nur 318 ob clinical assignment

OB CLINICAL PERFORMANCE APPRAISAL TOOL

The students should complete during the clinical period the following assignments:

1) Daily clinical log: Students will keep a daily clinical log on the provided form. Summary of strengths, weaknesses, areas for improvement, and overall impression of the day may be discussed. These will be TYPED and turned in during the semester to the clinical instructor. *This is a portfolio requirement. It should be completed and returned to the clinical instructor for a total of five clinical days (see page 3)

2) Patient teaching: The teaching plan should be done during the 6th week of the clinical experience or by 2/27/09 (see page 4 for instructions)

3) Clinical Care Plans: There are two care plans required during the semester. The first care plan will be completed and posted on your clinical blackboard assignments by 3/27/09. The second care plan will be completed and posted on your clinical blackboard assignments by 4/17/09 (see page 5-9 for instructions and scoring)

4) Labor and Delivery, Postpartum and Newborn Assessments. Complete one assessment in each of the three areas. This information may be used to assist you in developing your first care plan. Complete and post on your clinical blackboard assignment links. (see page 11-32 for instructions)

STUDENT RESPONSIBILITIES:

1. Assignments will be given for each unit by the clinical instructor.

2. Students are expected to arrive on the unit 15 minutes before the start of the experience and be ready to receive the assignment from the instructor.

3. Each student will be prepared for random oral inquiry regarding all facets of the assigned client's care utilizing the nursing process, during the clinical experience:

a. nursing history and diagnosisb. family historyc. physiological processd. nursing assessmente. planned nursing objectives and interventionsf. significant laboratory findingsg. client's medications: Each student is held responsible for verbalizing actions, indications, side

effects, contraindications, and nursing implications for all medications the client is to receive before administering medications. No medications are to be given unless discussed with instructor. Drug cards are recommended to facilitate the verbalization of medication information. The instructor will accompany each student, initially, during the preparation and administration of medications. Students are allowed to administer medications utilizing all routes with the exception of "IV push" medications.

h. specific nursing treatments: identify scientific principles and rationale, procedures (according to hospital policy), and needed equipment. If a student comes to clinical unprepared, the student will be asked to leave the unit and it will be counted as a missed clinical day.

4. A daily clinical log will be required for each student, for five of your clinical weeks. It may also include your thoughts of the day, assignment, etc. The log will be turned in throughout the semester for discussion with your

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clinical instructor. Completing the five logs at the end of the clinical will be unacceptable in passing the clinical experience.

5. Patient teaching the clients usually experience an array of new experiences during their hospital stay. The more knowledge and understanding of the various client experiences the student possess, the better the students ability will be to teach the client.

6. Clinical evaluations will be done at mid experience and at the end of the clinical experience. The clinical instructor will provide a sign-up sheet. Students are expected to come to the clinical evaluation session with a list of their strengths and a list of areas needing improvement.

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DAILY CLINICAL LOG (Format)

Student Name: Date:Clinical Site: Instructor/Course:

Patient InformationInitials:Diagnosis:Age/Sex:

Summary of strengths/weaknesses, areas for improvement, and overall impression of the day.

Skills acquired and activities participated in today.

List specific competencies attained from this clinical experience/ Consider all 8 curricular objectives (behaviors) .

Give examples of how you attained these competencies. Do not say “I met the culture competency today.” Explain how you attained it.

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TEACHING PLAN (Format)

Purpose: Since much of maternal/child health is achieved by the process of education, the student must appreciate &

practice health teaching both in & out of the hospital.

TEACHING PLAN FORMAT

I. TITLE:

Topic to be taught

II. ASSESSMENT of the LEARNER:

Who you’re teaching & why they need the information.

Discuss significance of the topic taught.

III. CONTENT:

What information will be taught!

List in outline form of ALL you plan to teach.

Cite content; book, lecture, other sources.

IV. METHODOLOGY:

What teaching strategies used? = How information is presented, i.e., discussion,

demonstration, etc.

V. EVALUATION:

How you know learner understood information =return demonstration, asked

questions to clarify, etc.

POSTPARTUM DISCHARGE Client Education

Teaching Plan - Postpartum Discharge: The information is limited only to the MOTHER’S PHYSICAL

changes/needs for the postpartum period at home: What the woman needs to recognize to call her caregiver!

The information for the mother should be concise, comprehensive, & limited to 20 minutes.

You must include teaching related to:

the two primary physical risks for a postpartum mother:

1. Infection sites

2. Bleeding: normal vs abnormal

one psychological risk: discuss postpartum depression r/t the key symptom to

recognize.

instruction for primary prevention related to the mother’s

urogenital gynecologic health: discuss Kegel exercise, wipe perineum

front to back, an No douching.

Presentation of the postpartum discharge information will be done during the clinical rotation with the instructor

observing.

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CLINICAL CARE PLAN INSTRUCTIONS

1. Purpose: This activity enables the student to conduct an assessment of a childbearing woman and plan nursing care specific to that client, based on nursing research and Standards of Care. The assessment will include the physiologic, psychological, social, cultural, and environmental influences pertaining to the client and her family.

2. For the first care plan, the student will select a patient who has a medical diagnosis of either:

Gestational Diabetes Hypertensive Disorder DepressionPreterm Labor Postpartum Hemorrhage Cesarean SectionDysfunctional Labor Postterm labor and birth Intrapartum InfectionPostpartum infection Thromboembolic disease Maternal Substance AbuseAdolescent pregnancy Neonatal infection Neonatal hyperbilirubinemiaNeonatal anomalies Postterm neonate SGA or LGA infantNeonatal trauma Preterm neonate

The second care plan will be developed from a simulation case study which will include priority nursing diagnoses and plan of care for labor, immediate postpartum and transition of neonate. (See Simulation Blackboard Site)

3. Select and list three NANDA nursing diagnoses based upon assessment data

4. Nursing assessments must include both subjective and objective data which supports the nursing diagnoses

Examples of data include current pregnancy, past pregnancy history, gynecological history, medical history, intrapartum course, delivery summary, postpartum status, condition of the newborn and social/cultural beliefs, values, behaviors and traditions.

5. Select the one priority nursing diagnosis from your list of nursing diagnoses and formulate a plan of care for your first care plan. Three priority nursing diagnoses for the second care plan. See enclosed Nursing Care Plan Format.

6. Develop patient focused objectives that are realistic, measurable & written as client behaviors

7. Interventions must be guided by standards of care and comprehensive in meeting your objectives such as frequency of monitoring, medications used or anticipated use, therapies such as perineal care, breast milk pumping, sitz baths, and to include a minimum of one teaching intervention.

(Standards of Care are throughout your textbook titled “Expected Outcomes of Care, Protocols for Care, Plan of Care or Care Paths”). Examples are seen on pages 253, 254, 272, 276, 362, 383,384, 389, 406, 418, 420 etc. (Lowerdemilk & Perry, 2006)

8. Sources for rationale include current literature from maternity textbooks and professional journals (not magazines or websites). Two nursing journals must be included in your citations using APA format. One article must be a nursing research article. If you have any questions regarding your choice of articles please see your clinical instructor for approval.

9. Evaluation indicates how objectives were or will be achieved; including alternative recommendations if objectives are not achieved.

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10. Must be typed. Do not use client’s name—assign a number to represent the client.

11. **The most points fall under nursing interventions and rationales. This is the most important part of your care plan. Information in these sections must be detailed and in-depth!!!

12. Points will be deducted for not following APA format for grammar, spelling, sentence structure, font, citations and bibliography as this is a strong indication of a student’s ability to follow directions.

9. Your care plan must include:

1. Clinical subjective and objective assessments (See labor and delivery, postpartum or newborn assessments for content)

2. Priority Nursing Diagnosis3. Patient Objectives4. Comprehensive nursing interventions including a teaching intervention

for one nursing diagnosis (minimum of 10 interventions)5. Rationale supported by literature citations (Author, date)6. Evaluation results or anticipated achievement of plan7. References using APA format

10. Submit complete care plan to your clinical instructor as directed in print or safe assignment.Example:

Nursing Diagnosis – sleep pattern disturbance related to anxiety about safety of fetus & outcome of pregnancy as evidenced by facial grimacing, crying, inability to initiate self care.

Patient Objectives-[STG] – After teaching, patient demonstrates relaxation techniques[LTG] – By discharge, patient sleeps for uninterrupted periods of time

Nursing Intervention (one teaching plan example given; your plan will include more interventions including a teaching plan)

1. RN will teach relaxation techniques; a. Slow-chest breathing b. Imagery

Rationale - Using relaxation techniques release tension from the mind and body and are beneficial in enhancing regular rest periods to promote uterine and fetal oxygenation (Lowdermilk & Perry, 2006).

Evaluation – Patient states this “helps me sleep!” or should relax patient to sleep 3-4 hours uninterrupted.

References

Lowdermilk, D., & Perry, S. (2006). Maternity nursing (7th ed.). St. Louis: Mosby.

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Running head: SAMPLE TITLE PAGE

Header should be 1"from top edge of paper.Running head description should be flush at themargin and two lines below the header.

Center and beginapproximately

4-inches from topedge of paper.

Title of Paper

Student Full Name

Student ID#

Site (if appropriate)

Center and begin approximately

8-inches from the topedge of paper.

Submitted in partial fulfillment of the requirements in the courseCourse NUR 318: Clinical Management of the Childbearing Family

Spring 2009

MATERNITY PATIENT CARE PLAN

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1. Priority Nursing Diagnosis (NANDA) :__________________________________2. Nursing Diagnosis: __________________________________________________________3. Nursing Diagnosis:______________________________________________________________________

ASSESSMENT:Significant Client Data

Client Objectives NURSING INTERVENTIONS RATIONALE FOR INTERVENTIONS

EVALUATION

Subjective:

Objective:

Short term:

Long term:

(Need to be specific to the maternity client.)

Short Term:

Long Term:

Grade Sheet for Care Plan

Student TotalScore Possible

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________ 5 1. Subjective Assessment Data Age, Gravida/Para, obstetrical history, gynecological history, prenatal history, past medical

history, surgical history, family history, labor and delivery summary including date & time psychosocial and cultural history, allergies, medications, ETOH, drugs, smoking, concerns, discomforts, knowledge deficits

________ 5 2. Objective Assessment Data Vital signs, laboratory data, physical assessment findings, fetal monitoring if indicated

3. Nursing Diagnosis (3)

2 A. Appropriate for assessment data

3 B. Prioritizes significant diagnosis 5

5. Objectives

5 A. Realistic, measurable & written as client behaviors

6. Nursing Interventions

_________ 10 A. Adheres to Standards of Care

__________ 15 B. Comprehensive including teaching outline

___________ 15 C. Individualized & specific to the nursing diagnosis40

7. Rationale

_______ 10 A. Current Literature focused upon the childbearing family______ 10 B. Relevant to interventions______ 5 C. Includes relevant research and nursing journal articles

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_______ 10 8. Evaluation of how objectives were met or expected and alternative recommendations if not

completed.

9. Grammar, spelling, citations, 5 Bibliography (APA format)

________ Total

COMMON OB DRUGS

PITOCIN GENTAMYCIN

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METHERGINE AMPICILLIN

TERBUTALINE AZITHROMYCIN

NIFEDIPINE DOXYCYCLINE

MAGNESIUM SULFATE BENZATHINE PENICILLIN G

DEMEROL ACYCLOVIR

NUBAIN METRONIDAZOLE

STADOL MICONAZOLE

PHENERGAN ERYTHROMYCIN EYE OINTMENT

BUPIVICAINE NARCAN

XYLOCAINE PROSTIN GEL

FENTANYL BETAMETHAZONE

MORPHINE DURAMORPH

PERCOCET / TYLOX RhoGAM

IBUPROPHEN RUBELLA VACCINE

TYLENOL HEPATITIS B VACCINE

COLACE ASPIRIN

TUCKS CYTOTEC

AMERICAINE/DERMAPLAST SPRAY VARIOUS ANTACIDS

PRENATAL VITAMINS VITAMIN K

ALDOMET PROCARDIA

PROCTOFOAM ZOFRAN

VICODIN TORADOL

*You must know the actions and side effects, doses and administration forms of these drugs prior to your clinical experience.*

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CLINICAL WORKSHEET GUIDELINES FOR ASSESSMENT OF THE LABORING WOMAN

Student Name: Date: Intrapartum Summary:

Labor began (contractions 10 min. apart and regular):

Date/Time________________________________________________________

Membranes ruptured: Date/Time______________ SROM AROM

Amniotic fluid: Clear Light meconium-stained Thick meconium-stained

Polyhydramnios Oligiohydramnios Foul-smelling

Induction Augmentation Method used:__________________________________

External □ or Internal Fetal Monitoring □ or Both □Fetal Heart RateFetal Heart VariabilityFHR Periodic Rate ChangesFHR AccelerationsFHR Early DecelerationsFHR Late DecelerationsFHR Variable DecelerationsNursing Interventions for Periodic Rate ChangesUterine Contraction PatternFrequency/Duration/Intensity Latent Phase Frequency/Duration/Intensity Active PhaseFrequency/Duration/Intensity Transition Phase

Identify actual or potential problems related to above data and state why

Stage II and III Delivery SummaryDelivery Date and Time: ______________________________________Delivery Method:

Spontaneous □ Forceps □ Vacuum Assisted □ Vaginal Birth after Cesarean □Cesarean Section Classical □ Lower Uterine Segment □Bilateral Tubal Ligation Yes □ No □

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Reason for Non-Spontaneous Delivery_______________________________________

______________________________________________________________________

Episiotomy None □ ML □ RML □ LML □ Extensions □ Lacerations 1st degree □ 2nd □ 3rd □ 4th □Estimated Blood Loss (EBL) ________ Fetal Position/Presentation __________

Placenta: Duncan □ Schultz □


Stage IV Labor/Immediate PostpartumTime to Recovery______ Time to Post Partum

Room______

Time Temp Pulse Resp BP Fundus Lochia Perineum Voiding


Medications During Four Stages of Labor

Drug/Amount/Time Purpose Noted Effect Nursing Actions

Stage 1Stage 2Stage 3Stage 4

Anesthesia:

Epidural □ Spinal □ General □ Local □

Identify actual or potential problems related to above data and state why12

Infant:

Female □ Male □ Weight ____ Length _______Anomalies__________________________________Apgar Score

Apgar Score 1 minute 5 minutesHeart RateRespiratory EffortMuscle ToneReflex ResponseColor Total


Summary of Family Adaptation/Bonding/Initiation of Feeding

Identify actual or potential problems related to above data and state why:

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NURS. 318: POSTPARTUM ASSESSMENT

Student Name_________________________________________Date______________

Client Information

Client Initials________ Age_______

Gravida _______ Term_______ Preterm ________ Abortions________ Living_______

Due Date: (LMP)_______ (Ultrasound)_________ Gestational Age ________ Prenatal Care Began_____________

Number of prenatal visits___________Childbirth education classes_________________

Marital Status/Significant Other_____________________________________________ Religious Preference_____________________________________________________

Occupation____________________________________________________________

Ethnic/Racial Background_______________Allergies___________________________

Admission Date____________ Admitted from: home Dr.’s office Other_________

Past Obstetrical History: Include dates of previous deliveries, Cesarean or vaginal births, forceps or vacuum extractions, length of labor, analgesia/anesthesia used, term or pre-term, weights of babies, health of infants at birth, abortions/miscarriages.

Complication(s) of this pregnancy: Include both concurrent medical diagnoses, such as diabetes, as well as problems directly caused by the pregnancy, such as PIH. Define and describe the condition(s) and current medical treatment.

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Prenatal Laboratory Findings: Postpartum Medications (Attach drug cards)

Blood typeRubella titerVDRL/RPRHBsAgGBSHIVChlamydiaGC

Pregnancy Laboratory Findings: Postpartum Laboratory Findings:

Hgb HgbHct HctWBC WBCUrine UrineOther Other

Compare the laboratory findings and describe the changes after birth. Explain if this finding is normal or abnormal:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name Dosage Route

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Past Medical/Surgical History: Summarize significant past illnesses, hospitalizations, surgeries, and/or injuries. Include dates.

PSYCHOSOCIAL ASSESSMENT : Include significant family dynamics, medical/genetic history, and psychosocial/spiritual stressors. Explain cultural beliefs that may affect the intrapartum or postpartum experience of this patient.

Ages and relationships of persons living in household:

Pregnancy planned? _________

Alcohol use: Before pregnancy? _______During pregnancy? _________________ If yes: type, frequency, amount_________________________________________ Tobacco use: Before pregnancy? _________ During pregnancy? __________ If yes: Type, frequency, amount (packs per day)__________________________ Illegal drug use: Before pregnancy? _______ During pregnancy? ___________If yes: type, frequency, amount ________________________________________ Have siblings been prepared for new baby?____How?______________________

Family Dynamics:

Medical/Genetic History:Stressors:

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Labor/Delivery Summary:

Labor began (contractions 10 min. apart and regular):

Date/Time________________________________________________________

Membranes ruptured: Date/Time______________ SROM AROM

Amniotic fluid: Clear Light meconium-stained Moderate meconium-stained

Thick meconium-stained Polyhydramnios Oligiohydramnios Foul-smelling

Induction Augmentation Method used:__________________________________

Monitoring used: Ultrasound Toco FSE IUPC Intermittent auscultation

FHR: Reassuring Nonreassuring

Describe FHR characteristics, including baseline rate, variability, periodic changes, and interventions if nonreassuring:______________________________________________

______________________________________________________________________

Coping mechanisms used during labor:_______________________________________

How was labor tolerated by this client?_______________________________________

Who provided the most support to her during labor?_____________________________

Describe what this person did that was helpful:_________________________________

Analgesia/anesthesia: Include medications, dosages, times, routes of administration, cervical dilation, effacement, and station when administered (attach cards):

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Delivery: Date________________ Time_________________

Vaginal VBAC (vaginal birth after cesarean)

Operative Vaginal delivery: Vacuum Forceps

Cesarean Reason:_______________________________________________

Episiotomy: Yes No N/A Lacerations: 1o 2o 3 o 4 oOther: ________

Male Female Weight:___________lbs./oz. _____________grams

Length ________________________Head Circumference_______________________

Chest Circumference__________Gestational Age ________ weeks (circle one): SGA AGA LGA

Apgars: _________ 1 min. ________ 5 min. Breastfeeding Bottlefeeding

Complications of labor/delivery: ______________________________________________________________________

Length of labor: 1st Stage ___________2nd Stage___________3rd Stage_____________

Was her labor typical considering her gravida and para? ______________________________________________________________________

POSTPARTUM ASSESSMENT:

MATERNAL PHYSIOLOGIC ASSESSMENT DATACARDIOVASCULAR/ RESPIRATORYVital signs date & time ______________ T____ P____ R_____ BP_________ Heart sounds ________________ Lungs_______________________________Color of skin/ mucous membranes ______________________________________________________________

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Pre-pregnant wgt ______ Current wgt ______ Total wgt gain________________ Edema: location & amount____________________________________________ Pedal pulses _______________________________________________________Capillary refill _______________ seconds Patient questions or concerns? _______________________________________


BREASTSPreferred method of infant feeding: Breast Bottle UndecidedPrior experience with preferred method? Yes NoIf yes, describe _________________________________________________________________ Breast size, symmetry, fullness _________________________________________________________________ Support bra available? _______ On?___ Breast pump needed? _______________Measures in use for lactation suppression_________________________________Presence of: Colostrum _____ Mature milk______ Engorgement __________If breastfeeding, shape of nipple (erect, flat, inverted). Nipples intact? Y N Patient questions or concerns? ________________________________________________________________


UTERUS/ LOCHIALocation & firmness of fundus_________________________________________Uterine cramping? Y NIf yes, pain rating (0-10 scale):_________________________________________Methods used for pain relief & effectiveness______________________________Lochia: Color ___________ Amount _______________ Odor ________________ # pads saturated in 8 hours _______________________ Any clots?____________ Patient questions or concerns? __________________________________________________________________

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INCISION (Cesarean or episiotomy)Episotomy: type _______________ Other lacerations/ extensions_____________ If C/S, type (location) ___________________ Dressing? Y N Describe incision using REEDA Redness ___ Edema ___ Ecchymosis ___ Drainage ___ Approximation______ Pain from incision / episiotomy? Y N Pain rating on 0- 10 scale __________

Pain relief methods used: Effectiveness:1. 1.2 2.3. 3.(use additional paper or back of page as needed) Patient questions or concerns? _______________________________________


PERINEUM/ ELIMINATIONAny swelling, lesions, venereal warts, condyloma, hemorrhoids, etc.? __________ If yes, describe______________________________________________________ Urine: Color, odor, amount ____________________________________________ Difficulty or discomfort with voiding? Y N Bladder palpable? Y N

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Interventions to promote voiding Effectiveness1. 1.2. 2.3. 3.

Bowel sounds ____ Flatus ___ Last BM (color/ consistency/ amount)__________ Abdominal tenderness? _____ Abdomen distended?______ Patient questions or concerns? _______________________________________


LOWER EXTREMITIESHoman’s Sign: R _______ L ________DTR’s : R _______ L _______ Clonus: R _______L _______ Antiembolism stockings on? Y N If yes, reason_________________________ Patient questions or concerns? _______________________________________


NUTRITION/ SLEEP & RESTDiet type _____________% taken at last meal _______ Patient’s satisfaction with food served _______________________________ Cultural/ ethnic food preferences (what does patient think that a postpartum woman should eat or not eat?) __________________________________________________________

Any nausea? Y NAny vomiting? Y N Fluid intake in last 8 hours: Oral ________ IV _________ Number of hours sleep since delivery ______ Naps? _______ Feel rested?______

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What interrupts sleep?________________________________________________ Patient questions or concerns? _________________________________________


TEACHING & DISCHARGE PLANNING NEEDSWhat specific teaching needs does the mother and/or family have during the hospital stay?

Mother’s or family’s opinion:

Health care provider opinion:

Your opinion:

Observe and describe each family member’s interactions with infant: Behavior Mother Father Other(Siblings, Grandparent, etc.)

Position while holding:

Response to infant cries:

Infant’s response

Proximity to infant crib:

Response to infant feeding:

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Communication with infant:

Acceptance of sex of infant:

Positive/negative comments about infant:

Evidence of bonding:

Patient concerns or questions:

Identify actual or potential problems related to above data and state why: Describe your findings as it relates to Maternal Role Attainment Theory):

Learning Needs/Discharge Planning: List three specific priority learning needs of this patient. Identify a discharge planning need other than teaching/learning:1.2.3.Discharge Planning Need

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Current Medical Orders (Lists each order excluding medications)

Patient’s order Rationale for this patient

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MEDICATION LIST(Add additional pages as needed for all sections)

Medication Dose Time Route Side Effects Significance for client

Nursing Implications

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IV Therapy

Solution Site Amount Frequency Infusion Pump

Significance for client

LABORATORY AND DIAGNOSTIC TESTS* Include prenatal labs ** Explain what the result indicates about the client’s condition

Test Date Norms* Pt results Interpretation/Analysis **

Chemistry:

Glucose

BUN

Uric Acid

Liver enzymes:

SGOT

SGPT

LDH

CBC:

Red blood cell count

Hematocrit *

Hemoglobin *

White blood cell count:

Differential

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

Erythrocyte

Sed rate

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Drug therapeutic levels:

Mg SO4

Culture results:

Syphillis-VDRL/RPR/ Serology *

Chlamydia

GC

Group Beta STREP

Blood Type/Rh *

Atypical Antibodies

Urinalysis:

Urine C&S

Ultra-sound: Biophysical Profile

Fetal breathing

Fetal movement

Fetal tone

Amniotic fluid volume/index

(AFV/AFI)

Non-stress test:

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Contraction Stress test

AFP (Alpha-fetoprotein)

Other

Rubella

Hepatitis B Surface Antigen

Glucose Screening

1o gtt 3o gtt

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WELL NEWBORN ASSESSMENT

NORMS INFANT OBSERVATION1. CardiovascularHeart rate

Peripheral pulses

2. Temperature

3. RespiratoryA. Rate

B. Breath sounds

C. Grunting, flaring, retractions

4. MusculoskeletalGeneral position at rest

Muscle tone

Spinal column

Hips

Clavicles

5. Average length inches/cm

Average weight lbs/oz and grams

Normal range of weight loss within the first week of life:

Head circumference inches/cms

Chest circumference inches/cms

6. Head A. Molding B. Fontanelles

C. Caput Succedaneum

D. Size-relation to body compared to adult

77. Eyes

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A. Sclera

B. Lacrimal glands

C. Neuromuscular control

D. Reflexes (PERRL – RED)

8. Ears – Position – Cartilage- Skin Tags

9. Nares

10. Palate – soft & hard

11. Skin integrityA. Vernix

B. Color

C. Variations r/t gestational age

D. Nevi (birthmarks)

E. Rash

12. GenitourinaryA. Male

B. Female

13. Gastrointestinal A. Abdomen

B. Bowel sounds

C. Stools

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14. Musculoskeletal

Reflexes present at birth (list five normal newborn reflexes, describe how to elicit them and the expected response by the newborn)

A.

B.

C.

D.

E.

Reflex Onset Inhibition Stimulus Behavior

Moro Birth Third month Supine PositionSudden loud noise causes rapid or sudden movement of infant’s head.

Stimulation will result in extension of the infant’s extremities, followed by return to a flexed position against the body.

Tonic neck-asymmetrical

Birth Sixth month Supine positionNeck is turned so head is facing left or right.

Extremities on side of body facing head position extend, those on side opposite flex.

Tonic neck-symmetrical

Birth Sixth month Supported sitting.Flexion or extension of infant’s head.

Extension or flexion of neck will result in extension of arms and flexion of legs.

Grasping Birth Fourth to sixth month

Supine position.Stimulation of the palm of the hand or ball of the foot.

Stimulation will result in a grasping action of the fingers or toes.

Babinski Birth Sixth month Supine position.Stimulation by stroking the sole of the foot.

Stimulation will result in extension of the toes.

Sucking Birth Third month Supine or supported sitting.Stimulus applied directly above or below the lips.

Touching area of mouth will result in a sucking action of the lips.


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nur 318 ob clinical assignment

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