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UNIVERSITY OF PERPETUAL HELP SYSTEM GMA BRGY.

. SAN GABRIEL, GMA, CAVITE COLLEGE OF NURSNG INSTRUCTORS GUIDE COURSE TITLE: NCM 104 (NURSING CARE MANAGEMENT II REHABILITATIVE) UNITS: 16 (8 hours lecture, 8 hours RLE) COURSE DESCRIPTION: Concepts and principles of nursing care management of clients with alterations in human functioning across the life span in varied settings. TERMINAL COMPETENCIES: Given a client with simple to complex health problems / work related health problems and life threatening conditions in any health care situation, the student provides nursing care utilizing the nursing process. PRE-REQUISITES: NCM 103 CONTENT: 1. ALTERATIONS IN HUMAN FUNCTIONING A. Maladaptive Patterns in Behavior B. Disturbances in Perception and Coordination C. Disturbances in Inflammatory and Immunologic D. Disturbances in Cellular Functioning E. The Client in Acute Biologic Crisis F. The Client in Emergency / Disaster Situation TEACHING-LEARNING POINTERS CONTENT PRESENTATION The Concept (Review) Epidemiology Pathophysiology Levels of Care Promotive Preventive Restoration Rehabilitation TEACHING METHODOLOGY Nursing Care Management Across the life span All settings Nursing Process Assessment Analysis/nursing diagnosis Planning/patient outcome Implementation/intervention Evaluation

Integrated Concepts communication caring cultural awareness self care teaching learning SAFETY FIRST PROTOCOL!!!

Week: 1 Subject: NCM 104 Topic

Day: 1 Revision No.

Effectivity date: 1st Sem, AY 2009-2010 Page 2/26

Orientation Specific Objectives: 1. Understand the course content of NCM 104. 2. Learn the house rules about attendance, decorum, requirements, grading system, schedules of examinations. 3. Familiarize themselves with the new instructor. 4. Familiarize themselves with fellow classmates. Time 30 minutes Content / Learning Activities *Overview of the course outline *Grading System: Attendance - 10% Decorum - 5% Quizzes - 40% Requirements 15% Performance - 30% Total CS 100% Class standing x 2 + long exam/ 3 *Rules concerning attendance & decorum shall be reviewed *Instructor will be introduced to the class. *Each student will be asked to introduce himself/herself in front of the class *Each class shall be divided into 4 groups. This groupings shall be enforced for the whole semester for purposes of group discussion and dynamics. Prepared By: Carlito S. Santos, MD, RN, MAN Assistant Professor III Teaching Strategies Discussion Evaluation

Date June 15, 2009

Approved By: Zeny C. Mina, RN, MAN, Ph.D College Dean

Topic MALADAPTIVE PATTERNS OF BEHAVIOR INTERMEDIATE COMPETENCIES: Given a hypothetical case, the student will be able to: 1. assess the client based on the various assessment criteria. 2. identify the various behavioral symptoms. Given a client, the student will be able to: 1. Write the nursing history. 2. Perform assessment. Given a situation, the student will be able to: 1. Distinguish the different levels of anxiety based on symptoms/characteristics. 2. Provide appropriate care for the patient. Time Content / Learning Activities Subject Matters: A. Maladaptive Patterns of Behavior ASSESSMENT 1. Appearance 2. Behavior, attitude and normal coping patterns 3. Communication and personality type 4. Emotional state or affect 5. Predisposing and precipitating factors 6. Appraisal of stressors 7. Cognitive functions - Orientation x 3 spheres - Memory - Thought process and content 8. Mood and Affect I. Anxiety response and Anxiety Disorders - Defining characteristics - Levels of Anxiety - Manifestations of the various anxiety disorders NURSING DIAGNOSIS 1. Severe/Panic level of anxiety 2. Moderate level of anxiety 3. Ineffective individual coping 4. Alteration in role performance 5. Self-care deficit PLANNING AND IMPLEMENTATION 1. Severe/Panic level of anxiety a. Establish a trusting relationship b. Self-awareness c. Protect patient d. Modify environment e. Encourage activity 2. Moderate level of anxiety a. Recognize anxiety b. Insight into the anxiety c. Cope with the threat Teaching Strategies Evaluation

d. Promote relaxation response TREATMENT MODALITIES 1. Pharmacology 2. Behavior Therapy 3. Milieu Therapy 4. Psychotherapy EVALUATION 1. Were maladaptive coping response learned? 2. Were new adaptive coping responses reduced? 3. Was the nurse accepting of the patient and able to monitor personal anxiety throughout the relationship?

Topic MALADAPTIVE PATTERNS OF BEHAVIOR INTERMEDIATE COMPETENCIES: Given relevant questions, the student will be able to: 1. Compare physical and behavioral characteristics associated with psychophysiologic, somatoform and sleep related disorders. 2. Recognize the impact of psychophysiologic, somatoform and sleep disorders on the client and family members. Given a client with a medical condition, the student will be able to: 1. Formulate a plan of care for clients with psychophysiologic and sleep related disorders. 2. Delineate specific approaches for the client with somatoform disorders. Given a relevant questions, the student will be able to: 1. Discuss the dynamics and characteristics of abusive and violent behavior. 2. Describe the manifestations and emotional reactions of the victims of abusive/violence. Given a case of grief and mood disorders, the student will be able to: 1. Compare the objective and subjective symptoms. 2. Describe the etiology of the said conditions. 3. Discuss the nursing interventions for the client. Given a client with mood disorders, the student will: 1. Assess the mood and behavior of the client. 2. Identify the problems of the client with mood disorders. 3. Apply various interventions appropriate for the clients problems. Time Content / Learning Activities Subject Matters: 2. Psychophysiologic Responses, Somatoform and Sleep Disorders 2.1 Psychophysiologic Responses Continuum ASSESSMENT: 1. Physical conditions affected by stress. 2. Physical and behavioral characteristics of sleep related disorders. 3. Specific somatoform disorders a. Prevalence b. Core symptoms NURSING DIAGNOSIS: Teaching Strategies Evaluation

1. 2. 3. 4. 5.

Impaired adjustment Sleep pattern disturbance Alteration in comfort Ineffective individual coping Self-care deficit

PLAN/IMPLEMENTATION: 1. Patient teaching - establish a daily routine - promote adequate nutrition and sleep 2. Expression of emotional feelings - recognize relationship between stress/coping and physical symptoms - limit time spent on physical complaints - limit primary and secondary gains 3. Coping strategies - emotion focused coping strategies e.g. relaxation techniques, deep breathing, guided imagery, distraction - problem-focused coping strategies e.g. problem-solving strategies, role-playing EVALUATION: 1. Decrease visits to MDs with physical complaints 2. Decrease use of medications and more (+) coping technique. 3. Abuse and Violence 3.1 Abuse - Child Abuse - Spouse/Partner Abuse 3.2 Family violence 3.3 Dissociative Disorders 3.4 Posttraumatic Stress Disorder ASSESSMENT: - Characteristics, manifestations of an abused client / victims of violence. NURSING DIAGNOSIS: 1. Self-concept 2. Body Image 3. Self-ideal 4. Self-esteem 5. Role Performance 6. Personal identity/Healthy Personality PLANNING/IMPLEMENTATION 1. Promote client safety 2. Help client cope with stress and emotions - deep breathing and relaxation techniques - distraction techniques e.g. physical exercise, listen to music, talk with others, hobby 3. Help promote clients self-esteem refer to client as survivor rather than

victim establish social support system in community

EVALUATION - Gradual progress in being able to keep self safe, learn to manage stress and emotions, being able to function in daily life. 4. Emotional Responses and Mood Disorders 4.1 Grief Reactions 4.2 Depression and Suicide 4.3 Mania ASSESSMENT: 1. Mood 2. Motor activity 3. Language thought process NURSING DIAGNOSIS: 1. Altered nutrition 2. Dysfunctional grieving 3. Constipation 4. Fatigue 5. Hopelessness 6. Powerlessness 7. Altered Role Performance 8. Self-care deficit 9. Self-esteem Disturbance 10. Sleep pattern disturbance 11. Social isolation 12. Spiritual distress 13. Potential for violence directed to self PLAN/IMPLEMENTATION: 1. Begin a therapeutic relationship 2. Ensure safety of clients with low self esteem 3. Listen closely for behavioral cues to suicidal thoughts 4. Create a structured and scheduled but nondemanding environment. 5. Promote independence by encouraging client to perform ADL. Assist only when he cannot perform. 6. Closely monitor for the side effects or antidepressants / antimanic agents. 7. Ensure that nutritional and fluid balance needs are met. EVALUATION: 1. Safety issues 2. Compare mood and effect before and after treatment 3. Changes in clients perception of quality of life.

Topic MALADAPTIVE PATTERNS OF BEHAVIOR INTERMEDIATE COMPETENCIES: Given a case scenario of a client with Schizophrenic/Cognitive disorders, the student will be able to: 1. Discuss the etiology of Schizophrenic and Cognitive Disorders. 2. Describe the assessment for the client with Schizophrenia. 3. Differentiate delirium and Dementia. 4. Develop a nursing care plan for the client with Schizophrenia/Cognitive disorder. Given an actual case of Schizophrenia/cognitive disorder, the student: 1. Utilizing the nursing process, will be able to render care to the client 2. Evaluate the effectiveness of the various treatment modalities for the patient. Given a set of cues, the student will be able to: 1. Recognize the characteristics of each personality disorder. 2. Identify the relevant nursing diagnosis for clients with personality disorders. 3. Describe the nursing interventions for patients with personality disorders. Given an actual case with personality disorder, the student will be able to: 1. Utilize the nursing process in managing a client with personality disorder. Time Content / Learning Activities Subject Matters: 5. Schizophrenia and other Psychotic and Cognitive Disorders 5.1 Types of Schizophrenia 5.2 Delusional Disorders 5.3 Delirium, Dementia and other Cognitive Disorders ASSESSMENT 1. Thought process 2. Affective response 3. Perceptual functions 4. Interpersonal relations 5. Related behavioral and physical symptoms NURSING DIAGNOSIS: 1. Risk for violence: self directed or directed at others 2. Altered thought process 3. Sensory/Perceptual alterations 4. Impaired verbal communications 5. Self-care deficit 6. Social isolation 7. Ineffective individual coping 8. Altered health maintenance PLANNING/IMPLEMENTATION 1. Promote safety of client and others and right to privacy and dignity 2. Establish trust 3. Use therapeutic communication 4. Interventions for hallucinations 5. Interventions for delusions 6. Coping with socially inappropriate behaviors 7. Ensure that the physiologic needs are met. Teaching Strategies Evaluation

EVALUATION 1. Have the clients psychotic symptoms disappeared? 2. Safety 6. Social Responses and Personality Disorders 6.1 Types of Personality Disorders ASSESSMENT - Symptoms/characteristics of each type. NURSING DIAGNOSIS 1. Ineffective individual coping 2. Altered role performance 3. Impaired social interaction 4. Patient for violence directed to others PLANNING/IMPLEMENTATION 1. Promotes client safety 2. Set limits to clients socially unacceptable behaviors 3. Help the client cope, problem solve and control emotions 4. Enhance social skills 5. Enhance role performance Topic: MALADAPTIVE PATTERNS OF BEHAVIOR INTERMEDIATE COMPETENCIES: Given a set of cues, the student will be able to: 1. Recognize the subjective and objective of substance abuse and dependent patients. 2. Develop a nursing care plan for substance dependence. Given an actual patient with substance dependence the student will: 1. Identify the needs of clients. 2. Plan appropriate intervention to the client. 3. Evaluate the effectiveness of the nursing interventions and treatment modalities to the client. 4. Education to the client to increase the knowledge regarding substance abuse. Given a relevant question, student will be able to: 1. Compare and contrast Anorexia and Bulemia Nervosa 2. Describe the etiology of eating disorders. 3. Develop NCP for patients with eating disorders. 4. Identify the treatment for client with eating disorders. Given a client with eating disorders, the student will be able to meet the needs of the client. Given a set of cues, the students will be able to: 1. Identify the sexual dysfunctions, paraphilias, and gender identity disorder. 2. Discuss the nurses role in the care of client with sexual disorders. Given hypothetical cases, the student will be able to: 1. Differentiate the characteristic features of infancy, childhood and adolescent disorders. 2. Identify principles of nursing intervention in the care of infants, children and adolescents with emotional problems. 3. Discuss the role of the family in prevention and management of childhood and adolescent disorders. Assigned a client exhibiting any of the infancy, childhood and adolescent disorders, the student will be able to: 1. Formulate a plan of care for specific behaviors manifested. 2. Implement appropriate nursing intervention. Time Content / Learning Activities Teaching Evaluation

Strategies Subject Matters: 7. Substance-Related Disorders ASSESSMENT - manifestations of substance abuse, intoxication and withdrawal NURSING DIAGNOSIS 1. Ineffective denial 2. Ineffective individual coping 3. Altered nutrition: less than body requirement 4. Self esteem disturbance 5. Knowledge deficit 6. Altered role performance 7. Altered family process PLANNING/IMPLEMENTATION 1. Convey an attitude of acceptance to the patient. 2. Confront the clients denial 3. Set limits on manipulative behavior. 4. Encourage verbalization of feelings. 5. Explain the effects of the substance in the body. 6. Ensure adequate nutrition. EVALUATION 1. Did the client express his feelings openly? 2. Did the client verbalize acceptance of responsibility for his behavior? 3. Did the client practice alternatives to deal with stressful situation? 8. Eating Disorders a. Anorexia Nervosa b. Bulemia Nervosa ASSESSMENT 1. Etiology 2. Symptoms, complications NURSING DIAGNOSIS 1. Altered nutrition 2. Powerlessness 3. Fluid volume deficit 4. Ineffective individual coping 5. Disturbance in body image 6. Anxiety IMPLEMENTATION 1. Establish nutritional eating disorders. 2. Assist client to develop nonfood coping strategies. 3. Help client deal with body image issues. 4. Provide client education on basic nutritional needs EVALUATION 1. Did the client attain ideal body weight within 5% -

10% of normal? 2. Was the client able to develop non-food coping strategies? 3. Is the client free of medical complications? 9. Sexual Disorders 9.1 Sexual dysfunctions 9.2 Paraphilias 9.3 Gender identity disorders ASSESSMENT 1. Difficulties in sexual performance and satisfaction. 2. Health history. NURSING DIAGNOSIS 1. Altered sexuality pattern 2. Anxiety 3. Ineffective individual coping 4. Impaired social interaction 5. Altered family process 6. Sexual dysfunction PLANNING/IMPLEMENTATION 1. Convey an attitude of acceptance. 2. Encourage expression of fears and concerns 3. Educate regarding sexual functioning 4. Enhance self-esteem 10. Emotional Disorders of Infants, Children and Adolescents 10.1 Pervasive Developmental Disorder 10.2 Mental Retardation 10.3 Disruptive Disorders Treatment considerations for the client in the home and community settings Application of the Nursing Process

Topic: DISTURBANCES IN PERCEPTION AND COORDINATION INTERMEDIATE COMPETENCIES: Given a client with disturbances in neurological perception, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests 3. Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health with neurological perception. Discuss common health problems of neurological perception across the life span. Time Content / Learning Activities Teaching Strategies Subject Matters: 1. Neurological Problems ASSESSMENT 1.1 Nursing History a. Health history b. Developmental history c. Social history d. Psychological history 1.2 Physical assessment 1.3 Diagnostic assessment NURSING DIAGNOSIS 1. Sensory perception alterations 2. Impairment of skin integrity 3. Altered growth and development 4. Ineffective family coping PLANNING FOR HEALTH MAINTENANCE AND RESTORATION: - Unconscious and Paralyzed clients 1. Maintain patent airway 2. Maintain vital sign and neurologic status 3. Maintain integrity of the skin 4. Maintain joint mobility 5. Maintain sensory function 6. Maintain fluid and nutritional status 7. Maintain bowel and bladder 8. Maintain psychosocial function IMPLEMENTATION 1. Common health problems of the Neonate and Infant 1.1 Cranial Abnormalities 1.1.1 Hydrocephalus 1.1.2 Encephalocele 1.2 Spinal Cord abnormality 1.2.1 Myelomeningocele

Evaluation

2. Common health problems of the Child and

Adolescent 2.1 Cerebral palsy 2.2 Reyes Syndrome 3. Common health problems of the Young Adult 3.1 Multiple Sclerosis 3.2 Myasthenia gravis 4. Common health problems of the Middle-aged Adult 4.1 Tic douloureaux (Trigeminal neuralgia) 5. Common health problems of the Older Adult 5.1 Cerebrovascular Disease 6. Common health problems that occur across the life span 6.1 Increase intracranial pressure 6.2 Head injury 6.3 Brain injury

Topic: DISTURBANCES IN PERCEPTION AND COORDINATION INTERMEDIATE COMPETENCIES: Given a client with disturbances in visual perception, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Discuss common health problems of visual perception across the life span. Given a client with disturbances in auditory and speech problem, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health with auditory and speech problems. Time Content / Learning Activities Subject Matters: 2. Visual Problems ASSESSMENT 1. Nursing History Health history Developmental history Psychological history Social history NURSING DIAGNOSIS/ANALYSIS 1. Sensory perception alteration 2. Alteration in comfort PLANNING FOR HEALTH RESTORATION AND MAINTENANCE/IMPLEMENTATION 1. Nursing Procedures 1.1 Instillation of eye medications 1.2 Glasses 1.3 Contact lenses VISUAL IMPAIRMENT IMPLEMENTATION 1. Common health problems of the Neonate and Child 1.1 Congenital Cataracts 1.2 Strabismus 1.3 Retinoblastoma 2. Common health problems of the Neonate and Adult 2.1 Glaucoma 2.2 Cataracts 2.3 Surgery for the eye problems Teaching Strategies Evaluation

3. Common health problems that occur across the life span

Errors of refraction Traumatic injury to the eye Infections and inflammation of the eye Retinal detachment 3. Auditory and Speech Problems ASSESSMENT 1. Nursing History 1.1 Health history 1.2 Developmental history 1.3 Psychological history 1.4 Social history 2. Physical Assessment 3. Diagnostic Assessment ANALYSIS/NURSING DIAGNOSIS 1. Alteration in comfort 2. Sensory perception alteration PLANNING FOR HEALTH RESTORATION AND MAINTENANCE/IMPLEMENTATION 1. Nursing Process 1.1 Eardrops and irrigation 2. Health effects and noise IMPLEMENTATION 1. Common health problems of the Neonate 1.1 Congenital Anomalies 2. Common health problems of Infants and Child 2.1 Otitis media 2.2 Mastoiditis 2.3 Foreign bodies 2.4 Articulation disorders 2.5 Disorder of rhythm stuttering 2.6 Voice quality education 3. Common health problems of Young Adult 3.1 Otosclerosis 3.2 Menieres disease 3.3 Laryngitis 3.4 CA of the Larynx 4. Common health problems that occur across the life span 4.1 Otitis media 4.2 Rupture of the tympanic membrane 4.2.1 Hearing Impairment

Topic: DISTURBANCES IN PERCEPTION AND COORDINATION INTERMEDIATE COMPETENCIES: Given a client with disturbances in coordination, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Discuss common health problems of musculoskeletal problem across the life span. Utilize appropriate nursing interventions to restore and maintain health of clients with musculoskeletal problem. Time Content / Learning Activities Teaching Evaluation Strategies Subject Matters: 4. Musculoskeletal Problem ASSESSMENT 1. Nursing History 1.1 Health history 1.2 Developmental history 1.3 Psychological history 1.4 Social history 2. Diagnostic Assessment NURSING DIAGNOSIS/ANALYSIS 1. Impaired mobility 2. Self care deficit 3. Altered growth and development 4. Alteration in parenting PLANNING FOR HEALTH PROMOTION AND MAINTENANCE/IMPLEMENTATION 1. Common health problems of the Neonate and Infant 1.1 Congenital hip displacement 1.2 Club foot 1.3 Torticollis 2. Common health problem of the child Disorders of bone development JRA Legg-Calve-Perthes Disease Ricketts 3. Common health problem of the Adolescent 3.1 Scoliosis 4. Common health problem of the Young Adult 4.1 Osteogenic Sarcoma 5. Common health problems of the Adult 5.1 Adult RA 5.2 Gout 5.3 Carpal Tunnel Syndrome 5.4 Osteomalacia 5.5 Osteoporosis 5.6 Degenerative Joint Disease (OA) 6. Common health problems that occur across the life span

Fractures Injury to the soft tissue Amputation Topic: DISTURBANCES IN INFLAMMATORY AND IMMUNOLOGIC INTERMEDIATE COMPETENCIES: Given a client with disturbances in inflammatory and immunology, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health of clients with inflammatory and immunologic problem. Given a client with disturbances in immunology, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation for normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health of clients with immunologic problem. Time Content / Learning Activities Teaching Evaluation Strategies Subject Matters: 1. Infection and Infection Control ASSESSMENT 1. Nursing history 2. Physical Assessment 2.1 Localized infections (focal point) 2.2 Generalized infections (Systemic) 3. Diagnostic Assessment 3.1 WBC 3.2 ESR 3.3 Culture of suspected infectious site ANALYSIS 1. Inflammation 2. Communicable Diseases 2.1 Stages of Infectious Disease 2.2 Chain of Infection 2.3 Reservoir 2.4 Portal of Exit 2.5 Means of Transmission 2.6 Portal of Exit 3. Nosocomial Infections 4. Infection Control 4.1 In the Community a. International-World Health Organization (WHO) b. National Center for Disease Control (CDC) c. Local Public Health Departments 1. Food and water control laws 2. Spraying areas for insect control 3. Immunizations a. Inactivated vaccines b. Live, attenuated vaccines

4.2 In the Hospital a. Prevention of nosocomial infection PLANNING FOR HEALTH RESTORATION AND MAINTENANCE/IMPLEMENTATION 1. Standard precautions (barrier) used with all clients 1.1 Handwashing 1.2 Gloving 1.3 Masks, eye protection, face shield 1.4 Gowns 1.5 Environmental Control 1.6 Patient placement 1.7 Transport 2. Transmission-based precautions 2.1 Airborne precautions 2.2 Droplet precautions 2.3 Contact precautions 3. Infectious Disorder in Children 3.1 Viral Infections a. Roseola infantum b. Rubella (German measles) c. Measles (Rubeola) d. Chickenpox (Varicella) e. Herpes Zoster f. Smallpox (Variola) g. Enteroviruses 1. Poliovirus infections: Poliomyelitis h. Integumentary System Herpes virus infections; warts i. CNS Rabies; Meningitis j. Other viral infections: mumps, infectious mono nucleosis; Dengue 3.2 Bacterial Infections a. Streptococcal Diseases: Scarlet fever; Impetigo b. Staphylococcal infections: Diphtheria; Pertussis; Anthrax; Tetanus (Lockjaw); Lyme disease 3.3 Other Infectious Pathogens a.Chlamydial infections Psittacosis b. Parasitic infections: headlice; scabies c.Helminthic infection: ascariasis; pinworms d. Protozoan infections: Giardiasis e. Fungal infections: superficial; candidiasis 4. Infectious Disorder in Adults 4.1 Neurological: GBS 4.2 Musculoskeletal: Osteomyelitis 4.3 Reproductive: STD a. AIDS b. Gonorrhea c. Hepatitis B d. Herpes genitalis e. Moniliasis f. Sy g. Trichomoniasis 4.4 Integumentary: Acne vulgaris; Furuncle; Carbuncle; Psoriasis

GIT: Hepatitis A; Salmonellosis; Typhoid fever; Dysentery; Amebiasis Respiratory: TB; Influenza; Pneumonia C2. IMMUNOLOGIC ASSESSMENT 1. Nursing History Types of Acquired Specific Deficiency a. Active/Natural b. Active/Artificial c. Passive/Natural d. Passive/Artificial 2. Physical Assessment 3. Diagnostic Test NURSING DIAGNOSIS/ANALYSIS 1. Immune Response 2. Allergen response 3. Nursing Diagnosis: Risk for infection R/T decreased immune system PLAN/IMPLEMENTATION 1. Immunodeficiency Disorder Primary (Congenital) Secondary (Acquired) Acquired Immunodeficiency Syndrome (HIV/AIDS) 2. Other Autoimmune Diseases Multiple Sclerosis GBS Addisons disease Type 1 DM Ulcerative colitis GN 3. Allergy (Hypersensitivity) Anaphylaxis Cytotoxic Immune complex mediated a. SLE b. Rheumatoid arthritis Cell-mediated hypersensitivity (Delayed Hypersensitivity) a. Transplant rejection b. Contact dermatitis 1. Atopic disorders 1.1 Hay fever (allergic rhinitis) 1.2 Eczema (Atopic dermatitis) 1.3 Asthma 2. Drug and Food Allergies 3. Sting/Insect Allergy Week: 10 Subject NCM 104 Revision Days: 20 Effectivity date: 1st Sem, AY 2009-2010 Page 22/26

Topic: DISTURBANCES IN CELLULAR FUNCTIONING (CELLULAR ABERRATION) INTERMEDIATE COMPETENCIES: Given a client with disturbances in cellular functioning, the student: 1. Identifies significant subjective data from the client history Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health with cellular functioning. Time Content / Learning Activities Teaching Evaluation Strategies 4 hours Subject Matters: - Lecture - Quizzes ASSESSMENT - Discussion 1. American Cancer Society Warning Signs (CAUTIONAL) ANALYSIS/NURSING DIAGNOSIS 1. Causative Factors Physical Chemical Genetic Viral Stress 2. Classification Carcinoma Sarcoma Lymphoma Leukemia 3. Potential Nursing Diagnosis 3.1 Skin integrity, impaired protection, altered PLAN/IMPLEMENTATION 1. Modalities of Treatment a. Surgery b. Chemotherapy c. Radiotherapy 1. External radiation 2. Internal radiation sealed and unsealed d. Immunotherapy 2. Nursing Care a. Skin care b. Mouth care c. Hair care d. Nutritional changes e. Pain relief f. Activity level g. Psychosocial issues Date June 15, 2007 Week: 11/13-16 Subject NCM 104 Revision Prepared By: Carlito S. Santos, MD, RN, MAN Assistant Professor III Days: 21-22/25-32 Approved By: Zeny Mina, RN, MAN, PhD College Dean Effectivity date: 1st Sem, AY 2009-2010 Page 23/26

Topic: THE CLIENT IN ACUTE BIOLOGIC CRISIS INTERMEDIATE COMPETENCIES: Given a client with complex health problems in any health care situation, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health of high risk pregnant client. Given a client with complex health problem in any health care situation, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and result of diagnostic tests. Utilize appropriate nursing intervention to restore and maintain health of high risk newborn and family. Discuss common health problems of high risk newborn. Given a client with complex health problems in any health care situation, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Utilize appropriate nursing interventions to restore and maintain health of a high risk adult. Discuss common health problems of high risk adult. Time Content / Learning Activities Teaching Strategies 40 hours Subject Matters: - Lecture 1. High Risk Pregnancy - Discussion ASSESSMENT - Video / Film 1. Nursing History showing 2. Physical Assessment 3. Diagnostic Assessment NURSING DIAGNOSIS 1. Anxiety 2. Fluid volume deficit 3. Risk for infection 4. Ineffective tissue perfusion 5. Knowledge deficit PLANNING FOR HEALTH RESTORATION AND MAINTENANCE 1. Physiologic functioning of the pregnancy 2. The woman and familys psychological acceptance 3. The duration of pregnancy as long as possible for the mother and fetus. IMPLEMENTATION 1. Complications of Pregnancy 1.1 Bleeding during pregnancy 1.2 Preterm labor 1.3 Preterm rupture of membranes 1.4 Pregnancy-induced hypertension 1.5 Multiple pregnancy 1.6 Hydramnios 1.7 Post-term pregnancy 1.8 Pseudocyesis 1.9 Isoimmunization (Rh Incompatibility)

Evaluation - Quizzes

1.10 Fetal death 1.11 Difficult labor due to hypo/hyperfunction of the uterus 2. With Pre-existing or Newly Acquired Illness 2.1 STD 2.2 Hematologic Disorder 2.3 Renal and Urinary disorder 2.4 Respiratory disorder 2.5 Rheumatic disorder 2.6 Gastrointestinal disorder 2.7 Neurologic Disorder 2.8 Musculoskeletal Disorder 2.9 Cardiovascular disorder 2.10 Endocrine disorder 2.11 Cancer 2.12 Mental Illness 2.13 Trauma ASSESSMENT 1. Nursing History 2. Physical Assessment 3. Diagnostic Assessment NURSING DIAGNOSIS 1. Risk for infection related to lack of knowledge 2. Impaired tissue perfusion 3. Social isolation related to prescribed bed rest 4. Fear regarding pregnancy outcome related to chronic illness PLANNING FOR HEALTH RESTORATION AND MAINTENANCE 1. Maintain health during pregnancy 2. HIGH RISK NEWBORN AND FAMILY ASSESSMENT 1. Nursing History 2. Physical assessment 3. Diagnostic assessment NURSING DIAGNOSIS 1. Ineffective airway clearance 2. Ineffective cardiovascular tissue perfusion 3. Ineffective thermoregulation 4. Risk for imbalanced nutrition 5. Risk for parenting 6. Deficient diversional activity (lack of stimulation)

PLANNING/IMPLEMENTATION 1. Altered Gestational Age or Birth Weight 2. Illness in the Newborn 3. Newborn at risk because of maternal infection or illness

3. HIGH RISK ADULT ASSESSMENT 1. Nursing History 2. Physical Assessment 3. Diagnostic Assessment NURSING DIAGNOSIS 1.Impaired gas exchange 2. Alterations in cardiac output PLAN/IMPLEMENTATION 1. Heart Failure 2. Dysrhythmias 3. Respiratory Failure 4. ARDS 5. Renal Failure 6. ESRD 7. Burns 8. Hepatic Coma 9. DKA/HHNK 10. Thyroid crisis 11. Adrenal crisis 12. Multi-system organ failure Date June 15, 2009 Prepared By: Carlito S. Santos, MD, RN, MAN Assistant Professor III Approved By: Zeny Mina, RN, MAN, PhD College Dean

Week: 17-18 Subject

Days: 33-36 Revision

Effectivity date: 1st Sem, AY 2009-2010 Page

NCM 104 Topic:

26/26

THE CLIENT IN EMERGENCY / DISASTER SITUATION INTERMEDIATE COMPETENCIES: Given a client with life threatening condition, the student: 1. Identifies significant subjective data from the client history. 2. Identifies deviation from normal using IPPA and results of diagnostic tests. Formulates appropriate nursing diagnosis as to priority. Time Content / Learning Activities Teaching Strategies 16 hours Subject Matters: - Lecture ASSESSMENT - Discussion 1. Nursing history - Video 2. Physical assessment presentation 3. Diagnostic assessment - Emergency evacuation drill NURSING DIAGNOSIS 1. Ineffective airway clearance 2. Impaired physical mobility related to severe burn 3. Parental fear related to outcome after head injury 4. Interrupted family process related to accident 5. Anxiety related to apprehension and lack of knowledge regarding medical treatment PLAN/IMPLEMENTATION 1. Head trauma 2. Abdominal trauma 3. Dental trauma 4. Near drowning 5. Poisoning 6. Foreign body obstruction 7. Trauma related to environment exposure 8. Bites 9. Burn trauma 10. Disaster a. Natural disaster b. Made disaster Date June 15, 2009 Prepared By: Carlito S. Santos, MD, RN, MAN Assistant Professor III Approved By:

Evaluation - Quizzes

Zeny Mina, RN, MAN, PhD College Dean

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