Course Name CARE OF CLIENTS · WITH PROBLEMS IN CELLULAR ABERRATIONS, ACUTE

BIOLOGIC CRISIS, EMERGENCY AND DISASTER NURSING

Course Code NCM 106
Course It deals with the· principles and techniques of nursing care management of sick
Description clients across the lifespan with emphasis on the I adult and older person with
alteration/problems, in cellular aberration, acute biologic crisis,- including
emergency and- disaster nursing and IV · Therapy.
Course Credit 6units lecture, 5units RLE (2units Skills Lab: 3units Clinical)
Contact
hours/sem 108 lecture hours, 255 RLE- Hours
Pre-requisite NCM 104-Care of clients with problems .in inflammatory and immunologic
response, perception and coordination

NCM 105-Care of clients with maladaptive patterns of behavior

Placement 4th Year, 1st Semester
Course At the end of the course, and given actual cl_ients with problems in . cellular
Objectives aberrations, acute biologic crisis and emergency, the student should be able to:
1. Utilize the nursing process in the care of individuals, families in community and
hospital settings.
- Assess with clientls his/her/their condition/health status through
interview, physical examination, interpretation of laboratory findings
- Identify actual and potential nursing diagnosis.
- Plan appropriate nursing interventions with client/s and family for
identified nursing diagnosis.
- Implement plan of care with client/s and family
- Evaluate the progress of his/her/their client's condition ad outcomes of
care
2. Ensure a well organized and accurate documentation system.
3. Relate with· client/s and their family .and the health team appropriately.
4. Observe bioethical concepts/ principles, core values and nursing standards in
the care of clients.
5. Promote personal and professional growth of self and others.
Course Outline I. The Individual across the lifespan
A. Risk factors assessment and screening procedures among clients that
contribute to the development of cellular aberration lung, breast, uterine,
prostate, colorectal and skin.
B. Significant subjective data from client - relevant inforp1ation. based on chief
complaints, functional patterns, including psychosocial arid behavioral
assessments
C. Principles and techniques of physical examination in newborn, children, adults
deviations from normal
1. Cellular aberration
a. Inspection - vasculature, symmetry, movement, nodules, discharges,
masses
b. Auscultation - heart sounds, breath sounds, bowel sounds, vascular
sounds, friction rub
c. Palpation - masses, tenderness, nodules, lesions, distention
 d. Percussion: gas patterns, areas of flatness and dullness, liver span,
masses, ascites
2. Acute biologic crisis or life-threatening situation Standard assessment of
the critically ill (focused on history-taking, discriminating PE - airway,
breathing circulation, including hemodynamics status)
D. Results and implications of diagnostic/laboratory examinations of clients with
reference to problems in:
1. Cellular aberration
a. Screening: SSE, pap smear, rectal examination,
b. Non-invasive: MRI, CT scan, bone scan, ultrasound, thyroid scan
c. Invasive: biopsy, digital rectal examination, cyst aspiration, cystoscopy,
lymph angiography, cerebral arteriography
2. Acute biologic crisis/multiorgan problem
a. Non-invasive: ECG, cardiac rhythms,
b. Invasive: ABG, hemodynamic monitoring, CVP, pulmonary capillary
wedge pressure (PCWP)
E. Pathophysiologic mechanisms:
1. Cellular aberrations a. Solid tumors - lung cancer, breast, uterine cancer,
prostate cancer, colorectal, brain cancer b. Liquid tumors - lymphomas,
leukemias
2. Acute biologic crisis /multiorgan system dysfunction/ emergency
• Cardiac failure
• Acute myocardial infarction
• Acute pulmonary failure
• Acute renal failure
• Stroke
• Increased intracranial pressure
• Metabolic emergencies - e.g. DKA/HHNK
• Massive bleeding
• Extensive surgeries
• Extensive burns
• Poisoning
• Emerging illnesses (SARS, Avian Flu)
• Multiple injuries
F. Nursing Diagnoses taxonomy pertinent to problems/alteration in
1. Cellular aberration
a. Potential for infection
b. Alteration in tissue perception
c. Activity intolerance
d. Potential for alteration in nutrition less than body requirement
e. Alteration in oral mucous membrane integrity
f. Alteration in comfort: pain/pruritus
g. Fluid volume deficit
2. Acute biologic crisis/ multi-organ failure
a. Impaired gas exchange
b. Inability to sustain spontaneous ventilation
c. Dysfunctional ventilatory weaning response
d. Decreased cardiac output (CO)
 e. Altered tissue perfusion systemic
f. Alterations in nutrition less than body requirement
g. Fluid volume deficit
h. Activity intolerance
G. Principles of various modalities of management
1. Health promotive
2. Disease preventive
3. Curative
4. Restorative
H. Principles of management for altered
1. Cellular aberration
a. Determination and management of cause
b. Definitive management; surgery, chemotherapy, radiation therapy,
biotherapy
c. Blood component replacement
d. 02 therapy
e. Drug therapy
f. Hydration
g. Prevention of infection
h. Supportive management
i. Prevention of complications
j. Rehabilitation
2. Acute biologic crisis / multi-organ failure
a. Determination and management of cause
b. Life saving interventions: basic life support, advanced cardiac life
support. first aid measures, fluid resuscitation
c. Life maintaining interventions: airway management and care of patients
with ventilator, parenteral fluid administration including blood and blood
component therapy, interventions for cardiac output problems,
pharmacologic interventions for hemodynamic instability, continuous
hemodynamic monitoring, interventions for neural regulation, fluid and
electrolyte problems, nutrition and perioperative problems
d. Psychosocial and behavioral interventions: measures to relieve anxiety,
fear, depression, critical care, concerns life: immobility, sleep deprivation,
sensory overload, body image alterations, grieving, sexuality, spirituality
e. Supportive management
f. Prevention of complication
g. Rehabilitation - pulmonary, cardiac, neurologic
I. Pharmacologic actions, therapeutic use, side effects, indications,
contraindication, and nursing responsibilities:
1. Cellular aberrations.
a. Anticancer agent
b. Analgesics
c. Narcotics
d. Corticosteroids
e. Antibiotics
f. Antipruritus
g. Analgesics, opioids
 3. Acute biologic crisis/multiorgan failure
a. Analgesics
b. Narcotics
c. Corticosteroids
d. Antihypertensive
e. Vasopressors
f. Antibiotics g. Parenteral fluids
J. Purpose, indications, nursing responsibilities for the following surgical and
special procedures
1. Cellular aberration
a. Major surgical procedures: lobectomy, pneumonectomy. mastectomy,
nephrectomy, prostatectomy, colectomy, colostomy, bone marrow transplant,
urinary diversion
b. Special procedure: brachytherapy, radiation therapy Reverse isolation,
chemotherapy,
2. Acute biologic crisis/multiorgan failure
a. Surgical procedure - coronary bypass, angioplasty, skin grafting.
b. Special procedures - advanced life support, parenteral hyperalimentation,
ventilatory support, fluid resuscitation, first aid measure including emergency
wound and trauma management, IV therapy
K. Safe and comprehensive perioperative nursing care
a. Assessment and care during the perioperative period
b. Techniques in assisting the surgical team during the operation
c. Principles of safety, comfort and privacy during the perioperative period
d. Nursing responsibilities during the perioperative period
L. Steps/pointers in decision making and prioritization with client ls having
problems in inflammatory and immunologic reaction, cellular aberration, acute
biologic crisis/multiorgan failure, including emergency an disaster preparedness
M. Principles, concept and application of bioethics in the care of clients.
N. Developing outcome criteria for clients with problems in inflammatory and
immunologic reaction, cellular aberration, acute biologic crisis/multiorgan failure.
including emergency and disaster preparedness·
O. Appropriate discharge plan including health education
P. Accurate recording and documentation
Ill. Disaster & emergency
A. Definition of emergency
B. Types of emergency
C. Triage
1. Objectives
2. START triage
3. Military triage
D. Hospital emergency incident command system
E. Incident command education
F. Hospital operations plan
G. Personal protective equipment
H. Hazardous materials
I. Decontamination
J. Biological warfare and biological agents
 K. Blast injuries
L. Natural disasters
M. Stress reactions
• Post traumatic
• Stress disorder critical incident stress management
• Debriefing
N. Nurses' role in disaster and emergency
IV. Intravenous parenteral therapy
A. Basic foundation of IV therapy
• Philosophy
• Historical background of IV therapy
• Standards and competencies of IV therapy
B. Content
• Review of anatomy and physiology of the vascular Peripheral and
integumentary system
• Fluid and electrolyte therapy
• Venipuncture technique on adult and children
• Complications of IV therapy
• Infection, control & microbiology
• Demonstration of procedure
• Documentation activity
C. Performance scale for IV therapy
Equipment Cellular Aberration · Breast. examination model, cervical examination model,
and Materials safety guidelines for chemotherapy and radiotherapy, safety I barriers, for
[these could chemotherapy and spill kits.
be found in; Acute Biologic Crisis: Cardiac monitor, EKG machine, oxymeter, ventilatory
nursing skills support equipment, endotracheal tubes, tracheostomy tube, airway, BP
lab, base apparatus, stethoscope, oxygen tank, 02 regulator, humidifier, monkey wrench,
hospital, 02 tubings, 02 cannula/catheter, 012 masks, croupette, 02 tent, suction
affiliating catheters, suction machine, cardiac arrest boa'rd, gloves, peak flow meter,
centers] tongue depressor, microscope. glass slide, one-way/two-way/three-way water
seal drainage, CVP manometer and tubing, peritoneal dialysis set, dialyzing
solution, : hemodialysis machine (optional), incubator, Billilight, lsolette, Model
for basic and advance life support, 1nclud1ng equipment and materials , for NCM
104 and NCM 105. IV Therapy: IV arm dummy, IV injection tray, IV needles,
cotton and alcohol