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Associate Degree Nursing Program

Nursing 333

Nursing Process and Practice in Health

Care of Women and Families During Childbearing

2019-2020

Developed by JSaxton, RN, MA, MS, CNM, FNP, ARNP / Fall 2009

Los Angeles Harbor College Mission Statement

Los Angeles Harbor College promotes access and student success through associate and transfer degrees, certificates, economic and workforce development, and basic skills instruction. Our educational programs and support services meet the needs of diverse communities as measured by campus institutional learning outcomes.

Table of Contents

Campus Etiquette………………………………………………………………………………….. ii Course Faculty and Contact Information…………….…………………………………………….. 1 Catalog Description………………………………………………………………………………... 1Credit/Contact Hours………………………………………………………………………………. 1Transferability………………………………………………………………………………...…….1Prerequisites………………………………………………………………………………………... 1 Student Learning Outcomes/Competencies……………………………..………………..……….. 1 Course Outcomes…………………………………………………………………………………... 2Required Textbooks……………………………………………………………………………….. 3Recommended Textbooks…………………………………………………………………………. 4 Required Clinic Guide……………………………………………………………………………... 4 Supplies……………………………………………………………………………………..……... 4Uniforms…………………………………………………………………………………………… 4 Course Policies……………………………………………………………………………………...4 Clinical Eligibility…………………………………………………………………………………. 4Plagiarism………………………………………………………………………………………….. 5Attendance Policy………………………………………………………………………………….. 5 Math Test Policy…………………………………………………………………………………... 5 Kaplan Testing Policy………………………………………………………………………….….. 5 Remediation Readmission Policy……………………………………………………………….…. 6 Course Credit Challenging Policy…………………………………………………………………. 6 College and Department Policies………………………………………………………………….. 7 Board Policies/Accommodations………………………………………………………………….. 7Course Grading………………………………………………………………………………….…. 7 Unit Exams and Assignments…………………..………………………………………………….. 7 Critical Outcomes……………………………………………………………………………… 8Learning Resources…………………………………………………………………………………8 Method of Instruction……………………………………………………………………………… 8 Study Time………………………………………………………………………………………… 8Evaluation Method………………………………………………………………………………… 8 Course Units:

Unit I - Postpartum Care…………………………………………………………… ……... 9 Unit II - The Newborn………………………………………………………….…….……. 13 Unit III - Labor and Delivery……………………………………………………………….18 Unit IV - Antepartum Care………………………………………………………………… 22

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Campus EtiquetteA student enrolling in the nursing program may rightfully expect that the faculty and administrators will maintain an environment in which there is freedom to learn. This requires that there be appropriate conditions and opportunities in the classroom.

1. No texting and cell phone use during class time.

2. No electronic devices with tones that may cause class disruption.

3. No children, friends, or guests in the classroom, simulation lab, study area, and clinical settings.

4. No food/drinks in the classroom at any time (water is permitted).

5. Any excessive talking will result in dismissal of the student from class.

6. Seats may be assigned at the discretion of the instructor.

7. No taping, recording, photography, or computer recording of the class without permission.

8. Bring your textbook to class as it will be referred to often.

9. Demonstrate professional behaviors in class, including but not limited to: prompt and timely arrival to class, using a respectful tone, language, and attitude. No falling asleep in class.

10. Academic integrity is expected by the college and the instructor will uphold these expectations. Any violation will result in zero points for the exam/assignment and a possible 1-2 day suspension from class. Be aware this may result in failure of the course.

11. The instructor may dismiss student(s) from class if they are being disruptive in any way.

12. DO NOT seek information about this course from inappropriate sources. If you have a question about the class, ask the instructor(s) of the course or clinic.

13. During testing, no caps, hats, or large sweatshirts are to be worn. No beverage containers are allowed on desks. All belongings are to be placed in a designated area of the classroom.

14. The test policy is included in the syllabus and will be followed without exception.

15. Any talking after the instructor has announced that the test has officially begun will result in zero points for the test.

Adopted from Dr. Frances Eason, EdD, MSN, CNE, ANEF East Carolina University School of Nursing

Adopted/revised by LAHC nursing faculty 6/2015

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Los Angeles Harbor CollegeAssociate Degree Nursing Program

Course Outline

Name of Course: Nursing 333- Nursing Process and Practice in the Health Care of Women and Families

Faculty Contact Information: N333: Alexandra Roberts-Ellis RN MSN: [email protected] N318: Elizabeth Stieglitz RN MSN

Course Description : Students experience includes both theory and practice in meeting the health care needs of women, and of the families during childbearing. Psychosocial as well as psychological nursing concepts, including cultural, emotional, developmental and environmental are emphasized. Settings include hospitals, clinics and parent education classes.

Credit/Contact Hours : This is a 3-unit 6-week course (including final). There are 27 hours of lecture and 81 hours of clinical laboratory.

Days & Time: Lecture : Monday: 0800-1005 Clinic: Tuesday: 0630-1900Thursday: 1200-1435

Lab: 1435-1510Room: TBA

** Concurrent enrollment in N318 is strongly recommended.

Transferability: Conditional

Prerequisites: Completion of all program prerequisites and a grade of “C” or better in all first year Nursing Program courses or admission through the Advanced Placement LVN to RN route, and a grade of “C” or better in Anatomy 1, Physiology 1, Microbiology 1 or 20, Psychology 1, Psychology 41 and English 101. Advanced placement LVN to RN students must complete N311, N321 and transition courses N329A & 329B. Transfer students and other advance placementstudents must meet eligibility requirements for 3rd semester determined by the Retention/ Readmission/Transfer/ Challenge (RRT&C) Committee.

Student Learning Outcomes/Competencies : At this level, which comprises courses in the third semester of the nursing program, students are expected to continue to apply and adapt medical surgical nursing concepts to patients across the life span in a variety of community based health care settings, modify plan of care and make decisions for patients at a variety of developmental stages on the basis of general guidelines or principles derived from previous experiences, organize and prioritize nursing interventions with supervision, and use appropriate resources to assist in solving patient problems. The student will adapt basic skills to different age groups and develop new skills applying guidelines that are based on cues from experts. They attempt to correlate and build on medical surgical theory and practice. The student learning outcomes for Level III are:

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1. Apply the nursing process using the Roy Adaptation Model in caring for individuals and groups across the lifespan during childbearing years and in developmental stages.

2. Practice professional behavior standards of nursing practice.3. Demonstrate clinical decision making that is accurate and safe.4. Provide safe, patient and family centered care.5. Function effectively within nursing and interprofessional teams utilizing effective

communication strategies.6. Incorporate evidence-based practices which support clinical reasoning.7. Identify areas for improvement in quality and safety of health care systems.8. Utilize technology to research patient information and communicate with interprofessional

teams.

Course Outcomes : At the end of this course, with appropriate study and practice in the classroom, campus-learning laboratory and hospital settings, the third semester student nurse will in relationship to the Student Learning Outcomes Level 3, #1-8 be able to achieve the following outcomes:1. Apply a scientific body of knowledge, critical thinking, nursing process and the Roy

Adaptation model to promote adaptation of women and their families during childbearingand inter-conception in the physiological modes: nutrition, oxygenation, activity and rest, fluid and electrolytes, elimination, endocrine regulation, protection, sensory, and neurological.[1, 3, 4, 5, 6]

2. Apply a scientific body of knowledge, critical thinking, nursing process and the Roy Adaptation model to promote adaptation of women and their families during childbearing and inter-conception in the psychosocial modes: self-concept, role function and interdependence. [1, 3, 4, 5, 6,]

3. Develops individualized care plans based on appropriate identification of the nursing diagnosis, formulation of goals with measurable outcomes, developmental tasks, physiological needs and psychosocial needs reflective of assessment findings. [1,3, 8]

4. Implements therapeutic nursing interventions to promote optimal health of women and infants that follow national, federal, state standards and guidelines as established in nursing protocols. [1, 3, 5, 6]

5. Demonstrates culturally sensitive care and applies cultural negotiation and human sexuality during childbearing and inter-conception based on the patient’s developmental stage. [1, 3, 5]

6. Assesses, plans and implements teaching plans for women and families based on short range goals that provide information and support to rehabilitate, restore and maintain health.[1, 3, 5, 6]

7. Evaluates the effectiveness of interventions, communication and teaching in achieving goals. Modifies and revises plans of care as indicated. [1, 4, 6, 7]

8. Demonstrates evidence-based practice by integrating theoretical and clinical knowledge with the best evidence currently available from systematic research, for clinical decision making to provide safe care for women and their families during childbirth and inter-conception. [2, 4, 5, 7]

9. Communicates and records assessments of patients and care given. Synchronizes care with health care team, verbally reports to team and documents patient care findings. [2, 3, 7]

10. Demonstrates computer literacy in accessing information from the internet related to course content, clinical preparation, clinical documentation, and patient management. Searches professional women’s health sites, medical sites and professional organizations for biophysiological, pathophysiological and psychosocial responses to illness and adaptation of women and families during

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childbearing and inter-conception. [2, 4, 5, 7, 8]11. Maintains patient confidentiality and security of all health records. [8]12. Performs nursing skills safely and demonstrates proficiency with previously learned skills

and competent skill acquisition of new procedures related to patients during childbearing (antepartum, intrapartum, postpartum, newborn) and inter-conception as follows: [1, 2, 3, 4, 5, 6, 7, 8] Leopold Maneuvers Application of external fetal monitor; assist with application of internal fetal monitor Interpretation of fetal monitor strips Physical assessment for the intrapartum patient Physical assessment for the postpartum patient Physical assessment for the newborn patient Breast self-awareness and breast self-exam Deep tendon reflexes (DTRs) Monitoring clonus Newborn heel stick Newborn eye prophylaxis Newborn vitamin K injection Newborn hepatitis B vaccine injection Phototherapy Bulb suctioning the newborn Newborn CPR

13. Implement pain management for women during childbearing.14. Assess and develop strategies to meet the education needs of patients and families.15. Prioritizes the care of 2 mother/baby couplets, 2 antepartum patients, and 2 gynecological

patients when assigned. Prioritizes sequence of care when assigned to intrapartum patient(s). [1, 4, 6, 8]

16. Demonstrates competent time management in completing care of assigned patients in the time allotted. [8]

17. Utilizes additional resources and seeks assistance from the instructor and members of the health care team, in a timely manner, when the student encounters a situation that exceeds the student’s level of knowledge and experience. [2, 3, 7]

18. Practices within the ethical and legal boundaries of the profession of nursing, agencies and college, and clinical agencies. [2, 3, 4]

19. Advocates for patients and families.20. Adheres to National Patient Safety goals and other safety guidelines. [2, 3, 7, 8]21. Assumes responsibility and accountability for own nursing actions. [2, 8]22. Meets professional responsibilities including appropriate grooming, punctuality, initiative

and dependability. [2]23. Describes areas for improvement in care of assigned patients in the health care setting.

[7]

4Required Textbooks :Murray, S. S., McKinny, E.S, et al (2019). Foundations of maternal-newborn and women’s

health nursing (7th ed.). St. Louis, MO: Saunders Elsevier.

Lewis, S., Bucher, L., Heitkemper, M. et al (2017). Medical-surgical nursing: Assessment and management of clinical problems (10thed.). St. Louis, MO: Mosby Elsevier.

Seo-Cho, J. (2000). Nursing process manual: Assessment tool for the roy adaptation model. Glendale, CA: Polaris Publishing Company.

Perry, A.G. & Potter, P.A. (2018). Clinical nursing skills and techniques (9th ed.). St.Louis, MO: Mosby Elsevier.

Green, C. J. (2016). Maternal newborn nursing care plans (3rd ed). Burlington, MA: Jones & Bartlett.

Davis’s drug guide for nurses (current edition). F. A. Davis: Philadelphia (or current drug text of choice).

Los Angeles Harbor College Associate Degree Nursing Program (current edition). Student Handbook. Wilmington, CA: Author

National Patient Safety Goals -https://www.jointcommission.org/standards_information/npsgs.aspx

Center for Disease Control - http://www.cdc.gov/vaccines/hcp/vis/index.html

Quality Safety Education in Nursing (QSEN) - http://qsen.org/competencies/pre-licensure-ksas/

Recommended Textbooks :Pickar, G. D. (2016). Dosage calculations: A ratio proportion approach (4th Ed.). New York:

Delmar.or

Pickar, G. D. (2013). Dosage calculations (9th Ed.). New York: Delmar.

Roy, Sr. C. (2009). The roy adaptation model (3rd ed.). Upper Saddle River, NJ: Pearson.

Taber’s cyclopedic medical dictionary or Mosby’s dictionary for medical, nursing and allied health (current edition)

Diagnostic/Laboratory text of choice

Supplies: PARSCORE answer sheets (100 item) for tests x 5

Uniforms: See Nursing Program Student Handbook

Clinical Eligibility: To be eligible for clinical attendance all students are required to meet the clinical health requirements as outlined in the Nursing Student Handbook. See Nursing Student Handbook. Evidence of ALL of the clinical health requirements must be turned in to your clinic instructor before starting clinic.

In addition to the clinical health requirements, all agency required forms/tests must be completed and submitted to your clinical instructor upon their request.

Any behavior by a student that puts the patient in jeopardy or is life threatening will be terminated

5from the program with a failing grade.

Academic Dishonesty:The Los Angeles Community College District (LACCD) Academic Dishonesty Policy 9803.28 describes academic dishonesty violations as follows: "Violations of Academic Integrity include, but are not limited to, the following actions: cheating on an exam, plagiarism, working together on an assignment, paper or project when the instructor has specifically stated students should not do so, submitting the same term paper to more than one instructor, or allowing another individual to assume ones identity for the purpose of enhancing ones grade."

Academic dishonesty will not be tolerated in the Nursing Division. For further clarification, the nursing faculty has addressed definitions for the four major forms of academic dishonesty.

Plagiarism: presenting the work of another as if it were student's own work. Each time a source is paraphrased, a citation for the source must be included in the text of the paper.

Cheating: engaging in an act of deception whenever by misrepresenting mastery of information on an academic exercise that has not been mastered.

Fabrication: falsifying research or invents information with the intent to deceive.

Academic misconduct: violation of college policies, tampering with grades, or distribution of any part of an unadministered test (e.g. use of test banks / knowledge of people using test banks and not taking it to the lead instructor or department chair) will not be tolerated.

Any form of academic misconduct is not tolerated within the LACCD and will result in a zero for the assignment in question and a possible one to two day suspension from the class (in most cases this will result in a fail for the course). Any students with an incident of academic misconduct will be referred to the Vice President of Student Services and may be expelled from the nursing program. Please refer to Student Handbook for further information, e.g. constraints of Social Media as they apply to the nursing program.

Attendance Policy: Class absences are not to exceed one lecture. If the student is ill or has an emergency, please contact lead instructor as soon as possible. Clinical hours cannot be missed. Nursing students are urged NOT to be absent and are reminded that the student is responsible for ALL information, announcements, learning materials given and completion of all work assigned in class during class time. Three tardies will be counted as one absence (8 week courses). Two tardies will be counted as one absence (6 week courses). Absence that exceeds specified maximum may result in exclusion from the course or receiving an “F” grade.

Course Evaluation: The N333 course evaluation will be done on-line through the LAHC website. This evaluation must be filled out during the last week of the course. Your feedback is essential if any opportunity for positive change is to occur. This is MANDATORY and not optional.

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Math Test Policy : The student must pass a basic math test with 90% accuracy. The student will have two opportunities to pass the exam. A calculator may be used, provided by the course instructor. If the student is unable to pass the math exam with 90% after two tries, she/he will not be able to meet course objectives and will have the option to withdraw from the course or continue and receive a failing grade.

Kaplan Testing Policy : Each student will take the required course Kaplan Integrated Test at the end of the course. Each student is required to pay the required test fee by the end of the first week of the course when contacted by Kaplan by e-mail. One point will be earned for meeting the benchmark level for the specified Kaplan test per course, 2 points is earned if student scored 5% above the benchmark level, 3 points is earned if student scored 10% above the benchmark level.*In order to receive additional points from Kaplan integrated test, student MUST be in passing status (75% or greater). Please Note: Students do not pay Kaplan fee by deadline will not be able to take the Kaplan test. Students who do not take the Kaplan test will be given an “Incomplete”for the course and will not be able to proceed to the next course.

Course Credit Challenging Policy: See Nursing Program Student Handbook (current edition) The student who satisfies the Los Angeles Harbor College requirements for receiving Credit by Examination is eligible to challenge Nursing 333 course and clinical requirements by:1. Achieving 90% or higher on a math test2. Achieving a minimal score of 75% for each of the course unit exams and final examination (on first attempt)3. Achieving a satisfactory performance rating for unit procedures4. Achieving 75% or higher on the Postpartum Assessment and Patient Teaching assignment.

The student is expected to complete all Course Syllabus reading materials and activities in preparation for the exam. All testing must be completed on the Los Angeles Harbor College campus, in a test-secured room within the nursing building. No more than 1.5 minutes are allotted for the completion of each exam question. The student is allowed 40 minutes to complete the practicum exam, allowing 20 minutes for each procedure

College and Department Policies: See College Catalog, and Nursing Student Handbook.

Remediation Readmission Policy: If a student fails to complete this course with a passing grade, including exiting the course before completion by exclusion or withdrawal, the student is required to complete an Exit Interview with the clinical instructor or lead instructor and the nursing remediation counselor. It is the student’s responsibility to officially withdraw from the course in Admissions. To be readmitted to the program, the student must complete a remediation plan and submit a RRT&C request form to the Department’s Administrative Secretary. The student request will be considered by the RRT&C Committee and readmission will be determined by eligibility of current admission policies, number of previous exits, completion of any required remediation and available space.Any student who has taken the N333 final exam and failed the course who is requesting readmission into N333 must show proof of the following remediation before she/he will be considered for readmission into N333:a. Successful completion of all remediation prescribed by instructor as stated on the individual plan for returnb. The student must remediate the unsecured OB Kaplan test at the 90% levelAny student who has not taken the N333 final exam and has failed the course who is requesting readmission into N333 must show proof of the following remediation before she/he will be considered for readmission into N333:a. Successful completion of all remediation prescribed by instructor as stated on the individual plan for returnReadmission to the program is not automatic; students must complete the program in a timely manner. Students out of the program for two or more semesters may be asked to do remediation work and/or repeat

7prior courses completed.**A student may enroll in a required nursing class a maximum of two times. A student who takes N333 and receives a grade of “C” may not repeat N333 a second time.Please refer to the Student Handbook (current edition) for the RRT&C Policy and Procedure for this course.

Board Policies/Accommodations:1. Nursing students requiring special accommodations in a course must present official documentation of the type of accommodations required to the nursing faculty.2. Board Rule 9803.12. Dishonesty, such as cheating, or knowingly furnishing false information to the college. Examples of academic dishonesty: A student copies from another student, to help an academically weaker student by providing answers to a test or using "crib" notes.3. Board Rule 9803.14. Obstruction or disruption of classes, administration, disciplinary procedures, or authorized College activities.4. Board Rule 9803.19. Alcohol and Drugs. Any possession of controlled substances which would constitute a violation of Health and Safety Code section 11350 or Business and Professional Code section 4230, any use of controlled substance the possession of which are prohibited by the same, or any possession or use of alcoholic beverages.**Please see college catalog and Nursing Student Handbook for a listing of all District Board Rules. Also, refer to the Student Discipline Procedure for due process for disciplinary issues, grievances and the student appeal process.

Course Grading :Nursing 333 is a combined course. Failure of either the theory or clinical portion results is a failure of the entire course. To successfully pass the clinical portion of this course, the student must pass all critical clinical criteria with a satisfactory rating according to clinical criteria.Weekly clinical evaluation performance will be rated as Satisfactory, Needs Improvement or Unsatisfactory. See “Grading Your Performance” and “Weekly Clinical Evaluation” for evaluation criteria. Exam scores and classroom performance will determine the final course grade if student performance in clinical is passing. If the final clinical grade is below passing, the highest course grade that can be earned is a “D.” Note: A “D” is not a passing grade in the nursing program.

The course has 280 points. Grades are earned from 5 module tests, 4 quizzes and a comprehensive final.

Unit Exams and Assignments:Unit I Exam 35 points

Class GradesA = 251-280 points = 90%-100%

Unit II Exam 50 points B = 226-250 points = 81-89%Unit III Exam 50 points C = 209-225 points = 75-80%Unit IV Exam 50 points D = 182-208 points = 60-74%Unit V Exam 20 points F = < 182 points = 0-59%Quizzes 20 pointsClass presentation/group paper 5 pointsFinal Comprehensive Exam 50 points

TOTAL = 280 points

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There are no scheduled make up exams. Students are urged to contact instructor, before the exam, if major illness requires missing an exam. The grade obtainable for an exam taken after the scheduled testing day is 75%. Make-up exams may be multiple choice, fill-in, essay, or assessment &/or nursing care plans, or a combination of all the above. To receive a grade of “W” (withdrawal) for the class, the student must officially drop the course in admissions by the end ofthe 4th week of the course (6 for 8 week course; 4 for 6 week course).

Critical Outcomes : A student must receive a “Satisfactory” rating on all critical outcomes identified for the current course in order to pass the clinical component by the end of the term. Students are responsible for all procedures learned and practiced in all previous nursing courses at a satisfactory level.

Learning Resources :College Library/College Library Databases Computer Lab Nursing Learning Lab

Learning Resource Center (Main Library) Hospital Libraries

Online Database: http://www.guideline.gov/

Method of Instruction: Related Readings Lectures Discussion Demonstrations

Videotapes, DVDs, CDs Internet Simulations Critical thinking exercises

Off campus clinical patient care experiences Computer-assisted Instruction

Study Time : The College expects a minimum of two hours of study/preparation by the student for each hour of lecture and one hour of preparation for each hour of clinical laboratory.

Evaluation Method: NCLEX-like blueprinted exams designed to measure knowledge, application, nursing judgment, and critical thinking. Overall score of 75% must be achieved.

Written assignments - required clinical papers assigned must meet specified criteria-see Clinical Grading Criteria.

Clinical Performance - see evaluation of clinical performance in assigned facility Clinic Guide.

Compliance with College, Nursing Program, and Course Policies

Proficiency level achieved on Kaplan Test

9Unit I POSTPARTUM CARE

Los Angeles Harbor College Associate Degree Nursing Program

Description:This module provides theoretical knowledge and clinical experiences in preparing the student to meet the health care needs of normal and high risk women and their families during the puerperium. Utilizing the Roy Adaptation Mode to implement the nursing process, the student will analyze psychosocial and bio-physiological patient responses and formulate a plan of care that promotes wellness and minimizes complications during the puerperium. Evidence based practice will provide the theoretical frame for assessing and managing complications of the puerperium. Disease prevention is emphasized. Contraceptive methods and selected neoplasms affecting women’s health will be included.

Estimated time of Achievement: 1-week lecture; 2 weeks clinical experience

Objectives Course Content Learning ActivitiesAfter appropriate study of the assigned resources, skills lab and clinical practice, the student will be able to:1. Identify normal bio-physiological and

psychosocial adaptations during the postpartum period.

2. Differentiate between adaptive and ineffective postpartum behaviors.

3. Discuss appropriate therapeutic nursing interventions to meet identified nursing goals for the childbearing family.

4. Compare the nursing needs of a woman who has experienced a cesarean birth with the needs of a woman who gave birth virginally.

5. Identify preventive measures, clinical manifestations and appropriate therapeutic interventions for the ineffective behaviors during the

1. Quality Safety Education in Nursing (QSEN) Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics

2. Bio-physiological adaptations during the puerperium Reproductive system Respiratory system Cardiovascular system Gastrointestinal system Urinary system Integumentary system Musculoskeletal system Endocrine system

Readings:Murray, S. S. & McKinny, E.S. et al (2019). Foundations of maternal- newborn nursing (7th ed.). St. Louis, MO: Saunders Elsevier. Chapters 8, 11, 17, 18, 22, 25, 26 and 27


Class Notes

Lecture/Discussion

Audiovisuals:VIDEOS:

#3168 - Care of Patient with Breast



puerperium.6. Discuss risks, benefits, mechanism of

action and use of contraceptive methods.7. Identify woman at risk for breast

cancer and cervical cancer.8. State prevention, clinical manifestations,

treatment and nursing management for patients with breast cancer and cervical cancer.

9. Identify indications of partner abuse through interactions, health history and physical examination.

10. Discuss risk factors, characteristics of abusers and the nurse’s role in prevention, screening and reporting of domestic violence.

11. Explain factors that may affect a woman’s ability to conceive.

Sensory organs3. Psychosocial adaptations during the

puerperium Becoming acquainted Maternal adaptation Family adaptation Factors influencing family adaptation Cultural influences on adaptation Home an community based care

4. Post-op/postpartum cesarean patient5. Ineffective behaviors during the

puerperiun Postpartum hemorrhageo Early

- Uterine atony- Lacerations of the genital tract- Retained placental fragments- Hematomas - vulvar, vaginal

and pelvic- Uterine inversion- Uterine rupture- Abnormal placental

implantation- Coagulation disorders-

Disseminated Intravascular coagulapathy

o Late- Subinvolution- Retention of placental

fragments- Infection

Perpueral Infectiono Metritis

Cancer#3243 - What I Wish I Knew - hosted

by Jill EikenberryCD-ROMs:

C66 - Nursing Assessment of the Postpartum Patient

DVDs:D19 - Caring for the Postpartum

Patient

Recommended Supplemental Materials: Pickar, G. D. (2016). Dosage calculations: A ratio proportion approach (4th Ed.).New York: Delmar.

orPickar, G. D. (2013). Dosage calculations (9th Ed.). New York: Delmar.




Clinical Requirements: Mother/Baby Prep Forms History and Assessment Forms Nursing Care Plans


o Parametrial celluliteso Peritonitiso Septic pelvic thrombophlebitis o Bacturemia and septic shock o Wound infectionso Urinary tract infectiono Mastitis Thromboemboletic Disorderso Superficial thromosiso Deep vein thrombosis (DVT)o Pulmonary embolis

Cystocele/rectocele/urethrocele and pelvic relaxation

Urinary retention Affective disorderso Postpartum blueso Postpartum depressiono Postpartum psychosis

Altered nutrition Altered parenting

6. Contraceptive methods7. Breast cancer

● Breast self-awareness/Breast self- exam (BSE)

8. Cervical cancer9. Infertility10. Cardiac Disease11. Domestic violence12. Patient teaching13. Nursing diagnosis14. Goal setting15. Nursing interventions

Case Studies

Online Student Resources: http://evolve.elsevier.com/Murray/ foundations


Online Resources: http://www.jointcommission.org/standards

information/npsgs.aspx http://qsen.org/competencies/pre-

licensure-ksas/ http://www.cdc.gov http://www.scip.org http://www.ihi.org http://www.ismp.org http://www.acog.org http://www.awhonn.org

College Library Databases

Skills: Fundal assessment Lochia assessment Bladder assessment Breast self-awareness/Beast self-exam Postpartum admission Postpartum discharge

Skill Activity:


Postpartum Assessment return demonstration: Student must achieve an > 75% on return demonstration to pass clinic and to pass the course. The student will have no more than 2 opportunities to pass the return demonstration, no exceptions.

Required Resource Books:Lewis, S. , Bucher, L., Heitkemper, M., et al (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Mosby Elsevier.

Perry, A.G. & Potter, P.A. (2018). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Mosby Elsevier.



Davis’s drug guide for nurses (current edition). F.A. Davis: Philadelphia (or current drug text of choice).

13Unit II THE NEWBORN


Description:After appropriate study and practice, the nursing student will demonstrate competence in utilizing the Roy Adaptation Model to implement the nursing process in meeting the physiologic and psychosocial needs of normal and high-risk newborn patients.

Estimated Time of Achievement: 1.5 weeks lecture, 2 weeks clinical experience

Objectives Course Content Learning Activities

After appropriate study of assigned resources and practice of critical thinking, psychomotor and communication skills, the nursing student will be able to:1. Identify bio-physiological and

psychosocial adaptation of the newborn (transition to extrauterine life).

2. Differentiate between adaptive and ineffective newborn behaviors.

3. Discuss appropriate therapeutic nursing interventions to meet identified nursing goals for the normal and high-risk newborn.

4. Differentiate characteristics of newborns and associated risk factors of newborns by their gestational age and birth weight.

5. Identify appropriate therapeutic interventions for ineffective behaviors: i.e., hypoglycemia, hyperbilirubinemia, respiratory distress, hypothermia, infection, hypocalcemia, preterm,


2. Bio-physiological adaptation to extrauterine life Initiation of respirations Respiratory adaptation Cardiovascular adaptation

º Fetal to neonatal circulation Neurological Adaptation

º Thermoregulation Hematological adaptation Gastrointestinal system Hepatic system Urinary system immune system

3. Psychosocial adaptation of newborn

Readings:Murray, S. S & McKinney, E. S. et al (2019). Foundations of maternal newborn nursing (7t ed.). St. Louis, MO: Saunders Elsevier. Chapters 4, 5, 11, 16, 19, 20, 21, 22, 23 and 24.

Class notes


#2078 - What Now? Baby’s First Days

#3167 - Newborn AssessmentDVDs:

D20 - Newborn Stabilization and Care

Recommended Supplemental Materials: Pickar, G. D. (2016). Dosage calculations: A ratio proportion approach (4thEd.). New


Unit II THE NEWBORN 14

ABO/Rh incompatibilities, birth injury, altered nutrition, and drug withdrawal.

6. Describe fetoplacental growth and development.

Periods of reactivity Behavioral states

4. Behavioral assessment of the newborn Brazelton Neonatal Behavioral

Assessment Neurological and sensory perceptual

functioning5. Fetal development6. Normal characteristics of newborn7. Ineffective behaviors of the newborn:

Cold stress Persistent pulmonary hypertension

(PPHN) Infections Respiratory Distress Syndrome Meconium Aspiration Transient Tachypnea Small for gestational age Large for gestational age Preterm infant Postterm infant Polycythemia Post term infant ABO/Rh Blood incompatibilities Dehydration Hypoglycemia Phenylketonuria (PKU),

galactosemia, Maple Syrup Urinary Disease (MSUD)

Drug withdrawal Birth injuries Fractured Clavical

York: Delmar.or

Pickar, G. D. (2013). Dosage calculations (9th Ed.). New York: Delmar.




Required Packet(s):Packet #605: Pamphlet 1 - Clinical

Review of Concepts & Characteristics in Infant DevelopmentPamphlet 2 - Variations and Minor Departures in Infants

Clinical Requirements: Mother/Baby Prep Forms History and Assessment Forms

Clinic Experiences: Hospital Rotation Case Studies

Online Student Resources:


Cephalohematoma Galactosemia, hypothyroidism,

phenylketonuria, Hyperbilirubinemia Hypothermia Hypoglycemia Hypocalcemia

8. Patient teaching9. Nursing diagnosis10. Goal setting11. Nursing interventions

http://evolve.elsevier.com/Murray/ foundations


Online resources: http://www.jointcommission.org/standards


licensure-ksas/ http://www.cdc.gov http://www.scip.org http://www.ihi.org http://www.ismp.org http://www.apa.org http://www.acog.org http://www.awhonn.org

LAHC Library Databases

Skills: Admission procedure of newborn Interventions for maintaining

neutral thermal environment Bulb suction Administration of Vitamin K

injection Administration of Hepatitis B

vaccine injection Administration of Erythromycin

ophthalmic Ointment Daily newborn care


Circumcision care Newborn Screening Heel stick Phototherapy Newborn CPR Assessment of parental learning

needs regarding infant characteristics and care

Parental teaching of infant feeding and care (Infant teaching tool)

Promote sensory stimulation (Amazing Newborn Video)

Newborn discharge

Required Resource Books:





Davis’s drug guide for nurses (current edition). F. .A. Davis: Philadelphia (or current drug text of choice).

18Unit III LABOR AND DELIVERY


Description:After appropriate study and practice, the nursing student will demonstrate competence in utilizing the Roy Adaptation Model to implement the nursing process in meeting the bio-physiological and psychosocial needs of laboring patients and their family.

Estimated Time for Achievement: 1 week lecture, minimum 1-week clinical experience

Objectives Course Content Learning ActivitiesAfter appropriate study of assigned resources and practice of critical thinking, psychomotor and communication skills, the nursing student will be able to:1. Describe maternal and fetal bio-

physiology during the birth process2. Differentiate between true and false

labor.3. Define and explain dilatation,

effacement, engagement, station, position and presentation.

4. Describe the four stages of labor and appropriate therapeutic nursing interventions.

5. Identify and define the critical factors (Components) of labor (passage, passenger, powers and psychological state).

6. Identify the mechanisms of labor.7. Identify comfort measures, analgesia,

and anesthesia utilized during labor and delivery and appropriate therapeutic nursing interventions.

8. Identify and describe appropriate


2. Maternal bio-physiological during labor Reproductive system Cardiovascular system Respiratory System Gastrointestinal system Urinary system Hematopoietic system

3. Fetal bio-physiology during labor Placental circulation Cardiovascular system Pulmonary system

3. Critical factors of labor Powers

º Uterine contractions

Readings:Murray, S. S. & McKinny, E.S. et al (2019). Foundations of maternal-newborn nursing (7th ed.). St. Louis, MO: Saunders Elsevier. Chapters 11, 12, 13, 14, 15, and 16

Class notes


#3166 - Art of Bedside Care: Providing Care During Delivery

#7066 - Managing the Experience of Labor and Delivery (interactive video, laser CD)

DVDs:#D21 - Electronic Fetal Monitoring

Recommended Supplemental Materials: Pickar, G. D. (2016). Dosage


nursing care for adaptive and ineffective behaviors during the intrapartum period

9. Define Apgar Score10. Describe immediate care and

identification of the newborn.11. Define adaptive and ineffective fetal

heart rate patterns (2008 NICHD Guidelines), scalp pH anddescribe appropriate therapeutic nursing interventions.

º Maternal pushing efforts Passage

º Maternal pelvisº Soft tissues

Passengerº Fetal headº Fetal lieº Attitudeº Presentation

Psycheº Anxiety and fear

- Catecholaminesº Relaxationº Culture

4. Normal Labor Theories of labor Promontory Signs True and false labor Mechanisms of labor

5. Stages and phases of labor First stage Second stage Third stage Fourth stage

6. Duration of labor7. Obstetric Procedures

Amniotomy Induction/Augmentation Version Operative vaginal delivery

º Forcepsº Vacuum extraction

Cesarean birth

calculations: A ratio proportion approach (4th Ed.). New York: Delmar.

orPickar, G. D. (2013). Dosagecalculations (9th Ed.). New York: Delmar.




Clinical Requirements:Labor and Delivery Prep Forms History and Assessment Forms Nursing Care Plans




Online Resources:


Vaginal birth after cesarean birth (VBAC)

8. Pain management Non pharmacological Pharmacological

9. Intrapartum fetal surveillance10. Ineffective behaviors

Excessive anxiety and fear Hypertonic labor patterns Hypertensive disorders of

pregnancy Postdate pregnancy Multiple pregnancy Shoulder dystocia Fetal Distress Stillborn Placenta previa Placental abnormalities Abruptio Placentae Prolapsed cord Hyperventilation Cardiovascular response to labor Amniotic fluid emboli Hemorrhage during labor and at

birth Diaphoresis and hyperventilation in

labor Prolonged labor Precipitate labor Failure to progress (FTP) Hydrominos >2000cc Diabetes Heart disease

http://www.jointcommission.org/standards information/npsgs.aspx

http://qsen.org/competencies/pre- licensure-ksas/

http://www.cdc.gov http://www.scip.org http://www.ihi.org http://www.ismp.org http://www.acog.org http://www.awhonn.org


Skills: Leopold’s maneuvers Auscultation of fetal heart tones Palpation of uterine contractions Application of external fetal monitor Assists with application of internal

fetal monitor Interpretation fetal monitor strips Deep tendon reflexes Clonus Bulb syringe

Required Resource Books:

Lewis, S. , Bucher, L., Heitkemper, M., et al (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Mosby Elsevier.


Urinary retention Meconium stained amniotic fluid Oligohydrominos <500cc Prolonged labor Malpositions Malpresentations Dysfunctional labor Preterm labor Cephalopelvic disproportion (CPD) Distended bladder Ineffective coping, and anxiety






22Unit IV ANTEPARTUM CARE


Description:Following appropriate study and practice, the nursing student will demonstrate competence in utilizing the Roy Adaptation Model to implement the nursing process in caring for antepartum patients and their families. The student will analyze bio-physiological and psychosocial patient responses. The student will then formulate a plan of care that promotes wellness and minimizes complications during the antepartum period. Evidence based practice will provide the theoretical frame for assessing and managing complications. Normal as well as high-risk antepartum patients will be addressed.

Estimated Time of Achievement: 1 week of lecture, plus clinical experience in hospital and outpatient clinic or simulation lab

Objectives Course Content Learning ActivitiesAfter appropriate study of assigned resources and practice of critical thinking, psychomotor and communication skills, the nursing student will be able to:1. Describe bio-physiological and

psychosocial changes in pregnancy2. Summarize cultural/psychosocial factors

influencing a family’s response to pregnancy and role development.

3. Describe pregnancy diagnosis, protocols for prenatal care including prenatal screening, signs of pregnancy, common problems, comfort measures, nutrition and fetal well-being.

4. Identify pathophysiology and appropriate nursing intervention for patients with complications of pregnancy, concurrent disorders of pregnancy and childbearing families at risk.


2. Bio-physiological changes in body systems pregnancy Reproductive system Respiratory system Cardiovascular system Gastrointestinal system Urinary system Integumentary system Musculoskeletal system Endocrine system Sensory organs

Readings:Murray, S. S. & McKinny, E.S. et al (2019). Foundations of maternal-newborn nursing (7th ed.). St. Louis, MO: Saunders Elsevier. Chapters: 1, 2, 3, 6, 7, 8, 9, 10, 11, and 22

Class notesAudiovisuals:

CD ROM: C67 Physiological &Psychological Adaptation Adaptation to Pregnancy and Prenatal Assessment

DVDs: D53 Head-to-Toe Examinationof the Pregnant Woman

Recommended Supplemental Materials: Pickar, G. D. (2016). Dosage calculations: A ratio proportion approach (4thEd.). New York: Delmar.

23Unit IV ANTEPARTUM CARE

3. Signs of pregnancy Presumptive Probable Positive

4. Antepartum assessment and care Preconception visit Initial prenatal visit Subsequent visits Multifetal pregnancy Common discomforts of pregnancy Cultural considerations Antepartum home care

5. Nutrition6. Psychosocial adaptations to pregnancy

Maternal role transition Paternal adaptation Adaptation of grandparents Adaptation of siblings Factors influencing psychosocial

adaptations Barriers to prenatal care Cultural influences

7. Antepartum fetal testing Non stress test Vibroacoustic stimulatiion Oxytocin challenge test Amniocentesis Chorionic Villi Sampling Biophysical Profile Percutaneous umbilical blood Ultrasound Alpha-fetoprotein Fetal kick counts

orPickar, G. D. (2013). Dosagecalculations (9th Ed.). New York: Delmar.




Clinical Requirements: Nursing Care Plans Case Studies




Online Resources: http://www.jointcommission.org/standards


licensure-ksas/ http://www.cdc.gov http://www.scip.org

Other tests9. Ineffective behaviors

Hypertensive disorders of pregnancy Abortion Ectopic pregnancy Abruptio placentae Placenta previa Hyperemesis gravidarum Hydatiform mole Diabetes and pregnancy Anemias Medical conditions Trauma Infections


http://www.ihi.org http://www.ismp.org http://www.acog.org http://www.awhonn.org


Skills: Leopold’s maneuvers Auscultation of fetal heart tones Application of external fetal monitor

Required Resource Books:Lewis, S. , Bucher, L., Heitkemper, M., et al (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Mosby Elsevier.

Perry, A.G. & Potter, P.A. (2018). Clinical nursing skills and techniques (9th ed.). St.Louis, MO: Mosby Elsevier.




25INTRAVENOUS INSERTION

LOS ANGELES HARBOR COLLEGE Associate Degree Registered Nursing Program

N333 UNIT V: Intravenous Instructional Unit

Description: In this instructional unit the student will be achieving objectives related to the basic concepts and principles of venipuncture and building upon the basic intravenous therapy concepts already learned. It includes techniques of peripheral venipuncture, complications, principles of equipment selection and clinical application.

Estimated Time of Achievement: 8 hours Objectives

Objectives Course Content Learning activitiesAfter appropriate study of assigned resources, participation in lecture/discussion and appropriate observation and practice the nursing student will be able to: Identify the anatomy and physiology of

venipuncture sites. Analyze factors to be considered in choosing a

site for venipuncture. Distinguish the selection of appropriate needle

gauge and length to use in venipuncture. Practice techniques that ensure a comfortable

venipuncture. Demonstrate a preliminary assessment of a

patient prior to venipuncture [sclerosed veins, bruises, hematomas, diagnosis and activity orders, purpose of venipuncture, handedness (right or left), solutions, blood transfusions, and so forth].

Examine common complications of peripheral IV therapy, associated signs and symptoms and interventions.

Compare alternate techniques used in venipuncture in the older adult patient.

Demonstrate venipuncture by inserting an intravenous needle or cannula using aseptic

An overview will be given that includes but is not limited to: Initiating IV therapy Care and maintenance of a

peripherally inserted central catheter

Regulating Intravenous Flow Rate Changing a peripheral intravenous

dressing Changing I.V solutions –

composition and use of commonly prescribed crystalloid solutions

Changing infusion tubing Discontinuing peripheral

Intravenous access Caring for Central Vascular Access

Devices Discussion of conditions requiring

I.V therapy An explanation of how to prepare

the patient, family, and/or significant other for I.V therapy

Factors that increase the risk of complications from I.V therapy

Individualized outcomes for

Resources: Readings:

Perry, A.G. & Potter, P.A. (2018). Clinical nursing skills and techniques (9th ed.). St.

Louis, MO: Mosby Elsevier. Media resources: Audiovisual: ♦ IV Therapy Internet: ♦ http://evolve.elsevier.com/Perry/skills

- Weblinks - Video clips - Mosby’s Nursing Skills Video -Exercises Instructional Methods: ♦ Lecture ♦ Skill demonstration♦ Audio/visual devices♦ IV Simulation Arms

Learning Support Services: E Moore and A Roberts-Ellis

UNIT V

http://evolve.elsevier.com/Perry/skills

26INTRAVENOUS INSERTIONtechniques and standard precautions.

Identify when to change various types of IV tubing and principals related to rotation of IV sight.

Demonstrate post venipuncture procedures, i.e. securing IV site, safe disposal of equipment and documentation of procedure.

patients requiring I.V therapy Techniques used to prevent

transmission of infection for a patient receiving I.V therapy

I.V therapy: Initiating IV therapy – MD orders,

choosing a site, choosing equipment, veins that are most commonly used, considerations that must be taken into account

Insertion technique Regulation of I.V flow rate Changing of IV solutions Changing of IV tubing Changing of IV dressings Discontinuing a peripheral IV Common types of vascular access

devices (VADs) and their care and maintenance.

Complications of VAD’s Educational needs of patients with

VADs. Evidenced based practice trends.

♦ Campus library ♦ Learning Resource Center♦ Nursing Learning Lab ♦ Internet ♦ SimulationHandouts: ♦ IV Insertion Guidelines ♦ Intravenous Insertion Competencies – checklist Evaluation: The student will be evaluated and graded in the following ways, for this learning experience: 1. Psychomotor skills will be evaluated through Peer Evaluation using a mannequin (IV arm). The peer evaluation mastery process will be conducted using the checklist of I.V Insertion competencies developed from the instruction unit I.V Insertion Guidelines. The evaluation process includes selecting appropriate equipment, assessing a need for venipuncture, choosing an appropriate site, inserting and securing the I.V catheter. 2. A written 20-point multiple choice and / or fill-in test at the end of the instructional unit will be used to evaluate cognitive knowledge. The test will consist of theoretical concepts from lecture, self-practice / tutorial activities, and viewing of the venipuncture audiovisual video.

E Moore and A Roberts-Ellis

UNIT V

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