1
California State University Bakersfield
Department of Nursing
Nursing 356 Expanded Syllabus 2010
Amy Zlomek Hedden
2
NURSING 356 EXPANDED SYLLABUS – 2010 – Guidelines and Forms
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
GUIDELINES AND FORMS
This booklet contains guidelines for Nursing 356 course assignments and the forms to use in completing these
assignments.
TABLE OF CONTENTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Topic:
Page
Student Information Sheet .......................................................................................................................... 3
Community Rotation Data Form ................................................................................................................. 4
Pediatric Scavenger Hunt ............................................................................................................................ 5
Instructor/Student Responsibility Form ...................................................................................................... 6
Required Pediatric Clinical Skills ............................................................................................................... 7
Information About the Community Rotation .............................................................................................. 8
Teaching Project Guidelines ..................................................................................................................... 12
Denver Developmental Screening Test (DDST) ....................................................................................... 17
Writing Nursing Diagnostic Statements .................................................................................................... 18
Special Considerations with Pediatric Medication, Calculation of IV
Drip Rate, Calculation of Maintenance IV Fluids ............................................................................. 21
Interpreting Blood Gases .......................................................................................................................... 22
Concepts in Fluid and Electrolytes for Pediatrics ...................................................................................... 24
Laboratory Diagnostic Tests: (Short form -> Long Form) ....................................................................... 25
Pediatric Neurologic Assessment .............................................................................................................. 28
Medication Administration Practice Test ................................................................................................. 29
Perioperative & Operative Learning Objectives & Assignment ............................................................... 32
What To Do In the NICU ......................................................................................................................... 33
Directions for Pediatric Process Plans with Functional Health Patterns .................................................... 34
Medication Worksheet: Instructions for Use ............................................................................................ 37
Forms:
22.
23.
24.
25.
26.
27.
28.
29.
30.
Community Rotation Log ......................................................................................................................... 38
Pediatric Long Nursing Process Plan ........................................................................................................ 39
Pediatric Short Nursing Process Plan ....................................................................................................... 49
Team Nursing Forms ................................................................................................................................. 54
Mini Care Plan Form ................................................................................................................................ 56
Ethical Dilemmas Log ............................................................................................................................... 57
Basic Needs Assessment for Immunizations.............................................................................................. 59
Clinical Performance Evaluation .............................................................................................................. 63
Mid-Term Evaluation Form ....................................................................................................................... 70
3
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
Student Information Sheet
Name: ______________________________________________________________________
Phone #_____________________________
Message Phone #_______________________
Address:_________________________________________________
E-Mail Address:_________________________________________________
How many units are you enrolled in this quarter?_________________
Classes other than Nursing: _____________________________________________________
Are you employed?______________
How many hours a week do you work: ____________
What languages do you speak besides English? ______________________________________
What experiences have you had working with children? _______________________________
____________________________________________________________________________
____________________________________________________________________________
What do you feel are your strengths? ______________________________________________
____________________________________________________________________________
____________________________________________________________________________
What do you feel are your weaknesses? ____________________________________________
____________________________________________________________________________
____________________________________________________________________________
What can I do to facilitate your learning? ___________________________________________
____________________________________________________________________________
What are your expectations for this clinical rotation? _________________________________
4
CSUB Department of Nursing
Nursing 356
COMMUNITY ROTATION
To help in arranging the Community Rotation assignments for this quarter more information is needed
about your schedules and location. Because of limitations on the number of students who can be
accommodated at the various agencies, it isn’t possible for students to select their assignments, and it is
difficult to place two students together. Input from students will be taken into consideration as much as
possible.
Please complete the following information and return to the team leader by this afternoon, if possible.
Student Name:
Phone Number:
N356 Section #
Clinical Faculty:
1.
Please list Tuesday and Wednesday class or work hours that would interfere with scheduled
community hours:
2.
Would you be able to take a Friday assignment instead of Tuesday or Wednesday for one of your
community rotations?
Yes
No
3.
Some of the school experiences will be outside of Bakersfield. Which of the following Kern County
School Districts would be most convenient for you?
4.
Comments, concerns, transportation problems:
5
“The Scavenger Hunt”
CODE USED TO ENTER THE UNIT____________
Please locate the following items on your unit:
____
Dressings
____ Nurse Manager’s Name
____
ABD
Emergency Codes:
____
4x4’s 2x2’s
Purple= _________ Pink=_________
____
Tape
White= __________ Blue=_________
____
Incentive Spirometer
Silver=__________ Gray=_________
____
IV Poles
Yellow=_________ Green=________
____
IV Solutions & Supplies
____ Dirty Utility Room
____
Wheelchairs & Gurneys
____ Linen Chart
____
Bottles & Formula
____ Linen Chute/Bags
____
Vital Sign Equipment
____ Clean Utility Room
____
Drinking Glasses
____ Nurse Report Room
____
Oxygen Equipment
____ Kitchen
____
Syringes, Needles
____ Patient Charts
____
Band-Aids
____ Patient Charge System
____
Playroom
____ Ice Machine
____
Video Tapes/ DVD’s/ Video Games
____ Bed Pans/Urinals
____
Chux, Underpads
____ Glucose Monitor
____
Feeding Tubes
____ Client Assignment Sheet
____
Chart Forms
____ Addressograph
____
Crash Cart
____ Alcohol Wipes
____
Ambu Bab
____ Urine Measuring Containers
____
Defibrillator
____ Bags - Patient & Trash
Phone Number to call a Code Blue _______
____ Isolation Supplies/Masks
____
Medication Carts
____ Reference Books
____
Narcotics
____ Policy & Procedure Information
____
Refrigerated Medications
____ MSDS Information
____
Pixis
____ Oxygen Shut Off Valve
____
Bulb Suction
____ Evacuation Route
____
Syringe Disposal Containers
____ Fire Extinguisher
____
Disposable Gloves
____ Disposable Tape Measures
____
Sterile Gloves
____ Growth Charts
____
Tub Room
____ Discharge Forms
____
Treatment Room
____ Admission Forms
____
Baby Scale
____ Incident Report Policy
____
Swings & Highchairs
Revised jan10
6
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Nursing Department
(FOR EACH NURSING CLINICAL COURSE)
THE INSTRUCTOR IS RESPONSIBLE FOR:
Orientation to Clinical Sites
Introduction of Nursing Personnel
Instruction on charting procedure
and forms
Demonstrations of use and care of
commonly used equipment
Tour of clinical agency
Introduction of each student to safety
and clinical care policies and
procedures
Med test as required
Other
Students are responsible for knowing and/or locating in the work area the following:
Policy and Procedure Manuals
Fire Extinguisher
MSDS Manual
Universal Precaution Policy
Fire Safety Policy
Infection Control Policy
Evacuation Route
Emergency Preparedness Policy
Incident Report Policy
Student Signature ____________________________ Date__________________________
Clinical Facility _____________________________
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CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Pediatric Rotation
REQUIRED CLINICAL SKILLS
In order to complete the requirements of Nursing 356 (pediatrics), it is each students responsibility to
have reviewed and be prepared to complete the following:
Required Skills:
Date(s) Completed
Instructor Initial’s
1.
IV Push Medication
2.
IVPB Medication
3.
Administer medication via syringe pump
4.
PO medication
5.
IV Fluid Therapy Maintenance
6.
Denver Developmental Screening:
Test 3 children/ different ages.
Analyze & attach results
1.
2.
3.
7.
Give feeding via gavage or gastrostomy tube
_______________________________________
8.
Collect or participate in obtaining one lab test:
dextrosix; urine; stool; sputum; etc.
9.
Child on C/R or apnea monitor
10.
Oximeter Reading
11.
Evaluate for Immunization
1.
Deficiency on 2 children
2.
12.
Assist with Admission
Recommended Skills:
1.
Parenteral medication (IM, SQ, or ID)
2.
Topical Medication
3.
O2 therapy or Ohio Tent
4.
Dressing change or wound care
5.
Suctioning
6.
Other(s)
AZH/jan10
8
CSUB Department of Nursing
Nursing 356
INFORMATION ABOUT THE
COMMUNITY ROTATION
Guidelines for Students When in the Community Agencies:
1.
Professional behavior:
Students must follow the Nurse Practice Act and policies of the specific agency they are assigned to
in regard to interactions with clients, client confidentiality, etc. Students are to remain under the
direct supervision of their assigned community facilitator during their rotation. Students are
expected to dress appropriately for the setting they are assigned to. In most settings, this does not
include jeans, shorts and sneakers. Some agencies may request students to wear lab coats or a
uniform. Specific instructions will be given when assignments are made. ALL sites require
students to wear their student name tags. A student who is not appropriately attired may be
dismissed from the site by the facilitator, and the faculty contact person will be notified.
There will not be an instructor assigned specifically to the community rotation. Agency staff will
have numbers to call in case any problems arise. Students who need to talk to a faculty member
while on a community assignment should call their clinical instructor at the hospital.
2.
Attendance:
Assignment schedules will be set up in advance, and students must notify both their instructor and
their community contact person if they are going to be absent from an assigned clinical experience.
It is essential for the community facilitator to know, at the beginning of the business day, if a
student is going to be late or absent, so they will not delay their schedule unnecessarily by waiting
for the student to arrive. Students are expected to remain in the clinical setting for the specified
time, unless specific exceptions are made. If, for any reason, the student decides she/he cannot
complete the day at the agency, the clinical instructor should be contacted before the student leaves
the agency. Attendance policies as written in the Nursing 356 syllabus and the Nursing Student
Policy Handbook also apply in the community rotation.
3.
Assignments:
School Nursing: write a three to four page report using the "General Objectives" and the “School
Agencies Report”.
Caring Corner or Darlyn’s Darlings: write a three to four page report using the “General
Objectives” and “Prescribed Pediatric Care Clinics”.
Be sure to title each report (ex: “General Objectives”) and to NUMBER EACH OBJECTIVE as you
write about it. DO NOT mix/combine reports/ objectives or credit will be deducted. These reports
will be due on the Friday immediately following the community experience. They are to be turned
in to your clinical instructor, just as your other clinical assignments are.
9
CSUB Department of Nursing
Nursing 356
COMMUNITY ROTATION
Introduction to the Community Rotation:
The current trend in pediatrics is to keep hospital stays for acute illness to a minimum period of time.
Assessing and interacting with well children, as well as those with chronic, long-term, and common health
problems that do not require hospitalization, is also important in pediatric nursing. For all of these reasons,
community experiences are integrated into the pediatric nursing clinical rotation.
Experiences in various community agencies give the student the opportunity to become familiar with
chronic, long-term and common health problems of children seen outside of the hospital setting as well as
to observe the growth and development of well children and the impact of illness. Through observation of
nursing care in community-based settings, the student will be able to apply knowledge system stability and
instability to specific pediatric populations and their families. Emphasis is given to health assessment,
health promotion and education as part of the nursing plan of care.
Students from each clinical group will be assigned to community agencies each week. Each student will be
in the community for a minimum of 16 hours (time equivalent to 2 clinical days).
General Objectives:
1.
Give an overview of your community experience. (How did it go? Did you like it?)
2.
Describe the purposes and services of the community agency.
3.
Describe the funding of the agency, (i.e., public, private, fees, grants, special funds).
4.
Describe the types of clients served/ observed/ cared for during your time at the agency, including
age, cultural-ethnic background, socioeconomic status, type of need/problem. (If there is a website
available, include this data. For schools try: www.greatschools.net, or the school’s name)
5.
Discuss two clients you observed during your community experience. State their needs, problems,
developmental level (actual -vs- expected for age), and the top 3 (prioritized) nursing diagnosis
during your care.
6.
Identify observed health care teaching provided by the agency during your assignment.
7.
Rate this community experience on a scale from 1 to 10. Give justification for your rating.
8.
Rate and justify your performance in this community setting on a scale of 1 to 10.
10
School Agencies Report:
Under the direct supervision of the designated school nurse, the student will meet the General Objectives
(p. 8) plus participate in as many of the following activities as possible in the specific assigned setting. Be
sure to identify if/ how each objective was met. If not met, state the objective number and that it was “not
met”. Number 10 must be completed (use references).
1.
Attend multi-disciplinary team conferences determining the educational and health care needs of the
school-aged child. Discuss.
2.
Identify and observe the referral process used to determine the child's eligibility for special
programs.
3.
Assist the community resource nurse in gathering a health/ developmental history on a pediatric
client.
4.
Perform a complete review of a selected child's health file, including nursing assessment, health and
developmental history and nursing plan of care.
5.
Interact directly, in the classroom setting, with children attending the assigned school/agency.
6.
Participate in home visits when possible.
7.
Assist with vision, hearing or other screening procedures when possible.
8.
Observe the school nurse or other staff members perform nursing tasks related to the care of
children in the assigned school settings.
9.
Make observations related to growth and development of specific students in the assigned school
settings and identify the impact of developmental level on health practices.
10.
Sharpen your developmental assessment skills! Each school agency presents endless opportunities
to observe children of different developmental levels in the school environment and this assignment
utilizes those opportunities to enable the student to more fully observe and assess developmental
behavior.
a.
b.
c.
d.
Choose a child representative of the client population your agency serves to observe during
your rotation.
Before observing your client, prepare a comprehensive list of developmental milestones you
would expect for the child's age and grade level. Include cognitive, social, physical, gross/fine
motor skills, etc. Reference your sources.
Next, arrange a time in which you may observe the child in the classroom setting. Document
the observed skills, tasks and milestones of the child both in the classroom and at play. Take
notes!
Contrast expected with observed milestones and write a short summary of your findings and
conclusions.
11
Homeless Shelter, Outpatient Pediatric Clinics. Offices
Under the direct supervision of the community facilitator, the student will meet the General Objectives
plus participate in as many of the following activities as possible in the specific assigned setting:
1.
Review agency policies and protocols related to pediatric visits.
2.
Describe intra-agency coordination of health services and benefits and methods of referral.
3.
Assist with procedures:
3.1
3.2
3.3
participating in intake interview.
taking vital signs.
measuring height and weight.
4.
Describe physical, developmental and/or psycho-social assessments and deviations from the normal
- done by the nurse, nurse-practitioner or physician and assist as indicated.
5.
Compare and contrast how the roles of the RN/ LVN/ Nursing Assistant are similar and different in
this health care setting. Also identify what is special about the RN/ professional nurse’s role.
Prescribed Pediatric Care Clinics (Caring Corner, Darlyn’s Darlings)
Under the direct supervision of the community facilitator, the student will meet the General Objectives,
complete the following, plus participate in as many of the following activities as possible in the assigned
setting:
1.
Identify 3 procedures that you observed or administered to technology dependent children at this
facility. (You MUST administer a G-tube feeding as this experience!)
2.
Identify play and therapeutic interactions that were provided to children in this facility.
3.
Describe education or special health instructions provided to children through this facility.
4.
Select/describe one specific age group served by this facility. Observe and explain how children in
this stage of growth and development react to care in this facility- including procedures, types of
play, feeding, and other interactions with staff and other children.
5.
Describe a life-threatening or adverse reaction that could occur with one of the high risk children in
this facility. What would be the appropriate nursing response in this situation?
6.
Compare and contrast how the roles of the RN/ LVN/ Nursing Assistant are similar and different in
this health care setting. Also identify what is special about the RN/ professional nurse’s role.
Azh/jan10
12
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
Teaching Project Guidelines
Objectives
The student will demonstrate the ability to:
1.1
Assess the learning needs of a family or group.
1.2
Develop a teaching module which identifies the target population, learning objectives,
content, methods of instruction, and evaluative methods.
1.3
Present the teaching module to a selected group at a prearranged place and time.
1.4
Evaluate the results of the presentation.
Rationale
A major role of the professional nurse is teaching--to individuals, families, groups, and organizations. The
nurse needs to have knowledge of assessment, planning, implementation, and evaluation in relation to the
teaching/learning process to enhance the care given to clients. She/he can then provide appropriate health
education within these parameters.
Part One
Preparation of the Project
5%
1.
Select a topic to be taught and identify a target population (family or group) who would
benefit from this teaching. State why this is an important topic for children. (Use
references).
10% 2.
Present the rationale for your choice of topic by assessing the learning needs of the target
population. Discuss all of the following: developmental, cognitive, cultural, economic,
pathophysiological and educational parameters. Investigate your target group via internet
and use other references.
10% 3.
Develop client-centered behavioral objectives including criteria for measurement (minimum
of three). Write as goals – Ex: The children will identify one way germs are spread.
10% 4.
Identify and write out an expanded outline of the content to be taught, utilizing the
assessment in 2. Cite references as appropriate.
10% 5.
Identify teaching methodologies (i.e., lecture, demonstration, etc.) that are congruent with
the topic to be taught and the client's needs. State how the methods selected relate to the
target population's developmental, cognitive, educational and/or pathophysiological status.
Use references.
5%
6.
Develop and state the evaluative methods you will use to assist in evaluating the
effectiveness of the teaching project. State the relationship of the methods to your target
population’s characteristics. Use references.
13
Part One (Items 1 to 6)
Is to be handed in at least three days prior to the planned presentation for grading by instructor. Changes
suggested by instructor on written teaching project must be implemented in the actual teaching project
presentation, or points will be deducted.
Part Two
30% - Presentation
Make necessary arrangements with the clients or agency to present the project. Plan with instructor for
time s/he can be present. Please plan early. Do not wait until the end of the allotted time to plan or present
your project.
Make the presentation. Each member of the team will be responsible to self-rate their individual and group
performance.
15% - Evaluation (separate evaluation done by each person involved in the teaching project)
Evaluate the project. If done with a group, explain who on your team was responsible for which activities.
In the written evaluation, state at what level the objectives were met and evaluate the project itself. State
how the presentation went, what you could have done differently, and other ways it could be improved.
5% - Format (Includes Part One and Part Two)
Write up and turn in a report on the project.
Include Part 1 (items 1-6), Part 2, the form “Evaluation of Teaching Project” (with your circled selfevaluation); your written evaluation; a reference list of sources used to complete the project (counts toward
APA format grade), and a copy of your selected journal article (see below).
All papers are to be typed and APA format is to be used. Spelling and punctuation count. The written
project is to be submitted on the Friday following the presentation, unless otherwise negotiated. A
minimum of two references are required. One reference should be from a current nursing journal or other
professional medical/ healthcare source.
RG 9/94
Revised: AZH/ jan10
14
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
Evaluation of Teaching Project
Student(s): __________________________________________________________
Topic: _________________________________________ Date: _____________
Part 1: (50%) Submitted prior to performing actual project.
Points
1.
2.
3.
4.
5.
6.
Identification of target population (5%)
Assessment of learning needs (10%)
Objectives and measurement criteria (10%)
Content (accurate, adaptable, informative, appropriate) (10%)
Teaching methodologies (10%)
Evaluative methods (5%)
Part 2:
Presentation (30%) Remember to circle self-evaluation below.
Outstanding
Unacceptable
a. Audience (clients or group) was made comfortable.
5
4
3
2
1
b. Delivery was clear, appropriately directed.
5
4
3
2
1
c. Content was accurate, understandable and adapted to client needs. 5
4
3
2
1
d. Use of language: grammar and word choice.
5
4
3
2
1
e. Innovative approaches were utilized.
5
4
3
2
1
f.
5
4
3
2
1
Style, methods, and materials were appropriate.
Evaluation of client learning (Total points 15%):
Utilizing evaluation criteria for your project, explain if the behavioral objectives were met (3%). How did it go
(3%)? How could it be improved (3%)? What could you have done differently(3%)? Portions each team
member was responsible for (3%).
Format of paper (5%)
Comments:
Revised RG 9/94/AZH Dec. 08
Project Grade
15
NURSING 356
Evaluation of Teaching Project: Levels of Achievement for Presentation
Presentation (30%)
a.
Audience (clients or
group) was made
comfortable
Outstanding
5
Good
4
Proficient
3
Marginal
2
 Clear introductions and
purpose of presentation
stated. Personal
appearance is completely
appropriate.
• Mostly clear
introductions and
purpose of presentation.
For the most part,
personal appearance is
appropriate.
• Presentation is
generally clear and well
organized. A few minor
points may be
confusing. Appropriate
to level of growth and
development of
audience. Audience
mostly attentive and
interactive.
• Somewhat clear
introduction and
purpose of presentation.
Personal appearance is
somewhat appropriate.
• Unclear introduction
and purpose. Somewhat
inappropriate personal
appearance.
• No given introduction
or purpose of
presentation.
Inappropriate personal
appearance.
• Listener can follow
presentation with effort.
Some points unclear.
Organization is
haphazard. Most areas
not appropriate to level
of growth and
development. Audience
sometimes interactive
and attentive.
• Presentation is difficult
to follow. Unclear,
illogical sequence of
ideas. Inappropriate
level for audience’s
growth and
development. Audience
not attentive. Loses
interest. Not
interactive.
• Some content
inaccurate. Enough
errors are made to
distract the listeners.
Explanations of
concepts are
incomplete. Listeners
gain little from the
presentation. Length
was inappropriate.
• Information presented is
sufficiently inaccurate.
Listeners are distracted
and misled.
Explanations of
concepts are poor.
Listeners gain no new
knowledge or insight.
Length of presentation
was inappropriate.
Instructor needed to
intervene.
• Listeners can
occasionally follow the
presentation. Many
grammatical errors are
present. Slang is
frequently used. Many
• Listeners are so
distracted by the
presenter’s difficulty
with grammar and
vocabulary they cannot
focus on the ideas
b. Delivery was clear
and appropriately
directed to audience.
• Presentation is
consistently clear, logical,
organized. Listener can
follow the reasoning.
Presentation is
appropriate to level of
growth and development
of audience. Audience
interested and interactive.
c. Content was accurate,
understandable, and
was adapted to client
needs.
• Information included in
presentation is
consistently accurate.
Complete,
understandable, age
appropriate explanations
of key concepts are
provided. Listeners gain
insights. Length of time
for presentation is
appropriate.
• No significant errors are
made. Listeners do not
recognize errors, if any
occur, presenter(s)
correct(s). Helpful
applications are
included. For the most
part, explanations of
concepts are accurate
and complete. Length
of time could be a little
longer or shorter.
• Presentation is
somewhat clear.
Organization needs
work. Some points are
confusing.
Questionably
appropriate to level of
growth and
development. Audience
interactive and attentive
at times.
• Listeners recognize
errors thought to be the
result of presenter’s
nervousness or
oversight. Explanations
of concepts are mostly
accurate and complete.
Few helpful
applications used.
Length of presentation
was notably long or
short.
d. Use of language:
Grammar and word
choice.
• Consistently, sentences
are complete and
grammatical; they flow
together easily. Words
are chosen for precise
meaning and are
• Usually (for the most
part), sentences are
complete and
grammatical. They
flow together easily.
With a few exceptions,
• Listeners can follow the
presentation but
grammatical errors are
present. Slang is used
occasionally. Sentences
are occasionally
Unacceptable
1
Presentation (30%)
Outstanding
5
appropriate for audience’s
level of knowledge.
e. Innovative
approaches were
utilized.
• Communication aids are
innovative. Approaches
that are utilized are
prepared in a professional
manner. Visuals are large
enough to be seen by all.
main points stand out.
Materials are appropriate
for level of development.
f. Style, methods, and
materials were
appropriate.
• Level of presentation is
appropriate for the
audience. Presentation is
well planned. Speaker is
clearly comfortable. The
entire group can hear and
comprehend the
presentation. behavioral
objectives completely
met.
REF:
Good
4
Proficient
3
Marginal
2
words are chosen for
their precise meaning,
application, and are
appropriate for the
audience’s level of
knowledge.
• Communication aids
and approaches
contribute to the
presentation. Materials
are mostly professional.
Visuals are large
enough to be seen by
almost all. Most
materials support main
points of presentation.
Materials are
appropriate for level of
development.
incomplete or halting.
Vocabulary is
sometimes
inappropriate for the
audience.
incomplete sentences
and periods of silence.
Vocabulary is
sometimes
inappropriate for the
audience.
• Communication aids are
poorly prepared or used
inappropriately.
Visuals can not be seen.
Too much information
is included or too little.
Unimportant material is
highlighted. Listeners
may be confused often
during the presentation.
• Level of presentation is
mostly appropriate for
the audience.
Presentation is
generally appropriately
planned. Speaker
sometimes speaks too
fast or too slow. The
group can usually hear
and comprehend. Most
or all of behavioral
objectives are met.
• Communication aids
and approaches
somewhat contribute to
the presentation.
Materials are somewhat
professional. Visuals
are large enough to be
seen by most. Too
much or too little
information is
presented. Materials
are sometimes
appropriate for
development level.
• Some aspects of the
presentation are too
basic or too
sophisticated for the
audience. Presenter
seems uncomfortable
some of the time. The
listener sometimes has
difficulty
understanding, hearing,
or comprehending.
Some of the information
is directly read. Some
of the behavioral
objectives are met.
• Many aspects of the
presentation are too
basic or too
sophisticated for the
audience. Presenter is
uncomfortable most of
the time. The listener
consistently has
difficulty
understanding, hearing,
and comprehending.
Most of the information
is directly read. Few of
the behavioral
objectives are met.
Oral Presentation Rubric (DRAFT 4-29-98) Department of Educational Leadership and Policy Studies/ Iowa State University/ Revised: AZH/Winter 2007
Total Score: ____________________________/30
16
Unacceptable
1
presented. Slang used.
Periods of silence.
Vocabulary
inappropriate for the
audience.
• No communication aids
are used, or they are so
poorly prepared that
they distract from the
presentation. Materials
are inappropriate for
developmental level.
Listeners are
uninterested and
confused.
• Presentation is
consistently too basic or
sophisticated for the
audience. Information
is read to the audience.
Presenter is obviously
anxious and cannot be
heard. Behavioral
objectives are not met.
17
Denver Developmental Screening Test (DDST)
You are required to perform 3 DDST’s during your pediatric rotation. These will be submitted at
the end of the quarter during your final clinical evaluation. They can all be done on 1 form or 3
separate Denver II forms. Be sure to include the N356 DDST Evaluation Form (see next page).
Calculating the child's age:
1.
Determine the child's birthdate.
2.
Subtract the birthdate from the test date. Start the calculation the right, figuring
first the day, then the month, then the year necessary to "borrow," 1 month = 30
days and 1 year = 12 months.
Year
Date of test
2010
Birthdate
-2008
Age of Child
2
3.
4.
Scoring:
1.
2.
3.
4.
Comments:
1.
2.
3.
4.
5.
Month
1
-1
0
Day
19
-9
10
Draw age line of chart through all four sectors at the child’s exact age. Write the
date of the test at the top of the age line.
Before drawing age line, ask if child was born early. If child was born 2 or more
weeks prematurely, subtract the number of weeks early from the age of the child,
draw the line at the adjusted age, and write number of weeks adjusted under date
at top of age line. (Only adjusted until child is 2 years old.)
Each item is designated by a bar representing ages at which 25%, 50%, 75% and
90% of tested population were able to perform item.
Score items as “pass,” “fail,” “refusal,” or “no opportunity.”
Interpretation of Scores:
Advanced: Passed an item completely to the right of the age line
OK: Passed, failed, or refused an item intersected by the age line between the
25th and 75th percentiles
Caution: Failed or refused items intersected by the age line on or between the
75th and 90th percentiles
Delay: Failed an item completely to the left of the age line; refusals to the left of
the age line may also be considered delays, since the reason for the refusal
may be inability to perform the task
Interpretation of Test:
Normal: No delays and a maximum of one caution.
Suspect: One or more delays and/or two or more cautions.
Untestable: Refusals on one or more items completely to the left of the age line
or on more than one item intersected by the age line in the 75% to 90% area.
Prepare toddlers and preschoolers by presenting it as a game.
Need to consider cultural variations that could influence results, in order to avoid
erroneously labeling the child as developmentally delayed.
Need to clarify to parents that this is not an intelligence test.
Explain to parent that child is not expected to perform every item on sheet.
Put each item away before beginning with next item.
18
N356 DDST Evaluation Form
Child #1- Initials________
Calculation of the child’s age:
Year
Month
Day
Date of test:
Birthdate:
- _____________________________
Calc.Child Age =
Interpretation of Testing/ Scores: (Normal, Suspect,Untestable) and why
Personal-Social:
Fine Motor-Adaptive:
Language:
Gross Motor:
Comments:
______________________________________________________________________
Child #2- Initials________
Calculation of the child’s age:
Year
Month
Day
Date of test:
Birthdate:
- _____________________________
Calc.Child Age =
Interpretation of Testing/ Scores: (Normal, Suspect,Untestable) and why
Personal-Social:
Fine Motor-Adaptive:
Language:
Gross Motor:
Comments:
______________________________________________________________________
Child #3- Initials________
Calculation of the child’s age:
Year
Month
Day
Date of test:
Birthdate:
- _____________________________
Calc.Child Age =
Interpretation of Testing/ Scores: (Normal, Suspect,Untestable) and why
Personal-Social:
Fine Motor-Adaptive:
Language:
Gross Motor:
Comments:
______________________________________________________________________
Azh/jan10
19
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
WRITING NURSING DIAGNOSTIC STATEMENTS
From assessment data gathered about structural variables, the client's perception, and the nurse's
inferences about subsystem and intersystem functioning, use the following components to
construct nursing diagnostic statements:
A.
For ACTUAL (acute and chronic) PROBLEMS the statement consists of four parts:
1)
2)
3)
4)
The Functional Health Pattern affected
+
Nursing diagnostic label (NANDA)
+
Related to (r/t) _____________________________________
(contributing factors)
+
Manifested by (m/b) ________________________________
(signs and symptoms, defining
characteristics, behaviors)
Example: FHP: Cognitive - Perceptual--Alteration in comfort: pain, related to surgical
intervention (appendectomy) m/b restlessness, crying, and statements that "my side
hurts."
B.
HIGH RISK NURSING DIAGNOSES refer to problems that the patient is at risk of
developing. They are labeled: “Risk for" to assist nurses in identifying clients who are
most vulnerable to certain problems. Contributing factors (as risk factors) are present,
but defining characteristics (signs and symptoms) are not. For POTENTIAL
PROBLEMS the diagnostic statement would consist of three parts:
1)
The Functional Health Pattern affected
+
2)
Nursing diagnostic category (NANDA) (preceded by "high risk for")
+
3)
Related to ________________________________________
(risk factors)
+
Example: FHP: Elimination--Risk for impaired skin integrity related to frequent, loose bowel
movements.
20
C.
For POSSIBLE PROBLEMS (i.e. may be present, but require additional data to confirm
or rule out) the statement will usually consist of three parts:
1)
2)
3)
The Functional Health Pattern affected
+
Nursing diagnostic category (NANDA) (preceded by "possible")
+
Related to _________________________________________
(factors that lead to diagnosis being suspected)
Example: FHP: Cognitive-Perceptual--Possible sensory-perceptual alteration (deprivation) r/t
decreased contact with others secondary to hospitalization in an isolation room.
D.
WRITING COLLABORATIVE PROBLEM STATEMENTS
Nursing diagnosis provides the basis for selection of nursing interventions to achieve
outcomes for which the nurse is accountable (NANDA, 1990). COLLABORATIVE
PROBLEMS are certain physiological complications that nurses monitor to detect their
onset or change in status (Carpenito, 1990).
Nurses make independent decisions for both nursing diagnoses and collaborative
problems. With collaborative problems, the definitive treatment to achieve desired
outcomes, is prescribed by both the nurse and the physician. The nurse primarily
monitors for the onset and change in status of physiologic complications to prevent
morbidity and mortality.
Collaborative problems are based on physiological complications that are usually related
to disease, trauma, treatments, medications, or diagnostic studies. Collaborative
problems are labeled “Potential Complications.” The statement will usually consist of:
1)
Potential Complication (PC): ______________
(Specify physiological complication)
2)
The Functional Health Pattern affected
For example, a patient has leukemia. Patients with leukemia generally receive
chemotherapy. Therefore, a collaborative problem for a patient would be:
PC: Antineoplastic Therapy Adverse Effects
(FHP: Multisystem)
This material is adapted from:
Carpenito, L. J. (1995). Nursing Care Plans and Documentation. Philadelphia:
Lippincott.
For further information and clarification of writing collaborative problem statements please see
Wilkinson, J. (2000). Nursing diagnosis handbook with NIC interventions and NOC outcomes.
Prentice Hall.
21
E.
WELLNESS NURSING DIAGNOSES
A Clinical judgment about an individual, group, or community in transition from a
specific level of wellness to a higher level of wellness.
A focus on patterns of wellness, healthy responses, or client strengths drawn from
assessment data. Progressive attainment of health behaviors or completion of
developmental tasks.
1)
Criteria for wellness nursing diagnosis:
a.
b.
2)
3)
Desire for a higher level of wellness.
Effective present status or function.
Label
a.
Wellness diagnostic statements are one part statements containing the
label.
b.
Include evidence to support your diagnosis
c.
Avoid judging whether a client’s or group’s present health status or
function is effective or ineffective; rely on the client’s/parents report of
perception.
Examples of Age Appropriate Wellness Diagnosis:
Infant - Beginning expressions of pleasure associated with age appropriate
activities as evidenced by smiling while shaking rattle
Toddler - Beginning sense of autonomy as evidenced by beginning potty training
School Age - Beginning cooperative play as evidenced by playing card games
with other children.
Adolescent - Developing relationships with opposite-sex peers as evidenced by
talking on telephone with opposite sex peer
This material was adapted from:
Carpenito, L.J. (1995). Nursing diagnosis: Application to clinical practice. (5th Ed.).
Philadelphia: Lippincott.
and
Stolte, K.M. (1996). Wellness: Nursing diagnosis for health promotion. Philadelphia:
Lippincott.
SPECIAL CONSIDERATIONS WITH PEDIATRIC
MEDICATION ADMINISTRATION SAFETY
22
1.
Take a drug allergy history. Be aware of drug-drug or drug-food interactions.
2.
Check the 5 “rights” prior to administering the medication
(Right: drug; dose; time; route; child/patient- always check name using 2 identifiers)
3.
Always double check the following medications with another nurse: **Digoxin; Insulin;
Heparin; Blood; Epinephrine; Narcotics; Sedatives; Chemotherapy; Cardiotoxic drugs.
4.
Involve the child in order to gain cooperation.
5.
Always praise the child for doing their best after they have received their medication.
CALCULATION OF IV DRIP RATE
When administering IV medications to a Pediatric patient, use a medication infusion pump
whenever possible. If not possible, use the following formula to calculate IV drip rate:
Volume to be infused X Drop factor of IV tubing
--------------------------------------------------------- = Flow rate in
Total infusion time (in Minutes)
drops per minute
CALCULATION OF 24-HOUR FLUID REQUIREMENT FOR PEDIATRIC PATIENTS
1.
Calculate the weight of the child in kilograms. (Weight of child in pounds ÷ 2.2
[lb/kg] = weight in kg)
2.
Allow 100 ml per kilogram for the first 10 kg.
3.
Allow 50 ml per kilogram for the second 10 kg.
4.
Allow 20 ml per kilogram for the remainder of weight in kilograms.
5.
Divide the total amount by 24 hours to obtain rate in milliliters per hour.
AZH/Dec. 2007
Reference: Wison, D. & Hockenberry, M. (2008). Clinical manual of pediatric nursing. (7th
ed).
St. Louis: Mosby.
23
INTERPRETING ARTERIAL BLOOD GASES
Arterial blood gasses (ABG’s) provide valuable information about the acid-base balance,
ventilatory ability, and oxygenation status of a client. The major components are: pH, pCO2,
HCO3, and pO2. Pulse oximetry (non-invasive measures) should be utilized before ABG’s are
performed.
pH - reflects the blood’s acid-base balance. Buffering systems to maintain a normal pH
are the respiratory and renal systems. In acidosis the pH decreases (below 7.35). In alkalosis the
pH increases (above 7.45).
PaCO2 - reflects the respiratory system’s efforts to maintain a normal pH. When the
blood becomes acidotic the respiratory system increases it’s rate and depth of ventilation to blow
off CO2 and decrease the acid level in the blood. If the blood is alkalotic the respiratory system
hypoventilates to retain CO2.
HCO3 - reflects the renal system’s efforts to maintain a normal pH. HCO3 is
manufactured by the kidneys in response to acidosis. It takes several days for the kidneys to
respond fully to changes in pH. If HCO3 is abnormal, the acid-base imbalance has a metabolic
cause.
PaO2 - is the amount of O2 dissolved in the plasma.
O2 saturation is the measure of hemoglobin saturated with O2. When 95% to 100% of
the hemoglobin carries O2, the tissues are receiving adequate amounts of O2.
ABG Component
pH
PaCO2
HCO3
PaO2
Normal Levels
7.35 – 7.45
35-45 mmHg
22-26 mEq/liter
90-110 mmHg
PRIMARY RESPIRATORY ACIDOSIS: due to airway obstruction, severe asthma, pneumonia,
neuromuscular disorders, respiratory center depression (trauma, narcotics, sedatives).
Acute uncompensated
Early compensated
Chronic compensated
pH
D
D
N
PRIMARY RESPIRATORY ALKALOSIS:
ventilation), hypoxemia.
pH
Acute uncompensated
I
Early compensation
I
Chronic compensated
N
pCO2
I
I
I
HCO3
N
I
I
Base excess/deficit
N
I (excess)
I (excess)
Due to hyperventilation (anxiety, fever, artificial
pCO2
D
D
D
HCO3
N
D
D
Base excess/deficit
N
D (deficit)
D (deficit)
PRIMARY METABOLIC ACIDOSIS: Due to increases in nonvolatile H+ (prolonged vomiting
of NG suctioning, diuretic therapy, adrenal steroid therapy), excessive bicarbonate intake, severe
diarrhea, diabetic ketoacidosis, starvation/malnutrition, kidney failure, shock, burns.
24
Acute uncompensated
Early compensation
Chronic compensated
pH
D
D
N
pCO2
N
D
D
HCO3
D
D
D
Base excess/deficit
D (deficit)
D (deficit)
D or N
PRIMARY METABOLIC ALKALOSIS: Due to loss of H+ (prolonged vomiting or NG
suctioning, diuretic therapy, adrenal steroid therapy), excessive bicarbonate intake cystic fibrosis.
Acute uncompensated
Early compensating
Chronic compensated
pH
I
I
N
pCO2
N
I
I
HCO3
I
I
I
Base excess/deficit
I (excess)
I (excess)
I or N
D = Decreased; I = Increased; N = Normal
REFERENCES
Kee, J. L. (2001). Handbook of laboratory and diagnostic tests. New Jersey: Prentice Hall.
Malarkey, L., & McMorrow, M.E. (1996). Nurse’s manual of laboratory tests and a diagnostic
procedures. Philadelphia: W.B. Saunders.
Pagana, K. & Pagana, T. (1995). Mosby’s diagnostic and laboratory test reference (2nd ed).
St. Louis: Mosby.
Treseler, K. (1982). Clinical laboratory tests. New Jersey: Prentice Hall.
Wilson, D., & Hockenberry, M. (2008). Clinical manual of pediatric nursing (7th ed). St. Louis:
Mosby.
AZH/w07
25
CONCEPTS IN FLUID AND ELECTROLYTES FOR PEDIATRICS
**For further data recommend: www.labtestsonline.org
Glucose
Stress
Malnutrition
Potassium
Dehydration
Vomiting, diarrhea
Sodium
Dehydration, vomiting, diarrhea
V/D
Creatinine
Dehydration
Chloride
Dehydration
Prolonged Vomiting
Co2
Severe prolonged vomiting
Severe diarrhea, dehydration, hypovolemia
Calcium
Dehydration
Malnutrition, prolonged IVF
HCT & HGB
Anemia (RBC normal, borderline or decreased with  RBC compensation for
blood loss, tissue hypoxia).
MCV
Mean volume or size of an RBC
Macrocytic anemia (larger than normal) – folate or B12 deficiency
Microcytic anemia (iron deficiency or thal.)
MCH
Wt of HGB per RB C
In macrocytic anemia
In microcytic anemia
MCHC
Average amount of Hgb in each RBC – a percentage
levels are not possible.
Macrocytic anemia – MCHC is normal
Microcytic anemia – MCHC is 
Most reliable to check for iron deficiency anemia
25
LABORATORY RESULTS
Room Number __________
Normal Range
TEST
(age dependent)
** Culture Results:
**Diagnostic test results:
Patient ________________
Admission
Date/Results
Current
Date/Results
Significance of Value for THIS Patient
CBC/Diff
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
RDW-CV (%)
PLT
NEUT/SEGS
LYMP
MONO
EOS
BASOS
Bilirubin
Total Bili
6.0-13.2
U Bili
1.0-10.0
C. Bili
0-1.2
BMP
Ca++
BUN
Na+
K+
C1
C02
Glu
Creat
References: Fishbach, F. A manual of laboratory & diagnostic tests (6 th Ed. (2000). NY: Lippincott Williams & Wilkins;
Special Thanks to: Stephanie Gates (Nursing Class of 2004)
26
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
Patient Initials ____
LABORATORY/DIAGNOSTIC TESTS:*
Normal Values - may
vary by age
CBC
WBC
RBC
Hgb
Hct
MCV
MCH
MCMH
RDW
Platelets
DIFFERENTIAL
LYMPH %
MONO %
NEUTRO (PMNs)
EOSINO
BASO
CHEMISTRIES
SODIUM
POTASSIUM
CHLORIDE
TCO2
GLUCOSE
HbA1c
CREATININE
ANION GAP
BUN/Creat Ratio
OSMOLARLITY
Ca
Phos
BUN
Chol
Total Protein
Albumin
Total
Bilirubin
SGOT/AST
SGPT/ALT
LDH
CPK
CLOTTING TESTS
APTT
PT
Date/Hour
Patient’s Value
#1
Purpose of Test/
Meaning of Abnormal Value
#2
3
5-10
3
m 4.2-5.4/10
f 4.2-5
m 13.5-17.5 q./dl.
f 12-16 q./dl.
m 40-50%
f 37-47%
87-103
26-34
31-37
8.5-11.5
150,000-350,00
20-40%
2-6%
60-70%
1-4%
0.5-1%
138-144 M Eq/L
3.4-4.7 M Eq/L
97-107
23-30 mmol/liter
60-100(F), 70-115(NF)
4.0-7.0%
0.3-0.7 mg/dl
<+ 12 mEq/l**
15-24/1
275-295
9.2-11.0 mg/dl
4.5-5.5
5-18 mg/dl
140-250
6.0-8.0
3.8-5
0.2-1 mg/dl
25-75
5-28 U/L
16-25 seconds
10-14 seconds
(F)=fasting, (NF)=non-fasting
*Where applicable, values reflect those for children.
**<16 mEq./liter if potassium concentration is used to calculate annion gap .
27
Normal
BLOOD GASES
pH
PCO2
PO2
HCO3
B.E.
O2SAT %
URINALYSIS
Sp. gr.
pH
protein
glucose
ketones
bilirubin
WBC
RBC
Epith.
Casts
Bacteria
Nitrate
CULTURE(S)
Blood
Urine
Wound
Other
CSF***
Clarity
Pressure
Total cell
count
glucose
Protein
Patient
Purpose
7.35-7.45
39 +/-7
80-100
24 +/-2
3 +/-2
95+
1.015-1.025
4.6-8.0
Neg.
Neg.
Neg.
Neg.
10-4/HPF
1/HPF
0-occasional
0-occ. hyline
0
crystal clear
50-180 mH20
0-5 WBC (lymphocytes)
40-70 mg/dl
ESR/Sed rste
CRP
Other
EKG Results: _______________________________________________________
_______________________________________________________
X-ray Results:_______________________________________________________
_______________________________________________________
Other:
_______________________________________________________
_______________________________________________________
Reference: Fischback, F. (1992). Laboratory diagnostic tests (3rd ed.).
Philadelphia: Lippincott.
JGR/1992/RJG/1994/azh dec07
28
Pediatric Neurologic Assessment
EYES
OPEN
BEST
MOTOR
RESPONSE
BEST
RESPONSE
TO
AUDITORY
AND/OR
VISUAL
STIMULUS
Older Child & Adult
Spontaneously
To speech
To pain
No response
4
3
2
1
Older Child & Adult
Obeys commands
Localizes pain
Flexion withdrawal
Flexion to pain (decorticate)
Extension to pain
(decerebrate)
No response
> 2 years old
Orientation
Confused
Inappropriate words
Incomprehensive words
No response
Endotracheal tube or trach
Coma Scale Total
Infant & Young Child
Spontaneously
To loud noise
To pain
No response
4
3
2
1
Infant & Young Child
6 Spontaneous movement
5 Withdraws to touch
4 Withdraws to pain
3 Abnormal flexion (decorticate)
2 Abnormal extension (decerebrate)
6
5
4
3
2
1
1
5
4
3
2
1
T
No response
5
4
3
2
1
< 2 years old
Smiles, listens, follows
Cries, consolable, irritable
Inconsolable, persistent cry
Restless, moans, grunts
No response
(0-15)

Remember that a neurologic scale determines the level of consciousness. The total score
reflects the brain's functional level. The lower the score, the closer to coma (< 8).

Recognize what is normal for the child and expected related to growth and development.

In children < 5 years old, speech is taken as any sound at all, even crying.
Modified from:
James, H.E., Anas, N.G., Perkin, R.M. (1985). Brain insults in infants and children. Orlando,
FL: Grune & Stratton.
Azh/w07
29
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
N356
Practice Test: Pediatric Medication Administration
Name:
Instructor:
Date:
______________________________________________________________________________
1.
Physician’s order reads Tylenol Elixir 7 gr p.o. (Label states 120mg/5ml.)
How many ml’s will you give?
2.
Physician’s order states Ampicillin 80mg p.o. (Label states 125mg/5ml.)
How many ml’s will you give?
3.
Physician’s order states Lanoxin .08mg p.o. (Bottle states .05mg/ml.)
How many ml’s will you give?
4.
Physician’s order states Lasix 16 mg/I.V.P. (Label states 20 mg/2ml).
How many ml’s will you give?
5.
Physician’s order states Solumedrol 2mg/kg loading dose, give now. Then Solumedrol
0.75mg/kg/dose every 6 hours (maintenance). Your patient weighs 31 pounds.
How much will you give for the loading dose?
How much will you give for the maintenance dose?
30
7. Physician’s order states Amipicillin 160 mg I.V.P. You have diluted the 250 mg Ampicillin
vial with 2.5ml normal saline. After withdrawing the entire amount from the vial, you have a
total of 2.8 ml.
How much will you give?
7.
Physician’s order states Valium 2mg I.V. (Label states 10 mg/2ml.)
How much will you give?
8.
Physician’s order states Tylenol Elixir 4 grain p.o. (Label states 120mg/tsp.)
How many ml’s will you give?
9.
Physician’s order states Phenobarbital 15 mg p.o. (Label states 20mg/5ml.)
How much will you give?
10.
Order reads: Administer NS bolus 100ml/kg over 2 hours. Your patient weighs 25 lbs.
How much total fluid will you give in the bolus?
How many mls’ will you adminster per hour?
31
11.
Order reads Theophylline 60 mg IVPB q 6 hours. (Theophylline dosage is
5-6mg/Kg/day). The patient’s weight is 12Kg.
How many mg/Kg/day is the child receiving? Is the dose appropriate for this patient?
12.
Order reads Gentamycin 5mg IVPB q 8 hours. (Gentamycin does is 5mg/Kg/day). The
patient’s weight is 3Kg.
How many mg/Kg/day is the child receiving? Is the dose appropriate for this patient?
13.
Using the formula in this syllabus Expanded Syllabus (Special considerations with
pediatric medication administration safety), calculate the 24-hour fluid requirement for
each of these patients:
a.
4-month-old male, pneumonia, 6.2 kg.
b.
5-year-old female, gastroenteritis, 50 lbs.
c.
12-year-old male, MVA, 98 lbs.
Azh dec08
32
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
Perioperative & Operative Learning Objectives & Assignment
Assignment:
At the completion of this experience, the student will be able to:
1.
State the patient’s age, medical diagnosis, and surgical procedure being performed. (__/2)
2.
Attach/ discuss the pathophysiology. Relate results of diagnostic tests and labs to your
patient and their current health status. (_____/13)
3.
Discuss the developmental considerations for the child you followed – include the stages
of growth and development they were in and age appropriate teaching methodologies that
could be utilized (use references). (_____/15)
4.
Describe, in detail, the preoperative process and its effect on the pediatric client. Compare
what is discussed in your textbook with what actually occurs. (____/15)
5.
Identify and explain the different types of uses of anesthetic agents: inhalation agents,
intravenous agents, muscle relaxants and regional anesthetics. (Use references.) Next
discuss which ones were used for your client. (_____/15)
6.
Discuss the OR environment and the effect on the client. Identify specific nursing roles
and other team member roles in the operating setting. Compare what you observed with
what is described in your textbooks. (Use references.) (_____/10)
7.
Discuss the postoperative progress and its effect on the pediatric client. Discuss specific
criteria for discharge and home care instructions for the patient you followed.
(_____/10)
8.
Identify the top (prioritized) nursing diagnoses for each of these areas. Be sure to
personalize for your specific pediatric patient.
(______/18 –> 3 points each)
Preoperative (2 nursing diagnosis)
Operative (2 nursing diagnosis)
Post anesthetic (2 nursing diagnosis)
9.
APA style and Reference List. (_____/2)
Review Craven & Hirnle; James & Ashwill; Wong spiral
Azh/dec.08
33
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356
What to Do in NICU
1.
Meet your preceptor and listen to change-of-shift report, scrub in.
2.
Check MD orders and progress notes.
3.
Review current labs and diagnostic testing results.
4.
Review the most current progress notes and notations from other disciplines.
5.
Obtain vital signs and assess your patient with your preceptor.
6.
Write up a complete assessment.
7.
Assist your preceptor in implementing the plan of care.
8.
Assist with nursing procedures such as po/ng/og feedings.
9.
Calculate drip rates on all IV’s and IV meds.
10.
Document all patient data as per protocol (e.g. VS, bedside tests, I&O, cluster care, etc.)
11.
Interact with parents and provide emotional support as appropriate.
12.
Evaluate the effectiveness of your nursing care with your preceptor and modify care
accordingly.
13.
Complete a mini or short pediatric Nursing Process Plan.
Azh/Dec. 2008
34
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 355
Directions for Pediatric Process Plans with Functional Health Patterns:
Long Pediatric Process Plan:
Page one of format:
Fill in the front sheet of the assessment. This sheet must be completed prior to giving nursing
care. Pay careful attention to the current diagnosis as it may be different from the admission
diagnosis.
Page two: One point will be deducted for lack of highlighting per section.
1.
Patho: Integration of patho to show how disease processes may impact each other (i.e.,
impacting and/or conflicting), or labs, medications and treatments. A branching diagram is
required with highlighting of your patient’s particulars so the information is personalized.
Two references are required, one MUST BE a pediatric source or points will be deducted.
2.
Developmental level: Complete using Wong or Ashwill as a guide. Highlight what
pertains to your patient. No photocopies allowed.
Page three: Complete medication worksheet. List the information for each medication ordered,
not just those given during your care. Don’t forget to include the IV administration rates.
Pages 4-7:
1.
Subjective Assessment columns: To complete the subjective data information, obtain data
from the following sources: the client, the health history form, the family or the chart. You
are encouraged to use the admitting nursing information and the physician’s data from the
chart. Use the guidelines to elicit information for each area. Address all of the Functional
Health Patterns in this manner. May use Wong’s Clinical Manual of Pediatric Nursing
Functional Health Pattern (FHP) Cues (check INDEX for page number). Highlight any
abnormals.
2.
Objective Assessment column: Physical assessment : In the objective data block, record
your physical health assessment using Wong, Jarvis, or Ashwill. Address each Functional
Health Pattern. Add any particulars that may be necessary for your patient even if the
prompts are not listed. Highlight any abnormals.
3.
Lab and Diagnostic column and additional Lab sheet: Gather supportive data to
substantiate observations with labs, procedures, and other objective data. Lab tests should
be reflected in each FHP where it is appropriate, although they may be relevant in more
than one FHP. Identify the abnormal values with arrows reflecting high or low values.
Then on the “lab sheet” give the values with the significance/meaning of the abnormals for
35
this patient. Be sure to attend to the relevance for your patient. List the normal labs also to
demonstrate ruled out problems.
4.
Nursing Diagnosis column: Each FHP needs at least one nursing diagnosis. List the
NANDA, wellness, or collaborative problems that apply to your patient. (1) Use the
NANDA wording. (2) Define the statement by “related to” (etiology here) or “risk for”
(Wilkinson, p. xv). (3) May use “secondary to” (use medical diagnosis here). (4) Using
the term “manifested by” identify the “defining characteristics” (Wilkinson, p. xiii). (5) If
there are no NANDA or collaborative problems, include a wellness diagnosis.
Page 8
Nursing Diagnosis Priority List:
List on the separate sheet, the top 5 to 8 Nursing Diagnoses (using NANDA wording) with the
priority number, rationale for selection, and reference for each. Include at least one wellness and
one collaborative diagnosis.
Page 9
Plan of Care:
1.
2.
3.
4.
5.
Column 1: Select the top two Nursing Diagnoses that you will be focusing on during your
care. Again, use NANDA wording to list.**
Column 2: Prioritize as to whether “1” or “2” and give rationale for this prioritization.
Include reference to substantiate your choice.
Column 3: Give NOC, followed by patient centered goal and measurement criteria (note
this is 3 bits of information).
Column 4: NIC, followed by planned nursing interventions with “who,” “when,” “how
often,” etc. (Wilkinson, p. xvii), and rationale for the specific nursing interventions with
references.
Column 5: The final area is the evaluation of the goal and measurement criteria, including
which nursing interventions were actually implemented, how successful they were and
what changes were needed.
**Confirm that any data that you have used in your NANDA for “as demonstrated by” is
documented somewhere.
Note: Each goal and nursing activity must be personalized for your specific patient using age,
developmental level, medical diagnosis, activity limitations, needs, etc. Do not just copy from
Nursing Diagnosis books or programs.
36
Short Pediatric Process Plan
Page 1: Fill in the front sheet of the assessment. This sheet must be completed prior to giving
nursing care.
Page 2: One point will be deducted for lack of highlighting per section.
Patho: Begin integration of patho with labs, medications, and treatments. Patho must include all
areas listed. See note under long care plan for criteria. A branching diagram is required.
Highlight your patient’s particulars so the information is personalized.
Lab and Diagnostic Section and additional Lab sheet:
Gather supportive data to substantiate observations with labs, procedures, and other objective
data. Identify the abnormal values with arrows reflecting high or low values. On the “lab sheet”
give the values with the significance/meaning of the abnormals for this patient. Be sure to
attend to the relevance for your pt. List the normal labs also to demonstrate ruled out problems.
Developmental Level:
Complete using Wong or Ashwill as a guide. Highlight what pertains to your client.
See note under long care plan for criteria.
Medication Worksheet:
On the medication sheet list the information for each medication ordered, not just the
medications you will give during your care. (See “Medication Worksheet: Instructions for
Use,”in expanded syllabus). Be sure to include administration rates for all IV medications.
Physical Assessment:
Complete form. Highlight abnormal findings.
Concept Plan:
Be sure to develop the primary medical diagnosis needing attention during your care.
Step#1- Start by completing the reason for seeking health care (chief complaint and medical
diagnosis- CENTER). Also: Identify key assessments that are relate to the reason for health care
and growth and developmental considerations.
Step#2- List the major problems (key problems) you have identified based on the assessment
data collected on the patient.
Step#3- Support problems with clinical patient data: abnormal physical assessment findings,
nutrition, treatments, nursing care, medications, activity level, IV’s, abnormal diagnostics and lab
tests, medical history, emotional state, cognition, and pain.
Step#4- Number to prioritize problems, and label each problem with appropriate nursing
diagnosis and FHP. Be sure to include at least one wellness diagnosis and one collaborative
problem on your care map.
Mini Care Plan: Complete when a patient has gone home, or a 2nd patient is assigned.
Option: If your patient is discharged early in the shift, you may just hand in the first 2 pages of
the long or short process plan, plus the Medication Administration form.
When 2 patients are assigned at the beginning, one long or short process plan is due, with one
mini plan.
37
Team Nursing Complete the “N356 Team Nursing” individual pt work-up for every pt on your
team. No pathos are required. Medication worksheets are required for each patient on your team.
Complete the “Team Objectives for Play Therapy” objectives. This assignment is to be worked
on together as much as possible. Each person in the group must hand in their own individual
copy (even though it may be identical for each person in the group). Please state who completed
which areas of the assignment. On the day of care work together as much as possible completing
assessments, treatments, documentation, baths, etc. You may want to assign medication
administration based on “who needs what” on their skills checklists. DO NOT just assign each
person their own patient to work on independently, this defeats the purpose of the assignment.
Medication Worksheet
Instructions for Use:
1.
List all ordered medications by name:
Generic NameBrand Name-
The name shown in lower case letters (is often
derived from the chemical name).
The name designed/designated by the drug
manufacturer (is capitalized).
2.
Classification:
Clinical indication and body system.
The classification of the drug leads to understanding of common
characteristics of other medications from the same classification.
3.
Route and Dose:
Every medication should have the dose and route the doctor
ordered. If administrating an IV medication, include rate.
4.
Pharmacokinetics:
Peak, onset, duration of action. Where metabolism occurs.
5.
Side-effects:
Are listed by system, with the most commonly occurring listed first.
6.
Management/Pt Care:
Important assessment data, information to provide to the
patient/family, how to evaluate the patient receiving the med.
7.
Calculate the actual medication dose ordered by the doctor (how many mg/kg/dose or day
the patient is receiving). Compare (using your medication book) the recommended dose for
your patient (how many mg/kg/dose or day).
At the bottom of the page be sure to list the IV solution ordered. Include rate, site,
rationale/purpose. Is the rate appropriate for the 24-hour fluid requirement and diagnosis?
Why?
38
COMMUNITY ROTATION
Log of Community Hours and Teaching Project Hours
Student Name: ____________________________________________________
Clinical Faculty Person: _____________________________________________
Date
Time Arrived
Time Left
*Reminder: A minimum of 16 community hours required.
Total Hrs.
Community
Facility/Experience
Preceptor Signature
39
California State University, Bakersfield
Department of Nursing
PEDIATRIC LONG NURSING PROCESS PLAN
Student Name: ________________________________________________
Date of Admission: ____________________________
Faculty: _____________________________________________________
Date of Care ___________________ Unit ________________________
Room #: ____________________________________
PATIENT INFORMATION:
PT Initials: ___ Age ___ Gender ___ Race/Ethnicity __________ Primary Language __________ Religious Affiliation __________
Current Medical Diagnosis: ____________________ Admit Reason/Symptoms: _________________________________________
Current surgeries or procedures (Planned or performed with date): _____________________________________________________
Past Medical History (Other Medical Diagnoses/Illnesses/Surgeries, give date if in last year): _______________________________
Family (Genetic) History of Diseases: ___________________________________________________________________________
Educational Level: _______________ Living Arrangement: __________________________________________________________
Discharge Plan and educational needs (Parent./Child): ______________________________________________________________
__________________________________________________________________________________________________________
Allergies & Reaction: ________________________________________________________________________________________
Precautions (circle) confusion, suicide, paralysis, infant or toddler, fall risk, other: ________________________________________
Advance Directives (Do Not Resuscitate/Other): Yes _____ No _____ Comments: _______________________________________
DAY OF CARE
IV Solution/additives and rate______________________________________________
Primary physical assessment area: ____________________
Respiratory Care: ________________________________________
All current MD orders for day of care____________________________________________________________________________
Diagnostic studies treatment for day of care (x-ray, ultrasound, CT, etc.) _______________________________________________
A.M. Prioritize activities for nursing care (activity, vs., diet, hygiene, education, play) 1. ___________________________________
2. _________________________________________________
4. __________________________________________________
3. _________________________________________________
5. __________________________________________________
Reprioritization : Midday
________________________________________________________ ( pg1 - ________/ 5 points)
On the back of this page: Patho (_______/5 points)
40
Use a diagrammatic approach, briefly relate the pathophysiology of the patient’s diagnosis. Provide a definition of the problem, its
etiology, and/or epidemiology. Identify the following areas relevant to the pathophysiology of the patient’s disease/illness/diagnosis:
signs and symptoms of the disease, relevant laboratory studies with indication of values if high or low (blood, or other body fluid
tests); diagnostic studies (x-rays, ultrasound, electrocardiograms, etc). Identify the interventions (surgical procedures, interventional
procedures, types of medications, etc.) used to treat/cure this disease or illness. Describe the complications (PC) that can develop from
this disease/illness. List specific nursing interventions provided to treat this disease/illness or to prevent complications from this
disease/illness. Highlight all that apply to your patient.
Identify whether this is an ACUTE ILLNESS (Treatable/curable without any sequelae); CHRONIC (requiring continued treatment—
specify what is required); TERMINAL. At least one reference must be from a pediatric source.
References:
1.
2.
Lab/ Radiology/Diagnostic Tests: Attach (_____/5 points)
Developmental Level:
1.
(______/5 points)
Develop a comprehensive list of expected developmental milestones. After caring for your pt, highlight milestones achieved.
Cognitive:
Social:
Physical:
Gross/fine motor:
2.
Discuss the Developmental level your patient is in according to the following theorists:
Erikson (psychological):
Piaget (cognitive):
Freud (psychosexual)
Reference:
41
Current Wt _____
Nursing 356 Medication Worksheet
Medication Name
Generic/Brand
Classification
IV Therapy Soln
Route &
Dose, Rate
Rate
Pharmacokinetics
Side-Effects
Site
Calculation of 24 hr. Fluid Requirement:
References:
(___________/10 points)
Management/
Patient Care
Rationale/Purpose
Calculate & Compare
Actual/Recommended
mg/kg/dose
Are doses appropriate?
PO +IV intake
appropriate to meet 24
hr fluid requirement?
Show Calculations.
42
+Subjective information may be from client, family, nurse admitting notes, or physician H & P or notes. If source is other than client,
please state. Each FHP is worth 5 points.
C = Client
F = Family
Nsg = Nursing Admit
Subjective+
(Prior to Hospitalization)
1. Health Perception & Management
Pattern
Reason for admission
General health
P = M.D.
Objective
(During Your Care)
Health perception & management
Vitals
p________ R_______
T ________ BP______
Lab/Diagnostic tests/Give
the significance of test
and abnormals*
Nursing Diagnosis/List in
each FHP*/Prioritize
(____/5 points)
General Appearance:
Grooming
Previous hospitalizations
Meds taken at home
Posture
Alternative/Complementary therapies use:
Facial expression
Immunizations:
Safety/Risk for Injuries based on growth
and development
Physical description
Physical (percentile on growth chart)
HTWTHC-
*For lab values, list significance of each lab with possible implications on laboratory form. If value is used for more than one FHP, list lab name
in each area. Do not repeat values, but make a note to refer to previous FHP. The significance must reflect data that is personal and pertinent to
your patient and FHP. Highlight any abnormal lab values identified.
Highlight any problem identified. For any problem or potential problem identified, a nursing diagnosis is required. If within a specific FHP no
problems are identified at least one wellness diagnosis is required. At least one collaborative problem is required in the appropriate FHP.
43
Subjective Data
(Prior to Hospitalization)
2. Nutritional-Metabolic Pattern
Favorite foods, beverages, snacks:
Foods/beverages disliked:
Feeding habits (bottle, cup, spoon, special
devices):
Food allergies
Food restrictions
Difficulty with chewing, swallowing, sore
gums, or tongue, spitting up
Objective
(During Your Care)
Nutritional-Metabolic Pattern
Skin:
Head:
Fontanelles:
Nails:
Mouth/oral:
Teeth:
Throat:
Dressing/Drains __________
Supportive Data:
IV Site:
12˚ fluid intake:
Diet: __________
Rationale for diet:
Lab/Diagnostics
Nsg Diagnosis
Use FHP
(______/5 points)
N&V, abd pains, stomach cramps
Skin, hair, nail conditions
Healing
Weight loss/weight gain
__________________________________________________
3. Elimination Pattern
Toilet habits: diaper, potty, toilet
Bowel habits: frequency __________ color
__________ pain __________
consistency__________
Tube feedings __________
TPN/Hyperal __________
Lab: cbc, wbc, albumin, protein, blood sugar
electrolytes
_____________________________________
Elimination Pattern
Abdomen (GI)
BM:
Gu:
Special Considerations:
Bladder Habits: Color __________
frequency __________ amt __________
Special Considerations:
Supportive data:
Output __________ (cc/12 hr)
Lab: urinalysis__________
SG __________ Culture__________
Guiac __________ U-stix __________
Procedures, x-rays
_______________
_________________
(_____/5 points)
44
Subjective
(Prior to Hospitalization)
4. Activity-Exercise Pattern
Objective
(During Your Care)
Musculoskeletal
Lab/data
Nursing Diagnosis
(_____/5 points)
Child’s daily schedule
Child’s favorite activities or toys:
Supportive Data:
x-rays; procedures; lab: sed rate
Respiratory
TV viewing, activities at home:
Limitations in activities:
Cardiovascular
Usual bathing schedule:
Dental habits (brushing, flossing, dental care):
5.
Cognitive-Perceptual Pattern
Hearing difficulty __________
Aid __________Vision __________
Glasses/contacts __________
Myringotomy tubes __________
Ability to communicate __________
Educational Level __________
Learning difficulties (explain):
Supportive Data:
CVL, Blood gases, cbc, Monitor, EKG
Other procedures (ECHO etc.)
Glasgow (use pediatric scale)
eyes open __________ motor __________
audio & visual _________ Total__________
Ears:
Eyes:
Nose:
Reflexes :
Neuro
Pupils __________
Orientation __________ Grips__________
Pain __________
Supportive Data
Cranial Monitoring, lab, procedures, EEG
(____/5 points)
45
Functional Health Pattern: Subjective
(Prior to Hospitalization)
Objective
(During hospitalization)
Nursing Diagnoses
6. Sleep Rest pattern
Usual bedtime __________
Usual awakening time __________
Naps __________
Bedtime Rituals __________
Type of bed __________
Home sleeping arrangements
Observed sleep/rest pattern:
(_____/5 points)
7. Sexual Reproductive
Normal male/female genitalia:
Begun puberty? __________
Performs SBE or TSE? __________
Tanner Stage:
Appearance of Genitalia
(_____/5 points)
8. Value-Belief Pattern
(with cultural considerations)
Practice of religion? __________________
Cultural practices? ____________________
Languages spoken ___________________
Religious practices that affect health or
childrearing?
Observed religious articles, practices, culture:
(_____/5 points)
9. Coping-Stress
What does child do when tired or stressed?
Observed coping/stress:
(_____/5 points)
Effect of illness on behaviors:
(_____/5 points)
Observed family interactions:
(_____/ 5 points)
Temper tantrums? ___________________
How does your child handle problems/
disappointments?
10. Self-Perception - Self-Concept
How would you describe your child?
Fears?
11. Role Relationship Pattern
Names & ages of people living in the home:
Pets:
46
List/Prioritize top 8 Nursing Diagnoses with FHP. (List must include a minimum of one wellness diagnosis and
one collaborative problem.)
(________/5 points)
Nursing Diagnosis Priority List
Rationale for Selection (reference required)
1. _______________________________________
________________________________________
_______________________________________
________________________________________
2. _______________________________________
________________________________________
_______________________________________
________________________________________
3. _______________________________________
________________________________________
_______________________________________
________________________________________
4. _______________________________________
________________________________________
_______________________________________
________________________________________
5. _______________________________________
________________________________________
_______________________________________
________________________________________
6. _______________________________________
________________________________________
_______________________________________
________________________________________
7. _______________________________________
________________________________________
_______________________________________
________________________________________
8. _______________________________________
________________________________________
_______________________________________
________________________________________
47
Plan of Care with NANDA, NOC and NIC (________/5 points)
Priority from Nursing
Diagnosis Sheet, FHP,
and NANDA Diagnostic
Statement
Nursing Outcome
Desired During Your
Shift (NOC)
Nursing Activities:
List 3-4, at least one
must be hands on. List
who will perform. (NIC)
Rationale for Each of
Your Nursing
Activities.
Use References.
Based on NOC Outcome
Criteria, Evaluate Nsg
Activities. Goals
If not met, what will you
change?
Priority #1:
NOC Outcome:
NIC:
Rationales:
Goal was: (circle one)
Met Not Met
Partially Met (explain):
FHP:
Patient Goals:
1.
1.
Evaluation of Nursing
Activities:
NANDA Statement:
Measurement Criteria:
2.
2.
Based on measurement
criteria:
What was happening with
your patient?
3.
3.
4.
4.
What will you change?
(priority, goal, actvities)
Reference(s):
48
Plan of Care with NANDA, NOC and NIC
Priority from Nursing
Diagnosis Sheet, FHP,
and NANDA Diagnostic
Statement
Nursing Outcome
Desired During Your
Shift (NOC)
Nursing Activities:
List 3-4, at least one
must be hands on. List
who will perform. (NIC)
(________/5 points)
Rationale for Each of
Your Nursing
Activities.
Use References.
Based on NOC Outcome
Criteria, Evaluate Nsg
Activities. Goals
If not met, what will you
change?
Priority #2:
NOC Outcome:
NIC:
Rationales:
Goal was: (circle one)
Met Not Met
Partially Met (explain):
FHP:
Patient Goals:
1.
1.
Evaluation of Nursing
Activities:
NANDA Statement:
Measurement Criteria:
2.
2.
Based on measurement
criteria:
What was happening with
your patient?
3.
3.
4.
4.
What will you change?
(priority, goal, actvities)
Reference(s):
49
California State University, Bakersfield Department of Nursing
PEDIATRIC SHORT NURSING PROCESS PLAN
Student Name: ________________________________________________
Faculty: _____________________________________________________
Date of Care ___________________ Unit ________________________
Date of Admission: ___________________________
Room #: ___________________________________
PATIENT INFORMATION:
PT Initials: ___ Age ___ Gender ___ Race/Ethnicity __________ Primary Language __________ Religious Affiliation __________
Current Medical Diagnosis: ____________________ Admit Reason/Symptoms: _________________________________________
Current surgeries or procedures (Planned or performed with date): _____________________________________________________
Past Medical History (Other Medical Diagnoses/Illnesses/Surgeries, give date if in last year): _______________________________
Family (Genetic) History of Diseases: ___________________________________________________________________________
Educational Level: _______________ Living Arrangement: __________________________________________________________
Discharge Plan and educational needs (Parent./Child): ______________________________________________________________
__________________________________________________________________________________________________________
Allergies & Reaction: ________________________________________________________________________________________
Precautions (circle) confusion, suicide, paralysis, infant or toddler, fall risk, other: ________________________________________
Advance Directives (Do Not Resuscitate/Other): Yes _____ No _____ Comments: _______________________________________
DAY OF CARE
IV Solution/additives and rate______________________________________________
Primary physical assessment area: ____________________
Respiratory care _________________________________________
Current MD orders for day of care ______________________________________________________________________________
Diagnostic studies treatment for day of care (x-ray, ultrasound, CT, etc.) ________________________________________________
A.M. Prioritize activities for nursing care (activity, vs., diet, hygiene, education, play) 1. __________________________________ )
2. _________________________________________________
3. _________________________________________________
Reprioritization : Midday
4. __________________________________________________
5. __________________________________________________
(pg1- ________/5 points)
50
On the back of this page: Patho (________/10 points)
Use a diagrammatic approach, briefly relate the pathophysiology of the patient’s diagnosis. Provide a definition of the problem, its
etiology, and/or epidemiology. Identify the following areas relevant to the pathophysiology of the patient’s disease/illness/diagnosis:
signs and symptoms of the disease, relevant laboratory studies with indication of values if high or low (blood, or other body fluid
tests); diagnostic studies (x-rays, ultrasound, electrocardiograms, etc). Identify the interventions (surgical procedures, interventional
procedures, types of medications, etc.) used to treat/cure this disease or illness. Describe the complications (PC) that can develop from
this disease/illness. List specific nursing interventions provided to treat this disease/illness or to prevent complications from this
disease/illness. Highlight all that apply to your patient.
Identify whether this is an ACUTE ILLNESS (Treatable/curable without any sequelae); CHRONIC (requiring continued treatment—
specify what is required); TERMINAL. At least one reference must be from a pediatric source.
References:
1.
2.
*Please attach laboratory/diagnostic test form with your patient’s results. (_____/10 points)
Developmental Level:
1.
(_______/10 points)
Develop a comprehensive list of expected developmental milestones. After caring for your pt, highlight milestones achieved.
Cognitive:
Social:
Physical:
Gross/fine motor:
2.
Discuss the Developmental level your patient is in according to the following theorists:
Erikson (psychological):
Piaget (cognitive):
Freud (psychosexual)
Reference:
51
Current Wt _____
Nursing 356 Medication Worksheet
Medication Name
Generic/Brand
Classification
IV Therapy Soln
Route & Dose
Rate if IV
Rate
Pharmacokinetics
Site
Side-Effects
Management/
Patient Care
Rationale/Purpose
Calculate & Compare
Actual/Recommended
mg/kg/dose
Are doses appropriate?
PO + IV intake
appropriate to meet 24
hr fluid requirement?
Show Calculations
Calculation of 24 hr. Fluid Requirement:
(_______/10 points)
52
PHYSICAL ASSESSMENT
Date: __________
(Please highlight abnormal findings)
Time: __________ (____/25 points)
Current vital signs, Ht/Wt/ HC and percentiles from growth chart:
General Survey:
Skin:
Head:
Eyes/Vision:
Ears/Hearing:
Nose:
Mouth/ Throat:
Neck:
Heart:
Thorax/Lungs/Breasts:
Abdomen/ GI:
Genitalia/GU:
Spine/ Back/ Extremities/MS:
Neurologic/Glasgow/Reflexes:
Psychosocial:
Pain:
Describe IV site:
Subsequent Assessment
Date: __________
Time: ___________
Please note any changes from when you performed the initial assessment.
Azh/dec08
53
INSERT SHORT CARE PLAN, Concept Plan (from link on Amy Hedden’s Website)
(_______30 points)
54
N356
TEAM NURSING
Student _________________________________________
Other Team Members: _____________________________
Room # _____ Patient _____ Diagnosis
Age _____ Sex _____ Concurrent Dx/Problems
Allergies__________________ Diet ____________ Wt.____ 24 Fluid Req._______________
Medications/IV Fluid Therapy
Attach Form
Nursing Care (Hygiene, feeding, treatments) and Current MD orders:
Nursing Diagnoses/Client Problems (Prioritized)
1.
2.
3.
Important labs & diagnostic tests: (give results and explain how relates to pt)
****************************************************************************
Room # _____ Patient _____ Diagnosis
Age _____ Sex _____ Concurrent Dx/Problems
Allergies________________Diet_____________ Wt._____ 24 Fluid Req._________________
Medications/IV Fluid Therapy
Attach Form
Nursing Care (Hygiene, feeding, treatments) and Current MD orders:
Nursing Diagnoses/Client Problems (Prioritized)
1.
2.
3.
Important labs & diagnostic tests: (give results and explain how relates to pt)
55
Team Objectives for Play Therapy
Play therapy report:
(_________/30 points)
Submit with one team care plan a written summary describing how you accomplished the specific
objectives for play therapy.
For children, play serves the functions of sensorimotor development, intellectual development, creativity,
self-awareness, and therapeutic communication.
Play Therapy: During one day of an acute care (hospital) team clinical experience, the student will:
1.
Identify and discuss the actual chronological and developmental ages of children on their pediatric
team.
Include stages of growth and development using appropriate theorists.
2.
Identify play related materials available on the pediatric unit. Discuss appropriateness related to:
safety, cultural, considerations, age and development.
3.
Plan at least two developmentally appropriate play activities for each child on your team.
4.
Evaluate the effectiveness of implemented play activities, i.e., play room, game, coloring, storytelling,
videogame, that requires interaction between yourself and the children on your team.
5.
List (posted) rules for the playroom on your unit. What does your theory book state about playrooms
in health care settings (p.316)? What does Wong’s clinical manual state about toy safety?
6.
State how each individual on the team contributed to the groups work.
Each person in the group must submit a completed copy of the entire assignment.
Suggested readings:
James, S. & Ashwill, J. (2007). Nursing care of children. (3rd ed). Philadelphia: W. B. Saunders.
Wilson, D. & Hockenberry, M. (2008). Wong's clinical manual of pediatric nursing (7th ed.). St. Louis,
MO: Mosby.
56
Student _____________________________ Date of Care
NURSING 356 - MINI CARE PLAN
Room # _____ Patient _____ Diagnosis
Age _____ Sex _____ Concurrent Dx/Problems
Allergies
Wt ______ 24 fluid req______________ Diet____________
Medications
Drug
Dose
IV Fluid Therapy:
Type of Solution
Route
Time
Additives
Purpose
Rate
Nursing Considerations
IV Site
Calc. Doses
Appropriate?
Prioritized Nursing Diagnoses/Client Problems (Risk, Actual, Wellness, Collaborative)
1.
2.
3.
4.
Planned Nursing Activities/Care/Special Considerations for this Child
Developmental/Play Considerations:
Lab and Diagnostic test results—relate to patho:
**Write the pathophysiology on the back of this sheet. Highlight data specific to your patient.
57
NURSING 356
Ethical Dilemma- Description of Assignment
Over the course of the quarter, describe ONE situation that occurred in a clinical area (hospital or
community setting) that provoked strong emotions. Discuss all information about the case that is
significant to clarify the ethical conflicts, including: who is involved, available choices, and possible
outcomes. Use the “Principles and Rules of Healthcare Ethics” and the “Seven Essential Values” discussed
below to guide you in writing your entry. Use the format provided to record your entry.
Must use at least one reference.
For Ideas: Review “Wong’s clinical manual of pediatric nursing” (2008) “Common Ethical Dilemmas…”, pg 339.
Supportive Data on Ethics
Ethics refers to standards of conduct and moral judgment reflecting values. Healthcare ethics pertain to
how professional nurses fulfill their responsibilities and provide care to their clients. As nurses it is
important to distinguish between personal values and professional ethics, and avoid allowing personal
judgments from biasing treatment of clients. In an ethical dilemma, a situation exists in which no solution
is completely satisfactory. An ethical dilemma occurs when the following exist: two or more choices are
available, and it is difficult to determine which choice is best; the needs of all those involved cannot be
solved by the available choices.
Principles and Rules of Healthcare Ethics:
1.
2.
3.
4.
5.
6.
7.
Beneficence: Promoting good; striving for optimal client outcomes.
Nonmaleficence: Avoid doing harm; not causing pain or suffering.
Autonomy: Self-determination; ct’s right to make decisions about their treatment/care; respect,
privacy.
Justice: Fairness; obligation to treat all clients in an equal and fair way.
Veracity: Telling the truth; being honest with the client.
Fidelity: Being faithful to commitments and promises; providing safe and competent care.
Confidentiality: Keeping client information private; not discussing client information outside of the
clinical setting.
REFERENCE: Craven & Hirnle; James & Ashwill; Wilson & Hockenberry
Seven Essential Values
1.
Altruism: Concern for the welfare of others.
2.
Equality: Having the same rights, privileges, or status.
3.
Esthetics: Qualities of objects, events, and persons that provide satisfaction.
4.
Freedom: Capacity to exercise choice.
5.
Human Dignity: Inherent worth and uniqueness of an individual.
6.
Justice: Upholding moral and legal principles.
7.
Truth: Faithfulness to fact/reality
REFERENCE: AACN, 1986, pp. 6-7.
Azh/Dec.2009
58
Ethical Dilemma
Student
Clinical Setting Situation Occurred in
Description of Situation and Ethical Conflict:
Available Choices:
Possible Outcomes:
Principles/Rules of Healthcare Ethics Involved: (Select top 3 and describe)
Essential Values Involved: (Select top 3 and describe)
Actual Outcome:
Azh/dec09
59
BASIC NEEDS ASSESSMENT IMMUNIZATIONS
This assignment must be handwritten!
1. Discuss these diseases in 2 to 3 sentences: the causative agent, how it is transmitted, and manifestations of the
disease if it is contracted. Be sure to include why these are serious diseases. ( ______30 points)
DISEASE
Haemophilus Influenzae B
Hepatitis A
Hepatitis B
Polio
Diphtheria
Tetanus
Pertussis
Mumps
Measles
Rubella
Varicella
Streptococcus pneumoniae
Neisseria meningitides
HPV (Human papillomavirus)
Causative agent/ Transmission/ Disease Manifestations
60
Rotovirus
Influenza/H1N1
2. According to the most current childhood immunization schedule, list the number of required doses
and when the following vaccines are routinely recommended to be given. Example: HPV: Human Papillomavirus3 dose series: 1st dose now; 2nd dose = 2 months after dose #1; 3rd dose = 6 months after dose #1. Recommended for girls 11-12 years of age.
(________/30 points)
Immunization
Hep A
Hep B
DTap
Tdap
Td
HiB
Polio
MMR
Varicella
Pneumococcal
Meningococcal
Rotovirus
Influenza
Number of doses needed
Schedule
61
3. Complete the following table. List the most common side effects for each specific vaccine. Identify
by which route they are given. Discuss who may not be able to receive this vaccine. ( _____ /28 points)
Vaccine
Route/Dose
Example: HPV
IM/ 0.5ml
IPV
HiB
Hep B
Hep A
DTaP/Tdap/Td
MMR
Varicella
Pneumococcal
Meningococcal
Rotovirus
Influenza
Common Side Effects
Mild problems: redness, swelling, pain,
itching at injection site, mild fever
Who May Not Receive
Anyone having a life-threatening allergic
reaction to yeast or any other component of the
HPV vaccine; Pregnant women. Anyone with
moderate or severe illness.
62
4.
What five things should you document when giving vaccinations? (________/5)
1.
2.
3.
4.
5.
5. Prior to receiving immunizations, the child or parent is asked routine health-related questions.
List five general health related questions you would ask prior to immunizing.
(________/5 points)
1.
2.
3.
4.
5.
6. List all references:
(________/2)
Recommended websites: www.cdc.gov/nip/ACIP; www.dhs.ca.gov/ps/dcdc/izgroup
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63
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Student/Name
Course
Instructor
Date
Evaluation will be based on the degree to which the student meets the course objectives as they are delineated by the
criteria stated in this evaluation tool.
A.
B.
To achieve a passing grade the student must meet the criteria in one of the following ways:
5.
Independent performance:
Performance safely and accurately each time without supportive cues from preceptor or instructor.
Demonstrates dexterity and spends minimal time on task.
Focuses on client.
Applies theoretical knowledge each time.
4.
Supervised performance:
Performs safely and accurately each time, requires supportive cues occasionally during performance of
tasks.
Demonstrates coordination, and spends reasonable time on task.
Focuses on client with some focus on task.
Applies theoretical knowledge with occasional cues.
3.
Assisted performance:
Performs safely and accurately each time, requires frequent supportive and occasional directive cues.
Demonstrates partial lack of dexterity.
Focuses primarily on task or own behavior, not on client.
Can identify principles but needs direction to coordinate with application.
2.
Provisional performance:
Performs safely under close supervision. Not always accurate, requires continuous supportive and
directive cues.
Demonstrates lack of skill and/or performs tasks with considerable delay with omissions and delays.
Focuses entirely on task or own behavior.
Applies principles inappropriately or adequately.
A student fails the objectives if any of the following are indicated.
1.
Dependent performance:
Performs in an unsafe manner, requires continuous supportive directions and cues.
Performs in an unskilled manner.
Attempts activity or behavior yet is unable to complete.
Focuses entirely on task or own behavior.
Unable to identify principles or apply them.
O. Negative Pattern: Demonstrates a pattern of unacceptable performances.
C.
NSO indicated not sufficiently observed N indicates no opportunity
Adapted from Krichbaum (1983). Criterion referenced definitions, Journal of Nursing Education, 22, p. 376.
bbp 11/96/ azh dec07
64
Summary of Clinical Performance. Use criteria as described to evaluate performance:
5—Independent; 4—Supervised; 3—Assisted; 2—Provisional; 1—Dependent; 0—Negative
Objecti
ve
1A.
1B.
1C.
1D.
1E.
1F.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Criteria
Interviewing (subjective data):
Data collecting
Elicits client information
Categorize and validate data
Objective Data:
Physical assessment
Assess mental status through applicable theories, growth
and development
Accurately record data
Diagnosis:
Identified actual, potential, wellness, and collaborative
nursing diagnoses.
Plan of Care:
Plan of care with economic, cultural, social forces,
physical components
Integrates information in nursing care
Intervention:
Assess and implement nursing activities
Demonstrate competency in skills
Integrate theory in clinical
Evaluation:
Evaluate medical diagnosis and gather supporting data
from labs, and procedures
Report and record observations pertinent to client
Integrates information in nursing care
Demonstrate assessment, critical thinking, knowledge of growth
and development, immunizations, pathophysiology
Applies knowledge related to assessing and maintaining
maximum functional status
Applies knowledge of cultural variations
Communicate effectively, prepares and implements delegated
medical treatments, interprets labs/ diagnostics
Demonstrate preparedness and safety for clinical with rationale
for procedures, medications, change of shift report
Completes community objectives and hours
Utilize current, relevant literature for assignments and patient
care
Client/ family education, Teaching Project
Behaves in a safe responsible manner while caring for patients,
and families.
Demonstrates class participation in clinical and post conference
Functions in framework of policies of hospital, CSUB, and Nurse
Practice Act
Demonstrates reliability and responsibility
Demonstrates professionalism in performance and attitude
356 (Peds)
65
N356 Clinical Performance Evaluation
Part I: General Clinical Performance
In order to pass the course, the student must demonstrate the ability to perform these behaviors in a safe,
organized manner in the clinical practice setting. Failure in any section will constitute failure in the course.
LEVEL 0-5 NSO
N
OBJECTIVE #1: Utilize the steps of the nursing process with the
CSUB Department of Nursing Conceptual Model as a framework
Assessment
Structures the environment to ensure safety, privacy and uninterrupted
time
A. Subjective
(1) Interview process utilizes communication skills to achieve the
goals of the interview, is client centered, and is focused on client
perceptions.
(2) Introduces, carries out, and closes interview effectively.
(3) Elicits data about client’s current status, past, family, and
psychosocial history relative to current health problems and risk
factors.
B. Objective
As appropriate, data elicited by:
(1) Physical examination, including:
—inspection/observation of overt behavior
—palpitation
—percussion
—auscultation
(2) Review of medical history, psycho-physiological condition of the
child, medical diagnosis results of laboratory tests.
C. Diagnosis
Synthesizes (correlates, interprets) all data collected (subjective and
objective data including clinical laboratory studies) in arriving at
identification of problems.
Demonstrates constructive and critical thinking in analyzing and
interpreting data collected.
(1) Diagnoses stated in NANDA format with identification of related
Gordon’s Functional Health Patterns.
(2) Identifies actual, potential, possible nursing problems,
collaborative problems and wellness diagnosis.
(3) Identifies and lists all client problems.
D. Planning Intervention
(1) Utilizes data collected.
(2) States objectives in behavioral terms.
(3) Identifies nursing actions appropriate to attaining objectives.
(4) Rationale for nursing action is clearly and concisely stated,
documented appropriately, and reflects current research findings
and other current publications.
66
LEVEL 0-5
E.
Intervention
(1) Establishes rapport with the child and family.
(2) Establishes priorities and organizes care.
(3) Skillfully performs nursing techniques with minimal discomfort to
client, taking concepts of growth and development into
consideration.
(4) Completes care in allotted time.
(5) Supports the child and family in acute and chronic intervention.
(6) Utilizes opportunities for teaching children self-care when
developmentally appropriate, and facilitates care giving activities.
(7) Demonstrates understanding of parameters of nursing practice as
prescribed by the California Nurse Practice Act.
(8) Performs care in a safe manner.
(9) Monitors child’s condition in a responsible manner.
(10) Reports child’s status in a timely fashion to the appropriate staff
members.
F. Evaluation
(1) Interprets child’s responses to therapy accurately.
(2) Correctly identifies ongoing stressors impacting child’s responses.
OBJECTIVE #2: Demonstrate assessment and critical thinking skills
in caring for clients from infancy through adolescence.
A.
B.
C.
D.
E.
F.
G.
Development
Utilizes Erikson’s, Piaget’s and Freud’s theory to evaluate the client’s
developmental level and status.
Identifies family structure and interactions and its impact on health
status and risk.
Psychosocial
Identifies child’s psychological responses to illness and their impact
on health status. Identifies family structure and interactions and its
impact on health status and risk.
Psychopathological
Utilizes knowledge of psychopathology to identify and analyze the
dynamics of psychological disorders and therapeutic interventions.
Physiological
Utilizes knowledge of physiology to analyze basic needs and
responses.
Pathophysiological
Utilizes knowledge of pathophysiology to identify and analyze the
dynamics of disease processes and therapeutic interventions.
Independently administer 3 developmental screening tests to assess
child development of language, interpersonal and gross motor skills.
Evaluate immunization status of children.
NSO
N
67
LEVEL 0-5
OBJECTIVE #3: Apply knowledge related to assessing and
maintaining maximum functional status.
A. Application of knowledge related to assessing and maintaining
maximum functional status as evidenced by:
(1) Assess present, actual level of client functioning for each Functional
Health pattern and identify nursing interventions that will help
clients to meet their maximum potential within each FHP.
(2) Accurately and safely carrying out medical orders and independent
nursing functions.
OBJECTIVE #4: Apply knowledge of cultural variations to planning
and implementing care for young clients and their families.
A. Assess the child or adolescent and the family’s background.
B. Recognize and utilize knowledge of the social and cultural factors
which influence family member’s definitions of health, illness, and
child rearing.
C. Identify social, cultural, and economic forces which influence delivery
of health care to the family, health outcomes, and client expectations.
OBJECTIVE #5: Demonstrate knowledge, skills and professionalism
in preparing for and implementing nursing activities and related
delegated medical treatment activities for clients from infancy through
adolescence.
A. State the medical diagnosis, pathophysiological changes, and results of
laboratory tests for the health problems of children being cared for by
the students.
B. State, make, record, and report in appropriate and timely manner,
observations pertinent to the psycho-pathological state of the child.
C. Demonstrates professional behavior in interaction with health team
members, and the public.
D. Nursing care plans include essential information, are organized
sequentially and logically, and includes appropriate references.
E. Completes written assignments using correct syntax, grammar and
spelling.
F. Communicates effectively with clients, families, staff, peers,
instructor.
OBJECTIVE #6: Demonstrate beginning management skills by
planning and implementing care and/or preparing and administering
medications for pediatric clients during a clinical day, and by
participating in change of shift report.
A. Plan and implement care for assigned pediatric clients.
B. State the purposes, usual dosage, and possible toxic symptoms of
medications given to pediatric clients and administer medications
safely.
C. Administer medications by various routes to children in different
stages of growth and development.
D. Receive and give change of shift report for assigned clients.
E. Demonstrate preparedness and safety, knows rationale for procedures.
NSO
N
68
LEVEL 0-5
OBJECTIVE #7: Identify community health care referral sources
which provide follow-up and continuity of care, and services for the
special needs of children and adolescents.
A. Identify arrangements for follow-up care and extension of nursing
services when a client is discharged from the hospital.
B. Identify health care resources for children and adolescents, in the
community.
C. Identify community resources that could be used as an aid in resolving
problems arising from illness and as a means of providing continuity
of care.
D. Identify the role of the school nurse in providing children with health
care.
OBJECTIVE #8: Utilize current research from appropriate literature
in planning care for children from infancy through adolescence.
A. Review current literature pertinent to the care of the student’s assigned
clients.
B. Utilize nursing publications and appropriate research findings for
management of child’s care.
C. Teaching project utilizes a minimum of one reference from a current
nursing journal.
OBJECTIVE #9: Utilize knowledge of the teaching-learning process to
prepare and present health education information to one or more
children and/or families.
A. Recognize and utilize opportunities to provide appropriate health
education to assigned clients and their families.
B. Prepare and present a teaching project for one or more children and/or
parents, utilizing knowledge of the teaching-learning process.
OBJECTIVE #10: Consistently behave in a safe and responsible
manner while providing nursing care to children, adolescents and
families.
A. Seeks out and utilizes opportunities for learning by:
(1) Consistently coming prepared for learning experiences (initial
written care plan as expected, review of skills, and other).
(2) Identifying challenging and varied experiences appropriate to selfdirected learning.
B. Prepared for and participates in clinical conferences.
C. Submits written assignments on time.
D. Makes arrangements with appropriate individuals when unable to meet
written or performance commitments.
E. Function in accordance with clinical faculty routine, policies and
regulations, and within the framework of the Nurse Practice Act.
F. Establish functional relationships with peers, staff, faculty and other
members of health care team.
NSO
N
69
LEVEL 0-5
NSO
G.
Seeks to enhance their own learning through client selection, client
care, discharge planning, and other independent activities.
OBJECTIVE #11: Identifies legal, political, economic and ethical
issues in a variety of health care settings that provide services for
children, adolescents and their families.
A. Recognizes and supports client’s autonomy and rights.
B. Recognizes ethical dilemmas and principles, and utilizes a problemsolving method in resolving the issues.
C. Recognizes legal, political, and economic issues that effect health care
and access to health care for children.
Comments:
Mid-Term Evaluation: (attach- next page)
Student Signature:
Date:
Faculty Signature:
Date:
______________________________________________________________________________
Final Clinical Evaluation:
Absent Days:
Clinical Skills Checklist Complete:
Clinical and Community hours complete:
Assignments Completed:
Strengths:
Areas for improvement:
Student Signature:
Date:
Faculty Signature:
Date:
__________________ PASS
____________________ FAIL
CALIFORNIA STATE UNIVERSITY, BAKERSFIELD
Department of Nursing
Nursing 356 – Midterm Evaluation : Pediatric Clinical
N
70
Student _____________________
Absent Days:
Clients Cared for:
Infants __________; Toddler__________; Preschooler________:
School-age________; Adolescent________; Developmentally Delayed_______
Skills Checklist:
Reviewed___________.
Skills Needed:________________________________
Careplans:
2 Long ________; 2 Short/OR ___________; Team Nsg________
Community Experiences:
Ethical Dilemma:
Teaching Project:
Topic:
Target Population/Age Group:
Date Completed:
Sim/ Skills Practice Lab:
Assignments:
Attendance:
Areas Needing Improvement:
Faculty Signature :__________________________ Date:___________
Student Signature:__________________________ Date:___________
Student Comments: