Teaching Plan INUR 3315

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College of Nursing, Christian University of ThailandTeaching Plan (Theory)Semester 2 Academic Year 2557

Course code: INUR 3315 Course Title: Midwifery IITeaching Topic: Nursing care management women at risk with complications throughout the course of normal deliveriesName of Instructor: Ms. Gladys U. DesmanosDay/Month/Year: 13/01/ 2015 Time: 9:00-11:00 Venue: Christian University Room 405Year of Students: Third Year

Learning Outcome : LO

The Responsible Distribution Map of Student Leaning Outcome from Curriculum to Courses (Curriculum Mapping) Major Responsibility Minor Responsibility -- NoneCourse Title/ Learning Outcome Ethics and MoralKnowledgeCognitive SkillsInterpersonal Skills and ResponsibilityNumerical Analysis, Communication and Information technology SkillsProfessional skills

1. Understanding of principle of religions, ethics and codes of ethics including human rights, children rights, consumer rights, patient rights and professional nursing rights which are important to nursing therapeutics.2. Be able to differentiate right, goodness and badness.3. Respect the value and dignity of humanity4. Be responsible for self-doing.5.Holding discipline and honesty.6.Practice according to nursing code of ethics and holding ability to manage ethical problems in daily living and professional nursing practice.7. Be a good role model to others in daily living and professional nursing practice.8. Advocate for patients/clients in obtaining understanding own rights in order to protect their own rights which are violated.

1.Holding knowledge and understanding of basic life science, basic health science which cover sciences, humanities, social sciences, laws and democratic governance 2.Holding knowledge and understanding of Nursing care for Midwifery and health system and factors influencing social changes and health system 3. Holding knowledge and understanding of nursing process and application in nursing therapeutics.4. Holding knowledge and understanding essential contents of knowledge searching process, knowledge management, research process, management process and nursing organizational management .5.Holding knowledge and understanding of nursing informatics and Minimum Nursing Data System (MNDS).

1.Be aware of once potentials and weaknesses of self in order to have self-development enhancingcapability leading to nursing practice, teaching, efficient knowledge searching and strong nursing leadership.2. Be able to search and analyze data from various sources.3. Be able to use data and evidence-based in reference and critically solve problems.4. Be able to have analytical system thinking by using professional knowledge and related knowledge including using experience-based for safety and quality nursing services.5.Be able to use scientific process, conducting research and appropriate nursing innovation in solving health and nursing problem.6. Be able to develop problem solving techniques related to health and efficient nursing ad relevant to changing health situation and contents.

1. Be able to adjust professionally and interact creatively with clients, colleagues and superiors.2. Be able to work as a team, leader and member of nursing health team and community team in public health service system on all levels of public health system in different contexts or situations.3.Be able to express leadership skill in driving appropriate changes in nursing organization in various situations and immediate situations4. Can work as a team leader and follower of the various roles in healthcare services at all levels and in different. situations.

1. Be able to apply logic, mathematics and statistics in nursing.2. Be able to transform nursing data into quality information and able to analyze reading and transfer nursing information to others with comprehension.3. Be able to effectively communicate in English language including speaking, listening, reading, writing and presenting, as well as being able to read journal and textbook with understanding.4. Be able to use essential basic computer programs.5. Be able to choose and use various approaches in presenting information communication and technology effectively and appropriately.

1. Be able to practice holistic nursing skills in physical, mental, social, cultures and spiritual dimensions by using nursing process, evidence-based and therapeutic communication to individuals, families, groups and community.2. Be able to practice in health promotion, disease prevention, nursing therapeutics and symptoms management and health rehabilitation for clients in all health status and all ages including midwifery in all levels of health care setting according to Nursing and Midwifery Acts ( B.E.2528 ) and the revise of Nursing and Midwifery Acts ( 2nd ed., B.E.2540 ) 3. Be able to practice nursing with mercy, kindness and caring nursing practice abiding by morality, ethics, laws and patient rights.4. Be able to practice nursing in consideration of individuality and transcultural aspects.5. Express leadership skills in professional nursing practice, ability to manage nursing team, multidisciplinary team working in the community health care setting.

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Behavioral Objectives of each teaching topicContent of Each Teaching Topic (in brief)Teaching and Learning ActivitiesTeaching AidesEvaluation MethodsEvaluation results

1. Explain and describe the labor dysfunctions.2. Describe the common deviations in the power and passenger that can cause complications during labor or birth.3. Identify the different clinical manifestations of a woman in labor and during birth for the deviations of the usual labor process.4. Identify the nursing interventions or nursing care of the labor dysfunctions.1.Labor dysfunctionsAlso known as labour dystocia, is when, even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked. Complications for the baby include not getting enough oxygen which may result in death. It increases the risk of the mother getting an infection, having uterine rupture, or having post-partum bleeding. Long term complications for the mother include obstetrical fistula. Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than twelve hours.1.1. Problems of the powerUterine dystocia or dysfunctional uterine contraction..1.1.1 Ineffective uterine contractionsAre the most common reason for slow progress of labour in a primigravida

1.1.2 Hypotonic contractionsThe second and more common type of uterine dysfunction is hypotonic uterine dysfunction, or secondary uterine inertia. The woman, who may be in her first or a subsequent pregnancy, initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The uterus is easily indented, even at the peak of contractions. Intrauterine pressure during the contraction (usually less than 25 mm Hg) is insufficient for progress of cervical effacement and dilation (Gilbert & Harmon, 1998). Cephalopelvic disproportion and malpositions are common causes of this type of uterine dysfunction.1.1.3 Hypertonic contractionsMost often occur in first-time mothers, Primigravidas. Contractions are ineffectual, erratic, uncoordinated, and of poor quality that involve only a portion of the uterusIncrease in frequency of contractions, but intensity is decreased, do not bring about dilation and effacement of the cervix.1.2.Problems of the passenger 1.2.1Prolapse of the umbilical cord Umbilical cord prolapse occurs when the umbilical cord comes out of the uterus with or before the presenting part of the fetus. It is a relatively rare condition and occurs in fewer than 1% of pregnancies. Cord prolapse is more common in women who have had rupture of their amniotic sac. Other risk factors include maternal or fetal factors that prevent the fetus from occupying a normal position in the maternal pelvis, such as abnormal fetal lie, too much amniotic fluid, or a premature or small fetus. 1.2.2 Multiple gestationMultiple gestations are high risk pregnancies which may be complicated by prematurity, low birthweight, pre-eclampsia, anaemia, postpartum haemorrhage, intrauterine growth restriction, neonatal morbidity and high neonatal and infant mortality. 1.2.3 Problems with fetal position, presentation or size.Malpositions are abnormal positions of the vertex of the fetal head (with the occiput as the reference point) relative to the maternal pelvis. Malpresentations are all presentations of the fetus other than vertex. The fetus is in an abnormal position or presentation that may result in prolonged or obstructed labour. 1.2.4 MacrosomiaMacrosomia, which literally means "big body," is sometimes confused with LGA. Some experts consider a baby to be big when it weighs more than 8 pounds 13 ounces (4,000 g) at birth, and others say a baby is big if it weighs more than 9 pounds 15 ounces (4,500 g). A baby is also called large for gestational age if its weight is greater than the 90th percentile at birth.[ 1.2.5 Shoulder dystociaShoulder dystocia is a specific case of obstructed labour whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. Shoulder dystocia is an obstetric emergency, and fetal demise can occur if the infant is not delivered, due to compression of the umbilical cord within the birth canal.

LectureDiscussionPowerPoint presentationQuizExamination Midterm and Final

Reference:1. Adele Pilliteri (2014). Maternal and Child Health Nursing 7th ed. Philadelphia2. Olds. S.B. al (2008). Maternal Newborn Nursing Womens Health Care. 8th ed. New Jersey : Pearson.Overview Assessment

College of Nursing, Christian University of ThailandTeaching Plan (Theory)Semester 2 Academic Year 2557

Course code: INUR 3315 Course Title: Midwifery IITeaching Topic: Nursing care management women at risk with complications throughout the course of normal deliveriesName of Instructor: Ms. Gladys U. DesmanosDay/Month/Year: 13/01/ 2015 Time: 9:00-11:00 Venue: Christian University Room 405Year of Students: Third Year











1. Explain and describe the labor dysfunctions.2. Describe the common deviations in the power and passenger that can cause complications during labor or birth.3. Identify the different clinical manifestations of a woman in labor and during birth for the deviations of the usual labor process.4. Identify the nursing interventions or nursing care of the labor dysfunctions.1.3 Problems of the passage 1.3.1 Cephalopelvic disproportionCephalo-pelvic disproportion exists when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal. This may be due to a small pelvis, a nongynecoid pelvic formation, a large fetus, an unfavorable orientation of the fetus, or a combination of these factors. Certain medical conditions may distort pelvic bones, such as rickets or a pelvic fracture, and lead to CPD.Transverse diagonal measurement has been proposed as a predictive method1.4 Psychological Problems1.4.1 Postpartum bluesThe postpartum blues, maternity blues, or baby blues is a transient condition that 75-80% of mothers could experience shortly after childbirth with a wide variety of symptoms which generally involve mood lability, tearfulness, and some mild anxiety and depressive symptoms. After the placenta is delivered, the placental "hormone factory" shuts down causing radical changes in hormone levels, and the woman can suffer symptoms due to withdrawal from the high pregnancy levels of estrogen, progesterone and endorphins. Combined with this shift in hormone levels is the physical, mental and emotional exhaustion - as well as sleep deprivation typical of parenting a newborn. All of these factors contribute to the condition.1.4.2 Postpartum depressionPostpartum depression (PPD), also called postnatal depression, is a type of clinical depression which can affect women after childbirth. Symptoms may include sadness, low energy, changes in sleeping and eating patterns, reduced desire for sex, crying episodes, anxiety, and irritability. While many women experience self-limited, mild symptoms postpartum, postpartum depression should be suspected when symptoms are severe and have lasted over two weeks.1.4.3 Postpartum psychosisPostpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth.

A typical example is for a woman to become irritable, have extreme mood swings and hallucinations, and possibly need psychiatric hospitalization. Often, out of fear of stigma or misunderstanding, women hide their condition



Teaching Plan (Theory)Semester 2 Academic Year 2557

Course code: INUR 3315 Course Title: Midwifery IITeaching Topic:High risk complications during the entire stages of labor:High risk complications during 1st and 2nd stages of laborName of Instructor: Ms. Gladys U. DesmanosDay/Month/Year: 27/01/ 2015 Time: 9:00-11:00 Venue: Christian University Room 405Year of Students: Third Year











1. Differentiate between preterm and low birth weight2. Identify risk factors for preterm birth.3. Discuss current interventions to prevent preterm birth.4. Discuss the use of tocolytics in preterm birth5. Define PROM.6. Describe the nursing management 7. Define Post term8. Identify the risk factors leading to post term birth.9. Discuss the complications 10. Describe the care of a woman experiencing post term pregnancy.1. High risk complications during 1st and 2nd stages of labor1.1. Preterm 1.1.1 Preterm labor and birthPreterm birth (Latin: partus praetemporaneus or partus praematurus) is the birth of a baby of less than 37 weeks gestational age; such a baby is sometimes referred to as a "preemie" or "premmie", depending on local pronunciation. The cause of preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging proposition. Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development1.2PROMPremature rupture of membranes (PROM), or pre-labor rupture of membranes, is a condition that occurs in pregnancy. It is defined as rupture, or breakage, of the amniotic sac more than one hour before the onset of labor.[1] The sac, or "membranes" contain amniotic fluid which surrounds and protects the fetus in the womb. After rupture, the amniotic fluid leaks out of the uterus through the vagina. This is informally known as one's "water breaking".Women with PROM usually experience a painless gush of fluid leaking out from the vagina, but sometimes a slow steady leakage occurs instead.When premature rupture of membranes occurs at or after 37 weeks completed gestational age (at term), there is minimal risk to the fetus and labor typically starts soon after.1.3 Post termPostmaturity is the condition of a baby that has not yet been born after 42 weeks of gestation, two weeks beyond the normal 40 Post-term, postmaturity, prolonged pregnancy, and post-dates pregnancy all refer to postmature birth. Post-mature births can carry risks for both the mother and the infant, including fetal malnutrition. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. If the fetus passes fecal matter, which is not typical until after birth, and the child breathes it in, then the baby could become sick with Meconium aspiration syndrome. Postterm pregnancy may be a reason to induce labor.




Course code: INUR 3315 Course Title: Midwifery IITeaching Topic:High risk complications during the entire stages of labor:High risk complications during 1st and 2nd stages of labor(cont.)Name of Instructor: Ms. Ruffel Joy C. ManaloDay/Month/Year: 27/01/ 2015 Time: 9:00-11:00 Venue: Christian University Room 405Year of Students: Third Year











1. Define obstructed labor.2. Identify risk factors for obstructed labor.3. Discuss current interventions to prevent obstructed labor4. Discuss the care management for obstructed labor5. Define uterine rupture.6. Identify the risk factors of uterine rupture.7. Explain the pathophysiology of uterine rupture.8. Describe the clinical features.9. Discuss the nursing diagnosis10. Discuss the nursing management for uterine rupture.11. Define amniotic fluid embolism.12. Identify the risk factors leading to amniotic fluid embolism13. Discuss the complications 14. Describe the care of a woman experiencing amniotic fluid embolism.2. High risk complications during 1st and 2nd stages of labor 1.4.Obstructed laborObstructed labour, also known as labour dystocia, is when, even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked.Complications for the baby include not getting enough oxygen which may result in death. It increases the risk of the mother getting an infection, having uterine rupture, or having post-partum bleeding. Long term complications for the mother include obstetrical fistula. The main causes of obstructed labour include: a large or abnormally positioned baby, a small pelvis, and problems with the birth canal. Abnormal positioning includes shoulder dystocia were the anterior shoulder does not pass easily below the pubic bone.Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency. It is also more common in adolescence as the pelvis may not have finished growing. Problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors. 1.4.1 Shoulder dystociaShoulder dystocia is a specific case of obstructed labour whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. Shoulder dystocia is an obstetric emergency, and fetal demise can occur if the infant is not delivered, due to compression of the umbilical cord within the birth canal.One characteristic of a minority of shoulder dystocia deliveries is the turtle sign, which involves the appearance and retraction of the fetal head (analogous to a turtle withdrawing into its shell), and the erythematous (red), puffy face indicative of facial flushing. This occurs when the baby's shoulder is obstructed by the maternal pelvis. 1.5 Uterine rupture 1.5.1 DefinitionUterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby.A uterine rupture typically occurs during active labor, but may already develop during late pregnancy.Uterine dehiscence is a similar condition, but involves fewer layers, less bleeding, and less risk. 1.6 Amniotic fluid embolism 1.6.1 DefinitionAmniotic fluid embolism (AFE) is a rare and incompletely understood obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and trigger an allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and coagulopathy. It was first formally characterized in 1941. While it is estimated to be the fifth most common cause of maternal mortality in the world, there has been discrepancy with respect to the incidence and mortality of amniotic fluid embolism.

LectureDiscussionPowerpoint presentationQuizExamination Midterm and Final



Course code: INUR 3315 Course Title: Midwifery IITeaching Topic:High risk complications during the entire stages of labor:High risk complications during 1st and 2nd stages of labor(cont.)Name of Instructor: Ms. Ruffel Joy C. ManaloDay/Month/Year: 27/01/ 2015 Time: 9:00-11:00 Venue: Christian University Room 405Year of Students: Third Year











15. Define uterine inversion.16. Identify the different types of uterine inversion. 17. Discuss the two components of uterine inversion management.18. Discuss the types of shock.19. Identify the etiological factors of shock 20. Explain the pathophysiology. Of shock.21. Describe the clinical features.22. Discuss the nursing management for shock.3. High risk complications during 1st and 2nd stages of labor 1.7. Uterine inversion 1.7.1 DefinitionUterine inversion is a potentially fatal childbirth complication with a maternal survival rate of about 85%. It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare. 1.7.2 Types of uterine inversion It has been classified on the basis of its duration and degrees Acute inversion :Occurs immediately after delivery and before the cervix constricts (most common >95%) occurs within 24 hours Subacute inversion: Occurs after the cervix constricts after 24 hours but before 4 weeks,Chronic inversion: Inversion noted 4 weeks after delivery; rare incidence 1:2000 deliveries

1.7.3 Two components of uterine Immediate treatment of Shock Replacement/Repositioning of the uterus inversion management1.7 Shock in obstetrics A state of circulatory impairment characterized by defective tissue perfusion resulting in abnormal cellular function and metabolism. This leads to a clinical syndrome of signs of decreased perfusion of vital organs, with possible alterations in the mental status (somnolence) and oliguria (urine output

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Teaching Plan INUR 3315

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