High Risk Newborn LP 5 Rle Learning Packet Theresa 2

LP 5
NCM 109 LEARNING PACKET ON RELATED LEARNING EXPERIENCE
RLE FOCUS UNIT: CARE OF HIGH RISK NEWBORN
COURSE CODE: NCM 109

COURSE TITLE: Care of Mother, Child at Risk or with Problems (Acute and
Chronic)-RLE
YEAR LEVEL, ACADEMIC YEAR: Level 2, 2nd Semester SY 2020-2021
CLINICAL AREA OF ASSIGNMENT: Neonatal Intensive Care Unit (NICU)
DATE OF CLINICAL EXPOSURE:
NO. OF HOURS: 64 RLE hours
MODULE OVERVIEW
Nursing is a profession that requires intensive training on both theoretical and clinical
perspective. The course NCM 109 deals with concepts, principles, theories and techniques in
the nursing care of individuals and families during childbearing and childbearing years toward
health promotion, disease prevention, restoration and maintenance, and rehabilitation. The
learners are expected to provide safe, appropriate and holistic nursing care to newborn.
For this module, you will be providing nursing care to high- risk newborn.
Having gone through the theoretical inputs in the NCM 109 lecture, the next step that you need
to learn is on the application of these principles and techniques in the nursing care of these
clients.
For this 48- hour related learning experience, you will be catered to flexible clinical
learning experiences through this self-instructional module.
Remember, this might not be a substitute for the actual clinical experience, but this can help
you navigate through your patient care experiences in this alternative learning platform. This
module has the following parts:
Prepared by: RELATED LEARNING EXPERIENCE ROTATION
Marites Gallardo, MAN HIGH RISK NEW BORN

Clinical Instructor
LEARNING MAP
(LEARNING ACTIVITIES SHOULD ALWAYS BE REFLECTED BY LEARNING OUTCOMES

IN LEARNING MAP.)
At the end of this 64 hours related learning exposure, you are expected to:
1. Assess the health status of high-risk newborn.
2. Assess a high-risk newborn, identifying the actual and potential problem after delivery.
3. Formulate nursing diagnosis related to the physiologic and neurologic problems that
may occur.
4. Establish expected outcomes to meet the needs of high-risk newborn.
5. Integrate knowledge of EINC in newborn with complication.
6. Document the care rendered to assigned patient in the simulated health care record
accurately.

Clinical Instructor

Clinical Instructor
FIRST STEP TO ACHIEVE YOUR OBJECTIVE
You had your discussion on the concepts and principles the care of individuals and
families during childbearing in maternal and child nursing and community health nursing in
your NCM 109 lecture
A nurse’s responsibility includes the identification of concerns of patients upon

admission to any Neonatal Intensive Care units or during bedside rounds. Choose from among
the following newborn who are at high-risk by writing True if the statement is correct and False
if otherwise.
_______ Baby girl Sweetheart appeared jaundice a day after birth the jaundice disappears at
her 7th day.
_______ A baby was born with an AOG 37 weeks. With birth weight of 2.20 kg. Appeared to be
pinkish with regular breathing and CR of 140 bpm.
_______ Baby Theresa who was 2 weeks old with soft and downy hair all around her trunk and
neck and appeared to be jaundice.
_______ Baby Anna was born together with a dark green sticky amniotic fluid and her body is
coated with whitish cheezie substance.
_______ Baby Rose was born with AOG of 42 weeks, pinkish in color , loud cry and active
movement with a birth weight of 3.5 kg.
You are now on duty in NICU room of Lorma Medical Center. In this 48 hour duty, you
are expected to handle newborn in the NICU. You are assigned to take care of at least 1
patient. You will be performing the following nursing responsibilities:
Vital Signs Monitoring

Bedside Care
Patient History
Physical Assessment
Special Nursing Procedure: neonatal resuscitation and NGT feeding.
Patient Care Documentation

Clinical Instructor
In your provision of the nursing care, you are reminded of the following behaviors:
 Professional behaviors – engage appropriate legal and ethical behaviors;

 Communication – communicate effectively with your patient, SO and the health team
 Clinical Decision-Making – develop critical thinking skills to make responsible
decisions related to assessing the newborn patient;
 Caring Interventions – maintaining a safe environment for the patient
 Teaching and Learning – provide health education to Significant Others(SO)
 Collaboration – collaborate with SO
As you start with this module, you are free to consult and coordinate with your assigned
clinical instructor. Be sure to get his/ her email address and contact number for
collaboration and assistance. Just keep going, you can do it!
THE BIG LEAP
CASE SCENARIO:
Sharon, a 37-year-old patient G4 P3, is at 36 weeks gestation is admitted in the ER at 10:30 am due
to prolapse of the cord. She is dilated 8 cm with obvious signs of ruptured membranes, no vaginal
bleeding. Vital signs assessed 15 minutes ago: Pulse 81, BP [blood pressure] 118/71, Respiratory
Rate 20, and Temperature 37.1. FHR [fetal heart rate] 135 with moderate variability and no
decelerations.
ER Nurse Matet informs everyone of prolapsed cord. She immediately covers the prolapse cord
with sterile OS soak with sterile saline solution. She alerted the Rapid Response Team. The team
arrived at the scene and assessed the case to determine whether vaginal delivery is possible given
the present situation.
AT 10:45 am FHR, which had been 135, begins to fall. A prolonged deceleration phase occurs, with
no progress in cervical dilatation. A pulsating umbilical cord is felt upon palpation. Then FHR
dropped to 90, prolonged deceleration phase continued.
The team decided to have emergency caesarian section. Operating Room was notified of the
emergency case and NICU staffs were alerted to get ready to receive the newborn and to
anticipate the need for the care of a high-risk newborn.
At 11:00 am Baby girl Wency was delivered. She did not cry immediately after delivery. Nurse
Guerly immediately received the neonate. Based from the initial assessment, the neonate
appeared pale and blueish, with weak pulses, poor perfusion with O2 Sat of 75, decreased
capillary refill, and persistent bradycardia with CR of 55. She has also minimal response to stimuli
and muscle tone and respiration is absent. Because of the cord prolapse, the newborn developed
hypovolemic shock secondary to acute blood loss. APGAR score was checked which is interpreted
by Nurse Guerly as “Severely Depressed”.
Nurse Guerly thoroughly dried and kept the baby warm, cleared the airway to remove obvious
secretions, then performed Neonatal Resuscitation. At the same time, and Doctor Ariel

Clinical Instructor
immediately created an A-line (arterial line) and IV (Intravenous access) and ordered to administer
IVF Plain NSS 25 ml in 10 minutes as STAT dose.
After the initial steps of resuscitation, Nurse Guerly, re-assessed Baby girl Wency and delivered 5
inflation breaths. Re-assessment of the neonate’s heart rate, tone, color and breathing was done
every 30 seconds. Even with efficient ventilation, the neonate did not respond positively which
gave the Code Team the decision to proceed to chest compression. Nurse Guerly started giving the
neonate 3 chest compressions with the help of another member of the team who managed the
airway. Upon re-assessment, respiration is still irregular and heartrate is still less than 60. Dr.
Ariel, the Code Team leader ordered to give Epinephrine 0.2mg IV STAT and to send a specimen
for ABG analysis. After 2- 3 minutes, perfusion is established with continuous neonatal
resuscitation. APGAR scoring was repeated with the following assessments: the newborn started
to have irregular breaths, turned pinkish, started to cry, still floppy, but with CR rate of 120.
At 11:15 am, Baby girl Wency was brought to the NICU (Neonatal Intensive Care Unit) for
continuous monitoring and observation. Post-resuscitation care was rendered which includes
administration of oxygen via CPAP (Continuous Positive Airway Pressure) at 100% FIO2 and
connecting the baby to a cardiac monitor. The baby is placed in a radiant warmer to avoid
possibility of hypothermia. An oro- gastric tube was also inserted to facilitate feeding of breast
milk taken from her mother at the amount of 20 ml every 4 hours. Vitals are continuously
assessed:
At 12:00 pm, ABG result arrived with the following values: PaCO2 is 32 mmHg; pH is 7.20, and
PaO2, of 70. Result relayed to Dr. Ariel who ordered to administer Sodium bicarbonate 2 mEq/kg
IV infusion over 4 hours and to repeat ABG analysis after infusion.
Few hours later, Baby girl Wency was now stable with hearth rate of 140bpm, O2 sat is 97% and
temperature of 36.7 °C. ABG results also have improved. Other routine EINC were conducted and
anthropometric measurement was done. The newborn weighs 2.0 kg.
ARRIVAL CHECK
TASKS: To immerse yourself in the care management of your patient, let’s take note of the
detailed description of your patient care tasks. Using the Case Scenario assigned to you, you are
expected to perform the following:(TASKS MAY VARY ACCORDING TO WHAT YOU HAVE COME
UP FOR EACH SCENARIO please see list of suggested RLE learning activities)
Conduct a patient history taking and physical assessment of your patient following the
format by the Lorma College of Nursing Patient History and Physical Assessment Form.
Formulate a Nursing Care Plan for you patient based on 3 prioritized problems using the
Lorma College of Nursing NCP Form. Integrate your nursing care interventions significant to
bioethical and legal standards in patient care.
Prior to administering the patient’s medications, you are required to make a drug study of
all medications required by your patient in oral or parenteral form and document it. Use
the Lorma Colleges Drug Study Format for your documentation.
Submit an article report/case journal using APA format with references. Use Lorma College
of Nursing Journal format.

Clinical Instructor
In your 5-day duty, you are required to document your care for 3 days (Day 2-5) using
Focus
Charting (FDAR). Be sure to indicate your patient’s vital signs using your own clinical
judgment.

Clinical Instructor
You will be graded based on your output:
EVALUATION PARAMETERS (please see portfolio)

Patient history and Physical Assessment 30pts 20%
Nursing Journals 35pts 30%
Nursing Care Plan 15pts 20%
Drug Study Report 10 pts per drug 15%
FDAR 10pts/day 15%
TOTAL 100%
REFLECTION TIME
Save one life, you’re a hero. Save 100 lives, you’re a nurse.
OPTION: you can also ask the student to conduct interviews, case study (please see list of
suggested RLE activities)
MODULE EVALUATION
Before we move on to the next topic, I would want to listen to your feedback for this RLE
learning packet. Kindly rate each area with a scale of 1-5 with 1 as the lowest and 5 as the
highest.
EVALUATION RATING
1.Comprehensive Content
2.Relevance of Content
3.Clarity of the text and the message
4.Alignment of the assessment activities to learning outcomes

Clinical Instructor
REFERENCES:
Palompon, Daisy (2020) Developing Self-Learning Modules for flexible Learning in the Related
Learning Experience, ADPCN Webinar August 3, 2020.
Mariann Harding, Julie S. Synder, Barbara A. Preusser Winningham”s Critical Thinking Cases in
Nursing 5th Edition

Clinical Instructor

High Risk Newborn LP 5 Rle Learning Packet Theresa 2

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LP 5

NCM 109 LEARNING PACKET ON RELATED LEARNING EXPERIENCE

RLE FOCUS UNIT: CARE OF HIGH RISK NEWBORN

COURSE CODE: NCM 109

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

(LEARNING ACTIVITIES SHOULD ALWAYS BE REFLECTED BY LEARNING OUTCOMES

1. Assess the health status of high-risk newborn.

4. Establish expected outcomes to meet the needs of high-risk newborn.

5. Integrate knowledge of EINC in newborn with complication.

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

Marites Gallardo, MAN HIGH RISK NEW BORN

A nurse’s responsibility includes the identification of concerns of patients upon

Vital Signs Monitoring

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

 Professional behaviors – engage appropriate legal and ethical behaviors;

THE BIG LEAP

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

Marites Gallardo, MAN HIGH RISK NEW BORN

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

EVALUATION PARAMETERS (please see portfolio)

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

Prepared by: RELATED LEARNING EXPERIENCE ROTATION

Marites Gallardo, MAN HIGH RISK NEW BORN

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