Download Preparation for Labor and Delivery Clinical Experiences

Preparation for Mother-Baby Clinical Experiences
Be prepared to perform and/or assist with the following:
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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)
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erythromycin eye ointment
hepatitis B vaccine (Recombivax)
OB Daily Worksheet
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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 ____
P ____
A ____
Pertinent medical history:
Past OB history:
G ____
T ____
L ____
Current OB History:
Delivery date/time ___________
Type of deliver:
Anesthesia:
Complications:
Infant sex_____
Birth weight ______
Apgar scores ______
Infant feeding:
Maternal blood type/Rh _____
Medications and indications:
Infant blood type/RH _____-
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
ACROCYANOSIS
ERYTHEMA TOXICUM
”newborn rash”
JAUNDICE
LANUGO
MILIA
DESCRIPTION
LOCATION
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 highrisk 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:
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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
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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
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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?