SCHOOL OF NURSING
COURSE OUTLINE
Course Title: Maternal/Child Health Nursing
LEVEL II
Catalog Number: NUR248
Credits: 4
Lecture & Clinical
Revised 5/11
TABLE OF CONTENTS
Course description
Prerequisites/co-requisites; purpose; time allotment; credit hours
Progression of core components
NUR248 course objectives
Methods of teaching; Required assignments; Methods of Student Evaluation
Academic integrity; Attendance policy
Required/optional textbooks
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TOPICAL OUTLINE-MATERNAL/CHILD HEALTH NURSING
Unit I
Course Overview; Family Centered Maternal Child Nursing,
Cultural Influences of Nursing Care on Childbearing Family
7
Unit II
Process of Conception, Influences on Fetal Development
8
Unit III
Adaptations to Pregnancy
9-10
Unit IV
Maternal & Fetal Assessment
10-11
Unit V/VI
Stages of Labor; Nursing Care of the Laboring Client;
Management of Discomfort
12-13
Unit VII
Adaptations in the Postpartum Client
13-14
Unit VIII
Complications of Pregnancy, Labor and Birth
14-16
Unit IX/X
Adaptation and Assessment of the Newborn;
High Risk Newborn
16-18
Unit XI
Barriers Affecting Conception
18-19
Unit XII
Adaptations to Sexuality/Adolescent Pregnancy
19-20
COURSE OVERVIEW & REQUIREMENTS
COURSE DESCRIPTION: - Maternal/Child Health Nursing
CREDIT HOURS: 4 Credits
Nursing process utilized in study of family health incorporating responses and adaptation to stress. Adaptation and stress
management promoted with families during childbearing. Experiences to integrate nursing theory and skills include
clinical experiences in health care settings and community agencies.
PURPOSE: Provide opportunities to develop and enhance students’ proficiency in delivering nursing care to childbearing
clients with functional and dysfunctional health patterns. Students are provided an opportunity to demonstrate their
knowledge and application of the nursing process to assist clients and families in obtaining optimum health outcomes.
PREREQUISITES: NUR133 and NUR136; or NUR124
COREQUISITES: BIO 244 and PSY 210
TIME ALLOTMENT:
Day
Lecture-----------------4.5 hours weekly
Clinical-----------------9 hours weekly
Evening
2.5 hours weekly
4.5 hours weekly
1
PROGRESSION OF CORE COMPONENTS IN THE NURSING PROGRAM
Level II
Professional Behavior
Level II





Adhere to standards of professional practice.
Demonstrate accountability for personal actions and delegated actions.
Practice nursing within legal, ethical and regulatory frameworks.
Utilize and incorporate resources for life long learning.
Demonstrate leadership in the nursing role.

Identify similarities and differences on a position and support their position with current
nursing literature.
Apply advanced techniques of therapeutic communication with clients, significant others and
members of the health care team.
Employ group dynamic strategies when communicating with team members.
Demonstrate increasing ability to communicate relevant, accurate and complete information
for groups of clients verbally and in written documentation.
Communication
Level II



Assessment
Level II




Analyze health status of acutely ill clients/groups of clients with multiple health problems.
Demonstrate advanced skill in completing a health history.
Integrate prior knowledge in assessing the effects of stressors on clients, families and
communities.
Prioritize responses to actual or potential health problems and to nursing interventions.
Clinical Judgment
Level II



Analyze dysfunctional health patterns and stressors of the individual, family and the
community.
Utilize evidence-based practice in order to formulate clinical decisions.
Maintain accurate and safe care & an awareness of current National Patient Safety Goals.
Caring Interventions
Level II


Perform effective and preventative nursing measures to facilitate health promotion and
maintenance in clients and groups.
Synthesize understanding of cultural, ethnic, social, and spiritual diversity and developmental
needs when caring for individual and family in order to provide sensitive, holistic nursing
care.
Teaching and Learning
Level II



Develop teaching plans to assist individuals and groups to promote health and manage acute
and chronic health problems.
Identify learning needs of the individual and family and modify interventions according to
developmental level.
Utilize teaching and learning concepts in leadership/management in assigned setting.
Collaboration
Level II


Collaborate with peers and multidisciplinary team members to deliver cost effective, quality
care to individuals, families and communities.
Convey mutual respect, trust, support and utilization of each discipline's role and
contributions to health care.
Managing Care
Level II







Apply principles of effective motivation.
Utilize key concepts underlying effective delegation.
Demonstrate leadership management skills when working with the multidisciplinary health
team members to deliver care to groups of clients.
Apply strategies of change theory with the health care team.
Employ techniques that can be used in evaluating the work of others.
Utilize conflict resolution skills.
Assess visionary skills and identify a plan to become more innovative.
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NUR248 COURSE OBJECTIVES
Upon completion of the study of the Childbearing years, the student will be able to meet wellness, acute care and longterm care needs for individuals and families across the lifespan by performing the following:
Professional Behavior
1. Adhere to standards of professional practice; be accountable for personal actions, behaviors and
practices nursing within legal, ethical and regulatory frameworks in diverse settings.
2. Assume responsibility for self-improvement and utilize & incorporate resources for life long learning.
Communication
3. Demonstrate advanced skills in communicating effectively to childrearing and childbearing families and
members of the healthcare team.
4. Continue to utilize information technology to meet client care needs and to assist childbearing families
to use self-management skills.
Assessment
5. Integrate prior knowledge from all sciences and humanities in assessing the effects of stressors on the
childbearing family unit.
Clinical Judgment
6. Use critical thinking to analyze dysfunctional health patterns and stressors of the individual and family in
community and clinical settings using evidence-based practice to formulate judgments that facilitate health
promotion and maintenance.
7. Perform effective therapeutic and preventative nursing measures to facilitate health promotion and maintenance
for the childbearing family based on established outcome criteria.
8. Maintain accurate and safe care and an awareness of current National Patient Safety Goals.
Caring Interventions
9. Synthesize understanding of cultural, ethnic, social, and spiritual diversity and developmental needs
when caring for the childbearing family in order to provide sensitive, holistic nursing care.
Teaching and Learning
10. Advocate health promotion, identify learning needs of the childbearing family and modify interventions
according to the developmental level.
11. Empower clients and communities to learn self-management skills.
Collaboration
12. Collaborate with multidisciplinary team members to deliver cost effective, quality care to the childbearing family.
Managing Care
13. Demonstrate leadership/management skills when working with the multidisciplinary team members to manage
resources effectively & efficiently to deliver quality client care to the childbearing woman and family.
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COURSE OVERVIEW AND REQUIREMENTS
TEACHING METHODS AND TOOLS:
1. Lecture, textbook, discussion, ATI materials
2. Clinical experiences and assignments
3. Clinical Pre and Post Conference
4. Audio-visual aids, videos, interactive software
5. Cooperative learning/Group activities
6. Bibliography and Library resources
7. Computer Software/ Internet resources
8. Simulation Hospital Experiences
REQUIRED CLINICAL ASSIGNMENTS: ALL ARE PASS/FAIL
1] Online Perinatal Community Assignment
2] Two Daily Nursing Process Plans will be presented at post conference when the student is on
the post partum unit. There will be a minimum of 2 unless the clinical instructor deems it
necessary for a 3rd to be completed. Information for the daily nursing process plan will
be gathered & completed during the clinical day.
3] One Newborn Assessment Tool with definitions is due once per course.
4] A professional evidenced based journal article with a summary & application relevant to your
patient is due once per course. Include a typed reference page in APA format and a printed copy
of the article.
5] Case Study [one per student] - to be presented in clinical post conference.
6] Evidence-Based Teaching Project- presented on last clinical day.
METHODS OF STUDENT EVALUATION:
Students must achieve a minimum passing grade of C and pass the clinical component to advance to the next
nursing course. Failure in any of the following areas constitutes failure of the course:
1. Unit Examinations (3)*
95%
2. Assessment Technologies Institute (ATI) (1)
5%
3. Dosage Calculations Test*
Pass/Fail
4. Clinical Performance
Pass/Fail
5. Clinical/Community Assignments
Pass/Fail
1.*
3 Unit Exams: Three 50 multiple item exams will be given.
a.
Test questions will be multiple choice and answered on a Scantron sheet
b.
All test questions will be drawn from lecture content, required reading assignment,
audio-visual material and handouts.
c.
One comprehensive 50 multiple item make-up exam will be given in case of a missed exam.
If both exams are missed the second test will receive a grade of zero.
d.
ALL students who receive a score less than 74% on any examination MUST make an
appointment to review their status, study habits and the examination with the
course lecturer within one-week following the examination. An advising form will be
placed in the students file if this is not done.
e.
FINAL GRADE: 33.3% of each of the Three Units Examinations = total of 95%; 5% of
grade from ATI.
2.
ATI: Students will complete assigned readings, do one (1) practice exam and one (1) proctored exam.
5% of your grade will be from ATI.
3. *
Dosage Calculations Test: Students must obtain 90% or higher on this test to remain in the program.
The dosage test may be repeated once for a total of 2 attempts to obtain a 90%. It will be administered
in class on the first day of lecture. The retake exam is to occur a ½ hour before or after a lecture period
and must be completed within one week. Documentation regarding a failure will be placed in the
student's record. A non-programmable calculator may be used. Students are not to share information
about exams in any form of communication.
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Clinical Performance:
4.
All clinical work must be completed by the last clinical day. Failure in the clinical area constitutes
a failure for the entire course. Each student will complete a self evaluation and receive a written
instructor evaluation of clinical performance. See self evaluation criteria guidelines.
Written Assignments
Assignments must be submitted on the specific date designated by the instructor. Unexcused late submission
of assignments will result in a failing grade for the assignment. It is expected that all work will follow
college standards of writing. Late assignments in the clinical area may be assigned as a ‘failed clinical
day” at the discretion of the instructor. All assignments are pass/fail.
**Academic Integrity: SEE STUDENT HANDBOOK
** Attendance Policy: SEE STUDENT HANDBOOK
CPR Certification Policy
Students are required to maintain a current BLS CPR certification throughout NUR133, NUR136, NUR246,
NUR248 and NUR240. BLS CPR certification includes training in CPR for the infant, child and adult, and
training in the management of choking in the conscious and unconscious victim.
Certification is not offered in the curriculum and must be obtained in addition to the nursing course work.
Students are required to present proof of current BLS CPR certification on the first day of NURi33,
NUR136, NUR246, NUR248 and NUR240. Students who are not able to show proof of community CPR
certification are considered unprepared for clinical and will earn a failed clinical day. If a student's CPR
certification expires during the semester, the student is responsible to obtain renewed certification and to
provide the lecture faculty with documentation of the renewal before the prior certification lapses. A student
who does not renew the lapsed CPR certification during the semester is also considered unprepared for clinical
and will earn a failed clinical day.
Student Health Policies and Requirements
Nursing students must comply with the Student Health Policies and Requirements that are published in the
Suffolk County Community College Nursing Student Handbook.
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REQUIRED TEXTBOOKS and SUPPLEMENTAL MATERIALS:
Deglin, J., Sanoski, C., & Valleran, A. (2011). Davis drug guide for nurses (12th ed.). Philadelphia, PA: F.A.
Davis. [ISBN-10: 0803623089] [ISBN-13: 978-0803623088]
London, M. Ladewig, P. Ball, J. & Binder, R. (2011). Maternal & child nursing care. (3rd ed.). &
MyNursingLab with Pearson eText Student Access Code Card, 3/E. NUR 246/248 Case Study Book – (2010).
Upper Saddle River, N.J.: Prentice Hall. [ISBN# 9780132166010] {bundled package}
Listed Separately:
London, M., Ladewig, P., Ball, J., Bindler, R. (2011) Maternal & child nursing care (3rd ed.). Upper Saddle
River, NJ. Prentice Hall [ISBN-10: 0135078466] [ISBN-13: 9780135078464]
MyNursingLab Student Access Code Card for Maternal & Child Nursing, 3/E [ISBN-10: 0132115115]
[ISBN-13: 9780132115117]
Visit www.mypearsonstore.com for further purchasing options.
Pickar, G. (2011). Dosage calculations: ratio prop with cd (3rd ed.) New York: Delmar Publishers. [ISBN-10:
1435454103] [ISBN-13: 9781435454101]
SCCC Custom NUR 246/248 Case Study Book [ISBN-10: 0-558-72350-0] [ISBN-13: 978-0-558-72350-7]
Treas, L.S. (Ed.) (2008). Registered nurse maternal newborn nursing review module. (7.1ed.)
Overland Park, KS: Assessment Technologies Institute, LLC
RECOMMENDED TEXTBOOKS:
Bindler, R., Ball, J., London, M., & Ladewig, P. (2011). Clinical nursing skills for maternal & child nursing
care. (3rd ed.). Upper Saddle River, N.J.: Prentice Hall. [ISBN-10: 0-13-509723-1] [ISBN-13: 978-0-13509723-6].
Fischbach, F. (2009). A manual of laboratory & diagnostic tests (8th ed.) Philadelphia: Lippincott,
Williams and Wilkens. [ISBN-10: 0781771943] [ISBN-13: 9780781771948]
American Psychological Association. (2010). Publication manual of the American Psychological
Association (APA). (6th ed.). Washington, DC: Author. [ISBN# 1433805618]
Nursing and Health Science Internet Sites:
Nursing Net-http://www.nursingnet.org
Nurseweek-http://www.nurseweek.com
New York Online Access to Health-http://www.noah.cunv.edu
U.S. Centers for Disease Control CDC-http://www.cdc.gov
Dept. of Health and Human Services-http://www.os.dhhs.gov
March of Dimes-http://www.modimes.org
WHO Breastfeeding – http://www.who.int/topics/breastfeeding/en
AWHONN - http://www.awhonn.org
The National Women's Health Information Center - http://www.womenshealth.gov/breastfeeding
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COURSE OUTLINE – CORRELATED LEARNINGS
UNIT I- FAMILYCENTERED MATERNAL CHILD NURSING, CULTURAL INFLUENCES,
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Identify the effects of family
1. Family Life
1. Assess the psychosocial stressors
lifestyles on childbearing.
a) Socioeconomic
and adaptations of the pregnant
2. Define the meaning of family.
b) Cultural
woman and her family to
3. Explain role changes that occur
c) Religious
pregnancy and/or childrearing.
in the childbearing family.
d) Age
2. Complete as appropriate:
4. Recognize factors/attitudes that
e) Sexuality
Obstetrical history
influence family growth.
f) Family Constellation
Postpartum assessment tool
5. Recognize ethnic and social
2. Stressors and Adaptations for
Newborn assessment tool
diversities in the childbearing
Childbearing
population.
a) Emotional Changes
b) Previous Negative
Experiences
c) Current Stressors
d) Family Interaction
PLANNING
1. Describe the impact of various
family lifestyles on the choice of
childbearing methods and
childrearing practices.
2. Explain how situational and
maturational crisis promote
family development.
3. Describe stressors, actual or
potential, for family members.
4. Give rationale for behavior or
situations which either promote
or inhibit growth of the family.
PLANNING
1. Develop a plan based on
assessment of individual family
needs.
PLANNING
1. Develop a plan of care for a
selected family based on analysis
of collected data and nursing
diagnoses.
IMPLEMENTATION
1. Intervene to increase knowledge
base and decision making ability
of the family.
2. Act as client advocates for
individual client and families.
3. Promote adaptations by creating
a supportive environment.
4. Formulate a teaching plan based
upon current knowledge of
client’s needs.
5.
EVALUATION
1. Evaluate effectiveness of nursing
intervention through ongoing
assessment.
IMPLEMENTATION
1. Measures which promote family
centered care:
Rooming-In
24 Hour postpartum home
care
Open visiting hours
IMPLEMENTATION
1. Implement a plan of care for a
selected family.
EVALUATION
1. Evaluate effectiveness of nursing
interventions by comparing
desired outcomes to client’s
response.
EVALUATION
1. Assess effectiveness of nursing
interventions.
2. Reassess family stressors and
interventions.
3. Alter plan of care based on client
adaptation.
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UNIT II – PROCESS OF CONCEPTION; INFLUENCES ON FETAL DEVELOPMENT
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Describe the process of
1. Process of conception:
1. Collect data related to
conception.
a) Ovulation
conception.
2. Describe normal prenatal
b) Spermatogenesis
EDC (EDD)
development from conception
c) Fertilization
LMP
through birth.
d) Implantation
Nägele’s Rule
3. Identify physiological
e) Fetal Development
2. Review and complete fetal
adaptations and stressors
2. Teratogens
development worksheet.
associated with fetal
a) Toxoplasmosis
3. Complete obstetrical
development.
b) Other
assessment tool.
c) Rubella
d) Cytomegalovirus
e) Herpes Virus
3. Environmental Teratogens
a) Chemicals
b) Radiation
c) Alcohol, smoking, drug use
PLANNING
1. Explain the physiological process
of conception/reproduction.
2. Explain the stressors and
adaptations related to teratogen
exposure.
3. Describe measures, which
minimize the effects of
physiological stressors.
PLANNING
1. Develop a plan based on
assessment of individual/family
needs.
2. Formulate nursing diagnosis
based on collection of data.
3. Determine expected outcomes
for individual clients/families.
PLANNING
1. Plans nursing care for individual
clients and families.
2. Participates in developing a
teaching plan for individual
clients and families.
IMPLEMENTATION
1. Implement therapeutic nursing
interventions that enhance
client’s knowledge regarding
conception/reproduction.
2. Provide information related to
effects of teratogen exposure and
fetal effects.
IMPLEMENTATION
1. Measures to increase adaptation
to stressors:
a) Genetic counseling
b) Genetic screening
c) Preconceptional counseling
d) Nutritional counseling
2. Avoidance and sequelae of
teratogen exposure.
a). Fetal anomalies
b). Pregnancy loss
EVALUATION
1. Evaluate effectiveness of nursing
interventions by comparing
desired outcomes to client’s
response.
IMPLEMENTATION
1. Implement a plan care for the
client with potential exposure
to teratogens throughout the
childbearing period.
2. Refer to appropriate
resources.
EVALUATION
1. Evaluate effectiveness of
nursing intervention through
ongoing assessment.
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EVALUATION
1. Assess effectiveness of nursing
interventions.
2. Reassess family stressors and
interventions.
3. Alter plan of care based on
client adaptation.
UNIT III - ADAPTATIONS TO PREGNANCY
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Describe the physiological
1. Review of systems through
1. Collect data related to
changes that occur during
each trimester.
conception:
pregnancy.
2. Manifestations of pregnancy
LMP
2. Differentiate presumptive,
-Chadwick’s sign
EDD
probable, and positive signs of
-Goodell’s sign
Pregnancy tests
pregnancy.
-Hegar’s sign
2. Obtain obstetrical history
3. Compute gravity and parity.
-Quickening
3. Complete postpartum assessment
4. Describe initial antepartum
3. Obstetrical History
tool (antepartum section)
assessment using to obtain
Physical Examination
4. Assess current signs and
subjective and objective data.
4. Review functional health
symptoms and adaptations to
5. Describe the common
patterns associated with
pregnancy of the antepartum
discomforts of pregnancy.
antepartum assessment:
client and family.
6. Describe the psychological
5. Common Discomforts of
5. Complete Food Pyramid and
responses of the antepartum
Pregnancy
Nutritional Assessment Sheet.
client and family.
-Changes in center of gravity
6. Analyze collected data and
7. Discuss the importance of
-Gastrointestinal discomforts
formulate nursing diagnosis
adequate nutrition and weight
-Musculoskeletal discomforts
based on client needs.
gain during pregnancy.
-Respiratory discomforts
-Genitourinary changes
-Integumentary changes
6. Psychological/Emotional
responses:
-Accepting the pregnancy
-Accepting the fetus
-Developing Attachment
-Mimicry
-Fantasy
-Role Transition
-Paternal Adaptation
7. Compare nutritional needs of
the pregnant versus
nonpregnant client.
PLANNING
1. Develop a plan for the
PLANNING
PLANNING
1. Describe nursing interventions
1. Develop a plan of care to
antepartum client and family
to increase the antepartum
assist the client and family
throughout the childbearing
client’s knowledge about
during the childbearing
period.
physiologic and psychological
period.
2. Referral to community
adaptations to pregnancy and
1. Develop a plan of care to
resources as appropriate:
common discomforts that may
promote comfort throughout
Lamaze
be encountered.
the childbearing period:
Prenatal Classes
1. Describe nursing measures to
-Relaxation techniques
Infant CPR
relieve common discomforts
-Exercise
La Leche League
during pregnancy.
-Clothing
Sibling preparation classes
-Hydration
-Breast care
-Positioning and posturing
9
-Dietary measures
-Kegel exercises
IMPLEMENTATION
1. Implement therapeutic nursing
interventions that enhance
client’s knowledge regarding
physiologic and psychosocial
changes associated with
pregnancy.
2. Implement therapeutic
interventions that enhance
client’s knowledge regarding
common discomforts of
pregnancy.
3. Implement therapeutic
interventions and teaching plan
specific to the nutritional
needs of the antepartum client.
IMPLEMENTATION
1. Measures to increase
adaptation to physiologic
psychological, and nutritional
alterations encountered
during pregnancy:
a) Stress importance of prenatal
care.
b) Nutritional counseling
c) Social worker consultation
IMPLEMENTATION
1. Implement a plan care for the
antepartum client and family
throughout the childbearing
period.
2. Refer to appropriate resources.
EVALUATION
1. Evaluate effectiveness of
nursing intervention through
ongoing assessment.
EVALUATION
EVALUATION
1. Evaluate effectiveness of nursing 1. Assess effectiveness of nursing
interventions by comparing desired
interventions.
outcomes to client’s response.
2. Alter plan of care based on
client adaptation.
UNIT IV - MATERNAL/FETAL ASSESSMENT
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Identify indications for prenatal
1. Uteroplacental circulation
1. Identify indications for
and/or fetal diagnostic
affected by uterine contractions.
prenatal diagnostic testing.
procedures.
2. Stressors affecting cognitive2. Assess prenatal records and
2. Identify signs of fetal
perceptual functioning.
current labor to determine
compromise.
3. Alpha-Fetoprotein Screening
degree of risk.
3. Assess client's level of
4. Amniocentesis
3. Assess FHR and pattern
knowledge.
5. Nonstress test- Contraction
4. Review monitor equipment
4. Assess the effects of cognitiveStress test
for fetal response.
perceptual patterns for
6. Reassuring/Nonreassuring
5. Identify factors associated
presence of stressors that
FHR patterns
with a reduction in fetal
precipitate dysfunction.
7. Fetal monitoring techniques
oxygen supply.
5. Describe characteristics of a
using:
reassuring FHR pattern.
a. Ultrasound
6. Describe characteristics of a
b. Electronic monitoring
nonreassuring FHR pattern.
equipment
c. Fetoscope
8. Percutaneous Umbilical
Blood Sampling
9. Meconium-stained amniotic
fluid
10. Application of FHR monitor
11. Alterations and physiologic
stressors of pregnancy
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PLANNING
1. Discuss purpose, advantages
and risks of each diagnostic
procedure.
2. Propose alternate measures to
assist client in adapting to
changes in physical and
psychological functioning.
3. Plan nursing care to prevent
and/or minimize injury to
client and fetus.
PLANNING
1. Develop a plan of care for
prenatal diagnostic testing
based on assessment data.
2. Develop a plan of care for
electronic FHR monitoring
based on assessment data.
3. Discuss FHR monitoring by
intermittent auscultation and
electronic methods.
4. Formulate a teaching plan to
assist client with increasing
knowledge of required
diagnostic tests.
PLANNING
1. Provide client with
appropriate information in
response to questions about
diagnostic procedures.
2. Design a plan of care for a
client having prenatal testing.
3. Formulate a plan of care for a
laboring client with a
nonreassuring FHR pattern.
IMPLEMENTATION
1. Discuss purpose, procedure,
advantages and risks of each
diagnostic procedure
2. Utilize the nursing process to
improve uteroplacental
circulation affected by
contractions.
3. Explain baseline FHR and
patterns.
4. Describe preventive measures
to maintain FHR patterns
within normal limits.
IMPLEMENTATION
1. Collect information important
to conducting the diagnostic
tests.
2. Review monitor tracings,
illustrate characteristics of
reassuring and nonreassuring
FHR patterns.
3. Differentiate between nursing
interventions for monitor
strips reflecting:
a. Tachycardia
b. Bradycardia
c. increased/decreased
variability
d. late and variable
decelerations
4. Review nursing
documentation for client
monitoring during labor.
IMPLEMENTATION
1. Teach warning signs of
preterm labor.
2. Promote safety measures
throughout pregnancy.
3. Provide client and family
with simple, clear
explanations of test, purpose,
frequency, length.
4. Teach follow-up care and
events to report to health team
5. Review and analyze three
monitor strips and determine:
a. FHR: baseline, variability
b. Periodic changes, if any
c. Contraction interval, duration,
intensity, and resting tone.
6. Describe appropriate nursing
actions for each of these
changes:
a. Accelerations
b. Early decelerations
c. Late decelerations
d. Variable decelerations
7. Design a teaching plan
discussing nursing care
measures to minimize injury
to client and fetus.
EVALUATION
1. Evaluate client understanding
of diagnostic procedures.
2. Evaluate periodic changes in
FHR.
EVALUATION
1. Evaluate effectiveness of
nursing interventions in
effecting outcomes.
EVALUATION
1. Identifies and reports
significant changes in FHR
patterns.
2. Evaluates effectiveness of
teaching plan for client
undergoing prenatal
diagnostic testing.
3. Evaluates nursing care
11
management based on
outcome criteria for the
laboring patient.
UNIT V/VI – STAGES OF LABOR; NURSING CARE OF THE LABORING CLIENT;
MANAGEMENT OF DISCOMF0RT
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Identify beliefs/practices of
1. Biophysical Intrapartal
1. Assess coping skills, level of
selected cultures about labor and
Assessment
anxiety and response to labor.
birth.
2. True/False labor
2. Assess couple's interactions
2. Assess coping skills, anxiety,
3. Psychosocial factors
and support system.
couple's interaction and support
4. Cultural factors
3. Determine cultural values that
system.
5. Stages & Phases of Labor
influence intrapartal care.
3. Review factors included in initial 6. Stress in labor
4. Assess labor progress.
assessment of the woman in
7. Mechanisms of Normal Labor
5. Assess woman's response to
labor.
8. Physiological Adaptations to
labor.
4. Describe the ongoing assessment
Labor/Birth
6. Assess FHR patterns
of progress during the three
9. Leopold's maneuvers
7. Assess parents' readiness to
stages of labor.
10. FHR and pattern monitoring
interact with newborn.
5. Identify the assessment of the
11. Uterine contractions-frequency,
fetus during the first and second
duration, intensity and interval
stages of labor.
12. Effacement and dilatation, fetal
6. Describe physiological stressors
descent
of labor.
13. Pain
7. Compare childbirth pain with
Measurement/Management
other types of pain.
14. Laboratory/diagnostic tests
8. Examine how physical and
15. Signs of potential complications
psychological forces interact in
16. Fetal head diameters
the laboring woman's pain
17. Fontanels/Molding
experience.
18. Fetal lie, attitude, position
19. Fetal Station
20. Presentation-cephalic, breech,
shoulder
21. Forceps, Vacuum Extractors
22. Amniotomy
23. Apgar score system
24. Fetal Distress
25. Cesarean Birth/VBAC
26. Placental Expulsion
PLANNING
1. Describe maternal and fetal
responses to labor.
2. Describe the role of the
woman's coach/family member
during the first, second and
third stages of labor.
3. Develop an appropriate plan
of care for first, second and
third stages of labor.
4. Describe the role and
PLANNING
1. Physiological integrity
2. Psychosocial integrity
3. Health promotion and
maintenance
4. Functional Health patterns in
intrapartal period.
5. Non-pharmacologic
/pharmacologic pain
management techniques.
12
PLANNING
1. Maintain a safe, effective care
environment.
2. Provide support and
encouragement to couple during
labor.
5. Monitor laboratory values.
4. Support ongoing comfort
measures and pushing efforts.
5. Promote maternal-fetal
well-being during the birth
responsibilities of the nurse
in emergency birth.
process.
IMPLEMENTATION
1. Implement nursing
interventions to enhance the
birthing experience.
2. Outline nursing actions in
preparation for birth.
3. Identify signs of potential
complications in the three
stages of labor.
3. Identify priorities in maternal
care immediately after the birth.
4. Describe how medications
may affect a pregnant woman
and the fetus or neonate.
IMPLEMENTATION
1. Positioning that promotes
comfort and assists pushing
efforts: lithotomy, kneeling,
squatting, side-lying, hands
and knees.
2. Observe signs of approaching
birth:
Perineal bulging
Appearance of fetal head
3. Comfort Measures:
Ice chips
Cool washcloth
Supporting body and/or
extremities during pushing
Analgesia/Epidural/Intrathecal
4. Measures to facilitate parentinfant interaction
EVALUATION
1. Understands and practices
safety measures
2. Evaluate effectiveness of
interventions through
ongoing assessment.
EVALUATION
1. Evaluate therapeutic
interventions to physiologic
stressors of labor/birth.
2. Evaluate effectiveness of
interventions to achievement
of outcomes.
IMPLEMENTATION
1. Complete maternal-fetal
physical assessments.
2. Provide support measures for
laboring client and coach.
3. Support and reinforce
breathing methods.
4. Identify frequency, duration and
intensity of contractions both by
palpation and with electronic
monitoring.
5. Monitor FHR in different stages
of labor.
6. Assist with positioning,
preparation for giving birth.
7. Manage labor discomfort.
8. Monitor changes in respiratory,
cardiac, gastrointestinal, and
renal systems during each stage
of labor.
9. Identify signs of placenta
separation.
10. Observe for approaching birth.
11. Assess Apgar score.
12. Promote parental-newborn
EVALUATION
1. Evaluate uterine contractions
every 30minutes and when FHR
is evaluated.
2. Evaluate progression of
cervical dilation, effacement,
and fetal descent.
3. Alter plan of care based upon
client's response and expected
outcomes.
UNIT VII - ADAPTATIONS IN THE POSTPARTUM CLIENT
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Describe physiologic changes
1. Physiological Adaptations in
1. Assess mother's emotional
that occur during the
postpartum:
status.
postpartum period.
VS, fundus, lochia, perineum
2. Determine progression of fourth
2. Describe maternal assessment
bladder, episiotomy/incision,
stage with normal limits.
- 4th Stage
hydration.
3. Assessment to monitor birth
3. Explain the process of bonding
2. Comfort measures
recovery.
and attachment, including the
3. Signs of postpartal
role of maternal touch and
emergencies.
verbal interactions.
4. Apgar score system
13
4. Identify neonatal complications
5. Bonding
6. Psychological adaptations
7. Postpartum blues
PLANNING
1. Compare nursing assessments
and care for women who have
undergone cesarean birth and
vaginal birth.
2. Identify maternal concerns and
how they change over time.
3. Discuss cultural influences on
family adaptation.
PLANNING
1. Safe, effective care
environment.
2. Promote physiological integrity
3. Promote psychosocial integrity
4. Plan of care based on
assessment data
5. Develop short and long term
goals for maternal & infant
well-being.
6. Promote bonding
PLANNING
1. Monitor maternal status.
2. Enhance maternal-newborn
attachment
3. Develop plan of care based
on assessment data
4. Describe assessments and
interventions elated to
postpartum psychosocial
adaptations.
IMPLEMENTATION
1. Teach self care measures to
prevent bleeding and enhance
comfort and safety.
2. Provide direct physical care.
3. Teach mother and baby care.
4. Discuss the cause,
manifestations and
interventions related to
postpartum blues.
IMPLEMENTATION
1. Identify physiological
adaptations attributed to 4th
stage of labor.
2. Provide various comfort
measures
3. Nutrition and hydration
4. Urinary elimination
5. Health promotion and
maintenance
6. Teaching
IMPLEMENTATION
1. Complete maternal
assessments every 15 minutes
for 1 hour, then every 30 min.
2. Nursing strategies that
promote psychosocial
adaptation.
3. Educate client on importance
of proper nutrition and
hydration.
4. Teach self care measures.
5. Provide anticipatory guidance
and counseling
6. Complete Apgar scoring.
EVALUATION
1. Ensure physical parameters are
monitored at frequent
intervals.
2. Evaluate interventions for
uneventful recovery period and
no complications.
3. Evaluate interaction and
bonding with newborn.
EVALUATION
1. Evaluate mother and baby's
response to birthing experience
and both maintains normal
physiological parameters.
EVALUATION
1. Determine that mother and
newborn maintains normal
physiological parameter.
2. Evaluate effectiveness of
interventions and strategies to
achievement of outcomes.
UNIT VIII - COMPLICATIONS OF PREGNANCY, LABOR AND BIRTH
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Describe maternal and fetal
1. Complications of pregnancy:
1. Collect data and complete
risks associated with
-Gestational diabetes/IDDMPostpartum assessment tool
complications of pregnancy.
NIDDM
(antepartum section).
2. Describe the maternal and fetal
-Preterm labor
2. Collect data and complete
risks associated with
-Premature rupture of
Postpartum assessment tool
complications of the
membranes
(intrapartum section).
intrapartum period.
-Abruptio placenta
3. Analyze collected data and
-Placenta previa
formulates nursing diagnoses
-Preeclampsia/Eclampsia
based on client needs.
14
-HELLP
-Hydatidiform Mole (GTD)
a. Early pregnancy loss:
-Inevitable
-Missed
-Threatened
-Complete -Incomplete
b. Ectopic pregnancy
2. Complications of Labor and
Delivery
-Prolapsed Cord
-Amniotic Fluid Embolism
-Uterine Rupture
-Uterine Inversion
-Subinvolution
-Retained placenta
-Placenta Accreta
-Cord Anomalies
PLANNING
1. Describe nursing interventions
to prevent maternal and fetal
risks associated with
complications of pregnancy
and/or labor and delivery.
2. Describe nursing care of the
high risk client during the
antepartum and/ or intrapartum
period.
3. Differentiate signs and
symptoms of complications of
pregnancy and/or labor and
delivery.
4. Describe nursing care of the
high-risk newborn.
5. Determine teaching needs of
the high-risk client and family.
IMPLEMENTATION
1. Implement therapeutic nursing
interventions that facilitate the
high-risk client’s adaptation to
complications of pregnancy
and/or labor and delivery.
2. Implement a teaching plan
specific to the needs of the
high-risk client.
PLANNING
1. Develop a plan of care to
assist in prevention of
maternal / fetal
complications.
2. Develop a plan of care to
promote adaptation to the
stressors associated with a
high risk pregnancy and/or
labor and delivery.
3. Develop a teaching plan
prioritizing physical and
psychological needs of the
high-risk client.
PLANNING
1. Develop a plan of care for a
high-risk client and family.
IMPLEMENTATION
1. Measures to increase
adaptation to physiologic and
psychological factors
associated with the high risk
client:
Pregnancy:
a. Diabetic education
b. Prevention of preterm
labor:
-Home monitoring
-Medications (tocolytics)
c. Premature rupture of
membranes:
-Assessment of amniotic
fluid
IMPLEMENTATION
1. Implement a plan care for the
high-risk client.
2. Implement a plan of care to
the specific complication of
the high-risk client.
15
-Bedrest
-Amnioinfusion
d. Placenta previa/abruption
-Hospitalization/bedrest
-C-Section
-Postoperative care
e. Preeclampsia/Eclampsia
-DTR’s
-MgSO4
-Urinary output
-Medications
(Antihypertensives)
-Lab work (Mg level)
-Seizure precautions
f. HELLP
-Lab work
g. Hydatidiform Mole
-D&C
-Oncology follow up
-Medications
(Chemotherapeutics)
h. Abortions
-Cerclage placement
-D&C
-Bedrest, hydration
i. Ectopic pregnancy
-Surgical treatment
-Medications
(Methotrexate)
2. Labor and Delivery:
- Change of position
- Oxygen therapy
- IV hydration
- Fetal monitoring
- Emergency c-section
EVALUATION
1. Evaluate effectiveness of
nursing intervention through
ongoing assessment.
EVALUATION
1. Evaluate effectiveness of
nursing interventions by
comparing desired outcomes
to client’s response.
EVALUATION
1. Assess effectiveness of
nursing interventions.
2. Reassess stressors and
adaptations.
3. Alter plan of care based on
client response.
UNIT IX/X – ADAPTATION, ASSESSMENT, NURSING CARE OF THE NEWBORN
AND HIGH RISK NEWBORN
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Explain the physiologic
1. Adaptations to extrauterine life: 1. Collect data related to the
changes of the body systems
-Mechanism of establishing
newborn:
necessary for the transition
respirations
APGAR scoring
from fetal to neonatal life.
-Extrauterine circulation
Vital signs
16
2. Describe thermoregulation in
the newborn.
3. Describe nursing assessments
of the newborn according to
Gordon’s functional Health
Patterns.
4. Explain the importance and
components of gestational age
assessment.
5. Identify the nutritional needs
of the newborn.
6. Identify sleep cycles of the
newborn.
7. Identify safety needs of the
newborn.
8. Assess family’s knowledge
regarding newborn care.
9. Compare variations of health
status in the low risk vs. highrisk newborn.
2. Thermal factors:
-Types of heat loss in the
newborn:
convection
conduction
radiation
evaporation
-Nonshivering thermogenesis
brown fat
-Neutral thermal environment
-Effects of cold stress
3. -Nutrition-metabolic
-Activity-exercise
-Elimination
4. Gestational age assessments:
-Ballard score
-Dubowitz score
-Physical characteristics
-Newborn reflexes
-Medications (Vit.K, EES)
5. Nutrition:
-Breast vs Bottle-feeding
-Advantages/disadvantages
6. Sleep patterns (cycles):
-Periods of reactivity
-Cyclical sleep
a. quiet sleep
b. active sleep
c. drowsy
d. quiet alert
e. active alert
g. crying
7. Safety needs:
-NYS car seat law
-Newborn screening
-Infant abduction
8. Parental responses to
newborn:
-Bonding
9. Disorders Prenatal
Development
-Gastroschisis
-omphalocele
-TEF-EA
-extrophy of bladder
10.Maladaptation to extrauterine
life:
-Prematurity:
a. BPD
b. ROP
c. NEC
11.Gestational age stressors
-Jaundice
17
2.
3.
4.
5.
6.
Lab testing (glucose, H/H,
PKU)
Newborn physical
assessment (ROS)
Complete newborn
assessment tool.
Complete gestational age
assessment tool.
Assess for presence of
bonding.
Assess parental teaching needs.
Analyze collected data and
formulate nursing diagnosis
based on client and family
needs.
-Respiratory distress
syndrome
-Neonatal sepsis
PLANNING
1. Describe nursing interventions
to facilitate the transition from
fetal to extrauterine life.
2. Describe nursing care of the low
risk newborn.
3. Differentiate signs and symptoms
of normal adaptations and
maladaptations of the newborn.
4. Describe nursing care of the high
risk newborn.
5. Determine teaching needs of
caregivers.
PLANNING
1. Develop a plan of care to assist
in transition from fetal to
extrauterine life.
2. Develop a plan of care to
promote healthy adaptation of
the newborn.
3. Develop a teaching plan
prioritizing knowledge needs of
caregivers.
PLANNING
1. Develop a plan for a low risk
infant and its needs.
2. Develop a plan of care for a
high-risk infant and its needs.
IMPLEMENTATION
1. Implement therapeutic nursing
interventions that facilitate the
transition from fetal to
extrauterine life
2. Implement therapeutic nursing
interventions to promote
optimal adaptation of the low
risk and/or high-risk newborn.
3. Implement therapeutic
interventions that enhance
caregivers knowledge regarding
infant care.
4. Implement therapeutic
interventions and teaching plan
specific to the nutritional
needs of the antepartum client.
IMPLEMENTATION
1. Measures to increase
adaptation to physiologic and
nutritional factors associated
with the neonate.
a. Nutritional counseling to
caregivers
b. Parent teaching classes:
-Infant bath
-Cord care
-Circumcision care (and
care of uncircumcised
care)
-Temperature taking
-Positioning
-Safety
-Feeding
-Bulb syringe
-Diaper change
-Behavior, feeding cues
2. Measures to increase
adaptation of the high risk
neonate:
-Respirators/Incubators
-Kangaroo care
-Interrupted Bonding
-Technical equipment
-Support groups
IMPLEMENTATION
1. Implement a plan care to
increase parental knowledge
of newborn care.
2. Refer to appropriate
resources.
(i.e. La Leche League)
3. Implement a plan of care
specific to the problems of
the high-risk newborn.
EVALUATION
1. Evaluate effectiveness of
nursing intervention through
ongoing assessment.
EVALUATION
1. Evaluate effectiveness of
nursing interventions by
comparing desired outcomes
to client’s response.
EVALUATION
1. Assess effectiveness of
nursing interventions.
2. Reassess stressors and
adaptations.
3. Alter plan of care based on
18
client response.
UNIT XI – BARRIERS AFFECTING CONCEPTION
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Identify the mechanism of
1. Contraception
1. Assess risks/ benefits of
action for each method of
-Hormonal preparations
various contraceptive
family planning available.
-Barrier methods
methods.
2. Identify physiological/
-Natural Family Planning
2. Assess client’s health status
psychological stressors
methods
and motivation for desired
associated with adolescent
2. Infertility
method.
pregnancy.
a. Etiology
3. Assess the adolescent client’s
3. Assess the adolescent client’s
b. Treatment options
physiological and
health perception and health
-IUI
developmental needs through
management needs.
-IVF
the childbearing period.
-GIFT
-ZIFT
c. Alternatives
-Adoption
-Surrogacy
-Child free living
3. Adolescent Pregnancy
a. Developmental
considerations
b. Nutritional considerations
c. Risk factors:
-Preeclampsia
-Cephalopelvic disproportion
-Gestational diabetes
-Preterm labor
-Stillbirth
-Nutritional deficits
-Socioeconomic alterations
PLANNING
1. Describe the role of the nurse
in helping couples choose
contraceptive methods.
2. Explain the risks/benefits of
particular contraceptive
methods.
3. Explain advantages/
disadvantages of infertility
treatment.
IMPLEMENTATION
1. Implement therapeutic nursing
interventions that enhance
client’s knowledge regarding
conception/reproduction.
2. Implement therapeutic
interventions that enhance
client’s knowledge regarding
PLANNING
1. Develop a plan based on
assessment of
individual/family needs.
2. Formulate nursing diagnosis
based on collection of data.
3. Determine expected
outcomes for individual
clients/families.
PLANNING
1. Plans nursing care for individual
clients and families.
2. Participates in developing a
teaching plan for individual
clients and families.
IMPLEMENTATION
1. Measures to increase
adaptation to stressors:
a. Genetic counseling
b. Genetic screening
c. Preconceptional counseling
d. Nutritional counseling
2. Measures to increase
IMPLEMENTATION
1. Implement a plan of care for
the client/s who faces
infertility issues throughout the
childbearing period.
2. Refer to appropriate resources.
19
infertility treatment/options.
3. Implement therapeutic
interventions and teaching plan
specific to the needs of the
adolescent client.
EVALUATION
1. Evaluate effectiveness of
nursing intervention through
ongoing assessment
adaptation to stressors:
a. Infertility counseling
b. Support groups
3. Sexual Education and
Pregnancy Prevention
a. Early intervention
b. Sexuality awareness
EVALUATION
1. Evaluate effectiveness of
nursing interventions by
comparing desired outcomes
to client’s response.
EVALUATION
1. Assess effectiveness of
nursing interventions.
2. Reassess family stressors
and adaptations.
3. Alter plan of care based on
client adaptation.
UNIT XII - ADAPTATIONS TO SEXUALITY/ ADOLESCENT PREGNANCY
BEHAVIORAL OBJECTIVES
COURSE CONTENT
CORRELATED LEARNINGS
ASSESSMENT
ASSESSMENT
ASSESSMENT
1. Identify clients who have been
1. Identify sexually transmitted
1. Identify sexually transmitted
exposed to or are at risk for
infections:
infections:
sexually transmitted infections.
HIV
HIV
2. Identify modes of transmission,
Hepatitis B
Hepatitis B
treatment options, methods of
Gonorrhea
Gonorrhea
reducing risk.
Chlamydia
Chlamydia
3. Identify clients who have been
Herpes Simplex Virus I & II
Herpes Simplex Virus I & II
exposed or who are at risk for
Syphilis
Syphilis
communicable diseases.
Human Papillomavirus
Human Papillomavirus
4. Review risks/benefits of
2. Identification of signs and
2. Identification of signs and
immunizations to promote
symptoms of communicable
symptoms of communicable
health.
disease:
disease:
Measles
Measles
Mumps
Mumps
Rubella
Rubella
Varicella
Varicella
Hepatitis B
Hepatitis B
Polio
Polio
Diphtheria
Diphtheria
3. Assess indications/
3. Assess indications/
contraindications of clients in
contraindications of clients in
need of immunizations
need of immunizations
according to NYS
according to NYS
Department of Health
Department of Health
guidelines.
guidelines.
PLANNING
1. Describe nursing interventions
PLANNING
PLANNING
to prevent and reduce risk and
2. Develop a plan of care to
3. Develop a plan of care to
transmission of sexually
prevent transmission of
prevent transmission of
transmitted infections.
sexually transmitted diseases
sexually transmitted diseases
2. Describe nursing measures to
and reduce spread of
and reduce spread of
prevent and reduce risk and
communicable diseases.
communicable diseases.
spread of communicable
2. Develop a plan of care to
2. Develop a plan of care to
diseases.
promote Healthy People
promote Healthy People
3. Explain rationale for
2010.
2010.
recommended immunization
20
schedule as provided by the
NYS Department of Health
(DOH).
IMPLEMENTATION
1. Implement therapeutic nursing
interventions that enhance
client’s knowledge regarding
exposure, transmission, and
prevention of Sexually
Transmitted Infections.
2. Implement therapeutic
interventions that enhance
client’s knowledge regarding
exposure and transmission of
communicable diseases.
3. Implement therapeutic
4. Interventions and teaching plan
specific to the needs of the client
in need of
immunizations.
EVALUATION
1. Evaluate effectiveness of
nursing intervention through
ongoing assessment.
IMPLEMENTATION
1. Measures to increase
knowledge regarding STI’s:
-Early Intervention
-Sexual Education
-Barrier methods for
prevention
2. Measures to increase
knowledge regarding spread
of communicable disease:
a. universal precautions
b. proper handwashing
techniques
c. up to date immunizations
IMPLEMENTATION
1. Implement a plan care for the
client/s who have been
diagnosed with a STI
including the causes,
treatments and nursing
considerations.
2. Refer to appropriate
resources.
3. Implement a plan of care for
the client exposed to a
communicable disease.
EVALUATION
1. Evaluate effectiveness of
nursing interventions by
comparing desired outcomes
to client’s response.
EVALUATION
1. Assess effectiveness of
nursing interventions.
2. Alter plan of care based on
client adaptation.
Revised 6/2007, 8/10
21