N R 465 MATERNAL NEWBORN NURSING SIM
STUDENT INFORMATION & PREP SHEET
SIMULATION LAB GUIDELINES:
The expectations in the SIM lab are similar to the clinical setting. You are expected to come prepared to care for your patient. As with clinical, if you
have not completed the required prep, you will not be able to care for your patient. You will be asked to reschedule your SIM experience at the
convenience of faculty with any associated make up fee.
OVERVIEW:
Please arrive at 8am (5pm for choice) for prebriefing & review of logistics about each sim room & how you will rotate through the stations. You will
work in groups of 2-5 students. You will participate in 4 sims:
1. Baby Boy Davis – Melanie’s newborn. This room will have a real person as the mother. The baby will be a manikin or doll. As you assess the
baby verbalize what you are assessing and the mother will provide you with the assessment findings. For example – if you say, “the baby’s
color is…”the mom will tell you if the baby is pink or acrocyanotic, etc. With the newborn stethoscope placed on the baby’s chest “I am
counting the apical heart rate for one minute. It is…” and the mom will give you the rate.
2. Women’s health outpatient clinic visit
BEFORE SIM: STUDENT PREP
Complete this Prep Sheet. Have a copy available for your SIM experience as you will need to be familiar with the standing orders to complete the
SIM. Be familiar with the objectives on this form as this is what you are expected to complete during the SIM.
DURING SIM:
1) Please arrive on time with completed prep paperwork.
2) Meet objectives as stated in prep assignment.
AFTER SIM: STUDENT SELF ASSESSMENT/CHARTING
After Simulation students have a self-assessment/reflection quiz in WorldClass
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CARE OF THE NEWBORN: Baby Boy Davis
The focus of this SIM will be the infant. **For the newborn (actress in bed with newborn doll), the sim starts at 1 hour 15 minutes after birth.
Report from L& D nurse: Melanie wishes to breastfeed. Baby was put to the breast at 45 minutes after delivery but has not achieved a successful
latch at this time. Baby Boy Davis is in the nursery and needs to be brought to MOC (mother of child) to feed. MOC is concerned that the baby’s
hands are shaky and he feels cold to the touch. Baby boy Davis has received his vit K injection, erythromycin ophthalmic ointment and is due for his
Hep B vaccination. Parents do not desire a circumcision. Baby has not voided or stooled yet.
Learning Objectives/Questions
1) Performs basic physical assessment of the newborn (APPLICATION).
2) Identifies signs and symptoms of hypoglycemia (KNOWLEDGE).
3) Performs appropriate nursing management interventions for the newborn experiencing hypoglycemia (APPLICATION).
4) Accurately informs patient of alternatives to breastfeeding (APPLICATION).
Questions to Prepare for the Simulated Clinical Experience:
1) Vocabulary – define/describe the following terms
a. Hypoglycemia
f. Cold stress
b. LGA
g. Lethargy
c. SGA
h. Supplemental Nursing System (SNS)
d. Macrosomia
i. Syringe-feed
e. Donor milk
2) What are the normal ranges of vital signs for newborns (temperature, pulse, respirations)?
3) List the anticipated symptoms/assessment findings for the hypoglycemic infant.
4) According to the text, what is the appropriate technique for performing a heel stick?
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5) What is a normal glucose range for a term neonate?
6) What is the relationship between reduced body temperature and glucose levels in the neonate?
7) What are potential risks for SGA and LGA neonates?
Familiarize yourself with the “Newborn Glucose Screen” algorithm below.
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WOMEN’S HEALTH EDUCATION
This worksheet is to be used to help prepare you for Simulation. During Simulation you will be providing education to a young woman
about contraceptive options, answering her questions related to her most recent pap test and counseling her on sexually transmitted
infection management and risk reduction.
Claire Smith’s Chart
21 year-old female was seen in the clinic 4 days ago for an annual exam with C/O increased vaginal discharge. Here today for results follow-
up (pap and CT/GC testing).
Past Medical History:
NKDA
Asthma – childhood
Wisdom teeth removal at 18y/o
No surgeries
Immunizations – UPT ( Gardasil 2 of 3)
Reproductive history:
Menarche -12y/o
Cycle hx – q 28-30 days –lasting 5 days with moderate flow
LMP- (15 days ago from today)
G0
Sexual History:
Total partners – 5 ( male)
2 partners in the last year
1 partner last 6 months
Condom use “most of the time”
Social History:
FT college student
Lives in an apartment with 2 other student roommates
Non smoker
Denies drug use
ETOH – 6-8 drinks a week (mostly on the weekends)
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Orders
1. Treat for + Chlamydia – per CT protocol
2. Education risk reduction for STIs
3. Education for ASCUS pap
4. Repeat pap in 1 year
5. Evaluate desire for more reliable contraception
STI Protocol (Chlamydia)
1. Zithromycin 1 gram PO now
2. Vitals – notify if HR > 95
3. Provide STI risk reduction education
4. Notify health department
5. Identify partner (s) for notification and/or EPT
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Women’s Health Guided Reading
(Chapters 4, 7, 8 & 11)
This worksheet is to be used to help prepare you for Simulation. During Simulation you will be providing education to a young woman about
contraceptive options, answering her questions related to her most recent pap test and counseling her on sexually transmitted infection management
and risk reduction.
Assessment and Health Promotion
1. Outline components of taking a health history related to reproductive health.
Identifying/biographic data, reason for seeking care, present health, history of present illness, past health, family history, screen for abuse, review
of systems, functional assessment (activities of daily living)
2. What is the pap test ( Thin Prep/ Surepath)? It is a collection of cells from the endocervix to screen for cervical cancer.
The ThinPrep or SurePath Pap test is a liquid-based method of preserving cells that reduces blood, mucus, and inflammation. The Pap specimen
is obtained in the manner described above except that the cervix is not swabbed before collection of the sample.
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Sexually Transmitted Infections ( STIs)
1. What infections are classified as STIs?
Chlamydia, gonorrhea, HSV, HPV, PID, syphilis, vaginitis
2. Outline the cornerstones of STI risk reduction and prevention? Any STI risk assessment questions that can be added to reproductive health
history intake?
An essential component of primary prevention is counseling women regarding risk-reduction practices, including knowledge of her partner, reduction
of the number of partners, low risk sex, avoiding the exchange of body fluids, and vaccination.
The Five P’s: Partners, Prevention of Pregnancy, Protection from Sexually Transmitted Infections (STIs), Practices, and Past History of STIs
1. Partners
• Do you have sex with men, women, or both?
• In the past 2 months, how many partners have you had sex with?
• In the past 12 months, how many partners have you had sex with?
• Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?
2. Prevention of Pregnancy
• What are you doing to prevent pregnancy?
3. Protection from STIs
• What do you do to protect yourself from STIs and human immunodeficiency virus (HIV)?
4. Practices
• To understand your risks for STIs, I need to understand the kind of sex you have had recently.
• Have you had vaginal sex, meaning ‘penis in vagina sex’? If yes, “do you use condoms: never, sometimes, or always?
• Have you had anal sex, meaning ‘penis in rectum/anus sex’? If yes, “do you use condoms: never, sometimes, or always?
• Have you had oral sex, meaning “mouth on penis/vagina”?For condom answers:
• If “never”, why don’t you use condoms?
• If “sometimes”, in what situations (or with whom) do you not use condoms?
5. Past History of STIs
• Have you ever had an STI?
• Have any of your partners had an STI?
Additional questions to identify HIV and viral hepatitis risk include:
• Have you or any of your partners ever injected drugs?
• Have any of your partners exchanged money or drugs for sex?
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• Is there anything else about your sexual practices that I need to know about?
3. What treatment and instructions are indicated for a + Chlamydia test result? +Gonorrhea test result?
Treatment of Chlamydia in nonpregnant women: azithromycin, 1 g orally once or doxycycline, 100 mg orally bid for 7 days.
Treatment of Chlamydia in pregnant women: azithromycin, 1 g orally once or amoxicillin, 500 mg orally tid for 7 days.
Pregnant women should be retested in 3 weeks to deter-mine if treatment was effective; if at high risk for reinfection, the pregnant woman should be
retested in the third trimester. Because chlamydia is often asymptomatic, the woman should be cautioned to take all medication prescribed. All
exposed sexual partners should be treated.
Treatment of Gonorrhea in nonpregnant women: ceftriaxone, 125 mg IM once (adolescents who weigh >45 kg can be treated with any regimen
recommended for adults), plus azithromycin, 1 g orally once or doxycycline, 100 mg orally bid for 7 days.
Treatment of Gonorrhea in nonpregnant women (>18 yr): ceftriaxone, 250 mg IM once, azithromycin, 1 g orally once or doxycycline, 100 mg orally
bid for 7 days.
Treatment of Gonorrhea in pregnant women: ceftriaxone, 250 mg IM once, plus azithromycin, 1 g orally once or amoxicillin, 500 mg orally tid for 7
days.
It is important to notify partners if a woman is diagnosed with a gonorrheal infection. Recent (past 30 days) sexual partners should be examined,
cultured, and treated with appropriate regimens. Most treatment failures result from reinfection. The woman must be informed of this, as well as of
the consequences of reinfection in terms of chronicity, complications, and potential infertility. Women are counseled to use condoms. All clients with
gonorrhea should be offered confidential counseling and testing for HIV infection.
Contraception
1. Briefly describe factors that need to be considered when help a woman choose a birth control method that is appropriate for her (factors to
consider: age, lifestyle, sexual activity).
- Factors to consider include reliability, relative cost of the method, any protection from sexually transmitted infections (STIs), the individual’s
comfort level with the method, and the partner’s willingness to use a particular birth control method.
- Assessing the woman’s reproductive history (menstrual, obstetric, gynecologic, contraceptive), physical examination, and, sometimes, current
laboratory tests.
- Determine the woman’s knowledge about reproduction, contraception, and STIs, as well as her sexual partner’s commitment to any particular
method.
- Religious and cultural factors may influence a couple’s choice regarding a particular contraceptive method. The couple may believe in certain
reproductive myths. For example, 30% of all adolescent pregnancies were in women who engaged in unprotected intercourse because of the
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perception that they could not get pregnant at the time of intercourse. Unbiased client teaching is fundamental to initiating and maintaining
any form of contraception.
2. Outline components of patient education/instruction for:
a. Combine Oral Contraceptives (COCs) - meds containing estrogen and progestin. Take pills every day for three weeks and fourth week
is placebo that brings your period. Lighter, shorter and regular periods.
b. IUD - intra uterine device. Prevents pregnancy. Hormonal or copper. Hormonal releases hormone to stop getting pregnant and copper
releases small amount of copper to prevent sperm from fertilizing the egg.
c. Nexplanon - rod inserted in arm gives off progestin which prevents the ovary from releasing an egg and prevents sperm from reaching
the egg.
Neoplasms of the Reproductive Tract
Describe in the form of speaking to a patient, how neoplastic changes of the cervix are classified with regard to follow-up. What system is used?
Cervical intraepithelial neoplasia (CIN): CIN 1 refers to abnormal cellular proliferation in the lower one third of the epithelium; this change tends
to be self-limiting and generally regresses to normal. CIN 2 involves the lower two thirds of the epithelium and may progress to carcinoma in situ.
CIN 3 involves the full thickness of the epithelium and often progresses to carcinoma in situ.
Carcinoma in situ (CIS) is diagnosed when the full thickness of epithelium is replaced with abnormal cells
Terms used to describe neoplastic changes in abnormal cervical cytology reports are low-grade and high-grade squamous intraepithelial lesions
(SILs);
Follow-up: Several options for follow-up of a finding of ASC of undetermined significance (ASC-US) are suggested. These include immediate
colposcopy, repeating cytology at 6 months and 12 months, or HPV testing and referral for colposcopy if the test is positive. Colposcopy is
recommended for evaluation of LSIL except in adolescents; teens can be followed with cytology tests at 6 and 12 months. Follow-up for a report of
HSIL includes colposcopy or loop electrosurgical excision
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Pap test results have been recorded by using several different classification systems. The reporting system most often used today is the Bethesda
system, which reports on gynecologic cytology as well as histology of cervical lesions. Changes secondary to inflammation, treatment (e.g.,
radiation), and contraceptive devices can be reported, as well as changes caused by infections. Epithelial cell abnormalities are described in three
categories: atypias, or atypical squamous cells (ASC); low-grade squamous intraepithelial lesions (LSILs); and high-grade squamous intraepithelial
lesions (HSILs).
Instruct the patient to monitor for abnormal bleedings, especially bleeding after sexual activity, which is a classic symptom of invasive cancer. Other
late symptoms you should teach the patient to monitor for are rectal bleeding, blood in their urine, back pain, leg pain, and anemia.
System used: The most widely used method to detect preinvasive cancer is the Pap test, which can detect 90% of early cervical changes.
2001 Bethesda System for Reporting Cervical Cytology Results:
Results/Interpretations
Negative for Intraepithelial Malignancy
•Organisms (e.g., evidence of infections)
•Other non-neoplastic findings (e.g., inflammation, radiation changes, atrophy)
•Glandular cells status post hysterectomy
•Atrophy
Epithelial Cell Abnormalities
•Squamous cells
- Atypical squamous cell (ASC)
- Of undetermined significance (ASC-US)
- Cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H)
•Low-grade squamous intraepithelial lesion (LSIL)
- Human papillomavirus (HPV), cervical intraepithelial neoplasia (CIN) 1
•HSIL
- CIN 2, CIN 3
•Squamous cell carcinoma
Glandular Cell
•Atypical cells including endocervical, endometrial, and glandular or not otherwise specified
•Atypical cells including endocervical or glandular, suggestive of neoplasia (endocervical or not otherwise specified)
•Endocervical adenocarcinoma in situ
•Adenocarcinoma (endocervical, endometrial, extrauterine, or not otherwise specified)
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