Newborn Scenario. Consolidated Instructor Manual. Frances Wickham Lee, DBA Heidi H. Schmoll, RN, MSN-Ed. Content Author: Sheila Smith RN, PhD

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1 Newborn Scenario Consolidated Instructor Manual Frances Wickham Lee, DBA Heidi H. Schmoll, RN, MSN-Ed. Content Author: Sheila Smith RN, PhD 1/23/13

2 Table of Contents Curricular Information 3 Faculty Information General Instructions 4 Faculty Information General Instructions 5 Setup and Equipment 12 Case Information 13 Debriefing Information 16 1/23/13 2

3 Curricular Information The Newborn Assessment set consists of five scenarios designed to provide practice to mastery in conducting a newborn nursing assessment. All scenarios can be licensed from the SimStore. Additional information about this course can be found on the HealthCare Simulation South Carolina website 1. Newborn Assessment Discharge (Baby Johnson) 2. Newborn Assessment Big Baby (Baby Mullins) 3. Newborn Assessment Born in Car (Baby Thompson) 4. Newborn Assessment Change of Shift (Baby Gonzoles) 5. Newborn Assessment Immediately after Delivery (Baby Schnell) 1/23/13 3

4 Faculty Information GENERAL INSTRUCTIONS for Running the Newborn Assessment Scenarios 1. Load scenario. A case stem providing pertinent information for participants will appear on monitor. 2. Take the scenario out of Pause Mode and undock the menu found under ABC. 3. Click the menu item START SCENARIO. The menu folders will open and the specific assessment checklist items will appear. Please note: these will vary slightly depending on the individual case requirements, but all are structured in a similar manner. 1/23/13 4

5 4. As the participant performs each step in the assessment, click on the corresponding menu item. 1/23/13 5

6 5. When the participant states they have completed the procedure, click on menu item END SCENARIO and GRADE. The following flag will appear on the monitor. 6. Wait to go to debrief until the following flag appears on the monitor. (IMPORTANT STEP! it may take several seconds to determine the grade.) 7. Go to debriefing and review performance as necessary. The debriefing record may be saved as a permanent, objective record of the participant s performance. 1/23/13 6

7 SPECIFIC INSTRUCTIONS for Running the Newborn Assessment Scenarios Scenario 1. Newborn Assessment Discharge (Baby Johnson) The Discharge scenario has 43 total steps with 40 graded steps. The non-graded steps include: a. Dons gloves. (The baby is being discharged and will have been bathed.) b. Assesses red reflex. (Optional step) c. Checks pulse oximetry. (Optional step) 1/23/13 7

8 Scenario 2. Newborn Assessment Big Baby (Baby Mullins) The Big Baby scenario has 47 total steps with 42 graded steps. The non-graded steps include: a. Dons gloves. (The baby is four hours old and will have been bathed.) d. Checks for caput succedaneum. (Optional step) e. Assesses red reflex. (Optional step) f. Checks pulse oximetry. (Optional step) g. Discusses gestational age characteristics. (Optional step) 1/23/13 8

9 Scenario 3. Newborn Assessment Born in Car (Baby Thompson) The Born in Car scenario has 48 total steps with 42 graded steps. The non-graded steps include: a. Draws heel stick glucose. (Optional step) b. Checks for caput succedaneum. (Optional step) c. Checks neuromuscular signs for indication of gestational age. Since the prenatal history for this scenario is unknown, participants may be required to assess the neurological signs for gestational age. d. Assesses red reflex. (Optional step) e. Checks pulse oximetry. (Optional step) *Please note: Checking several physical indicators of gestational age is required for this scenario, as is discussing the importance of determining gestational age in a case where there is no known prenatal history. 1/23/13 9

10 Scenario 4. Newborn Assessment Change of Shift (Baby Gonzoles) The Change of Shift scenario has 48 total steps with 42 graded steps. The non-graded steps include: a. Dons gloves. (The baby is four hours old and will have been bathed.) b. Checks for caput succedaneum. (Optional step) c. Checks for Mongolian Spot, a common finding in neonates of Asian, East Indian or African American descent. (Optional step) d. Assesses red reflex. (Optional step) e. Checks pulse oximetry. (Optional step) f. Discusses gestational age characteristics. (Optional step) 1/23/13 10

11 Scenario 5. Newborn Assessment Immediately after Delivery (Baby Schnell) The Immediately after Delivery scenario has 49 total steps with 42 graded steps. The non-graded steps include: a. Checks for caput succedaneum. (Optional step) b. Checks neuromuscular signs for indication of gestational age. (Optional step) c. Checks for Mongolian Spot, a common finding in neonates of Asian, East Indian or African American descent. (Optional step) d. Checks plantar surface as an indicator of gestational age. (Optional step) e. Assesses red reflex. (Optional step) f. Checks pulse oximetry. (Optional step) g. Discusses gestational age characteristics. (Optional step) 1/23/13 11

12 Setup and Equipment Suggested Logistics: The Newborn Assessment scenarios may be used for practice to mastery in conducting a newborn nursing assessment. Each scenario returns a final score of correct steps completed. This score may be used for formative or summative assessment of the participant s performance. Each scenario runs approximately 15 minutes. Debriefing time will vary; however, at least 30 minutes should be allotted for first time participants. Equipment Required: No special equipment is required for the Newborn Assessment scenarios. Participants should come prepared with a stethoscope and means for appropriate documentation. 1/23/13 12

13 Case Information Scenario 1. Newborn Assessment Discharge (Baby Johnson) Patient Name: Age: Weight: Height: Gender: Background: Setting: Baby Johnson 60 hours 2.7 kg 50 cm Male Baby Johnson was born 60 hours ago to a 29-year-old mother who received good prenatal care. The baby's parents want to take him home today. Newborn Nursery Patient Information: Birth weight 2.9 kg. Gestational age 39 weeks. Initial newborn assessment was within normal limits. Apgar was reported as 7 and 9. However, the baby did acquire a cephalhematoma and his testes are undescended yet palpable in the inguinal canal. He acquired mild jaundice at one day old. You are to perform a newborn assessment for discharge. Scenario 2. Newborn Assessment Big Baby (Baby Mullins) Patient Name: Age: Weight: Height: Gender: Background: Setting: Baby Mullins 4 hours 4.9 kg 51 cm Female Mrs. Mullins is a 32-year-old patient who was diagnosed with gestational diabetes at 28 weeks gestation. She had excellent prenatal care. Her blood sugars for the duration of the pregnancy were moderately controlled. She was admitted to the hospital on her due date in active labor and went on to vaginally deliver assisted with vacuum. Her admission glucose was 48 dl/mg. Newborn Nursery Patient Information: At 40 weeks gestation, Baby Mullins shoulders are large and she is very chubby. Baby Mullins seems jittery and somewhat lethargic and hypotonic. Apgar reported as 7 and 9. She is four hours old. The physician has ordered a heel stick glucose check. 1/23/13 13

14 Scenario 3. Newborn Assessment Born in Car (Baby Thompson) Patient Name: Age: Weight: Height: Gender: Background: Setting: Baby Thompson 2 hours 3.1 kg 50 cm Female Mother had minimal prenatal care. No ultrasound for dating of pregnancy. Baby was brought to the hospital after being delivered in parents car. Mom is a 16-year-old high school student. Family does not know about her pregnancy. Admitted via emergency department immediately transferred to Newborn Nursery for observation. Patient Information: Baby Thompson is two hours old. There has been noted bluish discoloration around mouth and acrocyanosis. The initial temperature was 96.9F. You are to perform a newborn assessment. Scenario 4. Newborn Assessment Change of Shift (Baby Gonzoles) Patient Name: Age: Weight: Height: Gender: Background: Setting: Baby Gonzoles 4 hours 3.0 kg 48 cm Female Baby Gonzales was born four hours ago to a 36-year-old mother, who received good prenatal care. Newborn Nursery Patient Information: Her Apgar scores were 8 and 9. Gestational age 40 weeks 3 days. She had a large amount of occiput posterior caput. You are to perform a newborn assessment. Scenario 5. Newborn Assessment Immediately after Delivery (Baby Schnell) Patient Name: Age: Weight: Height: Gender: Baby Schnell 0 hours 3.1 kg 48 cm Female 1/23/13 14

15 Background: Ms. Schnell has had a benign prenatal course. After 10 hours of labor, Ms. Schnell has delivered a female newborn. Fetal heart rate was in the 140s with accelerations. Ms. Schnell had no maternal complications. Setting: Labor and Delivery Unit, Birthing Suite Patient Information: Baby Schnell is a 39 week and 5 day gestational African American newborn. You are to perform a newborn assessment immediately after the delivery. 1/23/13 15

16 Debriefing Information Newborn Assessment scenarios are designed and programmed for debriefing using the Diagnostic Educational Objective-based Reflection (DEOR) methodology. Dr. John Schaefer, HealthCare Simulation South Carolina (HCSSC), developed DEOR to provide objective-based feedback to scenario participants. The debrief log for the Newborn Assessment scenarios includes an overall grade, with number and percentage of correct steps completed. More information about using the DEOR method of debriefing can be found at the HCSSC website **Please see the debriefing log example on the following page** 1/23/13 16

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