NR40 CourseOutline2007

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SCHOOL OF NURSING

COURSE OUTLINE

Course Title: Adult Health Nursing II Catalog No.: NR40

Credits: 8 Lecture & Clinical

Revised 6/06, 12/06


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COURSE DESCRIPTION: NR40 NURSING IINursing process is utilized in the study of adult health, incorporating responses and adaptation to stresscontinued from NR 33. Adaptation and stress management is promoted for adults who manifest their stressin acute and chronic physical illnesses and clients with multiple health problems. Experiences to integratenursing theory andskills include clinical experiences in health settings.

PRE-REQUISITE:NR24 or NR 33/NR36

CO-REQUISITE:BY 44 & PC 60

PURPOSE:

To assist the student to explore the effects of stress on human needs and the related nursing implications.Emphasis will be placed on utilizing the nursing process to assist individuals with acute and chronicconditions to re-establish a state of homeostasis and relative level of wellness. Preventative andrehabilitative factors will be integrated throughout each unit. Related nutritional, pharmacological,psychological and cultural/spiritual aspects will be considered. Community agencies will be utilized tocorrelate theory and practice. Application of management skills will be developed in the clinical area.

TIME ALLOTMENT:Lecture__________5 hours weeklyClinical__________9 hours weekly

CREDIT ALLOCATION: 8 Credits

PROGRAMS CONCEPTUAL FRAMEWORKThe nursing program reflects a clear organized structure, which is derived from the Nursing Philosophy.The framework for curriculum development emphasizes stress and adaptation, wellness, caring and theNursing Process. The faculty believes that all human beings have patterns, which contribute to health,quality of life, and achievement of human potential. Patterns focus on client-environment interactions, age-developmental norms, and cultural realities as they relate to stress and adaptation.

Nursing facilitates interdisciplinary collaboration with clients for health promotion, maintenance, restoration

or attainment of a dignified death. The nursing process allows for the systematic early identification andtreatment of actual and potential stressors. Unresolved dysfunctional patters may increase susceptibility tostressors. As adaptations diminish, assistance may be needed by the individual to obtain an optimal level of health. The goal of nursing is to facilitate client adaptations to life stressors. The nursing faculty believesthat caring assists clients to adapt to stressors to achieve positive outcomes.

The following core components are integrated into the nursing curriculum: professional behavior,communication, assessment, clinical decision-making, caring interventions, teaching and learning,collaboration and managing care.


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CORE COMPONENTS TO BE INTEGRATED THROUGHOUT EACH UNIT

Professional Behaviors : adhering to standards of professional practice; being accountable for ones actions;practicing nursing within legal, ethical, and regulatory frameworks; having concern for others; valuing theprofession of nursing; and participating in ongoing professional development.

Communication : a goal directed interactive process through which there is an exchange of information thatmay occur verbally, non-verbally, in writing, or through information technology.

Assessment : the holistic collection, analysis, and synthesis of relevant data from all of the clientsfunctional health patterns for the purpose of appraising the clients health status.

Clinical Decision Making : the systematic analysis and integration of knowledge and information toidentify dysfunctional health patterns and stressors in order to formulate clinical judgments and implementtherapeutic nursing interventions to assist the client toward a positive outcome. Evidence based practicedirects the modification of client care as indicated by the evaluation of outcomes.

Caring Interventions : the being with and doing for that assist clients to adapt to stressors to achievepositive outcomes; insuring the care provided is culturally and spiritually sensitive to the needs of a diversepopulation.

Teaching and Learning : the process of transmitting information to clients, significant others and membersof the healthcare team in order to assist clients and families to facilitate adaptations to stressors; promoteand maintain health; expand knowledge and change behavior.

Collaboration : working with other members of the healthcare team in a variety of healthcare settings inorder to achieve positive outcomes.

Managing Care : working efficiently and effectively with and through others and utilizing resources to meetclient needs and support organizational objectives.


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PROGRESSION OF CORE COMPONENTS IN THE NURSING PROGRAMProfessional BehaviorLevel I Identify the standards of care for basic nursing process, and demonstrate accountability

for nursing care given.Identify resources for life long learning.Begin to correlate and identify consequences of ethical, legal and regulatory aspects of professional nursing practice.

Recognize the necessity for and maintenance of client confidentiality.Initiate proactive involvement to facilitate empowerment for the nursing profession.Report errors of omission/commission in a timely manner.Demonstrate non-judgmental/culturally sensitive behaviors.

Maintain appropriate professional boundaries in the nurse-client relationship.Level II Adhere to standards of professional practice.

Demonstrate accountability for personal actions and delegated actions.Practice nursing within legal, ethical and regulatory frameworks.Utilize and incorporate resources for life long learning.

Demonstrate leadership in the nursing role.CommunicationLevel I Apply basic techniques of therapeutic communication when interacting with a client.

Demonstrate beginning ability in documenting client status in nursing notes and careplans.Demonstrate beginning skills in oral presentations to a group of fellow students.Identify and use information technology to access current nursing literature.Communicate therapeutically with significant others as well as clients and members of the health care team.Demonstrate increasing ability to communicate relevant, accurate, and completeinformation verbally and in written documentationUtilize appropriate verbal and non-verbal communication techniques to interact withindividual and groups of clients with impaired communication abilities.

Utilize effective communication techniques when interacting with peers and members of the health care team.

Level II Identify similarities and differences on a position and support their position with currentnursing literature.Apply advanced techniques of therapeutic communication with clients, significant othersand members of the health care team.Employ group dynamic strategies when communicating with team members.Demonstrate increasing ability to communicate relevant, accurate and completeinformation for groups of clients verbally and in written documentation.


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AssessmentLevel I Assess clients' health status to identify stressors that interfere with adaptation.

Assess human responses to stressIdentify strengths, resources and health care needs of a community.Complete a health history including a physical, cognitive, psychosocial and functionalassessment.Assess the client's response to actual and potential health problems.

Assess the client's response to interventions. Assess personal stress and adaptation.Level II Analyze health status of acutely ill clients/groups of clients with multiple health

problems.Demonstrate advanced skill in completing a health history.Integrate prior knowledge in assessing the effects of stressors on clients, families andcommunities.Prioritize responses to actual or potential health problems and to nursing interventions.

Clinical Decision MakingLevel I Identify evidence-based practice as the foundation for nursing decisions.

Utilize nursing process as the basis for clinical decisions.Maintain accurate and safe care.

Integrate prior knowledge and begin to question personal assumptions.Develop critical thinking and problem solving techniques as the foundation forappropriate clinical decision making.Develop diagnoses and plan care that focuses on health promotion, wellness andrestoration.Modify client care as indicated by evaluation of outcomes.

Level II Analyze dysfunctional health patterns and stressors of the individual, family and thecommunity.Utilize evidence-based practice in order to formulate clinical decisions.

Caring InterventionsLevel I Demonstrate caring behavior towards clients, significant other(s), peers, and other

members of the health team recognizing cultural and spiritual diversity.

Provide safe nursing care in all settings.Perform nursing skills competently.Identify community resources to support clients in the promotion and maintenance of health.Support the client and significant other when making healthcare and end-of-lifedecisions.Provide individualized interventions that include self-esteem enhancement, anxietyreduction, and coping enhancement.

Level II Perform effective and preventative nursing measures to facilitate health promotion andmaintenance in clients and groups.Synthesize understanding of cultural and spiritual differences and developmental needswhen caring for individual and family in order to provide sensitive, holistic nursing care.


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Teaching and LearningLevel I Identify the role of the nurse as a teacher and develop awareness of the principles of

effective teaching and learning.Apply teaching and learning concepts to assist clients and groups in managing wellnessand/or self-management of illness.Evaluate the progress of the client/significant other toward achievement of identifiedlearning outcomes.

Advocate health promotion.Level II Develop teaching plans to assist individuals and groups to promote health and manageacute and chronic health problems.Identify learning needs of the individual and family and modify interventions accordingto developmental level.

Utilize teaching and learning concepts in leadership/management in assigned setting.CollaborationLevel I Identify roles of members of the health care team.

Utilize multiple resources available for the individual and family within the community.Establish partnerships with clients and collaborate with the nursing team to achieve clientoutcomes.

Work cooperatively with others to achieve client outcomes.

Level II Collaborate with peers and multidisciplinary team members to deliver cost effective,quality care to individuals, families and communities.Convey mutual respect, trust, support and utilization of each discipline's role andcontributions to health care.

Managing CareLevel I Describe the qualities of effective leaders.

Utilize self-assessment to begin to develop leadership skills.Identify the relationship between power and leadership and management.Describe the role of the nurse in cost containment and implement-nursing strategies toprovide cost effective care.Demonstrate ability to prioritize client needs.Identify leadership/management skills necessary in planning and implementing client

care.Utilize team-building strategies.Describe principles of successfully motivating others.Identify key concepts underlying effective delegation.

Identify and implement strategies of behavior changeLevel II Apply principles of effective motivation.

Utilize key concepts underlying effective delegation.Demonstrate leadership management skills when working with the multidisciplinaryhealth team members to deliver care to groups of clients.Apply strategies of change theory with the health care team.Employ techniques that can be used in evaluating the work of others.Utilize conflict resolution skills.

Assess visionary skills and identify a plan to become more innovative.


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PROGRAM OBJECTIVES

1. Exhibit ethical behavior in all professional activities.2. Identify stressors and promote adaptation in clinical care.3. Integrate advances in knowledge from all sciences and humanities in the care of clients.4. Assume responsibility for health promotion by assisting the client in learning self- management

skills that provide and promote their health and serve as role models and resource for healthinformation and education.

5. Practice relationship-centered care with interdisciplinary teams that address the needs and concernsof culturally and spiritually diverse individuals, families and communities.

6. Utilizes critical thinking to provide evidence-based clinical practice that assists clients in healthpromotion, achievement of human potential, illness adaptation and preparation for death.

7. Assist in the delivery of primary care in diverse community-based settings.8. Function as a client advocate on the interdisciplinary health care team.9. Use communication and information technology effectively and appropriately.10. Utilize leadership management skills in collaboration with the interdisciplinary health care team to

manage resources effectively and efficiently to deliver quality client care.11. Introduce students to financial resources and constraints impacting delivery of health care services to

various populations.12. Empower clients and communities to learn self-management skills.13. Use established outcome criteria to measure effectiveness of care.14. Demonstrate social responsibilities through participation in service activities.15. Assume responsibility for self-improvement and use resources for life-long learning for self and

others.16. Practice nursing within the legal parameters of the NY State Nurse Practice Act in diverse settings.17. Advocate for public policy that promotes and protects the health care system.


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NR40 COURSE OBJECTIVES:

PROFESSIONAL BEHAVIORS1. Demonstrate accountability for own ethical behavior and for delegated actions.2. Apply advances in knowledge from the sciences and humanities in the care of clients.3. Practice within the framework of the New York State Practice Act and the American Nurses Association

Code of Ethics.

4. Assume responsibility for self-improvement and use resources for life-long learning for self and others.5. Develop an awareness of information technologies that impact on the delivery of health care.6. Promote and assure the individuals rights in a defined health care setting.

COMMUNICATION7. Advocate for clients and families by effectively communicating with members of the multidisciplinary

health team.

ASSESSMENT8. Integrate prior knowledge to analyze and prioritize individual and community needs, to promote health

and manage acute and chronic health problems.9. Demonstrate advanced skills in completing a health history.

CLINICAL DECISION MAKING10. Utilize critical thinking and evidence based practice to analyze clients, families and community stressors

and response to stressors in order to support clinical decision-making.11. Utilize information technology to meet care needs and to assist clients to use self-management skills.12. Use evidence based outcome criteria to measure effectiveness of care in the acute and chronically ill adult

client with multiple health problems.

CARING INTERVENTIONS13. Demonstrate empathy and caring with the ability to apply and reflect on ones own application of the

principles of interpersonal communications with clients, families, peers and other health team members ina diverse population.

14. Promote adaptation to the effects of stressors on acute and chronically ill clients with multiple healthproblems.

TEACHING AND LEARNING15. Integrate prior knowledge to identify, analyze and prioritize individual and community needs in order to

develop teaching plans to assist clients, families and communities to promote health and manage acuteand chronic health problems.

16. Demonstrate leadership management skills when working with the multidisciplinary health team to delivercare to groups of clients.

COLLABORATION17. Identify the social responsibilities of meeting the needs of acute and chronically ill clients with multiple

health problems and the community services available to them.18. Collaborate with peers and other multidisciplinary team members to deliver cost effective quality care to

individuals, groups and communities.19. Develop an interdisciplinary plan of care that conveys mutual respect, trust and support.

MANAGING CARE20. Demonstrate leadership management skills when working with the multidisciplinary health team to

deliver care to groups of clients.Revised 4/04, 8/04


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TOPICAL COURSE OUTLINE

Nursing Management of Clients with Stressors that require Home Care

Nursing Management of Clients with Stressors that affect Cardiac and Peripheral Function

Nursing Management of Clients with Stressors that affect Respiratory Function

Nursing Management of Clients with Stressors that affect Hematological Function

Nursing Management of Clients with Stressors that affect Musculoskeletal Function

Nursing Management of Clients with Stressors that affect Endocrine Function

Nursing Management of Clients with Stressors that affect Gastrointestinal and Hepatobiliary Function

Nursing Management of Clients with Stressors that affect Urinary and Renal Function

Nursing Management of Clients with Stressors that affect Male and Female Reproductive Organ Function

Nursing Management of Clients with Stressors that affect Neurological Function

Nursing Management of Clients with Stressors resulting from Disasters (Includes Burns and Shock States)


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SUFFOLK COUNTY COMMUNITY COLLEGE

School of Nursing

STUDENT RESPONSIBILITY FOR SAFE CLINICAL PRACTICE

Guidelines In Determining Student Clinical Grade

The clinical component of each nursing course provides nursing students with the opportunity to applynursing principles in a practice setting. This is an essential skill for every competent practitioner of nursing.

The four overriding criteria for a satisfactory passing grade in the clinical area are:

1. Using the steps of the nursing process for scientific problem solving.2. Maintaining medical and surgical asepsis.3. Maintaining physical safety.4. Maintaining psychological safety.

The critical behavior for evaluating student performance is the students ability to make clinical decisionsfor safe patient care . Such decision making reflects the ability of nursing students to apply nursing

principles in a variety of situations. Meeting these criteria constitutes competent performance and asatisfactory passing grade.

When a student jeopardizes patient care by violating one of these principles, it shall constitute afailure for that clinical day.* A student fails a course when repeated failures occur. The specificstandard for failure in each course is:

1. NR20 Three (3) failed clinical days. 5. NR46 Two (2) failed clinical days.2. NR24 Two (2) failed clinical days. 6. NR48 Two (2) failed clinical days.3. NR33 Two (2) failed clinical days. 7. NR40 Two (2) failed clinical days.4. NR36 Two (2) failed clinical days.

*Please note that a failed clinical evaluation will constitute a failed clinical day.

Students responsibilities in this situation include:

1. Taking responsibility for ones own actions.2. Identify own error. Ask for assistance.

3. Develop and utilize strategies to assist in clinical decision making.4. Please refer to document entitled " Guidelines for student written report for student

incident resulting in student warning or failed clinical day ".

Faculty responsibilities in this situation include:

1. Counseling the student.2. Providing a written notification regarding the failure.3. Provide recommendations for corrective action.


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SUFFOLK COUNTY COMMUNITY COLLEGESchool of Nursing

Clinical Skills Policy

Students are responsible for all skills taught throughout theprogram. Students are responsible to independently practice in thenursing lab during their out-of-class time in order to gain skillproficiency.

Students can make an appointment with the Professional Assistantin the nursing lab for additional practice.

SUFFOLK COUNTY COMMUNITY COLLEGESchool of Nursing


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GUIDELINES FOR STUDENT WRITTEN REPORT OF CLINICAL INCIDENTRESULTING IN CLINICAL WARNING OR FAILED CLINICAL DAY

Explanation

This is an additional assignment that is given when the faculty identifies student decisions and/or actionsthat fail to meet the course objectives or standards of nursing practice during a given clinical class. Theassignment is made in the spirit of student-centered learning and continued professional development. It

provides a framework that assists the student to analyze clinical events, to consult the nursing literature, andto plan future nursing goals for themselves that are in keeping with professional standards.

Instructions to Faculty

The students written report should be submitted on the clinical day following the critical incident. Thefaculty must discuss the critical incident with the student before making this assignment. The completion of the written assignment provides tangible evidence of the students perspective regarding the incident.Further discussion with the student or further action may/may not be necessary depending upon the insightdemonstrated in the written report as well as the students subsequent clinical practice.

Instructions to Students

1. Provide a written report of the critical incident to the clinical instructor.2. The report is due on the next clinical day following the critical incident.3. The report should consist of your answers to three basic questions.

A. What happened?Describe the details of the incident.What were your nursing actions? What was the patients response? What were the

actual and the potential consequences for the patient? Include any and all details youdeem pertinent.

B. What should have happened?Based upon your meeting with your clinical instructor after the incident, and based

upon the research you have done since the incident, what should have happened inthis clinical circumstances?

C. What Nursing Practices will you implement in the future to prevent therecurrence of similar incidents?

4. The report should include a bibliography of at least one pertinent nursing reference.


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SCHOOL OF NURSINGSTUDENT RESPONSIBILITY FOR SAFE CLINICAL PRACTICE

REPORT OF FAILED CLINICAL DAY

Learning Activities

1. Utilize the nursing practice lab to simulate:a. Practice independently to become familiar with:

b. Arrange an appointment with a nursing faculty member for supervised practice of this skill.

c. Demonstrate competency in __________________________________ in clinical area.

2. View video tapes on the following topics:And/or complete the following Computer Assisted Instructional (CAI) programs:

3. Discuss the principles of the above video tapes/CAI with assigned clinical instructor.

4. Review text material on the following topics:

5. Apply this knowledge and these skills in the clinical setting.

CONCLUSION: Student must successfully complete all the recommendations of this learning guide in order to progress in theNursing program. The student agrees to provide the faculty with a written summary of the specified learning activities he/she hascompleted by _____________________. (date)

Student Signature:________________________________________ Date_________________Student Comments:

Faculty Signature:________________________________________ Date__________________Faculty Comments:

Note: The clinical faculty member is responsible to distribute three copies of this report as follows:Student, Clinical Faculty and student file by way of the Course Coordinator and the Academic Chair/Assistant Chair

FFL/ds Rev 5/06


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REQUIRED TEXTBOOKS:

1) Ignatavicius, D. & Workman, L. (2006). Medical surgical nursing: Critical thinking for

collaborative care. (5 th ed.). Philadelphia: Saunders. *(single volume: 0-7216-0446-3; double

volume: 0-7216-0671-7)

2) Ignatavicius, D. (2006). Virtual clinical excursions 3.0 to accompany Medical-Surgical Nursing. (5 th

ed.). Philadelphia: Saunders. *( 1-4160-0103-4 )

3) Winningham, M. & Preusser, B. (2005). Critical thinking in medical-surgical settings : A case study

approach . (3rd ed.) St. Louis: Mosby. *(0-323-02566-8)

4) Ackley, B. & Ladwig, G. (2006). Nursing diagnosis handbook: A guide to planning care. (7 th ed.).

St. Louis: Mosby. *(0-323-03664-3) (Grant Campus)

5) Carpenito-Moyet, L. (2005). Nursing diagnosis: application to clinical practice (11 th ed.). New

York: Lippincott-Raven. * (0-7817-6131-X) (Ammerman campus)

6) Deglin, J., & Valleran, A. (2005). Davis drug guide for nurses (9 th ed.). Philadelphia: FA Davis.

*(0-8036-1152-8)

7) Ellis, J., & Hartley, C. (2005). Managing and coordinating nursing care . (4th ed.). New York:

Lippincott-Raven. *(07817-41068)

8) Pickar, G. (2004). Dosage calculations (7 th ed.). New York: Delmar. *(076686286-0)

9) Smith, S., Duell, D., & Martin, B. (2004). Clinical nursing skills-basic to advanced skills (6 th ed.).

(6 th ed.) New Jersey: Prentice Hall. * (013-049371-6)


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RECOMMENDED TEXTBOOKS

1) Lilley, L., Harrington, S., & Snyder, J. (2005). Pharmacology and the nursing process. (4 th ed.).

New York: Mosby. *(0-323024084)

2) Dudek, S. (2006). Nutrition essentials for nursing practice (5th ed.). New York: Lippincott-Raven.

*(0-78175382)

3) Fishbach, J. (2005). Nurses quick reference to common laboratory & diagnostic tests (4th ed.).

Philadelphia: Lippincott. *( 0-78174185)

4) Ignatavicius, D., Snyder, J. & Kerby, L. (2006). Critical thinking study guide for medical surgical

nursing. (5 th ed.). Philadelphia: Saunders. *(0-7216-06148)

5) Thomas, C. (2005). Tabers medical dictionary (20 th ed.). Philadelphia: F.A. Davis. *(08036

1207-9)


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SUFFOLK COUNTY COMMUNITY COLLEGENursing Program

ATTENDANCE POLICY(Please refer to college policy on attendance )

Applicable to all nursing courses:

1. Students must be able to meet ALL of the course objectives in the Course Outline and on thePerformance Evaluation Form in order to pass each nursing course.

2. Students are expected to attend ALL nursing classes in order to meet all objectives of the course. Preand post conferences are an integral aspect of the clinical experience and students are required toparticipate in this experience.

3. Students are expected to be ready to begin all nursing classes at the appointed time and to remain inclass until class is ended.

A pattern of lateness, leaving class early and/or absence in lecture, laboratory or the clinical setting willnegatively affect your grade.

4. Absence and lateness will be reviewed by a faculty committee. Appropriate action will be taken by thecommittee as to the status of the student in the course. Excessive absence or lateness may lead tofailure in the course.

5. In the rare event of an extreme emergency that requires the student to be late or absent, students will beexpected to notify the clinical agency. Call at least one hour prior to the beginning of the clinicalexperience.

a. Leave your message, being sure to state:- your name and phone number- your school- the hospital unit to which you are assigned- the clinical instructor's name

b. Obtain the name of the person taking the message, when possible.

6. In the rare event of an extreme emergency that requires the student to be late or absent for a lecture orcollege laboratory class, students will be expected to notify the faculty. Call at least one hour prior tothe beginning of class.

a. Leave your message, being sure to state:- your name and phone number- the reason for your absence or lateness

7. Students who are absent or late for Clinical, lecture, or college laboratory classes are expected to providea written explanation to the faculty immediately. This communication should be in the form of a neatand professionally written memorandum that will be placed in the students file at the college.


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT REQUIRE HOME CAREBEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assesses the Client and his

environment2. Assesses the clients level of

knowledge

DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients in the HomeCare Setting

PLANNING1. Proposes alternate nursing

measures to assist the clientin adapting to changes inlevels of physical andpsychological functioning inthe home care setting

2. Plans nursing measures thatallow for prevention/or earlydetection of complications

3. Formulates a teaching planfor a home care client

IMPLEMENTATION1. Implements measures to

promote optimal clientfunctioning in the home caresetting

2. Promotes adaptation bymanipulating the environmentto maintain optimal level of independence

ASSESSMENT1. Utilizing the nursing process

to identify client needsStressors affecting care in thehome

3. Safety issues in the homeenvironment

4. Identify family and othersupport systemsDescribe the role of the nursein home care

DIAGNOSISRisk for InjuryImpaired Home Maintenance R/TImpaired Cognitive, Emotional orPsychomotor FunctioningImpaired Home Maintenance R/TInadequate Support SystemsCare Giver Role Strain

PLANNING1. Formulates nursing diagnosis

based on assessment data2. Determines expected

outcomes for individualclients and families

IMPLEMENTATION1. Adaptations to maximize

functioning in the home caresetting

2. Maintaining a safe therapeutic

environment.3. Applying principles of

asepsis.4. Importance of

interdisciplinary teamfunctions.

ASSESSMENT1. Review client records prior to

visit.2. Arrange for home care visit.3. Home Care visit to assess

client and environment.4. Collaborate with Home Care

Nurse to complete forms forplanning and reimbursement.

DIAGNOSISAnalyze Data and FormulateDiagnoses

PLANNING1. Assists RN to coordinate and

delegate nursing home healthaide, physical therapy andother services delivered to theclient.

2. Participates in developing a

teaching plan

IMPLEMENTATION1. Assist the nurse to organize

client care2. Participate in direct client care3. Implements a plan of care

Incorporate theclients valuesand preferences in medicaldecision making and goalsetting.

4. Contribute to health teachingwith client and or family


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGS

EVALUATION1. Evaluates the effectiveness of

nursing action designed to:a. maintain current level of

functioningb. prevent complicationsc. improve level of

functioning2. Evaluates clients response

to drug, diet and activityregimen

3. Evaluates the effectivenessof client teaching

5. Effective communicationstrategies for dealing with theclient and care givers in thehome.

EVALUATION1. Outcome criteria for:

a. Self-care in the homeb. Home maintenance

members6. Assist the nurse to coordinate

discharge planning.

EVALUATION1. Reports and records

significant changes in clientstatus

2. Evaluates progress based onoutcome criteria for anindividual client in the homesetting

3. Evaluates the effectiveness of teaching

4. Illustrate with examples howhome care objectives weremet.

5. Summarize a journal articlerelated to home care nursing.


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECT CARDIAC ANDPERIPHERAL FUNCTIONBEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assesses the clients

circulatory status.a. Assesses the effects of

alterations in circulation onphysical and psychologicaladaptation

b. Assesses clients level of knowledge

DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients withCardiovascular and PeripheralDysfunction.


measures to assist the clientin adapting to changes inlevels of physical andpsychological functioning.

2. Plans nursing measures thatallow for prevention/or early

detection of complications3. Formulates a teaching plan for

a client within alteration incirculatory function

ASSESSMENT1. Stressors affecting circulation

a. Internal/External2. Assessment criteria for

alteration in circulation3. Effect of stressors:

a. Angina and MyocardialInfarction

b. Life-threateningdysrythmias

c. CHF, pulmonary edemad. Pulmonary and systemic

embolie. Peripheral vascular diseasef. Aneurysm

DIAGNOSISCommon Nursing Diagnoses forthese disorders include:

Impaired Gas ExchangeDecreased Cardiac OutputIneffective Tissue PerfusionActivity IntoleranceIneffective Therapeutic

ManagementPC Dysrythmias



outcomes for individualclients

ASSESSMENT1. Performs a circulatory

assessment2. Diagnostic tests:

CBC, cardiac isoenzymes,troponin, APTT, prothrombintime, INR, homocystinelevels, BNP, C ReactiveProtein, EKG, chest X-ray,cardiac catheterization, CVP,radionuclide studies,arteriograms, venograms

3. Analyzes information fromcardiac assessment anddiagnostic tests

4. Formulates, revises orconcurs with nursingdiagnosis


PLANNING1. Plans nursing care for a client

with an alteration incirculatory function

2. Participates in developing ateaching plan for a client withimpaired circulatory function

3. Incorporates homecare needs

as indicated.


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECT RESPIRATORYFUNCTION

BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assesses the client's

respiratory status forpresence of stressors thatprecipitate respiratorydysfunction

2. Assess the effects of alterations in respiration onphysical and psychologicaladaptation

3. Assesses clients level of knowledge

DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients withRespiratory Dysfunction


care measures to assist theclient in adapting to changesin physical andpsychological functioning

2. Formulates a teaching planfor self-care for client withrespiratory dysfunction

3. Proposes alterations innursing care to prevent

respiratory infections

ASSESSMENT1. Stressors affecting

respiratory status2. Assesses for alterations in:

Rate and character of respirations; pain;characteristics of breathing; skin color;hemoptysis

3. Effects of stressorsa. Cancer of the lungb. Respiratory Failure and

ARDSc. Chest Trauma-

Pneumothorax,Hemothorax

d. Pulmonary Embolism

DIAGNOSISCommon Nursing Diagnoses forthese disorders include:Impaired Gas ExchangeAcute Confusion RT hypoxiaIneffective Airway ClearanceIneffective Breathing PatternsImpaired Verbal Communication

PLANNING1. Formulates nursing diagnoses



ASSESSMENT1. Performs a respiratory

assessment2. Diagnostic Tests:

Lung ScanX-raysBronchoscopyThoracentesisBiopsyBlood GasesPulmonary Function TestsSputum Analysis

3. Formulates, revises, orconcurs with nursingdiagnosis


PLANNING1. Participates in developing a

teaching plan for a client withrespiratory problem

2. Plans nursing care for a clientwith respiratory dysfunction

3. Reviews establishedprotocols for assisting withrespiratory procedures i.e.Thoracentesis

4. Incorporates home care needs

as indicated


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSIMPLEMENTATION1. Utilizes the nursing process

with minimal assistance tomaintain/improve theclients current status

EVALUATION1. Evaluates effectiveness of

respiratory therapy2. Evaluates effectiveness of

nursing actions designed to:a. maintain or improve

current level of functioning

b. prevent complications3. Evaluates the effectiveness

of client teaching with

respiratory problems

IMPLEMENTATION1. Mechanical ventilation2. Chest drainage3. Suctioning4. Diet management5. Drug Management6. Teaching needs for self-care7. Surgery

a. Thoracotomyb. Lobe resections and

pneumonectomy


a. Respiratory adaptationsb. Self-care

IMPLEMENTATION1. Implements a plan of care for

client with respiratoryproblem

2. Implements teaching plan fora client with a respiratoryproblem

3. Assists client withpreventative or prescribedbreathing exercises

4. Implements the followingskills:a. endotracheal suctioningb. maintain water seal

drainage systemc. Safety aspects for a

ventilated client


significant changes inrespiratory status

2. Evaluates outcome criteriafor individual clients withrespiratory problem

3. Evaluates effectiveness of client teaching for a clientwith respiratory dysfunction


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECTHEMATOLOGICAL FUNCTION

BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assess the clients

hematological status andstressors that precipitatehematological dysfunction

2. Assess the effects of alterations in hematologicalfunction

3. Assess laboratory findings forclient with blood dyscrasia

4. Assess clients level of knowledge

DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients withHematological Dysfunction

PLANNING

1. Identify outcomes forprevention of illness andadaptation of client withhematological dysfunction

2. Develop a plan of care thatprioritizes nursing diagnosesbased upon subjective andobjective assessment.

3. Plan nursing interventions fora client with anemia

ASSESSMENT1. Pathophysiology of

hematologic dysfunctions2. Assess circulatory changes:

vital signs, bleeding, bloodcount, color, diet, petechiae,infections, sensory changes inextremities

3. Effects of stressors and clientadaptation:Polycythemia veraChronic Myoocytic LeukemiaChronic LymphocyticLeukemia


Risk for InfectionFatigueRisk for InjuryImpaired Oral Mucous

MembranesImbalanced NutritionAnxiety

PLANNING

1. Develops approaches tonursing care based onassessment of individualstatus.

2. Identify and prioritize nursingdiagnoses

3. Develop a plan of care thatprioritizes nursing diagnosesbased upon subjective andobjective assessment.

4. Determine client outcomes

appropriately and on anindividual basis.5. Develop a plan of care based

on clients variables includingpersonal, spiritual and culturaldiversity.

ASSESSMENT1. Assess stressors for client with

anemia, or bleedingdysfunction.

2. Reviews diagnostic tests:CBC, sed rate, WBC withdifferential UA

DIAGNOSIS

Analyze Data and FormulateDiagnoses

PLANNING1. Participates in developing a

teaching plan includingsensitivity to cultural andspiritual diversity

2. Plans nursing care thatenhances and/or maintainsoptimal functioning andquality of life.


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSIMPLEMENTATION1. Implements therapeutic

nursing interventions thatoptimize adaptation for theclient with leukemia.

2. Discuss clients role inmedical and surgicalmanagement of blooddysfunction.

3. Teach client about diagnosticstudies used to detecthematological dysfunction.

4. Teach client basic principlesof effective nutrition

EVALUATION1. Evaluate outcomes utilizing

outcome criteria developed inthe planning phase of care.

IMPLEMENTATION1. Measure to increase adaptation

to stressors:a. therapeutic nutritionb. pharmacologic

managementc. oxygen therapyd. blood transfusion

observatione. activity exercisesf. positioningg. bone marrow aspirationh. chemotherapyi. splenectomy j. prevention of infectionk. biopsychosocial supportl. teaching measures to

include diet, medication,safety, rest & exercise


a. Hematological adaptationb. Self-care

IMPLEMENTATION1. Communicates ideas

effectively with clients andother members of health careteam.

2. Demonstrates skill in:a. application of cold and

warm compressesb. therapeutic nutritionc. management of bleedingd. transfusionse. observations with

chemotherapy andradiation

3. Reviews protocols for bonemarrow aspiration andsplenectomy.

4. Provides supportive assistancein dealing with stressors andadaptation.

5. Carries out protective isolationprocedures.

6. Provides discharge planningand community referrals.

EVALUATION1. Evaluate clients

understanding and adaptationto nursing interventions.


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECTMUSCULOSKELETAL FUNCTION


musculoskeletal status andstressors that precipitatemusculoskeletal dysfunction

2. Assess the effects of alterations in musculoskeletaldysfunction

3. Assess laboratory findings forclient with musculoskeletaldysfunction


DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients with

PLANNING1. Proposes alterations in

nursing care to meet the needsof the immobilized client andto maintain optimal levels of mobility.

2. Reorders nursing priorities inaccordance with changingtherapeutic response.

3. Formulates a teaching plan toprepare the client with amotor problem to function athis maximal level of independence

ASSESSMENT1. Stressors affecting mobility2. Musculoskeletal assessment3. Effects of stress on

musculoskeletal systemsa. Musculoskeletal traumab. Osteomyelitis,

Osteoporosisc. Goutd. Osteoarthritise. Rheumatoid arthritisf. Systemic lupus

erythematosus


Risk for PeripheralNeurovascular dysfunctionAcute PainChronic PainDisturbed Body ImageImpaired Physical Mobility

PC Compartment SyndromePC ThromboembolismPC Delayed Healing or Non

Union

PLANNING1. Formulates nursing

diagnoses based onassessment data

2. Determine expectedoutcomes for individual

clients

ASSESSMENT1. Assesses problems of a client

with an alteration in mobility2. Diagnostic tests

ArthrocentesisArthroscopyBone Scan, TomogramCalcium, Phosphorous,

AlkalinePhosphataseUric Acid, Sed RateSerology tests associated

with joint disease3. Formulates, revises or

concurs with nursingdiagnosis



with a musculoskeletalproblem

2. Reviews establishedprotocols for assisting a client

in a cast or in traction, or aknee immobilizer3. Develops a teaching plan for

use of ambulatory aids


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSIMPLEMENTATION1. Manipulates the environment

to protect the immobilizedclient from further injury orimpairment

2. Selects appropriate First Aidmeasures for emergencytreatment of musculoskeletalinjuries

3. Revises approaches tonursing action in response toincreasing muscle spasm

4. Applies principles from thenatural sciences to maintaintraction apparatus

5. Manipulates the environmentto maintain a proper balancebetween rest and activity ininflammatory ordegenerative joint conditions

EVALUATION

1. Evaluates the effectiveness of nursing care and rehabilitationmeasures.

IMPLEMENTATION1. Adaptation to Maximize

Functiona. Cast care, pin careb. Traction, types and

maintenancec. Hot/cold applicationd. Measures to prevent joint

degeneratione. Diet/Drug managementf. First Aid and Positioning

with common fractures2. Teaching Needs for Self-care

a. Diet and Drug therapyb. Planned exercisec. Safety measures for heat

treatmentsd. Use of ambulatory aidse. Home adaptations for

independencef. Community agencies

3. Surgerya. Total hip replacement,

knee replacementb. Open reduction of

fracturesc. Amputations

EVALUATION

1. Outcome criteria for:a. Motor-Safety adaptationsb. Self-care


a client with aMusculoskeletal problem i.e.reinforcing physical therapyprogram

2. Implements a teaching planfor a client with amusculoskeletal problem

3. Implements the followingskills:a. Teach use of ambulatory

aidsb. Apply wet packs, splints,

bracesc. Maintain tractiond. Give cast care, pin caree. Teach use of self-help

devices4. Implements neurovascular

assessment

EVALUATION

1. Reports and recordssignificant changes in motorfunction

2. Evaluates outcome criteriafor a client with a specificmotor problem

3. Evaluates the effectiveness of an established plan of carefor a client with amusculoskeletal problem


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSIMPLEMENTATION1. Decrease external stressors

that interfere with theclients ability to cope withdeficiencies in regulatorymechanisms.

2. Implements measures topromote optimal clientfunctioning when ahormonal deficiency/excessexists.

3. Promotes adaptation byencouraging optimal levelsof independence in clientswith regulatory problems.

4. Teaches comprehensive self management to assist clientsadapting to endocrinedysfunction.


hormone replacementtherapy

2. Evaluates effectiveness of nursing actions designed to:a. maintain or improve


b. prevent complications3. Evaluates the effectiveness

of client teaching for aclient with a regulatoryproblem

IMPLEMENTATION1. Adaptations to achieve

homeostasisa. Drugs

*Hormone*Steroids

b. Diet Therapyc. Emergency Treatmentd. Fluid and electrolyte

balance2. Teaching Needs for Self care

a. Stress Managementb. Manifestations of

hormonedeficiency/excess

c. Monitoring effects of hormone therapy

d. Diet therapye. Situations requiring

professional interventionsf. Measures to prevent

infection and fatigueg. Community Agencies

3. Surgerya. Subtotal and Total

Thryoidectomyb. Adrenalectomyc. Parathyroidectomy

4. Irradiation therapy


a. regulatory adaptationsb. self-care


a client with a regulatoryproblem.

2. Plans nursing care for a clientwith a regulatory problem.


significant changes inregulatory status

2. Evaluates outcome criteriafor individual client withregulatory problemsreceiving hormonereplacement therapy

3. Uses established outcomecriteria to evaluateeffectiveness of clientteaching for a client withendocrine dysfunction


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECTGASTROINTESTINAL/HEPATOBILIARY FUNCTION


gastrointestinal andHepatobiliary status andstressors that precipitategastrointestinal orHepatobiliary dysfunction

2. Assess the effects of alterations in gastrointestinalor Hepatobiliary dysfunction

3. Assess laboratory findingsfor client withgastrointestinal orHepatobiliary dysfunction


DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients withGastrointestinal/HepatobiliaryDysfunction

ASSESSMENT1. Stressors effecting

Nutritional/Metabolic Patternson G.I./Hepatobiliaryfunctioninga. Internalb. Geneticc. External

1. Assesses for alteration inG.I./Hepatobiliary functionin: weight, dietary patterns,alcohol use, bowel habits,pain, nausea, vomiting,distension, anorexia, skinturgor, jaundice, ascitespruritis, bleeding, etc.

2. Effects of stressors:a. Peptic ulcersb. Inflammatory bowel

diseasec. Irritable Boweld. Appendicitis and

peritonitise. Intestinal obstructionf. Herniasg. Hepatitis and cirrhosish. Pancreatitis and

cholecystitisi. Cancer

j. Morbid obesity


Risk for HemorrhageRisk for Deficient Fluid VolumeAcute or Chronic PainFluid and Electrolyte Imbalance

Imbalanced NutritionIneffective Therapeutic Regimen

ManagementDisturbed Body ImageConstipation

ASSESSMENT1. Nursing history2. Diagnostic tests: X-rays,

sonogram, CBC and bleedingstudies, electrolytes, serumenzymes

3. Selects appropriate nursingdiagnosis for a client withgastrointestinal orHepatobiliary dysfunction



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measures to assist the clientin adapting to changes inlevels of physical andpsychological functioning.

2. Plans nursing measures thatallow for prevention and/orearly detection of complications

3. Formulates a teaching planfor a client having analteration in G.I orHepatobiliary function

IMPLEMENTATION1. Selects nursing measures to

maintain or improve theclients nutritional status

2. Discusses principles of dietmanagement for a clientwith an alteration in G.I.function

3. Teaches self-caremanagement to clientswith an ostomy promotes

adaptation by encouragingappropriate levels of independence

DiarrheaExcess Fluid VolumePC for HemorrhagePC Porto-SystemicEncephalopathyAcute PainImbalanced NutritionImpaired Skin IntegrityPC Drug ToxicityDisturbed Body ImagePC Fluid and electrolyte

ImbalancePC Hyperglycemia


diagnoses based onassessment data.

2. Determines expectedoutcomes for individualclients

IMPLEMENTATION1. Adaptations to minimize

function:a. Drug Therapyb. Diet therapyc. Colostomy and ileostomy

cared. Care of esophageal,

nasogastric and intestinaltubes, T-tubes

e. Measures to prevent

Hepatitisf. Stress reduction


with an alteration in G.I. orHepatobiliary function

2. Participates in developing ateaching plan for a client withan alteration in G.I. orHepatobiliary function

3. Incorporates homecare needsas indicated


a client with agastrointestinal/hepatobiliaryproblem

2. Implements a teaching planfor a client with an alterationin G.I. function

3. Implements the followingskills:a. Tube feedings

b. Ostomy carec. Maintenance of

nasogastric tubes and G.I.suction


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EVALUATION1. Evaluates the effectiveness

of nursing action designedto:a. Improve or maintain

current level of functioning.

b. Prevent complications2. Evaluates the effectiveness

of client teaching for a clientwith an alteration in G.I. orHepatobiliary functioning

2. Surgery:a. Gastrectomyb. Bariatric Surgeryc. Bowel resection,

colostomy, ileostomyd. Appendectomye. Herniorraphyf. Cholecystectomyg. Shunt procedures

3. Teaching needs for self-care:a. Drug/diet therapyb. Ostomy carec. Measures to decrease

stressd. Community agencies


a. Gastrointestinal orHepatobiliary adaptation

b. Self-care


significant changes in fluidand nutritional status

2. Evaluates progress based onoutcome criteria for anindividual client with analteration in G.I.orHepatobiliary function

3. Evaluates the effectiveness of client teaching for a clientwith an alteration in G.I. orHepatobiliary function


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECT MALE &FEMALE ORGAN REPRODUCTIVE FUNCTION

BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assesses the clients

reproductive organ status2. Assesses sexual/reproductive

patterns in the presence of stressors that precipitatereproductive dysfunction

3. Assesses the efforts of alterations in sexuality andreproduction in physical andpsychological adaptation

4. Assesses the clients level of knowledge related tooreproductive organ function

DIAGNOSIS

Formulate nursing diagnosesbased on a biopsychosocialassessment of clients with Maleand Female ReproductiveDysfunction

PLANNING1. Plans nursing care to assist

clients in dealing withfemale sexual/reproductiveconcerns

2. Proposes alternate nursingcare measures to assistclients in adopting changesin physical and

ASSESSMENT1. Stressors affecting

sexual/reproductive statesa. Internalb. Genetic i.e. family

historyc. External i.e. DES,

contraceptives2. Assesses for alterations male

and female reproductiveorgan functionEffects of stress:

Cervical cancer, uterine/ endometrial cancerovarian cancer

Hypertrophy of theProstrate

Prostate and TesticularCancer

DIAGNOSIS

Common Nursing Diagnoses forthese disorders include:

Body Image DisturbancePC HemorrhagePC MetastasisPC Urinary IncontinencePC Sexual DysfunctionAnticipatory Grieving




ASSESSMENT1. Diagnostic tests

a. Gynecological examb. Pap Smearc. MRI-CT of pelvis,

abdomen, bonesd. Cervical, endometrial,

vaginal biopsye. coloposcopyf. D & Cg. cystoscopyh. sigmoidoscopyi. endoscopy j. CA125 Antigen levelk. ultra sonographyl. PSA, Prostatic Alkaline

Phosphatasem. Alfa-feto Protein

2. Analyzes alterations in maleand female sexual/ reproductive function

3. Selects appropriate NursingDX for client withdeterioration in male andfemale sexual/reproduction

DIAGNOSIS

Analyze Data and FormulateDiagnoses


with alterations in male orfemale sexual/reproductivefunction

2. Formulates a teaching planfor the male and female clientwith a sexual/reproductiveorgan dysfunction


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSpsychological functioning

3. Formulates a teaching planfor prevention andmanagement in a client withfemale sexual/reproductivedysfunction

IMPLEMENTATION1. Utilizes the nursing process

to maintain/improve theclients currentsexual/reproductive status

2. Manipulates the environmentto manipulate alterations insexual/reproductive patterns

3. Teaches principles of prevention and managementof cervical and uterinecancer and management of ovarian cancer

4. Instructs theclient in self-care following interventionsfor cervical, uterine andovarian cancer

5. Discusses problems of sexuality in clients who haveundergone prostrate surgery.


of nursing actions designedto:a. prevent complicationsb. maintain or improve


Evaluates the effectiveness of client teaching for a clientwith female sexual/

reproductive dysfunction

IMPLEMENTATION1. Adaptations to maintain

functiona. testosterone sparing

drugsb. androgen deprivation

drugsc. Chemotherapyd. Radiation therapye. Prevent complications of

therapyf. Relieve pain

EVALUATION1. Outcome Criteria for:

a. Adaptations in sexualityand reproduction

b. Adaptations to bodyimage

c. Self care

3. Reviews established protocolfor clients receivingchemotherapy, Radiation andsurgical interventions

3. Incorporates home care needsas indicated


a client with cervical, uterineor ovarian cancer

2. Implements a plan of care fora client experiencinghysterectomy oroophorectomy, or pelvicexenteration

3. Implements a teaching planfor a client with asexual/reproductive organdysfunction

4. Implements a plan of care fora client with prostate ortesticular cancer

5. Implements the followingskills:

Care of continuous bladderirrigation


significant changes insexual/reproductive patterns

2. Develops outcome criteria fora client with a femalesexual/reproductive problem

3. Evaluates effectiveness of teaching for clients withmale or female sexual/ reproductive problems


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECT URINARY ANDRENAL FUNCTION

BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assesses the clients

genitourinary status.2. Assesses elimination/sexual

reproductive patterns forpresence of stressors thatprecipitate genitourinarydysfunction.

3. Assess the effects of alterations in genitourinaryfunction on physical andpsychological adaptation.

4. Assesses the clients level of knowledge

DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients with

Urinary and Renal Dysfunction

PLANNING1. Plans nursing care to assist

clients in dealing with

elimination concerns2. Proposes alternate nursing

care measures to assistclients in adapting tochanges in physical andpsychological functioning

ASSESSMENT1. Stressors effecting

eliminationa. Internalb. Geneticc. External

2. Assesses for alterations in:Pattern of micturation,characteristics of urine,pain, gastro-intestinalsymptoms, fluid balance,vital signs, emotionalchanges, level of consciousness, Sexualdysfunction.

Effects of stress:a. Urinary tract infectionsb. Glomerulonephritisc. Renal calculid. Renal failuree. Dialysisf. Transplantation

DIAGNOSISCommon Nursing Diagnoses forthese disorders include

Acute Pain

PC Fluid and ElectrolyteImbalances

PC Septic Shock Activity IntoleranceImbalanced NutritionDisturbed Thought ProcessPC Metabolic Acidosis

PLANNING1. Formulate nursing diagnosis

based on assessment data

2. Determines expectedoutcomes for individualClients


Blood chemistryClearance studiesConcentration and Dilution

studiesBacteriologic studiesRadiologic studiesAngiogramCystoscopyNeedle biopsy

2. Analyzes alterations inelimination

3. Selects appropriate nursingdiagnosis for a client with analteration in elimination



with alterations in urinary

elimination2. Formulates a plan for

teaching for the client with anelimination impairment

3. Reviews established protocolfor clients receiving chemo


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGS3. Formulates a teaching plan

for prevention andmanagement in a client withelimination dysfunction

IMPLEMENTATION1. Utilizes the nursing process

to maintain/improve theclients current eliminationstatus

2. Manipulates theenvironment to preventalterations in elimination

3. Teaches principles of prevention and managementto the client with a urinarytract infection or renalcalculi

4. Instructs theclient in self-care following urinarydiversion


of nursing actions designedto:a. prevent complicationsb. maintain or improve

current level of

functioning2. Evaluates the effectiveness

of client teaching for a clientwith eliminationsexual/patterns

IMPLEMENTATION1. Adaptations to maintain

function:a. Maintenance of fluid

balanceb. Drug therapy:

antibioticsurinary antisepticselectrolyte & vitamin

replacementdiureticsimmunosuppressants

c. Maintain and preventcomplications of venousaccess devices

d. Diet therapy


Adaptations inelimination and sexuality

and peritoneal dialysis4. Incorporates homecare needs

as indicated

IMPLEMENTATION1. Implements a plan of care

for a client in renal failure2. Implements a plan of care

for a client having urinarytract surgery or prostratesurgery

3. Implements a teaching planfor a client with anelimination problem

4. Implements the followingskills:a. Participation in care of

client undergoingdialysis

b. Urinary diversion care


significant changes inelimination

2. Develops outcome criteriafor a client with asexual/elimination problem

3. Evaluates effectiveness of teaching for clients withsexual eliminationproblems


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS THAT AFFECT NEUROLOGICALFUNCTION

BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT

1. Assesses the clientsNeurological status

2. Assesses cognitive-perceptual patterns forpresence of stressors thatprecipitate neurologicaldysfunction.

3. Assesses the effects of alterations in neurologicalfunction on physical andpsychological adaptation

4. Assesses the clients levelof knowledge

DIAGNOSISFormulate nursing diagnosesbased on a biopsychosocialassessment of clients withNeurologic Dysfunction

ASSESSMENTStressors effecting cognitive-perceptual :

a. Internalb. External

1. Assesses for alterations inneurological status i.e.: levelof consciousness, pupillaryresponse, vital signs, motorand sensory functions,mental status, speech,headache, vomiting,incontinence

2. Effects of stressorsa. Increasing intracranial

pressureb. Altered level of

consciousnessc. Neurological trauma:

head injury, spinal cordinjury, rupturedintervertebral disc

d. Cerebrovascular accidente. Degenerative Neurologic

Disorders: ParkinsonsDisease, MyastheniaGravis, Huntingtons

Disease, MultipleSclerosis, ALS, GullianBarre

f. Neurologic Tumors


Chronic ConfusionRisk for InjuryCompromised Family Coping

Impaired verbal CommunicationDisturbed Sensory PerceptionUnilateral NeglectImpaired Swallowing

ASSESSMENT1. Nursing history2. Diagnostic Tests:

X-rays/Cat scan, MRI, MRABrain scanCerebral AngiographyEEGLumbar PunctureElectromyograph, Nuclear

Magnetic ResonancePositron Emission

Tomography3. Analyzes the neurological

Assessment- Glasgow ComaScale

4. Selects appropriate nursingdiagnosis for a client with aneurological problem



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nursing actions designed to:a. Maintain current level

of functioningb. Prevent complications

improve level of functioning

c. Evaluates effectivenessof client teaching fora client withneurological problem

2. Cranial and Spinal Surgerya. Craniotomyb. Laminectomyc. Microdiscectomy


a. Neurological adaptationb. Self-care


significant changes inneurological functioning

2. Evaluates progress based onoutcome criteria for a clientwith a neurological problem

3. Evaluates effectiveness of clientteaching for clientwith neurological problems


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NURSING MANAGEMENT OF CLIENTS WITH STRESSORS RESULTING FROM BURNS,DISASTER AND SHOCK STATES

BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSASSESSMENT1. Assesses the clients status

in response to stressors as aresult of burn injuries, shock states and disasters.

2. Assesses airway, respiratory,circulatory, elimination andmetabolic status.

3. Assesses the client for risk factors implicated in burninjuries, shock states anddisasters

4. Assesses the burn areavarious methods

5. Assesses the impact of physical and emotionalstress on clientsexperiencing burns, shock states and disasters

6. Assess for epidemiologicalclustering of disaster events

7. Assesses clients level of knowledge related to burns,shock states and disasters

DIAGNOSISFormulate nursing diagnoses

based on a biopsychosocialassessment of clients withBurns/Shock States/Disasters

ASSESSMENT1. Stressors effecting the

recovery of clientsexperiencing burns, shock states and disasters

2. Assesses for alterations in:vital signs, intake and output,pain, lab values, burn areas

DIAGNOSISCommon Nursing Diagnoses for

these disorders include:Fluid and Electrolyte ImbalanceAcute Pain

Deficient Fluid VolumeDecreased Cardiac OutputIneffective Tissue PerfusionIneffective Breathing PatternIneffective ThermoregulationRisk for Infection TransmissionCoping Ineffective CommunityRisk for Post Trauma Syndrome

PowerlessnessSocial IsolationSpiritual Distress


CBCBSUAABGSBUN, CreatinineElectrolytesCulture &Sensitivity

2. Assesses fluid replacementRequirements to prevent andtreat shock states anddisasters

3. Formulates appropriatenursing diagnosis for a clientexperiencing burns, shock states and disasters

DIAGNOSISAnalyze Data and Formulate

Diagnoses


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSPLANNING1. Proposes alternate nursing

care to assist the client inadapting to changes inphysical and psychologicalfunctioning

2. Plans nursing actions:a. to preserve joint mobilityb. to prevent spread of

infectionc. for early detection of

shock and fluid overload3. Formulates a teaching plan to

prepare the client with burnsor injuries from shock statesor disasters to function atmaximal level of independence

IMPLEMENTATION1. Implements a plan of care

for a client with burninjuries, shock states anddisasters

2. Promotes adaptation byencouraging optimallevels of independence

3. Selects measures topromote and

maintain clientsnutritional status


diagnoses based onassessment dataDetermines expectedoutcomes for individualclients and groups

IMPLEMENTATION1. Provides measures to prevent

and treat complications of burns, shock states anddisasters

2. Adaptation to maintainfunction:a. positioningb. ROMc. physical therapy

3. Airway maintenance and O2administration

4. Pain Management5. Fluid resuscitation to prevent

and treat shock states, burnsand disasters

6. Surgical Interventionsa. Debridementb. Tissue Grafting

7. Wound care, Steriledressings

8. Therapeutic Communication9. Drug/Diet Therapy10. Rehabilitation Program

PLANNING1. Plans nursing care for a

client/group experiencingburns, shock states anddisasters

2. Reviews established practicesfor wound care of varioustypes of burns

3. Reviews established practicesfor care of clients in shock states and disasters

4. Develops a teaching plan forself care


a client with burn injuries,shock states and disasters

2. Implements the followingskills:a. triage methodologyb. wound carec. fluid resuscitationd. system assessment

e. pain controlf. therapeutic

communication


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BEHAVIORAL OBJECTIVES COURSE CONTENT CORRELATED LEARNINGSEVALUATION1. Evaluates effectiveness of

nursing actions designed to:a. Prevent complicationsb. Improve level of

functioningc. Determine effectiveness of

client teaching


a. self careb. coping strategiesc. response to treatment


significant changes2. Evaluates progress based on

outcome criteria3. Evaluates effectiveness of

client teaching

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NR40 CourseOutline2007

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