ASSOCIATE DEGREE NURSING PROGRAM

SYLLABUS NURSING 150 CHRONIC HEALTH PROBLEMS SPRING 2013

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COURSE PREFIX:

NUR 150

COURSE TITLE:

CHRONIC HEALTH PROBLEMS

COURSE DESCRIPTION:

This course is a study of the treatments used for chronic health problems in adult patients. The course emphasizes the application of the nursing process, critical thinking, communication and management to promote, maintain and restore the health of clients experiencing chronic complex health problems at various stages of the lifespan. General medical and rehabilitation facilities are used for clinical experiences.

CREDIT HOURS:

6 credit hours

CONTACT HOURS:

4 hours of class per week (Summer: 6 hours of class per week) 6 hours of clinical per week (Summer: 9 hours of clinical per week)

COURSE PLACEMENT:

This is the third nursing course in the nursing curriculum.

PREREQUISITES:

NUR 120

COREQUISITES:

BIO 225; NUR 162

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REQUIRED TEXTS Note: Textbooks (in earlier editions) may be brought forward from previous nursing courses. Associate Degree Nursing Student Handbook. (2012 updates) Nursing Department. Horry-Georgetown Technical College. (Available online at www.hgtc.edu, Academic Web page, ADN link. Curren, A.M. (2010) Dimensional Analysis for Meds. 4th Edition. Delmar/Cengage Learning. Dillon, Patricia M. (2007). Nursing Health Assessment: Clinical Pocket Guide. 2nd ed. Philadelphia: F. A. Davis. Gahart, B. and Nazareno, A. (2012). Intravenous Medications. 28th Ed. Elsevier: Mosby. Grodner, M., Roth, S., and Walkingshaw, B. (2012). Nutritional Foundations and Clinical Applications: A Nursing Approach. 5th Ed.: Elsevier: Mosby. Karch, A. Focus on Nursing Pharmacology. (2011). 5th Ed. Lippincott, Williams and Wilkins. (Note: This is the textbook utilized for NUR 161 Pharmacology). Smeltzer, S. and Bare, B. (2010). Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 12th Edition. Lippincott, Williams and Wilkins. Wilson, B.A., et al. (2011 or 2012). Nurses’ Drug Guide. Prentice Hall. RECOMMENDED TEXTS Kee, J.L. (2005). Handbook of Laboratory and Diagnostic Tests with Nursing Implications. 5th Edition. Appleton and Lange. Laws Governing Nursing in S.C. (2003). http://www.llr.state.sc.us and follow links.

State Board of Nursing for S.C. Available online. See

Thomas, C.L. (Ed.) (2005). Taber's Cyclopedic Medical Dictionary. 20th Ed., F.A. Davis.

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REQUIRED MATERIALS: The following materials are those needed for NUR 150 that must be provided by the student: 1. Course syllabus and required texts 2. Complete HGTC student nurse’s uniform, HGTC ID Badge 3. Portfolio-brought forward from N101 and N120; in N201. 4. Wrist watch with a second hand 5. Pen, pencil, paper, calculator 6. Pen light, Stethoscope, Hemostats, Bandage scissors FACULTY:

Barbara Thomas, RNC, MN (Course Coordinator) Speir Building Office 1106 Grand Strand Campus 843-477-2163 E-mail: [email protected] E-mail: NUR 150 WaveNet

OFFICE HOURS:

Joseph Mucha, PhD, RN Speir Building Office 1107 Grand Strand Campus 843-477-2164 E-mail: [email protected] E-mail: NUR 150 WaveNet

Office hours are posted on instructor’s office door and on Wavenet.

SPECIAL POLICIES: 1. 2.

3. 4. 5. 6. 7. 8. 9. 10.

Students enrolled in NUR 150 must have and maintain a current BLS provider course. This may be obtained from The American Heart Association - Healthcare Provider Course. Students enrolled in NUR 150 must have an active HGTC WaveNet and D2L accounts. Course materials, calendar, and access to course information will be via WaveNet and D2L. Students will be expected to utilize WaveNet and D2L throughout the course. Exams will be via computer on D2L. Students enrolled in NUR 150 must have active EVOLVE computer accounts. Students enrolled in NUR 150 must have active Kaplan computer accounts. Students enrolled in NUR 150 must have active PrepU computer accounts. This is accessed via thePoint computer site included with required textbook. Students must provide their liability insurance (included in course fees). Students are expected to provide their own transportation to the clinical sites and community settings. See the Makeup Test Policy at the end of the syllabus. See N150 Computer Testing Policy at the end of the syllabus.

SPECIAL DATES OF CONCERN: A course calendar is provided via WaveNet or D2L N150 Course Files for each student. Please review the calendar for updates.

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The NURSING 150 Student Learning Outcomes Support the Associate Degree Nursing Program Outcomes. Upon completion of NURSING 150, the student will: 1. SAFETY Demonstrate the application of safety concepts in the provision of nursing care to individuals experiencing chronic illness. 2. CLINICAL DECISION MAKING Implement nursing care that reflects critical thinking and application of nursing process for adults with selected chronic health problems. 3. TEAMWORK and COLLABORATION Demonstrate the integration of active teamwork, collaborative processes, and the effective use of appropriate communication in order to facilitate positive patient outcomes. 4. PROFESSIONAL BEHAVIORS Model behaviors that demonstrate accountability and reflect standards of the profession. 5. PATIENT-CENTERED CARE Respect the rights of individual patients while establishing a caring and empathetic connection with diverse patient populations. CLINICAL OBJECTIVES:

Are as outlined in the NUR 150 Clinical Performance Evaluation Tool.

COURSE REQUIREMENTS: 1.

2. 3. 4. 5.

6. 7. 8.

The student must follow the policies and procedures of HGTC Nursing Department as outlined in the Student Handbook received at the beginning of Fundamentals of Nursing or in the Transition from LPN to Associate Degree Nursing courses. Updated and revised policies are announced and available to students online on the Department of Nursing website. The student must achieve 90% or greater on the math calculation exam (maximum of three attempts) to receive a passing grade for NUR 150. A single CRITICAL EVENT (defined in the Clinical Performance Evaluation) may lead to clinical and course failure. The student must achieve a cumulative 77% on graded work as outlined in the test and evaluation section of the course syllabus. The student must achieve a pass on clinical performance as outlined in the NUR 150 Clinical Performance Evaluation Tool. Students must attend all hours of scheduled clinical experiences in order to pass clinical. The student must attend all outside clinical experiences. The student must be prepared to provide transportation to all clinical experiences. Written assignments are required for each clinical experience.

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METHODS OF INSTRUCTION In NUR 150, we will utilize class group work, class discussion, small group discussions, lab/clinical demonstrations, simulator clinical laboratory practice, internet/web site research, clinical exploratory papers, supervised clinical practice and written assignments. Tests will be composed of written objective questions based on clinical and class content covered in the current class and in prerequisite classes. Unit Exams and the Final Exam will be taken via computer. REQUIRED COURSE MEASURES and ARTIFACTS N150 CLASS: MATH CALCULATION EXAM; UNIT EXAMS (4); FINAL EXAM; KAPLAN INTEGRATED TEST N150 LAB: Group Clinical Demonstrations; Individual Clinical Demonstrations N150 CLINICAL: Clinical Evaluation Tool; Weekly Clinical Papers; Clinical Case Study; Portfolios; EVOLVE online Patient Case Reviews/Scenarios.

EVALUATION METHODS: Final grades for NUR 150 Spring 2013 will be computed per the Student Policy: Grading Policy UNIT EXAMS (4) Average FINAL EXAM

90% 10% 100%

In addition to the above stated grading: 1. 2. 3. 4. 5. 6. 7.

The student must achieve 90% or greater on the math calculation exam (maximum of three attempts) to receive a passing grade for NUR 150. Clinical performance will be assessed at the end of each clinical day. The CLINICAL/LAB portion of the course will be graded PASS/FAIL. Pass or satisfactory completion of the clinical/lab portion will be as outlined on the NUR 150 Clinical Evaluation Tool. EVOLVE Patient Case Reviews/Scenarios will be required and completion of tests at a minimum score of 77% will be counted as part of the pass/fail clinical grade. The N150 Computer Testing Policy will apply. The Makeup Test Policy will apply. The Final Grade for the course will be computed per the Student Policy 2: Grading Policy in the Student Handbook. Calculation of the final course grade is NOT rounded.

ACCOMMODATIONS for TEST TAKING Students who require special accommodations for test taking must self-identify to the course coordinator during the first week of the semester. The HGTC Testing Center guidelines will be followed. It is the responsibility of the student to assure that the appropriate forms are completed and to schedule time for the exam at the testing center during the time the exam is being administered to the entire class. NUR 150 Syllabus

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NUR 150 COURSE CONTENT OUTLINE Concept Integration Model of the HGTC Associate Degree Nursing Program. Application of the Concept Integration Model to the nursing care of the adult client experiencing chronic health problems. III. The Nursing 150 Student Learning Outcomes: 1. SAFETY Demonstrate the application of safety concepts in the provision of nursing care to individuals experiencing chronic illness. 2. CLINICAL DECISION MAKING Implement nursing care that reflects critical thinking and application of nursing process for adults with selected chronic health problems. 3. TEAMWORK and COLLABORATION Demonstrate the integration of active teamwork, collaborative processes, and the effective use of appropriate communication in order to facilitate positive patient outcomes. 4. PROFESSIONAL BEHAVIORS Model behaviors that demonstrate accountability and reflect standards of the profession. 5. PATIENT-CENTERED CARE Respect the rights of individual patients while establishing a caring and empathetic connection with diverse patient populations. I. II.

IV. INTEGRITY NEEDS Application of holistic assessments utilizing the integrity needs of humans. The integrity needs of the adult client experiencing chronic health problems: A. Sociological integrity B. Psychological and spiritual integrity C. Physiological integrity related to comfort and sleep needs D. Physiological integrity related to nutritional and fluid/electrolyte needs E. Physiological integrity related to oxygenation needs F. Physiological integrity related to safety/infection control needs G. Physiological integrity related to sensory needs H. Physiological integrity related to mobility needs I. Physiological integrity related to elimination needs J. Physiological integrity related to sexuality needs

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V. MANAGEMENT of CHRONIC HEALTH PROBLEMS The management of patients with selected chronic health problems. NUR 150 Selected Chronic Health Problems Topics A. Chronicity and the management of chronic illness. B. The roles of risk factors and the prevention of chronic illness. C. The adult client experiencing chronic complex health problems. D. Selected modalities of chronic care: hospice, palliative care, rehabilitation E. Management of the adult client experiencing chronic pain. F. Management of the adult client experiencing diabetes (DM). G. Management of the adult client experiencing chronic kidney disease (CKD). H. Management of the adult client experiencing chronic endocrine disorders. I. Management of the adult client experiencing chronic cardiovascular disease. J. Management of the adult client experiencing hypertension (HTN). K. Management of the adult client experiencing a cerebrovascular accident (CVA). L. Management of the adult client experiencing heart failure (HF). M. Management of the adult client experiencing peripheral vascular disease (PVD). N. Management of the adult client experiencing chronic obstructive pulmonary disease (COPD). O. Management of the adult client experiencing tuberculosis (TB). P. Management of the adult client experiencing human immumodeficiency virus (HIV/AIDS). Q. Management of the adult client experiencing hepatitis or cirrhosis. R. Management of the adult client experiencing Parkinson’s Disease (PD). S. Management of the adult client experiencing rheumatoid arthritis (RA). T. Management of the adult client experiencing systemic lupus erythematosus (SLE). U. Management of the adult client experiencing multiple sclerosis (MS). V. Management of the adult client experiencing myasthenia gravis (MG). W. Management of the adult client experiencing amyotrophic lateral sclerosis (ALS). X. Management of the adult client experiencing inflammatory bowel disease (IBD). Y. Management of the adult client experiencing chronic alterations in sexuality needs. Z. Management of the adult client experiencing sensory disorders: glaucoma, meniere’s disease.

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NUR 150: CHRONIC HEALTH PROBLEMS CLASS 1 Class Topics 1. Introduction to Nursing 150 2. Concept Integration Model applied to the nursing care of the adult client experiencing chronic health problems. Topical Outline 1. Syllabus review 2. Concept Integration Model applied to the nursing care of the adult client experiencing chronic health problems. A. B. C. D. E.

Safety concepts applied to the care of the client with chronic health problems. Clinical decision making concepts applied to the client with chronic health problems. Teamwork and collaboration concepts applied to the care of the client with chronic health problems. Professional behavior concepts related to the care of the client with chronic health problems. Patient-centered care concepts related to the care of the client with chronic health problems.

Class Learning Outcomes 1. Identify how N150 course learning outcomes build on NUR 101 and NUR 120, and NUR 201 learning outcomes. 2. State how the final grade for N150 is computed. 3. Identify expectations for the N150 Dosage Calculation Exam. 4. Describe special course experiences and how they will be evaluated. 5. Prepare for Lab I: Math/Chronic Management Lab. See Lab I objectives in syllabus. 6. Discuss the components of the concept integration model for the associate degree nursing program. 7. Discuss the components of the concept integration model for the associate degree nursing program related to the nursing care of the client with chronic health problems. 8. Review the integrity needs categories applied to the care of the client with chronic health problems. 9. Review the N150 course learning outcomes. References NUR 150 Syllabus HGTC Associate Degree Nursing Student Handbook

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NUR 150: CHRONIC HEALTH PROBLEMS CLASS 1 SOCIOLOGICAL INTEGRITY related to the care of the adult client experiencing chronic health problems Topical Outline A. Assessment of the chronically ill adult B. Roles of the chronically ill C. Rehabilitation concepts D. Social Isolation E. Resources F. Nursing care of the chronically ill Class Learning Outcomes: 1. Define chronic illness. 2. Identify factors related to the increasing incidence of chronic illness. 3. Analyze characteristics of chronic illnesses and their implications on client and family. 4. Describe the impact of chronic illnesses on the lifestyles/roles of the adult client. 5. Differentiate between adaptive responses to chronic stressors versus acute stressors. 6. Discuss the cultural impact on how adults and their families cope with chronic illnesses. 7. Differentiate between services provided in acute health care settings and long term settings. 8. Plan and implement nursing interventions for adult clients with chronic health problems which meet ANA Standards of Nursing Practice. 9. Discuss the implications of chronicity on the holistic needs of clients/families. 10. Describe the current philosophy of rehabilitation. 11. Discuss the interdisciplinary approach to rehabilitation. 12. Identify and prioritize common nursing diagnoses applicable to the generic client experiencing a chronic illness. 13. Make clinical judgements regarding therapeutic nursing interventions which promote self care through activities of daily living in a client experiencing a chronic illness. 14. Make clinical judgements regarding therapeutic nursing interventions which promote mobility and ambulation in the client experiencing a chronic illness. 15. Define social isolation in relation to the chronically ill client’s ability to meet their sociological needs. 16. Discuss how a chronic illness would contribute to the effects of social isolation and alter the client’s sociological integrity. 17. Identify economic issues, home factors and community resources to be considered in the discharge plan of the chronically ill client. 18. Evaluate therapeutic nursing interventions for the client with complex health problems. 19. Communicate pertinent data regarding the client’s chronic illness, interventions, and outcomes to the health care team.

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Assigned References: 1. Smeltzer & Bare 12th ed. Chapter 6 (78-95) Homeostasis, Stress, and Adaptation Chapter 10 (144-165) Chronic Illness and Disability Chapter 11 (166-199) Principles and Practices of Rehabilitation. 2. Grodner 5th ed. Chapter 1 Wellness Nutrition

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CLASS 1 (cont’d) PSYCHOLOGICAL AND SPIRITUAL INTEGRITY related to the adult client experiencing chronic health problems Topical Outline A. Assessment of the psychological stressors of chronic illness B. Physiological, psychological, social, and spiritual aspects of aging. C. Living with an infectious/contagious disease D. Ethical dilemmas E. Impact of chronic illness on developmental tasks of adults. F. Nursing care to promote the psychological and spiritual integrity of self concept Class Learning Outcomes: 1. Review the concepts of stress and adaptation. 2. Identify psychological stressors and anxieties associated with chronic illness. 3. Discuss how the self concept is affected by chronic illness. 4. Identify several ethical dilemmas common to the medical-surgical area of nursing practice, specifically death and dying issues and life with an infectious illness. 5. Develop a definition of aging based on developmental and sociologic theories of aging. 6. Discuss the physiologic aspects of aging that occur as a result normal aging. 7. Describe the significance of preventive health care and health promotion for the elderly. 8. Examine the concerns of older people and their families in the home, community, acute care setting and in a protected environment. 9. Describe the impact of chronic illness on the developmental tasks/needs of the adult. 10. Assess the client’s psychological and spiritual integrity, identifying behaviors indicative of ineffective coping and/or altered self-concept. 11. Identify and prioritize nursing diagnoses which describe the altered needs of the client with chronic addictive behaviours. 12. Plan and implement nursing interventions which promote positive self concept and spiritual integrity for clients experiencing chronic illnesses. 13. Utilize effective interpersonal communication and collaboration skills to plan and implement holistic care for the chronically ill client experiencing psychological and spiritual stressors. 14. Identify realistic client-centered outcomes for the client with ineffective psychological and spiritual responses.

Assigned References: 1. Smeltzer & Bare 12th ed. Chapter 6 (78-95) Homeostasis, Stress, and Adaptation Chapter 10 (144-165) Chronic Illness and Disability Chapter 11 (166-199) Principles and Practices of Rehabilitation. 2. Grodner 5th ed. Chapter 1 Wellness Nutrition

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CLASS 2/CLASS 3/CLASS 4 PHYSIOLOGICAL INTEGRITY RELATED TO NUTRITIONAL NEEDS The Adult Client with Diabetes Mellitus Topical Outline A. Assessment of the client experiencing chronic alterations in nutritional needs 1. Pancreatic responses B. Pathophysiology of common chronic illnesses affecting nutritional status 1. Diabetes Mellitus C. Pharmacological management of chronic diseases affecting the nutritional status of the client 1. Oral Antidiabetic agents; blood glucose control agents 2. Insulins D. Dietary considerations for clients with diabetes mellitus. E. Special nursing considerations related to client’s experiencing chronic alterations in nutritional needs 1. Holistic diabetic teaching a. Blood glucose control b. Administering insulins c. Foot/skin care d. Nutrition (carbohydrate counting) e. Prevention of complications 2. Living with long term chronic hormonal therapy replacement 3. Importance of adherence to therapeutic regimen. 4. Nursing care of the client experiencing chronic alteration in nutritional needs Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Review the function of the pancreas and the hormones it secretes. Discuss the pathophysiology of diabetes mellitus as it impacts the nutritional needs of the client. Compare and contrast Type1 Diabetes Mellitus, Type 2 Diabetes Mellitus and the mixed types of DM. Analyze subjective and objective assessment and diagnostic data for abnormalities as they relate to the client’s altered nutritional needs. Analyze the long term changes of integrity needs of the client experiencing alterations in insulin secretion. Relate the therapeutic treatment modalities to promote adaptation of the client with nutritional needs. Develop a comprehensive teaching plan for the client experiencing an alteration in nutritional needs related to chronic variances of insulin levels. Collaborate with the health care team, nutritionist, client, and family to develop a plan which will meet the nutritional needs of the client. Plan holistic nursing care for the client experiencing variances in insulin availability to promote adaptation and nutritional need integrity.

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10. 11. 12. 13.

Prioritize nursing diagnoses for the client with chronic alterations in nutritional needs considering the holistic needs of the client. Develop and evaluate client-centered outcomes for therapeutic nursing interventions for the client with chronic alterations in nutritional needs. Discuss the community resources and web resources available to the client and family to assist in meeting the needs of the client with diabetes mellitus. Communicate assessment data, plan of care, interventions, and outcome evaluation of the client with altered nutritional needs.

Assigned References 1. Smeltzer & Bare: Chapter 41 (1196-1244) Assessment and Management of Patients with Diabetes Chapter 28 (757-758) Management of Patients with Coronary Vascular Disorders Note: Focus on Risk Factors, Metabolic Syndrome 2. Grodner Chapter 10 Management of Body Composition Chapter 16 Interactions (focus: p. 366: Table 16-5 Diabetes) Chapter 19 Nutrition for Diabetes Mellitus 3. Karch 5th ed. Chapter 38 Agents to Control Blood Glucose Levels 4. Curren 4th ed. Chapter 11. Measuring Insulin Dosages. Complete the chapter questions and calculations.

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CLASS 5 PHYSIOLOGICAL INTEGRITY RELATED TO ELIMINATION NEEDS The client experiencing chronic kidney disease. A. Assessment of the client with chronic alterations in elimination needs 1. Urinary elimination B. Pathophysiology of common chronic diseases affecting elimination 1. Chronic Kidney Disease/Chronic Renal Failure/End Stage Renal Disease C. Pharmacological management of clients with elimination alterations 1. Diuretics 2. Pharmacological therapy of Chronic Kidney Disease D. Nutritional consideration for client’s with altered elimination needs 1. Fluid management 2. Nutritional guidelines for the client with Chronic Kidney Disease E. Special nursing considerations for clients experiencing elimination needs 1. Pre and post dialysis care 2. Care of a urinary diversion F. Nursing care of the client experiencing chronic alterations in elimination. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Review assessment of normal urinary elimination and fluid and electrolyte status. Discuss the pathophysiology of Chronic Kidney Disease (CKD). State the alterations in elimination needs. Analyze abnormal assessment and diagnostic data of the client with alterations in elimination needs. Discuss the nurse's role in pre and post dialysis care for the client with altered elimination needs. Discuss the nurse's role in pharmacological management of the client with elimination alterations by CKD. Identify selected nursing diagnoses from obtained assessment data to describe the altered elimination needs produced by CKD. Prioritize nursing diagnoses for the client with altered elimination needs within the holistic needs of the client. Make clinical judgements regarding nursing interventions which promote optimum functioning of the client with elimination alterations. Identify realistic client-centered outcomes of care for the client experiencing chronic alterations in elimination needs. Collaborate with the client with CKD to problem solve and modify their lifestyle and diet incorporating therapeutic diets. Provide the client with health promotion, maintenance and restoration information regarding their altered elimination needs. Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with specific elimination problems.

.

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Assigned References 1. Smeltzer & Bare Chapter 44 (1320-1346) Management of Patients with Renal Disorders; Focus: Renal Failure Chapter 14 Fluids and Electrolytes Focus on chart (Table 14-4) on pages 276-277 for review. 2. Grodner Chapter 21 Nutrition for Diseases of the Kidneys 3. Karch Chapter 37 (574-577) Parathyroid Agents; Chapter 37, p. 589-592 (Box on p. 589) Chapter 49 (790-799) (Erythropoietin; Iron) Chapter 51 Diuretic Agents

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CLASS 6 PHYSIOLOGICAL INTEGRITY RELATED TO FLUID/ELECTROLYTE and NUTRITIONAL NEEDS The client experiencing Cushing’s Disease. The client experiencing Addison’s Disease. Topical Outline A. Assessment of the client experiencing chronic diseases affecting their fluid and electrolytes and nutrition 1. Adrenal responses B. Pathophysiology of common chronic illnesses affecting nutritional status 1. Cushing’s Disease 2. Addison’s Disease C. Pharmacological management of clients with chronic diseases affecting their nutritional status 1. ACTH Hormones a. Glucocorticoids 1. Cortisol 2. Cortisone b. Mineralocorticoids 1. Aldosterone D. Special nursing considerations related to client’s experiencing chronic alterations in nutritional needs 1. Living with long term chronic hormonal therapy replacement 2. Nursing care of the client experiencing chronic alteration in nutritional needs Class Learning Outcomes: 1. Review the function of the adrenal and pituitary glands and the hormones they secrete. 2. Discuss the pathophysiology of Addison's Disease and Cushing's Syndrome as endocrine stressors impacting on nutritional needs. 3. Analyze abnormal subjective and objective assessment and diagnostic data found in clients with altered fluid/electrolyte and nutritional needs secondary to ineffective adrenal responses. 4. Identify and prioritize nursing diagnosis of clients with alterations in fluids/electrolytes and nutritional needs secondary to ineffective adrenal responses, within in the holistic needs of the chronically ill client. 5. Make clinical judgements regarding nursing interventions which promote optimal nutrition with the client experiencing the chronic health problems of Addison's Disease and Cushing's Syndrome. 6. Discuss the nurse’s role in the pharmacological management of clients with fluid/electrolyte and nutritional problems secondary to Addison's Disease and Cushing's Syndrome. 7. Use problem solving and collaboration to assist the client with lifestyle changes related to long-term hormonal replacement. 8. Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with nutritional alterations. 9. Identify realistic client-centered outcomes when chronic fluid/electrolyte and nutritional alterations such as Addison’s and Cushing’s Diseases exist. NUR 150 Syllabus

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Assigned References: 1. Smeltzer & Bare Chapter 42 (1275-1289) Assessment and Management of Patients with Endocrine Disorders 2. Grodner Chapter 15 Nutrition and Metabolic Stress 3. Karch Chapter 36 Adrenocortical Agents

Class 7: EXAM I

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CLASS 8 PHYSIOLOGICAL INTEGRITY RELATED TO COMFORT /SLEEP NEEDS The Client Experiencing Chronic Pain Topical Outline A. Assessment of the client with chronic pain B. Special nursing considerations for the client with chronic pain C. Identification of personal beliefs and values regarding pain D. Current treatment modalities for client's experiencing chronic pain E. Living with chronic pain Class Learning Outcomes: 1. 2.

3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Relate the neurophysiology of chronic pain to assessment data commonly seen in clients experiencing chronic pain. Explore common chronic illnesses which create chronic pain. For the adult client, review the causes and treatments of chronic pain secondary to cancer, chronic pain secondary to fibromyalgia, and chronic pain secondary to sickle cell anemia. Note: pain will be discussed in each class. Recognize abnormal psychological, spiritual, sociological, and physiological assessment data in the client with chronic pain. Review personal views/beliefs regarding pain and pain management. Discuss various treatment modalities of chronic pain specifically TENS, biofeedback, integrative therapies, and pharmacologic therapy. Plan and implement holistic nursing care for the client experiencing chronic pain which promotes adaptation and need integrity. Evaluate the outcomes of therapeutic interventions for pain through collaboration with the client. Communicate pertinent data regarding the client’s chronic pain, interventions, and outcomes to the health care team. Discuss pain management concerns and issues on the national health policy level. Apply the principle of pain assessment as the “fifth vital sign.” Document pain assessments utilizing a pain scale. State two nursing diagnoses related to pain. Discuss hospice care and palliative care as modalities of nursing care. Discuss cultural competence in relationship to the assessment of pain.

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Assigned References: 1. Smeltzer & Bare Chapter 13 (230-262) Pain Management. Focus Pages: (231-232) Chronic Pain Chapter 54 (1654-1655) Assessment and Management of Patients with Rheumatic Disorders: Fibromyalgia 2. Grodner Chapter 16 Interactions: Complementary and Alternative Medicine Focus: p. 349-351; Table 16-1 3. Karch Chapter 21 Antidepressant Agents Chapter 23 (373) Chart (see gabapentin and pregabalin)

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CLASS 9 PHYSIOLOGICAL INTEGRITY RELATED TO OXYGENATION NEEDS The client experiencing chronic cardiovascular disease. The client experiencing atherosclerosis and coronary artery disease. The client experiencing acute coronary syndrome (angina). Topical Outline A. Assessment of the cardiopulmonary system of a client with oxygenation needs 1. Cardiac system abnormalities a. Cardiovascular responses B. Pathophysiology of common disorders affecting oxygenation 1. Atherosclerosis 2. Angina C. Pharmacologic management of the client with oxygenation needs 1. Lipid Lowering Agents 2. Anti-anginals D. Nutritional considerations for clients with oxygenation needs 1. Cardiac Health Nutrition E. Special nursing considerations related to clients with oxygenation alterations. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Discuss the pathophysiology of atherosclerosis and angina as physiological responses to internal and external stressors. Compare and contrast atherosclerosis and coronary atherosclerosis. Differentiate between modifiable and non-modifiable risk factors for cardiovascular disease. Compare the relationship of coronary atherosclerosis and angina in the cardiac client. Compare and contrast stable, unstable and variant angina and non-cardiac pain. Recognize abnormal assessment data in the client with specific oxygenation problems. Identify selected nursing diagnoses, using assessment data to describe the oxygenation problems of the client with angina and atherosclerosis. Prioritize diagnoses among the total needs of the client with angina. Make clinical judgements regarding nursing interventions which promote optimum functioning in the client with the chronic problems of angina and atherosclerosis. Discuss the nurse’s role in the pharmacological management of the client with specific oxygenation problems using specified drugs. Use problem-solving to assist the client to modify their diet and lifestyle, specifically using principles of cardiac health nutrition. Provide clients with accurate health promotion and restoration information regarding their altered oxygenation needs. Communicate assessment data, plan of care, interventions and outcome evaluations of the client with specific oxygenation problems.

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Assigned References: 1. Smeltzer & Bare Chapter 26 (684-719) Assessment of Cardiovascular Function Chapter 28 (755-770) Management of Patients with Coronary Vascular Disorders 2. Grodner Chapter 16 Interactions (focus: p. 361; Box 16-4) Chapter 20 Nutrition for Cardiovascular and Respiratory Diseases 3. Karch Chapter 46 Antianginal Agents Chapter 47 Lipid-lowering Agents

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CLASS 10 PHYSIOLOGICAL INTEGRITY RELATED TO OXYGENATION NEEDS The client with hypertension. Topical Outline A. Assessment of the cardiopulmonary system of a client with oxygenation needs 1. Cardiac system abnormalities 2. Vascular responses B. Pathophysiology of common disorders affecting oxygenation 1. Hypertension C. Pharmacologic management of the client with oxygenation alterations 1. Antihypertensives a. Diuretics b. Angiotensin-Converting Enzyme Inhibitors c. Angiotensin II Receptor Blockers d. Antiadrenergics e. Calcium Channel Blocking Agents f. Vasodilators D. Nutritional considerations for clients with altered oxygenation needs 1. Sodium managed diets 2. Dietary Approaches to Stopping Hypertension (DASH). E. Special nursing considerations related to clients with oxygenation alterations 1. Education of client and family/significant other related to lifestyle changes needed for those with oxygenation needs 2. Nursing care of clients with ineffective cardiopulmonary responses altering oxygenation needs Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Discuss the pathophysiology involved in vascular disorders as they affect oxygenation needs. Analyze diagnostic and assessment data for ineffective oxygenation secondary to vascular responses. Identify selected nursing diagnoses to describe oxygenation problems of the client with ineffective vascular responses. Prioritize diagnoses according to the holistic needs of the client with hypertension. Make clinical judgements regarding nursing interventions which promote adaptation in the client with ineffective vascular responses. Discuss the nurse’s role in pharmacological management of the client with altered oxygenation needs. Use problem solving to assist clients through collaboration to modify diet and lifestyle specifically related to modifiable risk factors. Compare and contrast primary and secondary hypertension. Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with altered oxygenation needs.

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Assigned References 1. Smeltzer & Bare Chapter 32 (889-902) Assessment and Management of Patients with Hypertension Chapter 58 (1794-1795) Assessment and Management of Patients with Eye and Vision Disorders 2. Grodner Chapter 16 Interactions (focus: p. 361; Box 16-4) Chapter 20 Nutrition for Cardiovascular and Respiratory Diseases (p. 442 Teaching Tool Boxes) 3. Karch Chapter 43 Drugs Affecting Blood Pressure

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CLASS 11 PHYSIOLOGICAL INTEGRITY RELATED TO OXYGENATION NEEDS and SENSORY NEEDS The client experiencing a cerebrovascular accident. A. Assessment of the client with chronic alterations in sensory needs B. Pathophysiology of common neurological disorders which affect the senses 1. Cerebrovascular Accident (CVA) C. Pharmacological management of client's with sensorineural deficit 1. Antihypertensives 2. Platelet aggregation inhibitors D. Nutritional concerns for clients with sensorineural deficits 1. Dysphagia E. Special nursing considerations for the client with sensorineural deficits 1. Care of the client pre and post diagnostic imaging tests 2. Education of the family/significant other(s) of client's with sensorineural deficits 3. Multidisciplinary approach to discharge teaching of client's with sensorineural deficits 4. Nursing care of the client experiencing alterations in sensory needs. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Discuss the pathophysiology of the types of CVAs. Identify abnormal assessment data related to the client with different types of CVAs. Discuss the pathophysiology of CVA as it impacts on the physiological, oxygenation, mobility and sensory needs of the client. Compare and contrast the sensory needs/responses of a client with the different types of CVAs. Identify selected nursing diagnoses based on assessment data which describe the client with altered sensory needs. Prioritize the nursing diagnoses of the client with sensory needs among the holistic needs of the client. Make clinical judgements regarding therapeutic nursing interventions which promote optimum adaptation of the client with sensory alterations. Identify realistic client-centered outcomes when chronic sensory impairments exist. Discuss the nurse's role in pharmacological management of the client with sensorineural deficits secondary to CVA. Identify community resources and web resources to assist the client/family in caring for the client with sensorineural deficits. Plan nursing care for the client with sensorineural needs in the acute setting, rehabilitation setting, home care and long-term care setting. Communicate assessment data, plan of care, interventions and outcome evaluations of the client with sensorineural needs. Collaborate with client, family, and health team members to develop a comprehensive plan of care for long-term care of the client with chronic sensory alterations.

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Assigned References: 1. Smeltzer & Bare Chapter 62 (1895-1917) Management of Patients with Cerebrovascular Disorders 2. Grodner Chapter 17 Nutrition for Disorders of the Gastrointestinal Tract (focus: Dysphagia p. 371-375) 3. Karch Chapter 48 Drugs Affecting Blood Coagulation

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CLASS 12/CLASS 13 PHYSIOLOGICAL INTEGRITY RELATED TO OXYGENATION NEEDS The client with heart failure. Topical Outline A. Assessment of the cardiopulmonary system of a client with oxygenation needs 1. Cardiac system responses B. Pathophysiology of common disorders affecting oxygenation alterations 1. Heart failure 2. Valvular disorders C. Pharmacologic management of the client with oxygenation needs secondary to heart failure 1. Cardiac Glycosides 2. Antihypertensives 3. Diuretics D. Special nursing considerations related to clients with oxygenation needs 1. Preparation for diagnostic tests 2. Education of client and family related to specific effects of treatment modalities. 3. Education of client and family related to lifestyle changes needed for those with oxygenation needs. 4. Nursing care of clients with ineffective cardiopulmonary responses which alter oxygenation needs. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Analyze cardiovascular and diagnostic assessment data for abnormalities related to valvular disorders and heart failure. Discuss the pathophysiology of ineffective cardiac responses, specifically valvular disorders and heart failure, and their impact on oxygenation needs. Discuss the nurse's role in identification of the learning needs of the client with ineffective oxygenation. Compare and contrast the types of heart failure: right and left-sided heart failure; systolic and diastolic heart failure. Correlate the pathophysiology of hypertension, valvular disorders, and heart failure. Discuss the nurse's role in the pharmacologic management of the client with altered oxygenation needs secondary to impaired cardiac responses. Identify and prioritize selected nursing diagnoses that describe altered oxygenation needs secondary to cardiac responses. Make nursing judgements regarding interventions which will promote adaptation of the client with ineffective oxygenation secondary to ineffective cardiac responses. Use problem solving and collaboration to assist the client experiencing altered oxygenation needs with lifestyle and diet modifications. Discuss the effects of home oxygen therapy on health maintenance and restoration in the client with altered oxygenation needs related to ineffective cardiac responses. Provide clients with accurate health promotion and restoration information regarding their altered oxygenation needs.

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12. 14. 15.

Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with the specific oxygenation problems of valvular disorders and heart failure. Review the psychological and spiritual integrity needs specifically related to death and dying issues for the patient with an end-stage cardiac condition. Identify realistic client-centered outcomes for therapeutic interventions for the client with chronic alterations in oxygenation needs.

Assigned References: Class 12 Heart Failure 1. Smeltzer & Bare Chapter 30 (823-846) Management of Patients with Complications from Heart Disease Chapter 27 (729-732) Management of Patients with Dysrhythmias and Conduction Problems: Atrial Fibrillation 2. Grodner Chapter 20 Nutrition for Cardiovascular and Respiratory Diseases Focus: p. 442-443 Cardiac Failure 3. Karch Chapter 44 Cardiotonic Agents Assigned References: Class 13 Valvular Heart Disease 1. Smeltzer & Bare Chapter 29 (797-807) Management of Patients with Structural, Infectious, and Inflammatory Cardiac Disorders

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CLASS 14 PHYSIOLOGICAL INTEGRITY RELATED TO OXYGENATION NEEDS The client with peripheral vascular disease. Topical Outline A. Assessment of the cardiopulmonary system of a client with oxygenation needs 1. Cardiac system abnormalities 2. Vascular responses B. Pathophysiology of common disorders affecting oxygenation 1. Peripheral vascular disease C. Pharmacologic management of the client with oxygenation alterations 1. Antiplatelet Agents 2. Anticoagulants D. Nutritional considerations for clients with altered oxygenation needs 1. Cardiac Health Nutrition E. Special nursing considerations related to clients with oxygenation alterations 1. Education of client and family/significant other related to lifestyle changes needed for those with oxygenation needs 2. Nursing care of clients with ineffective cardiopulmonary responses altering oxygenation needs. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Discuss the pathophysiology involved in vascular disorders as they affect oxygenation needs. Analyze diagnostic and assessment data for ineffective oxygenation secondary to vascular responses. Identify selected nursing diagnoses to describe oxygenation problems of the client with ineffective vascular responses. Prioritize nursing diagnoses according to the holistic needs of the client with ineffective vascular responses. Make clinical judgements regarding nursing interventions which promote adaptation in the client with ineffective vascular responses. Discuss the nurse’s role in pharmacological management of the client with altered oxygenation needs. Use problem solving to assist clients through collaboration to modify diet and lifestyle specifically related to modifiable risk factors. Compare and contrast arterial and venous insufficiency Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with altered oxygenation.

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Assigned References 1. Smeltzer & Bare Chapter 31 (847-867; 872-888) Assessment and Management of Patients with Vascular Disorders and Problems of Peripheral Circulation 2. Grodner Chapter 20 Nutrition for Cardiovascular and Respiratory Diseases 3. Karch Chapter 48 Drugs Affecting Blood Coagulation

CLASS 15: EXAM II

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CLASS 16/CLASS 17 PHYSIOLOGICAL INTEGRITY RELATED TO OXYGENATION NEEDS The client with Chronic Obstructive Pulmonary Disease (COPD). Topical Outline A. Assessment of the cardiopulmonary system of a client with altered oxygenation needs 1. Respiratory system abnormalities. B. Pathophysiology of common chronic disorders affecting oxygenation 1. Chronic Obstructive Pulmonary Disease (COPD) C. Pharmacologic management of the client with oxygenation alterations 1. Bronchodilators 2. Anti-inflammatory agents 3. Inhalants D. Special nursing considerations related to clients with altered oxygenation needs 1. Preparation for diagnostic tests 2. Oxygen therapy 3. Education of client and family related to specific effects of treatment modalities 4. Education of client and family related to lifestyle changes needed for those with oxygenation needs 5. Nursing care of the client with ineffective cardiopulmonary responses altering oxygenation needs Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Analyze pulmonary assessment and diagnostic data identifying abnormalities in altered oxygenation needs secondary to COPD. Review beta adrenergic receptors and their function in the lungs specifically related to Chronic Obstructive Pulmonary Disease. Discuss the pathophysiology of COPD and stages of its development as a chronic illness altering effective oxygenation. Differentiate asthma, chronic bronchitis, and emphysema. Identify changes in pulmonary function studies and arterial blood gases for the client with COPD. Develop appropriate selected nursing diagnoses for the client with the oxygenation problem of COPD. Make clinical judgements regarding nursing interventions which promote optimum oxygenation in the client experiencing ineffective pulmonary responses. Discuss the nurse’s role in the pharmacological management of the client with COPD. Discuss the nurse’s role in client education and preparation for diagnostic tests related to altered oxygenation needs secondary to COPD. Prioritize nursing diagnoses describing the oxygenation problems related to COPD within the holistic needs of the client. Provide clients with accurate health promotion and restoration information regarding their altered oxygenation needs (specifically related to oxygen therapy, breathing techniques, and therapeutic management).

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12.

13. 14. 15. 16. 17.

Review the psychological and spiritual needs of the client with altered oxygenation specifically related to living with a chronic illness, end-stage illness, and death and dying issues. Communicate assessment data, plan of care, interventions and outcome evaluations of the client with oxygenation problems related to COPD. Use problem solving and collaboration to assist the client in lifestyle modification which will allow continued physiological, psychological, spiritual, and sociological integrity. Identify realistic client-centered outcomes of therapeutic interventions which promote adaptation in the client with chronic alterations in oxygenation. Discuss the risk factors associated with the development of sleep apnea and obstructive sleep apnea. Review the current respiratory care modalities associated with sleep apnea: CPAP and BiPAP.

Assigned References: 1. Smeltzer & Bare Chapter 22 (533-534) Management of Patients with Upper Respiratory Disorders: Focus: Sleep Apnea Chapter 24 (601-631) Management of Patients with Chronic Pulmonary Disease Chapter 25 (635-645) Respiratory Care Modalities Note: Use this as a review. 2. Grodner Chapter 20 Nutrition for Cardiovascular and Respiratory Diseases Focus: p. 445-447 Respiratory Diseases 3. Karch Chapter 55 Drugs Acting on the Lower Respiratory Tract

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CLASS 18/ CLASS 19 PHYSIOLOGICAL INTEGRITY RELATED TO SAFETY and INFECTION CONTROL NEEDS The client with tuberculosis (TB). The client with HUMAN IMMUNODEFICIENCY VIRUS (HIV/AIDS). Topical Outline A. Assessment of safety needs of clients with infections B. Pathophysiology of common chronic infectious diseases 1. Tuberculosis 2. HIV/AIDS & Opportunistic Infections C. Pharmacological management of a client with an infectious disease D. Nutritional needs for clients 1. Nutritional support 2. Food safety concerns E. Special Nursing considerations 1. Education of client and significant others related to lifestyle changes needed for those with safety and infection control issues 2. Personal belief review regarding individuals with chronic safety issues. 3. Community resources and web resources available. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Apply the use of standard precautions to client scenarios. Discuss the pathophysiology of HIV and it's progression to immunosuppression and threatened physiological safety. Describe the epidemiology of HIV infection, methods of transmission, and strategies for prevention. Discuss the nurse's role in addressing the psychosocial, legal and ethical issues and the impact of this disease on the National Health Care Policy. Discuss the pathophysiology of tuberculosis and how it impairs physiological safety. Describe the epidemiology of TB and methods of transmission. Relate the epidemiology of TB and HIV to the client with altered immunity and impaired physiological safety. Analyze abnormal assessment and diagnostic findings in the client with alterations in safety needs. Identify and prioritize selected nursing diagnoses for the client with safety alterations as a response to HIV, AIDS, and TB within the framework of holistic health needs. Make clinical judgements regarding nursing interventions which promote optimum adaptation of the client with altered safety needs. Use problem solving and collaboration to promote holistic lifestyle changes related to diet, risk prone behaviors, and standard precautions in the client with chronically altered safety needs. Discuss the nurse's role in the pharmacological management of the client with safety alterations. Provide clients and families with accurate health promotion, maintenance, and restoration information regarding safety needs. Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with specific safety needs accurately, descriptively, and concisely.

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15. 16. 17.

Identify realistic client-centered outcomes for care when chronic alterations of physiological safety exist due to immunosuppression. Review personal views and beliefs regarding clients with chronic alterations of physiological safety related to HIV, AIDS, and TB. Identify community resources and web resources available to assist those with chronically impaired safety needs.

Assigned References: 1. Smeltzer & Bare Chapter 23 (567-572) Management of Patients with Chest and Lower Respiratory Tract Disorders: Pulmonary Tuberculosis Chapter 52 (1573-1605) Management of Patients with HIV Infection and AIDS 2. Grodner Chapter 2 Personal and Community Nutrition (Focus: p. 39 Box 2-7 Foodborne Illness) Chapter 22 Nutrition in Cancer, AIDS, and Other Special Problems Focus: p. 476 Box 22-3; p. 481-486 3. Karch Chapter 9 (121-124) Antimycobacterials Chapter 10 (141-152) Agents for HIV and AIDS

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CLASS 20 PHYSIOLOGICAL INTEGRITY RELATED TO SAFETY and INFECTION CONTROL NEEDS PHYSIOLOGICAL INTEGRITY RELATED TO NUTRITIONAL NEEDS and FLUID and ELECTROLYTE NEEDS The client with hepatitis. Topical Outline A. Assessment of the client experiencing chronic alterations of nutrition 1. Liver responses B. Pathophysiology of common chronic illnesses affecting safety and nutritional status 1. Hepatitis C. Special nursing considerations for the client experiencing chronic alterations in nutritional needs 1. Education of client & family regarding lifestyle factors related to hepatitis. 2. Teaching client/family about lifestyle alterations necessary to promote quality of life and prevention of transmission of infectious disease 3. Nursing care of the client experiencing chronic alterations in safety and nutritional needs

Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Analyze hepatic assessment and diagnostic data for abnormalities related to ineffective liver responses. Identify the metabolic functions of the liver. Discuss the pathophysiology of the different types of hepatitis and their impact on the safety and nutritional needs of the client. Compare and contrast Hepatitis A, B, C, D and E. Analyze clinical manifestations of liver dysfunction in relation to nutritional needs secondary to ineffective liver responses. Relate jaundice and nutritional deficiencies to the altered nutritional needs as a result of hepatitis. Prioritize specific nursing diagnoses to describe the safety and nutritional problems of the client with specific types of hepatitis. Prioritize nutritional nursing diagnoses within the holistic needs of the client. Make clinical judgements regarding nursing interventions which promote optimum adaptation in the client with the chronic health problem of hepatitis. Discuss the nurse’s role in the pharmacological management of the client experiencing alterations in nutrition secondary to hepatitis. Use problem solving and collaboration to assist the client and family in lifestyle changes, such as the use of standard precautions. Provide clients and family with accurate health promotion and restoration information regarding their altered safety/infection control and nutritional needs. Communicate assessment data, plan of care, interventions and outcome evaluations of the client with specific safety and nutritional problems. Review standard precautions in relation to safety of self and for teaching purposes for the client and family.

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15. 16. 17.

Review the psychological and spiritual needs of the client living with an infection/transmittable disease. Identify realistic client outcomes for clients experiencing chronic alterations in safety and nutritional needs. Discuss the current risk factors leading to the development of non-alcoholic fatty liver disease.

Assigned References 1. Smelzer & Bare Chapter 39 (1116-1128; 1133-1158) Assessment and Management of Patients with Hepatic Disorders; p.1146-1147 Hepatic Cirrhosis. 2. Grodner Chapter 18 Nutrition for Disorders of the Liver, Gallbladder, and Pancreas 3. Karch Chapter 10 (152-154) Anti-Hepatitis B Agents Chapter 17 Immune Modulators Chapter 18 (285) (Focus on Vaccines for Hepatitis)

CLASS 21: EXAM III

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CLASS 22-CLASS 25 PHYSIOLOGICAL INTEGRITY RELATED TO MOBILITY and SENSORY NEEDS The client with Parkinson’s Disease. Topical Outline A. Assessment of the client with chronic alterations in mobility and sensory needs B. Pathophysiology of common neurological disorders which affect the mobility 1. Parkinson's Disease C. Pharmacological management of client's with sensorineural deficits 1. Agents utilized in the treatment of Parkinson’s Disease D. Nutritional concerns for clients with sensorineural deficits 1. Dysphagia and prevention of aspiration E. Special nursing considerations for the client with sensorineural deficits 1. Education of the family/significant other(s) of client's with sensorineural deficits 2. Multidisciplinary approach to discharge teaching of client's with sensorineural deficits 3. Nursing care of the client experiencing alterations in mobility and sensory needs. Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Discuss the pathophysiology of the sensory, safety, and mobility problems of clients experiencing Parkinson’s Disease. Identify abnormal assessment data related to clients experiencing Parkinson’s Disease. Discuss the pathophysiology of Parkinson's Disease and the impact on the basic mobility and sensory needs. Compare and contrast the sensory needs/responses of a client with CVA, Alzheimer's, and Parkinson's Disease. Identify selected nursing diagnosis based on assessment data which describe the client with altered mobility and sensory needs. Prioritize the nursing diagnoses of the client with sensory needs among the holistic needs of the client. Make clinical judgements regarding therapeutic nursing interventions which promote optimum adaptation of the client with sensory alterations. Identify realistic client-centered outcomes when chronic mobility and sensory impairments exist. Discuss the nurse's role in pharmacological management of the client with sensorineural deficits. Identify community resources and web resources to assist the client/family in caring for the client with sensorineural deficits. Plan nursing care for the client with sensorineural needs in the acute setting, rehabilitation setting, home care and long-term care setting. Communicate assessment data, plan of care, interventions and outcome evaluations of the client with sensorineural needs. Collaborate with client, family, and health team members to develop a comprehensive plan of care for long-term care of the client with chronic mobility and sensory alterations.

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Assigned References: 1. Smeltzer & Bare Chapter 12 (220) Health Care of the Older Adult: Impaired Mobility Chapter 54 (1643-1648; 1653-1654) Assessment and Management of Patients with Rheumatic Disorders (RA; SLE; Gout) Chapter 65 (1985-1992) Management of Patients with Oncologic or Degenerative Neurologic Disorders (PD) Chapter 58 (1767-1772) Assessment and Management of patients with Eye and Vision Disorders (Glaucoma) Chapter 59 (1819-1823) Assessment and Management of Patients with Hearing and Balance Disorders (Meniere’s Disease) 2. Grodner Chapter 17 (focus: Dysphagia p. 371-375) Appendix G (Purine Content of Foods) p. 520-521 3. Karch Chapter 16 Anti-inflammatory, Antiarthritis, and Related Agents Chapter 24 Antiparkinsonism Agents

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CLASS 22-CLASS 25 PHYSIOLOGICAL INTEGRITY RELATED TO MOBILITY and SENSORY NEEDS The client with chronic mobility and sensory changes. The client with myasthenia gravis (MG). The client with multiple sclerosis (MS). The client with amyotrophic lateral sclerosis (ALS). Topical Outline A. Assessment of a client with chronic inflammatory and neuromuscular deficits 1. Multiple Sclerosis 2. Myasthenia Gravis 3. ALS B. Pharmacological management of clients with chronic inflammatory and neuromuscular deficits: 1. Agents utilized in the treatment of multiple sclerosis 2. Agents utilized in the treatment of myasthenia gravis 3. Agents utilized in the treatment of ALS C. D.

Discussion of nutritional needs for client with chronic inflammatory and neuromuscular deficits Nursing care of the client experiencing chronic alterations in mobility needs

Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Discuss the pathophysiology of multiple sclerosis as it alters the physiological need of mobility. Discuss the pathophysiology of myasthenia gravis as it alters the physiological need of mobility. Discuss the pathophysiology of ALS as it alters the physiological need of mobility. Discuss the difference between inflammation and neuromuscular stressors on mobility. Compare and contrast the neuromuscular deficits of Multiple Sclerosis, Myasthenia Gravis, and ALS. Analyze the assessment data of the client with chronic mobility problems. Prioritize the nursing diagnoses of the client with chronic alterations in mobility needs among the holistic client needs. Make clinical judgements regarding therapeutic nursing interventions for the client with chronic mobility alterations. Identify realistic client-centered outcomes when chronic alterations exist in mobility. Discuss the nurse's role in the pharmacological management of the client with chronic mobility problems. Identify community resources and web resources to assist the client and family with adaptation to chronic mobility alterations. Provide clients with accurate health promotion and restoration information regarding their altered mobility needs. Communicate assessment data, plan of care, interventions and outcome evaluations of the client with mobility needs.

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Assigned References 1. Smeltzer & Bare Chapter 64 (1956-1966) Management of Patients with Neurologic Infections, Autoimmune Disorders and Neuropathies (MS; MG) Chapter 65 (1993-1995) Management of Patients with Oncologic or Degenerative Neurologic Disorders (ALS) 2. Grodner Chapter 17 (focus: Dysphagia p. 371-375) Appendix G (Purine Content of Foods) p. 520-521 3. Karch Chapter 17 Chapter 32 (502-504) See Table 32.2

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CLASS 22-CLASS 25 Physiological Integrity related to safety and mobility needs: Gout Rheumatoid Arthritis (RA) Systemic Lupus Erythematosus (SLE) Topical Outline A. Pathophysiology of gout, rheumatoid arthritis, systemic lupus erythematosus 1. Genetic factors 2. Clinical manifestations 3. Diagnostic tests B. Pharmacologic therapies related to gout, rheumatoid arthritis, systemic lupus erythematosus 1. Anti-gout agents 2. Corticosteroids 3. Medications for arthritis pain control 4. Disease modifying agents for RA C. Medical Management D. Nursing Management Learning Outcomes 1. State the pathophysiological cause of gout. 2. State the pathophysiological cause of rheumatoid arthritis. 3. Compare and contrast rheumatoid arthritis to osteoarthritis and gout. 4. Collaborate with the client and family to promote changes in the client's diet (specific to a low purine diet) in the management of gout. 5. State the pathophysiological cause of systemic lupus erythematosus 6. State the ethnic and gender factors associated with systemic lupus erythematosus. 7. Identify the different clinical manifestations of systemic lupus erythematosus. 8. Identify the major pharmacological therapies for systemic lupus erythematosus. 9. Identify the major complications associated with systemic lupus erythematosus, including skin lesions, pericarditis, arthritis, renal disease, multiple organ disease, and neurologic disease. 10. Prioritize the nursing assessments, diagnoses, and interventions for the client with systemic lupus erythematosus. 11. Identify the chronic care needs for the client with rheumatoid arthritis, gout, and systemic lupus erythematosus.

Assigned References: 1. Smeltzer & Bare Chapter 54 (1643-1648; 1653-1654) Assessment and Management of Patients with Rheumatic Disorders (RA; SLE; Gout) 2. Grodner Chapter 17 (focus: Dysphagia p. 371-375) Appendix G (Purine Content of Foods) p. 520-521 3. Karch Chapter 16 Anti-inflammatory, Antiarthritis, and Related Agents NUR 150 Syllabus

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CLASS 26 PHYSIOLOGICAL INTEGRITY RELATED TO ELIMINATION NEEDS The client experiencing chronic inflammatory bowel disease. The client experiencing diverticulosis. A. B.

C.

D.

E.

F.

Assessment of client’s with chronic alterations in elimination needs 1. Bowel Elimination Pathophysiology of common chronic diseases affecting elimination 1. Inflammatory Bowel Disease a. Crohn’s Disease b. Ulcerative Colitis 2. Diverticulosis, Diverticulitis Pharmacological management of clients with elimination alterations 1. Pharmacological therapy of Inflammatory Bowel Diseases 2. Pharmacological therapy of diverticulitis Nutritional consideration for client’s with altered elimination needs 1. Resting the bowel 2. Fiber in the diet 3. Total parenteral nutrition Special nursing considerations for client’s experiencing elimination needs 1. Gastointestinal diagnostic tests pre and post care 2. Care of a fecal diversion/stoma/pouch Nursing care of the client experiencing chronic alterations in elimination.

Class Learning Outcomes: 1. 2. 3. 4. 5. 6. 7. 8. 13. 14. 15. 16.

Perform assessment of normal and abnormal bowel elimination. Discuss the pathophysiology of inflammatory bowel disease (IBD), and Diverticulosis. State how they alter elimination needs. Analyze abnormal assessment and diagnostic data of the client with alterations in elimination needs. Discuss the nurse's role in pre and post diagnostic test care for the client with altered elimination needs. Discuss the nurse's role in pharmacological management of the client with elimination alterations by IBD and Diverticulosis. Identify selected nursing diagnoses from obtained assessment data to describe the altered elimination needs produced by IBD and Diverticulosis. Prioritize nursing diagnosis for the client with altered elimination needs within the holistic needs of the client. Make clinical judgements regarding nursing interventions which promote optimum functioning of the client with elimination alterations. Identify realistic client-centered outcomes of care for the client experiencing chronic alterations in elimination needs. Collaborate with the client to problem solve and modify their lifestyle and diet. State the rationale for altering fiber in diets. State the rationale for resting the bowel.

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17.

18.

Differentiate irritable bowel syndrome from the chronic inflammatory bowel disorders. Provide the client with health promotion, maintenance and restoration information regarding their altered elimination needs. Communicate assessment data, plan of care, interventions, and outcome evaluations of the client with specific elimination problems.

Assigned References: 1. Smeltzer & Bare Chapter 36 (1034-1041)) Gastrointestinal Intubation and Special Nutritional Modalities (Parenteral Nutrition) Chapter 38 (1073-1074; 1077-1098) Management of Patients with Intestinal and Rectal Disorders (IBS; Diverticular Disease; IBD) 2. Grodner Chapter 17 Nutrition for Disorders of the GI Tract (focus p. 381-386) 3. Karch Chapter 17 (270) (Infliximab)

CLASS 27: EXAM IV CLASS 28: KAPLAN INTEGRATED TESTING

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NUR 150 MATH/MEDICATION CALCULATIONS LAB CLINICAL LAB I LEARNING OUTCOMES

1. 2. 3. 4. 5. 6.

Calculate accurately intravenous medication problems. Calculate accurately heparin infusion problems. Calculate accurately medication dosages, intravenous medication dosages, and intravenous medication infusion dosages utilizing the patient’s weight in kilograms. Calculate accurately general medication and insulin dosage problems. Calculate accurately intake and output measurements. Calculate medication dosages with 90% accuracy on the NUR 150 Math Calculations Test.

Assigned References: 1.

NUR 150 Math Practice Sheets

2.

Curren, A.M. Dimensional Analysis for Meds. 4th ed. Chapter 11: Measuring Insulin Dosages Chapter 19: Heparin Infusion Calculations.

Note: All calculations in these chapters to be completed prior to Lab I.

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FALL 2012 NUR 150 TEST MAKE-UP POLICY 1) Students may miss a maximum of one (1) scheduled exam. The score on the final exam will be used as the score on the missed exam. 2) Any subsequently missed exams will receive a grade of 0. 3) No exams will be administered prior to the scheduled time.

NUR 150 COMPUTER TESTING POLICY 1) Students will be provided a password and scratch paper for computer tests given in NUR 150. 2) Scratch paper is to be signed and turned in to the test proctor before exiting the test. 3) Failure to turn in the scratch paper will result in a grade of zero for the exam.

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GENERAL ADN DEPARTMENT POLICIES After reviewing your student handbook, the syllabus for this course and the course clinical evaluation tool please sign, print name and date, and turn form into your instructor.

“I have read the Nursing Student Handbook and the Departmental Policies and Regulations for NUR 150 and agree to adhere to them.”

________________________________ Student signature

NUR 150 Syllabus

_________________________________ __________ Printed name Date