MPN 2030 - Medical and Surgical Nursing I for CMA

Safely and effectively apply scientific principles of nursing to the care of the adult medical-surgical patient.

Recognize the grieving process:

1. Trauma
2. Terminal illness
3. Complications of perioperative care

Identify the PN’s role in providing care to the acutely ill patient.

Recognize pathophysiological changes related to disease processes in the care of the adult patient.

1. Identify signs and symptoms of diseases related to each body system
2. Identify diagnostic studies in relation to each body system
3. Identify treatment modalities as related to diseases
4. Identify nursing measures as indicated in the following disorders

• Fluid and Electrolyte Balance Disorders
  • Differentiate among the following fluid compartments: intracellular, extracellular, interstitial, and intravascular.
  • Discuss at least four major nursing responsibilities associated with laboratory tests ordered by a clinician.
  • In the clinical laboratory, demonstrate a client and family teaching session, emphasizing the importance of fluid and electrolyte balance and the types of care that may be needed for the client.
  • Identify at least four possible causes of the two major types of fluid imbalances (fluid volume excess and fluid volume deficit), including at least two nursing considerations for each cause.
  • State at least two nursing considerations for each: dependent edema, sacral edema, pitting and non-pitting edema, and pulmonary edema.
  • State the normal serum levels for the following electrolytes: sodium, potassium, calcium, magnesium, chloride, and phosphorus.
  • Identify at least four causes of each type of electrolyte imbalance.
  • Discuss the major symptoms associated with each type of electrolyte imbalance, stating at least three nursing considerations related to each condition.
  • Differentiate among the four major types of acid-base imbalances: respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis.
  • Identify at least four nursing considerations related to the data collection, assessment, monitoring, and care of a client with acidosis and a client with alkalosis.
• Neurological Disorders
  • List physiological changes that occur in the nervous system with aging.
  • Discuss the Glasgow coma scale.
  • Identify the significant subjective and objective data related to the nervous system that should be obtained for a patient during assessment.
  • Explain the importance of prevention in problems of the nervous system, and give several examples of prevention.
  • Differentiate between normal and common abnormal findings of a physical assessment of the nervous system.
  • List common laboratory and diagnostic examinations for evaluation of neurological disorders.
  • Differentiate among the following diagnostic tests: computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), cerebral angiography, cerebral arteriography, myelography, brain scan, electroencephalography, and videotelemetry.
  • Discuss the nursing care involved for a client before and after a lumbar puncture (LP).
  • Compare and contrast migraine and cluster headaches, including nursing considerations for each condition.
  • List four classifications of seizures, their characteristics, clinical signs, aura, and postictal period.
  • Identify the main characteristics of at least three types of partial seizures and at least six types of general seizures.
  • Discuss the causes, signs and symptoms, and nursing implications for the following disorders involving nerves: trigeminal neuralgia, Bell’s palsy, and herpes zoster.
  • Discuss various neurological disturbances in motor function and sensory/perceptual function.
  • Compare paraplegia with quadriplegia, including a discussion of at least four differences in nursing care for each condition.
  • Give examples of six degenerative neurological diseases and explain the etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, and nursing interventions for each.
  • Describe at least five signs and symptoms, therapies, and at least five nursing considerations for each of the following degenerative disorders: multiple sclerosis, Parkinson’s disease, myasthenia gravis, Huntington’s disease, and amyotrophic lateral sclerosis.
  • Discuss the causes, signs and symptoms, therapies, and at least five nursing considerations for each of the following inflammatory disorders: brain abscess, meningitis, encephalitis, Guillain-Barré syndrome, post-polio syndrome, and acute transverse myelitis.
  • Discuss the etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, and nursing interventions for intracranial tumors, craniocerebral trauma, and spinal trauma.
  • List five signs and symptoms of increased intracranial pressure and why they occur, as well as nursing interventions that decrease intracranial pressure.
  • Explain the nursing care required for clients with concussion, brain laceration and contusion, skull fractures, and hematoma.
  • Identify at least three pre- and postoperative nursing considerations for a client undergoing craniotomy.
  • Discuss the etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, and nursing interventions for a stroke patient.
  • Explain the mechanism of injury to the brain that occurs with a stroke and traumatic brain injury.
  • Discuss patient teaching and home care planning for the patient with stroke, multiple sclerosis (MS), Parkinson’s disease, and myasthenia gravis.
• Sensory Disorders
  • Describe two changes in the sensory system that occurs as a result of the normal aging process.
  • Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the visual and auditory systems.
  • Describe age-related changes in the visual and auditory systems and differences in assessment findings.
  • State at least ten nursing considerations for the care of the client with: a visual deficit, including pre- and postoperative nursing considerations; a hearing deficit.
  • Define radial keratotomy, photorefractive keratectomy (PRK), and laser-assisted in situ keratomileusis (LASIK).
  • Define the following refractive errors: myopia, hyperopia, astigmatism, and presbyopia.
  • Describe the following: inflammatory and infectious eye disorders (conjunctivitis, blepharitis, hordeolum, chalazion, trachoma, and keratitis); structural disorders (ectropion, entropion, and ptosis).
  • Differentiate chronic open-angle glaucoma, acute closed-angle glaucoma, and secondary glaucoma, identifying at least three nursing considerations for each disorder.
  • Explain the causes and treatments for cataracts.
  • Identify at least two nursing considerations for each of the following types of eye traumas: hematoma, foreign bodies, hyphema, chemical burns, corneal abrasions, and detached retina.
  • Describe inflammatory conditions of the lid, conjunctiva, and cornea with etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis.
  • Compare the nature of cataracts, diabetic retinopathy, retinal detachment, glaucoma, and macular degeneration, and the etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis.
  • Discuss corneal injuries including etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis.
  • List tips for communicating with hearing- and sight-impaired people.
  • Give patient instructions regarding care of the eye and ear in accordance with written protocol.
  • Compare and contrast conductive hearing loss, sensorineural hearing loss, central hearing loss, and functional hearing loss.
  • Discuss noninfectious disorders of the ear, including etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis.
  • Discuss the causes and at least two nursing interventions for each of the following disorders of the external ear: impacted earwax, furuncles, foreign objects, external otitis, fungal infections, and punctured tympanic membrane; and disorders of the middle ear: otitis media, serous otitis media, acute purulent otitis media, and chronic otitis media.
  • Describe the appropriate care of the hearing aid.
  • Describe the care of a client who is to undergo a tympanoplasty and myringotomy with insertion of tympanostomy tubes.
  • Identify communication resources for people with visual and/or hearing impairment.
  • Describe home health considerations for people with eye or ear disorders, surgery, or visual and hearing impairments.
  • Describe the various surgeries of the ear, including the nursing interventions, patient teaching, and prognosis.
  • Discuss at least three nursing considerations for a client with Meniere’s disease.
  • Identify at least two nursing considerations for clients with a tactile, gustatory, or olfactory disorder.
• Respiratory Disorders
  • Differentiate the following Respiratory disorders: Acute asthma, streptococcal throat infectious, influenza, laryngitis, bronchitis, pneumonia, pleurisy, histoplasmosis, tuberculosis, and emphysema.
  • Describe nursing interventions to assist patients with retained pulmonary secretions.
  • Identify signs and symptoms that indicate a patient is experiencing hypoxia.
  • Identify strategies the nurse can teach patients to decrease the risk of infection.
  • Differentiate between tuberculosis infection and tuberculosis.
  • Discuss medications commonly prescribed for the patient with tuberculosis.
  • Discuss the principle of low-flow oxygen required for patients with emphysema.
  • Compare/contrast nursing assessment and interventions for the patient with chronic obstructive pulmonary disease (COPD) and the patient with pneumonia.
  • Discuss nursing interventions for the patient with a laryngectomy.
  • Identify possible nursing diagnoses for the patient with altered respiratory function.
  • Identify nursing interventions relevant to psychosocial concerns of the patient with altered respiratory functions.
  • Discuss risk factors associated with pulmonary emboli.
  • Cardiovascular or Peripheral Vascular Disorders.
  • Discuss the location, size, and position of the heart.
  • Identify the chambers of the heart.
  • List the functions of the chambers of the heart.
  • Identify the valves of the heart and their locations.
  • Discuss the electrical conduction system that causes the cardiac muscle fibers to contract.
  • Explain what produces the two main heart sounds.
  • Trace the path of blood through the coronary circulation.
  • Discuss risk factors in coronary artery disease (CAD), differentiating factors which can be modified and those that cannot.
  • Describe diagnostic tests used to evaluate cardiovascular function.
  • Describe five cardiac dysrhythmias.
  • Compare etiology/pathophysiology, signs and systems, medical management, and nursing interventions for patients with angina pectoris, and myocardial infarction, or heart failure.
  • Specify patient teaching for patients with cardiac dysrhythmias, angina pectoris, myocardial infarction, heart failure, and valvular heart disease.
  • Discuss the signs and symptoms of pulmonary edema.
  • Discuss medical management and nursing interventions for the patient with pulmonary edema.
  • Identify risk factors associated with peripheral vascular system.
  • Describe the effects of aging on the peripheral vascular system.
  • Compare and contrast signs and symptoms associated with arterial and venous disorder.
  • Discuss nursing interventions for arterial and venous disorders.
  • Compare essential (primary) hypertension and secondary hypertension.
  • Discuss the importance of patient education for hypertension.
  • Discuss appropriate patient education for thrombophlebitis.
• Endocrine Disorders
  • Discuss the etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis for patients with acromegaly, gigantism, dwarfism, diabetes insipidus, syndrome of inappropriate antidiuretic hormone (SIADH), hyperthyroidism, hypothyroidism, goiter, thyroid cancer, hyperparathyroidism, hypoparathyroidism, Cushing’s syndrome, and Addison’s disease.
  • Name the common laboratory tests and radiology procedures performed to evaluate functioning of the pituitary, thyroid, parathyroid, and adrenal glands, and pancreas.
  • Explain how to test for Chvostek’s sign, Trousseau’s sign, and carpopedal spasms.
  • Differentiate the four major tests used to test blood glucose levels.
  • Describe the difference between gigantism and acromegaly, and SIADH and diabetes insipidus.
  • Compare and contrast Graves’ disease, cretinism, and myxedema, including at least three nursing considerations for each.
  • List two significant complications that may occur after thyroidectomy.
  • Identify at least five pre- and postoperative nursing considerations for a client who needs a thyroidectomy.
  • Explain the differences between hyperparathyroidism and hypoparathyroidism.
  • Describe the three major adrenal gland disorders: Cushing’s syndrome, primary aldosteronism, and Addison’s disease.
  • Describe the etiology/pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis for patient with diabetes mellitus.
  • Explain the interrelationship of nutrition, exercise, and medication in the control of diabetes mellitus.
  • Discuss the various insulin types and their characteristics.
  • Differentiate between the signs and symptoms of hyperglycemia and hypoglycemia.
  • List five nursing interventions that foster self-care in the activities of daily living of the patient with diabetes mellitus.
  • Discuss the acute and long-term complications of diabetes mellitus.
  • Differentiate among the following type: type 1 and type 2 diabetes mellitus, gestational diabetes, and impaired glucose homeostasis.
  • Compare and contrast hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and nonketotic hyperosmolar state, including causes, signs and symptoms, treatment, and nursing considerations.
  • Identify two examples of macrovascular and microvascular complications of diabetes.
  • Prepare a diabetic client teaching plan that addresses at least ten topics for discussion.
  • Demonstrate the use of a blood glucose monitor in the skills laboratory.
• Gastrointestinal Disorders
  • Describe common diagnostic tests performed on clients with gastrointestinal disorders.
  • Describe nursing measures after liver biopsy.
  • Explain nursing management of clients undergoing diagnostic testing for a gastrointestinal disorder.
  • Discuss assessment findings and treatment of eating disorders, esophageal disorders, and gastric disorders.
  • Describe the nursing management of a client with a nasogastric or gastrointestinal tube or gastrostomy.
  • Identify strategies for relieving upper gastrointestinal discomfort.
  • Discuss the nursing management of clients undergoing gastric surgery.
  • List factors that contribute to constipation and diarrhea and describe nursing management for clients with these problems.
  • Explain the symptoms of irritable bowel syndrome.
  • Contrast Crohn’s disease and ulcerative colitis.
  • Describe the features of appendicitis and peritonitis.
  • Describe nursing management for a client with acute abdominal inflammatory disorders.
  • Describe the nurse’s role as related to care measures for the client with intestinal obstruction.
  • Differentiate between diverticulosis and diverticulitis.
  • Identify factors that contribute to the formation of an abdominal hernia.
  • Discuss nursing management for a client requiring surgical repair of a hernia.
  • Describe warning signs of colorectal cancer.
  • List common problems that accompany anorectal disorders.
  • Explain possible causes of jaundice.
  • List common findings manifested by clients with cirrhosis.
  • Discuss common complications of cirrhosis.
  • Identify the modes of transmission of viral hepatitis.
  • Discuss nursing management for clients with a medically or surgically treated liver disorder.
  • Identify factors that contribute to, signs and symptoms of, and medical treatments for cholecystitis.
  • Name techniques for gallbladder removal.
  • Summarize the nursing management of clients undergoing medical or surgical treatment of a gallbladder disorder.
  • Describe the treatment and nursing management of pancreatitis.
  • Describe the treatment of pancreatic carcinoma.
  • Explain the nursing management of clients undergoing pancreatic surgery.
  • Differentiate between ileostomy and colostomy.
  • Discuss preoperative nursing care of a client undergoing ostomy surgery.
  • List complications associated with ostomy surgery.
  • Discuss postoperative nursing management of a client with an ileostomy.
  • Describe the components used to apply and collect stool from an intestinal ostomy.
  • Cite reasons for changing an ostomy appliance.
  • Explain how stool is released from a continent ileostomy.
  • Describe the two-part procedure needed to create an ileoanal reservoir.
  • Discuss various types of colostomies.
  • Explain ways that clients with descending or sigmoid colostomies may regulate bowel elimination.
• Urinary/Renal Disorders
  • Discuss the purpose and nursing responsibilities related to the common diagnostic tests and procedures performed on the urine, kidneys, ureters, and bladder.
  • Discuss the prevention of and observation for side effects of diuretic therapy.
  • Discuss the treatment and nursing care for urinary incontinence.
  • Describe the treatment and care of acute and chronic glomerulonephritis patient.
  • Identify methods of preventing complications and renal damage in the patient with an infection of the urinary tract.
  • Discuss treatment and nursing interventions for the patient with urinary calculi and methods of preventing their formation.
  • Discuss treatment and care for patients with acute and chronic renal failure.
  • Explain the purpose of dialysis and differentiate between peritoneal dialysis and hemodialysis.
  • Differentiate preoperative and postoperative nursing interventions for patients with the following methods of urinary diversion: cutaneous ureterostomy and ileal conduit.
  • Discuss nursing interventions for diagnostic studies of the urinary system.
  • Identify the nursing responsibilities related to dressings, drains, and urinary drainage tubes after surgery on the urinary tract.
• Reproductive Disorders
  • Discuss the impact of illness on the patient’s sexuality.
  • Describe nursing interventions for patients with menstrual disturbances.
  • Discuss nursing interventions for the patient undergoing diagnostic studies related to the reproductive system.
  • Discuss the importance of the Papanicolaou (Pap) smear test in early detection of cervical cancer.
  • Describe the treatment and care of the patient with pelvic inflammatory disease (PID), endometriosis, and ovarian cancer.
  • Identify the clinical manifestations of a vaginal fistula.
  • Describe the preoperative and postoperative nursing interventions for the patient requiring major surgery of the female reproductive system.
  • Describe the common problems with cystocele, rectocele, and the related medical management and nursing interventions.
  • Discuss surgical approaches for cancer of the breast.
  • Discuss nursing interventions for the patient who has had a modified radical mastectomy, including discharge instruction.
  • Describe nursing interventions for the patient with prostatitis.
  • Distinguish between hydrocele and varicocele.
  • Discuss the importance of monthly testicular self-examination beginning at 15 years of age in males.
  • Discuss patient education related to prevention of sexually transmitted diseases
• Musculoskeletal Disorders
  • Discuss the diagnostic procedures pertinent to musculoskeletal function.
  • Compare methods of assessing circulation, nerve damage, and infection in a patient who has a traumatic insult to the musculoskeletal system.
  • Identify at least four major components of nursing care necessary to protect the client from the hazards of immobilization.
  • Compare the medical regimens for patients suffering from gouty arthritis, rheumatoid arthritis, and osteoarthritis.
  • Describe the nursing interventions appropriate for degenerative joint disease (osteoarthritis and ankylosing spondylitis).
  • List at least four healthy lifestyle measures people can practice to reduce the risk of developing osteoporosis.
  • Describe the surgical intervention for arthritis of the hip and knee.
  • Describe the nursing interventions for the patient undergoing a total hip or knee replacement.
  • Discuss nursing interventions appropriate for a patient with a fractured hip after open reduction with internal fixation (ORIF) and bipolar hip prosthesis (hemiarthroplasty).
  • Discuss at least six important areas of nursing care for the client who has had an amputation and now has a limb prosthesis.
  • Describe the phenomenon of phantom pain.
  • State at least three nursing considerations for clients with temporomandibular joint (TMJ), muscular dystrophy, and osteoporosis.
  • Differentiate between skin traction and skeletal traction, including indications and nursing considerations for each type of traction.
  • List at least two types of skin and skeletal traction.
  • Discuss at least three nursing measures for care of clients with the following treatments: external fixation, ORIF, and arthroplasty.
  • Identify at least nine complications of fractures or bone surgery.
  • Explain the difference between primary and metastatic bone tumors.
  • Discuss the physiology of fracture healing (hematoma, granulation tissue, and callus formation).
  • Describe the signs and symptoms of compartment syndrome.
  • List nursing interventions appropriate for a fat embolism.
  • List four nursing interventions appropriate for bone cancer.
• Integumentary Disorders
  • Identify at least eight types of skin lesions, providing an example of each type.
  • State at least four possible nursing diagnoses for a client with a chronic skin disorder.
  • Relate at least three nursing interventions for the care of a client with pruritus.
  • Discuss the following conditions, including at least two nursing considerations for each condition: acute and chronic skin conditions (urticaria, vitiligo, dermatitis, eczema, and psoriasis); infections (warts, condylomata acuminata, impetigo, and folliculitis); parasitic infestations (scabies, lice, bedbugs); and sebaceous gland disorders (sebaceous cysts, seborrhea, seborrheic dermatitis, and dandruff).
  • Describe at least four types of dressings, four types of topical medications, and the processes of debridement and skin grafting that may be used when treating burns.
  • State the pathophysiology involved in a burn injury.
  • Discuss the stages of burn care with appropriate nursing interventions.
  • Identify the methods used to classify the extent of a burn injury.
  • Identify at least five complications that occur during burn recovery.
  • Discuss at least four nursing considerations during the rehabilitative stage of burn healing.
  • Identify three common nonmalignant and malignant skin lesions.
  • Discuss at least four interventions that can be used to prevent skin cancer.
• Hematologic/Lymphatic Disorders
  • List the common diagnostic tests for evaluation of blood and lymph disorders, and discuss the significance of the results.
  • Apply the nursing process to care of the patient with disorders of the hematological and lymphatic systems.
  • Compare and contrast the different types of anemia in terms of pathophysiology, assessment, medical management, and nursing interventions.
  • Compare and contrast the disorders of coagulation (thrombocytopenia, hemophilia, disseminated intravascular coagulopathy (DIC)) in terms of pathophysiology, assessment, and nursing interventions.
  • Discuss medical management of patients with hemophilia and disseminated intravascular coagulopathy (DIC).
  • List six signs and symptoms associated with hypovolemic shock.
  • Discuss the important aspects that should be presented in patient teaching and home care planning for the patient with pernicious anemia.
  • Discuss the prognosis for patients with acute and chronic leukemia.
  • Discuss the nursing intervention and the patient teaching for the patient with multiple myeloma.
  • Discuss the primary goal of nursing interventions for the patient with lymphedema.
  • Differentiate between Hodgkin’s disease and non-Hodgkin’s lymphomas and related medical management and nursing interventions.
• Cancer
  • Discuss the risk factors for the development of and the warning signs.
  • Discuss development, preventions and detection of cancer.
  • Define the terminology used to describe cellular changes, characteristics of malignant cells, and types of malignancies.
  • Describe the pathophysiology of cancer, including the characteristics of malignant cells and the nature of metastasis.
  • Describe the major categories of chemotherapeutic agents.
  • Describe the process of metastasis.
  • Describe reasons for delay in seeking medical care when diagnosis of cancer is suspected.
  • List common diagnostic test used to identify the presence of cancer.
  • Define the systems of tumor classification: grading and staging.
  • Discuss general guidelines for the use of pain relief measures of the patient with advanced cancer.
  • Describe nursing interventions for the individual undergoing surgery, radiation therapy, chemotherapy, bone marrow or peripheral stem cell transplantation.
• Immune Disorders
  • Differentiate between natural and acquired immunity.
  • Describe mechanisms of immune response.
  • Compare and contrast humoral and cell-mediated immunity.
  • Explain the concepts of immunocompetency, immunodeficiency, and autoimmunity.
  • Discuss factors that influence the development of hypersensitivity.
  • Identify the clinical manifestations of anaphylaxis.
  • Outline the immediate aggressive treatment of systemic anaphylactic reaction.
  • Discuss selection of blood donors, typing and cross-matching, storage, and administration in the prevention of transfusion reaction.
  • Discuss the causation of autoimmune disorders; explain plasmapheresis in the treatment of autoimmune diseases.
  • Explain an immunodeficiency disease.
• Human Immunodeficiency Virus (HIV)/ Autoimmune Deficiency Syndrome (AIDS)
  • Describe the agent that causes HIV.
  • Describe definition of AIDS given by the Centers for Disease Control and Prevention.
  • Explain the difference between HIV infection, HIV Disease, and AIDS.
  • Describe the progression of HIV infection.
  • Discuss how HIV is and is not transmitted.
  • Discuss the pathophysiology of HIV disease.
  • Discuss the laboratory and diagnostic tests related to HIV disease.
  • Describe patients who are at risk for HIV infection.
  • Discuss the nurse’s role in assisting the HIV-infected patient with coping, grieving, reducing anxiety, and minimizing social isolation.
  • Identify signs and symptoms that may be indicative of HIV disease.
  • Identify opportunistic infections associated with advanced HIV and/or AIDS.
  • Discuss treatments and nursing care for the patient with AIDS.
• Care of the Surgical Patient
  • Identify the purposes of surgery.
  • Distinguish among elective, urgent, and emergency surgery.
  • Describe the pre-admission process.
  • Discuss laboratory, diagnostic tests and procedures required during perioperative phase.
  • Discuss factors which influence an individual’s surgical outcome.
  • Discuss considerations for the older surgical patient during the perioperative phases.
  • Discuss the emotional impact of surgery.
  • Describe the care of the client during the pre-operative surgical phase including:
  • Describe the care of the client during the intra-operative surgical phase.
  • Describe the care of the client during the immediate post- operative surgical phase.
  • Describe the care of the client during the later post-operative surgical phase.
  • Discuss the use of pain medication and their effects related to anesthesia.
  • Discuss the nurse’s role in informed consent.
  • Identify medications that are frequently used pre- and post- operatively.
  • Discuss how the client’s daily medications impact surgery.
  • Discuss the complications of anesthesia.
  • Discuss safety as it relates to the surgical patient during the perioperative phases.
  • Discuss the nursing process in care of the postoperative patient.
  • Discuss postoperative discharge criteria.
  • Identify and discuss common complications during the perioperative phases.
  • Describe the stages of the healing process and complications related to the surgical incision.