NRS 111 Course Syllabus Summer 2013 Nursing

ESSEX COUNTY COLLEGE
NURSING DEPARMTENT
NRS 111
SUMMER 2011
STUDY GUIDE
Revised APRIL, 2011

Revised April, 2012

NURSING DEPARTMENT
COURSE OUTLINE
COURSE DESIGNATION: NRS111
COURSE TITLE:
LPN MOBILITY-11
NUMBER OF CREDITS: 6
CONTACT HOURS:
LECTURE: 3 LAB: 3
Mandatory computer tutorial.
CLINICAL: 6
PREREQUISITES:
COREQUISITES:
NRS 107 or NRS 106, BIO 121, CHM 101, MTH 116
BIO 122
CATALOG DESCRIPTION: Students render care to clients who have commonly

occurring health alterations generally affecting middle adult populations.
Laboratory and clinical activities create a construct, which assists students to
develop the role of provider of care. Assessment skills and nursing diagnoses are
expanded with a focus on planning and intervention to meet the physiologic,
psychosocial and safety needs of clients.
General Education Goals: The aggregate of the core courses will have the
following goals: (Note: Each core courses need not address all nine goals.)
NRS 111 is not a general education course and is not required to meet general
education goals.
1. Students will communicate effectively in both speech and writing.
2. Students will use critical thinking and problem solving skills in analyzing
information gathered through different media and from a variety of
sources.
3. Students will recognize, analyze and assess ethical issues and situations.
4. Students will apply appropriate mathematical and statistical concepts and
operations to interpret data and to solve problems.
5. Students will apply the scientific method of inquiry to draw conclusions
based on verifiable evidence, use scientific theories and knowledge to
understand the natural world, and explain the impact of scientific theories,
discoveries and technological changes on society.
6. Students will use social science theories and concepts to analyze human
behavior and social and political institutions.
7. Students will analyze works of the literary, visual or performing arts.
8. Students will analyze historical events and movements in western and
non-western societies and assess their subsequent significance.
9. Students will analyze the implications of commonalities and differences
among culturally diverse peoples
COURSE COMPETENCIES:
Upon completion of this course, the student will:
1. Assess adult clients with commonly occurring health alterations using
Maslow's Hierarchy of Needs and Erikson's Developmental Theory with
emphasis on the Middle-aged adult.
1.1 Utilize physical assessment skills.
1.2 Apply knowledge from the biological and social sciences as a
resource to contribute to the database of the adult client.
1.3 Relate how alterations from health interfere with the fulfillment of
basic human needs.
2. Utilize concepts of critical thinking when planning care.
3. Formulate nursing diagnoses to define the needs of adult clients with
commonly occurring health alterations.
4. Develop a plan of care for adult clients with commonly occurring health
alterations in collaboration with other members of the healthcare team
which establishes priorities, short and long term client-centered goals, and
appropriate nursing interventions which are based on scientific rationale.
5. Implement caring interventions and selected nursing skills in a safe and
competent manner using current technology.
6. Compare adult client responses to nursing care with the established
outcome criteria.
7. Identify ethnic and cultural values and advocacy needs of the adult client
in
response to health care.
8. Practice principles
relationship
with adult clients.
of
communication
to
establish
therapeutic
9. Develop a teaching plan for adult clients with commonly occurring health
alterations.
10. Define legal and ethical responsibilities of the nurse when caring for adult
clients with commonly occurring health alterations.
11. Demonstrate behaviors that contribute to professional and personal
growth.
12. Demonstrate the nurses role when implementing the principles of
management and delegation while caring for an adult client.

COURSE CONTENT OUTLINE: See attached.
METHODS OF INSTRUCTION:
Lecture, discussion, role play, simulation, group projects, computer-assisted,
multimedia,
laboratory,
individual
conferences,
demonstration/return
demonstration, writing assignments including nursing care plans, and pre-and
post conference.
COURSE REQUIREMENTS:
In order to progress to Nursing III (NRS 233), the student must demonstrate:
1. A satisfactory clinical evaluation
2. All NRS 111 laboratory critical elements
3. A minimum theory grade of 75.
4. Complete the appropriate standardized exams.
5. Attendance is required in all scheduled classes and clinical laboratories.
In the event of absence from any class or laboratory, the student must
seek a conference with the appropriate instructor. See handbook for
attendance regulation.
METHOD OF EVALUATION:
1. Final grade will be calculated on the following basis:
Four (3) Exams (100 questions)
60%
Final Exam
(100 questions)
Total
100%
40%
A final grade of 75% must be achieved. A grade below 75% will result in a
failure in the course. Grades between 74% and 70% will be recorded as a D.
Grades below 70% will be recorded as an F (failure)
2. A written paper (see criteria for perioperative experience writing
assignment) must be completed. 75 points must be obtained on this
paper in order to pass the course.
3. A satisfactory grade must be achieved on campus and clinical laboratory
rating scales. Failure to achieve a satisfactory grade in these areas will
result in an F for the course grade.
4. All skills listed for the course must be evaluated and passed in order for
the student to proceed to NRS 233.
5. Clinical requirements: see attachment.

NURSING DEPARTMENT
NRS 111
Summer 2011
Required Textbooks
Doenges, M.A., Moorhouse, .F. & Geissier-Murr, A.C. (2010). Nurses pocket
guide: Diagnoses, Interventions, and rationales. (9th Ed) Philadelphia: F.A.Davis.
Hogan, M.A. & Madayag, and T. (2010) Medical-Surgical Nursing: Reviews &
Rationales. Upper Saddle River: Pearson Prentice Ha
Ignatavicius, Da & Workman, L (2012) Medical Surgical Nursing, 7 th ed. PatientCentered Collaborative Care; ISBN: 978-1-4377-2801-9
Potter & Perry (2012) Fundamentals of Nursing. (10th Ed.) Upper Saddle River,
NJ: Prentice Hall
Lehne (2012) Pharmacology for Nursing Care (8thEd.) Philadelphia, PA,
Elsevier.
Porth, C.M., (2011) Essentials of Pathophysiology, (3 rd Ed) Wolters
Kluwer/Lippincott/Williams and Wilkins, Philadelphia, PA
Any NCLEX RN Review book
Kaplan NCLEX-RN 2012-2013 Strategies, Practice, and Review WITH CD-ROM (Kaplan
Nclex-Rn Exam) 2013 | ISBN-10: 1609788915 | ISBN-13: 978-1609788919 | Edition: 1
Pap/Cdr [Paperback
NCLEX RN REVIEW BOOK ON LINE
http://www.scribd.com/doc/54288335/NCLEX-RN-Exam-Prep-Pearson
Any Current Nursing Drug Guide

Optional
Meyers, E. (2010) RNotes: Nurses Clinical Pocket Guide. Philadelphia: F.A.
Davis
Beasley, B.M. (2003) Understanding EKGs: A practical approach (2nd. Ed)
Upper saddle River: Pearson Education, Inc.
Nursing and Allied Health Division

NRS 111 LPN Mobility
Instructor:
Office:
Office Phone:
Office E-mail:
Office Hours:
Professor Janet Czermak Russell

Room 212 E HSB
973 877- 3428
czermak@essex.edu
Regular Tuesday 7:30- 8:30 am
Tuesday 4- 6 pm
By Appointment Thursday 12- 3 pm
Class Meeting Times: Lecture: Tuesday 8:30 AM 11:50 pm

Lab A: Tuesday 12:30- 3:00 pm
Lab B: 3:50 PM to 6:40 PM
Clinical: Thursday or Friday 8:30- 2:30 pm Evening 5: PM to
11:20 PM

NURSING DEPARTMENT
REQUIREMENTS FOR NRS 111
6
Written Requirements:
1. All written work is to be submitted on the day designated by the clinical
instructor.
2. A care plan is due for the clients cared for during weeks 4, 6, 8, 11. After
assessing the client, the student should identify all relevant Nursing
Diagnoses and list them on the Assessment form. A care plan should be
developed for three priority Nursing Diagnoses.
3. The student is responsible for explaining all medication information related
to ones client. Written medication information is expected with each care
plan. A maximum of eight medications will be required.
4. A process recording is due for the clients cared for during the following
weeks: 5, 7, and 9, .See the Clinical Guide: Therapeutic Communication.
5. The Perioperative writing assignment is outlined on the following page. It
is due 2 weeks after the OR experience. No exceptions.
Behavioral Requirements:
1. Absence
If the student must be absent from clinical, it is the students responsibility
to call the clinical unit and the college to report the absence for that day.
When contacting the school you may call or email the school. The student
must meet with the clinical instructor upon return to class to determine
how to meet the clinical objectives for the day(s). If absences are due to
illness, a doctors note is required and must state no physical restrictions
on clinical performance.
2. Lateness
Arriving late in the clinical area, lecture or laboratory sessions and
submitting late written work is not tolerated without justifiable reason. If the
student cannot arrive to the clinical area/school on time, or cannot submit
written work on schedule, the student should notify the instructor.
Persistent lateness, for whatever reason will result in the course failure.
3. Appearance and Equipment - See Nursing Student Handbook
4. Performance
The student is responsible for the application of all previously learned
skills and theory. One must be prepared to discuss the clients medical
and nursing diagnoses and plan of care, including medications. If not
prepared, the student will be counseled verbally and in writing. Persistent

lack of preparation will result in clinical failure.
NRS 111 Clinical Guide
Therapeutic Communication
This assignment is to be submitted on the following weeks in place of a care
plan: Weeks 6,8,10
1. Assess, plan and implement care for the client to which you have been
assigned.
2. Write a process recording based on a 5 minute segment of a therapeutic
conversation that you have had with your client.
Guidelines:
Introduce self to client.
Determine appropriate time and place to talk with your client.
Note your body language and that of your client.
Following the interaction, leave the room and record what was said by you and
the assigned client.
Analyze your response by determining if what you said was therapeutic. If it
wasnt state what you could have said to encourage the expression of your
clients feelings about him or herself. Use your textbook and the NRS 107
handout on Therapeutic Communication to help you to analyze your responses.
Student
Client
Analysis
ORIENTATION TO THE CLINICAL FACILITY

Today you will become familiar with the clinical facility/ patient environment.
1. Attend Pre-conference and identify its purpose

2. Explore the floor plan of the unit to which you are assigned. Locate:
a. Nurses station
b. Patient rooms and districts
c. Utility rooms (clean/soiled/treatment supply closet)
d. Medication room
e. Conference room
f. Staff rest room
2. Explore the physical plan of the Nursing Home and determine the location of its
various departments.
3. Observe various members of the health team in action and identify their role and
function.
4. Identify the role and function of the Essex County College clinical instructor in
the clinical setting.
5. Locate the fire safety equipment and the fire safety manual on the unit to which
you are assigned.
6. Locate the emergency code cart and the arrest procedure on the unit to which
you are assigned.
7. Identify the relationship of the nursing student with the nursing home staff.
8. Identify the type of unit to which you are assigned and the routine activities that
you need to know when giving patient care.
9. Review CDC Standard Precaution Guidelines
10. Have a Scavenger Hunt on the Nursing Home unit to which you are assigned.
Use the hand-out.
11. Identify and if possible use patient care equipment such as electric beds, side rails,
call light, wheelchair, Hoya lift, etc.
12. Meet the head or charge nurse and staff on the unit to which you are assigned
13. Tour other departments of the nursing home
14. Attend post-conference. Review the clinical evaluation tool. Review
Documentation. Practice vital signs or test-off if appropriate.
SCAVENGER HUNT
LOCATE THE FOLLOWING AREAS:
Name of the Charge nurse/Nurse manager
Nurses station
room
Medication room/cart
supply closet
Patient rooms
Nurses lounge
Visitor bathroom
clean utility room
dirty utility
linen closet/cart
laundry hampers
Patient lounge
conference room
bathtubs and showers for patients
ice machine
staff bathroom
LOCATE THE FOLLOWING ITEMS IN THE NURSES STATION

Review the electronic charting for the following areas
Patient charts- look for doctors orders, laboratory data, nurses notes, doctors progress
notes, and admission data
Vital sign book (if applicable)
Medication Administration record
Pyxis Location
Policy and Procedure manuals
PDR/ Drug Book
Laboratory manual
Infection control manual
Fire safety manual
LOCATE THE FOLLOWING SUPPLIES:
Bed pans
wash basin
Emesis basin
water pitcher, cups, straws
Sphygmomanometers
weight scales
Thermometers
toiletries for hygienic care
Dressing change supplies
sterile and clean gloves
Specimen collection equipment
LOCATE OXYGEN EQUIPMENT
Wall outlet or portable
Flow meter and adapter
Masks
oxygen masks
tissues
enema bags
tube feedings equipment
glucose monitor
nasal cannula
Sterile water / humidification
Locate suction equipment

Locate Fire alarm/ extinguishers
Locate Emergency Cart

NURSING DEPARTMENT
NRS 111
10
Guidelines for giving oral clinical report

Client Report
Clients name _________________Room #________ Sex______ Date ____
DNR Yes___No______Date___________
Primary Diagnosis (s)
Reason for admission
Surgery (This admission) Date ________Type______________# days post

op________
Current medical problems being treated
1) ______________________________________________________________
2) ______________________________________________________________
3) ______________________________________________________________
4) ______________________________________________________________
Scheduled for any diagnostic tests (When, reason for)
________________________________________________________________
________________________________________________________________
_______________
Nursing objectives for today
First Priority
1____________________________________________________________
Reason __________________________________________________
Second Priority
2) ____________________________________________________________
Reason__________________________________________________
Third Priority
3) ____________________________________________________________
Reason _________________________________________________
Identify if you client has pain medication ordered?
________________________________________________________________
Identify if your client requires any medication for bowel functioning?
________________________________________________________________
Identify if your client requires any medications for sleep? _______________
Baseline Data Vital Signs
Time Temperature
Apical
Radial
11
Respiration
B/P
Pain
1)
_______________________________________________________________
2)
_______________________________________________________________
3)
_______________________________________________________________
4)
_______________________________________________________________
NEURO ASSESSMENT:
Level of Consciousness:
Time:
Alert_________________________________________
Lethargic_____________________________________
Confused_____________________________________
Comatose____________________________________
Other ________________________________________
Level of Activity
BR_____BRP______OOB_________
Body Position Fowlers______ Semi-Fowlers ______Supine _____
Side rails
4_____2_____1_____none_____
Fall Precautions Yes____ No_____ if yes, know fall precaution policy
________________________________________________________________
Restraints Yes___ No_____ Renewal date____________
RESPIRATORY ASSESSMENT
Rate _______Rhythm ________Work of Breathing_________
Lung Sounds ______________
Oxygen Therapy
Nasal Cannula: ____LPM
Pulse Ox_______%
Mask Type- RB____ Non-RB ___ Liter Flow _____ %delivered______
Ventilator Mode CMV_____ IMV_____CPAP_____Assist
Control_________
FIO2______%
Tidal Volume________ cc
Respiratory Rate ______ Ventilator ______Clients rate_______
PEEP _______cms
Pressure ___________
Suctioning Color _____Consistency ______Amt ______Odor_______
CARDIAC ASSESSMENT
Pulse Rate & Rhythm___________
Heart sounds_________
Pulses
Strong ____ Weak _____ Bounding ______ Absent_______
Radial____________________________________________________
Dorsalis Pedal_____________________Posterior
Tibialis__________________
Chest pain: Yes___
No_____ Level # ______Site (if yes)
____Character_______
Radiating to________
Medications given____________________Time
administered______Evaluation_____
12
ECGs: Yes_____ No______ Date last taken/

result______________________
INTRAVENOUS THERAPY
Solution # 1 _____________
Infusion Rate_________
Site of Infusion_______
Amount in Bag _______
Peripheral Infusion site______
Central:
Subclavian___
Subclavian_______
Jugular____
PICC
Other____
Solution #2__________
Infusion Rate _____________
Site of Infusion____________
Amount in Bag _______
Peripheral Infusion Site______
Central:
Jugular_____
PICC______
Other____
Piggybacks
Time due
__________________
_________
__________________
_________
__________________
_________
GASTROINTESTINAL ASSESSMENT
Abdomen
Bowel Sounds Absent__ Hypoactive ____Normal ____Hyperactive_______
Last Bowel Movement_____ BM Color___ Consistency _______Amt
___Odor_____
Nasogastric Tube Size___Drainage Color ______Consistency
______Amount____
NGT/ PEG Tube Feeding
Type_____________________________________________
Infusion Rate________ Residual_____ Bolus_____ Amt Free
H2O______Frequency____
URINARY ASSESSMENT
Voiding: Yes___No_____
Color______Consistency_____Amount______Odor______
Catheter: Foley____Condom____Suprapubic_____Nephrostomy tube__
Size________Insertion
Date_______Irrigation_______Rate_______Other______
Date inserted______
Catheter
size_____Color_____Amount_____Consistency___Odor_
SKIN ASSESSMENT
Skin intact_____
Braden Scale ________
Decubitus
Site____________Stage____________Size__________Depth______
Protocol_______________________________________________________
Treatment______________________________________________
13
List Current Medications

Name
Dosage
Frequency Route
Lab Data
Parameters
1._______________________________________________________________
_______2.________________________________________________________
______________3._________________________________________________
_____________________4.__________________________________________
____________________________5.___________________________________
___________________________________6.____________________________
__________________________________________
PERIOPERATIVE EXPERIENCE
WRITING ASSIGNMENT
This assignment is to be completed 2 weeks after your observational experience
in the operating room and post-anesthesia unit
Main Objectives:
1. Explain the nursing responsibilities related to teaching a client during pre
and post-operative period.
2. Explain how the basic physiological and psychosocial needs of a client are
met
a. in the operating room and
b. in the recovery room.
3. Describe the roles of the nurse during the immediate and longer term
post-operative period.
4. Describe the discharge planning and teaching of a client who undergoes
surgery.
POINTS
5
CRITERIA:
1.
If possible, observe a major surgical procedure.
2.
Obtain the following data related to the client that you
have observed:
Patient initials
Age, gender, marital status
Medical diagnoses or past medical history
Name of the surgical procedure
15
3.
Research the surgical procedure in a textbook or over

the Internet. Give a brief account of how the anatomy
and physiology are altered either positively or
negatively as a result of this surgery. (This should be
approximately one typewritten page.)
20
4.
Write a pre-operative teaching plan that relates to and

is specific for the surgery which you have observed.
The plan must be specific to the surgery you have
14
observed. You can use the column format as is

shown but is not mandatory.
Goals
Interventions
Expected outcome
Client will participate in

Preop activities to minimize
Post op complications
by ? (Date).
15
5.
6.
Throughout your observation of the client undergoing

surgery, take notes or remember how the clients
needs for the following were met.
Bacteriological safety
Medical/thermal safety
Oxygen
Fluid needs (identify all solutions used)
Elimination
Pain and comfort needs (name the drugs used preand intraoperatively)
List the members of the surgical team and describe
their responsibilities.
15
7.
List the nursing actions of the post anesthesia unit

nurse and state the rationale for each intervention.
Must be specific to the PACU and surgery performed.
15
8.
List the postoperative nursing interventions that would

be appropriate if you were caring for this client on a
post-op nursing unit. List the rationale for each
nursing intervention.
9.
List 2 potential postoperative complication directly

related to the surgical procedure performed.
10.
Research from the literature, the discharge and home

care planning, and discharge teaching necessary for
this client in relation to this type of surgery.
15
Directions for writing the paper

1. Type the information obtained in items 2-10 in the form of a research
paper.
2. Information obtained for textbooks, journals or the internet MUST include
references i.e. if you paraphrase or take a direct quote from a source other
than yourself, you must cite the source in APA style. If material is not
referenced, it will be returned for correction.
15
http://www.apastyle.org/learn/tutorials/basics-tutorial.aspx
View tutorial for cover page, abstract, text and references
3. 5 other references are required in addition to the textbook.
4. 5 or more grammatical and or spelling errors will be returned for
correction.
5. The paper is due 14 days after the observational experience. An
extension may be granted per permission of the clinical instructor.
16
Grading:
1. The paper will be graded Satisfactory or Unsatisfactory.
2. A grade of Satisfactory can be obtained by the following in a complete
manner: the directions for writing the paper, which are listed above and
by obtaining a total of 75 points.
3. If a paper is graded Unsatisfactory, the student will have one (1) week to
correct the deficiency for regarding. If the paper is unsatisfactory after
regarding, a grade of F will be assigned. This will result in a clinical failure
of the course.
Reviewed
04/12
17

NURSING DEPARTMENT
NRS 111
STUDY GUIDE
Course Content
______________________________________________________________________
______
Week 1 April 30
Lecture Topic
Orientation & introduction to NRS 108
Care of the Middle Aged Adult, Cultural Competence and Teaching Learning
Principles
Nursing Lab
Intravenous fluid administration and calculation and Urinary catheterization
CD-ROM IV Therapy
Math Practice
http://www.alysion.org/dimensional/taketest.htm
IV equipment and math problems
http://employees.csbsju.edu/mbyrne/IVSite/abc_of_ivmain.htm
http://www.rnceus.com/course_frame.asp?exam_id=17&directory=picc
Video Principles of IV
Article: IV fluids what nurses Need to know Nursing 2011 May, pp30-38
Perry & Potter Chapter 41 Fluid and Electrolytes

Clinical Lab
On Campus
Practice IV fluid administration, calculations & catheterization
Week 2 MAY 7
Lecture
Alteration in regulation: AIDS general concepts
http://depts.washington.edu/hivaids/
http://depts.washington.edu/hivaids/cpa/CPA.html
Take the CME program and print out certificate of completion and submit to instructor
one week
The perioperative experience
Nursing Lab
Blood transfusion
CD-ROM Transfusion Blood transfusion
http://www.slideshare.net/specialclass/blood-transfusion- video slide presentation

Blood transfusion therapy- Dir. Rene Mendoza-discusses the transfusion reaction,
indication for blood products
SIMMAN Simulation: Post op Hip Arthroplasty with Blood transfusion
Clinical Lab
Agency Assess needs, plan, and implement care for clients with alteration in
regulation
Review expectations for assignment: Nursing care plan
18
Week 3 MAY 14
Lecture
Alteration in regulation: AIDS, Alteration in regulation: Cancer
Nursing Lab
Care of client with artificial airway
Audio-Visual CD-ROM Tracheostomy Care
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Cancer and clients who requ
suctioning
Therapeutic Communication due
________________________________________________________________________________________
Week 4 MAY 21
Lecture
Exam 1
Alteration in regulation: Hematology
Nursing Lab
Tracheostomy care & suctioning Test Off
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Hematological problems and
those requiring suctioning
Health Teaching due
__________________________________________________________________________________________
Week 5 MAY 28
Lecture
Alteration in regulation: Hematology (continued)
Nursing Lab
Nursing skills: Tracheostomy care & suctioning Test Off
*Students not testing off:
Audio-Visual CD-ROM Tracheostomy Care
Tracheostomy care & suctioning practice
Vital Sims: Identifying Lung Sounds
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Hematological problems and
those requiring suctioning
Nursing care plan due
____________________________________________________________________________________
Week 6 JUNE 4
Lecture
19
Alteration in need for oxygen: Assessment of respiratory disorders
Asthma http://meded.ucsd.edu/isp/1998/asthma/html/hpi0.html
Video Asthma Evidenced Based Practice
http://www.medscape.com/viewarticle/745863
Use of a spacer
http://www.youtube.com/watch?v=A8WT5moNJ0I&feature=plcp
Use of metered inhaler
http://www.youtube.com/watch?v=Lrt1nJ3tVFI&feature=plcp
COPD
Case presentation-start with diagnosis
Nursing Lab
Meeting the need for oxygen: Underwater seal chest drainage
Mr. Kane, an adult experiencing respiratory distress, Caring for a client with chest tubes,
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Respiratory Disorders
Health Teaching Due
____________________________________________________________________________________________
Week 7 JUNE 11
Lecture (continued)
Alteration in need for oxygen: assessment of Respiratory disorders
Nursing Lab
Nursing skills: Acid-base balance
SIMMAN Simulation: Severe asthma
Audio-Visual: CAI ABGs
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: gas exchange
Nursing Care Plan due
______________________________________________________________________________________
Week 8 JUNE 18
Lecture
Exam 2
Alteration in need for oxygen: Cardiovascular disorders
Nursing Lab
Nursing skills: Basic ECG interpretation, basic dysrhythmia interpretation
http://www.rnceus.com/course_frame.asp?exam_id=16&directory=ekg
Cardiac Monitoring/CAI Telemetry -Those fabulous nitrates
Kozier & Erb pp. 1402 1412,
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Cardiovascular disorders
Health Teaching due
Week 9 JULY 2 ( College closed June 24-June 30)
Lecture
Alteration in need for oxygen: Cardiovascular disorders (continued)
Nursing Lab
SIMMAN Simulation: Acute MI
20
Clinical Lab
Nursing care plan due
____________________________________________________________________________________________
Week 10 July 9
Lecture
Alteration in need for oxygen: Cardiovascular disorders (continued)
Nursing Lab
Nursing skills: Care of clients with pacemakers
SIMMAN Simulation: Identification of different types of blocks
Clinical Lab
_____________________________________________________________________________________________
Week 11 July 16
Lecture
Exam 3
Alteration in need for regulation: Endocrine disorders
Nursing Lab
Nursing skills: Thyroid crisis, Adrenal insufficiency,
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Endocrine disorders and
nutritional regulation
Nursing Care Plan due
_ ____________________________________________________________________________________________
Week 12 July 23
Lecture
Alteration in need for regulation: Diabetes
Nursing Lab
Nursing skills: Blood glucose monitoring, and insulin adminstration
SIMMAN Simulation:
Diabetic Hypoglycemia
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Diabetes
_____________________________________________________________________________________________
Week 13 July 30
Lecture
Exam 4
Alteration in need for nutrition: upper gastrointestinal disorders
Nursing Lab
Clinical Lab
Central venous catheters, Administration of Hyper-alimentation ,Dressing Central Lines
21
Different Venous Access Devices (VAD).

http://www.rnceus.com/course_frame.asp?exam_id=17&directory=picc
Assess needs, plan, and implement care for clients with alterations in regulation : Gastro intestinal Disorders
ALL CLINICAL ASSIGNMENTS MUST BE COMPLETED IN ORDER TO BE GRADED. FAILURE TO COMPILE MA
RESULT IN A
CLINICAL FAILURE. SUBMISSION OF ASSIGNMENTS ON A TIMELY BASIS IS YOUR PROFESSIONAL
RESPONSIBILITY.
_____________________________________________________________________________________________
Week 14 August 6
Lecture
Alteration in need for nutrition: liver, gallbladder & pancreas disorders
Nursing Lab Remember to bring your access code for your computerized testin
Computerized testing
Course/ Student Evaluation
Nursing skills: Tube feedings, gastroscopy tubes, feeding tubes, feeding pumps
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Gastrointestinal Disorders
Clinical Evaluations
_____________________________________________________________________________________________
Week 15 August 13
Lecture
Final Examination- Tuesday
Clinical Lab
Assess needs, plan, and implement care for clients with alterations in regulation: Gastrointestinal Disorders
_______________________________________________________________________________________

NURSING DEPARTMENT
NRS 111
WEEK 1
INTRODUCTION TO NURSING II
A. Development During the Middle Years
22
B. Teaching Learning Principles

C. Culture and Ethnicity
OBJECTIVES: Upon completion of this unit, the student will:
1. Identify developmental parameters as they apply to the assessment of basic
human needs in the middle years.
2. Discuss patient education as an essential component of nursing care directed
toward promotion, maintenance, and restoration of health.
3. Apply various concepts of culture and ethnicity to health care.
UNIT 1A
DEVELOPMENTAL CONCEPTS OF THE ADULT LIFE CYCLE: MIDDLEAGED ADULT
Learning Outcomes
Define health, incorporating the health-illness continuum and the concept

of high-level wellness.
Explain factors affecting functional health status.
Discuss the nurses role in health promotion.
Describe characteristics of health, disease, and illness.
Describe illness behaviors and needs of the client with acute illness and
chronic illness.
Describe the primary, secondary, and tertiary levels of illness prevention.
Compare and contrast the physical status, risks for alterations in health,
assessment guidelines, and healthy behaviors of the young adult, middle
adult, and older adult.
Explain the definitions, functions, and developmental stages and tasks of
the family.
Learning Activities:
Perry & Potter
Chapter 13 Young and Middle Adult
Lecture/Discussion Topics
1. Physical Changes
2. Psychosocial-emotional processes
23
3. Health concerns of middle age

4. Depression in Middle years
5. Nursing process
1.1 Assessment
1.2 Nursing diagnosis
1.3 Planning
1.4 Implementation
1.4.1 Client teaching
1.4.2 Changing health habits
1.4.3 Health promotion
1.4.4 Stress reduction
1.4.5
1.5 Evaluation
UNIT- 1B
PATIENT EDUCATIONAL/HEALTH TEACHING
Learning Outcomes:
1. Identify client education standards.
2. Describe the purpose & significance of health.
3. Define teaching & learning.
4. Explain the behaviors needed for cognitive affective and psychomotor
learning.
5. Describe the basic learning principles:
5.1 Motivation to learn
5.2 Ability to learn
5.3 Learning environment
6. Demonstrate ability to assess clients learning needs, motivation & ability to
learn, teaching environment and resources for learning.
7. Develop a teaching plan.
8. Relate the importance of speaking the clients language and using teaching
tools in learning process.
9. Describe methods of evaluating and documenting learning.
Read & Study
Classroom discussion
Ignatavicius (Chapter 4) pp. 27-34 Tutorials
Perry & Potter Chapter 25 Patient Education
24
Principles of Teaching and Learning

Principles of social learning theory
http://teachnet.edb.utexas.edu/~Lynda_Abbott/Social.html
Learning styles- take the test and identify your learning style
Be prepared to discuss your results in class
http://marciaconner.com/assess/learningstyle/
Motivational style- identify what motivates you to learn
http://marciaconner.com/assess/motivationstyle/
Self-directed learning- video what stage of self-directed learning are you at?
http://www.slideshare.net/bstokes/theories-of-teaching-and-learning-the-stagedselfdirected-learning-model-ggrow
1. Standards for the client
2. Purpose for health education
3. The nature of teaching and learning
4. Domains of learning
4.1 Cognitive learning
4.2 Affective learning
4.3 Psychomotor learning
5. Basic learning principles
6. Integrating the nursing & teaching processes
7. Special needs of children and older adults
25
UNIT 1C
CULTURE AND ETHNICITY
Learning Outcomes
1. Describe concepts related to culture such as race, ethnicity, ethnocentrism,
and acculturation.
2. Discuss health disparities among racial & cultural groups.
3. Describe ways culture influences communication patterns and how to provide
linguistically appropriate care.
4. Describe Cultural Models of care
5. Explain how the nurse can incorporate cultural sensitivity into nursing care
and into the working environment.
Read & Study:
Ignatavicius (Chapter 4) pp. 27-34
Perry & Potter Chapter 9 Culture and Ethnicity
Online Tutorials
Cultural Competence
http://erc.msh.org/mainpage.cfm?
file=4.0.htm&module=provider&language=English&ggroup=&mgroup=
Topics include:
Clinical Exchanges
Prior Assumptions and Prejudices

Medical History and Diagnosis
Patient Adherence
Working with an Interpreter
Non-Verbal Communication
Relating to Patient's Families
View all of the videos especially the video on effective communication and ineffective
communication (Diabetes) in clinical exchanges
1. Cultural concepts
1.1culture
1.2 Race
1.3 Ethnicity
1.4 Ethnocentrism
2. Health disparities
3. Communication Style
1.1 Verbal Communication
26
1.2 Nonverbal communication

1.3 Time orientation
1.4 Space orientation
1.5 Nutritional patterns
2. Cultural models of Care
2.1 Cultural Competence
2.2 Health Traditions Model
3. Giving nursing care to those who are culturally different.
3.1 Self-awareness
3.2 Conveying cultural sensitivity
ALTERATION IN THE NEED FOR BACTERIOLOGIC SAFETY:
WEEK 2
THE PERIOPERATIVE EXPERIENCE
Learning Outcomes
Discuss the differences and similarities between outpatient and inpatient

surgery.
Describe the various classifications of surgical procedures.
Identify diagnostic tests used in the perioperative period.
Describe nursing implications for medications prescribed for the surgical
client.
Provide appropriate nursing care for the client in the preoperative,
intraoperative, and postoperative phases of surgery.
Identify variations in perioperative care for the older adult.
Describe principles of pain management specific to acute postoperative
pain control.
Use the nursing process as a framework for providing individualized care
for the client undergoing surgery.
Learning Activities: Read & Study

Lehne Chapter 26-28) pp. 245-286
Ignatavicius (Chapter 16, 17, 18, 24) pp. 242-301, 440-459
Potter and Perry Chapter 50
Porth Chapter 3-4 pp 51-88
Case Studies
Learning Outcome 1
Compare the differences and similarities between outpatient and inpatient
surgery.
27
Determinants of Whether Surgery is Inpatient or Outpatient:

Complexity of surgery
Recovery
Expected needed level of postop care
Common Outpatient Surgeries:
Hernia repairs
Hemorrhoidectomies
Diagnostic procedures
Biopsies
Outpatient Surgery Advantages:
Outpatient and Inpatient Surgeries
Learning Outcome 2
Identify the three phases of perioperative care.
Preoperative Phase:
Intraoperative Phase:
Postoperative Phase:
Learning Outcome 3
Identify the significance of diagnostic tests used in the perioperative period.
Common Preoperative Laboratory Tests
Complete blood counts
Electrolyte studies
Coagulation studies
Urinalysis
Learning Outcome 4
Explain nursing implications for medications prescribed for the surgical patient.
Preoperative Medications Serve to Achieve:
Assessment of all Patients Medications
Over-the-counter
Vitamins/herbal medications
Illegal drugs
Aspirin
Special Considerations for Preoperative Medication with the Diabetic Patient
Intraoperative medications
Postoperative medications
Learning Outcome 5
Identify variations in perioperative care for the older adult.
Learning Outcome 6
Describe principles of pain management specific to acute postoperative pain
control.
Benefits of Postoperative Pain Relief
Guidelines for Perioperative Pain Management
Managing Postoperative Acute Pain
WEEK 3
28
ALTERATIONS IN THE NEED FOR REGULATION:

CARE OF THE CLIENT WITH AIDS
Learning Outcomes:
Discuss the characteristics of immunodeficiencies.
Identify laboratory and diagnostic tests used to diagnose and monitor
immune response.
Describe pharmacologic and other collaborative therapies used in treating
clients with altered immunity.
Provide teaching for clients with altered immune responses and their
families.
Correlate the pathophysiological alterations with the manifestations of
HIV/AIDS infection.
Use the nursing process as a framework to provide individualized care to
clients with altered immune responses.
Read & Study
Lehne, (Chapter93) pp. 1087-1132
Ignatavicius Chapter 19, 21) pp 306-321, 362-386
Porth (Chapter 15-16) pp 319-376
Grodner, Anderson, DeYoung, Nutrition pp. 641-646
CAI: Male with AIDS/ Female with AIDS (computer lab) HIV
http://depts.washington.edu/hivaids/
http://depts.washington.edu/hivaids/cpa/CPA.html
Take the CME program and print out certificate of completion
Learning Outcome 1
Review the normal anatomy and physiology of the immune system.
The Immune System
Human Leukocyte Antigens (HLAs)
B Lymphocytes (B cells)
Plasma cells
T Lymphocytes (T cells)
Learning Outcome 2
Compare and contrast the four types of hypersensitivity reactions.
Type I Hypersensitivity Reactions
Type II Hypersensitivity Response
Type III Hypersensitivity Response
Type IV Hypersensitivity Response
Learning Outcome 3
Explain the pathophysiology of autoimmune disorders and tissue transplant
rejection.
29
Autoimmune Disorders
Characteristics of autoimmune diseases
Genetics plays a role
Tissue Transplant Rejection
Graft-Versus-Host Disease (GVH)
Acute GVH
Chronic GVH
Learning Outcome 4
Discuss the characteristics of immunodeficiencies.
Characteristics of Immunodeficiencies
Learning Outcome 5
Identify laboratory and diagnostic tests used to diagnose and monitor immune
response.
Diagnostic Tests for Hypersensitivities
WBC count with differential
Radioallergosorbent test (RAST)
Blood type and cross match
Immune complex assays
Diagnostic Tests for Autoimmune Disorders
Diagnostic Tests Prior to Transplantation
Diagnostic Testing for HIV/AIDS
HIV rapid antibody test
Enzyme-linked immunosorbent assay (ELISA)
Western blot antibody testing
HIV viral load tests
CBC
Absolute CD4 lymphocyte count
Blood culture for HIV
Learning Outcome 6
Describe interdisciplinary therapies and medications used to treat patients with
altered immunity.
Hypersensitivity Medications
Immunotherapy
Antihistamines
Epinephrine
Corticosteroids
Combination of corticosteroids and cyclosporine
Antilymphocyte therapy and use of monoclonal antibodies
HIV/AIDS Medications
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Protease inhibitors (PIs)
HAART
30
Learning Outcome 7
Correlate the pathophysiological alterations with the manifestations of HIV/AIDS
infection.
Pathophysiology of HIV/AIDS
Early Manifestations of HIV/AIDS
Later Manifestations of HIV/AIDS
WEEK 3
ALTERATIONS IN THE NEED FOR REGULATION: CANCER
Learning Outcomes
Define cancer and differentiate benign from malignant neoplasms.

Describe the theories of carcinogenesis.
Explain and discuss known carcinogens and identify risk factors for
cancer.
Compare the mechanisms and characteristics of normal cells with those of
malignant cells.
Describe physical and psychological effects of cancer.
Describe and compare laboratory and diagnostic tests for cancer.
Discuss the role of chemotherapy in cancer treatment and classify
chemotherapeutic agents.
Discuss the role of surgery, radiation therapy, and biotherapy in the
treatment of cancer.
Identify causes and discuss the nursing interventions for common
oncologic emergencies.
Design an appropriate teaching plan for clients with cancer and their
families regarding cancer diagnosis, treatment, and coping strategies.
Learning Activities
Read & Study
Porth (Chapter 7) pp.131-158
Ignatavicius (Chapter 23-24) pp 399-439
Lehne, Chapter 100-102 pp 1167-1216
CAI: Chemotherapy I & II
Tutorial
Understanding Cancer from National Cancer Institute
http://www.cancer.gov/cancertopics/understandingcancer/cancer/page5r
Case Studies
Lecture/Discussion Topic
31
Learning Outcome 1
Define cancer and differentiate benign from malignant neoplasms
The type of tumor cells involved
How cancer cells invade normal tissue.
Benign Neoplasms
Malignant Neoplasms
Metastasis through the bloodstream.
Learning Outcome 2
Describe the theories of carcinogenesis.
Three Stages
Initiation stage
Promotion stage
Progression stage
Learning Outcome 3
Explain and discuss known carcinogens and identify risk factors for cancer.
Known Carcinogens
Include viruses, drugs, hormones, and chemical and physical agents
Risk Factors
Controllable and not controllable factors
Learning Outcome 4
Compare the mechanisms and characteristics of normal cells with those of
malignant cells.
Normal Cell Characteristics
Malignant Cell Characteristics
Learning Outcome 5
Describe physical and psychological effects of cancer.
Effects of Cancer
Learning Outcome 6
Describe and compare laboratory and diagnostic tests for cancer.
Grading and Staging
TNM classification system is used internationally
Tumor Marker
Oncologic Imaging
Routine x-ray imaging
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Ultrasonography
Nuclear imaging
Angiography
Lab Tests
Used in conjunction with other diagnostic tests
Rule out other pathologic conditions
32
Validate cancer diagnosis
Learning Outcome 7
Discuss the role of chemotherapy in cancer treatment, and classify
chemotherapeutic agents.
Role of Chemotherapy
Chemotherapeutic Agents
Alkylating agents
Antimetabolites
Antitumor antibiotics
Hormones and hormone antagonists
Learning Outcome 8
Compare and contrast the role of surgery, radiation therapy, and biotherapy in
the treatment of cancer.
Surgical Interventions
Prophylactic surgery
Diagnostic surgery
Radiation Therapy
Internal radiation (brachytherapy)
Biotherapy
Learning Outcome 9
Explain causes and discuss the nursing interventions for common oncologic
emergencies.
Superior Vena Cava Syndrome
Shock/Sepsis
Spinal Cord Compression
Learning Outcome 10
Design an appropriate care plan for patients with cancer and their families
regarding cancer diagnosis, treatment, and coping strategies.
Nursing Diagnosis and Interventions
Nursing goals
33
WEEK 4 & 5
ALTERATIONS IN THE NEED FOR REGULATION: HEMATOLOGIC
PROBLEMS
Learning Outcomes:
Relate the physiology and assessment of the hematologic system and
related systems to commonly occurring hematologic disorders.
Describe the pathophysiology of common hematologic disorders.
Explain nursing implications for medications and other treatments
prescribed for hematologic disorders.
Discuss indications for and complications of bone marrow or stem cell
transplantation, as well as related nursing care.
Compare and contrast the pathophysiology, manifestations, and
management of bleeding disorders.
Describe the major types of leukemia and the most common treatment
modalities and nursing interventions.
Differentiate Hodgkins disease from non-Hodgkins lymphomas.
1. Review the components of the Hematopoetic System.
2. Explain assessment parameters that relate to common problems of the
Hematopoetic System.
3. Describe the relevance of diagnostic studies pertinent to hematological
disorders.
4. Describe erythrocyte disorders in relation to etiology, prevention,
Pathophysiology,
Clinical manifestations, diagnostic studies, treatment, complications,
prognosis, nursing management, discharge planning, and desired outcomes.
5. Describe bleeding disorders in relation to etiology, Pathophysiology, clinical
manifestations, diagnostic studies, treatment, and nursing management.
6. Describes disorders associated with WBCs in relation to etiology,
Pathophysiology, prevention clinical manifestations, complication, treatment
and nursing management.
7. Apply the Nursing Process to a patient with leukemia.
8. Describe disorders associated with the Lymph System in relation to etiology,
pathophysiology, clinical manifestations, diagnostic studies, staging,
prognosis, nursing management.
34
Learning Activities
Read & Study
Lehne (Chapter 51, 54-55) pp.594-618, 625-646
Ignatavicius (Chapter41-42) pp. 876-927
Porth (Chapter11-13) pp 243-298
Learning Outcome 1
Relate the physiology and assessment of the hematologic system and related
systems to commonly occurring hematologic disorders.
Anemia
Physiology
Signs and symptoms
Anemia
Iron-deficiency anemia
Vitamin B12deficiency anemia
Folic aciddeficiency anemia
Sickle-Cell Anemia
Physiology
Signs and symptoms
Thalassemia
Physiology
Signs and symptoms
Acquired Hemolytic Anemia
Physiology
Signs and symptoms
Aplastic Anemia
Physiology
Signs and symptoms
Myelodysplastic Syndrome
Physiology
Signs and symptoms
Polycythemia
Physiology
Signs and symptoms:
Neutropenia
Physiology
Signs and symptoms
Learning Outcome 2
Describe the pathophysiology of common hematologic disorders.
35
Anemia
Nutritional Anemias
Hemolytic Anemia
Sickle-Cell Anemia
Thalassemia
Aplastic Anemia
Polycythemia
Neutropenia
Learning Outcome 3
Explain nursing implications for medications and other treatments prescribed for
hematologic disorders.
Anemia
Medications
Iron replacement therapy for iron-deficiency anemia
Parenteral vitamin B12 for vitamin B12deficiency anemia
Folic acid supplementation
Anemia
Medications
Hydroxyurea for sickle-cell anemia
Erythropoietin
Immunosuppressive therapy to treat aplastic anemia
Anemia
Treatments
Blood transfusion
Nursing diagnoses
Activity Intolerance
Impaired Oral Mucous Membranes
Risk for Decreased Cardiac Output
Self-Care Deficit
Myelodysplastic Syndrome
Nursing diagnoses
Risk for Ineffective Health Maintenance
Polycythemia
Treatment
Chemotherapeutic agents
Smoking cessations
Periodic phlebotomy
Medications
Nursing Diagnoses
Neutropenia
Treatments
Hematopoietic growth factor
Antibiotics
Isolation
Learning Outcome 4
36
Discuss indications for and complications of bone marrow or stem cell

transplantation, as well as related nursing care.
Allogeneic Bone Marrow Transplant
Allogeneic Stem Cell Transplant (SCT)
Graft-Versus-Host Disease
Complication: Graft-versus-host disease (GVH).
Graft-Versus-Host Disease
Learning Outcome 5
Compare and contrast the pathophysiology, manifestations, and management of
bleeding disorders.
Bleeding Disorders
Thrombocytopenia, hemophilia
Heparin-Induced Thrombocytopenia (HIT)
Manifestations:
Treatments/therapies:
Oral glucocorticoids
Withdrawal of heparin therapy is vital.
Platelet transfusions might be required.
Plasmapheresis or plasma exchange
Splenectomy
Nursing diagnoses can include Ineffective Protection and Impaired Oral
Mucous Membranes.
Hemophilia
Hemophilia B, known as Christmas disease, caused by deficiency of factor
IX
Von Willebrands disease a type of hemophilia
Hemophilia C caused by factor XI deficiency
Manifestations:
GI bleeding
Interdisciplinary care:
Nursing diagnoses:
Ineffective Protection and Risk for Ineffective Health Maintenance
Learning Outcome 6
Describe the major types of leukemia, and the most common treatment
modalities and nursing interventions.
Leukemia
Manifestations:
Major types of leukemia:
Acute lymphocytic (lymphoblastic) leukemia (ALL)
Chronic lymphocytic leukemia (CLL)
Acute myeloid (myeloblastic) leukemia (AML)
Chronic myeloid (mye-logenous) leukemia (CML).
Signs and symptoms
Treatments for Leukemia
Single or combination chemotherapy
Radiation therapy
37
Bone marrow transplant

Biologic therapies: interferons, interleukins
Nursing Diagnoses
Learning Outcome 7
Differentiate Hodgkins disease from non-Hodgkins lymphomas.
Hodgkin's or Non-Hodgkin's Lymphoma
Etiology
Manifestations of Hodgkins disease
Non-Hodgkins Lymphoma
Manifestations of non-Hodgkins lymphoma.
Interdisciplinary Care
Chemotherapy/ radiation therapy, alone or in combination
Stem cell transplant
Staging
Ann Arbor Staging System
Nursing diagnoses:
Required Reading
Lehne (Chapter 51, 54-55) pp.594-618, 625-646
Tutorials
Hematology
Explains Hematology /Pernicious anemia/Quiz
http://www.criticalthinking.uconn.edu/perniciousanemia.htm
http://www.aagbi.org/sites/default/files/242%20Blood%20transfusion%20part%201%20%20
http://www.nobelprize.org/educational/medicine/bloodtypinggame/about.html
http://www.slideshare.net/specialclass/blood-transfusion- video slide presentation
Blood transfusion therapy- Dir. Rene Mendoza-discusses the transfusion reaction,
indication for blood products
WEEK 6 & 7
ALTERATIONS IN THE NEED FOR OXYGEN: RESPIRATORY
Learning Outcomes
38
Relate anatomy, physiology, and pathophysiology and manifestations of

the upper and lower respiratory tract to commonly occurring disorders and
risk factors for these disorders.
Describe the pathophysiology of common upper and lower respiratory
tract disorders, relating their manifestations to the pathophysiologic
process.
Discuss nursing implications for medications and other interdisciplinary
care measures to treat upper respiratory disorders.
Describe surgical procedures used to treat upper/lower respiratory
disorders, nursing responsibilities in caring for clients undergoing these
procedures and their implications for client care and recovery.
Identify health promotion activities related to reducing the incidence of
upper respiratory disorders, describing the appropriate population and
setting for implementing identified measures.
Discuss treatment options for oral and laryngeal cancers with their
implications for the clients body image and functional health.
Describe the nursing implications for medications used to treat respiratory
disorders and oxygen therapy.
Relate the pathophysiology and manifestations of obstructive, pulmonary
vascular and critical respiratory disorders to their effects on ventilation and
respiration (gas exchange).
Compare and contrast the etiology, risk factors, and vulnerable
populations for disorders affecting ventilation and gas exchange within the
lungs.
Describe interdisciplinary care and the nursing role in health promotion
and caring for clients with disorders that affect the ability to ventilate the
lungs and exchange gases with the environment.
Discuss interdisciplinary interventions to provide airway and ventilatory
support for the client with respiratory failure, and nursing responsibilities in
caring for clients with airway and ventilatory support.
Describe the nursing implications for medications used to promote
ventilation and gas exchange.
Read and Study:
Lehne (chapter 75, 76, 69) pp. 888 - 912, pp 821-820
EDGT-Respiratory Assessment
Ignatavicius (Chapter 29, 31-34) pp. 552-570, 590-701
Lecture/Discussion Topic:
Learning Outcome 1
Describe the anatomy, physiology, and functions of the respiratory system.
Upper Respiratory System
Lower Respiratory System
Learning Outcome 2
Compare and contrast factors affecting respiration.
39
Respiratory Volume and Capacity

Pulmonary Ventilation
Learning Outcome 3
Identify specific topics for consideration during a health history interview of the
patient with health problems involving the respiratory system.
Health History
Current illness:
Lifestyle questions:
Smoking history
Exposure to environmental substances
Exercise
Use of recreational drugs
Learning Outcome 4
Give examples of genetic disorders of the respiratory system.
Genetic Predisposition
Asthma affects more than 5% of the population.
Small-cell lung cancer
Learning Outcome 5
Describe normal variations in assessment findings for the older adult.
Age-Related Changes
Learning Outcome 6
Identify abnormal findings that might indicate alterations in respiratory function.
Breath Sound Assessment
Learning Outcome 1
Relate anatomy and physiology of the upper respiratory tract to commonly
occurring disorders and risk factors for these disorders.
Infectious or Inflammatory Disorders
Upper Respiratory Infection
Influenza
Sinusitis.
Epiglottitis
Laryngitis
Learning Outcome 2
Describe the pathophysiology of common upper respiratory tract disorders,
relating their manifestations to the pathophysiologic process.
Viral Upper Respiratory Infection
Manifestations
Influenza
Manifestations: abrupt onset of chills and fever, malaise, muscle aches,
headache
Complications:
Sinusitis
Pathophysiology
Manifestations
Laryngitis
40
Pathophysiology
Manifestations
Learning Outcome 3
Discuss nursing implications for medications and other interdisciplinary care
measures to treat upper respiratory disorders.
Upper Respiratory Disorders
Treatment is symptomatic
Medications
Learning Outcome 4
Describe surgical procedures used to treat upper respiratory disorders, and
their implications for patient care and recovery.
Treatment of Sinusitis
Medications
Surgery.
Learning Outcome 5
Identify health-promotion activities related to reducing the incidence of upper
respiratory disorders, describing the appropriate population and setting for
implementing identified measures.
Viral Upper Respiratory Infection
Maintaining good general health
Stress-reducing activities
Limiting exposure to crowds
Good hand hygiene
Respiratory Syncytial Virus
Nursing care for the adult
Teaching for self-care
Identification of complications
Prevention of viral spread
Influenza
Immunization education
Risk-reduction activities
Avoiding crowds
Avoiding those who are ill
Sinusitis
Promote nasal drainage
Encouraging liberal fluid intake
Judicious use of nasal decongestants
Treating any obstructive process
Learning Outcome 6
Discuss treatment options for oral and laryngeal cancers and their implications
for the patients body image and functional health.
Treatment of Laryngeal Cancer
Determined by staging the cancer
Radiation therapy
Chemoradiotherapy
Chemotherapy
41
Goals of Surgery
Remove the malignancy
Maintain airway patency
Achieve optimal cosmetic appearance
Procedures
Laser laryngoscopy
Laryngectomy
Radical neck dissection
Modified neck dissection
Speech Rehabilitation
Necessary if entire larynx is removed
Techniques
Tracheoesophageal puncture with placement of a one-way
shunt valve
Esophageal speech
Use of speech generators
Learning Outcome 1
Relate the pathophysiology and manifestations of lower respiratory infections and
inflammation, lung cancer, chest wall disorders, and trauma to the ability to
maintain effective ventilation and respiration (gas exchange).
Acute Bronchitis
Signs and symptoms
Pathophysiology
Inflammation of lung parenchyma
Infectious
Noninfectious
Classified as community-acquired, nosocomial, or opportunistic
Pneumonia
Acute Bacterial Pneumonia
Inflammatory response results in alveolar edema.
Serous exudate, blood cells, fibrin, and bacteria fill the alveoli and
respiratory bronchioles.
Lobar pneumonia is consolidation of a large portion of an entire lung lobe.
Bronchopneumonia is a patchy consolidation that involves several lobules.
Manifestations
Rapid onset, chills, fever
Cough, rust-colored sputum
Pleuritic pain
Limited breath sounds, fine crackles, rales
Dyspnea and cyanosis
Manifestations
42
Bronchopneumonia
Insidious onset, low-grade fever, cough, scattered crackles
Atypical presentation
Headache confusion
Anorexia
Primary Atypical Pneumonia
Manifestations
Fever
Headache
Myalgias
Arthralgias
Dry, hacking, nonproductive cough
Viral Pneumonia
Manifestations
Flu-like symptoms
Headache
Fever
Fatigue
Malaise
Muscle aches
Lung Abscess
Manifestations
Productive cough
Chills and fever
Pleuritic chest pain
Malaise
Anorexia
Temperature elevation
Foul-smelling, purulent, blood-streaked sputum
Tuberculosis (TB)
Manifestations
Fatigue
Weight loss
Anorexia
Low-grade afternoon fever
Dry cough
Night sweats
Pleuritis
Manifestations
Pain aggravated by deep breathing, coughing, and movement
Rapid, shallow respirations
Limited chest wall movement
Diminished breath sounds
Pleural friction rub
Pleural Effusion
Excess fluid in the pleural space
43
Risk factors
Heart failure
Liver or renal disease
Connective tissue disorders
Pleural Effusion
Causes:
Pneumonia
Atelectasis
Tuberculosis
Lung cancer
Trauma
Pleural fluid:
Transudate or exudate
Pleural Effusion
Manifestations:
Dyspnea
Pain
Diminished breath sounds
Dull percussion tone over the affected area
Pneumothorax
Air in the pleural space
Causes:
Spontaneous
Result of blunt or penetrating trauma
Iatrogenic cause
Can be masked by primary injury
Tension Pneumothorax
Manifestations
Like pneumothorax
Presence of hypotension
Distention of the neck veins
Displacement of trachea to unaffected side
Shock
Lung Cancer
Manifestations
Chronic cough
Hemoptysis
Wheezing, shortness of breath
Dull, aching chest pain or pleuritic pain
Hoarseness and/or dysphagia
Weight loss, anorexia
Fatigue, weakness
Bone pain
Lung Cancer
Manifestations
Clubbing of the fingers and toes
44
Endocrine, neuromuscular, cardiovascular, hematologic symptoms

Learning Outcome 2
Compare and contrast the etiology, risk factors, and vulnerable populations for
lower respiratory infections, lung cancer, chest wall disorders, and trauma.
Acute Bronchitis
Risk factors
Lung Abscess
Most common etiology: aspiration, resultant pneumonia
At-risk population
Decreased level of consciousness
Tuberculosis
United States
Incidence fell until the mid-1980s
Resurgence late 1980s and early 1990s
Incidence is now declining
Worldwide
Continues to be a significant health problem
An estimated 2 million deaths each year
Tuberculosis
Risk
Impaired immune function
Prolonged contact with infected person
Lung Cancer
Leading cause of cancer deaths in U.S.
Population
Age over 50
Exposure to tobacco smoke
Exposure to ionizing radiation and inhaled irritants
Exposure to radon
Learning Outcome 3
Describe interdisciplinary care and the nursing role in health promotion and
caring for patients with lower respiratory infections, lung cancer, chest wall
disorders, and trauma.
Acute Bronchitis
Treatment
Symptomatic
Rest
Increased fluid intake
Acute Bronchitis
Medications
ASA or acetaminophen
Broad-spectrum antibiotic
Expectorant cough medication
Cough suppressant
Nursing interventions
Pneumonia
45
Interdisciplinary care
Prevention
Pneumococcal vaccine
Influenza vaccine
Medications
Antibiotics
Bronchodilators
Agents to liquefy mucus
Pneumonia
Treatments
Oxygen therapy
Chest physiotherapy
Nursing diagnoses
Ineffective Airway Clearance
Ineffective Breathing Pattern
Lung Abscess
Treatment
Antibiotic therapy
Postural drainage
Bronchoscopy for drainage of abscess
Placement of chest tube
Nursing diagnoses
Risk for Ineffective Airway Clearance
Impaired Gas Exchange; Hyperthermia
Anxiety
Tuberculosis
Early detection
Accurate diagnosis
Effective disease treatment
Preventing spread to others
Methods of tuberculin testing:
Intradermal PPD (mantoux) test and multiple-puncture (tine) testing
Tuberculosis
Pharmacologic treatment
Ensure compliance with long course of therapy.
Nursing strategies to maintain public health
Nursing diagnoses: Deficient Knowledge; Ineffective Therapeutic Regimen
Management; and Risk for Infection
Pleuritis
Medications:
Analgesics and NSAIDs
Codeine to relieve pain and to suppress associated cough
Nursing care:
46
Promoting comfort by medication administration, positioning, and

splinting the chest while coughing
Pleural Effusion
Diagnosis
X-ray
Thoracentesis aspiration of fluid for analysis
Treatment: Thoracentesis may be performed to remove fluid to allow the
lung to expand.
Complications: Cardiovascular collapse and pneumothorax
Pleural Effusion
Interdisciplinary care: supporting respirations and treating underlying
disease process
Nursing care: supporting respiratory function and assisting with
procedures to evacuate col-lected fluid
Nursing diagnoses
Impaired Gas Exchange
Pneumothorax
Treatment
Depends on the severity of the problem
Simple, small pneumothorax
A large pneumothorax
Pneumothorax
Tension pneumothorax
Medical emergency
Requires immediate intervention
Nursing diagnoses
Risk for Injury
Lung Cancer
Teaching abstinence from tobacco use
Staged by TNM
Treatments
Surgery
Radiation therapy
Lung Cancer
Nursing diagnoses
Pain
Anticipatory Grieving
Learning Outcome 4
Discuss surgery and other invasive procedures used to treat lung cancer, chest
wall disorders, and trauma, and nursing responsibilities in caring for patients
undergoing these procedures.
47
Thoracentesis
Preprocedure care
Verification of signed informed consent
Assessing knowledge and understanding
Medication administration
Positioning the patient
Teaching about level of discomfort
Thoracentesis
Procedure care
Monitoring pulse, color, oxygen saturation
Applying a dressing
Positioning patient on the unaffected side
Sending specimens to the laboratory
Postprocedure care
Monitoring vital signs
Oxygen saturations
Respiratory status
Chest Tubes
Preprocedure care
Verification of signed informed consent
Providing information about the procedure
Positioning the patient
Assisting with the procedure as necessary
Chest Tubes
Postprocedure care
Assessment of respiratory status
Maintaining closed chest tube drainage apparatus
Assisting with position changes
Sterile occlusive petroleum jelly dressing postchest tube removal
Lung Surgery
Preprocedure care
Routine preoperative care
Taking a history
Providing emotional support
Instructing about postoperative procedures
Establish means of communication
Lung Surgery
Postprocedure care
Provision of routine postoperative care
Assessing for pain control
Frequent assessment of respiratory status
Assist with effective coughing technique
Monitoring and maintaining effective mechanical ventilation
Maintaining patent chest tubes and drainage system
Assessing for development of infection
Assisting with early ambulation
48
Maintaining nutritional status

Learning Outcome 5
Describe the nursing implications for oxygen therapy and medications used to
treat respiratory disorders.
Pneumonia
Broad-spectrum antibiotic
Macrolide
Penicillin
Second- or third-generation cephalosporin
Fluoroquinolone
Bronchodilators
Sympathomimetic drugs
Pneumonia
Agent to break up mucus
Acetylcysteine
Potassium iodide
Guaifenesin
Tuberculosis
Single-drug therapy
Isoniazid (INH)
Bacillus Calmette-Guerin (BCG) vaccination
Tuberculosis
Three-or-more-drugs therapy
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
If a drug-resistant strain of TB
Therapy is tailored to that resistance
Lung Cancer
Combination chemotherapy treatment
Learning Outcome 1
Relate the pathophysiology and manifestations of obstructive, pulmonary
vascular and critical respiratory disorders to their effects on ventilation and
respiration (gas exchange).
Chronic Inflammatory Disorder of the Airways
Generally brief
Acute asthma can be fatal
Persistent inflammation of the airways
Chronic Inflammatory
Disorder of the Airways
Triggers
Allergens
Respiratory tract infection
Exercise
Inhaled irritants
49
Emotional upsets
Triggers
Secondhand smoke
Some medications
Acute/early response
Late response
Pathophysiology
Inflammatory mediators are released
Activation of inflammatory cells
Bronchoconstriction
Airway edema
Impaired mucociliary clearance
Work of breathing increases
Trapping of air impairs gas exchange
Manifestations
Chest tightness
Cough, dyspnea, and wheezing
Tachycardia, tachypnea, prolonged expiration
Fatigue, anxiety, apprehension
Respiratory failure
Breath sounds can improve right before failure
Status Asthmaticus
Severe asthma
Does not respond to routine treatment
Cough-Variant Asthma
Persistent cough without wheezing or dyspnea
Significant airway inflammation
Chronic Obstructive Pulmonary Disease (COPD)
Chronic airflow obstruction
Chronic bronchitis and/or emphysema
Characterized by slow progressive obstruction of airways
Resistance to airflow to increase
Expiration becomes slow or difficult
Mismatch between alveolar ventilation and perfusion
Impaired gas exchange
Chronic bronchitis
Inhaled irritants cause chronic inflammation.
Production of thick mucus
Narrowing of airways
Common recurrent infection
50
Emphysema
Destruction of the walls of the alveoli
Enlargement of abnormal air spaces
Airway collapse
Loss of alveolar surface area for gas exchange
COPD is classified according to severity, staged from 0 to 4.
Manifestations of COPD:
Morning cough
Dyspnea with activity
Presence of a barrel-shaped chest
COPD is classified according to severity, staged from 0 to 4.
Chronic bronchitis manifestations:
Cough productive of copious amounts of thick sputum
Cyanosis
Evidence of right-sided heart failure
Emphysema
Manifests severe dyspnea even at rest.
Barrel chest shape
Tachypnea
Use of accessory muscles to breathe
Prolongation of the expiratory phase
Breath sounds are diminished.
Hyperresonant percussive tone might be heard.
Cystic Fibrosis
Autosomal recessive disorder
Lack of CFTR protein
Abnormal electrolyte transfer
Bronchiectasis
Abnormal dilation of one or more large bronchi
Destruction of bronchial walls
Infection is often present.
Chronic cough productive
Large amounts of mucopurulent sputum
Other manifestations
Occupational Lung Diseases
Directly related to inhalation of noxious substances in the work
environment
Two major classifications
Pneumoconiosis
Hypersensitivity pneumonitis
Inhaled substances damage alveolar epithelium
Inflammatory process of the alveoli
Interstitial tissue of the lung
51
Inflammation produces scarring.

Lung becomes stiff, noncompliant.
Inhaled substances damage alveolar epithelium
Volumes decrease.
Work of breathing increases.
Alveolarcapillary diffusion is impaired.
Leads to hypoxemia.
Asbestosis
Diffuse interstitial fibrotic disease
Involves the terminal airways, alveoli, and pleurae.
Lung cancer and mesothelioma
Manifestations
Respiratory failure, marked hypoxemia can develop.
Silicosis
Silicosis is a nodular pulmonary fibrosis caused by inhalation of
silica dust.
Simple silicosis is asymptomatic.
Complicated silicosis characterized dyspnea and productive cough.
Progresses to severe disability
Cor pulmonale
Death
Coal workers pneumoconiosis, or black lung disease
Caused by inhalation of coal dust
Coal macules in lung tissue
Coal workers pneumoconiosis is asymptomatic
Can progress into massive fibrosis
Destruction of the pulmonary vascular bed and airways of the upper
lungs
Hypersensitivity pneumonitis
Allergic pulmonary disease
Affects airways and alveoli.
Develops in workers exposed to organic dusts and gases.
Acute hypersensitivity pneumonitis
Manifestations
Subacute syndrome
Elevation of sodium/chloride in sweat
Pulmonary Embolism (Thromboembolism)
Embolus obstructs blood flow in part of pulmonary vascular system
A medical emergency
Fifty percent of deaths occur within first 2 hours following
embolization
52

Effects
Large pulmonary artery occlusion
Can cause sudden death
Significant portion of smaller vessels
Lung tissue infarction
Obstruction of small segment of pulmonary circulation
Might cause no permanent injury
Manifestations
Depend upon size and location
Small emboli can be asymptomatic
Common manifestations
Manifestations of Fat Emboli
Pulmonary hypertension
Abnormal elevation of the pulmonary arterial pressure
Usually occurs secondarily to another condition.
Changes in the pulmonary artery lead to abnormal
growth/remodeling of pulmonary vessels.
Pulmonary hypertension is self-sustaining.
Pulmonary hypertension
Manifestations
Progressive disorder causing steady decline to death within 34
years
Acute Respiratory Failure
Consequence of severe respiratory dysfunction
Defined by arterial blood gas values
An arterial oxygen level of less than 5060 mmHg
Arterial carbon dioxide level of greater than 50 mmHg
In COPD
Acute drop in blood oxygen levels
Increased carbon dioxide levels
Failure of oxygenation: hypoxemia without a rise in carbon dioxide levels
Hypoventilation: hypoxemia with hypercapnia
Manifestations
Dyspnea
Restlessness, apprehension
Impaired judgment
Motor impairment
Tachycardia
Manifestations
53
Hypertension
Cyanosis
Dysrhythmias
Hypotension
Decreased cardiac output
Cor Pulmonale
Right ventricular hypertrophy
Results from long-standing pulmonary hypertension.
Manifestations
Respiratory Failure
Severe respiratory dysfunction
Defined by arterial blood gas values
Arterial oxygen level of less than 5060 mmHg
Arterial carbon dioxide level of greater than 50 mmHg
Respiratory Failure
In COPD, respiratory failure is indicated by an acute drop in blood oxygen
levels, with increased carbon dioxide levels.
Manifestations
Acute Respiratory Distress Syndrome
Non-cardiac pulmonary edema and refractory hypoxemia
Mortality due to multiple organ system dysfunction
Pathophysiology
Acute lung injury
Unregulated systemic inflammatory response
Tissue hypoxia
Metabolic acidosis
Manifestations
Develops 2448 hours after initial insult
Dyspnea, tachypnea, anxiety
Progressive respiratory distress
Cyanosis does not improve with oxygen administration
Learning Outcome 2
Compare and contrast the etiology, risk factors, and vulnerable
populations for disorders affecting ventilation and gas exchange within the
lungs.
Asthma Incidence
Prevalence relatively stable
Hospitalizations/deaths in decline
Asthma Incidence
Risk Factors
Allergies
Family history
Air pollution
Occupational exposures
54
Respiratory viruses
Exercise in cold air
Emotional stress
Chronic Obstructive Pulmonary Disease
Risk Factors
Cigarette smoking
Air pollution
Occupational exposures
Airway infection
Familial and genetic factors
Atelectasis
Etiology
Obstruction of the bronchus
Pneumothorax
Pleural effusion
Tumor
Loss of pulmonary surfactant
Atelectasis
Risk Factors
COPD
Smokers undergoing surgery
Prolonged bedrest
Mechanical ventilation
Cystic fibrosis (CF)
Atelectasis
Risk Factors
Most common lethal genetic disease in Caucasian Americans
About half of all cases of bronchiectasis are related to cystic
fibrosis.
Other causes
Atelectasis
Exposure to asbestos fibers occurs during mining, milling, manufacturing,
and application of asbestos products.
At risk: hard-rock miners, foundry workers, sandblasters, pottery
makers, granite cutters
Atelectasis
Pulmonary Embolism
Etiology
Thromboembolithe most frequent cause of pulmonary embolism
Venous system
Right side of the heart
Pulmonary Embolism
Etiology
Tumors
Fat or bone marrow
Amniotic fluid
55
Intravenous injection of air or other foreign substances

Risk Factors
Primary Pulmonary Hypertension
Familial and sporadic patterns
Primarily affects women in their 30s and 40s.
Respiratory Failure
Inadequate alveolar ventilation
Impaired gas exchange
Significant ventilationperfusion mismatch
COPD most common cause
Exact cause of ARDS is unknown.
Not a primary process
Learning Outcome 3
Describe interdisciplinary care and the nursing role in health promotion and
caring for patients with disorders that affect the ability to ventilate the lungs and
exchange gases with the environment.
Asthma
Control of symptoms
Prevention of acute attacks
Restoring airway patency
Restoring alveolar ventilation
Asthma
Treatments
Peak expiratory flow rate (PEFR)
Prevention
Nursing Diagnoses
Symptom relief
Minimization of obstruction
Slowing development of disability
Diagnosis
Pulmonary function tests
Ventilationperfusion scanning
Serum alpha1-antitrypsin levels
ABGs
Pulse oximetry
Capnogram
CBC with WBC differential
Chest x-ray
Treatments
Smoking cessation
Avoidance of airway irritants and allergens
56
Pulmonary hygiene measures

Adequate hydration
Regular aerobic exercise if applicable
Treatments
Breathing exercises
Long-term oxygen therapy
Transplant
Complimentary therapies
Nursing diagnoses
Imbalanced Nutrition: Less than Body Requirements
Compromised Family Coping
Decisional Conflict: Smoking
Heartlung
Atelectasis
Prevention
Reversing underlying cause
Bronchoscopy
Antibiotic therapy
Diagnosis
Chest x-ray
Nursing Care
Bronchiectasis
Maintain optimal pulmonary function
Preventing progression
Diagnosis
Based on history and physical
Chest x-ray
CT scan
Bronchiectasis
Treatments
Chest physiotherapy
Percussion
Postural drainage
Bronchoscopy
Surgery
Resection areas of localized lung tissue
Bronchiectasis
Nursing Diagnoses
57
Imbalanced Nutrition: Less than Body Requirements

Self-care Deficit
Bronchoscopy
Pulmonary function tests
ABGs
Lung scans
Lung biopsy
Pulmonary Embolism
Prevention
Early ambulation of medicalsurgical patients
External pneumatic compression of the legs
Elevating the legs
Active and passive exercising
Pulmonary Embolism
Treatments
Oxygen therapy
Analgesics
Pulmonary artery wedge pressure monitoring
Cardiac output monitoring
Cardiac rhythm monitoring
Pulmonary Embolism
Diagnosis
Plasma D-dimer levels
Chest CT with contrast
Lung scans
Pulmonary angiography
Chest x-ray
Pulmonary Embolism
Diagnosis
Electrocardiogram
ABGs
Exhaled carbon dioxide levels
Coagulation studies
Pulmonary Embolism
Surgery
Umbrella-like filter insertion
Nursing Diagnoses
Pulmonary Hypertension
Slow course of disease
Preventing thrombus formation
Reducing pulmonary vasoconstriction
Diagnosis
CBC
58
ABGs
Oxygen saturation
Chest x-ray
Electrocardiogram
Doppler ultrasonography
Heart catheterization
Treatment
Oxygen therapy
Phlebotomy for polycythemia
Salt and water restriction
Diuretic therapy
Surgery
Bilateral lung or heartlung transplant
Nursing Diagnoses
Learning Outcome 5
Describe the nursing implications for medications used to promote ventilation and
gas exchange.
Asthma
Long-Term Control
Anti-inflammatory agents
Long-acting bronchodilators
Leukotriene modifiers
Quick Relief
Short-acting adrenergic stimulants
Anticholinergic drugs
Methylxanthines
Asthma
Administration Methods
Metered-dose inhaler (MDI)
Dry powder inhaler (DPI)
Nebulizer
Immunizations against pneumococcal pneumonia and influenza
Broad-spectrum antibiotics
Bronchodilators
Corticosteroids
Alpha1-antitrypsin replacement therapy
Immunization against respiratory infections
Bronchodilators
Antibiotics
Inhaled bronchodilators
Oxygen
Anti-inflammatories
Anti-inflammatory
Immune-modifiers
59
Pulmonary Embolism
Heparin
Warfarin sodium
Thrombolytic therapy
Streptokinase
Urokinase
Tissue plasminogen activator
Calcium channel blockers
Short-acting direct vasodilators
Oral anticoagulants
Nursing Implications
Patient and family education
Effects on other bodily systems
Peak and trough levels
Therapeutic blood levels
IV compatibility
Respiratory
Asthma http://meded.ucsd.edu/isp/1998/asthma/html/hpi0.html
Video Asthma Evidenced Based Practice
http://www.medscape.com/viewarticle/745863
Use of a spacer
http://www.youtube.com/watch?v=A8WT5moNJ0I&feature=plcp
Use of metered inhaler
http://www.youtube.com/watch?v=Lrt1nJ3tVFI&feature=plcp
COPD
Case presentation-start with diagnosis
Tuberculosis
http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/htm/_no_50_no_0.htm
Principles of Antibiotic Therapy
http://www.youtube.com/watch?v=FH0BwlE7WKk&feature=related
WEEK 8, 9, & 10
ALTERATIONS IN THE NEED FOR OXYGEN, CARDIOVASCULAR
Learning Outcomes
Describe the anatomy, physiology, and functions of the heart.

Identify manifestations of impaired cardiac structure and functions.
Discuss the coronary circulation and electrical properties of the heart.
60
Compare and contrast the pathophysiology and manifestations of

coronary heart disease and common cardiac dysrhythmias.
Describe interdisciplinary and nursing care for clients with coronary heart
disease and or cardiac dysrhythmias.
Relate the outcomes of diagnostic tests and procedures to the
pathophysiology of cardiac disorders and implications for client responses
to the disorder.
Discuss nursing implications for medications and treatments used to
prevent and treat coronary heart disease and dysrhythmias.
Describe nursing care for the client undergoing diagnostic testing, an
interventional procedure, or surgery for coronary heart disease or a
dysrhythmia.
Compare and contrast the etiology, pathophysiology, and manifestations
of common cardiac disorders, including heart failure, structural disorders,
and inflammatory disorders.
Explain risk factors and preventive measures for cardiac disorders such as
heart failure, inflammatory disorders, and valve disorders.
Discuss the effects and nursing implications for medications commonly
prescribed for clients with cardiac disorders.
Describe nursing care for the client undergoing cardiac surgery or cardiac
transplant.
Learning Activities;
Read and Study:
Lemone (Chapter 29-32; pp. 870- 1066)
Lehne, (chapter 40-50
pp 443-454 (diuretics)
466-479 (RAA drugs)
480-487 (Ca CH Blockers)
488-493 (Vasodilators)
494-4515 (HTN drugs)
516- 531(heart failure)
533-552 (antidysrhythmics)
553-579 (anti-lipids)
580- 593 (Anti-anginal)
Ignatavicius (Chapter 35-40) pp. 704-876
Interactive Video: Care of the elderly cardiac patient
CAI: An Adult in Cardiovascular Crisis.
EDGT- Cardiac Assessment
Learning Outcome 1
61
Describe the anatomy, physiology, and functions of the cardiovascular and

lymphatic systems.
Parts of the Cardiovascular System
The heart
The peripheral vascular system
Cardiac Cycle and Cardiac Output
The cardiac cycle and cardiac output are affected by several factors.
CO = HR x SV.
Four major factors in determining cardiac output
Cardiac index is the cardiac output adjusted to the patients body
surface area.
Ejection fraction is the fraction or percent of blood that is ejected by
each contraction.
Learning Outcome 2
Describe normal variations in assessment findings for the older adult.
Age-Related Changes
Decreased myocardial efficiency and contractility
Decreased cardiac output
Left Ventricular Changes
Increased stroke volume
Increased blood pressure
Valve and Blood Vessels Changes
Increased blood pressure
Learning Outcome 3
Give examples of genetic disorders of the cardiovascular system.
Cardiovascular Genetic Disorders
Hypercholesterolemia
Marfans syndrome
Sickle-cell anemia
Learning Outcome 4
Identify specific topics for consideration during a health history assessment
interview of the patient with cardiovascular or lymphatic disorders.
Cardiovascular and Lymphatic Assessment
A health assessment interview and a physical assessment are used to
collect data to assess the cardiovascular and lymphatic systems.
Elements of the chief complaint to assess include:
Onset
Characteristics
Course and severity
Precipitating and relieving factors
Any associated symptoms
Other factors to assess during the interview include:
Past medical history
Health habits, including nutritional patterns
Related socioeconomic factors
Learning Outcome 5
62
Explain techniques used to assess cardiovascular and lymphatic structure and

function.
Assessment Techniques
Physical assessment of the heart:
Inspection, palpation, and auscultation over the precordium
Assessment of the peripheral vascular and lymphatic systems:
Inspecting the skin for changes
Noting alterations in color and temperature of skin
Auscultating blood pressure
Palpating the major pulse points of the body and lymph nodes
Elements of the functional assessment include:
The patients perception and management of disease
Nutritional assessment
Elimination patterns
Activity and exercise habits
Sleep and rest
Cognition and perception
Assessment Techniques
Elements of the functional assessment include:
Self-concept, roles and relationships
Sexuality and reproduction
Coping, stress, and tolerance
Values and beliefs
Learning Outcome 6
Identify manifestations of impaired cardiac structure and functions.
Manifestations of Impaired Cardiac Structure and Functions
Apical impulse assessment
Manifestations of Impaired Cardiac Structure and Functions
Heart rate assessment
Changes in rate (tachycardia or bradycardia)
Changes in rhythm (dysrhythmia)
Heart sound assessment
Presence of abnormal heart sounds
S3
S4
Learning Outcome 1
Discuss the coronary circulation and electrical properties of the heart.
Coronary Circulation and Electrical Properties of the Heart
Left main coronary artery
Anterior descending
Circumflex branch
Right coronary artery
Supplies the right ventricle
Posterior descending artery supplies posterior portion of heart t
63
Collateral channels
Develop between small arteries
Providing alternative routes for blood flow
Coronary Circulation and Electrical Properties of the Heart
Five properties of cardiac cells
Automaticity
Excitability
Conductivity
Refractoriness
Contractility
Controlled by the cardiac conduction system
Learning Outcome 2
Compare and contrast the pathophysiology and manifestations of coronary heart
disease and common cardiac dysrhythmias.
Atherosclerosis
Causes
Abnormal lipid metabolism
Injury or inflammation of the endothelial cells
Results in blood flow obstruction, weakened arterial walls
Major cause of aneurysms.
Myocardial Ischemia
Myocardial ischemia results from inadequate oxygen supply to the heart
muscle.
Two categories:
Chronic:
Stable and vasospastic angina, asilent myocardial ischemia
Acute angina:
From unstable angina to myocardial infarction
Angina Pectoris
Chest pain resulting from reduced coronary blood flow or ischemia
Pain might feel:
Tight
Squeezing
Heavy
Constricting substernal pain, radiates to jaw, epigastric area, back
Additional manifestations:
Dyspnea
Pallor
Tachycardia
Great anxiety or fear
Silent myocardial ischemia has no symptoms.
Women Can Present With Atypical Symptoms
Indigestion
Nausea
Vomiting
Upper back pain
64
Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a condition of unstable cardiac
ischemia; might or might not cause significant injury of myocardial tissue.
ACS usually causes angina to occur, precipitated by:
Rupture or erosion of atherosclerotic plaque
Coronary artery spasm
Progressive vessel obstruction by plaque or by restenosis after
treatment
Inflammation of a coronary artery
Increased myocardial oxygen demand and/or decreased supply
Acute Myocardial Infarction (AMI)
Death/irreversible damage of myocardial cells
Extent of the AMI can be limited by swift return of blood flow
AMIs are described:
As non-Q wave infarction or Q-wave infarction
By the damaged area of the heart
ECG changes characteristic of MI.
Cardiac Dysrhythmia
Disturbance or irregularity in the electrical system of the heart
Caused by disruption automaticity, excitability, conductivity, refractoriness
Classifications include:
Tachydysrhythmias
Bradydysrhythmias
Ectopic rhythms
Sudden Cardiac Death (SCD)
Unexpected abrupt death; occurs within an hour of onset of symptoms.
Caused by ventricular fibrillation and cardiac arrest
Preceded by acute coronary syndrome or myocardial infarction
Coronary Heart Disease
Affects 13.2 million people in the US
Can lead to
Angina pectoris
Acute coronary syndrome
Myocardial infarction
Dysrhythmias
Heart failure
Sudden death
Learning Outcome 3
Describe interdisciplinary and nursing care for patients with coronary heart
disease and cardiac dysrhythmias.
Coronary Heart Disease and/or Cardiac Dysrhythmias
Coronary heart disease
Aggressive risk factor management
Common Nursing Diagnoses:
Imbalanced Nutrition
Ineffective Health Maintenance
65
Angina
Managementmaintain coronary blood flow and cardiac function
Common nursing diagnoses:
Ineffective Tissue Perfusion
Risk for Ineffective Therapeutic Regimen Management
Coronary Revascularization Procedures
Percutaneous coronary revascularization
Percutaneous transluminal coronary angioplasty
Intracoronary stents placement
Coronary artery bypass grafting
Nursing care
Similar to that of angina and AMI
Acute Myocardial Infarction
Immediate treatment goals
Relieve chest pain
Reduce the extent of myocardial damage
Maintain cardiovascular stability
Decrease cardiac workload
Prevent complications
Other invasive procedures
Intra-aortic balloon pump placement
Ventricular assist device placement
Cardiac rehabilitation
Long-term program:
Medical evaluation
Exercise
Risk factor modification
Education
Cardiac rehabilitation counseling
To limit the physical/psychological effects of cardiac illness
To improve the patients quality of life
Nursing diagnoses:
Acute Pain
Ineffective Tissue Perfusion
Ineffective Coping
Fear
Cardiac Rhythm Disorders
Major goals of care
Identifying the dysrhythmias
Evaluating effect on physical/psychosocial well-being
Treating underlying causes
Counter shock
66
Synchronized cardioversion
Defibrillation
Sudden Cardiac Death
Goal of care: Restore cardiac output and tissue perfusion
Basic and advanced cardiac life support measures
Important concepts of emergency cardiac care
Learning Outcome 4
Relate the outcomes of diagnostic tests and procedures to the pathophysiology
of cardiac disorders and implications for patient responses to the disorder.
Outcomes of Diagnostic Tests and Procedures
Lipid profiles
C-reactive protein
Ankle-brachial blood pressure index
Exercise ECG testing
Electron beam computed tomography
Myocardial perfusion imaging
Angina
Diagnosis
Medical history and family history
Comprehensive description of chest pain
Physical assessment findings
Electrocardiography
Nonspecific ST and T wave changes
ST segment depressed or downsloping
T wave might flatten or invert
Angina
Other diagnostic testing
ECG stress testing
Radionuclide testing
Echocardiography
Coronary angiography
Diagnostic testing
ECG
Serum cardiac markers
Procedures
Transluminal coronary angioplasty
Laser angioplasty
Coronary atherectomy
Intracoronary stents
Coronary artery bypass grafting
Laboratory testing
Creatine kinase
CK-MB
Cardiac-specific troponin
67
Cardiac-specific troponin I
Myoglobin
CBC
ABGs
Diagnostic testing
Electrocardiography
Echocardiography
Myocardial nuclear scans
Hemodynamic monitoring
Cardiac Rhythm Disorder
Diagnostic tests
ECG
Cardiac monitoring
Electrophysiology studies
Laboratory tests
Serum electrolytes
Drug levels
Arterial blood gases
Learning Outcome 5
Discuss nursing implications for medications and treatments used to prevent and
treat coronary heart disease and dysrhythmias.
Coronary Heart Disease
Drug therapy to lower LDL levels, raise HDL levels
Four classes of cholesterol-lowering drugs
Angina
Medications reduce oxygen demand, increase oxygen supply
Three major classes of medications
Low-dose aspirin
Acute Coronary Syndrome Medications Reduce:
Myocardial ischemia (nitrates and beta blockers)
Risk for blood clotting (aspirin, other antiplatelet drugs, and heparin)
Aspirin considered an essential part of treating AMI
Fibrinolytic agents
Analgesics
Antidysrhythmic agents
Cardiac Rhythm Disorders
Medications suppress dysrhythmia formation
Antidysrhythmic drugs
For acute management
For chronic management
Learning Outcome 6
Describe nursing care for the patient undergoing diagnostic testing, an
interventional procedure, or surgery for coronary heart disease or a dysrhythmia.
68
Preoperative or
Pre-procedure Nursing
Comprehensive physical assessment
Education about procedure or surgery
Postoperative or
Post-procedure Nursing
Monitoring VS, cardiac rhythm, output, respiratory status, general physical
assessment
Monitor/manage IV medication administration
Monitor and treat pain
Nursing Diagnoses
Hypothermia
Acute Pain
Ineffective Airway Clearance/Impaired Gas Exchange
Risk for Infection
Disturbed Thought Processes
Learning Outcome 1
Compare and contrast the etiology, pathophysiology, and manifestations of
common cardiac disorders, including heart failure, structural disorders, and
inflammatory disorders.
Heart Failure
Etiology
Pathophysiology
Manifestations
Heart Failure
Systolic and diastolic failure
Left-sided and right-sided heart failure
Pulmonary Edema
Etiology, pathophysiology, and manifestations
Heart Failure
Infective and inflammatory diseases of the heart
Etiology, pathophysiology, manifestations:
Infective endocarditis
Myocarditis
Pericarditis
Figure 319 Constrictive pericarditis.
Valvular Heart Disease
Etiology
Pathophysiology
Manifestations
Tricuspid stenosis
Tricuspid regurgitation
Pulmonic stenosis
Pulmonic regurgitation
69
Cardiomyopathy
Etiology, pathophysiology, and manifestations
Primary and secondary
Dilated
Hypertrophic
Restrictive
Learning Outcome 2
Explain risk factors and preventive measures for cardiac disorders such as heart
failure, inflammatory disorders, and valve disorders.
Heart failure: Risk factors
Coronary artery disease
Cardiomyopathies
Hypertension
Congenital and Valvular Heart Disease Prevention
Education: reduce risks
Coronary artery disease and DM
Infective Endocarditis
Risk factors
Congenital deformities
Tissue damage due to ischemic disease
Valve prosthesis
Intravenous drug use
Invasive catheters
Dental health
Recent heart surgery
Prevention
Education
Prophylactic antibiotics
Myocarditis
Risk factors:
Alteration of immune response
Advanced age
Malnutrition
Alcohol use
Immunosuppression
Exposure to radiation
Stress
Prevention of rheumatic fever
Early and effective treatment of strep throat
Completing the full prescription of antibiotic
Prophylactic antibiotic therapy
Learning Outcome 4
Discuss the effects and nursing implications for medications commonly
prescribed for patients with cardiac disorders.
70
Heart Failure
Medications used to treat heart failure
ACE inhibitors
Angiotensin II receptor blockers
Beta blockers
Diuretics
Inotropic medications
Direct vasodilators
Antidysrhythmic drug
Heart Failure
Nursing diagnoses
Decreased Cardiac Output
Excess Fluid Volume
Deficient Knowledge: Low-Sodium Diet
Pulmonary Edema
Medications to treat pulmonary edema:
Morphine sulfate
Potent loop diuretics such as furosemide
Vasodilators such as nitroprusside; dopamine or dobutamine
Pulmonary Edema
Nursing diagnoses:
Fear
Anti-inflammatory drugs
Nursing diagnoses
Acute Pain
Medications used to treat infective endocarditis:
Prolonged course of antibiotics
Nursing Diagnoses
Risk for Imbalanced Body Temperature
Risk for Ineffective Tissue Perfusion
Pericarditis
Medications used to treat pericarditis:
Determined by manifestations
ASA and acetaminophen
NSAIDs
Corticosteroids
Pericardiocentesis
Pericarditis
Nursing Diagnoses
Acute Pain
71

Risk for Decreased Cardiac Output
Medications used to treat valvular heart disease:
Diuretics, ACE inhibitors, vasodilators, digitalis if heart failure
Digitalis, small doses of beta blockers, anticoagulant therapy if
atrial fibrillation
Prophylactic antibiotics prior to any dental work or surgery
Surgery and invasive procedures
Percutaneous balloon valvuloplasty
Valvuloplasty
Open commissurotomy
Annuloplasty
Valve replacement
Nursing diagnoses
Risk for Infection
Ineffective Protection
Cardiomyopathies
Medications used to treat cardiomyopathies
Dilated and restrictive cardiomyopathies
ACE inhibitors, vasodilators, and digitalis
Beta blockers with caution in dilated cardiomyopathy
Anticoagulants and antidysrhythmics
Cardiomyopathies
Medications used to treat cardiomyopathies
Hypertrophic cardiomyopathy
Beta blockers
Vasodilators, digitalis, nitrates, and diuretics are
contraindicated
Cardiomyopathies
Surgery and invasive treatments
Cardiac transplant
Ventricular assist devices
Removal of excess muscle
Dual-chamber pacemakers
Implantable cardioverter-defibrillators
Cardiomyopathies
Nursing diagnoses
Fatigue
72
Fear
Ineffective Role Performance
Anticipatory Grieving
Learning Outcome 5
Describe nursing care for the patient undergoing cardiac surgery or cardiac
transplant.
Placement of a Circulatory Assistance Device
Intra-aortic balloon pump
Left-ventricular assist device
Nursing Care of the Heart Transplant Patient
Similar to care of any cardiac surgery patient
Monitor chest tube drainage
Monitor cardiac rate and rhythm
Monitor cardiac output, pulmonary artery pressures, and CVP
Nursing Care
Learning Outcome 1
Compare and contrast the manifestations and effects of disorders affecting large
and small vessels, arteries, and veins.
Blood Pressure
Controlled by
Cardiac output
Systemic vascular resistance
Stimulation of sympathetic nervous system, hormones that control
fluid volume
Blood Pressure
Factors that increase blood pressure:
Factors affecting blood pressure.
Primary Hypertension
Pathophysiologic causes
Sympathetic nervous system overstimulation
Alterations of reninangiotensinaldosterone system
Manifestations
Initially asymptomatic
Headache, confusion
Nocturia
Nausea and vomiting
Visual disturbances
Complications
Cardiovascular
Neurologic
Renal systems
Hypertensive Crisis
Known as malignant hypertension
Rapid elevation of blood pressure
73
Treatment within 1 hour to prevent complications

Hypertensive Crisis
Manifestations include:
Headache, confusion
Papilledema, blurred vision
Restlessness
Motor and sensory defects
Aneurysm
Abnormal dilation of a blood vessel
Occurs in aorta/ peripheral arteries
Form due to weakness of arterial wall.
Hypertension is a major contributing cause.
Complications: Dissection possible if a tear in tunica intima and media
allows blood to invade the layers of vessel wall.
Abdominal Aortic Aneurysms
Associated with arteriosclerosis and hypertension
Can be asymptomatic
Patient can present with abdominal mass/pain in midabdominal region or
back.
Thrombi Can Embolize
Rupture causes hemorrhage, hypovolemic shock; can lead to death.
Peripheral Vascular Disease (PVD)
Narrowed peripheral arteries
Impaired blood supply to peripheral tissues
Manifestations:
Cramping or aching pain in calves of legs, thighs, and buttocks with
a predictable level of activity
Rest pain during inactivity
Increases with elevation of the legs.
Manifestations:
Pain decreases when legs are dependent.
Skin is thin, shiny, and hairless; discolored areas.
Toenails can be thickened.
Areas of skin breakdown, edema
Complications:
Gangrene
Rupture of abdominal aortic aneurysms
Infection
Sepsis
Thromboangitis Obliterans
Buergers disease
Occlusive vascular disease
74
Inflammation and spasm cause clots to form in peripheral arteries

Raynauds Disease (or Phenomenon)
Episodes of intense vasospasm in the small arteries and arterioles
No identifiable cause; can occur secondary to another disease.
Figure 329 Hands of a patient with Raynauds phenomenon. Note
cyanosis of fingers on the right hand and the left thumb and the extreme
pallor of the other digits of the left hand.
Acute Arterial Occlusion
Occurs acutely by thrombus or by embolism
An emergency condition
Venous Thrombosis
Thrombophlebitis
A blood clot forms on the wall of a vein.
Causes inflammation of vein and some degree of venous blood flow
obstruction.
Figure 3210 Common locations of venous thrombosis. A, The most
common sites of deep vein thrombosis. B, DVT extending from the calf to
the iliac veins. C, superficial venous thrombosis.
Chronic Venous Insufficiency
Inadequate venous return over a prolonged period
Common cause is deep vein thrombosis.
Venous status occurs, impairing arterial circulation.
Varicose Veins
Irregular, tortuous veins with incompetent valves
Commonly occurs in the lower extremities.
Learning Outcome 2
Explain risk factors for and measures to prevent peripheral vascular disorders
and their complications.
Education regarding risk factors and methods to prevent the development
of primary hypertension
Aging
Race
Family history of hypertension
High sodium intake
Low potassium, calcium, magnesium intake
Obesity
Education regarding risk factors and methods to prevent the development
of primary hypertension
Insulin resistance
Excess alcohol consumption
Stress
Hypertensive Crisis
Sudden discontinuation of medications
Poorly controlled hypertension
75
Aneurysm
Risk factors for the development of aneurysms:
Hypertension
Cystic medial necrosis
Male gender
Advancing age
Aneurysm
Risk factors for the development of aneurysms:
Pregnancy
Congenital defects of the aortic valve
Coarctation of the aorta
Inflammatory aortitis
PVD
The risk of peripheral vascular disease increases with:
Diabetes mellitus
Hypertension
Cigarette smoking
High homocysteine levels
Thromboangitis Obliterans
Cigarette smoking is most significant cause
Raynauds Disease
Signs and symptoms
Genetic predisposition
Embolisms
Acute arterial occlusion results from an embolism.
Embolisms
Embolisms
The following conditions increase risk of development of embolisms:
Atrial fibrillation
Foreign body embolism
Venous Thrombosis
Risk factors for the development of venous thrombosis
Venous Thrombosis
Hormone replacement therapy
Chronic Venous Insufficiency
Complications of chronic venous insufficiency:
Deep vein thrombosis
Varicose veins
Leg trauma
Varicose Veins
Risk factors for development of varicose veins:
Learning Outcome 3
Explain the nursing implications for medications and other interdisciplinary
treatments used for patients with peripheral vascular disorders.
Medication and Treatment - Hypertension
76
Management focuses on reducing blood pressure.

Medications used to treat primary hypertension:
Diuretics
Beta-adrenergic blockers
Central-acting sympatholytics
Vasodilators
ACE inhibitors
Angiotensin II receptor blockers
Lifestyle modifications to help reduce blood pressure:
Weight loss
Dietary changes
Restricted alcohol use
Smoking cessation
Increased physical activity
Stress reduction
Nursing diagnoses applicable to patients with hypertension
Risk for Noncompliance
Imbalanced Nutrition
Excess Fluid Volume
Medication and Treatment - Hypertensive Crisis
Management of hypertensive crisis:
IV antihypertensives medications
Continuous blood pressure monitoring
Titrating medications to blood pressure readings
Avoiding rapid blood pressure changes
Providing calm reassurance to the patient and family
Medication and Treatment - Aortic Aneurysm
Treatment of thoracic aortic aneurysms
Long-term beta blockers
Other antihypertensive medications
Medication and Treatment - Aortic Dissection
Therapies used to treat aortic dissection
IV beta-blockers
Sodium nitroprusside
Direct vasodilators are avoided
Postoperative anticoagulant therapy
Medication and Treatment - Aneurysm
Nursing diagnoses related to patients with aneurysms:
Risk for Ineffective Tissue Perfusion
Risk for Injury
77
Anxiety
Medication and Treatment - PVD
Medications used to treat peripheral vascular disease
Drugs to inhibit platelet aggregation
Platelet inhibitors
Drugs to decrease blood viscosity
Parenteral vasodilator prostaglandins
Medication and Treatment - PVD
Nursing diagnoses applicable to patients with peripheral vascular disease:
Ineffective Tissue Perfusion: Peripheral
Pain
Impaired Skin Integrity
Medication and Treatment - Thromboangitis Obliterans
Surgical treatment of thromboangitis obliterans
Sympathectomy
Arterial bypass graft
Medication and Treatment - Thromboangitis Obliterans
Nursing care for patients with thromboangitis obliterans
Promotion of arterial circulation
Prevention of prolonged tissue hypoxia
Smoking cessation support
Relief of acute manifestations
Medication and Treatment - Raynaud's Disease
Medications used in the treatment of Raynauds disease
Vasodilators
Sustained-release calcium channel blockers
Alpha-adrenergic blockers
Transdermal nitroglycerine
Longer-acting oral nitrates
Medication and Treatment - Raynaud's Disease
Nursing care for those with Raynauds disease
Education
Support
Medication and Treatment - Arterial Occlusion
Medications used in acute arterial occlusion
Anticoagulation
Thrombolytic therapy
Nursing diagnoses in acute arterial occlusion
Anxiety
Altered Protection
Medication and Treatment - Venous Thrombosis
Medications used in venous thrombosis
Anticoagulants
Thrombolytics
78
NSAIDs
Medication and Treatment - Venous Thrombosis
Nursing diagnoses for patients with venous thrombosis:
Pain
Ineffective Protection
Impaired Physical Mobility
Risk for Ineffective Tissue Perfusion: Cardiopulmonary
Medication and Treatment - Chronic Venous Insufficiency
Medications used in chronic venous insufficiency
Corticosteroids
Zinc oxide
Clotrimazole
Miconazole
Burrows solution
Medication and Treatment - Chronic Venous Insufficiency
Nursing diagnoses applicable to those with chronic venous insufficiency:
Disturbed Body Image
Risk for Infection
Impaired Physical Mobility
Impaired Skin Integrity
Medication and Treatment - Varicose Veins
Therapies for varicose veins
Compression stockings
Regular, daily walking
Discouraging prolonged sitting or standing
Regular periods of leg elevation
Medication and Treatment - Varicose Veins
Nursing diagnoses:
Chronic Pain
Risk for Impaired Skin Integrity
Risk for Peripheral Neurovascular Dysfunction
Medication and Treatment - Lymphedema
Treatments for patients with lymphedema
Generally conservative
Positioning
Avoidance of infection
Diuretic therapy
Nursing diagnoses
Impaired Tissue Integrity
Excess Fluid Volume
Disturbed Body Image
Learning Outcome 4
79
Describe preoperative and postoperative nursing care of patients having vascular

surgery.
Preoperative Nursing Care
Teaching
Routine preoperative care
Reduction of anxiety and fear
Medications to control blood pressure
Postoperative Care
According to surgical procedure performed
Learning Outcome 5
Relate the manifestations and diagnostic test results to the etiology and
pathophysiology of common peripheral vascular and lymphatic disorders.
Assessment of Blood Pressure
Hypotension
Hypertension
Orthostatic hypotension
Narrowing or widening of pulse pressure
Skin assessment can reveal:
Pallor or cyanosis
Edema, redness, induration, lesions resulting from lymphangitis,
lymphedema, infection, or malignancy
Artery and vein assessment
Redness, swelling, nodules
Pulse changes or asymmetry
Extremity assessment
Edema
Color changes
Temperature variations
Inadequate capillary refill
Arterial insufficiency
Lesions
Skin thickening
Varicose veins
Abdominal assessment
Pulsations, bulging, bruits
Presence of palpable spleen
Risk for Ineffective Health Maintenance
Primarily educational
WEEK 11
80
ALTERATIONS IN THE NEED FOR REGULATION: ENDOCRINE

Learning Outcomes
Apply knowledge of normal anatomy, physiology, and assessments of the

thyroid, parathyroid, adrenal, and pituitary glands when providing nursing
care for clients with endocrine disorders.
Compare and contrast the manifestations of disorders that result from
hyperfunction and hypofunction of the thyroid, parathyroid, adrenal, and
pituitary glands.
Explain the nursing implications for medications prescribed to treat
disorders of the thyroid and adrenal glands.
Provide appropriate nursing care for the client before and after a subtotal
thyroidectomy and an adrenalectomy.
to clients with disorders of the thyroid, parathyroid, adrenal, and pituitary
glands.
Learning Activities
Read and Study
EDGT- Physiology & Assessment: Endocrine System
Lehne (Chapter56-59) pp 657 - 717
Porth (Chapter 31-32 pp 761-798
Learning Outcome 1
Describe the anatomy and physiology of the endocrine glands.
Figure 181 Location of the major endocrine glands.
The Pituitary Gland
Anterior pituitary secretes six hormones.
Posterior pituitary secretes ADH and oxytocin.
The Thyroid Glance
The thyroid gland secretes:
Thyroid hormone (T4, T3)
Calcitonin
The Parathyroid Gland
The parathyroid glands secrete:
Parathormone (PTH)
Adrenal Glands
The adrenal medulla secretes:
Epinephrine (adrenaline)
Norepinephrine (noradrenaline)
The adrenal cortex secretes:
Mineralocorticoids
81
Glucocorticoids
Pancreas
The pancreas endocrine and exocrine gland.
Four types of endocrine cells (A, B, D, and F) produce hormones to regulate
carbohydrate metabolism.
Learning Outcome 2
Describe the function of hormones and explain how they are monitored, how they
are released, and how they travel.
Hormones
Chemical messengers
Hormones
Transported from endocrine gland cells to target cells
Endocrine glandsvia the bloodstream)
Learning Outcome 3
Assessing endocrine function: Describe the purpose and associated nursing care
of diagnostic tests
The Endocrine System
Diagnostic tests of the endocrine system
Support diagnosis of specific disease
Identify the appropriate medication or therapy
Monitor the patients responses to treatment
The Endocrine System Nursing care
Explaining procedure
Supporting patient during examination
Documenting procedures
Monitoring results
Post-procedure care/patient teaching
Thyroid Tests
Magnetic Resonance Imaging (MRI)thyroid
Radioactive Iodine Uptake (RIA)
Adrenal Tests
Pancreatic Endocrine Tests
Learning Outcome 4
Identify specific topics to consider during a health assessment interview and
physical assessment of the patient with health problems involving endocrine
function.
Genetic Considerations
Health Screening
Occupational and Social History
Physical Assessment
Palpating the thyroid gland from behind the patient. .
Learning Outcome 1
Apply knowledge of normal anatomy, physiology, and assessments of the
thyroid, parathyroid, adrenal, and pituitary glands when providing nursing care for
patients with endocrine disorders.
Nursing Care for Patients with Endocrine Disorders
82
Diagnostic tests
Change in appearance
Lifestyle changes
Psychological response
Nursing Care for Patients with Endocrine Disorders
Nursing care is directed toward:
Meeting physiologic needs
Providing education
Ensuring psychologic support for patient and family
Holistic approach is essential
Hypothyroid and Hyperthyroid
Learning Outcome 2
Compare and contrast the manifestations of disorders that result from
hyperfunction and hypofunction of the thyroid, parathyroid, adrenal, and pituitary
glands.
Hyperthyroidism
The effects of hyperthyroidism are systemic.
Signs and symptoms:
Palpitations
Increased sweating
Increased appetite
Weight loss
Hypothyroidism
Signs and symptoms:
Lethargy
Weight gain
Depression
Dry skin
Hyperparathyroidism
Signs and symptoms:
Hypertension
Psychosis
Muscle weakness
Renal calculi
Hypoparathyroidism
Signs and symptoms:
Tetany
Muscle spasms
Hyperactive reflexes
Cushing's Syndrome
Signs and symptoms:
Weakness
Easily bruised
Poor wound healing
Glycosuria
Psychological manifestations
83
Addison's Disease
Signs and symptoms:
Arrhythmias
Postural hypotension
Syncope
Dizziness
Confusion
Neuromuscular irritability
Pheochromocytoma
Signs and symptoms:
Paroxysmal hypertension
Increased cardiac output
Hyperpituitarism
Signs and symptoms:
Excess growth, which is exaggerated in the face, hands, and feet
Visual changes
Learning Outcome 3
Explain the nursing implications for medications prescribed to treat disorders of
the thyroid and adrenal glands.
Hyperthyroidism Medications
Short-term treatment
Iodine (SSKI, Lugols solution, Thyro-Block, and Pima)
Assess for hypersensitivity to iodine or shellfish prior to giving medication
Antithyroid drugs inhibit TH production:
Methimazole (Tapazole)
Propylthiouracil (PTU, Propylthyracil)
Hyperthyroidism Medications
Monitor for side effects:
Pruritus rash
Elevated temperature
Anorexia
Loss of taste
Menstrual changes
Fatigue
Weight gain
Treatment of Hypothyroidism
Thyroid hormone is used in the treatment of hypothyroidism:
Levothyroxine sodium (Synthroid)
Liothyronine sodium (Cytomel)
Levothyroxine sodium (Levothroid)
Liotrix (Euthroid)
Treatment of Hypothyroidism
Administer 1 hour prior to eating or at least 2 hours after
Monitor for bruising, bleeding gums, and blood in the urine
Monitor for coronary insufficiency, chest pain, dyspnea, and tachycardia
Hyperparathyroidism Therapy
84
Hyperparathyroidism treatments inhibit bone resorption:

Alendronate (Fosamax)
Zoledronate (Zometa)
Education to avoid OTC medications with calcium
Drink fluids
Remain active
Hypoparathyroidism Therapy
Dietary supplements important in hypoparathyroidism
Supplemental calcium and vitamin D
Treatment of Cushing's Syndrome
Medications used to treat Cushings syndrome have various actions:
Mitotane (Lysodren)
Aminogluthemide (Cytadren) and ketoconazole (Nizoral)
Somatostatin
Treatment of Addison's Disease
Addisons disease is treated with cortisol hormone replacement therapy.
Learning Outcome 4
Provide appropriate nursing care for the patient before and after a subtotal
thyroidectomy and an adrenalectomy.
Subtotal Thyroidectomy
Preop Nursing Care
Administration of medications
Teaching to support the neck; effective coughing, deep-breathing
exercises
Reassurance regarding the scar
Postoperative care
Comfort measures
Assess pain
Semi-Fowlers position
Subtotal Thyroidectomy
Assess for potential complications and keep emergency equipment ready
Adrenalectomy
Nursing Care Preop adrenalectomy care includes diet consultation
Use medical and surgical asepsis to prevent infection
Adrenalectomy
Postoperative Care
Periodic turning
Coughing
Deep breathing
Vital signs
Monitoring intake and output
Monitoring for potential complications
Learning Outcome 5
Use the nursing process as a framework for providing individualized care to
patients with disorders of the thyroid, parathyroid, adrenal, and pituitary glands.
Endocrine Disorders
85
Endocrine disorders cause multiple problems that need to be addressed

by the nurse.
Focus of care:
Meeting physiological needs
Providing education
Ensuring psychological support
Endocrine Disorders
Assessment:
History
Current physical data
Diagnostic data
Endocrine Disorders
Nursing diagnoses:
Fluid Volume Deficit
Anxiety
Risk for Injury
Risk for Infection
Body Image Disturbance
Interventions
Thyroid:
Goal is euthyroid function.
Observe for signs of hyper- or hypothyroid.
Parathyroid:
Observe for signs of hyper- or hypofunction.
Adrenal gland:
Observe for signs of Cushings syndrome or Addisons disease.
Interventions
Anterior pituitary gland:
Observe for signs of acromegaly.
WEEK 12
ALTERATIONS IN NEED FOR REGULATION: DIABETES MELLITUS
Learning Outcomes
Apply knowledge of normal anatomy, physiology, and assessments when

providing nursing care for clients with diabetes mellitus.
Describe the prevalence and incidence of diabetes mellitus.
Explain the pathophysiology, risk factors, manifestations, and
complications of type 1 and type 2 diabetes mellitus.
Compare and contrast the manifestations and interdisciplinary care of
hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar
hyperglycemic state (HHS).
86
Identify the diagnostic tests used for screening, diagnosis, and monitoring
of diabetes mellitus.
Discuss the nursing implications for insulin and oral hypoglycemic agents
used to treat clients with diabetes mellitus.
Provide accurate information to clients with diabetes mellitus to facilitate
self-management of medications, diet planning, exercise, and selfassessment, including foot care.
to clients with diabetes mellitus.
Read and Study
Lehne (Chapter 56) pp 657-688
Porth (Chapter 33) pp 799-828
Ignatavicius (Chapter 67) pp 1465-1525
http://www.bd.com/us/diabetes/hcp/main.aspx?cat=3065&id=3117
Go to health care professionals; we will review the case
studieshttp://www.bd.com/leaving/index2.asp?/20061+http://professional.di
abetes.org/CPR_search.aspx
Learning Outcome 1
Describe the prevalence and incidence of DM.
Diabetes Mellitus
Diabetes is a group of chronic disorders resulting in hyperglycemia.
Type 1 DM characterized by a total deficit of circulating insulin
Type 2 DM characterized by insulin resistance
One of the major roles of the nurse in diabetes management is education
of the diabetic patient.
Diabetes Mellitus
Nursing care and educational plans for the diabetic patient need to be
individualized based on:
Type of diabetes
Length since diagnosis
Prior knowledge
The patients individual health and socioeconomic circumstances
Diabetes Mellitus
Prevalence, incidence, and economic impact of DM
DM is widespread, and is the sixth-leading cause of death in the
United States.
Ninety percent of patients with diabetes have type 2 DM.
10% have type 1 DM.
Diabetes Mellitus
Type 2 diabetes is most common among these populations:
American Indian
87
Alaska native
Latino
There has been a sharp increase in type 2 diabetes related to rates of
obesity in the United States.
Diabetes Mellitus
Complications such as acute myocardial infarction, stroke, renal failure,
blindness, and traumatic amputations are common among diabetics with
poor glycemic control.
According to the American Diabetes Association, health care costs related
to diabetes exceeded $132 billion per year in 2002.
Learning Outcome 2
Explain the pathophysiology, risk factors, manifestations, and complications of
type 1 and type 2 DM.
Type 1 and Type 2 DM
All patients with DM experience hyperglycemia.
The signs and symptoms of hyperglycemia include
Polyuria
Polydipsia
Polyphagia.
Type 1 DM
Autoimmune destruction of the pancreatic islet cells
No insulin produced
Occurs in childhood/adolescence
Genetic predisposition plus environmental factors such as onset
following viral illness
Includes 510% of all patients with DM
Type 1 DM
Rapid onset
Risk factors
Type 2 DM
Results from insulin resistance
Occurs at any age
Heredity plays an important role, along with obesity
Includes 9095% of all patients with DM
Gradual onset
Risk factors
Diabetic complications result from chronic hyperglycemia
Chronic complications:
Result of endothelial inflammation and thickening
Learning Outcome 3
Provide rationale for the diagnostic tests used for screening, diagnosis, and
monitoring of DM.
88
Screening Tests for DM

Casual plasma glucose (PG)
Fasting plasma glucose (FPG)
Oral glucose tolerance test (OGTT)
Screening Tests for DM
Screening tests to determine diabetes management
FBG (fasting blood glucose)
A1C (glycosylated hemoglobin (c))
Urine glucose and ketone levels
Urine tests, serum cholesterol, and serum electrolytes
Learning Outcome 4
Discuss the nursing implications for insulin and oral hypoglycemic agents used to
treat patients with DM.
Treating DM
The patient with type 1 DM requires exogenous insulin.
The patient with type 2 DM may take oral medications or may take insulin.
Treating DM
Types of insulins:
Rapid-acting
Short-acting
Intermediate-acting
Long-acting
Treating DM
Teaching the patient to give insulin:
Measurement of blood glucose
Syringe and needle selection
Preparing the injection
Sites of injection
Mixing insulins
Storage of insulin
Food intake with insulin
Treating DM
Nursing considerations for patients taking either insulin or oral agents:
Assessment of therapeutic response
Monitoring blood glucose levels
Signs of hypo- or hyperglycemia
Patient Education:
Safe medication practices
Treating DM
Nursing Implications:
Assessing response to medications, especially in first 7 days
Assess for signs of hypoglycemia
Assess for signs of hyperglycemia
Learning Outcome 5
Discuss best practices of self-care management of DM related to diet planning,
sick day management, and exercise.
89
The Goals of Diabetes Treatment

Prevent hypo- and hyperglycemia
Maintain glucose levels close to normal
Dietary management of DM
Carbohydrates
Protein
Fats
Fiber
Sodium
Sweeteners
Alcohol
Dietary management of DM
Meal Planning
Diet plan for the older adult
Sick day management:
Increased need for insulin
Hyperglycemia
Continuing medications important
Food intake
Frequent monitoring
Exercise
Exercise is important to maintain glycemic control.
The person with DM should be assessed for potential health risks
prior to beginning an exercise program.
Exercise can cause hypoglycemia as well as hyperglycemia.
Responses to exercise should be monitored carefully and treated
as needed.
Exercise
Glycemic control improves with a regular exercise program.
Glycemic responses to exercise should be monitored.
Variables:
Type of DM
Intensity of exercise
Duration of exercise
The time of day
Learning Outcome 6
Compare and contrast the manifestations of hypoglycemia, diabetic ketoacidosis,
and hyperosmolar hyperglycemic state.
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) develops when there is an absolute
deficiency of circulating insulin
90
Manifestations of diabetic ketoacidosis
Hyperosmolarity (from hyperglycemia)
Metabolic acidosis from ketoacids and lactic acids
Volume depletion from osmotic diuresis as a result of
hyperosmolarity
Electrolyte imbalances from osmotic diuresis
Manifestations of Hyperosmolar Hyperglycemic State (HHS)
Hyperosmolarity from hyperglycemia (often more severe than in
DKA)
Volume depletion from osmotic diuresis as a result of
hyperosmolarity
Electrolyte imbalances from osmotic diuresis
Hypoglycemia is more common in diabetics who are insulin dependent.
Signs and symptoms of hypoglycemia result from responses of the
autonomic nervous system (release of stress hormones), and from a
deficiency of circulating glucose available for normal brain function.
WEEK 13 & 14
ALTERATIONS IN THE NEED FOR NUTRITION
UPPER GASTROENTESTINAL SYSTEM, LIVER & PANCREAS
Learning Outcomes
Describe the pathophysiology of common disorders of the mouth,

esophagus, and stomach.
Relate manifestations and diagnostic test results to the pathophysiologic
processes involved in upper gastrointestinal disorders.
Explain interdisciplinary care for clients with upper gastrointestinal
disorders.
Describe the role of the nurse in interdisciplinary care of clients with upper
gastrointestinal disorders.
Describe the pathophysiology of commonly occurring disorders of the
gallbladder, liver, and exocrine pancreas.
Use knowledge of normal anatomy and physiology to understand the
manifestations and effects of biliary, hepatic, and pancreatic disorders.
Relate changes in normal assessment data to the pathophysiology and
manifestations of gallbladder, liver, and exocrine pancreatic disorders.
Learning Activities
Read and study:
91

Grodner et al., pp 500 510, 526 - 538
NUTRITION AND DIET THERAPY ACTIVITIES

Develop a one day nutritional plan and answer the questions relating to the
disease mentioned.
1. Identify the basic principles of diet therapy for a client with esophageal
problems (6). Outline a diet that will exacerbate the symptom of esophageal
reflux in a client who has hiatus hernia. Revise the diet to reduce symptoms and
identify four activities to reduce gastric reflux.
2. What are the basic principles of a peptic ulcer diet? What the potential
deficiencies with this diet? (4) Identify the components of a therapeutic diet for a
client with diverticulitis.
3. Compare the diets for celiac disease and inflammatory bowel diseases. What
are the differences?
4. Identify the nutritional deficiencies in a client with celiac disease versus
inflammatory disease.
5. Write a one day meal plan for a 30 year old woman, 156cm (5ft., 6 in) tall, who
weighs 81 kg (180 lbs.) who has cholecystitis.
6. Identify a one day meal plan for a client with infectious hepatitis and compare it
to a client with cirrhosis of the liver, and another client with hepatic
encephalopathy.
Nutrition Study Questions
1. Be able to identify at least 5 foods in each food group:
a. Bread
b. Vegetable
c. Fruit
d. Diary
e. Protein
f. Fats
Saturated
Polyunsaturated
Monounsaturated
92
2. Know the functions of each Vitamin and the signs and

symptoms/complications of each deficiencies.
Vitamin A
D
E
K
Vitamin B1
B6
B12
C
Folic Acid
3. Sources of Iron (5)
Learning Outcome 1
Describe the anatomy, physiology, and functions of the gastrointestinal system
and the accessory digestive organs.
Figure 211 Organs of the gastrointestinal system and accessory
digestive organs.
Digestive Processes:
Ingestion
Movement
Secretion
Mechanical digestion
Chemical digestion
Absorption
Ingestion
Mouth
Mastication, forms food bolus
Movement
Pharynx (oropharynx and laryngopharynx)
Moves food via peristalsis to the esophagus
Esophagus
Passageway for food to the stomach
Mechanical Digestion
Stomach
Storage reservoir, continues mechanical breakdown
Chemical Digestion and Absorption
Small intestine
Food is chemically digested and absorbed as it moves toward the
large intestine
Chemical Digestion and Absorption
Accessory organs:
Liver
Gallbladder
93
Exocrine
Pancreas
Learning Outcome 2
Identify specific topics to consider during a health history interview of the patient
with gastrointestinal disorders.
Topics to Consider for Health History Interview
Health perceptionhealth management
Nutritionalmetabolic
Elimination
Activityexercise
Sleeprest
Topics to Consider for Health History Interview
Cognitiveperceptual
Self-perceptionself-concept
Role relationships
Sexuality
Copingstress tolerance
Valuesbelief system
Learning Outcome 3
Explain techniques used for assessing nutritional status and gastrointestinal
function.
Diagnostic Tests
Esophageal acidity and manometry
Barium swallow or upper GI series
Endoscopy (EGD)
MRI
Gastric analysis
Gallbladder/pancreatic tests
Ultrasound
Breath
Genetic History
Immediate family
.
Learning Outcome 4
Give examples of genetic disorders of the gastrointestinal system.
Gastrointestinal Disorders with Genetic Considerations
Pancreatic cancers
Obesity
Familial adenomatous polyposis (FAP) and hereditary nonpolyposis
colorectal cancer (HNPCC)
Crohns disease
Colon cancer
Celiac disease (CD)
Learning Outcome 5
94
Describe normal variations in gastrointestinal assessment findings for the older

adult. Explain techniques used for assessing nutritional and gastrointestinal
status.
Nursing Assessment
Teeth
Increased number of root cavities
Cavities around existing dental work
Tooth enamel harder and more brittle
Dentin is more fibrous
Tooth cusps flatten
Root pulp shrinks
Increasing loss of bone
Nursing Assessment
Gums
Gingiva retracts
Taste
Less acute as tongue atrophies
Saliva
Decreased amount is produced
Nursing Assessment
Esophageal motility
Decreased intensity of propulsive waves
Weaker gag reflex
Stomach
Mucosa atrophies
Decreased hydrochloric acid and pepsin
Gallstones
Less efficient handling of cholesterol and absorption
Learning Outcome 6
Identify abnormal findings that might indicate alterations in gastrointestinal
function.
Abnormal Findings
Esophagus and stomach
Esophageal varices
Inflammation
Hernia
Gallbladder and pancreatic tissue
Assessed by ultrasound, x-ray, and direct visualization
Identifies tumors, gallstones, obstructions
Abnormal Findings
Liver
Biopsy:
cancer
cyst
cirrhosis
Blood tests
95
Disease processes of the GI system

Endoscopic exams
Visualize gastrointestinal structures
Learning Outcome 1
Describe the pathophysiology of common disorders of the mouth, esophagus,
and stomach.
Nausea and Vomiting
Nausea
Stimulation of vomiting center in the brain
Vomiting
Coordinated by the brainstem
Requires synchronized movements of the thorax and abdominal
wall, the gut, the pharynx, and muscles of the mouth and face
Pathophysiology
Mouth
Stomatitis
Oral cancer
Esophagus
Gastroesophageal reflux disease (GERD)
Hiatal hernia
Esophageal cancer
Pathophysiology
Gastrointestinal Bleeding
Irritates stomach
Usually leads to nausea and vomiting
Accumulation stimulates peristalsis, leading to hyperactive bowel
sounds and diarrhea
Pathophysiology
Stomach
Peptic ulcer disease (PUD)
Zollinger-Ellison syndrome
Gastritis
Stomach cancer.
Learning Outcome 2
Relate manifestations and diagnostic test results to the pathophysiologic
processes involved in upper gastrointestinal disorders.
GERD Diagnostic Tests
Barium swallow
Upper endoscopy
24-hour ambulatory pH monitoring
Esophageal manometry
Esophageal Cancer
Diagnostic Tests
Barium swallow
Esophagoscopy
96
Chest x-ray, CT scans, or MRI

Complete Blood Count (CBC)
Manifestations of Gastrointestinal Bleeding:
Stomach irritation
Nausea and vomiting
Black and tarry or bloody stools
Gastrointestinal Bleeding Diagnostic Tests
Blood type and crossmatch
Serum electrolytes, osmolality, BUN
Liver function studies, coagulation profile
Upper endoscopy
Peptic Ulcer Disease
Manifestations of Peptic Ulcer Disease
Pain in the epigastric region
Heartburn or regurgitation and possible vomiting
Symptoms less clear in the older adult
Peptic Ulcer Disease
Peptic Ulcer Disease Diagnostic Tests
Upper GI Series using barium
Endoscopy
A biopsy urease test
Fecal H. pylori antigen tests and urea breath tests
Gastric analysis if Zollinger-Ellison syndrome suspected
Gastritis
Gastritis Diagnostic Tests
Gastric analysis
Hemoglobin, hematocrit, and red blood cell (RBC) indices
Serum vitamin B12 levels
Upper endoscopy
Stomach Cancer
Manifestations of Stomach Cancer
Early symptoms are vague
Ulcer-like pain unrelieved by antacids
Palpable abdominal mass
Occult blood in stool, indicating GI bleeding
Stomach Cancer
Stomach Cancer Diagnostic Tests
Upper GI x-ray with barium swallow
Ultrasound or other radiologic techniques
Upper endoscopy
Learning Outcome 3
97
Explain interdisciplinary care for patients with upper gastrointestinal disorders.

Interdisciplinary Care:
Nausea and Vomiting
Usually requires no treatment
Food initially withheld; clear liquids prevent dehydration
Antiemetic medications
Complementary and alternative medicine
Stomatitis
Diagnosed by physical examination
Treatment
Oral Cancer
Eliminate causative factors
Stage I thru IV require treatment surgery, radiation, and possible
chemotherapy
GERD
Lifestyle changes
Diet Modification
Drug therapy, in severe cases
Severe complications require surgery
Medications
Hiatal Hernias
Usually require no treatment
If symptoms present, treatment is similar to that of GERD
Severe cases involving incarcerated herniation can require surgery
Interdisciplinary Care: Esophageal Cancer
Controlling dysphagia
Maintaining nutritional status
Treatment might require surgery, radiation, chemotherapy
GI Bleeding
Depends on severity of the bleed
Massive bleeds must be treated in a critical care setting
Slow or chronic bleeds can be managed in a community-based setting
Gastric lavage may be used
Medications
Discontinued use of NSAIDs if ulcer is NSAID-induced
Maintaining good nutrition
Surgery might be required
Gastritis
Usually handled in the community-based setting
Treatment
98
Cancer of the Stomach
Surgical intervention when identified before metastasis
For patients with advanced disease
Palliative treatment
Can include surgery, radiation therapy, and chemotherapy
Learning Outcome 4
Describe the role of the nurse in interdisciplinary care of patients with upper
gastrointestinal disorders.
Health Promotion
Important for patients with upper GI disorders
Identify patients at risk
Suggest measures to reduce risk
Nursing Assessment
Health history with subjective and objective data
Determines cause of complaint
Facilitates appropriate nursing interventions
Medication Administration and Assessment
Patient and family health education about medications prescribed
Assess the effectiveness of the medication and whether the patient is
compliant
Learning Outcome 1
Describe the pathophysiology of commonly occurring disorders of the
gallbladder, liver, and exocrine pancreas.
Gallbladder
Cholelithiasis (gallstones)
Abnormal bile composition, biliary stasis, and inflammation of the
gallbladder
Cholesterol
Gallbladder
Cholecystitis
Inflammation of the gallbladder
Acute: chemical irritation and bacterial inflammation, stone
obstruction
Chronic: repeated bouts of the acute or persistent stone irritation
Gallbladder
Cancer of the Gallbladder
High mortality rate
Spreads by direct link to liver
Metastasizes via blood and lymph
Liver
Hepatitis (inflammation of the liver)
Caused by virus, toxin, or other pathogen
Inflammatory process damages cells and disrupts function
99
Liver
Viral hepatitis caused by HAV, HBV, HCV, HDV, or HEV
Chronic hepatitis caused by HBV, HCV, or HDV
Fulminant hepatitis related to HBV and HDV concurrently
Liver
Toxic hepatitis caused by alcohol, drugs, or other toxins
Autoimmune hepatitis caused by cell-mediated immune response
Liver
Cirrhosis
Fibrosis of liver tissue
Decreased mass, impaired function, and altered blood flow
Alcoholic cirrhosisend result of alcoholic liver disease
Liver
Cirrhosis
Post-hepatic cirrhosis caused by chronic HBV or HCV, autoimmune
hepatitis, or nonalcoholic fatty liver disease
Biliary cirrhosis caused by obstructed bile flow damaging and
destroying liver cells
Liver
Cancer of the Liver
Related to alcoholic cirrhosis, HBV, or HCV
Hepatocellular carcinoma arises from livers parenchymal cells
Cholangiocarcinoma forms in the bile ducts
Liver Trauma
Can cause surface hematoma, hematoma within liver parenchyma,
laceration of tissue, or disruption of vessels
Liver
Pancreatitis (inflammation of the pancreas)
Release of pancreatic enzymes into pancreatic tissue, causing
hemorrhage and necrosis
Acute (reversible): self-destruction of the pancreas through
autoingestion
Chronic (irreversible): inflammation, fibrosis, and gradual
destruction of tissue
Pancreas
Pancreatic cancer
Adenocarcinoma
Usually shows few symptoms until advanced
Fatal within 13 years after diagnosis
Learning Outcome 2
Use knowledge of normal anatomy and physiology to understand the
manifestations and effects of biliary, hepatic, and pancreatic disorders.
Gallbladder
100
Stores and secretes bile

Aids in digestion of fats and lipids
Obstruction
Inflammation
Increases risk of cholelithiasis
Liver
Essential functions
Hepatocellular failure
Impaired function of cells
Affects all metabolism
Reduces bile production
Jaundice
Yellow staining of tissues
Bilirubin accumulation in tissues
Liver
Portal Hypertension
Increased pressure in the portal system
When prolonged, can cause esophageal varices, splenomegaly,
ascites, portal systemic encephalopathy, and hepatorenal
syndrome
Pancreas
Secretes digestive enzymes
Inflammation (pancreatitis)
Causes self-destruction through autodigestion
Can lead to edema and necrosis
Can also be caused by a gallstone lodged in sphincter of Oddi
Learning Outcome 3
Relate changes in normal assessment data to the pathophysiology and
manifestations of gall-bladder, liver, and exocrine pancreatic disorders.
Gallbladder Diagnostic Tests
Serum bilirubin
Complete blood count (CBC)
Serum amylase and lipase
Ultrasonography
Abdominal x-ray
Gallbladder scan
Liver Diagnostic Tests
Hepatitis
Cirrhosis
Exocrine Pancreas Diagnostic Tests
Ultrasonography
Endoscopic ultrasonography
Contrast-enhanced CT Scan
MRCP
ERCP
101
Percutaneous fine-needle aspiration biopsy

WEEK 15
ALTERATIONS IN THE NEED FOR ELIMINATION
LOWER GASTROINTESTINAL SYSTEM
Learning Outcomes
Compare & contrast the causes, pathophysiology, and manifestations,

interdisciplinary and nursing care of patients with disorders of bowel
motility.
Explain the pathophysiology, manifestations, complications,
interdisciplinary care and nursing care of patients with acute or chronic
inflammatory bowel; disorders, neoplastic disorders and structural and
obstructive bowel disorders.
Discuss the purpose, nursing implications and health education for the
patient and family related to medications used to treat bowel disorders
Explain the rationale for using selected diets, including those for diarrhea
and constipation and low residue, gluten free and high fiber diets.
Describe selected surgical procedures of the bowel including colectomy,
colostomy, ileostomy and peri-anal surgery.
Learning activities
Read and study
Grodner et al, pp. 511
Lehne (Chapter 77-81) pp 915-969
Ignatavicius (Chapter 55-58, 63) pp 1216-1288,1386-1411
Learning Outcome 1
Compare and contrast the causes, pathophysiology, manifestations, and
interdisciplinary and nursing care of patients with disorders of bowel motility.
Diarrhea
Increase in the frequency, volume, and fluid content of the stool
Manifestations
Constipation
Infrequent or difficult passage of stools
Manifestations
102
Irritable Bowel Syndrome (IBS)
Chronic disorder with no identifiable organic cause
Manifestations
Fecal Incontinence
Loss of voluntary control of defecation
Manifestations
Learning Outcome 2
Explain the pathophysiology, manifestations, complications, and interdisciplinary
and nursing care of patients with acute or chronic inflammatory bowel disorders,
neoplastic disorders, and structural and obstructive bowel disorders.
Acute Inflammatory Disorders: Appendicitis
Inflammation of the vermiform appendix
Pathophysiology
Manifestations
Complications
Acute Inflammatory Disorders: Peritonitis
Inflammation of the peritoneum
Pathophysiology
Manifestations
Complications
Acute Inflammatory Disorders: Gastroenteritis
Inflammation of the stomach and small intestine
Pathophysiology
Manifestations
Complications
Nursing diagnoses
Acute Inflammatory Disorders:
Giardiasis (protozoa)
Amebiasis (amebic dysentery)
Helminths (parasitic worms)
Nursing diagnoses
Chronic Inflammatory Disorders: Inflammatory Bowel Disease
Ulcerative colitis
103
Crohns disease (regional enteritis)

Nursing diagnoses
Chronic Inflammatory Disorders: Diverticular Disease
Small outpouchings of the colon that occur in rows
Pathophysiology
Manifestations
Chronic Inflammatory Disorders: Diverticular Disease
Complications:
Peritonitis, abscess formation, bowel obstruction, fistula formation,
and hemorrhage
Nursing diagnoses
Neoplastic Disorders: Polyps
Masses of tissue that arise from the bowel wall and protrude into the
lumen
Pathophysiology
Manifestations
Nursing diagnoses
Neoplastic Disorders:
Colorectal Cancer
Third most common diagnosed cancer in the U.S.
Risk factors include:
Age over 50
Diet
Polyps in the colon
Genetics
Neoplastic Disorders:
Colorectal Cancer
Pathophysiology
Manifestations
Complications
Nursing diagnoses
Structural and Obstructive Disorders: Hernia
Abdominal wall defect that allows abdominal contents to protrude out of
the abdominal cavity
Pathophysiology
Manifestations
Complications
Nursing diagnoses
Structural and Obstructive Disorders: Intestinal Obstruction
Failure of intestinal contents to move through the bowel lumen
104
Pathophysiology
Manifestations
Small bowel: cramping or colicky abdominal pain, vomiting, and
signs of fluid and electrolyte imbalance.
Large bowel: constipation and colicky abdominal pain
Complications
Small bowel:
Hypovolemia and hypovolemic shock, renal insufficiency,
and pulmonary ventilation can be impaired
Large bowel:
Gangrene, perforation and peritonitis, atelectasis with
impaired diaphragm function, and impaired venous return
with pressure on the inferior vena cava
Nursing diagnoses
Learning Outcome 3
Discuss the purposes, nursing implications, and health education for the
patient and family related to medications used to treat bowel disorders.
Antidiarrheal Medications
Kaopectate, Donnagel, Pepto-Bismol
Purpose:
Absorbents
Protectants
Antisecretory
Nursing responsibilities
Administer 1 hour before or 2 hours after other oral medications
Assess for potential contraindications and observe patient's
response
Other precautions needed if administering opiates
Patient and family teaching
Take recommended dosage
Contact physician if diarrhea persists for more than 2 days
Avoid taking aspirin
If using opiates, avoid alcohol and OTC cold preparations
Laxatives and Cathartics
Citrucel, Colace, Lactulose, Dulcolax, Mineral oil
Purpose:
Promote stool evacuation
Bulk-forming agents, wetting agents, osmotic and saline
laxatives/cathartics, stimulant laxatives, lubricants
105
Teach constipation prevention through diet and lifestyle

modifications
Assess for contraindications
Administer with fluids
Drink at least 68 glasses of fluid daily
Agents may be mixed with fruit juice, water, or milk
Do not take at bedtime
Antiprotozoal Agents
Yodoxin, Humatin, Flagyl, Albenza
Purpose:
Local and systemic anti-parasitic medications
Administer as ordered
Observe for adverse side effects
Monitor stools
Antiprotozoal Agents
Take as prescribed, for full course
Take with food
Report adverse effects
Practice good hygiene to prevent spread
Inflammatory Bowel Disease
Assess baseline vital signs, weight, and renal function values
Administer as ordered
Have resuscitation equipment available
Monitor for desired and adverse effects
Inflammatory Bowel Disease
When and how to administer
Drink at least 2 quarts of liquid/day
Avoid aspirin and vitamin C
Report any adverse side effects
Learning Outcome 4
Explain the rationale for using selected diets, including those for diarrhea and
constipation, low-residue, gluten-free, and highfiber diets.
Diarrhea
Water and electrolytes are lost in diarrheal stool, leading to dehydration
Fluid replacement and bowel rest are primary concerns
Constipation
High-fiber diet to bulk up the stool mass and draw water into fecal mass
Raw fruits and veggies
106
Cereal bran
Drink 68 ounces of fluid daily
Reduce intake of refined foods and meats
Low-Residue Diet
Recommended for patients with ileostomies to avoid food blockage
High-fiber foods and foods that could cause blockage are limited
Symptoms of food blockage
Abdominal cramping, swelling of the stoma, and absence of
ileostomy output for over 46 hours
Gluten-Free Diet
Recommended for patients with celiac disease
Impaired absorption of fats and sensitivity to gluten
Gluten
Wheat, rye, barley, and oats
Prescribed diet is high in calories and protein to correct nutrient deficits
Gluten-Free Diet
High-fiber diet
Can benefit complications of diverticulosis
Includes foods from the cereal, fruit, and vegetable groups
Patients are advised to avoid foods with small seeds
Learning Outcome 5
Describe selected surgical procedures of the bowel, including colectomy,
colostomy, ileostomy, and perianal surgery.
Colectomy
Surgical resection and removal of the colon
Total colectomy with an ileal pouchanal anastomosis (IPAA)
Temporary or loop ileostomy performed at same time
Ostomy made in the colon, usually after surgical resection of the bowel
Indications
Take the name of the portion of colon from which they are formed
Ileostomy
An intestinal ostomy made in the ileum of the small intestine
Total proctocolectomy with permanent ileostomy
Temporary or loop ileostomy
Continent ileostomy
Perianal Surgery
Hemorrhoidectomy
Sphincterotomy
Check patient closely for bleeding
Pain is primary postoperative nursing consideration
Prescribe systemic analgesics and sitz baths
107

NURSING DEPARMTENT
Nursing II
NRS 108

NURSING DEPARTMENT
NRS 111
STUDY GUIDE
WEEK 1
108
INTRODUCTION TO NURSING II
D. Development During the Middle Years
E. Teaching Learning Principles
F. Culture and Ethnicity
4. Identify developmental parameters as they apply to the assessment of basic
human needs in the middle years.
5. Discuss patient education as an essential component of nursing care directed
toward promotion, maintenance, and restoration of health.
6. Apply various concepts of culture and ethnicity to health care.
UNIT 1A
DEVELOPMENTAL CONCEPTS OF THE ADULT LIFE CYCLE: MIDDLEAGED ADULT
Study Questions/Objectives
2. Identify normal physiological changes that occur in the middle-aged adult.
3. Explain psychosocial and emotional changes which occur in the middle-aged.
4. Explain health concerns & risks that occur during middle age.
5. Explain the risk factors for depression in the middle years.
6. Apply the nursing process when caring for the middle-aged adult.
109
Read & Study
Lemone (Chapter 1-2) pp. 4-35.
Kozier/Erb (Chapter 22-23) pp.393-425
1. Physical Changes
2. Psychosocial-emotional processes
3. Health concerns of middle age
4. Depression in Middle years
5. Nursing process
6.1 Assessment
6.2 Nursing diagnosis
6.3 Planning
6.4 Implementation
6.4.1 Client teaching
6.4.2 Changing health habits
6.4.3 Health promotion
6.4.4 Stress reduction
6.5 Evaluation
UNIT- 1B
110
PATIENT EDUCATIONAL/HEALTH TEACHING

6. Identify client education standards.
7. Describe the purpose & significance of health.
8. Define teaching & learning.
9. Explain the behaviors needed for cognitive affective and psychomotor
learning.
10. Describe the basic learning principles:
10.1
Motivation to learn
10.2
Ability to learn
10.3
Learning environment
11. Demonstrate ability to assess clients learning needs, motivation & ability to
learn, teaching environment and resources for learning.
12. Develop a teaching plan.
13. Relate the importance of speaking the clients language and using teaching
tools in learning process.
14. Describe methods of evaluating and documenting learning.
Read & Study
Lemone (Chapter 1-2) pp. 4-35.
Kozier/Erb (Chapter 27) pp.486-509
Classroom discussion
111
2. Standards for the client
3. Purpose for health education
4. The nature of teaching and learning
4. Domains of learning
4.1 Cognitive learning
4.2 Affective learning
4.3 Psychomotor learning
5. Basic learning principles
7. Integrating the nursing & teaching processes
8. Special needs of children and older adults
112
UNIT 1C
CULTURE AND ETHNICITY
6. Identify factors which contribute to heritage consistency and inconsistency.
7. Define culture, cultural competence, cultural awareness, ethnocentrism, and
transcultural nursing.
8. Describe the major components of a cultural assessment.
9. Identify traditional health and illness beliefs of Native Indians, Asian, African
Hispanic and European Americans.
10. Explain how the nurse can incorporate cultural sensitivity into nursing care
and into the working environment.
Read & Study:
Kozier/ Erb (Chapter 18) pp.312-328
Ignatavicius (Chapter 4) pp. 27-34
2. Culture, cultural competence, and cultural Awareness
3. Culture Assessment
3.1 Cultural heritage
3.2 Biocultural history
3.3 Social organization
3.4 Religious and Spiritual beliefs
3.5 Communication
3.6 Time orientation Space
3.7 Cultural belief practices
3.8 Prior experience with health providers
4. Health & Illness beliefs
4.1 Asian American
4.1 African American
4.2 Native American
4.3 Spanish Americans
4.4 European American
5. Giving nursing care to those who are culturally different.
5.1 Working with those who are culturally different
113
ALTERATION IN THE NEED FOR BACTERIOLOGIC SAFETY:

WEEK 2
THE PERIOPERATIVE EXPERIENCE
Upon completion of this unit, the student will:
1. Describe the perioperative period including its three phases: preoperative,
intraoperative and postoperative.
2. List and contrast the three general categories under which surgical
procedures are grouped and differentiate between major and minor surgery.
3. Define the purpose of different types of surgical procedures.
4. Specify the causes of pre-anxiety and nursing measures that allay anxiety.
5. Explain different types of admission.
6. Describe comprehensive pre-operative nursing assessment as a means of
identifying surgical risk factors.
7. Describe preoperative nursing inventions used for the surgical client.
7.1 Describe nursing responsibilities related to informed consent and
operative permit.
7.2 Explain how the client and family are physically prepared for surgery
9. Explain the major roles and responsibilities of the surgical team.
10. Describe the ways in which aseptic technique is maintained during the
intraoperative period.
11. Compare various types of anesthesia with regard to use, advantages,
disadvantages and nursing responsibilities.
11. Describe intraoperative complications.
12. Utilize the nursing process as a framework for managing care during the
intraoperative period.
13. Describe the immediate post-anesthesia phase.
14. Describe the components of the postoperative assessment and deviations
from normal.
114
15. List possible nursing diagnoses and expected outcomes of postoperative

care.
16. Explain nursing interventions of postoperative care that enhance normal
physiologic function and prevent postoperative complications.
17. Describe the nurses role in discharge planning and teaching.
Read & Study
Lemone (Chapter 4) pp. 53-85
Lehne Chapter 26-28) pp. 245-286
Ignatavicius (Chapter 16, 17, 18, 24) pp. 242-301, 440-459
Interactive Video: Nursing Decisions:
A Postoperative Patient
Case Studies
1.
The perioperative Period

1.1 Pre-operative
1.2 Intra-operative
1.3 Post-operative
2.
Preoperative Nursing Assessment

2.1 Surgical settings
2.2 History
2.3 Review of systems
2.4 Psychosocial /Anxiety
3.
Preoperative Nursing Interventions

3.1 Informed consent: Operative permit
3.2 Purpose and principles of preoperative teaching
4.
Necessary information for pre-operative teaching and pre-operative care

4.1 Pain Control
4.2 Nutrition and hydration
4.3 Deep breathing/coughing
4.4 Leg exercises/early ambulation
4.5 Bowel preparation
4.6 Skin preparation
4.7 Promoting sleep and rest
5.
Preoperative Physical Preparation
115
5.1 Diet
5.2 Skin preparation
5.3 Bowel preparation
5.4 Medications
5.5 Family
5.6 Preoperative Checklist
6.
The holding area and operating room/suite

6.1 Surgical team
6.2 Patient assessment before surgery
6.3 Aseptic technique maintenance
7.
Balanced Anesthesia
7.1 Conscious sedation
7.2 General and Local anesthesia
7.3 Adjuncts to general anesthesia
8.
Complications of the intraoperative period

8.1 Malignant hyperthermia
8.2 Hemorrhage
8.3 Cardiac arrhythmias and diminished circulation.
8.4 Respiratory depression
8.5 Overdose
8.6 Anaphylactic reactions
9.
Post anesthesia phase
10. Immediate postoperative assessment

10.1 Internal hemorrhage/shock
10.2 Respiratory status
10.3 Cardiovascular status
10.4 Level of consciousness
10.5 Skin
10.6 Dressing and incision
10.7 Intake and output
10.8 Discharge from PACU
12. Nursing Diagnoses & expected outcomes
116
12. Postoperative Care on unit

12.1 Pain Management
12.2 Wound care/drains
12.3 Fluid/electrolyte problems
12.4 Pulmonary problems
12.5 Cardiovascular problems
12.6 Gastrointestinal problems
12.7 Incision problems
13. Evaluation and documentation
14. Discharge planning and teaching
WEEK 3
117
ALTERATIONS IN THE NEED FOR REGULATION:

CARE OF THE CLIENT WITH AIDS
1. Review assessment of the Immune system.
2. Describe the pathophysiology and clinical manifestations of HIV/AIDS.
3. Define what is meant by an opportunistic infection and give examples.
4. Identify the risk factors which are associated with HIV/AIDS.
5. Describe the medical approach for the treatment of HIV and opportunistic
infections.
6. Identify appropriate nursing interventions for specific problems encountered in
clients who have AIDS.
7. Apply specific precautions when caring for clients with HIV/AIDS.
8. Describe the social and psychological issues which are associated with
HIV/AIDS.
Read & Study
Lemone (Chapter 13) pp. 324-340, 307-308
Lehne, (Chapter93) pp. 1087-1132
Ignatavicius Chapter 19, 21) pp 306-321, 362-386
CAI: Male with AIDS/ Female with AIDS (computer lab)
1. Assessment of the Immune system
2. AIDS/HIV
2.1 Pathophysiology
2.2 Clinical Manifestations
3. Opportunistic Infections
4. Common risk factors
6. Collaborative Care Management
118
6. Nursing Management
6.1 Assessment/Diagnosis
6.2 Planning Care
6.3 Intervention
6.4 Evaluation
7. Protective Technique
8. Social and Psychological Issues
WEEK 3 & 4
ALTERATIONS IN THE NEED FOR REGULATION: CANCER
119
1. Discuss the concept of cancer nursing in regards to the scope of the cancer
problem in the U.S. today.
2. Describe the etiologic agents that have been identified as carcinogens.
3. Explain the theories that are believed to cause cancer.
4. Relate the structure and function of the normal cell to the changes that occur
with a cancer cell.
5. Differentiate benign and malignant masses.
6. Describe the clinical manifestations of cancer.
7. Explain the factors which contribute the risk of cancer.
8. Relate risk factors and means of prevention according to cancer type, and the
nurses role for each type.
9. Describe the diagnostic tests indicated for detection of cancer.
10. Explain the various ways surgery is used for the prevention, diagnosis and
treatment of cancer.
11. Explain the therapeutic effects, indications and side effects of radiation
therapy.
12. Apply the nursing process to clients who undergo radiation.
13. Explain the principles and various aspects of chemotherapy.
14. Describe the nursing management of the patient receiving chemotherapy.
15. Explain other modalities that are used in cancer treatment.
16. Describe the Pathophysiology of oncology emergencies.
17. Identify the resources for cancer education, detection and rehabilitation.
120
Week 3 &4 (contd)

Learning Activities
Read & Study
Lemone (Chapter 14)-pp. 341-386
Porth (Chapter 7) pp.131-158
Lehne, Chapter 100-102 pp 1167-1216
CAI: Chemotherapy I & II
Case Studies
1. Nature of the problem and epidemiology
2. Etiology
2.1 Factors affecting growth
2.2 Host susceptibility
3. Pathophysiology of carcinogenesis
3.1 Abnormal structure or growth of cells
3.2 Viral theory
4. Normal versus cancer cell
4.1 Characteristics of normal cells
4.2 Pathophysiology of cancer cells
4.2.1 Appearance
4.2.2 Growth
4.2.3 Function
4.3 Pathophysiology of malignant tumors
4.3.1 Major characteristics
4.3.2 Grading, classification, staging
5. Major differences between benign and malignant masses
6. Clinical manifestations
6.1 Local effects
6.2 Systemic effects
6.3 Metastasis
7. Cancer prevention
8. Nurses role in early detection of common cancers.
8.1 Screening recommendations
8.2 Cancer detection
9. Laboratory and Radiological Tests
121
10. Surgery
10.1 Prevention
10.2 Diagnosis
10.3 Treatment
10.4 Nursing Management
11. Oncologic emergencies
11.1 obstructive
11.2 metabolic
11.3 cardiac
12. Cancer treatment
12.1 Radiation
12.1.1 principles
12.1.2 indications
12.1.3 method
12.1.4 external radiotherapy
12.2.5 internal radiation
12.1.6 sealed/unsealed internal
12.1.7 hazards to personnel
12.2.8 side effects
13. Chemotherapy
13.1 principles
13.2 cell-population growths
13.3 combination chemotherapy
13.4 cell-kill hypothesis
13.5 tumor resistance
13.6 hazards to healthcare professionals
13.8 classifications
13.9 side effects
13.10 guidelines for care
13.11 methods of administration
14. Immunotherapy
15. Resources for cancer education, detection, and rehabilitation
15.1 Federal organizations
15.2 American Cancer Society
15.3 Internet addresses
122
WEEK 4
ALTERATIONS IN THE NEED FOR REGULATION: HEMATOLOGIC
PROBLEMS
OBJECTIVES: Upon completion of this unit the student will:
9. Review the components of the Hematopoetic System.
10. Explain assessment parameters that relate to common problems of the
Hematopoetic System.
11. Describe the relevance of diagnostic studies pertinent to hematological
disorders.
12. Describe erythrocyte disorders in relation to etiology, prevention,
Pathophysiology,
Clinical manifestations, diagnostic studies, treatment, complications,
prognosis, nursing management, discharge planning, and desired outcomes.
13. Describe bleeding disorders in relation to etiology, Pathophysiology, clinical
manifestations, diagnostic studies, treatment, and nursing management.
14. Describes disorders associated with WBCs in relation to etiology,
Pathophysiology, prevention clinical manifestations, complication, treatment
15. Apply the Nursing Process to a patient with leukemia.
16. Describe disorders associated with the Lymph System in relation to etiology,
pathophysiology, clinical manifestations, diagnostic studies, staging,
prognosis, nursing management.
Learning Activities
Read & Study
Lehne (Chapter 51, 54-55) pp.594-618, 625-646
123
1. Hematopoetic System
1.1 Plasma
1.2 Hematopoiesis
1.3 Erythrocytes
1.4 Leukocytes
1.5 Platelets
1.6 Spleen
1.7 Liver
1.8 Bone Marrow
1.9 Clotting Cascade
2. Assessment
2.1 History
2.3 Physical examination
2.4 Psychosocial
3. Diagnostic studies
3.1 Complete blood count
RBC count
RBC Indices
Hematocrit
Hemoglobin
MCH, MCHC, MCV
Reticulocyte Count
Leukocyte Count (WBC)
Differential
3.2 Sedimentation Rate (ESR)
Partial Thromboplastin Time (PTT)
Prothrombin Time (PT)
International Normalized Ratio (INR)
Platelet Count
3.3 Fibrin split products
3.4 Coagulation factor assay
3.5 Shillings test
3.6 Iron studies
3.7 Hemoglobin electrophoresis
3.8 Plasma Proteins
3.9 Lymphangiography
3.10 Bone Marrow aspiration
124
Lecture/Discussion Topic cont.

4. Disorders Associated with Erythrocytes
4.1Anemias
4.1.1 Sickle cell Anemia
4.1.2 Megaloblastic/Macrocytic Anemia
4.1.3 Pernicious Anemia
4.1.4 Aplastic Anemia
4.1.5 Hemolytic Anemia
4.1.6 Iron deficiency
4.1.7 Polycythemia Vera
5. Disorders Associated with White blood cells
5.1 Leukemia
5.1.1 Acute myelogenous leukemia
5.1.2 Acute lymphocytic leukemia
5.1.3 Chronic myelogenous leukemia
5.1.4 Chronic lymphocytic leukemia
5.1.5 Bone Marrow Transplantation
6. Lymphomas
6.1
Hodgkin's Disease
6.2
Non-Hodgkins disease
7. Disorders of bleeding
7.1
Thrombocytopenia
7.2
Thrombotic Thrombocytopenic Purpura
WEEK 6 &7
125
ALTERATIONS IN THE NEED FOR OXYGEN: RESPIRATORY

1. Review respiration and ventilation and the relationship of pulmonary
circulation to these processes.
2. Describe various assessment parameters specific to determine major vs.
minor respiratory alterations.
3. Describe the use for and the nursing implications of the various procedures
used for diagnostic assessment of respiratory function.
4. Compare the upper respiratory infections with regard to cause, incidence
clinical findings, nursing management, pathophysiology and treatment.
5. Explain the etiology, epidemiology, prevention, pathophysiology,
clinical findings, diagnostic studies, complications, medical and
nursing management of lower airway and pulmonary vessel disorders.
6. Explain the etiology, epidemiology, prevention, pathophysiology, clinical
findings, complications, medical & nursing management of lower respiratory
infections.
7. Describe the etiology, epidemiology, pathophysiology, prevention, medicalsurgical and nursing management of lung cancer.
Read and Study:
Lemone (Chapters 34-37) pp. 1122-1285)
Lehne (chapter 75, 76, 69) pp. 888 - 912, pp 821-820
EDGT-Respiratory Assessment
Ignatavicius (Chapter 29, 31-34) pp. 552-570, 590-701
126
Lecture/Discussion Topic:
1. Physiological Overview:
1.1 Mechanics of ventilation
1.2 Pulmonary circulation
2. Assessment of respiratory tract
2.1 History & chief complaint
2.2 Review of Systems
2.3 Physical Examination
2.3.1 General inspection
2.3.2 Palpation
2.3.3 Percussion
2.3.4 Auscultation
8. Diagnostic assessment of respiratory function:
3.1Radiologic examination
3.1.1 standard chest x-ray
3.1.2 computed tomography (CT)
3.1.3 ventilation and perfusion scanning (V/Q scan)
3.2 pulse oximetry
3.3 pulmonary function tests
3.4 skin tests
3.5sputum tests
3.6 thoracentesis
3.7 long biopsy
4.
Upper respiratory disorders/infections:

4.1 Epitaxsis
4.2 Rhinitis
4.3 Sinusitis
4.4 Pharyngitis
4.4.1 Viral
4. 4. 2 Bacterial/Streptococcal
4.5 Influenza
5.
Lower Airway & Pulmonary Vessel Disorders

5.1 Bronchitis
5.2 Pneumonia
5.3 Tuberculosis
5.4 Bronchiectasis
6. Malignant lung tumors

7. Lower airway & Pulmonary Vessel Disorders
127
7.1 Asthma
7.2 COPD
7.3 Emphysema
7.4 Chronic Bronchitis
7.5 Pulmonary Embolism
7.6 Pulmonary hypertension
WEEK 8, & 9
ALTERATIONS IN THE NEED FOR OXYGEN, CARDIOVASCULAR
1. Review cardiac anatomy, physiology and the normal conductions system of
the heart.
2. Incorporate assessment of cardiac risk factors into the nursing history and
physical assessment of the cardiac patient.
3. Identify the clinical significance and nursing management of various tests and
procedures used for diagnosing cardiac disease
4. Describe the relationship between the cardiac diseases of coronary
atherosclerosis, angina pectoris and myocardial infarction in the terms
etiology, pathophysiology, clinical findings, diagnostic studies, treatment and
complications.
1.1 Describe medical management and nursing process related to prevention
and rehabilitation of coronary atherosclerosis, angina and myocardial
infarction.
5. Compare inflammatory diseases of the heart in relation to cause, prevention,
pathophysiology, clinical findings, diagnostics, complications, prognosis,
medical nursing management.
6. Compare the valvular diseases of the heart in regard to etiology, prevention,
pathophysiology, diagnostics, clinical findings, medical-surgical management.
7. Compare the various surgical procedures available for cardiac disease.
8.
Define heart failure

8.1 Explain the cause, pathophysiology, prevention, diagnostic tests,
complications, prognosis, medical management, and nursing process of
congestive heart failure.
128
8.2 Describe how compensatory mechanisms functions in heart failure to

increase cardiac output.
8.3 Compare and contrast the clinical findings for a patient with right-sided
heart failure & left sided heart failure.
8.4 Relate pulmonary edema as a complication of heart failure.
8.5 Describe the nursing management of a patient with congestive heart
failure and pulmonary edema.
9.
Review the anatomy and physiology of the body's vascular system.
10. Explain the etiology, prevention, pathophysiology, clinical findings,

diagnostics, treatment, complications, prognosis, nursing management and
desired outcomes of arterial and venous diseases and Hypertension.
Learning Activities;
Read and Study:
Lemone (Chapter 29-32; pp. 870- 1066)
Lehne, (chapter 40-50
pp 443-454 (diuretics)
466-479 (RAA drugs)
480-487 (Ca CH Blockers)
488-493 (Vasodilators)
494-4515 (HTN drugs)
516- 531(heart failure)
533-552 (antidysrhythmics)
553-579 (anti-lipids)
580- 593 (Anti-anginal)
Ignatavicius (Chapter 35-40) pp. 704-876
Interactive Video: Care of the elderly cardiac patient
CAI: An Adult in Cardiovascular Crisis.
EDGT- Cardiac Assessment
1. Self-review of cardiac anatomy and physiology
1.1 Normal Deviations associated with Aging
2. Cardiac assessment
2.1 Nursing history
2.1.1 Chief complaint
2.2 Past medical history
3. Diagnostics
3.1 Lab tests
3.1.1 Cardiac Enzymes
3.1.2 Chemistry, serum
129
3.2 x-ray/fluoroscopy
3.3 Stress test-holter monitoring
3.4 EPS
3.5 Transesophageal Echocardiography (TEE)
3.6 Scintigraphic studies
3.7 Hemodynamic studies
3.7.1 Central venous pressure
3.7.2 Pulmonary artery pressure
3.7.3 Cardiac output & cardiac index
3.8 Cardiac catheterization
3.10 Angiocardiography
4.
Inflammatory heart diseases

4.1 Rheumatic heart disease
4.2 Myocarditis
4.3 Pericarditis
4.4 Endocaditis
4.5 Cardiomyopathy
5Acquired valvular diseases of the heart

5.1 Mitral, Aortic, Tricuspid, Pulmonic
5.1.1 Pathophysiology
5.1.2 Prevention
5.1.3 Clinical Findings
5.1.4 Diagnostics
5.1.5 Medical management
5.1.6 Surgical management
5.1.7 Complications
5.1.8 Nursing Process
5.1.9 Discharge planning
6. Coronary artery disease/Angina Pectoris/
Myocardial infarction
6.1
Pathophysiology
6.2
Risk factors
6.3
Clinical findings
6.4
Diagnostic studies
6.5
Medical management
6.6
Complications
6.7
Surgical management
6.8
Discharge planning and home care
6.9
Cardiac rehabilitation
7.
Cardiac Surgery
130
8. Heart failure defined

8.1 Classifications
8.2 Congestive heart failure
8.2.1 Cause
8.2.2 Preventive
8.2.4 Diagnostic studies
8.2.6 Complications
9.
10.
Pulmonary edema
9.1
Prognosis
9.2
Nursing Process
Vascular system anatomy, physiology self-review
10.1 Arterial Disorders
10.1.1
Arterial occlusive disease
10.1.2
Arterial thrombi
10.1.3
Aneurysms
10.1.4
Thromboantitis obliterans
10.1.5
Raynauds disease
10.1.6
Amputation
10.2 Venous Disorders
10.2.1
Superficial thrombophlebitis
10.2.2
Deep vein thrombosis
10.2.3
Varicose veins
11. Hypertension
11.1 Epidemiology
11.2 Pathophysiology
11.3 Prevention
11.4 Medical management
11.5 Complications
11.6 Hypertensive crisis
11.7 Nursing process
WEEK 11
ALTERATIONS IN THE NEED FOR REGULATION: ENDOCRINE

131
1. Review the functions of the hormones secreted by each of the endocrine

glands excluding the pituitary gland.
2. Describe areas that are significant when assessing the endocrine system.
3. Identify the significance and nursing implications of various diagnostic tests
used to determine the function of the endocrine glands.
4. Compare and contrast Hyperthyroidism/Hypothyroidism, Thyroid cancer,
Pheochromocytoma, Cushings Disease and Addisons Disease in relation to
pathophysiology, etiology clinical manifestations, prevention, medical surgical
Learning Activities
Read and Study
Lehne (Chapter56-59) pp 657 - 717
Porth (Chapter 31-32 pp 761-798
1. Endocrine Gland
1.1 Thyroid gland hormones and functions
1.2 Parathyroid gland hormones and functions
1.3 Adrenal glands
1.3.1 Hormones of cortex medulla
1.3.2 Function of adrenal hormones
1.4 Feedback control in hormone regulation
2. Assessment of the client with Endocrine disorders
2.1 Fluid and nutrition
2.2 Elimination
2.3 Energy level
2.4 Perception of bodily change
2.5 Reproductive and sexual function
2.6 Tolerance to stressors
2.7 Head-to-toe physical examination
3. Diagnostic Tests
3.1 Thyroid Function Tests
3.2 Parathyroid Function Tests
3.3 Adrenal Function Tests
4. Hyperthyroidism/.Hypothyroidism /Thyroid cancer
132
4.1 Etiology/Pathophysiology
4.2 Clinical Manifestations
4.3 Prevention
4.4 Diagnostic tests
4.5 Medical/Surgical management
4.6 Nursing management
4.7
5. Addisons Disease/ Cushings disease
5.2 Clinical manifestations
5.3 Diagnostic tests
5.4 Medical/surgical management
WEEK 12
ALTERATIONS IN NEED FOR REGULATION: DIABETES MELLITUS
OBJECTIVE: Upon completion of this unit, the student will:
1. Define diabetes mellitus
2. Identify the incidence, etiology and risk factors associated with diabetes
mellitus.
3. Differentiate between Type 1 and Type II diabetes.
4. Describe the pathophysiology of Type I and Type II diabetes.
5. Explain the clinical findings of Type I and Type II diabetes.
6. Explain the diagnostic studies and reference values used to ascertain
diabetes mellitus.
7. Describe the medical management and treatment of diabetes mellitus.
8. Describe the methods for maintaining blood and urine glucose and ketones.
9. Explain special consideration in managing older patients with diabetes
mellitus.
10. Explain special consideration in managing older patients with diabetes
mellitus.
133
11. Apply the nursing process to the care of the patient with diabetes mellitus.
Read and Study
Lehne (Chapter 56) pp 657-688
Ignatavicius (Chapter 67) pp 1465-1525
1. Diabetes Mellitus
1.1 Definition
2. Diabetes Mellitus
2.1 Incidence
2.2 Risk factors
2.3 Etiology
2.4 Prevention
3. Types
3.1 Type I Diabetes Mellitus
3.2 Type II Diabetes Mellitus
3.3 Secondary diabetes mellitus
4. Pathophysiology
4.1 Type 1
4.2 Type II
5. Clinical Findings:
5.1 Type I diabetes
5.2 Type II diabetes
6. Diagnostic studies
7. Medical management and treatment
7.1 Dietary modification
7.2 Exercise
7.3 Oral antidiabetic drugs
7.4 Insulin
8. Monitoring control
8.1 Blood glucose testing
8.2 Urine testing
8.3 Glycosylated hemoglobin (Hgb A1C)
134
9. Complications of diabetes mellitus

9.1 Hyperglycemia
9.2 Hyperosmolar nonketotic coma
9.3 Diabetes ketoacidosis
9.4 Hypoglycemia
9.5 Infections
9.6 Macrovascular disease
9.7 Microvascular disease
9.8 Diabetic nephropathy
9.9 Diabetic retinopathy
9.10 Cataracts
9.11 Diabetic neuropathy
9.12 Foot problems
10. The elderly diabetic
11. Nursing management
11.1 History
11.3 Patient education
135
WEEK 13 & 14
ALTERATIONS IN THE NEED FOR NUTRITION
UPPER GASTROINTESTINAL SYSTEM, LIVER & PANCREAS
OBJECTIVE: Upon completion of this unit, the student will
1. Review the anatomy and physiology related to ingestion, digestion and
absorption of food, gastric motility, secretions and elimination of waste.
2. Describe subjective and objective assessment parameters of clients with
gastrointestinal alterations.
3. Describe the patient teaching and follow-up care appropriate for patients
having diagnostic tests of gastrointestinal infections.
4. Compare and contrast and cause, pathophysiology, clinical manifestations and
treatment for selected mouth infections.
5. Explain the etiology, epidemiology, pathophysiology, prevention,
medical/surgical management, and nursing process related to clients with
cancer of the mouth.
problems of the esophagus.
7. Compare acute gastritis, chronic gastritis, stress and peptic ulcer, and GI
bleeding in relation to etiology, pathophysiology, medical/surgical and
nursing
management and complications.
cancer of the stomach.
9. Describe the etiology, pathophysiology, medical and nursing management for
obesity.
10. Explain the etiology, pathophysiology, medical and nursing management of
nausea
and vomiting.
11. Explain the management of patients with gastric surgery.
136
12. Compare and contrast therapeutic diet regimes specific to clients with
disorders of ingestion, digestion and absorption.
13. Review the anatomy and physiology of the hepatic system.
14. Describe assessment parameters when gathering subjective data from
clients with hepatic alterations.
15. Explain diagnostic evaluation for liver dysfunction in relation to
pathophysiology of the liver.
16. Compare and contrast selected liver disorders according to etiology,
epidemiology,
prevention, pathophysiology, diagnostic tests, clinical
manifestations, medical, surgical and nursing management, prognosis, and
complications.
16.1 Differentiate types of jaundice related to Liver disease
17. Compare and contrast the etiologic transmission characteristics of Hepatitis
A, B, C,
D, E, and toxic hepatitis.
18. Differentiate types of cirrhosis
18.1 Explain the relationship between normal liver function and altered
function associated with cirrhosis.
19. Differentiate types of jaundice as they relate to biliary disorders.
19.1 describe pertinent tests and nursing care for the client who has jaundice.
19.2 List guidelines for decreasing the risk of bleeding in clients with jaundice
and prolonged PT time.
20. Differentiate the biliary disorders of cholelithiasis, cholecystitis, and
choledochlithiasis according to etiology, pathophysiology, prevention, and
diagnostic tests, and clinical manifestations, medical, surgical and nursing
management.
21. Differentiate acute and chronic panceatitis and pancreatic cancer according
to
etiology, pathophysiology, prevention, clinical manifestations,
medical, surgical
and nursing management and complications.
Learning Activities
Read and study:
137
Lemone (Chapter 21, pp.560-587; Chapter 23, pp.612-651 ; Chapter 25,

pp. 722-764
Lehne (Chapter 77-81) pp 915-969
Ignatavicius (Chapter 55-58, 63) pp 1216-1288,1386-1411
Liver and Hepatic
NUTRITION AND DIET THERAPY ACTIVITIES

Develop a one day nutritional plan and answer the questions relating to the
disease mentioned.
1. Identify the basic principles of diet therapy for a client with esophageal
problems (6). Outline a diet that will exacerbate the symptom of esophageal
reflux in a client who has hiatus hernia. Revise the diet to reduce symptoms and
identify four activities to reduce gastric reflux.
2. What are the basic principles of a peptic ulcer diet? What the potential
deficiencies with this diet? (4) Identify the components of a therapeutic diet for a
client with diverticulitis.
3. Compare the diets for celiac disease and inflammatory bowel diseases. What
are the differences?
4. Identify the nutritional deficiencies in a client with celiac disease versus
inflammatory disease.
5. Write a one day meal plan for a 30 year old woman, 156cm (5ft., 6 in) tall, who
weighs 81 kg (180 lbs.) who has cholecystitis.
6. Identify a one day meal plan for a client with infectious hepatitis and compare it
to a client with cirrhosis of the liver, and another client with hepatic
encephalopathy.
Nutrition Study Questions
2. Be able to identify at least 5 foods in each food group:
g. Bread
h. Vegetable
i. Fruit
j. Diary
138
k. Protein
l. Fats
Saturated, Polyunsaturated, Monounsaturated
2. Know the functions of each Vitamin and the signs and
symptoms/complications of each deficiencies.
Vitamin A, D,E, K
Vitamin B1,
B6
B12
C
Folic Acid
3. Sources of Iron (5)
1. Gastrointestinal System
1.1 Anatomy
1.2 Digestion
1.3 Gastric motility and secretions
1.4 Regulatory substances and bacteria
1.5 Digestion and absorption
1.6 Peristalsis
1.7 Defecation
2. Assessment physical
2.1 Inspection
2.1.1 Lips and mouth
2.1.2 Gums
2.1.3 Teeth
2.1.4 Mouth
2.1.5 Salivary glands
2.1.6 Neck
2.1.7 Upper Abdomen
2.2 Auscultation
2.3 Percussion
2.4 Palpation
2.5 Patient/Family History
2.6 Diet and Nutrition
2.7 Abdominal pain
2.8 Fatigue and weakness
2.9 Elimination patterns
2.10 Indigestion
2.11 Flatus
2.12 Vomiting
139
2.13 Hematemesis
3. Diagnostic Evaluation
3.1 Laboratory tests
3.2 Stool examination
3.3 Upper GI series
3.4 Barium enema
3.5 Ultrasonography
3.6 Computed tomography
3.7 Radionuclide imaging
3.8 Cholecystography
3.9 Cholangiography
3.10 Esophageal function rests
3.11 Tests of gastric function
2.12 Biopsy
2.13 Endoscopy
3. Self-study: Mouth Infections
1.1 Aphthous stomatitis
1.2 Herpes Simplex virus
1.3 Vincents angina
1.4 Candidiasis
1.5 Parotitis
2. Cancer of the mouth
2.1 Etiology
2.2 Epidemiology
2.3 Pathophysiology
2.4 Prevention
2.5 Medical/Surgical management
2.6 Nursing process
2.7 Home care considerations
6. Problems of the Esophagus
6.1 Achalasia
6.2 Esophageal cancer
6.2 Gastroesophageal reflux
6.3 Hiatal hernia
6.3.1 Etiology
6.3.2 Epidemiology
6.3.4 Prevention
6.3.5 Medical/surgical management
6.3.6 Nursing process
140
6.3.7 Home care considerations

7. Clients with Gastric Disorders
1.1 Gastritis
1.2 Peptic Ulcer
1.3 Stress Ulcers
1.4 Gastrointestinal bleeding
7.3.1 Etiology
7.3.3 Prevention
7.3.4 Medical/surgical
1.3.5 Nursing process
8. Nausea and Vomiting
8.2 Assessment
8.3 Safety and comfort
8.4 Diet modifications
8.5 Medications
9. Cancer of the stomach
9.1 Etiology
9.2 Epidemiology
9.3 Pathophysiology
9.4 Prevention
9.6 Nursing process
10. Surgical treatment for obesity
10.1 Etiology
10.3 Medical management
11 Gastric surgical
11.1 Preoperative care
11.2 Postoperative care
11.2.1 Airway/ventilation
11.2.2 Nutrition
11.3 Managing complications
11.3.1 dumping syndrome
11.3.2 malabsorption
11.3.3 Vitamin B deficiency
141
12. Therapeutic Diets related to:

12.1 Problems of the lips, mouth, teeth, gums
12.2 Problems of esophagus
12.3 Gastritis
12.4 Ulcer
12.4.1 peptic
12.4.2 Duodenal
12.5 Morbid obesity (500 cal)
12.5.1 Commercial
12.5.2 Hospital prepared
12.6 Post gastrectomy
12.7 Hepatitis
12.8 Diarrhea
12.9 constipation
12.10 cirrhosis (Hepatic)
12.11 Pre-op
12.12 post op
12.13 dumping syndrome
13 Hepatobiliary system
13.1 Anatomy
13.2 Metabolic functions of the liver
13.3 Bile/Bile Salts/Bilirubin
13.4 Detoxification
13.5 Storage of minerals, vitamins
13.6 Blood reservoir
14 Assessment of Hepatic alterations:
Subjective data
14.1 comfort status
14.2 nutritional status
14.3 fluid and electrolyte status
14.4 elimination patterns
14.5 energy level
14.6 mental status
14.7 exposure to toxins
Objective data:
14.8 jaundice
14.9 portal hypertension
14.10 ascites
14.11 nutritional deficiency
14.12 hepatic coma
142
15 Hepatic Evaluation
15.1 Diagnostics
15 .1.1 Liver function tests
15.1.2 Radiological tests
15.1.3 Biopsy
15.1.4 Paracentesis
15.1.5 Peritoneal lavage
15.1.6 Endoscopy
16 Liver disorders
16.1 Liver tumor/cancer
16.1.1 Etiology
16.1.3 Diagnostic tests
16.1.4 Clinical manifestations
16.1.5 Medial management
16.1.7 Nursing management
17. Jaundice
17.1 Obstructive
17.2 Hepatocellular
17.3 Hemolytic
17.4 Toxic Hepatitis
17.5 Viral Hepatitis A, B, C, D
17.5.1 Life-threatening variants
17.5.3 clinical signs
17.5 Viral Hepatitis A, B, C, D (cont)
17.5.4 Prevention
17.5.5 Medical/Nursing management
17.5.6 Complications
17.6 Nursing care
17.7 Test to differentiate
17.8 Decrease risk of bleeding
18 Cirrhosis of the liver
18.1 Laennecs
18.2 Postnecrotic
18.3 Biliary
18.4 Cardiac
18.5 Nonspecific/metabolic
18.2 Altered function
18.3 Prevention
143
18.6 Medical/Nursing management

18.7 Complications/management
- portal hypertension
- ascites
- esophageal varices
- encephalopathy
- hepato-renal syndrome
19
Cholelithiasis/Cholecystitis/Choledocholithiasis
19.1 Etiology
19.3 Prevention
19.5 Treatment lithotripsy
19.8. Patient teaching
19.8 Discharge teaching
19.10 Pre and post-op nursing care
19.11 Laparoscopic cholecystectomy
20. Acute/Chronic Pancreatitis and cancer of the pancreas

20.1 Etiology
20.4 Prevention
WEEK 15
ALTERATIONS IN THE NEED FOR ELIMINATION
LOWER GASTROINTESTINAL SYSTEM
144
1. Explain the etiology, pathophysiology, medical and nursing management of

clients with flatulence, constipation, diarrhea and fecal incontinence.
2. Describe the disorders of the intestine that are characterized by infection and
inflammation according to etiology, pathophysiology, prevention, clinical
manifestations, medical, surgical and nursing management and
complications.
3. Explain Malabsorption, malnutrition and Protein-Calorie malnutrition in terms
etiology, pathophysiology, medical and nursing management.
4. Describe various types of intestinal obstruction according to their etiology,
and location.
5. Describe the etiology, pathophysiology, medical, surgical and nursing
management, complications, and home care consideration of intestinal
obstructions.
6. Explain the etiology, pathophysiology, clinical manifestations, diagnostics,
medical, surgical and nursing management of cancer of the colon and rectum.
7. Compare various anorectal disorders in regards to etiology, pathophysiology,
medical, surgical and nursing management.
Learning activities
Read and study
Lemone (Chapter 24, pp. 652-720
Lehne (Chapter 78-79, 80) pp. 929-961
145
1. Altered Elimination:
Flatulence, Diarrhea constipation, Incontinence
1.1 Etiology
1.2 Pathophysiology
1.3 Medical/Nursing management
2. Infection/Inflammation of the intestine.
2.1 Appendicitis
2.2 Peritonitis
2.2.1 Etiology
2.2.3 Prevention
2.2.4 Clinical manifestations
2.2.7 Nursing management
2.2.8 Complications
2.3 Diverticular disease/Diverticulitis
2.4 Parasitic infections
2.5 Irritable bowel syndrome
2.6 Crohns disease
2.7 Ulcerative Colitis
3. Malabsorption and malnutrition
Protein-calorie malnutrition
3.1 Etiology
3.2 Pathophysiology
3.3 Medical/Nursing management.
8. Intestinal Obstructions
8.1 Adhesions
8.2 Intussusception
8.3 Volvulus
8.4 Paralytic Illeus
8.5 Hernias
8.6 Tumors
8.7 Mesenteric vascular occlusion infarction
8.8 Pathophysiology
8.9 Prevention
4.10 Medical Surgical management
3.12Complications
146
3.13Home care considerations

4. Abdominal hernias
1.2 Medical/nursing management
2. Colorectal Cancer
2.1 Etiology/pathophysiology
2.3 Diagnostic evaluation
2.4.1 Colostomy
2.4.2 Radiation
2.4.3 Chemotherapy
2.5 Nursing process
2.5.1 Risk factors
2.5.2 Psychoemotional considerations
2.5.3 Pre-operative
2.5.4 Post-operative
2.5.5 Home management
3. Anorectal Disease
1.1 Hemorrhoids
1.2 Anal fissure, abscess, fistula
1.3 Bowel surgery
1.3.1 Preoperative care
1.3.2 Postoperative care
147

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NRS 111 Course Syllabus Summer 2013 Nursing

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ESSEX COUNTY COLLEGE

Revised APRIL, 2011

ESSEX COUNTY COLLEGE

CATALOG DESCRIPTION: Students render care to clients who have commonly

management and delegation while caring for an adult client.

ESSEX COUNTY COLLEGE

Any Current Nursing Drug Guide

Nursing and Allied Health Division

Professor Janet Czermak Russell

Class Meeting Times: Lecture: Tuesday 8:30 AM 11:50 pm

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prepared, the student will be counseled verbally and in writing. Persistent

ORIENTATION TO THE CLINICAL FACILITY

1. Attend Pre-conference and identify its purpose

clean utility room

LOCATE THE FOLLOWING ITEMS IN THE NURSES STATION

Locate suction equipment

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Guidelines for giving oral clinical report

Reason for admission

Surgery (This admission) Date ________Type______________# days post

ECGs: Yes_____ No______ Date last taken/

List Current Medications

Research the surgical procedure in a textbook or over

Write a pre-operative teaching plan that relates to and

observed. You can use the column format as is

Client will participate in

Throughout your observation of the client undergoing

List the nursing actions of the post anesthesia unit

List the postoperative nursing interventions that would

List 2 potential postoperative complication directly

Research from the literature, the discharge and home

Directions for writing the paper

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Perry & Potter Chapter 41 Fluid and Electrolytes

http://www.slideshare.net/specialclass/blood-transfusion- video slide presentation

Alteration in need for oxygen: Assessment of respiratory disorders

Different Venous Access Devices (VAD).

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B. Teaching Learning Principles

Define health, incorporating the health-illness continuum and the concept

Chapter 13 Young and Middle Adult

3. Health concerns of middle age

Principles of Teaching and Learning

Prior Assumptions and Prejudices

1.2 Nonverbal communication

Discuss the differences and similarities between outpatient and inpatient

Learning Activities: Read & Study

Determinants of Whether Surgery is Inpatient or Outpatient:

ALTERATIONS IN THE NEED FOR REGULATION:

Define cancer and differentiate benign from malignant neoplasms.

Validate cancer diagnosis

Discuss indications for and complications of bone marrow or stem cell

Bone marrow transplant

Relate anatomy, physiology, and pathophysiology and manifestations of

Respiratory Volume and Capacity

Endocrine, neuromuscular, cardiovascular, hematologic symptoms

Promoting comfort by medication administration, positioning, and

Maintaining nutritional status

Inflammation produces scarring.

Pulmonary Embolism (Thromboembolism)

Intravenous injection of air or other foreign substances

Pulmonary hygiene measures

Imbalanced Nutrition: Less than Body Requirements

Surgery (This admission) Date Type______# days post

ECGs: Yes_ No__ Date last taken/