Disorder of the Gastrointestinal System Module 14

The Disorder of the Gastrointestinal System module starts with an introduction to the gastric tract. Many of the diagnostic tests are briefly explained. Disorders such as Peptic Ulcer Disease (PUD), GERD, GI Bleeding, constipation, diarrhea, gastroenteritis and diverticular disease as well as the nursing implications are addressed. Inflammatory Bowel Disease (IBD) such as ulcerative colitis and Crohn’s disease are reviewed. Colostomy and ostomy (urinary) care in general is briefly described.

During the practicum, I was lucky to get a patient with a colostomy. The colostomy care plan is conducted by a team of medical persons, ostomy care nurse, floor nurse and wound care nurse. This patient also had a wound vac to manage a previous slow healing wound. The dressing changes were done on Tuesdays and Fridays and took 1-2 hours. The nurses gowned up and used sterile technique because of the healing surgical wound. One nurse opened the dressings on the sterile field, procured supplies, and set up the wound vac system. As a refresher, I preformed the non-sterile float nurse role. I helped as much as I could and as much as I was allowed. As a refresher you will not be able to do everything.  The refresher student is not allowed to do the wound vac dressing but I was glad to help in any way of value and I observed, so I could learn to do the procedure at a later date.  I was able to do other dressings with supervision and I was happy with that experience.

The module addresses other organs in the abdominal cavity and some of the most common diseases of these organs. The signs and symptoms of Hepatitis, the diagnostic tests and the nursing interventions are discussed. The author also devotes a section to Pancreatitis including both acute pancreatitis and chronic pancreatitis. The final topic in this module is Cholecystitis or inflammation of the gallbladder.

As you can see there is a lot of information cramped into this one module. You are encouraged to visit the on-line library for further information on any of the listed topics.

Style Change

I am changing the style of this Blog. When I started the blog I was undertaking an adventure in the role of a Nurse Refresher Student. I will continue to review the nurse refresher modules but I want to add some personal clinical information. I completed my clinical experience at an Acute Care Hospital on a primarily postoperative surgical unit which included some medical patients. I plan to add information to the reviews that relate my personal experiences on returning to nursing. The RN Refresher experience as a whole was excellent! I did find a job back in research before I finished my first attempt at the practicum. I continued to work with the refresher program to find an opportunity to return and finish the practicum. I am happy to report that I was able to work with my employer in allowing flexible hours so I could complete the Clinical Practicum on the second attempt.

The first   attempt at the Clinical Practicum was a classroom type orientation very much like nursing school. Extra classes were offered in a clinical lab setting. We learned adult assessment, respiratory equipment usage, Intravenous care, wound care, using the PIC system to administering drugs, and practiced CPR on smart Annie dummies.

Annie was connected to monitors and proceeded to get very sick. Annie told us her symptoms and we had to decide how to best treat Annie. Annie proceeded to develop arrhythmias which we had to identify and treat.  We used a mock crash cart to get supplies. Annie had IVs hanging and we administered drugs via the IV lines. We set up for chest tube insertion and set up the drainage system. Annie had some large draining wounds. We set up a wound vac and dressed Annie’s wounds. We did CVP site care and changed IVs. We administered Oxygen therapy via nasal cannulas, mask, and tracheotomy. We suctioned secretions and cleared airways. We listened to heart sounds and breath sounds and learned to identify the different sounds to respond to how to best help Annie. We practiced starting IV on rubber tubing. It was an intense day but I am happy to report that Annie recovered and was resting comfortably when we left. Annie has gotten much more advanced and sophisticated since I first met her in nursing school.

We had another training day where we had our ID badges made. We got parking passes and a tour of the hospital as well as a tour of the floor where we would train. We spent a half day training on the computers. All nursing notes would be entered on the computer. We would get our patient updates from the computer and the staff. No more Kardex systems. We were instructed on patient privacy. We would now use room numbers not names. A room number was a way to attempt to protect patient’s identity. This was a big change from my nursing days. I can remember being reprimanded early in my career for using room numbers instead of a patient’s name. The idea then was that a room number depersonalized a patient and was inconsiderate. How is that for a 180 degree change in thinking?

Our instructor or preceptor was a nursing instructor at the School of Nursing in the University of North Carolina. She also worked in the hospital once a month to keep her skills current. All the refresher students completed the course work and scored 80 % or above on the course work. There were 10 students more or less. Most of the returning nurses worked in Clinical Research type jobs. Some had taken time off to raise families or pursue other career paths. As students found jobs they left the program with the hope of being able to complete the practicum at a later date. Students worked on the floor providing bed baths, linen changes, taking and recording vital signs on the computer systems. Our instructor reviewed everyone’s work and signed off on the effort.

We only worked 6 hours on the floor 3 days a week. Our instructor needed time to sign us off (thank goodness). Weekly, we were provided with handouts on case studies. We read the case studies at home, did the research, and had to be prepared to discuss the case study as well as any related lab and medication pertinent to the case study. The last hour was used for the discussion, review assignments, and questions. We were so tired we could barely drive ourselves home. We thought we were in good shape with walking every day.  We even had yoga and exercise instructors in the group. The reality is that we were on our feet working for 6 hours with no sitting except at lunch. The physical challenge was unbelievable. None of us were up to it. By the second week some were wearing expensive shoes from sporting stores. We all had trouble with ankle swelling. The standing was the hardest part of the practicum. The relentless standing got easier over time but the first 2 weeks were intimidating.

We had a check list of the experiences we needed to complete by the end of the practicum. We reviewed the list to determine what experiences we had acquired and what experiences were still outstanding. We worked with our instructor to get the check off list completed. I was half way through the practicum experience and received my midway evaluation by the time I had to leave.

My second attempt at completing the practicum was with a preceptor. The preceptor was a senior nurse on the floor.  The preceptor was arranged by the refresher program director. I worked out the schedule with my preceptor and my employer. I worked two 12 hour days at the hospital during the week. I worked 8 hour days remotely on the week end for my employer. I did not have any days off for 8 weeks. I was exhausted but it was a good experience. I had “one on one” mentoring experience. I no longer had to complete with other students for limited experiences and my instructor’s time. I got to administer a lot of drugs under supervision. I was not tired when I left the hospital. I often stayed late to give report and help. I was delighted that I could do it all and I was nursing again (even if I did not get paid). In fact I had to pay more to get the second opportunity to finish the practicum.

I am proud that I finished the RN Refresher Program and I can now incorporate my experience by adding personal comments to the module summaries.

Cardiovascular Disease Module 13

Cardiovascular Disease is my favorite topic, the area where I shine. The module introduces Myocardial Infarction but if you want a deeper understanding of cardiovascular topics, the Advanced Cardiac Life Support (ACLS) course might be for you. The ACLS course is not required but if you think your job might include responding to codes then the ACLS is for you. All nurses are required to be current in Basic Cardiac Life Support (BCLS) which is also another course not offered in the RN refresher course. Make sure that the BCLS course you take is an American Heart Association certified course. The BCLS course from the American Red Cross may not be acceptable to hospitals where you apply.

The module does a nice job discussing Heart Failure (HF). We are now discouraged from naming the diagnosis congestive heart failure because heart failure does not always mean congestive symptoms.  I like the break down into right and left heart failure and how to treat both. The 4 New York Heart Association (NYHA) Classification of heart failure is presented along with the Heart Failure Society of America (HFSA) stages. The stages supplement the NYHA classification. The stages were developed to treat patients earlier and improve survival.  This section has a nice table on the common causes of HF, the symptoms, and how to treat the various stages of HF including the nursing diagnosis, expected outcomes, and interventions.

Peripheral Vascular Disease is also discussed briefly. Hypertension is discussed throughout the module since Hypertension is one of the first processes leading to HF. Aortic aneurysm and stents are mentioned. There is an excellent table with drug classes at the end of the module. The table is nice because it lists the indication and the key nursing implications (what to watch for when administering cardiovascular drugs).

Common Diseases of the Respiratory System Module 12

As discussed in Module 11, the respiratory system is a big topic and two modules only offer an introduction. If you have the opportunity to take more classes or attend CEU offerings, I would highly recommend the extra classes and learning opportunities.


This module discusses nursing assessment, planning and interventions such as auscultation of the lungs, chest percussions and the classes of medication used in lung disorders. The Respiratory diseases such as Tuberculosis (TB) which are becoming more prevalent these days, Chronic Obstructive Lung Disease (COPD), Obstructive Sleep Apnea, Pneumothorax, and occupational disease are discussed. The visual description of Atelectasis is well done. In Atelectasis the alveoli collapse and become airless. If normal alveoli look like a bunch of grapes then Atelectasis alveoli would look like raisins. We try to prevent Atelectasis by encouraging coughing and deep breathing exercises in the postoperative patient.

Adult Respiratory Distress Syndrome (ARDS) is a diffuse inflammatory process involving both lungs and leads to progressive respiratory failure. The alveolar capillary membrane is damaged and the alveoli become filled with fluid. This is a life threatening condition and may be associated with other multi-system failure. A patient with ARDS will be in the intensive care unit and is usually on the mechanical ventilator.

Other obstructive inflammatory respiratory diseases include Asthma and Pulmonary Edema. These topics are also discussed in the module.

A nice feature in the manual is a medication chart at the end of module 12. The medications, dosage and side effects are laid out in easy to reference chart. The medication chart is a brief outline of the pertinent key points and is great for a quick respiratory therapy medication review.



Module 12 concludes Book II. The next blog will start with topics in Book III.

The Respiratory System Module 11 & 12

Yes the Respiratory System gets two modules. This is a big topic and I am amazed that it can be done in just two modules.


First the Respiratory system and general principles discuses the mechanics of the respiratory system and the equipment we use in nursing. There is an amazing array of equipment from nasal cannulas, masks, intubation tubes, tracheotomy tubes, and chest tube with water seal drainage. The basic principles that I learned and used several years ago while working with critically ill patients still applies. The equipment may look a little different. The newer models are improved and are less time consuming to set up.

I like the new patient care process for helping the patient clear secretions with the use of suctioning. Of course, I am thinking about the patient on mechanical ventilators. The patient is hyperventilated for 1 minute or uses 100% oxygen for a minute. The suction catheter is attached to the side of the endotracheal tube or tracheotomy tube. The suction catheter is enclosed in a sterile plastic sleeve. The catheter is fed through the plastic sleeve and withdrawn without the catheter ever being exposed outside the sterile environment. I actually used this device before I left nursing. It is nice because a closed system is maintained and the patient is not removed from the ventilator for the suctioning procedure. This procedure is less invasive and less traumatic for the patient.

The AHEC offered a hands-on class on respiratory equipment and patient care before we started our practicum. The class cost extra but was well worth the extra expense. Students played with the equipment and received instruction in a safe environment. We asked questions and practiced on life like dummies that came complete with a respiratory system. If you are a returning nurse and you have the opportunity to take more classes I would definitely recommend the class on respiratory care delivery and equipment.

Module 12 will be discussed in the next blog.

Module 10 - Infection Control

Yes you guessed it the next module is on protecting the Nurse and the patient. Hospital–Acquired infections are a big threat to both staff and patients. The proper use of gloves, hand washing, and protecting patients as well as self is very important. Hospitals now have hand sanitizers mounted on the wall at several locations including every patient room and patient care areas. I noticed during my practicum that bar soap is no longer provided in patient care equipment. Patients are encouraged to use shower gel for cleansing.


Dressing change techniques are specified in the Working Practice and Nursing Procedures. IV lines and CPV lines care is also specified and must be adhered to rigorously. Infection Control is now a department and any infection must be reported as soon as suspected. The Infection Control committee will determine how much barrier protection will be implemented (gown, gloves, mask, and environmental air control). Signs are posted with the correct precautions specified. The amount of protection or shielding is determined by Infection Control Protocol.

Controlling infections in the hospital is a priority these days. Evidence Based Practice is implemented in all nursing units. Instructions on hand washing are posted everywhere. This section also discusses the correct procedure for donning protective attire. Preventing antibiotic resistant infection is a concern for all levels of patient care.

It makes you feel good to know that if you were a patient your safety and protection is given such a high priority by all members of the staff.

Electrolytes in a nut shell

It’s Getting More Difficult!


I received the results from my first submission in the mail. The result also included a message advising me to slow down. I am not permitted to finish the course work in less than 12 weeks without permission from the university. The university instructors want students to have time to absorb the course material that the students are learning. Racing through the material in a mad dash to the finish line is not acceptable. I call my instructor and I agree to slow down. It is just as well. Module 9 is next and the topic is Fluid, Electrolyte, and Acid-Base Imbalance.

Module 9: The fluid intake and output section was a breeze but fluid transportation, Osmosis and oncotic pressure is a more difficult topic. We learn the different types of intravenous fluids and why that solution type is given. The role of kidney, heart and blood vessels, lungs, skin, and glands play in fluid volume and imbalance is discussed. How can they possibly condense this subject to one module? The module even goes into a discussion of the electrolytes and normal lab values as well as the reasons for the abnormal values. Oh we are not done! The pH, acid-base levels and how to determine if an imbalance in acid-base is due to a respiratory event or a metabolism event, are all discussed. Because the topic is so intense the module is divided into 2 sections. Section II discusses Blood and Blood Administration. This blood administration topic is a welcome reprieve from the acid-base topic. My head is full. I have to review this module more than once.