Download Weekly Lesson Plan Guide weeks 5

LWTech Nursing Program
Weekly Lesson Plan Guide
NEURO, SPINAL, RENAL
Course Number: NURS 241
Course Title: MED-SURG NURSING III
Week #: 5 & 6
1. Assignments: Chap 47, 58, 57, 61
2. Objectives:
a. Safe and Effective Care Environment
i. Identify and describe cerebral edema and analyze its impact on normal
neurological processes
ii. Describe the various ICP monitoring devices. Discuss and analyze the nursing
process for a patient receiving this type of monitoring. Identify the problems
associated with ICP monitoring.
iii. Compare and explain why brain attack is used to describe CVA. Identify and
apply emergency measures and assessments.
iv. Understand the importance of quick diagnosis for CVA. Know contraindications
to therapy such as thrombolytic and the life threatening complications if used
inappropriately and appropriately
v. Understand and implement immediate and emergency measures in the care of
a patient with meningitis, increased ICP, head trauma, spinal cord trauma or
issues and CVA
vi. Identify, describe and relate risk factors to patients who incur spinal cord
injuries
vii. Relate and analyze spinal cord level of injury and how it impacts patient survival
and emergency care
viii. Identify and implement nursing process and emergency measures for the acute
renal injury patient who presents themselves in life threatening conditions:
hyperkalemia, fluid overload, protection of dialysis access-patient lifelinemaintaining patency etc.
b. Health Promotion and Maintenance
i. List, describe and develop nursing care and interventions or the patient with
increased ICP. Include medications used to control ICP. Prioritize all of these
measures.
ii. Identify and analyze the CVA risk factors: include modifiable and nonmodifiable. Identify pertinent history relating to CVA event.
iii. Identify, compare and contrast the different types of CVA: ischemic CVA broken
down into thrombotic and embolic and hemorrhagic broken down into
intracerebral and subarachnoid
iv. Describe and relate the factors and clinical manifestations of TIA to CVA
v. List and describe diagnostic testing for CVA. Analyze results and relate these to
the disease process. Prioritize diagnostics when patient is in the emergency
situation.
vi. Describe CVA treatment. Discuss variations in treatment and relate to the
different types of CVA. Include medications and surgical interventions. Apply the
nursing process to these interventions. Include treatments and their
contraindications for both ischemic and hemorrhagic CVA.
vii. Identify challenges for the post CVA patient post discharge
viii. Identify assessment tools by the NIH for CVA. Describe why this tool is
pertinent. Apply symptomology of different strokes to pathology during
assessment procedures
ix. Understand which types of hematomas are true medical emergencies and why
(epidural, subdural and intracerebral)
x. Apply the Glasgow coma scale to the patient with altered LOC: cerebral
hematoma patient, CVA and meningitis
xi. Understand and relate the important of a quick and thorough neuro assessment
for CVA, acute head injury and meningitis. Apply emergency and priority
assessment that leads to priority and emergency measures.
xii. Explain the etiologies for meningitis and their clinical manifestations
xiii. Identify and discuss diagnostics and treatment measures for the meningitis
patient. Identify nursing implications and care for a patient with meningitis
xiv. Identify and apply pharmacologic interventions for the patient with increased
ICP
xv. Understand and be familiar with the syndrome of encephalitis: causes,
treatments and nursing implications and care
xvi. Understand and be familiar with implications and treatments associated with
brain tumors and brain abscesses
xvii. Understand the basics of cranial surgery and its nursing implications and postoperative care
xviii. Understand and identify treatments and nursing implications associated with
each level of the spinal cord injury: cervical, thoracic, lumbar. Identify
appropriate nursing assessments and precautions for these.
xix. Identify nursing measures associated with the problem of autonomic dysreflexia
xx. Identify how spinal cord injuries impact populations and individuals from a
social, health maintenance and personal care perspective
xxi. Identify, describe and relate the ASIA Impairment Scale and its results to patient
care on the continuum
xxii. Identify and explain differences in clinical manifestations in the spinal cord
injury patient and how this impacts the nursing process; identify all related and
affected systems
xxiii. List and relate diagnostic studies to the spinal cord patient and how these
results impact the nursing process
xxiv. Identify and describe signs and symptoms associated with spinal cord tumor and
their related nursing implications
xxv. Identify and relate differences between acute and chronic kidney disease
xxvi. List and explain nonsurgical (including medications) and surgical treatments for
the spinal cord patient. Relate the nursing process to these interventions
xxvii. Identify physiologic factors to be applied to the nursing process for the spinal
cord patient
xxviii. List and describe diagnostics used for the acute kidney disease patient and
relate these to the disease process
xxix. Identify and relate AKI treatment goals and apply the nursing process to these
goals. Include life threatening issues and their treatments to include
hyperkalemia, metabolic acid-base imbalances, and fluid overload
xxx. List and describe renal replacement therapies for the AKI patient (CRRT and
hemodialysis) and analyze their effectiveness. When are they indicated and how
do they differ from each other. Understand the fragility of these procedures in
the critically unstable patient to include disequilibrium syndrome and fluid
status.
xxxi. Describe the different vascular accesses used in the AKI patient undergoing
dialysis treatment
xxxii. Identify diagnostic and disease markers that relate chronic kidney disease
diagnosis
xxxiii. List and describe risk factors that present itself for the chronic kidney disease
patient. Apply knowledge of physiologic disequilibrium to emergency and acute
care.
xxxiv. List, describe and contrast treatment modalities for the CKD patient:
medications, nutrition, and dialysis (hemo, PD, transplant). Apply the nursing
process to these various measures. Understand dialysis disequilibrium and how
it is prevented and treated. Identify side effects and nursing care for each
therapy
xxxv. Identify the various dialysis access for CKD patients: hemodialysis and peritoneal
dialysis. Know the nursing implications for each access, complications and
nursing interventions related to these.
xxxvi. Identify treatment goals for the CKD patient and their nursing implications. For
example, how do nutritional challenges affect dialysis treatments? What
common lab values must the dialysis nurse be tracking during and between
treatments? How are medications involved with the CKD patient and their
dialysis treatments?
xxxvii. Describe and apply physiological changes seen in the spinal cord tumor patient
and related appropriate nursing measures including priority care decisions
c. Psychosocial Integrity
i. Identify, discuss the patient and family relational changes that will occur with
patients having altered neuro status (CVA, head injury, spinal cord)
ii. Identify and develop nursing process components for a neuro patient who
needs support and intervention with psychosocial challenges
iii. Identify, describe and develop nursing process to be applied to the spinal cord
patient dealing with immense individual and family coping, to include relational
changes as well.
iv. Analyze and develop nursing processes relating to patient undergoing renal
replacement therapy: how does this impact them individually, socially and
relationally
d. Physiological Integrity
i. Understand, describe and analyze the impact and physiologic mechanisms that
are involved in the normal compensatory system involving the Monroe-Kelly
doctrine. Explain autoregulation and what happens when it fails.
ii. Describe, explain and relate intracranial pressure to the normal intracranial
physiological balance and function. Know the normal ICP reading
iii. Identify and explain conditions that increase ICP. Analyze why increased ICP is a
problem. Explain cerebral edema and how it develops.
iv. List and explain the clinical manifestations of increased ICP: LOC, Cushing’s
response (VS), pupil changes, motor changes, breathing patterns, headache and
vomiting. Describe why these symptoms occur physiologically. Explain why
increased ICP is a danger. Explain how Glasgow coma scale is used in the patient
with increased ICP.
v. Review areas of the brain and their functions. Describe clinical manifestations of
these areas if there were increased ICP due to head trauma or brain tumor.
vi. List and explain the various types of TIA and CVA; describe motor deficits and
other clinical manifestations. Relate these to the pathophysiologic changes
vii. List, describe and discuss the types of acute head injury and intracerebral
hematoma. Identify the three types of hematomas: epidural, subdural,
intracerebral.
viii. Describe the pathophysiologic changes involved in meningitis
ix. Describe and apply physiological principles to the care of a post craniotomy
patient
x. Understand the basics of spinal cord pathophysiology, clinical manifestations
associated with each level of spinal cord injury: cervical, thoracic, lumbar.
Include all areas of the body: CV, respiratory, urinary, GI, etc. Also include
incomplete injuries such as Brown Sequard, central cord syndrome, etc.
xi. Explain the mechanism of autonomic dysreflexia
xii. Compare and contrast neurogenic and spinal shock. Relate appropriate nursing
interventions for each
xiii. Explain spinal tumor, it’s pathology, clinical manifestations and nursing
implications
xiv. Identify and describe how spinal tumors impact persons physiologically
xv. List, describe and analyze the various stages of spinal cord injury and its
pathophysiology
xvi. Identify compare and contrast spinal and neurogenic shock pathophysiology,
clinical manifestations
xvii. Identify and describe the mechanism of spinal cord injury; identify levels of
injury and their impact physiologically; identify the degree of spinal cord
injury(s) and explain its importance in patient outcomes
xviii. Describe and understand the diagnosis and pathophysiology relating to acute
kidney injury: pre-renal, intra-renal, post-renal
xix. List, analyze and integrate phases of AKI and how it manifests itself: oliguric,
diuretic and recovery
xx. List and relate clinical manifestations of AKI to the disease process.
xxi. Compare and contrast AKI and CKD clinical manifestations
xxii. Describe the differences in the pathophysiology between AKI and CKD. Include
causes, diagnostic criteria and clinical manifestations
xxiii. Understand the progression of CKD and describe how each body system is
affected.
3. Teaching Focus (You are not expected to address all competencies each week)
a. Patient Centered Care (QSEN KSAs)
i. Explain what a TIA is and why it is significant to CVA. Include treatment options
for this patient.
ii. Enlist multidisciplinary efforts to continue wellness for the spinal cord patient:
recreation and exercise programs, etc
iii.
b. Team work and Collaboration
i. Identify team members critical to the immediate care and stabilization of the
acute neuro patient
ii. Identify and describe how collaborative care is utilized with the spinal cord
patient: address all body systems
iii. Identify and describe team member roles and supports for the spinal cord injury
patient in the rehab phase: including respiratory, neurogenic bladder and
bowel, neurogenic skin, sexuality, grief and depression, gerontology factors
iv. Identify and explain how treatment goals for the CKD are multidisciplinary.
Understand team member roles and their importance in CKD patient wellness
over the continuum
v.
c. Evidence Based Practice
i. Identify and describe best practices that support thorough and standardized
care for neuro patients identify and apply risk populations relating to
neurological disturbances to include; CVA, meningitis, spinal cord and head
injury
ii. Explain FAST and why this tool is important for community awareness
iii. Explain how the NIH tool can be used for accurate and through CVA assessment
and analysis of recovery
iv. Identify and describe how collaborative care is utilized with the spinal cord
patient: address all body systems
v. Identify and describe team member roles and supports for the spinal cord injury
patient in the rehab phase: including respiratory, neurogenic bladder and
bowel, neurogenic skin, sexuality, grief and depression, gerontology factors
vi. Identify and explain how treatment goals for the CKD are multidisciplinary.
Understand team member roles and their importance in CKD patient wellness
over the continuum
vii.
d. Quality Improvement
i. Identify nursing measures that can prevent complications in the patient with
increased ICP
ii. Specify, list and describe immobilization techniques that are necessary to
prevent further spinal cord injury in an already fragile patient situation
iii. Identify preventive public health measures to prevent communicable disease
such as meningitis
e. Safety
i. Identify, list and describe safety measures for the neuro patient and how these
must be integrated into immediate and progressive care
f.
Informatics
i. Identify how the NIH scale can be utilized within charting systems
4. Concepts
a. Homeostasis
i. Identify and relate the importance of homeostasis with the patient who has
altered ICP. Identify nursing measures that help support the ICP patient
ii. Explain what is means to call a CVA a “brain attack”. Explain why this term is
important to incorporate into community teaching.
iii. Describe physiological disturbances in the spinal cord patient and how the
nursing process is applied to maintain homeostasis
iv. Describe physiological disturbances in the renal disease patient and how the
nursing process is applied to maintain homeostasis
v.
b. Immunity
i. Identify and develop nursing care that supports that patient susceptible to
meningitis and the related organisms
ii. Identify risk factors in patient impairments with spinal cord injury and how
these factors put the patient at risk for diseases
iii. Identify risk factors in patient impairment for the renal disease patient and how
these factors put the patient at risk for diseases
iv.
c. Stress
i. Identify and relate how stressor aggravate increased ICP and recovery of the
neurological impaired patient
ii. Identify and describe how stress can impact the disease process for the spinal
cord patients
iii. Identify how stress factors hinder patient recuperation and recovery in renal
disease
iv.
d. Teaching
i. Identify and describe the nursing process as it relates to the prevention,
stabilization and rehabilitation for the neuro patient
ii. List, identify and apply the nursing process to key areas that affect the spinal
cord patients progression in recovery
iii. List, identify and apply the nursing process to key areas that affect the renal
disease patients progression in recovery and life maintenance
iv.
e. Self-Care
i. Identify challenges for self-care and family involvement: role change, emotional
liability, etc
ii. Identify and incorporate multi system approach to home maintenance and
social reintegration for the spinal cord injury patients
iii. Identify and incorporate multi system approach to home, role and job
reintegration a for the renal disease patient
iv.
f.
Etc.
5. Student Chapter Resources (Student Assignments)
a. Textbook, canvas power points, videos, pretests with rationale, key points
6. Instructor Resources (Basis for your weekly evidenced based teaching plan)
a. Textbook, power points, videos, pretests, key points, question and answer with rational,
Elsevier case studies with animations
7. Teaching Strategies
Concept Focus
Content Highlights
Pathophysiologic Clinical manifestations,
change and
history, emergency
nursing care for care and after care
the CVA and ICP
 Disease
patients
process
Chronic renal
 Clinical
disease patient
manifestations
Nursing process
Learning Activities
Class participates
in animated case
study
Patient case study
to be presented to
class
Resources
Elsevier case
studies
Chapters
Readings
PowerPoints
Access to patient
in the clinical area