Course Competency 1: Integrate nursing care for clients with coronary artery disease

• Define cardiac output and factors affecting cardiac output.
• Identify focused assessments for altered cardiac output.
• Define preload, contractility, and afterload and how they can be affected by collaborative interventions.
• Identify normal lab values for cholesterol, LDL, HDL, BUN, EGFR and creatinine and relate how they can be affected by CAD.
• Describe how preload, contractility, and afterload can be altered.
• Outline how to perform emergency care procedures (CPR, Respiratory support, AED).
• Outline nursing responsibilities for patients undergoing hemodynamic monitoring.
• Identify what determines and/or affects systolic and diastolic blood pressure.
• Explain what mean arterial pressure (MAP) reflects.
• Outline the procedural steps for accurate manual measurement of blood pressure.
• Describe the classification of hypertension.
• Explain the long-term effects of hypertension on the heart, blood vessels and target organs.
• Explain how each of the following affects blood pressure: diuretics, ACE inhibitors, alpha agonist/antagonists, beta-adrenergic blockers, IV Nitroprusside, calcium channel blockers, high sodium diet, stress, catecholamine release, aldosterone, ADH, ANP.
• Explain how or why orthostatic hypotension occurs.
• Suggest measures for preventing problems associated with orthostatic hypotension.
• Explain risk factors, assessment findings and collaborative treatment required for hypertensive crisis.
• Outline priority health promotion teaching topics for patients with hypertension.
• Relate classes of medications to care for a patient with coronary artery disease or MI: antilipemics, antiplatelets, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, nitroglycerin (short acting, long acting and IV), morphine and heparin.
• Prioritize care for a patient with chest pain.
• Differentiate symptoms of chronic angina from those indicating acute coronary syndrome.
• Differentiate the nurse’s role in the care of patients experiencing a STEMI versus a non-STEMI.
• Explain how MIs are diagnosed and the significance of standard lab and ECG findings.
• Contrast ECG results indicating ischemia, injury and infarction.
• Identify nursing responsibilities for a patient following coronary artery bypass surgery, including monitoring for potential complications.
• Describe cardiac rehabilitation and its benefits.
• Identify pre- and post-procedural nursing responsibilities while caring for patients undergoing an exercise stress test, cardiac angiogram, cardiac angioplasty (PCI).
• Outline priority teaching topics for a patient with CAD, MI or post-CABG.
• Identify reversible causes of dysrhythmias (5 H's and 5 T's).
• Identify common dysrhythmias on ECG results and relate collaborative interventions for each (sinus bradycardia, sinus tachycardia, atrial fibrillation, premature ventricular tachycardia, ventricular tachycardia, ventricular fibrillation, asystole).
• Contrast synchronized cardioversion (with or without conscious sedation) and defibrillation.
• Identify when PVCs are considered dangerous.
• Explain common protocols initiated by nurses to maintain a patient's cardiovascular status (chest pain, STEMI, electrolyte replacement).
• Describe the nurse's role in a code.
• Differentiate when pacemakers or ICDs are needed.
• Identify the learning needs of patients with pacemakers and ICDs.
• Outline the New York Heart Association Classification of heart failure and how it can be used to plan nursing care for patients with heart failure.
• Differentiate manifestations of diastolic versus systolic heart failure, and manifestations of left- versus right-sided heart failure.
• Explain how the body attempts to compensate in CHF and how these mechanisms eventually result in decompensation.
• Differentiate between manifestations of stable left-sided heart failure versus acute pulmonary edema.
• Explain how lung disease promotes the development of cor pulmonale.
• Describe the nurse's role in a code.
• Contrast the signs and symptoms of stable heart failure with those occurring during an acute exacerbation.
• Outline collaborative interventions for an acute exacerbation of heart failure including common medications, BiPAP, intra-aortic balloon pump (IABP) and ventricular assist devices (VAD).

Course Competency 2: Integrate nursing care for clients with alterations in cardiovascular system

• Describe the development of atherosclerotic plaque and how atherosclerosis is related to modifiable risk factors.
• Contrast signs, symptoms, and interventions associated with chronic PAD, acute arterial occlusion, venous insufficiency and deep vein thrombosis.
• Differentiate manifestations of arterial and venous ulcers and collaborative interventions for each.
• Explain collateral circulation and its effects following arterial obstruction.
• Explain the risk factors, prevention and treatment of varicose veins.
• Contrast manifestations and collaborative interventions for an arterial aneurysm versus dissection.
• Contrast manifestations and collaborative care for valvular regurgitation versus stenosis.
• Explain how infectious endocarditis can lead to valvular dysfunction.
• Differentiate among risk factors, manifestations and collaborative care for infective endocarditis, pericarditis and cardiomyopathy.
• Explain how pericardial effusion and cardiac tamponade can be caused by pericarditis and the manifestations and collaborative care required.
• Explain why cardiac tamponade is a life-threatening situation.
• Relate the pathophysiology of rheumatic carditis to its manifestations and collaborative care.
• Outline symptoms of rejection of a heart transplant.
• Differentiate cyanotic and acyanotic congenital heart defects.
• Outline nursing responsibilities for infants and children with congenital heart defects.
• Explore the process of organ transplantation and associated ethical implications.
• Outline the shunts in fetal circulation (ductus venosus, foramen ovale and ductus arteriosus) and how blood flow changes when the baby is born.
• Outline priority teaching topics for parents with children with congenital heart defects.

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Course Competency 3: Integrate nursing care for clients with acute alterations in the respiratory system

• Describe surfactant and how it affects ventilation.
• Identify factors that will decrease the diffusion of gasses across the alveolar-capillary membrane.
• Describe the manifestations of hypoxia, hypercapnia and acidosis.
• Explain why caution is required when administering high levels of oxygen to people with chronic hypoxia.
• Review nursing’s role in oxygen administration and other respiratory cares.
• Review nursing responsibilities for patients receiving respiratory assistance (oxygen therapy, CPAP, BiPAP, PEEP, mechanical ventilation).
• Review the collaborative role of respiratory therapists when caring for patients with respiratory disorders.
• Explain how ABGs are used in the diagnosis and collaborative care of patients with acute respiratory disorders.
• Outline nursing responsibilities associated with procedures such as thoracentesis and bronchoscopy.
• Outline health promotion teaching about smoking cessation.
• Describe the symptoms associated with acute respiratory distress.
• Explain risk factors, signs and symptoms of ARDS.
• Explain why patients with respiratory distress may eventually become apneic.
• Explain ventilator settings such as FiO2, Tidal volume, and PEEP.
• Describe potential complications of PEEP and how to assess if they are occurring.
• Outline potential complications for patients on a ventilator and how they can be prevented.
• Compare/contrast causes and interventions for low pressure and high pressure alarms for a patient on a ventilator.
• Describe the effects of inflammation on the airways and pulmonary tissues.
• Outline infection control measures for patients with respiratory infections.
• Explain when respiratory infections are a public health concern.
• Explain how to interpret a Mantoux/ppd test.
• Describe how active tuberculosis is diagnosed.
• Describe specific isolation precautions for a patient with an active TB infection.
• Explain why multiple antibiotics are used for an extended period of time for patients with active tuberculosis.
• Describe who is at risk for atelectasis and how it can be prevented.
• Explain how atelectasis can lead to pneumonia.
• Outline patient instructions for proper use of incentive spirometry according to current guidelines.
• Differentiate between Community Acquired Pneumonia, Hospital Acquired Pneumonia and Ventilator Associated Pneumonia.
• Explain how symptoms of pneumonia are often different in an elderly patient.
• Outline risk factors and interventions to prevent pulmonary emboli.
• Explain why pulmonary emboli are a perfusion, not a ventilation, respiratory problem.
• Explain why cardiac output may be decreased in a patient with pulmonary emboli.
• Describe nursing responsibilities associated with the treatment of pulmonary edema using IV furosemide.
• Contrast the signs, symptoms and collaborative care of patients with pulmonary edema versus pleural effusion.
• Differentiate nursing responsibilities when caring for patients with pneumothorax, hemothorax and tension pneumothorax.
• Explain why a tension pneumothorax is life-threatening and requires emergent care.
• Describe nursing responsibilities associated with caring for patients with chest tube drainage systems.
• Relate the Tdap vaccine to the recent emergence of pertussis in children and adults.
• Describe the symptoms of pertussis and current guidelines for the treatment of patients and their close household contacts.
• Outline infection control and public health measures for a patient with pertussis.
• Differentiate between home management of croup and when hospital care is required.
• Outline acute collaborative care for a patient with croup.
• Relate the pathophysiology of epiglottitis to symptoms and collaborative care.
• Explain why epiglottitis is potentially a life-threatening condition.
• Outline infection control measures for a patient with bronchiolitis.

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Course Competency 4: Integrate nursing care for clients with chronic alterations in the respiratory system

• Explain how lung disorders can cause cor pulmonale.
• Relate spirometry terms such as FVC, FEV1 and residual volume to the collaborative treatment of asthma and COPD.
• Explain the therapeutic effects of the flutter device (acapella).
• Outline nursing interventions to address the anxiety that commonly occurs in patients with dyspnea.
• Describe the pathophysiology, potential complications, and collaborative interventions for sleep apnea.
• Explain how each of the following can result in a restrictive/interstitial lung disorder: dusts, drugs, radiation, fibrosis, connective tissue diseases.
• Describe the post-operative needs of patients following laryngectomy and pneumonectomy.
• Outline the risk factors for lung cancer and common collaborative treatments.
• Outline nursing responsibilities when caring for a patient with a tracheostomy, including trach care, suctioning, and promoting communication.
• Explain the purpose of cuff inflation and its potential adverse effects.
• Outline how to prevent aspiration in a patient with a tracheostomy.
• Describe assessments and interventions for tube obstruction.
• Explain the function of fenestrated tubes and caps/valves.
• Outline the weaning procedure for a patient with a tracheostomy.
• Outline priority teaching topics for home management for a patient with a tracheostomy.
• Outline steps to perform if the tracheostomy tube becomes dislodged.
• Describe how the three major problems associated with asthma (bronchoconstriction, mucosal edema, mucus production) affect oxygenation and the work of breathing.
• Describe how the collaborative care of patients with asthma is based on the step classification.
• Explain how "personal best" peak flow readings and the Asthma Action Plan are used for optimal self management of asthma.
• Differentiate from "control" medications versus "quick relief" medications for asthma and associated patient education.
• Describe common ABG results for a patient in an early asthma attack and how the results change as the patient's respiratory status worsens.
• Outline manifestations and collaborative care for a patient in status asthmaticus.
• Differentiate between manifestations of chronic stable COPD versus those signifying an acute exacerbation of COPD.
• Explain why people with COPD may develop a barrel chest (increase AP diameter).
• Explain the role of alpha-1-antitrypsin in the development of emphysema.
• Explain why people with COPD may develop secondary polycythemia.
• Explain why BiPAP therapy is often more beneficial than just oxygen therapy for a patient with an acute exacerbation of COPD.
• Relate the pathophysiology of COPD to common classes of medications used to treat it.
• Explain why weight loss is often associated with COPD and common nutritional interventions.
• Explain why pursed lip breathing is an effective breathing technique for patients with COPD.
• Describe collaborative care for patients with "end stage COPD."
• Explain why cystic fibrosis can cause both respiratory and digestive problems.
• Outline collaborative care for patients with cystic fibrosis.
• Explain common causes of early death for patients with cystic fibrosis and how they can be prevented.

Course Competency 5: Integrate nursing care for clients with alterations in hematology

• Explain the process of hematopoiesis (RBCs, WBCs, and platelets).
• Describe how oxygen and carbon dioxide are transported through the bloodstream.
• Explain the relationship between hematological problems, the need for oxygen, and common symptoms.
• Describe the role of platelets and clotting factors in hemostasis.
• Briefly outline the coagulation pathways.
• Identify abnormal values for the following lab tests: hemoglobin, hematocrit, white blood cell count, plateletncount, INR, aPTT.
• Explain the effects of anticoagulants, fibrinolytics and inhibitors of platelet activity on hematologic function.
•  Explain how to modify the environment to protect patients with neutropenia and thrombocytopenia.
• Identify priority concerns for a patient undergoing bone marrow biopsy.
• Relate the common symptoms of anemia to the level of hemoglobin.
• Explain how severe anemia can lead to chest pain and heart failure.
• Predict how renal failure can result in anemia.
• Explain when iron, vitamin B12 injections, and protein are needed to treat anemia.
• Relate the development of jaundice to hemolytic anemias.
• Review nursing concerns when transfusing blood and blood products.
• Identify the causes and treatment for polycythemia.
• Describe neutropenic precautions/protective environment and when they are indicated.
• Differentiate between leukemias and malignant lymphomas.
• Relate the manifestations of multiple myeloma to pathophysiology.
• Identify conditions/disorders/situations that increase the risk of clot formation.
• Explain when and how blood clots are dissolved.
• Explain therapeutic effects of daily aspirin and pre-operative or pre-procedural concerns related to aspirin.
• Identify appropriate nursing responses to abnormal lab results related to bleeding and clotting (e.g. high or low INR, aPTT, platelet, D-dimer).
• Identify nursing concerns when a patient is diagnosed with heparin-induced thrombocytopenia and other forms of thrombocytopenia.

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Course Competency 6: Integrate nursing care for clients with alterations in the endocrine system

• Outline the major features of the stress response.
• Explain the major effects of each of the following substances released during the stress response: ADH, Aldosterone, epinephrine, norepinephrine, and cortisol.
• Identify expected assessment findings in acute and chronic stress.
• Explain how stress alters nutritional requirements.
• Explain nursing responsibilities in assessing a patient's coping status and suggesting coping strategies and resources.
• Describe how to evaluate if patients' coping strategies are effective.
• Apply the nursing process to common endocrine disorders such as Diabetes Mellitus, Cushing's Syndrome, Adrenal insufficiency, SIADH, Diabetes Insipidus, Hyperthyroidism and Hypothyroidism.
• Identify the relationship of TSH, T3 and T4 levels and thyroid dysfunction.
• Explain how and when endocrine disorders can become life-threatening.
• Discuss the pathophysiology of cell starvation, hyperglycemia, and dehydration in diabetes mellitus.
• Differentiate between Type I and Type II diabetes mellitus.
• Identify etiological factors associated with Type I and Type II diabetes.
• Relate factors that influence blood glucose levels.
• Contrast Somogyi effect and Dawn phenomenon.
• Identify abnormal values for the following lab tests: fasting blood glucose, hemoglobin A1C.
• Describe oral agents and types of insulin used to treat diabetes.
• Identify the effects of insulin on serum potassium level.
• Identify aspects nurses should consider when administering anti-diabetic agents.
• Describe “carb counting” based insulin regimens.
• Describe proper foot care for a patient with diabetes.
• Develop a plan for teaching patients self-management (including diet, travel, sick day care).
• Explain how the effectiveness of diabetes treatment can be monitored.
• Explain why healing is impaired in patients with diabetes.
• Predict possible acute and chronic complications of diabetes mellitus.
• Prioritize nursing interventions for patients with DKA and HHS.
• Discuss developmental concerns in caring for patients with diabetes.
• Identify other providers’ importance in collaborative management of diabetes.

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Course Competency 7: Integrate nursing care for clients with alterations in fluid and electrolyte balance

• Explain how fluid volume and electrolytes are regulated.
• Explain the development and treatment of edema.
• Identify factors that can increase the risk of fluid and electrolyte imbalances.
• Explain how sodium and water imbalances affect neurological functioning.
• Explain the effects of altered potassium levels on membrane potential and the implications for the nurse.
• Identify abnormal values for the following lab tests: sodium, potassium.
• Differentiate between osmosis, diffusion, filtration, and active transport.
• Explain why severe fluid and/or electrolyte imbalances can become life-threatening.

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Course Competency 8: Integrate nursing care for clients with alterations in acid-base balance

• Explain where acids and bases come from in the body.
• Predict patients at risk for acid base imbalance.
• Explain the roles of the lungs, kidneys, and chemical buffers in maintaining acid base balance.
• Identify signs and symptoms of acidosis and alkalosis.
• Interpret basic arterial blood gas laboratory results.
• Predict the signs and symptoms observed with compensation for various acid-base imbalances.
• Suggest treatment measures for various acid-base imbalances.

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Course Competency 9: Integrate nursing care for clients with pain and alterations in comfort

• Differentiate various types of pain including: acute, chronic, referred, and neuropathic.
• Explain the decision-making process for selecting the appropriate medication to treat various types of pain (consider algorithms such as the WHO ladder).
• Identify nursing strategies for managing the side effects of pain medications.
• Discuss the care of a patient receiving patient-controlled analgesia.
• Explain how non-pharmacologic, complementary, and alternative treatments for pain and nausea can be incorporated into the plan of care.
• Suggest ways in which a nurse can help meet the needs of the families of patients with acute or chronic pain.
• Incorporate standards of practice for pain management into a plan of care for patients with acute pain, chronic pain, and end of life pain.
• Identify patients who might benefit from palliative care.
• Outline goals of palliative care.
• Discuss ways in which the nurse can promote comfort during the dying process.