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General Objectives for Cancer Nursing: Given a client with cellular aberration; the student will be able to; 1. Describe the prevalence, incidence, and death rates of Cancer. 2. Describe the processes involved in the biologypathology of Cancer. 3. Describe the role of the Immune system related to cancer. 4. Differentiate the three phases of

A. Review of Anatomy and Physiology Normal Cell B. Cellular Aberration 1. Assessment a. Subjective A1. Risk Factors heredity, age, gender, poverty, stress, diet, occupation, infection, tobacco use, alcohol use, recreational drug use, obesity, sun exposure A2. Health History b. Physical assessment 2. Nursing Diagnosis a. Risk for infection as evidenced by tissue trauma or impaired immune response b. Ineffective health maintenance as evidenced by lack of preventive care or health screening c. Ineffective protection as evidenced by high impaired immunity related to cancer therapy or HIV disease d. Risk for trauma as evidenced by high risk personal behavior 3. Pathophysiology a. Normal Cell Cycle b. The Cell Cycle

cancer development.

5. Explain the use of surgery, radiation therapy, chemotherapy, and biologic therapy in the treatment of Cancer. 6. Describe the effects of radiation therapy and chemotherapy on normal tissues. 7. Identify the types and effects of biologic therapy agents. 8. Explain the role of the nurse in the prevention, detection, cure and rehabilitation of Cancer. 9. Describe the complications

4. Planning a. Planning for Health Promotion and Maintenance Cancer prevention and Control Prevention, screening and early detection Approaches to Cancer prevention 5. Planning for Health Restoration Surgery Radiation therapy Chemotherapy Immunotherapy 6. Implementation a. Pharmacological therapy anti-neoplastic drugs b. Nutrition and Diet therapy ACS dietary guidelines to prevent cancer c. Complimentary therapies Botanical agents Nutritional supplements Dietary regimens Mind-body modalities Energy healing Spiritual approaches Miscellaneous therapies

that can occur in advanced cancer.

Given an adult client (young, middle, old, old-old) with acute responses to acute biologic crisis, the students will be able to; 1. Apply knowledge of normal anatomy and physiology and assessment techniques in caring for clients with acute biologic crisis. 2. Assess the health status of the client:

C. Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction 1. Shock a. Classification of Shock b. Stages of Shock c. Diagnostic Studies d. Collaborative Care D1. General measures Oxygen and ventilation Fluid resuscitation Drug therapy Nutritional therapy D2. Specific measures e. Nursing Management D1. Nursing assessment D2. Nursing diagnosis D3. Planning D4. Acute intervention D5. Ambulatory and home care f. Evaluation 2. Systemic inflammatory response syndrome and multiple organ dysfunction a. Etiology b. Pathophysiology c. Clinical manifestations of SIRS and MODS d. Nursing and Collaborative Management

a. Conduct a health history and functional health status of clients at risk for or with acute biologic crisis.

D1. D2. D3. D4.

Prevention and control of infection Maintenance of Tissue Oxygenation Nutrition and Metabolic Demands Support of Failing Organs

A. Respiratory Failure and Acute Respiratory Distress Syndrome 1. Respiratory Failure a. Etiology and pathophysiology b. Clinical manifestations c. Diagnostic studies d. Nursing and collaborative care Nursing assessment Nursing diagnoses Planning/implementation Prevention Restoration Respiratory therapy-oxygen therapy; mobilization of secretions; positive pressure ventilator Drug therapy Medical supportive therapy Nutritional therapy e. Evaluation 2. Acute respiratory Distress Syndrome a. Etiology and pathophysiology b. Clinical progression and Manifestation c. Complications d. Nursing and Collaborative Management Nursing Assessment Nursing Diagnoses Planning Respiratory therapy

b. Interpret deviations from normal findings in physical assessment, and diagnostic and laboratory examinations ,
c. Monitor the

results of

diagnostic tests and report abnormal findings. 3. Utilize the assessed data to: a. Prioritize nursing diagnosis b. Discuss the pathophysiological responses to acute biologic crisis c. Plan the care of clients utilizing evidenced based nursing research

Medical supportive therapy

d. Achieve the best clinical outcomes utilizing ethico-moral and legal principles e. Plan effective care

D. Critical Care Nursing 1. Hemodynamic Monitoring a. Terminology - Cardiac output and cardiac index - Preload - Afterload - Vascular resistance - Contractility b. Principles - Referencing - Zeroing c. Types - Invasive Pressure Monitoring Arterial blood pressure Pulmonary artery flow directed catheter - Noninvasive Oxygenation Monitoring d. Nursing management in Hemodynamic monitoring 2. Circulatory assistive Devices a. Intra-aortic balloon pump b. Ventricular assistive devices c. Implantable artificial heart d. Nursing Management in Circulatory assistive devices 3. Artificial Airways a. Endotracheal tubes b. ET intubations procedures c. Nursing management: Artificial Airway

f. Implement individualized nursing care safely and knowledgeabl y administer prescribed medications and treatments alternative and complementa ry treatments g. Actively participate in planning and coordinating culturally sensitive interdisciplin ary care.

4. Mechanical Ventilation a. Types b. Settings of Mechanical Ventilations c. Modes of volume ventilation d. Other ventilator maneuvers e. Complications of positive pressure ventilation f. Weaning from positive pressure ventilation and extubation. g. Chronic mechanical ventilation

h. Provide appropriate client education and health maintenance community-

based care of clients efficiently and effectively. i. Effectively utilize available resources in the care of clients to achieve outcomes.

E. Essentials of disaster Planning 1. Definition of disasters 2. Types of disasters a. Natural - Earthquakes - Floods - Tornadoes and hurricanes - Volcanic eruptions Tsunamis - Other geological or meteorological phenomena b. Man made - Biological terrorism - Biochemical terrorism - Chemical pills - Radiological (nuclear) events - Fires - Explosions (blast/bomb) - Transportation accidents - Armed conflicts - Acts of war

Given adult clients (young, middle, old, old-old, adult) experiencing

disasters, the students will be able to; 1. Apply knowledge of normal anatomy and physiology and assessment techniques in caring for clients experiencing disasters. 2. Assess health status of clients who have experienced a disaster and monitor, document, and the triage to the appropriate level of care. 3. Using assessment skills prioritize nursing diagnosis, develop quick plan, implement, and evaluate individualized nursing interventions for clients who are victims of disasters

Classifications of manmade Disasters Complex emergencies Technological disasters Disasters not caused by natural hazards but occur in human settlements

c. Combination or NA-TECHs other categories based on - Onset - Impact - Duration 3. Health effects disasters 4. Hazard Identification and Vulnerability Assessment a. Methods for data collection for disaster planning - Hazard identification and mapping - Vulnerability analysis - Risk assessment 5. Emergency Management Cycle a. Pre-impact b. Impact c. Post-impact 6. Phases of Disaster Management Program a. Preparedness b. Mitigation c. Response d. Recovery e. Evaluation 7. Types of disaster planning a. Agent-specific approach b. All-hazards approach

4. Provide skilled nursing care to treat disasterrelated injuries. 5. Integrate interdisciplinary care of clients which reflects understanding of the disaster response.

8. Internal Hospital disasters a. Phases - Alert phase - Response phase - Expanded response phase b. Hospital disaster plan c. Potential scenarios - Loss of power, including auxiliary power - Loss of medical gases - Loss of water and/or water pressure - Loss of compressed air and vacuum (suction) - Loss of telecommunications systems - Loss of information technology systems - Threats to safety of patients and staff (violence, terrorism and bombs) F. Disaster Management 1. Levels of disasters 1.1level I 1.2level II 1.3level III 2. Hospital emergency incident Command (HEIC) system

3. Triage 3.1definition 3.2objectives of triage 3.3types of triage 3.3.1. simple triage and rapid treatment (START) system a. Delayed walking wounded b. RPM (respiration, perfusion, mental status) c. Color coding (red, yellow, green and black) d. Zones for disaster triage (hot, warm and cold) 3.3.2. START Pediatric system 4. Disaster triage principles a. Never move a casualty backward (against the flow) b. Never hold a critical patient for further care. c. Salvage life over limb d. Triage providers do not stop treating patients 5. Communicating with media 6. Unique needs of children during disasters 7. Understanding the psychosocial impact of disasters a. Psychological reactions to disaster b. Horror, anger, panic

c. Magical thinking about microorganism d. Fear of invisible agents or fear of contagion e. Attribution of arousal symptoms to infection f. Anger at terrorist or the government g. Scapegoating h. Paranoia, social isolation, or demoralization

8. Common reactions of disaster survivors a. Emotional b. Bahavioral c. Cognitive d. Physical 9. Phases a. The b. The c. The d. The of emotional recovery (RED CROSS) heroic phase honeymoon phase disillusionment phase reconstruction phase

10.Special needs population a. Older adults b. The severely mentally ill culture and ethnic subgroups c. First responders and other helpers d. Nurses and hospital personnel 11.The role of Rituals in healing a. Mourning b. Milestone c. Anniversaries


NCM 106 Care of Clients with Problems in Cellular Aberrations, Acute Biologic Crisis, including Emergency and Disaster Nursing

COURSE DESCRIPTION clients across including

The course deals with the principles and techniques of nursing care management of sick the lifespan with alterations/problems in cellular aberrations, acute biologic crisis, emergency and disaster nursing and IV therapy.

Course Credit Contact Hours/Semester Prerequisite Placement Course Objectives situations;

6 units lecture; 5 units RLE (2 units skills lab; 3units clinical) : : : : 108 hours lecture; 255 hours RLE NCM 105 4th Year; 1st Semester Given an actual client with cellular aberrations, in acute biologic crisis and in emergency the students will be able to; 1. Utilize the nursing process in the care of the individuals, families in community and hospital settings. a. Assess with client/s his/her/their conditions/ health status through interview, physical examination, interpretation of laboratory findings. b. Identifies actual and potential nursing diagnosis c. Plans appropriate nursing diagnosis d. Implements plan of care with client/s and family e. Evaluates the progress of his/her/their clients condition and outcomes of care. 2. Ensure a well organized and accurate documentation system 3. Relate with clients and their family and the health team appropriately 4. Observe bioethical concepts/principles, core values and nursing standards in the care of the clients. 5. Promote personal and professional growth of self and others.