North Arkansas College

Nursing 2128 Medical-Surgical Nursing III Syllabus

2017

TABLE OF CONTENTS

Syllabus Acknowledgment ...... ii Calendar ...... 1-4 Course Title ...... 5 Course Number ...... 5 Credit Hours ...... 5 Weekly Course Schedule ...... 1-4 Course Instructor, Office & Hours, Phone & E-mail ...... 7 Course Description ...... 5 Audience for the Course ...... 5 General Course Goals ...... Course Outcomes/Objectives/Competencies ...... 5-6, 38 Gen Ed Outcomes (If Applicable)...... Assessment Procedures ...... 9 Required Textbooks ...... 8 Supplemental/Suggested Books ...... 8 Supplies ...... Available Nursing Resources ...... 8 Other Available Resources ...... Instructional/Teaching Method ...... 8 Outline of Course Requirements ...... 9 Course Evaluation Procedures ...... 9 Method of Evaluation ...... 9 Weight of each Method ...... 9 Minimum Performance Level on each Criteria ...... 9 Detailed Outline of what a student must do to earn each grade ...... 9, 11 Attendance Policy ...... 8 Excessive Absences ...... 8 Consequences of Absences ...... 8 How to Make Up Missed Work ...... 8 Tardiness Policy ...... 8 Academic Dishonesty ...... 8 Procedure Instructor will Follow if He/She Suspects Dishonesty ...... 8 Consequences if Dishonesty is Verified ...... 8 Provision for Changing the Syllabus (If Applicable) ...... 9 Lab Requirements (If Appropriate) ...... 8 Safety Rules (If Applicable) ...... 8 Statement of Student Responsibilities ...... 9 ADA Statement ...... 9

I

SYLLABUS ACKNOWLEDGMENT

COURSE: NURS 2128 Medical Surgical Nursing III

SEMESTER: Spring 2017

I acknowledge by signing below that I have received the syllabus for the course indicated above. I have reviewed the syllabus and understand the objective of this course. I understand how my performance will be evaluated and how my final grade will be determined. I am aware of my instructor’s office hours, and I know how to contact them for help with and/or clarification of course contents or procedures.

(Student Signature)

(Printed Name) (Date)

II

Monday Tuesday Wednesday Thursday Friday January 9 January 10 January 11 January 12 January 13 Skills Lab 0830-1230 0830-1220 (A104) 0830-1230 Cardiovascular Cardiovascular Cardiovascular Ch. 36 Ch. 33 Ch. 35, 38 Watch ECHO A104 January 16 January 17 January 18 January 19 January 20 0830-1500 0830-1220 (A104) MLK Holiday Unit 1 Exam Ch. 33,35,36,38 No classes Respiratory Modalities ------Skills Lab Respiratory Ch. 28, 32 12-3 NCLEX Questions Due January 23 January 24 January 25 January 26 January 27 0830-1220 (A104) Clinical Hematology Ch. 39 & 40 Clinical

1 January 30 January 31 February 1 February 2 February 3 0830-1220 (A104) Clinical Unit 2 Exam Ch. 28,32,39,40 Clinical ------Neuro Ch. 41-45

NCLEX Questions Due February 6 February 7 February 8 February 9 February 10 0830-1220 (A104) Clinical Clinical Calculation Exam ------Neuro cont.

1 February 13 February 14 February 15 February 16 February 17 0830-1220 (A104) Clinical Clinical Neuro presentations

Calculations Exam Retake February 20 February 21 February 22 February 23 February 24 0830-1220 (A104) Clinical Clinical Unit 3 Exam Ch. 41-45 ------Ch. 34 Dysrhythmias

NCLEX Questions Due February 27 February 28 March 1 March 2 March 3 0830-1220 (A104) Clinical Clinical Emergency Care, Disaster Preparedness Ch. 8, 9, 10 NCLEX Questions Due Calculation Exam Final Retake March 6 March 7 March 8 March 9 March 10 0830-1220 (HESC) ACLS ACLS Myocardial Ischemia Simulation 0830-1700 0830-1700 NCLEX Questions Due

March 13 March 14 March 15 March 16 March 17 0830-1220 (A104) Clinical Clinical Unit 4 Exam Ch. 8, 9, 10, 34 & & ------Multidisciplinary Multidisciplinary Urinary Ch. 65, 72 Simulation Simulation

2

March 20 March 21 March 22 March 23 March 24

 Spring Break 

March 27 March 28 March 29 March 30 March 31 0830-1220 (A104) Preceptor Clinical Starts Renal Ch. 66-68 (60 hours)

April 3 April 4 April 5 April 6 April 7 0830-1220 (A104) Preceptor Clinical Unit 5 Exam Ch. 65, 66, 67, 68, & 72 ------Abuse, Crisis, Suicide ATI Ch. 17,27,28 NCLEX Questions Due

April 10 April 11 April 12 April 13 April 14 0830-1220 (A104) Preceptor Clinical Anger, Family & Community, and Sexual Assault ATI Ch. 29-31 NCLEX Questions Due April 17 April 18 April 19 April 20 April 21 0830-1220 (A104) Preceptor Clinical Unit 6 Exam Comprehensive ATI Mental Health On-Line Module: Eyes/Ears, Ch. 46-48 NCLEX Questions Due

3 April 24 April 25 April 26 April 27 April 28 TBA Finish Preceptor Clinical ATI Med/Surg Predictor Hurst Review Hurst Review Hurst Review Exam (2) ATI Comprehensive Predictor Practice Exams Due May 1 May 2 May 3 May 4 May 5 Med/Surg III FINAL PINNING TONIGHT Graduation: May 7th

4 NURSING 2128

Course Title: Nursing 2128-- Medical Surgical Nursing III

Course Description: NURS 2128 Medical-Surgical Nursing III (8) 4L, 12LL Medical-Surgical Nursing III is a 16 week course that is a continuation of Medical-Surgical Nursing II. Student Learning Outcomes are expanded upon in this course with emphasis on core competencies of managing care in emergent and acute care patients, clinical decision making, informatics, collaboration, teaching/learning, professional behavior, and legal/ethical aspects of care. Theory and clinical experiences are related to the course content. Pre-requisites: NURS 2114 and NURS 2021.

Credit and Time Allotment: Eight semester hours Four hours of lecture/ week Twelve hours of clinical/ week

Placement: Second level (2nd year, 2nd semester)

Course Outcomes: At the end of the course, the student will be able to:

1. Formulate effective therapeutic communication techniques to establish and maintain therapeutic nurse-patient relationships with patients, families and significant others, small groups of patients, and colleagues. (Measured by observation in clinical setting and written critical thinking assignments). [Human Flourishing]

2. Use the Nursing Process to assess, plan, implement, evaluate and prioritize basic care for critically ill adult clients. (Measured by exams and written clinical assignments).[Nursing Judgment/Practice]

3. Support and value cultural competence while meeting the multicultural needs of critical care patients and their families. (Measured by written clinical assignments, clinical evaluation, and exams). [Human Flourishing]

4. Employ clinical decision making to critically think, analyze clinical problems, and strategically plan appropriate patient centered solutions consistent with associate degree nursing practice roles. (Measured by case scenarios, exams, clinical assignments).[Human Flourishing and Spirit of Inquiry]

5. Use management and leadership skills to provide care for individuals, groups, and communities in collaboration with other health care providers to ensure continuous and holistic care. (Measure by exams, clinical instructor evaluation, and case studies).[Nursing Judgment/Practice]

6. Examine evidence- based practice to support therapies such as ventilation, defibrillation, dialysis, and cardiac monitors in order to identify the benefits and /or complications relating to patient care management. (Measured by exams and critical care written assignment).[Nursing Judgment/Practice]

5 7. Formulate a patient centered teaching plan to assist patients and families about their plan of care, medical diagnosis, medication, and treatment regimen. (Measured by exams, written clinical assignments, and clinical evaluation) [Professional Identity]

8. Apply legal, ethical, and safety considerations while providing care to their patients and families. (Measured by exams, simulation, clinical instructor evaluation, and clinical written assignments)[Professional Identity and Nursing Judgment/Practice]

9. Assist patient with self-management in developing and attaining realistic goals. (Measured by exams, clinical evaluation and written critical thinking assignments.)[Professional Identity]

10. Identify safety concerns both real and potential to initiate quality improvement through procedural processes. (Measured by clinical written assignment, journaling, simulation, and exams)[Nursing Judgment/Practice]

11. Inventory the use of informatics and technological advances to correspond with and support clinical decision-making as it applies to the critically ill patients. (Measured by exams and clinical observation)[Professional Identity and Spirit of Inquiry]

12. Evaluate the management of care in organizing delegation activities. (Measured with group activities and clinical assignments).[Nursing Judgment/Practice]

6 Medical -Surgical III Instructors

Amy Gipson, MSN, RN, CNE

Office number: A100 A

Office phone: 870-391-3169

Email: [email protected]

Available to students at the following time: Monday: Clinical Tuesday: Clinical

Office Hours:

Monday: 8:30 am- 1:00 pm Wednesday: 9 am – 2:00 Thursday: 8:30 am- 3 pm Friday: By appointment

Carrie Geier RN BSN MSEd

Office number: M173

Office phone: 870-391 -3455

Email: [email protected]

Available to students at the following time: Monday: Clinical Tuesday: Clinical

Office Hours: Monday: 8 am – 2:30 pm Wednesday: 8 am – 2 pm

Thursday: 8:30 am – 3 pm Friday: By appointment

7 Major Learning Facilitation Activities:

Teacher: Lecture Audiovisual presentations Simulation activities Demonstrations Portal utilization Discussion Internet websites of interest

Learner: Discussion Group presentations Clinical experience Portal utilization Nursing Skills laboratory Role Play Concept Mapping and Case Studies

General Policies: The Medical Surgical Nursing III course adheres to all policies in the Registered Nursing Program Handbook and the Northark Student Handbook. You are responsible for knowing the information in the Registered Nursing Program Handbook for this course.

Absenteeism, Lab requirements, and Safety Rules: Refer to your Registered Nursing Program Handbook.

Make-Up Exams: 1. All exams should be taken at the scheduled time. 2. The student MUST notify the instructor prior to the exam if the student is unable to take the exam at the scheduled time. A missed examination is considered a class absence. 3. Arrangements must be made by the student as soon as possible. 4. Student may make-up ONE test only per semester at the instructor’s discretion. 5. Failure to comply with the stated requirements omits the privilege of taking a make-up test and a zero will be given for the test not taken. 6. An alternative exam may be administered

Academic Dishonesty: Refer to the Northark Student Handbook and the Registered Nursing Program Handbook.

Required Textbooks: Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8 th ed., St. Louis, MO: Elsevier-Saunders.

Syllabus for Nursing 2128-- Medical- Surgical Nursing III 2017

Registered Nursing Program Handbook

ATI Med/Surgical, Mental Health and Pharmacology

8 Grading: The course grade is determined as follows: 6 Unit Exams and a comprehensive ATI------70% Comprehensive Final------20% Assignments------10%

Students must have a passing average on unit exams and final before the written assignment score is added. If a student has less than a passing average (79%) on unit tests and the final the student will not progress in the program.

Students must pass the clinical component of the course in order to progress in the program. If the student fails the clinical component with an unsatisfactory summative evaluation, the theory grade drops to a “D” and the student cannot progress.

Students are encouraged to review unit exams within 1 week after the test was given.

Grading Scale: A------91-100 B------84-90 C------79-83 D------70-78 F------69 & below

Student Responsibilities: 1. The student is expected to attend class, laboratory sessions, and clinical. 2. The student is expected to be prepared for classroom, laboratory activities, and clinical. 3. The student is expected to complete all written assignments as directed by the instructor. 4. The student is expected to meet course outcomes.

ADA statement: North Arkansas College complies with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Students with disabilities who need special accommodations should make their requests in the following way: (1) talk to the instructor after class or during office hours about their disability or special need related to classroom work; and/or (2) contact Special Services in Room M154 and ask to speak to Kim Brecklein.

Final Note: All information contained this document is subject to change in the event of extenuating circumstances. Students will be notified via Portal and/or verbally if changes are made.

9

Course Assignments

10 Course Assignments

Course Assignments are weighted as 10% of the course grade. The following assignments related to NCLEX questions are worth 5 points each. The neuro presentation is also included in the assignment and is worth 25 points.

Below is a list of assignments. Adaptive Quizzing must be completed at a Mastery level 2, and on ATI assessments, you must receive at least 90% to receive credit. All Assignments must be completed by 8:30 am on the morning they are due. Late assignments will not be accepted. In addition, ATI exams that are not assignments will be opened for extra practice.

January 19– Adaptive Quizzing Evolve: Cardiovascular System

February 2– Adaptive Quizzing Evolve: Respiratory

February 23- Adaptive Quizzing Evolve: Neuromusculoskeletal System

March 2- ATI Targeted Medical Surgical 2013: Cardiovascular

March 9- ATI RN Medical Surgical Practice 2016 A

April 6- Adaptive Quizzing Evolve: Urinary and Reproductive

April 13- Mental Health ATI Practice Test B 2016

April 20- ATI RN Adult Medical Surgical Online Practice 2016 B

April 27- 2 ATI Comprehensive Predictor Practice Exams 2016 A & B

11 NEURO PRESENTATIONS Neurological disorders are to be presented in class. You may choose from the following disorders for your presentations. You may work in groups of 2-3 people. All topics must be presented. Huntington’s

Multiple Sclerosis

Myasthenia Gravis

Guillian Barre

Alzheimer’s

Parkinson’s

Meningitis

Creutzfeldt-Jakob

Peripheral Neuropathy

Muscular dystrophy

ALS

Spinal Cord Injury- Focus on discharge planning

You will have 20 minutes for your presentation. Please refer to the grading rubric for required content. Guest speakers are not permitted due to time constraints. Be creative! All groups should include a case scenario. You may act out the scenario or walk through it with the class. However, you must apply all of the required information into your content at some point. You may want to do a concept map in class with the students. Be prepared to answer questions from the audience. You can develop a game or another way to get your classmates involved. You may choose any method as long as learning occurs and your presentation follows the rubric.

Develop a handout regarding the disease process you are covering for fellow classmates. Please keep it to ONE page. This is to be used as a study guide.

12

Grading Rubric for Neuro Presentation

5 Points 4 Points 3 Points 2 Points 1 Point

Textbooks and peer Referenced at least 1 Referenced at least 1 Referenced at least 1 Referenced at least Did not reference reviewed journals textbook and 2 peer textbook and 1 journal textbook and 2 journal textbook or journal used textbook or journal reviewed journals (APA) (APA Format) but did not use APA may or may not have used APA format

Describes disorder Described in detail all four Described at least 3 Described at least 3 Described at least 2 Described 1 aspect with and nursing aspects including aspects including aspects and did not aspects with or w/o or w/o rationales interventions, rationales rationales include rationales rationales education, and safety

Identify treatments, Identified treatments Identified treatments Identified treatments Identified both pharm Identified either pharm both including pharm, S/A, including pharm and non- both pharm and non- and non-pharm or no pharm pharmacological dose as well as detailed pharmacological pharm, but only gave treatments but gave treatments, but not and non-pharm information on non- treatments, but did not some of the details about minimal details about both pharm treatment give specific information each such as S/A but not a both on one of the two dose

Use creativity, and Did not just stand and Was creative using skits, Stood and talked using a Only talked about Talked without any incorporate case talk, but utilized other role play, games etc., but power point and had at subjects without any Audio/visuals, skits, scenario teaching strategies, like did not have a case least 1 case scenario audio/visuals, skits, role role play, games, and skits, role play, games and scenario play, etc. Did have at did not have a case had at least 1 case least 1 case scenario scenario scenario

Evidence of Work was divided equally Work was obviously not Work was divided equally. Work was not equally Work was not equally teamwork and and all had parts. Class equally divided among Class was minimally divided and class divided and there was involvement of was involved and members, but the class involved in teaching participated minimally almost no participation classmates participated a lot in did participate a lot in from class teaching teaching

13

Learning Modules

14 Cardiovascular Assessment,

Unit 1 Course Outcomes: 2, 4, 11, 12

Objectives Content Learner Activities

After completion of this chapter, the learner should be able to I. Anatomic and Physiologic Ignatavivius, M. and Overview Workman, L. (2016) Medical- 1) Review the anatomy and physiology of the CV II. Function of the heart: Surgical Nursing: Patient- Conduction system (cardiovascular) system. Centered Collaborative Care, A. Physiology of Cardiac th Conduction 8 ed., St. Louis, MO: 2) Evaluate cardiac action potential and its role in the Elsevier-Saunders. electrical stimulus in the heart. III. Control of Heart Rate A. Medications 3) Define terms: depolarization, repolarization, refractory B. Physiological responses Read Ch. 33 period, stroke volume, cardiac output/ index, preload, afterload, contractility, ejection fraction, diastole, IV. Control of Stroke Volume systole, systemic vascular resistance (SVR), ACS A. Medications B. Physiological responses Diagram of Heart/ Conduction 4) List factors controlling heart rate of Heart

V. Special considerations PowerPoint presentation 5) Critically think to apply factors effecting stroke volume A. Gerontologic Considerations to example B. Genetic/ Gender Differences in Audio/Visual Cardiac Structure/ Function 6) Teach patients about evidence-based ways to Adaptive Quizzing: Evolve decrease their risk for CV health problems.

VI. Assessment Class activity – 7) Explain nursing implications related to CV changes that VII. Diagnostic Assessment affect perfusion in older adults. - critical thinking

exercises 8) Describe the focused physical assessment for patients - video with cardiovascular problems. - case scenarios

9) Distinguish between the various types of diagnostic evaluations and the associated nursing implications

15 Care of Patients with Cardiac Problems

Unit 1 Course Outcomes: 1-12

Objectives Course Content Learner Activities After completion of this chapter, the learner should be I. Pathophysiology, clinical manifestations, Ignatavivius, M. and Workman, L. able to assessment/ diagnostic findings, medical (2016) Medical-Surgical Nursing: management, nursing management of: Patient-Centered Collaborative 1.) Evaluate valvular disorders of the heart and a. Mitral Valve Prolapse Care, 8th ed., St. Louis, MO: describe the pathophysiology, clinical b. Mitral Regurgitation Elsevier-Saunders. manifestations, and management of patients c. Mitral Stenosis with mitral and aortic disorders. d. Aortic Regurgitation Read Ch. 35 e. Aortic Stenosis 2.) Design a patient centered teaching plan for f. Valvular heart disorders Power Point patients with structural cardiac disorders using evidence based approach. II. Pathophysiology, clinical manifestations, Audio/Visuals Assessment and Diagnostic Findings, Medical 3.) Analyze the pathophysiology, clinical Management, Nursing process with NCLEX review questions manifestations, and management of patients Cardiomyopathy with cardiomyopathies. a. Dilated Critical thinking exercises b. Hypertrophic 4.) Examine quality improvement strategies to c. Restricted improve safety concerns of acutely ill patients d. Arrhythmogenic right ventricular Class activities: with structural, infectious, and inflammatory e. Unclassified - Concept mapping cardiac disorders. - Group discussion III. Pathophysiology, clinical manifestations, - Case studies 5.) Evaluate the pathophysiology, clinical assessment/ diagnostic findings, medical - Lab simulation manifestations, and management of patients management, nursing management related to with infections of the heart. infectious diseases of the heart: a. Rheumatic endocarditis 6.) Describe the rationale for prophylactic antibiotic b. Infective endocarditis therapy for patients with mitral valve prolapse, c. Myocarditis valvular heart disease, rheumatic endocarditis, d. Pericarditis infective endocarditis, and myocarditis.

7.) Formulate a plan of care to manage patients with disorders in structural, infectious, and inflammatory cardiac disorders.

16 Care of Patients with Cardiac Problems: Heart Failure

Unit 1 Course Outcomes: 1-12

Objectives Course content Learner Activities After completion of this chapter, the learner should be Ignatavivius, M. and Workman, L. able to I. Pathophysiology, clinical (2016) Medical-Surgical Nursing: 1.) Diagram the management of care for patients manifestations, Patient-Centered Collaborative with heart failure. assessment/diagnostic findings, Care, 8th ed., St. Louis, MO: medical management, nursing Elsevier-Saunders. 2.) Formulate a comprehensive teaching plan for management of: patients with heart failure. Read ch. 38 a. Heart failure 3.) Analyze laboratory finding related to patients b. Cardiac tamponade PowerPoint presentation with heart disease. c. Thromboembolism d. Pericardial effusion Audio/Visuals 4.) Differentiate between left sided and right sided e. Cardiogenic shock heart failure. NCLEX review questions

5.) Explore medications used with patients who Class activities: have heart disease. - Concept mapping - Group discussion 6.) Differentiate manifestations and nursing - Case studies interventions among patients who have thromboembolism, pulmonary edema, pericardial effusion, cardiac tamponade, and cardiogenic shock.

7.) Examine gerontologic considerations among patients with heart disease.

8.) Inventory medical management and nursing interventions for patients experiencing pericardial effusion, cardiac tamponade.

17 Assessment and Management of Patients with Vascular Disorders and Hypertension

Unit 1 Course objectives: 1-12

Objectives Course content Learner Activities

After completion of this chapter, the learner should be able to: I. Anatomic and Physiologic Ignatavivius, M. and Overview Workman, L. (2016) Medical- 1.) Describe the pathophysiology as it relates to the vascular system. Surgical Nursing: Patient- II. Gerontologic considerations Centered Collaborative Care, 2.) Differentiate pathological vascular differences in the geriatric client in relation to regarding patho of vascular 8th ed., St. Louis, MO: prevalent vascular disorders seen in this population. system Elsevier-Saunders. 3.) Using the nursing process, compare the management of care and assessment with venous disorders and arterial disorders. III. Assessment Read ch 36 A. Health History 4.) Formulate a patient centered teaching plan, utilizing evidence based practice, B. Clinical Manifestations PowerPoint presentation related to vascular disorders. C. Diagnostic Evaluation Audio/Visuals 5.) Propose measures to increase safety and quality improvement in patients with IV. Review patho, risk factors, an occlusive arterial or venous diagnosis prevention, clinical NCLEX review questions manifestations, medical 6.) Inventory differences the nurse might find in a culturally diverse population when Class activities: assessing and teaching clients with vascular disorders management, nursing process related to: - Concept mapping 7.) Devise a plan of care that critically analyzes anticoagulant therapy - Group discussion a. Arterial insufficiencies - Case studies 8.) Evaluate signs, symptoms, and management of various arterial disease b. Thromboangitis obliterans processes- (aneurysms, dissecting aorta, arterial embolism/thrombosis, - Heparin orders (Beurger’s Disease) - Review Healthy Raynaud’s phenomenon) c. Various Aneurysms People 2020 9.) Identify signs, symptoms, and management of various venous disorders (deep d. Arterial Embolism/ Objectives

vein thrombosis, venous thrombosis, venous stasis, varicose veins, Thrombosis

thrombophlebitis) e. Reynaud’s f. Venous Disorders 10.) Evaluate current trends involving risk factors affecting HTN g. Lymphatic Disorders 11.) Diagram various classifications of hypertension as well as follow up and management considerations. V. Hypertension A. Types, risks, patho, 12.) Evaluate organ systems at risk for damage with a dx HTN. assessment, clinical s/s, & treatments

18 Care of Patients with Acute Coronary Syndromes

Unit 1 Course Outcomes: 1-12

Objective Course Content Learner Activities

After completion of this chapter, the learner should be able to Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: 1.) Relate coronary atherosclerosis to Angina, Myocardial I. Coronary Atherosclerosis Patient-Centered Collaborative Care, Infarction, and Sudden Cardiac Death A. Pathophysiology 8th ed., St. Louis, MO: Elsevier- B. Clinical 2.) Assess multicultural considerations that effect a client’s risk manifestations Saunders. factors C. Assessment D. Risk factors Read ch. 38 3.) Evaluate the causes of Coronary Artery Disease (CAD) and E. Medical patient centered teaching regarding modifiable risk factors Management Power Point using evidence based research. F. Nursing interventions Staging 4.) Critically appraise the differences between the various II. Angina types and treatments of atherosclerosis and angina A. Pathophysiology Audio/Visual B. Clinical 5.) Compare/ contrast various pharmacologic interventions and manifestations NCLEX review questions safety considerations with regards to atherosclerosis, C. Assessment angina, and myocardial infarction D. Risk factors Class Activities E. Medical 6.) Formulate a plan of care using the nursing process in a - 12- lead key hand outs patient with coronary atherosclerosis and angina. Management F. Nursing - Videos: Angina, pharmacology of an MI, 7.) Differentiate nursing interventions (pre/ post) for various interventions Cardiac rehab cardiac surgical interventions (i.e. PTCA, Stent placement, III. Acute Coronary - Case vignette on MI Atherectomy, CABG) Syndrome/MI A. Pathophysiology 8.) Analyze significant EKG findings from an MI B. Clinical manifestations 9.) Manage and identify collaborative team members C. Assessment associated with the care of the client with atherosclerosis, D. Risk factors angina, and acute coronary syndrome E. Medical Management 10.) Examine pharmacological treatment for patients with F. Nursing Coronary Artery disease interventions

19 Care of Patients with Respiratory Problems Requiring Oxygen, Tracheostomy, and the Critically Ill

Unit 2 Course Outcomes: 1-12

Outcomes Content Learner Activities Upon completion of this chapter, the learner should be I. Atelectasis Ignatavivius, M. and Workman, L. (2016) able to: Medical-Surgical Nursing: Patient- II. Respiratory Infections Centered Collaborative Care, 8th ed., St. 1.) Test the nursing process as a framework for care Louis, MO: Elsevier-Saunders. A. Pneumonia of the client with pneumonia. Read Ch. 28 & 32 B. Pulmonary Tuberculosis

C. Lung Abscess 2.) Prepare a teaching plan to incorporate safety **ATI skill module “Oxygen Therapy” D. Empyema with regards to patients who have located under Tutorials. View all of the E. Pleurisy tracheostomies. modules and take the pre and post F. Pleural Effusion tests.

3.) Relate cultural and societal influences r/t Power point III. Respiratory Failure smoking and air pollution to lung disorders. Audio Visual

NCLEX review questions IV. Acute Respiratory Distress 4.) Utilize clinical decision making when assessing Staging Syndrome the need for respiratory intubation.

Class activity V. Pulmonary Disorders 5.) Examine diagnostic values regarding patients in - critical thinking exercises respiratory distress. A. Pulmonary Hypertension - discussion questions B. Cor Pulmonale - concept Mapping 6.) Using the nursing process, compare the different C. Pulmonary Embolism types of chest trauma. VI. Other pulmonary disorders 7.) Relate the therapeutic management techniques of acute respiratory distress syndrome to the A. Pneumoconiosis underlying pathophysiology of the syndrome. B. Lung cancer C. Trauma 8.) Evaluate risk factors and safety concerns 1. Blunt appropriate for prevention and management of 2. Penetrating pulmonary embolism. 3. Pneumothorax 4. Cardiac Tamponade 9.) Inventory the complications and nursing 5. Subcutaneous management of chest trauma and their clinical Emphysema manifestations.

20 Respiratory Care Modalities Unit 2 Outcomes: 1-12

Outcomes Content Learner Activities Upon completion of this chapter, the learner should be Ignatavivius, M. and Workman, L. (2016) able to: I. Noninvasive Therapies Medical-Surgical Nursing: Patient- A. Oxygen Centered Collaborative Care, 8th ed., St. 1.) Analyze the nursing management for clients 1. Types of administration Louis, MO: Elsevier-Saunders. receiving oxygen therapy, BiPAP, CPAP. 2. safety 3. client education Read Ch. 30 & 32: 2.) Evaluate the nursing management and Power Point collaboration, with other healthcare members, of B. BiPAP; CPAP ATI Skills Modules: a client with an endotracheal tube and for a client - Airway management with a tracheostomy. II. Airway management - Oxygen Therapy A. Endotracheal intubation - Closed Chest Drainage 3.) Demonstrate tracheostomy care and suctioning. B. Tracheostomy NCLEX review questions C. Mechanical Ventilation 4.) Discuss best practice and quality care for clients 1. Types of vents Class activity receiving mechanical ventilation. 2. Assessment - critical thinking exercises 3. Weaning - discussion questions 5.) Examine legal/ethical and cultural considerations - concept mapping regarding extubation of clients with irreversible III. Thoracic Surgery - group teaching brain injuries. A. Preoperative Nursing Care B. Postoperative Nursing Care Lab – tracheostomy care, cleaning , and 6.) Critically think to analyze the principle of chest C. Care of Chest Drainage suctioning drainage and the nursing responsibilities using Systems – care of chest tubes clinical decision making related to the care of the – care of client on a ventilator client with a chest tube. - oxygen delivery devices

7.) Explore evidence based practice to support care of client with acute pulmonary complications.

8.) Describe the nursing care for a client with an endotracheal tube and for a client with a tracheostomy.

9.) Demonstrate tracheostomy care and suctioning.

10.) Identify safety measures while managing chest drainage systems.

21 Hematology

Unit 2 Course outcomes: 1-12

Objectives Course content Learner Activities After completion of this chapter, the learner should be able to I. Anatomic / Physiologic Overview Ignatavivius, M. and II. Assessment of the hematologic system Workman, L. (2016) III. Management of Hematologic Disorders Medical-Surgical Nursing: 1.) Compare underlying pathophysiology of various anemias. including: Patient-Centered

a. Clinical Manifestations, Collaborative Care, 8 th ed., 2.) Formulate a teaching plan using evidence based research, Assessment/ Diagnostic Findings, St. Louis, MO: Elsevier- including diet, for a client with iron deficiency anemia. Complications Saunders.

b. Medical/ Nursing Management 3.) Using informatics, examine guidelines for medication regimen IV. Hypoproliferative Anemias Read Ch. 39 & 40 for a patients with various types of anemias. a. Iron Deficiency

b. Renal Disease **ATI Skills Module 4.) Design a care plan for a patient with a coagulation disorder. c. Aplastic located under tutorials

d. Megaloblastic “Administering blood 5.) Assess lab values of various hematologic disorders including e. Myelodysplastic Syndrome Products” Complete all Leukemia, Hodgkin’s disease, and various bleeding disorders. V. Hemolytic Anemias modules, pre and post

VI. Polycythemias tests 6.) Analyze the clotting cascade and integrate various clotting a. Polycythemia Vera disorders, anticoagulants, as well as blood components. b. Secondary Polycythemia PowerPoint presentation

VII. Leukopenia/ Neutropenia 7.) Identify proper transfusion techniques, potential safety risks, VIII. Lymphomas Case scenarios within ATI and possible reactions for various types of blood components. a. Hodgkin’s Disease modules

b. Non- Hodgkin’s 8.) Debate the legal/ethical and safety aspects of refusing blood c. Multiple Myeloma Audio/Visuals products. IX. Bleeding Disorders

a. Thrombocytopenia 9.) Compare cultural differences regarding blood disorders. b. ITP NCLEX questions

c. Platelet Defects d. Hemophilia Class activities: X. Acquired Coag Disorders - Concept mapping a. Liver Disease - Group discussion b. Vit. K Deficiency - Case studies c. Disseminated Intravascular Coagulation (DIC) XI. Therapies for Blood Disorders XII. Procuring Blood/ Blood Products XIII. Transfusion Complications

22 Patients with Neurological Problems

Unit 3 course Outcomes: 1, 2, 4-12

Objectives Course content Learner Activities

Upon completion of this chapter, the learner should be able to: I. Anatomic and physiologic Ignatavivius, M. and Workman, Overview L. (2016) Medical-Surgical 1.) Recall the structures and functions of the central and Nursing: Patient-Centered peripheral nervous system. II. Neurologic Examination Collaborative Care, 8th ed., St. A. Health History 2.) Justify the significance of physical assessment to the B. Clinical Manifestations Louis, MO: Elsevier-Saunders. diagnosis of neurologic dysfunction. C. Physical Exam D. Diagnostics 3.) Inventory safety concerns as it relates to the changes in Read ch. 41-45 neurologic function associated with aging. III. Altered Level of Consciousness A. Pathophysiology PowerPoint presentation 4.) Differentiate between the technological advances in imaging B. Manifestations and other diagnostic tools related to the neurologic system. C. Assessment and Staging Diagnostics

5.) Examine the multiple needs of the client with altered level of D. Medical and Nursing consciousness using the framework of the nursing process. Management NCLEX review questions Audio/Visuals 6.) Evaluate the management of care re: the early and late IV. Increased Intracranial Pressure clinical manifestations of increased intracranial pressure. A. Pathophysiology Class activities: B. Manifestations - Concept mapping 7.) Distinguish between collaborative healthcare team members C. Assessment and - Group discussion involved with patients with altered cerebral function. Diagnostics - Case studies D. Medical and Nursing 8.) Compare the various types of seizures re: assessments and Management acute and long term treatments, as well as safety measures. 9.) Organize teaching plan for patient with seizures. V. Intracranial Surgery

10.) Manage pre and post-operative care for a patient having VI. Seizures intracranial surgery. A. Types of seizures B. Epilepsy 11.) Explore legal and ethical issues regarding end of life care for C. Nursing Care individuals with neurological dysfunctions. VII. Legal & Ethical Issues Regarding End-of-Life

23 Patients with Neurological Problems

Unit 3 Course Objectives: 1-12

Objectives Course content Learner Activities Upon completion of this chapter, the learner should be able to: I. Pathophysiology, manifestations, Ignatavivius, M. and Workman, L. assessment and diagnostics, (2016) Medical-Surgical Nursing: 1.) Assess and differentiate between various types of prevention, medical and nursing Patient-Centered Collaborative cerebrovascular disorders. management of the following: Care, 8th ed., St. Louis, MO:

2.) Identify the risk factors for cerebrovascular disorders and related A. Ischemic Elsevier-Saunders. measure for prevention using evidence based practice. B. Hemorrhagic Stroke C. Head Injuries 3.) Justify the criteria for t-PA administration and initiation of therapy. D. Spinal Cord Injury Read ch. 41-45 Power Point 4.) Relate the principles of nursing management to the care of a II. Brain Injury Audio/Visuals client in the acute stage of an ischemic and hemorrhagic strokes. A. concussion NCLEX review questions B. contusion NIHSS (stroke scale) 5.) Use the nursing process as a framework for care of a client with C. Intracranial hemorrhage a cerebral aneurysm. Class Activity - critical thinking exercises 6.) Examine essential elements for family teaching and preparation - Discussion for home care of the stroke client.

7.) Differentiate among clients with head injuries according to mechanism of injury, clinical sign and symptoms, diagnostic testing, and treatment options.

8.) Use the nursing process as a framework for care of clients with brain injury.

9.) Identify and educate the population at risk for spinal cord injury.

10.) Manage three clinical features of the client with neurogenic shock.

11.) Diagram the pathophysiology of autonomic dysreflexia and describe the appropriate nursing interventions.

12.) Use the nursing process as a framework for safety and care of client with spinal cord injury.

13.) Discuss legal/ethical considerations regarding traumatic brain and spinal cord injuries.

24 Patients with Neurological Problems

Unit 3 Course Objectives: 1-12

Objectives Course content Learner Activities

Upon completion of this chapter, the learner should be able to: I. Infectious Neurologic Disorders Ignatavivius, M. and Workman, L. A. Meningitis (2016) Medical-Surgical Nursing: 1.) Differentiate using clinical reasoning, the infectious disorders B. Brain Abscesses Patient-Centered Collaborative of the nervous system according to causes, manifestations, C. Herpes Simplex Care, 8th ed., St. Louis, MO: medical care, and nursing management. D. Fungal Encephalitis Elsevier-Saunders. E. Creutzfeldt-Jakob 2.) Analyze the pathophysiology, clinical manifestations and II. Autoimmune Disorders

medical and nursing management of autoimmune disorders A. Multiple Sclerosis utilizing evidence based guidelines. Read ch. 41-45 B. Myasthenia Gravis Power Point C. Guillain-Barre 3.) Select collaborative team members and their responsibilities Audio/Visuals D. Bell’s Palsy when treating oncologic disorders. NCLEX review questions III. Oncologic Disorders of the Brain and Class Activity 4.) Differentiate between brain and spinal cord tumors; their Spinal Cord - critical thinking exercises classification, clinical manifestations, diagnosis and medical B. Assessment, Clinical and nursing management. Manifestations, Management, - Discussion Diagnostics, Treatments - Skits 5.) Inventory safety and quality considerations involving clients Iv. Degenerative Disorders Class presentations of a receiving chemotherapy. A. Parkinson’s neurological disorder and

B. Huntington’s teaching plan 6.) Use the nursing process as a framework for care of clients C. Alzheimer’s with cerebral metastasis or inoperable brain tumors, and D. ALS degenerative neurologic disorders. E. MD

F. Degenerative Disc 7.) Identify resources for clients and families with oncologic and H. Herniated Disc degenerative neurologic disorders.

8.) Debate legal ethical issues related to end of life care, euthanasia, and genetic testing.

9.) Formulate a teaching plan using therapeutic communication which discusses a specific neurological disorder.

10.) Examine multicultural aspects of dealing with degenerative neurological disorders.

25 Dysrhythmias and Conduction Problems

Unit 4 Course Outcomes: 1-12

Objectives Content Learner Activities After completion of this chapter, the learner should be able to I. Dysrhythmias Ignatavivius, M. and Workman, L. (2016) Medical-Surgical Nursing: A. Electrocardiogram 1. Evaluate electrocardiogram and justify clinical decisions based on Patient-Centered Collaborative appraisal. B. Atrial dysrhythmias Care, 8th ed., St. Louis, MO: Elsevier- Saunders. C. Junctional dysrhythmias 2. Differentiate between the various cardiac dysrhythmias in order to manage client care. D. Ventricular Dysrhythmias Read Chapter 34

E. Conduction Abnormalities 3. Diagram the dysrhythmias, collaborative team members, and PowerPoint presentation possible treatments. Audio/Visuals II. Management of Dysrhythmias

4. Compare and contrast the different modalities of treatment for A. Cardioversion NCLEX review questions cardiac dysrhythmias.

B. Defibrillation Cardiac dysrhythmia strips 5. Formulate a patient centered teaching plan using that enforces C. Pacemaker therapy evidence based care for the client with Atrial fibrillation. Class activities: D. Implantable Cardioverter - Concept mapping 6. Test the nursing process related to management of the client with a Defibrillator (ICD) - Group discussion cardiac dysrhythmia. - Case studies E. Cardiac Conduction - Identify dysrhythmia strip 7. Design safety measures to ensure quality improvement during Surgery - Lab simulation Acute MI management of a client experiencing cardiac arrest. and F. ACLS protocols ACLS Certification 8. Examine technological advances used to treat life threatening cardiac dysrhythmias. **Practice ACLS Algorithms: 9. Plan pre and post-operative care for the client undergoing There are 3 megacode Pacemaker placement, ICD insertion, and cardiac conduction simulators. Please complete all of surgery. them

10. Debate legal/ethical and safety considerations regarding patients http://acls-algorithms.com/acls- with implanted devices. megacode-simulator/acls-simulator

11. Construct conversations using therapeutic communication with the family of the client in cardiac arrest.

12. Using the nursing process, prioritize the plan of care for a patient experiencing various cardiac dysrhythmias.

26 Emergency Nursing

Unit 4 Course Objectives: 1-12

Objectives Course content Learner Activities Upon completion of this chapter, the learner should be Ignatavivius, M. and Workman, L. able to: I. Safety in the ED (2016) Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th 1.) Plan and implement best practices to maintain II. Emergency Nursing Principles ed., St. Louis, MO: Elsevier-Saunders. staff and patient safety in the ED III. Providing care for patient and family Read Ch. 8, 9, 10 2.) Triage patients in the ED to prioritize the order of during when death occurs in the ED care delivery PowerPoint presentation IV. Trauma Centers and Systems 3.) Prioritize resuscitation interventions based on the Audio/Visuals primary survey of the injured patient V. Primary and Secondary Survey and Resuscitation Interventions NCLEX review questions 4.) Prevent or reduce common risk factors in the ED that contribute to adverse events in older adults VI. Heat and Cold Related Emergencies Learner activities  Concept mapping 5.) Employ therapeutic communication in providing VII. Pre-hospital and Hospital Care of Bites  Group discussion support for families after the death of a loved one and Stings

6.) Formulate a plan of care using evidence based VIII. Prioritize nursing care for a near- practice related to environmental emergencies. drowning victim 7.) Identify the types of disasters IX. Types of disasters 8.) Apply principles of triage to prioritize care delivery in a disaster situation X. Mass Casualty Triage

9.) Identify the roles of the nurse in emergency XI. Roles of the nurse in a disaster preparedness and response plan XII. Event Resolution and Debriefing 10.) Identify the type of patient’s to recommend for hospital discharge in a disaster situation

27 Management of Patients with Urinary Disorders and Male Reproductive Processes

Unit 5 Course Outcomes: 1, 2, 4-12

Objectives Course content Learner Activities Upon completion of this chapter, the learner should be able to: I. Disorders of the Urinary Tract Ignatavivius, M. and Workman, 1. Interpret factors contributing to urinary tract infections L. (2016) Medical-Surgical and A. Lower UTI Nursing: Patient-Centered B. Upper UTI Collaborative Care, 8th ed., St. 2. Formulate an evidenced based teaching plan for a Louis, MO: Elsevier-Saunders.

client with a urinary tract infection. 1. Pyelonephritis 2. Glomerulonephritis Read Chapter 66, 67, 72 3. Compare and contrast pyelonephritis, 3. Nephrotic Syndrome 4. Urolithiasis glomerulonephritis, and nephritic syndrome: causes, PowerPoint presentation pathophysiology, manifestations, management, and II. Urinary Diversions nursing care. Audio/Visuals A. Ileal Conduit 4. Explore types and care of urinary diversions in the B. Nephrostomy NCLEX review questions frame of the nursing process. C. Uterostomy D. Koch Pouch Class activities 5. Examine legal/ethical issues related to urinary diversions. III. Assessment of Male Reproductive - teaching plan for UTI system 6. Discuss nursing assessment of the male reproductive - critical thinking system and identify diagnostic test that complement IV. Disorders of Male Sexual exercises Dysfunction assessment.

A. Erectile Dysfunction 7. Evaluate Evidenced based treatments and causes of B. Infections male sexual dysfunction. C. Conditions of the Prostate D. Conditions affecting the 8. Use the nursing process as a framework for care of testes, penis and adjacent clients undergoing a prostatectomy. structures 1. Cryptorchidism 9. Identify clinical manifestations, medical and nursing 2. Testicular Cancer management of a client with prostate cancer. 3. Penile Cancer

V. Surgical interventions and Nursing Care

28 Management of Patients with Renal Disorders

Unit 5 Course Objectives: 1-12

Objectives Course content Learner Activities

Upon completion of this chapter the learner should be able to: I. Fluid and Electrolyte Ignatavivius, M. and A. Review F/E disturbances Workman, L. (2016) Medical- 1.) Inventory possible fluid and electrolyte disturbances seen in commonly seen with renal Surgical Nursing: Patient- clients with renal dysfunction. disorders. Centered Collaborative Care,

8th ed., St. Louis, MO: 2.) Differentiate between acute and chronic renal failure. II. Renal Failure Elsevier-Saunders. A. Chronic 3.) Use the nursing process as a framework for the care of clients B. Acute with acute and chronic renal failure. III. Dialysis Read Chapter 66, 68 4.) Compare and contrast types of renal replacement therapies A. Types of dialysis including hemodialysis, peritoneal dialysis, and kidney PowerPoint presentation transplantation. IV. Kidney Transplant NCLEX review questions 5.) Examine responsibilities of the different team members A. Preoperative Management involved in caring for clients with kidney disease. B. Postoperative Management Evidence Based Article

6.) Identify best practice when caring for a client undergoing V. Kidney Surgery Pre/Post op Class activities: kidney transplant. VI. Other Health Disorders R/T - Concept mapping - Group discussion 7.) Debate ethical dilemmas arising from the treatments of Kidney Failure dialysis and kidney transplants. - Case studies A. Anemia B. Pruritus 8.) Use the nursing process framework for care of clients - 24 hour diet plan for C. Sleep Disorders undergoing kidney surgery. chronic renal failure D. Amyloidosis client 9.) Formulate a comprehensive teaching plan for clients with kidney disease.

29 Care of Patients Related to Adult Abuse, Delirium, Dementia, Alcohol Abuse, and Psych Emergencies

Unit 6 Course Outcomes: 1-12

Objectives Course content Learner Activities Upon completion of this chapter, the learner should be able to: Characteristics of patients with: Ignatavivius, M. and Workman, L. I. Substances of abuse (2016) Medical-Surgical Nursing: 1). Identify substances of abuse and assessment of a patient A. assessment findings related to Patient-Centered Collaborative abusing certain addictive substances substances of abuse Care, 8th ed., St. Louis, MO: B. assessment of the patient in Elsevier-Saunders. 2) ) Discuss the care of the patient in alcohol and substance alcohol withdrawal abuse withdrawal C. nursing care of the patient in ATI Read Chapters 17, 27-31 alcohol withdrawal

3). Evaluate the medications used to treat patients in alcohol Ii. Psychiatric incidents and and substance abuse withdrawal emergencies A. Crisis and anger management 4). Explore the nurse’s role in psychiatric incidents and B. Suicide emergencies. C. Anger D. Family and community violence E. Sexual Assault

30 Assessment and Management of Patients with Eye and Vision Disorders

Unit 7 Course outcomes: 1-12

Objectives Course content Learner Activities

Upon completion of this chapter, the learner should be able to: I. Pathophysiology, assessment, Ignatavivius, M. and Workman, diagnostics, treatments, nursing L. (2016) Medical-Surgical 1.) Distinguish between diagnostic tests for assessment of vision management of: Nursing: Patient-Centered th and evaluation of visual and hearing disabilities. A. Low Vision and Blindness Collaborative Care, 8 ed., St. D. Glaucoma Louis, MO: Elsevier-Saunders. 2.) Using the nursing process, examine the clinical features of E. Cataracts ocular disorders, diagnostic assessment and examinations, F. Macular Degeneration Read Chapter 46-48 medical or surgical management, and client care. G. Conjunctivitis H. Enucleation On line module 3.) Describe therapeutic effects, safety, and infection control when I. Diabetic Retinopathy NCLEX review questions using ophthalmic medications.

4.) Formulate a teaching plan for a client discharged after ocular II. Hearing Loss nursing management - critical thinking surgery using therapeutic techniques. and treatments exercises C. Gerontologic - Case scenarios 5.) Differentiate collaborative team members associated with Considerations ocular disorders.

III. Conditions of the External Ear 6.) Evaluate the manifestations that may be exhibited by a person A. Cerumen impaction with a hearing disorder and communicative techniques. B. External Otitis

7.) Differentiate problems of the external and middle ear and the IV. Conditions of the Middle Ear clinical manifestations, diagnosis, and management. A. Perforation of Tympanic Membrane 8.) Compare and contrast innovative technologies available to the B. Otitis Media hearing impaired. V. Conditions of the Inner Ear A. Meniere’s Disease B. Vertigo C. Ototoxicity

31

Labs and Simulations

32 Respiratory Modalities Skills Lab

Learning Objectives:

1. Demonstrate tracheostomy care and suctioning. 2. Discuss the care of a client with a chest drainage system. 3. Teach another student how to assess a chest drainage system. 4. Discuss different methods of oxygen delivery. 5. Discuss best practice and quality care for clients receiving mechanical ventilation.

Student Preparation: Complete all of the following ATI Skills Videos including pre and post-test and practice challenges. -Airway Management - Oxygen Therapy - Closed Chest Drainage

Read in your book about chest drainage devices pages 577-580 Read in your book about intubation, extubation, and care of a client receiving mechanical ventilation pages 615-622 Watch this video describing the basics of ventilators. Also found at https://www.youtube.com/watch?v=gk_Qf-JAL84

Complete answers to questions and bring as a ticket to the skills lab.

1. What is BiPAP? Which clients might need BiPAP?

2. What are 2 priority problems for a client receiving mechanical ventilation?

3. What are potential complications the nurse is monitoring for clients on a ventilator?

33 Medical Surgical Nursing III Respiratory Simulation Case Study:

The following scenario will be accomplished using a high fidelity manikin with a variety of situations that will arise. Each simulation will be performed by two students. Student 1 will need to perform assessment and interventions accordingly after receiving report from the evening shift nurse. Student 2 will act in the role of evaluator, observing the simulation and being available to student 1 for advice.

Mr. Watkins was admitted yesterday and diagnosed with Community Acquired Pneumonia (CAP); a pneumothorax was seen on x-ray and placement of a 32 french chest tube was done in the ED. He has a history of COPD for the past 8 years and was recently diagnosed with type 2 diabetes. He continues to smoke 1 pack of cigarettes a day. He lives alone in a rural home. His wife passed away last year, he has a daughter and son who check on him regularly.

Mr. Watkins is in the ICU and you are the oncoming nurse caring for him today. The night nurse reports he slept fairly well and did not ask for pain medication. He is on oxygen to be titrated to keep his oxygen saturations above 91%. The night nurse did report increasing the O2 around 6 am from 2L to 4L due to a drop in his saturation and she has not been back in to check his status or look at the 0600 ABGs. Lab work and vital signs are on the patient’s chart at his bedside.

Simulation Objectives:

 Demonstrates a focused respiratory assessment using proper auscultation technique  Implements appropriate interventions based on assessment findings  Recognizes the need to reassess for changes in patient status after interventions and make new changes accordingly  Interprets ABGs and recognizes trends  Demonstrates effective teamwork when collaborating with multiple disciplines  Implements therapeutic communication  Recognizes safety issues at the patient’s bedside  Demonstrate effective communication with peers

Prep for simulation:

Watch ATI videos: ONLY 2 VIDEOS Oxygen Therapy Closed Chest Drainage Assignment before simulation: (this is your “ticket to simulation”, you will not be permitted to participate without completion) Read article: Chest-tube care: The more you know, the easier it gets /Answer questions at the end of the article and bring answers to simulation (found on portal under simulation) Complete respiratory worksheet and bring answers to simulation

Case Study: Work through the case study prior to simulation 34

Respiratory Worksheet

1. What can happen if we give patients with lung disease large amounts of oxygen? (I’m not looking for respiratory drive shut down)

2. What is respiratory acidosis? Explain, and give me an example of ABGs.

3. What are the signs of too much CO2 (respiratory acidosis)?

4. What other diseases might mimic respiratory acidosis?

5. What laboratory data might be helpful in coming up with a nursing diagnosis?

35

6. What assessment data would you want to perform to differentiate between the respiratory acidosis and other potential disorders?

7. If you suspected respiratory acidosis, what would nursing interventions would you perform? And give rationales.

8. What is the rationale for using BIPAP on a patient with respiratory acidosis? Why not CPAP? Support your answer.

9. What other medical interventions might you anticipate in a patient with respiratory acidosis? Support your answers.

10. Other information? (optional)

36

Lab Simulation

Myocardial Ischemia

Case Summary:

This case presents a patient in the Emergency Department, who is complaining of chest pain. The student will be expected to follow the protocol for the treatment of chest pain suggestive of ischemia. The patient complains of increasing angina and has an abnormal ECG. Students will identify ECG rhythm and treat according to ACLS protocol. Students will delegate assignments in the event of cardiac arrest and use therapeutic communication with family members at the bedside. Furthermore, students will collaborate with other members of the healthcare team.

Learning Objectives:

 Identifies primary nursing diagnosis  Implements patient safety measures  Evaluates patient assessment information including vital signs  Implements therapeutic communication  Implements direct communication to multidisciplinary team members  Demonstrates effective teamwork  Prioritizes and implements physician orders appropriately

Prepare for simulation by completing the following:

1. Recall ACLS protocol 2. Review ECG rhythms 3. Know the signs and symptoms of myocardial ischemia 4. Understand the roles of the multidisciplinary team in the event of cardiac arrest 5. Review medications that are commonly used for patients with ischemia and/or cardiac arrest

Please see portal for ticket to simulation.

37

Clinical Assignments

38 Clinical Objectives:

Throughout the 2128 clinical rotation, the nursing student will:

1. Examine the psychosocial aspects and community resources of caring for the critically ill patient and his/her family. (Measured by clinical assignment and/or reflective journaling) [Professional Identity]

2. Correctly assess and document changes in patient status including level of consciousness. (Measured by clinical assignment and critical care assignment)[Nursing Judgment/Practice]

3. Describe use of and safe nursing responsibilities related to monitoring equipment (i.e.- ventilators, telemetry, defibrillators, CVP and arterial lines, IV pumps, chest tubes, oxygen delivery) (Measured by critical care written assignment, and/or post conference discussion) [Nursing Judgment/Practice]

4. Explain nursing responsibilities for intubation and extubation, and care of a patient on a ventilator. (Measured by critical care written assignment, and/or post conference discussion) [Nursing Judgment/Practice]

5. Apply clinical reasoning skills to make evidence based decisions in identifying nursing priority problems and implementing nursing interventions recognized through assessment skills. (clinical assignment, preceptor assignment, simulation, and clinical evaluation) [Spirit of Inquiry]

6. Compare and contrast basic ABG's and ECG's and discuss appropriate interventions. (Measured by clinical assignment, and post conference discussion) [Nursing Judgment/Practice]

7. Analyze nursing responsibilities for pre/ post heart catheterization. (Measured by clinical assignment and/or post conference discussion) [Spirit of Inquiry]

8. Formulate a patient centered teaching plan to manage the care of a patient going home post heart cath and/or pacemaker insertion. (Measured by written clinical assignment and/ or post conference discussion)[Professional Identity]

9. Inventory patient centered care responsibilities of a pre/ post dialysis patient including safe and effective clinical decision making regarding medication. (Measured by written clinical assignment and/ or post conference discussion) [Nursing Judgment/Practice and Spirit of Inquiry]

10. Demonstrate therapeutic communication while advocating for a patient. (Preceptor assignment)[Human Flourishing]

11. Demonstrate respect while providing care for patients with ethical, spiritual and cultural differences (Measured by reflective journaling and preceptor assignment) [Human Flourishing]

12. Demonstrate accountability, professional communication, organization, prioritization, safe care and appropriate delegation in transitioning to a graduate RN. (Measured by reflective journaling, preceptor assignment, and clinical evaluation)[Nursing Judgment/Practice]

13. Identify quality improvement strategies including the use of informatics that are used to provide safe care. (Measured by reflective journaling and preceptor assignment)[Nursing Judgement]

14. Provide patient education including learning preferences and evaluation of patient learning (clinical assignment and preceptor assignment) [Professional Identity] 39

Clinical Assignments

Each clinical area has specific objectives and related assignments that guide the student through that clinical experience. Clinical assignments are designed to maximize learning. Prepare in advance of each clinical day by noting on the schedule which area you are assigned. Plan what assignment and objectives should be completed and print all necessary documents before arriving. Consult your clinical instructor if you are unsure. Some assignments will be completed while you are in the clinical setting while others will be completed and turned in at the time your clinical instructor requests. Late assignments will be reflected on your clinical evaluation.

Reflective Journaling

A reflective journal is meant for the writer to be able to think back about an experience learn about the meaning of the experience. As nursing students, journaling can help you learn about yourself, a disease process, discover holistic approach to nursing, how to really find value and demonstrate care to a patient or their family, discover mistakes and make corrections. Journaling will teach you how to internalize your learning and make it real.

Guidelines:

 You may either handwrite or type the entry.  Ideas about entries: . Describe an experience, observed behavior or perception of the experience during this clinical day. . Express your feelings or maybe the feeling of others involved in the experience (e.g. staff, patient, patient’s family) . Do you feel inadequate or better prepared to make decisions, plan care, and evaluate patient care after today’s encounter? What can you do to improve? . Any skills you feel you need to improve or develop?

40 Critical Care Assignment

Use the MS III clinical objectives to guide your experience in the Critical Care Unit.

1. Consider the psychosocial aspects of caring for the critically ill patient and his /her family. List 2 priority psychosocial nursing problems with at least 3 nursing interventions for each.

2. Explain how to evaluate the level of consciousness of a critically ill patient. List 2 nursing priorities for a patient with a neurological deficit or decreased LOC.

3. Describe the use of and nursing responsibilities associated with using monitoring equipment (Swan Ganz catheter, CVP and arterial lines)

4. Interpret 1 set of ABGs with treatment. (To include with written assignment)

5. Interpret 3 patient ECG strips with treatment. (To include with written assignment.)

6. Complete a rapid reasoning case study on one client.

41 CARDIAC REHAB ASSIGNMENT

Objectives: 1. Complete a teaching plan for a cardiac rehab client. 2. Assess patients before, during, and after exercise consider trends in data and report significant changes. 3. Identify priority problems with clients with a cardiac disorder. 4. Provide education to a client with a cardiac disorder.

During the rotation, the student will complete the following in writing

1. What are some goals or objectives of a cardiac rehab program?

2. What are the criteria for admission to a rehab program?

3. Describe the progression in a cardiac rehab program.

4. When is a client discharged from a rehab program?

5. Prepare a teaching plan on attached concept map for a cardiac rehab client. Consider issues such as, emotional support, home exercise, diet, smoking, medications, sex, heart disease, and compliance.

CARDIAC CATH LAB/ Post Heart Catheter ASSIGNMENT

Objectives: 1. Complete a discharge teaching plan for a patient post heart catheter. 2. Analyze nursing responsibilities for pre and post heart catheter. 3. Use clinical reasoning to identify nursing priority problems before, during and after a heart catheter procedure.

1. Evaluate nursing responsibilities for pre- op prior to heart cath. Be sure to include: important considerations for patient history, current medication, known allergies.

2. Prioritize nursing interventions post heart cath.

3. Design a discharge teaching plan using the attached concept map for a post cardiac catheter client

4. Describe the nursing care of a client in cath lab.

5. Discuss personnel involved in the cath lab. What are their roles in relation to the patient?

42 43

EMERGENCY DEPARTMENT and EMT Objectives: 1. Inquire about how patients are triaged. 2. Assess patients noting changes in status, trends in data, and report significant changes immediately. 3. Identify priority problems and priority nursing actions. 4. Interpret ABG, ECG and lab results. 5. Examine how care is safely delegated. 6. Use SBAR to communicate with other members of the healthcare team.

Assignment 1. Complete a rapid reasoning case study on one patient. For the EMT rotation adapt the rapid reasoning tool as much as possible.

2. Describe the legal implications of ED nursing care: child abuse, blood ETOH, DOA's, poison control, treatment of minors, psychiatric emergencies, physical restraint, and reporting incidents to law enforcement.

44 RAPID Reasoning Case Study-STUDENT I. Data Collection History of Present Problem:

Personal/Social History:

What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance:

RELEVANT Data from Social History: Clinical Significance:

What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medications treat which conditions? Draw lines to connect) PMH: Home Meds:

Lab/diagnostic Results:

Basic Metabolic Panel (BMP) Current High/Low/WNL? Most Recent:

Sodium (135-145 mEq/L)

Potassium (3.5-5.0 mEq/L)

Glucose (70-110 mg/dL) Creatinine (0.6-1.2 mg/dL) Misc. Chemistries:

What lab results are RELEVANT that must be recognized as clinically significant to the nurse? RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable:

Complete Blood Count (CBC) Current High/Low/WNL? Most Recent: WBC (4.5-11.0 mm 3) Hgb (12-16 g/dL) Platelets(150-450x 103/µl) Neutrophil % (42-72)

What lab results are RELEVANT that must be recognized as clinically significant to the nurse?

45 RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable:

II. Patient Care Begins: Current VS: WILDA Pain Scale (5th VS) T: Words: P: Intensity: R: Location: BP: Duration: O2 sat: Aggreviate: Alleviate:

What VS data is RELEVANT that must be recognized as clinically significant? RELEVANT VS Data: Clinical Significance:

Current Assessment: GENERAL Resting comfortably, appears in no acute distress APPEARANCE: RESP: Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks NEURO: Alert & oriented to person, place, time, and situation (x4) GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact

What assessment data is RELEVANT that must be recognized as clinically significant? RELEVANT Assessment Data: Clinical Significance:

III. Clinical Reasoning Begins… 1. What is the primary problem that your patient is most likely presenting with? 46

2. What is the underlying cause/pathophysiology of this concern?

3. What nursing priority(s) captures the “essence” of your patient’s current status and will guide your plan of care? (if more than one-list in order of PRIORITY)

4. What interventions will you initiate based on this priority? Nursing Interventions: Rationale: Expected Outcome:

5. What body system(s) will you most thoroughly assess based on the primary problem or nursing care priority?

6. What is the worst possible/most likely complication to anticipate based on the primary problem?

7. What nursing assessments will identify this complication EARLY if it develops?

8. What nursing interventions will you initiate if this complication develops?

Medical Management: Rationale for Treatment & Expected Outcomes Care Provider Orders: Rationale: Expected Outcome:

47 PRIORITY Setting: Which Orders Do You Implement First and Why? Care Provider Orders: Order of Priority: Rationale:

Medication Dosage Calculation: Medication/Dose: Mechanism of Action: Volume/time frame to Nursing Assessment/Considerations: Safely Administer:

Normal Range: Hourly rate IVPB: (high/low/avg?) IV Push Rate Every 15-30 Seconds?

9. What educational/discharge priorities will you identify once this patient is admitted to the unit?

Caring & the “Art” of Nursing 10. What is the patient likely experiencing/feeling right now in this situation?

11. What can I do to engage myself with this patient’s experience, and show that he/she matters to me as a person?

It is now the end of your shift. Effective and concise handoffs are essential to excellent care and if not done well can adversely impact the care of this patient. You have done an excellent job to this point, now finish strong and give the following SBAR report to the nurse who will be caring for this patient: Situation:

Background:

Assessment:

Recommendation:

48

CHARGE NURSE ROTATION WRITTEN ASSIGNMENT

Objectives: 1. Identify how the charge nurse uses informatics to provide safe care. 2. Collaborate with members of the interdisciplinary team to improve client outcomes. 3. Identify quality improvement strategies that are being used to improve client outcomes.

1. Define responsibilities of the charge nurse.

2. Identify the knowledge and skills needed by the charge nurse to function effectively.

3. Describe how a charge nurse organizes his/her time, prioritizes, and delegates either assignments or patient care.

TEAM LEADING ROTATION WRITTEN ASSIGNMENT

Objectives: 1. Gather report on all clients assigned to fellow students. 2. Determine priorities for each client using assessment findings as well as data from chart. 3. Collaborate with other team members including fellow student regarding changes in status or new orders. 4. Promote time management and organization in helping fellow students plan nursing care.

1. Complete attached active questioning form and discuss with your instructor soon after report.

2. Complete a reflective journal. Include what you did well, and what you would like to improve or

change.

49 Active Questioning

After assessing your patient answer these questions and discuss with your clinical instructor.

Patient 1 Patient 2 Patient 3 Patient 4 Patient 5

What are you on alert for today?

What are the priority assessments to make?

What complications may occur?

What interventions will prevent complications?

50

Objectives: 1. Demonstrate the ability to apply the nursing process when caring for patients with multiple health alterations. 2. Actively participate with patients, families and healthcare team members in accordance with the legal and ethical standard of the nursing profession. 3. Use communication techniques to function collaboratively with the health care team caring for ESRD patients. 4. Analyze at least one ESRD patient’s assessment of systems, psychosocial and medication needs. 5. Describe the management, supervision and delegation responsibilities of the RN at a dialysis center. 6. Demonstrate responsibility for continued personal and professional development.

Assignment  At the completion of the experience, submit a paper to your INSTRUCTOR that includes: a. The value to you in having had this experience. b. The value to other patients you will have in the future. d. Your observations about the nursing assessment of a fistula vs a graft or a catheter e. A summary of what you have observed about the impact of hemodialysis on ADLs’  A Concept Map including one patient’s diagnoses and Medications received  The Medication Sheet attached listing 5 drugs you have seen administered during your site visit

51 Respiratory Therapy- Senior Level

Objectives: 1. Determine nursing responsibilities of a patient on a ventilator, intubation, and extubation. 2. Interpret ABG results and compare results to client’s physical assessment. 3. Discuss how to safely monitor respiratory equipment such as ventilators. Assignment 1. Auscultate at least 3 client breath sounds using appropriate assessment techniques. Discuss and document your findings with the R.T. 2. Review radiology films/reports of a patient for treatment of COPD/pneumonia, asthma, and/or flu. What did you find? Any differences? 3. Observe at least one ventilator client. Notice settings. Answer below questions describing difference (if ventilator was not observed, describe each statement and differences) 4. What classification of ventilator is being used (positive pressure, negative pressure)? 5. What is the ventilator mode (assist-control, intermittent, synchronized – see your med- surg text book)? 6. What is the tidal volume set at, why is this important? 7. What is the FiO2 setting, why is this important? 8. What is the sensitivity setting, why is this important? 9. What is the sigh setting, why is this important? 10. What is the PEEP, why is this important?

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Registered Nursing Program

Clinical Warning Form

Definitions & Procedures

S = Satisfactory

Students meet minimum requirements for the program outcomes.

N = Needs Improvement

Students did not meet minimum requirements for 1 or more core competency for that program outcome. If an N is received then the student and instructor are expected to:

1. Discuss the issue during the clinical rotation. 2. The instructor will document the discussion on the clinical formative evaluation tool. 3. The instructor will fill out the clinical warning form. 4. The student will formulate a simple remediation plan to be presented to the clinical instructor and course coordinator. (if applicable) 5. If after remediation, the student receives another N, the process will be repeated once more. 6. If the student receives 3 N’s in the same program outcome category, such as Human Flourishing, on separate occasions during a course clinical rotation then they will receive a U for that clinical rotation and will be dismissed from the program.

U= Unsatisfactory (3 N’s)

Student did not demonstrate essential skills for patient safety, professional behavior etc. as stated on page 37 in the RN Handbook. If the student participates in any of the reasons for dismissal as listed under “Unsafe Clinical Practice” if the RN Handbook they will receive a U on the clinical formative evaluation tool.

53 North Arkansas College Department of Nursing Clinical Warning Form

Student Name______Clinical Rotation______

The above student has received a “Needs Improvement” evaluation from the clinical instructor. The following area(s) was/were designated as not meeting the minimal requirement.

(circle)

Human Flourishing Communication, Patient Centered Care, Cultural Diversity

Nursing Judgment/Practice Safety/Quality Improvement, Evidence Based Practice, Managing Care, Collaboration/Teamwork

Spirit of Inquiry Clinical Decision Making, Clinical Reasoning

Professional Identity Professional Behavior, Teaching-Learning, Informatics, Legal-Ethical

Specific area needing improvement – ______

Student’s plan for remediation – ______

I acknowledge that I have read and understand the above clinical evaluation.

Student______Date______

Instructor______Date______

Course Coordinator______Date______

INC 10-24-12 *Copy given to student, copy to instructor and/or course coordinator, original in student file.

54 North Arkansas College Semester______Revised 4-12 Department of Nursing RN Program 10-24-12 Formative Evaluation Tool Course______

Student Name______Clinical Rotation______S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not Applicable Fill in Clinical Dates HERE Communication Uses effective therapeutic communication skills with patients, health care team, faculty and others Actively participates in pre/post conferences

Documents appropriately in either writing or in the electronic health record Patient Centered Care Assess/plan for patient-family spiritual needs Respects the individual’s personal spirituality Assists the patient to meet their spiritual outcomes

Human Flourishing Human Demonstrates compassion for others Cultural Diversity Respects & values diverse cultures Provides culturally competent care Safety/Quality Improvement Uses standard precautions, hand hygiene and sterile technique Administers medications using the 6 rights Able to verbalize action, side effects, adverse reactions of medications Recognizes and intervenes for high risk patients Provides for a safe environment for self, others and patients Recognizes their role in a disaster preparedness “Identifies” quality improvement measurements Evidence Based Practice

Utilizes the nursing process to provide patient care Uses correct assessment techniques Identifies appropriate nursing diagnosis Plans patient care using current trends in health care Performs appropriate nursing interventions Evaluates patient outcomes and revises care as needed Managing Care Prioritizes patient care

Nursing Judgment/Practice Nursing Provides timely patient care Demonstrates organizational skills Completes assignments on time Collaboration/Teamwork Identifies members of the health care team (lower level) Compares the roles of the health care team (medium) Plans patient care with the health care team (higher level) Provides assistance to other health care team members Functions as a team member by demonstrating cooperativeness & displaying mutual respect

55 Fill in Clinical Dates HERE Clinical Decision Making Makes clinical judgments to ensure safe care Uses evidence-based information to evaluate patient outcomes Identifies problems, issues, and risks to promote health and safety Seeks out learning opportunities Explores alternatives to achieve patient goals

Spirit of Inquiry of Spirit Clinical Reasoning Questions underlying assumptions Offers new insight to improve quality of care Professional Behaviors Professional appearance (uniform and hygiene) Preparedness (comes to clinical with stethoscope, name tag, pen, etc.) Demonstrates positive attitude Role model for others Notifies clinical instructor of absence/tardiness per policy Does not show pattern of tardiness/absenteeism Accepts criticism and corrects mistakes willingly

Is self-motivated and directed Complies with agency and program policy Teaching and Learning Utilizes evidence-based teaching interventions Demonstrates mutual goal-setting

Professional Identity Professional Identifies resources (physical, emotional, spiritual, etc.) Promotes self-determination of patient and self Informatics Utilizes technology to provide safe patient care Access appropriate resources to support positive patient outcomes Legal/Ethical Practices with in the identified role of a student nurse Maintains confidentiality (HIPAA) Clinical Instructor Initial HERE

Instructor Comments:

Instructor Signature:______Date:______

Student Comments:

I acknowledge that I have read and understand the above clinical evaluation.

Student Signature:______Date:______

56 North Arkansas College Revised 10-12 Semester______Department of Nursing RN Program 10-24-12 Summative Evaluation Tool Course______

Student Name______Clinical Rotation______S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not Applicable S, N, U, Instructor Comments Communication NA

Uses effective therapeutic communication skills with patients, health care team, faculty and others Actively participates in pre/post conferences Documents appropriately in either writing or in the electronic health record

Patient Centered Care

Assess/plan for patient-family spiritual needs Respects the individual’s personal spirituality Assists the patient to meet their spiritual outcomes

Human Flourishing Human Demonstrates compassion for others

Cultural Diversity

Respects & values diverse cultures Provides culturally competent care

Safety/Quality Improvement

Uses standard precautions, hand hygiene and sterile technique Administers medications using the 6 rights Able to verbalize action, side effects, adverse reactions of medications Recognizes and intervenes for high risk patients Provides for a safe environment for self, others and patients Recognizes their role in a disaster preparedness “Identifies” quality improvement measurements

Evidence Based Practice

Utilizes the nursing process to provide patient care Uses correct assessment techniques Identifies appropriate nursing diagnosis Plans patient care using current trends in health care Performs appropriate nursing interventions Evaluates patient outcomes and revises care as needed

Managing Care

Prioritizes patient care Nursing Judgment/Practice Nursing Provides timely patient care Demonstrates organizational skills Completes assignments on time

Collaboration/Teamwork

Identifies members of the health care team (lower level) Compares the roles of the health care team (medium) Plans patient care with the health care team (higher level) Provides assistance to other health care team members Functions as a team member by demonstrating cooperativeness & displaying mutual respect

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Clinical Decision Making

Makes clinical judgments to ensure safe care.

Uses evidence-based information to evaluate patient outcomes. Identifies problems, issues, and risks to promote health and safety. Seeks out learning opportunities Explores alternatives to achieve patient goals

Clinical Reasoning

Spirit of Inquiry of Spirit

Questions underlying assumptions Offers new insight to improve quality of care

Professional Behaviors

Professional appearance (uniform and hygiene) Preparedness (comes to clinical with stethoscope, name tag, pen, etc.) Demonstrates positive attitude Role model for others Notifies clinical instructor of absence/tardiness per policy Does not show pattern of tardiness/absenteeism Accepts criticism and corrects mistakes willingly Is self-motivated and directed Complies with agency and program policy.

Teaching and Learning

Utilizes evidence-based teaching interventions Demonstrates mutual goal-setting Identifies resources (physical, emotional, spiritual, etc.) Promotes self-determination of patient and self

Professional Identity Professional

Informatics

Utilizes technology to provide safe patient care Access appropriate resources to support positive patient outcomes

Legal/Ethical

Practices with in the identified role of a student nurse Maintains confidentiality (HIPAA)

PASS FAIL Student Comments:

I acknowledge that I have read and understand the above clinical evaluation.

Student Signature:______Date:______

Instructor Signature:______Date:______

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