Nursing Pathophysiology

16
NUR 345
Nursing Pathophysiology
Course outline
10 Quick Life Hacks to Improve Your Immunity Almost Immediately
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Week 1
Concepts of Disease
Defense and Protection
Week 2
Body Systems
Week 3
Body Systems
Biological Factors
Environmental Factors
Week 4
Putting it all Together:
Presentations
Assignments
Due Date
(Preferred)
Percentage
Due Date
(Flex)
Flow charts X 3
Flow charts X 3
5/11
5/18
8am
8am
5% each = 30%
5/15
5/22
8am
8am
Exam 1
Exam 2
5/16
5/23
8am
8am
15% each = 30%
5/19
5/26
8am
8am
Presentation PowerPoint and Delivery Notes
5/18
8am
10%
5/24
8am
Integrated Pathophysiology-Burns
5/25
8am
15%
5/29
8am
Presentation – Team Assignment
5/30 & 6/1
10%
N/A
Presentation Exemplar Notes
6/1
12pm
5%
N/A
Preferred date: Subject to full credit if assignment criteria met.
Flex date: Assignment turned in after the specified preferred time, but by the flex date listed.
Subject to 2% grade reduction regardless of grade achieved.
Absolute date: Assignment turned in after the specified flex time, but by absolute date.
Absolute due date is June 8th, 2017 at 8am.
Subject to 5% grade reduction regardless of grade achieved.
Modes of Evaluation
Grading
* Does not apply to take-home examinations.
· To achieve a grade of “F” (0%)
· Assignment turned in unacceptably late, or not turned in at all.
· To achieve a grade of “F” (69%)
· Assignment turned in by absolute date.
· Assignment demonstrates little to no effort.
· To achieve a grade of “D” (77%)
· Assignment turned in by absolute date.
· Assignment done poorly, is mostly incorrect, does not meet minimum criteria.
· To achieve a grade of “C” (85%)
· Meets some of the assignment criteria and is turned in by absolute due date.
· To achieve a grade of “B” (92%)
· Meets most of the assignment criteria and is turned in by absolute due date.
· To achieve a grade of “A” (100%)
· Meets all the assignment criteria and is turned in by absolute due date.
FLOW CHARTS
Guidelines
Students are assigned 6 disease topics. A flow chart (concept map) is constructed for each topic. This can be done by hand or by computer, and must not be larger than a standard sheet of paper. The flow chart must clearly and simply explain the functional change that accompanies a syndrome or disease process. Students should not attempt to include all information and details, but must prioritize the most important points, symptoms, etc. Include a reference chart with each flow chart. It does not matter in which order the flow charts are turned in. Due dates are listed elsewhere in this document. Examples are found on the next two pages, but students are not obliged to use any format.
Grading
Based on (1) correct topic, (2) acceptable references, (3) accuracy and (4) completeness of flow chart.
Topics
1. Takotsubo cardiomyopathy
2. Hodgkin’s Lymphoma
3. Autonomic dysreflexia after vertebral compression fracture
4. Anemia in cirrhosis
5. Pneumonia in COPD
6. Lupus nephritis
References
Place this chart with each flow chart. Place page number used beside text author listed. You must use at least one assigned textbook and one other source-a total of two references for each flow chart. If an external source is used, please provide the entire APA reference to receive full credit. (These texts are listed in full within the syllabus.)
Reference author
Page number(s)
Giddens
Halter
Igatavicius
Lilley
Perry
Stanhope
VanMeter
Wilson
Other:
Pathophysiology Flow Chart Example
Pathophysiology Flow Chart Example
Non-modifiable Risk Factors
Modifiable Risk Factors
Risks contribute to disease process in what ways?
Change from normal physiology
Change from normal physiology
Disease/Diagnosis
Complications/Disease Progression
How to alleviate symptom
How to alleviate symptom
How to alleviate symptom
Symptom
Symptom
Symptom
Change from normal physiology
EXAM 1
EXAMS
Grading
Based on (1) Correct answers (2) acceptable reference (3) rationale. 110 points available per exam.
EXAM 1
Grading:
4pts per question
Question
Rationale
1
The nurse assesses a 10-year-old client who has taken steroids intermittently for the past three years for a chronic condition. Which finding most concerns the nurse?
a) Growth curve that has changed from the 20th percentile to the 5th percentile.
b) A cat scratch from one week previously that is itchy, reddened, and scabbed.
c) The child appears hyperactive in the clinic and is talks continuously during the visit.
d) Parents report child has a varied appetite and sometimes eats only twice per day.
1 pts Text and page number
5 pts Your answer choices
2
Routine application of sun block to skin would be an example of:
a) an iatrogenic cause of cancer.
b) a preventive measure.
c) a precipitating factor.
d) a predisposing condition.
1 pts Text and page number
5 pts Your answer choices
3
Which of the following would cause edema?
a) Decreased capillary hydrostatic pressure
b) Increased capillary osmotic pressure
c) Decreased capillary permeability
d) Increased capillary permeability
1 pts Text and page number
5 pts Your answer choices
4
The client states that they have an allergy to diphenhydramine. Which statement indicates to the nurse that the client experiences a side effect of diphenhydramine, and cannot be considered an allergy?
a) “It makes me too sleepy to keep working.”
b) “Last time I took Benadryl I couldn’t urinate.”
c) “It causes me to experience chest tightness.”
d) “When I take Benadryl I have an anxiety attack.”
1 pts Text and page number
5 pts Your answer choices
5
Ingesting a drug with a large meal may be likely to:
a) increase the level of the drug.
b) prevent gastric irritation.
c) ensure the dose is absorbed.
d) cause more rapid drug excretion.
1 pts Text and page number
5 pts Your answer choices
6
A client with Marfan syndrome has chronic bilateral knee pain has just had surgery for a spinal deformity. The client calls for pain medication. Which is the most appropriate response by the nurse?
a) “You have hydrocodone and OxyContin ordered. Which medication do you prefer?”
b) “Where is your pain, when did it begin, and can you please rate it on a scale of 0-10?”
c) “Please explain more to me about the characteristics of the pain you are experiencing.”
d) “The OxyContin and hydrocodone are due in an hour. I will bring them both then.”
1 pts Text and page number
5 pts Your answer choices
7
The warmth and redness at the site of injury results from:
a) increased interstitial fluid.
b) production of complement.
c) the WBC response.
d) increased blood flow.
1 pts Text and page number
5 pts Your answer choices
8
Glucocorticoids are used to treat inflammation because they directly:
a) promote the release of prostaglandins.
b) decrease capillary permeability.
c) mobilize lymphocytes and neutrophils.
d) reduce erythema, edema, and pain.
1 pts Text and page number
5 pts Your answer choices
9
The nurse assesses a client with major and deep burn wounds. Which finding most concerns the nurse?
a) Bleeding within the wound beds.
b) Urine output of 75 mL/hr.
c) Blood pressure of 84/41 mmHg.
d) Hematocrit level of 54%.
1 pts Text and page number
5 pts Your answer choices
10
What does seroconversion mean in relation to HIV and AIDS?
a) The virus has been identified in body fluid samples.
b) Antibodies for HIV have been identified in the blood.
c) HIV was found in lymphocytes and neutrophils.
d) Active, acute infection has developed in the client.
1 pts Text and page number
5 pts Your answer choices
B!
Multiple Response-10points-All or None
Circle the correct responses.
The nurse educator teaches a group of oncology nurses about cancer-related pain. What types of pain might the client experience while undergoing therapy for cancer? (Select all that apply.)
a) Neuropathic pain related to peripheral nerve damage.
b) Visceral pain caused by ischemia in anatomical structures.
c) Phantom pain resulting from exploratory laparotomies.
d) Acute pain from a co-morbid pathophysiological process.
e) Somatic pain that is described as flu-like, dull, and achy.
EXAM 2
Grading:
4pts per question
Question
Rationale
1
How are antiviral drugs effective in treating a viral infection?
a) They destroy the virus over a 2-week period.
b) They limit the acute stage and viral shedding.
c) They prevent any systemic effects of viruses.
d) They prevent any secondary bacterial infection.
1 pts Text and page number
5 pts Your answer choices
2
The client with a broken femur is assessed frequently for complications. Which finding most concerns the nurse?
a) Pain in the broken femur bone.
b) Inability of the client to bear weight.
c) Reported shortness of breath.
d) Edema and redness in the lower leg.
1 pts Text and page number
5 pts Your answer choices
3
What causes numbness and tingling in the fingers of individuals with untreated pernicious anemia?
a) Persistent hyperbilirubinemia.
b) Metabolic acidosis.
c) Peripheral nerve demyelination.
d) Small vascular occlusions.
1 pts Text and page number
5 pts Your answer choices
4
What is the cause of oral ulcerations and delayed healing occurring with any severe anemia?
a) Lack of folic acid for DNA synthesis.
b) Frequent microinfarcts in the tissues.
c) Deficit of oxygen for epithelial cell mitosis.
d) Elevated bilirubin levels in the blood.
1 pts Text and page number
5 pts Your answer choices
5
One of the reasons non-Hodgkin’s lymphomas are harder to treat than Hodgkin’s lymphomas is that they:
a) are usually larger than Hodgkin’s lymphomas.
b) involve widespread metastases and lymph nodes.
c) are not affected by monoclonal antibodies.
d) are asymptomatic until they reach stage IV.
1 pts Text and page number
5 pts Your answer choices
6
The nurse assesses a three-day old infant with suspected congestive heart failure. What is the most important question for the nurse to ask the parents?
a) “Can you tell me about eating patterns.”
b) “Have you noticed any skin yellowing?”
c) “What do you do for the feet puffiness?”
d) “Has the heart rhythm been normal?”
1 pts Text and page number
5 pts Your answer choices
7
With a tension pneumothorax, which factors contribute to severe hypoxia?
a) Decreasing compression of the inferior vena cava.
b) More air leaving the pleural cavity on expiration than entering with inspiration.
c) Shift of the mediastinal contents toward the affected lung.
d) Continually increasing pressure on the unaffected lung.
1 pts Text and page number
5 pts Your answer choices
8
Which is a significant sign of bronchogenic carcinoma in a smoker?
a) Frequent nonproductive cough.
b) Fever and generalized aching.
c) Production of large volumes of sputum.
d) Hemoptysis and weight loss.
1 pts Text and page number
5 pts Your answer choices
9
The nurse cares for a client with increased intracranial pressure. Which finding does the nurse monitor most closely for changes?
a) Decreased level of consciousness.
b) Blood pressure of 162/68 mmHg.
c) Pressure ulcers on bilateral heels.
d) Odiferous, loose bowel movements.
1 pts Text and page number
5 pts Your answer choices
10
The nurse cares for a client with type I diabetes who calls to the nurse stating, “I feel shaky.” In what order does the nurse perform the following actions?
a) Check to see when the client last ate.
b) Assess the client’s level of consciousness.
c) Perform a bedside glucose finger stick.
d) Administer a form of glucose to the client.
1 pts Text and page number
5 pts Your answer choices
B!
Multiple Response-10points-All or None
Circle the correct responses.
The nurse teaches the client about the effect of smoking tobacco on the development of coronary artery disease. Which teaching points does the nurse correctly include and elaborate upon? (Select all that apply.)
a) Smoking increases vasoconstriction.
b) Smoking alters oxygen transportation.
c) Smoking promotes platelet adhesion.
d) Smoking acts as an appetite stimulant.
e) Smoking decreases serum HDL levels.
Presentation PowerPoint and Delivery Notes
Guidelines
Prior to the presentation, students must turn in the Power Point and accompanying presentation notes. The student may alter or edit after turning in the notes and prior to the presentation, so this assignment can be considered a draft. The notes and PPT must follow this general outline:
I. Disease Exemplar Definition or Introduction
II. Normal Physiology
a. How the system should work
III. Pathophysiology
a. How the disease process works
IV. Assessment Findings
a. Findings consistent with diagnosis
V. System Interactions
a. How does this disease process affect other systems, if this was not already discussed in patho or assessment findings
VI. Clinical Implications
a. What must the nurse do to protect the client, to reduce injury, to reduce or reverse symptoms, to prevent mortality or morbidity?
VII. Comorbidities
a. How might this disease process or treatments for this disease process interact with other (co-morbid)disease processes?
VIII. Summary of Presentation
Grading
Based on correct topic, acceptable references, reference formatting, accuracy of notes, Power Point appearance, and completeness of drafted notes.
Topic
As Assigned
References
Should include text books, library articles, and sites such as MayoClinic, NIH, UpToDate, MedlinePlus, CDC, HHS, NCCAM.
Must not include poor internet sites such as eHow, AsktheDoctor, righthealth, PlanetRx, wellsphere, EveryDayHealth
Please provide the entire APA reference to receive full credit. (The texts references are listed in full within the syllabus.)
Integrated Pathophysiology-Burns
We will not cover burns in class, but will touch on aspects of burn pathophysiology in every class. For example, when we discuss fluid and electrolytes in class, the student should integrate that knowledge with reading that pertains to burns and the associated topics. Answering the following questions regarding thermal burn injuries is a work in progress that should evolve and be edited over the course of three weeks. Answers should be roughly one paragraph (1/4 of a page; 3-6 sentences) each or questions may be answered with a separate flow chart for each topic.
Each answer is worth 1 point, graded for completeness and accuracy. This assignment is to be turned in all together. Questions turned in one at a time will not be accepted.
1. INFLAMMATION: Describe how burns are an example of inflammation and healing.
2. FLUID BALANCE: Explain how third-spacing occurs after an extensive burn.
3. ELECTROLYTE BALANCE: Describe common laboratory results and why those lab values shift after a burn.
4. PAIN AND SENSATION: Explain how pain occurs after a burn – where, when, to what degree.
5. SPECIAL POPULATIONS: Explain why burns have more severe consequences in babies and elderly.
6. BURNS: Why are full-thickness burns more serious than partial-thickness burns?
7. AIRWAY: Explain the various effects of burns on the airway.
8. INFECTIONS: Discuss the infectious processes that are potential problems for the client with burns.
9. HYPERMETABOLISM: Discuss hypermetabolism, the stress response, and nutrition.
10. HEALING: Describe the role of physical therapy and occupational therapy in the healing process.
11. COAGULATION: Discuss the coagulation process after a burn.
12. SHOCK: Each type of shock, essentially, is a potential burn complication. Describe the process of hypovolemic shock after a burn.
13. ULCER: How does a stress ulcer occur after a severe burn injury?
14. RENAL: How do burns cause renal failure?
15. GLUCOSE: How will a severe burn injury affect the client with diabetes?
Presentation – Team Assignment
Guidelines
Students will present in partners (2-3 to a group). Groups must be formed within one day of the first class meeting or groups will be assigned. Topics will be drawn, and may be traded with other groups. Final topic chosen must be emailed to course faculty within one day of the second class meeting or topics will be assigned. Criteria for presentation below. (With permission, students may turn in a voice-over PowerPoint presentation for this assignment.)
Grading
· To achieve a grade of “C”
· Exhibits some knowledge of content relevant to topic.
· Mild disorganization, excessive use of verbal props, such as “um”.
· Completes presentation in under 5 minutes or must be stopped at 14 minutes.
· Does not attempt to engage audience or attempt is ineffectual.
· To achieve a grade of “B”
· Exhibits good knowledge of content relevant to topic.
· None to mild disorganization, noticeable use of verbal props, such as “um”.
· Completes presentation within 7-14 minutes.
· Engages audience with questions, activities, etc.
· To achieve a grade of “A”
· Exhibits knowledge of content relevant to topic.
· Uses effective presentation skills to deliver content.
· Completes presentation within 7-14 minutes.
· Engages audience with questions, activities, etc.
Topic
Will be chosen / assigned during the first week of the course.
References
Turned in with Power Point Presentation and Notes assignment.
Grading Sheet for Presentation
Student
Criteria
Met/
Not Met
Criteria Description
Notes
Exhibits knowledge of content relevant to topic.
I. Introduces disease, syndrome, or process.
II. Describe normal physiology
III. Discusses the pathophysiology
IV. Describes typical assessment findings
V. Explains how this process affects other body systems
VI. Discusses what the nurse does to protect the client, to reduce injury, to reduce symptoms, to prevent mortality and morbidity
VII. Explains how this process affects co-morbid processes
VIII. Summary of presentation
Uses effective presentation skills to deliver content.
· Avoids UMs, UHs, AHs, YOU KNOWs
· VOICE AND DELIVERY voice is well modulated and audible; words are enunciated clearly.
· SPEED OF DELIVERY Speaks at a deliberate pace.
· VOCABULARY Avoids clichés, junk words, fad words, and profanity.
· CLARITY Speech is always clear, concise, and convincing.
· SENTENCE STRUCTURE AND GRAMMAR Speaks in well-constructed sentences, using correct agreement, verb tense, punctuation, etc.
Completes presentation within 7-14 minutes.
Engages audience with questions, activities, etc.
Presentation Exemplar Notes
Integrate what you have learned and practice applying exemplar process to other similar diseases. These items are based on class presentations and learning throughout the course. Answers should be roughly 1-2 paragraphs (1/4-1/2 of a page) or you may create a flow chart for each question item. These should be easier to answer after the presentations, but can be done prior to, if the student prefers.
Describe the similarities between the pathophysiology of the following:
1. Rheumatic fever and rheumatoid arthritis.
2. Tuberculosis and histoplasmosis.
3. Multiple sclerosis and amyotrophic lateral sclerosis.
Describe how obstructive sleep apnea leads to the following:
4. Myocardial infarction.
5. Childhood hyperactivity.