Miami Dade College

School of Nursing
Professor Proctor
Contact# 772-708-9480
Clinical Week 1

• Call me if you are going to be late or miss a clinical. Do not send a message
through another student. Clinicals are Mandatory!!!

• Do not give any medications without my permission.

• Do not get a postpartum c/s patient out of bed for the first time alone.

• Do not leave floor or hospital grounds without my permission

• Do not get in any altercations with an employee, student or patient.

• NO CELLPHONES USE ON UNIT OR IN PATIENT ROOM!!!

• Review your drug administration skills (Po, IM, IV, SQ) and drug
calculations

Homework

• Vocabulary cards

• Review your lecture notes before coming to clinicals. You will be quizzed

• Review postpartum and newborn assessment

• Know what to do if you see newborn choking

• Know normal vital signs for newborns

Key Terms (know these for 1st clinical
experience)
• Gestation The period of fetal development
from conception until birth; pregnancy
• Parity: the number of times a woman or
female animal has given birth
• Term:
• Preterm: Occurring or appearing before the
expected time at the end of a full-term
pregnancy
• Postterm: extending beyond term; said of a
pregnancy or of an infant
• Antepartum occurring before parturition, or
childbirth, with reference to the mother.
• Intrapartum occurring during childbirth or
during delivery.
• Postpartum Of or occurring in the period
shortly after childbirth
• Abortion expulsion from the uterus of the
products of conception before the fetus is
viable.
• Stillborn born dead.
• Nulligravida A woman who has never
conceived a child
• Primigravida a woman pregnant for the
first time; gravida I
• Multigravida a woman who is
pregnant and has been pregnant at
least twice before
Cardinal movements: the typical sequence of
positions assumed by the fetus as it descends
through the pelvis during labor and delivery. The
positions are usually designated as
engagement, flexion, descent, internal rotation,
extension, external rotation or restitution, and
expulsion. The birth canal is a curved cylinder;
the head must enter it in a downward,
transverse direction but exit it in a more forward,
anteroposterior direction. In a vertex
presentation, engagement of the head in the
pelvic inlet requires that it have flexion with the
chin on the chest. After descent the head must
undergo extension to turn forward and be born
under the symphysis. The pelvic inlet is heart-
shaped, and the fetal head enters it facing
obliquely. However, the pelvic outlet is diamond-
shaped, and the head usually exits it facing
posteriorly and must undergo internal rotation to
do so. After delivery of the head, the shoulders
remain for a time in the oblique plane, and the
head undergoes external rotation or restitution to
allow the widest diameter of the shoulders to be
delivered from the longer anteroposterior
diameter of the pelvic outlet.
•
• Artificial rupture of membranes
• Bloody show Obstetrics A blood-tinged
mucus cervical plug that filled the
cervical canal during pregnancy, which
is a classic sign of impending labor; BS
also refers to the beginning of
menstruation
 • Crowning the appearance of a large segment
of the fetal scalp at the vaginal orifice in • Amniotomy
childbirth.
Surgical rupture of the fetal membranes to induce
or expedite labor.
• Braxton hicks contractions light, usually •
painless, irregular uterine contractions during
• Contraction stress test the monitoring
pregnancy, gradually increasing in intensity and
of the response of the fetal heart rate to
frequency and becoming more rhythmic during
spontaneous or induced uterine
the third trimester.
contractions by cardiotocography, with
• Ultrasound The use of ultrasonic waves for deceleration indicating possible fetal
diagnostic or therapeutic purposes, specifically hypoxia.
to visualize an internal body structure, monitor
• Nonstress test the monitoring of the
a developing fetus, or generate localized deep
response of the fetal heart rate to fetal
heat to the tissues.
movements by cardiotocography
• Physiologic anemia of pregnancy
• Vena cava syndrome
• Quickening The initial signs of fetal life felt by
• Frequency the number of occurrences
the mother as a result of fetal movement
of a periodic process in a unit of time.
Fetal Decelerations (early, late & variable) early
deceleration in fetal heart rate monitoring, a transient • Intensity
decrease in heart rate that coincides with the onset of a
uterine contraction. • Lightening The sensation of decreased
late deceleration in fetal heart rate monitoring, a
transient decrease in heart rate occurring at or after the abdominal distention during the latter
peak of a uterine contraction, which may indicate fetal
hypoxia. weeks of pregnancy following the
variable decelerations in fetal heart rate monitoring, a
transient series of decelerations that vary in intensity, descent of the fetal head into the pelvic
duration, and relation to uterine contraction, resulting
from vagus nerve firing in response to a stimulus such inlet
as umbilical cord compression in the first stage of labor.
•
• Malpresentation
• Lithotomy Surgical removal of a calculus,
Presentation of a part of a fetus other than the
especially from the urinary tract back of the head during parturition.
•
 • Molding the natural process by which a baby's • Fetal presentation
head is shaped during labor as it is squeezed
• Fetal attitude the relationship of the
into and through the birth passage by the
fetal parts to each other. An example is
forces of labor. The head often becomes quite
the "military" attitude, in which the fetal
elongated, and the bones of the skull may be
head is not flexed and the chin is not on
caused to overlap slightly at the suture lines.
the chest as usual but is held straight up
The biparietal diameter of the head may be
• Fetal lie the relationship of the long axis
compressed as much as 0.5 cm without
of the fetus to the long axis of the
intracranial damage. Most of the changes
mother. See also fetal presentation.
caused by molding resolve themselves during
• Naegele’s Rule
the first few days of life.

• Leopold's Maneuvers are a common and • Amniocentesis Amniocentesis is a

procedure used to diagnose fetal
systematic way to determine the position of a
defects in the early second trimester of
fetus inside the woman's uterus.
pregnancy. A sample of the amniotic
• Spontaneous rupture of membranes
fluid, which surrounds a fetus in the
• Station the location of the presenting part of
womb, is collected through a pregnant
the fetus in the birth canal, designated as −5 to
woman's abdomen using a needle and
−1 according to the number of centimeters the
syringe. Tests performed on fetal cells
part is above an imaginary plane passing
found in the sample can reveal the
through the ischial spines, 0 when at the plane,
presence of many types of genetic
and +1 to +5 according to the number of
disorders, thus allowing doctors and
centimeters the part is below the plane
prospective parents to make important
• Duration the length of time a current is flowing. decisions about early treatment and
Also called pulse width. interventio

Effacement The thinning out of the cervix that normally • Tocodynameter

occurs along with dilation shortly before delivery.
•

• Engagement
 • Fetal Acceleration the act of decelerating; TORCH= Toxoplasma, Rubella,

decreasing the speed Cytomegalovirus, and Herpes Simplex

What do the following abbreviations stand for: FHR= Fetal Heart Rate

VE = Vacuum Extraction (medicine) US= Ultrasound

ROM= Range of motion IUPC= Intrauterine Pressure Catheter

SROM= Spontaneous Rupture of Membranes

(medical)

AROM= Artificial Rupture of Membranes (medical)

PROM= Premature Rupture of Membranes (medical,

childbirth

GTPAL= Gravidity Term Preterm Abortion Living

FSE= Fetal Scalp Electrode
(prenatal nursing assessment)
VBAC= Vaginal Birth After Cesarean
NST=

CST=
AFP= Alpha Fetoprotein
BPP= Biophysical Profile
CPD= Citrate-Phosphate-Dextrose,,,,,
VDRL=
Continuous Peritoneal Dialysis
Venereal Disease Research Laboratory (blood
testing for syphilis) FTP= Failure to Progress

H&H= Hematocrit and Hemoglobin

T&C= Thoracic and Cervical

EDB=

NSVD=

Normal Spontaneous Vaginal Delivery

GBS= Group B Streptococcus (

Normal Pulse
EBL= Estimated Blood Loss
 Age Normal Average 14 Year 99-137 51-71 118/61
Newborn 100-170 140 Adult 100-140 60-90 120-80
1 year 80-170 120
3 year 80-130 110
6 year 75-120 100
10 Year 70-110 90
14 Year 60-110 90
Adult 60-100 80

Resting Respiration
Age Normal Average
Newborn 30-50 40
1 year 20-40 30
3 Year 20-30 25
6 Year 16-22 19
14 Year 14-20 17
Adult 12-20 18

Normal Body Temp

adult oral - 98.6
axillary - 97.6
rectal -99.6
70 + oral - 96.8
1 year old oral - 99.7
3 year old oral - 99.0
5 year old oral - 98.6
8-POINT POSTPARTUM ASSESSMEN

INSTRUCTIONS
1. Breast
A. Gently palpate each breast
B. If you feel nodules in the breast, the ducts
may not have been emptied at last .
Blood Pressure C. Stroke downward towards the nipple, then
Age Systolic Diastolic Average gently release the milk by manual.
Newborn 65-95 30-60 80-60 D. If nodules remain, notify the doctor.
Infant 65-115 42-80 90-61 E. Take this opportunity to explain the
3 Year 76-122 46-84 99-65 process of milk production, what to do
about engorgement, how to perform self
6 Year 85-115 48-64 100-56
breast examinations, and answer any
10 Year 93-125 46-68 109-58 questions she may have about
 breastfeeding.
2. Uterus
A. Palpate the uterus
B. Have the patient feel her uterus as you
explain the process of involution
C. If uterus is not involunting properly, check
for infection, fibroids and lack of tone.
3. Bladder
A. Inspect and palpate the bladder
simultaneously while checking the height
of the fundus.
B. An order from the physician is necessary
catherization may be done. An order for
culture and sensitivity test since definitive
treatment may be required.
C. Talk to mother about proper perineal care.
Explain that she should wipe from front to
back after voiding and defecating.
4. Bowel Function
A. Question patient daily about bowel
movements. She must not become
constipated. If her bowels have not
functioned by the second postpartum day,
the doctor may start her on a mild laxative
B. Inform the mother about what changes she
should expect in the lochia and when it
should cease.
C. Tell the mother about what changes she
should expect in the lochia and when it
should cease.
D. Tell the mother when her next menstrual
period will probably begin and when she
can resume sexual relations. 6. Episiotomy
E. Discuss family planning at this time. A. Inspect episiotomy thoroughly using A.
flashlight if necessary, for better visibility.
B. Check rectal area. If hemorrhoids are
present, the doctor may want to start on B.
sitz bath and local analgesic medication.
Reassure patient and answer questions she C.
may have regarding pain, cleanliness, and
coitus.
7. Homan’s Sign
A. Press down gently on the patient’s knee Pain or
(legs extended flat on bed) ask her to flex Homan
her foot thromb
notifie
8. Emotional Status
A. Throughout the physical assessment, notice
and evaluate the mother’s emotional status.
B. Explain to the mother and to her family
that she may cry easily for a while and that
her emotions may shift from high to low.
The changes are normal and are probably
caused by the tremendous hormonal
changes occurring in her body and by her
realization of new responsibilities that
accompany each child’s birth. NOTE: Be
sure that the mother has emptied her
bladder and that she is lying in supine
position on a flat bed before beginning
assessment. Place your free hand with your arm
along the spine on your baby's head.
Turn him over and keep the head
supported.
When newborn is choking: Carefully position him Lower the baby on your thigh face up
face down on your forearm with your hand with feet towards your hips and head
supporting his head and neck. Position your towards your knees. Push straight down
arm holding your baby on your thigh. on his chest between their nipples.
Press down about 1/2 inch. Do 5 of this
Support his head so it is lower than the rest of chest thrusts. Do the chest thrusts
his body. smoothly.
With the heel of your hand give him five firm Continue 5 times on back and 5 times
back blows between the shoulder blades. (Try on chest til whatever is dislodged.
to dislodge the object.)