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Obstetrical (OB) Nursing OB Preparation Packet including Medication LogStudent Name: (fill in your name & cohort)The first part of the OB Prep Packet will require you to view the OB Orientation informational video on (in NUR350) or in the Simulation Google classroom. You must view the video and use your textbook, Maternity & Women’s Health Care by Lowdermilk, et al. (2020) to complete this OB Preparation Packet. The OB Prep Packet is due by Friday, January 8, 2021.If you have clinical starting week 1 of the quarter (winter 2021), your OB Prep Packet needs to be completed before attending clinical. If your clinical starts the first week, let the OB professor know in your email subject line so it will be corrected first!The OB Prep Packet will be available week 11 of quarter 4, to view and download at (NUR350), Google Classroom, then on Canvas the first day of the quarter. During the 2nd half of the OB orientation, your instructors will spend additional time going over the questions to the case studies to help you complete this assignment.Medication Log: These medications will be used in simulation and seen at clinicals. Many clinical instructors want your completed OB Medication Log to be on individual 3x5 cards, preferably with a ring placed through the cards to make it easier to flip through the medications at the clinical site. Once Completed: When your OB Prep Packet is completed, RENAME the document with your name, date and cohort. Ex: “Sadie James (A1) OB Preparation Packet.” Save as a .doc or .docx. No PDFs. Then, email your OB Prep Packet document to Professor Janie Hanson-Ernstrom by the end of the first week of your OB didactic class; due by Friday, January 8, 2021. Email your OB Prep Project to: JHanson-Ernstrom@denvercollegeofnursing.eduFailure to email the completed OB Preparation Project/Medication Log by the due date, will lead to a failure for clinical. A student must achieve at least 78% on the OB Clinical Preparation Packet Rubric. Less than 78% will result in clinical failure. Note: Students do not need to upload the “How To Read Fetal Monitoring”; it is for your personal reference at your clinical site. All students must take the completed OB Preparation Packet to their individual clinical site. Grading Rubric:Competency21-25 points16-20 points15 pointsPoints EarnedLabor and DeliveryCompletely answers all questions to show understanding of concepts with 4 or less mistakesAnswers all questions with 5 or more mistakesDoes not answer all questions, or shows minimal understanding of materialPostpartumCompletely answers all questions to show understanding of concepts with 4 or less mistakesAnswers all questions with 5 or more mistakesDoes not answer all questions, or shows minimal understanding of materialNewbornCompletely answers all questions to show understanding of concepts with 4 or less mistakesAnswers all questions with 5 or more mistakesDoes not answer all questions, or shows minimal understanding of materialMedication LogMedication log is complete with action & use, dosage/route of administration, side effects/contraindications/precautions,nursing considerations and patient education for all medications with 4 or less mistakes Answers all questions with 5 or more mistakesNot all medications on log are completed, or with more than 3 missing areasTotal: OB Student Name: _________________________________________________Check list for the Clinical Instructor:First day of clinical, student has their finished OB Preparation Packet for L&D, Postpartum, the Newborn and the completed Medication Log.YesComments Student is present at clinical before the shift begins and stays through the required end time. After 7 minutes late, the student may not attend clinical and is sent home.Student’s adherence to Denver College of Nursing dress code at the clinical site- including DCN name badge. Student maintains academic integrity and adheres to the DCN Student Standards of Conduct.Students maintain HIPAA -includes PHI for electronic, written or oral information about the patient.Student has calculations checked by the faculty member prior to administering any medications.Student seeks help from faculty member as needed. Does not perform new skills/additional skills without consent or supervision of the faculty member.It is the student’s responsibility to notify the clinical office and the Instructor if they will be absent.Clinical Instructor will be present when the student performs the Newborn Assessment.OB Preparation: Labor and DeliveryUse your textbook Maternity and Women’s Health Care by Lowdermilk, et al., (2020), chapters 18 & 19 and the OB video viewed from to answer the questions based on the following scenario below.Camila Moreno just arrived in Labor and Delivery triage at 14:30. She is a 27 y/o latina female, gravida 2, para 1 (G2 P1 or G2 P1001) currently at 39 weeks gestation. Her first baby (now 2) was delivered via vaginal delivery after an induced labor of 16 hrs. She has received routine prenatal care, is GBS negative, blood type A positive, and is rubella immune. She plans to breastfeed. Camila stated that she has “been having contractions every 5-8 minutes for the last 2 hours and they are getting stronger.” She also stated that she had been having "a lot of false labor" in the last few days and feels anxious and hopes that this time it is “the real thing.” She reports active fetal movement and has some pink tinged vaginal discharge but denies any leakage of fluid. When asked to rate her pain, she replies that her current pain level is 7 on a scale of 0 to 10. Camila’s V/S are: temperature 98.8°F (37.1° C) pulse 80, respirations 18, and blood pressure 120/76. After 20 minutes on the monitor, the baseline fetal heart rate (FHR) is 130 bpm with moderate variability, and accelerations noted. Her contractions are now 3-5 min apart, lasting 60 sec & palpate moderate intensity. The nurse performs a sterile vaginal exam (SVE) and notes the patient’s cervix is 4 cm dilated, 80% effaced, soft and anterior with baby's head at +1 station (4/80/+1), with intact membranes. Her DTR’s are 2+, with 1+ edema in her lower extremities and no clonus. She gave a urine specimen 30 min ago in triage, results pending. States she had a BM this morning. She last ate at 0800- a breakfast of eggs, toast and juice. The nurse reports their findings to the Provider (CNM) and receives an order to admit the patient to L&D. What is the normal fetal heart rate (FHR) range? (p 364)Describe the FHR pattern from above, including baseline, variability and presence or absence of accelerations and/or decelerations. Is Camila’s fetus well oxygenated? Why or why not? Be specific. (Video & pp 363-366)What would be Camila’s specific “BUBBLE LE” assessment? (The BUBBLE LE is a DCN acronym for both the labor and postpartum “Focused Assessment.”) (from Video) B (Background/Breast/Bottle) U (Uterus- UCs & FHR)B (Bladder)B (Bowel)L (LOF)E (Effacement/Cervical exam)L (Lower extremities)E (Emotions)Using the acronym “VEAL CHOP,” describe what these decelerations below look like on the fetal monitor (length/duration of decel and in relation to a contraction).What is likely causing them? What specific intervention(s), if any, are needed? (Video & pp 367-368)Early deceleration-Late deceleration-Variable deceleration-What 5 priority RN interventions should the nurse implement to provide intrauterine resuscitation for the fetus in distress? (Video & pp 369-372)1)2)3)4)5)Post Delivery: the Apgar ScoresThe Provider arrives and at 1705 Camila gave birth to a baby boy in occiput anterior (OA) position. The baby was placed skin-to-skin on Mom’s chest and dried off. The clamping of the cord was delayed by 3 minutes. At 1725, the placenta was delivered. Camila is now bonding with her baby boy. What are the baby’s Apgar scores based on the following?Please rate the Apgar score by assigning the number following the heart rate, respiratory effort, muscle tone, reflex, and color on a 0-2 scale as described below then total the numbers:At one minute of age, the baby has:Heart rate: 120 Respiratory: cryingMuscle tone: active motionReflex: sneeze Color: blue, pale 1 minute Apgar score _____At five minutes of age, the baby has:Heart rate: 130 Respiratory: effort goodMuscle tone: active motionReflex: coughingColor: body pink, extremities blue 5 minute Apgar score _____ OB Preparation: PostpartumUse your textbook, Maternity & Women’s Health Care by Lowdermilk, et al., (pp. 425- 429, & pp.?722-724, fig.33.1) and the OB video you watched to answer questions pertaining to postpartum nursing care.Case Study:Abigail Rice has given birth to her newborn, baby girl Colby (Apgar scores: 7/9), 30 minutes ago. Abigail is 32-year-old biracial female, Gravida 1 now Para 1, who delivered at 40 1/7 weeks gestation and her husband Tyler is present at bedside. Baby Colby weighs 4196 grams (9lbs. 4oz.), length is 49.5 cm (19.4 inches) and she is large for gestational age (LGA). Abigail was GBS negative, blood type AB negative and rubella non-immune (titer of 1:8). It has been over 10 years since she last had a Tdap vaccination. Abigail had an epidural placed at 5 cm and received Pitocin augmentation for 8 hours. A 2nd degree midline vaginal laceration was repaired by the Provider (MD) and is well approximated. Perineal edema is present and two medium sized hemorrhoids are noted. QBL at delivery was 475 ml. You check Abigail’s vital signs: temperature 99.1° F (37.3 °C), pulse 92, respirations 18, O2 Sat 95% on RA, and blood pressure 108/68. On your initial postpartum assessment (BUBBLE LE for postpartum), you note moderate to heavy amount of lochia (postpartum bleeding) and several large clots. You check the fundus (top segment of the uterus) and it is “boggy,” 2 fingerbreadths (2 cm) above the umbilicus and deviated to the right of midline. You are concerned.What is a “boggy” uterus and why are you concerned? (pp 425, 722)What does it mean that the fundus is “deviated to the right of midline?” (p 428)What are Abigail’s 3 risk factors for uterine atony that could lead to a postpartum hemorrhage?What RN interventions are needed to firm up a boggy uterus and decrease the bleeding? Please list your top 3 immediate nursing interventions. (p 428)What if Abigail is unable to void? What RN interventions would be needed? (p 428) What vaccinations does Abigail (and her husband) need postpartum? Why? (p 433)OB Preparation: NewbornUse your textbook, Maternity & Women’s Health Care by Lowdermilk, et al., (chapter 24, pp. 486-530; 461 & pp. 734-758, 767) and the OB video you watched to answer questions pertaining to newborn assessment and nursing care.Case Study: Baby girl Colby is now 1 1/2 hours old and has been laying skin to skin contact on mom’s chest. (She weighs 4196 grams/9lbs. 4oz., length is 49.5 cm/19.4 inches, and LGA). Colby has abundant dark hair, no lanugo, peeling skin and long fingernails. Her mother, Abigail, is stable and has breast fed her infant, 5-7 min on each breast. Appropriate latch noted. After breastfeeding, you take a bedside blood glucose heel stick- and it is 45 mg/dL. Cord blood was sent down to the lab and the results are: blood type A+. You are assessing Colby’s VS, she is flexed, alert with eyes open: RR 50, HR 120, no murmur noted, Temp is 37.2° C. Anterior fontanel is 3 cm x 2cm and soft & flat; posterior fontanel is 1 cm x 2 cm and soft & flat. Head circumference is 36 cm/ 14.1 inches.Before evaluating the NEWBORN ASSESSMENT on baby girl Colby, you need to know and look up the following:What is the normal range in length of a newborn in inches & cm? (p. 494)What is the normal range in weight of a newborn in grams & lbs.? (p. 494) (Note: 1 kg = 2.2 lbs. 1 lb. = 453.59 grams)What is the normal range of a newborn’s head circumferences in inches & cm? (p. 494)What is the normal temperature range of newborns in both C° & F°? (p. 493)What is the normal newborn apical pulse range (sleeping and active)? (p. 492)What is the normal range of respirations in newborns (sleeping and active)? How long should you count respirations for? (Video & p. 493) What is the most critical physiologic change required of the newborn after birth? (Video & p. 461) Baby Colby is determined to be LGA. Define each of the acronyms below. What are the immediate risks for each? Be specific. (pp. 754-758)AGASGALGAThe Infant’s head has overriding sutures with some molding, why does this adaptation occur? When will the infant’s head return to its normal shape? (p 319)What assessments should be done to properly assess a newborn’s anterior and posterior fontanels? What are normal findings? What are abnormal findings and what do they indicate? (p. 496)Colby’s current blood glucose is 45 mg/dL. What is the range of normal newborn blood glucose levels in mg/dL? Include both less than AND greater than 24 hour levels. (p. 511, table 24.4) Hypoglycemia poses potential complications for the newborn: (pp. 468, 755 & 757).What signs and symptoms does the infant display when hypoglycemic? What is the specific blood glucose level for hypoglycemia that should be reported to the provider? What is the initial treatment for the mild hypoglycemic infant? If that doesn’t work, what are your next interventions? Thermoregulation of the infant is critical to the newborn’s survival. Please identify and define the 4 Heat Loss Mechanisms for the newborn and the interventions needed for each. (pp. 464-466, & pp. 734-735) 1)2)3)4)Early skin to skin contact between mother/parent and newborn soon after birth promotes what psychosocial and physiologic changes in mom and baby? (p. 444)Colby’s blood type is A positive and her mother Abigail is AB negative. What postpartum injection is needed for her mother and why? (pp. 784-785)right508000Student Name: Cohort:Drug NameAction, Use &Metabolism(onset, peak & duration)Administration- Dosage/Route/Frequency Side effects/ Contraindications/ PrecautionsNursing ConsiderationsPatient Teachingacetaminophen (Tylenol)prenatal/intrapartum/postpartum POWhat is the maximum dose in 24 hrs.?ampicillinchorioamnionitis/GBSIVPBbetamethasonefetal lung maturity for the newbornIM: given to pregnant momfor the preterm pregnant mom:bupivacaine/fentanylintrathecalPerformed by anesthesia provider; RN monitors patientSpinal/Epiduralcarboprost (Hemabate)postpartum hemorrhageIMloperamide (Lomotil)given with carboprost (Hemabate)POcefazolin (Ancef)pre-op C-sectionIVPBephedrinehypotension following epidural/spinal placementIV directerythromycin eye ointment for the newbornOphthalmicEducation for parents/caregivers-fentanyllabor pain reliefIV directgentamicinchorioamnionitisIVPBhepatitis B vaccinefor the newbornIM: given to newbornhydralazinehypertensive disorders of pregnancy IV directhydrocortisone 1% creamhemorrhoidsTopicalhydromorphone(Dilaudid)post C-section painreliefIV directIbuprofenpostpartumPOiron (FeS04) anemia in pregnancyPOketorolac (Toradol)post C-section painreliefIV directlanolinpostpartum breast feeding mothersTopical For breastfeeding mom:magnesium sulfatepreeclampsiaIVPBloading dosemaintenance dosecalcium gluconateantidote for magnesium toxicity in preeclampsia IV directmetoclopramide(Reglan) hyperemesis POmethylergonovine (Methergine) postpartum hemorrhagePOIMmisoprostol (Cytotec)cervical ripeningPOIntravaginal (PV)misoprostol (Cytotec)postpartum hemorrhagePO PRMMR vaccine (measles, mumps, & rubella)postpartumSubQnifedipine (Procardia)hypertensive disorders of pregnancy/preterm laborPOondansetron (Zofran)nauseaPOSublingualIV directoxycodone/acetaminophen(Percocet)postpartum pain reliefPOoxytocin (Pitocin)induction of laborIVPB oxytocin (Pitocin)postpartum hemorrhage IM IV boluspenicillin GGBSIVPB loading dose maintenance dosepyridoxine (B6) &doxylamine (Unisom)(Diclegis)nausea & vomiting of pregnancy (NVP)PORh immune globulin (Rhogam)Rh incompatibility intrapartum, postpartumIMTdap vaccine(tetanus, diphtheria, & pertussis)postpartumIMterbutalinepreterm labor/tachysystoleSubQIVtranexamic acid (TXA)postpartum hemorrhage(Lowdermilk, p 726)IVPB Given within how many hours post delivery?vitamin Kfor the newbornIMEducation for parents/caregivers-witch hazel pads (Tucks)postpartum perineal care/hemorrhoidstopical ................
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