NRSR 0022. Medical Surgical I and Pediatric Nursing
Units: 11
Prerequisite: Completion or equivalent of NRSR 21 with grade of "C" or better as determined by Dean/Department Chair or current LVN licensure and completion of BIOL 4, 5, 6, NUTF 10, HDEV 1, PSYC C1000, MATH 12 and ENGL C1000 with grades of "C" or better
Hours: 387 (104 lecture, 283 laboratory)
Theory and correlated clinical practice related to utilizing the nursing process based on Roy's Adaptation Model to promote adaptation by adult and pediatric clients and their families experiencing common and/or remedial illnesses/stressors. Students further develop skills and apply theory introduced in NRSR 21 in varied and more complex settings, and gain additional theory and skills related to new clinical areas and levels of responsibility. (letter grade only) (CSU)
NRSR 0022 - Medical Surgical I and Pediatric Nursing
http://catalog.sierracollege.edu/course-outlines/nrsr-0022/
Catalog Description Prerequisite: Completion or equivalent of NRSR 21 with grade of "C" or better as determined by Dean/Department Chair or current LVN licensure and completion of BIOL 4, 5, 6, NUTF 10, HDEV 1, PSYC C1000, MATH 12 and ENGL C1000 with grades of "C" or better Hours: 387 (104 lecture, 283 laboratory) Description: Theory and correlated clinical practice related to utilizing the nursing process based on Roy's Adaptation Model to promote adaptation by adult and pediatric clients and their families experiencing common and/or remedial illnesses/stressors. Students further develop skills and apply theory introduced in NRSR 21 in varied and more complex settings, and gain additional theory and skills related to new clinical areas and levels of responsibility. (letter grade only) (CSU) Course Student Learning Outcomes CSLO #1: Utilize the nursing process based on Roy’s Adaptation Model to provide direct total patient care to stable and noncritical geriatric or adult and/or pediatric clients with common and/or remedial health problems/stressors. CSLO #2: Analyze sociocultural and economic influences on the care of clients experiencing illness or procedure. CSLO #3: Demonstrate effective communication with health care team members regarding client status including during hand-off. CSLO #4: Identify the learning needs of clients with common or remedial illnesses/stressors and of their families. CSLO #5: Use basic teaching principles to convey information concerning daily health practices and treatment regimens. CSLO #6: Function as an effective member of the nursing team while caring for clients in the acute care setting. CSLO #7: Manage total patient care and appropriate level of care planning for two clients concurrently who are experiencing illness or procedure. CSLO #8: Take part in Advocacy for clients and self with members of the health care team. CSLO #9: Adhere to all college, program, and agency policies and regulations. CSLO #10: Administer intravenous fluids and intravenous medications with the exception of intravenous push medications. CSLO #11: Develop research skills to develop professional growth in evidence-based practice. Effective Term Fall 2025 Course Type Credit - Degree-applicable Contact Hours 387 Outside of Class Hours 208 Total Student Learning Hours 595 Course Objectives Lecture Objectives: 1. Explain and utilize the nursing process based on Roy's Adaptation Model to plan direct total care to stable and noncritical adult and/or pediatric clients with common and/or remedial health problems/stressors; 2. Describe and consider sociocultural and economic influences on the care of adult and pediatric clients experiencing common illnesses or procedures. 3. Identify how to confer appropriately with all members of the health care team and formulate effective intershift communication and client responsibility hand-off. 4. Identify the learning needs of clients with specific illnesses presented in the course. 5. Outline concepts of interdisciplinary team interactions necessary when caring for adult and pediatric clients with stable or noncritical illnesses. 6. Discuss basic legal and ethical practices for caring for adults and children with remedial illnesses, diagnostic or therapeutic procedures. 7. Describe the process for safe administration of intravenous fluids and intravenous medications, with the exception of intravenous push medications; 8. Describe concepts of prioritization and organizational skills needed to successfully manage total patient care and appropriate level of care planning for either two adults or two pediatric clients concurrently who are experiencing illness or procedures. 9. Formulate personal learning needs and goals. Clinical Laboratory Objectives: 1. Write comprehensive patient care plans using Roy's adaptation model to guide client care interventions in the clinical setting; 2. Demonstrate cultural sensitivity in care planning and when participating in direct client care for adult and pediatric clients. 3. Share and transfer client information throughout and at the end of the shift using the S-B-A-R format. 4. Use basic teaching principles to educate clients and families experiencing common disorders presented in the course. 5. Apply the concepts of ethical and legal professional practice in the development of clients care plans and when participating in direct client care 6. Perform as a member of the nursing team when caring for adult and pediatric clients with stable or noncritical illnesses. 7. Safely administer secondary intravenous medications in compliance with nursing procedure and in alignment with the nursing program's Safe Medication Administration Policy 8. Demonstrate adequate organizational and time management skills to manage total patient care and care planning for either two adult or pediatric clients. 9. Initiate a personal development plan to achieve self-identified learning needs and goals. General Education Information Approved College Associate Degree GE Applicability CSU GE Applicability (Recommended-requires CSU approval) Cal-GETC Applicability (Recommended - Requires External Approval) IGETC Applicability (Recommended-requires CSU/UC approval) Articulation Information CSU Transferable Methods of Evaluation Objective Examinations Example: Weekly nursing care plans/concept maps are required when students are assigned to the clinical laboratory. Completed nursing care plan/concept maps assignments demonstrate the student's ability to utilize the nursing process, think critically and plan care for actual adult and pediatric clients. Students are required to demonstrate a basic level of competency in performing required skills that were presented in skills lab before participating in the hospital clinical laboratory setting. Students must also pass a dosage calculation exam before administering intravenous medications in the clinical laboratory. Sample test question, Medical-Surgical Nursing: All these medications are ordered at 0900 for a client who has had a right-hip replacement the previous day and is scheduled to ambulate with the physical therapist for the first time at 0945. Which medication should be given first? a. Ceftriaxone (Rocephin) 500 mg intravenously, a cephalosporin antibiotic b. Oxycodone (Roxicodone) 5 mg orally, an opioid c. Enoxaparin (Lovenox) 30 mg subcutaneous, an anticoagulant d. Colace 100 mg orally, a stool softener Problem Solving Examinations Example: Sample test question, Dosage Calculation: 2.5 L D5NS to infuse in 24 hours. Drop factor: 10 gtt/mL. What is the hourly rate? ______ mL/hr Calculate the gravity flow rate: ______ gtt/min Projects Example: The student will complete a "Clinical Expert assignment." The student will choose a group partner. The students will choose a topic to teach the class regarding medical equipment or a medical procedure. The students will research using Ovid and scholarly resources to develop an outline, presentation, and handout to present to the class. Skill Demonstrations Example: Sample test question, Pediatrics: Bert is a 16-year-old who is admitted to the adolescent unit after an emergency appendectomy. He is in pain, and he has a NG tube in place which is draining light green fluid. There are three other teenagers in the room staring at him. What is your priority nursing intervention for Bert? a. Introduce him to the other young men and encourage interaction. b. Screen him from the other teenagers and administer a dose of pain medication. c. Tell the other boys to leave him alone and go to bed. d. Explain to the other boys what Bert has been going through. Repeatable No Methods of Instruction Laboratory Lecture/Discussion Distance Learning Lab: The student will formally interview a client about the client's surgery to gain insight into the surgical experience; the instructor will provide an assignment that includes specific prompts to elicit the client's perceptions. In addition, the instructor will arrange a surgical observational experience at the clinical facility that includes the surgical preparation area, the operating room and the recovery room. The instructor will provide a written assignment for students to record and log their perioperative observations. Grading based upon correct or incorrect answer to questions. Laboratory Human Patient Simulator: Instructor will demonstrate how to administer intravenous piggyback medication followed by the students properly performing the administering of intravenous piggyback medication under supervision. Lecture: The instructor will present an overview of musculoskeletal disorders through lecture and class discussion. The student will complete a case study containing questions which will prompt the students to explore and analyze the care of clients with total hip replacement, total knee replacement, sprains, and fractures. Instructor will guide the students to correct answers Distance Learning Faculty will enter a question in the discussion board pertaining to the content covered of the disease process. The student will answer the question and respond to two other student replies. Faculty will provide constructive feed back to the initial student post. Typical Out of Class Assignments Reading Assignments Reading assignments are regularly assigned from several adult and pediatric textbooks, current professional journals, pediatric professional association websites, government websites and consumer/client-oriented websites. Case studies assigned for lectures are to be completed before class and are used for discussion in the classroom. 1. Read the medical-surgical text chapter covering anatomy, physiology, and treatment of the gas exchange and respiratory function system of a client with COPD." Complete the assigned case study. Be prepared to discuss in class. 2. Read the material discussed in the case study, "The Infant with Congestive Heart Failure." Be prepared to discuss in class. Writing, Problem Solving or Performance 1. Weekly journal writing reflecting clinical laboratory experiences allows the student to explore options for handling clinical experiences, bridge the gap between theoretical and clinical knowledge, allow for expression of feelings, develop critical thinking, improve written communication skills, increase self-confidence, and validate assumptions and ideas. Examples of typical writing prompts: Identify one example of good leadership, delegation or management skills; note an observation of critical thinking; analyze problems encountered during the clinical week. 2. The Personal & Professional Growth in Nursing paper is a first-year capstone written assignment using weekly journal entries to analyze progression midway through the nursing program. 3. Required weekly nursing care plans demonstrate the student's ability to use the nursing process to problem-solve and plan care for clients in the clinical setting. 4. Required weekly written hand-off reports demonstrate effective intershift communication and client responsibility hand-off. 5. Clinical case studies facilitate the student's mastery of content and stimulation of critical thinking. Case studies are completed individually or in small groups and independently or as part of a lecture discussion. Examples of Arthroscopy Case Study Questions: What risk factors for hip fracture did the client exhibit? Why is the client receiving both enoxaparin (Lovenox) and warfarin (Coumadin)? What is the difference between arthroplasty and open reduction and internal fixation (ORIF)? List four critical, potential postoperative problems for the client, and explain why each is important. Other (Term projects, research papers, portfolios, etc.) Students are required to complete the Clinical Expert assignment, an exploratory, capstone project of the first year of the nursing program. Student groups present an overview of a clinical skill or operation of equipment or technology, develop written or kinesthetic learning materials and function as resources for their peers. Students must identify potential resources available at their clinical facility or in the healthcare/technology sectors in order to complete the assignment. Required Materials Fundamentals of Nursing Author: Potter and Perry Publisher: Elsevier Publication Date: 2023 Text Edition: 11th Classic Textbook?: OER Link: OER: Maternal Child Nursing Care Author: Perry, Lowdermilk, Cashion et al. Publisher: Elsevier Publication Date: 2023 Text Edition: 7th Classic Textbook?: OER Link: OER: Phillips's manual of IV therapuetics Author: Gorski Publisher: F. A. Davis Company Publication Date: 2023 Text Edition: 8th Classic Textbook?: OER Link: OER: Lewis's Medical-Surgical Nursing Author: Harding, Kwong, Hagler, Reinisch Publisher: Elsevier Publication Date: 2023 Text Edition: 12th Classic Textbook?: OER Link: OER: Lehne’s pharmacology for nursing care Author: Burchum, J. R. & Rosenthal, L. D. Publisher: Elsevier Publication Date: 2025 Text Edition: 12th Classic Textbook?: OER Link: OER: Other materials and-or supplies required of students that contribute to the cost of the course. All required textbooks and reference books for NRSR 0021 apply to this course. Books for dosage calculations, nursing care plans, drug reference, lab test reference, and medical dictionary, are also required and published in the course syllabus. Students must also purchase ATI practice tests for independent practice, preparation for clinical skills, and review of theoretical course content. Supplies for skills and clinical laboratory are also required.
NRSR 0023 - Medical Surgical II and Mental Health Nursing
http://catalog.sierracollege.edu/course-outlines/nrsr-0023/
Catalog Description Prerequisite: Completion of NRSR 22 with grade of "C" or better or current LVN licensure and BIOL 4, 5, 6, NUTF 10, HDEV 1, PSYC C1000, MATH 12 , and ENGL C1000 with grades of "C" or better; Completion of or concurrent enrollment in COMM C1000 and SOC 1 or ANTH 2 with grades of "C" or better Hours: 387 (104 lecture, 283 laboratory) Description: Theory and clinical practice related to application of the nursing process based on Roy's Adaptation Model. Students provide care for the adult client having a variety of complex medical-surgical health problems and learn to apply the nursing process for clients experiencing common mental health issues. Focus is on the role of the registered nurse in therapeutic communication, health teaching, leadership, management, and team work. Students further develop skills and apply theory introduced in NRSR 22 in varied and more complex settings, and gain additional theory and skills related to new clinical areas and levels of responsibility. (letter grade only) (CSU) Course Student Learning Outcomes CSLO #1: Apply the nursing process, based on Roy's Adaptation Model, to a team of 2-3 adult and/or geriatric clients having a variety of complex health problems within the medical-surgical environment. CSLO #2: Make use of the care planning process to aid in applying theory to clients in the clinical setting. CSLO #3: Utilize therapeutic communication (writing/verbal) skills to interact effectively with clients and their families who have complex and/or chronic physical and mental illnesses. CSLO #4: Formulate an effective transfer of care report for 2-3 adult and/or geriatric clients having a variety of complex health problems within the medical-surgical environment. CSLO #5: Evaluate the learning needs of geriatric and adult clients with common or remedial illnesses/mental health stressors and of their families. CSLO #6: Implement teaching plan for individuals, families and staff from various social, emotional, cultural and intellectual backgrounds specific to their learning needs. CSLO #7: Demonstrate effective principles of leadership: Delegation, supervision, team communication, legal aspects of care, and quality management in a team environment. CSLO #8: Prioritize advocacy for clients and self with members of the health care team. CSLO #9: Adhere to all college, program, and agency policies and regulations. CSLO #10: Model safe initiation and management of intravenous therapy to all adult age groups according to community standards and the principles set forth by the Infusion Nurses Society. CSLO #11: Evaluate progress towards weekly learning objectives based on identification of individual learning needs through joint instructor-student evaluation. Effective Term Fall 2025 Course Type Credit - Degree-applicable Contact Hours 387 Outside of Class Hours 208 Total Student Learning Hours 595 Course Objectives Lecture Objectives: 1. Review and remediate previous semester skills and objectives. 2. Identify community standards and the principles set forth by the Infusion Nurses Society when initiating intravenous therapy. 3. Compare effective principles of leadership: Delegation, supervision, team communication, legal aspects of care, and quality management in a team environment. 4. Analyze strategies to successfully manage total care for 3 clients in the medical surgical environment to include application of the nursing process and effective transfer of care. 5. Summarize components of effective professional communication and personal safety in high risk environment. Clinical Laboratory Objectives: 1. Maintain previous semester skills and objectives while caring for clients in the medical-surgical and mental-health settings. 2. Safely initiate and manage intravenous therapy according to community standards and the principles set forth by the Infusion Nurses Society. 3. Demonstrate effective principles of leadership, delegation, supervision, team communication, legal aspects of care, and quality management in a team environment. 4. Successfully manage total care for 3 clients in the medical surgical environment to include application of the nursing process and effective transfer of care. 5. Demonstrate effective professional communication and personal safety in a high risk environment. General Education Information Approved College Associate Degree GE Applicability CSU GE Applicability (Recommended-requires CSU approval) Cal-GETC Applicability (Recommended - Requires External Approval) IGETC Applicability (Recommended-requires CSU/UC approval) Articulation Information CSU Transferable Methods of Evaluation Objective Examinations Example: Sample Objective Question: 1. Which is an indication for use of seclusion and restraints for a client in a psychiatric facility? A. Client is loudly using profanities B. Client cannot verbally contract for safety C. Client is striking at other clients and staff D. Client is continually using the phone to call the White House Sample test question for leadership & management: 2. A client has just returned from the surgical suite following a colon resection. Which of the following tasks is appropriate for a nurse to delegate to assistive personnel? a. asking the client about his pain level every hour. b. Checking the placement of the nasogastric tube at least once a shift. c. Looking at the client's dressing and determining the amount of drainage every other hour. d. Obtaining the client's vital signs every hour x 4 and then every 4 hours for 48 hours. Projects Example: Clinical Leadership, Quality Improvement, & Change Proposal: Identifying an area needing change, proposing a specific change and outlining how the change process could be implemented and evaluated. Present a 5-minute overview of your proposal to your fellow students utilizing PowerPoint or other visual support. Skill Demonstrations Example: Initiate IV placement with two successful IV insertions. Skill validation and evaluation consists of scheduled faculty supervision and 100% success on skills checklist. Repeatable No Methods of Instruction Laboratory Lecture/Discussion Distance Learning Lab: Prior to the IV Start Skills Lab, the instructor will assign (a) readings from the Manual of IV Therapeutics (b) completion of the online Intravenous Therapy Learning Module/Healthy Community Forum (c) Mosby’s IV Therapy Skills Modules and (d) direct students to review the product web site product animations. In addition, the students will take the 101-question IV therapy exam and pass with 90% or will remediate. The instructor will also review safety protocols for the lab, with a focus on prevention of blood-borne contamination and accidental needle stick. With a maximum of 10 students in each lab, the instructor will demonstrate IV placement using a variety of catheters with a mannequin arm or IV start simulator. The instructor will observe each student simulating IV catheter placement. The instructor will review the Healthy Community Forum checklist criteria with volunteer RNs and will oversee the RNs directly observing students performing IV starts on each other. The instructor will offer direct guidance as needed. In the hospital clinical lab, the instructor will continue the observation/checklist criteria process and document when the student has successfully placed 6 IV catheters in human arms. In preparation for the Clinical Leadership, Quality Improvement, & Change Proposal project, the instructor will assign the students to review chapters in the leadership textbook, Whitehead. The instructor will distribute the Unit Assessment Worksheet and the Diagnosis & Planning Worksheet via the course syllabus. Once submitted, the instructor will review each group’s preliminary work and offer pertinent, formative feedback. Each group will post a Nursing Process SBAR (Situation, Background, Assessment, Recommendation)and details regarding their identified change proposal. At the conclusion of group presentations, the instructor will give overall feedback and grade the project according to the Clinical Leadership, Quality Improvement, & Change Proposal grading criteria/rubric is in appendix A of syllabus. Lecture: The instructor lectures on focused care, pathophysiology and standards of care. Students will then complete focused care plan, pathophysiology, standards of care, and medication sheet for each client. These are then turned in to the instructor who reviews and discusses with student. Distance Learning Faculty will enter a question in the discussion board pertaining to the content covered of the disease process. The student will answer the question and respond to two other student replies. Faculty will provide constructive feed back to the initial student post. Typical Out of Class Assignments Reading Assignments Students will follow weekly content from assigned readings in required and recommended text books and professional journals. 1. Medical-Surgical Nursing: read "Neurosensory Disorders." Use information to identify changes in client condition and provide care. 2. Mental Health Nursing: read "Schizophrenia and other Psychotic Disorders." Use information to identify changes in client condition and provide care. Writing, Problem Solving or Performance 1. Case studies are assigned as individual or group work to help the students learn concepts, nursing interventions and to stimulate critical thinking. Part of the lecture time is used for discussion of case studies. 2. Weekly Interpersonal Process Recordings, student journals and client assessments are required when student is in the hospital clinical setting with clients. 3. Nursing care plans using the nursing process and assessment tools are required in each area: leadership, management, adult medical surgical nursing and care of the client with mental health illness. The care plans demonstrate the student's ability to use the Nursing Process to problem-solve a plan for safe client care. 4. Complete Case Study: "Working with a Person who is Paranoid," completing the assessment, nursing diagnosis, planning, intervention and evaluation. Other (Term projects, research papers, portfolios, etc.) Using the Nursing Process, select a Quality Improvement project and research best practice guidelines using OVID (Sierra College library link. Design and present change proposal. Required Materials Medical-Surgical Nursing Assessment and Management of Clinical Problems Author: Harding, Kwong, Hagler, Reinisch Publisher: Elsevier Publication Date: 2023 Text Edition: 12th Classic Textbook?: OER Link: OER: Manual of IV Therapeutics Author: Gorski Publisher: F.A. Davis Publication Date: 2023 Text Edition: 8th Classic Textbook?: OER Link: OER: Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical Approach Author: Halter Publisher: Elsevier Publication Date: 2022 Text Edition: 9th Classic Textbook?: OER Link: OER: Other materials and-or supplies required of students that contribute to the cost of the course. Books and supplies required and suggested for previous semesters: NRSR 0021 and NRSR 0022.
