BAKERSFIELD COLLEGE
VOCATIONAL NURSING PROGRAM
NURSING 2LV
Instructor:
Jan Lewis RN
Office: MS 172
Office Phone: 395-4442
E-Mail:
Office Hours: Monday 7:30am – 12:30pm
Office appointment times available as needed
Clinical schedule:
Wednesday 3:30 – 5:30pm *
Thurs. & Fri. 6:00am – 3:30pm *
* times are subject to change;
every effort will be made to give as
much notice as possible
Clinical Sites
Kern Medical Center Bakersfield Memorial Hospital
1830 Flower St 420 34th St
326-2000 327-4647
HealthSouth Rehabilitation Hospital Mercy Hospital
5001 Commerce Way 2215 Truxtun Ave
323-5500 632-5000
Mercy Southwest Hospital San Joaquin Hospital
400 Old River Road 2615 Chester Ave
663-6310 395-3000
BAKERSFIELD COLLEGE
VOCATIONAL NURSING PROGRAM
NURSING 2LV – CLINICAL LABORATORY EXPERIENCE (6.00 UNITS)
MEDICAL-SURGICAL CLINICAL EXPERIENCE
INTRODUCTION
Nursing 2LV is the clinical course, which is correlated with corresponding second semester theory courses in the vocational nursing program. The major focus in this course will be the advanced application of skills learned in nursing 1LV, which are applied to clients in a medical/surgical and orthopedic/rehabilitation setting. Incorporated into this course will be the nursing process, which utilizes the skills of assessment, planning, intervention and evaluation to provide a systematic approach to nursing practice.
OBJECTIVES
Upon completion of this course, in the laboratory or clinical setting, the student will be able to meet the following objectives, which pertain to all clinical laboratory sites:
1. Demonstrated advanced application of skills learned in nursing 1LV.
2. Safely administer medication to a team of clients utilizing the six rights of drug administration, which includes proper documentation.
3. Demonstrate proper use of body mechanics in lifting, moving, and turning clients.
4. Assess for pain and implement measures other than medication for relief of pain.
5. Demonstrate team-leading skills.
6. Initial discharge teaching for orthopedic, cardiac, respiratory, surgical and endocrine clients.
7. Develop objectives prior to observing specialty areas.
8. Demonstrate the use of the nursing process through the skills of assessment, planning, intervention and evaluation of clients in a medical-surgical setting.
ORTHOPEDIC
9. Demonstrate proper use of the trapeze bar.
10. Demonstrate proper techniques of repositioning a client who is in traction.
11. Demonstrate proper cast care.
12. Demonstrate proper technique for assessing the neurovascular system
13. Demonstrate proper technique for moving, turning, and positioning patients with joint pinning and total joint replacement.
14. Assist clients with techniques learned in physical therapy.
15. Complete a head-to-toe physical assessment of a client with a musculoskeletal disorder and properly document findings.
RESPIRATORY
16. Complete a head-to-toe physical assessment of a client with a respiratory disorder and properly document findings.
17. Safely administer medications, which have an effect upon the respiratory system, using the six rights of drug administration, utilizing proper documentation.
SYLLABUS STATEMENT RECOMMENDATION:
"Students with disabilities who believe they may need accommodations in this class are encouraged to contact Disabled Student Programs & Services (661-395-4334), FACE 16, as soon as possible to better ensure such accommodations are implemented in a timely fashion."
BAKERSFIELD COLLEGE
VOCATIONAL NURSING PROGRAM
NURSING 2LV
Vocational Nursing VNRS B85LV and VNRS B86LV is the clinical portion of B85 and B86. This is a “Credit” or “No Credit” laboratory course. All of the following requirements must be met to receive a grade of “Credit” in 2LV.
Weekly Care Plans
Weekly care plans will be required for each client assigned to the student. Care plans must be typed or computer generated. Your assignments will be given on Wednesday afternoon clinic. During or after clinic on Wednesday, you must identify 2 nursing diagnoses and appropriate interventions for each client assigned. Thursday, further develop your first 2 nursing diagnosis and add 2 more based on your physical assessment and observations of your client’s need.
Care plans will be collected on Thursday morning by 0600, checked for completion, and returned to you. If your care plan is not complete, you will be sent home for being unprepared for clinical, receive an absent day, and a conference slip will be placed in your student file in the Allied Health office.
All completed care plans are to be turned in to your clinical instructor on Friday at the beginning of post conference; late papers will not be accepted. Remember to include your physical assessment. Your weekly care plans for each clinical rotation must average 75% or higher. If the student receives less than 75% for either rotation, he will be placed on probation. At the end of both medical/surgical rotations, all of the weekly care plans will be averaged together. The score must be 75% or higher to pass Nursing 2LV. If the student receives less than 75% he/she will receive a “No Credit” and will not be allowed to progress to third semester.
Process Care Plans
There will be two nursing process papers required this semester, one in each med/surg rotation. The student must achieve a 75% on each process paper. The student will be allowed to re-do the first process paper, but not the second. Both process papers must be typed or computer generated to be accepted, nothing handwritten will be accepted. You will be given due dates for each process paper during the clinical site orientation. Late papers will be penalized 5 points for each day the process is late, this includes week-end days also. Nursing diagnoses must include at least one in each of the following areas: psychosocial problems, teaching/learning needs and physiological problems. Failure to include one of these problems will result in a “0” for that nursing diagnosis and the student will have to re-do the process. Re-dos will result in a score that drops by one letter grade from the re-do score.
Laboratory Procedure Evaluation
There are 15 procedures, 4 of which the student is required to complete by the end of the semester. As adult learners, it is the student’s responsibility to seek out these experiences prior to the last week of the laboratory rotation. These procedures will be listed later in the syllabus.
Post Conference Presentation
Each student is required to make at least one oral presentation per rotation. Your presentation will be made on the day you are assigned as med nurse. The guidelines will be discussed later in the syllabus.
Laboratory Rotation Responsibilities
Client Care Guidelines for Nursing 2LV
1. You will be assigned two clients per week to provide care to.
2. A weekly care plan must be completed on your primary client. An abbreviated form must be completed on your second client, or when you are assigned a third client (if your client goes home or is transferred).
3. Completion of a head-to-toe physical assessment on the clients assigned to you for each day that care is provided.
4. Documentation to be completed by 1:00pm, remember to date and time all entries and sign your name after each entry. Your signature is first initial, last name and title (BCSN). Ex. J. Lewis BCSN.
5. Maintain accurate I&O on all assigned clients, which may include, oral intake, enteral feedings, supplemental snacks; output – NGT suction, CT drainage, colostomy drainage, urine, stool, emesis, drainage tubes – hemovac, wound vac, JP drain.
6. Performing all necessary procedures on clients which may include; dressing changes, suture or staple removal, placement of tubes or catheter, completing discharge and transfer forms.
7. Attend procedures with your client.
8. Be aware of all IV fluids, rates, and site condition.
9. Give a verbal and written report at the end of the day to your team leader.
10. Be in post conference on time!
Nursing 2LV Critical Elements
All critical areas will be considered in evaluation of clinical performance. Failure in any one of these areas will result in, a conference form, being placed on probation, or failure of the course.
1. Failure to wash hands at appropriate times
2. Failure to maintain privacy
3. Failure to properly identify client by arm band
4. Failure to report significant change(s) in client’s condition
5. Failure to validate with instructor, therapy rationale when contrary to classroom instruction
6. Failure to recognize and report any unsafe condition
7. Divulging confidential information
8. Failure to recognize a break in sterile technique
9. Failure to administer medications correctly
10. Failure to properly monitor IV therapy
11. Failure to recognize own limitations and/or misrepresent own abilities
B85LV and B86LV Laboratory Procedures Critical Elements
1. Change of shift report – take and give
2. SQ injections
3. Z-track intramuscular injection
4. Apply nasal cannula
5. Monitor oxygen saturation
6. Apply a condom catheter
7. Using incentive spirometry
8. Care of decubitus ulcers
9. Inserting a straight or indwelling catheter
10. Collecting a sterile urine specimen from an indwelling catheter
11. Measuring blood glucose level following a fingerstick
12. Inserting a nasogastric tube
13. Administering a respiratory treatment
14. Wet to dry dressing change
15. Dry dressing change
16. Administer an enema, Harris flush, or rectal tube
Critical elements will be given as a handout in clinical orientation
Nursing 2LV
Post Conference Student Reports
During this semester of Nursing 2LV, all students will be required to make at least one oral presentation during the post-conference time.
The order of presentations will be determined by the day that you are a team leader. The day that you are scheduled to do team leading, you will be required to make an oral presentation. Although there is no letter grade for this assignment, failure to complete the presentation will result in failure of the clinical rotation and the student will not be able to continue on in the program.
The presentation will be a case study of a patient that was assigned to you or to one of your team for care. The following should be included in your presentation:
1. Patient’s age and admitting diagnosis
2. Medical history (past and present) and physical findings
3. Diagnostic testing and labs and their results
4. Medications
5. Therapy and care administered
6. Five nursing diagnoses
7. What you learned by caring for this client
Your presentation should be about 15-20 minutes in length
Guidelines for Team Medications
1. You will give medications to an assigned number of patient who are assigned to you or your fellow classmates.
2. You are to obtain the following information on Wednesday (or the day prior to your med pass):
a. Patient initials
b. Medical diagnosis and a brief write-up
c. Medications to be given – all PO’s, IM’s, SQ’s, routine and PRN.
3. Make a medication reference sheet and a TACTIS form to include the following information:
a. Patient medical diagnosis
b. Medications to be given
c. The times the medications should be given
THIS IS TO BE DONE ON WEDNESDAY OR THE DAY PRIOR TO MEDICATION ADMINISTRATION
4. Bring these medication forms to clinic on the day of your med pass.
5. Double check the chart on the morning of the med pass, prior to the administration of medications to see if any new medications have been ordered or changed.
6. Check the doctor’s orders against the MAR and your med sheets first thing in the morning of your med pass. Report any discrepancies to your instructor.
7. Seek out the instructor at least 30 minutes prior to the med. administration time.
8. If insulin is to be administered, obtain a fingerstick blood sugar prior to insulin administration.
9. Be aware of times for insulin administration.
10. Prior to giving medications, you will be asked the following questions:
a. What is the medication for?
b. What is the dosage and is it correct and appropriate?
c. Why is the patient receiving the medication?
d. What are the drug’s side effects?
e. What is the route of administration?
f. If indicated, what are the patient’s vital signs (ie. Digoxin and antihypertensives).
11. You will take report on all patient’s you pass medications to.
16
PART III: PRESCRIBED MEDICATIONS: T A C T I S
MEDICATIONS – TRADE / GENERIC______
DOSE / ROUTE / FREQUENCY ______
PHARMACOLOGICAL CLASSIFICATION______
Why is THIS client receiving this drug? ______
______
______
TTherapeutic classification /
A
Action /C
Contraindications
(list only if contraindicated for this client)
/T
Toxic /Side Effects(Most serious &frequent) /
I
Interventions
(Include nsg intervention, labs, parameters for this med) /S
SafetySafe dose: □Yes □ No
Crush med: □Yes □ No
Allergies: ______
PART III: PRESCRIBED MEDICATIONS: T A C T I S
MEDICATIONS – TRADE / GENERIC ____________
DOSE / ROUTE / FREQUENCY______
PHARMACOLOGICAL CLASSIFICATION______
Why is THIS client receiving this drug? ______
______
______
TTherapeutic classification /
A
Action /C
Contraindications
(list only if contraindicated for this client)
/T
Toxic /Side Effects(Most serious & frequent) /
I
Interventions
(Include nsg intervention, labs, parameters for this med) /S
SafetySafe dose: □Yes □ No
Crush med: □Yes □ No
Allergies: ______
Vocational Nursing Program
Medication Pass Reference
Time
/ Medication,Dose and
Route /
Class and
Classification /Purpose
/ Nursing Considerations / Vitals / Labs / Side EffectsTime Schedule for Medication Administration
Room # / 6:30am / 7:00am / 7:30am / 8:00am / 9:00am / 10:00am / 11:00am / 11:30am / 12:00pm16
VOCATIONAL NURSING PROGRAM
NURSING 2LV
Laboratory Grading for Weekly and Nursing Process
Weekly Care Plan
The following grading scale will be used when grading the weekly care plan. Each weekly care plan is worth 50 points.
Grading Criteria / Possible PointsDemographics
· PMH (past medical history)
· HPI (history of present illness)
· Current MD orders / 5
Pathophysiology
· Work up primary diagnosis
· Highlight pertinent information specific to patient / 5
Medications (TACTIS)
· Generic / Trade / Classification
· Dose/Route/Frequency
· Reason why patient receiving drug / 10
Labs / Diagnostics
· Client specific / 5
Top 4 Nursing Diagnoses
· Prioritized
· Rationale / 5
One Nursing Diagnostic Statement
· Complete (R/T & EB or MB) / 5
Goals
· Realistic
· Short & long term / 5
Interventions
· Minimum of 3
· Appropriate
· Realistic / 10
FINAL SCORE / 50
Nursing Process Care Plan