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NURSING 1202 STUDY GUIDE/SYLLABUS 2007 UNIT 1-MEDICATION ADMINISTRATION LECTURE CONTENT 1. Describe the ways drugs are identified /classified. (pregnancy, safety, controlled substances) LAB CONTENT LAB #1/ CLINICAL #1 1. Discuss the methods of drug delivery. 2. State the factors to consider in choosing the various routes of drug administration. CLINICAL ACTIVITIES 1. Demonstrate ability to accurately calculate dosages for all routes of medication administration. 2. Identify and compare resource materials available for gaining knowledge of medications. 3. Interpret a drug order and the nursing responsibilities involved. 3. Describe the nurse's legal responsibilities in drug administration. 4. List the steps of setting up patients' medications. 4. Describe the physiological mechanisms of drug action, including absorption, distribution, metabolism, and excretion. 5. State and practice the "RIGHTS" of drug administration. 4. Properly record all drugs administered. 6. State the steps required to administer oral meds safely to any age group. 5. Safely dispose of contaminated medication equipment used in the administration procedure. 7. Discuss important nursing considerations for safe drug administration via oral, topical, ophthalmic, otic, nasal, inhalation, vaginal, and rectal. 6. Be prepared to relate the drug information that was discussed in class to clinical patient care. 5. Describe the effects & the interactions of drugs which nurses need to assess. 6. List and explain the variables influencing drug actions. 7. Discuss the involvement of the nursing process in the administration of medication. 8. Discuss measure to prevent medication errors. TEST ONE MATERIAL WILL COVER ALL LAB, LECTURE MATERIAL EXCEPT INFORMATION ON INJECTIONS. TEST ONE MATERIAL ENDS HERE 2. Prepare to correctly identify any drug administered to your assigned patients in clinical. 3. Assess each patient's need for and response to drug therapy across the life span. 7. Give complete nursing care to one patient, including all medications except intravenous. INDEPENDENT ACTIVITIES KEY: Required Suggested NOTE: For required computer assisted instruction students must complete each program and record date completed on computer list. Those dealing with medication administration are due prior to the first hospital clinical and all other are due before the related unit test. Read Kozier, Erb, Berman & Snyder Fundamentals of Nursing (FON): Ch. 35: p. 829-900. Exclude pages 878-885 (IV section). Read Kee & Hayes Pharmacology: pp. 2 – 118. Chapter 5 pp. 120-128. Video: Medicating Children (KIT. RJ560.M4P3) CAI - Delmar’s: Administering Oral Sublingual, and Buccal Medications CAI - Delmar’s: Administering Eye and Ear Medications CAI - Delmar’s: Administering Skin/Topical Medication CAI - Delmar’s: Administering Nasal Medication CAI - Delmar’s: Administering Rectal Medication CAI - Delmar’s: Administering Vaginal Medication CAI - Delmar’s: Administering Nebulized Medication 1 CAI - Delmar’s: Administering an Intradermal Medication CAI - Delmar’s: Administering a Subcutaneous Medcation CAI - Delmar’s: Administering an Intramuscular Medication CAI - Delmar’s: Administering Medications via Z-Track Injection CAI - Delmar’s: Withdrawing Medication from anVial CAI - Delmar’s: Withdrawing Medication from an Ampule CAI – Delmar’s: Mixing Medications from Two Vials into One Syringe Complete FON Study Guide: Ch 35. Complete Pharmacology Study Guide: p. 1-54. CAI – PDS: Clinical Nursing Concepts - Pharmacodynamics Parenteral Routes CAI – PDS: Clinical Nursing Concepts - Pharmacodynamics Nonparenteral Routes 2 UNIT 2-SPECIFIC DRUG CATEGORIES LECTURE CONTENT 1. Insulin: a. State the method by which insulin is given and why. b. Identify the classifications of insulin & some of the common types used. c. Discuss the dosages, storage, and administration of insulins. d. Discuss what you would do when an insulin reaction occurs. 2. Pain relievers / Anti-Inflammatories a. Identify the 3 classifications of analgesics. b. Identify how narcotics are controlled. c. Identify the classifications, actions, side effects, and nursing implications of the most common narcotic analgesics. d. Identify the classifications, actions, common side effects, and nursing implications of the most common agonist-antagonists. e. Describe patient-controlled analgesia and the nursing implications. f. Describe epidural pain control and the nursing implications. LAB CONTENT LAB #2/ CLINICAL #2 TEST TWO MATERIAL BEGINS HERE: 1. Identify the correct equipment required for injections. CLINICAL ACTIVITIES 1. Be prepared to relate the drug information to patient care that was discussed in class. 2. State the essential steps in mixing selected drugs from vials & ampules. 2. Read Nurse’s Drug Guide handbook for the drugs discussed in this unit and those ordered for patients care for in the hospital setting. 3. Precisely locate the sites for ID, subQ, & IM injections. * REVIEW INJECTION MATERIAL PRIOR TO TEST 2. 4. Demonstrate how to correctly assess for, draw up, & administer insulins. 5. State the rationales of the steps necessary to safely administer injections to any age group. 6. Discuss case studies, according to instructor's preference. INDEPENDENT ACTIVITIES Read Pharmacology: Ch. 50: p. 775-783. Ch. 21: p. 321-338. Ch. 27: p. 403-422. Ch. 28: p. 423-438. Ch. 29: p. 439-453. Ch. 30: p. 454-459. Ch. 31: p. 464-471. CAI - Delmar’s: Administering Patient-Controlled Analgesia CAI - Delmar’s: Administering Epidural Analgesia CAI - Delmar’s: Administering Medication via a Cartridge System CAI - Delmar’s: Managing Controlled Substances CAI - Delmar’s: Assisting with the Insertion and Maintenance of an Epidural Catheter Complete Pharmacology Study Guide: Ch. 50, 21, 27, 28, 29, 30, 31. Video: Pain Management: Pharmacologic Treatment Strategies (KIT.RB 127.P37 2002v2) CAI: Medication Administration Nursing Process: Patient Controlled Analgesia Epidural Analgesia Chart Smart Mastering Clinical Skills: Epidural Analgesia PCA g. Describe the use of NSAIDs, side effects, & the nursing implications. 3 h. Discuss the types adjuvants & the purposes of using them. i. Apply the nursing process to the use of pain relievers. 3. Anti-Infectives a. Define terms related to antiinfectives b. Discuss how an anti-infective is chosen. c. Nursing implications with antiinfectives. d. Know the 5 ways antibiotics are grouped based on their mechanism of action. e. Identify the actions, common side effects, and nursing implications of the following classifications of anti-infectives: i. Beta-lactam antibiotics ii. Cephalosporins iii. Vancomycin iv. Fluoroquinolones v. Aminoglycosides vi. Sulfonamides vii. Tetracyclines viii. Macrolides ix. Common miscellaneous anti-infectives f. Identify the actions, common side effects, and nursing implications of common antifungals. TEST #2 INCLUDES INJECTION MATERIAL, INSULIN, PAIN MEDS, ANTIBIOTIC INFORMATION g. Complementary anti-infectives 4 UNIT 3-ELIMINATION LECTURE CONTENT TEST 3 MATERIAL 1. Urinary elimination a. State several factors that affect normal elimination. b. Compare and contrast common alterations in urinary elimination patterns. c. List and explain the data needed to assess a person's urinary function: nursing history, physical assessment and urine assessment. d. Describe some common diagnostic measures and nursing implications to assess the urinary system. LAB CONTENT LAB #3 TEST 3 MATERIAL 1. Describe how to collect a urine specimen that is a clean-catch and from a foley. 2. Describe how to apply an external catheter. 3. Discuss types of urinary catheters and their purposes: a. straight b. foley catheter c. 3-way catheter 4. Discuss the following procedures: a. Inserting a urinary catheter. b. Care of the catheters c. Removing a urinary catheter. d. Self-catheterization CLINICAL ACTIVITIES 1. Describe the functions of: nephron, glomerular filtrate, bladder, urethra, urinary meatus. 2. Understand the physiological process of urine production. 3. Routinely assess assigned patients for normal urinary elimination. 4. Identify nursing diagnoses appropriate for alterations in urinary elimination. 5. Appropriately apply nursing measures to attain normal urinary elimination. 6. When given the opportunity, properly obtain urine specimens for the lab. 5. Discuss urinary irrigations. e. Describe some common interventions to maintain normal urinary elimination and to assist patients with urinary problems of urinary incontinence and retention. f. Discuss nursing measures to reduce UTI in the catheterized patient. LAB #4 TEST 3 MATERIAL 6. Using 100% aseptic technique, demonstrate the insertion of a urinary catheter. 7. Provide good catheter care to all patients with retention catheters. 8. Provide good catheter care to all patients with retention catheters. 9. Understand the physiological aspects of normal defecation. STUDENT ACTIVITIES Read FON: Ch 48. *CAI - Delmar’s: Applying a Condom Catheter CAI - Delmar’s: Inserting an Indwelling Catheter :Male CAI - Delmar’s: Inserting an Indwelling Catheter: Female *CAI - Delmar’s: Routine Catheter Care CAI - Delmar’s: Obtaining a Residual Urine Specimen from an Indwelling Catheter CAI - Delmar’s: Irrigating a Urinary Catheter CAI - Delmar’s: Irrigating the Bladder Using a Closed-System Catheter CAI - Delmar’s: Removing an Indwelling Catheter *CAI - Delmar’s: Testing Urine for Specific Gravity, Ketones, Glucose, and Occult Blood *CAI - Delmar’s: Collecting a CleanCatch, Midstream Urine Specimen *CAI – Mastering Clinical Skills: Urinary Catheters Complete FON Study Guide: Ch. 48. 5 2. Fecal elimination a. Discuss factors which influence fecal elimination. b. Describe some common fecal elimination problems. c. List and explain the data needed to assess fecal elimination function: history, physical assessment, fecal characteristics, and diagnostic tests. d. Describe some nursing measures that promote regular defecation and relieve problems. LAB #4 TEST 3 MATERIAL 7. Explain the steps to perform the following: a. Guaiac test for occult blood. b. Administer an S.S. or saline enema c. Adminster a Fleets enema. d. Remove a fecal impaction 8. Describe what a rectal tube is and its purposes. 10. Routinely assess assigned patient’s fecal elimination patterns for malfunctions. 11. Identify nursing diagnoses related to alterations in elimination. 12. When given the opportunity, properly obtain fecal specimens for the lab. 13. Appropriately apply nursing measures that will maintain or attain normal fecal elimination. Read FON: Ch 49. *CAI - Delmar’s: Testing for Occult Blood with a Hemoccult Slide CAI - Delmar’s: Administering an Enema CAI - Delmar’s: Digital Removal of a Fecal Impaction CAI - Delmar’s: Inserting a Rectal Tube Complete FON Study Guide: Ch 49 TEST #3 URINE AND FECAL ELIMINATION MATERIAL 6 UNIT 4-FLUIDS AND ELECTROLYTES/ACID BASE BALANCE CLASSROOM 1. Describe body fluid distribution and composition. 2. Define the terms: isotonic, hypotonic, and hypertonic fluids. 3. Explain the various types of fluid movement: diffusion, osmosis, filtration, and active transport. 4. Discuss the factors which affect the body's fluid balance. 5. List the clinical features of evaluating a patient's fluid status: history, physical assessment, & diagnostic tests. 6. Discuss the assessment of a patient in hypovolemic shock. 7. Discuss fluid deficits and excesses in various age groups. 8. Differentiate the major electrolytes of the body and the importance of each. 9. Discuss some major factors which affect the body's electrolyte balance. 10. List and explain the data needed to assess a patient for an electrolyte imbalance: history, physical assessment, and lab tests. 11. Discuss some clinical cases of electrolyte imbalances. LAB CONTENT . LAB #5 TEST1.4 MATERIAL 1. Identify and describe the essential parts of IV infusion equipment. 2. Discuss the physiological and psychological considerations that are important in parenteral administration. 3. Demonstrate the following parenteral procedures: a. Change primary IV solutions. b. Change primary IV tubing. c. Maintain the IV infusion. d. Regulate the infusion flow rates. e. Change IV dressings. f. Discontinuing IV infusions. 4. Discuss the procedures: a. Administrating an IVPB. b. Administrating an IVP. 5. Identify the types of mechanical problems that are commonly encountered with IV infusion systems and the appropriate nursing measures to cope with them. LAB #6 TEST 4 MATERIAL 1. Demonstrate ability to evaluate IV drip rate. 2. Spike IV bag, prime tubing, and regulate IV flow rate by gravity. (SEE NG/GT SECTION IN UNIT 5) CLINICAL ACTIVITIES STUDENT ACTIVITIES 1. Accurately assess your assigned patients for fluid and electrolyte imbalances. Read FON: Ch 52, Ch. 35- pp. 875, 878885. Read Pharmacology: Ch. 14- pp. 203220. 2. Determine if your patients are in an acid-base imbalance. 3. When the opportunity arises, be prepared to: a. Assemble the proper equipment & solutions for IV administration. b. Change IV tubing as indicated using aseptic technique. c. Change IV dressings as indicated using aseptic technique. d. Discontinue IV infusions. 4. Routinely calculate assigned patients' IV flow rates & regulate as indicated. 5. Routinely observe for any patient complications or mechanical malfunctions during parenteral therapy and apply the correct nursing measures. 6. Accurately document initiation of IV procedures, nursing interventions related to IV therapy, and assessment of the patient receiving an IV infusion. CAI – Mosby’s: Fluids and Electrolytes CAI - Delmar’s: Preparing an IV Solution CAI - Delmar’s: Administering Medications via Secondary Administration Sets (Piggyback) CAI - Delmar’s: Administering Medications via IV Bolus or IV Push CAI - Delmar’s: Preparing the IV Bag and Tubing CAI - Delmar’s: Setting the IV Flow Rate CAI - Delmar’s: Assessing and Maintaining an IV Insertion Site CAI - Delmar’s: Changing the IV Solution CAI - Delmar’s: Discontinuing the IV and Changing to a Saline or Heparin Lock Clinical Nursing Concepts: Fluid and Electrolyte Balance, Acid/Base Balance Found in: Clinical Ed. Software, then Clinical Nursing Concepts, then Fl. & Electrolyte Balance (2 scenarios), then Acid-Base Balance (4 scenarios) Video: Signs & symptoms of fluid & electrolyte imbalances. RD52.F59 S54 2002 7 12. Describe pH as related to the body's acid-base balance. 13. Discuss the 3 major body regulators for acid-base balance. 14. Discuss the 4 major acid-base imbalances and how to assess a patient's status. 15. Discuss some clinical cases of acidbase imbalances. *CAI - Delmar’s: Changing the IV Gown * CAI - Delmar’s: Adding Medications to an IV Solution * CAI - Delmar’s: Administering Medications via Volume-Control Sets Complete FON Study Guide: Ch 52, Ch.35 related to IV therapy. Complete Pharmacology Study Guide: Ch 14. 16. Identify the purpose, uses, and legal implications of IV therapy. 17. Differentiate the types of isotonic, hypotonic, & hypertonic solutions commonly used in IV therapy. 18. Discuss some common IV medications and how to administer them. TEST #4 MATERIAL ON FLUIDS, SHOCK, IV THERAPY, ACID BASE BALANCE 8 UNIT 5-PERIOPERATIVE CARE, WOUNDS, & OXYGENATION- *SEE COURSE SCHEDULE FOR WHEN UNIT 5 CONTENT WILL BE COVERED IN CLASS LECTURE CONTENT 1. Preoperative Care a. Describe the ways surgeries are classified. b. Discuss factors that increase surgical risks in patients. c. List and explain the data to include in the preop assessment of a surgical patient: history, physical assessment, and diagnostic tests. d. Identify the essential features of an informed consent for a surgical procedure. e. List and explain the nursing responsibilities for the patient prior to surgery. f. Discuss the required content of preop teaching. g. Discuss the importance of the universal protocol for patient safety. h. Identify the common types of anesthesia that may be used in surgery. i. Describe the effects of general and regional anesthesia. LAB CONTENT 1. 5 MATERIAL . LAB # 6 TEST 1. Discuss the reasons for GI intubation. 2. Explain the uses of the commonly used types of GI intubations. 3. Discuss the following procedures: Inserting an N/G tube. Charting, nursing Dx & nursing orders Removing an N/G tube. Irrigating an N/G or feeding tube. Maintaining an N/G or feeding tube. Administering meds per NG/GT. Avoiding complications that commonly occur with NG/GT. CLINICAL ACTIVITIES 1. When the opportunity arises, be prepared to use the techniques of GI intubation, irrigation, and feeding. 2. With the opportunity, be prepared to : a. Provide appropriate preop teaching. b. Prepare pt's skin before surgery. c. Adequately prepare & record patient’s care on the day of surgery. d. Accompany patients to surgery. e. Accompany patients to the PAR. 3. When given the opportunity, be prepared to: a. Assess pertinent data of the patient's postop condition and accurately record it. b. Prepare a postop nursing care plan. c. Provide nursing measures to relieve postop discomfort and prevent complications. INDEPENDENT ACTIVITIES Read FON: Ch. 36, Ch. 37, Ch. 47: p. 1265-1276, and Ch. 35: p. 856-857. Read nutrition book on postop diets. *CAI – Delmar’s: Applying Antiembolic Stockings *CAI – Delmar’s: Applying Pneumatic Compression Device *CAI – Delmar’s: Assisting with a Continuous Passive Motion Device CAI – Delmar’s: Administering Preoperative Care CAI – Delmar’s: Preparing A Surgical Site CAI – Delmar’s: Assessing Immediate Post-operative Care CAI – Delmar’s: Postoperative Exercise Instruction CAI – Delmar’s: Inserting and Maintaining a Nasogastric Tube CAI – Delmar’s: Assessing Placement of a Large Bore Feeding Tube CAI – Delmar’s: Assessing Placement of a Small Bore Feeding Tube CAI – Delmar’s: Removing a Naso Gastric Tube CAI – Delmar’s: Feeding and Medicating via a Gastrostomy Tube CAI – Delmar’s: Maintaining Gastrointestinal Suction Devices j. Discuss the SN role in the OR. k. List the nursing responsibilities involved in the immediate postop period and the significance of 9 each. l. Identify postoperative complications, their causes, and the nursing interventions to prevent them. m. Define types of wounds and the phases of the healing process. LAB # 7 TEST 5 MATERIAL GUEST SPEAKER: n. Identify factors that inhibit wound healing and measures to promote the healing process. 1. Identify the assessment data pertinent to wounds. 2. Discuss appropriate treatment, including dressings and other wound coverings of wounds. Discuss different types of wounds. o. Describe the nursing process involved with the care of wounds. 3. p. Describe the complications of wound healing. q. Discuss the types of drains most often seen with wounds. 4. When given the opportunity, be prepared to: a. Identify & gather proper dressing materials. b. Appropriately assess a wound. c. Change a dressing using aseptic technique, securing it well. d. Irrigate or pack a wound using aseptic technique. e. Remove skin sutures. f. Accurately record observations of wound care and nursing care. 5. Demonstrate the proper applications of bandages and binders. 6. In the clinical setting, use appropriate safety measures when applying heat or cold applications to patients. CAI – Delmar’s: Irrigating a Wound CAI – Delmar’s: Packing a Wound CAI – Delmar’s: Cleaning and Dressing a Wound with an Open Drain CAI – Delmar’s: Dressing a Wound with Retention Sutures CAI – Delmar’s: Maintaining a Closed Wound Drainage System CAI – Delmar’s: Care of the Jackson-Pratt Drain Site and Emptying the Drain CAI – Delmar’s: Removing Skin Sutures and Staples CAI – Delmar’s: Preventing and Managing the Pressure Ulcer CAI – Delmar’s: Applying a Pouch to a Draining Wound CAI – Delmar’s: Applying ABD, Tor Breast Binders *CAI – Delmar’s: Applying Moist Heat *CAI – Delmar’s: Applying Dry Heat *CAI – Delmar’s: Applying Cold Treatment CAI -Mastering Clinical Skills: GI tubes Enteral Feedings Complete FON Study Guide: Ch 35, 36, 37, 47. CAI – PDS-Clinical Nursing Concepts: Perioperative Care, Inflammation, Infection, and Wound Healing. 10 2. Oxygenation a. Define terms related to oxygenation. b. Describe factors which affect oxygenation. c. Describe the nursing assessment data that determines a patient's oxygen needs. d. Identify common diagnostic tests for oxygen deficits and explain their value in developing a nursing care plan. e. List and provide the rationales for measures to maintain or attain normal respiratory function. f. Discuss the procedures of: Oximetry Oropharyngeal / nasopharyngeal suctioning Incentive spirometer Caring for a pt c a nasal cannula Caring for a pt c a simple face mask Using the Venturi mask CPAP/BiPAP LAB #8 TEST 5 MATERIAL 1. Discuss the principles related to oral suctioning. 2. Demonstrate correct procedure for oral suctioning. 3. Complete bedside scenarios related to oxygen needs. 4. View video on oral suctioning. 7. Routinely assess and properly record your assigned patients' oxygen needs. 8. When given the opportunity, a. Collect and send sputum specimens to the lab. b. Take oximetry readings. c. Perform adequate suctioning for assigned patients. d. Teach correct use of spirometry. e. Provide nursing measures for patients with oxygen administration. Read FON: Ch 50. Except pages 13791381, and 1386-1395. CAI - Delmar’s: Administering Oxygen Therapy CAI - Delmar’s: Assisting a Client with Controlled Coughing and Deep Breathing CAI - Delmar’s: Assisting a Client with an Incentive Spirometer *CAI - Delmar’s: Administering Pulse Oximetry Complete FON Study Guide: Ch 50. *CAI - Delmar’s: Administering Pulmonary therapy and Postural Drainage CAI - Delmar’s: Administering Intermittent Positive-Pressure Breathing CAI - Mastering Clinical Skills: Oxygen Administration Pulse Oximetry e. Utilize the nursing process in planning the care of the patient with oxygenation. FINAL TEST! SURGICAL CARE, WOUNDS, NG/GT, AND OXYGENATION MATERIAL 9/24/07 11