Nusing 5552 Women’s Health Care II
NURSING 5552
WOMEN’S HEALTH CARE II
COURSE SYLLABUS
SPRING 2002
FACULTY:
Maria Alvarez Amaya, Ph.D., W.H.N.P.-C.
915-747-8583
COURSE SYLLABUS
Course: Nursing 5552: Women’s Health Care II
Placement in Curriculum: Graduate Level
Pre-requisites: N5351 (Grade of B or better)
Credit: 5 (3-0-6); Includes 90 hours clinical practicum
Course Description: Secondary and tertiary prevention in women with acute and chronic reproductive health problems. Emphasis on collaborative management approaches to attain, regain, and maintain health. Includes practicum.
Faculty:
Professor Maria Alvarez Amaya, WHNP-C
Paso del Norte Center for Border Health Research
1100 N. Stanton, Suite 410
915-747-8583
E-mail:
Office Hours: By appointment
Course Objectives: Upon completion of this course, the learner should be able to:
1. Collaborate with members of the health care team in developing, implementing and evaluating a clinical plan of care for women with acute and chronic health deviations.
2. Analyze developmental, psychological, and spiritual factors that affect outcomes in women with acute and chronic health deviations.
3. Utilize assessment findings, laboratory data, treatment modalities, and referral criteria in managing the care of women with acute and chronic health problems.
4. Evaluate management protocols for the diagnosis and treatment of acute and chronic health deviations with emphasis on obstetric complications and gynecologic disorders.
5. Synthesize research findings in the management of acute and chronic health problems in women.
6. Identify cultural and socioeconomic factors that affect the delivery of health care to women along the U.S.-Mexico border.
7. Refine critical thinking skills by investigating clinical problems using case studies and vignettes.
Student Responsibilities: Students are to notify the faculty if there are problems that interfere with their ability to fulfill the obligations of the course. Alternate due dates for assignments may be negotiated at the discretion of the faculty. This should be done in advance of the announced due date.
Academic Honesty: Students are accountable for all work that is submitted or presented for evaluation. While collaboration with others prior to completing an assignment is encouraged, unauthorized collaboration will be considered cheating or plagiarism. Use of information from publications or media productions without proper acknowledgment and citation is also considered plagiarism. Penalties for plagiarism and/or cheating will be imposed according to the regulations of the College of Health Sciences and UTEP. See your student handbook and graduate catalog for specific details.
Americans with Disabilities Act: Students who require accommodations for class assignments due to disabilities should initiate and maintain the processes as designated by University policy. Accommodations will not be made until these procedures have been followed. Call Disabled Student Services (ext. 5148) for additional information.
Teaching Methods: Faculty Lecture; Formal and informal group discussion; In-class student presentations; Independent study; Internet and e-mail interactions.
Attendance and participation: The student is expected to be in attendance at all scheduled classes and clinical practica. It is the responsibility of the student to inform the instructor of absences in advance. When, in the judgment of the instructor, a student has been absent to such a degree as to impair his/her status relative to credit for the course, the instructor may drop the student from the class with a grade of W before the course drop deadline and with a grade of F after the course drop deadline.
Clinical Practicum: Ninety (90) clinical hours are required. Clinical focus is on increasing independence, skill development and refinement of clinical judgements. Emphasis is on women experiencing acute and chronic health problems. Clinical experiences will include direct patient care. .
Evaluation and Grading:
A. Grade Scale: A=90-100 B=80-89 C=70-79 < 70=D or F
B. Evaluation Criteria:
Examinations (4) 40%
Faculty/Preceptor Evaluation 40%
SOAP Notes (5) 10%
Problem Review Paper 10%
____
100%
C. Incomplete grades: Assignment of the grade I (incomplete) is made only in exceptional circumstances and requires the instructor to file with the Director of Graduate Student Services and outline of the work to be completed and the time span (in no case longer than one calendar year) allowable for the work’s completion. In no case may repetition of the course be assigned as work to be completed. If the work has not been completed at the end of the specified time, the I will be changed to an F. Students will not be cleared for graduation until all incompletes, regardless of whether or not the courses are required for the degree, have been eliminated from their record.
Required Texts:
Cuningham, MacDonald, Gant, Leveno, Gilstrap. Williams Obstetrics. (20th ed.) Stanford: Appleton & Lange.
Dickey, R. (1998). Managing Contraceptive Pill Patients (9th ed.). Durant, OK: Essential Medical Information Systems, Inc.
Hatcher, R., Trussell, J.m Stewart, F., Stewart, G., Kowal, D., Guest, F., Cates, W., & Policar, M. (1998). Contraceptive Technology (17th ed.) New York: Irvinton Publishers, Inc.
Speroff, L., Glass, R.H. & Kase, N.G. (1999). Clinical Gynecologic Endocrinology and Infertility (6th ed.). Baltimore, Williams & Wilkins.
Star, W.L., Lommell, L.L. & Shannon,M.T. (Eds). (1995). Women’s primary health care: Protocols for practice. Washington, DC: American Nurses Association.
Star, W.L., Shannon, M.T., Sammons, L.N., Lommel, L.L., Gutierrez, Y. (1990). Ambulatory obstetrics: Protocols for nurse practitioners/nurse-midwives. San Francisco: UCSF.
Uphold, C., and Graham, M. (1998). Clinical Guidelines in Family Practice (3rd ed.). Gainesville Fla: Barmarrae Books, Inc.
Youngkin, E.Q. & Davis, M.S. (Eds.). Women’s health: A primary care clinical guide (2nd ed.). Norwalk, CT: Appleton & Lange.
Optional Texts:
American Psychological Association (1994). Publication Manual of the American Psychological Association (4th ed.). Washington D.C.: Author.
Fitzpatrick, T.B., Johnson, R.A., Wolff, K., Polano, M.K. & Suurmond, D. (1997). Color Atlas and Synopsis of Clinical Dermatology. New York: McGraw-Hill.
Springhouse. (2001). Nurse Practitioner’s Drug Handbook. Springhouse, PA: Author. (Or other reference manual)
Additional Readings may be assigned.
Topical Outline
I. Gynecologic Disorders
a. POD
b. DUB
c. PMS
d. Chronic pelvic pain
e. Endometriosis
f. Adenomyosis
g. Leiomyomas
h. Galactorrhea
i. PID
j. Toxic Shock Syndrome
II. Contraception in Chronic illness
a. Sickle Cell Disease
b. Juvenile Diabetes
c. Autoimmune diseases
d. Infectious diseases
e. Cardiovascular diseases
f. Organ failure
III. Complicated Pregnancy
a. Perinatal infections
b. STI’s & HIV
c. Hypertensive disorders & HELLP Syndrome
d. Gestational Diabetes
e. Preterm & Post-term labor
f. Emergency delivery
g. Multiple gestation
h. Bleeding
i. ABO-Rh hemolytic disease
j. IUD in situ
k. Spontaneous abortion
l. Molar pregnancy
m. Abnormal fetal growth
n. Adolescent pregnancy
o. Substance abuse
p. Ectopic pregnancy
q. Puerperal infections
r. Postpartum depression & postpartum psychosis
IV. Peri-Menopausal and Post-Menopausal Transition
a. Health maintenance
i. Screening
ii. Risk assessment
iii. Early diagnosis & primary prevention
iv. Contraception
v. HRT
vi. Osteoporosis
vii. Hyperlipidemia
viii. Complementary therapies
V. Neoplastic Diseases
a. Abnormal Pap Smear
b. Malignant & Benign Neoplasms
i. Cervical
ii. Ovarian
iii. Uterine
iv. Vulva & vagina
v. Breast
vi. Placental
VI. Male & Female Infertility
VII. Genetic Disorders
VIII. Elective Abortion
SPRING 2002 CLASS SCHEDULE
Thursday, Jan 17, 2002
9-12:00 Perinatal Infections
STI’s; HIV
Thursday, Jan 24, 2002
9-12:00 Hypertensive disorders of Pregnancy; HELLP Syndrome
Gestational Diabetes
Contraception in chronic illness
SOAP note due
Thursday, Jan 31, 2002
9-12:00 Preterm & Post-term labor
Emergency delivery
Thursday, Feb 7, 2002
9-12:00 Bleeding, Spontaneous Abortion, Ectopic Pregnancy
Exam I
Thursday, Feb 14, 2002
9-12:00 Multiple Gestation
Molar Pregnancy
IUD in situ
SOAP Note due
Thursday, Feb 28, 2002
9-12:00 Abnormal Fetal Growth
ABO-Rh Hemolytic Disease
Thursday, March 7, 2002
9-12:00 Puerperial Infections
Postpartum Depression & Post-partum Psychosis
SOAP Note due
Thursday, March 14, 2002
9-12:00 DUB, POD, Galactorrhea,
PMS
Exam II
Thursday, March 21, 2002
Spring Break
Thursday, March 28, 2002
9-12:00 Endometriosis, Adenomyosis, Leiomyomas
Chronic Pelvic Pain
SOAP Note due
Thursday, April 4, 2002
9-12:00 PID, Toxic Shock Syndrome
Cancer of the Reproductive Tract
Thursday, April 11, 2002
9-12:00 Menopause: HRT, Contraception, Osteoporosis
Exam III
Thursday, April 18, 2002
9-12:00 Menopause: Hyperlipidemia, Complementary Therapies
Problem Review Paper due
Thursday, April 25
9-12:00 Male/Female Infertility
Genetic Disorders
SOAP Note due
Thursday, May 2, 2002
9-12:00 Elective Abortion
Final Exam
GUIDELINES FOR PROBLEM REVIEW PAPERS
The patient problem review gives the student an opportunity to synthesize and apply research findings in the management of women’s health care. The project involves an actual case from the clinical practice experience, a literature review, and analysis of outcomes.
The paper is to be prepared using APA format, and 10 to 12 double spaced pages, not including the title page and references. A minimum of five references are required, at least three must be clinical research studies from the medical or nursing literature.
Criteria for Evaluation:
1. Briefly cite identifying information. (e.g. patient initials, age, etc.) (5%)
2. Identify the patient’s chief complaint, history of present illness, and any other subjective data that pertains to the problem. (5%)
3. Include only the objective data that is pertinent to the problem. Remember to include objective data related to a concomitant chronic problem that might influence your treatment plan for the presenting problem. (15%)
4. Discuss your assessment and differential diagnosis for the major problem. This discussion includes an explanation of how you decided on the actual diagnosis and excluded the others listed in the differential diagnosis. (20%)
5. Write your management plan that includes diagnostic, therapeutic, and patient education measures, and how you evaluated outcomes. State how you would (or did) incorporate pertinent research findings in the management of this client and/or groups of clients with this condition. (20%)
6. Briefly describe what you would change about your interaction with the patient if you had a similar problem (i.e. obtain more history, order a different test, perform a more/less comprehensive exam, alter your diagnostic, therapeutic, and/or patient education measures, etc.) using data from the literature review. (20%)
7. Cite references in your discussion and include a list of references at the end. (15%)
SOAP NOTES FORMAT
I. Presenting Problem - brief statement in patient’s own words of what the pr9lem is and its duration. (Attach corresponding assessment form used to develop this SOAP note)
II. HPI (see Analysis of a Symptom Guide)
A. Onset - acute, gradual, precipitating/predisposing factors
B. Characteristics - quality, quantity, consistency, location/radiation, intensity/severity, timing of symptoms, aggravating and relieving factors, associated symptoms, impact on daily activities, patient’s perception of the problem.
C. Course - progress since onset, treatment attempted and results
III. PMH directly related to chief complaint for episodic note. Do a complete PMH including gravida, para, menstrual history, hospitalizations, allergies, transfusions, STDss, etc. for a new client
IV. FH directly related to chief complaint, complete for a comprehensive visit
V. ROS for comprehensive visit
VI. Social information including alcohol and drug use, family situation, job/work information, work and home environment and exposures for comprehensive visit. Include only pertinent data for episodic note.
Objective:
I. Appropriate physical exam - positive findings, pertinent negatives
II. Appropriate laboratory data
Assessment:
I. Health Problems - diagnosis
Plan:
I. Diagnostic tests done today
II. Diagnostic tests scheduled
III. Treatment plans
IV. Patient education
V. Follow-up care; referrals
Bibliography: Minimum of 3 references; Cite at least 1 research article.
Clinical Objectives:
1. Perform accurate and comprehensive health assessment as relevant to client problem and clinical setting.
2. Order appropriate laboratory/diagnostic tests and distinguish between normal and abnoral values.
3. Synthesize assessment data utilizing a clinical decision making model.
4. Calculate the EDD and gestation data given the date of the LNMP, both with and without ultrasound data.
5. Accurately estimate the EDD utilizing data from the health history and physical examination.
6. Assess clients’ prenatal health status by collecting and evaluating data appropriate to each of the three trimesters of pregnancy.
7. Assess the nutritional status of clients and intervene as necessary.
8. Evaluate prenatal clients for common pregnancy discomforts utilizing history, physical and laboratory exam data to differentiate between complications, and develop a plan of management based on a theoretical framework and current literature.
9. Diagnose, manage, and/or refer obstetrical and gynecologic problems using signs, symptoms, and assessment data.
10. Perform pelvic exams on obstetrical and gynecologic patients independently with 95% accuracy in assessing uterine size, position and the presence of abnormalities.
11. Diagnose and manage common gynecologic infections and sexually transmitted diseases integrating pertinent research findings.
12. Provide age appropriate general health screening and health education for clients.
13. Provide pertinent counseling and anticipatory guidance to patients and significant others.
14. Plan client care in collaboration with other members of the multi-disciplinary team.
15. Develop succinct and organized case presentations.
16. Document complete and concise SOAP notes, including informed consent.
17. Integrate culture-specific concepts into all aspects of patient care.
18. Demonstrate increased independence in the nurse practitioner role.
8. Continue to maintain the clinical log.
9. Participate in the clinical evaluation process.
Clinical Log Form (SAMPLE)
Date Patient# Diagnosis Mini SOAP note
1/31/02 #1 Gest. GERD S:25 YO G2 P1 @ 34 wks gest. by sono. C/O substernal burning p.c. w/ regurgitation that worsens upon recumbency. States no relief from lifestyle/diet changes or MOM after 6 wks. States symptoms increasingly severe. Noted dk red blood in stool yesterday.
O: Hemoccult positive;
A: Gestational GERD
P:Schedule endoscopy; Refer to gastroenterologist
Clinical Log Form