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Unformatted text preview: SAN JOSE STATE UNIVERSITY School of Nursing NURS 126--Nursing Theory IV--4 units COURSE DESCRIPTION Focus on direct health care of children and the childbearing family in various health care settings. Exploration of bio-psychosocial processes involved in health, life transitions, and illness with identification of related preventive and therapeutic nursing behaviors. PREREQUISITES Completion of Semester 5 COURSE OBJECTIVES Upon completion of this course, the student will: 1. 2. 3. Identify the normal and pathological characteristics of health related conditions in children and the childbearing family; Apply Family Systems Theory concepts to identify major nursing interventions in select health care situations for children and childbearing families; Identify development issues, communication patterns, teaching/learning needs, sexual development, substance abuse, and violence childbearing/childrearing families within the context of rapidly changing, multicultural health care environment; 4. 5. 6. Identify expected responses of the individual and family to health related conditions according to developmental needs and cultural characteristics; Identify primary, secondary, and tertiary levels of prevention associated with health related conditions of childbearing/childrearing individuals, families, and groups; Identify priorities in the assessment, planning, implementation, and evaluation of direct nursing care as a member of a multidisciplinary health care team with a variety of health related conditions for individuals, families, and groups involved with child bearing/child rearing; 7. 8. Identify standards of practice, legal and ethical issues related to childbearing and childrearing families; Identify care management activities and needs for patient advocacy for childbearing/childrearing individuals, families, and groups. COURSE REQUIREMENTS 1. 2. Completion of assigned study guides, readings, learning modules, and class activities. Completion of three exams with an overall average of at least 73%. Revised 01/03/09 IG 1 EVALUATION AND GRADING Evaluation is a continuous process and is the responsibility of both faculty and student. Academic Testing Institute (ATI)--A Tool for NCLEX-RN Exam Success: In preparation for taking the NCLEX-RN exam, and as part of the nursing program, students will be required to participate in the Academic Testing Institute's (ATI) Comprehensive Assessment & Review Program (CARP). ATI-CARP is progressive and sequential. At the beginning of each semester students are required to pay directly to ATI online and register for their resources and permits for exams. Each semester, different resources and content exams will be administered. Semester 6 has been selected to give the following ATI exam(s): Maternal-Newborn and Nursing Care of Children. The ATI exams for Semester 6 will be given during a Nursing 136 class period approximately 2 weeks before the final exams. ATI points earned will apply to Nursing 126 course points. The maximum a student can achieve in Nursing 126 course is 400 points. From three to five percent of the total points in this course will be awarded to students achieving the specific scores on the semester ATI exam. SEM COURSE EXAM(s) Maternal-Newborn** (60 questions/60 min) Nursing Care of Children** (60 questions/60 min) % of course 5% 3% 5% 3% % 81.7% 75.0% 75.0% 70.0% Raw Score 49 45 45 42 6 Nursing 126 (4) 400 When, where, and how (computer or paper/pencil) the exam(s) will be given is dependent on faculty and university resources. Details will follow during the semester. For additional information please review the general information on the School of Nursing Website (http://www.sjsu.edu/nursing) under the heading: "IMPORTANT NEW REQUIREMENTS" and the ATI website: (http://www.atitesting.com/). Point distribution is as follows: Item Exam 1 Exam 2 Cumulative Final Case Studies/Activities ATI exam points Total Maximum Points 115 115 130 20 (10 each Mat/Peds) 20 (10 each exam) 400 For regular exams, please purchase SJSU Form T&E-200 answer sheet at the Spartan Bookstore. With the exception of documented true emergencies, students must contact the instructor PRIOR to an exam or quiz if he/she expects to miss the exam. If this is not done, the student will receive a zero on the exam. Faculty will decide if the student warrants a make-up exam and each situation will be dealt with individually. Students who receive LESS than a "C" grade should refer to the student progression policies for the School of Nursing. A copy is in the Student Handbook. Revised 01/03/09 IG 2 The following will be used for calculation the course grade, standardized in the School of Nursing 04/09; Grading Scale for 4 Unit Courses = 400 Points Total Point Spread 374 400 358 373 346 357 330 345 318 329 306 317 Percentages 94 100% 90 93% 87 89% 83 86% 80 82% 77 79% Grade Point Spread 290 305 278 289 266 277 250 265 Percentages 73 76% 70 72% 67 69% 63 66% Grade A AB+ B BC+ C CD+ D DF 238 249 60 62% 237 & 59% below Percentages calculated to the nearest .5% and rounded up (290/300 = 72.5%). REQUIRED TEXTS McKinney, E., James, S., Murray, S., and Ashwill, J. (2009). Maternal Child Nursing. (3rd ed.). St. Louis, MO: Elsevier. ATI (2007). Nursing Care of Children. RN Edition 7.0 Content Mastery Review Module. ATI (2007). Maternal-Newborn Nursing. RN Edition 7.1 Content Mastery Review Module Handbook of San Jose State University Nursing Students (Available in Print Shop) All readers designated for individual classes and sections (Available in Print Shop) TEACHING STRATEGIES Lecture-discussion, audiovisual aids, assigned readings, use of online resources. Class Notes, grades, and important communication will be available on the online classroom: BLACKBOARD-- http://sjsu6.blackboard.com/. Click on Spring 2010 classes. Also, a link to Semester 6 resources are available at my website: http://www.sjsu.edu/faculty_and_staff/faculty_detail.jsp?id=2760 POLICY STATEMENT on COURSE ACCOMODATIONS If you need course adaptations or accommodations because of a disability, or if you need special arrangements in case the building must be evacuated, please make an appointment with the instructor as soon as possible, or see the instructor during regularly scheduled office hours. Presidential directive 97-03 requires that students with disabilities requesting accommodations must register with DRC to establish a record of their disability. FACULTY Name: Office: Phone: Email: Website: Office Hours: Deepika Goyal PhD RN FNP HB 403 408-924-3149 [email protected] Irene Gonzales PhD RN CNP HB 412 408-924-3162 [email protected] Click on faculty on SON website: http://www.sjsu.edu/nursing/faculty.htm Thursdays around classes & by appt. Thursdays around classes & by appt. Revised 01/03/09 IG 3 POLICY STATEMENT on ACADEMIC INTEGRITY All SJSU Policies in the Catalog, Schedule of Classes and Academic Senate apply to this course (see http://info.sjsu.edu/static/catalog/policies.html ). Policies related to Academic Integrity, S02-4 and S03-7 can be found at. http://sa.sjsu.edu/download/judicial/Academic_Dishonesty_Policy.pdf With the increased use of the internet, frequently students unknowingly violate the Plagiarism policy. Before you complete assignments for this course please go to http://www2.sjsu.edu/leap/plagiar.htm and read more descriptions of plagiarism. If you have any questions regarding Academic Integrity, please ask the faculty for this course for clarification. DISRUPTIVE CLASS BEHAVIOR In the classroom environment, you must respect the rights of others seeking to learn, respect the professionalism of the instructor, and honor the differences of viewpoints. Student conduct which disrupts the learning process shall not be tolerated and may lead to disciplinary action and/or removal from class. COURSE WITHDRAWAL AND DROP/AD POLICY You are responsible for making sure you are registered for this class by the ADD date; in addition, you are responsible for dropping any class by the DROP date--found in the academic calendar for each semester. Please note: A student will not be able to add after the census date. SYLLABUS IS SUBJECT TO CHANGE The syllabus and schedule are subject to change in the event of extenuating circumstances. If you are absent from class, it is your responsibility to check on announcements made while you were absent. ADDITIONAL RESOURCES Additional Resources may be available on faculty Website. Preparation for class is defined as completing all assigned readings, pre-viewing assigned videos, and completing all learning activities prior to attending class. Faculty will attempt to clarify concepts and discuss variations seen in clinical settings throughout the life span. Students are strongly urged to review this information before class and exams. Online library research guides are available to you for this and any other class (http://www.library.sfsu.edu/instruction/guides/guides.html). The nursing guide has been updated recently, and the health sciences guide may be useful as well. Textbook resources for students from thePoint: http:thePoint.lww.com/Ricci-Kyle Clinical Simulation Model activities as recommended by Semester 6 faculty; contact Semester 6 chairperson for scheduling and details. Revised 01/03/09 IG 4 SCHEDULE OF CLASSES NURSING 126--Spring 2010 N126--Health of Women & Newborns Thursdays CL 222 1030am-1220pm DATE GENERAL TOPICS READING McKinney, James, Murray, & Ashwill, 2009, 3rd Ed ATI Maternal Newborn Nursing 7.1. 1/28/10 Course Overview Newborn Assessment Newborn Feeding Common Newborn Issues Normal Postpartum Postpartum Complications McKinney Chap 22, 23 ATI: Chap 19, 20, 22 McKinney Chap 24 ATI: Chap 21, 24 McKinney Chap 21 ATI: Chap 15. 18 McKinney Chap 28 ATI: Chap 17 2/4/10 2/11/10 2/18/10 2/25/10 3/4/10 3/11/10 3/18/10 3/25/10 4/1/10 4/8/10 4/15/10 4/22/10 4/29/10 5/6/10 MIDTERM 1 Newborn Complications Guest Speaker : Arlene Spilker Prenatal-Normal Changes Prenatal-Diagnostic tests/procedures Prenatal-Complications of Pregnancy McKinney Chap 29, 3 ATI: Chap 23 McKinney Chap 13, 14, 15 ATI: Chap 3, 4, 6 McKinney Chap 16 ATI: Chap 7 McKinney Chap 26 ATI: Chap 8 SPRING BREAK MIDTERM 2 Labor and Childbirth Labor and Childbirth-Procedures Fetal Assessment Complications of Labor & Birth FURLOUGH DAY NO LECTURE Conception, Contraception, and Infertility Out of Class Assignment Women's Health Issues: TBA Final Review Final Cumulative Exam TBA McKinney Chap 17, 19 ATI: Chap 9, 10 McKinney Chap 18, 20 ATI: Chap 11, 13 McKinney Chap 27 ATI: Chap 14 McKinney Chap 10, 11, 12 ATI: Chap 1, 2 McKinney Chap 31 5/13/10 5/19 - 5/25 *Updated 11/09 this schedule is subject to change and may not be all-inclusive. SCHEDULE OF CLASSES NURSING 126--Spring 2010 N126--Health of Children and Their Families-- Thursdays CL 222 1:30pm-3:20pm READINGS: DATE GENERAL TOPICS McKinney, James, etc, 2009; ATI -- Nursing Care of Children 7.0 1/28/10 Introduction and Basic Concepts Chapters 4, 32, 33, 35; Chapters 1, 2, 3, 11 Chapters 36, 37, 38, 39; Chapters 1, 2, 3, 12, 13 Chapters 5 & 6; Chapters 4 & 5 Chapters 7 & 8; Chapters 7 & 8 2/4/10 2/11/10 2/18/10 2/25/10 3/4/10 3/11/10 Basic Concepts continued Basic Concepts: Infant, Toddler, and Preschooler Basic Concepts: School Age and Adolescent MIDTERM 1 Respiratory System Cardiovascular and Blood Disorders Chapter 45; Chapters 15-19 Chapters 46, 47; Chapters 20-23 Chapters 49, 55; Chapters 29, 32-34 ; 49 Chapters 43, 51; Chapters 35-39 3/18/10 Integumentary Disorders in Children ENT Alterations Peds GI system Peds Endocrine & Metabolic SPRING BREAK MIDTERM 2 Peds Lymph/Immune/Infectious Diseases Musculo-Skeletal System Peds Neuro & Special Topics FURLOUGH DAY NO LECTURE Fluid & Electrolytes & Emergency Care Out of Class Assignment Genito-Urinary; Peds Heme-Onc Final Review Final Cumulative Exam TBA 3/25/10 4/1/10 4/8/10 4/15/10 4/22/10 4/29/10 5/6/10 Chapters 40, 41; Chapters 27-31 Chapter 50; Chapters 50-52 Chapter 52, 53, 54; Chapters 43-49 ; 54-56 Chapters 42, 34; Chapters 9, 53 Chapter 44, 48; Chapters 40, 41, 30 5/13/10 5/19 - 5/25 *Updated 11/09 this schedule is subject to change and may not be all-inclusive. The Normal Newborn Deepika Goyal, PhD, RN, FNP Newborn Exam Apgar Score Ballard Exam for Gestational Age Initial Physical Exam Prophylactic Medications Establish Feeding Immediately After Birth Priority Nursing Goals: Promote and maintain respirations (Bulb) Loss of Body Heat Collect pertinent data for initial assessment Institute prophylactic treatments against Gonorrhea Ophthalmia & Hemorrhagic Disorder Proper Identification Major Adjustments at Birth Institute and Sustain Respirations Clear Lung Fluid Stabilize Alveoli Redirect Blood Flow Close Down Fetal Shunts Activate All Organ Systems/Metabolic Processes Caring for Neonates Neonatal Period: First 28 Day of Life Early Neonatal Period: First Seven Days of Life Transitional Period: First 6 - 8 Hours of Life Physical Assessment of the Newborn Overview of the Newborn Assessment Size Macrocephaly or Microcephaly Changes in skin color Signs of birth trauma Malformations Evidence of respiratory distress Level of arousal Posture Tone Presence of spontaneous movement Symmetry of movements APGAR SCORES Caring for Neonates: Common Problems Soft Tissue Injury Skeletal Injury Hypothermia Hypoglycemia Hypocalcemia Polycythemia Physiologic Jaundice Variations in Gestational Age and Size Estimating Gestational Age Term: 37 to 42 weeks gestation Preterm: Less than 37 weeks gestation Post Term: Greater than 42 weeks gestation Size related to Gestational Age AGA: within 2 SD of the mean birth weight for a given gestational age SGA: more than 2 SD below the mean birth weight for a given gestational age (< 10th percentile) LGA: more than 2 SD above the mean birth weight for a given gestational age (> 90th percentile) Head & Face Head circumference and fontanelle size Check symmetry of face: when baby cries the sides of the face should move equally NEWBORN HEAD... Head... Check the head for molding, abrasions, or skin breakdowns Caput succedaneum Cephalhematoma Full range of motion--no masses motion--no Observe the eyes for discharge or irritation; check the pupils for reaction to light, equality of eye movements (normally there is some ocular inincoordination); check the sclerae for clarity, jaundice, or hemorrhage Newborn head... Caput Succedaneum (soft tissue swelling) Cephalohematoma (subperiostial bleeding) Head... Nose: patency of both nostrils; sneezing Mouth: check gums and hard and soft palates for any openings mucosa of the mouth normally clear (white patches that bleed on rubbing indicate thrush, a monilial infection) Head...Ears Head... Ears: auricles/canals open; vernix covers tympanic membrane, position? Upper earlobes normally curved (flatness may be indicative of kidney anomaly) Ear Positioning... Head - Eyes Assessment -- Chest Nipples mid-clavicular mid Chest auscultation: (noisy crackling sounds abnormal) Heart rate: regular 120 to 160 beats per minute (rubbing or unusual sounds abnormal) Respiratory Normal RR = 40-60 / min. 40 Lung Formation begins approx 4-8 wks 4 growth ends approx 4-5 yrs of age. 4- Assessment of fetal lung maturity Pulmonary surfactant PG L/S ratio - @ age 32 weeks, L/S ratio = 1, 2.0 by 35 weeks Airway dependent!--"Sniffing Position"--Use dependent!--" Position" --Use 100% O2 in Resuscitation Respiratory Surfactant synthesis and storage begins to occur 24-28 weeks gestation Surfactant surface active phospholipids lecithin and sphingomyelin critical for aveolar stability Newborn born before the lecithin/sphingomyelin (L/S) ratio is 2:1 will have varying degrees of respiratory distress May need synthetic surfactant if born with respiratory distress Respiratory Signs of Respiratory Distress: Grunting Flaring Retractions Duskiness Cyanosis (acrocyanosis vs. central cyanosis Loss of flexor tone Pallor CVS-Cardiovascular CVS Formation of Prenatal Heart approx. 3-7 wks gestation 3 3 Physiological Shunts--must Shunts--must close Ductus Venosus Foramen Ovale Ductus Arteriosus Fetal Circulation Cardiovascular System Normal rate 100-160--NSR 100- 160--NSR Blood Pressure 70/40-- MAP 40-50 70/40-40 Minimal Arrhythmias: Sinus Bradycardia/ Tachycardia--most common Tachycardia--most SVT-next most common SVTRare PVC's, or Blocks PVC' Central Nervous System Neuro-developmental Milestones NeuroReflexes Tone (flexor) Need for Sedation ? Pain Management? Seizures--vs Clonus, jitteryness, Seizures--vs jitteryness, tremors, apnea from resp. etiology The dysmorphic infant... Maternal & Family History, Variations from Normal, Microsigns, Dermatoglyphics, ? Chromosome Analysis Microsigns, Dermatoglyphics, and Genetics Consult CNS--Neuro/Development Gross Development done by 26-28 wks 26gestation, myelinization continues until term. Neural Tube Defects Folic Acid!!! Spina bifida to Meningomyocele Encephalocele Anencephaly Hydrocephalus Folic Acid: 1994 NTDs by 70% --take prenatal--12 wks gestation prenatal--12 Most embryos with NTDs die in first trimester (inc NTDs @ 26days = 2.6% Incid NTDs @ term =.006% NTDs by correcting a deficiency or by overcoming a genetically induced metabolic block CNS--Neuro/Development--more... CNS--Neuro/Development--more... Thermoregulation Goal: Neutral Thermal Environment Cold Stress -- Sources Evaporation -- 23% total body heat loss (first) Conduction -- 3% total body heat loss Convection -- 12% total body heat loss Radiation -- 62% total body heat loss Signs and Symptoms of Cold Stress Lethargy Feeding intolerance Respiratory depression Acidosis Bright red color Thermoregulation-Consequences of Cold Stress... COOLING Norepinephrine Pulmonary Vasoconstriction Pulmonary Artery Pressure Right to Left Shunting Pulmonary Vasoconstriction Increasing Acidosis Anaerobic Metabolism Hypoxia Extreme Cold Stress: When Thermoregulatory Mechanisms Fail Body Temperature Falls Precipitously and Results in: Metabolic Acidosis Hypoglycemia Decreased Arterial Blood Oxygen Levels Apnea Poor Growth and Repair Goal: Neutral Thermal Environment The temperature at which the newborn infant uses the least amount of calories to maintain normal body temperature for optimal health, growth, and repair. Neuro Assessment - Back: run a finger along the vertebral column; any dimples, separations, or swellings indicative of spina bifida Anus: patency confirmed with passage of meconium; inability to insert a rectal meconium; thermometer may be indicative of imperforate anus Breast feeding/Bottle feeding and Stooling Assessment -- Neuromuscular Development: Reflexes Rooting: (may persist for up to 12 months) Sucking: (persists throughout infancy) Gag: (persists throughout life) Grasp: lift the infant off a firm surface, baby will grasp; infant's head will lag as baby is raised (lessens by 8 months) More Reflexes... Babinski: toes will separate and flare out (< 1 year) Moro: (startle) sudden jar or change in equilibrium (< 3 to 4 months) Crawl: crawling movements will follow (< 6 weeks) Step or dance: (< 3 to 4 weeks) MORE systems... Skin Musculoskeletal Hematology Infectious Disease Assessment --Skin Body is normally pink (acrocyanosis normal), jaundice --abnormal < 24hrs --abnormal Milia (white,pinpoint spots over the nose caused (white,pinpoint by retained sebaceous secretions), birthmarks, nevi, forceps marks, ecchymosis, or papules are present Integumentary--Skin and Sweat glands, Hair, Nails More Mature and Intact with Increasing Gestational Age Newborns do not sweat--if they do they sweat--if are either very mad or have cardiac problems..... Skin Integrity essential for Immunological support--like adults--largest ORGAN! support--like adults--largest Assessment -- Extremities Hands and arms: thumbs clenched in fist Check for # and variation of fingers; wrist angle is zero Che...
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