Download objectives for antepartum rotation

OBSTETRICAL ORIENTATION - University Hospital at Stony Brook
Instructor: Mrs. J. Anderson MA, RN
Phone # (9 North) - 444-2150
1. Attendance – BE ON TIME!! ALLOW EXTRA TIME FOR PARKING, ELEVATORS, ETC.
2. Summary of Clinical Hours:
8:00AM
Preconference – Identify and discuss clinical focus.
Patient Assignment
8:20 AM
Check client charts, check with primary RN: additional information
Client/Newborn care, instruction/teaching, demonstrations, implementing the Nursing Process.
9:30 AM
Medication administration
12Noon
Lunch – 30 minutes
12:30 – 3PM Continuation of client/newborn care: demonstration of newborn care,
teaching instructions. Complete daily nursing process plan.
**Half the group listens to change of shift report
3:30 Complete writing Nurses Note, complete Flow Sheet interdisciplinary teaching sheet.
4:15
Post Conference – 1) share experiences in respective areas R/T stated clinical focus,
2) share community experiences
3) present case studies on indicated week
3. Clinical Time – students assigned to 5 areas (L/D, PP, N, NICU, AP)
L/D (Labor & Delivery)– 8 North Tower - 2 students
NICU – (Neonatal Intensive Care Unit) – 8 South Tower - 2 students
PP Post Partum unit– 9 North and 9 South Towers
Nursery– 9 South Tower
AP (Antepartum unit) - 12 North Tower
Staff is willing to show you many new procedures. You should be just as willing to participate.
Know how to do procedures – ex. foley catheterization.
**There will always be supervision. No new procedures/ no medication administration without either
instruction or RN supervision.
4. Uniforms - look professional! Hair off collar, clean shoes, name pin & emblem,
nails short with "no added decorations".
5. Valuables - Restrict all valuables on units – lock pocketbooks/ personal items in cars.
Jewelry - watch, stud earrings only. No dangling hoop earrings, multiple earrings or multiple rings .
6. Absence – Know college policy. Notify instructor by 7 AM
Phone # (9 North) - 444-2150
7. Medications – numerous opportunities will be provided. Students responsible for drug knowledge.
8. Evaluations – At mid semester and end of semester.
9.
Assignments – as per course syllabus. Includes NCPs include assessment tool, nutrition data,
annotated bibliography card, medication sheet or handwritten medication card.
Case Studies should be shared with clinical group – MAKE COPIES.
10. DUE TO THE UNCERTAIN NATURE OF SOME EXPERIENCES, EX DELIVERIES OR
NURSERY ADMISSIONS, CLINICAL ASSIGNMENTS MAY BE CHANGED. BE FLEXIBLE!!
Orientation to Antepartum
Clinical Instructor: Mrs J. Anderson MA,RN
SBUH Location – 12North Tower
Required Reading: Chapter 10 (prior to rotation)
OBJECTIVES FOR ANTEPARTUM ROTATION
The student working in collaboration with the Antepartum nurse will:
1. Assess the antepartum patient
2. Identify normal findings of pregnancy and any deviation from the norm.
3. Be able to differentiate between underlying medical conditions that complicate
pregnancy. Ex. Cardiac disease, Diabetes Mellitus, etc and complications of pregnancy.
4. Identify the effects of complications(pre-eclampsia, placenta previa, etc) on the mother and unborn child.
5. Formulate nursing diagnoses that address the needs of the mother and the fetus.
6. Plan nursing interventions that address both short and long term goals for the patient
with complications of pregnancy.
7. Implement nursing actions specific to the complication of pregnancy.
8. Evaluate effectiveness of nursing interventions.
It would to the students’ advantage to review the following for additional information in the care of the antepartum
patient
Review Standards of Care booklet relevant to patients.
LABOR AND DELIVERY ORIENTATION & ROTATION - University Hospital at Stony Brook
Location - 8 North Tower
Required Readings – Chapters. 17, 18 19, 20 (prior to rotation)
OBJECTIVES FOR L&D:
THE STUDENT WORKING IN COLLABORATION WITH THE LABOR AND DELIVERY ROOM WILL:
A. Assess the laboring patient. Obtain obstetrical history, assess the stages & signs of labor.
B. Assess uterine contractions and fetal heart rate.
C. Assess maternal and fetal progress vs exhaustion.
D. Formulate nursing diagnoses related to both the physiologic and psychologic aspects of labor.
E. Implement nursing care, ie comfort measures, and basic nursing care.
F. Observe the process of delivery. Observe the mother and infant during delivery.
G. Identify normal findings and deviations from normal.
H. Observe newborn care and identification process.
I. Provide nursing assessment and care post delivery during recovery(VS, fundus, lochia, IVs, emotions).
J. Assist RN with patient transfer to postpartum unit and listen to report.
1. Labor and Delivery suite - 8 LDRs (Labor/Deliver/Recover)
- 3 Operating Rooms (C/S are done in OR)
2. Triage (Mod G) Area - every patient goes to triage for assessment - 1 RN in Triage.
a. Nursing history and assessment, attached to FHM (Observe both)
b. IV Fluids- started c IVL. D51/2NS started at 125cc/hr. LR(Lactated Ringers) for scheduled
C/S patients. Approx 40% of midwives' patients have no IV fluids.
c. NPO - determined by MD or midwife. May order clear liquids/ice chips.
d. Labs - CBC c diff, T&S, PRP(syphilis), Hepatitis B screen if not previously done
Urine to lab - not allowed to dip for protein and ketones(as per Health Dept.)
e. Time - generally 1 Hour then transferred to L&D.
f. Additional procedures - D&C for miscarriage
- Prepare pts for Cerlage in OR(spinal anesthesia)
- D&E(dilatation and evacuation)-anomalies 24 weeks/high teens, come from AP
3. Fetal Monitors - On admission, RN gets baseline reading. Pts stay on FHM. A reactive NST(non stress
test is required before removal). Pp191-192.
4. Medications: Demerol 50mg and Phenergan 25mg IVP q3-4hrs, Stadol - occasionally used,
Fentanyl, Bupivacaine (Marcaine) - c epidural anesthesia (started at 4cm dilatation).
Duramorph – provided for C/S delivery via epidural.
5.
Anesthesia - given by anesthesiologists.
Types: epidural for NSD & C/S; general for emergency C/S;
6. Sterile Vaginal Exam - resident MDs assess station and dilatation.
7. Recovery - 'new mothers' stay 2 hours (NSD); C/S pts stay 2-3 hrs.(must be able to move legs)
Monitor LOC, IV, fundus, bleeding(lochia), dressing, perineum, I&O, emotions.
8. Coaching - generally done by the expectant father with assist/support from delivery room staff. If you
know Lamaze breathing techniques you can assist also.
9. ROM(rupture of membranes) - sometimes done artifically using sterile amnihook.
10. Clinical Time - student assigned to L/D RN. Spend time with patients, assess maternal progress vs exhaustiion.
Give back rub, help pt change position, take VS, assist with breathing and relaxation techniques.
POST PARTUM ORIENTATION
Location: 9 North and 9 South Towers
Required Reading –Chapters 23, 24, (prior to rotation)
Both PP units are designed for a MOTHER/BABY DYAD. Baby stays in mother’s room entire time unless mother
requests differently or mother/baby is sick.
1. Individual MD obstetrical orders for NSD and C/S patients are hand written. Orders are ‘picked up’ or reviewed
by RNs at the start of each shift. No Kardex exist. Mother/Baby Report Sheet is available in each district with
pertinent data.
2. Patient census is divided between 9 North Tower c 15 ‘new mothers’ and 9 South Tower c 16.
3. 'New mother' remains in the Recovery Room for a minimum of an hour (until stable). Upon transfer to PP unit,
RN is responsible for 8 point PP Assessment. VS are taken and recorded.
4. Perineal care is taught using peri bottle and warm tap water. Teach to blot perineal area with tissue. Apply a
covered cool pack to area to reduce edema and provide comfort prn. Sanitary pads are changed each time patient
voids or defecates. Prescribed medications can be applied for episiotomy discomfort. Sitz baths may be ordered.
5. Shower is permitted when patient is able, depending upon type of delivery. Assess ability to tolerate standing.
Check patient while she is in shower.
6. Vital Signs – small, transient rise is not uncommon x24 hours.
Measure VS as per agency schedule: ex. VS Q4h X 48 .
7.
Medications frequently used for new mothers:
Pain – Percocet, Demerol, Dilaudid
Stool Softeners – Colace, Dulcolax suppository, MOM
Breast discomfort- LaLeche recommends ‘air drying”. Lansino cream is provided.
Perineum – Tucks, Dermoplast spray, Anusol for hemorrhoids
Nausea/Vomiting – Compazine. Tigan, Reglan
PCA is used occasionally. Duramorph is common for C/S patients.
8. Non-nursing mothers are encouraged to wear good support bra to ‘dry up milk”. Ice packs for discomfort.
May need to wear bra 24hrs/day.
9. Breast feeding mother may nurse baby in DR. Remind to wash hands before each feeding. No breast
shields until leaking occurs.
10. OOB activity – NSD 3 hours or less. C/S 8 hours after delivery or in AM if evening delivery.
11. Diet – NSD Regular diet, check MD orders
C/S – NPO or clear, progress to Regular diet. Check MD orders(some go right to Regular)
12. Labs – NSD pts - 1st PPD - CBC
C/S pts - CBC and Chem 7
If T after 24 hours or complications are suspected, Urine C&S, Blood C&S
If T less than 24 hours, ambulate, spirometry prn and check T p 30 minutes.
13. Discharge Instructions – Check MD orders, usually related to 1) activity,
2) specific exercises
3) marital relations-advised to related to intercourse x 6 weeks or until post partum checkup.
ORIENTATION TO THE NURSERY
Clinical Instructor: Mrs. J. Anderson
Location - 9 South Tower
Required Reading - Chapters 27, 28, 29 (prior to rotation)
Newborn is transported to the Nursery (9 South) from the L/D (8th North) after bonding with mother and father (or
significant other).
1. Handwashing - Initial scrub with Hibiclens brush for 3-5 min. before entering Nursery, then 15 sec.
scrub with Hibiclens between babies and after changing soiled diapers.
***Wear disposable gloves for changing diapers.
2. Feedings - always check individual orders. Babies are NPO X 4 hours (except LGA, SGA,
gestational DM premies (3hrs). Nursing babies receive 1 feeding of sterile water,
then begin nursing (you may be asked to do it, be knowledgeable & confident before you do it)
Formula fed babies receive 1 feeding of G/W.
****1st G/W feeding is given in nursery by staff. Record time, amt. taken, tolerated or spit up.
Clean 4x4s are used if baby spits up. No diapers.
****When feeding infant in nursery, wear/use a barrier between baby. After all feedings, NB stays in
room. Remind mothers to position NB(newborn) on BACK (BACK TO SLEEP) Record I/O in nursery.
3. Positioning after feeding - Babies are placed on their back
"Back to sleep" - new recommendation.
4. Admission routine - Each NB has his own individual equipment/supplies in lower cabinet of crib.
WEAR DISPOSABLE GLOVES FOR ENTIRE ADMISSION ROUTINE.
a. Weight - done twice for accuracy
b. Head and chest measurement.
c. Rectal temp - when T is 98 , baby is bathed. (T is taken q4h until 24 hrs old)
d. Bath - use baby lather or warm water..
e. Position - most often flat, but if baby has a lot of mucus, head may be elevated
f. Check footprint sheet, birth record and chart completely.
g. All babies are placed on monitor/warmer for one (1) hour p birth.
5. Cord Care -Keep exposed and dry.
a. Cord stump and base is cleansed with alcohol on admission & every diaper change.
b. Clamp is removed when infant is 24 hrs old or when cord is dry. Note any exudate, bleeding, or
foul odor and report same to Clinician/MD.
c. Teach mother to continue exposing cord and applying alcohol to cord 3 to 4 times/day
until it falls off.
6. Security Transponder - every NB has one attached to umbilical cord after arrival in Nursery. It is
removed upon discharge. If anyone attempts to remove NB from hospital via exit door or
elevator analarm will sound and all elevators in the hospital will shutdown
7. Circumcision (Circ) Care - Baby is not operated on until T is stable, voided, been examined by MD.
a. Keep area clean and dry. Apply new vaseline prn at diaper change.
b. Check frequently for bleeding post-op.
c. Notify MD of bleeding, discharge or odor.
d. Teach mother to care for circ after discharge.
e. After circ - wash all instruments and tray.
8. Medications given immediately p birth. Vitamin K (Phytonadine 1mg/1/2cc) IM in LAT (left anterior thigh) in
delivery room if birth weight is 5lbs or more. Erythromycin drops instilled in both eyes..
9. Formula - Feeding schedule is 9AM, 1PM, 5PM,etc for formula feed babies and every 2-3 hrs
for breast fed babies.
Formula - Enfamil c Iron, Similac c Iron, ProSoBee
10. Clothing - baby is dressed in T shirt, diaper and blanket. Extra blanket and hat are used to raise body
temperature if low.
11. Stools - observe and record character, color, consistency, frequency. Note meconium plug expulsion.
Clean genital area with warm 4x4s. Wear gloves and grasp both feet when lifting NB to clean
area.
CODE: Mec - meconium; Y-yellow; Gr - green;
12. Urine - note first voiding and frequency mount thereafter. All voidings are recorded.
13. Phototherapy - Baby is placed in isolette. Eyes must be continuously protected. All clothing except
small diaper is removed. Rectal temps are taken q4h or as indicated to maintain desired
T . Baby remain under fluorescent lights until bilirubin 10 depending on the NBs
age.
Bili Blanket - recently being utilized instead of phototherapy.
14. Discharge Instructions - given to mother by pediatrician on day of discharge. Review same with
mother to ascertain full understanding.
15. Rooming In - Most babies are left in rooms with mother to enrich the childbirth experience.
All babies are brought to the Nursery from 8 to 10AM for Pediatrician checkup.
16. Equipment in each babies cabinet in crib - Lotion, tape measure, basin, bath lather, thermometer,
diapers, hair brush, tube of vaseline, 4x4s.
17.Lab Tests - a. PKU - heel blood is taken on day of discharge
- copy of results sent to Pediatrician.
b. Bilirubin work-up - done if jaundice appears within 24 hrs after birth (pathologic)
c. RH Negative Mothers - cord blood sent to lab for Coombs Test. If negative
titer, mother is given Rhogam injection.
18. Visiting Hours - Fathers or Significant Other 8AM to 10PM
Siblings 3 to 4PM - over 2 years old & healthy.
Grandparents - throughout the day
Regular Visiting - 3 to 4 PM; 7 to 8:30PM
19. Diabetic Mother - NB is test with Chem strips on admission and frequently thereafter.
Gestational DM babies are fed q3h.
20. All students are responsible for a Newborn Assessment and NCP.
21. Please advise instructor if you are ill or think you may have any type of infection (systemic or local).