NURS3608 Family Developmental Stressors Fall 2004 1
Note: These Self-Study Modules are designed to help students become familiar with terminology or interventions unique to maternal-child nursing. Students’ knowledge of this contentwill be tested on the last day of clinical preparation (see class schedule). Each student is expected to carry a copy of the completed pertinent Self-Study Module during their clinical practicum.
SELF-STUDY MODULE I: Clinical Orientation Guide for ANTEPARTUM/POSTPARTUM
I. REQUIRED ACTIVITIES:
A. Readings:
Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
B. Audiovisuals:
View VC 780; "Postpartum Assessment";
VC 1076 “Breastfeeding” (Medla)
VC 1001 Importance of Fatherhood
C. Be prepared to perform postpartum physical examination on the first day of your clinical experience.
II. STUDENT OBJECTIVES: By the completion of this module, the student should be able to:
A.Define the following terms as applicable during the antepartum period:
amniocentesisnonstress test
amniotic fluid indexoligohydramnios
antibodyparity
antigenpreterm labor
biophysical profilepolyhydramnios
clonustocolysis
fundal heightultrasound
gravida
B. Define the following terms as applicable during the postpartum period:
after painslochia
boggy uterusperineal lacerations
breast engorgementpostpartum blues
colostrumpostpartal chill
CVA tendernesspostpartum depression
diastasis rectiREEDA
episiotomyuterine involution
Homans’ signuterine atony
C. Collect information and demonstrate knowledge of the following medications frequently prescribed for antepartum/postpartum patients to include specific purpose, actions, usual dosages, routes, contraindications) and nursing responsibilities:
acetaminophen (Tylenol)magnesium sulfate (MgSo4) crystals
Dermoplastmagnesium sulfate (MgSo4) intravenous
dibucaine (Nupercainal) ointmentmeperidine (Demerol)
docusate sodium (Colace)methylergonovine maleate (Methergine)
ferrous sulfate or gluconatepromethazine (Phenergan)
hydrocodone/acetaminophen (Lortab) Rh immune globulin (RhoGAM)
hydroxyzine hydrochloride (Vistaril) rubella vaccine
ibuprofenterbutaline (Breathine)
lanolinvitamin E
magnesium hydroxide (MOM)zidovudine (AZT)
D. Identify the significance of the following laboratory work for the antepartum/postpartum patient (include normal ranges where applicable):
1. Antepartum:
blood typing: ABO and Rh Papanicolaou smear
Rh antibody screen or titer (indirect Coombs)red blood cell count (RBC)
glucose tolerance test, or 1 hr glucose loadingrubella antibody test (HAI titer)
gonorrhea/chlamydia/syphilis/HIV testsurinalysis
Group B streptococcus screenVDRL/RPR/FTA
hepatitis screen
2. Postpartum:
hemoglobin & hematocrit (H&H)
platelet count
prothrombin time/partial thromboplastin time (PT/PTT)
E.Briefly describe the following commonly seen conditions in patients during the antepartum/postpartum periods.
1. Antepartum:
multiple pregnancy
gestational diabetes (GDM)
pregnancy induced hypertension (PIH)
preeclampsia /eclampsia
2. Postpartum:
postpartum hemorrhage (PPH)
puerperal infection
mastitis
- Describe the following specialized skills/teaching in the antepartum/postpartum clinical area. Be prepared to perform these on the first day of your clinical experience.
1. Calculate estimated date of birth or delivery (EDB or EDD) using Nagele’s rule
2. Measure fundal height
3. Obtaining fetal heart tones (FHTs)/fetal movement count
4. Provision of perineal care
5. Assistance with breastfeeding
6. Teaching regarding postpartum experiences:
parent - infant interaction
self care
breastfeeding
infant care
7. Postpartum Maternal assessment:
breasts
uterine fundal height & position
abdominal assessment: (diastasis recti, bowel sounds, C/S incision)
CVA Tenderness
perineum for: REEDA, episiotomy, hemorrhoids, lochia, superficial lacerations
reflexes
clonus
Homan's Sign
SELF-STUDY MODULE II: Clinical Orientation Guide for LABOR & DELIVERY
I. REQUIRED ACTIVITIES:
A. Readings:
Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
B. Audiovisuals:
View VC 655 Fetal Monitoring; VC 1095A & B “Understanding Birth”.
II. STUDENT OBJECTIVES: By the completion of this module, the student should be able to:
A. Differentiate true labor and false labor to include Braxton Hicks contractions.
B. Define the following terms related to uterine contractions:
duration
frequency
intensity
intrauterine pressure catheter (IUPC)
tocotransducer (TOCO)
C. List and briefly define the stages and phases of labor.
D. Collect information and demonstrate knowledge of the following medications frequently used in labor and delivery to include specific purpose, actions, usual dosages, routes, contraindications and nursing responsibilities:
butorphanol (Stadol)misoprostol (Cytotec)
calcium gluconatemorphine sulfate (MSO4)
carboprost (Hemabate)nalbuphine (Nubain)ephedrine naloxone (Narcan)
fentanyl (Sublimaze) oxytocin (Pitocin)
Lactated Ringer’s (IV fluids)
E. Define the following terms in relation to fetal monitoring.
baseline fetal heart rate range variable decelerations
variabilitylate decelerations
bradycardiainternal vs. external fetal monitoring
tachycardiaearly decelerations
accelerations
F. Define the following terms in relation to the intrapartum period:
abruptio placentaLeopold’s maneuvers
amnioinfusionvaginal delivery (SVD)
amniotomy/amniohookplacenta previa
Cesarean section (C/S) uterine atony
G. Discuss the importance of maternal elimination and fluid intake during the intrapartum
period.
H. Define the following terms in relation to progress of labor:
dilation
station
effacement
I. Outline the nursing care for the laboring woman, fetus and family.
J. Identify six comfort measures for the laboring woman and give a rationale for each.
K. Discuss the nursing care of a laboring woman with epidural/spinal anesthesia.
L. Discuss the care of the laboring woman after the membranes have ruptured.
M. Identify the significance of meconium stained amniotic fluid.
N. Explain in detail how to determine the Apgar score and times it is assigned.
O. Discuss four priority interventions for immediate care of the newborn (first ten minutes) after birth.
P. Outline the care of a woman experiencing a C/S.
Q. Identify the nurse’s responsibility in the legal documentation for: time of birth and delivery of placenta, newborn and maternal identification, Apgar score and newborn’s weight.
R. Describe the nursing assessment and care of a patient during the 4th stage of labor.
SELF-STUDY MODULE III: Clinical Orientation Guide for Newborn Nursery
I. REQUIRED ACTIVITIES:
A. Readings and Workbook
1. Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
2. Smith, S., Duell, D. & Martin, B. C. (2004). Clinical nursing skill: Basic to advanced skills (6th ed). Upper Saddle River, NJ: Prentice Hall Health.
a. Bathing an infant
b. Newborn physical assessment
c. Infant urine specimen
d. Using the infant radiant warmer
e. Suctioning infant with bulb syringe
f. Using a pediatric oxygen face mask
g. Using an Oxygen Hood
B. Audiovisuals: Videos:
1.VC 1096 Providing Newborn Care
- VC 894, Gestational Age Assessment (1991) PurdueUniversity
- VC 671, Newborn care; VC 258 Bathing the newborn
- VC 677, Physical Assessment of the Normal Newborn – good review prior NBN assignment
C. Be prepared to perform a gestational age assessment (Ballard) and physical assessment on the first day of your clinical experience in Newborn Nursery.
II. STUDENT OBJECTIVES: By completion of this module the student should be able to:
A. Define the following terms:
1. The Skin:
a. acrocyanosisg. vernix caseosa
b. cyanosis h. Mongolian spots
c. jaundice (pathologic and physiologic) i. lanugo
d. plethoricj. milia
e. mottle/mottlingk. erythema toxicum
f. petechiae
2. Respiratory:
a. periodic breathingf. surfactant
b. nasal flaringg. respiratory distress syndrome (RDS)
c. expiratory grunt h. transient tachypnea
d. retractions (intercostal, substernal, i. crackles
sternal)j. wheezing/rhonchi
e. diaphragmatic respirationsk. xiphoid cartilage
3. Heart:
a. active precordiumd. ductus venosus
b. murmurse. foramen ovale
c. ductus arteriosus
4. Genitalia and rectum:
a. hypospadiasf. meconium
b. epispadiasg. pseudomenstruation
c. hydroceleh. uric acid crystals
d. hymenal/vaginal tagi. anal fissures
e. circumcision
5. Extremities:
a. polydactylyd. brachial plexus injury
b. syndactylisme. hip clicks and dislocated hips
c. Simian creasesf. clubfoot
6. Head, Neck, Face:
a. moldingf. cleft lip and cleft palate
b. caput succedaneumg. Epstein's pearls
c. cephalhematomah. macroglossia
d. fontanel (anterior, posterior)i. macrognathia
e. sutures (coronal, lambdoid, sagittal, squamosal)
7. Reflexes:
a. palmare. walking reflex
b. rootingf. Babinski
c. suckg. plantar
d. Moro
8. Eye:
a. conjunctivitis
b. subconjunctival and retinal hemorrhages
- tracking
- red reflex
9.Ears:
a. position
b. tubercles
c. ear tags, pits
10. Thermoregulation
a. nonshivering thermogenesisd. convection
b. neutral thermal environmente. evaporation
c. conductionf. radiation
11. Gestational Assessment
a. AGAe. VLBW
b. SGAf. IUGR
c. LGAg. gestational age assessment tool (Ballard)
- LBW
B. Know the following common drugs used in the clinical area in terms of the purpose, side effects, adverse affects, contraindications, and nursing responsibilities:
1. erythromycin ophthalmic ointment5. ampicillin
2. vitamin K6. gentamicin
3. triple blue dye7. hepatitis B immune globulin (HBIG)
4. hepatitis B vaccine8. oxygen
C. Identify normal laboratory findings in the newborn and relate abnormalities to pathologic conditions:
1. glucose, dextrostix5. electrolytes, calcium
2. complete blood count, differential, 6. magnesium level
and reticulocyte count7. septic work-up
3. bilirubin & Coombs test8. guiac stool
4. RBC antibody screen (direct Coombs 9. C-reactive protein (CRP) (see lab reference)
or direct antiglobulin)
D. Identify common problems and appropriate interventions with newborns: hypoglycemia, hypothermia and hyperbilirubinemia
E. Describe common skills performed in the newborn clinical area
1. taking vital signs
2. assessing gestational age using Ballard assessment tool
3. head to toe physical assessment of the NB:
a) obtaining anthropometric measurements
b) assessing the fontanels
c) assessing neonatal reflexes
d) performing Ortolani's maneuver
4. preventing heat loss in a neonate
5. performing routine neonatal care:
a) cleaning scalp and faceg) obtaining a urine specimen from a urine
b) feeding and diapering collection bag
c) umbilical cord careh) obtaining chemstrip accu check, dextrostix
d) suctioning with a bulb syringe serum glucose for blood sugar and/or
e) giving an IM injection hematocrit
f) performing a heel sticki) rectal temperature
j) administration of eye ointment
SELF-STUDY MODULE IV: Clinical Orientation Guide for Intermediate Care Nursery and Pediatrics
I. REQUIRED ACTIVITIES:
A. Readings and Workbook
1. Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
- Smith, S., Duell, D. & Martin, B. C. (2004). Clinical nursing skill: Basic to advanced skills (6th ed). Upper Saddle River, NJ: Prentice Hall Health
B. Videos:
1. VC 1039 Pediatric Medication: Principles and Calculations
II. STUDENT OBJECTIVES: By completion of this module the student should be able to:
- Describe oralgastric (OG) tube placement in a newborn.
- Describe development care for a high-risk newborn or ICN graduate (Pillitteri, 2003, p. 744-745)
- Review documentation of intake and output for neonate and pediatric patients, including blood out (Pillitteri, 2003, p. 733).
- Describe concept of playroom in Pediatrics.
- List signs and symptoms of child abuse.
- Review stages of psychosocial and cognitive development according to Erikson and Piaget (Pillitteri, 2003, p. 782-787) and age appropriate nursing implications.
- Describe family-centered care (Pillitteri, 2003, p. 20-21)
- List normal ranges for vital signs in pediatrics
- Collect information and demonstrate knowledge of the following medications frequently used in pediatrics to include specific purpose, actions, usual dosages (mg/kg and usual schedule), routes, contraindications and nursing responsibilities:
acetaminophen suppositorygentamicin sulfate
albuterolglycerin suppository
allopurinolmethylprednisolone sodium succinate (Solu-Medrol)
aminophyllinemetoclopramide hydrochloride (Reglan)
ampicillinmontelukast (Singulair)
caffeinemupirocin (Bactroban)
cefotaxime sodium (Claforan)phenobarbital
codeinephenytoin
digoxintheophylline
fosphenytoin sodiumvancomycin hydrochloride
furosemidezinc oxide
ABBREVIATIONS frequently found in maternal/child and/or pediatric health records (Provided for student information only; use of abbreviations in documentation is discouraged due to errors in communication):
Ab-Abortion
ALL:-Allergies, allergic
A.R.O.M.-Artificial rupture of membrane
B.O.W.-Bag of water
B.P.D.-Biparietal diameter
B.P.M.-Beats per minute
Br-Breast
B.T.L.-Bilateral tubal ligation
cm. or cms.-centimeter or centimeters
Contr or UC-Uterine Contraction
C/S-Cesarean Section
CVA- Costovertebral angle
Cx-cervix
D&C-Dilation and Curettage
D.R.-Delivery Room
EDB- Estimated date of birth
EDC- Estimated date of confinement
EDD- Estimated date of delivery
EFM-External Fetal Monitor
E.B.L.-Estimated blood loss
Eff.-Effacement
E.F.W.-Estimated fetal weight
ELF-Elective low forceps
F.H.R.-Fetal heart rate
F.H.T.-Fetal heart tones
F.L.-Femur length
Grav-Gravida
ICN-Intensive Care Nursery
Inc.ab-Incomplete abortion
IUFD-Intrauterine fetal demise
IUPC-Intrauterine Pressure Catheter
LBR-Labor Birthing Room
L&D-Labor and Delivery
L.G.A.-Large for gestational age
LMP-Last menstrual period
MgSO4-Magnesium Sulfate
Missed ab-Missed abortion
Multip-Multipara, has borne more than one viable fetus
NBN-Newborn nursery
NSVD-Normal spontaneous delivery
NKDA-No known drug allergies
Nullip-Nulliparous, never having borne a child
O.B.-Obstetrics
O.R.-Operating Room
Para-Parity
PCN-Penicillin
P.I.H.-Pregnancy Induced Hypertension
P.P.T.L.-Postpartum tuballigation
P.P.-Postpartum
p.p.-Presenting part
PPROM-Prolonged preterm rupture of membranes (>24 hrs, <37 wks)
Primip-Primipara, has produced one infant
PROM-Prolonged rupture of membranes (>24 hrs.)
REEDA- Redness, ecchymosis, edema, drainage, appearance
ROM-Rupture of membranes
R.R.-Recovery Room
SAB-Spontaneous abortion
Sta.-Station
SE or FSE-Scalp Electrode
S.G.A.-Small for gestational age
S.R.O.M.- Spontaneous rupture of membranes
TAB-Therapeutic abortion
TIUP-Term intrauterine pregnancy
TOCO-tocodynamometer
TOP-termination of pregnancy
US-Ultrasound
VE-Vaginal Exam
LTV-long-term variability
ABSENT 0-2 BPM
Minimal = 3-5 BPM
Average to moderate = 6-25 BPM
Marked = greater than 25 BPM
STV-Short Term Variability, Present, Absent
Late decel-Late deceleration
Early decel-early deceleration
VAR decel-variable deceleration
Revised by SGW, JW, & VF: 7/04