Unit outlines

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Southwest Tennessee Community College
Associate Degree Nursing Program
Spring 2012 Group I
Adult Health Nursing I (NURS 1213-251)
Class Date Topic Faculty
I Jan 12 Orientation Cummings/Livisay
Unit IV Diabetes Livisay
II Jan 17 Unit IV Diabetes Livisay
III Jan 19 Unit III Cardiovascular Cummings
IV Jan 24 Unit I GU and Blood Cummings
V Jan 26 Exam I (Diabetes, GU, and Cardiovascular) Cummings/Livisay
Exam I Review 1030-1130
VI Jan 31 Unit II Respiratory Cummings/Livisay
Cummings
VII Feb 2 Unit II Respiratory Cummings
Unit V Cancer Livisay
VIII Feb 7 Unit V Cancer Livisay
IX Feb 9 Exam II (Respiratory & Cancer) Cummings/Livisay
Exam II Review 1030-1130
X Feb 14 Unit IV Hepatic/Pancreatic Cummings/Livisay
Cummings
XI Feb 16 Unit VI Gastrointestinal Livisay
XII Feb 21 Unit VI Gastrointestinal Livisay
(2 hour)
XIII Feb 23 Exam III (Pancreatic, Hepatic & GI) 915- Cummings/Livisay
1015
XIV Feb 28 Exam III Review 1030-1130
HESI 910-1110

XV Mar 1 Final Exam (910-1110 a.m.) Cummings/Livisay

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UNIT I:
The Focus of This Unit Deals With The Nursing Care Of The Client With Genitourinary Problems, Blood And
Blood Administration.
LEARNING OUTCOMES
A. Genitourinary
1. Explain the etiology, pathophysiology, clinical manifestations, treatment and nursing care of clients with the urinary
disorders:
Pyelonephritis
Renal Calculi
Benign Prostatic Hypertrophy
2. Discuss the changes with urinary function and the prostate gland as i relates to aging and the implications for nursing care.
3. Explain the nursing implications of drugs used in the treatment of clients with Pyelonephritis, renal calculi, and BPH.
4. Discuss nursing implications and client education related to caring for clients after prostatectomy.
5. Identify and discuss the medical and surgical treatment of prostate cancer.
6. Discuss the nursing implications on the psychosocial needs of the patient with GU disorders.
B. Blood Administration
7. Identify different blood types.
8. Differentiate between blood and blood component therapy and their indication for use.
Whole Blood
Packed RBCS
Plasma
Platlets
Blood Alternative Products,
Packed Cells,
Plasma Administration,
Platelets,
Factor Administration And
Blood Alternative Administration.
9. Identify complications/adverse reactions related to blood donation and blood transfusion.

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10. Discuss the medical and nursing management of patients experiencing complications/adverse reactions to blood donation or transfusion.

11. Identify disqualifying factors associated with blood donation.
12. Identify misconceptions and religious beliefs regarding blood donation and transfusion.
ACTIVITIES
1. Review A&P GU system.

2. Review the procedure, prep and client education for the following: BUN, glomerular filtration rate (GFR), , retrograde pyelography, renal
angiogram/renal biopsy , cystometrography (CMG), voiding cystourethrography (VCUG)

3. Prepare medication sheets or drug cards for the following medications: Trimethoprim-sulfamethoxazole (Bactrim), levofloxin(Levaquin),
gentamicin sulfate (Garamycin) GU prostate meds: finasterade (Proscar), terazosin ( Hytrin), tamsulosin (Flomax),saw palmetto & GU irrigant:
Glycine, B&O suppository

4. Prepare medication sheets or drug cards for the following medications: acetaminophen (Tylenol), diphenhydramine (Benadryl), and deferoxamine
(Desferol).

5. Design a pamphlet/poster to promote wellness and prevent the health problems studied in this course.

RESOURCES
Lemone - Medical Surgical Nursing Chapters: 26-27
Delaune - Fundamentals of Nursing Standards and Practice:
Lemone – Medical Surgical Nursing Chapter 11; pp. 244-248, 263& 1078
Lehne – Pharmacology pp. 636, 824-827 & 840-842

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UNIT II:
The Focus Of This Unit Deals With The Nursing Care Of The Client With Respiratory Problems.
LEARNING OUTCOMES
1. Compare and contrast the etiological and pathological factors, the medical and surgical interventions, nutrition, medications and nursing
responsibilities for clients with the following respiratory dysfunctions:
Pneumonia
Chronic Obstructive Pulmonary Disease
Tb
Pulmonary Embolism
Lung Cancer
2. Explain therapeutic communication techniques to use when performing a nursing history of the adult client with a chronic stable respiratory
alteration.
3. Describe nursing assessment and data collection of clients with problems of the respiratory system.
4. Differentiate between normal, abnormal, and adventitious breath sounds.
5. Discuss lifestyle and environmental factors that increase the client’s risk for developing respiratory problems.
6. Discuss the use and benefit of the following respiratory treatments:
Postural Drainage
Breathing Exercises
Inhalers (MDI)
Coughing
Suctioning (Tracheal And Oropharyngeal)
7. Discuss signs and symptoms of oxygen deficit.
8. Identify JCAHO’s National Health Safety Goals (7) in regard to pneumonia and nosocomial respiratory infections.
9. Identify and discuss the significance of various abnormal respiratory patterns (Cheyne-stokes, Kussmaul and Biot’s breathing).
10. Discuss nursing measures which promote normal respirations.
11. Identify primary methods of oxygen administration, contraindications, safety measures and nursing implications.
12. Explain the nursing implications of drugs used in the treatment of clients with respiratory problems: bronchodilators, expectorants, antitussive
and corticosteroids.
13. Discuss how arterial blood gases and pulse oximetry are used to monitor respiratory function and identify common changes seen in clients with
pulmonary dysfunction.

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14. Identify differences in respiratory acidosis and alkalosis, as well as compensatory mechanism with the respiratory client.
15. Discuss various types of artificial airways and the nursing responsibilities for:
Tracheostomy
Endotracheal Tube
Oral Airway
16. Discuss the nurse’s role in managing care according to prioritized client needs.
17. Identify possible illness patterns that could indicate an unusual respiratory infectious disease outbreak.
ACTIVITIES
1. Review anatomical and physiological processes related to the respiratory system.
2. Review the following respiratory diagnostic test:
VQ Scan,
ABG’s,
PEAK EXPIRATORY FLOW
Chest X-Ray,
CT And
MRI Of Lung.
3. Prepare medication sheets or drug cards for

RESCUE INHALERS:
Albuterol (Proventil)
Levalbuterol (Xopenex)

LONG-ACTING INHALERS:
Ipratropium (Combivent)
Salmetrol (Advair,)
Formoterol (Foradil)
Heophylline (Bronkodyl)
Guaifenesin (Robitussin, Mucinex)
Benzonatate (Tessalon)

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Glucocorticoids (Prednisone And Solumedrol), Fluticasone)
(Tiotropium) (Spiriva)
Terbutaline (Brethine)
Ontelukast (Singulair)
Levofloxin (Levaquin)
Ceftriaxone (Rocephin
Heparin
Enoxaparin(Lovenox) And
Warfarin (Coumadin),
Ciprofloxacin


RESOURCES
Lemone – Medical Surgical Nursing Chapters: 34, 37 & pp.1143-1147
Lehne – Pharmacology Chapters: 75-76

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UNIT III:
The Focus Of This Unit Deals With The Nursing Care Of The Client With Cardiovascular Problems
LEARNING OUTCOMES
1. Assess the client history and identify risk factors in clients experiencing cardiovascular problems.
2. Identify common diagnostic tests related to cardiovascular functioning: cardiac catheterization, thallium treadmill, cardiac enzymes, prothrombin
time (protime, PT), international normalizing ratio (INR), partial Thromboplastin time (PTT), electrocardiography (EKG), echocardiogram (ECHO),
coronary angiography, transesophageal electrocardiography (TEE).
3. Discuss how cardiovascular diseases and other pyschophysiological disorders are related.
Hypertension
4. Review and discuss the pathophysiology, etiology, incidence and prevention of uncomplicated hypertension.
5. Discuss the differences between primary and secondary hypertension: pathophysiology, clinical signs and symptoms, medical treatment, nursing
care and client teaching.
6. Review categories of pharmacological agents used to treat essential hypertension, e.g., diuretics, antihypertensive, vasodilators, etc.
7. Identify and discuss reasons for non-compliance to antihypertensive therapy.
Coronary Atherosclerosis
8. Discuss the difference between arteriosclerosis and atherosclerosis, including pathophysiology, incidence, and prevention.
9. Identify nursing responsibilities and teaching to be included for the client and family with coronary artery disease.
10. Identify the etiology, pathophysiology clinical manifestations, medical treatments and nursing responsibilities for clients with angina pectoris.
11. Discuss current pharmacological agents and nursing implications of drugs used in the treatment of clients with angina pectoris.
12. Discuss how emotional stress leads to the development and worsening of angina pectoris.

ACTIVITIES
1. Review anatomical and physiological processes related to cardiovascular perfusion.
2. Prepare medications sheets or drug cards for each of the following:
Furosemide (Lasix),
Hydrochlorothiazide (HCTZ),
Nitroglycerin (Nitro-Dur),

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Isosorbide Dinitrate (Isordil),
Propranolol (Inderal),
Metoprolol (Lopressor),
Nifedipine (Procardia),
Diltiazem (Cardizem) ,
Sodium Nitroprusside (Nitropress, Nipride),
Hydralazine HCL (Apresoline)

3. Prepare medication sheets or drug cards for each of the following:

Morphine,
Streptokinase,
Tissue Plasminogen Activator (t-PA)


RESOURCES
Lemone – Medical Surgical Nursing Chapters: 29-30 32; pp. 1018-1034
Lehne – Pharmacology Chapters 43-46 & 49-51
Lehne – Pharmacology Chapters 49- 51

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UNIT IV:
The focus of this unit deals with the nursing care of clients with Diabetes Mellitus, pancreatic and hepatic
disorders.
LEARNING OUTCOMES
1. Identify the most common types of diabetes according to etiology, pathophysiology and clinical manifestations across the lifespan.
2. Discuss teaching/learning strategies to be used in communicating the role of diet, exercise and weight control to the adult client with diabetes
mellitus.
3. Discuss the clinical manifestations of short and long term complications of
DIABETES MELLITUS
Hypoglycemia
Hyperglycermia
Hyperosmolar
Hyperglycermia Nonketotic Syndrome (Hhs)
Diabetic Ketoacidosis
Microvascular Changes
Diabetic Neuropathy
Diabetic Retinopathy
Diabetic Nephropathy
4. Discuss current medical treatment and nursing implications for clients with diabetic retinopathy.
5. Assess client knowledge of disease and discuss important information to be included in a teaching plan for client’s who self-administer insulin.
6. Discuss current pharmacological agents and nursing implications of drugs used in the treatment of clients with Diabetes Mellitus.
7. Identify factors that affect the client’s adherence to a medical regimen: developmental level, cultural, spiritual variations.
8. Discuss the advantages and disadvantages of the insulin pump system and nursing implications.
9. Identify and discuss community support groups for clients and their families who are diagnosed with diabetes.
10. Identify and review diagnostic tests and nursing implications of blood glucose monitoring.
11. Discuss appropriate nursing diagnoses diabetes with short-term complications.
12. Discuss appropriate nursing diagnoses for diabetes with long-term complications.

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13. Identify community resources available to the student and staff to remain current on knowledge related to adult clients with diabetes.
Hepatic and Pancreatic Disorders
15. Monitor diagnostic tests related to hepatic dysfunction.
16. Identify the most common types of hepatitis according to etiology, pathophysiology and clinical manifestations across the lifespan.
17. Discuss safety measures necessary to prevent the spread of hepatitis.
18. Identify the current treatment for cirrhosis, hepatitis, and cancer of the liver to include dietary regimen, medications, alteration in
ADLs and threats to basic needs.
19. Identify and discuss nursing responsibilities and possible legal ethical dilemmas in cases of liver transplants.
20. Identify community health resources available for referral to support the client with potentially life threatening liver diseases.
21. Monitor diagnostic tests related to pancreatic dysfunction.
22. Discuss the difference between acute and chronic pancreatitis in relation to pathophysiology, etiology, signs/symptoms, and treatment.
23. Utilize the nursing process to identify the appropriate nursing care for the client wit pancreatic and/or hepatic dysfunction.
24. Discuss teaching/learning strategies for the adult client with pancreatic and/or hepatic disorders using the appropriate communication
techniques for age, culture, and educational level.
25. Discuss emotional adaptive behaviors and socioeconomic implications for adult clients with pancreatic and/or hepatic disorders.
26. Discuss the clinical manifestations and management of complications associated with pancreatic and hepatic disorders.
ACTIVITIES
1. Prepare medication sheets or drug cards on each of the following:
Glyburide (Micronase)
Glipizide (Glucotrol)
Metformin (Glucophage)
Rosiglitazone (Avandia)
Lispro (Humulog)
Humulin N
Humulin R
Glargine (Lantus)
Novolin 70/30
Novolog 70/30

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2. Address objectives as study questions.

3. Prepare medication sheets or drug cards on the following medications:
Immune Globulin
Lamivudine (Epivir)
Adefovir (Hepsera)
Iinterferon Alfa -2a, 2b (Intron
Peg Interferon
Ribavirin (Rebetol
Chronulac (Lactulose)
Neomycin (Neo- Tabs)
Aquamephyton Phytonadione (Vitamin K)
Folic Acid
Vsopressin (Pitressin)
Aminocaproic Acid (Amicar)
Pancrease Mt (Pancrelipase)
Hepatic Herbal Preparations (Milk Thistle, Silymarin)
RESOURCES
Lemone – Medical Surgical Nursing Chapter: 20
Lemone – pp. 539-547, 825, 849, 850t &1599-160
Lehne – Pharmacology Chapter: 56
Lemone – Medical Surgical Nursing Chapter 25
Lehne – Pharmacology Chapter 92, pp. 1076-1080

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UNIT V:
This Unit Focuses Deals With The Nursing Care Of The Client With Cancer And Those Receiving Treatment
LEARNING OUTCOMES
1. Describe the growth patterns of neoplasms that are classified as: benign or malignant.
2. Define the term cancer and discuss the psychological affects of having a diagnosis of cancer.
3. Discuss the incidence of cancer in relation to gender, age, race and geography.
4. Identify risk factors that increase the client’s risk of developing cancer.
5. Discuss the nursing implications in the following cancer diagnostic procedures:
Tumor Markers
Cytologic Tests
Mammogram
6. Discuss medical treatment options and types of surgeries related to cancer and nursing implications:
Radiation
Gene Therapy
Chemotherapy
Biological Response Modifiers
Bone Marrow Transplant
Tumor Removal
Stem Cell Transplant
Reconstruction
7. Identify the nurse’s role in caring for clients receiving external and internal radiation therapy.
8. Discuss classifications of chemotherapeutic agents and nursing implications for the client receiving chemotherapy.
9. Identify side effects to radiation and chemotherapy and the nursing implications for the client with cancer.
10. Discuss the following oncologic emergencies and the nursing care required:
Superior Vena Cava Syndrome
Tumor Lysis Syndrome
Hypercalcemia
Syndrome Of Inappropriate Adh (Siadh)
Pericardial Effusion
Cardiac Tamponade

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11. Identify the nurse’s role in assisting clients with coping to the following effects of cancer.
a) pain
b) malnutrition
c) infections
d) skin breakdown
12. Identify community resources available to clients and families with a diagnosis of cancer.
13. Identify the nurse’s role in assisting clients and families with end-of-life issues (i.e., advance directives).
14. Discuss the three most common cancers in both females and males.
15. Identify specific medical therapy and surgical interventions for cancer (hormones, chemotherapy, radiation, etc.).
16. Identify resources available to the student and the staff to remain current on knowledge related to the care of the adult client with cancer.
17. Define the role of hospice care nurse in the care of the client with a diagnosis of cancer.
18. Identify and discuss appropriate nursing diagnoses for cancer.

ACTIVITIES
The cancer unit is done via the cancer module “Oncology Nurse” in the computer labs. The units to be covered and objectives will be found in the
content folder in PAWS.
1. Review anatomy and physiology of the cell.

2. Review the nursing implications for the following diagnostic procedures in regard to cancer:
CAT Scan
MRI
Stool For Occult Blood
Chest And Body X-Ray

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3. Prepare medication sheets and drug cards for the following medications:
Doxorubicin (Adriamycin)
Tamoxifen (Nolvadex)
Cyclophosphamide (Cytoxan)
Cisplatin (Platinol)
Vincristine (Oncovin)
Methotrexate
5-Fluorouracil (5-F
4. Review the signs of impending clinical death.
5. Review Kubler-Ross’s stages of grieving

RESOURCES
Lemone – Medical Surgical Nursing Chapter: 14
Lemone – Medical Surgical Nursing Chapter 5

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UNIT VI:
THIS UNIT FOCUSES ON THE NURSING RESPONSIBILITIES OF CLIENTS WITH GASTROINTESTINAL DISORDERS
LEARNING OUTCOMES.
1. Discuss signs and symptoms that are indicators of GI disorders.
2. Discuss nursing responsibilities and client education for the following diagnostic tests:
Barium Swallow
Barium Enema
Cytology
Ultrasound
Radionuclide Uptake
Gastroscopy
Colonoscopy
Rectal Biopsy
CT Scan Of Abdomen
3. Discuss indications for administration of total parental nutrition (TPN) and nursing implications associated with TPN.

4. Discuss the etiology, pathophysiology, clinical manifestations, medical and surgical treatment and nursing care for the following disorders:
Gastroesophogeal Reflux (GERD)
Hiatal And Inguinal Hernias
Peptic Ulcer Disease (PUD)
Duodenal And Gastric Ulcers
Acute And Chronic Gastritis
Appendicitis
Peritonitis

5. Discuss dietary recommendations for clients with GI disorders.

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6. Discuss the action, side effects, and nursing responsibilities for gastrointestinal drugs;
Antacids
Anticholinergics
H2 Receptor Antagonists Drugs
Mucosal Barrier Fortifiers
Prostaglandin Analogs
Proton Pump Inhibitors

7. Describe the following surgical procedures, the nursing interventions, and client education related to each:
Gastric Resection
Billroth I
Billroth II
8. Discuss appropriate therapeutic communication techniques interacting with clients with GI disorders.
9. Discuss the following post-gastrostomy complications:
Nutritional Deficiency
Pernicious Anemia
Osteomalacia
10. Identify signs and symptoms, medical treatment and nursing care of clients with dumping syndrome.
11. Discuss the etiology, pathophysiology, clinical manifestations, medical and surgical treatment and nursing care for the following bowel disorders:
Irritable Bowel Syndrome
Ulcerative Colitis
Crohn’s Disease
Diverticular Disease
Intestinal Obstruction
Volvulus

12. Identify appropriate nursing diagnoses for addressing the client’s psychological and emotional adaptation to a fecal diversion.
13. Discuss the nurse’s role in assisting the client with an ileostomy, colostomy, or cecostomy with adapting to self-care (irrigation, dressings, and
dietary changes).

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14. Identify signs and symptoms of complications, pertinent assessment, and education of the client following intestinal surgery in regard to these
conditions:
Prolapse Of The Stoma
Retraction Of The Stoma
Ileostomy Dysfunction
Fistula
Herniation
15. Identify community agencies available to assist the client with fecal diversion.
16. Discuss nursing responsibilities and client education for the following diagnostic tests associated with disorders of the gallbladder:
Urobilinogen
Serum Bilirubin
Alkaline Phosphatase (Alp)
Endoscopic Retrograde Cholangiopancreatography (Ercp)
Esophagogastroduodenoscopy (Egd)
17. Discuss pre/post-operative care of the client having surgery of the gallbladder (i.e., laproscopic technique, positioning, t-tube care, pain, and
assessment).
18. Discuss specific complications that may occur following gallbladder and bile duct surgery and the medical management.
19. Identify individuals that are at risk for colorectal cancer.
20. Discuss the importance of age appropriate annual screenings for colorectal cancer.
21. Identify specific medical, nursing and surgical interventions for colorectal cancer.
ACTIVITIES
1. Review anatomy and physiology of the gastrointestinal system.
2. Review the mechanical and chemical processes of digestion.
3. Review the nursing responsibilities and client education for stool studies.
4. Prepare medication sheets or drug cards forthe following medications:
Cimetidine (Tagamet),
Famotidine (Pepcid),
Lansoprazole (Prevacid),
Pantoprazole (Protonix),
Calcium Carbonate (Tums),

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Magnersium Hydroxide (Maalox),
Bismuth Subsalicylate (Pepto Bismol),
Metrodinazole(Flagyl);
Aminosalicylates-Sulfasalazine
(Azulfidine),
Mesalamine (Asacol),
Prostaglandin Analog- Misoprostol (Cytotec);
Sulcrafate (Carafate),
Tegasarod (Zelnorm);
Metoclopramide (Reglan),
Promethazine(Phenergan),
Ondansetron (Zofran).


RESOURCES
Lemone – Medical Surgical Nursing Chapters: 21-24

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DATE TOPICS OBJECTIVES STUDENT ACTIVITIES
Introduction to course UNIT I
1/12 Conception/Fetal development 1-3,5 Chap 3, 12 & 13
Thursday Fetal Circulation 4
6
Physiological changes during pregnancy
Signs of pregnancy 7
1/17 Common discomforts of pregnancy 8,9 Chapters 3, 4, 13, 15 & 26
Tuesday Normal AP client; assessments/ vaccines 10,22
15
Fetal diagnostics
Psychological responses to pregnancy 11
01/19 Nutritional needs of pregnant client; alt socioeconomic/cultural clients 12,14 Chapters 1, 2, 4,5, 13,14, 15 & 32
Thursday Adaptations to pregnancy
13
Variations/barriers in prenatal care; Ethical issues
17,18,19
Violence against women
01/24 Pregnant client during a disaster; pre/post disaster assessments, type of disasters 20,21,23
Tuesday Complications of early pregnancy Unit II
01/26 Concurrent disorders during pregnancy, Trauma 1,2,3
Thursday Disorders of the placenta 4 Chapters 7, 27, 28, 29, 30, & 31
Hypertensive disorders 5
6
Infections during pregnancy/ STD’s
01/31 EXAM # 1-Units I & II UNIT III
Tuesday Theories of labor; premonitory signs 1,2 Chapter 16 & 19
True vs. False lab 3
Stages of Labor 4, 11
Feto-pelvic relationships 5-10
02/02 Nursing care during labor; immediate care of the newborn 12,19,20
Thursday 13,14,8 Chapters 16, 17,18, 19, & 33
Pain management during labor
Care of the Cesarean section client
Fetal Assessment; fetal distress 15-18
02/07 Complications of labor; obstetrical procedures 21,22 Chapters , 20, 21, 31, 33, & 34
Tuesday Physiological changes during PP; mgmt nursing & pharmacological UNIT IV
1-3, 4-7
Postpartum complications

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Psychological adaptations PP 9-10
02/09 Mental disorders during the PP period 10-13 Chapters 8,21, 22, & 32,
Thursday Family w/child with special needs 14
15
PP hlth education/ community resource/care at home
16,17
Birth control methods

EXAM 2 – Units III & IV
02/14 Newborn nutrition and feeding/lactation UNIT V
Tuesday NB physiological adaptation 1-3, 18 Chapter 23, 24, & 25
4
Behavioral characteristics of NB
5
NB assessments- cardio/thermoregulation 6
Gestational age assessment
Care of the NB with a circumcision 7
02/16 Complication of the NB of various gestational ages 8-10 Chapters 35, 36, 37, & 38
Thursday Complication of the NB; acquired or 11
12
Congenital conditions
Abortions; spontaneous vs. elective- ethical implications UNIT VI
02/21 Infertility; diagnosis/treatment 1,2 Chapters 6, 8, & 9
Tuesday Menopause; changes/treatment 3-11
Benign problems of the breast
02/23 Diagnostic procedures for cancer 12
Thursday Breast/ovarian cancer- diagnosis 13-15 Chapters 6, 10 & 11
16,17,19,20
Treatments for breast cancer/nursing care
21
Nurse role’s in cancer care 18
Community resources

2/28 EXAM 3 - UNITS V & VI
Tuesday HESI-6:15
02/29
Wednesday
FINAL EXAM

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TOPICAL OUTLINE
Unit THE NURSING PROCESS AS IT RELATES TO:
I 1. Conception and development of the placenta, umbilical cord and fetal membranes with the function of each
2. Development of fetus during each trimester with fetal circulation emphasized
3. Physiological changes during labor and common discomforts associated with these changes
4. Assessment of the prenatal client with special attention to her medical and obstetrical history combined with a
physical examination allowing risk factors to be identified
5. Nutritional requirement of the pregnant client throughout the pregnancy with special attention to the
adolescent client and those client with various cultural backgrounds
6. Assessment of the fetus during the prenatal period is association with those complications that may occur as a
result of the pregnancy or those that were predisposing
7. The pregnant client during a disaster or emergency and available care identified within the community
II 1. Those conditions that may occur during early pregnancy and result in pregnancy loss.
2. Management of those preexisting conditions and their effects on the pregnancy
3. Hemorrhagic disorders during late pregnancy
4. Hypertensive conditions that may be either preexisting or actually a result of the pregnancy and the severity of
the latter as it jeopardizes fetal safety
5. Those infectious processes that may cause fetal anomalies, loss of pregnancy, and/or preterm labor

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III 1. The theories of labor and those premonitory signs of true labor with differentiation of false labor reviewed
2. Stages of labor with the physical and psychological reactions to the events during the stages
3. Fetopelvic relationships and their importance to labor, type of delivery, nursing care, and operative procedures
that may be required for delivery
4. Analgesia and anesthesia available for the laboring client with client and fetal safety a priority
5. Fetal monitoring during labor and those interventions that may correct any baseline changes and/or no
reassuring patterns
6. The immediate care of the newborn involving the APGAR assessment and medications given in the delivery
room
7. Complications of the laboring process that may relate to the pelvis, passenger, and /or the passageway.
8. Preterm labor and premature rupture of membranes and the implications of each to fetal survival
9. The use of oxytoxic medications to induce labor in certain conditions and the potential complication of those
medications for the client and the fetus
10.Those obstetrical procedures that are implemented to shorten Stage 2 of labor or as an alternative to a vaginal
delivery as required by medical complication or the labor or delivery process
IV 1. The physiological alterations of the postpartum client that occur normally after vaginal or Cesarean delivery
2. Potential complications that may occur during the early or late postpartum period that may be life threatening
3. Areas of teaching that are required for the client after delivery to promote self care and care of the newborn
4. Nutritional needs of the new mother for her own wellbeing and recovery and those needs if she is breastfeeding
5. Adaptation of the new parents to the newborn with variations of the family unit including that of the adolescent
in the absence of the father of the infant
6. Those psychological disorders that may result during this period that may or may not warrant intervention to
maintain the safety of the infant
7. Adaptation of the family with an infant that was born premature, with an anomaly or that may have died before
or after delivery

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V 1. The physiological adaptation of the newborn after delivery to maintain homeostasis with focus on the cardio-
respiratory and thermoregulatory systems
2. Behavioral characteristics of the newborn as it adjusts to life out of utero in regards to their periods of activity
and reactivity and rest
3. The nutritional needs of the newborn with discussion on formula versus breast feeding as the nutritional source
4. Complications of the newborn period that relates to gestational age, Rh incompatibility, and pathological
jaundice
5. Conditions of the newborn that may be the result of preexisting maternal conditions or her risk taking
behaviors
VI 1. Physical, legal, and ethical implications of a woman who have an elective abortion or a sexually transmitted
disease
2. Education by the nurse on the physical effects and the importance of treatment of sexually transmitted diseases
3. Infertility and the factors that may contribute to a couple’s inability to conceive with testing for both partners
4. Psychological impact on a couple as they proceed through infertility testing and suffer interventional failures in
conceiving
5. The physical and psychological effects of menopause and the controversy of treatment of the condition with
hormone replacement therapy
6. Diagnostic procedures for detecting cancers of the female reproductive system
7. Teaching the client the importance of yearly screening for cervical and breast cancer as dictated by age for the
latter but also proper technique for self breast examination
8. Care, medical/surgical and psychological, for the woman diagnosed with breast cancer
9. Identification of national and community resources for the woman with breast cancer that provides education,
support, treatment options, and clinical trial options

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UNIT 1
OUTCOMES
Upon completion of UNIT 1 the student will be able to:
1. Relate ovulation and ejaculation to the human process of conception.
2. Explain implantation and nourishment of the embryo and development of the placenta.
3. Explain structure and function of the:
a. Placenta
b. Umbilical cord
c. Fetal membranes
4. Describe fetal circulation and the circulatory changes that occur after the birth of the newborn.
5. Describe normal fetal development in term of major developmental accomplishments in each trimester of pregnancy.
6. Differentiate presumptive, probably, and positive signs of pregnancy.
7. Describe physiological and anatomical changes that occur during pregnancy.
8. Describe the psychological response of the expectant mother and father to pregnancy.
9. Explain the maternal tasks of pregnancy.
10. Identify the nutrient needs of the pregnant client adapting to the physical changes of pregnancy
11. Identify special dietary alternatives with varying socioeconomic and cultural backgrounds.
12. Describe the initial antepartum assessments in terms of:
a. Medical history and physical
b. Obstetrical history
c. Estimated date of delivery
d. Risk assessment
e. Miscellaneous laboratory tests and procedures
13. Identify the following in regards to fetal diagnostics:
a. Purpose of the procedure
b. Risks of the each procedure
c. Nursing care during each
14. Determine the basic teaching/learning needs of client experiencing common discomforts of pregnancy.

15. Utilize the nursing process to discuss the common discomforts of pregnancy.

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16. Identify available educational opportunities for student/staff nurse to obtain additional knowledge about the childbearing client.
17. Discuss the legal/ethical implications with regards to the care of the above mentioned clients with special needs.
18. Identify the special needs of the pregnancy client during a disaster.
19. Discuss the major aspects of a post-disaster perinatal assessment.
20. Identify potential natural and manmade disasters.
UNIT 1
ACTIVITIES
Study Guide for Maternity & Women’s Health Care 10th ed. Lowdermilk, Perry, Cashion, and Alden
Review the study guide for the corresponding chapters outlined under resources.
Be prepared to discuss the above chapters the first day of class.
UNIT 1
RESOURCES
th
Maternity & Women’s Health Care 10 ed. Lowdermilk, Perry, Cashion, and Alden
Chapter 13 Conception and Fetal Development
Chapter 14 Anatomy and Physiology of Pregnancy
HO: Fetal circulation
HO: Fetal Development During Each Trimester
Video: The Ultimate Pregnancy Guide
Chapter 16 Nursing Care During Pregnancy
HO: Physiological Changes During Pregnancy
Chapter 14: Maternal and Fetal Nutrition
Nutrition during pregnancy and breastfeeding: http://www.nal.usda.gov/fnic/pubs/topics/pregnancy/precom.html
Chapter 26: Assessment for Risk Factors
Chapter 5: Violence against Women
HO: Diagnostic Assessments for Fetal Status
HO: Common Discomforts and Nursing carehttp://www.bioterrorism.slu.edu/nuclear.html.
HO: Nursing care for the pregnant client pre and post disaster.

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UNIT 2
OUTCOMES
UPON COMPLETION OF UNIT 2 THE STUDENT WILL BE ABLE TO:
1. Discuss the condition, treatment, and the nursing care of the following pregnancy-related complications:
a. Spontaneous abortion
b. Ectopic pregnancy
c. Gestational trophablastic disease
d. Cervical insufficiency
e. Hyperemesis gravidarum
f. Hypertensive disorders
2. Utilize basic therapeutic communication techniques in dealing with a family experiencing pregnancy loss at various gestational ages.
3. Utilize the nursing process in the management of the following health conditions during pregnancy:
a. Diabetes mellitus
b. Cardiovascular disorders
c. Respiratory conditions
d. Hematologic disorders
4.Explain how disorders of the placenta listed below result in hemorrhagic condition in late pregnancy:
a. Placenta previa
b. Abruption placentae
5. Utilize the nursing process in the management of hypertensive disorders of pregnancy.
6.Discuss the nursing management of the pregnancy at risk with the following infections:
a. Cytomegalovirus
b. Rubella
c. Herpes Simplex virus
d. Hepatitis B
e. Varicella zoster virus
f. Group B Streptococcus
g. Parvovirus B19
h. Toxoplasmosis
6. Discuss Sexually Transmitted Infections.
7. Discuss the issue of vaccination during pregnancy.

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8.Discuss the incidence and identify factors that contribute to those childbearing families that are vulnerable:
a. Pregnant adolescent
b. Pregnant woman over the age of 35
c. Women who are HIV positive
d. Pregnant women with substance abuse
UNIT 2 ACTIVITIES
Chapter 28: Antepartal Hemorrhagic Disorders.
Chapter 27: Hypertensive Disorders in Pregnancy
Chapter 38: Grieving the Loss of a Pregnancy.
Chapter 29: Endocrine and Metabolic Disorders
Chapter 30: Medical Surgical Problems in Pregnancy.
CDC National Prevention Information Network: http://www.cdcnpin.org
Chapter 7: Sexually Transmitted and Other Infections.
Chapter 22: Transition to Parenthood.
National Campaign to Prevent Teen Pregnancy:
http://www.teenpregnancy.com
http://www.hivinsite.ucsf.edu
http://cdc/nchs/about/otheract/hpdata2010/2010indicators.html
UNIT 2 RESOURCES
DEVELOP DRUG CARDS:
Zofran
Phenergan
Magnesium Sulfate
Calcium Gluconate
Terbutaline
Procardia
Betamethasine
Tetracycline
Pitocin

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Methergine
Hemabate
Ergotrate
Misoprostol
UNIT 3
OUTCOMES
1. Discuss various theories of initiation of labor, such as the progesterone theory, deprivation theory, oxytocin and the uterine stretch
theories.
2. Identify the premonitory signs of labor.
3. Differentiate true labor from false labor.
4. Define the four stages of labor, including maternal behavior typically displayed during each stage.
5. Explain the significance of Leopold’s maneuvers.
6. Differentiate between fetal attitude, lie, and presentation.
7. Relate the position of the fetal skull landmarks to fetal position and the maternal pelvis
8. Identify the categories of positions of the fetus.
9. Relate the station of the presenting part of the fetus to the maternal pelvis
10. Discuss the nursing interventions utilized during each stage of labor:
a. Assessment of labor progression
b. Assessment of fetal well-being
11. Identify various methods of pain relief utilized in the childbirth experience.
12. Identify nursing interventions to be used to provide pain relief for childbirth.
13. Identify baseline and periodic changes in fetal monitoring.
14. Differentiate between reassuring and nonreassuring fetal heart patterns and nursing interventions employed to correct each pattern.
15. Identify common signs of fetal distress.
16. Utilize the nursing process in the management of fetal distress.
17. Explain the APGAR scoring system and its significance in assessing the status of the newborn.
18. Identify the immediate care of the newborn.
19. Discuss independent and interdependent nursing interventions for the following high risk conditions:
a. Dysfunctional labor
b. Premature rupture of membranes

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c. Premature labor
d. Postdate pregnancy
e. Ruptured uterus
f. Fetal malposition and malpresentation
g. Cephalopelvic disproportion(CPD)
h. Prolapsed umbilical cord
i. Amniotic fluid-related embolism(AFE)
j. Precipitous labor & delivery
k. Emergency childbirth; childbirth during a disaster.
20. Explain risks, precautions, and contraindications for the following obstetrical procedures:
a. Amniotomy
b. Induction/augmentation of labor
c. Versions
d. Forcep/vacuum extractions
e. Episiotomy
f. Cesarean birth
UNIT 3
ACTIVITIES
CONTINUE WORKING ON THE CORRESPONDING CHAPTERS IN THE STUDY GUIDE
UNIT 3
RESOURCES
Chapter 16: Labor and the Birth Process
Birthworks: http://www.birthworks.org
Chapter 19: Nursing Care During Labor
Chapter 17: Management of Discomfort
Video: Epidural Anesthesia
HO: Analgesia & Anesthesia During Labor.
HO: Fetal Monitoring
Video: Fetal Monitoring
Chapter 24: Nursing Care of the Newborn.
HO: Immediate Care of the Newborn

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Chapter 31: Obstetric Critical Care
Chapter 33: Labor and Birth Complications
Video on Preterm Labor
Video on Induction and Augmentation of Labor.
UNIT IV
OBJECTIVES
1. Describe the normal physiological alterations of each system occurring in the postpartum client:
a. Reproductive
b. Endocrine
c. Cardiovascular
d. Urinary
e. Gastrointestinal
f. Neurological
g. Integumentary
h. Immune
2. Identify nursing interventions appropriate to sustain normal functioning during the postpartum period.
3. Describe the pharmacological actions, nursing implications and contraindications of drugs commonly used during this period.
4. Identify signs and symptoms of
a. involution,
b. subinvolution
c. after pains
d. engorgement
e. let-down reflex
f. puerperal sepsis
5. Develop a plan of care, including teaching aspects related to the following physiological occurrences:
a. Involution
b. Subinvolution
c. Autolysis
d. Lochia
e. After pains
f. Breast engorgement

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g. Let-down reflex
h. Puerperal sepsis
6. Recognize the signs, symptoms and risk factors for the development of each of the following postpartum complications:
a. Postpartum hemorrhage(early and late)
b. Thromboembolic disorders
c. Postpartum infections
7. Identify nursing interventions to prevent and treat the complications listed in the learning outcome above.
8. Develop a plan of care for a client who had a Cesarean delivery.
9. Describe effective teaching strategies for client education about birth control.
10. Compare and contrast various methods of birth control according to the following criteria:
a. Safety/effectiveness
b. Contraindications
c. Nursing responsibilities
d. Advantages/disadvantages
e. Expense
f. Preference
11. Describe the psychological dynamics of the postpartum client of various ages and her family.
12. Identify factors which influence parental-infant bonding or attachment.
13. Differentiate between the ways fathers and mothers interact with their infants.
14. Describe the two major mental disorders that may occur during the postpartal period.
15. Explain the effects on the postpartum family of a preterm infant, an infant with an anomaly, or a neonatal death.
16. Discuss the role of the nurse in postpartum education.
17. Describe postpartum home and community care.

UNIT IV
ACTIVITIES
Chapter 20: Postpartum Physiology
Center for Postpartum Health: https://www.postpartumhealth.com
Chapter 21: Nursing care of the Postpartum Woman.
HO: Postpartum Physiologic Adaptations
Chapter 34: Postpartum Complications
HO: Postpartum Complications
Chapter 8: Contraception and Abortion

32

Planned Parenthood Federation of America, Inc. http://plannedparenthood.org
Chapter 22: Transition to Parenthood
Video: “Begin with Love, connecting with your baby”
Chapter 32: Mental Health Disorders and Substance Abuse
HO: Postpartum Depression
Depression after Delivery: http://depressionafterdelivery.com
Chapter 24: Care of the Newborn and Family.
UNIT IV
RESOURCES
CONTINUE WORKING ON THE CORRESPONDING CHAPTERS IN THE STUDY GUIDE.
DRUG CARDS TO DEVELOP:
Rho-Gam
Meruvax
Colace
Feosol
Heparin
Coumadin
Develop pt. teaching guides for the different contraception options.
UNIT V
OBJECTIVES
Upon completion of the UNIT 5 the student will be able to:
1. Describe the newborn’s physiological adaptation to the birth process and biologic characteristics
2. Develop interventions to maintain normal physiological functions of the newborn as it adapts to its new environment.
3. Describe the physiological response of the newborn to hypothermia and identify factors that put the neonate at risk for cold
stress.
4. Describe the newborn’s behavioral characteristics in relation to periods of reactivity.
5. Describe the initial and ongoing assessments of the newborn with emphasis on the nurse’s responsibilities in the cardio-
respiratory and thermoregulatory assessments.
6. Explain the importance and components of gestational age assessments.
7. Explain the risks, benefits, and the care of the newborn following circumcision.
8. Identify the nutritional and fluid needs of the newborn.
9. Compare the advantages and disadvantages of breast feeding and formula feeding.

33

10. Explain the physiology of lactation.
11. Identify criteria for referral/consultation of a breastfeeding mother to a lactation specialist.
12. Explain the complications, treatments, and nursing care of infants with:
a. Preterm
b. Postmature syndrome
c. Large for gestational age(LGA)
d. Small for gestational
age(SGA)
e. Intrauterine growth restriction(IUGR
13. Explain the causes, significances, and nursing care of the infant with:
a. Pathologic jaundice
b. Effects of maternal diabetes
c. Effects of maternal substance
d. Common congenital anomalies
e. Rh incompatibility
UNIT V
ACTIVITIES
CONTINUE WORKING ON THE CORRESPONDING CHAPTERS IN THE STUDY GUIDE
UNIT V
RESOURCES
Chapter 24: Care of the Newborn and Family.
Chapter 23: Physiologic and Behavioral Adaptations of the Newborn.
DVD: Newborn Assessment
Chapter 25: Newborn Nutrition and Feeding
La Leche League International: http://www.lalecheleague.org
Chapter 37: Nursing Care of the High Risk Newborn
Chapter 35: Acquired Problems of the Newborn.
Chapter 36: Hemolytic Disorders and Congenital Anomalies

34

UNIT VI
OBJECTIVES
1. Discuss the condition, effects, management and nursing care of the woman experiencing a spontaneous and an elective abortion.
2. Explore the legal/ethical implications in the client having an elective abortion.
3. Discuss the physical effects of the client with sexually transmitted infection(STI).
4. Discuss the nurse’s legal/ethical role in the care for a client with a STI with focus on privacy laws.
5. List educational opportunities for health care providers related to STIs and pregnancy.
6. Describe teaching to prevent and control STIs.
7. Define infertility and explain factors that may cause it.
8. Identify specific evaluations, procedures, and treatment for the couple that is unable to conceive.
9. Describe the physical and psychological changes associated with menopause.
10. Discuss the risks versus the benefits of hormone replacement (HRT).
11. Identify basic teaching/learning principles determining the learning needs of clients going through menopause.
12. Discuss the nursing implications in the following cancer diagnostic procedures:
a. Tumor markers
b. Cytologic tests
c. Mammogram
d. Biopsies
13. Discuss breast and ovarian cancers in females.
14. Discuss the importance and proper technique of self-breast examination (SBE).
15. Identify individuals that are at risk for developing breast cancer.
16. Identify specific medical therapies and surgical interventions for breast cancer.
17. Identify resources available to the student and the staff to remain current on knowledge related to the care of the adult client with cancer.
18. Identify community resources available for the client who has had a mastectomy.
19. Discuss options available to the mastectomy client regarding breast reconstruction. Identify and discuss appropriate nursing diagnoses for
each type of cancer.
20. Discuss the nurse’s role in managing care according to prioritized client needs

35

UNIT VI
RESOURCES
Chapter 8: Contraception and Abortion
Chapter 7: Sexually Transmitted and Other Infections.
Center for Disease Control and Prevention: http://www.cdc.gov
Chapter 9: Infertility
HO: Infertility
Chapter 6: Reproductive System Concerns.
Chapter 11: Structural Disorders and Neoplasm’s of the Reproductive System.
Chapter 10: Problems of the Breast
Reach to Recovery though the American Cancer Society: http://www.cancer.org
Susan G. Komen Breast Cancer Foundation: http://www.komen.org
Living Beyond Cancer: http://Ibbc.org

36

REQUIRED TEXTBOOKS

Berman, A., Snyder, S.J., Kozier, B. & Erb, G. (2012). Kozier & Erb’s Fundamentals of NursingConcepts, Process and Practice. (9th
ed.). Upper Saddle River, NJ: Prentice Hall.

Kee, J. L., Paulanka, B. ., Purnell, L .D. (2010). Fluids and electrolytes with clinical applications: A programmed approach, (8th ed.).
Clifton Park, New York: Thomson/Delmar Learning.

Lehne, R. A. (2010). Pharmacology for nursing care. (7th ed.). St. Louis: Saunders.

LeMone, P., & Burke, K. M. (2011). Medical surgical nursing: Critical thinking in client care. (5th ed.). Upper Saddle River, NJ:
Prentice Hall.

LeMone, P., & Burke, K. M. (2011). Study guide for medical surgical nursing: Critical thinking in client care. (5th ed.). Upper Saddle
River, NJ: Prentice Hall.

REQUIRED TEXTBOOK:

1. Lowdermilk D., Perry S., Cashion K., Alden K. (2012). Maternity & Women’s Health Care. (10th ed.). St Louis: Missouri.
Mosby/Elsevier.
2. LeMone P. and Burke K.M. (2010). Medical-Surgical nursing: Critical thinking in client care. (4th ed.). New York: Prentice Hall,
Inc.
3. Lehne, R.A. (2010). Pharmacology for nursing care. (7th ed). St. Louis: W.B. Saunders.
4. Kee, J.L., Paulanka, B.J., and Purnell, L.D. (2010). Fluids and electrolytes with clinical applications: A programmed approach. (8th
ed). Clifton Park: New York. Thompson learning, Delmar.

1. Lowdermilk D., Perry S., Cashion K., Alden K. (2012). Study guide for Maternity & Women’s Health Care. (10th ed.). St Louis:
Missouri. Mosby/Elsevier.
2. Lehne, R.A. (2010). Study guide: Pharmacology for nursing care. (7th ed). St Louis: W.B. Saunders.
4. Any current (20011) text pertaining to laboratory and diagnostic testing.

37

January 11, 2012
Re: Clinical Spring 2012
th
Clinical orientation: All groups to meet at designated site at 2:45 P Friday the 13 .
Bring TCPS papers and the proof of TB; CPR; etc. Dress is business casual with lab coat and ID’s. Bring syllabus with signature forms ready to submit to
instructor. NO RECORDING or PICTURES ANYWHERE ON CLINICAL GROUNDS. We will review this information in clinical orientation. Please make 2 copies of
this as one copy will need your signature of understanding and submitted with your other papers.
Baptist Women’s: meet at fountain in front lobby:
Wednesday group: Kurt Amelang; Elizabeth Bruno; Sonia Gemora-Garrett; Jocelyn Jones; Anthia Jordan; Kari McLean; Dorice Shikhule
Friday group: Carrie Emerson; Ashley Gafa; Stacy Johnson; Lauren Lancaster; Georgia Leeper; Karen Otts.
The Med: meet in the lobby of the newborn center: (After the hospital portion you will then need to come over to the Women’s Hospital where we will go
over the paperwork etc. Plan to meet at the front lobby waterfall at 5:30pm).
Friday group: Pat Allen; Jessica Bryan; Lacey Delee; Laquita Griffin; Saira Hussain; Amber McNabb; Jessica Walker
Saturday Group: James Dabbs; Ana-Maria Ferro; Merry Mattix; Kimberly Mitchell; Pamela Moore; Stacie Wilkins; Maresha Woodson-Walker
Activity sheets are due before the start of clinical on the assigned due dates. They must be turned in complete at the beginning of clinical before student
assignments are made, if not complete, you will not be prepared for clinical and will be sent home.
th th st
L&D and AP will be due on the 18 /20 /21 – which ever your clinical day falls on. (Ex: if your clinical day is Wednesday, then your paperwork is due on the
th
18 )
st rd th
New Baby and Postpartum is due on the 1 /3 /4 -again on the actual day your clinical falls on.
General Expectations:
th th st
Each week 2 APIE’s will be due by the start of class on Tuesday’s. (Ex: clinical databases (found in your syllabus) from the 18 /20 /21 will be used to form
th
your APIE’s, and those APIE’s will be due on Tuesday the 24 at 9:10 am.).
Please get a folder that will be designated for clinical: a copy of your evaluation (found in your syllabus), all patient data sheets and all APIE’s must be kept in
the folder and turned in each week. The activity sheets will need to be turned in with your folders at the end of your clinical. We will cover this again during
face to face clinical orientation. I know it sounds very overwhelming, but we will all get through it together. Ms. Overbey, Ms. Bullard, Ms. Vaughn-Lloyd and I
are here to guide you through your learning experiences. We all also remember the stresses of being in nursing school!
Cell phones are not allowed in clinical. This includes your pockets!
Even if you do not usually eat in the mornings, please eat something!! Bring snacks; we don’t want to miss a delivery because we left the floor to eat! Believe it
or not, this is an area where it is not uncommon to PASS OUT!!! Please, if you ever feel light headed, sit where you are, those who quickly try to leave the
room…HIT THE FLOOR! :-/
Be on time; dressed in school approved shirt and pants and your lab coats; don’t forget your stethoscopes, pen lights or scissors (see syllabus); and always have
your student ID. The clinical sites will not allow you to stay if your do not have your ID’s.
Remember, never, never, never, leave the clinical area without first notifying your instructor and the nurse assigned to your patient. Even to go to lunch. And
leaving the clinical site to go to lunch is not allowed.
Remember, our particular patients are often very sensitive to odors, good and bad! No perfumes, but please do pay special attention to your daily hygiene
habits, including dental hygiene ;).
th
Please review and submit proof of the following programs: (copy the evaluation page): by beginning of class on Tuesday the 17 .
1.
http://www.urmc.rochester.edu/ob-gyn/education/peri-facts/

38

(Click on the “Peri-Facts subscribers only” as pictured)
Username: STCC-TN-01
Password: MOTHER (typed in ALL CAPS)

2.
http://www.orlive.com/shawneemission/videos/cesarean-section-birth
This is approx 30 minutes. Please view and take a screen shot of the end. (You will need to pause it to print off the screen shot.)
Again, please do not get overwhelmed. (Try). I am looking forward to meeting and working with all of you! Welcome to NCBF!
Mrs. Jones
My Cell # is 828-8865 & I have texting, if there is any pressing questions or concerns that cannot wait until class or clinical orientations.

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