Saturday, March 30, 2013

Obstetric Clinicals

By this time you should be on the home stretch to finishing nursing school. Obstetric (OB) clinicals are usually the last major clinical rotation a student will have to master. During this rotation, nursing students will education patients about maternity, labor and delivery, and infant care. Students will experience patients that are pregnant and about to deliver, postpartum, and women with obstetric issues.

OB nursing process and theories will be applied to maternity patients. Selected women's

health issues will also be examined. Some patients will be admitted for hysterectomy, myomectomy, and other obstetrical surgery procedures Application of the nursing process to assist in the health of high risk pregnant women and their families.

The tools needed for OB clinicals are mostly the same as adult health and pediatric clinicals. OB classes are held at the same time as clinicals so students will have already have talked about how to perform assessments, nursing diagnosis and care plans, and how to care for a patient in labor. Some schools have a lab where students can practice on manikins before clinicals. This would be a good time to get used to teaching and performing breast exams, measuring the fundus, how to read a fetal monitor strip, and what to teach the mother for postpartum care.

Students should keep an open mind during this clinical rotation. Different cultures should be taken into account when asking the patient questions and doing an assessment. Also be aware that some women have given birth but the fetus may be ill or not have survived. There is nothing more embarrassing than coming into a room and saying congratulations when you don't know the facts. The most important aspects of OB clinicals are knowing how to perform an assessment, the phases of labor, medications given during labor and delivery, and care plans. Some institutions will not let nursing students give medications to pregnant patients due to the high risk of harming the mom and fetus. Due to this fact, there will be a lot of observations on the student's behalf. This will be a good time to see a vaginal delivery, cesarean section, and breast feeding. Below is and example of a sample care plan for a patient who is in labor:

Nursing Diagnosis /Related to Altered urinary elimination r/t compression of bladder.

Pathophysiology: Pressure from an enlarging uterus and increase in blood volume causes a large volume of urine to be held causing urinary stasis. Urinary frequency also occurs from the pressure of the bladder and its displacement.

Nursing Activities (NIC)

1. Monitor blood glucose levels in infant.
2. Observe for signs of hypoglycemia.
3. Institute early feeding of breast or bottle milk.

Rationale (from nursing references)

1. To assess and detect early onset and prevent complications.
2. To assess and detect early onset and prevent complications.
3. This prevents or treats early hypoglycemia.

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