SCHOOL OF NURSING
CLINICAL PACKET
Catalog: NR48
Course Title: Maternal/Child Health Nursing
Credits: 4
Revised: 12/2007
6/2007
6/2006
JA/CK
NR48 CLINICAL PACKET
TABLE OF CONTENTS
OBSTETRIC INTERACTIVE SKILLS LAB 1
CLINICAL FOCUS 2
8 POINT POSTPARTUM ASSESSMENT 3
DAILY NURSING PROCESS PLAN 5
OBSTETRIC NURSING ASSESSMENT TOOL 8
NR48 LAB / DIAGNOSTIC TESTS 12
NEWBORN PHYSICAL ASSESSMENT TOOL 13
CLINICAL ASSIGNMENTS COVER PAGE 15
TEAM LEADER RESPONSIBILITIES 16
EVIDENCED BASED RESEARCH 18
CRITICAL THINKING RUBRIC TO ANALYZE THE APPLICATION OF
NURSING PROCESS IN STUDENT NURSING CARE PLANS 21
SELF EVALUATION CRITERIA 29
CLINICAL EVALUATION 30
GUIDELINES/FAILED CLINICAL DAY 33
WRITTEN ASSIGNMENT REQUIREMENTS 34
SUFFOLK COUNTY COMMUNITY COLLEGE
SCHOOL OF NURSING
NR48 Orientation - Obstetric Interactive Skills Lab
Work in groups of 3, students will choose and delegate tasks within each group.
Student 1 ______
Student 2 ______
Student 3 ______
COMPLETE ALL 7 PARTS AND GIVE COMPLETED FORM TO INSTRUCTOR
1. Undress newborn, measure and record: Student ______
a. Head circumference ______
b. Chest circumference ______
c. Length ______d. Weight ______lbs ______oz
e. Temperature (simulate) ______
2. Bathe newborn (based upon film). Identify what you will do in sequence of bathing newborn:
(extremities, diaper area, face, trunk, shampoo)
a. ______Student ______
b. ______
c. ______
d. ______
e. ______
3. Perform circ (circumcision) care and (umbilical) cord care.
Explain technique and supplies: Student ______
Circumcision care ______
Cord care ______
4. Each student will practice dressing newborn (NB) in undershirt, diaper and receiving blanket.
Student 1 ______
Student 2 ______
Student 3 ______
Which students' newborn was wrapped:
a. "the cutest" ______
b. "snugly" ______(remember NB likes to feel like they're still in the womb)
5. Demonstrate positioning newborn for feeding with formula and breastfeeding.
Demonstrate various positions for burping newborn.
6. Position newborn in "crib" after feeding. Student ______
What is the position to avoid? ______
What positions are suggested after feeding? ______
7. Practice 8 Point Post-Partum Assessment: “BUBBLE HE”
B - ______H - ______
U - ______E - ______
B - ______
B - ______
L - ______
E - ______
12/07
SUFFOLK COUNTY COMMUNITY COLLEGE SCHOOL OF NURSING
NR48
CLINICAL FOCUS
1. Identify obstacles to parenting, bonding and client learning about self and newborn.
2. Implement client education on one (1) important area of focus identified through
assessment.
3. Describe a comparison of Nursing Care for NSD vs C/S delivery.
4. Identify client adaptations to both physiological & psychological changes of pregnancy.
5. Assess complications of pregnancy and nursing interventions required, ie prolonged
nausea & vomiting àIV therapy (home or hospital).
6. Prioritize nursing interventions addressing postpartal physiological & psychological
changes.
7. Identify the impact of NB teaching and response for new parents.
8. Determine consequences of unexpected early deliver to a primipara vs multipara.
9. Discuss the impact of an adolescent pregnancy or substance abuse on Newborn, the family
and nursing staff.
10.Share the physical and emotional impact of respiratory stressors of a Newborn on the
family.
11. Discuss patient expectations/reactions to the intrapartal & postpartal experience.
12. Identify and present post partum stressors & adaptation for adolescent, Primip and
Multip.
SUFFOLK COUNTY COMMUNITY COLLEGE
SCHOOL OF NURSING
8 POINT POSTPARTUM ASSESSMENT
How carefully do you make routine postpartum checks? Do you follow a logical order of assessment or neglect one or two or maybe three steps now and again? Is your assessment as meaningful for the mother as for the next person who will read her chart?
To avoid any such problems on the maternity unit, our students use an 8 point check when assessing postpartum patients. It promotes concise, accurate charting and insures early detection of postpartum abnormalities. It also provides the opportunity to teach self and baby care to the mother during assessment. Here’s how you can use the system, too.
Before beginning, be sure that the mother has emptied her bladder and that she is lying in a supine position on a flat bed. Explain each procedure to her and inform her of your findings.
1. Breasts: Gently palpate each breast. What is the contour? Are the breasts full, firm, tender? Are the
veins distended? Is the skin warm? Does the patient complain of sore nipples and are her breast so engorged that she requires pain medication?
If you feel nodules (lumps) in the breasts, they may be there because the ducts were not emptied at
the last feeding.
Take this opportunity to explain the process of milk production. Instruct her on what to do about
engorgement; show her how to perform self-breast examinations, and answer any questions she may have about breastfeeding.
2. Fundus: (uterine) – Position client with knees flexed and head flat. Palpate the fundus with clean
examination gloves on. Stabilize uterus at symphysis with one hand. Below umbilicus, cup hand and press firmly into abdomen. It should be firm and should decrease, approximately one fingerbreadth below the umbilicus each day. Have the patient feel her uterus as you explain the process of involution. If the uterus is not involuting properly, check for infection, fibroids and lack of tone. Unsatisfactory involution may result if there are retained secundines or the bladder is not completely empty. Ex: Day 1 (2 to 24 hours) Fundus at umbilicus or just below, Firm @ U
3. Bladder: Inspect and palpate the bladder simultaneously while checking the height of the fundus.
Bladder distension should not be present after recent emptying. When it does occur, a suprapubic rounded bulge over the bladder area is observed, dull to percussion while at the same time, the mother usually feels a need to urinate. When bladder is distended, uterus is bogy well above umbilicus, and to client’s right side. Ask client to void, measure amount voided. If unable to void – an order from the physician is necessary so that catheterization may be done. The physician may order a culture and sensitivity test, since definitive treatment may be required. Reassess after voiding (catheterization). Bladder should not be palpable.
Infection of the urinary tract must be prevented from occurring. This is why it is imperative that the first three postpartum voidings be measured and should be at least 150 cc. Frequent small voidings, with or without pain and burning, may indicate infection or retention. If voidings are frequent and large, explain the diuresing process to the mother.
Talk to the mother about proper perineal care. Explain that she should wipe from front to back after voiding and defecating. This helps prevent urinary tract infection and is a hygienic principle that pertains to females of all ages. Peri bottle with warm water should be used every time she voids or defecates.
4. Bowel function: Question the patient daily about bowel movements. She must NOT become
constipated. If her bowels have not functioned by the second postpartum day, you may want to start her on a stool
softener. Encourage her to drink extra fluids and to select fruits and vegetables from her menu (avoid sweets, etc.).
Notify the doctor if the lochia looks abnormal in color or quantity, if it has an unusual odor or contains clots
other than small shiny ones. Inform the mother about what changes she should expect in the lochia and when it should cease. Instruct her on when her next menstrual period will probably begin and when she can resume sexual relations. You m ay also want to discuss family planning at this time.
5 Lochia: Assess the amount and color of lochia on the perineal pads in relation to the number of
postpartum days. Teach client that for the first 3 days, she should find a very red lochia, similar to the menstrual
flow. During the next few days it should become watery or serous, and on the tenth day, it should become thin and
colorless (yellow or white). Check linen under mother’s buttocks for additional drainage.
.
6. Episiotomy/Perineum: Ask or assist client to turn on her side and flex upper leg on hip. Although
episiotomies are routine, don’t overlook the importance of inspecting them thoroughly. Use a flashlight if necessary for better visibility. To determine if the wound is healing properly, check for infection, inflammation and suture sloughing. Is the surrounding skin warm to the touch and does the patient complain of discomfort? You should notify the doctor if any occur. Also check the rectal area. If hemorrhoids are present, the doctor may want to start the patient on a sitz bath and local analgesic medications.
Most postpartum patients – especially those who are mothers for the first time will have questions about stitches. “When will they be removed?” “Will they pull out during bowel movement?” Reassure her as you answer these and other questions she may have regarding her pain, cleanliness, and coitus.
7. Homan’sign – assess lower extremities for: swelling and’or tenderness.; full ROJM, no muscle eakness
skin warm, dry and intact. Dorsalis pedis and pedal pulses present
8. Emotional status: Throughout the physical assessment, notice and evaluate the mother’s emotional
status. Does she appear dependent or independent? Is she elated or despondent? What does she say about family support? Are there other nonverbal clues?
SA Hard drive/ J. Anderson Folder
Revised 5/15/07, 12/07
DAILY NURSING PROCESS PLAN
NR 48
NANDA DOMAINS1. Health Promotion 4. Activity and Rest 7. Role Relationships 10. Life Principles
2. Nutrition 5. Perception/Cognition 8. Sexuality 11. Safety/ Protection
3. Elimination 6. Self Perception 9. Coping/Stress Tolerance 12. Comfort
13. Growth/Development
Date of Care ______Pt. Initials_____ Age ____ Room #_____EDC_____ Date/Time of Delivery______Gestation______
Pregnancy History: G:_____ P:_____(T:______P:_____A: ____ L:_____) Type of Birth ______Reason______
Wt.______Ht. ______Diet ______Appetite ______Formula/Breast/Frequency______
Admitting Diagnosis: ______
Surgical Procedure (C/S, Episiotomy, Laceration, Anesthesia,)______
PMH/PSH/Social/Family (include birth health history, maternal (pregnancy) health history, childhood medical history,______
______
______
Allergy to drugs, food, or environment ______
Immunization Profile ______Activity ______
Vital signs: T:______Pulse: ______Apical: ______RR: ______B/P: ______SaO2 ______Pain Scale:______
IV ______( Solution, Site, Gauge, Date, Time)
Intake ______Output ______Foley Catheter ______Drains ______
SUBJECTIVE/OBJECTIVE ASSESSMENT: Circle and describeClient’s Stressors
Include positive and significant negative findings. (BUBBLE HE)
Domain #5, 11: Neurological
S:
O: / B
Domain # 5, 6: Mood/Affect/Emotions
S:
O / U
Domain # 4: Thorax and Lungs
S:
O / B
Domain # 4:Cardiovascular
S:
O: / B
Domain # 4: Peripheral Vascular
S:
O: / L
Domain # 2,3: Gastrointestinal
S:
O: / E
Domain # 3,8: Genitourinary
S:
O: / H
Domain # 4, 11: Musculo-Skeletal
S:
O: / E
Domain # 2, 3, 11, 13: Skin, Hair, Nails
S:
O:
DAILY NURSING PROCESS PLAN
Generic/Trade / Major Therapeutic Effect/
Major Adverse Effect / Nursing Responsibilities
Add additional pages as necessary.
Labs / Client Values / Expected Values / Labs / Client Values / Expected ValuesRBC / GBS Status
Hgb / Rubella Titer
Hct / Hep B sAg
Platelets / U/A
WBC
Type & Rh
HIV / Drug Level
RPR / Other
Add additional pages as necessary with interpretation of abnormal values.
Diagnostic Tests; Procedures; Treatments; Dressings:Client/Parent Teaching Topics: : (include health education/prevention based on developmental age and culture)
PRE/POST-CONFERENCE DIAGNOSES/COLLABORATIVE PROBLEMS
Tentative Nursing Diagnosis / Interventions / EvaluationsActual Nursing Diagnosis
Add additional pages as necessary
Nursing Note: Consider Subjective and Objective Data that records Client’s response to interventions for the Actual Diagnosis/Collaborative ProblemsNewborn
Date of Care ______Pt. Initials ______Age _____ Room # ______Date/Time of Delivery ______Apgar; ______
Birthweight: ______gms. ______lbs.______oz ______Length: ______cms ______inches
T: (should be .97.5)______AP: ______RR:______Skin color: ______
Voiding Pattern: ______Stooling Pattern:______
Umbilical Site: ______
Circumcision Site: (if applicable)______Voided after Circ ______
BLOOD TYPE ______COOMBS ______
Accucheck: ______mg/dL Frequency of Monitoring: ______
AC#1 ______AC#2______AC#3 ______
Feeding: Breastfeeding/Formula (circle one of both)
Breastfeeding:______Amount of Time on each breast at a feeding ______
Formula: ______Amount taken and tolerated ______
Frequency of feeding: ______Time of last feeding ______
Sleeping:
Numbers of hours during day______
Numbers of hours during night______
Complete Drug Order / Safe Dose? / Classification
Generic/Trade / Major Therapeutic Effect/
Major Adverse Effect / Nursing Responsibilities
Add additional page as necessary
Labs / Client Values / Expected Values / Interpretation of Abnormal Values
Glucose
Type & Rh
Total/ Direct Bilirubin
PRE/POST CONFERENCE DIAGNOSES/COLLABORATIVE PROBLEMS
Tentative Nursing Diagnoses / Interventions / Evaluations
Actual Nursing Diagnoses
SUFFOLK COUNTY COMMUNITY COLLEGE
SCHOOL OF NURSING
OBSTETRIC NURSING ASSESSMENT TOOL
Student's Name ______Date of care ______
Patient's Initials ______Marital Status ______Age ______Height ______Weight ______
Date of Admission ______T ______P ______Apical ______Resp. ______BP ______
Allergies (Drugs, Food, Tape, Dyes and others) ______
Reason for Admission ______
______
Definition of Diagnosis ______
Past Medical and Surgical History:
A. Previous hospitalization; injuries; surgeries______
B. Childhood/Adult illnesses______
C. Immunization history (especially note rubella status)______
D. Current health habits:
NO YES
1. exercise ¨ ¨ Identify: ______
2. smoking ¨ ¨ PPD ______
3. alcohol ¨ ¨ Frequency? ______How Long? ______
4. caffeine intake ¨ ¨ Identify? ______Frequency ______
E. Current medications:
Name, Dose, Frequency and reason for use: ______
______
Family Medical History: ______
Prenatal History:
A. G: ______; P:______; ** ( T:______; P: ______; A: ______; L: ______)
B. Blood Type & Rh ______Pertinent Lab Data: H&H ______WBC ______PLTS______
C. Describe prenatal care
1. Date prenatal care began______
2. Type of care (e.g.; ¨ clinic; ¨ private physician; ¨ nurse midwife, etc.)______
3. Client perception of prenatal care experience:
¨ satisfactory ¨ unsatisfactory ¨ other:
Explain ____________
D. Nutritional status during pregnancy
1. Weight gain (include pre-pregnant and pre-delivery weights)______