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Summer 2009 MCN Syllabus
NURS 3423 Childbearing Family

COURSE DESCRIPTION: This course focuses on the care of childbearing women and their families through all the stages of childbirth, as well as the first four weeks after birth. Genetics, Conception, and Fetal development is discussed. Maternal physiological changes during pregnancy are also presented. It will include the high risk mothers, postpartum complications, as well as high risk neonates.

CREDIT: 4 Credit hours (4 hrs. class/week, 8 hrs. clinical/week)

PROGRAM LEVEL: II

TEXTBOOKS:

Wong, D., Hockenberry, M., Perry, S., Lowdermilk, D. & Wilson, D. (2006). Maternal Child Nursing Care, 3rd Edition. St. Louis: Mosby.

COURSE COORDINATOR: Dr. Dorothy Diaz

OFFICE HOURS: Room 113.  by appointment.

COURSE OBJECTIVES:
At the end of this course, the student will be able to:
1. Define the role of the professional registered nurse in the care of the childbearing family.
2. Identify common health problems in women.
3. Understand genetics, conception and fetal development.
4. Describe the labor and birth process from the first stage of labor through the fourth stage of labor.
5. Develop a care plan for women in labor and during the post partum period in collaboration with the client and the interdisciplinary health care team based on evidence-based analysis of the data collected.
6. Discuss the signs and symptoms of fetal distress during the laboring process.
7. Describe care for the normal newborn and the newborn with special needs post delivery.
8. Discuss the different disease processes that make the pregnant woman at risk.
9. Identify of the differing needs of clients based on culture when planning and implementing nursing care for the client.
10. Understand the ethical and legal principles when caring for the client.
11. Develop a comprehensive teaching plan for a mother and her family concerning the care of their newborn.

CLINICAL OBJECTIVES:
At the end of this course, the student will be able to:
1. Care for the laboring woman from the first stage of labor to the fourth stage of labor.
2. Care for the normal newborn in either the newborn nursery or in a couplet care environment.
3. Observe the care of the critical infant in the Neonatal Intensive Care Unit.
4. Utilize the nursing process in delivery of care to the woman in the labor and delivery, postpartum period, and the infant post-delivery.
5. Deliver care to the client incorporating their cultural needs.
6. Apply ethical and legal principles when delivering care to the mother and her baby.
7. Utilize a comprehensive teaching plan in the delivery of care to the postpartum client and her family.
8. Refer families to resources available in the community that can assist with such things as breast feeding, food supplements, and various educational initiatives.

EVALUATION AND GRADING: A point system is used to determine the grade in the Childbearing Family.

A = 90-100
B = 80-89
C = 75-79
D = 70-74
F = 69 and below

EXAM One 10%
EXAM Two 10%
EXAM Three 10%
EXAM Four 10%
EXAM Five 10%
Student Seminar & Paper 17%

ATI 3%   (3 pt for level 3; 2 pt for level 2; 1 pt for level 1)

Journal weekly entries & 4 Nursing Care Plans 15%
FINAL EXAM 15%
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Total 100%

The clinical portion of the course in on a pass/fail basis and must be passed to pass the course. The level two clinical evaluation form will be used to determine the students pass or fail performance for this course.

Testing

Test dates and content will be published in the course syllabi.   A test blueprint will be prepared by the faculty and distributed to the student at least one week prior to the EXAM. The blueprint will provide the student with the subject content of the EXAM, the number of questions in that subject area and the type of question. The type of question will be categorized two ways. First the question will be categorized by the areas of the nursing process; assessment, planning, intervention and evaluation. The question will also be categorized by cognitive level; knowledge, analysis, application, and comprehension. In the event a faculty must change a test date, they must notify the students at least one week before the scheduled EXAM. If the student must miss an EXAM, they must notify the faculty that they will not be present for the EXAM and schedule a date for the make-up EXAM within one week of the date of the EXAM.

Make-up Tests

Occasionally a student will miss a test that is scheduled for a class. A student should contact his/her instructor to arrange the make-up test. The make-up test may be administered by the staff at the IH 35 location on Wednesdays, if both the instructor and the individual student contact the office to schedule the test. Tests begin at either 9:00 a.m. or 1:00 p.m. on Wednesday s and must be completed before the office closes at 5:00 p.m.

Class Attendance

1. The student must attend the class(es) for which he/she is enrolled.
2. A student enrolled at Wayland Baptist University should make every effort to attend all class meetings. All absences must be explained to the satisfaction of the instructor, who will decide whether the omitted work may be made up.
3. A student who misses twenty-five percent (25%) or more of the regularly scheduled class meetings will receive a grade of F for that class.
4. When a student reaches a number of absences considered by the instructor to be excessive, the instructor will so advise the student and file an Unsatisfactory Progress Report at the San Antonio Campus.
5. The instructor may count three tardies as one absence.


Clinical Attendance

Attendance to clinical is critical. This is the opportunity for the student to learn and practice skills  and then apply them later in patient care. All time spent in the skills lab and receiving instruction is considered clinical time. Any student missing a clinical must call in to the instructor prior to the scheduled clinical so arrangements can be made for their patient assignment to be taken care of. Any clinical missed must be made up. Required 4 nursing care plans: vaginal delivery, c-section, post-partum, newborn or nicu infant.
Course Outline

Unit 1: Contemporary Maternity Nursing
Unit 2: Genetics, Conception, and Fetal Development
Unit 3: Pregnancy
Unit 4: Pregnancy at Risk
Unit 5: Childbirth
Unit 6: The Postpartum Period
Unit 7: Newborn

Week 1 Monday 5/25/09  9-5

1  Contemporary Maternity Nursing
2  The Family and Culture
3  Community and Home Care
4  Health Promotion and Prevention
5  Health Assessment
6  Common Health Problems

Week 1 Wednesday 5/27/09

7  Infertility, Contraception, and Abortion
8  Genetics, Conception, and Fetal Development
9  Assessment for Risk Factors

Week 2 Monday  6/1/09 Exam1 (over Unit 1 and 2)

20  Maternal Physiologic Changes
21  Nursing Care During the Fourth Trimester
22  Transition to Parenthood
23  Postpartum Complications

Week 2 Wednesday 6/3/09 6:45-3 ClinicalOrientation: clinical area

Week 3 Monday 6/8/09  EXAM 2 (unit 3)

13  Pregnancy at Risk: Preexisting Conditions
14  Pregnancy at Risk: Gestational Conditions
15  Labor and Birth Processes

Week 3 Wednesday 6/10/09 6:45-3 Clinical

Week 4 , Monday 6/15/09

Reproductive years Films & other learning activities

Week 4 Wednesday 6/17/09 6:45-3 Clinical

Week 5 Monday 6/22/09 Exam 3 (unit 4)

16  Management of Discomfort
17  Fetal Assessment During Labor
18  Nursing Care During Labor
19  Labor and Birth at Risk

Week 5 Wednesday 6/24/09 6:45-3 Clinical

Week 6 Monday 6/29/09

20  Maternal Physiologic Changes
21  Nursing Care During the Fourth Trimester
22  Transition to Parenthood
23  Postpartum Complications

Week 6 Wednesday 7/1/09 6:45-3 Clinical

Week 7 Monday 7/6/09 Exam 4 (unit 5 and 6)

24  Physiologic Adaptations of the Newborn
25  Nursing Care of the Newborn
26  Newborn Nutrition and Feeding

Week 7 Wednesday 7/9/09 6:45-3 Clinical

Week 8 Monday 7/13/09 

27 Infants with Gestational Age-Related Problems

28 The Newborn at Risk: Acquired and Congenital Problems

Week 8 Wednesday 7/15/09 6:45-3 Clinical

Week 9 Monday 7/20/09 Exam 5 (unit 7)

Week 9 Wednesday 7/15/09 6:45-3 Clinical

Week 10 Monday 7/27/09

Week 10 Wednesday 7/29/09 6:45-3 Clinical

Week 11 Monday           ATI EXAM

Week 11 Wednesday     FINAL Comprehensive Exam

Group Seminar Paper  Criteria Points possible Points earned
Describe a problem/diagnosis relevant to maternal child health. Describe the causal factors. State specific nursing assessments relevant to the problem. 20
Review the protocols from hospital, a literature search, and your text (use 3-5 nursing sources). 30
Compare protocols with evidence based practice from literature search 20
Discuss management- include manner in which self-care is encouraged and holistic needs (mother, child, family) 20

Professional APA format 10
Totals 100

Group Grading Criteria for Seminar Presentation (same topic as paper)
Criteria Possible Points
Describes the problem clearly 20
Promotes group discussion of protocols 30
Promotes group discussion of management 30
Written evaluation of presentation (after)   10
a. did the members of the class grasp the problem and its impact
b. Was there group participation
c. what went well
d. what would you do differently if you started over
Written annotated bibliography (give to classmates & instructor 1 week before presentation) 10


Unit 1: Contemporary Maternity Nursing

Unit Objectives Student Assignments Learning Activities
1. Describe the scope of maternity nursing.
2. Evaluate contemporary issues and trends in maternity nursing.
3. Describe sociopolitical issues affecting the care of women and infants.
4. Compare selected biostatistical data among races and countries.
5. EXAMine social concerns in maternity nursing.
6. Explain quality management and standards of practice in the delivery of nursing care.
7. Debate ethical issues in perinatal nursing.
8. EXAMine the Health People 2010 goals related to maternal and infant care.
9. Explain family dynamics and how family dynamics contribute to accomplishing family functions.
10. Relate the impact of culture on childbearing families.
Read Wong Chapter 1, pp 3-21, Chapter 2, pp 22-58. Lecture and discussion

Unit 2: Genetics, Conception, and Fetal Development

Unit Objectives Student Assignments Learning Activities
1. List common causes of infertility.
2. Discuss the psychologic impact if infertility.
3. Compare reproductive alternatives for couples experiencing infertility.
4. Explain the key concepts of basic human genetics.
5. Describe expanded roles fro nurses in genetics and genetic counseling.
6. EXAMine ethical dimensions of genetic screening.
7. Summarize the process of fertilization.
8. Describe the development, structure, and functions of the placenta.
9. Describe the composition and functions of the amniotic fluid.
10. Identify three organs or tissues arising from each of the each of the three primary germ layers.
11. Summarize the significant changes in growth and development of the embryo and fetus.
12. Identify the potential effects of teratogens during vulnerable periods of embryonic and fetal development. Read Wong, Chapter 7, pp 150-158, Chapter 8, pp181-211. Lecture and discussion.

Unit 3: Pregnancy

Unit Objectives Student Assignments Learning Activities
1. Explore the scope of high risk pregnancy.
2. Discuss regionalization of health care services.
3. EXAMine risk factors identified through history, physical EXAMination, and diagnostic techniques.
4. Describe diagnostic techniques and implications of findings.
5. Describe the nursing role in antepartal risk assessment.
6. Determine the gavidity and parity using the five- and four-digit systems.
7. Explain the expected maternal anatomic and physiologic adaptations to pregnancy.
8. Differentiate among presumptive, probable, and positive signs of pregnancy.
9. Identify maternal hormones produced during pregnancy, their target organs, and their major effects on pregnancy.
10. Compare the characteristics of the abdomen, vulva, and cervix of the nullipara and multipara.
11. Describe the various types of pregnancy tests, including timing of tests and interpretation of results.
12. Describe the processes of confirming pregnancy and estimating the date of birth.
13. Summarize the physical, psychosocial, and behavioral changes that usually occur as the mother and other family members adapt to pregnancy.
14. Discuss the benefits of prenatal care and problems of accessibility for some women.
15. Outline the patterns of health care provided to assess maternal and fetal health status at the initial visit and at follow-up visits during pregnancy.
16. Identify the typical nursing assessments, diagnoses, interventions, and methods of evaluation in providing care for the pregnant woman.
17. Discuss education needed by pregnant women to understand physical discomforts related to pregnancy and to recognize the signs and symptoms of potential complications.
18. Explain the impact of culture, age, parity, and number of fetuses on the response of the family to the pregnancy and on the prenatal care provided.
19. Identify the purposes of childbirth education.
20. Compare the advantages and disadvantages of choosing different care providers.
21. Explain recommended maternal weight gain during pregnancy.
22. Compare the recommended level of intake of energy sources, protein, and key vitamins and minerals during pregnancy and lactation.
23. Give EXAMples of the food sources that provide the nutrients required for optimal maternal nutrition during pregnancy and lactation.
24. EXAMine the role of nutrition supplements during pregnancy.
25. List five nutritional risk factors during pregnancy.
26. Compare the dietary needs of adolescent and mature pregnant women.
27. Give EXAMples of cultural food patterns and possible dietary problems for two ethnic groups or for two alternative eating patterns.
28. Assess nutritional status during pregnancy. Read Wong, Chapter 8, pp 181-211, Chapter 9, pp 212-234, Chapter 10, pp 235-254, Chapter 11, pp 255-304, Chapter 12, pp 305-328. Lecture and discussion

Unit 4: Pregnancy at Risk

Unit Objectives Student Assignments Learning Activities
1. Differentiate the types of diabetes mellitus and their respective risk factors in pregnancy.
2. Compare insulin requirements during pregnancy, the postpartum period, and lactation.
3. Identify maternal and fetal risks or complications associated with diabetes in pregnancy.
4. Develop a plan of care for the pregnant woman with pregestational or gestational diabetes.
5. Compare the management of a pregnant woman with hyperthyroidism with one who has hypothyroidism.
6. Differentiate the management of various cardiovascular disorders in pregnant women.
7. Discuss the different types of anemia and their effects during pregnancy.
8. Explain the care of pregnant women with pulmonary disorders.
9. Describe the effect of gastrointestinal disorders on pregnancy.
10. Review the effects of neurologic disorders on pregnancy.
11. Describe the care of women whose pregnancies are complicated by autoimmune disorders.
12. Explain the effects on and the management of pregnant women with human immunodeficiency virus (HIV).
13. Discuss the care of pregnant women who use, abuse, or are dependent on alcohol or illicit or prescription drugs.
14. Differentiate among gestational hypertension, preeclampsia/eclampsia, and chronic hypertension.
15. Describe the etiologic theories and pathophysiology of preeclampsia.
16. Compare care management of women with mild preeclampsia versus care management of women with severe preeclampsia.
17. Describe HELLP syndrome, including appropriate nursing actions.
18. Explain the effects of hyperemesis gravidarum on maternal and fetal well-being.
19. Differentiate among causes, signs and symptoms, possible complications, and management of miscarriage, ectopic pregnancy, incompetent cervix, and hydatidiform mole.
20. Compare and contrast placenta previa and abruption placentae in relation to signs and symptoms, complications, and management.
21. Discuss the diagnosis and management of disseminated intravascular coagulation.
22. Explain the basic principles of care for a pregnant woman undergoing abdominal surgery.
23. Discuss implications of trauma on mother and fetus during pregnancy.
24. Identify priorities in assessment and stabilization measures for the pregnant trauma victim.
25. Differentiate signs and symptoms; effects on pregnancy, fetus, and newborn; and management during pregnancy of common sexually transmitted infections.
26. Describe signs, symptoms, and management of pregnant women with TORCH infections. Read Wong, Chapter 13, pp 329-369, Chapter 14, pp 370-416. Lecture and discussion.

Unit 5: Childbirth

Unit Objectives Student Assignments Learning Activities
1. Explain the five factors that affect the labor process.
2. Describe the anatomic structure of the bony pelvis.
3. Recognize the normal measurements of the diameters of the pelvic inlet, cavity and outlet.
4. Explain the significance of the size and position of the fetal head during labor and birth.
5. Summarize the cardinal movements of the mechanism of labor for a vertex presentation.
6. Assess the maternal anatomic and physiologic adaptations to labor.
7. Describe fetal adaptations to labor.
8. Compare various childbirth preparation methods.
9. Describe breathing and relaxation techniques used for each stage of labor.
10. Identify nonpharmacologic strategies to enhance relaxation and decrease discomfort during labor.
11. Discuss types of analgesia and anesthesia used during labor.
12. Compare pharmacologic methods of relief of discomfort in different stages of labor and for different methods of birth.
13. Describe nursing responsibilities appropriate for a woman receiving analgesia and anesthesia during labor.
14. Explain baseline fetal heart rate (FHR) and evaluate periodic changes.
15. Identify typical signs of nonreassuring FHR patterns.
16. Compare FHR monitoring done by intermittent auscultation (IA) with external and internal electronic methods.
17. Describe nursing measures that can be used to maintain FHR patterns within normal limits.
18. Differentiate among the nursing interventions used for managing specific FHR patterns, including tachycardia and bradycardia; increased and decreased variability; and late and variable decelerations.
19. Review the documentation of the monitoring process necessary during labor.
20. Review the factors included in the initial assessment of the woman in labor.
21. Describe the ongoing assessment of maternal progress during each stage of labor.
22. Recognize the physical and psychosocial findings indicative of maternal progress during labor.
23. Describe fetal assessment during labor.
24. Identify signs of developing complications during labor.
25. Discuss the nurses role in managing care for the woman and her significant others during each stage of labor.
26. Analyze the influence of cultural and religious beliefs and practices on the process of labor and birth.
27. Discuss research findings on the importance of support from family, partner, doula, and nurse in facilitating maternal progress during labor and birth.
28. Describe the role and responsibilities of the nurse in an emergency childbirth situation.
29. Identify the impact of perineal trauma on the womans reproductive and sexual health.
30. Analyze the nurses role as advocate in reducing the incidence of routine episiotomy.
31. Differentiate between preterm birth and low birth weight.
32. Identify risk factors for preterm birth .Discuss current interventions to prevent preterm birth.
33. Discuss the use of tocolytics and antenatal Glucocorticoids in preterm birth .
34. EXAMine the effects of prescribed bed rest on pregnant women and their families.
35. Define preterm premature rupture of membranes.
36. Describe nursing management of a trial of labor, induction and augmentation of labor, forceps- and vacuum-assisted birth, cesarean birth, and vaginal birth after a cesarean birth.
37. Discuss the criteria for evaluating the nursing care of women experiencing labor and birth complications.
38. Describe the care of a woman experiencing postterm pregnancy.
39. Discuss obstetric emergencies and their appropriate management. Read Wong, Chapter 15, pp 418-436, Chapter 16, pp 437-466, Chapter 17, pp 467-488, Chapter 18, pp 489-588. Lecture and discussion.

Unit 6: The Postpartum Period

Unit Objectives Student Assignments Learning Activities
1. Describe the anatomic and physiologic changes that occur during the postpartum period.
2. Identify characteristics of uterine involution and lochial flow and describe ways to measure them.
3. List expected values for vital signs and blood pressure, deviations from normal findings, and probable causes of the deviations.
4. Identify the priorities of maternal care given during the fourth stage of labor.
5. Identify common selection criteria for safe early postpartum discharge.
6. Summarize nursing interventions to prevent infection and excessive bleeding; to promote normal bladder and bowel patterns; and to care for the breasts of women who are breastfeeding or bottle-feeding.
7. Explain the influence of cultural expectations on postpartum adjustment.
8. Discuss discharge teaching and postpartum care.
9. Describe the nurses role in these postpartum follow-up strategies; home visits, telephone follow-up, warm lines and help lines, support groups, and referrals to community resources.
10. Discuss ways to facilitate parent-infant adjustment.
11. Describe sensual responses that strengthen attachment.
12. Identify infant behaviors that facilitate and inhibit parental attachment.
13. Differentiate the three periods in parental role change after childbirth.
14. Identify behaviors of the three phases of maternal adjustment.
15. Discuss paternal adjustment.
16. Discuss the effects of the following on parental response; parental age, social support, culture, socioeconomic conditions, personal aspirations, and sensory impairment.
17. Describe sibling adjustment.
18. Describe grandparent adaptation.
19. Identify causes, signs and symptoms, possible complications, and medical and nursing management of postpartum hemorrhage.
20. Differentiate among the causes of postpartum hemorrhage.
21. Describe thromboembolic disorders including incidence, etiology, signs and symptoms, and management.
22. Summarize the role of the nurse in assessing potential problems and managing care of women with postpartum complications in the home setting.
23. Discuss emotional complications of pregnancy, including management of mood disorders.
24. Differentiate among postpartum emotional complications including incidence, risk factors, signs and symptoms, severity, and management.
25. Describe emotional, behavioral, cognitive, and physical responses commonly experienced during the grieving process associated with perinatal loss.
26. Identify specific nursing interventions to meet the special needs of parents and their families related to perinatal loss and grief.
27. Differentiate among helpful and unhelpful responses in caring for parents experiencing loss and grief. Read Wong, Chapter 20, pp 590-598, Chapter 21, pp 599-628, Chapter 22, pp629-658, Chapter 23, pp 659-690. Lecture and discussion. Case studies.


Unit 7: Newborn

Unit Objectives Student Assignments Learning Activities
1. Describe the changes in the biologic system of the neonate during the transition to extrauterine life.
2. Describe the sequence to follow in assessment of the newborn.
3. Recognize deviations from normal physiologic findings during EXAMination of the newborn.
4. Compare and contrast the four types of heat loss in a neonate and describe how to prevent heat loss.
5. Describe the behavioral adaptations of the newborn, including periods of reactivity and sleep-wake states..
6. Describe the sensory and perceptual functioning of the neonate.
7. Identify the purpose and components of the Apgar score.
8. Compare and contrast the characteristics of preterm, term, postterm, and postmature neonates.
9. Perform a gestational age assessment on a newborn.
10. Explain what is meant by a safe environment.
11. Discuss phototherapy and the guidelines for teaching parents about this treatment.
12. Explain purposes and methods of circumcision, the postoperative care of the circumcised infant, and parent teaching information regarding circumcision.
13. Review procedures for a heel stick, collecting urine specimens, and assisting with venipuncture.
14. Evaluate pain in the newborn based on physiologic changes and behavioral observations.
15. Review anticipatory guidance nurses provide parents before discharge.
16. Describe current recommendations for feeding infants.
17. Discuss benefits of breastfeeding for infants, mothers, families, and society.
18. Describe nutritional needs of infants.
19. List newborn feeding readiness cues.
20. Describe the anatomy and physiology of breastfeeding.
21. Identify nursing interventions to facilitate and promote successful breastfeeding.
22. List signs of adequate intake in the breastfed infant.
23. Identify common problems associated with breastfeeding and nursing interventions to help resolve them.
24. Discuss patient teaching for the family using formula-feeding.
25. Compare and contrast the characteristics of preterm, term, and postterm neonates.
26. Discuss respiratory distress syndrome and the approach to treatment..
27. Compare methods of oxygen therapy for the sick infant.
28. Describe nursing interventions for nutritional care of the preterm infant.
29. Discuss the pathophysiology of retinopathy of prematurity and chronic lung disease, and identify risk factors that predispose preterm infants to these problems.
30. Describe the treatment of the infant with meconium aspiration.
31. Describe risk factors associated with the birth and transition of an infant of a diabetic mother.
32. Plan developmentally appropriate care for high risk infants.
33. Develop a plan to meet the needs of parents of high risk infants.
34. Summarize assessment and care of the newborn with soft tissue, skeletal, and nervous system injuries due to birth trauma.
35. Identify maternal conditions that place the newborn at risk for infection.
36. Describe methods used to identify infection in the newborn.
37. Describe the assessment of a newborn exposed to recreational drugs in utero.
38. Identify clinical signs of infection in the newborn.
39. Describe the role of the nurse in the diagnosis of neonatal sepsis.
40. Compare neonatal Rh and ABO incompatability.
41. Describe preoperative and postoperative nursing care of the newborn.
42. Describe congenital disorders presented in this chapter and identify the priority of nursing care for each.
Read Wong, Chapter 24, pp 691-726, Chapter 25, pp 727-767, Chapter 26, pp 768-794, Chapter 27, pp 795-828, Chapter 28, pp 829-872. Lecture and discussion.