Shaping the Learning Experience

Module IV- Learning Activity I Presented to Dr. Eva Stephens THE UNIVERSITY OF TEXAS SCHOOL OF NURSING AT GALVESTON In Partial Fulfillment Of the Requirements for the Course N5322 Educator Curriculum Design

Kim Abraham, MSN, RN, CPN Gina Wofford, MSN, RNC-NIC April 11th, 2014

The University of Texas Medical Branch School of Nursing

N4532 Nursing: Care of the Pediatric Patient and Family Summer 2014 Kimberly Abraham, MSN, RN, PNP, CPN Gina Wofford, MSN, RNC-NIC Course Faculty University of Texas Medical Branch School of Nursing

This syllabus is subject to change

N4532: Care of the Pediatric Patient and Family

Table of Contents
Course Details Faculty Information Educational Framework Program Objectives BSN Program Objectives Essentials of Baccalaureate Nursing Student Information Form/Emergency Contact Purpose of Course Course Description Course Objectives Letter to Students Required Resources/Textbooks Course Requirements Teaching Strategies Methods of Evaluation/Grading Procedures Faculty Expectations Course Policy Academic Accommodation/Disability Services Policy

Page
5 6 7 7 8 9 10 10 10-11 11 12-13 13 14 14 15
15-16 16

Occupational Exposure to Blood borne Pathogens Clinical Requirements Clinical Evaluation and Performance Expectations Course Module Outline Module 4: Respiratory Care Module 6: Emergency Care Appendix Course Calendar References

17-18 18 19 20-27 28-29 30 31-51 52-53 54-55

The University Of Texas Medical Branch School of Nursing N4532 Nursing: Care of the Pediatric Patient and Family Summer 2014

Course Details

Course Number: NURS 4532 Course Title: Nursing: Care of the Pediatric Patient & Family Placement in Curriculum: Senior Year Course Hour/Credits: 5 hours

Prerequisites/Co-requisites NURS 3290: Introduction to Professional Nursing NURS 3340: Health Assessment NURS 3410: Therapeutics of Pathology and Pharmacology in Nursing NURS 3511: Nursing Psychology Dimensions of Care NURS 3610: Adult Nursing I NURS 3632: Adult Nursing II NURS 4502: Community Based Nursing NURS 4531: Care of Mother and Child Knowledge of Child Growth and Development Knowledge of Nutrition

Faculty Information:

Gina Wofford Naremore, MSN, RNC-NIC Office: 3.1026 School of Nursing Phone: (Office) 409 772 8303 (Cell): 409 771 0611 Email: glwoffor@utmb.edu Office Hours: Thursdays, 1:00 PM 5:00 PM or by appointment Pediatric Specialty: Neonatal Intensive Care Unit and Congenital Hearts Preferred Method of Contact: Didactic questions/UTMB Email Clinical Faculty Role/Text Message Contact preference: I prefer to be contacted via cell phone or by email. You are free to text me, however remember that my phone is on silent during any meetings or classes. I will always return emails within 24 hours of receipt. I strive to reserve Sundays for mental repairs, however if it is of an emergent nature, I will answer emails and texts/calls. Kim Abraham, MSN, PNP, CPN Office: 3.306 School of Nursing Phone: (Office) 409-772-2137 (Cell) 832-368-0022 Email: kiabraha@utmb.edu Office Hours: Mondays, 1:00 PM - 5:00 PM or by appointment Pediatric Specialty: Pediatric Intensive Care Unit and Pediatric Procedures Contact preference: Please contact me via cell phone, text, or email. Phone will be silenced during meetings and classes. If non-emergent, expect a response within 24 hours.

Support Staff: Joyce Weiner, Course Secretary Office: 3.555 School of Nursing Phone: (409) 999 9999 Email: joweiner@utmb.edu Barbie Kent Technical Support Office: 3.666 School of Nursing Phone: (409) 888 8888 Email: bakent@utmb.edu

Educational Framework School of Nursing Organizing Framework for Nursing Education

The organizing framework for this course consists of an inner core representing holistic nursing, depicted by the circles in the center of the model. Holistic nursing embodies the art and science of the profession and encompasses the integrity and wholeness of persons. The concepts within nursing are health promotion activities, the human response to illness, and healing practices which are grounded in persons and environment. The circles overlap to illustrate the characteristics of separateness and mutual interrelatedness. Although bounded, the broken lines allow free exchange among and between the concepts. The professional values, core competencies, core knowledge, and role development represent the essentials of professional nursing education. Scholarship, teaching, and practice roles of the faculty contribute to the strength of the educational mission. The labels in each quadrant represent the influence that each of the components has on the other rather than the separateness of each activity.

BSN PROGRAM OBJECTIVES A successful graduate of the BSN program: Critically apply the nursing process to implement evidence-based, holistic, patientcentered nursing care. Participate in interprofessional healthcare teams to create a therapeutic and safe environment that results in high quality patient outcomes. Use effective oral, written, and electronic communication to facilitate information sharing, care giving, and interprofessional collaboration. Demonstrate leadership skills in the management and coordination of nursing care across the lifespan to promote health, provide healing, and prevent injury and disease for individuals, families, and populations. Manifest core values of nursing practice and ethical principles to maintain the highest standards of professionalism in the provision of culturally appropriate care. Analyze the impact of health policy, finance, and regulations on patients and professional nursing practice in healthcare systems. Assume accountability for personal and professional behaviors when providing, managing, and coordinating nursing care and evaluating ones own practice.

ESSENTIALS OF BACCALUAREATE NURSING EDUCATION

Essentials of Baccalaureate Nursing Education (2008) outline the curricular elements and competencies that must be present in programs conferring the Bachelor of Science in Nursing degree. The Essentials delineate the outcomes expected of graduates of baccalaureate nursing programs. These Essentials are for all graduates of a BSN program. The BSN Program Objectives and course objectives reflect the elements in The Essentials of Baccalaureate Nursing Education (2008). This course addresses Essentials I, II, III, IV, V, VI, VII, VIII, and IX> American Association of College of Nursing (2008). The Essentials of Baccalaureate Nursing Education. Retrieved from http://www.aacn.nche.edu/educationresources/BaccEssentials08.pdf

Student Information Form Please complete the attached form and return to your clinical faculty member before your first clinical rotation. Thank you. FACULTY:___________________________________________________________________ LOCATION: _________________________________________________________________________ Name: _____________________________________________________________________________ Address:____________________________________________________________________________ City:_______________________________________________________________________________ Telephone Number:__________________________________________________________________ Emergency Contact: Name:______________________________________________________________________________ Address:____________________________________________________________________________ Telephone Number:__________________________________________________________________ Relationship:________________________________________________________________________

THE UNIVERSITY OF TEXAS MEDICAL BRANCH

SCHOOL OF NURSING
N4532 NURSING: THE CHILD AND FAMILY SUMMER 2014

PURPOSE OF COURSE: This course is designed to provide the student with the basic knowledge and understanding of communication, growth and developmental milestones, disease prevention and health promotion of the pediatric population and their family.

COURSE DESCRIPTION: In this course, the student applies holistic principles to the professional nursing care of the pediatric population and their families during time of wellness, illness and at the end of life. Students learn to provide complex, developmentally appropriate nursing care in a variety of settings. Students collaborate with the pediatric population, their families, and the interdisciplinary team to facilitate positive health outcomes through health promotion and disease prevention. COURSE OBJECTIVES: Upon completion of this course and its related activities, the student will: 1. Recognize and understand the nursing process to facilitate health outcomes of the pediatric patient and their families from diverse backgrounds. (Foundational Knowledge and Application) 2. Acquire and describe concepts of growth and development in the safe and holistic nursing care of pediatric patient concepts and their families. (Foundational Knowledge and Application) 3. Be able to connect and collaborate with other health care professionals, pediatric patient, and their families to address identified health care needs. (Integration) 4. Want to communicate effectively with pediatric patients, their families and other health care professionals to deliver evidence based patient-centered care. (Integration, Learning How to Learn, Caring) 5. Be able to incorporate principles of teaching and learning to assist pediatric patients and their families from diverse backgrounds in meeting their need for health information, education, and use of information technologies. (Application, Integration, Learning How to Learn) 6. Be able to create and prioritize nursing interventions when providing care to pediatric patients and their families. (Application, Integration) 7. Develop personal boundaries and discuss values regarding the ethical, legal, and economic influences on the health, illness and end of life care of pediatric patients and their families. (Caring, Human Dimension) 8. Be able to use clinical nursing research in the application of evidenced based findings in providing nursing care to pediatric patients and their families. (Application, Learning How to Learn, Integration)

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Be able to modify psychomotor skills to provide nursing care to pediatric patients and their families. (Learning How to Learn) 9. Express the principles of pathophysiology including the role of genetics in the nursing care of pediatric patient. (Foundational knowledge)

Letter to Students The course faculty would like to extend our welcome to each of you as we begin Care of the Pediatric Patient and Family nursing course. We appreciate that some of you may have never had any personal experience with the pediatric population and we promise to support and guide you through this journey. The course faculty views this pediatric course as a continually evolving learning adventure and we welcome your feedback. Our goal is for you to have a fun, interactive, challenging, and rewarding time where you will be able to experience this population in a new way. Just maybe, you will be one of the students who will decide the Pediatric world is where you wish to embark as your first stop after graduation! The faculty has developed a curriculum which will suit many differing learning styles. We include individual and group learning activities, simulation and hands-on laboratory sessions, as well as clinical experiences in a variety of pediatric settings. As a faculty we want to assist you in reaching your full potential as a student and as a future registered nurse. Course faculty encourage active participate in all classroom and clinical settings and will seek to challenge and increase your clinical reasoning skills. The syllabus contains all the information you will need to be successful this semester and you will be referring to the content frequently. The course is divided into modules or topics. Each module will include a brief introduction, objectives, readings and resources, as well as your learning activities. As course facilitators, we recognize that each of you are adult learners and respect the many priorities and life occurrences that you may face. Each faculty member is available for any questions, comments, and assistance to you during this course. All course communication will be directed through the Blackboard discussion boards. There will be specific threads for faculty questions, announcements, calendar updates, and much more. Please take a moment to review the threads and to familiarize yourself with Blackboard. We look forward to an exciting semester and in getting to know each of you. Let the semester begin. Sincerely, The Pediatric Team

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THE UNIVERSITY OF TEXAS MEDICAL BRANCH SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY SUMMER 2014

REQUIRED RESOURCES: http://nnepi.gwnursing.org/ Perry, S. E., (2014). Virtual clinical excursion 3.0 for maternal child nursing care 5th edition. St. Louis, MO: Mosby. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, MO: Mosby. An audience response devices may be required: Turning Technologies ResponseCard XR (available in the bookstore)

ADDITIONAL COURSE AND TECHNOLOGY RESOURCES: ANA Code of Ethics for Nurses Child development text of your choice. Moody Medical Library. Evaluating Health Resources on the Web. *Pediatric facts made incredibly quick (2010). Philadelphia, PA: Lippincott. Texas Nursing Practice Act (Current) *Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Study guide for maternal child nursing care (5 Web Based: www.brightfutures.org (run a search on children, for example) www.nhtsa.dot.gov www.usda.gov(run a search on children, for example) http://www.cinahl.com/csources/csources.htm www.kidshealth.org http://www.cdc.gov/growthcharts/ (site to get growth charts)
th

ed.). St. Louis, MO: Mosby.

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http://www.cdc.gov/growthcharts/data/set1clinical/set1b&w.pdf (recommend saving this site or saving the file so that you can have the appropriate growth chart when needed. *Highly recommended

SMARTHINKING Tutoring for improving writing skills is now a part of this course through the SMARTHINKING online tutoring service. It is strongly recommended and may be required that students submit their papers to SMARTHINKING tutors for guidance with grammar, mechanics of writing and APA format. Students are also asked to utilize the SMARTHINKING Student Handbook for assistance in developing written assignments. This online tutoring service is accessed through the course homepage. When submitting materials for assistance from the online tutors, a request can be made for the first available tutor or for a specialist, such as an ESL tutor. The student is responsible for meeting the criteria outlined in the syllabus for the writing assignment. Use of SMARTHINKING does not guarantee a passing grade on writing assignments.

TURNITIN Turnitin is used to instantly identify papers containing un-original material (plagiarism). The resource website is: http://www.turnitin.com/static/training.html

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COURSE REQUIREMENTS: Course Requirements: To successfully complete this course, students must 1. Pass the Calculation exam 2. Achieve a 75% weighted average on the major exams (includes 3 unit exams and final) 3. Achieve a Pass in Clinical activities a. Achieving a pass indicator on required graded clinical plans of care (one written, one verbal, see attached rubric) b. Obtaining a passing clinical evaluation (see attached rubric) 4. An overall course grade of 75% TEACHING STRATEGIES: Team Based Learning Lecture/Discussion Pediatric Skills Lab Demonstration/Return Demonstration Computerized Tests (ATI) Inpatient Clinical Care Clinical Conferences Case Study Analysis Student Presentation (care plan) Web Based Activities METHODS OF EVALUATION: Course evaluation will be based on: Exams (3) Comprehensive Final Exam Pediatric Dosage and Calculation Exam ATI Exit Pediatric Exam Virtual Clinical Excursion Clinical Performance Evaluation* Clinical Journals* Clinical Plan of Care* *Rubrics are located in Appendix TOTAL Letter Grades are as follows: A = 90-100 B = 80-89 C = 75-79 D = 70-74 (NOT considered passing) F = 0 69 (NOT considered passing) Weight: 45% 25% 10% 10% 10% P/F P/F P/F

100%

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FACULTY EXPECTATIONS: 1. Be informed about the University and Professors teaching philosophy, which are presented in the course syllabus. 2. Attend all classes, except when emergencies arise. If health and weather allow, your instructor will be present and on time for every scheduled class meeting. So should you. 3. Be an active participant in class, taking notes, asking appropriate questions. Your involvement will benefit you and your classmates. 4. Treat the instructor and fellow students with courtesy. Always address your instructor as Ms. Or Mr. 5. Refrain from any behaviors that may distract others ( typing on laptop, dressing inappropriately, having individual conversations, texting) 6. Cultivate effective study strategies. Use your study time wisely. Seek help from the instructor when you need it. Take advantage of the many resources provided by the University. 7. Study course material routinely after each class. Study according to a regular schedule. Avoid cramming. Do not postpone working on assignments. Submit finished assignments on time. Accept the challenge of collegiate studying, thinking, and learning. Anticipate that the level and quantity of work in some courses will exceed your prior experiences. If you have significant responsibilities besides your studies, such as work and family, set realistic academic goals and schedules for yourself. COURSE POLICY: Attendance: Attendance is not mandatory but appreciated for lecture. However, a class roster will be circulated at each lecture for you to sign. If you find yourself in academic difficulty, the class roster will be reviewed to determine if you have been attending lectures. All lectures will be recorded using the Tegrity system and will be located on Blackboard after the class session has ended. Attendance is mandatory for all laboratory classes and clinical rotations. However, the faculty will ask that you do not attend clinical rotations if you are running a fever greater than 100.4 F, have a productive cough, or green/yellow mucus drainage. If you have any of these

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symptoms, you are to immediately contact your clinical faculty and report to Student Health Services or your personal physician for evaluation and a written release to return to the clinical settings. Make-ups for clinical rotations and laboratory classes are very difficult to arrange and will be done so by the Course Coordinator. Late Papers: Late papers will receive a 5 point deduction for each calendar day the assignment is late. Missed Tests: Due to the fast pace of this course, only under emergent situations will excuses be given for missing a test and written proof may be required from the student. The student will receive a short-answer and multiple choice test within 48 hours of the missed exam. Class Behaviors: It is hoped and desired that the classroom be an interactive and exciting environment for each of you. All individuals should be comfortable in discussing their opinions and viewpoints and respect should always be maintained. Specifically, cell phones are to be turned off before entering the classroom. Computer activity should be limited to classroom activities only and it is unacceptable for social activity to be conducted on your computer during classroom. This includes Facebook, Twitter, internet shopping, etc. Drinks and snacks are allowed in the class room, please ensure that your drinks are covered. Please take care of any physiological needs before entering the classroom so interruptions may be kept at a minimum. Dependent on the length of class, breaks will be provided. As adult learners, the expectation for professional behavior is a constant. Any instances of incivility will be treated on an individual basis by faculty. Academic Accommodation/Disability Services Policy: The University of Texas Medical Branch at Galveston complies with the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973, and state and local requirements regarding students with disabilities. Under these laws, no otherwise qualified and competitive individual with a disability shall be denied access to or participation in services, programs, and activities of UTMB solely on the

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basis of the disability. Copies of the ADA and Section 504 of the Rehabilitation Act of 1973 are available in the Office of Student Services. The University of Texas Medical Branch at Galveston is committed to equal opportunity for students with disabilities. If you have a documented disability or would like to obtain information regarding services for students with disabilities, a complete copy of the Student with Disabilities: Guidelines for Compliance may be obtained from the Universitys Office of Equal Opportunity and Diversity or the Office of Student Affairs of any of the four UTMB schools. Services for students with disabilities is a program within the Office of Student Services in coordination with the Office of Equal Opportunity and Diversity and the Student Affairs offices of the four UTMB schools. By law all students with disabilities are guaranteed a learning environment that provides reasonable accommodation of their disability. The legal protections mentioned above are civil rights provisions aimed at ending discrimination against persons with disabilities. All programs and offices at UTMB are committed to providing a supportive and challenging environment for students with disabilities who choose to attend UTMB. The Office of Student Services is located on the second floor of the Lee Hage Jamail Student Center. The Office of Equal Opportunity and Diversity is located on the ground floor of Rebecca Sealy Hospital. Medical Record Confidentiality Policy: To maintain confidentiality of patient information, medical records are not allowed to be printed. Patient health information is to be viewed on screen only. Students may not print any portion of a patients medical record at any location. Occupational Exposure to Blood borne Pathogens

1. Wash the area immediately. 2. Notify faculty supervisor.

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3. Report immediately to Student Wellness during regular working hours: Monday through Friday 8am - 5pm, 2.500 Rebecca Sealy. 4. For questions, call Student Wellness at 409-747-9508. 5. After hours, weekends and holidays report to the UTMB Emergency Department 6. For questions after hours call the Healthcare Hotline at 1-800-917-8906. 7. Chemoprophylaxis should be initiated within 2 hours of a high risk percutaneous exposure. 8. If off campus, follow the policies of the clinical agency and notify Student Wellness immediately. Access the student well and healthcare epidemiology websites for additional information and policies for off campus exposures.

CLINICAL REQUIREMENTS: For the clinical component, each student is expected to maintain current certification in CPR and complete all required immunizations including the annual Tuberculosis (TB) skin test (PPD). Annual UTMB compliance training must also be completed. Each student is required to have a background check on record at the School of Nursing. The student without evidence of these will not be allowed to attend clinical activities until such evidence is presented. This will be an unexcused absence and result in a clinical grade of zero for each day missed. Students can check their immunization status using the student system MyStar. Required immunizations are listed on the student wellness web site which is http://www.utmb.edu/studentwellness/. To validate current compliance training, go to http://training.utmb.edu/. Please make sure this is confirmed the first week of class. Additional requirements specific to individual clinical sites are communicated by the course coordinator the first week of the course.

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CLINICAL EVALUATION AND PERFORMANCE Evaluation of clinical performance is completed by the student's clinical instructor and the student and discussed weekly and/or midpoint and/or at the end of all clinical experiences, or during other conferences, if necessary. Students may request an evaluation of their progress in the course at any time, but are responsible for knowing their own status in the course.

Successful performance of required clinical skills is necessary for achieving a passing grade for this course. Students must be present for all scheduled clinical and laboratory periods. It is the student's responsibility to inform the appropriate person if she/he is unable to be present during scheduled clinical or laboratory periods. In the event of an obligatory absence from clinical practice (e.g. death in family, documented illness), the student plans, with the course coordinator and the clinical instructor, an appropriate make-up activity. Travel plans do not constitute legitimate excused clinical absence.

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THE UNIVERSITY OF TEXAS MEDICAL BRANCH SCHOOL OF NURSING N4532: Care of the Pediatric Patient and Family Summer 2014 Course Outline

MODULE: 1 A.

ADAPTING NURSING CARE TO THE PEDIATRIC PATIENT AND FAMILY

Communication and Health Assessment of the Pediatric patient and Family 1. Adapt communication and approaches to the developmental level of the pediatric patient 2. Describe approaches to the family that ethically, ethnically and culturally appropriate Adapt History and Physical to the needs of pediatric patient and family 1. Adapt health history to the developmental stage of the infant through the adolescent. 2. Describe how the process of conducting the physical exam varies from the infant through the adolescent 3. Adapt and interpret vital sign measurements to the developmental age of the pediatric patient. 4. Perform and adapt the review of systems and physical exam for the pediatric population. 5. Identify normal findings as they relate to the pediatric patients developmental stage. 6. Describe approaches which are developmentally, ethically, and culturally appropriate for the pediatric population and family. 7. Describe and document normal findings and abnormal findings. Family Centered Care of the Pediatric patient During Illness and Hospitalization 1. Analyze and discuss nursing interventions to manage and promote family involvement during the hospitalization of the pediatric population and family. 2. Describe nursing interventions for the pediatric patient of different developmental stages to lessen the impact of separation anxiety, loss of control and fear of bodily injury. 3. Utilize developmentally appropriate play activities to decrease the stressors of hospitalization. 4. Describe the nurses role in preparing pediatric patients for procedures and hospitalization. 5. Apply nursing interventions to assess and manage pain in the pediatric population including: a. The use of pain scales. b. Specific non-pharmacological and pharmacological interventions. c. The cultural impact and developmental stages related to the management of pain.

B.

C.

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D.

Role of Play to manage the effects of hospitalization 1. Forms of play 2. Age appropriate and therapeutic play 3. Role of nurse in providing anticipatory guidance regarding play 4. Incorporating play in nursing assessments and interventions HEALTH PROMOTION AND HEALTH PROBLEMS OF INFANTS AND FAMILIES

MODULE:2

A.

Infants 1. Describe the major physiological, psychosocial, cognitive and social developments of the infant (0-1 year). 2. Describe parental role in the attainment of appropriate growth and developmental milestones of the infant. 3. Relate the role of the parents in the prevention of injury of the infant. 4. Develop a plan to provide nutrition counseling to parents of infants 5. Describe the changes in the nutritional needs of infants in the first year of life. 6. Develop nursing plans of care for pediatric patients with: a. Food sensitivity. b. Diaper dermatitis. c. Atopic dermatitis (eczema) Toddlers and Preschoolers 1. Describe developmental characteristics of toddlers and preschoolers. 2. Discuss content to be incorporated into a plan for anticipatory guidance to parents of toddlers and preschoolers for the following: a. normal developmental issues. b. nutrition. c. safety. d. injury prevention. e. toilet training. f. play. g. pre-school. h. fears. 3. Describe the nursing care for pediatric patient who have or are suspected of having heavy metal poisoning. 4. Explain the nurses role in the care of pediatric patient who have suffered maltreatment. 5. Describe the nursing care for pediatric patient who have autism. School Age and Adolescent Pediatric patient 1. Describe the developmental characteristics of school-age and adolescent population. 2. Relate the processes of physical and psychosocial development in adolescents to health care needs. 3. Discuss health maintenance needs, injury prevention and anticipatory guidance for parents of the school-age and the adolescent population. 4. Discuss the components of a nutritional assessment for the school age and adolescent population.

B.

C.

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5. Develop a nursing teaching plan for anticipatory guidance to include these risk behaviors: a. bicycle safety. b. motor vehicle accidents. c. sports injuries. d. tobacco use. e. sexual activity. 6. Utilize the nursing process in the care of a pediatric patient with the following health problems: a. eating disorders. b. attention deficit disorder. c. school phobia. d. skin disorders and bites. e. acne, scabies and ringworm. 7. Identify community resources for the primary care and health promotion of the schoolage and the adolescent population. MODULE 3: A. HEALTH PROMOTION

B.

Immunizations 1. Develop a teaching plan to counsel care providers regarding the benefits of immunization. 2. Advise parents regarding the risks, benefits, adverse drug reactions (ADRs) and contraindications according to the Center for Disease Control (CDC) guidelines and American Academy of Pediatrics (AAP) of the following immunizations: a. DTaP, Td b. Haemophilus influenza type b (Hib) c. Hepatitis A d. Hepatitis B e. Influenza Seasonal and H1N1 f. Measles, Mumps & Rubella (MMR) g. Pneumococcal (Prevnar) h. Polio i. Varicella (Chicken pox) j. HPV (Gardasil & Cervarix) k. Meningococcal l. Rotavirus 3. Identify routes, dosages, sites and complications of injected immunizations. 4. Formulate nursing plans of care for the pediatric population with communicable disease . a. Conjunctivitis b. Strep Throat c. Fifth Disease d. Impetigo Screenings for the Pediatric patient a. vision & hearing b. scoliosis c. acanthosis nigricans d. physical assessment

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MODULE 4:

NURSING AND THE FAMILY WITH A PEDIATRIC PATIENT EXPERIENCING ACUTE HEALTH PROBLEMS

A.

Nursing care for the Pediatric patient with Altered Respiratory Function 1. Differentiate the anatomical differences between the respiratory tract of an adult and the pediatric population. 2. Relate the pharmacologic interventions used in the management of respiratory dysfunction in the pediatric population 3. Discuss the etiology, treatment modalities, nursing care management and discharge teaching required in care of the pediatric population with the following respiratory conditions: a. pharyngitis. b. otitis media. c. tonsillitis/tonsillectomy. d. foreign body. e. croup syndromes such as epiglottitis and laryngotracheobronchitis. f. RSV/bronchiolitis. g. asthma. h. pneumonia i. cystic fibrosis. j. respiratory distress syndrome and bronchopulmonary dysplasia. k. SIDS l. apnea 4. Identify the essential elements of care coordination and long-range planning for the pediatric population with impaired gas exchange and airway clearance. 5. Discuss the role of research in improving health care of pediatric patient with impaired gas exchange and airway clearance. The Pediatric patient with Gastrointestinal Dysfunction 1. Identify common nutritional needs and disturbances in the pediatric population. 2. Relate how vomiting and diarrhea result in fluid and electrolyte imbalances. 3. Formulate nursing management of care for the pediatric population with common fluid and electrolyte deficits and excesses. 4. Teach age-appropriate home care management of a pediatric patient with gastrointestinal dysfunction. 5. Apply the nursing process in the acute care of the pediatric patient and family with the following problems: a. pyloric stenosis. b. gastroesophageal reflux (GER). c. Hirschsprungs. d. appendicitis. e. cleft lip and palate. f. failure to thrive (FTT). g. colic. h. iron deficiency anemia. 6. Demonstrate components of health promotion and prevention in the care of pediatric patient with alterations in gastrointestinal dysfunction. 7. Describe the nursing care for pediatric patient who have or are suspected of having heavy metal poisoning.

B.

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C.

Pediatric patient with Cardiovascular Dysfunction 1. Identify the components of the nursing history and physical examination of the pediatric population with cardiovascular disorders. 2. Identify tests used to assess pediatric patient with cardiovascular disorders. 3. Utilize the nursing process to plan care for the pediatric patient with the following cardiovascular dysfunctions: a. patent ductus arteriosus. b. coarctation of the aorta. c. tetralogy of Fallot. d. atrial septal defect and ventricular septal defect. e. transposition of the great vessels. f. tricuspid atresia. g. congestive heart failure. h. rheumatic fever. i. bacterial endocarditis j. hyperlipidemia. k. Kawasaki disease. 4. Formulate nursing care management for a pediatric patient undergoing cardiac catheterization. 5. Examine the impact upon the family of a pediatric patient with cardiovascular disorders. 6. Apply pharmacologic and nutrition interventions in the care of the pediatric patient who has a cardiovascular disease. 7. Teach nursing strategies to assist the pediatric patient and family with cardiovascular disorders to achieve optimal wellness, including home management and reintegration into society. 8. Explore issues and areas in which research can assist in improving the lives of pediatric patient with cardiovascular disorders. Nursing Care of the Pediatric patient with Alterations in Urinary Elimination 1. Apply the nursing process to the care of the pediatric population with a defect in the physical development of the genitourinary tract including: a. hypospadias. b. epispadias. c. exstrophy of the bladder. 2. Apply the nursing process to the care of the pediatric patient with renal dysfunction including: a. UTI. b. acute post streptococcal glomerulonephritis. c. nephrotic syndrome. d. obstructive uropathy. 3. Discuss the impact of these conditions with respect to: a. body image. b. developmental implications. c. family functioning. d. preparation for diagnostic and surgical procedures Nursing care of the Pediatric patient with Endocrine Dysfunction

D.

E.

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1. Describe the effects of the following disorders on the pediatric patients physiological
and psychosocial states: a. growth hormone deficiency. b. diabetes insipidus. c. hypo/hyperthyroidism. d. SIADH. e. Cushings Syndrome. Discuss the nursing assessments and interventions for a pediatric patient with the following acute diabetic conditions: a. hypoglycemia. b. diabetic ketoacidosis. Analyze the developmental, socialization, emotional, and health maintenance needs of pediatric patient with endocrine disorders. Develop age appropriate teaching plans for the pediatric patient with diabetes and the family. Recognize the essential elements of care coordination and long-range planning for the pediatric patient and family with endocrine disorders.

2.

3. 4. 5.

MODULE 5: NURSING AND THE FAMILY WITH A PEDIATRIC PATIENT WHO HAS A LONG-TERM OR SERIOUS HEALTH PROBLEM A. The Pediatric patient with a Hematologic, Oncologic or Immunologic Dysfunction 1. Discuss the etiology, treatment modalities and discharge teaching in the case of the following pediatric cancers: a. leukemia. b. Wilmas tumor. c. retinoblastoma. d. estrogenic sarcoma. e. Ewings sarcoma. f. bone tumor. g. lymphomas. h. neuroblastoma. i. brain tumors. j. rhabdomyosarcoma. 2. Discuss the etiology, treatment modalities and discharge teaching for the pediatric hematologic disorders of the anemias and hemophilia. 3. Apply the nursing process in the acute care or active outpatient treatment of the pediatric patient with cancer, hematologic or immunologic disorders. 4. Describe the chemotherapeutic agents used to treat pediatric leukemias and lymphomas, their modes of action, therapeutic goals and untoward effects. 5. Develop plans of care to manage the untoward effects of chemotherapeutic agents while meeting the nutritional needs of the pediatric patient undergoing chemotherapy. 6. Assess the essential elements of care for a long-term: a. cancer survivor and of a pediatric patient who is to undergo bone marrow transplantation. b. coping with a chronic hematologic, cancer or immune disorder. Care of the Pediatric patient with Cerebral dysfunction

B.

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1. Identify relevant data for the health assessment of the infant or older pediatric patient
with the following problems: a. meningitis. b. increasing intracranial pressure. c. hydrocephalus. d. Reye syndrome. e. cerebral trauma 2. Develop plans for the nursing care for the pediatric patient: a. experiencing tonic clonic seizures. b. that is unconscious. c. exhibiting signs of increased intracranial pressure. d. receiving antibiotic treatment for meningitis. e. who has cerebral trauma. 3. Relate the role of the nurse in helping the pediatric population and family to manage the psychosocial issues associated with seizure disorders. C. Care of the Pediatric patient with Musculoskeletal, Articular or Neuromuscular Dysfunction 1. Incorporate evidence based practice in the development of plans of care which includes nursing intervention, parent education and psychosocial support for the pediatric patient and family who has these pathologies: a. developmental dysplasia of the hip. b. fractures. c. Traction. d. casted extremity(ies). e. muscular dystrophy. f. cerebral palsy. g. Guillain-Barre syndrome. h. osteomyelitis. i. club foot. j. juvenile idiopathic rheumatoid arthritis. k. spina bifida. l. Downs syndrome. m. Scoliosis. 2. Formulate a nursing plan of care for the preoperative and post-operative care of the pediatric patient who has a. fracture. b. unrepaired spina bifida. c. surgical repair of spina bifida. 3. Discuss the impact of nutritional support and pharmacological management for the pediatric patient with a neuromuscular or musculoskeletal dysfunction. CARE OF THE PEDIATRIC PATIENT AT THE END OF LIFE

MODULE 6: A.

Care of the Pediatric patient at the End of Life 1. Describe the pediatric patients concepts of and reactions to death based on developmental level. 2. Discuss developmentally appropriate nursing interactions with the pediatric population who are involved in a death and dying situation. 3. Formulate a nursing plan of care for a pediatric patient who has a life threatening illness or trauma.

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4. Implement nursing interventions to support the family and professional caregivers in

expressing grief. B. Care of the Pediatric patient in an emergency situation 1. Assess and apply appropriate resuscitation principles for the pediatric population. 2. Intervene appropriately to support the pediatric patient and family during the crisis period. 3. Formulate a nursing plan of care to support the pediatric population in a crisis situation. 4. Discuss various disasters situations and the nurses involvement in disaster preparedness.

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Module 4: Nursing Care of the Pediatric Patient with Respiratory Complications (3 Hours Didactic/Virtual In-class lab)

Introduction: Respiratory infections account for the majority of acute illnesses in the pediatric population. This module is designed to prepare the student to identify the various respiratory infections observed in the pediatric population, recognize signs of respiratory distress and impending respiratory failure, provide nursing interventions in an age appropriate manner and educate the family regarding therapeutic treatment plans for their child. Module Objectives: Upon completion of this course and its related activities, the student will
demonstrate the ability to: 1. Discuss the anatomical differences between the respiratory tract of a pediatric patient and an adult. (Foundational Knowledge) 2. Evaluate and discuss the diagnostic procedures frequently used in a pediatric patient with altered respiratory function (Foundational Knowledge/Application) 3. Discuss the etiology, treatment modalities, and discharge teaching in the care of the pediatric patient with the following respiratory conditions: (Foundational Knowledge/Application) a. pharyngitis. b. otitis media. c. tonsillitis/tonsillectomy. d. foreign body. e. croup syndromes such as epiglottitis and laryngotracheobronchitis. f. RSV/bronchiolitis. g. asthma. h. pneumonia i. cystic fibrosis. j. respiratory distress syndrome and bronchopulmonary dysplasia. k. SIDS l. apnea 4. Examine the application of the nursing process in the care of a pediatric patient with the above respiratory conditions. (Learning how to learn/Application) 5. Identify the essential elements of care coordination with in the interdisciplinary team and longterm planning for the pediatric patient with respiratory compromise. (Human Integration/Caring)

Required Readings and Preparation:

Perry VCE Workbook: Lessons 14, 15,16 Common Disorders Perry: 1208 - 1242 Newborn/Infant Disorders Perry: 685-688

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RDS/BPD Perry: 558, 1208-1209 Respiratory Disorders ATI 2010: 141-191

IN CLASS VIRTUAL CLINICAL LAB: PURPOSE: This clinical lab will help prepare students to care for the acutely ill infant diagnosed with RSV. CONTENT: Students will learn how to care for a 6 month old child: Carrie Richards with RSV, dehydration, and failure to thrive.

REQUIRED PREPARATION: Prior to 1st VCE day, in Perry textbook, review information regarding respiratory distress due to RSV, infant dehydration and failure to thrive. Complete questions 1 4 on pages 145 and 146 in Perry VCE workbook. On page 150, question #14, please write down the normal value next to each lab test for a 3 month-old female. Do not look up her current lab values. We will do that in class. Complete question 14 on page 165. A practice quiz will be available on Blackboard to help clarify the concepts. *Remember VCE participation counts for 10% of your total grade*

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MODULE 6: EMERGENCY CARE OF THE PEDIATRIC PATIENT AND FAMILY (1 Hour Didactic/4-6 Hours On-line Lab) OBJECTIVES: Upon completion of the class and its related activities, the student will Identify various disaster situations and the nurses involvement in disaster preparedness. (Human Integration) 2. Describe various disaster situations and the nurses involvement in planning before, during, and after a disaster. (Foundational Knowledge) 3. Be able to identify ways in which the nurse can assist the pediatric patient and family before, during and after a disaster. (Human Integration) 1. REQUIRED PREPARATION: Required Readings: 1. Pediatric Emergencies, ATI 2013 2. Center for Disease Control: Emergency Preparedness and You (2014). Retrieve from: http://emergency.cdc.gov/preparedness/ 3. Preparing for Disaster by S. Eckhart. Retrieve from: www.americannursetoday.com/Popups/ArticlePrint.aspx?id=5402 4. Disaster Preparedness for Bedside Nurses, Parts I, II & III by C. Romer and T. Hebda (2014) Retrieve from: http:nursing.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=262977

Required On-Line Activity: The National Nurse Emergency Preparedness Initiative (NNEPI) Note: You will need to register for this course. Access the course at: http://nnepi/gwnursing.org/ Please select the FREE version of the course if you do not require any CNEs at this time. CNEs are available for $24.00 (6 CNEs.) You will print out the certificate at completion of the course. You will submit the certificate to course faculty by the due date noted on the course calendar. Required Clinical Activity: You will be required to participate in clinical conference in a Case Study (presented by PPP and attached at the end of the syllabus) regarding an actual evacuation of a NICU during a natural disaster. You will be given a Pass/Fail on this activity in your clinical evaluation (see rubric at end of syllabus) by your clinical faculty. The date of the case study will be determined by clinical faculty and provided to you at your clinical orientation. There is no discussion board activity for this module due to the case study requirements

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Appendix

Pediatric Clinical Worksheet and Nursing Plan of Care template Pediatric Care Plan Evaluation Student Clinical Evaluation Clinical Journal Mrs. Woffords Teaching Philosophy Statement Mrs. Abrahams Teaching Philosophy Statement Course Calendar References

31-44 45 46-47 48 49-50 50-51 52-53 54-55

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THE UNIVERSITY OF TEXAS MEDICAL BRANCH

SCHOOL OF NURSING PEDIATRIC CLINICAL WORKSHEET AND NURSING PLAN OF CARE Student Name: Age: (include months) Sex: Unit Clinical Instructor: Date of Admission/Reason for Admission: This is the reason for ADMISSION, not the already existing diagnoses. For example: Reason for admission: coughing, wheezing, fever 102 , respiratory distress Medical history/dates: You will find this in the chart include pertinent pre-existing diagnoses, previous hospitalizations, etc Surgical history/dates: You will find this in the chart list ALL surgeries Based on the data you have gathered and your review of the pathology, describe your thoughts as to what is going on with this pediatric patient/family. Include summary of illness along with treatment received and planned. Also include what the evidence suggests the treatment plan should be. (Use citations as needed but no copying from any source. Use as references.) This is one of the most important sections of the care plan. It is your opportunity to give the overall clinical picture of the patient and sets the stage for your care plan. Go to your pathophysiology book and/or your pediatric textbook and/or a current reputable reference and write out what you learned about the pathophysiology of the disease process and include your citations here. Wikipedia is NOT a reputable source. Include a history of your patient starting with when symptoms started, comorbidities, etcbasicallywhat led them to the point of being in the hospital? Based on the pathophysiology, what signs and symptoms are you seeing in your patient that coincide what you learned? What treatment has your patient received for the illness and does the treatment they are receiving coincide with the research you did on the illness? What is their treatment and what is their plan for the future? Does research support their treatment? This is where you will learn to utilize evidence-based practice. Be sure to cite your work here as well. What is going on the family as far as their psychosocial issues? How will that impact their care? This is an overall picture of your patientfrom s/sx leading to hospitalization to what treatment they have received to what is their plan for discharge, including any co-existing issues such as cultural barriers, psychosocial factors impacting care, etc. When your faculty reads this section, they should understand what led your patient to the hospital, what their treatment is, what their plan is for treatment or discharge, and how psychosocial factors have been addressed as well as showing that research does or does not back up the treatment they are receiving.

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PHYSICAL ASSESSMENT With emphasis on areas directly related to the pathology (For Day 2, indicate only changes from Day 1) No copy/paste from!!!! Date/Time of Assessment(s):_____________________________________ Do not use abbreviations in your charting. Most hospitals are getting way from using abbreviations because of the risk for misinterpretation. As a general rule, do not. It would be helpful to review a cop y of the hospitals acceptable abbreviations. SKIN/NAILS/HAIR EYES/EARS/NOSE The best place to find out how to document an accurate, thorough assessment is your Health Assessment book! Remember to document a thorough assessment but only document what you actually assessed! This is a focused assessment as well, so be sure to put specific emphasis on the system that is most affected. For example: respiratory assessment should be more thorough in a patient with cystic fibrosis, cardiovascular and circulation assessment should be more thorough in a patient s/p cardiac surgery. Remember, this is a pediatric assessment and needs to reflect pediatric anatomy/physiology. You will probably not be able to feel the thyroid on an infant, for example or hear anything other than the S1 and S2 heart sounds. You might be able to hear an abnormal sound such as a murmur. MOUTH & THROAT If you write in this area that TM's are pink and pearly, translucent with visible landmarks and no fluid level, we are going to have to ask for your otoscope. DO NOT WRITE THINGS THAT SOUND GOOD IN YOUR TEXT BUT YOU DID NOT ACTUALLY SEE!!

FACE/HEAD/NECK Remember pediatric terms such as "normocephalic" and be sure to include assessment data regarding the fontanel.

RESPIRATORY (include rate)

CARDIOVASCULAR/PERIPHERAL VASCULAR (include rate and blood pressure)

GASTROINTESTINAL/NUTRITION Make sure you consider things like daily caloric needs vs intake, especially if you have an infant on formula or breast milk or a pediatric patient on a special diet. Is he getting the recommended amount of calories? Why is he on the diet he is on or that particular formula?

GU Intake and output for your shift goes here.

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MUSCULOSKELETAL

NEUROLOGICAL Do NOT write AAOx3 unless you have an adolescent. This is not an appropriate assessment for a 2 year old. Much of the neurological assessment comes from signs of being developmentally appropriate.

Appropriate/inappropriate verbal/non-verbal behavior: You will need to understand the pediatric development for your patients age. List out the behaviors you observed and heard and assert if that is appropriate for YOUR PEDIATRIC PATIENTS AGE. For instance: a patient refuses a medication and screams for 10 minutes because he doesnt want to take it. This is appropriate behavior for a toddler because of a toddlers development. This would NOT be appropriate behavior for an adolescent. This also includes the care provider at the bedside. How does that person interact with the pediatric patient? Do they voice concern but then ignore the pediatric patients needs? Are they attentive and interactive with the pediatric patient? GENERAL IMPRESSION (overall summary, objective statement) This is an overall summary, an objective statement giving me the overall clinical picture of your patient, as if you are giving report. For example: 14 year-old Caucasian female admitted for RLL pneumonia with history of cystic fibrosis. She has a 22G PIV to L FA with D5.45@110cc/hour via pump infusing. She has a 22G heplock IV to R wrist. She is on a pulse ox with O2 sats ranging between 92-93% on 2L O2. She is on double-coverage IV antibiotics. She receives CPT TID before meals. She gets pancreatic enzymes TID before meals. She is on a high-protein, high-calorie diet. Her mother is at the bedside. (And you can go on from here depending on how much you need to report about your patient.) This is a GREAT place to practice giving report and learning what is relevant to include.

Tobacco, Alcohol &/or Drug use (include type, frequency, and number of years for each; includes patient and family): It is ok to ask the family or patient (depending on age) if there is tobacco, alcohol, or drug use either for the patient or the family.

OTHER SIGNIFICANT INFORMATION (not included above such as financial status, occupation/retirement, support systems, activity/exercise, education level, etc.) You will get this information FROM THE FAMILY! The chart is not the best place to get informationyour patient and family will give you a better history on any part of this care plan than a chart will!

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Labs and Meds You are expected to know your patients labs and discuss with your preceptor each day. You are expected to know all about your patients medications and disc uss with your preceptor prior to administering Labs and Meds impact patient care. They should also be reflected in your plan of care. Are they? Labs Result and Meaning Meds Reason for Giving List out abnormal labs or labs that are pertinent to the disease process Write out what they mean FOR YOUR PEDIATRIC PATIENT. Not Hypernatremia can be caused by dehydration if your pediatric patient is not dehydrated! List out WHY they are abnormal FOR THE DISEASE PROCESS AND FOR YOUR PATIENT! You can look in your book for some lab values. Your PDA also has a program called Mosby Lab which provides normal and critical values as well as what the abnormal finding might mean. or try: www.labvaluesonline.com www.medlineplus.com List out medications your pediatric patient is receiving Write out why YOUR PATIENT is getting these, not just the drug class. You will find in pediatrics that many drugs are given for a reason completely different for their drug class. For example: if you have a 3 week-old receiving Viagra, it is not for erectile dysfunction! Though you will see that in drug books. Do some research and find out that some preemies are given Viagra for pulmonary hypertension.

CLIENT/FAMILY TEACHING Educational Need Method of Teaching (be specific as to what you are going to do or what you did) Tell me how you did the teaching was it a video, a verbal demonstration, a handout and list out WHAT YOU SAID TO THE FAMILY OR PATIENT. Client/family Response to Teaching

Remember to include simple things like good hand washing, keeping side rails up on the crib, etc. Then include educational needs tailored to what the family needs to know about the disease process, medications, how to administer feedings, etc. Use your critical thinking here!

How did the family respond to the teaching? Were they able to verbalize back to you the instructions given? Did they administer a tube feeding on their own after instruction and demo? If the family is not at the bedside while you were caring for the patient, you will tell what teaching you WOULD have done and just state that the family was not there for

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Educational Need

Method of Teaching (be specific as to what you are going to do or what you did)

Client/family Response to Teaching

actual teaching.

What are the discharge planning needs of this client/family? Are referrals needed?

This is definitely a section for critical thinking. What you need to ask yourself is, What am I going to do for this patient and family to get them home safely and keep them home safely? Examples: do they have a car seat? Do they have transportation home? Do they need home health care? Do they need access to discharge medications and how to give them? Do they need a wheelchair or crutches or other ambulatory devices? Is this a critical pediatric patient that would need home health services? Will they have multiple follow-up appointments which specialties do they need to see and what appointments should we set up prior to discharge? Do they need a social services consult because they lack transportation, money, or access to healthcare? Think about anything the patient would need to be able to be medically and safely cared for at home without nursing care present.

What are the long term health care needs based on the disease process, the physical assessment, the clients/familys understanding and the psychosocial factors? What about Follow-up or home meds?

Long-term healthcare needs are needs that you can anticipate as a prudent nurse for your patient weeks, months, even years down the line. For example, you know that a premature infant is at high risk for developmental delaystherefore, we would consider doing an ECI consult (Early Pediatric patient hood Intervention). Check out ECI services at http://www.dars.state.tx.us/ecis/index.shtml#eci Will this family need to have access to a parent support group to deal with a pediatric patient with a chronic illness? Did this pediatric patient have chemotherapy? We know now through research that chemotherapy has long-term effects on different body systems depending on the chemo given. Research the chemo and let the parents know thatfor instance, their pediatric patient will need EKGs every year for the rest of their life because the chemo can cause arrhythmias throughout adulthood even if they are no longer receiving it. Did you take care of a pediatric patient with a genetic illness? Will you need

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to consider talking to the family about genetic counseling if they decide to have another pediatric patient? This is where you will research long-term needs for your patient depending on what the disease process is and the psychosocial factors surrounding the family. PERSONAL REFLECTION Reflect on your clinical days. What are your thoughts, feelings & observations?

My learning goals for this week and evaluation of outcomes (relate these to your clinical objectives): My learning goals for the week were: .

I met/not met by ______________________, and ____________. If not met, other ways to meet goal include __________ and _______________.

GROWTH AND DEVELOPMENT GROWTH CHART Complete the appropriate growth chart for each pediatric patient and submit to clinical faculty Discuss the differences between the observed and the expected developmental stages of the pediatric patient you are caring for. (Be specific, give examples of behavior, language, reasoning, etc.) Fine motor Gross motor Language Cognitive (Piaget) Interpersonal stages (Erikson)

Expected

This information can come directly out of your textbook! Be sure to include your citations. What did you see your pediatric patient doing in relation to each of these categories? Why might it be different?

Observed

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Discuss how play is a part of this pediatric patients life. (Give specific examples of strengths or limitations.) Talk to your patient and find out what kind of play he did before going into the hospital. Discuss why play is important in the life of a pediatric patient. Then talk about what limitations the pediatric patient has regarding play because of the disease process or hospitalization, then discuss what modifications you can make for this pediatric patient to play during hospitalization, overcoming barriers? For example: you are taking care of an adolescent. Adolescent play can be video games, texting on their phone, talking to their friends, etc. In the hospital this can be difficult. Can you talk to the mom about bringing in a visitor to lift their spirits? Can you encourage them to go to the Teen Room at the hospital to interact with other teens and make some new friends? If you have a newborn, they play too!!! Play for infants can be having mom sing to them, caress them, offering mirrors or mobiles, playing soft music in the room, etc. Determine what knowledge the parents will need to know to help them guide their pediatric patient through the next stage of development. This is where you will show off how much you know about the development of your pediatric patients age group! Discuss what anticipatory care you will give to the parents to help this pediatric patient successfully complete their developmental stage. What will you tell her about: sleep, nutrition, development (ways to stimulate senses and play), elimination (toileting), friendships, school, etc. For example: in a 5 month-old, I will talk to mom about how much formula or breast milk he needs to take/day (computing the calories for her and telling her what is an appropriate amount), how often to feed him, make sure to do tummy time to strengthen muscles as he will begin to sit up on his own soon, how many hours he should be sleeping and if he should be napping, how to stimulate his development by talking to him, making faces at him, letting him put toys in his hand, showing him toys so he learns to track, offering mirrors and mobiles, sitting him up often to prevent plagiocephaly aka flat headI will give her developmental advice to help her get him from infancy to toddlerhood successfully. Resources to use for this could include: textbook www.brightfutures.org www.aap.org Determine what safety factors are involved for this pediatric patient and family. List out safety factors that relate to the disease process or any limitations the pediatric patient may have as well as GENERAL safety factors as well: car seat safety, medication safety, gun controls and locks, stranger safety, pediatric patient-proofing, internet safety whatever is appropriate for your patients developmental stage and age include what you will tell the family SPECIFICALLY.

Narrative Nursing Notes Date/Time Nurse Notes

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Date/Time

Nurse Notes

39

Pediatric Clinical Care Patient Data (be specific = NA is inappropriate) Medical Diagnosis: Comorbidities or Risk Factors: Risk for infection, co-morbidity cystic fibrosis, maybe they came in for pneumonia but have a history of Downs syndromelist those out here. Reason Seeking Health Care: Why did they come to the hospital? What brought them to admission? Psychosocial Factors Affecting Care: Does the family have insurance? Do they have limited funds? Do they live far away from the hospital? Is there a history of drug use in the family? Is there a history of abuse in the family? Are there multiple pediatric patient in the family that mom has to take care of and cant be at the hospital all the time? These are examples. Cultural Factors Affecting Care: Do not just write, Hispanic! That doesnt affect the kind of care we provide. Are there certain cultural barriers to care? Does their culture require that the pediatric patient have their head covered at all times? Does the culture require them to eat certain foods? Spiritual Factors Affecting Care: Do not just write, Catholic! What about them being Catholic will impact their care? Would they like to put a rosary on the pediatric patients crib? Would they like a clergy member to visit them? Would they like to pray over the pediatric patient? Does their religion prevent them from having blood transfusions or certain foods?

Prioritized Nursing Diagnoses Statements (List ALL the client/families problems real or potential - with related to statement and as evidence by data to support as needed) There is no minimum or maximum number of nursing diagnoses here. You will go through the NANDA list provided for you and list out every nursing diagnosis that is pertinent to your patient. You will then prioritize your top 2 and write those up below. You could have 5 nursing diagnoses or 25depending on your patient and family! PLAN OF CARE Nursing Diagnosis #1: Data to Support this diagnosis Subjective: Objective: What is the relationship between the patient data and the nursing diagnosis? (This will include the pathology to

40

support your data and your problem. How does this information make it a patient problem ?) Patient Goals: Remembergoals need to be objective (measurable), realistic, and have a time frame to be accomplished. You can have long-term and short-term goals. For example: If you have a 6 week-old infant admitted for failure to thrive: You will research and find out how much weight an infant of this age needs to gain, which is -1oz/day. Soyour short term goal could be, Patient will gain ounce by tomorrow at morning weight this goal is objective (measurable), has a time frame, and is realistic because the infant very well could gain oz by tomorrow. An example of an inappropriate goal would be, Patient will gain weight in the hospital. This is not measurable there is no listed measurable goal and does not really have a time frame. Or, Patient will gain 2 pounds by next week. Though it is objective (measurable) and has a time frame, it would not be realistic for an infant this age with this diagnosis to gain this much weight by next week and next week isnt a very good time frame list out a date you feel would be realistic to complete it by.

What do you want your patient to accomplish related to this problem?

Nursing Orders/Planned Interventions

Rationale with reference and citations for each

Nursing Implementation & Patient Response to Intervention

Specific to your patient? What do you, the nurse, want/plan to do for this patient related to this problem? 1. These are nursing orders or doctors orders that would be acceptable and needed for a certain patient diagnosis. For example: You have a 2-month-old admitted with fever. Administer antipyretics every 4-6 hours for fever > 38.5C Tylenol in a syringe followed with med cup of chocolate milk Or if there is a specific way this pediatric patient takes his medication i.e. syringe, with

What evidence supports doing what you planned to do? Cite reference for each!!!

What did you, the nurse, do for this patient related to this problem and what was the result? State whether appropriate or not. This is what would be documented in rd patient record. Use 3 person tense only. 1. Write out what you actually did for your patient regarding the order and what the patient response was to the order. State if this action was an appropriate action or not.

1. Here is where you do your research to write WHY you are doing what you are doing. Antipyretics decrease body temperature by (Wong, 2010, p. ___))

Tylenol 2.5mL was administered at 0600 for temperature 38.7C rectal. At 0630, temperature was reassessed. Temperature was 37.2 rectal. Action appropriate.

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Nursing Orders/Planned Interventions

Rationale with reference and citations for each

Nursing Implementation & Patient Response to Intervention

Specific to your patient? What do you, the nurse, want/plan to do for this patient related to this problem? chocolate milk, etc. These orders need to be make specific to your patient 2. 3.

What evidence supports doing what you planned to do? Cite reference for each!!!

What did you, the nurse, do for this patient related to this problem and what was the result? State whether appropriate or not. This is what would be documented in rd patient record. Use 3 person tense only.

2. 3.

2. 3.

4. 5.

4. 5.

4. 5.

6.

6.

6.

7.

7.

7.

Evaluation of Goals: State whether each goal met or not State status of each goal or plan (ongoing, revised, discontinued) Provide revisions as needed

Evaluate each of your goals and write if your patient met the goal or not. If they met it, the goal can be discontinued. If they did not meet it but you still feel it is a reasonable goal, the goal will be ongoing. If they did not meet the goal and you realize the goal was not realistic for the patient, you can revise the goal and write a different goal. An example of this would be: Goal 1: Patient will gain 1 oz by 8/15/12. The baby has been vomiting all day and is now NPO for a surgical procedure. The baby probably did not meet the goal and did not gain the ounce by the next day. You can revise the goal to state: Goal 1 revised: Patient will gain 1 oz by 8/18/12 or Patient will maintain weight of 8 lbs 5 oz by 8/16/12

Nursing Diagnosis #2:

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Data to Support this diagnosis Subjective: Objective: What is the relationship between the patient data and the nursing diagnosis ? (This will include the pathology to support your data and your problem. How does this information make it a patient problem ?) Patient Goals: What do you want your patient to accomplish related to this problem?

Nursing Orders/Planned Interventions

Rationale with reference and citations for each

Nursing Implementation & Patient Response to Intervention

Specific to your patient? What do you, the nurse, want/plan to do for this patient related to this problem? 1. 2. 3.

What evidence supports doing what you planned to do? Cite reference for each!!!

What did you, the nurse, do for this patient related to this problem and what was the result? State whether appropriate or not. This is what would be documented in patient record. Use 3rd person tense only. 1. 2. 3.

1. 2. 3.

4. 5.

4. 5.

4. 5.

6.

6.

6.

7.

7.

7.

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Nursing Orders/Planned Interventions

Rationale with reference and citations for each

Nursing Implementation & Patient Response to Intervention

Specific to your patient? What do you, the nurse, want/plan to do for this patient related to this problem? Evaluation of Goals: State whether each goal met or not State status of each goal or plan (ongoing, revised, discontinued) Provide revisions as needed Revised: June 2009 bkw

What evidence supports doing what you planned to do? Cite reference for each!!!

What did you, the nurse, do for this patient related to this problem and what was the result? State whether appropriate or not. This is what would be documented in patient record. Use 3rd person tense only.

REFERENCES References used (APA format). Include all textbooks, journals used, including drug reference. Use APA FORMAT HERE! You can look at the following website to assist you: http://owl.english.purdue.edu/owl/resource/560/01/ The following two pages include the evaluation of your performance .You are to complete the Student column for your evaluation of your performance and your faculty will complete the Instructor section. Use M, NI and NM for each box and be honest with yourself. See the key below for definitions. Also, you are expected to complete a narrative under the comments sections on all 3 sections on each form you turn in for grading. All forms need to be submitted electronically in Blackboard.

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THE UNIVERSITY OF TEXAS MEDICAL BRANCH SCHOOL OF NURSING Care of Pediatric patient and Family

NAME: _______________________ UNIT: ____________

DATE: _______________________

STUDENT PLAN OF CARE EVALUATION

This form is designed to provide feedback on students plan of care Plan of Care (verbal/written)
Assessment: Completes clinical preparation Documents an appropriate physical assessment Identifies appropriate long term/discharge care needs Completes growth chart correctly Identifies developmental and play needs Integrates pathophysiology & knowledge from other disciplines into clinical decision making Identifies subjective & objective data to support nsg diagnoses Nursing Diagnoses: Identifies appropriate nursing diagnoses with relationships Prioritizes nursing diagnoses Client Goals: Develops client centered and specific goals Develops measurable, observable, time limited, realistic goals Nursing Orders: Develops individualized, developmentally appropriate orders Demonstrates logical thought in relating plan to the problem Develops comprehensive, holistic, realistic, specific orders Incorporates appropriate developmental play needs Identifies resources for client referral Addresses educational and/or discharge needs Rationale: Demonstrates use of evidence-based practice in plan of care (within last 3 years) Cites references in APA format Implementation: Describes care performed Documents appropriateness of nursing orders Documents clients response to care Evaluation: Document if goals were met; provides supporting data Documents status of plan (continued, revised, discontinued) Documents revisions as needed Documents variables affecting pt ability to meet goals Professionalism/Accountability: Grammar, spelling, punctuation, neatness & organization Completes written assignments as scheduled Responds appropriately to verbal/written feedback KEY: (see detail on other side)
4 = Outstanding performance 3 = Exceeds expectations 2 = Meets expectation 1 = Needs improvement 0 = Does not meet expectations; requires constant assistance/prompting

St

Instructor
4 4 4 4 4 4 3 3 3 3 3 3 2 2 2 2 2 2 1 1 1 1 1 1 0 0 0 0 0 0

Comments
Student: Faculty:

4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 4 4 4 4 4 3 3 3 3 3 3 2 2 2 2 2 2 1 1 1 1 1 1 0 0 0 0 0 0

Describe strengths:
Student: Faculty:

Describe areas of needed improveme

Student: Faculty:

4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0 4 3 2 1 0
Plan of Care Scoring:

4s = ______x 1.000 = ______ 3s = ______x .900 = ______ 2s = ______x .800 = ______ 1s = ______x .745 = ______ 0s = ______x 0 = ______ Total = ______/28=_______

Student signature

_____________

Instructor signature _______________

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Evaluation: Please circle Revised for Pedi: 12/12/05, 12/21/06 , 5/08, 8/08 (BSN team)(without numbers) NAME: ________________________ final clinical grade THE UNIVERSITY OF TEXAS MEDICAL BRANCH Final SCHOOL OF NURSING UNIT: ____________ Pass Fail Care of Pediatric patient and Family DATE: ________________________ STUDENT CLINICAL EVALUATION Form designed to provide formative/summative feedback to identify areas of strengths and areas of needed improvement. Clinical Behavior St Instructor Comments
M NI NM Student: Accountability and Safe Practice: *Demonstrates preparedness (meds, tools, PDA, careplan) Utilizes time management *Maintains client confidentiality/security/privacy *Adheres to Joint Commission Safety Goals Participates appropriately in clinical conferences Seeks guidance/assistance from faculty/staff *Reports pertinent client information in timely manner and consults with interprofessional team Demonstrates initiative: Selects appropriate clients; seeks learning experiences; f/u with client problem/concerns Responds appropriately to feedback Identifies strengths/limitations Integrates pathophysiology and knowledge from other disciplines into clinical decision making NURSING PROCESS Assessment: Performs appropriate physical assessment in timely manner Recognizes influence of client/family health beliefs regarding health care Identifies assessment changes in client status Diagnosis: Identifies client problems Planning: Identifies clients holistic needs utilizing nsg. principles Integrates evidence and clinical judgment in planning care Integrates interprofessional perspectives & client preferences Implementation: Utilizes therapeutic communication/establishes rapport Utilizes technological resources to facilitate safe care *Administers medication utilizing the 6 rights *Verbalizes an understanding of meds administered *Demonstrates appropriate nsg. actions with med. admin Reviews plan with faculty Completes and documents care within time frame *Performs nursing care within a culture of safety Demonstrates ability to make accurate clinical judgments based on multiple sources of data Coordinates care for clients with interprofessional team *Provides and documents client/family teaching Discusses deviations and revisions from plan Documents asmt. data, nsg. care and client/fam. responses Integrates appropriate developmental level care *Provides client/family centered care Professionalism:

Faculty:

Describe strengths:
Student:

Faculty:

Describe areas of needed improvement:

Student:

Faculty:

KEY:
M = Meets expectation NI = Needs improvement NM = Not met; requires constant assistance/prompting

Student signature

________________
Instructor signature __________________ *Critical indicators must be met to pass course.

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*Adheres to legal/ethical standards of nursing practice *Identifies/analyzes ethical/legal concepts with client situations *Adheres to appearance/attendance/punctuality guidelines *Assumes accountability for personal & professional behavior *Demonstrates respect for self & others; Adheres to professional boundaries

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University of Texas Medical Branch School of Nursing NURS 4532: Care of the Pediatric Patient and Family Summer 2014 Clinical Journal Requirements

Students will submit a 1-3 page journal to their clinical faculty during weeks that care plans are not submitted. The journals will relate to the weeks clinical experience. Please submit journals to the Assignment Drop Box in Blackboard within 48 hours from the end of your clinical day. Please include your name, your nurses name, and the date of your clinical. Appropriate grammatical usage and APA formatting is required. Clinical faculty will review the journals and provide feedback as appropriate. Please note that this is a PASS/FAIL assignment. Criteria for Clinical Journal: 1. Basic information and report regarding the patient(s) you care for. Please include medications given and their rationale. (Pass/Fail) 2. Action and non-action with rationale (Pass/Fail) 3. Issues encountered. How was the issue resolved? If not resolved, what could have been done in your perception. If poor outcome, what could have been done differently? (Pass/Fail) 4. Professional growth. How has this experience helped you to grow as a professional nurse? (Pass/Fail) 5. Identify and discuss one potential safety risk. (Pass/Fail) 6. Identify your goal(s) this week. Was it met and if not, what factors led to you not meeting the goal? (Pass/Fail) Students Name: ________________________________ Facultys Name: _________________________________

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Ms. Woffords Teaching Philosophy Statement:

Move and the door will open. Zen Proverb As a registered nurse, meeting the patients needs has been my highest priority. As my career has evolved into nursing management, my priority shifted to nursing bedside nurses on the best practices Ive learned through continuing education and twenty years of experience. As nursing faculty, my focus is now central to nursing my students to reach their potential.

Each semester, as my students achieve success and enter the workforce, I regroup and refocus. I use the graduation experience to reflect on how to improve my lessons and

instructions for the upcoming semester and for my new group of incoming students. I continue to nurse. I also teach yoga, gradually building students experiences from a potentially unsure adventure to a master of the art. When students begin yoga and first encounter the mat

experience, I purposefully speak and instruct using what I refer to as my beginners mind. This practice of placing me on an even playing field with my students also correlates with my nursing instruction philosophy. As eager students walk through our doors, they may not have the tools they need to be successful and grow, but they are assured we will provide them with the knowledge and skills to achieve their dream. Keeping this concept at the forefront of each

semester, I enter my classrooms with a beginners mind, always recognizing that the learners have much they can teach me and my role is that of a facilitator and guide. After each class I brainstorm to further develop and refine my own practice as I work to mold the student. Thus, like the yoga master and student relationship, I seek to form a seemingly parallel relationship with the nursing students where we are each responsible for teaching equally important lessons that make us both better in our field, ensuring that I am always learning and improving. In my classroom I encourage my students to speak and embrace the mantra of the patient as the most important priority. I desire my classrooms to have the characteristics of

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openness, investigation, critical thinking, and passion. I desire for my students to recognize themselves as leaders and to understand the importance of this role in our profession. I believe leaders are developed and mentored; therefore I instill the notion of never settling and always striving for more. Each student possesses the basic qualities of leadership, and with the proper nurturing I encourage the development of these traits which can be used in the hospital setting. This is achieved by using real-world scenarios for them to critically analyze. I aspire for my

students to reason and communicate their rationales, and this is achieved by continued practice in the classroom setting and real-time role-playing in the clinical setting. I hope for my students to expand their scope of knowledge beyond the classroom and hospital setting, recognizing the importance of contributing to their community and the development of their profession by embracing a life-long commitment to learning. This discovery of self lends itself more to the art of our profession. Only in knowing how to find our own balance can we nurture and provide holistic care. Together, we will integrate the nursing material before us to achieve the

quality patient outcomes as the learners strive for clinical proficiency and self-discovery. Lastly, it is through open and civil communication in which we will all grow and achieve our potential. I encourage student-faculty contact, cooperation, prompt feedback and I believe in high expectations; not only of myself but of each student.

Mrs. Abrahams Teaching Philosophy Statement My personal teaching philosophy is currently a work in progress. I have been a pediatric nurse for nearly 20 years and have been involved in educating my patients, their families, and colleagues in a holistic, family-centered style. I decided to accept a position as nursing faculty in an undergraduate baccalaureate program as I am a strong believer in the importance of baccalaureate education for nursing. My goal is to facilitate the learning of nursing knowledge and the application of that knowledge toward evidence based care of the patients and families.

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The experiences and knowledge that I have gained in the hospital setting is what I want to use to guide you into applying that knowledge to your patients. As your professor, I want to instill my love, excitement and passion for nursing through my attitude, behavior and teachings. I hope to create a learning environment of trust and mutual respect for one another and the profession of nursing.

I do not have one particular teaching style. Every student learns in different ways and comes to our University with different expectations, experiences and perceptions. Because of this, I like to use a variety of teaching techniques that will actively engage you whether it is by lecture, group discussions or flipping the classroom. My goal as your Professor is to keep you interested in the content in which I am discussing through active participation in the class room, lab and clinical setting using narrative pedagogy. In Imogene Kings Theory of Goal Attainment under basic assumptions she says that transaction represents a life situation in which perceiver & thing perceived are encountered and in which person enters the situation as an active participant and each is changed in the process of these experiences. We all come to the table with vast personal experiences and knowledge that guides the way in which we perceive and store information. As soon as the teaching begins learners are deciding the relevance and applicability of the content by asking themselves do I really need to know this material?, and how will this information help me now? With this in mind, I strive to teach you relevant, current, evidence based information that you can use to make a difference in your patients lives and the lives of others. It is important for you to learn not only how things are done, but why they are done. My goal is for you to understand the relevance of evidence based practice and how it affects practice guidelines. I want you to gain the confidence to use evidence based practice guidelines to facilitate the change of long standing practices. I strongly agree with the great Alvin Toffler who said The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn (Toffler, 1984).

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May 2014
Sun Mon

N4532: Nursing Care of Child and Family

Tue

Wed
1

Thu
2

Fri
3

Sat

4 ** PLEASE NOTE ALL CLASSES and EXAMS WILL BE HELD IN Research Building, 1.202 Clinical Week 1 11 Clinical Week 2

5 9 10:00 Orientation 10-12 Lab Preparation Videos/Growth Chart

6 8-10 LAB: Physical Assessment 10-12 Lab Preparation AFTERNOON: CLINICAL ORIENTATIONS

7 8:30 Calculation Exam 10 LAB: Meds/IV; O2/Trach, Physical Assessment Online Module: Growth and Development 14 9-12 Respiratory 1-3 GI

10

Clinical Week 1

Clinical Week 1

Clinical Week 1

12 NOTE: NNEPI on-line module due

13 8-5 LAB: Safety/Wrapping, Feeding, Hearing & Vision

15

16

17

Clinical Week 2

Clinical Week 2

Clinical Week 2

18 Clinical Week 3

19

20 8-12 Exam 1 12-1 End of Life Practice (Optional) 1:30 3 GU 3:30 4:30 Exam Rev

21 8-10 Cerebral 10-12 VCE LAB 1-4 Immune

22 Clinical Week 3

23 Clinical Week 3

24 Clinical Week 3

25 Clinical Week 4

26 Memorial Day Holiday

27 8-11:30 Cardiac 12-14 End of Life Practice (Optional)

28 9-12 Musculoskeletal 1-3 Endocrinology

29 Clinical Week 4

30 Clinical Week 4

31 Clinical Week 4

2014

June 2014
Sun
1 ** PLEASE NOTE ALL CLASSES and EXAMS WILL BE HELD IN Research Building, 1.20 8 Clinical Week 5 2

N4532: Nursing Care of Child and Family

Tue Wed
4 9-12 Hematology and Oncology 10-12 Emergency/Disaster 11 8-12 Exam 3 2-3 Exam Review 5 Clinical Week 5

Mon
3

Thu
6

Fri
7 Clinical Week 5

Sat
Clinical Week 5

8-12 Exam 2 1-3 End of Life LAB 4-5 Exam Review

10 8-5 LAB: Emergency Simulations

12 Clinical Week 6

13 Clinical Week 6

14 Clinical Week 6

15

16

17 8-10 Final Exam 10:30 12 ATI Exam 1 PM Mother & Child Orientation

18

19

20

21

Clinical Week 6

22

23

24

25

26

27

28

29

30

References
ATI Nursing Education (2010). RN Nursing Care of Children (5th ed.). ATI AWHONN position statement: The role of the nurse in emergency preparedness. (2012). Retrieved from DOI: 10:1111/j.1552-6909.2011.01338x American Academy of Pediatrics. (2008). Policy Statement: the pediatrician and disaster preparedness. Retrieved from doi: 10.1542/peds.2005-2751 Bastable, S. B. (2008). Nurse as educator (3rd ed.). Sudbury, MA: Jones & Bartlett. Billings, D. M., & Halstead, J. A. (2012). Teaching in Nursing: A Guide for Faculty (4th ed.). St. Louis, MO: Elsevier. CCNE Accreditation. (2014). Retrieved from www.aacn.nche.edu/ccne-accreditation Eckart, S. (2006). Preparing for disaster. Retrieved from www.americannursetoday.com/Popups/ArticlePrint.aspx?id=5402 Grunert- OBrien, J., Cohen, M.W. & Mills, B.J. (2008). The course syllabus: A learning centered approach (2nd ed.). San Francisco, CA: Jossey Bass pp. 39-110. Fink, L. D. (2003). Creating significant learning experiences. San Francisco, CA: Jossey Bass.Integrating emergency preparedness and response into undergraduate nursing curricula. (2008). Retrieved from www.who.int/hac/publications/Nursing_curricula_followup_Feb08.pdf Knowles, M. S., Holton, E. F., & Swanson, R. A. (2011). The adult learner (7th ed.). Oxford, UK: Elsevier. National nurse emergency preparedness initiative. (2009). Retrieved from http://nursing.gwu.edu/national-nurse-emergency-preparedness-initiative

Perry, S. E., (2014). Virtual clinical excursion 3.0 for maternal child nursing care 5th edition. St. Louis, MO: Mosby. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, MO: Elsevier. Romer, C., & Hebda, T. (2014). Disaster preparedness for bedside nurses, parts one, two and three. Retrieved from http://nursing.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=262977 Standards for Accreditation of Baccalaureate and Graduate Degree Nursing Programs. (2009).Retrieved from www.accn.nche.edu Stokowski, L. (2012). Ready, willing, and able: preparing nurses to respond to disasters. Retrieved from http://www.medscape.com/viewarticle/579888_print