NCENH06 Lesson: CARE OF CLIENTS WITH PROBLEMS IN CELLULAR ABBERATIONS /

ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

Lesson: Nursing Diagnoses taxonomy

Overview
In the early 1970s the need for a precise and computerizable language of nursing phenomena
was identified. This need stimulated the formation of the National Conference Group for the
Classification of Nursing Diagnoses. The group began the work of identifying nursing diagnoses
and developing a taxonomic structure for their classification. Based on the initial success with
the development of nursing diagnoses, the conference group became the North American
Nursing Diagnosis Association (NANDA). There are two benefits of taxonomic development
within nursing: one is scientific in nature, while the other is applied or practical. The
development of this taxonomy has occurred over a span of 17 years including nine national
conferences. Details of this development have been abstracted from the proceedings of the nine
conferences and the minutes of the Taxonomy Committee in order to explicate the taxonomic
structure. The rules for the classification, developed by the committee, are presented. Future
directions for taxonomic development and collaboration with other health care professions are
proposed [ CITATION War19 \l 13321 ].

Objective of the module:

1.Explain the different knowledge of physical, social, natural and health sciences and
humanities in managing client with life threatening condition/ acutely ill/ multi organ problems/
high acuity and emergency situation. Acute and chronic
2. Utilizes the nursing process in managing a group of clients with Life threatening condition
Instruction please read first the suggested readings, after you have read the suggested
reading please come up with a journal reaction at least 1 paragraph each with 100 words
and one reference each topic. Please click the hyperlink website to access the journals.
PLEASE AVOID PLAGIARISM BECAUSE I CAN DETERMINE IF YOU CUT AND PASTE
YOUR WORK VIA INTERNET.
Topics/materials
1. Impaired gas exchange
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547073/

Title of the study: Impaired gas exchange: accuracy of defining characteristics in children
with acute respiratory infection

2. Inability to sustain spontaneous ventilation

https://www.atsjournals.org/doi/10.1164/rccm.201605-1081CP

Title of the study: Mechanical Ventilation to Minimize Progression of Lung Injury in Acute
Respiratory Failure
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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

3. Dysfunctional ventilatory weaning response

https://www.ncbi.nlm.nih.gov/pubmed/19243524

title of the study: Ventilatory weaning: a case study of protracted weaning. Take note this is only
an abstract meaning that the study is restricted for full study manuscript.

4. Decreased cardiac output (CO)

https://www.ncbi.nlm.nih.gov/books/NBK470455/

title of the study: Physiology, Cardiac Output

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Lesson Summary/ Cases pertaining to different nursing diagnosis.

1. Impaired gas exchange
Case Study: Cough That Won't Quit
Three weeks ago, 20-year-old Erica came down with symptoms typical of the common cold.
She had a runny nose, fatigue, and a mild cough. Her symptoms had been starting to improve,
but recently her cough has been getting worse. She is coughing up a lot of thick mucus, her
throat is sore from frequent coughing, and her chest feels very congested. According to her
grandmother, Erica has a “chest cold.” Erica is a smoker and wonders if her habit is making her
cough worse. She decides that it is time to see a doctor.
Dr. Johnson examines Erica and asks about her symptoms and health history. She checks the
level of oxygen in Erica’s blood by attaching a device called a pulse oximeter to Erica’s finger.
Dr. Johnson concludes that Erica has bronchitis, which is an infection that commonly occurs
after a person has a cold or flu. Bronchitis is sometimes referred to as a “chest cold,” so Erica’s
grandmother was right! Bronchitis causes inflammation and a build-up of mucus in the bronchial
tubes in the chest.
Because bronchitis is usually caused by viruses and not bacteria, Dr. Johnson tells Erica that
antibiotics are not likely to help. Instead, she recommends that Erica try to thin and remove the
mucus by drinking plenty of fluids and using a humidifier or spending time in a steamy shower.
She also recommends that Erica get plenty of rest.

Dr. Johnson also tells Erica some things not to do — most importantly, to not smoke while she
is sick, and to try to quit smoking in the long-term. She explains that smoking can make people
more susceptible to bronchitis and can hinder recovery. She also advises Erica to not take over-
the-counter cough suppressant medication.

As you read this chapter on the respiratory system, you will be able to better understand what
bronchitis is and why Dr. Johnson made the treatment recommendations that she did. At the
end of the chapter, you will learn more about acute bronchitis, which is the type that Erica has.
This information may come in handy to you personally because chances are high that you will
get this common infection at some point in your life — there are millions of cases of bronchitis
every year!
Chapter Overview: Respiratory System
In this chapter, you will learn about the respiratory system — the system that exchanges gases
such as oxygen and carbon dioxide between the body and the outside air. Specifically, you will
learn about:
 The process of respiration, in which oxygen moves from the outside air into the body and
carbon dioxide and other waste gases move from inside the body into the outside air.
 The organs of the respiratory system, including the lungs, bronchial tubes, and the rest
of the respiratory tract.
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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

 How the respiratory tract protects itself from pathogens and other potentially harmful
substances in the air.
 How the rate of breathing is regulated to maintain homeostasis of blood gases and pH.
 How ventilation, or breathing, allows us to inhale air into the body and exhale air out of
the body.
 The conscious and unconscious control of breathing.
 Nasal breathing compared to mouth breathing.
 What happens when a person is drowning.
 How gas exchange occurs between the air and blood in the alveoli of the lungs; and
between the blood and cells throughout the body.
 Disorders of the respiratory system including asthma, pneumonia, chronic obstructive
pulmonary disease (COPD), and lung cancer.
 The negative health effects of smoking.
As you read the chapter, think about the following questions:
1. Where are the bronchial tubes and what is their function?
2. What is the function of mucus and why can too much mucus be a bad thing?
3. Why did Dr. Johnson check Erica’s blood oxygen level?
4. Why do you think Dr. Johnson warned Erica to not take cough suppressant medications?
5. How does acute bronchitis compare to chronic bronchitis and how do they both relate to
smoking?
Complete This Worksheet:
During this simulation learning experience, the participants will care for an elderly patient with
chronic
obstructive pulmonary disease (COPD) who requires surgery to remove the gall bladder
(cholecystectomy). To prepare for this simulation summarize what you have learned from class
sessions
and the assigned journal articles by completing the following questions:
1. Describe the underlying pathophysiology (what happens in the lungs) in patients diagnosed
with
chronic obstructive pulmonary disease.
- It's a combo of emphysema and bronchitis most commonly. Bronchitis causes inflammation of
the bronchi which constricts airways making if difficult to inhale and exhale. Emphysema is
damage to the alveoli leading to trapping of air leading to the patient not being able to inhale
and exhale appropriately. This may lead to retaining CO2 or respiratory acidosis.

IV. Learning Insight: Please indicate your nursing insight in our activity, What did you learn from
the Activity.

_________________________end of lesson Nursing Diagnosis________________________

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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

Lesson: Principles of various modalities of management

Overview:

2.HEALTH PROMOTION, DISEASE PREVENTIVE, CURATIVE AND RESTORATIVE.

Health, according to Florence Nightingale, was defined as the absence of disease and illness.
Throughout the years, this definition has changed significantly. At the current time, the World
Health Organization (WHO) defines health as "a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity." The World Health Organization
defines health promotion as "the process of enabling people to increase their control over, and
improve their health". These definitions of health and health promotion have implications for
nurses and the health care profession.
Objectives of the activity
1. To apply available theories and models of different nursing theorist into practice and to
as an output the student must apply the model into their practice as a student nurse, as
to become a FUTURE professional nurse.
2. To come up with a realization that this different theorist can change the perspective of
every individual patient to change their behavior for better health outcomes.
3. The student is expected to be knowledgeable and can apply different perspective of
health promotive measures by applying research and theorist in patient care.
4. The students are expected to use their critical decision making back up with scientific
knowledge in order to provide a holistic care to their patient.
ACTIVITY:
Please select a system model of health ex. The system model of Neuman, behavioral model
and etc. from this model kindly, discuss the concepts that affect the health of individual and how
will you intervene to promote health and wellness of an individual by applying the system model.
I will give the case scenario and it is up to you what model will you apply to this case scenario.
CASE:
This case requires the nurse to recognize the signs of hyperglycemia and convey an
understanding of diabetes-related lab values. Type 1 and type 2 diabetes, complications of
diabetes, and dietary guidelines are discussed. The nurse must consider the impact that culture
may have on diabetes management. The nurse works with a diabetes educator to educate this
newly diagnosed diabetic about blood glucose monitoring, medication administration, foot care,
sick day management, and proper diet and exercise. The ethical and legal considerations of
using an interpreter are addressed.
Mr. Jenaro is a 61-year-old Spanish-speaking man who presents to the emergency room with
his wife Dolores. Mrs. Jenaro is also Spanish speaking, but understands some English. Mr.
Jenaro complains of nausea and vomiting for two days and symp-toms of confusion. His blood
glucose is 796 mg/dL. Intravenous regular insulin (Novolin R) is prescribed and he is admitted
for further evaluation. He will require teaching regarding his newly diagnosed diabetes.
Case Study Mr. Jenaro is newly diagnosed with diabetes. His hemoglobin A1C is 10.3%. Mr.
Jenaro is slightly overweight. He is 5 feet 10 inches tall and weighs 174 pounds (79 kg). He
NCENH06 Lesson: CARE OF CLIENTS WITH PROBLEMS IN CELLULAR ABBERATIONS /
ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

reports no form of regular exercise. He does not follow a special diet at home. He states, “I eat
whatever Dolores puts in front of me. She is a good cook.” For the past few months, Mrs.
Jenaro has noticed that her husband “has been very thirsty and has been up and down to the
bathroom a hundred times a day.” Neither can recall how long it has been since these changes
in Mr. Jenaro began. Dolores states, “It has been quite a while now. It just seems to be getting
worse and worse.”
 How will you apply a certain nursing theory or nursing model to this case scenario?
IV. Learning Insight: Include Nursing insight how will you apply this concept into practice?

___________________end of lesson ______________________________________

NCENH06 Lesson: CARE OF CLIENTS WITH PROBLEMS IN CELLULAR ABBERATIONS /
ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

3.Lesson: Pharmacologic actions, therapeutic use, side effects, indications,

contraindication, and nursing responsibilities:
Overview
In modern health care, there is an increasing reliance on medication therapy to manage illness
and disease, to slow progression of disease, and to improve patient outcomes. Medications
offer a variety of potential benefits to the patient: relief of symptoms, support for necessary
physiological processes, and destruction of toxic substances or organisms that cause disease,
to name a few. Yet medications also have the potential to do harm, even when administered
properly—and the harm is likely to be exacerbated if they are administered incorrectly.
Pharmacology is the study of the actions of drugs, incorporating knowledge from other
interrelated sciences, such as pharmacokinetics and pharmaco-dynamics. Knowledge from the
various pharmaco-logic classes enables the nurse to understand how drugs work in the body, to
achieve the therapeutic (intended) effects, and to anticipate and recognize the potential side
effects (unintended or unavoidable) or toxicities.
Objectives:
1. The student will be able to identify a range of drugs used in medicine and discuss their
mechanisms of action.
2. The student will be able to translate pharmacological principles into clinical decision-
making.
Reading Material:
Neurotransmitter Receptors
Neurotransmitters and Receptors

Neurotransmitters are chemicals that allow neurons (nerve cells) to communicate with each
other, usually by being “released” into the small space between two neighbouring cells called a
synaptic cleft.

These neurotransmitters then freely bind to receptors on the postsynaptic cell, triggering a
response (usually causing or inhibiting an action potential–see Nerve Signal Transmission hand
out) in that cell. Thus the neurotransmitters are considered ligands for their receptors.

These receptors are specific to particular neurotransmitters, just like a lock and key.

For example, acetylcholine receptors can only interact with acetylcholine and not with
dopamine or epinephrine.

A neurotransmitter can bind to multiple types of receptors just like a master key in a building.
This depends on the final desired physiological result; binding to some receptors can stimulate
the recipient neuron to become active, but others can inhibit an already active neuron.

Agonists (aka ligands) will activate a receptor and cause a response. In the lock and key
scenario, the agonist would be the key. Antagonists will block a receptor from being activated by
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agonists. In the lock and key scenario, the key would break inside the lock, and no other keys
could be used to open the lock.
Below are examples of two neurotransmitters and their different receptors that are particularly
important for pharmacology. The effect of an agonist binding is described, and the main
locations for these receptors are indicated in bold. Knowing the effects of each receptor agonist
will help you figure out side effects of any drug. An antagonist binding to the receptors would
have the opposite effect of what is written below (e.g. if an agonist causes constriction, an
antagonist/blocker would cause dilation).
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Activity for Pharmacology

1. A patient has been prescribed a 2-agonist for her asthma, but she is concerned about the
side effects of this drug. Is this the correct drug for her diagnosis? What side effects could she
encounter?
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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

2. A patient comes in with tachycardia. The doctor prescribes two different drug types to ensure
the tachycardia subsides. What two types of drugs would be logical? Why?

3. A patient who struggles to urinate has been prescribed an 1-antagonist. Is this the best
choice of drug for the patient?
4. A new diet drug has come on the market that claims to have fewer side effects than the
previous drug from the same receptor family. Which receptor would the new drug likely target?
The old drug?
IV. Nursing Insight: Please reflect what did you learn about the activity how will affect your
current practice as a nursing student?
____________________________end of lesson___________________________________
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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

Finals 4.
This is the summary of our lecture from 1st grading up to finals.
Cardiovascular Case study:
A 59-year-old black female is admitted at midnight with a diagnosis of Chest Pain. She
complains of a squeezing type pain across her chest and into her left jaw area. Vital signs are:
Blood Pressure-200/110; Pulse-128 beats per minute; Respirations- 26 per minute;
Temperature-99.8; Saturation of Oxygen-86% on room air; pain level 9/10. During your initial
assessment she is rubbing her mid-chest, grimacing and is diaphoretic. The pain has been
occurring intermittently throughout the evening and night. Her color is pale except around her
lips which are bluish. Cardiac auscultation reveals a rapid regular rhythm and a murmur, no
pulse deficit.  She has never had this pain before. Lungs sounds are crackles in both bases with
clear upper lobes. She is afraid she is going to die. Per standing orders, a nurse administers &
administers Nitroglycerine 0.4mg sublingually; applies cardiac electrodes for continuous cardiac
monitoring; obtains an electrocardiogram; places a peripheral intravenous catheter with saline
lock; positions patient in low Fowlers. On assessment vital signs are Blood Pressure-180/95;
Pulse-108 beats per minute; Respirations- 22 per minute; Temperature-99.0; Saturation of
Oxygen-90% on 2 liters per minute; Pain level 8/10. She says her chest pain hasn’t changed.
Heart and lung sounds are unchanged. Color is pale without previous blue changes.
 
 Is the type of pain this patient is having typical or atypical of cardiac type of chest pain.
 What other types of pain would indicate a cardiac type problem but would not be
specifically in the chest area?
 Describe how women often present with cardiac problems and how they are different
from men.
 What health history information would the nurse assess after the patient's pain is gone.
 What abnormals are present in the patient's vitals signs (first set)?
 What statements by the patient depict extreme anxiety and feelings of doom?
 What labs would be drawn for this patient that would identify if the pain is from cardiac
origin?
 What would the results be if the patient is having cardiac damage?
 A provider orders Aspirin 81 mg x 3 tabs by mouth chewed. What is the rationale for this
order?
 What is the reason for the diaphoresis?
 The patient's skin color is abnormal, describe this in medical terms?
 Does this patient need oxygen? If so what type of oxygen administration device would
be applied and what rate of flow?
 Describe how you assess JVD in this patient?
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 What results would indicate that the patient has JVD?

 If JVD is present this would indicate right or left sided heart failure?
 The patient has lung crackles: Is this right or left sided heart failure?
 What type of heart sound would the nurse listen for to indicate that the patient might
have left sided failure?
 A nurse would expect the provider to order what type of medication if the patient has
congestive heart failure?
 Describe the rationale for your answer as well as what labs you would check before you
give this medication?
 The nurse administers one nitroglycering tablet sublingually. What will this medication do
for this patient? What side effects will the nurse have to assess for and manage?How
many doses of Nitroglycerin can be given and within what time period? The pain
assessment must be conducted before and after each dose. The desired outcome is for
the pain to decrease.
 Identify and prioritize the problem list for this client.
 Use the data in the case study to write 2 nursing diagnosis (include and prioritize 2-
three-part assessment diagnoses w/at least 4 interventions each)
IV. Learning Insight / Reflection: 
_______________________________END______________________________________
Prepared by: Roniefhel N. Apsay RN
Clinical Instructor

Verified by: Evangeline I. Soliba RN, MAN.

BSN Program Chair

Noted by: Helen D. Alalag RN, MAN.

School of Nursing Dean
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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

APPENDIX
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ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING
NCENH06 Lesson: CARE OF CLIENTS WITH PROBLEMS IN CELLULAR ABBERATIONS /
ACUTE BIOLOGICAL CRISIS EMERGENCY AND DISASTER NURSING

Rubrics for the written output that will be submitted

Your output will be graded as
Knowledge/strategies/importance 20 percent
Critical/creative thinking 20 percent
Communication 20 percent
Quality and writing 20 percent
Spelling and grammar 20 percent
Total score 100 percent