Adult Gerontology Acute Care Nurse Practitioner Courses Johns Hopkins University, School of Nursing

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1 Adult Gerontology Acute Care Nurse Practitioner Courses Johns Hopkins University, School of Nursing Reproduced with Permission, 2012 COURSE NUMBER AND TITLE: NR Health Assessment and Measurement: Adult/Geriatric Variations NUMBER OF CREDITS: 1 COURSE OFFERED: Spring PRE OR CO-REQUISITES: FACULTY: NR Advanced Health Measurement and Assessment Benita Walton-Moss, DNS, FNP-BC COURSE DESCRIPTION: This course provides an intensive and comprehensive introduction to the skills of history taking and advanced physical assessment for the adult/geriatric patient. Lectures (and clinical experiences) are designed to help the family or adult (primary or acute care) nurse practitioner or clinical nurse specialist student apply their knowledge of physical assessment of adult/geriatric clients to the primary care or acute care setting. Emphasis is placed on the differentiation between normal and abnormal findings, recognition of common health problems, development of a differential diagnosis and the process of critically thinking through problems related to adult/geriatric health. COURSE OVERVIEW: Adult/Geriatric variations in history taking, screening, anticipatory guidance, examination techniques, physical findings, and common health problems will be addressed. COURSE OBJECTIVES: Upon completion of this course the student will be able to: 1. Identify normative changes that occur in adults as they age, and distinguish them from pathological changes. 2. Distinguish themes within the aging client s history and physical, such as high risk behaviors and their sequelae. 3. Distinguish patterns of the aging individual s health risk based on current literature and the guidelines of Healthy People Identify potential barriers to access to health care that affect this client population. Geriatric Health History Geriatric Dermatology Nutrition in the Elderly Sensory Changes in the Elderly Mobility and Function in the Elderly Incontinence & Constipation Cardiac Assessment in the Elderly Respiratory Assessment in the Elderly Dementia, Delirium and Depression in Geriatrics Saxon, S.V., Etten, M. J., Perkins, E. A. (2010). Physical Change and Aging: A Guide for the Helping Professions, Fifth Edition. New York: Springer Publishing.

2 COURSE TITLE Advanced Diagnostics and Therapeutics and NUMBER: NR NUMBER OF CREDITS: 2 COURSE OFFERED: Fall, Tuesdays 4 PM 7 PM PRE/CO-REQUISITES: COURSE FACULTY: NR Physiological/Pathophysiological Basis of Advanced Practice NR Advanced Health Assessment and Measurement NR Advanced Health Assessment and Measurement: Geriatric Variations NR Diagnosis, Illness and Symptom Management Adults - I Filissa Casserta, MSN, ACNP, CNRN Julie Stanik - Hutt, PhD, ACNP/GNP, CCNS, FAAN COURSE OVERVIEW: This clinical course introduces students to the principles of diagnostic and treatment modalities utilized in acute/critical care settings. Content includes principles such as fluid replacement, hemodynamic monitoring and electromechanical interventions. Analysis of relevant laboratory data and interpretation of radiographs and ECGs will be included. Laboratory practice will include procedures such as suturing, intubation and line insertion, as well as application of invasive therapeutic and diagnostic devices. COURSE OBJECTIVES: By the end of the semester, the student will: 1.1 Demonstrate knowledge of indications and contraindications for performing selected diagnostic and therapeutic procedures. 2.6 Demonstrate implementation of principles of informed consent. 3. Understand principles of advanced interventional and non-interventional diagnostic testing. 4.1 Describe principles of fluid replacement and hemodynamic monitoring in acutely ill patients. 5. Demonstrate psychomotor skills necessary to perform selected procedures. 6. Analyze laboratory data of patients with acute and/or complex health problems. 7.2 Interpret 12 lead EKGs and basic chest and abdomen radiographs. 8.5 Recommend systematic approach when trouble shooting potential problems in selected procedures. 9.4 Relate managed care and current health policy guidelines to the utilization and delivery of common acute care procedures Incorporate relevant research and current literature to ensure appropriate procedural technique Discuss specific ethical issues related to the diagnostic and therapeutic measures learned Identify cultural and age related differences which may require modifications in diagnostic and therapeutic procedural technique(s). 13. Maintain integrity of holistic nursing approach while performing technologically advanced procedures and assessments. Introduction to Adult Gerontology ACNP Practice (role, scope, patient needs) Obtaining informed consent Preoperative evaluation Baseline assessment of hospitalized older adults (functional and cognitive status, hospitalization risks) Providing conscious (moderate) sedation Enteral and Parenteral Nutrition Electrolyte Imbalances Fluid Resuscitation Transfusion Therapy

3 Accessing CSF Thoracentesis and tube thoracostomy Interpretation of ABGs Advanced Assessment of oxygenation, ventilation and perfusion Airway Management Methods of mechanical ventilation Obtaining central venous access Insertion of arterial catheters Wound care (local anesthesia and suturing) Marini, J. & Wheeler, A. (2009). Critical Care Medicine (4 rd Ed). Philadelphia: Lippincott Williams & Wilkins McLean, B. & Zimmerman, J. (2007). Fundamental Critical Care Support (4 th Ed). Mt. Prospect, IL: Society of Critical Care Medicine. National Panel for Acute Care Nurse Practitioner Competencies (2004). Acute Care Nurse Practitioner Competencies. Washington, D.C.: National Organization of Nurse Practitioner Faculties. available for free download at: AACN (2006). Scope and Standards of Practice for The Acute Care Nurse Practitioner. Aliso Viejo, CA.:American Association of Critical Care Nurses. Recommended Texts: Gerontology Kane, R., Ouslander, J., Abrass, I. & Resnick, B. (2009). Essentials of Clinical Geriatrics (6 th Ed). New York: McGraw Hill Medical. Internal Medicine Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., & Loscaizo, J. (Eds.). (2011). Harrisons Principles of Internal Medicine.(18 th Edition). New York: McGraw-Hill. or McPhee, S, McPhee, S. J., Papadakis., M., & Rabow, M. (2011). Current Medical Diagnosis & Treatment. New York:Lange Medical Books/McGraw Hill

4 COURSE TITLE and NUMBER: NR Advanced Practice in Acute Care I NR Advanced Practice Nursing: Cases Studies in Acute Care Nursing* CREDITS: 4 ALLOCATION OF CREDITS Clinical practicum 196 hours acute care with 50 hours gerontology enrichment COURSE OFFERED: COURSE SCHEDULE: PRE and CoREQUISITES: FACULTY: Spring Thursdays 4-6 pm SON, NR (P) Physiological/Pathophysiological Basis of Advanced Practice NR (P) Health Assessment & Measurement NR (P) Diagnosis, Symptom & Illness Management NR (C) Clinical Pharmacology Julie Stanik-Hutt, PhD, ACNP/GNP, CCNS, FAAN Filissa Caserta, MSN, ACNP, CNRN COURSE DESCRIPTION: This course fosters clinical competency and emphasizes evidence-based practice in adult acute/critical and chronic healthcare settings. It emphasizes the integration of theory, assessment and advanced therapeutics for adults and frail elders in high acuity patient settings. Students will perform comprehensive clinical assessment including appropriate diagnostic and therapeutic testing. Management of acute and chronic health problems will be accomplished with the direction of clinical preceptors. Clinical placements are arranged by faculty and will include placement one of a variety of acute/critical care areas including, but not limited to, CCU, MICU, SICU, ED, intermediate care, and specialty services such as transplant and oncology. Gerontology experiences in complex long term care, rehabilititation and/or inpatient units specializing in the Acute Care of Elders will also be provided. At weekly seminars, currently recommended diagnostic and treatment regimens will be discussed in a lecture and case study format. Information presented will focus on pathophysiology, subjective and objective clinical data including physical examination, laboratory and diagnostic test results, differential diagnosis and development of a management plan within the scope of Adult-Gerontology ACNP practice. COURSE OBJECTIVES: By the end of this course the student will: 1.1 Comprehensively assess the health status of physiologically compromised adults of all ages based on scientific knowledge, methodology and evidence- based practice. 1.2 Examine the effect of critical/acute illness on families and social support systems. 1. Record findings using the POMR format. 2. Initiate appropriate testing and therapeutic options for database information, diagnosis confirmation, and treatment for specified illnesses and disease entities. 3.1 Utilize available multidisciplinary health care services and resources in treating and optimizing the functional status of patients at varying levels of acuity. 3.2 Interact effectively with members of the multidisciplinary team. 4. Demonstrate an understanding of the current social, political, and economic aspects of health care delivery through practice and inquiry Relate the validity of current practice regimens in site specific areas that deserve further quantitative or qualitative investigation Incorporate ethical considerations in dealing with directives influencing acutely and chronically ill patients and their families or support systems. 7.7 Customize assessment, diagnosis, and treatment to individualize care of adults across the age span. 8.5 Implement an evidence-based management plan for an acutely and chronically ill patients based on history and physical examination at the novice level. Within this plan, the student will demonstrate the breadth of

5 the advanced practice role. Hazards of Immobility Preventing Functional Declines in Hospitalized Older Adults Geriatric Syndromes and Acute Care Change in Mental Status (Meningitis, Status Epilepticus, Delirium & Dementia) Pain Management Fever of Unknown Origin (FUO, HCAI, Endocarditis) Diabetic emergencies (DKA, Hyperosmolar Coma) Endocrine emergencies (Thyroid Storm, Myxedema Coma, Sick Euthyroid, Adrenal Insufficiency) Shortness of Breath (CAP/HAP, PE, Status Asthmaticus, Pneumonia, Pneumothorax, Pleural Effusions) HTN Urgency and Emergency Renal Failure Abdominal Pain (Pancreatitis, Cholangitis, Small Bowel Obstruction, Mesenteric Ischemia, GI Bleeding) Atrial Fibrillation Acute Coronary Syndromes Shock Marini, J. & Wheeler, A. (2009). Critical Care Medicine (4 rd Ed). Philadelphia: Lippincott Williams & Wilkins McLean, B. & Zimmerman, J. (2007). Fundamental Critical Care Support (4 th Ed). Mt. Prospect, IL: Society of Critical Care Medicine. Kane, R., Ouslander, J., Abrass, I. & Resnick, B. (2009). Essentials of Clinical Geriatrics (6 th Ed). New York: McGraw Hill Medical. Recommended Internal Medicine Texts: Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., & Loscaizo, J. (Eds.). (2011). Harrisons Principles of Internal Medicine.(18 th Edition). New York: McGraw-Hill. or McPhee, S, McPhee, S. J., Papadakis., M., & Rabow, M. (2011). Current Medical Diagnosis & Treatment. New York:Lange Medical Books/McGraw Hill

6 COURSE NUMBER and TITLE: NR Advanced Practice in Acute Care II NR Advanced Practice Nursing: Acute Care of Adults* CREDITS: 3 ALLOCATION OF CREDITS: Clinical practicum 168 hours acute care with 50 hours gerontology enrichment COURSE OFFERED: COURSE SCHEDULE: PRE AND COREQUISITES: FACULTY: Summer Thursdays 4-6 pm SON, NR (P)Adv. Practice In Acute Care I Julie Stanik-Hutt, PhD, ACNP/GNP, CCNS, FAAN Filissa Caserta, MSN, ACNP, CNRN COURSE DESCRIPTION: This course prepares students to diagnose, treat and follow patients across the adult age span with acute/critical health problems. Emphasis is on the highest acuity of the disease entities encountered in acute/critical areas. COURSE OBJECTIVES: 1. Comprehensively manage the health status of acutely ill adults and frail elders, at a level of expertise greater than novice, using scientific methodology and concepts. 2. Demonstrate vital acute care procedures in the assessment, diagnostic, and treatment aspects of medically/surgically compromised patients. 3. Participate actively as a member of a multidisciplinary patient care team to improve patient services for adults and frail elders in an acute care setting. 4. Analyze the political and social issues in health care which may be relevant to the NP s role in practice at the student s clinical site. 5. Anticipate potential physical and psychosocial problems, in management of the patient in the acute care/ critical and chronic care setting. 6. Implement evidence-based clinical practice. Identify potential acute care topics for NP research. 7. Discuss ethical dilemmas relative to specific acute and chronic care situations with the patient, family member(s), and/or care team member(s) involved. 8. Adapt treatment plans for patients and/or families of a diverse ages and ethnic/ cultural background. 9. Adapt algorithmic protocols for selected acute care patients and frail elders problems and situations. Stroke Oncologic Emergencies Burns Trauma Valvular Heart Disease Heart Failure & Cardiomyopathy Respiratory Failure (ALI, ARDS) Hepatic Failure Solid Organ Transplantation Marini, J. & Wheeler, A. (2009). Critical Care Medicine (4 rd Ed). Philadelphia: Lippincott Williams & Wilkins McLean, B. & Zimmerman, J. (2007). Fundamental Critical Care Support (4 th Ed). Mt. Prospect, IL: Society of Critical Care Medicine.

7 Kane, R., Ouslander, J., Abrass, I. & Resnick, B. (2009). Essentials of Clinical Geriatrics (6 th Ed). New York: McGraw Hill Medical. Recommended Internal Medicine Texts: Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., & Loscaizo, J. (Eds.). (2011). Harrisons Principles of Internal Medicine.(18 th Edition). New York: McGraw-Hill. or McPhee, S, McPhee, S. J., Papadakis., M., & Rabow, M. (2011). Current Medical Diagnosis & Treatment. New York:Lange Medical Books/McGraw Hill

8 COURSE NUMBER COURSE TITLE NR Clinical Topics And Professional Issues For Adult Gerontology Acute Care Nurse Practitioners CREDITS: 4 Clinical practicum 196 hours acute care with 50 hours gerontology COURSE OFFERED: COURSE SCHEDULE: PRE / CO-REQUISITES: FACULTY: Fall Wednesdays 4:30-6:30 pm SON, NR Advanced Practice in Acute Care II Julie Stanik-Hutt, PhD, ACNP/GNP, CCNS, FAAN Filissa Caserta, MSN, ACNP, CNRN COURSE DESCRIPTION: This course integrates the biomedical, psychological, and social elements of nurse practitioner practice. Under the supervision of an experienced preceptor, students will provide in-depth, advanced practice nursing care to patients with acute, critical, chronic and complex health problems across the adult age span. Integration of current nursing and biomedical research evidence into the clinical decision-making process will be emphasized. Professional issues relevant to nurse practitioners will be explored. COURSE OBJECTIVES: 1.5 Incorporate evidence based decision-making into assessment of, and therapeutic plan for adult patients across the age span and in acute, critical and chronic care settings. 2. Record findings using the problem-oriented medical record format. 3.1 Evaluate health/illness status of patients via history and physical examination. 4. Initiate appropriate laboratory and diagnostic testing. 5.3 Provide case management related to the health promotion, disease prevention, illness and end of life management needs of patients and their families. 6.4 Assess barriers to health care and develop strategies to improve access. 7. Serve as a patient advocate in multidisciplinary encounters. 8.4 Analyze the impact of legal and legislative and institutional parameters on advanced nursing practice. 9.5 Integrate research findings from collaborating disciplines into advanced nursing practice Demonstrate respect for patient autonomy in collaborative decision-making Protect patients rights to confidentiality in all encounters and discussions Demonstrate appreciation for cultural differences in the collection of health history data Articulate the role of the nurse practitioner in practice setting. 14. Model integrity in advanced nursing practice and professional arenas. Neurologic Syndromes (Myasthenia Gravis, Multiple Sclerosis & Gullian Barre) Introduction to Palliative and End of Life Care Losses at the end of life (driving, IADLs, finances, social network, independence) Legal issues at end of life (Surrogate decision makers, levels of care) Delivering Bad News Delivering Bad News: Simulation with Standardized Patient s Nuts and Bolts of End of Life Care Transition to Practice: Interviewing, Credentialing, and Orientation ACNP Boards: Comparing ANCC to AACN Getting to the Interview: Cover letters, CVs and Resume s Contract Negotiation Outcomes of Care Provided by NPs

9 Regulatory Issues related to NP Practice Risk management for NPs Billing and Coding for ACNPs Marini, J. & Wheeler, A. (2009). Critical Care Medicine (4 rd Ed). Philadelphia: Lippincott Williams & Wilkins McLean, B. & Zimmerman, J. (2007). Fundamental Critical Care Support (4 th Ed). Mt. Prospect, IL: Society of Critical Care Medicine. Kane, R., Ouslander, J., Abrass, I. & Resnick, B. (2009). Essentials of Clinical Geriatrics (6 th Ed). New York: McGraw Hill Medical. Recommended Internal Medicine Texts: Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., & Loscaizo, J. (Eds.). (2011). Harrisons Principles of Internal Medicine.(18 th Edition). New York: McGraw-Hill. or McPhee, S, McPhee, S. J., Papadakis., M., & Rabow, M. (2011). Current Medical Diagnosis & Treatment. New York:Lange Medical Books/McGraw Hill.