ANGELES UNIVERSITY FOUNDATION

Angeles City

College of Nursing

RELATED LEARNING EXPERIENCE (RLE) 0109

CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEM (ACUTE AND CHRONIC)

Second Semester, Academic Year 2020 – 2021

ACTIVITY INSTRUCTION FOR PROBLEM BASED LEARNING

NURSING CARE OF AT RISK MOTHER’S DURING THE LABOR AND DELIVERY PROCESS

GENERAL DESCRIPTION:

Unique in its integral emphasis on core content, Problem-Based Learning (PBL) is a self-directed, independent and interdependent strategy in which the
problem drives the learning process. Possessing a student-centered learning approach, PBL is based on typical case scenarios that learners can encounter and
must work on real life situations to becoming active rather than passive learners.

While case scenarios may not fully present in themselves all distinct concepts related to a particular health condition, learners are motivated to capture details of
scenarios that become reference for active learning, researching and collaborating with other learners within a group. PBL is different from question-aided
scenarios where the learners are required to formulate an output (e.g. nursing care plan, care map) or make an analysis of the situation based on what the guide
questions or instructions ask them to accomplish. The direction of learning in a PBL is based on learner-motivation and curiosity as there are no guide or follow up
questions. To acquire learning through a PBL, principles threaded in this strategy can be summarized into (1) activation of prior knowledge, (2) elaboration of
knowledge, (3) encoding specificity, (4) epistemic curiosity, and (5) contextual dependency of learning

PURPOSES OF PBL:
 1. PBL embraces the principles of good learning and teaching (Chen, et al., 2006).
2. PBL has distinct characteristics as a student-centered learning approach/method (Stern, et al., 2005).
3. It gives the teachers /instructors the chance to develop the students they say they want – independent, self-motivated, drawing on a wide range of
resources, challenging the parameters of the course and producing interesting work (Kiley, 2000).
4. It is student directed, fosters intrinsic motivation, promotes active learning and deep learning, and develops collegial learning skills (Felder, 2005).
5. Taps into students’ existing knowledge, encourages reflection on the teaching/learning process (Kiley, 2000).
6. It is conducive to a research-oriented curriculum, involves timely feedback and can support student self-assessment and peer assessment (Chen, et al.,
2006).
7. Students are encouraged to be active rather than become passive learners, and to cooperate rather than to compete. They are given greater control over
their learning as they move from dependency to independency (Kiley, 2000).

GENERAL INSTRUCTIONS: In this activity, the learners will be able to acquire learning using PBL as a learner-centered strategy in the context of nursing care
management of clients with high-risk pregnancy condition. To accomplish this, the following are the guidelines for completion:
1. This is a group, graded activity. The class will be divided accordingly into RLE groups.
2. This activity is posted in myClass’ Assignment tab.
3. There will be a clinical case scenario to work on. Remember that there are no guide questions to answer.
4. Please make sure that all members of the group shall participate. Here is the list of every member’s roles: ROLES and RESPONSIBILITIES.
A. Facilitator -Moderates team discussion, keeps the group on task, and distributes work.
B. Recorder -Takes notes summarizing team discussions and decisions and keeps all necessary records.
C. Reporter -Serves as group spokesperson to the group or a mini-instructor, summarizing the group’s activities and/or conclusions.
D. Timekeeper -Keeps the group aware of time constraints and deadlines and makes sure meetings start on time
E. Devil’s Advocate -Raises counterarguments and constructive objections; introduces alternative explanations and solutions.
F. Checker -Checks to make sure all group members understand the concepts and the group’s conclusions.
G. Technologist - Prepares the presentation using the most appropriate application; determines the application; and prepares the link for the synchronous
discussion if needed.
4. The Problem-based Learning Session 1 has seven (7) steps. Please be guided.
Step 1: Identify the problem
Step 2: Activate prior knowledge (what do we know?)
Step 3: Brainstorm
Step 4: Generate learning questions and explanatory hypotheses.
Step 5: Formulate learning issues
Step 6: Identify learning resources
Step 7: Feedback on group process
5. A rubric is available for reference. Be mindful of the criteria that serve to evaluate the output.
6. Formatting guidelines: Arial, font size: 10, tabular, landscape orientation, PDF
7. Submission of work for this activity will be accomplished via file upload in myClass’ Assignment tab on (date/time).
8. The group is also task to formulate 10 Nursing Diagnosis, EACH member will be assigned to make 1 NCP from the formulated Nursing Diagnosis.
9. The Clinical Instructors will facilitate the presentation and defense scheduled on (date/ time) as a form of evaluating learning and feedback.
10. For the guidance of the group please use this template:
 LEARNING LEARNING CRITERIA FOR
LEARNING ISSUE SOURCES/MATERIALS EVIDENCES
OBJECTIVE QUESTION EVALUATION

What do I want or need to

learn?
What specific questions/ What will I do to meet What are my references? How will I demonstrate Who will evaluate my
issues will I address? my objectives/answer my what I have learned? evidences?
learning questions?
• Knowledge • Tutor to student
What or who can help me
• Skills • Student to
learn what I want to learn?
• Attitudes/values student

What criteria?

• Participation
• Written output

What deadline?

5. Note: Include the AUF Honor Code in each submitted output…

As an Angelenean who lives by the core values of pagiging mabuti, magaling at may malasakit sa kapwa, I hereby commit that I complete my academic work with integrity.
This means that I shall accomplish my academic work without receiving or giving unauthorized assistance. My work also observes scholarly and intellectual standards, rules
on proper citation of sources, and appropriate collection and use of data
CASE SCENARIO

A 32-year-old pregnant female, gravida 1, para 0, was referred to the obstetric department for tertiary care at 28+0 weeks of gestation with uterine prolapse. She
complained of intermittent vaginal blood spotting after voiding that began 12 days (26+2 weeks of gestation) earlier. Her height and body weight were 157 cm and
55 kg, respectively, and her body mass index was 22.4. Her medical and obstetric history was unremarkable regarding pelvic trauma, prolapse, or stress incontinence.
She had no surgical history or family history of connective tissue disease. However, during the current pregnancy she had needed urinary catheterization several
times because of voiding difficulty and urinary retention early in the first trimester. At that time, examination by the local obstetrician revealed no abnormality of her
uterus and cervix.

She complained no discomfort including increased urine frequency, dysuria and residual urine sensation. A second-stage uterus prolapse was diagnosed at 27+2
weeks of gestation in the local clinic. Pelvic examination revealed a second-stage prolapse, with point C as the leading edge according to the pelvic organ prolapse
quantification staging system uterine prolapse (Aa -1.0, Ba -1.0, C -0.5, gh 2.0, pb 3.0, tvl 9.0, Ap -1.0, Bp -0.5, D -2.0). The eroded cervix was descended to the
level of the vaginal introitus. There was no evidence of cystocele or rectocele.
No fetal abnormality was identified by ultrasonography. Estimated fetal weight was 1,174 g. No uterine mass or pelvic mass was detected. Sonographic examination
revealed a short cervix with 17 mm length and a T-shape (Figure 1).

Figure 1. Ultrasonography revealed a short cervix with 17-mm length and a T-shape

A progesterone capsule, Uterogestan 200 mg was administrated vaginally daily. Vaginal pessary was inserted.
Two weeks later (30+0 weeks of gestation), she was admitted to our hospital again because of regular uterine contractions. Pelvic examination revealed an enlarged
and edematous uterine cervix and a second-degree uterine prolapse. The eroded cervix was projecting near the vaginal introitus (Figure 2).

Figure 2. Physical exams show second-degree uterine prolapse. The eroded

cervix projected through the vaginal introitus.

The cervical orifice was closed. Sonographic examination revealed a more shortened cervix with 10-mm length and a T-shape. Estimated fetal weight was 1,470 g.

Doctor’s orders:

- Start D5LRS 1L to run for 8 hrs

- Initiate Terbutaline (Brethine) at 2.5-5 mcg/min IV, increase gradually as tolerated at 20-30 minute intervals, then continue infusion for 12 hr following cessation
of uterine contractions; not to exceed 48-72 hr
- Magnesium Sulfate 20g in 500mL NSS
 - Dexamethasone 6mg IM every 12 hours x 4 doses
- Azithromycin 1000mg PO

Acute onset of preterm uterine contractions necessitated tocolytic therapy with a favorable outcome. Corticosteroids were also administered. We recommended bed
rest in a slight Trendelenburg position. Vaginal culture at admission revealed mycoplasma infection. She was treated with a single dose of azithromycin 1,000 mg.
Follow-up culture revealed no evidence of infection.

At 34+0 weeks of gestation, uterine contractions disappeared without tocolytics. She was discharged. Three weeks later (37+0 weeks of gestation), she was admitted
to our hospital again because of regular uterine contractions. The cervix was still prolapsed at the same level and the cervical orifice was opened to about 3 cm
width. Latency period to delivery was 5 hours and estimated blood loss was about 400 mL, which was not different with them of normal pregnancy. A live healthy
male neonate of 2,670 g was delivered after a 6-hour labor. Apgar scores were 10 at 1 minute and 10 at 5 minutes.
The prolapsed uterus was manually reduced. The postnatal period was uneventful. Two days after delivery, she was discharged in good health and with complete
resolution of the cervical prolapse. At follow-up examination 1 and 6 months postpartum, no sign of uterine prolapse was evident.
 ANGELES UNIVERSITY FOUNDATION
Angeles City
College of Nursing
PROBLEM-BASED LEARNING’S CRITICAL APPRAISAL RUBRIC
(35 Points)

CRITERIA EXEMPLARY ACCOMPLISHED DEVELOPING BEGINNING LAUNCH ING SCORE

Problem It addresses all aspects Most of the aspects of the Some aspects of the The objectives, questions, No aspect 0f the
Identification of the problem within the problems are addressed problem are identified with and issues fail to address problem sue,
framework of identified through critical thinking and occasional evidence of the problem through (e. s
objectives, questions, reasoning. critical thinking and inconsistencies and question,
Assigned and issues through reasoning. inexplicable thinking and is
Weight: effective critical thinking reasoning. objectives)
and reasoning. is
16.67%
identified

5 5 3.75 2.5 1.25 0

points points points points points point
Depth of Addresses all Addresses most conceptual Encourages superficial rather Displays inaccurate No
Content significant issues related to the than in-depth dealing of explanation of key content
conceptual issues objectives. conceptual issues with the concepts, incomplete and displayed
directly related to inconsistency of objectives. confusing information
major content details.
objectives. Formulates a description
Formulates a good of information details that
Formulates a rich description of most allows for minimal
description of information information details that allows difficulties in
Assigned details that allows the understanding the content.
the readers to understand the
Weight: readers to understand the content.
16.67% content.
 5 5 3.75 2.5 1.25 0
points points points points points point
Integration It shows evidence of There is evidence of more There is evidence of There is a limited No
multiple areas of previous than one area of previous previous learning but the presentation of previous evidence
learning and includes learning and has concepts included concepts show learning, limited knowledge of
concepts that are specific that are cross-linked with basic knowledge without the of basic concepts without integration
and highly relevant to the other concepts. integration of concepts to linking to other concepts.
topic with multiple valid other concepts.
Assigned cross-links to other
Weight: concepts.
23.33%

7 points 5.25 points 3.5 points 1.75 points

7 points
0 point

Organization Pieces of evidence are Most pieces of evidence Some pieces of evidence are Pieces of evidence are No organization
clear and organized are organized with an clear and sequentially disorganized due to a of evidence
Assigned presented in clear, adequate amount of clarity presented. lack of logical
Weight: sequential order. and sequencing. organization, clarity and
11.67% sequencing.
0 point
3.5 points 3.5 points 2.625 points 1.75 points
0.875
point
Discovery Shows several varied Demonstrates an acceptable Shows some new areas of Demonstrates little or no No evidence of
areas of new knowledge level of new knowledge knowledge from limited evidence of generated new research/
Assigned through substantive and through resources knowledge owing to limited discovery
Weight: relevant gathered resource materials or absence of research
16.67% research resources resources
0 point
5 points 5 points 3.75 points 2.5 points 1.25 points

Format Shows full compliance on Shows moderate Shows fair compliance on Shows poor compliance on Very poor
Compliance the required format (e.g. compliance on the the required format (e.g. the required format (e.g. compliance on the
font, required format (e.g. font, font, size, spacing, margin) font, size, spacing, margin) required
Assigned size, spacing, margin) size, spacing, margin) format
Weight:
5%
 0.75 point 0.375 point
1.5 points 1.5 points 1.125 point

0
point
Grammar Displays competent Displays minor grammatical Displays noticeable Displays several and major No data coherence
Usage grammar use errors grammatical errors grammatical errors owing to grave
grammatical errors

Assigned
Weight:
5%

1.5 1.5 s 1.125 0.75 0.375 0

points Point point Point Point Point
Timeliness Submits requirement on Submits requirement a day Submits requirement two (2) Submits requirement Submits requirement
time after days after the scheduled three (3) after the for more than three
the scheduled submission submission date scheduled submission (3) days after the
date date scheduled
submission date
Assigned
Weight:
5%

1.5 Points
1.5 1.125 point 0.75 0.375 0
points Point Point Point
Peer evaluation Has consistently made Has made valuable Has made some valuable Has made minimal No contribution was
5 points valuable contributions in contributions in the contributions in any phase of contributions in any phase of made
the conceptualization, conceptualization, creation and the conceptualization, creation the conceptualization, creation
creation and finalization of finalization of the group’s output. and finalization of the group’s and finalization of the group’s
the group’s output. output. output.

3.75 points
 5 points 2.5 points 1.25 points
0 point
* For peer evaluation, ALL group members are required to evaluate each other. In a group that has 10 members for instance, each learner must be able to receive
evaluation made by 9 peers/ group members where the average will be obtained from the scores of the 11 learners. A Google Worksheet must be created where
the link must be sent to the learners that contains the following details:
Name of Evaluator:
Name of Learners Evaluated:
Corresponding Evaluation Score: (e.g. 4 points)

Computation Guidelines:

1. There are eight (9) criteria on this rubric. Each criterion carries a specific weight reflective of its relative importance to the other criteria.
2. Similarly, there is a pre-assigned weight or point on each category (e.g. exemplary, developing) of a given criterion. You CANNOT assign a score
that is between categories.
3. The highest possible score on this activity is 35 points.

Prepared by:
ACTIVITY:
BRENDA B. POLICARPIO, RN,RM,MN
NADINE VICTORIA LISING, RM,MAN
Faculty, College of Nursing

RUBRIC
Alfredo Z. Feliciano, RN, PhD
Faculty, College of Nursing
Reviewed by:

Brenda B. Policarpio, RN, RM, MN

Level II RLE Coordinator, College of Nursing

Doroteo S. Dizon, RN, MAN

Research Coordinator, College of Nursing

Approved by:

Zenaida S. Fernandez, RN, PhD

Dean, College of Nursing
 ANGELES UNIVERSITY FOUNDATION
Angeles City
College of Nursing

ORAL PRESENTATION RUBRIC (20 Points)

Learner: Final Score:

Date of Evaluation: Section: Group No.

CRITERIA EXEMPLARY ACCOMPLISHED DEVELOPING BEGINNING LAUNCHING SCORE

Overall Presents TOPIC effectively according to: Presents the TOPIC with Presents the Topic with Presents the TOPIC None is presented
Presentation minimal inconsistencies noticeable inconsistencies with major/ grave
Quality 1. Clarity and organization of according to: according to: inconsistencies
presentation aids according to:
2. Communication skills 1. Clarity and organization of 1. Clarity and organization
presentation aids of presentation aids 1. Clarity and
2. Communication skills 2. Communication skills organization of
presentation aids
2. Communication
6 points 3 points skills
Assigned
Weight: 4.5 points
1.5 points
6 Points
0 point

Quality of Responses are accurate and complete Responses are mostly Responses are Responses are mostly No response
Responses to that reflect in-depth knowledge of the complete and accurate that ocassionally incomplete incomplete and
Questions in topic. reflect adequate knowledge of and inaccurate that reflect a inaccurate that reflect
terms of the topic. basic/ baseline knowledge inadequate knowledge
Subject of the topic of the topic
Knowledge
 Assigned
Weight:
6 points 3 points
6 Points
4.5 points 1.5 points

0 point

Quality of Ability to answer questions reflects well- Ability to answer questions Ability to answer questions Ability to answer No answer
Responses to developed critical thinking skills owing reflects fairly developed critical reflects poorly-developed questions does not
Questions in to a thorough comprehension of the thinking skills owing to a critical thinking skills reflect critical thinking
terms of topic partial comprehension of the owing to an occasional skills owing to a lack
Critical topic lack of comprehension of of comprehension of
Thinking Skills the topic the topic

Assigned
Weight:
6 points
6 Points
3 points
4.5 points
1.5 points

0 point
 Attitude to Deals with criticisms positively with a Somewhat deals with criticisms Deals with criticisms Deals with most Deals with all criticisms
Criticisms commendable attitude positively with a receptive positively with occasional criticisms negatively negatively with a defensive
attitude negative responses and a with a defensive attitude attitude
tendency towards a
defensive attitude
0 point

Assigned
Weight: 1 point
2 points
2 Points 0.5 point

1.5 points

Computation Guidelines:
1. There are four (4) criteria on this rubric. Each criterion carries a specific weight reflective of its relative importance to the other criteria.
2. Similarly, there is a pre-assigned weight or point on each category (e.g. exemplary, developing) of a given criterion. You CANNOT assign
a score that is between categories.
3. The highest possible score on this activity is 20 points.
Prepared by:
Alfredo Z. Feliciano, RN, PhD
Assistant Professor, College of Nursing
Reviewed by:

Angela P. Apostol, RN, MN

Level III RLE Coordinator, College of Nursing

Brenda B. Policarpio, RN, RM, MN

Level II RLE Coordinator, College of Nursing
Doroteo S. Dizon, RN, MAN
Research Coordinator, College of Nursing

Approved by:

Zenaida S. Fernandez, RN, PhD

Dean, College of Nursing