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Medical Surgical Nursing

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COURSE DESCRIPTION: Students investigate the impact of illness on adult and geriatric patients and their families. They examine physiological, pathophysiological, psychological, financial, spiritual, and social changes affecting ill adults. Emphasis is placed on nursing interventions that promote, maintain, and restore health. Safety principles are highlighted. Students provide care for adult patients, emphasizing care needs of frail elders, in secondary and tertiary health care agencies.

1. Apply theories of illness and aging to the nursing care of older adults and their families. ( UGNUR 1, ANA 2, AACN 1, QSEN 1). 2. Assess the nursing care needs of adult patients with co-morbid conditions using a comprehensive database. (UGNUR 3, ANA 1, AACN 2, QSEN 1,2,6). 3. Use critical thinking skills to identify nursing diagnoses for elderly patients and their families. (UGNUR 2, ANA 2, AACN 4, QSEN 3,4,7). 4. Deliver a plan of nursing care for elderly adults supported by evidence-based interventions
and illness, aging, and nursing theories with an emphasis on frailty and vulnerability. (UGNUR 4, 5, ANA 4, AACN3, QSEN 1,7). 5. Communicate with elders and members of their support networks when planning nursing care. (UGNUR 6, ANA 5, AACN 6, QSEN 2,5,7). 6. Apply knowledge of safe and therapeutic care when planning and providing nursing care for adults and elders. (UGNUR 4, ANA 5, AACN 4, QSEN 1,2,6). 7. Provide teaching interventions incorporating health promotion principles for culturally diverse patients. (UGNUR 6, ANA 5, AACN 7, QSEN 5,7). 8. Evaluate the effect of the interventions of nurses and multidisciplinary teams of health care professionals on care outcomes. (UGNUR 7,8, ANA 6, AACN, QSEN 5) 9. Examine legal and ethical dilemmas associated with aging and health care interventions that confront nurses, elderly patients, and their families. (UGNUR 7, ANA 12, AACN 8, QSEN 1,7). 10. Demonstrate knowledge and respect of the rights of elders to maintain control of their environment and health care decisions. (UGNUR 9, ANA 11, AACN 9, QSEN7). 11. Demonstrate professional demeanor and behavior during clinical interactions. (UGNUR 8, ANA 5,7,9, AACN 2,8,9, QSEN7).

Course student learning outcomes are aimed at meeting the Undergraduate Nursing Program Learning Goals of the LaSalle University School of Nursing (UGNUR), ANA Scope and Standards of Practice (ANA SP, and AACN Essentials (AACN)., QSEN Competencies (QSEN)

Teaching Strategies:
Lecture/discussion; PowerPoint; videotapes/DVDs; handouts; questions for discussion; student presentations; practice test questions; case studies, independent study via Bb

Required Textbooks:
Cadenhead-Colgrove, K., & Callicoatt, J. (2011). Med-surg success (2nd ed.). Philadelphia:
Hinkle/Cheever (2014). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, (13th ed.) Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins. Hinkle Lippincott’s CoursePoint PrepU Adaptive Quizzing
for Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 13e

Hinkle Lippincott’s CoursePoint VitalSource eBook for Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 13e

Recommended Textbooks: (Some may be hard copy or software in PDA) Academy of Medical-Surgical Nurses. Standards of medical-surgical nursing practice (2nd ed.). Pitman, NJ: A. J. Jannetti, Inc.

American Nurses Association. (l998) Standards of clinical nursing practice (2nd ed.). Washington DC: ANA Publishing. Billings, D.M. (2008). NCLEX-RN( 9th ed.). Philadelphia: Lippincott Williams & Wilkins. Castillo, L. (2006). Strategies, techniques, & approaches to thinking: Critical thinking cases in nursing (3rd ed). St. Louis: Elsevier

Craig, G. P. (2008). Clinical calculations made easy: Solving problems using dimensional analysis. (4th ed.). Philadelphia:Lippincott. Gasper, M. & Dillon, P. (2012) Clinical simulations for nursing education. Philadelphia: Davis. Vallerand, Sanoski & Deglin (2013). Davis drug guide for nurses (13th ed). Philadelphia: Davis Venes, D. et al. (2009). Taber’s cyclopedic medical dictionary (21st ed.). Philadelphia: Davis. Swearingen, P. (2004). All-in-one care planning resource. St. Louis: Mosby.

Evaluation: School of Nursing Grading Scale
A = 93 – 100
A-= 90 – 92
B+ = 87 – 89
B = 84 – 86
B- = 81 – 83
C+= 78 – 80
C = 75 – 77
D = 70 – 74
F = 69 and below

Evaluation Methods:

Exam Information:
1. Four examinations (25% each) The course schedule identifies examination dates. The faculty retains the right to change these dates should such a change be necessary. If a student cannot be present for a scheduled examination, it is the student’s responsibility to notify the course coordinator prior to the examination start time. A message may be left at the faculty member’s office. The student must arrange for an examination make-up. Should a student fail to schedule an examination make-up within 2 days of the missed examination, the student will receive a 0% as the examination grade. Only one make-up opportunity will be scheduled. In general, make up examinations will be given within 5 business days of the examination. Student should expect to reschedule this examination outside of usual course/clinical activities. If a student misses an examination, faculty reserves the right to test the student in an alternative format. Faculty also reserves the right to give such student a grade equal to that of the lowest passing grade achieved.

Quiz Information:
2. PrepU Quiz Assignments (Pass/Fail): Students are required to Pass this component. Students will need to complete 8 of 14 posted quiz assignments on PrepU in order to achieve a score of “Pass”. Students who do not complete the 8 quiz assignments by the last day of scheduled class will receive a score of “fail” for this assignment, and may Fail the course.

3. Drug calculation competency examination: (Pass/Fail): Students will be given no more than 3 testing opportunities to achieve a 90% on a drug calculation competency examination. Students will not be permitted to administer medications before math competency is demonstrated. The calculation examination will be offered the 4th week of class per the course schedule. Subsequent testing will take place at the convenience of the instructor outside of course time but must be completed by the 6th week of the course. Should a student fail 2 testing opportunities, required tutoring, using the nursing laboratory support personnel and resources, must be satisfactorily completed before the third testing opportunity will be offered. Tutoring documentation will be required. If the student is unable to achieve the 90% grade after 3 attempts, the student will not be permitted to administer medications and will fail the clinical experience. Drug calculation problems may be a part of each objective testing opportunity.

4. Laboratory Practicum Skills Testing: (Pass/Fail) Each student will participate in skills testing that will be held in the Learning Resource Center. Students are required to earn a score of 80% for the skills testing practicum. Any student who does not earn a score of 80% will be given one additional opportunity to test at a time assigned by the instructor. If the student is unable to achieve a score of 80% on the second attempt, the student will fail the clinical experience for the semester. The procedure for the lab practicum is outlined further on in the syllabus. Any student who achieves a grade of less than 75 for any section of the lab practicum test will be given a learning referral and will be required to have remediation for that skill.

**Appointments for testing will be the student’s responsibility. Introduction & practice for the skills will be completed on the first clinical orientation day. After that time students may practice in LRC. Students are to make an appointment at the LRC, throughout the semester, to test individually. Skills testing will begin February 10, 2014 and Successful completion of skills practicum is required by of April 11, 2014. Any student who does not make the appointment during the required times or is unsuccessful after remediation is in jeopardy of failing the course.

5. Clinical (Satisfactory/Unsatisfactory) Student will demonstrate clinical competencies in a health care agency. As part of the clinical experience student submits a Correlation Guideline with a Reflective Record for each patient assigned to the student for care each week. This is graded on a pass/fail basis. A care plan will be submitted by the student at the end of the clinical for their scheduled clinical day. This is also graded on a pass/fail basis. Unsatisfactory paperwork will be returned for revision.

Self-Evaluation of the Student Clinical Experience:
1. The student completes a self-evaluation of his/her clinical experience. The instructor contributes to this evaluation. Both the faculty member and student sign the evaluation. 2. The evaluation becomes a part of the student’s permanent file. 3. This is due at mid semester and the last session of the clinical laboratory.

Faculty-Evaluation of the Student Clinical Experience:
1. The faculty member completes an evaluation of the student’s clinical experience. Both the faculty member and student sign the evaluation.
2. The evaluation becomes a part of the student’s permanent file. 3. This is due at mid semester and the last session of the clinical laboratory.

Clinical Preparation: Students are responsible for their transportation to and from the assigned clinical site. Clinical experience is a mandatory requirement of this course. You are expected to notify your clinical faculty by 6:00am of any absence or emergency. Failure to notify faculty of clinical absence or lateness may result in clinical failure. All absences will require make-up work. Faculty retain the right to disallow student participation in a clinical activity should the student present in an unprepared state. All pass/fail course experiences must be satisfactorily completed by the last class day of the semester. Absence from clinical, late arrival or lack of preparation for the clinical assignment may place student in clinical jeopardy due to inability to meet course objectives.

Please note that students must pass the theory portion of the course with a 75 or above and must have a satisfactory clinical grade. Failure in clinical and/or failure in theory results in course failure.

Students are required to use the “My La Salle” portal to obtain electronic mail and for submission of any course assignments. Class notes will be posted on Bb. Students will be required to periodically visit particular web sites to review information. Materials sent via electronic mail or given as
part of the laboratory learning experiences are considered testable materials. Academic Integrity

Cheating, plagiarism, and other forms of academic dishonesty will not be tolerated. All work submitted by a student must be the student’s own work. When you summarize or directly quote other people’s ideas, they must be acknowledged (in APA style). The first instance of academic dishonesty will result in a grade of zero on the relevant assignment. Further instances may result in a grade of F for the course. Please refer to the following web site for more information

School Closure
If La Salle University closes for an extended period, students should attempt to complete weekly readings and other assignments while waiting the re-opening of the University.

Academic and Learning Support Services:
Students are required to submit well-written papers that are grammatically correct, spell-checked, and written with clarity. Academic and Learning Support Services are available at

Classroom Attendance Policy

Regular attendance is expected in all courses of the undergraduate nursing program. Preparation for class is required. In the Undergraduate Nursing programs, class and clinical hours for Nursing major courses are set according to the curriculum plan approved by the PA State Board of Nursing. A student’s grade will drop one grade level for more than two classroom absences (in any increment, including lateness or leaving a class early). Beyond two absences (in any increment of time) the student’s grade will drop one grade level for each time missed (e.g., if an A to an A-; A- to a B+; etc.). In the case of any of these special circumstances, specific documentation is required from a third party: death of an immediate family member; hospitalization (not a physician or nurse practitioner visit); mandated legal hearing; military obligations; and University athletic required participation events.

Class participation
Class participation is an expectation. Guided in class discussions, a regular part of class, will be useful in comprehension of course materials. The extent and quality of class participation and completion of learning activities are directly related to success in this course. Attendance at clinical is mandatory. Missed clinical days will require scheduled make-up days.

Student Counseling Center:
The Student Counseling Center provides individual counseling, group counseling, psychiatric consultation, psychological assessment, crisis intervention, and outreach and referral services to LaSalle University students. Please visit this web site for specific information. http://studentaffairs.lasalle.edu/scc

Student Guide to Rights and Responsibilities:
Please visit this web link on LaSalle portal for the Student Guide to resources, Rights and responsibilities:

Class Modules
Learner Objectives
Course Introduction
1) Orientation to Course
2) Elderly Patients in Health and Illness
3) Demographics and epidemiology of aging
4) Aging Theories including theories of normal aging
a) Biological Aging Theories
i) Free radical
ii) Immunologic/Autoimmune
b) Functional/Activity Theories
i) Standardized instruments for assessment of functional status (1) ADL assessment
5) Best practices for Elders
a) http://www.hartfordign.org/resources/education/tryThis.html i) Urinary continence
ii) Pressure ulcer
iii) Pain
6) Older adult as patient
7) Discrimination
8) Family of older patients and involvement in care
9) Models of care and inter-professional care for older adults

Students will:
1. Recognize the Academy of Medical Surgical Nursing (AMSN) (www.medsurgnurse.org) as one national nursing organization focused on medical-surgical nursing. 2. Identify current priorities in medical-surgical nursing, including emphases related to frail and vulnerable elders. 3. Describe the role of medical-surgical nurses in implementing National Patient Safety Foundation goals. 4. Incorporate evidence-based practice web resources into repertoire of study materials. 5. Contrast healthy aging to unhealthy aging within the context of selected theories of aging. 6. Identify professional organizations with a geriatric focus that provide resources for patients, families, and nurses.

I. Nursing Care of the Patient with Alteration in Comfort: Pain Principles 1) Theories of pain relevant aging: chronicity
2) Standards for best practice in pain management for elders a) AHRQ: Agency for Healthcare Research and Quality
b) NICHE program/Hartford Institute for Geriatric Nursing

Students will:
1. Differentiate chronic pain from acute pain.
2. Apply theories of pain to the care of adults and elders experiencing pain. 3. Discuss pharmacologic and non-pharmacologic interventions designed to reduce the pain experience. 4. Identify evidence-based instruments for pain evaluation.

5. Discuss current literature specific to elders’ pain experiences including research relating to the pain experience of confused elders. 6. Identify sources for pain management best practices and standards.

III and IV

V and VI.

Nursing Care of the Patient Alterations in Sensory Functioning 1) Altered sensorium and safety concerns
in unique populations
a) Age-related considerations
b) Chronic neurologic conditions
c) Home safety and modifications
d) In-patient/outpatient safety concerns
2) Eye Disorders
a) Normal Aging compared to disease
b) Glaucoma
c) Cataracts
d) Retinal detachment
e) Macular degeneration
f) Ear Disorders
g) Normal Aging versus disease

Nursing Care of the Patient with Alteration in Neurological Function 1) Review of Neuro-anatomy and physiology
2) Cranial Nerve Abnormalities
a) Swallowing and Dysphagia
(1) Dietary modifications
(2) Feeding modalties
3) Pathophysiology/Risk factors-genetics/Assessment/Diagnostics/Collaborative Care/Pharmacology/Nursing Care/Education and Health Promotion

Nursing Care of the Patient with Alteration in Blood Pressure: Hypertension 1) Blood pressure regulation and age-related changes
2) Disorders of blood pressure regulation
3) Stepped Care Approach: National Blood Institute guidelines. 4) Primary hypertension
5) Isolated systolic hypertension
6) Secondary hypertension
7) Hypertensive crisis 8) Hypertension Therapy
9) Results of long-term disease
10) Renin Angiotensin Aldosterone System

Nursing Care of the Patient with Alteration in Peripheral Circulation 1) Peripheral vascular Anatomy & Physiology
2) Assessment of Peripheral vascular Status
3) Peripheral Vascular Disease
4) Disorders of peripheral arteries
5) Peripheral arteriosclerosis
6) Arterial thrombosis/embolism
7) Buerger’s disease
8) Raynaud’s disease
9) Venous disorders
10) Thrombophlebitis
11) Deep vein thrombosis
12) Chronic venous insufficiency
13) Varicose veins
14) Pathophysiology/Risk factors-genetics/Assessment/Diagnostics/Collaborative are/Pharmacology/Nursing Care/Education and Health Promotion

Students will:
1. Differentiate between hearing and vision assessment findings related to normal aging versus those resulting from disease. 2. Identify prioritized nursing interventions for the patient experiencing retinal detachment. 3. Develop a comprehensive teaching plan for the patient post-cataract surgery. 4. Describe macular degeneration and elderly specific web-based resources available to promote self-care activities. Contrast conductive to neurological hearing loss.

Students will:
1. Apply cranial nerve and neurological assessment skills in the care of patients potentially experiencing impaired swallowing. 2. Describe common cranial nerve disorders and associated nursing care priorities, including Bells Palsy, and Trigeminal Neuralgia (tic douloureux). 3. Discuss current research priorities specific to tic douloureux and associated clinical trials, emphasizing those investigating pharmacological and non-pharmacological interventions.

Students will:
1. Compare patient blood pressures to individual baseline measurements and federally established guidelines to develop prioritized plans of care 2. Retrieve research-based strategies for promoting and maintaining health perfusion pressures that incorporate patient preference, resources, and evidence. 3. Collaborate with health care team members to implement and evaluated stepped care approaches to managing hypertension using age-appropriate risk reduction and intervention strategies. 4. Apply principles of anatomy and physiology in both normal and altered states to the plan of care for patients with altered states of venous and arterial perfusion. 5. Identify the regional and national health care challenges related to perfusion alterations and within the context of health disparities and Healthy People 2010. 6. Develop an evidence-based plan of care for smoking cessation. 7. Describe normal age-related changes to vascular and cardiac systems. VIII.

Nursing Care of the Patient with Alteration in Pulmonary Function 1) Pulmonary Anatomy & Physiology
a) Age related changes in pulmonary function tests
2) Pulmonary Assessment
a) Age related parameters for pulse oximetry, arterial blood gases, activity tolerance. b) Arterial Blood Gas interpretation
3) Environmental risk factors:
a) Radon
b) Second-hand smoke
c) Smoking
4) Pneumonia/Atelectasis
5) Tuberculosis
6) Smoking cessation
7) Pathophysiology/Risk factors-genetics/Assessment/Diagnostics/Collaborative Care/Pharmacology/Nursing Care/Education and Health Promotion

Students will:
1. Differentiate between the differing pathophysiologic conditions that contribute to atelectasis and lung inflammation with an expressed understanding of related nursing process priorities. 2. Operationalize independent nursing actions targeting improving gas exchange. 3. Collaborate with physicians and other health care team members to establish a plan of care that prevents or intervenes in states of altered gas exchange. 4. Evaluate the effectiveness of pulmonary related health promotion and disease prevention strategies for patients, community members, and nurse health. 5. Apply principles of normal anatomy and physiology to interpret normal and fully compensated arterial blood gas results. IX.

Nursing Care of the Patient with Alteration in Endocrine Function: Diabetes Mellitus and Thyroid conditions 1) Anatomy & Physiology of the Pancreas
2) Pathophysiology of Diabetes Mellitus
3) Types of Diabetes Mellitus
4) Education and Management: Strategies for developing age-appropriate teaching plans, targeting elders. a) Pharmacologic Treatment
b) Dietary Issues
c) Exercise Considerations
d) Complications: Chronic Issues
i) Sick day care
ii) Travel care
iii) Polypharmacy and Elders: Implications with diabetes mellitus and signs/symptoms of glycemic abnormalities. 5) Thyroid conditions- hypothyroidism & hyperthyroisism
Students will:
1. Describe altered states of glucose metabolism.
2. Contrast pharmacologic agents used to manage altered states of glucose metabolism. 3. Apply knowledge of the multi-system effects of altered glucose metabolism within the context of micro and macro angiopathies to a nursing plan of care. 4. Describe the epidemiology of diabetes mellitus and relate this information to health promotion and disease management strategies within urban and/or vulnerable groups. 5. Relate exercise plans to glucose metabolism.

6. Strategize prioritized interventions for uncomplicated diabetes related emergencies, including hypoglycemia. X.
Nursing Care of the Patient with Altered Cell Growth: Cancer 1) General Principles
a) Normal and abnormal cell growth
b) Etiologic factors: Carcinogenesis
2) Benign vs. Malignant Growths
3) Metastases (TNM) Classification
4) Development, Prevention & Detection within the context of age and risk a) Cancer signs/symptoms versus age-related changes
b) Screening and early detection barriers in older adults.
5) Chemotherapy
6) Treatment protocols
a) Risks
b) Cell Cycle Relationship
c) Treatment of side effects
7) Infusion techniques/IV ports and devices
8) Radiation Therapy
9) Principles of therapy
10) Treatment of side effects
11) Review of classic Agents: Cytoxan, Cisplatin, Methotrexate, Vica Alkaloids, Tamoxifen, Adriamycin 12) Biologic therapy for cancer
i) Hematopoietic growth factors
ii) Interleukins
iii) Monoclonal antibodies
iv) Gene Therapy
v) Clinical Trials
13) Bronchogenic Cancer
14) Thoracotomy
15) Pleuritis
16) Pleural effusion
i) Chest tube Care ii) Heimlich
17) Laryngeal Cancer
18) Breast Cancer
19) Lymphedema
20) Ovarian Cancer
21) Cervical Cancer
22) Testicular Cancer
23) Pathophysiology/Risk factors-genetics/Assessment/Diagnostics/Collaborative Care/Pharmacology/Nursing Care/Education and Health Promotion 24) Genetics/ genomics
Students will:
1. Discuss the promotion of carcinogenic processes incorporating genetic, environmental, and personal risks. 2. Apply evidence-based practices for prevention and detection of malignancies within individuals and groups. 3. Verbalize rationales for collaborative interventions in the treatment of oncologic processes. 4. Develop a plan of care for the patient experiencing selected solid tumor growths, incorporating holistic, non-traditional interventions with traditional therapies. 5. Ascertain personal risk for cancer using risk inventories and established instruments. 6. Relate
chemotherapy to the cell cycle.

7. Apply knowledge of chemotherapy, radiation, and cell cycle to the management of treatment side effects. 8. Verbalize an understanding of the role and responsibilities of the oncology nurse as described by the Oncology Nursing Society. XI.

Nursing Care of the Patient with Alteration in Urinary Function 1) Genito-Urinary System Review
a) Urine Formation
2) Urine Testing
3) Urinary Tract Dysfunctions
4) Urinary Tract Infections
5) Renal Calculi
6) Benign Prostatic Hypertrophy
a) Assessment strategies
i) Bladder scan
ii) Post-void residual
b) Pharmacologic management
d) Prostatectomy Surgeries
e) Radium seeding
7) Continuous Bladder Irrigation
8) Prostate Cancer and Bladder Cancer
a) Disparities
i) www.ahrq.gov
9) Urinary Diversions: Ileal conduit, nephrostomy tubes
10) Pathophysiology/Risk factors-genetics/Assessment/Diagnostics/Collaborative Care/Pharmacology/Nursing Care/Education and Health Promotion

Students will:
1. Identify potential abnormalities in urine flow and formation related to sex and age and the diagnostic/assessment procedures used to diagnose obstructive processes. 2. Develop a comprehensive, evidence-based plan of
care for the patient with benign and/or malignant prostatic hypertrophy, including age-related screenings, and incorporating research findings specific to race/culture to encourage screening participation. 3. Demonstrate safe practice when providing care to the patient requiring continuous bladder irrigation, suprapubic catheters, nephrostomy tubes, or urinary diversions. 4. Contrast prostate cancer epidemiology and mortality based upon race using Agency for Healthcare Research and Quality resources. 5. Apply principles of infectious disease prevention and management to care plans for patients at risk for or experiencing urinary tract infections. 6. Contrast acid to ash diets as intervention strategies to reduce renal calculi risk. 7. Discuss pain management strategies for the patient experiencing an acute exacerbation of renal colic. 8. Develop an evidence-based plan of care for the patient diagnosed with a renal calculus requiring lithotripsy.

XII. and XIII.
Nursing Care of the Patient with Alteration in Upper Gastrointestinal Function 1) Gastrointestinal Anatomy & Physiology
2) Gastrointestinal Assessment
3) Nutrition for Older Adults
i) Nutrient needs for older adults
ii) Food habits of older adults
iii) Diet types
(1) Mechanical soft diet
(2) High fiber diet
(3) Enteral Feedings
(4) Parenteral Feedings
4) Peptic Ulcer Disease
a) Medical management
b) Surgical management
6) Hiatal Hernia
7) Hernia
8) Cancer of the Stomach
a) Bilroth I& Bilroth II
i) Dumping Syndrome
9) Esophageal Cancer
10) Constipation
11) Diarrhea
12) Fecal incontinence
13) Diverticulosis/ diverticulitis

Students will:
1. Describe common alterations in upper gastrointestinal functioning with associated diagnostic findings, symptomatology, and intervention strategies. 2. Develop a plan of care designed to minimize signs and symptoms associated with dumping syndrome. 3. Describe age-related nutritional needs in relation to types of oral diets, enteral feedings, and parenteral feedings. 4. Demonstrate safe care of patients requiring gastrointestinal intubation including the insertion, maintenance, and removal of GI tubes.

Nursing Care of the Patient with Alterations in Movement
1) Musculoskeletal Anatomy & Physiology
a) Age-related Changes
2) Musculoskeletal Assessment
3) Falls prevention
a) NICHE: Best practice
b) Cochrane Library: Systematic Review: Fall prevention
c) National Guidelines Clearinghouse
4) Fractures and Immobilization
i) Traction
ii) Casts
5) Chronic Back Injury
6) Hip fracture
7) Strains & Sprains
i) Ace Wraps
8) Gout
9) Osteomyelitis
10) Osteoporosis
11) Bone Tumors
12) Joint Replacement
i) Hip
ii) Knee
(1) PROM Machine
13) Amputations

Students will:
1. Apply musculoskeletal assessment strategies in the care of patients experiencing acute musculoskeletal trauma including strains, sprains, and fractures. 2. Demonstrate correct techniques when applying RICE (rest, ice, compression, elevation) interventions with associated teaching in the event of musculoskeletal trauma. 3. Develop a teaching plan for the patient requiring immobilization via traction, splinting, casts, and assistive devices. 4. Describe nursing care priorities for the post experiencing open reduction internal fixation post traumatic hip fracture. 5. Collaborate with healthcare team members to establish a comprehensive plan of care for the patient requiring lower extremity or upper extremity amputation. 6. Apply knowledge of health promotion and assessment in the care of the patient interested in reducing osteoporosis risk beginning with young adult years through senior years.

Course schedule continued on following pages.
NUR 316
Sections 41, 42 & 43 Care of Older Adults in Health and Illness Spring 2014 Schedule
*Use the prior topic list for specific topics in the assigned chapters. Date
Clinical Location
Week #1
Orientation to Course; Adult Client in Health & Illness; Aging Theories, Best
Practices for Elders, Older Adult as Patient

Textbook: Chapters 5 and 11

No Clinicals this week
Week #2
Nursing Care of the Patient with Alteration in Comfort: Pain Principles

Nursing Care of the Patient with Alterations in Sensory Functioning: Eye and Ear Nursing Care of the Patient with Alterations in Neuro Functioning

Textbook Chapter 12
Chapter 63 and 64and 65 and pages 2046-2050

1/27, 1/29 or 1/31 as assigned
On Campus Clinical Orientation/immersion (8 hours)
Prep:Meds-morphine (MS Contin); oxycodone (Percocet

Week #3

Exam 1

Assigned Case study: Aging
Required Case study via Bb as assigned.
2/3, 2/5, or 2/7 (8 hours total—
4 hours orientation at site and 4 hours on unit))
Hospital Orientation (individual sections vary-see Instructor for details). NCP- ineffective therapeutic regimen: hypertension; Meds-enalapril (Vasotec); metroprolol (Lopresor)

Week #4
Nursing Care of the Patient with Alteration in Blood Pressure

Textbook: Chapter 31
Medication Calculation Quiz #1

2/10; 2/12; 2/14
NCP- Ineffective tissue perfusion (peripheral); Meds-enoxaparin(Lovenox; clopidgrel (Plavix Week #5
Nursing Care of the Patient with Alteration in Peripheral Circulation

Textbook: Chapter 30

Medication Calculation Quiz # 2 if needed (time to be scheduled) 2/17; 2/19; 2/21
NCP- ineffective airway clearance; Meds-moxifloxacin(Avelox cefuroxime (Ceftin). Week #6
2/18 2/20
Nursing Care of the Patient with Alteration in Pulmonary Function

Textbook: Chapter 20, 21, 22 pages 557-567, chapter 23 pages 586-591 and pages 605-610

Medication Calculation Quiz #3 if needed (time to be scheduled)

Week #7
Exam 2

Required Case study via Bb as assigned.

2/24; 2/26; 2/28 Hospital
**Midterm Evaluations due
Spring Break

No Class
No Clinical

Week #8
Nursing Care of the Patient with Alteration in Endocrine Function: Diabetes Mellitus Thyroid Conditions

Textbook: Chapter 51 and chapter 52, pages 1470-1484

3/10; 3/12; 3/14
NCP- Risk for injury R/T hypoglycemia; Meds-insulin; lispro, regular, NPH. NCP- Imbalanced nutrition R/T hyperglycemia; Meds-glipizide (Gluctrol); metformin (Glucophage);
Week #9
Nursing Care of the Patient with Altered Cell Growth: Cancer Genetics/ Genomics

Textbook: Chapter 8 and 15 and pages 887-888.

3/17; 3/19; 3/21
NCP- Risk for infection R/T decreased neutrophils; Meds-filgrastim (Neuopen)

# 10
Cancer continued
Reproductive and solid cancers
Textbook : Chapters 57 , chapter 58 (pages 1667-1678), chapter 59 cancers of prostate and testicles

3/24; 3/26; 3/28 Hospital

Week #11
Exam 3

Required Case study via Bb as assigned.
3/31; 4/2; 4/4 Hospital
NCP- Activity intolerance R/T weakness Meds- epoetin (Epogen)

Week #12
Nursing Care of the Patient with Alteration in Urinary Function

Bladder Cancer
Urinary Diversions

Textbook: Chapters 53 and 55

4/7; 4/9; 4/11
(NCP-Acute urinary retention (collaborative); Meds-flutamide (Eulixin); furosemide (Lasix)

Week #13
Nursing Care of the Patient with Alteration in Upper Gastrointestinal Function

Textbook: Chapter 44, 45, chapter 46 pages 1251-1254 and 1256-1257, chapter 47 and chapter 48 pages 1286-1292 and 1318-1327

4/14; 4/16 Hospital (4hours)
No Friday Clinical this week.
Final clinical Evaluations due
Week #14 4/22

Nursing Care of the Patient with Alterations in Movement

Textbook: Chapter 40, 41, 42 and 43 pages 1132-1135 and 1141-1154

4/25 Friday only 4 hours
Final Clinical Evaluations due

Week #15
Case Study Review

Textbook: All areas covered within specific chapters


Final Examination

* Clinical time at the hospitals is 7:00 A.M. to 3:30 P.M. PLUS independent skills testing as below.

**Independent Skills Testing at the LaSalle learning Lab: Make appointments for one half hour week during the semester, before April 10, 2014 as per the syllabus.

Scheduled clinical make up days are 4/28, 4/30 and 5/2 as needed.

Students are expected to have an assignment of two patients each week except for the one week they are assigned to the O.R. and the first week of actual clinical practice. You can expect to administer medications to at least one patient each week.

Faculty reserves the right to change or alter any of this syllabus or course schedule as necessary.

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