Nurr 201 10 Credits Fall 2009 table of contents section a page no

Course Name: Advanced Nursing Interventions Part 1

Central Course Objective: Applies the concepts of caring, wellness, and illness in meeting the needs of unique individuals with increasingly complex health issues through the use of the nursing process and critical thinking.

Theory Objective: Analyzes the needs of the unique individual with the focus on advanced medical/surgical health conditions.

III through VIII

III through VIII
1. Fluid & Electrolytes, acid-base imbalances

A. Pathophysiological deviations in patients experiencing fluid and electrolyte imbalances.

1. Causes, clinical manifestations, and therapeutic and nutritional management of imbalances in: Potassium, sodium, calcium, magnesium, and phosphate.

2. Fluid excess/deficit: clinical manifestations, therapeutic and nutritional management

B. Acid Base Imbalances

1. Metabolic Acidosis and alkalosis; Respiratory acidosis and alkalosis

2. Compensatory mechanisms

3. Systematic assessment of arterial blood gases.

C. Oral and IV fluid and electrolyte replacement
2. Genitourinary system disorders: Describe the pathophysiological impact on patients experiencing impairments in the functioning of the genitourinary system:

A. Structures, functions, assessment and diagnostic studies of the urinary system

B. Urinary tract infection and pharmacological management of the adult and child

1. Lower UTI – cystitis

2. Upper UTI – acute and chronic pyelonephritis

3. Urethritis

4. Urethral diverticula

5. Interstitial cystitis

6. Renal Tuberculosis

C. Disorders of the kidney: etiology, clinical manifestations, therapeutic pharmacologic, and nutritional management of the adult and child

1. Acute and chronic glomerulonephritis and acute poststreptococcal glomerulonephritis

2. Good pasture Syndrome

3. Nephrotic syndrome

D. Obstructive uropathies: Etiology, clinical manifestations, therapeutic pharmacologic, and nutritional management

1. Urinary tract calculi

2. Strictures: Ureteral or urethral

E. Renal Vascular Problems

1. Nephrosclerosis

2. Renal artery stenosis

3. Renal vein thrombosis

F. Hereditary renal disease

1. Polycystic kidney disease

Lecture/class discussion

Readings:

Lewis et al., 2007, Ch. 17

Associated Study Guide for Lewis

Adams & Koch, Ch. 42
Prior to class:

Complete the Study guide (with answer sheet) provided in the assignment section of Blackboard

Lecture/class Discussion

Readings:

Lewis, 2007 Ch. 45 & 46

Associated study guide for Lewis Hockenberry, Ch. 27

Brooks, Lesson 4

Adams & Koch, Ch. 51
Preusser Case Study, Ch 5, #59
Quizzes

Exam

Quiz

Exam

III through VIII

G. Neoplastic disorders of the urinary tract

1. Wilms Tumor

2. Kidney, bladder, or prostate cancer

H. Urinary incontinence and retention

I. Instrumentation

1. Ureteral catheters

2. Suprapubic catheters

3. Nephrostomy tubes

J. Surgery of the urinary tract

1. Urinary diversion

A. Describe the structure and function of the upper and lower respiratory tract and chest wall.

B. Differentiate normal and abnormal findings of altered pulmonary function and identify nursing assessment related to the following clinical manifestations.

1. Dyspnea

2. Abnormal breathing pattern

3. Hypo/hyperventilation

4. Cough/hemoptysis/sputum

5. Cyanosis

6. Pain

7. Clubbing

9. Sounds breath/voice/percussion

C. Identify common measures of pulmonary function and relationship of lung volumes and capacities.

D. Analyze difference between restrictive and obstructive pulmonary disease

E. Identify and describe the etiology, pathophysiology, clinical manifestations, interdisciplinary care, and appropriate nursing care of adults with upper respiratory problems.

1. Nasal fracture

2. Expistaxis

3. Chronic Sinusitis

4. Influenza

5. Sleep Apnea

6. Tracheostomy

7. Laryngectomy

F. Identify basics of respiratory acid-base physiology with respiratory alterations. Priority nursing diagnosis for acid-base disturbance, collaborative and nursing management of a patient experiencing an acid-base disturbance

G. Identify and describe etiology, pathophysiology, clinical manifestations, interdisciplinary care, and appropriate nursing care of patients with lower respiratory and obstructive problems.

1. Pneumothorax

2. Acute bronchitis

3. Pneumonia

4. Tuberculosis

a. Diagnostic tests: Mantoux test, CXR, sputum for acid fast bacillus

b. Drug regimen

5. COPD emphysema and chronic bronchitis

a. use of oxygen, methods of administration,

b. CO2 narcosis, and oxygen toxicity

c. nutritional therapy for the COPD

d. patient teaching

6. Asthma

a. Compare the inflammatory process early vs. late phase

b. Diagnostic measures and classification

c. Nurses role in prevention

d. Management during an acute attack

e. Current recommendations for pharmacologic treatment

7. Lung Cancer

a. Risk factor for lung cancer

b. Nurses role in primary prevention

c. Nursing implications for three standard

d. Treatments of lung cancer

e. Surgical Therapy

8. Radical neck dissection and other surgical interventions

9. Bronchiectasis

10. Cystic Fibrosis

H. Identify various pharmacologic agents used to treat respiratory disorders and discuss nursing implications for patients receiving these medications.

1. Corticosteroids

2. Beta agonist

3. Mast cell stabilizers

3. Leukotriene modifiers i.e. Singular

4. Methylxanthines

5. Anticholinergics

6. Expectorants and mucolytics

7. Antitussives

I. Identify how respiratory function is affected in infants and children by structural differences and immunologic immaturity.

J. Identify and describe the etiology, pathophysiology, clinical manifestations, and interdisciplinary care and appropriate nursing care of the following pediatric respiratory disorders.

1. Croup Syndromes

2. Acute epiglottitis

3. Acute Laryngitis

4. LTB

5. Acute spasmodic laryngitis

7. Pharyngitis

8. Tonsillitis

9. Pneumonia

10. Otitis Media

11. RSV

13. Tuberculosis

14. Asthma

15. Cystic Fibrosis

K. Describe the diet therapy, rationale and related nursing interventions used to meet the nutritional needs of patients with respiratory disorders.

Lecture/class discussions/case studies

Readings:

Brooks Lesson 3

Lewis Chapters 26, 27, 28, 29

Lewis Chapter 17, 333-341

Sole, 2009, Ch. 9, pp. 173-193, pp. Sole, 2005, pp. 159 – 179

Grodner, Chapter 20. pp 460-463

Lilley, 2007, Ch. 35, 36, 37, 38, & 40

Hockenberry Chapter 23

Murphy Chapter 23

Preusser, 2009, Ch. 2

Case Study

Written assignment

III-VIII

6. Hematologic/Lymphatic System

A. Review the pathophysiology of the hematologic and lymphatic systems of adult and children

B. Differentiate the types of blood cells and their function.

C. Identify assessment findings common to deviations in the

hematologic/lymphatic systems.

1. 
   Assessment findings
   
2. 
   Lab data
   

and lymphatic systems.

E. Identify and describe the etiology, pathophysiology,

interdisciplinary care, risk factors, diet therapy and appropriate

nursing care of adults and children with the following

hematologic/lymphatic system disorders:

1. 
   Anemia
   

b. Iron-deficiency anemia

c. Thalassemia

d. Vitamin B12 deficiency

e. Folate deficiency

f. Acute hemorrhagic anemia

g. Aplastic anemia

h. Anemia of chronic illness

2. Sickle cell disease

3. Hemochromatosis

4. 
   Polycythemia
   

4. 
   Thrombocytopenia
   
5. 
   Hemophilia A & B
   
6. 
   DIC
   

4. 
   Neutropenia
   
5. 
   Myelodysplastic Syndrome
   
6. 
   Leukemia
   

4. 
   Hodgkin’s Lymphoma
   
5. 
   Non-hodgkin’s Lymphoma
   
6. 
   Multiple Myeloma
   

1. Vitamins and Minerals

a. Vitamin K

b. Cyanocobalamin

c. Iron

d. Folic Acid

a. Erythropoietin

b. Neupogen

G. Identify the different types of, care involved, and adverse

reactions in blood component therapy.

Lecture/class discussions

Practice NCLEX questions

Video: Blood

Lewis; Ch. 30

Lewis Ch. 31
Sole (2005) Ch. 15 or Sole (2009) Ch. 16
Hockenberry (2005) Ch. 26, pp. 939-972 and pp. 978-980, or Hockenberry (2009) Ch. 26, pp. 912-939 and pp. 943-946
Lilley; Ch. 49, pp. 767-769

Ch. 54, pp. 832-833, pp. 836-838

Chapter 56
Grodner; Ch. 7, pp. 137-140

Ch. 8 pp. 174-177

Review Lilley and Grodner

Review Lewis, Sole, and Hockenberry

Written exam
Quizzes

III-VIII

A. Review the anatomy, physiology and assessment of the cardiovascular system in adults and children.

1. Heart and vascular system

2. Conduction system

3. Mechanical system

B. Identify pertinent assessment findings that are related to the cardiovascular system

1. Subjective data

2. Objective data

3. Assessment abnormalities, etiology and significance

4. Geriatric differences

C. Emphasize the role of the autonomic nervous system in regulation of the cardiovascular system.

D. Describe the pathophysiology, clinical manifestations, complications, nursing and collaborative care of patients with hypertension.

1. Mechanisms involved in regulation of BP

2. Classification of hypertension

3. Primary versus secondary hypertension

4. Hypertensive crisis

5. Pediatric hypertension

E. Identify strategies the nurse implements in the prevention of hypertension; risk factors, nutrition, patient and family teaching.

F. Describe the pathophysiology, clinical manifestations, and complications of coronary artery disease.

1. Modifiable risk factors

2. Unmodifiable risk factors

3. Cultural and ethnic considerations

4. Types of serum lipids

5. Health promoting behaviors for decreasing risk factors

6. CAD in women

G. Describe the pathophysiology, clinical manifestations, complications, diagnostic studies, nursing and collaborative care for patients with angina.

H. Describe the clinical pathophysiology, clinical manifestations, complications, diagnostic studies, nursing and collaborative care for patients following a myocardial infarction.

1. Emotional and behavioral responses to MI

2. Patient and family teaching

I. Identify pharmacologic therapy and the corresponding nursing management for patients with coronary artery diseases.

1. Positive Inotropic Drugs

2. Antidysrhythmic Drugs

3. Antianginal Drugs

4. Antilipemic Drugs

5. Coagulation Modifier Drugs

6. Morphine

J. Describe the clinical pathophysiology, clinical manifestations, complications, diagnostic studies, nursing and collaborative care for patients with or at risk for sudden cardiac death.

K. Describe the clinical pathophysiology, clinical manifestations, complications, diagnostic studies, nursing and collaborative care for adults and children with heart failure and cardiomyopathy.

1. Types of heart failure (HF)

2. Acute decompensated HF and pulmonary edema

a. Core measures for HF

3. Chronic HF

4. Drug therapy

5. Nutritional therapy

6. Cardiac transplantation

L. Dysrhythmias

1. Infective endocarditis

2. Pericarditis

3. Myocarditis

4. Rheumatic fever and heart disease

5. Cardiomyopathy

N. Describe the clinical pathophysiology, clinical manifestations, complications, diagnostic studies, nursing and collaborative care for patients with vascular disorders.

1. Peripheral arterial disease

2. Aortic aneurysms

3. Disorders of the vein

O. Explain the purpose and actions of anticoagulant therapy and the nursing management of patients receiving them.

Lecture, Class Discussion, Case studies, discussion

Lewis; Chapter 32

Sole, 2005, Ch. 11, or Sole 2009, Ch. 12

Hockenberry, 2005, Ch 7, pp. 139-146 and 160-162 or Hockenberry, 2009 Ch. 6, pp. 145-148.

Brooks; Lesson 6

Lewis; Chapter 33

Grodner; Chapter 20

Lilley; Chapter 24, 25

Hockenberry, Ch. 25

Lewis; Chapter 34

Lilley; Chapter 21. 22, 23, 27 and 28

Lewis; Chapter 35

Lewis Chapter 37

Lewis; Chapter 38

Exam

Quizzes

All

All

All

A. Describe the structure and function of the nervous system

1. Central nervous system

2. Peripheral nervous system

3. Autonomic nervous system

3. Cerebral circulation

B. Assessment of the nervous system

1. Mental status

2. Cranial nerves

3. Motor system

4. Sensory system

4. Reflexes

C. Diagnostic studies used to assess the nervous system and related nursing actions.

1. Lumbar puncture

2. Radiologic studies

3. Electrographic studies

D. Pathophysiology, clinical manifestations, pharmacologic management, and collaborative care of patients with acute intracranial problems

1. Intracranial pressure

a. Identify normal physiologic mechanism that maintains constant intracranial pressure (ICP)

b. Classify common etiologies of conditions associated with increased intracranial pressure

c. Differentiate decorticate and decerebrate posturing and etiology

2. Unconsciousness

a. Classify various causes of unconsciousness

b. Explain the mechanism of unconsciousness

c. Generate an outline of nursing management for the unconsciousness patient

3. Generate outline for nursing management of the patient with increased ICP

4. Head Injury

a. Differentiate type of head injury by mechanism of injury, clinical manifestation and treatment

4. Brain tumor

a. Compare the types, clinical manifestations, and collaborative care

of patients with brain tumors.

b. Describe nursing management of the patient with a brain

tumor.

5. Meningitis

b. Describe collaborative care and nursing management of

meningitis.

6. Encephalitis, rabies, and brain abscess

a. Compare the primary causes, collaborative care, and nursing

management of encephalitis and brain abscess.

b. Describe the etiology, clinical manifestations, and nursing and

collaborative management of the patient with rabies.

E. Connect pathophysiology, clinical manifestations, pharmacologic management, and collaborative care of patients with a stroke

1. Identify incidence and risk factors

2. Three types of stroke: Thrombotic, embolic, and hemorrhagic

3. Clinical manifestations of each type of stroke

4. Collaborative care; preventative, acute, and rehabilitative care of stroke patient

5. Describe surgical interventions

6. Pharmacologic and diet therapy recommended for stroke patients

7. Generate an outline for nursing management of the stroke patient

F. Connect pathophysiology, clinical manifestations, pharmacological, collaborative care and gerontologic considerations of patients with chronic neurological problems

1. Headache

a. Compare and contrast different types of headaches.

b. Describe the etiology, clinical manifestations, collaborative care,

and nursing management of tension-type, migraine, and cluster

headaches.

2. Seizure disorder including complications, patient and family teaching

a. Describe the etiology of seizure disorders.

b. Compare and contrast nursing management, collaborative care,

and complications of generalized and partial seizures.

c. Outline the major goals of treatment for patients with seizures.

3. Multiple Sclerosis

a. Describe the etiology of multiple sclerosis.

b. Describe diagnostic studies utilized for multiple sclerosis.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with multiple sclerosis.

d. Outline the major goals of treatment for patients with multiple

sclerosis.

4. Parkinson’s Disease

a. Describe the etiology of Parkinson’s disease.

b. Describe diagnostic studies utilized for Parkinson’s disease.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Parkinson’s disease.

d. Outline the major goals of treatment for patients with

Parkinson’s disease.

5. Myasthenia Gravis

a. Describe the etiology of Myasthenia Gravis.

b. Describe diagnostic studies utilized for Myasthenia Gravis.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Myasthenia Gravis.

d. Outline the major goals of treatment for patients with

Myasthenia Gravis.

6. Restless legs syndrome

a. Describe the etiology of Restless legs syndrome.

b. Describe clinical manifestations and nursing and collaborative

care of the patient with restless legs syndrome.

c. Outline the major goals of treatment for patients with

restless legs syndrome.

7. Amyotrophic Lateral Sclerosis

a. Describe the etiology of Amyotrophic Lateral Sclerosis.

b. Describe diagnostic studies utilized for Amyotrophic Lateral

Sclerosis.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Amyotrophic Lateral Sclerosis.

d. Outline the major goals of treatment for patients with

Amyotrophic Lateral Sclerosis.

8. Huntington’s Disease

a. Describe the etiology of Huntington’s Disease.

b. Describe diagnostic studies utilized for Huntington’s Disease.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Huntington’s Disease.

d. Outline the major goals of treatment for patients with

Huntington’s Disease.

G. Connect etiology, pathophysiology, clinical manifestations and collaborative care of patients with peripheral nerve and spinal cord problems.

1. Trigeminal neuralgia

a. Describe the etiology of Trigeminal Neuralgia.

b. Describe diagnostic studies utilized for Trigeminal Neuralgia.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Trigeminal Neuralgia.

d. Outline the major goals of treatment for patients with

Trigeminal Neuralgia.

2. Bell’s Palsy

a. Describe the etiology of Bell’s Palsy.

b. Describe diagnostic studies utilized for Bell’s Palsy.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Bell’s Palsy.

d. Outline the major goals of treatment for patients with

Bell’s Palsy.

3. Guillain Barre’

a. Describe the etiology of Guillain Barre’.

b. Describe diagnostic studies utilized for Guillain Barre’.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Guillain Barre’.

d. Outline the major goals of treatment for patients with

Guillain Barre’.

4. Botulism

a. Describe the etiology of Botulism.

b. Describe diagnostic studies utilized for Botulism.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Botulism.

d. Outline the major goals of treatment for patients with

Botulism.

5. Tetanus

a. Describe the etiology of Tetanus.

b. Describe diagnostic studies utilized for Tetanus.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Tetanus.

d. Outline the major goals of treatment for patients with

Tetanus.

6. Neurosyphilis

a. Describe the etiology of Neurosyphilis.

b. Describe diagnostic studies utilized for Neurosyphilis.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Neurosyphilis.

d. Outline the major goals of treatment for patients with

Neurosyphilis.

7. Spinal cord tumors

a. Explain the types, clinical manifestations, collaborative care,

and nursing management of spinal cord tumors.

8. Post polio syndrome

a. Describe the etiology of Post polio syndrome.

b. Describe diagnostic studies utilized for Post polio syndrome.

c. Describe clinical manifestations and nursing and collaborative

care of the patient with Post polio syndrome.

d. Outline the major goals of treatment for patients with

Post polio syndrome.

9. Spinal Cord Injury

a. Identify risk factors for spinal cord injury

b. Describe classification of spinal cord injury.

1. Mechanism of injury

2. Level of injury

3. Degree of injury.

c. Explain the physical and psychological problem associated with spinal cord injury.

d. Generate outline for nursing management of the patient with a spinal cord injury.

Lecture/Class discussion

Reading:

Lecture/class discussion

Reading:

Lewis, 2007 Ch. 57

Sole Ch. 12

Hockenberry, Ch 28

Brooks lesson 10

Associated study guides for assigned readings in Lewis and Hockenberry

Lewis, 2007 Ch. 58

Sole pp. 391 - 404

Associated study guide for Lewis

Lecture/class discussion

Reading:

Lewis, 2007 Ch. 59

Lilley, 2007 Ch. 12, 13, & 14

Lecture/class discussion

Video: Parkinson’s Disease

Associated study guide for Lewis

Reading:

Lewis, 2007 Ch. 61

Sole p. 401 - 404

Hockenberry Ch. 32

Associated study guides for Lewis and Hockenberry

Lecture/class discussion

Reading:

Sole pp. 404 – 416

Exam

In-class assignment Case Study

Quiz

Exam

Quiz

Quiz

Quiz

Quiz

III through VIII

III through VIII


9. Gastrointestinal Disorders

A. Functions and structures of the gastrointestinal system.

1. Ingestion and propulsion of food, digestion, absorption, and elimination through the GI tract.

2. Liver, Biliary Tract, and Pancreas

B. Assessment of the gastrointestinal system

1. Functional health patterns

2. Common assessment abnormalities

3. Diagnostics studies

4. Liver function tests

C. Etiology and pathophysiological impact on all age patients experiencing impairments in the functioning of the gastrointestinal system. Describe diagnosis, treatments, including pharmacologic treatments, and nursing implications for:

1. Upper gastrointestinal problems

a. Oral infections and oral cancer

b. Structural defects: Cleft lip and palate

c. Gastroesophageal reflux disease

d. Hiatal hernia

e. Esphophageal cancer and other esophageal disorders

f. Nausea and vomiting

g. Upper gastrointestinal bleeding

h. Gastritis

i. Pyloric stenosis

j. Peptic ulcer disease

k. Stomach cancer

l. Food poisoning

2. Lower gastrointestinal problems

a. Diarrhea, constipation, and fecal incontinence

b. Acute abdominal pain and abdominal trauma

c. Irritable Bowel Syndrome

d. Appendicitis

e. Peritonitis

f. Gastroenteritis

g. Inflammatory bowel disease

1. Ulcerative colitis

2. Crohn’s disease

h. Intestinal obstruction

1. Hirshsprung’s

2. Intussuception

i. Polyps

j. Colorectal cancer

k. Malabsorption syndromes

l. Diverticulosis and diverticulitis

m. Hernias

n. Anorectal problems

o. Ostomy surgery

1. Ileostomy

2. Colostomy

D. Liver, Biliary tract, and Pancreatic problems

1. Pathophysiology, clinical manifestations, management, and care of patients with disorders of the liver, biliary tract and pancreas:

b. Jaundice

c. Hepatitis

d. Cirrhosis and cancer of the liver

e. Liver transplantation

f. Acute and chronic pancreatitis

g. Cancer of pancreas and gallbladder

h. Disorders of gallbladder and biliary tract

E. Explore the drug therapy utilized for treating patients with gastrointestinal disorders.

1. Acid-controlling drugs

2. Antidiarrheals and laxatives

3. Antiemetic agents

Lecture/class discussion

Small group activity

Associated Study Guides

ATI Associated sections

Lewis, Ch. 39, 42, 43, and 44

Quiz

Exam

Case Study