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Transcript
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B/BL Health Deviations 3
Spring 2012
Edited by: Maricela Arnaud, RN, MSN, FNP
Julie Bean, RN, MSN
© Long Beach City College Associate Degree Nursing Program, Long Beach, CA 90808
ADN12B Spring 2012
To be turned in on
the first day of class.
Please this print
document for
submission.
Name________________________________________________
Print legibly
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B Health Deviations 3
Course Syllabus for Theory Content
Spring 2012
Edited by:
Maricela Arnaud, RN, MSN, FNP
Julie Bean, RN, MSN
© Long Beach City College Associate Degree Nursing Program, Long Beach, CA 90808
ADN12B Spring 2012
GENERAL INFORMATION
ADN12B Spring 2012
Long Beach City College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B - Health Deviations 3
TABLE OF CONTENTS
General Information
Course Information………………………………………………………..1.0
Course Outline…………………………………………………………….1.2
Theoretical Framework “Orem”………………………………..……….…1.4
Course Requirements-Theory ………………………………………….….1.5
Learning Outcomes for Theory………………………………………….…1.6
Challenge Policy Statement for Advanced Placement………………….…1.7
Challenge Option Specific to ADN 12B ……………….………………....1.8
Application for Challenge by Examination for ADN 12B……...………....1.9
Weekly Schedule………………………………………………………….1.10
Assignment Grading………………………………………...………........1.11
Theory Content
Developmental Self-Care Requisites of the Middle Aged Adult……….2.0
Acute Neurological Disorders/ CVA ..…………………………………..3.0
Worksheet: Neurological Diagnostic Tests……………………..3.2
Vocabulary: Neurological ...……………………………………..3.4
Nutritional Support ...................................................................................4.0
Hematological Health Deviations .............................................................5.0
Worksheet: Hematological Drugs .................................................5.2
Blood and Blood Components ..................................................................6.0
Vocabulary: Hematological/Blood...............................................6.1
Study Guide: Blood and Blood Components ................................6.2
Worksheet: Blood Transfusion Reactions ....................................6.3
Acid/Base Balance ....................................................................................7.0
Worksheet: Acid/Base Imbalance ................................................7.1
Acid/Base Practice Sheet ..............................................................7.2
Chronic Renal Failure ...............................................................................8.0
Worksheet: End-Stage Renal Disease ...........................................8.1
Worksheet: Laboratory Tests, Diagnostic Studies ........................8.2
Worksheet: Medications, Diet ......................................................8.3
Liver Disorders .........................................................................................9.0
Worksheet: Diagnostic Tests Used in Liver Disease ....................9.1
Worksheet: Medications Used to Treat Liver Disease ..................9.3
i
ADN12B Spring 2012
Diabetes Mellitus ....................................................................................10.0
Worksheet: Laboratory Tests in Diabetes Mellitus ....................10.3
Worksheet: Medications to Treat Diabetes Mellitus ..................10.4
Worksheet: Short Term Complications of DM ...........................10.6
Worksheet: Late Complications of DM ......................................10.7
Immunological Disorders, Connective Tissue ........................................11.0
Worksheet: Immune Modulating Drugs .....................................11.1
Immunological Disorders, AIDS ............................................................12.0
Worksheet: Drugs Used in Treatment of AIDS ..........................12.2
Endocrine Health Deviations ..................................................................13.0
Worksheet: Endocrine Disorders ................................................13.1
Worksheet: Endocrine Drugs ......................................................13.6
Cardiovascular Health Deviations………………………………………14.0
Heart Failure…………………………………………………….14.0
Cardiovascular Health Deviations………………………………………15.0
Myocardial Infarction…………………………………………...15.0
Submodule: Vision and Hearing…………………………………………..……16.0
Course Evaluation
Clinical Evaluation Information for ADN 12B and ADN 12BL
(to be completed via online survey) ........................................................17.0
ii
ADN12B Spring 2012
Long Beach City College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B - Health Deviations 3
Course Information
Course Description
This course continues to explore the professional role of the nurse and patient demands for
increased care necessitated by health deviations in the hospitalized adult. The content emphasizes the
nursing process using Orem's Self-Care Theory, specifically the requisites of sufficient intake of water
and food, elimination, and excretion. Focus is placed on collaborative management of care,
communication, safety, and critical thinking in assuming the expanding role of the registered nurse.
Additionally, the effects of specific pathological health deviations and medical treatment modalities for
the medical patient are studied with attention to teaching and learning.
Time allotment, sequencing and enrollment
2.5 college semester units
Class/Lectures: 5 hours per week for 9 weeks, Total of 45 hours
This course is offered in the second semester during the second half of each 18 week semester with
enrollment as space and resources allow. Concurrent enrollment with ADN 12BL required.
Required Texts
Deglan, J.H., Vallerand, A.H. & Sanoski, C.A. (2010). Davis’s drug guide for nurses (12th ed.).
Philadelphia, PA: F.A. Davis Company.
Dudek S.G. (2006). Nutrition essentials for nursing practice (12th ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.
Ladwig, G.B., & Ackley, B.J. (2008). Guide to nursing diagnosis (2nd ed.). St. Louis, MO: Mosby Elsevier.
Leifer, G., & Hartston, H. (2004). Growth and development across the lifespan: A health promotion
focus. St. Louis, MO: Saunders.
Pagana, K.D, & Pagana, T.J. (2006). Mosby’s manual of diagnostic and laboratory tests. St. Louis, MO:
Mosby Elsevier.
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby Elsevier.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s textbook of
medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
EDose One year license. 100% web-based math tutorial. Purchase at the LBCC Bookstore.
Staff. ADN 12B course syllabus, 12BL course syllabus. (Fall 2011). Retrievable at the ADN12B/BL
website.
Staff. Student handbook: Associate degree nursing (year of admission)
Teaching Methods
Class/lecture discussion
Reading assignments
Media programs: AV, CD and DVD
NCLEX-RN type questions
Student Evaluation
Quizzes
Final Examination
Total Points
Written assignments
Independent study
Interactive/web-based case studies
Collaborative student presentations
Possible Points
150
100
250
Student Course Grade
Students must be concurrently enrolled in ADN 12B and ADN 12BL. When students achieve
satisfactory clinical performance in ADN 12BL, the percentage of theory grade in ADN 12B will
become the course grade for both courses.
1.0
ADN12B Spring 2012
Course Instructors
Name & Credentials
Office
Telephone
e-mail
Maricela Arnaud, RN, MSN, FNP, Lead
I
(562) 938- 4170
cell (714) 457-0330
[email protected]
Julie Bean, RN, MSN-ED
R
(562) 938-41781
cell (562) 569-8620
[email protected]
Instructor’s office hours are posted on the office door. Other hours may be arranged. Part-time teachers
may be reached by special arrangement with the individual teacher (when utilized).
1.1
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
Course Outline
Course Content
1. Developmental Self-Care Requisites of the Middle Aged Adult
A. Review Orem's developmental self-care requisites
B. Review Erickson's stages of psychosocial development
C. Gould's developmental themes
D. Health promotion and teaching techniques
2. Acute Neurological Disorders and Cerebral Vascular Accident
A. Levels of consciousness
B. Stroke/CVA
C. Diagnostic tests
D. Transient Ischemic Attack
E. Medical and nursing treatments
F. Rehabilitation following a stroke
H. Neurological medications and pharmacology
3. Nutritional Support
A. Enteral and parenteral nutrition
B. Solutions providing nutritional support
C. Types of central venous catheters
D. Parenteral and enteral administration standards of care
E. Potential complications of parenteral and enteral nutrition
4. Hematological Health Deviations, Blood Administration
A. Types of blood components
B. Complete blood count (CBC)
C. ABO blood groups
D. Nursing management of transfusions
E. Potential complications of transfusions
F. Blood tests and values
G. Types of anemia
H. Leukemia’s
I. Lymphomas
J. Bleeding disorders
5. Acid/Base Balance
A. Definition and implications of pH
i. respiratory/metabolic acidosis
ii. respiratory/metabolic alkalosis
B. Buffer systems
C. Obtaining arterial blood for blood gas analysis
D. Measuring oxygenation
E. Interpretation of arterial blood gases
1.2
ADN12B Spring 2012
6. Diabetes Mellitus
A. Screening recommendations
B. Type 1 vs. type 2
C. Management of diabetes
D. Oral and parenteral diabetic medications
E. Complications and nursing care of diabetes
F. Alterations in sexuality with diabetes
7. Liver Disorders
A. Portal circulation
B. Diagnostic tests
C. Drugs related to liver disorders
D. Cirrhosis
E. Hepatic encephalopathy
F. Management of ascites
G. Viral hepatitis
H. Nutritional needs with liver failure
8. Immunologic Disorders
A. Immune system
B. Autoimmune disorders
C. Hypersensitivity disorders
D. Sepsis
E. HIV and AIDS
10. Endocrine Health Deviations
A. Principles of endocrine function
B. Role of pituitary and hypothalamus
C. Endocrine disorders-except diabetes mellitus
D. Nursing management
E. Endocrine and sexuality
F. Endocrine drugs
11. Cardiovascular Health Deviations-Heart Failure
A. Left and right-sided heart failure
B. Nursing and medical management
C. Nursing diagnoses and collaborative problems
12. Cardiovascular Health Deviations-Myocardial Infarction
A. Coronary artery disease
B. Nursing and medical management
C. Tests related to diagnosis of MI
D. Nursing diagnoses and collaborative problems
1.3
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
Orem’s Self Care Model
Conceptual Framework Curriculum Implementation
SELF CARE MODEL
THEORY
CLINICAL
IMPLEMENTATION
IMPLEMENTATION
Health Deviation Self Care
Requisites are needs
generated by illness and the
medical diagnostic
procedures and treatments
associated with disease.
Developmental Self Care
Requisites are needs
associated with development
throughout the life cycle.
The concept of Health
Deviation Self Care
Requisites is discussed with
emphasis placed on the
medical patient.
Students provide care for two
to three acutely ill patients in
the hospital medical settings.
Whenever possible, patients
are selected to correspond
with classroom theory.
The basic principles of
intravenous therapy and
administration of intravenous
medications are utilized as
commonly used medical
treatments associated with
health deviations.
Students apply the entire
nursing process of assessing,
diagnosing, planning,
implementing, and
evaluating.
The following health
problems are studied in
depth:
1. Developmental SelfCare requisites
2. Acute neurological
disorders
3. Nutritional support
4. Hematologic
disorders/Blood
administration
5. Chronic renal failure
6. Acid/base disorders
7. Diabetes mellitus
8. Liver disorders
9. Immunology/HIV &
AIDS
10. Endocrine disorders
11. Cardiovascular health
deviations: HF & MI
The Self Care Requisites
generated by these health
problems and problems with
associated diagnostic and
treatment modalities are
studied.
The nursing process
considers the Universal Self
Care Requisites,
Developmental Self Care
Requisites, as well as the
Health Deviation Self Care
Requisites of patients with
the studied problems.
Developmental Self Care
Requisites are applied to the
middle aged adult.
1.4
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
COURSE REQUIREMENTS
During this course each student will:
1. Independently review any material from previous required courses as needed.
2. Arrive to class prepared and on time.
3. Prepare prior to class for discussion of each assigned behavioral objective.
4. Complete all required reading, audio-visual, and written work prior to class.
5. Turn in assigned written work on time, using correct format as described in ADN
Student Handbook or course syllabus.
6. Initial the attendance roster to demonstrate attendance at lecture and campus lab.
7. Actively participate in class/conference discussions.
8. Assume responsibility for meeting behavioral objectives when absent from class.
9. Take quizzes when scheduled. The quiz number and student ID number must be written
on each scantron and bubbled in pencil. Scores will be posted online.
10. Achieve at least 75% overall on all scored materials at the completion of the course.
11. Comply with the standards of the College and Student Handbook Policies on Academic
Honesty as published in the Student Handbook and in the College Catalog.
1.5
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
ADN 12B LEARNING OUTCOMES
Upon satisfactory completion of this course, the student will be able to:
Develop a comprehensive and holistic understanding of major health deviations of the
acutely ill, middle-aged adult in the acute care setting.
Professional Role
 Develop and integrate professional values of caring, integrity, honesty, and respect for
human dignity within the professional role as an evolving nursing student.
Communication
 Utilize appropriate communication skills with colleagues and faculty using proper
English while displaying respect for cultural diversity.
Orem’s Self-Care Theory as it relates to the Nursing Process
 Apply Orem’s Self-Care Theory and the nursing process to the theoretical care of a
middle aged adult in the acute care, medical setting.
 Apply Orem’s Self Care Theory of nursing practice and the nursing process while
integrating critical thinking to case studies discussed in class.
Critical Thinking
 Develop critical thinking and the ability to prioritize the theoretical needs of the patient
based on scientific, evidence-based research.
Safety
 Integrate the professional role of the registered nurse utilizing effective communication,
patient advocacy/safety, and critical thinking.
Teaching and Learning
 Synthesize knowledge from the arts, sciences, and nursing to assimilate safe nursing
practices.
 Examine self-learning needs and identify appropriate resources for meeting course
objectives.
Collaborative Management of Care
 Develop collaborative teaching/learning concepts necessary to safely practice the art
and science of nursing.
 Collaborate with colleagues during group assignments to apply and teach new
knowledge while discussing effective methods for success in theoretical applications.
1.6
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
POLICY STATEMENT
Challenge Option for Advanced Placement
1. The challenge option for each course consists of two parts:
1. 1st: challenge of the theory course
2. 2nd: Challenge of the laboratory course
2. An announcement regarding the challenge options will be made at the beginning of every
course on the first day of class.
3. The student must have evidence on file in the college and program cumulative folder of
formal instruction in this course content.
4. Formal instruction and direct patient care experience (in the content of the course being
challenged) must have taken place within the three years previous to the challenge request.
5. If the student satisfactorily passed the clinical exam the grade earned for the course or
potion of the course will be the grade achieved on the theory course.
6. The student must utilize both the conceptual framework and the nursing process in the
laboratory challenge portion of this option.
7. For details refer to the LBCC Catalog “Nursing Programs and Courses: Policies for
Transfer Credit, Advanced Placement and Credit by Examination for the Associate
Degree.”
1.7
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
CHALLENGE OPTION
Specific to ADN 12B and 12BL
General Announcement
Students interested in challenging must let the instructor know by the last day of the
first week of the course. The student should complete the department “Application for
Challenge by Examination for ADN 12B” and complete the college formal application for
challenge by examination. Upon acceptance of the challenge option by the teaching team, an
appointment will be made for the student to take the written theory exam at the beginning of
the second week of the course.
Written Test
A 150 point comprehensive, objective (NCLEX style) test will be given. The student
must achieve a minimum score of 75% to continue with the challenge.
Upon successful completion of the ADN 12B course challenge, the student then
proceeds to the next step; the challenge of ADN 12BL.
1.8
ADN12B Spring 2012
APPLICATION FOR CHALLENGE BY EXAMINATION
ADN 12B- Health Deviations 3
Student Name________________________________
Date____________________
Student complete section A below:
A. Justification of this request:
Student Signature_____________________________________
Teaching team complete section B below:
B. Decision:
Yes________ If yes, write contract below.
No________ If no, state reason for denial.
C. Contract
Written test completed by ___________________________
Signatures:
Lead Instructor: _____________________________
Date:___________________
Instructor:__________________________________
Date:___________________
Instructor:__________________________________
Date:___________________
Student:____________________________________
Date:___________________
D. Disposition of Challenge_________________________________________________
1.9
ADN12B Spring 2012
Monday
Lecture
C101
0800-1100
W
E
E
K
1
2
LONG BEACH CITY COLLEGE
ADN-12B-Health Deviations 3
ADN 12BL – Health Deviations 3
Weekly Schedule, Spring 2012
Clinical Lab
Friday
Wed /Thurs
Lecture
8 hour day
Room D237
0800-1000
3/12
Lec: Intro to Course
Lec: DSCR
EDose test scheduled
per team
Wed
3/14
Flex
Day
3/19
Lec: Blood
Wed
3/21
Thurs
3/15
Orientation
Medical Center
7 hour day
Thurs
3/22
Medical Center
7 hour day
3
3/26
Quiz #1 (50 points)
Wed
3/28
Lec: Diabetes
4
5
6
4/9
Wed
4/11
Thurs
4/12
Wed
4/18
Thurs
4/19
Medical Center
7 hour day
4/23
Wed
4/25
3/30
Test: Intradermal
2nd EDose Completed by
1500
4/6
Lec: Nutritional Support
4/6
Test: Neuro Assessment
4/13
4/13
4/20
Lec: Acid/ Base
4/20
Lab: Physical assessment
Due: Written Case Studies
Pass Vision/Hearing
submodule by 1500
5/4
Lec: Immunology-CTD
5/4
Test: Physical assessment
5/11
Lec: Immunology AIDS
Thurs
5/3
Medical Center
7 hour day
Wed
Thurs
5/9
5//10
Medical Center
7 hour day
5/11
Test: Suctioning/trach care
Clinical evals due to
instructor
5/14
FINAL EXAM
(100 points)
Wed
Thurs
5/16
5//17
Simulation Hospital
5/18
ALL SKILLS DUE BY
NOON!
4/30
Lec: Liver
5/7
Quiz #3 (50 points)
Thurs
4/26
Break
4/27
Lab: Suctioning/trach
Med Center
7 hour day
Lec: MI
9
Thurs
4/5
3/30
Lec: Finish Diabetes
4/27
Lec: Heart Failure
Quiz #2 (50 points)
8
3/23
Lab: Neuro Assessment
Medical Center
7 hour day
Endocrine CD-Rom
due prior to lecture
7
Thurs
3/29
Medical Center
7 hour day
Wed
4/4
4/16
Lec: Endocrine
Due:
1st EDose completed by
1500
3/23
Lec: Hematology
3/16
Lab: Managing IV fluids
Lab: Intradermal
Due:
1stVision/Hearing submodule
by 1500
4/2
Lec: Chronic Renal
Failure
Spring
3/16
Lec: Acute Neuro/CVA
Campus Lab
C302
Sec 1 1030-1230
Sec 2 1300-1500
Wed
5/2
Intro to 3rd semester
ATI Test
1.10
ADN12B Spring 2012
5/18
Clinical Evaluations!!!!
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B Health Deviations 3
Quiz Grades
The 12B teaching team reserves the right to administer "pop" quizzes at any time during the
course. The total points for 12B will remain 250. Quiz points will be adjusted accordingly if a
"pop" quiz is given.
Possible Points
Quiz # 1
Quiz # 2
Quiz # 3
50
50
50
Final
Total
100
250
Points Earned
Percent
Grade
LETTER GRADES
A = 91 - 100
B = 83 - 90
C = 75 - 82
D = 67 - 74 (failing in nursing)
F = 66 and below
Course evaluations will be done on the day of ATI testing via an online survey.
AGENCY REQUIREMENTS

Annual Tuberculosis skin testing or health clearance

Hepatitis B vaccine (3 completed)

Proof of varicella, measles, mumps and rubella immunity (titer only).

Current professional malpractice insurance

Current CPR for health care providers (American Heart Association)

Annual influenza vaccine

Tdap (Tetanus, diphtheria, Pertussis [whooping cough]) immunization
A student folder is maintained by the Nursing Department. All of the above requirements are to
be current each semester. The student is responsible to maintain a personal folder with the
originals of the required documents. All documents are to be brought to the first day of class
for verification if needed.
1.11
ADN12B Spring 2012
THEORY
CONTENT
ADN12B Spring 2012
THEORY: OREM’S DEVELOPMENTAL SELF-CARE REQUISITES OF THE MIDDLE
AGED ADULT
BEHAVIORAL OBJECTIVES:
1. Review Orem’s developmental self-care requisite changes and task of the middle aged
adult from ADN 12A.
2. Review Erikson’s psychosocial developmental stage of the middle adult from ADN
12A.
3. Compare and contrast Gould’s developmental themes to Havighurst’s’ and Erikson’s
developmental tasks for the middle aged adult 35-60.
4. Discuss health promotion activities for the middle aged adult (to prevent poor health or
disability on Orem’s list of conditions affecting human development).
 Prevention of obesity
 Prevention of cardiovascular disease
 Early detection of treatable chronic diseases
 Sexuality
5. Discuss teaching techniques that would be effective in assisting the middle age adult to
maintain a positive health status.
ASSIGNMENTS:
Leifer, G., & Hartson, H. (2004). Growth and development across the lifespan: A health
promotion focus. St. Louis, MO: Saunders. Chapter 11, 179-191
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby
Elsevier, 138-140; 184-189; 428
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins, 51-52, 697.
2.0
ADN12B Spring 2012
THEORY: NEUROLOGICAL DISORDERS/CVA
BEHAVIORAL OBJECTIVES:
1. Independently review the anatomy and physiology of the central nervous and
autonomic nervous systems.
2. Discuss the definition, clinical manifestations, and management of the following
conditions:
Brain tumors:
glioma
astrocytoma
medulloblastoma
meningioma
angioma
3. Independently define the vocabulary words listed in the Neurological Vocabulary
worksheet.
4. Independently review the definition, clinical manifestations, diagnostic evaluation and
management of transient ischemic attack.
5. Independently describe the procedure and list nursing responsibilities of diagnostic
tests performed to assess cerebral vascular disease found in the Neurological
Diagnostic Tests Worksheet. Be familiar with invasive vs. noninvasive procedures.
6. Discuss the following areas related to the care of a patient with acute cerebral vascular
accident:
Definition
Causes
Risk factors
Clinical manifestations
Nursing management to restore normalcy
Cultural responses
Nutrition
Sexual problems
Medical management for ischemic and hemorrhagic strokes
Surgical management including carotid endarterectomy
7. Compare the clinical manifestations and nursing management of a patient with a CVA
in the right hemisphere versus a patient with a CVA in the left hemisphere.
8. Discuss general management of a patient with a stroke after the acute phase including
permanent health deviations and common methods of restoring normalcy (the
rehabilitation phase).
3.0
ADN12B Spring 2012
9. Independently review the following medications in regard to sub class, action and
nursing responsibilities:
aspirin
warfarin (Coumadin)
pentoxifylline (Trental)
dexamethasone (Decadron)
phenytoin (Dilantin)
heparin
low molecular weight heparin
ranitidine (Zantac)
dipyridamole (Persantine)
ticlopidine (Ticlid)
10. Describe the goals of heparin and Coumadin therapy. Discuss heparin protocol for a
patient with an acute occlusive CVA and teaching needs for the patient on Coumadin
therapy.
ASSIGNMENTS:
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins. Chapters 60, 61, & 62. (See index)
Deglan, J.H., & Vallerand, A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia,
PA: F.A. Davis Company. As needed
Article:
Cross, S., Walker, C. (2008). Stroke care: a nursing perspective. Nursing Standard, 22,23, 4756.
STUDY GUIDES:
Neurological Diagnostic Tests
Vocabulary: Neurological Health Deviations
3.1
ADN12B Spring 2012
WORKSHEET: HEALTH DEVIATION REQUIRING NEUROLOGICAL
DIAGNOSTIC TESTS
TEST
Description
What
abnormal
findings
may be
found?
Lumbar Puncture
Cerebral Angiogram
(Arteriogram)
EEG
(Electroencephalogram)
Carotid Flow Studies
3.2
ADN12B Spring 2012
Preparation
for the Test
Post Test
Nursing
Care
TEST
Description
What
abnormal
findings may
be found?
CT Scan: Computed
Tomography
MRI: Magnetic
Resonance Imaging
PET: Positron
Emission Tomography
Evoked Potential
Studies
3.3
ADN12B Spring 2012
Preparation
for the Test
Post Test
Nursing Care
VOCABULARY: NEUROLOGICAL HEALTH DEVIATIONS
Agnosia
Aphasia
Receptive aphasia
Expressive aphasia
Apraxia
Diplopia
Dyslexia
Dysarthria
Hemiparesis
Hemiplegia
Hemianopia
Emotional lability
Perseveration
Proprioception
Decorticate Posturing
Decerebrate Posturing
Babinski Reflex
Plantar Reflex
Ipsilateral
Contralateral
Vertigo
3.4
ADN12B Spring 2012
THEORY: HEALTH DEVIATIONS REQUIRING THE ADMINISTRATION OF
NUTRITIONAL SUPPORT PARENTERAL NUTRITION AND ENTERAL FEEDINGS
BEHAVIORAL OBJECTIVES:
1. Define enteral feeding and parenteral nutrition and common health deviations that may
require the need for these particular therapies. Discuss the major factor that determines
why one is chosen over the other by the physician.
2. List the advantages and disadvantages, including common complications, of enteral
feedings and parenteral nutrition.
3. Define the following enteral formulas and identify and common health deviations that
may require the need for these therapies.
a. Intact nutrient formulas
b. High protein formulas
c. High calorie formulas
d. Formulas containing fiber
e. Specialty formulas for specific diseases
f. Elemental formulas
4. Review the nursing care of the patient receiving enteral feedings and provide the
rationale for the following nursing standards of care.
a. Elevate the head of the bed at least 30 degrees for at least one hour after
feedings.
b. Check residual every 8 hour shift. If over 50 ml, hold feedings for one hour.
c. For NG tubes, check placement at least every 8 hour shift.
d. Flush tube with water before and after giving medications per tube and when
discontinuing feedings for more than a few minutes.
e. Flush tube with water when stopping the feeding.
f. Change enteral bag, tubing, and formula every 24 hours.
5. Define peripheral parenteral nutrition (PPN) and total parenteral nutrition (TPN).
Identify common health deviations that may require the need for PPN or TPN.
Differentiate between the venous access sites used for peripheral parenteral nutrition
and total parenteral nutrition.
6. Describe the following types of central venous catheters and explain how the nurse can
identify the type of catheter placed in an individual patient.
a. Peripherally inserted central catheter (PICC line)
b. Subclavian and jugular vein central lines
c. Tunneled central lines (Hickman, Broviac)
d. Implanted central venous ports.
7. Describe the contents of the solutions used for PPN, TPN and lipid infusions.
8. Using the nursing process as an outline, identify the standard nursing care for patients
receiving PPN and TPN nutritional support.
9. Discuss the potential complications of total parenteral nutrition, including central venous
catheter considerations.
4.0
ADN12B Spring 2012
ASSIGNMENTS:
Dudek S.G. (2010). Nutrition essentials for nursing practice (6th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins, 356-384.
Potter, P.A., & Perry, A.G. (2009). Fundamentals of Nursing (7th ed.). St. Louis, MO: Mosby
Elsevier, 1111-1128.
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins, 1027-1041.
Article:
McKnight, K., Carter, L. (2008). From trays to tube feedings: Overcoming the challenges of
hospital nutrition and glycemic control. Diabetes Spectrum. 21, 233-240.
4.1
ADN12B Spring 2012
THEORY: HEALTH DEVIATIONS OF HEMATOLOGICAL DISORDERS
BEHAVIORAL OBJECTIVES:
1. Independently review the vocabulary words listed on the “Vocabulary” worksheet.
2. Independently review the components of the hematological system.
3. Independently review the following laboratory tests, stating the normal ranges and
clinical significance of each test:
Hemoglobin electrophoresis
Coombs’, direct and indirect
Bleeding time
Prothrombin time (PT) reported as INR (International Normalized Ratio)
Activated Partial thromboplastin time (aPTT)
4. Discuss the etiology, clinical manifestations, diagnosis, medical and nursing
management of the patient with the health deviation anemia (include avoidance of
hazards and promotion of normalcy).
5. Discuss the pathophysiology and special management of the following types of health
deviations (anemias).
A. Hypoproliferative Anemia
Aplastic
Anemias in Renal Disease
Anemia of Chronic Disease
Iron Deficiency Anemia
Megaloblastic anemias: Vitamin B 12 Deficiency, Folic Acid Deficiency
B. Hemolytic Anemias
Sickle cell (include sickle cell crisis)
Immune Hemolytic Anemia
6. Discuss the incidence, prognosis and distinguishing features of the following health
deviations or hematopoietic malignancies:
A. Leukemias
Acute myelogenous leukemia (AML)
Chronic myelogenous leukemia (CML)
Acute lymphocytic leukemia (ALL)
Chronic lymphocytic leukemia (CLL)
B. Malignant Lymphomas
Hodgkins disease
Non-Hodgkins lymphoma
5.0
ADN12B Spring 2012
7. Discuss the pathophysiology, clinical manifestations and special management of the
following health deviations or bleeding disorders:
A. Platelet defects
Thrombocythopenia
Idiopathic thrombocytopenic purpura (ITP)
B. Clotting Factor Defects:
Hemophilia
Von Willebrand’s disease
Disseminated intravascular coagulation
8. List two potential nursing diagnoses and/or collaborative problems associated with each
of the hematological health deviations.
ASSIGNMENT:
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins, Chapter 33.
Article:
McRae, C. (April 26, 2007). Accurate history the key to diagnosis of macrocytic anemias. The
Practitioner, 72-77
Simmons, S. (June 2010). Anemia. Nursing 2010. 40(6), 36.
5.1
ADN12B Spring 2012
WORKSHEET: HEALTH DEVIATION OF HEMATOLOGIC DISORDERS DRUGS
MEDICATION
ACTION IN
HEMATOLOGICAL
DISORDERS
Oral iron supplements
Ferrous sulfate
Parenteral Iron
Iron Dextran
Folic Acid
Vitamin B12
Cyanocobalamin
Erythropoietin
Epogen, Procrit
Neupogen
Vitamin K
Phytonadione
5.2
ADN12B Spring 2012
NURSING
RESPONSIBILITIES
THEORY: HEALTH DEVIATIONS THAT REQUIRE ADMINISTRATOIN OF BLOOD
AND/OR BLOOD COMPONENTS
BEHAVIORAL OBJECTIVES:
1. Describe the blood components on the study guide, identifying their action, indications
and administration guidelines for patients with health deviations that require
administration of blood and/or blood components.
2. Describe the individual tests reported in a “complete blood count” (CBC). Discuss the
clinical significance of each individual item:
RBC (red blood cell count)
Hemoglobin
Hematocrit
MCV (mean corpuscular volume)
MCH (mean corpuscular hemoglobin)
MCHC (mean corpuscular hemoglobin concentration)
Platelets
WBC (white blood cell count)
Differential leukocyte percentage
Absolute leukocyte counts
3. Discuss the clinical significance of the ABO blood groups and Rh type along with the
laboratory tests used to match blood for transfusion.
4. Describe the medical management and nursing management before, during and
immediately following the administration of blood and/or blood components.
5. Prior to class, complete the blood transfusion reaction worksheet.
6. Identify the health deviations potentially transmitted by blood and blood component
transfusions. Indicate the relative risk for such transmission today.
7. Identify the disqualifying factors that blood banks use to exclude people from donating
blood.
8. Identify the information on a blood container/bag label.
ASSIGNMENTS:
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby
Elsevier, 1022-1027.
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams &
Wilkins, 903-910, 967-972.
Miller, J., & Starks, B. (2010). Deciphering clues in the CBC count. Nursing2010, 40(7), 52-55.
6.0
ADN12B Spring 2012
VOCABULARY: HEALTH DEVIATIONS OF HEMATOLOGIC/ BLOOD
Agranulocytosis
Aplasia
Ecchymosis
Erythrocyte
Erythropoiesis
Granulocyte
Granulocytopenia
Hematocrit
Hemoglobin
Hematopoiesis
Hemolysis
Histiocyte
Hypochromia
Leukocyte
Lymphocyte
Macrophage
Monocyte
Neutropenia
Petechiaae
Platelet
Polycythemia
Reticulocyte
Thrombocyte
Thrombocytopenia
6.1
ADN12B Spring 2012
STUDY GUIDE: BLOOD AND BLOOD COMPONENTS
Name of
Component
Action
Indication
Whole Blood
Packed Red Blood
Cells
Platelets
Fresh Frozen
Plasma (FFP)
Albumin
Cryoprecipitate
Factor VIII/ Factor
IX Concentrate
6.2
ADN12B Spring 2012
Administration
WORKSHEET: BLOOD TRANSFUSION REACTIONS
PROBLEM
ASSESSMENT
Hemolytic Reactions:
a. Immediate
b. Delayed
Circulatory Overload
Febrile Reactions:
a. Immune Response
to Leukocytes,
Platelets
b. Bacterial pyogen
reaction
Allergic Reactions:
a. Mild
b. severe
6.3
ADN12B Spring 2012
INTERVENTION
THEORY: ACID/BASE BALANCE
BEHAVIORAL OBJECTIVES:
1. Independently review fluid and electrolyte material from ADN 11A, 12A and science
courses.
2. Define pH and describe what the pH scale means.
3. Describe the three mechanisms that regulate acid-base balance. Discuss each
mechanism. Identify the importance of each and the speed of corrective action.
a. Chemical buffer systems: bicarbonate-carbonic acid; phosphate; and protein
b. Respiratory regulation
c. Renal regulation
4. List the normal arterial blood gas values. Describe nursing responsibilities to ensure
accurate blood gas results.
5. Compare and contrast the accuracy and usefulness of measurements of oxygenation via
the following:
a. Hemoglobin saturation via pulse oximetry
6. Describe the various oxygen delivery systems from previous courses, including nasal
cannula, simple face mask, venturi mask, and non-rebreather mask.
7. Explain the relationship between oxygenation and acid-base balance.
8. Using the Acid Base Practice Sheet, demonstrate the ability to recognize an acid/base
abnormality, determine whether the abnormality is metabolic or respiratory in origin,
and evaluate the patient’s oxygenation status.
9. Describe the common causes, clinical manifestations, and management for metabolic
acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis.
10. Using the acid/base balance worksheet, determine the probable arterial blood gas
health deviation for each of the clinical situations given.
ASSIGNMENT:
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby
Elsevier, 971-972; 974-977.
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins, 293-298, 508-509, 637-639, 1297.
Articles:
Pruit, B. (2010). Interpreting ABGs: An inside look into your patient’s status. Nursing 2010,
40(7), 31-35.
RECOMMENDED:
Computer Program in Learning Center, “Arterial Blood Gas Interpretation”.
7.0
ADN12B Spring 2012
Hx/Medical Dx
Clinical
manifestations
A 25-year old “high
strung’ female
hospitalized for
treatment of
multiple trauma in
an auto accident.
She is sobbing
uncontrollably and
crying that she feels
like she is dying,
and her ands and
mouth are tingling.
A 39-year old male,
insulin dependent
diabetic for 10
years, acutely ill
with severe
gastroenteritis, and
diabetic
ketoacidosis;
admitted from the
ED.
A 75-year old male,
with pneumonitis
and pleurisy, with
shallow, slow
respirations that he
is controlling to
reduce the pain. He
is becoming
increasingly
confused since the
baseline assessment.
WORKSHEET: ACID/BASE IMBALANCES
Probable
Probable
Nursing Process
Metabolic
ABGs
r/t Acic-Base
Disorder
Imbalance
Assessment
Dx
Outcomes
Interventions
Assessment
Dx
Outcomes
Interventions
Assessment
Dx
Outcomes
Interventions
7.1
ADN12B Spring 2012
ACID BASE PRACTICE SHEET
LAB RESULTS
A
B
C
D
pH
7.25
7.62
7.30
7.55
PaCO2
40
30
50
40
PaO2
96
98
80
90
HCO3
16
26
24
40
LAB RESULTS
E
F
G
H
pH
7.25
7.30
7.58
7.31
PaCO2
60
42
26
50
PaO2
70
92
80
68
HCO3
26
15
24
25
Health Deviation
Health Deviation
7.2
ADN12B Spring 2012
THEORY: CHRONIC RENAL FAILURE HEALTH DEVIATION
BEHAVIORAL OBJECTIVES:
1. Review the function of the kidneys including fluid and electrolyte regulation, regulation
of erythropoesis, and acid/base regulation.
2. Identify the etiology and stages of chronic renal failure health deviation.
3. Identify the metabolic, fluid, and electrolyte disorders and systemic changes that occur
with chronic renal failure (end stage renal disease) health deviation.
4. Identify the medications and nutritional support usually ordered to correct or reduce the
metabolic, fluid and electrolyte disorders associated with end stage renal disease health
deviation. Discuss the need for reduction in dosage of many medications.
5. Discuss peritoneal dialysis, including home self-care requisites of patients choosing
peritoneal dialysis.
6. Discuss hemodialysis, including the various types of circulatory access devices.
7. Discuss the nursing interventions for chronic dialysis patients admitted to the acute care
hospital. Include alteration of drug dosing, fluids, and diet to accommodate the dialysis
schedule.
8. Briefly discuss the social and psychological impact of dialysis upon the patient and the
family system.
9. Identify the source of funding for the health care of patients with end stage renal disease
health deviation. Discuss the role of free-standing dialysis units in the self-care of these
patients.
10. Discuss nursing considerations and health promotion in patients needing kidney
transplant surgery.
ASSIGNMENTS:
Dudek S.G. (2010). Nutrition essentials for nursing practice (6th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins, 514-535.
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins, 1325-1333.
Complete the course study guide worksheets.
ARTICLES:
Banerjee, S. (2009). Beyond needle placement: The role of the nephrology nurse in
arteriovenous fistula management. Nephrology Nursing Journal, 36(6), 657-659.
Beto, J. (2010). Improving first-year mortality in patients on dialysis: A focus on nutrition and
exercise. Nephrology Nursing Journal, 37(1), 61-65; 98
Simmons, L. (2009). Dorthea Orem’s self care theory as related to nursing practice in
hemodialysis. Nephrology Nursing Journal, 36(4), 419-421.
8.0
ADN12B Spring 2012
Associated Disorder
Worksheet
End-Stage Renal Disease
Pathophysiologic
Systemic Changes
Basis for Disorder
Fluid Volume Excess
Fluid Volume Deficit
Electrolyte
Imbalance:
Potassium
Acid/ Base
Imbalance
Waste Elimination
Anemia
Calcium Balance
Hypertension
Cardiac Disease
Pulmonary Disease
Impaired Drug
Metabolism
8.1
ADN12B Spring 2012
Treatment
Laboratory
Test
BUN
Renal Worksheet:
Laboratory Tests, Diagnostic Studies
Normal Reference
Expected Change with
Pathophysiologic Basis for
Range
Chronic Renal Failure
Change
Creatinine
24 Hour
Creatinine
Clearance
Diagnostic
Study
Renal
Arteriogram
Glomerular
Filtration Rate
(GFR):
Description of
Study
Pre-Procedure Care
KUB
CT, MRI
Intravenous
Pyelogram
(IVP)
Renal Biopsy
8.2
ADN12B Spring 2012
Post-Procedure Care
Potential Complications
Renal Worksheet: Medications, Diet
Medication
Therapeutic Effect
Nursing Responsibility
Alteration from Normal Diet
Rationale
Beta Blocker
ACE Inhibitor
Epoetin
Vitamins
Nutritional
Element
Fluid
Calories
Fat
Protein
Potassium
Sodium
Phosphorous
Calcium
8.3
ADN12B Spring 2012
THEORY: LIVER DISORDERS HEALTH DEVIATION
BEHAVIORAL OBJECTIVES:
1. Independently review and come prepared to discuss the anatomy and physiology of the
liver including the portal circulation.
2. Complete the liver diagnostic tests and drug worksheets.
3. Discuss cirrhosis health deviation, including etiology, pathophysiology, clinical
manifestations, and medical and nursing management.
4. Discuss ascites health deviation, including the etiology, pathophysiology, and medical
and nursing management.
5. Describe the pathophysiology of hepatic encephalopathy health deviation. Describe
clinical manifestations, and medical and nursing management.
6. Describe and differentiate between the peritoneal-venous shunt for management of
ascites and the portal venous shunt for management of portal hypertension. Briefly
discuss the self-care demands and requisites of patients undergoing either one of these
shunt procedures.
7. Identify the differences in etiology and prevention of viral hepatitis A, B, C, D, and E
health deviations. Discuss the risk of contracting hepatitis for health care workers.
Describe the stages, clinical manifestations, medical and nursing management for the
patient with viral hepatitis health deviation.
8. Discuss the nutritional self-care demands and requisites of a patient with liver disease.
9. Discuss the influence of cirrhosis on the patient’s sexuality and family relationships.
10. Discuss the relationship between culture and attitudes towards alcohol intake and
alcoholism.
ASSIGNMENTS:
Smeltzer, S.C, Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams
& Wilkins, 1116-1194.
Diagnostic Tests and Medication worksheets
Articles:
McKinley, M.G. (2009). Recognizing and responding to acute liver failure. Nursing2009,
39(3), 38-43.
9.0
ADN12B Spring 2012
ADN 12B - Health Deviations 3
DIAGNOSTIC TESTS USED IN LIVER DISEASE
CHEMISTRIES
CLINICAL SIGNIFICANCE AND NURSING
IMPLICATIONS
Albumin, (serum) below
normal levels
Bilirubin, above normal
levels in serum and urine
Serum Aspartate
Aminotransferase, (AST,
old name was SGOT) above
normal levels
Serum Alanine
Aminotransferase, (ALT,
old name was SGPT) above
normal levels
Lactic Dehydrogenase,
(LDH), above normal levels
in serum
Serum Ammonia (above
normal levels)
Prothrombin Time (PT) or
International Normalized
Ratio (INR) prolonged
9.1
ADN12B Spring 2012
DIAGNOSTIC STUDIES
PROCEDURE AND
PURPOSE
Non-invasive imaging
studies: plain x-ray of
abdomen; ultrasound of
liver and spleen; CT scan of
abdomen; MRI of abdomen;
Doppler flow studies of
abdominal vessels.
Invasive vascular studies:
Hepatic vein wedge
pressure; abdominal
arteriogram
Endoscopies:
Esophogogastroscopy,
endoscopic sclerotherapy,
endoscopic “banding” of
varices
Abdominal Paracentesis
Liver biopsy: needle biopsy
9.2
ADN12B Spring 2012
NURSING
RESPONSIBILITIES
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B – Health Deviations 3
MEDICATION
ACTION IN LIVER DISEASE
Lactulose
(Cephulac, etc.)
30 to 45 ml po
tid-qid
Neomycin
1 g po q6h
Spironolactone
(Aldactone)
50 to 100 mg po bid
Vitamin K
(menadiol or
phytonadione)
oral or IM
Octreotide
Propranolol
9.3
ADN12B Spring 2012
NURSING
RESPONSIBILITIES
THEORY: DIABETES MELLITUS
BEHAVIORAL OBJECTIVES:
1. Review diabetes mellitus material from science prerequisite courses regarding normal
blood sugar levels, and factors that affect the homeostasis of blood sugar.
2. Review current screening recommendations made by the American Diabetes
Association for subgroups at highest risk.
3. Review Type 1 and Type 2 diabetes in terms of pathophysiology, presenting symptoms,
and therapeutic management.
4. Review the five major components of diabetes management:
a. Dietary recommendations. Include exchange lists, carbohydrate counting, and
glycemic index.
b. Exercise guidelines
c. Monitoring. Include blood sugar, urine sugar, urine acetone, glycosylated
hemoglobin (Hgb A1c), and microalbuminuria.
d. Educational needs
1. Medication guidelines:
a. Differences between Type 1 and Type 2
b. Considerations for periods of physiologic or psychological stress
c. Prevention of renal failure
5. Discuss the clinical use of insulin, identifying the onset, peak action, duration, and
nursing responsibilities of insulin given by subcutaneous injection:
Rapid Acting Insulin
Intermediate acting insulin
Insulin Lispro
NPH
(Humalog)
Lente Insulin
Insulin Aspart
Human insulin modified for
(Novolog)
long action
Fast Acting Insulin
Insulin glargine (Lantus)
Regular Insulin
Ultralente
6. Briefly discuss nursing responsibilities and methods of insulin delivery by IV push and
IV drip.
7. Discuss onset, peak action, duration, and nursing responsibilities of the oral diabetic
drugs:
Sulfonylureas
Alpha-glucosidase inhibitors
glipizide (Glucotrol)
Acarbose (Precose)
glyburide (DiaBeta,
Miglitol (Glyset)
Micronase)
Biguanides
glimepiride (Amaryl)
metformin (Glucophage)
Meglitinides
Thiazolidinediones
repaglinide (Prandin)
Pioglitazone (Actos)
nateglinide (Starlix)
Rosiglitazone (Avandia)
10.0
ADN12B Spring 2012
8. Using the worksheet in the course study guide, discuss the clinical manifestations,
medical management, and nursing process for short term complications of Diabetes
Mellitus:
Hypoglycemia
Hyperglycemia with Diabetic Ketoacidosis in persons with Type 1 Diabetes
Hyperglycemia with Hyperosmolar Nonketotic Syndrome in persons with Type 2
Diabetes
9. Discuss the health deviations of the late complications of Diabetes Mellitus and show
how these affect the self-care needs of persons with diabetes:
Macrovascular diseases
Coronary Artery Disease
Cerebral Vascular Disease
Peripheral Vascular Disease
Microvascular diseases
Diabetic Retinopathy
Nephropathy
Neuropathy
10. Describe the nursing standards of care for patients with diabetes. Include foot care.
11. Briefly discuss problems with sexuality that commonly occur in persons with diabetes.
12. Be prepared to discuss in class the following nursing diagnosis that often apply to
patients with diabetes mellitus (see nursing diagnosis book).
a. High Risk for Injury related to decreased tactile sensation in lower extremities
b. High Risk for Injury related to diminished visual acuity
c. Altered Comfort: burning pain related to diabetic peripheral neuropathy
d. Individual Fear related to insulin injections
e. Potential ineffective therapeutic management related to complex self-care
regimen and inadequate knowledge
f. Collaborative Problem: Potential for hypo/hyperglycemia
10.1
ADN12B Spring 2012
ASSIGNMENTS:
Dudek S.G. (2010). Nutrition essentials for nursing practice (6th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins, 451-484.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook of
medical-surgical nursing (12th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins, 1196-1243.
Drug Handbook and Internet if needed for newer drugs: www.fadavis.com
Complete DM Worksheets prior to class
Articles:
American Diabetes Association. Nutrition recommendations and interventions for diabetes:
A position statement of the American Diabetes Association (2007). Diabetes Care (30)1,
S48-S65.
Kumar, C. P. (2007) Application of Orem’s self-care deficit theory and standardized nursing
languages in a case study of a woman with diabetes. International Journal of Nursing
Terminologies and Classifications, 18(3), 103-110.
RECOMMENDED:
www.diabetes.org
10.2
ADN12B Spring 2012
WORKSHEET: Laboratory Tests in Diabetes
Diagnostic Test
Rationale for Use of Test
Nursing Responsibilities
Fasting Blood Sugar
Glycosylated Hemoglobin (Hemoglobin
A1C)
AC and HS glucose monitoring
Urine test for acetone/ketones
Urinalysis for microalbuminuria
10.3
ADN12B Spring 2012
MEDICATIONS TO TREAT DIABETES MELLITUS
Insulins
Onset
Peak Effect
Duration
Very Rapid
Action
Lispro
Humalog
Rapid Action
Regular Insulin
Intermediate
Action
NPH
Lente
Long Acting
Lantus
Ultralente
Combination
70/30 Insulin
10.4
ADN12B Spring 2012
Nursing Responsibilities
Oral Drugs
Action
Onset
Peak Effect
Sulfonylurias
Glipizide
Glucotrol
Glyburide
Diabeta
Micronase
Glimepiride
Amaryl
Meglitinides
Repaglinide
Prandin
Nateglinide
Starlix
Alphaglucosidase
inhibitors
Acarbose
Precose
Miglitol
Glyset
Biguanide
Metformin
Glucophage
Glitazones
Pioglitazone
Actos
Rosiglitazone
Avandia
10.5
ADN12B Spring 2012
Duration
Nursing
Responsibilities
DIABETES MELLITUS: SHORT TERM COMPLICATIONS
HYPOGLYCEMIA
DIABETIC
KETOACIDOSIS
Effects of:
Food Intake
Insulin or Oral
Drugs
Stress/ Illness
Clinical
Manifestations:
Blood Sugar
Ketones in blood
and urine
Acid/ Base effects
Electrolyte effects
Signs and
Symptoms
Treatment:
Give glucose/ food
Glucagon
Insulin
Fluids
Electrolytes
10.6
ADN12B Spring 2012
HYPEROSMOLAR
NONKETOTIC
SYNDROME
LATE COMPLICATIONS OF DIABETES MELLITUS
Large Vessel Disease
Cause
Clinical
Manifestations
Screening and Management
Coronary
Artery Disease
Cerebral
Vascular
Disease
Peripheral
Vascular
Disease
Small Vessel Disease
Cause
Clinical
Manifestations
Retinopathy
Nephropathy
Peripheral
Neuropathies
Autonomic
Neuropathies
10.7
ADN12B Spring 2012
Screening and Management
THEORY: IMMUNOLOGICAL DISORDERS, CONNECTIVE TISSUE HEALTH
DEVIATIONS
BEHAVIORAL OBJECTIVES:
1. Review and be prepared to discuss the organs, cells, and immunoglobulins of the
normal immune system.
2. Describe the phases of the normal immune response.
3. Describe the four types of hypersensitivity reactions. Discuss anaphylaxis including
clinical manifestations, stages, potential complications, and appropriate interventions
for each stage.
4. Discuss Systemic Lupus Erythematosus (SLE) health deviation in regard to:
Pathophysiology
Diagnostic Evaluation
Clinical Manifestations
Clinical Management
Nursing assessing, diagnosing, planning, implementing and evaluation
Promotion of normalcy and prevention of hazards
5. Discuss Rheumatoid Arthritis health deviation in regard to:
Pathophysiology
Diagnostic Evaluation
Clinical Manifestations
Clinical Management
Nursing assessing, diagnosing, planning, implementing and evaluation
Promotion of normalcy and prevention of hazards
6. Discuss Scleroderma health deviation in regard to:
Pathophysiology
Diagnostic Evaluation
Clinical Manifestations
Clinical Management
Nursing Process
Promotion of normalcy and prevention of hazards
7. Independently complete the worksheet “Immune Modulating Drugs” and be prepared to
discuss their clinical use in various types of immune disorders.
ASSIGNMENTS:
Deglan, J.H., & Vallerand, A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia,
PA: F.A. Davis Company. As needed.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing (12th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins,
Chapter 50 & 54.
ARTICLES:
Babin, L.A. (2007). Connective tissue disorders. Dermatology Nursing, 19(3), 200, 207.
Pullen, R.L., Brewer, S., & Ballard, A. (2009). Putting a face on systemic lupus erythematosus.
Nursing2009, 22-28.
11.0
ADN12B Spring 2012
WORKSHEET: IMMUNE MODULATING DRUGS
Drug/Action
SYMPTOM
CONTROL
NSAIDs (COX-1)
Salicylates: Aspirin
DISEASE
MODIFYING
Antirheumatic
drugs (DMARDS)
hydroxychloroquine
(Plaquenil)
chloroquine (Aralen)
Gold-containing
compounds
sulfasalazine
(Azulfidine)
penicillamine
(Cuprimine, Depen)
Methotrexate
azothioprine
(Imuran)
cyclophosphamide
(Cytoxan)
Cyclosporine
(Neoral)
ADN12B Spring 2012
Route/Lab
Monitoring
Side
Effects
Nursing
Management
Immunomodulators
Rituximab
(Rituxan)
Epratuzumab
(humanized anitCD22 Antibody
Antimalarial
Medications
TNF Blocking
Agents
Akalimumab
(Humira)
inflixamab
(Remicade)
etanercept
(Enbrel)
golimumab
(Simponi)
Interleukin-1
receptor antagonist
Anakinra (Kineret)
Corticosteroids
Prednisone
11.2
ADN12B Spring 2012
THEORY: IMMUNOLOGICAL HEALTH DEVIATIONS -AIDS
BEHAVIORAL OBJECTIVES:
1. Discuss the current epidemiology of the health deviation HIV including populations
affected and routes of transmission.
2. Discuss the spectrum of HIV-1 infection from the primary infection through the late
stages of Acquired Immunodeficiency Syndrome (AIDS) with regard to the following:
a.
b.
c.
d.
e.
f.
Pathophysiology
Diagnostic evaluation
Clinical manifestations
Clinical management
Nursing assessment, diagnosis, planning, intervention, evaluation
Promotion of normalcy and prevention of hazards
3. Discuss opportunistic infections, cancers, and syndromes associated with HIV health
deviation including clinical manifestations, diagnostic tests, prophylaxis, medical
therapies, and symptom management.
a. Pneumocystis pneumonia (PCP)
b. Mycobacterium avium complex, (MAC)
c. Cryptococcal meningitis
d. Cytomegalomegalo (CMV) retinitis
e. Kaposi’s sarcoma
f. B-cell lymphoma
g. Tuberculosis
h. Oral Candidiasis
i. Wasting syndrome
j. Progressive multifocal leukoencephalopathy (PML)
k. Toxoplasma gondii encephalitis
l. Herpes simplex
m. Human papilloma virus (HPV)
4. Independently complete the worksheet: “Drugs used in the Treatment of AIDS” and be
prepared to discuss the current clinical use of these drugs to treat HIV infections and to
prevent post-exposure infection.
5. Identify how cultural differences could influence the patient and care-giver’s response to
patients with AIDS health deviation.
6. Identify the changes in sexual behavior that need to occur in persons with AIDS health
deviation.
7. Identify and discuss ethical issues that sometimes arise in relation to HIV infections and
the treatment of AIDS health deviation in the United States and worldwide.
8. Discuss issues related to self-care demands and requisites of the patient dying of AIDS.
12.0
ADN12B Spring 2012
ASSIGNMENT:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing. (12th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins,
Chapter 52.
Dudek S.G. (2010). Nutrition essentials for nursing practice (6th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins, 536-561.
Recommended for updates on the Internet: http://hivinsite.ucsf.edu – Information data base
managed by UCSF AIDS Program at San Francisco General Hospital and the UCSF Center
for AIDS Prevention Studies.
www.cdc.gov/mmwr – Center for Disease Control Morbidity & Mortality Weekly Report
www.aegis.com – AIDS Education Global Information System
Article:
Palmer, R. (2008). Use of complementary therapies to treat patients with HIV/AIDS. Nursing
Standard, 22(50), 35-41.
12.1
ADN12B Spring 2012
WORKSHEET: DRUGS USED IN TREATMENT OF AIDS
Drug and
Action
Food
Interactions
Side
Effects
Reverse
Transcriptase
Inhibitors
Abacavir (ABC,
Ziagen)
Didanosine (ddl,
Videx)
Lamivudine
(3TC, Epivir)
Stavudine (d4T,
Zerit)
Zalcitabine
(ddc,Hivid)
Zidovudine
(ZDVor AZT or
Retrovir)
Zidovudine +
Lamivudine
(Combivir)
Non-Nucleoside
Reverse
Transcriptase
Inhibitors
(NNRTIs)
Delavirdine
DLV
(Rescriptor)
Efavirenz (EFV,
Sustiva)
Neviparine
(NVO,
Viramune)
Etravirine
(TMC125,
Intelence)
12.2
ADN12B Spring 2012
Nursing
Management
Drug and
Action
Protease
Inhibitors
Route
Lab Monitoring
Side
Effects
Indinavir
(IDV, Crixivan)
Nelfinavir
(NFV, Viracept)
Ritonavir
(RTV, Norvir)
Saquinavir
(SQV, Invirase)
Fusion
Inhibitors
Enfuvirtide (T20, Fuzeon)
Maraviroc
(Selzentry)
Integrase
Strand
Transfer
Inhibitor
Raltegravir
(Isentress)
12.3
ADN12B Spring 2012
Nursing
Management
DRUGS USED TO TREAT OPPORTUNISTIC INFECTIONS
Drug and
Action
Isoniazid
INH
Infection
Treated or
Prevented
Tuberculosis
Rifabutin
Mycobacteriu
m avium
Complex
MAC
Azithromycin
Clarithromycin
Mycobacteriu
m avium
Complex
MAC
Amphotericin B
Cryptococcal
Meningitis
Foscarnet
(Foscavir
CMV
Retinitis
Fluconazole
(Diflucan)
Cryptoccal
Meningitis
Side
Effects
12.4
ADN12B Spring 2012
Nursing
Management
THEORY: ENDOCRINE HEALTH DEVIATIONS
BEHAVIORAL OBJECTIVES:
1. Independently review the anatomy and physiology of the endocrine system from science
courses and the medical surgical nursing textbooks.
2. Define and give examples of negative and positive feedback control mechanisms and
target tissues of the endocrine system.
3. Complete the endocrine disorders worksheet and be prepared to discuss the clinical
manifestations, medical management, and nursing process for hypo and hyperactivity of
the thyroid, parathyroid, and adrenal, and pituitary glands.
4. Identify typical abnormal laboratory values associated with each endocrine condition.
Discuss nursing responsibilities and precautions associated with these laboratory values.
5. Discuss the pre and post-op nursing management of the patient following neck surgery
including thyroidectomy and parathyroidectomy.
6. Discuss the problems of sexuality related to endocrine dysfunction.
7. Complete the endocrine drug worksheet and be prepared to discuss endocrine drugs listed
on the worksheet.
REQUIRED ASSIGNMENTS:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing (12th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins,
Chapter 42.
Deglan, J.H., & Vallerand, A.H. (2007). Davis’s drug guide for nurses (10th ed.). Philadelphia,
PA: F.A. Davis Company. As needed.
Articles:
Carson, M. (2009). Assessment and management of patients with hypothyroidism. Nursing
Standard (23(18) 48-56. doi:219883523.
Rosner, M. (2011). Hyponatremia: An Update on the management of SIADH. Renal & Urology
News 10(10), 26-29. doi:900102090
13.0
ADN12B Spring 2012
WORKSHEET: ENDOCRINE DISORDERS
Condition and Etiology
Pituitary
Posterior Lobe
ADH (Anti Diuretic
Hormone)
Hypoactivity
Clinical Manifestations
Diagnostic Tests
Diabetes Insipidus
Pituitary
Posterior Lobe
ADH (Anti Diuretic
Hormone)
Hyperactivity
SIADH
(Inappropriate Secretion
of ADH)
13.1
ADN12B Spring 2012
Medical Management
Nursing Process
Worksheet: Endocrine Disorders
Condition and Etiology
Clinical Manifestation
Diagnostic Tests
Pituitary
Anterior Lobe
Growth Hormone (GH)
Hypoactivity
Childhood onset:
Pituitary Dwarfism
Pituitary
Anterior Lobe
Growth Hormone
Hyperactivity
Childhood Onset:
Gigantism
Adult Onset:
Acromegaly
13.2
ADN12B Spring 2012
Medical Management
Nursing Process
Condition and Etiology
WORKSHEET: ENDOCRINE DISORDERS
Clinical Manifestations
Diagnostic Tests
Medical Management
Hypothyroidism
(Thyroid Hypoactivity)
Childhood Onset:
Cretinism
Adult Onset:
Hashimoto’s Thyroiditis
Myxedema
Hyperthyroidism
(Thyroid Hyperactivity)
Graves Disease
Thyrotoxicosis
13.3
ADN12B Spring 2012
Nursing Process
Condition and Etiology
WORKSHEET: ENDOCRINE DISORDERS
Clinical Manifestations
Diagnostic Tests
Medical Management
Hypoparathyroidism
Hypocalcemia
Hyperparathyroidism
Hypercalcemia
13.4
ADN12B Spring 2012
Nursing Process
WORKSHEET: ENDOCRINE DISORDERS
Condition and Etiology Clinical Manifestations
Diagnostic Tests
Adrenal Medulla
Hyperactivity
Pheochromocytoma
Adrenal Cortical
Insufficiency
Addison’s Disease
Excessive adrenocortical
activity:
Cushing’s Disease
Excessive exogenous
cortisone:
Cushing’s syndrome
13.5
ADN12B Spring 2012
Medical Management
Nursing Process
WORKSHEET: ENDOCRINE DRUGS
Drug and Action
Condition Used
For
Pituitary, Posterior Lobe
DDAVP
(Desmopressin)
Side/ Toxic Effects
aqueous vasopressin
(Pitressin)
chlorpropamide
(Diabenese)
Lasix (furosemide)
Declomycin
(demeclocycline)
Pituitary, Anterior Lobe
Human Growth
Hormone
Bromocriptine
Thyroid
levothyroxine
(Synthroid)
propranolol
(Inderal)
propylthiouracil
(PTU)
methimazole
(Tapazole)
Radioactive Iodine
Therapy
13.6
ADN12B Spring 2012
Nursing Process
Parathyroid
Calcium Gluconate
oral Calcium
Vitamin D
Calcitriol
Normal Saline and
IV Lasix
Pamidronate
disodium
Estrogen therapy
Calcitonin
Mithramycin
(plicamycin)
Adrenocorticosteroids
Glucocorticoids:
hydrocortisone
(Solu-Cortef)
dexamethasone
(Decadron)
Prednisone
Mineralocorticoids:
fludrocortisone
(Florinef)
13.7
ADN12B Spring 2012
THEORY: HEALTH DEVIATIONS OF THE CARDIOVASCULAR SYSTEM - HEART
FAILURE
LEARNING OBJECTIVES
1. Trace the circulation of the blood through the pulmonary circulation (right side of the
heart) and the systemic circulation (left side of the heart).
2. Define the health deviation congestive heart failure; right-sided failure; left-sided failure.
3. List the common predisposing causes of CHF.
4. Discuss clinical manifestations, diagnostic evaluation and medical management of CHF,
including dietary restrictions.
5. Discuss the nursing assessment, diagnosis, planning, implementations and evaluation
related to cardiac failure.
6. Discuss the use of core measures for CHF.
7. Discuss the drug therapy of CHF. For each medication identify the mode of action, oral
dosage range, common side effects, and nursing responsibilities:
Loop diuretics:
Furosemide (Lasix)
Digoxin: loading dose and maintenance dose
Angiotensin Converting Enzyme (ACE) inhibitors
Enalapril
8. Discuss the clinical use of the following nursing diagnoses and collaborative problems in
a patient with CHF:
Collaborative Problem:
Potential pulmonary edema
Potential cardiogenic shock
Nursing Diagnosis:
Activity Intolerance R/T fatigue and dyspnea secondary to decreased cardiac
output
Knowledge Deficit regarding low salt diet
Anxiety R/T breathlessness and restlessness secondary to inadequate oxygenation
ASSIGNMENTS:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.).Philadelphia, PA: Lippincott, Williams &
Wilkins, 684-714; 825-843.
Dudek S.G. (2010). Nutrition essentials for nursing practice (6th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins, 485-513.
Drug Guide as needed
14.0
ADN12B Spring 2012
Articles:
Luckson, J. (2009). Managing chronic heart failure. Practice Nurse, 37(4), 39-44.
Washburn, S.C., Hornberger, C.A. (2008). Nurse educator guidelines for the management of
heart failure. The Journal of Continuing Education in Nursing, (39)6, 236-267.
14.1
ADN12B Spring 2012
THEORY: HEALTH DEVIATIONS OF THE CARDIOVASCULAR SYSTEMMYOCARDIAL INFARCTION
LEARNING OBJECTIVES:
1. Define the health deviation myocardial infarction.
2. Describe various tests used to diagnose acute MI (include ECG changes, CK-MB, Myoglobin, and
Troponin). Relate the abnormal results to the progression of the occlusion, necrosis, and healing
process.
3. Describe the pathophysiology, clinical manifestations, medical management and nursing
assessment, diagnosis, planning, and implementation for an acute MI patient.
4. For each medication identify the mode of action, side effects and nursing responsibilities.
Oral antiarrhythmics: beta blockers, calcium channel blockers, nitrates, and antiplatelets
Thrombolytic agents: streptokinase, tissue plasminogen activator (t-PA)
5. Discuss the following nursing diagnoses and collaborative problems for patients with the health
deviation acute MI to determine if self-care requisites are being met:
Collaborative Problems/Potential Complications:
Potential recurrent myocardial infarction
Potential cardiac dysrhythmia
Potential cardiogenic shock
Potential for bleeding secondary to thrombolytic agents
Nursing Diagnoses:
Alteration in comfort: chest pain R/T occlusion or narrowing of coronary artery
Activity intolerance R/T insufficient oxygenation for ADLs
Knowledge deficit regarding medications, diet, or risk factors R/T
Anxiety/Fear R/T outcome of acute MI
6. Discuss the educative supportive nurse’s role with sexuality problems that may occur in patients
with cardiovascular disease.
7. Discuss the health deviation core measure for patients with myocardial Infarction.
Critical Thinking Exercise:
Using the critical pathway in Smeltzer and Bare as a guide, explain the provision of care needed
during the typical hospital course and home recovery of a 55 year old man who has suffered an
acute, uncomplicated MI. He received a thrombolytic agent (tissue plasminogen activator,
streptokinase or urokinase) in the emergency room that partially relieved the vessel obstruction.
He had an uneventful course in the hospital
ASSIGNMENT:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook of
medical-surgical nursing (12th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins, 728, 755795.
Dudek S.G. (2010). Nutrition essentials for nursing practice. (6th ed.). Philadelphia, PA: Lippincott
Williams & Wilkins, 485-513.
Drug Guide as needed
15.0
ADN12B Spring 2012
Submodule
16.0
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B - Health Deviations 3
VISION AND HEARING
SUBMODULE
I. Introduction
A. Purpose: This submodule is designed to encourage the second semester nursing
student to improve skills in self-directed learning.
B. Method: This submodule is designed as a self-instructional unit. The learning
objectives can be accomplished with the Potter and Perry, (newest edition) and
Smeltzer, et al., (newest edition).
II. Submodule Content
A. Theoretical considerations important in vision and hearing in the middle age
population.
B. Use of the nursing process in the acute care of patients with vision and hearing
disorders, both as first aid procedures (any setting) or MD ordered interventions in
a health care facility.
1. Assessments relevant to vision and hearing.
2. Clinical decisions
3. Planning and goal setting
4. Implementation - methods/procedures regarding vision and hearing.
5. Evaluation of effectiveness
C. Modification of hospital procedures to the home and/or ambulatory setting.
III.
Learning Objectives
A. Vision objectives related to Middle Age Adult.
1. Review and describe the anatomy and physiology of the eye
2. Describe the procedure for safe emergency removal of contact lenses.
3. Discuss the emergency management for the following eye problems:
corneal abrasions, foreign body on surface, penetrating injuries, chemical
burns and contusions.
4. Describe the pathophysiology, clinical manifestations, diagnostic tests,
medical management, self-care requisites, nursing diagnosis, and nursing
management on the following listed eye conditions.
a. Detached retina
b. Conjunctivitis, bacterial and viral
c. Uveitis
d. Orbital cellulites
e. Orbital and ocular tumors
5. Identify benefits and potential complications of LASIK (Laser-assisted in
situ Keratomileusis)
16.1
ADN12B Spring 2012
6. Describe the actions, side effects and nursing interventions for the
following ophthalmic drugs used to treat the eyes locally (eye drops,
ointments, pledgets)
a. Anti-infectives: ciprofloxacin, gentamycin, sulfacetamide
b. Corticosteroids and Nonsteroidal Anti-inflammatory drugs:
dexamethasone, prednisolone
c. Ocular irrigants and Lubricants: Dacriose, Methyl or Hydroxypropyl
cellulose (artifical tears)
B. Hearing objectives related to Middle Age Adult
1. Review and describe the anatomy and physiology of the ear.
2. Identify common ear infections and their treatments.
3. Discuss the following drugs that cause an ototoxic effect and the nursing
responsibilities for them: antibiotics and loop diuretics.
a. Anti-inflammatory agents: salicylates (aspirin), indomethacin
b. Anti-infectives: Aminoglycosides such as toabramycin, gentamycin,
neomycin, streptomycin. Other antibiotics: erythromycin,
polymyxin
c. Diuretics: furosemide (Lasix), acetazolamide
d. Antimalarial agents: quinine, chloroquine
e. Cheomotherapeutic agents: cisplatin
4. Review the procedure for administering eardrops and for irrigating the
external auditory canal to remove cerumen.
5. Describe the clinical manifestations, diagnostic evaluation, medical/surgical
care, and nursing management of Meniere’s disease, labyrinthitis, acoustic
neuroma, and perforated tympanic membrane.
16.2
ADN12B Spring 2012
IV. Assignments
A. Smeltzer et al. (newest edition) as needed.
B. Potter and Perry: (newest edition) as needed.
C. Davis’s Drug Guide: (newest edition) as needed.
V. Evaluation of Learning Objectives
The criteria for successful completion of this submodule is passing the multiple-choice
test "Vision and Hearing" with 85% accuracy on the first testing. The test is to be
scheduled at the student's convenience in the Learning Center.
If the student does not achieve an 85% or better score the first time, the test can be
retaken. A score of 88% must be achieved on the second attempt.
If the student does not achieve an 88% or better score the second time, the test can be
retaken after student has met with the instructor. A progress note will be written and
placed in the student's cumulative file. The learning objectives must be written out and
given to the responsible instructor. A score of 90% must be achieved on the third
attempt.
If the student does not achieve a 90% or better score on the third time, the student must meet
with the teaching team instructor who is responsible for the vision and hearing submodule.
Any other remediation is at the discretion of the teaching team. The student is to retake the test
until passed. If the submodule is not completed and the test passed, a course grade of
“incomplete” will be given. Please review submodule policy in the ADN Student's Handbook
for further details.
16.3
ADN12B Spring 2012
COURSE
EVALUATION
17.0
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B - Health Deviations 3
ADN12B COURSE EVALUATION INFORMATION
The course evaluation will be done via an on-line survey. The survey will be done in the
computer lab located in the LAC library on the day ATI testing is scheduled. Access to the
survey will be provided at that time and done just before ATI testing. The survey should take
10-15 to complete and your comments, feedback and input are welcomed, and appreciated.
17.1
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12B Health Deviations 3
Course Syllabus
For
Campus Laboratory
and
Clinical
SPRING 2012
Edited by:
Maricela Arnaud, RN, MSN, FNP
Julie Bean, RN, MSN, ED
© Long Beach City College Associate Degree Nursing Program, Long Beach, CA 90808
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL - Health Deviations 3 Laboratory
TABLE OF CONTENTS
General Information
Course Information………………………………………………………………………..1.0
Course Outline………………………………………………………………………….…1.2
Theoretical Framework……………………………………………………………………1.3
Course Requirements…………………………………………………..……………….…1.4
Entry and Exit Skills………………………………………………………………………1.5
Learning Outcomes for Laboratory & Clinical………………………………….……...…1.6
Challenge Policy…………………………………………………………………………..1.7
Application for Challenge by Exam 12BL………………………………………………..1.8
Skills Assessment Expectations…………………………………………………….…….1.9
Attendance Policy and Make-up Assignment……………………………………...…..…1.10
Campus Laboratory Content
Skill Lab: Neurological Assessment ........................................................................................... 16.0
Study Guide: Levels of Consciousness ................................................................................ 16.2
Worksheet: Neurological Assessment ................................................................................. 16.5
Skill Assessment: Neurological Assessment........................................................................ 16.7
Skill Lab: Intradermal Skin Testing............................................................................................ 17.0
Skill Assessment: Intradermal Injections ............................................................................. 17.2
Skill Lab: Care of the Patient with a Tracheostomy ................................................................... 18.0
Skill Lab: Suctioning Nasally, Orally, or by Tracheostomy....................................................... 18.1
Skill Lab: Tracheostomy Care .................................................................................................... 18.2
Skill Assessment: Suctioning the Patient with a Tracheostomy Tube ................................. 18.4
Skill Assessment: Tracheostomy Care ................................................................................. 18.5
Intravenous Therapy........................................................................................................19.0
Skill Lab: Advanced Management of IV Fluid Replacement .............................................. 19.0
Worksheet for Intravenous Therapy, Part I ................................................................... 19.1
Skill Lab: IV Drip Calculations ........................................................................................... 19.4
IV Drip Calculation Worksheet ........................................................................................... 19.5
Physical Assessment ................................................................................................................... 20.0
Skill Assessment: Physical Assessment of the Dependent Patient ...................................... 20.2
Nursing Care Worksheet for Physical Assessment .............................................................. 20.3
i
ADN12B Spring 2012
Case Study
Guidelines, including format ................................................................................................ 21.0
Information on APA Style ............................................................................................. 21.3
Grading Criteria for Case Study ................................................................. …..……….21.4
General Information for Clinical
Clinical Practice Experiences in ADN 12BL ....................................................................... 22.0
Clinical Orientation Day ...................................................................................................... 23.0
Self-Orientation to a Nursing Unit………………………………………......……….23.1-23.5
Guidelines for Selection of Patient Assignment .................................................................. 24.0
Student Assignments Form .................................................................................................. 25.0
Behavioral Objectives for Group Leader ..................................................................... 26.0-26.3
Patient Information Worksheet for Group Leader ....................................................... 26.4-26.5
Medication Worksheet for Group Leader .................................................................... 26.6-26.7
Peer Evaluation Sheet .......................................................................................................... 26.8
Sample Daily Schedule for Team Member……………………………………………...…27.0
Nursing Care Plan Assessment Guidelines .......................................................................... 28.0
Medical/ Surgical Nursing Care Plan with drug therapy worksheet ............................ 29.0-29.2
Ambulatory Care Experience ............................................................................................... 30.0
Student Clinical Evaluation
Evaluation tool……………………………………………………………………..31.0
ii
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL - Health Deviations 3 Laboratory
Course Information
Course Description
On-campus lab practice and application of course content utilizing Orem's Self-Care Theory
and the nursing process in the live nursing situation. Skill activities include intravenous
therapy, physical assessment, and medical and surgical aseptic practice with related skills.
Students assume the professional role of the registered nurse while collaborating and
managing the safe care of a multiple patient assignment in the medical areas of the acute care
facilities. Communication, teaching and learning, and critical thinking skills are emphasized.
Time allotment, sequencing and enrollment
1.5 college semester units, 9 week course
Clinical/campus labs: 9 hours per week, 2 hours campus lab; 7 hours clinical;
Total 81 hours. This course is offered in the second semester during the second half of
each 18 week semester with enrollment as space and resources allow. Concurrent
enrollment with ADN 12B required.
Required Texts
1. All texts required for ADN 12B Health Deviations 3
Recommended Texts
1. All texts recommended for ADN 12B Health Deviations 3
2. Supplementary readings: Nursing journal articles to be found in the Learning Center
and Library.
Teaching Methods
Campus lab discussions
Reading assignments
Case studies
Skills demonstration and skills testing
Clinical written work/Nursing care plans
Laboratory assignments
Media programs: AV, CD, DVD
Student compliance with clinical agency requirements
All students must comply with clinical agency requirements for documentation of health
status and training. The student is to keep original documents. Copies of the following
documents must be maintained in the student’s file in the program director’s office:

Hepatitis B vaccine (completed series unless previously positive)

Annual TB screening

Proof of varicella, measles, mumps, and rubella immunity (titer)

Current professional malpractice insurance and CRP for health care providers.

Annual influenza immunization

Tdap (Tetanus, diphtheria, Pertussis [whooping cough]) immunization
1.0
ADN12B Spring 2012
Student clinical evaluations
See Student Clinical Evaluation forms and Clinical Behavioral Objectives in syllabus.
Student Course grade
The theory and lab portion of this course must be taken concurrently and both theory and
lab must be passed in order for the student to proceed in the program. The student will
receive the same letter grade for theory and for lab unless he/she is less than satisfactory
clinically in which case the policy in the Student Handbook for marginal or unsatisfactory
clinical ratings will be followed. A minimum theory grade of 75% (C) is required to
satisfactorily complete the course.
Course Instructors
Name & Credentials
Office
Telephone
e-mail
Maricela Arnaud, RN, MSN, FNP, Lead
G
office (562) 938-4170
cell (714) 457-0330
[email protected]
Julie Bean, RN, MSN- ED
R
office (562) 938-4178
cell
(562) 569-8620
[email protected]
Full-time teachers' office hours are posted on their office doors. Other hours may be arranged.
Part time teachers may be reached by special arrangement with the individual teacher.
1.1
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
Course Outline
Course Outline
1. Neurological Assessment
A. Components of neurological examination
B. Neurological assessment
C. Neurological abbreviated exam
D. Pupillary assessment
E. Assessment of corneal, gag, and Babinski reflexes
F. Neurological assessment of the comatose patient
G. Neurological assessment of the alert patient
F. Use of the Glasgow Coma Scale
2. Intradermal Skin Testing
A. Common diagnostic tests
B. Standard technique for intradermal placement
C. Patient instructions
D. CDC method of reading TB skin tests
3. Naso/Oral Pharyngeal and Tracheostomy Suctioning and Tracheostomy Care
A. Suctioning and care of tracheostomy equipment
B. Procedure for naso pharyngeal suctioning
C. Hazards of suctioning
D. Rationale for tracheostomy care
E. Procedure for tracheostomy care
4. Advanced Management of Intravenous Fluid Therapy
A. Fluid replacement
B. Drip calculations
5. Physical Assessment
A. Synthesize all of the previously learned components of physical assessment
B. Perform a head-to-toe assessment
C. Document assessment findings
6. Case Study Presentations
7. Performance of basic nursing skills in the assigned clinical facility.
1.2
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3 Lab
Orem’s Self Care Model
Conceptual Framework Curriculum Implementation
SELF CARE MODEL
THEORY
CLINICAL
IMPLEMENTATION
IMPLEMENTATION
Health Deviation Self Care The concept of Health
Students provide care for
Requisites are needs
Deviation Self Care
two to three acutely ill
generated by illness and the Requisites is discussed
patients in the hospital
medical diagnostic
with emphasis placed on
medical settings. Whenever
procedures and treatments
the medical patient.
possible, patients are
associated with disease.
selected to correspond with
The basic principles of
classroom theory.
intravenous therapy and
administration of
Students apply the entire
intravenous medications
nursing process of
are utilized as commonly
assessing, diagnosing,
used medical treatments
planning, implementing,
associated with health
and evaluating.
deviations.
The nursing process
The following health
considers the Universal
problems are studied in
Self Care Requisites,
depth:
Developmental Self Care
Requisites, as well as the
 Diabetes mellitus
 Endocrine disorders Health Deviation Self Care
Requisites of patients with
 Neurological
the studied problems.
disorders
 Blood and blood
products
 Acid/Base disorders
 Hematology.
 Cardiovascular
deviations
 MI
 Heart failure
Developmental Self Care
The Self Care Requisites
Requisites are needs
generated by these health
associated with
problems and problems
development throughout
with associated diagnostic
the life cycle.
and treatment modalities
are studied.
Developmental Self Care
Requisites are applied to
the middle aged adult.
1.3
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3
COURSE REQUIREMENTS
During this course each student will:
1.
Independently review any material from previous required courses as needed.
2. Arrive to campus lab and clinical well-prepared and on time.
3. Prepare prior to class for discussion of each assigned behavioral objective.
4. Complete all required reading, audio-visual, and written work prior to class and/or
conference.
5. Turn in assigned written work on time, using correct format as described in ADN
Student Handbook or course syllabus.
6. Initial the attendance roster to demonstrate attendance at campus lab.
7. Actively participate in lab and conference discussions.
8. Assume responsibility for meeting behavioral objectives when absent from campus lab
and completing a make up assignment if absent from clinical.
9. Achieve a minimum of 75% overall on all scored materials at the completion of the
course.
10. Comply with the standards of the College and Student Handbook Policies on
Academic Honesty as published in the Student Handbook and in the college catalog.
1.4
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
AND 12BL- Health Deviations 3
ENTRY AND EXIT SKILLS
Entrance Skills
Upon entrance to ADN 12BL, the student will demonstrate the following skills, concepts
and/or information:
1. Continuing mastery of all procedural skills taught in previous courses in the ADN program.
2. Application of nursing theory taught in all previous courses in the ADN program.
3. Demonstrate readiness to participate in skills taught in this course.
Exit Skills
Upon successful completion of ADN 12BL, the student will demonstrate competence in the
following skills, concepts and/or information:
1. Application of theory taught in ADN 12B to the adult in the medical/surgical nursing units
and relevant diagnostic labs in an acute care hospital.
2. Continuing application of theory taught in all previous courses in the ADN program.
3. Competency in the ADN 12BL procedural skills required in nursing care to the patient with
complex medical problems, such as: neurological assessment, complete head to toe physical
assessment, tracheostomy care and suctioning, and standard precaution skills.
4. Continuing competency in all procedural skills taught in all previous lab courses in the
ADN program.
5. Progressive competency in the RN role as demonstrated by adequate functioning as a group
leader on the medical nursing unit.
6. Organization and time management skills needed to complete a multiple patient (2-3)
bedside care assignment and function as a team member on the acute medical nursing unit.
7. Application of the proper principles of English usage and mechanics to the health care
setting by communicating with patients, instructors, and staff verbally and in writing; and by
preparing nursing care plans and recording the application of the nursing process in the
medical record.
1.5
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3
ADN 12BL LEARNING OUTCOMES
Upon satisfactory completion of this course, the student will be able to:
Professional Role
 Illustrate professionalism, effective communication, and collaborative nursing care in
the clinical setting.
 Assimilate and integrate professional values of caring, integrity, honesty, patient
advocacy, and respect for human dignity within the professional role.
Communication
 Utilize appropriate communication skills with colleagues, clinical staff, and faculty
using proper verbal and written English and document care utilizing the clinical
agency’s set protocols and formal method of communication (e.g. SBAR).
 Demonstrate respect for cultural diversity and unique individual differences in
communication style and preference.
Orem’s Self Care Theory and the Nursing Process
 Coordinate Orem’s Self-Care Theory and the nursing process in the care of a multiple
patient assignment in the acute medical setting.
 Develop and implement a plan of care for acutely ill medical patients using Orem’s
Self-Care Theory and the nursing process.
Critical Thinking and Safety
 Utilize critical thinking and clinical judgment in the provision of safe care to the
hospitalized medical patient.
 Integrate core competencies of critical thinking and scientific inquiry with ethical
principles as a basis for making professional judgments and assimilate new content to
adapt for safe clinical practice.
Teaching and Learning
 Assess and evaluate learning needs of the medical patient and develop a plan of care to
teach fulfillment self-care deficits.
 Promote health seeking behaviors; teach illness prevention, risk reduction, and disease
management to patients and families in the clinical setting.
 Seek out patient assignments to apply new skills and theoretical knowledge to meet
learning needs and ask for guidance/assistance when needed.
Collaborative Management of Care
 Collaborate with the interdisciplinary health care team to promote optimal patient
outcomes and coordinate/delegate patient care in the clinical setting to accomplish the
interventions and goals set forth for each patient.
1.6
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3
CHALLENGE OPTION
ADN 12BL
General Announcement
Students interested in challenging must let the instructor know by the last day of the
first week of the course. The student should complete the department “Application for
Challenge by Examination for ADN 12BL” and complete the college formal application for
challenge by examination. Upon acceptance of the challenge option by the teaching team, an
appointment will be made for the student to take the written theory exam at the beginning of
the second week of the course.
Written Test
A 150 point comprehensive, objective (NCLEX style) test will be given. The student
must achieve a minimum score of 75% to continue with the challenge.
Upon successful completion of the ADN 12B course challenge, the student then
proceeds to the next step; the challenge of ADN 12BL.
Challenge of ADN 12BL
The student submits the department “Application for Challenge by Examination for
ADN 12BL” and the college application for challenge by examination.
Case Study
The student will complete a written case study to be assigned by the instructor. The
case study is due by the last day in the second week of the course.
Clinical
Clinical assessment will be individualized to evaluate the clinical competency of the
student. The student is advised to attend clinical orientation day. The student and
instructor will plan a specified number of days, not less than two, on a medicalsurgical nursing unit. During this time, the student is to demonstrate competencies
expected of a student at the end of ADN 12BL.
Grade for ADN 12BL
If successful, the grade earned for ADN 12BL will be the same that is earned in the
challenge of ADN 12B.
Completion of the Challenge Option for both ADN 12B and ADN 12BL
All the components of the challenge are to be completed by the end of the third week.
1.7
ADN12B Spring 2012
APPLICATION FOR CHALLENGE BY EXAMINATION
ADN 12BL- Health Deviations 3
Student Name________________________________
Date____________________
Student complete section A below:
A. Justification of this request:
Student Signature_____________________________________
Teaching team complete section B below:
B. Decision:
Yes________ If yes, write contract below.
No________ If no, state reason for denial.
C. Contract
Case study completed by ___________________________
Clinical assessment completed by __________________________
Signatures:
Lead Instructor: _____________________________
Date:___________________
Instructor:__________________________________
Date:___________________
Instructor:__________________________________
Date:___________________
Student:____________________________________
Date:___________________
D. Disposition of Challenge_________________________________________________
1.8
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
SKILLS ASSESSMENT EXPECTATIONS
The philosophy of the Associate Degree Nursing Program faculty includes the concept
that students should be held accountable for all skills learned previously in the nursing
program. In the original “SKILLS ASSESSMENT STATEMENT” in the 11B syllabus, the
following criteria can be found:
The critical elements for specific skills are listed on Campus Lab and Skill Assessment
Sheets. All of the parts of the skill MUST be performed in order that the skill is
evaluated as having been done satisfactorily. Skill Assessment sheets are kept on file
to validate that the student has successfully completed the skill. Skill competency may
be tested at any time throughout the program in scheduled campus labs. Students are
expected to meet the critical elements of any skill after testing at any time in the
hospital setting.
See also Skills Testing in the Student Handbook.
Previously learned skills are listed in the Clinical Behavioral Objectives in this
syllabus. The student is responsible for being prepared to perform these skills in the clinical
area under supervision, with minimal on-the-spot review or teaching.
The student must follow appropriate standard precautions for each skill learned.
If self-assessment by the student demonstrates that he/she is not able to safely perform
previously learned skills, the following are suggested resources:
1.
2.
3.
4.
5.
6.
Review media in the learning center.
Review appropriate syllabus pages to see that all critical elements are being met.
Make an appointment with a Skills Adjunct Lab teacher.
Practice in the skills lab with a peer who is proficient in the skill.
Make an appointment with your clinical instructor for help.
Review the hospital procedure manual.
If the student is unable to perform a previously learned skill with 100% accuracy in the
clinical area during this course, the student will receive an overall clinical marginal until
remediation is achieved and clinical practice of skills is satisfactory.
1.9
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
ATTENDANCE POLICY AND MAKE-UP ASSIGNMENT
1. Attendance: (from the Associate Degree Nursing Student Handbook)
1.1 The Long Beach City College Associate Degree Nursing Program mission and goals
include preparation of nurses for entry-level registered nurse positions. Reliable and
prompt attendance at the assigned time and nursing unit is both a professional
responsibility and a minimal expectation of employers of entry level registered
nurses. Therefore, during the nursing program, students must demonstrate reliable
attendance and promptness behaviors.
For each nine-week course the following guidelines shall apply:
1.1.1 Overall Course Attendance: The college policy shall be enforced, i.e.,
“Attendance is the student’s responsibility. In the event of excessive
absences, the instructor may drop a student from a course or lower a student’s
grade. Students who are absent more than twenty percent of the total class
hours or for two consecutive weeks shall be automatically dropped from the
class.” See current college catalog.
1.1.2 Clinical and campus laboratory hours
1.1.2.1 Any combination of three episodes of absences and/or tardiness
within a course shall result in the student receiving a Progress Report
and a “Must Improve” rating in the appropriate area of the clinical
evaluation. Any further absences and/or tardiness in the same course
shall result in an “Unsatisfactory” rating in the appropriate area of the
clinical evaluation and an overall clinical marginal rating for the
course. (Approved 3/96)
Making up a clinical day is not always an option. It is not possible to
make up a clinical day; a written assignment may be required.
2. Make-up assignment for ADN 12BL
Missing clinical time may result in the student not meeting behavioral objectives for
the course.
At the discretion of the teaching team, a student missing clinical time may be asked to
make up the clinical day, schedule simulation in the Simulated Hospital, or be given a written
assignment to help make up for the lost clinical time. The exact assignment and due date will
be established on an individual basis by the teaching team.
1.10
ADN12B Spring 2012
ADN 12 BL
Health Deviations 3 Laboratory
CAMPUS
LABORATORY
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
SKILL LAB OVERVIEW: NEUROLOGICAL ASSESSMENT
BEHAVIORAL OBJECTIVES:
1. Describe methods of assessing each of the six components of a complete
neurological examination by completing the neurological assessment worksheet
prior to class.
2. Describe patient behavior associated with levels of consciousness. Relate these
descriptive states to the Glasgow coma scale.
3. Describe decerebrate and decorticate posturing and the implications of these
findings.
4. Describe the components of a complete neurological examination as performed by
an MD or neurologist, a neurological screening assessment as performed by an MD
or psychologist, and a neuro check as performed by an RN.
5. Describe and be prepared to demonstrate the neuro check of an alert patient.
6. Describe and be prepared to demonstrate the neuro check of a comatose patient.
7. Use correct terminology in reporting and recording neurological findings.
CRITICAL ELEMENTS:
1. If patient is awake, ask questions to determine orientation to time, place, and
person
2.
Assess pupils for size, equality, and shape.
3. With flashlight, assess briskness of pupillary response to light.
4. Assess upper extremity strength by asking patient to squeeze nurse’s fingers, and
compare to normal.
5. Assess lower extremity strength by asking the patient to dorsi-flex and plantar-flex
each foot.
6. Score the Glasgow Coma Scale of an awake patient accurately.
7.
If the patient is comatose, assess level of consciousness by using the correct order
of stimulation: calling the patient’s name, stimulating by touch, and stimulating by
deep pain.
8. Demonstrate the correct method of assessing response to deep pain and note the
reaction to stimulation.
9. Assess pupils for size, equality, and shape.
16.0
ADN12B Spring 2012
10. Assess protective reflexes: gag and corneal.
11. Assess plantar reflex.
12. Score Glasgow Coma Scale accurately for a comatose patient and be able to record
neurological assessment data on the flow sheet provided in the syllabus.
13. Complete neurological assessment of both awake and comatose patient within 10
minutes.
ASSIGNMENTS:
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby
Elsevier, 631-640.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook of
medical-surgical nursing (12th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins, 18421850; 1859-1864.
Syllabus:
Levels of Consciousness
Glasgow Coma Scale
Worksheet: Neurological Assessment
HOW THIS SKILL WILL BE TESTED:
On-campus lab, with 100% accuracy, according to critical elements.
16.1
ADN12B Spring 2012
Study Guide: LEVELS OF CONSCIOUSNESS
Level of Consciousness Term
Awake/ Alert
Lethargic, drowsy
Stupor
Semi coma
Vegetative State
Deep Coma
Brain Death
Description
Arouses easily. Responds to verbal
stimulus. May or may not follow
commands or be oriented.
Goes to unconscious state at intervals.
Responds slowly, but is responsive.
May or may not follow commands or be
oriented.
Requires repeated or moderate verbal
stimuli or painful/noxious stimuli to
arouse. Will lapse into sleep if not
stimulated. May move spontaneously
without stimuli. Little purposeful
movement.
Confused and disoriented when awake,
may reorient briefly.
Purposefully withdraws from pain.
A partial or mild comatose state. May be
aroused with stimulus, but returns to
unconscious state when not stimulated.
Response to noxious stimuli is organized.
Protective reflexes (corneal, gag) are
present.
As in Semi comatose state, but may open
eyes and may track (follow examiner with
eyes), but does not follow commands.
Little or no response to deep pain.
Protective reflexes may not be present.
No or minimal spontaneous movement,
flaccid.
Irreversible cessation of all functions of the
brain, including the brain stem. Determined
by a neurologist. Generally accepted
standards include: fixed, dilated pupils, no
gag or corneal reflex; no activity on EEG
x3, several hours apart; no spontaneous
respirations during apnea test (ventilator
turned off), no eye movement when cold
water injected into ear canal (cold calorics),
negative doll’s eyes. Temp >35 and no
sedatives.
16.2
ADN12B Spring 2012
Study Guide: GLASGOW COMA SCALE
Pupil Scale
Scoring of Eye Opening
(in mms)
4=patient opens eyes spontaneously
3= patient opens eyes in response to speech
(spoken or shouted)
2=patient opens eyes only in response to painful
stimuli
 Pressure at proximal end of nail bed
with pencil
 Pressure to supra orbital ridge
1= patient does not open eyes in response to
painful stimuli
C=if eyes are closed by swelling
Pupil Reaction
+ =reacts
Ø =no reaction
S=sluggish
C=eyes closed
Scoring of Best Motor Response
6=patient can obey a simple command
5=patient purposefully tries to remove the painful
stimulus from more than one area
4=patient responds to painful stimuli by
attempting to withdraw from source of pain
3=Decorticate posturing: patient has an abnormal
spastic flexion of the upper extremities and
simultaneous rigidity of the lower extremities
either spontaneously or in response to
tactile/painful stimuli
2=Decerebrate posturing: patient has an abnormal
spastic extension of both upper and lower
extremities either spontaneously or in responds to
tactile/painful stimuli
1=patient has no motor response to pain in any
limb
16.3
ADN12B Spring 2012
Reflexes
Corneal= cornea lightly stroked with a
wisp of cotton, the patient automatically
blinks if the corneal reflex is intact.
Gag=elicited by stroking each side of the
mucous membrane of the posterior pharynx
with a tongue blade or suction catheter.
Plantar=Normal reflex. Plantar
(downward) flextion of the toes.
Scoring of Best Verbal Response
5=patient is oriented to time, person and place
4= patient is able to converse although not
oriented to time, place or person
3=patient only speaks in words or phrases that
make little or no sense
2=patient responds with incomprehensible sounds
such as groans or moaning without recognizable
words
1=patient does not respond verbally at all
Babinski=Abnormal reflex. Extension or
dorsi flexion of the big toe. May have
fanning of the toes.
+= present
Ø= absent
B =Babinski
Muscle Strength: Hand and Foot
Strong
Weak
Ø Flacid
Muscle Strength
5=raises limb and holds against pressure
4=raises limb and holds against light touch
3=raises limb but unable to hold against gravity
2=weak contraction, movement, but not against
gravity
1=isometric contraction but no movement
0=no movement
16.4
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
WORKSHEET: NEUROLOGICAL ASSESSMENT
Part I, Mental Status
Area
Techniques
Normal/Abnormal
Speech
Orientation
Memory
Attention
Span
Calculations
Judgment
Abstract
Reasoning
Part II, Level of Consciousness – Glasgow Coma Scale
Area
Techniques
Normal/Abnormal
Eye
Opening
Motor
Response
Verbal
Response
16.5
ADN12B Spring 2012
Part III, Motor Function
Area
Techniques
Normal/Abnormal
Upper
Extremities
Lower
Extremities
Part IV, Peripheral Sensory Function
Area
Techniques
Normal/Abnormal
Light Touch
Pain
Temperature
Part V, Reflexes
Area
Techniques
Normal/Abnormal
Pupils
(PERRLA)
Corneal
Blink Reflex
Gag
Plantar
Reflex
Deep Tendon
Reflexes
16.6
ADN12B Spring 2012
ADN 12BL - Health Deviations 3 Laboratory
Skill Assessment: NEUROLOGICAL ASSESSMENT
Name: _________________________________
Date _________________________
Evaluator:
CRITICAL ELEMENTS
Pass
Fail
Comment
1. Accurately assess patient’s neurological
status.
2. Perform maneuvers that cause only
mild or no distress.
PROCEDURAL ELEMENTS
For Alert Patient:
1. Ask questions to determine orientation
to time, place and person.
2. Assess pupils for size, equality, shape,
and reaction to light.
3. Assess upper and lower extremity motor
strength.
4. Score the Glasgow Coma Scale
accurately.
For Comatose Patient:
1. Assess level of consciousness using
correct order of stimulation.
2. Demonstrate correct method of
assessing response to deep pain.
3. Assess pupils for size, equality, shape,
and reaction to light.
4. Assess protective reflexes: gag and
corneal blink reflex.
5. Assess plantar reflex.
6. Score GCS accurately for comatose pt.
1. Record neurological assessment data
including normal and abnormal
findings for both the alert and
comatose patient on the flow sheet
chart provided.
2. Complete all critical elements within 10
minutes.
RETEST:
Date:_________________________
Skills Evaluator:___________________________
16.7
ADN12B Spring 2012
NEURO CHECK FLOW SHEET
Glasgow Coma Scale
Score Alert Coma
4
3
2
1
6
5
4
3
2
1
5
4
3
2
1
Spontaneously
To Verbal
To Pain
No Response
Obeys Verbal
Localizes Pain
Flex Withdrawal
Decorticate
Decerebrate
No Response
Oriented/Converses
Disoriented
Inappropriate Words
Incomprehensible
No Response
Eye Open Response
Best Motor Response
Best Verbal Response
Glasgow Coma Score for Alert Patient=______________________
Glasgow Coma Score for Comatose Patient=__________________
+/- +/-
+ -
+
RLE LLE
R L R L R L R L R L R L
od/os
Alert
Patient
Coma
Patient
-
+
/
/
/
/
Pupil Reaction to Light:
Motor Strength
B=Brisk
S=Sluggish
N=Non-Reactive
S=Strong
M=Moderate
W=Weak
A=Absent
16.8
ADN12B Spring 2012
-
Lower Extremity
thigh
Rxn / Size
od os/ od os
Upper Extremity
knee
Plantar
B=Babinski
Foot
Cough
shoulder
Gag
elbow
Time
Corneal
Reflex
hand
Date
Pupil
Check
ADN 12BL – Health Deviations 3 Laboratory
SKILL LAB: Intradermal Skin Testing
BEHAVIORAL OBJECTIVES:
1. Briefly describe the delayed-reaction allergic response (cell mediated hypersensitivity)
of the skin.
2. List the diagnostic tests commonly performed by intradermal (ID) skin tests.
3. Discuss who is legally qualified to:
a. Order diagnostic skin tests
b. Place ordered intradermal skin tests
c. Read diagnostic skin tests
d. Interpret the results of diagnostic skin tests.
4. Describe and demonstrate the standard technique for intradermal placement of 0.1 ml
of solution.
a. Selection of needle and syringe
b. Selection of site
c. Preparation of skin
d. Insertion with needle bevel up or needle bevel down.
e. Angle and depth of needle insertion
f. Injection of test solution and size of bleb in the skin
g. State the actions to be taken if a bleb is not raised in the skin
5. List the instructions to the patient for care of the site.
6. Identify the Center of Disease Control and Prevention (CDC) specified time for test
reading for TB skin tests.
7. Describe CDC method of reading TB skin tests if agency policy allows.
CRITICAL ELEMENTS
1.
2.
3.
4.
5.
Five rights are used in preparation and administration of intradermal test solution.
Sterile technique is maintained during preparation and administration of test solution.
Verbalization of need to raise a bleb of 6 to 10 mm with the ID injection
Accurate instruction is provided for the patient.
Verbalization of the time and method for accurate reading of a skin test.
17.0
ADN12B Spring 2012
HOW THIS SKILL WILL BE TAUGHT:
1.
2.
4.
3.
Clarification of learning objectives in campus lab setting.
Demonstration of techniques/procedures to meet the critical elements.
Practice injection technique on injection arm.
Student return demonstration of simulated ID injections on another student using 0.1
ml normal saline and syringe without a needle and return demonstration of actual
injection using ID practice arm.
HOW THIS SKILL WILL BE TESTED:
1. On campus laboratory situation as scheduled on weekly schedule. Return
demonstration of an intradermal injection with 100% accuracy according to the
critical elements.
TEACHER RESPONSIBILITY:
1.
2.
3.
4.
Clarify behavioral objectives.
Demonstrate each step of the procedures
Provide equipment for practice on ID practice arms.
Provide equipment and supervise practice of students in simulated ID injection on
another student and actual ID injection using practice arm or other teaching device.
STUDENT RESPONSIBILITY:
1. Come to lab prepared to learn and practice intradermal injection technique.
2. Perform steps as directed by instructor in lab.
3. Simulate technique for ID injections on another student. Inject 0.1ml intradermally
using ID practice arm or other teaching device. Verbalize correct actions if a 6-10 mm
bleb was not raised.
4. Verbalize time and method of measuring skin test.
ASSIGNMENT
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO:
Mosby Elsevier, Chapter 35.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing. (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins,
1612-1613.
17.1
ADN12B Spring 2012
ADN 12BL - Health Deviations 3 Laboratory
SKILL ASSESSMENT:
INTRADERMAL INJECTIONS
Student Name:
Date:
______
Classroom Evaluator: ________________________________
CRITICAL ELEMENTS
Pass
Fail
COMMENTS
1. Verify written order for PPD or other ID test
2. Use the five rights in administration of test.
Maintain sterile technique in preparation and
administration of intradermal test.
3. Use the correct technique for ID injection.
Simulate injection on another student using
syringe without needle.
Inject test solution intradermally using ID practice
arm or other teaching device.
Verbalize the need to raise a bleb of 6 to 10 mm in
the skin.
Document on back of form the correct instructions
to patient.
Document time and method to read a PPD test
including positive results on back of form.
RETEST:
Date:_________________________
Skills Evaluator:____________________________
17.2
ADN12B Spring 2012
ADN 12BL- Health Deviations 3 Laboratory
SKILL LAB: TRACHEOSTOMY
BEHAVIORAL OBJECTIVES:
1.
List the reasons why a tracheostomy is performed and maintained as the primary airway
for some patients.
2.
Identify and recognize types of tracheotomies including cuffed and fenestrated.
3.
Identify and recognize the parts of a tracheotomy tube including inner/outer cannula,
neck flange, cuff, inflating tube and pilot balloon, obturator, and fenestration cannula.
4.
Review infection control procedures related to tracheostomies and their care.
5.
Identify potential hazards of tracheotomies as well as preventive measures and correct
nursing responses to untoward events such as tracheostomy occlusion or dislodgement.
STUDENT RESPONSIBILITIES:
1. Come to lab–ready to discuss the behavioral objectives, identify and practice the critical
elements, and having read the required textbook pages.
2. Demonstrate the ability using critical thinking skills to identify appropriate actions in the
event of a problem with the tracheostomy.
TEACHER RESPONSIBILITIES:
Clarify and review behavioral objectives.
ASSIGNMENT:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing. (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins,
648-652, 673.
18.0
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
SKILL LAB: SUCTIONING NASALLY, ORALLY, OR BY TRACHEOSTOMY
BEHAVIORAL OBJECTIVES:
1. Identify the clinical manifestations that indicate a need for suctioning the patient with
a tracheostomy tube.
2. Describe the possible complications and infection transmission concerns related to
suctioning.
3. List the equipment needed and the sequence of steps for nasally and orally suctioning
a patient.
4. Demonstrate oral and nasal suctioning.
5. Describe the sequence of steps for suctioning the patient with a tracheostomy.
6. Demonstrate suctioning of the patient with a tracheostomy.
7. Identify care of the equipment following suctioning.
8. Identify items to be recorded and reported following suctioning.
9. Demonstrate safe and effective suctioning of the patient with a tracheostomy tube.
CRITICAL ELEMENTS:
1. The patient’s airway will be cleared.
2. The patient’s oxygenation status will not deteriorate unnecessarily.
PROCEDURAL ELEMENTS
1. Position the patient to facilitate removal of secretions.
2. Set correct pressure on suction source (-80 to 120 mm Hg).
3. Set up sterile equipment before connecting catheter to suction tubing.
4. Verify patency of suction catheter.
5. Apply suction continuously only when withdrawing catheter for a maximum of 10
seconds at a time.
6. Protect patient and self from contamination.
STUDENT RESPONSIBILITIES:
1. Come to lab prepared to discuss the behavioral objectives and critical elements.
2. Practice procedure in lab and independently on own time asking for help as needed.
TEACHER RESPONSIBILITIES:
1. In lab, demonstrate suctioning a patient with tracheostomy tube and be available for
questions in lab.
2. Test according to critical elements in campus lab.
ASSIGNMENTS:
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby
Elsevier, 931-950.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook of
medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins, 648-652;
673.
18.1
ADN12B Spring 2012
ADN 12BL- Health Deviations 3 Laboratory
SKILL LAB: TRACHEOSTOMY CARE
BEHAVIORAL OBJECTIVES – NURSING PROCESS APPLICATION:
1. Assessment
a. Define what is meant by the term ‘tracheostomy care’.
b. Identify the standard frequency as well as physical findings and behaviors in
patients that indicate the need for tracheostomy care.
c. Identify and list all the equipment necessary to perform tracheostomy care at the
bedside.
2. Planning
a. Review Standard Precautions and the tracheostomy care implementation section;
identify nursing skills and techniques necessary to protect both the patient and
nurse from possible contamination.
b. Explain the rationale for suctioning the patient before tracheostomy care.
3. Implementation
a. Suction patient unless trachea is clear.
b. Open tracheostomy cleaning tray using aseptic technique.
c. Pour hydrogen peroxide and NS into one compartment of the tray and NS in the
other.
d. Put on sterile gloves provided in the kit.
e. Remove inner cannula and discard if cannula is disposable.
f. If inner cannula is not disposable, place the cannula in the hydrogen peroxide/ NS
chamber. Using the small brush and gauze that are in the tray, clean the inner
cannula.
g. Rinse the inner cannula in normal saline.
h. Reinsert the new or cleaned inner cannula into the outer cannula locking it in place.
i. Remove the tracheostomy dressing.
j. Cleanse stoma and tracheostomy area with cotton swabs moistened with normal
saline.
k. Place a fresh tracheostomy dressing while stabilizing the cannula and cuff.
l. If the tracheostomy ties are soiled replace them in a safe manner.
m. Empty the solutions and throw away the tray, remove gloves, and wash hands.
4. Evaluation
a. Identify and describe expected outcomes for tracheostomy care including the
following:
i. Patient remains ventilated, without respiratory distress
ii. Secretions continue to be easily suctioned
iii. Tracheostomy site remains free from infection.
CRITICAL ELEMENTS:
1. The patient’s airway is not compromised.
2. Cleanliness is maintained surrounding the tracheostomy stoma.
18.2
ADN12B Spring 2012
STUDENT RESPONSIBILITIES:
1. Come to lab ready to discuss the behavioral objectives, identify and practice the critical
elements, and having read the required textbook pages.
2. Perform critical and procedural element steps during practice sessions, seeking
assistance as needed.
3. During skill testing be able to perform tracheostomy care with 100% accuracy per the
critical elements.
TEACHER RESPONSIBILITIES:
1. Clarify and review behavioral objectives.
2. Demonstrate the steps/critical elements of tracheostomy care.
3. Provide tracheostomy care supplies and observe students during practice session,
assisting prn.
ASSIGNMENT:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins,
648-650.
SKILL TESTING:
Will be tested in on-campus laboratory, on date indicated on schedule.
18.3
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
Skill Assessment: SUCTIONING A PATIENT WITH A TRACHEOSTOMY TUBE
Name: _________________________________
Date _________________________
Classroom Evaluator: ___________________________________
CRITICAL ELEMENTS
Pass
Fail
Comment
1. The patient’s airway was cleared
2. The patient’s oxygenation status did not
deteriorate.
PROCEDURAL ELEMENTS
1. Set correct pressure on suction source
2. Set up sterile equipment before
connecting catheter to suction tubing
3. Verify patency of suction catheter
4. Apply suction continuously only when
withdrawing catheter no more than 10
seconds at a time
5. Protect patient and self from
contamination
6. Complete procedure within 5 minutes.
RETEST:
Date: ______________________
Skills Evaluator: ______________________________
18.4
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
SKILL ASSESSMENT: TRACHEOSTOMY CARE
Name_______________________________________________
Date______________
Evaluator____________________________________________
CRITICAL ELEMENTS
Pass
6.
The patient’s airway is not compromised.
Cleanliness is maintained surrounding the tracheostomy
stoma.
PROCEDURAL ELEMENTS
Suction the patient if needed before cleaning
the inner cannula
Set up sterile tracheostomy cleaning materials before
beginning procedure.
Apply sterile gloves without contamination.
Remove inner cannula while steadying outer cannula
plate.
Discard disposable inner cannula, or clean and rinse
thoroughly before replacing it.
Replace inner cannula while steadying outer cannula.
7.
Remove soiled tracheostomy dressing.
1.
2.
1.
2.
3.
4.
5.
Fail
Comments
8.
Cleanse stoma and tracheostomy area; replace
tracheostomy dressing.
9. If indicated, change ties. Verbalize safe procedure for
changing tracheostomy ties.
10 Practice standard precautions throughout the procedure.
RETEST:
Date:_____________________
Skills Evaluator:________________________________
18.5
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
SKILL LAB: INTRAVENOUS THERAPY-ADVANCED MANAGEMENT OF
INTRAVENOUS FLUID VOLUME REPLACEMENT
LEARNING OBJECTIVES
1. Analyze clinical situations when the ordered fluid volume may be behind or ahead of
schedule and determine flow rates to get back on schedule.
2. Discuss patient health deviations and needs that should be considered when deciding
to make up missed intravenous fluid intake.
3. Discuss how IV therapy is included in Intake and Output for the shift.
HOW THESE SKILLS WILL BE LEARNED
1. Discuss and clarify learning objectives in scheduled lab.
2. Practice placing time lines and setting IV rates in campus lab
3. Practice analyzing the situations and calculation problems on the worksheets
4. Record complicated intake and output totals on the IV Credit Problems/Exercise
STUDENT RESPONSIBILITIES:
1. Come to lab ready to discuss the behavioral objectives, identify and practice the critical
elements, and having read the required textbook pages.
2. Review ADN 12 AL Parental Infusion Guidelines and Critical elements for maintaining
intravenous therapy.
TEACHER RESPONSIBILITIES:
1. Clarify and review behavioral objectives.
ASSIGNMENT:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins,
303-310.
SKILL TESTING:
Math computation skills will be tested on the ADN 21B/BL quizzes and exams. Managing IV
therapy will be assessed for satisfactory performance in the clinical setting.
19.0
ADN12B Spring 2012
WORKSHEET FOR INTRAVENOUS THERAPY – PART I
IV CREDIT PROBLEMS/EXERCISE
CALCULATE IV CREDIT FOR THE IV’S LISTED BELOW:
1. The night shift RN hung a 1000cc bag of 5%D/W at 1:00 a.m. which infused at 100cc per
hour. At 6:00 am the night shift RN recorded
ml IV intake on the I and O sheet.
Credit for the 7-3 shift is
ml.
2. The night shift RN hung a 1000cc bag of 5%D/NS at 12 midnight. The IV infused at
80cc/hour. At 6:00 am the night shift RN recorded
ml IV intake on the night
shift I and O sheet. Credit for the 7-3 shift is
ml.
3. The night shift RN hung a 1000cc bag of 5%D/NS at 12 midnight. The IV infused at
50cc/hour. At 5:00 a.m. the physician ordered the IV rate increased to 75cc per hour and the
RN made this adjustment. At 6:00 am the night shift RN recorded
ml IV intake on the night shift I and O sheet. Credit for the 7-3 shift is
ml.
4. At the beginning of the day shift you note that your patient has an IV of D5W to run at 100
cc/hour. At 6:00 a.m. the night shift RN gave the day shift an IV credit of 300cc of 5D/W. At
9:00 am a bag of 1000cc of 5%D/NS was hung to infuse at 75cc/hour. The IV infused all shift
without any interruptions. Record the day shift intake (at 1400) for both IV fluids.
a. IV Intake: 1.
Ml 5D/W.
2.
ml 5D/NS.
b. Credit for 3-11 shift is
ml 5D/NS.
I
N
T
A
K
E
5. Record the IV intake from problem #4 for the day shift on the record below:
D
E
N 24 hour
D
E
N
24 hour
Oral
Tube Feeding
IV
IV
IV
Blood/Blood Products
O
U
T
P
U
T
TOTALS
Urine
Emesis
Gastric
Other
Feces
Liquid/Formed
TOTALS
19.1
ADN12B Spring 2012
6. At the beginning of the day shift you note that your patient has an IV of D5½NS to run at 90
cc/hour. At 6:00 a.m. the night nurse gave the day shift an IV credit was 800cc of D5½NS. At
8:00 am this IV was turned off and 250cc of packed cells were infused over 2 hours. At 10:00
a.m. 500cc of Hespan was given over 1 hour. At 11:00 am the IV of D5½NS was increased to
infuse at 125cc/hour. Complete the IV intake for 7a-3p shift:
a.
ml D5½NS.
b.
ml Packed Red cells.
c.
ml Hespan.
d. Credit for the 3-11 shift is
ml of D5½NS
7. Record the intake from problem # 6 on the record below.
D
I
N
T
A
K
E
O
U
T
P
U
T
E
N
24 hour
Oral
Tube Feeding
IV
IV
IV
Blood/Blood Products
TOTALS
Urine
Emesis
Gastric
Other
Feces
Liquid/Formed
TOTALS
ANSWERS:
1.Night shift recorded 500 ml credit for 7-3 500 ml
2. Night shift recorded 480 ml credit for 7-3 520 ml.
3. Night shift recorded 325 ml credit for 7-3 675 ml.
4. a.
1. 300 ml. 5 D/W
2. 375 ml. 5 D/NS
b. 625 ml
5.
IV D5W
IV D5NS
6.
IV D5½NS
IV Hespan
Packed Red cells
6. d.245 cc credit of D5½NS
D
300
375
D
555
500
250
19.2
ADN12B Spring 2012
D
E
N
24 hour
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
SKILL LAB: IV Drip Calculations
LEARNING OBJECTIVES
1. Describe reasons for medications to be given by IV drip.
2. Discuss the hazards associated with continuous IV drip medication.
3. For each of the listed medications, describe the desired medication effects, side effects,
and hazards and identify the unit dose per unit of time that the drug is given in.
 Heparin
 Magnesium Sulfate
 Regular Insulin
 Pitocin
4. Given a dose of IV drip medication in a quantity of IV fluids, calculate the ml per hour
rate required to administer a specified dose of medication.
5. Be prepared to calculate the dose of IV medication infusing in the clinical area and on
tests.
HOW THESE SKILLS WILL BE LEARNED
1. Discuss and clarify learning objectives in the scheduled lab.
2. Use practice problems to validate skill acquisition.
3. Prepare to demonstrate learning on tests and in the clinical area.
STUDENT RESPONSIBILITIES:
1. Come to lab ready to discuss the behavioral objectives, identify and practice the critical
elements, and having read the required textbook pages.
2. Review ADN 12 AL Parental Infusion Guidelines and Critical elements for maintaining
intravenous therapy.
TEACHER RESPONSIBILITIES:
1. Clarify and review behavioral objectives.
ASSIGNMENT:
Smeltzer, S.C., Bare, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner & Suddarth’s textbook
of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins,
303-310.
SKILL TESTING:
Math computation skills will be tested on the ADN 21B/BL quizzes and exams. Be prepared
to calculate the dose of IV medication infusing in the clinical area
19.3
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
IV Drip Calculation Worksheet
PROCEDURE:
1. Identify the unit and time measure of the drug to be given. Ex: Heparin is given in units
per hour.
2. Given an ordered dose of medication to be given by IV drip and a quantity of drug in an
IV bag, use D/H x Q to calculate the Ml/hour rate needed to deliver the ordered dose.
Ex: Your patient is to receive 250 units per hour of Heparin. The pharmacy sends a bag
labeled Heparin 25,000 units in 500 Ml D5W. What is the Ml/hour rate required to infuse
the Heparin at the desired dose?
Desired:
250 units
On Hand: 25,000 units
Quantity: 500 Ml
250/25,000 x 500 = 5 Ml/ hour
3. Given a quantity of drug in an IV bag, and a Ml/hour rate of drug infusion, calculate the
amount of medication that the patient is receiving per hour.
Ex: Your patient has an IV bag hanging labeled Heparin 25,000 units in 500 Ml. The IV
pump is set to run at 20 Ml/hour. What dose of Heparin is the patient receiving?
Desired: X units
On Hand: 25,000 units
Quantity: 500 Ml
Ml/ hour rate: 20 Ml/hour
X/25,000 x 500 = 20
Cancel out: X/50 = 20
X = 1000
The patient is receiving 1000 units per hour of Heparin
Practice Questions:
1. The patient is to receive an IV drip of Regular Insulin at 2 u/ hour. The bag hanging is
Regular Insulin 100 units in 100 cc. What rate should the pump be set for?
2. The nurse needs to administer 1200 U/hr of Heparin. The label states there are 25,000
U/500 ml of fluid. Calculate the rate for the IV pump.
3. At the beginning of the shift, the nurse notes that Theophylline 1gm/ 500ml is
infusing at 20 ml/hr. The order is for Theophylline at 60 mg/hr. Is the rate correct?
19.4
ADN12B Spring 2012
Key to Practice Questions:
1. 2 mL/hour
2. 24 mL/hour
3. No, the pump should be set at 30 mL/hour
19.5
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
SKILL LAB: PHYSICAL ASSESSMENT OF THE DEPENDENT PATIENT
BEHAVIORAL OBJECTIVES:
1. Independently review previously learned physical assessment skills.
a. Baseline assessment taught in preparation for long-term care facility in ADN 11AL.
b. Exam of the Lower Extremities in ADN 11BL
c. Assessment of thorax and lungs in ADN 11BL
d. Exam of the abdomen in ADN 11BL
e. Cardiovascular assessment in ADN 12AL
f. Neurological assessment in ADN 12BL
2. Discuss variations in techniques that may be necessary or useful in ill patients who are
resting in bed.
3. Discuss sequencing of physical assessment techniques for facilitating an efficient and
accurate basic nursing assessment, such as required for admission to a nursing inpatient unit.
4. Discuss the process of assessment of all body regions to determine important areas for
hygiene care.
CRITICAL ELEMENTS:
1. Abnormalities and normal variations in the basic clinical findings of the patient will be
accurately identified
2. The clinical findings will be accurately recorded on the ADN 12AL Nursing Care
Worksheet.
3. The patient will remain comfortable during the examination.
PROCEDURAL ELEMENTS
1. Position patient (student) in bed, moving patient no more than necessary to perform an
accurate assessment.
2. Following a pre-determined sequence, correctly carry out all physical assessment
procedures previously learned.
3. Complete all relevant portions of the assessment column of the ADN 12AL Nursing
Care Plan, using terminology according to ADN 12AL guidelines.
4. Complete the above tasks in 15 minutes or less.
20.0
ADN12B Spring 2012
STUDENT RESPONSIBILITIES
1. Come to lab prepared to function as both a nurse and a patient. Bring a stethoscope and
BP cuff and dress appropriately to facilitate a physical examination.
2. Practice previously learned techniques if necessary. Develop a systematic sequence to
follow. Request assistance as needed.
TEACHER RESPONSIBILITIES
1. Clarify behavioral objectives and critical elements.
2. Demonstrate a procedure to meet the critical elements.
3. Test students according to critical elements in scheduled campus lab.
ASSIGNMENTS:
1. Potter, P.A., & Perry, A.G. (2009). Fundamentals of Nursing (7th ed.). St. Louis, MO:
Mosby Elsevier, 854-862.
2. Giddens, J.F. (2007). A survey of physical assessment techniques performed by RNs:
Lessons for nursing education. Journal of Nursing Education, 46, 83-87.
3. Review previously assigned textbook materials regarding physical assessment.
4. Review course study guides from ADN 11A, 11BL and 12AL for relevant information.
5. Review videos in learning center if needed: selected portions of video: Head to Toe
Assessment. Written and filmed by LBCC faculty.
HOW THIS PROCEDURE WILL BE TESTED
During scheduled campus lab, the student will demonstrate a complete basic nursing
physical assessment according to critical elements with 100% accuracy.
20.1
ADN12B Spring 2012
ADN 12BL – Health Deviations 3 Laboratory
SKILL ASSESSMENT: PHYSICAL ASSESSMENT OF THE DEPENDENT PATIENT
Student Name_________________________________________ Date______________
Student Signature: _____________________________________
Evaluator____________________________________________
CRITICAL ELEMENTS
Pass Fail Comments
1. Performs examination in pre-determined sequence to
include maneuvers that will complete the basic nursing
assessment and identify abnormalities and normal variations
of clinical findings of the patient.
2. Documents clinical findings accurately on the Nursing
Care Worksheet.
3. The patient remains comfortable during the examination.
PROCEDURAL ELEMENTS:
1. Position patient as if on bed rest. Move patient only as
necessary to perform assessment.
2. Assesses mucous membranes of mouth.
3. Complete a neurovascular assessment.
4. For cardiac assessment, listens over all four valvular areas.
5. For thorax assessment listens over several areas of the
anterior and posterior lung fields.
6. For abdominal assessment listens in all four quadrants and
lightly palpates for tenderness.
7. For musculoskeletal assessment, checks muscle strength in
all four extremities.
8. For lower extremities, checks bilaterally: (a) pedal pulses and
(b) ankle and pre-tibial edema
9. For skin assessment, views posterior as well as anterior
portions of the body. Assess for hygiene needs.
10. Records findings in appropriate areas of Nursing Care
Worksheet.
11. Completes the basic nursing assessment within 15 minutes.
RETEST:
Date:_______________________
Skills Evaluator:________________________________
20.2
ADN12B Spring 2012
Associate Degree Nursing Program
Nursing Care Worksheet for ADN 12BL – Health Deviations 3 Laboratory
Student _________________________
Physical and Functional
Assessment
Mental & Psychosocial Assessment
Cardiorespiratory Assessment
GI, Metabolic Assessment
GU, Fluid and Electrolyte Assessment
MS, Integument & Comfort Assessment
20.3
ADN12B Spring 2012
CASE STUDY
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3 Laboratory
GUIDELINES AND FORMAT FOR CASE STUDY
A. Policy for written work in the nursing program:
1. Eight and a half by eleven standard size white paper is to be used for all written assignments.
2. All written assignments are to be typed or written legibly in ink on one side of the paper only.
3. The following format is to be used for all written work.
a. Title on the first page with student’s name, date and clinical instructor’s name in the
center of the page.
b. All pages are to be numbered (including the title page)
c. The text of the paper is to be double-spaced.
d. Assignments of more than one page must be stapled together. The average length of the
case study for second semester should be 8-10 pages.
e. Each section of the case study is to be identified by a heading.
f. References should be cited throughout the paper.
4. Documentation style must be APA (American Psychological Association) except where
otherwise directed by these guidelines (see Information on APA Style).
B. Select one of your assigned patients to present in the case study. Discuss the selection with your
clinical teacher during the hospital day. The selected patient must be approved by your clinical
teacher.
C. The case study will be submitted in writing to your clinical instructor and will be presented orally
to your clinical group on an assigned day. A visual aid must be used for your presentation. See
your clinical instructor for suggestions.
D. Format for the case study
Basic conditioning factors
Include all information from the top of the nursing care worksheet.
Be sure to include the developmental level on a separate paragraph. Define the developmental
level. Provide a rationale for why the patient has achieved or failed to achieve resolution of
the appropriate Erickson’s developmental level using the definition of the developmental
level. Remember to cite information.
Anatomy and Physiology of the involved organs
Include a brief statement about the structure and function of each of the involved organs.
Include anatomy so it is easier to explain the patient’s pathology. This section is not to be
copied verbatim from a textbook but is to be paraphrased, in your own words, from
knowledge gained from biology and nursing textbooks. It is considered plagiarism if copied
verbatim. Remember to cite all of your material.
21.0
ADN12B Spring 2012
Pathophysiology
This section must include general information including statistics regarding the incidence
(how many patients have this condition/year) of the condition, predisposing and/or
precipitating factors, and the most common causes of the selected pathophysiology. Describe
what went wrong for this particular patient, the cause (if known), and any signs and symptoms
that your patient exhibited. Briefly describe any surgical or procedures that were performed.
Remember to cite all material.
Medical Orders
List the orders in effect for this patient (when you were assigned to that patient).
1. Activity, diet, IV fluid replacement, drains, etc., as the MD wrote the orders.
2. List all medications as the MD wrote: drug, dose, frequency, and route. Add the expected
therapeutic effect upon this particular patient.
3. List the results of the major diagnostic tests/procedures, including labs tests and state how
they contributed to the diagnosis.
Health Deviations (Two parts)
Balance Between Solitude and Social Interaction
1. For each category of the Universal Self-Care Requisites, describe the patient’s health
deviations that were caused by the illness (from the patient’s diagnosis).
2. For each category of the Universal Self-Care Requisites, describe the patient’s health
deviations that were brought on by diagnostic tests and treatments.
Nursing Diagnosis
Identify the PRIORITY nursing diagnoses (one) and the PRIORITY collaborative problem
(one) with specific goals and interventions. Attach your nursing care plan that you wrote for
this patient on the assigned day. If your nursing care plan was unsatisfactory, redo the nursing
care plan. Attach both nursing care plans with your paper.
References
Include a list of references, with publication dates within 5 years. Use APA style.
Include and attach a copy of a RESEARCH NURSING article that relates to the patient’s
problems and was helpful in writing this case study. Use the Cumulative Index of Nursing and
Allied Health Literature (CINAHL) in the college library or one of the health data bases to
help you find appropriate articles. Proquest is an excellent data base. There is a Proquest
tutorial link on the website at: http://nursing.lbcc.edu/ This may assist your search in finding
an appropriate journal article.
The article should be from a refereed journal. Articles that cite nursing research are preferred.
Refereed journal means that all articles are reviewed by peers before publication.
The article MUST be referenced in the body of your paper at least once. Give a short
synopsis of the article in the body of your paper and state how this article relates to your
topic.
21.1
ADN12B Spring 2012
Recommended: Visit the LAC LBCC library. The library has health care databases, with
many health care journal articles that are in full text on the database. For students who have
Internet access at home, the databases may be searched externally.
Below is the link to a Proquest tutorial that will help to narrow the search for appropriate articles
(courtesy of Karen Vogel, LBCC Librarian). The tutorial may also be found on the internet at the
LBCC RN homepage.
http://nursing.lbcc.edu/ProQuest%20Tutorial%20Nursing.htm
21.2
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3 Laboratory
INFORMATION ON APA STYLE
The American Psychological Association (APA) style of documentation differs from the
Modern Language Association (MLA) style taught in the English composition courses at LBCC in
English 1 and higher courses. The APA style, commonly used by the discipline of nursing, emphasizes
the date of publication. Sources more than five years old are considered outdated, although there may
be older sources with historical value (classics). APA maintains a Web site where up-to-date
information is provided at: www.apastyle.org
21.3
ADN12B Spring 2012
Long Beach Community College District
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL – Health Deviations 3 Laboratory
GRADING CRITERIA FOR CASE STUDY
Attach this page to the back of your case study.
Student Name __________________________________Date______________________
Correct
ITEM TO BE EVALUATED
Assignment typed in black ink on one side of 8
1/2” by 11” white paper.
2. Page formatting is according to APA 6th edition.
 Student’s name, date, and clinical instructor’s
name is centered on the title page.
 Pages are numbered and bound together.
 Each section of the case study is identified by
heading.
3. The format and content are college level.
 Documentation style is APA 6th edition.
 Paragraphs are organized and logical.
 Sentences are complete and grammatically
correct.
 Style is appropriate for a documented essay.
 Spelling is correct.
 All content taken from sources is referenced
and paraphrased or correctly quoted.
4. The patient selected was approved by the clinical
teacher.
5. A visual aid was utilized in the oral presentation.
6. Basic Conditioning Factors included all
information.
7. The rationale for the selected Erikson’s
developmental level was reasonable, defined and
supported with evidence.
8. Anatomy and physiology (structure & function) of
the involved organ is complete and accurate.
9. Pathophysiology of the patient’s health deviations
is correct.




Statistics regarding incidence are given.
Predisposing and/or precipitating factors are
listed.
Most common causes are identified.
Source of the information is correctly cited.
21.4
ADN12B Spring 2012
Not
Correct
Comments
Correct
ITEM TO BE EVALUATED
10. Pathophysiology of the selected patient is
complete.
 Possible causes for the disease in this patient
are given.
 The disease process is discussed (correlate the
theory with your patient)

Diagnostic test results including laboratory
studies related to the disease are given.
Interpretations are given.
11. Medical orders in effect are listed:
 Medications are listed along with expected
therapeutic effect and nursing
responsibilities are discussed and supported.
 Medical treatments and the patient’s
response to those treatments are included.
12. Health Deviations are listed according to
Universal Self-Care Requisite categories and are
described according to:
1.
Health Deviations brought on by illness
are identified accurately
2.
Health Deviations brought on by
diagnostic tests and treatments.
13. Nursing Diagnoses are listed and PRIORITY.
 Nursing Diagnoses accurately reflect patient
needs.
 Collaborative problems are included and are
accurate.
 Goals are specific for the patient and the
nursing diagnosis or collaborative problem.
 Interventions are specific for the patient and
the nursing diagnosis or collaborative
problem addressed.
14. The satisfactory Nursing Care Plan is attached.
15. A copy of a nursing research article is
attached. The article was approved by the clinical
instructor. This article is used in the case study and
is correctly referenced.
The article was cited once in the body of the paper (give
a synopsis of the article and state how it relates to the
paper)
16. The list of references is included.
21.5
ADN12B Spring 2012
Not
Correct
Comments
GENERAL INFORMATION
FOR
CLINICAL
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL - Health Deviations 3 Laboratory
CLINICAL PRACTICE EXPERIENCES IN ADN 12BL
Clinical Practice
Your clinical practice in this course will be in medical nursing units in an acute care
medical center. You will be working with patients who have, in addition to any chronic illnesses,
acute illnesses that are commonly treated by advanced medical interventions that require twentyfour hour nursing services. Medical patients may be combined with surgical patients on some
medical/surgical floors.
The laboratory course time is 10 hours a week, the same as in ADN 12AL. The laboratory
time is divided into a single 8-hour clinical day and a 2-hour campus lab.
You will continue to monitor and add IV fluids to existing intravenous access catheters.
In local acute care hospitals all intravenous fluids and medications are administered by registered
nurses. By California regulations, only registered nurses may give ordered intravenous
medications by IV push. In every case the nurse administering intravenous medications does so
following agency policies. You must read and follow the LBCC policies regarding IVs that are
provided in the campus laboratory material.
You will also be assigned to be a group leader at some point during the rotation. In this
role, you will be supervising a group of students.
In addition you will also be assigned one or more days off the nursing unit to
observe/participate in special procedure areas where nurses play a vital role in monitoring and
maintaining the health and safety of the patient. Follow the guidelines in the course study guide
for these learning assignments.
The Team Member student must prepare ADN 12BL Nursing Care Plans on all of his or
her assigned patients each week. The completed Nursing Care Plan is to be submitted to your
clinical instructor during the clinical day. The time of submission of the care plan will be
arranged with your individual instructor. The goal for the semester is to complete all care plans
and have them turned in within two hours of the beginning of the shift. You are expected to do
preliminary work on the Nursing Care Plan at home after
choosing your patient in the clinical facility. The care plan must be completed with all ordered
treatments and medications, whether or not you carried out the nursing activities.
If you are ill or unable to attend clinical, you must notify the instructor and if you have
posted an assignment, the floor on which you are assigned. Failure to notify both the instructor
and the assigned floor may result in a progress note. Your instructor may ask that you make up
the assigned day by coming in for another clinical day or by completing a written assignment.
22.0
ADN12B Spring 2012
Written Work
1. Each clinical day as Team Member:
a. Before arrival on the unit, have the names of medication to be given by you,
along with the nursing responsibilities, written on the Drug Therapy Worksheet.
The nursing responsibilities of any new medications to be given will be looked
up before giving the medication.
b. Early in the shift, by 0800, have your initial assessment and vital signs completed
on all of your patients and be prepared to discuss the patient’s assessment, orders
including medications, laboratory data, and your plan for the day. Complete the
assessment portion of your Nursing Care Plan. Vital signs are to be charted in the
patient’s chart immediately after completing them.
c. Have the assessment in the patient’s chart completed by 0900.
d. The DAR notes that are to be charted on each of your patients are due by 1130 so
that they can be checked by your instructor.
e. Nursing Care Plans are to be completed and turned in to the instructor during
your shift. The Nursing Care Plan is intended to be a plan of care for the day
therefore they are to be completed early in the shift at a time designated by your
instructor. Group leaders will collect the care plans and begin reviewing them
before the instructor begins grading them.
2. Each clinical day as Group Leader:
a. Complete observational rounds on each assigned patient and have the completed
“Patient Information Worksheet for Group Leader” ready to review with your
instructor by 0800.
b. Complete the medication times grid on the “Medication Information Worksheet
for Group Leader” including all members of your team by 0800. Your instructor
will need this information to properly supervise the students.
c. Complete a brief evaluation of each student addressing strengths and areas
needing improvement. Review this evaluation with each of the group members.
5. When assigned to an observational experience, complete an ambulatory care experience
assignment and turn in to your instructor on Friday.
22.1
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
School of Health and Science
Associate Degree Nursing Program
ADN 12BL Health Deviations 3 Laboratory
CLINICAL ORIENTATION DAY
BEHAVIORAL OBJECTIVES:
Bring the “Self-Orientation to Nursing Unit,” this page and your entire clinical manual with you
on the hospital orientation day.
During your assigned clinical orientation day:
1. Complete a “Self –Orientation to a Nursing Unit” by identifying:
a. The physical arrangement of the clinical area.
b. The names and roles of staff members.
c. The location of emergency equipment: CPR cart and fire equipment.
d. The usual times for daily activities.
e. The agency medication procedure and legal checks.
f. The types and location of various sections of the patient chart.
g. Forms on chart and elsewhere which must be completed as part of patient care.
h. Documentation procedures used at the assigned agency.
2. Provide nursing care for patient as assigned.
3. Document in the agency flow sheets, following agency policy.
4. Identify the various ethnic minorities and socioeconomic groups served by this clinical
agency.
5. Discuss the health care need of at least two of the identified ethnic minorities and/or
socioeconomic groups.
6. Discuss how the health care agency works to meet the identified health care needs of the
identified ethnic minorities and/or socioeconomic groups.
23.0
ADN12B Spring 2012
Long Beach City College
Associate Degree Nursing Program
Self-Orientation to a Nursing Unit
Student Name:
Agency:
You will be assigned to many different nursing units during your educational program. It
is important that you develop the ability to assess a unit and its routines rapidly. The following
form gives a format for self-orientation and is to be completed on your hospital orientation day.
Your clinical instructor will give you additional directions as necessary. Share information with
each other. Go about the orientation quietly, to keep confusion to a minimum. Ask staff for
clarification only after you have exhausted all other sources. Any further questions will be
clarified in conference.
I. General
A. What is the usual daily routine?
1. Change of shift report time AM
Place
Who listens to this report?
2. Patient meal times: Breakfast
PM
Lunch
Who passes out trays?
3. Routine vital signs times
4. Conference time
Place
B. Where are the Nursing Policy and Procedures manuals?
C. When are visiting hours?
D. List name and title of four staff members on the unit today:
_____________________________
_____________________________
______________________________
______________________________
E. Identify room numbers in the corridors. Locate sterile supply room, linen and
utility rooms, medication rooms, medication room (cart), unit pharmacy.
23.1
ADN12B Spring 2012
II. Communication
A. Where is the daily staff assignment sheet posted?
Who makes this out?
When
Where is student assignment sheet posted?
B. How do you know which patients are NPO?
C. How and who would you notify if you were going to be tardy or absent?
D. Investigate the floor’s call light system. How do you turn off the patient call light?
________________
III. Safety
A. Where is the crash cart located?
Who is responsible for checking the cart?
How often?
B. Where are the fire extinguishers?
Fire Hoses?
C. What do you do when a fire code is announced?
D. How do you initiate an emergency CPR event?
E. How is an emergency CPR event announced?
F. What is your responsibility as a student in an emergency CPR event (code)?
IV. Medication
A. Identify the medication record and the correct method of charting medications as given or
not given.
______________________________________________________________
B. Where are medications including refrigerated IVPBs kept?
______________________________________________________________________________
C. How is the medication record checked with the medical orders?
__________________________________________________________________
23.2
ADN12B Spring 2012
D. How do you obtain a missing oral or parenteral medication?
__________________________________________________________________
E. Where are the IV fluid bags stored? _____________________________________
Where are the IVPB and other IV medication kept? ________________________
What kind of needleless system is used? _________________________________
F. Where are narcotics kept?
_____________________________
If there is a key, who carries it?
How are narcotics signed out?
__________________
______________________________
H. How are you notified of a change and/or new medication order?
__________________________________________
V. Patient Care
A. You are to take vital signs. What type of thermometer is used?
Where is it located?
lubricant?
Where is rectal thermometer?
BP Cuff
scales?
stethoscope
Where is the TPR recorded? ____________________
B. You are preparing to give AM care. There is no equipment in the room. Where
would you find the following?
clean linen
dirty linen receptacle
soap
bedpan
wash basin
water pitcher
sterile urine specimen bottle
________________
denture cup
_____________
C. You are to insert a Foley catheter. Where would you find the following?
Sterile cath tray
extra catheter
extra sterile gloves
drainage bag
How is the patient charged for what is used?
flash light
_____________
D. You are going to change a dressing. Where are the supplies such as tape, 4x4’s?
etc.?
ADN12B Spring 2012
How do you charge for what is used?
23.3
E. An IV is to be started. Where are supplies stored? IV Solutions
IV pole
tubing
IV catheter
____
pumps _____________________
F. What does AM Care mean?
G. Where do you put full soiled linen bags?
H. Where do you put items to be returned for cleaning and sterilization?
VI. Paper Work
A. What kind of time is used?
B. Where do you chart voiding?
Meals
BM
__________________________________________________
C. Who charts vital signs on the flow sheet?
When
__________________________________
D. What type of nursing notes are done and where are they charted? (format)
__________________________________________
_____
E. Where are the bedside I & O worksheets kept?
F. When is the end of shift I & O totaled?
Where is it recorded?
___________________________________
Who is responsible for totaling the I & O
G. How are nurses notified of new orders?
Where and how are charts with new orders handled?
______
____________
______
VII. Patient Population
A. Identify the two most populous ethnic minorities or socio-economic groups served by the
agency.
1.
2.
23.4
ADN12B Spring 2012
B. Discuss how the health care needs of these identified groups may be different from those
of the majority or affluent members of our society.
1.
2.
C. Discuss how the agency works to meet the needs of these identified groups.
1.
2.
23.5
ADN12B Spring 2012
Long Beach Community College
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL - Health Deviations 3 Laboratory
GUIDELINES FOR SELECTION OF PATIENT ASSIGNMENTS
1. Independently review these guidelines prior to planning the clinical day. Communicate
with other members of the student team to coordinate the selection of patients. The staff
nurses will appreciate your helping each other by relaying information rather than asking
the nurses the same question several times.
2. Avoid going to the hospital at change of shift time.
3. Go to the nursing unit in business-type clothing or navy blue scrubs with your white
uniform jacket, including patch and name pin. Casual dress, such as open-toed shoes and
blue jeans, are not appropriate attire. Bring all the needed worksheets and some extra
paper.
4. Upon arrival at the nursing unit look for a student assignment sheet to determine if
patients have already been selected. If you are the first student to be selecting patients,
post a Student Assignments form on which you will post your assignments.
5. Review the patients on the unit for acuity, number of IVs, and complexity by reviewing
charts or the computer and by asking staff on the unit. The nurses may know whether
patients will likely to be going home before your assigned day.
6. You may introduce yourself to your assigned patients.
7. Post your patient selection by room number and patient’s name on the “LBCC Nursing
Student Assignment” form and post in the designated area only.
24.0
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
School of Math, Health and Science
Associate Degree Nursing Program- ADN12BL Health Deviations 3
STUDENT ASSIGNMENTS
Nursing Unit _______________________
Instructor: __________________________
Cell # __________________
Day and Date:________________________
Time on unit:____________
STUDENT
ASSIGNMENT
Bed # and Pt’s Initials
Group/Team Leader
Member
Member
Member
Member
Member
Member
Member
Member
Off the ward
Location
Comments:
25.0
ADN12B Spring 2012
Assigned RN/Lunch Time
Long Beach Community College
LONG BEACH CITY COLLEGE
Associate Degree Nursing Program
ADN 12BL - Health Deviations 3 Laboratory
BEHAVIORAL OBJECTIVES FOR GROUP LEADER
A. Demonstrate increasing competency in the role of nurse manager of care by:
1. Assuming responsibility of selecting or arranging with the student group members to
select patients for the next day’s clinical experiences as directed by written guidelines and
the instructor’s verbal instructions.
2. Performing the role of the group leader according to the written guidelines and the verbal
instructions of the clinical instructor.
3. Demonstrating increasing ability of how to prioritize nursing care for a group of
patients/patients.
4. Demonstrating increasing effectiveness of communication and work skills needed to lead
a work group.
B. Specific behavioral objectives for the clinical day:
1. Under the direction of the instructor and the staff registered nurses, serve as a student
group leader on the day shift.
2. With the assistance of the registered nurse team leader, assume professional nursing
responsibility for the group of patients assigned to the student group members.
3. Serve as a liaison for the nursing instructor.
GUIDELINES FOR GROUP LEADER
Group Leader Preparation
Several days before the scheduled clinical experience
1. Independently review these behavioral objectives and guidelines for the group leader role.
2. Prepare a five-minute presentation on a topic pertinent to the course that you believe will
be new information for the other students. Please have the topic approved by your clinical
instructor prior to the clinical day. You will present the short topic during clinical
conference.
26.0
ADN12B Spring 2012
Before the scheduled clinical experience
1. Contact the other members of your student group and obtain the room numbers, names,
and diagnoses of assigned patients.
2. Prepare a tag to add to your name pin: “GROUP LEADER.”
The day before the scheduled clinical experience
1. After exchanging information with all group members, prepare a 12BL “Patient
Information Worksheet for Group Leader”. Include all of the patients assigned to the
student group. Prepare this in pencil.
2. Prepare the “Medication Worksheet Information for Group Leader” for each assigned
patient. Write in the medications to be given in the correct hour box, using only one line
for each patient. When completed, this will give you a grid of patients, times, and
medications to be given including IV medications.
3. Remember to prepare for the clinical day by gathering the information needed to care for
the patients assigned to your group. This information includes reviewing or researching
the pathology and nursing care associated with the various medical diagnoses, surgical
procedures, and prescribed therapies.
Before the shift begins
1. Wear your group leader tag identifying yourself as the student group leader.
2. Verify that all of the patients assigned yesterday are still there. Verify that no students
have called in sick or tardy.
3. Make sure the up-to-date student assignment is posted in the correct area. Initial beside
your name to indicate you are on duty.
4. When staff assignments have been made, write the name of the staff person co-assigned
with each student on your worksheet.
C. During the morning
1. Remind students to listen to report on their patients. Coordinate efforts to fill in for each
other for the change of shift report. If report is delayed, begin your “Quick Look” rounds.
2. Listen to report on the patient assigned to your group. Listen to report on as many patients
as possible to obtain up-to-date information on all of the assigned patients.
3. Quickly visit each patient assigned to your group to perform “Quick Look” rounds.
26.1
ADN12B Spring 2012
By one hour after the start of the shift
1. Early in the shift, confer with each student group member at the bedside. Review the
observational rounds assessment and planned interventions with the student for
completeness and accuracy.
2. Complete and or revise the medications' time schedule for the instructor to review.
3. Assign student group members to their breaks and lunch times so that at least one
member of each group is on the unit at all times.
During the morning
1. Show the instructor your completed “Patient Information Worksheet for Group Leader”
and discuss any concerns or questions relevant to the care of the patients.
2. Show the instructor your completed medication worksheet.
3. Assist with finding new learning experiences on the unit.
4. Identify students who need more practice with desired skills. Help them seek out
opportunities to perform these skills.
5. Assist group members as needed with their assigned patients.
6. Serve as liaison for the instructor to:
a. Identify needed student supervision or instruction
b. Identify problems as they occur
7. About two hours after the start of the shift, check the patient charts to see that the
morning agency assessments are recorded.
8. Collect nursing care plans from students as directed by your instructor.
9. Expect the other students to have most of the morning care provided for their patients by
1100.
26.2
ADN12B Spring 2012
Afternoon, after lunch
1. Ensure that all tasks for assigned patients have been completed. If there are tasks that will
not be completed, advise the responsible nurse now.
2. Assess how you and other students have functioned during the shift. Complete the
evaluation form for your student group members.
3. Visit each patient again for observational rounds and review charts for completion.
End of Student Shift
1. Give report on your group’s patients to the registered nurse team leader.
2. Assess how you and other students have functioned during the shift. Complete the
evaluation forms for yourself and for each of the other students. You may do this after
conference if necessary or convenient.
3. Check that all students have reported off to their RN and are ready to leave. Have
students go to the assigned conference room.
E. Scheduled Conference
1. Present previously approved five-minute information session.
2. Clinical will be dismissed by the instructor following conference. No one is to leave until
all tasks, including documentation, are completed.
26.3
ADN12B Spring 2012
Long Beach City College Associate Degree Nursing 12BL – Health Deviations 3 Laboratory
PATIENT INFORMATION Worksheet for Group Leader
Student Group/Team Leader___________________________
Date:_______________________
Student
member
RN
Observational Rounds
“Quick Look”
Rm/bed
Name
M/F Age
Admitted:
Medical Dx
Vital
Signs
Observational Rounds
“Quick Look”
Rm/bed
Name
M/F Age
Admitted:
Medical Dx
Wounds
Drains
Out
Sig.
labs
Priority
New orders
Need/Prob. Info. from report
Out
Sig.
labs
Priority
New orders
Need/Prob. Info. from report
Out
Sig.
labs
Priority
New orders
Need/Prob. Info. from report
Site
Condition
Saline Lock [ ]
Fluids
Rate
Fluids:
Vital
Signs
Resp.
status
Activity:
LOC,
Comfort, PRN
Treatments:
Nutrition F&E
oral
enteral
In
IV Fluids
Begin
Shift
Wounds
Drains
Site
Condition
Saline Lock [ ]
Fluids
Rate
Medical Orders: Diet:
Appointments/procedures
RN
In
IV Fluids
End
Shift
NA
Student
member
Nutrition F&E
oral
enteral
Begin
Shift
Medical Orders: Diet:
Appointments/procedures
RN
LOC,
Comfort, PRN
End
Shift
NA
Student
member
Resp.
status
Observational Rounds
“Quick Look”
Rm/bed
Name
M/F
Age
Admitted:
Medical Dx
NA
Medical Orders: Diet:
Appointments/procedures
Fluids:
Vital
Signs
Resp.
status
Activity:
LOC,
Comfort, PRN
Treatments:
Nutrition F&E
oral
enteral
In
IV Fluids
Begin
Shift
Site
Condition
Saline Lock [ ]
Fluids
Rate
End
Shift
Fluids:
Activity:
26.4
ADN12B Spring 2012
Wounds
Drains
Treatments:
Student
GTL
RN
“Quick Look”
Rm/bed
Name
M/F Age
Admitted:
Medical Dx
NA
Signs
status
Comfort, PRN
oral
enteral
IV Fluids
Site
Condition
Saline Lock [ ]
Fluids
Rate
Begin
Shift
Drains
labs
Need/Prob. Info. from report
Out
Sig.
labs
Priority
New orders
Need/Prob. Info. from report
Out
Sig.
labs
Priority
New orders
Need/Prob. Info. from report
End
Shift
Medical Orders: Diet:
Fluids:
Activity:
Treatments:
Appointments/procedures
Student
GTL
RN
Observational Rounds
“Quick Look”
Rm/bed
Name
M/F Age
Admitted:
Medical Dx
NA
Vital
Signs
Resp.
status
LOC,
Comfort, PRN
Nutrition F&E
oral
enteral
In
IV Fluids
Begin
Shift
Wounds
Drains
Site
Condition
Saline Lock [ ]
Fluids
Rate
End
Shift
Medical Orders: Diet:
Fluids:
Activity:
Treatments:
Appointments/procedures
Student
GTL
RN
Observational Rounds
“Quick Look”
Rm/bed
Name
M/F Age
Admitted:
Medical Dx
NA
Medical Orders: Diet:
Vital
Signs
Resp.
status
LOC,
Comfort, PRN
Nutri tion, F&E
oral
enteral
In
IV Fluids
Begin
Shift
Site
Condition
Saline [ ]
Fluids
Rate
End
Shift
Fluids:
Activity:
Appointments/procedures
26.4
ADN12B Spring 2012
Wounds
Drains
Treatments:
Long Beach City College Associate Degree Nursing 12BL -Health Deviations 3 Laboratory
Medication WORKSHEET Information for Group Leader
Group Leader ________________________
Date
MEDICATION TIMES
Student
Rm/bed
Patient
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
DX:
IV:
0700
0800
0900
1000
1200
1300
1400
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
po
IM
IV
26.6
ADN12B Spring 2012
1100
PRN MEDICATIONS
Directions: Include any prn medications given by team members here.
Rm/
Drug Name
Subclass
PRN
Nursing
Name
generic and brand
Action
for
Responsibilities
TASK COMPLETION CHECK LIST
Directions: When performing as the student group leader, use this form to verify that the student team members that you
are supervising have completed all of the assigned tasks.
Student Nurse Team Member
LDA 08 VS Nrs A/I Meds Treatments I & O
12 VS
charted done & charted charted
recorded Charted
charted
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Student Nurse Team Member
LDA 08 VS Nrs A/I
charted done &
charted
Meds Treatments I & O
12 VS
charted charted
recorded Charted
LDA 08 VS Nrs A/I
charted done &
charted
Meds Treatments I & O
12 VS
charted charted
recorded Charted
LDA 08 VS Nrs A/I
charted done &
charted
Meds Treatments I & O
12 VS
charted charted
recorded Charted
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Student Nurse Team Member
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Student Nurse Team Member
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
Rm/Bed _____ Patient __________________
26.7
ADN12B Spring 2012
PEER EVALUATION SHEET
Group Leader Name ____________________ Date __________________________
Student __________________________
Strengths:
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
_____________ _________________
Evaluator
Student Signature
Student __________________________
Strengths:
_____________ ___________________
Evaluator
Student Signature
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
_____________ ____________________
Evaluator
Student Signature
Student __________________________
Strengths:
_____________ ____________________
Evaluator
Student Signature
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
_____________ ___________________
Evaluator
Student Signature
Student __________________________
Strengths:
_____________ ___________________
Evaluator
Student Signature
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
____________
Evaluator
___________________
Student Signature
_____________
Evaluator
26.8
ADN12B Spring 2012
___________________
Student Signature
PEER EVALUATION SHEET
Group Leader Name ____________________ Date __________________________
Student __________________________
Strengths:
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
_____________ _________________
Evaluator
Student Signature
Student __________________________
Strengths:
_____________ ___________________
Evaluator
Student Signature
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
_____________ ____________________
Evaluator
Student Signature
Student __________________________
Strengths:
_____________ ____________________
Evaluator
Student Signature
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
_____________ ___________________
Evaluator
Student Signature
Student __________________________
Strengths:
_____________ ___________________
Evaluator
Student Signature
Student __________________________
Strengths:
Areas to improve:
Areas to improve:
____________
Evaluator
___________________
Student Signature
_____________
Evaluator
26.8
ADN12B Spring 2012
___________________
Student Signature
ADN 12BL -- Health Deviations 3 Laboratory
SAMPLE DAILY SCHEDULE
for
TEAM MEMBER
The evening before:
1. Go to the medical center the day before to select your own patients. Arrange with your
group leader the time and method of communication.
2. Write, in pencil, on the “Drug Therapy Worksheet” the names, action, and nursing
responsibilities of the medications to be given to each patient.
3. On the “Drug Therapy Worksheet” complete (in pencil) the names, action, and nursing
responsibilities of the medications you will be giving. Include the PRN medications that
you might give.
4. Review any laboratory studies that you are unfamiliar with using your Diagnostic
Studies reference book.
5. Review the medical and surgical diagnoses of your assigned patients, using your
medical/surgical nursing text and other reference material.
Each clinical day:

Arrive and get prepared for the shift. Initial the assignment sheet to show that you
are on duty. Introduce yourself to the responsible RN when he/she arrives.

Verify that your medication worksheet and grid are complete. Write in the
planned nursing interventions on the “Nursing Care Plan.”

Meet with the Group Leader to review medications times and patient care
priorities. Exchange and clarify information regarding the planned care for the
day.

Vital signs must be on the medical record immediately after they are obtained.
The physical assessment should be on the chart within two hours from the start of
the shift.

With clinical instructor give oral, IM and Sub-Q medications at scheduled times.
Have any nursing responsibilities, such as taking blood pressure, completed just
prior to calling your instructor to give medications.

Carry out planned nursing interventions including daily bath and linen change.

Complete your nursing care plans. These care plans are plans of care for the day
and are to be completed early in the shift. Your instructor will specify the time
that they are to be collected by the group leader.
27.0
ADN12B Spring 2012

After lunch, write DAR notes for your assigned patients and review them with
your instructor before writing them in the chart.

Complete all nursing tasks and documentation. Complete the intake and output
record as directed by your assigned RN.

Report off to the responsible staff RN and to the Group Leader. When you are
finished go to the assigned conference room for clinical conference.
27.1
ADN12B Spring 2012
Long Beach City College
Associate Degree Nursing Program
Nursing Care Plan Assessment Guidelines
Mental and Psychosocial:
*Level of Consciousness, Orientation, Affect
Communication deficits including language, hearing, speech, sight.
Significant other, home caregiver
*Spiritual or psychosocial concerns, quote patient/family as needed
Cardio respiratory:
*Vital signs, include pulse ox if appropriate with oxygen delivered.
Respiratory pattern, skin color, c/o dypsnea if applicable
*Lung sounds, Heart sounds
Cough?, productive?, appearance of sputum
*Edema
*Pulses, cap refill
GI Metabolic:
*Appetite, % of diet taken
Difficulty eating? Dentures?
Any nausea?
Mouth: mucous membranes
Recent blood sugar if diabetic, insulin coverage?
*Body habitus: cachexic, normal, obese; Height and weight if abnormal.
Any enteral or IV feedings with type and rate, residual amount.
*Abdominal assessment: bowel sounds, soft or firm to palpation
*Last BM with amount, consistency, color if known
GU, Fluid and Electrolyte:
*Skin turgor
*Mucous membranes
*IV site, solution, rate
Daily weight: include admission wt if available (if ordered or appropriate)
Abdominal girth if ordered daily
*Urine color, amount
Intake and output from previous day: esp. in CHF, renal failure pts.
Continent?
Musculoskeletal, Integumentary, and Comfort:
*Activity level
Assistive devices
Skin condition: lesions? Dressings Continent?
*Muscle strength
Posture/ alignment
Amputations? Deformities?
Restraints? DVT prevention?
Level of wakefulness: restless? lethargic?
*Pain, discomfort with scale
*Sleep report
*To be included even if normal
28.0
ADN12B Spring 2012
Long Beach City College ADN Program
Medical-Surgical Nursing Care Plan ADN12BL
Student ________________________Date______________Patient’s Initial_______RM/Bed#_________Adm Date_______________
Responsible Nurse_________________Coassigned NA
MD
Medical Diagnosis
Reason Pt Nsg Care
Basic conditioning factors: Age
Sex
Religion
Occupation
Ethnicity
Family Role
Develop level
Allergies
Code status
Predisposing factors/Past medical hx
Universal
Self Care
Requisites
Maint. of
balance
between
Solitude &
Social
Interaction
Physical Assessment
Lab Data – Dx tests
Self Care Deficits
Nursing Dx, r/t, 2º, AEB
Collaborative problems
CNS & Psychosocial
Cardio-respiratory
Maint. of
Sufficient
Intake of
Air
Maint. of
Sufficient
Intake of
Food
GI metabolic
Elimination
Process
Maint. of
Sufficient
Intake of
Water
GU, Fluid, electrolytes
Elimination
Process
MS, Integument, & Comfort
Maint. of
Balance
between
Activity &
Rest
****** Star the priority problem ******
ADN12B Spring 2012
29.0
Goals
Nursing Interventions
Independent, Collaborative,
Dependent and Drugs
Nsg
Agy
TASK WORKSHEET for Team Member
Include medications and tasks to be completed
Rm/Bed
Patient
0700
0800
VS
0900
Px. As.
1000
1100
Note
Describe the pathophysiology of the patient’s disease process.
DAR/PIE/Outcome Nursing Notes:
29.1
ADN12B Spring 2012
1200
VS
1300
1400
Long Beach City College
ADN12BL
Drug Therapy Worksheet
Student___________________________ Date_______________________ Pt initials and room #____________
Drug Name
Generic/Brand
and
Dose
Route
Class of
Drug
Drug
Action
Reason
prescribed to
THIS patient
29.2
ADN12B Spring 2012
Nursing
Responsibilities/
Labs/Drug levels
Normal Dose
Range
Laboratory or
Test Name
Normal Range
Patient
Results for
previous days
Patient Results
for assigned
day
Wbc
Hbg
Hct
plt
eGFR
BUN
Creatinine
K+
Na+
Mg++
Ca++
Glucose
AST
ALT
Bili T & D
INR
PTT
PT
UA
Urine Cx
Wound Cx
CXR
MRI
29.3
ADN12B Spring 2012
Nursing Responsibility, Clinical
Implications
Probable cause of any abnormals
ADN 12BL - Health Deviations 3 Laboratory
AMBULATORY CARE EXPERIENCE
BEHAVIORAL OBJECTIVES
Type the behavioral objectives on a separate sheet of paper and submit to your clinical
instructor on the Friday following the experience.
1. List and describe three (3) of the roles of the RN observed in the assigned area.
2. Describe the critical thinking necessary to work in the assigned area and give one example
of critical thinking you observed.
3. Identify the primary concern of three (3) patients you cared for and write one complete
nursing diagnosis for each of the patients.
4. List and provide details for three (3) procedures you observed.
5. List and describe three (3) procedures you performed.
6. Describe any new nursing skills or critical thinking activities that you observed.
7. State how this experience will assist you in future clinical rotations.
30.0
ADN12B Spring 2012
STUDENT
CLINICAL
EVALUATION
31.0
ADN12B Spring 2012
LONG BEACH CITY COLLEGE
Associate Degree Program
ADN 12 BL Health Deviations 3
STUDENT CLINICAL EVALUATION
Student Name _______________________________________________
Dates of Course ______________________________
Theory: _______%, Course Letter Grade: _______ (Do not put your grade in this box, your instructor will)
Overall Clinical Rating:
( ) Satisfactory,
( ) Marginal,
( ) Unsatisfactory
Dates:____/____/________Through:____/_____/_____
Clinical Agency: _______________________________
Clinical Absences:__________ Tardies: _____________
Lab Absences:____________ Tardies: _____________
Introduction:
The student is expected to satisfactorily participate as a member of the clinical team; to complete all assigned course outcomes while safely, effectively, and consistently
using acceptable principles of client care.
Directions:
Both the student and instructor will evaluate each student’s performance. The student evaluates self in the indicated column. If the instructor agrees, no additional mark
will be made. If the instructor’s evaluation differs with that of the student, the instructor will circle the student’s mark and initial. The instructor will then mark the
column indicating the evaluation of the student.
Criteria:
--Overall Satisfactory Rating
At the end of the course, each student is expected to receive a satisfactory rating on 75% or more of the clinical days to receive a passing grade.
--Overall Clinical Marginal Rating
An overall clinical marginal rating may be based on one overriding area of safety or on a group of behaviors that have been identified as “Marginal” (Must Improve) in 50%
to 74% of the behavioral objectives for the course.
--Unsatisfactory Clinical Rating
An unsatisfactory clinical rating will be given for clinical practice whenever the student receives a second Overall Clinical Marginal Evaluation, or whenever the student
demonstrates unsafe clinical practice, i.e., patient safety or welfare is compromised, or meets less than 50% of the behavioral objectives for the course. See Student
Handbook for explanation of process and options.
Criteria Definition:
-A check in the S (Satisfactory) column indicates that 75% or more of the time, the student demonstrated appropriate behavior, knowledge, and skills consistent with the
current level of student experience.
-A check in the M (Marginal) column indicates that 50% to 74% of the time, student behavior does not meet the expected objective(s). Documented comments should clarify
the problem area(s).
-A check in the U (Unsatisfactory) column indicates that the student met their objectives less than 50% of the time, and that behavior is below the acceptable level of
performance. A behavior compromising the safety of the client will result in an unsatisfactory evaluation. Unsatisfactory areas will be documented in the appropriate
section(s) on the evaluation.
-A check in the N (Not Applicable, or not observed) column indicates that the behavior was not evaluated.
ADN12B Spring 2012
Clinical Outcomes for Health Deviations 3
At the completion of this course the student will satisfactorily complete the following clinical outcomes for the medical patient.
I. Professional Behaviors
1. Assimilates and integrates professional values of caring, integrity, honesty, patient
advocacy and respect for human dignity within the professional role.
2 Practices within the ethical, legal, and regulatory frameworks of nursing and standards of
professional nursing practice in the Health Deviations 3 course.
a. Attendance - follows student handbook policy.
b. Promptness - on duty on time, returns on time from break.
c. Appearance - follows dress code. Refer to student handbook.
d. Provides up-to-date Health and Safety requirements.
e. Upholds the Honesty Policy.
f. Meets clinical agency requirements.
3. Demonstrates responsibility and accountability for one's actions and learning needs.
a. Preparation - comes with proper materials and written preparation to perform assigned role.
b. Submits all assignments within designated time frame, including make-up assignments.
c. Calls attention to own errors and reports situation accurately
d. Maintains professional boundaries in the nurse-patient relationship
e. Performs with reasonable composure
f. Requests supervision when needed.
g. Shows initiative in meeting learning needs.
4. Maintains organizational and patient confidentiality/abides by HIPAA standards.
5. Maintains professional and collegial relationships with the healthcare team and instructor
ADN12B Spring 2012
S>
75%
M 50-74%
U < 50%
N/A
Comments
II. Communication
S>
75%
M 50-74%
U < 50%
N/A
Comments
S>
75%
M 50-74%
U < 50%
N/A
Comments
1. Utilizes effective communication skills with colleagues, clinical staff, and instructor
using proper verbal and written English.
2. Communicates relevant, accurate, and complete information concisely.
a. Communicates clearly in English both verbally and written.
b. Agency charting and nursing notes are relevant, accurate, complete, and clear.
3. Reports and documents assessments and interventions and progress toward
patient outcomes.
a. Documents according to LBCC and agency policy and guidelines.
4. Utilizes appropriate channels of communication to achieve positive patient outcomes.
a. Identifies self as caregiver and delineates responsibilities to the co-assigned licensed
personnel and staff at the beginning of the shift.
b. Gives report prior to leaving unit.
c. Utilizes agency’s designated communication/hand-off tool (e.g. SBAR).
5. Applies speech communication skills in oral case study presentation to the clinical group.
III. Orem’s Self-Care Theory as it relates to the Nursing Process
1. Utilizes Orem's Theory to establish each patient's database.
a. Considers patients developmental self-care requisites and their ability to provide self-care.
b. Collects and validates data pertinent to the patient's condition to determine deficits in the
USCR.
c. Utilizes appropriate nursing agency when providing for patients' self-care deficits
2. Nursing Process
a. Assessment
i. Performs a thorough head-to-toe assessment; elicits subjective data.
ii. Collects and validates additional data pertinent to the patient's condition to determine
ADN12B Spring 2012
III. Orem’s Self-Care Theory as it relates to the Nursing Process (Continued)
b. Diagnosis
i. Selects a minimum of two priority patient-specific NANDA approved nursing diagnoses
for each patient.
ii. Selects a minimum of one priority collaborative patient-specific problem for each patient.
iii. Supports diagnoses with defining characteristics.
c. Planning/Outcomes
i. Develops a comprehensive/holistic plan of care based on assessment data
i. Identifies goals/outcomes
(i). Formulates specific, measurable, attainable and realistic goals/outcomes within a
time frame that correlate with nursing diagnoses (SMART).
(ii). Formulates a nurse oriented goal/outcomes that correlates with the collaborative problem.
d. Implementation
i. Identifies a minimum three patient-specific nursing interventions appropriate to achieve
goals/outcomes for each nursing diagnosis and collaborative problem.
ii. Assists the patient to obtain optimum comfort and functioning
iii. Demonstrates empathy when providing nursing care.
iv. Provides for privacy at all times.
v. Demonstrates respect and caring behavior towards the patients, significant others
vi. Shows interest in the patient's needs and responds in a positive manner
e. Evaluation
i. Evaluates interventions for efficacy.
ii. Re-evaluates patients' response to care.
3. Submits two to three complete nursing plans of care at the time specified per syllabus.
ADN12B Spring 2012
S>
75%
M 50-74%
U < 50%
N/A
Comments
IV. Critical Thinking
S>
75%
M 50-74%
U < 50%
N/A
COMMENTS
S>
75%
M 50-74%
U < 50%
N/A
COMMENTS
1. Utilizes clinical judgment throughout the nursing process in providing care.
a. Utilizes critical thinking and verbalizes rationale in providing care with minimal verbal cues.
i. Demonstrates application of theory to clinical situations.
ii. Correlates patients' pathophysiology with relevant lab values and medications.
iii. Utilizes assessment data, lab values, and clinical judgment in administering medications.
2. Uses clinical judgment in prioritizing nursing care for a three patient assignment.
3. Utilizes evidence-based information to support clinical decision-making.
a. Builds upon previous knowledge and applies newly learned content to clinical setting.
4. Formulates a written case study as per course requirements.
V. Safety
1. Provides accurate and safe performance of nursing skills.
a. Demonstrates continuing progress in mastering previously learned skills.
b. Performs newly learned skills with minimal verbal skills and increasing competency.
2. Reports actual/potential unsafe practices to instructor and co-assigned licensed personnel
a. Provides a safe physical and psychosocial environment for the patient.
b. Identifies and reports any potential safety hazards in the clinical setting.
3. Administers medications safely to assigned patients each clinical day.
a. Utilizes agency's policy to properly identify patients.
b. Respects patients' five rights before administering any medication.
c. Prepares, administers & manages oral, IM, SQ, ID medications safely with minimal verbal
cues.
d. Prepares, administers & manages intermittent intravenous medications safely with minimal
verbal cues.
e. Administers medications with 100% accuracy and monitors drug regimen.
f. Manages intravenous fluid therapy with minimal verbal cues.
4. Completes total patient care on a three patient assignment in a safe manner.
ADN12B Spring 2012
VI. Teaching and Learning
S>
75%
M 50-74%
U < 50%
N/A
COMMENTS
S>
75%
M 50-74%
U < 50%
N/A
COMMENTS
1. Identifies and plans for the learning needs for the patients.
2. Provides the patient and significant others with accurate information and skills needed to
achieve desired goals/outcomes.
a. Provides simple explanations and instructions to patients.
b. Instructs the patient prior to interventions and procedures.
c. Documents and reports patient's response to instruction.
VII. Collaborative Management of Care
1. Collaborates with the interdisciplinary health care team to achieve optimal patient outcomes.
2. Practices within guidelines of ADN 12BL; individual knowledge and expertise; and seeks
assistance for care beyond level of knowledge.
3. Acts as a team member in the multidisciplinary care of patients.
4. Provides leadership and support to peers as a group leader.
5. Manages a two to three patient assignment in an organized and efficient manner completing
care within allotted time frame.
ADN12B Spring 2012
Student Comments
Strengths:
Areas Needing Improvement:
Instructor Comments:
Problem Areas:
Student Signature
____________________________ (Do not sign until you meet with your instructor)
Date
____________________________
Instructor Signature
____________________________
ADN12B Spring 2012