Hazleton Area Career Center Practical Nursing Program Care of Adult Patient II

COURSE TITLE: CARE OF ADULT PATIENT II PLACEMENT: LEVEL II TOTAL HOURS: 95 80 - Care of Adult Patient II 15 – Therapy

Course Description: This course consists of theory and clinical experience in nursing care of adult patients with moderately complex medical and surgical disorders, including musculoskeletal, cardiac, urinary and reproductive disorders. It identifies the physical as well as psychological needs of patients with cancer and the dying patient. Integrated in this course are dietary modifications and pharmacology related to the treatment of these disorders.

Methods of Instruction: To implement the program, the instructor will utilize the following methods of instruction:

1. Lecture and discussion 2. Audiovisual aids 3. Use of smartboard, bulletin board, and easel. 4. Assignment of related readings and discussion 5. Computer-based assignments/Internet access Methods of Evaluation: 1. Class participation 2. Written assignments 3. Quizzes 4. Examinations - satisfactory achievement of all examinations (83%) 5. Achievement of the course objectives 6. Student evaluation of course Texts: Gulanik, Nursing Care Plans, Mosby, 9th Edition, 2017 Lutz, Przytulski, & Diet Therapy, F.A. Davis, 6th Edition, 2015 Linton, Introduction to Medical Surgical Nursing, Elsevier, 6th Edition, 2016 Linton, Introduction to Medical Surgical Nursing Study Guide, Elsevier, 6th Edition, 2016 Kizior, Saunders Nursing Drug Handbook 2018

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References:

Deglin; Davis Drug Guide for Nurses; F.A. Davis, 13th Edition, 2013 Williams/Hopper, Understanding Medical Surgical Nursing, 5th edition, 2015 Kockrow, Foundation of Nursing, 6th Edition, 2011 USDA My Pyramid.gov @ www.mypyramid.gov Myers; LPN Notes, Clinical Pocket Guide, F.A. Davis, 4rd 2016 Taber's Cyclopedic Medical Dictionary; F. A. Davis, 22nd Edition, 2013 Olsen, Medical Dosage Calculations, Pearson, 11th Edition, 2016 Hopkins, LabNotes, FA Davis, 3rd Edition, 2015 Rinehart, NCLEX-PN Exam Cram, Pearson, 4th Edition, 2014

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Objectives: At the completion of this course, the student practical nurse will:

1. Describe the predominant characteristics of cancer and its treatments 2. Identify the common methods of diagnosis and treatment of cancer 3. Identify the behavior characteristics of each stage of Dying: Denial, Anger, Bargaining, Depression, and Acceptance. 4. Identify the physical, emotional, social and spiritual needs that are common to the dying patient. 5. Describe the nursing responsibilities associated with diagnostic testing of patients with cardiovascular disorders. 6. Describe the risk factors for cardiovascular disorders 7. Differentiate between the assessments findings for chronic and acute arterial and venous disorders. 8. Discuss the risk factors, signs and symptoms, diagnosis, treatment, and complications of hypertension 9. List various blood disorders and their treatments 10. Describe the pathophysiology, signs and symptoms, medical diagnosis, and medical treatment for selected disorders of the immune system. 11. Discuss symptoms and causes of various musculoskeletal disorders and their treatments 12. Identify disorders of the urinary system including diagnostic tests, nursing care, treatment and Drug therapy. 13. Describe problems affecting the male and female reproductive system including diagnostic tests, nursing care, treatment and drug therapy. 14. Identify disorders of the urinary system including diagnostic tests, nursing care, treatment and drug therapy. 15. Utilize the nursing process in meeting the physical, psychological and social needs of clients with these disorders in the clinical area. 16. Identify ways the basic diet is modified for therapeutic purposes. 17. Identify ways in which foods, nutrients, drugs, and can interact. 18. Discuss the importance of diet in weight management, Mellitus, Cardiovascular, Renal disease, Digestive disease and Cancer.

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UNITS OF INSTRUCTION:

Care of Adult Patient II

Nursing Care of the Patient with Cancer Nursing Care of the Dying Patient/Terminally Ill Nursing Care of the Cardio-Vascular Patient Nursing Care of Patient with Hypertension Nursing Care of Hematologic Disorders Nursing Care of Immunologic Disorders Nursing Care of Patient with Musculoskeletal Disorders/Connective Tissue Disorders/Fractures/Amputations Nursing Care of a Patient with Urologic Disorders Nursing Care of Patients with Female and Male Reproduction Disorders

Review and Examinations: TOTAL 80 Hours

UNITS OF INSTRUCTION: Diet Therapy

Diet Modifications Food & Drug Interactions Weight Management Mellitus & Diet in Cardio-Vascular Disease Diet in Renal Disease Diet in Digestive Disease Diet and Cancer Review and Examinations: TOTAL 15 Hours

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LEVEL II - 17 Weeks - 517 HOURS THEORY CLINICAL HOURS EXPERIENCE

Care of Adult Patient II 95 Maternal Child Health 65 Nursing Fundamentals II 70

230 Hours 287 Hours *Final grade determined by the following percentage: Care of Adult Patient II = 80% Diet Therapy = 20% 100%

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 25 Cancer Identify A. Differentiate between benign and malignant Lecture Student will: Characteristics of tumors Cancer B. Classification of tumors Discussion Read chapters 1. Site 2. Stage White board Take notes in class 3. Appearance 4. Differentiation Overhead Take unit test and C. Risks factors transparencies achieve a passing 1. Carcinogens grade of 83% or D. Seven warning signs of cancer (c-a-u-t-i-o-n) Unit test/examination higher E. Cancer prevention and early Detection Remediation with nurse tutor Cancer Diagnosis A. Physical examination B. Diagnostic test Download C. Laboratory studies instructor power point Cancer Treatment A. Surgery B. Radiation (internal & external) C. Chemotherapy 1. Identify antineoplastic drugs and their classifications 2. Side effects of chemo D. Biotherapy E. Bone marrow and stem cell transplant F. Alternative therapies

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Identify Nursing A. Physical care Responsibilities B. Psychosocial needs Associated with C. Spiritual needs Various Degrees of D. Nutritional needs Cancer E. Risks for infection/injury, etc. F. Recovery & rehabilitation

Discuss Terminal A. Resources available Illness B. Treatment for terminally ill patients

Identify A. Hypercalcemia Oncological B. Syndrome of inappropriate ADH Emergencies and C. DIC Treatments

Chapter 24 Loss, Death, and End-of-Life Care

Discuss types of A. Change in self image Lecture: Student will: loss B. Developmental changes C. Loss of possessions Discussion Read chapters D. Loss of significant other White board Take notes in class A. Stages of grieving Identify the 1. Dr. Elisabeth Kubler-Ross five stages Overhead Take unit test and achieve Grieving Process  Denial transparencies a passing grade of 83% or  Anger higher  Bargaining Unit test/examination

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

 Depression Remediation with nurse  Acceptance tutor 2. B.C. Martocchio five clusters of grief 3. T.A. Rando three phases of mourning Download instructor B. Signs and symptoms of grieving power point

Discuss fears A. Fears associated with 1. Pain terminal illness 2. Loneliness 3. Meaninglessness B. Clinical signs of impending death C. Physical changes after death

Discuss Nursing A. Clinical assessment Care of B. Nursing interventions Terminal/Dying C. Care of body after death Patients

Identify Issues A. Organ donation Related to B. CPR Terminal Illness C. Advanced directives and Death

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 36 Cardiac Disorders

Overview of Anatomy and physiology of the heart Lecture Student will: Cardiac System Discussion Read chapters Diagnostic Tests A. ECG and Procedures B. Holter monitors White board Take notes in class C. Implantable loop recorders D. Echocardiograms Overhead Take unit test and achieve E. Stress test transparencies a passing grade of 83% or F. MRI higher G. MUGA scan Unit test/examination H. Myocardial Perfusion Imaging Remediation with nurse I. CAT scan tutor J. Cardiac Catherization K. Electrophysiology study Download instructor L. Laboratory tests power point

Cardiac Drug A. Glycosides Therapy B. Antianginals C. Antidysrhythmics D. ACE inhibitors E. Diuretics F. Anticoagulants G. Antiplatelet H. Fibrinolytic I. Lipid-lowering drugs J. Analgesics

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Discuss Oxygen A. Pulse oximeter monitoring Therapy B. Types of oxygen

Identify Types of A. Nursing care of patient with a pace maker and Pacemakers and implantable defibrillators Implantable Cardioverter Defibrillator

Identify Types of A. Preoperative and Postoperative Care Cardiac Surgery

Discuss Common A. Coronary Heart Disease (CHD) Cardiac Disorders B. Arteriosclerosis C. Atherosclerosis D. Angina E. Myocardial infarction (MI)

Discuss A. Signs and symptoms Complications of B. Medical diagnosis Common Cardiac C. Medical treatments Disorders 1. Percutaneous coronary intervention 2. Coronary Artery Bypass Graft Surgery (CABG)

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Discuss the role of A. Acute MI the nurse in B. Heart Failure treating cardiac C. Decreased Cardiac output disorders D. Excess fluid volume E. Cardiomyopathy

Discuss Cardiac A. Donor/Recipient Transplants B. Rejection

Discuss A. Infectious Endocarditis Inflammatory B. Pericarditis Disorders

Identify Valvular A. Mitral Stenosis Diseases B. Mitral Regurgitation C. Mitral Valve Prolapse D. Aortic Stenosis

Discuss A. Interpreting ECG strip Dysrhythmias 1. Rate/Rhythm 2. P Waves 3. PR Interval 4. QRS Complex 5. ST segment 6. T Waves 7. QT Interval B. Common dysrhythmias 1. Atrial

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

2. Ventricular 3. Heart blocks

Hemodynamic A. Central venous catheter Monitoring B. Pulmonary artery catheter

Chapters 37 Vascular Disorders

Overview of the Anatomy and physiology of the vascular system Lecture Student will: Vascular System Discussion Read chapters Diagnostic Tests A. Ultrasonography B. Pressure measurements White board Take notes in class C. Exercise tolerance D. Angiography Overhead Take unit test and achieve transparencies a passing grade of 83% or Discuss Common A. Exercise higher Therapeutic B. Stress management Unit test/examination Measures C. Pain management Remediation with nurse D. Smoking cessation tutor E. Elastic stockings F. Intermittent pneumatic compression Download instructor G. Positioning power point H. Thermotherapy

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Surgical A. Embolectomy Procedures B. Percutaneous Transluminal Angioplasty (PTA) C. Endarterectomy D. Sympathectomy E. Vein Ligation and Stripping F. Sclerotherapy G. Laser Therapy

Discuss Peripheral A. Peripheral Artery Disease (PAD) Vascular Disorders B. Thromboangiitis obliterans (Buergers) C. Rayaunds D. Aneurysms E. Aortic Dissection F. Varicose Vein Disease G. Venous thrombosis H. Chronic Venous Insufficiency I. Lymphangitis

Discuss A. NSAIDS Medications for B. Anticoagulants Peripheral C. Vasodilators Disorders D. Thrombolytic agents

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapters 38 Hypertension

Discuss Types of A. Primary (Essential) & Secondary Hypertension Lecture Student will: Hypertension 1. Signs and symptoms 2. Physical examination Discussion Read chapters 3. Diagnostic tests and procedures 4. Medical treatment White board Take notes in class 5. Life style modification 6. Pharmacologic therapy Overhead Take unit test and achieve 7. Diet therapy transparencies a passing grade of 83% or higher Discuss A. Medical Diagnosis Unit test/examination Hypertensive Crisis B. Medical Treatment Remediation with nurse tutor

Download instructor power point

Chapters 33 Hematologic Disorders

Overview of the Anatomy and physiology of components of the Lecture Student will: Blood Components Hematologic system Discussion Read chapters Discuss Diagnostic A. Lab values Tests B. Bone marrow biopsy White board Take notes in class

Overhead Take unit test and achieve transparencies a passing grade of 83% or

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Identify Disorders A. Chronic anemia higher of Red Blood Cells B. Polycythemia Unit test/examination C. Aplastic anemia Remediation with nurse D. Autoimmune Hemolytic anemia tutor E. deficiency anemia F. Pernicious anemia Download instructor G. Sickle cell anemia power point

Identify Disorders A. Thrombocytopenia of Coagulation B. DIC C. Hemophilia

Identify Treatments A. Blood transfusion or blood removal for Red Blood B. Medication/Supplement Cells Disorders

Chapters 34 & 35 Immunologic Disorders

Overview of the Anatomy and Physiology of the Immune System Lecture Student will: Immune System Discussion Read chapters Diagnostic Tests A. Laboratory values and Procedures B. Lymphangiography White board Take notes in class C. Spleen scan D. Gallium scan Overhead Take unit test and achieve E. Skin test transparencies a passing grade of 83% or F. Bone marrow transplant higher Unit test/examination

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Disorders of White A. Neutropenia Remediation with nurse Blood Cells B. Non-Hodgkin Lymphoma tutor C. Hodgkin Disease D. Leukemias Download instructor E. Immune responses power point F. Idiopathic thrombocytopenic purpura G. Thrombotic thrombocytopenic purpura H. Autoimmune diseases I. HIV

Chapters 43 Musculoskeletal Disorders/Connective Tissue

Overview of Anatomy and Physiology of Connective Tissues Lecture Student will: Connective Tissue Discussion Read chapters Diagnostic Tests A. Blood Studies 1. CBC White board Take notes in class 2. ESR 3. C-reactive protein Overhead Take unit test and achieve 4. VDRL transparencies a passing grade of 83% or 5. RF higher 6. Creatinine Unit test/examination 7. ANA Remediation with nurse 8. Uric acid tutor 9. WBC B. Radiologic imaging Download instructor power point

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Disorders of A. Osteoarthritis Connective Tissue 1. Signs and symptoms 2. Drug therapy 3. Surgical treatment B. Rheumatoid arthritis 1. Signs and symptoms 2. Medical Diagnosis 3. Drug therapy 4. Surgical treatment C. Osteoporosis 1. Signs and symptoms 2. Medical diagnosis 3. Drug therapy D. Gout 1. Signs and symptoms 2. Medical diagnosis 3. Drug therapy E. Scleroderma 1. Signs and symptoms 2. Medical diagnosis 3. Medical treatment F. Dermatomyositis and Polymyositis 1. Signs and symptoms 2. Medical diagnosis 3. Drug therapy

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapters 43 Fractures

Types of Fractures A. Complete Lecture Student will: B. Incomplete C. Greenstick Discussion Read chapters

Classifications A. Open White board Take notes in class B. Closed Overhead Take unit test and achieve Fracture Healing A. Stages 1 through 5 transparencies a passing grade of 83% or higher Signs and A. Discuss symptoms of a fracture Unit test/examination Symptoms of B. Diagnostic tests and procedures Remediation with nurse Fractures tutor

Discuss Medical A. Cast, splint or immobilize Download instructor Treatment B. Traction power point C. Electrical stimulations

Identify Surgical A. Fixations (open & closed) Interventions B. Replacements

Therapuetic A. Assistive devices Measures B. Physical therapy

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Complications of A. Infections Fractures B. Fat embolism C. Deep vein thrombosis D. Compartment syndrome E. Shock F. Joint stiffness and contractures G. Malunion, nonunion, and delayed union H. Posttraumatic arthritis I. Avasular necrosis J. Complex regional pain syndrome

Chapters 45 Amputations

Indications for A. Trauma Lecture Student will: Amputations B. Disease C. Tumors Discussion Read chapters D. Congenital defects White board Take notes in class Discuss A. Vascular studies Diagnostics Tests B. Pulse volume recording Overhead Take unit test and achieve C. Thermography transparencies a passing grade of 83% or D. Doppler ultrasound higher E. Biopsy Unit test/examination Remediation with nurse Identify Medical A. Open amputation & closed amputation tutor and Surgical B. Post-operative care Intervention C. Replantation Download instructor D. Emergency treatment power point

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 42 Urologic Disorders

Overview of Anatomy and Physiology of the Urinary System Lecture Student will: Urinary System Discussion Read chapters Diagnostic Tests A. Urine tests for Urinary B. Blood tests White board Take notes in class Disorders C. Radiographic tests D. Computer Tomography and Magnetic Resonance Overhead Take unit test and achieve Imaging transparencies a passing grade of 83% or E. Invasive procedures higher F. Urodynamic studies Unit test/examination Remediation with nurse Therapeutic A. Catheterization tutor Measures for B. Ureteral catheter Urinary Disorders C. Nephrostomy tube Download instructor D. Urinary stent power point E. Urologic surgery F. Medications

Identify Urinary A. Urethritis Tract Infections, B. Cystitis inflammations, and C. Pyelonephritis Disorders. D. Acute glomerulonephritis E. Ploycystic kidney disease F. Renal calculi G. Urologic/Kidney trauma H. Cancers of the urinary system

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

I. Renal failure 1. Acute 2. Chronic 3. Dialysis J. Renal transplant

Chapter 49 Female Reproductive Disorders

Overview of Anatomy and Physiology of Female Reproductive Lecture Student will: Female System Reproductive Discussion Read chapters Systems White board Take notes in class Discuss A. Obstetric-Gynecologic history Menstruation and Overhead Take unit test and achieve Menopause transparencies a passing grade of 83% or higher List Female A. Pelvic exam Unit test/examination Diagnostic Tests B. Cultures Remediation with nurse C. Biopsies tutor D. Colposcopy E. Culdoscopy Download instructor F. Laparoscopy power point G. Dilation and Curettage (D&C) H. Mammography I. Breast biopsy

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Therapeutic A. Douching Measures B. Cauterization C. Heat application D. Drug therapy E. Surgical procedures

Discuss Disorders A. Uterine bleeding of Female B. Infections Reproduction C. Fibrocystic changes D. Pelvic Inflammatory disease E. Benign growths F. Endometriosis G. Cysts H. Fibroids tumors I. Cystocele and Rectocele J. Uterine Prolapse K. Vaginal Fistulas L. Cancer 1. Breast 2. Vaginal 3. Ovarian 4. Cervical 5. Vulvar M. Infertility N. Menopause

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 50 Male Reproductive Disorders

Overview of Male Anatomy and Physiology of Female Reproductive Lecture Student will: Reproductive System System Discussion Read chapters

Identify Diagnostic A. Laboratory studies White board Take notes in class Tests for Male B. Radiologic imaging studies Reproductive Overhead Take unit test and achieve Disorders transparencies a passing grade of 83% or higher Discuss Disorders A. Infectious and inflammatory conditions Unit test/examination of Male B. Benign prostatic hyperplasia (hyperthrophy) Remediation with nurse Reproduction 1. Surgical treatments tutor 2. Invasive treatments C. Prostatic Cancer Download instructor 1. Medical treatments power point 2. Surgical treatments D. Erectile dysfunction (Impotence) E. Peyronie Disease F. Priapism G. Phimosis and paraphimosis H. Infertility I. Penile Cancer J. Testicular Cancer

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 50 Sexually Transmitted Diseases

Diagnostic Tests A. Serologic Tests Lecture Student will: B. Smears, swabs, and cultures Discussion Read chapters Sexually A. Chlamydial Infection Transmitted B. Gonorrhea White board Take notes in class Infections C. Syphilis D. Herpes Simplex Overhead Take unit test and achieve E. Trichomoniasis transparencies a passing grade of 83% or F. Human Papillomavirus higher G. Bacterial Vaginosis Unit test/examination H. Human Immunodeficiency Virus Infection Remediation with nurse tutor

Download instructor power point

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Diet Therapy (15 hours)

Chapter 14 Nutrition Delivery

Discuss Diets and A. Nutrient diets (increased or decreased) Lecture Student will: Diet Modifications B. Calories (restricted or increased) C. Textures or consistency Discussion Read chapters D. Fiber (restricted or increased) E. Fluids (increased or decreased) White board Take notes in class F. Clear liquid G. Full liquid Overhead Take unit test and achieve H. Soft diets transparencies a passing grade of 83% or I. Pureed diets higher J. General or regular diets Unit test/examination K. Disease specific formula Remediation with nurse tutor Methods of A. Enternal nutrition Nutrient Delivery 1. Continuous Download instructor 2. Intermittent power point 3. Bolus B. Parenteral nutrition C. Oral delivery

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 15 Interactions: Food & Nutrients Versus Medications and Supplements

Discuss Food and A. Grapefruit and its effect on calcium channel Lecture Student will: Drug Interactions blockers/benzodiazepines B. Cranberry juice and its effect on anticoagulant Discussion Read chapters C. Milk and its effect on tetracycline D. Foods that contain Tyramine and its effects on White board Take notes in class MAOIs. E. Dietary protein and its effects of Levodopa Overhead Take unit test and achieve F. Sodium intake and increased fluid intake and its transparencies a passing grade of 83% or effect on lithium higher G. Folic acid and its effects on aspirin Unit test/examination Remediation with nurse tutor

Download instructor power point

Chapter 16, 17, 18, 19, 20, & 21 Chapter 16 - A. Lecture Student will: Discuss Weight B. Eating Disorders Management 1. Anorexia Nervosa Discussion Read chapters 2. Bulimia 3. Binge-eating disorder White board Take notes in class

Overhead Take unit test and achieve

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

Chapter 17 – A. Macronutrient distribution of protein, transparencies a passing grade of 83% or Discuss Diet in and fat. higher Diabetes Mellitus B. Exchange list Unit test/examination and Hypoglycemia C. My-plate for diabetics Remediation with nurse tutor Chapter 18 – A. Sodium controlled diet Discuss Diet in B. Reducing intake Download instructor Cardiovascular C. Discuss DASH diet power point Disease D. Foods containing omega 3 fatty acids

Chapter 19 – A. Dietary Components Discuss Diet in 1. Calories Renal Disease 2. Protein 3. Sodium 4. Potassium 5. , D, and calcium 6. Fluid 7. Saturated fat and 8. Iron, , and minerals 9. Purines

Chapter 20 – A. Foods to avoid Discuss Diet in B. Soft pureed Digestive Diseases C. Small frequent meals D. Medication avoidance E. Reduce fat F. Increase/decrease fiber G. Clear liquids

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Unit Chapter Objective Chapter Content Teacher Activity Student Activity

H. Minimize carbonated beverages, caffeine & alcohol I. Low FODMAP diet J. Hydration

Chapter 21- A. Avoid red or processed meats Discuss Diet and B. Restrict alcohol Cancer C. Avoid salt preserved foods D. Importance of fruits, vegetables, and whole grains E. Taste alterations in advanced stages 1. Soft foods that provide nutrition 2. Cold foods 3. Use of drinking straws 4. Avoid irritants 5. Adequate hydration 6. Sugarless candy, chewing gum and popsicles 7. Balanced diet for side effects of treatment

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Bibliography

Suren, P.,“Parental Obesity and Risk of Autism Spectrum Disorder”, Pediatrics 2014. Flett, K. “Outpatient Course and Complications Associated with Home Oxygen Therapy for Mild Bronchitis” Pediatrics, 2014

Internet Access to Articles

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