Health, Healing, and Nursing Process 3: Orientation

• This is an orientation and introduction to Health, Healing, and the Nursing Process 3.

Learning Outcomes

• Get to know Health, Healing and Nursing Process 3 faculty and peers.
• Understand the learning sequence and evaluation methods of the course.
• Know the resources and supports available to students.

Course Agenda

• Introductions
• Course overview
• Learning plan
• Assignment outlines and expectations
• Introduction to preoperative nursing care
• Next steps

Course Resources

• Lewis Medical Surgical Nursing in Canada (2023), Fifth Edition, ISBN: 978-0-323-79156-4, Elsevier, Canada.
• Potter and Perry's Canadian Fundamentals of Nursing (2024), 7th edition, Elsevier.
• PN Clinical Learning Suite – Elsevier
• PN handbook (2023-2024)

Class Details

• Core theory course in Semester 3 of the program.
• Heavy content expected.
• Focus is on acute/surgical conditions.
• Live lecture and seminar each week via Zoom.
• Preparatory readings, videos and activities are required before lecture and seminar.
• A minimum grade of 60% is required to pass.

Lectures vS Seminars

• Fully online course with an online lecture and an online seminar
• Lecture is 2 hours + Seminar is 2 hours
• Schedules are separate on timetable
• Separate Zoom links are in course shell
• Lectures focus on teaching content.
• Seminars focus on application of content.
• Both are needed to be successful.

Course Completion Time Frame

• Module 1 – Welcome and Intro to Perioperative nursing
• Module 2 – Intraoperative and Postoperative nursing
• Module 3 – Acute and surgical renal and urological
• Module 4 – Acute gastrointestinal
• Module 5 - Cancer Part 1
• Module 6 - Cancer Part 2
• Module 7 – MIDTERM and Integumentary conditions
• BREAK WEEK – NO CLASSES
• Module 8 – Acute cardiac and vascular
• Module 9 – Acute respiratory
• Module 10 - Special populations: pediatrics
• Module 11 - Neuro and shock
• Module 12 - Mental health Part 1
• Module 13 - Mental health Part 2
• Module 14 – FINAL EXAM

Evaluation Schedule

• All quizzes and assignments are due/close on Fridays at 1700
• Online Quizzes: Weeks 4, 9, 13, 15% of grade, Online
• Midterm: Week 7, 20% of grade, Onsite (IAHS)
• Group Collaborative Learning Activities: Weeks 3, 6, 9, 15% of grade, Online
• Policy and Procedure Group Assignment: Week 12, 15% of grade, Online
• Final Exam (cumulative): Week 14, 25% of grade, Onsite (IAHS)
• Seminar attendance and participation: Weekly (Weeks 2-13), 10% of grade, Online

Evaluation Types

• Quizzes
  • Open Mondays at 0800, close Fridays at 1700
  • One attempt
  • 15 questions in 45 minutes
  • Tricky questions will be reviewed during lecture the following week after a quiz closes
  • Questions come from quiz banks
• Midterm and Final exam
  • Week 7 and Week 14 (dates/times TBD)
  • On campus and in-person – expectation that students attend
  • 50 questions
  • The final exam is cumulative.

Group Evaluation Details

• Create groups under "People"
  • 4 students per group
  • Work in small groups for all group assignments and during Seminar activities
• Group contract
• Collaborative Learning Activities (x3)
  • 3 parts: 1) Answer questions, 2) create a case scenario + question and post to Discussion board, 3) answer another groups question on Discussion board
• Policy and Procedure Group Assignment
  • 2 topics to choose from
• MyCanvas has assignment descriptions, expectations, and rubrics

Seminar Evaluation

• Students are evaluated weekly: attendance, preparation, participation, collaboration, professionalism, etc.
• Attendance is determined by the seminar professor and you need to attend to get marks.
• This semester there is a change and students expected to take a leadership role during Seminar (rotate on a weekly basis).
• See MyCanvas for description, expectations, and rubric

Remote Learning Tips

• Need a Mohawk account using a Mohawk email for Zoom
• Join virtual classes on time from a quiet space, minimize distractions and don't multi-task
• Come to classes prepared, engaged and ready to participate; take notes and ask questions
• Access MyCanvas and Mohawk Email daily for announcements and updates
• Manage time and know your dates (due dates, academic dates, etc.)
• Stay organized, join a study group and find study strategies that work
• Be accountable and professional

Course Success Strategies

• Do not procrastinate or fall behind; stay on top of readings and assignments
• Ensure learning environment is conducive, take notes, ask questions, be engaged
• Time management and organization are essential
• For every 1-hour of class time (lecture/seminar), have at least 2 hours of prep time
• Use supports such as program coordinators, instructors, the student success advisor, peers, class reps, etc.; do not hesitate to ask for help when struggling

What if the Teacher is Late?

• Communicate via Announcement on MyCanvas
• Stay in the class for 15 minutes, and faculty will send a message in that time

Class Break Times

• Each lecture and seminar has a 5–10-minute break
• Microphone should be muted and camera turned off during breaks

Academic Calendar Details

• https://www.mohawkcollege.ca/academic-and-important-dates
• Key dates for students, faculty, and staff
• Contains specific semester dates: start/end dates, registration, withdraw, add/drop classes, graduation, holidays, etc.
• The calendar is posted each year
• Students are not expected to travel during the semester

Student Services

• Student Success Advisor: Joanne Tansley
• Learning Support Center
• Accessible Learning Services
• Library, digital skills
• Student health and wellness
• Peer mentors
• Class representatives

Academic Integrity

• Academic Integrity demonstrates a commitment to honesty, trust, fairness, respect, responsibility, and courage
• Breaches of academic integrity include:
  • Using someone else’s words, ideas, etc. without citations or giving credit (plagiarism Giving another student work you have completed, Using AI platforms talking, copying, using aids,Impersonation of any kind,posting assignments, Falsification of documents
  • https://www.mohawkcollege.ca/about-mohawk/leadership-and-administration/policies-and-procedures/corporate-policies-and-19

Missed Evaluations

• Students are responsible for submitting all assignments and completing all quizzes/exams on time
• Alternate arrangements are only for students with legitimate medical or exceptional circumstances, or an accommodation through Accessible Learning Services
• Faculty follow the Student Assessment Policy and the PN Handbook
• Notify faculty ahead of the deadline whenever possible
• If the deadline has passed, connect with faculty within 5 days
• Extensions cannot be provided for group assignments, or same-day.
• Never send supporting documentation directly to professors

Module 1: Perioperative Nursing Care

• The topic covers Health, Healing, and the Nursing Process 3

Learning Outcomes

• Rationales for surgery settings
• Preoperative nursing care, priorities, assessments, risk evaluation, and common medications
• The nurse's role in preparing patients physically, psychologically, and educationally for surgery
• Role of informed consent, components, and the nursing role

Surgery Definitions

• Perioperative is the total surgical episode
• Performed for
  • Cure or repair
  • Palliation and prevention
  • Diagnosis and exploration
  • Cosmetic improvements

Surgical Settings

• Emergency: Unexpected, urgent
• Elective: Planned
• Same-day admission with a hospital stay after surgery
• Ambulatory (same-day surgery)
  • Procedures usually take less than 2 hours
  • Usually less than 3–4 hours in Post-Anesthesia Care Unit (PACU)
  • Patient discharged home same day of surgery

Surgical Settings Nurse Information

• Know the nature of the disorder necessitating surgery and any coexisting disease processes.
• Identify the individual client's response to the stress of surgery.
• Assess the results of appropriate preoperative diagnostic tests.
• Consider the bodily alterations and potential risks and complications associated with the surgical procedure and any coexisting medical problems.

Pre-operative Assessment Points

• Client interview in advance of surgery.
• Physical assessment, collection of admission data, review consent forms, pre-anesthesia evaluation, client's weight and airway history and lab test and diagnostic tests.

Information Provided Includes

• Protocol for taking routine medication on day of surgery.
• The medications (e.g., anticoagulants) or herbal remedies to stop prior to surgery and when to stop them.
• Nothing-by-mouth (NPO) instructions.
• Pain management options.
• Infection prevention and wound care.
• Postoperative exercise instructions.
• Postoperative discharge and care.

Nursing Assessment on Surgery Day

• Overall goals are confirming and identifying changes to physical status.
• Determine psychological status.
• Establish baseline data, e.g., VS, lab values.
• Review medications.
• Ensure preoperative lab and diagnostic tests are completed and documented.
• Support the client and family.
• Determine informed decision to have surgery.
• Understand discharge plan and has postoperative support.

Subjective Data: Psychosocial Assessment

• Use interpreter if needed.
• It is important to know the meaning of surgery to a patient and also one's susceptibility to stress (ex. coping Strategies; age; past experiences, current health; socioeconomic status etc.), which can negatively affect surgery outcomes.
• Anxiety stems from a lack of knowledge, uncertain outcomes, a lack of control, and other possible complications and information and support lessens anxiety
• Common fears: Fear of death, pain and discomfort, mutilation or change in body image
• In those circumstance it is important to remain non-judgmental, provide information and reassurance, and consult with other team members.

Subjective Psychosocial Assessment Day of Surgery

• Situational Changes
• Concerns with the Unknown
• Concerns with Body Image
• Past Experience
• Knowledge Deficit

More Day of Surgery Points

• Coping with surgery is important because the transition through the perioperative period affects postoperative recovery.
• Spirituality, inner peace, and hope all act as positive coping mechanism
• Assess and support the whole patient and implement preoperative approach to client care

Subjective Health History Assessment Points

• Follow hospital policy
• Ask about diagnosed medical conditions and current health issues, and reason for surgery, then about previous hospitalizations and surgeries
• Also note any problems with past surgeries, complications, or reaction to anesthetics
• Ask about the patients menstrual/obstetric and familial health history as well as about cardiac or endocrine diseases Reactions/problems to anesthesia

Subjective: Current Medications Note

• Prescription and over-the-counter (OTC) medications
• Herbal, Dietary supplements, and vitamins
• Specific herbs and concern during the complementary period
• Recreational drug use

Allergies on Assessment Day

• Pharmaceuticals
• Non-Pharmaceuticals
• Foods, metals, chemicals, tape, and pollen
• Check for possible latex allergies and if there is contact dermatitis, allergies to nuts, bananas, avocados, kiwi

Review of Systems

• Review of the nervous system
• Includes an evaluation of one's neurological functioning and influence responses
• Cognition to assess deficits before surgery

Cardiovascular and Surgery Day

• The key is to determine pre-existing conditions for effective monitoring during surgery and recovery
• Includes asking about use of cardiac drugs history of pacemaker. Vitols should be recorded and bleeding reviewed

Respiratory System Prior to Surgery

• Inquire about recent or chronic upper respiratory infections.
• Note the procedure can be postponed due to increased risk
• Take note of history of and treatment for asthma
• Smokers should be encouraged to quit 8 weeks before procedure to decrease risk of complications and pulmonary problems.
• Pack years are a big risk

Urinary and Inguementary Systems

• If there is a history of urinary problems and function checks that should be investigated and catheter considered
• Inguementary also need to be checked due to skin conditions for infections

Muscoskeletal System Prior to Surgery

• Identify joints affected with arthritis and mobility restrictions may affect positioning and ambulation, so bring mobility aids to surgery
• Report any problems with the neck, as it can affect anaesthesia and management airway

Surgery and the Endocrine System

• Patients are at higher risk of hypo/hyperglycemia during surgical treatment. So baseline blood glucose should be checked regularly

Immune Systems

• Compromised and suppressed immune systems can affect wound and risk of infection and surgery

Fluid and Electrolyte Status

• Vomiting, diarrhea, or difficulty swallowing can cause imbalance Identify drugs that alter status • Diuretics

Nutritional Status and Surgery

• Obesity comes with risks related to the stress of surgery
• Malnutrition makes linked to slow healing

Objective Data: Physical Examination

Each province/territory and health authority mayhave its own policies on preoperative healthassessments, but it is important to have aphysical examination documented on the chart in case surgical complications arise Includes: neurological system, cardiovascularsystem, respiratory system, urinary system,hepatic system, endocrine and hematologicalsystems, integumentary system, MSK system,Gastrointestinal-nutritional system Table 20.5

20-4 ASA PHYSICAL STATUS CLASSIFICATION SYSTEM

• ASA I: Healthy normal patient
• ASA II: Patient with mild systemic disease
• ASA III: Patient with severe systemic disease
• ASA IV: Patient with severe systemic disease that is a constant threat to life
• ASA V: Moribund patient not expected to survive without surgery
• ASA VI: Brain-dead patient

Objective: Assessment

• Laboratory and Diagnostic Testing The need for preoperative laboratory andelectrocardiogram testing is determinedbased on the client’s history Common tests
• Table 20.6 Nurses Document relevant findings and reportto perioperative team Obtain and evaluate results oflaboratory tests Ensure results are on the chart

Preoperative Education Key Points

• It is important to empower education
• It is important to be aware of language and health literacy

Preoperative Education Points Continued

• Identify client's education needs: age, reading level, other issues
• Education is a team effort
• Three types of information
• sensory information
• process general information
• Procedural information

Other Information

• There should be the clients information recorded Then they should be educated on NPO and breathing in the event of Post OP

Ambulatory surgery

• There are special things that need to be reviewed for pre OP

Surgery needs Legal Preparation

• Make sure all information is signed and understood

Surgery and Voluntary Contact

Patient can remove consent whenever Operative consent understood

Next Steps

• Following week's topic: Intraoperative care
• Upcoming assignments and assignments: group reports
• Small group seminars, to meet with week 2

Orientation and introduction to Health, Healing, and the Nursing Process 3. Get to know the faculty and peers. Understand the learning sequence, evaluation methods and available resources. This course focuses on acute/surgical conditions.