HANOI MEDIAL UNIVERSITY

CALIFORNIA STATE UNIVERSITY, LONG BEACH

College of Health & Human Services
School of Nursing

NRSG 331
Spring 2014
Introduction to Critical Care Nursing
Priciple organizer:
Nguyen Thi Thanh Hoa, MD
Lecture Instructors & Clinical Instructors:
Nguyen Thi Thanh Hoa, MD
Bui Thi Huong Giang, MD
Do Ngoc Son, MD, PhD
Ha Tran Hung, MD, PhD
Ngo Duc Ngoc, MD, PhD
Nguyen Anh Tuan, MD
Hoang Bui Hai, MD
Ngo Duc Hung, MD
Nguyen Viet Ha, MD
I. General Information
A. Course Number: NRG 331
B. Title: Introduction to Critical Care Nursing
 C. Units: 5 (2 units for lecture and 3 units for clinical work)
D. Principle Instructor: Nguyen Thi Thanh Hoa, MD
E. Phone: 0904642889
F. E-mail: drthanhhoa@yahoo.com
G. Term: Spring 2014
H. Faculty: Nguyen Thi Thanh Hoa, MD
Bui Thi Huong Giang, MD
Do Ngoc Son, MD
Ha Tran Hung, MD
Ngo Duc Ngoc, MD
Nguyen Anh Tuan, MD
Hoang Bui Hai, MD
Ngo Duc Hung, MD
Nguyen Viet Ha, MD
P. Clinical Meeting Times: Varies according to facility
Q. Clinical Location: As assigned
(HMU Hospital, Bach Mai Hospital: ED, ICU, PCC)

R. Contact information:
Faculty Email Tel
Nguyen Thi Thanh Hoa drthanhhoa@yahoo.com 0904642889
Bui Thi Huong Giang giangbth@yahoo.com 0904061986
Do Ngoc Son sonngocdo@yahoo.com 0914669880
Ha Tran Hung hatranhung@yahoo.com 0913028360
Ngo Duc Ngoc ngoducngoc@gmail.com 0982000999
Nguyen Anh Tuan bstuanccbm@gmail.com 0913045467
Hoang Bui Hai hoangbuihai@gmail.com 0984128080
Ngo Duc Hung hungdryhn@yahoo.com.vn 0912530518
Nguyen Viet Ha viethahscc33@gmail.com 0982842806

II. Catalog Description

Advanced study of acute and critically ill patients. Utilizes complex knowledge and
applications required to provide comprehensive evidence based nursing care to patients and
families experiencing critical illness or injury in a variety of settings.
III. Expected Outcomes
A. Demonstrate academic readiness to progress through the nursing curriculum.
B. Demonstrate achievement of entry level nursing practice competence for safe and
effective practice in the course content area tested.
C. Demonstrate the application and synthesis of theoretical knowledge to practice in the
critical care setting.
D. Describe the practitioner, leadership, education and research roles of the critical care
nurse in the management of critically ill patients experiencing transitional health care
states.

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 E. Evaluate the clinical application of evidence-based research related to the management of
patients experiencing complex acute and critical health problems.
F. Describe appropriate collaborative management and nursing interventions for patients
with various cardiac, respiratory, renal, gastrointestinal, neurological, endocrine
disorders, as well as shock states and traumatic injury.
G. Describe the indications, measurement, normal values, complications, and nursing
implications associated with monitoring of invasive right atrial, left atrial, pulmonary
artery, and intraarterial pressures and those equated with noninvasive monitoring of
hemodynamic indices.
H. Analyze the conditions that alter hemodynamic values.
I. Recognize changes in population demographics, health care economics, and service
delivery that necessitate improved professional preparation for palliative care.
J. Describe the philosophy and principles of palliative care that can be integrated across
critical care settings to affect quality care at the end of life.
K. Identify the need for collaboration between interdisciplinary team members while
implementing the nursing role in end-of-life/palliative care.
L. Utilize palliative care principles to provide high quality nursing care to patients and
families at the end of life.
M. Using the nursing process demonstrate comprehensive nursing assessment skills, analysis
and utilization of system data, while coordinating the care of critically ill patients with
various medical surgical problems across the life span.
N. Evaluate coping mechanisms and support systems utilized by culturally diverse
individuals and families in crisis situations where altered role, altered family processes,
powerlessness, and self-care deficit become considerable areas of concern.
O. Utilize the nursing process at an advanced level to develop, implement and evaluate a
multidisciplinary plan of care for clients with acute health problems.
P. Prioritize patient, family and group problems based on assessment, and formulate the
appropriate nursing diagnoses and interventions for acutely ill individuals and families.
Q. Demonstrate professional behavior, dress and therapeutic communication skills, while
interacting with assigned client, families, and other members of the health care
environment.

IV. Required Texts:

Sole, M.L., Klein, D.G., & Moseley, M.J. (2009). Introduction to critical care
nursing (5th ed.). St. Louis: Saunders Elsevier.

Recommended:

Baird, M.S., Keen, J.H., & Swearingen, P.L. (2005). Manual of critical care
nursing: Nursing interventions and management (5th ed.). St. Louis: Elsevier Mosby.

Pepid RN Student Clinical Companion electronic resource. WWW.pepid.com

(This is available through the book store much cheaper than purchasing on-line).

V. Course Outline

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A. Concepts of Hemodynamic Pressure Monitoring
Bui Thi Huong Giang, MD
Ha Tran Hung, MD
1. Physiological basis for hemodynamic monitoring in critically ill patients
2. Indications, measurement, complications, and nursing implications associated
with monitoring of invasive right atrial, left atrial, pulmonary artery, and
intraarterial pressures and those equated with noninvasive monitoring of
hemodynamic indices
3. Appropriate nursing actions for patients with alterations in hemodynamic
values
B. Palliative Care and Quality of Life
Nguyen Thi Thanh Hoa, MD
1. Factors impacting the delivery of palliate care in critical care settings
2. Theoretical background for palliative care and quality of life
3. Strategies for reducing pain, anxiety, and other symptoms of suffering in
critically ill patients
C. Pulmonary Disorders
Do Ngoc Son, MD
1. Pathophysiology of acute respiratory failure
2. Etiology, pathophysiology, assessment, nursing diagnoses, interventions, and
outcomes for acute respiratory failure in the patient with adult respiratory
distress syndrome, chronic obstructive pulmonary disease, asthma,
pneumonia, and pulmonary embolus
3. Formulate a plan of care for the patient with acute respiratory failure
D. Ventilatory Assistance
Do Ngoc Son, MD
1. Review of anatomy and physiology of the respiratory system
2. Methods for assessing the respiratory system, including physical assessment,
interpretation of arterial blood gases, and noninvasive techniques
3. Indications for initiation of mechanical ventilation
4. Types and modes of mechanical ventilation
5. Complications associated with mechanical ventilation
6. Methods for weaning patients from mechanical ventilation
7. Formulate a plan of care for the mechanically ventilated patient
E. Nursing care during critical illness: Shock and Sepsis
Bui Thi Huong Giang, MD
1. Definitions of shock, SIRS, MODS and their continuum
2. Four classifications of shock to their pathophysiology
3. Progression of shock through three stages
4. Relationship of assessment findings to the classification and stage of shock
5. Management strategies for each type of shock
6. Individualized plan of care for patients with shock, SIRS, MODS, that
includes nursing diagnosis, expected outcomes, nursing interventions, and
rationale
F. Hematologic disorders
Nguyen Anh Tuan, MD

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 1. Pathophysiology of hematological system
2. Nursing and medical management of patients with thrombocytopenia,
disseminated intravascular coagulation (DIC)
3. Genetic implications associated with coagulation disorders
H. Nursing care during critical illness: Nervous System Alterations
Nguyen Thi Thanh Hoa, MD
1. Pathophysiology of increased intracranial pressure
2. Nursing and medical management of patients with increased intracranial
pressure
3. Pathophysiology of head injury, complications, collaborative management
4. Nursing and medical management of patients with a spinal cord injury,
cerebrovascular disease, status epilepticus/seizure disorders
I. Nursing care during critical illness: Trauma Management
Nguyen Thi Thanh Hoa, MD
1. Mechanisms of traumatic injury commonly seen in the critical care setting
2. Prehospital care, emergency care, and resuscitation of the trauma patient
3. Assessment and management of common traumatic injuries
4. Nnursing interventions for care of the trauma and burn patient, including
prevention of complications
J. Nursing care during critical illness: Acute Renal Failure
Hoang Bui Hai, MD
1. Pathophysiology of the three categories of acute renal failure
2. Systemic manifestations of acute renal failure
3. Methods for assessing the renal system, including physical assessment,
interpretation of serum and urine laboratory values, and radiological
diagnostic tests
4. Medical and nursing management of the patient with acute renal failure
5. Nursing assessment and care of the patient receiving dialysis or continuous
renal replacement therapy
K. Nursing care during critical illness: Gastrointestinal Alterations
Ngo Duc Ngoc, MD
1. Pathophysiology, assessment, nursing diagnoses, outcomes, and
interventions for acute upper gastrointestinal bleeding, acute pancreatitis,
and hepatic failure
L. Nursing care during critical illness: Endocrine Alterations
Ha Tran Hung, MD
1. Disorders resulting from alterations in hormones secreted by the pancreas,
adrenal, thyroid, and posterior pituitary glands
2. Pathophysiology, assessment, nursing diagnoses, interventions and
outcomes for hyperglycemic crises, hypoglycemic crisis, adrenal crisis,
thyroid storm, myxedema coma, diabetes insipidus, and the syndrome of
inappropriate antidiuretic hormone

VI. Methods of Presentation

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 A. Lecture
B. Assigned Readings
C. In -Class activities & discussion
D. Audiovisual media/web-based activities
E. Clinical activities

VII. Methods of Evaluation

A. Lecture
1. Final exam (MCQ)

B. Clinical Laboratory
1. Patient worksheets
2. Midterm clinical evaluation
3. Final clinical evaluation

C. Clinical Components
1. Critical Clinical Student Behaviors
a. Seek assistance immediately in all aspects of patient care in
which he/she lacks confidence or skills.
b. Perform delegated nursing procedures and treatments correctly.
c. Communicate important changes in the patient’s condition
honestly, accurately and without delay.
d. Carry out all assigned duties within student guidelines and inform
the appropriate persons of his/her inability to do so in adequate time.
e. Prepare, explain and administer medications safely. Ensure that
all medications are checked by instructor or staff prior to administration. All
narcotics, insulin and anticoagulants are to be countersigned by the RN. Verbal
orders may not be taken and IV push medications may only be given under direct
supervision.
f. Be directly accountable to the primary nurse, notify when leaving
and upon return to the unit.
g. Identify and demonstrate knowledge of the patient’s
physiological and psychosocial problems.
h. Identify and explain possible causes for laboratory abnormalities.
i. State the pathophysiological basis for all abnormal findings.
j. Relate the patient’s drug and IV therapy to relevant
pathophysiological problems.
k. Maintain relationships with patients, co-workers and supervisors
which tend to enhance or promote the quality of patient care.
l. Be present for report and able to articulate:
 Current patient condition
 Laboratory and diagnostic studies pending and current results
 Status of IV and I&O
 Current treatment plan
 Any problems from previous shift

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 m. Refrain from completing interventions that require competency
validation and/or certification by hospital employee.
n. Protect the patient from environmental hazards and provide for the safety of the
patient, self and others.
o. Organize workload and set priorities appropriate to the clinical setting.
p. Recognize and assume responsibilities for the consequences of own behavior or
actions. Communicate errors of omission or commission immediately, honestly
and accurately.
2. Student Accountability
It is understood that different types and levels of skill are emphasized, taught and utilized
during each clinical course. This does not imply however, that students have any less
responsibility for maintaining competence in all nursing skills taught during the previous
clinical courses.

Students are expected to consistently demonstrate competence in skills taught at each

clinical level.

Students are required to demonstrate mastery of the following skills prior to beginning
N331:

 IVPB administration
 SQ/IM injections
 NG tube insertion, care and medication administration
 Intake and output
 Mouth care
 Dressing changes (sterile and clean)
 Principles of aseptic technique
 Physical examination technique
 Cranial nerve assessment
 Point of care glucose monitoring
 Heparin and insulin injection
 Foley care and insertion
 Medication calculation and IV drip calculations
3. Dress and Behavior Code
For clinical activities the following guidelines apply.

a. Female and male students are to wear picture ID name badge on the upper left
side of their uniform.
b. Female and male students are to wear clean white shoes with enclosed toes and
heels. If nylons are worn, they must be white or neutral-shade. No fancy patterns
or other color hose are allowed.
c. Students are expected to be equipped with black pen, pencil, a small note pad,
wrist watch with second hand, portable blood pressure cuff and stethoscope.
d. Jewelry is to be kept at a minimum. No ornate jewelry or dangling earrings are to
be worn. Only one pair of earrings can be worn. No facial or oral jewelry can be

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 worn. Rings are to be of smooth metal with no elevated stones. Only short,
narrow, non-dangling chains are acceptable.
e. Hair, for both male and female students, is to be off the collar and should appear
clean, neatly trimmed and arranged. Hair should not fall forward when the
head/neck is flexed or when the student leans forward in the performance of tasks.
f. Use of lightly or non-scented deodorant and oral hygiene products are
recommended to manage body odors with clean, odor-free clothing.
g. Fingernails: clean and short. Non-chipped light or clear nail polish is optional.
Students may not wear acrylic nails.
h. Chewing gum is not permitted in the clinical area.
i. Basic guidelines of courtesy are applicable in addressing and interacting with
clients, visitors, staff, faculty and peers, and in the utilization of space, time,
supplies, and equipment within the clinical agency.
j. Students are to comply with agency policy and procedures relative to the
management of sound, including voices in the clinical setting.
k. Hallways, elevators, stairways, cafeteria lines are to be kept open for movement
of personnel. It is especially important not to congregate in heavy traffic areas
such as the Nurse’s Station.
l. As arranged, students are to inform the lab instructor IN ADVANCE of any
absence and to call the instructor immediately when it appears that an
UNAVOIDABLE LATE ARRIVAL will occur.
m. Questions relative to the appropriateness of student’s appearance and/or behavior
are to be addressed, in private, immediately by the student instructor and agency
personnel, as needed.
n. Professional nurse role development incorporates dress and behavior. Growth and
consistently acceptable compliance are expected.
4. Patient Care Worksheets
A completed patient care worksheet must be submitted each week throughout the course
or as directed by the lab instructor. All worksheets will be evaluated weekly; four
careplans will be graded and counted toward the final grade. At the instructors
discretion, two careplans prior to the midterm and two prior to finals will be chosen for
grading.
 Note: Students are expected to complete the patient worksheets prior to each
clinical day. If students come to clinical unprepared or with an incomplete
worksheet, the student may be sent home and given a zero for the day at the
discretion of the instructor. Examples of incomplete work include, but are not
limited to: missing major pathophysiology, missing medications (does not include
medications ordered since pre-planning day), missing priority nursing diagnoses
and interventions. At the discretion of the instructor, the incomplete worksheet
will be counted as one of the four graded worksheets and will be graded as a zero.

5. Midterm Clinical Evaluation

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 Evaluation is a critical component of a student’s safe progression through each course.
All students will complete a self-evaluation at mid-term, and set goals with faculty, to
assure that course objectives are being met satisfactorily. The instructor will conduct a
mid-term evaluation based on their clinical observations and interactions with the student
as well as the student self-evaluation.
6. Final Clinical Evaluation
The instructor will conduct a final evaluation.
7. Clinical Skills Checklist
Students are provided a competency skills check list, with common basic nursing and
critical care skills. Students are responsible for demonstrating clinical competence in each
skill. Each skill must be signed off by clinical instructor, or registered nurse in ICU, and
submitted to instructor at final evaluation. The skills checklist will be filed in the
student’s record in the nursing office.

VIII. University Attendance Policy

Follow HMU policy applies to both the lecture and clinical portions of this course.

IX. Late Arrival to Clinical and Absences

Unexcused absences and late arrival will not be tolerated.

Clinical arrival time may vary among clinical groups and facilities. Arriving to clinical
after the time specified by your clinical instructor will be considered a late arrival.
Arriving more than 30 minutes late to clinical will be considered an unexcused absence,
and at the discretion of the clinical faculty, the student may be sent home for the day and
receive a zero for one of their four graded careplans. Three episodes of being tardy will
be equal to one unexcused absence. Late arrivals and unexcused absences result in
students missing required clinical hours. Clinical faculty are not required to provide
make-up activities for late arrivals and unexcused absences. Students with 3 or more late
arrivals or unexcused absences may receive an incomplete for the course.

X. Clinical Hours
Hours vary from facility to facility. Therefore, arrival and departure times will be
different for each clinical group. Students are expected to prepare for clinical on their
own time.