Preparation for Mother-Baby Clinical Experiences



Preparation for Mother-Baby Clinical Experiences

Be prepared to perform and/or assist with the following:

___ Routine Care: a.m. hygiene, linen, vitals/BP, meals, turning, ambulating

___ Postpartum (BUBBLE) Assessment: head-to-toe systems assessment

___ Breast/nipples-assessment, care for breastfeeding & bottle-feeding

___ Uterus – fundal firmness, level, midline deviation

___ Bowel-distention, bowel sounds, return of flatus

___ Bladder-distention, UTI symptoms

___ Lochia: amount, character /___Legs: s/s thrombophlebitis, Homan’s sign

___ Episiotomy – perineum & hemorrhoids

___ Incision – abdominal/tubal ligation

___ Emotional/psychosocial/educational needs

___ Injections-IM, sub-Q

___ IV therapy

___ newborn vital signs, including normal limits

___ newborn assessment

___ basic care: bathing, feeding, diapering, positioning, cord care

___ bottle-feeding

___ assisting breastfeeding mother

___ infant safety and security measures

___ circumcision care

Medication Cards – Due by first clinical

▪ name of drug, including generic name

▪ indications

▪ side effects

▪ nursing considerations

Postpartum/Antepartum Medications:

___ Colace (docusate sodium)

___ Pericolace

___ simethicone (Mylicon)

___ nutritional supplements: ___ ferrous sulfate ___folic acid

___ antibiotics: ___ampicillin ___ gentamicin ___cefazolin

___ methegine

___ Rho-gam

___ vaccines: ___Rubella ___Rubeola ___MMR

___ Betamethasone

___ Depo-Provera

___ Insulin: ___regular ___NPH

___ Analgesics: ___Percocet___Tylenol___codeine___ibuprofen___Toradol

Nursery Medications:

___ Vitamin K IM)

___ erythromycin eye ointment

___ hepatitis B vaccine (Recombivax)

OB Daily Worksheet

▪ Your need to obtain this information every day for each client.

▪ This worksheet will assist you in developing a daily plan of care, receiving and giving shift report, and discussing your client in post-conference.

Client initials ____ Age ____ EDB ____ Weeks gestation ____

Pertinent medical history:

Past OB history:

G ____ T ____ P ____ A ____ L ____

Current OB History:

Delivery date/time ___________

Type of deliver:

Anesthesia:

Complications:

Infant sex_____ Birth weight ______ Apgar scores ______

Infant feeding:

Maternal blood type/Rh _____ Infant blood type/RH _____-

Medications and indications:

Nursing Coventions:

Nursing Diagnoses:

1.

2.

Discharge Plan:

Teaching/Referral needs:

Mother-baby Clinical

Education Preparation Worksheet

Due as directed by your clinical instructor:

In preparation for providing discharge education for new mothers, the student will complete a written teaching plan. Write this plan as you would instruct your client. Information is to be found in the textbook and class notes.

The student will include information on the following topics:

1. Maternal self-care following a vaginal delivery:

Perineal care, sitz bath, process of involution, breast care, signs of illness.

2. Maternal self-care following a cesarean delivery:

Care of incision, signs of infection.

3. Maternal and family psychological adaptation:

Postpartum blues, postpartum depression, time management, sibling rivalry.

4. Maternal nutritional needs.

Breastfeeding, bottle feeding, Cesarean delivery.

5. Breast self-examination.

6. Basics of infant care:

Bathing, diapering, cord care, circumcision care, bulb syringe.

7. Basics of infant safety:

Care seat law, positioning for sleep and feedings, prevention of accidents, immunizations, signs of illness.

8. Basics of bottle feeding.

Formula prep, frequency, amount, burping.

9. Basics of breastfeeding:

Positioning, latch-on, frequency and length of feeds, how to know baby is getting enough, care of sore nipples.

This paper is to be neatly written or typewritten.

Nursery Preparation WORKSHEET: Name:________________________

(Due prior to clinical as directed by your instructor)

TERM DESCRIPTION LOCATION

ACROCYANOSIS

ERYTHEMA TOXICUM

”newborn rash”

JAUNDICE

LANUGO

MILIA

MONGOLIAN SPOTS

PETECHIAE

PLETHORA

NEVUS FLAMMEUS

“port wine stain”

TELANGIECTATIC NEVI

“stork bites”

VERNIX CASEOGA

SAMPLE CLINICAL SCHEDULE (Mother-Baby)

0630 Report to unit, scrub, look over charts

Complete clinical preparation sheets

0700 Listen to shift report

0730 Report to instructor, look over chart

0730- Initial patient assessment, vital signs

0800

0800 Medications, breakfast

0830- Maternal assessment, change beds, AM care, patient education, discharge

1030 planning

Newborn assessment, assist with infant feedings, bath demonstrations, immunizations, assist with circumcision

1100 Patient assessment, vital signs, teaching

1130 Patient Assessment, Charting, report to staff nurse

1200 Post-conference

ANTEPARTUM CLINICAL OBJECTIVES

During the clinical experience on the Antepartum Unit, the student will:

1. Verbalize understanding of nursing theory pertaining to high-risk antepartum clients and families.

2. Apply the nursing process in the care of high-risk antepartum clients.

3. Perform a high-risk antepartum client’s emotional status.

4. Assess the high-risk antepartum client’s emotional status.

5. Demonstrate the management skills necessary to plan and implement care for high-risk antepartum clients.

6. Provide safe, appropriate nursing interventions for high-risk pregnancy.

7. Educate clients/families to promote coping with a high-risk pregnancy.

8. Verbalize knowledge of safe, appropriate medication and ministration for high-risk antepartum clients.

9. Discuss discharge planning, continuing health needs and the use of community resources for high-risk antepartum clients/families.

10. Utilize appropriate communication skills including:

a. written documentation

b. verbal interaction with clients and families

c. professional communication with members of the health care team

11. Explore the role of the nurse on the high-risk antepartum health care team.

12. Demonstrate professional behavior and development by:

a. participating in planning individualized clinical experiences.

b. displaying professional behavior in all clinical settings.

c. managing professional responsibilities related to clinical experience.

d. initiating discussions with the instructor to demonstrate fulfillment of objectives.

LABOR & DELIVERY OBJECTIVES

Due to the nature of the Labor & Delivery unit, a variety of patients and procedures may be encountered. The students will be primarily observing laboring women whom may deliver vaginally or by cesarean section.

The students should arrive on the unit to allow time to change into scrubs and be ready for morning report. The nurse preceptor is ultimately responsible for patient care; however , there are many ways that students can assist. You may provide support for the patient and family (i.e., be in the room and available for their questions). While the nurse is responsible for charting, the student should discuss his/her assessments, interventions and evaluation and chart with the preceptor’s supervision. During each clinical day on Labor/Delivery the student will demonstrate fulfillment of the clinical objectives through initiation of discussions with the instructor, focusing on use of the nursing process and theoretical basis for the care given.

Students assigned to the Labor & Delivery Unit with fulfill the following objectives:

1. Relate the client’s prenatal health and care to the current labor process

2. Apply theory to describe the client’s progress through labor.

3. Provide emotional and physical support for the laboring family

4. Use the nursing process as a basis for nursing care

5. Provide patient/family education where appropriate

6. Interact with the family and health care team in a professional manner

7. Demonstrate knowledge of medications used in this area, including indications and side effects.

8. Examine the use of technology to assist with care of the laboring patient

9. Describe the role of a registered nurse in this health care team

10. Learn about the standards of care used in this labor & delivery unit

11. Describe the discharge planning started on the labor/delivery unit

12. Complete and hand in Labor and Delivery worksheet as directed by your clinical instructor.

Preparation for Labor and Delivery Clinical Experiences

Be prepared to perform and/or assist with the following:

____ antepartum assessment

____ intrapartum care – process and coaching

____ auscultation of fetal heart tones

____ preoperative preparation and care

____ female catheterization

____ application of external fetal monitor & toco transducer

____ epidural/spinal anesthesia

____ local anesthesia

____ identify obstetric complications:

pregnancy induced hypertension (PIH)

preterm labor (POL)

Medication Cards – Due by firs clinical

▪ name of drug, including generic name

▪ indications

▪ side effects

▪ nursing considerations

Labor and Delivery Medications:

____ oxytocin (Pitocin)

____ magnesium sulfatge (MgSO4)

____ ritodrine

____ terbutaline

____ nifedipine

____ misoprostil (Cytotec)

Narcotics:

____ morphine

____ stadol

____ duramorph

____ fentanyl

L & D Preparation: Name: _______________________

(Due prior to clinical as directed by your instructor)

1. Define cervical DILATION:

2. Define EFFACEMENT:

3. Describe STAGE ONE LABOR

a. Latent Phase

b. Active Phase

c. Transition Phase

.

4. Describe STAGE TWO

5. Describe STAGE THREE

6. How is DURATION of contractions measured?

7. How is FREQUENCY of contractions measured?

8. Describe each of the following FETAL HEART RATE PATTERNS:

a. Accelerations

b. Early Decelerations

c. Late Decelerations

d. Variable Decelerations

9. List 3 non-pharmacologic methods of pain control for the laboring woman:

10. List 2 nursing diagnoses which may apply to the laboring woman

LABOR AND DELIVERY WORKSHEET

(Due after clinical as directed by your instructor)

Name __________________________

Date ___________________________

History:

Patient initials: _________ Age: _______ G _______ T _____ P _____ A ______L ____

EDB: ________

Prenatal Care: yes ____ no ____

Significant Pregnancy-related Problems & Treatment:

Significant Non-pregnancy Health Problems:

Medications (including pain meds) and indications:

Assessment:

Cervical Dilation _____ Effacement ______ Station ____

In which stage and/or phase of labor is your client?

Fetal Monitor Evaluation:

1. External monitor (ultrasound) _____ internal (fetal scalp electrode ________

2. What is the baseline fetal heart rate? ______________________

is it within normal limits? __________________________

3. What is the fetal heart rate variability? ____________________

is the variability:

a. decreased

b. average

c. increased

4. Are any periodic changes present? ____________________

If so, are they:

a. accelerations

b. early decelerations

c. variable decelerations

d. late decelerations

Uterine Activity Evaluation

1. External monitor (Toco) ______ Internal (IUPC) _________

2. Describe the uterine contraction pattern:

Frequency:___________________________

Duration: ____________________________

Intensity: ____________________________

Is the contraction pattern within normal limits? _________________

Nursing Coventions and Evaluation

Based upon your assessment of the laboring woman and the monitor strip, what nursing care would you administer?

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