Nursing 3770
Nursing of Women and Newborns
Course and Clinical Syllabus
Winter 2005
FACULTY
Pamela Evans-Smith, MSN, FNP
Course Coordinator
Instructor of Clinical Nursing
S408 School of Nursing Building
573-882-0222 (voice); 573-884-4544 (fax)
E-mail: Evans-SmithP@missouri.edu
Pager 817-3954 (tone numeric)
Anne Heine, RN, MS(N)
Clinical Coordinator
Instructor of Clinical Nursing
S416 School of Nursing Building
573-882-0273 (voice); 573-884-4544 (fax)
E-mail: Heine@missouri.edu
Tonya Eddy, RN, MSN
Clinical Instructor
S450 School of Nursing Building
(573) 882-0252 (voice); 573 884-4544 (fax)
E-mail: EddyT@missouri.edu
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COURSE INFORMATION
COURSE NUMBER: N3770
COURSE TITLE:
Nursing of Women and Newborns
CREDIT HOURS:
5
COURSE DESCRIPTION:
Focuses on newborn care, women's reproductive and post reproductive health, and health deviation concerns
of women and newborns. Emphasizes development, implementation, and evaluation of nursing systems for
families and their members. Prerequisite: N3270, Pharmacology.
RATIONALE:
This 5 credit hour (3 didactic, 2 clinical) course is focused on the nursing care of women and newborns
within a family context. This course assumes prerequisite knowledge of anatomy, physiology,
pharmacology, growth and development, and fundamental nursing skills. Content of this class is directed
toward assisting the student to understand the physiological and psychological adaptations and health
deviations during antepartum, intrapartum, postpartum, and newborn periods. Women's health and health
deviation concerns are also included in the didactic and clinical portions of the course. The student will
utilize the nursing process to assist women, newborns, and their families in meeting their needs. Knowledge
from prerequisite courses is applied to nursing needs of women, newborns, and families. Learning
experiences are structured to provide the students with an opportunity to develop professional nursing
agency. Research, ethical, social, cultural, economic, and legal issues are discussed throughout the course.
COURSE OBJECTIVES:
1.
Integrate knowledge and skills from previous courses to didactic and clinical situations caring for
women, newborns, and families.
2.
Demonstrate proper assessment techniques and beginning clinical judgment skills necessary for safe
care of the antepartum, intrapartum, postpartum, and newborn patient.
3.
Demonstrate a beginning mastery of American Nurses Association (ANA) standards of care which
include assessment, diagnosis, outcome identification, planning, implementation, and evaluation for
nursing care of women and newborns.
4.
Demonstrate effective communication techniques when collaborating with other health care
professionals and in caring for women, newborns, and families.
5.
Demonstrate responsibility and accountability for the development of one’s own personal and
professional role. These activities include, but are not limited to: quality care, performance appraisal,
education, research, and resource utilization. Special emphasis will be placed on collegiality, ethics,
and collaboration with fellow health care professionals.
6.
Analyze personal values as they relate to moral, ethical, political, legal, social, cultural, economic,
alternative lifestyle choices, and management issues that impact professional nursing practice with
women, newborns, and families.
7.
Utilize assessment and teaching skills to promote health in newborns, childbearing families, and
women from menarche through menopause.
8.
Discuss changes in family dynamics, structure, function, roles, and developmental stages including
common family problems associated with pregnancy and birth.
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9.
10.
Set goals to enhance professional development through identification of interests, strengths, and
weaknesses.
Use selected research findings in planning and providing nursing care for women, newborns, and
families.
Revised 12/02 PeS
CLASSROOM/CLINICAL MEETING TIMES:
Classroom meetings: First Block- Monday & Friday 9:00-11:50
Second Block- Monday 1:00-3:50 & Friday 9:00-11:50
Classroom location: S265
Clinical times and locations vary depending on clinical assignment.
Please check the schedule posted on Pamela Evans-Smith’s office door (S408).
METHODS OF INSTRUCTION:
Lecture, class and clinical discussions, audio-visual materials, demonstrations, problem-based cases
MODES OF EVALUATION:
Exams, clinical assignments, clinical performance, class assignments, faculty and self evaluations, pop
quizzes, presentations
MAJOR REFERENCES REQUIRED:
Olds, S.B., London, M.L., Ladewig, P.A., & Davidson, M.R. (2004). Maternal newborn nursing &
Women’s Health Care. (7th ed.). New Jersey: Pearson Prentice Hall.
Olds, S.B., London, M.L., Ladewig, P.A., & Davidson, M.R. (2004). Clinical handbook: Maternal newborn
nursing. (7th ed.). New Jersey: Pearson Prentice Hall.
COURSE AND CLINICAL WEB PAGES:
Additional information for this course is on the web at http://www.missouri.edu/~nurshein. This site has
web links corresponding to class and clinical content. These web pages are:
·
Other Course Information contains General Course Overview, Internet Resources, Student
Feedback, MU Handbook, and Disabilities Resources.
·
Other Clinical Information contains: Other Clinical Experiences, Community Resources and
Exploration, Family Study Option, High School Teaching, Maternity Fair, Resource Moms, Stork=s
Nest, Baby Coupons and Freebies List, Home Visit Option, Hospital Dress Policy, Legislative Letter
Tips, and Web Evaluation
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CLINICAL SUPPLIES:
Required: Stethoscope, pen light, black pen, lab coat, School of Nursing (SON) patch, and one two-pocket
folder for clinical assignments.
Recommended: A clipboard for clinical syllabus and other papers for easy reference during clinical.
Optional: Reflex hammer, small pocket notebook, and a drug reference book.
CONTENT OF COURSE:
·
·
·
·
·
·
·
·
·
·
·
·
·
·
Trends & Issues in Health Care of the Childbearing Family
The Human Reproductive System (review on your own)
Conception and Fetal Development; Genetic Counseling
Healthy Pregnancy; Preparation for Childbirth
Electronic Fetal Monitoring; Assessment of Fetal Well-being
Age-related Considerations in Childbearing; Maternal Nutrition
Normal Labor and Delivery; Pharmacological Pain Relief During Labor and Delivery
The Postpartal Period; High Risk Postpartum
The Normal Newborn
Newborn Nutrition
The High-Risk Newborn: Needs and Care
High Risk Pregnancy: Care of the Mother and Fetus
Complications During the Intrapartal Period: Medical and Nursing Management
Women’s Health Care: Gynecologic and Related Concerns
STUDENT REQUIREMENTS:
1.
Attend all classes and all clinical experiences unless excused. Please be on time. Students who are
unprepared/un-excused for two clinical experiences receive a failing grade for the course.
2.
Come to class and clinicals with preparatory readings and assignments completed.
3.
Meet all assignment and exam deadlines.
4.
Participate fully in class and group activities. Have a positive attitude every day.
5. Demonstrate respectful and professional behavior.
6.
Demonstrate an understanding and appreciation for the ideas and viewpoints of others.
7.
Resolve conflicts/disagreements in an assertive and respectful manner.
8.
Maintain an environment conducive to learning.
9.
Support and nurture peers/colleagues in stressful situations.
10. Complete formal evaluations of yourself, your clinical instructor, and the course.
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MULTICULTURAL GROUND RULES FOR THE COURSE:
We are committed to incorporate multicultural perspectives into the teaching/learning process. The purpose
is to promote understanding of contributions and perspectives of people of differing race, ethnicity, culture,
language, religion, gender, sexual orientation, and physical abilities, and disabilities. We have an obligation
to actively combat the myths and stereotypes so that we can break down walls that prohibit group
cooperation and group gain. We want to create a safe atmosphere for open discussion and will respect the
views of others by:
1.
2.
3.
4.
5.
Acknowledging differences amongst us in skills, interests, values, and experiences.
Striving for tolerance, understanding and respect for all as demonstrated by open minded and
nonjudgmental attitudes and behaviors.
Assuming that people are always doing the best they can, both to learn the material and to behave in
non-racist, non-sexist, and culturally sensitive ways.
Actively pursue opportunities to learn about our own groups and those of others, yet not enter or
invade others’ privacy when unwanted.
Agreeing not to demean, devalue, or put down people for their experiences.
COURSE REQUIREMENTS and GRADING CRITERIA:
To pass N3770, you must successfully achieve all of the following:
· A C average (73%) on combined exam scores
· Satisfactory ratings on your clinical evaluation and clinical assignments
Exams:
•
•
•
•
50 pts.
50 pts.
50 pts.
100 pts.
Exam I
Exam II
Exam III
Final Exam (50% comprehensive)
Case Study – Case studies may be presented to students during class. Questions pertaining to the case study
or assigned reading will follow. This is an in class assignment, the student MUST be in class to participate
and be eligible for the points.
Plan of Care Presentation (5 points)- This is a group project. The students will be assigned groups by the
instructor. Each group will present a plan of care for their assigned patient to the class. The presentation
should last between 10-15 minutes. Overheads may be used but are not required.
Thought Paper (10 points) A 2-3 page paper written on a scenario given by the instructor. This is not a
research paper but rather an evaluation of the student’s own feelings. The paper must take into consideration
the feelings of the parents as well as the how the student would feel as the nurse in the situation. The
grading rubric may be found on Web CT.
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If unable to take an exam on the scheduled date, you must notify the instructor before the scheduled exam
so arrangements can be made to take a make-up exam at the earliest time possible. You may page the
instructor or leave a voice mail message. DO NOT use E-mail as a form of communication for this
particular topic. I do not always check E-mail prior to the start of class. You may be given a different exam.
The instructor reserves the right to administer unannounced quizzes (pop quizzes) or require pages of
workbooks to be submitted if students repeatedly come to class unprepared or do not participate in
discussions.
Clinical Evaluation/Assignments: Pass/Fail determination based on the following:
· Safe practice: Preparation for clinicals, application of knowledge & skills, drug competency.
· Clinical performance: Caring, professionalism, critical thinking, & assignment completion.
GRADING SCALE: See Student Handbook
FACULTY COMMITMENT TO STUDENTS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Encourage student-instructor contact. Let us know when you need help.
Cooperation with students.
Promote active learning.
Give prompt feedback & encourage and respect student feedback.
Communicate high expectations.
Respect diverse talents and ways of learning.
Promote critical thinking and problem solving.
Foster professional role development. (See ANA Nursing Professional Standards).
Facilitate exploration of personal feelings & attitudes encountered during clinical.
Treat students with kindness, empathy, and personal regard.
FACULTY COMMITMENT TO STAFF:
•
•
•
•
•
•
Safeguard the rights of patients.
Orient students to the clinical area.
Keep staff informed of student assignments and changes.
Work with the primary nurse to supervise students' activities and care.
Promote & maintain communication between instructor and staff.
Encourage students to provide high quality care.
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ADA STATEMENT:
If you need accommodations because of a disability, if you have emergency medical information to share
with me, or if you need special arrangements in case the building must be evacuated, please inform me
immediately. Please see me privately after class, or at my office.
Office location:
S408
Office hours: Monday 1:30-2:30 & Wednesday 09:00-11:00
To request academic accommodations (for example, a note taker), students must also register with Disability
Services, AO38 Brady Commons, 882-4696. It is the campus office responsible for reviewing
documentation provided by students requesting academic accommodations, and for accommodations
planning in cooperation with students and instructors, as needed and consistent with course requirements.
Another resource, MU’s Adaptive Computing Technology Center, 884-2828, is available to provide
computing assistance to students with disabilities. For more information about rights of people with
disabilities, please see ada.Missouri.edu or call 884-7278.
ACADEMIC DISHONESTY:
Academic honesty is fundamental to the activities and principles of a university. All members of the
academic community must be confident that each person's work has been responsibly and honorably
acquired, developed, and presented. Any effort to gain an advantage not given to all students is dishonest
whether or not the effort is successful. The academic community regards academic dishonesty as an
extremely serious matter, with serious consequences that range from probation to expulsion. When in doubt
about plagiarism, paraphrasing, quoting, or collaboration, consult the course instructor.
SINCLAIR SCHOOL OF NURSING NONDISCRIMINATION STATEMENT:
Faculty and staff at the Sinclair School of Nursing are committed to cultural diversity and nondiscrimination
toward all people with regards to race, color, religion, national origin, ancestry, gender, age, all veterans,
and sexual orientation.
Approved unanimously at the Dean’s Forum on February 15, 1999
GRIEVANCE PROCEDURE:
Information concerning student grade appeal procedures and non-academic grievances and appeals may be
found in the Student Handbook.
RECOMMENDED JOURNALS:
Examples of good nursing journals in this area of nursing are Journal of Obstetric, Gynecologic, and Neonatal
Nursing (JOGNN), Birth, Maternal Child Nursing Journal (MCN), Journal of Human Lactation, and others.
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Nursing 3770
Nursing of Women and Newborns
Clinical Syllabus
_____
Winter 2005
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
GETTING TO KNOW YOU ASSIGNMENT
Read the N3770 syllabus and the web @ http://www.missouri.edu/~heinea/. Let your clinical instructor know if
you have any comments, questions and/or concerns about the class or clinical.
T
T
Complete a 3x5-index card with the following information: Due 1st clinical day.
P
Your name
Phone #
Your Picture
(I prefer a colored photo if possible)
P
Clinical group
Draw a picture of
something unique about
you (interests, family,
funny thing, whatever) and
write what it is @ the
bottom of the card.
On the back of the index card answer the following questions:
1. Where were you born? Is it different than where you say you are from?
2. What commitments do you have related to work, family, Greek life, or other activities?
3. What other anticipated concerns do you have (e.g. illness)?
4. What facilitates your learning? What inhibits your learning?
5. What do you expect from your instructor?
6. What experiences do you have related to this course?
E-mail: “You’ve got mail!”
Your instructor will use e-mail to communicate important information so check your e-mail the day before clinical
each week.
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
Clinical Assignments Due & Check-Off Sheet
Student Name: _______________________
Clinical Group: _____________
Directions: The following is a description and tips on clinical assignments due. Use this check–off to record your progress.
Assignments Due Code: Complete BEFORE clinical (B), Complete DURING clinical (D), and Complete AFTER clinical (A).
Hospital Clinical Assignments
Week 1: Preparation Work: Complete all the first week (B)
____ Index card completed (p. 9) Due the first day of clinical
____ Have 4 copies made of pp. 19-22, p. 14 (OCE sheet)
____ Booster Cards: NB/PP VS’s & labs
____ Preparation questions (see pp. 25, 28, 34, 38).
Review these on your own to help you in clinical.
____ Medications and labs
Week 1: Audiovisuals: Complete the first week (B)
____ Breastfeeding: Starting out right (HSL & skills lab) 20 mins.
____ Assessment of the newborn (IVD) 1-2 hrs.
____ Managing the labor and delivery experience (IVD) 2-4 hrs.
____ Postpartum Assessment video (HSL & skills lab) 20 mins.
____ Home before you know it video (HSL & skills lab) optional
Week 1: Clinical Orientation & Buddy Day: Due end of 1st wk.
____ Practice completing N3770 Data Collection & Plan of Care.
____ See resources & checkout the Clinical Resource Manual.
____ Review the N3770 web site at www.missouri.edu/~heinea
Comments & Tips:
This helps us get to know you all better.
These are care plan pages. Will use one as practice on week 1.
Index cards to carry with you in clinical to refer to as needed..
Key questions to know. Review your clinical handbook, text,
and clinical resource manual to help answer these questions.
Review common meds and labs to know for all areas.
See these REQUIRED AV’s to help prepare you for the areas
you will be in this semester. They are located in the 3rd floor
skills lab and the Health Science Library (HSL) except IVD’s
are only in the 3rd floor skills lab.
Weeks 2-6: N3770 Patient Assignment Sheet: (B)
Complete N3770 data collection, labs, medications,
physiology/pathophysiology, and plan of care before clinical.
Always gather data about mom and baby when possible.
Get “hands-on” experience with VS’s, assessments, & charting
in as many areas as you can. We will practice preplan, answer
questions, review the N3770 web site and other resources.
Follow the Student Responsibilities for Hospital Pt. Care Days
(p. 17-18). See p. 23 for sample nursing diagnosis. Develop
different diagnoses each week.
Use Patient Assignment Sheet (p. 40) as needed.
Read, summarize, and critique 3 professional nursing journal
articles over the clinical block (____, ____, ____.)
At least one must be a research study. You will present your
research article in conference (p 16).
Weeks 2-6: Weekly Critical Reflective Journal: (A)
Write a reflective journal summarizing your clinical experience
and critically reflect on the top 3 lessons you learned.
Weeks 2-6: Other Assignments and Information:(D)
Labor & Delivery (L&D):
____ Complete Electronic Fetal Monitoring Guide (p. 27)
Include your greatest accomplishment/s, how you made the
most of your clinical day, and how you are going to improve.
Observe and assist with VS’s, assessment, & charting as much
as possible during L&D and recovery. Read pp. 25.
Newborn (NB):
____ Complete the Initial NB assessment guide (pp. 31-32)
____ Do 2 Ballard gestational age assessments (p. 33)
Work together with staff, faculty, & peers to complete initial
assessments, perform Ballards, (see p. 33) and do pt. teaching.
Ballard sheets will be given to you and extras are in the NBN.
Read pp.28-33.
Postpartum (PP):
Remember to include protocols, pt. teaching, support, and
community resource referrals for each clinical. Read pp.34-37.
High-risk Antepartum (AP):
Provide support & learn about high-risk pregnancy condition/s
& its impact. See p.39 for AP assessment guide.
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NICU: Week _______
____ Review high-risk newborn info. in your handbook/text. (B)
____ Turn in completed OCE Evaluation Worksheet (A)
OCE Week: ____
Choose any of the following options or negotiate others with your
clinical instructor. Have your mentor complete p.14 each OCE.
____ Prepare for these by reading your textbook related to the area
you are scheduled for your OCE. (B)
____ Complete an OCE Evaluation Worksheet for each OCE. (D)
____ Write an evaluation on the back of your OCE sheet. (A)
____ Childbirth Class
____ Perinatal Assessment Suite (PAS)
____ Planned Parenthood Clinic (PPC)
____ Community Resource Exploration (CRE)
____ Family Study (FS)
____ Hospital Experiences (HE)
(arrange HE’s in advance with instructor)
____ Other: Let instructor know of other OCE’s you want
____ Total Hours (8 hours of OCE needed during clinical block).
Clinical Presentations: Due during post-conference weeks 3-6
____ Cultural/Diversity Presentation (p. 15)
____ Research Article Presentation (p. 16)
Learn all you can about the conditions & care of high-risk
newborns and the ethical & legal issues these nurses encounter
Choose activities you are most interested in to enhance your
learning. Read pp. 12-13.
Keep track of the time for each experience. You need 8 hours
of OCE’s completed before your last day of clinical.
Sign-up for clinics and childbirth classes, LaLeche League,
and other opportunities on N3770 bulletin board. Make sure
you are not scheduled to be in clinical on those dates.
If you make any changes after these schedules have been faxed,
you have to call the areas and notify them of the changes made.
Call the clinic the day before to make sure there are enough
patients scheduled & that the clinic is still scheduled.
Sign-up for these presentations will be done on week 1.
Choose your favorite research article & present in conference.
Tips for Clinical Assignment Completion:
•
Turn in your clinical assignments in a two-pocket folder each week.
• Put your name and clinical group in the upper right hand corner.
• Inside the folder, write “New” on one side for new work and “Old” on the other side for work already reviewed.
• Folders will be due on Friday or Monday before N3770 class (depending on your clinical group).
• Folders should be turned-in and picked-up in the 3rd floor student mailroom to your instructor’s mailbox.
P
•
P
Preparation, effort, completion of assignments, critical thinking, and professionalism are keys to successful
completion of this clinical.
Attendance:
•
You are expected to attend each clinical assignment prepared and on time. If you are not prepared to provide safe
and competent care (knowing data about your patient, the physiology/pathophysiology of the patient’s condition, the
medications, and the plan of care), you may be asked to leave the clinical area and make-up this clinical time.
•
Clinicals that are missed due to illness or family emergencies will be made up at a mutually agreed upon time between
you and your clinical instructor. You must be fever free for at least 24 hours before you can provide direct patient
care. If you are unable to attend clinical, you MUST notify the agency and your clinical instructor AT LEAST onehour prior to clinical.
Questions, concerns, and/or unsatisfactory progress:
•
Please make an appointment with your instructor to discuss any concerns or unsatisfactory assignments and/or
clinicals as soon as possible.
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SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
OTHER CLINICAL EXPERIENCE (OCE) INFORMATION
When you have an OCE on your clinical schedule, you do not come to the hospital and you will not need to preplan for a particular patient that day. For NICU clinical, you will not have to pre-plan for a particular
patient. You will help the staff with their assessments and learn the care for their patients during these
experiences.
STUDENT ACTIVITIES & ASSIGNMENTS
• Complete 8 hours of OCE’s when you are not scheduled for a hospital experience & during your clinical block.
• Sign-up for classes and clinics on the N3770 Bulletin Board during your first clinical week.
• Prepare for these by reading your textbook related to the area for your OCE before the experience.
• Include what you learned and an evaluation of your OCE activity on the back of the OCE sheet you turn in.
OTHER CLINICAL EXPERIENCE OPTIONS
• Childbirth Education Classes (CBC): 2 hrs/class
• OB/GYN Clinic (APC): Observe advanced practice nurses and other health-care professionals provide care to women
seeking preventative and/or episodic care in outpatient settings.
• Perinatal Assessment Suite (PAS): Observe non-stress tests, ultrasounds, amniocentesis, biophysical profiles & other
tests (depending what is scheduled) & interact with women undergoing these procedures and the staff who provide
their care.
• Planned Parenthood Clinic (PPC): Observe advance practice nurses provide care to women coming for annual exams,
contraception counseling, and care related to diagnosis & treatment of infections. Not recommended for male
students. Experience depends upon if patients will allow students in the room.
• Community Resource Exploration (CRE): Choose any of the Community Resources listed on the web page to visit,
to learn more about, and to share with your clinical group. Attend a La Leche League meeting (females only) Parents
as Teachers meeting, Resource moms meeting, WIC meeting.
• Family Study (FS): Find a patient to follow prenatally, be on call for her L&D, and follow her postpartum. For the
family study, you will need to keep a journal of you experiences & contacts as described above. The time allowed for
this needs to be negotiated with your clinical instructor. Find a pregnant patient in CBC’s, AP clinic, or in the
hospital who will agree to have you be with her for an AP visit and in L&D.
• Hospital Experience: Scheduled time in the hospital needs to be negotiated with your clinical instructor.
DAY OF THE EXPERIENCE EXPECTATIONS
• Dress professionally (NO JEANS!); wear lab coat (except for CBC & CRE) and your name badge.
• Bring your stethoscope, a black pen, and a small notebook.
• Arrive 15 minutes early and introduce yourself to your mentor.
• Provide teaching & support measures as needed and as you feel comfortable doing.
• Explore & critique any written & audiovisual patient education materials available.
• Be sure to have your Other Clinical Experiences Evaluation Worksheet signed by your mentor and give it to your
instructor after the experience along with an evaluation of the experience.
• Remember – you are an invited guest. We expect you to demonstrate high professional standards and behaviors. Be
sure to thank them for their time.
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
Other Clinical Experience (OCE)
IMPORTANT FACILITY PHONE NUMBERS AND LOCATIONS
Below is a list of the phone numbers and locations of the most common OCE opportunities.
Antepartal & Women’s Health Clinic (APC)
Columbia Regional Hospital (CRH) Health Pavilion: 499-6032
404 Keene Street, 3rd Floor of Pavilion (Building connected to Regional Hospital)
Family Health Center: 449-8524
1500 Vandiver Drive, Suite 110 (in New Resource Center area), Columbia, MO
Childbirth Class (CBC):
CRH Childbirth Education Office: Health Pavilion:
3rd floor Health Pavilion
Health Pavilion, 404 Keene Street, (Building attached on to Regional Hospital)
Boone Hospital Center: 815-6667
Maternal Child Health Classroom
1600 East Broadway, Columbia, MO
Hospitals:
Boone Hospital Center: Postpartum: 815-3298; Labor & Delivery: 815-3331
1600 East Broadway, Columbia, MO
Columbia Regional Hospital Family Birth Center: Labor & Delivery: 499-6110;
Postpartum: 499-6140; Newborn Nursery: 499-6165; NICU: 499-6180
404 Keene Street, Columbia, MO
Perinatal Assessment Suite (PAS):
Health Pavilion Perinatal Assessment Suite (PAS): 499-6050
Health Pavilion, 404 Keene Street, (Building attached to Regional Hospital)
Planned Parenthood Clinic (PPC):
If you are unfamiliar with Planned Parenthood or want to learn more about their services check out their
web site at: http://www.plannedparenthood.org/
Planned Parenthood Clinic: 443-0427 (Columbia); 653-2882 (Jefferson City)
711 N. Providence Road, Columbia, MO;
1005 Northeast Drive, Jefferson City, MO
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
OTHER CLINICAL EXPERIENCE EVALUATION WORKSHEET
STUDENT: PLEASE TAKE THIS WITH YOU TO BE COMPLETED BY YOUR MENTOR AND
TURNED IN TO YOUR CLINICAL FACULTY AFTER COMPLETION OF YOUR OCE
AND NICU EXPERIENCES. Make as many copies as you need to have one for each OCE. Write
an evaluation of the experience on the back of this paper and turn it in to your instructor after the
experience (put in your folder).
Dear Mentors,
I would like to take the opportunity to thank you for the time and support you give to the University of Missouri
nursing students. Your experience and expertise is highly valued and a wonderful addition to the MU nursing
program. In helping with the learning process, please fill out the following short evaluation of the nursing student
you have with you today. Again, thank you for your time. If you have any additional comments or questions,
please feel free to write them on this form or contact the clinical faculty directly. You can mail the form back to
the faculty if preferred. Don’t hesitate to contact me if you have any problems, questions or concerns. Sincerely,
Anne Heine, RN, MS(N), Instructor of Clinical Nursing: (573-882-0273) Heine@missouri.edu
Clinical Faculty ______________________
Phone Number __________________
Mentor ______________________
Facility ______________________
Date ______________________
Time ______________________
Student ______________________
Key: S = Satisfactory
U= Unsatisfactory
1)
Maintains professional appearance in both dress and manner.
S___ U___
2)
Demonstrates warmth, care, concern, and respect towards patients.
S___ U___
3)
Comes prepared for clinical experience.
S___ U___
4)
Acts in a courteous and respectful manner.
S___ U___
5)
Demonstrates open-minded and non-judgmental behavior.
S___ U___
6)
Seeks and utilizes guidance from preceptor and/or staff.
S___ U___
7)
Arrives and leaves clinical on time.
S___ U___
8)
Demonstrates self-direction, initiative, and enthusiasm for learning.
S___ U___
9)
Maintains patient confidentiality.
S___ U___
10)
Conduct self in a mature, friendly, and cooperative manner.
S___ U___
Comments:
THANK YOU FOR YOUR TIME AND ASSISTANCE!
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
CULTURAL or DIVERSITY PRESENTATION
Purpose:
To increase your understanding of diversity issues in caring for women and newborns and
how to deliver culturally competent care to persons different than yourself. Diversity issues
include race, ethnicity, culture, language, religion, gender, age, sexual orientation, class,
physical abilities and disabilities....
Assignment:
Learn about cultural differences related to any of the following areas/topics: pregnancy care,
pica, alternative birthing, breastfeeding, male & female circumcision, gay childbearing....
Interview someone about the diversity issue you have chosen.
Or learn about a different culture related to childbearing. Choose one we see in this area Latino, Asian (Korean, Chinese), Muslim, & Amish. Read information about that culture and
interview a person about their cultural practices. The following are some areas to
explore: Birth setting, pain management, paternal involvement, role of the caregivers, use of
technology, routines of care - preparation, length of stay in hospital, activity
recommendations, support..., infant feeding practices, events surrounding childbirth, cost of
that care, personal meaning of the birth experience, differences and similarities between their
first and subsequent births. Did what was written in the literature match your findings about
their cultural practices or beliefs? If not, what is your explanation for the difference?
You can work in groups of 2-3 for this presentation. Each student will need to contribute
at least one high quality professional reference article, web site (not .com), book, or other
resource (not > 5 years old) about the diversity issue or culture you have chosen. Bring a
copy of your sources (at least 1/student) to show your clinical instructor on the day of your
presentation. Prepare a 1-2 page typed handout with key information you learned (can bullet
out) and your references (cited APA) for your group.
Due Date:
You will sign-up for a presentation date during the first week of N160 clinicals. These
presentations will be done during clinical conferences between the 3rd-6th weeks of clinical.
Criteria for a satisfactory presentation: (Plan 10 mins. with 5 mins. more for questions)
•
•
•
•
Relevant with adequate information to understanding how to deliver culturally competent care.
An interesting presentation of your findings. Use visuals, be creative, and make it fun!
A one-two page typed summary of key points including APA citation of your references.
Relevant and reputable sources related to the cultural/diversity issue: At least 1 per student.
Ideas for cultural contacts are:
• The MU International Center: http://international.missouri.edu/about/
• Centro Latino (Eduardo Crespi, RN): http://centrolatino.missouri.org/
• MU Lesbian, Gay, Bisexual, Transgender Resource Center: http://www.missouri.edu/~lgbt/
• Cultural Sites Information: http://www.missouri.edu/~heinea/html/internet_resources.html#Cultural
HT
TH
HT
TH
HT
TH
HT
TH
AH Rev. 06/96, 5/97, 12/00, 6/01, 11/01, 12/04
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
RESEARCH ARTICLE PRESENTATION
Purpose:
To share a nursing research article related to women and newborns. Critical analysis of the article and
application of the findings to nursing practice should be evident in the presentation.
Assignment: Sign-up during the first clinical week for a date to share a research article. Read and critique a research
article related to nursing of women and newborns. The article should be < 5 years old and from a
professional nursing journal (not .com). Type a bulleted handout and include the APA citation of the
article. Bring the article to conference and include the article in your folder. Use the following questions to
help you critique the article and include in your presentation:
•
•
•
•
•
•
•
•
•
What is the research question?
What did you learn from the literature review?
How did they do the study (type of study, sample size, setting, data collection …)?
What were the results?
What did you learn from the discussion?
What are the limitations? Is it generalizable?
What are the implications of the study for clinical practice?
Would you recommend applying these findings to clinical practice and if so, how?
What recommendations do you have for further research or to improve the study?
Due Date: You will present your research article during post-conference on the date you sign up (weeks 3-6).
Criteria for satisfactory presentation: (Plan 5-10 minutes)
• The research is relevant to nursing of women and newborns.
• Information presented is organized, succinct, and visually appealing.
• Relevant and reputable article is selected as described above.
• A critical analysis of the article is evident along with implications for clinical practice.
Suggested Research/Topic Questions:
Sore nipple management, cabbage leaves for engorgement, expressing breastmilk, NB skin care/bathing, pain
control/relief measures (NB circumcision, L&D, PP), PP depression, PP teaching, pericare pain relief measures, kangaroo
care, bed rest for high-risk pregnancy, nursing care for patients with Pregnancy Induced Hypertension (PIH) on MgSO4,
HELLP syndrome, newborn screening (hearing, genetic testing, blood sugar, congenital anomaly appraisal, cord care),
preterm labor treatment, effects of community resources for parents/teens, induction of labor.
Helpful Suggestions:
This is not a teaching presentation. It is a research article review. Be sure to include what the review of the literature was
so students can appreciate what has been found on the topic and why this study is important.
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
Student Responsibilities for Hospital Patient Care Days
PREPLANNING DATA COLLECTION GUIDELINES:
Assignments are posted on the bulletin board located in the break room. Faculty will provide additional
information and guidelines regarding this process during clinical orientation. Dress code for preplanning
includes wearing professional clothes - a lab coat with the School of Nursing patch, your University Hospital ID
badge, and closed toe shoes. DO NOT WEAR JEANS!
Complete your N3770 Patient Assignment Sheet by reviewing and recording pertinent information:
• Patient's Chart: Review the following and record information needed
• Physicians' notes, Multidisciplinary notes and consultations.
• “Face Sheet” for insurance type and religion
• Lab tests, other information.
• Nurses admission form.
• Nurse’s notes - last 24 hours.
• Physician orders - Record specific therapies & times; look up anything unfamiliar.
• Check Medication Administration Record (CMAR) - Record on your Current Medication Sheet
• List and review management protocols (MPs) used for the pt. This will help you in care planning for your
patient.
ADDITIONAL PREPLANNING ACTIVITIES:
• Review Physiology/Pathophysiology/Tests/Procedures Related to Your Patient Situation. Use the
N3770 text and one other relevant article or professional source to help you understand your patient’s
situation and care. Be prepared to discussion what you learned in pre/postconference.
•
Review Laboratory Results. Be prepared to explain why these tests are important, what they mean, and
how abnormal or certain test results impact the patient/fetus and the care you provide. Be prepared to
discuss and explain the implications behind abnormal results in pre/postconference.
•
Complete: Medication Cards/Information. Know why your patient is receiving the medication,
classification, mechanism of action, five main side effects, nursing implications, and patient teaching. You
will need to obtain instructor/PN approval before giving medications.
•
Design your Plan of Care based on data collected and nursing care needed. Review your Clinical Resource
Manual for patient teaching and protocols and list important nursing actions you will implement in
providing care for your patient. Know age appropriate vital signs and assessment techniques. Consider
normal growth and development, cultural factors, family, and social factors influencing care needed. Know
abbreviations, procedures, tests, that were ordered for your patient so you are prepared to perform and
interpret these tests.
•
Identify your strengths and weaknesses related to providing competent, appropriate patient care. Create a
plan to eliminate identified weaknesses and implement the plan prior to clinical.
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SAFETY:
Safety is a major issue in the clinical setting. Preparation for your experience will help you provide safe nursing
care. We expect you to come prepared for clinicals and to ask questions when you need help or reassurance in
providing care for your patient.
PRECONFERENCE:
It is expected that students will arrive on time, be prepared to lead discussion, and answer questions related to
patient care assignments. Come with a sense of what is to be accomplished and with your clinical assignments
completed as directed. If you come to clinical unprepared you may be sent home and will have to make up
the clinical time.
NURSING CARE begins with:
• Checking the CMAR and the chart for any changes since preplanning.
• Attending report.
• Meeting the co-assigned caregiver and reviewing your plans for the day.
• Assessing the patient/s: VS’s pain level, head-to-toe assessment and charting results within one hour
after report. Report to your PN and instructor any abnormalities, questions, and concerns, or if you are
having trouble completing your care/assignment in a timely manner.
NURSING CARE concludes with:
• Completing assigned care including oral care, bath, treatments, teaching, and bed linen change.
• Approval of your charting by faculty and your primary nurse.
Show your chart to them so they can review it directly.
• Reporting off to your primary nurse.
• Be sure to thank your patient for the opportunity to take care of them.
POSTCONFERENCE:
Students will lead postconference discussion. Be prepared to highlight key things you learned, what you didn’t
understand, or problems you had in the clinical setting. This is a time to learn from each other and obtain
support from those who have similar feelings, fears, concerns, and successes. Cultural and research
presentations will be done weeks 3-6. Enjoy and have fun learning together!
L&D DAY OF CLINICAL ACTIVITIES: If a labor patient is available:
• Buddy with a primary nurse (PN) and obtain report on your patient.
• Perform VS, and other skills under your PN's supervision and direction.
• Provide comfort and support measures; assist with breathing, relaxation, pushing PRN.
• Perform Apgar scoring of the infant. Check your results with the Health Care Provider (HCP).
• If time permits, recover your patient after delivery for at least one hour. This should include assessing and
recording VS, fundus, lochia, episiotomy, IV therapy status, bladder, activity, nutrition, and bonding;
intervene as necessary; report abnormalities to your P.N.
• Chart with P.N. direction or practice charting as if you were the P.N.
• Complete the Electronic Fetal Monitoring Guide and check your findings with your nurse.
• Report off to your P.N. before leaving the clinical area. This report should include your assessment,
interventions, and client's response.
If no L&D patient is available, you will be assigned a high-risk pregnant patient or another patient based on availability.
REMEMBER, “Blessed are the flexible, for they shall not be BENT out of shape.”
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Date: _______________
N3770 Patient Assignment Sheet
Student: _________________________
Room: _____ Pt. Initials: ___ Doctor: ________________ Nurse: _____________ Insurance: Y/N
Age: ____ Marital Status: _____ Race: ____ G ____ P ____ [ T ____ P____ A____ L____ ]
Admit Date/Time: _______________ Diagnosis: _____________________________________
LMP: _______ EDC: ________
Gestational Age: ______
Date/Time of Delivery: ________Vaginal: ___ Episiotomy: _____ Lacerations: _____________
C/S (Reason for): ________________________________________EBL: ________ BTL: ____
Sex: _____ Apgars: _________ Weight: ________ Anesthesia/Analgesia in L&D: _________
NBN: ___
Transition: ___
NICU: ___
Breast: ___ Bottle: ___
Labs-Maternal: Blood Type: ____ Antibodies:____ RhoGAM (28-32 wks.):___ MSAFP:_____
CVS/Amino:_____ Rubella:_____ VDRL:_____ HbAbg:____ PAP:____ GBBS:____
1hr glucose:_______ 3hr GTT:_____________________ AP Hct.:_____ PP Hct.: _______
Other: ______________ RhoGAM needed:_______ given:_____
Maternal – Significant History, Complications, Concerns …
Newborn – Complications, Concerns…
Labs-Newborn: 1hr. Hct:_____ 1hr. Chemstrip/Blood Sugar: _____
Blood Type:___ Antibodies:____ Other:
HCP Orders: VS: ______________ Diet: _______
IV’s: ___________________________
PCA/Epidural: ______________________________
SL: ____
I&O: __________ Voids: _________ Foley: __________
Drains: ______
Activity: _______________ IS: ______ TCDB: _________ O2: ___________
Call H.O. for: ________________________________________________________________
Procedures: Accuchecks: _________ 24 hr. urine: ______________ NST: _______
Other:
New HCP Orders:
Medications* & Allergies:
Time Drug, Dose, Route, Frequency
Time
Drug, Dose, Route, Frequency
* Write out & know classification, patient teaching, nursing implication, key side effects and
why your patient is receiving each medication.
Nursing Care:
VS’s:___ Assessment:___ Charting:___ Check New Orders & Progress notes:___
AM care:___ Peri-care:___ Sitz Bath:___ Linen Change:___
Teaching: Self-care:___ Breastfeeding:___ Discharge Instructions: ___ Support: ___
Referrals: WIC:___ Parents as Teachers:___ LaLeche League:___ Resource Moms:___
Parents of Twins: ___ NICU Tour:___ Social Service:___ Home Health:___ Chaplin:___
Other:
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Highlight key data that will
impact your nursing care.
Explain significant lab findings.
Prioritize your plan of care based
on this data.
Physiology/Pathophysiology of the Patient’s Condition
Identify at least 2 topics you don’t know or understand about your patient from the data collected that will impact your
nursing care. These could be related to their diagnosis or condition (postpartum, newborn, need for teaching/support…).
Read your textbook and at least one other professional source (professional nursing journals, UpToDate…) and type,
write legibly, diagram or bullet out the specifics of what you learned and how you will apply this to clinical practice
(2-3 pages). Cite the sources using APA style and reference it in your work. If you use your textbook, include page
numbers used. Turn in any articles you referenced.
Professional Nursing Journal Articles
You will need to read 3 professional nursing journal articles during this block and write a summary, bullet out, or map
out what you learned. If you use a professional nursing journal for the physiology/pathophysiology section, you can
count this toward the 3 articles needed. These articles can be about any topic you are interested in related to this area of
nursing or to your particular patient situation. They can relate to the same or different topics. You will need to complete
at least one article/week until you have satisfactorily completed this requirement. At least one article needs to be a
research study, but you can also use this same research article to share with your group on the day of your research
presentation (see pg. 16 in the syllabus for further information on how to review, summarize, and critique the article).
Turn in the article/s with your summary, cite the sources using APA style, and reference it in your work.
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Plan of Care
Bullet out, diagram, or map the top 3 nursing diagnosis. Include specific nursing actions, teaching, referrals & resources.
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Critical Reflective Journal
Each week, type or write legibly a reflective journal summarizing your clinical experience and critically reflect on the
top 3 lessons you learned personally and/or professionally about yourself. Describe what happened with these lessons
learned. Include your greatest accomplishment, how you most of your clinical, and how you are going to improve.
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Sample Nursing Diagnosis
Below are samples of nursing diagnosis that you may use and/or modify for your patient/s. These are not
exclusive but are meant to give you an idea of common diagnosis used in this area of nursing.
Labor & Delivery:
• Risk of injury to mother and fetus related to labor and delivery process and/or pitocin induction….
• Pain related to labor and delivery process.
• Anxiety related to fear of the unknown and/or new situation in labor and delivery.
• Risk for infection related to procedures, IV, IUPC, frequent Sterile Vaginal Exams (SVE’s)….
• Risk for ineffective coping related to inadequate support systems or unexpected outcome.
Postpartum
• Risk for pain related to perineal edema from birth, episiotomy, afterpains, and generalized discomfort.
• Altered respiratory function related to interthecal spinal anesthesia.
• Knowledge deficit related to inexperience regarding self-care.
• Knowledge deficit related to inexperience regarding breastfeeding or breast pumping.
• Risk for ineffective family coping related to new baby being incorporated into the family unit.
• Risk for ineffective coping related to lack of social support and/or or young age.
• Risk of infection related to C/Section incision, IV, foley…
• Activity intolerance related to anemia and/or excessive blood loss from L&D.
• Risk for infection related to lacerations.
• Risk for nipple soreness related to breastfeeding.
• Risk for postpartum depression related to history of depression or postpartum complications.
• Risk for ineffective coping related to infant’s condition (jaundice, illness, prematurity).
• Fatigue related to L&D process, anemia, and/or frequent interruptions of rest for newborn care.
• Interrupted/ineffective breastfeeding related to maternal-infant separation NICU or nipple problems.
Newborn:
• Risk of injury related to adaptation to extrauterine life.
• Risk of inadequate nutrition related to breastfeeding or bottle-feeding.
• Risk of pain related to procedures (circumcision, blood drawing, NG insertion…).
• Risk of inadequate nutrition related to sleepy baby, breastfeeding problems…
• Risk of hypothermia related to SGA status and/or inability to maintain temperature.
• Knowledge deficit related to inexperience regarding newborn care.
• Risk for ineffective family adaptation related to new baby being incorporated into the family unit.
• Risk of hypoglycemia related to LGA status and/or low blood sugar.
• Risk of hazards related to newborn status (SIDS, car safety, immunizations, normal G&D).
• Risk of sepsis related to mom’s beta strep positive status.
High-risk Pregnancy:
• Anxiety related to high-risk pregnancy.
• Risk of hazards of immobility related to activity restrictions imposed due to high-risk pregnancy.
• Risk for maternal/fetal injury related to high-risk pregnancy.
• Potential ineffective coping related to high-risk pregnancy.
• Risk for ineffective family coping related to high-risk pregnancy.
• Knowledge deficit related to high-risk pregnancy condition and self-care strategies
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Labor & Delivery Preparation Questions
Below are questions to help you focus your preparation on how to assess and provide care for the laboring
patient. Review your clinical handbook and text to answer these questions. You can highlight information in
your clinical handbook/text or write out the information.
1.
Describe the stages and phases of labor (1st [latent, active, transition], 2nd, 3rd, 4th, and key nursing
care for each stage.
2.
Describe the maternal systemic response to labor (CV system, BP, respiratory, renal, GI, and
immune system).
3.
Describe the fetal heart rate assessment: Baseline, variability, accelerations, and the 3 most common
decelerations [early, variable, late], what they mean, and the nursing care to implement when these
occur.
4.
Describe the uterine assessment (frequency, duration, intensity, resting tone), what is normal, and
what to do if problems occur (hyperstimulation).
5.
Describe non-pharmacological comfort measures used to help the patient cope with labor and
delivery.
6.
What effect does a full bladder have on labor progress and what care should be implemented?
7.
What is the nursing care for a patient who presents with possible rupture of membranes?
8.
What is the most common side effect of epidural, why does it occur, and what is the nursing care before,
during, and after initiation of an epidural?
9.
What effect does positioning have on the labor progress and fetal well-being?
10.
Describe the nursing care for a patient receiving Pitocin to induce or augment labor.
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Labor and Delivery Assessment & Nursing Intervention Guide
Use the following guide and demonstrate satisfactory performance and charting of this information.
Labor & Delivery Assessment
Nursing Interventions
Vital Signs & Pain Assessment
IV Therapy Assessment & Interventions:
Fluid/rate/time
Site appearance
Epidural infusion
Saline lock/IVPB
IV bolus
Fetal Assessment:
External/Fetal Scalp Electrode
Baseline
Variability: Short-term/Long-term
Accelerations
Decelerations: Early, Variable, Late
Uterine Assessment:
External (Toco)
Intrauterine Pressure Catheter (IUPC)
Contraction:
Frequency/Duration/Intensity/Resting tone
Montevideo units (MVU=s)
Maternal Assessment:
Sterile Vaginal Exam:
Dilation/Effacement/Station
Amniotic fluid (color, amount, odor)
Heart sounds: Rate, rhythm, murmurs
Lung sounds
Bowel sounds
Elimination: Bowel & bladder assessment
Safety Interventions:
Call light near/bed height low
Seizure precautions
Position changes
O2 nearby
Epidural precautions
Teaching & Support Measures:
Anticipatory guidance, explaining options,
words of encouragement & support....
Comfort Measures:
Ice chips, cool cloth, positioning,
rocking chair, back rubs, foot message
medications...
Epidural Assessment/Monitoring
Relaxation Measures:
Breathing (deep cleansing breath), music,
shower, efflurage, focal point
Extremities: Reflexes/Clonus/Homan=s
Edema/Capillary refill/Skin color
Emotional:
Level of conscientiousness
Psychosocial adaptation
Support system: Supportive other contacts
Requests:
Feeding preference after delivery?
Knowledge & skills with breastfeeding?
Other requests
Nursing Diagnosis:
Reassuring/Non-reassuring
Maternal Status: Stable/Unstable
Activity Assessment:
Type/toleration/turning frequently q 2 hrs.
Diet: Intake & Output Assessment
Type/amount/toleration
Accuchecks
Hygiene:
Skin care/keeping clean & dry
Linen changes
Referrals:
Social Service
NICU
Chaplin
Other
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Electronic Fetal Monitoring (EFM) Guide
Complete this information DURING your labor and delivery experience and turn it in. Define any terms
you don’t know prior to completing this assignment. Ask your instructor or nurse to check over your
findings as compared to the monitor strip you interpreted and comment on your findings below.
EFM NURSING PROCESS CARD
Student Name:_______________________
BASELINE DATA: Date/Time_________________________
Maternal HX: EDC__________ G__________ P__________ Age__________
Maternal VS: T__________ P__________ R__________ BP__________
Cervix: Dilatation____________ Effacement____________ Station____________
Membranes: Intact______ AROM(time)______ SROM(time)______ Color______
Fetal Presenting Part: _____ Medications (type, dose, route, time):_________________
ASSESSMENT:
Contractions:
Monitor(TOCO)_______
Frequency_______
Duration_______
Intensity_______
Fetal Heart Rate:
Monitor(US)_______
(FSE)_______
Baseline_______
Variability_______
Periodic changes: Early decels_______
Late decels________
Variable decels_________
(IUPC)_______
Accelerations___________
NURSING DIAGNOSIS: Reassuring__________ Reassuring with Follow-up_______
Nonreassuring_______
NURSING PLAN:
Position change: Lateral______ Trendelenburg______ Knee chest____
Semi-fowlers_______ Oxygen by face mask _______ Hydrate/fluid bolus_______
DC or decrease oxytocin_______________ Call for consult___________ with RN/MD
Continue observation_____________________ Other_____________________
EVALUATION:
INSTRUCTOR or NURSE COMMENTS:
FIGURE 1. Electronic Fetal Monitoring Process Card. Used with permission from Mahley & Witt.
Mahley, S., Witt, J., & Beckman, C.A. (1999). Teaching nursing students to critically evaluate electronic fetal
monitoring tacings. JOGNN, 28(3), 237-240.
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Newborn Preparation Questions
Below are questions to help you focus your preparation on how to assess and provide care for the
newborn patient. Review your clinical handbook and text to answer these questions. You can
highlight information in your clinical handbook/text or write it out.
1.
2.
Describe the physiological changes that occur in the newborn period. Use the newborn
assessment guide to describe the normal findings that occur immediately after delivery, what
causes these changes, and what to expect over the next few weeks.
Briefly (use key words) define the following terms used in the newborn assessment: (You need to
know these to do your Initial Newborn Assessment Guide pp. 33-34)
Plethoric
Jaundiced
Cyanosis
Acrocyanosis
Desquamated
Vernix
Lanugo
Milia
Mongolian spot
Erythema toxicum
Ecchymosis
Petechiae
Nevi
Caput succedaneum
Cephalhematoma
Subconjunctival hemorrhage
Candida albicans
Epstein’s pearls
Point of Maximal Impulse (PMI)
Pilonidal dimple
Hymenal tag
Simian crease
Metatarsus varus
3. How is bilirubin excreted, what causes hyperbilirubinemia, what are the risk factors for developing
it, and what helps decrease the incidence of it’s occurrence?
4.
What are the signs and symptoms of newborn problems to teach the parents to report to their HCP?
5.
Discuss the safety measures related to newborn care to teach the parents to implement.
6.
Discuss what to teach parents about newborn behavioral capabilities, the sleep/wake cycles, and
how to comfort a crying baby?
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N3770 Nursing of Women and Newborns
Newborn Policies and Guidelines
I.
Universal Precautions and Handwashing:
A. Do 3 minute hand-to-elbow scrub, remove rings. Wash hands before touching another baby.
B. WEAR GLOVES WHEN COMING INTO CONTACT WITH ANY BODY SECRETIONS, IF TOUCHING NON-INTACT
SKIN, OR CHANGING DIAPERS.
C. Review and use UNIVERSAL PRECAUTIONS with all patients.
D. For your own protection, report any injury or break in technique.
E. Nursing students must not be alone in the NBN with a baby unless there is a Nurse or Physician present.
II.
Nursing Care "Routines"
A. Vital signs and Pain Assessment
1. Take and record TPR (q shift: 0800, 1600, 2400); (q 4 hr: 0400, 0800, 1200, 1600 ...)
2. Assess alterations as indicated by primary nurse.
B. Assessments
1. REPORT TO PN & INSTRUCTOR: Any deviation from normal assessment and/or vital signs.
2. Follow the baseline assessment standard at your clinical site.
C. Hygiene
1. Check with primary nurse to see if baby needs a bath. Do cord care, clean shirt, diaper change (if needed) and bed
change (if needed) at beginning of each shift and prn.
D. Feeding
1. Infants fed on demand (never let baby go without eating for more than 5 hours).
2. Assist breastfeeding mothers, or ask instructor or primary nurse to assist as needed.
3. Record time of feeding, number of minutes baby nursed on each breast, and how well baby nursed.
4. Assist bottle feeding mothers, or ask instructor or primary nurse to assist as needed.
5. Record time of feeding, volume, and brand of formula consumed, and how well baby ate.
E.
Elimination
1. Assess urine output, frequency, and color.
2. Assess patent anus, bowel sounds, stool status
F.
Medications
1. Before you give any medication, be sure you have looked up info for usual dosage, action, contraindications, common
side effects to watch for, nursing considerations - NO IV meds
2. Check 6 R's with instructor before giving meds: Right medication, dose, route of administration, patient, time, and
technique.
G. Chart your assessments and interventions.
1. The University uses flow charts and charting by exception. Be sure to chart within one hour after report is over VS’s and
assessment. Include when the baby leaves & returns to the NBN.
2. Ask your clinical instructor to assist you with late entries or error corrections.
3. Boone Hospital Center uses Focus Charting. Your clinical instructor MUST cosign each entry.
4. Always use a pen with black ink for charting.
5. Primary nurse or clinical instructor must review all charting.
6. Information must be entered onto chart according to agency policy and procedure.
7. Remember the chart is the patient's legal record. If you have questions or corrections, be sure to ask your clinical
instructor for assistance.
H. Transporting babies to and from the nursery.
1. IF you have done a 3 minute scrub, you may transport the baby in the crib (don't carry). BE SURE to check baby bands
on mom and baby to see that they match.
I.
Visiting policies: Review Postpartum Policies and Guidelines
J.
Discharge (Assist primary nurse and nursery staff with discharge instructions and procedures)
1. Staff will sign mothers and baby's ID record. STUDENT NURSE MAY NOT DO THIS.
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Newborn Assessment & Nursing Intervention Guide
Use the following guide and demonstrate satisfactory performance and charting of this information.
Newborn Assessment
Nursing Interventions
Observe:
Environment
Activity Level
Behavioral State (sleep/wake)
Skin (color, condition, temp.)
Head (eyes, ears, nose, mouth)
Respiratory rate/effort
Safety Interventions:
Take and Record:
Vital Signs & Pain Assessment
R____A____T____BP____
Auscultate:
Heart Sounds:
(rate, rhythm, murmurs)
Lungs Sounds:
(clear/congested/equal bilaterally)
Bowel Sounds
(+/ -/ / )
Observe/Palpate:
Fontanels: Condition
(soft/flat/sutures)
Abdomen (soft/flat/distended)
Cord Site (moist/dry/bleeding)
Genitals (hymenal tag/
orifice/rugae/ testicles)
Circ. Site (bleeding/healing)
Muscle Tone (normal well-flexed)
Movement (spontaneous/active/
stimulated/lethargic/jittery)
Elicit Newborn Reflexes:
ID band legible/checked
Supervised in NBN/Mom's room
Universal Precautions used
Positioned on back
Cord care with ETOH TID & prn
Circ. care as prescribed
Skin care protocol implemented
Hygiene:
AM/PM care per protocol/ lotion bath
Diaper care after elimination
Activity:
Note when taken to & from NBN
Bonding/interaction support
Nutrition:
Type & amount of feeding
Toleration of feeding
Feeding techniques used
Elimination:
Type & amount of stool
Color & amount of urine
Teaching:
Infant Care
Videos/Class
Materials given
______Rooting______Startle (Moro)
______Sucking______Stepping
______Palmar ______Tonic Neck
______Plantar
Support Measures Implemented/Needed
Describe:
Social Service/PHN/VNA
Parents as Teachers 886-2204
La Leche League
Parent Stress Helpline 1-800-367-2543
Parentlink Connection 1-800-552-8522
Parents of Twins Club
TEL-LINK 1-800-835-5465
WIC 874-7384
Resource Moms
Others
Bonding Behaviors
Nutrition (feed time/amount taken
toleration/emesis/spitting-up)
Elimination (urine & stool)
(color/amount/type)
Teaching Needs
Support System Assessment
Gestational Age (Ballard)
Referrals Implemented/Needed:
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N3770: Initial Newborn Assessment Guide
Student Name: ______________________ Today's Date: _____________
Baby's Initials: ___________
Baby's Birthdate & time: _____________________________
Instructions: Know terms below. Check observed items. Note description, location, & other findings. Successfully complete this
Assessment Guide & 2 Ballard exams DURING clinical. Work together to gather this data and help each other. This will increase your
exposure to normal newborn findings and variations. Enjoy!
Physical Assessment
Birthweight: _______________
Color:
pink
pale
plethoric
jaundiced
cutis marmorata
acrocyanosis
cyanosis:
nailbeds
circumoral
general
Respirations:
non-labored
nasal flaring
grunting
abdominal
shallow
retracting
rate: _____
rhythm: _____
breath sounds:
bilateral
diminished
Today's weight: __________
Birth length: ___________
Skin:
clear
dry
desquamated
vernix
lanugo
milia
skin tags
mongolian spot
rash
pressure marks
erythema toxicum
ecchymosis
petechiae
nevi
forceps marks
temperature: _____
Head:
symmetrical
molding
caput succedaneum
cephalohematoma
hair
fontanels:flat
sunken
bulging
sutures: approximated
separated
overlapping
circumference: _____
Eyes:
Neck:
freely movable
masses
Chest:
symmetrical
clavicles intact
circumference: _____ (size)
Heart:
PMI location: _____
rate: _____
rhythm: _____
(breath sounds)
Abdomen:
symmetrical
cord status: _____
femoral pulses bilateral
diminished
Trunk:
pilonidal dimple
tufts of hair
straight spinal column
patent anus
sclera white
jaundiced
subconjunctival hemorrhage
chemical conjunctivitis
PERRLA red reflex
follow object distance _____
Ears:
symmetrical
aligned with eyes
low set
responds to sound
Mouth:
mucous membranes pink
pale
cyanotic
candida albicans
hard palate intact
clefts
Epstein's pearls
soft palate intact
clefts
lips symmetrical
drooping
clefts
sucking callous
Nose:
Symmetrical, patent nares
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Genitals:
Female
Extremities:
Upper symmetrical
spontaneous movement
stimulated movement
simian crease
# digits _____
Lower symmetrical
spontaneous movement
stimulated movement
metatarsus varus 7 or L)
symmetrical gluteal creases
# digits _____
vaginal opening
hymenal tag
pseudomenstruation
Male:
location of urethral orifice _____
scrotum pendulous
rugated
testes palpable
circumcision
Neurological Assessment
Check Reflexes if Observed:
_____ Moro
_____ Swallowing
_____ Babinski
_____ Plantar Grasp
_____ Rooting
_____ Yawning
_____ Blinking
_____ Other (list):
_____Sucking
_____Sneezing
_____Palmar Grasp
Gestational Age Assessment
(Ballard Form)
Time of last feeding: _____
Infant State During Assessment (circle one):
deep sleep
light sleep
drowsy quiet alert
active alert
crying
Gestational age on chart: _____
Gestational age, based on your assessment: _____ Circle your findings: AGA
LGA
SGA
Gestational Age Interpretation (Ballard)
• Complete both sides of the Ballard exam. You should be within 2 weeks of the chart’s results.
• If not, repeat on another infant and compare your results.
Below are some of the main causes and common complications of both SGA and LGA babies.
•
SGA causes:
1. Drugs, alcohol, smoking
2. Pregnancy Induced Hypertension
3. Infections & malnutrition
SGA complications:
1. Hypoglycemia, hypocalcemia, polycythemia
2. Neonatal asphyxia, meconium aspiration
3. Infection
•
LGA causes:
1. Gestational Diabetes
2. Heredity – constitutional large
3. Excessive maternal wt. gain
LGA complications:
1. Hypoglycemia, polycythemia, hyperbilirubinemia
2. Birth trauma, broken clavicle, forcept use or C/S delivery
3. Meconium aspiration, respiratory distress
If your baby was LGA or SGA, circle the contributing factors and potential complications above that were
present in your baby’s situation or if not listed, describe below?
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BALLARD ASSESSMENT INFORMATION
Complete two Ballard exams. You should be within 2 weeks of the chart’s results. If not, repeat on
another infant and compare your results. Do as many Ballards as you can to improve your skills. Work
together to increase your exposure to infants of different gestational ages and sizes. Fun to do activity!
The following information will be helpful in completing your Ballard gestational age assessment. For
further instructions in completing the Ballard, see guidelines in the newborn nursery (NBN). These are
located in an area labeled AMU nursing students@. The Ballard forms will be given to you in clinical.
Extra forms are available in the NBN or from your instructor.
SOME NOTES ON TECHNIQUES OF ASSESSMENT OF NEUROLOGIC CRITERIA
POSTURE: Observed with infant quiet and in supine position. Score 0: arms and legs extended; 1:
beginning of flexion of hips and knees, arms extended; 2: stronger flexion of legs, arms extended; 3:
arms slightly flexed, legs flexed and abducted; 4: full flexion of arms and legs.
SQUARE WINDOW: The hand is flexed on the forearm between the thumb and index finger of the
examiner. Enough pressure is applied to get as full a flexion as possible, and the angle between the
hypothenar eminence and the ventral aspect of the forearm is measured and graded according to
diagram. (Care is taken not to rotate the infant's wrist while doing this maneuver.)
ARM RECOIL: With the infant in the supine position, the forearms are flexed for 5 seconds, then fully
extended by pulling on the hands and then released. The sign is fully positive if the arms return briskly
to full flexion (score 2). If the arms return to incomplete flexion or the response is sluggish, it is graded
as score 1. If they remain extended or are only followed by random movements the score is 0.
POPLITEAL ANGLE: With the infant supine and his pelvis flat on the examining the thigh is held in
the knee-chest position by the examiner's left index finger and thumb supporting the knee. The leg is
then extended by gentle pressure from the examiner's right index finger behind the ankle, and popliteal
angle is measured.
SCARF SIGN: With the baby supine, take the infant's hand and try to put it around the neck and as far
posteriorly as possible around the opposite shoulder. Assist this maneuver by lifting the elbow across
the body. See how far the elbow will go across and grade according to illustrations. Score 0: elbow
reaches axillary line; elbow between midline and opposite axillary line; 2: elbow reaches midline; 3:
elbow will not reach midline.
HEEL TO EAR MANEUVER: With the baby supine, draw the baby's foot as near to the head as it
will go without forcing it. Observe the distance between the foot and the head as well as the degree of
extension at the knee. Grade according to the diagram. Note that the knee is left free and may draw
down alongside the abdomen.
There is also a book by Mead Johnson AVariations and Minor Departures in Infants@ that is helpful in
seeing pictures of common findings and variations and is in the NBN.
Reference: Dubowitz, L. M. S. & Dubowitz, V. (1977). Gestational Age of the Newborn. Reading, MA: Addison-Wesley Publishing Company.
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Postpartum Preparation Questions
Below are questions to help you focus your preparation on how to assess and provide care for
the postpartum patient. Review your clinical handbook and text to answer these questions.
You can highlight information in your clinical handbook/text or write out the information.
1.
What is the most common complication immediately after delivery and the nursing care to
implement?
2.
Describe the physiological changes that occur in the postpartum period & involution. Use
the BUBBLE - HE assessment guide to describe the normal findings that occur
immediately after delivery, what causes these changes, and what to expect over the next 6
weeks.
3.
What is the nursing care to help alleviate the following postpartal discomforts and the rationale
behind these recommended strategies/care? (episiotomy/laceration pain, hemorrhoidal pain,
incisional pain, afterpains, gas pains, and nipple soreness/pain)?
4.
Discuss the differences in nursing care for a cesarean delivery versus a vaginal delivery patient?
5.
What are the warning signs and symptoms to teach the postpartum patient to report and the self
care strategies to help promote optimal healing and recovery/adaptation?
6.
Describe the differences between a 1st, 2nd, 3rd, and 4th degree laceration and the nursing care to
promote optimal recovery.
7.
Discuss the differences in teaching breast care to a breastfeeding verses a bottlefeeding patient.
8.
What is RhoGAM, who is eligible to receive it, what is the nursing care for administering it, and
what does it help prevent?
9.
What is the nursing care to promote parental role adaptation and facilitate bonding?
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UNIVERSITY OF MISSOURI-COLUMBIA
SINCLAIR SCHOOL OF NURSING
N3770 Nursing of Women and Newborns
Postpartum Policies and Guidelines
I.
Universal Precautions and Handwashing:
A. Wash hands prn as learned in N110, especially before caring for each pt. and between pts.
B. WEAR GLOVES WHEN COMING INTO CONTACT WITH ANY BODY SECRETIONS, IF TOUCHING
NON-INTACT SKIN, OR DEALING WITH VARIOUS TUBING, DRAINS.
C. Review and use UNIVERSAL PRECAUTIONS with all patients.
D. Follow specified isolation procedures as ordered - consult with primary nurse and instructor.
E. For your own protection, report any injury or break in technique.
II.
Nursing Care "Routines" Postpartum at University Hospitals (these are similar but not exactly the same for Boone
Hospital Center - consult with your BHC clinical instructor)
A.
Vital signs & Pain Assessment
1. TPR, BP (Routine: 0800, 1600, 2400); (q 4 hr: 0400, 0800, 1200, 1600, 2000, 2400)
2. Assess elevations as indicated by primary nurse.
.
3. Record VS’s and pain/sedation level.
B.
Assessments
REPORT TO PRIMARY NURSE (PN) & INSTRUCTOR: Temp > 38C, severe pain, urine output <
30 cc/hr, heavy vaginal discharge and/or any other abnormal findings or concerns.
1. Vaginal deliveries ((BUBBLE-HE or whatever method you choose). Do: V/S, Breast (engorgement,
nipples-cracks, soreness), Uterus/fundus (firmness and location), Lochia (amount, type, odor, clots),
Bladder (volume, burning or itching, difficulty voiding), Bowel (abd. distention, flatus, BM),
Episiotomy (REEDA), perineum (general healing and hemorrhoids), Homan's sign, leg/ankle edema,
bonding/emotional status, nutrition/diet status, pain status, activity toleration, and learning needs.
2. Cesarean deliveries (same as vaginal PLUS lung sounds, bowel sounds, incision (REEDA), IV site
and fluid rate, and volume, I&O, skin color, movement.
3. GYN surgery patients: lung sounds, bowel sounds, incision status, vaginal discharge, Homan's sign,
skin color, pain status, elimination status, IV status.
C.
Food and fluids
1. Breakfast 0745 to 0830; lunch 1200 to 1230; dinner 1700 to 1800. Diabetic snacks delivered at 930, 1430,
2030 - be sure you get them to the patient.
2. Record portions eaten or NPO status.
D.
Hygiene
1. Baths/Showers
a. Uncomplicated delivery--shower daily.
b. C-delivery/GYN-daily shower after dressing is removed (cover IV with plastic wrap).
2. Sitz baths--TID and prn for episiotomy, lacerations, hemorrhoids.
E.
Breast Care
1. Assess breast 1 x per shift and prn. Teach BSE as indicated.
2. All postpartum mothers wear supportive bras or breast binders.
3. Nursing mothers rub expressed milk (or ointment if ordered) on nipple/areola after each feeding & air-dry.
4. Ice bags are used to relieve discomfort if lactation being suppressed; warm packs to promote lactation.
5. Tea bags are used for sore nipples and cool compresses may be used to relieve engorgement.
6. Teach bottlefeeding mothers to avoid all nipple and breast stimulation until engorgement resolves.
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F.
Perineal care
1. Water bottle: should use clean warm water to rinse perineum after each voiding, stool, & prn.
2. Teach patient to wipe from front to back
3. Encourage patient to change peri-pads at each voiding or at least frequently.
G.
Elimination
1. Assess urine output, frequency, UTI symptoms, bladder distention, and foley status
2. Assess bowel sounds, bowel status, passing gas, last BM, any lacerations?, meds needed?
3. Evaluate intake with regard to output (I&O)
4. Post delivery assess for bladder distention. Assess adequacy of the first two voidings, and then assess prn.
H.
Assess Uterus and Lochia.
1. Immediately after delivery, assess fundus, perineum, and peripad q 15 min. x 4, qh x 4, then q 4h x 2, then
q 8.
2. Assess fundal height position and consistency before and after voiding until routine VS.
I.
Medications
1. Before you give a medication, be sure you have looked up info. for usual dosage, action, contraindications,
common side effects to watch for, nursing considerations
2. Check 6 R's with instructor before giving meds: Right medication, dose, route of administration, patient,
time, and technique.
3. IV meds - give only with instructor or with primary RN.
J.
Chart your assessments and interventions.
1. Try to chart AT THE TIME you perform the assessment or intervention and within one hour after report.
University uses flow charts and charting by exception but you must chart your assessment and any
deviations from normal. Ask your clinical instructor to assist you as needed.
2. Boone Hospital Center uses Focus Charting. Your clinical instructor MUST cosign each entry.
3. MUST use pen with black ink
4. Either your primary nurse or clinical instructor must review all charting.
5. Information must be entered onto chart according to agency policy and procedure.
6. Remember the chart is the patient's legal record. If you have questions or corrections, be sure to ask your
clinical instructor for assistance.
K.
Transporting babies to and from the nursery.
1. IF you have done a 3 minute scrub, you may transport the baby in the crib (don't carry).
BE SURE to check baby bands on mom and baby to see that they match.
2. You may ask nursery staff to transport the baby.
L.
Visiting policies
Anyone can visit who is not sick. Siblings should be free of communicable diseases and up-to-date on their
immunizations. If questions, ask.
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Postpartum Assessment & Nursing Intervention Guide
Use the following guide and demonstrate satisfactory performance and charting of this information.
Postpartum Assessment: ("BUBBLE-HE)
Vital Signs & Pain Assessment:
T_____P_____R_____BP_____
Dizzy with ambulation? ___Yes ___No
Heart Sounds:
Rate Regular/Irregular/ Murmur
Breath Sounds:
Clear/Rales/Rhonchi/Congestion
Cough Productive/Non-productive
IS/ TCDB/ Self-Initiated/ T.V._______
Breasts:
Soft/Non-tender/Filling/Engorged/Lumps
Nipples: Clean/Cracked/Tender/Non-tender
Blisters/Bruised/Bleeding
Bra On/off/ Position Change/Airdry
Warm Packs/ Tea Bags/ Pumping/Feeding
Uterus:
Firm/ Boggy
Midline/ Level_______
Bladder:
Dysuria/ Urgency/ Frequency
Burning/ Painful/ No Problems
Foley: Color/ Amount/DD
Bowel:
Abdomen: Soft/Firm/Distended
Bowel Sounds: +/ -/ /
Flatus: Present/Absent
BM Date_____Soft/ Hard
Stool softener/Laxative needed
Lochia:
Rubra/ Serosa/ Alba
Scant/Moderate/ Heavy
Odor/ Clots/ Peri-care
Episiotomy/Incision: ("REEDA")
Clean/ Dry/ Dressing On
Redness/ Edema/ Ecchymosis
Drainage/ Approximation
Ice Packs/Sitz/Tucks/Spray/Ointment
Homans' Sign:
Positive/ Negative
Emotional Status:
Rooming-in/ Supportive others
Parenting:
Bonding Behaviors/Sibling visit
Nursing Interventions
IV Therapy Assessment:
Fluid/Rate/Time
Site Appearance
PCA Infusion
Saline Lock
IVPB
Safety Interventions:
Call Light Near
Bed Height Low
Other Interventions
Seizure Precautions
Activity Assessment:
Type
Toleration
Turn/Freq.
Leg Exercises
Hygiene:
Bath/Shower
Oral Care
Skin Care
Diet:
Type
Amount
Toleration
Accuchecks
Teaching:
Self-Care
Videos/Class
Materials
Infant-Care
Videos/Class
Materials
Support Measures:
Referrals:
Social Service/PHN/VNA
Parents as Teachers
Resource Moms
La Leche
Parent Stress Helpline
Others
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Antepartum Preparation Questions
Below are questions to help you focus your preparation on how to assess and provide
care for the antepartal patient. Review your clinical handbook and text to answer these
questions. You can highlight information in your clinical handbook/text or write it out.
1.
Describe what the following tests are and why they are performed:
Non-stress test: What is a reactive, non-reactive, and unsatisfactory test?
Biophysical profile:
Ultrasound:
Fetal Kick Counts (FKC’s):
2.
List patient education topics to be taught during the trimester your patient is experiencing.
3.
Describe the discomforts of pregnancy during the trimester your patient is experiencing and
the self-care measures to help them cope.
4.
Explain the nursing care needed for patients related to their high-risk
situation/condition? What are the hazards of bed rest and what is the nursing care
needed to decrease the risk of these complications occurring?
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Antepartal Clinical Information and Assessment Guide
Below is a guide to use if you have the opportunity to care for a high-risk antepartum patient.
• Perform VS’s, assessment, charting, teaching, comfort, and support measures as needed.
• Give medications as ordered.
• Read the chart to learn more about the patient’s high-risk condition and treatment.
• Help preform and interpret the Non-stress test (NST) and other procedures.
• If you have time and your patient is willing, interview her and gather information from her chart to answer thefollowing
questions. Turn this paper in to your clinical instructor.
What factors placed her pregnancy in the high-risk category?
What are the physical and psychosocial stressors she has identified as a result of her high-risk situation and how
much stress does this put on she and her family?
What type of antepartal testing has she experienced and how do she and her family feel about these tests?
What supportive measures have helped the patient and her family cope with the situation?
Are there any additional measures she and her family would appreciate to help make her experience better?
Antepartal Assessment Check List: Use the following assessment with your high-risk AP patient.
Take VS
Assess Pain
Auscultate
heart
lungs
bowel sounds
Assess S & Sx’s PIH
visual disturbances
N/V
epigastric pain
reflexes
clonus
urine protein
edema
H/A
Fetal Heart Tones
activity (kick counts)
Assess Elimination
voiding
BM
Perform Non Stress Test (NST)
FHR: baseline, variability, accelerations, decelerations
Uterine: contraction frequency, duration, intensity
Assess Vaginal discharge
amount
color
bleeding
odor
Assess Homan’s Sign
Assess Skin Condition
Assess Emotional Adaptation
diversional activities
support systems
Assess S & Sx’s PTL
low back pain
pelvic pressure
cramps
contractions
change in vaginal discharge
capillary refill
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Room
V/S
Patient
TPR
Activity
BP
FHTs
I
Diet
History
Patient Assignment Sheet
Nursing Care
V/S
TPR
Activity
BP
FHTs
I
Diet
History
V/S
TPR
Activity
BP
FHTs
I
Diet
History
V/S
TPR
Activity
BP
FHTs
I
Diet
History
V/S
TPR
Activity
BP
FHTs
Diet
I
History
Breastfd
Protocol
Infant
Mom
Teaching
Teaching
Nursing Care
Breastfd
Protocol
Infant
Mom
Teaching
Teaching
Nursing Care
Breastfd
Protocol
Infant
Teaching
Breastfd
Protocol
O
Allergies
Blood type
Sitz
Bath
Data/SON/Course/N160/3770/2004/N160SylF04
Infant
Mom
Teaching
Teaching
Nursing Care
Time
Medications/Dosage
Route
Time
Medications/Dosage
Route
Time
Medications/Dosage
Route
Blood type
Sitz
Bath
Patient
Route
O
Allergies
Room
Medications/Dosage
Blood type
Sitz
Bath
Patient
Time
O
Allergies
Room
Breastfd
Protocol
Blood type
Sitz
Bath
Patient
Infant
Mom
Teaching
Teaching
Nursing Care
O
Allergies
Room
Route
Blood type
Sitz
Bath
Patient
Medications/Dosage
O
Allergies
Room
Time
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Mom
Teaching