Welcome to Childrearing Clinical
Orientation
1
How do we contact our Childrearing clinical
instructors? (page 1)
• Michelle Maloy
• C: (302) 379-3478, E-mail:mmaloy1@dtcc.edu
• Gail McIlvain-Simpson
• C: (302) 690-2744, E-mail: gsimpso7@dtcc.edu
• Diane Toto
• C: (610) 425-0526, E-mail dtoto@dtcc.edu
2
When and What time
3
Exercise
Write name on colored index
card
• Write down one thing
you would like to learn
by the end of this
rotation.
• Are you looking forward
to the rotation or fearful
of it and why?
• What is your experience
with children?
4
5
What to Bring?
Clinical
Notebook
Blank
Paperwork
(Database &
Concept
Map)
DTCC ID
Stethoscope,
penlight,
watch with
2nd hand,pen
Epic ID &
password
What do you need to start your
day?
• Active orders
and MAR
• Preconference
• Computer to gather
information
Plan out your Clinical Day
8
Case Study
• You are assigned to a 3 month old ex Premie who was
admitted yesterday with a diagnosis of bronchiolitis and RSV.
• What are you going to do first?
9
What are 3 pieces of Information you need
and how do you get them?
10
Case Study
• On 2 L of oxygen and receives nebulizer treatments every 4
hours. Febrile and receiving acetaminophen for fever above
38.5. Additionally, has a history of gastroesophageal reflux and
poor feeding. Parents are unable to stay in the hospital with
the child.
• What comes next?
Getting report –
Ask specific questions in regards to your
individual patient (what do you need to
know to effectively care for that patient
during your clinical time on the unit.)
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12
ADIET
• Acknowledge, eye contact, smile, positive
attitude& welcome
• Duration
• Introduce
• Explanation (explain what you are doing and
why)
• Thank you
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•
•
•
•
•
Bath/Linen changes
Assessments
Physiologic assessments
Developmental stimulation
Required nursing skills with
instructor
• Offer help to classmates &
nurses
• Intravenous therapy &
medications
• Respiratory medications
• TPN (Total parenteral
nutrition)
• Point of care testing (Gail
& Elizabeth)
• Document in EPIC
Alarming – What to do?
15
VS, Pain scale, PO2(hourly)
mood
Time, route, & patient
• See clinical notebook &
• handout
16
Required Nursing Skills
Instructor needed (pg.6)
Omission =Clinical advisement
1. Procedures related to alternative feeding
techniques
2. Pediatric Administration of Medications
3. Dressing Changes
4. Catheterization, suctioning, and enemas
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Pain Scale (page 17,18)
18
Weights and Heights (pg. 4)
19
Syringe or Kangeroo pump
20
Need to do on every Child (pg.4)
Intake
Output
21
22
Hourly Rounding
• Pain
• Potty
• Position
• Patency
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Giving Meds???
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Medications
• Are you giving medications that day?
Did you inform your nurse that you were giving medications?
Identify resources – Drug info – Lexi Comp
Have MAR & know how to read it
Make sure a Computer with med scanner is in room
Is the computer charged (check LED)?
Does the patient have on ID bracelet?
Have you explored how patient takes medication
What supplies are needed?
Have you notified instructor of best timing for medication?
Have you thought about Developmental implications?
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Medication Administration
Medication Room
Pyxis
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Pediatric Medication Knowledge (pg. 7)
•
•
•
•
•
•
Generic and trade name.
Classification
Mechanism of Action
Dosage – compare to calculation of min/max per dose
Side effects and possible adverse reactions
Nursing considerations including necessary assessment before/after giving the
medication.
• Patient education/preparation
• Have pertinent Lab data and assessment available (electrolytes, PTT, BP, HR, etc.)
• The information must be readily available prior to the instructor’s presence
(written in your care plan, on individual cards, or on notepaper.
• Note: An omission at any step in the procedure may be reflected on a Clinical
Advisement Form.
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28
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Break/Lunch (pg 5)
• A mid-morning break (20minutes) or lunch/dinner break will
be provided.
• The timing of the break should be based upon your child’s
needs and the nursing care needed.
• Let the staff nurse and the instructor know when you are
going to leave the unit.
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Downtime
• Make sure you have collected essential information
needed for Databases and Concept Maps
• Are there other services you can provide to your child
and their family?
• Is the room straightened up & restocked?
• Can you assist fellow students with their
assignments?
• Every student needs to complete all work before we
can leave
• Is there anything you can do to help the unit?
• Explore resources
• Are there other learning opportunities?
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What resources do I have available?
Personnel
•
•
•
•
•
•
•
•
•
Advanced Practice Nurses
Specialty nurses
Social Work
Child Life
Library
Pharmacist
Ward/unit clerk
Aide
ETC…………
Non Personnel
• Lexi Comp – pharmacy
issues
• Info Link – evidence
based medicine
• KIDSHEALTH.org –
child/family information
• Library
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You go where your patient
goes
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34
Announcements
• Code Blue
• Code Red
• Tag alert
• Delta alert
• Trauma alert
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Giving report – Be succinct & organized
Demographics, assessments (VS, I&O, pain scales, weight,
ht, head circumference), tests, alerts, status.
Consultations, visitors.
You must give report before leaving unit!!
Return paperwork
37
Childbearing Community Protocol
You will be in the community for your pediatric clinical experience on
• Monday ______________
• This is a MANDATORY Clinical Day
•
•
•
•
In blackboard -“Course Protocols”
Select Childrearing Community Protocol
Then Community Protocol Information
Then Agency Protocols (take copy of questions)
• Time 0800-1400 except Head Start (AbJones and Marshalton) 0815-1300
• Take your lunch
•
Your clinical instructor will be rotating to all of the community clinical sites.
• Assignment: Answer your Questions on Blackboard by Wednesday
Call your clinical instructor to notify her of any absence or lateness by 0700.
•
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Pediatric Community Schedule
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Assignments
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Assignments for Clinical Weeks
Please make change in Clinical Notebook
• Refer to Clinical Notebook and Clinical Instructor for specifics
• Community Self Evaluation
• Research Article & Rubric
•
•
•
•
Data Base (Discuss with clinical instructor)
Concept Maps
Growth chart
Self Reflection – Part 2
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Assignment for Community Week
Pediatric nursing evidence-based research article
2008-2013 year of publication
Research conducted in US
Use library Database – see specific instructions on Blackboard i.e. EBSCO Host
Article should not be a letter to the editor, news letter, medical newsletter, case
study, professionals discussion or Kidshealth.org.
You are welcome to show or email your article to your instructor
Read the article and highlight key information
Use Rubric from clinical notebook to evaluate article
To be complete you need to
write score and comments on rubric
Complete the self-evaluation for the community on Blackboard as we explained
previously
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Article Example
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Department of Associate Degree of Nursing
NUR 144
Student Name: _________________________________________
Research Article Rubric
Factor
Code/
Description
W1
Content
Relevance
W2
Quality of
Expression
Total
Pts
30
30
W3
References
20
W4
Mechanics
10
W5
Formatting
10
Unacceptable
Article misses
some of the
content specified
by the instructor
and/or the
coverage of the
content is
superficial
(1-23)
Article is unclear
and/or
disorganized;
use of vocabulary
and/or syntax
would be
unacceptable for
professional
publication
(1-23)
References are
not cited and/or
the primary
sources are from
non-peer
reviewed sources
(1-15)
Article has
numerous
typographical,
spelling and/or
punctuation
errors
(1-7)
Article is not
research-base
generated and/or
is in substantial
non-compliance
with APA
guidelines
(1-7)
Acceptable
Target
Article addresses the
content specified by
the researcher
(24-26)
Article fully and
thoroughly addresses
the content specified by
the researcher
(27-30)
Article is clear;
vocabulary and syntax
are sometimes less
formal than expected
for professional
publication
(24-26)
Article has a scholarly
quality, express points
in a clear, logical and
organized manner;
contain vocabulary and
syntax that reflect
standards suitable for
professional
publications
(27-30)
Article has cited
references from
primarily peer reviewed
journals
(18-20)
Article has references
many of which are not
from peer reviewed
journals
(16-17)
Article has few
typographical,
grammatical, spelling
and/or punctuation
errors
(8)
Article is free of
typographical,
grammatical, spelling
and punctuation errors
(9-10)
Article is researchbase generated and is
in substantial
conformance to APA
guidelines; minor
deviations are noted
(8)
Article is research-base
generated and in
conformance to APA
guidelines
(9-10)
Date: _________________
Scor
e
Comments
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100
Database Review
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Student name:
NUR 144 Concept Map
Chief Complaint: My child is having trouble breathing
Medical Diagnosis: Pneumonia
#1
Impaired Gas Exchange
related to
ventilation/perfusion imbalance
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Respiratory rate: 52
Heart rate: 180
Substernal and subclavicular retractions
Breath sounds: bilateral wheezes, lower lobe crackles
Lethargic
Pulse Ox: 96%
O2 2 liters nasal cannula
Skin color: pale
Semi-fowlers position
Respiratory therapy treatments: q 4 hours
Chest x-ray: bilateral pneumonia lower lobes
IV therapy: D51/2 NS at 50ml/hr
Rocephin 500 mg IV q hours
Provide frequent rest periods
Minimize fatigue
Teach parent how to recognize retractions
Short Term Goal
Maintain pulse ox at 95% or greater
Met
X
Unmet
#2
Hyperthemia
related to
illness
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Temp 39.2C axillary
Tylenol 180 mg every 4 hrs for temp>38.5C
Tylenol po 180mg suspension given at 0900
Temp reassessed at 1000: 38.2C
Monitor intake and output
I: 200ml O: 150ml
Lumbar puncture: negative
White blood cell count: 11.5
Blood cultures: negative
For each Nursing Diagnosis, include the following: Assessment from related
system, Lab Values, Interventions, Nursing actions, Medications, therapies,
and patient teaching.
Short-term goal, must be realistic, measurable, have a time frame and an
evaluation.
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Self Reflection Assignment
• Refer to Blackboard
Assignments
• You should have a well
written objective to
discuss in Part 2
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Clinical Objectives *****
To pass this course clinically, the student must meet all clinical objectives.
Specific Clinical Performance Criteria for each clinical objective are listed in the course syllabus.
1. Implement safe nursing care incorporating theoretical knowledge, the nursing
process and concepts of critical thinking for the individual patient.
2. Employ therapeutic communication techniques when interacting with the
client and members of the health care team.
3. Demonstrate caring behaviors respecting the diversity of the individual
patient.
4. Demonstrate the management concepts of organization and collaboration
while caring for the individual patient.
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5. Incorporate knowledge of the ethical and legal standards of nursing practice
when caring for the individual patient.
Implement safe nursing care incorporating theoretical
knowledge, the nursing process and concepts of
critical thinking for the individual patient.
NANDA
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Database
Concept
Map
Employ communication techniques when interacting with
the patient and members of the health care team.
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Demonstrate caring behaviors acknowledging the
.
diversity of the individual patient
•
•
•
Identify available resources
Demonstrate nonjudgmental approach
Tactful & respectful approach
51
Demonstrate the management concepts of organization and
collaboration while caring for the individual patient.
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Incorporate knowledge of ethical and legal standards of nursing
practice when caring for the individual patient.
d. Follow course protocol for reporting absences and lateness.
f. Submit written materials on time.
• Professionalism
• Being prepared for clinical
• Submitting assignments on time
53
What will make you
successful or unsuccessful?
Successful
•
•
•
•
•
•
•
•
Show up on time
Appropriately prepared
Critically thinking
Good organization
Use resources
Help others
Complete your job
Non judgmental
•
•
•
•
•
•
•
Unsuccessful
Late or do not call
Unprepared
Not connecting the dots
Poor organization
Disregard resources
Sitting around, studying
NUR 143/144 content
Doing work that should
have been completed as
homework
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Advisements
• Issues regarding clinical objectives will be sited via
advisements
• For example : Not calling instructor as per protocol for
lateness or absence.
• Not submitting required work on time
• Inability to perform vital signs
• Unprofessional behavior
55
Attention!!!!
• Please read DTCC emails,
announcements and
check voice mails daily
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Case Study #1 Pain Assessment 5th vital
sign
•
•
•
•
•
Patient: 2 year old, white, female
Chief Complaint: “Fever, neck red and swollen”
Admitting Diagnosis: Left Lateral Neck Cellulitis
Objective Data: VS- 38.2C, 145, 26, 127/72;12kg, 85cm
Left lateral neck swelling, erythematous ulceration (4cm in diameter), warm
to touch, small amount of serosanguinous drainage noted, pt. holding head
towards the right and guarding neck, pt’s mother reports, “she’s not herself,
usually very playful and talkative”, pt. now fussy, with occasional moans,
more difficult to console, increased tone in b/l legs, and a worried facial
expression.
• Subjective Data: Pt. reports, “boo boo” as she points to her left lateral neck.
• Orders: Q4 VS, I & O, IVF’s, IV antibiotics, Regular diet as tolerated, Bid
dressing changes, I&D of wound, blood cultures, and patient isolation
• Medications: IV Clindamycin, PO Tylenol
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As a group please answer the following
questions:
• What is the pts weight percentile?
• What is the pts height percentile?
• What immunizations should this pt have had already? And, at
what ages?
• In evaluating the pts level of pain, which pain tool would you
choose? Why?
• List 2 possible nursing diagnosis for this patient?
• What developmental stage is appropriate for this pt according
to Freud? Erickson? & Piaget and what are some
interventions.
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Immunizations
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Any Questions?
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Thanks for your attention!!
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