Bachelor's degree in Nursing (to qualify as a nurse) (Verona)

Critical nursing care [Matricole pari] (2018/2019)

Course code
4S000102
Credits
8
Coordinator
Domenico Girelli

Teaching is organised as follows:
Unit Credits Academic sector Period Academic staff
CHIRURGIA D'URGENZA 2 MED/18-GENERAL SURGERY INF VR - 3° anno 1° sem Giovanni de Manzoni
MEDICINA D'URGENZA 1 MED/09-INTERNAL MEDICINE INF VR - 3° anno 1° sem Domenico Girelli
INFERMIERISTICA CHIRURGICA SPECIALISTICA 1 MED/45-NURSING INF VR - 3° anno 1° sem Juri Salazzari
RIANIMAZIONE 2 MED/41-ANAESTHESIOLOGY INF VR - 3° anno 1° sem Leonardo Gottin
INFERMIERISTICA IN SITUAZIONI DI CRITICITA' 1 MED/45-NURSING INF VR - 3° anno 1° sem Stefano De Togni
INFERMIERISTICA CLINICA NEI SERVIZI DI EMERGENZA 1 MED/45-NURSING INF VR - 3° anno 1° sem Massimiliano Girlanda

Learning outcomes

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MM: CHIRURGIA D'URGENZA
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Within the evaluation and management of the critical patient, surgical disease certainly presents peculiar elements in diagnosis and therapeutic timing. The aim of the course is to provide the student with the knowledge of the major emergency pathologies that may include surgical management: from epidemiology to deepen clinical presentation in abdominal and thoracic pathologies. The "ideal" paths will also be described in order to achieve a correct diagnosis. It will also provide the student with elements of therapy.
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MM: MEDICINA D'URGENZA
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To give to the students a basic knowledge on the main medical urgencies and emergencies, including early recognition of life-threatening conditions, flow-charts regarding the main acute syndromes, with particular reference to the specific role of the nurse.
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MM: INFERMIERISTICA CHIRURGICA SPECIALISTICA
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The aim of the course is to investigate physiopathologic, clinical and emergency aspects of emergency / emergency situations selected according to their epidemiological relevance and exemplarity in different contexts (territory, domicile, hospital); Focuses on identifying the risks and the complexity of interventions and post-intervention complications and on the patient's urgency and complexity by identifying intervention priorities The MOD: SPECIALIST SURGICAL NURSING aims to provide the student with the contents and methodologies of the patient working in chest and cardiac surgery
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MM: RIANIMAZIONE
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The teaching aims to study physiopathological aspects, clinical and nursing aspects in emergency situation, selected based on their epidemiological and exemplarity importance in different situations (territory, hospital, home); it focuses on risks’ individuation, on intervention’s complexity and compliance and on patient’s urgent and complex nursing need identifying the priorities.
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MM: INFERMIERISTICA IN SITUAZIONI DI CRITICITA'
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1. Recognize critical situations in patients between practice settings. 2. Describe the clinical evolution monitoring interventions, support of compromised function and prevention of complications. 3. Describe the specific strategies support for the adaptation of the patient and family in ICU.
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MM: INFERMIERISTICA CLINICA NEI SERVIZI DI EMERGENZA
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The teaching aims to study physiopathological aspects, clinical and nursing aspects in emergency situation, selected based on their epidemiological and exemplarity importance in different situations (territory, hospital, home); it focuses on risks’ individuation, on intervention’s complexity and compliance and on patient’s urgent and complex nursing need identifying the priorities.

Syllabus

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MM: CHIRURGIA D'URGENZA
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Vascular Urgencies: From Acute Mesenteric Ischemia to Chronic Vascular Insufficiency Blunt abdominal trauma and polytrauma: definition, classification of diagnostic iter and therapeutic timing Digestive hemorrhage: Clinical presentation and treatment. Pain in the right iliac fossa: epidemiology, clinical presentation and differential diagnosis. Acute and chronic pancreatitis: diagnostic flow chart and role of surgeon. Acute diverticulitis: from physiopathology to clinic with emphasis on diagnostic criteria, classifications and treatment strategies. Acute disease of the esophagus: from perforations to the effect of caustic swallowing. Intestinal occlusion: clinical, diagnosis and therapy.
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MM: MEDICINA D'URGENZA
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APPROACH TO ACUTE CHEST PAIN IN THE EMERGENCY ROOM. Rapid recognition of life-threatening conditions (Acute Coronary Syndromes, Pulmonary Embolism, Hypertensive Pneumothorax, Mediastinitis, Aortic Dissection, Pericardial Tamponade). Differential diagnosis (principles). ACUTE CORONARY SYNDROMES (ACS) ST-Elevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial Infarction (NSTEMI), Unstable Angina (UA). Definitions, pathophysiology, symptoms. Role of the nurse in the management of patients with ACS. Principles of treatment of ACS. Recognition and management of the main complications, like cardiogenic shock and arrhythmias (particularly Ventricular Fibrillation and III-degree Atrioventricular Block. The main drugs used for cardiovascular urgencies and emergencies (mechanism of action, indications/contraindications, adverse reactions). AORTIC DISSECTION Definition, pathophysiology, symptoms. Principles of diagnosis and treatment. CARDIOGENIC ACUTE PULMONARY EDEMA Definitions, pathophysiology, symptoms. Principles of diagnosis and treatment. Role of the nurse in the management of patients with cardiogenic acute pulmonary edema. NON-CARDIOGENIC ACUTE PULMONARY EDEMA (Acute Respiratory Distress Syndrome, ARDS) Definition, pathophysiology, symptoms. Principles of diagnosis and treatment. Role of the nurse in the management of patients with non-cardiogenic acute pulmonary edema. VENOUS THROMBOEMBOLISM (VTE) Deep Venous Thrombosis (DVT) and Pulmonary Embolism. Definition, pathophysiology, symptoms. Risk factors. Strategies for VTE prevention. Diagnostic algorithms. Role of the Well’s score (or other similar scores) and of D-dimer. Principles of VTE treatment. MAIN ACUTE ORGAN FAILURES. ACUTE LIVER FAILURE Definition, pathophysiology, symptoms. Porto-Systemic Encephalopathy. Main acute complications in the cirrhotic patient. Principles of diagnosis and treatment. MAIN METABOLIC URGENCIES. MAIN ACUTE COMPLICATIONS IN THE PATIENT WITH DIABETES MELLITUS. DIFFERENT TYPES OF DIABETIC COMA. Classification. Definition, pathophysiology, symptoms. Principles of diagnosis and treatment. Role of the nurse in the management of patients with diabetic coma. MAIN INTOXICATIONS/POISONING Approach in the emergency room. Clinical recognition based on physical examination (vital signs, ocular signs, body temperature, halitosis, cutaneous discoloration). Acetaminophen intoxication. Acute alcoholic intoxication. Opioid intoxication. Cocaine intoxication. CO intoxication.
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MM: INFERMIERISTICA CHIRURGICA SPECIALISTICA
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Pleural space - nursing, educatio e riabilitation in toracic surgery. approach by toracotomy and Video assisted Thoracoscopy surgery. Follow up Nursing of the chest drain tube and plaural drainage. Indication of inserction of chest tube in PNX and pleural effusion. Nursing approach to the patient operated in sternotomy - By pass - Valve illness - Aortic dissection - perioperative nursing - CEC - post-operative complications - anticoagulant therapy - post-operative rehabilitation.
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MM: RIANIMAZIONE
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Diagnostic approach to shocked patient Severe breathing insufficiency, ARDS Post-anoxia coma Hypothermic therapy Cranial trauma Post traumatic coma
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MM: INFERMIERISTICA IN SITUAZIONI DI CRITICITA'
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1. critical and critical care patient: the care peculiarities. 2. Supervision and monitoring of the patient with neurological and cardiorespiratory instability: a. Monitoring and management of respiratory function: - Invasive ventilation: purposes and management of endotracheal intubation and artificial ventilation; monitoring and prevention strategies of early and late complications related to endotracheal intubation and respiratory device; - Non-invasive ventilation: indications, contraindications, monitoring and adaptation strategies and prevention of complications in the NIV; - Tracheotomy: indications, main types of access, tracheal stoma care, patient care tracheostomy feeding and phonation. b. assessment indicators and monitoring of neurologic function. c. Monitoring and management of cardiovascular function: indications and management of invasive blood pressure monitoring and PVC. 3. Monitoring, expected effects, side effect, interactions and responses to intravenous complex drug treatments. 4. Impact of stay in the ICU: - Hemodynamic changes related to the maneuvers of nursing and transportation; - Peculiarities in critical care patient’s hygiene and infection prevention; - Stress and adaptation of the patient and the family. 5. Nutritional approach to critical patients
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MM: INFERMIERISTICA CLINICA NEI SERVIZI DI EMERGENZA
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Primary and secondary emergency patient’s evaluation Triage Multi traumatic patient’s approach Hemodynamic evaluation First intervention’s situations Wound and tampon’s measures Emergency system’s precepts

Assessment methods and criteria

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MM: CHIRURGIA D'URGENZA
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The exam will take place through multiple-choice quizzes
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MM: MEDICINA D'URGENZA
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Multiple-choice items with automated correction.
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MM: INFERMIERISTICA CHIRURGICA SPECIALISTICA
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As a shared teaching program with the Teaching Coordinator
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MM: RIANIMAZIONE
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Writing Test
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MM: INFERMIERISTICA IN SITUAZIONI DI CRITICITA'
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Integrated exam with others of the same teaching modules. Written test consisting of 60 quizzes (10 per module) multiple choice.
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MM: INFERMIERISTICA CLINICA NEI SERVIZI DI EMERGENZA
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Writing Test

Reference books
Author Title Publisher Year ISBN Note
Stefano Grifoni Medicina d'Urgenza - Fisiopatologia Clinica Piccin 2019 978-88-299-2983-2
Gai V. Medicina d'urgenza: pratica e progresso II Edizione C.G. Edizioni Medico Scientifiche, Torino 2013
Maurizio Chiaranda Urgenze ed emergenze. Istituzioni PICCIN 2016
Renzo Dionigi Chirurgia Masson Editore 2017
Gentili A., Nastasi M., Rigon L.A., Silvestri C., Manganelli P. Il Paziente critico: clinica ed infermieristica in Anestesia e Rianimazione Casa Ed. Ambrosiana, Milano. 1997
Smelzer SC, Bare BG Nursing Medico Chirurgico - Brunner e Suddarth 1 Casa Ed. Ambrosiana, Milano 2017 8840811893




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