Prerequisites:  Nursing 25, Nursing 25L, Nursing 30 and Nursing 30L or accepted into advanced placement and completion of Nursing 19 with C grade or better.

Corequisites:  Nursing 35L

The focus in this course is to enable the student to develop competencies in understanding complex health problems and managing health deviations related to the neurosensory, cardiovascular, and respiratory disorders and the burn injury patient.  Students will develop competencies in utilizing Orem’s Self-Care Model and the nursing process in self-care requisites of selected patients and the universal self-care demands.  Students will   determine the therapeutic self-care demand and design a plan of care that promotes the optimal level of function of adults and older adults with complex health problems.  Principles of delegation are explored.        

1. Assess the self-care requisites of patients with health deviations of the cardiovascular, neurosensory, respiratory systems and the burn injury patient.
2. Design a plan of care that facilitates acquisition and maintenance of optimal health for a patient with alteration of the cardiovascular, neurosensory, respiratory systems and the burn injury patient.
3. Discuss the impact of multi-system failure on the selected health deviations.
4. Differentiate the nursing interventions required to promote and maintain optimal health of the adult and older adult with health deviations of the neurosensory, cardiovascular, respiratory systems, the burn injury patient.
5. Develop teaching plans that will assist in meeting the self-care requisites of the patient to promote and maintain optimal health.
6. Discuss behaviors that illustrate knowledge of professional responsibility inherent to principles of delegation.
7. Discuss the importance of communicating through appropriate channels to effectively achieve goals in the health care setting.

Upon completion of instruction, the Nursing 35 nursing student will achieve the following objectives at a minimum of 75% or higher level:
     A.  Basic Critical Care Concepts

1.      Explain emergency nursing care as a collaborative holistic approach in meeting the needs of the patient.

2.      Discuss priority measures instituted in caring for the critically ill patient.

3.      Describe management of patients with critical conditions.

4.      Discuss the care of patients on life support and requiring invasive monitoring.

5.      Discuss the role of the critical care nurse.

     B.  Respiratory Disorders

1.      Describe ventilation, perfusion, and shunting and the relationship of pulmonary circulation to these processes.

2.      Identify the nursing implications of the various procedures used for the diagnostic evaluation of respiratory function.

3.      Use the nursing process in the care of patient with a laryngectomy.

4.      Compare the various pulmonary infections with regard to causes, clinical manifestations, nursing management, complications and prevention.

5.      Discuss the pathophysiology and nursing management of upper and lower airway obstruction.

6.      Discuss pathophysiology of pleurisy, pleural effusion and empyema to pulmonary infections.

7.      Discuss environment and lifestyle influences as a causative factor to pulmonary disease. 

8.      Utilize Orem’s Self-Care Model as a framework for the care of the patient with chronic pulmonary disease.

9.      Differentiate the nursing care for a patient with an endotracheal tube and for a patient with a tracheostomy.

10. Explain the principles of chest drainage and the nursing responsibilities related to the care of the patient with water-seal drainage.

11. Describe the patient education and home care considerations for patients who have had thoracic surgery.

C.  Cardiovascular and Circulatory Alterations
       1.   Compare and contrast the clinical manifestations, treatment and
             therapeutic nursing interventions associated with angina pectoris
              and myocardial infarction.

        2.   Describe expected outcomes and the nursing responsibilities
              when administering medications to treat patients with
              cardiovascular alterations.

        3.  Determine the therapeutic self-care demand of a patient with
             alterations of the cardiovascular and circulatory systems.
        4.  Describe the pathophysiology associated with the development
             of coronary artery disease.
        5.  Interpret the results of diagnostic/lab tests used in the care of
             patients with cardiovascular alterations.
        6.  Identify common dysrhythmias and describe the nursing
              responsibilities, medical treatment for each dysrhythmia.
        7.  Develop a teaching plan for a patient with coronary ischemia
             that requires lifestyle changes.
        8.  Describe the conduction of electrical impulses in the heart and
             the relationship to systole and diastole.
        9.  Explain the pathophysiology of heart failure.
      10.  Provide rationale for each nurse prescribed and physician
             prescribed intervention in patients with congestive heart failure,
             common structural and infectious disease of the heart.
      11. Compare and contrast the clinical manifestations, clinical
            monitoring devices of patients with right-sided failure and patients
            with left-sided failure.
      12. Discuss the pathophysiology of cardiogenic shock.
      13. Formulate nursing interventions for a patient pre and post cardiac
            catheterization.
      14. Develop a plan of care for a patient following open-heart surgery.
      15. Discuss the relationship of fat, cholesterol, and sodium intake to the
            development of cardiovascular disease.
      16.  Identify nutritional strategies likely to reduce the risk of
             cardiovascular disease.

      17.  Describe the low-fat and 2 gram sodium diets.            

D.  Neurosensory Alterations

1. Compare and contrast the pathophysiology, therapeutic regimen nursing intervention of patients with selected neurological disorders: Alzheimer’s disease, Huntington’s disease, amyotrophic lateral sclerosis, and muscular dystrophy
2. Describe the nursing interventions for a patient with seizure disorders. 
3. Discuss the nursing concepts associated with long-term care, home care, or rehabilitation for patients with common neurological problems.
4. Identify the physiological and psychosocial of principles underlying the care of the patient with a degenerative neurological disorder.
5. Design a plan of care for patients with degenerative neurological disorders.
6. Discuss major medications and surgical procedures that may be used to treat cerebrovascular disorders.
7. Develop a plan of care for a patient in the acute state of cerebrovascular disorder.
8. Describe the therapeutic regimens and nursing interventions associated with cerebral edema, intracranial bleeding, syndrome of inappropriate secretion of antidiuretic hormone, diabetes insipidus, meningitis and hyperthermia/hypothermia.
9. Describe the etiology, pathophysiology, clinical manifestations and medical management for patients with intracranial disorders.
10. Describe the etiology, pathophysiology, clinical manifestations and medical therapeutic regimen and nursing interventions for a patient with spinal cord injury.
11. Discuss spinal shock and autonomic dysreflexia and their management.

      12.  Compare and contrast the rehabilitation needs of patients with
       different forms of central nervous system impairments.

E.  Management of the Burn Injury Patient

1. Discuss the classification system used for burn injuries.
2. Describe the local and systemic effects of a major burn injury.
3. Describe the three phases of burn care and the priorities of care for each phase.
4. Discuss fluid and electrolyte alterations, emergent/resuscitative interventions in the acute phase of burn management.
5. Develop a plan of care for patients with various states of burn injuries.
6. Describe the nursing implication in the following areas of care:  pain, mobility, pulmonary, and psychological support of the patient and family.
7. Develop a plan of care for the burn patient during the rehabilitation phase.