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

2

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

3

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: jfeighert@northark.edu cjacobs@northark.edu

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

4

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.

5

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 username@mail.northark.edu

Available On-Campus Resources

6

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 bfrietas@northark.edu 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

7

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.

8

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.

9

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.

10

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.

11

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.

12

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

13

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.

14

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.

15

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

16

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

17

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

18

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.

23

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_______________________

29

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.

31

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

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

41

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?

44

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.

45

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.

46

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:

47

TIME MANAGEMENT

ROOM 0800 0900 1000 1100 1200 1300 1400 1500

48

49

Related Concepts

Related Labs

Priority Assessments

Priority Teaching/ Discharge Goals

Priority Nursing Interventions

Priority Problem(s)

Think Out loud

CONCEPT MAP

50

DIAGNOSTIC PROCEDURE / THERAPEUTIC

PROCEDURE

NURSING INTERVENTIONS

(pre, intra, post)

PROCEDURE NAME

INDICATIONS OUTCOMES/EVALUATIONS

POTENTIAL COMPLICATIONS

NURSING INTERVENTIONS CLIENT EDUCATION

51

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.

52

TEXTBOOK DATA CLIENT BEHAVIOR INTERVENTIONS EVALUATION

Stage/Phase:

53

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________________________________________________

54

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:

55

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:

56

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

57

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

58

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

59

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

60

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:

61

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:

62

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:

63

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?

64

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:

65

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?

66

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/

67

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

68

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

69

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

70

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.

71

Appendix C

Post Conference Material

72

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?

73

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

74

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.

75

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.”

76

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?

77

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.

78

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

79

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.

80

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