SBAR ACTIVITY
EST. TIME: 1 HOUR
This SBAR activity assists you in building the skill of communicating pertinent information when
caring for a patient. Appropriate actions you should do to complete this activity include finding
appropriate data to provide a thorough SBAR report.
STUDENT LEARNING OUTCOMES
At the end of this activity, you will be able to:
1. Identify pertinent data in a patient’s electronic health record using Lippincott DocuCare.
2. Communicate pertinent information for a patient with a postpartum hemorrhage using
SBAR.
ASSIGNMENT
1. Log in to thePoint and launch Lippincott DocuCare, following all instructions posted on
your learning management system.
2. Open Fatime Sanogo’s electronic health record.
3. Complete a SBAR for this patient using the following document.
4. Submit for review.
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SBAR ACTIVITY WORKSHEET
SITUATION
Patient’s name, age, specific
reason for visit
Fatime Sanogo is a 23-year-old female who just gave vaginal
delivery one hour ago. She was admitted yesterday at 0600 for
oxytocin induction of labor secondary to postdates. She declined
any pain medication during labor. Dr. Schultz delivered her
placenta manually at 0635 and then bleeding was controlled by a
fundal massage. She has an infusion of oxytocin which is running
at 20 mL/hr. and there is approximately 100 mL left in the bag.
Fatime Sanogo was admitted on July 8, 2020 with an admissions
diagnosis of induction to labor secondary to postdates. Fatime is
on a regular diet and we are encouraging PO fluids. She is
Patient’s primary diagnosis, date ambulating with assistance until she is able to bear weight. She
of admission, current orders for may shower when she is able to ambulate without assistance. Her
patient
vital signs are taken Q 4 hours then Q 8 hours thereafter if vital
signs are within normal ranges. A fundal, bladder, lochia and
perineal check should be performed Q 4 hours for the first 24
hours then 8 Q hours. She is on Ibuprofen, morphine, Oxytocin
and Misoprostol.
BACKGROUND
An assessment was performed 20 minutes ago on Fatime Sanogo
with the following findings. She is breathing at 19 breaths
per/min, HR 109, pulse: present. Blood pressure is 98/50, SpO2
Current pertinent assessment
97% and Temperature is 98.6. The patient stated she was in pain
data using head to toe
so 5mg of morphine was given through her IV at 0710. Breath
approach, pertinent diagnostics, sounds are clear and equal bilaterally. There were regular heart
vital signs
sounds without murmurs and her bowel sounds were heard. I
assessed the patient’s perineum and there was minimal redness,
minimal edema, no ecchymosis, and no discharge from the repair,
and it was well approximated. A lot of blood and lochia was seen
in the vaginal. She was bleeding at a moderate rate. I checked the
bed for blood, lochia and fluid and changed the bed pads. The
weight of the bed pads suggests that approximately 1240 mL of
lochia was on the pads. The last time the pad was changed
suggested a bleeding rate of approximately 1980 mL/hr.
ASSESSMENT
RECOMMENDATION
I recommend her vital signs are taken Q 4 hours until bleeding is
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under control and until her vital signs are consistently in normal
Any orders or recommendations ranges. Keep checking her bed pads for bleeding regularly and
you may have for the provider
weighing the amount found. The patient is in pain so making sure
for this patient
pain medication is working effectively to control that pain. Also try
to get the patient moving when possible and encourage PO fluids.
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PHARM 4 FUN
EST. TIME: 1 HOUR
This activity presents you with a variety of tasks that will assist you in navigating in an electronic
health record using Lippincott DocuCare and appropriate pharmacology resources to provide
pertinent patient education related to oxytocin.
STUDENT LEARNING OUTCOMES
At the end of this activity, you will be able to:
1. Identify pertinent data in a patient’s electronic health record to provide appropriate patient
education regarding postpartum hemorrhage.
2. Explain purpose of administering oxytocin/Pitocin.
3. Discuss pertinent patient education related to oxytocin/Pitocin.
ASSIGNMENT
1. Log in to thePoint and launch Lippincott DocuCare, following all instructions posted on
your learning management system.
2. Locate and open Fatime Sanogo’s electronic health record.
3. Review Fatime’s patient information, demographics, current visit, history of chief present
concern under admission assessment, notes, vital signs, diagnostic results, and past physical
assessments.
4. Go to Fatime’s medication administration record and view the order for oxytocin/Pitocin.
5. After viewing the Smart Sense link for oxytocin/Pitocin, complete the following patient
education document.
6. Submit for review.
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PHARM 4 FUN WORKSHEET
NAME OF MEDICATION AND INCLUDE PROTOTYPE FOR OXYTOCIN
OXYTOCIN (PITOCIN)
ORDERED DOSE, TIME, AND ROUTE
Initially infuse 10-40 milliunits/min, then adjust to control urine atony
PURPOSE FOR TAKING THIS MEDICATION
To initiate or improve uterine contraction at term, management of inevitable, incomplete, or missed
abortion, stimulation of uterine contractions during third stage of labor
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
Report sudden, severe headache immediately Postpartum hemorrhage Nausea Vomiting Hypotension
Edema Increased blood flow
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COMPARE & CONTRAST
EST. TIME: 1 HOUR
This activity requires you to compare and contrast nursing considerations related to medications
administered to manage postpartum hemorrhage and the available modes of administrating
medications.
STUDENT LEARNING OUTCOMES
At the end of this activity, you will be able to:
1. Discuss nursing considerations related to different medications utilized to manage
postpartum hemorrhage – Cytotec, Methergine, Hemabate.
2. Compare and contrast nursing considerations related to the following medications used to
manage postpartum hemorrhage – Cytotec, Methergine, Hemabate.
ASSIGNMENT
1. “Compare and contrast” the following medications and delivery systems on worksheet.
2. Complete the following worksheet.
3. Submit for review.
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COMPARE & CONTRAST WORKSHEET
Compressed tablet
Injectable or oral tablet
Injectable
Misoprostol (Cytotec) 800 mcg per
rectum ×1
Methylergonovine maleate 0.2 mg
po or IM ×1, may be repeated in 5
min for IM injection
Carboprost (Hemabate) 0.25mg IM
every 15–90 min up to 8 doses.
Classification:prostagiandin
Classification:prostaglandin analog
Classification:ergot alkaloids
How this medication works
How this medication works
How this medication works
medication protects your stomach Methergine
Carboprost is a synthetic
lining by lowering the amount of (methylergonovine maleate) acts prostaglandin. It binds the
acid that comes in contact with it. directly on the smooth muscle of prostaglandin E2 receptor, causing
This medication is also used in
the uterus and increases the tone, myometrial contractions, casuing
combination with
rate, and amplitude of rhythmic
the induction of labour or the
another drug (mifepristone) to end contractions. Thus, it induces a
expulsion of the placenta.
a pregnancy (abortion).
rapid and sustained tetanic
Prostaglandins occur naturally in
uterotonic effect which shortens the the body and act at several sites in
third stage of labor and reduces
the body including the womb
blood loss.
(uterus).
Onset of this medication per
rectal administration
misoprostol has an 8 minute onset
of action and a duration of
action of approximately 2 hours, a
sublingual dose has an 11
minute onset of action and
a duration of action of
approximately 3 hours, a vaginal
dose has a 20 minute onset of
action and a duration of action of
approximately 4 hours
Delivery technique for rectal
administration
Misoprostol tablets should be
placed deep into the vagina two
hours before your planned
admission time.
Patient education
Onset of this medication per
rectal administration
Onset of this medication per
rectal administration
it induces a rapid and sustained
Intramuscular response to the drug
tetanic uterotonic effect which
occurs within 3-5 minutes, with a
shortens the third stage of labor and clinical response lasting about 2-3
reduces blood loss. The onset of hours. The drug may be stored at
action after I.V. administration is room temperature. o Side Effects:
immediate; after I.M.
Side effects are rare in the absence
administration, 2-5 minutes, and of prolonged use. Nausea and
after oral administration, 5-10
vomiting have been reported.
minutes.
Delivery technique for rectal
administration
Delivery technique for rectal
administration
administration is immediate; after 15-Methyl
I.M. administration, 2-5 minutes, PGF2α (Hemabate, Carboprost) is
and after oral administration, 5 10 administered at a dose of 0.25 mg
minutes. Pharmacokinetic studies IM (or intramyometrial) every 15–
following an I.V. injection have
90 minutes with an eight dose (or 2
shown that methylergonovine is mg) maximum. PGE1 (Misoprostol,
rapidly distributed from plasma to Cytotec) is administered at a dose
peripheral tissues within 2-3
of 800–1000 mcg and
minutes or less.
placed rectally.
Patient education
Patient education
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Misoprostol is usually taken with Follow all directions on your
meals and at bedtime. Follow your prescription label. Do not take this
doctor's instructions. You may have medicine in larger or smaller
nausea, stomach cramps, or
amounts or for longer than
diarrhea while taking this medicine, recommended. Methylergonovine
especially during the first few
should not be used for longer than
weeks after you start
1 week unless your doctor has told
taking misoprostol. These
you otherwise. Store at room
symptoms usually last for about a temperature away from moisture,
week
heat, and light.
The most common complications
when HEMABATE was utilized
for abortion requiring additional
treatment after discharge from the
hospital were endometritis, retained
placental fragments, and excessive
uterine bleeding,
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THINK-PAIR-SHARE
EST. TIME: 1 HOUR
This activity asks students to consider a patient situation, discuss pertinent patient education, and then
share findings with the class.
1.
2.
3.
4.
5.
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THINK-PAIR-SHARE WORKSHEET
Medical Diagnosis
Postpartum Hemorrhage
What is it?
Excessive bleeding
How does it happen?
Main cause – Uterine atony, inability of the uterus to contract Injury to the birth canal during delivery
Retention of tissue from placenta or fetus Bleeding disorders
What are the symptoms?
500ml of blood loss after a vaginal birth 1000ml of blood after C-section Boggy uterus on assessment
Oliguria Saturating pads within 15mins or less Blood bigger clots Hypovolemic shock – LOC, tachycardia,
hypotensive
What is the treatment?
Fundal massage Fluid volume replacement Catheter Elevate mom’s leg to promote venous return
Medications – uterotonic drugs Blood products if indicated, depends on severity D & C Hysterectomy if
bleeding not controlled
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