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MIDDLESEX COUNTY VOCATIONAL AND TECHNICAL SCHOOLS PRACTICAL NURSING PROGRAM MEDICAL SURGICAL NURSING 2 SYLLABUS including Clinical Pharmacology and Clinical Nutrition Medical Surgical Nursing care incorporates the clinical concepts of the pharmacology and nutrition courses. Application of medical surgical nursing is based upon a thorough comprehension of correct anatomy and physiological characteristics in the human body, comprehension of the pathophysiology of each disease process, pharmacological interventions (as well as indications, incompatabilities, and side effects) appropriate to each disease, proper nutrition for the health care condition and cultural implications of nursing care. Objectives: By the end of this course, the student will be able to safely provide care for patients with disorders in the following systems: 1. Neurological a. Identify significant subjective and objective neurological data that should be obtained from a patient during an assessment. b. Discuss the Glasgow coma scale c. List 5 signs & symptoms of increased intracranial pressure, why they occur, & what nursing interventions that can decrease / prevent increase of the pressure. d. Differentiate between trigeminal neuralgia & Bell’s palsy. e. Discuss various neurological disturbances in motor & sensory-perceptual function. f. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. 6 degenerative diseases ii. Stroke iii. Meningitis/ Encephalitis iv. AIDS v. Guillian-Barre` syndrome vi. Intracranial tumors/ brain trauma/ spinal trauma g. Compare & contrast stroke and traumatic brain injury h. List 4 classifications of seizures, the characteristic clinical signs, aura and postictal period. i. Discuss patient teaching and home care planning for patients with Stroke/ MS/ Parkinson’s disease and myasthenia gravis j. Review effects of vitamins on the neurological system. k. Discuss nutritional support of the peri-surgical patient. l. Identify the major drug classifications that affect the CNS. m. Discuss the following medications for classification, effect, major side effects, toxicity symptoms, nursing interventions and patient teaching: i. Migraine medications ii. Sedative / Hypnotics 1 iii. Seizure medications iv. Antiemetics/ antivertigo v. Antidepressants vi. AntiParkinson’s disease vii. CNS stimulants viii. Common anesthetics ix. Analgesics n. Compare and contrast drug addiction and drug tolerance. o. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 16 and bring to class prior to the exam in this content. 2. Special senses a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Refractory errors: astigmatism/ strabismus/ myopia/ hyperopia ii. Inflammatory conditions iii. Sjorgen syndrome/ ectropion/ entropion iv. Corneal injuries v. Cataracts/ diabetic retinopathy/ macular degeneration/ retinal detachment and glaucoma vi. Major ear inflammatory & infectious / noninfectious disorders b. Identify teaching tips for communicating with hearing and vision impaired people c. Discuss patient teaching and home care planning for people with eye/ ear disorders, post- surgical recovery & hearing/ vision impairments d. Differentiate between conductive & sensorineural hearing loss. e. Describe specific administration techniques for eye, ear, and skin medications. f. Discuss 3 medications each for eye, ear and skin problems for classification, effect, major side effects, toxicity symptoms, nursing interventions and patient teaching: g. Discuss the role of sodium, chocolate and aged food products on the special senses. h. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 23 and bring to class prior to the exam in this content. 3. Respiratory a. Identify signs & symptoms the patient is experiencing hypoxia. b. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Disorders of the upper airway ii. Disorders of the lower airway iii. Emphysema/ chronic bronchitis/ asthma/ bronchiectasis. c. Discuss nursing interventions for a laryngectomy patient. d. Compare arterial oxygen tension and arterial oxygen saturation. e. Discuss 5 interventions for patients with retained pulmonary secretions. f. Differentiate between tuberculosis infection and tuberculosis disease. 2 g. List four medications used to treat tuberculosis; discuss classification, side effects, adverse effects and pertinent nursing interventions of each. h. List 3 risk factors associated with pulmonary emboli. i. List 5 assessments/ interventions related to care of the patient with closed-chest drainage system. j. Discuss patient teaching and home care planning for the patient with respiratory disorders using room air and needing oxygen supplementation. k. Identify major antihistamines used to treat breathing problems caused by allergens. l. Compare antitussives and expectorants. m. Discuss medications used to treat and prevent asthma attacks. Note “rescue meds”. n. List 6 medications used as decongestants. o. Discuss the effects and contraindications of nasal steroid usage. p. Discuss the following medications for effect, major side effects, toxicity symptoms, nursing interventions and patient teaching: i. Penicillins ii. Tetracyclines iii. Aminoglycosides iv. Fluorquinolones v. Cephalosporins vi. Sulfonamides vii. Antitubercular viii. Antiviral ix. Amebicides x. Antihelminths q. Discuss the role of water, vitamin C and Zinc in the patient with respiratory issues. r. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 11 and 12; bring to class prior to the exam in this content. 4. Cardiovascular a. Describe 5 dysrhythmias. b. Identify risk factors and the effects of aging on the peripheral vascular system. c. Compare essential/ primary, secondary and malignant hypertension d. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Angina pectoris/ myocardial infarction/ heart failure/ valvular heart disease ii. Pulmonary edema iii. Rheumatic heart disease/ pericarditis/ endocarditis iv. Arterial aneurysm/ Buerger’s disease/ Raynaud’s disease v. Thrombophlebitis/ varicose veins/ stasis ulcers vi. Hypertension e. Discuss the indications & contraindications of cardiac transplantation. f. Discuss appropriate nursing diagnoses and patient education for each disorder. g. Discuss the following medications for classification, effect, major side effects, toxicity symptoms, nursing interventions and patient teaching: i. Antianginal medications 3 ii. Antilipidemics iii. Dysrhthymic iv. Cardiotonics v. Hypertensive medications/ treatments (A2, B, C, D, E, F) h. Discuss nutritional risk factors that contribute to the development of coronary heart disease and hypertension. i. Discuss the role of fats, sodium and water in heart disease. j. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 15 and bring to class prior to the exam in this content. 5. Blood and Lymph a. List the commonly used diagnostic tests which evaluate blood & lymph disorders; what is the significance of the result b. List 6 signs & symptoms associated with hypovolemic shock. c. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Anemia ii. Acute and chronic leukemia iii. Coagulation disorders: thrombocytopenia/ hemophilia/ DIC iv. Multiple myeloma/ malignant lymphoma/ Hodgkin’s lymphoma d. Discuss care intervention for a patient with lymphedema. e. Discuss appropriate nursing diagnoses and patient education for each disorder. f. Discuss the role of iron and vitamins K & B12 in patients with blood disorders. g. Discuss the following medications for classification, effect, major side effects, toxicity symptoms, nursing interventions and patient teaching: i. Anticoagulants/ antiplatelet aggregates/ thrombolytics ii. Toxoids/ Vaccines (bacterial & viral)/ immune serums/ in vivo agents h. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 19 and bring to class prior to the exam in this content. 6. Endocrine a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Acromegaly/ gigantism/ dwarfism ii. Diabetes insipidus/ syndrome of inappropriate antidiuretic hormone iii. Hypothyroidism/ hyperthyroidism/ goiter/ thyroid cancer iv. Hyperparathyroidism/ hypoparathyroidism v. Cushing’s syndrome / Addison’s disease vi. Diabetes mellitus – type 1 VS type 2 b. Differentiate symptoms between the following: i. Diabetes insipidus & SIADH ii. Hypothyroidism & hyperthyroidism iii. Hyperparathyroidism & hypoparathyroidism iv. Cushing’s syndrome & Addison’s disease 4 c. d. e. f. g. h. i. j. k. l. m. v. Hypoglycemia & hyperglycemia Discuss diabetic ketoacidosis; hyperosmolar hyperglycemic nonketotic coma & hypoglycemic reaction Discuss the role of exercise, nutrition & medication in controlling diabetes mellitus. Discuss short term and long term complications of diabetes mellitus. Discuss the medication categories used to treat diabetes as follows: i. Insulin: rapid acting, intermediate acting and long acting ii. Oral hypoglycemics: 1. Metformin 2. Receptor agonists 3. Absorptive rate adjusters 4. Pancreatic beta cell stimulants 5. Appetite suppressants Discuss 5 nursing interventions that increase self-care in the individual with diabetes’ ADL’s. Discuss appropriate nursing diagnoses and patient education for each disorder. Discuss the following medications for classification, effect, major side effects, toxicity symptoms, nursing interventions and patient teaching: i. Insulin: rapid, short, intermediate and long acting ii. Sulfonylureas iii. Metformin iv. Avandia & Actos v. Precose & Glyset vi. Prandin & Starlix vii. Byetta & Smylin viii. Januvia ix. Levothyroxine and liothyronine vs Propylthiouracil x. Vasopressin Discuss the ‘Somogyi’ effect. Compare mineralcorticoids and glucocorticoids. Describe one day’s meal plan for a diabetic patient needing 1800cal ADA diet. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 20 and bring to class prior to the exam in this content. 7. Gastrointestinal a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Disorders of the mouth, esophagus, stomach and intestines ii. Ulcerative colitis and Crohn’s disease iii. Acute abdominal inflammations iv. Hernias: external and hiatal v. Intestinal obstructions: mechanical and nonmechanical vi. Colorectal cancer vii. Fecal incontinence b. Discuss laboratory and diagnostic exams for the gastrointestinal system. 5 c. Compare food intolerance to food allergy. d. Identify various types of hospital diets, fluid consistencies and formulas for GT feeds. e. Discuss nursing interventions for patients with gastric reflux, hiatal hernia & impaired swallowing. f. Compare high fiber and low fiber diets; determine which GI diseases benefit from use of fiber. g. Discuss pancreatic enzyme supplementation needs. h. Discuss requirements for implementation of PO, enteral and parental feedings. i. Identify common uses for antacids, histamine H-2 receptor antagonists & proton pump inhibitors. j. Compare and contrast anticholinergic, antidiarrheal and antispasmodic medication’s effects on the GI tract. k. Discuss the 5 types of laxatives, including action and side effects. l. Discuss the purpose, action and effect of disulfiram. m. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 18 and bring to class prior to the exam in this content. 8. Accessory organs a. Describe the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Cirrhosis of the liver, hepatitis, liver abscesses, cholecystitis, pancreatitis ii. Liver cancer, pancreatic cancer b. Discuss 6 types of viral hepatitis and modes of transmission. c. Discuss cholecystitis and cholelithiasis treatments and dietary management. d. Discuss indications for liver transplant, debate the ethics, discuss immunosuppressant medications and dietary management. 9. Urinary a. Identify the effects of aging on the urinary system’s function. b. Discuss patient concerns of changes in body image, changes in family function and altered sexuality related to renal dysfunctions. c. Design culturally sensitive care plans incorporating community resources to increase support for the patient with renal impairment. d. Describe clinical conditions in which uricosuric therapy would be used. e. Identify foods that cause calculi production in the tissue and kidneys. f. Review Edmunds chapter 15. 10. Musculoskeletal a. Describe the risk factors for primary and secondary osteoporosis and ways to reduce them. b. Discuss drug therapies in prevention and management of osteoporosis. c. Compare and contrast osteomyelitis, osteoporosis and osteomalaccia. d. Discuss types of malignant bone cancers; nursing interventions and psychosocial impact for the patients. 6 e. Discuss the pathophysiology, risk factors and treatment options for carpal tunnel syndrome. f. Discuss common disorders of the foot. g. Discuss various fracture types; their symptoms; normal bone healing; complications of fractures and develop nursing diagnoses for the fractures discussed. h. Differentiate the need for casting, traction and fixation in fractured bones. i. Develop a care plan for a patient with each stabilization method. j. Discuss reasons for amputations; common types; psychosocial aspects to surgery; and discuss nursing interventions. k. Identify common sports related injuries and ways to prevent them. l. Describe the pathophysiology of muscular dystrophy and myasthenia gravis. m. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 22 and bring to class prior to the exam in this content. 11. Reproductive a. Review the etiology, pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for each of the following: i. Infections of the reproductive system ii. Cancers of the reproductive tract iii. Endometriosis iv. Self examination for female breast and male testes & breast b. Differentiate between cystocele, rectocele, hydrocele and varicocele. c. Review patient education on prevention of sexually transmitted infections. d. Discuss antiviral, antiretroviral and antifungal medications used in treatment of STIs. Complete the Emunds Pharmacology PN review questions on www.evolve.com for chapter 13 and bring to class prior to the exam in this content. TOPICAL SCHEDULE Class Number Class 1 Topic Care of a Pt with Neurological Disorders Class 2 Class 3 Class 4 Class 5 Class 6 Class 7 Continue with chapter 14 Continue with chapter 14 Continue with chapter 14 Continue with chapter 14 Continue with chapter 14 Disorders of the Eye and Ear Class 8 Continue with chapter 13 Books/ chapters Christensen: Ch.14; p. 650-718 Edmunds: Ch. 16 & 17; CNS medications Nix: Table 17-2, p. 341. Nix: pp. 447-460 As above As above As above As above Christensen, Ch. 13, pp. 601649 Edmunds Ch. 23, p. 411 Nutrition 7 Class 14 Class 15 Class 16 Class 17 Class 18 Care of a Pt with Respiratory Disorders Continue chapter 13 Continue chapter 13 Continue chapter 13 Care of a Pt with a Cardiovascular Disorder Continue chapter 8 Continue chapter 8 Continue chapter 8 Continue chapter 8 Blood and Lymph Disorders Class 19 Class 20 Continue chapter 7 Endocrine Disorders Class 21 Class 22 Class 23 Class 24 Continue chapter 11 Continue chapter 11 Disorders of the GI System Continue chapter 5 Class 25 Class 26 Continue chapter 5 Accessory Organ Disorders Class 27 Class 28 Continue chapter 6 Urinary Disorders Class 29 Class 30 Class 31 Class 32 Class 33 Continue chapter 10 Continue chapter 10 Musculoskeletal Disorders Continue chapter 4 Continue chapter 4 Class 34 Reproductive: Female Class 35 Class 36 Class 37 Class 38 Class 39 Reproductive: Female Reproductive: Male ATI Testing MS2 Review Final Exam Class 9 Class 10 Class 11 Class 12 Class 13 Christensen: Ch. 9, pp. 373-433 Edmunds: Ch. 11, p. 136 Edmunds: Ch. 12, p.161 And Nutrition As above Christensen: Ch. 8, pp. 303-372 Edmunds: Ch. 15, p. 211 Nix: Ch. 19, pp. 379-397 As above As above As above Christensen: Ch. 7, pp. 262-302 Edmunds: Ch. 20, p. 354; Ch. 22, p.400 Nix: p. 115&116; pp.140-144 Christensen: Ch. 11, pp. 484532 Edmunds: 19, p334+. Nix: Ch. 20, pp. 400-424 Christensen: Ch. 5, pp 175 -230 Edmunds: Ch. 19, p 334 Nix: Ch. 18, pp. 352-370 Nix: Ch. 22, pp. 460-466 Christensen: Ch. 6, 231-261, Nix 370-375 As above Christensen: Ch. 10, pp. 434483 Edmunds: p. 328- 332 Nix: p 442-444 Christensen: Ch. 4, pp. 109-174 Edmunds: Ch. 18, p312 Nix: Ch. 16, pp. 311-327 & burns: 466-468 Christensen: Ch. 12, pp. 533600.Nix: Folic acid, p.428. Edmunds: Ch. 13, pp. 188-198 As above 8 GRADING: Grade Determinants: As per the student handbook, the lowest quiz grade in the course will be dropped. The final must be completed prior to beginning the next course. Unit Quizzes 40% (Any project assigned will equal one quiz grade) Final Exam 60% Students must receive a total didactic grade of 75% to progress to the next course. Your clinical grade will be averaged with your passing didactic grade to become your course grade. TEXTBOOKS: Christensen, B. & Kockrow, E. (2011). Adult Health Nursing, 6th ed. Elsevier Mosby, St. Loius, Mo. Christensen, B. & Kockrow, E. (2011). Adult Health Nursing Workbook, 6th ed. Elsevier Mosby, St. Loius, Mo. Edmunds, M.W. (2013). Introduction to Clinical Pharmacology, 7th ed. Elsevier Mosby, St. Loius, Mo. Edmunds, M.W. (2013). Introduction to Clinical Pharmacology Workbook, 7th ed. Elsevier Mosby, St. Loius, Mo. Nix, S. (2013). William’s Basic Nutrition and Diet Therapy, 14th. ed. Elsevier Mosby, St. Loius, Mo. EXPECTATIONS OF ALL STUDENTS: 1. Electronic copying and/ or taping of (during) the class are prohibited. Cell phone use is not permitted in the class during the didactic portion. If used in class for other than instructor approved reasons, the cell phone will be placed on the instructor’s desk for the remainder of the class. Repeated offenses are frowned upon. 2. ATI testing will be completed prior to the final for the course. The benchmark has been set at level 2 for the students in this course. If you achieve a level 3, you will be given one (1) grade point higher on the final course grade (EX: 79 could become 80). If you do not achieve the benchmark of 2, but get level 1, you will lose 1 point on your final course grade, and a ‘below level 1’ would lose 2 points on their final grade (Ex: 76 would become a 75. HOWEVER, you cannot fail the course based upon your ATI score. A 75 would not become 74. ALSO, you cannot pass the course by achieving a level 3 adding 1 point to your grade. EX 74 will not become 75 for the passing grade). Your ATI print out is an excellent guide to show you where your weaknesses are located. 3. You must complete the Medical Surgical ATI student practice with a 90% or better as a class requirement. Not achieving this/ doing the practice would result in an incomplete for the course until it is satisfactorily submitted. You may take the practice test as many times as you like; it is for your practice. You may hand in the practice at a 90% or better pass anytime within the course. It is a requirement, NOT a grade. 9 4. Your professional portfolio is to be handed in to the instructor no later than the second day of class with proof of current health and nursing insurance. It is your responsibility to ensure the required items are current for the entire semester. The completed professional portfolio must be handed in to the instructor by the requested date at the end of the semester or the grades for the class will be withheld until the criteria have been met. 5. Upon completion of the program and PRIOR to graduation, all senior students are required to complete EXIT testing. Students are required to take and pass a (1) comprehensive exam, (2) a pharmacology exit exam, and (3) a critical thinking exit exam. 6. To be eligible for graduation: a. The comprehensive exam is scored as a percentage likelihood of passing the NCLEX. The percentage of potential to pass needs to be 90% or greater, therefore, the individual’s score at the top of the report sheet needs to be 68% or greater. b. Pharmacology exam needs to be passed at the national level of 75. This number is located at the bottom of the report. The individual score is not what we are measuring. c. Critical thinking needs to show improvement from the first exam taken at the beginning of the program. 7. After you complete the above, all your courses and pay any outstanding tuition, your letter of completion will be sent to the board of nursing to get your NCLEX testing process started. GOOD LUCK IN MS2!! 10