NORTH SEATTLE COMMUNITY COLLEGE
Health & Human Services Division
NUR 133
FAMILY NURSING THEORY
FAMILY NURSING CLINICAL
Revised JANUARY 2007
NORTH SEATTLE COMMUNITY COLLEGE
Health & Human Services
Division
Family Nursing Theory
4th Quarter
Course Outline & Expectations
Instructor:
Office:
Office Phone:
Email:
Office Hours:
Sandra Liming, R.N., M.N.
2304B
206-528-4560
sliming@sccd.ctc.edu
posted on door (by appointment only)
Course Description:
In conjunction with NUR 134, this course is a study of the care of families: obstetrical clients and their
partners, infants and children. The focus of nursing care for children will center on health promotion and
wellness maintenance as well as parenting.
Course Goals:
Appreciate the role of the LPN in caring for obstetrical clients, infants, and children.
NSCC General Education Learning Outcomes and/or Related Instructional Outcomes (for
technical courses) Met by Course:
Outcome 1: Think critically in reading and writing.
Outcome 4: Access, evaluate, and apply information from a variety of sources and a variety of contexts.
Course Outcomes/Learning Objectives:
Upon successful completion of this course the student should be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Identify principles of human reproduction
Identify components of prenatal care.
Discuss nursing care implemented during childbirth and postpartum.
Discuss special situations in childbearing.
Discuss newborn assessment.
Discuss nursing care related to neonatal loss.
Discuss principles of parenting.
Discuss growth and development of children.
Discuss wellness promotion and health maintenance in children
Discuss play as therapy.
Discuss hospitalization of children.
Discuss principles of medicating children.
Topical Outline and/or Major Divisions:
1.
2.
3.
4.
5.
Human Reproduction
Prenatal Care
Childbirth and Postpartum
Special Situations in Childbearing
Newborn Assessment and Care
2
6.
7.
8.
9.
10.
11.
12.
13.
Neonatal Loss
Parenting
Growth and Development of Children
Assessment of Children
Wellness Promotion and Health Maintenance in Children
Play as Therapy
Hospitalization of Children
Medicating Children
Course Requirements (Expectations of Students)
1. Students will be expected to participate in class discussion.
2. Students will be expected to complete all assignments and exams as indicated by the instructor.
3. Students will be expected to exhibit professional behavior in the classroom.
Students will be expected to demonstrate the ability to perform specific competencies listed under “Course
Outcomes/Learning Objectives.”
Methods of Assessment/Evaluation:
Final grades are assigned according to published grading standards for course. Methods of assessment
will include:
Written Exams/Assignments
Required Text(s) and/or Materials:
As determined by instructor.
Supplemental Text(s) and/or Materials:
As required by instructor.
3
Class Policies and Assignments
Participation
1.
2.
3.
A sign-in sheet will be available in each class.
Read assigned material BEFORE class.
Be prepared to participate in class discussion.
Assignments
1.
Vocabulary Work Sheets:
Provide short definitions for terms that are related to Maternity/Newborn care.
care.
2.
Medication Work Sheets:
Short summary of the drug's use in Family Nursing care.
3.
Case Studies:
Groups of 4, prepare to present to class (10 min.) using overhead projector.
You will need to purchase transparencies and pen.
4.
Teaching Presentations:
a.
group project (3-4)
b.
10 minute role play presentation to class
5.
Pediatric Dosage Calculations
6.
Toy Project (see grading sheet included in syllabus)
Assignments #3 and #4 will be graded based on the following criteria:
Group Presentation will be graded as follows:
Category
Pts.
Category
Contribution Overall
4
Contributed Ideas
Cooperation & Teamwork
4
Attended Planning Meetings
Listened to Others
4
Total
* Each group member to evaluate one another and self.
Pts.
4
4
20
Category
Pts.
Category
Clear Presentation
4
Coordination of Presentation
Informative
4
Information Useful
Research Evident
4
Total
* Each group will be evaluated by the other groups and the instructor.
Pts.
4
4
20
4
3.
Term Paper Criteria and Grading:
a.
Paper must be typewritten, 3-4 pp. in length (excluding bibliography and
title page) and double-spaced.
b.
Paper topic must relate to information covered this quarter.
c.
APA format must be used.
d.
The paper should include discussion of how you, the nurse, will be
involved in the care of the client.
d.
When you resubmit the paper after making final revisions, the original
paper, and grade sheet must be included. Also, any revisions must be
highlighted with a marker on the new paper. If you don’t include the grade
sheet I will deduct 1 pt.
c.
If you need help, this is available in the writing lab.
d.
Grading will be based on content, style and form. The grading scale will
be
1-20 pts. based on the following:
Content
Topic clearly stated
Accuracy of information
Creativity
Nursing Process
Pts.
2
3
3
5
Style and Form
Grammar, punctuation, & spelling
Appropriate documentation of references
Neatness & organization
Total
Pts.
3
2
2
20
All assignments except the term paper may be handwritten. However, they must
be neat and legible or they will not be graded. Please just STAPLE pages together. NO
NOTEBOOKS OR FOLDERS or you will lose 1 pt.
5
TERM PAPER GRADING SHEET
(Turn this in with your draft and final paper.)
Category
Earned
Self check-List
Pts. Possible
Topic clearly stated
___________
2
_________
Accuracy of information
___________
3
_________
Nursing process
___________
5
_________
Creativity
___________
3
_________
Grammar, punctuation,
spelling
___________
3
_________
Appropriate documentation ___________
2
_________
Neatness & organization
2
--------------__________
20
--------------
TOTAL
___
__________
-------------------___
__________
6
Pts.
TOY PROJECT
Choose an age group for which you wish to design a toy and complete the reading necessary to address the
grading criteria listed below. A typewritten paper is to be submitted with the toy. The paper should
include the rationale for the design, age group appropriateness based on growth & development, safety,
how the toy is supposed to work, and donation information. Finally, complete the necessary steps for
donating the toy (i.e. daycare, hospital, developmental center, school group) by listing the agency, a contact
person, a telephone number, and delivering the toy to the agency.
TOY PROJECT GRADING
Group Members:
1.
2.
3.
Criteria
Written Explanation (10 pts)
Check List
_______
Grade
______
Creativity (5 pts)
_______
____ __
Safety (10 pts)
_______
______
Growth & Development (10 pts)
Donation (5 pts)
_______
_______
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______
______
GRADING
1.
Students must maintain a 2.0 or better in ALL subjects in order to progress to the
next quarter. A 2.0 cumulative grade point must be maintained to be eligible for
a Certificate of Achievement. (Note: 2.0 = 77%)
3.
If unforseen circumstances prevent you from taking an exam at the scheduled,
you must contact me to arrange a make-up exam.
GRADING FOR NUR 133:
ASSIGNMENTS
Vocabulary Sheets
Case Studies Presentation
Pediatric Dosage Calculations
Toy Project
Teaching Presentation
Term Paper
Exam Mid-Term
Final Exam
PTS.
5%
10%
5%
10%
35%
35%
**NOTE: A total of 77% is necessary for a passing grade. (In addition, you must
have a total of 77% in N133 before you can participate in N134 clinical rotation.)
ATTENDANCE AT FAMILY NURSING LAB IS MANDATORY.
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NAME:
VOCABULARY WORKSHEET:
Be sure you know these vocabulary words.
1.
Maternal Mortality Rate
2.
Infant mortality rate
3.
Obstetrics
4.
Pediatrics
5.
Neonatal period
6.
Fundus
7.
Cervix
8.
Gynecoid pelvis
9.
Android pelvis
10.
True pelvis
11.
False pelvis
12.
Conception
13.
Amniotic Sac
14
Zygote
15.
Embryo
16.
Fetus
17.
Placenta
18.
Implantation
19.
Gravida
20.
Para
21.
Trimester
22.
Braxton Hicks Contractions
23.
Nagele's rule
24.
Amniocentesis
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25.
Dilation
26.
Effacement
27.
Station
28.
Position
29.
Presentation
30.
Episiotomy
31.
Crowning
32.
Colostrum
33.
Lanugo
34.
Vernix Caseosa
35.
Meconium
36.
Fundal massage
37.
L/S ratio
38.
Involution
39.
Acrocyanosis
40.
Phototherapy
41.
PKU
42.
Physiologic jaundice
43.
Circumcision
44.
Respiratory distress syndrome (RDS)
45.
Small for gestational age (SGA)
46.
Down syndrome
47.
Erythroblastosis fetalis
48.
Hyaline Membrane Disease
49.
Cephalopelvic Disproportion
50.
Infertility
10
NAME:_________________________________
DRUG WORKSHEET: Be sure you know the use of these medications in the
Family Nursing field of nursing.
1.
Ergotrate
23.
Immune gamma globulin
2.
Pitocin
24.
Ritodrine
3.
Methergine
25.
Tylenol with codeine
4.
Terbutaline
26.
Doss
5.
Surfactant
27.
Narcan
6.
Erythromycin Oint.
28.
Vistaril
7.
Fentanyl
29.
Tylox
8.
Morphine
9.
Phenergan
10.
Estrogen
11.
Magnesium Sulfate
12.
Calcium Gluconate
13.
Tucks
14.
Phenobarbital
15.
Progesterone
16.
Rho-gam
17.
Pergonal
18.
Clomid
19.
Aqua-Mephyton
20.
Toradol
21.
Marcaine
22.
Xylocaine
11
FAMILY NURSING THEORY
CASE STUDIES
1.
Mary Jo is a 24 year-old primipara who has come to the clinic for her second
prenatal visit and has been calculated to be at approximately 11 weeks gestation.
She complains of frequent nausea and vomiting, especially in the morning, slight
constipation and flatulence and frequent urination associated with urgency and
burning. She brings in a specimen of her first voided urine this A.M. Her
husband has accompanied her today and both talk animatedly about the expected
pregnancy and baby.
A.
What nursing procedures/tests will be performed on Mary Jo and her
urine specimen today?
B
What can the nurse teach Mary Jo regarding care of herself during this
stage of her pregnancy? (List at least 4 different categories of instruction
and what you would instruct)
C.
What other teaching/encouragement might now be appropriate for Mary
Jo and her husband? (List at least 5 things)
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2.
Anna is entering her 7th month of pregnancy and has had a relatively easy 1st
and 2nd trimester, without complications. Since last month she has gained 12
lbs. and her rings no longer fit. This morning she awoke with slight "puffiness"
around her eyes. Her blood pressure has been running 110/70 and today is
140/85. She had ham and eggs for breakfast with a glass of orange juice but was
in a hurry for lunch so grabbed a pack of potato chips and a soda-pop. She also
states she has noticed an increased vaginal discharge without odor or itching and
is experiencing occasional "excruciating" leg cramps.
A.
What kind of test, measurements would be needed on Anna today? (List
at least 8 things)
B.
What kind of precautions and doctor's visits can Anna probably
anticipate in the remaining weeks of her pregnancy?
C.
What teaching is necessary for Anna at this point in her pregnancy? (List
at least 4 categories with appropriate, very brief, instruction)
13
3.
Your client was admitted to the hospital early this morning with the diagnosis of
"Severe PIH." You are instructed to care for the client, meeting her needs, under
R.N. supervision. You know her name is Sue and she is a 25 year old primipara.
Her BP on admission was 190/100, pulse 72, Respirations 20 and temp. 98.6o.
Her orders are the following:
1.
2.
3.
4.
5.
6.
7.
Bedrest
VS q 1 hr., including reflexes
Clear liquids
Magnesium Sulfate per I.V. drip at 2 mg/min and regulate with
reflexes
Limit visitors to husband only
Amniocentesis @ 11 A.M. today
Seizure precautions
A.
What kind of equipment, medication and safety precautions would you
check for in Anna's room?
B.
What nursing measures and environmental controls are necessary to
consider in Anna's case?
C.
What kind of instructions does Anna need prior to her Amniocentesis
test?
14
NUR 133 - Case Studies
4.
MaryLou is 14 weeks pregnant, primi gravida, and is at her doctor's office
complaining of spotting and mild cramping. Her doctor tells her she wants to do
a pelvic exam to determine if she is experiencing preterm labor.
A.
What kind of information/teaching should the doctor and/or nurse give
MaryLou at this time?
B.
Why would the doctor want to do a pelvic exam at this time and what
would she be observing for during the exam?
C.
MaryLou has been placed on bedrest at home. What
information/teaching should the nurse give MaryLou at this time?
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5.
MaryLou has now been admitted into the hospital, accompanied by her husband.
The nurse has taken her history, obtained a copy of her prenatal record and
oriented the couple to the labor, delivery unit. MaryLou's contractions began
about 5 hours ago and are now fairly regular at 4-5 minutes apart, lasting 45-60
seconds. She is laughing and joking. She continues to normally interact even
during contractions. Vaginal exam on admission reveals her cervix to be 3 cm.
dilated, 95% effaced and presenting part at -1 station. Membranes are intact.
A.
During this latent part of this stage of labor, what might be some logical
nursing goals?
B.
It is 3 hours later and MaryLou has become uncomfortable with her
contractions but remains in good control using modified pace breathing
techniques. Suddenly, during one contraction, MaryLou feels a big gush
of warm fluid between her legs and it frightens her.
C.
What nursing observations are necessary at this time?
D.
What nursing care is indicated?
Soon after this MaryLou starts crying and complaining that nobody is helping
her and her husband may as well leave because his attentions are just distracting
her. She is very uncomfortable during her contractions and has difficulty
maintaining control. In addition, the nurse notices that her BP has dropped from
110/60 to 90/40, her pulse has risen to 120, and FHT have dropped to a baseline
of 80. MaryLou is lying on her back and is not relaxing between contractions.
A.
What are some appropriate nursing actions?
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6.
7.
Four hours after being admitted to labor and delivery the nurse checks MaryLou
and finds she is 9 cm dilated and the presenting part at +1 station. She has
indicated she would like an epidural anesthetic for delivery and the
anesthesiologist is summoned.
A.
What preparations will be made for the anesthesia?
B.
What post-anesthesia observations must be made by the nursing staff?
At 2:37 PM MaryLou and her husband become parents of a 9 lb. 6 oz. baby girl.
She gave birth vaginally with a midline episiotomy and a 3rd degree laceration.
She has nursed the baby and is resting comfortably, accompanied by her partner.
Her orders include:
1.
2.
3.
4.
5.
1 amp (10mg), Pitocin to be added to present I.V.
May DC I.V. when completed.
Tylox 1 tablet po prn pain.
Ice-glove to perineum.
General diet.
You are assisting the L&D nurse. Fill out the info. below for recovery care. List
at least 5 different categories for observation/assessment.
Normal Observations
Possible Abnormal Findings
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Nursing Actions
8.
9.
Mrs. Brown is gravida 2, para 2 who delivered a 9lb 10oz boy after 3 hours of
labor. Her vital signs when she arrives in postpartum 2 hours after birth are
98.9-110-20-90/60. Her fundus is slightly boggy and she has saturated her peripad and the wheelchair pad. She is pale and light-headed. She came into the
Family Maternity Center completely dilated, so she does not have an i.v.
A.
Identify the abnormal assessment findings.
B.
Based on your assessment findings, what do you think might be going on
with Mrs. Brown?
C.
What factors contributed to Mrs. Brown current condition?
D.
Identify appropriate nursing interventions/client teaching.
Ms. Jones had a cesarean birth at 37 weeks gestation for third trimester bleeding
and fetal distress. She has been on bedrest for the past 8 weeks for a partial
previa. She had a normal postoperative course, free of complications. This is
her third postoperative day and she calls you into her room because when she got
out of bed this morning she felt a sharp pain down her right calf. You notice her
right foot and ankle are slightly swollen and cool to the touch. Her vital signs
are: 102-100-18-116/68.
A.
Identify the abnormal assessment findings.
18
10.
B.
Based on your assessment findings, what do you think might be going on
with Mrs. Brown?
C.
What factors contributed to Mrs. Brown's current condition?
D.
Identify appropriate nursing interventions/client teaching.
Ms. White is a primipara who gave birth to a 8lb 8oz baby girl after pushing for
3 hours. The physician finally had to use forceps to help her give birth. She had
a lot of perineal swelling, which you have been treating with ice packs. She had
a regional anesthesia that is beginning to ear off. She is complaining of severe
perineal pain. Her vital signs are 99.8-112/20-88/56.
A.
Identify the abnormal assessment findings.
B.
Based on your assessment findings, what do you think might be going on
with Ms. White?
C.
What factors contributed to Ms. White's current condition?
D.
Identify appropriate nursing interventions/client teaching.
19
Post-Partum Assessment for NUR 133
1.
2.
3.
4.
5.
6.
7.
Done early in shift to determine care and teaching needs.
Follow logical order.
"3 B's" Assessment
Meaningful and instructional for mother and informative to staff
members.
Promotes concise, accurate charting.
Insures early detection of post-partum abnormalities.
Opportunities to teach self and baby care during assessment.
Head to Toe Assessment
A.
Preparation:
1.
2.
3.
4.
5.
6.
7.
8.
empty bladder
ct. in supine position on flat bed
explain each procedure and inform her of findings nurse wash hands!
Emotional status/pain/comfort
Breasts - palpate each breast gently, assessing:
a.
contour
b.
full, tender, firm, shiny
c.
veins distended
d.
skin temp.
e.
sore and/or requirement
f.
pain med. requirement
g.
nursing or bottle (how is it going?)
h.
explain process of milk production, taking care of
engorgement, self breast exams, questions regarding
breastfeeding, hygiene
Uterus - palpate and assess
a.
firmness
b.
location compared to umbilicus
c.
have ct. feel own fundus, explain need for firmness and
process of involution
Bladder - inspect and palpate
a.
note emptying or retaining of urine
b.
any signs of infection
c.
instruct regarding perineal care
Lochia - assess amount and type
a.
amount
b.
clots
c.
color
d.
odor
e.
instruct mother regarding what to expect
Episiotomy
a.
infection
b.
discomfort
c.
clots, swelling
d.
explain sitz bathes and local anesthesia meds
e.
answer questions regarding care at home, bowel function,
etc.
Bowel function
a.
last B.M.; avoid constipation
b.
instruct regarding fluid and diet
Homan's sign - press down on knee and have pt. flex foot; pain or
tenderness in calf is positive.
20
Postpartum Maternal Physical Assessment
"The 3 B's"
I.
"Breasts"
a.
(soft, filling, engorged)
b.
nipples (tender/nontender; cracked or bleeding)
II.
"Belly"
a.
bowel tones (present/absent)
b.
fundus (firm/soft; at, above or below umbulicus)
c.
apply fundal pressure; observe for freeflow of lochia on pad
III.
"Bottom"
a.
perineum (swollen/nl; tender/nontender)
b.
espisiotomy lacerations (repair intact/not repaired; bleeding or discharge)
c.
hemorrhoids (present/not present)
d.
lochia-check pad for color (ruba, serous, albans), amount (light,
moderate, heavy), odor (fleshy, foul)
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