Module 1
discussion

Preventative Care / Care of Women and Children

Respond to each discussion prompt as your initial post. All
students are required to review all posts for general knowledge. Keep in mind
that you will earn points for your initial discussion posts, as well as your
responses. If you do not posts responses, you cannot earn full credit. Refer to
the Discussion Rubric on how points are earned.

Group A:

Healthy People 2010 – is a guide to promote preventative
care. Review primary, secondary and tertiary prevention and relate this to
women and children at risk in your community. Identify those risk factors that
a prevention program could impact the health of the group you identify.

This video is the Healthy People 2020 initiative

Group B:

Please research medical technological advances that may be
unique to the care of women and children. Discuss how this technology will
improve care to women and children. (ideas may be: genetic screening, public
health initiatives, mammography, cervical screening, Fetal monitoring,
Electronic medical records, telemedicine).

Which technological advances have been utilized in your
local hospital? How has it impacted the care of women and children?

Module 2
discussion

Emergency Contraception / Emergency Department

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Group A will complete the following discussion and then
respond to Group B discussion.

Emergency Contraception:

A16 year old reports to the local Family Planning clinic
with concerns regarding pregnancy. She relates she had unprotected intercourse
2 nights ago and believes she may be ‘fertile’. She wants to learn more about
the ‘morning after pill’

What additional information should you obtain from her?

What do you know about emergency contraception and the side
effects?

What educational points should you provide to her?

Group B will complete the following discussion and respond
to Group A’s discussion post.

Vaginal Bleeding in pregnancy:

A pregnant patient arrives in the Emergency Department with
complaints of vaginal bleeding. You will choose the gestational age of your
patient, and based on that gestational age answer the following questions:

Knowing the gestational age, provide information on LMP, and
EDD

What are the possible reasons she is bleeding at this
gestational age?

What are your nursing interventions for this issue, and
please include education to your patient.

Module 3
discussion

Labor Management

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Part 1: An 18 year old Primigravida presents to Labor And
Delivery with what appears to be active labor. Upon questioning, you discover
she has received no prenatal care. In obtaining some history while placing her
on the fetal monitor you learn she is a smoker, approximately 1 pack per day,
occasional marijuana for stress, and denies any support system. The Father of
the Baby (FOB) has no knowledge of the pregnancy. No prenatal vitamins – they
were too hard to swallow. She has no idea when her LMP was and she relates
always being very irregular. * remember LMP is to ask the first day of the Last
Menstrual cycle, not when the bleeding stopped*

What other questions are essential for her safe care?

What lab values do you need to obtain?

What exam findings should you obtain at this time?

What education will you provide for her?

She asks you how long this will take to have the baby – what
is your best response?

Group B

Part 2: Objective information:

Fetal heart tones are 130, with minimal variability

Vaginal exam is 4 cm/90%effaced/ -1 station

She is complaining of pain – 8/10 on a numerical scale.

An IV has been started with an 18 gauge catheter with 1
liter of Lactated Ringers at 150 ml per hr in left forearm.

How can you provide non pharmacological comfort to this
patient?

What are the pharmacological methods to use?

Without prenatal records or history GBS is unknown. What
must you provide?

Contractions are 5 minutes apart and you receive an order to
augment labor – what non pharmacological methods can you employ (or ask the MD
to provide?)

Pitocin is ordered, please include at what rate you will
start Pitocin, and how often you titrate. What equipment is needed to hang and
run Pitocin IV?

Preterm Labor Management

Preterm labor

Group B: complete Part 1

Part 1: 25 y/o presents to Labor and Delivery with
complaints of uterine cramping and lower back pain. Denies any vaginal bleeding
at this time. Has related history of a preterm birth at 32 weeks gestation with
her last pregnancy. The baby is 3 years old now and has no developmental
issues.

Her current gestational age is 30 weeks.

She is O+ and all other lab values are normal. No noted
STI’s.

1. Group Beta Strep is missing from the labs – most often is
obtained at 35 – 37 weeks gestation.

2. Without this information it is often determined to treat
the patient anyway – presumptively to protect a premature baby from the risk.

3. What other information would you like to ask her?

4. What nursing intervention will you provide?

5. What screening tests are often obtained to help determine
her risk for preterm labor.

6. And if it is determined she is in preterm labor what
medications may you want to use with a doctors order?

7. Please also give dose, side effects and possible result
of the medication.

Group A to complete Part 2 after Part 1 is completed.

Part 2: The patient is now 3cm/100% effaced /-2 station.
What is the plan of care for the safety of this patient and her baby? Fetal
heart rate is 160 with moderate variability. Contractions are now mild and 15
minutes in frequency.

1. Magnesium Sulfate is used to stop the contractions, and
this has been successful.

2. What is the dose you will start with, what is the
maintenance dose>

3. Please indicate what nursing interventions are necessary
for use with Magnesium Sulfate?

Module 4
discussion

Discussion A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Discussion Group A:

Mary’s 1st baby was delivered via c/section due to the baby
being in the breech position. She is requesting a VBAC (vaginal birth after
c/section) for this her second baby. By ultrasound this baby is in the vertex
position. In reviewing the postoperative report from her first surgery – it is
noted that she had a low transverse uterine incision.

What are your thoughts on having a vaginal birth with this
second baby?

What education can you provide to her?

What is the risk to her and does this change your thoughts
and advise?

Group B Response

Mary is not progressing in labor appropriately, and the
decision has been made to move toward a cesarean section. She understands,
agrees, and signs the consent for surgery. You will again accept this patient
in the recovery – or initial postpartum period.

Recognize that you will complete BUBBLEHE assessment. In
addition, the abdominal assessment will also include assessment of the
incision. Note the type of dressing used to cover the incision. Is it
approximated? Is there any bleeding? Does she have bowel sounds? Is the abdomen
distended? Is it soft? Do you assess the fundus and where is it located? It
should be firm. Note pain assessment.

Discussion Group B will provide initial post to the
following questions, and respond to Group A.

Discussion Group B:

Postpartum:

Susan P. had a SVD (spontaneous vaginal delivery) today approximately
2 hours ago. The labor and delivery nurse is calling to give you report. She is
new and not sure what you want to know from her.

What questions do you need to ask to provide comprehensive
care to this patient once she is transferred into your care?

Group A Response

Note that you discover that Susan is Rh negative, her baby
is Rh positive. What now?

Please discuss Rhogam. The drug, the need, the route, the
risk.

When must you give this and under what circumstances will
you give this injection?

Please also recall any other reason Rhogam would be given,
and when.

Module 5
discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

DISCUSSION A

Group A will complete the initial post. Group B will
respond. You are called to the room and find Michael 2 hours old has been very
irritable and spitting up large amounts of formula. He is very jittery. You do
not know the maternal history before coming into the room so you advise the
mother that you would like to return the baby to the nursery for an assessment
and monitoring. In the medical record you focus on prenatal history. You
witness the baby having some significant tremors. What would you suspect?
Michaels VS are: T (axillary) – 36.0, RR- 70, HR- 166, he is very alert,
irritable, and does not console easily. Is moving constantly, and sucking very
vigorous on the pacifier you provide for comfort. You place the baby under the
warmer and obtain what labs?

It is determined that this baby is going through opioid
withdrawal. Neonatal Abstinence Syndrome requires close observation and
scoring. Methadone may be used. Neonatal Abstinence Syndrome Shows both the
signs of withdrawal, scoring and the nursing care of a baby with Neonatal
Abstinence Syndrome.

Group B Response

What is your feeling and knowledge regarding breastfeeding
this baby?

DISCUSSION B

Group B will complete the initial post. Group A will
respond. Baby Leah had a very traumatic vaginal birth. After a vacuum
extraction for fetal heart rate tracing changes and a resultant shoulder
dystocia, Leah has a mild Erb’s palsy, some facial and truncal bruising.
Pediatrician has ordered physical therapy for the palsy and the doctor expects
routine care to be provided to her. In addition, do not forget the education
you must give to the new parents regarding this injury. Due to the bruising
there is an increase in bilirubin levels and some behavioral changes occur with
Leah. Please describe what is different and what will you discuss with the
family to ensure safety? The bilirubin level requires phototherapy. What
precautions must you take? What is essential to manage and treat the elevated
bilirubin in addition to phototherapy?

Group A Response Phototherapy is discontinued at the
hospital, but at home the parents are encouraged to provide some ‘routine’
therapy for Hyperbilirubinemia. What would you suggest? Do not forget routine
discharge instruction for this parent.

Module 6
discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

DISCUSSION A

Robert and Jenna Smith’s 2nd child has Down Syndrome. Philip
is 14 years old. He has a sibling that is older and one younger. 15 year old
sister, Lucy and a little brother Danny who is 10 years old. As all 14 year
olds he is becoming more interested in his sexuality and expressing that with
curiosity. He has been known to have some overt aggression toward his sister
and some classmates in his public school.

Discuss how you could help this family cope and guide Philip
to learn appropriate behavior.

Group B Response

Will this behavior interfere with his interest in being in
the local Boy Scout troop? His troop leader is his father.

DISCUSSION B

Toddlers have some very unique behavioral characteristics as
they move from infancy to childhood. Identify these behavioral changes. Include
the challenges that parents may face with these characteristics including identifying
temperament, nutritional barriers, hygiene, activity, and sleep.

Group A Response

Can you help parents learn to deal with these behaviors and
provide them some insight and guidance that will ease this transition for the
child and parent?

You work in the pediatrician’s office.

Assessments and education are the focus of your work.

Module 7
discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Discussion A: Group A will complete initial post, Group B
will respond to the post.

Bobby was hospitalized 6 days ago for appendicitis. After an
appendectomy following a perforated appendix, he now has an open incision
requiring BID dressing changes and contact isolation due to a hospital acquired
MRSA infection. It is anticipated that he will be here for 5-10 more days for
long term antibiotic therapy and wound care. He is 13 years old. He has been
afebrile for 24 hours. The wound is open with minimal serous drainage.

He is withdrawn and relates “just tired” when you
inquire about how he is this morning. Last week he shared his interest in
school. Gets A’s in math, computer science and was supposed to be competing in
the school science fair this week.

What do you know about the adolescent and the appropriate
developmental level?

Keeping his diagnosis in mind, what about visitation?

Is socialization a need?

What other questions should you ask?

Group B Response

It is 10 pm and you make assessment rounds and find Bobby
crying. You ask him what his pain level is. What pain scale are you using?

He says he misses his family and wonders when they are going
to come to get him and take him home? He relates his dad told him to be brave
but he couldn’t stay with him since

Bobby was going to be in the hospital for such a long time
and his dad had to work. He has 2 other brothers older than him. You also
notice that his tray is untouched.

In addition to Erikson’s theory of development, children
have fear of loss. What is Bobby’s fear?

(do not forget the interdisciplinary team members)

Video: Pre-operative teaching

Discussion B: Group B will complete the initial post, Group
A will respond to the post.

Tina is 5 years old, lives with her mother and grandmother.
Mother works 2 jobs to help support her mother and her daughter. Tina is well
cared for but is now admitted for a cardiac catheterization due to the
Ventricular Septal Defect (VSD) that was noted at birth.

Tina has an extensive history of respiratory infections and
a nursing diagnosis of ‘activity intolerance’. Her mother relates that she does
not allow her to play organized or competitive games due to her health. Tina
smiles broadly when you come in the room to begin the pre-operative checklist.
She starts to ask you a question when her grandmother tells her she must stay
in the bed. “The nurse knows what she is doing and you will just be in the
way.” Tina continues to smile at you but moves back to the bed.

You have identified some unique family dynamics, please
relate.

What is the Erikson developmental level that Tina should
exhibit? And where do you think she is?

How can you assist in the developmental growth?

What education can you give to Tina and her grandmother pre
operatively?

What will she expect post operatively?

Group A Response

You begin to explain that the first thing you will need to
get done is an I.V. Tina’s grandmother doesn’t give you a chance to ask her to
help. She excuses herself and says she can’t watch. She will go to the
cafeteria and return later. Tina starts to cry and begins to suck her thumb.

What tools have you brought with you?

How can you comfort Tina?

What methods of communication might you use to help relieve
anxiety?

Can you give Tina choices?

How can you successfully get the IV in?

Module 8
discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Discussion A

Missy is 3 years old. She enjoys being with mom and grandma
in the kitchen. She pulls a chair close to the stove, climbs on the chair and
looks inside the pot of boiling water. The steam is hot on her face, she steps
back and as she falls off the chair, the boiling water is pulled down on her.
Missy is rushed to the emergency department. Grandma has put some butter on her
fingers, but her face was not treated.

Review the Rule of Nines found on page 1021.

In the ED, the nurse discovers that her hands, face, chest
and arms are burned. The Dr. believes it to be a partial thickness burn, but
notes her hands are blistered and very edematous.

Provide nursing care to this young patient that is
complaining of pain, crying, and uncooperative. Educate the mother and
grandmother on the extent of the burn and the on-going care that will be
needed.

Include medication you may wish to request from the
physician and the dosage.

Group B Response

After several days the doctor begins discussing grafting of
the hands and face. Can you educate the parents on the care the child will need.
What is the home care situation for this child? Please also discuss long term
issues, physical, emotional, how will she relate to peers?

Discussion B

Due to a fall from a second story townhouse, Jimmy sustained
a fractured left femur and a mild head injury. Jimmy is 10 years old. He was
reaching for a ball that had gotten lodged into the gutter over the small
balcony of his parent’s bedroom. He thought if he stood on the railing and
reached with the badminton racket he could get it.

Currently he is 2 days postoperative from repair of the left
femur. He is being transferred out of the pediatric ICU where the Neurologist
has stated he is stable but needs continued neuro checks q2 hours. He has a
full left leg cast. The Foley catheter is to be replaced today, or he can
attempt to roll onto a bedpan if needed.

Please list the systems that are affected by this boy’s
injuries.

List the nursing interventions now that he is on your
nursing unit.

Start a list of nursing diagnosis match the system you are
presenting.

Group A Response

Please add the interdisciplinary team that needs to attend
to this boy’s health care needs. Plan home care if appropriate. And continue
the list of nursing diagnosis.

Module 9
discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Discussion A: Complete the initial discussion

Roslyn is complaining of severe pain. She is 6 years old and
has been placed in public school for the first time. Now she is complaining of
her legs hurting. She is so excited about being in school finally, but her
parents report that she is not participating in play time, seems weaker, and is
pale. She is diagnosed with sickle cell anemia, parents undergo genetic testing
as well as all her siblings and it is found that she is the only child with the
disease.

Provide nursing diagnosis and nursing interventions for this
child. What is your priority nursing care?

Group B: Complete the subsequent discussion

Once the crisis is over what education will you provide to
Roslyn and her parents?

Discharge teaching should include?

Is it appropriate that Roslyn stay in school? What about
activities?

Group B: complete the initial discussion

Charley is 10 months old. His parents brought him to the
pediatrician because he was sleeping more than average, refusing to eat, and is
not pulling himself up as other children.

He cries while in the ‘jumper’ and screams when they try to
have him stand. After some time Charley’s pediatrician informs the parents that
the diagnosis is ALL.

In your research, what have you learned regarding this
cancer and the prognosis?

What are the treatment modalities recommended for this
disease?

Group A: Complete the subsequent discussion

Charley’s parents are devastated with the diagnosis and are
grieving. Their pediatrician and oncologist are supportive but realistic and
scheduling a meeting with hospice for education and grief counseling.

Describe grieving.

Provide palliative care to your patient. Provide support to
his parents.

Module 10
discussion

Discussions A/B

Complete the discussion in Group A or B as assigned by the
instructor and then respond to the alternate group. All students are required
to review all posts for general knowledge. Keep in mind that you will earn
points for your initial discussion posts, as well as your responses. If you do
not posts responses, you cannot earn full credit. Refer to the Discussion
Rubric on how points are earned.

Group A – Complete the initial response.Intimate Partner
Violence: A 30 y/o woman presents to the Emergency Department with a complaint
of sexual assault by a co-worker in her office. She has no facial or body
trauma, bruising or lacerations. She is withdrawn, crying and relates feeling
very guilty about coming into the clinic but is afraid of getting pregnant.
They had begun dating a week ago, but she never believed this man would become
so aggressive.

How can you best help this woman?

What medical care should be provided?

What education will you provide to her?

Group B: responding to this discussion

Care for this patient does not conclude at the end of this
ED visit.

What follow up care should be provided?

Who is best suited to provide care to this patient?

http://www.rainn.org/ this is a link to the web site.

Discussion: Group B – please complete this initial
discussion.

You are working in a rural Family Planning Health clinic and
a 16 y/o presents with complaints of vaginal pain, discharge, odor x 4 days. Pain
is getting worse. Her mother relates she has a cognitive learning delay and has
tried to talk to her about her consensual sexual behavior with multiple
partners. She tells you she has “felt some ‘bumps’ down there.” She
relates multiple sexual partners because she is now popular and it is part of
the ‘game’ to stay popular with her new friends. Diagnosis: HPV with several
condyloma lesions, a vaginal yeast infection, and chlamydia.

She is given a prescription for Chlamydia, and the vulvar
lesions, told to follow up in 2 weeks.

How do you approach her and begin the conversation regarding
safe sexual practices? What are your thoughts about this young lady? How do you
feel about her game? How would you proceed to give her education?

Group A: respond to this discussion.

This client is a victim to sexual coercion. As the nurse
what is your role and responsibility.

As the nurse what is your role and responsibility?

Can you direct her to a support system that would be on
going to assist her?

What will happen to her if she begins to refuse to
participate in this sexual behavior?