COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
N101
FUNDAMENTALS OF NURSING
LECTURE
(M 8-10 AM and On-line for 1 hour per week)
FALL 2006
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
N101
FALL 2006
Week 1: Tuesday, September 5, 2006
INTRODUCTION TO NURSING AT COMMUNITY COLLEGE OF
PHILADELPHIA
Objectives:
At the end of the class, the student will:
1. Discuss the Nursing Department’s philosophy.
2. Describe clinical and classroom objectives for N101.
3. Identify roles of the professional nurse.
Required Reading :
Topical Outline:
-Nursing Department's philosophy
-Department policies and standards
-Nursing 101 Syllabus and Week to Week Outline
-Methods of communication between faculty and students
-Clinical and classroom expectations for this semester.
-Socialization into the Professional Role
There will be time for questions and answers.
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
N101
FALL 2006
Week #2 : September 11, 2006 (W2-47)
Week #3 : September 18, 2006 (W2-48)
Topic: HEALTH PROMOTION NEURO/SENSATION AND PREVENTION OF PAIN
Objectives: At the end of the content presentation the student will:
1. Explain concepts of physiological integrity, psychosocial integrity and a safe, effective care environment in relation to the neurosensory system.
2. Describe neurosensory health patterns across the life span.
3. Use nursing care planning to promote client's health needs in the neurosensory system.
4. Discuss ways to maintain a safe and effective care environment for clients experiencing glaucoma, cataracts and macular degeneration.
5. Develop a care plan for Josephine for Acute Pain.
Required Readings :
Craven: Chapter 45:Pain Perception, pp. 1179-1195; Chapter 46: Sensory Perception, pp. 1212-1231
Gulanick, Chapter 2: Acute Pain p. 121-125; Disturbed Sensory Perception: Visual, p. 143-146
Learning Activities:
Topical Outline: Power Point Presentation (attached)
CASE STUDY: Josephine
Josephine Pinella is 83 years old. She has lived alone with her sister Angelina (age 72) for all of her adult life. Josephine and Angelina share a row home in South Philadelphia; Josephine worked as an administrative assistant in a perfume company for 50 years, retiring when she was 68. Angelina worked on an assembly line for 35 years; she has been retired for 5 years now. Their lives have always been highly structured and predictable. Josephine handles all financial matters (the sisters have adequate pensions to live quite comfortably); she makes all major decisions. Angelina is the social butterfly of their South Philadelphia neighborhood; she knows everyone, talks for hours on the phone and loves to invite neighbors in for coffee. Angelina rarely makes decisions about the household or about daily routines.
The sisters' routine is the same each day. They rise between 7 and 8 each day; eat a breakfast of cereal, a fruit and a glass of milk, "one cup of coffee only." Josephine often relates that the most important thing to her is a proper diet. "You must take a multi-vitamin each day." She tells anyone who will listen that she weighs the same (121 lbs. 5'3") now as when she was 20 (she's wearing the same skirts she bought in 1960!) and that she watches her salt and cholesterol intake. The sisters have their "big meal" at lunch (minimum of one protein, two vegetables and one fruit) and eat lightly at dinner time because as Josephine says, "The second most important thing in life is adequate rest and you can't sleep well after a hearty meal." They both sleep 8-9 hours a night. About once a week they have a nip of dry vermouth "just to relax."
Josephine and Angelina consider themselves to be in excellent health. For the past ten years, each day they walk for one hour; they see the doctor regularly. Josephine has moderate hypertension and was prescribed a diuretic (Diuril) but stopped taking it due to dizziness. Her BP is usually about 150-160/90-100. Angelina has arthritis which is fairly well controlled with Aleve BID.
The sisters have a structured weekly schedule: Monday is cleaning; Tuesday is shopping; Wednesday is visiting their sister whose husband has Alzheimer's Disease; Thursday is weekly chores and Friday is the day to get their hair done. They rarely watch TV and keep themselves very busy each day. They come from a large Italian family who are continually inviting them to dinner and family parties: They always attend (weather permitting) but leave well before dark. Their nephew sees them weekly to check the house and inquire about things they may need (i.e., cleaning windows, oil heater, etc.) They are most generous with their nieces and nephew and value highly the support the family gives them. Josephine often says, "We love our privacy but it's good to know our family is always there, if we need them."
Last week, while Angelina was out visiting neighbors, Josephine felt faint and fell as she attempted to sit down. Her left arm became "numb and tingling." When Angelina returned, Josephine was on the floor conscious and very scared. Angelina called her neighbor who came over and contacted paramedics. Josephine suffered a stroke and her left side was involved.
Josephine was hospitalized for a week before returning home with Angie’s help. Throughout her hospitalization Josephine stated, “I want to go home and do the things I have always done. I want to be able to go back to my routines”. She expressed concern that she would be able to manage at home and wondered if there were services available to help her and Angie “be able to stay in our little home together”. Josephine told the nurses that the most important thing to her is being in control of her daily life, being able to walk and cook, “being able to take care of myself, with Angie”.
Neuro/Sensation and Pain Case Study
About two months after her initial stroke, Josephine Pinella experienced another stroke. This time she experienced full paralysis of both left arm and left leg. Fortunately, her speech was not affected. After six days in the acute care hospital to stabilize her neurological/cardiovascular status, she was transferred to a rehabilitation facility.
Transfer note to the rehab, facility stated: Alert and fully oriented 83-year-old female. At times, she forgets the date and day of the week, but she clearly recalls what she ate for meals and appointment times for PT and OT. Neurological status is WNL. Pupil size 5mm bilateral and pupil reactivity is brisk. Full muscle strength on right side with no motor response on left side. She wears glasses; no hearing loss. Lab values are WNL. Temperature 98.2 although she continually complains of feeling cold. Pulse 60-66; BP 140-150/90-100; respiration's 16-18/minute. Slight rales in lower left base. Will cooperate with C + DB. Patient complains of pain on movement of left arm and leg. Medicated with Motrin every 4 hours for pain relief. Sometimes takes Tylenol 650mg qHs. Meds: Restoril 25mg tab qHs PRN for sleep; Digoxin 0.125mg qHs; Inderal 10mg PO Q1D.
Josephine has been in the rehab center for three weeks now. You are assigned to care for her. Her schedule is as follows:
8:00 - 9:00 Breakfast
9:00 - 9:30 Speech Therapy
9:30 - 10:30 P.T.
12:00 - 1:00 Lunch
1:00 - 2:00 P.T.
3:00 - 3:30 O.T.
5:30 Dinner
Josephine rises at 6:00 am to complete morning care. She insists on washing as much as she can with "my good hand". Upon arising, she complains of discomfort on her left side. When you mover her left arm for ROM, she grimaces with pain and states, "Please be careful; you can't go so fast; that hurts me". She says her pain could be rated at "6". As you complete AM care, Josephine tells you that she is exhausted. "I usually sleep for 8 hours a night and I can't fall asleep with my room-mates TV on. Last night I didn't fall asleep until midnight and now you wake me up at 5:30 am; that's not enough sleep for me. I need my rest". She asked for her glasses to read the menu and then reminds you, "Please find my dark glasses; I wear them to P.T. because I can see better. It's so bright in there".
Josephine eats her breakfast in her room and then begins her rehabilitation schedule. Upon returning from P.T. at 10:30 am, she complains of pain in her left leg. "It throbs and aches. I'm so uncomfortable. I could barely walk on the parallel bars in P.T. because of the pain. And my back is so sore from sitting this wheelchair".
Josephine also tells you about the temperature in P.T.; "It's an icebox down there and there are drafts up here. I don't want to sit in the hall or by the door; can't you feel the cool air coming in? "At night, I used 3 blankets, one up around my neck to it from becoming stiff. I'm always worried about getting cold". She states that her hands are cold "all the time". She tells you that yesterday, Angelina took her outside since it was warm and sunny day (75°). "As long as I can wear a sweater, a hat and extra blankets, I'll go outside. But the other nurses laughed at me and told me I looked like I was going to Alaska. They are always saying that it isn't cold in here but I feel cold and I worry about the drafts and I don't want to catch a cold".
Josephine ate lunch in the dayroom at a table with four other residents in her wheelchair. She then asked to be toileted before afternoon P.T. "I don't really have to go but it's a good time to get the nurses' help since they are so busy. Sometimes you wait a half-hour before they come. I'm so worried I will have an accident". When Josephine returns from O.T. at 3:30 she again complains of aching and soreness in her back and in her left arm and left leg. "It hurts to touch my leg and the throbbing in my arm is so bad I can't think about anything else. And I'm so tired. Do you think I could have a nap?" When Angelina arrives to stay with Josephine for dinner, Josephine's states, "Is it time for dinner already? I'm so mixed up. I can't even remember if I slept well last night. When did I go the bathroom last? What time does dinner come anyway?" Angelina tells the evening nurse that Josephine can't eat dinner in the day room. "It's too many people and she is not used to eating with all those people. They are nice people, don't get me wrong, but she needs some peace and quiet". Josephine adds, "With all the noise at night in the hall and my room-mates TV and all her phone calls, it's just too much. I need my rest".
At 7:00 PM Josephine asks to be put to bed. She pivots herself from wheelchair to the toilet and voids. The pain in her left arm increases. "Movement makes it worse." She asks the nurse to arrange her room so that the curtain hides the glare from the night light. Josephine states, "I hope the noise in the hall isn't too bad tonight. Did I go to the bathroom? It's hard to keep everything straight. It feels so good to be in bed. My back feels better already".
Consider the following care plans for Josephine:
Health Promotion: Pain Regulation
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
NURSING 101
FALL 2006
Week #2: September 11, 2006 (W2-48)
Week #3: September 18, 2006 (W2-47)
Topic: HEALTH PROMOTION/DISEASE PREVENTION:
MOBILITY/REST AND THE HAZARDS OF IMMOBILITY
Objectives:
At the completion of the content presentation, the student will:
1. Explain concepts of physiological integrity, psychosocial integrity, and a safe, effective care environment in relation to the musculoskeletal system.
2. Identify changes in physiological and psychosocial function associated with mobility and immobility.
3. Use nursing care planning to maintain/promote client’s health care related to the hazards of immobility and changes in the sleep-wake cycle.
Required Activities:
Lilley: Chapter 12, pp 187-195, 198-202 (Central Nervous System Depressants & Relaxants)
Chapter 50, pp 857, 862-868 (Constipation, Laxatives & Stool Softners)
Gulanick: Chapter 2, p.107-110 (Impaired Physical Mobility), p.152-155 (Disturbed Sleep Pattern)
AJN article, “The Hazards of Immobility” (attached).
Sleep/Rest
Craven: Chapter 44: Review pp 1155-1160
Required pp 1160-1173
Lilley: Required pp 857-85, 862-870 Laxatives
Recommended Activities:
1. Read case study attached.
2. Review case study under Pain Lecture.
3. Answer study questions.
Topical Outline:
I. Health Promotion: Sleep/Wake Cycle
A. Sleep patterns across the life span
1. Normal sleep patterns
2. Factors that promote adequate sleep
B. Physiology of sleep
1. Circadian rhythm
2. Stages of sleep
C. Factors affecting sleep
1. Physiologic
2. Psychosocial
3. Sleep disorders
D. Interventions that promote sleep
1. Non-pharmacological
2. Pharmacological
II. Health Maintenance: Mobility
A. Mobility patterns across the life span
B. Factors that promote mobility
C. Impact of immobility
1. Physiologic
a. Respiratory system
b. Cardiovascular system
c. Metabolism
d. Fluids and electrolytes
e. Gastrointestinal system
f. Musculoskeletal system
g. Integumentary system
2. Psychosocial
a. Cognition
b. Stress
c. Sensory perception
d. Isolation
D. Nursing interventions to prevent complications of immobility
1. Non-pharmacological
2. Pharmacological: NSAID’s and ASA
Mobility/Immobility Case Study
Since Josephine has been at home with limited mobility, Angelina has not been able to take her daily hourly walk or sleep her usual 8-9 hours a night. Angelina states that she has noticed that “my arthritis has really been acting up”. She complains of increase in morning stiffness, painful joints and greater limitations in her activities of daily living. This limits Angie’s ability to keep up with her usual routine. Angie continues to take Aleve BID for discomfort.
Angie goes to the local HMO (where her family doctor participates) complaining of pain in the knees and generalized fatigue.
The nurses in the clinic assess her knees to be painful and swollen; her gait is steady and balanced; upper body coordination slightly limited due to pain. She experiences full ROM in upper extremities and limited in the lower with good muscle tone. She states that she finds it difficult to sleep at night. She complains of fatigue and is unable to take naps during the day since she must do all the chores alone now.
She appears frustrated and tired with her lack of sleep, painful legs and Josephine’s prolonged illness. The nurse notices her eyes appear slightly red and she states that she tires easily now and has difficulty concentrating on all her daily chores.
Study Questions
1. Which defining characteristics did Angie experience that relate to Health Promotion Mobility and Health Promotion Sleep/Rest?