2016 Adn221l

ASSOCIATE DEGREE NURSING PROGRAM
ADN 221 L
ADULT NURSING CLINICAL
Vangie Howard RN MSN

Mary Livingston RN MSN
Linda McDonald RN MSN
Sandra Peppard RN MSN
FALL 2016
ADN221L Fall 2016
Southwestern College
ADN 221L
TABLE OF CONTENTS
SECTION I
Instructor Information .... 4
Course Description and Outcomes.5
Graduation Competencies. .. 6
Core Values and Curriculum Threads 6
Quality and Safety Education for Nurses(QSEN)
6
Joint Commission Hospital National Patient Safety Goals(NPSG)6
Textbooks and Websites ..... 7
Criteria for Evaluation and Grading 8
How to use On-Campus Lab 9
Essential Nursing Actions . 10
SECTION II Hospital Clinical
Clinical Outcomes/Related Content /Clinical Assignments. 12
Medical/Surgical Clinical Assignments.. 16
Handouts ... 26
SECTION III Home Health and Ambulatory Care Clinicals
Clinical Outcomes/Related Content/Clinical Assignments 32
Home Health/Ambulatory Care Assignments 36
Adult Physical Assessment Handouts.39
Home Health Handouts 45
Ambulatory Care Handouts...53
SECTION IV Psychiatric Clinical
Clinical Outcomes/Related Content/Clinical Assignments 62
Psychiatric Clinical Assignments 66
Data Collection Tool .............78
Southwestern College recommends that students with disabilities or specific learning needs
contact their professors during the first two weeks of class to discuss academic
accommodations. If a student believes that they may have a disability and would like more
information, they are encouraged to contact Disability Support Services (DSS) at (619) 4826512 (voice), (619) 207-4480 (video phone), or email at
DSS@swccd.edu<mailto:DSS@swccd.edu>. Alternate forms of this syllabus and other course
materials are available upon request.
Refer to student handbook for guidelines regarding academic integrity and attendance policy.
Evaluations for this course are completed online at the end of the semester.
ADN221L Fall 2016
SECTION I
ADN221L Fall 2016
Instructor Information
Course Description and Outcomes
Graduation Competencies
Core Values and Curriculum Threads
Quality and Safety Education in Nursing (QSEN)
National Patient Safety Goals (NPSGs)
Textbooks and Websites
Criteria for Evaluation and Grading
How to Use On-Campus Lab
Essential Nursing Actions
Southwestern College
ADN 221L
Instructor Information
Professor:
Office:
Phone:
Cell
E-mail:
Office Hours:
Mary Livingston, RN, MSN

4126
(619) 216-6750 Ext. 4433
619-813-9678
mlivingston@swccd.edu
Monday 1130 1230, 1500 1800
Tuesday by appointment
Wednesday 1600 1700(clinical site)
Thursday by appointment
Friday by appointment
Professor:
Office:
Phone:
Cell
E-mail:
Office Hours:
Linda McDonald, RN, MSN

4401C
(619) 216-6750 Ext. 4439
858-692-4780
lmcdonald@swccd.edu
Monday 1130 1230, 1500 1730
Tuesday By appointment
Wednesday - 1800 1930 (clinical site)
Thursday By appointment
Friday By appointment
Asst. Professor:
Office:
Phone:
Cell:
E-mail:
Office Hours:
Vangie Howard RN, MSN

4401C
(619) 216-6750 Ext. 4434
(858)225-1259
ehoward@swccde.edu
Monday 1400 1630
Tuesday by appointment
Wednesday 1400 1630
Professor:
Office:
Phone:
Cell:
E-mail:
Office Hours:
Sandra Peppard, RN, MSN

4124
(619) 216-6750 Ext. 4412
(619) 992-9891
speppard@swccd.edu
Monday 1130 1230, 1500 1730
Tuesday By appointment
Wednesday 1800 1930 (clinical site)
Thursday By appointment
ADN221L Fall 2016
SOUTHWESTERN COLLEGE
ADN 221L
Course Description and Outcome

Course Description: (5 unit course) ADN 221 L is a companion course for ADN 221. Clinical
sites include medical, surgical, psychiatric inpatient, home health and ambulatory clinics and
community facilities.
Student Learning Outcomes (SLOs):
Upon completion of this course, the student will demonstrate the ability to utilize the nursing
process in provision of care of the adult patient in the medical-surgical and psychiatric setting.
Upon completion of this course, the student will demonstrate the ability to analyze and interpret
data related to the adult patient in the acute care setting.
Course Outcomes: The Student will:
1.
Differentiate and apply principles of psychiatric nursing in the acute inpatient psychiatric
facility with sensitivity to developmental stage and needs of the individual.
2.
Compare and contrast non-therapeutic communication and therapeutic communication

including the use of informatics.
3.
Contrast normal and abnormal EKG and ABG results and compare appropriate course of
action.
4.
Compare and contrast, and evaluate clinical reasoning skills and EBNP in the clinical
setting.
5.
Relate and analyze cultural influences on health behavior and illness.
6.
Compare and contrast principles of safety prior to implementing nursing care.
7.
Differentiate and examine priorities among goals for more than one patient/client.
8.
Examine and modify a written teaching plan as needed for an assigned patient/client and
personnel.
9.
Compare and contrast family and team conferences while participating in formally and
informally.
10. Compare and contrast considerations of cost, quality and opportunities for quality
improvement in the clinical setting.
11. Compare and contrast ethical dilemmas as they occur in the clinical area.
12. Compare and contrast high level wellness behaviors in acute and chronic illness.
13. Examine and modify a self-evaluation, identifying strengths and areas for improvement.
14. Relate and analyze current nursing concepts to interventions in clinical practice.
15. Examine and modify nursing care using developmental theory as it relates through the
lifespan.
16. Differentiate theoretical concepts related to roles of the nurse and apply this information in
the clinical setting.
17. Differentiate and examine quality improvement processes to outcomes as it occurs in the
provision of nursing care to all adult patients/clients.
ADN221L Fall 2016
ADN 221L
Graduate Competencies
Refer to Student Handbook for detailed review of program outcomes and graduate
competencies.
Core Values and Curriculum Thread
These are values the nursing faculty has deemed essential to the practice of nursing and to
this nursing program and are threaded throughout the curriculum.
Conceptual Framework Within The Total Curriculum Process
PROGRAM PHILOSOPHIES AND BELIEFS
Man
Health/Illness
Nursing
Students/Faculty
Education
Man
Environment
Health
Nursing
Bio-psychosocial
Physical
Wellness/Illness
Assessment
Social
Diagnosis
Cultural
Planning
Spiritual
Implementation
Evaluation
CURRICULUM THREADS
Communication
Clinical Reasoning
Cultural Diversity
Health Promotion/Illness Prevention
Lifespan Development
Nursing Theory / Skills
Roles of the Nurse
Safety
Evidence Based Nursing Practice
Quality Improvement
ADN221L Fall 2016
Quality and Safety Education for Nurses(QSEN)

This nursing program follows the principles of (QSEN) which include the following concepts:
Patient-centered Care
Teamwork and Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics
Joint Commission National Patient Safety Goals: Below are the links to the 2015 National
Patient Safety Goals for Ambulatory Health Care, Behavioral Health Care and the Hospital.
http://www.jointcommission.org/standards_information/npsgs.aspx
ADN221L Fall 2016
ADN 221L
Textbooks and Websites

Required Textbooks:
Refer to ADN 221 Syllabus or Student Handbook for more details
Medical/Surgical Text:
Cheever, K. & Hinkle, J. (2013) Brunner & Suddarth's Textbook of Medical-Surgical

Nursing 13th Ed. ISBN/ISSN: 9781451130607
Psychiatric Text:
Videbeck, Sheila L. (2014 Psychiatric Mental Health Nursing, Lippincott, 6th Edition.
Optional Textbooks:
Curren, A.(2010) Dimensional Analysis for Meds, 4th edition, Delmar
Aehlert, B. ( 2011) ECGs Made Easy 5th edition, Elsevier
Websites:
http://www.nami.org/ (National Alliance on Mental Illness)
http://evolve.elsevier.com (textbook resources)
http://www.who.org (World Health Organization)
http://www.qsen.org/ (Quality and Safety Education for Nurses QSEN)
http://www.jointcommission.org (The Joint Commission)
http://www.nursingworld.org (American Nurses Association)
HIPPA 101 (UCSD) www.health.ucsd.edu/compliance_training.shtml
California Board of Registered Nursing www.rnca.gov
National League for Nursing www.nLn.org
Dosage Calculations Refer to ADN 221 Blackboard site.
Medication Information Refer to ADN 221 and ADN 221L Blackboard site.
ADN221L Fall 2016
ADN 221 L
Criteria for Evaluation and Grading

Grading for clinical is Pass/No Pass (15 credit units)
Hours: Campus Skills Lab 15 hrs for 1st two weeks
Clinical Rotation an average of 15 hrs/week rotating through medical surgical, psychiatric and
home health/ambulatory care clinical sites.
DATE
Hospital Rotation
Home Health OR
Ambulatory
Care Rotation
Psychiatric
Rotation
ASSIGNMENT
Journals APA format (Total of 3)

Concept Mapping
Teaching Plan & Presentation APA
formate
Quality Project (QSEN)
Other/Math
Kaplan/Course Point Assignments
Complete each chapter/focus review
and submit proof on the day of the Test
1, 2, 3, & final
POSSIBLE POINTS
15
30
10 + 10
10
Pass/No Pass
Pass/No Pass
Total Points
75
Home Health OR Amb. Care Paper

Self-Reflective Journals (Total of 5)
Other/Math
Kaplan/Course Point AssignmentsComplete each chapter/focus review
and submit proof on the day of the Test
1, 2, 3, & final
50
25
Pass/No Pass
Pass/No Pass
Total Points
75
Interaction Process Analysis

AA Paper/ Other
Journals
Other/Math
Kaplan/Course Point AssignmentsComplete each chapter/focus review
and submit proof on the day of the
Test1, 2, 3, & final
25
25
25
Pass/No Pass
Total Points
ACTUAL POINTS
Pass/No Pass
75
GRADING: All students must achieve at least a 78% average or a total of 56 points on all
assignments in each clinical rotation, and Kaplan/Course Point Assignments. Student must achieve
100% on Math Competencies prior to starting clinical.
ADN221L Fall 2016
WRITTEN ASSIGNMENT: College level English and correct spelling are expected to be used. Written
assignments must be submitted on time, or ZERO points will be earned. In the event of illness or
absence, it is the responsibility of the individual student to contact and speak with the instructor about
the submission of written assignments which may be due. If the student does not follow this
responsibility, the assignments will be considered late and will receive no points.
CLINICAL PREPARATION: Student is expected to read about his/her assigned patients diagnosis
and related nursing care prior to clinical experience.
MATH: All students will be given a math competency the first week of school. Students must achieve a
score of 100%. If a student does not achieve 100%, the student will have the opportunity to remediate
and retake the math competency within a specified time period. If the student does not pass with100%
on 2nd try, a contract will be issued. Students will not be permitted to administer meds during clinical
until they have successfully completed the math competency with 100%. This may result in
unsatisfactory clinical performance. Please refer to student Handbook.
COURSE POINT: After completing the assigned chapter from each lecture topic, you must take the
PrepU quiz from that chapter in Course Point. You must print out proof and that you completed a level
5/6 or higher. All assignments are due at the beginning of the test day in ADN 221 class.
KAPLAN NCLEX PREPARATION/REMEDIATION: For the BEST results, you should review questions
answered correctly to reinforce successful critical thinking and review questions missed to learn from
your mistakes.
ADN221L Fall 2016
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ADN 221 L
HOW TO USE THE ON CAMPUS LAB

EFFECTIVELY AND SATISFACTORILY
Skills are performed according to criteria in the lab, then evaluated by the instructor. If
the criteria is met, the student is checked off and is expected to perform the skill in the
same manner meeting the same criteria in all future care activities. Passing a skill in the
lab makes the student accountable for safe, satisfactory performance of that skill in the
clinical setting.
PREPARATION:
1.
2.
3.
4.
5.
Review syllabus and lab objectives

Note skills to be practiced
Read skills book and competencies for each skill.
View Video
Review Kaplan/Course Point
SCHEDULED LAB PERIODBRING TO LAB:

1.
2.
3.
Module and learning objectives.

Skill book with competencies.
Personal goals for use of lab time.
ACTIVITES IN LAB:
1.
2.
3.
Review and practice skills according to criteria

Seek guidance and feedback from instructor/lab assistant as necessary
Consistently demonstrate appropriate behaviorcooperation with peers in
practice, consideration for others and demonstration of a positive learning
attitude.
ADN221L Fall 2016
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ADN 221 L
ESSENTIAL NURSING ACTIONS COMMON TO ALL NURSING SKILL

PROCEDURES
The following nursing actions are an integral part of every nursing procedure and should be
referred to before reading or practicing any procedure.
1. Check the need for the procedure
2. Make sure that there is a valid order for the procedure if an order is needed.
3. When appropriate, take into consideration the patients preferences and the way the
procedure has been done before.
4. Assemble the equipment needed, paying attention to efficiency and economy.
5. Maintain medical asepsis at all times, with special emphasis on proper hand
washing/universal precautions.
6. Identify the patient.
7. Explain the purpose and nature of the procedure to the patient and/or family. Explain the
patients role and how he/she can help.
8. Protect the privacy of the patient.
9. Use protective body mechanics at all times.
10. Assess the status of the patient before starting the procedure to obtain a baseline for
determining the effectiveness of the procedure.
11. Communicate appropriately with the patient throughout the procedure (seek feedback
about the effect of the procedure, give psychological support, continue an ongoing
nursing history, or teach).
12. Leave the patient comfortable and the unit tidy at the end of the procedure.
13. Take care of equipment in accordance with the nature of the procedure, type of
equipment, and policies of the institution.
14. Report and/or record the outcome of the procedure legibly, promptly, completely, and
accurately.
ADN221L Fall 2016
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SECTION II
Hospital
Clinical Outcomes/Related Content/Clinical Assignment
Medical/Surgical Clinical Assignments
Handouts
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
CLINICAL OUTCOMES
Assessment
1.
Examine and modify
assessment of adult
patients/clients to
determine ability to
maintain essential
functioning.
2.
3.
Compare and contrast

objective and
subjective data from
multiple resources
including the family.

lab value and report
significant changes to
instructor and/or nurse
preceptor.
ADN221L Fall 2016
RELATED CONTENT
CLINICAL ASSIGNMENT
ADN 112 on Assessment
Successfully pass a skills focus

assessment lab prior to
administering medications in
the clinical setting.
ADN 112 on Documentation
Complete a Medical Diagnosis

Card weekly during hospital
rotation
CLINICAL ROTATIONS:
Hospitals
ADN 11 A/ADN 111 B

ADN 221 Reading
Assignments
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ADN 221 L
Medical/Surgical
CLINICAL OUTCOMES
Diagnosis
1.
Differentiate and apply

appropriate nursing
diagnoses
2.

nursing diagnoses.
Planning
1.

prioritization and care for
patients.
2.
Relate and demonstrate

collaboration with others
including families and staff
when planning patients
care.
3.
4.

realistic goals for
patients/clients.
Examine and modify a
health teaching plan for
patient and family.
5.
Relate and analyze cultural

awareness when planning
patient care.
6.
Differentiate and examine

discharge planning.
7.

appropriate referral
agencies for patient/client
& family.
8.

developmental factors
when planning care.
ADN221L Fall 2016
CLINICAL
ASSIGNMENT
RELATED CONTENT
ADN 112 on Nursing Process Complete Nursing Care Plan

(NCP) in Hospital
ADN 112 on nursing

Process, Communication,
Documentation
ADN 112 on
Teaching/Learning/ ADN 221
ADN 112
ADN 221
NCP
Complete Teaching Project

and present to clinical group
in post-conference in
Hospital
ADN 112
ADN 221
ADN 112
ADN 221
ADN 113 Pediatrics
Attend discharge planning

conference in M/S if possible,
noting referral agencies
used. Suggests other
possible referral agencies.
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ADN 221 L
Medical/Surgical
CLINICAL OUTCOMES
RELATED CONTENT
CLINICAL
ASSIGNMENT
Implementation
1. Differentiate and apply safety
principles when delivering
patient care.
ADN 112
ADN 221
2. Differentiate and apply

ADN 112
patient/client care including all ADN 111 A/ 111 B
medications. IVs and
Pharmacology
treatments completed in a safe
and organized manner.
ADN 112
3. Examine and modify
ADN 221
theoretical knowledge to
patient care.
ADN 112
therapeutic communication
principles to patient, families
and staff.
5. Documents all intervention
using a variety of charting
methods.
NCP
Delivers total pt. care to

2-3 patients in the
hospital including
medications and
treatments.
ADN 112 on Documentation
Completes Charting all

Patients
ADN 112 on Nursing Process
Completes Charting all

Patients
Evaluation
1.

patients outcomes to nursing
interventions.
ADN 112
ADN 114
2.
Examine and modify goal

attainment and revises care
as needed.
ADN 113 Pediatrics
3.
Evaluates self-based on
clinical goals.
ADN221L Fall 2016
NCP
Complete Self-evaluation
at beginning of each
clinical rotation
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ADN 221 L
Medical/Surgical
CLINICAL
OUTCOMES
Manager of Care
RELATED
CONTENT
CLINICAL ASSIGNMENT
1. Relate and demonstrate

care for a minimum of (2)
patients
ADN 112
ADN 221
Makes own patient assignment

taking a minimum of 2 pts in
Medical/Surgical
2. Relate and demonstrate

ability to work as part of
the team as a team
leader for a group of
patients.
ADN 112
ADN 114
Oversees care on 4-5

patients/clients in M/S
3. Compare and contrast

costs and quality
considerations when
delivering care.
ADN 112
Reports and discusses costs

and quality considerations in
Medical/Surgical Nursing
ADN 112
ADN 114
Makes assignment for 1-2 other

students and supervises them
and patient care appropriately.
2. Develop a teaching
project.
ADN 112

delegation styles
ADN 112
Conducts a teaching project

that may include clinical facility
staff.
Delegates to CNA and peers
when needed.
Delegation and
Supervision
1. Differentiate and
examine assignments for
peers while providing
positive and negative
feedback.
Interdependence
ability to interact with
multi-disciplinary team.
2. Evaluates peers
informally.
Member Within Discipline
1. Identifies own strengths
and weaknesses, and
identifies goals for
clinical.
ADN221L Fall 2016
ADN 112
ADN 112
ADN 114
ADN 112
ADN 114
Participates in discharge
planning conferences, patient
care conferences and teaching
project.
Evaluates peers during clinical.
Completes a self-evaluation
prior to each clinical rotation.
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ADN221L Fall 2016
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ADN 221 L Medical/Surgical (Hospital)

Assignments
Reflective Journal APA format (15 pts.)

(Due date determined by your clinical instructor)
MS clinical instructor
Due on Monday at 0900
Concept Care Mapping (30 pts.)

Teaching Plan (10 pts.) & Presentation (10 pts.)

QSEN, Quality Improvement Project (10 pts)

Four Hours of Community Service(Pass/No Pass)

(Turn in documentation proof to your clinical instructor using form on Blackboard)
Kaplan/Course Point Assignments (Pass/No Pass)

Achieve a level 5/6 or higher on Course Point on each
chapter per lecture topic.
(Complete each chapters/focus review and submit proof on the day of the Test 1, 2, 3, & final)
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
REFLECTIVE JOURNAL
(3 journals at 5 points each)
Requirements: Mandatory
Due:
Weekly while in the clinical setting unless otherwise directed by your

clinical instructor.
PURPOSE: This assignment is formatted to help you increase your learning

ability, improve communication and critical thinking skills and to
foster personal growth.
This is an introspective assignment in which you record your thoughts,
feelings and experiences related to your clinical experience of the past
week. It is hoped that both you and your instructor gain insight into your
experiences in the clinical setting. The insight gained may help both you
and your instructor in facilitating your clinical experiences to best meet your
needs. It also allows for a noncritical dialogue between and your instructor
about your clinical experience.
1)
FORMAT: A Triangle. The journal will be typed on paper that can be

handed in or e-mailed weekly for review. Structure your entries to reflect
on your (1) personal and professional life as a student nurse, (2) reflect on
classroom and clinical experience highlighting the caring aspect of your
role as a student nurse, and (3) reflect on your readings and assignments.
The journal entries will be in APA format and should be two (2) pages in
length and double spaced. The journal must include a minimum of two
evidence based nursing articles written within the five (5) years to support
your observations.
#3
#1
ADN221L Fall 2016
#2
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ADN 221 L
Medical/Surgical
CONCEPT CARE MAP

The Nursing Process Mapping format is a tool to allow you to think critically about patient care and organize
your thoughts and actions through a creative process. Mapping is to be completed on a patient/client in your
clinical setting. Your finished format will vary tremendously in format and terminology each time, but it must
reflect thought and insight needed to care for patient. The following examples are provided but use your
imagination and create a map that is unique. Zero points for late assignments.
Create a Map (see grading criteria)

Oral Presentation of Care Map
in Post-Conference
TOTAL
25 points
+ 5 points
30 POINTS
CONCEPT CARE MAP (30 PTS.)
Figure 3. Preparatory mini mind-mapped care plan. ON this particular map, octagon = signs/symptoms; oval = nursing diagnosis;
rectangle = nursing actions; hearth = patient determined outcome.
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
Critical Strategies for Concept Care Map

1. Place the patient at the center of the concept map. It is critical to have the patient at the center of the
map, this helps you to always focus on the patient and not on the illness or primary diagnosis. Focusing on
the patient moves you away from the medical model toward a nursing model of care.
2. Designate an area of the concept map to focus on patient optimal functioning. To further move your
thinking toward nursing and away from an exclusive emphasis on diagnosis, you are required to include
two perspectives of outcomes. These perspectives include what the nurse sees as patient/client optimal
functioning and what the client sees as his optimal functioning given his current condition.
3. Use standardized color coding to identify parts of the nursing process. The use of color coding
enables both students and faculty to see at a glance all components of the nursing process. It facilitates
both learning and evaluation. The idea of red for danger, yellow for think and green for move is used as
part of the color coding system. Highlighters or colored pens are the most common tools students use. This
translates as:
Red: expected signs and symptoms R/T each nursing diagnoses/collaborative

problems. (3 pts.)
Yellow: nursing diagnoses/collaborative problems (list 3) (1 pts.)
Green: nursing orders/ interventions/ actions; (List at least 4 for nursing diagnosis)
(9pts.)
Black: outcomes for each nursing diagnosis/collaborative problem; (1 short term and 1
long term goal for each nursing diagnosis). (6 pts.)
Blue: optimal functioning outcomes identified by the client (1 pts.)
Overall Presentation (4 pts.)
Oral presentation (5 pts.)
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
Concept Care Map

When creating the comprehensive mapped plan of nursing care, you should identify all aspects of the
patients care needs after caring for the patient. This map should include all assessed and observed
data related to the patient; this includes diagnostic tests, lab results, and medications, as well as all
nursing care. In addition, you must identify the patients optimal functioning as seen by the nurse as
well as what the patient wants as her/his optimal functioning in relation to the illness. These maps are
large enough that they are often written on poster paper. Learning related to mapping is enhanced as
you present your comprehensive mind-mapped nursing care plans to your clinical group in postconference. By going over the mind map, you will explain your thinking to the group. An additional
advantage is to see how others might think and problem solve differently. While having the same
critical components, two students mind maps on the same patient would look very different
depending on how each student related to the patient, what data was collected, and how each saw
the whole picture. Each care plan is creatively unique in connections and overall look. This is not true
of the traditional care plan.
Pit falls for Concept Care Map
The art of learning mind mapping is not without its drawbacks. Mapping by its very definition
implies that there is more than one way to make connections. Students who have been socialized into
thinking there is only one right way of doing things have a difficult time creating their own maps.
Maps are a reflection of the manner in which students, as individuals, categorize and connect
concepts related to patient care. The uniqueness of connections can be demonstrated by eliciting
alternative ideas during the generic mapping of a camping trip. By asking other students where they
would hook the information, students see how others link the same idea.
While mind mapping can be a dynamic learning strategy for many, it can be a real challenge
for students who think in a very linear manner. These students often perceive mapping as chaotic. As
long as the connections the students has made reflect the interconnectedness of the nursing care
plan pieces, the style will be accepted.
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
CONCEPT CARE MAP GRADING CRITERIA

30 points total
Nursing Diagnosis. (3) (Each Diagnosis worth pt.)

Total Pts. 1.5
Yellow
Signs & Symptoms. (Includes labs, diagnostic tests, etc. R/T

each nursing diagnosis) Total pts. 3
Red
Interventionsat least 4 for each nursing diagnosis

Total pts. 9
Green
Outcomes:
1 Short term goal for each nursing diagnosis
Total pts. 3
Black
1 Long term goal for each nursing diagnosis

Total pts. 3
Black
Optimal functioning outcomes for each problem ( pt. each)

Total pts. 1.5
Blue
Overall Presentation (how it looks, use of color, following guidelines)

Total pts. 4
Oral Presentation in post conference.

Total pts. 5
_______________________
Total: Max is 30 points
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
TEACHING PLAN with Grading Criteria

(10 Points Total Due with Hospital/Rotation)
(The teaching is on a subject of your choice that you present to a patient/client, friend or peer.)
STUDENT: _______________________________________________
______________
Date of Teaching
WHO DID YOU TEACH?:____________________________________ AGE (s) ___________
DIAGNOSIS: ________________________________________________________________
RATIONALE FOR TEACHING PLAN (1 pt.) ________________________________________
___________________________________________________________________________
Learning Objectives for Patient/ Client/Community/ Staff/ Other (3 pts.)
1.
2.
3.
CONTENT OF TEACHING PLAN (2 pts.)
TECHNIQUES/METHODS
USED TO TEACH CONTENT (1 pt.)
Evaluation of Plan (3 pts.) (Self evaluation of how the teaching went and was each objective met?) ___________
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
TEACHING PRESENTATION with Grading Criteria

10 PTS. TOTAL
(To be presented in post-conference. Please present this grading form to your clinical instructor prior
to your presentation.)
Report should include diagnosis definition, Etiology, diagnostic tests, clinical manifestations or Signs
& Symptoms, complications, prognosis, nursing interventions, and related nursing diagnoses.
DATE: _______________________________
NAME: _______________________________
TOPIC: _______________________________
Presentation Skills: (1 point each)
1. Eye Contact
2. Voice Projection
3. General Style (appearance, distracting movements)
Content & Organizations: (1 point each)
4. Introduction
5. Objectives/Outline (Handout)
6. Depth of Knowledge
7. Accuracy of Content
8. Flow of Presentation
9. Audience Involvement/ Handouts used
10. Closure Q & A
COMMENTS:
TOTAL SCORE out of 10: _________________
ADN221L Fall 2016
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ADN 221 L
Medical/Surgical
Quality and Safety Education for Nurses (QSEN)

Quality Improvement Project (10 points)
Upon competition of this activity the students will be able to:
1. Review the website: qsen.org for the QSEN competencies. The following are QSEN Competencies.
Quality Improvement (QI): Use data to monitor the outcomes of care processes and use
improvement methods to design and test changes to continuously improve the quality and safety
of healthcare systems.
Safety: Minimize risk of harm to patients and providers through both system effectiveness and
individual performance.
Teamwork and Collaboration: Function effectively within nursing and interprofessional teams,
fostering open communication, mutual respect, and shared decision-making to achieve quality
patient care.
Patient-centered Care: Recognize the patient or designee as the source of control and full
partner in providing compassionate and coordinated care based on respect for patients
preferences, values, and needs.
Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and
patient/family preferences and values for delivery of optimal health care.
Informatics: Use information and technology to communicate, manage knowledge, mitigate
While at clinical, you will identify a clinical problem on the nursing unit by using one of the QSEN
competencies (see examples below). The student will individually prepare and write a reflective journal
emphasizing best practices in your clinical area. The journal should be written in an APA format and
should be two (2) pages in length and double spaced. The journal must include a minimum of two
evidence based nursing articles written within the 5 years. The QSEN project will also be presented in
post-conference.
Examples:
Pain Assessment and Management

Fall preventions
Medication errors
Communication -SBAR (Situation, Background, Assessment, Recommendation)
Types of Alarms - clinical
Hand hygiene
HIPPA and safety of patient information
EMR (Electronic Medical Record) and bar coding scanning
Braden scale
Preventing pressure ulcers and turning practices
QSEN Grading Grid

Topic is a QSEN competency and pertinent for clinical area
Presents Topic in a logical manner, 2 pages in length
APA format followed
Grammar and Spelling
ADN221L Fall 2016
Points
1
7
1
1
27
Four Hours of Community Service

Complete forms posted on Blackboard
ADN221L Fall 2016
28
ADN 221 L
Medical/Surgical
Collecting Data for Patient Care

On a separate sheet of paper, answer the following:
1.
Patient information:
Age:
Reason for admission:
Date of admission:
Diagnostic Procedures:
Surgical procedure:
Diet:
Activity:
2.
Medications:
Drug:
Reason why it was prescribed:
Therapeutic effects expected:
Adverse effects to monitor:
(Complete for all medications prescribed.)
3. Patient history:
Important information from history:
From the history, the most important data impacting this hospitalization is:
4. Diagnostic tests:
Name of test:
Why was this test ordered?
(Complete for each test ordered.)
5. Problems occurring for this patient during the preceding 24 hours:
How were the above problems handled?
6. Was the physician called for any reason? If so, why?
What information was gathered prior to notifying the physician?
What actions were taken?
7.
Potential problems that could occur for this patient:
Interventions to prevent the potential problems:
8. Look at the patients nursing care plan:
List the nursing diagnoses:
Prioritize the nursing diagnoses:
How did you determine the order of prioritization of the nursing diagnoses?
What are the interventions for the top two nursing diagnoses?
Prioritize those interventions:
Which of these interventions can be delegated and to whom?
9.
Look at the shift report sheets for the past 24 hours. Based on those report sheets,
what is the MOST IMPORTANT nursing intervention for you to carry out this
shift?
10.
If the physician came in at this moment and discharged this patient, what are the most
important teaching instructions for this patient?
11. What if
ADN221L Fall 2016
29
ADN 221 L
Medical/Surgical
COMMONLY USED DRUGS

Know the purpose and side-effects of the following drugs: Complete before clinical.
(1)
Morphine
(2)
Monistat (miconazole nitrate)
(3)
Prednisone
(4)
Garamycin (gentamicin sulfate)
(5)
Rifadin (rifampin)
(6)
INH (isoniazide)
(7)
Clinoril (sulindac)
(8)
Catapres (clonidine hydrochloride)
(9)
HydroDiuril (hydrochlorothiazide)
(10) Procardia (nifedipine)
(11) Lidocaine (Xylocaine)
(12) Quinidine Sulfate
(13) Orinase (tolbutamide)
(14) Insulin--Long Acting
--Short Acting
(15) Folic Acid
(16) Prolixin (fluphenazine hydrochloride)
(17) Haldol (haloperidol)
(18) Neupogen (filgrastim)
(19) Amethopterin (methotrexate)
(20) Calcium Folenate (leucovorin calcium)
(21) Cytoxan (cyclophosphamide)
(22) Xanax (alprazolam)
(23) Robaxin (methocarbamol)
(24) Dalmane (flurazepam)
(25) Dilantin (phenytoin)
(26) Epogen (erythropoietin)
(27) Indocin (Indomethacin)
(28) Digoxin (Lanoxin)
(29) Thorazine (Chlorpromazine hydrochloride)
(30) Additional drugs per individual unit assigned.
ADN221L Fall 2016
30
ADN 221 L
Medical/Surgical
ASSESSMENT PERSON
If you cannot get the habit of observation one way or another, you had better give up the idea of
being a nurse, for it is not your calling, however kind and anxious you may be.
--Florence Nightingale
STUDENT NAME
DATE _______________
PT INIT
RM#
ADN221L Fall 2016
SEX
AGE
MEDICAL DX ____________________
31
Report/Plan of Care Student:___________________________________________________ Date: __________

Patient:
Age/Sex:
Room:
Admit Date:
Situation (chief complaint/dx):
Attending MD:
Consulting MDs:
Background (history):
Allergies:
Code Status:
Isolation:
Fall Risk:
Vaccinations: PNA Flu Core measure: CHF Stroke PNA
Report
Assessment
VS:
VS:
Neuro:
Pain/Meds:
Psyc/Social/Spiritual:
Neuro:
Pain/Meds:
Cardiac:
Tele:
Respiratory:
O2:
GI:
Diet:
LBM:
GU:
Cardiac:
Tele:
Resp:
O2
GI:
Diet:
LBM:
GU:
Musculoskeletal:
ADLs:
IV:
Fluids/ I&O:
Tubes:
Musculoskeletal:
ADLs:
IV:
Fluids/ I&O:
Tubes:
Skin:
Wounds:
Skin:
Wounds:
Labs/Diagnostics:
BS 0800_____ 1300 _____ 1730 ______ HgbA1c
H/H
RBC
BUN/Cr
Meds: 07
WBC
Na+
08
09
10
ADN221L Fall 2016
11
PT/INR
K+
12
13
14
Troponin/BnP:
Ca+
15
16
17
Mg+
18
19 prn:
32
Recommend:
(plan, new orders, 4Ps)
ADN221L Fall 2016
33
Report/Plan of Care Student: ____________________ Date: __________

Patient:
Age/Sex:
Age/Sex:
Patient:
Room:
Admit Date:
Attending MD:
Situation
(diagnoses):
Admit Date:
Room:
Consulting MD:
Code Status:
Patient:
Age/Sex:
Admit Date:
Attending MD:
Consulting MD:
Situation (diagnoses):
Background
(history):
Situation
(diagnoses):
Background (history):
Allergies:
B Background (history):
Code Status:
Allergies:
Code Status:
Isolation:
Fall Risk:
Isolation:
Fall Risk:
Vaccinations: PNA Flu Core Measure: CHF Stroke PNA

Report
VS:
Assessment
VS:
Vaccinations: PNA Flu Core Measure: CHF Stroke PNA

Report
VS:
Assessment
VS:
Neuro:
Neuro:
Cardiac:
Cardiac:
Respiratory:
Respiratory:
GI:
GI:
DIET:
DIET:
GU:
GU:
Musculoskeletal:
Musculoskeletal:
ADLs:
ADLs:
IV:
IV:
Fluids / I&O
Fluids / I&O
Tubes:
Tubes:
Skin:
Skin:
Wounds:
Wounds:
MEDS: 07 08 09 10 11 12 13 14 15 16 17 18
Labs/Diagnostics:
H/H
Room:
prn:
MEDS: 07 08 09 10 11 12 13 14 15 16 17 18
BS 08 _____ 12_____ 18_____ __ _____
RBC
BUN/Cr
Recommend:
ADN221L Fall 2016
WBC
Na+
PT/INR
K+
Labs/Diagnostics:
H/H
Ca+
prn:
BS 08 _____ 12_____ 18_____ __ _____
RBC
WBC
BUN/Cr
Na+
Recommend:
34
PT/INR
K+
Ca+
SECTION III
HOME HEALTH AND AMBULATORY CARE

CLINICAL OUTCOMES/RELATED CONTENT/CLINICAL
ASSIGNMENT
CLINICAL ASSIGNMENT CRITERIA
HANDOUTS
ADN221L Fall 2016
35
ADN 221 L
HOME HEALTH/AMBULATORY CARE CLINICS
CLINICAL OUTCOMES
RELATED CONTENT
CLINICAL ASSIGNMENT
ASSESSMENT
1.

assessment needs of patients
to determine ability to maintain
essential functioning.
ADN 221 Assessment
Perform a Complete Client

Assessment
ADN 112 on Assessment

and Documentation
Completing an Intake
Assessment
2. Explain how to obtain an intake

assessment on clients.
Assist in Admitting Patients to

the Clinic and to Home Health
3. Relate and demonstrate how to

admit a patient
DIAGNOSIS

appropriate nursing
diagnoses.
ADN 112 on Nursing

Process
Discuss in journals and postconferences
ADN 112 on Nursing

Process, Communication
ADN 221 on
Communication
Prioritizes Patients to be seen

first in Clinic and in Home
Health
2. Differentiates and applies the

prioritization of nursing
diagnoses
PLANNING
1. Differentiates and applies the
prioritization of care for clients.
2. Differentiate and examine
collaboration with family by
members and interdisciplinary
staff when planning clients care.
3. Relates and demonstrates
realistic goals for clients while
involving families/or significant
other
4. Compare and contrast a Health
Teaching Plan for a client in
Home Health including the
family and/or significant other.
Develop a Health Teaching Plan
for a patient and family in the
clinic
5. Relates and analyzes Cultural
Awareness when planning
clients care
6. Participates in Discharge
Planning
7. Differentiate and examine
appropriate referral agencies for
family and client.
8. Includes Development Factors
ADN221L Fall 2016
Charting and updating NCP

ADN 112 on Nursing
Process
ADN 112 on
Teaching/Learning
Home Health Paper

Ambulatory Care Paper
Attend Discharge Planning

conference in Home Health
ADN 112
ADN 112
ADN 112
ADN 113
Pediatrics
Discharges patients in the

Clinic.
Refers Clients to Appropriate
Agencies
Charting
Refers patients for appropriate
follow up
36
when planning care.
ADN 221 L
CLINICAL OUTCOMES
RELATED CONTENT
CLINICAL ASSIGNMENT
IMPLEMENTATION
1. Applies Safety Principles when
delivering client/patients care.
ADN 112
ADN 111A/111B
Pharmacology
ADN 221
2. Differentiate and apply nursing
ADN 112
ADN 221
procedures specifically performed in

the Home Health Care
setting/Ambulatory Care Clients.

Theoretical knowledge to clients/ care
(Patient)

Therapeutic Communication
Principles to clients/patients and their
families
Delivers safe client/patient care

including Medications, IVs, and
treatments.
Completes Home Health Paper

OR Ambulatory Care Paper
ADN 112
ADN 221
ADN 112
ADN 221
DIAGNOSIS
appropriate nursing diagnoses.
ADN221L Fall 2016
ADN 112 on Nursing Process
Reflective in Journals
37
ADN 221 L
CLINICAL OUTCOMES
2. Compare and contrast Safety
Principles when delivering
client/patients care.
RELATED CONTENT
CLINICAL ASSIGNMENT
ADN 112
ADN 114
Completes Self-evaluation at
beginning of Each Clinical
Rotation
3. Evaluates Self Based on Clinical

Goals.
MANAGER OF CARE
1. Delivers care for 3-5 clients each
day in home health/hospice.
Delivers care for 8-15 patients each
day in the clinic.
2. Differentiate and examine Costs
and Quality considerations
when delivery care and how cost
containment has changed Health
Care Delivery
3. Differentiate and apply Roles of the
nurses in Home Health
Agencies/Ambulatory Care Clinics
4. Compare and contrast concerns
about Payment for Health Care in
Home Health or in the Clinics.
5. Compare and contrast types of
Clients Qualified for Home
Health Care or to be seen in
the Clinics
ADN221L Fall 2016
ADN 112, ADN
Obtains Client Assignments

day of Home Health Rotation
ADN 112
ADN 112
ADN 112
ADN 112
Reports Costs and Quality

considerations in Home
Health and Ambulatory Care
Paper
Home Health Paper
Home Health Paper
Home Health Paper
38
ADN 221 L
CLINICAL OUTCOMES
RELATED CONTENT
CLINICAL ASSIGNMENT
DELEGATION AND SUPERVISION

1. Relate adn demonstrate appropriate
delegation techniques
ADN 112
Delegates to Home Health

Aids when necessary and to
Medical Assistant in clinics.
Delegates to Assistance
Personnel when necessary.
INTERDEPENDENCE
1. Relate and demonstrate interaction
with Multi-disciplinary Team.
ADN 112
Participates in Discharge
Planning Conferences, patient
Care Conferences and
informal teaching.
Coordinates Patient Care with
Staff
MEMBER WITHIN DISCIPLINE
1. Differentiate and examine own

Strength and Weaknesses, and
Areas for Self Growth
ADN221L Fall 2016
ADN 112, ADN 114
Completes a Self-evaluation
at beginning of rotation and at
the end to determine growth.
39
ADN 221L Home Health/Ambulatory

Care Assignments
Home Health or Ambulatory

Care Paper (50 pts.)
Self Reflective Journals (25 pts.)

(Total of 5due dates TBD)
Kaplan/Course Point Assignments

(Pass/No Pass)
ADN221L Fall 2016
40
ADN 221 L
HOME HEALTH PAPER ASSIGNMENT
(50 points Due with Home Health Rotation)
Complete either home health or ambulatory care paper based on your clinical rotation. Five points will be
deducted for each day the paper is late. Write a two page paper (no more and no less), following basic APA
format Refer to Student Handbook for APA guidelines. The paper should include at least 2 references and should
address the following objectives:
7 pts.
1.
Identify how home health differs from traditional hospital nursing.
6 pts.
2.
Distinguish roles of the multi-disciplinary home care team as it relates to the

home care delivery system.
7 pts.
3.
Identify common nursing procedures performed in home health including health

teachings provided to the client and family members.
4 pts.
4.
Identify the type of clients qualified for home health care.
5 pts.
5.
Explain how to obtain an intake assessment on clients.
5 pts.
6.
Identify concerns and issues about payments and reimbursement practices in

home health.
6 pts.
7.
Discuss pros and cons of the home health care delivery system.
5 pts.
8.
APA FORMAT (Refer to Student Handbook)/References
5 pts.
9.
Grammar/Composition
AMBULATORY CARE PAPER ASSIGNMENT

(50 points Due with Ambulatory Care Rotation)
Refer to instructions above. Your paper should address the following objectives.
7 pts.
1.
Identify how Ambulatory Care differs from traditional hospital nursing.
6 pts.
2.
Distinguish roles of the multi-disciplinary team in the Ambulatory Care setting.
7 pts.
3.
Identify common nursing procedures including procedures including health

teaching that is provided.
4 pts.
4.
Identify the type of clients qualified for Ambulatory Care delivery system.
5 pts.
5.
Explain how to obtain an assessment for clients entering an Ambulatory Care

setting and the cost per visit.
5 pts.
6.
Discuss pros and cons of the Ambulatory Care delivery system.
6 pts.
7.
Explain how cost containment has changed health care delivery.
5 pts.
8.
APA FORMAT (Refer to Student Handbook)/References
5 pts.
9.
Grammar/Composition
ADN 221L
ADN221L Fall 2016
41
Self Reflective Journal

(25 Points Total)
PURPOSE
Self-reflection on clinical practice is valuable because it challenges one to think in new ways.
Research shows self-reflection can lead to enhanced clinical performance.
DUE
One entry typed and doubled spaced is due each week you are at the clinical site. You must e-mail
the paper to the instructor at a mutually agreed upon time. A total of 5 entries are due in the
rotation, each worth 5 pts.
FORMAT
A one to two page double-spaced entry of one clinical event written at an academic level will be due
weekly. Choose one concept and reflect on a situation that occurred in clinical practice. Include how
the situation actually occurred and how the situation could be changed in the future for improved
practice. In the past students have written on concepts such as caring, accountability, physical
assessment, communication, medication administration, time management, legal or ethical situations,
or teaching. You do not have to limit your report to these topics, but it must be an area relevant to
nursing practice and it must be written in a professional manner.
To complete this assignment please make sure you write about only ONE concept. Write the concept
on title of paper at the top of the page. If you have questions about the suitability of your concept
please check with the clinical instructor prior to completing this assignment.
ADN221L Fall 2016
42
ADN 221 L

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Age:
Date of admission:
Surgical procedure:
Diet:
Activity:
Medications:
Drug:
Patient history:
Diagnostic tests:
Name of test:
Problems occurring for this patient during the preceding 24 hours:
Was the physician called for any reason? If so, why?
Look at the patients nursing care plan:
Look at the shift report sheets for the past 24 hours. Based on report sheets, what is
the MOST IMPORTANT nursing intervention for you to carry out this shift?
If the physician came in at this moment and discharged this patient, what are the most
What if
ADN221L Fall 2016
43
ADN 221 L
ADULT PHYSICAL ASSESSMENT

CARDIAC
I.
ANATOMY AND PHYSIOLOGY

A. Location of heart inside chest
B.
Cardiac chambers R atrium, R ventricle, L atrium, L ventricle
C.
Valves Tricuspid, Pulmonic, Mitral, Aortic
D.
Cardiac cycle
1. Systole ventricular contraction
rapid rise in pressure. Aortic and pulmonic valves open.
2. Diastole Ventricular relaxation. Pressure falls almost to zero. Aortic &
pulmonic valves closed. Mitral and tricuspid valves open.
E.
Heart sounds 1. S1 onset of systole. Closure of both mitral and tricuspid valves.
2. S2 onset of diastole. Closure of both aortic and pulmonic valves.
Murmurs intensity
2. Grade 1 very faint only heard after listener has tuned in.
3. Grade 2 quiet but heard immediately with putting stethoscope on chest.
4. Grade 3 moderately loud
5. Grade 4 loud
6. Grade 5 very loud, may be heard with stethoscope partly off chest
7. Grade 6 may be heard with stethoscope entirely off chest
8. Pitch high, medium or low
9. Quality blowing, rumbling, harsh, or musical
Timing of murmurs
1. Systolic aortic or pulmonary stenosis, or mitral insufficiency
2. Diastolic aortic or pulmonary insufficiency or mitral stenosis
ADN221L Fall 2016
44
ADN 221 L
ABDOMEN
I. ANATOMY
A.
Landmarks costal margins, umbilicus, iliac crests, pubic bone, inguinal ligament.
B.
Quadrants RUQ, LUQ, RLQ, LLQ, Epigastric, umbilical, suprapubic
C.
Organs
1. RUQ liver, gallbladder, right kidney, pancreas, duodenum, hepatic flexure of
colon.
2. LUQ spleen, stomach, left kidney, pancreas, splenic flexure of colon.
3. RLQ large and small intestines, right ovary, cecum and appendix.
4. LLQ sigmoid colon, left ovary and tube.
5. Suprapubic bladder, uterus
II. EXAMINATION
A.
Inspection Skin lesions, scars, rashes
Umbilicus hernia, Contour rounded, protuberant, scaphoid, Masses, peristalsis,
pulsations, fluid (ascities)
B.
Auscultation listen for bowel sounds, bruits
C.
Percussion Check all four areas. Percuss liver and spleen.
D.
Palpation Feel in all four quadrants - check for masses, tender areas.
Check kidneys, liver, aorta, spleen
EVALUATING ABDOMINAL PAIN
I. HISTORY
A. Where is it?
1. Upper abdomen stomach, duodenum, liver, pancreas, biliary, abdominal
wall
2. Mid-abdomen jejunum, ileum
3. Hypogastrium colon, kidney, ureter, female organs
4. Subcostal abdominal wall, biliary, liver
B.
Does it spread?
1. Shoulder liver, gallbladder
2. Back duodenum, biliary, pancreas
3. Substernal esophagus
C.
What does it feel like?

1. Burning, gnawing, hunger-like peptic ulcer
2. Cramping intestinal obstruction
3. Squeezing biliary colic
D.
When does it occur?

1. After meals (1-3 hours) peptic ulcer
2. Night duodenal ulcer (2-4 a.m.), biliary, pancreas
3. Before BM IBS
4. With menses IBS, uterine disease
How long does it last?
1. 1-few hours biliary
2. Usually less than 1 hour peptic ulcer
E.
ADN221L Fall 2016
45
F.
How often does it occur?

1. Every few weeks, years biliary, peptic ulcer
2. All the time abdominal wall, cancer, functional
G.
What makes it better?

1. Food peptic ulcer
2. Bowel movement IBS
3. Change in position abdominal wall, pancreatic
H.
What makes it worse?

1. Food IBS, pancreatic
2. Twisting, stretching abdominal wall
3. Stress IBS
I.
What other signs/symptoms?

1. Anorexia, weight loss cancer
2. Nausea, vomiting biliary, ureteral, peptic ulcer, non-ulcer dyspepsia
3. Diarrhea IBS, gastroenteritis
4. Constipation IBS
5. Hematuria ureteral
6. Jaundice biliary, pancreatic
7. Dyspareunia gynecologic disorder, IBS
J.
What substances are used?

1. NSAIDs peptic ulcer
2. Alcohol peptic ulcer, pancreatitis
3. Tobacco peptic ulcer
K.
Is there a family history? peptic ulcer, gallstones
L.
Past & present psychosocial history?

1. Childhood abuse IBS, chronic pelvic pain
2. Anxiety, depression - IBS, chronic pelvic pain
II. PHYSICAL EXAMINATION
A. Tenderness location
1. Generalized - gastroenteritis
2. Epigastric stomach, duodenum
3. RUQ gallbladder, liver, abdominal wall
4. LLQ (rope-like sigmoid) IBS
5. Costal margin abdominal wall
6. Small area abdominal wall
B. Tenderness unimproved/worsened by abdominal muscle contraction
1. Yes abdominal wall
C. Mass cancer, diverticulitis, Crohns disease
ADN221L Fall 2016
46
REVIEW of SYSTEMS (subjective information)

A.
SKIN:
Color or pigment changes, eruptions, itching, scaling, bruising, bleeding.
HAIR:
Color or texture change, loss of growth, distribution changes.
NAILS: Change in color or brittleness, pitting, curving, thickening.

B.
LYMPH: Enlargement, pain, draining.
C.
BONES/JOINTS/MUSCLES:
Fracture, dislocation, sprain, arthritis, myositis, pain, swelling, stiffness, distribution,
degree of disability, muscular weakness, wasting or atrophy, or nocturnal cramping.
D.
HEMATOPOIETIC:
Anemia (type, treatment and response), lymphadenopathy, bleeding (spontaneous,
traumatic or familiar).
E.
ENDOCRINE:
Hx of growth, weight change, goiter, exophthalmos, dryness of skin, heat or cold
intolerance, tremor, polyphagia, polydipsia, polyuria, impotence, sterility.
F.
ALLERGIC:
Dermatitis, urticaria, angioneurotic edema, eczema, hay fever, vasomotor, rhinitis,
asthma, migraine, seasonal influence of any of above. Known sensitivity to pollen,
food, dander, or drugs. Previous skin tests results and tx.
G.
HEAD: Headache, trauma, vertigo, syncope, convulsions, seizures.
H.
EYES:
Visual loss or color blindness, diplopia, hemianopsia, trauma, inflammation,

discharge, itching, pain, glasses.
I.
EARS:
Deafness, change in hearing, tinnitus, vertigo, discharge, pain.
J.
NOSE: Discharge, obstruction, epistaxis.
K.
MOUTH: Soreness of mouth or tongue, dental problems, lesions.
L.
THROAT: Hoarseness, soreness, tonsilar swelling, voice change, dysphagia.
M.
NECK: Swelling, lesions, enlarged lymph nodes, stiffness, limited motion.
N.
BREASTS: Gynecomastia, lactation, nipple discharge, lumps, pain, discoloration.
O.
RESPIRATORY:
Pain, S.O.B., wheezing, dyspnea, nocturnal dyspnea, orthopnea, cough, sputum,
hemoptysis, night sweats, hx TB or contact, pneumonia, asthma, other respiratory
infection.
ADN221L Fall 2016
47
P.
CARDIOVASCULAR:
Palpitations, tachycardia, irregularities, chest pain, dyspnea at rest or exertion,
orthopnea, cough, cyanosis, edema, intermittent claudication, cold extremity phlebitis,
hypertension. Drugs: digitalis, quinidine, nitro., diuretics, other.
Q.
G.I.
Appetite, weight change, dysphagia, nausea, vomiting, eructation, flatulence, pain,

hermatemesis, jaundice, color of urine and stool, stool frequency and consistency,
change in bowel habits, hemorrhoids, rectal bleeding.
R.
G.U.
Color of urine, polyuria, oliguria, nocturia, dysuria, hematuria, pyuria, urinary

retention, frequency, incontinence, pain, passage of stones or gravel.
MENSTRUATION:
Age at onset, frequency, regularity, duration, amt. of flow, dysmenorrheal, of LMP,
date of menopause, post-menopausal bleeding.
PREGNANCIES:
Number of pregnancies, abortions, miscarriages, stillbirths, complications and
pregnancy.
S.T.D.
S.
Chancre, discharge, odor, pain
NERVOUS SYSTEM:
Disturbances of smell (CN-1) or vision (CN-2, 3, 4, 6), orofacial paresthesia and
difficulty chewing (Cn-5)m facial weakness and taste disturbance (CN-7),
disturbance in tasting and equilibrium, (CN-8), difficulty in speech, swallowing, taste
(CN-9, 10, 12), limitation in neck motion (Cn-11).
MOTOR:
Paralysis, atrophy, involuntary movements, convulsions, gait, coordination
SENSORY:
Pain, paresthesia, hyperesthesia.
AUTONOMIC:
Control of urination and defecation, excessive sweating, erythema, cyanosis pallor,
reaction to heath and cold.
T.
MENTAL STATUS:
Reactions to family and others, mood liability, hallucinations, grandiose idea, sleep
disturbances, orientation to person, place and time.
ADN221L Fall 2016
48
ADN 221L
HOME HEALTH SKILLS

The following is a list of skills the student should be able to perform on all age groups during their
Home Health Rotation. Each student has different background experiences; therefore, some
students may need more assistance than others when performing these skills. However, all students
have had these skills and it is their responsibility to review them prior to performing and to always ask
questions when in doubt about any procedure. If a student is unable to perform any of these skills
competently; please let the instructor know so the students can return to the lab to review the skill.
IVS:
Starting
Changing central line dressings
Setting up and administering IVPBS
Discontinuing IVS
Use of CAD pump and IV pumps (with assistance)
Blood draw and labeling
DRESSINGS:
W-D dressings
Packing and irrigating wounds
OTHER:
Catheter Care
Ostomy Care
Blood Glucose Testing
Pain assessment and management
Perform physical assessment
Enteral feeding
N/G tube insertion/suctioning/trach care
TPN
Injections: SC, IM, ID, Z-track
Documenting follow-up visit
Documenting at least one (1) Intake (Medicare, Private, Capitated, Medical)
Client and family teaching
Make a referral(s)
Communicate with Physician and other disciplines
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ADN 221 L
HOME CARE NURSING STANDARDS
The American Nurses Association has produced Home Care Nursing Standards to fulfill the professions
obligation to provide a means of improving the quality of care provided to consumers. Standards reflect the
current state of knowledge in the field and are the basis for characterizing, measuring, and providing guidance
in achieving quality care. The nurse uses the code for nurses established by the American Nurses Association
as a guide for ethical decision making in practice.
Standard I.
Organization of Home Health Services
All home health services are planned, organized, and directed by a masters-prepared professional nurse with
experience in community health and administration.
Standard II. Theory
The nurse applies theoretical concepts as a basis for decisions in practice.
Standard III. Data Collection
The nurse continuously collects and records data that are comprehensive, accurate, and systematic.
Standard IV. Diagnosis
The nurse uses health assessment data to determine nursing diagnoses.
Standard VII. Planning
The nurse develops care plans that establish goals. The care plan is based on nursing diagnoses and
incorporates therapeutic, preventive and rehabilitative nursing actions.
Standard VI. Intervention
The nurse, guided by the care plan, intervenes to provide comfort, to restore, improve, and promote health, to
prevent complications and sequelae of illness, and to effect rehabilitation.
Standard VII. Evaluation
The nurse continually evaluates the clients and familys responses to interventions in order to determine
progress toward goal attainment and to revise the data base, nursing diagnosis, and POC. c
Standard VIII. Continuity of Care
The nurse is responsible for the clients appropriate and uninterrupted care along the health care continuum,
and therefore, uses discharge planning, case management, and coordination of community resources.
Standard IX. Interdisciplinary Collaboration
The nurse initiates and maintains a liaison relationship with all appropriate health care providers to assure that
all efforts effectively complement one another.
Standard X. Professional Development
The nurse assumes responsibility for professional development and contributes to the professional growth of
others.
Standard XI. Research
The nurse participates in research activities that contribute to the professions continuing development of
knowledge of home health care.
Standard XII. Ethics
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ADN 221 L
CHARTING IN HOME HEALTH
AVOID THE FOLLOWING WORDS
Monitor, supervise-denotes a stable patient.
USE INSTEAD
Assess, evaluate. Monitor may be used when
managed care is ordered and the skilled nurse is
supervising paraprofessionals to ensure safe delivery
of the therapeutic regimen.
Healing wellsuggests that visits are unnecessary,

and supports patient discharge from home health
services.
Objectively describe the wound in terms of size, depth,

drainage, color, and odor.
Discusseddoes not require the skills of a

professional; anyone can discuss.
Teach, educate, instruct, demonstrate.
Prevent/prevention. Not covered. Must be done

incidental to a skilled service such as assessment,
teaching, and treatment.
Focus on restorative, rehabilitative, and/or palliative

(hospice) interventions.
Stable, independentnegates medical necessity

and supports patient discharge from home health
services.
Document response to treatment.
Feeling better-subjective and supports patient

discharge from home health services.
Went to the market/going to church, etc.negates

homebound status.
Patient not at home.
Continue care plan.

Maintenance. Never use this word because it
negates the necessity of visits, and supports
patient discharge from home health services.
Confused.
Chronic conditionis indicative of a stable
condition.
Reinforce, reinstruct. Repetitive instruction will not
be covered unless learning difficulties are
documented.
Observed. Anyone can observe
ADN221L Fall 2016
Document specific problems with coping or refusal to

follow the plan of care as source of referral to
psychiatric home health nurse or social worker.
Document refusal to follow the plan of care as a
justification for a learning contract or per home health
agency policy, patient discharge.
Document equipment, manual assistance, and number
of people required for patient to leave home. Verify
homebound status each visit. If the patient leaves the
home, explain why trips were taken as related to
lifestyle or medical necessity.
Not available for visit or no answer to locked door.
Document on next visit why patient was not available
for visit.
Describe what your next visit plans are based on; e.g.,
assess cardiopulmonary status of CHF patient.
Document response to the plan of care or case
management needs.
Describe disorientation to person, place, or time.
Describe ability to follow commands, short-and longterm recall.
Describe exacerbation of the chronic condition that
requires the services of a skilled nurse.
Document comprehension difficulties, attention deficit,
or other problems that hamper ability to learn and
necessitate repeating instructions. Use words such as
demonstrate, teach, instruct, or educate.
Use assess or evaluate. Skilled observation may be
used as a component of patient education to document
patient/ caregiver return demonstration.
51
HOME SAFETY ASSESSMENT

Throughout the home there are several features which should be carefully checked for safety.
Yes
No
Are scatter rugs firmly anchored with rubber backing?

Are electrical cords in good repair, especially a heating pad?
Light, Heat and ventilation: Is there adequate night lighting?
Are stairways continually lighted?
Is temperature within a comfortable range?
Is there cross ventilation?
Is furniture sturdy enough to give support?
Is there a minimum of clutter allowing room for easy mobility as well as fire hazard?
Are smoke detectors present (at least one on each level of home)?
Are emergency telephone number posted in a hand place to read? (Ambulance, doctor, fire
department, nearest relative 911)
If you are alone for a period of time, do you have someone who checks on you?
If you have limited vision, does phone have enlarged dial?
If you have impaired hearing, does phone have amplified receiver?
If you have small pets, do they ever get in your way, causing you to trip or fall?
The kitchen can be evaluated for the following:
Is the stove free of grease and clear of flammable objects?
Is baking soda available in case of grease fire?
Are matches safely stored if there is not a pilot light on stove?
Is the refrigerator working properly?
Is the sink draining well?
Is food being stored properly?
Is trash taken out daily?
Is there a sturdy step stool available?
Are there skid proof mats on the floor?
In the bathroom, are the following safety features observed:
If needed, are handrails beside the tub and toilet?
Are skid proof mats in the bathtub and/or shower?
Are electrical outlets and appliances a safe distance from the bathtub?
Earthquake safety front of telephone book: Radio and batteries
Flashlight and extra batteries
Three days food and five gallons water
Bookcase, water heater secured
Know how to turn off gas
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ADN 221 L
Home Health Environmental Assessment and Safety Considerations in the Home
Neighborhood
Accessibility
Lighting inside and out
Sturdy Handrails
Non-skid Stair Tread
Telephone and Emergency Telephone Numbers
Electrical Cords and Appliances
Furniture-Arranged for Unobstructed Passage
Comfortable Temperature
Smoke Detectors
Fireplaces/Heaters Protective Screens
Throw Rugs Tacked down, Rubber backed, Non-skid or Removed
Alternative Exits
Basement and Attics Well It and Ventilated
Slippers and Shoes Non-Skid, Fit Properly, Good Repair
Medication Storage
Cleanliness
Plumbing in good condition
Shelves Easy to See and Reach
Poisons Clearly Marked and Stored Separately
High Toilet Seats
Grab Bars
First Aid Kit
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ADN 221 L
HOME HEALTH TEACHING GUIDELINES

A.
Special circumstances the home health nurse must consider:

1.
The difference in home care patient education is control of the environmentthe nurse is a guest
in the patients home and, therefore, has less control than in other settings.
2.
The nurse serves as both facilitator and collaborator for patients and caregivers as they assume primary
responsibility and make decisions about the best means to accomplish the treatment goals.
3.
Special circumstances must be considered:
(a) Home health care requires active participation by the client and/or caregiver in the treatment.
(b) Consistent, understandable information is important in facilitating patient participation.
(c) The nurse must reassess the clients skills/care in the home environment as the transition from the
hospital to home may cause increased levels of anxiety and reduce the clients ability to
comprehend information.
(d) During hospitalization the client may have been exposed to a large team of health professionals with
conflicting concerns and perspectives. The home health nurse must determine what has already
been taught and continue to coordinate the approach in the home.
4.
A structured teaching program is required to meet initial home care learning needs.
5.
The amount of follow-up instruction must be individualized according to the complexity of information and
caregiver skill level.
6.
General concepts; e.g., infection control in the home, use of equipment, restricted activities, medication
schedule and administration, recognition and prevention of side effects, signs and symptoms to report
and identification of emergency situations must be taught before a patient can be independent in
providing self-care.
B.
Types of Learners
1.
There are four types: visual, auditory, tactile, and combination
2.
Learning strategies for different kinds of learners:
(a) Visual: benefits most from written instructions and visual demonstrations. Video instruction may be
helpful.
(b) Auditory: benefits most from verbal explanations and instruction. Video instruction is often helpful.
(c) Tactile: benefits most from hands-on instruction; learns best how to perform a procedure by actually
doing it.
(d) Combination: benefits most from either visual, auditory, or tactile methods or tools.
C.
Adult Learning Principles

1.
Learning is an active process and adults prefer to participate actively.
Relevancy to Home Care: When the nurse with his/her clients during information-givingsessions, they
will remember more.
2.
Learning is goal-directed and adults are trying to satisfy a need.
Relevancy to Home Care: The information people want and need is in direct relation to their lives as
they see it and the way they want to resume living.
3.
Learning that is applied immediately is retained longer and is more subject to immediate use than that
which is not.
Relevancy to Home Care: Teach skills under your supervision. This will increase the clients comfort
level at home.
4.
Learning is must be reinforced. Reinforcement means repetition.
Relevancy to Home Care: Use a variety of teaching learning methods with consistent information
provided.
5.
Learning new material is facilitated when it is related to what is already known.
Relevancy to Home Care: build on what your clients already know.
6.
The existence of periodic plateaus in the rate of learning necessitates frequent changes in teaching
methods to ensure continuous progress.
Relevancy to Home Care: People can absorb only so much at one time. They learn from a variety of
teaching methods.
7.
Learning is must be reinforced. Reinforcement means repetition.
Relevancy to Home Care: If clients realize the have made progress in what they need to know to take
care of themselves, they feel good about themselves and are willing to learn more.
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8.
Learning is facilitated when there is logic to the subject matter and the logic makes sense in relation to the
learners repertoire of experience.
Relevancy to Home Care: Ask your clients what their experience is with a particular illness.
D.
Guideline for Effective Education

1.
Be sure you are skilled in presenting information in a clear, concise, orderly manner.
2.
Be sure the client and caregiver are ready to learn.
3.
Ask the client to assist you in determining any learning needs/methods. Do not rely on verbal o printed
material alone. Always provide written instructions for the client to refer to.
4.
Select a location for instruction that is free from distraction and includes all support persons.
5.
Divide information into essential and nonessential information. Teach only the essential material initially.
6.
Emphasize the positive, what to do, what not to do. Avoid long explanations.
7.
Have the client restate instructions as the procedure is being demonstrated and provide immediate
feedback and praise.
8.
Demonstrate each procedure and then watch the client perform the procedure.
9.
Do not suggest alternative procedures until a routine is established.
10.
Obtain the clients input/suggestions and preferences to facilitate a successful plan of care.
11.
Attempt to personalize your teaching to the clients life experiences.
12.
Consider psychomotor, cognitive and affective dimensions of the client before/during instruction.
13.
Implement a flow sheet(s) for the client to use as a tool for instruction and as a measure of compliance.
E.
Determining the Readiness of the Learner

1.
Determine what has already been learned.
2.
Assess the clients and familys perception of the seriousness of the situation.
3.
Determine the emotional response to illness.
4.
Determine what degree of support is provided b the family members.
5.
What are the clients and caregivers education and reading levels?
6.
Determine the amount of fatigue and discomfort.
7.
Assess the effects of medications and treatments.
8.
Consider the clients and caregivers physical condition, including functional status, vision, hearing, fine
motor skills, and cognitive abilities.
9.
Determine any deficits in short-term memory.
10.
Assess the familys social support system and methods of dealing with stress, including cultural factors
such as male/female role relationships, age, and country of origin.
F.
Selecting Patient Education Materials

1.
Select combinations of text and line drawings.
2.
Make reading levels for approximately sixth to ninth grade for most patients.
3.
Materials with short words and short sentences.
4.
Consistent terms
5.
Materials should focus on what the reader should do, not what they should not do (e.g., use medications
that are clear, rather than do not use medications that are cloudy)
6.
Good print quality, with strong color contrast to assist people with limited vision, and paper that does not
produce glare.
G.
Documentation Considerations for Client Teaching

1.
Document all aspects of the patients education including:
(a) The topic of education
(b) Assessment of retained learning
(c) All activities involved in teaching, including teaching aids used
(d) Ability of the patient and caregiver to understand/return demonstrate/verbalize
(e) All reteaching that is required and the reason
H.
Challenges in Client and Family Education

1.
Client or family member feels overwhelmed.
Response: Goal setting: Help the family focus on tasks at hand. Review goals that have been attained
to boost morale.
2.
Anxiety and fear of performing complex procedures
Response: Establish an atmosphere of acceptance. Do not be in a hurry. Offer opportunities for talk
and questions. Reassure the client/family that they have made the right treatment choice.
3.
Emotions associated with chronic or terminal conditions
Response: Provide opportunities to express feelings. Offer referrals to community resources.
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4.
5.
6.
7.
8.
Caregiver burnout and illness

Response: Simplify patient management where possible; e.g., scheduling drug doses to reduce
nighttime treatment. Remain accessible when possible.
Client fatigue, especially associated with chronic illnesses
Response: Help the client identify individual tolerance for tiredness in planning for as much active
participation in the family as possible.
Low literacy skills
Response: Teach in concrete terms, using words already understood. Use simple line drawings and
frequent repetition.
Geriatric Considerations: Decreased visual acuity
Response: Use teaching materials with large, bold type. Encourage the use of magnifying glass.
Pediatric Considerations: Decreased compliance with treatment and education
Response: Emphasize the importance of taking medications on schedule. Use stickers to reward the
compliant child. Stories and puppets are often effective with young children.
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ADN 221 L
AMBULATORY CARE CLINICS
DEFINITION -Personal health care provided to an individual who is not a bed patient in a health care
institution. It includes all health services provided to ambulatory patients.
EXAMPLES OF NURSES CLINICS THROUGH KAISER INCLUDE:
Foot Care Clinic
Hypertension Clinic
Infusion Clinic
INH Clinic (pulmonary)
Musculoskeletal Clinic
Coumadin Clinic
New OB Visits
Primary Care
Travel Advisory Clinic
Womens Center
Diabetes Clinic
Dysplasia Clinic
Enterostomal/Wound Care Clinic
Child Abuse Assessment Clinic
Health Appraisal
Orthopedic Clinic
GI Clinic
Emergency Clinic
Pediatric Clinic
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ADN 221 L
AMBULATORY CARE SKILLS
The following is a list of skills the student should be able to perform on all age groups during their
Ambulatory Care Rotation. Each student has different background experiences; therefore, some students
may need more assistance than others when performing these skills. However, all students have had
these skills and it is their responsibility to review them prior to performing and to always ask questions
when in doubt about any procedure. If a student is unable to perform any of these skills competently;
please let the instructor know so the students can return to the lab to review the skill.
IVs
Other
Starting IV
Injections: SC, IM, ID, Z-trach
Changing central line dressings
Catheter Care
Setting-up and administering IVPBs
Ostomy Care
Discontinuing IVs
Ear lavages/use of otoscope
Blood draws and labeling
Eye washes
Blood glucose testing
Dressings
W-D Dressings
Communicate w/Dr.
Packing and irrigating wounds
Communication w/ team,
Removing sutures and staples
Client and family teaching

Documentation
Makes referrals
Physical assessment
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ADN 221 L
Nursing skills in Ambulatory Clinics focus on:
Interviewing
Rapid Physical Assessment
Adult Learning Principles
In depth Health Assessment
Care Management
Telephone Advice/Triage
Goals include:
Health Promotion
Health Maintenance
Navigating the Health Care System
Ambulatory Nursing Roles:

Prevention and Health Maintenance
Health Teaching
Early Detection of Disease
Health Histories
Examinations
Screening Sessions
Health Maintenance for Chronic Conditions
Teaching
Monitoring Health Status
Mobilizing Resources
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ADN 221 L
ASSESSMENT: SORTING OUT THE FACTS

Subjective Assessment
1.
The patients illness and health history as the patient sees it.
2.
Data gathered is patients own interpretation and recollection.
3.
Obtained through interviewing patient or significant others.
Data Categories
1.
Chief complaint
2.
Age, sex, pregnancy status
3.
Description of problem
Location
Onset
Duration
Intensity
Quality or character
Aggravating factor
4.
Associated symptoms
5.
Review of pertinent symptom
6.
Time of incident
7.
Mechanism of injury
8.
Any home treatment administered
9.
Pertinent past medical history
10.
Medications and allergies
11.
Menstrual, pregnancy history (when appropriate).
General Practical Assessing Pain PQRST

P=
Q=
R=
S=
T=
ADN221L Fall 2016
Providing or Alleviating Factors

Quality of Pain
Region or Location
Severity or Intensity
Timing of Pain
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ADN 221 L
INTERVIEWING SKILLS
Interpersonal Skills
1.
Speak slowly, clearly and distinctly.
2.
Be professional.
3.
Be kind, reassuring, and unhurried.
4.
Utilize listening skills.
5.
Be supportive honest and attentive.
6.
Speak at patients level of understanding.
7.
Be receptive.
8.
Use patience, understanding and discretion.
9.
Be flexible.
Blocks to Effective Interviewing

1.
Rushing the interview.
2.
Losing the professional perspective.
3.
Starting with delicate questions too soon.
4.
Intimidation.
5.
Letting personal biases interfere.
6.
Using medical terminology inappropriately.
7.
Showing annoyance or exasperation when patient hits a memory block or uses poor English.
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ADN 221 L
PRIORITY RATING SYSTEM

- Any delay in medical care could increase morbidity or mortality.
Examples:
Emergent
1.
Cardio pulmonary arrest.
2.
Severe respiratory distress.
3.
Major trauma or burns.
4.
Cardiac chest pain.
5.
Massive hemorrhage/arterial bleeding.
6.
Ingestion of rapid acting poison.
7.
Severe allergic reaction.
8.
Hyper of Hypothermia.
9.
Neuro/vascular impairment.
10.
Coma or altered level of consciousness.
Urgent
NonUrgent
t
- A condition requiring medical attention within the period of a few hours: a possible
danger exits to the patient if medically unattended. Pain level.
1.
Non - cardiac chest pain.
2.
Emotional disturbance.
3.
Vaginal bleeding (controlled).
4.
Moderate pain or shortness of breath.
5.
Checks for sexually transmitted diseases.
6.
Urinary tract infections.
7.
Mild abdominal complaint
- Not life threatening; does not need to be seen.

1.
Skin rashes.
2.
Minor orthopedic injuries.
3.
Mild/chronic headaches.
4.
Cold/flu/back to work slips.
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SECTION IV
PSYCHIATRIC NURSING
CLINICAL OUTCOMES/RELATED CONTENT/CLINICAL

ASSIGNMENT
CLINICAL ASSIGNMENTS/GRADING CRITERIA
DATA COLLECTION TOOL
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PSYCHIATRIC ROTATION
ADN 221L
CLINICAL OUTCOMES
1. Relate and analyze the rights of
mentally ill adults.
2. Examine and modify patients who are
detained on an involuntary hold and
state the rationale for that hold.
RELATED CONTENT
ADN 221 Introduction to
psychiatric/mental health
nursing concepts
ADN 113 Pediatric Patient
Lecture
3. Examine and Modify essential areas,

equipment and assignment.
4. Differentiate and apply precautions to
provide safety for self and others.
ADN 221 Syllabus SBAR
CLINICAL ASSIGNMENT
Start a journal before
entering clinical area that
explores your personal
feelings about entering a
psychiatric unit including:
Expectations
Fears
Hopes
Challenges
5. Compare and contrast procedures for

codes (Red-Blue-Green) used in
emergency situations.
6. Compare and contrast procedures for
close observation, 1:1 supervision,
seclusion and restraint.
7. Compare and contrast communicable
diseases most common to this patient
population.
8. Differentiate and apply appropriate
precautions when a communicable
disease has been identified.
9. Relate and analyze conversations with
mentally ill adults observing nonverbal
cues.
ADN 112 Communication

Lecture/Reference material
Talk with clients in the milieu.
ADN 111B Psychiatric Illnesses
Attend milieu activities.
Compare and contrast effective

communication techniques.
and Medication Lecture
11. Differentiate and examine patients for

effects of medications prescribed to
control symptoms of a psychiatric
illness.
ADN 221 Reading assignment
10.
12. Examine and modify characteristics
ADN 221 Lecture/reading

assignments
In post conference, give

report on your client using
SBAR format.
which contribute to a therapeutic milieu

in this clinical setting.
13.Relate and analyze your role in

contributing to the therapeutic milieu.
14. Relate and demonstrate during post

conference:
a. Patient population.
b. Effects of stigma on the mentally ill.
c.Own perceptions, thoughts and
feelings about mental illness.
d. Similarities and differences in the
role of a nurse as observed in this
facility and in a general hospital.
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ADN 221L
CLINICAL OUTCOMES
1. Relate and demonstrate a plan to
reduce anxiety in a selected
patient.
2. Compare and contrast use of
effective communication
techniques while implementing the
plan to eliminate or reduce the
level of anxiety in a selected
patient.
RELATED CONTENT
ADN 112 Documentation
ADN 221
4. Differentiate and apply correct

terminology and facility format to
chart on the selected patient.
Depression
a. Compare and contrast
specific problems to be
addressed based on
assessment of the patient
presented.
b. Differentiate and apply an
assessment for suicide
potential and state rationale
for assigned level of risk.
c. Compare and contrast
medications prescribed for this
person in terms of clinical
indications, major actions,
expected results,
contraindications and side
effects.
CLINICAL ASSIGNMENT
ADN 111B
Discuss in post conference:

One adult who is
depressed and one who
is manic.
ADN 111B
Mania
a. Compare and contrast
specific problems to be
addressed based on
assessment of the patient
presented.
b. Differentiate and apply a
nursing care plan related to
the identified problems.
c. Compare and contrast normal
doses, lab values, side effects
and signs of toxicity related to
medications prescribed for this
person.
d. Compare and contrast the
components of a lithium workup.
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ADN 221L
CLINICAL OUTCOMES
1.
Relate and demonstrate correct

use terminology essential to
assessment of a mentally ill
adult.
2.
Differentiate and apply your

knowledge in completing a
nursing assessment on a
mentally ill adult.
3.
Compare and contrast accurate

nursing diagnoses, expected
outcomes and nursing
interventions for an adult with
mental illness.
4.
Compare and contrast expected

outcomes in terms that are
behavioral, realistic and
measurable.
5.
Differentiate and apply specific

techniques when interacting with
a person experiencing delusions.
6.
Compare and contrast specific

techniques when interacting with
a person who is hallucinating.
7.

appropriate nursing interventions
to interrupt the hallucinatory
process.
8.
Relate and demonstrate

participation in activities with
patients experiencing
hallucinations, delusions, or
paranoid thoughts assisting them
to cope at the highest possible
level.
9.
Compare and contrast accurate

nursing diagnoses, expected
outcomes and nursing
interventions for a person with
schizophrenia.
10.

patients for effects of medications
prescribed to control the
symptoms of schizophrenia.
ADN221L Fall 2016
RELATED CONTENT
CLINICAL ASSIGNMENT
ADN 221 Lecture/reading
Develop a nursing care plan

for a patient with a major
mental illness (i.e.) Mood
disorder, schizophrenia.
ADN 112
ADN 221
Work with (2) patients each

day. Use the nursing
process.
ADN 112
ADN 112
ADN 112, ADN 221
ADN 221
ADN 112, ADN 221
ADN 112, ADN 221
ADN 111B, ADN 221
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ADN 221L
CLINICAL OUTCOMES
RELATED CONTENT
CLINICAL ASSIGNMENT
1.
Relate and Demonstrate activities of

the day in post conference..
ADN 112, ADN 221
Present nursing care plan in

post-conference.
2.
Differentiate and apply groups as a

modality and how they assist
mentally ill adults.
ADN 221
Work with (2) patients, one of

whom has an AXIS II diagnosis
each day. Use the nursing
process and chart.
3.
Differentiate and examine the

behavior of patients with an Axis II
diagnosis.
4.
Using DSM-IV, compare and contrast

observed behaviors with criteria for
diagnosis.
5.
Differentiate and apply complete

evaluations of self, clinical facility and
course.
ADN 221
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ADN 221L Psychiatric Clinical Assignments
Interaction Process Analysis (25 pts.)

AA Paper (25 pts.)
Journals (25 pts.)
Kaplan/Course Point assignments (Pass/No
Pass)
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ADN 221 L
INTERACTION PROCESS ANALYSIS

GUIDELINE FOR USING THE PROCESS RECORDING
(25 points - due in psych - rotation)
The process recording is a written record of the exact conversation between the nurse and the
patient during the time they were together. It may be used for a short period of interaction or a long,
extended time. Although formats for the process recording will vary greatly, most will include what the
nurse did, said, and felt, and what the patient did, said, and felt. Observations of the patient and of
the process occurring may also be included.
Utilizing the process recording as a tool for assessment allows the learner the opportunity to
look closely at his/her interaction with the patient and more effectively relate and assess the needs of
the patient. Also, it allows the student the opportunity to honestly express and analyze how he/she
was feeling and responding. In this manner, it is a growth promoting process for the learner. This
process recording may be used as a base for formulating, implementing, and evaluating the nursing
care plan.
Usually, the process recording is begun with a brief summary of the patient's situation and
events leading to the specific interaction that is described. This may go in columnar form under
observation or may be a short paragraph preceding the process recording. Observations of the
patient are made upon initial contact and as the dialogue proceeds other observation, for instance,
gestures, change in position, are made.
Columns are used for what the nurse said or did or felt, and what the patient said or did and
inferences on how the patient felt.
Immediately following the interaction, the nurse records from recall (do not write while talking
with the patient!) enough of the interaction to present the situation as clearly as possible. It is helpful
to write the conversation (include pauses and silences) in detail so that transactions of seemingly little
importance are not left out. Sometimes what is not said is more important than what is said. The
nurse writes her honest feelings in the process and what feelings she thinks the patient had. When
analyzing the process, sometimes additional feelings, thoughts, and interchanges are recalled and
they can be added to the recording.
The recording may be analyzed in regard to what the patient was trying to communicate in his
verbal and nonverbal behavior. What needs were identified by the nurse? Were the patient's needs
met her? What did you learn in this exchange? What were your feelings about the patient? What
would you do differently in the same interaction if you could redo it? This column is completed after
the interaction has been recorded.
Coffey, Lou.: Modules for Independent-Individual Learning in Nursing.
F.A. Davis Company, Philadelphia, 1975: P. 114.
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EXAMPLE OF INTERACTION
PROCESS ANALYSIS (Self-awareness)
In order to learn the function of therapeutic intervention, the process of a therapeutic nurse-client
relationship, you must be able to study and review with objectivity the components of this process. As
the responsible individual in the interaction, you must review both verbal and nonverbal components
for their potential meaning. They may be expressing problems or attempts at resolving problems.
The tool used for this review is the interaction process analysis. An IPA is a verbatim and progressive
recording of the verbal and nonverbal interactions between client and nurse within a given period of
time. It consists of:
1.
A summary of the circumstances associated with the recorded interaction. This should include
all introductory exchanges such as giving recognition and significant data from previous
interactions.
2.
An accurate and objective recording of the verbal and behavioral communication between
client and nurse within the period. It may describe nonverbal communication alone, if
conversation does not occur. If conversation does occur, the IPA must both record the words
and describe accompanying nonverbal communication by each participant in the interaction.
Nonverbal behavior is described in parentheses. Exchanges must be recorded in proper
sequence, to indicate the direction of the communication. Include ten sequential exchanges
between the nurse and the client. The recording must reflect the ability to discuss feelings. A
recording of patient teaching is not acceptable.
3.
For each significant communication (verbal or nonverbal), a statement in the nurse- or the
client-centered analysis (or both) that specifies the following:
a.
An analysis or interpretation of the possible meaning of the communication,
b.
Identification of the nurse's own emotions and the possible intent of the nurse's
communication, whether conscious or unconscious,
c.
Perceptions of the emotions expressed by the client and the intent of the client's
communication, whether conscious or unconscious,
d.
Evaluation of the effectiveness of the nurse's approach, based on the above data.
Identify each technique used by the nurse and state whether it was therapeutic or nontherapeutic.
e.
If the technique was determined to be non-therapeutic, suggest nursing alternatives in

order of their usefulness.
Source: Adopted from Holly Skodal Wilson and Carol Ren Kneisl, Psychosocial Nursing Concepts,
An Activity Book, pp. 175-179.
ADN221L Fall 2016
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CLIENT-centered:
The patient will be able to:

What behavioral change are you looking for?

INTERACTION
(Verbal and Nonverbal)
1.
Nurse
Patient
NURSE-CENTERED
ANALYSIS
CLIENT-CENTERED
ANALYSIS
This reflects an evaluation of

your effectiveness in use of
techniques. Identify the
technique used.
What the patient

perceived, felt or thought.
Look for incongruencies
(verbal vs. nonverbal).

2.
Nurse
Patient
Was it effective or
ineffective?
There must be 10
sequential exchanges.
If it was not effective, give

an example of what you
might have said to make it
more therapeutic.
Patient teaching is not

acceptable.
ADN221L Fall 2016
What did you think about

what was happening?
How do you feel?
73
Example
Circumstances
Description of environmental setting:
Where did this interaction take place?
Feeling tone
Nurse's: Comfortable? Nervous?
Scared?
Client's: Calm?
Scared?
Anxious?
Eager?
Unit milieu:
Directable?
Hostile?
What is going on this day?
Description of client:
Busy? Quiet? High acuity?
Include patients diagnosis. Age sex, physical state

Include DSM IV diagnosis
Include Medications
Significant data prior to interaction: Introductory statements belong here as well as cues from previous
interactions which lead you to believe that this discussion was
important.
Goals
Nurse-centered
The nurse will:

This comes from the Master Treatment Plan for this patient when in a psychiatric
setting.
Client-centered
The patient will be able to:

What behavioral change are you looking for?
ADN221L Fall 2016
74
Summary
Themes perceived in interaction:
What topic continues to surface?
Are verbal and non-verbal messages compatible?
Evaluation in terms of goals

Nurse-centered goals:
To what extent were you able to reach the goal you set prior to this interaction?
Client-centered goals:
Was the patient able to demonstrate the desired behavioral change?
(i.e. able to discuss treatment issues, less anxious)
Goal accomplishment is desirable but it may not be the case. The patient may have an
immediate concern that must be addressed. If you were unable to reach your goals, state why.
Reference: (2 References)
Therapeutic/non-therapeutic techniques must come from the ADN Communication Module.
INTERACTION PROCESS ANALYSIS
Circumstances
ADN221L Fall 2016
75
Description of environmental setting:
Feeling tone
Nurse's:
Client's:
Unit milieu:
Description of client:
Significant data prior to interaction:
Goals
Nurse-centered
Client-centered
ADN221L Fall 2016
76
CLIENT
INTERACTION
(Verbal Nonverbal)
ADN221L Fall 2016
NURSE-CENTERED
ANALYSIS
CLIENT-CENTERED
ANALYSIS
77
CLIENT
INTERACTION
(Verbal and Nonverbal)
ADN221L Fall 2016
NURSE-CENTERED
ANALYSIS
CLIENT-CENTERED
ANALYSIS
78
Summary
Themes perceived in interaction:
Evaluation in terms of goals

Nurse-centered goals:
Client-centered goals:
References to theory (articles or books read as preparation for IPA):
ADN221L Fall 2016
79
ADN 221 L
AA PAPER
(25 points)
Report on Observation of Open Meeting of Alcoholics Anonymous
Purpose:
The main purpose of this observational experience is to enhance your role as a professional resource person
for the alcoholic individual and/or his/her family. In addition, the California BRN requires attendance at a selfhelp group as part of your clinical experience in the area of Chemical Dependency.
3.
Guidelines:
1.
Select an open Alcoholics Anonymous meeting which is located conveniently for you. This may be
done by logging on to www.aasandiego.org
2.
Attend a meeting during the time of Psychiatric Clinical Rotation.
The two-page, typed, double-spaced, paper is due on
..
AA PAPER
Directions:
1.
Include an introductory paragraph which identifies the time, date, and location of the meeting attended.
Also address your overall impressions of the Alcoholics Anonymous meeting and how this experience
will benefit you as a nurse.
2.
Select one of the following areas for discussion:
a.
3.
The twelve steps related to recovery and indications observed by you of how members
discussion focused on a specific step.
b.
Select one of AAs slogans such as keep it simple and discuss that slogan in terms of what you
heard at the meeting.
c.
Recognizing that addiction is a disease of denial, identify techniques used during the meeting to
help members overcome denial of their illness.
d.
Choose a specific principle such as self-help, anonymity of mutual support and discuss how that
principle was incorporated into the attended meeting.
e.
Discuss ways in which attending the AA meeting would be helpful for you in a general hospital
and for the care of an alcoholic who states AA is for skid row drunks.
The paper must be two pages, typed, double-spaced and no longer.
References:
Use of AAs big book or other AA literature is encouraged to increase your understanding. Literature used must
be documented in the paper. Must use at least two current references (not older than five years).
GRADING CRITERIA:
25 points total: 15 points for presentation of content; 5 points for your overall impressions and how the visit will
benefit you as a nurse; 5 points for spelling, grammar and APA format.
ADN221L Fall 2016
80
ADN 221 L
WEEKLY JOURNAL
(5 points each for a total of 25 points)
Requirements: Mandatory
Due:
Weekly while in the clinical setting unless otherwise directed by your clinical
instructor.
PURPOSE:
This exercise is formatted to help you increase your learning

ability, improve communication and critical thinking skills and to
foster personal growth.
This is an introspective exercise in which you record your thoughts, feelings and
experiences related to your clinical experience of the past week. It is hoped that
both you and your instructor gain insight into your experiences in the clinical setting.
The insight gained may help both you and your instructor in facilitating your clinical
experiences to best meet your needs. It also allows for a non-critical dialogue
between and your instructor about your clinical experiences.
FORMAT:
A Triangle....The journal will be typed on paper that can be handed in weekly for
review. Structure your entries to reflect on your (1) personal and professional life as
a student nurse, (2) reflect on classroom and clinical experiences highlighting the
caring aspect of your role as a student nurse, and (3) reflect on your readings and
assignments. The (5th) and last journal should include the previous. Four journal
entries with a Title Page and Table of Contents, which includes a Title or Theme for
each journal. A one page typed Summary Report should be submitted explaining if
the experience of journal writing helped you and why.
#3
#1
ADN221L Fall 2016
#2
81
ADN221L Fall 2016
82
ADN 221 L

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Age:
Date of admission:
Surgical procedure:
Diet:
Activity:
Medications:
Drug:
Patient history:
Diagnostic tests:
Name of test:
Problems occurring for this patient during the preceding 24 hours:
Was the physician called for any reason? If so, why?
Look at the patients nursing care plan:
Look at the shift report sheets for the past 24 hours. Based on those report sheets, what
is the MOST IMPORTANT nursing intervention for you to carry out this shift?
If the physician came in at this moment and discharged this patient, what are the
most
What if
ADN221L Fall 2016
83

2016 Adn221l

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ASSOCIATE DEGREE NURSING PROGRAM

Vangie Howard RN MSN

ADN221L Fall 2016

ADN221L Fall 2016

ADN221L Fall 2016

Course Description and Outcomes

Core Values and Curriculum Threads

Quality and Safety Education in Nursing (QSEN)

National Patient Safety Goals (NPSGs)

Textbooks and Websites

Criteria for Evaluation and Grading

How to Use On-Campus Lab

Essential Nursing Actions

Mary Livingston, RN, MSN

Linda McDonald, RN, MSN

Vangie Howard RN, MSN

Sandra Peppard, RN, MSN

ADN221L Fall 2016

Course Description and Outcome

Compare and contrast non-therapeutic communication and therapeutic communication

Relate and analyze cultural influences on health behavior and illness.

Compare and contrast principles of safety prior to implementing nursing care.

ADN221L Fall 2016

Quality and Safety Education for Nurses(QSEN)

ADN221L Fall 2016

Textbooks and Websites

Cheever, K. & Hinkle, J. (2013) Brunner & Suddarth's Textbook of Medical-Surgical

ADN221L Fall 2016

Criteria for Evaluation and Grading

Journals APA format (Total of 3)

Home Health OR Amb. Care Paper

Interaction Process Analysis

ADN221L Fall 2016

ADN221L Fall 2016

HOW TO USE THE ON CAMPUS LAB

Review syllabus and lab objectives

SCHEDULED LAB PERIODBRING TO LAB:

Module and learning objectives.

Review and practice skills according to criteria

ADN221L Fall 2016

ESSENTIAL NURSING ACTIONS COMMON TO ALL NURSING SKILL

ADN221L Fall 2016

ADN221L Fall 2016

Compare and contrast

Compare and contrast

ADN221L Fall 2016

ADN 112 on Assessment

Successfully pass a skills focus

ADN 112 on Documentation

Complete a Medical Diagnosis

ADN 11 A/ADN 111 B

Differentiate and apply

Compare and contrast

Compare and contrast

Relate and demonstrate

Differentiate and apply

Relate and analyze cultural

Differentiate and examine

Differentiate and examine

Differentiate and examine

ADN221L Fall 2016

ADN 112 on Nursing Process Complete Nursing Care Plan

ADN 112 on nursing