College of DuPage Associate Degree Nursing Program Course Syllabus Fall

N1207syllabusfall2009 10/08/08 FALL 2008 1

College of DuPage Associate Degree Nursing Program

Course Syllabus Fall 2009

A. Course title and number: Nursing 1207, The Childbearing Family B. Course Description: Nursing care of the woman and family during the reproductive years. Focus on the childbearing process and wellness of the family in the childbearing years. Women’s health is emphasized. Adverse outcomes of pregnancy and care of the well and hospitalized child and family are presented. Clinical experiences include acute and/or non-acute settings. 5 Semester credit hours Lecture 2.5 Lab 1.0 Clinical 6.0 Pre-requisite criteria: Nursing 1104 and 1105, Psychology 2237 or concurrent enrollment C. General Course Objectives: At the completion of this course, the student should be able to:

1. Utilize professional, ethical and legal principles when caring for patients. (Ia, Ie, If, IVc) 2. Effectively communicate with patients, significant support persons and members of the healthcare team to promote safe, effective care. (Id, IIa, IIb, IVa) 3. Identify critical assessment data accessing multiple sources when caring for patients. (Ia, Ie, IIa, IIb) 4. Apply critical thinking and clinical reasoning in the evaluation of assessment data to plan care. (IIIa, IIIb) 5. Prioritize therapeutic nursing interventions for patients. (Ia, Ic, Ie) 6. Deliver compassionate and culturally sensitive care to maintain or enhance patient health. (Ib, Iva, Ivb, Va, Vb, Vc) 7. Implement teaching plans that address healthcare needs. (Ia, Ie) 8. Modify teaching plans for patients and their families to achieve identified learning outcomes.(Ia, Ib, Id, Ie, If, IIa, IIb, IIb, IIIa, IIIb, IVb, Va) 9. Participate in collaborative relationships with patients, significant support persons and members of the healthcare team for the purpose of providing or enhancing patient care. (Id, Ie, IIa, IIb, IIc, IVb, Va) 10. Delegate aspects of patient care to qualified assistive personnel when managing patient care. (Ia, Id, Ie) 11. Analyze the differences between the professional role of the nurse in a specialized care unit/general medical-surgical unit. (Ic, IIIa, Ivb, Va)

D. Specific Course Objectives: Upon successful completion of the course the student should be able to do the following: Theory

1. Identify the role of the nurse in assisting patients and families during the child bearing process


2. Effectively communicate with patients, significant support persons, and members of the healthcare team to promote the safe and effective care of women and their families

3. Assess the teaching-learning needs of patients and families during the childbearing and early childrearing years

4. Describe the components of optimal health care of families and young children 5. List the developmental tasks experienced by women and families 6. Describe physiological and psychological changes of clients and families during the

antenatal, intrapartal and postnatal periods 7. Identify common pharmacological agents utilized during the childbearing years 8. Explain the effects of hospitalization on the child and family 9. Demonstrate competency in the performance of nursing skills 10. Apply nursing concepts, principles and theories to clinical situations/simulations 11. Utilize clinical decision-making skills in providing patient care 12. Apply the nursing process in promoting an optimal level of wellness in women and their

families 13. Deliver compassionate and culturally sensitive care to maintain or enhance the health of

women and their families At the completion of this course the student will be able to demonstrate the following behaviors related to the preparation and care of the family, before, during and after childbirth. Clinical

1. Demonstrate professional behavior in the clinical setting. 2. Manage the care of one to two hospitalized clients in a maternity setting. 3. Apply knowledge of assessment skills to the care of clients. 4. Identify appropriate nursing diagnoses based on data collected during assessment. 5. Recognize appropriate nursing interventions in the planning of care for assigned clients. 6. Perform nursing skills specific for the care of assigned clients. 7. Evaluate client’s responses to nursing care and identify the need for modification of care

plans. 8. Utilize effective communication techniques in both verbal and written form. 9. Identify learning needs of clients and significant others. 10. Discuss the application of theory, concepts and principles to the care of assigned clients. 11. Complete required written coursework nursing care plans and observations on assigned

clients Laboratory

1. Demonstrate skills for physical assessment of intrapartal, postpartal and neonatal patients. 2. Identify comfort and relaxation measures for intrapartal client. 3. List nursing interventions for the high risk infant and mother. 4. Construct a patient plan of care utilizing a concept map. 5. Identify common pharmacological agents utilized in care of perinatal patients.

Unit Objectives See “Learning Outcomes” listed at the beginning of assigned readings. E. The curriculum is based on the ANA standards of practice Standards of Practice: The American Nurses Association Standards of Practice were used in the development and presentation of this course.


F. Textbook Materials Required: Carpenito-Moyet, L.J. (2006). Nursing Diagnosis: Application to Clinical Practice. (11th Ed). Philadelphia, PA: Lippincott William & Williams. Craig, G.P. (2005). Clinical Calculations Made Easy: Solving Problems Using Dimensional Analysis. (3rd Ed.). Philadelphia, PA: Lippincott Williams & Williams. Lewis, S.M., Heit Keupen, M.M. & Dirkson, S.R. (2008). Medical Surgical Nursing Assessment and Management of Clinical Problems. (7th Ed.). St. Louis, Mo Mosby. Pillitteri;, A. (2007). Material and Child Health Nursing:Care of the Childbearing and Child- Rearing Family. (5th #D.). Philadelphia, PA: Lippincott, Williams and Williams. G. Methods of Evaluating Students 1. Students will be evaluating by tests, clinical performance and demonstration of skills. 2. Students must meet guidelines of a satisfactory clinical performance of the course. 3. Projects and/or class attendance may also be a factor in evaluation. 4. Grading: your final grade is determined according to the following grading scale:

Percentage Grade 90.0%-100% A 84.0%-89.9% B 78.0%-83.9% C 70.0%-77.9% D Below 70.0% F

The numerical value of exams and final course grades will not be rounded. Your final course grade is based on a point system as determined by your instructor(s). Your final course grade is based on a point system as determined by your instructor(s):

Item Description Possible Points Your Points Exam 1 100 Exam 2 100

Exam 3 (Final) 100 Postpartum Care Plan 5 Newborn Assessment 5 Teaching Presentation 5

Concept map 5 Math Quiz Pass

Total Points 320 H. Program Policies and Procedures This course will be conducted according to the policies and procedures as discussed in the Associate Degree Nursing Student Handbook.


I. Course Specific Information 1. Lecture-Discussion

One five (5) hour class period per week will be utilized for the presentation, clarification and discussion of course content. Students are expected to complete the assigned readings prior to lecture. Required readings are outlined in the appendices in the syllabi.

2. Clinical

A total of ninety–six hours of clinical activities will be presented. Students will apply the nursing process to the client and the family. This time includes: a. Pre-conference: which will be held prior to each clinical day for the purpose of

identifying objectives, discussing appropriate nursing care and reviewing specific theory. b. Post-conference: Which will be held following the clinical day for the purpose of

sharing experiences and assessing the degree to which clinical objectives were achieved. Assignments

a. Written assignments are all due one week after caring for the client. Forms for the following assignment are included in the appendices of the syllabi. They include:

1) Postpartum assessment and care plan 2) Newborn assessment 3) Labor and delivery observation 4) In addition, patient data sheets will be completed by the student by the second

clinical session. 5) Perinatal Nursing Guide

Guidelines, forms and grading criteria for each activity are provided in the appendix of

the syllabus. Please review the information in the policy and procedure section of syllabus regarding written assignments. It is imperative that students adhere to the stated curriculum requirements or risk failure of course. All assignments must be completed to meet the objectives of this course. The Perinatal Nursing Guide is due on the second clinical day. All sources must be cited and referenced in APA format on all written

assignments. Students are responsible for printing and bringing these materials to clinical; copies cannot be made at the clinical site. b. Teaching Presentation

Each student will do a 10-15 minute teaching presentation on a selected topic related to the course. The presentation will be given in post conference at clinical. This will be scheduled with your clinical instructor. All presentations will be delivered at a professional level. Sources must be cited and referenced in APA format.

c. Concept Map


Each clinical group will do a formal presentation utilizing a concept map. Theory will be discussed during the lab component of the course. This is a case study presentation involving an actual client cared for in the clinical area. This is a group activity and the grade criteria is included in the appendix. All sources must be cited and referenced in APA format.

3. Community Activities

Each student shall complete 3 community activities. The student will complete. 1) A nurse-midwife clinic session. 2) A well-child observation session. 3) A childbearing/childrearing education session

Registration for the nurse-midwife and well-child observations will take place in class. The student will contact the health care agency to register for the childbearing education class. The student must receive permission from the class instructor prior to attending the class. The criteria for class selection are as follows: 1) The class must be taught by a registered nurse. 2) The class must be at least two hours in length.

Suggested classes include: prenatal, breastfeeding, infant safety, C-section, VBAC, sibling, grand- parenting, and infant care; contact your clinical instructor for approval for other classes.

A signed verification of attendance form must be submitted for each activity.

Students will be in full uniform with name tag (as described in the student handbook) for each of theses activities.

4. Math Quiz

A math quiz will be given at clinical each week and you must pass one at 100% by week four in the rotation. The test must be successfully completed by the end of the last assigned clinical day of that week. Students must pass the math exam before they are able to pass medications in clinical. Students who do not pass the math test by the stated deadline will not be able to meet the objectives of this course.

5. Examinations

All examinations will include tests items that reflect lecture, lab, and assigned readings.


J. Reading List Nursing 1207 Reading List

Week

Topic

Pillitteri

Lewis

1

Prenatal Care

Chapter 8 (pp.181-197) Chapter 9 (pp.212-239) Chapter 10 (pp.240-270) Chapter 11 (pp.271-298) Chapter 12 (pp.299-322)

2

Intrapartal Care

Chapter 13 (pp.321-343) Chapter 18 (pp.487-541) Chapter 19 (pp.542-563) Chapter 20 (pp.564-587) Chapter 21 (pp.588-617)

3 Exam 1 Postpartal Care

Chapter 22 (pp.621-653) Chapter 23 (pp.654-678)

4

Newborn / High Risk Newborn

Chapter 24 (pp.679-721) Chapter 25 (pp.722-746) Chapter 26 (pp.747-795) Chapter 28

5

High Risk OB

Chapter 14 (pp.344-397) Chapter 15 (pp.398-442) Chapter 16 (pp.443-460) Chapter 17 (pp.461-484)

6

Exam 2 Well Child/ Hospitalized Child

Chapter 33 (pp.975-1035) Chapter 34 (pp.1036-1063) Chapter 35 (pp.1067-1105)

7

Women’s Health

Chapter 49 (pp.1339-1359) Chapter 50 (pp.1360-1383) Chapter 52 (pp.1400-1434)


K. Faculty Contact List Name Phone E-Mail Office Maureen Waller (630)942-2204 [email protected] HSC 2207C Janice Miller (630)942-2318 [email protected] HSC2207A Nancy Michels (Edward Clinical) Laureen Martin (lab) Email is the preferred mode of communication in this course. Who do I contact? For questions regarding lecture, please contact the instructor that gave the lecture. For questions regarding clinical, please contact your clinical instructor. For questions regarding the test, please contact the faculty member responsible for that content. If you need further assistance, please contact your course team leaders (Maureen Waller and Janice Miller) L. The syllabus is subject to change

mailto:[email protected]

mailto:[email protected]


APPENDIX


1. Postpartum Care Plan/Newborn Assessment

The purpose of these assignments is to provide a learning experience which will enable the student to: 1) Integrate theoretical concepts and scientific principles when applying the nursing process when administering nursing care and; 2) develop and implement a plan of nursing care for an assigned client based on his/her holistic needs.

The student will select a client and follow the instructions on the care plan forms provided in the syllabus. Due date will be one week after selecting your client. All written assignments must be presented in a professional manner. Assignments must be legible, complete and submitted on time. A one-point deduction from your total grade will be made each day they are late. Your clinical instructor will give you instruction, guidance and feedback as needed. Your implementation and evaluation of the developed nursing care plans will assist in the assessment of your clinical performance.

2. Labor and Delivery Observation

A form is provided in the syllabus for your observations during clinical of one client. Forms should be complete, legible and due one week after selected observation.

3. Patient Data Sheets

Patient data sheets should be submitted on each mother/baby couplet cared for. Data should be submitted within one week of caring for your client.

B. Teaching Presentation Guidelines

Each student will develop a 10-15 minute presentation on a topic related to maternal-newborn or family centered care. This presentation should be directed to clients and families. Students will present during post-conference. The presentation should include appropriate teaching aids such as handouts, posters and other material related to the topic. Suggested topics include:

• Bathing your baby (tub bath) • Bathing your baby (sponge bath) • Caring for the breasts while nursing • Techniques for breastfeeding • Post partum care • Sudden Infant Death Syndrome (SIDS) • Shaken Baby Syndrome • Bottle feeding your baby


• Comfort techniques for labor • Sex after pregnancy • Contraception • Programs in DuPage County for new families • Circumcision; pros and cons (include care of the circumcised and uncircumcised male infant) • Signs of illness in the neonate • Newborn/Infant Safety • Infant massage • Signing with your baby

*Other topics may be appropriate; please consult your clinical instructor.



NUR 1207 Grading Sheet: Teaching Presentation Name of Student ______________________________ Date ____________ Possible Points Your Points Objectives clearly presented (1) _____ Content and delivery of presentation (2) _____ Teaching Aids (2) _____ ________ Total 5 _____ Comments: Points earned ______ Instructor Signature ______________________________ Date _________________


TESTING GUIDELINES FOR NURSING 1207

1. Seating for all exams will be provided by a random number system. On the day of the exam,

students will wait outside of the classroom while a faculty member will number the seats in the classroom. At the assigned test time, the faculty member will provide each student with a number as they enter the classroom.

2. Faculty will not answer questions related to the exam on the day of the exam. Please feel free to

contact instructors regarding questions prior to that time. 3. Exam results will be distributed one week after the exam is administered. 4. Questions regarding exam content should be directed to the faculty member who presented the

lecture material. 5. To review your exam, contact the faculty member who proctored the exam. 6. Any discussion regarding test items must occur within one week after exam results are

distributed. All scores become final after that point.


NUR 1207 – THE CHILDBEARING FAMILY ATTENDANCE VERIFICATION FORM (to be used for each observational experience) Name of Student Date and Time of Activity Name of Activity Location of Activity Name of Contact Person Signature of Contact Person Phone number of Contact Person


Maternal – Infant Nursing Student’s Name: _____________________ Patient Data Sheet Date: _____________

Room

Patient’s Initials

Age

Allergies

Physician’s Orders

Diet Activity IV Additional Physician’s Orders

Nursing Activities (orders/Interventions) (please include your own) Current Diagnosis

Concurrent Medical Conditions and their Relationship to current diagnosis

LAB/Diagnostic tests(include results and interpretation)

Type/ Date/Time of Delivery

Blood Type _____ Rh _____ Hep B ____ STS/VDRL/RPR _______

T ___________ P ____________ R ___________B/P LOC and orientation Ability to follow commands Pupils (PERLA) Senses: Vision Hearing Touch Speech Complaints of discomfort Skin: Color Condition Mucous membranes Respiratory status: Quality O2 Lung sounds Use of accessory muscles Cardiac status: Apical purse Regularity Appetite Nausea Vomiting Bowel sounds Bowel Movements Abdomen Surgical incision Dressing Voiding Foley

Peripheral IV: ml/hr site Saline lock site Extremities: Upper: Color Warmth Capillary refill

Lower: Color Warmth Capillary refill Pedal pulses Peripheral edema Mobility status Galt Transfer Ability to perform ADL Muscle strength Emotional status/concerns: Verbal communication Nonverbal communication Spiritual concerns/needs Ethnic/cultural concerns/needs Maternal/Infant Bonding Assessment Pain Assessment (0-10 Scale) ____________________________________ Other comments:


Postpartum Assessment:

Breasts: Soft _____ Full _____

Fundus: Firm? _____ Midline? _____ Location _____

Lochia: Type _____ Amount _____

Episiotomy/incision: Type Condition Bladder Palpable _____ Non-Palpable_____ Voiding________________ Assessment for signs of DVT________________ Neonatal Assessment:

Sex _____ Birthweight _____ Kg. Gestational Age _____ Length_________in___ Head Circumference_________cm

Vital signs – T______ P________R_________

Respirations -__________________________________

Color -________________________________________

Feedings -_____________________________________

Urination -_____________________________________

Stooling -______________________________________

Circumcision -__________________________________

Vitamin K Given

Erythromycin Ointment Given_________

Summary of Newborn Physical Assessment

Nursing Diagnoses (*include Gordon’s Functional Health Patterns for each diagnosis) Postpartum (3) Neonate (3) Teaching presented: ____________________________________________ Discharge Planning Hep B __________ RhoGam ________ Circ ___________ Rubella Vaccine _________ Picture _________ Newborn Screening __________ Discharge Teaching___________

Postpartum Care Plan



COLLEGE OF DUPAGE NAME __________________________ ADN PROGRAM DATE NURSING 1207 INSTRUCTOR

POSTPARTUM ASSESSMENT AND CARE PLAN Mother's Initials____ Age____ Gravida____ T_____ P._____ A_____ L_____ EDD____ Delivery Date____ Time____ Postpartum day____ Type of delivery_________________ Wound__________________ Diet______________ Activity____________ Breast or formula feeding_________ Physician's Initials_____________

Current Physician's Orders (Include All Postpartum orders)

Rationale Relevance for this Client


I. Collection of Data A. Significant Social, Psychological, Medical History 1. Social a. education _____________ marital status __________________ career plans _________________________________________ b. family (who is living at home, extended family in area) __________________________________________________ c. husband's (or significant other's) career _______________ 2. Cultural/Spiritual Needs a. ethnicity __________ religion __________ b. effects on postpartum care _________________ 3. History of psychiatric or emotional problems _______________ ___________________________________________________________ 4. Medical history (not related to reproductive system) a. previous illnesses _____________________________________ b. previous hospitalizations ______________________________ c. previous surgeries _____________________________________ d. family history (genetic disorder, cancer, diabetes, etc.) _______________________________________________________ e. other __________________________________________________ B. Significant Reproductive and Obstetrical History a. previous surgeries, hospitalizations ___________________ _______________________________________________________ b. previous labor and delivery experiences ________________ _______________________________________________________ c. age of onset of menses ______ duration of menses _______ L.M.P. _________ abnormalities _______________________ d. date of first prenatal visit ____ number of visits ____


e. wt. gain _____ medications taken during pregnancy ______

________________________________________________________

f. Blood type ________ RH _______

g. preparation for childbirth _____________________________

h. diagnostic tests done during pregnancy (include Blood type, Rh, RPR, or STS, Rubella, and Hep B, ultrasound exams, Genetic Studies, and other tests should also be included)

(see prenatal record)

Name Date Results Norms Significance

C. Identified Medical, Obstetrical, or Genetic Risk Factor D. Events Precipitating this Hospital Admission (why did she come to the hospital when she did: contractions, ruptured membranes, etc.) E. Labor and Delivery 1. length client normal range evaluation length first stage _______ ____________ __________ length second stage _______ ____________ __________ length third stage _______ ____________ __________ 2. Medications (identify drug classification, name route, dosage, time etc.) analgesic anesthetic oxytocic first stage ___________ __________ __________ second stage ___________ __________ __________ third stage ___________ __________ __________ other medications used:


3. Fetus/Neonate FHR range during labor ________ Monitor leads used ________ Signs of distress _________________________________________ ___________________________________________________________ Sex of baby _____ 1 minute Apgar _____ 5 minute Apgar _____ Anomalies? _________________ Resuscitation needed (other than bulb syringe) ________________________________________ Condition now _____________________________________________ 4. Mother Complications during labor and/or delivery? _______________ ___________________________________________________________ Her description of the experience _________________________ ___________________________________________________________ Her contact with neonate in delivery room (see, touch, hold, etc.) ___________________________________________________________ support system ____________________________________________ other relevant information ________________________________ F. First 2-3 hours postpartum complications _________________________________________________ comments or significant data __________________________________ II. Current General Assessment A. Circulatory Status B. Temperature Status C. Respiratory Status D. Mental Status


E. Emotional Status F. State of Rest and Comfort G. Sensory Perception H. Mobility Status I. Nutritional Status J. Elimination Status K. State of Skin and Mucous Membrane L. Family Involvement III. Assessment Specific to the Postpartum Client A. Vital sign's (Today's) Your client's Normal Significance Temperature _____________ ___________ ____________ Pulse _____________ ___________ ____________ Respiration _____________ ___________ ____________ B. Fundus 1. Present location in relation to umbilicus____ firmness _____ 2. Expected location and firmness for this postpartum day _____ C. Lochia 1. Flow today (rubra, serosa, alba) _______________ 2. Expected flow for this postpartum day ______________ 3. Amount (none, scant, mod., heavy) ________ Expected ________


D. Perineum 1. Wound (type)___________________ Appearance _________________ Expected appearance ________________________________________ Deviations from normal: ____________________________________ 2. Describe present care of wound ________________________ Is she complaining of discomfort due to her wound?________ If yes, what is being done to decrease this discomfort?_______ 3. Does she have hemorrhoids? ______ Are hemorrhoids expected at this time?_______ Why? _____________________________________ What is/can be done to reduce discomfort due to hemorrhoids? ____________________________________________________________ 4. other ______________________________________________________ E. Breasts 1. Describe appearance and consistency (soft, firm, engorged, painful, redness, lumps, etc.) ____________________________ ___________________________________________________________ 2. Expected appearance and consistency for this postpartum day ____________________________________________________________ 3. Condition of nipples (red painful, inverted, cracks, etc.) ____________________________________________________________ 4. Expected condition for this postpartum day _________________ ____________________________________________________________ 5. Deviations from normal:_____________________________________ ____________________________________________________________ 6. If she is breastfeeding, describe degree of success: _______ ____________________________________________________________ 7. If breastfeeding, describe present breast care being given: ____________________________________________________________


9. Does this patient need a referral to a lactation consultant? _____________________ Why?_______________________________________________________________ F. Elimination 1. Time of first voiding after delivery _______ Amount ________ 2. Expected length of time between delivery and first voiding: ____________________________________________________________ 3. Deviations from normal: ____________________________________ G. If delivered by C/S 1. Condition of incision/dressing _____________________________ ____________________________________________________________ 2. Deviations from normal: ____________________________________ 3. Type of incision (classical, low cervical transverse)_______ 4. Abdomen (soft, distended) ________ Bowel sounds ____________ Flatus ___________________ 5. Urinary Catheter _________________ 6. I.V. ___________________ 7. Lungs __________________ 8. Legs (tenderness, Homan's sign) _______________ 9. Activity: __________________________________________________ ____________________________________________________________ 10. Level of comfort: __________________________________________


H. Bonding 1. Is mother at "taking in" or "taking hold" phase? ___________ (Support answer with illustrations) ________________________ ____________________________________________________________ Expected phase for this postpartum day _____________________ Comments ___________________________________________________ 2. Identify factors which might be significant in interfering with bonding between this mother

and baby (consider prenatal, labor & delivery, support system, sex of child, comfort of mom, etc.)

3. Identify signs that indicate a healthy mother-baby relationship (remember, baby should be

included). 4. Identify signs that indicate that mother and baby are having some difficulty establishing a

positive relationship.


I. Current Medication (include PRN Medications) NAME OF DRUG DOSE FREQUENCY SIDE EFFECTS NURSING

IMPLICATION


Nursing Diagnoses (list actual and potential and include "related to" and "manifestation" factors can be wellness-related) List in order of priority. A minimum of 5 diagnoses are required; Additional diagnoses constitute a stronger care plan. (* Include Gordon’s Functional Health Pattern for each Diagnosis)

Develop one diagnosis:

Nursing Diagnosis Goal Nursing Intervention Scientific Rationale Evaluation

Nursing Diagnosis: Gordon’s Functional Health Pattern:

Objective

Related to: Outcome Criteria Subjective

As manifested by: Conclusion





Objective







Objective








Objective



NUR 1207 Postpartum Assessment and Care Plan Grading Sheet Name of Student ______________________________Date____________ Area Possible Point(s) Your point(s) General Assessment 1 ______ Nursing Diagnoses/Gordon’ Functional Health Patterns 2 ______ Nursing Process 2 ______ Total 5 ______ Comments: Points earned ______ Instructor Signature ______________________________ Date _________________



Newborn Assessment

College of DuPage NAME _______________________ ADN Program NEONATAL ASSESSMENT AND CARE PLAN NURSING 1207 DATE _______________________ INSTRUCTOR _______________________ Age of neonate at time of Assessment ____________________ I. Newborn Assessment Mother's Initials _________ Date of Birth __________ Time of birth __________ Sex _______________ Instructions: Using the assessment guide provided, do a complete assessment on your client. In the first column, write the data for your neonate. In the second column, write the expected, or normal findings, according to your texts. In the third column, write your evaluation of the comparison between the expected data and your infant. Remember to be descriptive, specific and objective and to evaluate in relation to: gestational age, anomalies, central nervous system function, peripheral nerve function. Do not put WNL!

Your neonate Expected or normal range Significance A. Nutritional Status 1. Birth weight and length

2500 – 4000 grams 18” - 22” (48-52 cm.)

2. Weight now (% lost)

10% or less

3. Intake per 24 hours

Breast feeding – q 2-3 hours Bottle feeding – q 3-4 hours

4. Type of feedings (Calories)

Calculate based on type of formula or breast milk.

5. General Appearance (sub q fat, etc.) tone

Pink skin is elastic and returns to normal shape after pinching; acrocyanosis may be normal.

6. Regurgitation, emesis

Occasional spitting of mucus or feeding normal; emesis should not

exceed 10-15 ml.


Your neonate Expected or normal range Significance B. Physical Characteristics 1. Head Circumference

32-37 cm

a. anterior fontanel size

3-4 cm long by 2-3 cm wide;

diamond-shaped

b. posterior fontanel size

1-2 cm at birth; triangle-shaped. May not

be palpable due to molding.

c. other (caput, cephalhematoma, etc.)

May be present in first 48 hours

2. Chest a. circumference

32.5 cm on average

b. cm. difference between head and chest

1-2 cm less than head

c. shape

Normal shape without depression

3. Genitalia a. appearance

Male: Testicles descended Female: Labia majora covers

labia minora

b. discharge

White discharge and blood-tinged discharge may be present in

females

c. any abnormalities

N/A


Your neonate Expected or normal range Significance C. Temperature Status (State whether baby asleep, awake, etc.)

Axillary – 36.5-37.2 Rectal – 36.6-37.2

D. Respiratory Status 1. Rate, rhythm, depth

30-60 per minute. Irregular breathing normal; pauses

do not exceed 15-20 seconds

2. Muscles used

No accessory muscles can be used.

3. Symmetry of movement

Abdomen and chest movements are synchronous.

4. Breath sounds

Clear and equal bilaterally.

5. Patency of nose

When mouth is occluded by nipple, infant breathes easily through nose.

6. Presence and characteristics of mucous

Small amounts, clear and thin. May see more in C-section babies soon

after birth.

E. Circulatory Status (State whether awake or asleep)

NA NA

1. Apical pulse rate, rhythm, strength

120-160 BPM Asleep – greater than 100 BPM

Crying – up to 180 BPM

2. Presence of abnormal sounds, rubs, murmurs

No abnormal sounds present.


Your neonate Expected or normal range Significance F. Elimination Status (State whether breast or bottle)

NA NA

1. Bowel a. color, consistency, amount

First 24 hours – Black, tarry meconium. Transitional stool –

greenish, soft.

b. flatus

Occasionally present

c. deviations from normal

N/A

2. Bladder a. frequency

6-8 wet diapers/day Should void within 24 hours of birth

b. color, consistency, amount, odor

Yellow, non-offensive, mild odor. Child may void scant to moderate

amounts per void.

c. deviations from normal

N/A


Your neonate Expected or normal range Significance G. State of Skin and Mucous Membrane 1. Skin a. texture

Smooth; occasional dryness after initial bath; peeling on hands

and feet in post-term infants.

b. color (pallor, cyanosis jaundice, acrocyanosis)

Pink; acrocyanosis may be normal. Jaundice pathologic in first 24

hours.

c. intactness/lesions

No lacerations; no lesions.

d. turgor/dryness

Elastic over abdomen; returns to normal after pinching.

e. rashes, birthmarks, Mongolian spots, etc.

All may be present as normal.

f. vernix/lanugo

May be present on infants born prior to term; assess in axillary & groin areas for vernix and over scapulae

for lanugo.

2. Mucous Membranes a. color

Pink – Assess oral membrane. Moist

b. teeth, gums

Precocious teeth may be present; assess gums for lesions;

Epstein’s pearls.

c. intactness

No lesions or lacerations present.


Your neonate Expected or normal range Significance 3. Umbilicus a. appearance

Cord clamped for first 24 hours; drying; changing in color from

white to a dark color.

b. no. vessels

3 (2 arteries; 1 vein)

c. discharge

None

4. Hair (include eyebrows and eyelashes) a. texture

Smooth; fine variations may be present due to ethnic background.

b. length

Varies

c. distribution

Even over scalp

5. Nails a. texture

Soft, smooth

b. length

May be long and peeling in post-term infants


Your neonate Expected or normal range Significance H. Anomalies (describe)

NA

I. Lab and Diagnostic Studies 1. Blood type and Rh

Any human blood type, Rh

2. Other

Coombs test should be negative

J. Emotional Status 1. Reactions to discomfort (wet diapers, pain,

etc.)

Responds to uncomfortable

stimuli by crying.

2. Reactions to comfort (being held, etc.)

Quiets with comfort measures

K. State of Rest and Comfort 1. Sleep pattern - 24 hrs a. time duration

16-20 hours

b. reactions to noise

Startle response Turns head toward sound if awake.

2. Awake, alert state a. activity - describe

Sleeps 16-20 hours per day. Refer to text for sleep states


Your neonate Expected or normal range Significance 3. Pain, discomfort, restlessness a. time occurs, location

N/A

b. duration, frequency, how relief obtained

N/A

L. Neurological and Reactivity State 1. Level of consciousness a. alertness-quick to respond

N/A

b. drowsy-slow to respond

N/A

c. difficult to arouse

N/A

2. CNS Status Reflexes (describe expected response and

how elicited) a. Babinski

Fanning and extension of all toes when one side of foot is stroked from the heel upward across ball of foot.

b. Moro

Systemic extension and abduction of arms with fingers extended; return to normal relaxed flexion. A response to sudden movement on loud noise.

c. Stepping

When held upright and one foot touching flat surface, will step alternately.


Your neonate Expected or normal range

Significance

d. Palmar grasp

Fingers grasp adult finger when palm is stimulated and held momentarily.

e. Feeding a. rooting

While awake and hungry, stroke side of cheek. Infant will turn in that direction and open mouth.

b. sucking

Infant will suck when gloved finger is inserted into mouth.

c. swallow

Infant will swallow in response to sucking or fluid in mouth.

d. gag

Infant will gag in response to hypopharyngeal stimulation.

f. Protective a. vision

Tracks objects to midline. Fixed focus on objects at t distance of 10-20 inches.

b. hearing

Attends to sounds; sudden or loud noise elicits Moro reflex.

c. sneezing, coughing

Sneeze or cough in response to stimuli.


Your neonate Expected or normal range Significance

3. Muscle tone a. symmetry of movement of

extremities

Symmetrical spontaneous movements.

M. Gestational Age 1. Scarf Sign

Place supine; draw arm across chest toward opposite shoulder. Compare to midline of chest.

2. Areolar Tissue

Areolar and nipple development increases as infant nears term.

3. Popliteal Angle

Degree of knee flexion: Place on back, thigh is flexed, the abdomen flat. Assess angle of flexion on back of knee.

4. Heel-to-ear maneuver

Thing is flexed on the abdomen and chest. Place finger behind ankle to extend the lower leg until resistance is met.

5. Posture

Muscle tone increases as infant approaches term.

6. Foot creases

One crease at top of toe at 36 weeks; increase in number of creases as approaches term.

7. Genital development

Labia majora covers minora as term approaches. Scrotum develops rugae and testicles. Descend near term.



Your neonate Expected or normal range Significance

N. Medications 1. Given in DR

Erythromycin ophthalmic ointment to both eyes; vitamin K 1 mg IM; both given within 1 hour of birth.

2. Given in Nursery

Above medications if not given in DR; Hepatitis B vaccine may be ordered.

II. Developmental stage as described by Erikson: ________________________________________________________ Cognitive stage as described by Piaget: _____________________________________________________________ Describe the rationale for each of the following stimuli for the neonate: black and white mobile, reading to neonate, listening to classical music. Explain

how each stimulus will assist the neonate to accomplish developmental tasks.

NUR 1207 Newborn Assessment Grading Sheet Name of Student _____________________________Date________________ Area Possible Point(s) Your point(s) Student assessment findings 2 ____ Analysis of assessment findings 2 ____ Growth and Development 1 ____ Total 5 ____ Comments: Points earned ______ Instructor Signature ______________________________ Date _________________




Labor and Delivery

Observation


LABOR AND DELIVERY OBSERVATION Nursing 1207 Name _________________________________ Instructor ______________________________ Date __________________________________ I. Identify nursing interventions which you observed in the 4 stages of labor and the rationale for each.

Intervention Rationale Stage 1 1. 1. 2. 2. 3. 3. Stage 2 1. 1. 2. 2. 3. 3. Stage 3 1. 1. 2. 2. 3. 3. Stage 4 1. 1. 2. 2. 3. 3.


II. Develop 2 Nursing Diagnoses specific to each stage of labor (physical and psychological). Stage 1 1. 2. Stage 2 1. 2. Stage 3 1. 2. Stage 4 1. 2. III. List all the medications used on your unit for each stage of labor and the primary action of each. Include

the medications used in the epidural, IV push meds, augmentation meds, etc. Medication Action Stage 1 Stage 2 Stage 3 Stage 4 IV. Identify any of the fetal monitoring patterns that you observed. Describe the nursing implications related

to the observed patterns. (Variability, Bradycardia, Tachycardia, Early Decelerations, Late Decelerations, and Variable Decelerations).


TEST ITEMS Query Form

Student may appeal a test question following the format below. Query forms must be submitted within one week after test results are distributed All queries will be evaluated on an individual basis. If an appeal is granted, there will not be any group distribution of points.

Student Name: __________________________________________________________________ Exam # _________ Date of Exam _____________ Appeal Submitted (Date) ______________ Submitted to: (Instructor) _________________________________________________________ 1. Write the # of the test question below. # Question 2. What concern do you have about this question? What was the rationale for your choice? 3. Cite Three References using the required materials for this course to support your rationale. 1.

2.

3.

Add any additional comments in this section that support your appeal on a separate sheet of paper Faculty Response: ________ Accepted ________ Denied Rationale: Faculty Signature: ___________________________ Date: ________________________ Students who have a query-denied should make an appointment with the faculty member to discuss any concerns about the appeal. Submission of a test item query does not guarantee a change in grade.


Guidelines for Medication Administration NUR 1207

• All medications must be administered with the clinical instructor • Students cannot administer medications with staff nurses • Students cannot administer medications in labor and delivery • Students must be prepared for medication administration by knowing the following prior To the administration of each drug: -Name of drug -Classification -Action of the drug at the cellular level -Side effects -Adverse effects -Nursing implications -Patient education -Is it safe to give? -Correct documentation • Students must know patient allergies at the beginning of each shift • Please be sure that supplies needed for medication administration are available prior to

administration time(fresh water, cup, straw, etc., unless contraindicated)

Concept Map Grading Criteria Group Participants: ______________________________________________________ Possible Points Your Points

1. Provided objectives for the concept 1 _______

2. Presentation/design 1 _______

3. Oral communication 1 _______

4. Stated application/relevance to practice 1 _______

5. Group participation 1 _______ Comments: Points earned ______ Instructor Signature ______________________________ Date _________________


Perinatal Guidelines


Perinatal Nursing Guide DIRECTIONS: Please complete the following norms for the areas of intrapartal, postpartum, and neonatal nursing. This assignment is to be completed by the beginning of your second clinical day (or as directed by your instructor). Please bring the completed assignment with you on the second day of your clinical experience in obstetrics. I. Intrapartal Nursing A. Describe the three phases of the first stage of labor.

1. Early (latent) 2. Active 3. Transition

B. Define the cervical changes that occur during labor. C. Describe ways that the patient can cope with the discomforts of the first stage of labor. D. List aspects of the role of the labor support person (coach). E. Nurses assess the frequency, duration, and intensity of uterine contractions. Describe how

you would assess contractions in each of these areas.

1. Frequency 2. Duration 3. Intensity

F. Describe the nursing assessment/management of a client with an epidural anesthesia in

labor


G. Define the second stage of labor and list its characteristics. H. Describe the third stage of labor. I. Describe four signs of placental separation:

1. 2. 3. 4.

J. Describe 4 nursing assessments in the fourth stage of labor.

1. 2. 3. 4.

II. Postpartum Nursing A. What are the normal pulse and blood pressure ranges for postpartum women? B. Where should the uterine fundus be palpable one hour after delivery? Where should the uterine fundus be palpable one day after delivery? When does it become a pelvic organ? C. Identify and describe the three types of lochia present in the postpartum period.

1. 2. 3.

D. What is the normal hemoglobin for a newly delivered postpartum woman?


E. List three ways a nurse can promote comfort for the postpartum woman?

1. 2. 3.

F. Identify and describe three positions for breastfeeding.

1. 2. 3.

G. Why is it important to know the mother’s Rh status and status of immunity to rubella

prior to discharge? III. Neonatal Nursing A. What is the normal range of heart rate for a neonate? B. What is the normal respiratory rate for a newborn? C. Are newborn respirations usually even and rhythmical? D. What is the normal range for a newborn’s temperature? (Centigrade and Fahrenheit)

1. Rectal 2. Axillary

E. Define meconium. F. Describe the normal stool pattern for a newborn infant. G. How often should a newborn be fed?

1. Breastfed infant 2. Formula fed infant

H. What is acrocyanosis?


I. What is an Apgar score? J. What is Ilotycin (erythromycin ophthalmic ointment)? What is it used? K. What is Aquamephyton? Why is it used? L. What is the first immunization given to the newborn? When is it typically given? M. What are three signs of respiratory distress in the newborn?

1. 2. 3.



Clinical Evaluation Tool


Student's Name ___________________________

Instructor ___________________________

Clinical Site _________________________________

COLLEGE OF DuPAGE ASSOCIATE DEGREE NURSING PROGRAM

CLINICAL EVALUATION TOOL NURSING 1207 Childbearing Family

The following evaluation tool has been developed by faculty to evaluate the clinical performance of each nursing student as it relates to their clinical experience. There are eight major areas for clinical evaluation. This evaluation tool is based on criteria for each course, ranging from Satisfactory to Unsafe. The purpose of the criteria is to give students direction as well as delineate expectations of student clinical performance. Code: S – Satisfactory NI-Needs Improvement U-Unsatisfactory US-Unsafe NO-Not observed NA-Not applicable

CRITERIA FOR EVALUATION Mid Final Comments I. PROFESSIONAL BEHAVIORS

A. Practice within the ethical, legal, and regulatory frameworks of nursing and standards of professional nursing practice.

B. Identify unsafe practices of healthcare providers using appropriate channels of communication.

C. Demonstrate Accountability for Nursing Care given by self and/or delegated to others. D. Use standards of nursing practice to perform patient care. E. Maintain patient rights. F. Maintain organizational and patient confidentiality with respect to HIPPA guidelines. G. Practice within the parameters of individual knowledge and experience. H. Assimilate evidence based to ensure safe effective medication and procedural safety

per institutional guidelines.

I. Recognize the impact of economic, political, social, and demographic forces on the delivery of healthcare.

J. Develop a plan to meet self-learning needs. K. Recognize professional boundaries in the nurse-patient relationship. L. Demonstrates preparedness for the clinical experience. M. Adhere to the standards of behavior in the program handbook and college guidelines.


II. EFFECTIVE COMMUNICATION Mid Final Comments

A. Describe therapeutic communication skills to use when interacting with patients and significant support person(s).

B. Communicate relevant, accurate, and complete information in a concise and clear manner. C. Report assessments, interventions, and progress toward patient outcomes. D. Utilize information technology to support and communicate the planning and provision of

patient care.

E. Utilize appropriate channels of communication to achieve positive patient outcomes. III. ASSESSMENT (Gordon’s level of functioning) MID FINAL COMMENTS

A. Determine the patient’s response to changes in function. B. Assess patient and significant support person(s) for learning strengths, capabilities,

barriers, and educational needs.

C. Assess the patient for changes in levels of functioning D. Assess the patient’s ability to access available community resources. E. Assess the environment for factors that may impact the patient’s health status. F. Assess the strengths, resources, and needs of patients within the context of their

community

IV. CLINICAL DECISION MAKING MID FINAL COMMENTS

A. Review initial clinical judgments and management decisions with instructor to ensure accurate and safe care.

B. Utilize assessment and reassessment data to plan care. C. Apply the nursing process based on Gordon’s functional assessment. D. Determine the effectiveness of care provided in meeting patient outcomes. E. Modify patient care as indicated by the evaluation of outcomes.

V. CARING INTERVENTIONS: MID FINAL COMMENTS

A. Protect the patient’s dignity. B. Adapt care based on the patient’s values and emotional, cultural, religious, and spiritual

influences on the patient’s health.

C. Demonstrate caring behaviors toward the patient, significant support person(s), peers, and other members of the healthcare team.

E. Implement the prescribed care regimen within the legal, ethical, and regulatory framework of nursing practice.

F. Assist the patient to achieve optimum comfort and functioning, including illness prevention and wellness care.

G. Support the patient and significant person(s) when making health care decisions. H. Assess response to interventions.


VI. TEACHING AND LEARNING MID FINAL COMMENTS

A. Identify key elements in an individualized teaching plan based on assessed needs. B. Provide the patient and significant support person(s) with the information to make

choices regarding health.

C. Evaluate the progress of the patient and significant support person(s) toward achievement of identified learning outcomes.

D. Modify the teaching plan based on evaluation of progress toward meeting identified learning outcomes.

E. Teach the patient and significant support person(s) the information and skills needed to achieve the desired learning outcomes.

VII. COLLABORATION MID FINAL COMMENTS

A. Observes the decision making process with the patient, significant support person(s), and other members of the healthcare team.

B. Work cooperatively with others to achieve patient and organizational outcomes. C. Identify how to work with the patient, significant support person(s), and other

members of the healthcare team to evaluate progress toward achievement of outcomes.

VIII. MANAGING CARE MID FINAL COMMENTS

A. Prioritize patient care. B. Review with the instructor the implementation of an individualized plan of care for

patients and significant support person(s).

C. Coordinate aspects of patient care with qualified assistive personnel. D. Adapt the provision of patient care to changing healthcare settings and management

systems.

E. Assist the patient and significant support person(s) to access available resources and services.

F. Identify nursing strategies to provide cost efficient care. Comments: Faculty signature Date Student signature Date The student’s signature signifies that the student has read and discussed this evaluation with the clinical instructor.


STUDENT EVALUATION CRITERIA

S = SATISFACTORY NI = NEEDS IMPROVEMENT U = UNSATISFACTORY I PROFESSIONAL BEHAVIORS S Maintains standards set by College handbook, Program Handbook

Treats others with respect and consideration (colleagues, instructor, patient and family). Develops teamwork skills (flexibility, support of others…). Practices within nursing standards Maintains professional role Identifies and addresses own learning needs Demonstrates understanding of patient rights, especially confidentiality.

NI Needs reminders as to how to function in clinical setting. Does not volunteer or take advantage of learning experiences Identifies weaknesses but unclear in making a plan for improvement. Has difficulty recognizing limitations of student role

U Disrespectful, unethical Unprepared to practice skills, interventions Breaks confidentiality, sees patient and family outside of clinical setting. Jumps in to a situation without reflection, supervision, or being prepared. Compromises patient and unit safety. Diverts medication or supplies

II EFFECTIVE COMMUNICATION S Maintains confidentiality

Applies skills of therapeutic communication Develops a positive nurse-patient relationship Recognizes verbal and non-verbal communication of self and others. Elicits health information from client. Uses charting and written assignments to communicate information effectively

NI Awkward and fearful in communication Avoids interactions with staff


III ASSESSMENT S Collects data accurately and makes assessments based on such data.

Assess major facets of the patient as to individualize care. (physical, developmental, emotional, cultural, religious, spiritual) Determine factors that may inhibit patient recovery.

NI Avoids patient assessment by spending majority of time utilizing written record. Identifies key elements, but needs help incorporating this information accurately.

U Does not collect data comprehensively. Data is inaccurate Unaware of changes in health status

IV CLINICAL DECISION MAKING S Apply critical thinking to designing patient care

Makes decisions within the realm of nursing and within the limitations of a nursing student. Seeks appropriate supervision and assistance. Individualizes plan of care. Evaluates interventions to adapt plan of care

NI Needs instructor assistance to make a substantial amount of decisions Lacks sensitivity to patient needs.

U Makes decisions that are inappropriate or unsafe. Does not communicate with instructor regarding planned actions.

V CARING INTERVENTIONS S Consciously implements planned nursing interventions specific for

identified problems Demonstrates holistic approach to interventions. Sets priorities when administering caring interventions. Maintains a safe environment for patient and self. Adept in new skills and previously learned skills.

NI Needs continuous feedback to implement identified interventions. Needs repeated supervision/instruction of basic skills.

U Does not implement planned nursing interventions when caring for a patient. Takes actions outside the realm of a nursing student. Repeatedly does skills incorrectly.


VI TEACHING AND LEARNING S Identify learning needs of patient/family/community

Integrate teaching/ learning needs when making clinical decisions.

NI Consistently needs instructor to identify learning needs and interventions U Lacks awareness of importance of learning needs in planning and decision

making.

VII COLLABORATION S Demonstrates working relationship with others in the health care team.

Collaborates with patient/family/community Involve assistive personnel in meeting objectives by providing relevant instruction. Able to adapt approaches by working within a team. Actively participates in pre and post-conference. Engages in self-evaluation within the healthcare team.

NI Needs prompting and additional supervision to make better use of team. Ineffective implementation of collaborative efforts. Is not motivated to participate in treatment setting unless prompted.

U Inflexible within a team. Unable to identify areas for room for improvement. Does not collaborate with the healthcare team.

VIII MANAGING CARE S Maintains patient health and wellbeing in a healthcare setting.

Reports changes in patient status with healthcare team. Sets priorities when administering care for assigned patients.

NI Needs frequent prompting to organize and prioritize activities. Requires assistance to set priorities when attempting to care for assigned patients.

U Unable to effectively manage patient care. Unaware that priority setting is important. Ignores priorities when giving care.

Documents

College of DuPage Associate Degree Nursing Program Course Syllabus Fall