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NURS 303 Medical-Surgical Nursing Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 1
NURS 303
Actividades de laboratorio y simulación clínica
Laboratory and Clinical Simulation Activities
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 2
TABLA DE CONTENIDO/TABLE OF CONTENTS
PÁGINA/PAGE
INFORMACIÓN GENERAL DEL LABORATORIO .................................................................. 3
LABORATORY GENERAL INFORMATION............................................................................. 5
TALLER UNO................................................................................................................................ 7
WORKSHOP TWO ...................................................................................................................... 10
TALLER TRES ............................................................................................................................ 13
WORKSHOP FOUR .................................................................................................................... 15
TALLER CINCO .......................................................................................................................... 18
WORKSHOP SIX ......................................................................................................................... 20
TALLER SIETE ........................................................................................................................... 23
APÉNDICES/APPENDICES ....................................................................................................... 24
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 3
I. INFORMACIÓN GENERAL DEL LABORATORIO
A. Objetivos Clínicos
Al finalizar el curso, el estudiante será capaz de:
1. Aplicar el conocimiento relacionado con el crecimiento y la etapa de desarrollo para
una medicina holística de escenarios de interacción y cirugía holística.
2. Aplicar el proceso de enfermería para brindar atención a adultos y personas mayores
según los estándares de la práctica.
3. Aplicar las habilidades de comunicación para brindar atención centrada segura y de
calidad al paciente.
4. Demuestre el trabajo colaborativo apropiado durante el equipo interprofesional.
5. Valorar los principios éticos y legales, y la sensibilidad cultural que se deben
considerar en la toma de decisiones al proporcionar atención de enfermería a la
población adulta y anciana.
6. Usar la racionalidad científica en el cuidado de adultos y ancianos.
7. Interpretar la fisiopatología y su relación con el adulto.
8. Demostrar el uso de la tecnología al aplicarla en el manejo de pacientes adultos y
ancianos.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 4
Evaluación Clínica
PRÁCTICA CLÍNICA
CRITERIOS DE EVALUACIÓN
CRITERIOS DESCRIPCIÓN ESPECÍFICA TALLER(ES)
Examen de cálculo
de dosis
Los estudiantes presentarán la prueba durante el primer día del
curso clínico. La prueba debe aprobarse con un mínimo de 80 %
para poder continuar con el componente clínico.
Nota: Tendrás dos intentos: el primer intento en la semana 1
y un segundo intento en la semana 7 del curso clínico. De no
aprobar el mismo, el estudiante no podrá practicar en el área
clínica y fracasará el componente de laboratorio.
1 y 7 P
Pruebas cortas Pruebas cortas semanales para evaluar habilidades clínicas. 2-6 P
Prueba de práctica
de habilidades
durante el taller
Demostración final de habilidades seleccionada al azar. 7 P
Actividades previas
relacionadas a los
trabajos asignados
para atender
clientes
Planes de cuidado
Estudios de caso
Plan de enseñanza
Plan nutricional
Evaluación de Competencia Cultural
Recursos: Clinical Essentials, libro de texto del curo
2 - 15 P
Práctica clínica
diaria y simulación
durante la práctica
clínica
Estudios de caso
Simulación de la ejecución
Plan de cuidado de enfermería
(SBAR) Informe
Transferencia del paciente
Documentación del paciente
Recursos: Clinical Essentials
8 - 15 P
Rendimiento
clínico durante el
taller
Evaluación del rendimiento del alumno durante la práctica
clínica. Se basa en el instrumento Clinical Evaluation Tool for
Midterm and Final.
1511 Midterm
12.5%
15 Final 12.5%
P
Calificación Pass/Fail
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 5
II. LABORATORY GENERAL INFORMATION
A. Clinical Objectives
Upon completing this course, the student will be able to
1. Apply knowledge related to growth and development stage for a holistic adult
interaction scenarios medicine and surgery.
2. Apply the nursing process to provide care to adults and elderly population based
on standards of practice.
3. Apply communication skills to deliver safe and quality patient centered care.
4. Demonstrate appropriate collaborative work during interprofessional team.
5. Appraise ethical and legal principles, and cultural sensibility to be considered in
decision making by providing nursing care to adult and elderly population.
6. Use the scientific rational in the care of adults and elderly.
7. Interpret the pathophysiology and its relationship to adult.
8. Demonstrate use of technology by applying it in the management of adult and old
patients.
9. Use electronic information systems to provide optimal care in adult and old
population.
10. Integrate security measures and knowledge to administer drug therapy to adult and
old.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 6
B. Clinical Evaluation
EVALUATION TABLE
CLINICAL PRACTICE
CRITERIA SPECIFIC
DESCRIPTION
WORKSHOP
(S)
WEIGHT
Dosage calculation
exam The students present the test during the first day of the
clinical course. The test must be passed with a
minimum of 80 % in order to continue to the clinical
component.
Note: You will have two attempts to take the test.
First attempt on week one and second attempt on
workshop seven.
* If the student fails to achieve an 80% on the test,
he will not be able to proceed with the clinical
practice and will fail the Clinical Component of of
the course.
1& 7 P
Quizzes Weekly skills quizzes. 20% 2-6 P
Skills Practice
Test
During Workshop
Final demonstration of randomly selected skill. 20%
7 P
Patient Workload
Assignments
Before Workshop
Care Plans
Case Studies
Teaching Plan
Nutritional Plan
Cultural Competency Assessment
Recursos: Clinical Essentials , libro de texto del curo 20%
2 - 15 P
Daily Clinical
Practice and
Simulation
During Workshop
Case Studies
Simulation Execution
Nursing Care Plan
(SBAR) Report
Patient Transfer
Patient Documentation
Recursos: Clinical Essentials 20%
8-15 P
Clinical Performace
During Workshop
Evaluation of the student performance during clinical
practice. Is based in the instrument Clinical Evaluation
Tool for Midterm and Final 20%
11 Midterm
12.5%
P
15 Final 12.5%
Total 100 %
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 7
TALLER UNO
A. El estudiante practicará las siguientes destrezas en el laboratorio de simulación clínica,
bajo la supervisión directa y asistencia del facilitador.
1. Los estudiantes tomarán un examen de cálculos matemáticos, el cual deben aprobar
con 80 % o más. La aprobación de este examen es determinante para poder continuar
en el curso. De no aprobar en el primer intento, el estudiante podrá intentar
nuevamente en la semana número dos. De no aprobar en la semana dos, el estudiante
no podrá continuar en el curso. Tenga en consideración que, de no aprobar el
componente clínico, tampoco puede aprobar el componente teórico.
2. Acceda a su plataforma de Evolve Elsevier y bajo el producto Clinical Skills
complete las siguientes competencias de destrezas clínicas:
a. Incorporar objetos a un campo de trabajo estéril
b. Establecer y mantener un campo de trabajo estéril
c. Hacer una cama para cirugías
d. Manejo del dolor
e. Colocar guantes estériles
f. Preparación de cliente para cirugía
g. Proveer cuidado posoperatorio
h. Enseñanza de ejercicios posoperatorios
i. Utilizar un campo previamente esterilizado
El ejercicio de destrezas clínicas será calificado utilizando la opción de average.
3. Bajo la supervisión directa y la asistencia del facilitador:
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 8
a. Evalúe las manifestaciones clínicas y el estado del equilibrio ácido-base de un
cliente, basado en los detalles que el facilitador le brinde. Establezca
intervenciones eficaces por orden de prioridad. El facilitador evaluará estas
actividades con la rúbrica de participación en clase (Apéndice F), y la de destrezas
de comunicación oral (Apéndice E) y la de simulaciones que se encuentran en la
sección de apéndices de Blackboard. Además, evaluará y validará las destrezas que
los alumnos adquirieran como parte de la práctica clínica y el laboratorio, según
aplique. Los formularios de evaluación se encuentran en la carpeta llamada
Supplemental Information for Nursing Courses.
B. Laboratorio de Simulación:
a. Preparación de un cliente para cirugía y atención posoperatoria
b. Antisepsia quirúrgica de manos
c. Preparación de un campo estéril, utilización de bata cerrada y guantes
d. Habilidades farmacológicas (manejo del dolor, PCA, anestesia epidural)
e. Reconocimiento de los diferentes tipos de soluciones (líquidos y electrolitos)
C. Bajo la supervisión directa y la asistencia del facilitador:
a. Evalúe las manifestaciones clínicas y el estado del equilibrio ácido-base de un
cliente, basado en los detalles que el facilitador le brinde. Establezca intervenciones
eficaces por orden de prioridad. El facilitador evaluará estas actividades con la
rúbrica de participación en clase (Apéndice C), la de destrezas de comunicación oral
(Apéndice A) y la de simulaciones que se encuentran en la sección de apéndices de
Blackboard. Además, evaluará y validará las destrezas que los alumnos adquirieran
como parte de la práctica clínica y el laboratorio, según aplique. Los formularios de
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 9
evaluación se encuentran en la carpeta llamada Supplemental Information for
Nursing Courses.
D. Referencias específicas del taller
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-
centered collaborative care. (8va ed.). St. Louis, MO: Saunders.
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination
(6th ed.). St. Louis, MO: Saunders.
Evolve Elsevier. Recuperado de https://evolve.elsevier.com/
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 10
WORKSHOP TWO
The student will practice the following skills in the clinical laboratory under the direct
supervision and assistance of the facilitator:
A. Laboratory Activities (Skills, Simulation, and Debriefing)
1. Access to your Evolve Elsevier platform and click in to the Clinical Skills tool and
perform the following clinical skills:
a. Applying a nasal cannula or face mask
b. Assessing respiration: rate, rhythm, and effort
c. Assessing the thorax and lungs
d. Ensuring oxygen safety
e. Maintaining and airway
f. Measuring oxygen saturation with pulse oximetry
g. Performing nasotracheal and nasopharyngeal suctioning
h. Performing oropharyngeal suctioning
2. Students will practice the following skills in the clinical skills laboratory under the direct
supervision and assistance of the facilitator:
a. Oxygen therapy
b. Applying nasal cannula or oxygen mask
c. Administering oxygen therapy
d. Use of incentive spirometry
e. Care of client with mechanical ventilator
f. Performing tracheostomy care, endotracheal tube and suctioning
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 11
3. The laboratory activities will include a clinical simulation scenario related to the
management of a perioperative client, pain assessment, and pain management.
a. Simulation practice includes a pre-simulation orientation during which the facilitator
will review the major points of the scenario, as well as the rules of engagement.
b. Following the pre-simulation orientation, students will proceed accordingly to the
specific organization of every scenario and will perform their assigned roles.
c. After the practical exercise, students will move to the debriefing room for a
comprehensive analysis and evaluation of the practical activity. (90 min.)
4. Using the SUAGM Nursing Care Plan Template (refer to the Appendix Section), students
will create a comprehensive care plan for the client evaluated during simulation. Students
will upload their completed care plan to the area designated by the facilitator in
Blackboard.
5. The facilitator will evaluate the activities of the clinical laboratory with the Participation
Rubric (Appendix C), Oral Communication Skills Rubric (Appendix A), and the
simulation rubric located in the Appendix section in Blackboard. The facilitator will also
evaluate and validate the skills students acquire during the laboratory sessions using the
forms located within the Supplemental Information for Nursing Courses folder located in
Blackboard.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 12
B. Specific Workshop References
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-centered
collaborative care (8th ed.). St. Louis, MO: Saunders.
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination (6th
ed.). St. Louis, MO: Saunders.
Virtual Library- Recinto de Carolina
http://bibliotecavirtualut.suagm.edu/en
Elsevier Adaptive Quizzing and Case Studies
https://evolve.elsevier.com/
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 13
TALLER TRES
A. El estudiante practicará las siguientes destrezas en el laboratorio de simulación clínica, bajo
la supervisión directa y asistencia del facilitador.
1. Acceda a su plataforma de Evolve Elsevier y bajo el producto Clinical Skills realice
las siguientes destrezas clínicas:
a. Venipuntura
b. Extracción de sangre y administración de líquidos
c. Administrar medicamentos a cuestas (by piggy bag)
d. Administrar medicamentos por bolo IV
e. Cambio de apósitos intravenosos
f. Recolectar una muestra de orina midstream
g. Interrumpir la terapia intravenosa
h. Tomar más de un tipo de insulina
i. Obtención de una muestra del catéter urinario permanente
j. Realizar una prueba de glucosa en sangre
k. Preparación y administración de insulina
2. Practique las siguientes destrezas en el laboratorio clínico, bajo la supervisión directa
y la asistencia del facilitador:
a. Iniciación de terapia de acceso intravenoso y vascular
b. Medidas de emergencia para el soporte vital (administración de código)
c. Monitoreo de glucosa en la sangre
d. Recolección de muestras de sangre y orina
e. Obtención de una muestra de gases arteriales en sangre
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 14
f. Realización de un electrocardiograma
3. El facilitador compartirá los detalles de la siguiente simulación clínica:
a. Evalúe a un cliente que requiera oxigenoterapia.
b. Organice su trabajo según el escenario que le planteen.
c. Desempeñe las funciones asignadas.
d. Trasládese a la sala de interrogatorio para analizar y evaluar exhaustivamente la
actividad práctica (90 minutos).
El facilitador evaluará el lenguaje de estas actividades con la Rúbrica de Participación
(Apéndice F), la Rúbrica de Comunicación Oral (Apéndice E). El contenido de la
misma se evaluará utilizando la rúbrica de simulaciones que se encuentran en la
sección de apéndices de Blackboard.
Referencias específicas del taller
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-
centered collaborative care. (8th ed.). St. Louis, MO: Saunders.
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination
(6th ed.). St. Louis, MO: Saunders.
Evolve Elsevier. EAQ Custom Quizzing – Medical-Surgical Level 3. Recuperado de
https://evolve.elsevier.com/
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 15
WORKSHOP FOUR
The student will practice the following skills in the clinical laboratory under the direct
supervision and assistance of the facilitator:
A. Laboratory Activities (Skills, Simulation, and Debriefing)
1. Access to your Evolve Elsevier platform and click in to the Clinical Skills tool and
perform the following clinical skills:
a. Assesing wounds
b. Caring for pressure ulcers
c. Changing a dressing
d. Collecting a specimen for wound culture
e. Irrigating wounds
2. Students will practice the following skills in the clinical skills laboratory under the direct
supervision and assistance of the facilitator:
a. Wound and irrigation
b. Removing staples and sutures
c. Managing wound drainage
d. Applying types of dressing, gauze and elastic bandage
e. Obtaining wound specimens
f. Therapeutic use of cold and hot temperatures
3. Students will participate in the clinical simulation scenario related to the care of a client
with cardiovascular shock.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 16
a. The clinical simulation practice includes a pre-simulation orientation during
which the facilitator will revise major points of the scenario, as well as the rules
of engagement.
b. Following the pre-simulation orientation, students will proceed accordingly to the
specific organization of every scenario and will perform their assigned roles.
c. After the practical exercise, students will move to the debriefing room for a
comprehensive analysis and evaluation of the practical activity. (90 min.)
d. The clinical simulation activities will be evaluated using the Clinical Simulation
Rubric located in the Appendix section in Blackboard.
4. The facilitator will evaluate the language of the activities of the laboratory using the
Participation Rubric (Appendix F), the Oral Communication Skills Rubric (Appendix
E), and the simulation rubric located in the Appendix section in Blackboard. These
language rubrics can be accessed in the Course Menu section of Blackboard under the
link titled Appendices: Language Rubrics. The facilitator will also evaluate and validate
the skills students acquire during the laboratory sessions using the forms located within
the Supplemental Information for Nursing Courses folder located in Blackboard.
G. Specific Workshop References
Elsevier Adaptive Quizzing and Case Studies
https://evolve.elsevier.com/
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-
centered collaborative care (8th ed.). St. Louis, MO: Saunders.
Pressure Ulcer Prevention
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 17
http://search.alexanderstreet.com/view/work/2065763
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN
examination (6th ed.). St. Louis, MO: Saunders.
Virtual Library- Recinto de Carolina
http://bibliotecavirtualut.suagm.edu/en
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 18
TALLER CINCO
A. El estudiante practicará las siguientes destrezas en el laboratorio de simulación clínica, bajo
la supervisión directa y asistencia del facilitador.
1. Acceda a su plataforma de Evolve Elsevier y bajo el producto Clinical Skills
realice las siguientes destrezas clínicas:
i. Initiating a transfusión
ii. Monitoring for adverse reactions to a transfusion
iii. Preparing for a transfusion
2. Practique las siguientes destrezas en el laboratorio clínico, bajo la supervisión
directa y la asistencia del facilitador:
a. Comienzo de terapia hematológica
i. Transfusión
1. Seguimiento a reacciones adversas por transfusiones
ii. Paso a paso
3. Participe en la simulación clínica que trata acerca del cuidado del cliente con
problemas de piel y evaluación y manejo de heridas.
a. A modo de orientación, el facilitador explicará no solo el escenario
clínico, sino las reglas de la simulación.
b. Organice su trabajo según el escenario que le planteen.
c. Desempeñe las funciones asignadas.
d. Después del ejercicio práctico, trasládese a la sala de evaluación para que
analice y evalúe exhaustivamente la simulación.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 19
El facilitador evaluará estas actividades con la rúbrica de participación en clase
(Apéndice F), la de destrezas de comunicación oral (Apéndice E) y la de
simulaciones que se encuentra en la sección de apéndices de Blackboard. Además,
evaluará y validará las destrezas que los alumnos adquirieran como parte de la
práctica clínica y el laboratorio, según aplique. Los formularios de evaluación se
encuentran en la carpeta llamada Supplemental Information for Nursing Courses.
B. Referencias específicas del taller
Evolve Elsevier. EAQ Mastery Quizzing – Medical-Surgical Level 3. Recuperado de
https://evolve.elsevier.com/
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-centered
collaborative care. (8th ed.). St. Louis, MO: Saunders.
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination
(6th ed.). St. Louis, MO: Saunders.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 20
WORKSHOP SIX
The student will practice the following skills in the clinical laboratory under the direct
supervision and assistance of the facilitator:
A. Laboratory Activities (Skills, Simulation, and Debriefing)
1. Access to your Evolve Elsevier platform and click in to the Clinical Skills tool and
perform the following clinical skills:
i. Applying a condom catheter
ii. Assisting with an urinal
iii. Inserting an indwelling catheter to a female patient.
iv. Inserting an indwelling catheter to a male patient.
v. Irrigating urinary catheter
vi. Measurement of the intake and output
vii. Pouching a colostomy
viii. Pouching a urostomy
2. Students will practice the following skills in the clinical skills laboratory under the direct
supervision and assistance of the facilitator:
a. Pouching a colostomy or an ileostomy
b. Pouching a urostomy
c. Catheterizing a urinary diversion
3. The first laboratory activity will include a clinical simulation scenario in which a client
suddenly experiences a respiratory emergency.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 21
a. Students will intervene while keeping in mind the type of conversations
(psychosocial in nature), he/she initiates with the client and the therapeutic vs.
non-therapeutic techniques applied.
b. The facilitator will continue to modify the simulation according to how students
take action as a medical-surgical nurse.
c. After the simulation, students will engage in a simulation debriefing during
which the facilitator with emphasize ways of communicating with the client
during the respiratory emergency.
4. Students will participate in a second clinical simulation scenario related to the care of a
client with hematologic problems/transfusion and/or the care of a client with
inflammatory intestinal disorder/ostomy management.
a. The simulation practice includes a pre-simulation orientation during which the
facilitator will review the main points of the scenario, as well as the rules of
engagement.
b. Following the pre-simulation orientation, students will proceed accordingly to
the specific organization of every scenario and will perform their assigned roles.
c. After the practical exercises, students will move to the debriefing room for a
comprehensive analysis and evaluation of the practical activity. (90 min)
The facilitator will evaluate the language of this activity using the Appendix E: Oral
Communications Skills Rubric and Appendix F: Participation Rubric. These language
rubrics can be accessed in the Course Menu section of Blackboard under the link titled
Appendices: Language Rubrics. The content will be evaluated using the simulation
rubric located in the Appendix section in Blackboard. The facilitator will also evaluate
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 22
and validate the skills students acquire during the laboratory sessions using the forms
within the Supplemental Information for Nursing Courses folder located in Blackboard.
B. Specific Workshop References
Elsevier Adaptive Quizzing and Case Studies
https://evolve.elsevier.com/
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-
centered collaborative care (8th ed.). St. Louis, MO: Saunders.
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination
(7th ed.). St. Louis, MO: Saunders.
Virtual Library- Recinto de Carolina
http://bibliotecavirtualut.suagm.edu/en
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 23
TALLER SIETE
A. El estudiante practicará las siguientes destrezas en el laboratorio de simulación clínica,
bajo la supervisión directa y asistencia del facilitador.
Actividades del laboratorio clínico (destrezas de laboratorio, simulación clínica,
práctica clínica) (90 min)
a. Se ofrecerá un examen práctico e individual acerca de todos los temas que los
alumnos han estudiado durante las primeras seis semanas del curso (instrucción
práctica). El examen se calificará como “aprobado o desaprobado” y se
considerará como requisito para continuar participando en la parte clínica de la
clase. El facilitador evaluará y validará las destrezas que los alumnos adquirieran
como parte de la práctica clínica y el laboratorio, según aplique. Los formularios
de evaluación se encuentran en la carpeta llamada Supplemental Information for
Nursing Courses.
B. Referencias específicas del taller
Evolve Elsevier. EAQ CustomQuizzing – Medical-Surgical. Recuperado de
https://evolve.elsevier.com/
Ignatavicius, D. D., & Workman, L. M. (2015). Medical-surgical nursing patient-
centered collaborative care. (8th ed.). St. Louis, MO: Saunders.
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination
(7th ed.). St. Louis, MO: Saunders
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 24
APÉNDICES/APPENDICES
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 25
Guide to the Nursing Process
This guide will be of help to your organization in the preparation of the Nursing Process. You should start
preparing it as soon as you select your client. If in doubt, consult your teacher.
1. Presentation page - See APA.
2. Table of Contents - See APA.
3. Introduction - Give the reader a general idea of the content of the work.
4. Customer Profile - It is a spoken portrait of your client. You must include customer identification data
such as: age, sex, religion, marital status, medical diagnoses, days of hospitalization, reason for
hospitalization, signs and symptoms that the client presented at the time of admission and when you
intervened with him or her , medicines he/she uses and special treatments..
5. Data Analysis - You must use a table format (see table I attached). Remember to cite the source used
when doing the analysis. The analysis is to compare the data obtained from the client with the data of the
literature and to establish the relationship between the two.
6. Laboratory and studies performed - Includes laboratories significant to the condition of the client with
their results. It will include the description of the laboratory or study, the values obtained by the client, the
normal values and the relationship of these results with the condition of the client. See Table II.
7. Medications - Include the medications the client is currently using. Includes complete medical order
(name, dose, route, frequency), indication, side effects, nursing responsibility and relation to the client.
See Table III.
8. List of problems or needs (current and potential), strengths (resources) and limitations (weaknesses) -
You must organize it in order of priority. It includes everything that helps or supports the client to satisfy
or solve their needs or problems, as well as what prevents or limits. See Table IV.
9. Care Plan - Use the format given in class. The diagnosis of nursing must be separated from the analysis
of previous data and the identification of problems or needs. Select the highest priority nursing diagnoses
(current, potential and health promotion) and submit it with the PES system. Prepare the plan of care for
nursing diagnoses. Remember to write the objective (s) correctly using the five elements: subject, verb,
situation (condition), adequacy (criteria) and time (see the notes of the Class and textbook). Care plans
will be delivered using Docu Care
10. Conclusion of the work - Includes a summary of the content of the work and its
usefulness for professional development.
11. References - These must be updated (last 5 years), written according to APA and there must
be at least 5 references. All references cited in the Data analysis should be included in the
list of references.
12. Appendix - Health history and physical examination will be delivered using Docu Care. The
appendices contain any other material used to provide a client care. Example:
Information materials, whether brochures, Pamphlets, information taken from the Internet. |
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 26
Remember to quote the appendices and identify them correctly. The last part of the appendix
are the Evaluation Criteria.
*Check the work before submitting it (wording, sequence, spelling, etc.).
Also use the criteria to verify that the work includes all parts which will be evaluated. Hand in the work at
the time that stipulates the norms of Course. Below is a model of the tables that should be included.
I. Table for Presentation and Analysis of Data
Data Analysis
Client Information
Some data to analyze:
Examples:
A) Age (use theorists
like: Erick Erickson).
B) Gender
C) Place of Residence
D) Civil Status
E) Academic level
F) Religion
G) Occupation
H) Previous hospitalizations
I) Medical Diagnosis
Current
J) Significant findings
of physical examination
Perform an assessment of
Needs according to Maslow
Theories and sources of reliable information
should be apply in data analysis.
Literature review data are compared with client
data.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 27
II. Table of Laboratories
Name and
Description
Results client's
Values
Normal Values Relationship with
Client’s Condition
Example: "Complete
Blood Count "
(CBC) - Explain the
Components of the
Lab and the
importance.
Ex: Hemoglobin
(HGB) = 13.5 g / dl
Write the rank of
Values expected.
Ex: Men:
12.4-14.9 g /DL
Women:
11.7 to 13.8 g /
DL
Explain the relationship
of
the results with the
Current condition of
the patient
III. Table of Medications
Name, Dose,
Via and
Frequency
Indication Secondary
Effects
Nursing
Responsibility
Relationship
with the
Client
Tylenol 500mg
PO Every 6 hours
Explain how to
use and for what
is use
Write the
Adverse effects
reactions
Common and
the more
Dangerous for
Each system.
Which are the
Aspects / care
that the nursing
personal should
take into account
to administer this
medicine?
What
purpose is use
in the client?
(take in account
the health history.
and
current status)
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 28
IV. Table Problems of the Client
EXAMPLE OF WHAT TO INCLUDE IN THE CARE PLAN
Problems Resources Limitations
Must be arrange in priority.
The student must place all
Problems identified in a list
that is divided into current and
potential
Aspects that
support the client to
solve his/her needs.
Aspects that prevent or
limit the client.
Nursing
Diagnosis
Client’s
Objectives
Nursing
Interventions
Rationale Evaluation
P - Problem
E - Etiology
S - Signs and
Symptoms that
show the
existence of the
problem
Format of
Potential Problem:
P - Problem
E - Etiology
Each objective
Should:
1. Be directed
to the patient.
2. Have a verb
(Measurable).
3. Present one
situation.
4. Have
Adequacy.
5. Have a period
of time to achieve
the objective
Include what the
Nursing
Professional
will do to
direct the client to
achieve the
objectives.
Classify
independent /
Collaborative
Explain the reason
and importance
of each
intervention
It must be
grounded and
justified the
explanation of
each nursing
intervention
Indicate to what
extent the
objectives
were achieved
through
each nursing
intervention.
There must be a
explanation of
how the
evaluation
was done for each
objective.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 29
Evaluation Criteria for the Nursing Process
Name___________________________ Date___________________
Professor___________________________ Points/ Grade_____________
Criteria 4 3 2 1 0 N/A Comments
I. Competent Practice
A. Make a nursing assessment
1. Writes a complete patient profile.
2. Writes: nursing history, physical
examination, and data relevant to the
patient's current condition in the
electronic record.
3. Describes the significant findings of
the patient's nursing history and
physical examination correctly and
relates them to the current problem.
II. Critical Thinking
A.Interprets significant data from the
nursing assessment related to the
current situation or problem
1. Analyze laboratory results and / or
studies.
2. Analyze medications used by the
patient.
3. Analyze the pathophysiology of the
medical diagnoses
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 30
4. Analyzes the stage of growth and
development according to Eric Erikson
and the impact of health condition.
5. Apply Abraham Maslow's theory of
needs satisfaction to the patient's
current situation to Identify and explain
affected needs
6. Identify current and potential list of
nursing problems by considering the
patient as a holistic being.
7. Writes nursing problems in priority
order.
8. Describe patient's strengths and
limitations to work with the health
situation or problem.
III. Clinical Judgment
A. Design a nursing care plan for the
nursing diagnoses and
Solution of the patient's highest priority
problems.
1. The identified diagnoses contain the
necessary elements (problem, etiology,
signs and symptoms).
a. Performs a minimum of three nursing
diagnoses; one diagnosis focused on a
current problem, another diagnosis
related to a risk (potential problem) and
one in health promotion. You must
present justification for not having each
type of diagnosis indicated.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 31
2. Writes observable objective behavior
(includes 5 components of objectives).
3. Write nursing interventions for the
identified diagnosis (classified in
independent and collaborative).
4. Describe the scientific rationale for
designed nursing actions
5. Establish the aspects to be considered
as nursing professionals in the
evaluation of the objective (s).
6. Writes a conclusion with a reflection
on the client's situation, the role of the
nursing professional in his care and
his/her learning as a student.
IV. Research Skills
A. Evidences the search and use of
relevant and scientific literature when
relating information from the literature
with findings found in the assessment
V. Presentation of Paper
A. The use of the APA format is
evidenced.
B. Has a clear introduction.
C. Makes use of grammar rules.
D. Has clear and coherent ideas.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 32
E. The references used in the
preparation of the work:
1. Diversity of professional sources
2. Complete and correct
3. Last 5 years.
Scale:
4 - Has complete mastery of the knowledge and / or skills required all the time
3 - Has mastery of the knowledge and / or skills required most of the time.
2 - Has mastery of knowledge and / or skills required sometimes.
1 - Has mastery of the knowledge and / or skills rarely required.
0 - No evidence of any knowledge or skills in its execution.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 33
Evaluation criteria Evidenced Based Nursing Practice
Names:
Criteria
4
3
2
1
0
Comments
I. Introduction
A. Explains the importance of Evidence-Based Practice for
the nursing professional
B. Introduces the selected theme clearly
C. Justification
A. Explain what motivated the search for research
literature to improve nursing practice
B. The selected topic is relevant in the assigned unit.
C. Ask the PICOT question.
D. Critical Analysis of Evidence
A. Mentions the databases searched for the articles and
keywords used in the search.
Date: ___________________
Grade: _____
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 34
B. Presents the number of articles found, and the
inclusion and exclusion criteria used.
C. Describes the level of evidence (hierarchy) found in
the articles.
D. Presents critical analysis of best evidence.
Describes the limitations and strengths of literature.
Summarizes the conclusions derived from the tests
that support the change in practice.
This content should not be more than 5 pages.
E. Concludes if there is sufficient scientific evidence to
integrate the findings into the practice of the nursing
profession.
IV. Conclusion and Recommendations
A. Discusses the relevance or importance of nursing findings.
B. Analyzes the usefulness and impact of research conducted
to improve the practice of the nursing profession and care
for clients.
C. Expresses personal opinion
V. References
A. Select professional articles with no more than five (5)
years of publication
B. Complete and correct wording according to APA.
VI. Appendices
A. Completes the Research Study Analysis Guide for
each article used
B. Presents the completed matrix of the selected articles.
C. Includes copy of articles used.
D. Includes the minutes of the group meetings using the
format established for the course.
VII. Style and Presentation of Written Work
A. Demonstrates appropriate use of APA style and format.
B. Presents logically organized content.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 35
C. Makes use of grammatical rules.
D. Work Sharpness.
Scale:
4 Clear evidence, precise, relevant and highly selective. Complies with all elements of the
criterion.
3 Evidence quite clear, precise, relevant and selective. It complies with most of the elements of
the criterion.
2 Evidence unclear, precise, relevant and selective. It complies only partially with most of the
elements of the criterion.
1 Evidence confusing, inaccurate, irrelevant and not selective. It complies with very few parts of
the elements of the criterion.
0 Does not meet elements of the criteria.
Instructions:
1. Each student in the group will submit a minimum of 2 (two) recent research articles.
2. Professional literature is required; Pub Med, CINAHL, Cochrane is suggested.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 36
Evaluation Criteria Leadership Role Competencies
Name: _________________________________ Date ____________________________
Professor: ________________________________ Grade: ______ % ______
*During the clinical practice of this course the student is expected to achieve the competences with
minimum
or no teacher help.
Criteria 4 3 2 1 0 N/
A
Comments
I. COMPETENT PRACTICE
A. Communication Skills (15%)
1. Shows therapeutic communication skills with:
a. Patient
b. Family
c. Professor
d. Peers
e. Interdisciplinary Health team
2. Demonstrates appropriate communication:
a. Tone
b. None verbal language
c. Professional vocabulary
d. Follows communication channels
3. Written Communication with minimal or no help from the teacher.
a. Task assignment
b. Weekly work plan
c. Writes modifications to the nursing plan
d. Evaluates own implementation of the plan
B. Cultural and ethical sensitivity (5%)
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 37
Criteria 4 3 2 1 0 N/
A
Comments
1. Respets cultural preferences, values, beliefs and behaviors of the
patient, family, peers and interprofessional team
2. Demonstrates an ethical behavior in the care and management of
patients in their professional role by respecting values (Respect for
Human Dignity, Responsibility, Commitment, Honesty, Integrity,
Loyalty, Justice, Equity, Authenticity
C. Leadership (60%)
1. Supervision
a. Arrives early (1 hour before)
b. Notify teacher in time when unable to assist the clinical
c. Wears full and clean uniform with identifications.
d. Brings complete equipment to the clinical setting
e. Report to teacher when task begins or ends
f. Oversees team members to carry out their tasks
g. Demonstrates Leadership Qualities
a. Demonstrates initiative in the execution of task
b. Keeps control of emotions
c. Handles unexpected events
according to the qualities of a leader.
h. Deliver data relevant to continuity of care to the leader of the
next shift.
i. Provides complete and organized documentation to the teacher
(Portfolio-1 week after completing his / her leader role)
2. Work Assignment
a. Carries out the essential elements of planning, organization,
direction and evaluation of the team in charge
a. Verify patient census
b. Verify the work program of the unit's staff
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 38
Criteria 4 3 2 1 0 N/
A
Comments
c. Evaluates the level of staff preparation when assigning the task
d. Establish the categorization of patients according to individual
needs
e. Assign other tasks related to patient care
f. Assigns tasks related to patient safety and care environment
g. Assign tasks related to quality improvement
h. Distributes tasks evenly
1.Provides specific oral instructions on allocation
2. It takes into consideration the location of
patients
3. Is available to answer question that may arise
4. Assigns lunch time and break
i. Includes infection control management in assignment of tasks
3. Team / patient education
a. Estimate the educational need
b. Plan ahead
c. Write the objectives, content, educational strategies and the
evaluation plan
1. Promotes educational activity
d. Discuss the subject and content with the teacher prior to the
activity
e. Facilitates assistance to team members
f. Has mastery of content
g. Stimulates audience participation
h. Answer related questions of the topic
i. Evaluates the educational activity
D. Management of information systems (5%)
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 39
Criteria 4 3 2 1 0 N/
A
Comments
1. Complies with the regulations and rules of the HIPAA Act)
2. Complies with the regulations of the Institution
E. Patient Care Technologies
1. Demonstrates knowledge and skills in the use of technologies for
patient care (technological equipment for patient care)
II. CRITICAL THINKING
A. Autoevaluación Objetiva (10%)
1. Engages in an objective self-evaluation process considering their
beliefs and values and how they relate to their practice as a leader.
2. Entrega reflexión final que refleje su desarrollo profesional al
profesor
1. Intervenes using critical judgment according to institutional
standards
2. Promotes the defense of patient's rights
III. RESEARCH SKILLS
A. Uses relevant literature (5%)
1. Uses reliable and relevant scientific literature to apply it in its role
as leader
2. Demonstrates skills in finding, evaluating, and synthesizing
evidence to improve care outcomes with minimal assistance and
support
Critical judgment and decision making
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 40
Criteria 4 3 2 1 0 N/
A
Comments
3. Integrates non-traditional alternatives for the solution and
improvement of situations involving patients or interprofessional
team
Professor’s Signature: _______________________ Student’s Signature:
_________________________
Date: ______________________
Scale:
4 - Has complete mastery of the knowledge and / or skills required all the time
3 - Has mastery of the knowledge and / or skills required most of the time.
2 - Sometimes has mastery of knowledge and / or skills required.
1 - Rarely has mastery of the knowledge and / or skills required.
0 - No evidence of any knowledge or skills in its execution.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 41
Health and Physical Assessment
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 42
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 43
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 44
Evaluation Criteria for Documentation in the Electronic Record
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 45
Name___________________________ Date___________________
Professor___________________________ Points/ Grade_____________
Scale:
Yes (1 point) - The criterion is fully completed and as indicated.
No (0 point) - Does not take into account the criterion.
N / A- Criterion does not apply
Criteria Yes No N/A Comments
1.Competent Practice
A. Nursing Documentation
1.Writes relevant data that reflects the
current condition (nursing assessment)
of the patient
2. Evidence of nursing interventions
according to identified problems
3. Evidence of the patient's response to
the nursing interventions offered.
4. Entries in the electronic record are
complete
5. The information is presented in
logical order (nursing note).
6. Nursing notes follow grammatical
rules (consistent in syntax, spelling).
7. Deliver on time the documentation
made.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 46
Evaluation Criteria for Education Plan
Name___________________________ Date___________________
Professor___________________________ Points/ Grade_____________
Criteria 4 3 2 1 0 N/A Comments
Critical Thinking
I. Planning
A. Select topic according to
needs of the patient
B. Coordinates the activity with
members of the health team.
C. Prepares the physical and
psychological environment to
facilitate learning.
D. Discuss the detailed outline
with the teacher one week in
advance (subject, plan, visual
and demonstrative material).
II. Content:
A. Selects the content relevant
to the topic.
B. Writes objectives in terms of
observable behavior
C. The content is in accordance
with the objectives formulated.
D. Presents the content in a
logical sequence.
III. Method - Strategies:
A. Selects the strategies that
most facilitate the
presentation of the content and
shows creativity.
B. The method is selected
according to the number and
characteristics of the clients for
whom the activity is planned.
Professional Competence
C. Implements the selected
strategy.
IV. Development of the Plan:
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 47
A. Faces the clients
B. Gets the attention of the
clients.
C. Speaks clearly and slowly.
D. Discusses planned
educational material.
E. Uses a simple language in
tune with the learner's
educational level.
F. Pays attention and listen to
the group's reactions as he/she
speak.
G. Clarifies the scientific terms
used in the presentation
H. Offers opportunity for
participation.
I. Uses quality audiovisual
material (clear and of adequate
size).
J. Remains within the allotted
time limit.
K. Clarifies other situations
brought by clients
L. Creates quality written
material that meets the
established objectives.
M. Demonstrates mastery of
content.
N. Closes the topic by
mentioning the most important
points.
V. Evaluation:
A. Performs assessment of
learning at the end of the
educational activity.
B. Carries out the evaluation
according to the objectives
outlined.
C. At the end of the activity,
leaves the area used in order.
VI. Written and oral
presentation:
A. Follows the rules for
submitting papers
according to APA style.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 48
B. Completes the teaching plan
format.
C. Follows grammatical rules.
D. Expressed correctly.
E. References.
1. Recent dates (last 5 years).
2. Correct and complete
Research Skills
Evidences the search and use
of diverse, relevant and
scientific literature when
preparing the content of the
educational activity
(minimum 3 sources).
Scale:
4 - The criteria are complete.
3 - The criteria almost complete.
2- The criteria partially complete.
1- The criteria are not complete
N / A - Does not apply.
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 49
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Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 50
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 51
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 52
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 53
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 54
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 55
NURS 303 Medical-Surgical Nursing
Nursing Universidad Ana G. Méndez, Recinto de Gurabo
©2019. Universidad Ana G. Méndez. All rights reserved. 56
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