103sdlp

Self-Directed Learning Packets
NUR 103 Lab

SDLP #1 SDLP #2 SDLP #3 SDLP #4 SDLP #5 SDLP # 6 SDLP #7

Directions for use:

1. Look at the lab schedule for your section. In the first column you will see the number of the Self Directed Learning Packet (SDLP) that you will be using in lab for each day.

2. The SDLP has 2 major parts: Preparation for Lab and Lab Time Activities.
Before each lab, do the assignments in the SDLP listed under Preparation for Lab.
These include reading pages in the textbook Fundamentals of Nursing by Kozier, answering study guide questions (available as a handout in NUR 103), and answering the critical thinking questions listed in the SDLP. Some of these questions are difficult. They are meant to challenge your thinking. Do the best you can. We will discuss them during the lab class. All of the SDLPs except for the first two, have a video presentation of the skill. The skills are all on the video Nursing 103 Skills Video. You are to watch the video at home and begin practicing the skill before you come to lab.

3. Bring your NUR 103 Syllabus (which has the SDLP and Skills Check off Record) and Study Guide Handout to lab. Your instructor will check to see that you have completed the study guide and critical thinking questions. We will also go over the skill together and the instructor will answer your questions. You will then have time to practice the skill, view other videos for further learning, and work on related computer programs. The steps of the skills are found in the assigned reading in Kozier. They are also on the CD that accompanies the book.

4. When you have practiced the skill and can do it correctly, smoothly and quickly, your instructor will test you. If you fail the performance test, you retest until you are successful. The skills are generally introduced one week and tested during the next week’s lab session. Refer to the lab schedule for your section.

5. There is an option to videotape your performance of a skill for testing purposes. See the Guidelines for Video Taping Performance Tests in the Lab in this syllabus.

Self-Directed Learning Packet #1

A. Preparation
1. You will find the assignments under Unit 1 in the syllabus.
2. Reading: Kozier p. 265-269, 428-432
3. Video- There is no required video for this unit
4. Study Guide Questions- “Focus on Critical Thinking” Kozier p. 442, questions 1-4 and review questions p 442-443, questions 1-5.
Also make sure you have completed the Orientation Study Guide and bring it with you to lab.
5. Critical Thinking Questions-
Write a response to each of the following client statements using the technique listed. Use the information on pages 440-442 to help you.
1. “I really feel beat today.”
Seeking clarification

2. “I keep seeing shadows on the wall. It looks like bats flying around.”
Presenting reality

3. “I try to walk but then I get so dizzy. I have to sit down and rest. I’m so frustrated “
Paraphrasing

4. “I don’t understand what you mean when you say I have hypertension.”
Giving information

5. “I’ve been having so many problems walking lately. I get dizzy. I feel weak”.
Focusing

6. “Last night I couldn’t get to sleep. I took a pill for my pain”
Clarifying time sequence

7. Look over the list of therapeutic communication techniques. Pick two
techniques that you think would be best for beginning an interview.
You will be interviewing adult clients about their health. Write 2 opening
statements using the techniques that you choose as best for beginning an
interview:

8. You are working in a clinic. You are interviewing a new client. You
introduce yourself and begin the interview. The client appears uncomfortable, does not look directly at you and only answers yes and no. What has caused this client’s response? List as many possibilities as you can:

9. Think back to when you have had a friend or relative come to you to discuss a problem. Evaluate how well you responded to them based on what you now know about therapeutic communication. What was the outcome of the conversation?

Was the outcome influenced by your use or non-use of therapeutic
communication techniques?

Questions that I have for my instructor after preparing for lab:

B. Lab time

1. Performance tests-You will be interviewing each other using the Health Assessment Forms. This will be an opportunity to practice using your therapeutic techniques. It will not be graded. You may also test out on the validation skills.
2. There is an orientation quiz online. You may use your Orientation Study Guide to help you answer the quiz questions.
3. You will orient to the computer lab and use the computer program- Building Rapport & Trust
4. You have the option of viewing the following videos to enhance your learning:
*Communicating with Children and Families

Self-Directed Learning Packet #2

A. Preparation
1. You will find the assignments under Unit 2 in the syllabus. The skills checklists/procedures for teaching self-breast exam and testicular self exam are in your SDLP.
2. Reading- Kozier p. 129-130, 588-592, 619-621, 986-988
3. Video- “Breast Health” and “Testicular Self Exam” will be shown in class.
4. Study Guide Questions- None
5. Critical Thinking Questions-
1. Are the following findings normal or significant findings that need to be reported to the physician?
______ inversion of one nipple (has been present since puberty)
______ dimple noted on left breast
______ skin resembles an orange peel (exaggerated pores) on left
breast
______ left breast slightly larger than right
______ left nipple larger than right
______ tender 1 cm mass on left breast
______ soft, spongy tube that is slightly tender palpated at the top of
both testes
______ left testes is slightly lower than right testes
______ small hard round mass on left testes

2. You are interviewing a modest 70-year-old woman. She has a strong
history of cancer in her family. When you bring up the subject of self
breast exam, she says “ Why bother! I’m old and I will die soon anyway.” Then she changes the subject.
What could have caused her to respond this way? List all of the possibilities that you can imagine.

What would you say? Explain the rationale for your response.

3. In what situations is discharge from the nipple normal? List as many possibilities as you can.

4. You are admitting a woman to the hospital for hypertension (high blood pressure). She tells you that she found a mass in her left breast. What further questions would you ask?

What further assessments would you make?

Write what you would record in her chart including a description of the
mass.

5. You have been asked to teach an eighth grade class of boys how to do
a testicular self exam. When you begin the class the boys are start laughing and making jokes. How would you approach this group and what would you tell them about testicular self exam?

Questions that I have for my instructor after preparing for lab:

B. Lab Time

1. Performance tests- You will be asked to teach another student or the instructor how to do the self breast and testicular exams using a model.
Completing the Personal Health Habit History and a physical fitness test (p.129-130) is also part of the first lab. The physical fitness test is found at the following web site. You will do it in the lab.
http://www.hooah4health.com/4You/apft.htm
2. Written tests- none
3. Computer- Vital Signs: Blood Pressure.
Explore Health Promotion Sites on the Internet
4. In class videos- Breast Health: Self Exam and Early Detection
Testicular Self Exam
5. Out of Class Assignment- Cultural Videos or Web site

Self-Directed Learning Packet # 3

A. Preparation
1. Assignments will be found under Unit 4 in the syllabus. The Basic Physical Exam is not in the skills book. It is in your SDLP.
2. Readings- Kozier- p. 524-531 & others as listed below
3. Video- Basic Physical Exam is on the NUR 103 Skills Video. Watch it at home before class.
4. Study Guide Questions- as assigned in handout
5. Critical Thinking Questions

1. What is the significance or meaning of each of the following abnormal assessment findings?
a. absence of pedal pulses or weak, thready pulses (page 586 in Kozier)

b. decreased skin turgor “stays tented” (page 539 in Kozier)

c. edema (page 535 in Kozier)

d. delayed response to the blanch test (capillary refill)
(page 543 in Kozier)

e. What changes in the hair do you see with severe protein malnutrition? (page 540 in Kozier)

f. List some conditions that may affect the size of the pupils:
(page 547 in Kozier)

Mydriasis (enlarged pupil)

Miosis (constricted pupil)

Anisocoria (unequal pupils)

g. What is the purpose of the extraocular muscle tests?
What does this test determine? (page 552 in Kozier)

h. What is the significance of hyperactive and hypoactive bowel sounds? (page 595 in Kozier)

2. You are working in an emergency room. A woman brings in her 2 year old child with the following signs and symptoms:
Rapid, weak thready pulse, decreased skin turgor, hyperactive bowel sounds, dry, brittle hair, responds to verbal stimuli, sleepy,
weak, mouth dry, swollen and reddened gums,
height- 90th percentile, weight- 40th percentile.
What further questions would you ask?

What further assessments would you make?

What are some possible problems that would cause these signs and symptoms?

3. Of the 2 people described below, which one, according to your definition of health, is most healthy? Why?

Mr. A
Age 70
Diabetic, takes insulin and follows a diabetic diet, one glass of wine daily with dinner
Has had a stroke and must use a wheel chair, moves to chair with the help of one person
Alert and oriented, decreased sense of smell and taste, decreased sensation in both feet
Height and weight ideal
Bald
Happy, volunteers at local church

Mr. B
Age 20
No illnesses
40 pounds overweight
High fat diet
Wears glasses
Smokes 1 pac per day
Drinks about 10 beers each Saturday and Sunday
Exercises at gym 3 times a week
Works full time and goes to school at night
Feels stressed out
Few friends, feels lonely at times

Your definition of health:

Who’s healthier? Why?

Questions I have for my instructor after preparing for lab:

B. Lab time
1. Performance Test- You will perform the Basic Physical Exam on another student.
2. There is no written test.
3. Computer program: Developing Nursing Judgment
4. You have the option of viewing the following videos to enhance your learning:
*Beginning Physical Assessment
*Pediatric Assessment
*Physical Assessment of the Elderly
*Assessment of the Older Adult: The Physical Exam
*Assessment of the Older Adult: An Overview
*Practical Skills in Physical Assessment
*Assessing the Adult Head to Toe

Self-Directed Learning Packet # 4

A. Preparation
1. Assignments will be found under Unit 4 in the syllabus.
2. Readings: Kozier p. 531-570
3. Nursing 103 Skills video- Assessment of Mental Status, Skin, Nails, Skull, Face, Eyes, Ears, Mouth & Neck
Watch it at home before class.
4. Study Guide Questions: as assigned in handout
5. Critical Thinking Questions:
1. What is your main concern for a client who is withdrawn, has frequent mood changes from laughing to crying, speaks rapidly, slurs the words, and is confused as to the date, time and place?

What interventions would you initiate?

2. What is the significance of cyanosis (p 1279)?

3. Cyanosis would most likely be found along with which nail shape (p. 547 & 551)?

4. A client has a slow response to the blanch test (greater than 3 seconds). Would you expect him to have strong or weak pedal pulses?

5. Describe the visual field assessment findings associated with glaucoma (p.547 & 551)

6. Describe the assessment findings associated with cataracts (p. 547):

8. Complete the following table:
Type of hearing loss Cause of hearing loss Response to Response to
Weber test Rinne Test

Conductive

Sensorineural

10. For each of the following assessment findings, write what the
implications are and what you would do because of them:
a. dry, cracked lips, dry buccal mucosa, dry, furry tongue

b. spongy, red, tender gums that bleed easily

c. smooth red tongue

11. Read the following story about Mario Lemieux. What is important to learn about assessment from this story?

Questions I have for my instructor after preparing for lab:

C. Lab time
1. Performance test: You will be asked to demonstrate assessments of the mental status, skin, nails, skull, face, eyes, ears, mouth and neck. The test will be the same as you have seen on the Nursing 103 Skills video. The instructor will ask you questions and show you pictures of different skin lesions, nail shapes, etc that you will need to identify. The pictures will be available in the lab for you to practice with.
2. Written test- none
3. Computer program
Physical Assessment- Assessing the Integument, Eyes, Ears, Head
4. You have the option of viewing the following video to enhance your learning:
*Biologic Changes of Aging: Physical Appearance & Special
Senses
*Assessment of Mental Status

Self-Directed Learning Packet # 5
A. Preparation
1. Assignments are found under Unit 4 in the syllabus.
2. Readings: Kozier p. 571-588, 592-599.
3. Video- Nursing 103 Skills Video- Assessment of the Thorax, Cardiovascular system, Peripheral vascular system, and Abdomen. View at home before class.
4. Study Guide Questions: as assigned in handout
5. Critical Thinking Questions:
1. Which of the following assessment findings would indicate possible respiratory problems?
____ barrel chest
____ kyphosis
____ scoliosis
____ lordosis

2. You are admitting a client to the emergency room. He fell off of a ladder. He complained of pain on the right side of his rib cage. You felt a lump over his 8 and 9 ribs. What further questions would you ask? What further assessments would you make?

        You find that his respiratory excursion is not symmetrical- the
        right side of his chest does not move as much as the left. Also
        you note no breath sounds on the right and no tactile fremitus
        on the right. What do you think is wrong with your client?
        Why/ what evidence of that problem exists?

3. Your client has pneumonia. The bases of both lungs are filled
with a purulent exudate. What change in tactile fremitus would you expect to find over the bases?

What percussion sound would you expect over the bases?

4. What could the following assessment findings signify?
a. shortness of breath, crackles auscultated over lungs , and cyanosis
b. heave lateral to apex of heart, PMI displaced to the left

c. bilateral jugular venous distention

d. carotid bruit and thrill

e. positive Homan’s sign, warm, red area over vein of leg, swelling of calf

f. large abdomen with tense glistening skin

g. patient hasn’t urinated for 12 hours. Palpable smooth, round, tense mass in lower mid abdomen

5. Of the assessment findings listed above in a through g, list the top 3 priority findings. In other words, which findings would concern you the most, cause you to intervene or call the physician immediately. Explain the rationale for your choices:

Questions I have for my instructor after preparing for lab:

B. Lab time
1. Performance test: You will be asked to demonstrate assessments of the thorax, cardiovascular system, peripheral vascular system, and the abdomen. The test will be the same as you have seen on the Nursing 103 Skills video.
2. Written test- none
3. Computer program- Pulse and Respiration
Auscultation of Normal Breath Sounds
Physical Assessment- Respiratory and Cardiovascular System, Abdomen
4. You have to option of viewing the following videos to enhance your learning
*Assessing Breath Sounds
*Assessing Heart Sounds
*Physical Assessment: The Heart
*Physical Assessment: The Lungs

Self-Directed Learning Packet #6

A. Preparation
1. Assignments will be found under Unit 4 in the syllabus.
2. Readings: Kozier: p. 599-614
3. Video- Nursing 103 Skills Video- Assessing the Musculoskeletal System, Motor Function and Sensory Function
4. Study Guide Questions: as assigned in handout
5 Critical Thinking Questions
1. What nursing diagnosis would apply to a client with…
A. intention tremors

B. spasticity of all limbs

C. flexion contractures of both knees (frozen joints)

2. Your client has expressive aphasia. How would you assess their orientation and memory?

3. You are admitting a client who burned both of her arms while cooking. She is oriented times 3, but has trouble finding the right words. She is unable to repeat 5 digits back to you and can’t recall items that you listed earlier in the interview. She lives alone. What type of discharge planning would you initiate?

4. What are the safety implications for the client with each of the
following assessment findings? List as many as you can think of.
a. positive Romberg’s sign

b. failed finger to nose test

c. hypoesthesia (touch, temperature) of both feet in a diabetic client

Questions I have for my instructor after preparing for lab:

C. Lab time
1. Performance Test- You will be asked to demonstrate assessments of the musculoskeletal system, motor function and sensory function. The test will be the same as you have seen on the Nursing 103 Skills video.
2. Written Test- none
3. Computer program- Physical Assessment- Musculoskeletal and Neurological System
4. You have the option of viewing the following video to enhance your learning:
* Identifying Neurological Deficits

Self-Directed Learning Packet # 7

A. Preparation
1. Assignments will be found under Unit 6 in the syllabus
2. Readings-Kozier- p. 786-810, 839-853
3. Video- Nursing 103 Skills Video- Oral Meds and Topical Meds
4. Study Guide Questions- as assigned in handout
5. Critical Thinking Questions:
1. You give your patient a new antibiotic orally. A few minutes later, he calls you to his room. You find him short of breath, respiratory rate = 36, BP = 80/40, pulse = 120.
What happened? List as many possibilities that you can think of.

What further assessments would you want to make?

What will you do? Why?

2. Your patient has cancer. He has been getting the
Narcotic Morphine 60 mg orally for 2 weeks. It had been working well until the last 2 days. He tells you that it doesn’t relieve his pain anymore.
List possible reasons for the Morphine’s reduced effectiveness:

List the assessments you would make:

List possible actions you would take:

3. Your client had a stroke. He has difficulty swallowing. You have an order to give him potassium which are very large pills. When you give them, he begins to cough. What are some possible solutions to this problem?

4. Your client has the following meds ordered. He states that he’s feeling nauseous and would like to wait 2 hours before taking his medications. It is now 7:30 am.
Patient Data: History of Diabetes, high blood pressure, admitted with pneumonia. VS= 150/94, 90, 24 Temp= 102. Glucose = 200
Medications:
0730- Glucotrol
0800-Lasix daily
          Potassium daily                 *all meds are oral
          Lopressor q 8 hours
          Keflex q 6 hours
Prn Compazine
       Tylenol

What further assessments would you make?

What are possible solutions to this problem?

6. Your patient is being discharged with prescriptions for 4 oral medications. She has poor eyesight, impaired long and short term memory, and poor fine motor control. She lives alone. What problems do you foresee in relation to her medications and what are possible solutions?

7. You are to administer eye drops for glaucoma to a resident in a nursing home. You see that the conjunctiva are red with white thick discharge and the resident is complaining of itching and pain in her eyes. What’s wrong and what would you do?

8. You are to administer a Tylenol suppository to a client with a fever of 102 and vomiting. You note large, bleeding hemerrhoids and the client is complaining of rectal pain. What would you do?

9. You are to administer vaginal antifungal cream to an elderly woman who has flexion contractures of both knees.
How would you position her for the vaginal instillation?

10. You have just started a new job as a staff nurse on a busy medical unit. You are passing medications with your preceptor. You go into the next patient’s room and he calls from the bathroom to you telling you to leave the medications on the bedside table. He will take them when he gets out. The preceptor tells you that he is oriented and responsible and to go ahead and leave the medications for him. Would you do?
Reasons for leaving the medications Reasons against leaving the medications

How would you handle the situation?

Questions I have for my instructor after preparing for lab:

B. Lab time
1. Performance test- You will be tested on oral meds during the last week of NUR 103. You will do the performance test for topical meds during the first week of NUR 104. You will be given an order for medications and you will need to prepare them and give them to the patient. You must look up the meds first and make the necessary assessments before giving them. You will be asked to calculate doses.
2. Written test- You will have a written test covering oral and topical meds during the last week of NUR 103. It will also contain dose calculations
3. Computer Programs-
          Dosage and Calculations Made Easy
                                                                Medication Administration
                                                                Oral Medications
                                                               Safe Dosages
                                                        Medication Maestro
4. You have the option of viewing the following videos to
enhance your learning:
*Administering Non-parenteral Medications
*Avoiding Medication Errors