NURS3608 Family Developmental Stressors Fall 2004
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Note: These Self-Study Modules are designed to help students become familiar with
terminology or interventions unique to maternal-child nursing. Students’ knowledge of this
content will be tested on the last day of clinical preparation (see class schedule). Each student
is expected to carry a copy of the completed pertinent Self-Study Module during their clinical
practicum.
SELF-STUDY MODULE I: Clinical Orientation Guide for ANTEPARTUM/POSTPARTUM
I. REQUIRED ACTIVITIES:
A. Readings:
Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and
childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
B. Audiovisuals:
View VC 780; "Postpartum Assessment";
VC 1076 “Breastfeeding” (Medla)
VC 1001 Importance of Fatherhood
C. Be prepared to perform postpartum physical examination on the first day of your
clinical experience.
II. STUDENT OBJECTIVES: By the completion of this module, the student should be able to:
A. Define the following terms as applicable during the antepartum period:
amniocentesis
nonstress test
amniotic fluid index
oligohydramnios
antibody
parity
antigen
preterm labor
biophysical profile
polyhydramnios
clonus
tocolysis
fundal height
ultrasound
gravida
B. Define the following terms as applicable during the postpartum period:
after pains
lochia
boggy uterus
perineal lacerations
breast engorgement
postpartum blues
colostrum
postpartal chill
CVA tenderness
postpartum depression
diastasis recti
REEDA
episiotomy
uterine involution
Homans’ sign
uterine atony
C. Collect information and demonstrate knowledge of the following medications frequently
prescribed for antepartum/postpartum patients to include specific purpose, actions, usual
dosages, routes, contraindications) and nursing responsibilities:
acetaminophen (Tylenol)
magnesium sulfate (MgSo4) crystals
Dermoplast
magnesium sulfate (MgSo4) intravenous
dibucaine (Nupercainal) ointment meperidine (Demerol)
docusate sodium (Colace)
methylergonovine maleate (Methergine)
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ferrous sulfate or gluconate
promethazine (Phenergan)
hydrocodone/acetaminophen (Lortab) Rh immune globulin (RhoGAM)
hydroxyzine hydrochloride (Vistaril) rubella vaccine
ibuprofen
terbutaline (Breathine)
lanolin
vitamin E
magnesium hydroxide (MOM)
zidovudine (AZT)
D. Identify the significance of the following laboratory work for the antepartum/postpartum patient
(include normal ranges where applicable):
1. Antepartum:
blood typing: ABO and Rh
Papanicolaou smear
Rh antibody screen or titer (indirect Coombs)
red blood cell count (RBC)
glucose tolerance test, or 1 hr glucose loading
rubella antibody test (HAI titer)
gonorrhea/chlamydia/syphilis/HIV tests
urinalysis
Group B streptococcus screen
VDRL/RPR/FTA
hepatitis screen
2. Postpartum:
hemoglobin & hematocrit (H&H)
platelet count
prothrombin time/partial thromboplastin time (PT/PTT)
E. Briefly describe the following commonly seen conditions in patients during the
antepartum/postpartum periods.
1. Antepartum:
multiple pregnancy
gestational diabetes (GDM)
pregnancy induced hypertension (PIH)
preeclampsia /eclampsia
2. Postpartum:
postpartum hemorrhage (PPH)
puerperal infection
mastitis
F. Describe the following specialized skills/teaching in the antepartum/postpartum clinical area.
Be prepared to perform these on the first day of your clinical experience.
1. Calculate estimated date of birth or delivery (EDB or EDD) using Nagele’s rule
2. Measure fundal height
3. Obtaining fetal heart tones (FHTs)/fetal movement count
4. Provision of perineal care
5. Assistance with breastfeeding
6. Teaching regarding postpartum experiences:
parent - infant interaction
self care
breastfeeding
infant care
7. Postpartum Maternal assessment:
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breasts
uterine fundal height & position
abdominal assessment: (diastasis recti, bowel sounds, C/S incision)
CVA Tenderness
perineum for: REEDA, episiotomy, hemorrhoids, lochia, superficial lacerations
reflexes
clonus
Homan's Sign
SELF-STUDY MODULE II: Clinical Orientation Guide for LABOR & DELIVERY
I. REQUIRED ACTIVITIES:
A. Readings:
Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and
childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
B. Audiovisuals:
View VC 655 Fetal Monitoring; VC 1095A & B “Understanding Birth”.
II. STUDENT OBJECTIVES: By the completion of this module, the student should be able to:
A. Differentiate true labor and false labor to include Braxton Hicks contractions.
B. Define the following terms related to uterine contractions:
duration
frequency
intensity
intrauterine pressure catheter (IUPC)
tocotransducer (TOCO)
C. List and briefly define the stages and phases of labor.
D. Collect information and demonstrate knowledge of the following medications frequently used
in labor and delivery to include specific purpose, actions, usual dosages, routes,
contraindications and nursing responsibilities:
butorphanol (Stadol)
misoprostol (Cytotec)
calcium gluconate
morphine sulfate (MSO4)
carboprost (Hemabate)
nalbuphine (Nubain)
ephedrine
naloxone (Narcan)
fentanyl (Sublimaze)
oxytocin (Pitocin)
Lactated Ringer’s (IV fluids)
E. Define the following terms in relation to fetal monitoring.
baseline fetal heart rate range
variable decelerations
variability
late decelerations
bradycardia
internal vs. external fetal monitoring
tachycardia
early decelerations
accelerations
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F. Define the following terms in relation to the intrapartum period:
abruptio placenta
Leopold’s maneuvers
amnioinfusion
vaginal delivery (SVD)
amniotomy/amniohook
placenta previa
Cesarean section (C/S)
uterine atony
G. Discuss the importance of maternal elimination and fluid intake during the intrapartum
period.
H. Define the following terms in relation to progress of labor:
dilation
station
effacement
I. Outline the nursing care for the laboring woman, fetus and family.
J. Identify six comfort measures for the laboring woman and give a rationale for
each.
K. Discuss the nursing care of a laboring woman with epidural/spinal anesthesia.
L. Discuss the care of the laboring woman after the membranes have ruptured.
M. Identify the significance of meconium stained amniotic fluid.
N. Explain in detail how to determine the Apgar score and times it is assigned.
O. Discuss four priority interventions for immediate care of the newborn (first ten
minutes) after birth.
P. Outline the care of a woman experiencing a C/S.
Q. Identify the nurse’s responsibility in the legal documentation for: time of birth and delivery of
placenta, newborn and maternal identification, Apgar score and newborn’s weight.
R. Describe the nursing assessment and care of a patient during the 4th stage of labor.
SELF-STUDY MODULE III: Clinical Orientation Guide for Newborn Nursery
I. REQUIRED ACTIVITIES:
A. Readings and Workbook
1. Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and
childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
2. Smith, S., Duell, D. & Martin, B. C. (2004). Clinical nursing skill: Basic to advanced skills
(6th ed). Upper Saddle River, NJ: Prentice Hall Health.
a. Bathing an infant
b. Newborn physical assessment
c. Infant urine specimen
NURS3608 Family Developmental Stressors Fall 2004
d.
e.
f.
g.
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Using the infant radiant warmer
Suctioning infant with bulb syringe
Using a pediatric oxygen face mask
Using an Oxygen Hood
B. Audiovisuals: Videos:
1. VC 1096 Providing Newborn Care
2. VC 894, Gestational Age Assessment (1991) Purdue University
3. VC 671, Newborn care; VC 258 Bathing the newborn
4. VC 677, Physical Assessment of the Normal Newborn – good review prior NBN assignment
C. Be prepared to perform a gestational age assessment (Ballard) and physical assessment on the
first day of your clinical experience in Newborn Nursery.
II. STUDENT OBJECTIVES: By completion of this module the student should be able to:
A. Define the following terms:
1. The Skin:
a. acrocyanosis
g. vernix caseosa
b. cyanosis
h. Mongolian spots
c. jaundice (pathologic and physiologic) i. lanugo
d. plethoric
j. milia
e. mottle/mottling
k. erythema toxicum
f. petechiae
2. Respiratory:
a. periodic breathing
b. nasal flaring
c. expiratory grunt
d. retractions (intercostal, substernal,
sternal)
e. diaphragmatic respirations
f. surfactant
g. respiratory distress syndrome (RDS)
h. transient tachypnea
i. crackles
j. wheezing/rhonchi
k. xiphoid cartilage
3. Heart:
a. active precordium
b. murmurs
c. ductus arteriosus
d. ductus venosus
e. foramen ovale
4. Genitalia and rectum:
a. hypospadias
b. epispadias
c. hydrocele
d. hymenal/vaginal tag
e. circumcision
f. meconium
g. pseudomenstruation
h. uric acid crystals
i. anal fissures
5. Extremities:
a. polydactyly
b. syndactylism
c. Simian creases
d. brachial plexus injury
e. hip clicks and dislocated hips
f. clubfoot
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6. Head, Neck, Face:
a. molding
f. cleft lip and cleft palate
b. caput succedaneum
g. Epstein's pearls
c. cephalhematoma
h. macroglossia
d. fontanel (anterior, posterior)
i. macrognathia
e. sutures (coronal, lambdoid, sagittal, squamosal)
7. Reflexes:
a. palmar
b. rooting
c. suck
d. Moro
e. walking reflex
f. Babinski
g. plantar
8. Eye:
a. conjunctivitis
b. subconjunctival and retinal hemorrhages
c. tracking
d. red reflex
9. Ears:
a. position
b. tubercles
c. ear tags, pits
10. Thermoregulation
a. nonshivering thermogenesis
b. neutral thermal environment
c. conduction
11. Gestational Assessment
a. AGA
b. SGA
c. LGA
d. LBW
d. convection
e. evaporation
f. radiation
e. VLBW
f. IUGR
g. gestational age assessment tool (Ballard)
B. Know the following common drugs used in the clinical area in terms of the purpose, side
effects, adverse affects, contraindications, and nursing responsibilities:
1. erythromycin ophthalmic ointment
5. ampicillin
2. vitamin K
6. gentamicin
3. triple blue dye
7. hepatitis B immune globulin (HBIG)
4. hepatitis B vaccine
8. oxygen
C. Identify normal laboratory findings in the newborn and relate abnormalities to pathologic
conditions:
1. glucose, dextrostix
5. electrolytes, calcium
2. complete blood count, differential,
6. magnesium level
and reticulocyte count
7. septic work-up
3. bilirubin & Coombs test
8. guiac stool
NURS3608 Family Developmental Stressors Fall 2004
4. RBC antibody screen (direct Coombs
or direct antiglobulin)
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9. C-reactive protein (CRP) (see lab reference)
D. Identify common problems and appropriate interventions with newborns: hypoglycemia,
hypothermia and hyperbilirubinemia
E. Describe common skills performed in the newborn clinical area
1. taking vital signs
2. assessing gestational age using Ballard assessment tool
3. head to toe physical assessment of the NB:
a) obtaining anthropometric measurements
b) assessing the fontanels
c) assessing neonatal reflexes
d) performing Ortolani's maneuver
4. preventing heat loss in a neonate
5. performing routine neonatal care:
a) cleaning scalp and face
g) obtaining a urine specimen from a urine
b) feeding and diapering
collection bag
c) umbilical cord care
h) obtaining chemstrip accu check, dextrostix
d) suctioning with a bulb syringe serum glucose for blood sugar and/or
e) giving an IM injection
hematocrit
f) performing a heel stick
i) rectal temperature
j) administration of eye ointment
SELF-STUDY MODULE IV: Clinical Orientation Guide for Intermediate Care Nursery and
Pediatrics
I. REQUIRED ACTIVITIES:
A. Readings and Workbook
1. Pillitteri, A. (2003). Maternal & child health nursing: Care of the childbearing and
childrearing family (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
2. Smith, S., Duell, D. & Martin, B. C. (2004). Clinical nursing skill: Basic to advanced skills
(6th ed). Upper Saddle River, NJ: Prentice Hall Health
B. Videos:
1. VC 1039 Pediatric Medication: Principles and Calculations
II. STUDENT OBJECTIVES: By completion of this module the student should be able to:
A. Describe oralgastric (OG) tube placement in a newborn.
B. Describe development care for a high-risk newborn or ICN graduate (Pillitteri, 2003, p. 744745)
C. Review documentation of intake and output for neonate and pediatric patients, including blood
out (Pillitteri, 2003, p. 733).
D. Describe concept of playroom in Pediatrics.
E. List signs and symptoms of child abuse.
F. Review stages of psychosocial and cognitive development according to Erikson and Piaget
(Pillitteri, 2003, p. 782-787) and age appropriate nursing implications.
G. Describe family-centered care (Pillitteri, 2003, p. 20-21)
H. List normal ranges for vital signs in pediatrics
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I. Collect information and demonstrate knowledge of the following medications frequently used
in pediatrics to include specific purpose, actions, usual dosages (mg/kg and usual schedule),
routes, contraindications and nursing responsibilities:
acetaminophen suppository
gentamicin sulfate
albuterol
glycerin suppository
allopurinol
methylprednisolone sodium succinate (Solu-Medrol)
aminophylline
metoclopramide hydrochloride (Reglan)
ampicillin
montelukast (Singulair)
caffeine
mupirocin (Bactroban)
cefotaxime sodium (Claforan) phenobarbital
codeine
phenytoin
digoxin
theophylline
fosphenytoin sodium
vancomycin hydrochloride
furosemide
zinc oxide
ABBREVIATIONS frequently found in maternal/child and/or pediatric health records
(Provided for student information only; use of abbreviations in documentation is discouraged
due to errors in communication):
Ab
- Abortion
ALL:
- Allergies, allergic
A.R.O.M.
- Artificial rupture of membrane
B.O.W.
- Bag of water
B.P.D.
- Biparietal diameter
B.P.M.
- Beats per minute
Br
- Breast
B.T.L.
- Bilateral tubal ligation
cm. or cms. - centimeter or centimeters
Contr or UC - Uterine Contraction
C/S
- Cesarean Section
CVA
- Costovertebral angle
Cx
- cervix
D&C
- Dilation and Curettage
D.R.
- Delivery Room
EDB
- Estimated date of birth
EDC
- Estimated date of confinement
EDD
- Estimated date of delivery
EFM
- External Fetal Monitor
E.B.L.
- Estimated blood loss
Eff.
- Effacement
E.F.W.
- Estimated fetal weight
ELF
- Elective low forceps
F.H.R.
- Fetal heart rate
F.H.T.
- Fetal heart tones
F.L.
- Femur length
Grav
- Gravida
ICN
- Intensive Care Nursery
Inc.ab
- Incomplete abortion
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IUFD
IUPC
LBR
L&D
L.G.A.
LMP
MgSO4
Missed ab
Multip
NBN
NSVD
NKDA
Nullip
O.B.
O.R.
Para
PCN
P.I.H.
P.P.T.L.
P.P.
p.p.
PPROM
Primip
PROM
REEDA
ROM
R.R.
SAB
Sta.
SE or FSE
S.G.A.
S.R.O.M.
TAB
TIUP
TOCO
TOP
US
VE
LTV
-
Intrauterine fetal demise
Intrauterine Pressure Catheter
Labor Birthing Room
Labor and Delivery
Large for gestational age
Last menstrual period
Magnesium Sulfate
Missed abortion
Multipara, has borne more than one viable fetus
Newborn nursery
Normal spontaneous delivery
No known drug allergies
Nulliparous, never having borne a child
Obstetrics
Operating Room
Parity
Penicillin
Pregnancy Induced Hypertension
Postpartum tubal ligation
Postpartum
Presenting part
Prolonged preterm rupture of membranes (>24 hrs, <37 wks)
Primipara, has produced one infant
Prolonged rupture of membranes (>24 hrs.)
Redness, ecchymosis, edema, drainage, appearance
Rupture of membranes
Recovery Room
Spontaneous abortion
Station
Scalp Electrode
Small for gestational age
Spontaneous rupture of membranes
Therapeutic abortion
Term intrauterine pregnancy
tocodynamometer
termination of pregnancy
Ultrasound
Vaginal Exam
long-term variability
ABSENT 0-2 BPM
Minimal = 3-5 BPM
Average to moderate = 6-25 BPM
Marked = greater than 25 BPM
STV
- Short Term Variability, Present, Absent
Late decel
- Late deceleration
Early decel - early deceleration
VAR decel
- variable deceleration
Revised by SGW, JW, & VF: 7/04
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