School of Nursing

Obtaining CNA 1 Certification

Nursing MSN
The Nursing and Midwifery Council insists on a minimum of 35 hours of education every three years, as part of its post registration education and practice PREP requirements. This ultimately saves the hospital money because they deal with less problematic incidents. It is recommended that you use newer versions of Google Chrome, or Firefox web browsers. African Americans, native Hawaiians, and non-Hispanic whites have greater risk of lung cancer. The following prerequisite science courses must also have been completed within the last 10 years in order to be eligible for consideration:

Obtaining CNA 2 Certification

Please submit a concise essay no more than words that clearly describes how the completion of the RN to BSN option will influence your nursing practice. Your essay will be reviewed by the Admissions Committee so that we may learn more about you; it also serves as a writing sample.

The Admissions Committee is looking for a well-articulated response. A copy of your active, unrestricted State of Maryland or compact state RN license. This program is not eligible for F-1 or J-1 student visa sponsorship by the University of Maryland, Baltimore due to the amount of online courses. Your recommendation must come from a recent professional source. Please submit a concise essay that addresses your prior education and work experience, as well as how you expect the BSN and the MS to enhance your professional career goals.

A well-written essay will incorporate the following:. Download, print, and complete the Prerequisite Course List. We are currently accepting applications and will continue to review complete applications based on class space availability. Please submit a ,word essay that addresses the following:.

Applicants to the CNL program who meet minimum standards to be considered for admission will be asked to interview in person as part of the selection process. The interview will also include a proctored writing sample. Start your application now. For all Spring and later applicants, a form and letter will be required.

Only the first two recommendations received will be considered. Applicants are expected to submit a concise essay no more than words addressing the following: Complete the form and submit by mail to: An interview with selected applicants will be arranged after the applications are received and reviewed.

This program is not eligible for F-1 or J-1 student visa sponsorship by the University of Maryland, Baltimore. Applicants should possess a bachelor's or master's degree from an institution recognized by either the U. Department of Education for domestic institutions or the equivalent ministry of education for institutions outside of the United States. All applicants must satisfy the general requirements of the University of Maryland Graduate School and submit the following materials:.

Official Transcript s in English or native language transcript or mark sheets if applicable from your undergraduate and graduate schools listing subjects studied or marks received and rank in class or division. Transcripts should delineate a cumulative grade point average of at least 3.

If the GRE is required you must have taken the test within five years of application date. The Admission Committee will review completed applications on a rolling basis and release decisions throughout the admission cycle. Space may be limited so applicants are highly encouraged to apply early and well in advance of the deadline.

If you are accepted, you will receive notification and more details on course registration, tuition status, compliance requirements, etc. Applications and supporting material submitted to the School of Nursing become the property of the University of Maryland and will not be returned. Applicants should make and retain copies of all application documents before submission. Note that your Login ID is case sensitive. Questions about the application process? Contact the Office of Admissions at option 2 or admissions.

The University of Maryland School of Nursing embraces a culture that embodies UMB's core values of accountability, civility, collaboration, diversity, excellence, knowledge, and leadership. Become a University of Maryland nurse. How to Apply Step 1: Complete an online application. Write it down and keep it in a secure place so that you can return to your application before your final submission and check your application status. Send us your supporting materials.

Click on your program of interest below for full admission requirements and deadlines. All application materials must be submitted by the dates listed above.

Prior to applying, applicants must complete a minimum of: Applicants can have no more than four total courses in progress at the time of application.

Additionally, due to the timing: To use AP scores you must have scored a 4 or higher. If you have completed coursework outside of the U. Submit by mail to: Register to take the TEAS at a local community college. For more information or for any registration issues, contact ATI at If you do not have a degree from a U. July 15 spring enrollment: Prior to applying, applicats should complete a minimum of: A well-written essay will incorporate the following: Your motivation and primary reasons for pursuing a graduate degree.

Based on your professional experience, specify qualities that you feel are essential to nursing. Address the specific specialty area you would like to pursue as well as the population you plan to serve. Describe your specific research interests in this specialty area. Spring We are currently accepting applications and will continue to review complete applications based on class space availability.

Fall Application Opens: Baccalaureate degree in a major other than nursing with an overall cumulative GPA of 3. Its included patient history, physical psychosocial assessment, and result from Diagnostic tests. Smoking history, other risk factors family history, occupational risks , associated diseases COPD, tuberculosis, and emphysema , symptom description and onset.

Ask if the patient has experienced a change in normal respiratory patterns or hoarseness. Some patients initially report pneumonia, bronchitis, and epigastria pain, symptoms of brain metastasis, arm or shoulder pain, or swelling of the upper body.

Ask if the sputum has changed color, especially to a bloody, rusty, or purulent hue. Elicit a history of exposure to risk factors by determining if the patient has been exposed to industrial or air pollutants. Lung auscultation, respiratory rate and depth, palpitation of supraclavicular area for tumor or lymphatic involvement or both, clubbing, nicotine stains to skin, hair, teeth.

Lung cancer clinical manifestations depend on the type and location of the tumor. Because the early stages of this disease usually produce no symptoms, it is most often diagnosed when the disease is at an advanced stage. Auscultation may reveal a wheeze if partial bronchial obstruction has occurred. Auscultate for decreased breath sounds, rales, or rhonchi. Note signs of an airway obstruction, such as extreme shortness of breath, the use of accessory muscles, abnormal retractions, and stridor.

Monitor the patient for oxygenation problems, such as increased heart rate, decreased blood pressure, or an increased duskiness of the oral mucous membranes. Metastases to the mediastinum lymph nodes may involve the laryngeal nerve and may lead to hoarseness and vocal cord paralysis. The superior vena cava may become occluded with enlarged lymph nodes and cause superior vena cava syndrome; note edema of the face, neck, upper extremities, and thorax.

Psychosocial The patient is faced with a psychological adjustment to the diagnosis of a chronic illness that frequently results in death. Patient undergoes major lifestyle changes as a result of the physical side effects of cancer and its treatment. Interpersonal, social, and work role relationships change. Diagnostic tests For Lung Cancer Chest radiographs plain anterior-posterior and lateral views not reliable to find lung tumors in their earliest stage.

Chest Computed Tomography CT three-dimensional image of the lungs and lymph nodes can detect tumors as small as 5 millimeters. Spiral computed tomography of the chest.

The PET scan uses a glucose analogue radiopharmaceutical to identify increased glycolysis in tumor tissues. The PET scan is a highly sensitive test in the diagnosis and staging of lung cancer. Bronchoscopic detection of tumor auto fluorescence could improve cure rates in selected groups at high-risk. Sputum cytology Percutaneous transthoracic needle biopsy Fine needle aspiration or biopsy Bronchoscopy. Mediastinoscopy to evaluate lymph node involvement.

Scalene node biopsy evaluate lymph node involvement experimental Photodynamic therapy; An injection of a light-sensitive agent with uptake by cancer cells, followed by exposure to a laser light within 24 to 48 hours, will result in fluorescence of cancer cells or cell death.

Assessment of distant metastasis: Impaired gas exchange related to Removal of lung tissue, altered oxygen supply. Ineffective Airway Clearance May be related to: Increased amount or viscosity of secretions, Restricted chest movement, pain, Fatigue, weakness Acute Pain May be related to: Situational crises, Threat to or change in health status, Perceived threat of death.

Deficient Knowledge [Learning Need] regarding condition, treatment, prognosis, self-care, and discharge needs. May be related to: Lack of exposure, unfamiliarity with information or resources, Information misinterpretation, Lack of recall Common Treatment Methods of Lung Cancer A common treatment method of Lung Cancer is Surgery, chemotherapy and radiotherapy is all classified as a treatment for lung cancer.

Knowing the stage of Lung Cancer is important because treatment is often decided according to the stage of a Lung cancer. Lung cancer accounts for more deaths than prostate, breast, and colon cancer combined.

The survival rate for lung cancer has not improved over the last 10 years. Before surgery patient must know the risk factor from Lung Cancer Surgery; Risks from lung cancer surgery include damage to structures in or near the lungs, general risks related to surgery, and risks from general anesthesia Patient education before surgery: Chemotherapy Treatment for Lung Cancer Researchers are continually looking at different ways of combining new and old drugs for advanced non-small cell lung cancer.

Chemotherapy Treatment for Non-Small Cell Lung Cancer Customize treatment; Erlotinib Tarceva for people whose tumors have epidermal growth factor receptors, a genetic mutation.

Gefitinib Iressa effective in people whose lung tumors have similar genetic mutations. Targeted treatments for advanced non-small cell lung cancer; Sunitinib Sutent works by cutting off blood supply and blockingnthe cancer cells their ability to grow.

Sorafenib Nexavar suppresses receptors for vascular endothelial growth factor platelet derived growth factor—plays a critical role in the growth of blood vessels that feed the cancer angiogensis. Cetuximab binds to epidermal growth factor receptors EGFR , preventing a series of reactions in the cell that lead to lung cancer.

Single-agent Docetaxel, Gemcitabine, Paclitaxel Investigational New treatment approaches are being investigated all the time. Vaccine-autologous dendritic cell-adenovirus p53 Chemotherapy treatment Complications, Myelosuppression infection, anemia, bleeding , nephrotoxicity, nausea and vomiting, mucositis inflammation of the mucous membranes , fatigue, SIADH and hyponatremia, hypotension, anaphylaxis, alopecia hair loss , neurotoxicity peripheral neuropathies, central nervous system toxicity , cardiomyopathy, arrhythmias, congestive heart failure, myocardial infarction, pneumonitis or pulmonary fibrosis, taste changes.

Radiation therapy Treatment for Lung Cancer External beam radiotherapy used as an adjunct to surgery to decrease tumor size, to cure patients considered inoperable for medical or pathologic reasons, or to decrease symptoms. Brachytherapy placement of radioactive sources seeds or catheter directly into or adjacent to a tumor. Symptom palliation relief of pain from bone metastases, hemoptysis, superior vena cave syndrome, airway obstruction. Complications of radiation therapy: Dyspnea, cough, initial increase in mucus production, and then dry cough, fatigue, skin erythema, esophagitis and dysphagia, pneumonitis, lung fibrosis.

Treatment alternatives Neoadjuvant is therapy given before the primary therapy to improve effectiveness e. Adjuvant treatments are equally beneficial and often given concurrently or immediately following one another to maximize effectiveness e. During and after radiation therapy: Dyspnea, fatigue is common lasting 4—6 weeks after therapy, good nutrition, liquid diet supplement during periods of esophagitis, avoid wearing tight clothes, skin care.

During and after chemotherapy, advise patients: To identify all treatment related side effects and report changes Fatigue may last weeks to months To plan their day, and allow for periods of rest Try activities such as yoga, exercise, meditation, and guided imagery Keep a diary and document symptoms, activity level, nutrition, treatments, and emotions To monitor effectiveness of pain medications To monitor for any signs of infection, such as an increased temperature, redness or swelling, and that the latter symptoms may not be present during weeks of impaired immunity following chemotherapy administration Monitor weight change and appetite Nutritional supplements Pulmonary rehabilitation programs: Lung Cancer specific, Better Breathers Club a support group sponsored by the American Lung Association for patients with chronic lung disease.

Common Nursing Diagnosis found in nursing care plan for Lung Cancer: Situational crises, Threat to or change in health status, Perceived threat of death, Deficient Knowledge [Learning Need] regarding condition, treatment, prognosis, self-care, and discharge needs.

Lack of exposure, unfamiliarity with information or resources, Information misinterpretation, Lack of recall Sample Nursing care Plan for Lung Cancer with interventions and rationale Nursing diagnosis Impaired gas exchange May be related to: Nursing outcomes and evaluation criteria client will: The patient will maintain a patent airway. Note respiratory rate, depth, and ease of respirations. Observe for use of accessory muscles, pursed-lip breathing, or changes in skin or mucous membrane Rationale Respirations may be increased as a result of compensatory mechanism to accommodate for loss of lung tissue or pain.

Auscultate lungs for air movement and abnormal breath sounds. Rationale Consolidation and lack of air movement on operative side are normal in the client who has had a pneumonectomy; but in a client who has had a lobectomy should demonstrate normal airflow in remaining lobes.

Investigate restlessness and changes in mentation and level of consciousness. Rationale May indicate increased hypoxia or complications such as mediastinum shift in a client who has had a pneumonectomy when accompanied by tachypnea, tachycardia, and tracheal deviation.

Assess client response to activity. Encourage rest periods, limiting activities to client tolerance. Rationale Increased oxygen consumption and demand and stress of surgery may result in increased Dyspnea and changes in vital signs with activity; however, early mobilization is desired to help prevent pulmonary complications and to obtain and maintain respiratory and circulatory efficiency.

Adequate rest balanced with activity can prevent respiratory compromise. Note development of fever. Rationale Fever within the first 24 hours after surgery is frequently due to atelectasis. Temperature elevation within postoperative day 5 to 10 usually indicates an infection, such as wound or systemic. Maintain patent airway by positioning, suctioning, and use of airway adjuncts.

Rationale Airway obstruction impedes ventilation, impairing gas exchange. Reposition frequently, placing client in sitting and supine to side positions. Rationale Maximizes lung expansion and drainage of secretions. Avoid positioning client with a pneumonectomy on the operative side. Encourage and assist with deep-breathing exercises and pursed lip breathing, as appropriate.

Rationale Promotes maximal ventilation and oxygenation and reduces or prevents atelectasis. Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-humidity face mask, as indicated. Rationale Maximizes available oxygen, especially while ventilation is reduced because of anesthetic, depression, or pain, and during period of compensatory physiological shift of circulation to remaining functional alveolar units.

Assist with and encourage use of incentive spirometer. Rationale Prevents or reduces atelectasis and promotes reexpansion of small airways. Monitor and graph ABGs and pulse oximetry readings. Note hemoglobin Hgb levels. Significant blood loss results in decreased oxygen-carrying capacity, reducing PaO2.

Maintain patency of chest drainage system following lobectomy and segmental wedge resection procedures. Rationale Drains fluid from pleural cavity to promote re expansion of remaining lung segments. Note changes in amount or type of chest tube drainage. Rationale Bloody drainage should decrease in amount and change to a more serous composition as recovery progresses.

A sudden increase in amount of bloody drainage or return to frank bleeding suggests thoracic bleeding or a hemothorax, sudden cessation suggests blockage of tube, requiring further evaluation and intervention.

Observe for presence of bubbling in water-seal chamber. Rationale Air leaks appearing immediately postoperatively are not uncommon, especially following lobectomy or segmental resection; however, this should diminish as healing progresses. Prolonged or new leaks require evaluation to identify problems in client versus a problem in the drainage system.

Nursing diagnosis Ineffective Airway Clearance May be related to: Nursing Interventions nursing care Plan for Lung Cancer Nursing diagnosis Ineffective Airway Clearance Auscultate chest for character of breath sounds and presence of secretions. Noisy respirations, rhonchi, and wheezes are indicative of retained secretions or airway obstruction. Assist client with and provide instruction in effective deep breathing, coughing in upright position sitting , and splinting of incision.

Rationale Upright position favors maximal lung expansion, and splinting improves force of cough effort to mobilize and remove secretions. Splinting may be done by nurse placing hands anteriorly and posterior over chest wall and by client, with pillows, as strength improves. Observe amount and character of sputum and aspirated secretions. Investigate changes, as indicated.

Rationale Increased amounts of colorless or blood-streaked or watery secretions are normal initially and should decrease as recovery progresses. Presence of thick, tenacious, bloody, or purulent sputum suggests development of secondary problems for example, dehydration, pulmonary edema, local hemorrhage, or infection that require correction or treatment. Suction if cough is weak or breathe sounds not cleared by cough effort.

Avoid deep endotracheal and nasotracheal suctioning in client who has had pneumonectomy if possible. Rationale Suctioning increases risk of hypoxemia and mucosal damage. Deep tracheal suctioning is generally contraindicated. If suctioning is unavoidable, it should be done gently and only to induce effective coughing. Encourage oral fluid intake, within cardiac tolerance.

Rationale Adequate hydration aids in keeping secretions loose and enhances expectoration. Assess for pain and discomfort and medicate on a routine basis and before breathing exercises. Rationale Encourages client to move, cough more effectively, and breathe more deeply to prevent respiratory insufficiency. Provide and assist client with incentive spirometer and postural drainage and percussion, as indicated. Rationale Improves lung expansion and ventilation and facilitates removal of secretions.

Postural drainage may be contraindicated in some clients, and, in any event, must be performed cautiously to prevent respiratory embarrassment and incision discomfort. Use humidified oxygen and ultrasonic nebulizer. Provide additional fluids intravenously IV , as indicated.

Rationale Maximal hydration helps promote expectoration. Impaired oral intake necessitates IV supplementation to maintain hydration. Administer bronchodilators, expectorants, and analgesics, as indicated.

Rationale Relieves bronchospasm to improve airflow. Expectorants increase mucus production and liquefy and reduce viscosity facilitating removal of secretions. Nursing Diagnosis Acute Pain May be related to: Determine pain location and characteristics. Have client rate intensity on a scale of 0 to Rationale Helpful in evaluating cancer related pain symptoms, which may involve viscera, nerve, or bone tissue.

Use of rating scale aids client in assessing level of pain and provides tool for evaluating effectiveness of analgesics, enhancing client control of pain.

Assess client verbal and nonverbal pain cues. Rationale Discrepancy between verbal and nonverbal cues may provide clues to degree of pain and need for and effectiveness of interventions. Note possible pathophysiological and psychological causes of pain. Rationale Fear, distress, anxiety, and grief can impair ability to cope.

Posterolateral incision is more uncomfortable for client than an anterolateral incision. Discomfort can greatly increase with the presence of chest tubes. Evaluate effectiveness of pain control. Encourage sufficient medication to manage pain; change medication or time span as appropriate. If client is unable to provide input, the nurse should observe physiological and nonverbal signs of pain and administer medications on a regular basis.

Encourage verbalization of feelings about the pain. Rationale Fears and concerns can increase muscle tension and lower threshold of pain perception.

Provide comfort measures such as frequent changes of position, back rubs, and support with pillows. Encourage use of relaxation techniques including visualization, guided imagery, and appropriate Diversional activities. Rationale Promotes relaxation and redirects attention. Relieves discomfort and therapeutic effects of analgesia. Schedule rest periods, provide quiet environment. Rationale Decreases fatigue and conserves energy, enhancing coping abilities.

Assist with self care activities, breathing, arm exercises, and ambulation. Rationale Prevents undue fatigue and incision strain. Encouragement and physical assistance and support may be needed for some time before client is able or confident enough to perform these activities because of pain or fear of pain.

Assist with patient-controlled analgesia PCA or analgesia through epidural catheter. Administer intermittent analgesics routinely, as indicated, especially 45 to 60 minutes before respiratory treatments, and deep-breathing and coughing exercises.

Rationale Maintaining a constant drug level avoids cyclic periods of pain, aids in muscle healing, and improves respiratory function and emotional comfort and coping. Evaluate client and significant other SO level of understanding of diagnosis.

Rationale Client and SO are hearing and assimilating new information that includes changes in self-image and lifestyle. Understanding perceptions of those involved sets the tone for individualizing care and provides information necessary for choosing appropriate interventions.

Rationale Support may enable client to begin exploring and dealing with the reality of cancer and its treatment. Client may need time to identify feelings and even more time to begin to express them. Provide opportunity for questions and answer them honestly. Be sure that client and care providers have the same understanding of terms used.

Rationale Establishes trust and reduces misperceptions or misinterpretation of information. Rationale When extreme denial or anxiety is interfering with progress of recovery, the issues facing client need to be explained and resolutions explored.

Note comments and behaviors indicative of beginning acceptance or use of effective strategies to deal with situation. Rationale Fear and anxiety will diminish as client begins to accept and deal positively with reality.

Provide time to prepare for events and treatments. Rationale May help restore some feeling of control and independence to client who feels powerless in dealing with diagnosis and treatment. Rationale It is difficult to deal with emotional issues when experiencing extreme or persistent physical discomfort.

Nursing Diagnosis Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs Related to: Nursing Interventions and rationale nursing care Plan for Lung Cancer with nursing diagnosis Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs: Discuss diagnosis, current and planned therapies, and expected outcomes.

Rationale Provides individually specific information, creating knowledge base for subsequent learning regarding home management. Radiation or chemotherapy may follow surgical intervention, and information is essential to enable the client and SO to make informed decisions. Incorporate this information into discussion about short- and long-term recovery expectations.

Rationale Length of rehabilitation and prognosis depend on type of surgical procedure, preoperative physical condition, and duration and degree of complications.

Tuesday, January 18, 2011