NURS 2255 - Intermediate Adult Medical-Surgical Nursing B

Objectives: The student will:

1. The student will interpret subjective and objective data for patients with urinary, renal, and endocrine problems.
2. The student will interpret data to select appropriate nursing diagnoses and collaborative problems.
3. The student will describe evidence‐based collaborative management for the patient with urinary, renal, and endocrine problems.
4. The student will choose evidence‐based nursing interventions for patients with urinary, renal, and endocrine problems.

Outcome 2: Upon completion of this course, students will be able to explain national patient safety goals and quality indicators for patients with urinary, renal, and endocrine problems.

Objectives: The student will:

1. The student will describe and apply the national patient safety goals addressing minimization of indwelling catheter‐related infections.
2. The student will describe and apply the quality indicators addressing prevention of urinary tract infections.
3. The student will describe and apply the quality indicators for the diabetic patient population.

1. Overview
   1. Physiology associated with aging
   2. Diagnostic studies of urinary and renal system
   3. Patient safety/best practices prior to diagnostic studies
2. Infectious Disorders: Cystitic, Interstitial Cystitis
   1. Pathophysiology/risk factors
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
      1. Pharmacological management
      2. Urinary elimination management
      3. Other interventions
   5. Evidence‐based practice/quality indicators for urinary catheters
   6. Cultural, ethnic, and/or gender considerations
3. Non‐infectious Disorders: Strictures, Incontinence, Urolithiasis, Urothelial Cancer
   1. Pathophysiology/risk factors
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
      1. Non‐surgical management
         1. Behavioral
         2. Nutritional
         3. Pharmacological management
      2. Surgical management
      3. Other interventions
   5. Cultural, ethnic, and/or gender considerations

Unit 2 Renal Disorders

1. Overview
   1. Physiology associated with aging
   2. Functions of the kidney
2. Congenital Disorders: Polycystic Kidney Disease
   1. Pathophysiology
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
3. Obstructive Disorders: Hydronephrosis, Hydroureter, Strictures
   1. Pathophysiology
   2. Assessment
   3. Collaborative management and interventions
4. IV. Infectious Disorders: Pyelonephritis
   1. Pathophysiology
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
5. Immunologic Disorders: Acute and Chronic Glomerulonphritis, Nephrotic Syndrome
   1. Pathophysiology
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
6. Degenerative Disorders: Nephrosclerosis, Renovascular Disease, Diabetic Nephropathy
   1. Pathophysiology
   2. Assessment
   3. Collaborative management and interventions
7. Renal Cell Carcinoma
   1. Pathophysiology
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
8. Renal Trauma
   1. Assessment
   2. Collaborative management
      1. Non‐surgical
      2. Surgical

Unit 3 Renal Failure

1. Overview
   1. Review of terms
   2. Progression
2. Acute Kidney Injury
   1. Etiology and pathophysiology
   2. Types
      1. Prerenal
      2. Intrarenal
      3. Postrenal
   3. Clinical course
      1. Onset phase
      2. Oliguric phase
      3. Diuretic phase
      4. Recovery phase
   4. Assessment
      1. Physical assessment/history
      2. Clinical manifestations
      3. Diagnostics
   5. Collaborative management
      1. Drug therapy
      2. Nutrition management
      3. Dialysis therapies
         1. Hemodialysis
         2. Peritoneal dialysis
         3. Access sites
         4. Other therapies
3. Chronic Kidney Disease
   1. Pathophysiology
      1. Stages
      2. Kidney changes
      3. Metabolic changes
      4. Hematologic changes
      5. Gastrointestinal changes
      6. Neurological changes
   2. Incidence/prevalence
   3. Collaborative management and interventions
      1. Assessment/physical and psychosocial
      2. Clinical manifestations
      3. Lab assessment and other diagnostics
      4. Specific nursing care issues
   4. Cultural and ethnic disparities
4. Renal Replacement Therapies
   1. Hemodialysis
      1. Patient selection
      2. Procedure
      3. Access
      4. Nursing care while on dialysis
      5. Post‐procedure care
      6. Complications
   2. Peritoneal dialysis
      1. Patient selection
      2. Procedure
      3. Complications
      4. Nursing care during dialysis
5. Renal Transplantation
   1. Candidate selection
   2. Donors
   3. Preoperative care
   4. Operative procedures
   5. Immunosuppressive drug therapy
   6. Manifestations of Organ Rejection
   7. Health teaching and resources
6. Evidence‐Based Practice and Safety Related to Renal Failure
   1. Quality of life issues
   2. Adherence to medication regimen

Unit 4 Endocrine Disorders

1. Endocrine Assessment
   1. Anatomy and physiology overview
   2. Endocrine changes associated with aging
   3. Assessment
      1. Physical
      2. Lab
      3. Diagnostic
2. Diabetes: A Focus on Complications
   1. Overview of diabetes mellitus
      1. Pathophysiology
      2. Incidence
      3. Clinical manifestations
      4. Diagnostics
      5. Pharmacological management
         1. Insulin
         2. Oral agents
      6. Collaborative management
      7. Quality indicators related to diabetes
   2. Acute complications of diabetes
      1. Diabetic ketoacidosis
         1. Pathophysiology
         2. Clinical manifestations
         3. Collaborative management
         4. Prevention
      2. Hyperglycemic‐hyperosmolar state
         1. Pathophysiology
         2. Clinical manifestations
         3. Collaborative management
      3. Hypoglycemia
         1. Symptoms ‐ neuroglycopenic and neurogenic
         2. Management
         3. Prevention
   3. Chronic complications of diabetes
      1. Macrovascular
         1. Cardiovascular
         2. Cerebrovascular
      2. Microvascular
         1. Eye and vision
         2. Diabetic nephropathy
         3. Neuropathies ‐ polyneuropathies and autonomic neuropathies
3. Disorders of the Thyroid Gland
   1. Hyperthyroidism
      1. Pathophysiology
      2. Collaborative management
         1. Assessment
         2. Clinical manifestations
         3. Diagnostic assessment
         4. Interventions
         5. Best practices for patient safety and quality care
4. Disorders of the Parathyroid Gland
   1. Hyperparathyroidism
      1. Pathophysiology
      2. Collaborative management
         1. Assessment
         2. Clinical manifestations
         3. Interventions
   2. Hypoparathyroidism
      1. Pathophysiology
      2. Collaborative management
         1. Assessment
         2. Clinical manifestations
         3. Interventions
5. Disorders of the Adrenal Gland
   1. Adrenal gland hypofunction ‐ Addison’s
      1. Pathophysiology
      2. Collaborative management
         1. Assessment
         2. Clinical manifestations
         3. Labs
         4. Interventions
      3. Best practice for patient safety and quality care
   2. Adrenal gland hyperfunction ‐ Cushing’s
      1. Pathophysiology
      2. Collaborative management
         1. Assessment
         2. Clinical manifestations
         3. Labs
         4. Interventions
      3. Hyperaldosteronism
      4. Pheochromocytoma
         1. Pathophysiology
         2. Assessment
         3. Interventions
6. Pituitary Disorders
   1. Hypopituitarism
      1. Pathophysiology
      2. Management
   2. Hyperpituitarism
      1. Pathophysiology
      2. Interventions
         1. Surgical
         2. Non‐surgical
7. Disorders of the Posterior Pituitary Gland
   1. Diabetes insipidus
      1. Pathophysiology
      2. Assessment
      3. Interventions
   2. Syndrome of inappropriate ADH
      1. Pathophysiology
      2. Assessment
      3. Interventions
8. Pharmacological Management
   1. Urinary Disorders
      1. Sulfonamides
      2. Fluoroquinolones
      3. Urinary antiseptics
      4. Drugs used for BPH
         1. Alpha blockers
         2. 5alpha reductase inhibitors
      5. Drugs used for Erectile Dysfunction
   2. Renal Impairment
      1. Calcium products/Phosphate binders
      2. Vitamin D preparations
      3. Erythropoietin
   3. Diabetes
      1. Review of insulins
      2. Review of oral hypoglycemic agents
      3. Insulin drip to treat DKA
   4. Thyroid Disorders
      1. Antithyroid drugs
      2. Thyroid hormone replacement
   5. Adrenal Disorders
      1. Adrenocorticoids/Mineralocorticoids
      2. Drugs for Cushing’s disease
   6. Pituitary Disorders
      1. Posterior Pituitary Hormones
      2. Drugs for Acromegaly