Adult Health Nursing 2

This course is also of 8 credit hours just like the first part of adult health nursing (AHN). It gives you the chance to deliver safe & competent treatment for patients with a range of neurological, respiratory, endocrine, musculoskeletal, and cardiovascular diseases. As they care for a range of patients, including those who require long-term care, with an emphasis on patient teaching and discharge planning, they get assistance in developing their critical thinking and nursing judgement.

 

AHN 2

AHN 2 Objectives:

At the end of the Adult Health Nursing II, you will be able to learn about the following topics.

1. Demonstrate an ability to utilize nursing process in extending holistic care to adult patients with a variety of Cardiovascular, Respiratory, Endocrine, Musculo-skeletal, Neurological and ENT (Ear, Nose and Throat) related disorders.

2. Describe the risk factors, etiology, signs & symptoms and integrate Pathophysiology of various disease processes using a nursing framework, (Functional Health pattern) to assess patient’s needs and problems.

3. Discuss the need to use relevant research findings in designing appropriate nursing care for the patients.

4. Demonstrate an awareness of legal and ethical standards in caring for patients with various disorders in a variety of acute and intermediate care settings.

 

Teaching/Learning Strategies:

Within different methods of teaching and learning these method will be used; Lectures, discussions, role-plays, clinical conferences, skills demonstrations /return demonstrations, group work/videos, tutorials, presentations and viva examinations.

 

Evaluation Criteria

According to the new evaluation criteria, 30% marks will be internal and 70% will be of KMU or other university.

·       Test(s) = 15%

·       Case Presentation (Group) = 15%

·       Scenario based Tutorial = 20%

·       Skill Performance exam = 20%

·       Final Exam = 30%

·       Total = 100%

 

 

AHN 2 Outline

 The following units and objectives will be cover in this course of Adult Health Nursing. As the Units are very lengthy, that's why, we will give you read more option, upon which you will go to the specific unit and will be able to read and download their PowerPoint Slides.  And if you wanted all PowerPoint Slides in only one slide, Then Click Here to download.  

 

UNIT 1: Orthopedic Nursing (Read More)

This unit will assist you in effective utilization of nursing process in delivering care to patients with musculo-skeletal problems. The course places emphasis on the important concepts applicable in musculo-skeletal conditions and rehabilitation of patients.

By the end of this unit, you will be able to learn the following points.

1. Relate the normal anatomy and physiology of the musculo-skeletal system to alterations of normal structures and functions.

2. Display the ability to assist in carrying out diagnostic procedures related to the musculo-skeletal system and also recognizes and reports the abnormalities in the results.

3. Identify the needs of the client, with different types of tractions and amputation.

4. Use nursing concepts in identifying potential complications associated with musculo-skeletal disorders.

5. Utilize nursing process in delivering care, promoting and maintaining the optimal wellness of clients with musculo-skeletal disorders.

6. Collaborate with other members of the health care team in health teaching and discharge planning.

7. Incorporate relevant research findings in designing a plan of care for clients with musculo-skeletal disorders.

8. Understands and performs Neuro-Muscular assessment independently on patients having musculo-skeleton disorder.

9. Demonstrate pre and post operative nursing care in patients with Musculo-skeletal surgeries.

·       Soft tissue injury

·       Fracture.

·       Amputation.

·       Paget’s disease and Gout.

·       Osteomylitis.

·       Osteoarthritis

·       Osteoperosis

·       Rheumatoid Arthritis

·       Bone tumors.

·       Tuberculosis.

 

UNIT 2: Endocrine Nursing (Read More)

This unit is about care of clients with disorders of Pituitary Gland.

This unit gives an introduction to the endocrine system. Disorders of anterior and posterior pituitary gland are discussed with a focus on physiology and disorders of secretion of growth hormone. Both hypo-secretary and hyper-secretary disorders are dealt with here. By the end of this unit, the you will be able to:

1. Discuss treatment modalities of patients with pituitary gland disorders.

2. Utilize nursing process in the provision of care for patients with disorder of pituitary gland and for patients undergoing surgery of the gland.

3. Discuss the impact of various endocrine disorders on patients and their families

Care of clients with disorders of Diabetic

In this unit, you will gain an understanding of pathogenesis of different types of diabetes mellitus. Acute and chronic complications of diabetes mellitus will be discussed along with medical and nursing management of clients. Research related to this disorder and its treatment will be discussed. Client education and home management will also be the focus areas of this unit.

1. Discuss the preparation for patients undergoing diagnostic tests/ procedures for a patient with diabetes.

2. Identify pathogenesis and manifestations of the acute and chronic complications of diabetes mellitus.

3. Assess: Hypo and Hyperglycemic conditions.

4. Discuss the medical and pharmacological treatment for a diabetic client.

5. Discuss the purpose and plan of diet for diabetic clients.

6. Describe the nursing management of a newly diagnosed diabetic client.

7. Describe the nursing management of a diabetic client who has Ketoacidosis, Hypoglycemia, and who is undergoing surgery

8. Explain the psychological impact of diabetes mellitus on the client and his family.

9. Explain the nursing responsibilities in the long-term management of the diabetic client.

Care of client with Thyroid gland disorders

This unit deals with review of structure of thyroid gland and patient emphasis on physiology and hormone production. This information is integrated while discussing the disorders of thyroid hormone secretion i.e. hypo and hyper-thyroidism. Moreover, goiter is also discussed in this unit.

By the end of this unit the you will be able to:

1. Demonstrates understanding of medical and surgical management of patients with thyroid disorders.

2. Describe pre and post-operative care of thyroidectomy.

3. Identify potential complications of thyroid disorders and describe appropriate measures in that regard.

4. Explain the complications of thyroidectomy.

 

Care of patients with Parathyroid disorders

In this unit, you learn about the function of parathyroid hormone and effect of impaired hormone secretions on body. They are expected to apply this information while discussing the disorder of parathyroid gland.

By the end of this unit the you will be able to:

1. Describe treatment modalities of patients with parathyroid disorders.

2. Utilize nursing process in provision of care to patients with disorders of parathyroid gland.

 

Care of patients with disorders of Adrenal gland

In this unit, the focus is on the hormones secreted by the adrenal medulla and adrenal cortex. Their significance to life is discussed. Various disorders of hyper secretion and hypo secretion of hormones of adrenal cortex and medulla are discussed.

By the end of this unit the you will be able to:

1. Integrate the disorders associated with adrenal cortex and medulla.

2. Describe treatment modalities of patients with adrenal gland disorders.

3. Utilize the nursing process in the provision of care to patients with adrenal gland disorder.

4. Review effects and side effects of gluco-corticoid therapy and plan client teaching accordingly.

5. Explain the systemic effects of short and long term use of corticosteroid therapy.

 

UNIT 3: Neurological Nursing (Read More)

It can be further divided into the following objectives.

Increased ICP (Intra cranial pressure) and Head Injury

This unit will assist you in applying nursing knowledge to the care of a patient with increased ICP and head injury, in an acute care setting.

By the end of this unit the you will be able to:

1. Review anatomy and physiology of brain and its protective structures.

2. Differentiate between primary and secondary head injuries and demonstrate an understanding of the related pathophysiology.

3. Anticipate major complications that may result from head injuries.

4. Utilize nursing process in caring for a patient, with head injury.

 

Spinal Cord Injury

This unit aims at helping you understand the physical, physiological and psychological sequel of spinal cord injuries. Unit will also focus on preventive and curative care of patients with intervertebral disc herniation.

By the end of this unit you will be able to learn the following.

1. Review basic anatomy and physiology of spinal cord and its protective structures.

2. Describe various mechanisms of injury that may be involved in spinal cord injury.

3. Relate pathophysiological changes that take place after a partial or complete cord transaction.

4. Identify life threatening complications that may result from spinal cord injury.

5. Appreciate the need for prompt interventions in case of a patient with spinal shock and autonomic dysreflexia.

6. Describe the nursing care of a patient with spinal cord injury in an emergency and acute care setting.

7. Explain briefly the rehabilitative needs of patients with Spinal cord injury.

8. Identify the causes and mechanism of injury involved in intervertebral disc herniation.

9. Describe the role of nurses in surgical and non-surgical management of a patient with intervertebral disc herniation.

10. Discuss the importance of maintaining proper body mechanics in preventing intervertebral disc herniation.

 

Cerebro Vasular Accident (CVA)

This unit will help you understand the needs of patients with CVAs depending upon the extent location and manifestations of CVAs. It will also focus on the distinguishing features of CVAs and TIAs and their respective nursing care. By the end of this unit the you will be able to:

1. Utilize nursing process in caring for the patient with CVA.

Infections/Inflammations of CNS (Central Nervous System)

Meningitis/ Encephalitis/ Brain abscess

This unit focuses on the alterations in intracranial dynamics, resulting from infections/inflammation of CNS and the role of nurses in preventing and managing complications associated with meningitis, encephalitis and brain abscess.

By the end of this unit you will be able to learn the followings.

1. Describe alterations in intracranial dynamics resulting from infectious disorders of Central Nervous System (CNS).

2. Differentiate between the etiology, manifestations and diagnostic markers of meningitis, encephalitis and brain abscess.

3. Discuss the pharmacological and nursing management of patients with inflammations and infections of CNS.

 

Epilepsy/Seizures

This unit aims at increasing you understanding of clinical and social sequel of epilepsy and the role of nurses in managing patients with epileptic disorder.

1. Use nursing process to provide care to patients with various seizures disorders.

2. Demonstrate an understanding of the side effects and nursing care of some common antiepileptic drugs.

3. Appreciate the psychological effects of epilepsy for a patient and family.

 

Disorders of Neuromuscular Transmission.

Myasthenia Gravis (MG)/Gullien Barrie Syndrome (GBS) (Tutorial)

This unit will assist you in understanding their role as nurses in assessing and managing patient with common neuromuscular disorders and in identifying complications associated with it.

·       Relate the normal physiology of neuro-muscular transmission to the pathophysiological mechanisms involved in GBS and MG.

·       Distinguish the signs and symptoms of MG and GBS.

·       Describe nurses’ role in caring for patients undergoing diagnostic procedures to rule out MG and GBS.

·       Identify major complications associated with Myasthenic Crises and Cholinergic Crisis.

·       Utilize effective nursing process in caring for patients with neuromuscular transmission disorder.

Pain and painful disorders related to nervous system.

This unit focuses on the etiology, Pathophysiology, manifestations and nursing care of a patient with headache and facial pain.

By the end of this unit the you will be able to:

1. Trigeminal Neuralgia

·       Review the basic anatomy of trigeminal nerve and its main division.

·       Explain the etiology and Pathophysiology of trigeminal neuralgia.

·       Recognize the clinical manifestations of trigeminal neuralgia.

·       Identify the diagnostic techniques used to rule out the above disorder.

·       Explain medical and surgical management of the same.

·       Utilized nursing process in providing care and teaching to a patient with trigeminal neuralgia.

 

2. Migraine / Headache.

·       Classify the various types of headaches according to their etiology and pathophysiology.

·       Describe dietary and other precipitants of migraine headache.

·       Explain the pharmacological and symptomatic treatment used for patients with various types of headaches.

·       Describe nursing responsibilities in caring and teaching of a patient with headaches.

 

Chronic Neurological Disorders

1. Parkinson’s disease

This unit will help you in understanding Parkinson’s disease, its etiology, pathophysiology and manifestations and emphasizes on the role of a nurse in managing patients in hospital setting and out patient setting and family teaching. By the end of this unit the you will be able to:

·       Discuss the medical surgical management.

·       Utilized nursing process to extend care to a patient with Parkinson’s disease.

·       Appreciate patient and family needs for teaching and home management.

 

2. Alzheimer’s Disease

This unit describes the etiology, pathophysiology, manifestations of Alzheimer’s disease with emphasis on understanding the social and psychological aspects in caring for patients with this disorder. By the end of this unit the you will be able to:

·       Define Alzheimer ’s disease.

·       Discuss its etiology and pathophysiology

·       Identify signs and symptoms exhibited by patient with Alzheimer’s disease

·       Appreciate the social and psychological sequel for patient with Alzheimer’s disease.

3. Brain damage and special states of altered consciousness.

By the end of this unit the you will be able to:

·       Describe various causes of Brain damage classified as: Anoxia/Hypoxia and perfusion failure.

·       Explain the pathophysiological mechanism of anoxic and ischemic brain injury

·       Discuss general signs and symptoms manifested by a patient with brain damage.

·       Demonstrate an understanding of special states of altered consciousness: Persistent vegetative state locked in syndrome and brain stem death.

·       Discuss the essential state involved in brain stem death criteria.

·       Discuss general nursing interventions and ethical Legal issues involved in caring for a patient with brain damage

 

UNIT IV: Cardiovascular Disorders (Read More)

By the end of the unit you will be able to:

1. Review the anatomy& physiology of cardiovascular system.

2. Discuss the causes, Pathophysiology and manifestation of the following cardiovascular disorders

3. Discuss the diagnostic, medical and surgical management of the below mentioned disorders

4. Basic ECG (Electro Cardiogram) interpretation

5. Apply nursing process including assessment, planning, implementation and evaluation of care provided to the clients with cardiovascular disorders

6. Develop a teaching plan for a client experiencing disorders of the cardiovascular and lymphatic system

A. Disorders of the Arterial circulation

Atherosclerosis and Aneurysm

1. Review the anatomy & physiology of blood vessels

2. Use Poiseulle’s & Laplace’s laws to explain the factors affecting blood flow

3. Discuss the role of low density lipoprotein in terms of lipid transport and development of atherosclerosis

4. List risk factor in atherosclerosis

5. Describe the mechanisms involved in the development of atherosclerosis

6. Discuss the causes and mechanisms involved in the development of aneurysm

7. Differentiate among Berry’s, aortic and dissecting aneurysm

8. Discuss medical, surgical and nursing management of patients.

B Disorders of the venous circulation:

1.     Varicose veins and venous thrombosis

2.     Review the factors assisting venous return of blood from lower extremities.

3.     Discuss the relation of muscle pump and the effects of gravity in the development of varicose vein

4.     Discuss the risk factors and manifestation associated with venous thrombosis

5.     Discuss medical, surgical and nursing management of patients with disorders in venous circulation

 

C. Alteration in blood pressure: Hypertension

Define hypertension

Discuss the role of cardiac output and peripheral vascular resistance in the mechanism of hypertension

3. Discuss the risk factors contributing in the development of hypertension

4. Discuss pathophysiology and clinical manifestations of HTN (hypertension)

5. Discuss medical and nursing management of patients with HTN.

D. Alteration in cardiac function:

1. Infectious disorders: Pericardiatis, Myocardiatis and Endocardiatis:

·       Review the anatomy & physiology of pericardium, myocardium & endocardium

·       Discuss the causes, pathophysiology and manifestation of pericardiatis, myocardiatis and endocardiatis.

·       Discuss the causes, pathophysiology and manifestation of cardiomyopathies.

·       Discuss medical, surgical and nursing management of patients with alterations in cardiac infections and myopathies.

 

E. Coronary heart diseases:

1. Describe blood flow in the coronary circulation and relate if to the metabolic needs of the heart

2. Discuss the pathophysiological changes and clinical manifestation in patients with Coronary Artery Disease (CAD)

·       Myocardial ischemia (angina & its types)

·       Myocardial infarction

3. Discuss medical, surgical and nursing management of patients suffering from coronary artery diseases.

F. Valvular disorders:

1. Discuss the alteration in hemodynamic function of the heart that occurs with valvular disease

2. Differentiate the effects of stenotic and regurgitant mitral & aortic valvular heart disease on cardiovascular function.

G. Heart failure:

1. Discuss the factors effecting cardiac performance in the light of Frank starling law i.e. pre load, after load and cardiac contractility

2. Describe the pathological mechanism underlying the manifestation of congestive heart failure

3. Differentiate between:

·       Systolic versus diastolic failure

·       Right side versus left side failure

4. Discuss the clinical manifestation of congestive heart failure

5. Discuss medical, surgical and nursing management of patients with heart failure

H. Disorders of Cardiac Conduction and Rhythm:

1. Review the anatomy & physiology of cardiac conduction system

2. Review the electrical activity of the conduction system on an Electrocardiography (ECG) tracing.

3. Describe the mechanism for dysrhythmia generation

·       Discuss the different types of dysrhythmias.

·       Discuss various heart blocks

·       Discuss medical, surgical and nursing management of patients with disorders of cardiac conduction and rhythm.

 

Heart Blocks and Pacemaker

In this unit you will review the basic interpretation of electrocardiogram including different types of arrhythmia. Moreover focus will be on nursing and medical management of clients with pacemaker. At the completion of the session, you will be able to:

1. Discuss the different kinds of heart blocks.

2. Discuss the care

 

UNIT V: Pulmonary Nursing (Read More)

By the end of the unit, you will be able to learn the following.

1. Review the anatomy & physiology of upper respiratory tract

2. Discuss the causes, Pathophysiology and manifestation of the following respiratory tract disorders

3. Discuss the diagnostic, medical and surgical management of the below mentioned disorders

4. Apply nursing process including assessment, planning, implementation and evaluation of care provided to the clients with respiratory disorders

5. Develop a teaching plan for a client experiencing disorders of the respiratory tract.

 

Upper respiratory tract infections:

·      Sinusitis

·      Pharyngitis

·      Tonsillitis

 

Lower respiratory tract infections:

·      Influenza

·      Pneumonia

·      Pulmonary T.B ( tuberculosis)

·      Lung Abscess

 

Obstructive lung diseases:

·      Asthma

·      COPD ( Chronic obstructive pulmonary disease)

·      Lung cancer

·      Acute Respiratory failure

·      Acute Respiratory Distress Syndrome

·      Chest trauma

 

 

UNIT 6: Eye and ENT Nursing (Read More)

Otitis media and Mastoiditis/Meinere’s Disease

In this unit you will understand the care of a patient with Otitis media and Meinere’s disease. They will learn the preventive measures related to Otitismedia, Mastoiditis and Meinere’s disease.

1. Review anatomy and physiology of External and Middle ear.

2. Differentiate between Otitis Externa and Otitis media.

3. Discuss the measures to prevent the spread of infection from the middle ear to the Mastoid process.

4. Utilize nursing process while caring for patients with Otitis Media.

Epistaxis and Deviated Nasal Septum.

This unit will emphasize on care of patients with Epistaxis and deviated Septum. You will also learn about emergency care of patients with Epistaxis at home.

By the end of this unit the you will be able to:

1. Review the anatomy and physiology of nose.

2. Discuss the nursing care of patients with deviated nasal septum.

3. Explain the emergency care of a patient with epistaxis.

Tonsillitis.

This unit will focus on care of a patient with tonsillitis and the criteria for surgical interventions. You will understand the care of patients with tonsillectomy.

By the end of this unit the you will be able to:

1. Review the anatomy and physiology of throat.

2. Discuss the important nursing care of a patient with tonsillitis.

3. Identify the signs and symptoms of tonsillitis.

4. Discuss the criteria for tonsillectomy.

5. Utilize nursing process for a patient undergoing surgery.

Laryngitis.

You will learn about role of a nurse in taking care of patients with laryngitis. This unit will also help you learn about speech therapy and resources available for speech therapy after laryngectomy.

By the end of this unit the you will be able to:

1. Explain the important nursing care of a patient with laryngitis.

2. Utilize nursing process while caring for patient with a patient undergoing laryngectomy.

3. Describe the speech therapy and resources available in the country for speech therapy after laryngectomy.

Infections/Inflammations of the eye.

This unit will assist you to learn about different infectious conditions of eye. It will also provide you an opportunity to utilize nursing process while caring for patients with different eye infections in hospital and community setting.

By the end of this unit you will be able to:

1. Review anatomy and physiology of eye.

2. Differentiate between the sign and symptoms of different eye infections.

3. Utilize nursing process while caring for patients with different infections.

4. Discuss different medical treatment for Blephaaritis, Hordeolum, Chalazia Trachoma and conjunctivitis.

Glaucoma/Retinal Detachment.

This unit will focus on preventive and curative care of patients with Glaucoma. This unit will also focus on care of a patient with Retinal Detachment.

By the end of this unit the you will be able to:

1. Identify the causes of Glaucoma.

2. Describe different diagnostic procedures and signs and symptoms present in a person with Glaucoma.

3. Utilize the nursing process while taking care of a patient with Glaucoma.

4. Discuss different causes of retinal detachment.

5. Explain the signs and symptoms a person would develop after having a detached retina.

6. Describe the role of nurses in caring for patients with detached retina.

 

Cataract

This unit aims at helping you to learn about different changes take place in the eye while developing cataract and focus on nursing care of patients with cataract.

By the end of this unit the you will be able to:

1. Identify the causes of cataract.

2. Utilize nursing process while caring for patient with cataract.

3. Discuss the role of nurses in helping patients after surgical interventions.

4. Explain home care of a patient with surgical interventions.

 

Burns

The unit places emphasis on the need for the diversity of nursing care required in immediate and the intermediate post burn period with major emphasis on the concepts of fluid and electrolyte imbalances.

At the completion of this unit, you will be able to:

1. Define burns.

2. Discuss problems of impaired skin integrity.

3. Describe various types of burns and their causative agents.

4. Classify the size and depth of a burn.

5. Demonstrate understanding of the Pathophysiology of a major burns injury.

6. Discuss the nursing care of a burn-injured patient in immediate post-burn period.

7. Demonstrate a basic understanding of the management of cardiac arrest in an in-patient care setting.

8. Demonstrate an understanding of the commonly used drugs in the management of cardiac arrest.

9. Describe the complications of Cardio Pulmonary Resuscitation (CPR).

 

Clinical Objectives AHN

So that was the end of this course, and now lets talk about the clinical objectives of Adult health Nursing 2. Followings are the objectives of AHN 2.

1. Applies the nursing process and critical thinking in delivering Holistic nursing care to clients with various medical/surgical conditions in institutions and communities.

2. Formulate Nursing Care plans while caring for all adult clients in the units.

3. Incorporate cognitive, interpersonal and technical skills from the humanities, natural and behavioral sciences while providing nursing care to clients.

4. Demonstrate awareness of legal and ethical standards when providing nursing care.

5. Develop awareness for self-evaluation of effectiveness in dealing with clients with Endocrine, Cardio vascular, Respiratory, ENT, Neurological and Orthopedic disorders.

6. Demonstrate the knowledge of pharmacology used to treat all medical surgical disorders.

7. Demonstrate leadership abilities necessary to foster change in the delivery of care for the patients.

8. Provide culturally sensitive and realistic teaching to clients and families in collaboration with other health team members.

9. Incorporate research findings relevant to nursing practice.

10. Collaborate with members of the health care team to promote and maintain optimum wellness of adult clients.

11. Prepares and provide care for patients going for following diagnostic tests/examinations:

·       C.T. Scan

·       Cerebral Angiography

·       Lumber puncture

·       Mylogramme

·       Audimetric

·       Thyroid scanning.

12. Document all assessments, nursing care and discharge teaching provided to the clients.

 

SPECIFIC CLINICAL OBJECTIVES

In the Med/Surgical rotations you will be able to:

·       Identifies the normal values and alterations in the diagnostic tests carried out for clients.

·        Demonstrates an understanding of the psychological needs of patients and their families during hospitalization and surgery.

·       Discuss the possible reaction that a family member may exhibit when confronted with trauma, illness, and death and dying.

13. Assist the following skills:

·       Lumber puncture

·       12 Lead ECG

·       Blood sugars

·       Eye and ear irrigation.

·       Eye bandaging.

·       Skin and Skeletal traction.

·       Application of Plaster, cast

 

14. In this, the following 2 are included.

 a) Develop Skills in preparing and assisting in skin tractions, Knee

mobilizer and CPM

b) Demonstrate pre and post operative nursing care in patients with Musculo-skeletal surgeries.

15. Provide holistic care to the patients who are bed ridden and immobile.

16. Identify normal sinus rhythm on cardiac monitor and differentiate it with the abnormal rhythms.

17. Identify signs of increased ICP in-patients with neurological conditions.

18. Observe the Emergency room systems and apply the concepts of triage.

19. Differentiate the role and responsibilities of each individual in E.R. from other units.

 

CLINICAL SKILLS LIST

1. Tracheostomy care

2. Suctioning (oral, nasal, tracheal)

3. Assist in procedures

4. Lumber puncture

5. Thoracentesis

6. Paracentesis

7. Chest tube insertion

8. Dressing

9. ECG (electrocardiogram)

 

References:

1. Brune, B. (July 2001). Deep vein thrombosis prophylaxis: The effectiveness and implications of using below knee or thigh length graduated compression stocking. (Vol. 30). Heart and lung 277-284.

2. Dolan, J. T. (1991). Critical care nursing: Clinical management through nursing process. Philadelphia: Davis.

3. Hunt, J. O., Hendrata, M. V., and Myles, P. S. (November/December, 2001). Quality of life 12 months after coronary artery bypass graft surgery. (Vol. 29) Heart and lung. 401-411.

4. Ignatavicius, D., & Workman, M. (2002). Medical surgical nursing (4th ed.)Critical thinking for collaborative carePhiladelphia: Saunder.

5. Ross, & Wilson, K. J. (2002). Anatomy and physiology in health and illness. (7th ed.). Hong Kong: Livingstone.

6. Sole, M. L., Lamborn, M. L., & Hartshorn, J. C. (2001). Introduction to critical care nursing (3rd ed). .New York: Saunders.

7. Smeltzer, S. C., & Bare, B. G. (2000). Text book of medical-surgical nursing (9th ed.). Philadelphia: Lippincott.

8. Then, A. a. K., I. A. (September/October, 2001). Acute myocardial infarction with angiographically normal coronary arteries. (Vol. 29)Heart and lung, 348-350.

9. Thompson, J. M., McFarland, G. K., Hirsch, J. E., & Tucker, S. M. (2002a). Clinical nursing (5th ed). London: Mosby.

10. Thompson, J. M., McFarland, G. K., Hirsch, J. E., & Tucker, S. M. (2002b). Burns (5th ed.) Clinical nursing. London: Mosby.

11. Tortora, G. J. G., S. R. (2000). Principles of anatomy and physiology (9th. ed). New York: John Wiley & Sons Inc.