Process

Process

Divide the large group into three smaller groups of two. Remember that even though you are responsible for one person to care for, in the end your plan will be combined with the other two groups, so that your total care will include mother, baby, family or significant other. The Nursing Process which is similar to Bloom's Taxonomy includes Assessment, Diagnosis, Planning, Implementation, and Evaluation, which should be used to guide you in developing your plan of care.

*Use the picture hyperlinks on the right hand side to guide your way to additional information.

Group 1- You will be responsible for the care of the laboring woman.
A) Your job will consist of obtaining a through medical and obstetrical history from the woman along with pertinent information about who her obstetrician is. 1) Gravid - The number of total pregnancies 2) Term- Past pregnancies that have produced a viable infant 37 weeks or greater 3) Preterm - Past pregnancy that is 36 weeks or less 4) Abortions- Abortions and miscarriages are often lumped together 5) Live- Births that have been born alive 6) Past History- Medical and surgical history including immediate family 7) Present History - Pregnancy history
B) You will evaluate her stage of labor 1) First Stage Of Labor 2) Second Stage of labor 3) Third Stage of labor
C) You will assess her vitals and assist the doctor in a sterile vaginal exam (SVE), to evaluate her status.
D) You will determiner her pain level, and provide pain medication if needed . 1) Non pain medication relief 2) Medications available
E) You will research the roll of a Doula 1) Uses of labor support, physically and emotionally
F) You will prepare the delivery room with accompanying instruments and sterile drapes Set up a delivery table with needed instruments 1) A bulb syringe 2) 2 hemostats 3) 2 Kelly clamps 4) 1 suture scissor, 1 cord scissor 5) 1 needle holder 6) 2 forceps, 1 smooth and 1 with teeth 7) 1 Hollister clamp 8) 2 basins, 1 small and 1 large 9) 2 sponge sticks 10) Raytex, (sponges)
G) A IV will be placed in for easy vein access for medications and needed fluids as well as drawing blood. 1) Draw CBC and type and cross for blood products. 2) Lactated Ringers used for electrolyte replacement.
H) Using the five steps of the Nursing Process will assist you in formulating a plan of care. Remember to document each step you perform for your patient. After you have completed your task share your information with the other two groups. 1) What are the five steps of the Nursing Process? 2) Why is documentation so important? 3) The Nursing Process helps you to research, formalize a plan, implement it and then add or change if needed.
Group 2 - You will be responsible for the baby before and after it is born.
A) If able to determine a fetal heart rate before delivery, do so by using a hand held Doppler place over lower part of mothers abdomen.
B) Prepare for imminent delivery of baby including thermoregulation guidelines. Document time of delivery, sex of baby and color of amniotic fluid. 1) What is thermoregulation and it's four types of heat loss? 2) What measures can be used for thermal protection of the newborn before and after delivery? 3) How does the warm chain, help in thermal protection? 4) Why is time an important factor in thermoregulation of the newborn? 5) How should a newborn temperature be taken?
C) During delivery assess baby for meconium stained fluid making sure to document the time the membranes ruptured and whether they were spontaneous or artificially ruptured by the doctor. 1) Normal color of amniotic fluid is clear 2) Amniotic fluid can be greenish in color ( meconium) what does that mean? 3) What steps are taken for meconium stained fluid of a newborn?
D) At 1 minute and 5 minutes of birth a Apgar scores must be performed, as you do a quick physical assessment of the newborn's heart rate, respirations, reflexes and color. Don't forget to document this information. 1) What does a Apgar score stand for? 2) How is one done? 3) Document number of vessels in the cord, a) 2 umbilical arteries ( return deoxygenated blood to the placenta) b) 1 umbilical vein (that carries oxygenated blood to the fetus)
E) Prepare for neonatal resuscitation if needed 1) Equipment needed a) Bulb syringe b) Infant disposal ambue bag c) Radiant warmer or warm blankets away from a drafty area d) Neonatal meds
F) Using the five steps of the Nursing Process will help you in formulating a plan of care . Remember to document each step you perform for your patient. After you have completed your task share your information with the other two groups. 1) What are the five steps of the Nursing Process? 2) Why is documentation so important 3) The Nursing Process helps you to research, formalize a plan, implement it and then add or change if needed.
Group 3- You will be responsible for care of family members or other people involved with the patient.
A) You will provide specific information to family members with patients approval
B) What are HIPAA regulations? 1) how do they relate to patients rights ?
C) Your job is to keep the situation and all the persons involved calm and in control, while maintaining the patients privacy. 1) What steps can you take to assure this?
D) Using the five steps of the Nursing Process, will help you in formulating a plan of care. Remember to document each step of care you perform for your patient. After you have collected your data share your information with the other two groups
E) Maintain open communication between sending and receiving hospital concerning transfer of mother and baby after delivery. Also, assure communication continues between ER doctor and patient's obstetrician
F) Make sure transport accommodations and paper work is complete.
All Groups -After the information is gathered by each group you will then come together to share as well as demonstrate by way of a mock delivery. What you have learned allows each of the three groups to benefit from all the information gathered.

TP & JB