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How do you approach her and

Module 1 discussion

Preventative Care / Care of Women and Children

Respond to each discussion prompt as your initial post. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Group A:

Healthy People 2010 – is a guide to promote preventative care. Review primary, secondary and tertiary prevention and relate this to women and children at risk in your community. Identify those risk factors that a prevention program could impact the health of the group you identify.

This video is the Healthy People 2020 initiative

Group B:

Please research medical technological advances that may be unique to the care of women and children. Discuss how this technology will improve care to women and children. (ideas may be: genetic screening, public health initiatives, mammography, cervical screening, Fetal monitoring, Electronic medical records, telemedicine).

Which technological advances have been utilized in your local hospital? How has it impacted the care of women and children?

Module 2 discussion

Emergency Contraception / Emergency Department

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Group A will complete the following discussion and then respond to Group B discussion.

Emergency Contraception:

A16 year old reports to the local Family Planning clinic with concerns regarding pregnancy. She relates she had unprotected intercourse 2 nights ago and believes she may be ‘fertile’. She wants to learn more about the ‘morning after pill’

What additional information should you obtain from her?

What do you know about emergency contraception and the side effects?

What educational points should you provide to her?

Group B will complete the following discussion and respond to Group A’s discussion post.

Vaginal Bleeding in pregnancy:

A pregnant patient arrives in the Emergency Department with complaints of vaginal bleeding. You will choose the gestational age of your patient, and based on that gestational age answer the following questions:

Knowing the gestational age, provide information on LMP, and EDD

What are the possible reasons she is bleeding at this gestational age?

What are your nursing interventions for this issue, and please include education to your patient.

Module 3 discussion

Labor Management

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Part 1: An 18 year old Primigravida presents to Labor And Delivery with what appears to be active labor. Upon questioning, you discover she has received no prenatal care. In obtaining some history while placing her on the fetal monitor you learn she is a smoker, approximately 1 pack per day, occasional marijuana for stress, and denies any support system. The Father of the Baby (FOB) has no knowledge of the pregnancy. No prenatal vitamins – they were too hard to swallow. She has no idea when her LMP was and she relates always being very irregular. * remember LMP is to ask the first day of the Last Menstrual cycle, not when the bleeding stopped*

What other questions are essential for her safe care?

What lab values do you need to obtain?

What exam findings should you obtain at this time?

What education will you provide for her?

She asks you how long this will take to have the baby – what is your best response?

Group B

Part 2: Objective information:

Fetal heart tones are 130, with minimal variability

Vaginal exam is 4 cm/90%effaced/ -1 station

She is complaining of pain – 8/10 on a numerical scale.

An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm.

How can you provide non pharmacological comfort to this patient?

What are the pharmacological methods to use?

Without prenatal records or history GBS is unknown. What must you provide?

Contractions are 5 minutes apart and you receive an order to augment labor – what non pharmacological methods can you employ (or ask the MD to provide?)

Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?

Preterm Labor Management

Preterm labor

Group B: complete Part 1

Part 1: 25 y/o presents to Labor and Delivery with complaints of uterine cramping and lower back pain. Denies any vaginal bleeding at this time. Has related history of a preterm birth at 32 weeks gestation with her last pregnancy. The baby is 3 years old now and has no developmental issues.

Her current gestational age is 30 weeks.

She is O+ and all other lab values are normal. No noted STI’s.

1. Group Beta Strep is missing from the labs – most often is obtained at 35 – 37 weeks gestation.

2. Without this information it is often determined to treat the patient anyway – presumptively to protect a premature baby from the risk.

3. What other information would you like to ask her?

4. What nursing intervention will you provide?

5. What screening tests are often obtained to help determine her risk for preterm labor.

6. And if it is determined she is in preterm labor what medications may you want to use with a doctors order?

7. Please also give dose, side effects and possible result of the medication.

Group A to complete Part 2 after Part 1 is completed.

Part 2: The patient is now 3cm/100% effaced /-2 station. What is the plan of care for the safety of this patient and her baby? Fetal heart rate is 160 with moderate variability. Contractions are now mild and 15 minutes in frequency.

1. Magnesium Sulfate is used to stop the contractions, and this has been successful.

2. What is the dose you will start with, what is the maintenance dose>

3. Please indicate what nursing interventions are necessary for use with Magnesium Sulfate?

Module 4 discussion

Discussion A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Discussion Group A:

Mary’s 1st baby was delivered via c/section due to the baby being in the breech position. She is requesting a VBAC (vaginal birth after c/section) for this her second baby. By ultrasound this baby is in the vertex position. In reviewing the postoperative report from her first surgery – it is noted that she had a low transverse uterine incision.

What are your thoughts on having a vaginal birth with this second baby?

What education can you provide to her?

What is the risk to her and does this change your thoughts and advise?

Group B Response

Mary is not progressing in labor appropriately, and the decision has been made to move toward a cesarean section. She understands, agrees, and signs the consent for surgery. You will again accept this patient in the recovery – or initial postpartum period.

Recognize that you will complete BUBBLEHE assessment. In addition, the abdominal assessment will also include assessment of the incision. Note the type of dressing used to cover the incision. Is it approximated? Is there any bleeding? Does she have bowel sounds? Is the abdomen distended? Is it soft? Do you assess the fundus and where is it located? It should be firm. Note pain assessment.

Discussion Group B will provide initial post to the following questions, and respond to Group A.

Discussion Group B:

Postpartum:

Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago. The labor and delivery nurse is calling to give you report. She is new and not sure what you want to know from her.

What questions do you need to ask to provide comprehensive care to this patient once she is transferred into your care?

Group A Response

Note that you discover that Susan is Rh negative, her baby is Rh positive. What now?

Please discuss Rhogam. The drug, the need, the route, the risk.

When must you give this and under what circumstances will you give this injection?

Please also recall any other reason Rhogam would be given, and when.

Module 5 discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

DISCUSSION A

Group A will complete the initial post. Group B will respond. You are called to the room and find Michael 2 hours old has been very irritable and spitting up large amounts of formula. He is very jittery. You do not know the maternal history before coming into the room so you advise the mother that you would like to return the baby to the nursery for an assessment and monitoring. In the medical record you focus on prenatal history. You witness the baby having some significant tremors. What would you suspect? Michaels VS are: T (axillary) – 36.0, RR- 70, HR- 166, he is very alert, irritable, and does not console easily. Is moving constantly, and sucking very vigorous on the pacifier you provide for comfort. You place the baby under the warmer and obtain what labs?

It is determined that this baby is going through opioid withdrawal. Neonatal Abstinence Syndrome requires close observation and scoring. Methadone may be used. Neonatal Abstinence Syndrome Shows both the signs of withdrawal, scoring and the nursing care of a baby with Neonatal Abstinence Syndrome.

Group B Response

What is your feeling and knowledge regarding breastfeeding this baby?

DISCUSSION B

Group B will complete the initial post. Group A will respond. Baby Leah had a very traumatic vaginal birth. After a vacuum extraction for fetal heart rate tracing changes and a resultant shoulder dystocia, Leah has a mild Erb’s palsy, some facial and truncal bruising. Pediatrician has ordered physical therapy for the palsy and the doctor expects routine care to be provided to her. In addition, do not forget the education you must give to the new parents regarding this injury. Due to the bruising there is an increase in bilirubin levels and some behavioral changes occur with Leah. Please describe what is different and what will you discuss with the family to ensure safety? The bilirubin level requires phototherapy. What precautions must you take? What is essential to manage and treat the elevated bilirubin in addition to phototherapy?

Group A Response Phototherapy is discontinued at the hospital, but at home the parents are encouraged to provide some ‘routine’ therapy for Hyperbilirubinemia. What would you suggest? Do not forget routine discharge instruction for this parent.

Module 6 discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

DISCUSSION A

Robert and Jenna Smith’s 2nd child has Down Syndrome. Philip is 14 years old. He has a sibling that is older and one younger. 15 year old sister, Lucy and a little brother Danny who is 10 years old. As all 14 year olds he is becoming more interested in his sexuality and expressing that with curiosity. He has been known to have some overt aggression toward his sister and some classmates in his public school.

Discuss how you could help this family cope and guide Philip to learn appropriate behavior.

Group B Response

Will this behavior interfere with his interest in being in the local Boy Scout troop? His troop leader is his father.

DISCUSSION B

Toddlers have some very unique behavioral characteristics as they move from infancy to childhood. Identify these behavioral changes. Include the challenges that parents may face with these characteristics including identifying temperament, nutritional barriers, hygiene, activity, and sleep.

Group A Response

Can you help parents learn to deal with these behaviors and provide them some insight and guidance that will ease this transition for the child and parent?

You work in the pediatrician’s office.

Assessments and education are the focus of your work.

Module 7 discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Discussion A: Group A will complete initial post, Group B will respond to the post.

Bobby was hospitalized 6 days ago for appendicitis. After an appendectomy following a perforated appendix, he now has an open incision requiring BID dressing changes and contact isolation due to a hospital acquired MRSA infection. It is anticipated that he will be here for 5-10 more days for long term antibiotic therapy and wound care. He is 13 years old. He has been afebrile for 24 hours. The wound is open with minimal serous drainage.

He is withdrawn and relates “just tired” when you inquire about how he is this morning. Last week he shared his interest in school. Gets A’s in math, computer science and was supposed to be competing in the school science fair this week.

What do you know about the adolescent and the appropriate developmental level?

Keeping his diagnosis in mind, what about visitation?

Is socialization a need?

What other questions should you ask?

Group B Response

It is 10 pm and you make assessment rounds and find Bobby crying. You ask him what his pain level is. What pain scale are you using?

He says he misses his family and wonders when they are going to come to get him and take him home? He relates his dad told him to be brave but he couldn’t stay with him since

Bobby was going to be in the hospital for such a long time and his dad had to work. He has 2 other brothers older than him. You also notice that his tray is untouched.

In addition to Erikson’s theory of development, children have fear of loss. What is Bobby’s fear?

(do not forget the interdisciplinary team members)

Video: Pre-operative teaching

Discussion B: Group B will complete the initial post, Group A will respond to the post.

Tina is 5 years old, lives with her mother and grandmother. Mother works 2 jobs to help support her mother and her daughter. Tina is well cared for but is now admitted for a cardiac catheterization due to the Ventricular Septal Defect (VSD) that was noted at birth.

Tina has an extensive history of respiratory infections and a nursing diagnosis of ‘activity intolerance’. Her mother relates that she does not allow her to play organized or competitive games due to her health. Tina smiles broadly when you come in the room to begin the pre-operative checklist. She starts to ask you a question when her grandmother tells her she must stay in the bed. “The nurse knows what she is doing and you will just be in the way.” Tina continues to smile at you but moves back to the bed.

You have identified some unique family dynamics, please relate.

What is the Erikson developmental level that Tina should exhibit? And where do you think she is?

How can you assist in the developmental growth?

What education can you give to Tina and her grandmother pre operatively?

What will she expect post operatively?

Group A Response

You begin to explain that the first thing you will need to get done is an I.V. Tina’s grandmother doesn’t give you a chance to ask her to help. She excuses herself and says she can’t watch. She will go to the cafeteria and return later. Tina starts to cry and begins to suck her thumb.

What tools have you brought with you?

How can you comfort Tina?

What methods of communication might you use to help relieve anxiety?

Can you give Tina choices?

How can you successfully get the IV in?

Module 8 discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Discussion A

Missy is 3 years old. She enjoys being with mom and grandma in the kitchen. She pulls a chair close to the stove, climbs on the chair and looks inside the pot of boiling water. The steam is hot on her face, she steps back and as she falls off the chair, the boiling water is pulled down on her. Missy is rushed to the emergency department. Grandma has put some butter on her fingers, but her face was not treated.

Review the Rule of Nines found on page 1021.

In the ED, the nurse discovers that her hands, face, chest and arms are burned. The Dr. believes it to be a partial thickness burn, but notes her hands are blistered and very edematous.

Provide nursing care to this young patient that is complaining of pain, crying, and uncooperative. Educate the mother and grandmother on the extent of the burn and the on-going care that will be needed.

Include medication you may wish to request from the physician and the dosage.

Group B Response

After several days the doctor begins discussing grafting of the hands and face. Can you educate the parents on the care the child will need. What is the home care situation for this child? Please also discuss long term issues, physical, emotional, how will she relate to peers?

Discussion B

Due to a fall from a second story townhouse, Jimmy sustained a fractured left femur and a mild head injury. Jimmy is 10 years old. He was reaching for a ball that had gotten lodged into the gutter over the small balcony of his parent’s bedroom. He thought if he stood on the railing and reached with the badminton racket he could get it.

Currently he is 2 days postoperative from repair of the left femur. He is being transferred out of the pediatric ICU where the Neurologist has stated he is stable but needs continued neuro checks q2 hours. He has a full left leg cast. The Foley catheter is to be replaced today, or he can attempt to roll onto a bedpan if needed.

Please list the systems that are affected by this boy’s injuries.

List the nursing interventions now that he is on your nursing unit.

Start a list of nursing diagnosis match the system you are presenting.

Group A Response

Please add the interdisciplinary team that needs to attend to this boy’s health care needs. Plan home care if appropriate. And continue the list of nursing diagnosis.

Module 9 discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Discussion A: Complete the initial discussion

Roslyn is complaining of severe pain. She is 6 years old and has been placed in public school for the first time. Now she is complaining of her legs hurting. She is so excited about being in school finally, but her parents report that she is not participating in play time, seems weaker, and is pale. She is diagnosed with sickle cell anemia, parents undergo genetic testing as well as all her siblings and it is found that she is the only child with the disease.

Provide nursing diagnosis and nursing interventions for this child. What is your priority nursing care?

Group B: Complete the subsequent discussion

Once the crisis is over what education will you provide to Roslyn and her parents?

Discharge teaching should include?

Is it appropriate that Roslyn stay in school? What about activities?

Group B: complete the initial discussion

Charley is 10 months old. His parents brought him to the pediatrician because he was sleeping more than average, refusing to eat, and is not pulling himself up as other children.

He cries while in the ‘jumper’ and screams when they try to have him stand. After some time Charley’s pediatrician informs the parents that the diagnosis is ALL.

In your research, what have you learned regarding this cancer and the prognosis?

What are the treatment modalities recommended for this disease?

Group A: Complete the subsequent discussion

Charley’s parents are devastated with the diagnosis and are grieving. Their pediatrician and oncologist are supportive but realistic and scheduling a meeting with hospice for education and grief counseling.

Describe grieving.

Provide palliative care to your patient. Provide support to his parents.

Module 10 discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Group A – Complete the initial response.Intimate Partner Violence: A 30 y/o woman presents to the Emergency Department with a complaint of sexual assault by a co-worker in her office. She has no facial or body trauma, bruising or lacerations. She is withdrawn, crying and relates feeling very guilty about coming into the clinic but is afraid of getting pregnant. They had begun dating a week ago, but she never believed this man would become so aggressive.

How can you best help this woman?

What medical care should be provided?

What education will you provide to her?

Group B: responding to this discussion

Care for this patient does not conclude at the end of this ED visit.

What follow up care should be provided?

Who is best suited to provide care to this patient?

http://www.rainn.org/ this is a link to the web site.

Discussion: Group B – please complete this initial discussion.

You are working in a rural Family Planning Health clinic and a 16 y/o presents with complaints of vaginal pain, discharge, odor x 4 days. Pain is getting worse. Her mother relates she has a cognitive learning delay and has tried to talk to her about her consensual sexual behavior with multiple partners. She tells you she has “felt some ‘bumps’ down there.” She relates multiple sexual partners because she is now popular and it is part of the ‘game’ to stay popular with her new friends. Diagnosis: HPV with several condyloma lesions, a vaginal yeast infection, and chlamydia.

She is given a prescription for Chlamydia, and the vulvar lesions, told to follow up in 2 weeks.

How do you approach her and begin the conversation regarding safe sexual practices? What are your thoughts about this young lady? How do you feel about her game? How would you proceed to give her education?

Group A: respond to this discussion.

This client is a victim to sexual coercion. As the nurse what is your role and responsibility.

As the nurse what is your role and responsibility?

Can you direct her to a support system that would be on going to assist her?

What will happen to her if she begins to refuse to participate in this sexual behavior?

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