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Frances Payne Bolton School of Nursing - Case Western Reserve ...

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CASE WESTERN RESERVE UNIVERSITYFRANCES PAYNE BOLTON SCHOOL OF NURSINGCOURSE REVIEWFall 20081COURSE NUMBER: NUNP 444COURSE TITLE:CREDIT HOURS:Advanced Management <strong>of</strong> Acutely Ill Adults4 semester hours (2 didactic, 2 clinical)PRE-REQUISITES: NURS 438, NUNP 443FACULTY:Chris Winkelman, RN, PhD, ACNP, CCRNEmail: Chris.Winkelman@case.eduOffice: 368-0700I am available to meet with students with disabilities to discuss academicaccommodations after the student has met with the Coordinator <strong>of</strong> Disability Services,Educational Support Services.CLASS TIME: varies as a semi-intensive format; schedule distributed and posted on registrar’s site.COURSE DESCRIPTION:This course focuses on concepts specific to complex, multi-dimensional health problems <strong>of</strong> hospitalized adults.Pathophysiology, assessment and diagnostic strategies specific to complex health problems are emphasized. Clinicalpractice focuses on case management <strong>of</strong> acutely ill hospitalized adults with complex health problems.OBJECTIVES:Upon successful completion <strong>of</strong> this course, the student will be able to:1. Initiate appropriate assessment and diagnostic approaches for acutely ill hospitalized adults.2. Integrate concepts from physiology and pathophysiology to explain diagnostic work-up, differential diagnosis,treatment and follow-up <strong>of</strong> acutely ill hospitalized adults with complex health problems.3. Recommend diagnostic testing and treatment for acutely ill hospitalized adults based on evaluation <strong>of</strong> past and currentresearch.4. Promote strategies to enhance, maintain and restore health based on critique <strong>of</strong> current research.5. Implement components <strong>of</strong> case management and collaboration to facilitate the plan <strong>of</strong> care for the acutely illhospitalized adult with complex medical problems.Academic Integrity:All students are expected to maintain academic integrity, including cheating and plagiarism. Any violation will result in afailure <strong>of</strong> the course. Students are required to adhere to all policies listed in the <strong>Frances</strong> <strong>Payne</strong> <strong>Bolton</strong> <strong>School</strong> <strong>of</strong> <strong>Nursing</strong>Handbook and the FPB <strong>School</strong> <strong>of</strong> <strong>Nursing</strong> Bulletin.The student is expected to recognize that we are living in a community <strong>of</strong> learning, that we are accountable.


Teaching Strategies:Lecture, case studies and discussions are the major teaching strategies utilized in this course.2Evaluation Methods:Clinical 30% (must receive a passing grade on evaluation to pass this course) DUE MONDAY DEC 15Clinical Conference 5%<strong>Case</strong> Presentation Part I 10%, Part II 10%Practice Issues Controversies Presentation 15%Abstract related to controversies (co-authored) 10%Midterm 5%Final Exam 15%Required/Recommended Textbooks: Choose one related to differential diagnosis and treatment, and one for diagnostictests. Build your library as a continuation <strong>of</strong> last semester. There are several great specialty textbooks—ask for arecommendation if you want to invest in one.Adler, S.N.,(2008). A Pocket Manual <strong>of</strong> Differential Diagnosis. (5 th ed). Philadelphia: Lippincot Williams &Wilkins.Cavalli, F. Hansen, H.H. & Kaye, S.B. (2004). Textbook <strong>of</strong> Medical Oncology (3 rd ed). Malden, MA: BlackwellScience. ISBN 184184389XCooper, D.H et al. (2008). The Washington Manual <strong>of</strong> Medical Therapeutics (33rd ed.). Philadelphia:Lippincott Williams & Wilkins. (new editions come out in March). Also comes in PDA and CD-ROM versions.Corne J, Carroll M. & Delany D. (2002). Chest X-Ray Made Easy. Elsevier. Similar texts for abdomen,orthopedics, etc.Daly, B.J. (ed.). (1997). Acute care nurse practitioners. NY: Springer. (out <strong>of</strong> print—use Health Sci Lib copy)Domino, F.J. (2009). 5 Minute Clinical Consult. Philadelphia: Lippincott, Williams & Wilkens. Also PDAversion.Fauci. A., Braunwald, E. et al. (2008). Harrison's principles <strong>of</strong> internal medicine (17 th ed.). New York: McGrawHill.Ferrell, B.R. & Coyle, N. (2005). Textbook <strong>of</strong> palliative nursing. New York: Oxford: University Press.ISBN# 0195175492Goldman, L. & Ausiello, D (Eds.) (2007). Cecil’s textbook <strong>of</strong> medicine (23 rd ed). Elsevier.McPhee, S.J. & Papdakis, M.A. & Tierney, L. (eds.) (2008). Current Medical Diagnosis and Treatment. NewYork: McGraw-Hill. Note: several recent grads recommend this text for certification preparation.Nicoll, D., McPhee, S.J., Pignone, M., Detmer, W.M. & S.J., Chou, T.M. (2007). Pocket Guide to DiagnosticTests (4th ed.). New York: McGraw Hill.Schwartz, D.T. & Reisdorf, E. (2000). Emergency Radiology. New York: McGraw-Hill.Wallach, J. (2006). Interpretation <strong>of</strong> Diagnostic Tests, 8 th ed. Philadelphia: Lippincott Williams & Wilkins.Websiteswww.nurse.org/acnp American College <strong>of</strong> NPwww.aanp.org American Academy <strong>of</strong> NPwww.neonp.org Northeast Ohio Nurse Practitioner Groupwww.ooapn.org Ohio Association <strong>of</strong> Advanced Practice Nurses (1/444-886-5107)www.uptodateonline.com www.lungusa.orgwww.guideline.govwww.healthlinksusa.comwww.ahrq.govwww.uptpdateonline.comwww.americanheart.org www.medscape.comwww.pacep.org (pulmonary artery catheter education project from novice to expert)http://owl.english.purdue.edu/handouts/research/r_apa.htmlFor Personal Digital Assistants (PDAs)www.pdamd.comwww.worksmartdoc.comwww.epocrates.com or www.tarscon.comwww.skyscape.com.


3CXR Library:http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/cxr/atlas/cxratlas_f.htmRadiology for all organ systems, incl. a section on infections.http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Harrisons/Harrisons_f.htm Atlas<strong>of</strong> Radiologic Images.http://student.bmj.com/issues/00/11/education/408.php Student BMJ website—good infohere!Clinical Component <strong>of</strong> NUNP 444The clinical requirement for NUNP 444 is 16 hours per week for 15 weeks. It is highly recommended that there are twoclinical days weekly and that these days are consecutive. It is required that patient(s) are seen at least three times perweek (even if the third contact is only during rounds) twice during the semester (i.e. 2/15 weeks require clinical presence3 times weekly).Requirements: Current Ohio R.N. License, current ACLS certification, insurance as a NP studentVerification <strong>of</strong> TB Status/ Hepatitis VaccineClinical Objectives: At completion <strong>of</strong> the clinical experience, the student will:1) Competently perform complete history and physical examinations on patients with complex health problems in anefficient manner2) Thoroughly document assessment data, diagnostic study results, problem lists and plan <strong>of</strong> care3) Determine appropriate diagnostic strategies based on pathophysiology and assessment <strong>of</strong> the client4) Independently formulate a comprehensive problem list based on past medical history and current complaint5) Explain rationale for treatment based on concepts <strong>of</strong> pathophysiology6) Select advanced nonpharmacologic/pharmacologic therapies and evaluate their effectiveness7) Incorporate theory and findings <strong>of</strong> clinical research into clinical decision making8) Present patient data in a concise, efficient manner9) Provide care for patients from admission to discharge including necessary referral and collaboration10) Demonstrate collaborative decision making regarding patient care11) Make decisions on behalf <strong>of</strong> patients in an ethical manner12) Assess learning needs and provides client teaching--------------------------------------------------------------Students should be pr<strong>of</strong>icient with the following skills. The clinical conference should include the following:Client Pr<strong>of</strong>ileChief ComplaintPast Medical HistoryPast Surgical HistoryFamily HistorySocial History: occupation, marital status, children, educationMedicationsReview <strong>of</strong> SystemsPhysical ExaminationLaboratory and Diagnostic Study ResultsProblem list (include differential diagnosis)Plan (include further diagnostic testing, pharmacological as well as nonpharmacological strategies)


Schedule 2008 NUNP 444 Discussion questions are to aid in reading/preparationDate Topic Reading/PreparationAugust 26 Roles, and trends for the ACNP—theDNP. Certification exam preparationSep 2Sep 9Sep 23-Common problems-Nausea, vomiting, diarrhea-Renal problems: acute kidney injury,chronic kidney injury-Skin disordersDischarge planningGuest: Barbara Haubrich, GNPNeuro<strong>Case</strong> Study presentations Part A5 studentsShockRadiology (Guest)<strong>Case</strong> Study presentations Part A4 studentsRhoades, j. & Houck, J. (2005). Point/Counterpoint Squaring <strong>of</strong>f over the practicedoctorate. The Journal for Nurse Practitioners (July/August) pages 28-29. Accessat www.npjournal.orgDiscuss: what are the characteristics <strong>of</strong> case management?How to plan for graduation, certification and APN practice.Text <strong>of</strong> choice: Nausea, vomiting, diarrheaAcute kidney injury (acute renal failure, renal insufficiency) and chronic kidneyinjury (chronic renal failure).Common problems quick review: pain, delirium/ depression/ dementia, sleep,symptom management at end <strong>of</strong> life, poisoning and drug/ETOH abuse, electrolytedisturbances, feverReview Evelyn Duffy’s dermatology lecture online:http://fpblrc.cwru.edu/courses/NUNP419/exd4/skin.htmhttp://fpblrc.cwru.edu/courses/NUNP419/exd4/Eczematousconditions.htmhttp://fpblrc.cwru.edu/courses/NUNP419/exd4/Part3.htmhttp://fpblrc.cwru.edu/courses/NUNP419/exd4/Part4.htmhttp://fpblrc.cwru.edu/courses/NUNP419/exd4/Part5.htmCellulitis, herpes, skin cancers, dermatitis from drugsHuckstadt, A.A. (2002). The experience <strong>of</strong> hospitalized elderly patients. J <strong>of</strong>Gerontological Nurs, 28(9), 24-29.Naylor, M.D., Bowles, K.H. & Brooten, D. (2000). Patient problems and advancedpractice nurse intervention during transitional care. Public Health <strong>Nursing</strong>, 17(2),94-102.Young, H.M. (2003). Challenges and solutions for care <strong>of</strong> frail older adults. OnlineJournal <strong>of</strong> Issues in <strong>Nursing</strong>, 8(2), ms4.Discuss: what criteria should be considered for discharge from ICU? Intermediateunit? Floor?Stroke, neurological diseases (MS, Parkinson’s, ALS, Gillian Barre), SubarachnoidhemorrhageDiscuss: Assessment and diagnostic approaches to differentiate neurologicalsymptoms. Value and use <strong>of</strong> case management for complex care.Coralli, C.H. (2006, reprint). Effective case presentations—an important clinicalskill for nurse practitioners. JAANP, 18, 216-220.Text <strong>of</strong> choice: Shock. Distributive and Obstructive. Cardiogenic, neurologic,septic, anaphylactic, hypovolemic/hemorrhagic.Discuss: Definitions and characteristics <strong>of</strong> shock. Diagnostic strategies.Treatment.Source <strong>of</strong> choice: interpreting x-rays, CTs and MRIsDiscus: What characterizes a “good” film? What is a systematic approach tointerpretation?4Oct 7Oct 21Midterm handed outCancerGuest: Colleen DvorakMidterm take home due<strong>Case</strong> Histories Part B (All)Text <strong>of</strong> choice: Lymphoma and Leukemia, other common cancers (esp., lung,colorectal)Discuss: Contrast signs and symptoms <strong>of</strong> leukemia with those <strong>of</strong> lymphoma. Whatcommon symptoms/problems need early follow-up or referral? Key diagnostic tests.Midterm reviewNov 4 Controversies (All) Please look at the rubric!Nov 18HematologyTopic <strong>of</strong> choice, if timeText <strong>of</strong> choice: anemia, polycythemia, thrombocytopenia, DIC & coagulopathy,sickle cell crisisDiscuss: Differential diagnoses related to anemia, diagnostic testing and commontreatments.Abstracts dueDec 2 Final Exam Two parts: scheduled oral exam and multiple choice.Text <strong>of</strong> Choice: Harrison’s, Washington Manual or Tierney’s Current Medical Diagnosis.To receive a grade in this course (rather than an “incomplete”), you must have all forms & clinical hours completed and in my hands byDEC 15 4pm (Monday).

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