Don Mariano Marcos Memorial State University

South La Union Campus

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union, Philippines

NURSING PROFESSIONAL COURSE 119

(Related Learning Experience)

MODULE II
CARING for CLIENTS with METABOLIC,
GASTROINTESTINAL and ELIMINATION PROBLEMS
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MODULE II
CARING FOR CLIENTS WITH METABOLIC,
GASTROINTESTINAL, AND ELIMINATION
PROBLEMS

Content Page
Introduction 3
Learning Outcomes 3
Module Organizer 3
Case Scenario 1: 4
Case Scenario 2: 7
Module Summary 9
Module Evaluation 9
References 10
Appendices 11

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MODULE II

CARING FOR CLIENTS WITH METABOLIC, GASTROINTESTINAL, AND

ELIMINATION PROBLEMS

INTRODUCTION
This self- learning module on related learning experience presents the principles
and techniques of nursing care management of sick clients with problems in
metabolism, digestion and elimination.

The case scenarios are set at Ilocos Training and Regional Medical Center Medical
Ward. Your related learning experience on this topic is composed of 64 hours.

LEARNING OUTCOMES

After studying the module, you should be able to:

1. Utilize the nursing process in the care of clients with metabolic,

gastrointestinal and elimination problems
2. Perform a holistic health assessment based on the case scenarios provided
3. Utilize assessment information to formulate client-centered plan of care
4. Explain appropriate nursing interventions per problem identified
5. Apply bioethical concepts/ principles, core values, and nursing standards in
the care of clients with cellular aberrations

MODULE ORGANIZER

There are two case scenarios in the module. Work on the exercises carefully.

Spaces are given for you to write your answers. You may wish to use additional
sheet/s of paper if necessary. The templates of the forms are attached on the
appendices. Rubrics in evaluating your outputs are also included.

Submit your outputs to us your tutors at the CCHAMS office. You may also wish
to send an electronic copy of your outputs to our email or to our NUPC 119 RLE Google
classroom using your official DMMMSU email.

Aside from the main content, there are supplementary materials included in this
module to strengthen your learning represented by the following icons:

Books or Journals

Video Links

Website Pages

In case you encounter difficulty, discuss this with us during the face-to-face
meeting as per schedule, if the situation permits. If not, contact your instructors on
Mondays and Tuesdays from 8:00 am to 5:00 pm through Facebook messenger, Google
classroom or Google email.

Good luck and have fun learning!!!

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CASE 1
NUTRITIONAL PROBLEM

As part of your clinical rotation, you are assigned to work with the nutritional
support team at the hospital. The team includes a registered nurse, registered dietitian,
pharmacist, and medical physician. Patients with actual or potential nutritional issues
are referred to this team for management of their nutritional care as well as support
for those caring for these patients including the nursing staff and family.
The census list for consultation for the day’s rotation includes four patients:

PROFILE: Client 1

Ms. Michelle Ryan, a 42-year-old female

with difficulty breathing secondary to Living with COPD
exacerbation of COPD.
Ms. Ryan tells you, “I just don’t have much
of an appetite anymore and I know I need to eat to get better.”

TASK 1
Identify strategies which you may do to ensure the client’s adequate
nutrition.

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PROFILE: Client 2

Ms. Amelia Stroupe, a 77-year-old female with right-sided weakness and mild
dysphagia. Mrs. Stroupe has been placed on aspiration precautions.

TASK 2
Formulate a Nursing Care Plan addressing the client’s risk of aspiration
using the prescribed template.

PROFILE: Client 3

Body Mass Index

Mr. Adam Belcher, a 37-year-old Computation
male with severe hypertension.
Mr. Belcher needs dietary instruction in
regard to calorie reduction and sodium restriction. He tells you, “I just don’t feel like
I am that overweight like the doctor says I am. I’ve always been big boned and played
football—I still do some pickup games. I am 6 feet tall and only 265 pounds and in great
shape.”

TASK 3
Based on the client’s current situation and need, create a Teaching
Plan using the prescribed template. Develop also an appropriate
Infographic on the topic.

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PROFILE: Client 4

Mrs. Sharon Feinstein, an 81-year-old

female with dementia and weight loss.
Tube Feeding
Calculations The nurse tells you that Mrs. Feinstein
has the characteristics of malnutrition. The
family wishes to try trial feedings for 6 weeks
to enhance her quality of life. Orders are received to place a feeding tube in
preparation for enteral feedings.

TASK 4
On a separate sheet, make a flow chart of activities you are going to
do in the insertion of a feeding tube.

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CASE 2
ELIMINATION PROBLEM

The change of shift report tells you that Ms. Priscilla Barnes, a 47-year-old,
admitted with acute asthma, had a restless night. She is still dyspneic at 28
breaths/min and still demonstrating inspiratory and expiratory wheezes,
although not as acute as they were at admission.

She is maintaining an oxygen saturation

of 90% to 92% on oxygen at 4 L/min via nasal
cannula. She is receiving breathing treatments Fluid and
every six hours and but needed a prn treatment Electrolytes
around 0300. She is receiving IV fluids of NS at
150 mL/hr and an aminophylline drip at 35
mL/hr.

As you enter the room to do your shift assessment, Ms. Barnes tells you, “I don’t
know what is going on with me. I have to go to the bathroom all the time and I just
can’t make it there. I am so embarrassed—I just wet myself and the bed. I can’t catch
my breath when I get up and I can’t get there fast enough with all this stuff attached
to me.”

TASK 1
Using the prescribed format, develop a Nursing Care Plan for the
client’s functional urinary incontinence. Include a drug study of
Aminophylline.

Despite the interventions for her

asthma, Ms. Barnes’s respiratory status
Urinary Medications deteriorates and she is unable to use the
bedpan without compromising her
oxygenation status. You receive an order to
insert an indwelling catheter to bedside drainage to monitor and manage her urinary
output. Ms. Barnes states, “I have to sit straight up or I can’t catch my breath—please
don’t lay me down flat.”

TASK 2
On a separate sheet, make a flow chart of activities you are going to
do in the insertion of an indwelling catheter.

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During the evening medication rounds,

Ms. Barnes says to you, “I sure hope I don’t get
Catheter- Associated Urinary
an infection like I did with that catheter after Tract Infection (CAUTI)
my second baby was born. I was so miserable (CDC,2009)
when I got home from the hospital. I know
that was a long time ago but I sure do
remember how miserable I was and it seems I have been prone to them ever since.”

TASK 3
Create a Teaching Plan and an Infographic addressing the client’s
concern using the prescribed template.

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MODULE SUMMARY

In module I, you have learned about caring for clients affected with problems in
metabolism, GI and elimination.

There are two case scenarios in module 2.

Case 1 focuses on giving care to various adult clients affected by nutritional

problems.
Case 2 presents a situation of a client having elimination problems.

Hooray! You have just finished Module 2.

MODULE EVALUATION

Before moving to the next topics, we would like to hear your honest feedback
with this module. This will not in any way affect your grade for this course.

Kindly rate the following areas with a scale of 1 to 5, with 5 as the highest and
1 as the lowest.

Criteria Rating

1. Completeness of Content

2. Relevance of Content

3. Clarity of the text and message

4. Alignment of the assessment activities with the

learning outcomes

Comments and Suggestions:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

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REFERENCES

RegisteredNurseRN (n.d). Playlists [YouTube channel]. YouTube. Retrieved October 8,2021,

from https://www.youtube.com/c/RegisteredNurseRN/playlists
Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education:
Designing Assignments and Evaluting with Rubrics. New York City: Springer Publishing
Company.
Simple Nursing (n.d.). Playlists [YouTube channel]. YouTube. Retrieved October 8,2021, from
https://www.youtube.com/c/SimpleNursing/playlists
Trueman, Margaret Sorrell (2014). Case Studies in Nursing Fundamentals. Philadelphia: F.A.
Davis Company.

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APPENDIX A

NURSING CARE PLAN TEMPLATE

NURSING CARE PLAN

Explanation of Goals and

Assessment Intervention Rationale Evaluation
the Problem Objectives

*Note: Landscape Layout

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APPENDIX B

TEACHING PLAN TEMPLATE

TEACHING PLAN

Learner’s Name:_____________Age: __ Diagnosis_______________________________

Topic: _________________________Venue: ________Duration: __________________
Goal:___________________________________________________________________

Learning Content Time Instructional Instructional

Evaluation
Outcome Outline Allotment Method Resources

*Note: Landscape Layout

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APPENDIX C

DRUG STUDY TEMPLATE

DRUG STUDY

Side
Effects
Drug Mechanism Indications and Nursing
Drug and
Classification of Action Contraindications Responsibilities
Adverse
Reactions

Indications:
Generic
Name:

Brand
Name:

Contraindications:

Dosage,
Route,
Frequency
and
Timing:

*Note: Landscape Layout

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APPENDIX D

RUBRIC FOR CASE STUDY (Problem Solving)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
20 15 10 5
Identifies, Identifies, labels, Identifies, Unable to identify,
labels, and and understands all labels, and label, and
Identification
understands but one or two understands understand
of the Main
all relevant relevant main all but three relevant main
Issues/
main issues issues and/ or or four issues and/or
Problems
and/or problems relevant main problems
problems issues and/or
problems
24 18 12 6
Insightful and Thorough analysis Superficial Incomplete analysis
thorough of most of the analysis of of the problems/
Analysis of analysis of all problems/questions some of the questions
Issues the programs/ presented in the problems/ presented in the
questions case questions case
presented in presented in
the case the case
16 12 8 4
Excellent Good inquiry into Limited Incomplete or no
inquiry into the inquiry into inquiry into
the problems/ problems/questions the problems/ problems/questions
questions with with clearly questions with with clearly
clearly documented clearly documented
Linkage of
documented linkages to the documented linkages to the
Course
linkages to material read in linkages to material read in
Readings and
the material class, and/or other the material class, other
Other
read in class, assigned resources, read in class, assigned resources,
Resources to
other assigned previously gained or other previously gained
Problem/
resources, knowledge, and/or assigned knowledge, and/or
Question
previously outside resources resources, outside resources
gained previously
knowledge, gained
and outside knowledge, or
resources out- side
resources
20 15 10 5
Each response Each response is Each response Each response is
is correct, mostly correct, or is minimally incorrect, or poorly
Effective
well-written, well-written, or correct, well- written, or
Response
appropriately appropriately written or unreferenced, and
and/ or
referenced, referenced, and appropriately irrelevant to
Solutions to
and relevant relevant to referenced, or question(s) or
Case Study
to question(s) question(s) or irrelevant to problem(s)
Questions
or problem(s) problem(s) question(s) or presented
presented presented problem(s)
presented
TOTAL (80)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 167-173

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APPENDIX E
RUBRIC FOR CASE STUDY (Nursing Care Plans)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
24 18 12 6
Correctly Correctly Correctly Correctly
Assessment
identifies ten identifies eight identifies six identifies four
clear, specific clear, specific, clear, specific, clear, specific,
Interview:
and relevant and relevant and relevant relevant
includes
interview and interview and interview and interview and
subjective and
physical data physical data physical data physical data
historical data
points. All data points. All data points. Data are points. Data are
are organized are organized marginally unorganized,
Physical
and are related and/ or are organized, and and relevance to
Assessment:
to a nursing mostly related relevance to nursing diagnosis
includes
diagnosis. to a nursing nursing is unclear.
objective data
diagnosis. diagnosis is
unclear.
20 15 10 5
Properly Properly Properly Diagnoses are
identifies five identifies four identifies three not NANDA
Nursing or more nursing or fewer nursing or fewer approved,
Diagnosis diagnoses that diagnoses that diagnoses that appropriate for
are clearly are clearly are clearly patient, or not
Includes supported by supported by supported by prioritized.
relevant the data and the data and the data and Diagnosis may
NANDA- reflect accurate reflect accurate reflect accurate not be clearly
approved clinical clinical clinical supported by
diagnoses judgement. judgement. judgment. They assessment
written in They are They are may not be data.
proper form appropriate for appropriate for appropriate for
(stem related to the patient, the patient, the patient,
and as well prioritized, well prioritized, well prioritized,
evidenced by) NANDA NANDA NANDA
approved, and approved, and approved or
written in written in written in
correct format. correct form. correct format.
16 12 8 4
At least five Four short- and Three or fewer Goal portion is
Outcomes/
short- and long- long- term goals short- and long- incomplete or
Planning
term goals are are identified term goals are completely
identified that that clearly identified. unrelated to the
Includes patient
clearly related related to the Goals may not nursing
and family
to the nursing nursing relate to the diagnosis.
short- and long-
diagnosis, are diagnosis, are nursing
term goals
written in a written in a diagnosis, may
based upon the
patient- focused patient- focused not be written
diagnosis. Goals
manner, and manner, and in a patient-
must be patient
are realistic. are realistic. focused manner
focused,
Each goal Each goal or are
realistic and
contains clear contains clear unrealistic.
have clear
criteria for criteria for Each goal is
measurable
measurement measurement missing clear
criteria with a
and a time and a time criteria for
target date/
frame for frame for measurement
time
evaluation. evaluation. and a time
frame for
evaluation.
16 12 8 4
Implementation Identifies at Identifies fewer Identifies fewer Interventions
least three than three than three are unclear or
Nursing specific specific specific do not clearly
interventions or interventions interventions interventions focus on the
actions that for each for each for each etiology of the

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directly relate outcome outcome outcome nursing diagnosis

to the etiology criterion in criterion in criterion related or relate to the
of the nursing order to help order to help to the etiology patient goals
diagnosis and the patient/ the patient/ of the nursing outcomes.
the patient goal family reach the family reach the diagnosis. Not Rationales
and desired desired goal desired goal. all interventions provided do not
outcome. Each may be specific. demonstrate an
intervention Rationalizations understanding of
must include are included but the purpose of
referenced they may be the
rationale weak, or interventions or
(including references are no references
source, page incomplete or are provided.
number if from sources
applicable) that may not be
reliable.
16 12 8 4
Evaluation
Evaluation Clearly states Evaluation Evaluations
portion contains how each portion does not portion is
Outlines the
data that are outcome would consistently incomplete or
methods to be
listed as criteria be evaluated. contain data does not relate
used in
in goal Able to that are listed to diagnosis,
evaluating
statement and correctly as criteria in goal statement,
outcome
lists identify criteria goal statement. or interventions
criteria,
expectations for for goal being May also not
expectations for
meeting the met, partially describe goal as
goals being
goal. Clear met, or unmet. met, partially
met, and what
explanation of Identifies met, or not
would
criteria for revisions for met. May also
determine that
goals being care plan but not include
goal is met,
met, partially may not include revision or new
partially met,
met, or not accurate evaluation
or unmet.
met. Includes rationale for date/time.
Explain how the
plan for revision, or
plan of care
continuation or references may
would be
revision, clearly be from sources
revised or
referenced that may not be
continued in
rationale for reliable, or a
each case,
revisions from new date is not
including a new
reliable provided for
realistic
sources, and a reevaluation.
evaluation
new evaluation
date/ time
date/ time
8 6 4 2
No errors in APA Minimum errors May have some Multiple errors
citations or in APA citation errors in APA in APA citations
references. and references. citations and and references.
There are no There are references. There are
Format,
mechanical minimal There are some multiple
Spelling,
errors such as mechanical mechanical mechanical
Grammar
spelling, errors such as errors such as errors such as
formatting, and spelling, spelling, spelling,
grammar. formatting, and formatting, and formatting and
grammar. grammar grammar

TOTAL (100)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 167-173

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APPENDIX F
RUBRIC FOR CASE STUDY (Drug Study)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
8 6 4 2
There are no There are There are some There are
mechanical minimal mechanical multiple
Format, errors such as mechanical errors such as mechanical
Spelling and spelling, errors such as spelling, errors such as
Grammar formatting, and spelling, formatting, and spelling,
grammar. formatting, and grammar formatting and
grammar. grammar

32 24 16 8
Content 95- 100 % of 50 – 95 % of the < 50 % of the All of the data
data are data are data are are incorrect/
Generic Name accurate and accurate and accurate and No output;
Brand Name correct; 95 – correct; 50 – correct; < 50 % Grossly
Dosage 100 % complete 95% complete complete incomplete/ No
Drug Little to no data Some data are Most data are output
Classification are lacking missing missing
Mechanism of
Action
Indication
Side and
Adverse Effects
Nursing
Responsibilities

TOTAL (40)

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APPENDIX G
RUBRIC FOR CLINICAL TEACHING PLAN
EXCEEDS NEARLY MEETS
CRITERIA MEETS EXPECTATIONS SCORE
EXPECTATIONS EXPECTATIONS
6 4 2
There are no There are minimal There are multiple
Format, mechanical errors mechanical errors mechanical errors
Spelling and such as spelling, such as spelling, such as spelling,
Grammar formatting, and formatting, and formatting, and
grammar. grammar. grammar

12 8 4
Performs needs Performs needs Performs needs
assessment. Identify assessment. Partially assessment.
special needs. identifies special Establishes barriers to
Assessment Determines preferred needs. Partially successful learning.
learning style. determines learning
Establishes readiness style. Identifies
to learn. barriers to successful
learning.
15 10 5
Outcome Goal for teaching is Goal for teaching is Goal for teaching is
Identification identified with clear identified. Objectives identified.
and measurable goals. are established.
18 12 6
Content relevant to Content relevant to Some content not
Content patient or family patient or family relevant to patient or
situation, situation with critical family situation,
comprehensive, and information included. critical information
in-depth. missing, lacks depth
12 8 4
Synthesizes patient Reflects on teaching Determines method of
needs and chosen needs of the patient. presentation. Identify
method of Identify where required materials.
presentation. Identify teaching will take
required materials. place. Identify
Identify where required materials.
Teaching
teaching will take
Strategies
place.
Create positive
learning environment.
Formulate
lesson/teaching plan
supported by scientific
rationale.
12 8 4
Manages a positive Identifies all possible Identifies minimal
learning environment. teaching points. teaching needs of the
Lesson/teaching plan Considers most patient
Planning/
is supported by effective approach for
Implementation
scientific rationale. the patient.
Teaching is designed
to achieve desired
outcomes.
12 8 4
Determines Determines Determines
effectiveness of effectiveness of effectiveness of
Evaluation teaching plan with teaching plan with teaching plan.
patient-centered patient-centered
focus. Revise plan as focus.
needed.
TOTAL (87)

Reference: RCampus (2020). iRubric: Maternity: Patient Teaching Project. Retrieved from https://www.rcampus.com/rubricshowc.cfm?code=NXA5XB2&sp=yes&

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APPENDIX H
RUBRIC FOR INFOGRAPHICS

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
20 15 10 5
Information is Information is Information is Information is
displayed in an displayed in a displayed in a displayed in a
organized somewhat somewhat disorganized
manner. organized disorganized manner.
Appropriate manner. manner. Some Appropriate
headings are Appropriate appropriate headings are not
used. Sections of headings are headings used. used. Sections of
the material are used. Sections of Sections of the the material are
separated by the material are material are not separated by
Layout
space with no separated by poorly separated space with no
text or graphics. space with no by space with no text or graphics.
There is an text or graphics. text or graphics. There is no
obvious There is a There is no sequence to the
sequence to the sequence to the sequence to the display of
display of display of display of information.
information. information but information.
it is not
immediately
obvious.
24 18 12 6
Exemplary The infographic The infographic Infographic
infographic of of assigned topic did include omitted required
assigned topic with required required content content.
with required content at but superficial Lack of even
content at appropriate and/or several basic knowledge
appropriate depth and inaccuracies of topic evident
depth, detail, detail. Some noted. through the
and accuracy minor Superficial material. It is of
within the space inaccuracies knowledge of no educational
Content/
restrictions of a noted. the topic evident benefit. No
Scientific
poster. Extensive Knowledge of through the discussion of the
Quality
knowledge of the topic is material. It is of scientific
the topic is evident through little evidence.
clearly evident the material. It educational
through the is educational benefit. Limited
material. It is for others. Good discussion of
educational for discussion of scientific
others. scientific evidence related
Exemplary evidence related to topic.
discussion of the to topic.
scientific
evidence related
to topic.
16 12 8 4
Reference list Reference list References list References listed
includes at least includes at least includes at least only 1 reference.
5 references 4 references 3 references Multiple errors in
with at least 3 with at least 2 of with fewer than APA citations
Use of high-quality these high- 2 of these high- and references.
Scientific research studies quality research quality research
Evidence cited. No errors studies. No more studies. More
in American than two errors than two errors
Psychological in APA citations in APA citations
Association or references. and references.
(APA) citations
or references.
Visual 20 15 10 5
Presentation

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No errors in No more than More than two Many errors in

spelling, word two errors in errors in spelling, word
usage, or spelling, spelling, word usage,
punctuation. word usage, or usage, or or punctuation.
Font size and/or punctuation. punctuation. Font selection
selection Font Font selection and/or size
appropriate. size and/or and/or size inappropriate.
Good use of selection inappropriate. Use of
color appropriate. Distracting distracting colors
and contrast. Good use of colors or poor or visuals.
Appropriate use color and contrast. Distracting
of only contrast. Use of Distracting graphics or
relevant graphics slightly graphics or inadequate
graphics. less than or inadequate graphics. No
Exemplary more than graphics. creativity
creativity appropriate. Little creativity demonstrated.
demonstrated. Some creativity demonstrated.

TOTAL (80)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 193-196

NUPC 119 (RLE): Module II BSN Level IV