Download Course # N 487

Nursing 487 Content Mapping
Catalogue Description:
Provides the student with opportunities to synthesize nursing knowledge with complex patient healthcare situations.
Emphasizes principles of management of: Multidimensional patient problems, quality improvement, health care economics,
evidenced based practice, professional competency and accountability.
COURSE OBJECTIVES:
Upon successful completion of N487, the learner will:
Analyze application of identified theoretical concepts and knowledge central to nursing practice in complex healthcare situations
with diverse populations.
Develop priorities in nursing care of complex patients based on analysis of pertinent data.
Formulate nursing interventions in complex patient management considering principles of health restoration, promotion, and
maintenance strategies.
Incorporate standards of care and evidence/ outcome based decision-making in complex patient care situations.
Course # N 487
Credit Hours: 2
Lecture Outline
Time
Methodology
Unit
I. Decision-Making
Clinical judgment,
critical thinking
Unit Objectives:
1. compare and
contrast these
concepts in complex
patient care
situations
I. Clinical Judgment, Knowledge Development
& Skills acquisition of nurses
2 hours
Lecture
Powerpoint
Discussion
Case studies
Web Blogs
II. Clinical Decision-Making in Complex Patient
Situations
A. Patient Focused Decisions
 ABC’
 Setting Priorities
 Proactive Nursing Judgment
B. Population Focused Decisions
 Evidenced Based Practice
 Systemic Reviews
 AHCPR
 Outcome Based Practice/CQI
 CQI/Outcome Based Practice
Performance Measurement
 Local Focus
 PDAC: Plan – Do - Act – Check
Evaluation
Method
 Exam
 Critical
Thinking
process
learning
activity
 National Health Initiatives
C. Other Factors
 Fiscal/Ethical Factors
 Risk-Benefit ratios
 Insurer Issues
 Judgmental Issues
II. Critical Thinking vs Clinical Judgment
A. Theorists:
 Brookfield
 Benner
B. Discussion re: Clinical Judgment vs critical
thinking
C. Critical Incident exercise
Unit II.
Unit Objectives:
Oxygenation/perfusion 1. discuss
Respiratory Alterations mechanical support
of respiratory failure.
2. Apply principles
of and prioritize
nursing care of
common complex
respiratory
alterations/situations,
i.e. respiratory
failure, ARDS
I. Patho Review:
A. Functions of Respiratory system
B. Optimal gas exchange
 work of breathing
 compliance
 Hemodynamic/Cardiac Function
C. Respiratory Assessment
 Pulmonary Function Tests
Tidal Volume, Vital Capacity, Minute Ventilation,
NIF
D. Remembering ABGs: Case Studies
II. Ischemia - Hypoxia - Hypoxemia
A. Pulmonary Shunt
III. Mechanical Ventilation
A. Intubation
 Supplies needed
 Rapid sequence intubation
B. Invasive versus non-invasive mechanical
4 hours
Lecture
Powerpoint
Discussion
Case studies


Exam
Case
studies
ventilation
C. BASICS of mechanical ventilation
D. Complications of Mechanical Ventilation
E. nursing care and and mechanical ventilation
 Suctioning - pulmonary hygiene
 Complications
 Weaning
IV. Respiratory Alterations: Case studies (to
apply above principles)
 Acute Resp failure
 ARDS
 Pulmonary Embolism
 Pneumonia
Unit III.
Unit Objectives:
Oxygenation/perfusion 1. Discuss principles
Cellular Alterations
of hemodynamic
monitoring systems
Hemodynamic
monitoring and shock 2. Apply principles
of and prioritize
nursing care to
prevent and manage
patient in shock.
I.



II.



Oxygenation a function of:
Pulmonary system
Transport system
Cellular metabolism
deficits in cellular metabolism
Serum Lactate
Base deficit
Mixed venous O2 saturation monitoring
III. Patho Review
 Cardiac output
 Preload, afterload, SVR,CO,
IV. hemodynamic monitoring
 CVP lines, Arterial lines, PA catheters
 Nursing care
V. Application of principles in complex patient
care
2 hours
Lecture
Powerpoint
Discussion
Case studies


Exam
Case
studies
Unit IV.
Unit Objectives:
Oxygenation/perfusion 1. Apply principles
Cardiac Alterations
of and prioritize
nursing care in
management of
common complex
cardiac alterations.
 Shock
 Sepsis
 MODS
I. base knowledge: EKG rhythm
interpretation.
students responsible to id basic rhythms (NSR,
SB, ST, Afib, Asystole, Vfib, Vtach, heart
blocks), calculate rhythms, etc
II. Case Studies in CAD
 Cardiac Arrest
 Primary Survey
 Secondary Survey
 Code 14
 VFib/VT Intervention Sequence
 Bradycardia Intervention Sequence
 Asystole Intervention Sequence


Acute Coronary Syndromes
 Risk Factors – old and new
 Acute Coronary Syndromes patho
review
 Risk Stratification
 Cardiac Markers (Enzymes)
 EKG changes & ACS (NSTEMI)
Treatment Goals of Acute Coronary
Syndromes
 Improve coronary artery perfusion
o MONA
o Anticoagulants
o Beta-blockers/ACEI
o Reperfusion drugs
o Interventional techniques for
reperfusion
4 hours
Lecture
Powerpoint
Discussion
Case studies


Exam
Case
studies

Unit III:
Alteration
in
Responsive
Improve Cardiac Pump:Controlling
Arrhythmias
o DRUGS
o Pacemakers & AICDs
o transvenous routes

Atrial Fibrillation
 Controlling Rate & Rhythm
 Cardioversion
o Conscious sedation protocol
o Stroke Prevention

Heart Blocks
 Patho revisisted
 treatment

Congestive Heart Failure
 Patho review
o Neurohormonal paths: RAS, SNS,
hBNP
o Symptomatic Failure
 Assessment of CHF
 Treatment Goals of CHF
o Pharm Tx
o Electrical Therapies (CRT)
o Left ventricular Assist Devices
(LVAD)
o Quality of Life issues
o
Unit Objectives
 Review neurological anatomy
and physiology.
 Discuss altered cerebral
Head Injuries
I.
Statistics
II.
Etiology
120
minu
tes
Lecture
Discussion
Case studies
ness




perfusion.
Explain physiologic effects
associated with spinal cord
injury.
Recall assessment techniques
related to neurological system.
Formulate nursing diagnoses
and interventions related to
management of patients with
complex neurological
processes.
Examine the long-term effects
of stroke, SCI, and head injury
on individuals, family, and
caregivers.
III.
IV.
V.
VI.
VII.
VIII.
IX.
Anatomy and physiology of cerebral
perfusion
a. Blood-brain barrier
b. Veins/venous circulation
c. Cerebrospinal fluid dynamics
Cranial Vault Contents: brain, blood,
CSF
a. Brain
b. Cerebral blood volume
c. Cerebrospinal fluid
d. Monro-kellie hypothesis
Relationship between increased
intracranial volume and pressure
a. normal ICP
b. compensation mechanisms
1. displacement of CSF
2. cerebral blood volume
changes including
autoregulation
3. brain volume
Cerebral Oxygenation
Uncompensated Compartmental
Volume Increases due to:
a. brain volume
b. blood volume
c. cerebrospinal fluid volume
Consciousness
a. arousal
b. content
Clinical Assessment
a. arousal
b. content
c. papillary reactions
d. vital signs including Cushing’s
Triad
X.
XI.
XII.
XIII.
e. cranial nerve reflexes
f. other reflexes including
oculovestibular and oculocephalic
Documentation
a. Glasgow Coma Scale
b. Ramsey Scale
Space-Occupying Lesions
a. review types of closed head
injuries
b. complications of closed head
injuries
Nursing Diagnoses, interventions and
pharmacological therapies
a. Adaptive Capacity, Intracranial,
Decreased
b. Potential for injury related to
impaired content
Intracranial pressure monitoring
devices
Spinal Cord Injuries
I.
Review of anatomy and physiology
including neural function
II.
Mechanism of injury
a. blunt
b. penetrating
c. nontraumatic
III.
Initial/Primary
a. complete
b. incomplete
IV.
Secondary injury
a. cellular membrane destruction:
1. ischemia
2. electrolyte shifts
3. inflammatory process
70
minu
tes
V.
VI.
VII.
VIII.
IX.
X.
Stabilization methods
Pharmaceutical therapy
a. goals of treatment
b. specific medications
c. nursing considerations
Functional assessment
a. spinal shock
b. motor assessment
c. sensory assessment
d. reflex activity
Nursing care in the high-acuity phase
a. respiratory
b. cardiovascular
c. thermoregulation
d. elimination
e. gastrointestinal
f. metabolic
g. integument
Physiologic compilations
a. immobility
b. abnormal perfusion (autonomic
dysreflexia)
c. abnormal reflex activity
(bladder/bowel, sexual
dysfunction)
Psychosocial issues of SCI
Acute Cerebral Dysfunction (Brain
Attack/Stroke)
I.
Definition and etiology
II.
Epidemiology
III.
Classifications of strokes
a. ischemic
b. hemorrhagic
1. subarachnoid
80
minu
tes
IV.
V.
VI.
VII.
VIII.
IX.
2. primary intracerebral
c. Hypertensive crisis
Review of risk factors
a. modifiable
b. nonmodifiable
Pathophysiology of stroke
a. cerebral blood flow
b. autoregulation
c. chemoregulation
d. cellular ischemic cascade
Emergency management
a. assessment and diagnostic
testing
b. pharmacologic management
1. anticoagulant therapy
2. antiplatelet therapy
3. blood pressure
management
4. neuroprotective therapy
Surgical management
a. carotid endaraterectomy
b. cerebral angioplasty
c. ventricular CSF Shunting
Focused assessment for acute stroke
a. history of presenting symptoms
b. ABCs
c. Neuro checks
d. Stroke scale
Complications of stroke
a. cardiac
b. pulmonary
c. gastrointestinal
d. fluid and electrolyte
e. perfusions complications
f. seizures
X.
Unit IV:
Alterations in
Nutritional/Metab
olic
Unit Objectives:
 Characterize the autoimmune
dysfunction of systemic lupus
erythematosus.
 Identify the causes of acute
renal failure.
 Describe the stages of acute
renal failure and nursing care
associated with each stage.
 Formulate appropriate nursing
diagnoses and interventions for
the patient with acute renal
dysfunction.
 Describe prevalence, incidence,
and death rates of cancer in the
U.S.
 Describe nursing management
for the patient receiving
radiation and chemotherapy.
 Describe oncologic
emergencies.
 Discuss the effect of HIV on
individuals, families, and
caregivers.
Nursing diagnoses and interventions
a. Impaired Physical Mobility
b. Alterations in Nutrition
c. Alterations in Elimination
d. Alterations in Sensation
e. Visual-Spatial-Perceptual
Alterations
f. Impaired Communication
g. Ineffective Patient and Family
Coping
I. Metabolic Alterations
 Altered Immune function (organ
transplant, HIV & Cancer)
 Altered glucose metabolism (DKA &
HHNC)
 Altered renal dysfunction
II. Normal Metabolism
 Metabolism and immune function
 Metabolic response to stress
–macroendocrine system
–autonomic nervous system
–cell-cell communication system
III. The Immune System in the high-acuity
patient
 Metabolic Alterations in Specific Disease
States
 Assessment of Metabolic status
 Protein indicators
 Total Lymphocyte count
 Anergy Screen
 Oxygen consumption (SVO2)
100
minu
tes
Lecture
Discussion
Case studies
Guest
Speaker
IV. Metabolic Alterations in the High-Acuity
Patient
 Immune function
 Organs of the Immune system
–Thymus (T cells)
–Bursa equivalent (B cells)
–Lymph system (reservoir)
–Spleen (reservoir)
 Immune responses
 Cell-Mediated Immunity
 Humoral Immunity
 Complement System
 Interferons
 Nonspecific Immunity/Phagocytosis
V.




Immunodeficiency
HIV
Cancer
Organ transplant
Immunocompetence in High-Acuity Patient
VI. Nursing Management
 Goals
VII. Case Studies:
 Immunocompetency
 Transplant patient Donor & recipient
 Cancer
 Altered glucose Metabolism: Diabetic
Ketoacidosis and Hyperosmolar, Hypertonic
Non-ketotic Coma
Metabolic Alterations related Renal
Failure
Stages of Chronic Renal Failure
Acute Renal Dysfunction
I.
Review of Normal Kidney Function
II.
Review of body systems on renal
function
a. cardiovascular
b. nervous
c. endocrine
III.
Causes of acute renal failure
a. prerenal
b. intrarenal
c. postrenal
IV.
Stages of acute renal failure
a. onset or initial
b. oliguric/anuric
c. diuretic
d. late(recovery) diuretic
e. convalescent
V.
Assessment of renal dysfunction
a. clinical assessment
1. physical
2. laboratory
VI.
Effects of acute renal dysfunction on
F/E
VII.
Management of acute renal failure
including related nursing diagnosis
and interventions
a. F/E balance
b. Removing nitrogenous waste
c. Nutrition
d. Infection
e. Anemia
VIII. Dialysis
a. purpose/uses
100
minu
tes
b. types
c. general nursing care