CLINICAL
INFORMATION
37
1ST 8 Weeks
DX Group
EX Group
CLINICAL SCHEDULE FOR NURSING 222 – 2016
Wednesday, January 20, 2016 – Preclinical Skills Lab
Bring N222 Syllabus and Nurse Kit
Place: Nursing Skills Center
Time: 0800 – 1400
Susan Graven, Instructor
Tuesday, January 26, 2016 – Orientation
Bring N222 Syllabus and Nurse Kit
Wear uniform, CSM patch, and name tag
Meet at Peninsula Hospital Lobby
Time: 0800 – 1400
Susan Graven, Instructor
Thursday, January 21, 2016 – Preclinical Skills Lab
Bring N222 Syllabus and Nurse Kit
Place: Nursing Skills Center
Time: 0800 – 1400
Irene Luciano, Instructor
Friday, January 22, 2016– Orientation
Bring syllabus, wear uniform, CSM patch, and nametag
Meet at Kaiser Redwood City Hospital Lobby
Time: 0800 – 1400
Irene Luciano, Instructor
2nd 8 Weeks
AX Group
BX Group
CX Group
37
Thursday, March 23, 2016 – Preclinical Skills Lab
Bring N222 Syllabus and Nurse Kit
Place: Nursing Skills Center
Time: 0800 – 1400
TBA, Instructor
Friday, March 24, 2016 – Orientation
Bring syllabus, wear uniform, CSM patch, and nametag
Meet at Kaiser Hospital Hospital Lobby
Time: 0800 – 1400
TBA, Instructor
TBA – Preclinical Skills Lab
Bring N222 Syllabus and Nurse Kit
Place: Nursing Skills Center
Time: 0800 – 1400
TBA, Instructor
TBD – Orientation
Bring syllabus, wear uniform, CSM patch, and nametag
Meet at Kaiser Redwood City Hospital Lobby
Time: 0800 – 1400
TBA, Instructor
Tuesday, March 21, 2016 –Preclinical Skills Lab
Bring N222 Syllabus and Nurse Kit
Place: Nursing Skills Center
Time: 0800 – 1400
Susan Graven, Instructor
Wednesday, March 22, 2016 – Orientation
Bring syllabus, wear uniform, CSM patch, and nametag
Meet at Peninsula Hospital Lobby
Time: 0800 – 1400
Susan Graven, Instructor
NURSING 222 MATERNITY NURSING
Pre-clinical Skills Lab Content
∗
∗
See clinical schedule page for the date for your clinical group. There is only
one preclinical skills lab in this course. The other clinical day during the first
week will be used for orientation to the clinical facility.
Bring nursekit and London textbook.
Skills Lab Focus:
Common medications administered to women and neonates
IV maintenance, flow rates – primary and secondary
Assessment: postpartum patient and neonate
Interventions for postpartum patient related to perineal, hemorrhoidal pain,
comfort and hygiene
Breastfeeding – positioning, latch, interventions, problems
Activities:
Review procedure for medication cards and highlight common medications
administered and rationale for administration
IV’s – practice priming, labeling and running primary and secondary bags for
gravity flow and pump
Discuss and practice how to set the IV pump for various rates
Assessment – Postpartum Assessment
View video on postpartum assessment
Practice assessment on manikins
Discuss common interventions for perineal, hemorrhoidal pain
Discuss perineal pads, assessment and removal
Breastfeeding
View video – Breastfeeding – How to
Discuss techniques, latch, positioning, sore nipples and other potential
problems and interventions
Assessment – Newborn Assessment
View videos – Assessment of the Newborn/Gestational Age Assessment
Highlight and discuss assessment techniques
Readings: London, 4th edition, Chapters 24, 25, 26, and 29-30.
37
Clinical Orientation Guidelines
* Categories will vary with clinical agency
LDR ROOMS
1. Locate patient charts and procedure manuals. May be located on computer.
2. Explore an empty room and locate fetal monitoring equipment, sterile supplies, and
neonatal supplies stored in the room.
3. Find the census board where patient’s names or initials and labor status are
recorded.
4. Locate the operating rooms where surgical births take place.
5. Discover the mechanics of the birthing bed.
POSTPARTAL EQUIPMENT OR AREA
1. Locate supplies commonly used, such as peripads, linens, breast pumps, panties, IV
tubing, fluids.
2. Search the medication area, pyxis or cart and book. Identify the most commonly
given medications and how to document them.
3. Find the equipment used for vital signs and place to document.
4. Find charts and procedure manuals. May be located in computer.
5. Located teaching materials, including any audiovisuals.
6. Locate the room or unit refrigerator and tray areas. Find out how meals are served.
7. Find out what the visitor policy is for fathers, siblings, and extended family
members.
NURSERY AREA AND EQUIPMENT
1. Locate commonly used equipment, such as scales, thermometers, medications,
diapers, formula, linens, bottles, etc.
2. Identify the open radiant warmer and its temperature regulating features.
3. Find out where syringes, lancets, blood glucose monitors are kept.
4. Locate the board and equipment used for circumcision.
5. Locate resource materials and patient charts. May be located on computer.
37
CLINICAL NURSING COMPETENCIES MEASURED IN ALL ASPECTS OF CARE
As you progress through the nursing program, each course builds on the knowledge, skills,
and abilities of the previous course. Therefore, you are expected to perform competently in
the information already learned as you satisfactorily progress from course to course.
There are five specific nursing competencies or critical elements for which you are
responsible: Asepsis, Emotional Well-being, Interpersonal Relations, Physical Well-being,
and Professional Behaviors. You are responsible to competently implement these specific
critical elements. Any violation of the following critical elements will result in a clinical
failure. The areas listed below are examples, but are not all inclusive.
A.
ASEPSIS: The prevention of the introduction and/or transfer of organisms. Special
consideration should be given to handwashing.
1. Washes hands as appropriate.
2. Protects self from contamination.
3. Protects patient from contamination.
4. Disposes of contaminated material in designated containers.
5. Confines contaminated material to contaminated area.
6. Establishes a sterile field where required.
B.
EMOTIONAL WELL-BEING: Any action or inaction on the part of the student which
threatens the emotional well-being of the patient or significant others places that
person in emotional jeopardy. This can occur through omission, imminent, or actual
incorrect action by the student. Students must promote emotional well-being.
1. Maintains or respects patient confidentiality, including HIPAA guidelines.
a. Uses only patient initials on CSM worksheets and assignments.
b. Does not discuss patients data with anyone except healthcare staff. Does not
discuss data with patient’s family or significant other unless permission is
given by patient.
c. Does not discuss patient data in public areas such as hallways, elevators, etc.
C.
INTERPERSONAL RELATIONS: The patient-focused verbal and nonverbal interaction
between student
nurse and patient and or significant other.
1. Establishes verbal communication with patient at
beginning of
implementation phase by using at least one (1) of the following actions:
a. Introducing self.
b. Explaining nursing actions to be taken, or
c. Using touch with the patient who is a no communicating adult.
2. Interacts verbally with patient by using at least one (1) of the following methods:
a. Asking questions at least once to determine patient’s response to nursing care.
b. Asking questions at least once to determine patient’s comfort.
c. Directing the focus of communication toward patient-oriented interests.
d. Talking to a no communicating adult.
37
3. Uses language consistent with patient’s level of understanding.
4. Uses verbal expressions that are not excessively familiar, patronizing, demeaning,
abusive, or otherwise unacceptable.
5. Uses physical expressions that are not excessively familiar, patronizing,
demeaning, abusive, or otherwise unacceptable.
D.
1.
2.
3.
4.
E.
PHYSICAL WELL-BEING: Any action or inaction on the part of the student could
threaten the patient’s physical well-being. Students are accountable for the
patient’s safety. Physical well-being includes:
Maintaining the physical well-being of a patient such as reporting deterioration in
the patient’s clinical condition or imminent or actual incorrect action by the
student.
Appropriate use of physical restraints.
Appropriate use of side rails.
Correct use of procedures as learned in skills lab or identified in Clinical
Procedure Manual.
PROFESSIONAL BEHAVIORS: Maintains professional boundaries in all physical,
written, and verbal interpersonal encounters including but not limited to patients,
significant others, staff, peers, and faculty.
CoreCompetencies Rev2010.doc
Rev. 09/10
37
COLLEGE OF SAN MATEO
NURSING DEPARTMENT
CLINICAL EVALUATION
NURSING 222
STUDENT__________________________________
CLINICAL AREA_____________________________
DATE______________________________________
CLINICAL GRADE: PASS_____
NO PASS_____
ABSENCES__________________________________
CODE: P = Pass; NP = No Pass; NI = Needs Improvement
** = 100% Required To Pass; * = 96% Of Starred Criteria Required To Pass (39/41)
All “Competencies of Care” from previous courses are to be met.
ALL NURSING PROGRAM CORE COMPETENCIES MUST BE MET
**A. Asepsis
**B. Emotional Well-being
**C. Interpersonal Relations
**D. Physical Well-being
**E. Professional Behaviors
P
CLINICAL OBJECTIVES
P
I. OPERATIONALIZES THE NURSING PROCESS TO PROMOTE
HOMEOSTASIS
Uses the nursing process, with guidance, to provide safe nursing care for
pregnant women/families with common well-defined health needs.
A. Collects and organizes data from a variety of sources including data on
developmental levels to identify basic patient needs.
*1. Collects data from a variety of sources to identify the woman’s
___
newborn’s and family’s needs including grandparents..................
**2. Is prepared for patient assignment in each perinatal area………… ___
*3. Gathers data pertinent to patient, from patient, family, Kardex,
report, and chart and utilizes critical thinking skills to differentiate
normal from abnormal................................................................... ___
37
NP
COMMENTS - NI AND NP
REQUIRES EXPLANATION
NI
NP
COMMENTS - NI AND NP
REQUIRES EXPLANATION
NI
___
___
___
___
___
___
CLINICAL OBJECTIVES
P
*4. Correlates patient data with nursing theory to prepare for patient
assignment......................................................................................
B. Assess patient status
**1. Assesses the woman’s recovery from the birth process with a
thorough postpartum assessment…………………………………..
*2. Evaluates maternal/infant bonding behaviors.................................
**3. Assesses/describes the adaptation of the newborn to extra-uterine life
and identifies real/potential threats to homeostasis (e.g., vital signs,
skin color, reflexes, elimination, etc.)..............................................
*4. Determines the woman’s ability to meet the biopsychosocial needs
following birth and identifies potential problems..............................
*5. Identifies nursing diagnoses, and states related outcome criteria
written in care plans…………………………………………………
*6. Applies theoretical data to nursing practice.......................................
C. Plans with guidance, individualized nursing interventions designed to
assist women/family to meet their basic needs and to promote their
homeostatic adaptive mechanisms.
**1. Identifies nursing interventions that will assist in meeting stated
outcome criteria – written in care plans ........................................
*2. Involves the woman/family including grandparents in the plan of care…
*3. Presents plan to instructor/resource person prior to care..................
*4. Applies critical thinking principles to a variety of clinical situations…….
D. Consistently performs, with guidance, appropriate nursing interventions
safely and competently.
**1. Applies previously learned knowledge as well as perinatal concepts
to provide safe nursing care...........................................................
**2. Demonstrates knowledge of medications.....................................
*3. Adjusts nursing care to meet the needs of the maternity patient and
extended family members..............................................................
**4. Correctly performs treatments and administration of medications…
**5. Utilizes principles of asepsis and universal precautions......................
*6. Expands comfort measures to include those pertinent to the
perinatal patient.....................................................................
**7. Follows accepted protocols for safe newborn care............................
*8. Identifies priorities when organizing care, utilizing principles of time
management................................................................................
37
NP
COMMENTS - NI AND NP
REQUIRES EXPLANATION
NI
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
CLINICAL OBJECTIVES
E. Recognizes, with guidance, whether nursing intervention(s) met
identified needs.
*1. Explains appropriate rationales for nursing intervention(s) with
references, keeping in mind the specific needs of the perinatal
patient..........................................................................................
*2. Assists in revising nursing care by evaluating whether objectives
were met on the daily care worksheet...........................................
*3. Modifies the nursing care as needed keeping in mind the specific
needs of the perinatal patient....................................................
**F. Demonstrates competent performance of designated skill.....................
II. ASSUME ROLE AS A COMMUNICATOR
A. Utilizes a variety of basic communication skills to support the
woman/family, and to interact with other members of the health team.
*1. Assesses maternal verbal and non-verbal behaviors........................
**2. Communicates data and questions, regarding the woman/family to
appropriate health care professionals..............................................
*3. Communicates results of care during report and conferences............
*4. Evaluates effectiveness and identifies barriers to communication.......
*5. Identifies own limitations when giving information...........................
**6. Utilizes HIPAA guidelines for all verbal and written
communications………………………………………………………
B. Reports and records accurately, with guidance, patient assessments,
nursing interventions and their effectiveness, and other significant
occurrences affecting patient status.
*1. Charts accurately in a legible, pertinent, organized manner using
acceptable abbreviations, grammar and format for postpartum and
neonate patients in both paper and electronic modalities where
applicable……………………………………………………………
*2. Uses Nursing Care Plan as a guide for charting.................................
**3. Reports status of patient during clinical time and prior to leaving
unit................................................................................................
*4. Contributes in conferences..............................................................
P
COMMENTS - NI AND NP
REQUIRES EXPLANATION
NI
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
III. ASSUME ROLE AS A TEACHER
A. Recognize the woman’s/family’s obvious need for health teaching and
either conveys information or takes other appropriate action.................. ___
37
NP
___
___
___
___
___
CLINICAL OBJECTIVES
P
III. ASSUME ROLE AS A TEACHER
*1. Considers obvious factor(s) that may interfere with ability to learn…
**2. Initiates teaching as well as supports the teaching plan of others……
**3. Gives instruction in health promotion that assists in meeting the
needs of the perinatal patient, extended family members and the
newborn..........................................................................................
*4. Uses teaching materials provided by the clinical facility....................
*5. Documents patient/family teaching..................................................
**6. Completes graded teaching presentation............................................
IV. ASSUME ROLE AS A LEADER/MANAGER
A. Recognizes the patient’s/family need for the services of other team
members and/or agencies and discusses the need for appropriate
referrals.
*1. Assumes responsibility for managing care for assigned patient(s)….
*2. Identifies sociocultural differences and seeks help when necessary
(e.g., interpreter, dietitian, etc.)......................................................
**3. Completes post conference cultural presentation……………….…..
*4. Consults with health team members to meet needs that cannot be
met by the student............................................................
B. Identifies priorities and provides care for two to three patients within
the assigned clinical time.
*1. Implements care in stressful situations.............................................
*2. Describe RN role in perinatal care....................................................
V. ASSUME ROLE AS MEMBER WITHIN THE PROFESSION
Practices within the ethical standards and legal framework with guidance.
*1. Researches agency policies and procedures as needed........................
*2. Identifies ethical issues in the clinical area and discusses such with
instructor and at conference............................................................
*3. Describes the interventions used by a nurse functioning as a patient
or family advocate..........................................................................
B. Identifies own learning needs and demonstrates initiative in obtaining
specific experiences.
37
NP
COMMENTS - NI AND NP
REQUIRES EXPLANATION
NI
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
CLINICAL OBJECTIVES
P
NP
COMMENTS - NI AND NP
REQUIRES EXPLANATION
NI
V. ASSUME ROLE AS MEMBER WITHIN THE PROFESSION
*1. Communicates learning goals to instructor in writing on last page of
evaluation……………………………………………………………..
*2. Uses additional learning resources available......................................
C. Evaluates learning experiences and objectively assesses own progress
regularly with the instructor
**1. Completes weekly journal entry and submits to instructor for
review…………………………………………………………………
**2. Completes self evaluation and learning goals at end of the course or
as otherwise indicated by instructor.................................................
**3. Modifies performance based on previous evaluation of clinical
performance and current feedback.................................................
**4. Takes corrective actions when in error; reports such to the instructor
and follows through with appropriate written report.......................
D. Is accountable for his/her professional behavior
*1. Is punctual for clinical (cannot be late more than two times)............
*2. Is punctual for post-conference (cannot be late more than two times
without prior agreement with instructor.)........................................
**3. Is punctual in submitting written assignments..................................
*4. Completes clinical make up assignments according to policy………..
**5. Is punctual with medication and treatments....................................
**6. Follows correct procedure for notifying agency regarding absences
from clinical areas...........................................................................
**7. Follows dress code as described in the Nursing Student Handbook….
37
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
MIDTERM:
__________________
DATE
______________________________________________________________________
STUDENT (Signature indicates only that this evaluation has been read.)
__________________
DATE
______________________________________________________________________
INSTRUCTOR
COMMENTS:
STUDENT:
FACULTY:
≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈
FINAL:
__________________
DATE
______________________________________________________________________
STUDENT (Signature indicates only that this evaluation has been read.)
__________________
DATE
______________________________________________________________________
INSTRUCTOR
COMMENTS:
STUDENT:
FACULTY:
STUDENT LEARNING GOALS:
01/15
N222 Clinical Evaluation
37
CLINICAL CHECKLIST FOR LABOR AND DELIVERY
OR LDRP ROOM
* NOTE – with supervision indicates RN or instructor must be present.
OBJECTIVES/SKILLS
1. Assess and document vital signs.
2. Monitor uterine contraction pattern.
3. Observe and assist with electronic fetal monitoring.
4. Begin to interpret monitoring patterns.
5. Assess patient’s pain level.
6. Assist patient with relaxation techniques for pain
management.
7. Perform basic comfort and hygiene measures.
8. Observe a vaginal delivery.
9. Observe a cesarean delivery.
10. Give medications with supervision – IVPB, IM SC, PO
routes. (not IV push)
11. Assist in setting up IV drip.
12. Start IV’s (after week 5-6) with supervision.
13. Perform urinary catheterization with supervision.
14. Follow the instructions of caregivers during a delivery.
15. Give neonatal medications with supervision.
16. Perform postpartal assessments and document.
17. Maintain confidentiality of patient and family.
18. Participate in the transfer of the patient to
the postpartal unit. (differs with agencies)
37
DATE COMPLETED
CLINICAL CHECKLIST FOR POSTPARTUM OR LDRP ROOM
DATE COMPLETED
OBJECTIVES/SKILLS
1. Admits a patient to the unit (differs with agencies).
2. Completes a physical and psychosocial assessment of a vaginal
delivery patient.
3. Completes a physical and psychosocial assessment of a cesarean
birth patient.
4. Monitors vital signs according to agency protocol.
5. Assists with breastfeeding and refers to lactation consultant as
necessary.
6. Instructs patient in self-care measures.
7. Administers routine and prn medications with supervision.
8. Monitors and documents IV therapy.
9. Completes appropriate documentation.
10. Participates in discharge instructions.
11. Maintains confidentiality of patient and family.
12. Reviews and updates care plan as needed.
37
CLINICAL CHECKLIST FOR NEWBORN CARE
DATE COMPLETED
OBJECTIVES/SKILLS
1. Completes a newborn admission assessment (varies with agency)
with supervision.
2. Completes a physical assessment/gestational assessment with
supervision.
3. Assesses maternal/neonate attachment.
4. Performs a neonatal bath.
5. Performs circumcision care.
6. Performs cord care.
7. Performs a neonatal heelstick for glucose.
8. Assists with feeding.
9. Completes appropriate documentation.
10. Administers newborn medication.
11. Participates in discharge instruction.
12. Participates in teaching normal newborn care.
13. Maintains patient and newborn confidentiality.
14. Maintains newborn safety in crib, during transport, positioning,
and accurate identification.
15. Follows agency protocol for neonate abduction prevention.
37
Nursing 222 Maternity Nursing Sample Math Test
1. The IV order is to infuse 1 Liter D5LR over the next 8 hours. After 4 hours, 250 ml are
remaining in the IV bag. How many hours AHEAD is the IV running? _________
2. The order reads: Loading dose of Magnesium Sulfate 4 Gms IV to be administered over a
20 minute period. On hand is a premixed bag of 20 Gm of magnesium sulfate in 500 ml of
H2O.
Set the rate and volume to be infused on the pump.
Rate __________
Volume ________
3. The order reads: Maintenance dose of Magnesium Sulfate 2 Gms per hour IV. Continue
this order using the same premixed bag of 20 Gm of magnesium sulfate in 500 ml of H2O
that you used in #2.
Set the rate and volume to be infused on the pump.
Rate __________
Volume ________
4. Calculate the rate and volume to be infused for an order reading Penicillin 5 million units
mixed in 250 mls of NS to be administered over 2 hour. Set the pump for rate _________
and volume to be infused ________________.
37
5. Cefazolin (Anecef) 1.5 GMS is ordered for a labor patient with a temperature of 39°C. To
reconstitute the drug, the directions indicate to add 10 mls to a 5 Gm. Powered vial for a
dosage of 5 GM= 10mls. Once reconstituted, how many mls would you add to a secondary
bag for a dosage of 1.5 Gms to be given NOW? _________
6. Morphine sulfate is ordered for a neonate weighing 3.2 kg for pain. The range for neonates
is 0.02 mg/kg to 0.05 mg/kg every 3-4 hours. Calculate the correct MAXIMUM dosage for
this neonate. _________
7. Terbutaline 250 mcg sc is ordered for a preterm labor patient. Available is 1mg/ml.
Calculate the correct amount to be given. _________
8. Methergine 200 mcg is ordered for a postpartum patient who is experiencing postpartum
hemorrhage. Calculate the correct amount to be given with available amount of 0.4 mg.ml.
_________
9. Pitocin 20 units in 1000 ml LR is ordered to run at 150 mls per hour. Using a drop factor of
10 gtts.ml, calculate the drop rate. _________
10. Celestone Soluspan (betamethasone) has an available dosage of 6 mg/ml. Prepare a 4mg
injection. _________
37
Answers:
1.
2 hours
2.
300mL/hr, 100mls
3.
50mL/hr, 400mLs
4.
125mL/hr, 250mLs
5.
3mLs
6.
0.16 mg
7.
0.25 mL
8.
0.5 mL
9.
25 drops per minute
10. 0.67mLs
37
CLINICAL
MAKEUP
37
PREPARED CHILDBIRTH CLASS
(Assignment or clinical makeup)
At the completion of this experience, the student will be able to:
1. Compare and contrast three different methods of childbirth education.
2. Demonstrate one relaxation exercise observed during the class.
3. Demonstrate one breathing technique used for labor purposes.
4. Identify two concerns about the labor and delivery process expressed by the participants in
the class.
5. Describe the teaching style used by the instructor.
ASSIGNMENT
Type the answers to the following questions and submit to your clinical instructor one week after the
experience.
1.
2.
3.
4.
5.
Summarize the similarities and differences among three methods of childbirth education.
Describe one breathing technique that you saw demonstrated in the class.
Describe one relaxation exercise that was practiced in the class.
List two concerns about labor and delivery that were expressed by class participants.
Describe one effective teaching technique used by the instructor.
N222ChecklistForL&D.doc
37
ASSIGNMENTS
37
MEDICATION ADMINISTRATION CARDS
OVER VIEW: The purpose of this assignment is to assist in the preparation of common
medications during the maternity rotation. Since the patient stay is so short,
preparation in advance is not practical or possible. A list of commonly ordered
medications from the clinical facilities has been compiled to facilitate your preparation
prior to administration.
See the next page for the list. You are required to prepare a medication card for each
medication listed. *Bring the cards to clinical each day. A preprinted card will be
accepted, provided that the required information is highlighted. Include or highlight
the following information
On each card:
Name (trade and generic)
Usual dosage
Routes of administration
Classification
Action *This needs to be specific to the maternity or neonatal patient. May need to
write in specific information for preprinted card.
Common side effects
Nursing considerations
In addition to using the drug handbook, be sure and use the textbook for any
maternity or neonatal considerations.
N222MedAdministrationCards.doc
37
Medication List
The following is a list of commonly prescribed medications used in the perinatal
areas. See directions on the previous page of the syllabus.
NEONATE
Bacitracin
EMLA
Erythromycin Ointment
Hepatitis B vaccine
Vitamin K
Narcan
Lidocaine
LABOR PATIENT
POSTPARTUM PATIENT
Ampicillin
Benadryl
Colace
Cefotetan
Demerol
Dulcolax
Ferrous sulfate
Gentamycin
Hemabate
Lortab
Lovenox
Magnesium Sulfate
Methergine
Morphine sulfate
Motrin
Norco
Nubain
Pepcid
Percodan
Phenergan
Reglan
Rhogam
Rubella vaccine
TDAP
Toradol
Tylenol with codeine
Vistaril
Benadryl
Betamethasone
Cytotec
Clindamycin
Fentanyl
Keflex
Lidocaine
Lobetalol
Magnesium Sulfate
Nifedipine
Pitocin
Penicillin
Prostaglandin gel (PG gel)
Reglan
Terbutaline
Vancomycin
Zofran
N222MedicationList
37
GUIDELINES FOR THE GRADED TEACHING PRESENTATION
The postpartum or mother/baby experience provides the best opportunity for teaching
the family. Teaching may be provided for a new mother and any other family members
present. Demonstration of a baby bath and return demonstration also works well with a
group of parents. The topic chosen must be approved by the clinical instructor. The
student will sign up for a date to teach at the beginning of the rotation, depending on his
or her schedule.
References:
American Academy of Pediatrics
Teaching manual or other materials at the clinical facility
Guidelines for the Graded Teaching Presentation.doc
37
POSTPARTUM TEACHING PRESENTATION AND PAPER
Grade: Competent/not yet competent
Directions: During this rotation, the student will be responsible for one formal teaching
presentation, which will be graded by the instructor. The student and clinical instructor will agree
on a date and topic. The student will show the instructor a brief outline, notes and objectives prior
to doing the presentation. Following the presentation, the student will type the formal paper to b e
submitted one week after the teaching session.
5 points = competency = 80% of total (4/5 pts) = Cr
I. DATA COLLECTION (0.5 points)
Patient Initials, Room Number, Age
Date and Time of Delivery
Gravida and Para
Maternal Complications: labor, delivery, postpartum
Neonatal Complications:
II. LEARNING NEEDS ASSESSMENT (0.5 points)
State here the subjective and objective evidence for learning needs.
(Example: patient statements, questions indicating knowledge deficit)
III. SUMMARY OF PLAN AND TYPE OF PRESENTATION (0.5 points)
Indicate topic presented and type of presentation
(Example: baby bath – demonstration and discussion of normal newborn
deviations, reflexes and needs.)
IV. OUTLINE OF CONTENT TO BE PRESENTED (0.5 points)
Summarize in a brief outline form the content of the presentation. Include and
attach a copy of any audiovisual materials given to the patient.
V. OBJECTIVES (0.5 points)
List at least THREE objectives which you hope you have accomplished by the end
of the presentation. Objectives must be stated in measurable form. (Example :
By the end of this presentation, the patient will be able to demonstrate the
correct technique for bathing a baby)
VI.
EVALUATION (0.5 points)
State to what the extent the objectives were accomplished
(Example : The patient was able to demonstrate the correct technique for bathing the
baby, but needs more practice.)
* Describe here how you might change your presentation the next time to better
accomplish the objectives
SEE NEXT PAGE FOR TEACHING PRESENTATION GUIDELINES
N222TeachingPresentation&Paper.doc
37
TEACHING PRESENTATION GUIDELINES
GRADING CRITERIA FOR THE PRESENTATION
STUDENTS ________________________________________
DATE _______________
TOPIC ____________________________________________
(POINTS POSSIBLE FOR PRESENTATION: 2 points)
Competent
1. Topic is appropriate for this
patient. Content is current,
accurate, and well prepared.
0.5
2. Presentation is clear, organized,
speed is well paced, notes can be
referred to, but not read.
Audiovisual aids are used.
0.5
3. Presentation is summarized by
briefly repeating key terms or
asking the patient key questions.
0.5
4. Presentation is completed within
10-15 minutes. (Time limit within
instructor’s discretion, considering
topic)
0.5
TOTAL STUDENT GRADE
_____
PAPER SECTION (3 points possible)
_____
PRESENTATION SECTION (2 points possible)
_____
37
Not Yet Competent
Neonatal Assessment
5 Points
DIRECTIONS: After completing a head-to-toe physical & gestational age assessment on a normal
newborn:
1. Use the Sim Chart to document your assessment including the required information regarding the
infant’s mother and delivery information. Use gestational age form (Dubowitz/Ballard) to
record gestational age assessment.
2. Complete the Maternal-Newborn Attachment Tool.
2. Type the remaining information required below.
3. Submit a paper copy of your Sim Chart record along with the Maternal-Newborn Attachment Tool,
the Gestational age form, and this paper to your clinical instructor ONE WEEK after
completing the newborn assessment.
The due date will vary with your clinical schedule.
Section A
Data Collection
1.
Complete a cover page, stating your name and date of assessment
2.
Newborn’s date of birth
3.
Newborn’s age at time of assessment (in hours or days)
4.
Type of delivery (vaginal vs surgical)-SIM CHART
5.
Apgar Score-SIM CHART
6.
List any complications if applicable-paper and/or SIM CHART
(Section A point value=0.5 points)
Section B
1.
Growth and Development
Weigh, measure, and assess the estimated gestational age using your clinical
agency’s growth chart and gestational age form. -SIM CHART, Dubowitz/Ballard
2.
State the length, head circumference, chest circumference, and weight-SIM CHART
3.
State if normal or abnormal according to the norms of the textbook.
4.
Compare the weight you obtained to the birth weight and explain any differences.
5.
Attach the completed gestational age assessment form to this section. State
whether the neonate is AGA, SGA, or LGA and whether the neonate is term,
preterm, or post-term.
(Section B point value=1 point)
37
Section C
1.
Physical Assessment and Vital Signs
List the vital signs for this neonate and state whether the vitals are within normal
limits for this neonate. -SIM CHART
2.
Complete head-to-toe assessment-use Newborn Patient Worksheet Assessment as
a guide.- SIM CHART
(Section C point value=2 points)
Section D
1.
Psychosocial Adaptation
Using the standard assessment tool on the next page, assess maternal-neonate
bonding of this neonate and mother. Attach the completed tool to this paper and
discuss your observations in a separate typed paragraph.
Example: the score was 7 because…which causes some concerns, etc.
-MATERNAL-NEWBORN ATTACHMENT TOOL
(Section D point value=0.5 points)
Section E
1.
2.
Medications
State the purpose of giving Erythromycin eye ointment to the neonate.
Describe the nursing implications, including dosage, routes, and any potential side
effects.- SIM CHART and paragraph
3.
State the purpose of giving Vitamin K to the neonate.
4.
Describe the nursing implications, including the dosage, route, and any side
effects.-SIM CHART and paragraph
(Section E point value=1 point)
37
MATERNAL‐NEWBORN ATTACHMENT TOOL

This tool is to be scored and attached to the newborn paper. Include an explanation
of your score and your impressions of the interaction.
1 point for each YES answer.
10 points maximum.
8‐10 = positive interaction
5‐7 = continue to observe
0‐4 = refer to health care provider
YES
MATERNAL BEHAVIORS
Appropriate touch‐fingertip‐palming‐
enfolding
Holds neonate in “enface” position + eye
contact
Refers to neonate by name (initially “it”,
but quickly a name)
Responds consistently to neonate cues or
signals
Expresses satisfaction with feeding
method (breast or formula)
NEONATE BEHAVIORS
+ eye contact – mutual gazing
“Tracks” face with eye movement
Grasps finger and holds on
Moves with synchronized movement in
response to parent’s voice
Comforted by parent’s voice or touch
Neonatal Assessment.doc
37
NO
LABOR AND DELIVERY PAPER
(Point Value = 5 points)
DIRECTIONS: Observe a birth, whether vaginal or surgical, collect the following data and answer
questions regarding the experience. Type the answers to the following questions and submit to
your clinical instructor one week after the experience.
PAGE NUMBER: 3‐5 pages
PART I
DATA COLLECTION (O.5 points)
DATE:
STUDENT NAME:
Patient Initials:
Marital Status:
Age:
Ethnic Background:
Gravida, Para:
Length of Labor:
Complications: (examples – long labor, premature membrane rupture, extensive lacerations,
etc.)
PART II
THE BIRTH EXPERIENCE (3.0 points)
Describe the experience in terms of the following:
1. Location of birth, type of birth attendants and support persons present (0.25 points)
2. Interaction of the laboring woman and her partner/coach with each other and with the
nursing/medical staff attending the birth. Discuss any cultural implications and their
significance to the birth. If not apparent implications, state this here.
(0.25 points)
3. a. The type of and effectiveness of analgesia/anesthesia and bearing‐down efforts used
(vaginal birth only) OR
b. The type of and effectiveness of analgesia/anesthesia used for a surgical delivery
(cesarean birth only)
(0.5 points)
4. Immediate care the delivered woman for the first 2 hours following the birth. Immediate
assessments, interventions, and their effectiveness. Be sure to include SPECIFIC
assessments and interventions on YOUR patient. This includes the various postpartal
checks which are routinely made on each patient.
(1 point)
5. Immediate care of the newborn for the first 2 hours following the birth. Include
assessments and interventions following the birth. Include SPECIFIC assessments and
interventions on your neonate.
(1 point)
37
PART III
MATERNAL MEDICATIONS (1 point)
1. List ALL maternal medications used during the labor and delivery process. Include
analgesics, anesthetics, labor induction agents, and any other medications.
2. List the following information for each medication:
a. Name
b. Classification
c. Action
d. Dosage
e. Route
f. Nursing interventions
Be SPECIFIC to your patient’s situation.
PART IV
SUMMARY (0.5 points)
In one paragraph, describe:
a. How was this birth unique?
b. How was care individualized based on this patient’s unique situation?
Labor & Delivery Paper.doc
37
OB/GYN CLINIC EXPERIENCE
OBJECTIVES:
At the completion of this experience, the student will be able to:
1. Summarize the essential components of a prenatal history.
2. Define common terminology used in the history taking process.
3. Describe physiological changes expected to occur in the various trimesters.
4. Observe teaching taking place during the visit, whether prenatal, postpartum, or
gynecological visit.
5. Identify laboratory or screening tests performed and list the significance of abnormal
results.
6. Observe a postpartal checkup.
7. Review a typical prenatal, postpartal, or gynecological chart.
8. Describe the risk screening process for prenatal patients,
9. Identify the process for a typical gynecological checkup visit.
10. Observe typical information given by the advice RN.
ASSIGNMENT
Complete the paper which BEST pertains to your observation in the outpatient setting. Type the
answers to the questions and submit to your instructor one week after the experience.
Some students will observe prenatal visits and others will observe gynecological visits.
Choose the assignment which best fits your observation.
PRENATAL PATIENT ASSIGNMENT
Choose one patient observed as a model for your answers.
1. Identify your patient’s age, trimester of pregnancy, gravida and para.
2. List five factors which may affect the course of pregnancy. Identify any factors which
may affect the course of THIS pregnancy as identified by the patient’s caregiver.
3. Define the following terms: primigravida, multigravida, primipara, and multipara.
Identify which of these terms apply to your patient.
4. Describe typical physiological changes observed in your patient. Include in your
description if these changes are appropriate for your patient’s trimester of pregnancy.
5. Describe any teaching needs observed during the visit and explain how you would meet
these needs.
6. List any laboratory tests performed on this patient and explain the significance of any
abnormal values.
7. If the opportunity arose to listen to advice given over the telephone, describe one
caller’s question and the advice given.
37
GYNECOLOGICAL VISIT
Assignment:
If your patient’s visit was primarily gynecological in nature, i.e., checkup, gynecological problem,
etc., complete this assignment INSTEAD of the prenatal one.
Using one patient as an example, type the answers to the following:
1. Identify your patient’s age, reason for visit, chief complaint, if applicable.
2. Define your patient’s medical diagnosis OR attach pertinent internet printout.
3. List risk factors for this medical diagnosis and identify those which apply to your
patient.
4. Describe signs and symptoms displayed by your patient.
5. If the visit is a routine checkup, describe any testing completed and explain the
rationale for the tests completed.
6. Describe teaching observed during the visit and explain how you would meet these
needs.
7. List any laboratory tests performed on this patient. Explain the significance of any
abnormal values.
8. Describe the treatment prescribed for this patient, if applicable, and explain its
rationale in this case.
Ob‐Gyn Clinic Experience.doc
37
NEONATAL LEVEL II NURSERY
OBSERVATIONAL EXPERIENCE
OBJECTIVES
After completing the observational experience, the student will be able to:
1. Compare and contrast the role of the registered nurse in the Level I nursery with
the role of the registered nurse in the Level II Nursery.
2. Define the medical diagnosis of one patient observed as well as the treatment that
the newborn received for that medical diagnosis.
3. Describe one piece of equipment that was used in the Level II Nursery that is not
routinely used in the Level I nursery.
4. Discuss the care of the newborn who is being fed by alternate means than breast or
bottle. From your research, identify appropriate laboratory studies and other
nursing interventions needed to ensure that the newborn is receiving adequate
nutrition.
5. Describe the reaction of one newborn who was observed during a painful
experience. Identify several nursing interventions which were utilized as comfort
measures.
ASSIGNMENT
During your assigned visit, focus your observations on the objectives as much as possible.
Type your answers to the above objectives and submit to your clinical instructor one week
after the experience.
37
NURSING 222 MATERNITY NURSING
Objectives and Assignment for Lactation Education Experience
OBJECTIVES
1. Identify common concerns of lactating women.
2. List appropriate interventions for common breastfeeding problems.
3. Describe assessment techniques used by the nurse when assisting lactating women.
4. Discuss the purpose and services provided by the lactation education center.
ASSIGNMENT
After observing rounds with the lactation educator and observing activities in the lactation
education center, type the answers to the following questions.
1. Describe the three most common concerns expressed by lactating women while on
rounds with the lactation educator.
2. Using one lactating woman as an example, describe the assessment and
intervention techniques utilized by the lactation educator. List any questions asked
by the woman and any problems discovered during the interaction.
3. Using printed patient teaching materials from the lactation center, list and define
three lactation problems which should be reported to the health care provider.
4. Briefly describe the services provided by the lactation center. Focus on client needs,
community needs, and the benefits for lactating women and their newborn.
Type and submit to the clinical instructor one week after the experience.
Attach any pertinent patient teaching materials.
37
Urology Objectives
1. Provide a brief description of one patient encounter, including patient age, procedure
performed and rationale for testing/procedure
2. List any laboratory tests performed on this patient. Explain the significance of any
abnormal values
3. Describe the role of the RN/MA during this patients encounter
4. Describe any patient learning needs and how the staff addressed them during the
procedure
5. Describe any follow-up instructions or needs anticipated for this patient following the
procedure
6. Describe the differences between a diagnostic vs. therapeutic procedure performed in
this department
Assignment
Complete the paper pertaining to your observation in the outpatient setting. Type the answers
to the questions and submit to your instructor one week after the experience.
1. Identify your patient’s age, reason for visit, chief complaint, if applicable.
2. Define your patient’s medical diagnosis OR attach pertinent internet printout.
3. List risk factors for this medical diagnosis and identify those which apply to your
patient.
4. Describe signs and symptoms displayed by your patient.
5. If the visit is a routine checkup, describe any testing completed and explain the
rationale for the tests completed.
6. Describe teaching observed during the visit and explain how you would meet these
needs.
7. List any laboratory tests performed on this patient. Explain the significance of any
abnormal values.
8. Describe the treatment prescribed for this patient, if applicable, and explain its
rationale in this case.
37
PERINATAL CULTURAL VARIATIONS
POST CONFERENCE ASSIGNMENT AND DISCUSSION
PURPOSE: The purpose of this assignment is to explore various cultural variations of the
perinatal experience and to share this information with students in your clinical group in a
postconference setting.
DUE DATE: To be determined by the clinical instructor.
ASSIGNMENT:
1. Choose a culture, either your own or one that particularly interests you.
2. Sign up with your clinical instructor to avoid duplication of culture.
3. Use the internet to access information regarding perinatal aspects of this culture.
4. On the assigned date, be prepared to discuss the following variations of the culture,
as applicable.
a. Prenatal care
b. Preparation for childbirth
c. Labor and birth
d. Postpartum self‐care
e. Nutrition ‐ prenatal, lactation
f. Role of grandparents and other extended family members
g. Breastfeeding
h. Circumcision
i. Other variations?
5. Submit your notes and internet printout to instructor on the assigned date.
37
ANTEPARTUM TESTING – OBSERVATIONAL EXPERIENCE
(Mills Peninsula Health Services only)
OBJECTIVES:
1. Describe the role of the RN and the Perinatologist in the antepartum testing unit.
2. List and describe three tests utilized in the antepartum testing unit to help assess fetal
well being.
3. Provide a brief description of one patient encounter, include the patient’s age,
gravida, para, gestational age and the rationale for testing.
4. Describe any patient learning needs and how the staff addressed them during the
visit.
Submit the typed answers to the above objectives one week after the visit
to your clinical instructor.
GESTATIONAL DIABETIC EDUCATION OBSERVATIONAL EXPERIENCE
OBJECTIVES:
Provide typed answers to these objectives to your clinical instructor one week
following the experience.
1. Define gestational diabetes.
2. List the population groups considered to be at high risk for gestational diabetes.
3. Describe the testing criteria utilized for pregnant patients.
4. Describe the current treatment regimes prescribed for pregnant patients.
5. Identify the primary learning needs of the newly diagnosed gestational diabetic
patient. Prioritize these needs and describe how you would teach this type of patient.
N222 Antepartum Testing.doc
37
N222 Maternity Nursing
Critical Thinking-Clinical Reflections
Purpose/Objective
Critical thinking is a process or way of thinking that enables the nurse to give his/her
clients the very best individualized care. It involves the use of the mind in forming conclusions,
making decisions, drawing inferences and reflecting. (Gordon, 1995). The purpose of this
assignment is to develop your critical thinking skills in the area of reflection. Reflection is
defined as the process of thinking back or recalling an event to discover the meaning and purpose
of that event. (Miller and Babcock, 1996). As a student nurse, reflecting back on a clinical
experience or an interaction with a professional colleague can help you to understand how the
concepts from the theory class apply to the lab or the hospital experience. It also helps you to
evaluate yourself and to think about how you might have handled the situation differently to
achieve a more satisfying outcome.
Keeping a clinical journal is a way to develop your critical thinking skills in the area of
reflection. The journal should reflect your attitudes, feelings and actual learning experiences as
you enter the clinical setting of this course for the first time. As you progress in this semester of
the nursing program, this journal will be a resource for you to look back at significant
experiences and gain insight into your own professional development as a critical thinker. You
will be able to see the transition now from your novice beginnings in N211 through the specialty
areas of pediatric and maternity nursing.
ASSIGNMENT:
At the end of each week of clinical, starting with the first week of preclinical lab and
orientation, select an experience from either clinical day that stimulated your thinking. This
experience could be an interaction with a client, a family, a fellow student, or a teacher. For
each entry, cover the following four aspects:
1. Describe as completely as possible what happened and what you did.
2. Describe what you were thinking at the time, why you decided to do what you did or say
what you said.
3. Describe what you would do differently the next time when encountering a similar
incident or experience.
4. Describe your strengths and weaknesses in dealing with this particular situation. What
were you feeling?
Your clinical teacher will provide time at the end of the postconference for you to make your
entries. The completed journal will be due to the clinical teacher on the last day of clinical. It
is the teacher’s option to review the journal each week or at the end of the eight weeks.
GRADING: This is a required credit/no credit assignment for completion of N222.
37
EVALUATION SESSION TO DEMONSTRATE COMPETENCY
Purpose: Competency has been integrated into the curriculum to set
standards for student achievement. Nursing students need to be prepared
to perform at an entry level of practice. We are attempting to simulate
different evaluation situations and conditions that are similar to those
which you will encounter as a professional nurse. The purpose of the
evaluation session is to evaluate your performance of a situationally based
skill under testing conditions at a competent level. Competency is defined
as the correct performance, in the designated order the behaviors from
memory within a set time period.
Learning Objective: At the completion of the evaluation session, the student
will correctly administer a medication using the intramuscular route to a
neonate under testing conditions.
Skill: Administration of an intramuscular injection to a neonate.
Time Period: 15 minutes
Procedure: You must pass the medication administration test and the
evaluation session before administering an intramuscular injection to a
neonate. You will need to be determined competent in this section no later
than the end of the third week of class. Initial skill practice will take place
during the 225 lab. Additional practice time is available during open lab
hours. Sign up for a time slot with your clinical instructor.
Competency will be determined by a checklist (which will be distributed to
all students) and completion within the timeframe. You will have more than
one opportunity to achieve competency. If you have questions regarding the
skill, be sure to clarify with the clinical or skills lab instructor.
37
1. Checks doctor’s orders. Release order, see MAR
2. Obtains equipment-alcohol swabs, 1 mL syringe with needle
medication, 2x2 gauze, and gloves.
3. Pull medication from Pyxis and check-name, dosage, and
expiration date-1st check.
4. Washes hands.
5. Performs 2nd medication check and wipes top of medication
vial with alcohol.
6. Injects dosage amount of air into the vial.
7. Inverts vial and withdraws correct amount of dosage.
8. Expels any air bubbles.
9. Checks dosage for accuracy. Verbalizes correct dosage.
10. Takes all equipment to the crib side.
11. Identifies neonate by checking ID band. Perform 3rd med
check.
12. Applies gloves and identifies correct site.
13. Grasps leg with non-dominant hand and simulates bunching of
muscle.
14. Cleanse the site with alcohol or facility-preferred agent.
15. Verbalizes correct angle of injection
16. Applies pressure with 2x2 gauze pad until no further bleeding.
17. Disposes of syringe in sharps container.
18. Rewraps neonate snugly.
19. Removes all equipment and gloves.
20. Washes hands.
21. Documents correctly using present time and date
22. States I am finished and accesses instructor.
Competent _________________________
Not yet competent ___________________
37
No
N222SkillsChecklist.doc-2016
Partner Check Off #4
Yes
Partner Check Off #3
N222 COMPETENCY
SKILLS CHECKLIST: Administration of an
intramuscular injection to an infant.
Partner Check Off #2
Time allotted: 15 minutes
Partner Check Off #1
Name: ___________________________Date:_____________