Nursing 356 Expanded Syllabus 2008 - California …ahedden/Docs/N356EXP SYLLABUS '10.doc · Web...

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California State University BakersfieldDepartment of Nursing

Nursing 356 Expanded Syllabus 2010

Amy Zlomek Hedden

NURSING 356 EXPANDED SYLLABUS – 2010 – Guidelines and Forms

CALIFORNIA STATE UNIVERSITY, BAKERSFIELDDepartment of Nursing

Nursing 356

GUIDELINES AND FORMS

This booklet contains guidelines for Nursing 356 course assignments and the forms to use in completing these assignments.

TABLE OF CONTENTSTopic: Page

1. Student Information Sheet .................................................................................................................... 32. Community Rotation Data Form .......................................................................................................... 43. Pediatric Scavenger Hunt ..................................................................................................................... 54. Instructor/Student Responsibility Form ................................................................................................65. Required Pediatric Clinical Skills ......................................................................................................... 76. Information About the Community Rotation ........................................................................................87. Teaching Project Guidelines ...............................................................................................................128. Denver Developmental Screening Test (DDST) .................................................................................179. Writing Nursing Diagnostic Statements ..............................................................................................1810. Special Considerations with Pediatric Medication, Calculation of IV

Drip Rate, Calculation of Maintenance IV Fluids ........................................................................2111. Interpreting Blood Gases .................................................................................................................... 2212. Concepts in Fluid and Electrolytes for Pediatrics.................................................................................2413. Laboratory Diagnostic Tests: (Short form -> Long Form) ..................................................................2514. Pediatric Neurologic Assessment ........................................................................................................ 2815. Medication Administration Practice Test ............................................................................................2916. Perioperative & Operative Learning Objectives & Assignment ..........................................................3217. What To Do In the NICU ................................................................................................................... 3318. Directions for Pediatric Process Plans with Functional Health Patterns................................................3419. Medication Worksheet: Instructions for Use.......................................................................................37

Forms:

22. Community Rotation Log ................................................................................................................... 3823. Pediatric Long Nursing Process Plan ..................................................................................................3924. Pediatric Short Nursing Process Plan ..................................................................................................4925. Team Nursing Forms........................................................................................................................... 5426. Mini Care Plan Form .......................................................................................................................... 5627. Ethical Dilemmas Log........................................................................................................................ 5728. Basic Needs Assessment for Immunizations........................................................................................5929. Clinical Performance Evaluation ........................................................................................................ 6330. Mid-Term Evaluation Form................................................................................................................ 70

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CALIFORNIA STATE UNIVERSITY, BAKERSFIELD

Department of NursingNursing 356

Student Information Sheet

Name:________________________________________________________________________Phone #_____________________________ Message Phone #________________________Address:_________________________________________________E-Mail Address:_________________________________________________

How many units are you enrolled in this quarter?_________________

Classes other than Nursing:_______________________________________________________

Are you employed?______________ How many hours a week do you work:_____________

What languages do you speak besides English?_______________________________________

What experiences have you had working with children?________________________________

_____________________________________________________________________________

_____________________________________________________________________________

What do you feel are your strengths?_______________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

What do you feel are your weaknesses?_____________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

What can I do to facilitate your learning?____________________________________________

_____________________________________________________________________________

What are your expectations for this clinical rotation?___________________________________

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CSUB Department of Nursing Nursing 356

COMMUNITY ROTATION

To help in arranging the Community Rotation assignments for this quarter more information is needed about your schedules and location. Because of limitations on the number of students who can be accommodated at the various agencies, it isn’t possible for students to select their assignments, and it is difficult to place two students together. Input from students will be taken into consideration as much as possible.

Please complete the following information and return to the team leader by this afternoon, if possible.

Student Name:

Phone Number:

N356 Section # Clinical Faculty:

1. Please list Tuesday and Wednesday class or work hours that would interfere with scheduled community hours:

2. Would you be able to take a Friday assignment instead of Tuesday or Wednesday for one of your community rotations?

Yes No

3. Some of the school experiences will be outside of Bakersfield. Which of the following Kern County School Districts would be most convenient for you?

4. Comments, concerns, transportation problems:

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“The Scavenger Hunt”

CODE USED TO ENTER THE UNIT____________Please locate the following items on your unit:____ Dressings

____ ABD____ 4x4’s 2x2’s____ Tape

____ Incentive Spirometer____ IV Poles____ IV Solutions & Supplies____ Wheelchairs & Gurneys____ Bottles & Formula____ Vital Sign Equipment____ Drinking Glasses____ Oxygen Equipment____ Syringes, Needles____ Band-Aids____ Playroom____ Video Tapes/ DVD’s/ Video Games____ Chux, Underpads____ Feeding Tubes____ Chart Forms____ Crash Cart

____ Ambu Bab____ Defibrillator

Phone Number to call a Code Blue ___________ Medication Carts____ Narcotics____ Refrigerated Medications____ Pixis____ Bulb Suction____ Syringe Disposal Containers____ Disposable Gloves____ Sterile Gloves____ Tub Room____ Treatment Room____ Baby Scale____ Swings & Highchairs

____ Nurse Manager’s NameEmergency Codes:

Purple= _________ Pink=_________White= __________ Blue=_________Silver=__________ Gray=_________Yellow=_________ Green=____________ Dirty Utility Room____ Linen Chart____ Linen Chute/Bags____ Clean Utility Room____ Nurse Report Room____ Kitchen____ Patient Charts____ Patient Charge System____ Ice Machine____ Bed Pans/Urinals____ Glucose Monitor____ Client Assignment Sheet____ Addressograph____ Alcohol Wipes____ Urine Measuring Containers____ Bags - Patient & Trash____ Isolation Supplies/Masks____ Reference Books____ Policy & Procedure Information____ MSDS Information____ Oxygen Shut Off Valve____ Evacuation Route____ Fire Extinguisher____ Disposable Tape Measures____ Growth Charts____ Discharge Forms____ Admission Forms____ Incident Report Policy

Revised jan10

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CALIFORNIA STATE UNIVERSITY, BAKERSFIELDNursing Department

(FOR EACH NURSING CLINICAL COURSE)THE INSTRUCTOR IS RESPONSIBLE FOR:

Orientation to Clinical Sites Introduction of Nursing Personnel

Instruction on charting procedure Demonstrations of use and care of and forms commonly used equipment

Tour of clinical agency Introduction of each student to safety and clinical care policies and

Med test as required procedures

Other

Students are responsible for knowing and/or locating in the work area the following:

Policy and Procedure Manuals Fire Extinguisher

MSDS Manual Universal Precaution Policy

Fire Safety Policy Infection Control Policy

Evacuation Route Emergency Preparedness Policy

Incident Report Policy

Student Signature ____________________________ Date__________________________

Clinical Facility _____________________________

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Pediatric Rotation

REQUIRED CLINICAL SKILLSIn order to complete the requirements of Nursing 356 (pediatrics), it is each students responsibility to have reviewed and be prepared to complete the following:

Required Skills: Date(s) Completed Instructor Initial’s

1. IV Push Medication

2. IVPB Medication

3. Administer medication via syringe pump

4. PO medication

5. IV Fluid Therapy Maintenance

6. Denver Developmental Screening: 1. Test 3 children/ different ages. 2.

Analyze & attach results 3.

7. Give feeding via gavage or gastrostomy tube _______________________________________

8. Collect or participate in obtaining one lab test:dextrosix; urine; stool; sputum; etc.

9. Child on C/R or apnea monitor

10. Oximeter Reading

11. Evaluate for Immunization 1.

Deficiency on 2 children 2.

12. Assist with Admission

Recommended Skills:1. Parenteral medication (IM, SQ, or ID)

2. Topical Medication

3. O2 therapy or Ohio Tent

4. Dressing change or wound care

5. Suctioning

6. Other(s) AZH/jan10

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CSUB Department of NursingNursing 356

INFORMATION ABOUT THECOMMUNITY ROTATION

Guidelines for Students When in the Community Agencies:

1. Professional behavior:

Students must follow the Nurse Practice Act and policies of the specific agency they are assigned to in regard to interactions with clients, client confidentiality, etc. Students are to remain under the direct supervision of their assigned community facilitator during their rotation. Students are expected to dress appropriately for the setting they are assigned to. In most settings, this does not include jeans, shorts and sneakers. Some agencies may request students to wear lab coats or a uniform. Specific instructions will be given when assignments are made. ALL sites require students to wear their student name tags. A student who is not appropriately attired may be dismissed from the site by the facilitator, and the faculty contact person will be notified.

There will not be an instructor assigned specifically to the community rotation. Agency staff will have numbers to call in case any problems arise. Students who need to talk to a faculty member while on a community assignment should call their clinical instructor at the hospital.

2. Attendance:

Assignment schedules will be set up in advance, and students must notify both their instructor and their community contact person if they are going to be absent from an assigned clinical experience. It is essential for the community facilitator to know, at the beginning of the business day, if a student is going to be late or absent, so they will not delay their schedule unnecessarily by waiting for the student to arrive. Students are expected to remain in the clinical setting for the specified time, unless specific exceptions are made. If, for any reason, the student decides she/he cannot complete the day at the agency, the clinical instructor should be contacted before the student leaves the agency. Attendance policies as written in the Nursing 356 syllabus and the Nursing Student Policy Handbook also apply in the community rotation.

3. Assignments:

School Nursing: write a three to four page report using the "General Objectives" and the “School Agencies Report”. Caring Corner or Darlyn’s Darlings: write a three to four page report using the “General Objectives” and “Prescribed Pediatric Care Clinics”.

Be sure to title each report (ex: “General Objectives”) and to NUMBER EACH OBJECTIVE as you write about it. DO NOT mix/combine reports/ objectives or credit will be deducted. These reports will be due on the Friday immediately following the community experience. They are to be turned in to your clinical instructor, just as your other clinical assignments are.

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CSUB Department of Nursing Nursing 356

COMMUNITY ROTATION

Introduction to the Community Rotation:

The current trend in pediatrics is to keep hospital stays for acute illness to a minimum period of time. Assessing and interacting with well children, as well as those with chronic, long-term, and common health problems that do not require hospitalization, is also important in pediatric nursing. For all of these reasons, community experiences are integrated into the pediatric nursing clinical rotation.

Experiences in various community agencies give the student the opportunity to become familiar with chronic, long-term and common health problems of children seen outside of the hospital setting as well as to observe the growth and development of well children and the impact of illness. Through observation of nursing care in community-based settings, the student will be able to apply knowledge system stability and instability to specific pediatric populations and their families. Emphasis is given to health assessment, health promotion and education as part of the nursing plan of care.

Students from each clinical group will be assigned to community agencies each week. Each student will be in the community for a minimum of 16 hours (time equivalent to 2 clinical days).

General Objectives:

1. Give an overview of your community experience. (How did it go? Did you like it?)

2. Describe the purposes and services of the community agency.

3. Describe the funding of the agency, (i.e., public, private, fees, grants, special funds).

4. Describe the types of clients served/ observed/ cared for during your time at the agency, including age, cultural-ethnic background, socioeconomic status, type of need/problem. (If there is a website available, include this data. For schools try: www.greatschools.net, or the school’s name)

5. Discuss two clients you observed during your community experience. State their needs, problems, developmental level (actual -vs- expected for age), and the top 3 (prioritized) nursing diagnosis during your care.

6. Identify observed health care teaching provided by the agency during your assignment.

7. Rate this community experience on a scale from 1 to 10. Give justification for your rating.

8. Rate and justify your performance in this community setting on a scale of 1 to 10.

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http://www.greatschools.net/

School Agencies Report:

Under the direct supervision of the designated school nurse, the student will meet the General Objectives (p. 8) plus participate in as many of the following activities as possible in the specific assigned setting. Be sure to identify if/ how each objective was met. If not met, state the objective number and that it was “not met”. Number 10 must be completed (use references).

1. Attend multi-disciplinary team conferences determining the educational and health care needs of the school-aged child. Discuss.

2. Identify and observe the referral process used to determine the child's eligibility for special programs.

3. Assist the community resource nurse in gathering a health/ developmental history on a pediatric client.

4. Perform a complete review of a selected child's health file, including nursing assessment, health and developmental history and nursing plan of care.

5. Interact directly, in the classroom setting, with children attending the assigned school/agency.

6. Participate in home visits when possible.

7. Assist with vision, hearing or other screening procedures when possible.

8. Observe the school nurse or other staff members perform nursing tasks related to the care of children in the assigned school settings.

9. Make observations related to growth and development of specific students in the assigned school settings and identify the impact of developmental level on health practices.

10. Sharpen your developmental assessment skills! Each school agency presents endless opportunities to observe children of different developmental levels in the school environment and this assignment utilizes those opportunities to enable the student to more fully observe and assess developmental behavior.

a. Choose a child representative of the client population your agency serves to observe during your rotation.

b. Before observing your client, prepare a comprehensive list of developmental milestones you would expect for the child's age and grade level. Include cognitive, social, physical, gross/fine motor skills, etc. Reference your sources.

c. Next, arrange a time in which you may observe the child in the classroom setting. Document the observed skills, tasks and milestones of the child both in the classroom and at play. Take notes!

d. Contrast expected with observed milestones and write a short summary of your findings and conclusions.

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Homeless Shelter, Outpatient Pediatric Clinics. Offices

Under the direct supervision of the community facilitator, the student will meet the General Objectives plus participate in as many of the following activities as possible in the specific assigned setting:

1. Review agency policies and protocols related to pediatric visits.

2. Describe intra-agency coordination of health services and benefits and methods of referral.

3. Assist with procedures:

3.1 participating in intake interview.3.2 taking vital signs.3.3 measuring height and weight.

4. Describe physical, developmental and/or psycho-social assessments and deviations from the normal - done by the nurse, nurse-practitioner or physician and assist as indicated.

5. Compare and contrast how the roles of the RN/ LVN/ Nursing Assistant are similar and different in this health care setting. Also identify what is special about the RN/ professional nurse’s role.

Prescribed Pediatric Care Clinics (Caring Corner, Darlyn’s Darlings)

Under the direct supervision of the community facilitator, the student will meet the General Objectives, complete the following, plus participate in as many of the following activities as possible in the assigned setting:

1. Identify 3 procedures that you observed or administered to technology dependent children at this facility. (You MUST administer a G-tube feeding as this experience!)

2. Identify play and therapeutic interactions that were provided to children in this facility.

3. Describe education or special health instructions provided to children through this facility.

4. Select/describe one specific age group served by this facility. Observe and explain how children in this stage of growth and development react to care in this facility- including procedures, types of play, feeding, and other interactions with staff and other children.

5. Describe a life-threatening or adverse reaction that could occur with one of the high risk children in this facility. What would be the appropriate nursing response in this situation?

6. Compare and contrast how the roles of the RN/ LVN/ Nursing Assistant are similar and different in this health care setting. Also identify what is special about the RN/ professional nurse’s role.

Azh/jan10

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Nursing 356

Teaching Project GuidelinesObjectives

The student will demonstrate the ability to:1.1 Assess the learning needs of a family or group.1.2 Develop a teaching module which identifies the target population, learning objectives,

content, methods of instruction, and evaluative methods.1.3 Present the teaching module to a selected group at a prearranged place and time.1.4 Evaluate the results of the presentation.

RationaleA major role of the professional nurse is teaching--to individuals, families, groups, and organizations. The nurse needs to have knowledge of assessment, planning, implementation, and evaluation in relation to the teaching/learning process to enhance the care given to clients. She/he can then provide appropriate health education within these parameters.Part OnePreparation of the Project5% 1. Select a topic to be taught and identify a target population (family or group) who would

benefit from this teaching. State why this is an important topic for children. (Use references).

10% 2. Present the rationale for your choice of topic by assessing the learning needs of the target population. Discuss all of the following: developmental, cognitive, cultural, economic, pathophysiological and educational parameters. Investigate your target group via internet and use other references.

10% 3. Develop client-centered behavioral objectives including criteria for measurement (minimum of three). Write as goals – Ex: The children will identify one way germs are spread.

10% 4. Identify and write out an expanded outline of the content to be taught, utilizing the assessment in 2. Cite references as appropriate.

10% 5. Identify teaching methodologies (i.e., lecture, demonstration, etc.) that are congruent with the topic to be taught and the client's needs. State how the methods selected relate to the target population's developmental, cognitive, educational and/or pathophysiological status. Use references.

5% 6. Develop and state the evaluative methods you will use to assist in evaluating the effectiveness of the teaching project. State the relationship of the methods to your target population’s characteristics. Use references.

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Part One (Items 1 to 6)

Is to be handed in at least three days prior to the planned presentation for grading by instructor. Changes suggested by instructor on written teaching project must be implemented in the actual teaching project presentation, or points will be deducted.

Part Two

30% - Presentation

Make necessary arrangements with the clients or agency to present the project. Plan with instructor for time s/he can be present. Please plan early. Do not wait until the end of the allotted time to plan or present your project.

Make the presentation. Each member of the team will be responsible to self-rate their individual and group performance.

15% - Evaluation (separate evaluation done by each person involved in the teaching project)

Evaluate the project. If done with a group, explain who on your team was responsible for which activities. In the written evaluation, state at what level the objectives were met and evaluate the project itself. State how the presentation went, what you could have done differently, and other ways it could be improved.

5% - Format (Includes Part One and Part Two)

Write up and turn in a report on the project.

Include Part 1 (items 1-6), Part 2, the form “Evaluation of Teaching Project” (with your circled self-evaluation); your written evaluation; a reference list of sources used to complete the project (counts toward APA format grade), and a copy of your selected journal article (see below).

All papers are to be typed and APA format is to be used. Spelling and punctuation count. The written project is to be submitted on the Friday following the presentation, unless otherwise negotiated. A minimum of two references are required. One reference should be from a current nursing journal or other professional medical/ healthcare source.

RG 9/94Revised: AZH/ jan10

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Nursing 356

Evaluation of Teaching Project

Student(s): __________________________________________________________Topic: _________________________________________ Date: _____________

Part 1: (50%) Submitted prior to performing actual project.Points

1. Identification of target population (5%)2. Assessment of learning needs (10%)3. Objectives and measurement criteria (10%)4. Content (accurate, adaptable, informative, appropriate) (10%)5. Teaching methodologies (10%)6. Evaluative methods (5%)

Part 2:Presentation (30%) Remember to circle self-evaluation below.

Outstanding Unacceptable

a. Audience (clients or group) was made comfortable. 5 4 3 2 1

b. Delivery was clear, appropriately directed. 5 4 3 2 1

c. Content was accurate, understandable and adapted to client needs. 5 4 3 2 1

d. Use of language: grammar and word choice. 5 4 3 2 1

e. Innovative approaches were utilized. 5 4 3 2 1

f. Style, methods, and materials were appropriate. 5 4 3 2 1

Evaluation of client learning (Total points 15%): Utilizing evaluation criteria for your project, explain if the behavioral objectives were met (3%). How did it go (3%)? How could it be improved (3%)? What could you have done differently(3%)? Portions each team member was responsible for (3%).

Format of paper (5%)

Comments: Project Grade

Revised RG 9/94/AZH Dec. 08

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15NURSING 356

Evaluation of Teaching Project: Levels of Achievement for Presentation

Presentation (30%) Outstanding5

Good4

Proficient3

Marginal2

Unacceptable1

a. Audience (clients or group) was made comfortable

Clear introductions and purpose of presentation stated. Personal appearance is completely appropriate.

• Mostly clear introductions and purpose of presentation. For the most part, personal appearance is appropriate.

• Somewhat clear introduction and purpose of presentation. Personal appearance is somewhat appropriate.

• Unclear introduction and purpose. Somewhat inappropriate personal appearance.

• No given introduction or purpose of presentation. Inappropriate personal appearance.

b. Delivery was clear and appropriately directed to audience.

• Presentation is consistently clear, logical, organized. Listener can follow the reasoning. Presentation is appropriate to level of growth and development of audience. Audience interested and interactive.

• Presentation is generally clear and well organized. A few minor points may be confusing. Appropriate to level of growth and development of audience. Audience mostly attentive and interactive.

• Presentation is somewhat clear. Organization needs work. Some points are confusing. Questionably appropriate to level of growth and development. Audience interactive and attentive at times.

• Listener can follow presentation with effort. Some points unclear. Organization is haphazard. Most areas not appropriate to level of growth and development. Audience sometimes interactive and attentive.

• Presentation is difficult to follow. Unclear, illogical sequence of ideas. Inappropriate level for audience’s growth and development. Audience not attentive. Loses interest. Not interactive.

c. Content was accurate, understandable, and was adapted to client needs.

• Information included in presentation is consistently accurate. Complete, understandable, age appropriate explanations of key concepts are provided. Listeners gain insights. Length of time for presentation is appropriate.

• No significant errors are made. Listeners do not recognize errors, if any occur, presenter(s) correct(s). Helpful applications are included. For the most part, explanations of concepts are accurate and complete. Length of time could be a little longer or shorter.

• Listeners recognize errors thought to be the result of presenter’s nervousness or oversight. Explanations of concepts are mostly accurate and complete. Few helpful applications used. Length of presentation was notably long or short.

• Some content inaccurate. Enough errors are made to distract the listeners. Explanations of concepts are incomplete. Listeners gain little from the presentation. Length was inappropriate.

• Information presented is sufficiently inaccurate. Listeners are distracted and misled. Explanations of concepts are poor. Listeners gain no new knowledge or insight. Length of presentation was inappropriate. Instructor needed to intervene.

d. Use of language: Grammar and word choice.

• Consistently, sentences are complete and grammatical; they flow together easily. Words are chosen for precise

• Usually (for the most part), sentences are complete and grammatical. They flow together easily.

• Listeners can follow the presentation but grammatical errors are present. Slang is used occasionally.

• Listeners can occasionally follow the presentation. Many grammatical errors are present. Slang is

• Listeners are so distracted by the presenter’s difficulty with grammar and vocabulary they cannot

Presentation (30%) Outstanding5

Good4

Proficient3

Marginal2

Unacceptable1

meaning and are appropriate for audience’s level of knowledge.

With a few exceptions, words are chosen for their precise meaning, application, and are appropriate for the audience’s level of knowledge.

Sentences are occasionally incomplete or halting. Vocabulary is sometimes inappropriate for the audience.

frequently used. Many incomplete sentences and periods of silence. Vocabulary is sometimes inappropriate for the audience.

focus on the ideas presented. Slang used. Periods of silence. Vocabulary inappropriate for the audience.

e. Innovative approaches were utilized.

• Communication aids are innovative. Approaches that are utilized are prepared in a professional manner. Visuals are large enough to be seen by all. main points stand out. Materials are appropriate for level of development.

• Communication aids and approaches contribute to the presentation. Materials are mostly professional. Visuals are large enough to be seen by almost all. Most materials support main points of presentation. Materials are appropriate for level of development.

• Communication aids and approaches somewhat contribute to the presentation. Materials are somewhat professional. Visuals are large enough to be seen by most. Too much or too little information is presented. Materials are sometimes appropriate for development level.

• Communication aids are poorly prepared or used inappropriately. Visuals can not be seen. Too much information is included or too little. Unimportant material is highlighted. Listeners may be confused often during the presentation.

• No communication aids are used, or they are so poorly prepared that they distract from the presentation. Materials are inappropriate for developmental level. Listeners are uninterested and confused.

f. Style, methods, and materials were appropriate.

• Level of presentation is appropriate for the audience. Presentation is well planned. Speaker is clearly comfortable. The entire group can hear and comprehend the presentation. behavioral objectives completely met.

• Level of presentation is mostly appropriate for the audience. Presentation is generally appropriately planned. Speaker sometimes speaks too fast or too slow. The group can usually hear and comprehend. Most or all of behavioral objectives are met.

• Some aspects of the presentation are too basic or too sophisticated for the audience. Presenter seems uncomfortable some of the time. The listener sometimes has difficulty understanding, hearing, or comprehending. Some of the information is directly read. Some of the behavioral objectives are met.

• Many aspects of the presentation are too basic or too sophisticated for the audience. Presenter is uncomfortable most of the time. The listener consistently has difficulty understanding, hearing, and comprehending. Most of the information is directly read. Few of the behavioral objectives are met.

• Presentation is consistently too basic or sophisticated for the audience. Information is read to the audience. Presenter is obviously anxious and cannot be heard. Behavioral objectives are not met.

REF: Oral Presentation Rubric (DRAFT 4-29-98) Department of Educational Leadership and Policy Studies/ Iowa State University/ Revised: AZH/Winter 2007Total Score: ____________________________/30

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Denver Developmental Screening Test (DDST)

You are required to perform 3 DDST’s during your pediatric rotation. These will be submitted at the end of the quarter during your final clinical evaluation. They can all be done on 1 form or 3 separate Denver II forms. Be sure to include the N356 DDST Evaluation Form (see next page).

Calculating the child's age:1. Determine the child's birthdate.2. Subtract the birthdate from the test date. Start the calculation the right, figuring

first the day, then the month, then the year necessary to "borrow," 1 month = 30 days and 1 year = 12 months.

Year Month DayDate of test 2010 1 19Birthdate -2008 -1 -9 Age of Child 2 0 10

3. Draw age line of chart through all four sectors at the child’s exact age. Write the date of the test at the top of the age line.

4. Before drawing age line, ask if child was born early. If child was born 2 or more weeks prematurely, subtract the number of weeks early from the age of the child, draw the line at the adjusted age, and write number of weeks adjusted under date at top of age line. (Only adjusted until child is 2 years old.)

Scoring:1. Each item is designated by a bar representing ages at which 25%, 50%, 75% and

90% of tested population were able to perform item.2. Score items as “pass,” “fail,” “refusal,” or “no opportunity.”3. Interpretation of Scores:

Advanced: Passed an item completely to the right of the age lineOK: Passed, failed, or refused an item intersected by the age line between the

25th and 75th percentilesCaution: Failed or refused items intersected by the age line on or between the

75th and 90th percentilesDelay: Failed an item completely to the left of the age line; refusals to the left of

the age line may also be considered delays, since the reason for the refusal may be inability to perform the task

4. Interpretation of Test:Normal: No delays and a maximum of one caution.Suspect: One or more delays and/or two or more cautions.Untestable: Refusals on one or more items completely to the left of the age line or on more than one item intersected by the age line in the 75% to 90% area.

Comments:1. Prepare toddlers and preschoolers by presenting it as a game.2. Need to consider cultural variations that could influence results, in order to avoid

erroneously labeling the child as developmentally delayed.3. Need to clarify to parents that this is not an intelligence test.4. Explain to parent that child is not expected to perform every item on sheet.5. Put each item away before beginning with next item.

N356 DDST Evaluation Form

Child #1- Initials________Calculation of the child’s age:

Year Month DayDate of test:Birthdate: - _____________________________ Calc.Child Age =

Interpretation of Testing/ Scores: (Normal, Suspect,Untestable) and whyPersonal-Social: Fine Motor-Adaptive:Language:Gross Motor:

Comments:______________________________________________________________________




Comments:______________________________________________________________________




Comments:______________________________________________________________________

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Nursing 356

WRITING NURSING DIAGNOSTIC STATEMENTS

From assessment data gathered about structural variables, the client's perception, and the nurse's inferences about subsystem and intersystem functioning, use the following components to construct nursing diagnostic statements:

A. For ACTUAL (acute and chronic) PROBLEMS the statement consists of four parts:

1) The Functional Health Pattern affected+

2) Nursing diagnostic label (NANDA)+

3) Related to (r/t) _____________________________________(contributing factors)

+4) Manifested by (m/b) ________________________________

(signs and symptoms, defining characteristics, behaviors)

Example: FHP: Cognitive - Perceptual--Alteration in comfort: pain, related to surgical intervention (appendectomy) m/b restlessness, crying, and statements that "my side hurts."

B. HIGH RISK NURSING DIAGNOSES refer to problems that the patient is at risk of developing. They are labeled: “Risk for" to assist nurses in identifying clients who are most vulnerable to certain problems. Contributing factors (as risk factors) are present, but defining characteristics (signs and symptoms) are not. For POTENTIAL PROBLEMS the diagnostic statement would consist of three parts:


2) Nursing diagnostic category (NANDA) (preceded by "high risk for")+

3) Related to ________________________________________(risk factors)

+Example: FHP: Elimination--Risk for impaired skin integrity related to frequent, loose bowel

movements.

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C. For POSSIBLE PROBLEMS (i.e. may be present, but require additional data to confirm or rule out) the statement will usually consist of three parts:


2) Nursing diagnostic category (NANDA) (preceded by "possible")+

3) Related to _________________________________________ (factors that lead to diagnosis being suspected)

Example: FHP: Cognitive-Perceptual--Possible sensory-perceptual alteration (deprivation) r/t decreased contact with others secondary to hospitalization in an isolation room.

D. WRITING COLLABORATIVE PROBLEM STATEMENTS

Nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable (NANDA, 1990). COLLABORATIVE PROBLEMS are certain physiological complications that nurses monitor to detect their onset or change in status (Carpenito, 1990).

Nurses make independent decisions for both nursing diagnoses and collaborative problems. With collaborative problems, the definitive treatment to achieve desired outcomes, is prescribed by both the nurse and the physician. The nurse primarily monitors for the onset and change in status of physiologic complications to prevent morbidity and mortality.

Collaborative problems are based on physiological complications that are usually related to disease, trauma, treatments, medications, or diagnostic studies. Collaborative problems are labeled “Potential Complications.” The statement will usually consist of:

1) Potential Complication (PC): ______________(Specify physiological complication)

2) The Functional Health Pattern affected

For example, a patient has leukemia. Patients with leukemia generally receive chemotherapy. Therefore, a collaborative problem for a patient would be:

PC: Antineoplastic Therapy Adverse Effects(FHP: Multisystem)

This material is adapted from:

Carpenito, L. J. (1995). Nursing Care Plans and Documentation. Philadelphia: Lippincott.

For further information and clarification of writing collaborative problem statements please see Wilkinson, J. (2000). Nursing diagnosis handbook with NIC interventions and NOC outcomes. Prentice Hall.

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E. WELLNESS NURSING DIAGNOSES

A Clinical judgment about an individual, group, or community in transition from a specific level of wellness to a higher level of wellness.

A focus on patterns of wellness, healthy responses, or client strengths drawn from assessment data. Progressive attainment of health behaviors or completion of developmental tasks.

1) Criteria for wellness nursing diagnosis:

a. Desire for a higher level of wellness.b. Effective present status or function.

2) Label

a. Wellness diagnostic statements are one part statements containing the label.

b. Include evidence to support your diagnosis

c. Avoid judging whether a client’s or group’s present health status or function is effective or ineffective; rely on the client’s/parents report of perception.

3) Examples of Age Appropriate Wellness Diagnosis:

Infant - Beginning expressions of pleasure associated with age appropriate activities as evidenced by smiling while shaking rattle

Toddler - Beginning sense of autonomy as evidenced by beginning potty training

School Age - Beginning cooperative play as evidenced by playing card games with other children.

Adolescent - Developing relationships with opposite-sex peers as evidenced by talking on telephone with opposite sex peer

This material was adapted from: Carpenito, L.J. (1995). Nursing diagnosis: Application to clinical practice. (5th Ed.). Philadelphia: Lippincott.

andStolte, K.M. (1996). Wellness: Nursing diagnosis for health promotion. Philadelphia: Lippincott.

SPECIAL CONSIDERATIONS WITH PEDIATRICMEDICATION ADMINISTRATION SAFETY

21

1. Take a drug allergy history. Be aware of drug-drug or drug-food interactions.

2. Check the 5 “rights” prior to administering the medication

(Right: drug; dose; time; route; child/patient- always check name using 2 identifiers)

3. Always double check the following medications with another nurse: **Digoxin; Insulin; Heparin; Blood; Epinephrine; Narcotics; Sedatives; Chemotherapy; Cardiotoxic drugs.

4. Involve the child in order to gain cooperation.

5. Always praise the child for doing their best after they have received their medication.

CALCULATION OF IV DRIP RATE

When administering IV medications to a Pediatric patient, use a medication infusion pump whenever possible. If not possible, use the following formula to calculate IV drip rate:

Volume to be infused X Drop factor of IV tubing--------------------------------------------------------- = Flow rate in Total infusion time (in Minutes) drops per minute

CALCULATION OF 24-HOUR FLUID REQUIREMENT FOR PEDIATRIC PATIENTS

1. Calculate the weight of the child in kilograms. (Weight of child in pounds ÷ 2.2[lb/kg] = weight in kg)

2. Allow 100 ml per kilogram for the first 10 kg.

3. Allow 50 ml per kilogram for the second 10 kg.

4. Allow 20 ml per kilogram for the remainder of weight in kilograms.

5. Divide the total amount by 24 hours to obtain rate in milliliters per hour.

AZH/Dec. 2007

Reference: Wison, D. & Hockenberry, M. (2008). Clinical manual of pediatric nursing. (7th ed).

St. Louis: Mosby.

22

INTERPRETING ARTERIAL BLOOD GASES

Arterial blood gasses (ABG’s) provide valuable information about the acid-base balance, ventilatory ability, and oxygenation status of a client. The major components are: pH, pCO2, HCO3, and pO2. Pulse oximetry (non-invasive measures) should be utilized before ABG’s are performed.

pH - reflects the blood’s acid-base balance. Buffering systems to maintain a normal pH are the respiratory and renal systems. In acidosis the pH decreases (below 7.35). In alkalosis the pH increases (above 7.45).

PaCO2 - reflects the respiratory system’s efforts to maintain a normal pH. When the blood becomes acidotic the respiratory system increases it’s rate and depth of ventilation to blow off CO2 and decrease the acid level in the blood. If the blood is alkalotic the respiratory system hypoventilates to retain CO2.

HCO3 - reflects the renal system’s efforts to maintain a normal pH. HCO3 is manufactured by the kidneys in response to acidosis. It takes several days for the kidneys to respond fully to changes in pH. If HCO3 is abnormal, the acid-base imbalance has a metabolic cause.

PaO2 - is the amount of O2 dissolved in the plasma. O2 saturation is the measure of hemoglobin saturated with O2. When 95% to 100% of

the hemoglobin carries O2, the tissues are receiving adequate amounts of O2.

ABG Component Normal Levels pH 7.35 – 7.45PaCO2 35-45 mmHgHCO3 22-26 mEq/literPaO2 90-110 mmHg

PRIMARY RESPIRATORY ACIDOSIS: due to airway obstruction, severe asthma, pneumonia, neuromuscular disorders, respiratory center depression (trauma, narcotics, sedatives).

pH pCO2 HCO3 Base excess/deficitAcute uncompensated D I N NEarly compensated D I I I (excess)Chronic compensated N I I I (excess)

PRIMARY RESPIRATORY ALKALOSIS: Due to hyperventilation (anxiety, fever, artificial ventilation), hypoxemia.

pH pCO2 HCO3 Base excess/deficitAcute uncompensated I D N NEarly compensation I D D D (deficit)Chronic compensated N D D D (deficit)

PRIMARY METABOLIC ACIDOSIS: Due to increases in nonvolatile H+ (prolonged vomiting of NG suctioning, diuretic therapy, adrenal steroid therapy), excessive bicarbonate intake, severe diarrhea, diabetic ketoacidosis, starvation/malnutrition, kidney failure, shock, burns.

23

pH pCO2 HCO3 Base excess/deficitAcute uncompensated D N D D (deficit)Early compensation D D D D (deficit)Chronic compensated N D D D or N

PRIMARY METABOLIC ALKALOSIS: Due to loss of H+ (prolonged vomiting or NG suctioning, diuretic therapy, adrenal steroid therapy), excessive bicarbonate intake cystic fibrosis.

pH pCO2 HCO3 Base excess/deficitAcute uncompensated I N I I (excess)Early compensating I I I I (excess)Chronic compensated N I I I or N

D = Decreased; I = Increased; N = Normal

REFERENCESKee, J. L. (2001). Handbook of laboratory and diagnostic tests. New Jersey: Prentice Hall.

Malarkey, L., & McMorrow, M.E. (1996). Nurse’s manual of laboratory tests and a diagnostic procedures. Philadelphia: W.B. Saunders.

Pagana, K. & Pagana, T. (1995). Mosby’s diagnostic and laboratory test reference (2nd ed). St. Louis: Mosby.

Treseler, K. (1982). Clinical laboratory tests. New Jersey: Prentice Hall.

Wilson, D., & Hockenberry, M. (2008). Clinical manual of pediatric nursing (7th ed). St. Louis: Mosby.

AZH/w07

24

CONCEPTS IN FLUID AND ELECTROLYTES FOR PEDIATRICS

**For further data recommend: www.labtestsonline.org

Glucose StressMalnutrition

Potassium DehydrationVomiting, diarrhea

Sodium Dehydration, vomiting, diarrheaV/D

Creatinine Dehydration

Chloride DehydrationProlonged Vomiting

Co2 Severe prolonged vomitingSevere diarrhea, dehydration, hypovolemia

Calcium DehydrationMalnutrition, prolonged IVF

HCT & HGB Anemia (RBC normal, borderline or decreased with RBC compensation for blood loss, tissue hypoxia).

MCV Mean volume or size of an RBCMacrocytic anemia (larger than normal) – folate or B12 deficiencyMicrocytic anemia (iron deficiency or thal.)

MCH Wt of HGB per RB CIn macrocytic anemiaIn microcytic anemia

MCHC Average amount of Hgb in each RBC – a percentagelevels are not possible.

Macrocytic anemia – MCHC is normalMicrocytic anemia – MCHC is

Most reliable to check for iron deficiency anemia

25

25LABORATORY RESULTS ** Culture Results:

**Diagnostic test results:Room Number __________ Patient ________________

TESTNormal Range

(age dependent)Admission

Date/Results Current

Date/Results Significance of Value for THIS PatientCBC/Diff

WBCRBCHGBHCTMCVMCHMCHCRDW-CV (%)PLTNEUT/SEGSLYMPMONOEOSBASOS

BilirubinTotal Bili 6.0-13.2U Bili 1.0-10.0C. Bili 0-1.2

BMPCa++BUNNa+K+C1C02

GluCreatReferences: Fishbach, F. A manual of laboratory & diagnostic tests (6 th Ed. (2000). NY: Lippincott Williams & Wilkins; Special Thanks to: Stephanie Gates (Nursing Class of 2004)

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Nursing 356Patient Initials ____

LABORATORY/DIAGNOSTIC TESTS:*

Normal Values - may Date/Hour Purpose of Test/ vary by age Patient’s Value Meaning of Abnormal Value CBC #1 #2WBC

5-103

RBCm 4.2-5.4/10

3

f 4.2-5Hgb m 13.5-17.5 q./dl.

f 12-16 q./dl.Hct m 40-50%

f 37-47%MCV 87-103MCH 26-34MCMH 31-37RDW 8.5-11.5Platelets 150,000-350,00

DIFFERENTIALLYMPH % 20-40%MONO % 2-6%NEUTRO (PMNs) 60-70%EOSINO 1-4%BASO 0.5-1%CHEMISTRIESSODIUM 138-144 M Eq/LPOTASSIUM 3.4-4.7 M Eq/LCHLORIDE 97-107TCO2 23-30 mmol/literGLUCOSE 60-100(F), 70-115(NF)HbA1c 4.0-7.0%CREATININE 0.3-0.7 mg/dlANION GAP <+ 12 mEq/l**BUN/Creat Ratio 15-24/1OSMOLARLITY 275-295Ca 9.2-11.0 mg/dlPhos 4.5-5.5BUN 5-18 mg/dl

Chol 140-250Total Protein 6.0-8.0Albumin 3.8-5Total Bilirubin 0.2-1 mg/dlSGOT/AST 25-75SGPT/ALT 5-28 U/LLDHCPK

CLOTTING TESTSAPTT 16-25 secondsPT 10-14 seconds

(F)=fasting, (NF)=non-fasting *Where applicable, values reflect those for children.**<16 mEq./liter if potassium concentration is used to calculate annion gap .

Normal Patient PurposeBLOOD GASESpH 7.35-7.45PCO2 39 +/-7PO2 80-100HCO3 24 +/-2B.E. 3 +/-2O2SAT % 95+URINALYSISSp. gr. 1.015-1.025pH 4.6-8.0protein Neg.glucose Neg.ketones Neg.bilirubin Neg.WBC 10-4/HPFRBC 1/HPFEpith. 0-occasionalCasts 0-occ. hylineBacteria Nitrate

0

CULTURE(S)BloodUrineWoundOtherCSF***Clarity crystal clearPressure 50-180 mH20Total cellcount 0-5 WBC (lymphocytes)glucose 40-70 mg/dlProtein

ESR/Sed rsteCRPOther

EKG Results: ______________________________________________________________________________________________________________

X-ray Results:______________________________________________________________________________________________________________

Other: ______________________________________________________________________________________________________________

Reference: Fischback, F. (1992). Laboratory diagnostic tests (3rd ed.).Philadelphia: Lippincott.

JGR/1992/RJG/1994/azh dec07

27

Pediatric Neurologic Assessment

Older Child & Adult Infant & Young ChildSpontaneously 4 Spontaneously 4

EYES To speech 3 To loud noise 3OPEN To pain 2 To pain 2

No response 1 No response 1

Older Child & Adult Infant & Young ChildObeys commands 6 Spontaneous movement 6

BEST Localizes pain 5 Withdraws to touch 5MOTOR Flexion withdrawal 4 Withdraws to pain 4

RESPONSE Flexion to pain (decorticate) 3 Abnormal flexion (decorticate) 3Extension to pain (decerebrate)

2 Abnormal extension (decerebrate) 2

No response 1 No response 1

BEST > 2 years old < 2 years oldRESPONSE Orientation 5 5 Smiles, listens, follows

TO Confused 4 4 Cries, consolable, irritableAUDITORY Inappropriate words 3 3 Inconsolable, persistent cry

AND/OR Incomprehensive words 2 2 Restless, moans, gruntsVISUAL No response 1 1 No response

STIMULUS Endotracheal tube or trach T

Coma Scale Total (0-15)

Remember that a neurologic scale determines the level of consciousness. The total score reflects the brain's functional level. The lower the score, the closer to coma (< 8).

Recognize what is normal for the child and expected related to growth and development.

In children < 5 years old, speech is taken as any sound at all, even crying.

Modified from:

James, H.E., Anas, N.G., Perkin, R.M. (1985). Brain insults in infants and children. Orlando, FL: Grune & Stratton.

Azh/w07

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N356Practice Test: Pediatric Medication Administration

Name: Instructor: Date:______________________________________________________________________________

1. Physician’s order reads Tylenol Elixir 7 gr p.o. (Label states 120mg/5ml.)How many ml’s will you give?

2. Physician’s order states Ampicillin 80mg p.o. (Label states 125mg/5ml.)How many ml’s will you give?

3. Physician’s order states Lanoxin .08mg p.o. (Bottle states .05mg/ml.)How many ml’s will you give?

4. Physician’s order states Lasix 16 mg/I.V.P. (Label states 20 mg/2ml).How many ml’s will you give?

5. Physician’s order states Solumedrol 2mg/kg loading dose, give now. Then Solumedrol 0.75mg/kg/dose every 6 hours (maintenance). Your patient weighs 31 pounds.

How much will you give for the loading dose?

How much will you give for the maintenance dose?

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7. Physician’s order states Amipicillin 160 mg I.V.P. You have diluted the 250 mg Ampicillin vial with 2.5ml normal saline. After withdrawing the entire amount from the vial, you have a total of 2.8 ml.

How much will you give?

7. Physician’s order states Valium 2mg I.V. (Label states 10 mg/2ml.)How much will you give?

8. Physician’s order states Tylenol Elixir 4 grain p.o. (Label states 120mg/tsp.)How many ml’s will you give?

9. Physician’s order states Phenobarbital 15 mg p.o. (Label states 20mg/5ml.)How much will you give?

10. Order reads: Administer NS bolus 100ml/kg over 2 hours. Your patient weighs 25 lbs.

How much total fluid will you give in the bolus?

How many mls’ will you adminster per hour?

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11. Order reads Theophylline 60 mg IVPB q 6 hours. (Theophylline dosage is 5-6mg/Kg/day). The patient’s weight is 12Kg. How many mg/Kg/day is the child receiving? Is the dose appropriate for this patient?

12. Order reads Gentamycin 5mg IVPB q 8 hours. (Gentamycin does is 5mg/Kg/day). The patient’s weight is 3Kg.

How many mg/Kg/day is the child receiving? Is the dose appropriate for this patient?

13. Using the formula in this syllabus Expanded Syllabus (Special considerations with pediatric medication administration safety), calculate the 24-hour fluid requirement for each of these patients:

a. 4-month-old male, pneumonia, 6.2 kg.

b. 5-year-old female, gastroenteritis, 50 lbs.

c. 12-year-old male, MVA, 98 lbs.

Azh dec08

31


Nursing 356Perioperative & Operative Learning Objectives & Assignment

Assignment:

At the completion of this experience, the student will be able to:

1. State the patient’s age, medical diagnosis, and surgical procedure being performed. (__/2)

2. Attach/ discuss the pathophysiology. Relate results of diagnostic tests and labs to your patient and their current health status. (_____/13)

3. Discuss the developmental considerations for the child you followed – include the stages of growth and development they were in and age appropriate teaching methodologies that could be utilized (use references). (_____/15)

4. Describe, in detail, the preoperative process and its effect on the pediatric client. Compare what is discussed in your textbook with what actually occurs. (____/15)

5. Identify and explain the different types of uses of anesthetic agents: inhalation agents, intravenous agents, muscle relaxants and regional anesthetics. (Use references.) Next discuss which ones were used for your client. (_____/15)

6. Discuss the OR environment and the effect on the client. Identify specific nursing roles and other team member roles in the operating setting. Compare what you observed with what is described in your textbooks. (Use references.) (_____/10)

7. Discuss the postoperative progress and its effect on the pediatric client. Discuss specific criteria for discharge and home care instructions for the patient you followed.

(_____/10)

8. Identify the top (prioritized) nursing diagnoses for each of these areas. Be sure to personalize for your specific pediatric patient. (______/18 –> 3 points each)

Preoperative (2 nursing diagnosis)Operative (2 nursing diagnosis)Post anesthetic (2 nursing diagnosis)

9. APA style and Reference List. (_____/2)

Review Craven & Hirnle; James & Ashwill; Wong spiralAzh/dec.08


32

Department of Nursing

Nursing 356

What to Do in NICU

1. Meet your preceptor and listen to change-of-shift report, scrub in.

2. Check MD orders and progress notes.

3. Review current labs and diagnostic testing results.

4. Review the most current progress notes and notations from other disciplines.

5. Obtain vital signs and assess your patient with your preceptor.

6. Write up a complete assessment.

7. Assist your preceptor in implementing the plan of care.

8. Assist with nursing procedures such as po/ng/og feedings.

9. Calculate drip rates on all IV’s and IV meds.

10. Document all patient data as per protocol (e.g. VS, bedside tests, I&O, cluster care, etc.)

11. Interact with parents and provide emotional support as appropriate.

12. Evaluate the effectiveness of your nursing care with your preceptor and modify care accordingly.

13. Complete a mini or short pediatric Nursing Process Plan.

Azh/Dec. 2008

33


Nursing 355

Directions for Pediatric Process Plans with Functional Health Patterns:

Long Pediatric Process Plan:

Page one of format:

Fill in the front sheet of the assessment. This sheet must be completed prior to giving nursing care. Pay careful attention to the current diagnosis as it may be different from the admission diagnosis.

Page two: One point will be deducted for lack of highlighting per section.

1. Patho: Integration of patho to show how disease processes may impact each other (i.e., impacting and/or conflicting), or labs, medications and treatments. A branching diagram is required with highlighting of your patient’s particulars so the information is personalized. Two references are required, one MUST BE a pediatric source or points will be deducted.

2. Developmental level: Complete using Wong or Ashwill as a guide. Highlight what pertains to your patient. No photocopies allowed.

Page three: Complete medication worksheet. List the information for each medication ordered, not just those given during your care. Don’t forget to include the IV administration rates.

Pages 4-7:

1. Subjective Assessment columns: To complete the subjective data information, obtain data from the following sources: the client, the health history form, the family or the chart. You are encouraged to use the admitting nursing information and the physician’s data from the chart. Use the guidelines to elicit information for each area. Address all of the Functional Health Patterns in this manner. May use Wong’s Clinical Manual of Pediatric Nursing Functional Health Pattern (FHP) Cues (check INDEX for page number). Highlight any abnormals.

2. Objective Assessment column: Physical assessment : In the objective data block, record your physical health assessment using Wong, Jarvis, or Ashwill. Address each Functional Health Pattern. Add any particulars that may be necessary for your patient even if the prompts are not listed. Highlight any abnormals.

3. Lab and Diagnostic column and additional Lab sheet: Gather supportive data to substantiate observations with labs, procedures, and other objective data. Lab tests should be reflected in each FHP where it is appropriate, although they may be relevant in more than one FHP. Identify the abnormal values with arrows reflecting high or low values. Then on the “lab sheet” give the values with the significance/meaning of the abnormals for

34

this patient. Be sure to attend to the relevance for your patient. List the normal labs also to demonstrate ruled out problems.

4. Nursing Diagnosis column: Each FHP needs at least one nursing diagnosis. List the NANDA, wellness, or collaborative problems that apply to your patient. (1) Use the NANDA wording. (2) Define the statement by “related to” (etiology here) or “risk for” (Wilkinson, p. xv). (3) May use “secondary to” (use medical diagnosis here). (4) Using the term “manifested by” identify the “defining characteristics” (Wilkinson, p. xiii). (5) If there are no NANDA or collaborative problems, include a wellness diagnosis.

Page 8

Nursing Diagnosis Priority List:

List on the separate sheet, the top 5 to 8 Nursing Diagnoses (using NANDA wording) with the priority number, rationale for selection, and reference for each. Include at least one wellness and one collaborative diagnosis.

Page 9

Plan of Care:

1. Column 1: Select the top two Nursing Diagnoses that you will be focusing on during your care. Again, use NANDA wording to list.**

2. Column 2: Prioritize as to whether “1” or “2” and give rationale for this prioritization. Include reference to substantiate your choice.

3. Column 3: Give NOC, followed by patient centered goal and measurement criteria (note this is 3 bits of information).

4. Column 4: NIC, followed by planned nursing interventions with “who,” “when,” “how often,” etc. (Wilkinson, p. xvii), and rationale for the specific nursing interventions with references.

5. Column 5: The final area is the evaluation of the goal and measurement criteria, including which nursing interventions were actually implemented, how successful they were and what changes were needed.

**Confirm that any data that you have used in your NANDA for “as demonstrated by” is documented somewhere.

Note: Each goal and nursing activity must be personalized for your specific patient using age, developmental level, medical diagnosis, activity limitations, needs, etc. Do not just copy from Nursing Diagnosis books or programs.

35

Short Pediatric Process PlanPage 1: Fill in the front sheet of the assessment. This sheet must be completed prior to giving nursing care.

Page 2: One point will be deducted for lack of highlighting per section.

Patho: Begin integration of patho with labs, medications, and treatments. Patho must include all areas listed. See note under long care plan for criteria. A branching diagram is required. Highlight your patient’s particulars so the information is personalized.

Lab and Diagnostic Section and additional Lab sheet:Gather supportive data to substantiate observations with labs, procedures, and other objective data. Identify the abnormal values with arrows reflecting high or low values. On the “lab sheet” give the values with the significance/meaning of the abnormals for this patient. Be sure to attend to the relevance for your pt. List the normal labs also to demonstrate ruled out problems.

Developmental Level:Complete using Wong or Ashwill as a guide. Highlight what pertains to your client.See note under long care plan for criteria.

Medication Worksheet:On the medication sheet list the information for each medication ordered, not just the medications you will give during your care. (See “Medication Worksheet: Instructions for Use,”in expanded syllabus). Be sure to include administration rates for all IV medications.

Physical Assessment:Complete form. Highlight abnormal findings.

Concept Plan:Be sure to develop the primary medical diagnosis needing attention during your care. Step#1- Start by completing the reason for seeking health care (chief complaint and medical diagnosis- CENTER). Also: Identify key assessments that are relate to the reason for health care and growth and developmental considerations.Step#2- List the major problems (key problems) you have identified based on the assessment data collected on the patient.Step#3- Support problems with clinical patient data: abnormal physical assessment findings, nutrition, treatments, nursing care, medications, activity level, IV’s, abnormal diagnostics and lab tests, medical history, emotional state, cognition, and pain.Step#4- Number to prioritize problems, and label each problem with appropriate nursing diagnosis and FHP. Be sure to include at least one wellness diagnosis and one collaborative problem on your care map.

Mini Care Plan: Complete when a patient has gone home, or a 2nd patient is assigned.Option: If your patient is discharged early in the shift, you may just hand in the first 2 pages of the long or short process plan, plus the Medication Administration form.

When 2 patients are assigned at the beginning, one long or short process plan is due, with one mini plan.

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Team Nursing Complete the “N356 Team Nursing” individual pt work-up for every pt on your team. No pathos are required. Medication worksheets are required for each patient on your team. Complete the “Team Objectives for Play Therapy” objectives. This assignment is to be worked on together as much as possible. Each person in the group must hand in their own individual copy (even though it may be identical for each person in the group). Please state who completed which areas of the assignment. On the day of care work together as much as possible completing assessments, treatments, documentation, baths, etc. You may want to assign medication administration based on “who needs what” on their skills checklists. DO NOT just assign each person their own patient to work on independently, this defeats the purpose of the assignment.

Medication WorksheetInstructions for Use:

1. List all ordered medications by name:Generic Name- The name shown in lower case letters (is often

derived from the chemical name).

Brand Name- The name designed/designated by the drug manufacturer (is capitalized).

2. Classification: Clinical indication and body system.The classification of the drug leads to understanding of common characteristics of other medications from the same classification.

3. Route and Dose: Every medication should have the dose and route the doctor ordered. If administrating an IV medication, include rate.

4. Pharmacokinetics:Peak, onset, duration of action. Where metabolism occurs.

5. Side-effects: Are listed by system, with the most commonly occurring listed first.

6. Management/Pt Care: Important assessment data, information to provide to the patient/family, how to evaluate the patient receiving the med.

7. Calculate the actual medication dose ordered by the doctor (how many mg/kg/dose or day the patient is receiving). Compare (using your medication book) the recommended dose for your patient (how many mg/kg/dose or day).

At the bottom of the page be sure to list the IV solution ordered. Include rate, site, rationale/purpose. Is the rate appropriate for the 24-hour fluid requirement and diagnosis? Why?

37

COMMUNITY ROTATION Log of Community Hours and Teaching Project Hours

Student Name: ____________________________________________________Clinical Faculty Person: _____________________________________________

Date Time Arrived Time Left Total Hrs. CommunityFacility/Experience

Preceptor Signature

*Reminder: A minimum of 16 community hours required.

38

California State University, BakersfieldDepartment of Nursing

PEDIATRIC LONG NURSING PROCESS PLANStudent Name:_________________________________________________ Date of Admission: ____________________________Faculty:______________________________________________________Date of Care____________________ Unit_________________________ Room #: ____________________________________PATIENT INFORMATION:PT Initials: ___ Age ___ Gender ___ Race/Ethnicity __________ Primary Language __________ Religious Affiliation __________Current Medical Diagnosis: ____________________ Admit Reason/Symptoms:__________________________________________Current surgeries or procedures (Planned or performed with date):______________________________________________________Past Medical History (Other Medical Diagnoses/Illnesses/Surgeries, give date if in last year):________________________________Family (Genetic) History of Diseases:_____________________________________________________________________________Educational Level: _______________ Living Arrangement:___________________________________________________________Discharge Plan and educational needs (Parent./Child):___________________________________________________________________________________________________________________________________________________________________________Allergies & Reaction:_________________________________________________________________________________________Precautions (circle) confusion, suicide, paralysis, infant or toddler, fall risk, other:_________________________________________Advance Directives (Do Not Resuscitate/Other): Yes _____ No _____ Comments:________________________________________

DAY OF CARE IV Solution/additives and rate_______________________________________________Primary physical assessment area:_____________________ Respiratory Care:__________________________________________All current MD orders for day of care_____________________________________________________________________________Diagnostic studies treatment for day of care (x-ray, ultrasound, CT, etc.)________________________________________________A.M. Prioritize activities for nursing care (activity, vs., diet, hygiene, education, play) 1.____________________________________2.__________________________________________________ 4.___________________________________________________3.__________________________________________________ 5.___________________________________________________

Reprioritization : Midday _________________________________________________________( pg1 - ________/ 5 points)On the back of this page: Patho (_______/5 points)

39

Use a diagrammatic approach, briefly relate the pathophysiology of the patient’s diagnosis. Provide a definition of the problem, its etiology, and/or epidemiology. Identify the following areas relevant to the pathophysiology of the patient’s disease/illness/diagnosis: signs and symptoms of the disease, relevant laboratory studies with indication of values if high or low (blood, or other body fluid tests); diagnostic studies (x-rays, ultrasound, electrocardiograms, etc). Identify the interventions (surgical procedures, interventional procedures, types of medications, etc.) used to treat/cure this disease or illness. Describe the complications (PC) that can develop from this disease/illness. List specific nursing interventions provided to treat this disease/illness or to prevent complications from this disease/illness. Highlight all that apply to your patient.Identify whether this is an ACUTE ILLNESS (Treatable/curable without any sequelae); CHRONIC (requiring continued treatment—specify what is required); TERMINAL. At least one reference must be from a pediatric source.

References:1.2.

Lab/ Radiology/Diagnostic Tests: Attach (_____/5 points)

Developmental Level: (______/5 points)

1. Develop a comprehensive list of expected developmental milestones. After caring for your pt, highlight milestones achieved.

Cognitive:

Social:

Physical:

Gross/fine motor:

2. Discuss the Developmental level your patient is in according to the following theorists:

Erikson (psychological):

Piaget (cognitive):

Freud (psychosexual)

Reference:

40

Nursing 356 Medication Worksheet Current Wt _____

Medication NameGeneric/Brand Classification Route &

Dose, RatePharmacokinetics Side-Effects

Management/Patient Care

Calculate & CompareActual/Recommended

mg/kg/doseAre doses appropriate?

IV Therapy Soln Rate Site Rationale/Purpose PO +IV intake appropriate to meet 24 hr fluid requirement?Show Calculations.

Calculation of 24 hr. Fluid Requirement:

References: (___________/10 points)

41

+Subjective information may be from client, family, nurse admitting notes, or physician H & P or notes. If source is other than client, please state. Each FHP is worth 5 points.

C = Client F = Family Nsg = Nursing Admit P = M.D.

Subjective+(Prior to Hospitalization)

Objective(During Your Care)

Lab/Diagnostic tests/Give the significance of test

and abnormals*Nursing Diagnosis/List in

each FHP*/Prioritize1. Health Perception & Management

Pattern

Reason for admission

General health

Previous hospitalizations

Meds taken at home

Alternative/Complementary therapies use:

Immunizations:

Safety/Risk for Injuries based on growth and development

Health perception & managementVitalsp________ R_______T ________ BP______

General Appearance:Grooming

Posture

Facial expression

Physical description

Physical (percentile on growth chart)HT-WT-HC-

(____/5 points)

*For lab values, list significance of each lab with possible implications on laboratory form. If value is used for more than one FHP, list lab name in each area. Do not repeat values, but make a note to refer to previous FHP. The significance must reflect data that is personal and pertinent to your patient and FHP. Highlight any abnormal lab values identified.Highlight any problem identified. For any problem or potential problem identified, a nursing diagnosis is required. If within a specific FHP no problems are identified at least one wellness diagnosis is required. At least one collaborative problem is required in the appropriate FHP.

42

Subjective Data(Prior to Hospitalization)

Objective(During Your Care)

Lab/Diagnostics Nsg DiagnosisUse FHP

2. Nutritional-Metabolic Pattern

Favorite foods, beverages, snacks:

Foods/beverages disliked:

Feeding habits (bottle, cup, spoon, special devices):

Food allergies

Food restrictions

Difficulty with chewing, swallowing, sore gums, or tongue, spitting up

N&V, abd pains, stomach cramps

Skin, hair, nail conditions

Healing

Weight loss/weight gain__________________________________________________3. Elimination Pattern

Toilet habits: diaper, potty, toilet

Bowel habits: frequency __________ color __________ pain __________consistency__________

Special Considerations:

Bladder Habits: Color __________frequency __________ amt __________

Special Considerations:

Nutritional-Metabolic PatternSkin: Head:Fontanelles:Nails: Mouth/oral:Teeth:Throat:Dressing/Drains __________Supportive Data:IV Site:12˚ fluid intake:Diet: __________ Rationale for diet:

Tube feedings __________TPN/Hyperal __________Lab: cbc, wbc, albumin, protein, blood sugar electrolytes_____________________________________Elimination PatternAbdomen (GI)

BM:

Gu:

Supportive data:Output __________ (cc/12 hr)Lab: urinalysis__________ SG __________ Culture__________Guiac __________ U-stix __________Procedures, x-rays

_______________

(______/5 points)

_________________ (_____/5 points)

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Subjective(Prior to Hospitalization)

Objective(During Your Care) Lab/data Nursing Diagnosis

4. Activity-Exercise Pattern

Child’s daily schedule

Child’s favorite activities or toys:

TV viewing, activities at home:

Limitations in activities:

Usual bathing schedule:

Dental habits (brushing, flossing, dental care):

Musculoskeletal

Supportive Data:x-rays; procedures; lab: sed rateRespiratory

Cardiovascular

Supportive Data:CVL, Blood gases, cbc, Monitor, EKGOther procedures (ECHO etc.)

(_____/5 points)

5. Cognitive-Perceptual Pattern

Hearing difficulty __________Aid __________Vision __________ Glasses/contacts __________Myringotomy tubes __________Ability to communicate __________Educational Level __________Learning difficulties (explain):

Glasgow (use pediatric scale)eyes open __________ motor __________audio & visual _________ Total__________Ears: Eyes: Nose:Reflexes :NeuroPupils __________Orientation __________ Grips__________ Pain __________ Supportive DataCranial Monitoring, lab, procedures, EEG

(____/5 points)

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Functional Health Pattern: Subjective (Prior to Hospitalization)

Objective(During hospitalization) Nursing Diagnoses

6. Sleep Rest patternUsual bedtime __________Usual awakening time __________Naps __________Bedtime Rituals __________Type of bed __________Home sleeping arrangements

Observed sleep/rest pattern: (_____/5 points)

7. Sexual ReproductiveNormal male/female genitalia:

Begun puberty? __________ Performs SBE or TSE? __________

Tanner Stage:Appearance of Genitalia

(_____/5 points)

8. Value-Belief Pattern(with cultural considerations)Practice of religion? __________________Cultural practices? ____________________Languages spoken ___________________Religious practices that affect health or childrearing?

Observed religious articles, practices, culture: (_____/5 points)

9. Coping-StressWhat does child do when tired or stressed?

Temper tantrums? ___________________How does your child handle problems/ disappointments?

Observed coping/stress: (_____/5 points)

10. Self-Perception - Self-ConceptHow would you describe your child?

Fears?

Effect of illness on behaviors: (_____/5 points)

11. Role Relationship PatternNames & ages of people living in the home:

Pets:

Observed family interactions: (_____/ 5 points)

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List/Prioritize top 8 Nursing Diagnoses with FHP. (List must include a minimum of one wellness diagnosis and one collaborative problem.) (________/5 points)

Nursing Diagnosis Priority List Rationale for Selection (reference required)

1. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

2. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

3. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

4. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

5. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

6. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

46

7. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

8. ________________________________________ _________________________________________

________________________________________ _________________________________________

________________________________________

47

Plan of Care with NANDA, NOC and NIC (________/5 points)

Priority from Nursing Diagnosis Sheet, FHP,

and NANDA Diagnostic Statement

Nursing Outcome Desired During Your

Shift (NOC)

Nursing Activities:List 3-4, at least one

must be hands on. List who will perform. (NIC)

Rationale for Each of Your Nursing

Activities.Use References.

Based on NOC Outcome Criteria, Evaluate Nsg

Activities. GoalsIf not met, what will you

change?

Priority #1:

FHP:

NANDA Statement:

NOC Outcome:

Patient Goals:

Measurement Criteria:

NIC:

1.

2.

3.

4.

Rationales:

1.

2.

3.

4.

Reference(s):

Goal was: (circle one)Met Not Met

Partially Met (explain):

Evaluation of Nursing Activities:

Based on measurement criteria:What was happening with your patient?

What will you change?(priority, goal, actvities)

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Plan of Care with NANDA, NOC and NIC (________/5 points)

Priority from Nursing Diagnosis Sheet, FHP,

and NANDA Diagnostic Statement

Nursing Outcome Desired During Your

Shift (NOC)

Nursing Activities:List 3-4, at least one

must be hands on. List who will perform. (NIC)

Rationale for Each of Your Nursing

Activities.Use References.

Based on NOC Outcome Criteria, Evaluate Nsg

Activities. GoalsIf not met, what will you

change?

Priority #2:

FHP:

NANDA Statement:

NOC Outcome:

Patient Goals:

Measurement Criteria:

NIC:

1.

2.

3.

4.

Rationales:

1.

2.

3.

4.

Reference(s):

Goal was: (circle one)Met Not Met

Partially Met (explain):

Evaluation of Nursing Activities:

Based on measurement criteria:What was happening with your patient?

What will you change?(priority, goal, actvities)

49

California State University, Bakersfield Department of NursingPEDIATRIC SHORT NURSING PROCESS PLAN

Student Name:_________________________________________________ Date of Admission: ___________________________Faculty:______________________________________________________Date of Care____________________ Unit_________________________ Room #: ___________________________________PATIENT INFORMATION:PT Initials: ___ Age ___ Gender ___ Race/Ethnicity __________ Primary Language __________ Religious Affiliation __________Current Medical Diagnosis: ____________________ Admit Reason/Symptoms:__________________________________________Current surgeries or procedures (Planned or performed with date):______________________________________________________Past Medical History (Other Medical Diagnoses/Illnesses/Surgeries, give date if in last year):________________________________Family (Genetic) History of Diseases:_____________________________________________________________________________Educational Level: _______________ Living Arrangement:___________________________________________________________Discharge Plan and educational needs (Parent./Child):___________________________________________________________________________________________________________________________________________________________________________Allergies & Reaction:_________________________________________________________________________________________Precautions (circle) confusion, suicide, paralysis, infant or toddler, fall risk, other:_________________________________________Advance Directives (Do Not Resuscitate/Other): Yes _____ No _____ Comments:________________________________________

DAY OF CARE IV Solution/additives and rate_______________________________________________Primary physical assessment area:_____________________ Respiratory care___________________________________________Current MD orders for day of care_______________________________________________________________________________Diagnostic studies treatment for day of care (x-ray, ultrasound, CT, etc.)_________________________________________________A.M. Prioritize activities for nursing care (activity, vs., diet, hygiene, education, play) 1.___________________________________)

2.__________________________________________________ 4.___________________________________________________3.__________________________________________________ 5.___________________________________________________

Reprioritization : Midday (pg1- ________/5 points)

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On the back of this page: Patho (________/10 points)

Use a diagrammatic approach, briefly relate the pathophysiology of the patient’s diagnosis. Provide a definition of the problem, its etiology, and/or epidemiology. Identify the following areas relevant to the pathophysiology of the patient’s disease/illness/diagnosis: signs and symptoms of the disease, relevant laboratory studies with indication of values if high or low (blood, or other body fluid tests); diagnostic studies (x-rays, ultrasound, electrocardiograms, etc). Identify the interventions (surgical procedures, interventional procedures, types of medications, etc.) used to treat/cure this disease or illness. Describe the complications (PC) that can develop from this disease/illness. List specific nursing interventions provided to treat this disease/illness or to prevent complications from this disease/illness. Highlight all that apply to your patient.Identify whether this is an ACUTE ILLNESS (Treatable/curable without any sequelae); CHRONIC (requiring continued treatment—specify what is required); TERMINAL. At least one reference must be from a pediatric source.

References:1.2.

*Please attach laboratory/diagnostic test form with your patient’s results. (_____/10 points)

Developmental Level: (_______/10 points)

1. Develop a comprehensive list of expected developmental milestones. After caring for your pt, highlight milestones achieved.

Cognitive:

Social:

Physical:

Gross/fine motor:

2. Discuss the Developmental level your patient is in according to the following theorists:

Erikson (psychological):

Piaget (cognitive):

Freud (psychosexual)

Reference:

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Nursing 356 Medication Worksheet Current Wt _____

Medication NameGeneric/Brand Classification Route & Dose

Rate if IVPharmacokinetics Side-Effects

Management/Patient Care

Calculate & CompareActual/Recommended

mg/kg/doseAre doses appropriate?

IV Therapy Soln Rate Site Rationale/Purpose PO + IV intake appropriate to meet 24 hr fluid requirement?

Show Calculations

Calculation of 24 hr. Fluid Requirement:

(_______/10 points)

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53

PHYSICAL ASSESSMENT Date: __________ Time: __________ (____/25 points)(Please highlight abnormal findings)

Current vital signs, Ht/Wt/ HC and percentiles from growth chart:

General Survey:

Skin:

Head:

Eyes/Vision:

Ears/Hearing:

Nose:

Mouth/ Throat:

Neck:

Heart:

Thorax/Lungs/Breasts:

Abdomen/ GI:

Genitalia/GU:

Spine/ Back/ Extremities/MS:

Neurologic/Glasgow/Reflexes:

Psychosocial:

Pain:

Describe IV site:

Subsequent Assessment Date: __________ Time: ___________

Please note any changes from when you performed the initial assessment.

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INSERT SHORT CARE PLAN, Concept Plan (from link on Amy Hedden’s Website)

(_______30 points)

54

N356TEAM NURSING

Student __________________________________________Other Team Members:______________________________

Room # _____ Patient _____ Diagnosis

Age _____ Sex _____ Concurrent Dx/Problems

Allergies__________________ Diet ____________ Wt.____ 24 Fluid Req._______________

Medications/IV Fluid TherapyAttach Form

Nursing Care (Hygiene, feeding, treatments) and Current MD orders:

Nursing Diagnoses/Client Problems (Prioritized)1.2.3.

Important labs & diagnostic tests: (give results and explain how relates to pt)

****************************************************************************Room # _____ Patient _____ Diagnosis


Allergies________________Diet_____________ Wt._____ 24 Fluid Req._________________

Medications/IV Fluid TherapyAttach Form

Nursing Care (Hygiene, feeding, treatments) and Current MD orders:

Nursing Diagnoses/Client Problems (Prioritized)1.2.3.

Important labs & diagnostic tests: (give results and explain how relates to pt)

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Team Objectives for Play TherapyPlay therapy report: (_________/30 points)

Submit with one team care plan a written summary describing how you accomplished the specific objectives for play therapy.

For children, play serves the functions of sensorimotor development, intellectual development, creativity, self-awareness, and therapeutic communication.

Play Therapy: During one day of an acute care (hospital) team clinical experience, the student will:

1. Identify and discuss the actual chronological and developmental ages of children on their pediatric team.Include stages of growth and development using appropriate theorists.

2. Identify play related materials available on the pediatric unit. Discuss appropriateness related to: safety, cultural, considerations, age and development.

3. Plan at least two developmentally appropriate play activities for each child on your team.

4. Evaluate the effectiveness of implemented play activities, i.e., play room, game, coloring, storytelling, videogame, that requires interaction between yourself and the children on your team.

5. List (posted) rules for the playroom on your unit. What does your theory book state about playrooms in health care settings (p.316)? What does Wong’s clinical manual state about toy safety?

6. State how each individual on the team contributed to the groups work.

Each person in the group must submit a completed copy of the entire assignment.

Suggested readings:

James, S. & Ashwill, J. (2007). Nursing care of children. (3rd ed). Philadelphia: W. B. Saunders.

Wilson, D. & Hockenberry, M. (2008). Wong's clinical manual of pediatric nursing (7th ed.). St. Louis, MO: Mosby.

Student _____________________________ Date of Care

56

NURSING 356 - MINI CARE PLAN

Room # _____ Patient _____ Diagnosis


Allergies Wt ______ 24 fluid req______________ Diet____________

MedicationsDrug Dose Route Time Purpose Nursing Considerations Calc. Doses

IV Fluid Therapy:Type of Solution Additives Rate IV Site Appropriate?

Prioritized Nursing Diagnoses/Client Problems (Risk, Actual, Wellness, Collaborative)1.

2.

3.

4.

Planned Nursing Activities/Care/Special Considerations for this Child

Developmental/Play Considerations:

Lab and Diagnostic test results—relate to patho:

**Write the pathophysiology on the back of this sheet. Highlight data specific to your patient.

57

NURSING 356Ethical Dilemma- Description of Assignment

Over the course of the quarter, describe ONE situation that occurred in a clinical area (hospital or community setting) that provoked strong emotions. Discuss all information about the case that is significant to clarify the ethical conflicts, including: who is involved, available choices, and possible outcomes. Use the “Principles and Rules of Healthcare Ethics” and the “Seven Essential Values” discussed below to guide you in writing your entry. Use the format provided to record your entry. Must use at least one reference.

For Ideas: Review “Wong’s clinical manual of pediatric nursing” (2008) “Common Ethical Dilemmas…”, pg 339.

Supportive Data on Ethics

Ethics refers to standards of conduct and moral judgment reflecting values. Healthcare ethics pertain to how professional nurses fulfill their responsibilities and provide care to their clients. As nurses it is important to distinguish between personal values and professional ethics, and avoid allowing personal judgments from biasing treatment of clients. In an ethical dilemma, a situation exists in which no solution is completely satisfactory. An ethical dilemma occurs when the following exist: two or more choices are available, and it is difficult to determine which choice is best; the needs of all those involved cannot be solved by the available choices.

Principles and Rules of Healthcare Ethics:

1. Beneficence: Promoting good; striving for optimal client outcomes.2. Nonmaleficence: Avoid doing harm; not causing pain or suffering.3. Autonomy: Self-determination; ct’s right to make decisions about their treatment/care; respect,

privacy.4. Justice: Fairness; obligation to treat all clients in an equal and fair way.5. Veracity: Telling the truth; being honest with the client.6. Fidelity: Being faithful to commitments and promises; providing safe and competent care.7. Confidentiality: Keeping client information private; not discussing client information outside of the

clinical setting.

REFERENCE: Craven & Hirnle; James & Ashwill; Wilson & Hockenberry

Seven Essential Values1. Altruism: Concern for the welfare of others.2. Equality: Having the same rights, privileges, or status.3. Esthetics: Qualities of objects, events, and persons that provide satisfaction.4. Freedom: Capacity to exercise choice.5. Human Dignity: Inherent worth and uniqueness of an individual.6. Justice: Upholding moral and legal principles.7. Truth: Faithfulness to fact/reality

REFERENCE: AACN, 1986, pp. 6-7. Azh/Dec.2009

58

Ethical Dilemma

Student

Clinical Setting Situation Occurred in

Description of Situation and Ethical Conflict:

Available Choices:

Possible Outcomes:

Principles/Rules of Healthcare Ethics Involved: (Select top 3 and describe)

Essential Values Involved: (Select top 3 and describe)

Actual Outcome:

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BASIC NEEDS ASSESSMENT IMMUNIZATIONS

59

This assignment must be handwritten!

1. Discuss these diseases in 2 to 3 sentences: the causative agent, how it is transmitted, and manifestations of the disease if it is contracted. Be sure to include why these are serious diseases. ( ______30 points)

DISEASE Causative agent/ Transmission/ Disease Manifestations Haemophilus Influenzae B

Hepatitis A

Hepatitis B

Polio

Diphtheria

Tetanus

Pertussis

Mumps

Measles

Rubella

Varicella

Streptococcus pneumoniae

Neisseria meningitides

HPV (Human papillomavirus)

Rotovirus

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Influenza/H1N1

2. According to the most current childhood immunization schedule, list the number of required doses and when the following vaccines are routinely recommended to be given. Example: HPV: Human Papillomavirus- 3 dose series: 1st dose now; 2nd dose = 2 months after dose #1; 3rd dose = 6 months after dose #1. Recommended for girls 11-12 years of age. (________/30 points)

Immunization Number of doses needed Schedule

Hep A

Hep B

DTap

Tdap

Td

HiB

Polio

MMR

Varicella

Pneumococcal

Meningococcal

Rotovirus

Influenza

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3. Complete the following table. List the most common side effects for each specific vaccine. Identify by which route they are given. Discuss who may not be able to receive this vaccine. ( _____ /28 points)

Vaccine Route/Dose Common Side Effects Who May Not ReceiveExample: HPV IM/ 0.5ml Mild problems: redness, swelling, pain,

itching at injection site, mild fever Anyone having a life-threatening allergic reaction to yeast or any other component of the HPV vaccine; Pregnant women. Anyone with moderate or severe illness.IPV

HiB

Hep B

Hep A

DTaP/Tdap/Td

MMR

Varicella

Pneumococcal

Meningococcal

Rotovirus

62

Influenza4. What five things should you document when giving vaccinations? (________/5)

1.

2.

3.

4.

5.

5. Prior to receiving immunizations, the child or parent is asked routine health-related questions. List five general health related questions you would ask prior to immunizing. (________/5 points)

1.

2.

3.

4.

5.

6. List all references: (________/2)

Recommended websites: www.cdc.gov/nip/ACIP; www.dhs.ca.gov/ps/dcdc/izgroup

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http://www.cdc.gov/nip/ACIP


Student/Name Instructor Course Date

Evaluation will be based on the degree to which the student meets the course objectives as they are delineated by the criteria stated in this evaluation tool.

A. To achieve a passing grade the student must meet the criteria in one of the following ways:

5. Independent performance:Performance safely and accurately each time without supportive cues from preceptor or instructor. Demonstrates dexterity and spends minimal time on task.Focuses on client.Applies theoretical knowledge each time.

4. Supervised performance:Performs safely and accurately each time, requires supportive cues occasionally during performance of tasks.Demonstrates coordination, and spends reasonable time on task.Focuses on client with some focus on task.Applies theoretical knowledge with occasional cues.

3. Assisted performance:Performs safely and accurately each time, requires frequent supportive and occasional directive cues.Demonstrates partial lack of dexterity.Focuses primarily on task or own behavior, not on client.Can identify principles but needs direction to coordinate with application.

2. Provisional performance:Performs safely under close supervision. Not always accurate, requires continuous supportive and directive cues.Demonstrates lack of skill and/or performs tasks with considerable delay with omissions and delays.Focuses entirely on task or own behavior.Applies principles inappropriately or adequately.

B. A student fails the objectives if any of the following are indicated.

1. Dependent performance:Performs in an unsafe manner, requires continuous supportive directions and cues.Performs in an unskilled manner.Attempts activity or behavior yet is unable to complete.Focuses entirely on task or own behavior.Unable to identify principles or apply them.

O. Negative Pattern: Demonstrates a pattern of unacceptable performances.

C. NSO indicated not sufficiently observed N indicates no opportunity

Adapted from Krichbaum (1983). Criterion referenced definitions, Journal of Nursing Education, 22, p. 376.

bbp 11/96/ azh dec07

64

Summary of Clinical Performance. Use criteria as described to evaluate performance:

5—Independent; 4—Supervised; 3—Assisted; 2—Provisional; 1—Dependent; 0—Negative

Objective

Criteria 356 (Peds)

1A. Interviewing (subjective data):Data collectingElicits client informationCategorize and validate data

1B. Objective Data:Physical assessmentAssess mental status through applicable theories, growth and developmentAccurately record data

1C. Diagnosis:Identified actual, potential, wellness, and collaborative nursing diagnoses.

1D. Plan of Care:Plan of care with economic, cultural, social forces, physical componentsIntegrates information in nursing care

1E. Intervention:Assess and implement nursing activitiesDemonstrate competency in skillsIntegrate theory in clinical

1F. Evaluation:Evaluate medical diagnosis and gather supporting data from labs, and proceduresReport and record observations pertinent to clientIntegrates information in nursing care

2. Demonstrate assessment, critical thinking, knowledge of growth and development, immunizations, pathophysiology

3. Applies knowledge related to assessing and maintaining maximum functional status

4. Applies knowledge of cultural variations5. Communicate effectively, prepares and implements delegated

medical treatments, interprets labs/ diagnostics6. Demonstrate preparedness and safety for clinical with rationale

for procedures, medications, change of shift report7. Completes community objectives and hours

8. Utilize current, relevant literature for assignments and patient care

9. Client/ family education, Teaching Project 10. Behaves in a safe responsible manner while caring for patients,

and families.Demonstrates class participation in clinical and post conferenceFunctions in framework of policies of hospital, CSUB, and Nurse Practice ActDemonstrates reliability and responsibilityDemonstrates professionalism in performance and attitude

65

N356 Clinical Performance EvaluationPart I: General Clinical Performance

In order to pass the course, the student must demonstrate the ability to perform these behaviors in a safe, organized manner in the clinical practice setting. Failure in any section will constitute failure in the course.

LEVEL 0-5

NSO N

OBJECTIVE #1: Utilize the steps of the nursing process with the CSUB Department of Nursing Conceptual Model as a framework

AssessmentStructures the environment to ensure safety, privacy and uninterrupted time

A. Subjective(1) Interview process utilizes communication skills to achieve the

goals of the interview, is client centered, and is focused on client perceptions.

(2) Introduces, carries out, and closes interview effectively.(3) Elicits data about client’s current status, past, family, and

psychosocial history relative to current health problems and risk factors.

B. ObjectiveAs appropriate, data elicited by:(1) Physical examination, including:

—inspection/observation of overt behavior—palpitation—percussion—auscultation

(2) Review of medical history, psycho-physiological condition of the child, medical diagnosis results of laboratory tests.

C. DiagnosisSynthesizes (correlates, interprets) all data collected (subjective and

objective data including clinical laboratory studies) in arriving at identification of problems.

Demonstrates constructive and critical thinking in analyzing and interpreting data collected.

(1) Diagnoses stated in NANDA format with identification of related Gordon’s Functional Health Patterns.

(2) Identifies actual, potential, possible nursing problems, collaborative problems and wellness diagnosis.

(3) Identifies and lists all client problems.D. Planning Intervention

(1) Utilizes data collected.(2) States objectives in behavioral terms.(3) Identifies nursing actions appropriate to attaining objectives.(4) Rationale for nursing action is clearly and concisely stated,

documented appropriately, and reflects current research findings and other current publications.

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LEVEL 0-5

NSO N

E. Intervention(1) Establishes rapport with the child and family.(2) Establishes priorities and organizes care.(3) Skillfully performs nursing techniques with minimal discomfort to

client, taking concepts of growth and development into consideration.

(4) Completes care in allotted time.(5) Supports the child and family in acute and chronic intervention.(6) Utilizes opportunities for teaching children self-care when

developmentally appropriate, and facilitates care giving activities.(7) Demonstrates understanding of parameters of nursing practice as

prescribed by the California Nurse Practice Act.(8) Performs care in a safe manner.(9) Monitors child’s condition in a responsible manner.

(10) Reports child’s status in a timely fashion to the appropriate staff members.

F. Evaluation(1) Interprets child’s responses to therapy accurately.(2) Correctly identifies ongoing stressors impacting child’s responses.

OBJECTIVE #2: Demonstrate assessment and critical thinking skills in caring for clients from infancy through adolescence.

A. DevelopmentUtilizes Erikson’s, Piaget’s and Freud’s theory to evaluate the client’s

developmental level and status.Identifies family structure and interactions and its impact on health

status and risk.B. Psychosocial

Identifies child’s psychological responses to illness and their impact on health status. Identifies family structure and interactions and its impact on health status and risk.

C. PsychopathologicalUtilizes knowledge of psychopathology to identify and analyze the

dynamics of psychological disorders and therapeutic interventions.D. Physiological

Utilizes knowledge of physiology to analyze basic needs and responses.

E. PathophysiologicalUtilizes knowledge of pathophysiology to identify and analyze the

dynamics of disease processes and therapeutic interventions.F. Independently administer 3 developmental screening tests to assess

child development of language, interpersonal and gross motor skills.G. Evaluate immunization status of children.

67

LEVEL 0-5

NSO N

OBJECTIVE #3: Apply knowledge related to assessing and maintaining maximum functional status.A. Application of knowledge related to assessing and maintaining

maximum functional status as evidenced by:(1) Assess present, actual level of client functioning for each Functional

Health pattern and identify nursing interventions that will help clients to meet their maximum potential within each FHP.

(2) Accurately and safely carrying out medical orders and independent nursing functions.

OBJECTIVE #4: Apply knowledge of cultural variations to planning and implementing care for young clients and their families.A. Assess the child or adolescent and the family’s background.B. Recognize and utilize knowledge of the social and cultural factors

which influence family member’s definitions of health, illness, and child rearing.

C. Identify social, cultural, and economic forces which influence delivery of health care to the family, health outcomes, and client expectations.

OBJECTIVE #5: Demonstrate knowledge, skills and professionalism in preparing for and implementing nursing activities and related delegated medical treatment activities for clients from infancy through adolescence.A. State the medical diagnosis, pathophysiological changes, and results

of laboratory tests for the health problems of children being cared for by the students.

B. State, make, record, and report in appropriate and timely manner, observations pertinent to the psycho-pathological state of the child.

C. Demonstrates professional behavior in interaction with health team members, and the public.

D. Nursing care plans include essential information, are organized sequentially and logically, and includes appropriate references.

E. Completes written assignments using correct syntax, grammar and spelling.

F. Communicates effectively with clients, families, staff, peers, instructor.

OBJECTIVE #6: Demonstrate beginning management skills by planning and implementing care and/or preparing and administering medications for pediatric clients during a clinical day, and by participating in change of shift report.A. Plan and implement care for assigned pediatric clients.B. State the purposes, usual dosage, and possible toxic symptoms of

medications given to pediatric clients and administer medications safely.

C. Administer medications by various routes to children in different stages of growth and development.

D. Receive and give change of shift report for assigned clients.

68

E. Demonstrate preparedness and safety, knows rationale for procedures.

69

LEVEL 0-5

NSO N

OBJECTIVE #7: Identify community health care referral sources which provide follow-up and continuity of care, and services for the special needs of children and adolescents.A. Identify arrangements for follow-up care and extension of nursing

services when a client is discharged from the hospital.B. Identify health care resources for children and adolescents, in the

community.C. Identify community resources that could be used as an aid in resolving

problems arising from illness and as a means of providing continuity of care.

D. Identify the role of the school nurse in providing children with health care.

OBJECTIVE #8: Utilize current research from appropriate literature in planning care for children from infancy through adolescence.A. Review current literature pertinent to the care of the student’s

assigned clients.B. Utilize nursing publications and appropriate research findings for

management of child’s care.C. Teaching project utilizes a minimum of one reference from a current

nursing journal.OBJECTIVE #9: Utilize knowledge of the teaching-learning process to prepare and present health education information to one or more children and/or families.A. Recognize and utilize opportunities to provide appropriate health

education to assigned clients and their families.B. Prepare and present a teaching project for one or more children and/or

parents, utilizing knowledge of the teaching-learning process.OBJECTIVE #10: Consistently behave in a safe and responsible manner while providing nursing care to children, adolescents and families.A. Seeks out and utilizes opportunities for learning by:

(1) Consistently coming prepared for learning experiences (initial written care plan as expected, review of skills, and other).

(2) Identifying challenging and varied experiences appropriate to self-directed learning.

B. Prepared for and participates in clinical conferences.C. Submits written assignments on time.D. Makes arrangements with appropriate individuals when unable to

meet written or performance commitments.E. Function in accordance with clinical faculty routine, policies and

regulations, and within the framework of the Nurse Practice Act.F. Establish functional relationships with peers, staff, faculty and other

members of health care team.

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LEVEL 0-5

NSO N

G. Seeks to enhance their own learning through client selection, client care, discharge planning, and other independent activities.

OBJECTIVE #11: Identifies legal, political, economic and ethical issues in a variety of health care settings that provide services for children, adolescents and their families.A. Recognizes and supports client’s autonomy and rights.B. Recognizes ethical dilemmas and principles, and utilizes a problem-

solving method in resolving the issues.C. Recognizes legal, political, and economic issues that effect health care

and access to health care for children.

Comments:

Mid-Term Evaluation: (attach- next page)

Student Signature: Date:

Faculty Signature: Date: ______________________________________________________________________________

Final Clinical Evaluation:

Absent Days:

Clinical Skills Checklist Complete:

Clinical and Community hours complete:

Assignments Completed:

Strengths:

Areas for improvement:

Student Signature: Date:

Faculty Signature: Date:

__________________ PASS ____________________ FAILCALIFORNIA STATE UNIVERSITY, BAKERSFIELD

Department of NursingNursing 356 – Midterm Evaluation : Pediatric Clinical

71

Student _____________________ Absent Days:

Clients Cared for:Infants __________; Toddler__________; Preschooler________:

School-age________; Adolescent________; Developmentally Delayed_______

Skills Checklist:Reviewed___________.

Skills Needed:________________________________

Careplans: 2 Long ________; 2 Short/OR ___________; Team Nsg________

Community Experiences:

Ethical Dilemma:

Teaching Project:Topic:Target Population/Age Group:Date Completed:

Sim/ Skills Practice Lab:Assignments:Attendance:

Areas Needing Improvement:

Faculty Signature :__________________________ Date:___________Student Signature:__________________________ Date:___________

Student Comments:

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