Content Outline and Competencies:

I. Professional Issues and Conceptual Thinking in Nursing Practice

A. Professional Behaviors

1. Explore nursing behaviors that demonstrate professionalism.

2. Acknowledge the need for lifelong professional learning.

B. Caring Practices

1. Discuss the meaning of caring.

2. Evaluate the importance of self-care for the professional nurse.

C. Advocacy and Accountability

1. Examine the criteria of the profession and the professionalization of nursing.

2. Provide examples of the nurse performing in the role of advocate.

D. Communication and Collaboration

1. Suggest strategies to promote successful verbal/nonverbal communication.

2. Apply the techniques necessary to establish trust in the therapeutic nurse-patient relationship.

E. Nursing Process

1. Define the nursing process, focusing on assessment, nursing diagnosis, planning and implementation.

2. Describe the relationships among the nursing process, critical thinking, the problem-solving process and the decision-making process.

3. Discuss the evaluation component of the nursing process as it relates to basic nursing interventions.

F. Health Promotion and Delivery Systems

1. Differentiate different types of healthcare agencies and the type of services they provide.

2. Discuss the advantages and disadvantages of different frameworks for delivering care.

G. Evidence-Based Practice

1. Discuss the importance of evidence-based practice in healthcare and nursing.

2. Describe the goals and purpose of evidence-based practice.

3. Explore the importance of developing an attitude of clinical inquiry.

H. Safety and Quality Improvement in the Healthcare Environment

1. Identify potential hazards in the healthcare environment, including but not limited to: medical/surgical asepsis, protective precautions, medication administration and appropriate perioperative practices.

2. Employ safe practices including but not limited to: medical/surgical asepsis, protective precautions, medication administration and appropriate perioperative practices.

3. Explore the importance of a comprehensive health/physical assessment, including risk identification.

4. Identify basic patient care activities/procedures that are wasteful and potentially unsafe.

5. Discuss national initiatives for quality healthcare improvement.

I. Clinical Judgment

1. Identify the skills and attitudes required for critical thinking.

2. Discuss how the concept-based curriculum forms a framework for learning.

3. Provide an example of a nursing concept and associated exemplars.

II. Professional Standards in Nursing Practice

A. Ethics and Values

1. Explain the ANA Code of Ethics and Kansas Nurse Practice Act.

2. Discuss basic principles of ethical decision-making.

3. Identify values and ethics in the nursing profession.

B. Legal Implications in Nursing Practice

1. Discuss the rights of patients in the healthcare system.

2. Explain the need for patient advocacy.

3. Discuss the impact of HIPAA on nursing practice.

C. Roles of the Registered Nurse and the Multidisciplinary Team

1. Discuss the collaborative role of the nurse within the healthcare team.

2. Identify the members and roles of the multidisciplinary team.

D. Facilitator of Learning

1. Examine individual learning needs.

2. Identify appropriate resources to meet the learning needs of stable patients.

3. Discuss useful teaching strategies for patients with diverse learning needs.

E. Documentation and Informatics

1. Discuss the required elements for nursing documentation.

2. Compare similarities and differences in paper, electronic and hybrid healthcare records.

3. Accurately document patient data in the health record.

4. Discuss informatics security in the healthcare setting.

III. Psychosocial Basis in Nursing Practice

A. Self-Concept

1. Explore the impact of one’s self-concept in the nurse-patient relationship.

2. Verbalize the importance of assessing humanistic values.

B. Spiritual Health

1. Define the concept of spirituality as it relates to nursing and healthcare.

2. Demonstrate common assessments to determine the needs of patients.

3. Discuss how spiritual preferences may affect an individual’s healthcare choices.

C. Cultural Diversity

1. Discuss the concept of cultural identity.

2. Identify the implications for safe, individualized nursing care.

3. Discuss how cultural preferences may affect an individual’s healthcare choices.

D. Grief and Loss

1. Identify the fundamental principles of grief and loss.

2. Discuss caring interventions that address normal grief and loss.

E. Stress and Coping

1. Define the stress response.

2. Identify commonly occurring alterations in stress and coping.

3. Differentiate between positive and negative coping strategies in health and illness.

F. Cognition and Mood/Affect

1. Discuss normal presentation of the patient in a balanced mental state, including caring practices to maintain mental wellness.

2. Describe common alterations in mental state (e.g., confusion, anxiety and depression).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in mental state including collaborative interventions (medical/surgical and pharmacology).

5. Discuss the scientific principles underlying the mind/body connection.

IV. Physiological Basis for Nursing Practice

A. Comfort

1. Discuss normal presentation of the patient in a state of comfort, including caring practices to maintain comfort.

2. Describe common alterations in comfort (e.g., pain and fatigue).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in comfort, including collaborative interventions (medical/surgical and pharmacology).

B. Nutrition/digestion/absorption

1. Discuss normal presentation of the patient in a balanced nutritional state.

2. Identify common alterations in nutritional health (e.g., nausea, vomiting and anorexia).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in nutritional state, including collaborative interventions (medical/surgical and pharmacology).

C. Elimination

1. Discuss normal presentation of the patient in a balanced state of urinary and bowel health.

2. Identify common alterations in urinary and bowel health (e.g., constipation and diarrhea).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in urinary and bowel health, including collaborative interventions (medical/surgical and pharmacology).

D. Mobility

1. Discuss normal presentation of the patient with stable musculoskeletal system.

2. Identify common alterations in the musculoskeletal system and hazards of immobility (e.g., fractures, joint and spine alterations).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in musculoskeletal system, including collaborative interventions (medical/surgical and pharmacology).

E. Tissue Integrity

1. Discuss normal presentation of the patient with tissue integrity.

2. Identify common alterations in tissue integrity (e.g., pressure ulcers and simple wounds).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in tissue integrity, including collaborative interventions (medical/surgical and pharmacology).

F. Oxygenation

1. Discuss normal presentation of the patient with normal oxygenation.

2. Identify common alterations in oxygenation (e.g., pneumonia, dyspnea and bronchitis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in oxygenation, including collaborative interventions (medical/surgical and pharmacology).

G. Perfusion, Transport, Exchange

1. Discuss normal presentation of the patient with adequate perfusion, transport and exchange.

2. Identify common alterations in perfusion, transport and exchange (e.g., hypertension and coronary artery disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in perfusion, transport, and exchange, including collaborative interventions (medical/surgical and pharmacology).

H. Inflammation, Infection, Immunity

1. Discuss normal presentation of the patient with a healthy immune system.

2. Identify common alterations in inflammation, infection and immunity (e.g., influenza, peptic ulcer disease and hypersensitivity).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in inflammation, infection and immunity, including collaborative interventions (medical/surgical and pharmacology).

I. Cellular Regulation

1. Discuss the presentation of the patient with normal cellular function.

2. Identify common alterations in cellular regulation (e.g., anemia and colon cancer).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in cellular regulation, including collaborative interventions (medical/surgical and pharmacology).

J. Fluids and Electrolytes

1. Discuss the presentation of the patient with normal fluid and electrolyte balance.

2. Identify common alterations in fluid and electrolyte balance (e.g., fluid volume excess/deficit).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in fluid and electrolyte balance, including collaborative interventions (medical/surgical and pharmacology).

K. Acid-Base Balance

1. Discuss presentation of the patient with normal acid-base balance.

2. Identify basic alterations in acid-base balance (establishing a foundation for future courses).

L. Metabolism

1. Discuss the presentation of the patient in metabolic balance and homeostasis.

2. Identify common alterations in metabolism (e.g., obesity and diabetes mellitus).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in metabolism, including collaborative interventions (medical/surgical and pharmacology).

M. Sensory Perception

1. Discuss the presentation of the patient with normal sensory perception.

2. Identify basic alterations in sensory perception (establishing a foundation for future courses).

N. Intracranial Regulation

1. Discuss the presentation of the patient with normal neurological function.

2. Identify common alterations in neurological function (e.g., seizures and levels of consciousness).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in neurological function including collaborative interventions (medical/surgical and pharmacology).

Content Outline and Competencies:

I. Foundations for Health Assessment

A. Components of Health Assessment

1. Differentiate between the different types of health assessment.

2. Differentiate between subjective and objective data.

3. Describe the relationship of health assessment to health promotion.

4. Compare organizing frameworks for collecting assessment data.

5. Discuss characteristics of an assessment that promote critical thinking.

B. Obtaining the Health History

1. Compare emergency, focused and comprehensive health histories.

2. Perform a complete review of systems and basic health history.

3. Apply principles of therapeutic communication during the health history interview.

4. Identify teaching opportunities for health promotion and risk reduction.

5. Accurately and thoroughly document techniques and findings using appropriate medical terminology.

C. General Overview: The Head To Toe Assessment

1. Appropriately apply standard precaution guidelines during the physical assessment.

2. Correctly perform a basic shift assessment using proper techniques including inspection, palpation, and auscultation.

3. Use critical thinking to identify indications for focused assessments and vital signs.

4. Accurately measure, record and report vital signs.

5. Differentiate normal from abnormal, age-related and cultural variations in vital signs.

6. Accurately and thoroughly document the head-to-toe assessment.

D. Sensory-Perceptual Assessment (Pain, Mental Health, Sleep, Safety)

1. Identify appropriate questions for a problem-based history related to mental health status (e.g., depression, anxiety).

2. Ask appropriate questions to effectively assess all aspects of pain.

3. Compare multidimensional pain assessment tools for newborns, children and older adults.

4. Outline objective data indicative of acute and chronic pain.

5. Identify appropriate questions for a problem-based history related to sleep (e.g., insomnia, sleep apnea, safety).

II. Focus on Systems Health Assessment of the Adult

A. The Integument (Skin and Wound)

1. Recognize skin-related findings in patients with light versus dark skin.

2. Identify common symptoms of skin disease (pruritis, rashes, cyanosis, erythema, jaundice, pallor, petechiae).

3. Conduct routine inspection and palpation of the skin for texture, temperature, moisture, turgor.

4. Correlate abnormal findings of skin and hair distribution with possible systemic disease.

B. Head, Eyes, Ears, Nose and Throat

1. Identify possible risk factors associated with hearing and vision loss.

2. Identify appropriate questions for a problem-based history related to headaches, dizziness, vertigo, visual changes, hearing loss, tinnitus, nasal discharge, sore throat, oral lesions.

3. Conduct routine inspection of ocular structures, conjunctiva, pupils, mouth, lips, teeth, gums, tongue, palate, oropharynx, neck.

4. Correlate abnormal findings associated with the head and neck with possible disease processes.

C. Lung and Respiratory System

1. Identify possible risk factors associated with lung cancer.

2. Identify appropriate questions for a problem-based history related cough, shortness of breath, chest pain with breathing.

3. Conduct routine inspection and auscultation of anterior, posterior and lateral thorax.

4. Differentiate among various adventitious and normal breath sounds.

5. Correlate abnormal findings associated with the lung assessment with possible disease processes.

D. Heart and Peripheral Vascular System

1. Identify possible risk factors associated with hypertension and coronary artery disease.

2. Identify appropriate questions for a problem-based history related to chest pain, shortness of breath, cough, nocturia, fatigue, fainting, peripheral edema, claudication, peripheral neuropathy.

3. Conduct routine inspection, palpation and auscultation of the heart and peripheral vascular system.

4. Correlate abnormal findings associated with the heart and peripheral vascular system with possible disease processes.

E. Abdominal Assessment (Gastrointestinal and Genitourinary Systems)

1. Identify possible risk factors associated with abdominal cancers.

2. Identify appropriate questions for a problem-based history related to abdominal/flank pain, distention, jaundice, change in bowel habits and/or urination.

3. Collect objective data with the inspection, auscultation and palpation of organs within the abdominal cavity.

4. Identify normal, variations of normal and abnormal findings within the abdominal assessment.

5. Correlate assessment data and abnormal findings with possible causative factors and/or disease processes.

F. Musculoskeletal System

1. Identify possible risk factors associated with musculoskeletal disease processes.

2. Identify appropriate questions for a problem-based history related to pain, problems with movement and/or activities of daily living, safety issues.

3. Conduct routine symmetrical inspection and palpation of the extremities, joints and spine.

4. Differentiate musculoskeletal pain from neuropathic pain.

5. Correlate abnormal findings associated with the musculoskeletal assessment with possible causative factors and/or disease processes.

G. Neurological System

1. Identify possible risk factors associated with cerebral vascular accident.

2. Identify appropriate questions for a problem-based history related to dizziness, seizures, loss of consciousness, changes in movement and/or sensation, dysphagia and aphasia.

3. Conduct routine assessment of mental status, level of consciousness, speech and gait.

4. Observe basic cranial nerve function throughout the interview and exam.

H. Reproduction system: Male and Female Genitalia and Rectal Assessments

1. Recognize age, ethnicity and cultural differences in approaching assessment of the male and female genitalia.

2. Identify teaching opportunities for health promotion and risk reduction related to the reproduction system in male and female clients.

3. Identify appropriate questions for a problem-based history related to present health status, past medical history and sexual history.

4. Identify components of a physical assessment for the male genitalia, rectum and prostate.

5. Identify components of a physical assessment for the female genitalia and rectum, pelvic examination and screening tests.

6. Identify normal, variations of normal and abnormal findings within the abdominal assessment.

7. Correlate assessment data and abnormal findings with possible causative factors and/or disease processes.

III. Health Assessment and Special Populations

A. Children and Adolescents

1. Identify structures and functions of each body system that may be different in the child or adolescent than in the adult.

2. Identify teaching opportunities for health promotion and risk reduction in children and adolescents.

3. Identify appropriate questions for a problem-based history appropriate for the patient and/or caregiver.

4. Recognize how the physical assessment process may be different from that employed in the adult population.

B. Older Adults

1. Identify normal changes that occur with aging.

2. Identify risk factors in older adults for malnutrition, impaired mobility, polypharmacy and skin breakdown.

3. Identify teaching opportunities for health promotion and risk reduction in this population.

4. Identify appropriate questions for a problem-based history appropriate for the patient and/or caregiver.

5. Recognize how the physical assessment process may be adjusted for this population.

IV. The Comprehensive Health Assessment: Pulling it all together

A. Individualize the comprehensive health assessment by considering the condition, age, gender, culture and spirituality of the patient.

B. Determine criteria for conducting a comprehensive physical assessment based on patient situation and setting.

C. Demonstrate competency in conducting a basic shift and focused assessment, and/or comprehensive physical assessment as determined by faculty.

Note: Assessment relevant to the specialty areas (pregnant woman, newborn, infant, child, adolescent and older adult) will be emphasized in greater depth in subsequent courses.

Content Outline and Competencies:

I. Care of the Childbearing Family and Child: Professional Issues and Conceptual Thinking

A. Professional behaviors

1. Demonstrate professional nursing behaviors.

2. Discuss the nursing roles that are unique to the childbearing family and child.

B. Caring practices

1. Demonstrate a caring approach to the patient and family.

2. Plan care incorporating the developmental level, the family culture, spirituality and environment.

C. Advocacy and accountability

1. Demonstrate flexibility with the patient’s family, allowing them to speak for/represent themselves when possible.

2. Develop a plan of care to include patient rights.

D. Communication and collaboration

1. Participate in group activities and discussion regarding patient care.

2. Identify the key competencies for effective communication and collaboration.

3. Collaborate with the healthcare team to provide quality and safety in nursing care.

E. Nursing process

1. Complete an accurate physical assessment specific to mother, infant and child.

2. Implement the nursing process that is individualized to the childbearing family and child.

F. Health promotion and delivery systems

1. Develop a teaching plan for the health promotion needs of the childbearing family and child.

2. Differentiate types of health care systems and how they provide delivery of care to the childbearing family and child.

3. Identify community resources available to the childbearing family and child.

G. Evidence-based practice

1. Implement evidence-based practice in the care of specialized populations.

2. Provide scientific rationales for nursing interventions.

3. Seek advice, resources or information to improve patient care.

H. Safety and quality improvement in the healthcare environment

1. Describe the nurse’s role in reducing risk and improving quality.

2. Implement appropriate safety measures for specialized populations.

3. Perform an age-appropriate comprehensive health/physical assessment including risk identification.

4. Implement patient care activities/procedures that are not wasteful and potentially unsafe.

I. Clinical judgment

1. Make clinical judgments based on an understanding of the whole picture for moderately complex patient populations.

2. Identify patterns and trends that may predict the direction of illness.

3. Discuss own vulnerability and/or low resiliency in clinical decision-making situations.

II. Care of the Childbearing Family and Child: Professional Standards

A. Ethics and values

1. Identify potential ethical dilemmas.

2. Identify principles in ethical decision-making unique to the childbearing family and child.

3. Advocate for patient’s rights with the childbearing family and children.

B. Legal implications in nursing practice

1. Examine the impact of HIPAA on the childbearing family and child.

2. Apply the requirements for protecting patient information.

C. Roles of the registered nurse and the multidisciplinary team

1. Discuss the expanded role of the nurse within the childbearing family and child.

2. Engage in collaboration to plan and implement care.

D. Facilitator of learning

1. Use appropriate resources to meet learning needs of patients with limited personal/psychological supportive resources.

2. Implement individualized teaching strategies for patients with diverse learning needs.

E. Documentation and informatics

1. Accurately document patient data in the health records that are unique to the childbearing family and child.

2. Perform security measures to ensure informatics security in the healthcare setting.

III. Care of the Childbearing Family and Child: Psychosocial Concepts

A. Self-Concept

1. Explore strategies to promote a healthy self-concept.

2. Examine the relationship between psychosocial development and self-concept.

B. Spiritual health

1. Describe the influence of spiritual belief on birth, life changes and death.

2. Assess the spiritual beliefs to determine the needs of the patient.

C. Cultural diversity

1. Describe the influence of cultural diversity on birth, life changes and death.

2. Demonstrate the nursing process in providing culturally competent care.

D. Grief and loss

1. Develop a plan of care for a patient/family working through the grieving process.

2. Contrast normal grief responses to those that indicate an alteration in the grieving process.

E. Stress and coping

1. Discuss stress as it relates to changes in family dynamics.

2. Plan nursing care to incorporate coping strategies appropriate to the stressor.

F. Cognition and mood/affect

1. Discuss mental health and developmental levels specific to the childbearing family and child.

2. Describe common alterations in mental health and developmental levels. (e.g., post-partum depression and developmental disabilities).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in mental health and developmental levels, including collaborative interventions (medical/surgical and pharmacology).

IV. Care of the Childbearing Family and Child: Physiological Basis

A. Sexuality and reproduction

1. Discuss sexual development and diversity.

2. Describe common alterations in reproduction (e.g., infertility, abortion and sexually transmitted infections).

3. Compare the advantages and disadvantages of various methods of contraception.

4. Explain the etiology and pathophysiology of relevant exemplars.

5. Apply the nursing process to the care of the childbearing family and child with alterations in reproduction, including collaborative interventions (medical/surgical and pharmacology).

B. Comfort

1. Compare and contrast a normal versus abnormal presentation of pain in the childbearing family and child.

2. Describe common alterations in comfort in this unique population (e.g., pain and fatigue).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in comfort, including collaborative interventions (medical/surgical and pharmacology).

C. Nutrition/digestion/absorption

1. Describe the nutrition, digestion and absorption processes unique to the childbearing family and child.

2. Identify common alterations in nutritional health (e.g., hyperemesis gravidarum and gastroesophageal reflux disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in nutrition, digestion, and absorption, including collaborative interventions (medical/surgical and pharmacology)

D. Elimination

1. Compare and contrast normal versus abnormal developmental aspects of urinary and bowel elimination.

2. Identify common alterations in urinary and bowel elimination (e.g., hemorrhoids, Hirschsprung's disease, vesicle ureteral reflux, and pyelonephritis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in urinary and bowel elimination, including collaborative interventions (medical/surgical and pharmacology).

E. Mobility

1. Compare and contrast normal versus abnormal developmental aspects of mobility.

2. Identify common alterations in the musculoskeletal system (e.g., lower back pain, scoliosis and congenital hip dysplasia).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in mobility, including collaborative interventions (medical/surgical and pharmacology).

F. Tissue integrity

1. Discuss normal presentation of the childbearing family and child with tissue integrity.

2. Identify common alterations in tissue integrity (e.g., episiotomy incision, burns and skin lesions).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in tissue integrity including collaborative interventions (medical/surgical and pharmacology).

G. Oxygenation

1. Discuss normal presentation of the childbearing family and child with normal oxygenation.

2. Identify common alterations in oxygenation (e.g., asthma, respiratory syncytial virus, meconium aspiration and cerebral palsy).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in oxygenation, including collaborative interventions (medical/surgical and pharmacology).

H. Perfusion, Transport, Exchange

1. Discuss normal presentation of the childbearing family and child with adequate perfusion, transport and exchange.

2. Identify common alterations in perfusion, transport and exchange (e.g., pre-eclampsia, cardiomyopathy and congenital heart disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in perfusion, transport and exchange, including collaborative interventions (medical/surgical and pharmacology).

I. Inflammation, infection, immunity

1. Compare and contrast the unique features of the mature versus immature infant immune system.

2. Identify immunization needs and immune response in the childbearing family and child (e.g., Rh disease and vaccinations).

3. Identify common alterations in inflammation, infection and immunity with the childbearing family and child (e.g., group beta streptococcus, meningitis and appendicitis).

4. Explain the etiology and pathophysiology of relevant exemplars.

5. Apply the nursing process to the care of the childbearing family and child with alterations in inflammation, infection and immunity, including collaborative interventions (medical/surgical and pharmacology).

J. Cellular regulation

1. Discuss the presentation of the childbearing family and child with normal cellular function.

2. Identify common alterations in cellular regulation (e.g., sickle cell anemia, leukemia, breast and testicular cancer).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in cellular regulation, including collaborative interventions (medical/surgical and pharmacology).

K. Fluids and electrolytes

1. Discuss the normal presentation of fluids and electrolytes in the childbearing family and child.

2. Identify common alterations in fluid and electrolyte balance (e.g., hemodilution, hemoconcentration, and acute vomiting and diarrhea).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in fluid and electrolyte balance, including collaborative interventions (medical/surgical and pharmacology).

L. Acid-Base balance

1. Discuss presentation of the childbearing family and child with normal acid-base balance.

2. Identify basic alterations in acid-base balance for this unique population.

M. Metabolism

1. Discuss the presentation of the childbearing family and child in metabolic balance and homeostasis.

2. Identify common alterations in metabolism (e.g., gestational diabetes and diabesity).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in metabolism, including collaborative interventions (medical/surgical and pharmacology).

N. Intracranial regulation

1. Discuss the presentation of the childbearing family and child with normal neurological function.

2. Identify common alterations in neurological function (e.g., eclamptic seizures, febrile seizures, epilepsy and neural tube disorders).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the childbearing family and child with alterations in neurological function, including collaborative interventions (medical/surgical and pharmacology).

Content Outline and Competencies:

I. Care of the Adult, Childbearing Family, Child and Adolescent: Professional Issues and Conceptual Thinking

A. Professional behaviors

1. Demonstrate professional nursing behaviors.

2. Discuss the nursing role for this patient population.

B. Caring practices

1. Demonstrate a caring approach to the patient and family.

2. Plan care incorporating the developmental level, the family culture, spirituality and environment.

C. Advocacy and accountability

1. Demonstrate flexibility with patient’s family, allowing them to speak for/represent themselves when possible.

2. Develop a plan of care to include patient rights.

D. Communication and collaboration

1. Participate in group activities and discussion regarding patient care.

2. Identify the key competencies for effective communication and collaboration.

3. Collaborate with the healthcare team to provide quality and safety in nursing care.

E. Nursing process

1. Complete an accurate physical assessment.

2. Implement the nursing process that is individualized to this patient population.

F. Health promotion and delivery systems

1. Develop a teaching plan for the health promotion needs of this patient population.

2. Differentiate types of healthcare systems and how they provide delivery of care to this patient population.

3. Identify community resources available to this patient population.

G. Evidence-based practice

1. Implement evidence-based practice in the care of this patient population.

2. Provide scientific rationales for nursing interventions.

3. Seek advice, resources or information to improve patient care.

H. Safety and quality improvement in the healthcare environment

1. Describe the nurse’s role in reducing risk and improving quality.

2. Implement appropriate safety measures for this patient population.

3. Perform an age-appropriate comprehensive health/physical assessment, including risk identification.

4. Implement patient care activities/procedures that are not wasteful or potentially unsafe.

I. Clinical judgment

1. Make clinical judgments based on an understanding of the whole picture for moderately complex patient populations.

2. Identify patterns and trends that may predict the direction of illness.

3. Discuss own vulnerability and/or low resiliency in clinical decision-making situations.

II. Care of the Adult, Childbearing Family, Child and Adolescent: Professional Standards

A. Ethics and values

1. Identify potential ethical dilemmas.

2. Identify principles in ethical decision-making unique to this patient population.

3. Advocate for patient’s rights with this patient population.

B. Legal implications in nursing practice

1. Examine the impact of HIPAA on this patient population.

2. Apply the requirements for protecting patient information.

C. Roles of the registered nurse and the multidisciplinary team

1. Discuss the expanded role of the nurse within this patient population.

2. Engage in collaboration to plan and implement care.

D. Facilitator of learning

1. Use appropriate resources to meet learning needs of patients with limited personal/psychological supportive resources.

2. Implement individualized teaching strategies for patients with diverse learning needs.

E. Documentation and informatics

1. Accurately document patient data in the health records that are unique to this patient population.

2. Perform security measures to ensure informatics security in the healthcare setting.

III. Care of the Adult, Childbearing Family, Child and Adolescent: Psychosocial Concepts

A. Self-concept

1. Explore strategies to promote a healthy self-concept.

2. Examine the relationship between psychosocial development and self-concept.

B. Spiritual health

1. Describe the influence of spiritual belief on birth, life changes and death.

2. Assess the spiritual beliefs to determine the needs of the patient.

C. Cultural diversity

1. Describe the influence of cultural diversity on birth, life changes and death.

2. Demonstrate the nursing process in providing culturally competent care.

D. Grief and loss

1. Develop a plan of care for a patient/family working through the grieving process.

2. Contrast normal grief responses to those that indicate an alteration in the grieving process.

E.Stress and coping

1. Discuss stress as it relates to changes in family dynamics.

2. Plan nursing care to incorporate coping strategies appropriate to the stressor.

F.Cognition and mood/affect

1. Discuss mental health and developmental levels specific to this patient population.

2. Describe common alterations in mental health and developmental levels. (e.g., postpartum depression and developmental disabilities).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in mental health and developmental levels, including collaborative interventions (medical/surgical and pharmacology).

IV: Care of the Adult, Childbearing Family, Child and Adolescent: Physiological Basis

A. Sexuality and reproduction

1. Discuss sexual development and diversity.

2. Describe common alterations in reproduction (e.g., infertility, abortion and sexually transmitted infections).

3. Compare the advantages and disadvantages of various methods of contraception.

4. Explain the etiology and pathophysiology of relevant exemplars.

5. Apply the nursing process to the care of this patient population with alterations in reproduction, including collaborative interventions (medical/surgical and pharmacology).

B. Comfort

1. Compare and contrast a normal versus abnormal presentation of pain in this patient population.

2. Describe common alterations in comfort in this unique population (e.g., pain and fatigue).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in comfort, including collaborative interventions (medical/surgical and pharmacology).

C. Nutrition/digestion/absorption

1. Describe the nutrition, digestion and absorption processes unique to this patient population.

2. Identify common alterations in nutritional health (e.g., hyperemesis gravidarum and gastroesophageal reflux disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in nutrition, digestion and absorption, including collaborative interventions (medical/surgical and pharmacology).

D. Elimination

1. Compare and contrast normal versus abnormal developmental aspects of urinary and bowel elimination.

2. Identify common alterations in urinary and bowel elimination (e.g., Hirschsprung's disease, vesicoureteral reflux and pyelonephritis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the patient with alterations in urinary and bowel elimination, including collaborative interventions (medical/surgical and pharmacology).

E. Mobility

1. Compare and contrast normal versus abnormal developmental aspects of mobility.

2. Identify common alterations in the musculoskeletal system (e.g., lower back pain, scoliosis and congenital hip dysplasia).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to this patient population with alterations in mobility, including collaborative interventions (medical/surgical and pharmacology).

F. Tissue integrity

1. Discuss normal presentation of this patient population with tissue integrity.

2. Identify common alterations in tissue integrity (episiotomy incision, burns and skin lesions).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in tissue integrity, including collaborative interventions (medical/surgical and pharmacology).

G. Oxygenation

1. Discuss normal presentation of this patient population with normal oxygenation.

2. Identify common alterations in oxygenation (e.g., asthma, respiratory syncytial virus, meconium aspiration and cerebral palsy).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to this patient population with alterations in oxygenation, including collaborative interventions (medical/surgical and pharmacology).

H. Perfusion, transport, exchange

1. Discuss normal presentation of this patient population with adequate perfusion, transport and exchange.

2. Identify common alterations in perfusion, transport and exchange (e.g., pre-eclampsia, cardiomyopathy and congenital heart disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to this patient population with alterations in perfusion, transport and exchange, including collaborative interventions (medical/surgical and pharmacology).

I. Inflammation, infection, immunity

1. Compare and contrast the unique features of the mature versus immature infant immune system.

2. Identify immunization needs and immune response in this patient population (e.g., Rh incompatibility and vaccinations).

3. Identify common alterations in inflammation, infection and immunity with this patient population (e.g., group beta streptococcus, meningitis and appendicitis).

4. Explain the etiology and pathophysiology of relevant exemplars.

5. Apply the nursing process to this patient population with alterations in inflammation, infection and immunity, including collaborative interventions (medical/surgical and pharmacology).

J. Cellular regulation

1. Discuss the presentation of this patient population with normal cellular function.

2. Identify common alterations in cellular regulation (e.g., sickle cell anemia, leukemia and lymphoma).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in cellular regulation, including collaborative interventions (medical/surgical and pharmacology).

K. Fluids and electrolytes

1. Discuss the normal presentation of fluids and electrolytes in this patient population.

2. Identify common alterations in fluid and electrolyte balance, including nursing care of the patient receiving IV solutions (e.g., hemodilution, hemoconcentration, and acute vomiting and diarrhea).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in fluid and electrolyte balance, including collaborative interventions (medical/surgical and pharmacology).

L. Acid-base balance

1. Discuss presentation of this patient population with normal acid-base balance.

2. Identify basic alterations in acid-base balance for this unique population.

M. Metabolism

1. Discuss the presentation of this patient population in metabolic balance and homeostasis.

2. Identify common alterations in metabolism (e.g., gestational diabetes and obesity).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in metabolism, including collaborative interventions (medical/surgical and pharmacology).

N. Intracranial regulation

1. Discuss the presentation of this patient population with normal neurological function.

2. Identify common alterations in neurological function (e.g., eclamptic seizures, febrile seizures, epilepsy and neural tube disorders).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of this patient population with alterations in neurological function, including collaborative interventions (medical/surgical and pharmacology).

Content Outline and Competencies:

I. Care of the Vulnerable Adult Patient: Professional Issues and Conceptual Thinking

A. Professional behaviors

1. Demonstrate professional nursing behaviors with increasingly vulnerable adult patients.

2. Apply the principles of the nursing role that are unique to the vulnerable adult patient.

B. Caring practices

1. Demonstrate a caring approach to the vulnerable adult patient with increasing independence.

2. Plan care incorporating the developmental level, the family culture, spirituality and environment with increasing independence.

C. Advocacy and accountability

1. Demonstrate flexibility with the increasingly vulnerable adult patient, allowing them to speak for/represent themselves when possible.

2. Plan care incorporating the vulnerable adult patient’s rights.

D. Communication and collaboration

1. Contribute to group activities and discussion regarding vulnerable adult patient care.

2. Utilize the key competencies for effective communication and collaboration.

3. Collaborate with the healthcare team to provide quality and safety in nursing care of the increasingly vulnerable adult patient.

E. Nursing process

1. Complete an accurate comprehensive assessment specific to the vulnerable adult patient.

2. Implement the nursing process that is individualized to the vulnerable adult patient.

F. Health promotion and delivery systems

1. Implement a teaching plan for the health promotion needs of the vulnerable adult patient.

2. Differentiate types of healthcare systems and how they provide delivery of care to the vulnerable adult patient.

3. Participate in community activities utilizing resources available to the vulnerable adult patient.

G. Evidence-based practice

1. Implement evidence-based practice in the care of the vulnerable adult patient.

2. Examine scientific rationales for nursing interventions.

3. Interpret advice, resources or information to improve vulnerable adult patient care.

H. Safety and quality improvement in the healthcare environment

1. Demonstrate the nurse’s role in reducing risk and improving quality.

2. Implement appropriate safety measures for the vulnerable adult patient.

3. Perform an age-appropriate comprehensive assessment, including risk identification of the vulnerable adult patient.

4. Organize patient care activities/procedures that are not wasteful or potentially unsafe.

I. Clinical judgment

1. Determine clinical judgments based on an understanding of the whole picture for vulnerable adult patients.

2. Interpret patterns and trends that may predict the direction of illness.

3. Examine personal self-awareness in clinical decision-making situations.

II. Care of the Vulnerable Adult Patient: Professional Standards

A. Ethics and values

1. Examine potential ethical dilemmas.

2. Discuss principles in ethical decision-making unique to the vulnerable adult patient.

3. Advocate for patient’s rights with the vulnerable adult patient.

B. Legal implications in nursing practice

1. Examine the impact of HIPAA on the vulnerable adult patient.

2. Apply the requirements for protecting patient information independently.

C. Roles of the registered nurse and the multidisciplinary team

1. Demonstrate the expanded role of the nurse within the vulnerable adult population.

2. Participate in collaboration to plan and implement care with increasing independence.

D. Facilitator of learning

1. Plan appropriate resources to meet learning needs of patients with limited personal/psychological supportive resources.

2. Formulate individualized teaching strategies for patients with diverse learning needs.

E. Documentation and informatics

1. Accurately document patient data in the health records that are unique to the vulnerable adult patient with increasing independence.

2. Implement security measures to ensure informatics security in the healthcare setting.

III. Care of the Vulnerable Adult Patient: Psychosocial Concepts

A. Self-concept

1. Design strategies to promote a healthy self-concept in the vulnerable adult patient.

2. Analyze the relationship between psychosocial development and self-concept.

B. Spiritual health

1. Examine the influence of spiritual belief on life changes and end of life.

2. Analyze the spiritual beliefs to determine the needs of the vulnerable adult patient.

C. Cultural diversity

1. Examine the influence of cultural diversity on life changes and end of life.

2. Demonstrate the nursing process in providing culturally competent care with increasing independence.

D. Grief and loss

1. Implement a plan of care for a patient/family working through the grieving process.

2. Assess normal grief responses compared to those that indicate an alteration in the grieving process.

E. Stress and coping

1. Examine stress as it relates to changes in the vulnerable adult patient.

2. Implement nursing care to incorporate coping strategies appropriate to the stressor.

F. Cognition and mood/affect

1. Analyze mental health and developmental levels specific to the vulnerable adult patient.

2. Examine common alterations in mental health and developmental levels (e.g., dementia and personality disorders).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult with alterations in mental health and developmental levels, including collaborative interventions (medical/surgical and pharmacology).

IV. Care of the Vulnerable Adult Patient: Physiological Basis

A. Comfort

1. Compare and contrast a normal versus abnormal presentation of pain in the vulnerable adult patient.

2. Describe common alterations in comfort in this unique population (e.g., sleep and rest disorders).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in comfort, including collaborative interventions (medical/surgical and pharmacology).

B. Nutrition/digestion/absorption

1. Describe the nutrition, digestion and absorption processes unique to the vulnerable adult patient.

2. Analyze common alterations in nutritional health (e.g., dysphagia).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in nutrition, digestion and absorption, including collaborative interventions (medical/surgical and pharmacology)

C. Elimination

1. Compare and contrast normal versus abnormal developmental aspects of urinary and bowel elimination.

2. Analyze common alterations in urinary and bowel elimination (e.g., incontinence and benign prostatic hypertrophy).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in urinary and bowel elimination, including collaborative interventions (medical/surgical and pharmacology).

D. Mobility

1. Compare and contrast normal versus abnormal developmental aspects of mobility.

2. Analyze common alterations in the musculoskeletal system (e.g., hip fracture and Parkinson’s disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in mobility, including collaborative interventions (medical/surgical and pharmacology).

E. Tissue integrity

1. Discuss normal presentation of the vulnerable adult patient with tissue integrity.

2. Analyze common alterations in tissue integrity (e.g., skin cancer).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in tissue integrity, including collaborative interventions (medical/surgical and pharmacology).

F. Oxygenation

1. Discuss normal presentation of the vulnerable adult patient with normal oxygenation.

2. Analyze common alterations in oxygenation (e.g., chronic obstructive pulmonary disease and sleep apnea).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in oxygenation, including collaborative interventions (medical/surgical and pharmacology).

G. Perfusion, transport, exchange

1. Discuss normal presentation of the vulnerable adult patient with adequate perfusion, transport and exchange.

2. Analyze common alterations in perfusion, transport and exchange (e.g., cerebral vascular accident and compensated heart failure).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in perfusion, transport and exchange, including collaborative interventions (medical/surgical and pharmacology).

H. Inflammation, infection, immunity

1. Explain the unique features of the vulnerable adult patient’s immune system.

2. Describe immunization needs and immune response in the vulnerable adult patient (e.g., pneumonia and flu vaccines)

3. Analyze common alterations in inflammation, infection and immunity with the vulnerable adult patient (e.g., nephritis and rheumatoid arthritis).

4. Explain the etiology and pathophysiology of relevant exemplars.

5. Apply the nursing process to the care of the vulnerable adult patient with alterations in inflammation, infection and immunity, including collaborative interventions (medical/surgical and pharmacology).

I. Cellular regulation

1. Discuss the presentation of the vulnerable adult patient with normal cellular function.

2. Analyze common alterations in cellular regulation (e.g., leukemia and lung cancer).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in cellular regulation, including collaborative interventions (medical/surgical and pharmacology).

J. Fluids and electrolytes

1. Discuss the normal presentation of fluids and electrolytes in the vulnerable adult patient.

2. Analyze common alterations in fluid and electrolyte balance (e.g., dehydration and eating disorders).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in fluid and electrolyte balance, including collaborative interventions (medical/surgical and pharmacology).

K. Acid-base balance

1. Discuss presentation of the vulnerable adult patient with normal acid-base balance.

2. Examine basic alterations in acid-base balance for this unique population (e.g., respiratory acidosis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in acid-base balance, including collaborative interventions (medical/surgical and pharmacology).

L. Metabolism

1. Discuss the presentation of the vulnerable adult patient in metabolic balance and homeostasis.

2. Analyze common alterations in metabolism (e.g., metabolic syndrome and alterations in thyroid function).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in metabolism, including collaborative interventions (medical/surgical and pharmacology).

M. Sensory perception

1. Discuss the presentation of alterations in sensory perception of the vulnerable adult patient.

2. Analyze common alterations in sensory perception (e.g., cataracts and Meniere’s disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in sensory perception, including collaborative interventions (medical/surgical and pharmacology).

N. Intracranial regulation

1. Discuss the presentation of the vulnerable adult patient with normal neurological function.

2. Analyze common alterations in neurological function (e.g., head injury and SIADH).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in neurological function, including collaborative interventions (medical/surgical and pharmacology).

O. Sexuality and reproduction

1. Discuss changes in sexuality with aging in the vulnerable adult patient.

2. Describe common alterations in reproduction (e.g., erectile dysfunction and benign prostatic hypertrophy).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the vulnerable adult patient with alterations in reproduction, including collaborative interventions (medical/surgical and pharmacology).

Content Outline and Competencies:

I. Care of the Highly Vulnerable Adult: Professional Issues and Conceptual Thinking

A. Professional behaviors

1. Demonstrate professional nursing behaviors with highly vulnerable adult patients.

2. Select the principles of the nursing role that are unique to the highly vulnerable adult patient.

B. Caring practices

1. Independently demonstrates a caring approach to the highly vulnerable adult patient.

2. Manage care of a group of patients, incorporating the developmental level, the family culture, spirituality and environment.

C. Advocacy and accountability

1. Advocate for highly vulnerable adult patients, allowing them to speak for/represent themselves when possible.

2. Plan care incorporating the highly vulnerable adult patient’s rights.

3. Evaluate healthcare practices and policies focusing on the impact to patient care.

D. Communication and collaboration

1. Contribute to group activities and discussion regarding highly vulnerable adult patient care.

2. Utilize the key competencies for effective communication and collaboration.

3. Collaborate with the healthcare team to provide quality and safety in nursing care of the highly vulnerable adult patient.

E. Nursing process

1. Complete an accurate comprehensive assessment specific to a group of highly vulnerable adult patients.

2. Implement the nursing process that is individualized to the highly vulnerable adult patient.

3. Prioritize care of a group of highly vulnerable adult patients.

F. Health promotion and delivery systems

1. Implement a teaching plan for the health promotion needs of the highly vulnerable adult patient.

2. Evaluate types of healthcare systems and how they provide delivery of care to the highly vulnerable adult patient.

3. Utilize resources within the acute care setting promoting healthy outcomes for the highly vulnerable adult patient.

G. Evidence-based practice

1. Evaluate evidence-based practice in the care of the highly vulnerable adult patient.

2. Analyze scientific rationales for nursing interventions.

3. Assess advice, resources or information to improve highly vulnerable adult patient care.

H. Safety and quality improvement in the healthcare environment

1. Demonstrate the nurse’s role in reducing risk and improving quality for a group of highly vulnerable adult patients.

2. Implement appropriate safety measures for a group of highly vulnerable adult patients.

3. Perform an age-appropriate comprehensive assessment, including risk identification of the highly vulnerable adult patient.

4. Prioritize patient care activities/procedures that are not wasteful or potentially unsafe.

I. Clinical judgment

1. Demonstrate clinical judgments based on an understanding of the whole picture for a group of highly vulnerable adult patients.

2. Evaluate patterns and trends that may predict the direction of illness.

3. Analyze diverse viewpoints in the interpretation of data and in determining conclusions regarding clinical decision-making situations.

II. Care of the Highly Vulnerable Adult Patient: Professional Standards

A. Ethics and values

1. Formulate a plan of care for patients experiencing ethical dilemmas.

2. Apply principles in ethical decision-making unique to the highly vulnerable adult patient.

3. Advocate for patient’s rights within a group of highly vulnerable adult patients.

B. Legal implications in nursing practice

1. Determine the impact of HIPAA on the highly vulnerable adult patient.

2. Protect patient information.

C. Roles of the registered nurse and the multidisciplinary team

1. Demonstrate the expanded role of the nurse in caring for a group of highly vulnerable adult patients.

2. Independently collaborate with the healthcare team in caring for a group of highly vulnerable adult patients.

D. Facilitator of learning

1. Selects appropriate resources to meet the learning needs of patients and families lacking necessary knowledge, skills and social systems resources.

2. Collaborate with the patient/family to set patient-driven goals for learning.

E. Documentation and informatics

1. Accurately document patient data in the health records that are unique to a group of highly vulnerable adult patients.

2. Choose measures to ensure informatics security in the healthcare setting.

III. Care of the Highly Vulnerable Adult Patient: Psychosocial Concepts

A. Self-concept

1. Evaluate strategies to promote a healthy self-concept in the highly vulnerable adult patient.

2. Assess the relationship between psychosocial development and self-concept.

B. Spiritual health

1. Examine the influence of spiritual belief on the highly vulnerable adult patient.

2. Analyze the spiritual beliefs to determine the needs of the highly vulnerable adult patient.

C. Cultural diversity

1. Evaluate the influence of cultural diversity on the highly vulnerable adult patient.

2. Demonstrate the nursing process in providing culturally competent care to a group of highly vulnerable adult patients.

D. Grief and loss

1. Construct a plan of care for a highly vulnerable patient/family working through the grieving process.

2. Assess alterations in the grieving process of a highly vulnerable patient.

E. Stress and coping

1. Examine stress as it relates to changes in the highly vulnerable adult patient with atypical presentations.

2. Implement nursing care to incorporate coping strategies in patients with minimal reserves.

F. Cognition and mood/affect

1. Analyze mental health and developmental levels specific to the highly vulnerable adult patient.

2. Examine common alterations in mental health and developmental levels (e.g., complex co-morbidities).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult with alterations in mental health and developmental levels, including collaborative interventions (medical/surgical and pharmacology).

IV. Care of the Highly Vulnerable Adult Patient: Physiological Basis

A. Comfort

1. Compare and contrast a normal versus abnormal presentation of pain in the highly vulnerable adult patient.

2. Describe common alterations in comfort in this unique population (e.g., end of life care).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in comfort, including collaborative interventions (medical/surgical and pharmacology).

B. Nutrition/digestion/absorption

1. Describe the nutrition, digestion, and absorption processes unique to the highly vulnerable adult patient.

2. Analyze common alterations in nutritional health (e.g., nutrition at end of life and gastroparesis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in nutrition, digestion and absorption, including collaborative interventions (medical/surgical and pharmacology)

C. Elimination

1. Assess urinary and bowel elimination of the highly vulnerable adult patient.

2. Analyze common alterations in urinary and bowel elimination (e.g., renal transplant and dialysis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in urinary and bowel elimination, including collaborative interventions (medical/surgical and pharmacology).

D. Mobility

1. Assess mobility needs of the highly vulnerable adult patient.

2. Analyze common alterations in the musculoskeletal system (e.g., spinal cord injury and multisystem trauma).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in mobility, including collaborative interventions (medical/surgical and pharmacology).

E. Tissue integrity

1. Discuss normal presentation of the highly vulnerable adult patient with tissue integrity.

2. Analyze common alterations in tissue integrity (e.g., diabetic mellitus and peripheral vascular disease).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in tissue integrity, including collaborative interventions (medical/surgical and pharmacology).

F. Oxygenation

1. Discuss normal presentation of the highly vulnerable adult patient with normal oxygenation.

2. Analyze common alterations in oxygenation (e.g., acute respiratory distress syndrome and lung cancer).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in oxygenation, including collaborative interventions (medical/surgical and pharmacology).

G. Perfusion, transport, exchange

1. Discuss normal presentation of the highly vulnerable adult patient with adequate perfusion, transport and exchange.

2. Analyze common alterations in perfusion, transport and exchange (e.g., decompensated heart failure and pulmonary embolism).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in perfusion, transport and exchange, including collaborative interventions (medical/surgical and pharmacology).

H. Inflammation, infection, immunity

1. Explain the unique features of the highly vulnerable adult patient’s immune system.

2. Describe the immune response in the highly vulnerable adult patient (e.g., organ rejection)

3. Analyze common alterations in inflammation, infection, and immunity with the highly vulnerable adult patient (e.g., sepsis and pancreatitis).

4. Explain the etiology and pathophysiology of relevant exemplars.

5. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in inflammation, infection and immunity, including collaborative interventions (medical/surgical and pharmacology).

I. Cellular regulation

1. Discuss the presentation of the highly vulnerable adult patient with normal cellular function.

2. Analyze common alterations in cellular regulation (e.g., complications associated with cancer treatment).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in cellular regulation, including collaborative interventions (medical/surgical and pharmacology).

J. Fluids and electrolytes

1. Discuss the normal presentation of fluids and electrolytes in the highly vulnerable adult patient.

2. Analyze common alterations in fluid and electrolyte balance (e.g., acute and chronic renal failure).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in fluid and electrolyte balance, including collaborative interventions (medical/surgical and pharmacology).

K. Acid-base balance

1. Discuss presentation of the highly vulnerable adult patient with normal acid-base balance.

2. Examine basic alterations in acid-base balance for this unique population (e.g., metabolic acidosis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in acid-base balance, including collaborative interventions (medical/surgical and pharmacology).

L. Metabolism

1. Discuss the presentation of the highly vulnerable adult patient in metabolic balance and homeostasis.

2. Analyze common alterations in metabolism (e.g., cirrhosis and complications of diabetes mellitus).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in metabolism, including collaborative interventions (medical/surgical and pharmacology).

M. Sensory perception

1. Discuss the presentation of alterations in sensory perception of the highly vulnerable adult patient.

2. Analyze common alterations in sensory perception (e.g., Guillain-Barre and multiple sclerosis).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in sensory perception, including collaborative interventions (medical/surgical and pharmacology).

N. Intracranial regulation

1. Discuss the presentation of the highly vulnerable adult patient with normal neurological function.

2. Analyze common alterations in neurological function (e.g., neurogenic shock).

3. Explain the etiology and pathophysiology of relevant exemplars.

4. Apply the nursing process to the care of the highly vulnerable adult patient with alterations in neurological function, including collaborative interventions (medical/surgical and pharmacology).

Content Outline and Competencies:

I. Professional Nursing Issues/Management of Patient Care

A. Professional issues: RN role assumption/standards of care.

1. Discuss the ANA standard of care and course competencies

2. Discuss the RN responsibilities within the health care system

B. Professional issues: risk management.

1. Discuss the RN role to implement risk management standards

2. Describe high risk patients and strategies to promote safety

3. Describe indications for transfer to long-term care facilities after discharge

4. Describe different types of health care reimbursement to plan for discharge

C. Professional issues: leadership/delegation and collaboration.

1. Describe the process and principles of leadership/delegation/collaboration to assume the role as a member of the healthcare team

D. Professional issues: conflict management.

1. Describe the models of conflict resolution that can be used in the healthcare environment to resolve conflict

2. Identify potential conflicts and strategies for promoting personal health and management of stress

E. Professional issues: legal implications.

1. Describe the legal aspects of the nursing role and patient care (i.e., consents, healthcare legislation, restraints, documentation and do not resuscitate order)

2. Discuss the Patient Bill of Rights document and implication for nursing care

3. Discuss patient confidentiality while managing patient care

F. Risk for injury: standards of care.

1. Discuss management of the patient environment to promote safety

2. Describe nursing interventions to prevent nosocomial infections and disease specific protective precautions

3. Describe safe administrations of medications and intravenous fluids to prevent errors

4. Evaluate pharmacodynamics and therapeutic responses for patients receiving complex medication therapy

II. Nursing Management of Patients with Alterations in Gastrointestinal, Endocrine and Vascular Response

A. Alteration in comfort: pain/nausea

1. Differentiate between acute and chronic pain management

2. Describe the pathophysiology of gastrointestinal function and management of nausea prior to and after surgery

B. Nutrition: less than body requirements.

1. Differentiate between acute and chronic gastrointestinal alterations

2. Describe the pathophysiology of intestinal obstruction

C. Fluid volume imbalance: risk for

1. Describe the fluid needs and losses of a patient with a bowel obstruction and/or a chronic inflammatory gastrointestinal process

D. Management of the therapeutic regime: ulcerative colitis.

1. Discuss the pathophysiology, complications and management of patients with ulcerative colitis

E. Management of the therapeutic regimen: diabetes mellitus.

1. Discuss the pathophysiology, complications and management of patients with diabetes mellitus

F. Ineffective tissue perfusion: impaired circulation.

1. Discuss the pathophysiology of hypertension episodes and management of blood pressure

G. Ineffective protection: hypovolemic shock.

1. Discuss the underlying physiological defects occurring in shock regardless of cause

H. Psychosocial response.

1. Describe stress management in relation to health alterations and lifestyle changes

2. Describe the alterations in affect, speech, perception, and interactions exhibited by a patient experiencing depression

III. Nursing Management of Patients with Altered Oxygenation, Peripheral Vascular Function, Endocrine and Immune Response

A. Risk for infection: alterations in immune function and deficiency.

1. Describe the structure and function of the immune system

2. Discuss immune system abnormalities that place patients at increased risk for infections

3. Differentiate between altered immune states: autoimmunity, primary and secondary immune deficiency

B. Impaired gas exchange: acute exacerbated Chronic Obstructive Pulmonary Disease (COPD).

1. Describe COPD according to pathophysiology, gas exchange dynamics and clinical manifestations

2. Differentiate between COPD and other forms of chronic respiratory alterations

3. Describe acute signs of respiratory distress and management

C. Ineffective airway clearance: acute exacerbated COPD.

1. Develop a plan of care for the COPD patient which includes airway clearance, mobilization of secretions, controlled coughing techniques, oxygenation, nutrition, rest/activity and breathing exercises

D. Management of the therapeutic regimen: diabetes mellitus.

1. Discuss the pathophysiology, complications and management of patients with diabetes mellitus

2. Discuss concepts of multi-organ failure as it relates to diabetes

E. Ineffective tissue perfusion: impaired circulation.

1. Discuss the pathophysiology of hypertension, coronary artery disease and peripheral vascular disease

2. Describe the impact of cardiac and vascular changes in relation to an altered arterial blood gas

F. Impaired mobility: rheumatoid arthritis.

1. Describe the pathophysiology and management of altered joint function as related to an immune response

G. Psychosocial response.

1. Differentiate between positive and negative coping strategies in health/illness

2. Describe anxiety management techniques for patients with acute and chronic illnesses

3. Describe factors that influence patient’s acceptance and therapeutic management of the illness

IV. Nursing Management of Patients with Altered Cardiac Perfusion and Immune Dysfunction

A. Decreased cardiac output: myocardial infarction.

1. Describe the pathophysiology of decreased cardiac output, excess fluid volume, and ineffective transport and exchange of oxygen, nutrients, waste products fluid and electrolytes

2. Describe the sign and symptoms, diagnosis, pharmacological therapy and management of the patient experiencing myocardial infarction and related basic arrythmias

3. Discuss electrolyte imbalance and management of potential cardiac dysrythmias

B. Ineffective protection: Human Immunodeficiency Virus (HIV) Infection and Acquired Immune Deficiency Syndrome (AIDS).

1. Explain the impact of HIV on immunity

2. Describe the sequence of events leading to immune deficiency from HIV

3. Describe assessment and care of the patient with HIV infection and/or AIDS

C. Risk for ineffective coping: psychosocial, ethical and legal implications of HIV/AIDS.

1. Identify ethical and legal issues involved with management of HIV/AIDS

2. Analyze cases to determine personal issues and biases that may interfere with care provided to patients with HIV/AIDS

V. Nursing Management of Patients with Altered Cardiac and Cerebral Perfusion, Neurological Function and Musculoskeletal Function

A. Fluid volume excess: Congestive Heart Failure (CHF) and Pulmonary Edema.

1. Describe the signs and symptoms, diagnoses, pharmacological therapy and management for the patient experiencing congestive heart failure and pulmonary edema

2. Discuss the teaching needs related to activity/rest, medication and nutrition

3. Correlate the pathophysiology of right and left heart failure with clinical manifestations

B. Tissue perfusion: altered cerebral.

1. Discuss the pathophysiology, risk factors, signs and symptoms, pharmacological therapy and management for the patient experiencing cerebral vascular accident

2. Discuss management of impaired memory, communication patterns and psychosocial needs of the patient

C. Alterations in potassium and sodium.

1. Discuss the relationship between sodium and water and management of imbalances

2. Select appropriate interventions for the type of potassium and sodium imbalance

3. Discuss the implications of digoxin toxicity and electrolyte imbalance

D. Physical mobility: impaired.

1. Describe the signs and symptoms, diagnosis, pharmacological therapy and management for the patient experiencing inflammatory vs. non-inflammatory degenerative musculoskeletal system

2. Differentiate the common motor and sensory impairments manifested with altered cerebral perfusion

E. Psychosocial response.

1. Discuss the impact of transition of independent living to long term care facility for the older adult

2. Discuss the changes in family dynamics and roles when caring for older adult

3. Describe the potential for anticipatory grief process with acute health alterations

VI. Nursing Management of Patients with Altered Renal Function, Altered Blood Function and Infectious Hepatic Function

A. Excess fluid volume: Chronic Renal Failure (CRF).

1. Differentiate between acute and chronic renal failure

2. Describe assessment and management of patients with CRF

B. Management of therapeutic regimen: dialysis.

1. Describe assessments and care of patients undergoing blood or peritoneal dialysis

C. Activity intolerance: impaired.

1. Compare and contrast signs and symptoms and management of different types of anemias and blood dyscrasias

D. Ineffective protection: liver dysfunction: Cirrhosis and Hepatitis.

1. Select appropriate nursing diagnoses for patients experiencing altered metabolism secondary to liver disease

2. Select interventions that will assist the patient in adapting to chronic liver dysfunction

3. Compare the incidence, risk factors, transmission, serological markers, prophylaxis, safety precautions and care for patients with Hepatitis A, B or C

E. Psychosocial response.

1. Discuss the potential for family violence and dysfunction with stress from alterations in health

VII. Nursing Management of Patients with Acute Blood Disorder, Acid-Base Imbalance, Hypoxemia and Infectious Process

A. Ineffective protection: alterations in metabolic acid-base balance.

1. Identify common factors of metabolic acid-base imbalances

2. Select interventions to prevent and/or minimize metabolic acid-base imbalances

3. Discuss the rationale for selected interventions used to manage metabolic acid-base imbalances

B. Risk for injury: Thrombocytopenia.

1. Describe the pathophysiology of altered blood products in relation to the transport and exchange of oxygen, nutrients, immune function, and fluid and electrolytes

2. Describe the sign and symptoms, diagnosis, pharmacological therapy and management of the patient experiencing acute leukemia and related complications

C. Ineffective protection: Sepsis and Septic Shock.

1. Differentiate between septic and other forms of shock

2. Describe care of patients during and following septic shock

D. Ineffective coping: substance abuse.

1. Discuss the pathophysiology and management of the patient with alcohol dependence

2. Discuss signs of alcohol toxicity

3. Discuss the effect of prolonged substance abuse on patient behavior and family members

E. Hopelessness/powerlessness.

1. Discuss specific approaches to patients/significant others exhibiting emotional responses to a newly diagnosed cancer

2. Describe the potential for anticipatory grief process with acute health alterations

VIII. Nursing Management of Patient with Altered Immune and Renal Function, Infectious Process and Cardiovascular/Respiratory Compromise

A. Ineffective protection: autoimmunity.

1. Describe underlying immune defects that occur with autoimmunity

2. Describe physiologic changes that produce symptoms in patients with systemic lupus erythematosus and systemic sclerosis

3. Describe care of patients with system lupus erythematosus

B. Excess fluid volume: Acute Renal Failure (ARF).

1. Describe the etiologies and stages of acute renal failure

2. Discuss prevention, assessments and care of patients during and after ARF

3. Describe pathophysiological changes that produce the clinical manifestations of ARF

C. Impaired gas exchange: alterations in respiratory acid-base balance.

1. Identify common factors of respiratory acid-base imbalances

2. Select interventions to prevent and/or minimize respiratory acid-base imbalances

3. Discuss the rationale for selected interventions used to manage respiratory acid base imbalances

4. Describe how the respiratory and renal systems interact to maintain acid-base balance

5. Support arterial blood gas interpretation with scientific principles about oxygenation, gas exchange and compensation

D. Risk for allergy response: hypersensitivity.

1. Discuss immune alterations that lead to hypersensitivity

2. Describe the underlying physiological alterations that result in anaphylactic shock

3. Describe prevention and care of patients experiencing hypersensitivities and anaphylactic shock

4. Compare and contrast care for the patient with hypovolemic, septic and anaphylactic shock

E. Psychosocial response.

1. Discuss the management of individual stress and implications for health

IX. Professional Issues/Management

A. Altered role performance: collaborating with the healthcare team.

1. Identify principles of delegation as they apply to the health care environment

B. Professional issues: role transition.

1. Apply a theory of change to the transition for registered nurses to enter the acute care setting

C. Decisional conflict/risk for spiritual distress - care versus cure, e.g., shifting focus to palliative care.

1. Discuss ways of eliciting patient/family perspectives on the extent of disease, goals and results of treatment

2. Describe the transition to palliative care

3. Find common hopes with the terminally ill patient

4. Discuss cultural influences that impact care

D. Death anxiety - conversations at the end-of-life: e.g., the patient and family.

1. Discuss empathic ways to communicate about end-of-life issues

2. State common fears of family during the dying process that can be addressed through therapeutic communication

3. Review effective communication techniques for talking with families managing anger and distrust

E. Chronic pain: end-of-life care and symptom management.

1. Identify common physical and psychological symptoms associated with end-of-life processes

2. Discuss interventions that can prevent or diminish symptoms and improve quality of life prior to death

F. Family processes interrupted: preparation and care at the time of death.

1. Discuss the need for family rituals and memories at the time of death

2. Discuss ways in which nursing staff cope with loss and grief

3. Describe the multiple nursing roles to improve quality care at the end of life

4. Discuss phases of communication that occur with the patient, family and interdisciplinary team throughout end-of-life care

5. Discuss the role of nurses in advocating for patients at the end of life

X. Independent Modules: Skills and Proficiencies

A. Drug/intravenous dose calculation proficiency exam.

1. Calculate complex drug and intravenous calculations accurately

B. Pharmacology proficiency exam.

1. Compare and contrast drug classifications in regards to action, side effects and nursing interventions to manage patient symptoms

C. Psychomotor skills.

1. Perform the following skills safely and accurately using aseptic technique with rationale to adapt skills to specific patient situations:

a. Physical assessments

b. Medication administration

c. Intravenous access and administration of fluids by gravity or with infusion pumps

d. Infusions of total parenteral nutrition, blood products

e. Dressing changes: sterile and clean technique

f. Foley catheterizations

g. Nasogastic tube placement

h. Gastrostomy tube feedings and medication administration

i. Airway management

j. Cardiac monitoring