NET ED 0050- 24 DIPLOMA IN NURSING INTEGRATED GENERAL NURSING SCIENCE 2 SECTION B STUDY GUIDE MAY 2024.pdf
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DIPLOMA IN NURSING INTEGRATED GENERAL NURSING SCIENCE 2 STUDY GUIDE PART 2 Author: Netcare Education Curriculum Committee NET ED 0050/24 Date: May2024 COPYRIGH...
DIPLOMA IN NURSING INTEGRATED GENERAL NURSING SCIENCE 2 STUDY GUIDE PART 2 Author: Netcare Education Curriculum Committee NET ED 0050/24 Date: May2024 COPYRIGHT WARNING NOTICE This document is the property of Netcare Education (Pty) Ltd. Copyright subsists in this work. Any unauthorized reproduction, publication or translation of the work are acts of copyright infringement, make the doer liable for civil law copyright infringement, and may make the doer liable to criminal prosecution. The compilation and input to the document was obtained from experts in Netcare Education – Faculty of Nursing and Ancillary Healthcare and/or NETCARE and/or additional consulting experts. Any changes and alterations can only be made with the approval of Netcare Group Director of Nursing and Nursing Education and/or as duly delegated to a relevant, authorized person. Reference to one gender can be interpreted to imply as belonging to either gender. All documents for programmes offered by Netcare Education are under the management of Netcare Education – Faculty of Nursing and Ancillary Healthcare and/or NETCARE as applicable. Studies conducted with Netcare Education are subject to the provisions of, and requirements set out in terms of all applicable laws, as promulgated in the Republic of South Africa, from time to time, compliance with which is mandatory for Netcare Education FNAH students. For comments and suggestions, please e-mail the Netcare Education Academic Head [email protected] i TABLE OF CONTENT SECTION A.............................................................................................................................1 1. STUDENT SUPPORT....................................................................................................1 1.1 Academic Support......................................................................................................1 1.2 Academic Resources..................................................................................................1 1.3 Technical Support.......................................................................................................2 2. HOW TO USE THIS STUDY GUIDE.............................................................................2 3. PROGRAMME AND STUDY AREA OVERVIEW............................................................5 3.1 Programme Overview................................................................................................5................................................................................................................................................6 4. MODULE OVERVIEW...................................................................................................6 4.1 NQF Level....................................................................................................................7 4.2 Credits for the Module...............................................................................................7 4.3 Purpose of the Module..............................................................................................7 4.4 Critical Cross-Field Outcomes of the Module..........................................................8 4.5 Module Exit Level Outcomes and associated assessment criteria........................9 4.6 Module Learning Outcomes................................................................................... 10 4.7 Learning Units.......................................................................................................... 11 5. LITERATURE RESOURCES........................................................................................ 14 5.1 Prescribed Resources............................................................................................. 14 5.2 Recommended Resources...................................................................................... 14 5.3 Additional Resources.............................................................................................. 15 6. ASSESSMENT OF THIS MODULE............................................................................. 15 6.1 Formative Assessments.......................................................................................... 15 ii 6.2 Summative Assessment.......................................................................................... 16 6.3 Monitoring of Academic Progress......................................................................... 17 6.4 Requirements to Pass and Calculation of Marks................................................. 17 7. PERSONAL OBJECTIVES........................................................................................... 18 SECTION B. LEARNING UNITS........................................................................................... 19 LEARNING UNIT 6 DISORDERS AFFECTING OXYGENATION.......................................... 20 Learning Unit 6.1 Introduction to Disorders Affecting Oxygenation............................ 23 Learning Unit 6.2 Management of Patients Diagnosed with Disorders Affecting Oxygenation....................................................................................................................... 30 Learning Unit 6.3 Management of Patients Diagnosed with Chronic Obstructive Pulmonary Disorders........................................................................................................ 39 Learning Unit 7 skin, skin integrity and the maintenance of skin integrity................. 43 Learning Unit 7.1 Disorders Related To Tissues And Cells............................................ 45 Learning Unit 7.2 Introduction To Disorders Of The Skin............................................. 48 Learning Unit 7.3 Management of Disorders of the Skin.............................................. 51 Learning Unit 7.4 Management of a Patient Presenting with a Burn Injury................ 53 Learning Unit 7.5 Wound Healing.................................................................................... 55 Learning Unit 7.6 Skin Agents.......................................................................................... 59 Learning Unit 8 disorders affecting mobility and exercise/ mobilisation.................... 62 Learning Unit 8.1 Introduction To The Disorders Affecting Mobility And Exercise..... 67 Learning Unit 8.2 Management Of Disorders Affecting Mobility And Exercise........... 70 Learning Unit 9 Disorders Affecting Urinary Elimination.............................................. 80 Learning Unit 9.1 Introduction To The Disorders Affecting Urinary Elimination........ 83 Learning Unit 9.2 Management Disorders Affecting Urinary Elimination Related To The Renal/Urologic System............................................................................................... 87 iii Learning Unit 10 Disorders Affecting Nutrition and Fecal Elimination........................ 97 Learning Unit 10.1 Introduction To The Disorders Affecting Nutrition And Fecal Elimination....................................................................................................................... 100 Learning Unit 10.2 Management Of Disorders Related To The Upper Gastrointestinal System.............................................................................................................................. 107 Learning Unit 10.3 Management Of Disorders Related To The Lower Gastrointestinal System.............................................................................................................................. 114 Learning Unit 10.4 Management Of Disorders Related To The Accessory Organs Of Digestion........................................................................................................................... 120 Learning Unit 11 Disorders Affecting Hormonal Regulation/The Endocrine System 125 Learning Unit 11.1 Introduction To And Management Of Disorders Affecting Hormonal Regulation/The Endocrine System.............................................................. 127 Learning Unit 11.2 Management Of Diabetes Mellitus And Related Metabolic Disorders.......................................................................................................................... 135 Learning Unit 12 Disorders/Drugs Affecting the Nervous System/ Intracranial Regulation........................................................................................................................ 141 Learning Unit 12.1 Introduction To And Management Of Disorders Affecting The Nervous System/Intracranial Regulation...................................................................... 145 Learning Unit 12.2 Autonomic Nervous System Agents.............................................. 160 Learning Unit 12.2.1 Adrenergic Agonists (Sympathomimetic) And Adrenergic Blockers (Sympatholytic)................................................................................................. 161 Learning Unit 12.2.2: Cholinergic Agonists And Anticholinergics.............................. 164 Learning Unit 12.3 Neurologic And Neuromuscular Agents....................................... 168 Learning Unit 12.3.1 Central Nervous System Stimulants.......................................... 168 Learning Unit 12.3.2 Central Nervous System Depressants....................................... 173 Learning Unit 12.3.3 Anticonvulsants – Refer To Learning Unit 12.1 (17).................. 175 iv Learning Unit 12.3.4 Drugs For Neuromuscular And Neurodegenerative Disorders - Refer To Learning Unit 12.1 (13; 14).............................................................................. 176 LEARNING UNIT 13 DISORDERS RELATED TO SENSATION AND PERCEPTION.......... 178 Learning Unit 13.1 Ear, nose and throat disorders and the management thereof.. 178 Learning Unit 13.2 Eye and Vision Disorders and the management thereof............ 182 Learning Unit 13.3 Medications for Eye and Ear Disorders......................................... 185 v STUDENT PERSONAL INFORMATION My Name My Student Number My telephone number My e-mail address My clinical facility Year of study vi SECTION A 1. STUDENT SUPPORT 1.1 Academic Support Your module coordinator’s name is Your module coordinator’s contact no is Your module coordinator’s e-mail address is Should you require any assistance during the facilitation process, you may obtain this assistance through any of the following ways: a. Questioning during class, b. Making an appointment with the programme coordinator in person, via e-mail or telephonically, and/or c. Posing questions via e-mail. Please ensure that you prepare yourself for the remediation session to pinpoint exact learning needs, misconceptions or learning difficulties. Group remediation sessions are conducted when necessary and must be arranged in advance. Remediation, whether in groups or individually, takes place in the student’s own time and you are responsible for making necessary arrangements to accommodate work obligations. 1.2 Academic Resources Netcare InSight, the e-learning platform for Netcare and Netcare Education contains a section on Academic Resources available for the use of students and academic staff. You are Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 1 of 195 encouraged to supplement your learning with additional reading and literature you can access through the Academic Resources section. Primal Pictures (Anatomy.tv!), EBSCOhost and OVID, among others can be accessed through the Academic Resources section. EBSCOhost and OVID are databases you can use to search for additional information. Your module coordinator or Campus-Based Academic Staff member will arrange an orientation session for you on the use of the Academic Resources section. 1.3 Technical Support The campus academic resource centre (ARC) is open and may be accessed by you from 08h00 until 16h00 during the week. You will receive a library card which you will use to access the ARC. The ARC has books and online resources that you can utilise to supplement your studies and to work on your assignments. The ARC custodian is available to assist you with queries and online searches, between 08h00 and 15h00 during weekdays. 2. HOW TO USE THIS STUDY GUIDE a. Ensure that you orientate yourself to how this module fits into your programme. b. Read the overview of the module carefully so that you can obtain a feel for what the module is all about. c. Decide which objectives you would like to reach and write them into the space provided. Ensure that they are specific, measurable, attainable, realistic, time specific (SMART), and a challenge for you. Objectives which are too easy or difficult to reach will demotivate you. d. Enter your due dates into your year planner. Remember to add interim deadlines to ensure you work consistently throughout the year and that you successfully reach your deadlines. e. Work through the learning unit objectives before class. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 2 of 195 f. It is imperative that you complete pre-lecture preparation activities and come to class prepared. Pre-lecture preparation ensures that you are ready to listen effectively and participate in class. g. Gather information utilising your prescribed book/s, recommended reading, and the internet as per the module instructions. Utilize the Academic Resources section to supplement your reading/resources. h. You are required to engage with evidence-based nursing care to ensure you can deliver state of the art, evidence-based nursing care to a variety of patients across the different stages of life in a variety of health care settings. i. Summarise your work in a format that will be easy to learn from. It is advisable to do these summaries electronically as this would enable you to add additional information after the class. j. Read your summaries and list your questions to the facilitator. k. Attend the class and take notes during lectures, and complete the learning activities in the class. Ensure that you ask all your questions and that you receive adequate guidance on these. l. Complete your summaries after class. m. Read all the work again and ensure you have summarised the work with sufficient depth to be able to answer all the objectives. n. Compile spider diagrams/brain charts to facilitate your learning. o. Apply the knowledge to the practice daily. p. Complete the learning unit activities and assignments. Compile all your completed activities in a portfolio to provide evidence of your competence. q. Participate in web-based discussion forums. You will be required to write your reflections on selected topics and comment on at least two other students’ comments/reflections. r. Upon completion of the learning unit complete the reflection at the end of the learning. Write your reflections in a diary and bring them to class for possible discussions. s. Digitally Enhanced Learning (DEL) refers to the use of a variety of digital technologies to enrich your learning experiences. During DEL supportive learning material will be Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 3 of 195 uploaded on the Netcare InSight platform under the DNIGNS 2 (Diploma in Nursing Integrated General Nursing Science 2) module. InSight is a Moodle-based learning management system we use to support the delivery of theoretical content enhancing your learning. Be sure to access the student lesson guides before class to assist you with preparation for class, participate in class and reflect on your learning after class. t. Be on the lookout for interesting learning opportunities where you and your colleagues can work together on objectives, activities, and assignments e.g., Wikis and Chat rooms. Participate in the virtual classrooms “Big Blue Button” (BBB) and online discussions. u. You are required to revise the related Anatomy and Physiology before class, as this will not be revised during class. However insufficient knowledge of anatomy and physiology will affect your ability to understand pathophysiology, formulate nursing diagnoses for disease-related health problems and prescribe nursing interventions. v. Remember to identify the key concepts and terminology of each learning unit and make a note of the definitions. w. You can also use Primal Pictures / Anatomy.tv through the Netcare InSight Platform “Academic Resources for Netcare Education” to revise your anatomy and physiology. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 4 of 195 3. PROGRAMME AND STUDY AREA OVERVIEW 3.1 Programme Overview This programme is a three-year programme. The figure below illustrates the programme content and indicates where the current module fits in: Year 1 Year 2 You are here. Year 3 DNAP1 DNIGNS2 DNIGNS3 Year Modules DNPSS1 DNPHC2 DNPHC3 DNIGNS1 DNND3 DNNR3 Semester Modules DNEPP1A DNMHN2A NA 1st 2nd Semester DNND2B Modules DNPHARM1B NA DNNR2B DNAP Anatomy and Physiology DNPSS Psychosocial Science 1 Integrated General Nursing Ethos and Professional Abbreviations DNIGNS DNEPP Science Practice DNPHARM Pharmacology DNPHC Primary Healthcare DNMHN Mental Health Nursing DNND Nursing Dynamics DNNR Nursing Research Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 5 of 195 3.2 Study area overview This module belongs to the study area of Integrated General Nursing Science (IGNS). You have successfully completed General Nursing Science 1. In IGNS 2 you will be introduced to diseases, disease processes and the management thereof, furthering your knowledge of nursing and building on the foundation laid in your first year. IGNS 2 consists of a theoretical and a clinical component. You are required to successfully complete General Nursing Science 2 to progress to IGNS3. INTEGRATED GENERAL NURSING SCIENCE (IGNS) DN DN DN IGNS1 IGNS2 IGNS3 You are here. 4. MODULE OVERVIEW In this section, an overview of the module is provided. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 6 of 195 4.1 NQF Level IGNS2 is presented on an NQF Level 6 4.2 Credits for the Module IGNS2 comprises 78 credits of which 31.2 are theory and 46.8 are Work Integrated Learning (WIL) credits. 4.3 Purpose of the Module This module is an integral part of a qualification that enables the graduate to function as a clinically focused, service orientated, independent registered General Nurse, who can render nursing care as determined by the appropriate legislative framework. The module progressively develops the student’s ability to make decisions about what is within and beyond the defined scope of practice, as well as an understanding of the referral system in place for anything outside of the scope of practice. The student will be guided to apply evidence-based nursing practice which is based on research or established practices that have proven to be effective both nationally and internationally within the profession. The IGNS2 module lays the foundation for the development of a competent nursing practitioner in a range of healthcare settings. The module further aims to equip the future graduate with a range of skills, knowledge and attitudes that will enable them to make a meaningful contribution to health services. The student will gradually develop transferable skills for application in other professions, disciplines, and general life. These include: Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 7 of 195 a. A methodical, solution-based approach to problem solving. b. An empowerment strengths-based approach to personal development c. Competence in written and oral communication d. Capacity to assess and implement health and other policies. e. Ability to plan, implement and manage projects of a varied nature. f. Ability to work independently and as part of a team. Upon successful completion of this module the student will progress to the IGNS3 module provided all modules are successfully completed. Successful completion of the IGNS modules, together with the other modules in the programme will render the student eligible for registration as a General Nurse with the South African Nursing Council. 4.4 Critical Cross-Field Outcomes of the Module 1 Problem-solving skills Use your own knowledge to identify and solve problems within the realm of nursing in both familiar and unfamiliar, but related contexts. 2 Teamwork Work effectively as part of the healthcare team to promote health, prevent illness, restore health, and alleviate suffering. 3 Self-responsibility skills Managing oneself and taking responsibility for one's own performance and personal and professional development in a supervised environment. Take responsibility for one’s own actions and decisions within a well-defined context. 4 Critical thinking Ability to gather evidence, analyze, organize, and critically evaluate information and the effectiveness of nursing interventions. 5 Communication skills Communicate effectively, using visual and linguistic skills in oral and written format. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 8 of 195 Produce clear and accurate verbal and written records of the nursing and health care delivered to health care users. 6 Technological enablement Use science and technology effectively and show and advanced literacy responsibility for the environment and others. Knows the procedures and techniques particular to the field of learning and demonstrates the ability to select and apply the procedures and techniques particular to the field of nursing to effectively implement nursing care throughout the lifespan. 7 Understand the world as a Demonstrate an understanding of the world as a set of set of related systems related systems by recognizing that problem-solving contexts do not exist in isolation. Understand the operating environment 8 Reflect on own learning Demonstrate the ability to reflect on own learning and learning which will enable further learning 9 Responsible citizenship Participate as responsible citizens in the life of local national and global communities 10 Culturally and Demonstrate cultural and aesthetic sensitivity. aesthetically sensitive Understand the operational environment in a wider context 4.5 Module Exit Level Outcomes and associated assessment criteria No. Exit level outcome Associated assessment criteria Apply knowledge of natural Knowledge of anatomy and physiology is 1. and biological sciences in the 1.1 applied in providing nursing care for the practice of nursing. health care user. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 9 of 195 No. Exit level outcome Associated assessment criteria Knowledge of psychology and sociology is 2.1 applied in ways which benefit the quality of Apply knowledge of psycho- health care delivered to health care users. 2. social sciences in the practice Social and diversity-sensitive care is 2.3 of nursing. implemented in nursing practice. Emotional demands of nursing practice are 2.5 dealt with effectively. Preventative, promotive, curative, and Provide nursing care rehabilitative nursing care is provided to 4. throughout the lifespan in 4.1 different age groups in various health care various health care settings. settings. Render nursing care within a Nursing care is rendered within an ethical legal 5. 5.1 legal and ethical framework. framework. Use and maintain health care Health care information systems are used and 6. information systems for 6.1 maintained in the practice of nursing. nursing practice. 4.6 Module Learning Outcomes Upon completion of the module, you will be able to: a. Provide nursing care and promote health throughout the lifespan in various healthcare settings related to disorders affecting the various body systems e.g., circulation, oxygenation, immunity, elimination, mobility, sensation, and perception. Provide preventative, promotive, curative, and rehabilitative care to different age groups in various healthcare settings. b. Apply your knowledge of the anatomy and physiology of the various body systems affected by disease e.g., cardiovascular, respiratory, urinary, immune, musculoskeletal and neurological systems in nursing practice. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 10 of 195 c. Apply your knowledge of psychology and sociology to meet the psychosocial needs of vulnerable populations of patients e.g., patients with acute or chronic disorders affecting circulation, oxygenation, immunity, elimination, mobility, sensation, and perception. d. Maintain professionalism in your own practice of nursing throughout the spectrum of nursing care delivered to vulnerable populations of patients such as ethnic minorities, children, elderly and socioeconomically disadvantaged. e. Participate in the assessment, planning, implementation, and evaluation of nursing care delivered to vulnerable individuals and groups with stable, uncomplicated health problems related to the altered physiological needs of these individuals and patients. f. Promote optimum function, prevent further disability and promote rehabilitation of individuals and groups with disabilities. g. Participate in the diagnosis and treatment of minor ailments and impaired / altered physiological needs. 4.7 Learning Units To reach the above purpose, module outcomes and critical cross-field outcomes, part 1 of the module study guide contains the following learning units: Theory DNIGNS2 Credits Part 1 1. The Nursing Process 1.1 Critical Thinking and Nursing Practice 1.2 Assessment - (Objective and Subjective Data collection) 1.3 Nursing Diagnoses 2 1.4 Planning Nursing Interventions 1.5 Implementing and evaluating 1.6 Documentation and Reporting Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 11 of 195 Theory DNIGNS2 Credits 2. Disorders of the Immune System 2.1 Inflammation, Infections, and Inflammatory processes 2.2 Autoimmune disorders 3.5 2.3 Allergic Disorders 2.4 Infectious Diseases 3. Pain Management 4. Disorders related to circulation and perfusion 4.1 Introduction to Circulatory Disorders 4.2 Management of Disorders of the heart and related structures 3.5 4.3 Management of Coronary Artery Disease 4.4 Management of the Disorders of the Blood Vessels 4.5 Management of Disorders of the Haematological System 5. Disorders Related to the Lymphatic System 1 Part 2 of the study guide will contain the following learning units 6. Disorders Related to Oxygenation and Gas Exchange 6.1 Disorders Affecting the Lower Respiratory Airways 3.5 6.2 Disorders Affecting the Upper Respiratory Airways 6.3 Management of Chronic Disorders 7. Skin, skin integrity and the maintenance of skin integrity 7.1 Disorders of Tissues and Cells 7.2 Introduction to Disorders of the Skin 7.3 Management of Disorders of the Integumentary System 4 7.4 Management of burn injury 7.5 Wound healing 6.6 Dermatological (Skin) agents 8. Disorders affecting Mobility and Exercise/Mobilisation 1 8.1 Introduction to Disorders affecting movement and mobility Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 12 of 195 Theory DNIGNS2 Credits 8.2 Management of Disorders affecting movement and mobility 9. Disorders related to Urinary Elimination 9.1 Introduction to Disorders of Urinary Elimination 2.5 Management of Patients Diagnosed with Renal and Urinary 9.2 disorders 10. Disorders of Nutrition and Faecal Elimination 10.1 Introduction to Disorders of Nutrition and Faecal Elimination 10.2 Management of Upper GI Tract Disorders 2.5 10.3 Management of Lower GI Tract Disorders 10.4 Management of Disorders of the Accessory Organs of Digestion 11. Endocrine System Disorders (Hormonal Regulation) 11.1 Management of Endocrine System Disorders 2.5 11.2 Management of Diabetes Mellitus Disorders/Drugs Affecting the Nervous System/ Intracranial 12. Regulation Introduction to and Management of Disorders/Drugs affecting 12.1 3 the Nervous System/Intracranial Regulation 12.2 Autonomic Nervous System Agents 12.3 Neurologic and Nervous System Agents 13. Sensation and Perception 13.1 Ear, nose and throat disorders and the management thereof 2.2 13.2 Eye and vision disorders and the management thereof 13.3 Medication for eye and ear disorders Total 31.2 Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 13 of 195 5. LITERATURE RESOURCES 5.1 Prescribed Resources Adams, M. P., Holland, N. & Urban, C., 2020. Pharmacology for Nurses a Pathophysiologic approach. Sixth Edition ed. Hoboken: Pearson Education, Inc. Berman, A., Snyder, S. J. & Frandsen, G., 2021. Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice. 11th Global ed. Essex: Pearson Education Limited. Geyer, N, 2023, Communicable diseases. 1st Ed. Cape Town: Juta and Company (Pty) Ltd Mehtar, S. 2023. Understanding Infection Prevention and Control, 2nd Edition, Cape Town: Juta and Company (Pty) Ltd Mulder, M., Joubert, A. & Olivier, N., 2020. Practical Guide for General Nursing Science. 2nd ed. Cape Town: Pearson South Africa (Pty) Ltd. Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. 5.2 Recommended Resources Ernstmeyer, K. & Christman, E. (Eds.), 2020. Nursing Pharmacology. [Online] Available at: https://wtcs.pressbooks.pub/pharmacology/ [Accessed 24 February 2024]. Marieb, E. N. and Hoehn, K. M., 2019. Human Anatomy and Physiology. 11th Global ed. Essex: Pearson Education. Schellack, G., 2016. Pharmacology in Clinical Practice: Application Made Easy for Nurses & Allied Health Professionals. 3rd ed. Cape Town: Juta and Company (Pty) Ltd. Taylor, J., ed., 2019. Bailliere's DICTIONARY for NURSES and HEALTH CARE WORKERS. 27th ed. Edinburgh: Elsevier Ltd. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 14 of 195 5.3 Additional Resources Additional resources related to each learning unit are listed with the learning unit. All Netcare Standard Operating Procedures (SOPs) you may require are available on the Netcare Intranet. Where required the SOPs will be made available to you, either through your Hospital-Based Academic Staff (HBAS) member or InSight, under the DNIGNS2 module. Access articles for additional reading through the Netcare InSight Platform “Academic Resources for Netcare Education”. 6. ASSESSMENT OF THIS MODULE 6.1 Formative Assessments 1. To ensure that you are progressing successfully in reaching the outcomes of this module, the following formative theoretical assessments (FTAs) will be conducted: a. Three written knowledge questionnaires each of which contributes 16% towards your summative theoretical assessment entry mark (STAE). b. One assignment which could be an individual or group assignment will count 16% towards your STAE mark. c. Six small stakes online or other formative theoretical assessments (sFTA) contributing 6% each towards your STAE; and selected learning unit assignments. The exact format of each FTA/sFTA will be communicated to you by your programme coordinator. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 15 of 195 You can keep track of your marks in the table below (Updated): Formative Theory Your Mark (Your mark multiplied x Contribution Assessments the percentage below) ÷ to STAE 100 Example 70% 30% 21 FTA1 Written FTA2 questionnaire FTA3 Assignment 16% FTA4 Written questionnaire sFTA2a sFTA2b Online or sFTA3a other 6% sFTA3b assessments sFTA4a sFTA4b 2. You must achieve an average of 50% to gain summative assessment entry. 3. Should you obtain less than 50%, one additional FTA knowledge questionnaire will be granted. 6.2 Summative Assessment a. The summative theoretical assessment (STA) consists of two knowledge questionnaires. b. The duration of each knowledge questionnaire is 180 minutes (3 hours) and counts out of 100 marks. c. Each knowledge questionnaire contributes 50% towards the summative theoretical assessment mark. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 16 of 195 d. The minimum requirement to pass each knowledge questionnaire is 50%. e. Should you obtain less than 50% for one or both the knowledge questionnaires you will be granted one supplementary assessment event for the assessment where you obtained less than 49%. You will only be required to write a supplementary assessment for the knowledge questionnaire you obtained less than 49%. Should you obtain less than 49% for both assessments you will be required to write both supplementary assessments. f. Should you fail either one of the two STAs after the supplementary assessment you fail the module in its entirety. g. The maximum mark for the module obtained after a supplementary summative assessment was granted is 50%. The assessment of the module should be read in conjunction with the “Netcare Education Assessment, Progression and Promotion Letter” for the Diploma in Nursing 2. 6.3 Monitoring of Academic Progress Academic progress will be monitored according to the Netcare Education Performance Standard. 6.4 Requirements to Pass and Calculation of Marks The requirements to pass this module and the calculation of marks will be as per the Academic Progression and Promotion letter for this programme. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 17 of 195 7. PERSONAL OBJECTIVES I would like to achieve the following objectives during this module: Due Date Objective Reflection Comments Date Accomplished Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 18 of 195 SECTION B. LEARNING UNITS Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 19 of 195 LEARNING UNIT 6 DISORDERS AFFECTING OXYGENATION INTRODUCTION The need for oxygen is the most fundamental physiological need of a person. The absence of oxygen can lead to cellular, tissue, and organ death (Berman, et al., 2021, p. 1303). Oxygen is required to extract energy from food. Oxygenation includes the uptake and utilization of oxygen by the tissues, while at the same time the elimination of carbon dioxide from the tissues. The processes of oxygenation include breathing, gas exchange in the lungs, transportation of oxygen to the tissues via the circulatory system, uptake, and utilization of oxygen in the cells, transportation of carbon dioxide to the lungs via the circulatory system, and the exhalation of carbon dioxide via the lungs. Any factor interfering with the processes may lead to an unmet oxygenation need e.g., the lack of oxygen, inadequate circulation and/or pulmonary ventilation and gas exchange. In learning unit 6 we will be exploring disorders affecting oxygenation. The learning unit consists of 3 sub-divisions. See the section on pre-lecture preparation and ensure you come to class prepared. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 20 of 195 PRE-KNOWLEDGE 1. Anatomy and Physiology related to the respiratory system and respiratory processes - https://wtcs.pressbooks.pub/pharmacology/chapter/5-2-respiratory-basics/ b. Major respiratory structures c. Functional division of the respiratory system into a conducting zone and a respiratory zone d. Respiratory rate and control e. Inhalation and Exhalation 2. Factors affecting respiratory function (Berman, et al., 2021/2022, pp. 1307 - 1308). 3. Alterations in respiratory function (Berman, et al., 2021/2022, pp. 1308 - 1309). 4. Vital data. (Berman, A., Snyder, S. J. & Frandsen, G., 2021. Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice. 11th Global ed. Essex: Pearson Education Limited. (Chapter 28, Vital Signs – Respiration and oxygen saturation) PRE-LECTURE PREPARATION 1. Review: the anatomy and physiology of the structure and processes of the respiratory system (Berman, et al., 2021/2022, Chapter 49 - Oxygenation). 2. Use Primal Pictures / Anatomy.TV to review the anatomy and physiology of the respiratory system 3. Answer: the anatomy and physiology review questions related to the respiratory system in Berman, et al., 2021, Chapter 49 4. Explore: You will find a summary of the structure and function of the respiratory system and the processes of inhalation and exhalation at: https://app.pandai.org/note/read/kssm-sc-09-02-01/KSSM-F3- SC-02-01 Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 21 of 195 5. Review: The Movement and Exchange of Gases in the Human Body at: https://app.pandai.org/note/read/kssm-sc-09-02-02/KSSM-F3-SC-02-02 LEARNING UNIT OUTCOMES Through completion of the objectives of this learning unit you will be able to: 1. Demonstrate an understanding of the disorders affecting oxygenation and the management thereof. 2. Apply your knowledge related to disorders affecting oxygenation in the care and management of patients presenting with disorders affecting oxygenation. 3. Apply the nursing process in the management of patients diagnosed with disorders affecting oxygenation. a. Conduct a focused respiratory assessment of a patient presenting with a disorder affecting oxygenation. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 22 of 195 b. Apply the pathophysiology of disorders affecting oxygenation and gas exchange to formulate nursing diagnoses for patients diagnosed with disorders affecting oxygenation. c. Formulate Specific, Measurable, Achievable, Realistic, and Time-referenced (SMART) expected outcomes for patients diagnosed with disorders affecting oxygenation and gas exchange related to the nursing diagnoses. d. Formulate holistic, evidence-based, specific, and ethical nursing interventions to address each nursing diagnosis and achieve the set expected outcomes for patients diagnosed with disorders affecting oxygenation to promote and maintain oxygenation. e. Participate as a member of a nursing care team to implement nursing care for patients diagnosed with disorders affecting oxygenation. f. Evaluate the effectiveness of the implemented nursing interventions and the patient outcomes against the expected outcomes. g. Record all interventions and report any abnormalities. 4. Demonstrate an understanding of the pharmacological treatment for patients presenting with disorders affecting oxygenation. 5. Integrate and apply knowledge of pharmacology in the nursing care and management of patients presenting with disorders affecting oxygenation. Learning Unit 6.1 Introduction to Disorders Affecting Oxygenation INTRODUCTION Oxygen is required to ensure optimum functioning of all living cells. The absence of oxygen can lead to cellular, tissue, and organism death (Berman, et al., 2021/2022, p. 1303). Cellular metabolism produces carbon dioxide which needs to be eliminated from the body. The delivery of oxygen and the removal of carbon dioxide require the integration of several systems including the respiratory, haematological, and cardiovascular systems. In this integrated system, the respiratory system provides the first process i.e., the movement and Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 23 of 195 transfer of gasses between the atmosphere and the blood. Impairment of the respiratory system can significantly affect our ability to breathe, transport gases, and participate in everyday activities. OBJECTIVES Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate disorders affecting oxygenation: 1. The classification of acute and chronic disorders affecting oxygenation. a. Define each of the disorders affecting oxygenation a patient may present with. b. Indicate the respiratory structures involved in each disorder. c. Relate the underlying physiological and pathophysiological processes to the presenting signs and symptoms. 2. Physiological and pathophysiological processes Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 24 of 195 a. Gas Exchange - https://www.respiratorytherapyzone.com/gas-exchange/ b. Pulmonary diffusion - https://www.respiratorytherapyzone.com/gas-exchange/ c. Alveolar-Capillary Membrane - https://www.respiratorytherapyzone.com/gas- exchange/ d. Ventilation (V), perfusion (Q), V/Q Ratio – https://www.ncbi.nlm.nih.gov/books/NBK539907/ e. Ventilation, oxygenation and respiration – https://www.respiratorytherapyzone.com/ventilation-vs-oxygenation/ f. Impaired gas exchange g. Ineffective breathing h. Ineffective airway clearance i. Increased oxygen requirements j. Ventilation/Perfusion (V/Q mismatch) 3. The nursing assessment of a patient diagnosed with a respiratory disorder. 4. Individual risk factors. 5. The various diagnostic studies and the related nursing and patient care considerations related to the diagnostic studies. 6. The general procedures and treatment modalities to maintain respiratory function: a. Artificial airway management – types of airways b. Mobilization of secretions – nasotracheal suctioning, chest physical therapy. 7. The administration of oxygen therapy: a. Nursing assessment and interventions b. Community and homecare considerations 8. Airway pharmacotherapy/Respiratory Agents Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 25 of 195 Mechanism Indications Therapeuti Adverse/ Administratio Patient of Action for use c effects side-effects n and special Education/ considerations Person- Centred considerations a. Antihistamines b. Decongestants c. Antitussives d. Expectorants e. Beta-Z Agonist f. Anticholinergics g. Corticosteroids h. Leukotriene Receptor Antagonists i. Xanthine Derivates DEFINITIONS / KEY CONCEPTS AND TERMINOLOGY Remember to identify the key concepts and terminology of the learning unit and make a note of the definitions. In addition to the key concepts below study the terminology in Nettina, 2019, p. 162. Term Meaning Acute pharyngitis Allergic rhinitis Antihistamine Antitussives Bronchiectasis (Chronic inflammatory condition) Bronchospasm Bronchoconstriction Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 26 of 195 Term Meaning Bronchodilation Common cold Decongestants Expectorants Lung abscess Paradoxical Effect Pharmaco-therapeutic Pleurisy Pleural effusion Rebound nasal congestion Restrictive lung disease Rhinorrhea Sinusitis PRESCRIBED READING Adams, M. P., Holland, L. N. & Urban, C. Q., 2020. Pharmacology for Nurses A Pathophysiologic Approach. 6th ed. Hoboken: Pearson Education. Chapter 39. Berman, A., Snyder, S. J. & Frandsen, G., 2021. Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice. 11th Global ed. Essex: Pearson Education Limited. Chapter 49 - Oxygenation Mulder, M., Joubert, A. & Olivier, N. eds., 2020. Practical Guide for General Nursing Science. 2nd ed. Cape Town: Pearson South Africa (Pty) Ltd. Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. Unit II Respiratory Health – Chapter 10, Respiratory Function and Therapy; Chapter 11, Respiratory Disorders. Unit IX Immunologic Health – Chapter 28 Asthma and Allergy Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 27 of 195 RECOMMENDED READING National Department of Health, 2018. Health for all: A health promotion tool for health care professionals. [Online] Available at: https://www.knowledgehub.org.za/elibrary/health-promotion-tool-health- professionals-health-all [Accessed 26 October 2022 ]. NMNES Curriculum Committee, 2018. NMNES Concept: Gas Exchange. [Online] Available at: https://www.nmnec.org/wp-content/uploads/2020/06/Gas- Exchange.rev01.18.18.Final-Ed-Version.pdf [Accessed 22 February 2024]. Open Resources for Nursing (Open RN), 2020. Nursing Pharmacology. [Online] Available at: https://wtcs.pressbooks.pub/pharmacology/ [Accessed 24 February 2024]. Pérez-Nieto, O. R. et al., 2023. Hemodynamic and respiratory support in pulmonary embolism: a narrative review. [Online] Available at: https://www.frontiersin.org/articles/10.3389/fmed.2023.1123793/full [Accessed 22 February 2024]. ASSIGNMENTS AND ACTIVITIES ASSIGNMENTS AND SELF-ACTIVITIES 1. Design an information sheet / “fact sheet” for the community regarding common respiratory system illnesses, their presentation, management at home, and measures of prevention. Add the fact sheet to your self-development portfolio. 2. Formulate a nursing diagnosis for the following patients. Motivate your selection of the health problems for each patient. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 28 of 195 a. Mrs. Z presented with an acute respiratory infection. Mrs. Z presented with a productive cough upon auscultation you hear fine, short, interrupted crackling sounds. Mrs. Z was diagnosed with pneumonia. b. Mrs. K returns from theatre after major abdominal surgery. Upon assessment, she rated her pain at 6/10. Mrs. K presented with rapid, shallow breathing and a distended abdomen. c. Mr. L, sixty years of age, was diagnosed with Chronic Obstructive Pulmonary Disease. Mr. L presented with dyspnoea. Due to his illness, Mr. L cannot perform his daily activities of living. d. Mr. C was admitted to your unit with acute bronchitis. Mr. C presented with hypoxia, tachycardia, cyanosis, and dyspnoea. 3. Review the information in your textbook on nursing interventions to facilitate pulmonary ventilation (Berman, et al., 2021, Chapter 49 - Oxygenation). Describe the nursing interventions you would implement to manage a patient with oxygenation problems. The overall outcomes your patient needs to achieve are to: a. Maintain a patent airway. b. Improve comfort and ease of breathing. c. Maintain and improve pulmonary ventilation and oxygenation. Add your activities and assignments to your self-development portfolio. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 29 of 195 APPLICATION OF KNOWLEDGE AND SKILLS Upon completion of this learning unit, you will be able to demonstrate the integration of knowledge regarding the management of patients diagnosed with disorders affecting oxygenation. 1. Participate in the assessment and management of patients with disorders related to oxygenation. 2. Conduct a focused physical assessment of the respiratory system using inspection, palpation, and auscultation. 3. Participate in the care and management of a patient receiving supplemental oxygen. 4. Administration of oxygen therapy. 5. Administration of nebulization with medication. 6. Monitor vital data, oxygen saturation, MEWS and AVPU. 7. Demonstrate competence in assisting a patient during a cough. 8. Oropharyngeal suctioning. 9. Provide essential health information to patients/clients in the prevention and management of disorders affecting oxygenation. Learning Unit 6.2 Management of Patients Diagnosed with Disorders Affecting Oxygenation INTRODUCTION According to Nettina (2019, p. 191), respiratory failure might involve one or both of the patient's lungs directly resulting in poor gas exchange. Tuberculosis is the most serious preventable disorder of the lower respiratory tract in South Africa. Pulmonary tuberculosis, most often occurring in association with HIV / Aids, is a major health problem in South Africa. More than 50% of patients diagnosed with tuberculosis (TB) are HIV-positive with a much higher mortality rate than patients suffering from TB alone. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 30 of 195 In this learning unit, we will be looking comprehensively at some of the major respiratory conditions affecting the mortality and morbidity of patients. OBJECTIVES Complete the following objectives: Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate disorders affecting the lower respiratory tract: 1. Apply the framework below to describe the management of patients presenting with specific conditions of the lower respiratory tract: a. Acute Bronchitis b. Pneumonia c. Pulmonary Embolism d. Acute pulmonary oedema e. Tuberculosis f. Asthma Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 31 of 195 2. Describe the classification of asthma. 3. Compile guidelines for a patient diagnosed with bronchial asthma on community and home care. 4. Design a nursing care plan for a patient diagnosed with a disorder of the lower respiratory airway. 5. Pharmacotherapy for upper respiratory disorders. Describe the pharmacotherapy of Allergic Rhinitis according to the prescribed format. a. Antihistamine – first and second generation b. Intranasal corticosteroids 5.1 Describe the pharmacotherapy of nasal congestion according to the prescribed format. a. Decongestants – nasal and systemic b. Describe how the concept of “rebound nasal congestion” is involved in the side effects/adverse effects of decongestant use. c. Justify the limitations in the use of decongestants for patients with hypertension. 5.2 Describe the pharmacotherapy used to treat cough. Opioid and nonopioid antitussives 5.3 Describe the pharmacotherapy used to control excess mucous production. a. Expectorants b. Mucolytics 6. Describe the pharmacotherapy used in the treatment of Asthma according to the prescribed format. a. Acute Asthma – Sympathomimetics – Beta Agonists b. Chronic Asthma – Anticholinergics Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 32 of 195 c. Chronic Asthma – Methylxanthines 7. Describe the prophylactic pharmacotherapy of asthma. a. Leukotriene antagonists b. Mast cell stabilizers – Cromolyn c. Glucocorticoids – inhaler, table, intravenous. 8. Describe the pharmacotherapy used in the treatment of COPD. 9. Differentiate between medicine groups used to treat COPD and asthma. 10. Explain why theophylline levels need to be monitored. 11. Take cognisance of the following congenital disorders a. Tracheo-oesophageal fistula b. Congenital Diaphragmatic Hernia 12. Describe the following traumatic disorders: a. Pneumothorax b. Chest injuries 13. Describe thoracic surgery under the following headings: a. Indications b. Types of thoracic surgical procedures c. Specific pre-and post-operative care of a patient undergoing thoracic surgery. DEFINITIONS / KEY CONCEPTS AND TERMINOLOGY Remember to identify the key concepts and terminology of the learning unit and make a note of the definitions. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 33 of 195 Term Meaning Apnea Bradypnea Dyspnea Hemoptysis/hypercapnia Hypercarbia Hypoventilation Hypoxemia Hypoxia Orthopnea Paroxysmal nocturnal dyspnoea PRESCRIBED READING Adams, M. P., Holland, L. N. & Urban, C. Q., 2020. Pharmacology for Nurses A Pathophysiologic Approach. 6th ed. Hoboken: Pearson Education. Chapter 39 Berman, A., Snyder, S. J. & Frandsen, G., 2021. Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice. 11th Global ed. Essex: Pearson Education Limited. Chapter 49 - Oxygenation Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. Unit II Respiratory Health – Chapter 10, Respiratory Function and Therapy; Chapter 11, Respiratory Disorders. Unit IX Immunologic Health – Chapter 28 Asthma and Allergy Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 34 of 195 RECOMMENDED READING NMNES Curriculum Committee, 2018. NMNES Concept: Gas Exchange. [Online] Available at: https://www.nmnec.org/wp-content/uploads/2020/06/Gas- Exchange.rev01.18.18.Final-Ed-Version.pdf [Accessed 22 February 2024]. Open Resources for Nursing (Open RN), 2020. Nursing Pharmacology. [Online] Available at: https://wtcs.pressbooks.pub/pharmacology/ [Accessed 24 February 2024]. Pérez-Nieto, O. R. et al., 2023. Hemodynamic and respiratory support in pulmonary embolism: a narrative review. [Online] Available at: https://www.frontiersin.org/articles/10.3389/fmed.2023.1123793/full [Accessed 22 February 2024]. ASSIGNMENTS AND ACTIVITIES ASSIGNMENTS AND SELF-ACTIVITIES 1. Describe the role of the professional nurse in the management and prevention of tuberculosis. 2. Review the case study of Ms Singh a 39-year-old secretary admitted to the hospital with an elevated temperature, fatigue, rapid laboured breathing, and mild dehydration (Berman, et al., 2021, Chapter 49, Oxygenation). Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 35 of 195 a. Describe the subjective and objective data obtained during the assessment of Ms, Singh. b. Evaluate the nursing diagnosis formulated for Ms Singh. Do you agree? Motivate your answer. c. Evaluate the outcomes set for Ms Singh. Do you agree? If not, how would you re- formulate the outcomes? d. Describe nursing interventions for Ms Singh. Choose the most appropriate choice: 1. Leukotriene receptor modifiers work by: a. Inhibiting cyclic adenosine monophosphate (CAMP) breakdown and blocking adenosine receptors. b. Blocking inflammatory action that causes signs and symptoms of asthma. c. Preventing the release of or counteracting biochemical mediators that cause inflammation. d. Stimulating the production of Camp 2. A patient using a nasal decongestant may experience: a. Rebound congestion b. Hypotension c. Oedema d. Anorexia 3. What action should the patient take after using an inhaled corticosteroid? a. Wait 2 hours before eating b. Have blood levels drawn Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 36 of 195 c. Drinking 2 – 3 litres of fluid per day d. Rinse his/her mouth with water 4. Which medication is most effective for a patient with a non-productive cough that occurs more frequently at night? a. Acetylcysteine b. Benzonatate c. Phenylephrine d. Theophylline 5. You must monitor the serum levels of which drug? a. Albuterol b. Montelukast c. Theophylline d. Methylprednisolone 6. A patient is receiving theophylline. Which assessment findings indicate the patient is responding positively to the drug? a. Easy, unlabored respirations b. Heart rate of 92 beats per minute c. Urine output of 450ml/shift d. Blood pressure of 138/82 mmHg 7. You are checking for adverse reactions in a patient who has just been given metaproterenol for asthma. Which reactions are most likely to occur with this drug? a. Oedema, moon face Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 37 of 195 b. Tachycardia, shaking. c. Bleeding peptic ulcer, vomiting. d. Moderate hypotension, dizziness 8. You are instructing a patient about the use of albuterol and beclomethasone inhalation therapy at home. You should teach the patient to: a. Use the corticosteroid followed by the bronchodilator. b. Use the bronchodilator followed by the corticosteroid. c. Alternate the order of use each time to prevent tolerance. d. Rinse the mouth both before and after use to prevent gum breakdown. 9. A patient comes into the hospital with an upper respiratory tract infection evidenced by nasal stuffiness, low grade fever and a productive cough. He reports difficulty coughing up the mucus. The chest examination is consistent with bronchitis. He would like cough syrup. Which ingredient commonly included in cough syrups is most appropriate for the patient? a. Codeine b. Dextromethorphan c. Diphenhydramine d. Guaifenesin 10. A patient who had an upper respiratory tract infection has been using oxymetazoline nasal spray twice daily for 10 days. Although the patient gets some relief after using it, he says he has to use it more and more, and if he doesn’t use it, the congestion comes back. What’s the most likely explanation for this problem? a. He has used the oxymetazoline for too long. b. The twice daily dosing interval is too short for oxymetazoline Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 38 of 195 c. A viral infection has probably become a secondary bacterial infection. d. He has developed a tolerance to the pharmacologic effects of oxymetazoline 11. You are assessing the serum theophylline level in a patient with asthma. Which serum theophylline level represents the therapeutic range for treating asthma? APPLICATION OF KNOWLEDGE AND SKILLS Upon completion of this learning unit, you will be able to demonstrate the integration of knowledge regarding the management of patients with conditions of the lower respiratory tract. Learning Unit 6.3 Management of Patients Diagnosed with Chronic Obstructive Pulmonary Disorders INTRODUCTION Chronic Obstructive pulmonary disease (COPD) is a condition characterised by a persistent resistance to bronchial airflow (Nettina, 2019, p. 214). COPD is a significant contributor to morbidity and mortality in South Africa. Recent health statistics indicate that approximately 4.5% of the population suffer from chronic bronchitis and/or emphysema, 3.75% suffer from asthma and 59% of the population experience some signs and/or symptoms associated with COPD, i.e., dyspnoea, bronchospasm, cough, and a reduced peak flow with dyspnoea on exertion. In this learning unit, you will obtain the knowledge to effectively manage patients diagnosed with obstructive pulmonary diseases. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 39 of 195 OBJECTIVES Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate chronic obstructive airway disorders: 1. Apply the framework below to describe the management a patient presenting with Chronic Obstructive Pulmonary Disease 2. Compile a nursing care plan for a patient diagnosed with chronic obstructive pulmonary disease. 3. Describe the effective monitoring of a patient’s response to treatment. 4. Take cognisance of interstitial lung disease. DEFINITIONS / KEY CONCEPTS AND TERMINOLOGY Remember to identify the key concepts and terminology of the learning unit and make a note of the definitions. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 40 of 195 Term Meaning Emphysema Hyperinflation Anteroposterior diameter Exacerbation PRESCRIBED READING Adams, M. P., Holland, L. N. & Urban, C. Q., 2020. Pharmacology for Nurses A Pathophysiologic Approach. 6th ed. Hoboken: Pearson Education. Chapter 39 Berman, A., Snyder, S. J. & Frandsen, G., 2021. Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice. 11th Global ed. Essex: Pearson Education Limited. Chapter 49 - Oxygenation Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. Unit II Respiratory Health – Chapter 10, Respiratory Function and Therapy; Chapter 11, Respiratory Disorders. Unit IX Immunologic Health – Chapter 28 Asthma and Allergy RECOMMENDED READING Open Resources for Nursing (Open RN), 2020. Nursing Pharmacology. [Online] Available at: https://wtcs.pressbooks.pub/pharmacology/ [Accessed 24 February 2024]. ASSIGNMENTS AND ACTIVITIES ASSIGNMENTS AND SELF-ACTIVITIES Design a patient education leaflet on home care and health maintenance for patients diagnosed with COPD. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 41 of 195 Add your assignment to your self-development portfolio. APPLICATION OF KNOWLEDGE AND SKILLS Upon completion of this learning unit, you will be able to demonstrate the integration of knowledge regarding the management of patients with obstructive pulmonary disorders. SUMMARY Chronic Obstructive Pulmonary Disorder was discussed in this learning unit. Asthma can both be classified as an inflammatory pulmonary disorder and an obstructive pulmonary disorder. COPD, except for asthma, is preventable. The key to the prevention of COPD is the cessation of smoking, as inhaled cigarette smoke irritates the mucous membrane of the bronchi contributing to inflammation with repeated infection leading to pathophysiological changes typical of COPD. Health information and prevention are essential to the management of chronic obstructive pulmonary diseases. This learning unit aims to equip you with the required knowledge to effectively manage patients suffering from obstructive pulmonary diseases. REFLECTION Diagnosis with a life-altering condition affecting oxygenation can have a serious impact on the quality of life of a person. Consider factors in your life that can contribute to acquiring a disorder affecting oxygenation. What lifestyle modifications will you make to reduce your risk of acquiring a disorder affecting oxygenation? Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 42 of 195 LEARNING UNIT 7 SKIN, SKIN INTEGRITY AND THE MAINTENANCE OF SKIN INTEGRITY LEARNING UNIT OUTCOMES Through completion of the objectives of this learning unit you will be able to: 1. Demonstrate knowledge and understanding of the disorders related to tissues, cells, the skin, burn injuries, and wound healing. 2. Apply your knowledge of the disorders related to tissues, cells, the skin, burn injuries, and wound healing in the care and management of patients presenting with disorders related to tissues, cells, the skin, burn injuries, and wound healing. 3. Apply the nursing process in the care and management of patients with presenting with disorders related to tissues, cells, the skin, burn injuries, and wound healing. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 43 of 195 4. Participate as a member of the nursing care team in the management of patients presenting with disorders related to tissues, cells, disorders of the skin, burn injuries, and wound healing. 5. Integrate the pharmacological management in the nursing care of patients presenting with disorders related to tissues, cells, the skin, burn injuries, and wound healing. 6. Integrate and interpret the diagnostic assessments and findings related to patients presenting with disorders related to tissues, cells, the skin, burn injuries, and wound healing Learning Unit 7 consists of six sub-units: Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 44 of 195 Learning Unit 7.1 Disorders Related To Tissues And Cells INTRODUCTION The cell is known as the smallest unit of life. When you define the properties of cells, you define the properties of life. Organisms are made of one or more cells. Cells are the structural and functional building blocks of an organism (Marieb & Hoehn, 2019, p. 93). Tissues (tissue woven) are groups of cells that are similar in structure and perform a common or related function (Marieb & Hoehn, 2019, p. 148). Healing is a quality of living tissue; it is referred to as the regeneration of tissues and cells. In this learning unit, the disorders associated with cell integrity and function will be discussed, with particular emphasis on wounds. PREPARATION FOR CLASS 1. Review the stages/grading of pressure injuries (Reed, 2024). 2. Review the primary and other contributing factors/risk factors related to the formation of pressure injuries (Berman, et al., 2021, Chapter 36; Mulder, et al., 2020, pp. 106 - 108). 3. Use Primal Pictures / Anatomy.TV to review the anatomy and physiology of the cell and the functions of the cell. 4. Review your knowledge of the inflammatory process that is initiated when the body’s first line of defence is broken. 5. List common pressure sites (Berman, et al., 2021/2022, Chapter 36). Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 45 of 195 6. Review the information on “Tissue Integrity” - https://www.nmnec.org/wp- content/uploads/2020/06/Tissue-Integrity.rev01.17.19.Final-Ed-Version-1.pdf PRE-KNOWLEDGE 1. The pathophysiology of inflammation and the inflammatory process. 2. Acute, chronic, and auto-immune based inflammation. 3. Inflammation vs. infection 4. The nursing and pharmacological management of a patient presenting with inflammation. 5. The essential health information you will provide to a patient related to the management of inflammation and infection. OBJECTIVES Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate disorders related to the tissues and cells: 1. Risk factors for injury or death of cells. 2. The pathophysiological process involved during cell response to injury. 3. The different cell adaptations in response to injury. 4. The different types of exudates. 5. The signs and symptoms related to inflammation. 6. The nursing assessment – subjective and objective data - and common findings in a patient admitted with disorders related to tissues and cells. 7. The pathophysiology of a pressure injury and the risk factors contributing to the development of pressure injuries. 8. Staging of pressure injuries (Reed, 2024). 9. The nursing interventions to prevent the development of pressure injuries. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 46 of 195 10. Differentiate between arterial, venous, and neuropathic ulcers. 11. Draft a nursing care plan for a patient with disorders of cells and tissues. DEFINITIONS / KEY CONCEPTS AND TERMINOLOGY Remember to identify the key concepts and terminology of the learning unit and make a note of the definitions. Term Meaning Infection Inflammation Exudates Pressure injuries Ischemia PRESCRIBED READING Berman, A., Snyder, S. J. & Frandsen, G., 2021. Kozier & Erb's Fundamentals of Nursing Concepts, Process, and Practice. 11th Global ed. Essex: Pearson Education Limited. Chapter 36 Marieb and Hoehn, 2019. Human Anatomy and Physiology. Global 11th ed. Essex Pearson Education. Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. (Chapter 33). RECOMMENDED READING Reed, L. A., 2024. Bedridden Breakdown: Classifying Pressure Injuries. [Online] Available at: https://reference.medscape.com/slideshow/classifying-pressure- injuries-6005748 [Accessed 31 March 2024]. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 47 of 195 Mulder, M., Joubert, A. & Olivier, N. eds., 2020. Practical Guide for General Nursing Science. 2nd ed. Cape Town: Pearson South Africa (Pty) Ltd. (Module 16, pp. 269 – 276; Module 45, pp. 745 - 775). Netcare Nursing, 2023. Pressure Care. NUR-POL-03-SOP15 ed. Sandton: Netcare Limited. ASSIGNMENTS AND ACTIVITIES ASSIGNMENTS AND SELF-ACTIVITIES Review evidence-based practices to assess the risk for the development of pressure injuries. APPLICATION OF KNOWLEDGE AND SKILLS Upon completion of this learning unit, you will be able to demonstrate the integration of knowledge related to the disorders of tissues and cells. Conduct a skin risk assessment. Learning Unit 7.2 Introduction To Disorders Of The Skin The skin and its derivatives (sweat and oil glands, hairs, and nails) make up a complex set of organs that serve several functions, mostly protective. Loss of skin integrity through wounds or any other skin breakdown means loss of protection of underlying structures. The preservation of skin integrity and the prevention of skin breakdown are important aspects of the basic nursing management of patients. PRE-LECTURE PREPARATION 1. Review your knowledge of the anatomy and physiology of the skin and integumentary system. Consider using Primal Pictures and Anatomy.TV. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 48 of 195 2. Review the structure and function of the skin (Adams, et al., 2020, pp. 793 - 794). 3. Review the interrelationships of the integumentary system with the other body systems (Adams, et al., 2020, p. 795). OBJECTIVES Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate disorders related to the skin: 1. Dermatologic conditions according to the morphology of the lesions that appear on the skin – type (primary, secondary/other), size, shape, colour, pattern, and distribution. 2. The subjective and objective nursing assessment of the patient with a skin disorder. 3. The role of nutrition in disorders of the skin. 4. Design a general nursing care plan for a patient diagnosed with a disorder of the integumentary system. 5. The essential health information for a patient who suffers from a skin disorder DEFINITIONS / KEY CONCEPTS AND TERMINOLOGY Remember to identify the key concepts and terminology of the learning unit and make a note of the definitions. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 49 of 195 Term Meaning Urticaria Pruritis Erythema Acne vulgaris Rosacea Dermatitis Psoriasis PRESCRIBED READINGS Adams, M. P., Holland, L. N. & Urban, C. Q., 2020. Pharmacology for Nurses A Pathophysiologic Approach. 6th ed. Hoboken: Pearson Education. Chapter 49, Drugs for Skin Disorders. Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. Chapter 33, Dermatological Disorders. ADDITIONAL READING Mulder, M., Joubert, A. & Olivier, N., 2020. Practical Guide for General Nursing Science. 2nd ed. Cape Town: Pearson South Africa (Pty) Ltd. ASSIGNMENTS AND ACTIVITIES 1. Design a pamphlet or poster depicting the morphology of the lesions that appear on the skin – type (primary, secondary/other), size, shape, colour, pattern, and distribution. 2. Design a poster to inform secondary school learners about the principles of skin care. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 50 of 195 Learning Unit 7.3 Management of Disorders of the Skin OBJECTIVES Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate disorders related to the skin: 1. The psychosocial and occupational impact on a person living with a chronic skin disorder. 2. The classification of the various dermatological conditions in Nettina (2019, pp. 910 – 917). Summarize the clinical manifestations, management, and nursing considerations of the most common skin disorders in South Africa. a. Bacterial infections b. Fungal infections c. Parasitic and other infestations d. Viral infections e. Other conditions 3. Three broad classifications of skin disorders (Adams, et al., 2020, p. 794). 4. Types of psoriasis (Adams, et al., 2020, p. 804). 5. Integrate your knowledge of dermatological disorders related to the: a. Pathophysiology b. Clinical manifestations c. Management d. Complications e. Nursing assessment. f. Apply the pathophysiology of dermatological disorders in the formulation of nursing diagnoses. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 51 of 195 g. Formulate Specific, Measurable, Achievable, Realistic, and Time-referenced (SMART) expected outcomes for patients diagnosed with dermatological disorders. h. Formulate holistic, evidence-based, specific, and ethical nursing interventions to address each nursing diagnosis and achieve the set expected outcomes for patients diagnosed with dermatological disorders. i. Integrate and apply knowledge of pharmacology in the nursing care and management of patients presenting with dermatological disorders. j. Essential health information and health education. PRESCRIBED READINGS Adams, M. P., Holland, L. N. & Urban, C. Q., 2020. Pharmacology for Nurses A Pathophysiologic Approach. 6th ed. Hoboken: Pearson Education. Chapter 49, Drugs for skin disorders. Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. ADDITIONAL READING Anderson, L. A., 2020. 10 of the Most Common Skin Conditions: Photos and Treatments. [Online] Available at: https://www.drugs.com/slideshow/most-common-skin-conditions-1086 [Accessed 28 August 2021]. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 52 of 195 ASSIGNMENTS AND ACTIVITIES 1. You are working in the paediatric unit and nursing patients diagnosed with parasitic and other infestations. Prepare health education for the mothers on the following topics: a. Pediculosis (lice) amongst children of school-going age (primary school). b. Scabies (itch mite) amongst elderly, debilitated patients requiring extensive hands-on care. 2. Prepare a health education talk for teenagers and young adolescents of acne visiting the local clinic. Learning Unit 7.4 Management of a Patient Presenting with a Burn Injury INTRODUCTION “Burns are a form of traumatic injury caused by thermal, electrical, chemical, or radioactive agents. Inhalation injury and associated pulmonary complications are a significant factor in mortality and morbidity from burn injury (Nettina, 2019, p. 919).” Objectives Upon completion of this learning unit, you will be able to reliably demonstrate knowledge and understanding, and the ability to apply, analyse, synthesize, and evaluate the management of a patient presenting with a burn injury: 1. The concepts “burn injury” and “inhalation injuries”. 2. The pathophysiology of localised and systemic changes in major burns and the related risks. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 53 of 195 3. The immediate assessment of a patient with a burn injury according to the “rule of nine”. 4. The nursing management of patients with burn injuries: a. Nursing assessment b. Apply the pathophysiology of localised and systemic changes in major burns in the formulation of nursing diagnoses. c. Formulate Specific, Measurable, Achievable, Realistic, and Time-referenced (SMART) expected outcomes for patients presenting with burn injuries. d. Formulate holistic, evidence-based, specific, and ethical nursing interventions to address each nursing diagnosis and achieve the set expected outcomes for patients presenting with burn injuries. e. Integrate and apply knowledge of pharmacology in the nursing care and management of patients presenting with burn injuries. f. Essential health information and health education 5. Identify risk factors that influence recovery of skin after a burn 6. Identify management principles of a patient with burns in terms of: a. First aid/pre-hospital care b. Criteria for transfer of the patient to a burn unit c. Immediate care in hospital/burn unit 7. The principles of wound care/wound management in a patient who sustained a burn injury. 8. Various therapeutic positions of a patient with burns to prevent contractures 9. Design a nursing care plan for a patient with a burn injury 10. The rehabilitation of a patient after a burn injury. 11. The psychosocial and emotional impact of burn injuries on the patient. Title Number Version DIPL IGNS 2 NET ED 0040/24 MAY 2024 STUDY GUIDE PART 2 Page Page 54 of 195 PRESCRIBED READINGS Nettina, S. M., 2019. Lippincott Manual of Nursing Practice. 11th ed. Philadelphia: Wolters Kluwer. Chapter 34, Burns. ADDITIONAL READING Deniz, S. & Arslan, S., 2017. Pain and Anxiety in Burn
