Syllabus with-itp-ncm103

Course Name : CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTE BALANCE, NUTRITION AND METABOLISM AND ENDOCRINECourse Code : NCM 103Course Description : This course deals with the principles and techniques of nursing care management of sick clients across lifespan with emphasis on the adult and

the older person, population group in any setting with alterations/problems in oxygenation, fluid and electrolyte balance, nutrition and metabolism and endocrine function.

Course Credit : 8 units lecture; 6 units RLE (1 unit skills lab, 5 units Clinical)Contact Hours/ Semester : 144 lecture hours; 306 RLE hoursPre-requisite : NCM 102Placement : 3rd year, 1st semesterCourse Objectives : At the end of the course and given relevant actual clients with problems in oxygenation, fluid and electrolyte balance, nutrition and metabolism,

and endocrine function, the student should be able to:1. Utilize the nursing process in the care of individuals, families in community and hospital settings.

Assess with client/s his/her/their condition/health status through interview, physical examination, interpretation of laboratory findings.

Identify actual and at-risk nursing diagnosis Plan appropriate nursing interventions with client/s and family for identified nursing diagnosis Implement plan of care with client/s and family. Evaluate the progress of his/her/their client’s condition and outcomes of care.

2. Ensure a well organized and accurate documentation system;3. Relate with client/s and their family and the health team appropriately;4. Observe bioethical concepts/principles, core values and nursing standards in the care of clients; and,5. Promote personal and professional growth of self and others.

OBJECTIVES INTERMEDIATE COMPETENCIES

COURSE CONTENT TEACHING-LEARNING ACTIVITIES

VALUES INTEGRATION

TIME FRAME

EVALUATION

At the end of the lecture discussion, the students will be able to:1. Utilize the nursing

process in the care of individuals, families with problems in oxygenation in community and hospital settings;

1. Identify risk factors among clients that contribute to the development of problems in Oxygenation- cardiovascular risk factors (modifiable and non-modifiable).

The different risk factors among clients that contribute to the development of problems in oxygenation:

Current respiratory problems History of respiratory disease Lifestyle (smoking, alcoholism, exercise

patterns) Presence of cough Presence of Chest Pain Lung Cancer

Pre-tests Case Analysis Small Group

Learning Lecture Discussion Post test

Assertiveness Cooperation Participation Sensitivity

2.5 hoursAfter the discussion, the students will be able to identify the modifiable and non-modifiable risk factors that contribute to the development of problems in oxygenation.

2. Ensure a well organized and accurate documentation system;

3. Relate with client/s and their family and the health team appropriately;

4. Observe bioethical concepts/principles, core values and nursing standards in the care of clients; and,

5. Promote personal and professional growth of self and others.

Cardiovascular disease Stroke Tuberculosis Obesity Dietary assessment Medication history

2. Identify significant subjective data from client history related to problems in oxygenation.

a. Chief complaintsb. Relevant information, to include eleven

functional patterns Health perception management pattern Nutritional/metabolic pattern Elimination pattern Activity/exercise patterns Cognitive/perceptual pattern Sleep-rest pattern Self-perception-self-concept pattern Role relationship pattern Sexuality-reproductive pattern Coping-stress tolerance pattern Value-belief pattern


Learning Lecture Discussion Postl test


2 hours The students should be able to identify significant subjective data from client’s history by enumerating the possible chief complaints and recording relevant information guided by the eleven functional patterns.

3. Enumerate the principles and techniques of physical examination in assessing the oxygenation status in newborn, children, adults.

a. Inspection- gas exchange, perfusionb. Palpation- gas exchange, perfusionc. Percussion- gas exchanged. Auscultation- gas exchange- heart sound, breath

sounds, deviations, fluid transport

Demonstration Return

Demonstration Lecture Discussion Post test


3 hours The students will be able to perform the proper techniques in physical examination and apply the principles in correctly assessing the newborn, children, and adult’s oxygen status by comparing any deviations from normal findings.

4. Identify results and implications of diagnostic/laboratory examinations of clients with reference to problems in Oxygenation.

Screening procedure- peak flow meter Diagnostic Procedures Non-invasive: Pulmonary: e.g. sputum microscopy, chest x-

ray, pulmonary function tests, smoke analyzer Fagerstrom test – standardized degree of

nicotine dependence Cardiac: ultrasound, ECG, 2-D echo, stress test Vascular: Doppler ultrasonography Blood: pulse oximeter Invasive: Pulmonary: bronchoscopy, ABG, horacentesis,




2.5 hours Given actual laboratory results of a patient, the student should be able to identify deviations from normal findings.

pulmonary angiography Cardiac: CO determination, cardiac

catheterization, CVP, hemodynamics monitoring, enzyme levels, Serum, Cholesterol

Vascular: angiography Blood: CBC and bone marrow biopsy

5. Determine the Patho-physiologic mechanisms of the Alterations in oxygenation

a. Alteration in gas exchange – ventilator dysfunction, impaired perfusion

b. Alteration in cardiac performance – heart rate problems, impaired stroke volume secondary to altered preload, afterload, myocardial contractility

c. Alteration in vascular integrity – transport network impairment

d. Alteration in oxygen carrying capacity of the blood- decreased circulating erythrocytes (anemia), increased circulating erythrocytes (polycythemia)




16 hours The students should be able to determine the patho-physiologic mechanisms in the different oxygenation problems.

6. Enumerate Nursing diagnoses taxonomy pertinent to problems/alteration in Oxygenation.

a. Ineffective breathing patternb. Ineffective airway clearancec. Impaired gas exchanged. Inability to sustain spontaneous

ventilatione. Dysfunctional entilatory weaning

responsef. Decreased cardiac output (CO)g. Altered tissue perfusion systemich. Impaired gas exchange related to

altered O2 carrying capacity of blood due to decreased erythrocytes/hemoglobin

i. Activity intolerance related to malnutrition tissue hypoxia




2 hours The students should be able to identify possible nursing diagnoses taxonomy pertinent to the derived assessment data to pertinent problems in oxygenation.

7. Identify principles of various modalities of management of clients with problems in oxygenation taking into consideration the following levels of care:

1. Health promotive2. Disease

preventive3. Curative and

restorative

a. For altered pulmonary function: Airway patency Oxygen therapy Adequate ventilation Drug therapy Hydration Removal of secretion Prevention of infection Prevention of complications Prevention of psychosocial problems Rehabilitation




4 hours The students should be able to apply the various principles in the management of clients with problems in oxygenation in the actual clinical nursing practice.

The students should be able to provide the patients/clients with the

b. For cardiac function Hemodynamics monitoring O2 therapy Drug therapy Hydration Prevention of infection Prevention of complications Prevention of psychosocial problems Rehabilitation

c. Oxygen carrying capacity of the blood Blood component replacement O2 therapy Drug therapy Hydration Prevention of infection Prevention of complications

proper teachings on health promotion, disease prevention and curative and health restoration.

8. Enumerate Pharmacologic actions, therapeutic uses, side effects, indications, contraindications, and nursing responsibilities in administering medications clients with oxygenation problems.

a. Pulmonary Bronchodilators Expectorants Antitussives Antihistaminesb. Cardiac Sympathomymetic agents Sympatholytic agents Anti-anginal agents Anti- arrhythmic agents Angiotensin converting enzyme inhibitors Antilipemic agents Anticoagulant agents Thrombolytics Peripheral vascular agentsc. Blood Hematinics Vitamin supplements




2 hours The students should be able to enumerate the different pulmonary, cardiac, blood medications, with their corresponding pharmacologic actions, therapeutic uses, side effects, indications and contraindications and nursing responsibilities in the different medications of clients with oxygenation problems.

9. List the purposes, indications, nursing responsibilities for the surgical and special procedures in alterations in oxygenation.

1. Safe and comprehensive perioperative nursing care1.1 Assessment and care during the

perioperative period1.2 Techniques in assisting the surgical team

during the operation1.3 Principles of safety, comfort and privacy

during the perioperative period1.4 Nursing responsibilities during the




2 hours The students will be able to list the different surgical and special procedures for clients with oxygenation problems and identify the nursing responsibilities in each procedure.

perioperative period Preoperative – physical,

psychological, spiritual preparation Intraoperative – circulating nurse

functions, scrub nurse functions Postoperative – airway, breathings,

circulation priorities. Meeting the physical, psychological and spiritual needs of the cliet.

2. Pulmonarya. Surgical procedures – tracheostomy,

thoracostomy, lung resection, lobectomy, pneumonectomy, thoracoplasty, decortications

b. Special procedures – endotrcheal/tracheal suctioning and care, humidication, IPPB, ventilator assist

3. Cardiac a. Surgical procedures – coronary aretery bypass,

pacemaker insertion, valve replacement, repair of congenital abnormality, insertion of ventricular assist device, heart plansplant

b. Special procedures – laser therapy, basic life support, advance life support

3.1 Vasculara. Surgical procedures – endarterectomy,

aneurysmectomy, insertion of intravascular stents

b. Special procedures – application of antiembolic stockings

3.2 Blood forming organsa. Surgical procedures – bone marrow

aspiration, bone marrow transplantb. Special procedures – blood component

transfusion, reverse isolationAt the end of the lecture discussion, the students will be able to:

1. Utilize the nursing process in the care of individuals, families with problems in Fluids and electrolyte imbalances in

10. Identify risk factors among clients that contribute to the development of problems in Fluid and Electrolytes.

Potential factors for exceeding renal reserve capacity, dietary habits to include salt intake, hypertension, infection, diabetes.




1.5 hours After the discussion, the students will be able to identify the modifiable and non-modifiable risk factors that contribute to the development of problems in fluid and electrolyte imbalances.

11. Enumerate the Inspection- signs of dehydration, overhydration Demonstration Assertiveness 2 hours The students will be able to

community and hospital settings.





principles and techniques of physical examination in newborn, children, adults, deviations from normal.

Palpation- edema, ascites, neck vein filling, hand vein filling, neuromuscular irritability, characteristic of pulse

Percussion- abdomen for presence of air, fluid Auscultation- rates

Return Demonstration

Lecture Discussion Post test

Cooperation Participation Sensitivity

perform the proper techniques in physical examination and apply the principles in correctly assessing the newborn, children, and adult’s fluids and electrolyte balance status by comparing any deviations from normal findings.

12. Identify results and implications of diagnostic/laboratory examinations of clients with reference to problems in

a. Diagnostic tests Non-invasive: electrolyte determination, intake

and output, KUB-IVP and ultrasound Invasive – biopsyb. Weightc. Vital Signs





13. Determine the Patho-physiologic Mechanisms of Fluid and electrolyte imbalances.

a. Volume impairment – fluid volume deficit, fluid volume excess, third space fluid shift

b. Osmotic imbalances – hyponatremia, hypernatremia

c. Ionic concentration problems – hypo- and hyperkalemia; hypo and hyperchloremia; hypo- and hypermagnesemia; hypo- and hyperphosphatemia

d. Acid and base imbalances – metabolic acidosis and alkalosis; respiratory acidosis and alkalosis




12 hours The students should be able to determine the patho-physiologic mechanisms in the different fluid and electrolyte imbalances.

14. Enumerate Nursing diagnoses taxonomy pertinent to problems/alteration in Fluid and electrolyte imbalance.

a. Risk for fluid volume deficitb. Fluid volume excessc. Fluid volume deficitd. High risk for injury related to electrolyte

deficit/excesse. High risk for injury related to acid/base

imbalancef. Altered urinary eliminationg. Impaired integumentary integrity




2 hours The students should be able to identify possible nursing diagnoses taxonomy pertinent to the derived assessment data to pertinent problems in fluid and electrolyte imbalances.

15.Identify principles of various modalities of management of clients with problems in fluid and electrolyte imbalances taking into consideration the following levels of care:

a. Fluid Volume Deficit Determination and management of

cause Hydration Blood transfusion as needed Drug therapy – electrolyte Supportive management




12 hours The students should be able to apply the various principles in the management of clients with problems in fluid and electrolyte imbalance in the actual

a. Health promotiveb. Disease preventivec. Curative and

restorative

Prevention of infection Prevention of complication Prevention of psychosocial problems Rehabilitation

b. Fluid Volume Excess Determination and management of

cause Drug therapy – diuretics, electrolytes Dietary restriction – sodium Supportive management Prevention of infection Prevention of complication Prevention of psychosocial problems Rehabilitation

c. Electrolyte Deficit – hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hypophosphatemia Determination and management of

cause Drug therapy – electrolyte replacement Dietary management Supportive management Prevention of complication Prevention of psychosocial problems Rehabilitation

d. Electrolyte Excess – hyperkalemia, ypercalcaemia, hypermagnesemia, hyperphosphatemia Determination and management of

cause Drug therapy – electrolyte replacement Dietary management Supportive management Prevention of complication Prevention of psychosocial problems Rehabilitation

e. Metabolic Alkalosis – Base bicarbonate exces Determination and management of

cause Drug therapy Dietary management Supportive management Prevention of complication Prevention of psychosocial problems

clinical nursing practice. The students should be

able to provide the patients/clients with the proper teachings on health promotion, disease prevention and curative and health restoration.

Rehabilitationa. Metabolic Acidosis- base

bicarbonate deficit Determination and management of

cause Drug therapy Dietary management Supportive management Prevention of complication Prevention of psychosocial problems Rehabilitation

f. Respiratory Alkalosis – carbonic and acid deficit Determination and management of


g. Respiratory Acidosis – carbonic acid excess Determination and management of


16. Enumerate Pharmacologic actions, therapeutic uses, side effects, indications, contraindications, and nursing responsibilities in administering medications clients in fluid and electrolyte imbalances.

a. Fluid Parenteral fluids Hypotonic Hypertonic Isotonic

b. Electrolyte Sodium Potassium Calcium Magnesium Phosphate

c. diuretics Potassium-sparing Potasium-losing




2.5 hours The students should be able to enumerate the different medications in managing clients with fluid and electrolyte imbalances, with their corresponding pharmacologic actions, therapeutic uses, side effects, indications and contraindications and nursing responsibilities in the different medications.

Osmotic diureticsd. Vitamin D supplements

17. List the purposes, indications, nursing responsibilities for the surgical and special procedures in alterations in fluid and electrolyte imbalances.

Renal dysfunction a. Major surgical procedures –

nephrectomy, nephrostomy, cystectomy, uterostomy, renal transplants, urinary diversion

b. Special procedures- peritoneal dialysis, hemodialysis, bladder training, cystoclysis/bladder irrigation




2.5 hours The students will be able to list the different surgical and special procedures for clients with fluid and electrolyte imbalance and identify the nursing responsibilities in each procedure.


process in the care of individuals, families with problems in nutrition and metabolism in community and hospital settings.





18. Identify risk factors among clients that contribute to the development of problems in Nutrition and Metabolism.

Risk factors related to malnutrition, obesity. Pre-tests Case Analysis Small Group



1 hour After the discussion, the students will be able to identify the modifiable and non-modifiable risk factors that contribute to the development of problems in nutrition and metabolism.

19. Identify significant subjective data from client history related to problems in nutrition and metabolism.

a. Chief complaintsb. Relevant information, to include eleven





2 hours The students should be able to identify significant subjective data from client’s history by enumerating the possible chief complaints and recording relevant information guided by the eleven functional patterns

20. Enumerate the principles and techniques of physical examination in newborn, children, adults, deviations from normal.

3.3 Gastrointestinal function – IPPA Inspection- color, texture of skin,

mucous membrane, growth patterns, scars, masses

Auscultation- bowel sounds, bruits Palpation – focus on GIT for presence of

masses, ascites, rebound tenderness, distention

Percussion – liver span, masses




1.5 hours The students will be able to perform the proper techniques in physical examination and apply the principles in correctly assessing the newborn, children, and adult’s nutritional and metabolic status by comparing any deviations from normal findings.

21. Identify results and implications of diagnostic/laboratory examinations of clients with reference to problems in Nutrition and Metabolism.

a. Non-invasive: ultrasound of the abdomen, stool culture

b. Invasive: to include: barium swallow, esophagoscopy, biopsy, cytology examination, gastric secretion analysis, endoscopy (gastroscopy, duodenoscopy), proctosigmoidoscopy and rectal examination





22. Determine the Patho-physiologic mechanisms of the Alterations in Nutrition and Metabolism.

a. Disturbances in ingestion – problems in buccal cavity and esophagus

b. Disturbances in digestion – peptic acid disease, gastritis and gastric cancer

c. Disturbances in absorption – malnutrition, malabsorption syndrome and inflammatory bowel conditions

d. Disturbances in elimination – bowel obstruction, hemorrhoids, diarrhea and constipation.




12 hours The students should be able to determine the patho-physiologic mechanisms in the different nutritional and metabolic problems.

23. Enumerate Nursing diagnoses taxonomy pertinent to problems/alteration in Nutrition and Metabolism.

a. Alteration in nutrition less than body requirementb. Alteration in nutrition more than body

requirementc. Alteration in oral mucous membrane integrityd. Alteration in comfort: epigastric pain/abdominal

paine. Fluid volume deficit




1.5 hours The students should be able to identify possible nursing diagnoses taxonomy pertinent to the derived assessment data to pertinent problems in nutrition and metabolism.

24.Identify principles of various modalities of management of clients with problems in Nutrition and Metabolism taking into consideration the following levels of care:

4. Health promotive5. Disease

preventive6. Curative and

restorative

A. Disturbances in ingestion Determination and management of


B. Disturbances in digestion Determination and management of


C. Disturbances in absorption Determination and management of




12 hours The students should be able to apply the various principles in the management of clients with problems in nutrition and metabolism in the actual clinical nursing practice.

The students should be able to provide the patients/clients with the proper teachings on health promotion, disease prevention and curative and health restoration.


D. Disturbances in elimination Determination and management of


E. Disturbances in hepatic, biliary and pancreatic functions Determination and management of


25. Enumerate Pharmacologic actions, therapeutic uses, side effects, indications, contraindications, and nursing responsibilities in administering medications clients with Nutrition and Metabolism problems.

Antiemetics Anticoagulants Hematinics agents Laxatives and stool softeners Antipruritus Vitamin supplement Antacids Antihyperlipidemics Antispasmodics Antidiarrheal




2 hours The students should be able to enumerate the different pulmonary, cardiac, blood medications, with their corresponding pharmacologic actions, therapeutic uses, side effects, indications and contraindications and nursing responsibilities in the different medications of clients with nutrition and metabolism disorders.

26. List the purposes, indications, nursing responsibilities for the surgical and special procedures in alterations in

a. Surgical procedures – gastrostomy, gastrectomy, colostomy, hemorrhoidectomy, gastrointestinal bypass, ileostomy

b. Special procedures – parenteral hyperalimentation; feeding per nasogastric,


Learning Lecture Discussion


2.5 hours The students will be able to list the different surgical and special procedures for clients with nutrition and metabolism problems and

Nutrition and Metabolism. jejunostomy, gastrostomy tubes; colostomy care and irrigation, dietary planning for common GT and endocrine problems; administering medications via NGT, J tube, G tube; hot sitz bath

Post test identify the nursing responsibilities in each procedure.


process in the care of individuals, families with problems in endocrine functioning in community and hospital settings.





27. Identify risk factors among clients that contribute to the development of problems in Endocrine Function.

Risk factors related to endocrine hypo or hyper-functioning.




1.5 hours After the discussion, the students will be able to identify the modifiable and non-modifiable risk factors that contribute to the development of problems in endocrine functioning.

28. Identify significant subjective data from client history related to problems in endocrine functioning.

A. Chief complaintsB. Relevant information, to include eleven





2 hours The students should be able to identify significant subjective data from client’s history by enumerating the possible chief complaints and recording relevant information guided by the eleven functional patterns

29. Enumerate the principles and techniques of physical examination in newborn, children, adults, deviations from normal in the endocrine system.

Inspection- color, texture of skin, mucous membrane, growth patterns, obesity

Auscultation – bruit, heart sounds, breath sounds

Palpation- organ-thyroid enlargement, masses, edema

Percussion- fluid, edema Others – weight, delayed healing of wounds




1.5 hours The students will be able to perform the proper techniques in physical examination and apply the principles in correctly assessing the newborn, children, and adult’s endocrine functioning by comparing any deviations from normal findings.

30. Identify results and implications of diagnostic/laboratory examinations of clients with reference to problems in endocrine functioning.

a. Screening: glucose tolerance test Non-invasive: e.g. GI x-ray, ultrasound

abdomen, Radio-iodine assay (RAI), protein bound iodine (PBI), thyroid scan, free thyroxin level, basal metabolic rate (BMR), thyroxine stimulating hormone (TSH) test, OGTT (Glucose tolerance test) urinalysis (glycosuria, ketonuria)

Invasive: e.g. percutaneous transhepatic





cholangiogram, liver function test, serum thyroxine and triiodothyronine test, iodine 131 uptake, blood sugar tests (fasting blood sugar –FBS), random blood sugar (RBS), glycosylated hemoglobin (Hgb), two-hour post prandial blood glucose, endocrine assay.

31. Determine the Patho-physiologic mechanisms of the Alterations in endocrine functioning.

a. Hypo- and Hyperfunction of the pituitary organb. Hypo- and Hyperfunction of the hypothalamusc. Hypo- and Hyperfunction of the thyroid organd. Hypo- and Hyperfunction of the parathyroid

organe. Hypo- and Hyperfunction of the adrenal organf. Hypo- and Hyperfunction of the gonadsg. Problems in glucose metabolism – hypoglycemia

and hyperglycemia (IDM, NIDDM)




10 hours The students should be able to determine the patho-physiologic mechanisms in the different endocrine problems.

32. Enumerate Nursing diagnoses taxonomy pertinent to problems/alteration in endocrine functioning.

a. Alterations in nutrition less than body requirement

b. Fluid volume deficitc. Activity intolerance




1.5 hours The students should be able to identify possible nursing diagnoses taxonomy pertinent to the derived assessment data to pertinent problems in endocrine functioning.

33. Enumerate Pharmacologic actions, therapeutic uses, side effects, indications, contraindications, and nursing responsibilities in administering medications clients with endocrine problems.

Corticosteroids Alpha-adrenergic blocking agents Beta-adrenergic blocking agents Tyrosine inhibitors Dopamine receptor antagonists Glucocorticoids Parathyroid hormone agents Thyroid hormone agents Insulin Oral hypoglycemic agents




2.5 hours The students should be able to apply the various principles in the management of clients with problems in endocrine functioning in the actual clinical nursing practice.

The students should be able to provide the patients/clients with the proper teachings on health promotion, disease prevention and curative and health restoration.

34.Identify principles of various modalities of management of clients with problems in endocrine functioning taking into consideration the following levels of care:

Determination and management of cause Drug therapy - diuretics, electrolytes Dietary management Supportive management Prevention of complication Prevention of psychosocial problems




12 hours The students should be able to enumerate the different pulmonary, cardiac, blood medications, with their corresponding pharmacologic actions,

a. Health promotiveb. Disease preventivec. Curative and

restorative

Rehabilitation therapeutic uses, side effects, indications and contraindications and nursing responsibilities in the different medications of clients with endocrine problems.

35. List the purposes, indications, nursing responsibilities for the surgical and special procedures in alterations in endocrine functioning.

a. Surgical procedures – thyroidectomy, parathyroidectomy

b. Special procedures – monitoring of blood glucose levels; maintenance of blood glucose – diet, exercise, drugs




2.5 hours The students will be able to list the different surgical and special procedures for clients with endocrine problems and identify the nursing responsibilities in each procedure.

References:1. Lippincott Williams & Wilkins. The Lippincott Manual of Nursing Practice – 7th edition. 2001.2. Marieb, Elaine N. Essentials of Human Anatomy and Physiology – 8th edition. Pearson Education South Asia PTE. LTD. 20063. Brunner and Suddarth. Textbook of Medical-Surgical Nursing – 12th edition. 2010