RNRS 251: Medical-Surgical Nursing IV

• Demonstrate a broad base of knowledge and critical thinking in the application of the nursing process by generating and modifying nursing care plans for assigned clients experiencing complex, critical, traumatic or multi-system failure in various health care settings in order to provide individualized and competent nursing care.
• Apply critical thinking and evidenced based practice to all aspects of client care.
• Consistently utilize verbal and written communications in English with the purpose of assisting clients to promote, maintain, or restore well-being, or to assist the client/family of the client during the active phase of dying in the medical-surgical or critical care health settings.
• Design and implement patient teaching plans using principles of adult teaching/learning to be able to provide individualized care to clients with complex, critical, traumatic or multi-system failure and/or alterations in wellness.
• Operate as a collaborative member of the health care team, formulating nursing care plans for assigned clients with minimal guidance from an instructor, with the intention of rendering entry-level professional nursing care, needed for successful job retention.
• Independently seek in-depth information about concepts covered in class/clinical to improve client care and outcomes in critical care health settings, reflected in nursing care plans and concept maps.
• Demonstrate knowledge of the legal and ethical framework by consistently practicing within the scope of practice set forth by the state of California’s Nurse Practice Act, when providing care to assigned clients in the medical-surgical and critical care settings.

1. Complex Alterations in Cardiovascular function
   1. Review of pathophysiology, onset and clinical course of acute cardiovascular disorders
   2. Review of diagnostic exams/laboratory indicators related to cardiovascular alterations and nursing responsibility
   3. Cultural/ Geriatric considerations
   4. Nursing management and application of the nursing process and ADN Conceptual Framework
   5. Client/family teaching
2. Complex Alterations in respiratory function
   1. Review of pathophysiology, onset and clinical course
   2. Review of diagnostic exams/laboratory indicators related to respiratory alterations and nursing responsibility
   3. Cultural/ Geriatric considerations
   4. Nursing management and application of the nursing process and ADN Conceptual Framework
   5. Client/family teaching
3. Complex Alterations in Neurological function
   1. Review of pathophysiology, onset and clinical course
   2. Review of diagnostic exams/laboratory indicators related to neurologic alterations and nursing responsibility
   3. Cultural/ Geriatric considerations
   4. Nursing management and application of the nursing process and ADN Conceptual Framework
   5. Client/family teaching
4. Complex Alterations in Renal functions
   1. Review of pathophysiology, onset and clinical course
   2. Review of diagnostic exams/laboratory indicators related to renal alterations and nursing responsibility
   3. Cultural/ Geriatric considerations
   4. Nursing management and application of the nursing process and ADN Conceptual Framework
   5. Client/family teaching
5. Complex Alterations in Endocrine Function
   1. Review of pathophysiology, onset and clinical course
   2. Review of diagnostic exams/laboratory indicators related to endocrine alterations and nursing responsibility
   3. Cultural/ Geriatric considerations
   4. Nursing management and application of the nursing process and ADN Conceptual Framework
   5. Client/family teaching
6. Other Acute Problems/concepts related to Nursing Care: Conditions includes burns, shock, multisystem failure, critical care, emergency and disaster nursing care, and evidence based practice
   1. Review of pathophysiology, onset and clinical course
   2. Review of diagnostic exams/laboratory indicators related to acute alterations and nursing responsibility
   3. Cultural/ Geriatric considerations
   4. Nursing management and application of the nursing process and ADN Conceptual Framework
   5. Client/family teaching

7. Implicit bias training with a focus for healthcare providers.

a. Identification of previous or current unconscious biases and misinformation.

b. Identification of personal, interpersonal, institutional, structural, and cultural barriers to inclusion.

c. Corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose.

d. Information on the effects, including, but not limited to, ongoing personal effects, of historical and contemporary exclusion and oppression of minority communities.

e. Information about cultural identity across racial or ethnic groups.

f. Information about communicating more effectively across identities, including racial, ethnic, religious, and gender identities.

g. Discussion on power dynamics and organizational decision making.

h. Perspectives of diverse, local constituency groups and experts on particular racial, identity, cultural, and provider-community relations issues in the community.

Under the supervision of a clinical instructor, the student will be able to:

1. Perform a comprehensive physical assessment of the client within the physiologic, psychologic, social, cultural, and spiritual realms.
2. Cluster assessment cues into relevant groups of identifying criteria and formulate individualized nursing diagnoses.
3. Identify and prioritize nursing diagnoses and individual interventions to be carried out by the health care team.
4. Direct and carry out nursing interventions, participate in the implementation of collaborative interventions, and follow up on those interventions appropriately delegated to other members of the health care team.
5. Identify behavioral cues in a client with complex medical/surgical or traumatic injury problems and apply these cues to a communication plan to be used by the nursing team in caring for the client.
6. Administer medications through all routes demonstrating critical thinking  regarding pharmacologic interventions.
7. Consistently complete documentation per each clinical facility for care rendered to assigned clients in a timely manner.