Course Syllabus

OLFU VISION

A premier inclusive university of choice aspiring to improve man as man by developing individuals through a legacy of excellent education and compassionate value formation.

OLFU MISSION

The noble dictum “improving man as man” embodies the existence of Fatima Medical Science Foundation and Our Lady of Fatima University as educational institutions dedicated to the holistic formation of men and women imbued with the necessary skills, virtues and academic development. To achieve this end, the university aims to:

Commit itself to the service of society through quality education;
Develop the capabilities of individuals in order to maximize their potentials;
Nurture future professionals with the requisite academic foundation and conventional skills so as to mold them into highly-respected leaders and members of society;
Respond effectively to the changing needs and conditions of the times through continuing professional education and research;
Inculcate social awareness through community outreach program;
Instill and apply environmental awareness in order to protect our national and global resources;
Imbue a deep sense of nationalism and pride in our Filipino heritage;
Uphold virtues of truth, justice integrity, compassion and faith in God.

OLFU CORE VALUES

Through innovative learning strategies focused on strong and updated academic foundation with enhanced industry skills and experience, a graduate of OLFU is expected to be an ACHIEVER. In the community and in the workplace, an OLFU graduate will be known as a person who:

A – Aspires to Do His Best

C – Credible and Compassionate

H – Hardworking and Honorable

I – Inspiration to Others

E – Efficient, Effective and Ethical

V – Visionary

E – Entrepreneurial, Employable and Excellent Work Habits

R – Responsible

COLLEGE VISION

The College of Nursing envisions itself as the foremost provider of quality Philippine nursing education and service in 2030.

COLLEGE MISSION

The College of Nursing is committed to develop professionally competent and goal-driven nurse practitioners who will lead as role models in the healthcare society.

Course Title	:	CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS/ ACUTELY ILL/ MULTI-ORGAN PROBLEMS/ HIGH ACUITY AND EMERGENCY SITUATIONS, ACUTE AND CHRONIC
Course Code	:	NCMB 418
Course Description	:	This course deals with the principles and techniques of nursing care management of sick clients in varied settings with life-threatening conditions/ acutely ill/ multi-organ problems/ high acuity and emergency situations, acute and chronic
Course Credit	:	Theory: 4 units (72 hours); RLE: 5 units (255 hours) [2 units Skills Laboratory (102 hours) and 3 units Clinical (153 hours)]
Independent Study	:	51 – 76 hours
Placement	:	Fourth year First Semester
Pre-requisites	:	NCMB316 and NCMB317

Level Outcomes: At the end of fourth year, given groups of clients (individuals, families, population groups, and communities) with health problems and special needs, the learners demonstrate safe, appropriate and holistic care utilizing the nursing process and can assume first level entry positions in any field of nursing.

Course Outcomes: After successful completion of NCMB418, students are able to:

Apply knowledge of physical, social, natural and health sciences and humanities in the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Provide safe, appropriate, and holistic care of group of clients with life- threatening conditions, acutely ill / multi-organ problems, high acuity and emergency situation utilizing the nursing process.
Apply guideline and principles of evidence-based practice in the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity and emergency situation.
Practice nursing research in accordance with existing laws, legal, ethical, and moral principles nursing in the care of the clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity and emergency situation.
Communicate effectively in speaking, writing and presenting using culturally appropriate language in the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Document to include client care accurately and comprehensively in nursing care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Work effectively in collaboration with inter-, intra-, and multi-disciplinary and multi-cultural teams in the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Practice beginning management and leadership skills in the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Conduct research with an experienced researcher the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Engage in lifelong learning with a passion to keep current with national and global developments in general, and nursing and health developments in nursing research
Demonstrate responsible citizenship and pride in being a Filipino.
Apply techno-intelligent care systems and processes in the care of group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Adopt the nursing core values in the delivery of care to the group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Apply entrepreneurial skills in the delivery of nursing care in the group of clients with life-threatening conditions, acutely ill/ multi-organ problems, high acuity, and emergency situation.
Apply institutional core values of an A.C.H.I.E.V.E.R.


Week	Learning Outcomes	Course Content
Week	Learning Outcomes	Course Content
1	ORIENTATION: Understand and analyze how the study of critical care and emergency nursing shares in the achievement of the vision-mission of the University and graduate attributes. Integrate relevant principles of social, physical, natural and health sciences and humanities in a given health and nursing situations based on epidemiologic profile Apply appropriate nursing concepts and actions holistically and comprehensively. Coordinate tasks and functions of other nursing personnel. Manage resources (human, physical, time) efficiently and effectively. Ensure multidisciplinary and sectoral collaboration in the delivery of health care. Collaborate with other members of the health team in the implementation of programs and services. Apply principles of partnership and collaboration to improve delivery of health services.	Revisit: a. OLFU vision-mission, PO, CO, ILOs b. Course outline (syllabus) and course requirements INTRODUCTION TO CRITICAL CARE NURSING A. Scope of Critical Care Practice 1. Development of Critical Care Nursing Practice, Education and Professional Activities in the Philippines 2. Critical care Body knowledge a. Critical care Competencies b. Professional Organizations B. Critical Care Nursing Roles C. Leadership in Critical Care 1. Standard of practice 2. Clinical leadership 3. Management systems and resources a. Resource and supports in the Governance and management of a critical care unit b. Physical design and Equipment Requirements of CCU c. Human resource requirements, supports and training of the workforce d. Leadership and management Principles influencing quality, efficacy and appropriateness of a CCU e. Risk management D. Multi-disciplinary and multi-cultural teams 1. Interprofessional care maps 2. Collaborative care of acute / chronic clients 3. Multi-organ problems, high acuity 4. Emergency situation
2	Adhere to ethico-legal considerations when providing safe, quality, and professional nursing care. Adhere to established norms of conduct based on the Philippine Nursing Law and other legal, regulatory, and institutional requirements relevant to safe nursing practice and protect client rights based on “Patient’s Bill of Rights and Obligations.” Apply ethical reasoning and decision-making process to address situations of ethical distress and moral dilemma Implement strategies and polices related to informed consent as it applies in multiple contexts. Customize nursing interventions based on Philippine culture and values.	ETHICO-LEGAL CONSIDERATIONS IN CRITICAL CARE a. Patient safety guidelines in critical care b. Ethical and legal considerations in the care of the critically ill c. Scope of Nursing Practice based on R.A. 9173 d. Patient’s Bill of Rights and Obligations: Unconscious client ICU Nurse as a Patient’s Advocate A. End of life care B. Palliative Care for Critically Ill C. Safe Practice in the ICU Filipino culture values and practices in the care of group of clients with life threatening ocnditions, acutely ill / multi-organ problems, high acuity and emergency situations
3	Provide appropriate evidence-based nursing care derived from a variety of theories, care standards, research and client preferences. Use of appropriate technology to perform safe and efficient nursing activities. Participate in the development and improvement of policies and standards regarding safe nursing practice and relevant to human resource management Demonstrate continued competence and professional growth. Participate as a member of research in the conduct of a research study. Assume responsibility for lifelong learning, own personal development and maintenance of competence. Engage in advocacy activities to deal with health-related concerns and adopts policies that foster the growth and development of the nursing profession. Model a professional behavior. Implement system of informatics to support the delivery of health care. Use of appropriate technology to perform safe and efficient nursing activities.	QUALITY AND SAFETY A. Evidence-based Nursing (EBN) 1. Steps in the EBN Process 2. Population, Intervention, Comparison, Outcome (PICO) format 3. Sample, Phenomenon Design, evaluation, Research (SPIDER) Type 4. Types of outcomes B. Clinical Practice Guidelines - Steps in developing clinical Guidelines C. Quality and safety Monitoring 1. Care bundles 2. Checklists 3. Continuous Quality Improvement 4. PDCA (Plan, Do, Check, Act) PROFESSIONAL DEVELOPMENT A. Research, Publications and Conference Presentations Continuing Professional Development in Critical care Nursing B. Nurses’ Role as Member of the Research Team C. ICU / CCU and IV trainings D. Advocacy: Access to social care services 1. PhilHealth 2. DOH 3. DSWD 4. PAGCOR 5. PCSO E. Professional decorum in critical care Information and communication technologies in CCU 1. Clinical Information System 2. Computerized provider order entry (CPOE) 3. Hand-held Technologies 4. Tele-health Initiatives
4-5	Discuss the pathophysiologic responses with life- threatening conditions, acutely ill / multi-organ problems, high acuity and emergency situation. Analyze a sick adult client’s health status/competence. Formulate a plan of care based on client’s priorities to address the needs/ problems. Institute appropriate corrective actions to prevent or minimize harm arising from adverse effects. Apply safe and quality interventions to address the client’s identified needs/ problems. Offer client health education using selected planning models as appropriate for the sick adult client. Document nursing care and services rendered and processes outcomes of the findings/ result of the client data. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing Care of Clients with Life-Threatening Conditions, Acutely Ill / Multi-organ Problems, High ACUITY, and emergency Situation Nursing Care of Clients with Altered Ventilatory Function 1. Pulmonary Embolism 2. Acute Respiratory Distress 3. Syndrome / Acute lung injury 4. Acute and Chronic Obstructive Pulmonary disease 5. Pneumonia (Ventilator acquired) 6. Respiratory Pandemics 7. Pulmonary Hypertensions 8. Pneumothorax A. Assessment 1. Subjective data – Nursing History 2. Objective Data 3. Physical Assessment 4. Diagnostic Assessment - Non-invasive – Oximetry b. Invasive - ABG - Pulmonary Capillary Wedge Pressure - Pleural Fluid Analysis - Pulmonary Angiography - Ventilation-Perfusion (V/Q) Scan - Capnography B. Nursing diagnoses C. Planning (health promotion and restoration and maintenance) D. Implementation of nursing care (independent, interdependent, client education) a. Medical-Surgical Management - Mobilization of secretions - Artificial airway Management - Administering Oxygen Therapy - Mechanical Ventilation Thoracic Surgeries - Lung transplantation b. Pharmacologic Management - Complementary alternative medicine – Echinacea, Goldenseal, Zinc c. Diet therapies - Tube feedings - Fluid therapy - High CHON, High Calorie Supplements E. Client outcome evaluation F. Reporting and documentation
6	PRELIM EXAM
7-8 7-8	Discuss the pathophysiologic responses with life- threatening conditions, acutely ill / multi-organ problems, high acuity and emergency situation. Analyze a sick adult client’s health status/competence. Formulate a plan of care based on client’s priorities to address the needs/ problems. Institute appropriate corrective actions to prevent or minimize harm arising from adverse effects. Apply safe and quality interventions to address the client’s identified needs/ problems. Offer client health education using selected planning models as appropriate for the sick adult client. Document nursing care and services rendered and processes outcomes of the findings/ result of the client data. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing Care of Clients with Altered Tissue Perfusion 1. Acute Ischemic Heart Disease 2. Heart failure 3. Cardiogenic Shock 4. CAD 5. Arterial Disease 6. Hypertensive Crisis 7. Cardiomyopathy 8. Arrhythmias A. Assessment 1. Subjective data – Nursing History 2. Objective Data 3. Physical Assessment 4. Diagnostic Assessment a. Non-invasive – ECG, echocardiography b. Invasive - Cardiac catheterization - Central venous Pressure (CVP) - Pulmonary Artery Pressure (PAP) - Intra-arterial Blood Pressure monitoring - Left arterial pressure Monitoring B. Nursing diagnoses C. Planning (health promotion and restoration and maintenance) D. Implementation of nursing care (independent, interdependent, client education, and diet therapies / management) 1. Medical-Surgical Management - Recanalization - Palliative Care for End Stage Heart failure - Percutaneous Transluminal Angioplasty - Pacemakers - Cardioversion - CABG - IABP - Heart Transplantation - Pharmacologic management – First-line and Second-Line Pharmacotherapy of heart failure 2. Complementary alternative medicine - Fish oil / omega 3 fatty acids - Hawthorn - Gingko biloba - Ginseng - Garlic E. Client outcome evaluation F. Reporting and documentation
9-10	Discuss the pathophysiologic responses with life- threatening conditions, acutely ill / multi-organ problems, high acuity and emergency situation. Analyze a sick adult client’s health status/competence. Formulate a plan of care based on client’s priorities to address the needs/ problems. Institute appropriate corrective actions to prevent or minimize harm arising from adverse effects. Apply safe and quality interventions to address the client’s identified needs/ problems. Offer client health education using selected planning models as appropriate for the sick adult client. Document nursing care and services rendered and processes outcomes of the findings/ result of the client data. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing Care of Clients with Altered Metabolic-Gastrointestinal and Liver Function 1. Acute GI Bleeding 2. Intra-Abdominal 3. Hypertension and Abdominal Compartment Syndrome 4. Liver Failure 5. Acute Pancreatitis 6. Bariatric 7. Diabetic Ketoacidosis 8. HHS A. Assessment 1. Subjective data – Nursing History 2. Objective Data 3. Physical Assessment 4. Diagnostic Assessment - Non-invasive – Guaiac test , Hepatobiliary scan, CBG a. Invasive - Invasive Blood Glucose Monitoring - Esophagogastroduodenoscopy (EGD) - Endoscopic Retrograde Cholangiopancreatography (ERCP) - Percutaneous Transhepatic Cholagiography (PTC) - Liver Biopsy - Serum Blood studies A. Nursing diagnoses B. Planning (health promotion and restoration and maintenance) C. Implementation of nursing care (independent, interdependent, client education, and diet therapies) 1. Medical-Surgical Management - Volume Restoration - Nasogastric Suction tubes - Esophagogastric Balloon Tamponade Tubes Billroth I and II - Transjugular Intrahepatic Portosystemic Shunt - Liver Transplantation - Reverse Hydration - Reverse Ketoacidosis - Electrolyte Replacement - Rapid Hydration 2. Pharmacologic management 3. Complementary alternative medicine – Ginger, Bitter fruit (Ampalaya) D. Client outcome evaluation E. Reporting and documentation
11	Discuss the pathophysiologic responses with life- threatening conditions, acutely ill / multi-organ problems, high acuity and emergency situation. Analyze a sick adult client’s health status/competence. Formulate a plan of care based on client’s priorities to address the needs/ problems. Institute appropriate corrective actions to prevent or minimize harm arising from adverse effects. Apply safe and quality interventions to address the client’s identified needs/ problems. Offer client health education using selected planning models as appropriate for the sick adult client. Document nursing care and services rendered and processes outcomes of the findings/ result of the client data. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing Care of Clients with Altered Elimination 1. Renal Failure (Acute & Chronic) 2. Criteria for Diagnosis of acute renal failure: - The Risk, Injury and failure criteria with outcomes of loss and end-stage renal disease (RIFLE) A. Assessment 1. Subjective data – Nursing History 2. Objective Data 3. Physical Assessment 4. Diagnostic Assessment a. Non-invasive - Urinalysis - 24-hr urine collection - Renal ultrasound b. Invasive - Serum studies - IVP B. Nursing diagnoses C. Planning (health promotion and restoration and maintenance) D. Implementation of nursing care (independent, interdependent, client education, and diet therapies / management) 1. Medical-Surgical Management - Fluid resuscitation - Peritoneal Dialysis - Hemodialysis - Continuous renal replacement therapy (CRRT) 2. Pharmacologic management - First-line and Second-Line Pharmacotherapy of heart failure 3. Diet and Nutrition management - Electrolytes Restriction - Fluid Restriction - High CHO Diet 4. Complementary alternative medicine - Halamang gamot E. Client outcome evaluation F. Reporting and documentation
12	MIDTERM EXAM
13 - 14	Discuss the pathophysiologic responses with life- threatening conditions, acutely ill / multi-organ problems, high acuity and emergency situation. Analyze a sick adult client’s health status/competence. Formulate a plan of care based on client’s priorities to address the needs/ problems. Institute appropriate corrective actions to prevent or minimize harm arising from adverse effects. Apply safe and quality interventions to address the client’s identified needs/ problems. Offer client health education using selected planning models as appropriate for the sick adult client. Document nursing care and services rendered and processes outcomes of the findings/ result of the client data. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing Care of Clients with Altered Perception 1. Traumatic Brain Injury 2. Acute Ischemic Stroke, 3. Traumatic SCI A. Assessment 1. Subjective data – Nursing History 2. Objective Data 3. Physical Assessment 4. Diagnostic Assessment Brain Imaging techniques – CT, MRI, PET, Cerebral Angiography, Cerebral Perfusion, Intracranial Pressure Monitoring a. Pulse waveforms b. Assessment of CPP c. Assessment of cerebral oxygenation – Jugular venous oximetry, partial brain tissue oxygenation monitoring d. Non-invasive: Transcranial doppler, Continuous EEG, Near infrared spectroscopy e. Neurologic assessment - LOC – GCS, Full Outline of UnResponsiveness (FOUR) score, mental status - Cranial nerve testing - Cerebellar testing - Sensory assessment - Motor assessment - Reflexes B. Nursing diagnoses C. Planning (health promotion and restoration and maintenance) D. Implementation of nursing care (independent, interdependent, client education, and diet therapies / management) 1. Medical-Surgical Management - Bleeding management, Evacuation of blood clots 2. Pharmacologic management - First-line and Second-Line Pharmacotherapy of heart failure 3. Diet and Nutrition management – Antioxidants, Phytochemicals 4. Complementary alternative medicine - Bilbery E. Client outcome evaluation F. Reporting and documentation
15	Recognize and examine the client with life-threatening conditions, acutely ill/ multi-organ problems, high acuity and emergency situation. Determine a client’s the health status/ competence and or expected outcomes of nurse –client working relationship. Record client’s responses/ nursing care services rendered and processes/ outcomes of the nurse client working relationship. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing Care of Clients with Multisystem Problems - Shock - Systemic Inflammatory Response syndrome (SIRS) - Multiple Organ Dysfunction Syndrome (MODS) A. Assessment - Clinical manifestations and Effects - -Sequential Organ failure - Assessment (SOFA) - Diagnostic Studies B. Nursing diagnoses C. Planning (health promotion and restoration and maintenance) D. Implementation of nursing care (independent, interdependent, client education, and diet therapies / management) - Drug therapy - Medical and Nursing management E. Client outcome evaluation F. Reporting and documentation
16-17	Recognize and examine the client with life-threatening conditions, acutely ill/ multi-organ problems, high acuity and emergency situation. Determine a client’s the health status/ competence and or expected outcomes of nurse –client working relationship. Record client’s responses/ nursing care services rendered and processes/ outcomes of the nurse client working relationship. Ensure completeness, integrity, safety, accessibility, and security of information. Adhere to protocols of confidentiality in safekeeping and releasing of records and other information. Evaluate the client’s health status / competence and/or expected outcomes of nurse-client working relationship.	Nursing care of Clients in Emergency Situation 1. Airway, Breathing, Circulation (ABC) - Foreign body obstruction - Inhalation Injury - Anaphylaxis - Thoracic Emergency - Cardiac Arrest - External Hemorrhage 2. Disability (D) - Head Injury - Stroke 3. Environmental Emergency - Heat related emergency - Submersion Injuries - Stings and Bites - Poisoning - Drowning and Near - Drowning - Diving - Lighting soil erosion/ - Landslide - Volcanic Eruption - Floods A. Assessment - Triage (Five-Level, Emergency severity Index (ESI) - Primary Survey - History Nursing diagnoses B. Planning (health promotion and restoration and maintenance) C. Implementation of nursing care (independent, interdependent, client education, medications, and diet therapies / management) D. Client outcome evaluation E. Reporting and documentation
18	FINAL EXAM

References:

Textbooks / eBooks:

Burns, S. and Delgado, S. (2019). Essentials of Critical Care Nursing, 4th ed. USA: McGraw-Hill
Schumacher,L and Chernecky,C.(2006). Saunders Nursing Survival Guide: Critical Care & Emergency Nursing 2nd Edition
American Heart Association: Advanced cardiac life support, Dallas.2006, AHA
(2017).Fast Facts for the ER Nurse: Emergency Department Orientation in a Nutshell Springer Publishing
(2018). Acute and Critical care Nursing at a Glance .PB
Good & Kirkwood.(2018).Advanced Critical Care Nursing.(2nd ed.) ELS
(2019). The 12-Lead ECG in Acute Coronary Syndrome.(14th ed.) ELS
(2018). Critical Care Nursing: Diagnosis and Management. (8th ed.). ELS

Websites:

American association of Critical-Care Nurses. https://aacnjournals.org/
Critical Care Nurses Association of the Philippines (CCNAP). https://www.ccnapi.org/
EBSCO for Academic Libraries. https:www.ebsco.com/
Science Direct. https:www.sciencedirect.com/
Lecturio. https://olfu.lecturio.com/

Journals:

D’ Souza, M.S., et. al. (19 March 2020). Testing a diabetes keotacidosis simulation in critical care nursing: A randomized control trial. Clinical Epidemiology and Global Health. https://doi.org/10.1016/j.cegh.2020.03.011
Klopton, E.L. and Hyrkas, E.K. (January 2020). Modeling emergency department nursing workload in real time: An exploratory study. International Emergency Nursing, 48. https://doi.org/10.1016/j.ienj.2019.100793
Koontalay, A., Sangsaikaew, A., and Khamrassame, A. (February 2020). Effect of a Clinical Nursing Practice Guideline of Enteral Nutrition Care on the Duration of Mechanical Ventilator for Critically Ill Patients. Asian Nursing Research, 14(1). https://doi.org/10.1016/j.anr.2019.12.001
Romero-Garcia, M., et. al. (November 2019). Level of satisfaction of critical care patients regarding the nursing care received: Correlation with sociodemographic and clinical variables. Australian Critical Care, 32(6). https://doi.org/10.1016/j.aucc.2018.11.002
Rubio-Nvarro, A., Garcia-Capilla, D., Torralba-Madrid, M.J., and Rutty, J. (September 2019). Ethical, legal and professional accountability in emergency nursing practice: An ethnographic observational study. International Emergency Nursing, 46. https://doi.org/10.1016/j.ienj.2019.05.003
Cros, R., Morphet, J., and Miller, C. (November 2018). Emergency nursing students’ and nurse educators’ perception of care delivery: A comparison study of self-assessment ratings. International Emergency Nursing, 41. https://doi.org/10.1016/j.ienj.2018.05.006