NURS 2255 - Intermediate Adult Medical‑Surgical Nursing B

Credit Hours: 1.50

1. Analyze and apply the critical components of evidence-based nursing practice.

Course Outcome:

1. Upon completion of this course, students will be able to apply evidence‐based practice for patients with urinary, renal, and endocrine problems.

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.

Program Outcome/Student Learning Outcome:

2. Recognize quality improvement strategies as an integral component of nursing practice.

Course 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. Age-related changes of urinary system
   2. Review of definitions related to urinary system
   3. Diagnostic studies of urinary and renal system
   4. Patient safety/best practices prior to diagnostic studies
   5. CDC guidelines for indwelling urinary catheters
   6. Devices used in management of urinary disorders
2. Infectious Disorders: Cystitis, 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
      2. Pharmacological management
      3. Surgical management
      4. Other interventions
   5. Cultural, ethnic, and/or gender considerations
4. Male reproductive disorders: BPH, Prostate Cancer, Testicular Cancer
   • a. Pathophysiology/risk factors
   • b. Assessment/clinical manifestations
   • c. Diagnostics
   • d. Collaborative management: non-surgical, pharmacologic, surgical management
   • e. Cultural considerations
5. Erectile Dysfunction: definition and pharmacological management

Unit 2 Renal Disorders

1. Overview
   1. Age-related changes of renal system
   2. Functions of the kidney
   3. Hormonal functions of 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 including nephrostomy tubes
4. Infectious Disorders: Pyelonephritis
   1. Pathophysiology
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
5. Acute and Chronic Glomerulonephritis, Nephrotic Syndrome
   1. Pathophysiology
   2. Assessment/clinical manifestations
   3. Diagnostics
   4. Collaborative management and interventions
6. 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. Renal replacement therapies
         1. Hemodialysis
         2. Peritoneal dialysis
         3. Access sites
3. Chronic Kidney Disease
   1. Pathophysiology
      1. Stages
      2. Cardiovascular/pulmonary changes
      3. Metabolic changes
      4. Hematologic changes
      5. Gastrointestinal changes
      6. Neurological changes
      7. Integumentary 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. Hemodialysis
   1. Principles
      1. Patient selection
      2. Procedure
      3. Access
      4. Nursing considerations before, during, after dialysis
      5. Complications
5. Peritoneal dialysis
   1. Patient selection
   2. Procedure
   3. Complications
   4. Advantages over hemodialysis
6. Renal Transplantation
   1. Candidate selection
   2. Donors
   3. Preoperative care
   4. Operative procedures
   5. Immunosuppressive drug therapy
   6. Types of rejection: hyperacute, acute, and chronic
   7. Manifestations of Organ Rejection
   8. Health teaching and resources
7. 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 ‐ adrenergic (SNS) and neuroglycopenic
         2. Management
         3. Prevention
      4. Other hypoglycemic disorders
   3. Chronic complications of diabetes
      1. Macrovascular
         1. Cardiovascular
         2. Cerebrovascular
      2. Microvascular
         1. Eye and vision
         2. Diabetic nephropathy
      3. Neuropathies ‐ sensorimotor and autonomic neuropathies
   4. Gerontologic considerations
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 (acromegaly/gigantism)
      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 (SIADH)
      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. Corticosteroids
      2. Mineralocorticoids
   6. Pituitary Disorders
      1. Posterior Pituitary Hormones (DDAVP)
      2. Drugs for Acromegaly