Nursing Course O - Frosinone ASL Frosinone Umberto I

Activity type

Interdisciplinari e cliniche

SSD

MED/09

Year

N/D

Semester

N/D

CFU

2

Hours distribution

24 classroom hours

Lecturers

GIANCARLO LABBADIA

Activity type

Primo soccorso, Scienze medico - chirurgiche

SSD

BIO/14, BIO/14

Year

N/D

Semester

N/D

CFU

2

Hours distribution

24 classroom hours

Lecturers

GIOVANNI SEBASTIANO ALEMA'

Activity type

Scienze infermieristiche

SSD

MED/45

Year

N/D

Semester

N/D

CFU

2

Hours distribution

24 classroom hours

Lecturers

Lucia Capoccetta

The general objective of the course is to provide the nurse with the basic concepts of the study of a drug and its therapeutic effects. The student will also be helped to understand the principles of the variability of the pharmacological response and the interaction between drugs and with them the fundamental concept of safety of a drug.
The primary purpose of the course is also to provide the nurse with practical information for the correct administration of drugs.
Finally, the aim of the course is to lead the nurse to the understanding and correct use of the main terminologies used in the pharmacological field.
The objectives will be achieved through the analysis of the most important aspects of pharmacokinetics, pharmacodynamics, toxicology.
The student learns to recognize signs and symptoms related to the main pathologies of medical interest and related to internal medicine and medical pathology
At the end of the course the student must be able to identify the problems of a nursing nature related to the main pathologies of medical interest; use the care planning applied to the person with internal medicine problems; know the operating procedures for the application of the main diagnostic-therapeutic procedures in the medical area.

Pharmacology
Pharmacokinetics
● Define the term pharmacokinetics
● Identify the ways in which drugs cross cell membranes
● Identify the factors that influence the absorption of molecules and describe the first-pass effect
● Describe how the route of administration and dosage form influence drug absorption
● Describe the advantages and disadvantages of different routes of administration
● Describe the factors that influence drug distribution: body fluid compartments, plasma protein binding, capillary permeability, and the blood-brain barrier
● Discuss the factors that alter biotransformation processes: general principles, phases of metabolism, types of metabolites, metabolic induction and inhibition
● Identify the modes of excretion of drug molecules from the body: the three mechanisms of renal excretion, hepatic excretion
Clinical Pharmacokinetics and Pharmacodynamics
● Correlation between blood drug levels and therapeutic and toxic effects of drugs
● Definitions related to drug concentrations over time
● Definition of bioavailability
● Explain the physiological substrate of drug kinetics: first-order and zero-order
● Explain the meaning of clearance and its variability
● Explain the meaning of terminal half-life and the practical use of half-lives
● Explain the meaning of volume of distribution and its variability
● Define steady state and how it is achieved
● Definition of washout, loading dose, and saturable kinetics
● Define the concept of receptor and pharmacological target
● Define the properties of agonist and antagonist drugs
● Describe the concept of therapeutic index and tolerance
● Pharmacotherapy
● Definition of the risk/benefit ratio
● Know the main factors that influence the variability of therapeutic response and Describe observable changes: weight, age, sex, pathologies, pharmacogenetics
● Know the definition of an adverse reaction and be able to distinguish between: side effects and toxic effects, drug allergies and idiosyncrasies, type A and type B ADRs; provide at least one example for each category.
● Describe pharmacovigilance, understand its importance and functioning, and outline the flow of information.
● Understand how drug-drug and drug-food interactions occur.
● Be able to describe possible pharmacokinetic mechanisms and list some examples.
Autonomic Nervous System Drugs
● Define the autonomic nervous system in its components, describe its anatomy, its functions, and identify its neurotransmitters.
● Name the four receptor subtypes of the sympathetic nervous system. For each, indicate the location and probable actions mediated on effector tissues.
● Describe the pharmacokinetics and indications of epinephrine and salbutamol, and describe their side effects and contraindications.
● Describe the pharmacokinetics and indications of alpha-blockers and beta-blockers, demonstrating knowledge of the main differences in their action and
specificity. Indicate their therapeutic uses and side effects.

Cardiovascular Drugs
● Outline the normal control mechanisms that regulate blood pressure and define hypertension.
● Outline the goal of stepped therapy for hypertension.
● Describe the effect of ACE inhibitors on the mechanisms that determine blood pressure.
● List the most common adverse effects.
● Outline the mechanisms of action and indicate the uses of the three main classes of diuretics.
● List the main side effects and interactions of loop diuretics and thiazide diuretics.
● Describe the risk factors for ischemic heart disease and define angina and its different types.
● Describe the mechanisms of action of nitrates and relate them to the underlying pathology of ischemic heart disease.
● List two common side effects associated with antianginal drugs.
● Briefly outline the mechanisms of physiological and pathological hemostasis processes (thrombosis and embolism).
● Describe the mechanisms of action of drugs used to modify coagulation and platelet aggregation.
● List four clinical situations in which therapy with anticoagulants, antiplatelet drugs, and fibrinolytics is appropriate.
● Describe the side effects and contraindications for each class. ● Indicate antidotes. for heparin and warfarin overdose
● Describe the possible interactions commonly associated with the use of oral anticoagulants
● Central Nervous System Drugs
● Discuss the characteristics, signs, and symptoms of anxiety
● Define the mechanism of action of benzodiazepines
● Describe the pharmacological effects of benzodiazepines and therapeutic indications
● Discuss the important features of benzodiazepine pharmacokinetics
● List the side effects of benzodiazepines
● Discuss the safety of benzodiazepines and possible interactions
● Describe the problems of chronic benzodiazepine therapy
● Understand the temporal and pathogenetic definitions of pain
● Describe the origin and transmission of pain from the periphery to the brain, understanding the mechanisms of pain sensation and its modulation through the endogenous opioid system
● Describe the WHO pain scale, pain therapy guidelines, and the choice of administration methods
● Understand the toxic effects and relapse phenomena Tolerance
● List the main opioid drugs based on potency and efficacy and understand their main characteristics.
● Understand the main methods of subjective and objective pain assessment.

To understand the contents of the Pharmacology module and achieve the learning objectives, the student must know the elements of chemistry and biochemistry, physics and biology, as well as histology, anatomy and physiology.

Module: INTERNAL MEDICINE
N/D
Module: PHARMACOLOGY
General Pharmacology
Pharmacokinetics: Routes of drug administration and their different characteristics. Mechanisms and principles that regulate the absorption, distribution, metabolism and elimination of drugs.
Clinical pharmacokinetics: Bioavailability, volume of distribution, clearance, half-life, steady state, loading dose.
Pharmacodynamics: General principles of action of drugs. Drug-receptor interaction. Agonists and antagonists. Dose-response curves and other pharmacodynamic parameters. Characteristics of the main receptors (receptors for neurotransmitters, channel receptors, intracellular receptors. Pumps and transporters, enzymes, receptors for chemotherapy), tolerance, therapeutic index.
Clinical Pharmacology Factors that influence the action of drugs: physiological states, age, genetic factors, pathological states. Adverse reactions and drug abuse. Pharmacovigilance. Interactions between drugs

Special Pharmacology
Autonomic Nervous System Drugs: SNS and SNPS, Sympathomimetics and Sympatholytics.
Cardiovascular System Drugs: Calcium antagonists, ACEs, diuretics; nitrates; clotting drugs
Drugs active on the Central Nervous System: Anxiolytics, opioid analgesics and antipsychotics


Module: NURSING IN THE MEDICAL AREA
LESSON 1 - THE PATIENT WITH PAIN
 Pathophysiology, typology, and characteristics of pain
 National legislation; Pain-Free Hospital
 Classification: Acute, Subacute, Chronic Pain
 Cancer Pain, Emergency Pain, Pain in the Elderly, Cancer Pain in Pediatrics, Pain in Children, Postoperative Pain, Dressing Pain, Pain from Deafferentation
 Nervous Mechanisms of Pain
 Nursing Skills in Pain Management
 Pain Detection and Monitoring
 Measurement Systems: Unidimensional Rating Scales
 Pain Treatment: Pharmacological and Non-Pharmacological Treatments
LESSON 2 - NURSING RESPONSIBILITY IN MANAGING THE THERAPEUTIC
PROCESS
 Administration
 Clinical Risk of Drugs
 Medication Errors
 Strategies to Reduce Errors
 5 "G" Rule
 Dose, Posology, Therapeutic Effect
 Classification of Drugs
 Method of administration
 Routes of administration
 Pharmaceutical forms
RECONSTITUTION AND CALCULATION OF PHARMACOLOGICAL DOSAGE
 Reconstitution and dilution of drugs
 Preparation phase
 Reconstitution of IV drugs
 Infusion System Administration Routes
 Bolus Drug Administration
 Intravenous Therapy
 Preparation and Administration Phases of Infusion Therapy

LESSON 3 - MANAGEMENT OF VENOUS ACCESSES: TYPES AND MANAGEMENT OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER
 PICC
 Role of the Implant Nurse
 PICC Team
 PICC Dressing and Management
 Infections
TYPES AND MANAGEMENT OF CENTRAL VENOUS CATHETER
 Types of CVCs for Hemodialysis
 Choosing the Site for CVC Insertion
 CVC Management
 Role of the Nurse
 Device Management

LESSON 4 - THE HEMATOLOGICAL ONCOLOGY PATIENT
 Therapies Antineoplastics: Chemotherapy and complications, new therapies with beta-specific antibodies and CAR-T, and management of complications (CRS: Cytokine Release Syndrome and ICANS-induced neurological toxicity)
 Management of chemotherapy drugs and side effects
 Preparation and administration of antiblastic drugs
 Management of extravasation
 Hematopoietic stem cell transplantation

LESSON 5 – PATIENT WITH NEUROLOGICAL PROBLEMS
 Ischemic stroke: definition and clinical manifestations
 Recognition of symptoms and assessment scales: Glasgow Coma Scale, Cincinnati
Prehospital Stroke Scale, Rankin Scale, NIHSS (National Institute of Health Stroke
Scale), Barthel Index Code, Conley Scale, Braden Scale, Malnutrition Universal
Screening Tool
 Treatments for ischemic stroke: Fibrinolysis
 Nursing care for patients suffering from ischemic stroke: management
of the patient in the acute and post-acute phase;
 Addressing care needs: hygiene, mobilization, breathing,
nutrition, hydration, urinary-intestinal elimination, cardiovascular stabilization, infection prevention, safety, and interaction in
communication
 Discharge
 Rehabilitation
 Hemorrhagic stroke: definition and clinical manifestations
LESSON 6 – CARE FOR PATIENTS UNDERGOING EXPLORATORY DRUG INSPECTION
 Thoracentesis
 Paracentesis
 Spinal puncture
 Osteomedullar biopsy
 Fine-needle bone marrow aspiration
CARE FOR PATIENTS UNDERGOING ENDOSCOPIC PROCEDURES
 EGDS (Esophagogastroduodenoscopy)
 Colonoscopy
 ERCP (Endoscopic Retrograde Cholangiopancreatography)
 Bronchoscopy
LESSON 7 - PATIENT WITH RESPIRATORY PROBLEMS
 Ventilation
 Cough
 Bronchial Asthma
 Spirometry
 COPD (Chronic Obstructive Pulmonary Disease)
 Inhalation Therapy for COPD
 Pulmonary Rehabilitation for COPD
 Dyspnea: Definition, Types, Causes, Non-Pharmacological and Pharmacological Interventions,
Classification
 Respiratory Failure: Definition, Symptoms, Effects of Hypoxemia and Hypercapnia,
Diagnosis, Treatment, Types
 Acute, Chronic, and Exacerbated Respiratory Failure: Definition, Causes, Treatment
 Nursing Interventions in Acute and Chronic Respiratory Failure
 Breath Sounds: Crackles, Wheezing, Rubs
 Breathing Changes: Respiratory Rate, Breathing Patterns, Breathing Changes
(Tachypnea, Bradypnea, hyperpnea, apnea)
 Pathological breathing: Dyspnea, Kussmaul breathing, Cheyne-Stokes breathing, Biot breathing, ataxic breathing
 Assessment of respiratory function: Pulse oximetry
 Arterial blood gas analysis: Standard procedure for performing an arterial blood gas analysis,
Interpretation of the ABG
 Oxygen therapy: Methods of oxygen administration, administration devices (low-flow and high-flow), Nursing interventions in oxygen administration, how to
reduce oxygen therapy
 Cultures

PATIENTS WITH KIDNEY PROBLEMS
 Acute kidney failure and chronic kidney disease
 Replacement treatments: Hemodialysis, peritoneal dialysis, kidney transplantation
 Nursing management of the patient undergoing hemodialysis

Module: INTERNAL MEDICINE
N/D
Module: PHARMACOLOGY
Conforti, Cuzzolin, Leone, Moretti, Pignataro, Taglialatela, Vanzetta
Farmacologia per le professioni sanitarie
SORBONA Idelson-Gnocchi

Di Giulio, A Gorio, S Carelli, SG Cella e F Scaglione
Farmacologia generale e speciale
Piccin

Amico-Roxas, Caputi, Del Tacca
Compendio di Farmacologia generale e speciale
UTET


Module: NURSING IN THE MEDICAL AREA
 Nursing clinico. Tecniche e procedure di Kozier. A. Berman et al.
 Calcoli e dosaggi farmacologici. La responsabilità dell’infermiere. Casa Editrice Ambrosina.
 L’infermiere in oncologia. La gestione dei farmaci antiblastici. Carocci Faber Editore.
 Infermieristica clinica in medicina interna. Hoepli
 Infermieristica medico-chirurgica. Brunner.Suddarth. Vol 1, Vol 2. CEA
 Emodialisi e dialisi peritoneale. S. Gozzini, P. Procaccio et al. McGraw-Hill
 Gestione infermieristica degli accessi vascolari per emodialisi. F. Tesio, M. Canzi. Arianna
Editrice
 Patologia medica per infermieri professionali. Vol 1, Vol 2. A. Zangara. Piccin
 Diagnosi infermieristiche. Applicazione alla pratica clinica. L. J. Carpenito. CEA

Module: INTERNAL MEDICINE
N/D
Module: PHARMACOLOGY
N/D
Module: NURSING IN THE MEDICAL AREA
N/D

The teacher delivers frontal lectures with traditional methods, with audiovisual aids and scheduling of lessons as reported on GOMP Aule/Orari system, published on the website of the CdS.

Pursuant to the Degree Programme Regulations, students are required to attend the academic and professional development activities of the Course. Attendance is verified by instructors through signature/roll-call sheets, based on updated lists provided by the Academic Secretariat as established by the CCL. A certificate of attendance for the mandatory educational activities of a course is required for students to take the relevant exam.

The Clinical Nursing in the Medical Area exam is an oral exam.
The grade will be the average of the scores from the three different exams.
A successful pass (>18) on all three exams will allow the exam to be recorded. Otherwise, the entire exam must be retaken.

The oral exam in Pharmacology must assess preparation in the first part of General Pharmacology and the second part of Special Pharmacology. Therefore, the exam consists of two questions.
PLEASE NOTE: Starting September 5, 2024, the Pharmacology exam will change.
One question from General Pharmacology and then one from Special Pharmacology will be drawn at random.

Pharmacology
List of questions for the oral exam in

General Pharmacology

For each question, refer to the specific objectives divided by lesson to explain the topic in terms of clinical practice, drug administration, and patient monitoring during drug therapy.

1. Routes of Drug Administration and Drug Absorption
2. Drug Distribution and Metabolism
3. Drug Excretion and Clinical Pharmacokinetic Parameters
4. Pharmacodynamics
5. Variation in the Therapeutic Response
6. Adverse Drug Reactions

List of Questions for the Oral Exam in

Special Pharmacology

To answer each question, after a brief introduction to the mechanism of action, including the pharmacological target and the pathophysiology related to the drug's use,
the candidate must explain for each drug or class of drugs covered during the lectures:
• the actions on the body (related to the above-mentioned mechanism of action)
• the indications and uses in therapy (indicating the primary and secondary uses)
• the routes of administration (explaining any incompatibilities and peculiarities)
• any important peculiarities for therapy and use by the nurse regarding pharmacokinetics (renal or hepatic elimination, half-life, metabolism) etc.)
• Side effects and toxic effects (preferably starting from the mildest and most common and progressing to the most serious)
• Any contraindications and interactions with other important medications
• Specific characteristics of the drug class that affect the patient's therapy and management
• If different types of drugs are present within the same drug class, distinguish between them, explaining the differences in use and/or side/toxic effects
• Nursing activity in the use of the drug/drug class and any instructions to the patient/family member
To prepare for each question, refer to the learning objectives, key terms, and clinical cases presented in the slides for each lecture.
Study from any textbook and compare them with the lecture slides to guide your choice of topics.
The contents of the slides with a red cross in the top right or the information highlighted on the side with a red cross are ESSENTIAL. Also pay attention to anything written in bold and/or a different color in the text.
Question no. 1
Tell me about sympathetic nervous system agonists and antagonists
Question no. 2
Tell me about the classes of drugs used for hypertension
Question no. 3
Tell me about the drugs used for angina pectoris and ischemic heart disease
Question no. 4
Tell me about the classes of coagulation drugs and thrombotic disorders
Question no. 5
Tell me about anxiolytic-sedative drugs
Question no. 6
Tell me about the drugs used for pain treatment

Module: INTERNAL MEDICINE



Module: PHARMACOLOGY



Module: NURSING IN THE MEDICAL AREA