St. Catharine CollegeAssociate Degree Nursing Program

NUR232Medical-Surgical Nursing II

Spring 2009

NUR232 Medical Surgical Nursing II

The St. Catharine Nursing Student will continue their second year of the nursing program

with medical-surgical nursing. This is the second semester of a two semester year ending their

nursing program. NUR232 is an 8 week course consisting of medical-surgical nursing instruction

in adult care.

This 6 credit hour course is the second in a two-part series of courses designed to utilize

the nursing process as part of reflective practice in providing care to clients across the lifespan.

Teaching/learning principles will be introduced and applied in the care of clients at various

developmental levels during acute/chronic episodes of altered basic human needs as well as

during states of wellness. Emphasis on advanced nursing skills, critical thinking, and application

and analysis of knowledge will begin to be incorporated into the nurse’s role as provider and

manager of care using the nursing process. Topics include: problems of ventilation and oxygen

transport, reproductive, and critical care among others.

Many methods are used to deliver instruction and to introduce new material to the

nursing student. These methods will include lecture, discussion, audiovisual, computer activities,

simulation, class interaction, group work, care plans, case study, written assignments, laboratory

assignments, and clinical care of the client. This course was developed toward fulfillment of the

program’s philosophy and outcomes. All materials utilized in this course including text books,

study aids, and on-line applications were chosen by experienced instructors in the medical-

surgical field.

Continued application of the nursing process is reinforced with critical thinking. At this

level in the nursing program critical thinking is utilized as a process to allow the student to apply

their knowledge to treatment of the client. By using critical thinking to apply the nursing process

in the care of the client each student is able to draw upon their previous experience and

knowledge in making decisions concerning nursing care utilizing the nursing process..

The text for this course introduces the concepts of the nursing process including

assessment, planning, implementation, and evaluation. The text also continues the study of

principles of health promotion, patient teaching, and community health nursing. Throughout the

course there is also the reinforcement of the standards of the American Nurses’ Association as

well as evidence based practice, with cultural considerations.

Cognitive learning is evaluated throughout the semester with exams and case studies.

Culmination of learning is evaluated by a comprehensive final examination. In this course the

students have access to nursing faculty for 1:1 tutoring in any area that the student or instructor

identifies as an area for improvement ensuring their student’s success. This course utilizes a

clinical component in the medical-surgical setting. In the clinical setting experienced instructors

are provided to guide the student in the application of the nursing process in nursing care to the

client in a hospital setting. Emphasis is placed on the use of critical thinking in all aspects of care

from admittance to discharge of each client with individual plans of care. This setting allows the

medical-surgical nursing student to gain the confidence and competence in the care of the client

with the resource of an experienced clinical faculty member at hand for questions and feedback.

A clinical practicum consisting of 120 hours of clinical practice shared with a clinical

preceptor allows for the application of the nursing process in the clinical setting where each

student is able to put the education acquired in the classroom to use. The didactic and clinical

components of this course allow for the success of the nursing student in obtaining licensure and

providing competent and compassionate nursing care.

St. Catharine CollegeAssociate Degree Nursing Program

NUR232 Medical-Surgical Nursing II Course Syllabus Spring 2009

Course Description:This second course in a two-part series of courses is designed to utilize the nursing process as a part of reflective practice in providing holistic care to clients across the lifespan. Teaching/learning principles will be introduced and applied in caring for clients at various developmental levels during acute/chronic episodes of altered basic human needs as well as during states of wellness. Emphasis on advanced nursing skills, critical thinking, and application and analysis of knowledge will begin to be incorporated into the nurse’s role as provider and manager of care. Topics covered include problems of oxygenation, ventilation, transport, male/female reproduction, and critical care.

Prerequisite and Co requisite Courses:BIO 204, BIO 205, BIO 250, CHE 103, ENG 101, ENG 102, PHI 231, PSY 100, PSY 150, MAT 106, NUR 115, NUR 120, NUR 201, NUR 202, NUR 221, NUR 222 and REL.

Course Placement:Fourth semester of the nursing program.

Credit Hours:8 week Session: 6 credit hoursLecture (9 contact hours)

Instructor:Jenny Burch, MSN, RN – 859-336-5082, ext. 1277; email: jburch@sccky.eduOffice Hours: Tuesday by appointment, Thursday 9am – 12pm.

Methods of Instruction:May include discussion, scenarios, audiovisuals, computer activities, simulation, class interaction, care plans, written assignments, laboratory assignments, debates, or presentations.

Course Requirements:A letter grade will be given for examinations and selected assignments. A theory grade of C (77%) or better must be earned to successfully complete the course. *Exam average must be > 77% in order to successfully pass the course. If the exam average is not 77% or higher, the course grade reported to the Registrar will reflect the exam average only.

Grading Scale:A 93 – 100B 86 – 92C 77 – 85 D 65 – 76F 0 – 64

Methods of Evaluation:Nasogastric Tube Practice, Check off/Quiz Pass/FailAverage of Unit Exams (I, II, III, IV) 60%Comprehensive Final Exam 35%Care Plan Presentation 5%

Note: Assignment grades and course grades are NOT rounded.

Required Resources:

Lewis, S.M., Heitkemper, M.M.,Dirksen, S.R., O’Brien, P.G., & Bucher, L. (2007). Medical-surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby. ISBN: 0323036600.

Lewis, S.M. & O’Brien, P.G. (2004) Study guide for medical-surgical nursing (7th ed.). St. Louis: Mosby. ISBN: 0323018556.

Silverstri, L. A. (2005). Saunders comprehensive review for the NCLEX-RN examination (3rd ed). St. Louis: Mosby. ISBN: 1416031995.

In addition, the textbooks from the first year of nursing classes will be required. This includes:

Taylor’s Skills Performance ChecklistThe Art and Science of Nursing CareAPA’s Publication Manual (5th ed.)Deglin & Vallerand’s Davis’s Drug Guide (or comparable text)Pagana & Pagana’s Mosby’s Diagnostic and Laboratory Reference (or comparable text)Stedman’s Medical Dictionary (or comparable text)Dillon’s Health Assessment Text

Recommended Resources:Handbook of nursing diagnosis (10th ed.)

Carpenito-Moyet ISBN: 0781743559

NCLEX-RN 250 new format questions: Preparing for the revised NCLEX-RNSpringhouse ISBN: 1582553076

Course Objectives:A. Apply the nursing process and critical thinking to the basic human needs of selected adult

medical-surgical clients within the acute care and community settings.B. Communicate effectively with clients, families, and the health care team.C. Practice nursing skills safely, considering both the internal and external environments of

the client.D. Perform nursing actions according to legal and ethical standards.E. Demonstrate accountability in the professional nursing role.F. State the impact of health care economics on the practice of nursing and practice nursing accordingly.G. Evaluate one’s personal effectiveness, caring behaviors, and nursing care of clients.H. Provide evidence-based nursing care.I. Utilize teaching-learning principles to promote and maintain an optimal level of health

for clients across the lifespan.J. For each of the following units: Cardiovascular, Neurologic, Visual, Auditory, Critical

Care, Emergency and Disaster:

1. Review normal body structure and function as related to meeting the nursing needs of clients with health problems presented in each unit.2. Identify the pathophysiology present in relation to the common health problems presented in each unit.3. Identify common diagnostic measures related to the health problems presented in each unit with emphasis on nursing assessment and responsibilities.4. Explain the various intrinsic and extrinsic factors which may influence the health problems as presented in each unit.5. Indicate common symptoms and/or nursing problems associated with the health problems presented in each unit.6. Identify the general medical/surgical management of clients with health problems presented in each unit.7. Identify the general nursing management of the clients with health problems presented in each unit including: a) physical management b) psychosocial concepts c) diet modifications d) drug therapy e) teaching aspects

Assessment: The student’s ability to master the above stated outcomes and therefore provide appropriate nursing care to the client with the previously identified conditions will be assessed through objective exams.

Theory Expectations and Attendance:See Nursing Student Handbook, Spring 2009.

Client Confidentiality:It is a program expectation that HIPAA regulations will be followed.

Late Assignments:Assignments turned in late will result in a zero on that assignment unless prior authorization by the instructor is given.

Grades and Course Updates:Course updates and grades will be available via the computer. Each student must have a valid email address to which course information may be sent. It is recommended that students check their email at least weekly.

Changes in Course Syllabus:The purpose of this syllabus is to serve as a guide and is no way a binding contract between student and faculty. The syllabus may be subject to change, decided by circumstances, which occur throughout the course. Students will be notified in writing of any changes as they occur.

NCLEX-RN CD-ROM EXAMS:The Saunders CD-Rom should be utilized in preparation for classroom discussion and exams.

Unit Exams I-IV, Comprehensive Final:Each Unit/Final exam is timed. Calculators will be provided if needed. Nothing is allowed on the tables except what is provided by the instructor. #2 pencils must be used to mark the scanner forms, so please make sure you bring them on exam days. Cell phones are not to be out or on during testing. If you finish before the exam is over, you may remain in the classroom and must remain quiet. You may not get into your book bag or anything else that will cause noise. You may not write notes back and forth with your neighbor. You may not whisper to anyone. You may bring a non-nursing text to read, as reading your nursing book/notes will not be allowed. You may also leave the classroom once finished with your exam.

Exam grades will be posted on mygradebook.com within 48 hours of the completion of the exam.

Make – up Exams:In the event of an absence on the day a unit test is scheduled, a make-up exam may be taken. All make-up exams are administered at the end of the semester. Refer to the schedule for the exact date. The make-up exam may not be in the same format as the regularly scheduled exam. Only one make-up exam may be taken. If a student is absent for a second exam, a zero will be assigned for the second test. Make-up for the final will be offered at the discretion of the instructor after consultation with the department chair.

Clinical Practice/Laboratory Assignments:Quizzes on lab skills will be graded as “Pass/Fail”.

Quiz on Lab SkillsNGT Insertion February 25

Check off for NGT Insertion March 4

Care Plan Presentation

A. The student is to create a scenario from one of the topics presented in NUR232. This scenario may be inpatient, outpatient, home health or community based.

B. This scenario must have enough data in order to develop a care plan.C. Each care plan must have:

1. Subjective and objective data.2. A NANDA-approved nursing diagnosis.3. A short term and a long term patient goal and outcome.4. At least 4 nursing interventions.5. A rationale to support each nursing intervention.6. Evaluation of each goal.

D. The care plan presentation must be visually and orally presented during class time in any format the student selects (e.g. poster, PowerPoint).

EVALUATION CRITERIA FOR CARE PLAN PRESENTATION*

Student Name: Date:

CRITERIA % EARNED/COMMENTSCONTENT (50%)

Nursing diagnosis correlates to the data and is correctly stated as a NANDA-approved diagnosis

“Related to” (R/T) correlates with client situation and is NOT a medical diagnosis“, “as evidenced by” (AEB) correlates with assessment data

Minimum of 2 goals (one short term and one long term) with a measurable time frame

At least four (4) nursing interventions contribute to achievement of the goals, are comprehensive, and include scientific rationales with valid references listed in APA format

The evaluation correlates with the goals

ORGANIZATION (20%) Presentation is well-organized and attention

getting; scenario is well thought out. Highlights of the plan are verbally presented in

a sequenced manner Emphasis on key concepts is clear.

PRESENTATION (30%) Demonstrates creativity Demonstrates preparation Presentation is suitable to audience and

content, including graphic and/or multimedia choices

Verbal/Volume and pace are suitable to audience and content; pitch, tone and volume vary

Non-verbal eye contact; facial, hand gestures are appropriate

Responds appropriately to audience feedback Encourages and handles audience participation

constructivelyTOTAL

COMMENTS:* The student must obtain a 77% in order to pass this presentation assignment.

Topic I Problems of Oxygenation: Perfusion – Cardiovascular System, Hypertension, Dysrhythmias

Learning Objectives:

Upon completion of this topic the student will be able to:

1.       Describe the anatomic location and function of the following cardiac structures: pericardial layers, atria, ventricles, semilunar valves, and atrioventricular valves.

2.       Describe coronary circulation and the areas of heart muscle supplied by the major coronary arteries.

3.       Explain the normal sequence of events involved in the conduction pathway of the heart.4.       Describe the structure and function of arteries, veins, capillaries, and endothelium. 5.       Define blood pressure and the mechanisms involved in its regulation.6.       Identify the waveforms and the associated cardiac events represented on a normal

electrocardiogram. 7.       Identify the significant subjective and objective assessment data related to the

cardiovascular system that should be obtained from a patient.8.       Describe the appropriate techniques used in the physical assessment of the cardiovascular

system.9.       Differentiate normal from common abnormal findings of a physical assessment of the

cardiovascular system.10.      Describe the age-related changes of the cardiovascular system and differences in

assessment findings.11.      Describe the purpose, significance of results, and nursing responsibilities of diagnostic

studies of the cardiovascular system.

Hypertension:

1.      Describe the mechanisms involved in the regulation of blood pressure.2.      Identify the pathophysiologic mechanisms associated with primary hypertension.3.      Describe the clinical manifestations and complications of hypertension.4.      Describe strategies for the prevention of primary hypertension.5.      Describe the collaborative care for hypertension, including drug therapy and lifestyle modifications. 6.      Discuss the collaborative care of the older adult patient with hypertension.7.      Describe the nursing management of the patient with hypertension, emphasizing patient education. 8.      Describe the clinical manifestations and collaborative care of hypertensive crisis.

Dysrhymias:

1. Describe the nursing management of patients requiring continuous electrocardiographic (ECG) monitoring.

2. Identify the clinical characteristics and ECG patterns of normal sinus rhythm, common dysrhythmias, and acute coronary syndrome (ACS).

3. Describe the nursing and collaborative management of patients with common dysrhythmias and ECG changes associated with ACS.

4. Differentiate between defibrillation and cardioversion, identifying indications for their use and physiologic effects of each.

 5.      Describe the management of patients with temporary and permanent pacemakers. 6.      Describe the management of patients with implantable cardioverter-defibrillators. 7.      Explain the management of patients undergoing electrophysiologic testing and radiofrequency catheter ablation therapy.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of perfusion. 2. Analyze the role and responsibility of the nurse when caring for a

client with problems of perfusion.

3. Discuss the clinical implications for the nurse and client when dealing with problems of

perfusion

Learning Activities:

Read:Lewis, et al, Ch. 32, Ch. 33, Ch. 36

Review Key Terms:

afterload, p. 742arterial blood pressure, p. 743asystole, p. 855atrial fibrillation, p. 852atrial flutter, p. 851automaticity, p. 846blood pressure, p. 762cardiac index, p. 742cardiac output, p. 742cardiac pacemaker, p. 858cardiac reserve, p. 742complete heart block, p. 854diastole, p. 742diastolic blood pressure, p. 743dysrhythmias, p. 842ejection fraction, p. 757

electrocardiogram, p. 843

hypertension, p. 761hypertensive crisis, p. 781mean arterial pressure, p. 744orthostatic hypotension, p. 778point of maximal impulse, p. 750prehypertension, p. 761preload, p. 742premature atrial contraction, p. 850premature ventricular contraction, p. 854primary hypertension, p. 765pulse pressure, p. 743secondary hypertension, p. 765systemic vascular resistance, p. 762systole, p. 742systolic blood pressure, p. 743ventricular fibrillation, p. 855ventricular tachycardia, p. 854

Recommended Websites:

ABC of hypertension: Blood pressure measurement Part I; ABC of hypertension: Blood pressure measurement Part II; ABC of hypertension: Blood pressure measurement Part III; ABC of hypertension: Blood pressure measurement Part IV A series of articles from BMJ, the British Medical Journal, 2001. Well illustrated; adapted by the book of the same name.

American Heart Association Heart and Stroke Statistical Update

Anatomy & Physiology Animations and illustrations by Marcy Thomas. Includes online movie on Heart Valves

Cardiovascular Diseases and Disorders A collection of links to web resources, organized by topics, from the Stanford Health Library.

Cardiovascular Pathology Index From the Internet Pathology Laboratory; includes illustrations of normal heart, and pathologic conditions. ECG Learning Center in Cyberspace An extensive site on ECG's from the University of Utah School of Medicine.

Electrocardiology and Cardiac Arrhythmias Online guide from McGill University. Excellent review of basics plus quizzes and some dynamic cartoons.

New Developments in the Management of Hypertension Online article from American Family Physician, September 1, 2003.

Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome Online article from American Family Physician, August 1, 2003.

Be prepared to discuss the following case study in class:

Patient ProfileJason Gilbert is a 40-year-old man who comes to the community health screening. He says he came to “see how he is doing.”

   Initial Objective Data

·         Alert and oriented and cooperative·         5 feet 6 inches, 230 pounds·         Blood pressure 172/94, pulse 90, respirations 24, temperature 97.0° F 

  Subjective Data

·         States he is a truck driver and eats a lot of fast foods·         States it is hard to “eat healthy” on the road·         States this is his first checkup in many years·         States he smokes one pack of cigarettes per day and this helps him stay calm

   Critical Thinking Questions             1.      What is the nurse’s priority at this health screening?             2.      What other information will the nurse want to obtain?             3.      State at least one goal for Mr. Gilbert.             4.      What lifestyle modifications are indicated?             5.      What patient teaching is indicated?

Topic I Problems of Oxygenation: Perfusion – Coronary Artery Disease, Heart Disorders

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the etiology and pathophysiology of coronary artery disease, angina, and acute coronary syndrome.

2. Identify risk factors for coronary artery disease and the nursing role in the promotion of therapeutic lifestyle changes in patients at risk.

3. Compare and contrast the precipitating factors, clinical manifestations, and collaborative care and nursing management of the patient with coronary artery disease and chronic stable angina.

4. Describe the clinical manifestations, complications, diagnostic study results, and collaborative care of the patient with acute coronary syndrome.

5.  Describe the pathophysiology of myocardial infarction from the onset of injury through the healing process.

6. Identify commonly used drug therapy in treating patients with coronary artery disease and acute coronary syndrome.

7. Identify key issues to include in the rehabilitation of patients recovering from acute coronary syndrome and coronary revascularization procedures.

8.  Describe the precipitating factors, clinical presentation, and collaborative care of patients who are at risk for or have experienced sudden cardiac death.

9. Describe the etiology, pathophysiology, and clinical manifestations of infective endocarditis and pericarditis.

10. Discuss the collaborative care and nursing management of the patient with infective endocarditis and pericarditis.

11. Explain the importance of prophylactic antibiotic therapy in infective endocarditis.12. Explain the etiology, clinical manifestations, collaborative care, and nursing

management of myocarditis.13. Describe the etiology, pathophysiology, and clinical manifestations of rheumatic fever

and rheumatic heart disease.14. Discuss the collaborative care and nursing management of the patient with rheumatic

fever and rheumatic heart disease.15. Identify the etiologies of acquired valvular heart diseases.16. Discuss the pathophysiology, clinical manifestations, and diagnostic studies for the

various types of valvular heart disease.17. Describe the collaborative care and nursing management of the patient with valvular

heart disease.18.  Describe interventions used in management of the patient with valvular heart disease.19. Describe the pathophysiology and clinical manifestations of the different types of

cardiomyopathies.20. Discuss the nursing and collaborative management of patients with different types of

cardiomyopathies.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems with oxygenation related to perfusion. 2. Analyze the role and responsibility of the nurse when caring for a client with perfusion disorders. 3. Discuss the clinical implications for the nurse and client when dealing with perfusion disorders.

Learning Activities:

Read:Lewis, et al, Ch. 34, Ch. 37

Review Key Terms:

acute coronary syndrome, p. 802angina, p. 796aortic stenosis, p. 880 aortic valve regurgitation, p. 880Aschoff’s bodies, p. 876atherosclerosis, p. 785cardiomyopathy, p. 885chronic stable angina, p. 796collateral circulation, p. 786coronary artery disease, p. 785coronary revascularization, p. 801dilated cardiomyopathy, p. 886hypertrophic cardiomyopathy, p. 888infective endocarditis, p. 865Janeway’s lesions, p. 867metabolic equivalent (MET), p. 817mitral valve prolapse, p. 879

myocardial infarction, p. 803myocarditis, p. 874Osler’s nodes, p. 867pericardial effusion, p. 872pericardial friction rub, p. 872pericardiocentesis, p. 873pericarditis, p. 871percutaneous coronary intervention, p. 801Prinzmetal’s angina, p. 797regurgitation, p. 878rheumatic fever, p. 875rheumatic heart disease, p. 875silent ischemia, p. 797stent, p. 801sudden cardiac death, p. 817unstable angina, p. 802

Recommended Websites:

ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Full-text From the American Heart Association.

ACLS.Net Includes online practice algorithms, mnemonics, and online self-test quizzes.

Aspirin as a Therapeutic Agent in Cardiovascular Disease A Statement for Healthcare Professionals From the American Heart Association.

Coronary Angiogram and Angioplasty An audiovisual online tutorial from the National Library of Medicine. DASH Diet & Cookbook web site from the Oregon Dairy Council.

Heart Attack An interactive online tutorial from the National Library of Medicine.

Hypertension Treatment and the Prevention of Coronary Heart Disease in the Elderly Online article from American Family Physician, March 1, 1999.

Therapeutic Lifestyle Changes From the The National Heart, Lung, and Blood Institute (NHLBI); includes The Virtual Grocery Store, Cyber Kitchen, Cyber Cafe, TLC Diet, and more.

Be prepared to discuss the following case study in class:

Patient ProfileMr. Monroe is a 74-year-old obese white man who comes to the emergency department (ED) with a 2-day history of severe chest pain. Over the weekend the pain increased, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

  Subjective Data·         Describes recurring chest pain for the past 6 months that was relieved by rest;

describes that pain as a feeling of heaviness·         Recently the pain has become severe and is no longer relieved by rest

   Objective Data

Physical Examination·         Alert and oriented to person, place, and time·         Obese·         Vital signs: blood pressure 180/90, pulse 92, temperature 99.8º F, respirations 20 ·         Skin diaphoretic and clammy·         Heart rhythm regular, no murmurs or extra heart sounds·         Denies nausea and vomitingDiagnostic Studies and Procedures·         Hemoglobin 14 g/dl·         Na, K, Cl, and HCO3 normal·         Cardiac enzymes pending·         Electrocardiogram showing changes that correlate with non–ST-segment–elevation

myocardial infarction (NSTEMI) ·         D5W infusing into the intravenous catheter·         Nitroglycerin and morphine given with relief of pain

   Psychosocial Data

·         States he has a positive family history of heart disease·         Denies alcohol or drug use·         States he smokes one and a half packs of cigarettes per day·         Describes his lifestyle as sedentary

  

Critical Thinking Questions             1.      Which risk factors (modifiable and nonmodifiable) does Mr. Monroe have for

coronary artery disease (CAD)?             2.      What is the difference between chronic stable angina pain and pain associated

with myocardial infarction?             3.      What diagnostic studies are indicated for Mr. Monroe?   Case Study Progression  Mr. Monroe is diagnosed as having a myocardial infarction.             4.      What is the priority nursing care for Mr. Monroe?             5.      What are common complications after an MI?

Topic I Problems with Oxygenation: Perfusion – Heart Failure, Vascular Disorders

Learning Objectives:

Upon completion of this topic the student will be able to:

1.      Compare the pathophysiology of systolic and diastolic ventricular failure.2.      Discuss the compensatory mechanisms involved in heart failure.3.      Describe the nursing and collaborative management of the patient with acute decompensated heart failure and pulmonary edema.4.      Describe the collaborative care and nursing management, including drug and nutritional

therapy, of the patient with chronic heart failure.5. Describe the indications for cardiac transplantation and the nursing management of

cardiac transplant recipients.6. Describe the etiology and pathophysiology of peripheral arterial disease.7. Identify the major risk factors associated with peripheral arterial disease.8. Describe the pathophysiology, clinical manifestations, and collaborative care of aortic

aneurysms.9. Discuss the perioperative nursing care of a patient having an aortic aneurysm repair.10. Describe the pathophysiology, clinical manifestations, and collaborative care of aortic

dissection.11. Discuss the clinical manifestations, collaborative care, and surgical management of

peripheral arterial disease of the lower extremities.12. Discuss the nursing management of the patient with acute arterial insufficiency

affecting the lower extremities.13. Differentiate the pathophysiology, clinical manifestations, and collaborative care of

thromboangiitis obliterans (Buerger’s disease) and Raynaud’s phenomenon.14. Identify the risk factors predisposing to the development of superficial

thrombophlebitis and deep vein thrombosis.15. Differentiate between the clinical characteristics of superficial thrombophlebitis and

deep vein thrombosis.16. Describe the collaborative care and nursing management of the patient with venous

thrombosis, including superficial thrombophlebitis and deep vein thrombosis.17. Describe the nursing management of the patient receiving anticoagulation therapy.18. Discuss the pathophysiology, clinical manifestations, and collaborative and nursing

management of patients with varicose veins, venous insufficiency, or venous leg ulcers.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems with oxygenation and perfusion. 2. Analyze the role and responsibility of the nurse when caring for a client with perfusion disorders. 3. Discuss the clinical implications for the nurse and client when dealing with perfusion disorders.

Learning Activities:

Read:Lewis, et al, Ch. 35, Ch. 38

Review Key Terms:

acute arterial ischemia, p. 907aneurysms, p. 894aortic dissection, p. 898cardiac transplantation, p. 837chronic venous insufficiency, p. 919critical limb ischemia, p. 903deep vein thrombosis, p. 909diastolic failure, p. 822heart failure, p. 821intermittent claudication, p. 900paroxysmal nocturnal dyspnea, p. 825

peripheral arterial disease, p. 893pulmonary edema, p. 824Raynaud’s phenomenon, p. 908superficial thrombophlebitis, p. 909systolic failure, p. 822thromboangiitis obliterans (Buerger’s disease), p. 908varicose veins, p. 917venous thrombosis, p. 909Virchow’s triad, p. 909

Recommended Websites:

Abdominal Aortic Aneurysms from the National Library of Medicine.

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article From the Journal of the American College of Cardiology, 2005; 46:1116-1143.

ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina Full text online from the American Heart Association.

Aneurysms A collections of links to web resources from Medline Plus. Includes link to the online slide show on

Arteries An interactive learning program with schematic diagrams of location of major arteries; from Lumen, Loyola University.

Blood Clots Basic level illustrations and information from the Medical Encyclopedia, Medline Plus. A collection of links is provided to related topics such as Arterial embolism, Pulmonary embolus, Deep Venous Thrombosis, and others.

Carotid Endarterectomy An interactive tutorial from Medline Plus.

Cholesterol Information and a collection of links to web resources from Medline Plus. Includes sections on Treatment and Tutorials.

Coumadin® and Vitamin K From the National Institutes of Health Warren Grant Magnuson Clinical Center; includes a list of foods high in vitamin K.

Diagnosis and Management of Diastolic Dysfunction and Heart Failure An article by Chhabi Satpathy, MD, Trinath K. Mishra, MD, Ruby Satpathy, MD, Hemant K. Satpathy, MD, and Eugene Barone, MD, from American Family Physician, March 1, 2006, Vol. 73 No. 5.

Digoxin Oral Information from Medline Plus Drug Information.

DVT and Pulmonary Embolism: Part I. Diagnosis and DVT and Pulmonary Embolism: Part II. Treatment and Prevention Online articles by Dino W. Ramzi, MD, CM, and Kenneth V. Leeper, MD, from American Family Physician, June 15, 2004.

Furosemide Information from Medline Plus Drug Information.

Heart Failure Online consumer level information from the National Heart Lung and Blood Institute.

Homan's sign in the diagnosis of deep venous thrombosis. Online article by Frank L. Urbano, Hospital Physician, March 2001.

Managing Heart Failure: A Case Study Approach Online continuing education article by Mary MacKlin, from the American Association of Critical-Care Nurses.

Peripheral Arterial Disease and Claudication From the American Academy of Family Physicians.

Point-of-Care Guides: Predicting Mortality Risk in Patients with Acute Exacerbations of Heart Failure By Mark H. Ebell, MD, MS, available online from American Family Physician, April 15, 2007, Vol. 75 No. 8.

Transplant Statistics From the US Transplant -- Scientific Registry of Transplant Recipients.

Varicose Veins An online audio slide show from the National Library of Medicine.

Venous Stasis Ulcers Information about venous stasis ulcers, complete with images and descriptions. From the Wound Healing / Burns / Stasis Ulcers site by John L. Bezzant, MD.

Be prepared to discuss the following case study in class:

Patient ProfileMrs. Guerra is a 56-year-old Hispanic woman who was diagnosed with heart failure 4 years ago. She has been admitted to the hospital for shortness of breath.

   Subjective Data

·         States she was taking a diuretic at home but ran out 2 days ago; has not been able to refill her prescription ·         Complains of difficulty breathing

·         States she noticed some swelling in her feet that seemed worse than usual   Objective Data

Physical Examination·         Alert and oriented to person, place, and time·         Fine crackles bilateral lower lobes·         Shortness of breath on exertion·         Oxygen saturation 89%, room air·         S1 and S2 without murmur or extra heart sounds·         Bowel sounds normoactive and present in all four quadrants·         Abdomen soft and nondistended·         Capillary refill sluggish in lower extremities, normal in upper extremities·         2+ edema bilateral lower extremities

   Collaborative Care

·         The physician orders oxygen 2 L per minute through a nasal cannula and furosemide 20 mg by mouth twice a day. The pharmacy has furosemide 40 mg available.

   Critical Thinking Questions             1.      How much furosemide will the nurse give, and how often?              2.      What assessment data will the nurse use to determine the effectiveness of the physician’s orders?             3.      What are the clinical manifestations of left-sided heart failure? Right-sided heart failure?              4.      What nursing diagnoses might be appropriate for this patient?

Topic II Problems Related to Movement and Coordination – Nervous System

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the functions of neurons and neuroglia.2. Explain the electrochemical aspects of nerve impulse transmission.3. Explain the anatomic location and functions of the cerebrum, brainstem, cerebellum,

spinal cord, peripheral nerves, and cerebrospinal fluid.4. Identify the major arteries supplying the brain.5. Describe the functions of the 12 cranial nerves.6. Compare the functions of the two divisions of the autonomic nervous system.7. Describe age-related changes in the neurologic system and differences in assessment

findings.8. Identify the significant subjective and objective data related to the nervous system that

should be obtained from a patient.9. Describe the techniques used in the physical assessment of the nervous system.10. Differentiate normal from common abnormal findings of a physical assessment of the

nervous system.11. Describe the purpose, significance of results, and nursing responsibilities related to

diagnostic studies of the nervous system12. Compare and contrast tension-type, migraine, and cluster headaches in terms of

etiology, clinical manifestations, collaborative care, and nursing management.13. Describe the etiology, clinical manifestations, diagnostic studies, collaborative care,

and nursing management of seizure disorders, multiple sclerosis, Parkinson’s disease, and myasthenia gravis.

14. Describe the clinical manifestations and nursing and collaborative management of restless legs syndrome, amyotrophic lateral sclerosis, and Huntington’s disease.

15. Explain the potential impact of chronic neurologic disease on physical and psychologic well-being.

16. Outline the major goals of treatment for the patient with a chronic, progressive neurologic disease.

17. Define dementia and describe its impact on society18. Compare and contrast different etiologies of dementia.19. Describe the clinical manifestations, diagnostic studies, and collaborative management

of dementia.20. Describe the clinical manifestations of mild cognitive impairment. 21. Describe the clinical manifestations, diagnostic studies, and collaborative management

of Alzheimer’s disease.22. Describe the nursing management of the patient with Alzheimer’s disease.23. Describe other neurodegenerative disorders associated with dementia, including Lewy

body disease, Pick’s disease, Creutzfeldt-Jakob disease, and normal pressure hydrocephalus.

24. Describe the etiology, pathophysiology, clinical manifestations, diagnostic studies, and collaborative management of delirium.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to the nervous system. 2. Analyze the role and responsibility of the nurse when caring for a client with neurological disorders. 3. Discuss the clinical implications for the nurse and client when dealing with neurological disorders.

Learning Activities:

Read:Lewis, et al, Ch. 56, Ch. 59, Ch. 60

Review Key Terms:

Alzheimer's disease, p. 1564amyotrophic lateral sclerosis, p. 1558autonomic nervous system, p. 1449blood-brain barrier, p. 1452central nervous system, p. 1442cerebrospinal fluid, p. 1448cranial nerves, p. 1448Creutzfeldt-Jakob disease, p. 1575delirium, p. 1576dementia, p. 1561dermatome, p. 1448epilepsy, p. 1533frontotemporal dementia, p. 1576headache, p. 1527Huntington’s disease, p. 1558Lewy body dementia, p. 1575lower motor neurons, p. 1445meninges, p. 1452

mild cognitive impairment, p. 1564multiple sclerosis, p. 1542myasthenia gravis, p. 1555neurofibrillary tangles, p. 1565neuroglia, p. 1442neuron, p. 1442neurotransmitter, p. 1444Parkinson’s disease, p. 1547peripheral nervous system, p. 1442Pick's disease, p. 1576reflex, p. 1445restless legs syndrome, p. 1557seizure, p. 1532sundowning, p. 1573synapse, p. 1443upper motor neurons, p. 1445vascular dementia, p. 1562

Recommended Websites:

Alzheimer's Disease Fact Sheet From the Alzheimer's Association.

Alzheimer's Disease Fact Sheet and Care Giving: Home and Family resources and links to additional web sites from ADEAR: Alzheimer's Disease Education & Referral Center of the National Institute on Aging.

Basic Neural Processes A "collection of tutorials on basic neural functions" by John H. Krantz, PhD, Hanover College, Indiana. Site includes an interactive quiz on the human brain, animated information on basic neurological function, and a glossary of terms.

The Blood Brain Barrier Illustration and overview article from the Society for Neuroscience.

Cerebral Palsy A collection of links to web resources from the National Library of Medicine's Medline Plus.

The Cranial Nerves From Loyola University, Chicago.

Dana BrainWeb An extensive site from the Dana Foundation that includes information on Memory, Alzheimer's Disease, Head Injuries, Stroke, Parkinson's Disease and more.

Dementia in the Elderly An online continuing education article by Caroline Fox, RN, C, CALA & Cynthia Richardson, BS, MA, from Nurse.com.

Does He Have Alzheimer's Disease? By Chris Neal and Michael Meyer, MD; a case study from the University of Missouri's Virtual Health Care Team™ site.

Epilepsy Information from Medline Plus.

Huntington's Disease Information Page and Huntington's Disease — Hope Through Research, an online booklet, from the National Institute of Neurological Disorders and Stroke.

EMG & Nerve Conductions Homepage By Joe F. Jabre, MD; includes Electronic EMG Manual ©; Quick-Anatomy: Nerves; Quick-Anatomy: Muscles; Quick Set-Ups: Nerve Conductions; Nerve Conduction TeleEMG Calculator ©.

History & Physical Examination: Clinical Patterns Part of the web site Neuromuscular Evaluation Protocols on the Neuromuscular Disease Center site, Washington University School of Medicine, St. Louis. Also includes information on Lab Testing: Especially for treatable diagnoses after history & examination and Nerve Biopsy.

Magnetic resonance imaging, MRI Information and an online game from the Nobel Foundation.

Multiple Sclerosis An online tutorial from Knowledge Weavers, Spencer S. Eccles Health Sciences Library, University of Utah; includes videos, images, and extensive lecture materials.

The Nervous System in Old Age From Neuroscience for Kids, Copyright, 1996-2007, Eric H. Chudler, PhD, a professor at the University of Washington.

Neurologic Diseases Extensive links to web resources from the National Library of Medicine's Medline Plus.

The Normal Brain Illustrated overview from Roberta J. Seidman, MD, Associate Professor, SUNY Stony Brook Pathology Department.

Neurologic Diseases Extensive links to web resources from the National Library of Medicine's Medline Plus.

Parkinson's Disease From Medline Plus.

Parkinson's Disease: What a Nurse Should Know An online continuing education article by Mary Lloyd, RN, PhD & Heather Maccarone, RN, BSN, from Nurse.com.

Polio and Post-Polio Syndrome A collection of links to web resources from Medline Plus.

Be prepared to discuss the following case study in class:

Patient ProfileMr. Denver, a 58-year-old African American man, was diagnosed with myasthenia gravis several years ago. He has been taking pyridostigmine (Mestinon) and prednisone since then and has had few symptoms. Recently, while visiting his daughter, he developed severe weakness in his arms and legs along with respiratory distress.

   Subjective Data

·         Reports difficulty “getting enough air”·         Tires easily·         Reports food “gets stuck in my throat” ·         Reports difficulty speaking clearly

   Objective Data

Physical Examination·         Jaw muscle weakness·         Generalized weakness·         Tense and anxious·         Shallow respirationsDiagnostic Studies·         Chest CT scan shows large mediastinal mass, likely thymoma·         Pulmonary functions tests show decreased expiratory effort

   Critical Thinking Questions             1.      What is the pathophysiology of myasthenia gravis (MG)?              2.      What is this exacerbation called?              3.      What are typical triggers of a myasthenic crisis?              4.      What is the likely treatment plan for Mr. Denver?              5.      What might be appropriate nursing diagnoses for a patient with MG?

Topic II Problems Related to Movement and Coordination – Nervous System

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Identify the physiologic mechanisms that maintain normal intracranial pressure.2. Identify the common etiologies, clinical manifestations, and collaborative care of the

patient with increased intracranial pressure.3. Describe the collaborative and nursing management of the patient with increased

intracranial pressure.4. Differentiate types of head injury by mechanism of injury and clinical manifestations.5. Describe the collaborative care and nursing management of the patient with a head injury.6. Compare the types, clinical manifestations, and collaborative care of patients with brain

tumors. 7. Discuss the nursing management of the patient with a brain tumor.8. Describe the nursing management of the patient undergoing cranial surgery.9. Compare the primary causes, collaborative care, and nursing management of meningitis,

encephalitis, and brain abscess.10. Describe the incidence of and risk factors for stroke.11. Explain mechanisms that affect cerebral blood flow.12. Compare and contrast the etiology and pathophysiology of ischemic and hemorrhagic

strokes.13. Correlate the clinical manifestations of stroke with the underlying pathophysiology.14. Identify diagnostic studies performed for patients with strokes.15. Describe the collaborative care, drug therapy, and nutritional therapy for a patient with a

stroke.16. Describe the acute nursing management of a patient with a stroke.17. Describe the rehabilitative nursing management of the patient with a stroke.18. Explain the psychosocial impact of a stroke on the patient and family.19. Explain the etiology, clinical manifestations, collaborative care, and nursing management

of trigeminal neuralgia and Bell’s palsy.20. Explain the etiology, clinical manifestations, collaborative care, and nursing management

of Guillain-Barré syndrome, botulism, tetanus, and neurosyphilis.21. Describe the classification of spinal cord injuries and associated clinical manifestations.22. Describe the clinical manifestations, collaborative care, and nursing management of

spinal cord shock.23. Correlate the clinical manifestations of spinal cord injury with the level of disruption and

rehabilitation potential.24. Describe the nursing management of the major physical and psychologic problems of the

patient with a spinal cord injury.25. Describe the effects of spinal cord injury on the older adult population.26. Explain the types, clinical manifestations, collaborative care, and nursing management of

spinal cord tumors.27. Describe the pathophysiology, clinical manifestations, and nursing and collaborative

management of postpolio syndrome.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to the nervous system. 2. Analyze the role and responsibility of the nurse when caring for a client with neurological disorders. 3. Discuss the clinical implications for the nurse and client when dealing with neurological disorders.

Learning Activities:

Read:Lewis, et al, Ch. 57, Ch. 58, Ch. 61

Review Key Terms:

aphasia, p. 1508autonomic dysreflexia, p. 1603Bell's palsy, p. 1584botulism, p. 1587brain attack, p. 1502cerebral edema, p. 1469coma, p. 1469concussion, p. 1482contusion, p. 1482embolic stroke, p. 1506encephalitis, p. 1497epidural hematoma, p. 1483Glasgow Coma Scale, p. 1476Guillain-Barré syndrome, p. 1585hemorrhagic strokes, p. 1506intracerebral hemorrhage, p. 1506intracerebral hematoma, p. 1484intracranial pressure, p. 1468

ischemic stroke, p. 1505meningitis, p. 1493neurogenic bladder, p. 1604neurogenic shock, p. 1590neurosyphilis, p. 1589nuchal rigidity, p. 1494paraplegia, p. 1590postpolio syndrome, p. 1610spinal shock, p. 1590stroke, p. 1502subarachnoid hemorrhage, p. 1506subdural hematoma, p. 1483tetanus, p. 1588tetraplegia, p. 1589thrombotic stroke, p. 1505transient ischemic attack, p. 1504trigeminal neuralgia, p. 1581unconsciousness, p. 1471

Recommended Websites:

Anatomy of the Brain On the public information resource of the American Association of Neurological Surgery.

Anatomy of the Spine Information from the American Association of Neurological Surgeons.

Basic Neural Processes A "collection of tutorials on basic neural functions" by John H. Krantz, PhD, Hanover College, Indiana. Site includes an interactive quiz on the human brain, animated information on basic neurological function, and a glossary of terms.

Bell's Palsy A collection of links to web resources from Medline Plus.

The Blood Brain Barrier Illustration and overview article from the Society for Neuroscience.

Carpal Tunnel Syndrome Extensive resource edited by Frederick A. Matsen III, MD, from the Hand & Wrist section of the University of Washington Orthopaedics and Sports Medicine web site.

Carotid Endarterectomy An interactive tutorial from Medline Plus.

Cooling for Acute Ischemic Brain Damage (COOL AID) An Open Pilot Study of Induced Hypothermia in Acute Ischemic Stroke An online article from Stroke, 2001;32:1847.

Coma From NOVA Online, produced for PBS by the WGBH Science Unit.

The Cranial Nerves From Loyola University, Chicago.

Degenerative Spine Disease Online article by John R. Hesselink, MD, FACR, with references; from the Degenerative Disease Syllabus, Teaching File Database, from the University of California San Diego.

Encephalitis A collection of links to web resources from Medline Plus.

Facts about Concussion and Brain Injury and Where to Get Help From the Centers for Disease Control and Prevention. Includes an online movie.

Guidelines for Management and Prognosis of Severe Traumatic Brain Injury Online book (286 pages) from a joint project of the Brain Trauma Foundation and American Association of Neurological Surgeons

Guillain-Barre Syndrome A collection of links to web resources from Medline Plus.

Head and Brain Injuries A collection of links to web resources from Medline Plus.

History & Physical Examination: Clinical Patterns Part of the web site Neuromuscular Evaluation Protocols on the Neuromuscular Disease Center site, Washington University School of Medicine, St. Louis. Also includes information on Lab Testing: Especially for treatable diagnoses after history & examination and Nerve Biopsy.

Killer Disease on Campus Companion web site to the PBS program on meningococcal meningitis. Includes an animation of "how meningococcal bacteria wreak havoc inside a victim's body".

Magnetic resonance imaging, MRI Information and an online game from the Nobel Foundation.

Management of the Acute Migraine Headache Online article by Glen Aukerman, MD, Doug Knutson, MD, and William F. Miser, MD, MA from American Family Physician, December 1, 2002.

The Nervous System in Old Age From Neuroscience for Kids, Copyright, 1996-2007, Eric H. Chudler, PhD, a professor at the University of Washington.

Neurologic Diseases Extensive links to web resources from the National Library of Medicine's Medline Plus.

Neurosurgery - What Is It? An online tutorial from the National Library of Medicine's Medline Plus site.

NINDS Encephalitis and Meningitis Information Page From the National Institute of Neurological Disorders and Stroke.

NINDS Hydrocephalus Information Page Overview of the disorder and links to organizations and additional information from the National Institute of Neurological Disorders and Stroke.

Screening Physical Exam Select the section on the Nervous System, by Arcot J. Chandrasekhar, MD, FRCP, FACP, FCCP, Loyola University.

Stroke Statistical overview from the Centers for Disease Control and Prevention.

Stroke From the American Heart Association. Comprehensive information regarding stroke and the role that the AHA plays in fighting this disease. Check out the links at the bottom of the page. There is also a collection of Scientific Publications on Stroke.

Toxic Neuropathies: Clinical and Pathological Features From Washington University, St. Louis.

Transient Ischemic Attack A collection of web resources from the National Library of Medicine's Medline Plus site.

Trigeminal Neuralgia Definition and illustration from the Trigeminal Neuralgia Association National Office, U.S.

Trigeminal Neuralgia (Tic Douloureux) Information from the InteliHealth web site, featuring consumer materials from the Harvard Medical School.

When a headache isn't just a headache An online article from Neurology Reviews, November 2000.

Topic II Problems Related to Movement and Coordination – Musculoskeletal Assessment, Orthopedic Surgery

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the gross anatomic and microscopic composition of bone.2. Explain the classification system of joints and movements at synovial joints.3. Describe the types and structure of muscle tissue.4. Describe the functions of cartilage, muscles, ligaments, tendons, fascia, and bursae.5. Describe age-related changes in the musculoskeletal system and differences in

assessment findings.6. Identify the significant subjective and objective data related to the musculoskeletal

system that should be obtained from a patient.7. Describe the appropriate techniques used in the physical assessment of the

musculoskeletal system.8. Differentiate normal from abnormal findings of a physical assessment of the

musculoskeletal system.9. Describe the purpose, significance of results, and nursing responsibilities related to

diagnostic studies of the musculoskeletal system. Explain the etiology, pathophysiology, clinical manifestations, and collaborative care of soft tissue injuries, including strains, sprains, dislocations, subluxations, bursitis, repetitive strain injury, carpal tunnel syndrome, rotator cuff injury, meniscus injury, and muscle spasms.

10. Describe the sequential events involved in fracture healing.11. Differentiate among closed reduction, cast immobilization, open reduction, and traction

regarding purpose, complications, and nursing management.12. Describe the neurovascular assessment of an injured extremity.13. Explain common complications associated with a fracture and fracture healing.14. Describe the collaborative care and nursing management of patients with specific

fractures.15. Describe the indications for and collaborative care and nursing management of the patient

with an amputation.16. Describe the types of joint replacement surgery associated with arthritis and connective

tissue diseases.17. Identify the preoperative and postoperative management of the patient having joint

replacement surgery.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to the musculoskeletal system. 2. Analyze the role and responsibility of the nurse when caring for a client with musculoskeletal disorders. 3. Discuss the clinical implications for the nurse and client when dealing with musculoskeletal disorders.

Learning Activities:

Read:Lewis, et al, Ch. 62 Ch. 63

Review Key Terms:

ankylosis, p. 1623arthrocentesis, p. 1627arthroplasty, p. 1662arthroscopy, p. 1624atrophy, p. 1623bursitis, p. 1635carpal tunnel syndrome, p. 1633compartment syndrome, p. 1650contracture, p. 1623crepitation, p. 1623dislocation, p. 1632fat embolism syndrome, p. 1651

fracture, p. 1635isometric contractions, p. 1618isotonic contractions, p. 1618kyphosis, p. 1623lordosis, p. 1623phantom limb sensation, p. 1660repetitive strain injury, p. 1633sprain, p. 1630strain, p. 1630subluxation, p. 1632synovectomy, p. 1662traction, p. 1638

Recommended Websites:

About Joint Arthroscopy An animated online presentation from the Arthritis Foundation.

Amputees A collection of links to web resources from the National Library of Medicine's Medline Plus.

Athletic Injuries Select a body part to get more information; from the Yale Sports Medicine Center.

Bone Cancer "oncologist-approved cancer information" from People Living With Cancer, "the patient information website of the American Society of Clinical Oncology (ASCO)".

Bones, Joints and Muscles Topics A directory to topical collections of web resources on these topics; from Medline Plus. Includes online tutorials and links to relevant organizations.

Characteristic Gait Patterns in Neuromuscular Pathologies An online article by Deanna J. Fish, MS, CPO.

Compartment syndromes and fat embolism Online overview from Surgical Tutor.

Diagnosis and Management of Osteomyelitis An online article from American Family Physician, June 15, 2001.

Diagnosis and Treatment of Paget's Disease of Bone Online article from American Family Physician, May 15, 2002.

Diagnostic and Therapeutic Injection of the Shoulder Region An online article from American Family Physician, March 15, 2003.

Dwarfism: Achondroplasia and Hypochondroplasia From the International Center for Limb Lengthening, Sinai Hospital of Baltimore.

Guidelines for Evaluation of Neuromusculoskeletal Disability From the California Industrial Medical Council.

Hip Information site from the American Academy of Orthopaedic Surgeons' consumer information site. Includes sections on Activities after a Hip Replacement, Live it Safe-Prevent Broken Hips, and more.

Hip Injuries and Disorders A collection of links to web resources from the National Library of Medicine's Medline Plus.

Hip Replacement A collection of links to web resources from the National Library of Medicine's Medline Plus.

Knee Arthroscopy An online audiovisual tutorial from the National Library of Medicine.

Knee Injuries and Disorders Links to web resources from Medline Plus.

Management of Ankle Sprains An extensively illustrated article from American Family Physician, January 1, 2001.

Physical Examination of the Knee Movie on Lumen, Loyola University, by Jerold Stirling, MD. Romberg and Sharpened Romberg By Susan L. Whitney, PhD, PT, ATC, for the Pennsylvania Physical Therapy Association.

Pin Care Protocol From the University of Michigan Health System.

Rotator Cuff Injuries An interactive online tutorial from the National Library of Medicine.

Shoulder Arthroscopy An online audiovisual tutorial from the National Library of Medicine.

Shoulder Injuries and Disorders Links to web resources from Medline Plus.

Screening for Idiopathic Scoliosis in Adolescents: Recommendation Statement From the American Academy of Family Phtysicians, May 15, 2005. Includes a direct link to the

Vertebral Compression Fractures in the Elderly An illustrated article by Jerry L. Old, MD, and Michelle Calvert, MD, from American Family Physician, January 1, 2004.

Topic II Problems Related to Movement and Coordination – Musculoskeletal Problems & Arthritis

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of osteomyelitis.

2. Describe the types, pathophysiology, clinical manifestations, and collaborative care of bone cancer.

3. Differentiate between the causes and characteristics of acute and chronic low back pain.4. Describe the conservative and surgical therapy of intervertebral disk damage.5. Describe the postoperative nursing management of a patient who has undergone spinal

surgery.6. Explain the etiology and nursing management of common foot disorders.7. Describe the etiology, pathophysiology, clinical manifestations, and collaborative and

nursing management of osteomalacia, osteoporosis, and Paget’s disease.8. Compare and contrast the sequence of events leading to joint destruction in

osteoarthritis and rheumatoid arthritis.9. Describe the clinical manifestations, collaborative care, and nursing management of

osteoarthritis and rheumatoid arthritis.10. Compare and contrast the pathophysiology, clinical manifestations, collaborative care,

and nursing management of ankylosing spondylitis, psoriatic arthritis, and reactive arthritis.

11. Describe the pathophysiology, clinical manifestations, and collaborative care of septic arthritis, Lyme disease, and gout.

12. Describe the pathophysiology, clinical manifestations, collaborative care, and nursing management of systemic lupus erythematosus, polymyositis, dermatomyositis, and Sjögren's syndrome.

13. Describe the drug therapy and related nursing management associated with arthritis and connective tissue diseases.

14. Compare and contrast the possible etiologies, clinical manifestations, and collaborative and nursing management of myofascial pain syndrome, fibromyalgia syndrome, and chronic fatigue syndrome.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems with the musculoskeletal system. 2. Analyze the role and responsibility of the nurse when caring for a client with musculoskeletal disorders. 3. Discuss the clinical implications for the nurse and client when dealing with musculoskeletal disorders.

Learning Activities:

Read:Lewis, et al, Ch. 64, Ch. 65

Review Key Terms:

ankylosing spondylitis, p. 1711arthritis, p. 1693chronic fatigue syndrome, p. 1728degenerative disk disease, p. 1680dermatomyositis, p. 1725fibromyalgia syndrome, p. 1727gout, p. 1715herniated intervertebral disk, p. 1680Lyme disease, p. 1714muscular dystrophy, p. 1675myofascial pain syndrome, p. 1726osteoarthritis, p. 1693osteochondroma, p. 1673

osteogenic sarcoma, p. 1674osteomalacia, p. 1686osteomyelitis, p. 1668osteoporosis, p. 1686Paget's disease, p. 1690polymyositis, p. 1725Raynaud's phenomenon, p. 1723rheumatoid arthritis, p. 1702Sjögren's syndrome, p. 1726systemic lupus erythematosus, p. 1716systemic sclerosis, p. 1723

Recommended Websites:

Adolescent Idiopathic Scoliosis: Review and Current Concepts Online article from American Family Physician, July 1, 2001. Allopurinol (Zyloprim) Information from Medline Plus Drug Information. See also Gout From Medline Plus. Provides links to many web based resources on diagnosis and treatment. There is also a complete online tutorial.

Alternative Therapies for Traditional Disease States: Osteoarthritis An online article from American Family Physician, January 15, 2003. Includes information on Glucosamine and Chondroitin.

Bone Cancer "oncologist-approved cancer information" from People Living With Cancer, "the patient information website of the American Society of Clinical Oncology (ASCO)."

Bone Health and Osteoporosis: A Report of the Surgeon General Issued October 14, 2004. Available online [437 pages] from the related site from the Office of the Surgeon General, which contains related brochures, fact sheets, and other materials.

Chronic Fatigue Syndrome Links to resources from the National Institute of Allergy and Infectious Diseases. Includes a Chronic Fatigue Syndrome State of the Science Conference Report, October 23-24, 2000.

Disease Management of Osteoarthritis An online continuing education article by Karen Gabel Speroni, RN, PhD, from Nurse.com.

FDA Public Health Advisory FDA Announces Important Changes and Additional Warnings for COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) April 7, 2005 Advisory from the U.S. Food and Drug Administration.

Fibromyalgia An interactive tutorial from the National Library of Medicine. Fortnightly review: The muscular dystrophies Online article by Alan E H Emery, from BMJ 1998;317:991-995 ( 10 October ); includes definitions and classifications and illustrations.

Osteomalacia Extensively illustrated site from the University of Washington. Part of a larger site

Osteoporosis and Bone Physiology maintained by Susan Ott, MD.

Pathophysiology of Osteoarthritis From the Johns Hopkins Arthritis Center

Polymyalgia Rheumatica and Temporal Arteritis An online article by Ted D. Epperly, COL, MC, USA, Kevin E. Moore, CPT, MC, USA, and James D. Harrover, CPT, MC, USA; from American Family Physician, August 15, 2000. Osteoarthritis An online audiovisual tutorial from the National Library of Medicine.

 

Topic III Problems of Ingestion, Digestion, Absorption, and Elimination – Assessment & Obesity

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the structures and functions of the organs of the gastrointestinal tract.2. Describe the structures and functions of the liver, gallbladder, biliary tract, and

pancreas.3. Explain the processes of ingestion, digestion, absorption, and elimination.4. Explain the processes of biliary metabolism, bile production, and bile excretion.5. Describe age-related changes in the gastrointestinal system and differences in

assessment findings.6. Identify the significant subjective and objective data related to the gastrointestinal

system that should be obtained from a patient.7. Describe the appropriate techniques used in the physical assessment of the

gastrointestinal system.8. Differentiate normal from common abnormal findings of a physical assessment of the

gastrointestinal system.9. Describe the purpose, significance of results, and nursing responsibilities related to

diagnostic studies of the gastrointestinal system.10. Describe the essential components of a nutritionally good diet and their importance to

health.11. Describe possible adverse interactions between drugs and various foods.12. Describe the common etiologic factors, clinical manifestations, and management of

malnutrition.13. Explain the indications for use, complications, and nursing management of tube

feedings.14. Describe the types of feeding tubes and related nursing management.15. Define the indications, complications, and nursing management related to the use of

parenteral nutrition.16. Compare the etiologic factors, clinical manifestations, and nursing management of

eating disorders.17. Discuss the etiologies and collaborative care of obesity.18. Describe the classification systems for determining a person’s body size.19. Explain the health risks associated with obesity.20. Discuss nutritional therapy and exercise plans for the obese patient. 21. Describe the different bariatric surgical procedures used to treat obesity.22. Describe the nursing management related to conservative and surgical therapies for

obesity. 23. Describe the etiology, clinical manifestations, and nursing and collaborative

management of metabolic syndrome.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of ingestion, digestion, absorption and elimination.

2. Analyze the role and responsibility of the nurse when caring for a client with problems of ingestion, digestion, absorption and elimination.

3. Discuss the clinical implications for the nurse and client when dealing with problems of ingestion, digestion, absorption and elimination.

Learning Activities:

Read:Lewis, et al, Ch. 39, Ch. 40, Ch 41

Review Key Terms:

anorexia nervosa, p. 968bariatric surgery, p. 982body mass index, p. 974borborygmi, p. 940bulimia nervosa, p. 969cheilosis, p. 939endoscopy, p. 944enteral nutrition, p. 960hematemesis, p. 939hepatocytes, p. 930Kupffer cells, p. 931lipectomy, p. 984malabsorption syndrome, p. 953malnutrition, p. 951

marasmus, p. 952melena, p. 940metabolic syndrome, p. 987morbidly obese, p. 974parenteral nutrition, p. 965protein-calorie malnutrition, p. 951pyorrhea, p. 939pyrosis, p. 939obese, p. 974overweight, p. 974steatorrhea, p. 940tenesmus, p. 940waist-to-hip ratio, p. 974Valsalva maneuver, p. 930

Recommended Websites:

The Abdomen By Richard Rathe, MD. Updated: July, 1997. Copyright © 1997 by Richard Rathe, MD. All Rights Reserved. Extensively illustrated with drawings and photographs.

American Cancer Society Includes current Statistics. Reports for previous years are also available. Includes links to Cancer Facts and Figures reports.

American Heart Association Dietary Guidelines and Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association. Site also includes eating plans and information on the older Step I , Step II and TLC Diets with links to the new An Eating Plan for Healthy Americans and Easy Food Tips for Heart-Healthy Eating (also available in Spanish).

Body Measurements Statistics and links from FastStats, National Center for Health Statistics.

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults 2003, full-text, with special topics such as Body Mass Calculator, Evidence Tables, and Tip Sheets; and OEI Treatment Guidelines Implementation Tool for Palm OS and PocketPC 2003 Devices. Available online from the National Heart Lung and Blood Institute, NHLBI. See also: The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, order information and access to online versions of this 1998 report from the National Heart, Lung, and Blood Institute.

Diagnosis of eating disorders in primary care Online article from American Family Physician, January 15, 2003.

Dying to Be Thin A PBS broadcast that you can actually view on the Web. Includes additional resource materials and a teacher's guide.

Evaluation of Epigastric Discomfort and Management of Dyspepsia and GERD A Practice Guideline by Barrett M. Schroeder, from American Family Physician, September 15, 2003.

Health Risk Classification According to Body Mass Index (BMI) [Table] From Healthy Weights site, Health Canada.

National Digestive Diseases Information Clearinghouse Includes well illustrated materials; includes Spanish language materials.

National Institute of Diabetes and Digestive and Kidney Diseases

Overweight and Obesity Web site from the Centers for Disease Control and Prevention. Includes statistics, diet information, state statistics and much more.

Parenteral Nutrition for the Acutely Ill By Patricia Worthington, RN, MSN, CNSN, Karen A. Gilbert, RN, MSN, CNSN, and Beth A. Wagner, RN, MSN, CNSN; an online continuing education article available full-text from AACN Clinical Issues Advanced Practice in Acute & Critical Care.

Total Parenteral Nutrition An overview from Medline Plus for the patient on TPN.

U.S. Preventive Services Task Force - USPSTF Site provides online guidelines and recommendations, including Screening for Colorectal Cancer, released July 2002; and Screening for Pancreatic Cancer, released February 2004. Wound, Ostomy and Continence Nurses Society - WOCN

Topic III Problems of Ingestion, Digestion, Absorption, and Elimination – Upper & Lower GI

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the etiology, complications, collaborative care, and nursing management of nausea and vomiting.

2. Describe the common etiology, clinical manifestations, collaborative care, and nursing management of upper gastrointestinal bleeding.

3. Describe the etiology, clinical manifestations, and treatment of common oral inflammations and infections.

4. Describe the etiology, clinical manifestations, complications, collaborative care, and nursing management of oral cancer.

5. Explain the types, pathophysiology, clinical manifestations, complications, and collaborative care, including surgical therapy and nursing management, of gastroesophageal reflux disease (GERD) and hiatal hernia.

6. Describe the pathophysiology, clinical manifestations, complications, and collaborative care of esophageal cancer, diverticula, achalasia, and esophageal strictures.

7. Differentiate between acute and chronic gastritis, including the etiology, pathophysiology, collaborative care, and nursing management.

8. Compare and contrast gastric and duodenal ulcers, including etiology and pathophysiology, clinical manifestations, complications, collaborative care, and nursing management.

9. Describe the clinical manifestations, collaborative care, and nursing management of stomach cancer.

10. Identify the common types of food poisoning and nursing responsibilities related to food poisoning.

11. Explain the common etiologies, collaborative care, and nursing management of diarrhea, fecal incontinence, and constipation.

12. Describe common causes of acute abdominal pain and nursing management of the patient following an exploratory laparotomy.

13. Describe the collaborative care and nursing management of acute appendicitis, peritonitis, and gastroenteritis.

14. Compare and contrast the inflammatory bowel diseases of ulcerative colitis and Crohn’s disease, including pathophysiology, clinical manifestations, complications, collaborative care, and nursing management.

15. Differentiate among mechanical, neurogenic, and vascular bowel obstructions, including causes, collaborative care, and nursing management.

16. Describe the clinical manifestations and collaborative management of colorectal cancer.17. Explain the anatomic and physiologic changes and nursing management of the patient

with an ileostomy and a colostomy.18. Differentiate between diverticulosis and diverticulitis, including clinical manifestations,

collaborative care, and nursing management.

19. Compare and contrast the types of hernias, including etiology and surgical and nursing management.

20. Describe the types of malabsorption syndrome and collaborative care of celiac disease, lactase deficiency, and short bowel syndrome.

21. Describe the types, clinical manifestations, collaborative care, and nursing management of anorectal conditions.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of ingestion, digestion, absorption and elimination.

2. Analyze the role and responsibility of the nurse when caring for a client with problemsof ingestion, digestion, absorption and elimination.

3. Discuss the clinical implications for the nurse and client when dealing with problems of

ingestion, digestion, absorption and elimination.

Learning Activities:

Read:Lewis, et al, Ch. 42, Ch. 43

Review Key Terms:

achalasia, p. 1012appendicitis, p. 1048Barrett’s esophagus, p. 1004celiac disease, p. 1079colostomy, p. 1069Crohn’s disease, p. 1051diverticulum, p. 1076dysphagia, p. 1001esophageal cancer, p. 1009esophageal diverticula, p. 1011esophagitis, p. 1004gastritis, p. 1013gastroenteritis, p. 1050gastroesophageal reflux disease, p. 1003hemorrhoids, p. 1082hernia, p. 1077hiatal hernia, p. 1007ileostomy, p. 1069

inflammatory bowel disease, p. 1051irritable bowel syndrome, p. 1046lactase deficiency, p. 1081leukoplakia, p. 1001Mallory-Weiss tear, p. 995nausea, p. 990ostomy, p. 1069paralytic (adynamic) ileus, p. 1060peptic ulcer disease, p. 1014peritonitis, p. 1049physiologic stress ulcers, p. 1017short bowel syndrome, p. 1081steatorrhea, p. 1079stomach cancer, p. 1028stress-related mucosal disease, p. 1017ulcerative colitis, p. 1051vomiting, p. 990

Recommended Websites:

About Ulcerative Colitis From the Disease Information site of the Crohn's and Colitis Foundation of America.

ACS Colorectal Cancer Facts and Figures - Special Edition 2005 From the American Cancer Society.

Acute Stress Ulceration (GI) By Philip Cumpston ; from the Australian and New Zealand Intensive Care Society.

Can Colorectal Polyps and Cancer be Found Early? From the American Cancer Society.

Clostridium difficile-Associated Diarrhea An article by Michael S. Schroeder, MD, available online from American Family Physician, March 1, 2005, vol. 71, no. 5.

Colorectal cancer screening and surveillance: Clinical guidelines and rationale—Update based on new evidence By Sidney Winawer , Robert Fletcher , Douglas Rex , John Bond , Randall Burt , Joseph Ferrucci , Theodore Ganiats , Theodore Levin , Steven Woolf , David Johnson , Lynne Kirk , Scott Litin , Clifford Simmang and for the U.S. Multisociety Task Force on Colorectal Cancer. From Gastroenterology, Volume 124, Issue 2, Pages 544-560 (February 2003), official journal of the American Gastroenterological Association, available online.

Constipation in the Elderly Online article by David C. Schaefer, MD, PhD, and Lawrence J. Cheskin, MD, from American Family Physician September 15, 1998.

Diarrhea Information from the Division of Parasitic Diseases, National Center for Infectious Diseases. Includes specific information about different parasites and about waterborne diseases.

Gastroesophageal Reflux: Medical and Surgical Treatment Options An editorial from American Family Physician, October 1, 2003.

GERD Information Resource Center Sponsored by AstraZeneca LP.

Hernia A collection of links to web resources from the National Library of Medicine's Medline Plus. Includes materials available in Spanish.

Inflammatory Bowel Disease An online article by William A Rowe, from eMedicine. Updated October 4, 2005.

Proton Pump Inhibitors: An Update Online article by Bruce T. Vanderhoff, MD, and Rundsarah M. Tahboub, MD; from American Family Physician, July 15, 2002.

Ulcers and other Gastric Disorders From the Doctor's Guide to the Internet.

Update on Helicobacter pylori Treatment An online article from American Family Physician, February 1, 2007. Inflammatory Bowel Disease Information by Jean-Paul Achkar, MD, American College of Gastroenterology.

Be prepared to discuss the following case study in class:

Patient ProfileMrs. Johnson is a 53-year-old white woman transferred via ambulance to the hospital for a burn from spilled grease. She was cooking dinner when she bent over to pick up something from the floor, knocking a pan of hot grease on her. Her husband called 911, and the ambulance team brought her to the emergency department.At the hospital she received a tetanus shot, morphine for pain, and 2 L of intravenous fluids. The patient is complaining of difficulty opening her right eye. She can open it enough to see, although her vision is blurry.

   Objective Data

Physical Examination·         Vital signs: blood pressure 190/80, pulse 88, temperature 99º F, respirations 20 ·         Alert and oriented to person, place, and time·         Pupils equal, round, reactive to light and accommodation; right eye swollen ·         Heart rate and rhythm regular; no murmur·         Lungs clear to auscultation ·         Abdomen soft, nondistended·         Bowel sounds present and active in all four quadrants·         Moves all extremities·         Second- and third-degree burns over right side of face and neck, right side of anterior trunk, two thirds of lower right thigh, and right arm. Total body surface affected estimated at 25%.

   Psychosocial Data

·         Married, lives with husband ·         Mother of three adult children·         Denies tobacco, alcohol, and drug use

   Critical Thinking Questions

1. What is the difference between a second-degree (partial thickness) and third- degree (full-thickness) burn?

             2.      How is the extent of a burn injury determined?              3.      What are the three stages of burns?              4.      What phase is Mrs. Johnson in? How does the nurse make this determination?              5.      What are the primary nursing concerns during this phase?             6.      What nursing and collaborative management are important during this phase?             7.      What interventions can the nurse use to address the emotional needs of a burn patient?

Topic III Problems of Ingestion, Digestion, Absorption, and Elimination – Liver & Pancreas

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Define jaundice and describe signs and symptoms that may occur with the different types of jaundice.

2. Differentiate among the types of viral hepatitis, including etiology, pathophysiology, clinical manifestations, complications, and collaborative care.

3. Describe the nursing management of the patient with viral hepatitis.4. Describe the pathophysiology, clinical manifestations, complications, and collaborative

care of the patient with nonalcoholic fatty liver disease.5. Explain the etiology, pathophysiology, clinical manifestations, complications,

collaborative care, and nursing management of the patient with cirrhosis of the liver.6. Describe the clinical manifestations and management of liver cancer.7. Describe the pathophysiology, clinical manifestations, complications, and collaborative

care of acute and chronic pancreatitis.8. Describe the nursing management of the patient with pancreatitis.9. Explain the clinical manifestations and collaborative care of the patient with pancreatic

cancer.10. Explain the pathophysiology, clinical manifestations, complications, and collaborative

care, including surgical therapy, of gallbladder disorders.11. Describe the nursing management of the patient undergoing conservative or surgical

treatment of cholecystitis and cholelithiasis.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of ingestion, digestion, absorption and elimination.

2. Analyze the role and responsibility of the nurse when caring for a client with problems of ingestion, digestion, absorption and elimination.

3. Discuss the clinical implications for the nurse and client when dealing with problems of ingestion, digestion, absorption and elimination.

Learning Activities:

Read:Lewis, et al, Ch. 44

Review Key Terms:

acute pancreatitis, p. 1118ascites, p. 1104asterixis, p. 1106cholecystitis, p. 1126cholelithiasis, p. 1126chronic pancreatitis, p. 1124cirrhosis, p. 1101esophageal varices, p. 1104gastric varices, p. 1104

hepatic encephalopathy, p. 1104hepatitis, p. 1088hepatorenal syndrome, p. 1106jaundice, p. 1088nonalcoholic fatty liver disease, p. 1101paracentesis, p. 1107portal hypertension, p. 1104spider angiomas, p

Recommended Websites:

ABC of diseases of liver, pancreas, and biliary system: Portal hypertension-1: varices Illustrated online article from the StudentBMJ.

The ABCs of Hepatitis Online continuing education program by Carmen Hench, RN & Sandra Simpkins, MSN, RN; from Nurse.com.

Acute Pancreatitis: Diagnosis, Prognosis, and Treatment An article by Ennifer K. Carroll, MD, MPH; Brian Herrick, MD, Teresa Gipson, MD, and Suzanne P. Lee, MD, from American Family Physician,, May 15, 2007, vol. 75, no. 10.

Alcohol's Effect on Organ Function An issues of Alcohol Research & Health Volume 21, Number 1, 1997. Full-text online; includes sections on pancreas, liver, and gastrointestinal effects; from the National Institute on Alcohol Abuse and Alcoholism.

Chronic Hepatitis C: Current Disease Management From the National Digestive Diseases Information Clearinghouse - NDDIC.

Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation An article by Joel J. Heidelbaugh, MD, and Michael Bruderly, MD, from American Family Physician,, September 1, 2006.

Diagnosis and Management of Acute Pancreatitis Online article from American Family Physician, July 1, 2000.

Endoscopic Retrograde Cholangiopancreatography (ERCP) for Diagnosis and Therapy NIH Consensus Statement, January 14-16, 2002 Vol. 18, No. 1, full-text online. Gallstones and Laparoscopic Cholecystectomy NIH Consensus Development Conference, Sept. 14-16, 1992; full-text online.

Guidelines for the Management of Occupational Exposures to Hepatitis B, Hepatitis C, and HIV and Recommendations for Postexposure Prophylaxis Updated U.S. Public Health Service Guidelines, 2001, and Updated U.S. Public Health Service Guidelines for the Management of

Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis September 2005.

Hepatitis A, Hepatitis B, and Hepatitis C Collections of links to web resources from Medline Plus.

The Liver: Introduction and IndexWell illustrated and animated site from the Pathophysiology of the Digestive System site, Colorado State University.

The Sol Goldman Pancreatic Cancer Research Center An extensive site from the Johns Hopkins University. Includes a section on Surgery for Pancreatic Cancer with an illustration of the Whipple Procedure.

Viral Hepatitis: Epidemiology and Prevention of Viral Hepatitis A to E: An Overview. PowerPoint and Adobe Acrobat files available for downloading from the Centers for Disease Control and Prevention.

Topic IV Problems Related to Altered Sensory Input – Visual & Auditory System/Problems

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the structures and functions of the visual and auditory systems.2. Describe the physiologic processes involved in normal vision and hearing.3. Identify the significant subjective and objective assessment data related to the visual and

auditory systems that should be obtained from the patient.4. Describe the appropriate techniques used in the physical assessment of the visual and auditory systems.5. Differentiate normal from common abnormal findings of a physical assessment of the

visual and auditory systems.6. Describe age-related changes in the visual and auditory systems and differences in

assessment findings.7. Describe the purpose, significance of results, and nursing responsibilities related to

diagnostic studies of the visual and auditory systems.8. Describe the types of refractive errors and appropriate corrections.9. Describe the etiology and collaborative care of extraocular disorders.10. Explain the pathophysiology, clinical manifestations, and nursing management and

collaborative care of the patient with selected intraocular disorders.11. Describe the nursing measures that promote the health of the eyes and ears.12. Explain the general preoperative and postoperative care of the patient undergoing surgery

of the eye or ear.13. Describe the action and uses of drug therapy for treating problems of the eyes and ears.14. Explain the pathophysiology, clinical manifestations, and nursing management and

collaborative care of common ear problems.15. Compare the causes, management, and rehabilitative potential of conductive and

sensorineural hearing loss.16. Explain the use, care, and patient teaching related to assistive devices for eye and ear

problems.17. Describe the common causes and assistive measures for uncorrectable visual impairment

and deafness.18. Describe the measures used to assist the patient in adapting psychologically to decreased

vision and hearing.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of altered sensory perception.2. Analyze the role and responsibility of the nurse when caring for a client with problems of altered sensory perception.3. Discuss the clinical implications for the nurse and client when dealing with problems of altered sensory perception.

Learning Activities:

Read:Lewis, et al, Ch. 21, Ch. 22

Review Key Terms:

amblyopia, p. 417aqueous humor, p. 399astigmatism, p. 400blepharitis, p. 422cataract, p. 425conjunctiva, p. 400conjunctivitis, p. 422enucleation, p. 437external otitis, p. 438glaucoma, p. 432hyperopia, p. 400keratitis, p. 423keratoconus, p. 425

labyrinthitis, p. 442lens, p. 401myopia, p. 417nystagmus, p. 409otosclerosis, p. 440presbycusis, p. 446presbyopia, p. 417retina, p. 401retinopathy, p. 429sclera, p. 400tinnitus, p. 409vertigo, p. 409

Recommended Websites:

Acoustic Neuroma A collection of links to web resources from the National Library of Medicine's Medline Plus site.

Acute Otitis Media: Part I. Improving Diagnostic Accuracy Online article from American Family Physician, April 1, 2000.

Acute Otitis Media: Part II. Treatment in an Era of Increasing Antibiotic Resistance Online article from American Family Physician, April 15, 2000.

Cataracts Interactive online audiovisual tutorial from the National Library of Medicine.

Cholesteatoma Illustrated site by Mark J. Levenson, MD, FACS; from the Ear Surgery Information Center.

Diabetes - Eye Complications Interactive online audiovisual tutorial from the National Library of Medicine.

Differential Diagnosis and Treatment of Hearing Loss An article by Jon E. Isaacson MD, and Neil M. Vora MD, from American Family Physician, September 15, 2003, 68:1125-1132.

The Eye An extensive online lecture with animations, simulations, and interactive experiments related to vision. Part of the extraordinary site on Neurophysiology, an extensive collection of detailed tutorials on neurophysiologic functions with flash animations and online interactive experiments.

Eye and Ear On JayDoc HistoWeb; lavish illustrations; University of Kansas Medical Center.

Vision Problems in the U.S.--Prevalence of Adult Vision Impairment and Age-Related Eye Diseases in America "A joint project of the National Eye Institute and Prevent Blindness America"; includes a map demonstrating rates of vision impairment and blindness, and related tables.

Eye Care America The public service foundation site of the American Academy of Ophthalmology. Provides an extensive collection of materials on eye care and disease related eye problems.

Eye Disease Simulations Pictures that demonstrate how the world appears to individuals with different eye diseases; from the National Eye Institute.

Glaucoma Interactive online audiovisual tutorial from the National Library of Medicine.

Hearing Aids Information from the National Institute on Deafness and Other Communication Disorders.

Hearing Loss From the National Institute on Aging.

Laser Eye Surgery A collection of links to web resources from the National Library of Medicine's Medline Plus site.

LASIK Interactive online audiovisual tutorial from the National Library of Medicine.

National Eye Health Education Program (NEHEP) Information in English and Spanish from the National Eye Institute. Covers Diabetic Eye Disease, Glaucoma, and Low Vision. NetSurgery.com Information and online videos of surgical procedures from Healthology Inc., a Health Education Company. Includes several items on laser eye surgery. Use search or browse functions to locate other specific topics.

A Practical Guide to Drug-Induced Ocular Side Effects On the New York Glaucoma Research Institute server, reprinted with permission from Review of Ophthalmology, Kristine Morrell, Managing Editor.

Tinnitus Interactive online audiovisual tutorial from the National Library of Medicine.

Vision Problems in the U.S.--Prevalence of Adult Vision Impairment and Age-Related Eye Diseases in America "A joint project of the National Eye Institute and Prevent Blindness America"; includes a mapdemonstrating rates of vision impairment and blindness, and related tables.

Vision Impairment and Blindness Links to web resources from the National Library of Medicine's Medline Plus.

Topic IV Problems Related to Altered Sensory Input – Integumentary System/Problems & Burns

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Describe the structures and functions of the integumentary system.2. Describe age-related changes in the integumentary system and differences in

assessment findings.3. Describe the significant subjective and objective data related to the integumentary

system that should be obtained from a patient.4. Describe specific assessments to be made during the physical examination of the skin

and appendages.5. Explain the critical components for describing a lesion.6. Describe the appropriate techniques used in the physical assessment of the

integumentary system.7. Explain the structural and assessment differences in dark skin color.8. Differentiate normal from common abnormal findings in a physical assessment of the

integumentary system.9. Describe the purpose, significance of results, and nursing responsibilities related to

diagnostic studies of the integumentary system.10. Describe health promotion practices related to the integumentary system.11. Explain the etiology, clinical manifestations, and nursing and collaborative

management of common acute dermatologic problems.12. Describe the psychologic and physiologic effects of chronic dermatologic conditions.13. Explain the etiology, clinical manifestations, and collaborative care of malignant

dermatologic disorders.14. Explain the etiology, clinical manifestations, and collaborative care of bacterial, viral,

and fungal infections of the integument.15. Explain the etiology, clinical manifestations, and collaborative care of infestations and

insect bites.16. Explain the etiology, clinical manifestations, and collaborative care of allergic

dermatologic disorders.17. Explain the etiology, clinical manifestations, and collaborative care related to benign

dermatologic disorders.18. Describe the dermatologic manifestations of common systemic diseases.19. Explain the indications and nursing management related to common cosmetic

procedures and skin grafts. 20. Describe the causes and prevention of burn injuries.21. Describe the burn injury classification system.22. Describe the relationship between the involved structures and the clinical appearance of

partial- and full-thickness burns.23. Identify the parameters used to determine the severity of burns.24. Describe the pathophysiology, clinical manifestations, complications, and nursing and

collaborative management of the three burn phases.

25. Explain fluid and electrolyte shifts during the emergent and acute burn phases.26. Describe the nutritional therapy of the burn patient during the three burn phases.27. Describe the interventions that the nurse may use in the management of pain in the

burn patient.28. Explain the physiologic and psychosocial aspects of burn rehabilitation.29. Describe the nursing management of the emotional needs of the burn patient and

family.30. Discuss the issues involved and rationale for preparing the burn patient to return home.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of altered sensory perception.2. Analyze the role and responsibility of the nurse when caring for a client with problems of altered sensory perception.3. Discuss the clinical implications for the nurse and client when dealing with problems of altered sensory perception.

Learning Activities:

Read:Lewis, et al, Ch. 23, Ch. 24, Ch. 25

Review Key Terms:

actinic keratosis, p. 463alopecia, p. 452apocrine sweat glands, p. 451basal cell carcinoma, p. 463burn, p. 483chemical burns, p. 484contracture, p. 504cultured epithelial autograft, p. 501cryosurgery, p. 476curettage, p. 476debridement, p. 496dermis, p. 450dysplastic nevi, p. 466eccrine sweat glands, p. 451epidermis, p. 449escharotomy, p. 491electrical burns, p. 485

enzymatic debridement, p. 501excision and grafting, p. 501full-thickness burns, p. 486hypermetabolic state, p. 499intertriginous, p. 454lichenification, p. 477keloids, p. 457keratinocytes, p. 450malignant melanoma, p. 465melanocytes, p. 449partial-thickness burns, p. 486pruritus, p. 454sebaceous glands, p. 451smoke and inhalation injuries, p. 484squamous cell carcinoma, p. 464sun protection factor (SPF), p. 461thermal burns, p. 484

Recommended Websites:

Ambulatory Management of Burns An illustrated online article from American Family Physician, November 1, 2000. Includes links to two patient handouts on this topic.

Anatomy and Histology of Normal Skin By Jason R. Swanson and Jeffrey L. Melton, MD, Loyola University; this extensive site includes the skin and appendages.

Assessment and Initial Care for Burn Patients Full-text online standard from the American College of Surgeons; requires Adobe Acrobat Reader to view or print.

Burns A collection of links to web resources from Medline Plus. Includes links on treatment and prevention.

Burns Online audiovisual program from the National Library of Medicine.

Care of Burn Patients in the Hospital Overview from the educational resources site of the International Society for Burn Injuries.

Cellulitis A collection of links to web resources from Medline Plus.

Cuts, Scrapes and Stitches: Caring for Wounds from the American Academy of Family Physicians.

Dermatologic Image Database An extensive collection of images from the Department of Dermatology, University of Iowa College of Medicine.

Piercing and Tattoos A collection of web based resources from Medline Plus, National Library of Medicine.

Primary Care Dermatology Module: Nomenclature of Skin Lesions An illustrated online tutorial developed by Gary Williams, MD, and Murray Katcher, MD, PhD, Department of Pediatrics, University of Wisconsin, Madison, with funding and support from the Wisconsin Area Health Education Center (AHEC) System.

Screening Physical Exam Select the section on Skin; by Arcot J. Chandrasekhar, MD, FRCP, FACP, FCCP; from Loyola University.

Skin Cancer (PDQ®): Screening An extensive site from the National Cancer Institute.

Skin Care and Aging From the National Institute on Aging.

Skin Conditions and Skin, Hair, and Nails Topical directories to collections of web resources from Medline Plus.

Skin engineering, the future treatment for burns and wounds An article from the Faculty of Medicine, University of Hong Kong, Public Health Education Campaign, Issue 29.

Split-thickness skin graft Online review by Don R. Revis Jr., MD, and Michael B. Seagel, MD; from eMedicine.

Split-Thickness & Full Thickness Grafts Illustrated site from Burn Survivors Throughout The World, Inc.

Sunburn An online review by Lyn Guenther, MD, Benjamin Barankin, MD, and Julie Powell, MD; from eMedicine.

Topic V Nursing Care in Specialized Settings – Shock & Respiratory Failure

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Define shock.2. Differentiate the two major classifications of shock: low blood flow and maldistribution

of blood flow.3. Describe the pathophysiology and clinical manifestations of the different types of

shock.4. Compare and contrast the effects of shock, systemic inflammatory response syndrome,

and multiple organ dysfunction syndrome on the major body systems.5. Compare the collaborative care, drug therapy, and nursing management of patients with

different types of shock.6. Describe the nursing management of a patient experiencing multiple organ dysfunction

syndrome.Compare the pathophysiologic mechanisms that result in hypoxemic and hypercapnic respiratory failure.

7. Differentiate between early and late clinical manifestations of acute respiratory failure.8. Describe the nursing and collaborative management of the patient with hypoxemic or

hypercapnic respiratory failure.9. Relate the pathophysiologic mechanisms that result in acute respiratory distress

syndrome (ARDS) to the clinical manifestations.10. Describe the nursing and collaborative management of the patient with ARDS.11. Identify complications that may result from acute respiratory failure or ARDS and

measures to prevent or reverse these complications.

To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of nursing care in specialized settings.2. Analyze the role and responsibility of the nurse when caring for a client in a specialized

setting.3. Discuss the clinical implications for the nurse and client when administering care in

specialized settings.

Learning Activities:

Read:Lewis, et al, Ch. 67, Ch. 68

Review Key Terms:

acute respiratory distress syndrome, p. 1812alveolar hypoventilation, p. 1802anaphylactic shock, p. 1777cardiogenic shock, p. 1773diffusion limitation, p. 1802hypercapnia, p. 1799hypercapnic respiratory failure, p. 1800hypoxemia, p. 1799hypoxemic respiratory failure, p. 1799hypoxia, p. 1804

hypovolemic shock, p. 1775multiple organ dysfunction syndrome, p. 1794neurogenic shock, p. 1777refractory hypoxemia, p. 1813sepsis, p. 1778septic shock, p. 1778shock, p. 1772systemic inflammatory response syndrome, p. 1794

Recommended Websites:

ABC of intensive care: Respiratory support Illustrated article by Maire P Shelly and Peter Nightingale; from BMJ 1999;318:1674-1677 ( 19 June ).

ABG Tutorial Online review by Margaret Hansen, EdD, MSN, RN, from the Nursing Education web site.

The Acute Respiratory Distress Syndrome: Myths and Controversies By Joseph Varon, MD, FACA, FACP, and Olivier Wenker, MD, DEAA; online article from the Internet Journal of Emergency & Intensive Care Medicine.

Anaplyaxis.com Information site for health professionals from the manufacturers of EpiPen®.

Cardiogenic Shock Online article from eMedicine, updated July 18, 2005.

Targeting the Underlying Cause in the Assessment and Evidence-Based Management of Dyspnea Online continuing education article by Nancy Spector, RN, DNSc & Diane Klein, RN, PhD; from Nurse.com.

Chest drains An overview from Surgical Tutor, UK.

Eliminate the air of mystery from chest tubes An article by Deborah Lazzara, from Nursing 2002, June 2002, Volume 32, Number 6, Pages 36 - 43. Available online from Nursing Center.

Hemodynamics and Fluid Disturbances: Edema, Congestion, and Shock Lewis D. Johnson, University of South Carolina. An online learning module from the Basic Medical Pathology Series. Includes online videos and quizzes.

Interpretation of ABGs: Acid - Base Balance A Four Step Method An online course by Mark Guinan, RN, CCRN.

Learning from SARS: Preparing for the Next Disease Outbreak -- Workshop Summary Stacey Knobler, Adel Mahmoud, Stanley Lemon, Alison Mack, Laura Sivitz, and Katherine Oberholtzer, Editors; Forum on Microbial Threats; 376 pages, 2004. Available full-text online from the National Academies Press.

A Multisite Survey of Suctioning Techniques and Airway Management Practices Online continuing education article by Mary Lou Sole, Jacqueline F. Byers, Jeffery E. Ludy, Ying Zhang, Christine M. Banta, and Kathy Brummel; from the American Journal of Critical Care, May 2003, vol. 12, no. 3.

A Practical Guide to Anaphylaxis An online article by Angela W. Tang, MD, from American Family Physician, October 1, 2003.

Respiratory Failure Online tutorial by Patrick Neligan, University of Pennsylvania, from the

Severe Acute Respiratory Syndrome A collection of links to web resources from Medline Plus.

Surviving Sepsis Campaign: Guidelines for management of severe sepsis and septic shock Full text from Critical Care Medicine, 2004, vol.32, no. 3, pp. 858-873; from the Society for Critical Care. There is also an erratum on the Society's Guidelines page.

Topic VI Nursing Care in Specialized Settings – Critical Care, Emergency & Disaster Nursing

Learning Objectives:

Upon completion of this topic the student will be able to:

1. Differentiate among the certification roles of critical care nurses: CCRN, PCCN, CCNS, and ACNP.

2. Select appropriate nursing interventions to manage common problems and needs of critically ill patients.

3. Develop effective strategies to manage issues related to the families of critically ill patients.

4. Discuss the principles of hemodynamic monitoring and collaborative care and nursing management of the patient receiving hemodynamic monitoring.

5. Describe the purpose, indications, and function of circulatory assist devices and related collaborative care and nursing management.

6. Describe types of artificial airways and appropriate nursing interventions to manage the care of an intubated patient.

7. Differentiate the indications for and modes of mechanical ventilation.8. Describe the principles of mechanical ventilation and collaborative care and nursing

management of a patient receiving mechanical ventilation. Apply the sequential steps in triage, the primary, and the secondary survey to a patient in an emergency situation.

9. Describe the pathophysiology, assessment, and collaborative care of select environmental emergencies, including hyperthermia, hypothermia, submersion injury, and animal bites.

10. Describe the pathophysiology, assessment, and collaborative care of select toxicologic emergencies.

11. Differentiate between the various types and victims of violence.12. Identify the agents most likely to be used in a terrorist attack.13. Differentiate the responsibilities of health care providers, the community, and select

federal agencies in emergency and mass casualty incident preparedness.  To achieve these objectives, the student will need to:

1. Review the literature pertaining to problems of nursing care in specialized settings.2. Analyze the role and responsibility of the nurse when caring for a client in a specialized

setting.3. Discuss the clinical implications for the nurse and client when administering care in

specialized settings.

Learning Activities:

Read:Lewis, et al, Ch. 66, Ch. 69

Review Key Terms:

bioterrorism, p. 1838circulatory assist devices, p. 1747continuous positive airway pressure, p. 1762emergency, p. 1842endotracheal intubation, p. 1751heat cramps, p. 1828heat exhaustion, p. 1829heatstroke, p. 1829hemodynamic monitoring, p. 1738high-frequency ventilation, p. 1763hypothermia, p. 1831

intraaortic balloon pump, p. 1748jaw-thrust maneuver, p. 1823mass casualty incident, p. 1842mechanical ventilation, p. 1759negative pressure ventilation, p. 1759phlebostatic axis, p. 1739positive end-expiratory pressure, p. 1762positive pressure ventilation, p. 1760pressure ventilation, p. 1760triage, p. 1822ventricular assist device, p. 1750volume ventilation, p. 1760

Recommended Websites:

AACN Standards: Standards for Acute and Critical Care Nursing Practice Online overview and ordering information for the expanded version; from the American Association of Critical-Care Nurses.

Advanced Trauma Life Support web site From the American College of Surgeons. Information on where and when materials and courses are available.

Best BETs - Best Evidence Topics site. Reviews of literature for best practices for emergency care developed by the Emergency Department of Manchester Royal Infirmary, UK.

Emergency Cardiovascular Care From the American Heart Association.

Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient Online handbook [134 pages] from the American College of Emergency Physicians, 1999.

Injuries and Wounds Topics From Medline Plus. A collection of links to appropriate web resources is available for each topic.

Mass Casualty Event Preparedness and Response "Information and tools to aid preparation for and response to mass trauma events." From the Centers for Disease Control and Prevention.

National Trauma Data Bank From the American College of Surgeons. Includes online reports.

Trauma Web site from the American College of Surgeons; includes a link to a collection of online resources on standards for trauma care and management of specific types of injury. Violence in the Emergency Care Setting 7/2001 Position statement from the Emergency Nurses Association.

St. Catharine CollegeAssociate Degree Nursing Program - NUR232Spring 2009 Class Schedule

Tentative Class Schedule*Topic I Problems of Oxygenation: Perfusion

OVERVIEW DATE READING ASSIGNMENTS

OTHER ASSIGNMENTS

CLASS MEETINGCourse OverviewReview of the Syllabus

Cardiovascular System, Hypertension, Dysrhythmias

1/12/09

Lewis, et al. Ch 32, pg 739-760Lewis, et al. Ch 33, pg 761-783Lewis, et al. Ch 36, pg 842-864

Be prepared to discuss case study found in syllabus

CLASS MEETINGCoronary Artery Disease, Acute Coronary Syndrome, Inflammatory and Structural Heart Disorders

1/14/09 Lewis, et al. Ch 34, pg 784-820Lewis, et al. Ch 37, pg 865-891

Be prepared to discuss case study found in syllabus

CLASS MEETINGHeart Failure, Vascular Disorders

1/15/09 Lewis, et al. Ch 35, pg 821-841Lewis, et al. Ch 38, pg 892-925

Holiday 1/19/09CLASS MEETINGExam I – Topic I 1/21/09 Review Study GuideTopic II Problems Related to Movement and Coordination – Nervous System

OVERVIEW DATE READING ASSIGNMENTS OTHER ASSIGNMENTSCLASS MEETINGNursing Assessment of the Nervous System, Chronic Neurologic Problems, Alzheimer’s Disease and Dementia

1/22/09 Lewis, et al. Ch 56, pg 1441-1466Lewis, et al. Ch 59, pg 1527-1560Lewis, et al. Ch 60 pg 1561-1579

Be prepared to discuss case study found in syllabus

CLASS MEETINGAcute Intracranial Problems, Stroke, Peripheral Nerve and Spinal Cord Problems

1/26/09 Lewis, et al. Ch 57, pg 1467-1501Lewis, et al. Ch 58, pg 1502-1526Lewis, et al. Ch 61, pg 1580-1613

Be prepared to discuss case study found in syllabus

Topic II Problems Related to Movement and Coordination-Musculoskeletal System

OVERVIEW DATE READING ASSIGNMENTS

OTHER ASSIGNMENTS

CLASS MEETINGNursing Assessment Musculoskeletal System, Musculoskeletal Trauma and Orthopedic Surgery

1/28/09 Lewis, et al. Ch 62, pg 1614-1628Lewis, et al. Ch 63, pg 1629-1667

CLASS MEETINGNursing Management of Musculoskeletal Problems, Arthritis and Connective Tissue Diseases

1/29/09 Lewis, et al. Ch 64, pg 1668-1692Lewis, et al. Ch 65, pg 1693-1732

CLASS MEETINGExam II –Topic II, Nervous & Musculoskeletal System

2/2/09 Review Study Guide

Topic III Problems of Ingestion, Digestion, Absorption, and EliminationOVERVIEW DATE READING

ASSIGNMENTSOTHER

ASSIGNMENTSCLASS MEETINGNursing Assessment Gastrointestinal System, Nutritional Problems & Obesity

2/4/09 Lewis, et al. Ch 39, pg 926-947Lewis, et al. Ch 40, pg 948-970Lewis, et al. Ch 41, pg 971-989

CLASS MEETINGUpper & Lower GI Problems

2/5/09 Lewis, et al. Ch 42, pg 990-1034Lewis, et al. Ch 43, pg 1035-1086

Be prepared to discuss case study found in syllabus

CLASS MEETINGLiver, Pancreas, and Biliary Tract Problems

2/9/09 Lewis, et al. Ch 44, pg 1087-1135

Topic IV Problems Related to Altered Sensory InputOVERVIEW DATE READING

ASSIGNMENTSOTHER

ASSIGNMENTSCLASS MEETINGNursing Assessment of Visual and Auditory Systems, Visual and Auditory Problems

2/11/09 Lewis, et al. Ch 21, pg 398-415Lewis, et al. Ch 22, pg 416-448

CLASS MEETINGNursing Assessment of the Integumentary System, Integumentary Problems, Burns

2/12/09 Lewis, et al. Ch 23, pg 449-459Lewis, et al. Ch 24, pg 460-482Lewis, et al. Ch 25, pg 483-508

CLASS MEETINGExam III –Topic III, Problems of Ingestion, Digestion, Absorption, and Elimination, Topic IV Problems Related to Altered Sensory Input

2/16/09 Review Study Guide

Topic V Nursing Care in Specialized SettingsOVERVIEW DATE READING

ASSIGNMENTSOTHER

ASSIGNMENTSCLASS MEETINGEmergency & Disaster Nursing, Critical Care

2/18/09 Lewis, et al. Ch 66, pg 1733-1771Lewis, et al. Ch 69, pg 1821-1844

CLASS MEETINGShock, Systemic Inflammatory Response Syndrome, Multiple Organ Dysfunction Syndrome, Respiratory Failure

2/19/09 Lewis, et al. Ch 67, pg 1772-1798Lewis, et al. Ch 68, pg 1799, 1820

CLASS MEETINGExam IV -Topic V Shock, Multi Organ Failure, Emergency & Disaster Nursing, & Critical Care

2/23/09 Review Study Guide

LABORATORY MEETINGNasogastric Tube Insertion

2/25/09 Taylor, Skill 11-2, pg 602-610Skill 11-4, pg 619-620

NGT Quiz

CLASS MEETINGCare Plan Presentations

2/26/09 Refer to Rubric found in syllabus

CLASS MEETINGEvaluationsFinal Exam Review

3/2/09 Ms. McNary

LABORATORY MEETINGNasogastric Tube Insertion

3/4/09 Skill Check Off

CLASS MEETINGComprehensive Final Exam

3/5/09 Topic I - V

*Any Changes Will Be Announced In Class