Chest Tubes

CKD

Understand the etiology and pathophysiology of ChronicKidney Disease (CKD)            •             What is CKD? •             High risk groups •             Stages of CKD 9.           Recognize the clinical manifestations associated with CKD     •             Clinical manifestations of chronic uremia affecting bodily systems.   10. Describe the diagnostic studies related to CKD. •             Renal ultrasound, scan and biopsy •             Serum urea, Cr, BUN, eGFR, Ca, electrolytes, albumin, para-thyroid hormone •             Urinalysis including 24-hour urine test. •             Urine cultures •             Serum hemoglobin and iron indices 11. Understand the different treatment modalities in the management of CKD.            •             Nonpharmacological therapy •             Pharmacological therapy •             Nutritional therapy •             Supportive care •             Dialysis •             Kidney Transplant 12. Apply the nursing process in patients with CKD.      •             Nursing assessment (including nursing diagnoses) •             Planning/goals •             Implementation •             Evaluation 13. Understand the principles of dialysis.          •             Peritoneal dialysis •             Hemodialysis 14. Identify the complications associated with dialysis. •             Peritoneal dialysis •             Hemodialysis •             Vascular accesses 15. Understand Continuous Renal Replacement Therapy (CRRT) as an alternative or adjunctive method for treating AKI.       •             Types of CRRT •             Features of CRRT that differ from HD 16. Understand the principles of Kidney Transplant. •             Features of kidney transplant •             Postoperative care •             Complications of transplantation

AKI

1.                      Review the structures and functions of thekidney.               •             Functionsof the nephron •             Functionsof the kidneys 2.                      Understand the etiology and pathophysiology ofAcute Kidney Injury (AKI).        Common causes of AKI •             Prerenal •             Intrarenal •             Postrenal 3.           Describethe clinical manifestations associated with AKI. Manifestations associated with: •             Prerenal •             Intrarenal •             Postrenal Manifestations associated with the phases of acute tubularnecrosis (ATN): •             Initiationphase •             Maintenancephase •             Recoveryphase 4.           Understandthe diagnostic studies associated with AKI. •             Urinalysis •             Renalultrasound •             Renalscan •             Computedtomography (CT) •             Retrogradepyelogram •             Bloodwork (serum Cr, BUN, electrolytes) 5.           Understandthe treatment modalities and interventions in AKI.              •             Treatmentof precipitating cause •             Fluidrestrictions •             Crystalloids •             Nutritiontherapy •             Treatmentsof hyperkalemia (including pharmacotherapy) •             Calciumsupplements or phosphate-binding agents •             Totalparenteral nutrition (if indicated) •             Enteralnutrition (if indicated) •             Renalreplacement therapy (RRT) (if indicated) 6.           Understandpharmacological interventions in AKI.       •             Antihypertensives •             Diuretics •             Treatmentsof hyperkalemia •             Calciumsupplements or phosphate-binding agents 7.           Apply thenursing process in patients with AKI. •             Nursingassessment (including nursing diagnoses) •             Planning/goals •             Nursingintervention •             Evaluation

Endocrine 1

1. Understand the function of the Pituitary gland &adrenal system.                  AnteriorPituitary: •             Thyroidstimulating hormone. •             Adrenocorticotropichormone (ACTH) Posterior Pituitary: •             Antidiuretichormone (ADH) Adrenals: •             Adrenalmedulla •             Adrenalcortex Regulation of hormone secretion: •             Negativefeedback •             Positivefeedback 2. Understand the pathophysiology related to the Pituitarygland.                Pituitarytumors: •             Acromegaly •             Hypopituitarism •             Tumors •             DiabetesInsipidus (DI) •             Syndromeof Inappropriate Antidiuretic Hormone Secretion (SIADH) 3. Understand the pathophysiology related to the Adrenalglands.                Adrenalmedulla: •             Norepinephrine •             Epinephrine Adrenal Cortex •             Cortisol •             Cushing’sdisease •             Addison’sdisease              Hyperaldosteronism 4. Understand the assessment abnormalities related to thePituitary. •             DiabetesInsipidus (DI) •             Syndromeof Inappropriate Antidiuretic Hormone Secretion (SIADH) •             Tumors 5. Understand the assessment abnormalities related to theAdrenal glands.   •             Cushing’sdisease •             Addison’sdisease 6. Describe the diagnostic studies related to the pituitary& adrenal glands. •             Bloodstudies •             Radiology •             Urinestudies 7.  Describe themedical & pharmacological management of the pituitary and Adrenal glands.                Medical: •             Pituitarysurgery Pharmacological: •             Corticosteroids •             ACTH •             Dexamethasone 8. Apply nursing interventions for the patient experiencingAdrenal and pituitary insufficiency. •             DiabetesInspidius •             SIADH •             Addison’sdisease •             Cushingsyndrome

Chest Tubes

1.       Understand the mechanism of breathing.          Pressure relationships in the thoracic cavity: •             intrapulmonarypressure •             intrapleuralpressure •             importanceof negative pressure in intrapleural space   2.       Understand the rationale for insertion of chesttubes in specific medical-surgical conditions. •             Thoracotomy •             Lobectomy •             Pneumothorax •             Empyema 3.       Understand the rationale of a water-seal system.          •      Preventreentry of air into the lung 4.       Understand three mechanisms to drain fluid andair from the pleural cavity.   •             Positiveexpiratory pressure, deep breathing, and coughing •             Gravity •             Suction 5.       Understand four types of pleural drainagesystems.      Pleura-evac: •             wetsuction control chamber •             drysuction control chamber •             Heimlichvalves •             pigtailcatheters 6. Understand nursing responsibilities in caring for aclient with chest tubes.                 Assessment of client •             vitalsigns •             lungsounds •             clinicalsigns of complications •             respiratorystatus •             dressing •             discomfort   Maintaining chest tubes and closed chest drainage: •             ensuringthat the system is airtight. •             assessmentof drainage in the collection container •             assessmentof fluctuation of fluid level in the water-seal chamber of the Pleura-evac unit •             assessmentfor intermittent bubbling in the water of the water-seal chamber •             assessmentfor gentle bubbling in the suction control chamber •             inspectionof the air vent •             inspectionof the drainage tubing for kinks or loops •             Chesttube dressing changes as per hospital protocol.

Chest Trauma

1.  Define chest trauma.             2.  Identify the causes of chest injury.   •             Planned-Surgical •             Unplanned accidents 3. Identify the common types of planned chest surgery.             •             Thoracotomy •             Pneumonectomy •             Lobectomy •             Wide resection •             Segmental resection 4. Describe classifications of chest trauma.                  Penetrating              Non-penetrating 5. Understand the methods of assessing chest trauma.                          Initial Assessment ABCs              History              Physical Examination              Chest x-ray              Laboratory tests                ABGs                ECG 6.  Understand the complications of severe chest trauma.                    Pneumothorax              Open pneumothorax                  Mediastinal flutter              Tension Pneumothorax and mediastinal shift              Hemothorax              Fractured ribs              Flail chest   7. Understand the therapies used in treating chest traumaand complications of chest injury. •             Oxygenation •             Pharmacotherapy •             Medical therapy •             Surgery 8. Identify the physiological issues related to chest injury.         •             Hypoxia •             Inadequate Gas Exchange •             Ventilatory Impairment •             Immobility •             Activity Intolerance •             Anxiety 9. Identify the nursing interventions relate to chestinjuries.      •             Assessment •             Nursing management of chest tubes •             Recording assessment findings •             Trouble shooting