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Trinity Valley Community College Vocational Nursing Program VNSG 1510 – Nursing in Health and Illness III Course Objective and Rudimentary Outline Content I. II. Introduction A. Identify aspects of professionalism, character, and nursing behaviors which contribute to the well-being of the adult medical-surgical patient. B. Discuss care of the medical-surgical patient with regards to the nurse scope of practice, legalities, confidentiality, and ethical decision making. C. Discuss components of patient teaching as they apply to the adult medical-surgical patient and family. D. Discuss the impact of cultural diversity, ethnicity, and socioeconomic status of the adult medical-surgical patient. E. Discuss the Nursing Process of the adult medical-surgical patient in relation to 1. Focus assessment and identifying alterations of patient responses to therapeutic interventions in comparison to the expected outcomes. 2. Setting priorities in planning and evaluating patient care. 3. Identifying changes in patient status and life threatening situations. F. Discuss patient advocacy, consumer rights and responsibilities of the adult medical-surgical patient. G. Identify principles of patient referral and resources to facilitate continuity of care, restoration, maintenance of health, and prevention of illness in the adult medical-surgical patient. H. Discuss the role of the family and significant others involved in providing care and support of the adult medical-surgical patient. I. Uses systemic problem solving and clinical reasoning in the care of the adult medicalsurgical patient. J. Uses evidence based practice with valid scientific sources to provide quality improvement in the care of the adult medical-surgical patient. K. Identify the role and function, including collaboration and communication within the health care/interdisciplinary team. Discuss assessment of clients with neurological disorders. A. History B. Physical assessment 1. Neurological exam a. Cerebral function b. Glasgow Coma Scale c. Muscle strength d. Balance and coordination e. Reflexes f. Sensory exam 2. Altered level of consciousness a. Conscious – unconscious 1) Stupor 2) Coma b. Confusion – delirium 1) Confusion – disorientation 2) Delirium 3) Delirium tremors III. IV. V. 3. Increased intracranial pressure a. Symptoms 1) Restless, confused 2) Increased blood pressure 3) Widened pulse pressure 4) Decreased pulse and respiration 5) Sluggish or non-reactive pupils C. Risk factors D. Developmental variations Identify clinical significance and nursing implications of various tests and procedures used for diagnosis of neurological disorders. A. Diagnostic/imaging 1. Scans 2. Skull/vertebral x-ray 3. Cerebral angiography 4. Myelogram B. Special procedures 1. Lumbar procedures 2. Caloric test C. Electrophysiologic tests 1. Electroencephalogram 2. Electromyography Describe etiology, pathophysiology, and clinical manifestations of selected neurological disorders. A. Multiple sclerosis B. Parkinson’s disease C. Head injury D. Spinal cord injury 1. Autonomic hyperreflexia E. Tumors of brain and spinal cord Use the nursing process to describe care for clients with selected neurological disorders, including treatments, medications, teaching plans and complications. A. Dependent Interventions 1. Medications a. Central nervous system stimulants b. Central nervous system depressants 1) Anesthetics 2) Hypnotics and sedatives 3) Tranquilizers c. Analgesics 1) Narcotic 2) Non-narcotic d. Anticonvulsants e. Osmotic diuretics f. Corticosteroids B. VI. VII. VIII. IX. X. Independent Interventions 1. Safety 2. Temperature regulation 3. Mobility 4. Bowel and bladder training 5. Prevent deformities 6. Self-care 7. Patient education C. Interdependent Interventions 1. Rehabilitation 2. Communication 3. Electrical stimulation procedures (TENS) Discuss nursing care for the clients having surgeries involving the nervous system. A. Craniotomy B. Neurosurgical pain management. Discuss assessment of clients with integumentary disorders. A. History B. Physical assessment 1. Clients with dark skin 2. Skin integrity 3. Lesions 4. Staging tools for pressure ulcers 5. Temperature 6. Vascularity and hydration 7. Hair and nails C. Risk factors D. Developmental variations Discuss clinical significance and nursing implications of various test and procedures used for diagnosis of integumentary disorders. A. Skin biopsy B. Patch testing Describe etiology, pathophysiology, and clinical manifestations of the selected disorders of the integumentary system. A. Pressure ulcers B. Infections 1. Bacterial 2. Herpes simplex a. Type I and II 3. Herpes zoster C. Psoriasis D. Melanoma E. Burns Use the nursing process to describe care for clients with selected skin disorders, including treatments, medications, teaching plans and complications. A. Dependent Interventions XI. XII. 1. Medications a. Topical medications 1) Soothing substances 2) Emollients 3) Demulcents 4) Astringents 5) Irritants 6) Keratolytics 7) Antifungal agents 8) Anti-infectives 9) Antibiotics 10) Local anesthetics B. Independent Interventions 1. Safety issues 2. Prevention 3. Patient education 4. Refer to community resources a. American Cancer Society b. National Psoriasis Foundation c. American Burn Association d. Burn Prevention Association e. The Phoenix Society for Burn Survivors C. Interdependent Interventions 1. Therapeutic baths 2. Soaks/wet dressing 3. Paste boots 4. Soaks Discuss nursing care for the clients having surgeries involving the integumentary system. A. Incise and drain (I&D) B. Skin graft C. Debridement D. Escharotomy Discuss the concept of mental illness. A. Diagnosis of mental illness 1. Diagnostic and Statistical Manual of Mental Disorders IV 2. Psychological tests a. Minnesota Multiphasic Personality Inventory b. Rorschach inkblot 3. Physiological tests a. Blood tests b. Computed tomography (CAT) c. Positron emission tomography (PET) B. Legal and ethical issues 1. Laws 2. Commitment XIII. XIV. XV. a. Voluntary b. Involuntary 3. Patient rights 4. Patient advocacy 5. Patient safety 6. Community resources Discuss the treatment modalities used to treat mental health alterations. A. Therapeutic milieu B. Psychoanalysis C. Behavior modification D. Rational-emotive therapy E. Humanistic/person-centered therapy F. Counseling G. Group therapy H. Electroconvulsive therapy (ECT) Identify classifications, uses, actions, side effects, and nursing considerations for selected classifications of psychopharmacologic medications. A. Antipsychotics B. Antianxiety agents C. Antidepressants D. Antimanics E. Stimulants F. Antiparkinson agents Describe and discuss the characteristics, treatment modalities, teaching plan, and nursing care involved with the various types of mental health disorders. A. Mood/affective disorders 1. Major depression 2. Manic-depressive 3. Involutional depression B. Personality disorders 1. Borderline 2. Paranoid 3. Dependent 4. Narcissistic 5. Passive-aggressive 6. Antisocial/sociopath C. Schizophrenia 1. Paranoid 2. Disorganized 3. Catatonic D. Organic mental disorders 1. Delirium from medical conditions 2. Alzheimer’s 3. Dementia E. Somatoform disorders XVI. XVII. XVIII. XIX. 1. Conversion 2. Hypochondriasis 3. Somatization F. Dissociative disorders 1. Psychogenic amnesia 2. Psychogenic fugue 3. Depersonalization 4. Multiple personality Describe and discuss the characteristics, treatment modalities, and nursing care involved with the various types of substance-related disorders. A. Types 1. Alcohol abuse 2. Drug abuse a. Stimulants b. Depressants c. Marijuana d. Cocaine e. Crack f. LSD g. PCP B. Characteristics 1. Family dynamics 2. Co-dependency C. Treatment modalities D. Nursing care E. Community resources Describe and discuss the characteristics, treatment modalities, and nursing care involved with the various types of eating disorders. A. Types 1. Anorexia nervosa 2. Bulimia 3. Morbid obesity B. Characteristics C. Treatment modalities D. Nursing care Discuss the components of suicide and related nursing interventions. A. Populations at risk B. Myths and truths C. Warning signs/behavior D. Assessment of the suicidal patient E. Nursing care of suicidal patients Discuss the aspects of abuse and related nursing interventions. A. Definitions B. Characteristics of abuser C. Characteristics of abused D. XX. XXI. Categories of abuse 1. Child 2. Elder 3. Spousal 4. Sexual 5. Physical 6. Psychological E. Criteria for suspicions of abuse F. Nursing care of abused G. Legal implications 1. Chain of evidence 2. Mandatory reporting Describe methods the nurse can utilize to defuse/control anger, aggression or assaultive behaviors. A. Conflict resolution B. Talk down C. Constructive vs. destructive D. Gut feeling E. Avoiding staff behaviors that increase potential for violence F. Seclusion G. Restraints Discuss “sexual” situations that the nurse may be confronted with, her reactions and how this affects the patient. A. Types of situations B. Possible reactions by nurse C. Effect of nurse’s reactions on patient D. Strategies for dealing with situations Revised 11/2013