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 health care 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 and palpation.

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. Pregnancy

1. Describe how pre-existing conditions impact or are impacted by pregnancy.

2. Describe changes in the pregnant abdomen over the course of the gestation.

3. Identify risk-reduction opportunities for teaching pregnant patients and minimizing potential complications of pregnancy.

4. List common complaints of pregnancy.

5. Describe subjective data collected for urinary tract infection, periumbilical pain, back pain, Braxton Hicks contractions, and labor.

C. Newborns and Infants

1. Describe key features relevant to the infant’s expected physical growth, motor and speech development.

2. List critical components of an acute assessment of the newborn and older infant.

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

4. Identify appropriate questions for a problem-based history appropriate for the caregiver.

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

D. 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 emphasize 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 health care 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 health care 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 health care 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 health care 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 health care 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 the highly vulnerable adult patient, 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 health care 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).

FEES: Students will be assessed fees for national competency exams and
liability insurance.  These fees will be collected each semester as part of
the tuition and fee structure and are non-refundable.

NOTE: Specific Unit Objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

NOTE: Specific Unit Objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

Content Outline and Competencies:

I. Foundations of Reproduction, Fertility, Maternity Nursing and Care
of the Antepartum Patient
   A. Professional issues: Maternal newborn nursing
      1. Review basic standards of care.
      2. Discuss ethical and legal issues in maternal newborn nursing.
      3. Discuss the role of the nurse as patient/family advocate.
      4. Demonstrate collaboration with the health team.
   B. Preconception health
      1. Discuss health status prior to conception.
      2. Describe the various reasons for infertility and the modalities
employed to restore fertility.
      3. Discuss genetic issues related to pregnancy.
   C. Reproductive decision
      1. List the means of conception prevention and family planning.
      2. Describe the pathology of abortion and the nursing care
required.
      3. Discuss options of infant relinquishment, abortion, and the
legal/ethical issues encountered.
   D. Care of the antepartum family
      1. Describe the physiological changes of pregnancy and implications
for nursing care.
      2. Discuss benefits of breastfeeding.
      3. Discuss maternal and fetal nutritional needs during pregnancy.
      4. Describe developmental stage, emotional and role changes that
occur during pregnancy for the childbearing family.
      5. Describe cultural assessments and the modifications in care that
may be required.
      6. Discuss the rationale for antepartum testing and diagnostics.
      7. Discuss the rationale for fetal monitoring and surveillance.
      8. Identify complications that may occur in the Antepartum phase of
pregnancy.

II. Care of the Family During the Birth Experience
   A. Care of the intrapartum family
      1. Discuss various childbirth preparation methods.
      2. Discuss developmental, cultural, and psychosocial influences in
labor and delivery.
      3. Describe the stages of labor and the implications for nursing
care.
         a. Identify types of nonpharmacologic and pharmacologic
strategies utilized during the     childbearing process.
         b. Compare the typical signs of non-reassuring fetal heart rate
patterns with reassuring            patterns.
         c. Identify basic standards of care in labor and delivery in the
patient care areas.
      4. Describe complementary therapies utilized during the birth
experience.
      5. Identify complications in the labor/delivery setting and
implications for nursing care for the following types of deliveries:
Induction, Vacuum extractor, Forceps, and Cesarean delivery.
   B. Care of the postpartum family
      1. Describe each of the physiological and psychosocial changes which
occur during the   puerperium.
      2. Discuss the influence of culture during the postpartum period.
      3. Prioritize actions to facilitate effective breast and/or
bottle-feeding.
      4. Prioritize care to assist with parent-infant attachment, sibling
adjustment, and grandparent adaptation.
      5. Describe complications and role changes that may occur during the
postpartum period.
      6. Prioritize care to postpartum patients based on standards of
care.
   C. Care of the newborn
      1. Describe the physiologic and behavioral adaptations of the normal
newborn.
      2. Recognize deviations from normal physiologic findings during
assessment of the newborn.
      3. Discuss the implications of jaundice in the neonate.
      4. Distinguish characteristics of a normal, physiologic event of
hyperbilirubinemia from a hematologic crisis.
      5. Identify priority interventions to promote optimum newborn
nutrition and feeding.
      6. Implement standards of care with well newborns.

III. Care of the High Risk Pregnant Patient
   A. Complications of pregnancy
      1. Discuss predisposing factors, pathophysiology, signs, symptoms,
diagnosis, medical treatment, and nursing care of patients at risk for
pregnancy complications: Preeclampsia, Eclampsia, Disseminating
Intravascular Coagulation, Premature labor, Incompetent cervix, and
medical disorders e.g., Diabetes, Cardiac, Anemia, and Substance abuse.

IV. Care of the High Risk Infant
   A. Newborn complications
      1. Discuss predisposing factors, pathophysiology, signs, symptoms,
diagnosis, medical treatment, and nursing treatment of the premature
infant.
      2. Identify common newborn complications, signs, symptoms,
diagnosis, medical treatment, and nursing care of infants: e.g., Sepsis,
Transient tachypnea of the newborn, and Jaundice.
      3. Describe the treatment and priority care needed for infants born
with withdrawal secondary to intrauterine exposure to substance abuse.
   B. Care for the family experiencing neonatal loss
      1. Describe interventions to meet the needs of childbearing families
experiencing grief.

V. Psychosocial Stressors in the Family
   A. Violence against women/family
      1. Assess for signs of abuse in high risk families.
      2. Evaluate resources available to families experiencing abuse.
      3. Discuss the role of advocate with high-risk families.

1. Exams
2. Clinical evaluation of application of theoretical concepts
3. Psychomotor/Communication skill proficiencies
4. Assignments and/or Projects
5. Proficiency exams

Percent
  A = 89.5% to 100%
  B = 79.5% to  89.4%
  C = 77.5% to  79.4%
  D = 69.5% to  77.4%
  F = < 69.4%

Grade levels are determined by the nursing faculty and announced at the
beginning of the course.  Letter grades are assigned on the following
basis:
      
Clinical Evaluation:

Clinical performance is graded on a pass/fail basis.  Clinical performance
must be satisfactory in order to receive a passing grade for the course. 
Periodic assessment of progress throughout the semester provides the
student with a basis for identifying and meeting course objectives.  The
measurement tools enhance student motivation by defining areas of
achievement and areas needing improvement to meet course objectives
satisfactorily.  Clinical nursing progress is measured by attainment of
specific objectives as defined by the Clinical Nursing Progress Report
(CNPR) Handbook.  This evaluation may be done in either the clinical
setting or the Health Resource Center.

Proficiency skill check-offs are required.  These check-offs are a part of
the preparation for clinical, are evaluated according to established
criteria and require successful completion by established deadlines. 
Students who fail to demonstrate competency of these skills by deadlines
will be in clinical jeopardy as documented on the CNPR.

Promotion:

Promotion to other nursing courses is based on:

1. A total cumulative score of 77.5% or higher on exams, assignments
and/or projects.
2. Satisfactory completion of clinical objectives as outlined in the
Clinical Nursing Progress Report (CNPR).
3. Completion of proficiency exams.
4. Completion of assignments and/or projects.

Unless withdrawal is made prior to the college withdrawal deadline date,
students who do not receive a passing evaluation in the clinical will
receive a D for the final grade; students whose total exam points fall
below a C will receive the letter grade that corresponds with their final
total points (D or F).

FEES: Students will be assessed fees for national competency exams and
liability insurance.  These fees will be collected each semester as part of
the tuition and fee structure and are non-refundable.

NOTE: Specific Unit Objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

NOTE: Specific Unit Objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

Content Outline and Competencies:

I. Overview of Nursing of Children:  Concepts of Normal Growth and
Development, Health Promotion, Assessment, Safety and Communications.
   A. Professional issues
      1. Review basic standards of care in pediatric nursing.
      2. Discuss ethical and legal issues in nursing care of children.
      3. Discuss the role of the nurse as patient and family advocate.
      4. Demonstrate collaboration with the health team.
   B. Review of growth and development
      1. Discuss the age-related stages of physical, cognitive, and
psychosocial development.
      2. Discuss the interventions related to the care of the child with
failure to thrive.
   C. Therapeutic communication with children and families
      1. Discuss the complexity of the communication process with
pediatric patients.
      2. Utilize strategies and techniques for effective communication.
      3. Utilize therapeutic communication techniques in the health care
environment with sensitivity to culturally diverse children and families.
   D. Health promotion and safety
      1. Review milestones of growth and development for infants to
adolescents.
      2. Discuss rationale for safe/accurate medication administration.
      3. Review concepts of wellness/prevention guidelines of
immunizations, childhood illnesses as it relates to stages of growth and
development.
      4. Discuss the difference in techniques used when assessing
pediatric patients versus adults.
      5. Identify normal and abnormal assessment data while completing a
pediatric assessment.

II. Concepts in Caring for Children Experiencing Alterations in Health,
Part I
   A. Impaired physical mobility: Alterations in cognitive and
neurological function
      1. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, complications, and therapeutic management of
problems of impaired mobility: e.g., Neural tube defects, Scoliosis,
Cerebral Palsy, Hydrocephalus.
      2. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, complications, and therapeutic management of the
child with meningitis.
   B. Decreased cardiac output: Congenital anomalies, sickle cell disease,
hemophilia
      1. Discuss the nursing care, pathophysiology, etiology/risk factors,
signs and symptoms, and therapeutic management of the child with a cardiac
anomaly.
      2. Discuss the nursing care, pathophysiology, genetic pattern, signs
and symptoms, diagnostic evaluation, complications, and therapeutic
management of the child with sickle cell disease and hemophilia.
   C. Impaired gas exchange: Acute and chronic respiratory conditions
      1. Describe the pathophysiology, signs and symptoms, diagnostic
evaluation, and therapeutic management of chronic respiratory conditions:
e.g., Asthma and Cystic Fibrosis.
      2. Manage nursing care for prevention and acute exacerbations of
symptoms of asthma and status asthmaticus.
      3. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, complications, and therapeutic management of the
child with acute respiratory conditions: e.g., Respiratory Synctival Virus
(RSV), Epiglottitis, and Croup.

III. Caring for Children Experiencing Alternations in Health, Part II.
   A. Management of therapeutic regimen: Concepts of nutrition and
metabolism
      1. Discuss the various types and routes of infant feedings.
      2. Discuss the nursing care, pathophysiology, etiology/risk factors,
signs and symptoms, complications, and therapeutic management for the
patient with Type I Diabetes Mellitus.
      3. Discuss the nursing care of the patient experiencing diabetic
ketoacidosis.
   B. Ineffective feeding pattern:  Alteration in oral intake
      1. Discuss the nursing care, etiology/risk factors, complications,
and therapeutic management for the child born with a cleft lip and/or
palate.
   C. Risk for fluid volume deficit/electrolyte imbalance
      1. Discuss the nursing care, pathophysiology, etiology/risk factors,
diagnostic evaluation, complications, and therapeutic management of the
child with acute symptoms: e.g., gastroesophageal reflux, pyloric
stenosis, intussusception, tracheoesophageal fistula, anorectal
malformations, Hirschsprung’s Disease, and appendicitis.
      2. Compare and contrast the physiologic response of the pediatric
vs. adult patient experiencing a fluid and electrolyte imbalance.
      3. Discuss the nursing care, pathophysiology/etiology, and
therapeutic management   of child with a burn.
      4. Describe burn wound characteristics and therapeutic management.
   D. Impaired urinary elimination: Genitourinary alterations
      1. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, and therapeutic management of three types of
nephrotic syndrome.
      2. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, and therapeutic management of vesicoureteral
reflux.
   E. Impaired physical mobility: Musculoskeletal alterations
      1. Describe the different types of fractures and treatment including
casting, surgery, and traction therapy.
      2. Discuss nursing care of the child with a cast or traction
set-up.
      3. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, and therapeutic management: e.g., Juvenile
Rheumatoid Arthritis, Osteomyelitis, Legg-Calve-Perthes, Torticollis,
Slipped Femoral Capital Epiphysis, Club Feet, and Sports Injuries.
   F. Risk for Infection: Alterations in regulatory/defense mechanisms
      1. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, and therapeutic management of the child with
leukemia and lymphoma.
      2. Discuss the nursing care, pathophysiology, signs and symptoms,
diagnostic evaluation, and therapeutic management of nervous system
tumors, bone tumors, solid tumors, Wilm’s tumor, Rhabdomyosarcoma, and
Retinoblastoma.  
   G. Impaired parenting: Psychosocial alterations
      1. Describe the underlying societal and family issues of child
abuse.
      2. Recognize the physical emotional signs of abuse in the child:
e.g., Shaken baby syndrome and head injury.
   H. Potential compromised family coping:  Emotional disorders
      1. Apply nursing process to children and adolescents who have
emotional disorders: e.g., Autism, Attention-Deficit/Hyperactivity
Disorder, Depression/Suicide, Substance Abuse, and Loss/Grief.

1. Exams
2. Clinical evaluation of application of theoretical concepts
3. Psychomotor/Communication skill proficiencies
4. Assignments and/or projects
5. Proficiency exams

Percent
  A = 89.5% to 100%
  B = 79.5% to  89.4%
  C = 77.5% to  79.4%
  D = 69.5% to  77.4%
  F = < 69.4%

Grade levels are determined by the nursing faculty and announced at the
beginning of the course.  Letter grades are assigned on the following
basis:

Clinical Evaluation:

Clinical performance is graded on a pass/fail basis.  Clinical performance
must be satisfactory in order to receive a passing grade for the course. 
Periodic assessment of progress throughout the semester provides the
student with a basis for identifying and meeting course objectives.  The
measurement tools enhance student motivation by defining areas of
achievement and areas needing improvement to meet course objectives
satisfactorily.  Clinical nursing progress is measured by attainment of
specific objectives as defined by the Clinical Nursing Progress Report
(CNPR) Handbook.  This evaluation may be done in either the clinical
setting or the Health Resource Center.

Proficiency skill check-offs are required.  These check-offs are a part of
the preparation for clinical, are evaluated according to established
criteria and require successful completion by established deadlines. 
Students who fail to demonstrate competency of these skills by deadlines
will be in clinical jeopardy as documented on the CNPR.

Promotion:

Promotion to other nursing courses is based on:

1. A total cumulative score of 77.5% or higher on exams, assignments
and/or projects.
2. Satisfactory completion of clinical objectives as outlined in the
Clinical Nursing Progress Report (CNPR).
3. Completion of proficiency exams.
4. Completion of assignments and/or projects.

Unless withdrawal is made prior to the college withdrawal deadline date,
students who do not receive a passing evaluation in the clinical will
receive a D for the final grade; students whose total exam points fall
below a C will receive the letter grade that corresponds with their final
total points (D or F).

FEES: Students will be assessed fees for national competency exams and
liability insurance.  These fees will be collected each semester as part of
the tuition and fee structure and are non refundable.

Note:  Specific Unit Objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

Note:  Specific Unit Objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

Content Outline and Competencies:

I. Professional Issues in Nursing/Nursing Management of Patients with
Altered Cardiac Perfusion and Defense Mechanisms
   A. Professional Issues:  Ethical decision-making and critical thinking
      1. Discuss the principles of critical thinking in nursing.
      2. Discuss nursing ethics and its relationship to common moral
frameworks.
      3. Discuss the nurse’s role in moral situations that arise in the
practice of nursing.
   B. Professional Issues: Health Care Delivery
      1. Discuss the impact of health care delivery systems.
   C. Professional Issues: Caseload Management
      1. Explore interactive and leadership styles among members of the
health care team.
      2. Define accountability in professional nursing practice.
   D. Professional Issues: Leadership/Delegation and Collaboration
      1. Describe the process and principles of
leadership/delegation/collaboration used by the registered nurse with
members of the health care team.
   E. Professional issues: Conflict management
      1. Describe the models of conflict resolution that can be used in
the health care environment to resolve conflict.
      2. Identify potential threats to and strategies for promoting
personal health and well being.
   F. Professional issues: Interviewing
      1. Discuss the formal interviewing process for a graduate nurse
position.
      2. Describe the key components of a resume`and how to communicate
personal and professional skills effectively.
   G. Professional Issues: Role Transition
      1. Discuss transition from student nurse to graduate nurse role.
   H. Decreased cardiac output: Cardiopulmonary resuscitation
      1. Perform basic skills of cardiac resuscitation.
   I. Decreased cardiac output: Cardiac dysrhythmias 
      1.Characterize common dysrhythmias in terms of rate, rhythm,
causation, manifestations, and treatment.
      2. Prioritize collaborative nursing activities for common cardiac
dysrhythmias.
      3. Differentiate between common dysrhythmias seen on
electrocardiogram (ECG) and patient signs/symptoms.
      4. Select appropriate antidysrhythmics for a variety of common
rhythm alterations.
      5. Demonstrate the proper application and use of an automatic
external defibrillator (AED).
   J. Management of the therapeutic regimen: Antidysrhythmic medication 
      1. Discuss medications used to treat common cardiac dysrhythmias.
   K. Decreased cardiac output: Pacemakers, cardioversion, defibrillation,
AED 
      1. Differentiate between defibrillation and cardioversion.
      2. Outline a teaching plan and safety issues for the patient with a
pacemaker or automatic internal cardiac defibrillator.
      3. Identify possible causes of pacemaker malfunctioning.

II. Nursing Management of Patients with Altered Oxygenation and Urinary
Elimination
   A. Risk for infection: Alterations in immune function, deficiency, and
autoimmunity
      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. 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. Infection: Opportunistic infections in patients with immune
deficiency
      1. List common opportunistic infections occurring with HIV
infection.
      2. Describe care of patients with opportunistic infections.
   D. Management of therapeutic regimen: Antiretroviral therapy for
HIV/AIDS
      1. Discuss indications for the use of anti-retroviral medication.
      2. Describe care for patients receiving anti-retroviral medication.
   E. 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.
   F. 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. 
   G. 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.
   H. Ineffective breathing pattern: Acute Exacerbated Chronic Obstructive
Pulmonary Disease (COPD)
      1. Differentiate between pulmonary emphysema and other forms of
COPD.
   I. Impaired gas exchange: Acute exacerbated COPD
      1. Describe emphysema according to pathophysiology, gas exchange
dynamics, and clinical manifestations.
   J. 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. 
   K. Impaired gas exchange: Acute Respiratory Distress Syndrome (ARDS)
      1. Compare the etiology and pathophysiology of ARDS with other forms
of respiratory dysfunction.
      2. Describe the clinical progression and complications of patients
with ARDS.
   L. Impaired spontaneous ventilation: (ARDS)
      1. Discuss management of patients with ARDS.  
   M. Impaired spontaneous ventilation: Mechanical ventilation
      1. Differentiate between the various modes of mechanical ventilator
support.
   N. Dysfunctional ventilatory weaning response: Mechanical ventilation
      1. Identify the essential components necessary for successfully
weaning a patient from mechanical ventilation.
   O. Impaired gas exchange: Alterations in respiratory acid-base balance
      1. Identify common causative and contributing factors to respiratory
acid-base imbalances.
      2. Select appropriate nursing activities to prevent and/or minimize
respiratory acidosis or alkalosis.
      3. Discuss the rationale for select medical interventions used to
treat respiratory acidosis or alkalosis.
      4. Explain how the respiratory and renal systems interact to
maintain acid-base balance.
      5. Support arterial blood gas interpretation with scientific
priniciples about oxygenation, gas exchange, and compensation.
      6. Describe care of the patient with an acid-base imbalance.
   P. Decisional conflict: Lung cancer 
      1. Identify the link between smoking and the development of lung
cancer.
      2. Describe the incidence of lung cancer according to cell type.
      3. Describe clinical manifestations and management of the patient
with lung cancer.
   Q. Ineffective Health Maintenance: Smoking Cessation 
      1. Explain how to successfully quit smoking according to current
recommended guidelines.
   R. Potential complications of chest surgery:  Thoracotomy/chest tubes
      1. Differentiate between partial and total lung resection surgery.
      2. Discuss management of the patient with lung resection.
      3. Identify precautions to be observed in the care of patients with
chest tubes and closed drainage system. 
   S. Ineffective Airway Clearance: Tracheostomy Care 
      1. Demonstrate the ability to perform tracheostomy care.
      2. Describe differences between various endotracheal and tracheal
tubes.
      3. Discuss principles and techniques of tracheostomy suctioning. 
      4. Implement tracheotomy and ventilator care.
   T. 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 acute renal  failure.
      3. Implement care for the patient with acute renal failure. 
      4. Describe pathophysiological changes that produce the clinical
manifestations of acute  renal failure.
      5. Plan interventions for patients with acute renal failure.
   U. Excess fluid volume: Chronic Renal Failure (CRF)
      1. Differentiate between acute and chronic renal failure. 
      2. Describe assessment and management of patients with chronic renal
failure. 
   V. Management of therapeutic regimen: Dialysis 
      1. Describe assessments and care of patients undergoing hemo or
peritoneal dialysis.
   W. Management of therapeutic regimen: Organ transplantation
      1. Describe the organ donation and procurement process.
      2. Describe care of the patient undergoing organ transplantation.

III: Nursing Management of Patients with Altered Cellular Proliferation
and Homeostasis
   A. Ineffective protection: Alterations in metabolic acid-base balance 
      1. Identify common causative and contributing factors to metabolic
acid-base imbalances.
      2. Select appropriate activities to prevent and/or minimize
metabolic acidosis or alkalosis.
      3. Discuss the rationale for select medical interventions used to
treat metabolic acidosis or alkalosis.
   B. 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.
   C. Ineffective protection:  Hypovolemic shock
      1. Discuss the underlying physiological defects occurring in shock
regardless of cause. 
      2. Differentiate between actual and relative hypovolemia.
      3. Describe care of patients during and following shock.
   D. 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.
   E. 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. Implement care for the patient with hypovolemic, septic, and
anaphylactic shock.
      5. Differentiate between the clinical manifestations of hypovolemic,
septic and anaphylactic shock.
      6. Plan interventions for the patient experiencing shock.
   F. Decreased cardiac output: Advanced Congestive Heart Failure (CHF)
and Cardiovascular Shock 
      1. Correlate the pathophysiology of right and left heart failure
with their clinical manifestations. 
      2. Select appropriate interventions to improve the quality of life
for patients with  advanced heart failure.
      3. Provide rationale for pharmacologic and nonpharmacologic
interventions used in   managing cardiogenic shock.
   G. Ineffective protection: Pathophysiology of the malignant process 
      1. Distinguish between the characteristics of benign and malignant
neoplasms.
      2. Explain the process of grading and staging abnormal
tissue/tumors.
      3. Formulate appropriate nursing diagnoses that address patient
responses to the malignant process.
   H. Hopelessness/powerlessness - Cancer diagnosis: e.g.,  psychological,
spiritual aspects of having cancer
      1. Identify personal biases about cancer and cancer treatment.  
      2. Collect data about family and cultural preferences for care.  
      3. Evaluate the effect of cultural differences on views, behaviors,
and rituals regarding  death and dying.
      4. Discuss specific approaches to patients/significant others
exhibiting emotional responses to a terminal illness.
   I. Managing the therapeutic regimen: Chemotherapy 
      1. Identify nursing diagnoses common to all patients receiving
chemotherapy.
      2. Identify activities to minimize chemotherapy side effects.
   J. Ineffective protection: Internal and external radiation 
      1. Identify interventions to minimize radiation side effects.
      2. Compare and contrast safety principles for use of internal versus
external radiation therapy.
   K. 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.
   L. 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. Describe post-mortem nursing care.
      3. Discuss ways in which nursing staff cope with loss and grief.
      4. Describe the multiple nursing roles to improve quality care at
the end-of-life.
      5. Discuss cost containment when providing quality care at the
end-of-life.
      6. Discuss phases of communication that occur with the patient,
family and interdisciplinary team throughout end-of-life care.    
      7. Discuss the role of nurses in advocating for the patients at the
end-of-life.

IV. Nursing Management of Patients with Altered Structural and Metabolic
Processes 
   A. Altered role performance: Collaborating with the health care team
      1. Identify principles of delegation as they apply to the health
care environment.
   B. Ineffective protection- Autoimmunity: e.g., Lupus Erythematosus and
Systemic Sclerosis 
      1. Describe underlying immune defects that occur with autoimmunity.
      2. Describe pathophysiological changes that produce symptoms in
patients with  Systemic Lupus Erythematosus and Systemic Sclerosis.
      3. Describe care of patients with System Lupus Erythematosus and
Systemic Sclerosis.
   C. Disturbed body image/ineffective protection: e.g., Multiple
Sclerosis (MS)
      1. Describe pathophysiological changes that produce symptoms in
patients with MS.
      2. Describe care of patients with MS.
   D. Ineffective protection: Gullian’ Barre Syndrome (GBS)
      1. Describe possible etiologies and pathophysiological changes that
produce symptoms in the person with GBS.
      2. Describe management of patients with GBS.
   E. Impaired gas exchange/Ineffective protection: Myasthenia Gravis
(MG)
      1. Describe pathophysiological changes that produce symptoms in
patients with MG.
      2. Describe management of patients with MG.
   F. Impaired gas exchange/Ineffective protection:  Amyotrophic Lateral
Sclerosis (ALS)
      1. Describe pathophysiological changes that produce symptoms in
patients with ALS. 
      2. Describe management of patients with ALS. 
   G. Disturbed body image/Impaired physical mobility: Spinal cord injury

      1. Distinguish between the signs/symptoms and care measures for the
patient with upper versus lower motor neuron lesion.
      2. Select appropriate interventions for patients in the acute and
chronic phase of spinal cord injury.
   H. 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, serologic
markers, prophylaxis, safety precautions, and care for patients with
Hepatitis A, B, or C.
   I. Risk for infection: New and reemerging infectious diseases
      1. Identify new and reemerging infectious diseases.
      2. Discuss care of patients with unusual and/or highly infectious
diseases. 
   J. Community coping: Bioterriorism 
      1. Discuss current chemical and biological threats to the United
States.
      2. Describe the role of the nurse in preparing for and during
biological warfare.  
   K. Professional issues: Role transition 
      1. Apply a theory of change to the transition from student to
graduate nurse/registered nurse.

1. Exams
2. Clinical evaluation of application of theoretical concepts
3. Psychomotor/Communication skill proficiencies
4. Assignments and/or projects
5. Proficiency exams

Percent
  A = 89.5% to 100%
  B = 79.5% to  89.4%
  C = 77.5% to  79.4%
  D = 69.5% to  77.4%
  F = < 69.4%

Grade levels are determined by the nursing faculty and announced at the
beginning of the course.  Letter grades are assigned on the following
basis:

Clinical Evaluation:

Clinical performance is graded on a pass/fail basis.  Clinical performance
must be satisfactory in order to receive a passing grade for the course.
Periodic assessment of progress throughout the semester provides the
student with a basis for identifying and meeting course objectives. The
measurement tools enhance student motivation by defining areas of
achievement and areas needing improvement to meet course objectives
satisfactorily. Clinical nursing progress is measured by attainment of
specific objectives as defined by the Clinical Nursing Progress Report
(CNPR) Handbook.  This evaluation may be done in either the clinical
setting or the Health Resource Center.

Proficiency skill check-offs are required.  These check-offs are a part of
the preparation for clinical, are evaluated according to established
criteria and require successful completion by established deadlines. 
Students who fail to demonstrate competency of these skills by deadlines
will be in clinical jeopardy as documented on the CNPR.

Promotion:

Promotion to other nursing courses is based on:

1. A total cumulative score of 77.5% or higher on exams, assignments
and/or projects.
2. Satisfactory completion of clinical objectives as outlined in the
Clinical Nursing Progress Report (CNPR).
3. Completion of proficiency exams.
4. Completion of assignments and/or projects.

Unless withdrawal is made prior to the college withdrawal deadline date,
students who do not receive a passing evaluation in the clinical will
receive a D for the final grade; students whose total exam points fall
below a C will receive the letter grade that corresponds with their final
total points (D or F).

Specific unit objectives are outlined on the Guides to Learning
provided for each student at the beginning of each unit.

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
health care team.
   D. Professional issues: conflict management
      1. Describe the models of conflict resolution that can be used in
the health care 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, health care 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, serologic
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 health care 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

 1. Exams                           70-90% of grade
 2. Assignments and/or projects     10-30% of grade 
                                    ----------------
    Total:                           100%
      
The following will be graded Pass/Fail:         
 3. Clinical evaluation of application of theoretical concepts      
 4. Psychomotor/communication skill proficiencies
 5. Proficiency exams

The course is graded on a pass/fail basis. The passing grade will be a
cumulative grade of 80% for assignments and exams. The passing grade for
proficiency exams will be 100%.
      
Clinical Evaluation 

Clinical performance is graded on a pass/fail basis.  Clinical performance
must be satisfactory in order to receive a passing grade for the course.
Periodic assessment of progress throughout the course/preceptorship
provides the student with a basis for identifying and meeting course
objectives. This evaluation may be done in either the clinical setting or
the Health Resource Center.

Proficiency skill check-offs are required. These check-offs are a part of
the preparation for clinical, and require successful completion by
established deadlines. Students who fail to demonstrate competency of
these skills by deadlines will need to repeat those proficiency skill
check-offs.