Question

oReflect on ethical dilemmas uncovered during scenario watching or debriefing. oDescribe an “Aha” moment experienced during the simulation. oWhat are some of the aspects of the client’s care you didn’t feel prepared for? oDo you have any other suggestions on what you would like to implement for the patient’s care?

TONI: Hi. Welcome to the medical center. I'm TONI, and I'll be conducting your prenatal and newborn education class, today. CLAIRE: Hi. I'm Claire, and this is Kyle. KYLE: It's nice to meet you. TONI: Please, have a seat. I'm excited to help you prepare for your birth and the care of your new baby. Did you happen to bring in your client preferences form you filled out with your provider? CLAIRE: Yes. Here it is. TONI: Our review this as we go through the teaching today. Let's start by discussing the topics we'll be reviewing, like your birth plan. KYLE: What's a birth plan? TONI: A birth plan is the vision that you and Claire have for your birth experience. A birth plan includes things like pain management, birthing options, and newborn feeding preference. CLAIRE: That's great. I have gestational diabetes. Will that affect our birth plan? TONI: There may be additional interventions needed during your labor and delivery. We'll address those as we go through the talk this morning. We'll use your client preferences form to help you create a more detailed birth plan. Here's a folder with information about your birth plan options. CLAIRE: Great. I'm excited to get started. KYLE: Me too. TONI: Claire, have you thought about how you want to manage your pain during labor? CLAIRE: Yes. I talked about it with my provider and I don't want an epidural. I am interested in information on IV medications. Do you have some information on that? TONI: Absolutely. Let's talk about your options. There's a handout in the folder with information about commonly used IV pain medications.

CLAIRE: I feel better now that I have more information about pain management. TONI: So there are several stations set up throughout the room. We'll visit each one and discuss your preferences for your birth plan. Sandra, the charge nurse, will come later to assist with some of the stations. CLAIRE: OK. TONI: Let's get started. [FADE] Let's talk about skin-to-skin contact right after your baby is born. CLAIRE: Why should we do skin-to-skin contact? TONI: Immediate skin-to-skin contact provide several benefits for your baby. Some of these include—

TONI: Skin-to-skin contact helps your baby maintain body temperature. It also regulates blood sugar, heart rate, and promotes early breastfeeding. While you're doing skin-to-skin contact, a nurse will assess your baby and assign an Apgar score at one and five minutes after birth. CLAIRE: I've heard of the Apgar score, what does that score mean for my baby? TONI: Why don't we take a quick break and I'll gather that information for you. [FADE] TONI: Sandra, I'm glad I ran into you. It's been a while since I taught my last class, would you mind reviewing Apgar scoring information with me before I go over this information with the parents in my class?

TONI: Thank you for reviewing the Apgar information with me before I explain it to Claire and Kyle. SANDRA: No problem, Toni, I got here early because I want to make sure the stations are ready. I'll just check on them while you continue. TONI: Great. I'll introduce you to Claire and Kyle. [FADE] TONI: Claire, Kyle, this is Sandra, the charge nurse. SANDRA: Hi there, we're happy you're here with us today. I'm going to be checking on the other stations, just to make sure they're ready while Toni continues your teaching. I'll be available if you have any questions. And Toni, just let me know if there's anything I can do to help. TONI: That sounds great. Thank you. Here's the pamphlet with more information about Apgar scoring. This scoring is done at one and five minutes and will determine how well your baby's transitioning after birth. If you don't have any further questions about Apgar scoring, let's review the medications that are recommended for your baby after birth.

KYLE: Well what does the hospital do to prevent infant abduction? TONI: We've implemented several steps to prevent infant abduction from our facility. KYLE: What kind of things do you do? TONI: Let's go over the safety precautions now.

TONI: Shortly after your baby is born, while you're doing skin to skin contact, a nurse will apply two ID bands on your baby, one on the wrist, and one on the ankle. Both you and Kyle will also receive armbands that match your baby's. You need to leave these on throughout your hospital stay. You can easily remove them with scissors when you get home. Another safety precaution we take is to identify all staff members on the mother-baby unit with the pink stripe on their ID badge. CLAIRE: OK I'm glad to know the hospital takes these precautions. You said earlier there might be additional interventions because I have gestational diabetes. What does that mean? TONI: Your baby may have difficulty maintaining his blood sugar level the first day or so after birth. We will monitor blood sugar levels closely to make sure they don't drop too low. CLAIRE: So will they have to take blood several times a day? TONI: No, we need a very small sample of blood to test blood sugar level. And we'll get that small sample from your baby's heel. Here, let me show you on this doll where we'll take the sample

CLAIRE: How will the nurses know when it's time to check my baby's blood sugar? TONI: There are several symptoms a newborn may have that let us know when their blood sugar is low. Some of these include—

TONI: Symptoms of hypoglycemia we watch out for other than jitteriness are poor feeding, sweating, rapid breathing, and a low body temperature. KYLE: Well, we'll be sure to watch for these symptoms. CLAIRE: So how do we prevent our baby from having low blood sugar? TONI: I see here on your client preferences form, you plan on breastfeeding. Early breastfeeding within the first hour of life can help maintain your baby's blood sugar level, as well as promote successful breastfeeding. CLAIRE: I'm glad you brought up breastfeeding because I have a lot of questions. [LAUGHS] TONI: OK. Well, let's move on to the breastfeeding station next. [FADE] Here's a breastfeeding pillow. It helps with the different positions for breastfeeding. TONI: Well, there are four primary positions for breastfeeding. So let's use the doll and pillow, and I'll show them to you now.

CLAIRE: I really like the football hold. It's the one I'm most comfortable with. KYLE: How will we know when our baby's ready to eat? TONI: Let's talk about feeding cues.

TONI: Let's talk about colostrum, which is the fluid your breasts began to produce around the 16th week of pregnancy. This is the fluid your baby will receive during the first few days after birth. CLAIRE: I've heard that there's not very much colostrum, but that it's really good for the baby. TONI: Yes. While there isn't a large amount of colostrum, it has many benefits for your baby. Some of these are—

CLAIRE: You said that I'll produce a small amount of colostrum. Was there anything I can do to increase how much I produce? TONI: Though it isn't a lot, your body will produce an amount of colostrum typically sufficient to meet your baby's needs until you begin producing actual breast milk. At that time, there are a few things that can influence the amount and quality of your breast milk. CLAIRE: I'd like to learn more about that.

TONI: I hope you both enjoyed class this morning. CLAIRE: Yes, I've learned a lot. And I think we're less anxious and feel more prepared to take care of our baby. TONI: Well, it was a pleasure having you in class. And I hope the last few weeks of your pregnancy go smoothly and that you have a great birth experience. CLAIRE: Thanks. We're really excited for our baby to finally get here.

TONI: Good morning. Congratulations to you both. CLAIRE: Thank you. We are so excited. TONI: Isn't it great to finally get to hold your baby in your arms? How are things going so far, Claire? CLAIRE; Pretty good, I think. I've been walking in the halls and trying to get sleep when I can. TONI: That's great. Getting enough rest is important during the next few weeks. CLAIRE: I do have a question though. The nursery nurse mentioned something about a hepatitis B vaccine. Can you tell us about that? TONI: Sure. Let me go over it with you.

TONI: Look how perfectly swaddled your baby is. KYLE: Another nurse did that. We have no idea how to do that. [LAUGHS] TONI: I can teach you if you'd like. KYLE: Sure

CLAIRE: I actually have another question while you're here. I've seen the nurses using that bulb syringe. I've never used anything like that before. TONI: The bulb syringe helps keep your baby's airways free from mucus. Let me tell you more about it.

CLAIRE: My baby has had a couple of wet diapers so far, but no bowel movements. Is that something we should be worried about? TONI: No, not at all. Let's talk about what's expected as far as wet and dirty diapers.

CLAIRE: When we're changing a diaper, we aren't sure what to do about the umbilical cord. TONI: Well, let's talk about the umbilical cord and what you need to do to take care of it.

KYLE: Since Claire will have time to bond with the baby during breastfeeding, are there opportunities for me to bond, like maybe during baths? TONI: Bathing is an excellent opportunity for you to bond with and care for your baby. How about if we go ahead and review how to give your baby a bath? KYLE: Oh, that would be great

TONI: So now you should have a good understanding of how to safely give your baby a bath. Do you have any other questions? CLAIRE: Actually, yes. My sister gave us a crib that she purchased two years ago. Is it OK to use a crib that's been given to us? TONI: Oh, yes. That's fine. Since it's not an older-style crib that may have lead paint. CLAIRE: What else should we know to keep our baby safe when sleeping?

TONI: I noticed in the medical record that you signed the consent form for circumcision. Do you have any questions about how to care for the circumcision site? KYLE: We do, actually. TONI: OK. Let's talk about it now.

TONI: Here's your copy of the discharge instructions we reviewed. Did Kyle go to get the car seat? CLAIRE: Yes. He'll be back any minute. TONI: Perfect timing. Let's go over a few things about car seat safety, and we'll get you on your way.

CLAIRE: I can't believe it's already time to go home. TONI: Yep. Do you and Kyle feel prepared to care for your newborn? CLAIRE: Yes. I really appreciate everything you have taught us. TONI: You're off to a great start. Let's get you home.

Answer 1

oReflect on ethical dilemmas uncovered during scenario watching or debriefing.

- what all requirements at the time of admission

- the briefing was if everything happens very smoothly ,but when any emergency occur like ante partum and post partum hemorrhage, the treatment is emergency termination of pregnancy that is caesarean section. It's importance and indications was also to be explained.

- intial take of breathe of the newborn and it's complications as she was a diabetic mother

oDescribe an “Aha” moment experienced during the simulation.

- apgar score --> it is a score of well being of the neonate , immediately after birth and after resuscitation if any done or at 10 minute, it should be above 8 for normal or active baby

-hepatitis B vaccination: when it is to be given, time to be given, subsequent doses.

-

oWhat are some of the aspects of the client’s care you didn’t feel prepared for?

1) Apgar score:

2) umbilical cord care: how it is to be done, whether dressing to be done or not

3) wound care of the mother either caesarean site or episiotomy site.

4) when to visit hospital, if any signs of bleeding or infection that is pus discharge, fever,

5) first visit to hospital after delivery : a visit after 45 days is mandatory it is to assess the wound site, and to assess the utreus whether it has reached its prepregnant size

Do you have any other suggestions on what you would like to implement for the patient’s care?

-- how to get along with the changing sleep cycle of the baby

- burping the baby after each breast feeds: as there is chance for vomiting if not properly burped.

- in early months babies will be sleeping through out the day, but parents should breast fed them every two hours.

- exclusive breast feeding up to 6months

- how much extra calories of food to be taken at the time pregnancy as well as during lactation.