THE UNIVERSITY OF TEXAS AT BROWNSVILLE AND TEXAS SOUTHMOST COLLEGE ASSOCIATE DEGREE NURSING PROGRAM

RNSG 2441 ADVANCED CONCEPTS OF CLINICAL DECISION MAKING LECTURE AND LABORATORY COURSE SYLLABUS
PROFESSORS: JOE LACHER, M.S.N., R.N., C.N.A.,B.C. NORMA SILVA, M.S.N.,R.N. BETSY FREETH, M.S.N., R.N. SPRING 2006

THE UNIVERSITY OF TEXAS AT BROWNSVILLE AND TEXAS SOUTHMOST COLLEGE ASSOCIATE DEGREE NURSING PROGRAM RNSG 2441 ADVANCED CONCEPTS OF CLINICAL DECISION MAKING

COURSE DESCRIPTION: (WECM) Application of advanced concepts and skills for development of the professional nurse’s role in complex client/nursing situations. Emphasis on clinical decision-making for clients in medical-surgical settings experiencing health problems involving cardiovascular disorders; neurologic disorders; liver, biliary and pancreatic disorders; renal and urinary disorders; hematologic disorders; and cancer. Focus given to knowledge, judgment, skills, and professional values within a legal/ethical framework. Lec.4, Lab 1 KEY CONCEPTS AND COURSE PLAN This classroom and simulated laboratory course provides an opportunity for the Level III student to acquire knowledge, including scientific principles from the biological, psychological and social sciences and the concepts of caring, that relate to providing care to groups of adult clients and their families with complex health care problems. Classroom learning experiences require the nursing student to use current literature, critical thinking, the nursing process, assessment of cultural factors, and legal standards and ethical principles to plan care for hypothetical clients and their families. This course examines the nurse’s role as teacher and communicator and how these roles interface with his/her role as provider of care for the adult client and his/her family with common health care needs. It also examines the nurse’s role as coordinator of care as it relates to promoting an optimal level of wellness and continuity of care. How the nurse, in the role of coordinator, involves other members of the health care team to provide care for the adult client and his/her family is also discussed. The role of the nurse as a member of a profession and as an advocate is also discussed. PRE-REQUISITES RNSG 2201, RNSG 2162, RNSG 2213, RNSG 2163, SPCH 1318, ENGL 1301 CO-REQUISITES RNSG 2360, RNSG 2121, RNSG 2166, HUMANITIES ELECTIVE

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Course Learning Outcomes (WECM) The student will utilize critical thinking and a systematic problem-solving process as a framework for providing care for clients in complex client/nursing situations; and analyze the roles of the professional nurse in the provision of care for clients and families. COURSE LEARNING OUTCOMES (UTB/TSC) Upon completion of this course the student should be able to meet the following course learning outcomes: Provider of Care 1. Using case studies and/or other simulations of client encounters, analyze how basic human needs of a group of clients and their families are affected by complex health care problems. 2. Using case studies and/or other simulations of client encounters, analyze and use scientific principles from the biological, psychological and social sciences to develop an individualized plan of care for groups of clients and their families with various complex health care needs. 3. Using case studies and/or other simulations of client encounters, apply the use of current literature, critical thinking and the nursing process to organize the care of a group of clients and their families experiencing various complex health care problems. 4. Examine how to evaluate the response of a group of clients and their families to various therapeutic and culturally sensitive nursing interventions used to assist those with complex health care needs. 5. Examine how to evaluate the effectiveness of communication techniques used with a group of clients and their families with complex health care needs. 6. Using case studies and/or other simulations of client encounters, examine how to evaluate the effectiveness of health teaching presented to groups of clients and their families experiencing various complex health care needs. 7. Examine legal and ethical issues that relate to the performance of nursing interventions for groups of clients and their families with various complex health care needs.

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Coordinator of Care 8. Examine various ways the nurse evaluates and revises the management of human and material resources to provide quality health care to a group of clients and their families with complex health care needs. 9. Examine how the nurse evaluates the effectiveness of communication in collaborating with other members of the health care team to coordinate care of a group of clients and their families with various complex health care needs. 10. Examine how the nurse evaluates, in collaboration with other members of the health care team, the effectiveness of teaching plans for groups of clients and their families with various complex health care needs. 11. Using case studies and/or other simulations of client encounters, develop a plan of care that includes appropriate institutional and/or community referral resources to assist groups of clients and their families in meeting complex health care needs and to ensure continuity of care. Member of a Profession 12. Examine how the nurse evaluates and revises activities related to client advocacy for groups of clients and their families with complex health care needs. 13. Examine responsibilities that the nurse is liable and accountable for in relation to caring for groups of clients and their families with complex health care needs. TEACHING METHODS Lecture, discussion, audiovisual aides, simulation, computer assisted instruction (C.A.I.), case studies, group projects. TEACHING PERSONNEL JOE LACHER, M.S.N., R.N., C.N.A.,B.C. NORMA SILVA, M.S.N.,R.N. BETSY FREETH, M.S.N., R.N. Guest Speakers Faculty members are available during office hours and by appointment.

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METHODS AND CRITERIA FOR EVALUATION EVALUATION 1. Unit Examinations = 2. Comprehensive Final Exam PERCENTAGE OF GRADE
60% (#1=15%, #2=15%,#3=15%, #4=15%)

40%

GRADING SYSTEM OF A.D.N. PROGRAM A = 90–100% B = 80-89% C = 74.50-79% D = 70-74.50% F = 0-69%

Meds Publishing-Learning System RN The student must complete the following LSRN exams as part of the course requirement. It is the student’s responsibility to take the exam and provide a printout to the faculty. The student must make a 90% on the exam in order to receive credit. Five (5) attempts are allowed EXCEPT the one (1) attempt allowed for each Integrated exam (there are 2: Med/Surg and Disaster Planning). Med/Surg Test # 1 Cardiovascular Med/Surg Test # 2 Integumentary Med/Surg Test # 3 Endocrine Med/Surg Test # 4 Gastrointestinal Med/Surg Test # 5 Genitourinary Med/Surg Test # 6 Hematologic Med/Surg Test # 7 Immunologic Med/Surg Test # 8 Infectious Med/Surg Test # 9 Musculoskeletal Med/Surg Test # 10 Neurological Med/Surg Test # 11 Oncology Med/Surg Test # 12 Respiratory Med/Surg Test # 13 Sensory Med/Surg Test # 14 Integrated Disaster Planning Test 1 Integrated Bio Terrorism Triage

No make up examinations will be given. If a unit examination is missed because of illness or emergency, the percentage from the unit exam will be added to the percentage for the final exam. The student must earn an overall grade of 74.50% or greater in order to pass the course. It is the student’s responsibility to ensure that all the exam questions have been answered prior to leaving the classroom. THE STUDENT WHO NEEDS NOTE-TAKING AND/OR TEST-TAKING ACCOMMODATIONS MUST NOTIFY THE FACULTY MEMBER PRIOR TO THE FIRST EXAM.

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REQUIRED TEXTBOOKS Boyer, M. (2004) Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 10th Ed., Lippincott: Philadelphia, Pennsylvania. ISBN: 0-7817-3215-8 Corbett, J. (2004) Laboratory Test & Diagnostic Procedures, 6th Ed., Appleton & Lange: Pearson Prentice Hall: New Jersey. ISBN: 0-1304-9369-4. Smeltzer, S. & Bare, B. (2004) Brunner and Suddarth’s Textbook of Medical Surgical Nursing, 10th Ed., Lippincott: Philadelphia, Pennsylvania. ISBN: 0-7817-3193-3 RECOMMENDED TEXTBOOKS Silvestri, L. (2005) Saunders’ Comprehensive Review for NCLEX-RN Examination, 3rd Ed. Mosby (Elsevier Health). ISBN: 07216-0347-5 RESOURCES Black Board Course Website: http://myutbtsc.blackboard.com Lippincott Connection: Smeltzer and Bare textbook online resources: http://connection.lww.com/go/smeltzer All previous course textbooks should be used as resources. SCANS The Secretary’s Commission on Achieving Necessary Skills (SCANS) has identified Reading, Writing, Arithmetic or Mathematics, Speaking and Listening, Thinking Skills, Personal Qualities, Work Place Competencies and Basic Use of Computers as competencies required to enter employment. This course is part of a program in which all eight of these competencies are integrated. Reading, Writing, Arithmetic or Mathematics, Speaking and Listening, Thinking Skills, Personal Qualities, Work Place Competencies, and Basic Use of Computers are practiced in this course. STATEMENT ON DISABILITIES (UTB/TSC) Students with disabilities, including learning disabilities, who wish to request accommodations in this class should notify the Disability Services Office early in the semester so that the appropriate arrangements may be made. In accordance with federal law, a student requesting accommodations must provide documentation of his/her disability to the Disability Services counselor. For more information, call or visit the Counseling Center at Tandy 205 (956-882-8292).

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COURSE INFORMATION Examinations and Assignments A multiple-choice exam will be administered at the completion of each Unit. Exam questions will be directed at the student’s ability to assess, analyze, plan, implement and evaluate client care. General examination policies are as follows: A. It is the student’s responsibility to notify the faculty member in advance if he/she is unable to take a scheduled exam. B. It is the student’s responsibility to assure that he/she has answered all test items before leaving the room. To preserve the integrity of examinations, the following policies apply: A. B. C. D. E. F. Students will not have access to purses, paper, hats, caps, or any other items during the exam. Students may be assigned seats by faculty proctors. Cell phones and pagers are not permitted at any time during exams or exam reviews. #2 pencils ONLY are permitted during an exam: no pens or calculators. Food and/or drinks are not permitted during exams. No one is permitted to leave the room after the exam has started. Persons who leave must turn in their exam for grading before exiting the room. G. Note-taking materials and any kind of recording device are not permitted during exam reviews.

Exam reviews will be conducted at the discretion of the faculty. The focus of the exam review will be on the most frequently missed test items as demonstrated by the item analysis. The purpose of the review is to correct misconceptions and promote understanding of the content. No challenges to exam questions will be accepted. Adjustments to exam answers will be based solely on the computerized item analysis. Readings will consist of textbook readings and additional selected readings as assigned by faculty. Additional required and/or recommended instructional computer software can be found in the Nursing Resource Center. All course assignments (papers, projects, exams, etc.) must represent the student’s own accomplishments. The faculty reserves the right to make additional or alternate assignments in order to assess the student’s progress in the program.

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Attendance Policy Classroom attendance is required as per UTB/TSC Catalog and UTB/TSC A.D.N. Faculty Policy. Refer to A.D.N. Student Guide

Extra Assistance It is the responsibility of the student to seek assistance as necessary. Faculty members are available to assist students during office hours or by appointment. Counselors are available in the Learning Assistance Center to assist students with such skills as test taking, study habits, time management and prioritizing. Classroom Attire and Decorum Clothing worn to classes at UTB/TSC may range from dressy to casual. Although many styles are acceptable, it is recommended that fashion excesses and extremes be avoided. Students are expected to observe the following guidelines for classroom behavior:
1. Neither children nor pets may be brought to classes. Children must not be left unattended in any area in the school or on the school 2. 3. 4. 5.

grounds. Guests may be brought to class if permission is previously obtained from the faculty member in charge of the class. Permission to tape record class sessions needs to be obtained from the faculty presenting the class. Classes will begin and end at the designated time. A 10-minute break will be provided for each hour of class. No pagers or cellular phones are allowed while class is in session.

UNITS Unit One contains Advanced concepts of clinical decision making in the areas of Cardiac and Respiratory Function Unit Two contains Advanced concepts of clinical decision making in the areas of Urinary and Cancer Function Unit Three contains Advanced concepts of clinical decision making in the areas of Neurological and Endocrine Function Unit Four contains Advanced concepts of clinical decision making in the areas of Multi-system and Emergency nursing function.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
Performance Outcomes 1. Review assessment of the cardiovascular system with particular attention to assessment findings such as edema, jugular vein distention and bruits and relate these findings to complex cardiovascular disorders. ()* 2. Examine the significance of increasing or decreasing pulse pressure as related to complex cardiovascular disorders. ()* 3. Analyze the clinical significance and related nursing implications of various tests and procedures used to diagnose complex cardiovascular disorders. ()* Key Concepts Cardiovascular Assessment (Edema, Jugular Vein Distention, Bruits) Pulse Pressure Tests and Diagnostic Procedures Cardiac Enzymes, Cardiac Catheterization Cardiac Cath: Nursing Responsibilities Complex Cardiac Monitoring: CVP, Pulmonary Artery, Intra-arterial Abnormal Electrocardiogram (ECG) Findings Cardiac Dysrhythmias:
Sinus: Bradycardia, Tachycardia; Ventricular: PVC’s, Life
Threatening V-Tach, V-Vib, Asystole; Atrial: PAC’s, A-Fib, A-Flutter; Delays & Blocks: 1st Degree, 2nd Degree I & II, 3rd Degree, Bundle Branch

Learning Activities Assessment Text and Medical Surgical Text (REVIEW A&P AND ASSESSMENT OF CARDIOVASCULAR SYSTEM PRIOR TO CLASS) Read Brunner, chapter 26, pg 662-663 Read Brunner, Chapter 26, pg 668-681

4. Examine pre and post care nursing responsibilities for the client undergoing cardiac catheterization. ()* 5. Compare and contrast central venous pressure (CVP) monitoring, pulmonary artery pressure monitoring and systemic intra-arterial monitoring with regard to clinical usefulness and significance, possible complications, and nursing responsibilities. ()* 6. Analyze abnormal findings of the electrocardiogram that result from myocardial ischemia, injury, infarction, and excess or deficits in electrolytes. ()* 7. Compare and contrast the etiology, ECG criteria, prevention, medical management, and nursing implications for various cardiac dysrhythmias and conduction problems. ()*

Read Brunner, Chapter 26, pg 675-676 Read Brunner, Chapter 26, pg 677-681 Read Brunner, Chaopter 30, pg 788-792

Read Brunner, chapter 27 Basic EKG Rhythms tutorial online at: http://www.randylarson.com/acls/start.html Read Brunner, Chapter 27

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
Performance Outcomes 8. Differentiate between cardioversion and defibrillation procedures and the indications for use of each of these procedures. ()* 9. Compare and contrast various medications used to treat dysrhythmias. ()* 10. Compare and contrast different types of pacemakers, their uses, nursing implications and interventions. ()* 11. Examine the application of the nursing process to plan and coordinate effective care for clients experiencing various cardiac dysrhythmias and conduction problems. ()* Key Concepts Noninvasive Procedures: Cardioversion & Defibrillation Antiarrhythmic Medications Pacemakers: Nursing Implications and Interventions Nursing Process: Common Nursing Diagnosis, Planning Interventions (including client teaching, home care), Evaluation Acute Myocardial Infarction: Assessment Findings Nursing Process:
Analysis (Altered tissue
perfusion, Decreased cardiac output, activity intolerance; Interventions: (Nutrition, Activity, Client/Family Education,); Evaluation (Absence of chest pain, control of dysrhythmias, pre-infarct activity level)

Learning Activities Read Brunner, Chapter 27, pag 705-707

Read Brunner, Chapter 27 Read Brunner, Chapter 27, pg 700-704

Read Brunnert Chapter 27, Case Studies, Critical Thinking Exercises

12. Interpret assessment findings in a client with acute myocardial infarction. ()* 13. Examine the application of the nursing process to plan and coordinate effective care for clients experiencing a myocardial infarction. (1)*

Read Brunner, Chapter 28, Case Studies Read Brunner, Chapter 28, Case Studies Critical Thinking Exercises

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
Performance Outcomes 14. Compare and contract medications used to treat myocardial infarction. ()* 15. Examine the application of the nursing process to planning and coordinating the care of clients experiencing cardiac arrest. ()* Key Concepts Medications for Myocardial Infarction:
Thrombolytics, Analgesics, ACE Inhibitors Assessment: Signs & Symptoms, ECG Strips

Learning Activities Read Brunner, Chapter 28

Read Brunner, Chapter 30, pg 810-812, Case Studies, Critical Thinking Exercises

Nursing Diagnoses:
Altered Tissue Perfusion, Impaired Gas Exchange Interventions: CPR

16. Compare and contrast the medications used to manage cardiac arrest. ()* 17. Develop a pre-operative nursing care plan for clients and their families undergoing coronary artery bypass graft surgery (CABG). ()*

Evaluation Epinephrine, Atropine, Read Brunner, Chapter 30, pg 812 Bicarbonate, Lidocaine Read Brunner, Chapter 28 Pre-operative Care Case Studies Plan (CABG):
Assessment (Unique client/family psychosocial needs), Analysis, Interventions Reduce fear by explaining CCU environment, incisions, tubes; Educate of respiratory and leg exercises & pain management

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
Performance Outcomes 18. Develop a post-operative nursing care plan for clients and their families undergoing coronary artery bypass graft surgery (CABG). ()* Key Concepts Pre-operative Care Plan (CABG):
Assessment: Physiological status (Hemodynamics, Ventilation, Rhythm, Fluid/Lytes), Potential Complications (Cardiac failure, pulmonary edema, dysrhythmias, pericardial effusion; Analysis; Interventions (Cardiac Output, gas exchange, fluid/lytes balance, rest, tissue perfusion)

Learning Activities Read Text Chapter 30, Case Studies

19. Develop a nursing care plan for clients and their families with various types of pacemakers (temporary, external, permanent implantable defibrillators ()* 20. Examine the nursing and medical management of clients and their families experiencing acute cardiac failure. ()*

Assessment, Analysis, Interventions (Educating
client & family of prevention of infection & self-care program)

Read Brunner, Chapter 27, pg 700-704 Online tutorial: http://www.chfpatients.com/implants/pace makers.htm Read Brunner, Chapter 30 Case Studies

Cardiac Failure: Medical Management, Nursing Management:
Assessment, Analysis, Interventions (Education – Dietary Modifications)

21. Examine the etiology, pathophysiology of pulmonary edema and the medical interventions used to care for clients with pulmonary edema ()*

Medical Interventions:
Furosemide, Morphine, Oxygen, Aminophylline, Nitroglycerin infusion, Nitroprusside infusion, foley catheter, intubation, ventilation

Read Brunner, Chapter 30

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
Performance Outcomes 22. Examine the clinical manifestations and management of clients with cardiogenic shock. ()* Key Concepts Cardiogenic Shock:
Clinical manifestations, Collaborative management, Assessment (Signs &
symptoms, diagnostic evaluation, pulmonary artery catheter);

Learning Activities Read Brunner, Chapter 30

Analysis, Planning, Implementation, Evaluation

23. Differentiate between cardiogenic shock and hypovolemic shock. ()* 24. Explore the pathophysiology and assessment findings of clients with pericardial effusion/tamponade and the medical interventions used to care for those with pericardial effusion/tamponade. ()*

Cardiogenic Shock Vs Hypovolemic Shock Pericardial Effusion/Tamponade:
Pathophysiology, Assessment Findings, Medical Management
(Pericardial aspiration, Diuretics, Corticosteroids, Pericardial window)

Read Brunner, Chapter 30 Read Brunner, Chapter 30

25. Compare and contrast the pathophysiology, clinical manifestations and management of the various valvular heart diseases. ()*

Pathophysiology of Valvular Heart Diseases: Mitral
Insufficiency, Mitral Valve Prolapse, Aortic Stenosis, Aortic Insufficiency

Read Brunner, Chapter 29

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
Performance Outcomes 26. Examine the application of the nursing process to planning and coordinating the care of clients and their families undergoing cardiac valve surgery. ()* Key Concepts Cardiac Valve Surgery
Assessment, Analysis
(Decrease cardiac output, Activity intolerance, Fear),

Learning Activities Read Brunner, Chapter 29 Case Studies, Critical Thinking Exercises

Planning/Implementation
(Maintain hemodynamics),

27. Compare and contrast the pathophysiology, prevention and collaborative management of clients and their families with inflammatory and infectious heart diseases ()*

Evaluation Pathophysiology of: Infective
Endocarditis, Pericarditis, Pericardial effusion, cardiac tamponade, cardiomyopathy

Read Text Chapter 29

Collaborative Management, Nursing Assessment, Nursing Diagnoses
(Decreased cardiac output, Potential for ineffective coping),

Planning/Implementation
(Drug therapy, nonpharmacologic, surgical), Evaluation

Advocacy Class discussion 28. Examine how the nurse can be an advocate for the client experiencing complex cardiovascular disorders. ()* Complex Cardiovascular 29. Examine legal and ethical issues and effective Class discussion Disorders: Legal/Ethical communication techniques related to the care of the clients Issues, Communication and their families experiencing complex cardiovascular disorders. ()* *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit I NURSING MANAGEMENT OF CLIENTS WITH COMPLEX CARDIOVASCULAR DISORDERS
LABORATORY Performance Outcomes Key Concepts 1. Demonstrate auscultation of the aortic , pulmonic, tricuspid Advanced Assessment of Heart and mitral areas and the ability to recognize S3 and S4 on auscultation. ()* Learning Activities Review Assessment Text Read Text Chapter 26 Online tutorial: Auscultation Assistant: http://www.med.ucla.edu/wilkes/lungintro. htm Advanced Assessment Read Text Chapter 26 2. Demonstrate the ability to measure jugular venous of Cardiovascular distention. ()* Video: Cardiac Signs and Symptoms Status Demonstration, Simulation, Supervised Practice & Return Demonstration 3. Differentiate between pericardial and pleural friction rubs. Advanced Assessment Online tutorial: Auscultation Assistant: of Cardiovascular ()* http://www.med.ucla.edu/wilkes/lungintro. Status htm Complex Cardiac Care Read Text Chapter 27 4. Demonstrate the ability to set up tubing and prepare a Demonstration, Simulation, Supervised Skill client for pulmonary artery catheter insertion. ()* Practice & Return Demonstration 5. Interpret heart rates from electrocardiogram strips. ()* Complex Cardiac Care Software: Recognizing Common Skill Dysrhythmias Rhythm analysis exercises 6. Systematically analyze cardiac rhythm strips. ()* Complex Cardiac Care Read Text Chapter 27 Rhythm analysis exercises Skill 7. Interpret EKG strips that depict a pacemaker’s rhythm and Complex Cardiac Care Read Text Chapter 27 Rhythm analysis exercises Skill analyze pacemaker function. ()* 8. Demonstrate mastery of content covered in UNIT I. ()* Unit I Content UNIT I EXAMINATION *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit II NURSING MANAGEMENT OF CLIENTS WITH COMPLEX RESPIRATORY DISORDERS
Performance Outcomes 1. Demonstrate mastery of content covered in UNIT I. ()* 2. Review assessment of the respiratory system with particular attention to assessment findings such as upper airway obstruction, sternal retraction and hypoxemia and relate these findings to complex respiratory disorders. ()* 3. Examine the clinical manifestations of respiratory failure and upper airway obstruction. ()* 4. Develop a nursing care plan for clients experiencing respiratory failure. ()* Key Concepts Unit Content Respiratory Assessment (Upper
Airway Obstruction, Sternal Retraction, Hypoxemia)

Learning Activities UNIT I EXAMINATION (REVIEW A&P AND ASSESSMENT OF RESPIRATORY SYSTEM PRIOR TO CLASS) Read Brunner, Chapter 21 Read Brunner, Chapter 22, pg 503-514

Respiratory Failure & Upper Airway Obstruction
Assessment (Upper airway
obstruction, endotracheal intubation, tracheostomy, sternal retraction, hypoxemia, ABG’s);

Read Brunner, Chapters 23, 24, 25 Case Studies, Critical Thinking Exercises

Nursing Diagnoses
(Ineffective airway clearance, Decreased cardiac output, impaired gas exchange);

Planning/Implementation
(Avoid O2 induced hypoventilation, O2 toxicity, Intubation, Suctioning, Mechanical Ventilation

5. Examine the rationale for the nursing interventions used for Nursing Interventions & Rationale for Intubated airway management of intubated clients. ()* 6. Examine the indications for mechanical ventilation, compare the types of mechanical ventilators. ()* 7. Examine the application of the nursing process to plan and coordinate the care of mechanically ventilated clients. Include planning for teaching, home care and therapeutic and culturally sensitive interventions. ()*

Read Brunner, Chapter 25 Read Brunner, Chapter 25 Brunner, Chapter 25, pg 620-622 Case Studies, Critical Thinking Exercises

Clients Mechanical Ventilation: Indications, Types of Ventilators Nursing Care: Ventilated Clients – Settings, PEEP,
CPAP, Monitoring client, Managing the machine, Maintaining airway, Preventing complications, Troubleshooting, Weaning, Positioning, Client Teaching

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit II NURSING MANAGEMENT OF CLIENTS WITH COMPLEX RESPIRATORY DISORDERS
Performance Outcomes Key Concepts
Management Nursing Process: Assessment; Nursing Diagnoses (Pain, Ineffective

Learning Activities

8. Compare and contrast indications and medical management Thoracic surgical Procedures: Indications & of various thoracic surgical procedures. ()* 9. Examine the application of the nursing process to plan and coordinate the care of clients experiencing thoracic surgery and/or the presence of chest tubes. Include planning for teaching, home care and therapeutic and culturally sensitive interventions. ()*

Read Brunner, Chapter 25, pg 626-641 Read Brunner, Chapter 25, pg 626-641 Case Studies, Critical Thinking Exercises

airway clearance, Impaired gas exchange); Planning & Implementation (Pain control, Maintain airway, Decreased hypoxia, Surgical management (Pre-op, Post-op chest tubes & water –seal drainage));

10. Examine the application of the nursing process to plan and coordinate the care of clients experiencing adult respiratory distress syndrome (ARDS) or non-cardiogenic pulmonary edema. Include planning for teaching and therapeutic and culturally sensitive interventions. ()*

Evaluation Nursing Process: ARDS & Pulmonary Edema Collaborative Management; Assessment, Nursing Diagnoses, Planning & Implementation (Ventilation,
Sedation, Maintain airway, Corticosteroids, Antibiotics, Fluid balance parameters, Nutrition, High Lipids, High energy, low effort foods

Read Brunner, Chapter 23, pg 544-547 Case Studies, Critical Thinking Exercises

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit II NURSING MANAGEMENT OF CLIENTS WITH COMPLEX RESPIRATORY DISORDERS
Performance Outcomes 1. Skillfully interpret blood gas analyses. ()* LABORATORY Key Concepts
Advanced Nursing Skill Blood Gas Interpretation

Learning Activities Read Brunner, Chapter 14, pgs 278-282, Online: Arterial Blood Gas Exercises: http://maagnursing.com/ABG/ Read Text Chapter 25, Demonstration, Simulation, Supervised Practice & Return Demonstration Read Text Chapter 25, Demonstration, Simulation, Supervised Practice & Return Demonstration Read Text Chapter 25, Demonstration, Simulation, Supervised Practice & Return Demonstration

2. Skillfully demonstrate tracheostomy care and tracheal/endotracheal suctioning. ()* 3. Demonstrate the ability to manage a ventilator. ()*

Tracheostomy care and Tracheal/Endotracheal Suctioning Advanced Nursing Skill: Ventilator Management Advanced Nursing Skill: Assisting with Chest Tube Insertion and Chest Drainage Set-Up Advanced Nursing Skill: Maintaining Chest Tubes

4. Demonstrate the procedure for assisting a physician with chest tube insertion and chest drainage set-up. ()*

5. Demonstrate the ability to maintain chest tubes (water-seal Read Text Chapter 25, Demonstration, management, care of tubes, changing chest tube dressing). Simulation, Supervised Practice & Return ()* Demonstration *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit III NURSING MANAGEMENT OF CLIENTS WITH COMPLEX URINARY AND RENAL DISORDERS
Performance Outcomes 1. Demonstrate mastery of content covered in UNIT II. ()* 2. Review the anatomy and physiology and the assessment of the urinary and renal system. Relate particular assessment findings such as elevated B.U.N. and creatinine to complex renal disorders. ()* 3. Compare and contrast chronic and acute renal failure. ()* Key Concepts Unit II Content Urinary and Renal A&P and Assessment Learning Activities UNIT II EXAMINATION Assessment Text and Medical Surgical Text (REVIEW PRIOR TO CLASS)

Renal Failure: Acute (Classifications, Phases, Management, Prevention and Health Maintenance Chronic (Stages, Metabolic alterations, Management with ESRD, Hemodialysis, Peritoneal Dialysis, Renal Transplant)

Read Text Chapter

Read Text Chapter, Case Studies, Critical Nursing Process: 4. Examine the application of the nursing process to the care Thinking Exercises Renal Failure (Acute of clients and their families experiencing renal failure. and Chronic) Include planning for teaching, home care and therapeutic and culturally sensitive interventions. (2, 3, 5, 12)* Read Text Chapter 5. Examine the application of the nursing process to plan and Nursing Process: PreCase Studies, Critical Thinking Exercises coordinate the care of clients and their families undergoing op & Post-op Considerations, kidney surgery or transplantation. Include planning for Collaborative teaching and therapeutic and culturally sensitive Management interventions. ()* Read Text Chapter 6. Examine the application of the nursing process to plan and Nursing Process: Case Studies, Critical Thinking Exercises coordinate the care of clients and their families undergoing Clients Undergoing surgery for urinary diversion. Include planning for teaching Urinary Diversion and therapeutic and culturally sensitive interventions. ()* *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit III NURSING MANAGEMENT OF CLIENTS WITH COMPLEX URINARY AND RENAL DISORDERS
LABORATORY Performance Outcomes Key Concepts Legal and Ethical Examine the legal and ethical issues related to kidney Issues Related to transplantation and how the nurse can be a client advocate Kidney in regard to kidney transplantation. ()* Transplantation, Client Advocacy Legal and Ethical Examine the legal and ethical issues related to hemodialysis and how the nurse can be a client advocate in Issues Related Hemodialysis, Client regard to kidney transplantation. ()* Advocacy Demonstrate the ability to interpret abnormal renal function Interpreting Renal Function Studies results. ()* Demonstrate the process of peritoneal dialysis. ()* Peritoneal Dialysis Learning Activities Read Text Chapter

1.

2.

Read Text Chapter

Read Text Chapter, Exercises with Renal Function Studies Results 4. Read Text Chapter, Demonstration, Simulation, Supervised Practice & Return Demonstration *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome. 3.

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The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit IV NURSING MANAGEMENT OF CLIENTS WITH CANCER
Performance Outcomes 1. Demonstrate mastery of content covered in UNIT III. ()* 2. Compare and contrast the various diagnostic tests used to detect cancer. ()* 3. Differentiate among the purposes of surgical procedures used in cancer treatment, diagnosis, prophylaxis, palliation and reconstruction. ()* 4. Compare and contrast the following therapies used in treating cancer: Surgery, radiation therapy, chemotherapy, hyperthermia, biologic response modifiers and gene therapy.()* 5. Examine possible complications and special nursing needs of clients receiving chemotherapy. ()* Key Concepts Unit III Content Diagnostic Tests to Detect Cancer (Include Early Detection) Purposes of Various Cancer Treatments
(Surgical procedures, diagnosis, prophylaxis, palliation, reconstruction)

Learning Activities UNIT III EXAMINATION Read Text Chapter

Read Text Chapter Case Studies, Critical Thinking Exercises

Comparison of Cancer Therapies

Read Text Chapter

Clients & Chemotherapy: Complications, Nursing Needs

Read Text Chapter Case Studies, Critical Thinking Exercises

Read Text Chapter Nursing Process: 6. Examine common nursing diagnoses and collaborative Nursing Diagnoses problems that relate to clients with cancer. ()* Read Text Chapter Legal and Ethical 7. Examine legal and ethical issues and effective communication techniques related to the care of the clients Issues, experiencing cancer and how the nurse can be an advocate Communication, Advocacy for the client experiencing cancer. ()* Read Text Chapter 8. Examine the application of the nursing process to plan and Nursing Process, Case Studies, Critical Thinking Exercises Teaching: Cancer coordinate the care of clients and their families with cancer. Include planning for teaching and therapeutic and culturally sensitive interventions. Hospice Care Read Text Chapter 9. Examine the concept of hospice in providing care for clients with advanced cancer. *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

22

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit IV NURSING MANAGEMENT OF CLIENTS WITH CANCER
Performance Outcomes 10. Compare the various leukemias, their incidence, risk factors, physiologic alterations, clinical manifestations, management and prognosis. ()* 11. Examine the application of the nursing process to plan and coordinate the care of clients and their families with various leukemias. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 12. Examine the causes, risk factors, clinical manifestations and specific diagnostic tests that relate to the diagnosis of lymphoma. ()* Key Concepts Leukemias: Incidence,
Physiologic alterations, Clinical Manifestations, Management, Prognosis

Learning Activities Read Text Chapter

Read Text Chapter Nursing Care of Case Studies, Critical Thinking Exercises Clients and Their Families with Leukemia Read Text Chapter Lymphoma: Causes, risk factors, clinical manifestations, diagnostic tests 13. Examine the application of the nursing process to plan and Nursing Process: Care Read Text Chapter Case Studies, Critical Thinking Exercises of Clients and Their coordinate the care of clients and their families with Families with lymphoma. Include planning for teaching and therapeutic Lymphoma and culturally sensitive interventions. ()* Cancer of Respiratory Read Text Chapter 14. Analyze etiologies and risk factors that predispose a client System: Etiology, Risk to cancer of the respiratory system. ()* Factors Clinical Manifestations Read Text Chapter 15. Compare and contrast clinical manifestations of a client with cancer in the upper respiratory system with those of a of Cancer: Upper & Lower Respiratory client with cancer of the lower respiratory system. ()* 16. Examine the application of the nursing process to plan and Nursing Process: Care Read Text Chapter Case Studies, Critical Thinking Exercises coordinate the care of clients and their families undergoing of Clients and Their Families Undergoing laryngectomy. Include planning for teaching and Laryngectomy therapeutic and culturally sensitive interventions. ()* *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

23

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit IV NURSING MANAGEMENT OF CLIENTS WITH CANCER
Performance Outcomes 17. Explore the medical and nursing management of clients and their families with cancer of the lung. ()* Key Concepts Lung Cancer: Medical Management, Nursing Care Learning Activities Read Text Chapter Case Studies, Critical Thinking Exercises

Etiology, Incidence, Risk 18. Compare and contrast the etiology, incidence, risk factors Read Text Chapter Factors, Prevention of and prevention of the following cancers: renal, bladder, Cancer (Renal, Bladder, prostate, testicular, endometrial, ovarian, uterine, cervical Prostate, Testicular, Endometrial, Ovarian, Uterine, Cervical, Breast) and breast cancers. ()* Nursing Process: Types of 19. Compare and contrast the application of the nursing Read Text Chapter Cancer (Renal, Bladder, process to plan and coordinate the care of a clients and Case Studies, Critical Thinking Exercises Prostate, Testicular, their families with various types of renal and reproductive Endometrial, Ovarian, cancers. Include planning for teaching and therapeutic and Uterine, Cervical, Breast) culturally sensitive interventions. ()* Pre-op and Post-op 20. Develop a pre-op and post-op plan of care for clients and Read Text Chapter Care: Nephrectomy, their families undergoing the following surgical Case Studies urinary interventions due to cancer: nephrectomy, cystectomy with Cystectomy withProstectomy, diversion, TUR, urinary diversion, transurethral resection (TUR), Orchiectomy, Oopherectomy, Hysterectomy, Mastectomy prostetectomy, orchiectomy, oopherectomy, hysterectomy and mastectomy. ()* Read Text Chapter Nursing Care Needs: 21. Examine nursing care needs that are specific to the care of Eye Cancer clients and their families with an eye tumor. ()* Nursing Process: Types of 22. Compare and contrast the application of the nursing Read Text Chapter Cancer: Lip, Oral Cavity process to plan and coordinate the care of a clients and Case Studies, Critical Thinking Exercises (Neck Dissection their families with various types of gastrointestinal cancers. Required), Tongue, Include planning for teaching and therapeutic and Salivary Glands, Stomach, culturally sensitive interventions. ()* Colorectal) *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

24

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit IV NURSING MANAGEMENT OF CLIENTS WITH CANCER
Performance Outcomes Key Concepts Nursing Process: 23. Compare and contrast the application of the nursing Cancers of the process to plan and coordinate the care of clients and their Endocrine System families with various types of cancers involving the (Liver, Pancreas, endocrine system. Include planning for teaching and Thyroid) therapeutic and culturally sensitive interventions. ()* 24. Examine the application of the nursing process to plan and Nursing Process: Cancers of the Central coordinate the care of clients and their families with neoplasms of the central nervous system. Include planning Nervous System (Intracranial Tumors) for teaching and therapeutic and culturally sensitive interventions. ()* LABORATORY Collaboration: 1. Examine community resources that are available to meet Community Resources the needs of clients and their families dealing with cancer. ()* Maintaining 2. Examine the unique nutritional needs of clients Nutritional Status experiencing the effects of cancer treatment. ()* (Anorexia, Cachexia, Malabsorption 3. Demonstrate the ability to perform ileostomy care. Skill Post-Bladder Surgery Learning Activities Read Text Chapter Case Studies, Critical Thinking Exercises

Read Text Chapter Case Studies, Critical Thinking Exercises

Read Text Chapter

Read Text Chapter

Read Text Chapter, Demonstration, Simulation, Supervised Practice & Return Demonstration Read Text Chapter, Demonstration, Skill Post-Bladder, 4. Demonstrate the ability to perform 3-way bladder Simulation, Supervised Practice & Return Prostate Surgery irrigation. Demonstration *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

25

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit V NURSING MANAGEMENT OF CLIENTS WITH COMPLEX NEUROLOGICAL DISORDERS
Performance Outcomes 1. Demonstrate mastery of content covered in UNIT IV. ()* 2. Review assessment of the neurological system with particular attention to assessment findings such as decreased level of consciousness (LOC), increased cranial pressure (ICP), abnormal motor function and abnormal respiratory patterns and relate these findings to complex neurological disorders. ()* 3. Analyze the clinical significance and related nursing implications of various tests and procedures used to diagnose complex neurological disorders. ()* Key Concepts Unit IV Content Neurological Assessment (Decreased
LOC, Increased ICP, Abnormal motor function, Abnormal respiratory patterns)

Learning Activities UNIT IV EXAMINATION Assessment Text and Medical Surgical Text (REVIEW A&P AND ASSESSMENT OF NEUROLOGICAL SYSTEM PRIOR TO CLASS)

4. Compare and contrast the clinical manifestations and the application of the nursing process to plan and coordinate care for clients and their families with the following neurological disorders: increased ICP, unconsciousness, cerebral vascular accident (CVA) and intracranial surgery. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 5. Compare and contrast the application of the nursing process to plan and coordinate the care of clients and their families in the critical stage of various types of neurological disorders. Include planning for teaching and therapeutic and culturally sensitive interventions. ()*

Tests and Diagnostic Procedures Arteriography, CAT Scan, EEG, Lumbar Puncture, MRI Nursing Process: IICP, Unconsciousness, CVA, Intracranial Surgery

Read Text Chapter

Read Text Chapter Case Studies, Critical Thinking Exercises

Comparison : Nursing Read Text Chapter Case Studies, Critical Thinking Exercises Process in Critical Stage of Epilepsy (Seizures), Multiple Sclerosis, Myasthenia Gravis *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

26

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit V NURSING MANAGEMENT OF CLIENTS WITH COMPLEX NEUROLOGICAL DISORDERS
6. Performance Outcomes Key Concepts Nursing Process: Compare and contrast the application of the nursing Infective/Inflammatory process to plan and coordinate the care of clients and their (Meningitis, Encephalitis, families in the critical stage of various types of Brain Abscess, Guillaininfective/inflammatory neurological disorders. Include Barre Syndrome, planning for teaching and therapeutic and culturally Neurosyphillis, TB) sensitive interventions. ()* Nursing Process: Brain Compare and contrast the application of the nursing Injury, Spinal Cord process to plan and coordinate the care of clients and their families in the critical stage of brain injury and spinal cord Injury injury. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Neurological Examine legal and ethical issues and effective communication techniques related to the care of the clients Disorders: Legal & Ethical Issues, and their families in the critical stages of neurological Advocacy disorders and how the nurse can act as an advocate for these clients. ()* LABORATORY Examine assessment tools used to assess ICP. ()* ICP Assessment:
Rancho Los Amigos Scale, Glasgow Coma Scale, ICP Monitoring (Ventricular Catheter or Bolt)

Learning Activities Read Text Chapter Case Studies, Critical Thinking Exercises

7.

Read Text Chapter Case Studies, Critical Thinking Exercises

8.

Read Text Chapter

1.

Read Text Chapter

Read Text Chapter, Simulated Case Neurological Care 2. Demonstrate documenting neurological assessment Studies Practice Documentation Flow Sheet findings on a critical nuerological care flow sheet. ()* *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

27

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VI NURSING MANAGEMENT OF CLIENTS WITH COMPLEX ENDOCRINE DISORDERS
Performance Outcomes 1. Demonstrate mastery of content covered in UNIT V. ()* 2. Review the anatomy and physiology and the assessment of the endocrine system. Relate such assessment findings as G.I. hemorrhage ascites, polyuria, polydipsia, blurred vision, weakness, headache, abdominal pain, nausea, vomiting, acetone breath, and Kussmaul respirations to complex endocrine disorders. ()* 3. Analyze the clinical significance and related nursing implications of various tests and procedures used to diagnose complex endocrine disorders. ()* Key Concepts Unit V Content Endocrine Assessment
(G.I. hemorrhage Ascites, Polyuria, Polydipsia, Blurred Vision, Weakness, Headache, Abdominal Pain, Nausea, Vomiting, Acetone Breath, and Kussmaul Respirations)

Learning Activities UNIT V EXAMINATION Assessment Text and Medical Surgical Text (REVIEW A&P AND ASSESSMENT OF ENDORINE SYSTEM PRIOR TO CLASS)

Tests and Diagnostic Procedures
(Serum liver function studies (AST, ALT, Ammonia, Prothrombin Time, Barium Studies, Measurement of Portal Pressure, EEG, Angiography, CT Scan, MRI, Serum Glucose, Ketones, Electrolytes, Arterial Blood Gases, Creatinine, BUN, Serum Antidiuretic Hormone)

Read Text Chapter

Read Text Chapter Nursing Process: 4. Examine the application of the nursing process to the care Acute or Critical Stage Case Studies, Critical Thinking Exercises of clients and their families experiencing critical complications in cirrhosis of the liver such as coma and/or of Cirrhosis of the seizures. Include planning for teaching and therapeutic and Liver culturally sensitive interventions. ()* Nursing Process: Liver Read Text Chapter 5. Examine the application of the nursing process to the care Case Studies, Critical Thinking Exercises Transplantation of clients and their families undergoing liver transplantation. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Long-Term Complications 6. Compare and contrast the clinical manifestations, medical Read Text Chapter of Diabetes: Macrovascular, management and nursing management of long-term Microvascular (Ocular), complications of diabetes()* Neuropathy *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

28

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VI NURSING MANAGEMENT OF CLIENTS WITH COMPLEX ENDOCRINE DISORDERS
Performance Outcomes Key Concepts Learning Activities Nursing Process: DKA Read Text Chapter 7. Compare and contrast the application of the nursing Case Studies, Critical Thinking Exercises and HHNK process to the care of clients and their families experiencing diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNK). Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Read Text Chapter, Nursing Process: DI 8. Compare and contrast the medical management and Case Studies, Critical Thinking Exercises application of the nursing process to the care of clients and and SAIAH their families experiencing diabetes insipidus (DI) and syndrome of. inappropriate antidiuretic hormone (SAIAH). Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Read Text Chapter, Nursing Process: 9. Examine the application of the nursing process to the Case Studies, Critical Thinking Exercises critical care of clients and their families experiencing acute Acute Pancreatitis (Critical Care) pancreatitis. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Read Text Chapter Nursing Process: 10. Examine the etiology, diagnosis, management and Thyrotoxic Crisis application of the nursing process to the critical care of (Critical Care) clients and their families experiencing a thyrotoxic crisis. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Read Text Chapter Nursing Process: 11. Examine the etiology, diagnosis, management and Addisonian Crisis application of the nursing process to the critical care of (Critical Care) clients and their families experiencing acute Addison’s disease (addisonian crisis). Include planning for teaching and therapeutic and culturally sensitive interventions. ()* *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

29

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VI NURSING MANAGEMENT OF CLIENTS WITH COMPLEX ENDOCRINE DISORDERS
LABORATORY Performance Outcomes Key Concepts Compare and contrast legal and ethical issues and effective Legal and Ethical communication techniques related to the care of clients and Issues Related to Complex Endocrine their families experiencing various complex endocrine Disorders disorders. ()* Nurse Advocacy for Examine how the nurse can be an advocate for the client Clients with Complex experiencing various complex endocrine disorders ()* Endocrine Disorders Liver Transplantation: Examine legal and ethical issues related to liver Legal & Ethical Issues transplantation. ()* Pharmacologic Agents Compare and contrast pharmacologic agents used to treat Used to Treat: Acute various complex endocrine disorders.()*
Liver Cirrhosis, Liver Transplantation, DKA, HHNK, DI, SAIAH, Acute Pancreatitis, Thyrotoxic Crisis, Addisonian Crisis

1.

Learning Activities Read Text Chapter

2.

Read Text Chapter

3. 4.

Read Text Chapter Read Text Chapter

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

30

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VII NURSING MANAGEMENT OF CLIENTS WITH MULTISYSTEM DISORDERS
Performance Outcomes 1. Demonstrate mastery of content covered in UNIT VI. ()* 2. Compare and contrast the etiology, pathophysiology and clinical manifestations of the various types of shock and multiple organ dysfunction syndrome (MODS). ()* 3. Compare and contrast the medical management of the various types of shock and multiple organ dysfunction syndrome. ()* 4. Compare and contrast the application of the nursing process to the critical care of clients and their families experiencing various types of shock and MODS. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 5. Examine the etiology, clinical manifestations, medical management and nursing management of disseminated intravascular coagulation (DIC). ()* 6. Examine the pathophysiology, modes of transmission, the physiology underlying the clinical manifestations, and the management of HIV infection. ()* Key Concepts Unit VI Content
Etiology, Pathophysiology, Clinical Manifestations: Hypovolemic, Cardiogenic, Anaphylactic, Neurogenic, Septic Shock & MODS Medical Management: Hypovolemic, Cardiogenic, Anaphylactic, Neurogenic, Septic Shock & MODS Nursing Process: Critical Care Hypovolemic, Cardiogenic, Anaphylactic, Neurogenic, Septic Shock & MODS Etiology, Clinical Manifestations, Medical & Nursing Management of DIC (Planning – Treat underlying
disease, Inhibit thrombin action, Replace coagulation factors)

Learning Activities UNIT VI EXAMINATION Read Text Chapter

Read Text Chapter

Read Text Chapter Case Studies, Critical Thinking Exercises

Read Text Chapter

HIV Infection: Pathophysiology, Modes of Transmission, Physiology underlying Clinical Manifestations

Read Text Chapter Case Studies, Critical Thinking Exercises

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

31

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VII NURSING MANAGEMENT OF CLIENTS WITH MULTISYSTEM DISORDERS
Performance Outcomes Key Concepts Learning Activities Nursing Process: AIDS: 7. Examine the application of the nursing process to the care Read Text Chapter family, of clients and their families experiencing acquired immune Assessment (History ofSTD’s; Case Studies, Critical Thinking Exercises sexual practices, other Signs of infection; Psychosocial deficiency syndrome (AIDS). Include planning for teaching findings, Laboratory findings) and therapeutic and culturally sensitive interventions. ()* Nursing Diagnoses (Diarrhea, Risk
for Infection, Ineffective airway clearance, Altered nutrition, less than body requirements, Knowledge deficit, Social Isolation) Planning & Implementation (Administer medications, Resource management, Care based on nursing diagnoses, Support, Coordinated care, Detailed care)

8. Relate possible clinical manifestations found in multiple body systems to the diagnosis of AIDS. ()*

Clinical Manifestations in Multiple Body Systems Related to AIDS: Respiratory (Opportunistic
diseases such as pneumocystis carinii pneumonia, Mycobacterium avium complex, Tuberculosis), Gastrointestinal (Loss of appetite, nausea, vomiting, oral and esophageal candidiasis, chronic diarrhea, wasting syndrome) Oncologic (Kaposi’s Sarcoma, B-Cell lymphomas), Neurologic (HIV encephalopathy), Integumentary (Seborrheic dermatitis, Herpes zoster & simplex), Reproductive (Other STD’s), Psychologic (Depression)

Read Text Chapter

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

32

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VII NURSING MANAGEMENT OF CLIENTS WITH MULTISYSTEM DISORDERS
Performance Outcomes 9. Examine the local and systemic effects of a major burn injury. ()* Key Concepts
Major Burn Injury: Local & Systemic Effects
(Cardiovascular, Fluid & Electrolyte, Pulmonary, Renal Function, Decreased Immunologic Defense, Body Temp. Regulation, G.I.)

Learning Activities Read Text Chapter

10. Differentiate between the three phases of burn care and the priorities of care for the acute/intermediate and rehabilitation phases (priorities of care for the emergent/resuscitative phase with be examined in the emergency care unit). ()* 11. Examine the application of the nursing process to plan and coordinate the care of clients and their families experiencing major burns. Include planning for teaching and therapeutic and culturally sensitive interventions. ()*

Phases of Burn Care

Read Text Chapter

Nursing Process: Major Burns Assessment (Size: Rule of
Nine, Berkoro’s Method, Lund & Browder, Depth, Type, Location, Client age, Medical history) Planning & Implementation (Monitor F&E Balance, Detect and Prevent Infection, Wound Care, Provide Adequate Nutrition, Promote Skin Integrity, Pain Management) Collaborative Care (Physical Therapy for joint immobility, Respiratory Therapist, Nutritionist, Other Team Members to strengthen coping strategies & support client/family processes)

Read Text Chapter, Case Studies

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

33

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making SPRING 2006 Unit VII NURSING MANAGEMENT OF CLIENTS WITH MULTISYSTEM DISORDERS
LABORATORY Performance Outcomes Key Concepts Legal and Ethical 1. Examine legal and ethical issues and effective communication techniques related to the care of clients and Issues in Caring for Clients with their families experiencing multisystem disorders. ()* Multisystem Disorders Client Advocacy in 2. Examine how the nurse can be an advocate for clients and Multisystem Disorders their families experiencing multisystem disorders. ()* 3. Examine the common problems experienced by clients and Common Client Problems in Critical Care Settings their families in critical care settings and nursing and Nursing Prevention interventions that can be implemented to prevent these Interventions Psychosocial problems. ()* (Coping with Stressors –
Regression, Suppression, Denial, etc.; Self-concept Disturbances; Familiy Needs & Coping Strategies, Sleep Deprivation, Nutritional Impairment. Stress Ulcers

Learning Activities Read Text Chapter, Case Studies

Read Text Chapter Read Text Chapter Case Studies

4. Relate various emotional, ethical, and legal issues to those clients and their families experiencing AIDS. ()*

5. Examine how the nurse can be an advocate for the clients and their families experiencing AIDS. ()* Nursing Issues: Stressors in Read Text Chapter 6. Examine the following issues that concern the nurse when Caring for Burn Clients, caring for clients with major burns: stressors specific to Continuity of Care, Caring caring for burned clients, continuity of care and caring for for Burns at Home burns in the home setting. ()* *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

Read Text Chapter Emotional, Ethical & Legal Issues Related to Caring for Clients/Families with AIDS Advocacy: AIDS Read Text Chapter

34

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making Spring 2006 Unit VIII NURSING MANAGEMENT OF CLIENTS REQUIRING EMERGENCY CARE
Performance Outcomes 1. Examine the steps of accurate, rapid client assessment in a pre-hospital setting and the impact pre-hospital care has on morbidity and mortality. ()* 2. Relate the concepts of holism and collaboration to emergency care. ()* 3. Examine priority emergency measures instituted for any client with an emergency condition.()* 4. Differentiate between basic and advanced life support. ()* Key Concepts
Pre-hospital Assessment:
(Environmental security, Primary survey, Secondary survey, Triage system, Physical Assessment in ED) Impact on Morbidity

Learning Activities Read Text Chapter

and Mortality Holism and Collaboration in Emergency Care (Include client, family and significant others in care) Priorities Emergency Measures: Preserve life, Prevent deterioration, Restore to optimal function Basic Life Support (Airway
management, Circulation, One & Two-man CPR) Advanced Life Support (Oropharyngeal airway, Endotracheal intubation, Surgical procedures for airway management, O2, Cardiac medication administration, External & Internal Defibrillation)

Read Text Chapter

Read Text Chapter

Read Text Chapter

5. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing various cardiac emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()*

Nursing Process: Care of Cardiac Emergencies
(Angina, M.I., Congestive Heart Failure, Cardiac tamponade, Aortic dissections) Therapeutic Interventions: Priority setting, Pharmacologic Intervention (Nitroglycerin, Morphine, Nitrous Oxide, TPA, Lidocaine) ECG Monitoring

Read Text Chapter Case Studies, Critical Thinking Exercises

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

35

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making Spring 2006 Unit VIII NURSING MANAGEMENT OF CLIENTS REQUIRING EMERGENCY CARE
Performance Outcomes 6. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing various medical and traumatic respiratory emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Key Concepts
Nursing Process: Care of Respiratory Emergencies
(Upper airway obstruction, Pulmonary embolus, Spontaneous pneumothorax, Pleurisy, Pneumonia, Pulmonary edema, Asthma, ARDS, Near Drowning (Sea water, Fresh water) Blunt & Penetrating Trauma, Hemothorax, Contusions

Learning Activities Read Text Chapter Case Studies, Critical Thinking Exercises

7. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing various oncologic emergencies that may occur as a result of malignancy, metastasis or the effects of chemotherapy and/or radiation therapy. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 8. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing various medical and traumatic neurologic emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()*

Nursing Process: Care of Respiratory Emergencies
(Superior Vena Cava Syndrome, Spinal Cord compression , Hypercalemia, DIC, Septic Shock, SIADH, Hyperuricemia, Pericardial effusion/tamponade)

Read Text Chapter Case Studies, Critical Thinking Exercises

9. Compare and contrast the application of the nursing Read Text Chapter process to plan and coordinate the care of clients Case Studies, Critical Thinking Exercises experiencing various endocrine and metabolic emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* Care of Client 10. Examine the application of the nursing process to plan and Nursing Process:Interventions: in Read Text Chapter ED with Shock: coordinate the care of clients experiencing shock. Include Case Studies, Critical Thinking Exercises Pneumatic Anti-shock Garment, Maintain Airway, Fluid/Blood planning for teaching and therapeutic and culturally Replacement, Maintain Body sensitive interventions. ()* Temperature *Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

Nursing Process: Care of Neurologic Emergencies Hypertensive Crisis, Hypertensive Cerebrum, Seizures, TIA, CVA, Diving Accidents, Head Injury (Concussion, Contussion, Laceration, Epidural & Subdural HemorrhageSpinal Cord Injury) Nursing Process: Care of Endocrine & Metabolic Emergencies (DKA, Thyroid Crisis, Hypothyroid Coma, Electrolyte Disorders, Acute Alcohol Intoxication, Drug Overdose)

Read Text Chapter Case Studies, Critical Thinking Exercises

36

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making Spring 2006 Unit VIII NURSING MANAGEMENT OF CLIENTS REQUIRING EMERGENCY CARE
Performance Outcomes 11. Examine the application of the nursing process to plan, prioritize and coordinate the care of clients experiencing multiple trauma injury. ()* Key Concepts
Nursing Process: Care of Client with Multiple Trauma Injury Primary Assessment ABC4 – Airway,
Breathing, CC1 (Circulation), CC2 (Cervical Spine), CC3 (Chest), CC 4 (COC) Secondary

Learning Activities Read Text Chapter Case Studies, Critical Thinking Exercises

12. Examine the application of the nursing process to plan and coordinate the care of clients experiencing intra-abdominal injuries. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 13. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing various vascular (hemotalogic) emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 14. Compare and contrast the emergency management of clients who have been exposed to poisons by swallowing or inhaling poisons, eating poisoned food or by skin contact with poisons. ()* 15. Compare and contrast the emergency management of clients with the following environmental emergencies: heat stroke, frostbite, hypothermia, snake bites and spider bites. ()*

Assessment Survey Nursing Process: Care of Client with IntraAbdominal Injuries Nursing Process: Care of Vascular (Hemotalogic) Emergencies (Sickle Cell
Disease, Hemophiliac Anemia, Thrombocytopenia, DIC)

Read Text Chapter Case Studies, Critical Thinking Exercises

Read Text Chapter Case Studies, Critical Thinking Exercises

Assessment, Intervention
(Pain management, Pharmacologic)

Emergency Management of Clients Exposed to Poisons
(Swallowing, Inhaling, Eating Poisoned Food, Skin Contact)

Read Text Chapter

Nursing Process: Care of Client in ED with Shock: Interventions: Pneumatic Antishock Garment, Maintain Airway, Fluid/Blood Replacement, Maintain Body Temperature

Read Text Chapter Case Studies, Critical Thinking Exercises

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

37

The University of Texas at Brownsville and Texas Southmost College Associate Degree Nursing Program

RNSG 2441 Advanced Concepts of Clinical Decision Making Spring 2006 Unit VIII NURSING MANAGEMENT OF CLIENTS REQUIRING EMERGENCY CARE
Performance Outcomes 16. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing genitourinary emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 17. Examine the application of the nursing process to plan and coordinate the care of clients experiencing intra-abdominal injuries. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 18. Compare and contrast the application of the nursing process to plan and coordinate the care of clients experiencing various vascular (hemotalogic) emergencies. Include planning for teaching and therapeutic and culturally sensitive interventions. ()* 19. Compare and contrast the emergency management of clients who have been exposed to poisons by swallowing or inhaling poisons, eating poisoned food or by skin contact with poisons. ()* 20. Compare and contrast the emergency management of clients with the following environmental emergencies: heat stroke, frostbite, hypothermia, snake bites and spider bites. ()* Key Concepts
Nursing Process: Care of Genitourinary Emergencies Traumatic (Renal, Bladder, Urethral) Non-traumatic
(Infections, Renal colic & calculi, Dialysis clients with clotted grafts or shunts, Hematuria, Oliguria, Anuria)

Learning Activities Read Text Chapter Case Studies, Critical Thinking Exercises

Nursing Process: Care of Client with IntraAbdominal Injuries Nursing Process: Care of Vascular (Hemotalogic) Emergencies (Sickle Cell
Disease, Hemophiliac Anemia, Thrombocytopenia, DIC)

Read Text Chapter Case Studies, Critical Thinking Exercises

Read Text Chapter Case Studies, Critical Thinking Exercises

Assessment, Intervention
(Pain management, Pharmacologic)

Emergency Management of Clients Exposed to Poisons
(Swallowing, Inhaling, Eating Poisoned Food, Skin Contact)

Read Text Chapter

Nursing Process: Care of Client in ED with Shock: Interventions: Pneumatic Antishock Garment, Maintain Airway, Fluid/Blood Replacement, Maintain Body Temperature

Read Text Chapter Case Studies, Critical Thinking Exercises

*Numbers in parentheses after each performance outcome correspond with course learning outcomes met by this outcome.

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