SUPPLEMENTARY MATERIALS

INDEX

DESCRIPTION / PAGE
Pediatric Pre-Clinical Worksheet / 31
Nursing Care Plan – Pediatric Clinical Paperwork / 33
Medication for Pediatric Rotation / 41
Postpartum Assessment Form / 42
Nursing Care Plan / 47
Medications for Women’s Center / 48
Prep for Newborn Nursery / 49
Postpartum Prep Form / 50
Prep for Labor Patient / 51
Fetal Heart Monitor Worksheet / 52
Assessment of the Newborn / 53
Surgery Prep Sheet / 56
Family Care Plan / 57
Family Visit Prep Form / 59
Family Assessment Guide /
60
Family Care Plan Agreement / 64

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NUR.3805.S12.pt2

ARKANSAS TECH UNIVERSITY

Department of Nursing

NUR 3805 – Practicum in Nursing II

Pediatric Pre Clinical Worksheet

  1. Read Chapters 35, 41. Chapter 33 is also recommended.
  2. Familiarize self with current immunization recommendations - Print and attach: http://www.cdc.gov/vaccines/recs/schedules/downloads/child/0-18yrs-pocket-pr.pdf
  3. Create vital sign flashcards for normal heart rate and respiratory rates in children for the following age groups:

Newborn, < 2years, 2-6 years, 6-10 years, and 10+ years.

  1. Identify a normal rectal temperature.
  2. List and describe Erikson’s psychosocial stages through adolescence.
  3. Define the role of play therapy. Give appropriate examples of play for the hospitalized child for each of the age groups: (Infant, Toddler, Pre-school & School-age)
  4. Develop communication skills with children of varying ages: You are administering a flu vaccination. How do you communicate this to an infant? A toddler? A pre-schooler? A school-age child? An adolescent?
  5. Complete the fill-in-the-blank items (a-p):
  6. Children are ______small adults. There are important ______and ______differences between children and adults that will change based upon a child’s ______and ______.
  7. The head is proportionately ______, making child susceptible to head ______.
  8. Children have a ______metabolic rate.
  9. Children have ______oxygen needs.
  10. Children have ______caloric needs.
  11. Until about ______years, there is a ______respiratory rate, ______and ______alveoli, and ______lung volume. Tidal volume is ______to weight.
  12. Up to about 4-5 years, the ______is the primary breathing muscle. ______is not effectively expired when child is ______, making the child susceptible to ______.
  13. Until puberty, bones are ______and more easily ______and ______.
  14. Muscles lack ______, ______, and ______during infancy.
  15. The tongue is relatively ______compared to ______nasal and oral passages.
  16. Short, narrow ______in children under ______years makes them susceptible to ______obstruction.
  17. Until late school age and adolescence, ______is ______dependent NOT ______dependent, making the heart rate more ______.
  18. The abdomen offers ______protection for the liver and spleen, making them susceptible to ______.
  19. Until ______to ______months of age, kidneys DO NOT ______urine effectively and do not exert ______control over ______secretion and absorption.
  20. Until later ______, proportion of body weight in water is ______, with more water in ______spaces. Daily water exchange rate is ______.
  21. The anterior fontanelle can be palpable up to about ______months.

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NUR.3805.S12.pt2

ARKANSAS TECH UNIVERSITY

Department of Nursing

NUR 3805 – Practicum in Nursing II

Pediatric Clinical Paperwork

Patient Initials: ______Age: ______Male or Female

Allergy & Reactions: ______□NKA

Medical Diagnose(s) for this hospitalization: ______

Chronic Illness: ______□ N/A

Event(s) that brought patient to the hospital:

Birth History IF <2 years of age:

Document a brief developmental assessment (compare to norms):

HEIGHT / Inches / % Growth Chart
WEIGHT / KG / % Growth Chart
HEAD CIRCUMFERENCE <2yo / Inches / % Growth Chart

Gastrointestinal

Type of Diet
Feeding Assistance
Special Dietary Needs
Factors Affecting Intake/Output
Date of Last BM

Intake & Output

24 Hour Fluid Requirement:
100cc FIRST 10kg
50cc NEXT 10kg
20cc REMAINDER OF WT kg / SHOW YOUR MATH:
□ N/A if >70kg
What was your patient’s total shift intake?
______cc / Was the intake adequate?
□ YES □ NO
Rationale:
Type of IV Fluid:
______@ ______hour
Tubing change due ______/ Why is the patient receiving IV fluids?
□No IV □Saline Lock
24 Hour Output Requirement
1cc/kg/hour / Calculate: (1 x Weight x # of Shift Hours)
□ N/A if > 30cc/hour
What was your patient’s total shift output? / Was the output adequate?
□ YES □ NO
Rationale:

VITAL SIGNS

VITAL SIGNS / MORNING / AFTERNOON / INTERPRET / NURSING
INTERVENTIONS
Temperature / NORMAL HIGH LOW
Pulse / NORMAL HIGH LOW
Respiration / NORMAL HIGH LOW
Blood Pressure / NORMAL HIGH LOW
Oxygen Saturation / NORMAL HIGH LOW

PAIN

CIRCLE Pain Scale Utilized: CHEOPS NIPS RIPS 0-10 FLACC FACES

Pain Score: ______

Interventions for discomfort? ______

Effectiveness: ______□N/A

FAMILY

Who cares for the child? ______

Siblings: ______

Do you observe any abnormal family interaction? □YES □NO

EXPLAIN: ______

INTERVENTIONS NECESSARY: ______

TEACHING

What did you teach the child or family? Why or why not?

Evaluate your teaching:

Play THERaPY

What type of play did you initiate or observe? What toys did you use?

CRITICAL THINKING

1.  During your first interaction with the child/family, what did you notice (odors/smell, general appearance, location and position of child, family & visitor interaction, equipment in room? What were your initial thoughts about the child and family? What emotions did you feel? What came to mind?

2.  What things are connected to or inserted in your client? Make a list of all dressings, tubes, lines, monitors, and equipment that are being utilized for patient care. For each item, explain:

a.  Purpose of item?

b.  How you know the item is accomplishing its intended result?

c.  What about the item or client should be reported to the instructor and staff, why, & how soon?

3.  What are the signs and symptoms of your patient’s problem today?

4.  What interventions did you implement for your patient/family? Include a rationale for each intervention.

5.  Were your interventions effective? Explain. What other interventions could have been implemented?

6.  In your opinion, what did you do well today? What do you need to improve upon? How could your clinical day be improved?

LAB & DIAGNOSTIC TESTING

IdENTIFY THE LAB OR
DIAGNOSTIC TEST / WHY WAS IT ORDERED? / IdENTIFY abnormal RESULTS & cause / nursing interventions

MEDICATIONS

BRAND & GENERIC NAME & DOSAGE / DRUG CLASS / WHY IS DRUG PRESCRIBED / RECOMMENDED DOSAGE / WEIGHT BASED (mg/kg)
DOSAGE CALCULATION
Show your math. / SAFE
Y or N

Prep Sheet

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MEDICATIONS FOR PEDIATRIC ROTATION

The following list includes some commonly prescribed pediatric medications. The student is required to prepare medication cards before their first day of pediatric practicum and maintain throughout the clinical rotation.

Albuterol
Ampicillin
Ibuprofen
Gentamycin
Prelone Syrup/Prednisone Tabs
Pulmicort
Rocephin
Singulair
Solu-Medrol
Tobramycin
Tylenol
Vancomycin
Xopenex
Zithromax

Important Pediatric Measurement Conversions:

5cc = 1 teaspoon
3 tsp = 1 tablespoon
15 cc = 1 tablespoon
30 cc = 1 ounce
1 kg = 2.2 pounds
2.5 cm = 1 inch
1 mcg = 0.001mg
1mL = 1cc
1 gram = 1cc

Pediatric Dosage Calculation EXAMPLE:

Amoxil 40mg/kg/day divided TID

The patient weighs 15 kg.

This drug comes in the concentration of 250mg/5cc.

How many mg per dose? How many cc’s per dose?

40 mg x 15 kg = 600 mg per day

600 mg ÷ 3 = 200 mg per dose

200 mg ÷ 250 mg = 0.8 mg

0.8 mg x 5 cc = 4 cc per dose

POSTPARTUM ASSESSMENT

Student Name:______

IDENTIFYING DATA Date:______Pt initials: ______Age: ______Race: ______Allergies:______

Occupation: ______Medical Diagnosis:______Delivery Type:______

FATHER Age: ______Race: ______Occupation: ______

Gravida: ______Para: ______Abortions: ______

Term: ______Preterm: ______Living: ______

Complications (maternal/fetal): ______

RESPIRATORY

Respirations: Rate______Quality______

Breath Sounds: ______

History of Dyspnea  (caused by): ______

Cough  productive/nonproductive

Bronchitis  Asthma  URI (recent) 

Other: ______

Smoker: yes/no Pk/day: ______No. of years ______

Temperature ______

CIRCULATORY

B/P: ______Pulse: ______

Heart Sounds: ______

Homans: positive/negative

Peripheral Pulses: Radial:______Dorsalis pedis: ______

FOOD/FLUID

Prepregnancy wt: ______Pregnancy wt: ______

Height: ______Skin turgor: ______

Mucous membranes: ______Nausea/Vomiting: ______

Edema:(specify)______

Prescribed diet: ______Appetite: ______

Food preferences/restrictions: ______

Current intake IV solution: ______cc’s (24hr): ______

Fluid intake cc’s (24hr): ______Meal %: ______

ELIMINATION

Usual bowel pattern: ______Laxative use: ______

Last bowel movement: ______Bowel sounds: ______

Hemorrhoids: ______

Difficulty voiding: ______Bladder papable: ______

Foley catheter: ______Protein(if applicable): ______

Output: Urine(cc’s): ______Estimated Blood Loss: ______

Other: ______

Urinalysis report: ______

PAIN/COMFORT

Location: ______Quality: ______Duration: ______

Precipitating factors: ______Guarding: ______Facial Grimace: ______

Pain Scale: No Pain 0 1 2 3 4 5 6 7 8 9 10 Worst Pain Imaginable

HYGIENE

General Appearance: ______

Skin/Hair: ______

ACTIVITY/REST

Prescribed activity: ______Activity tolerance: ______

Gait: ______Range of motion: ______

SAFETY

Hgb&Hct (Pre Delivery& Post Delivery:) ______Rubella Titer______HIV: ______Hep. B: ______Group B Strep: ______

Whitecount: ______Blood Type: ______Baby’s Blood Type ______

Coombs: ______

CBC: Platelets: ______Serology/Syphillus______

BREAST Breast or Bottle Feeding (circle one)

If breastfeeding, complete the following – poor, fair, well (circle one)

Bra: ______Nipples (shape,condition): ______

Colostrum: ______Latching on: ______

Any referral to Lactation specialist______Any pt education during stay?___

UTERUS

Fundus: Consistency:______Height:______Position:______

Lochia: Color:______Amount:______Clots:______

IF antepartum FHT’s ______

Episiotomy/Lacerations: Type______Swelling______Redness/or drainage: ______

Surgical incision: Appearance:______

Type: ______Dressing: ______


SEXUALITY

Menarche: ______Frequency: ______Duration: ______

Amount: ______LMP: ______

Pap smear: ______Contraceptive Plan: ______

Self Breast Exam: ______

SOCIAL INTERACTION/EGO INTEGRITY

Pregnancy planned (Y/N): ______

Cient/father adjustment to newborn: ______

Marital Status: ______Living With: ______

Role within family structure:______

Extended family/other support: ______

Financial Concerns: ______

Religion: ______Cultural Factors: ______

Report stress factors: ______

Emotional status: (check those which apply) Calm Anxious Angry Depressed Fearful Irritable Resistive Other(specify): ______

Verbal/nonverbal communication with family/significant other: ______

Bonding behavior: ______

NEUROSENSORY

Hearing Aid: ______Glasses: ______Contacts: ______

Headaches: Location: ______Frequency: ______

Seizures: ______Reflexes: ______

MEDICATIONS (List all routine and prn meds given)

Drug name/mg How prescribed Purpose

______

TEACHING/LEARNING

Educational background (mother/father): ______

Previous childbirth experience: ______

Preperation: Books______Classes______

Learning needs identified by client: ______

Learning needs identified by Nurse: ______

Referrals: ______

In Hospital teaching: ______

Discharge Teaching: ______

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NURSING CARE PLAN
DATE / NURSING DIAGNOSIS / PLAN (Outcome) / IMPLEMENTATION / RATIONALE / EVALUATION

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The student is expected to maintain a drug card, or mark in drug book, on each of the medications ordered for their assigned client. It is the responsibility of the student to know and understand the drugs. The following lists are some of the common drugs used.

DRUGS
Nursery Meds / Post partam/Labor & Delivery Meds / Post partam/Labor & Delivery Meds
Ampicillin / Alka-Seltzer Gold / MMR
Aquamephyton (Vit K) / Anaprox DS/Anaprox / Morphine
Claforan / Aldomet / (Narcan) Naltrexone
Erythromycin ointment / Apresoline / Penicillin G
Gentamyacin / Benadryl / Peri-Colace
Hep B / Bicitra / Phenergan
Narcan (Naloxone) / Brethine (Terbutaline) / Pitocin
Calcium Gluconate / Reglan
Cervidil / Rhogam
Cytotec / Stadol
Demerol / Tylox/Percocet
Duramorph / Vistaril
Dulolax / Vicodin
Ephedrine / Xylocaine
Fentanyl / Zofran
FESO4 / TDAP
Hemabate / Clindamycin
Labetalol
Magnesium Sulfate
Methergine
Ancef

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PREP FORM FOR NEWBORN NURSERY

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1. Discuss the risk for respiratory and cardiovascular complications in the newborn.
2. Discuss the risk for heat loss in the newborn and what nursing interventions are used to prevent them.
3. Discuss the pathophysiology in regards to newborn jaundice. Also discuss the
different types/causes of jaundice and treatment.
4. Discuss elimination patterns of the newborn (voiding and stooling).
5. Complete the clinical significance for the assessment of the newborn including
normals and abnormals.
6. Describe the process of assigning APGARS at birth including the fine criteria of
assessment.
7. Summarize the indication and use of Vitamin K, Hepatitis B, and Erythromycin.
(Including site of administration and proper equipment)
8. Identify teaching and learning needs of the new mother and family of a newborn.
9.  Discuss hypoglycemia criteria and treatment in the newborn.
10.  Discuss feeding methods and timing in the newborn. (breast, bottle, gavage)

Be prepared to answer questions, verbally or by quiz, during the clinical day.

1. Describe the physiologic and psychologic changes that occur in the postpartal period and the proper nursing assessment techniques utilized during the first 24 hours.
2. Discuss nursing interventions related to Pregnancy Induced Hypertension.
3. Define Fundus and discuss techniques and deviations to assess.
Discuss Involution and expected progression.
Define Lochia and discuss stages, dosing, and administration.

4. Discuss the use of MMR and DTAP vaccines.

Also discuss the indications, dosing, and administration of Rhogam.
(Be prepared to discuss appropriate sites, syringe, and needle size and length.)
5. Discuss care of the episiotomy site.
6. Discuss breast care for the lactating and non-lactating mother.
7. Describe the nurse=s role in teaching and learning needs of the new mother and family and how early discharge effects this process.
8. Discuss the risk factors for postpartum complications and the nursing assessment needed to identify the factors and interventions to prevent them.
9. Discuss the TORCH diseases and identify the current protocols for prevention in the immediate postpartum period.
10.  Discuss the role of Rhogam. Discuss when and who should receive this medication.

Be prepared to answer questions, verbally or by quiz, during the clinical day.

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NUR.3805.S12.pt2

PREPARATION FOR LABOR PATIENT

To improve the student's learning experience when attending and caring for the first labor patient the following should be completed. The information should be written on additional pages.
1. Identify those characteristics which impact significantly on the client=s expectations in labor.
2. Discuss physical and psych-social care needed by all patients in labor.
3. Complete asterisk* areas on Fetal Heart Monitor Strip Worksheet.
4. List normals in the following statistics:
Blood pressure:
Pulse:
Fetal heart rate:
Respirations:
5. Discuss symptoms which signify dangers to mother and/or infant and the pathophysiology.
6. Be able to define terms: Presentation, position, dilation, station, effacement, contraction, duration, frequency and intensity.
7. Discuss the different types of anesthesia and analgesia during labor and possible effects to mother and/or baby.
8. Discuss pitocin for induction vs. use during the recovery period. Discuss Magnesium Sulfate for the pre-eclamptic pt vs. the preterm patient. Discuss assessment and risk factors for both pitocin (oxytocin) and magnesium sulfate. Identify the antidote for magnesium sulfate toxicity
9. Discuss the risks for pre-term labor, the current means for identifying patients at risk, and the identification and protocols for group B strep.

Be prepared to answer questions, verbally or by quiz, during the clinical day.