COLLEGE OF NURSINGCOURSE SYLLABUS

Fall 2012

COURSE NUMBER NGR 6054C, section 5717

COURSE TITLE Advanced Neonatal Health Assessment and DiagnosticReasoning

CREDITS 4 (2 credits didactic, 2 credits laboratory)

PLACEMENT First clinical course in Neonatal Nurse Practitioner Track

PRE/COREQUISITES NGR 6320C Neonatal Nurse Practitioner INGR 6140 Physiology and

Pathophysiology for Advanced Nursing Practice

FACULTY:

Leslie A. Parker, PhD, NNP-BC parkela@ufl.edu

Jacqui Hoffman, DNP, NNP-BChoffmanjm@ufl.edu

DEPARTMENT CHAIR

HPNP 2227

(352) 273-6384Beeper: (352) 413-3212Cell (352) 215 9360

Cell (727) 709 9211

Thurs., 10:00 – 12:00

Virtual on Adobe Connect Tues. 1:00-2:00 PM

Office hours: Virtual on Adobe Connect, Tues. 1:00–2:00 PM; available for additional hours by appt

Susan Schaffer, PhD, ARNP-BCDepartment Chairsdschaf@ufl.eduGainesville Campus

HPNP 2229

Office 352-273-6366 Available by appt

CAMPUS DIRECTOR JAXAndrea Gregg, DSN, RNAssociate Professorgreggac@nursing.ufl.eduJacksonville Campus

JAXLRC, 3rd Floor

Office: 904-244-5172Fax: 352-273-6568

Available by appt

NGR 6054CCOURSE OUTLINEPAGE 2

COURSE DESCRIPTION This course provides the student with knowledge and clinical experience in advanced health assessment of both pre-term and term neonates within the context of the advanced practice role. Emphasis is on acquisition and analysis of relevant data for the development of a comprehensive and holistic assessment. The major focus is on the symptom/health problem assessment in neonates and interpretation of screening and diagnostic tests to formulate a differential diagnosis.

COURSE OBJECTIVES Upon completion of this course the student will be able to:

1. Demonstrate proficiency in performing comprehensive and focused health assessments.

2. Recognize patterns of abnormal embryological and fetal growth and development including the genetic and environmental variables which influence those patterns.

3. Demonstrate proficiency in performing focused health assessments.

4. Organize and present holistic health assessment data.

5. Differentiate normal physiological alterations from pathological findings.

6. Demonstrate proficiency in performing illness assessments based on selected chief complaints.

7. Utilize the diagnostic reasoning process in the selection and interpretation of appropriate screening and diagnostic tests.

COURSE SCHEDULE    Day TimeClass On-line First class will be on Wednesday August 22nd with the remaining

classes on Tuesdays from 9 am –noon on Adobe Connect. On Neo I exam dates, class will be Tuesday afternoons from noon – 3 PM.

Seminar On-line Tuesday 2-4 on Adobe Connect (Sept 25, Oct 9, Nov 6, Nov 27)

E-Learning in Sakai is the course management system that you will use for this course. E-Learning in Sakai is accessed by using your Gatorlink account name and password at http://lss.at.ufl.edu. There are several tutorials and student help links on the E-Learning login site. If you have technical questions call the UF Computer Help Desk at 352-392-HELP or send email to helpdesk@ufl.edu.

It is important that you regularly check your Gatorlink account email for College and University wide information and the course E-Learning site for announcements and notifications.

Course websites are generally made available on the Friday before the first day of classes.

NGR 6054CCOURSE OUTLINEPAGE 3

ATTENDANCE

Students may be expected to attend on-campus or synchronous classes periodically. Students are expected to participate in the activities and discussions as listed in the course syllabus and on the course web-site. A grade penalty may be assigned for late assignments or exams. Timeframes for the posting and receiving of materials are listed in the course materials on the course web-site. Make-up exams may not be available in all courses.

This course will use one of UF’s web hosted collaborative software applications (Adobe Connect and or Voice Thread) for lecture presentation and or assignments. These collaborative applications have the functionality of recording your text, audio and or video comments. If you do not want to be recorded please notify assigned faculty member prior to the first class. You do not need to provide a photo or use the video comment option, this is your choice. The recordings are accessed through web links provided by your faculty member and should not be share with anyone not enrolled in the course. The recordings are available to the class during the semester. The recordings will not be used in another course.

ACCOMMODATIONS DUE TO DISABILITY

Each semester, students are responsible for requesting a memorandum from the Disability Resource Center to notify faculty of their requested individual accommodations. This should be done at the start of the semester.

COUNSELING AND STUDENT HEALTHStudents may occasionally have personal issues that arise on the course of pursuing higher education or that may interfere with their academic performance. If you find yourself facing problems affecting your coursework, you are encouraged to talk with an instructor and to seek confidential assistance at the University of Florida Counseling Center, 352-392-1575, or Student Mental Health Services, 352-392-1171. Visit their web sites for more information: http://www.counsel.ufl.edu/ or http://www.health.ufl.edu/shcc/smhs/index.htm#urgent

STUDENT HANDBOOK

Students are to refer to the College of Nursing Student Handbook for information about College of Nursing policies, honor code, and professional behavior.

TOPICAL OUTLINE

1. Characteristics of holistic assessment based on systems theory.

NGR 6054CCOURSE OUTLINEPAGE 4

2. Organization of comprehensive and focused health assessment data 3. Verbal and written communication of comprehensive and focused health assessment

data, 4. Advanced health assessment 5. Assessment for congenital anomalies including family history, physical examination,

and laboratory evaluation. 6. Risk assessment taking into consideration prenatal and perinatal circumstances and

gestational age 7. Screening tests for physical and mental health as appropriate for the neonate).8. Diagnostic tests for presenting symptoms in the pre-term and full term neonate.9. Selected advanced psychomotor skills and therapeutic diagnostic techniques

TEACHING METHODS

Lecture, discussion, case studies, written materials, computer assisted instruction and audiovisual materials.

LEARNING ACTIVITIES

Case studies, clinical presentations, learning modules, physical assessment of a live newborn, discussions, and exam.

EVALUATION

Course work will be evaluated by written examination and written assignments. Clinical performance will be graded on satisfactory/unsatisfactory basis. Students must achieve a satisfactory grade in the clinical area in order to successfully complete the course.

Clinical modules 34% Due weekly as scheduled

Case Presentation 33% Scheduled during orientation and presented during one of 4 scheduled seminars (see page 5)

Final Exam (Take Home)

33% Due Dec 10th Distributed October 31st

Final physical assessment Scheduled during last 3 weeks of semester exam

All graded assignments will be graded and returned to the student within 2 weeks of submission. For more information on grades and grading policies, please refer to University’s grading policies:

NGR 6054CCOURSE OUTLINEPAGE 5

Graduate: http://gradschool.ufl.edu/catalog/current-catalog/catalog-general-regulations.html#grades

CRITERIA FOR CASE PRESENTATION

Grade Percentage: 33%

DirectionsSelect one patient for in-depth study and evaluation. You will be expected to present to

the class your subjective and objective findings, a differential diagnosis, pathophysiology (including diagnosis and etiology) and the therapeutic plan. Please use power point for your presentation. Be prepared for discussion related to pathophysiology of the disease process, etiology, clinical findings and treatment modalities. Utilize appropriate documentation from various sources.

Use APA guidelines for format and documentation.

CRITICAL ELEMENTS % OF GRADE

I. Evaluation of Subjective/Objective Data 35%A. History and Physical Findings 15B. Family Assessment 5C. Laboratory/Radiographic Data 15

II.

III.

Pathophysiology of Primary Disease Process(including diagnosis and etiology)

Discussion of Therapeutic Plan

30%

25%

A. Comprehensive 10

IV.

B.

A.

Rationale

Format (including references)

15

10%

Clinical Modules

Clinical modules will be posted weekly based on the weekly schedule. These are short assignments that will be due before the start of class the following week. Assignments will not be accepted following that time. Each module will be discussed during class.

NGR 6054CCOURSE OUTLINEPAGE 6

Final physical exam: during the final three weeks of class, each student will be observed performing a physical examination on a well infant. Grading of this physical will be completed by the student’s clinical preceptor or a UF faculty member. Passing this exam with a satisfactory grade is necessary for successful completion of this course.

GRADING SCALE A         95-100 (4.0)                C         74-79* (2.0)            A-        93-94   (3.67)              C-        72-73   (1.67)            B+       91- 92  (3.33)              D+       70-71   (1.33)            B         84-90   (3.0)                D         64-69   (1.0)            B-        82-83   (2.67)              D-        62-63   (0.67)            C+       80-81   (2.33)              E          61 or below (0.0)

** 74 is minimal passing grade

REQUIRED TEXTS

Tappero, E.P. & Honeyfield, M.E. (2009). Physical assessment of the newborn: A comprehensive approach to the art of physical examination (4th ed.). NICU INK. ISBN – 978-1-887571-17-3.

WEEKLY CLASS SCHEDULE

Date Topic/ Laboratory Reading/ Online modules

Orientation and all day class (August 14 and 15) – Drs. Hoffman & Parker

Radiologic interpretationTaking a historyClinical presentationCase studies

Class handouts

Week 1 Wed, August 22nd Dr. Hoffman

Prenatal and Perinatal assessment

F/E/N assessment: Calculation of feedings

See pregnancy at risk lecture in NGR 6320 (Dr. Hoffman)

Module: F/E/N #1, X-ray #1

Week 2August 28th Dr. Parker

Prenatal and Perinatal assessment (cont)

Lab Assessment:

Gestational age assessment video: there are 5 chaptershttp://www.youtube.com/watch?v=-Q0tpBHkY7M

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Gestational age assessment

Lab Assessment:Umbilical cord gas

Module: Gestational age assessment, Lab #1

Week 3September 4th Dr. Hoffman

Health assessment of the HEENT

F/E/N assessment: IVF calculations

Fuloria, M. & Kreiter, S. (2002). The newborn examination: Part I. Emergencies and common abnormalities involving the skin, head, neck, chest and respiratory and cardiovascular systems. American Family Physician, 65(1), 61-68.

Furdon, S. & Clark, D. 2003. Scalp hair characteristics in the newborn infant. Advances in Neonatal Care. 3(6) 286-296.

Furdon, S. & Clark, D. 2001. Differentiating scalp swelling in the newborn. Advances in Neonatal Care. 1(1) 22-27.

Parker, L. (2005). Part 1: Early recognition and treatment of birth trauma: injuries to the head and face. Advances in Neonatal Care. 5(6):288-97.

Spilman, L. Examination of the external ear. (2002). Advances in Neonatal Care 2(2). 72-80.

Tappero, chapter 5

Module: F/E/N #3, X-ray #5

Week 4Sept 11th Dr. Hoffman

Health Assessment of the Immune System

Lab Assessment: CBC, diff and platelets; CRP

Milcic. (2010). The complete blood count. Neonatal Network, 29(2), 109-15.

Hawk. (2008). C-reactive protein

NGR 6054CCOURSE OUTLINEPAGE 8

in neonatal sepsis. Neonatal Network, 27(2), 117-20. Module: Lab #2, X-ray #2

Supplemental readingsChiesa, C., Natale, F., Pascone,

R., et al. (2011). C reactive protein and procalcitonin: Reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta, 412: 1053-9.

Christensen, R., Baer, V., Gordon, P. et al. (2012). Reference ranges for lymphocyte counts of neonates: Associations between abnormal counts and outcomes. Pediatrics, 129: e1165-72.

Hoher, N., Zacharias, E., Muller, W., & Resch, B. (2012). An update on the use of C-reactive protein in early-onset neonatal sepsis: Current insights and new tasks. Neonatology, 102: 25-36.

Hornik, C., Benjamin, D., Becker, K., Benjamin, D. Jr, et al. (2012). Use of the complete blood cell count in early-onset neonatal sepsis. Pediatric Infectious Disease Journal, 31: 799-802.

Hornik, C., Benjamin, D., Becker, K., Benjamin, D. Jr, et al. (2012). Use of the complete blood cell count in late-onset neonatal sepsis. Pediatric Infectious Disease Journal, 31: 803-807.

Murphy, K. & Weiner J. (2012). Use of leukocyte counts in

NGR 6054CCOURSE OUTLINEPAGE 9

evaluation of early-onset neonatal sepsis. Pediatric Infectious Disease Journal, 31: 16-9.

Srinivasan L. & Harris, M. (2012). New technologies for the rapid diagnosis of neonatal sepsis. Current Opinion in Pediatrics, 24: 165-71.

Week 5Sept 18th Dr. Hoffman

Heath assessment of the skin

F/E/N assessment: Calculation of IVF

Tappero.(2003). Chapter 4.

Furdon, S. & Clark, D. (2001). Discriminating between skin lesions in the newborn. Advances in Neonatal Care. 1(2) 84-90.

Module: F/E/N #2, X-ray #3

Week 6 Sept 25th Dr. Hoffman

Health assessment of the skin (cont)

Lab assessment: LP results; Gram stain and cultures

Pacatte (2008). Analysis of CSF in the neonate. Neonatal Network, 27(6), 419-422

Module: Lab #3, X-ray #4

Supplemental readingsChadwick, S., Wilson, J., Levin,

J. & Martin, J. (2011). Cerebrospinal fluid characteristics of infants who present to the emergency department with fever: Establishing normal values by week of age. Pediatric Infectious Disease Journal, 30: e63-7.

Eslami, S., Nassirian, H., Mojgan, B., et al. (2012). Comparison of cerebrospinal fluid in newborns and in infants ≤ 2 months old with or without meningitis. Pediatric Int, 54: 336-40.

NGR 6054CCOURSE OUTLINEPAGE 10

Week 7Oct 2nd Dr. Parker

Lab assessment: ABG interpretation

Lab assessment: Electrolytes, anion gap

FEN assessment: Calculating increasing feeds and decreasing IVF

Brown, B. and Eilerman, B. (2006). Understanding blood gas interpretation, Newborn and Infant Nursing Reviews. 6(2), 57-62.

Mandell. (2009). Serum anion gap in metabolic acidosis. Neonatal Netw, 28(4):252-4.

Nash. (2007). Potassium and sodium homeostasis in the neonate. Neonatal Network, 26(2), 125-132.

Shaw. (2008). Bicarbonate and chloride equilibrium and acid-base balance in the neonate. Neonatal Network, 27(4):261-6.Module: Lab #4 and #5, F/E/N #4

Supplemental readings:Askin, D. (1997). Interpretation

of neonatal blood gases, Part I: Physiology and acid-base homeostasis. Neonatal Network, 16(5): 17-21.

Askin, D. (1997). Interpretation of neonatal blood gases, Part II: Disorders of acid-base balance. Neonatal Network, 16(6): 23-9.

Week 8Oct 9th Dr. Parker

Health assessment of the chest and lungs

F/E/N assessment: TPN

Tappero, Chapter 6

Raney, M., Donze, A., & Smith, J. (2008). Insulin infusion for the treatment of hyperglycemia in low birth weight infants: Examining the evidence. Neonatal Network, 27: 127-140. Module: FEN#5, X-ray #6

Module: Heart and Lung soundshttp://www.med.ucla.edu/wilkes/intro.html

NGR 6054CCOURSE OUTLINEPAGE 11

Week 9 Oct 16th

No formal classFANNP conference

Work on case evaluation and case presentations

Week 10 Oct 23rd Dr. Hoffman

Health Assessment of the CV system

Lab assessment: Echo, EKGs, and Pulse oximetry

F/E/N assessment: More FEN

Tappero, Chapter 6

Federspiel, M. (2010). Cardiac assessment in the neonatal population. Neonatal Network, 29(3), 135-141.

Mahle, W., Newburger, J., Matherne, G., Smith, F., et al. (2009). Role of pulse oximetry in examining newborns for congenital heart disease: A scientific statement from AHA and AAP. Pediatrics, 124: 823-836.

Nash, P. (2008). Brain type natriuretic peptide. Neonatal Network, 27: 343-346.

Theorell, C. (2002). Cardiovascular assessment of the newborn. Newborn and Infant Nursing Reviews. 2(2). 111-127

Modules: F/E/N #6, Lab #6, X-ray #7

Supplemental Readings:Liebman, J. (2010). The normal

electrocardiogram in the newborn and neonatal period and its progression. Journal of electrocardiology, 43: 524-29.

Schwartz, P., Garson, A., Paul, T., et al. (2002). Guidelines for the interpretation of the neonatal electrocardiogram: A Task Force of the European Society of Cardiology. European Heart Journal, 23: 1329-1344.

NGR 6054CCOURSE OUTLINEPAGE 12

Week 11Oct 30th Dr. Hoffman

Heath assessment of the GI system

Lab assessment: LFTs

Tappero Chapter 8

Donlon, C. & Furdon, S. (2002). Part II: Assessment of the umbilical cord outside of the delivery room. Advances in Neonatal Care 2(4) 187-197

Donlon, C. Furdon, S. & Clark, D (2002). Look before you clamp: Examination of the umbilical cord. Advances in Neonatal Care 2(1) 19-26.

Fuloria, M. & Kreiter, S. (2002). The newborn examination: Part II. Emergencies and common abnormalities involving the abdomen, pelvis, extremities, genitalia and spine. American Family Physician, 65(2), 265-70. Nash. (2009). Transthyretin (aka Prealbumin): why is it part of TPN labs? Neonatal Network, 28(5), 339-41.

Parker, L. (2006). Part 2: Birth trauma: Injuries to the intraabdominal organs, peripheral nerves, and skeletal system. Advanced in Neonatal Care, 6(1): 7-14.

Modules: Lab #7, X-ray #8

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Week 12Nov 6th Dr. Hoffman

Health assessment of the GU system

Lab assessment: UA Analysis, urine culture

Tappero, Chapter 9

Benjamin, K. (2002). Scrotal and inguinal masses in the newborn period. Advances in Neonatal Care. 2(3) 140-148.

Hardy, P. (2010). Urinalysis interpretation. Neonatal Network, 29(1), 45-49.

Modules: Lab #8, X-ray #9

Week 13Nov 13th Dr. Parker

Health assessment of the neurologic system and cranial nerves

Lab assessment: Hct, retic and bilirubin

Tappero, Chapter 11

Modules: Lab #9, X-ray #10

Week 14 Nov 20th Dr. Parker

Health assessment of the musculoskeletal system

Lab assessment: Clotting factors

Tappero chapter 10

Furdon, S & Donlon, C. (2002). Examination of the newborn foot: Positional and structural abnormalities. Advances in Neonatal Care. 2(5) 248-258.

Modules: Lab #10, X-ray #11

Week 15Nov 27th Dr. Parker

Health assessment of the behavioral system

Developmental Care in the NICU

Lab assessment: Thyroid fx

Tappero chapter 12Knobel. (2007). Thyroid

hormone levels in term and preterm neonates, Neonatal Netw. 26(4), 253-9. Module: Lab #11, Physical Assessment video: 18 chaptershttp://www.youtube.com/watch?v=eO9eHco3SV4&feature=related

Week 16Dec 4th

No formal class Work on final exams

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Week 17Week of Dec 10th

Finals week Final exam due