OB nursing

Station 1

Routine Gynecology- normal

Expected Outcomes:

· Identify standard testing for routine gynecology appointments.

· Familiarize yourself with the tools and equipment necessary to perform routine testing.

· Identify the female anatomy needing assessment during a gynecology exam.

Questions:

· Why is it important to have yearly gynecology exams?

· What can a pap smear detect?

· What education can you provide to the client during a routine gynecology exam?

· How would you explain self breast exam procedure, timing, and frequency to a client?

Skills:

· Familiarize yourself with anatomy, equipment, and tools to perform a gynecology exam.

· Teach a classmate how to do a self breast exam.

Station 2

Complicated Gynecology

Expected Outcomes:

· To identify complications that can occur in a woman related to her reproductive and sexual health.

· To identify contraception options for female and male clients.

· To identify signs and symptoms of STI’s and their treatment.

Questions:

· Client has multiple sex partners. What would be the best form of contraception to prevent contracting or spreading STI’s?

· What is a complication that can occur if a client does not complete their treatment regimen for an STI?

· What kind of problems can a woman who has a history of STI’s have when trying to conceive?

Math Calculation:

· Your client is ordered Ceftriaxone IM for pelvic inflammatory disease (PID). The primary care provider orders 250mg IM now. Utilizing the medication label provided, calculate the mL’s needed for your clients 250mg IM dose.

· Order: Ampicillin 500mg IM q6 hours

Available: Ampicillin 250mg

Directions for mixing: Add 0.9 mL of sterile water to yield 125mg/0.5mL

How many mL will you give per dose?

Station 3

New OB Appointment

Expected Outcomes:

· To determine what specific tests, procedures, and education is necessary throughout the pregnancy at each appointment.

· To determine how the nurse can be supportive to a client at each obstetric visit.

· To determine what kind of education is necessary by the nurse during each obstetric visit.

Questions:

· What is the importance of family centered care and why?

· What is the frequency of obstetric appointments for an uncomplicated pregnancy?

· What tests, procedures, and education is done at the first obstetric appointment?

· When and what tests, procedures and/or education is done at future appointments?

Skills:

· Fundal height measurement- Name 2 major things that the measurement can determine.

· Vital signs- what are normal baseline vital signs for a pregnant patient?

· Lab Values – what are normal lab values for a pregnant patient?

Station 4

Fetal Monitoring Station

Expected Outcomes:

· To recognize fetal heart rate (FHR) patterns including variability, baseline, accelerations, and decelerations.

· To identify abnormal fetal heart rate (FHR) patterns.

· To understand the pathophysiology behind the various fetal heart rate (FHR) patterns.

· To determine interventions for abnormal fetal heart rate (FHR) patterns.

· Determine fetal position by performing Leopold’s Maneuvers.

· To identify various equipment that we utilize to monitor fetal heart rate (FHR) and contractions on a client. Both external and internal monitoring.

Questions:

· What is a normal fetal heart rate (FHR) baseline?

· Explain VEAL CHOP

· What interventions would a nurse do for a patient who is experiencing fetal distress?

· What is each Leopold’s maneuver determining?

1st Maneuver	2nd Maneuver	3rd Maneuver	4th Maneuver

· How is the information obtained by performing Leopold’s Maneuvers relevant to the care of a client?

· You are suspicious that a fetus is in the breech position, prepare an SBAR for the provider.

S-situation
B-background
A-assessment
R-recommendation

Skills:

· Perform Leopold’s maneuvers on a client.

· Place external fetal heart rate (FHR) and contraction monitors on a client.

· How do we determine strength of contractions on a patient with external monitors?

· Identify internal fetal heart rate (FHR) and contraction monitors.

· Recognize FHR characteristics and patterns on bedside monitor or FHR strips provided.

Station 5

Antenatal Testing

Expected Outcomes:

· Identify the various types of antenatal testing.

· Determine which clients need antenatal testing.

· Identify antepartum, intrapartum and postpartum in relation to a pregnancy.

Questions:

· Why and when do we perform antenatal testing on a client?

· Why is it important to know the clients gestational age when deciding what testing to do?

· What do the results of a non-stress test (NST) and Biophysical profile (BPP) determine?

· What is the difference between a non-stress test (NST) and a contraction stress test (CST)?

· What are the differences between the following? Why would a patient in each of these periods of pregnancy require a indwelling urinary catheter?

Antepartum	Intrapartum	Postpartum

Station 6

Triage

Expected Outcomes:

· Determine what reasons a client would need to be seen in triage.

· Identify what equipment would be seen in the triage setting to assess a client.

· Determine why a client would be admitted or sent home from triage.

· Identify the meaning of dilation, effacement, and station.

· Understand what kick counts mean.

Questions:

· What are some reasons a client would be seen in triage?

· Why would we admit a client from triage to the labor and delivery unit?

· Why would we discharge a client from triage to home?

· What is the difference between true and false labor?

· Why do we administer Betamethasone to a pregnant client?

Math Calculation Practice:

Order: Betamethasone 12 mg IM now

Available:

How many mL will you give the client and what location would you administer the medication?

Skills:

· Familiarize yourself with the anatomy, equipment, and tools that you may see or utilize in the triage setting.

· Educate a fellow classmate on kick counts.

Station 7

Labor Management

Expected Outcomes:

· Identify the 4 stages of labor.

· Determine the difference between nonpharmacological and pharmacological pain management.

· Discuss pharmacological interventions and the pros and cons of each.

· Identify client positions utilized during labor.

Questions:

· What are the 4 stages of labor? When do they start and end?

1st Stage
2nd Stage
3rd Stage
4th Stage

· What nonpharmacological support can a nurse provide to a client who desires a natural delivery?

· What nursing assessments are important to do prior to administering a narcotic pain medication to a laboring client? Maternal and fetal considerations?

· What physician order should a nurse expect to perform prior to assisting with an epidural?

· What nonpharmacological support can a nurse provide to a client in preparation during an epidural insertion?

Skills:

· Practice laboring positions with a partner.

· Practice supporting a patient during epidural insertion with a partner.

Station 8

Vaginal Delivery

Expected Outcomes:

· Identify nursing interventions that you would do for a client during delivery.

· Identify client positions that can be utilized during the pushing stage to promote a successful vaginal delivery.

· Identify the normal amount of blood loss for a vaginal delivery.

Questions:

· What is the best way to assess a client’s goals and expectations during labor and delivery?

· How would you assess the client and their support teams knowledge and understanding of the birth process? (what kind of learner is the patient?, is this their 1st or 10th baby?, when was their last delivery?, did they take childbirth classes?, how did their last delivery go?, do they have a birth plan?)

· What ways can we include the support person in the clients care during labor and delivery?

· What is the normal amount of blood loss for a vaginal delivery?

Skills:

· Demonstrate different pushing positions with a mannequin or a partner.

Station 9

Operative Delivery

Expected Outcomes:

· Identify what an operative delivery means.

· Identify what equipment is utilized for the various operative delivery methods.

· Describe circumstances that would indicate a need for the various vaginal operative delivery methods.

· Identify what circumstances indicate the need for a scheduled cesarean section vs an emergent cesarean section.

· Identify the normal amount of blood loss for a cesarean section.

Questions:

· What are the various vaginal operative delivery methods?

· What are reasons for a client to have a scheduled cesarean section?

· What are reasons for a client to have an emergent cesarean section?

· What is the normal amount of blood loss for a cesarean section?

· What is the nurses role during a vaginal operative delivery?

· What is the nurses role during a cesarean section?

Skills:

· Familiarize yourself with the equipment that is utilized for the various vaginal operative delivery methods.

Station 10

HTN Station

Expected Outcomes:

· Distinguish the difference between gestational hypertension, preeclampsia, and eclampsia.

· Recognize the signs and symptoms in a client with hypertensive disorders of pregnancy.

· Identify treatment methods for a client with hypertensive disorders of pregnancy.

Questions:

· What is the biggest difference in a client that has preeclampsia vs eclampsia?

· What are some of the most common assessment findings of a client with hypertensive disorders?

· What acronym would help guide you in your physical and laboratory value assessment to determine that a client has a hypertensive disorder of pregnancy?

· What medication is frequently used to treat preeclampsia and eclampsia of pregnancy?

· What are signs and symptoms of Magnesium toxicity?

· What magnesium lab value is considered Magnesium toxic in a client who is receiving the medication?

· What is a PC ratio?

Skills:

· Practice upper and lower reflexes on a classmate (brachial & patellar)

Math Calculation:

· A pregnant patient is admitted to the labor & delivery unit with high blood pressures and other signs of preeclampsia. The physician orders Magnesium Sulfate 20 gms mixed in 500ml lactated ringers. Order reads: Infuse a maintenance dose of Magnesium Sulfate at 4gms/hr. What would you set the IV pump rate at in ml/hr?

· I&O calculation

Patient has had the following:

200ml of water

80 ml of chicken broth

1 cup of mashed potatoes

Lactated ringers 50 ml per hour x 8 hours

120 ml of jello

Measured void from urinary catheter 500 mL

Formed stool x1

What is the client’s total I&O?

Station 11

GDM Station

Expected Outcomes:

· Identify when a pregnant client is tested for gestational diabetes during her pregnancy.

· Determine resources that would support a newly diagnosed diabetic client.

· Identify complications that could occur with a diabetic pregnancy.

Questions:

· What test is performed to determine if a client has gestational diabetes?

Screening vs. Diagnosis

· At what gestational age is a client tested for gestational diabetes?

· What complications can occur to a fetus of a diabetic mother?

· What is important to look out for in a newborn born to a diabetic mother?

Station 12

Postpartum Station

Expected Outcomes:

· Identify the acronym for a focused postpartum assessment and define each letter of the acronym.

· Demonstrate proper postpartum fundal check on a postpartum patient and identify normal vs abnormal fundal assessment.

· Distinguish normal vs abnormal postpartum bleeding.

· Identify the various wounds a postpartum patient may have after delivery.

· Identify breast care for a client who is planning on breastfeeding vs bottle feeding.

· Identify 4 potential postpartum complications.

Questions:

· What is the acronym for a postpartum assessment and define each letter?

B
U
B
B
L
E
E
B

· What is a normal fundal assessment after delivery?

· What postpartum care would be specific for a postpartum cesarean section client?

· You administer 800mg Ibuprofen to a patient who is complaining of perineal pain 4/10. You reassess 30 minutes later and the patient is now complaining of perineal pain 8/10. What would you be most suspicious of this patient having?

· What are 4 potential postpartum complications?

Name of Complication	Signs/Symptoms	Treatment
1.
2.
3.
4.

Skills:

· Perform a focused postpartum assessment on a mannequin or partner.

· Perform a postpartum fundal check.

· Teach a fellow classmate as if they were a postpartum patient being discharged about normal vs abnormal postpartum bleeding.

· Teach a fellow classmate the difference between breast care for a breastfeeding mother vs bottle feeding mother.

· Prepare supplies and teach pericare to a postpartum patient.

Station 13

Newborn Care- Initial

Expected Outcomes:

· Demonstrate head to toe newborn assessment.

· Determine accurate newborn heart rate via auscultation.

· Identify normal newborn vital signs.

· Identify newborn reflexes.

Questions:

· What are normal newborn vital signs (heart rate, respiratory rate, and temperature)?

· What additional newborn assessments, labs, and/or procedures are included in the initial newborn care?

· What other newborn assessments, labs, and/or procedures are necessary to complete before discharging the newborn to home?

· Describe the following common newborn skin and head conditions.

Vernix caseosa
Stork bite
Milia
Congenital dermal melanocytosis
Erythema toxicum
Molding
Caput succedaneum
Cephalhematoma

Skills:

· Perform initial newborn nursing interventions immediately after delivery.

· What is APGAR scoring? What are we assessing and how often do we assess?

· Weigh & measure newborn (weight, length, chest/head circumference).

· Do a head to toe assessment on the newborn.

· Assess 5 different newborn reflexes and identify them.

· Listen to newborn and determine accurate heart rate, respiratory rate, lung sounds and bowel sounds.

· Administer erythromycin eye ointment and Vitamin K IM injection on the newborn.

Station 14

Basic Newborn Care

Expected Outcomes:

· Identify the following newborn care: swaddling, diapering, bathing, feeding, bonding, burping, umbilical cord care, circumcision vs uncircumcised care.

· Distinguish between the various breastfeeding positions.

· Identify safe sleep practices for the newborn.

· Identify a newborn who is experiencing withdraw.

Questions:

· What is a normal percentage of weight loss for a newborn?

· What are the signs and symptoms of withdraw in a newborn?

· Describe the Pros & Cons of breastfeeding vs bottlefeeding.

	Breastfeeding	Bottlefeeding
Pros
Cons

Math Calculation Practice:

· Baby Nathan is born and weighs 4.2kg. What is the weight in lbs and oz?

The next day the baby has lost some of its weight and is now 4000gms. How many kg’s is that and how many lbs/oz is that?

Skills:

· Assess vital signs on a newborn

· Assess lung sounds on a newborn

· Assess bowel sounds on a newborn

· Perform the following on a newborn: swaddle, diaper, bath, bond, holding positions, cord care, circumcision vs uncircumcised penis care.

· Practice breastfeeding positions.

Station 15

Medications- NUR 131

No 3-ring binder needed

Expected Outcomes:

· Applies knowledge of medication to calculate, prepare, administer and records medications safely including anticipating interactions, therapeutic and adverse effects.

Skills:

· Practice matching medication game.

Station 16

Discharge Teaching

Mom, Newborn, Family, Friends, & Pets

Expected Outcomes:

· Identify topics to discuss with a postpartum patient.

· Identify topics to discuss with the postpartum family in regards to newborn care.

· Identify family dynamics that may influence discharge teaching and resources to a postpartum patient.

· Differentiate the difference between postpartum blues, depression, and psychosis.

Questions:

· Differentiate the difference between postpartum blues, depression, and psychosis.

Postpartum Blues	Postpartum Depression	Postpartum Psychosis

· What other interdisciplinary team members could your client possibly need at discharge?

Skills:

· Provide safe sleep discharge instructions to parents/caregivers of a newborn.

· Provide discharge instructions to a patient and her support team about postpartum blues, depression, and psychosis (warning signs & resources).