Spring 2018

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NURSING 222 SYLLABUS

MATERNITY NURSING

TABLE OF CONTENTS

CONTENT PAGETitle IX Information……………………….. ......................................................................................4Course Description and Objectives ...................................................................................5N225 Course Description and Objectives………………………………………………………………………….15Skills Lab Supplies …………………………………………………………………………………………………….….18Course Grading ……………………………………………………………………………………………………….…….19Dates to Remember ………………………………………………………………………………………..……….....22Clinical Schedules …………………….………………………………………………………….…………………..…..24Skills Lab - Preclinical Content …………………………………………………………………………..……..26Clinical Orientation ………………………………………………………………………………………………….…….27Clinical Competencies ………………………………………………………………………………………….…..……28Clinical Evaluation Tool ………………………………………………………………………………….…………....39Clinical Checklist: Labor and Delivery ……………………………………………………………….……….30Clinical Checklist: Postpartum ……………………………………………………………………….….………….31 Clinical Checklist: Nursery ………………………………………………………………………………...………….32Sample Medication Administration Test ……………………………………………………..……...………33Answers to Test ………………………………………………………………………………………………….…………35Clinical Makeup …………………………………………………………………………………………………..……..…..36Assignments …………………………………………………………………………………………………………..…………38Medication Administration Cards …………………………………………………………………….……….…..39Medication List ……………………………………………………………………………….……………………..……….40Postpartum Teaching Presentation and Paper ………………………………………………..…………41Guidelines for the Graded Teaching Presentation ……………………………………..…………….43Neonatal Assessment Paper ……………………………………………………………………………….…………44Labor and Delivery Paper ………………………………………………………………………………….…………47Objectives for Ob/Gyn/Urology Clinic Experience ………………………………………..…………...49Assignment for Prenatal Clinic …………………………………………………………………………………….50Assignment for Gynecologic Clinic ………………………………………………………………….…………..50Assignment for Urology Clinic………………………………………………………………………………………..….51Assignment for Neonatal Intensive Care ………………………………………………….………………..52Assignment for Lactation Education …………………………………………………………………..……….53Perinatal Cultural Variations Discussion ……………………………………,,,,,,,,,,,,,,,,………………….54Antepartum Testing and Gestational Diabetic Education …………………,,,,,,,,,,,……………55

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TABLE OF CONTENTS CON’T

CONTENT PAGEClinical Reflections- A Critical-thinking Journal ………………………………………………………….……56N222 Competency-Neonatal IM Injection ……………………………………………………………… ……...57Checklist for Competency Evaluation …………………………………………………………….……………58ATI Maternal Newborn Nursing Test ………………………………………………,,,,,,,,,,,,,,……………59ATI Tips / Guidelines for Students the Day of the Test………………………………………………………60Appendices …………………………………………………………………………………………….……,,,,,,,,,,,,,,,,…..61LATCH Scoring for Breastfeeding………………………………………………………………………………………62CSM PATIENT CARE WORKSHEET-PP………………………………………………………………………………..63CSM PATIENT CARE WORKSHEET -Newborn……………………………………………………………………65

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SMCCCD’s Title IX

The San Mateo County Community College District is committed to maintaining safe and caring college environments at Cañada College, College of San Mateo and Skyline College. The District has established policies and procedures regarding Sexual Misconduct, Harassment, and Assault. A District website has also been developed which provides you with important information about sexual misconduct and sexual assault. http://smccd.edu/titleix/

To learn more about these issues and how you can help prevent them, you are encouraged to view the Not Anymore videos, which can be found on WebSMART under the Student Services link. Click on Not

Anymore Video

.

If you have any questions, please feel free to contact Eugene Whitlock, Vice Chancellor of Human Resources or your campus Vice President of Student Services.

*You are also responsible for information covered both in the CSM Student Handbook as well as the Nursing Student

Handbook.

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College of San MateoOfficial Course Outline

1. COURSE ID: NURS 222 TITLE: Maternity Nursing Semester Units/Hours: 4.5 units; a minimum of 40.0 lecture hours/semester; a minimum of 96.0 lab hours/semester Method of Grading: Letter Grade Only Prerequisite: NURS 212 Corequisite: Concurrent enrollment in NURS 225

2. COURSE DESIGNATION:Degree CreditTransfer credit: CSU

3. COURSE DESCRIPTIONS:Catalog Description:Needs and problems of the family during the maternity cycle along with identifying needs and problems of male and female reproduction. Supervised learning experiences corresponding with classroom instruction in off-campus health care facilities. (Spring only.)

4. STUDENT LEARNING OUTCOME(S) (SLO'S):Upon successful completion of this course, a student will meet the following outcomes: A. Demonstrate competency in managing nursing care for one or several women and neonates throughout the various phases of the childbearing cycle.B. Assess educational needs of childbearing women and their families and communicate effectively when relaying information regarding health promotion for women and neonates. C. Utilize comprehensive theoretical knowledge as a basis for the nursing process when caring for childbearing women and neonates.

5. SPECIFIC INSTRUCTIONAL OBJECTIVES:Upon successful completion of this course, a student will be able to: THEORY OBJECTIVES:I. OPERATIONALIZES THE NURSING PROCESS TO PROMOTE HOMEOSTASIS A. Describes the process of ovulation and fertilization. B. Identifies major landmarks in fetal development. C. List the anatomical and physiological changes that occur during pregnancy. D. Describes placental function and list the major hormones produced by the placenta.E. Assesses needs and states appropriate nursing interventions for the pregnant woman

(i.e., nutrition, hygiene, exercise, relaxation, emotional support, and learning). F. Describes the routine prenatal visit. G. Describes psychosocial factors which affect pregnancy.

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H. Identifies essential parenting functions. I. Discusses effects of pregnancy on family members including grandparents. J. Discusses cultural/ethical/religious diversity as it affects the pregnant woman/family,

including grandparents. K. Identifies nursing interventions for women with minor discomforts/problems during

pregnancy. L. Identifies causes of bleeding in pregnancy and in the prenatal period; identifies

nursing interventions. M. Identifies hypertensive disorders in pregnancy and in the prenatal period; identifies

nursing interventions. N. Identifies existing cardiovascular problems which might adversely affect pregnancy. O. Describe how diabetes affects the pregnant woman and her fetus; identify nursing

interventions. P. Discusses nursing interventions for women experiencing high risk pregnancies

including those with multiple gestations, blood disorders, infections, and psychosocial problems such as abuse

Q. Discusses fetal assessment studies. R. Identifies signs and possible causes of fetal intolerance of labor; list related nursing

interventions S. Describes the normal pattern of labor, its various components and related nursing

care. T. Recognizes factors that interfere with the normal progress of labor and state

appropriate nursing interventions. U. Describes nursing interventions for the patient needing analgesic or anesthetic

support. V. Lists and describes the normal anatomic, physiologic and emotional/psychological

changes that occur during the postpartum period. W. Identifies nursing interventions that promote a normal recovery during the

postpartum period including those pertinent to home care. X. Identifies complications of the postpartum period and states appropriate nursing

interventions. Y. Discusses the use of medications used in perinatal and women's health care. Z. Lists problems which may occur in the newborn during adaptation to extra-uterine

life.AA. Explains six normal newborn reflexes and responses. BB. Determines the fluid and nutrient requirements for the infant during the neonatal

period. CC. Lists appropriate steps in prevention of infection when caring for the newborn. DD. Compares the full term and preterm infant as to: characteristics of development,

temperature control, respiratory function, and nutritional requirements. EE. Lists nursing interventions to meet the needs of the grieving

individual/family/extended family members.

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FF. Utilizes critical thinking skills when applying nursing process to actual and simulated perinatal patient situations.

GG. Discusses alterations in homeostasis relative to women's health care and describes pertinent nursing care.

HH. Lists signs and symptoms of common reproductive disorders for women andmen of all age groups.

II. Describes genetic factors/abnormalities which affect pregnancy.

II. ASSUMES ROLE AS A COMMUNICATOR A. Identifies appropriate communication methods to utilize with family and

extended family members. B. Identifies verbal and non-verbal behaviors that should be observed and

incorporated into the nursing care plan.

III. ASSUMES ROLE AS A TEACHER A. Identifies learning needs of the woman/family throughout the maternity cycle. B. Lists examples of family planning; compare their actions, effectiveness,

advantages and disadvantages. C. Discusses advantages and disadvantages of different methods of infant feeding. D. Teaches safety principles to the woman/extended family includinggrandparents for

care of the newborn. E. Demonstrates methods of breast self-examination techniques. F. Identifies early warning signs of cancer in the male/female reproductive systems.

G. Identifies and lists learning needs common to reproductive disorders for all patients of all age groups.

IV. ASSUMES ROLE AS A LEADER/MANAGER A. Cites one example of appropriate counseling resources in reference to reproductive

dysfunction. B. Cites examples of available support groups for woman/family/and expectant or new

grandparents. C. Describes various expanded roles for perinatal nurses.

V. ASSUMES ROLE AS A MEMBER WITHIN THE PROFESSION OF NURSING A. Identifies essential qualities of a nurse caring for women experiencing

childbearing or reproductive disorders/cancers. B. Lists community functions of the nurse caring for women experiencing

childbearing or reproductive disorders. C. Identifies trends in maternity nursing.

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D. Identifies ethical and legal issues relating to perinatal nursing. E. Describes role of patient advocate in perinatal setting. F. Identifies essential qualities of a nurse caring for men experiencing

reproductive disorders/cancers.

CLINICAL OBJECTIVES I. OPERATIONALIZES THE NURSING PROCESS TO PROMOTE HOMEOSTASIS

A. Utilizes the nursing process, with guidance, to provide safe nursing care of the pregnant woman/family with common well-defined health needs. Collects and organizes data from a variety of sources including data on developmental levels to identify basic patient needs. 1. Collects data from a variety of sources to identify the woman's, newborn's and

family's needs including grandparents. 2. Prepares for patient assignment in each perinatal area. 3. Gathers pertinent data from the patient, family, medical record and report;

utilizes critical thinking skills to differentiate normal data from abnormal.

4. Correlates patient data with nursing theory to prepare for patient assignment.B. Assesses

1. Assesses the woman's recovery from the birth process with a thoroughpostpartum assessment.

2. Evaluates maternal/infant bonding behaviors. 3. Assesses/describes the adaptation of the newborn to extra-uterine life and

identifies real/potential threats to homeostasis. 4. Determines the woman's ability to meet the biopsychosocial needs following

birth and identifies potential problems. 5. Identifies individualized nursing diagnoses and states related outcome criteria. 6. Applies theoretical data to nursing practice.

C. Plans and performs, with guidance, individualized nursing interventions designed to assist the woman/family to meet needs and to promote homeostatic adaptive mechanisms. 1. Identifies nursing interventions that will assist in meeting stated

goals/objectives. 2. Involves the woman/family including grandparents of newborn in the plan of

care.

3. Presents plan to instructor/resource person prior to care. 4. Applies critical thinking principles to a variety of clinical situations.

D. Consistently performs, with guidance, appropriate nursing interventions safely and accurately. 1. Applies previously learned knowledge as well as perinatal concepts to provide

safe nursing care. 2. Demonstrates knowledge of medications.

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3. Adjusts nursing care to meet the needs of the maternity patient and extended family members.

4. Correctly performs treatments and administers medications. 5. Utilizes principles of asepsis and universal precautions. 6. Expands comfort measures to include those pertinent to the maternity

patient. 7. Follows accepted protocols for safe newborn care. 8. Identifies priorities when organizing care, utilizing principles of time

management. E. Recognizes, with guidance, whether nursing interventions met identified needs.

1. Explains rationale for nursing interventions keeping in mind the specific needs of the perinatal patient.

2. Assists in revising nursing care by evaluating whether objectives were met onthe daily care worksheet.

3. Modifies the nursing care as needed, keeping in mind the needs of the perinatal patient.

4. Demonstrates competency performing a neonatal medication injection in Open lab prior to caring for a neonate.

II. ASSUMES ROLE AS A COMMUNICATOR A. Utilizes a variety of basic communication skills, with guidance to support the

woman/family, and to interact with other members of the health team. 1. Assesses maternal verbal and non-verbal behaviors. 2. Communicates data and questions, regarding the woman/family to

appropriate health care professionals. 3. Communicates results of care during report and conference. 4. Evaluates effectiveness of communication and identifies barriers to

communication. 5. Identifies own limitations when giving information.

B. Reports and records accurately, with guidance, significant occurrences and patient assessments, interventions and their effectiveness. 1. Charts accurately in legible, pertinent, organized manner using acceptable

abbreviations, grammar and format with utilization of an electronic medical record when applicable.

2. Uses Nursing Care Plan as a guide for charting. 3. Reports status of patient clearly and concisely. 4. Contributes in conferences.

III. ASSUMES ROLE AS A TEACHER A. Recognizes the woman's/family's obvious needs for health teaching and either

conveys information or takes other appropriate action.

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1. Gives instruction in health promotion that assists in meeting the needs of the perinatal patient, extended family members and the newborn.

2. Initiates teaching as well as supports the teaching plan of others. 3. Uses teaching materials provided by the clinical facility. 4. Considers obvious factor(s) that may interfere with ability to learn. 5. Documents patient/family teaching. 6. Completes graded teaching presentation.

IV. ASSUMES ROLE AS A LEADER/MANAGER A. Recognizes the patient's/family's needs for the services of other health team

members and/or agencies and discusses the need for appropriate referrals. 1. Assumes responsibility for managing care for assigned patient(s). 2. Identifies sociocultural differences and seeks help when necessary (i.e.

interpreter, dietitian, etc.) 3. Consults with health team members to meet needs that cannot be met by the

student. B. Identifies priorities and provides care for designated patients within the assigned

clinical time. 1. Implements care in stressful situations. 2. Describes the RN role in a variety of perinatal care settings.

V. ASSUMES ROLE AS A MEMBER WITHIN THE PROFESSION OF NURSING A. Practices within the ethical standards and legal framework with guidance.

1. Researches agency policies and procedures as needed. 2. Identifies ethical issues in the clinical area and discusses such with instructor

and at conference. 3. Describes the interventions used by a nurse functioning as a patient or family

advocate. B. Identifies own learning needs and demonstrates initiative in obtaining specific

experiences. 1. Communicates learning goals to instructor in writing on last page of

evaluation. 2. Uses additional learning resources available.

C. Evaluates learning experiences and objectively assesses own progress regularly with the instructor. 1. Completes self-evaluation and learning goals at end of course or as otherwise

indicated by instructor. 2. Modifies performance based on previous evaluation of clinical performance

and current feedback. 3. Takes corrective actions when in error and reports such to instructor and

follows through with appropriate written report.

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D. Is accountable for his/her own professional behavior. 1. Is punctual for clinical. (Cannot be late more than two times). 2. Is punctual for post conference (Cannot be late more than two times without

prior agreement with instructor). 3. Is punctual in submitting written assignments. 4. Completes clinical make up assignments according to the policy. 5. Is punctual with medications and treatments.6. Follows correct procedure for notifying agency regarding absence from clinical

areas. 7. Follows dress code as described in the Nursing Student Handbook.

6. COURSE CONTENT:A. LECTURE CONTENT:

1. Introduction to Maternity Nursing2. Normal Pregnancy-Antepartum3. Fetal Assessment4. Labor and Delivery-Intrapartum5. Analgesia and Anesthesia6. Postpartum7. Normal Newborn8. High Risk Neonate9. Complications of Pregnancy10. Complications of Labor and Delivery11. Complications during the Postpartum Period12. Disorders of the Female and Male Reproductive System13. Infertility, Genetics, and Care of the Transgender Patient

B. LAB CONTENT:1. Labor and Delivery observation: Paper due one week after experience

regarding either observing a vaginal or surgical delivery.2. Providing nursing care for a mother and her newborn on the

Postpartum/Mother/Baby unit.3. Neonatal Assessment: Paper due one week after completion of head to toe

physical/gestational-age assessment.4. Formal teaching presentation to a new mother with paper due one week after

presentation.5. Outpatient clinic observation (Ob/Gyn, Urology, Antepartum testing, and

Gestational Diabetic education): Paper due one week after experience.6. Special Care (Level II) Nursery observation: Paper due one week after

experience.

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7. Post conference: Opportunity to review, discuss, and analyze events that were observed during the clinical day.

8. Cultural Variation presentation: Oral presentation at Post Conference

7. REPRESENTATIVE METHODS OF INSTRUCTION:Typical methods of instruction may include:A. Lecture B. Lab C. Activity D. Discussion E. Guest Speakers F. Individualized Instruction G. Observation and Demonstration H. Other (Specify): Instruction includes classroom presentations, related discussion of

patient scenarios, focusing on critical thinking skills. Students view media or computer related instruction to enhance classroom presentations or focus on other content. The postconference setting in clinical provides an avenue for small group discussion of the events of the day and reinforce the concurrent theory content.

8. REPRESENTATIVE READING ASSIGNMENTS:Representative assignments in this course may include, but are not limited to the following:A. Assigned TextbookB. Nursing Journal articles are assigned per lecture. Copies of articles can be found in

the Library.C. Additional information materials within the Syllabus.All reading assignments are listed in the Study Guide of the syllabus.

9. REPRESENTATIVE METHODS OF EVALUATION:Representative methods of evaluation may include: A. Class ParticipationB. Exams/Tests

1. Multiple choice theory examinations with "alternate question" format2. Pop quizzes

C. Papers- reflect the use of the nursing process and related critical thinking skills.1. Care of Laboring Woman2. Newborn Assessment3. Patient Educational Teach4. Observational Experiences

D. SimulationE. Clinical evaluation tool based on satisfactory completion of clinical objectives

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10. REPRESENTATIVE TEXT(S):Required textbooks include: A. Ackley, B., Ladwig, G., & Makic. Nursing Diagnosis Handbook. 11th ed. Philadelphia,

PA: Elsevier, 2017B. Ignatavicius. D. & Workman, M. Medical-Surgical Nursing: Patient-Centered

Collaborative Care: Single Volume. 8th ed. Philadelphia, PA: Elsevier, 2016C. London, M.L., Ladewig, P., Davidson, M., Ball, J., Bindler, R., & Cowan, K. Maternal and

Child Nursing Care, 5th ed. Hoboken, NJ: Pearson Education, Inc., 2017D. Zerwekh, J. & Garneau, A. Nursing Today-Transitions & Trends. 9th ed. Philadelphia,

PA: Elsevier, 2017

Possible textbooks include: E. Perry, Potter, and Ostendorf. Clinical Nursing Skills and Techniques, 9th ed.

Philadelphia, PA: Elsevier, 2017F. Potter, P., Perry, A., Stockert, P., & Hall, A. Fundamentals of Nursing: Enhanced Multi-

Media Edition Package. 9th ed. Philadelphia, PA: Elsevier, 2017G. Phillips, L. Manual of I.V. Therapeutics: Evidenced-based Practice for Infusion

Therapy. 6th ed. Philadelphia, PA: F.A. Davis, 2014

Origination Date: August 2010Curriculum Committee Approval Date: November 2013

Effective Term: Fall 2014

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College of San MateoCourse Outline

New CourseUpdate/No changeCourse Revision (Minor)Course Revision (Major) Date: ***

Department: Nursing Number: 225

Course Title: Nursing Skills Lab II Units: 0.5

Total Semester Hours Lecture: Lab: 24 Homework: By Arrangement:

Length of Course

Semester-long

Short course (Number of weeks __)

Open entry/Open exit

GradingLetter

Pass/No Pass

Grade Option (letter or Pass/No Pass)

1. Prerequisite (Attach Enrollment Limitation Validation Form.)

Nursing 212 or equivalent

2. Corequisite (Attach Enrollment Limitation Validation Form.)

Concurrent enrollment in N221/N222 or equivalent

3. Recommended Preparation (Attach Enrollment Validation Form.)

4. Catalog Description (Include prerequisites/corequisites/recommended preparation. For format,please see model course outline.)

(.5) (Pass/No Pass grading.) One and one-half lab hours per week. Prerequisite: NURS 212 orequivalent with a grade of C or higher. Corequisite: concurrent enrollment in NURS 221 and 222.This course is an adjunct to the corequisite nursing courses listed above. It provides individualand group practice of nursing skills with competency evaluation of the skills identified for theconcurrent nursing courses. (Spring only.) (AA)

5. Class Schedule Description (Include prerequisites/corequisites/recommended preparation. Forformat, please see model course outline.)

This course provides for nursing skill development and competency testing for skills identified for concurrent nursing courses. Prerequisite: Completion of Nurs 212. Corequisite: Concurrentenrollment in Nurs 221 and Nurs 222.

6. Student Learning Outcomes (Identify 1-6 expected learner outcomes using active verbs.)

Upon successful completion of the course, the student will be able to:14

1. Demonstrate competency in skills related to maternity and pediatric nursing

a. Successfully perform one neonatal intramuscular injection following the guidelines presented in Skills lab to pass Maternity clinical rotation.

2. Demonstrate competency in medication calculation for maternity and pediatric patients3. Apply nursing methods to the care of maternity and pediatric patients.

7. Course Objectives (Identify specific teaching objectives detailing course content and activities.For    some   courses,    the    course   objectives   will   be    the    same   as    the    student    learning   outcomes.    In this    case,    “Same   as    Student   Learning   Outcomes”    is   appropriate   here.)1. Demonstrates a simulated physical assessment of a neonate, child, and childbearing women.2. Demonstrates a simulated teaching session for new parents of a child regarding

preventive health care 3. Demonstrates correct calculation and administration of medications in pediatric and

perinatal settings. 4. Demonstrates a simulated developmental assessment of a child

8.. Course Content (Brief but complete topical outline of the course that includes major subjectareas [1-2 pages]. Should reflect all course objectives listed above. In addition, a samplecourse syllabus with timeline may be attached.)

A. Physical and gestational age assessment of the normal newborn.B. Physical assessment of the well and ill child.C. Developmental assssment of a childD. Teaching in maternity and pediatric settingsE. Math calculation skills for maternity and pediatric patientsF. Neonatal ResuscitationG. Venipuncture and IV therapyH. Medication administration in maternity and pediatric settings.I. Critical Thinking exercises

9. Representative Instructional Methods (Describe instructor-initiated teaching strategies thatwill assist students in meeting course objectives. Describe out-of-class assignments, requiredreading and writing assignments, and methods for teaching critical thinking skills. If hoursby arrangement are required, please indicate the additional instructional activity which will be provided during these hours, where the activity will take place, and how the activity will be supervised.)

Skill demonstration, discussion, multimedia instruction and skill competency practice.

10. Representative Methods of Evaluation (Describe measurement of student progress towardcourse objectives. Courses with required writing component and/or problem-solving emphasismust reflect critical thinking component. If skills class, then applied skills.)

Competency evaluation of skills identified for concurrent nursing coursesLab attendance

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11. Representative Text Materials

A. Perry, Potter, and Ostendorf. Clinical Nursing Skills and Techniques, 9th ed. Philadelphia, PA: Elsevier, 2017

B. London, M.L., Ladewig, P., Davidson, M., Ball, J., Bindler, R., & Cowan, K. Maternal and Child Nursing Care, 5th ed. Hoboken, NJ: Pearson Education, Inc., 2017

C. Phillips, L. Manual of I.V. Therapeutics: Evidenced-based Practice for Infusion Therapy. 6th ed. Philadelphia, PA: F.A. Davis, 2014

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N225 Skills Lab SuppliesLab # 1- Bring lab bag for review of equipment

5-1ml syringes with 25 G 5/8 needleVial of normal saline5 18 G needlesAlcohol prepsGloves2 X 2’s

Lab # 2- No supplies neededLab # 3- Alcohol preps

GlovesIV start kitsExtra 2 X 2’sBand aidsVacutainers 23 G needlesYellow vacutainer tubesVacutainer needles3 each lavender/jungle top lab tubes

Lab # 4- Alcohol prepsGlovesIV start kitAdditional 2 X 2’sBand aidsInsyte catheters (24 and 22 G)Saline locks10 ml vial normal saline

Lab # 5- Regular IV tubing & Secondary tubingBags of normal saline (any size)Medication labels/marking pensGloves

Lab # 6- No supplies neededLab # 7- Open lab-bring remaining items in Lab bagLab # 8- No supplies needed

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NURSING 222 – COURSE GRADING 1. Academic Grading Scale - A minimum grade of “C” is required to progress to the next nursing course.

A = 90 -100%B = 80 - 89%C = 75 -79%

2. Theory Grading2 Exams at 60 points each ………………………………………………………….120 pointsFinal/Challenge Cumulative exam at 100 points ………………..……………100 pointsPharmacology Test ……..………………………………………………………………..….10 pointsATI Maternal Newborn Nursing……………..………………………..…….……..……3 pointsPostpartum Teaching Presentation & Paper ………………………. Comp/Not compLabor and Delivery Paper …………………………………………………..…........5 pointsNewborn Assessment Paper ……………………………………………………….........5 pointsObservational Experience Papers .............................................................CR/NCMedication Administration Test* …………………………………………………….… CR/NC*Calculators may used on Medication Administration Test only, not on Theory exams

TOTAL POINTS for exams only………..220 points Required to attain 75% = 165 points TOTAL POINTS including projects = 243 points

3. Course Rules and RegulationsA. In order to achieve a passing grade in N222, a student must score a minimum of 75%

on the three Theory tests. If the student has not achieved an average of 75% on the three tests, the student will not progress to N231 and must repeat N222. After this criteria is met, the written papers and other exams (ATI and Pharmacology) will be averaged in to determine the overall grade for N222. A minimum grade of “C” is the overall passing grade.

B. Failure to complete any of the above assignments for N222 will result in a grade of “Incomplete” for the course. All clinical papers are due to the clinical instructor one week after the clinical experience. For papers that are worth points, one point will be deducted for each working day that the paper is late. A pattern of turning in papers late will result in a grade of “NO PASS” on the clinical evaluation form in the section dealing with professional role. 1 point will be deducted for every 5 misspellings,

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grammar and punctuation errors. Every project is to have a face sheet, use APA format, and follow the Student Handbook Guidelines.

C. Clinical Lab Grading: Clinical performance is graded on a Pass/No Pass basis. 96% of all starred criteria must be passed and 100% of those which are double starred. In addition, all students must pass the section entitled “Clinical Nursing Competencies Measured in All Aspects of Care” and the skills lab competency evaluation on medication administration to a newborn. A student who receives a NO PASS as a final clinical grade will not be permitted to progress to N231. A “No Pass” [NP] clinical grade nullifies the final theory grade.

All students will participate in the performance-based Competency Assessment Day as part of their clinical experience. This day may or may not fall on a regularly scheduled clinical day.

D. Testing: A 5% penalty will be assessed to any student taking a test in this course other than on the test date. The test makeup must be completed within one week of the test date. The student is responsible for notifying the faculty that they will be taking the test at another time and for rescheduling. Medication administration tests are given per the policy outlines in the student handbook.

E. N225: Students are required to attend weekly skills lab. Students must call the instructor if they will be absent to arrange for makeup.

F. N817 (Open Lab): Students are required to attend lab hours in order to receive course credit. Students must sign in in order to receive credit for the hours attended. N817 is a required course. In order to proceed to the next nursing course, students must receive credit (pass) in N817. If you have Open Lab prior to your N225 section, you MUST log out of N817 before the start of class.

G. AttendanceN222: May miss no more than 2 theory classes/8 weeksN225: May miss no more than 2 skills lab sessions/16 weeks

H. Disability Policy StatementIf you have a documented disability and need accommodations for this class, please see me as soon as possible or contact the Disabled Students Programs and Services (DSPS) for assistance. The DSPS is located in Bldg. 10, Room 120. (650) 574-6438; TTY (650) 574-6230.

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I. Academic Integrity Refer to the Prohibited Actions section under the Student Conduct section of the Student Handbook of the College Catalog. Among the following actions which are prohibited and may lead to appropriate disciplinary action is “16. Dishonesty such as cheating, plagiarism or knowingly furnishing false information to the College and its officials.” Refer also to the Academic Integrity Policy in the Nursing Student Handbook.

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Nursing 222 Dates to Remember - 2018First 8 weeks

January 18, 2018 Lecture #1

January 22, 2018 Medication Calculation Test

February 5, 2018 Test #1

February 26, 2018 Test #2

March 5, 2018 *Must complete Practice tests prior to Proctored test→

ATI* (3pm) and Pharmacology Tests (430p)Maternal Newborn Online Practice 2016A&B

March 6, 2018 Competency Assessment

March 15, 2018 Final Exam

Variable due dates for projects/papers

Postpartum Teaching Project (4/5 for comp) Neonate Assessment Paper (5 points)Labor and Delivery Paper (5 points)

Nursing 222 Dates to Remember - 2018Second 8 weeks

March 19, 2018 Lecture #1

March 22, 2018 Medication Calculation Test

April 12, 2018 Test #1

April 30, 2018 Test #2

May 7, 2018 *Must complete Practice tests prior to Proctored test→

ATI* (3pm) and Pharmacology Tests (430p)Maternal Newborn Online Practice A&B

May 8 2018 Competency Assessment

May 17, 2018 Final Exam

Variable due dates for Postpartum Teaching Project (4/5 for

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projects/papers comp)Neonate Assessment Paper (5 points)Labor and Delivery Paper (5 points)

CLINICAL INFORMATION

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CLINICAL SCHEDULE FOR NURSING 222 – 2018First 8 weeks

DX Group Preclinical Skills Lab -Tuesday, January 16, 2018Bring N222 Syllabus and Nurse KitPlace: Nursing Skills CenterTime: 1400 – 2000Irene Luciano, InstructorOrientation -Wednesday, January 17, 2018Bring N222 Syllabus and Nurse KitWear uniform, CSM patch, and name tagMeet at Kaiser Redwood City Hospital LobbyTime: 0800 – 1400* Only orientation at this timeIrene Luciano, Instructor

EX Group Preclinical Skills Lab- Tuesday, January 16, 2018 Bring N222 Syllabus and Nurse Kit Place: Nursing Skills Center Time: 0800 – 1400 Irene Luciano, Instructor

Orientation- Wednesday, January 17, 2018 Bring N222 Syllabus and Nurse Kit Wear uniform, CSM patch, and name tag Meet at Kaiser Redwood City Hospital Lobby Time: 0800 – 1400 Irene Luciano, Instructor

Second 8 weeks

AX Group Preclinical Skills Lab- Tuesday, March 20, 2018 Bring N222 Syllabus and Nurse Kit Place: Nursing Skills Center Time: 0800 – 1400 Lisa Rael, Instructor

Orientation- Wednesday, March 21, 2018 Bring N222 Syllabus and Nurse Kit Wear uniform, CSM patch, and name tag Meet at Kaiser Redwood City Hospital Lobby Time: 0800 – 1400 Lisa Rael, Instructor

BX Group Preclinical Skills Lab- Friday, March 23, 2018 Bring N222 Syllabus and Nurse Kit Place: Nursing Skills Center

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Time: 0800 – 1300 Patty Wieser-Instructor

Orientation- Friday, March 23, 2018* Note Date Bring N222 Syllabus and Nurse Kit Wear uniform, CSM patch, and name tag Meet at Kaiser Redwood City Hospital Lobby Time: 1400 – 2000 Patty Wieser -Instructor

CX Group Preclinical Skills Lab -Tuesday, March 20, 2018Bring N222 Syllabus and Nurse KitPlace: Nursing Skills CenterTime: 1400 – 2000TBD, InstructorOrientation -Wednesday, March 21, 2018Bring N222 Syllabus and Nurse KitWear uniform, CSM patch, and name tagMeet at Kaiser Redwood City Hospital LobbyTime: 1400 – 2000TBD, Instructor

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Pre-clinical Skills Lab Content(Readings: London, 5th edition, Chapters 23-25, and 28-29;

Perry & Potter, 8th edition, Chapter 33-pp. 815-827)1. Check clinical schedule page for the date for your clinical group

A. There is only one preclinical skills lab in this course. The other clinical day during the first week will be used for orientation to the clinical facility.

B. Bring Nurse kit and London textbook.

2. Skills Lab FocusA. Common medications administered to women and neonatesB. IV maintenance, flow rates – primary and secondary

C. Assessment: postpartum patient and neonateD. Interventions for postpartum patient related to perineal, hemorrhoidal pain,

comfort and hygieneE. Foley insertion on antepartum and postpartum woman

F. Breastfeeding – supplies for breast and bottle feeding mothers

3. Activities A. Review procedure for medication cards and highlight common medications

administered and rationale for administrationB. IV’s – practice priming, labeling and running primary and secondary bags for

gravity flow and pumpC. Discuss and practice how to set the IV pump for various rates

D. Postpartum Assessment1. View video on postpartum assessment

2. Practice assessment on manikins-including urinary catheter insertion/care3. Discuss common interventions for perineal, hemorrhoidal pain

4. Discuss perineal pads (assessment/removal) 5. Assess I & O from IV and Foley

E. Newborn Assessment1. View videos – Assessment of the Newborn/Gestational Age Assessment

2. Practice assessment on manikins3. Discuss hygiene and thermoregulation of newborn

F. Breastfeeding1. Review supplies for breastfeeding and bottle feeding mothers

2. Each section will meet with their clinical facility’s Lactation staff to review breastfeeding techniques, LATCH score, positioning, sore nipples and other potential problems and interventions

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Clinical Orientation Guidelines

* Categories will vary with clinical agency

1. LDR ROOMSA. Locate patients’ charts in EMR (electronic medical record) system and on-line

procedure manuals. Facility may still be using paper forms/binders.B. Explore an empty room and locate fetal monitoring equipment, sterile supplies, and

neonatal supplies stored in the room.C. Find the census board where patient’s names or initials and labor status are recorded.D. Locate the operating rooms where surgical births take place. E. Discover the mechanics of the birthing bed.F. Identify the open radiant warmer and review its temperature and oxygen-regulating

features.

2. POSTPARTUM (MOTHER/BABY) EQUIPMENT OR AREAA. Locate supplies commonly used, such as peripads, linens, breast pumps, panties, IV

tubing, fluids.B. Search the medication area, Pyxis or cart and book. Identify the most commonly given

medications and how to document them. C. Find the equipment used for vital signs and place to document. D. Locate patients’ charts in EMR system and on-line procedure manuals. Facility may

still be using paper forms/binders.E. Located teaching materials-including any audiovisuals or hands-on toolsF. Locate the unit refrigerator (and labels) where patients/families may store food.

Locate where used trays are stored for pick-up. Find out how meals are served. G. Find out what the visitor policy is for fathers, siblings, and extended family members.

3. NURSERY (LEVEL II/SPECIAL CARE) AREA AND EQUIPMENTA. Locate commonly used equipment, such as scales, thermometers, medications,

diapers, formula, linens, bottles, etc.B. Identify the open radiant warmer and review its temperature and oxygen-regulating

features.C. Find out where syringes, lancets, blood glucose monitors are kept.D. Locate the board and equipment used for circumcision.E. Locate resource materials on the unit and patients’ charts in EMR system and on-line

procedure manuals. Facility may still be using paper forms/binders.

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CLINICAL NURSING COMPETENCIES MEASURED IN ALL ASPECTS OF CARE

As you progress through the nursing program, each course builds on the knowledge, skills, and abilities of the previous course. Therefore, you are expected to perform competently in the information already learned as you satisfactorily progress from course to course.

There are five specific nursing competencies or critical elements for which you are responsible: Asepsis, Emotional Well-being, Interpersonal Relations, Physical Well-being, and Professional Behaviors. You are responsible to competently implement these specific critical elements. Any violation of the following critical elements will result in a clinical failure. The areas listed below are examples, but are not all inclusive.

1. ASEPSIS: The prevention of the introduction and/or transfer of organisms. Special consideration should be given to handwashing/hand hygiene.A. Washes hands or de-germs as appropriate.

B. Protects self from contamination.C. Protects patient from contamination.

D. Disposes of contaminated material in designated containers.E. Confines contaminated material to contaminated area.

F. Establishes a sterile field where required.

2. EMOTIONAL WELL-BEING: Any action or inaction on the part of the student which threatens the emotional well-being of the patient or significant others places that person in emotional jeopardy. This can occur through omission, imminent, or actual incorrect action by the student. Students must promote emotional well-being.

A. Maintains or respects patient confidentiality, including HIPAA guidelines.1. Uses only patient initials on CSM worksheets and assignments.

2. Does not discuss patient’s data with anyone except healthcare staff (this includes patient’s family or significant other unless permission is given by patient).

3. Does not discuss patient data in public areas such as hallways, elevators, etc.4. Does not discuss any info that could potentially identify patient specific scenario- ex:

combination of date/facility/room and MD/ RN names.5. http://www.hhs.gov/hipaa/for-individuals/index.html

3. INTERPERSONAL RELATIONS: The patient-focused verbal and nonverbal interaction between student nurse and patient and or significant other. A. Establishes verbal communication with patient at beginning of implementation phase by

using at least one (1) of the following actions:1. Introducing self.

2. Explaining nursing actions to be taken

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3. Using touch with the patient who is a nonverbal adult/child.

B. Interacts verbally with patient by using at least one (1) of the following methods:1. Asking questions at least once to determine patient’s response to nursing care.

2. Asking questions at least once to determine patient’s comfort.3. Directing the focus of communication toward patient-oriented interests.

4. Able to communicate with a nonverbal patient.C. Uses language consistent with patient’s level of understanding.

D. Uses verbal expressions that are not excessively familiar, patronizing, demeaning, abusive, or otherwise unacceptable.

E. Uses physical expressions that are not excessively familiar, patronizing, demeaning, abusive, or otherwise unacceptable.

4. PHYSICAL WELL-BEING: Any action or inaction on the part of the student could threaten the patient’s physical well-being. Students are accountable for the patient’s safety. Physical well-being includes:

A. Maintaining the physical well-being of a patient such as reporting deterioration in the patient’s clinical condition or imminent or actual incorrect action by the student.

B. Appropriate use of physical restraints.C. Appropriate use of side rails.

D. Correct use of procedures as learned in skills lab and/or identified in the Clinical Procedure Manual and/or facility policies and procedures posted online.

5. PROFESSIONAL BEHAVIORS: Maintains professional boundaries in all physical, written, and verbal interpersonal encounters including but not limited to patients, significant others, staff, peers, and faculty.

CoreCompetencies Rev2016.doc

Rev. 03/16

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CLINICAL CHECKLIST FOR LABOR AND DELIVERY OR LDRP ROOM

* “With supervision” indicates RN or instructor must be present.

OBJECTIVES/SKILLS DATE COMPLETED

1. Assess and document vital signs.

2. Monitor uterine contraction pattern.3. Observe and assist with electronic fetal monitoring.

4. Begin to interpret monitoring patterns.5. Assess patient’s pain level.

6. Assist patient with relaxation techniques for pain management.7. Perform basic comfort and hygiene measures.

8. Observe a vaginal delivery. 9. Observe a cesarean delivery.

10. Give medications with supervision – IVPB, IM SC, PO routes. (not IV push) 11. Assist in setting up IV drip.

12. Start IV’s (after week 4) with supervision.13. Perform urinary catheterization with supervision.

14. Follow the instructions of caregivers during a delivery.15. Give neonatal medications with supervision.

16. Perform postpartum assessments and document in EMR.17. Maintain confidentiality of patient and family.

18. Participate in the transfer of the patient to the postpartum unitunless facility has LDRPs (labor/delivery/recovery/postpartum).

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CLINICAL CHECKLIST FOR POSTPARTUM OR LDRP ROOM

OBJECTIVES/SKILLS DATE COMPLETED

1. Admits a patient to the unit (differs with agencies).

2. Completes a physical and psychosocial assessment of a vaginal

delivery patient.

3. Completes a physical and psychosocial assessment of a cesarean birth patient.

4. Monitors vital signs according to agency protocol.

5. Assists with breastfeeding and refers to Lactation Consultant as

necessary.

6. Instructs patient in self-care measures.

7. Administers routine and prn medications with supervision.

8. Monitors and documents IV therapy.

9. Completes appropriate documentation in EMR.

10. Participates in discharge instructions.

11. Maintains confidentiality of patient and family.

12. Reviews and updates care plan as needed.

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CLINICAL CHECKLIST FOR NEWBORN CARE

OBJECTIVES/SKILLS DATE COMPLETED

1. Completes a newborn admission assessment (varies with agency) with supervision.

2. Completes a physical assessment/gestational assessment with supervision.

3. Assesses maternal/neonate attachment.

4. Performs a neonatal bath (varies with agency).

5. Performs circumcision care as needed.

6. Performs cord care.

7. Performs a neonatal heel-stick for glucose (varies with agency).

8. Assists with feeding.

9. Completes appropriate documentation in EMR.

10. Administers newborn medication with supervision.

11. Participates in discharge instruction.

12. Participates in teaching normal newborn care.

13. Maintains patient and newborn confidentiality.

14. Maintain and educate mother/parents regarding newborn safety in crib, during transport, positioning, and accurate identification.

15. Follows agency protocol for neonate abduction prevention.

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Nursing 222 Maternity Nursing Sample Math Test

1. The IV order is to infuse 1 Liter D5LR over the next 8 hours. After 4 hours, 250 mLs are remaining in the IV bag. How many hours AHEAD is the IV running? _________

2. The order reads: Loading dose of Magnesium Sulfate 4 g IV to be administered over a 20 minute period. On hand is a premixed bag of 20 g of magnesium sulfate in 500 mLs of H2O. Set the rate and volume to be infused on the pump.

Rate __________ Volume ________

3. The order reads: Maintenance dose of Magnesium Sulfate 2 g per hour IV. Continue this order using the same premixed bag of 20 g of magnesium sulfate in 500 mLs of H2O that you used in #2.

Set the rate and volume to be infused on the pump. Rate __________ Volume ________

4. Calculate the rate and volume to be infused for an order reading Penicillin 5 million units mixed in 250 mLs of NS to be administered over 2 hours. Set the rate and volume to be infused on the pump.

Rate __________ Volume ________

5. Cefazolin (Ancef) 1.5 g is ordered for a labor patient with a temperature of 39°C. To reconstitute the drug, the directions indicate to add 10 mLs of solvent to a 5 g powered vial for a dosage of 5 g= 10mLs. Once reconstituted, how many mLs would you add to a secondary bag for a dosage of 1.5 g to be given NOW? _________

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6. Morphine sulfate is ordered for a neonate weighing 3.2 kg for pain. The range for neonates is 0.02 mg/kg to 0.05 mg/kg every 3-4 hours. Calculate the correct MAXIMUM dosage for this neonate. _________

7. Terbutaline 250 mcg sc is ordered for a preterm labor patient. Available is 1mg/ml. Calculate the correct amount to be given. _________

8. Methergine 200 mcg is ordered for a postpartum patient who is experiencing postpartum hemorrhage. Calculate the correct amount to be given with available amount of 0.4 mg/ml. _________

9. Pitocin 20 units in 1000 mLs LR is ordered to run at 150 mLs per hour. Using a drop factor of 10 gtts/mL, calculate the drop rate. _________

10. Celestone Soluspan (betamethasone) has an available dosage of 6 mg/ml. Prepare a 4mg injection. _________

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Answers:1. 2 hours2. 300mL/hr, 100mLs3. 50mL/hr, 400mLs4. 125mL/hr, 250mLs5. 3mLs6. 0.16 mg7. 0.25 mL8. 0.5 mL9. 25 drops per minute10. 0.67mLs

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CLINICAL MAKE-UP

ASSIGNMENT

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CHILDBIRTH PREPARATION CLASS(Assignment or clinical makeup)

1. At the completion of this experience, the student will be able to: A. Compare and contrast three different methods of childbirth education. B. Demonstrate one relaxation exercise observed during the class. C. Demonstrate one breathing technique used for labor purposes. D. Identify two concerns about the labor and delivery process expressed by the

participants in the class. E. Describe the teaching style used by the instructor.

2. Assignment -Type the answers to the following questions and submit to your clinicalinstructor one week after the experience.

A. Summarize the similarities and differences among three methods of childbirth education.

B. Describe one breathing technique that you saw demonstrated in the class. C. Describe one relaxation exercise that was practiced in the class. D. List two concerns about labor and delivery that were expressed by class participants. E. Describe one effective teaching technique used by the instructor.

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ASSIGNMENTS

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MEDICATION ADMINISTRATION CARDS

1. Overview: The purpose of this assignment is to assist in the preparation of common medication during the maternity rotation. Since the patient stay is so short, preparation in advance is not practical or possible. A list of commonly ordered medications from the clinical facilities has been compiled to facilitate your preparation prior to administration.

2. See the next page for the list: You are required to prepare a medication card for each medication listed. Bring the cards to clinical each day. A preprinted card will be accepted, provided that the required information is highlighted. Include or highlight the following information on each card:

A. Name (trade and generic)B. Usual dosageC. Routes of administrationD. ClassificationE. Action-This needs to be specific to the maternity or neonatal patient. May

need to write in specific information on preprinted card.F. Common side effectsG. Nursing considerations

*In addition to using the drug handbook, be sure to use the textbook for any maternity or neonatal considerations.

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Medication ListThe following is a list of commonly prescribed medications used in the perinatal

areas. See directions on the previous page of the syllabus.

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NEONATEErythromycin Ointment Vitamin K Bacitracin

Hepatitis B Vaccine Naloxone (Narcan)EMLA Lidocaine

LABOR PATIENTAcetaminophen (Tylenol, Ofirmev)Ampicillin

BetamethasoneBupivacaine (Marcaine)

Cefazolin (Ancef, Kefzol)Cephalexin (Keflex)

Clindamycin (Cleocin)Diphenhydramine (Benadryl)

Fentanyl (Sublimaze)Gentamicin

Hydralazine (Apresoline)Hydroxyzine (Vistaril, Atarax)

LidocaineLabetalol

Magnesium SulfateMetoclopramide (Reglan)

Misoprostol (Cytotec)Nalbuphine Hydrochloride (Nubain)

Nifedipine (Procardia)Ondansetron (Zofran)

Oxytocin (Pitocin)Penicillin

Prostaglandin (Cervidil, Prostin E2)Sodium citrate (Bicitra)

Terbutaline (Brethine)Vancomycin (Vancocin)

POSTPARTUM PATIENTAcetaminophen (Tylenol, Ofirmev)Ampicillin

BetamethasoneBisacodyl (Dulcolax)

Carboprost Tromethamine (Hemabate)Cefazolin (Ancef, Kefzol)

Cefotetan (Cefotan)Cephalexin (Keflex)

ClindamycinDiphenhydramine (Benadryl)

Docusate (Colace)Fentanyl (Sublimaze)

Ferrous SulfateGentamicin

Hydrocodone w/ Acetaminophen (Norco) Ibuprofen (Motrin, Advil)

Ketorolac (Toradol)Labetalol

Magnesium SulfateMeperidine (Demerol)

Metoclopramide (Reglan)Misoprostol (Cytotec)

Naproxen (Naprosyn, Aleve)Oxycodone (Oxicontin, Roxicodone)

Oxycodone w/ Acetaminophen (Percocet)Promethazine (Phenergan)

RhoGAMRubella Vaccine

TDAP VaccineVenofer (iron sucrose)

THE POSTPARTUM TEACHING PRESENTATIONGrade: Competent/Not competent

1. Goal: The postpartum or mother/baby experience provides the best opportunity forteaching the family. Teaching may be provided for a new mother and anyother family members present. The postpartum mother/family will be able verbalize or demonstrate back the topic presented by the student.

2. Directions: The student will be responsible for one formal teaching presentation, whichwill be graded by the instructor. While the student and clinical instructor willagree on a date and topic, the student should consider asking the patientand/or family what topics they are interested in learning about or skills theyneed assistance with when choosing their presentation. The student willshow the instructor a brief outline, notes, and objectives prior to doing thepresentation. Following the presentation, the student will type the formalpaper to be submitted one week after the teaching session.

Total points: 5 points Need 80% of total (4/5 pts) to pass competency requirement

I. DATA COLLECTION (0.5 points) A. Patient Initials, Room Number, Age B. Date and Time of Delivery C. Gravida and Para D. Maternal Complications: labor, delivery, postpartum E. Neonatal Complications:

II. LEARNING NEEDS ASSESSMENT (0.5 points) A. State here the subjective and objective evidence for learning needs. (Example: patient statements, questions indicating knowledge deficit)

III. SUMMARY OF PLAN AND TYPE OF PRESENTATION (0.5 points) A. Indicate topic presented and type of presentation (Example: baby bath – demonstration and discussion of normal newborn deviations, reflexes and needs.)

IV. OUTLINE OF CONTENT TO BE PRESENTED (0.5 points) A. Summarize in a brief outline form the content of the presentation.

B. Include/attach a copy of any types of materials given to the patient.

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V. OBJECTIVES (0.5 points) A. List at least THREE objectives which you hope you have accomplished by the end of the presentation.

B. Objectives must be stated in measurable form. (Example: By the end of thispresentation, the patient will be able to demonstrate the correct technique forbathing a baby)

VI. EVALUATION (0.5 points) A. State to what the extent the objectives were accomplished (Example: The patient was able to demonstrate the correct technique for bathing the baby, but needs more practice.)

B. Describe here how you might change your presentation the next time to better accomplish the objectives

SEE NEXT PAGE FOR TEACHING PRESENTATION GUIDELINES

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TEACHING PRESENTATION GUIDELINESGRADING CRITERIA FOR THE PRESENTATION

STUDENT: _______________________________________ DATE: _______________TOPIC: __________________________________________________________(POINTS POSSIBLE FOR PRESENTATION: 2 points)

Competent Not Competent 1. Topic is appropriate for this 0.5

patient. Content is current,accurate, and well prepared.

2. Presentation is clear, organized, 0.5is well paced, notes can beto, but not read. Audiovisualaids are used.

3. Presentation is summarized by 0.5briefly repeating key terms orasking the patient key questions.

4. Presentation is completed within 0.510-15 minutes. (Time limit withininstructor’s discretion, consideringtopic)

PRESENTATION SECTION (2 points possible) _____

PAPER SECTION (3 points possible) _____

TOTAL STUDENT’S SCORE _____(Competency requirement achieved at 4 points or higher)

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Neonatal Assessment5 Points

DIRECTIONS: After completing a head-to-toe physical & gestational age assessment on anormal newborn:

1. Document your assessment: Including the required information regarding the infant’s mother and delivery information. Use gestational age form (Dubowitz/Ballard) to record gestational age assessment- Newborn Patient Worksheet Assessment

2. Complete the Maternal-Newborn Attachment Tool.3. Type the remaining information required below. 4. Submit Newborn Patient Worksheet Assessment-along with the Maternal-Newborn

Attachment Tool, the Gestational age form, and this paper to your clinical instructor ONE WEEK after completing the newborn assessment.

The due date will vary with your clinical schedule.

Section A Data Collection1. Complete a cover page, stating your name and date of assessment2. Newborn’s date of birth3. Newborn’s age at time of assessment (in hours or days)4. Type of delivery (vaginal vs surgical)5. Apgar Score6. List any complications if applicable-paper (Section A point value=0.5 points)

Section B Growth and Development1. Weigh, measure, and assess the estimated gestational age using your clinical

agency’s growth chart and gestational age form (Dubowitz/Ballard).2. State the length, head circumference, chest circumference, and weight3. State if normal or abnormal according to the norms of the textbook.4. Compare the weight you obtained to the birth weight and explain any

differences.5. Attach the completed gestational age assessment form to this section. State

whether the neonate is AGA, SGA, or LGA and whether the neonate isterm, preterm, or post-term.

(Section B point value=1 point)

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Section C Physical Assessment and Vital Signs1. List the vital signs for this neonate and state whether the vitals are within

normal limits for this neonate. 2. Complete head-to-toe assessment-use Newborn Patient Worksheet

Assessment.(Section C point value=2 points)

Section D Psychosocial Adaptation1. Using the standard assessment tool on the next page, assess maternal

neonate bonding of this neonate and mother. Attach the completedtool to this paper and discuss your observations in a separate typedparagraph. Ex: the score was 7 because…which causes someconcerns, etc.-MATERNAL/NEWBORN ATTACHMENT TOOL

(Section D point value=0.5 points)

Section E Medications1. State the purpose of giving Erythromycin eye ointment to the neonate. 2. Describe the nursing implications, including dosage, routes, and any potential

side effects.3. State the purpose of giving Vitamin K to the neonate.4. Describe the nursing implications, including the dosage, route, and any side

effects.(Section E point value=1 point)

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MATERNAL NEWBORN ATTACHMENT TOOL‐*This tool is to be scored and attached to the newborn paper. Include an explanation

of your score and your impressions of the interaction.

1 point for each YES answer. 10 points maximum. 8 10 = positive interaction ‐5 7 = continue to observe ‐0 4 = refer to health care provider ‐ YES NO MATERNAL BEHAVIORS 1. Appropriate touch fingertip palming‐ ‐ ‐

enfolding 2. Holds neonate in “enface” position + eye

contact 3. Refers to neonate by name (initially “it”,

but quickly a name) 4. Responds consistently to neonate cues or

signals 5. Expresses satisfaction with feeding

method (breast or formula) NEONATE BEHAVIORS

1. + eye contact – mutual gazing 2. “Tracks” face with eye movement 3. Grasps finger and holds on 4. Moves with synchronized movement in

response to parent’s voice 5. Comforted by parent’s voice or touch

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LABOR AND DELIVERY PAPER(Point Value = 5 points)

DIRECTIONS: Observe a birth, whether vaginal or surgical, collect the following data

and answer questions regarding the experience. Type the answers to the following questions and submit to your clinical instructor one week after the experience.

PAGE NUMBER: 3 5 pages ‐ PART I DATA COLLECTION (O.5 points)

Date: Student Name: Patient Initials: Marital Status: Age: Ethnic Background: Gravida, Para: Length of Labor: Complications: (ex: long labor, premature membrane rupture, extensive

lacerations, etc.) PART II THE BIRTH EXPERIENCE (3.0 points)

Describe the experience in terms of the following: 1. Location of birth, type of birth attendants and support persons

present (0.25 points)

2. Interaction of the laboring woman and her partner/coach with each other and with the nursing/medical staff attending the birth. Discuss any cultural implications and their significance to the birth. If not apparent implications, state this here. (0.25 points)

3. a. The type of and effectiveness of analgesia/anesthesia andbearing down efforts used (vaginal birth) OR

b. The type of and effectiveness of analgesia/anesthesia used fora surgical delivery (Cesarean birth)

(0.5 points)

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4. Immediate care the delivered woman for the first 2 hours followingthe birth. Immediate assessments, interventions, and theireffectiveness. Be sure to include SPECIFIC assessments andinterventions on YOUR patient. This includes the variouspostpartum checks which are routinely made on each patient.

(1 point) 5. Immediate care of the newborn for the first 2 hours following the

birth. Include assessments and interventions following thebirth. Include SPECIFIC assessments and interventions onYOUR neonate.

(1 point) PART III MATERNAL MEDICATIONS (1 point)

1. List ALL maternal medications used during the labor and deliveryprocess. Include analgesics, anesthetics, labor inductionagents, and any other medications.

2. List the following information for each medication: a. Name b. Classification c. Action d. Dosage e. Route f. Nursing interventions

Be SPECIFIC to your patient’s situation. PART IV SUMMARY (0.5 points)

In one paragraph, describe: a. How was this birth unique? b. How was care individualized based on this patient’s unique

situation?

AMBULATORY OB/GYN OR UROLOGY CLINIC EXPERIENCE

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1. OBJECTIVES FOR OB/GYN OBSERVATION:

At the completion of this experience, the student will be able to: A. Summarize the essential components of a prenatal/gynecological history. B. Define common terminology used in the history taking process. C. Describe physiological changes expected to occur in the various trimesters. D. Observe teaching taking place during the visit, whether prenatal,

postpartum, or gynecological visit. E. Identify laboratory or screening tests performed and list the significance of

abnormal results. F. Observe a prenatal, postpartum, or gynecological checkup. G. Review a typical prenatal, postpartum, or gynecological chart. H. Describe the risk screening process for prenatal patients.I. Identify the process for a typical gynecological checkup visit. J. If contraceptive method prescribed/administered/inserted, describe method

used including (when applicable) dosing, route, and side effects.K. List any medications prescribed for patient (name, classification, action,

dosage, route, and side effects)L. List any immunizations given including route, why vaccine given, and side

effects.M. Observe typical information given by the advice RN.

2. OBJECTIVES FOR UROLOGY OBSERVATION:At the completion of this experience, the student will be able to: A. Provide a brief description of one patient encounter, including patient age,

procedure performed and rationale for testing/procedureB. List any laboratory tests performed on this patient. Explain the significance

of any abnormal valuesC. Describe the role of the RN/MA during this patient’s encounterD. Describe any patient learning needs and how the staff addressed them

during the procedureE. Describe any follow-up instructions or needs anticipated for this patient

following the procedureF. Describe the differences between a diagnostic vs. therapeutic procedure

performed in this department

3. ASSIGNMENT

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A. Complete the paper which BEST pertains to your observation in theoutpatient setting. (OB vs GYN vs Urology)

B. Type the answers to the questions and submit to your instructor one weekafter the experience.

4. PRENATAL PATIENT ASSIGNMENT Choose one patient observed as a model for your answers. A. Identify your patient’s age, trimester of pregnancy, gravida and para. B. List five factors which may affect the course of pregnancy. Identify any

factors which may affect the course of THIS pregnancy as identified by the patient’s caregiver.

C. Define the following terms: primigravida, multigravida, primipara, and multipara. Identify which of these terms apply to your patient.

D. Describe typical physiological changes observed in your patient. Include in your description if these changes are appropriate for your patient’s trimester of pregnancy.

E. Describe any teaching needs observed during the visit and explain how youwould meet these needs.

F. List any laboratory tests performed on this patient and explain thesignificance of any abnormal values.

G. List any medications prescribed for patient (name, classification, action,dosage, route, and side effects)

H. List any immunizations given including route, why vaccine given, and sideeffects.

I. If the opportunity arose to listen to advice given over the telephone, describe one caller’s question and the advice given.

5. GYNECOLOGICAL VISIT ASSIGNMENT

If your patient’s visit was primarily gynecological in nature (ex: checkup, postpartum visit, gynecological problem), complete this assignment INSTEAD of the prenatal one. Choose one patient observed as a model for your answersA. Identify your patient’s age, reason for visit, chief complaint, if applicable. B. Define your patient’s medical diagnosis OR attach pertinent internet

printout. C. List risk factors for this medical diagnosis and identify those which apply to

your patient. D. Describe signs and symptoms displayed by your patient.

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E. If the visit is a routine checkup, describe any testing completed and explain the rationale for the tests completed.

F. Describe teaching observed during the visit and explain how you would meetthese needs.

G. List any laboratory tests performed on this patient. Explain the significance ofany abnormal values.

H. Describe the treatment prescribed for this patient, if applicable, and explain its rationale in this case.

6. UROLOGY VISIT ASSIGNMENTChoose one patient observed as a model for your answers.A. Identify your patient’s age, reason for visit, chief complaint, if applicable. B. Define your patient’s medical diagnosis OR attach pertinent internet

printout. C. List risk factors for this medical diagnosis and identify those which apply to

your patient. D. Describe signs and symptoms displayed by your patient. E. If the visit is a routine checkup, describe any testing completed and explain

the rationale for the tests completed. F. Describe teaching observed during the visit and explain how you would meet

these needs. G. List any laboratory tests performed on this patient. Explain the significance of

any abnormal values. H. Describe the treatment prescribed for this patient, if applicable, and explain

its rationale in this case.

NEONATAL LEVEL II/SPECIAL CARE NURSERY OBSERVATIONAL EXPERIENCE

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1. OBJECTIVES

After completing the observational experience, the student will be able to: A. Compare and contrast the role of the registered nurse in the Level I nursery

with the role of the registered nurse in the Level II/Special Care Nursery. B. Define the medical diagnosis of one patient observed as well as the

treatment that the newborn received for that medical diagnosis. C. Describe one piece of equipment that was used in the Level II/Special Care

Nursery that is not routinely used in the Level I nursery. D. Discuss the care of the newborn who is being fed by alternate means than

breast or bottle. From your research, identify appropriate laboratory studies and other nursing interventions needed to ensure that the newborn is receiving adequate nutrition.

E. Describe the reaction of one newborn who was observed during a painful experience. Identify several nursing interventions which were utilized as comfort measures.

2. ASSIGNMENT A. During your assigned visit, focus your observations on the objectives as much

as possible. B. Type your answers to the above objectives and submit to your clinical

instructor one week after the experience.

Lactation Education Experience

1. OBJECTIVES

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A. Identify common concerns of lactating women. B. List appropriate interventions for common breastfeeding problems. C. Describe assessment techniques used by the nurse when assisting lactating

women. D. Discuss the purpose and services provided by the lactation education center.

2. ASSIGNMENT

After observing rounds with the lactation educator and observing activities in the lactation education center, type the answers to the following questions. A. Describe the three most common concerns expressed by lactating women

while on rounds with the lactation educator. B. Using one lactating woman as an example, describe the assessment and

intervention techniques utilized by the lactation educator. List any questions asked by the woman and any problems discovered during the interaction.

C. Using printed patient teaching materials from the lactation center, list anddefine three lactation problems which should be reported to the health careprovider.

D. Briefly describe the services provided by the lactation center. Focus on clientneeds, community needs, and the benefits for lactating women and theirnewborn.

Type and submit to the clinical instructor one week after the experience.

Attach any pertinent patient teaching materials.

PERINATAL CULTURAL VARIATIONSPOST CONFERENCE ASSIGNMENT AND DISCUSSION

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1. PURPOSE: The purpose of this assignment is to explore various cultural

variations of the perinatal experience and to share this informationwith students in your clinical group in a postconference setting.

2. DUE DATE: To be determined by the clinical instructor. 3. ASSIGNMENT:

A. Choose a culture, either your own or one that particularly interests you. B. Sign up with your clinical instructor to avoid duplication of culture. C. Use the internet to access information regarding perinatal aspects of this

culture. D. On the assigned date, be prepared to discuss the following variations of the

culture, as applicable: 1. Prenatal care 2. Preparation for childbirth 3. Labor and birth 4. Postpartum self care ‐5. Nutrition prenatal, lactation ‐6. Role of grandparents and other extended family members 7. Breastfeeding 8. Circumcision 9. Other variations?

E. Submit your notes and internet printout to instructor on the assigned date.

ANTEPARTUM TESTING – OBSERVATIONAL EXPERIENCE(Mills-Peninsula Health Services only) NOT in 2018

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1. OBJECTIVES:A. Describe the role of the RN and the Perinatologist in the Antepartum Testing

Unit.B. List and describe three tests utilized in the antepartum testing unit to help

assess fetal well-being.C. Provide a brief description of one patient encounter, include the patient’s

age, gravida, para, gestational age and the rationale for testing.D. Describe any patient learning needs and how the staff addressed them

during the visit.

2. PAPER-Submit the typed answers to the above objectives one week after the visit toyour clinical instructor.

GESTATIONAL DIABETIC EDUCATION OBSERVATIONAL EXPERIENCE(Mills-Peninsula Health Services only)- NOT in 2018

1. OBJECTIVES : A. Define gestational diabetes.B. List the population groups considered to be at high risk for gestational

diabetes.C. Describe the testing criteria utilized for pregnant patients.D. Describe the current treatments prescribed for pregnant patients.E. Identify the primary learning needs of the newly diagnosed gestational

diabetic patient. Prioritize these needs and describe how you would teachthis type of patient.

2. PAPER-Provide typed answers to these objectives to your clinical instructor one

week following the experience.

Clinical Reflections-A Critical-thinking Journal1. Purpose/Objective:

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Critical thinking is a process or way of thinking that enables the nurse to give his/her clients the very best individualized care. It involves the use of the mind in forming conclusions, making decisions, drawing inferences and reflecting. (Gordon, 1995). The purpose of this assignment is to develop your critical thinking skills in the area of reflection. Reflection is defined as the process of thinking back or recalling an event to discover the meaning and purpose of that event. (Miller and Babcock, 1996). As a student nurse, reflecting back on a clinical experience or an interaction with a professional colleague can help you to understand how the concepts from the theory class apply to the lab or the hospital experience. It also helps you to evaluate yourself and to think about how you might have handled the situation differently to achieve a more satisfying outcome.

Keeping a clinical reflections journal is a way to develop your critical thinking skills in the area of reflection. The journal should reflect your attitudes, feelings and actual learning experiences as you enter the clinical setting of this course for the first time. As you progress in this semester of the nursing program, this journal will be a resource for you to look back at significant experiences and gain insight into your own professional development as a critical thinker. You will be able to see the transition now from your novice beginnings in N211 through the specialty areas of pediatric and maternity nursing.

2. Assignment:At the end of  each  week  of clinical, starting with the first week of preclinical

lab and orientation, select an experience from either clinical day that stimulated your thinking. This experience could be an interaction with a client, a family, a fellow student, or a teacher. For each entry, cover the following four aspects:

1. Describe as completely as possible what happened and what you did.2. Describe what you were thinking at the time, why you decided to do what

you did or say what you said.3. Describe what you would do differently the next time when encountering a

similar incident or experience.4. Describe your strengths and weaknesses in dealing with this particular

situation. What were you feeling?

→Your clinical teacher will provide time at the end of the postconference for you to make your entries. The completed journal will be due to the clinical teacher on the last day of clinical. It is the teacher’s option to review the journal each week or at the end of the eight weeks.3. Grading: This is a required credit/no credit assignment for completion of N222.

N222 Competency-Neonatal IM Injection

1. Purpose:

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Competency has been integrated into the curriculum to set standards for student achievement. Nursing students need to be prepared to perform at an entry level of practice. We are attempting to simulate different evaluation situations and conditions that are similar to those which you will encounter as a professional nurse. The purpose of the evaluation session is to evaluate your performance of a situationally based skill under testing conditions at a competent level. Competency is defined as the correct performance, in the designated order the behaviors from memory within a set time period.

2. Learning Objective: At the completion of the evaluation session, the student will correctly administer a

medication using the intramuscular route to a neonate under testing conditions.

3. Skill: Administration of an intramuscular injection of a neonate.

4. Time Period: 15 minutes

5. Procedure: You must pass the medication administration test and the evaluation session before

administering an intramuscular injection to a neonate. You will need to be determined competent in this section no later than the end of the third week of class. Initial skill practice will take place during the first 225 lab. Additional practice time is available during open lab hours. Sign up for a time slot with your skills lab instructor.

6. Competency: Competency will be determined by a checklist (which will be distributed to all

students) and completion within the timeframe. You will have more than one opportunity to achieve competency. If you have questions regarding the skill, be sure to clarify with the clinical or skills lab instructor.

Name: ___________________________ Date:_____________ Time allotted: 15 minutes

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N222 COMPETENCYSKILLS CHECKLIST: Administration of an

intramuscular injection to an infant.

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States I am finished and accesses instructor.

1. Checks doctor’s orders. Release order, see MAR

2. Obtains equipment-alcohol swabs, 1 mL syringe with needle medication, 2x2 gauze, and gloves.

3. Pull medication from Pyxis and check-name, dosage, and expiration date-1st check.

4. Washes hands.

5. Performs 2nd medication check and wipes top of medication vial with alcohol.

6. Injects dosage amount of air into the vial.

7. Inverts vial and withdraws correct amount of dosage.

8. Expels any air bubbles.

9. Checks dosage for accuracy. Verbalizes correct dosage.

10. Takes all equipment to the crib side.

11. Identifies neonate by checking ID band. Perform 3rd med check.

12. Applies gloves and identifies correct site.

13. Grasps leg with non-dominant hand and simulates bunching of muscle.

14. Cleanse the site with alcohol or facility-preferred agent.

15. Verbalizes correct angle of injection

16. Applies pressure with 2x2 gauze pad until no further bleeding.

17. Disposes of syringe in sharps container.

18. Rewraps neonate snugly.

19. Removes all equipment and gloves.

20. Washes hands.

21. Documents correctly using present time and date

Competent _________________________ Not yet competent ___________________N222SkillsChecklist.doc-2018

ATI Maternal Newborn Nursing Test

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You will take a proctored ATI online exam near the end of your Maternity section of the Nursing Program. The ATI exam will be administered in the Business Lab (Building 14, Room 105). The date can be found in the N222 syllabus under “Dates to Remember”.

Any students registered with the Learning Disability department will be provided with reasonable time accommodation to take the exam in the DSPS (Building 10, room 120).

This 60+ item test offers an assessment of the student’s basic comprehension and ‐mastery of maternal newborn nursing content. Reference: ATI Maternal Newborn Nursing. ‐(2016) RN Edition 10.

To be able to take the proctored ATI exam, you must have completed no less than 2 practice ATI exams (RN Maternal Newborn Online Practice 2016 A/B) and have passed one version with a score of > 80%. You can take the practice ATI exams as many times as you need to reach the mandatory score. You have until the Sunday night PRIOR to your Monday exam date to complete the requirement so do not wait until the last minute to complete your practice exams.

ATI Contact Information: Where Questions Get AnsweredFor sales inquiries: sales@atitesting.comFor general inquiries: comments@atitesting.comPhone: 1.800-667-7531Fax: 913-661-6245

Address: 11161 Overbrook Road, Leawood, Kansas 66211

Standard Office Hours7:00 am to 7:00 pm (Central), Monday – Friday Seasonal Office Hours (August 1 – September 30)7:00 am to 9:00 pm (Central), Monday – Friday8:00 am to 12:00 pm (Central), SaturdayFor after-hours operational issues please send an email to helpdesk@atitesting.com. All emails will be returned the following business day.

ATI Tips / Guidelines for Students the Day of the Test 1. All N222 course, nursing program and college testing policies apply to ATI testing.

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2. Do not arrive late. Get to class with plenty of time to spare before the test begin. Arrive by 1445 and wait outside Business Lab in Building 14, Rm 105. Test begins at 1500.

3. No pens, paper, coffee/drinks, or backpacks/purses at your computer station. Pleaseturn off cell phones and place inside backpacks.

4. Pace yourself so you are able to complete the test within the allotted time. If youcannot decide, make an educated guess. Trust your knowledge.

5. Avoid reading into the question. Deal only with the information in the test question. 6. Earplugs may be of help. Students may leave quietly when the completed the test. 7. Sign on to ATI testing site (atitesting.com). Use your password you created when you

registered on the site. 8. There’s a “drop down” calculator for math problems but be careful not to use it “too

fast” – it won’t work. 9. When using the cursor for the test, do not move outside your “page.” It will indicate to the proctor that you are “cheating.” 10. If you need to take a break, there is a “pause” button at the top of the screen. It will

pause your time for 5 minutes only, then your test clock starts to tick again. 11. Please log off when done. 12. There is no printing available at the computer lab. 13. The course points for the ATI Fundamental Predictor test will be allocated by the

following percentage points:

Percentage Points0 54 ‐ 055 65 ‐ 166 79 ‐ 280 100 ‐ 3

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APPENDICES

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LATCH Scoring for Breastfeeding

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CSM PATIENT CARE WORKSHEETN222 - Postpartum Patient

Student: ________________________________ Date: ___________________________

Patient’s Initials: ___________ RM#: _________ Age: ________ Religion: ________________________ Admission Date: ___________ Family Role: __________________ Occupation: ______________________

Type of Delivery: ____________________________ Complications: _____________________________ Newborn Gestational Age: ____________________

Gravida/Para: _______________________________ Newborn Sex: ______________________________

Priority Identified Teaching Needs:

Patient Teaching Plan & Goal:

Referrals:

Newborn Apgar Score:

Ethnic/Cultural Implications:

Safety Issues (Mom/Newborn):

IV Fluids: Type: ______________ IV Balance: _________ ________ Rate of Flow: ________ ________(Beginning) (Ending) (cc/hr) (gtts/min)

Epidural Catheter in place:_______ IV Medications: ___________________________IV Site Assessment: ____________________________ Protocols in Progress: _______________________

Allergies:Treatments/Therapy

Time

Order MedicationsDate Time

Stop Date

Significant Diagnostic Data(lab, radiology, special procedures, etc.)

MOMDate Test Results Significance

NEWBORNDate Test Results Significance

N222PTWRKSH.DOC

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LABOR HISTORY:

ASSESSMENT CRITERIAMOM

ASSESSMENTS/OBSERVATIONS

INTEG: color, temp, moisture, turgor, integrity, episiotomy, laceration, c/s incisionNEURO: A&O x 4, PERRLA, symmetry, facial expressions, EOMs, fine/gross motor fxn, MAE, grips, sensation, speech, strength

T=

*RESP: rate rhythm, depth, effort, breath sounds, incentive spirometry, m. membranes

R=

*CV: pulses, capillary refill, edema, CSM, Homan's sign

B/P=

*GU: amount, urine characteristics, bladder distention, lochia, breasts, nipples, fundusGI: intake, appetite, BM, bowel sounds, distention, hemorrhoids

*MS: ROM, spine, MAE, Strength

EENT: vision, glasses

EMOT/PSYCH: affect, mood, cooperation, family support systems, bondingPAIN: location, intensity, characteristics, pharmacological and nonpharmacological interventions

*Include any accessory equipment used on patient (monitor, 02, foley)

TIME MANAGEMENT PLAN *If “couplet” care include Mom & BabyPrimary Patient Goal:

TIME PLAN ANALYSIS OF DAY

N222PtWrksh.doc

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CSM PATIENT CARE WORKSHEETN222 - Newborn Patient

Student: ___________________________________ Date: ______________________________Newborn Initials: ______________ Sex: ____ Date & Time of Birth: __________________Type of Birth: _____________________________ Apgar Score: ________________________Complications: _____________________________ Birth Weight: ________________________Type of Feeding: ___________________________ Gestational Age: _____________________Safety Issues: _____________________________ Referrals: ___________________________

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ASSESSMENT CRITERIA ASSESSMENTS/OBSERVATIONSINTEG: color, temp, turgor, integrity, rashes, lanugo, vernix, lesions, cord, birthmarks, , other variationsNEURO: symmetry, cry, MAE, reflexes (list), fontanels

T=

RESP: rate, rhythm, depth, effort, breath sounds, O2 sat, mucous membranes

R=

CV: apical pulse, murmur, peripheral pulses, capillary refill, CSM

AP=

GU: number of voids, color, discharge, external genitalia, circumcision site, meatusplacementGI: intake, feeding reflexes, BM, bowel sounds, patent anus, cord vessels/status

MS: MAE, spine, symmetry, posture, extremities

EENT: discharge, nares, response to sounds, red reflex, palate, ears

EMOT/PSYCH: bonding, response to touch, eye contact, parental support

PAIN: cry, vital sign changes, consolability, interventions

5/00N222PtWrksh.doc

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