Nursing REPLICA V-ASL VITERBO

Activity type

Interdisciplinari e cliniche

SSD

MED/06

Year

2nd year

Semester

2nd semester

CFU

1

Hours distribution

12 classroom hours

Lecturers

FRANCESCA PRIMI

Activity type

Interdisciplinari e cliniche

SSD

MED/10

Year

2nd year

Semester

2nd semester

CFU

1

Hours distribution

12 classroom hours

Lecturers

Elisa Catasca

Activity type

Interdisciplinari e cliniche

SSD

MED/11

Year

2nd year

Semester

2nd semester

CFU

1

Hours distribution

12 classroom hours

Lecturers

carlo andrea stazi

Activity type

Interdisciplinari e cliniche

SSD

MED/13

Year

2nd year

Semester

2nd semester

CFU

1

Hours distribution

12 classroom hours

Lecturers

ALFONSO PEZZELLA

Activity type

Interdisciplinari e cliniche

SSD

MED/14

Year

2nd year

Semester

2nd semester

CFU

1

Hours distribution

12 classroom hours

Lecturers

FRANCESCA TINTI

Activity type

Interdisciplinari e cliniche

SSD

MED/15

Year

2nd year

Semester

2nd semester

CFU

1

Hours distribution

12 classroom hours

Lecturers

MARIA ROSARIA RICCIARDI

Upon completion of the course, students will be able to describe the fundamental aspects of the main pathological conditions in hematology, oncology, nephrology, cardiology, endocrinology, and respiratory medicine. The clinical, diagnostic, and therapeutic knowledge acquired during the lessons dedicated to the various medical specialties in the individual modules will enable students to identify and describe the appropriate instrumental investigations and laboratory diagnostic tests for different pathological cases. Students will also be able to integrate this knowledge into planning the nursing management of patients with complex conditions in these specialty areas.

The student has an advantage in following the lessons and studying the topics of the integrated course if he has basic knowledge of biology, anatomy and physiology

Module: ONCOLOGY
Course Contents
• Gene mutations and genomic alterations. The process of tumor transformation: multiphase process, monoclonality, tumor heterogeneity. Classes of genes important in tumor transformation: oncogenes, tumor suppressor genes, cyclins, proofreader genes, genes inducing apoptosis and cell survival. Genetic cooperation for tumor transformation. The double- and single-hit theory. Examples of genes involved in tumor transformation: p53 and RB.
Characteristics of the tumor cell: blockade of contact growth inhibition, morphological characteristics, mitotic index, nuclear-cytoplasmic inversion. Benign and malignant tumors: characteristics. Invasiveness and metastasis. Neoangiogenesis. Staging system: TNM.
• Innate and acquired immune response. Antigen-presenting cells: macrophages and dendritic cells. Effectors of the innate response: NK cells and adaptive response: T and B lymphocytes. Overview of antigen recognition mediated by T and B lymphocytes: TCR/HLA-peptide complex and antibody.
The antitumor immune response: the 3E theory or immunoediting. The phases of elimination, equilibrium, escape, or immunosuppression.
• Antitumor therapeutic strategies: Surgery (role, purpose, and types); Radiotherapy (principles and administration methods, combination with surgery or chemotherapy); Medical therapy: chemotherapy (classes of chemotherapy and mechanisms of action, alkylating agents, antimitotics, antimetabolites, platinum analogs, anticancer antibiotics, topoisomerase inhibitors); hormone therapy (mechanisms of action and types of therapy); targeted therapies (outline);
• Immunotherapy: active and passive. Use of monoclonal antibodies in therapy (e.g., trastuzumab and bevacizumab). Adoptive T-cell immunotherapy: TILs, CIKs, and CARs, overview. Vaccination strategy: peptide administration and administration of modified dendritic cells.


Module: RESPIRATORY SYSTEM DISEASES
Anatomy and Physiology of the Respiratory System. Introduction to Respiratory Problems.
Diagnostic Procedures in Respiratory Diseases: Chest Pain; Lung Cancer; Pneumonia; Abdominal Pneumonia; Tuberculosis; COPD; Bronchial Asthma; Bronchodilators; Tracheostomy Management; Air Pollution; Respiratory Failure; Oxygen Therapy.

Learning objectives (knowledge and understanding)
Understand the anatomy, physiology, and pathophysiology of the respiratory system, with particular reference to the main types of complex respiratory diseases. Acquire the knowledge needed to determine the appropriateness of instrumental and laboratory tests and the main diagnostic procedures. Integrate the acquired knowledge with that of other modules, with particular emphasis on nursing management.



Module: DISEASES OF CARDIOVASCULAR SYSTEM
Cardiac Anatomy
Coronary Anatomy
History of Hemodynamics
Coronary Angiography
Angioplasty - PCI: Percutaneous Coronary Intervention

Chronic Ischemic Heart Disease (IHD)
Electrocardiogram (ECG)

Arrhythmias: Tachyarrhythmias and Bradyarrhythmias

sr (Sinus Rhythm)
AF (Atrial Fibrillation)
VT (Ventricular Tachycardia)
AVB (Atrioventricular Block)
PSVT (Paroxysmal Supraventricular Tachycardia)


STEMI (Anterior / Inferior / Lateral)
(= ST-Elevation Myocardial Infarction, Anterior/Inferior/Lateral Walls)

NSTEMI alto rischio (avr up, precordiali negative)
High-Risk NSTEMI (positive aVR, negative precordial leads)
(NSTEMI = Non-ST Elevation Myocardial Infarction

Heart failure
Cardiogenic Shock
Pulmonary Embolism (PE)

Arterial Blood Gas (ABG)


Module: ENDOCRINOLOGY
Introduction to the Endocrine System: Mechanisms of Hormone Action
Pathophysiology of the Hypothalamic-Pituitary Axis
Secreting and Non-Secreting Pituitary Adenomas: Clinical Practice, Diagnostics, and Nursing Management of Patients with Pituitary Diseases
Hypopituitarism
Empty Sella Syndrome
Central Diabetes Insipidus
Thyroid Pathophysiology: Hyperthyroidism and Hypothyroidism
Acute, Subacute, and Chronic Thyroiditis
Endemic Goiter
Thyroid Nodule Management
Thyroid Tumors: Histological Classification and Therapeutic Considerations
Calcium/Phosphorus Metabolism
Pathophysiology of the Parathyroid gland: Hypo- and Hyperparathyroidism
Pathophysiology of the Adrenal Glands:.
Dynamic Tests for the Diagnosis of Major Endocrine Disorders
Disorders of the Adrenal Medulla: Pheochromocytoma
Endocrine Hypertension. Primary Hyperaldosteronism
Metabolic Syndrome
Classification of Diabetes: Type I, Type II, and Other Types
Diagnostic Criteria for Diabetes
Laboratory Tests in the Diagnosis and Treatment of Diabetic Patients
Nursing Management of Patients with Diabetes
Glycemic Monitoring
Treatment of Type I and Type II Diabetes (Hints)
Nursing Management of Acute and Chronic Complications of Type I and Type II Diabetes
Gestational Diabetes: Diagnostic Criteria, Nursing Management of Patients with Diabetes During Pregnancy, Treatment.



Module: NEFROLOGIA
Anatomical overview of the kidney and urinary tract; elements of renal physiology.The nurse–hospitalized patient relationship in the context of renal diseases: assessment of vital signs related to renal function; evaluation of fluid balance; management of abdominal and pelvic drains, and stomas. Nursing diagnosis.Glomerular filtrate, general concept and evaluation of clearance.Basic elements of kidney and urinary tract semeiotics.Oliguria, anuria, polyuria, and dysuric symptoms. Nocturia.Urinalysis and its abnormalities (hematuria, leukocyturia, cylindruria, urinary retention). Urine culture.Overview of instrumental diagnostics. Renal biopsy.Main nephrological conditions of nursing interest: urinary tract infections, acute and chronic renal failure, nephritic and nephrotic syndromes, brief overview of glomerulonephritis and polycystic kidney disease. Main risk factors for kidney diseases.Indications and management of renal replacement therapy: hemodialysis, peritoneal dialysis, kidney transplantation. Vascular and peritoneal access


Module: BLOOD DISEASES
AIMS

The aim of the course is to provide students with the necessary guidelines for the classification of the main haematological diseases. The course also aims to make students acquire knowledge about the principles of treatment and management of the onco-haematological patient.

At the end of the course the student must be able to 1) know and describe the main haematological diseases, 2) interpret simple diagnostic reports and 3) know the principles of treatment and management of the onco-haematological patient.

SYLLABUS
Hematopoiesis. The hematopoietic stem cell and hematopoietic progenitors.
Diagnostic tests in hematology: peripheral blood and bone marrow.
Anemias: classification
Platelet and coagulation disorders.
Onco-hematology
Definition of neoplasia. General features of the neoplastic cell.
Integrated diagnostic pathway in onco-hematology:
 Morphological examination
 Flow cytometry
 Cytogenetics and molecular genetics
 Molecular investigations
Definition and classification:
 Acute myeloid and lymphoid leukemia
 Chronic myeloproliferative neoplasms
 Chronic lymphatic leukemia
 Hodgkin's lymphoma, non-Hodgkin's lymphomas,
 Monoclonal Gammopathies and Multiple Myeloma

Stem cell transplantation: autologous and allogeneic.

Module: ONCOLOGY
General Pathology, Pontieri, Piccin
General Pathology and Pathophysiology, Pontieri, Piccin
Lecture notes.


Module: RESPIRATORY SYSTEM DISEASES
Reference Textbooks
Lacedonia, Donato; Carpagnano, Giovanna Elisiana; Scioscia, Giulia: Compendium of Respiratory System Diseases. SEU, 2023
Santus - Radovanovic – AAVV: Respiratory System Diseases. Idelson – Gnocchi, 2022.
Teaching materials and other supporting information (slides and handouts) will be provided by the teacher during class.
Reference Books. Harrison: Internal Medicine, McGraw-Hill, 2021



Module: DISEASES OF CARDIOVASCULAR SYSTEM
Lecture Slides
Renato Massini "Internal Medicine" (4th Edition) MC Graw Hill


Module: ENDOCRINOLOGY
F. Monaco Endocrinology (for health professions degree courses) Società Editrice Universo.


Module: NEFROLOGIA
Materials provided by the lecturer during the lessons- Renato Massini – Internal Medicine – Nursing Degree. McGraw Hill Education- Raffaele Antonelli Incalzi – Internal Medicine. For Nursing Sciences. Piccin-Nuova Libraria


Module: BLOOD DISEASES
L’Ematologia di Mandelli - G. Avvisati, second edition (2019) ISBN: 978-88-299-2307-6; Piccin.
Any other recently published hematology textbook can be used.
Teaching materials (ppt slides) provided by the teacher during the lessons.

Module: ONCOLOGY
Scientific articles indicated by the instructor


Module: RESPIRATORY SYSTEM DISEASES
Recent bibliography recommended in class.


Module: DISEASES OF CARDIOVASCULAR SYSTEM
N/D
Module: ENDOCRINOLOGY
Recent bibliography recommended in class.


Module: NEFROLOGIA
Recent bibliography recommended in class.


Module: BLOOD DISEASES
Recent bibliography recommended in class.

The lessons will be held in the classroom with the aid of PowerPoint presentations prepared by the teacher on the various topics of the program.

Mandatory attendance with at least 66% attendance. Attendance will be recorded by the instructor in a specific class register, which will be submitted to the degree program office at the end of the course.

The final exam will be administered by the teachers, either oral or written (consisting of 10 multiple-choice questions) for each module. Students who achieve a passing grade in each module will pass the exam.

- Pulmonary embolism risk factors
- Difference between asthma and chronic bronchitis
- Methodical spirometry

- Endocrine-related hypertension
- Nursing assistance in performing dynamic tests

- Describe the main classification criteria for anemias
- Clinical manifestations of leukemias and lymphomas

_What is STEMI and how is it treated?
_How is atrial fibrillation characterized by an ECG?

- What are the nurse's direct responsibilities in managing patients with chronic renal failure on dialysis?
- What defines creatinine clearance?

- What is the primary purpose of adjuvant chemotherapy?
- What are the risk factors for lung cancer?

Module: ONCOLOGY

•  Gene mutations and genomic alterations. The process of tumor transformation: multiphase process, monoclonality, tumor heterogeneity. Classes of genes important in tumor transformation: oncogenes, tumor suppressor genes, cyclins, proofreader genes, genes inducing apoptosis and cell survival. Genetic cooperation for tumor transformation. The double- and single-hit theory. Examples of genes involved in tumor transformation: p53 and RB.Characteristics of the tumor cell: blockade of contact growth inhibition, morphological characteristics, mitotic index, nuclear-cytoplasmic inversion. 


• Antitumor therapeutic strategies: Surgery (role, purpose, and types); Radiotherapy (principles and administration methods, combination with surgery or chemotherapy); Medical therapy: chemotherapy (classes of chemotherapy and mechanisms of action, alkylating agents, antimitotics, antimetabolites, platinum analogs, anticancer antibiotics, topoisomerase inhibitors); hormone therapy (mechanisms of action and types of therapy); targeted therapies (outline);• Immunotherapy: active and passive. Use of monoclonal antibodies in therapy (e.g., trastuzumab and bevacizumab). Adoptive T-cell immunotherapy: TILs, CIKs, and CARs, overview. Vaccination strategy: peptide administration and administration of modified dendritic cells.


• Benign and malignant tumors: characteristics. Invasiveness and metastasis. Neoangiogenesis. Staging system: TNM.• Innate and acquired immune response. Antigen-presenting cells: macrophages and dendritic cells. Effectors of the innate response: NK cells and adaptive response: T and B lymphocytes. Overview of antigen recognition mediated by T and B lymphocytes: TCR/HLA-peptide complex and antibody.The antitumor immune response: the 3E theory or immunoediting. The phases of elimination, equilibrium, escape, or immunosuppression.

• Anatomy and Physiology of the Respiratory System. Introduction to Respiratory Problems.


• Diagnostic Procedures in Respiratory Diseases: Chest Pain; Lung Cancer; 


• Pneumonia; Abdominal Pneumonia; Tuberculosis; COPD; Bronchial Asthma; Bronchodilators; 


• Tracheostomy Management; Air Pollution; Respiratory Failure; Oxygen Therapy.

• Cardiac Anatomy  Coronary Anatomy  History of HemodynamicsCoronary AngiographyAngioplasty - PCI: Percutaneous Coronary InterventionChronic Ischemic Heart Disease (IHD)  Electrocardiogram (ECG)Arrhythmias: Tachyarrhythmias and Bradyarrhythmias
  • Books: Slide


• sr (Sinus Rhythm)AF (Atrial Fibrillation)VT (Ventricular Tachycardia)AVB (Atrioventricular Block) PSVT (Paroxysmal Supraventricular Tachycardia)STEMI (Anterior / Inferior / Lateral)  (= ST-Elevation Myocardial Infarction, Anterior/Inferior/Lateral Walls)NSTEMI alto rischio (avr up, precordiali negative)High-Risk NSTEMI (positive aVR, negative precordial leads)  (NSTEMI = Non-ST Elevation Myocardial Infarction


• Heart failureCardiogenic ShockPulmonary Embolism (PE)Arterial Blood Gas (ABG)

• Introduction to the Endocrine System: Mechanisms of Hormone ActionPathophysiology of the Hypothalamic-Pituitary AxisSecreting and Non-Secreting Pituitary Adenomas: Clinical Practice, Diagnostics, and Nursing Management of Patients with Pituitary Diseases Hypopituitarism Empty Sella Syndrome Central Diabetes Insipidus


• Thyroid Pathophysiology: Hyperthyroidism and HypothyroidismAcute, Subacute, and Chronic ThyroiditisEndemic GoiterThyroid Nodule ManagementThyroid Tumors: Histological Classification and Therapeutic ConsiderationsCalcium/Phosphorus MetabolismPathophysiology of the Parathyroid gland: Hypo- and HyperparathyroidismPathophysiology of the Adrenal Glands:.Dynamic Tests for the Diagnosis of Major Endocrine DisordersDisorders of the Adrenal Medulla: Pheochromocytoma Endocrine Hypertension. Primary Hyperaldosteronism Metabolic Syndrome


• Classification of Diabetes: Type I, Type II, and Other TypesDiagnostic Criteria for DiabetesLaboratory Tests in the Diagnosis and Treatment of Diabetic PatientsNursing Management of Patients with DiabetesGlycemic MonitoringTreatment of Type I and Type II Diabetes (Hints)Nursing Management of Acute and Chronic Complications of Type I and Type II DiabetesGestational Diabetes: Diagnostic Criteria, Nursing Management of Patients with Diabetes During Pregnancy, Treatment.

• Anatomical overview of the kidney and urinary tract; elements of renal physiology.The nurse–hospitalized patient relationship in the context of renal diseases: assessment of vital signs related to renal function; evaluation of fluid balance; management of abdominal and pelvic drains, and stomas. Nursing diagnosis.Glomerular filtrate, general concept and evaluation of clearance.


• Basic elements of kidney and urinary tract semeiotics.Oliguria, anuria, polyuria, and dysuric symptoms. Nocturia.Urinalysis and its abnormalities (hematuria, leukocyturia, cylindruria, urinary retention). Urine culture.Overview of instrumental diagnostics. 


• Renal biopsy.Main nephrological conditions of nursing interest: urinary tract infections, acute and chronic renal failure, nephritic and nephrotic syndromes, brief overview of glomerulonephritis and polycystic kidney disease. Main risk factors for kidney diseases.Indications and management of renal replacement therapy: hemodialysis, peritoneal dialysis, kidney transplantation. Vascular and peritoneal access

• Hematopoiesis. Hematopoietic progenitors and stem cells. Diagnostic tests in hematology: peripheral blood and bone marrow.Oncohematology- Definition of neoplasm. General characteristics of the neoplastic cell. Integrated diagnostic workup in oncohematology• Morphological examination• Immunophenotype• Cytogenetics and molecular genetics• Molecular investigations


• Oncohematology- Classification:• Acute myeloid and lymphoid leukemias• Chronic myeloproliferative neoplasms• Chronic lymphocytic leukemia• Hodgkin's lymphoma, non-Hodgkin's lymphomas• Monoclonal gammopathies and multiple myeloma. 


• Anemias: classification Platelet and coagulation disorders. Hematopoietic Stem cell transplantation: autologous and allogeneic.