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BERGEN COMMUNITY COLLEGE
THE SCHOOL OF HEALTH PROFESSIONS
DEPARTMENT OF NURSING
NUR 281
LEVEL II
ADULT HEALTH NURSING - A
COURSE OUTLINE
4 CREDITS
LECTURE: 4 HOURS PER WEEK
CLINICAL: 10 HOURS PER WEEK
CLINICAL CONFERENCE: 2 HOURS PER WEEK
Fall 2019/Spring 2020
2
TABLE OF CONTENTS
Course Description………………………………………………………………. .............. 4
Course Learning Outcomes ....................................................................................... 4
Required texts……………………………………………………………………………….5
Level Requirement .................................................................................................... 5
Course Requirements…………………………………………………………………. ...... 6
Resources ................................................................................................................. 7
NUR-281 Video List ……………………………………………………………………….8
Teaching/Learning Activities .................................................................................. 9-19
Tracheostomy Care with Suctioning …………………………………………………20-22
Process Recording Rubric………………………………………………………….……..23
Nursing Care Plan Rubric………………………………………………………………24-25
Clinical Evaluation tool…………………………………………………………………26-28
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ALL POLICIES AND COURSE REQUIREMENTS ARE SUBJECT TO REVISION ON A
SEMESTER BY SEMESTER BASIS. STUDENTS WILL BE NOTIFIED OF ANY
REVISION(S) AT THE BEGINNING OF THE SEMESTER IN WHICH THE POLICY OF
REQUIREMENTS IS/ARE TO BE IMPLEMENTED DURING THE FIRST MEETING OF THE
APPROPRIATE NURSING CLASS.
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NUR-281, Adult Health Nursing A
COURSE DESCRIPTION
NUR-281, Adult Health Nursing A is a second level course in the nursing sequence which focuses on the health
care of individuals and families who have needs related to fluid and electrolytes, oxygenation and circulation.
Students will use the nursing process in a variety of health care settings to assist individuals, families and groups
achieve optimum health. This course runs for half the semester concurrently with NUR-282.
PREREQUESITITES: NUR-181, NUR-182, NUR-183, WRT 101, BIO-109
CO-REQUSIITES: BIO-209, PSY-106, WRT 201, NUR 282
Lecture (4.00) Laboratory (Clinical Conference) (2.00), Clinical (10.00), 4 credits
NUR 281 STUDENT LEARNING OUTCOMES
1. Demonstrates critical thinking via the nursing process for individuals with deficits in Orems’s identified USCRs
of Air and Water.
2. Applies nursing care that reflects the developmental, socioeconomic, cultural and spiritual capabilities of
individuals.
3. Engages in therapeutic and professional communication techniques when interacting with individuals,
families, and other health team members.
4. Selects nursing activities that support personal, professional, and educational development.
5. Behaves in a professional, ethical, and legal manner effecting nursing practice in the current health care
environment.
6. Applies skills in nursing care through the use of a variety of technological resources.
7. Utilizes pharmacological concepts in the clinical and classroom setting to correctly calculate drug and
solution problems. Passes the Semester II, Pharmacological Math Computation Exam (PMCE) with a
score of 90% or higher.
8. Creates and implements a teaching plan which meets the educational needs of a client.
Means of Assessment
Students learning outcomes are assessed via unit exams, nursing care plans, a pharmacologic math computation
exam (PMCE), a process recording, skills validation, and clinical performance.
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Required texts:
All textbooks from previous courses: NUR 181, NUR 182, and NUR 183.
Brunner & Suddarth. Textbook of Medical-Surgical Nursing. Lippincott, 14th Edition.
2 (volume).
Recommended text:
Lutz & Przytalski. Nutrition and Diet Therapy. F.A. Davis, 4th Edition, 2006. ISBN: 13-978-0-8036-1336-2
SEMESTER
REQUIREMENT
Passing a Pharmacological Math Computation Exam (PMCE) with a score of 90% is a semester
requirement. The PMCE will be given in the first course of each level. If the student does not attain the
required 90% passing grade, he/she will be provided two retake opportunities within the confines of that
course. Failure to achieve and 90% in the PMCE will result in an "F" for the course in which the test
was administered. Calculators may be used at Level II.
Office of Special Services (OSS)
The Office of Specialized Services (OSS) seeks to provide students the opportunity to participate fully in the
College’s educational programs and benefit from all aspects of campus life through the use of reasonable and
appropriate accommodations and auxiliary services. Annual documentation of certification need must be
provided on the first day of class to lead faculty.
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COURSE REQUIREMENTS
1. Nursing Care Plan(s) Completion of two Nursing Care Plans. One
plan must address the USCR for water (cardiovascular). Another
addresses the USCR for air (respiratory).
Detailed teaching interventions
should be included. Please see NCP rubric.
2. Unit Tests
Cardiovascular, 50 questions
Arrythmias, shock, Fluid/Electrolytes, resp assess/diagnosis.
50 questions
Respiratory, 50 questions
All test answers must be placed on the exam card.
4. Patient teaching To be addressed in Nursing Care Plan.
5. One Satisfactory Process Recording Follow Process Recording Guide distributed in Level I.
See Process Recording Rubric.
6. CAI Viewing of CAI listings found in Teaching/Learning
Activities and text supplements.
7. Skills Validation Satisfactory trach skills validation performance. Absence from
Validation results in a clinical absence. At the discretion of the
faculty, students may be instructed to submit skill validation via
videos. All students are to wear their clinical uniforms for skill
validation.
8. Required classroom learning activities Classroom learning activities are designed to enhance student
understanding and comprehension. Completion and
comprehension of these activities are reflected in unit exams.
9. Passing Clinical Performance grade
& Adherence to Attendance Policy Clinical Evaluation tool located in syllabus
Policy
3. Pharmacological Math Review pharmacology/computation text purchased in NUR 182
Sample questions on Moodle.
Computation Exam (PMCE) A basic calculator is permitted.
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COURSE EVALUATION
Course grade will be determined by:
There will be 3-unit tests totaling 95% of the letter grade.
The average of the first NCP and the second NCP will equal 5% of the total letter grade
The student must achieve C+ (77.45) or greater to pass NUR 281.
Students are required to earn a ‘P’ or Pass on all sections of the clinical evaluation tool at the final
evaluation.
Clinical Grade: A failing Clinical grade will result in an "F" for the course.
Pass the Trach Skill Validation
Pass with 90% or greater the Pharmacology Math Computation Exam (PMCE)
Completion of all required classroom learning activities
A = 89.45 – 100
B+ = 85.45 – 89.44
B = 81.45 – 85.44
C+ = 77.45 – 81.44
C = 73.45 – 77.44
D = 69.45 – 73.44 F = 69.44 & below D.
Target for Success: At Risk students receiving 78% or less on unit exams are to complete a target for
success form found on Moodle and email back to course professors.
E. Exam reviews are announced and take place on the date and time as indicated by course faculty.
Students are expected to comply with the stated day and time of the exam review.
Additional learning resources available to supplement classroom lecture, reading, discussion and self-study.
I. The Point (Supplement to Brunner)
Activities: NCLEX practice, Watch and Learn Videos,
Journal Articles, Tutorials, Concepts in
Action/Animation, Practice and Learn
Cardiovascular: Chapters 25-31
Shock: Chapter 14
Fluid and Electrolytes: Chapter 13
Respiratory: Chapters 20-24
II. ATI (electronic text)
Video Case Studies
Acid Base Imbalance
Blood Administration
Fluid Volume
Meter Dose Inhaler
Oxygenation
8
Priority Setting
Skills Module
Airway management
Central Venous Access
Closed Chest Drainage
Blood Administration
Oxygen Therapy
Practice Exams
Fluid and Electrolyte Acid Base
Cardiovascular
Respiratory
Supplemental learning activities
Lecture Clinical Conference Discussion
Audio Visuals Case Studies (Classroom, CAI, On-line)
Clinical Practice: Assigned and Self-Directed Readings
Acute Care Power Point Presentations
Sub-Acute Care Facilities NCLEX Review Questions
Judy Miller Tapes The Point Tutorials
Computer Tutorials
Moodle
Simulation
ATI resources
Related Web Sources
1. www.bergen.edu
2. www.mayohealth.org for cardiac & respiratory resources
3. New Jersey State Nurse's Association: www.njsna.org (scholarship information)
4. American Heart Association: www.americanheart.org
5. American Lung Association: www.lungusa.org
6. American thoracic Society: www.thoracic.org
7. www.nursingcenter.com/library
8. http://thepoint.lww.com/student)
9. ATI programs and supplemental learning materials
10. NUR 281 Moodle Site
9
Theoretical Content Teaching/Learning Activities
CARDIAC DIAGNOSTICS
I. Lab tests
A. Cardiac enzymes
1. CK
2. MB fraction
3. Troponin levels
4. BNP
B. Cholesterol
1. HDL
2. LDL
C. Coagulation studies
1. PT
2. PTT
3. INR
D. Electrolytes
1. Potassium
2. Magnesium
E. CBC
1. Hgb
2. Hct
II. Cardiac function
A. EKG
B. Stress test
C. Holter monitor
D. Thallium/persantine/cardiolyte stress test
E. Calcium scoring
III. Cardiac ultrasound
A. Echocardiogram
B. Transesophogeal echocardiogram
Read: Brunner and ATI (Cardiac diagnostics)
Read: A&P text chapter on cardiovascular system
Read: Chapter in Physical Assessment Text on
Cardiac Assessment
Required coursework, handwritten, submitted
upon entry to class, located on Moodle:
Cardiovascular terminology.
IV. MUGA scan
V. Cardiac catheterization (femoral and radial)
A. Indications
B. Implementation of pre and post
procedure nursing agency
HYPERTENSION (USCR: Water)
I. Regulation of Blood pressure
A. Cardiac output
B. Systemic vascular resistance
Review: Basic Concepts and Skills
Nursing "Blood Pressure Measurement"
Read: Brunner and ATI (Hypertension)
II. Systemic influences on Blood Pressure
A. Sympathetic nervous system
B. Renal system
C. Endocrine system
Read: Nutrition text, chapters on low fat & sodium
controlled diet
Read: Pharmacology text chapters on diuretics,
antihypertensives, beta blockers & calcium
channel blockers
III. Classification of Blood Pressure Classroom: Powerpoint at faculty discretion
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IV. Definition of hypertension
A. Primary hypertension
B. Secondary hypertension
The Point
V. Risk Factor and Preventative Measures for
Hypertension
VI. Clinical Manifestations of
Hypertension
VII. Systemic Effect of Hypertension
A. Cardiac
B. Cerebral
C. Peripheral vascular
D. Renal
E. Retinal
VIII. Conservative Treatment of Hypertension
A. Diet
B. Exercise
C. Smoking cessation
D. Stress management
Lutz (Nutrition Text)
Chapter 18
IX. Pharmacologic Management of Hypertension
A. Diuretics
B. Beta blockers
C. Vasodilators
D. Ace inhibitors
E. Calcium channel blockers
F. Nursing responsibilities
PERIPHERAL ARTERIAL DISEASE (USCR: Air or
Water)
I. Pathophysiology
Read: Brunner and ATI (Peripheral
arterial disease)
Classroom: Power Point at faculty
discretion
II. Risk Factors The Point
III. Clinical Manifestations/Complications
IV. Diagnosis
V. Clinical Management
A. Medication
B. Surgery
VI. Implementation of Nursing Agency for a Patient
with PAD
VII. Burger's Disease/Raynaud's Phenomenon
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VENOUS DISORDERS
I. Thombophleblitis
A. Pathophysiology
B. Risk factors
C. Clinical manifestations/complications
D. Diagnosis
E. Clinical management
1. Anticoagulation
2. Surgical
F. Implementation of nursing agency for a
patient with a DVT
Read: Brunner and ATI (Venous disorders)
Classroom: Power Point at faculty discretion
II. Pulmonary Embolism
A. Pathophysiology
B. Clinical manifestations/complications
C. Diagnosis
D. Clinical management
1. medical
2. surgical
E. Implementation of nursing agency for a
patient with a pulmonary embolism
Read: Brunner and ATI (Pulmonary emboli)
ANEURYSMS (USCR: Water)
I. Thoracic Aortic Aneurysm
A. Pathophysiology
B. Clinical manifestations
Read: Brunner and ATI (Aneurysms)
Read: Chapter in Physical Assessment Text relating
to Aneurysms
Classroom: Power Point at faculty discretion
II. Abdominal Aortic Aneurysm
A. Pathophysiology
B. Clinical manifestations
III. Diagnosis of an Aneurysm
IV. Clinical Management of an Aneurysm
A. Medications
B. Surgery
V. Aortic Dissection
A. Pathophysiology
B. Clinical manifestations
C. Complications
D. Diagnosis
E. Clinical management
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ACUTE CORONARY SYNDROME (USCR: Air or Water)
I. Pathophysiology of CAD
Read: Brunner and ATI (Acute coronary syndrome)
Read: Pharmacology text, chapter on vasodilators,
anticoagulants, & thrombolytics
Read: Nutrition text, chapter on cardiac prevention
IV. Angina Pectoris
A. Precipitating factor
B. Types of angina
1. stable
2. unstable
3. Prinzmetal's angina
C. Clinical manifestations of angina
D. Clinical management of angina
The Point
Classroom: Power Point at faculty discretion
1. percutaneous coronary trans-
luminal angioplasty (PCTA)
2. stents
3. nitrates
4. anticoagulants
5. beta blockers
6. calcium channel blockers
A. Implementation of nursing agency for a
patient with angina
V. Myocardial Infarction
A. Diagnosis of an MI
1. clinical presentation
2. EKG changes
3. cardiac enzymes
B. Clinical management of an MI
1. nitrates
2. pain management
3. thrombolytics
4. coronary artery bypass
Critical thinking exercise: "What do We do Next
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C. Implementation of nursing agency for a
patient with an MI
D. Cardiac rehabilitation
VI. Sudden Cardiac Death
A. Causes
B. Treatment
1. coronary artery bypass
2. percutaneous transluminal
coronary angioplasty
3. electrophysiology studies (EPS)
4. implanted ventricular defibrillators
CONGESTIVE HEART FAILURE (USCR: Air or Water)
I. Pathophysiology of heart failure
A. Right sided CHF
B. Left sided CHF
Read: Brunner and ATI (Heart failure)
Read: Pharmacology text, chapter on cardiac
glycosides
Classroom: Case study
II. Causes of heart failure
A. Right sided CHF
B. Left sided CHF
The Point
Classroom: Power Point at faculty
discretion
III. Clinical manifestations
A. Right sided CHF
B. Left sided CHF
IV. Clinical Management of Heart Failure
A. Positive inotropes
B. Diuretics
C. Nitrates
D. Diet
E. Oxygen
V. Implementation of nursing agency
for a patient with CHF
CARDIOMYOPATHY (USCR Air or Water)
I. Dilated
II. Restrictive
III. Hypertrophic
IV. Related factor clinical manifestations
Read Brunner and ATI
(cardiomyopathy)
Classroom: Power Point at
faculty discretion
INFECTIVE HEART DISEASE (USCR: Air or Water)
I. Endocarditis
A. Risk factors & preventative measures
B. Clinical manifestations/complications
C. Diagnostics
D. Clinical management
1. prevention
2. antibiotics
E. Implementation of nursing agency
1. rest
2. ROM
Read: Brunner and ATI
(Infectious heart disease)
Classroom: Power Point at
faculty discretion
The Point
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II. Pericarditis
A. Risk factors & preventative measures
B. Clinical manifestations/complications
C. Diagnostics
D. Clinical management
1. NSAID
2. Pericardial window
E. Implementation of nursing agency
1. pain relief
Theoretical Content Teaching/Learning Activities
VALVULAR HEART DISEASE (USCR: Air or Water)
I. Mitral stenosis
A. Related factors
B. Clinical manifestations
Read: Brunner and ATI (Valvular heart disease)
Classroom: Power Point at faculty discretion
The Point
II. Mitral Insufficiency or Mitral Regurgitation
A. Related factors
B. Clinical manifestations
III. Mitral Valve Prolapse
A. Related factors
B. Clinical manifestations
IV. Aortic Stenosis
A. Related factors
B. Clinical manifestations
V. Aortic Insufficiency/Regurgitation
A. Related factors
B. clinical manifestations
VI. Diagnosis of Valvular Disease
VII. Clinical Management of Valvular Disease
A. Medications
B. Surgery/Vascular approaches
VIII. Implementation of nursing agency for a Patient
with Valvular Heart Disease
SHOCK (USCR: Water)
I. Clinical manifestations/stages of
Shock
A. Initial
B. Compensatory
C. Progressive
D. Irreversible
II. Clinical Management of Shock
A. Distributive
1. neurogenic
2. septic
3. anaphylactic
B. Hypovolemic
C. Cardiogenic
Read: Brunner and ATI (Shock)
Classroom: Power Point at faculty discretion
The Point
15
III. Implementation of Nursing Agency for Shock
A. Fluids
B. Oxygen
C. Medications
D. Positioning
E. Intraaortic balloon pump
F. Transfusions
ARRHYTHMIAS (USCR: Water)
I. Sinus rhythm
A. Sinus bradycardia
B. Sinus tachycardia
C. Precipitating factors
D. Treatment modalities
Read: Brunner and ATI (arrhythmia)
Read: Pharmacology text, chapter on antiarrythmics
The Point
Classroom: Power Point at faculty discretion
II. Atrial dysrhthmias
A. Atrial fibrillation
B. Atrial flutter
C. Precipitation factors
D. Treatment modalities
III. Ventricular dysrhythmias
A. Premature ventricular contractions
B. Ventricular tachycardia/ fibrillation
C. Treatment modalities
IV. Heart Blocks
A. Precipitating factors
B. Treatment modalities
C. Caring for a patient with a pacemaker
THE USCR FOR WATER FLUID,
ELECTROLYTE AND ACID-BASE
DISTURBANCES
I. Definition of the need for water
Prior to the beginning of this unit review the
physiologic processes that regulate fluid, electrolyte
and acid-base.
Read: Brunner and ATI
(Fluid and Electrolytes)
16
Theoretical Content Teaching/Learning Activities
II. Extracellular fluid imbalances: excesses
and deficits
A. Health history
B. Clinical manifestations
C. Nursing assessments and interventions
1. I-O
2. vital signs
3. neurologic changes
4. daily weights
5. skin
D. Identification of SCDs
1. preventative measures
2. related nursing diagnoses
III. Electrolyte Imbalances: excesses (hyper)
and deficits (hypo)
A. Sodium
B. Potassium
C. Calcium
D. Phosphate
E. Magnesium
Read: Pharmacology text, chapter on Fluid
& Electrolytes
IV. Causes and clinical manifestations
and interventions of electrolyte
imbalances
A. Appearance
B. Behavior
C. Musculoskeletal
D. Cardiovascular
E. Gastrointestinal
F. Neuromuscular
G. Respiratory
H. GU
V. Acid-base imbalances
A. Respiratory acidosis and alkalosis
B. Metabolic acidosis and alkalosis
C. Partially compensated/fully compensated
D. Clinical manifestations & interventions
Read: Brunner and ATI (Arterial blood gas)
VI. Correction of fluid, electrolyte and acid-
base imbalances
A. IV fluids
1. isotonic
2. hypotonic
3. hypertonic
B. IV additives
C. Food sources
D. Potential hazards
E. WC/PC/SENS to control
and prevent imbalances
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Theoretical Content Teaching/Learning Activities
USCR FOR AIR
THE RESPIRATORY SYSTEM
I. Definition of the USCR for Air
II. Assessment of the respiratory system
A. Health history
B. Physical exam
C. Diagnostic studies and related nursing
responsibilities (i.e. consents, SENS
(Supportive Educative Nursing System) for
test preparations, etc.)
1. blood studies
2. oximetry
3. sputum studies
4. radiologic studies
5. endoscopic exams
6. lung biopsies
D. Effects of aging on the respiratory system
Read: Anatomy & Physiology, Chapter on
Respiratory System
Read: Chapter in Physical Assessment text
on respiratory assessment
The Point
Read: Brunner and ATI
(Respiratory System)
UPPER RESPIRATORY PROBLEMS
I. Structural, traumatic, infectious disorders of the
nose
II. Problems related to the trachea and larynx
A. Airway obstruction
B. Endotracheal intubation
C. Tracheostomy
D. Laryngectomy
E. Influenza
Read: Brunner and ATI (upper respiratory)
Read: Pharmacology text, Chapters on
antihistamine, decongestants, antitussives &
expectorants
LOWER RESPIRATORY PROBLEMS
I. Pulmonary infections
A. Bronchitis, Pneumonia
1. pathophysiology (P)
2. clinical manifestations
(CM )
3. diagnostic studies (DS)
4. complications
5. therapeutic management
a. vaccines
b. antibiotics
6. nursing assessment
7. identification of self-care deficits
a. preventative measures
b. related nursing diagnoses
8. nursing interventions
The Point
Read: Brunner and ATI, (Lower respiratory)
Read: Pharmacology text chapters on antibiotics
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Theoretical Content Teaching/Learning Activities
LOWER RESPIRATORY PROBLEMS
(continued)
B. Tuberculosis (TB)
1. review P, CM, DS
2. classification
3. complications
4. drug therapy
a. prophylaxis
b. treatment
5. nursing assessment
6. identification of SCDs
and related NDs
7. nursing interventions
a. prevent
recurrence
b. prevent spread
c. maintain normal
pulmonary
function
C. Lung cancer
1. review pathophysiology, clinical
manifestations and diagnostic
studies
2. complications
3. surgical interventions
Read: Brunner and ATI,
(Tuberculosis)
Read: Pharmacology text, chapter on antitubercular
agents
The Point
Read: Brunner and ATI (lung cancer)
II. Chest trauma and thoracic injuries
A. Pneumothorax: closed, open,
tension, hemothorax
B. Fractured ribs
C. Flail chest
D. Chest tubes-nursing
management
E. Chest surgery-postoperative care
Read: Brunner and ATI (chest trauma and surgery)
III. Restrictive respiratory disorders
A. Pleural effusion
B. Pleurisy
C. Therapeutic management
The Point
Read: Brunner and ATI (Pleural Disorders)
OBSTRUCTIVE PULMONARY DISEASES
I. Asthma
A. Review, P, CM, DS
B. Triggers of asthma attacks
C. Classification
D. Status asthmaticus
Read: Brunner and ATI (obstructive disorders)
Read: Pharmacology text, chapter on
bronchodilators and other respiratory agents
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Theoretical Content Teaching/Learning Activities
OBSTRUCTIVE PULMONARY DISEASES
(continued)
E. Therapeutic management
1. oxygen therapy
2. pharmacological management
a. bronchodilators
b. antiinflammatory
c. cromolyn
d. nonprescription
II. Emphysema and Chronic Bronchitis (COPD)
A. Irritants
1. cigarette smoke
2. infection
3. inhaled irritants
4. aging
B. Review P, CM, DS
C. Complications
1. respiratory failure
2. pneumonia
3. ulcers, GI reflux
4. corpulmonale
D. Therapeutic management
1. respiratory therapy
a. chest PT
b. peak flow meters
2. nutritional management
3. activity
E. Nursing assessment
F. Identification of SCDs
1. preventative measures
2. related nursing diagnoses
G. Nursing interventions
The Point
RESPIRATORY FAILURE AND ARDS
I. Risk factors
II. Prevention
III. Assessment
IV. Nursing interventions
A. Ventilator management
Read: Brunner and ATI
(respiratory failure and ARDS)
Lutz (Nutrition Text) Chapter 22
The Point
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Sample Course Calendar
Monday
Class HP 302
9:30-12:30
Tuesday
Clinical
Wednesday
Clinical
Thursday
Class HP 302
9:30-10:20/10:35-
12:50
1/13
Course Orientation
Math review
1/14
Cardiac diagnostics
Hypertension
1/15
PAD/DVT
Aneurysms
1/16
PMCE
Acute coronary
syndrome
1/20
MLK day
No Class
1/21
Clinical
1/22
Clinical
1/23
ACS
Valves/infectious
1/27
Exam #1
Heart failure
1/28
Clinical
1/29
Clinical
NCP #1 due
1/30
Arrythmias
2/3
Shock
2/4
Clinical
2/5
Clinical
Process record due
2/6
F and E
2/10
Assess resp function
2/11
Clinical
2/12
Clinical
2/13
ABG’s and O2 therapy
2/17
Exam #2
Upper resp disorders
2/18
Clinical
2/19
Clinical
NCP #2 due
2/20
Chest tubes
Lower resp disorders
2/24
Ventilators
2/25
Clinical
2/26
Clinical
2/27
COPD asthma
3/2
Lungs cancer
ARDS
3/3
Resp critical thinking
activities
¾
Exam #3
3/5
Clinical evals
21
SKILLS FOR NURSING PRACTICE
22
GENERAL GUIDELINES PRIOR TO STARTING ANY PROCEDURE
* 1. Check physician/health care provider orders/
* 2. Wash your hands.
3. Organize your equipment.
* 4. Identify patient.
* 5. Introduce yourself
* 6. Explain procedure to patient.
* 7. Provide for privacy.
8. Raise the bed to a working level.
9. Position patient as needed.
10. Maintain safety.
11. Perform procedure.
12. Observe patient's response.
13. Wash your hands.
14. Document accordingly.
* Must be stated prior to starting validation procedure
23
VIDEO CAN BE SEEN ON MOODLE
(Real Player is required for viewing)
PROCEDURE SATIS-
FACTORY
UNSATIS-
FACTORY
COMMENTS
TRACHEOSTOMY CARE WITH SUCTIONING
1. Check physician's order.
2. Assemble equipment: suction machine,
suction kit, normal saline, hydrogen peroxide,
disposable inner cannulas, clean gloves, sterile
4x4's/sterile Q-tips, trach dressing gauze.
3. Wash hands.
4. Identify patient and explain procedure.
5. Position patient in Semi-Fowler's position.
6. Auscultate lungs.
7. Turn on suction machine and check for suction
pressure.
8. Open suction kit and set up sterile field.
9. Pour saline into sterile cup.
10. Don sterile gloves (one hand will be sterile, the
other clean).
11. Attach catheter to suction tubing.
12. Test patency of suction catheter with saline in
cup.
13. Suction inner cannula, assess patient and
provide supplemental O2 as necessary.
14. Remove trach dressing.
15. Discard catheter, gloves and cup.
16. Apply clean gloves.
17. Open box containing sterile inner cannula.
18. Remove patient's inner cannula by squeezing
wings of inner cannula.
19. Pick up new inner cannula by wings and insert
into trach tube and lock.
20. Pour 1/2 parts N/S and H2O2 into sterile
container.
21. Open sterile 4x4's and Q-tips.
22. Open trach dressing gauze.
23. Cleanse around stoma with Q-tips touching
handle of Q-tips only. Dry with 4x4.
24. Slide new dressing under trach.
25. Auscultate lungs.
26. Document procedure & pt. response.
In addition to the above procedure, patients on ventilators also have inline suctioning performed.
PROCESS RECORDING GUIDE
The Process Recording does NOT include patient teaching, collecting a health history or doing a nursing assessment.
Nurse’s Communications Patient’s Communications Evaluation of
Communication Technique
Interpretation/Evaluation
of Communication
What you said, did and felt:
Verbal statements:
• Exact words and pauses, silences
• Use guide for pt’s verbal communication.
• Verbal communication
• Were your choice of words easy?
• Did you find yourself laughing, crying, sighing,
yawning?
Non-verbal communications
• Place observations of your own behavior here.
• Use guide for pt.’s non-verbal communication
Expressed & Implied Feelings and Thoughts, e.g.:
• Record those feelings and thoughts you experienced
during the interaction.
• Use the guide for pt.’s feelings and thoughts (See list
in Column II-C)
What Pt. says, and does, include:
A. Verbal statements
1. words
2. silences
3. tone of voice
4. sighs, laughs, cries
5. stammers, stutters
6. pace of speech, etc.
B. Non-verbal communications
1. facial expressions
2. silences
3. postures assumed
4. gestures
5. eye contact
6. restlessness, yawns
7. attention span, etc.
C. Feelings & thoughts, e.g.:
1. anxiety *
2. anger
3. fearfulness
4. frustration
5. hopelessness
6. loneliness
7. sadness
8. humor
9. love
10. happiness
11. empathy
12. accomplishment, etc.
Therapeutic vs. non-therapeutic
• Name the technique
• Alternative technique
What do you conclude about the communication?
Use these questions to evaluate each of your
responses to the patient.
1. Were your statements clear and appropriate?
2. How did you feel during interaction, were your
muscles tense, did you smile too much, did
your voice sound funny, did you find it hard to
sit still, look into pt.’s eyes?
3. Did you move away from pt., run out of room,
etc.?
4. What body language do you need to improve
on? How?
5. What feelings did the pt.’s communication
trigger?
6. Can you relate your feelings to an event in
your past?
7. Can you provide a one word summary for your
feelings about this interaction?
8. What are the covert and overt themes?
SIGNS OF ANXIETY: sweating, tightening of muscles, elevated pulse, dilation of pupils, sighing, yawning, increased or decreased flow of speech, inability to make eye contact, change in pacing of speech, changing of topics,
trying to focus on the nurse or on details, and when words are in conflict with non-verbal expressions.
BERGEN COMMUNITY COLLEGE
Process Recording
Student’s Name
Date, Time, and Duration of Interaction
Barriers to communication
(i.e. physical, environmental, drugs, etc.)
Goal for the interaction
(Purpose of the interaction based upon the needs of the patient
Instructors Comments:
Patient’s Initials
Patient’s Age
Patient’s Sex
Major Medical Diagnosis
Description of patient’s appearance at time of interaction
NCP RUBRIC
Note: Nursing Care Plans are to be submitted on the assigned due dates. Late submission will result in a 5
point deduction per day after due date.
IDENTIFIES SCA/SCD’S FORMULATES NURSING
DIAGNOSIS
IDENTIFIES PATIENT
OUTCOMES
SELECTS APPROPRIATE
INTERVENTIONS
STATES REFERENCED
RATIONALES
EVALUATIONS
8-
10
Includes ALL relevant assessment data
with attention to:
• Subjective data (BCFs)
• Objective data (checklist)
• Vital signs
• Lab values
• Behavioral and verbal cues
Related to the specifically identified
USCR and nursing diagnosis
• Selects priority nursing
diagnosis (es) from NANDA
list accurately reflecting
patient assessment in the
PES format.
• All 3 elements from PES are
correctly stated.
• Medical diagnosis is not
used in the nursing
diagnosis.
• Nursing diagnosis identifies
a problem that nursing can
correct.
Clearly states one or two
measurable, realistic and
appropriate outcomes that
reflects resolution of the
stated problem.
Includes all (5 minimum)
interventions required to treat
problem. Interventions are:
• Timed when appropriate
• Realistic
• Include assessment
actions
• Reflects independent and
collaborative treatment/care
actions
• Documents teaching
actions
• Identifies interventions that
may be delegated and to
appropriate caregiver (NA,
LPN)
• Documents scientific
principles, theories or
concepts underlying nursing
interventions.
• Documents the source with
author, page number. Full
citation on NCP cover.
• Rationales explain how the
action resolves the
problem.
Documents findings related to the
intervention including:
• Assessment data
• Vital signs
• Teaching
• Labs
• Comfort and care
• Patient response to each
intervention
• Proposes alternate actions for
unmet goals or ineffective
interventions
5-7
Includes some relevant, but not
complete assessment data as related to
the identified USCR and nursing
diagnosis
3 of 4 criteria present as stated for 4
above
Goal non-measurable, or
not realistic
Priority actions omitted, actions
are not timed when appropriate.
Either assessment, care or teaching
actions omitted. I.D. actions that
may be delegated doesn’t
designate appropriate caregiver
Scientific rationales are broad,
limited scientific theory,
limited reflection of underlying
patho-physiology.
The majority of the interventions
are implemented with findings
documented. Patient response to
interventions inconsistently
documented.
2-4
Assessment data sparse, irrelevant, and
incomplete
2 of 4 criteria present as stated for 4
above
Goal does not reflect
stated problem.
Interventions are sparse, priority
interventions omitted, not timed,
and reflect only assessment or care
or teaching. Incorrectly delegates
action.
Rationales are general, generic,
without a scientific basis, no
documentation of sources
evident.
More than half of stated
interventions not implemented.
Either ability to implement and or
patient response omitted. General
evaluation given for all actions.
0-1
No or minimal assessment data present
for the identified USCR/nursing
diagnosis
1 of 4 criteria present as stated for 4
above
Goal not stated and/or
without any relevance.
Goal not measurable.
No interventions stated or
interventions omitted,
interventions do not treat stated
problem, or not timed, attend to
only one category of assessment,
care, or teaching. No mention of
delegation.
Rationales omitted, non
scientific, no documentation of
sources evident.
Interventions not evaluated or
limited evaluation documented.
No reflection of assessment, care
or teaching evident.
6/06
Bergen Community College
Nursing Department
Clinical Evaluation Tool for NUR 281/282
Student:________________________________ Course Number:________________________________
Faculty:_________________________________ Course Name:__________________________________
Semester/Year:___________________________ Agency:_______________________________________
Dates of Experience:_______________________ Absences:_____________________________________
Mid-Course Grade:________________________ Final Grade:___________________________________
Essential Clinical Behaviors
THE FOLLOWING IS A LIST OF NECESSARY NURSING BEHAVIORS APPLICABLE TO CLINICAL SETTINGS. THIS IS NOT A COMPLETE LIST! THESE ESSENTIAL CLINICAL BEHAVIORS ARE IN ADDITION TO ADEQUATE
THEORY AND SKILLS PREPARATION FOR CLINICAL, TO APPROPRIATE NURSING CARE PLAN FORMULATION AND TO ACCEPTABLE IMPLEMENTATION AND EVALUATION OF NURSING CARE.
o Correct patient identification maintained
o Bed in lowest position when leaving patient, locked, and appropriate side rails
o Call bell and bedside table (with phone) within reach
o Restrain protocol followed
o Appropriate precautions maintained (standard/isolation)
o Skin integrity protected and proper alignment maintained
o Changes in a patient’s clinical status will be monitored and reported promptly to the clinical instructor and the clinical staff
o Any change of status reported immediately
o Assesses all prescribed therapeutic devices
o Identifies the appropriate assessment parameters prior to medication administration
o More than 2 clinical absences will result in a clinical failure. Exceptional circumstances for clinical absences may be reviewed by the clinical instructor, team, and Program Director at the request of
the student.
o A “U” (unsatisfactory) on any section of the Final clinical evaluation too will result in a clinical failure.
Clinical Practice
1. Provides care based on Orem’s self-care model to adult individuals with deficits in USCR’s.
a. Completes an accurate and thorough patient assessment of the Basic Conditioning Factors
(BCF) identifying self-care agency (SCA) and self-care deficits (SCD) in a timely manner.
b. Distinguish normal from abnormal assessment findings
c. Identifies and reports changes from patient’s baseline in a timely manner
d. Verbalizes the scientific rationale for nursing interventions
e. Develops goals in collaboration with patient/significant other
f. Protects patient from physical jeopardy (any action or inaction on the part of the student
which threatens patient physical well-being).
Midterm
S U
Final
S U
Faculty Comments
g. Protects patient from emotional jeopardy (any action or inaction on the part of the student
which threatens the emotional well-being of the patient)
h. Administer medications according to nursing standards, agency protocol and patient safety
goals, including accurate and timely documentation.
i. Identifies relevant diagnostic tests and lab data reflecting underlying pathophysiology
j. Prioritizes nursing interventions to assist patients in meeting self-care needs or deficits.
Human Development
2. Provides nursing care according to each individuals developmental capabilities
a. Provides care based on the uniqueness of the patients cultural and spiritual needs.
b. Identifies personal biases that may impact nursing care.
c. Implements care based on patients age, developmental level, or disability
Midterm
S U
Final
S U
Communication
3. Employs therapeutic and professional communication techniques when interacting with adults and
health team members.
a. Focuses on patient centered communication, goals, and concerns.
b. Uses language consistent with patient’s level of understanding.
c. Demonstrates respect for the values, dignity, and culture of others in patient interactions.
d. Reports pertinent data to staff and instructor in a timely manner.
e. Demonstrates documentation that is accurate, complete, current, concise and organized.
f. Demonstrates verbal shift report that is complete, appropriate and accurate.
g. Asks pertinent questions related to patient condition and care.
h. Actively contributes relevant information in clinical conference.
Midterm
S U
Final
S U
Knowledge
4. Provides nursing care based upon biological, psychological, sociological, cultural, spiritual and economic
factors that influence the health of adults.
a. Correlates scientific theory with clinical practice.
b. Integrates prior and current learning with clinical practice
c. Maintains proficiency in previously learned skills.
d. Implements skills according to evidence based standards, policies, and current National
Patient Safety Goals.
e. Differentiates appropriate unlicensed assistive personnel responsibilities.
Midterm
S U
Final
S U
Professional Development
5. Selects activities which support personal, professional and educational development.
a. Seeks assistance appropriately from instructor, peers, and other professionals.
b. Acts on constructive feedback to improve clinical performance.
c. Plans clinical time to ensure safe, efficient patient care
d. Manages time effectively to complete clinical assignments
e. Arrives on time and prepared to practice for all clinical activities.
f. Complies with dress code and grooming standards for clinical practice.
g. Demonstrates professional demeanor in interactions with patients.
h. Utilizes appropriate materials as sources of information.
i. Demonstrates awareness of need for areas for self-improvement.
j. Demonstrates initiative by seeking opportunities for new learning.
Midterm
S U
Final
S U
Professionalism Midterm
S U
Final
S U
6. Employs nursing care interventions and personal behaviors consistent with ethical and legal standards of
nursing practice.
a. Practices according to ANA Code of Ethics, ANA Standards of Practice, and the New Jersey
State Nurses Practice Act.
b. Maintains confidentiality and adheres to Health Insurance Portability and Accountability Act
(HIPAA).
Technology
7. Applies skills in nursing care through the use of a variety of technological resources.
a. Locates technological resources for the improvement of patient care.
b. Obtains data from technological resources for the improvement of patient care.
Midterm
S U
Final
S U
Critical Thinking
8. Utilizes critical thinking when providing nursing care to adults.
a. Demonstrates self-direction and critical thinking skills in clinical practice.
b. Employs evidence based practice to modify interactions based on assessment of patient SCA’s
and SCD’s.
Midterm
S U
Final
S U
Quantitative Reasoning
9. Correctly calculates drug and solution medication problems according to the level 2 Pharmacological Math
Computation Exam (PMCE) blueprint.
a. Calculates prescribed drug dosage correctly.
b. Calculates IV flow rate accurately and monitors infusion rate correctly.
Midterm
S U
Final
S U
Teaching Learning
10. Implements a teaching plan based on knowledge of teaching and learning principles.
a. Employs the supportive educative role while addressing an identified learning need with the
patient or significant other.
Midterm
S U
Final
S U
The student signature on the evaluation form acknowledges review of the evaluation with the instructor.
Mid-Course Evaluation Final Evaluation
_________________________________________________ ______________________________________________
Student Signature and comments Date Student Signature and comments Date
_________________________________________________ ______________________________________________
Faculty Signature and comments Date Faculty Signature and comments Date