the Institutional Student Learning Outcome (ISLO) that the objective meets. Objectives without this information are not linked to institutional student learning outcomes.

Upon successful completion of the course the student will be able to:

1. Use effective verbal and nonverbal communication skills when proving care for patients and working with family members and the health care team. (ISLO 7)

2. Apply ethical and legal concepts to the care of patients in acute care settings. (ISLO 7)

3. Demonstrate the role of the nurse as provider and manager of care to patients experiencing commonly occurring acute and chronic disruptions in health. (ISLO 7)

4. Demonstrate development of critical thinking skills through the use of reflective thinking, journaling, and problem solving through the nursing process. (ISLO 6)

5. Develop organization and independence in the performance of nursing skills for two patients by the end of the medical/surgical rotation. (ISLO 7)

B. Linkage of the course to nursing program educational outcomes

Student Learning Outcomes Incorporate principles from the bio/psycho/social sciences, mathematics, literacy and

nursing in the provision of patient care. Apply the nursing process in a caring manner to safely meet the holistic needs of patients

across the lifespan Utilize a broad range of communication skills to promote understanding


Utilize a spirit of inquiry to integrate current evidence-based guidelines and nursing science when making clinical practice decisions

Apply concepts of caring, cultural sensitivity and respect for all persons Apply principles of teaching and learning to empower patients and families to effectively

manage healthcare Incorporate principles of collaboration and teamwork with patients, families and the

health care team to achieve patient centered care Provide and manage care that reflect the ethical values of nursing within professional

standards and legal parameters of the profession

II. Clinical Schedule: 90 hours

1. Wednesday, Thursday, Friday, or Saturday for (8) 10 hour days from 0600 to 1500 with a 30-minute lunch and (2) 15 minute breaks on a medical/surgical unit and a pre and post-conference at 0600 - 0700 and 1500 - 1600.

2. OR experience: Wednesday, Thursdays or Fridays for (2) 10 hour days from 0600 to 1445 with a 30-minute lunch and (2) 15-minutes breaks in a peri-operative setting and post-conference at 1500-1600.

3. A clinical orientation to the facility that provides an understanding of the location of different areas within the facility, core measures, and the policies and procedures that students need to follow.

4. A one hour Intravenous (IV) medication and IV management clinical check-off to be scheduled during first and second weeks of the semester.

III. Grading

The clinical grade is PASS/FAIL. It is determined by:1. Mandatory completion of 8 medical surgical clinical experiences and 2 OR

experiences or make-up for missed days designated by the clinical instructor.2. Maintaining a satisfactory (S) performance in the clinical rotations. The student

receives a “Satisfactory” for clinical performance by maintaining safe practice and receiving a Satisfactory evaluation as determined by objectives in the Basic Student Clinical Performance Evaluation Tool (BSCPET) and the course specific objectives.

3. Completion of all assignments. Submitting written assignments & concept maps on the assigned due dates (online in the appropriate assignment drop box). This is a weekly expectation and no late work will be accepted! The expectation of progression of learning is that the student will achieve a level 8 or higher by completion of the semester on the individualized concept maps. Failure to do so will result in failure of the clinical course.

4. Participation in pre and post-clinical conferences that is respectful and contributes to the learning experience of self and others. (Refer to the student handbook for standards of behavior and misconduct)


IV. Mandatory Assignments

1. Preload assigned patho maps and medication cards due on Friday Jan 18, 2019. Please bring printed copy.

2. Daily patient Plan of Care completed and uploaded to Canvas dropbox by midnight the day following the assigned clinical experience (8 Med-Surg).

3. Applied Conceptual Care maps completed and uploaded to Canvas dropbox (3 total).

4. OR Report, graded by clinical faculty, grade applied to NURS 165 (due 1 week following your 2nd scheduled OR experience, Week 15 OR clinicals due by 5/12/19).

5. Discharge Plan, graded by theory faculty, grade applied in NURS 165 (due 05/05/19 by midnight to Canvas drop box).

6. Journaling, reflective thoughts on each day’s clinical experience (due every 5 weeks).

7. Daily clinical performance feedback form (due daily).8. Clinical self-evaluation & Facility evaluation (due at course end).

9. Course evaluation (due at course end).

V. Dress Code

1. Uniform: During medical surgical clinicals: White scrub shirts with Logo, royal blue uniform pants, WNC lab coat, white socks (or nylons) and white or black shoes. A long sleeve white T-shirt may be worn under scrub tops. No jackets, or sweat shirts are to be worn over scrubs during clinical experience. Long hair must be up off the collar not just tied back. All facial piecing jewelry must be removed. Students must have their student & facility ID visible.

2. Supplies: Scissors, stethoscope, pen light, watch with a second hand, and black ink penStudents who show up without all of the above supplies will be considered unprepared for clinical and may be sent home and/or given a "U".

VI. Attendance 1. Students must notify the instructor if they are going to be late or absent. All

clinical absences must be made up. Method of make-up is to be discussed with the clinical instructor. See student handbook for further information.

2. General Time Line Expectation for Medical/ Surgical Units0600 Pre-conference with clinical instructor, review Care Plan Part 1, activities of day0700 Change of shift report with nurse0730 Initial assessment including VS, check all dressings, IV’s; check orders and review

treatments and medications, develop plan of care0800 You are responsible for total patient care of your assigned patient0830 Complete assessment, begin administering medications0930 Provide personal hygiene, treatments, procedures, patient teaching


1000 Morning documentation completed, includes hourly rounding on an hourly basis1100 30-minute lunch (coordinate specific time with the nurse you are working with)12001300 Continue monitoring patient, complete treatments/teaching, focus assessments,

admissions, discharges, afternoon documentation completed, hourly rounding1430 SBAR report off to resource nurse. 1500 Post-conference

3. General Time Line Expectation for OR0630 Dressed in OR attire, receive case assignment Lunch and Breaks (coordinate with the nurse you are working with)1500 Post-conference

4. Reporting on a Change or Critical Condition Students are expected to know the following information on their patient when there is a change in condition. SBAR is a standard format used at Carson Tahoe Regional Medical Center. This information is standard knowledge the nurse should assess. Any change in condition must be immediately reported to the RN caring for the patient AND your clinical instructor.S SituationB BackgroundA AssessmentR Recommendations

5. End of Shift Report to the RNBefore leaving unit for breaks, lunch and end of day a report on the patient’s current condition and care received must be communicated to the RN caring for the patient.

Shift Report Using SBAR Format

The Situation and Background will only need to be entered the first time you report on this patient

Situation Patient name, age, sexRoom numberPhysician/Providers

Background Admission diagnosis (date of surgery)Past medical history that is significant (hypertension, CHF, etc.)Allergies

This information should be included in each report if applicableAssessment Code status (any advance directives, DNR orders, POAHC)

Procedures done in previous 24 hours including results/outcomes (include where we stand with post procedure vitals/assessment)Abnormal and relevant assessment findingsAbnormal vital signsIV fluids/drips/site; when is site to be changedCurrent pain score – what has been done to manage painSafety needs – fall risk, skin risk, etc.

Recommendations Needed changes in the plan of care (diet, activity, medication,


consultations)?What are you concerned about?Discharge planningPending labs/x-rays, etc.Calls out to Dr. _______ about______________What the next shift needs to do or to be aware of – i.e., labs to be drawn in the AM, etc.

VII. Clinical Faculty

Debi Ingraffia-Strong PhD(c), MSN, RN Office: Cedar 216 AProfessor of Nursing Office phone: [email protected] Cell phone: 775-901-0612

Lisa Dunkelberg MSN, RN Office: Cedar 216 CNursing Instructor Office phone: [email protected] Cell phone: 775-450-6865

Raylene Stiehl MSN, RN Fallon Lab: 775-423-9463Nursing Instructor Cell phone: 775-685-4100

[email protected]

Heather Reardon MSN, RN Office: Cedar 216 BNursing Instructor Office phone: [email protected]

Elizabeth Carrasco MSN, RN Cell phone: 775-790-5301Nursing [email protected]

Mary Sellars BSN, RN Cell Phone: 775-671-4531Nursing [email protected]

CTH Vocera system: During clinical hours the following faculty are available on the CTH Vocera system. If calling on an outside line call 775-445-5510 and ask for the person you are attempting to reach. If calling from an in-house line or from Sierra Surgery dial 5510 and ask for the person you are attempting to reach. You are able to leave a message at any time.

Debi Ingraffia-Strong Lisa Dunkelberg Mary Sellars


mailto:[email protected]





VIII. Clinical Forms Attached

General Clinical Schedule Grading RubricsClinical Forms Medication Administration PolicyCare plan and concept map templates linked within Basic Student Clinical Performance Evaluation Tool (BSCPET) (continued from semester 1 – available in the students file @ WNC) and course specific objectives

2018 167/151 Clinical Schedule

Weeks 1-5 6-10 10-15 Dates

A Wed CTH Wed CTH Wed Psy 1/23, 1/30, 2/6, 2/13, 2/20, 2/27, 3/6, 3/13, 3/27, 4/3, 4/17, 4/24, 5/1, 5/8; Sim: 4/10 (8-12)

B Wed Psy Wed CTH Wed CTH 1/30, 2/6, 2/13, 2/20, 2/27, 3/6, 3/13, 3/27, 4/3, 4/10, 4/17, 4/24, 5/1, 5/8; Sim: 1/24 (8-12)

C Thurs CTH Fri Psy Thurs CTH 1/24, 1/31, 2/7, 2/14, 2/21, 3/1, 3/8, 3/15, 3/29, 4/11, 4/18, 4/25, 5/2, 5/9; Sim: 2/28 (8-12)

G Fri Psy Thurs CTH Thurs CTH 2/1, 2/8, 2/15, 2/22, 2/28, 3/7, 3/14, 3/28, 4/4, 4/11, 4/18, 4/25, 5/2, 5/9; Sim: 1/24 (1-5p)

D Fri CTH Fri CTH Thurs Psy 1/25, 2/1, 2/8, 2/15, 2/22, 3/1, 3/8, 3/15, 3/29, 4/5, 4/11, 4/18, 4/25, 5/2; Sim: 5/9 (8-12)

F Fri CTH Wed Psy Fri CTH 1/25, 2/1, 2/8, 2/15, 2/22, 2/27, 3/6, 3/13, 3/27, 4/12, 4/19, 4/26, 5/3, 5/10; Sim: 3/28 (1-5)

E Sat CTH Sat CTH Fri Psy 1/26, 2/2, 2/9, 2/16, 2/23, 3/2, 3/9, 3/16, 3/30, 4/6, 4/12, 4/19, 4/26, 5/3, Sim: 4/11 (8-12)

CTH = Med-Surg @ Carson Tahoe Hospital Psy = Mental Health @ NNAMHS

Lead Faculty Debi Ingraffia-Strong, email questions to [email protected]



NURS 167: Plan of Care Evaluation Rubric

Student Name: Date: Instructor:

Plan of Care completed and discussed with clinical instructor in timely manner: Plan of Care must be clear, complete, and concise. Individualized.

Plan of Care submitted in timely manner: Satisfactory _______ Unsatisfactory _______ Total Score _______

Domains Level: Not EvidentScore = 0

Level: DevelopmentScore = 1 to 4Each area worth 1 point

Level: ProficientScore = 5 to 8Each area worth 2 points

Level: DistinguishedScore = 9 to 12Each are worth 3 points

Total

Critical Thinking

No interpretation of data(0)

Logical interpretation of data with maximum help from instructor(1)

Logical interpretation of data with minimal help from instructor(2)

Logical interpretation of data independentlyCreative(3)

Problem Identification

Unable to identify problems(0)

Able to identify problems with maximum help from instructor(1)

Able to identify problems with minimal help from instructor(2)

Able to identify problems independently(3)

Problem Solving

Fails to identify and implement appropriate nursing interventions with maximum assistance(0)

Identifies and implements appropriate nursing interventions with maximum help from instructor(1)

Identifies and implements appropriate nursing interventions with minimal help from instructor(2)

Identifies and implements appropriate nursing interventions independently(3)

Cognitive Skills

Fails to evaluate outcomesNo teaching plan(0)

Evaluation and Teaching require maximum assistance from instructor(1)

Evaluation and Teaching require minimal assistance from instructor(2)

Evaluation and Teaching Independently(3)

Comments

The student’s ability to utilize the nursing process in a competent and caring manner to safely meet the needs of the patient in an acute care setting is evaluated each week when completing the Plan of Care. This must be uploaded to the weekly drop box in Canvas by midnight of the day following the clinical experience.

Students are given a satisfactory grade for completing Part and discussing their plan with their clinical instructor during the clinical day. If the student fails to complete or articulate the plan of care with the clinical instructor, the student is given an unsatisfactory grade for the day. Students are scored using this rubric to show progression of learning and implementation of the nursing process. The student earns a grade in one of four levels: Not evident, Development, Proficient, and Distinguished determined by how much help and guidance is needed by the student to develop the plan of care.


WESTERN NEVADA COLLEGENURS 167: Concept Care Map

Evaluation Rubric

Student Name: Date: Instructor:

Individualized Concept Maps (3) completed and uploaded to the Canvas drop box throughout the clinical rotationConcept Care Map must be clear, complete, concise, and individualized. Students will be prepared to interlink concepts and their impact upon one another and will be presented in post-conference.

Complete Concept Care Map: Satisfactory _______ Unsatisfactory _______ Total Score _______

Domains Level: Not EvidentScore = 0

Level: DevelopmentScore = 1 to 4Each area worth 1 point

Level: ProficientScore = 5 to 8Each area worth 2 points

Level: DistinguishedScore = 9 to 12Each are worth 3 points

Total

Critical Thinking and Review of Systems

No interpretation of data(0)

Logical interpretation of data with maximum help from instructor(1)

Logical interpretation of data with minimal help from instructor(2)

Logical interpretation of data independentlyCreative(3)

Specific aspects within concepts and their impact upon one another of

Unable to identify linkage of concepts(0)

Able to identify linkage of concepts with maximum help from instructor(1)

Able to identify linkage of concepts with minimal help from instructor(2)

Able to identify linkage of concepts independently(3)

Problem Solving/Nursing Interventions

Fails to identify and implement individualized nursing interventions with maximum assistance(0)

Identifies and implements individualized nursing interventions with maximum help from instructor(1)

Identifies and implements individualized nursing interventions with minimal help from instructor(2)

Identifies and implements individualized nursing interventions independently(3)

Cognitive Skills/Patient Education

Fails to evaluate outcomesNo teaching plan(0)

Evaluation and Teaching require maximum assistance from instructor(1)

Evaluation and Teaching require minimal assistance from instructor(2)

Evaluation and Teaching Independently(3)

Comments

The student’s ability to develop a concept map that applies a patient’s specific data (assessment, lab, diagnostics, plan of care, etc.) to identified concepts within the concept map. The student will link concepts and their impact to one another and be able to discuss in post conference with their clinical group. Concept Maps will be uploaded to Canvas in the appropriate drop box.

Students are given a satisfactory grade for completing the concept map discussing their plan with their clinical instructor. If the student fails to complete or articulate the plan of care with the clinical instructor, the student is given an unsatisfactory grade for the day. Students are scored using this rubric to show progression of learning and application of the concepts.


Medical-Surgical Clinical Weekly ExperienceWestern Nevada College

Journal

Name _______________________ Date______________________

Clinical experiences can be meaningful, pointless, or harmful. Reflection is the key to getting meaning from your service experience. What is reflection? The experience is a process by which learners think critically about their experiences. Reflection can happen through writing, speaking, listening, and reading about the service experiences. Why is reflection important? Learning happens through a mix of theory and practice, thought and action, observation and interaction. The encounter allows the student to learn from his or her experience and that of others. You may use these questions to guide your reflections, or free writing.

What did you learn about yourself?

What excited, troubled, or unnerved you?

What do you think your patient &/or family gained?

What was the most significant thing that happened to me as a learner this week?

The experience shows that I have more to learn about?


NURS 167 ~ First Year Nursing Student ~ Daily Clinical Performance Feedback ~ Spring 2019

Student Name________________________________ DATE_______________

E = Excellent The student consistently performs at a level superior to most student nurses, asks questions and is interested in learning.

S = Satisfactory The student consistently performs in a manner that is safe and within the guidelines of standard nursing process.

NP = Needs Practice The student demonstrates inconsistent performance. Performs safely but needs more practice.U = Unsatisfactory The student performs in an unsafe manner or not at all.N/A = Not Applicable Not observed

Resource RN – Please provide brief feedback to the clinical instructor by circling the appropriate letter on the following checklist.

1. Demonstrates professional communication and interpersonal E S NP . N/A relationships with staff, peers and all healthcare personnel.

2. Assumes responsibility for nursing performance by asking E S NP . N/A appropriate questions, clarifying when needed and demonstrating appropriate independence for a first year nursing student.

3. Written and verbal communication is clear and organized. E S NP . N/A Reports off when leaving unit.

4. Utilizes technology and social media appropriately. (no texting E S NP . N/A or personal phone calls). Computer charting is accurate.

5. Consistently administers medications and treatments in a safe E S NP . N/A manner. 2 patient identifiers & allergy check used with all medication administration.

6. Demonstrates competent nursing care within the profession's E S NP . N/A and legal framework.

Comments:_________________________________________________________________________________________________________________________________________________________________________________Instructors

1. Manages time effectively (prompt for pre and post conference E S NP U N/A lunch, breaks)

2. Is prepared for clinical rotation prior to pre-conference E S NP U N/A (pathophysiology, plan of care, prioritization of care, knowledge of medications and diagnostic tests, student role in care.)

3. Provides safe, effective nursing care utilizing nursing process E S NP U N/A (assessments, changes in condition, documentation, reporting) to RN and faculty, performs procedures ONLY with faculty approval.

4. Adheres to WNC professional behaviors including dress code, use E S NP U N/A of computers and other social media, HIPPA

5. Concept map, integrated plan of care - individualized and specific to patient. Careplan Grade________


WNC Student Nurse Shift Report Form & Worksheet

ROOM: CODE STATUS: ALLERGIES:

PHYSICIAN/PROVIDER: HISTORY:

DIAGNOSIS:

ASSESSMENT MEDS/TO DO LIST

Neuro:

CV:

Pulm:

GI: GU:

Skin: Activity:

Diet: Social/Family Dynamic:

IVs DC plan:

I&O:

0630-0700 Preconference

0700

0800

0900

1000

1100

1200

1300

1400

1500-1600 Post conference

LABS & PROCEDURES


WESTERN NEVADA COLLEGE’S NURSING PROGRAMGuidelines for the Administration of Medications [Prescription and OTC medications including herbals]

1ST YEAR Spring Clinical Sessions 2019

1. AS A STUDENT NURSE, YOU MUST BE INITIALLY CHECKED-OFF ON YOUR ABILITY TO ADMINISTER MEDICATIONS SAFELY AND COMPETENTLY BY A WNC NURSING INSTRUCTOR DURING CLINCIAL. IF YOU RECEIVE A SATISFACTORY RATING FOR YOUR PERFORMANCE, THEN YOU MAY ADMINISTER MEDICATIONS (EXCEPT FOR EXPERIMENTAL DRUGS) UNDER THE SUPERVISION OF A CLINICAL INSTRUCTOR. A LICENSED NURSE (RN OR LPN) OR A RESPIRATORY THERAPIST (FOR MDI & AEROSOL TREATMENTS ONLY) MAY SUPERVISE MEDICATION ADMINISTRATION ONCE THE STUDENT HAS DEMONSTRATED COMPETENCE AND THE CLINICAL INSTRUCTOR HAS GRANTED PERMISSION. IV MEDICATIONS MAY BE ADMINISTERED FOLLOWING SUCCESSFUL CHECK-OFF OF COMPETENCY IN THE LAB (NURS 166) AND WITH CLINICAL FACULTY APPROVAL.

2. Prior to administrating medications in a clinical setting, the student is to review the following information:a. General principles of medication administration, including methods required for patient identification.b. Specific procedures for administration of medications by all routes c. Conversions and calculations of dosesd. Common abbreviationse. Routine times for medication administration f. Facility documentation recordsg. Management of:

1. Children and/or elders 2. Drugs with objectionable taste3. Drugs that can be crushed and those that cannot be crushed4. Patient who refuses drug5. Patient with difficulty swallowing6. Nasogastric/PEG/Gastrostomy tubes7. Drugs with dispensing restrictions

3. The following guidelines are used for evaluating student competency during administration of medications in the clinical setting:a. The student will be responsible for administering medications during the clinical time for the assigned patient

and others as assigned by the clinical instructor. The student will administer the medications according to facility policies. Prior to administering drugs for the day, the student will notify the clinical instructor or nurse of the specific time(s) monitoring is needed for medication administration.

b. The student is expected to have the following information available on each of the patients that the student will be medicating:i. Name, age, gender, allergies, Code statusii. Medical diagnoses or chief complaint iii. List of all routine and PRN medications, including the name on the MAR, dose, route, frequency and

reason the patient is receiving medication.c. During administration, the student will demonstrate:

i. Checking each medication with the medication record to ensure that it is the right drug, dose, route, time for the right patient 3 times.

ii. Preparing the medication using aseptic technique and maintaining a clean work area. iii. Drug conversion or calculation accurately.iv. Identifying the right patient prior to administration using 2 patient identifiers; verify allergies - both from

the patient’s medical record and with patient.v. Assessing the patient prior to and after administration for any signs and symptoms appropriate to the

drug use. vi. Explaining the medications to the patient that they will be receiving.


vii. Disposing of medication waste in appropriate containers. viii. Documenting on the EMAR with instructor/nurse with co-signature per facility policies.

d. The student is expected to answer questions regarding the medications, over-the-counter (OTC) drugs, herbal products, vitamins and minerals, and nutritional supplements to be administered, as well as PRNs the patient maybe receiving including the following information as appropriate to their care:i. name (generic and/or trade/brand name)ii. use/purpose/indication (for what anticipated effect is this patient receiving this drug)iii. actioniv. pharmacokineticsv. contraindications/precautionsvi. adverse reactions/side effectsvii. interactionsviii. dose (acceptable range?), route, frequency and time to be givenix. nursing implications (assessment, lab test considerations, potential nursing diagnoses, significant

implementation considerations, desired outcomes)x. patient/family teaching xi. Special considerations to individualize procedure (e.g. hard of hearing [HOH]; dysphagia-crush pills

and add to pudding, O2 flow rate, delivery method)xii. Drug conversion and calculations as appropriate

e. Failure to perform according to established protocol and/or lack of adequate preparation will be considered unacceptable and merit an unsatisfactory for this critical skill as well as possible termination from the program.

4. Throughout your first-year clinical experiences, you will be responsible for all the guidelines above and must

alert your instructor to areas of performance where you need additional supervision or practice (such as location of alternative sites for IM injections, mixing drugs, etc.). The clinical instructor can make a clinical referral to the lab for additional skill practice. You may arrange a time with the lab instructor for personal practice times in the lab.

Guidelines for the Administration of Medications.

Printed name

Signature

__________________________________________________Date

NURS 165/167Peri-operative Case Report Rubric

*due 1 week following your 2nd scheduled OR experience, Week 15 OR clinicals due by 5/12/19

Points Follow a patient through the perioperative period and write a report using the following rubric. This is a paper – utilizing APA format. Tables may be included to synthesize data.

8 Report must be typed in narrative form following outline below, cite and reference list per APA.4 In one paragraph reflect on what you learned from this experience including communication, relationships, and teamwork


between the OR staff, physicians and ancillary personnel.4 PATIENT GENERAL INFORMATION

1. gender2. age3. ethnicity4. medical diagnosis5. surgical procedure6. any vision, hearing impairment, language barrier7. any disabilities8. allergies (note reaction)

6 PATHOPHYSIOLOGY AND CONTRIBUTING FACTORSa. Description of pathophysiology underlying patient’s medical diagnosis and indication for surgery.b. Medical history related to diagnosis and/or contributing to risks (co-morbidities).

4 SPECIFIC PREOPERATIVE ORDERS AND PREPARATIONa. Medications – include IV solutionsb. Dietc. Urinary status: voided prior to surgery_____catheterized in OR_____Indwelling catheter_____.d. Pre-operative teachinge. Consent signed

2 INTRAOPERATIVE CAREa. Skin prep: agent and locationb. Time out c. Position during procedure and nursing considerationsd. Brief description of surgical procedure

5 List of the type of anesthetics used and adjunct drugs given; anticipated nursing interventions based upon the effects of anesthesia and related drugs.

5 POSTOPERATIVE CARE FOR THIS TYPE OF PROCEDUREa. List of post-op physician ordersb. Specific measures for this patient: airway_____, O2 l/min_____, positioning_____, dressings____, active warming_____, pain control_____, NG tubes_____, drains_____, immobilizer_____, other_____________________

4 IDENTIFY ANY COMPLICATIONS from the list below that occurred or may occur during the postoperative recovery and explain the interventions employed by the staff (See Lewis test)Tongue falling back_____, retained secretions_____, Atelectasis_____, Dyspnea_____, Apnea_____, Laryngospasm_____, bronchospasm_____, hypoventilation_____, pulmonary edema_____, aspiration_____, hypotension_____, hypertension_____, arrhythmias_____, emergence delirium_____, delayed awakening_____, hypothermia_____, hyperthermia_____, pain location and scale_____, nausea_____, vomiting_____, bleeding_____, wound dehiscence_____, wound evisceration_____, other______________________________________

4 VITAL SIGNS Preoperative B/P, P, R, Temp, O2 sat, PainIntraoperative B/P, P, R, Temp, O2 sat, Pain Postoperative B/P, P, R, Temp, O2 sat, PainPatient transferred or when you leave B/P, P, R, Temp, O2 sat, Pain

4 Appropriate For Patient:Anticipated NANDA Nursing DiagnosesList PCs

50 Total points possible

Comments:

Instructor:______________________________________________________________________

NURS 167: Pre-clinical Pathos and Medications – Preload – due 1/18/19 – Bring a printed copy

Student_________________________________________________________________

Faculty_________________________________________________________________


For each patho write a one paragraph synapsis or bullet pointed detail (in your own words – not copy/pasted) of the pathophysiologic process (must be at the cellular level…what happens to the body at the cellular level). Be sure to cite your references. Use reputable resources, not allowed are Wikipedia, Mayo Clinic, or WebMD, these are not in-depth enough. Then utilize the patho template for the remaining components. The medications must be individual work completed on the medication card template (attached).

Pathophysiology List Pathophysiology List Medication List Medication List

Diabetes Type 1 Diabetes Type 2 promethazine (inj) midazolam (inj)Pancreatitis Alcoholism ondansetron (inj) morphine sulfate (inj)Hypertension Pneumonia prochlorperazine (inj) hydromorphone (inj)Coronary Artery Disease COPD milk of magnesia (PO) fentanyl (inj)Hypothyroid Hyperthyroid dulcolax PO & PR) metronidazole (PO & IV)Osteoarthritis - DJD Bronchitis fleets enema (PR) ceftriaxone (IV)Osteomyelitis Stroke/TIA colace/senna/docusate (PO) enoxaparin (subcut)Heart failure Chronic Renal Failure diphenhydramine PO & inj heparin (SQ & IV)Myocardial infarction Anemia metoclopramide (IV) warfarin (PO)Hyperlipidemia PAD/PVD pantoprazole (PO & IV) clopidogrel (PO)Cholecystitis Leukemia vancomycin (IV) aspirin (PO)Atrial fibrillation Asthma ceftazidime (IV) levofloxacin (IV)Deep Vein Thrombosis Pulmonary Emboli meropenem (IV) linezolid (IV)Diverticulitis GERD albuterol atroventSepsis Cellulitis potassium (PO & IV) magnesium (PO & IV)Rhabdomyolysis humalog (SQ) insulin glargine (SQ)Intravenous solutions:Normal Saline (0.9% NS)Lactated Ringers (LR)5% Dextrose with 0.45 Normal Saline (D5 ½ NS)

Oxygen


Medication/Drug Card Reference

Drug Nursing Drug ReferenceTrade name:Generic name:Drug classification:Route(s)Drug indications:Mechanism of actionMOA explained in your own words – how would you explain this to your patient?Onset of action: Duration of action:Contraindications:

Drug interactions:Adverse effects:

Nursing Implications:

References


Pathophysiology Template

~You may use this template, or create one of your own~Be sure to address the pathophysiology process at the level of – what happens to the body at the

cellular level. This is in more detail and depth than those in first semester.


Medical Condition

Pathophysiology

Clinical ManifestationsLabs & Diagnostics

Usual TreatmentMeds, Vaccinations,

Treatments

Nursing Considerations

Anticipated Nursing Diagnoses

Clinical ManifestationsPatient signs & symptoms

References

Documents

€¦ · Web viewCTH = Med-Surg @ Carson Tahoe HospitalPsy = Mental Health @ NNAMHS Lead Faculty Debi Ingraffia-Strong, email questions to [email protected] NURS 167: Plan