Portland Community College | Portland, Oregon

This course builds on Nursing in Acute Care I, focusing on more complex and/or unstable patient care conditions, some of which may result in death. These patient care conditions require strong noticing and rapid decision making skills. Evidence base is used to support appropriate focused assessments, and effective, efficient nursing interventions. Life span and developmental factors, cultural variables, and legal aspects of care frame the ethical decision-making employed in patient choices for treatment or palliative care for disorders with an acute trajectory. Case scenarios incorporate prioritizing care needs, delegation and supervision, and family and patient teaching for either discharge planning or end-of-life care. Exemplars include acute conditions affecting multiple body systems. Includes classroom and clinical learning experiences.

Prerequisites: Completion of First year of Nursing Curriculum: NRS 110; NRS 111; NRS 112; NRS 221, 230,231,232, 233

By the end of the course, the student will be able to:
1. Conduct evidence-based assessment, using age, and developmentally and culturally appropriate communication skills, specifically by:monitoring a variety of data and accurately interpreting obvious deviations from expected patterns in increasing complex acute conditions (e.g. co-morbidities, complications, high-risk pregnancies, acute psychosis, life threatening situations, diverse health beliefs);recognizing potential problems and rapidly changing physiologic and behavioral situations;recognizing pathophysiological changes and symptoms experienced by the patient which are
associated with the dying process; regularly monitoring patient’s level of comfort and ability to manage symptoms and symptom distress;assessing family’s response to client’s illness; and recognizing impact of individual development, as well as family development and dynamics on physiologic and behavioral status.
2. Developing and using evidence-based, individualized, developmentally appropriate interventions that are dynamic and based on changing needs of client and family.
3. Collaborating with health care team members to provide comfort and symptom management.
4. Developing discharge plans in collaboration with client, family and health care team members.
5. Reflecting on experiences in caring for clients with acute conditions.

Intended Outcomes for the course:

1. Conduct evidence-based assessment, using age, and developmentally and culturally appropriate communication skills by:

• Compare (monitor) a variety of data, accurately interpret obvious deviations from expected patterns in increasing complex acute conditions, and apply to specific patient situation (e.g. co-morbidities, complications, high-risk pregnancies, acute psychosis, life threatening situations, end-of-life, diverse health beliefs);
• Identify potential problems and rapidly changing physiologic and behavioral situations;
• Distinguish pathophysiological changes and symptoms experienced by the patient which are associated with life threatening or end-of-life process;
• regularly monitoring patient’s level of comfort and ability to manage symptoms and symptom distress;
• assess patient and family’s response during patient’s illness and/or End-of-Life situation
• formulate impact of individual development, as well as family development and dynamics on physiologic and behavioral status.

2. Develop and use evidence-based, individualized, developmentally appropriate interventions that are dynamic and based on changing needs of patient and family.

3. Collaborate with health care team members to provide comfort and symptom management.

4. Develop discharge plans in collaboration with patient, family, health care team members, and service providing agencies.

5. Reflect on experiences in caring for patients with acute conditions.

Discussion groups

Required Readings
Clinical evaluation
Project/Papers
Multiple choice exams
Lab performance evaluation

Clinical performance evaluation

Papers/Project Rubrics
Multiple choice exams
Lab performance evaluation

Themes, Concepts & Issues:

Clinical Judgment Model

Care coordination

Communication

Symptom Management

Advocacy

Teaching

Evidence-based best practices

Skills: This is not an exhaustive list but is a minimum skill set to be completed anytime throughout  NRS 221, NRS 222 or NRS 224

Intravenous Therapy and Regulation: Central lines

Central Line Intermittent IV Therapy via Secondary Infusion (piggyback)

PCA (patient controlled analgesia) pump

 Central Venous Access Devices

 Peripheral IV Direct Medications (IV push)

TPN administration and maintenance

Blood Administration

Chest Tube Maintenance

Telemetry: Cardiac Dysrhythmias  

Tracheostomy Care

Tracheostomy Suctioning

Post Mortem Care

Epidural maintenance (classroom theory)

Ventilator/ETT (classroom theory)

Code Roles

Code

Chronic Pain Advanced Interventions

Advanced Wound Care