S550 NOELLE Teaching Tips

Contents

Welcome... 1 Before you begin...1

Alice... 2 Admission...2 Labor...4 Delivery...5 Neonate...6 Postpartum...7

Beth... 8 Admission...8 Labor...11 Delivery...11 Neonate...12 Postpartum...13

Cynthia... 15 Admission...15 Labor...17 Delivery...18 Neonate...19 Postpartum...20

Donna... 22 Admission...22 Labor...25 Delivery...27 Neonate...28 Postpartum...29

Elaine... 31 Admission...31 Transition...34 Delivery...36 Neonate...36 Postpartum...37

Contents |

Francine... 38 Admission...38 Labor...41 Delivery...42 Neonate...45 Postpartum...45

Gloria... 46 Admission...46 Labor...47 Delivery...49 Neonate...50 Postpartum...52

Helen... 53 Admission...53 Transition...55 Delivery...57 Neonate...58 Postpartum...62

Irene... 64 Admission...64 Labor...66 Delivery...68 Neonate...69 Postpartum...71

Contents |

Welcome to NOELLE S550 Teaching Tips Teaching Tips will take you through the nine scenarios discussed in the NOELLE Instructor and Student Guide. These nine scenarios give students training in labor and delivery care and neonatal care. Students will develop an understanding of nursing procedures, responsibilities, and priorities.

Before you begin The scenarios are designed to assist in: •

Classroom discussions

•

Tabletop exercises

•

Role-playing in clinical simulations

Each scenario is different: Alice Manage a labor and birth as a normal process with good outcomes for the mother and her baby. Beth Manage the delivery of the neonate while maintaining a calm and supportive environment with a difficult patient. Cynthia Manage a shoulder dystocia delivery which causes the neonate to have a fractured clavicle. Donna Manage a precipitous vaginal breech of a premie and then care for both Donna and her 32 week premie. Elaine Manage a pregnancy induced hypertension (PIH) labor and delivery and a neonate that requires aggressive neonatal resuscitation. Francine Manage a repeat Cesarean Delivery complicated by an active Herpes infection and a neonate that stabilizes after blow-by oxygen. Gloria Manage a preterm labor and delivery with cord prolapse which results in fetal death. Helen Manage a patient with excessive blood loss before, during, and after delivery and a neonate with extensive resuscitation. Irene Manage preterm labor and delivery and a premie that requires aggressive resuscitation. Welcome | 1

Alice The Alice scenario presents labor and birth as a normal process with good outcomes for the mother and her baby. Alice is a 24 year old gravida 2/1 at 39 weeks. Note: Before starting this scenario, review Introduction and Objectives on pages 61-62 in the NOELLE Instructor and Student Guide.

Admission To get started: 1. Thoroughly lubricate the fetal head and shoulders, the inside of the cervix, and the inside of the vulva.

2. Place the fetus in the ROA position with the placenta high in the abdomen, and then line up the blue dots.

Blue dots

3. Select a birthing speed of 1, 2, 3, or 4 and fetal heart rate using the NOELLE Birthing Controller. You may pause the delivery or change the baseline FHR at anytime; however, do not change the speed once it is selected. Note: 1 is the fastest speed which delivers the fetus in 2-3 minutes. 4. Inflate the bladder beneath the fetal head lifting it anteriorly for palpation.

Alice | 2

The NOELLE Perinatal Monitor program includes FHTs, vital signs for Alice, the neonate, and more. You may also use the Scenario Editor to create any FHTs you want. The Perinatal Monitor program may be purchased as Gaumard product CD500 or CD501. Tip: You may want to display the FHTs and vital signs using a LCD projector or by using the Paint program on your computer to produce a hardcopy for teaching and/or testing purposes.

To use the Perinatal Monitor program: 1. Once the program is installed, double-click the

icon on your desktop.

2. From the Scenarios menu, select Alice, and then select Stage 1, Active Phase.

Alice | 3

This is Alice’s condition on admission. FHTs show the fetal heart rate at 140-145 with accelerations, average FHRV, and no decelerations. Alice’s vital signs are WNL.

Labor Alice’s labor progresses without difficulty. You may want to pause at this point and ask students “what-if ” questions.

Near crowning, the student may palpate the fontanelles, look for meconium, and prepare to suction the mouth and then the nose. Note: The delivery mechanism automatically stops near the shoulders if one adapter is used or near the lower torso if two adapters are used.

Alice | 4

Alice’s labor continues to progress without difficulty. As shown on the Perinatal Monitor, contractions are occurring more rapidly, the FHTs still exhibit accelerations, and Alice’s vitals remain WNL. To follow along using the Perinatal Monitor, from the Scenarios menu, select Alice, and then select Stage 1, Transition Phase.

Delivery

The delivery mechanism rotates the fetus allowing for shoulder presentation. Slight traction can free both the upper and lower shoulders.

Alice | 5

The FHTs show early decelerations, contractions have increased, and vitals remain WNL. As Alice’s labor progresses, the Instructor may click on successive images for students to interpret. To follow along, from the Scenarios menu, select Alice, and then select Stage 2. Note: Each time you click the mouse, random variations of FHTs will be shown.

Neonate

NOELLE models 550.100 and 550 are supplied with a full term neonate which has a patent umbilical vein and palpable pulse. The 550.100 neonate changes color with resuscitation attempts. In order to intubate, use a Miller 1 blade and 2.5 mm - 3.0 mm ETT. When intubating, the chest will rise at approximately 25 cm water pressure. Note: Lubricate the distal end of the ETT prior to intubation.

Alice | 6

Postpartum

You may want to install the postpartum kit to demonstrate massage techniques. Practicing these techniques will teach students how to massage a “boggy” uterus.

Once the postpartum kit is installed, practice massaging the “boggy” uterus in order to feel the smaller, harder uterus hidden inside. Note: As an alternative technique, the student may compress the uterus using a gloved hand inserted into the vagina while the other hand compresses the fundal area.

Tip: For supplemental readings, discussion questions, tests and answers, take a look at pages 61-86 in the NOELLE Instructor and Student Guide.

Alice | 7

Beth In the Beth scenario, the challenge for the student will involve maintaining a calm and supportive environment with a difficult patient while managing the delivery of the neonate. Beth is a 16 year old gravida 2/0 (1 elective AB) at 37 weeks. Note: Before starting this scenario, review Introduction and Objectives on pages 87-88 in the NOELLE Instructor and Student Guide.

Admission To get started:

1. Wrap the umbilical cord once around the neck.

2. Thoroughly lubricate the fetal head and shoulders, the inside of the cervix, and the inside of the vulva.

Beth | 8

3. Place the fetus in the ROA position with the placenta high in the abdomen, and then line up the blue dots.

Blue dots

4. Select a birthing speed of 1, 2, 3, or 4 and fetal heart rate using the NOELLE Birthing Controller. You may pause the delivery or change the baseline FHR at anytime; however, do not change the speed once it is selected. Note: 1 is the fastest speed which delivers the fetus in 2-3 minutes. 5. Inflate the bladder beneath the fetal head lifting it anteriorly for palpation.

The NOELLE Perinatal Monitor program includes FHTs, vital signs for Beth, the neonate, and more. You may also use the Scenario Editor to create any FHTs you want. The Perinatal Monitor program may be purchased as Gaumard product CD500 or CD501. Tip: You may want to display the FHTs and vital signs using a LCD projector or by using the Paint program on your computer to produce a hardcopy for teaching and/or testing purposes.

Beth | 9

To use the Perinatal Monitor program: 1. Once the program is installed, double-click the

icon on your desktop.

2. From the Scenarios menu, select Beth, and then select Stage 2.

This is Beth’s condition on admission. The fetal baseline is 150 with minimal variability and moderate variable decelerations. Beth’s vital signs reflect her highly agitated condition.

Beth | 10

Labor As Beth’s labor progresses quickly, she is screaming and out of control – role-play is essential in this situation.

A nuchal cord is evident and must be reduced. Use a gloved hand to move the cord below the fetal head and shoulders. Near crowning, the student may palpate the fontanelles, look for meconium, and prepare to suction the mouth and then the nose. Note: The delivery mechanism automatically stops near the shoulders if one adapter is used or near the lower torso if two adapters are used.

Delivery

The delivery mechanism rotates the fetus allowing for shoulder presentation. Slight traction can free both the upper and lower shoulders.

Beth | 11

At this point, the neonate female is limp, dusky, and does not cry spontaneously at delivery. To follow along using the Perinatal Monitor, from the Scenarios menu, select Beth, and then select Stage 3 (a).

Neonate In this scenario, drying stimulates respiratory effort; however, the neonate female remains hypothermic and tachypneic.

NOELLE models 550.100 and 550 are supplied with a full term neonate which has a patent umbilical vein and palpable pulse. The 550.100 neonate changes color with resuscitation attempts. In order to intubate, use a Miller 1 blade and 2.5 mm - 3.0 mm ETT. When intubating, the chest will rise at approximately 25 cm water pressure. Note: Lubricate the distal end of the ETT prior to intubation.

Beth | 12

Postpartum

In this scenario, immediate postpartum bleeding is heavy and the uterus is “boggy”. You may want to install the postpartum kit to demonstrate massage techniques. Practicing these techniques will teach students how to massage a “boggy” uterus.

To aid in reducing the bleeding, the student should get an IV started and administer a drug like Pitocin.

Beth | 13

Once the postpartum kit is installed, practice massaging the “boggy” uterus in order to feel the smaller, harder uterus hidden inside. Note: As an alternative technique, the student may compress the uterus using a gloved hand in the vagina and the other compressing the fundal area.

Tip: For supplemental readings, discussion questions, tests and answers, take a look at pages 87-107 in the NOELLE Instructor and Student Guide.

Beth | 14

Cynthia In the Cynthia scenario, the challenge for the student is to be prepared immediately and appropriately to intervene during shoulder dystocia, an intrapartum crises. Cynthia is a 31 year old gravida 3/1 (2yo boy/1 spont AB) at 41 weeks. Note: Before starting this scenario, review Introduction and Objectives on pages 109-110 in the NOELLE Instructor and Student Guide.

Admission To get started: 1. Place the faceskin provided over the fetus’ head since a FSE and vacuum cup or forceps will be used. 2. Thoroughly lubricate the fetal head and shoulders, the inside of the cervix, and the inside of the vulva.

3. Place the fetus in the ROA position with the placenta high in the abdomen, and then line up the blue dots using two extensions.

Blue dots

4. Select birthing speed 5 using the NOELLE Birthing Controller. Note: Speed 5 is designed to birth the fetal head, retract slightly, move forward once again, and pause for 3 minutes. 5. Select a fetal heart rate. Note: You may pause the delivery and change the fetal heart rate at any time. 6. Inflate the bladder beneath the fetal head lifting it anteriorly for palpation.

Cynthia | 15

The NOELLE Perinatal Monitor program includes FHTs, vital signs for Cynthia, the neonate, and more. You may also use the Scenario Editor to create any FHTs you want. The Perinatal Monitor program may be purchased as Gaumard product CD500 or CD501. Tip: You may want to display the FHTs and vital signs using a LCD projector or by using the Paint program on your computer to produce a hardcopy for teaching and/or testing purposes.

To use the Perinatal Monitor program: 1. Once the program is installed, double-click the

icon on your desktop.

2. From the Scenarios menu, select Cynthia, and then select Stage 1, Active Phase.

Cynthia | 16

This is Cynthia’s condition on admission. Her labor progresses WNL initially. The fetal baseline is 140 with average variability and no decelerations.

Labor Cynthia progresses normally and the fetal baseline remains about 140. Pain meds are administered when dilation is 7-8 cm. AROM reveals clear fluid and a FSE can be screwed into the soft faceskin covering the fetal scalp.

The Instructor may pause delivery at this point and ask students to deliver the head using a lubricated vacuum cup, applying traction only during contractions.

Cynthia | 17