Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Archive for March, 2010

Different Teaching Styles

Posted by Laura on March 30, 2010

In class we created Posters to explain different teaching styles: My group did Role Play.

My notes from the posters presented are listed below.

Poster Notes taken by Laura.

Contractual Agreement –

  • Contract. Words signed by student. words signed by rn
  • Verbal contract – what is in it.
  • Agreement notes responsibilities of both teacher and learner. Accomplishing importance of mutual commitment.
  • is it legally binding? No
  • Is it appropriate for patient
  • agreement can serve to motivate

 

Discussion

  • Between patient and teacher. Requisites: emotionally invested. Learning readiness, cognitive capabilities, participation.
  • Distraction free
  • Active participation

 

Audio Visual Learning

  • most versatile
  • involved – capture specific teaching
  • sight & sound
  • 50% audio/visual

Lecture

  • teacher/learner
  • verbal
  • nurses must be aware of progression

Printed materials

  • Pros & cons
  • Requisites: available, literate, ready to learn, personal.
  • Cons: can you see, larger, illiteracy, language barriers, visual deficits
  • Problems: dyslexia, follow up, may be misunderstood, manual impairment.
  • Braille

Demonstration

  • Advantages: appeals to more than one sense. Provides for individual guidance. Allows for reinforcement. Emphasizes proper sequence.
  • Requsites: emotionally ready, motivated, ready to learn.
  • Requisite of the teacher: turn into learner. edits learner’s information. acts on teachable moments. clarifies often, honors the learner as a partner in the educational experience
  • disadvantages: limited to small groups, Repetition can be time consuming. Some tools require a increase risk of teaching skills

Lecture

  • Requisites: ability to learn, motivation, language, hearing, cognitive ability

Role Modeling

  • affective
  • actions speak louder than words
  • lead by example
  • personal experience maters
  • monkey see/ monkey do

 

Role Paying – was mine – didn’t take notes J

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Accomplishing the A’s of Grief

Posted by Laura on March 29, 2010

What does grief feel like? According to what I have read, you start with a “…somatic distress,  a tightness in the throat followed by an empty feeling inside the abdomen, a lack of muscle power, and intense disabling distress.” (Brunner & Suddarth, 2008)

What can a nurse do as an intervention? 

Accomplish the A’s of  Anguish.

Acceptance

Acknowledgement

Adaptation

Activities

If you see Dr. Kubler-Ross 5 Stages of Dying, you can try to apply these A’s.

  • The working upon Acceptance – to the focus of Denial
  • Acknowledgement of the pain and intensity of the loss – in relation to Anger and Bargaining
  • Adaptation to the changes in life – to get through the Depression
  • And back to Acceptance

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Some ABC’s of OB Notes

Posted by Laura on March 28, 2010

Asthma

Avoid morphine for woman with asthma who is in labor.

Cancer

Malignant melanoma: the only cancer that crosses the placenta to the fetus.

Cycle of Violence

Phase 1—building: increased tension, anger, blaming, and arguing

Phase 2—battering: hitting, slapping, kicking, choking, use of objects or weapons; sexual abuse; verbal threats and abuse

Phase 3—calm state (may decrease over time): batterer may deny violence, state he was drunk, say he’s sorry, and “promise it will never happen again,” returns to phase 1.

Fetal Maturity— Assessment

Phosphatidyl glycerol is more accurate indicator of fetal lung maturity in women who are diabetic.

Gestational Diabetes—Assessment the 3 P’s

Polydipsia

Polyphagia

Polyuria

Heart Failure—Assessment

Heart rate is the most sensitive and reliable indicator of impending heart failure.

HELLP Syndrome

Hemolysis

Elevated Liver (enzymes)

Low Platelets

HELLP Syndrome—Complication

Hypoglycemia: ≤ 40 mg/dL

Hypoglycemia can lead to maternal mortality.

Hydatidiform Mole or GTD

Complete H. mole: only condition that can lead to maternal cancer.

Hypertension—Definition

Systolic: 30+ mm Hg above baseline

Diastolic: 15+ mm Hg above baseline

Infections

Vaginitis: avoid douching during pregnancy.

STDs in the U.S.: highest prevalence among teens.

AIDS in the U.S.: fourth leading cause of death among women of reproductive age.

Insulin Requirements in Pregnancy

Trimester one: ↓

Trimester two: ↑

Trimester three: ↑

Postpartum: ↓

Placenta Previa

Vaginal examinations contraindicated with undiagnosed vaginal bleeding.

Pre-eclampsia

Proteinuria differentiates pre-eclampsia from other pregnancy-induced hypertension (PIH) states.

• Pre-eclampsia is a disorder of hypovolemia.

• Home care may eliminate the need for hospitalization

RHoGAM—Give RhoGAM to:

1. RhoGam is given to Rh- mother who gives birth to Rh+ neonate.

2. Rh- mother after spontaneous or induced abortion (> 8 wk).

3. Rh- mother after amniocentesis or chorionic villous sampling (CVS).

4. Rh- mother between 28 and 32 wk gestation.

RhoGAM and Rubella Titer

Since RhoGAM is an immune globulin, rubella vaccination, given at about the same time, may not “take”; rubella titer needs to be redone at 3 mo.

TORCH Infections

Toxoplasmosis

Other (hepatitis A virus [HAV], hepatitis B virus [HBV], group B streptococcus [GBS])

Rubella

Cytomegalovirus (CMV)

Herpes type 2

Posted in NS 121 - OB, Semester II | Comments Off on Some ABC’s of OB Notes

My Insulin Card – Short & Sweet

Posted by Laura on March 27, 2010

Insulin Card

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Hi Class – This is an Fundraising Email from Kendra Mason!

Posted by Laura on March 26, 2010

  BINGO NIGHT VOLUNTEERS

 
SNAC Spring 2011 is looking for volunteers for our Bingo Night Fundraisers. The next Bingo Night Fundraiser will be April 16th from 4:30pm to 11pm. Volunteers are not required to work the entire time, but we must maintain a least 7 volunteers for the night. The job is very easy. You will help bingo players with purchasing additional bingo cards and pull-tab tickets (sort of like scratchers where they can win between $1 to $400). These pull-tab tickets can be exchanged for more bingo cards or ink daubers. It was enjoyable to do and easy work. In exchange our CLASS gets a $350 donation towards our fundraising efforts. We are looking for two types of people:
1) Anyone who would like to work prescheduled Bingo nights. All Bingo nights from April 16th forward and every 6 weeks are ALL on Friday nights. You can work from 1 hour to 6-1/2 hours…your choice.
2) Anyone who would be willing to work on a moment’s notice (same day) to act as a substitute for organizations that were not able to come in on their appointed day. We would substitute for them and we would get the $350 for OUR organization. It’s a way for us to earn donations more often than just every 6 weeks. But, you must be able to assist on the day that you would be called. I am aware that this can be difficult for some people, but we are looking for people who are motivating into helping our CLASS raise more money. Angel’s Bingo operates on Thursday, Friday and Saturday, so none of the days would be other than those three.
If you have any other questions regarding Bingo nights, please feel free to contact me via e-mail and I will gladly answer them.
Thank you for your assistance. All volunteers are greatly appreciated.
Kendra Mason – kannmason@aol.com

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Dr Phil – Fundraising

Posted by Laura on March 26, 2010

  Hi Class!

We are scheduled to go to the Dr Phil show April 5nd. The bus will leave around 630-7am and return either 130 or 330 depending if we wish to stay for lunch.

I don’t have the full details yet, but when I have 40 people signed up, (I need 5 more!) I will get all the detail information to you and we can decide about lunch.

The Dr Phil show will bring in $500 to our class for being part of their taping. They are sending a charter bus to the school to pick us up and bring us back. This is a great way for us to all get together and have a little fun!

I need 5 more people. Remember, you can invite anyone! I think there is an age limit, so try to keep the people you invite above 18.

Please let me know as soon as possible because if we can’t get 40 people before wednesday next week, I will have to cancel. First come, first served – so email me quickly! Thanks! – Laura Barron

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CANDY FUNDRAISER

Posted by Laura on March 26, 2010

Candy Sales

SNAC Spring 2011 in accordance with suggestions has looked into candy fundraising through both See’s and World’s Finest.  Information has been sent from See’s and World’s Finest has their information available online.  We are definitely interested in doing this aspect of fundraising and many of you have stated you would be interested in helping with this type of fundraising.  We would like one eager, motivated person from our class to volunteer to Chair this fundraiser.  The responsibilities would be as follows:

  • Research and report to SNAC of the two possibilities which one would be the most profitable for our CLASS.
  • Work with SNAC in deciding how much should be ordered.
  • Maintaining records of inventory sold.

And,

  • Acting as Financial liaison between all people selling candy and the Treasurer.

If you think you have enough time to be able to volunteer, this would help us tremendously.  This is volunteering on your time and schedule and we can assist with providing a point person from each of the clinical rotations.

Please let either Laura Barron or Kendra Mason know if you would be interested in doing this for our class.

Thank you!

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Bishop Score

Posted by Laura on March 23, 2010

The bishop score is a scoring given to women to determine their favorable condition for chemically augmenting their cervical ripeness for induction of labor.

(available at: http://www.freewarepocketpc.net/ppc-tag-score-2-date.html)
Though there are 5 items looked at –

  • Cervical Consistency  is measured on a scale of firmness from firm to soft.  The softer the cervix is, the better the chance of vaginal delivery.
  • Cervical Position refers to the positioning of the cervix.  If the cervix faces front (anterior) it is more favorable, while posterior is less favorable. 
  • Cervical Effacement refers to the softening and thinning of the cervix.  You won’t feel this happening;  it may only be measure with a vaginal exam.  Effacement is measured in percent.  When your cervix is normal, it is considered to be 0% effaced.  When you’re 50% effaced, your cervix is half its original thickness.  When your cervix is 100% effaced it is completely thinned out and you are ready for vaginal delivery.
  • Cervical Dilation is measured in centimeters, from 0 to 10.  Your cervix is fully open and you should be able to push when it is dilated to 10 centimeters.  Occasionally, a physician will measure dilation in “fingers.”  Dilation often begins days or weeks before labor actually begins.  At first, the progress may be very slow.  Some women may be dilated 2 to 3 centimeters long before labor.  Once active labor begins, you will begin to dilate more quickly.
  • Cervical Station is a term used to describe the descent of the baby into the pelvis.  An imaginary line is drawn between the two bones in the pelvis (known as ischial spines).  This is the “zero” line, and when the baby reaches this line it is considered to be in “zero station.”  When the baby is above this imaginary line it is in a minus station.  When the baby is below, it is in a “plus” station.  Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet.

 mnemonic –   CPEDS

– two of these items, Cervical Consistency and Cervical Position, are only scored from 0-2

Bishop's Score Readiness

 

There are modifiers to the scale which includes adding and deleting points dependent upon preexisting conditions and timeline of parity.

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Does anyone want to vote??

Posted by Laura on March 21, 2010

Liza said

March 19, 2010 at 9:08 am e

Hi,

My name is Liza and I write for the Lydia’s Uniforms Blog. I just wanted to leave you a quick comment because we’re currently holding a contest where our readers can vote on the top nurse blogs. We’ve selected Student Nurse Laura to be on our list of the top 25 – congratulations! If you would like to vote for your blog, or have others vote, please visit this link: http://blog.lydiasuniforms.com/blog/lydias-uniforms/0/0/top-nurse-blogs-cast-your-vote. We’ll be announcing the winners during Nurses Week 2010.

Best of luck and thanks for your time!

Reply

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Do the Math

Posted by Laura on March 21, 2010

If the outlet of the pelvis is WNL, will a NB with a Biparital of 10.5 be a SVBD?

The marked variability of a FHR BL at 139 is ________to ______.

If you have 2 accelerations of less than 15 bpm for at least 15 seconds, is it considered to be a reactive trace?

If your patient/mom is on MgSo4 with a lab level of 10, what is your concern?

An doctor orders the patient to receive 2 mU per minute. What do you set the IV infusion rate at?

Answers

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Exam 3 Math

Posted by Laura on March 21, 2010

I was speaking with a teacher the other day and wanted to share the views and thoughts of this wonderful instructor. With math in the nursing program, it isn’t just multiplication and division, but the life that runs through your veins giving expertly concise information to the needing patient who will respond from this elixir. It’s more than math, its your ability to provide a nursing intervention and care by using this tool. 

 

** Love your Math**

From Modules 7 & 8 these are the following things Math Related – well, first I’m walking – then I’ll post! Stay tuned!

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AVC Chapter of the CNSA under NSNA

Posted by Laura on March 19, 2010

Our second meeting of the Antelope Valley College (AVC) California Nursing Students Association (CNSA) of the National Student Nursing Association happened today.

We are officially a club under the ASO of AVC and we are officially a club under the NSNA!!!

Today we voted and passed to offer all graduating student nurses a blue and white graduation cord of the NSNA if they are a member.

 

Being able to share in whatever way we can to make our fellow student’s step forward into nursing a better one is awesome.

 

Congratulations to all the graduating student nurses!

 

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OB In the News

Posted by Laura on March 17, 2010

Human Reproduction reported today a study that reviewed postpartum severe uterine bleeding with mothers who had received radiation as a child due to cancer.  Also was noted a 4 week less gestation period… Find more articles from this journal at http://humrep.oxfordjournals.org/

BJOG International Journal of Obstetrics and Gynaecology reports that the number of births involving triplets has increased two and a half times since 1970s figures. This study does not include invetrofertilization placement. It is suggested in this study, due to the increase use of hormones. Also noted was the increase rate of death for triplets, compared to single or twins is 10 times higher…..  more information can be found at  http://www.bjog.org/view/0/index.html

(article – http://www.bjog.org/details/news/589297/Triplet_births__trends_in_mortality_and_care.html)

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High-Risk Pregnacy of a Diabetic Mother

Posted by Laura on March 16, 2010

Diabetes mellitus .pdf

Insulin Shock & DKA

metabolic condition

causes

symptoms

interventions

hypoglycemia or insulin shock excess insulin

insufficient food – missed or delayed

excessive exercise or work

indigestion, diarrhea, vomiting

irritability

hunger

sweating

nervousness

personality change

weakness

fatigue

blurred or double vision

dizziness

headache

pallor, clammy skin

shallow respirations

rapid pulse

lab: urine = negative for sugar & acetone; Blood glucose < 60mg/dl

check b.g.level. eat:

< 60 mg/dl foods that contain 10-15 g of simple carbohydrates:

½ cup unsweetened fruit juice

½ cup (4 oz) regular soda

5 -6 LifeSavers candies

1 tablespoon honey or corn syrup

1 8oz glass  milk

2-3 glucose tablets

recheck b.g.l. q 15 min until stabilized. If no change – notify primary HCP. If unconscious 50% dextrose IV push, 5-10% dextrose in water IV drip or glucagon

ketoacidosis DKA metabolism stressed by illness or infection

tocolytic drugs such as terbutaline

failure to take insulin appropriately

insufficient exercise

Emotional stress

Excess or wrong kinds of food

thirst

nausea or vomiting

abdominal pain

constipation

drowsiness

dim vision

increased urination

headache

flushed, dry skin

rapid breathing

weak, rapid pulse

acetone (fruity) breath odor

Lab: urine = pos for sugar & acetone; Blood glucose = >200 mg/dl

Notify PCG. Admin insulin in accordance with b.g.l. med chart.

Give IVF NS or 1/2NS, K+ when urinary output is inadequate; bicarbonate for pH < 7.

Monitor labs of blood & urine

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Biophysical Profile Table/Score

Posted by Laura on March 15, 2010

My creation of the Biophysical Profile.  download .pdf

Posted in NS 121 - OB, Semester II | Tagged: , | 3 Comments »

Student Nurse Flo

Posted by Laura on March 14, 2010

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Some Vocab

Posted by Laura on March 14, 2010

Ruptured uterus – rare, can be caused by separation of c/s scar, congenital uterine, spontaneous UC, Meds, overextended uterus, malpresentation, external or internal version, difficult forceps-assisted birth. Classified as complete (extends entire U wall) or incomplete.

CPD – Cephalopelvic disproportion characterized by excessive fetal size 4G or > assoc. w/diabetes mellitus, obesity, multiparity or L size of parents.

Prolapsed cord – protrusion of the umbilical cord in advance of the presenting part – when cord lies below the presenting part of fetus. common to see frank prolapse directly after ROM. Contributing factors : long cord, malpresentation, transverse lie, unengaged presenting part from hydramnios resulting cord to be displaced downward. 

Amniotic fluid embolism – AFE. Embolism resulting from amniotic fluid entering the maternal blood stream during labor and birth after ROM; often fatal to the woman if it is is a pulmonary embolism

Malposition – most common persistent occipitoposterior position (ROP or LOP). prolonged labor, severe back pain from occiput pressing against sacrum. Relief of back pain and facilitation  of rotation to anterior position.

Malpresentation – Breech presentation (4 types: frank, complete, incomplete w knee extends below the buttocks, and incomplete with foot extends below buttocks). Associated with multifetal gestation, preterm birth,fetal & maternal anomalies, hydramnios, oligohydramnios. VB with manipulation ECV or CS if > than 3800 < 1500

Multifetal Pregnancy – > 1 infant. Complications: preterm, IUGR, cord prolapse, placental separation onset, cerebral palsy, dystocia, C/S, breech positioning, increased risk for HTN, anemia, PPM, Uterine atony, & abruptio placenae.

catecholamines – Hormones/neurotransmitters released in response to stress which may cause dystocia. Anxiety , confinement, pain and absence of support person can make these hormones act on the smooth muscles of the uterus increasing levels causing reduction of UCs.

amniotomy – Artificial Rupture of membranes. FHR assessed before and immediately after  to detect any changes that may indicate cord compression or prolapse. T checked q 2 hrs./

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Dystocia

Posted by Laura on March 14, 2010

Dysfunctional Labor is described as hypertonic or hypotonic increases a woman’s risk for uterine dystocia.

Dysfunctional Labor .pdf

Prolonged – Nursing Diagnoses:

  • Risk for infection RT – PPROM,  – operative procedures
  • Ineffective individual coping RT – exhaustion, – pain, inadequate support system
  • Risk for maternal or fetal injury RT – interventions implemented for dystocia       

                Interventions:

  • coach mother in bearing down w/contractions, assist w/relaxation between UCs
  • Position mother in favorable position for pushing
  • Reduce epidural infusion rate
  • Prepare for CS if nonreassuring fetal status occurs
Precipitous – Nursing Diagnoses:

  • Powerlessness RT – loss of control
  • Ineffective individual coping RT –  pain, inadequate support system
  • Risk for infection RT – PPROM, 
Hypotonic – Nursing Diagnoses:

  • Risk for infection RT – PPROM,  – operative procedures
  • Ineffective individual coping RT – exhaustion             

                Interventions:

  • Perform ultrasound/Radiographic exam to rule out CPD, assess FHR, characteristics of AF if ruptured, and maternal well-being
  • If above findings are normal, then – ambulation, position changes hydrotherapy, AROM, Oxytocin infusion
Hypertonic – Nursing Diagnoses:

  • Powerlessness RT – loss of control
  • Ineffective individual coping RT – exhaustion, –    pain  

                Interventions:

  • Initiate therapeutic rest measures.  – Analgesics if no ROM or cephalopelvic disproportion not present. (morphine, nalbuphine, meperidine)
  • Relieve pain to permit mother to rest
  • Assist with measures to enhance rest & relaxation(hydrotherapy)

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CPR Classes

Posted by Laura on March 14, 2010

I was asked where a person can find an ongoing CPR course.

Currently, as students of AVC in the health profession, we are required to have ours attained by American Heart Association. The American Red Cross also gives CPR courses, but make sure you get exactly what your school requires.

If you are in the greater Antelope Valley area – an ongoing place to take many different courses is Life Support Associates, Medical Education Consultants http://www.lifesupportassociates.com/ in Acton, CA. This is where I took the ECG course.

Steve Rodgers (Instructor, Owner) who taught my class said he would give a price break for a group from our school/class for any course we wanted to take. Please check their site and give them a call.

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Mechanisms of Labor & Vocab

Posted by Laura on March 12, 2010

7 cardinal movements

  1. Engagement – biparietal diameter of head passes the pelvic inlet.
  2. Descent – process of presenting part through pelvis. (Forces descent depends upon: pressure exerted by AF, pressure exerted by contracting fundus on fetus, force of contraction of maternal diaphragm and ABD muscles in 2nd stage of labor, Extension and straightening of fetal body)
  3. Flexion – chin of head brought into closer contact with fetal chest, allowing smallest diameter to present first to inlet.
  4. Internal Rotation – fetal head guided by body pelvis and muscles to rotate occiput anteriorly to fit at outlet
  5. Extension – emerging head by first the occiput, then face then chin.
  6. Restitution and External Rotation – rotation of head (45°) after born to the position it occupied when it was engaged in the inlet. Then (external rotation) the head rotates further as the anterior shoulder engages.
  7. Expulsion – After birth of shoulders, baby is born by flexing laterally in the direction of the symphysis pubis.

Synclitism – Pelvic inlet plane is parallel with sagital suture of infants head. Each ear of the infant passing through the inlet at the same time.

Asynclitism – Pelvic inlet plane is intersected by the plane of the sagital suture. You can think of this as one ear passing through the inlet before the other.

True Labor vs. False Labor – 

Signs of false labor include:

  • Contractions are irregular, unpredictable
  • No progression is seen over time
  • Contractions are felt as a generalized abdominal tightening
  • Change in activity or position causes contractions to slow down or stop
  • Usually no bloody show
  • Membranes will not rupture

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