LONG BEACH CITY COLLEGE

Associate Degree Nursing Program

ADN 22AAdvanced Nursing Critical Care Life Span

COURSE SYLLABUS

for

ADULT THEORY CONTENT

Edited by:Sigrid Sexton, RN, MSN, FNP

2011 Long Beach City College Associate Degree Nursing Program, Long Beach CA 90808

ADULT THEORY BEHAVIORAL OBJECTIVES

Theory Content: CARDIOVASCULAR DISORDERS.......................................................3.0Heart Failure Worksheet................................................................................3.2Heart Failure - Drug Worksheet.....................................................................3.3Hypertension Drug Worksheet.......................................................................3.4Hemodynamic Effects of Drugs......................................................................3.5Sympathetic Drugs........................................................................................3.6

Theory Content: CARDIAC DYSRHYTHMIAS...............................................................4.0Cardiac Dysrhythmias Worksheet..................................................................4.1Dysrhythmia Practice Worksheets..................................................................4.3

Theory Content: CARDIOPULMONARY ARREST..........................................................5.0Cardioversion vs. Defibrillation......................................................................5.2Cardiac Dysrhythmias and Code Blue Drug Worksheet..................................5.3

Theory Content: ACUTE MI AND CARDIAC SURGERY.................................................6.0Complications of MI........................................................................................6.2Comparison of MI and Pulmonary Embolism..................................................6.3Myocardial Infarction Drug Worksheet...........................................................6.4

Theory Content: RESPIRATORY FAILURE...................................................................7.0Verification of CD-ROM Completion Form.......................................................7.1Acute Respiratory Failure Worksheet.............................................................7.2Acute Respiratory Disorders Drug Worksheet................................................7.4Classification of Respiratory Disorders...........................................................7.5

Theory Content: ACUTE RENAL FAILURE...................................................................8.0Renal Worksheet: Causes of Renal Failure.....................................................8.2Renal Worksheet: Phases of Acute Renal Failure...........................................8.3

Theory Content: NEUROLOGICAL DISORDERS IN CRITICAL CARE..............................9.0Worksheet: Medications for Critically Ill Neurological Patient.........................9.2Vocabulary: Neurological Health Deviations..................................................9.3

Theory Content: Health Deviations: Cardiovascular Disorders

1. Independently review anatomy and physiology of the heart and systemic circulation from previous nursing and biology classes.

2. Describe health deviations associated with the following cardiac compensatory mechanisms: tachycardia, cardiac dilatation and cardiac hypertrophy.

3. Define and explain cardiac output, ejection fraction, Starling’s law of the heart, stroke volume, cardiac contractility, and peripheral vascular resistance.

4. Define preload and afterload. List factors contributing to changes in preload and afterload including medical and nursing actions. Include the collaborative role in adjusting preload and afterload to maximize cardiac output in the patient with heart failure. Complete the Hemodynamic Effect of Drugs worksheet on page 3.6 of the syllabus.

5. Describe causes of heart failure including valve disease, pericarditis, and endocarditis. Describe the specific medical treatment for each cause of heart failure.

6. Discuss the pathophysiology and stages of heart failure including effects on health deviations. Describe theoretical frameworks used to describe heart failure including right and left sided heart failure and systolic and diastolic failure.

7. Differentiate between clinical manifestations seen in early and late stages of heart failure. Consider and describe the nurse’s response to each of these clinical findings.

8. List non-cardiac causes of pulmonary edema. Consider the critical thinking required to effectively collaborate with the healthcare team when many critical illnesses have multiple causes.

9. Describe collaborative problems and team goals of treatment in the management of the patient with heart failure.

10. Review the categories of drugs used in the treatment of heart failure as included in the Heart Failure Drug Worksheet.

11. Discuss the hazards associated with potassium replacement therapy including phlebitis, cardiac arrhythmias, and cardiac arrest and the nursing actions taken to protect the patient against these hazards.

3.0

12. Describe diagnostic tests used in patients with heart failure including chest x-ray, laboratory studies including BNP and arterial blood gases.

13. Describe the pulmonary artery catheter. Define and state the normal values for pulmonary artery, central venous, and wedge pressures.

14. Describe the intra-aortic balloon pump (IABP) including indications, insertion, actions and expected outcomes, and hazards of use. Describe the nurse’s role in preventing hazards and optimizing the effectiveness of the balloon pump.

15. Prioritize common nursing diagnoses for the patient in acute and chronic heart failure. Develop a teaching plan for a heart failure patient.

16. Describe the pathophysiology of shock states. Describe the hemodynamic differences between cardiogenic shock and distributive (septic) shock. Describe the collaborative role in caring for the patient in acute failure and the role of the nurse in assuring patient safety.

17. Review pathophysiology, risk factors, complications, and dietary management of hypertension. Describe the possible learning needs of a patient with hypertension.

18. Compare and analyze the differences between essential hypertension and secondary hypertension according to pathology, etiology, incidence, and clinical manifestations.

19. List health deviations that occur as a result of hypertension. Group these effects according to target organ systems.

20. Describe the nursing care of the patient in hypertensive crisis including health deviations, medical therapies, and the collaborative role of the nurse.

21. Identify how antihypertensive and cardiovascular drugs affect the elderly differently.

22. Describe the clinical manifestations, complications, and medical and surgical treatment of aortic aneurysm. Describe the priorities of nursing and collaborative care during the immediate post-operative period.

23. Describe how cultural differences in diet and health seeking behaviors may affect the nursing and medical management of heart failure and hypertension.

3.1

ASSIGNMENTS:

1. Texts: Brunner, 11th edition: pp. 781-790, 798, 813-820, 914-942, 944-969, 997-1001, 1021-1033, and as needed.

Urden, Stacy, & Lough, 5th ed., pp.151-170, 199-213, 241-244, 248-251, and as needed.

Davis: as needed.Dudek:5th ed., pp. 454-460 (nutrition in acute stress), 547-564 (heart failure, hypertension), and as needed.

2. Complete the worksheets in the syllabus PRIOR to class.Heart Failure WorksheetHeart Failure Drug WorksheetHypertension Drug WorksheetHemodynamic Effects of Drugs

3.2

Heart Failure Worksheet

Place the following conditions into the following table:

Effects (these go in the top section of the table under either right or left heart failure)Systemic edemaPulmonary congestionEngorgement of organs and tissues w/ edemaPoor perfusion of organs and tissuesIncreased pulmonary venous pressure

Reabsorption of sodium and water Increased preload Decreased renal and adrenal perfusion Increased blood volumeIncreased systemic venous pressure Fluid seepage into alveoli

Symptoms (these go in the bottom section under either right or left heart failure)HemoptysisSudden onsetWheezingGradual onsetCough Milder symptomsSevere symptoms

Dependent edema Hepatomegaly, splenomegaly Paroxysmal nocturnal dypsnea SOB, orthopnea AscitesWeight gain

RIGHT HEART FAILURE LEFT HEART FAILUREBackward congestion: Backward congestion:

Forward failure: Forward failure:

SYMPTOMS

3.3

HEART FAILURE - DRUG WORKSHEET

Category Drugs Actions and Uses Adverse Effects Nursing ResponsibilitiesDrugs affecting RAA system

Ace Inhibitors

Angiotensin Receptor Blockers

CaptoprilVasotec (enalapril)

Diovan (valsartan)

DiureticsLoop

Thiazides

Aldosterone antagonist

Lasix

Hydrochlorothiazide

Aldactone

Cardiac Glycoside Digoxin

Beta Adrenergic Blockers

metoprolol (Toprol-XL)

carvedilol (Coreg)

Direct VasodilatorHydralazine

Isordil

Natrecor

Phosphodiesterase Inhibitors

Milrinone (Primacor)Inamirinone (Inocor)

Inotropic Drugs Dobutamine

3.4HYPERTENSION DRUG WORKSHEET

CLASS ACTIONS DRUGS SIDE EFFECTS NURSING INTERVENTIONS

Diuretics

Thiazides

Loop Diuretics

Aldosterone blocker

Hydrochlorothiazaide

Lasix

Aldactone

Calcium Channel Blockers amlodipine

nicardipine

nifedipine

Adrenergic Antagnoists:

Beta-adrenergic blockers

Alpha1-adrenergic blockers

Alpha2-adrenergic agonists

Lisinopril

Captopril

Direct VasodilatorsApresoline

Nitroprusside

3.5HEMODYNAMIC EFFECT OF DRUGS

Drug Classification Effect on Heart Rate Effect on Preload Effect on Afterload Effect on Cardiac Contractility

Digoxin

Dopamine

Dobutamine

Nitroglycerin

Nitroprusside

Levophed

Epinephrine

Calcium Channel Blockers

Beta Adrenergic Blockers

3.6

THEORY CONTENT: HEALTH DEVIATION: CARDIAC DYSRHYTHMIAS

1. Independently review the electrical conduction system and mechanical response of the heart.

2. Describe the following dysrhythmias according to physiology, origin of impulse, criteria for identification, hazards, treatment and health deviations.. Complete the Cardiac Dysrhythmia worksheet found on page 4.1.

sinus tachycardia (ST) atrial fibrillation (A-Fib)sinus bradycardia (SB) ventricular tachycardia (V-Tach)premature atrial contraction (PAC) ventricular fibrillation (V-Fib)premature ventricular contractions (PVC) asystole

3. Identify dysrhythmias found on pages 4.3 to 4.5 of the syllabus.

4. Discuss the role of pacemakers in cardiac dysrhythmias. Describe the code system used to designate pacemaker modes using a three letter system.

5. Discuss nursing assessments and care of the patient with a temporary or permanent cardiac pacemaker. Include promotion of normalcy.

6. Describe the nursing assessments and care of a patient undergoing an electrophysiology study (EPS). Describe radiofrequency catheter ablation including the goals of treatment.

7. Discuss the importance of communicating collaboratively with the physician and monitor technician in adjusting care and monitoring needs for the patient with dysrhythmias.

REQUIRED ASSIGNMENTS:Text: Brunner, 11th edition, pp. 816, 823-856, 875-876, and as needed

Urden, Stacy & Lough, 5th edition, pp. 137-151, 624-680, 686-776 and as needed.

Syllabus: Cardiac Dysrhythmias WorksheetsEKG recognition practice

RECOMMENDED ASSIGNMENTS:

Nursing Video Skill Series:Video #215: "Reading ECG Rhythm Strips”:

CD-ROM: "EKG Rhythm Strip Recognition Courseware", available at

http://itdc.lbcc.edu/cps/nursing/EKGwebsite/ekg.htm ; written by Sigrid Sexton, RN faculty.

4.0

CARDIAC DYSRHTHMIAS WORKSHEET

Dysrhythmia Physiology andOrigin of Impulse

Monitor PatternDescription

Prognosis/Treatment

Sinus Bradycardia

Sinus Tachycardia

Supraventricular Tachycardia

Premature Atrial Contractions (PACs)

Atrial FibrillationAtrial Flutter

4.1

CARDIAC DYSRHTHMIAS WORKSHEET

Dysrhythmia Physiology andOrigin of Impulse

Monitor PatternDescription

Prognosis/Treatment

Premature VentricularContraction

VentricularTachycardia

VentricularFibrillation

Ventricular Standstill(Asystole)

4.2

Long Beach City CollegeADN 22A Critical Care

EKG Recognition practice

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4.3

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4.4

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4.5

THEORY CONTENT: HEALTH DEVIATION: CARDIOPULMONARY ARREST

1. Describe the expected assessment findings of a patient with health deviations pertaining to cardiopulmonary arrest and respiratory arrest.

2. Compare respiratory arrest and cardiac arrest as to etiology, assessment, wholly compensatory nursing interventions and emergency measures.

3. Differentiate between Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS).

4. Give the actions, doses, and routes of the following emergency drugs: Amiodarone, calcium chloride, epinephrine, atropine sulfate, morphine sulfate, oxygen, dopamine, and sodium bicarbonate.

5. Compare and analyze the differences between cardioversion and defibrillation (see worksheet).

6. Describe the Automated External Defibrillator (AED) and its use in pre-hospital cardiac care and in-hospital transport of patients.

7. Describe the Automated Implantable Cardiac Defibrillator (AICD) and the psychological stressors associated with its use. Discuss how the AICD may affect sexual intimacy.

8. Discuss the physical and emotional care of the patient who has been resuscitated and the educative/supportive role for the family.

9. Discuss the medical and legal considerations concerning cardiopulmonary resuscitation and end of life care in the ICU.

10. Identify priorities of care for the patient with bradycardia, tachycardia, PEA, ventricular fibrillation, ventricular tachycardia, and asystole. Identify medical and nursing responsibilities.

11. Discuss the role of collaborative management during a Code Blue and during end-of- life care in the ICU.

REQUIRED ASSIGNMENTSText: Brunner, 11th edition: pp. 969-972, and as needed.

Urden, Stacy & Lough, 5th edition: pp.109-117, 131-150, and as needed.

5.0

Syllabus: Cardioversion/ Defibrillation worksheet.ACLS algorithmsCode Blue Drug Worksheet

Library Article: Impact of a Multifaceted Intervention on Nurses and Physicians Attitudes and Behaviors Towards Family Presence During Resuscitation. Criticalcare Nurse. February 2007; 27 (1)

Tomas, K. Rapid Response Team; Challenges, Solutions, Benefits. Critical Care Nurse. (2007). 27 (1)

Web Site: http://www.madsci.com/manu/indxacls.htm

5.1

CARDIOVERSION DEFIBRILLATION

Differences

1. Definition - use of electrical shock to convert non-lethal atrial and ventricular tachyarrhythmias.

Refers to a high voltage shock delivered through the chest wall in order to stop the chaotic electrical activity of lethal ventricular arrhythmias.

2. Usually a non-emergency, elective situation. ALWAYS an emergency situation.

3. Used to convert atrial flutter, atrial fibrillation, or ventricular tachycardia with a pulse.

Attempts to convert ventricular fibrillation and ventricular tachycardia to sinus rhythm.

4. Patient is usually alert, so the consent, IV, pre-medication, and crash cart are ready.

Patient is usually unconscious;Exception: early ventricular tachycardia.

5. Synchronized - electrical impulse must NOT hit the T wave. So the synchronization button is depressed so that it will synchronize with the R waves.

NOT synchronized - if switch is ON machine will wait for QRS - which may not exist.

6. 25 - 100-watt seconds Is increased on successive tries.

Usually start with minimum of 200-watt seconds, maximum of 360 watt-seconds.

7. Digitalis preparations are often held for several days.

Unable to wait in order to allow digitalis levels to go down.

Similarities

Both stop the electrical activity of the heart by depolarizing the heart muscle. Same paddle placement –

o Standard placement - To the right of the upper sternum below the clavicle and just to the left of the left nipple in anterior-axillary line.

o Alternative placement - anteriorly over the left precordium and posteriorly behind the heart.

Adhesive disposable paddles in elective situations and after the initial shock in emergency situations.

If paddles are used, conductive pads are used with paddles to facilitate the flow of electricity and to prevent burns.

Oxygen is turned off. All personnel stand away from bed when the "all clear" command is called.

5.2

THEORY CONTENT: HEALTH DEVIATION: ACUTE MYOCARDIAL INFARCTION AND CARDIAC SURGERY

1. Independently review Cardiovascular Health Deviations from ADN 12A and Biology courses with emphasis on:

Cardiac Anatomy and PhysiologyCoronary CirculationCardiac Conduction SystemPathophysiology of Coronary Artery Disease (CAD)

2. Discuss the health deviations as it relates to the pathophysiology of coronary insufficiency including ischemia, injury, and infarction.

3. Compare and contrast the clinical manifestations, medical therapies, and nursing care cardiovascular patients with angina, Acute Coronary Syndrome (ACS), and Myocardial Infarction (MI).

4. Define the implications of intramural, subendocardial, and transmural MI’s. Describe the implications of a ST elevation MI (STEMI) vs. a non-STEMI.

5. Identify and discuss briefly the stages of healing, and complications that occur after myocardial infarction.

6. Identify and analyze the complications of an MI according to incidence and severity, clinical manifestations/ assessments, nursing intervention. Complete the worksheet prior to class.

7. Discuss the specifics of drug and diet therapy, emotional and sexual adjustments, the role cultural diversity plays, progressive activity, and the functions of the nurse in the educative/ supportive role for the client who has had an acute myocardial infarction. Use worksheets provided in the syllabus.

8. Complete the drug worksheet and identify how the drugs on the worksheet affect the elderly differently.

9. Discuss the following medical/ surgical measures for angina and acute MI clients: Thrombolytic therapy, Percutaneous Coronary Angioplasty (PTCA), and Intracoronary stents.

10. Name and describe the incisions used for cardiovascular by-pass surgery and how this affects the nursing care of a cardiac surgery client. Include pain management.

11. Briefly discuss the functions of a cardio-pulmonary bypass using the heart-lung machine and the implications for post-op nursing care.

12. Identify the pre-op care and promotion of normalcy of the cardiac surgery clients.6.0

13. Compare and contrast the incisions, procedures, and recovery for a patient undergoing a CABG vs. a Minimally Invasive Direct Coronary Artery Bypass (MID-CAB).

14. Identify the common post-op complications and how these affect the self-care requisites of valve replacement coronary artery by-pass surgery. Include health deviations associated with these complications.

15. Discuss the effect of cardiac dysfunction including myocardial infarction and cardiac surgery on the client’s intimacy and sexuality.

ASSIGNMENTS Prior to class, complete the following required reading and worksheets in syllabus.1. Texts: Brunner, 11th edition: pp. 791-813, 858-911 and as needed.

Urden, Stacy & Lough, 5th edition, pp.174-198, 227-241 and as needed.Dudek, 5th edition pp. 525-546 (nutrition for patients with cardiovascular

disorders) and as needed.Davis Drug Handbook and Carpenito. as needed.

2. Required Articles:Massive Pulmonary Embolism. Critical Care Nursing. February 2007;

27(1): 39-50Unstable Angina: Is your Care up to Snuff. RN, February 2005, 22-27.

3. Complete the following worksheets in the syllabus: Complications of MI, Comparison of MI and PE, and MI drug worksheets

4. Recommended viewing in Learning Center:Video: Cardio-Vascular Nursing Principles of Hemodynamic Monitoring.

6.1

COMPLICATIONS OF MI

COLLABORATIVEPROBLEMS

SEVERITY/INCIDENCE ASSESSMENT

NSG DIAG./ NSG.INTERV.

1. Arrhythmias

2. CHF

3. Cardiogenic Shock

4. Thromboembolic Episodes Pulmonary Emboli

Mural Thrombi

Leg, Pelvic Thrombi

5. Cardiac Rupture/ Tamponade

6. Ventricular Aneurysm

7. Pericarditis

8. Extension of MI/ Another MI

6.2

Worksheet: Comparison of Myocardial Infarction and Pulmonary Embolism

Acute MI Pulmonary EmbolismOnset of Pain

Location of Pain

Quality of Pain

Pain Induced by…

Duration, Frequency of Pain

Response to Nitroglycerin

Anxiety

Diaphoresis, pale skin

Hypoxia

Nausea

Dypsnea

Fever

Leukocytosis

Cardiac Enzymes

12 Lead EKG

Rhythm Strip

D-dimer (lab test)

V/Q Lung Scan

CT Scan

Arteriogram

6.3

MYOCARDIAL INFARCTION DRUG WORKSHEETClass Specific Action Condition Used for Drugs Side/Toxic Effect Nsg.Interventions/

Educ. SupportiveCORONARY artery vasodilatorsNitrates/NitritesShort Acting

Long Acting

Coronary Artery Spasms.Angina

ASHDPost MI

Nitroglycerine

NitropasteIsordil

VASODILATORSAfterload reducers. Cardiogenic Shock

Heart failureHTN Crisis

Nitroprusside (Nipride)

MYOCARDIAL workload reducersBeta Blockers

Calcium Channel Blockers

Angina Post MIInderalCorgard

VerapamilCardizenProcardia

VASOPRESSORS/ Inotropes Cardiogenic shockSevere CHF Dopamine

Dobutamine

ANTIARRHYTHMIC Arrhythmias LidocaineQuinidine

ANTILIPEMICS Atherosclerosis QuestramClorfilrateNiacinLopid

THROMBOLYTICS Recent MI orMI in progress

StreptokinaseUrokinasetPA (Tissue PlasmaAntigen)

6.4

THEORY CONTENT: HEALTH DEVIATION: ACUTE RESPIRATORY FAILURE

1. Independently review the anatomy and physiology of respiration from nursing prerequisite courses.

2. Prior to class complete the Acute Respiratory Failure Worksheet. Define each of the following terms and be prepared to discuss the effect of acute respiratory disorders on these factors:

a. stimulus for breathingb. distributionc. ventilationd. respiratione. perfusionf. diffusiong. shuntingh. compliancei. surfactant productionj. cardiac output

3. Identify the disorders that interfere with the mechanics of respiration and categorize them according to the areas affected using the Classification of Respiratory Disorders worksheet.

4. Review the following diagnostic tests commonly used to assess the patient with a respiratory health deviation. Be prepared to interpret ABGs identifying acid/base imbalances and the presence of compensation.

a. Arterial blood gassesb. Pulse oximetryc. Pulmonary function testingd. Chest X-raye. Mixed venous saturationf. Bronchoscopy

5. Identify the clinical manifestations of respiratory failure in early and later stages. Discuss nursing and collaborative interventions for respiratory failure.

6. Discuss the nutritional needs and management of the client in respiratory failure. Include needs related to increased work of breathing and the effect of excessive dietary carbohydrates.

7. Discuss etiology, pathophysiology, preventive measures, clinical manifestations, and medical and nursing management associated with the following respiratory illnesses:

a. Adult Respiratory Distress Syndromeb. Chronic Obstructive Pulmonary Disease (emphysema, chronic bronchitis)

7.0

c. Asthmad. Cor Pulmonalee. Ventilator Associated Pneumonia (VAP)f. Oxygen toxicityg. Pulmonary Embolismh. Pulmonary Edema, including non-cardiac causesi. Pleuritis and pleural effusionj. Pneumothorax

8. Identify common nursing diagnoses, potential complications and interventions for the client with the respiratory diseases listed above.

9. Complete the respiratory drug worksheet provided in your syllabus.

REQUIRED ASSIGNMENTS:

Text: Urden, Stacy & Lough, 5th edition: pp. 255-322 and as neededBrunner: 11th edition, pp. 522-586, 624-680, 686-776, and as neededDavis: as neededDudek:5th ed, pp. 464-466, and as needed

Syllabus: Acute Respiratory Failure WorksheetsClassification of Respiratory Disorders Worksheet

Library Articles: Six steps to ABG Analysis, Nursing 2007, March, Vol.2, #2, pages 48-52.

CD-Rom: ABGs

Web Sites: http://www.rnceus.com/abgs/abgmethod.html

RECOMMENDED ASSIGNMENTS:

Videos: Mechanical VentilationAcid/Base Balance: Ups and downs of pH.Metabolic alkalosis and acidosis.Respiratory alkalosis and acidosis.Assessing Breath Sounds.

7.1

Long Beach City CollegeAssociate Degree Nursing Program

ADN 22AVerification of CD-ROM completion

To be signed by a Learning Center representative.

The student, _________________, has completed the CD-ROM, ABG’s.

Signed__________________________

7.2

ACUTE RESPIRATORY FAILURE WORKSHEETS

I. Define the steps involved in the pathophysiology of respiration and list the disorders that interfere with each step.

DEFINITION DISORDERSstimulus for breathing

distribution

ventilation hypoventilation

hyperventilation

respiration

perfusion

diffusion shunting

surfactant production

Cardiac Output

II. Define these parameters related to respiratory failure and give their normal values.DEFINITION NORMAL VALUES

tidal volume

minute ventilation

vital capacity

compliance (peak inspiratory pressure)

SVO2 (mixed venous oxygen saturation)

pulse oximetry

7.3

III. Complete the following chart of expected blood gas findings and indicate whether these values are elevated or lowered in the conditions below.

ABG'S NORMAL VALUE

METABOLICACIDOSIS

METABOLICALKALOSIS

RESP.ACIDOSIS

RESPIRTORYALKALOSIS

PH

PCO2

PO2 (room air)

HCO3

base excess

O2 saturation

IV. Practice ABGs.

#1 #2 #3 #4 #5 #6 #7 #8pH 7.10 7.48 7.42 7.10 7.27 7.50 7.47 7.30

PCO2 47 30 26 90 65 28 40 37

PO2 58 107 88 80 57 55 67 85

HCO3 14 23 16 24 30 25 29 15

Base excess:

-15 7 7 +2 1 1 6 -15

O2 sat: 79% 98% 97% 90% 85% 90% 94% 98%

Inter-pretation

7.4

ACUTE RESPIRATORY DISORDERS – DRUG WORKSHEET

Class –Actions Conditions Used For Drugs Side/Toxic Effects Nursing Responsibilities/

Interventions

Beta-Adrenergic Agonists

Maxair (pirbuterol)

Proventil (albuterol)

Serevent (salmeterol)

Anticholinergics Atrovent (ipratropium)

Spiriva (tiotropium)

Methylxanthines Theo-Dur (theophylline)

Corticosteroids Beconase (beclomethasone)

Prednisone

Solumedrol

Leukotriene Modifiers Accolate (zafirlukast)

Singulair (montelukast)

Mast Cell Stabilizers Intal (cromolyn)

7.5

CLASSIFICATION OF RESPIRATORY DISORDERS

Place the following conditions into the correct category:

Pulmonary emboli Asthma Pulmonary fibrosisForeign body obstruction Pulmonary edema ARDSPneumothorax Sepsis PolioMyasthenia Gravis crisis Tumor EmphysemaPneumonia Trauma Thoracic wall surgeryObesity Flail chest ScoliosisBotulism Hyperthermia CardiomyopathyShock MI Heart FailureCystic fibrosis Bronchitis

Nonpulmonary Disorders:

Pleura and chest wall pathology:

Respiratory muscle and nerve pathology:

Increased oxygen consumption:

Inadequate cardiac output:

Pulmonary Disorders:

Airway Obstruction:

Parenchymal Diseases:

Vascular diseases:

7.6

THEORY CONTENT: HEALTH DEVIATION: ACUTE RENAL FAILURE

10. Independently review the anatomy and physiology of the kidneys from nursing prerequisite courses.

11. Discuss the following functions of the kidneys as it pertains to preventing health deviations:a. Regulation of water and electrolytesb. Regulation of blood pressurec. Regulation of acid-based. Regulation of erythropoiesise. Regulation of calcium and phosphate

12. Define and describe the common health deviations resulting from acute renal failure, acute tubular necrosis and nephrotic syndrome.

13. Describe, differentiate and discuss the etiology/ risk factors, pathophysiology, assessment, nursing interventions and management of the patient in acute renal failure in terms of the categories of prerenal, intrarenal and postrenal failure. Use “Causes of Acute Renal Failure” worksheet, page 8.2.

14. Describe and discuss the purpose/ rationale, normal values, and nursing responsibilities for the following tests:a. Serum BUN f. Renal Angiographyb. Serum Creatinine g. Renal Biopsyc. Serum Osmolarity h. Renal Ultrasoundd. Creatinine Clearance i. KUBe. 24 hour urine

15. Identify and differentiate between the three phases of (Oliguric, Diuretic, and Recovery) of acute renal failure in terms ofa. Pathophysiologyb. Clinical manifestations/ assessmentc. Fluid, electrolytes, and metabolic changesd. Management and nursing interventions

16. List the nursing interventions associated with each of the three nursing agencies (wholly compensatory, partially compensatory, and educative supportive) for the patient progressing through the phases of acute renal failure.

17. Describe the educative/ supportive nursing interventions pertaining to the dietary restrictions for the acute renal patient in each of the three phases of acute renal failure.

8.018. Explain the action, effects, and rationale for the following medications that may be

prescribed for the acute renal failure patient:

a. Sodium Bicarbonateb. Glucose and Insulinc. Kayexalate

19. Describe the common causes, pathophysiology, treatment and possible complications of rhabdomyolysis.

20. Describe the following in regards to acute glomerulonephritis:a. Etiologyb. Pathophysiologyc. Clinical manifestations

21. Identify the possible complications of peritoneal dialysis and hemodialysis. Describe the collaborative management of these complications.

REQUIRED ASSIGNMENTS:

Text: Urden, Stacy & Lough, Priorities in Critical Care Nursing, 5th edition, Chapters 19 and 20.

Brunner and Suddarth’s Textbook of Medical Surgical Nursing, 12th Edition, Chapters 43, 44, and 45.

Dudek: 5th edition: Nutrition Essentials for Nursing Practice, Chapter 20: Nutrition for Patients with Renal Disorders

Davis: as needed

Syllabus: Causes of Renal Failure, page 8.2

8.1

RENAL WORKSHEETCauses of Acute Renal Failure

Type of Failure

Etiology/ Predisposing

Factors

Pathophysiology

Assessments Nursing Interventions/

Medical Management

Prerenal

Intrarenal

Postrenal

8.2

RENAL WORKSHEETPhases of Acute Renal Failure

Phase Pathophysiological Results of Nursing

Changes Pathophysiologic Changes

Interventions Medical

Management Educative

Supportive Role

Oliguric

Diuretic

Recovery

8.3

THEORY CONTENT: NEUROLOGICAL HEALTH DEVIATIONS IN CRITICAL CARE

1. Independently review anatomy and physiology, assessments, health deviations, and diagnostic tests related to the nervous system from ADN 12B and previous courses.

2. Define intracranial pressure (ICP) and identify the pathophysiologic process, common causes, signs and symptoms, health deviations, and medical and nursing management of increased intracranial pressure using the Increased Intracranial Worksheets. Define Cerebral Perfusion Pressure (CPP) and discuss its significance in monitoring the patient with a high ICP.

3. Describe the various types of ICP monitors and drains. Describe the health deviations, risks and nursing responsibilities associated with these devices.

4. Discuss health deviations found in patients with head trauma including concussion, diffuse axonal injury, cerebral contusion, and basilar skull fracture. Describe nursing and medical management of each type of injury.

5. Review the various types of cerebral bleeds including intracerebral hemorrhage, subdural hematoma, epidural hemorrhage, and subarachnoid hemorrhage. Describe the causes, clinical manifestations, and nursing role in the treatment of each type of cerebral bleed.

6. Describe the causes, pathophysiology, and common complications of subarachnoid hemorrhage.

7. Complete the Neurological Medications Worksheet.

8. Describe the potential complication of brain herniation, including predisposing factors and the nurse’s role in prevention.

9. Describe the pituitary complications associated with brain injury.

10.Describe emergency and critical care treatment of patients with Cerebrovascular Accident (CVA) including interventional procedures and the use of thrombolytic medications.

11.Describe the criteria used to determine brain death. Discuss special considerations in the care of the brain dead patient in preparation for organ donation. Describe the educative/supportive role of the nurse in the care of the family of the brain dead patient.

12.Describe the special problems and nursing management of the unconscious patient. Be prepared to discuss applicable nursing diagnoses.

9.0

ASSIGNMENTS:

Text:Brunner and Suddarth: 12th edition, pp. 1828-1856, 1895-1948.Lippincott Nurse’s Drug Guide, as needed.Urden, Stacy & Lough, 5th edition.

Syllabus:Worksheet: Neurological MedicationsWorksheet: Vocabulary: Neurologic Health Deviations

9.1

Worksheet: Medications for the Critically Ill Neurological Patient

Drug Action/Indication

Route/Dose Nursing Considerations

Dilantin

Phenobarbital

Mannitol

Solu-Medrol

3% Normal Saline

9.2

VOCABULARY: NEUROLOGICAL HEALTH DEVIATIONS

Doll’s Eyes

Nystagmus

Nuchal Rigidity

Deep Tendon Reflexes

Craniotomy

Burr Holes, Bone Flap

Vertigo

Hydrocephalus

Decorticate Posturing

Decerebrate Posturing

Kernig’s Sign

Brudzinski’s Sign

Halo Sign

Periorbital Edema

Papilledema

Battle’s sign

Racoon eyes

Cushing’s Triad

Babinski’s Reflex

Plantar Reflex

Dermatomes

Ipsilateral

Contralateral

9.3