BELLINGHAM TECHNICAL COLLEGE HEALTH OCCUPATIONS Nursing Program Dev. I. Farquhar 08/04 NUR 211 Rev. S. Bouma 07/09 DEPT/COURSE #: NUR 211 CLOCK HOURS: 7 credits (7 hours) COURSE TITLE: Nursing Dimensions I INSTRUCTORS: Rhonda Gray, MN, RN Office phone 360-752-8386 Email: [email protected][email protected]Cell: 360-820-1956 Sue Bouma RN, BSN, CRNI Graduate Student University of Washington, Bothell Office phone 360-752-8386 Email: [email protected][email protected]Cell: 360-319-7361 COURSE DESCRIPTION: This course focuses on the role transition and role differentiation between LPN and RN. The student is introduced to critical thinking and leadership skills required for professional nursing when incorporated into the nursing process. Content focuses on understanding human health patterns while supporting the physiological changes of the client in the role of the registered nurse. Primary topics include physical assessment, alteration in mental health, fluid, electrolyte and acid base imbalance, cardiac, respiratory and renal systems dysfunctions related across the life span (adult, aging, pediatric and pregnant mother). Integrated are advocacy, cultural perspectives, communication, nutrition, pharmacology, and health teaching. 1
Transcript
BELLINGHAM TECHNICAL COLLEGE HEALTH OCCUPATIONSNursing Program Dev. I. Farquhar 08/04NUR 211 Rev. S. Bouma 07/09
Sue Bouma RN, BSN, CRNIGraduate Student University of Washington, BothellOffice phone 360-752-8386Email: [email protected][email protected]: 360-319-7361
COURSE DESCRIPTION:
This course focuses on the role transition and role differentiation between LPN and RN. The student is introduced to critical thinking and leadership skills required for professional nursing when incorporated into the nursing process. Content focuses on understanding human health patterns while supporting the physiological changes of the client in the role of the registered nurse. Primary topics include physical assessment, alteration in mental health, fluid, electrolyte and acid base imbalance, cardiac, respiratory and renal systems dysfunctions related across the life span (adult, aging, pediatric and pregnant mother). Integrated are advocacy, cultural perspectives, communication, nutrition, pharmacology, and health teaching.
COURSE OJECTIVESUpon completion of this course the student as a:
I Provider of Care will be able to: Summarize the role of the nurse as caregiver. Appraise competent, safe professional nursing practice. Discuss the importance of the nursing process in guiding nursing practice. Discuss the impact of growth and development, family and cultural issues on the care of
the client. Discuss the significance of evaluation in the nursing process. Adapt the nursing process as a framework for developing care for a client with alteration
in health patterns—(mental, cardiac, respiratory, renal, and fluid and electrolyte). Describe the pathophysiology associated with complex alteration in health patterns.
Describe the appropriate techniques of inspection, percussion, palpation, and auscultation used in the physical assessment. Compare and contrast the difference in assessment between the techniques used for a child, adult or aging client.
Examine the impact of critical thinking on learning and the practice of nursing. Understand the need for certain types of IV therapy and calculate accurately intravenous
fluid administration. Understand the different types of central venous catheters available. Perform insertion of intravenous catheter.
II Manager of Care is able to:
Describe strategies used in making decisions regarding the prioritization of care of alteration in health patterns.
Relate teaching-learning principles to the various alterations in health patterns including nutrition and pharmacological information.
Describe the importance of effective communication to quality nursing care. Discuss coordination of care for an individual or group of clients with varying health care
needs and cultural beliefs. Describe the rules and regulations regarding the delegation of nursing care for Washington
State. Find the legal parameters for nursing practice in Washington State. Determine community resources in caring for clients with alteration in health patterns. Discuss own feelings and values in relationship to the role of being an advocate for a client
exhibiting ethical issues.
III Member within the Discipline of Nursing is able to: Compare and contrast the role of the LPN with that of the RN as outlined by the Washington
State Nurse Practice Act. Internalize ethical standards, within the legal framework, for nursing practice. Analyze the NCLEX-RN test plan, explain the categories of client needs and describe the
rationale for the cognitive level of the question and develop a plan of action for studying for NCLEX.
Generate an individual plan for role transition.
LEARNING STRATEGIES:Group discussion, written assignments, mini-lectures, and audio-visual aids.
COURSE TIME AND LOCATION:Time: 8:00 a.m. to 3:00 a.m. (except where otherwise specified on course calendar).(day of week dependent upon instructor).Location: Haskell Center 204
REQUIRED STUDENT SUPPLIES & MATERIALS:
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Deglin, J. & Vallerand, A. (2006). Davis’s Drug Guide for Nurses. (10th Ed.) F.A. Davis Company: Philadelphia.
Fortinash, K, & Holoday Worret, P. (2008). Psychiatric Mental Health Nursing. (4th Ed.) Mosby: St. Louis.
Harrington, N. & Terry, C.L. (2003). LPN to RN Transitions; Achieving Success in Your New Role (3rd ed.). Lippincott Williams & Wilkins.
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri.
Pedersen, D. (2005). Psych Notes. F.A. Davis Company: Philadelphia.
Phillips, L. (2005). I.V. Therapy Notes. F.A. Davis Company: Philadelphia
Pillitteri, A. (2006). Maternal & Child Health Nursing: Care of the Childbearing and Childrearing Family. (5th. Ed). Lippincott Williams & Wilkins: Philadelphia..
Ralph, S. & Taylor C. (2008). Sparks and Taylor’s Nursing Diagnosis Reference Manual. (7th Ed.) Lippincott Williams & Wilkins: Philadelphia.
Zerwekh, J & Claborn, J.C. (2006). Nursing Today: Transition and Trends(5th ed.), Saunders: St. Louis.
NCSBN. (2007). Test Plan for the National Council Licensure Examination for Registered Nurses: https://www.ncsbn.org/RN_Test_Plan_2007_Web.pdf
REQUIRED MATERIALS
Stethoscope and Pen Light—Please bring to class on the day of assessments. Since you will be doing assessment in the skills lab you must wear a scrub top.
I.V. start kit. Simple calculator: no cells phones, PDA, or any other device that incorporates a calculator. Scantron scoring sheet.
EVALUATION & GRADING:
Grades will be assigned according to the following criteria:
Class Participation: (10 points)2 points – Consistently comes prepared.2 points – Demonstrates leadership.2 points – Demonstrates appropriate communication skills.2 points – Motivation/attitude towards learning.2 points – Participates equally with in group discussion.
Students will evaluate the individuals that are part of their group. The teacher may include her Input as part of this evaluation process.
Attendance: (4 points)4 points – 96% to 100% attendance2 points – 91% to 95.9% attendance0 points – less than 91% attendance
Attendance score includes both excused and unexcused absences. Included in attendance is therequirement of being on time. Three times being tardy equals an absence.
B. Criterion for PassingIn order to pass this course, you must receive a minimum of 76% as an average. Pleasesee the student handbook if this criterion is not met. Please remember that both NUR 211 and NUR 212 are concurrent courses. Should you fail either one of the course, you must retake both courses.
COURSE POLICIES
Written Assignments Assignments must be type written and ready for discussion at the time scheduled. Late assignments will not be accepted.
Group Teaching PresentationThere will be one group presentation. The topics will be assigned to the team learning groups. Prepare a teaching plan that can be given in 20 minutes using the form posted in Share Point at http://access.btc.ctc.edu/Nursing/. The required resources are from the World Wide Web (WWW) or library journals and from your required books. There must be at least 3 resources. You will be working as team in the presentation. The group will be graded based on the form locate in Share Point. The teaching plan must reflect the information from the resources that are used. The teaching plan must be typed using APA format. A copy of the article that was obtained from the WWW or library journals will be included in the written teaching plan.
There will be two math quizzes this quarter. One quiz for review of general math principles as applied to medication administration and the second will be on I.V. administration. Please refer to your calendar for scheduled dates. You must pass these quizzes at 100% within two retakes otherwise you will not be allowed to continue in the program. Remember to bring your calculator.
SHARE POINTVarious different assignments, announcement, and study notes are posted on the Share Point web site. To access this site type in the following internet address: http://access.btc.ctc.edu/Nursing/. Please check this site frequently. You are expected to keep abreast with announcements and assignments posted on this site.
EMAILBecause class is meeting once a week, communication is important. Therefore students are to have an e-mail address and access to a computer. If you have any questions, please contact the instructor.
Tests:Students are expected to complete all written examinations on time. For those who score below 80% percent on any given exam, there is an expectation to remediate before the next examination. Arrangements will be made on an individual basis with the instructor and student. Please talk with the instructor regarding this remediation. Remember to bring your calculator with each test because there will be math problems related to the disease process that is discussed in class.
The Nursing faculty believes that collaborative testing is a powerful, cooperative, educational strategy to help students share their learning experience. Collaborative testing is comprised of traditional individual testing, followed by identified groups taking the same test together. Students will be responsible for developing positive interpersonal relationships with group members, promoting each other’s learning, being responsible for a fair share of the work, using appropriate small group process skills, and actively evaluating the effectiveness of the group. The discussion enhances learning and critical thinking skills such as analysis, explanation, inference, and interpretation.
The student will take all written tests and quizzes as an individual assignment. At the discretion of the instructor there may be a group test given.
Questions may be challenged either verbally or in writing, at the discretion of the instructor,a challenged question must have a written rational and a book references.
Critical Thinking ExercisesThere are several critical thinking exercises included in the modules. Please answer the questions and be ready to share these answers within your class room groups. There will be additional questions that will be included in the classroom discussion.
Video and DVDThere are many videos and DVD reserved in the library. These cannot be checked out, please allow study time to view these in the library. These are part of preparation for class and information will be included on your test. Please organize your time wisely so that you can review them.
A standardized ATI Fundamental, Psychiatric Nursing, and Critical Thinking exams will be given during this quarter. The questions help assess areas of strength and weakness and the materials you have learned and need to know to pass the NCLEX-RN exam. You are encouraged to do as well as possible on this exam and follow through with any areas of weakness noted on the results. Preparation for these tests includes passing the non proctor tests at the web site: www.atitesting.com. You must receive a 90% on these practice tests before taking the proctor exam. If you do not receive 90% on the first attempt, you must retake the test until you obtain this score. There must be 24 hours between tests to allow time for studying.
Students must have a score of 70% on the ATI Fundamental, Psychiatric Nursing, and Critical Thinking Examination. For those that score above the 70% level, one extra point will be given. For those that score above 80%, 2 extra points will be given. For those that score above 90%, 3 extra point will be given. These points will be added at the end of the quarter after your grade has been averaged. If a student does not meet these levels, the student will be required to remediate in the areas determined as weakness from test results of the ATI exam completed. Remediation assignments will be determined by the instructor based on individual student’s test results. Each student is to complete the assigned remediation individually. This is not a group project and turning in copied or collaborative assignments that are completed by anyone other than your self will be considered an act of academic dishonesty.
Responsibilities and Assumptions:
The students are responsible for their own learning. This responsibility includes studying for success. The minimum expectation is 2 hours a day for each credit earned in order that knowledge will be gained that is necessary for application of clinical decision and judgment making as related to case study scenarios. It is the expectation that the student will be prepared for class by reading the assignment and answering the objectives in the syllabus. The information learned is a process of building and keeping knowledge within the student’s memory to be used again and again throughout the program. Being prepared for class assists students in the discussion within the learning groups. It is the assumption of this course that students bring to the discussion material that they have learned as a practical nurse. This foundational knowledge, learned in the practical nursing program, is expanded with application to caring for the patient as a registered nurse. Please review information that you have previously learned.
The student is also responsible for the learning of classmates. Cooperative learning is an interactive teaching strategy that stimulates critical thinking, fosters a feeling of community within the group, develops professional communication strategies in defending positions and discussing answers in a constructive manner, and promotes individual responsibility for learning through group process techniques. This spirit of cooperation provides an active environment in the classroom with each of the students participating in discussion and group process which promotes the atmosphere for learning; this supports the goal of Bellingham Technical College.
Honesty StatementBecause honesty is crucial to all members in the class, any acts of dishonesty will lead to disciplinary action. (See College Catalog)
If you have a verified need for an academic accommodation as per the Americans with Disabilities Act or Section 504 of the Rehabilitation Act, please contact your instructor within the first week of the quarter. This must be a written documentation in order for you to receive reasonable accommodations. Please refer to BTC web site for student responsibilities.
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Bellingham Technical CollegeDepartment of Nursing
Student Evaluation of the Class Room Experience
How many hours on an average did you study per week? _____________________________
How many hours on an average did you work per week? _____________________________
What aspects of this class contributed most to your learning this quarter?
What aspects of this class were barriers to your learning this quarter? What are your suggestions for changing the barriers?
What directions or assignments would you like to change in the syllabus? Please give a reason why.
Which assignments or directions would you keep in this syllabus?
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MODULES
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MODULE 1: ORIENTATION
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Discuss the policies and structure of NUR 211.
2. Demonstrate an awareness of assignments and due dates.
3. Review the meaning of the BTC Nursing Department's Curriculum Model for the AAS Degree Program, and its application in NUR 211.
4. Discuss ways students learn.
5. Discuss group formation/team building.
PREPARATION GUIDELINES
1. Read the NUR 211 Course Syllabus.
2. Review the Associate Degree Program's Philosophy, Objectives, and Curriculum Model in the Student Handbook.
3. Bring your NUR 211 Syllabus.
4. Bring your Student Handbook.
4. Complete the "Orientation Quiz" on the following pages of the syllabus.
5. Complete the "Student Information Sheet" on the following pages of the syllabus.
6. Complete the “Dosage and Equivalent Practice” on the following pages of the syllabus.
7. Zerwekh, J & Claborn, J.C. (2006). Nursing Today: Transition and Trends(5th ed.), Saunders: St. Louis.. Chapter 2, Self Care Strategies. Chapter 11, Effective Communication and Team Building.
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Name ___________________________________
ORIENTATION QUIZ Theory
Directions: On true and false questions, if the answer is false, please make the necessary corrections.
1. Where are various assignments, announcements, and study notes posted?
2. TRUE OR FALSE: The student must pass the math quiz at 80%.
3. What happens if you do not pass the ATI Psychiatric Nursing exam at 70 percent?
4. How many hours per day must you study to be successful?
5. Who is responsibility for your learning in the classroom?
6. How many resources does the student need for the teaching plan?
7. TRUE OR FALSE: Written assignment maybe turned in at any time and day.
8. TRUE OR FALSE: Tests may be given individually or as a group test. 9. TRUE OR FALSE: Pass grade for theory is 76%.
10. TRUE OR FALSE: Written assignments maybe hand written.
11. TRUE OR FALSE: I may leave the classroom when I am done with a test.
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DOSAGE & EQUIVALENTS PRACTICE
Calculate the following problems. Remember that correct expression of your results is just as important as correct math calculation. Use approved symbols in recording your results. The dosage and calculation quiz will be similar to the following problems.
SHOW ALL WORK!
1. 1000 mL = oz.
2. 5000 ml. = liter(s)
3. 1 pound= kg.
4. 2 tsp = mL
5. The doctor has ordered 650 mg. of aspirin. The tablet comes in 300 mg. How many tablets would you give?
6. Doctor's order Atropine 0.8 mg IM Stat. The vital reads 400 mcg/ml. How much would you give?
7. Doctor's order: Amoxicillin 10 mg/kg every 6 hr. p.o. Patient weighs 77 pounds. How many mL would you give? ___________How many mg. would the individual receive in 24 hours? ____________The maximum dose is 1 gram in 24 hours. Is this a safe does? ____________
Drug Label
Amoxicillin for Oral Suspension250 mg per 5 ml150 ml bottleWarnerChilcott
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LPN to RN New Student Information Sheet
Name__________________________________I prefer to be called____________________
Employer/Area of work______________________Shift/days/hours____________________
Work Number____________________.It is okay to call me at work ______yes ______no
How long have you ben an LPN? _________Years _______Months_______Days_______
Miles to commute to class_______________ Languages Spoken___________School that you graduated from your LPN program_____________________year_______________Do you plan to go on for a BS DEGREE_________________________?
What grade are you expecting to receive this quarter? What is your plan to reach that goal?
Have you taken an IV therapy class?
What areas are your strengths in class room setting?
Tell me a little about your self: Married, single, hobbies.
Fill in the following form
Skills Level of skill:(Independent, perform with assist,or never done)
Amount of experiencelast two years:
Comments
Enemas
Oral Medication admin.
IM, IV or SQ admin.
Insertion NG/Feeding Tube
Tracheal Suction
Urinary Catheter Insertion
Development of Client’sPlan of care
Physical Assessment(Head to toes)
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Module 2 Assessment
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Outline the steps of physical assessment of the normal pediatric, adult client. 2. Describe age-related changes in the respiratory, cardiac, muscle skeletal and GI, and Neuro
systems with differences in assessment.3. Discuss the significant subjective and objective data related to alteration of respiratory,
cardiac, muscle skeletal and GI, neuro systems functions and mental health that should be obtained from a client.
4. For each of the following body parts or systems write a question that would be appropriate to ask a client or parent while conducting a health interview.General appearanceSkinHead and neckEyesEarsNose, mouth, throat, gumsRespiratory systemCardiovascular systemGastrointestinal systemGenitalia and rectumBack and extremitiesMusculoskeletal systemNeurologic systemSocial/cultural influences on health, support systems.
5. Describe the appropriate techniques of inspection, percussion, palpation, and auscultation used in the physical assessment. Compare and contrast the difference between the technique for a child and that of an adult.
6 Differentiate normal from abnormal findings of a physical assessment.7. Discuss the proper data to be included in documentation.
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PREPARATION GUIDELINES1. Lewis, S. M, Heitkemper, M.M., & Dirksen, S.R., (2007). Medical-surgical nursing:
Assessment and management of clinical problem (7th. ed.). St. Louis: MosbyChapter 21 Nursing Assessment, Visual and Auditory Systems, Chapter 26, Nursing Assessment, Respiratory System. Chapter 32 Nursing Assessment, Cardiovascular system. Chapter 39 Nursing Assessment, GI Assessment. Chapter 45, Nursing Assessment, Urinary System. Chapter 56, Nursing Assessment, Nervous System. Review videos of assessment and audio sounds on companion CD
2. Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins: Philadelphia. Chapter 33, Child Health Assessment.
Required MaterialsStethoscope and Pen Light—please bring to class. Since you will be doing assessment on each other please, wear a uniform top and loose fitting for practice in the skills lab.
3. Available in Library (Information Technology Resource Center)
Video-- Rapid assessment of the ill or injured child produced by Concept Media.Video-- Young children: physical assessment and administration of medication by Concept MediaVideo--Performing respiratory assessment [presented by] Springhouse CorporationVideo- Performing cardiac assessment [presented by] Springhouse CorporationVideo--Gastrointestinal system by SpringhouseVideo--Nervous system in consultation with Linda S. Baas, Robert F. Mowery.
√ for pass 0 for fail Peer:______________________________________________________
Peer Peer1. Wash Hands2. Introduce yourself3. Gather your equipment4. Identify patient in two ways
Explain procedureProvide Privacy
A. Subjective Assessment1) Ask 3 questions relate to neuro system
B. Objective History1. Inspection
General AppearanceOrientation
Person Y_____N_____ Place Y_____ N_____ Time Y_____N_____
Memory Long Term Y_____N_____ Short Term Y_____N_____Arousal_________Emotions________Thought Process__________Speech Normal______Slurred_____Aphasia_____PERRLA Y______N______Facial Expression and Movement__________Gait___________Muscle Tone__________Finger to Nose Test Neg______Postive______
A child’s heart rate should be counted for one full minute. Irregularities in rhythm and or rate should be documented. Significant tachycardia is usually an indication of a potentially serious underlying condition
Heart rates lower than expected require immediate attention and intervention.
Average Resting Heart RateAge Beats/minute
Birth – 1 month 90-1601 month – 1 year 80-1501-3 years 80-1303-6 years 70-1206-11 years 70-11511-13 years 70-11013-18 years 65-105Adult >18 years 60-100
Respiration
The respiratory rate should be counted for one full minute while observing the movement of the abdominal wall. Assessment of respiration includes monitoring for sings of respiratory distress such as grunting, nasal flaring, retraction, stridor, tachypnea, or cyanosis.
Average Resting Respiratory RateAge Beats/minute
Birth – 1 month 30-601 month – 1 year 27-401-3 years 25-353-6 years 20-306-11 years 18-2411-18 years 16-24Over 18 16-24
Blood Pressure
The most common sites for blood pressure measurement in children are the upper arm and lower leg. The width of the cuff bladder should occupy ¾ of the upper arm segment or length sufficient to completely encircle arm/leg without overlap. Significant hypotension in infants and children requires immediate intervention to prevent cardiopulmonary collapse. Hypertension, although rare, also requires immediate intervention.
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Average Resting Blood PressureAge Systolic Diastolic
Birth – 1 month 50-101 42-641 month – 1 year 69-105 39-691-3 years 76-107 41-693-6 years 78-111 42-706-11 years 81-119 44-7711-18 years 90-136 51-75Adult >18 years 90-135 60-85
CASE STUDY
A. The nurse is assigned the care of four children. Based on the following information received during report, rank the order of priority (1st, 2nd, 3rd, and 4th) for assessing each of the following children. Discuss how the child’s illness and vital signs affected your decision.
Child Assessment Priority Rationale4-year-old hospitalized child with an acute asthmatic episode. The vital signs are: HR 130, RR 33, B/P 93/48, and an axillary temperature of 98o F.7-year-old with cerebral palsy hospitalized for gastroesophageal reflux. The vital signs are HR 100, RR 30, BP 96/54, axillary temperature 99.5o F.8-month-old with pneumonia, The vital signs are HR 166, dropping to 60’s occasionally during the previous shift, RR 76, BP 112/72, axillary temperature 99.5o F.2-month-old with fever and bilateral acute otitis media. The vital signs are HR 172, RR, 36, BP 108/64, rectal temperature, 102.5o F (taken immediately prior to report, no intervention initiated).
2. Discuss the nurse’s role in safely administering I.V. medication in relationship to rate of administration, side effects and compatibility of drugs when used as intravenous injection. Identify two medications that need to be given through a central venous line.
3. Describe the use, nursing care and advantages and disadvantages of the following central lines.
PICCa. Groshongb. Power PICCc. Solo
Hickman Central Venous Catheters/Swan Ganz line Implanted Port-A-Cath/Power Port Perma-Cath
4. Explain the nursing responsibility in a patient where IV fluids are being withheld and the nurse’s role as an advocate for a patient and family who would refuse I.V. Therapy.
5. Differentiate the roles of the RN and LPN in administering IV therapy based on Standard of Care.
6. Describe the steps of preparing and hanging and I. V. bag including calculation of drops per minute and ml/hr.
7. Utilizing an IV therapy book, identify the steps for insertion of an IV cannula. Plan to practice and be skills tested on insertion of an I. V.
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PREPARATION GUIDELINES1. Phillips, L. (2005). I.V. Therapy Notes. F.A. Davis Company: Philadelphia.2. Any dosage and calculation book 3.Available in Library (Information Technology Resource Center:
Nursing I.V. drug handbook. Philadelphia, PA; London: Lippincott Williams & Wilkins, 2004Video--Detecting and managing I.V. therapy problems produced by Springhouse
CorporationVideo--Administration of intravenous medication. Administering IV meds to adultsVideo--Administration of intravenous medication. Intravenous medication administration to children [video recording] / [presented by] Intercollegiate College of Nursing, Washington State University College of Nursing; a Learning Resources Center production.
Visit this site online: http://www.bardaccess.com/ Good description of the variour CVC lines available.
4. Bring I.V kit to skills lab.
CRITICAL THINKING EXERCISE
1. Explain and demonstrate the technique used during dressing changes and discontinuing I. V. (peripheral and central) lines. (Remember that all facilities have policy and procedure manuals).
2 IV FLOW RATES
Solve the following problems.
1. Give 1000 ml in 8 hours. There are 10 drops in each ml. Calculate drops/minute_________
2. Give 1 L in 8 hours. There are 15 drops in each ml. Calculate drops/minute_________
3. Give 1500 ml in 8 hours. There are 20 drops in each ml. Calculate drops/minute_________
4. Give 3500 cc in 24 hours. There are 20 drops per ml of solution. Calculate drops/minute_________
5. The physician orders 1000 ml of 5% dextrose and water at 100 ml/hr. You have available 20 drops factor tubing. Calculate drops/minute_________
6. The physician orders 1000 ml of 5% dextrose and 0.45% sodium chloride at 150 ml/hr. You have available 15 drops factor tubing. Calculate drops/minute_________
7. The physician orders Rocephin (ceftriaxone) 1 gram every 12 hours. Look in drug book to determine solution amount._________________. What is the rate of administration? _________ Calculate drops/minute___________________.
8. The physician orders Heparin 100 units/ hour. The I.V. bag has 25000 units in 1000 ml. Calculate ml per hour.____________________.
9. The physician orders Dobutamine 5mcg/kg/min. The patient weights 100 kg. The I. V. bag has 500 mg/100 ml. Calculate ml an hour. ________________.
10. The physician orders Lasix 20 mg I. V. push. The medication vial is 40 mg/mla. How many ml. would the nurse administer? ___________b. What is the rate of administration? ______________c. Is the drug to be diluted? _____________________d. There is Insulin 5 ml/hour and an I.V. or normal saline at 20 ml per hour. Which one
of the I.V. is compatible with Lasix and therefore can be given through that I. V. line____________?
Following completion of the assignment, the student will be able to:
1. Describe the transition process from LPN to RN and from working to student role.
2. Generate an individual plan for role transition
3. Compare and contrast the role of the LPN with that of the RN.
4. Discuss the difference between the scopes of practice of the LPN with that of the RN
PREPARATION GUIDELINES1. Harrington, N. & Terry, C.L. (2003). LPN to RN Transitions; Achieving Success in Your New
Role. (3nd ed.). Lippincott Williams & Wilkins. Chapter1, Lifelong Learning: Returning to School. Chapter 2, Role Development and Transition. Chapter 4, Transitions Throughout Nursing’s History. Chapter 6, Individualizing a Plan for Role Transition.
2. . Zerwekh, J & Claborn, J.C. (2006). Nursing Today: Transition and Trends, Saunders: St. Louis.
Chapter 1, Reality Shock
3. Web site: http://www.doh.wa.gov/hsqa/Professions/hpqalinks.htm http://apps.leg.wa.gov/WAC/default.aspx?cite=246-840-700 Find the regulations on the difference between the scopes of practice of the LPN with the RN
4. Develop a personal role transition plan (Chapter 6, LPN to RN Transitions). Be prepared to share with your group.
Following completion of the assignment, the student will be able to:
1. Describe the Roles and Competencies as defined by NLN.2. Examine the impact of critical thinking on learning and the practice of the nurse.3. Define the components of the nursing process and describe the thinking related to each
component.4. Apply personal thinking approaches to the nursing process.5. Identify the variety of thinking styles used with the nursing process.6. Determine the thinking required to develop nursing conclusions.7. Analyze the NCLEX-RN test plan, explain the categories of client needs and describe the rationale for
the cognitive level of the question.
PREPARATION GUIDELINESHarrington, N. & Terry, C.L. (2003). LPN to RN Transitions; Achieving Success in Your New
Role (3nd ed.). Philadelphia: Lippincott Williams & Wilkins. Chapter 7, Test Success for the LPN: Challenge of NCLEX-RN Questions. Chapter 9, Critical Thinking and Clinical Judgement in Nursing.
Zerwekh, J & Claborn, J.C. (2006). Nursing Today: Transition and Trends, Saunders: St. Louis. Chapter 5, NCLEX-RN and the New Graduate.
NCSBN. (2007). Test Plan for the National Council Licensure Examination for Registered
Mr. and Mrs. Harris’ four year-old son Donny is in your intensive care unit. The day care van in which he was riding was hit by an oncoming car; Donny was thrown from the vehicle. He remains unconscious; doctors are optimistic but cautious. You, as Donny’s nurse, must prepare your plan of care.
Donny’s care requires the integration of critical thinking and the nursing process to fully address the multiple and complex aspects of his care and his family’s needs. Design a care plan using critical thinking skills and integrate the nursing process. Again, begin with what you already know about similar situations and use the concepts of critical thinking to organize your thoughts, i.e., exploring, analyzing, prioritizing, explaining, deciding, and evaluating.
Cast Study 2: A group of nurses who work in a long-term care facility are alarmed at an increase in pressure ulcers among the patients. The nurses believe this may be caused by infrequent repositioning and related to recent staff cuts. The nurses decide to conduct a study that will examine the cause of increased pressure ulcers.
1. What type of reasoning would be used to connect the increase in pressure ulcers to a specific cause?
2. Before studying the problem, the nurses must clearly state what the problem is and what they wish to learn. Which Socratic questions should be asked about the problem statement before beginning the study?
3. One nurse says, "I know the patients are suffering because we don't have enough staff. I don't see why we need a study." What is the problem with this statement?
4. Before the study is completed, a nurse becomes angry about low staffing and decides to walk off the job. What steps would you recommend she take to deal with her anger before she makes a hasty decision that could harm her career and her patients?
. Common terms used in critical thinking and the nursing process
Creativity Thinking that results in the development of new ideas and products.
Critical analysis A set of questions one can apply to a particular situation or idea to determine essential information and ideas and discard superfluous information and ideas.
A cognitive process that includes creativity, problem solving, and decision making. Decision making
The process of establishing criteria by which alternative courses of action are developed and selected.
Deductive reasoning Making specific observations from a generalization.
Hunch An intuitive feeling.
Inductive reasoning Making generalizations from specific data.
Intuition The understanding or learning of things without the conscious use of reasoning.
Nursing process A systematic rational method of planning and providing nursing care.
Problem solving Obtaining information that clarifies the nature of the problem and suggests possible solutions.
Socratic questioning A technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view, and differentiate what one knows from what one merely believes.
Critical Thinking: To Think Like a Nurse
To become a professional nurse requires that you learn to think like a nurse. What makes the thinking of a nurse different from a doctor, a dentist or an engineer? It is how we view the client and the type of problems we deal with in practice when we engage in client care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.
Critical thinking is the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action (Paul, Ennis & Norris). In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip). Critical thinking when developed in the practitioner includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgements and safe decision-making.
Intellectual Standards for Reasoning
Practitioners in nursing who are critical thinkers value and adhere to intellectual standards. Critical thinkers strive to be clear, accurate, precise, logical complete, significant and fair when they listen, speak, read and write. Critical thinkers think deeply and broadly. Their thinking is adequate for their
intended purpose (Paul, Scriven, Norris & Ennis). All thinking can be examined in light of these standards and as we reflect on the quality of our thinking we begin to recognize when we are being unclear, imprecise, vague or inaccurate. As nurses, we want to eliminate irrelevant, inconsistent and illogical thoughts as we reason about client care. Nurses use language to clearly communicate in-depth information that is significant to nursing care. Nurses are not focused on the trivial or irrelevant.
Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas
Elements of Reasoned Thinking
Reasoning in nursing involves eight elements of thought. Critical thinking involves trying to figure out something; a problem, an issue, the views of another person, a theory or an idea. To figure things out we need to enter into the thinking of the other person and then to comprehend as best we can the structure of their thinking. This also applies to our own thinking as well. When I read an author I'm trying to figure out what the author is saying; what problem or issue the author is addressing, what point of view or frame of reference he is coming from, what the goal or purpose is of this piece of writing, what evidence, data or facts are being used and what theories, concepts, principles or ideas are involved. I want to understand the interpretations and claims the author is making and the assumptions that underlie his thinking. I need to be able to follow the author's lines of formulated thought and the inferences which lead to a particular conclusion. I need to understand the implications and consequences of the author's thinking. As I come to understand the author in-depth I will also begin to recognize the strength and weakness of his reasoning. I will be able to offer my perspective on the subject at hand with a clear understanding of how the author would respond to my ideas on the subject.
The Elements of Thought
All thinking, if it is purposeful, includes the following elements of thought (Paul, 1990).
1. The problem, question, concern or issue being discussed or thought about by the reasoner. What the reasoner is attempting to figure out.
2. The purpose or goal of the thinking. Why we are attempting to figure something out and to what end. What do we hope to accomplish.
3. The frame of reference, points of view or even world view that we hold about the issue or problem.
4. The assumptions that we hold to be true about the issue upon which we base our claims or beliefs.
5. The central concepts, ideas, principles and theories that we use in reasoning about the problem.
6. The evidence, data or information provided to support the claims we make about the issue or problem.
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7. The interpretations, inferences, reasoning, and lines of formulated thought that lead to our conclusions.
8. The implications and consequences that follow from the positions we hold on the issue or problem.
When nurses reason they use these elements of thought to figure out difficult questions and recognize that their thinking could be flawed or limited by lack of in-depth understanding of the problem at issue therefore, they critically monitor their thinking to ensure that their thinking meets the standards for intellectual thought.
In summary, as a critical thinker, I am able to figure out by reading or listening critically what nurse scholars believe about nursing and on what basis nurses act as they practice nursing. To do this I must clearly comprehend the thinking of another person by figuring out the logic of their thinking. I must comprehend clearly the thinking of myself by figuring out my own thoughts on the subject at hand. Finally, I must use intellectual standards to evaluate my thinking and the thinking of others on a given problem such that I can come to a defensible, well reasoned view of the problem and therefore, know what to believe or do in a given circumstance. To do this I must be committed to developing my mind as a self-directed, independent critical thinker. I must value above all else the intellectual traits and habits of thought that critical thinkers possess.
Intellectual Traits and Habits of Thought
To develop as a critical thinker one must be motivated to develop the attitudes and dispositions of a fair-minded thinker. That is, one must be willing to suspend judgements until one truly understands another point of view and can articulate the position that another person holds on an issue. Nurses come to reasoned judgements so that they can act competently in practice. They continually monitor their thinking; questioning and reflecting on the quality of thinking occurring in how they reason about nursing practice. Sloppy, superficial thinking leads to poor practice.
Critical inquiry is an important quality for safe practice. Nurses must pose questions about practice and be willing to attempt to seek answers about practice. Nurses must be willing to attempt to seek answers to the difficult questions inherent in practice, as well as the obvious. Question posing presupposes intellectual humility and a willingness to admit to one's areas of ignorance as well as, intellectual curiosity and perseverance and willingness to seek answers. Critical thinkers in nursing are truth seekers and demonstrate open-mindedness and tolerance for others' views with constant sensitivity to the possibility of their own bias.
Nurses, who are critical thinkers, value intellectually challenging situations and are self-confident in their well reasoned thoughts. To reason effectively, nurses have developed skills and abilities essential for sound reasoning.
Critical Thinking Skills and Abilities
Critical thinkers in nursing are skilful in applying intellectual skills for sound reasoning. These skills have been defined as information gathering, focusing, remembering, organizing, analyzing, generating, integrating and evaluating (Registered Nurse's Association of British Columbia, 1990). The focus of classroom and clinical activities is to develop the nurse's understanding of scholarly, academic work through the effective use of intellectual abilities and skills. As you encounter increasingly more complex practice situations you will be required to think through and reason about nursing in greater depth and draw on deeper, more sophisticated comprehension of what it means to be a nurse in clinical practice. Nursing is never a superficial, meaningless activity. All acts in nursing
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are deeply significant and require of the nurse a mind fully engaged in the practice of nursing. This is the challenge of nursing; critical, reflective practice based on the sound reasoning of intelligent minds committed to safe, effective client care.
To accomplish this goal, students will be required to reason about nursing by reading, writing, listening and speaking critically. By doing so, you will be thinking critically about nursing and ensuring that you gain in-depth knowledge about nursing as a practice profession.
Critical Thinking...a Holistic Approach
Critical Listening: A mode of monitoring how we are listening so as to maximize our accurate understanding of what another person is saying. By understanding the logic of human communication - that everything spoken expresses point of view, uses some ideas and not others, has implications, etc., critical thinkers can listen so as to enter empathetically and analytically into the perspective of others.
Critical Thinking: 1) Disciplined, self-directed thinking which implies the perfection of thinking appropriate to a particular mode or domain of thinking. 2) Thinking that displays master of intellectual skills and abilities. 3) The art of thinking about your thinking while you are thinking in order to make your thinking better: more clear, more accurate, or more defensible.
Critical Writing: To express oneself in languages required that one arrange ideas in some relationships to each other. When accuracy and truth are at issue, then we must understand what our thesis is, how we can support it, how we can elaborate it to make it intelligible to others, what objections can be raised to it from other points of view, what the limitations are to our point of view, and so forth. Disciplined writing requires disciplined thinking; disciplined thinking is achieved through disciplined writing.
Critical Reading: Critical reading is an active, intellectually engaged process in which the reader participates in an inner dialogue with the writer. Most people read uncritically and so miss some part of what is expressed while distorting other parts. A critical reader realizes the way in which reading, by its very nature, means entering into a point of view other than our own, and the point of view of the writer. A critical reader actively looks for assumptions, key concepts and ideas, reasons and justifications, supporting examples, parallel experiences, implications and consequences, and any other structural features of the written text to interpret and assess it accurately and fairly. ( Paul), 1990, pp 554 & 545)
Critical Speaking: Critical speaking is an active process of expressing verbally a point of view, ideas and thoughts such that others attain an in-depth understanding of the speaker's personal perspective on an issue. Monitoring how we express ourselves verbally will ensure that we maximize accurate understanding of what we mean through active dialogue and openness to feedback on our views. (Heaslip, 1993).
References:
Paul, R.W. (1990). Critical thinking: What every person needs to survive in a rapidly changing world. Rohnert Park, California: Center for Critical Thinking and Moral Critique
Norris, S. P. & Ennis, R.H. (1989). Evaluating critical thinking. Pacific Grove, CA: Midwest Publications, Critical Thinking Press
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Module 6 Mental Health Assessment: Legal Issues, Therapies, Communication and Psychopharmacology of Mental Illness
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Describe and discuss the various forms of admissions to mental health facilities2 Outline the steps of a mental health assessment.2. Explain the difference between confidentiality and privileged communication.3. Discuss the nurse’s role in maintaining the right of client in admission to a mental
facility.4. Discuss the nurse’s role in therapeutic communication in working with difficult situation,
cultural and language differences and legal issues.5. Explain the nursing issues related to psychopharmacology and nonpharmacologic treatment
and alternative therapies.6. Discuss the role of the nursing when giving psychopharmacological medications.
PREPARATION GUIDELINES1. Fortinash, K, & Holoday Worret, P. (2004). Psychiatric Mental Health Nursing. (4th Ed.) Mosby: St. Louis.
Chapter 1, Principles of Psychiatric Nursing: Theory and Practice. Chapter 4, Therapuetic Communication. Chaper 8, Legal and Ethical Aspects in Clinical Practice. Chapter 24, Psychopharmacology. Chapter 25, Complementary and Alterative Therapies.
2. Wissmann, J. (Ed.). (2007). Mental Health Nursing, Assessment Technologies Institute
Unit 1 Foundations for Mental Health Nursing, Unit 2 Traditional Nonpharmacological Therapies.
3. Videos: Psychotropic Drugs: Caring for patients with psychiatric disorder:a. [video 1]. Assessment, intervention and treatment.b. [video 2]. Schizophreniac. [video 3]. Bipolar Disordersd. [video 4]. Depressione. [video 5]. Anxiety Disorders
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Mental Health Examination
The mental status examination is the recorded observation of the client’s appearance, symptoms, mood and psychological function. This information can be elicited during the process of the first interview or during a time that you are talking with the patient.
Appearance and behavior.Well groomed_______Disheveled______________ Bizzare_________________Hygiene: Normal__________Poor__________Others______________________Affect: Bland____flat_____inappropriate_____depress_______
Anxious_____WNL____pressured______
Stream of TalkWNL________fast_____slow__________flight of ideas________ coherent______Concise______disconnected word salad______distractibility__________________Others: _______________________________________
GI symptoms: diarrhea, constipation, anorexia, weight loss_______________Insomnia_____Other_________________________________
Content of thought and fantasyConcerns_______preoocupations_______topic of conversation__________________Phobias_________obsessions_________difficulty concentrating__________________Hallucinations___________________delusions____________grandiosity___________Suicidal thoughts_______________________________________________________Others_________________________________________________________________
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Mental Status Examination page 2
Sensorium and Intellect:Orientation: time______place______person__________situation_________Memory Remote (use questions regarding date of birth or historical events) __________Memory Recent (use questions regarding last 24 hours) ___________________________Retention and Recall: use number forward or backward and see how many they can recall. Educate them in regards to a medication that they are on and then before you leave ask them a question regarding the medication_____________________________________________________________________________________________________
Intelligence: Knowledge consistent with education and background._______________________________________________________________________________________
Ability to abstract: Ask question regarding difference such as a child and a midget or similarities such as an ocean and a river.
Insight:Understand symptoms___________denial of problem________________
Judgment:Plans for the future
Motivation: Does the client want therapy?______ How is the client participating in care?_____________________________________________________
Rapport:Was there any?______________Significant verbal and non-verbal cues________________
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ABNORMAL INVOLUNTARY MOVEMENT SCALEAIMS
Examination Procedure
Either before or after completing the examination procedure observe the patient unobtrusively, at rest (e.g., in waiting room)
The chair to be used in this examination should be a hard, firm one without arms.
1. Ask patient whether there is anything in his/her mouth (i.e. gum, candy, etc.) and if there is to remove it.
2. Ask patient about the current condition of his/her teeth, Ask patient if he/she wears dentures. Do teeth or dentures bother patient now?
3. Ask patient whether he/she notices any movements in mouth, face, hands, or feet. If yes, ask to describe and to what extent they currently bother patient or interfere with his/her activities.
4. Have patient sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at entire body for movements while in this position).
5. Ask patient to sit with hands hanging unsupported. If male, between legs, if female and wearing dress, hanging over knees. (Observe hand and other body areas.)
6. Ask patient to open mouth. (Observe tongue at rest within mouth.) Do this twice.
7. Ask patient to protrude the tongue (observe abnormalities of tongue movement.)
8. Ask patient to tap thumb, with each finger, as rapidly as possible for 10-15 seconds; separately with right hand, then with left hand. (Observe facial and leg movements.)
9. Flex and extend patient’s left and right arms (one at a time). Note any rigidity
10. Ask patient to stand up. (Observe profile. Observe all body areas again, hip included.)
11. Ask patient to extend both arms outstretched in front with palms.
12. Have patient walk a few paces turn and walk back to chair. (Observe hands and gait.) Do this twice.
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Module 7 Mental Illness—Mental Health Disorders
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Discuss the pathophysiology of the following mental health disorders that leads to the signs and symptoms of the disease and treatment. Schizophrenia Depression Bipolar disorders Anxiety Disorders Alzheimer’s disease Alcoholism/substance related disorders/fetal alcoholism Autistic disorders Personality Disorders
2. Discuss the role of the nurse in maintaining a safe environment for the client exhibiting behavioral disorders.
3. Discuss techniques for deescalation of aggressive behavior.4. Identify Community resources available to the client with mental illness.5. Based on the following nursing diagnoses, discuss prioritized interventions to meet the child,
adult and geriatric client’s needs.
Disturbed thought processes Non compliance Risk for injury Interrupted family process Self-care deficit Disturbed sensory perception Ineffective family and individual coping
6. Discuss how family and cultural background influence the care of the client during manifestation of symptoms of the above disorders.
7. Discuss your role as a member of the health care team in assessment and interventions of a member that is exhibiting substance use in the work place.
PREPARATION GUIDELINES1. Fortinash, K, & Holoday Worret, P. (2004). Psychiatric Mental Health Nursing. (4th
Ed.) Mosby: St. Louis. Part II, Psychiatric Disorders, Chapters 9-19, Chapte 21, Suicide: Prevention and intervention.
2. Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis Missouri Chapter 9, Stress and Stress Management
Chapter 12, Addictive Behavior
3. Lewis, S.M. companion CD Stress busting kit for nursing students.
4. Wissmann, J. (Ed.). (2007). Mental Health Nursing Assessment Technologies Institute Unit 4, Psychobiologic Disorders, Psychiatric Emergencies, and
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Mental Health Nursing Care of Special Populations.
CRITICAL THINKING EXERCISE
Case Study 1
Watch the movie A Beautiful Mind. Answer the following questions.
Compare the symptoms of schizophrenia with the symptoms that John Nash exhibited.
Based on his symptoms develop a care plan which includes assessment, 2 nursing diagnoses, interventions, and evaluation.
Case Study 2
You suspect that one of your coworkers is taking narcotics while working in the hospital setting. Discuss the steps that you would take in confronting this problem.
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Module 8 Growth and Development
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Compare and contrast the psychosocial and physical development of the young, middle-aged and late adults.
2. Discuss therapeutic relationship that is used while obtaining a psychosocial assessment.3. Identify and modify personal feelings regarding age bias.4. Integrate the care of the dying client identifying cultural, religious and
personal attitudes and feelings.6. Discuss the strategies used by the nurse to meet the needs of the older adults based on
Maslow’s Hierarchy of Needs.
PREPARATION GUIDELINES
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri. Chapter 6, Older Adults, Chapter 11, End of Life and Palliative Care.
Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins: Philadelphia. Chapter 27, Principles of Growth and Development.
Fortinash, K, & Holoday Worret, P. (2004). Psychiatric Mental Health Nursing. (4th Ed.) Mosby: St. Louis. Chapter 16, Disorders of Infancy, Childhood and Adolescence.
Video: Pediatrics psychosocial care / MedVid Productions1. Infants & toddlers (31 min.) 2. Preschool & school age (29 min.) 3. Adolescents (31 min.) 4. The dying child (30 min.).
CRITICAL THINKING EXERCISE
CASE STUDY 1
James, a 30 year old man was driving his motorcycle when he failed to negotiate a turn and crashed on a patch of sand. Luckily, he WAS wearing a HELMET. Unfortunately, he did not have on other protection and was only wearing a T-shirt, shorts and sports shoes. As a result, he has multiple abrasions and deep lacerations that required suturing on his left lateral leg, hip, and buttocks. His right arm was fractured requiring surgical intervention including an open reduction with internal
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fixation (pinning). After surgery his arm was casted. Jim’s hands and left shoulder also have deep abraded areas and he reports being in a “lot of pain.”
How are these physical changes going to affect the physical, psychological, cultural, sociological, and spiritual aspects of Jim’s life?
CASE STUDY 2
Fifty-four-year-old Samuel calls the doctor’s office for the fourth time this month complaining of severe in-digestion and requesting a medication that will work to fix it. He has refused to have any x-rays or other diagnostic tests because he “can’t fit them into” his “busy schedule.” Samuel owns a pet store. His wife Sandy quit her job when her son turned 13 to monitor his behavior since he had not been going to school every day. Samuel and Sandy have twin daughters, but they are both in college in another state.
Why might Samuel be experiencing health problems?What is affecting the developmental tasks Samuel needs to meet?
CASE STUDY 3
You are attending to a 58-year-old female who has been diagnosed with terminal breast cancer. Her family requests you to join them in prayer at her bedside. (Since you have been her favorite nurse)
How would you feel about this request?What factors or beliefs would influence your decision to participate or the decline?How would you respond if you were uncomfortable with this situation?
CASE STUDY 4 You are working in a long-term-care facility delivering care to an 89-year-old male Muslim. His family is at the bedside as he begins to confess his sins and is begging for forgiveness. A few days later, he dies. Based on your knowledge of the Islamic faith, you know that only the relatives and family can touch the body after death. You cannot move the body and need the family to provide the care. When you return to the room after the family has completed care, you find the body moved in an unusual direction. The room that he is in is not a private room and the location of the body blocks the way for the other resident to enter the room.
What will you do to allow the body to continue facing Mecca?How do you feel not being able to deliver post-mortem care?What were you thinking during the confession period?Did the begging for forgiveness bother you?
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Module 9 The role of the nurse as a teacher, supporter of culture, delegator, and priority setting
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Relate teaching-learning principles to a variety of health care settings.2. Explain why client education is an important nursing responsibility in an every-changing healthcare
setting.3. Specify assessment data necessary to determine client’s learning needs.4. Describe strategies to make decisions regarding the prioritization of care.5. Describe the rules and regulations regarding the delegation of nursing care in Washington State.6. Explain how to provide direction to self and others to efficiently use time and resources.7. Discuss strategies to meet the cultural needs of a client with varying health care problems.8. Develop a knowledge base to increase the appreciation of unique differences among clients
PREPARATION GUIDELINES
Fortinash, K, & Holoday Worret, P. (2004). Psychiatric Mental Health Nursing. (4th Ed.) Mosby: St.Louis.
Chapter 28, Caring for Clients in the Community.
Harrington, N. & Terry, C.L. (2003). LPN to RN Transitions; Achieving Success in Your New Role (3rd ed.). Lippincott Williams & Wilkins. Chapter 12, The Nurse as a Teacher
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri. Chapter 3, Culturally Competent Care. Chapter 5, Patient and Family Teaching.
Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins: Philadelphia. Chapter 3, Sociocultural Aspects of Maternal and Child Health Nursing.
Zerwekh, J & Claborn, J.C. (2006). Nursing Today: Transition and Trends, Saunders: St. Louis. Chapter 12, Conflict Management. Chapter 13, Time Management. Chapter14, Delegation in the Clinical Setting.
Available in Library (Information Technology Resource Center)Video--Delegating care to unlicensed assistive personnel by Concept Media.Video--Cultural assessment—medcom, Inc
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A Common Approach to Identifying Immediate PrioritiesMajor Principles1. Always consider the relationship between the problems: For example if Problem Y causes Problem Z, Problem Y takes priority over Problem Z. 2. Treatment for first- and second-level priorities is usually initiated in rapid succession or simultaneously. At times, the order of priority might change, depending on the seriousness of the problem and relationship between the problems. For example, if abnormal lab values are life-threatening, they become a higher priority; if your patient is having trouble breathing because of acute pain, treating the pain might become the highest priority
Secondary-level priority problems (immediate, after treatment for first-level problems is initiated) Mental status change Acute pain Acute urinary elimination problems Untreated medical problems requiring immediate attention (e.g., a diabetic problems
is initiated) Abnormal lab values Risks of infection, safety, or security (for patient or for others)
Note: To help you remember the above, mnemonic MAA-U-AR provides the first letter of each of the second-level priority problems.
Third-level priority problems (later priorities) Health problems that don’t fit into the above categories (e.g., problems with lack of
knowledge, activity, rest, family coping)____________Alfaro-Lefevre, R. (2004). Critical Thinking in Nursing. Philadelphia: W.B. Saunders Co. (p.168).
SETTING PRIORITIES ACCORDING TO MASLOW’S HIERARCHY OF HUMAN NEEDS
PRIORITIES 1 Problem with survival needs (e.g. food, fluids, oxygen, elimination warmth, physical comfort).
PRIORITIES 2 Problems with safety and security needs (e.g. risks of injury or infection, threats to feeling secure.
PRIORITIES 3 Problems with love and belonging (e.g. family problems, separation from loved ones)
PRIORITIES 4 Problems with self-esteem needs (needs for privacy, respect, independence, and positive self-image)
PRIORITIES 5 Problems with self-actualization needs (e.g. need to grow and achieve outcomes)
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Module 10 Imbalance Fluid, Electrolyte, and Acid Base
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Discuss normal physiology of fluid and electrolyte and acid-base balance in the body.
2. Compare and contrast the pathophysiology of hypovolemia and dehydration.
3. Discuss the nursing assessment of a patient (pediatric, adult and aged) with fluid, electrolyte and acid-base imbalances.
4. Discuss the pathophysiology, etiology, symptoms, and the nurse’s role in the treatment of the following imbalances:
5. Analyze and correctly interpret an arterial blood gas report.6. Review the following medication list, discuss the nurse’s role in safely administering each
medication especially discuss rate of administration, side effects and compatibility of these drugs as an intravenous injection.
7.Define the following and identify two IV fluids that would be in each category: Hypotonic Isotonic Hypertonic
8. Formulate nursing interventions with priority setting for the following nursing diagnoses. Ineffective airway clearance Ineffective breathing patterns Deficient fluid volume Excess fluid volume Impaired gas exchange Risk for Injury
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PREPARATION GUIDELINES
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri. Chapter 17, Fluid, Electrolyte, and Acid-Base Imbalances.
Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins: Philadelphia. Chapter 37, Nursing Care of the Child Undergoing Medication Administration and Intravenous Therapy.
Required Materials:
In the library:Charnecky, C. & Murphy-Ende, K. (2001). Real-World Nursing Survival Guide Fluids and Electrolytes. Mosby: Philadelphia.
On the Web:http://www.wisc-online.com/ This is a free site but you will have to create a user profile.
Case Study: 1
A 74-year-old woman, who lives alone, is admitted to the hospital because of weakness and confusion. She has a history of chronic heart failure. She has had the flue for the past 2 days. Urinated last evening: Drank ½ cup of coffee with her drugs in the a.m.; her drugs are Lasix (furosemide) 40 mg p.o., b.i.d. potassium chloride 15 meq. t. i. d., Hydrochlorothiazide 12.5 mg daily, and Cardizem (diltiazem) 180 mg daily.
Assessment: Confused, slow to respond to questioning, B. P. 90/62, HR 120 and irregular. ECG shows Atrial Fibrillation; Lungs clear, respiration 12/minute and shallow; decreased skin turgor and dry mucous membranes.
Laboratory Data:
Sodium 155 mEq/L
Potassium 2.5 mEq/L
Chloride 114 mEq/L
Calcium 9.0 mg/dl
BUN 42 mg/dl
Creatinine 1.9
HCT: 50%
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Arterial Blood Gases: pH 7.52
PaCO2 45 mm Hg
PaO2 90 mm Hg
HCO3- 35 mEq/L
1. Analyze the blood test and ABG results. What would be the medical diagnosis of the results? What would be the etiology of the imbalance? Which of the physical findings support the analysis?
2. What is the daily assessment should be included in the plan of care for this client?
3. The doctor has ordered an I. V. of D5W for this client to run at 100 ml/hour. The I. V. is running at 25 drops/minute. Four hours after the client has arrived to the unit the nurse does the assessment. This client is restless and continues to be confused. The lungs have rales in the bases; the respirations are 24 and shallow; the Foley catheter has drained 50 ml in the last 4 hours. There is jugular vein distention. I.V. intake for the last 4 hours is 1000 ml.
a. Discuss the cause of the symptoms that are being exhibited.
b. Outline the steps in solving the problem and list them in priority.
1. The client is being discharged to home and she will continue with her medications. Discuss patient teaching of this client particularly addressing medication and disease process.
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Module 11 Alteration in Elimination
CLASS OBJECTIVES
Following completion of the assignment, the student will be able to:
1. Discuss the pathophysiology of the following urinary problems in relationship to signs, symptoms and medical treatment.
Nephrolithiasis Acute and Chronic Renal Failure Renal calculi
2. Describe the steps of physical assessment for an adult and child in relationship to altered urinary function.
3. Describe the nurse’s role in the prevention of renal calculi.
4. Formulate nursing interventions with priority setting for the following nursing diagnoses. Infection Activity intolerance Ineffective therapeutic regimen management Fluid Volume Excess Acute Pain Fatigue Impaired skin integrity Anticipatory grieving Imbalance in nutrition: more/less than body requirements Altered pattern of urinary elimination Ineffective family and individual coping
5. Discuss the process of including the family in caring for clients with renal failure and receiving hemodialysis/peritoneal dialysis.
6. Discuss nutritional education for a client who has nephrolithiasis, nephrotic syndrome, or renal failure.
7. Explain the nurse’s role as an advocate for a client facing renal transplantation.
8. Compare cultural considerations in caring for a client with renal failure.
9. Discuss the postop nursing care and the prevention of complications for a client who has placement of A.V. fistula.
10. Discuss the nursing intervention and education for a client who has hemodialysis or peritoneal dialysis. Include medications that would be given/not given prior to dialysis.
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11. Find four drugs in your book,specific for urinary problems under each of the following classifications or disease processes and describe the action, side effect and nursing education .
12. Explain the impact of physical environment (home) on the patient who has altered urinary disfunction.
13. Describe community resources that are available for clients who have chronic renal failure.
Required Reading
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri. Chapter 46, Renal and Urologic Problem Chapter 47, Acute Renal Failure and Chronic RenalFailure.
Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins.: Philadelphia. Chapter 46, Nursing Care of the Child With a Renal or Urinary Tract Disorder.
1. Formulate nursing interventions with priority setting for the following nursing diagnoses for the mother, infant, pediatric,adult and geriatric patient.
2. Discuss the Pathophysiology of the following conditions and describe the medical treatment and complementary and alternative therapies based on the clinical manifestations and physical assessment.
3. Discuss post operative care of an adult/child who has open heart surgery: heart valve, cardiac
transplantation, and coronary heart bypass, peripheral artery bypass. heart catheterization or placement of stent.
4. Review the following medication classifications. Identify four medications (although a couple of these classifications may only have one medication) that would fall under these classifications. Discuss the use of the medications, dose and route, contraindications, side effects, nursing implications and patient teaching.
1. Antianginals-nitrates
2. Antiarrhythmics Class 1A Class 1B Class 1C Class II Class III Class IV miscellaneous
6. Practice reading an ECG strip.7. Explain the role of the nurse in the treatment of dysrhythmia.8. Outline education for a patient with a pace maker or cardio-defibrillator device.9. Discuss cultural implications of disease processes. 10. Explain the impact of dysrhythmia on the activities of daily living in the physical
environment (home, transportation, or job etc.).
PREPARATION GUIDELINES
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri. Chapter 33, Hypertension.Chapter 34, Coronary Artery Disease and Acute Coronary Syndrome. Chapter 35, Heart Failure. Chapter 36, Dysrhythmias. Chapter 37, Inflammatory and Structural Heart Disorders. Chapter 38,Vascular Disorders.
Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins: Philadelphia. Chapter 8, The Growing Fetus,, Chapter 41, Nursing Care of the Child With a Cardiovascular Disorder.
Companion CD Case studies: chronic peripheral arterial diseaseAtrial fibrillationMyocardial infarctionHypertension
Module 13 Alteration in Oxygenation
COGNITIVE AND AFFECTIVE OBJECTIVES
Upon completion of this module the student will be able to:
1. Explain the pathophysiology/etiology, signs and symptoms and medical/surgical treatment for: Pneumonia Pneumothorax Hemothorax Pulmonary Edema Pulmonary embolism Emphysema Asthma
Respiratory Failure Sudden Infant Death Syndrome Cystic Fibrosis
2. Describe the steps of physical assessment for a child and/or an adult in relationship to the signs and symptoms that are being exhibited as the result of alteration in oxygenation.
3. Formulate nursing interventions with priority setting for the following nursing diagnoses. Ineffective airway clearance Ineffective breathing patterns Risk for imbalanced fluid volume Impaired gas exchange Anxiety Imbalanced nutrition: less than
body requirement Knowledge deficit Disturbed sleep patterns
Risk for infection Activity intolerance Social Isolation Altered health maintenance Ineffective individual/family
coping
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4. Compare and contrast tracheostomy tubes from endotracheal tubes and relate proper use and care in your discussion.
5. Describe the different types of mechanical ventilators and the nursing interventions to prevent complications of this device.
6. Discuss the assessment of client who has a chest tube.
7. Discuss the process of including the family in caring for clients with alteration in oxygenation.
8. Compare culture consideration in caring for a client with acute respiratory failure and the client is in ICU.
9. Review the following medication classifications. Identify four medications (although a couple of these classifications may only have one medication) that would fall under these classifications. Discuss the use of the medications, dose and route, contraindications, side effects, nursing implications and patient teaching.
10. Explain the impact of physical environment (home) on the patient who has COPD or asthma.
11. Describe community resources that are available for clients who are exhibiting alteration in oxygenation.
Required Reading:
Lewis, S. M, Heitkemper, M.M. & Dirksen, S.R., (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problem. (7th. Ed.). Mosby: St. Louis, Missouri.Chapter 27, Upper Respiratory Problems. Chapter 28 Lower Respiratory Problems. Chapter 29, Obstructive Respiratory Diseasese.
Pillotteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family (5th ed.). Lippincott Williams and Wilkins: Philadelphia. Chapter 40, Nursing Care of a Child With a Respiratory Disorder.
On line Great introduction to lung soundshttp://www.stethographics.com/main/physiology_ls_introduction.html
Video Respiratory Care made incredibly easy. Available in the library. 2001
