Course Name: CARE OF CLIENTS WITH PROBLEMS IN CELLULAR ABERRATIONS, ACUTE BIOLOGIC CRISIS, EMERGENCY AND DISASTER NURSING

Course Code : NCM 106 Course Description: It deals with the principles and techniques of nursing care management of sick clients across the lifespan with emphasis on the adult and older persons with alterations/problems in cellular aberrations, acute biologic crisis, including emergency and disaster nursing and IV Therapy. Course Credit : 6units lecture, 5units RLE (2units Skills Lab ; 3units Clinical) Contact Hours/sem: 108 lecture hours, 255 RLE Hours Prerequisite : NCM 104, NCM 105 Placement : 4th Year, 1st Semester Course Objectives: At the end of the course, and given actual clients with problems in cellular aberrations, acute biologic crisis and emergency, the student should be able to: 1. Utilize the nursing process in the care of individuals, families in community and hospital settings. a. assesses with client/s his/her/their condition/health status through interview, physical examination, interpretation of laboratory findings b. identifies actual and potential nursing diagnosis c. plans appropriate nursing interventions with client/s and family for identified nursing diagnosis

A. Risk factors assessment and screening procedures among clients that contribute to the development of cellular aberration lung, breast, uterine, prostate, colorectal, skin B. Significant subjective data from client relevant information based on chief complaints, functional patterns, including psychosocial and behavioral assessment C. Principles and techniques of physical examination in newborn, children, adults, deviations from normal: 1. Cellular aberration a. Inspection vasculature, symmetry, movement, nodules, discharges, masses b. Auscultation heart sounds, breath sounds, bowel sounds, vascular sounds, friction rub c. Palpation masses, tenderness, nodules, lesions, distention d. Percussion gas patterns, areas of flatness and dullness, liver span, masses, ascites 2. Acute biologic crisis or life threatening situation Standard assessment of the critically ill (focused historytaking, discriminating PE - airway, breathing, circulation, including hemodynamic status ) D. Results and implications of diagnostic/laboratory examinations of clients with reference to problems in: 1. Cellular aberration a. Screening: BSE, Pap smear, rectal examination, b. Non-invasive: MRI, CT scan, Bone scan, ultrasound, thyroid scan c. Invasive: Biopsy, digital rectal examination, cyst aspiration, cystoscopy, lymph angiography, cerebral arteriography 2. Acute biologic crisis/multiorgan problem a. Non-invasive: ECG, cardiac rhythms, b. Invasive: ABG, hemodynamic monitoring, CVP, pulmonary capillary wedge pressure (PCWP) E. Pathophysiologic mechanisms: 1. Cellular aberrations a. Solid tumors lung cancer, breast, uterine cancer, prostate cancer, colorectal, brain cancer b. Liquid tumors lymphomas, leukemias 2. Acute biologic crisis /multiorgan system dysfunction/ emergency a. b. c. d. Cardiac failure Acute Myocardial infarction Acute pulmonary failure Acute renal failure

d. implements plan of care with client/s and family e. evaluates the progress of his/her/their clients condition and outcomes of care 2. Ensure a well organized and accurate documentation system 3. Relate with client/s and their family and the health team appropriately 4. Observe bioethical concepts/ principles, core values and nursing standards in the care of clients 5. Promote personal and professional growth of self and others Course Outline : I. THE INDIVIDUAL ACROSS THE LIFESPAN

e. Stroke f. Increased Intracranial pressure g. Metabolic emergencies e.g. DKA/HHNK h. Massive Bleeding i. Extensive surgeries j. Extensive Burns k. Poisoning l. Emerging illnesses (SARS, Avian Flu) m. Multiple injuries F. Nursing Diagnoses taxonomy pertinent to problems/ alteration in: 1. Cellular aberration a. Potential for infection b. Alteration in tissue perception c. Activity intolerance d. Potential for Alteration in nutrition less than body requirement f. Alteration in oral mucous membrane integrity g. Alteration in comfort: pain/pruritus h. Fluid volume deficit 2. Acute biologic crisis/ multi-organ failure a. Impaired gas exchange b. Inability to sustain spontaneous ventilation c. Dysfunctional ventilatory weaning response d. Decreased cardiac output (CO) e. Altered tissue perfusion systemic f. Alterations in nutrition less than body requirement g. Fluid volume deficit h. Activity intolerance G. Principles of Various Modalities of Management 1. Health Promotive 2. Disease Preventive 3. Curative 4. Restorative H. Principles of Management for altered 1. Cellular aberration a. Determination and management of cause b. Definitive management; Surgery, chemotherapy, radiation therapy, biotherapy c. Blood component replacement d. O2 therapy e. Drug therapy f. Hydration g. Prevention of infection h. Supportive management i. Prevention of complications j. Rehabilitation 2. Acute biologic crisis / multi-organ failure a. Determination and management of cause

b. Life saving interventions: Basic life support, advanced cardiac life support, first aid measures, fluid resuscitation c. Life maintaining interventions: Airway management and care of patients with ventilator, parenteral fluid administration including blood and blood component therapy, interventions for cardiac output problems, pharmacologic interventions for hemodynamic instability, continuous hemodynamic monitoring, interventions for neural regulation, fluid and electrolyte problems, nutrition and perioperative problems d. Psychosocial and behavioral interventions: measures to relieve anxiety, fear, depression, critical care concerns life: immobility, sleep deprivation, sensory overload, body image alterations, grieving, sexuality, spirituality e. Supportive management f. Prevention of complication g. Rehabilitation pulmonary, cardiac, neurologic I. Pharmacologic actions, therapeutic use, side effects, indications, contraindication, and nursing responsibilities: 1. Cellular aberrations a. Anticancer agent b. Analgesics c. Narcotics d. Corticosteroids e. Antibiotics f. Antipruritus g. Analgesics, opioids 2. Acute biologic crisis/multiorgan failure a. Analgesics b. Narcotics c. Corticosteroids d. Antihypertensive e. Vasopressors f. Antibiotics g. Parenteral fluids J. Purpose, indications, nursing responsibilities for the following surgical and special procedures 1. Cellular aberration a. Major surgical procedures: lobectomy, pneumonectomy. mastectomy, nephrectomy, prostatectomy, colectomy, colostomy, bone marrow transplant, urinary diversion b. Special procedure: brachytherapy, radiation therapy, reverse isolation, chemotherapy 2. Acute biologic crisis/multiorgan failure a. Surgical procedure coronary bypass, angioplasty, skin grafting,

b. Special procedures advanced life support, parenteral hyperalimentation; ventilatory support, fluid resuscitation, first aid measure including emergency wound and trauma management, IV Therapy K. Safe and comprehensive perioperative nursing care a. Assessment and care during the perioperative period b. Techniques in assisting the surgical team during the operation c. Principles of safety, comfort and privacy during the perioperative period d. Nursing responsibilities during the perioperative period L. Steps/pointers in decision making and prioritization with client/s having problems in inflammatory and immunologic reaction, cellular aberration, acute biologic crisis/multiorgan failure, including emergency and disaster preparedness M. Principles, concept and application of bioethics in the care of clients N. Developing outcome criteria for clients with problems in inflammatory and immunologic reaction, cellular aberration,acute biologic crisis/multiorgan failure, including emergency andisaster preparedness O. Appropriate discharge plan including health education P. Accurate recording and documentation II. DISASTER & EMERGENCY A. Definition of Emergency B. Types of Emergency C. Triage 1. Objectives 2. START Triage 3. Military Triage D. Hospital Emergency Incident Command System E. Incident Command Education F. Hospital Operations Plan G. Personal Protective Equipment H. Hazardous Materials I. Decontamination J. Biological Warfare and Biological Agents K. Blast Injuries L. Natural disasters M. Stress Reactions 1. Post Traumatic
3. 2.

2. Stress Disorder Critical Incident Stress Management 3. Debriefing N. Nurses Role in Disaster and Emergency III. INTRAVENOUS PARENTERAL THERAPY A. Basic Foundation of IV Therapy Philosophy Historical Background of IV Therapy Standards and competencies of IV Tehrapy B. Content Review of Anatomy and Physiology of the Vascular Peripheral and Integumentary System Fluid and Electrolyte Therapy Venipuncture Technique on Adult and Children Complications of IV Therapy Infection, Control & Microbiology Demonstration of Procedure Documentation Activity C. Performance Scale for IV Therapy
Guide for RLE Provide opportunities to demonstrate procedures needed in acute biologic crisis. Acute Biologic Crisis: Provide opportunities for actual experience to ensure competencies in caring for clients with acute biologic crisis and those with emergency situations are developed. For Disaster Situations: You may provide simulated scenarios/situations for these experience. IV Therapy: Faculty member handling the course must have a current certificate as IV Therapist Provide opportunities for demonstration/return demonstration through the use of an IV dummy arm and one-on one intravenous insertion

Equipment and Materials: [these could be found in nursing skills lab, base hospital, affiliating centers] 1. Cellular Aberration: Breast examination model, cervical examination model, safety guidelines for chemotherapy and radiotherapy, safety barriers, for chemotherapy and spill kits. Acute Biologic Crisis: Cardiac monitor, EKG machine, oxymeter, ventilatory support equipments, endotracheal tubes, tracheostomy tube, airway, BP apparatus, stethoscope, oxygen tank, O2 regulator, humidifier, monkey wrench, O2 tubings, O2 cannula/catheter, O12 masks, croupette, O2 tent, suction catheters, suction machine, cardiac arrest board, gloves, peak flow meter, tongue depressor, microscope, glass slide, oneway/two-way/three-way water seal drainage, CVP manometer and tubing, peritoneal dialysis set, dialyzing solution, hemodialysis machine (optional), incubator, Billi light, Isolette, Model for basic and advance life support, including equipment and materials in NCM 104 and NCM 105. IV Therapy: - IV arm dummy, IV injection tray, IV needles, cotton and alcohol acp2012