Adult Health Nursing Department

JORDAN UNIVERSITY OF SCIENCE & TECHNOLOGY FACULTY OF NURSING

ADULT HEALTH NURSING DEPARTMENT

COURSE SYLLABUS

NUR317: ADULT HEALTH NURSING PRACTICUM II Course coordinator Feda Swees RN, MSN

Aram Habhab,RN, MSN

INSTRUCTORS Ibtihal Al-makzomiRN, PhD

Manal Al-zgol, RN, PhD l

Asfa Amarneh, RN, PhD

Mona Taiem,RN,MSN

Abeer Al-kofahi,RN,MSN

Lamis Kazaela,RN,MSN

Alaa Anshasi,RN,MSN

Mahmood Nasrallah, RN,MSN

Awad Abo AWwad, RN,MSN IRBID-JORDAN Spring 2008-2009

NUR 317 2 Course Number & Title: NUR 317: Adult care Nursing Practicum II

Credits: Three (3) credit hours

Prerequisites: Nur (223), Nur (315),

Clinical Date & Time: SectionI: sun, Tues

Section II: Mon ,Wed

Course Coordinator: Fedaa Al-swies,Rn;MSN

Aram Habhab,RN, MSN

Course Description:

The clinical course for adult care nursing is offered in two semesters. Adult Health Nursing 2 (Clinical) is the second part. NUR 223 is the first part of this course. The objectives of both parts are to expand students' cognitive, psychomotor, and communicative skills. The students are guided to build on their past experience in the care of adult clients who are experiencing alterations in (metabolic, endocrine, renal, musculoskeletal, infectious diseases, nervous, immunology system, special senses & dermatology. Nursing process will be used to explore the role of the professional nurse in assisting clients to meet the biophysiological and psychosocial needs in different clinical settings. Communication skills, critical thinking, decision making, psychomotor skills, teaching-learning principles, keeping updated with current literature, and moral principles are emphasized in dealing with selected clients in clinical settings. A clinical rotation in variance clinical care setting will provide practical application of this course content.

Course Objectives: At the end of this course students will be able to:

a) Plan comprehensive care for clients experiencing health problems that incorporate a holistic analysis of client related variables, including clinical findings and treatments, gender, age, environment, and relevant psychosocial factors. b) Implement basic concepts from allied sciences and nursing in assisting clients to meet their needs. c) Recognize the need to view clients as holistic beings.

NUR 317 3 d) Develop critical thinking, and problem solving skills in dealing with selected alterations in health status. e) Use effective communication skills in collaborating with other health care professionals to meet the needs of socioeconomically diverse clients with health problems.

f) Provide accurate documentation for their nursing actions.

g) Demonstrate ability to function within a team.

h) Demonstrate responsibility for their nursing interventions.

i) Implement teaching-learning principles as a learner and a health care provider.

j) Demonstrate acceptable level of competency in selected psychomotor skills necessary for the care of adult clients with alterations in health status.

k) Demonstrate accountability, and responsibility for safe professional nursing practice.

l) Support their nursing actions with appropriate research findings.

m) Exercise ethical, legal, regulatory, and social responsibilities expected in the role of the student of professional nursing.

n) Organize time and resources in providing nursing care.

TEACHING STRATEGIES: Clinical Case studies Clinical discussion Clinical assignments Case presentations

RECOMMENDED BOOKS:

1. Smeltzer, S., and Bare, B. (2008). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (10th edition) J.B. Lippincott Co., Philadelphia, PA 2. Bickley L. S. & Hoekelman R. A. (2007). Bates guide to physical examination and history taking. (9th ed.). Philadelphia: J.B. Lippincott Company. 3. A recent drug handbook. 4. A recent laboratory and diagnostic tests handbook

NUR 317 4 Course Evaluation:

1. Clinical Evaluation 4/ semester. 30% (see Appendix A)

2. Work sheet 2/ semester. 5% (See Appendix B)

3. Patient Teaching 10% (See Appendix D) 5 Nursing Care Plan 10% (See appendix E) 6. Lab exam 5%

TOTAL 60%

4.OSCE 20% (See appendix D)

6. Written clinical 20%

TOTAL 40% TOTAL 100%

NUR 317 5 COURSE INFORMATION and POLICIES

1. Students are responsible for all special requirements and information presented in the course syllabus and Student Handbook.

2. Academic Progress: Students are responsible for contacting faculty members for consultation regarding a problem with, or questions about the course. Any student who earns a grade of 50% or less on any test or assignment is advised to contact the course instructor to discuss their academic progress.

3. Clinical Attendance: Clinical experience is designed to offer the student an opportunity for clinical practice under direction. It is very difficult to duplicate missed clinical time. However,

 The clinical day starts at 7:30 am, all the students must be in their assigned units picking patient assignment by 7:30 am. If the student arrived between 7:30 – 8:00 am he/she will be considered LATE. Three late instances/days are considered one absent, and absenteeism and tardiness will affect student clinical evaluation grade negatively.

 If a student misses more than 20% of the clinical days, he/she will fail the course and receive a course grade of 35%.

 If a student needs to discuss a grade received in clinical day, he/she must first meet with the responsible instructor.

4. Attire in Clinical Agency: Students are representatives of the Faculty of Nursing at JUST while in the clinical setting and must dress appropriately. Details regarding acceptable professional clinical attire (uniform, shoes, make-up, jewelry, etc.) will be explained to students prior to starting hospital clinical. Student who does not follow the policies regarding attire in clinical will not be allowed to stay in clinical site, will be asked to leave, and will be considered absent. Please refer to the student handbook for specific policies regarding attire in clinical setting.

NUR 317 6 5. Clinical Tools/Resources: a. Each student in clinical must be equipped with the following items:  Black, blue, and red pen  Pencil  Scissors  Stethoscope  Penlight torch  Eraser rubber  syllabus

b. Each clinical group of students must have the following resources:  One sphygmomanometer (borrowed from the school lab)  One text book  One laboratory and diagnostic procedure handbook  One drug handbook  One assessment book

6. Clinical Assignments: Various clinical assignments may be given to enhance student learning and interaction during clinical experience. Points will be deducted for late assignments. Graded assignments turned in after the due time noted will be lowered 10%. An additional 10% grade level will be lost for each successive late day.

7. Evaluation/Testing Policy and Procedure a. Clinical Evaluation/Testing Policy -Students are expected to be prepared for their clinical testing/evaluation (such as, clinical focus presentation, clinical assignment, teaching presentation etc.) on the assigned time and date. -Students must always be prepared for discussing their assigned clinical case with their clinical instructor/s.

- If a student is ill and unable to discuss their clinical assignment (clinical focus presentation, teaching presentation etc.), that student must inform the clinical instructor/s 24 hours before the due date. You must negotiate with the instructor/s to make-up clinical assignment within one week. Students that miss a scheduled clinical assignment with out an acceptable excuse MAY NOT BE ALLOWED TO MAKE-UP that assignment.

-Any doubts regarding students’ sharing of information, talking during, or any other indication of academic dishonesty during clinical testing/or evaluation will not be tolerated. (Refer to College/Student Handbook). Academic dishonesty will instances will be treated according to the college policy.

NUR 317 7 8. Announcements: You are responsible for any announcements posted by the Faculty of Nursing or by any member of the faculty. Additional notices and messages are posted on appropriate bulletin boards in the College of Nursing hallways. Students are responsible for messages announced in the lab and the bulletin boards. PLEASE CHECK THESE BULLETIN BOARDS ON A REGULAR BASIS.

9. Academic Honesty: When we use the information and language of others to enrich our reflection and research papers we must:  Tell the reader when we are quoting and indicate the source (person, book, article, etc.) of the quotation  Tell the reader when we are paraphrasing and indicate the source (person, book, article, etc.) of that information.  Quoting or paraphrasing the information and/or language of a source without naming the source is plagiarism. Plagiarism is unacceptable in an academic institution and is subject to penalty. Please consult your faculty member for additional information and policies regarding academic honesty.

10. Visitors: The Faculty of Nursing adheres to the following policy regarding visitors in the clinical setting: Students are not permitted to bring children, family members, or other guests to the clinical setting.

11. Disability: If you have specific physical, psychological or learning disabilities and require accommodations, please let us know early in the semester so that your learning needs may be appropriately met.

12. Diversity: The Faculty of Nursing adheres to the following policy regarding diversity: Students are to show respect for the interest, preferences, and opinions of others (clients, students, faculty, staff, etc.). There will be zero tolerance for displays of prejudice, discrimination, or hostility based on differences such as gender, nationality, religion, disability, age, or health status. Any student who violates this policy will be referred to the Dean.

13. Equipment/Materials: Any equipment or materials loaned to students becomes their responsibility and must be returned in proper condition at the designated date, time, and place. Students will not receive a course grade until all equipment and materials are returned.

NUR 317 8

Clinical Guideline

 By the end of the semester each student should have 4 clinical evaluation (see Appendix A).

 By the end of the semester each student should have 2 worksheets (see Appendix B).

 Each student should submit daily documentation sheet according to the case assigned(see Appendix C). 

 At the end of each clinical day, post conference will be conducted in order to discuss clinical focus topics (review clinical focus topics).  Each should be prepared for post conference topics.  Students will be assigned to discuss specific topics with his clinical instructors and colleagues.

 When the student has an assignment as clinical focus he/she has to be prepared according to the theoretical part week by week( see appendix D) .

 Each student should attend OSCE exam at the end of the semester. OSCE exam will be evaluated by clinical instructors according to the schedule

 Each student has to develop and conduct a teaching plan for a selected patient (see Appendix C)

 Each student will complete and submit a nursing care plan. The patient will be assigned for the students by the clinical instructors. ( see Appendix E).

 Each student should prepare and distribute the medication for his/her assigned patient under supervision of teaching assistant.

 student are required to know the medication ordered for his/her patient why they

were ordered, dosage, side effect, and are able to correctly calculate the doses.

 When administering medication remember Five Rights of Medication

Administration:

NUR 317 9 * Right patients: Check the medical order, check the medication label and check the patient. Don't assume you know who the patient is, and NEVER go by room and bed number alone. Simple ways to ensure your patient's identity are to ask him for his name, date of birth, physician name.

* Right Medication: Check the medical order and check the medication label.

* Right Dose: Check the medical order and the medication label.

* Right Time: Check the medical order and check the medication label. Check the time and give the medication at the time prescribed.

* Right Route: Check the medical order and check the medication label. Make sure the route is accessible. If it's p.o., can the patient swallow meds? If not, can it be crushed? Is the IV site appropriate? Can it be given via a peripheral line or does it need to be a central line, and vice versa?

 A clinical lab with common psychomotor skills for this course will conduct at the beginning of semester ,and at the end of these labs the student is required to be prepared for QIUZ in the topics and procedures conducted in the lab.

Jordan University of Science & Technology Faculty of Nursing

NUR 317 10 NUR 317

Appendix A CLINICAL EVALUATION TOOL

Students’ progress towards achievement of course outcomes will be evaluated based on their performance on written work, and clinical experiences. Below are the criteria that will be used to determine student achievement of the course outcomes. Students’ behavior will be assessed during each interaction throughout the course and feedback will be provided on an ongoing basis. A rating for each criteria will be assigned at the end of the course, based upon patterns of observed behavior, using the five-point scale described below.

4 = Excellent Performs safely and accurately without supportive cues. Assumes responsibility of behavior with initiative and in a self- directed manner. Synthesizes appropriate data and knowledge.

3 = Very Good Performs safely and accurately with minimal supportive cues Assumes responsibility of behavior; frequently takes initiative. Synthesizes appropriate data and knowledge with some assistance.

2 = Satisfactory Performs safely and accurately; requires frequent supportive cues. Assume responsibility of behavior; occasionally takes initiative. Synthesizes appropriate data and knowledge with frequent assistance.

1 = Provisional Performs safely and accurately only with supervision. Assumes responsibility; lacks initiative. Synthesizes appropriate data and knowledge only with assistance.

0 = Unsatisfactory Performs unsafely and inaccurately. Does not assume responsibility of behavior; displays no initiative. Unable to synthesize appropriate data and knowledge.

NUR 317 11 Student’s Name ______Student ID ______

Item 0 1 2 3 4 1 Adhere to the academic course information and policies in clinical practice. 2 Complete assignments on time. 3 Conduct comprehensive subjective and objective assessment, including physiological, psychological, medications, treatments, and diagnostic tests when planning care. 4 Maintain confidentiality concerning patient, doctors, nurses, clinical institution, peers, and others. 5 Behaviors indicate appropriate preparation for clinical experience 6 Maintain patient's privacy during nursing care. 7 Collect all equipments and perform nursing procedures correctly, completely, and on time. 8 Demonstrate self confidence and control in clinical situations 9 Perform nursing interventions appropriately and safely to meet patients’ needs. 10 Prioritize nursing interventions according to patient condition 11 Identify rationales for nursing interventions based on the current literature 12 Student’s actions are safe to patient, self, and others. 13 Follow the universal precautions when implementing nursing actions. 14 Utilize appropriate communication skills when interacting with patients, staff, peers, and faculty. 15 Assess and implement health teaching in patient/ family situations. 16 Keep instructor and staff informed about patient’s condition and seek their assistance in regards to decision making as needed. 17 Document nursing interventions clearly, completely, and precisely. 18 Assume responsibility of own actions. 19 Demonstrates the ethical and professional standards of nursing in practice. 20 Accept constructive criticism in a professional manner

Comments:------

NUR 317 12 Jordan University of Science & Technology Faculty of Nursing NUR 223 Appendix B The worksheet

Background Data: 5 POINTS Student Name: ______I. D. No: Date: ______Room/ Bed: Admission Date: ______Medical Diagnosis: Surgical Procedure: ______Date of Surgery Diet: ______

______History: Reasons for seeking care ( chief complaints on admission ): ( 2 points )

History of present illness: ( 6points ) ______significant events ( 1 points )

______focus of the care ( 1 points ) ______

NUR 317 13 Subjective data: 10 POINTS ______

Objective data (including medications, significant physical examination, and significant laboratory and diagnostic tests): 15 POINTS ______

______

Diagnosis (two prioritized nursing diagnosis): 10 POINTS 1. 2.

Planning: 10 POINTS Goal______Objective______Goal ______Objective______

Intervention ( 20 ) Rationales ( 10 )

NUR 317 14 Evaluation: 10 POINTS 1. ______

2.______

Jordan University of Science & Technology Faculty of Nursing NUR 223 Appendix C Documentation Sheet

Student Name: ------ID: ------

Biographical Data: Patient name: Admission date: Age: Medical diagnosis:

Date/Hour Focus ( Problem ) Progress notes

D: (Data):

A: (Action):

R: (Response):

NUR 317 15 ]

Appendix D Nursing 317 Patient Teaching Evaluation Criteria

Each student has to develop and conduct a teaching plan for a selected patient. The patient assigned for teaching must be different from the patient assigned for nursing case round presentation. The teaching plan will be evaluated according to the following criteria.

1. Background: 1% A. States patient profile B. States health history: 1. Chief complain 2. Heath habits. 3. Past health history. C. States significant abnormal physical examination findings. D. States the significant diagnostic procedure.

2. Assessment: 1.5% A. Collects Subjective and Objective data available resources. B. validates data according to current health problems.

3. Nursing Diagnosis 1.5% A. correctly states learning needs. B. Appropriately establish prioritize learning needs.

3. Planning: 1% A. States behavioral objectives that are measurable, observable, applicable, and reflect the stated needs B. Objectives must include cognitive, affective, and psychomotor domain

4. Implementations: 3% A. Content accurate, complete, and appropriate to patient level of understanding B. Teaching methods are appropriate C. content of teaching methods are prepared independently

NUR 317 16 5. Evaluation: 1% A. Evaluate client response to teaching regarding stated objectives; reflecting the cognitive, psychomotor, and affective domain B. Develop alternative plan, if objectives were not achieved

6. Documentation: 1% A. Submit a brief teaching process at the end of teaching B. Document patient response and outcome under the supervision of faculty.

Patient Teaching Documentation

S:------O------Nsg Dx------Evaluation (patient response)------

Student signature------Date------

NUR 317 17

Appendix E

Comprehensive Nursing Care Plan NUR 317 I. Student Profile: Student Name: I. D. No.: Instructor: Date:

II. Patient Profile: Patient’s Name: Date and place of Birth: Hospital: Ward: Room No.: Bed NO.: Admission Date: Medical Diagnosis: Date of Surgery: Diet: Physical Limitations: Allergies: Safety Precautions: I.V. Therapy: Religion: Religious Practices: Specific Treatments: (specify type and frequency): Communication Problems:

III. Health History: (see appendix F for more details) 1. Health Perception/ Health Management Patterns: Perception of Quality of Health:

Importance of Health:

Primary Care Provider:

Perceived control and management of health:

2. Health Habits: Smoking: Cigarettes/ day Alcohol: times/day Legal/ illegal drugs: type, frequency, rout, & rationale. Seat belt: Regular Exercise:

Dietary considerations and restrictions: 3. Current Health Status: (Chief Complaint and History of Present Illness)

NUR 317 18 4. Past Health History: Prenatal and Birth History:

Problems in Growth and Development:

Common Childhood illnesses:

Immunizations:

Screening Tests:

Hospitalizations:

Serious Accidents, Injuries, Illnesses, Treatments:

5. Environmental Factors:

Income:

Other Income sources: (specify source, & amount):

Marital Status:

No. of Children:

Age, Sex, and occupation:

No. of Family members:

Primary Provider:

Occupation:

Job Satisfaction/Concerns:

6. Family History: Draw a Family Tree: Grandparents, parents, siblings, mate, children, grandchildren. Indicate health status of each as age and (alive or dead), cause of death and significant illnesses or problems.

IV. Review of Body Systems: (see appendix G for more details)

V. Physical Examination: (See Appendix H for more details) General:

NUR 317 19 Vital Signs, Height, Weight: Temp.: Pulse: B.P.: Resp.: Height: Weight:

Nutrition Assessment:

Mental Status:

Nose and Sinuses:

Mouth and Pharynx:

Peripheral Vascular:

Thorax and Lungs:

Heart:

Breast and Axillae:

Abdomen:

Inguinal area:

Spine and Extremities: (Musculoskeletal)

Spine and Extremities: (Neurological)

NUR 317 20 VI. Special Tests including lab, x-ray, or any other diagnostic procedures.

Test or Procedure Results Interpretations

VII. Medications:

Medication’s name, dose, Classification Nursing implications route, frequency

NUR 317 21 WORKING NURSING CARE PLAN ASSESSMENT DIAGNOSES PLANNING IMPLEMENTATION EVALUATION

NUR 317 22 Guide to Grade Nursing Care Plan NUR 317 Each student will complete a nursing care plan on a selected patients. The patients chosen for nursing care plan must be different from the ones used for case study. The first nursing care plan due date is

Nursing care plans will be evaluated according to the following specific criteria:

I. Background 40% 1. Student Profile 1% 2. Patient Profile 2% 3. Health history 10% A. Health Perception 1% b. Health Habits 1% c. Current Health status 2% d. Past health history 2% e. Environmental Factors 2% f. Family History 2% Total 10% 4. Review of body system 8% 5. Physical Examination 9% 6. Special Tests 5% 7. Medications 5% Total 40% II. Working Nursing Care Plan: 60% 1. Assessment 15% a. Assessment includes objective data which support the nursing diagnoses (5%) b. Assessment include subjective data Which support the nursing diagnosis. (5%) c. Assessment data reflect patient current Problems. (5%) Total 15% 2. Diagnosis: 10% a. Nursing diagnoses are derived from the assessment data. (3%) b. Nursing diagnosis are prioritized. (4%) c. Nursing diagnoses are stated in appropriate terminology. (3% ) Total 10% 3. Planning 10% a. Goals and objectives relate specifically to the identified nursing diagnoses. (4%) b. Goals objectives reflect the direction of the nursing interventions. (3%) c. Objectives are attainable, measurable, and

NUR 317 23 appropriate to the patient. (3%) Total 10% 4. Implementations: 15% a. Nursing intervention are specific and inclusive (4%) b. Nursing intervention are prioritized. (3%) c. Nursing intervention are individualized. (2%) d. Teaching interventions are based on identified learning needs. (2%) e. Interventions are updated. (2%) f. Rationales are scientifically accurate. (2%) Total (15%) 5. Evaluation: (10%) a. Evaluations reflect stated objectives and goals (4%) b. Evaluations indicates how well objectives were achieved/ not achieved. (3%) c. Evaluations indicate if and why objectives were appropriate. (3%) Total 10% Total 60%

NUR 317 24 Appendix F Guide lines for Health History NUR 317

Use the following format to complete health history for all your assignments this semester.

1. Current health status A. Admission chief complaints B. History of the present illness.

2. Health Habits: A. Smoking: (include No. of cigarettes/ day) B. Alcohol : ( include amount/ day) C. Legal and illegal drugs (include type, amount, rout and rational) D. Seat belt E. Regular Exercises ( include type duration) F. Dietary practices ( include preference, considerations, and restrictions)

3. Past health history: A. Parental and birth history. B. Problems in growth and development. C. Common childhood illness D. Immunizations. E. Screening tests: F. Past hospitalizations. G. Serious accidents, injuries, illnesses, and treatments

4. Environmental factors: A. Income (include other income resources specifying source and amount) B. Marital status (if married include No. of children, their ages, sexes, and occupations) C. No. of people living in the same household. D. Primary care providers. E. Job satisfaction/ concerns F. Marital satisfaction/ concerns.

NUR 317 25 Appendix G Nursing 317 Guidelines for Review of Body Systems

Use the following format for review of body systems to completes all your assignments:

GENERAL:

[ ] Recent weight changes. [ ] Fever/ chills. [ ] Malaise/ general weakness. [ ] Mood changes

SKIN, HAIR, AND NAILS:

[ ] Rashes [ ] Lesions [ ] Itching [ ] Color change [ ] Dryness [ ] Brittle nails [ ] Cracking [ ] Others

[ ] Headache [ ] Seizure [ ] Fainting [ ] Head injuries [ ] Dizziness

[ ] Changes in vision [ ] Blindness [ ] Cataract [ ] Diplopia [ ] Redness [ ] Pain [ ] Photophobia [ ] Glasses (last exam date and results) [ ] Contact lenses (type) [ ] Glaucoma

NUR 317 26 [ ] Drainage [ ] Infection [ ] others

[ ] Difficulty in hearing/ deafness [ ] Tinnitus [ ] Vertigo [ ] Infection [ ] Discharge [ ] Others

NOSE AND SINUSES:

[ ] Nasal stuffiness [ ] Frequent colds [ ] Hay fever [ ] Nose bleeds [ ] Sinus troubles/ infection

MOUTH, PHARYNX, AND NECK:

[ ] Bleeding from gums/ teeth [ ] Oral infection [ ] Dental problems [ ] Dentures (last exam, time and results) [ ] Hoarseness [ ] Swelling in neck [ ] Frequent sore throats [ ] Lumps in neck [ ] Dysphagia [ ] Stiffness in neck [ ] other

BREASTS:

[ ] Prurutus, pain, lumps [ ] Nipple discharge [ ] Dimpling of skin [ ] Enlargement (gynecosmastia) [ ] Performance of self breast exam [ ] Mammograms (date, results)

NUR 317 27 [ ] Steroids [ ] others

LUNGS:

[ ] Shortness of breath [ ] Dyspnea on exertion [ ] Orthopnea [ ] Pain with respiration [ ] Cough [ ] Sputum (color, frequency, quantity) [ ] Hemopteysis [ ] Wheezing [ ] Cyanosis [ ] Pneumonia [ ] Bronchitis [ ] Emphysema [ ] Asthma [ ] TB test ( results and date) [ ] TB exposure [ ] Chest X-ray ( date and results) [ ] others

HEART:

[ ] Heart troubles [ ] High blood pressure [ ] Heart murmurs [ ] Paroxysmal nocturnal dyspnea [ ] Chest discomfort/ pain [ ] Palpitations [ ] Syncope [ ] Rheumatic fever [ ] Coronary Artery disease [ ] Heart attack [ ] ECG ( results and dates) [ ] Other heart tests [ ] Others

PERIPHERAL VASCULAR:

[ ] Edema [ ] Swelling/ pain calves [ ] Pain/ ulcerations or discoloration of extremities

NUR 317 28 [ ] Cramps [ ] Varicose veins [ ] Others GASTROINTESTINAL: [ ] Nausea [ ] Vomiting [ ] Hematemesis [ ] Indigestion/ heart burn [ ] Abdominal pain [ ] Jaundice [ ] Hepatitis [ ] Melena [ ] Clay colored stools [ ] Incontinence of stool [ ] Diarrhea [ ] Change in bowel habit [ ] Constipation [ ] Hemorrhoids [ ] Excessive gas [ ] Hernia [ ] Ulcer [ ] Gall bladder stone/ colic [ ] Pancreatic disease [ ] Others

URINARY: [ ] Frequency [ ] Urgency [ ] Infection [ ] Dysuria [ ] Nocturia [ ] Hematuria [ ] Stream site and force [ ] Hesitancy [ ] Incontinence (stress, urge, dribbling) [ ] Others

MALE GENITALIA: [ ] Discharge [ ] Genital lesions [ ] Testicular pain/ mass [ ] Syphilis positive serology [ ] Gonorrhea [ ] Sexual problems [ ] Others

NUR 317 29 FEMALE GENITALIA: [ ] Viginal discharge [ ] Pruritis [ ] Genital lesions [ ] Painful intercourse [ ] Post menstrual bleeding [ ] Post coital bleeding [ ] Pap smear ( results, dates) [ ] Other ENDOCRINE: [ ] Heat and cold intolerance [ ] Thyroid problems [ ] Neck Surgery [ ] Diabetes

HEMATOPOIETIC: [ ] Abnormal bleeding/ bruising [ ] Anemia [ ] Transfusions [ ] Leukemia [ ] Blood type [ ] Others

SPINE AND EXTREMITIES: MUSCOLOSKELETAL [ ] Arthritis [ ] Joint stiffness [ ] Joint swelling [ ] Joint pain [ ] Muscle weakness [ ] Muscle cramps [ ] Backache [ ] Limited ROM [ ] Others

SPINE AND EXTREMITIES: NEUROLOGICAL [ ] Paresthesia/ numbness [ ] Paralysis [ ] Incoordination [ ] Disturbed balance [ ] Fainting (LOC) [ ] Blackouts [ ] Tics [ ] Tremors [ ] Spasms [ ] Others

NUR 317 30 PSYCHIATRIC (Problems in the following areas): [ ] Spouse [ ] Family [ ] Peers [ ] Insomnia [ ] Depression (interfering with ADL’s) [ ] Anxiety interfering with ADL’s) [ ] Mood swings [ ] Delusions [ ] Hallucinations [ ] Eating, sleeping, memory problems [ ] Others

NUR 317 31 Nur 317 Appendix H Guidelines for Physical Assessments Use the following format to conduct and record results of physical examination for all assignments 1. GENERAL: Statement to include observed state of health, posture, appearance, body odors, manner, affect, signs of distress, speech, and level of awareness. 2. VITAL SIGNS: Temp., Pulse, BP, Resp., Height, and Weight. 3. NUTRITION: Describe diet and determine the following: Weight loss, Ideal Body Weight (IBW), Usual Body Weight (UBW), Present Body Weight (PBW), Energy requirements, and fluid Requirements. In addition identify risk factors. Determine IBW As follows: Adult Male: Allow 106 pounds for the first 60 inches and add 6 pounds for each additional inch. Adult Female: Allow 100 pounds for the first 60 inches and add 5 pounds for each additional inch. Determine weight loss as follows: IBW - PBW ------X 100 = % IBW IBW OR

UBW - PBW ------X 100 = % of weight loss

UBW Determine energy requirements as follows: Body weight in Kg X 35 Kcal Determine fluid requirements as follows: Body weight in Kg X 35 cc. Note: Increase calories 7% and fluids 125cc for each 1 F increase in temp. Risk factors: 4. MENTAL STATUS: Record a statement about the observation of appearance, behavior, mood, thought process, thought content, perceptions, cognitive functions. 5. SKIN: Note color, temp., texture, moisture, presence of lesions, mobility, turgor, and describe appearance of nails. 6. HEAD: Describe hair, scalp, skull, and results of cranial nerves testing. 7. EYES:

NUR 317 32 Report visual acuity, appearance of eyebrows, eyelids, eyelashes, lacrimal apparatus, sclera, cornea, conjunctiva, corneal light reflection, pupilary light response, extra occular muscle movement, accommodation, peripheral vision.

8. EARS: Record result of inspection, palpation of the outer ear, hearing acuity, whisper test. 9. NOSE AND SINUSES: Report description of the external nose, nasal mucosa, septum, presence of tenderness, transillumination. 10. MOUTH AND PHARYNX: Record description of observation of lips, buccal mucosa, gums, teeth, roof of the mouth, tongue, pharynx, movement of uvula, gage reflex. 11. NECK: Note palpation of lymph nodes, thyroid gland, position of trachea, presence or absence of masses. 12. PERIPHERAL VASCULAR: Record peripheral pulses, capillary refill, edema, skin temp., and enlarged nodes in lower limbs. 13. THORAX AND LUNGS: Record results of inspection, palpation, and auscultation of lungs. Note diaphragmatic excursion. 14. HEART: Record results of inspection, palpation, and auscultation of the heart, note apical pulse, presence of extra heart sounds, or murmurs. 15. BREAST AND AXILLAE: Record results of inspection and palpation of breast and axillae. 16. ABDOMEN: Record result of inspection, palpation, percussion, and auscultation of abdomen. Note liver size, palpable organs, tenderness, and umbilical reflexes. 17. INGUINAL AREA: Record results of inspection and palpation of inguinal area. Note presence or absence of hernias. 18. SPINE AND EXTREMITIES: MUSCULOSKELETAL Record results of inspection and palpation of all joints. Note test results of ROM and muscle strength of all extremities. Check for scoliosis. 19. SPINE AND EXTREMITIES: NEUROLOGICAL Record results for reflex tests, gait, balance, and coordination. Note sensation to pain, temp. light touch vibration. Note position discrimination.

NUR 317 33 JUST

Faculty of Nursing

Nur 317

Clinical focus management of patients with hepatic & biliary disorders.

1. Identify the metabolic functions of the liver and the alterations in the functions that occur with liver disease. 2. Relate jaundice, portal hypertension, ascites, nutritional deficiencies , and hepatic coma to pathophysiologic changes of the liver 3. Develop a system to assess patients with hepatic dysfunction; physical exam ,lab tests, skin, eye, abd. , renal assessment ,…..etc. 4. Compare the various types of hepatitis and their causes, prevention, clinical manifestations, management, prognosis, and home health care needs. 5. Identify hepatic cirrhosis ( pathophysiology, clinical manifestations, and management ) 6. Discuss common approaches to management of biliary disorders ( cholelithiasis, cholecystitis, )

Procedures

7.Interpret liver function test and diagnostic tests

8.Identify the nursing role for patient undergoing liver biopsy, paracentesis, and E.R.C.P.

9.Demonstrate effective assessment and management for patients with viral hepatitis and undergoing surgery for gall bladder disease

Post-conference

10.Discuss the importance of lab test and diagnostic procedure for the process of diagnosis

11.Discuss a plan to prevent the risk of contracting viral hepatitis

NUR 317 34 JUST

Faculty of Nursing

Nur 317

Clinical focus

Management of patients with DM

1. Define type I and type II DM 2. Relate clinical manifestations to pathophysiological changes 3. Develop a system to assess patients with DM; physical exam, Lab tests cardiovascular, skin and neurological assessment. 4. Identify early manifestations of acute and chronic complications 5. Discuss common approaches of insulin and oral hypoglycemic agents

Procedures

6. Practice methods used to insulin administration, injection site, preparation. 7. Teach patients the significance of nutritional, self-monitoring and exercise management 8. Demonstrate and teach self-management of insulin administration 9. Interpret Lab findings, blood and urine test 10. Demonstrate effective assessment and management of diabetic foot

Post-conference

11. Discuss the importance of compliance for glucose control 12. Discuss a plan to prevent/delay complications of DM 13. Discuss the importance of Lab test, glucose, for the process of diagnosis

NUR 317 35 JUST

Faculty of Nursing

Nur 317

Clinical focus

Management of patients with endocrine disorders:

1. Describe the functions and hormones secreted by each of the endocrine glands. 2. Develop a system to assess patients with endocrine disorders , physical exam , skin, thyroid gland, ….and lab test 3. Compare hypothyroidism and hyperthyroidism: their causes, clinical manifestations, management, and nursing interventions. 4. Compare hyperparathyroidism and hypoparathyroidism: their causes, clinical manifestations, management, and nursing interventions. 5. Compare Addison’s disease with Cushing’s syndrome: their causes, clinical manifestations, management, and nursing interventions. 6. Differentiate between acute and chronic pancreatitis.

Procedures

7. Demonstrate effective assessment and management for patient undergoing thyroidectomy 8. Teach patients the significance of corticosteroid therapy 9. Interpret lab findings and diagnostic evaluation

Post conferences

8. Discuss the major side effects of corticosteroid therapy and dosage schedule.

NUR 317 36 JUST

Faculty of Nursing

Nur 317

Clinical focus

Assessment and management of urinary and renal function

1. Use assessment parameters for determining the status of renal and urinary function. 2. Describe diagnostic tests used to determine renal and urinary function: (urinalysis, renal function test , ultrasound, endourology, urodynamic, x- ray and imaging studies( KUB, CT, IVP, ANGIOGRAPHY…)) 3. measurement1. Describe the sequence of events leading to urinary tract infection in a patient with an indwelling urinary catheter. 4. Outline the principles of management of a patient with an indwelling urinary catheter. 5. Compare and contrast urinary retention and urinary incontinence: their causes, clinical manifestations, complications, and management. 6. Compare and contrast hemodialysis and peritoneal dialysis in terms of underlying principles, procedures, complications, and nursing considerations.

Procedures

7. Practice methods of catheter administration and managemen 8. Interpret lab test and diagnostic procedure 9. Demonstrate effective assessment and management for patient undergoing dialysis

Post conferences

10.Discuss a plan to prevent /delay complications of peritoneal and hemodialysis 11.Discuss strategies for the management of urinary incontinence in elderly patients

NUR 317 37 JUST Faculty of nursing Nur 317

Clinical Focus

Management of patient with musculoskeletal dysfunction

1. Identify types of fractures 2. Identify the clinical manifestations of a fracture and the emergency management of the patient with a fracture. 3. Discuss nursing care for patient with a simple fractures and vertebral fractures. 4. Identify management measures of immediate and delayed complications of fractures. 5. Discuss of nursing care and management of the patient with a cast. 6. Discuss the potential complication of applying cast and relate clinical manifestation to path physiological changes 7. Differentiate between skeletal & skin traction 8. Compare the nursing needs of the patient undergoing total hip replacement with those of the patient undergoing total knee replacement.

Procedures

9. Demonstrate effective assessment and management of patient with cast and traction

10. Practice method of applying skin traction ,and apply dressing

9. Practice pre-post operative care of patient under going total hip and total knee replacement 10. Apply the important physical exam for such patient: musculoskeletal peripheral, and neurological system

Post conferences

11. Discus management plan for patient with cast and traction 12. Discus the importance of X-rays and blood tests of diagnosis

Clinical Focus

Special Senses

Assessment and management of patients with vision problems

1. Assess of patients with vision disorders including health history and physical exam 2. Identify the management for patients with glaucoma. 3. Identify the management for patients with cataract 4. Describe the emergency care of patients with traumatic eye injury. 5. Describe the nursing care related to retinal detachment

Procedures

6. Identify diagnostic tests for assessment of vision and evaluation of visual disabilities(e.g slit lamp) 7. Demonstrate instillation of eye drops and ointment 8. Teach patient discharge instruction after ocular surgery

Post conferences

9. Differentiate between cataract and glaucoma. 10. Discuss the teaching plan for patient undergoing eye surgery

Clinical Focus

Assessment and management of hearing problems and ear disorders

1. Identify the clinical manifestations and management of the patient with different ear problems including hearing loss. 2. Differentiate problems of the external ear from those of the middle ear and inner ear.

Procedures

3. Demonstrate instillation of ear drops and ointment 4. Demonstrate ear irrigation for external auditory canal 5. apply ear physical exam

Post conferences

6. Discuss ear problems(external, middle and internal) and there management

NUR 317 40

JUST Faculty of nursing Nur 317

Clinical Focus

Management of patients with Burn Injury

1. Identify the classification system used for burn injuries 2. Identify the local and systemic effect of burn injuries. 3. Identify the three phases of burn care and the priorities of care for each injury. 4. Relate nursing management to the following areas of management: pain management, restrictions of activity and joint motion, psychological support of the patient and family, nutritional support, pulmonary care, patient and family education.. 5. Use the nursing process as a framework for care of the patient during the emergent/resuscitative phase, the acute phase, and the rehabilitation phase of burn care.

Procedures

6. Apply the nurse's role in each of the following: wound cleansing, dressing changes, topical antibacterial therapy, and debridement 7. Teach patient the importance of clean dressing, nutritional management, using fluid therapy and antibiotics

Post conference

8. Discuss the classification system used for burn injuries 9. Discuss the three phases of burn care and the priorities of care for each injury 10.Discuss the nurse's role in each of the following: wound cleansing, dressing changes, topical antibacterial therapy, and debridement

NUR 317 41 JUST Faculty of Nursing Nur 317

Clinical focus

Management of patients with neurological disorders/dysfunctions

1. Develop a system to assess and identify health problems of patients with neurological disorders 2. Demonstrate effective skills related to management of patients with increased intracranial pressure and altered level of consciousness 3. Discuss major drugs used for patients with increased intracranial pressure, epilepsy, Parkinson's disease and other neurological disorders 4. Relate clinical manifestations of cerebrovascular accidents to pathological alterations occurred.

Procedures:

5. Demonstrate skills required for a systemic history taking and physical examination for patients with neurological health problems 6. Identify nursing interventions/skills for patients undergoing a diagnostic procedure, lumber puncture, MRI, CTS, EEG 7. Demonstrate effective skills in preparation and administration of thrombolytic agents for patients with cerebrovascular accidents. 8. participate in nursing care required for patients with increased intracranial pressure and altered level of consciousness

Post-conference 9. Discuss a comprehensive nursing care plan for patients with altered level of consciousness 10. Discuss interventions required to prevent/decrease intracranial pressure 11. Discuss nursing interventions to maintain the safety of patients with neurological disorders 12. Discuss interventions used to improve communication of patients with neurological disorders.

Clinical focus

Oncology Nursing

1. Describe the significance of health education and prevention care in decreasing the incidence of cancer. 2. Utilize nursing process for a patient with cancer

Procedures 3. Document nursing care for cancer patient using nursing process approach

Post –conference 4. Differentiate between benign and malignant tumors 5. Describe the role of surgery, radiation therapy, chemotherapy, bone marrow transplantation, and other therapies in treating cancer. 6. Describe the special nursing needs of patient receiving chemotherapy. 7. Use the nursing process as a framework for care of patient with cancer.

Clinical focus

Management of patient with vascular disorders

1. Define and compare between venous insufficiency and arterial insufficiency 2. Relate clinical manifestations of both venous and arterial insufficiency to pathophysiological changes. 3. Assess the peripheral vascular system and explore any changes related to the disorder 4. Utilize nursing process for a patient with vascular disorders 5. Identify the common complications for venous and arterial insufficiency. 6. Define the Hypertension and categories of abnormal BP 7. Identify the risk factors for Hypertension 8. Utilize nursing process for a patient with hypertension

Procedures

7. Practice methods used for measurement of blood pressure and pulse. 8. Teach patients with peripheral vascular disorders the significance of nutritional therapy, self monitoring , lifestyle changes, and medications. 9. interpret diagnostic procedures and lab findings that directly related to patient with a vascular disorder. 10. Document nursing care using nursing process approach.

Post –conference 11. Discuss different types of vascular insufficiencies and their complications such as leg Ulcers, edema, etc..

NUR 317 44

NUR 317 45