SCHOOL OF NURSING
Clinical Packet
Course Title: Child Health Nursing Catalog: NUR 246
Credits: 4 Clinical
Revised 6/12
1 Suffolk County Community College Nursing Department NUR 246 Pediatric Clinical Focus
Identify psychosocial stressors and adaptation when a child is hospitalized
Describe measures which minimize these stressors for a child
Identify child abuse/neglect in a pediatric population
Identify the impact of respiratory problems for the child
Implement parent/child education on one important area of focus identified through assessment
Identify obstacles to parenting a sick child
Promote optimal functioning for a child with cardiac dysfunction
Identify factors interfering with perception and cognition
Identify factors which interfere with elimination
Impact of diabetes and other endocrine disorders on child and family
Promote family’s level of adaptation to neuromuscular disorders
Describe pediatric differences related to blood disorders and different types of childhood cancer
2 NUR 246 Written Assignment Requirements
1. Written assignments are due as per clinical instructor.
2. Pediatric Assignments: One Pediatric Nursing Care Plan (NCP) Daily Nursing Process Plans Two Journals (Initial & Final Reflection) One Clinical Case Study Presentation Leadership Assignment
3. Each assignment has specific criteria delineated which must be followed. Students must satisfy every one of the criterion in order to satisfactorily pass the required written assignments.
4. Attach a blank copy of the appropriate grading criteria when you submit your assignment.
5. Assignments must be submitted on the specific date designated by the instructor. Unexcused late submission of assignments will result in a failing grade for the assignment. It is expected that all work will follow college standards of writing. Late assignments in the clinical area may be assigned as a ‘failed clinical day” at the discretion of the instructor.
3 SUFFOLK COUNTY COMMUNITY COLLEGE SCHOOL OF NURSING NUR 246 CLINICAL ASSIGNMENTS
STUDENT'S NAME ______
ASSIGNMENTS DUE DATE/REVISIONS
1. Nursing Care Plan 3 nursing diagnoses in PES format each with: -2 outcomes (short and long term goal) -5 nursing interventions -5 scientific reasonings with APA citations -5 evaluations (one per intervention) 2. Daily Nursing Process Plan (one per clinical patient) Submit completed form on patient used for NCP 3. Pediatric Assessment Form 4. Priority List-10 diagnoses in PES format 5. Medication Sheets 6. Abnormal Lab/Diagnostic Tests Evaluation and Nursing Interventions 7. Copy of full text professional nursing journal article and One page written summary with relevance to patient 8. Reference list (in APA format – refer to Library web site)
CASE STUDY
Title: ______
REFLECTIVE JOURNALS (2) Initial & Final
LEADERSHIP/MANAGEMENT ASSIGNMENT Submit to: Professor Ortiz/Aymong (Ammerman) Professor Daley (Grant)
4 SUFFOLK COUNTY COMMUNITY COLLEGE SCHOOL OF NURSING NUR 246 DAILY NURSING PROCESS PLAN
Student Name: Date of Care ______Patient Initials ______Chronological Age______Developmental Age ______Diet ______Formula/Breast/Frequency______Appetite ______BMI______Weight ______lbs ______kg Wt percentile ______Height/Length______Ht percentile ______Head Circumference (up to 3yo)______Head circumference percentile______Admitting Diagnosis______Surgical Procedure (if applicable) ______PMH/PSH/ Social History/Family History/Birth and Maternal Health History: ______Allergy to food, drugs, or environment ______Immunizations Up to Date for Age (per parent): Yes ______No______VS 2x/shift: T______Pulse: ______Apical ______RR ______B/P ______Pain Level ______Scale Used:______T______Pulse: ______Apical ______RR ______B/P ______Pain Level______Scale Used:______IV ______Solution, Site, Gauge, Date, Time) End of Shift: Oral Intake ______ml Enteral Intake______ml IV Fluids Intake______ml End of Shift: Urinary Output ______ml Drains:______ml Emesis______ml Check One - Diapers Foley Urinal Bedpan OOB to Bathroom
Physical Assessment Address each section by checking the appropriate box as it relates to Write Additional Subjective and Objective Findings patient status. Any change in condition requires documentation in a progress note. SAFETY: Call bell within reach. Bed in low position. Crib or bed siderails up. Environment clutter free. Fall precautions YES NO Restraints YES NO HYGIENE: Complete Partial Self By Parent ORAL CARE: Complete Self FAMILY PSYCHOSOCIAL: Stressors______Child’s Favorite Toy:______Child/Adolescent’s School/Work:______Problems Related to Illness/Condition______NEUROLOGICAL: A & O X 3. PERRLA. Appropriate behaviors. Verbalization clear and understandable. No dysphasia. Active ROJM all extremities. No numbness or tingling. RESPIRATORY: Respirations regular and unlabored. No SOB. No cough. Nailbeds and mucous membranes pink. Breath sounds clear bilateral. No dyspnea on exertion. No nightsweats. O2 therapy: specify______CDB/IS Suction SaO2______CARDIOVASCULAR: No chest pain. Pulse regular. No Murmurs. No edema of extremities. Vital Signs Stable.. Extremities warm. Brisk capillary refill. GI: Abdomen soft, non-tender. Audible bowel sounds. Passing flatus. Stools within own normal pattern and consistency. Diapers Date of Last BM / Stools______GU: Urine clear and yellow to amber.
GYN List Tanner Staging ______Pregnant LMP______Sexually Active BCP type______Declined/Deferred (Explain why):______Muscular and Skeletal: Symmetrical, aligned, moves all extremities, equal muscle strength and tone, gait steady Skin, Hair, Nails: Clean, intact, warm, dry Braden Scale Score______
5 List Scheduled Medications (Complete Order) List Non-Scheduled Medications (Complete Order and Time of Last Dose)
Parent/Patient Teaching: (include health education prevention based on developmental age and culture)
PRE-POST CONFERENCE DIAGNOSES/COLLABORATIVE PROBLEMS Tentative Nursing Diagnoses
Actual Nursing Diagnoses
Nursing Note (Narrative, SOAP, or as per clinical instructor’s directive) Consider the Subjective and Objective Data that records the Client's response to the interventions for the Actual Diagnoses/Collaborative Problems (Add additional pages as necessary)
6 ABNORMAL LABORATORY AND DIAGNOSTIC TEST INTERPRETATION
Client Expected Significance To Client Appropriate Nursing Lab Values Values Care Interventions Test High (H) / Age (Cause/Etiology of Lab Low(L) Specific Value)
Diagnostic Test Result Significance to Appropriate Nursing Client Care Interventions
7 NUR 246 DRUG EVALUATION GUIDE
(Make additional copies for each medication)
Brand Name: ______
Generic Name: ______
Classification: ______
Action: ______
Indications for use: ______
Reason Why This Patient Is Taking Medication:______
Complete MD order:______Dose to Administer:______(mg/mL)
Drug Guide safe administration range (mg/kg or age-based)______
Drug guide 24-hr maximum mg/day______
Show Calculation of Safe Dose:
Is MD order safe for this patient? Yes No Explain______
Route Prescribed ______Alternate Routes available______
Major Side Effects and Toxicity______
8 Nursing Implications patient assessments and pertinent lab data/serum levels):______IV drug incompatibilities (if applicable to this patient) ______
Contraindications and Precautions______
Patient/Family Education______
Suffolk County Community College School of Nursing Pediatric Assessment Guide NUR 246 Patient Profile
Initials of Patient ______Age ______Sex ______School and Grade ______
Plot Height and Weight on appropriate graph from http://www.cdc.gov/growthcharts and Child or Teen BMI Calculator on CDC website and submit with NCP
Reason for Admission as per Patient/Family______
Race and Ethnic Background ______
Culture ______Pertinent Cultural Practices ______Religion ______
Type of dwelling patient lives in ______
Family Constellation (members living with child in household)
Relationship to Child Age Health Status
1. ______2. ______3. ______4. ______5. ______
Past Medical History and response to any previous hospitalizations ______
9 List ALL immunizations applicable to the child’s age, including number of doses according to Advisory Committee on Immunization Practices (ACIP) Recommended Childhood Immunization Schedule (see http://www.cdc.gov/nip/acip and submit appropriate schedule with NCP) ______
10 Present Health
Allergies to: medications, foods, environment, include reaction ______
Sleep Routine ______
Bowel Routine: state usual pattern (diapers, toilet trained, incontinence, methods/supplies) ______
Nutrition: identify the expected caloric intake for a child of your patient’s age. ______
For children 2 years of age and older, using a typical 24 hour recall compare the child’s diet to the recommended diet on the food plate @ http://www.choosemyplate.gov and submit with NCP. ______
For children < 2 years of age, state a typical 24 hour recall compare the child’s diet to the textbook. ______
State food preferences (uses cup, finger foods, feeds self, food jags) ______
Dentition (number of primary or secondary teeth, daily oral health care, cavities, dentist visits, orthodontics) ______
Favorite toy, interests, hobbies: ______
Home medications (include herbs, minerals, vitamins) ______
11 Developmental Assessment - Complete one assessment depending on your patient’s age
Complete the Denver II if your patient is between the ages of 0 and 6 years. This is a tool for screening the apparently normal child. This screen identities those children who may have developmental delays. Further evaluation is needed for a definite diagnosis.
Directions: 1. Print out the Denver II in this packet 2. Age Calculation: Draw a vertical line for the age of the child. For children born before 38 weeks’ gestation, age should be corrected for prematurity, up to 2 years of age. Each item that intersects or is just adjacent to the age line should be scored.
3. Scoring Advanced: Child passes item that falls completely to the right of age line. Normal: Child passes, fails, or refuses item on which the age line falls between the 25th and 75th percentiles Caution: Child passes, fails, or refuses item on which the age line falls between the 75th and 90th percentiles Delayed: Child passes, fails, or refuses item that falls completely to the left of age line Assessment: Child fails if two or more delays are noted. Child passes with no delays and a maximum of one caution
4. Based on the result of your Denver Development II, what are the results? What is the approximate developmental age of your patient? Be specific.
Personal – Social ______
Fine Motor – Adaptive ______
Language ______
Gross Motor ______12 Development Milestones: If the patient you are providing care for is over 6 years of age do not use the Denver Development II.
Instead, compare/contrast developmental tasks/needs stated in the textbook (include physical, gross motor, sensory, language, socialization)
Textbook Patient
13 14 15 Nursing Care-
How did you approach this patient to provide nursing care, based on your patient’s developmental age? ______
How did you incorporate developmentally appropriate therapeutic play into the care of your patient? Remember all pediatric patients play, this does not refer to the use of toys only! See text for description of play in all aged children and the value to nursing care.
______
16 Teaching Plan regarding Developmental Level of Child includes:
Anticipatory Guidance: based on the developmental age of the patient
Nutrition ______
Elimination ______
Sleep Patterns ______
Social/Family Relationships ______
Parenting Practices ______
Injury Prevention ______
Behavioral Development ______
Discharge Planning /Anticipated Home Care Needs/Applicable Community Resources ______
Journal Article: Review the sections of your nursing assessment and select a current (< 5 yrs) article from a professional nursing journal that relates to the child you are taking care of. Type on a separate piece of paper a summary of the article, relevance to your patient, and how the findings in the article relates (or not) to your patient care.
References: Using APA format identify texts, journals and other relevant sources used when writing your NCP. Dictionaries and medical “manuals” are not acceptable references. Submit this
17 reference information on a separate sheet of paper. Reference page must be typed. USE OF AN OUTLINE GENERATOR IS NOT ACCEPTABLE. Proper use of APA references and citation instructions on following page.
Instructions for using APA format
APA Bibliographic and Parenthetical (in-text) Citations Publication Manual of the American Psychological Association, 6th ed. Ref. BF76.7 .P83 2010 (Ammerman and Grant)
For APA Online. Electronic References go to. http://www.apastyle.org/elecref.html
You can access information on APA format from the College web site. Follow the directions below to access this information:
1. Go to http://www3.sunysuffolk.edu/index.asp 2. Click on Academics 3. Click on Library 4. In the upper right hand corner of the library web page, scroll on Hours, Directions, Services, etc until you get to Library Handouts 5. Click on Library Handouts 6. Look under Ammerman campus and you will find various guidelines to APA format 7. Click on each of the following: Guide to APA format, APA Reference List: Basic Rules, APA Citations for Nursing and APA Sample References. 8. In the upper right hand corner there is a Print Friendly Version link for each of the above guidelines. Print this information. 9. Refer to this information when writing your NCP and Reference List.
18 CRITICAL THINKING RUBRIC TO ANALYZE THE APPLICATION OF NURSING PROCESS IN NUR 246 NURSING CARE PLAN
PURPOSE OF THE RUBRIC
This critical thinking rubric is designed to analyze the application of nursing process in the student nursing care plan.
COMPONENTS OF THE RUBRIC
Each criterion contains performance criteria to demonstrate critical thinking for each step of the nursing process used in the development of a nursing care plan. The performance criteria describe behaviors and traits that are linked to a level of performance. There are three levels of performance. The levels of performance represent the degrees in which critical thinking is applied to accomplish the step in care planning.
USING THE RUBRIC
Students
Students can use the rubric to facilitate nursing care plan preparation and development. Prior to submission for faculty grading, the student will be able to perform a self-assessment to identify levels of performance in each of the steps of nursing process and identify areas for future development. The student's ability to identify with level three performances will enhance their self- confidence in the reasoning abilities and develop their disposition to critical thinking.
Grading of Care Plan:
The care plan is only graded in whole numbers. The minimum acceptable score is 22. The student will be asked to resubmit or remediate the care plan if any section on the rubric receives a score of level 1. The care plan will be remediated until an acceptable score of 2 or 3 in that section is achieved. Total care plan scores less than 22 constitute as a failed nursing care plan and results in a failed clinical day. Two failed clinical days constitute as a failing clinical and will result of a grade of F for the course.
19 SUFFOLK COUNTY COMMUNITY COLLEGE SCHOOL OF NURSING NURSING PROCESS RUBRIC
Student Name: ______Submission Date: ______Resubmission Date: ______
Instructor Name: ______Course: ______ASSESSMENT: () 5/5 = Outstanding 4/5 = <4 = Satisfactory Unsatisfactory 1. Collects subjective and objective data that is pertinent and accurate. 2. Describes general observations, health history, diagnostic studies and physical assessment in data collection. 3. Any omissions in data collection are thoroughly explained. 4. Includes complete Daily Nursing Process Plan with Nurse’s Note. 5. Ongoing data is collected and explained through the use of inquiry. LAB / DIAGNOSTIC TESTS: () 3/3 = 2/3 = <2 = Outstanding Satisfactory Unsatisfactory 1. Pertinent lab and diagnostic data are recorded. 2. Lab and diagnostic tests are included on Daily Nursing Process Plan and an
additional sheet is submitted with interpretation. 3. Lab and diagnostic data are integrated into plan of care.
MEDICATION SHEETS: () 3/3 = 2/3 = <2 = Outstanding Satisfactory Unsatisfactory 1. Identifies all current medications including intravenous solutions and PRN medications. 2. Completes comprehensive medication form. 3. Current medications are integrated into plan of care. NURSING DIAGNOSIS: () 5/5 = 4/5 = <4 = Outstanding Satisfactory Unsatisfactory 1. Include a list of all appropriate nursing diagnostic statements in priority order. 2. Selects______(# dependent on course) NANDA approved nursing diagnoses from priority list to be used in development of plan of care. 3. Provides adequate supporting data for each diagnosis selected. 4. Formulates each diagnostic statement using PES components. 5. Individualizes each diagnostic statement to reflect actual and potential patient problems.
20 OUTCOME CRITERIA: () 3/3 = 2/3 = <2 = Outstanding Satisfactory Unsatisfactory 1. Provides an expected outcome for each appropriate diagnosis. 2. Chooses expected outcomes that are realistic and measurable. 3. Selects expected outcomes that are patient centered. NURSING INTERVENTIONS: () 5/5 = 4/5 = <4 = Outstanding Satisfactory Unsatisfactory 1. Identifies 5 or more interventions for each diagnosis. 2. Prioritizes realistic nursing interventions.
3. Relates nursing interventions to diagnosis and outcomes. 4. Appropriate rationale for each intervention is cited in APA format. 5. Individualizes interventions which are patient centered. 3/3 = 2/3 = <2 = EVALUATION: () Outstanding Satisfactory Unsatisfactory 1. Identifies if outcome was met or unmet. 2. Identifies specific data on effectiveness of all interventions. 3. Identifies if plan should be continued or if revisions are needed. . REFERENCE LIST: () 3/3 = 2/3 = <2 = Outstanding Satisfactory Unsatisfactory 1. Has varied, current and appropriate references. 2. APA format is correctly used. 3. An article summary, relevant to the patient and from a professional nursing journal is included.
FORMAT: Satisfactory Outstanding Unsatisfactory Minimal errors (<5) in spelling, No errors in spelling, grammar, punctuation. Multiple errors (>5) in spelling, grammar, punctuation. Fairly Consistent, accurate use of terminology. Precise grammar, punctuation. Inconsistent consistent use of appropriate language. Legible print, black ink. use of terminology. Unclear terminology. Clear language. language, illegible. Legible print, black ink.
Must achieve Satisfactory in all criteria to pass GRADE: ______Comments:
21 SUFFOLK COUNTY COMMUNITY COLLEGE NUR 246 NURSING CARE PLAN
ASSESSMENT DATA FOR NURSING DIAGNOSIS
NURSING DIAGNOSIS / COLLABORATIVE PROBLEM
EXPECTED OUTCOME WITH INDICATORS
SHORT TERM:
LONG TERM:
22 SUFFOLK COUNTY COMMUNITY COLLEGE NUR 246 NURSING CARE PLAN
NURSING INTERVENTION SCIENTIFIC RATIONALE EVALUATION EFFECTIVENESS OF NURSING INTERVENTION
23 SUFFOLK COUNTY COMMUNITY COLLEGE NUR 246 NURSING CARE PLAN
Assessment Data for Nursing Diagnosis Expected Outcomes with Nursing Intervention Scientific Rationale Evaluation/Effectiveness of Nursing Diagnosis Collaborative Problems Indicators Nursing Intervention
Short Term
Long Term
24 SUFFOLK COUNTY COMMUNITY COLLEGE SCHOOL OF NURSING CLINICAL EVALUATION LEVEL II Name: ______Mid Semester ____ Final ______Clinical Agency: ______NUR246 _____ # Of Absences: ______Date: From: ______To: ______Per # Of Clinical Experiences _____ EVALUATION CRITERIA All areas are critical. In Part I, a minimum rating of 2 or better in each category must be achieved on the final evaluation to receive a passing grade. I. PROFESSIONAL BEHAVIOR 1 2 3 NA /NO A. Adheres to standards of professional practice. B. Demonstrates accountability for personal actions and delegated actions. C. Practices nursing within legal, ethical and regulatory frameworks. D. Utilizes and incorporates resources for life long learning. E. Demonstrates leadership in the nursing role. F. Initiates actions that facilitate empowerment for the nursing profession. G. Utilizes constructive criticism, evaluates own nursing competencies and changes behavior accordingly. H. Reports to clinical facility on time. I. Submits written assignments on time. J. Clinical absences do not exceed policy limit. K. Presents a professional appearance. L. Identifies appropriate alternatives when unable to meet a course obligation. M. Reports errors of omission/commission in a timely manner. N. Satisfactory completion of all written assignments II. COMMUNICATION A. Identifies similarities and differences on a position and supports their position with current nursing literature. B. Applies advanced techniques of therapeutic communication with clients, significant others and members of the health care team. C. Employs group dynamic strategies when communicating with team members. D. Demonstrates increasing ability to communicate relevant, accurate and complete information for groups of clients verbally and in written documentation. III. ASSESSMENT A. Analyzes health status of clients with multiple health problems. B. Demonstrates advanced skill in completing a health history. C. Integrates prior knowledge in assessing the effects of stressors on clients, families and communities. D. Prioritizes responses to actual or potential health problems and to nursing interventions for individuals/groups of clients in a timely manner. IV. CLINICAL DECISION MAKING A. Analyzes data pertaining to dysfunctional health patterns and stressors of the individual, family and the community. B. Utilizes evidence-based practice in order to formulate clinical decisions. C. Maintains accurate and safe care and an awareness of current National Patient Safety Goals. D. Develops diagnoses and plans care that focuses on actual or potential health problems, promotion, wellness and restoration. E. Modifies client care as indicated by evaluation of outcomes. 25 V. CARING INTERVENTIONS 1 2 3 NA /NO A. Initiates and performs effective and preventative nursing measures to facilitate health promotion and maintenance in clients and groups. B. Acts as an advocate and synthesizes understanding of cultural, spiritual, and developmental needs when caring for individuals/families in order to provide sensitive, holistic nursing care. C. Demonstrates aseptic techniques correctly. D. Administers medications accurately and in accordance with agency protocol. VI. TEACHING AND LEARNING A. Develops teaching/discharge plans to assist individuals and groups to promote health and manage acute and chronic health problems. B. Identifies learning needs of the individual and family and modifies interventions according to developmental level. C. Utilizes teaching and learning concepts in leadership/management in assigned setting. D. Informs patient and family about appropriate community resources. VII. COLLABORATION A. Collaborates with peers and multidisciplinary team members to deliver cost effective, quality care to individuals, families and communities. B. Conveys mutual respect, trust, support and utilization of each discipline’s role and contributions to health care. VIII. MANAGING CARE A. Applies principles of effective motivation. B. Utilizes key concepts underlying effective delegation. C. Demonstrates leadership management skills when working with the multidisciplinary health team members to deliver care to groups of clients. D. Applies strategies of change theory with the health care team. E. Employs techniques that can be used in evaluating the work of others. F. Utilizes conflict resolution skills. G. Assesses visionary skills and identifies a plan to become more innovative.
KEY TO PERFORMANCE APPRAISAL
3 = Performance meets clinical objectives and exceeds requirements 2 = Performance meets clinical objectives 1 = Performance does not meet clinical objectives N/A = Not applicable N/O = Not observed
INSTRUCTOR'S COMMENTS: Written Assignment NCP Score Other 26 Instructor's Signature ______Date ______
STUDENT'S COMMENTS:
Student’s Signature ______Date ______
Revised 5/20/10
References for Pediatric Clinical 27 Vital Sign Norms in Children
RESPIRATORY RATE HEART RATE BLOOD PRESSURE (systolic/diastolic) Infant 30 to 60 Infant 120 to 160 Refer to Pediatric Blood Pressure Toddler 24 to 40 Toddler 90 to 140 Tables, Appendix D on pages 1841- Pre-School 22 to 34 Pre-School 80 to 110 1842 in textbook School-Age 18 to 30 School-Age 75 to 100 Adolescent 12 to 16 Adolescent 60 to 90
Fluid Maintenance Requirements for Children
0 to 10 KG = 100 ML/KG 11 to 20 KG = 1000 + 50 ML/KG 21 to 30 KG = 1500 + 25 ML/KG 31 to 40 KG = 1750 + 10 ML/KG
Minimum Urinary Output Infants 1 mL/kg/hr Children (2+ yrs) 2 mL/kg/hr
Pain Scales
Numeric Pain Scale Wong-Baker Faces Scale FLACC (2 months-7 yrs) NIPS (Neonates and Newborns)
28