VNSG 1400 Health & Illness I
Common Physical Care Problems of the Elderly
Course Objectives / Content / Learning ExperienceConsider general principles of client disease process when providing care ( e.g.,injury, repair, immunity & cellular structure)
Monitor client for actual or potential adverse effects of medications( e.g., prescribed, OTC & or herbal supplements)
Reinforce client teaching on possible adverse effects of medications ( common adverse effects, when to notify the physician)
Notify physician of actual/ potential adverse effects of medications.
Identify clients at risk for impaired elimination (e.g., medication, hydration, status)
Intervene to improve client elimination by instituting bowel or bladder management.
Perform risk monitoring (eg., sensory impairment, potential for falls, & level of mobility)
Check client for mobility, gait, strength, motor skills
Monitor and provide for nutritional needs of client / Common Physical Care Problems
Impaired mobility (Ca+, decrease bone density & flexibility)
Alteration in elimination
Alteration in nutrition
Sensory deficits
Polypharmacy
Urinary Incontinence
Behavioral Approaches
Bladder retraining
Prompted voiding
Times voiding
Nursing Interventions to promote mobility
Weight training
Dancing
Gardening
Preventing Falls in the Home
Wearing properly
Keeping things in easy reach
Having well-lighted stairs
Making contrasting stair treads to improve visibility
Alteration in Nutrition related to diseased teeth, or dentures, & degenerative processes
Sensory Deficits: vision, hearing, memory / DeWitt (2009) 3rd.Ed.
Fundamental Concepts and Skills for Nursing
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DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
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Concepts of Basic Nutrition and Cultural Considerations
Monitor And provide for nutritional needs of the client
Collect data on client nutrition or hydration status
Discuss the function of proteins, carbohydrates, fats, vitamins, minerals, and water in the human body.
Identify food sources of proteins, carbohydrates, fats, vitamins, and minerals.
Reinforce client teaching on special diets based on client diagnosis/ nutritional needs & cultural considerations ( high protein, kosher diet, calorie restriction)
Monitor client ability to eat (chew & swallow)
Monitor impact of disease/illness on client nutritional status.
Discuss components of a basic nutritional assessment. / Dietary Guidelines
Protein
Functions of Protein
Food Sources of Protein
Dietary Reference Intakes of Protein
Protein Deficiency
Protein Excess
Vegetarian Diets
Carbohydrates
Functions of Carbohydrates
Simple Carbohydrates
Complex Carbohydrates
Recommendations for Intake
Fiber
Fats (Lipids)
Functions of Fat
Food Sources of Fat
Vitamins
Minerals
Water
Factors that Influence Nutrition
Cultural Influences on Nutrition
Nutritional Needs Throughout the Life Span / DeWitt (2009) 3rd Ed.
Fundamental Concepts and Skills for Nursing
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W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 26
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Providing Wound Care Treating Pressure Ulcers
Consider general principles of client disease process when providing care (injury & repair, immunity, cellular structure)
Identify and use measures to maintain client integrity (skin care, turning, or use of a special mattress).
Explain the major purpose of a wound drain.
Identify signs & symptoms of infection (temperature changes, swelling, redness, mental confusion, or foul smelling order & green or yellow drainage)
Discuss actions to be taken if wound dehiscence or evisceration occurs.
Provide emergency care for wound disruption (evisceration& dehiscence)
Provide wound care and/or dressing changes / Body Response to Injury
Physiology of Wound Healing
Factors Affecting Wound Healing:
Age
Nutrition
Lifestyle
Medications
Infection
Chronic illness
Drains and Drainage Devices
Active
Passive
Signs and Symptoms of Inflammation
Complications of Wound Healing:
Dehiscence
Evisceration
Wound Cleansing and Dressing Changes / DeWitt (2009) 3rd Ed., Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
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Assisting With Respiration and Oxygen Delivery
Explain the function of the respiratory system.
Evaluate client respiratory status by measuring oxygen (02) saturation
Intervene to improve client respiratory status by giving a breathing or respiratory treatment, suctioning or repositioning.
Describe the various methods used for oxygen delivery.
Discuss the steps involved in suctioning a client.
Explain the rationale for using sterile technique
when performing nasopharyngeal or
tracheobronchial suctioning on a client.
Provide care for a client with a tracheostomy
Discuss the rationale for insertions of a chest tube
on a client.
Provide care for client drainage device (chest tube) / Structures involved in respiration
Functions of the respiratory structures
Changes that occur with aging that affect respiration
Hypoxemia
Symptoms of hypoxia
Pulse oximetry
Airway obstruction and respiratory arrest
Clearing respiratory secretions
Oxygen administration
Cannula
Masks
Artificial airways
Nasopharyngeal suctioing
Aseptic technique
Disposable sterile suction sets
Tracheobronchial suctioning
Tracheostomy
Chest drainage tubes
Care of clients with chest tubes / DeWitt (2009) 3rd Ed.
Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd.Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 28
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Promoting Musculoskeletal Function
Course Objectives / Content / Learning ExperienceProvide client teaching on methods of mobility (active/passive range of motion, strengthening, isometric exercises)
Apply or remove immobilizing equipment (splints & braces)
Identify signs & symptoms of venous insufficiency & intervene to promote venous return ( elastic stockings, sequential compression device)
Describe appropriate care of a cast as it dries.
Identify & use measures to maintain client skin integrity ( skin care, turning, or use of a special mattress)
Provide care to client in traction
Maintain client correct body alignment
Check client for mobility, gait, strength, motor skills / Systemic Effects of Immobilization
Psychosocial Effects of Immobilization
Types of Immobilization
Splints
Traction
Casts
External Fixators
Devices Used to Prevent Problems of Immobility
Specialty Beds
Pressure Relief Devices
Continuous Passive Motion Machine
Therapeutic Exercise / DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing
Philadelphia:
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DeWitt (2005) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
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Delegation, Leadership, and Management
Recognize tasks/assignments you are not prepared to perform & seek assistance.
Verify abilities of staff members to perform assigned tasks ( job description, scope of practice, training, experience )
Monitor client care tasks performed by assistive personnel.
Use data from various sources in making clinical decisions.
Organize & prioritize care for assigned group of patients.
Use effective time management
Recognize & manage staff conflict through appropriate use of chain of command.
Transcribe physician orders
Take verbal orders
Document client care
Report identified performance improvement/ quality improvement concerns to appropriate personnel (nurse manager, risk manager) / Beginning Management
The Chain of Command
Leadership Styles
Keys to Effective Leadership
Effective Communication
Clinical Competence and Confidence
Organization
Delegation
Leadership Roles
Management Skills for the LVN
Time Management
Using the Computer
Transcribing Written Orders
Taking Verbal Orders
Documentation for Reimbursement
Risk Management / DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
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Complementary and Alternative Therapies
Course Objectives / Content / Learning ExperienceUse an alternative/complementary therapy
(acupressure, music therapy or herbal therapy in providing client care).
Assist in planning comfort interventions for client with impaired comfort.
Discuss five commonly used complementary and alternative medicines.
Provide non-pharmacological measures for pain relief (imagery, massage or repositioning)
Make adjustments to care with consideration
of client spiritual or cultural beliefs.
Respect cultural background/practices of client (does not include dietary preferences)
Direct patients to information needed to make a decision on whether to use a herbal preparation.
Describe the desired outcome of spinal manipulation during chiropractic treatment. / Alternative Medical Systems
Homeopathic Medicine
Naturopathic Medicine
Traditional Chinese Medicine
Ayurveda
Shamanism
Folk Medicine
Mind-Body Interventions
Relaxation Therapy
Imagery
Meditation
Biofeedback
Hypnotherapy
Music, Art, and Dance Therapy
Yoga
Humor
Prayer
Biologically Based Therapies
Herbal Therapy
Aromatherapy
Manipulative and Body-Based Methods
Energy Therapies
The Nurse’s Role in Complementary & Alternative Therapies / DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 32
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Pharmacology and Preparation for Drug Administration
Apply knowledge of pathophysiology when addressing client pharmacological agents.
Review pertinent data prior to medication administration (vital signs, lab results, allergies)
Follow the rights of medication administration.
Perform calculations required for medication administration
Reinforce teaching of client/family/significant others about actions & therapeutic effects of medications.
Identify a contraindication to the administration of a prescribed or over the counter medication.
Discuss areas of concern regarding medication administration to children or the elderly.
Describe issues of medication administration in home care.
Discuss measures used to prevent medication errors. / Pharmacology
Uses for Drugs
Classification of Drugs
Legal Control of Drugs
Basic Concepts of Pharmacology
Medication Administration and Safety
Considerations for Infants and Children
Considerations for the Elderly
Considerations for Home Care
Types of Orders
Distribution of Drugs
Problems of Noncompliance / DeWitt (2009) 3rd Ed.
Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 33
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Pain, Comfort, and Sleep
Course Objectives / Content / Learning ExperienceExplain the physiology of pain using the gate control
theory.
Assist in planning comfort interventions for client with impaired comfort
Validate pain using rating scale.
Discuss the implications for patient care of the JCAHO pain standards.
Use an alternative/complement therapy (acupressure, music therapy or herbal therapy) in providing care.
Identify client usual rest & sleep patterns (bedtime, sleep rituals)
Provide measures to promote sleep/ rest.
Schedule care activities to promote adequate rest & sleep.
Discuss how the need for sleep changes over the life span.
Describe the sleep disorders insomnia, sleep apnea, and narcolepsy.
Identify factors that might interfere with assigned patients’ usual sleep. / Pain and Discomfort
Theories of Pain
Types of Pain
Acute
Chronic
Nociceptive
Neuropathic
Phantom
Sleep
Functions of Sleep
Stages of Sleep
Normal Sleep Requirements
Factors Affecting Sleep
Sleep Disorders / DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 31
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Diagnostic Tests and Specimen Collection
Course Objectives / Content / Learning ExperienceReinforce teaching to prevent complications due to client diagnostic tests/ treatments/procedures.
Monitor diagnostic or laboratory test results.
Reinforce client teaching on purposes of laboratory & diagnostic tests.
Discuss how to prepare to client for aspiration procedure such as lumbar puncture and thoracentesis.
Use Universal Standard Precautions whenever obtaining or handling specimens for diagnostic tests.
Monitor client laboratory values that are deviations from the norm (ABGs, ALT, AST,BUN, LDL, HDL,PTT, ESR, APTT, PT, WBC, Lytes, HCT, RBC, Hgb, BS etc.).
Notify primary healthcare provider about client laboratory results.
Describe each of the seven categories of test commonly performed.
Describe documentation required for specimen collection. / Laboratory Tests:
Hematology Tests
Blood Chemistry Tests
Serology Tests
Urinalysis
Aspiration Procedures
Explanation
Nursing Interventions
Obtaining Throat and Wound Cultures.
Obtaining Urine and Stool Cultures.
Laboratory Tests
Radiology Procedures
Cardiopulmonary Studies
Endoscopic Examinations
Aspirations
Ultrasonography
Electro Encephalography
Flexible sigmoidoscopy
Client and Family Teaching / DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt, (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 24
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Activities:
Practice specimen collection in the lab.
Practice assisting with special procedures.
Practice teaching clients in preparation of various procedures.
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Common Psychosocial Care of the Elderly
Identify needs of client with altered sensory perception ( hallucinations, delirium)
Identify client knowledge on aging process & assist in reinforcing teaching on expected changes related to aging.
Verify client ability to communicate needs.
Provide are to that meets the special needs of clients aged 65-85 years of age.
Identify the interrelationship between alcoholism, depression, and suicide in the elder.
Assist in the care of the cognitively impaired client.
Recognize risk factors for elderly abuse/neglect. Identify signs and symptoms of physical, psychological or financial abuse in client (family involvement, inadequate weight gain, poor hygiene)
Provide safe environment for abused/neglected client.
Evaluate client/family/significant other’s response to interventions.
Discuss two future psychosocial issues for the elderly. / Changes in Cognitive Functioning in the Elderly
Assessment of Cognitive Changes in the Elderly
Common Cognitive Disorders in the Elderly
Delirium
Dementia and Depression
Alzheimer’s Disease
Depression/Alcoholism/Suicide
Crimes Against the Elderly
Elder Abuse
Future Issues of Concern to the Elderly
Planning for the Future / DeWitt (2009) 3rd Ed.
Fundamental Concepts and Skills for Nursing
Philadelphia:
W.B. Saunders.
DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
Chapter 41
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Administering Intravenous Solutions and Medications
Course Objectives / Content / Learning ExperienceMonitor anticipated interactions among client prescribed fluids( IVs).
Monitor client intravenous site & flow rate.
Administer IVPB medications.
Describe seven principles related to IV therapy of fluids or medications.
Identify & treat a client intravenous line infiltration.
Describe four guidelines to follow when caring for a patient with an IV.
Describe the possible complications that can arise from the use of the IV route and the corrective actions you should take for each complication.
Monitor transfusion of blood products.
Describe the signs and symptoms of a blood transfusion reaction and the steps you should take should one occur. / Types of Intravenous Solutions
Equipment for Intravenous Administration
Complication of Intravenous Therapy
Infiltration, sepsis, circulatory overload, phlebitis,
Electrolyte imbalance, air embolism, thrombophlebitis,
Hemorrhage
Monitor- Lytes, I&O, lung sounds / DeWitt (2009) 3rd Ed., Fundamental Concepts and Skills for Nursing
Philadelphia:
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DeWitt (2009) 3rd Ed. Fundamental Concepts and Skills for Nursing Study Guide
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Care of the Surgical Patient