NRSG 355 9.2009

NRSG 355 HEALTH ASSESSMENT and PATHOPHYSIOLOGY

Bachelor of Science in Nursing

CONTRIBUTORS

The following individuals contributed

Patricia A. NielsDr. Lisa Evoy-Unger, December 2005 and May 2003

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Spiritual

Personal Professional

Spiritual Growth Mor

Lead

Professional

Life-Long

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Personal

Service

ONU Nurse

NRSG 355 9.2009

CONTRIBUTORS

The following individuals contributed to the completion of this course of study:

Patricia A. Nielsen, Assistant Professor of Nursing Olivet Nazarene University

November 2007

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NRSG 355 HEALTH ASSESSMENT AND PATHOPHYSIOLOGY

Statement of Faith “As an educational enterprise of the Church of the Nazarene, we

pursue truth in order to glorify the God and the Father of our Lord Jesus Christ: praying for the coming of the spirit; remembering

the promise of Scripture and tradition; keeping our hearts faithfully attuned to the voice of God; and being thoughtfully,

acutely, and critically engaged.” 2002-2004 Catalog. Bourbonnais, IL: Olivet Nazarene University.

COURSE DESCRIPTION/OVERVIEW The focus of this course is to strengthen physical assessment knowledge through the understanding of selected pathophysiological processes. Emphasis is placed on the concepts of cellular injury, inflammation, hypoxia, and cancer, as well as the health continuum, the nursing history, examination, and interviewing techniques, and documentation.

COURSE LEARNING OUTCOMES Upon completion of this course, the learner will be able to:

Recognize the pathogenesis that can occur from cellular injury, inflammation, hypoxia, and cancer.

Differentiate adaptive from maladaptive compensations in selected disease processes.

Correlate pathophysiological processes with common manifestations notable during physical assessment.

Recognize differences in the physiological effects of normal aging and disease in the adult and the elderly.

Utilize effective communication skills in the development of a trusting and cooperative relationship with a client.

Collect, interpret, and condense all assessment data and write it in an organized past history, history of present illness, and review of systems.

Teach forms of healthcare prevention when risk factors or physical findings are discovered.

COURSE MATERIALS

Required Textbooks:

American Psychological Association. (2001). Publication manual of the American Psychological Association (5th ed.). Washington, DC: America Psychological Association.

Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th ed.). St. Louis: Mosby, Inc.

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Course Textbooks, articles, and access to blackboard will be made available to the learner. Assignments may include discussion topics, individual assignments, and projects. Specifics are outlined in the course syllabus.

Special Requirements:Internet AccessMicrosoft Office 2007 SoftwareCompletion of the Online Blackboard Training Student Classroom is required.

COURSE ASSIGNMENTS/ASSESSMENTS

The learning outcomes will be fostered and assessed in a variety of ways. As best practice suggests, assessment will be formative and summative and will include the application of acquired course knowledge to real world practice settings. This course will include the following:

WEEKLY DISCUSSION POSTINGSWRITTEN ASSIGNMENTSCUMULATIVE PORTFOLIO

Assignments Points

Discussion The discussion assignments each week may be online or on ground

(Refer to the class instructor for discussion preference if not an online course)

Discussion Rubric is applicable for either online or on ground participation requirements

6 @ 5 points each week 30

Assessment and Pathophysiology PaperDUE Week 4 - Day 3 35 35

Assessment and Pathophysiology PPTDUE Week 6 - Day 3 35 35

TOTAL COURSE POINTS 100

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WEEKLY WORKSHOP TOPICS

WEEK 1: ASSESSMENT INTERVIEW AND TECHNIQUESWEEK 2: RESPIRATORY SYSTEMWEEK 3: CIRCULATORY SYSTEMWEEK 4: NEUROLOGICAL AND MUSCKULOSKELETAL SYSTEMWEEK 5: DISCUSS THE NEUROLOGICAL ASSESSMENTCASE

SCENARIOWEEK 6: COMPLETE A NURSING HISTORY AND A PHYSICAL

ASSESSMENT FROM YOUR PAPER AND PRESENT IT AS A PPT IN CLASS.

STUDENT ATTENDANCE

Students are to communicate directly with the course instructor regarding any circumstance that may result in absence of course participation. Course participation is met through discussions in class and/or postings and submission of assignments by the required due date. Due to the nature of some discussions, instructors may not allow students to post in advance or in retrospect to discussions due to absences. Students with an unexcused absence will receive a 50% grade reduction for any assignment submitted during that week.

RNBSN ACADEMIC INFORMATION AND POLICIES

School of Graduate and Continuing Studies – Attendance Policy

One absence (and only one) may be excused without the grade being affected provided make-up work is satisfactory completed:

o The learner must contact the instructor.o The absence must be the result of unavoidable circumstances.o Make-up work is satisfactory completed before the start of the following

workshop.

If the first absence is unexcused, the following scale will be used for grade reduction:o For courses with 7, 8, or 9 workshops/sessions:

1st absence will result in a final course grade no higher than a “B” 2nd absence will result in a final course grade no higher than a “C” 3rd absence will result in a final course grade of “F”

o For courses with 4, 5, or 6 workshops/sessions: 1st absence will result in a final course grade no higher than a “C” 2nd absence will result in a final course grade of “F”)

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All subsequent absences (if first absence is excused) will result in an automatic grade reduction.

The number of absences relative to grade reduction will reflect number of workshops in the course (assuming one absence is excused based on the approved criteria listed above):

o For courses with 7, 8, or 9 workshops/sessions: 2nd absence will result in a final course grade no higher than a “B” 3rd absence will result in a final course grade no higher than a “C” 4th absence will result in a final course grade of “F”

o For courses with 4, 5, or 6 workshops/sessions: 2nd absence will result in a final course grade no higher than a “C” 3rd absence will result in a final course grade of “F”

o For courses with 2 or 3 workshops/sessions An alternative cohort must be found so learner can attend the course in

total

Grades will be monitored with final attendance. Grades must reflect absence – no exceptions. If the first absence is not excused or the learner does not complete the necessary make-up

work, the grade will be reduced beginning with the first absence. Instructors will address tardiness on an individual basis. Learners are expected to arrive

for class on time and remain for the entire four hour period.

Attendance – Online Courses

Students are required to participate in class three different days each week. Your initial posting is NOT a RESPONSE to classmates. Both the quantity and quality of participation are evaluated. In courses where there are team/group activities, those discussions are NOT counted as part of the discussion postings. In addition to participation, the discussion rubric provides further details on possible points according to quality of posting.(Refer to the RNBSN Student Handbook for Policy Details)

Students are expected to communicate directly with the course instructor regarding any circumstance that may result in absence of course participation. Course participation is met through discussion postings and submission of assignments by the required due date.

1. Learners in online courses must post at least one substantive online message per course week to be considered in attendance.

2. Failure to log in and post at least once a week will result in an unexcused absence. Grade reductions according to the Attendance Policy in this handbook will be applied.

3. Participation is not the same as attendance. Participation requirements are determined by the instructor and will be thoroughly explained in the course syllabus.

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4. Students with an unexcused absence will receive a 50% grade reduction for any assignments submitted during that week.

Instructors will address tardiness on an individual basis. Learners are expected to arrive for class on time and remain for the entire session.

(Refer to the RNBSN Student Handbook for details)

EVALUATION PROCEDURE AND Grading System95 – 100 A92 – 94.9 A-89 – 91.9 B+86 – 88.9 B 83 – 85.9 B-80 – 82.9 C+77 – 79.9 C_____________________________________74 – 76.9 C- Non-passing scores 71 – 73.9 D+68 – 70.9 D65 – 67.9 D-

The student will receive credit for assignments in the following ways:

DISCUSSIONSThe grading for discussion activities is outlined in the course-grading rubric. Students are required to support their discussions with citations, write in APA and provide a reference list at the bottom of their posting.

Participation points, which may be given, based on the Discussion Postings. If this is a required part of the course assessment, the standard policy for discussion requirements and the grading rubric are consistent in each course syllabus. When discussion is part of the required assessment to ensure all members of the learning community have sufficient time to respond you are expected to adhere to the following guidelines:

Post your initial activity no later than the third day of each week by midnight. Respond to three of your colleagues’ initial postings during each week on three different

days. Provide colleagues with reflective thoughts, personal experience, resources, or general

thoughts on the topic. Posting after the required date will result in a grade reduction as stated in the rubric.

ASSIGNMENTSPoints will be given based on the assessment outlined for each course. Refer to the course assignments and the corresponding grading rubric provided found in the course link identified as (rubric). Each week the course guide will provide the student with the required assignment. The learner as a guide for formulating written objectives should utilize the grading rubric for the assignment.

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Students with an unexcused absence will receive a 50% grade reduction for any assignment submitted during that week.

LATE WORK POLICYNo late papers/assignments will be accepted after the date and time stated in the syllabus or otherwise stated by the professor. In extreme circumstances exceptions may be made (i.e. illness). However, this must be agreed upon by the student and professor prior to the due date.

POLICIES ON PLAGIARISMPlagiarism is defined as use of intellectual material produced by another person without acknowledging its course. For example:

Wholesale copying of passages from works of others into an assignment, paper, posting, or thesis without acknowledgement.

Using the views, opinions, or insights of another without acknowledgement. Paraphrasing another person’s characteristic or original phraseology, metaphor, or other

literary device without acknowledgment. Faculty will monitor for evidence of plagiarism. All work must be submitted through the

correct blackboard process to be assessed for evidence of plagiarism. Self-plagiarism is the use of the learner’s work from a previous class and is highly

discouraged. Should the learner’s previous work be used, it must be cited as such.

For further information on Olivet Nazarene University Conduct and Responsibilities, see the Catalog at the course link (ONU Bulletin).

Students suspected of plagiarism require faculty to contact the Chair, Director of Nursing Department at ONU directly.

OVERVIEW WEEK 1

In Siedel, Chapter 1 explores the importance of developing a partnership with the patient in order to complete a thorough health history. Techniques are reviewed to assist the learner in communicating with the patient effectively. Finally this chapter compares the history and interviewing process for adults with the interviewing process for adults with the interviewing process for special populations such as pregnant women, adolescents, children, and older adults.

Chapter 3 examines the techniques of inspection, palpation, percussion, and auscultation that are used throughout the physical examination and the correct application for each technique.

Chapter 4 assists the learner to develop techniques to assess mental status. A review of the history of present illness is presented with a discussion of abnormalities related to common diagnoses. Finally, this chapter evaluates the mental status examination findings in relation to common abnormalities of the adult and various populations.

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Chapter 8 examines the anatomy and physiology of the skin, hair, and nails, including specifics for special populations such as older adults, infants, and children. A review of the key elements of the history of present illness, past medical history, and personal and social history is discussed with special emphasis on each area of skin, hair and nails.

RESOURCES WEEK 1

Devotion

READING ASSIGNMENT WEEK 1

Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th ed.). St. Louis: Mosby, Inc.

Chapter 1 - “The History and Interviewing Process”Chapter 3 - “Examination Techniques”Chapter 4 - “Mental Status”Chapter 8 - “Skin, Hair, and Nails”

WEBSITES WEEK 1

Interactive online 'life change events' stress test From Stress Management™.

Roy Adaptation Model Web page of Sr. Callista Roy, PhD, RN, FAAN, Boston College.

Stress and Disease: The contribution of Hans Selye to Neuroimmune Biology. A personal Reminiscence. An online article by Istvan Berczi, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

AGENCIES AND ORGANIZATIONS

Association for Applied and Therapeutic Humor

National Institute of Mental Health

The Immune System: Friend and Foe "Four lectures on immunology by John W. Kappler, PhD, and Philippa Marrack, PhD." Online video lectures from 1996, from the Howard Hughes Medical Institute. Series requires RealOne Player to view. Includes: How Immune Cells Create Trillions of Receptors from a Few Hundred Parts; How the Immune System Detects Invaders; How the Host Avoids "Friendly Fire"; and Stalking the Elusive Pathogen.

Understanding the Immune System: How It works A 65 page online publication from the National Cancer Institute and the National Institute of Allergy and Infectious Diseases, 2003.

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CHAPTER 1 THE HISTORY AND INTERVIEWING PROCESS

AAFP Clinical Recommendations from the American Academy of Family Physicians.

Communicating with Patients and the online brochure The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities From the American Hospital Association. Available in multiple languages.

"Talk to Me": Communication with Older Adults An online continuing education module from the University of Florida Geriatric Education Center.

American Academy of Family Physicians

National Center on Elder Abuse - NCEA Includes an overview document The Basics: Major Types of Elder Abuse.

CHAPTER 3 EXAMINATION TECHNIQUES

AAFP Clinical Recommendations From the American Academy of Family Physicians.

The Auscultation Assistant From UCLA; requires speakers for audio. Text and sound copyright 1997, Christopher Cable, MD.

Merck Manual of Geriatrics Editors Mark H. Beers, MD, and Robert Berkow, MD; Copyright© by Merck & Co., Inc. Available online.

American Academy of Family Physicians An extensive site with material for patients and health providers.

American Association of Nurse Assessment Coordinators For resident assessment in long term care.

Chapter 4 Mental StatusA narrative approach to mental health in general practice Education and debate on "Narrative based medicine"; "the second in a series of five articles on narrative based medicine"; by John Launer, senior lecturer in general practice and primary care. BMJ - British Medical Journal 1999; 318:117-119 (9 January), full-text online.

CHAPTER 8 SKIN, HAIR, AND NAILS

Caring for Wounds and Pressure Ulcers Online continuing education program from the University of Florida; part of a larger program Health Management for Older Adults. Includes audio presentations.

Diabetic Foot Ulcers: Prevention, Diagnosis and Classification An online article by David G. Armstrong, DPM, and Lawrence A. Lavery, DPM, MPH; American Family Physician, March 15, 1998.

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Integumentary Assessment By Peg Gray; a slide presentation that focuses on the nails.

Dermatology Nurses Association

OTHER RESOURCES WEEK 1

Click here for Power Points to support learning this week!

The History and Interviewing ProcessExamination Techniques and EquipmentMental StatusSkin, Hair, and Nails

DISCUSSION ACTIVITY WEEK 1

1. Investigate the website on Roy’s Adaptation System Theory. Compare and contrast her theory and how it relates to your health and how you handle stress.

2. Take the online “life change events” stress test. Review the results from the test. Do these “events” have a positive or a negative effect on your life and how can you learn from these changes?

3. Describe how immunology affects your particular patient population. 4. Post your discussion to the board.5. Read all of your colleagues’ postings.6. Respond to at least three of your colleagues’ initial postings.

*Be sure to support your posting with citations from this week’s resources. Refer to the APA Publication Manual to assure your citations in the text and reference list are correct.

ASSIGNMENT WEEK 1

There is no assignment for Week One.

Looking Ahead Tip:

Looking ahead to Week Two your activity will be posting on the discussion board a case scenario that you must complete. You must critique one of your colleagues’ work on their case studies and post the critique so they may have feedback in a timely manner. You will be graded on your response. To enhance your learning, you are encouraged to select a case study on a patient population that will challenge you. For example if your practice entails Geriatrics, pick a Pediatric case to expand your knowledge base.

Case Study is due in Week 2 - Day 3 by 11:59 p.m.

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OVERVIEW WEEK 2

This week you will review topics include Alterations in oxygen transport and gas exchange, obstructive and restrictive pulmonary disorders. The learner will discuss the causes and effect of hypoxia, and the pathophysiological causes of anemia.

In Siedel, you will be reading Chapter 2, which examines culture and its impact on health assessment and care of the patient. Definitions of cultural competence and cultural awareness are reviewed. In addition, this chapter compares and contrasts the patient-centered model with the family-centered model of health care. Finally this chapter examines the impact of cultural response and the components that affect the clinician’s health assessment.

Chapter 13 discusses the anatomy and physiology of the respiratory system. Age-specific variations in the chest and lung examinations are distinguished from the adult population. In addition, an analysis of normal and abnormal examination findings are related to various conditions of the chest and lungs. Finally this chapter evaluates the history and physical examination findings for common abnormalities.

RESOURCES WEEK 2

Devotion

READING ASSIGNMENT WEEK 2

Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th Ed.). St. Louis: Mosby, Inc.

Chapter 2 - “Culture Awareness”Chapter 13 - “Chest and Lungs”

WEBSITES WEEK 2

Blood-Chemistry Tutorials Online tutorials from the Chemistry Department, Washington University, St. Louis; includes Hemoglobin and the Heme Group: Metal Complexes in the Blood for Oxygen Transport; Iron Use and Storage in the Body: Ferritin and Molecular Representations; Maintaining the Body's Chemistry: Dialysis in the Kidneys; and Blood, Sweat, and Buffers: pH Regulation during Exercise.

Sickle Cell Anemia From the National Heart, Lung and, Blood Institute; requires Adobe Acrobat.

RESPIRATORY FUNCTION AND ALTERATIONS IN GAS EXCHANGE

Acid-Base Tutorial By Alan W. Grogono, MB, BS, MD, FRCA, Tulane University School of

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Medicine.

The Auscultation Assistant By Christopher Cable, MD, UCLA School of Medicine. This site requires considerable disk cache space.

The Human Respiratory System Extensive site from the American Lung Association that includes an animated explanation of how the lungs work.

Interactive Respiratory Physiology By Wilmot C. Ball Jr., MD, Johns Hopkins School of Medicine. Includes Tutorials, an encyclopedia, dictionary, and interactive quizzes that provide immediate feedback.

OBSTRUCTIVE PULMONARY DISORDERS

Asthma An extensive interactive tutorial from the University of California at San Diego School of Medicine.

Chronic Bronchitis: Primary Care Management Online article by John M. Heath, MD, from American Family Physician, May 15, 1998.

Chronic Obstructive Pulmonary Disease: Epidemiology and Evaluation Online article by David M. Mannino, MD, FCCP, from Hospital Physician, October 2001.

LungCancer.org Copyright © 2007 by It's Time To Focus On Lung Cancer; sponsored by Cancer Care, Inc. and the Oncology Nursing Society; contains both professional and patient resources.

RESTRICTIVE PULMONARY DISORDERS

The Acute Respiratory Distress Syndrome: Myths and Controversies By Joseph Varon, MD, FACA, FACP, and Olivier Wenker, MD, DEAA; online article from the Internet Journal of Emergency & Intensive Care Medicine.

Acute respiratory distress syndrome Online article by Kahdi F. Udobi, MD, Ed Childs, MD, and Karim Touijer, MD, from American Family Physician, January 15, 2003.

Respiratory Distress Syndrome From the Neonatal Handbook, Newborn Emergency Transport Service, Victoria, Australia.

Severe Acute Respiratory Syndrome (SARS) Guidelines and recommendations from the Centers for Disease Control and Prevention. CULTURAL AWARENESS

Checklists for cultural assessment From the State of Queensland, Queensland Department of Health, Australia site on Multicultural Health.

Clinical Practice Guidelines for Nurses in Primary Care An online guide from Health Canada;

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covers multiple organ systems; "intended primarily for use by qualified and licensed nurses working in nursing stations and treatment health centers located in semi-isolated and isolated First Nations and Inuit communities". There is also a site for Pediatric Clinical Practice Guidelines for Nurses in Primary Care.

Transcultural Nursing: Basic Concepts & Case Studies; Created by Victor Fernandez RN and Kathy Fernandez RN. Sites include: Asian Community; Hispanic American Community; Middle Eastern Community; Deaf Culture; The Black-American Community; A Hispanic Migrant Community Assessment.

OTHER RESOURCES WEEK 2

Click here for Power Points to support learning this week!

Cultural AwarenessChest and Lungs

DISCUSSION ACTIVITY WEEK 2

1. Choose one case study from those listed below.2. After reading the case study, what were the pertinent laboratory findings, the etiology of

the disease process, and what would you expect to find on your physical assessment of the patient?

3. What compensatory mechanisms are occurring in the patient? 4. Post your discussion to the board.5. Read all of your colleagues’ postings.6. Respond to at least three of your colleagues’ initial postings.

*Be sure to support your posting with citations from this week’s resources. Refer to the APA Publication Manual to assure your citations in the text and reference list are correct.

CASE STUDIES

1. Pediatric Case Study : C.Q. was recently exposed to a group a hemolytic streptococcus and subsequently developed pharyngeal infection. Clinical examination by the nurse reveals an oral temperature of 102.3, skin rash, and reddened throat mucosa with multiple pustules. C.Q. complains of sore throat, malaise, and joint stiffness.

2. Older Adult Case Study: R.V. is a 72-year-old male in the clinic for increasing shortness of breath. On physical examination, he is found to be slightly hypertensive at 150/94 and has a ruddy complexion. He is a long –time cigarette smoker. Laboratory evaluation reveals a hematocrit of 50% with hemoglobin of 20g/dL. Oximetry reveals a hemoglobin saturation of 92%.

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3. Middle Age Case Study : R.S. worked for many years spray-painting cars at his autobody repair business. He has bronchitis COPD. He also has a history of coronary artery disease and peripheral vascular disease. His arterial blood has values are: pH=7.23, PaCO2=60 mm Hg, PaO2=50mm Hg, HCO3= 30mEq/L. His hematocrit is 52% with normal red cell indices. He is taking an inhaled beta agonist and the theophylline to treat his respiratory condition. At his clinic visit, the nurse notes that R.S. has an area of consolidation in his right lobe thought to be consistent with pneumonia.

ASSIGNMENT WEEK 2

There is no assignment for Week Two.

LOOKING AHEAD TIP!

In WEEK 4 - DAY 3 you will have a 3-5 page typed written paper due on the pathophysiology of a disease process and the assessment findings you may find in that particular disease process. This does not include the title or reference page. You should focus on a disease process that you have learned about or unfamiliar with. Some diseases you may want to focus on are: Autoimmune Diseases (i.e., Rheumatoid Arthritis, Lupus, Diabetes Mellitus, etc.), Cardio/Pulmonary or any Neoplasm Disease Process. In addition to writing about the pathophysiology, you will include the assessment findings in that particular patient. You are encouraged to focus on a patient population that you are unfamiliar with to expand your knowledge base. You will frame your discussion around the physical, emotional, and spiritual needs of the patient. Please make sure you get your topic cleared by your instructor by WEEK 3.

MAJOR POINTS TO FOCUS IN THE PAPER:

1. Identify the population you will discuss2. Explain the Pathophysiology 3. Describe the assessment findings of your selected disease4. Discuss the physical, emotional and spiritual needs of the patient with your selected

disease.

Specific APA requirements include:

1. You want to make sure the content of the paper is comprehensive, and accurate.

A. Major points are stated clearly, and are supported by specific details, examples and analysis.

B. Research is adequate and timely for the topicC. The content and purpose of the writing is clear.

2. Organization

A. The introduction provides sufficient background on the disease and previews major points.

B. The structure of the paper is clear and easy to follow.

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C. The paper’s organization emphasizes the central theme or purpose and is directed. D. Paragraph transitions are present and logical and maintain the flow of thought

throughout the paper.

3. Format

A. The paper follows designated guidelines for APA format including citations references.

B. The paper uses reference appropriately

4. Grammar/Punctuation/Spelling

A. Spelling is correct. B. Word usage is correct. C. Punctuation is correct.

5. Readability/Style

A. Sentences are complete, clear, and concise. B. Sentences are well constructed with consistently strong, varied,

structure C. Sentence transitions are presented and maintain the flow of

thought. D. The tone is appropriate to the content and assignment. E. Development of each paragraph provides one idea per paragraph and provides

consistency and flow

PLEASE REFER TO THE GRADING RUBRIC FOR THE BREAK DOWN OF POINTS IN EACH SECTION.

OVERVIEW WEEK 3

This week your review addresses cardiac function. Chapter 14 in Siedel describes the anatomy and physiology of the heart. Age-related and diagnosis variations of the heart are discussed. Interviewing techniques related to the heart and condition variations are described. Finally, this chapter examines the health history and physical examination related to symptoms and clinical findings associated with cardiac abnormalities.

Chapter 15 in Siedel begins with the anatomy and physiology of blood vessels. Age-related and condition variations are described. A discussion of interviewing techniques to gather data for the health history related to the blood vessels is described. Finally abnormal history and physical examination findings are discussed related to various pathologic conditions of the blood vessels.

RESOURCES WEEK 3

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Devotion

READING ASSIGNMENT WEEK 3 Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th

ed.). St. Louis: Mosby, Inc.

Chapter 14 - “Heart”Chapter 15 - “Blood Vessels”

WEBSITES WEEK 3

CARDIAC FUNCTION

Aspirin as a Therapeutic Agent in Cardiovascular Disease A Statement for Healthcare Professionals From the American Heart Association.

The Auscultation Assistant By Christopher Cable, MD, UCLA School of Medicine; this site requires considerable disk cache space.

ALTERATIONS IN CARDIAC FUNCTION

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article From the Journal of the American College of Cardiology, 2005; 46:1116-1143.

National Heart Lung and Blood Institute (NHLBI) and NHLBI Morbidity and Mortality Chart Book 2004 which requires Adobe Acrobat.

National High Blood Pressure Education Program (NHBPEP) Contains online slide sets and other resources; from the National Heart, Lung, and Blood Institute (NHLBI).

AGENCIES AND ORGANIZATIONS

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

American Association of Critical-Care Nurses (AACN)

HEART FAILURE AND DYSRHYTHMIAS: COMMON SEQUELAE OF CARDIAC DISEASES

Antiarrhythmic Agents From Einthoven Advances in Cardiac Arrhythmias site.

EKG Quiz Extensive ECG site from McGill University. .

Heart Failure Society of America Maintains an extensive consumer level site About Heart

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Failure, which includes an online learning module on Heart Failure Medicines.

Managing Heart Failure: A Case Study Approach Online continuing education article by Mary MacKlin, from the American Association of Critical-Care Nurses.

SHOCK

Cardiogenic Shock From eMedicine World Medical Library.

Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries By the Committee on Fluid Resuscitation for Combat Casualties, Institute of Medicine; 208 pages, 1999. Full text online from the National Academies Press.

Practice Parameters for Hemodynamic Support of Sepsis in Adult Patients Guideline from the Society of Critical Care Medicine.

http://evolve.elsevier.com/Seidel

HEART

Aspirin as a Therapeutic Agent in Cardiovascular Disease A Statement for Healthcare Professionals From the American Heart Association.

The Heart An Online Exploration from the Franklin Institute, consumer level.

Heart Sounds and Murmurs Includes audio and video files; from Introduction: Examination for Heart Sounds and Murmurs, Advanced Physical Diagnosis Skills for the Bedside By Linda E. Pinsk, MD, and Linda E. Pinsky, MD, Department of Medicine, University of Washington, Seattle.

AGENCIES AND ORGANIZATIONS

American Association of Critical-Care Nurses Includes many online continuing education articles related to cardiovascular disorders.

American College of Cardiology An extensive site with many useful items, including expert consensus documents.

American College of Chest Physicians

Council on Cardiovascular Nursing of the American Heart Association

Kids with Heart National Association for Children's Heart Disorders, Inc.

National Heart, Lung, and Blood Institute - NHLBI

Society for Vascular Nursing

OTHER RESOURCES WEEK 3

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Click here for Power Points to support learning this week!

1. Heart 2. Blood Vessels

DISCUSSION ACTIVITY WEEK 3

1. Choose one case study from those listed below.2. After reading the case study, what were the pertinent laboratory findings, the etiology of

the disease process, and what would you expect to find on your physical assessment of the patient?

3. What compensatory mechanisms are occurring in the patient? 4. Post your discussion to the board.5. Read all of your colleagues’ postings.6. Respond to at least three of your colleagues’ initial postings.

*Be sure to support your posting with citations from this week’s resources. Refer to the APA Publication Manual to assure your citations in the text and reference list are correct.

CASE STUDIES

1. Older Adult Case Study : A.O. was an 89-year-old woman with a long history of congestive heart failure secondary to a large left ventricular infarct. She has poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She took digitalis, Lasix, KCl, and sublingual nitroglycerin.

2. Pediatric Case Study : C.J. is a 12-yar-old high school student who is in the clinic for sports physical prior to beginning basketball practice. The nurse assesses that he has no known allergies. A review of systems reveals only that C.J. gets winded earlier than most boys on the team. He attributes this to needing to get in better shape. The physical exam is unremarkable except for a grade III systolic murmur heard over the entire pericardium. An echocardiogram and cardiac cath reveals a VSD with moderate pulmonary hypertension.

3. Young Adult Case Study : T.V. is hospitalized with deep vein thrombosis in her left leg as a complication of abdominal surgery. She is being treated with bed rest and anticoagulant therapy. On the third postoperative day, she suddenly experiences severe dyspnea and is placed on supplemental oxygen. A blood gas is drawn with demonstrated hypoxemia and mild respiratory alkalosis.

ASSIGNMENT WEEK 3

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There is no assignment for Week Three.

OVERVIEW WEEK 4

The purpose of this week is to understand how the CNS, peripheral nervous system, and the autonomic nervous system interrelate.

Different types of traumatic brain injury, increased intracranial pressure, and under what conditions these occur are reviewed. The three different types of strokes are compared and contrasted. Meningitis, encephalitis, infective organisms, CSF fluid findings, clinical manifestations, and treatment are all presented.Chapter 21 of Siedel covers the anatomy and physiology of the musculoskeletal system. The musculoskeletal anatomy and physiology of various populations are reviewed. Interviewing techniques are described to assist in information gathering of the musculoskeletal system. Health history and physical examination findings that deviate from normal are evaluated to correlate with clinical findings of common pathologic conditions of the musculoskeletal system.

Chapter 22 begins with a description of the anatomy and physiology of the neurologic system. Variations of the neurologic system in selected populations are also described. The techniques of the physical examination are examined with a discussion of specific abnormal findings. Finally, common pathologic disorders are described with related symptoms and clinical findings.

RESOURCES WEEK 4

Devotion

READING ASSIGNMENT WEEK 4

Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th ed.). St. Louis: Mosby, Inc.

Chapter 21 - “Musculoskeletal System”Chapter 22 - “Neurologic System”

REMEMBER YOUR PAPER IS DUE THIS WEEK!!!

WEBSITES WEEK 4

Nervous System From JayDoc HistoWeb; University of Kansas Medical Center; illustrations and text.

The Whole Brain Atlas By Keith A. Johnson, MD, J. Alex Becker, Harvard University.

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ACUTE DISORDERS OF BRAIN FUNCTION

Management of the Acute Migraine Headache Online article by Glen Aukerman, MD, Doug Knutson, MD, and William F. Miser, MD, MA, from American Family Physician, December 1, 2002.

Stroke From the American Heart Association. Comprehensive information regarding stroke and the role that the AHA plays in fighting this disease. Check out the links at the bottom of the page. There is also a collection of Scientific Publications on Stroke, and American Heart Association Heart and Stroke Statistical Update.

Stroke Statistical overview from the CDC.

AGENCIES AND ORGANIZATIONS

American Stroke Association A division of the American Heart Association.

Brain Injury Association

National Headache Foundation

National Institute of Neurological Disorders and Stroke

National Stroke Association

CHRONIC DISORDERS OF NEUROLOGIC FUNCTION

Multiple Sclerosis An online tutorial from Knowledge Weavers, Spencer S. Eccles Health Sciences Library; University of Utah; © John W. Rose, MD; Maria Houtchens, MSIII; and Sharon G. Lynch, MD.

Neuromuscular Disease Center At Washington University School of Medicine, St. Louis; comprehensive site, large sections on specific diseases, diagnostic procedures, anatomy, physiology, toxic neuropathies, and much more.

AGENCIES AND ORGANIZATIONS

American Academy of Neurology

American Association of Spinal Cord Injury Nurses

National Spinal Cord Injury Association

ALTERATIONS IN SPECIAL SENSORY FUNCTION

Age-Related Macular Degeneration: What you should know Information from the National Eye Institute.

Cataract: What you should know Information from the National Eye Institute.

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Eye and Ear From JayDoc: HistoWeb; lavish illustrations; University of Kansas Medical Center.

PAIN

Efficacy of Cold for Pain: Fact or Fallacy? An Online Continuing Education Program article by Jenny Sauls, RNC, DSN, from Sigma Theta Tau International.

The Use of Opioids for the Treatment of Chronic Pain "A consensus statement from the American Academy of Pain Medicine and the American Pain Society."

http://evolve.elsevier.com/Seidel

MUSCULOSKELETAL SYSTEM

Bone Cancer "oncologist-approved cancer information" from People Living With Cancer, "the patient information website of the American Society of Clinical Oncology (ASCO)."

Musculoskeletal System Chapter 7 of the Clinical Practice Guidelines for Nurses in Primary Care, an online guide from Health Canada; "intended primarily for use by qualified and licensed nurses working in nursing stations and treatment health centers located in semi-isolated and isolated First Nations and Inuit communities". Includes sections on common problems and emergencies.

Osteoarthritis An online audiovisual tutorial from the National Library of Medicine.

Osteoporosis An online audiovisual tutorial from the National Library of Medicine.

NEUROLOGIC SYSTEM

Advances in the Treatment of Epilepsy Online article by Selim R. Benbadis, MD, and William O. Tatum IV, DO; from American Family Physician, July 1, 2001; includes a link to a patient handout.

American Academy of Neurology Practice Guidelines These cover a wide range of topics.

Head and Brain Injuries A collection of links to web resources from Medline Plus.

History & Physical Examination: Clinical Patterns Part of the web site Neuromuscular Evaluation Protocols on the Neuromuscular Disease Center site, Washington University School of Medicine, St. Louis. Also includes information on Lab Testing: Especially for treatable diagnoses after history & examination and Nerve Biopsy.

Stroke From the American Heart Association. Comprehensive information regarding stroke and the role that the AHA plays in fighting this disease. Check out the links at the bottom of the page. There is also a collection of Scientific Publications on Stroke.

OTHER RESOURCES WEEK 4

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Click here for Power Points to support learning this week!

Musculoskeletal SystemNeurologic System

DISCUSSION ACTIVITY WEEK 4

1. Choose one case study from those listed below.2. After reading the case study, what were the pertinent laboratory findings, the etiology of

the disease process, and what would you expect to find on your physical assessment of the patient?

3. What compensatory mechanisms are occurring in the patient? 4. Post your discussion to the board.5. Read all of your colleagues’ postings.6. Respond to at least three of your colleagues’ initial postings.

*Be sure to support your posting with citations from this week’s resources. Refer to the APA Publication Manual to assure your citations in the text and reference list are correct.

CASE STUDIES

1. Older Adult Case Study : J.S. is a 72-year-old woman with a long history of atherosclerosis. One afternoon, her grandson found her sitting in a chair staring blankly. She was tilting toward the right, drooling, and had been incontinent of urine. She was able to focus her eyes on him, when he spoke to her, but she was unable to verbalize a response. She was transported to the local hospital and diagnosed with CVA.

2. Young Adult Case Study : T.L. is a 32-year-old mother of two, has a history of multiple sclerosis for 5 years. She is currently enrolled in a school of nursing. Her husband is supportive and helps with the care of their preschool sons. T.L. is visiting the clinic today for diagnostic studies related to symptoms of visual disturbances.

3. Pediatric Case Study : M.N. is a 13year-old male who received a head injury as a result of a bike accident. You noticed he has increased ICP of 30mmHg as a result of a massive closed head injury.

ASSIGNMENT WEEK 4

Your Pathophysiology and Assessment Paper Part I is due on Day 4 of this week.

LOOKING AHEAD TIP!

In WEEK 6 - Day 3, as a final project in the class, you will be doing a Power Point Presentation on your paper. You will be presenting on your disease process and your assessment findings.

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This presentation should include how you would be teaching a new graduate nurse on how to assess your patient with this particular disease process. Please have the presentation approved by your instructor 1 WEEK prior to presenting for approval by your instructor. The Power Points need to be professional looking. The presentation itself should be about 5 minutes in length. The information on the slides should include the following information:

1. Introduction of your presentation2. Description of the disease and the pathophysiology3. Assessment findings4. Physical, Emotional and Spiritual needs of your patient5. Teaching Perils for the New Graduate Nurse

You should expect 1 minute per slide. You should have a total of 8 slides. Your slides should include: a title page and a reference slide at the end.

Please refer to the grading rubric for Power Point Presentation for Week 6 for a breakdown of Points.

OVERVIEW WEEK 5

For this week, the learning includes the difference between neoplastic from normal cells, how benign and malignant cells differ. You will explain the relationship between immunosuppression and cancer. The chapter concludes with how personal history, social history, and nutrition relate to preventions, remission, and healing of cancer.

Chapter 24 in Siedel examines the physical examination sequence, discussing patient positioning and its relation to the specific examinations completes. Techniques for examining infants, children, pregnant women, older adults, and adult patients are compared. Finally, this chapter summarizes a functional assessment for the older adult.

RESOURCES WEEK 5

Devotion

READING ASSIGNMENT WEEK 5 Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th

ed.). St. Louis: Mosby, Inc.

Chapter 24 - “Putting it all together”

WEBSITES WEEK 5

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Cancer Guide A site for cancer patients on how to research their own disease.

Cancer Literature An extensive resource from the National Cancer Institute that includes open-access to PDQ (state of the art summaries on cancer therapies for physicians and patients) and an online bibliographic database for researching cancer topics that is searchable via PubMed.

Preventing and Controlling Cancer: The Nation's Second Leading Cause of Death Information from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

DATABASES

The National Cancer Institute has many full text documents, and online Cancer Literature resources. This site includes a dictionary, information on treatment options for specific types of cancer, resources and literature, and the access to a searchable database of articles via PubMED. Some materials are available in English and Spanish.

RESOURCES WEEK 5

Click here for Power Points to support learning this week!

Putting It All Together

DISCUSSION ACTIVITY WEEK 5

1. Choose one case study from those listed below.2. After reading the case study, what were the pertinent laboratory findings, the etiology of

the disease process, and what would you expect to find on your physical assessment of the patient?

3. What compensatory mechanisms are occurring in the patient? 4. Post your discussion to the board.5. Read all of your colleagues’ postings.6. Respond to at least three of your colleagues’ initial postings.

*Be sure to support your posting with citations from this week’s resources. Refer to the APA Publication Manual to assure your citations in the text and reference list are correct.

CASE STUDIES

1. Karen is a 38 year old white female in good health presenting with a chief complaint of a small lump in the left breast of approximately 18 months duration. A mammogram was performed in May and again in August with both normal. Ultrasound was also performed in October. Karen was informed by her physician that the lump was fibrocystic and

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benign. Father died age 62 from MI, mother and three sisters are healthy. Divorced with 2 daughters ages 10 and 11. She is employed as an occupational therapist. Menses at age 16.

2. Mr.Titus had problems with repeated falls. In June 1982, he went to his doctor who, among other tests, carried out a needle biopsy on his brain. This produced a diagnosis of astrocytoma (brain cancer), very bad news indeed, which was given to the patient on his birthday, June 25th . Mr. Titus consulted two other doctors for their "second opinions," but the diagnosis and the prognosis were the same: he would be dead by Christmas. Surgery was offered as a treatment option. However, he had a friend who some six months earlier had submitted to surgery for a brain tumor. He had emerged from the surgery reduced to the status of a vegetable, and had died shortly before Edward was given his diagnosis. With this experience fresh in his mind, he refused surgery.

3. A 31-year-old man was admitted to your oncology unit with an enlarged testicular mass that had been present for 1 y, left leg pain, weakness, and numbness of 6 months' duration. For the past 2 mo he needed crutches, 30-pound weight loss over the year. Abnormalities on physical examination were tenderness over the left iliac crest and an 8 cm non-tender mass in the right testis. No muscle wasting was noted, but left hip flexion and quadriceps strength were diminished. Left patellar tendon and ankle reflexes were absent, and sensation was decreased over the medial aspect of the left thigh.Laboratory examination showed WBC 11.6 k/µl, Hct 43%, Hb 13.8 g/dl, platelets 520 k/µl. LDH was 612 units, alpha-fetoprotein 13,000 units, and ß-hCG 69 units.Radiographic findings included multiple 0.5 to 2 cm lung nodules. CT scans of the abdomen showed a mass eroding the left side of the pelvis and involving gluteal muscles but not viscera, and a pathologic fracture of the left femoral head. Small retroperitoneal nodes were also noted. A right radical orchiectomy was performed.

ASSIGNMENT WEEK 5

There is no assignment for Week Five.

LOOK AHEAD TIP:

Reminder your PPT is DUE NEXT WEEK!

OVERVIEW WEEK 6

This last week you will present your PPT to the class. Post your PPT on Blackboard, make sure to have them posted/available no later than Week 6 – Day 3 so your colleagues may respond to them. Remember to refer to the rubric for grading of the PPT. Allow for time after the presentations for any questions.

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RESOURCES WEEK 6

Devotion

READING ASSIGNMENT WEEK 6

There is no reading assignment for Week 6.

DISCUSSION ACTIVITY WEEK 6

1. How would you describe your personal and professional growth today?2. Give one example of how you have expanded your knowledge in health assessment.3. Using a disease process you have discussed in during this course, provide a journal article

as an example of how to address primary, secondary, and tertiary prevention in your practice.

4. Post your discussion to the board.5. Read all of your colleagues’ postings6. Respond to at least three of your colleagues’ initial postings.

ASSIGNMENT WEEK 6

Your PowerPoint Posting is due on Day 3 this week.

In WEEK 6 - Day 3, as a final project in the class, you will be doing a Power Point Presentation on your paper. You will be presenting on your disease process and your assessment findings. This presentation should include how you would be teaching a new graduate nurse on how to assess your patient with this particular disease process. Please have the presentation approved by your instructor 1 WEEK prior to presenting for approval by your instructor. The Power Points need to be professional looking. The presentation itself should be about 5 minutes in length. The information on the slides should include the following information:

1. Introduction of your presentation2. Description of the disease and the pathophysiology3. Assessment findings4. Physical, Emotional and Spiritual needs of your patient5. Teaching Perils for the New Graduate Nurse

You should expect 1 minute per slide. You should have a total of 8 slides. Your slides should include: a title page and a reference slide at the end.

Please refer to the grading rubric for Power Point Presentation for Week 6 for a breakdown of Points.

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FINAL COURSE REMINDERS!

CHECK THE PORTFOLIO GUIDELINE FOR ARTIFACTS REQUIRED FOR THIS COURSE.

REMEMBER TO COMPLETE THE ONLINE COURSE ASSESSMENT.

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References

American Psychological Association. (2001). Publication manual of the American Psychological Association (5th ed.). Washington, DC: America Psychological Association.

Siedel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby’s guide to physical examination (6th ed.). St. Louis: Mosby, Inc.

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GRADING RUBRICS

DUE WEEK# 4 - DAY 3: PATHOPHYSIOLOGY AND ASSESSMENT PAPER

PART I

CONTENT POSSIBLEPOINTS

POINTS RECEIVED

FACULTYCOMMENTS

Clear identification of the population that is discussed

5.5

Discussion on the Pathophysiology of the disease process

6

Description of the assessment findings of your selected disease

10

Identifies the physical, emotional and spiritual needs of the patient

10

The paper follows designated guidelines for APA format including citations and references

3.5

Total Points 35 Received

Support your work with citations from Journal articles, textbook assigned readings, and other scholarly references utilized throughout the course.

DUE WEEK# 6 – DAY 3: POWER POINT PRESENTATION

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CONTENT POSSIBLE POINTS

POINTS RECEIVED

FACULTY COMMENTS

Introduction 2.5

Discussion of the pathophysiology of the disease

5

Description of the assessment findings.

9

Spiritual, emotional, and physical needs

5

Teaching perils of the new graduate nurse

5

Professionalism of the presentation

5

References 3.5

Total Points 35 Received

Support your work with citations from Journal articles, textbook assigned readings, and other scholarly references utilized throughout the course.

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Discussion Requirements and Rubric

Up to 0.5 points can be deducted for APA and/ or grammar.

5 Points (Exemplary) Discussion postings and responses are responsive to the requirements of the Discussion

instructions and are posted by the due date. Discussion postings and responses significantly contribute to the quality of interaction by

providing rich and relevant examples, applicable research support, discerning ideas, and/or stimulating thoughts/probes, and are respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Discussion postings and responses demonstrate an in-depth understanding of concepts and issues presented in the course (e. g., insightful interpretations or analyses, accurate and perceptive parallels, and well-supported opinions), and are well supported, when appropriate, by pertinent research.

Discussion postings and responses provide evidence that the student has read and considered a sampling of colleagues' postings and synthesized key comments and ideas, as applicable.

4 Points (Proficient) Discussion postings and responses are responsive to the requirements of the Discussion

instructions and are posted by the due date. Discussion postings and responses contribute to the quality of interaction by providing

examples, research support when appropriate, ideas, and/or thoughts/probes, and are respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Discussion postings and responses demonstrate some depth of understanding of the issues and show that the student has absorbed the general principles and ideas presented in the course, although viewpoints and interpretations are not always thoroughly supported.

Discussion postings and responses provide evidence that the student has considered at least some colleagues' postings and synthesized some key comments and ideas, as applicable.

3 Points (Sufficient) Discussion postings and responses are posted by the due date but are not always

responsive to the requirements of the Discussion instructions. Discussion postings and responses do little to contribute to the quality of interaction or to

stimulate thinking and learning. Discussion postings and responses demonstrate a minimal understanding of concepts

presented, tend to address peripheral issues, and, while generally accurate, display some omissions and/or errors.

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Discussion postings and responses do not provide evidence that the student has considered at least some colleagues' postings or synthesized at least some key comments and ideas, as applicable.

2 or Less Points (Developing) Discussion postings and responses are posted past the late deadline, defined as 11:59 p.m.

on the due date, and/or do not address the requirements of the Discussion instructions. Discussion postings and responses do not contribute to the quality of interaction or

stimulate thinking and learning. Discussion postings and responses do not demonstrate an understanding of the concepts

presented in the course, and/or do not address relevant issues, and/or are inaccurate and contain many omissions and/or errors.

Discussion postings and responses do not provide evidence that the student has read or considered colleagues’ postings, as applicable.

Possible Points = 30

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