COURSE OVERVIEW

COURSE TITLE: TOTAL COURSE HOURS: PLACEMENT OF COURSE: MAXIMUM ENROLLMENT: COURSE COORDINATOR: Nursing Science 111 3.5 Units (2 Units Theory/1.5 Units Clinical) (2 Units Theory = 36.0 hours) (1.5 Units Clinical = 81.0 hours) Third Semester, four times a year 24 = 3 clinical instructors x 12 students Kim Hollingshead, RN, MSN

COURSE DESCRIPTION: This course focuses on the nurse as a provider of care, manager of care and member of the profession in a variety of maternal child settings. Course content includes clients needs during the antenatal, intrapartal, postpartal, neonatal period and reproductive health care cycle. Building upon Maslows Hierarchy of Needs and the Nursing Process, course content in Maternal Child Nursing will be presented within the framework of the wellness/illness continuum of the client and family during the reproductive and post productive years.
Teaching Methods: Lecture, discussion, laboratory activity, field experience, nursing care plans, peer teaching presentations, demonstration, clinical practice. Evaluation Methods: Nursing care plans, oral presentations, dosage calculation quiz, maternal/child examinations, clinical performance.

NS 111 GRADE POINT SHEET Maternity Exam #1 (_____/80) Maternity Exam #2 (_____/80) Maternity Exam #3 (_____/125) Oral Presentation (_____/10)

85 85 120

Total theory points 300 A = 100-90% 300-270 points B = 89-80% 269 240 points C = 79-75% 239 - 225 points <224 points = F = course failure

MATH
The grade achieved on math quizzes will not be factored into the grade for the course. However, students are required to achieve an 85% on each quiz given in NS 111. Failure to achieve a minimum score will result in the student having to complete a math remediation program devised by the course instructor. The remediation program will be taken from the required math textbook for the course. Students will be required to sign a remediation contract with the course instructor regarding the remediation plan. The student must complete a make-up examination with a minimum of 85% accuracy. A date for completion of remediation will be determined. Students are advised that failure to complete remediation in a timely basis could result in clinical failure for the course, as students will not be allowed to administer medication, at the course instructors discretion, in the clinical setting until the remediation plan is complete. * NO TAPE RECORDING OF LECTURES IS ALLOWED.

CLINICAL AGENCIES HOLLYWOOD PRESBYTERIAN VALLEY PRESBYTERIAN HOSPITAL UCLA SANTA MONICA

TYPES OF EXPERIENCES LABOR AND DELIVERY, POSTPARTUM, NEWBORN NURSERY, ANTEPARTUM TESTING INSTRUCTORS: KIM HOLLINGSHEAD, DOT OLMASSAKIAN

REQUIRED TEXT
1.Ricci, S. 2009 Essential of Maternity, Newborn, and Womens Health Nursing

RECOMMENDED Hogan, Maternal-Newborn Nursing Reviews and Rationale *Texts from previous course will supplement course information.

Skills Lab Students enrolled in the third semester are required to enroll in NSG 115. The hours of attendance will be announced in the first week of class. All students are required to meet the hours of attendance. Student Disabilities If you are a student with a disability requiring classroom accommodations, and have contacted SSD, do so in a timely manner. Student Disabled Services is located in the Student Services Annex, room 175 or call SSD at (818) 947-2681 or TTD (818)947-2680 to meet with a SSD counselor. If SSD has already sent the memo to the instructor confirming accommodations required by the student for this class, please meet with me to discuss arrangements

COURSE OBJECTIVES
1. Identify legal/ethical implications of maternal child nursing 2. Complete reproductive health care assessment for clients and families within the Frameworks of Maslows Hierarchy of Needs. 3. Identify impact of culture and beliefs on clients/families in the reproductive and womens health care setting. 4. Analyze needs and articulate plans of care for women/families experiencing variations in reproductive health. 5. Evaluate psychological and physical needs of clients/families within the wellness illness continuum in the maternal/child and womens health care setting. 6. Evaluate clients/families ability for self-care and implement teaching according to needs assessment.

STUDENT LEARNING OUTCOMES At the completion of NS111 Reproductive Nursing and Womens Health the student will be able to: Formulate, organize and implement an evidence based plan of care for women/families in various reproductive settings at a nurse generalist level. COURSE COMPETENCIES When caring for clients and families in the maternal/ child health care setting the student will: I As the provider of care Collect complete client and family history using the human needs framework to prioritize clients/family needs. Implement therapeutic nursing interventions based upon assessment of the client/family physiological, psychological, sociocultural, developmental and spiritual needs. Analysis/Diagnosis Formulates Framework. Planning and prioritizes nursing diagnosis based upon Maslows Human Needs

Collaborates with health team members in organizing, providing and evaluating client and family care in the reproductive and womens health care setting. Utilize critical thinking skills in conjunction with the nursing process to prioritize assessed Human Needs for childbearing women and families with alterations in wellness. Develop goals that are attainable, measurable and specific to assessed needs of the client and families with alterations in reproductive health. Utilize evidenced based practice to develop individualized teaching plans for client/families and significant others focusing on promotion, restoration and maintenance of wellness.

Implementation Implement and demonstrate caring interventions that are sensitive to the clients human sexuality, culture, values and beliefs. Incorporate the familys lifestyle, cultural beliefs, health behaviors and support systems when using the nursing process. Demonstrate knowledge of pharmacology principles as they apply to the safe administration of medication. Provide interventions, which are evidenced, based and accurately document rationale for nursing action in the reproductive health care setting.

Evaluation Evaluate individual client and family responses to nursing interventions utilized to promote and maintain wellness. Demonstrate ongoing self-evaluation with identification of strengths and areaseeding improvement. As a Communicator Demonstrate the use of therapeutic communication skills to develop a caring nurse client relationship, which reflects cultural sensitivity.

Use therapeutic communication to promote the psychological, emotional and spiritual well being of the client and family in the reproductive health care setting. Demonstrate the ability to effectively communicate clients responses to nursing interventions and medical regimes clearly concisely and accurately through nursing notes and documentation. Provide an accurate oral report to instructor/charge nurse or members of the health care team in the reproductive health care setting.

Manager of Care Apply time management skills for multiple clients while demonstrating effective use of resources for clients and families in the reproductive health care setting. Demonstrate leadership/management skills through application of knowledge, acting as a facilitator of care and appropriate delegation of responsibilities. Function as an active and cooperative member of the health care team in the reproductive health care setting. Demonstrate client/family advocacy of client rights in the reproductive health care setting. Member of the Profession Practices in a manner consistent with federal and state laws according to legal/ethical ANA Code of Ethics, Scope and Standards of Care, Board of Registered Nursing regulatory framework and AWHONN Standards of Care. Demonstrates a beginning commitment to lifelong learning as part of professional development. Demonstrates client confidentiality according to HIPPA guidelines. Demonstrates accountability for own actions and is able to self evaluate.

Course Competencies r/t Content/ Unit Activities Content Competencies Week I Discuss past and current Discuss the principles of Ricci Chapters 1-2 family centered care. trends of womens health. Compare current and future Use Maslow's human needs model to health care trends that will explain wellness and illness related to affect womens health. families utilizing the healthcare system.

http://www.healthypeople.gov/ Summarize the health care Discuss the role of indicators that affect Healthy People 2010 in http://www.4woman.gov/ establishing disease womens health. prevention and health promotion.

Discuss the disparity of Summarize the barriers to health care in the United health care. Include: Preconceptual and prenatal States. care Racial disparities Insurance Health habits Poverty Access to health care Financial Cultural Violence Identify sources that provide Discuss legal and ethical guidelines for safe and legal issues that influence the nursing practice. Include: State Practice Act maternal/child nurse. Standards of Care (ANA)

Describe the current trend towards community based nursing.

Compare the role of nursing in the community based setting with those in the acute setting.

Describe community based nursing in relation to care for women and infants.

Summarize the role of the nurse in providing comprehensive community centered care. Include: Prenatal care Labor and delivery Birthing Center Home birth Postpartum and newborn care Home visits Womens Health Explain and compare the three levels of nursing provided in the community.

Discuss the levels of care provided by community based nursing.

Discuss the benefits (for each levels of preventive care) of community based nursing.

Summarize the impact of culture on the family unit and the implication for community based nursing. Describe the characteristics of a nurse who provides culturally competent care. Discuss the role of complimentary and alternative medicine (CAM) in health care. Review female and male anatomy

Explore cultural beliefs and behaviors that are common during the childbearing period. Explain the process of developing and providing culturally competent care. Identify the role of nursing when caring for clients whom practice CAM. http://www.nursingworld. org/ojin/topic20/tpc20_2.htm

Summarize the female reproductive cycle and hormones of the menstrual cycle. Describe the process of Identify and summarize the fertilization and embryonic function of: development Embryonic membranes Amniotic fluid

Ricci Chapter 3

Ricci Chapter 10

Umbilical cord- Whartons jelly Placenta Hormones Classroom activity: Summarize significant Identify significant List 3-4 questions parents may ask during changes in fetal growth and milestones of fetal an ultrasound of their fetus. development. development

Compare the causes genetic abnormalities

of Differentiate genetic abnormalities. Include: Chromosomal abnormalities Numeric abnormalities Structural abnormalities Inheritance patterns Autosomal dominant Autosomal recessive

Using the wellness/illness model, develop nursing care plan for parents seeking preconceptual counseling. Identify factors that may place women/families at risk for genetic abnormalities.

Summarize nursing responsibilities in genetic testing.

Critical Thinking: Who should have access to genetic testing results?

Week 2
Discuss the signs and Differentiate the changes of pregnancy as objective, symptoms of pregnancy. subjective or diagnostic. Summarize major Describe changes (systemic physiological changes that and time frame) that occur during pregnancy. Include: occur during pregnancy. Reproductive GI Cardiovascular Respiratory Renal Musculoskeletal Integumentary Endocrine Immune Discuss the psychosocial adaptation to pregnancy. Compare the various psychological responses of the mother, partner and

Ricci Chapter 11

Utilize the wellness/illness model to describe the developmental tasks of the family during pregnancy.

Ricci Chapter 12 Using the wellness/illness model, develop nursing care plan for parents seeking

family during pregnancy Summarize the goals of preconceptual counseling. Discuss the findings of a complete health care assessment that require nursing education or screening. Analyze the purpose of prenatal care. Discuss common diagnostic tests useful in promoting a healthy outcome: Pregnancy test Serological testing Titers HIV testing STD Pap smear

preconceptual counseling. Utilize the terms G-T-P-A-L to summarize a clients current and past pregnancies.

Define the terms and summarize the components of obtaining a prenatal care history.

Web sites: http://www. nlm.nih.gov/medlineplus/prenatalcare.html

Develop nursing care plan using Maslows Human needs model that prioritizes risk factors related to pregnancy

Identify roles and responsibilities of the health care team for the childbearing family

Compare normal physical findings with alteration and possible cause during a prenatal assessment.

Compare and contrast the risks and benefits of the following diagnostic tests which assess fetal well being: Fetal heart rate (movement) Chorionic villi sampling Ultrasound Doppler AFP Amniocentisis NST CST Biophysical profile

Develop a teaching plan that promotes self-care during pregnancy.

Describe nursing education related to Hygiene Breast care Clothing Exercise Sleep rest Sexual activity Medications Immunizations

Plan care that will focus on promoting wellness for the common discomforts of pregnancy.

Differentiate the common discomforts of pregnancy by: Trimester and the relationship to physiological change

Summarize the normal weight gain of an expectant mother and the recommended daily allowance of nutrition.

Develop therapeutic teaching plan that assist the mother to meet the increase nutritional demands of pregnancy.

Summarize the impact of ethnicity, religion and culture on dietary choices.

Discuss disorders and populations that are at risk for alteration in nutrition. Adolescents Pica Anorexia Bulimia Discuss considerations clients/families may have when making decisions regarding a birth plan

Classroom activity:

Develop anticipatory teaching plan for woman with special diets.

Differentiate various childbirth preparation methods.

Suggested Activity: Attend a childbirth education class at a local hospital. See objectives in back of syllabus.

Compare nutritional requirement of the breastfeeding and nonbreastfeeding mother.

Discuss maternal and newborn Specific information for benefits to breastfeeding. expectant mothers can be found:
http://www.babyzone.com Video: Mat 27 Pregnancy-2004

Plan therapeutic interventions that promote safety and education r/t the danger signs of pregnancy. Review premonitory signs of labor. Evaluate the factors that effect labor.

Differentiate danger signs by trimester

Web sites: www. midwife.org www.healthy.net/cims Ricci Chapter 13

Compare true labor with false labor Correlate the anatomy of the female pelvis and the anatomy of the fetal skull with the orientation of the fetus in utero. Consider the following factors Passageway Passenger Powers Position Psychological Response

Simkin, P. Supportive Care During Labor, JOGGN, 31, 721-732, 2002 Available in Nursing Lab.

Describe maternal and fetal physiological responses to labor.

Explore the relationship of the womans ability to cope with the stress of labor and psychological state.

Summarize the normal physiological/psychological changes that occur during labor. Prioritize a physical assessment of a woman being admitted for labor. . Discuss assessment data and interventions used to assess the progress of labor.

Describe nursing assessment related to the stages and phases of labor.

Describe assessment data on admission to a perinatal unit. Describe: Maternal assessment Vaginal examinations Uterine contractions Leopolds maneuver

Ricci, Chapter 14 Video: Mat 28 Labor and Delivery 2004

Fetal monitoring Plan caring interventions for variations in fetal heart tones. Consider variations in fetal heart tones and nursing management for variables, late and early deceleration patterns Classroom activity: Use fetal heart tone tracing paper and draw variations in fetal heart tones and nursing interventions appropriate to each pattern.

Discuss nursing management of client with nonreassuring fetal heart tone tracing.

Identify rationale for: Informing M.D. Repositioning Administration of 02 IV fluids Discontinuing pitocin Compare the advantages and disadvantages of analgesia / anesthesia / non pharmacological measures Include: Labor support Position changes Breathing techniques Systemic Regional (spinal and epidural) Contraindications Nursing education Interpret the physiological findings of the mother and fetus that occur during each stage of labor. Video: Mat 29 Pain Control During Labor 2004

Plan therapeutic nursing interventions that will assist the client/family cope with the discomfort of labor.

Plan caring interventions that promote optimal outcomes for each stage of labor. Plan and prioritize care to stabilize the newborn physiologically following delivery.

Use an intrapartal nursing assessment and Maslows human needs to prioritize care of the intrapartal client and family. Describe the components of a Classroom Review assigning newborn assessment following APGAR score for newborn. birth

Plan therapeutic nursing interventions for the third

Recognize the risk factors and s/s of hemorrhage in the

stage of labor.

immediate post partum period.

Plan therapeutic nursing interventions for the third stage of labor. Plan nursing interventions for the postpartum client and family. Develop teaching plan that will focus on assisting the postpartum client/ family towards restoring wellness.

Describe nursing interventions for the third stage of labor. Describe physiological changes that occur in the postpartum period. Describe nursing interventions related to relieving: Perineal discomfort Breast Engorgement Afterpains Discuss the developmental sequence of psychological changes experienced by the postpartum family.

Ricci, Chapter 15

Assess family for paternal/maternal bonding.

Week 3 Summarize the impact of culture on the family unit and the implications for developing a teaching plan. Plan therapeutic nursing interventions for client and families. Discuss nursing assessment finding that place the client at risk for complications during the postpartum period Course competencies r/t

Discuss specific cultural practices related to: Breastfeeding Diet Clothing Describe the physiological changes that occur during the postpartum period. Explain conditions that place the postpartum client at risk for infection or hemorrhage.

Ricci, Chapter 16

Content/unit competencies

Activities

content Develop teaching plan that will focus on assisting the postpartum client/ family towards restoring wellness.

Describe nursing interventions related to: Perineal discomfort Breast Engorgement Afterpains Promoting bonding Rest/Activity Discuss self care measures related to: Perineal care Kegel exercise Safety Sexuality Breast care Lactation suppression Describe the benefits of breastfeeding, include: Let down process Attaching infant to the breast Breaking suction Breast care and nipple evaluation. Discuss assessment criteria necessary for discharge planning, home care and follow-up. Discuss the physiological changes that occur after birth. Include: Cardiovascular Respiratory Temperature regulation Hepatic GI Immunity Neurological Compare behavior patterns to behavioral responses.

Plan nursing interventions focused on promoting selfcare for client/families.

Plan care that incorporates the principles of successful breastfeeding.

Delineate criteria and teaching topics related to postpartum discharge

Prioritize nursing care according to Maslows human needs model for the newborn transitioning from intrauterine to extrauterine life.

Ricci Chapter 17 Video: Physical Assessment of the Newborn

Plan interventions appropriate to the behavioral adaptations of the newborn.

Summarize the physical and behavioral characteristics of the newborn.

Describe assessment of assessing newborn: Vial signs Weight Length Head circumference Chest circumference Skin Describe eliciting newborn reflexes. Identify nursing interventions of the newborn. Include: Vital signs Activity Color Feeding Elimination Calculate the gestational age of a newborn based upon physical and neuromuscular findings.

Ricci Chapter 18

Class Activity: Review APGAR scores.

Plan care for the admission of the neonate to the hospital. Correlate care to maintenance of wellness.

Class Activity: Complete Gestational Age Assessment on page 478 Class Activity: Review administration of Vitamin K and Erythromycin

Plan care for successful breastfeeding. Integrate teaching learning principles in parent education related to the care of the newborn.

Compare advantages of breastfeeding to bottle feeding. Describe: Proper holding Proper positioning Infant safety practices Bathing Umbilical cord care Circumcision care Immunizations Bonding Jaundice Newborn screening

Course competencies r/t content Week 4 Plan therapeutic/caring

Content/unit competencies Identify assessment findings

Activities Ricci, Chapter 19

interventions that will promote a healthy outcome for the pregnant woman/family whose fetus well-being is threatened by a high risk condition.

for each of the following conditions which will threaten maternal and fetal well being. Spontaneous abortion Threatened abortion Imminent abortion Complete abortion Habitual abortion Missed abortion Ectopic pregnancy-identify etiologies Previa vs.abruptio placentaedistinguish similar and dissimilar findings Distinguish treatment modalities

Classroom activity: Prioritize nursing care, according to Maslows human needs, for women experiencing a hemorrhage. Web sites: www. midwife.org www.healthy.net/cims

Plan nursing interventions for the client experiencing hyperemesis gravidarum.

Describe nursing interventions to minimize nausea and vomiting.

Develop nursing care plan for management of mild vs. severe preeclampsia. Include: Self care Education Diet Activity

Differentiate assessment findings between mild / severe preeclampsia and HELLP, identify risk factors. Differentiate management in the antepartal, intrapartum and postpartum period. Consider route, dosage, side effects, contraindications and therapeutic levels. Classroom Activity: List nursing assessments and interventions for clients receiving magnesium sulphate.

Discuss the rationale for the administration of Magnesium Sulphate for the treatment of preeclampsia.

Plan care for mother/ fetus experiencing ABO incompatibility.

Describe etiology of blood incompatibility.

Plan nursing care for women with alterations in amniotic fluid.

Describe treatment and nursing management for oligohyramnios and polyhydramnios.

Differentiate management of women experiencing preterm labor with premature rupture of membranes

Describe risk factors in a womans prenatal history that place her at risk for PTL and PROM.

Ricci, Chapter 20 Plan therapeutic nursing interventions that will promote a healthy outcome for the client and fetus with diabetes during pregnancy. Discuss the pathology and clinical treatment for gestational diabetes. Include: Classifications Maternal/fetal risks Laboratory assessment.

Compare antenatal, intrapartal and postpartum management of gestational diabetes.

Discuss goals of clinical care for clients in the antenatal, intrapartal and postpartum setting. Identify subjective/objective finding for classifications of heart disease.

Discuss the cultural/familial implications of diabetes in pregnancy.

Differentiate nursing management of client with cardiovascular disease during pregnancy.

Plan nursing interventions for woman with a respiratory condition during pregnancy.

Explain effects and treatment of asthma and tuberculosis during pregnancy.

Plan nursing care for women with hematological disorders of pregnancy. Plan nursing interventions for the pregnant woman that will prevent or limit exposure to TORCH. Differentiate nursing care for those populations at risk for an adverse outcome during pregnancy.

Differentiate nursing management of types of anemia. Review the meaning of TORCH and populations a t risk for exposure. Identify assessment findings for the following populations that threaten maternal and fetal well being. Adolescents Woman over 35 Woman infected with HIV Substance abuse Differentiate risks to mother and newborn.

Identify etiology, subjective and objective assessment findings that threaten the well being of the laboring woman and fetus.

Describe nursing interventions which promote a healthy outcome for the laboring woman with dystocia: Dysfunctional labor Problems with the passenger Multiple gestation Macrosomia Problems with the passageway Psychological stress

Ricci, Chapter 21

Week 5 Plan nursing management of client with post term labor and birth Plan care for the client requiring induction or augmentation of labor.

Compare term vs. post term nursing interventions. Compare nonpharmacological, mechanical and pharmacological agents used for induction and augmentation.

Discuss assessment/ management of obstetrical emergencies.

Describe obstetrical emergency situations.

Plan teaching interventions for the laboring woman who requires a birth related procedure.

Discuss indications for common obstetrical procedures. Include: External cephalic version Amnioinfusion Vacuum/forceps assisted delivery Cesarean section Vaginal birth after cesarean section (VBAC) Differentiate management for client with: Uterine atony Trauma Idiopathic thrombocytopenia Von Willbrand Disease Thromboembolic Conditions

Class discussion: Discuss nursing assessment of client receiving oxytocin. Formulate nursing diagnosis related to labor induction.

Plan care for women with vaginal or cesarean birth at risk postpartum hemorrhage

Utilize the postpartum assessment form to collect data that indicates the postpartum woman may be at risk for puerperal infection.

Identify predisposing factors, etiology, subjective and objective findings for client with postpartum infection.

Week 8

Comprehensive Final Exam

Group Presentation
Students will form groups and perform a teaching presentation to the rest of the class. The schedule for presentation will be discussed. Submit topic for group presentation no later than second week of class. The group presentation will be no longer than 15 minutes. Points will be deducted for those groups exceeding the time limits. You will be graded as a group for your overall participation and presentation as well as individually, as a member of the team. 1. You will work in groups of 4-5. You may self select your groups. 2. The group is to select 2-3 current journal articles that are no more than 3 years old. The articles must relate to course content. 3. The goal of this presentation is to teach the class about your article in the time allotted for your presentation. 4. For your presentation, you may se various forms of audio visual support such as power point, video, role playing, handouts, posters, audio, ect. The nursing skills lab may be for group activity and filming of scenarios, with faculty approval. 5. Submit copies of your articles on the day of the presentation. 6. Please discuss the topic the group has chosen before beginning your presentation. 7. Remember: You will want to keep your audience engaged while teaching them about your article.

Evaluation will be based upon; 1. 2. 3. 4. Appropriateness of presentation to the third semester level students. Clarity of material presented. Presentation- including supporting media, handouts, ect. Group participation.