maternal-neonatal nursing nursing 1124 syllabus
TRANSCRIPT
HARRISON, ARKANSAS
Maternal-Neonatal Nursing
Nursing 1124
Syllabus
Spring 2017
1
March 2017
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
March 6 March 7 March 8 March 9 March 10
Unit 1 – Online
Unit 2 Preclinical Lab
8:30 A102
Unit 1 – Online
Unit 2 Preclinical Lab
08:30 A102
TEST #1
Unit 5 Chapters 7
March 13 March 14 March 15 March 16 March 17
Clinical
Clinical
Unit 3, Chapters 3 & 4 Unit 4, Chapter 5 Unit 5, Chapter 6
March 20 March 21 March 22 March 23 March 24
Spring Break
Spring Break
Spring Break
Spring Break
Spring Break
March 27 March 28 March 29 March 30 March 31
Clinical
Clinical
TEST #2
Unit 6, Chapter 8
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April 2017 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
April 1
April 3 April 4 April 5 April 6 April 7
Clinical
Clinical
Unit 6
Chapter 10 Breast Disorders Chapter 19
April 10 April 11 April 12 April 13 April 14
Clinical
Clinical
TEST #3
Unit 7, Chapters 12-14, 18, 19
April 17 April 18 April 19 April 20 April 21
Clinical
Clinical
Unit 8
Chapters 15-17
April 24 April 25 April 26 April 27 April 28
Clinical
Clinical
MAKE-UP CLINICAL (for missed clinical time)
TEST #4
Review for Final
May 2017 May 1 May 2 May 3 May 4 May 5
Clinical
Clinical
ATI Proctored Exam as
Final Exam
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Department of Registered Nursing
Course Title: Maternal-Neonatal Nursing
Course Number: NURS 1124
Course Description: Maternal Neonatal Nursing is an 8 week course focusing on nursing care of the child-bearing family. The Student Learning Outcomes serve as the basis for course outcomes and are incorporated into experiences in theory and clinical. Emphasis is placed on the role and practice of the nurse in assisting the patient and family during the antepartal, intrapartal, postpartal, and neonatal periods. Pre-requisite: NURS 1107 and 1114.
Credit Hours: 4 semester credit hours
Weekly Course Schedule: Thursday 8:30-12:30, 8 Weeks 12 hours of clinical each week
Location: A106
Course Instructor(s): Jennifer Feighert, MSN, RN Carla Jacobs, MSN, RN, CNE Office: A100F M178
Hours: Monday: Clinicals Site (NARMC) Tuesday: 8:30am – 3:00 pm Wednesday: 8:30 am – 3:00 pm Thursday: 8:30am – 3:00 pm Friday: By Appointment only
Phone: 870-391-3261 870-391-3535 E-Mail: [email protected] [email protected]
Rationale: In the clinical component of Nursing 1124, students develop and expand skills and
behaviors needed to assist clients and their families in various phases of the health-illness continuum. The students utilize all steps of the nursing process and apply principles, concepts and nursing skills learned in this and in prerequisite courses to the care of clients and families during the childbearing cycle. The settings for clinical experience include: newborn nursery, labor and delivery, postpartal unit, and prenatal clinic
Audience for the Course: First Level, 2nd semester Traditional RN students. Course Outcomes/Objectives/ Competencies:
Student Learning Outcomes: Core Competencies Human Flourishing Communication Patient-Centered Care Cultural Diversity Nursing Judgment Safety/Quality Improvement Evidence-Based Practice Managing Care Collaboration/Teamwork
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Course Outcomes / Objectives/Competencies (continued)
Spirit of Inquiry Clinical Decision-Making Clinical Reasoning Professional Identity Professional Behavior Legal/Ethical Teaching/Learning Informatics
Upon successful completion of this course, the student will be able to:
Human Flourishing 9. Provide patient-centered care incorporating effective communication and
respect for cultural diversity. Measured by clinical practice and exam.
Nursing Judgment 2. Incorporate evidence-based practice to provide competent care based on client
responses to physiological and psychological adaptations during antepartum, postpartum and newborn periods. Measured by clinical practice, exam and written assignments.
3. Identify safety measures employed in maternal-neonatal health care settings.
Measured by exam and clinical practice.
4. Discuss the nurse’s role in promoting quality improvement in maternal-neonatal health care settings. Measured by discussion.
5. Collaborate with the health care team in managing the care of maternal-neonatal patients. Measured by written exam and clinical discussion.
Spirit of Inquiry 6. Demonstrate clinical decision-making to plan and prioritize for a family-centered
approach in meeting the needs of childbearing clients. Measured by clinical written assignment.
7. Apply clinical reasoning based on the nursing process to the care of patients in maternal-neonatal health care settings. Measured by exam: Develop a Concept Map related to an actual or potential health problem that might occur during the childbearing cycle.
Professional Identity 8. Model professional behaviors including teaching/learning and use of informatics
in the provision of nursing care. Measured in clinical practice and discussion.
9. Examine legal and ethical aspects of maternal-neonatal nursing. Measured by written exam and clinical discussion.
Northark General Learning Outcomes:
1. Apply critical thinking and problem solving skills across disciplines. 2. Apply life skills in areas such as teamwork, interpersonal relationships, ethics, and study habits. 3. Communicate clearly in written or oral formats. 4. Use technology appropriate for learning. 5. Discuss issues of a diverse global society. 6. Demonstrate math and/or statistical skills.
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Required Textbooks: Chapman, L. & Durham, R. (2014). Maternal-newborn nursing: The critical components of nursing care (2nd ed.). Philadelphia, PA: F.A. Davis.
Ignatavicius, D. D., & Workman, M. L. (2017). Medical surgical nursing: Patient-centered collaborative care (8th ed.). St. Louis. Elsevier Saunders.
Syllabus for Nursing 1124 — Maternal-Neonatal Nursing
ATI RN Maternal-Newborn Nursing, 8th Ed.
Elsevier Adaptive Quizzing
Supplemental/Suggested Books:
Current nursing journals and textbooks other than required for this course are available in the library or on-line via Portal.
Available Nursing Resources:
Northark, Campus Libraries, Videos
Other Available Resources:
Northark’s Jenzabar Portal is like a “digital commons”, or a student and staff center on the web. This new portal connects students to instructors, counselors, and staff with a single point of access. You will be able to find your classes, connect to BlackBoard, and find groups that you are involved in, like Honors, PBL, Rodeo or other clubs. With one login and password, you have 24/7 access to your campus e-mail, calendars, chat rooms or on-line exams. Without any other login, you can see your Campus Connect services. You can customize your home page as well!
SMARTHINKING is a web-based tutoring system that connects students to qualified einstructors (on-line tutors) anytime, from any internet connection. This service supplements on-campus courses, distance-education courses and the Northark Learning Assistance Center. This service is FREE to currently enrolled students. Find the link to SMARTHINKING on the Northark Web page, student tab. When you click on this link, instructions for starting your own account are provided. This is a service purchased by the Title III grant.
Atomic Learning provides web-based software training for more than 100 applications that students and educators use every day. The web-site has short, easy-to-understand tutorial movies and resources that can be used like a help-desk for computer questions. This is a FREE service to students and staff (it even answers questions about i-Pods!). Go to: http://highed.atomiclearning.com. Northark students should type in: Username: northark Login: pioneers.
Learn about your personal preference for taking in new information, and how you can study differently to get the most out of your education. Students who take this assessment find out how they prefer to learn, how teachers may prefer to teach, and how to meet in the middle! Students can maximize their time and success in school by following some time-tested strategies for “Studying Without Tears (SWOT)”.
Personal computer – The student is expected to have access to a computer with these
system requirements. If you have any problems with your computer, i.e., computer crashes, internet goes down, or etc., it is your responsibility to have a backup plan.
E-Mail Account – A Northark e-mail account was issued to you automatically when you
enrolled in your classes. To access your e-mail, navigate to Northark’s Web site at www.northark.edu. On the Students tab, you should see a link to Student E-mail. You may also access your e-mail from web.mail.northark.edu. Your email address will be your [email protected]
Available On-Campus Resources
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Other Available Resources: (continued)
o Computers: JPH business Building – Computers are available in rooms B206, 207, 208,
209 & 302. (See schedule on the wall beside Mary Bausch’s Office on the 2nd Floor.
Libraries – There are computers available for all Northark students on the south campus. South Campus: Monday-Thursday, 7:30 a.m.-9:00 p.m.; Friday, 7:30
a.m.-5:00 p.m.; Saturday, 8:00 a.m.-5:00 p.m. South Campus Library houses the Testing Center. Call 391-3533 for
hours. o Learning Resources Center has computers/printers, tutors and writing help. o Assistance Available for the Course – If you are having any issues in your on-
line course, the first person you should contact is your instructor by e-mail. If you need technical assistance for log-on issues, contact Brenda Freitas (Northark IT Department) at [email protected] or 870-391-3275.
Instructional/Teaching Method:
The instructor will utilize a variety of teaching strategies to actively engage the student to enhance learning and critical thinking including Lecture, Class Discussion, PowerPoint Presentations, Case Studies, Audiovisual presentations, Demonstrations, Nursing Skill Laboratory Practice, Critical Thinking Exercises, Games, Student response systems (clickers), muddiest point, one minute papers, think-pair-share, etc.
Course Content: Unit 1: Trends and Issues in Maternity Care
Ethics and Standards of Practice Issues Unit 2: Maternal-Neonatal Nursing Skills Unit 3: Preconception Health Care Genetics Conception Fetal Development Infertility Assessment of the Reproductive System Woman’s Well Health Unit 4: Pre-natal care Unit 5: Antepartal Testing Pregnancy at risk Unit 6: Processes of Labor and Birth Promoting Comfort During Labor and Delivery Labor Related Complications Breast Disorders Unit 7: Postpartal Adaptations Postpartum at Risk Alterations in Women’s Health Unit 8: Adaptation to Extra-uterine Life Nursing Assessment of the Neonate Nursing Intervention Nutritional Needs and Feeding Newborn Care Legal/Ethical Care Unit 9: Newborns at Risk Newborn Birth Related Stressors Perinatal Loss
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Course Evaluation Procedures:
A. Unit Examinations Test I: Chapters 1, 2 & 9 Chapman Test II: Chapters 3-7 Chapman Test III: Chapters 8-11 Chapmen
Test IV: Chapters 12-19 Chapman Test V: ATI Comprehensive Final Exam
B. Completion of Miscellaneous Homework and Assignments (pop quizzes, individual and group reports, study guide assignments, etc.)
Method of Evaluation: Unit Examinations 70%
Homework Assignments 10% Comprehensive Final 20% Clinical Component Pass
Grading Scale: A------------------------------ 91-100 B-------------------------------84-90 C-------------------------------79-83 D-------------------------------70-78 F-------------------------------69 & below
Students must be passing with a 79% on unit tests and the final, or the student will not progress. Credit for Homework Assignments will not be added unless the student is passing with a 79%.
Clinical Evaluation:
A clinical evaluation by the clinical instructor will be given a "satisfactory/unsatisfactory" rating. Formative evaluations will be given by the clinical instructor each week. A summative evaluation is completed at the end of the semester. Upon request by an instructor, the director and the faculty may require a student to be evaluated by another instructor. Students must pass the clinical component of the course in order to progress in the program. If the student fails the clinical component, the theory grade drops to a "D" and the student cannot progress. Clinical component is Pass/Fail.
S = Satisfactory Students meet minimum requirements for the program outcomes.
N = Needs Improvement Students did not meet minimum requirements for 1 or more core competency for
that program outcome. If an N is received then the student and instructor are expected to:
1. Discuss the issue during the clinical rotation. 2. The instructor will document the discussion on the clinical formative
evaluation tool. 3. The instructor will fill out the clinical improvement form.
4. The student will formulate a simple remediation plan to be presented to the clinical instructor and course coordinator. (if applicable)
5. If after remediation, the student receives another N, the process will be repeated once more.
6. If the student receives 3 N’s in the same program outcome category, such as Human Flourishing, on separate occasions during a course clinical rotation then they will receive a U for that clinical rotation and will be dismissed from the program.
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Clinical Evaluation: (continued)
U= Unsatisfactory (3 N’s)
Student did not demonstrate essential skills for patient safety, professional behavior etc., as stated on page 37 in the RN Handbook. If the student participates in any of the reasons for dismissal as listed under “Unsafe Clinical Practice” in the RN Handbook they will receive a U on the clinical formative evaluation tool.
General Policies: Refer to the Registered Nursing Program Handbook for policies concerning daily
assignments, clinical policies and evaluation, tardiness, make-up work, dress code, academic integrity, student responsibilities and ADA Statement.
Attendance Policy: Students are expected to attend all class meetings. Tardiness will not be tolerated. A
pattern of tardiness will result in disciplinary action at the discretion of the instructor. Student’s that miss excessively will be counseled with regard to likelihood of program failure. Excessive absences are defined as 15% or more of class time (see Northark catalog).
Tardiness Policy: Students are responsible for the content in class when absent. Lecture content missed
will not be repeated. Check the Portal for course materials.
Make-up Exams: 1. All exams should be taken at the scheduled time. 2. The student MUST personally notify the instructor prior to the exam if the
student is unable to take the exam at the scheduled time. A missed examination is considered a class absence.
3. Students may make-up one test only per semester at the instructor’s discretion. 4. Missed exams must be taken within 3 days from the original exam date. 5. Failure to comply with the stated requirements omits the privilege of taking a
make-up exam. A zero will be given for a text not taken. 6. Students are expected to remain in their seat during exams. Students needing to
use the bathroom must be recognized and granted permission by the faculty prior to leaving the room or the exam will be picked up and a zero will be given.
Withdrawal Policy: It is the responsibility of faculty members to advise their classes, in writing of their
attendance policy and make up policies. It is the student’s responsibility to discuss any absences and the possibility of make-up work with the instructor as soon as possible. Students are expected to attend all class meetings and officially withdraw from courses they are no longer attending. Faculty will not drop a student from the course.
Academic Dishonesty: North Arkansas College's commitment to academic achievement is supported by a strict
but fair policy to protect academic integrity. This policy regards academic fraud and dishonesty as disciplinary offenses requiring disciplinary actions. Any student who engages in such offenses (as here defined), will be subject to one or more courses of action as determined by the instructor, and in some cases the Division Chairperson or Program Director, the Vice President of Instruction, and Institutional Standards and Appeals Committee as well.
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Academic Dishonesty: (continued)
Academic fraud and dishonesty are defined as follows: Cheating: Intentionally using or attempting to use unauthorized materials,
information, or study aids in any academic exercise. Test Tampering: Intentionally gaining access to restricted test booklets, banks, questions,
or answers before a test is given; or tampering with questions or answers after a test is taken.
Plagiarism: Intentionally or knowingly representing the words and ideas of another as
one's own in any academic exercise. Facilitating Academic Dishonesty: Intentionally or knowingly helping or attempting to help another commit
an act of academic dishonesty. Statement of Student Responsibilities:
The stated schedule, assignments, and procedures in this course are subject to change in the event of extenuating circumstances. Students will be notified verbally or in writing of changes by the instructor.
A. Read the college catalog and all materials you receive during registration. These materials tell you what the college expects from you.
B. Read the syllabus for each class. The syllabus tells you what the instructor expects from you.
C. Attend all class meetings. Something important to learning happens during every class period. If you must miss a class meeting, talk to the instructor in advance about what you should do.
D. Be on time. If you come in after class has started, you disrupt the entire class. E. Never interrupt another class to talk to the instructor or a student in that class. F. Be prepared for class. Complete reading assignments and other homework
before class so that you can understand the lecture and participate in discussion. Always have pen/pencil, paper, and other specific tools for class.
G. Learn to take good notes. Write down ideas rather than word-for-word statements by the instructor.
H. Allow time to use all the resources available to you at the college. Visit your instructor during office hours for help with material or assignments you do not understand; use the library; tapes, computers, and other resources in Learning Commons.
I. Treat others with respect. Part of the college experience is being exposed to people with ideas, values, and backgrounds different from yours. Listen to others and evaluate ideas on their own merit.
J. If at midterm your examination grade point average is below 79%, schedule an appointment to meet with your instructor.
K. Cell phones are not permitted in the classroom or clinical area. No text messaging in class/clinical.
L. No food/drink in classroom. M. Must use simple calculator. Do not share with friends. N. Please review the Nursing Program inclement weather policy (870) 743-7669
(SNOW), Information, Policies, and Standards Manual.
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ADA Statement: Provision for changing syllabus:
North Arkansas College complies with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Students with disabilities who need special accommodations should make their requests in the following way: (1) talk to the instructor after class or during office hours about their disability or special need related to classroom work; and/or (2) contact Special Services in Room M154H and ask to speak to Kim Brecklein.
The stated schedule, assignments, and procedures in this course are subject to change in the event of extenuating circumstances. Students will be notified verbally or in writing of changes by the instructor.
Syllabus Acknowledgement:
Syllabus acknowledgement will be submitted as an online assignment. See portal, coursework.
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Unit 1: Maternal-Neonatal Overview Course Objectives: 1, 2, 6 & 8
Unit Outcomes Content Learner Activities
1. Identify key Internet sites/resources that provide statistical information regarding maternal-newborn health-care issues.
2. Discuss current trends in management of pregnancy, labor and birth.
3. Review current maternal-newborn health outcomes and the implications of these trends for expectant couples, parents, and health-care providers.
I. Trends and Issues A. Definitions of key terms B. Factors affecting maternal-newborn
outcomes C. Health disparities
D. Maternal and Infant health goals E. Role of the nurse in perinatal care
Read Chapman Chapter 1 Watch Echo Capture
4. Collaborate with the primary provider and health-care team to promote positive outcomes for the childbearing family.
5. Discuss ethical dilemmas that may be encountered in the care of mothers and neonates.
6. Describe the standards of practice related to the care of families during the antepartum, intrapartum, and postpartum periods.
7. Discuss potential legal issues confronting maternal-newborn nurses.
II. Ethics and Standards of Practice Issues A. Ethical issues in maternal-newborn
care. B. Standards of practice for maternal-
newborn nursing C. Legal issues D. Evidence-based practice
Read Chapman Chapter 2 Watch Echo Capture Professional Identity: Perform an internet search for articles related to ethical/ legal issues in Maternal-Newborn nursing.
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Unit 2: Pre-Clinical Skills Lab Course Outcomes: 2, 3, 4, 5, 7 & 8
Unit Outcomes Content Learner Activities
1. Calculate the estimated date of delivery. 2. Use Leopold’s maneuver’s to determine fetal
position.
III. Maternal-Neonatal Nursing Skills A. Calculation of due date B. Leopold’s maneuver’s
Read Chapman p. 53 Calculation of Due Date
Box 8-3, p. 208, Leopold’s Maneuvers
3. Apply the electronic fetal monitor (EFM) to assess fetal heart rate.
C. Fetal heart rate assessment 1. Ultrasound transducer 2. Tocotransducer 3. Interpretation of fetal heart rate
pattern 4. Nursing interventions
Read Chapter 9
4. Compare and contrast non-stress test and contraction stress test to assess fetal status.
5. Discuss the components of fetal heart rate patterns essential to interpretation of monitor strips.
6. Identify correct nursing actions based on interpretation of EFM strips.
D. Non-stress test 1. Purpose 2. Procedure 3. Interpretation 4. Actions
Read Chapman p. 125-126, Non-Stress Test
Clinical Decision-Making: Practice interpreting EFM strips and planning interventions.
7. Analyze contraction duration, frequency, and intensity.
E. Contraction stress test 1. Purpose 2. Procedure 3. Interpretation 4. Actions
Read Chapman p. 126, Contraction Stress Test
8. Monitor intravenous pitocin infusions for induction or augmentation of labor.
9. Safely perform uterine fundal massage during postpartum.
10. Explain Apgar scores
11. Assess newborn vital signs.
12. Plan nursing interventions to maintain newborn temperature.
F. Pitocin induction/augmentation 1. Dosage 2. Effects 3. Risks
G. Postpartum fundal massage
H. Newborn Apgar scores
I. Newborn vital signs
J. Thermoregulation in the newborn
Read Chapman p. 275, Labor Augmentation Read Chapman p. 358—359 Uterine Atony
Read Chapman p. 216, Neonatal Apgar Score
Read p. 384-85 Table 15-3 Read p. 432-33, Temperature Taking Read p. 377-79, Thermoregulatory System
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Unit 3: Antepartum Nursing Care—Preconception Issues; Conception Course Outcomes: 1, 2, 3, 4, 5, 6, 7 & 8
Unit Outcomes Content Learner Activities
1. Write a plan for preconception health care.
2. Define key inheritance patterns.
3. Explain the relevance of genetics in providing care to childbearing families.
4. Discuss the impact of genetic research and cloning
5. Discuss the process of conception.
6. List milestones of fetal development.
7. Identify factors posing a risk to normal development of the fetus.
8. State common causes of infertility. 9. Explain various diagnostic tests related
to infertility. 10. Compare assisted fertility technologies. 11. Advocate for the patient desiring
assisted reproduction. 12. Discuss the emotional/social aspects of
infertility.
13. Perform a focused physical assessment
of the patient with a female reproductive system problem.
14. Develop a teaching plan for recommended reproductive screening tests.
I. Preconception Health Care A. Promoting health before pregnancy B. Anticipatory guidance/education
II. Genetics
A. Inheritance patterns
B. Relevance to the Nursing role
C. Genetic cloning
III. Conception
IV. Fetal Development A. Milestones B. Placental function C. Amniotic fluid function D. Risks to normal development
V. Infertility A. Common causes B. Testing C. Assisted fertility technology
VI. Well Woman’s Health A. Health Promotion B. Changes across the life span C. Osteoporosis D. Adolescent Health E. Lesbian Health
Read Chapman Ch. 3
ATI Chapter 1
ATI Chapter 2 Concept Map: Infertility
Read Chapman Chapter 18.
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Unit 4: Antepartal Nursing Care—Physiological and Psych-Social-Cultural Aspects of Pregnancy Course Outcomes: 1, 2, 3, 4, 5, 6, 7 & 8
UNIT OUTCOMES CONTENT LEARNER ACTIVITIES
1. List subjective and objective signs and symptoms of pregnancy.
2. Discuss methods of diagnosing pregnancy.
3. Calculate the estimated date of delivery. 4. Use appropriate terminology in
describing a woman’s obstetrical status. 5. Link anatomical and physiologic changes
of pregnancy to the signs and symptoms and common discomforts of pregnancy.
6. Educate the patient for each trimester. 7. Describe expected emotional changes of
pregnancy. 8. Identify major developmental tasks of
pregnancy as they relate to maternal, paternal, and family adaptation.
9. Apply ethnic and cultural considerations to the nursing care of the childbearing family.
10. Analyze factors which influence
plans/preparations for birth. 11. Participate in providing childbirth
education.
I. Pregnancy A. Diagnosis
1. Signs and symptoms 2. Pregnancy tests 3. Estimated date of delivery
B. Assessment terminology
C. Physiologic changes 1. Anatomical changes 2. Discomforts of pregnancy
a. Nursing interventions b. Patient/family education c.
D. Psycho-Social-Cultural Aspects 1. Maternal tasks 2. Variables affecting adaptations 3. Paternal tasks 4. Family tasks 5. Interventions 6. Cultural considerations
E. Planning for birth
1. Provider 2. Place 3. Plan 4. Education
Read Chapman Ch. 4 Chapter 4 Prenatal Worksheet Concept Maps: Cardiovascular Adaptations Respiratory Adaptations Integumentary Adaptations Chapter 5 Case Study Human Flourishing: Cultural Diversity In-Class Discussion: Independent Research: Examine cultural meanings of childbirth as reflected in the population of this geographical area (Rural Caucasians and Hispanics). Areas to consider: terminology related to customs and beliefs; behaviors expected during pregnancy; restrictive behaviors; what is taboo.
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UNIT 5 -- Pregnancy at Risk Course Outcomes: 1, 2, 3, 4, 5, 6, 7 & 8
OUTCOMES CONTENT LEARNER ACTIVITIES
1. Compare and contrast various antepartal tests and the information provided by each.
2. Describe nursing responsibilities related to
key antepartal tests. 3. Write a teaching plan to explain diagnostic
techniques and implications of findings to clients and their families.
4. Differentiate between reassuring and non-
reassuring fetal heart rate patterns. 5. Examine factors that contribute to changes
in fetal heart rate patterns. 6. Identify appropriate nursing interventions
for various fetal heart rate patterns. 7. Identify risk factors for preterm labor and
birth. 8. Implement nursing interventions for clients
at risk for preterm labor and birth. 9. Collaborate with the heath care team to
manage the client with premature rupture of membranes.
10. Discuss risks to the client and the fetus
related to a gestational complication.
I. Antepartal testing A. Biophysical assessment
1. Ultrasound 2. Doppler studies 3. Magnetic resonance imaging
B. Biochemical assessment 1. Amniocentesis 2. Chorionic villus sampling 3. Percutaneous umbilical blood sampling
C. Maternal assays 1. Maternal serum - alpha-fetoprotein 2. Multiple marker screen
D. Fetal status assessment 1. Daily fetal movement counts 2. Non-stress tests 3. Vibroacoustic stimulation 4. Contraction stress test 5. Amniotic fluid index 6. Biophysical profile
II. Pregnancy at risk A. Gestational complications
1. Pre-term labor and birth a. Risk factors b. Medical management c. Nursing interventions
2. Premature rupture of membranes a. Risk factors b. Medical Management c. Nursing interventions
3. Incompetent cervix 4. Multiple gestation 5. Hyperemesis gravidarum
Read Chapman Chapter 6.
Read Chapman Chapter 7.
Chapter 7 Case Study
Maxi Learn: Page 5 magnesium sulfate
Page 11 calcium channel blocker
Page 91 beta adrenergic agonist
Page 29 glucocorticoids
Page 121 methotrexate
Concept Maps: Premature Labor
Placenta Previa
Abruptio Placenta
Ectopic Pregnancy
Hydatiform Mole
Gestational Diabetes Case Study
Maxi Learn pages: 31, 32
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11. Teach the client concerning in-hospital management of hyperemesis gravidarum and follow-up care at home.
12. Explain the risks or complications associated with diabetes during pregnancy.
13. Compare insulin requirements during pregnancy, postpartum, and with lactation.
14. Plan care for pregnant clients with a preexisting disorder, physiologic condition that complicates the pregnancy.
15. Compare and contrast nursing management of the client with mild preeclampsia from that of the client with severe preeclampsia.
16. Evaluate the client's response to medications and interventions implemented to manage pregnancy induced hypertension, preeclampsia, or eclampsia.
17. Define HELLP syndrome and associated risks. 18. Discuss the diagnoses and management of
disseminated intravascular coagulation. 19. Plan nursing interventions appropriate to
the safety and care of clients experiencing a bleeding disorder of pregnancy.
20. Compare and contrast the signs and symptoms, risks, and management of placenta previa and abruptio placenta.
21. Teach about the effects of sexually transmitted diseases on pregnancy and the fetus.
22. Identify priorities in assessing and managing the pregnant client experiencing surgery or trauma. (Nursing Judgment: Managing Care)
23. Identify the maternal and fetal risks related to various pregestational disorders.
B. Diabetes 1. Pre-gestational 2. Gestational
C. Pregnancy-induced hypertension 1. Classifications 2. Diagnostics 3. Medical management 4. Nursing interventions
D. Bleeding disorders 1. Placenta previa 2. Abruptio placenta 3. Placenta accreta 4. Spontaneous abortion 5. Ectopic pregnancy 6. Hydatidiform mole
E. Infections
F. Trauma and abuse emergencies
G. Pregestational complications 1. Cardiac disorders 2. Anemia 3. Pulmonary disorders 4. Gastrointestinal disorders
H. Substance abuse
Pregnancy Induced Hypertension Case Study
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UNIT 6 -- Intrapartum Nursing Care Course Outcomes: 1, 2, 3, 4, 5, 6, 7 & 8
OBJECTICVES/OUTCOMES CONTENT LEARNER ACTIVITIES
1. Identify normal measurements of the diameters of the pelvic inlet, cavity and outlet.
2. Assess fetal lie, attitude, presentation, station, and engagement.
3. Explain the cardinal movements as part of the mechanisms of labor.
4. Define involuntary and voluntary powers.
5. Explain how the position of the fetus affects labor.
6. Analyze the psychological response to labor.
7. Identify prodromal signs of labor.
8. Differentiate between true and false labor.
9. Describe the stages of labor.
10. Explain effacement and dilatation.
11. Discuss nursing assessment and care of the mother and fetus in each stage of labor.
12. Describe the physiologic basis for pain in labor and delivery.
13. Compare and contrast the action of local, regional, and general anesthesia as used in labor and delivery.
14. Assess the degree and type of pain a woman in labor is experiencing and her ability to cope effectively.
15. List common measures used for pain relief in labor and delivery, including relaxation methods and pharmacologic management.
I. Processes of Labor and Birth A. Factors affecting labor, 5 P's
1. Passageway 2. Passenger
3. Powers
4. Position
5. Psychological response
B. Process of Labor 1. Signs of labor 2. Stages of labor 3. Mechanism of labor
C. Intrapartal Nursing Assessment 1. Fetal 2. Maternal
II. Promoting Comfort During Labor and Delivery A. Nursing process overview for pain relief
during childbirth B. Factors affecting the experience of
pain/discomfort during labor and delivery C. Management of discomfort/pain
1. Nonpharmacologic 2. Pharmacologic
D. Immediate care at delivery
1. Safety 2. Fourth stage
Read Chapman Chapter 8. Chapter 8 Case Study Concept Map: Epidural Anesthesia
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16. Analyze ways to maintain family-centered
care when analgesia and anesthesia is used in childbirth.
17. Discuss how the nurse can promote the mother/newborn/family relationship after delivery.
18. Describe the nursing care of the mother immediately after delivery.
19. Cite factors that increase the client's risk for dysfunctional labor.
20. Explain interventions to manage dysfunctional labor.
21. Educate the client scheduled for induction of labor.
22. Evaluate the effectiveness of and risks of pitocin administration for induction/augmentation of labor.
24. Collaborate with the health care team to safely manage the client and family experiencing an obstetric emergency. (Human Flourishing: Patient-Centered Care)
25. Describe the three-pronged approach to early detection of breast masses.
26. Discuss the psychosocial aspects of breast cancer and treatment.
27. Develop a post-operative plan of care for a patient with breast cancer.
III. Labor-Related Complications
A. Dysfunctional labor
B. Birth-Related Procedures 1. Version 2. Labor induction 3. Labor augmentation 4. Assisted birth
C. Obstetric emergencies
1. Shoulder dystocia 2. Prolapsed umbilical cord 3. Uterine rupture 4. Amniotic fluid embolism
IV. Breast Disorders
A. Self-Breast Exam B. Mammography C. Clinical Breast Exam D. Fibrocystic Changes E. Breast Cancer
1. Risk Factors a. Breast cancer genes
2. Diagnosis
Read Chapman Chapter 10. Concept Maps: Labor Induction Shoulder Dystocia Read Chapman p. 523-527 Breast Disorders Read Iggy Chapter 70, Care of Patients with Breast Disorders
19
UNIT 7 -- Postpartum Nursing Care Course Outcomes: 1 2, 3, 4, 5, 6, 7 & 8
OBJECTICVES/OUTCOMES CONTENT LEARNER ACTIVITIES
1. Describe physiologic adaptations during the postpartum period.
2. Identify changes that occur in the uterus,
cervix, perineum after delivery, and state rationale.
3. Assess and plan nursing care of the
puerperal patient. 4. Document rationales for the use of oxytocic
drugs during the postpartal period. 5. List ways to facilitate infant-parent
interaction and bonding. 6. Identify causal factors and appropriate
comfort measures for minor stressors in the puerperium: chills, diaphoresis, afterbirth pains, episiotomy, hemorrhoids, and engorgement.
7. Collaborate with client and family for self-
care. 8. Explain behaviors of the three phases of
maternal adjustment. 9. Contrast the symptoms and prognosis of
postpartum blues, postpartum depression, and psychosis.
I. Postpartal Adaptations A. Physiological
1. Involution 2. Lochia 3. Cervix 4. Perineum 5. Clinical changes
B. Psychological 1. Bonding and attachment 2. Maternal/paternal role behavior
C. Postpartal nursing care 1. Assessment of physiologic status 2. Identification of risk factors 3. Intervention to support adaptation 4. Management of discomfort
D. Discharge/self-care instructions
1. Health promotion 2. Contraception
E. Home care/community follow-up for the postpartal family
F. Psychologic adjustment 1. Taking-in 2. Taking-hold 3. Letting-go 4. Postpartum "blues" 5. Depression 6. Psychosis
G. Anticipatory guidance
Read Chapman Chapters 12 & 13 Chapter 12 & 13 Case Studies Concept Maps: Oral Contraceptives Rh Isoimmunization
20
10. Plan teaching to prepare new parents to care for the infant at home. (Human Flourishing; Professional Identity)
11. Discuss medical and nursing management
of postpartum hemorrhage. 12. Summarize care of the client with a
postpartum infection. 13. Describe sequelae of childbirth trauma. 14. Analyze the role of the nurse in the home
care setting in managing the care of the client with postpartum psychological complications.
15. Describe evidence-based health promotion
and maintenance to prevent or detect gynecologic concerns.
16. Develop a plan of care for a patient
undergoing a hysterectomy.
II. Postpartum at Risk
A. Postpartum hemorrhage B. Postpartum infections C. Childbirth trauma
D. Psychological complications III. Alterations in Women’s Health
A. Menstrual Disorders B. Polycystic Ovary Syndrome C. Endometriosis D. Infections/STD’s E. Cystocele & Rectocele F. Urinary Incontinence
Read Chapman Chapter 14 Concept Maps: Mastitis Read Chapman Chapter 19
21
UNIT 8 -- Nursing Care of the Newborn Course Outcomes: 1, 2, 3, 4, 5, 6, 7 & 8
OBJECTICVES/OUTCOMES CONTENT LEARNER ACTIVITIES
1. Discuss neonatal physiologic adaptations to
extra-uterine life. 2. State the normal range of neonate's vital
signs. 3. Collaborate with parents to maintain
thermoregulation in the newborn. 4. Teach the effects of cold stress on the
neonate. 5. Describe the physical examination of the
neonate and state the norms. 6. Estimate the gestational age of a newborn. 7. Review the components of the Apgar score. 8. Apply safety and security measures in the
maternal-neonatal unit. (Nursing Judgment)
9. Discuss common drugs administered in the
neonatal period and their nursing implications.
10. Discuss the nursing care of the newborn during the transition to extra-uterine life.
11. Write a teaching plan for new parents,
include post circumcision care.
I. Adaptation to Extra-uterine Life A. Immediate adjustments
1. Initiation of respirations 2. Circulatory changes
B. Physiological adaptation 1. Respiratory 2. Circulatory 3. Thermoregulation 4. Renal system 5. Gastrointestinal system 6. Neurological system 7. Sensory functions 8. Immunologic system 9. Hemopoietic system 10. Reproductive system 11. Hepatic system 12. Integumentary system
II. Nursing Assessment of the Neonate
A. Physical B. Gestational C. Neurological D. Behavior
III. Nursing Intervention A. Immediate needs
1. Patent airway 2. Thermoregulation 3. Protection from infection and injury 4. Nutrition 5. Parent-infant interaction 6. Security measures
Read Chapman Chapter 15. Chapter 15-17 Case Studies Concept Maps: Thermoregulation Hypoglycemia Cold Stress Audiovisual: •Gestational Age Assessment •Normal Newborn Assessment
22
12. Explain the rationale and method for screening infants for phenylketonuria (PKU) and hypothyroidism.
13. Compare breast and bottle feeding,
including advantages and disadvantages. 14. Identify community resources for
nutritional concerns. 15. Provide newborn care information to
parents incorporating safety and cultural values.
16. Communicate legal, ethical concerns in
caring for newborns. (Professional Identity)
B. Observations 1. Vital signs 2. Signs of distress 3. Elimination 4. Circumcision
C. Metabolic screening 1. PKU 2. Hypothyroidism
IV. Nutritional Needs and Feeding
A. Nutrient Needs B. Types of Feeding C. Lactation
1. Benefits of 2. Physiology of 3. Instructing mother 4. Community resources
V. Newborn Care
A. Safety B. Parental education C. Cultural values
VI. Legal/Ethical Issues
Read Chapman Chapter 16.
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UNIT 9 -- The Newborn at Risk Course Outcomes: 1, 2, 3, 4, 5, 6, 7 & 8
OBJECTICVES/OUTCOMES CONTENT LEARNER ACTIVITIES
1. Differentiate characteristics of preterm, term, postterm, and postmature neonates.
2. Incorporate cultural and spiritual values of
the family into the care of the neonate with an acquired or congenital problem.
3. Summarize assessment and care of the
neonate with an acquired or congenital problem.
4. Communicate to the parents the plan of
care for the neonate with an acquired or congenital problem.
5. Identify specific nursing interventions to
meet the special needs of the parents and family experiencing perinatal loss.
6. Differentiate therapeutic and non-
therapeutic responses in caring for the parents and family experiencing perinatal loss.
I. Newborns at Risk A. Pre-term Neonates
1. Assessment findings B. Post-term Neonates
1. Assessment findings C. Specific disorders
1. Respiratory Distress 2. Hyperbilirubinemia 3. Substance abuse exposure 4. Neonatal Infection
D. Care management 1. Oxygen therapy 2. Nutrition 3. Parenteral support 4. Cultural issues 5. Spiritual issues
II. Newborn Birth-Related Stressors
A. Birth injuries B. Respiratory distress C. Cold stress D. Hypoglycemia E. jaundice
III. Perinatal Loss
Read Chapman Chapter 17 Concept map: Hyperbilirubinemia
24
APPENDIX A
GUIDELINES FOR WRITTEN ASSIGNMENTS
25
NURS 1124: Maternal-Neonatal Nursing ASSIGNMENT #1
Concept Map Objective: Prepare a concept map on a selected maternal-
neonatal topic from the list below. Points possible: 50 (see the grading rubric on the following page). Topics Date due
1. Premature Labor ................................................ .3/9
2. Placenta Previa .................................................. .3/9
3. Abruptio Placenta............................................... .3/9
4. Ectopic Pregnancy ............................................. .3/9
5. Hydatiform Mole ................................................. .3/9
6. Infertility ............................................................. 3/16
7. Maternal Cardio/Hematologic Adaptations……..3/16
8. Maternal Respirations Adaptations .................... 3/16
9. Prenatal Nutrition……………………………….…3/16
10. Epidural Anesthesia……………………..………..3/30
11. Labor Induction…………………………….…….…4/6
12. Shoulder Dystocia………………………….……....4/6
13. Oral Contraceptives………………………..……..4/13
14. Rh Isoimmunization………………………….……4/13
15. Discharge Teaching for Mother…………….……4/13
16. Mastitis……………………………………………..4/13
17. Hypoglycemia of the Newborn…………….…….4/20
18. Newborn Safety………………………………..….4/20
19. Hyperbilirubinemia…………………………..…….4/20
CREATING A CONCEPT MAP
26
2 people work together on one topic
1. Select the topic, reading, or client for whom you wish to develop a
map.
2. Identify the most general concepts first and place them at the top (or middle) of the map.
3. Identify the more specific concepts that are related in some way to
the general concepts.
4. Tie the general and specific concepts together with linking words in some fashion that make sense or have meaning to you.
5. Look for cross-linkages between the more general and more specific
concepts.
6. Discuss, share, think about, and revise the map.
7. Present to class on assigned day.
27
28
Grading Rubric for Concept Map Assignment
Student Name(s) _______________________________________________________ Topic ________________________________________________________________ If you score poor on more than two categories, then you will receive a failing grade for this assignment.
Topic Excellent Good Poor Comments
Organization of Content (10 points)
Content demonstrated clear organization of content – able to follow relationships easily between concepts
Content demonstrated fair organization of content – able to follow relationships with moderate ease between concepts
Content demonstrated poor organization of content – not able to easily follow relationships between concepts
Eye Appeal (10 points)
Very eye-catching – used color and shape to enhance concepts
Moderately eye-catching – used some color and shape to enhance concepts
Poor eye appeal – lacked color and shapes to enhance concepts
Established Relationships between Concepts (10 points)
Clear and appropriate demonstration of relationships between concepts
Fair demonstration of relationships between concepts
Poor demonstration of relationships between concepts
Professionalism (10 points)
Presentation was presented professionally – both in appearance and speech
Presentation could have been more professional – contained some aspects of professionalism
Presentation was poorly presented – lacked preparedness and quality
Critical Reasoning (CR) (10 points)
Presentation demonstrated clear CR and stimulated class discussion
Presentation demonstrated some CR and class discussion
Lacked CR and did not stimulate class discussion
Points_________________ Date_______________________
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APPENDIX B
CLINICAL OBJECTIVES
GUIDELINES
and
WORKSHEETS
30
NURS 1124 Maternal Neonatal Nursing
Clinical Competencies Human Flourishing
1. Perform and document accurate assessments expected in the maternal-neonatal unit.
Nursing Judgment
2. Demonstrate competency in performing the following skills:
a. Assessment of the pregnant patient
b. Insertion of peripheral IV
c. Safe administration of medications
d. Correct application of the tocotransducer and ultrasound transducer
e. Basic interpretation of the electronic fetal monitoring strips
Spirit of Inquiry
3. Demonstrate clinical reasoning skills in the following situations:
a. Care of a couple experiencing infertility.
b. Care of an antenatal patient experiencing a complication.
c. Care of a patient experiencing labor.
d. Care of a newborn at delivery.
Professional Identity
4. Participate in high and low fidelity simulation and technology available in the nursing simulation
lab.
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CLINICAL GUIDELINES
1. Preparation for clinical and clinical conferences is required. Clinical rotations will be distributed to each student and in the appropriate units at the clinical agency assigned. Agency-specific guidelines will be provided by the clinical instructor.
A. Students are expected to be prepared for clinical. Faculty at each clinical site will make
appropriate assignments. Each student will be observed and evaluated accordingly on preparation and the ability to perform in the following areas:
1. Verbally relate process of assessment used to identify patient’s stressors and needs.
2. Verbally relate establishment of priorities based on the patient’s stressors and/or need.
3. Verbally relate planned nursing objectives and nursing interventions. 4. Verbally relate scientific rationale in the implementation of nursing interventions. 5. Ability to actually implement nursing interventions. 6. Utilization of scientific principles while caring for patients. 7. Evaluation of plan of care and altering it appropriately as needed. 8. Verbally relate knowledge of treatments and nursing procedures. 9. Verbally relate information on drugs and administer drugs safely. 10. Demonstrate personal and professional growth. B. Standards for written work: 1. No written work will be accepted late. 2. Assignments need not be typed, but should be written legibly. 3. The quality of written work is enhanced by its neatness. Students should not use
paper torn out of a notebook. 4. Never identify a patient by name or other identifying data. Confidentiality is
imperative. Use the patient’s initials or first name, but not surname. 5. Use references where appropriate. Plagiarism in any form violates faculty’s belief
in the importance of honesty in nursing. 6. Proper grammar and spelling are expected. 7. Complete at least one of the three assessments (labor, postpartum or newborn)
2. Evaluation will be based on the student’s ability to successfully achieve clinical requirements and clinical objectives. Students are encouraged to schedule conferences with their instructor as often as necessary to review care plans, discuss strengths and weaknesses of clinical performance and seek guidance to enhance learning.
3. Clinical absences are strongly discouraged because of the limited amount of time in each rotation and the impossibility of duplicating clinical experiences missed. Refer to the clinical absence policy in the Registered Nurse Program Handbook.
32
NURSING 1124 – MATERNAL/NEONATAL NURSING
CLINICAL OBJECTIVES At the completion of this semester, the nursing student should be able to: Labor and Delivery
1. Accurately monitor uterine contractions manually and electronically.
2. Monitor fetal heart rate with the use of the fetoscope and Doppler.
3. Describe measures to maintain bladder and bowel elimination in the client in labor.
4. Document all pertinent observations and/or activities concerning the patient in labor.
5. Provide supportive care for the patient in labor.
6. Describe the effects of analgesic agents on maternal and fetal behavior.
7. Provide nursing measures for the management of pain during labor and delivery.
8. Provide and/or maintain environment conducive to relaxation of the patient throughout the labor process.
9. Properly identify the mother and infant before transfer to recovery room and newborn nursery.
10. Safely administer intramuscular and/or IV medications during labor.
11. Observe and report significant changes in the condition of the labor patient.
12. Monitor the uterine contractions of the patient receiving oxtoxic drugs, accurately record your observations, report any deviations from normal and initiate appropriate nursing action.
13. Evaluate the condition of the newborn with the use of APGAR scoring system.
14. Apply nursing interventions to maintain body temperature and respirations in the newborn
infant.
15. Assess and record pertinent observations during the fourth stage of labor. (i.e. fundus, pain, vital signs, IV, etc.)
33
Post-Partum
16. Utilize the nursing process in the management of the post-partal patient.
17. Provide perineal care for the post-partal patient, including teaching the patient to do self-care.
18. Assess uterine contractibility and initiate appropriate action.
19. Assess lochia discharge and explain the significance of your findings.
20. Assess learning needs of the client related to care of self and infant and initiate teaching to meet these needs.
21. Assess behaviors of the mother and father that are indicative of bonding with the infant.
Newborn
22. Monitor temperature, heart rate and respiratory rate of the newborn and compare your reading to the normal rates of the newborn.
23. Perform an initial examination on the newborn and accurately chart your observations.
24. Perform a gestational age and maturity rating assessment on a newborn.
25. Instill ophthalmic ointment or drops in the newborn eyes.
26. Apply the principles of asepsis to the care of the newborn in the hospital nursery.
27. Provide immediate and daily umbilical cord care on the newborn infant.
28. Provide post-circumcision nursing care and instruct mother in caring for the infant after
discharge.
29. Safely administer an IM injection to the newborn.
34
Registered Nursing Program
Clinical Improvement Form
Definitions & Procedures
S = Satisfactory
Students meet minimum requirements for the program outcomes.
N = Needs Improvement
Students did not meet minimum requirements for 1 or more core competency for that program outcome. If an
N is received then the student and instructor are expected to:
1. Discuss the issue during the clinical rotation.
2. The instructor will document the discussion on the clinical formative evaluation tool.
3. The instructor will fill out the clinical improvement form.
4. The student will formulate a simple remediation plan to be presented to the clinical instructor and course
coordinator. (if applicable)
5. If after remediation, the student receives another N, the process will be repeated once more.
6. If the student receives 3 N’s in the same program outcome category, such as Human Flourishing, on separate
occasions during a course clinical rotation then they will receive a U for that clinical rotation and will be
dismissed from the program.
U= Unsatisfactory (3 N’s)
Student did not demonstrate essential skills for patient safety, professional behavior etc as stated on page 37 in
the RN Handbook. If the student participates in any of the reasons for dismissal as listed under “Unsafe Clinical Practice”
if the RN Handbook they will receive a U on the clinical formative evaluation tool.
35
North Arkansas College Department of Nursing RN Program
Formative Evaluation Tool
Student Name: ________________ Clinical Rotation: ______________ S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not Applicable
Fill in Clinical Dates HERE
Hu
man
Flo
uri
shin
g
Communication Uses effective therapeutic communication skills with patients, health care team, faculty and others
Actively participates in pre/post conferences Documents appropriately in either writing or in the electronic health record
Patient Centered Care Assess/plan for patient-family spiritual needs Respects the individual’s personal spirituality Assists the patient to meet their spiritual outcomes Demonstrates compassion for others
Cultural Diversity Respects & values diverse cultures Provides culturally competent care
Nu
rsin
g Ju
dgm
en
t/P
ract
ice
Safety/Quality Improvement Uses standard precautions, hand hygiene and sterile technique Administers medications using the 6 rights Able to verbalize action, side effects, adverse reactions of medications Recognizes and intervenes for high risk patients Provides for a safe environment for self, others and patients Recognizes their role in a disaster preparedness “Identifies” quality improvement measurements
Evidence Based Practice Utilizes the nursing process to provide patient care Uses correct assessment techniques Identifies appropriate nursing diagnosis Plans patient care using current trends in health care Performs appropriate nursing interventions Evaluates patient outcomes and revises care as needed
Managing Care Prioritizes patient care Provides timely patient care Demonstrates organizational skills Completes assignments on time
Collaboration/Teamwork Identifies members of the health care team (lower level) Compares the roles of the health care team (medium) Plans patient care with the health care team (higher level) Provides assistance to other health care team members Functions as a team member by demonstrating cooperativeness & displaying mutual respect
Semester: Spring 2017
Course: 1124
Revised 4-12 10-24-12
36
Pro
fess
ion
al Id
en
tity
Professional Behaviors Professional appearance (uniform and hygiene) Preparedness (comes to clinical with stethoscope, name tag, pen, etc.) Demonstrates positive attitude Role model for others Notifies clinical instructor of absence/tardiness per policy Does not show pattern of tardiness/absenteeism Accepts criticism and corrects mistakes willingly Is self-motivated and directed Complies with agency and program policy
Teaching and Learning Utilizes evidence-based teaching interventions Demonstrates mutual goal-setting Identifies resources (physical, emotional, spiritual, etc.) Promotes self-determination of patient and self
Informatics Utilizes technology to provide safe patient care Access appropriate resources to support positive patient outcomes
Legal/Ethical Practices with in the identified role of a student nurse Maintains confidentiality (HIPAA)
Clinical Instructor Initial HERE
Instructor Comments: Instructor Signature:__________________________________________________ Date:_____________________ Student Comments: I acknowledge that I have read and understand the above clinical evaluation.
Student Signature:___________________________________________________ Date:_____________________
Fill in Clinical Dates HERE
Spir
it o
f In
qu
iry
Clinical Decision Making Makes clinical judgments to ensure safe care Uses evidence-based information to evaluate patient outcomes Identifies problems, issues, and risks to promote health and safety Seeks out learning opportunities Explores alternatives to achieve patient goals
Clinical Reasoning Questions underlying assumptions Offers new insight to improve quality of care
37
North Arkansas College Department of Nursing RN Program
Summative Evaluation Tool Student Name: ___________________________ Clinical Rotation: NARMC – Mondays
S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not Applicable
Hu
man
Flo
uri
shin
g
Communication S, N, U,
NA Instructor Comments
Uses effective therapeutic communication skills with patients, health care team, faculty and others Actively participates in pre/post conferences Documents appropriately in either writing or in the electronic health record
Patient Centered Care
Assess/plan for patient-family spiritual needs Respects the individual’s personal spirituality Assists the patient to meet their spiritual outcomes Demonstrates compassion for others
Cultural Diversity
Respects & values diverse cultures Provides culturally competent care
Nu
rsin
g Ju
dgm
en
t/P
ract
ice
Safety/Quality Improvement
Uses standard precautions, hand hygiene and sterile technique Administers medications using the 6 rights Able to verbalize action, side effects, adverse reactions of medications Recognizes and intervenes for high risk patients Provides for a safe environment for self, others and patients Recognizes their role in a disaster preparedness “Identifies” quality improvement measurements
Evidence Based Practice
Utilizes the nursing process to provide patient care Uses correct assessment techniques Identifies appropriate nursing diagnosis Plans patient care using current trends in health care Performs appropriate nursing interventions Evaluates patient outcomes and revises care as needed
Managing Care
Prioritizes patient care Provides timely patient care Demonstrates organizational skills Completes assignments on time
Collaboration/Teamwork
Identifies members of the health care team (lower level) Compares the roles of the health care team (medium) Plans patient care with the health care team (higher level) Provides assistance to other health care team members Functions as a team member by demonstrating cooperativeness & displaying mutual respect
Semester: Spring 2017
Course: Med Surg I
Revised 10-12 10-24-12
38
Spir
it o
f In
qu
iry
Clinical Decision Making
Makes clinical judgments to ensure safe care. Uses evidence-based information to evaluate patient outcomes. Identifies problems, issues, and risks to promote health and safety. Seeks out learning opportunities Explores alternatives to achieve patient goals
Clinical Reasoning
Questions underlying assumptions Offers new insight to improve quality of care
Pro
fess
ion
al Id
en
tity
Professional Behaviors
Professional appearance (uniform and hygiene) Preparedness (comes to clinical with stethoscope, name tag, pen, etc) Demonstrates positive attitude Role model for others Notifies clinical instructor of absence/tardiness per policy Does not show pattern of tardiness/absenteeism Accepts criticism and corrects mistakes willingly Is self-motivated and directed Complies with agency and program policy.
Teaching and Learning
Utilizes evidence-based teaching interventions Demonstrates mutual goal-setting Identifies resources (physical, emotional, spiritual, etc.) Promotes self-determination of patient and self
Informatics
Utilizes technology to provide safe patient care Access appropriate resources to support positive patient outcomes
Legal/Ethical
Practices with in the identified role of a student nurse Maintains confidentiality (HIPAA)
PASS FAIL Student Comments: I acknowledge that I have read and understand the above clinical evaluation. Student Signature:___________________________________________________ Date:_____________________ Instructor Signature:__________________________________________________ Date:_____________________
39
BEHAVIORAL HEALTH ASSIGNMENT
Clinical Objectives 1. Demonstrate increasing competency in using therapeutic communication skills with psychiatric/mental health clients.
2. Demonstrate the ability to observe and describe problematic behavior in a clinical setting.
3. Analyze clinical therapeutic modalities and their effectiveness with clients.
4. Demonstrate professional standards of moral, ethical, and legal conduct.
5. Assume accountability for personal and professional behaviors.
6. Demonstrate professionalism, including attention to appearance, demeanor, respect for self and others, and attention to
professional boundaries with patients and families as well as among caregivers.
7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and
health literacy considerations to foster patient engagement in care.
8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan.
9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions.
10. Create and maintain a safe and effective therapeutic milieu that results in high quality patient outcomes.
ASSIGNMENT
Using therapeutic communication complete Mental Health Nursing Assessment this will include gathering
information from the chart in addition to performing an abbreviated mental health assessment.
Complete Maxi-learn cards for medications of that patient
Complete Concept map
Each student to answer the below questions related to the ‘nursing’ group
1. Identify and describe the components of a nurse led group/activity. (Are the individual goals measurable and/or clinically relevant?)
2. Discuss the responsibilities and behaviors of the RN to be included in evaluation of group processes.
Complete an interaction analysis while attending a therapeutic group
1. Identify least 3 therapeutic interaction techniques 2. Identification of 2 blocks or barriers to the communication process. 3. Identification of 3 client behavioral responses that characterize defense mechanisms
and/or are indicative of their diagnosis.
40
Mental Health Nursing Assessment
Student’s Name: __________________________________ Date: ____________________________
I. Client Assessment
A. Client’s Demographic Data
Client’s initials: _____ Client’s Age: ____ Client location/room: ___________________
Admit date: ________ Gender: ________ Marital Status: _______ Children: ________
Career: ___________________ Last worked: ___________ Education: _____________
Cultural background: ________________________ Primary language: ______________
Spiritual belief/Religion: ___________________________________________________
Legal status: _____________ Privileges: _______________ Precautions: ____________
Living arrangements: ________________________ ADLs: _______________________
Family/community supports: ________________________________________________
Erikson’s developmental stage: ______________________________________________
B. DSM-IV-TR Admitting Diagnoses
Axis I- (Admitting psychiatric disorder(s)): ____________________________________
Axis II- (Personality disorder(s) or DD: _______________________________________
Axis III- (General medical diagnoses): ________________________________________
Axis IV- (Psychosocial/environmental factors): _________________________________
Axis V- (GAF Score):______________________________________________________
C. Psychopathology Leading to Current Admission
(Behavior, thought processes, dysfunction, crisis event, and past history or mental illness or addictions)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
D. Contributing History or Events (i.e., social, cultural, family, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
E. Discharge Plan
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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II. Mental Status Exam Flow Sheet
A. Identifying Data
Client initials: ____________ Living arrangements: ________________________
Gender: _________________ Religious preference: ________________________
Age: ____________________ Allergies: _________________________________
Race/Culture: _____________ Special diet: _______________________________
Occupation: _______________ Chief complaints: ___________________________
Significant Other: __________ Medical diagnoses: __________________________
B. General Description
1. Appearance
Grooming/dress: _________________ Hair color/texture: ______________
Hygiene: _______________________ Scars/tattoos: __________________
Posture: ________________________ Appears age?: __________________
Height/weight: ___________________ Level of eye contact: ____________
2. Motor activity
Tremors: ________________________ Rigidity: ______________________
Tics/movements: __________________ Gait: _________________________
Mannerisms: _____________________ Echopraxia: ___________________
Restlessness: _____________________ Psychomotor retardation: _________
Aggressiveness: ___________________ Range of motion: _______________
3. Speech patterns
Slow or rapid pattern: _______________ Volume: ______________________
Pressured speech: __________________ Speech impediment: _____________
Intonation: _______________________ Aphasia: ______________________
4. General attitude
Cooperative/uncooperative: ___________ Interest/apathy: _________________
Friendly/hostile/defensive: ____________ Guarded/suspicious: _____________
C. Emotions
1. Mood
Sad: ___________ Depressed: _____________ Despairing: ____________________
Irritable: ________ Anxious: ______________ Elated: _______________________
Euphoric: _______ Fearful: _______________ Guilty: _______________________
Labile: __________
2. Affect
Congruence with mood: ____________________________________________________
Constricted or blunted: _____________________________________________________
Flat: ____________________________________________________________________
Appropriate or inappropriate: ________________________________________________
D. Thought Processes
1. Form of thought
Flight of ideas: __________________________ Associative looseness: ______________
Circumstantiality: ________________________ Tangentiality: ____________________
Neologisms: ____________________________ Concrete thinking: ________________
42
Clang associations: _______________________ Word salad: _____________________
Perseveration: ___________________________ Able to concentrate: _______________
Echolalia: ______________________________ Mutism: _________________________
Poverty of Speech: _______________________ Attention span: ___________________
2. Content of thought
Delusions: persecutory: __________ Grandiose: __________ Reference: _________
Control: _____________ Somatic: ____________ Nihilistic: _________
Suicidal/homicidal ideas: ___________________________________________________
Obsessions: _____________________________________________________________
Paranoia/suspiciousness: ___________________________________________________
Magical thinking: _________________________________________________________
Religiosity: ______________________________________________________________
Phobias: ________________________________________________________________
Poverty of content: ________________________________________________________
E. Perceptual Disturbances
Hallucinations: Auditory: __________________ Visual: ____________________
Tactile: ____________________ Olfactory: _________________
Gustatory: __________________
Illusions:
Depersonalization: ________________________________________________________
Derealization: ____________________________________________________________
F. Sensory and Cognitive Ability
Level of alertness/consciousness
Orientation: Memory:
Time: ____________________________ Recent: _____________________________
Place: ____________________________ Remote: ____________________________
Person: ___________________________ Confabulation: _______________________
Circumstances: _____________________ Capacity/abstract thought: ______________
G. Impulse Control
Ability to control impulses related to the following:
Aggression: ________________________ Guilt: ______________________________
Hostility: __________________________ Affection: ___________________________
Fear: ______________________________ Sexual feelings: ______________________
H. Judgment and Insight
Ability to solve problems
Ability to make decisions
Knowledge about self: awareness of limitations, awareness of consequences of actions, awareness of
illness
Adaptive/maladaptive use of coping strategies and ego defense mechanisms.
43
Laboratory Data
Write normal value range, exact value for patient, and indicate if this is normal, high, or low.
Sodium
White Blood Cells
Potassium
Red Blood Cells
Chloride
Hemoglobin
Glucose
Hematocrit
Blood Urea Nitrogen
Total Bilirubin
Creatinine
AST
Calcium
ALT
Magnesium
Alkaline Phosphatase
Phosphorous
Lithium/Depakote/Tegretol Level
Total Protein
TSH
Albumin
UA
Pre-Albumin
Drug Toxicology
Cortisol Level
What information can you obtain from these lab values? Why is this information important for this
specific patient?
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HOSPICE HOUSE CLINICAL ASSIGNMENT
Select one patient to complete the following assignment.
1. What positions are included in the ‘hospice team’?
2. Describe the roles of each position.
3. How was therapeutic communication and empathy used?
4. What was the patient or families view on death and dying?
5. What makes one eligible for Hospice care?
6. Research Arkansas Medicare and describe what is and is not covered (e.g.: level of care, medication,
length of coverage).
7. Write a short paragraph about how this hospice nursing differs from hospital nursing.
HOME HEALTH ASSIGNMENT
1. List four types of home health agencies.
2. Describe health care services that a client could receive at home.
3. Describe how the family is utilized in home health nursing.
4. Identify client criteria that must be met to obtain home health services.
5. Discuss ways to promote safety measure in the home and community.
6. Discuss the roles of a RN versus an LPN in the delivery of home health nursing care.
7. For one visit, describe nursing interventions that the home health nurse implemented.
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8. Find a recent (within the last 5 years) article based on current research and/or evidence based practice.
CRITICAL REASONING FOR CLINICALS
Patient Age_________ Allergies___________________________________________________________
Date of Patient Admit/Surg _____________________________________ M/F__________
Primary medical diagnosis and brief pathophysiology:
Lab/Diagnostics:
Lab: H & H______________________ WBC_____ K+_____ N+_____ Glucose_____ BUN____________
PT,, PTT, INR ______ RBC______ Blood Cultures______ MIC (S/R)________________________
Cardiac Markers (troponin, CKMB)_____ BNP_____ D-Dimer_____ Creatinine________________
Urinalysis_______________ Ketones_______ Urine Cultures___________ Myoglobin__________
Phenytoin____________ Digoxin_______ Lipase______ Amylase_____ Occult stool___________
H-pylori__________ Liver Enzymes__________ ABGs___________________________________
(try to determine if your patient was alkalotic or acidotic, why is this important?)_________________
HDL__________ LDL__________
*Add other lab values specific to your patient ______________________________________________
Which ones will you continue to monitor R/T medical dx or meds?________________________________
Compare to previous draws or collections? Note any change.____________________________________
Radiology (C-T scans, films, MRI, Ultrasound)? Why were these done? What were the results and how were they used to diagnose or determine treatment?_______________________________________________ Any PRNs? Just list and note if patient has needed them. ______________________________________
Equipment? Vent, Monitors, Drains, Wound Vac, Foley, Bi-Pap, Pumps, Central Lines, defibrillators, pacemakers,
stimulators, implants, prostheses or reconstructive hardware; Treatments? Respiratory treatments; GI procedures;
stress tests, etc.
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Name:
Date of Admission:
Diagnosis: Room:
History: Code Status:
Iso:
Allergies: Dr.
Nursing Care/Safety:
Education:
Blood glucose testing:
Report:
Resp:
Cardio:
Neuro:
(mental status)
GI/GU:
Musculo:
Ca:
Mg:
Ph:
INR:
PTT:
BUN:
Na+:
Cl-:
Glu:
K:
CO2:
Hgb:
Hct:
Platelets:
WBC:
Diagnostics/Tests:
Interdisciplinary consults:
IV: Oxygen: Incentive Spirometer
Wounds/Incisions/Drains:
Diet:
Intake Output
Last BM:
Vitals & Frequency:
T:
P:
R:
BP:
O2:
0700
0800
0900
1000
1100
1200
Activity:
TED
SCD’s
Tele:
Meds:
□0700 □0800 □0900 □1000 □1100 □1200 □1300 □1400 □1500
PaiN/Last Pain Med:
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TIME MANAGEMENT
ROOM 0800 0900 1000 1100 1200 1300 1400 1500
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Related Concepts
Related Labs
Priority Assessments
Priority Teaching/ Discharge Goals
Priority Nursing Interventions
Priority Problem(s)
Think Out loud
CONCEPT MAP
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DIAGNOSTIC PROCEDURE / THERAPEUTIC
PROCEDURE
NURSING INTERVENTIONS
(pre, intra, post)
PROCEDURE NAME
INDICATIONS OUTCOMES/EVALUATIONS
POTENTIAL COMPLICATIONS
NURSING INTERVENTIONS CLIENT EDUCATION
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OB CLINICAL ASSIGNMENT (9 PAGES)
ASSESSMENT OF CLIENT IN LABOR
Student _____________________________
Date_________________________
Client Initials______ Age_____ G_____ T____ P_____ A______ L____ EDD____
A. Summarize client data from time of admission to the time your observation begins.
Include admission data related to labor status, therapies instituted, any abnormal findings or developments and labor progress.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
B. Record observations of stage(s) and phase(s) of labor that occur during your clinical
experience. Textbook Data - expected physical findings, client behavior and duration of specific
stage(s)/phase(s). Client Behavior - physical findings and client’s response and coping related to the
stage/phase of labor. Include time when a change in stage/phase occurs. Include pertinent data related to fetal well-being. Also include behavior of father-of-baby if present.
Interventions - interventions by yourself, the nurse or the physician. Evaluation - response of patient to interventions – i.e. effectiveness of comfort
measures, response to analgesia, correction of FHR pattern, etc.
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TEXTBOOK DATA CLIENT BEHAVIOR INTERVENTIONS EVALUATION
Stage/Phase:
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Student____________________________
Date________________________
ASSESSMENT OF POSTPARTAL CLIENT
I. Patient History: Age______ Primary Language _____________________________________ Cultural Considerations ______________________________________________ Spiritual Considerations______________________________________________ G______ P______ A______ L_____ c/s______ EDD______ Date/Time of Delivery______________ Method_____________ Total labor time_______ Labor Complications__________________________ ________________________________________________________________ Concurrent Medical Conditions________________________________________ Infant: Wt______ Sex______ Apgar______ Br/Bo fdg________________ general condition__________________________________________________ II. Physical Exam Fundus: position____________________ height____________________ firm/boggy___________________ tenderness___________________ interventions________________________________________________ Lochia: type_______________________ amount_____________________ odor_______________________ clots_______________________ Perineum: episiotomy________________ lacerations__________________ swelling____________________ bruising_____________________ hematoma_________________ discomfort____________________ interventions________________________________________________
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Breasts: engorgement________________ nipples____________________
lumps__________ redness__________ discomfort__________
interventions________________________________________________
Elimination: Voiding pattern________________________________________
c/o pain/burning________________ bowel sounds______________
date last BM___________________
interventions_________________________________________________
C-Section: incision location_______________ appearance______________
drainage_____________________ discomfort_________________
interventions_______________________________________________
Circulation/Oxygenation: BP______ P______ R______ T______
breath sounds___________________ Pulses__________________
c/o leg pain_________________________________________________
interventions________________________________________________
Nutrition: pre-pg wt______ wt gain______ present wt______
appetite___________________ special diet___________________
past or current eating disorder________________________________
interventions_______________________________________________
Lab Tests (explain significance of results)_______________________________
________________________________________________________________
ABO/Rh________ Rubella________ HBsAg________ GBS________
III. Psychosocial
Marital Status_____________________ Support System_________________
Serious financial problems___________________________________________
Labor/Delivery Experiences as perceived by pt. __________________________
________________________________________________________________
Pt. Interaction with family and staff_____________________________________
________________________________________________________________
Bonding behaviors between parent(s) and infant__________________________
________________________________________________________________
________________________________________________________________
History of Mental Disorder/Depression__________________________________
IV. Learning Needs r/t self-care, newborn care, contraception:
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Student___________________________
Date_______________________
NEWBORN ASSESSMENT
I. Infant History:
DOB________________ EDD________________ Gestational Age_____
Sex_____ Apgar Scores______ Birthweight___________
Current Weight______
Voiding:_____ Stool_____
Method of Feeding___________________ Last feeding__________________
Assessment of Feeding__________________________ LATCH Score:_____
Delivery Complications______________________________________________
________________________________________________________________
II. Maternal History: Age_______ G____ T____ P____ A____ L____
Length of labor_________________ Delivery Method____________________
Pregnancy Complications: __________________________________________
________________________________________________________________
Newborn Treatments & Procedures:
Newborn Medications/Vaccines:
Family Teaching Needs:
Priority Family Needs:
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III. Physical Assessment:
ASSESSMENT NORMAL FINDINGS ASSESSMENT COMPONENT COMMON VARIATIONS FINDINGS VITAL SIGNS Temperature Pulse-Rate Rhythm Heart Sounds Respiration Rate Rhythm Breath Sounds MEASUREMENTS Head Chest Length Weight INTEGUMENT Color Texture Turgor Integrity Mucus Membrane
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ASSESSMENT NORMAL FINDINGS ASSESSMENT COMPONENT COMMON VARIATIONS FINDINGS HEAD Shape Hair Texture Fontanelles Face Eyes Ears Nose Mouth NECK/SHOULDER Shape Movement Trachea CHEST Shape Breasts
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ASSESSMENT NORMAL FINDINGS ASSESSMENT COMPONENT COMMON VARIATIONS FINDINGS ABDOMEN Shape Tone Umbilical Cord Bowel Sounds Femoral Pulses GENITALIA Male Female BACK, HIPS, BUTTOCKS Knee Height Hip Stability Spine Gluteal Folds Anus
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ASSESSMENT NORMAL FINDINGS ASSESSMENT COMPONENT COMMON VARIATIONS FINDINGS EXTREMITIES Arms (pulses) Hands & Fingers Legs (pulses) Feet & Toes REFLEX STIMULUS/RESPONSE ASSESSMENT FINDINGS Babinski Moro Stepping Tonic Neck Palmar Grasp Rooting Sucking
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RAPID REASONING MED/SURG CLINICAL ASSIGNMENT I. Data Collection History of Present Problem:
Personal/Social History:
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History: Clinical Significance:
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds:
Lab/diagnostic Results:
What lab results are RELEVANT that must be recognized as clinically significant to the nurse?
Basic Metabolic Panel (BMP) Current High/Low/WNL? Most Recent:
Sodium (135-145 mEq/L)
Potassium (3.5-5.0 mEq/L)
Glucose (70-110 mg/dL)
Creatinine (0.6-1.2 mg/dL)
Misc. Chemistries:
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RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable:
What lab results are RELEVANT that must be recognized as clinically significant to the nurse?
RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable:
II. Patient Care Begins:
What VS data is RELEVANT that must be recognized as clinically significant?
RELEVANT VS Data: Clinical Significance:
Complete Blood Count (CBC) Current High/Low/WNL? Most Recent:
WBC (4.5-11.0 mm 3)
Hgb (12-16 g/dL)
Platelets(150-450x 103/µl)
Neutrophil % (42-72)
Current VS: WILDA Pain Scale (5th VS)
T: Words:
P: Intensity:
R: Location:
BP: Duration:
O2 sat: Aggreviate:
Alleviate:
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What assessment data is RELEVANT that must be recognized as clinically significant?
RELEVANT Assessment Data: Clinical Significance:
III. Clinical Reasoning Begins… 1. What is the primary problem that your patient is most likely presenting with?
2. What is the underlying cause/pathophysiology of this concern?
3. What nursing priority(s) captures the “essence” of your patient’s current status and will guide your plan of care?(if
more than one-list in order of PRIORITY)
4. What interventions will you initiate based on this priority?
Nursing Interventions: Rationale: Expected Outcome:
Current Assessment:
GENERAL
APPEARANCE:
RESP:
CARDIAC:
NEURO:
GI:
GU:
SKIN:
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5. What body system(s) will you most thoroughly assess based on the primary problem or nursing care priority?
6. What is the worst possible/most likely complication to anticipate based on the primary problem?
7. What nursing assessments will identify this complication EARLY if it develops?
8. What nursing interventions will you initiate if this complication develops?
Medical Management: Rationale for Treatment & Expected Outcomes Care Provider Orders: Rationale: Expected Outcome:
PRIORITY Setting: Which Orders Do You Implement First and Why? Care Provider Orders: Order of Priority: Rationale:
Medication Dosage Calculation: Medication/Dose:
Mechanism of Action: Volume/time frame to
Safely Administer:
Nursing Assessment/Considerations:
Normal Range: (high/low/avg?)
Hourly rate IVPB:
IV Push Rate Every
15-30 Seconds?
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9. What educational/discharge priorities will you identify once this patient is admitted to the unit?
Caring & the “Art” of Nursing 10. What is the patient likely experiencing/feeling right now in this situation?
11. What can I do to engage myself with this patient’s experience, and show that he/she matters to me as a person?
It is now the end of your shift. Effective and concise handoffs are essential to excellent care and if not done well can
adversely impact the care of this patient. You have done an excellent job to this point, now finish strong and give the
following SBAR report to the nurse who will be caring for this patient:
Situation:
Background:
Assessment:
Recommendation:
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1. Define Gerontologic nursing and “aging”. 2. Discuss Erikson’s maturity stage of development. Apply to a specific patient. 3. Define “ageism” and give examples of negative stereotypes observed about the older adult. 4. Identify important mental health issues experienced by older adults and how does this
affect the ability to function? 5. List three medications and environmental factors that combine to alter safety and increase
risk of falls in the elderly population. 6. What is the nurse’s role in health promotion and health maintenance of the elderly? 7. Identify nursing diagnoses that reflect the learning needs of the older adult patient?
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It has been said that “Often it is not until crisis, illness…or suffering occurs that the illusion (of
security) is shattered…illness, suffering…and ultimately death…become spiritual encounters as
well as physical and emotional experiences.”(Ganstrom)
Spirituality is about hope, strength…giving meaning and purpose to life…forgiveness…love and
relationships. It may be to some a belief and faith in self, others or belief in a deity/higher power.
It might encompass morality, creativity and self-expression. (2011)
Assignment:
1. Identify the point of objective assessment that brought you to the realization that your patient or the
family may have a spiritual need?
2. How did the patient or the family express this need?
3. Interview nursing staff about the resources available to them for meeting the “end of life” needs for
patients.
4. Does the agency have a call list of religious practitioners (Ministers, Chaplain, Priests, Rabbi, Pastors, etc.)?
Ask to see this list. If not available what might you do to develop this need?
5. Describe the approach you (or staff) used to discuss desires of the patient or family concerning end of life
care?
6. Briefly describe the agency policy concerning notification of ARORA. (Arkansas Region Organ Recovery
Agency)
7. Does the patient have a traditional or non-traditional belief or support system?
References:
Hitchens. E.W. (1988) Stages of faith and values development and their implications for dealing with
spiritual care in the student nurse-patient relationship. Unpublished Ed.D Thesis, Seattle: University of
Seattle.
Royal College of Nursing (2011). RCN spirituality survey 2010, London: RCN.
http://www.arora.org/
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Writing –reflecting on the day’s clinical experience gives you opportunity to recall and possibly allow you to recognize both your strengths and weaknesses. Are you able to appreciate another’s pain, concerns, fears-can you face your own? Reflections help you to self-evaluate, develop your skill level, recognize your ability to empathize, and show compassion (or maybe the need to improve). As you progress in your training you should see a change in your ability to express your experiences and learn from them. Some ideas to get you started:
Describe an experience, observed behavior or perception of the experience during this clinical day.
Express your feelings or maybe the feeling of others involved in the experience (e.g. staff, patient, patient’s family)
Do you feel inadequate or better prepared to make decisions, plan care, and evaluate patient care after today’s encounter? What can you do to improve?
Any skills you feel you need to improve or develop?
Musculoskeletal
1. How does the patient describe their discomfort? Is complaint muscle or skeletal related? 2. Does the injury/complaint affect the ability to perform ADLs? If so what are the deficits and what interventions might
you suggest to assist or alleviate the problem? 3. How is the patient being treated? What collaborative referrals are made? 4. What medications is the patient receiving? Will these decrease pain? Increase fall risk? 5. Was the patient using any assistive devices prior to injury/surgery? Will they be able to use them on discharge? 6. What is a priority nursing diagnosis for this patient? 7. Complete the physical assessment with focus on musculoskeletal system. 8. Complete Teaching plan for a patient experiencing musculoskeletal problems. (part II-clinical assignments)
During the clinical rotation at the physician offices, the student should complete the below:
1. Identify the role of the RN in the practice.
2. Discuss communication methods used in the clinical setting.
3. Pick a specific client’s diagnosis and relate with specific medical interventions.
4. Identify the use of wellness interventions to promote health in the community population.
5. How was the concept of human growth and development applied to different age groups of clients within
the clinic setting?
CLINIC OFFICE
ROTATION
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R.T. & P.T. CLINICAL ASSIGNMENT
1. Auscultate at least 3 client breath sounds using appropriate assessment techniques.
Discuss and document your findings with the R.T.
2. Review radiology films/reports of a patient for treatment of COPD/pneumonia, asthma,
and/or flu. What did you find? Any differences?
3. Observe at least one ventilator client. Notice settings. Answer below questions describing
difference (if ventilator was not observed, describe each statement and differences)
a. What classification of ventilator is being used (positive pressure, negative pressure)?
b. What is the ventilator mode (assist-control, intermittent, synchronized – see your
med-surg text book)?
c. What is the tidal volume set at, why is this important?
d. What is the FiO2 setting, why is this important?
e. What is the sensitivity setting, why is this important?
f. What is the sigh setting, why is this important?
g. What is the PEEP, why is this important?
4. Observe the R.T. administering pulmonary treatments (such as updrafts, use of incentive
spirometers, chest percussion). What were the common medications administered? What
route are they being given and why were they being given?
5. Observe the RT drawing ABG’s? What is the purpose of an ABG and what does it assess,
describe?
6. What is/are the reason(s) for using a gait belt?
7. Describe the following tests and measurements (how and why) there were done?
a. Range of motion
b. Manual muscle testing
c. Vital signs
d. Posture analysis
e. Sensory testing
f. Gait assessment
g. Aerobic capacity and endurance
h. Integumentary integrity
i. Balance assessment
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Student Learning Outcomes:
1. Observe nursing process and describe therapeutic communication skills demonstrated by the wound care
nurse.
2. Identify and describe at least two methods for wound care.
3. Identify 3 different types of wounds and the interventions used for each type of wound.
4. Utilize best practice to assess a client’s wound status. Describe how this was done.
5. Relate 3 examples of wound healing to co-morbidities that the client may be experiencing (such as diabetes
or peripheral vascular disease).
6. Identify the services that wound care program provides to the community.
7. How is a patient accepted into the wound care program? Is a referral necessary?
8. Identify safety and infection control practices used during wound care. What PPE (personal protective equipment)
was used?
9. Discuss one patient visit. Include:
a. The assessment involve
b. nursing care provided
c. Education/instructions given to patient or caregiver, (d) documentation.
10. Discuss the nurses’ interdisciplinary collaboration with the healthcare team (i.e. physical therapist, social worker,
occupational therapist, dietitian, physician, etc)
11. Define osteomyelitis? How is it treated? What is the patho involved?
12. How does the Hyperbaric Chamber help with wound healing?
http://youtu.be/ZSl2UeMVdMo
WOUND CARE -
CLINICAL ROTATION
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Perioperative Clinical Written Assignment Objectives: Upon completion, completing the assigned reading, and observation in the perioperative area, the student will be
able to:
1. Utilize the nursing process to plan care for the perioperative patient. 2. List priority areas to be included in the instruction of a preoperative patient. 3. Describe the roles of nurses and other members of the operating room team. 4. Identify types of anesthesia and rationales for use in a variety of surgeries. 5. State priority postoperative interventions for selected patients. 6. Describe changes in physiological status which occur as patients recover from anesthesia.
Answer the below:
Preoperative Phase:
Describe your first interaction with your assigned patient.
What was the patient’s response to having a student nurse with them?
If the response was positive, what do you think aided this? If negative, what could have been done differently?
Discuss your patient’s thoughts and feelings in response to having surgery. Include verbal and non-verbal observations..
Explain what pre-operative teaching was done prior to the patient being taken to the operating room. What was the patient’s response to this teaching?
Describe the role of the preoperative nurse.
Describe your overall view of the patient’s preoperative phase.
Intraoperative Phase:
How was the patient greeted upon entering the operating room?
What special preparations were done prior to surgery beginning and why?
Discuss the Time-Out process and its purpose. Must cite reference in the text.
Discuss the interactions of the OR team.
Discuss the role of the intraoperative nurse.
Discuss how you feel the patient was treated during surgery. PACU Phase:
Discuss unique aspects of the PACU environment.
Discuss the role of the PACU nurse.
Discuss SBAR technique and its purpose. Must cite reference in the text.
Describe the nurse-to-nurse report when the patient was transferred into PACU. Was it comprehensive? How did it align or differ from SBAR technique?
Was the information shared during report appropriate? If not why? Post-operative Care:
Describe the nurse-to-nurse report when the patient was transferred onto the postoperative floor. Was it comprehensive? How did it align or differ from SBAR technique?
Was the information shared during report appropriate? If not why?
Discuss how the electronic system used for medication administration impacts patient safety. How does it address the 10 rights of medication administration?
Discuss the role of the postoperative nurse. Evaluation of Surgical Follow Through:
Choose one of the provided articles. Identify whether the care provided your patient met this evidence based practice. Discuss why or why not.
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Appendix C
Post Conference Material
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Week 1 Maternal-Neonatal
Case Study Antepartum (Prenatal) 13 Maternal and Obstetric Care
Scenario P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test and the result was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician.
1. What are the two most important questions to ask to determine possible pregnancy?
2. You ask whether she has ever been pregnant, and she tells you she has never been pregnant. How would you
record this information?
3. What additional information would be needed to complete the TPAL record?
4. It is important to complete the intake interview. What categories will you address with P.M.?
CASE STUDY PROGRESS According to the clinic protocol, you obtain the following for her prenatal record: complete blood count, blood type with Rh factor, urine for urinalysis (protein, glucose, blood), vital signs, height, and weight. Next, the nurse-midwife does a physical examination, including a pelvic examination and confirms that P.M. is pregnant. P.M. has a gynecoid pelvis by measurement, and the fetus is at approximately 6 weeks' gestation.
CHART VIEW VITAL SIGNS
Blood pressure 116/74 mm Hg Heart rate 88 beats/min Respiratory rate 16 breaths/min Temperature 98.9 ° F (37.2 ° C)
5. Do any of these vital signs cause concern? What should you do?
6. P.M. tells you that the date of her last menstrual period (LMP) was February 2. How would you calculate her due
date? What is her due date?
7. What is the significance of a gynecoid pelvis?
8. What specimens are important to obtain when the pelvic examination is done? Case Study Progress
CASE STUDY PROGRESS
Nursing interventions focus on monitoring the woman and fetus for growth and development; detecting potential complications; and teaching P.M. about nutrition, how to deal with common discomforts of pregnancy, and activities of self-care.
9. A psychological assessment is done to determine P.M.'s feelings and attitudes regarding her pregnancy. How do
attitudes, beliefs, and feelings affect pregnancy?
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10. P.M. asks you whether there are any foods that she should avoid while pregnant. She lists some of her favorite
foods. Which foods, if any, should she avoid eating while she is pregnant? Select all that apply.
Hot dogs
Sushi
Yogurt
Deli meat
Cheddar cheese
11. As the nurse, you know that assessment and teaching are vital in the prenatal period to ensure a positive outcome.
What information is important to include at every visit and at specific times during the pregnancy?
12. After her examination, P.M. states that she is worried because her sister had an ectopic pregnancy and had to have
surgery. She asks you, “What are the signs of an ectopic pregnancy?” Which of these are correct? Select all that
apply.
a. Fullness and tenderness in her abdomen, near the ovaries
b. Pain, either unilateral, bilateral, or diffuse over the abdomen
c. Nausea
d. Dark red or brown vaginal bleeding
e. Increased fatigue
13. P.M. asks the nurse about what should be reported to her doctor. List at least six of the danger signs during
pregnancy.
14. Changes in the body caused by pregnancy include relaxation of joints, alteration to center of gravity, faintness,
and discomforts. These changes can lead to problems with coordination and balance. In teaching P.M. about
safety during pregnancy, what will you include in your teaching?
15. P.M. asks, “Is a vaginal examination done at every visit?” Select the best response and explain your answer
“Yes, an examination is done with each visit because it allows the examiner to note any possible
infections that may be developing.”
“Yes, an examination is done with each visit because it offers vital information about the status of the
pregnancy.”
“No, a vaginal examination will not be done again until you go into labor.”
“No, vaginal examinations are not routinely done until the final weeks of your pregnancy.”
CASE STUDY PROGRESS
P.M. makes an appointment for her next checkup. You tell her that an ultrasound may be done at about 8 to 12 weeks' gestation to check fetal growth
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Week 2 Maternal-Neonatal
Case Study Gestational Diabetes Mellitus Scenario You are working as a registered nurse (RN) in a large women's clinic. Y.L., a 28-year-old Asian woman, arrives for her regularly scheduled obstetric appointment. She is in her 26th week of pregnancy and is a primigravida. After examining the patient, the nurse-midwife tells you to schedule Y.L. for a glucose challenge test. You review Y.L.'s chart and note she is 5 feet, 3 inches tall and weighs 143 pounds; her prepregnancy body mass index (BMI) was 25. Her father has type 2 diabetes mellitus (DM), and both paternal grandparents had type 2 DM. You enter the room to talk to Y.L.
1. What is the purpose of a glucose challenge test?
2. When is a glucose challenge test performed?
3. What instructions would you provide Y.L. regarding the test?
Chart View
Laboratory Test Results
Time of test Value Normal Range 0730 109 mg/dL Less than or equal to 92 mg/dL 0830 213 mg/dL Less than or equal to 180 mg/dL 0930 162 mg/dL Less than or equal to 153 mg/dL
4. Interpret the results of Y.L.'s test.
5. Y.L. is diagnosed with gestational diabetes mellitus (GDM). What is GDM?
6. List five risk factors for GDM. Place a star or asterisk next to those risk factors that Y.L. has. CASE STUDY PROGRESS Medical nutrition therapy is the primary treatment for the management of GDM. Because treatment must begin immediately, you call the dietitian to come see Y.L. You also schedule Y.L. to meet with other members of the DM management team later in the week.
7. What is the goal of medical nutrition therapy?
8. Describe the usual diet used in treating GDM.
9. Why is medical nutrition therapy for a woman with GDM higher in fat and protein than for a woman who is not
pregnant?
10. Women with GDM cannot metabolize concentrated simple sugars without a sharp rise in blood glucose. Name
five examples of simple sugars you would teach Y.L. to limit.
11. Complex carbohydrates (CHOs) do not cause a rapid rise in blood glucose when eaten in small amounts. Identify
five foods from this group.
13 Maternal and Obstetric Car CASE STUDY PROGRESS Study Progress During the meeting with the dietitian, Y.L. gives a diet history that is high in noodles and rice with little protein. She informs the dietitian she is lactose intolerant but can have dairy products occasionally in small portions.
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12. Is it important that Y.L. take a calcium supplement along with her prenatal vitamins?
13. Y.L. is instructed to monitor her fasting blood glucose first thing in the morning and 2 hours after every meal.
What are the purposes of this request?
14. Y.L. is instructed to complete ketone testing using the first-voided urine in the morning. What is the rationale for
this request?
15. Y.L. asks whether having gestational diabetes will hurt her baby. How would you respond?
16. At the conclusion of the visit, you need to evaluate your teaching. Which statement made by Y.L. indicates that
clarification is necessary?
“I will stay on the diabetic diet described by the dietitian.”
“I will monitor my glucose levels at least four times each day.”
“I need to stop exercising because I will need more carbohydrates.”
“I should immediately report any ketones in my urine.”
17. Y.L. states that she plans to have another child soon and asks you if she will develop GDM with that pregnancy.
Select the best response:
“Yes, once you develop GDM during a pregnancy, you will develop it with any future pregnancies.”
“No, there is no further risk for development of GDM if you get pregnant again.”
“If you lose weight and do not eat any sweets before your next pregnancy, you will not develop GDM
again.”
“There is a risk for recurrence of GDM in the next pregnancy. Let your health care provider know that
you had GDM with this pregnancy.”
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Week 3 Maternal-Neonatal
Case Study – Intrapartum Assessment & Interventions
Scenario As the nurse, you admit Margarite Sanchez to the labor and delivery unit. She arrived in the triage unit at
midnight in early labor. She presented with uterine contractions that were 5 minutes apart for 3 hours. The
patient is a 28-year-old G3 P1 Hispanic woman. She is at 39 weeks’ gestation. José, her husband, has
accompanied her to the unit. Two years ago, she had a normal spontaneous vaginal delivery after an 18-hour
labor for a baby girl, Sonya, who weighed 7 lb, 3 oz. Margarite’s cervix is now 4 cm/80%/0 station, and the
fetal position is left occiput anterior.
Prenatal Labs:
- Blood type O+
- RPR NR
- GBS negative
- Hgb
- Hct
- Hepatitis negative
Vital signs: - Blood pressure 110/60
- pulse 84 bpm
- respiratory rate 18
- temperature 98.6°F (37°C)
Margarite received regular prenatal care, beginning at 10 weeks of gestation. She gained 22 lb during
pregnancy, and her current weight is 164 lb. She is 5 ft, 4 in. tall. She has no prior medical complications and
has experienced a normal pregnancy. Her first pregnancy ended in miscarriage at 8 weeks’ gestation. She has
no allergies to food or medication. She does not have a birth plan and says, “I just hope for a normal delivery
and a healthy baby.”
1. What stage and phase of labor is Margarite in?
2. Detail the aspects of your initial assessment.
Electronic fetal monitoring reveals an FHR baseline in the 140s, with moderate variability and accelerations
to the 160s 20 seconds. Margarite is uncomfortable with the contractions and rates her pain at 5. She
requests ambulation, because she feels more comfortable walking.
At 1:20 a.m., she has a spontaneous rupture of membranes (SROM), releasing a large amount of clear
amniotic fluid. FHR baseline is in the 130s, with moderate variability, and accelerations and contractions are
every 3 minutes and feel moderate when palpitated. Her sterile vaginal examination (SVE) reveals that her
cervix is 5 cm/90%/0 station. She is very uncomfortable with the contractions but does not want pain
medication at this time. José appears anxious and at a loss as to how to help his wife.
3. What is your priority assessment after rupture of membranes and rationale?
4. What teaching would you include?
5. Discuss nursing diagnosis, expected outcome, and interventions related to managing Margarite’s care.
6. What are appropriate nonpharmacological interventions for managing Margarite’s labor pain?
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At 2 a.m., Margarite is increasingly uncomfortable with contractions and cries out that she can no longer take the pain. Her cervical
examination reveals that her cervix is 6 cm/100%/0 station. She requests pain medication and is given a dose of Nubain at 2:15 a.m.
for pain relief in active labor. José asks how much longer the labor will be and when the baby will be born.
7. Detail the assessment that should be done before giving pain medication.
8. What are your current priorities in nursing care for Margarite Sanchez?
Discuss the rationale for your priorities.
At 4:10 a.m., Margarite is very uncomfortable with contractions and cries out that she feels more pressure. She vomits a small
amount of bile-colored fluid and is perspiring and breathing hard with contractions. Her cervical examination reveals that her
cervix is 8 cm/90%/0 station. She requests pain medication and is given a dose of Nubian at 4:40 a.m. for pain relief in transition.
9. What stage and phase in Margarite in now?
10. What are additional interventions for this phase?
At 6:30 a.m., Margarite reports a strong urge to bear down and push with contractions, is very uncomfortable with contractions,
and cries out that she feels more pressure. Her SVE reveals that her cervix is 10 cm/100% and +1 station. Contractions are
occurring every 2 minutes and are strong when palpitated. The fhr is in the 130s, with moderate variability, and drops to 90 bpm for
40 seconds with pushing efforts.
11. What stage is she in now?
12. What are your immediate priorities in nursing care for Margarite Sanchez?
Discuss the rationale for your priorities.
13. What does the FHR indicate?
Margarite continues to bear down, pushing with contractions, and the fetal head is descending with contractions. The fetal heart
rate is in the 130s, with moderate variability, and the FHR drops to 90 bpm for 40 seconds with pushing efforts. At 7:30 a.m.
Margarite is increasingly unfocused with contractions and states, “I can’t push...call my doctor to get the baby out!” José is at her
side, holding her hand and encouraging her pushing efforts.
14. What are your immediate priorities in nursing care for Margarite Sanchez?
Discuss the rationale for your priorities.
At 8:15 a.m., Margarite continues to bear down with contractions, and the fetal head is descending with contractions. The FHR is in
the 130s, with moderate variability, and the FHR drops to 90 bpm for 40 seconds with pushing efforts. Margarite is focused on
contractions. The fetal head is starting to crown with pushing efforts.
15. What are your immediate priorities in nursing care for Margarite Sanchez?
Her doctor comes into the labor and delivery room, and she delivers a baby boy at 8:39 a.m., with a second-degree perineal
laceration. Margarite’s son weighs 3,800 g and 1- and 5-minute Apgar scores are 8 and 9, respectively. Both Margarite and José
begin to cry when their son is born, and José holds his son and hugs his wife. The placenta is delivered apparently intact at 8:45
a.m. Both Margarite and her son are stable, and you initiate immediate postpartum and transition care for the mother and baby.
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Potential Complications
Week 4
Related Labs / DIAGNOSTICS
Priority Nursing Interventions /
Primary Nursing Diagnosis
RISK FACTORS
PATHO & ETIOLOGY
Priority Nursing Diagnosis
Cesarean Birth (Pre, Intra, Post)
PRIORITY/FOCUSED ASSESSMENT
MEDICATIONS/IVF (pertinent to dx)
INTERPROFESSIONAL TREATMENT
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Week 5 Maternal-Neonatal
Case Study POSTPARTUM
Scenario T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.
1. What is important to note in the initial assessment?
2. You find a boggy fundus during your assessment. What corrective measures can be instituted?
3. The patient complains of pain and discomfort in her perineal area. How will you respond?
4. The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby has a special
identification bracelet that matches a bracelet worn by T.N., and reviews other security procedures. Which
statement by T.N. indicates a need for more teaching?
“If I have a question about someone's identity, I can ask about it.”
“If someone comes to take my baby for an examination, that person will carry my baby to the
examination room.”
“Nurses on this unit all wear the same purple uniforms.”
“Each staff member who takes my baby somewhere will have a picture identification badge.”
5. An hour after admission, you recheck T.N.'s perineal pad and find that there is a very small amount of drainage on
the pad. What will you do next?
Ask T.N. to change her perineal pad
Check her perineal pad again in 1 hour
Check the pad underneath T.N.'s buttocks
Document the findings in T.N.'s medical record
6. That evening, the nursing assistive personnel assesses T.N.'s vital signs. Which vital signs would be of concern at
this time?
Chart View Vital Signs
Temperature 99.9 ° F (37.7 ° C) oral Pulse rate 120 beats/min Blood pressure 100/50 mm Hg Respiratory rate 16 breaths/min
7. What will you do next?
8. After your prompt intervention, you need to document what happened. Write an example of a documentation
entry describing this event.
9. Two hours later, you perform another perineal pad check and note the findings in the diagram. How will you
describe the amount of drainage in your note?
Scant
Light
Moderate
Heavy
10. T.N.'s condition is stable and you prepare to provide patient teaching. What patient teaching is vital after
delivery?
11. T.N. tells you she must go back to work in 6 weeks and is not sure she can continue breastfeeding. What options
are available to her? utcome CASE STUDY OUTCOME
T.N. is discharged to home and plans to consult a lactation specialist before returning to work.
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WEEK 6
POST-CONFERENCE
Plan a discharge teaching for a patient who had a
1. Vaginal delivery of a healthy newborn
2. Then discuss how teaching is altered for the patient
experiencing a cesarean delivery
3. What additional teaching is needed for a newborn that
experienced distress/or is at risk for following discharge.
4. Discharge teaching for a parent who is breastfeeding
5. Discharge teaching for a parent that is bottle-feeding