DS 212 Syllabus - Chattanooga State Community...

CHATTANOOGA STATE COMMUNITY COLLEGE CHATTANOOGA, TENNESSEE

DIVISION OF NURSING & ALLIED HEALTH DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM

COURSE SYLLABUS US 212 – Obstetrics & Gynecology II

Class Hours: 2 Credit Hours: 2 Laboratory Hours: 1

Semester: SPRING 2011 Dates: 01/18/11-04/26/11, EVERY OTHER Tuesday & 1 Lab Wed. each month Times: Class on Tues. 1:00-5:00 p.m. / Lab on designated Weds. 1:00-5:00 p.m. Course & Lab Instructor: Jody Arnold Hancock, MAEd, RDMS, RVT, RT(R) Voice Mail: (423)697-3341 E-Mail: [email protected] Fax No.: (423)697-3324 Office: Chatt. State HPF Building, Office 177 Office Hours: M-F, 8:30 a.m.-5:00 p.m. (unless clinic travel or class) Additional Lab Instructor: Lori Robinson, AS, RDCS, RDMS, RVT, RT(R,CT) Voice Mail: (423)697-3262 E-Mail: [email protected] Fax No.: (423)697-3324 Office: Chatt. State HPF Building, Office 180 Office Hours: M-F, 8:30 a.m.-5:00 p.m. (unless clinic travel or class)

CATALOG COURSE DESCRIPTION: The second of a three-course sequence; the role of ultrasound in the evaluation of fetal anatomy will be the main topic of discussion. The student will learn to estimate gestational age through fetal biometry techniques. Detection of fetal anomalies and intrauterine growth retardation and their management are addressed. The student will learn transabdominal and transvaginal techniques for assessing early intrauterine and ectopic pregnancies. ENTRY LEVEL STANDARDS: Successful completion of US 202, as documented by a minimum grade of "C" in the course, as well as proper demonstration of patient care within the clinical environment and good relational abilities between didactical coursework and actual clinical involvement of these principles. In addition, the student should demonstrate a responsible attitude toward attendance, independent learning activities, classroom and clinical participation, and course preparation. The student should be computer literate and capable of navigating a Web site. OTHER COURSE REQUIREMENTS: The student should have access to the Internet to gather topic assignments. Networked computers are available for student use on campus, including in the sonography computer laboratory and the library. Students wishing to become proctored on exams between classes may do so with an approved clinical proctor. This process will require access to a computer with an Internet connection at the clinical facility, as well as the ability to download the Respondus Lockdown browser to access the exam through the Chattanooga State Distributed Education Web site. PREREQUISITE: US 202, with a minimum grade of “C” COREQUISITES: US 210, US 211, US 213, and US 215.

mailto:[email protected]�

2 Rev. 09/10 SACS / jh

TEXTBOOKS & RESOURCES FOR COURSE: 1. Curry, Tempkin (2004). Sonography: An Introduction to Normal Structure and Functional Anatomy, 2nd ed.

Philadelphia: W.B. Saunders & Co. 2. Curry, Tempkin (2004). Exercises in Sonographv: An Introduction to Normal Structure and Functional Anatomv,

2nd ed. Philadelphia: W.B. Saunders & Co. 3. Hagen-Ansert, S. (2006). Textbook of Diagnostic Ultrasonographv., Vol. One & Two, 6th ed. St. Louis: Mosby

Elsevier. 4. Tempkin, B. (1999). Ultrasound Scanning: Principles and Protocols , 2nd ed. Philadelphia: W.B. Saunders & Co. 5. Hickey, Goldberg (1999). Ultrasound Review of Obstetrics and Gvnecologv. Philadelphia: Lippincott-Raven. COURSE DELIVERY FORMAT:

Hybrid Format – This format requires significant online activity. Students in hybrid classes must access course content and assessments using the Internet in order to pass the class, whether it meets full-time or part-time in the classroom. Faculty need not hand out a copy of the syllabus and any other required course material, including their contact information.

PRESENTATION METHODS:

♦ PowerPoint Presentations ♦ Reading Assignments ♦ Instructor-Led Reviews ♦ Student-Directed Reviews ♦ Multimedia / Computer-Directed Aids ♦ Textbook & Worksheet Exercises – Both Independent Study & Instructor-Led ♦ Laboratories for Simulations and Practical Clinical Correlation

OUTCOMES & OBJECTIVES

ISLOs - INSTITUTIONAL STUDENT LEVEL OUTCOMES: Specific definitions of each may be found in your Program Handbook. Graduates of the accredited diagnostic medical sonography programs will demonstrate reflective outcomes related to knowledge, skills and attitudes that a community college graduate is expected to develop, to include:

ISLO1. Effective Communication ISLO2. Critical Thinking and Analytical Skills ISLO3. Information Technology Skills ISLO4. Societal & Cultural Awareness ISLO5. Foundational Knowledge in a Specialty ISLO6. Work Ethic

PSLOs - PROGRAM STUDENT LEVEL OUTCOMES: This course is offered in conjunction with other pre-requisite and/or co-requisite courses as part of the accredited sonography program. At the end of the program year, the student will demonstrate mastery of the following knowledge, skills, attitudes and/or values as related to all program learning.

PSLO1. Obtain, review, and integrate pertinent patient history and supporting clinical data to facilitate optimum diagnostic results. (RELATES TO ISLO 5)

PSLO2. Perform appropriate procedures and record anatomic, pathologic, and/or physiologic data for interpretation by a physician. (RELATES TO ISLO 5)

PSLO3. Record, analyze, and process diagnostic data and other pertinent observations made during the procedure for presentation to the interpreting physician. (RELATES TO ISLO 3)

PSLO4. Exercise discretion and judgment in the performance of sonographic and/or other diagnostic services. (RELATES TO ISLO 2)


PSLO5. Demonstrate appropriate communication skills with patients and colleagues. (RELATES TO ISLO 1)

PSLO6. Act in a professional and ethical manner. (RELATES TO ISLO 6) PSLO7. Provide patient education related to medical ultrasound and/or other diagnostic vascular

techniques, and promote principles of good health. (RELATES TO ISLO 4)

CSLOs - COURSE STUDENT LEVEL OUTCOMES: To be better prepared to interact and function in the sonography department upon course completion, the student will achieve the following course outcomes.

CSLO1. Sonographically assess early intrauterine pregnancies for normality and proper development. (RELATES TO PSLO 2)

CSLO2. Assess both clinically and sonographically any complications related to early pregnancies, including ectopic gestations. (RELATES TO PSLO 1)

CSLO3. Sonographically evaluate normal fetal anatomy at different developmental stages of progress. (RELATES TO PSLO 2)

CSLO4. Biometrically assess fetal growth and development through sonographic technique. (RELATES TO PSLO 3)

CSLO5. Physically assess fetal growth and development through sonographic technique. (RELATES TO PSLO 4)

CSLO6. Develop proper sonographic techniques for assessment of high-risk pregnancy factors. (RELATES TO PSLO 2)

CSLO7. Use proper detection and management methods in assessing for fetal intrauterine growth restriction (IUGR). (RELATES TO PSLO 7)

LEARNING INDICATORS AND OBJECTIVES: These objectives assist in assuring the student will be better prepared to interact and function in the sonography department upon course completion. These learning indicators have also been included, and expanded upon, within the Instructional Objectives of each Topic section of this syllabus, to correlate with assignments for the purpose of focused student comprehension.

LO1. Assess patient indications and clinical considerations for first trimester sonographic examinations. (CSLO 1)

LO2. Identify absolute and potential events, by their anticipated time periods of early pregnancy, as related to sonographic representation. (CSLO 1)

LO3. Differentiate the specific meanings, by complications and presentations, of various types of abortions as potential events of pregnancy. (CSLO 2)

LO4. Demonstrate the usefulness of sonography in the diagnosis and treatment of variant presentations in pregnancy (e.g., cervical incompetence, hydatidiform mole). (CSLO 2)

LO5. Provide a complete assessment for ectopic pregnancy, to include patient history and clinical, laboratory and sonographic considerations. (CSLO 2)

LO6. Establish discriminatory hCG levels for both TAS and TVS assessment of early pregnancy, to assist in the determination of normal versus abnormal presentation. (CSLO 2)

LO7. Differentiate various types of ectopic pregnancy locations and presentations. (CSLO 2) LO8. Reconsider the female post-menarchal cycle, specifically related to deciualization and

hormonal influence of early pregnancy. (CSLO 1) LO9. Designate anticipated normal anatomic and sonographic findings associated with embryonic and

fetal development. (CSLO 3) LO10. Describe various sonographic scan techniques to assure appropriate visualization of fetal and

extraembryonic structures for anatomic, physiologic, and biometric assessment. (CSLO 5) LO11. Score a biophysical profile (BPP) assessment according to biologic, physiologic, and measurement

considerations for fetal well-being. (CSLO 4) LO12. Define sonography’s role in the assessment and management of high risk pregnancies. (CSLO 6) LO13. Sonographically and clinically differentiate types and presentation variations of multiple

gestations. (CSLO 6) LO14. Sonographically and clinically assess for intrauterine growth restriction (IUGR), relating findings

to prior learning on high risk assessment and BPP, while building upon this base knowledge specific to Doppler indices. (CSLO 7)


REQUIRED ASSESSMENTS

Syllabus Review Submit Syllabus Acknowledgement Statement

ISLO 1

Laboratory Detail Fulfillment of Lab Duty Assignment (e.g., Clean up, laundry)

ISLO 4

Topic 1 Objectives Part 1 Instructional Objectives in Syllabus LO 1, 2

LO 3-7 CSLO 1 CSLO 2

PSLO 2 PSLO 1

ISLO 5

Topic 1 Workbook Curry & Tempkin workbook, Ch. 17 LO 2 LO 4

CSLO 1 CSLO 3

PSLO 2 ISLO 5

Voluntary Case Study Early intrauterine pregnancy (IUP) – bring case write-up & images to share

LO 1 LO 4

CSLO 1 CSLO 2

PSLO 2 PSLO 1

ISLO 5

Topic 2 Objectives Part 2 Instructional Objectives in Syllabus LO 6

LO 8 LO 9

CSLO 2 CSLO 1 CSLO 3

PSLO 1 PLSO 2

ISLO 5

Topics 1 & 2 Review Sheet

Complete Review Sheet on Topics 1 & 2 (submit in dropbox for grade)

LO 1, 2 LO 3, 4

CSLO 1 CSLO 2

PSLO 2 PSLO 1 ISLO 5

Laboratory 1

Activity 1: CD-Rom – ADAM 9-month miracle: Conception thru Month 3 (Submit outline of each section for credit)

LO 1, 2 LO 9 LO 6


PSLO 2

PSLO 1 ISLO 5

Laboratory 1 Activity 2: TV/Early OB C1 Cases 3 & 1 completed on Simulator (Printed Cases will provide assessment grade)

LO 4 LO 9

LO 10


PSLO 1 PSLO 2 PSLO 4

ISLO 5

ISLO 2

Laboratory 1 Activity 3: Early OB Diagram Post-Test Grade (Pre-Test will be given first for study)

LO 2 LO 8

CSLO 1 PSLO 2 ISLO 5

Laboratory 1 Activity 4: Videotape – Gulfcoast: Early OB Scanning (Student to submit worksheet quiz answers for grade)

LO 1, 2, 8 LO 9

LO 3, 4, 6


PSLO 2

PSLO 1 ISLO 5

Protocol Assignment

Early OB Protocol Cards (Follow instructions on Early OB Protocol Handout; graded based on Protocol Card Assessment Tool)

LO 2, 8 LO 9 LO 6

LO 10

CSLO 1

CSLO 2 CSLO 5

PSLO 2

PSLO 1 PSLO 4

ISLO 5

ISLO 2

Topic 3 Ectopic Case Study Objectives

Information due at time of Ectopic Case Lab (student presentations & discussion) LO 5 CSLO 2 PSLO 1 ISLO 5

Topic 3 Objectives Part 3 Instructional Objectives in Syllabus LO 4 CSLO 2 PSLO 1 ISLO 5

Topic 3 Review Sheet Complete Review Sheet on Topic 3 (submit in dropbox for grade)

LO 5, 6, 7 CSLO 2 PSLO 1 ISLO 5

Laboratory 2a

Activity 1: TAS Pelvic Review Scan Lab – compare endometrial/ovarian phases; review pelvic muscles (bring clinic manual if wish to complete simulation)

LO 8 CSLO 1 PSLO 2 ISLO 5

Laboratory 2a Activity 2: Female Pelvis Review Quiz (submit for grade)


Mandatory Case Study for Lab 2b

Activity 1: Ectopic Case – bring case write-up and images to share (attempt to obtain hCG levels)

LO 5 LO 6


Laboratory 2b

Activity 2: Early OB Simulation cases: Ectopic, Hydatidiform mole + bonus case for student interpretation (Printed cases w/ bonus answer will provide assessment

LO 4, 7 CSLO 2 PSLO 1 ISLO 5


grade)

Laboratory 2b Activity 3: IAME Internet Lab: Ectopic Pregnancy (Submit quiz grade in dropbox. Do NOT pay for CME.)

LO 4, 6, 7 LO 8

LO 13


PSLO 1 PSLO 2

ISLO 5

Exam 1

Covers Topics & Materials on: Topic 1 – Embryologic Development Topic 2 – Early Intrauterine Pregnancy Topic 3 – Ectopic Pregnancies

LO 1, 2, 8, 9

LO 13 LO 3-7 LO 10

CSLO 1, 3


PSLO 2

PSLO 1 PSLO 4

ISLO 5

ISLO 2


LO 9 CSLO 2 CSLO 3

PSLO 1 PSLO 2

ISLO 5

Topic 4 Workbook Curry & Tempkin workbook, Ch. 18

LO 2 LO 9

LO 10


PSLO 2

PSLO 4

ISLO 5

ISLO 2

Laboratory 3

Activity 1: CD-Rom – ADAM 9-month miracle: Months 4-6 (Submit outline of each section for credit)

LO 1, 2 LO 9

LO 13 LO 6

LO 10

CSLO 1 CSLO 3 CSLO 6 CSLO 2 CSLO 5

PSLO 2

PSLO 1 PSLO 4

ISLO 5

ISLO 2

Laboratory 3

Activity 2: OB P2 Case 9 (w/ student impression of diagnosis) & Case 8 completed on Simulator (Printed Cases will provide assessment grade)

LO 2 LO 9 LO 4


PSLO 2

PSLO 1 ISLO 5

Laboratory 3

Activity 3: Video – SDMS OB (submit an outline of key points for grade)

LO 1, 2 LO 9

LO 13 LO 6

LO 10

CSLO 1 CSLO 3 CSLO 6 CSLO 2 CSLO 5

PSLO 2

PSLO 1 PSLO 4

ISLO 5

ISLO 2

Laboratory 3 Activity 4: Internet Lab – Late OB (Follow Instructions & Submit Answers on Handout)

LO 2 LO 9

LO 10


PSLO 2

PSLO 4

ISLO 5

ISLO 2

Protocol Assignment

Late OB Protocol Cards (Follow instructions on Late OB Protocol List Handout; graded based on Protocol Card Assessment Tool)

LO 9 LO 10

CSLO 3 CSLO 5

PSLO 2 PSLO 4

ISLO 5 ISLO 2


LO 10 CSLO 3 CSLO 5

PSLO 2 PSLO 4

ISLO 5 ISLO 2


LO 11 CSLO 3 CSLO 4

PSLO 2 PSLO 3

ISLO 5 ISLO 3

Laboratory 4

Activity 1: Interactive CD/Rom – SilverPlatter OB Principles: 4 cases, hands-on group participation (sign activity sheet for completion credit)

LO 1 LO 12 LO 4

LO 10

CSLO 1 CSLO 6 CSLO 2 CSLO 5

PSLO 2

PSLO 1 PSLO 4

ISLO 5

ISLO 2

Laboratory 4 Activity 2: CD-Rom – ADAM 9-month miracle: Months 7-9 (Submit outline of each section for credit)

LO 9 LO 12 LO 10


PSLO 2

PSLO 4

ISLO 5

ISLO 2

Laboratory 4 Activity 3: Group demo w/ instructor – Assess Quadruplets case (labeled “Triplets”) & Hydrops case

LO 12 LO 13


Laboratory 4

Activity 4: Late OB Simulation Case 8/Abnormal Triplets (Printed Cases WITH STUDENT’S DIAGNOSTIC IMPRESSION will provide assessment grade)

LO 12 LO 13



Exam 2

Covers Topics & Materials on: Topic 4 – Normal Fetal Anatomical Img. Topic 5 – Fetal Biometry Topic 6 – Fetal Growth & BPP

LO 1, 2 LO 9

LO 12, 13 LO 4

LO 10 LO 11

CSLO 1 CSLO 3 CSLO 6 CSLO 2 CSLO 5 CSLO 4

PSLO 2


ISLO 5

ISLO 2 ISLO 3

Voluntary Case Study Multiple Gestation – bring case write-up & images to share


Topic 7 Quiz Twin Quiz – submit WITH Part 7 Instructional Objectives (will be graded as a portion of objectives)



LO 12, 13 CSLO 2 CSLO 6

PSLO 1 PSLO 2

ISLO 5

Topic 7 Workbook Curry & Tempkin workbook, Ch. 19 LO 11

LO 12, 13 LO 14



ISLO 3 ISLO 5 ISLO 4

Topic 8 Objectives Part 8 Instructional Objectives in Syllabus LO 14 CSLO 7 PSLO 7 ISLO 4

Laboratory 5 Activity 1: Internet Lab - IUGR (submit to dropbox for grading)


Laboratory 5 Activity 2: Internet Lab – BPP (submit graded score to dropbox)


Laboratory 5 Activity 3: Internet Lab – Twin Growth (submit graded score to dropbox)

LO 12 LO 13


Laboratory 5 Activity 4: Late OB Simulation P1 Case 5 & P2 Cases 8 & 2 (Printed Cases will provide assessment grade)


Exam 3 / Final Exam

Covers Topics & Materials on: Topic 7 – High Risk Pregnancy Topic 8 – Detection & Mgmt of IUGR

LO 1 LO 12, 13

LO 4 LO 10 LO 11 LO 14

CSLO 1 CSLO 6 CSLO 2 CSLO 5 CSLO 4 CSLO 7

PSLO 2

PSLO 1 PSLO 4 PSLO 3 PSLO 7

ISLO 5

ISLO 2 ISLO 3 ISLO 4

EXAMS:

Three (3) Non-Cumulative objective exams – 75% of final course grade All test scores will be calculated as – 25% each of the final grade All exam scores, however, MUST be passing (70% or higher) /or/ remediation will be expected.*

Note that the Final Exam is NOT comprehensive (although all materials comprehensively build upon one another throughout the semester). The final exam is the 3rd non-cumulative exam.

The student will be tested on comprehension of anatomic, physiologic, and pathologic processes, as well as patient scanning and care considerations of the obstetrical and limited pelvic procedures, as related to sonography. *Remediation of an exam must take place if the student does not pass the exam with a score of 70% or greater. The policy of the CSTCC DMS program is to allow remediation of one(1) non-cumulative exam per course. This means that:

• When a final exam is cumulative, it is not eligible for remediation. (The student must pass with a minimum score of 70% to progress to the next course or to complete the program if the course exists in the final semester.)

• If a student has already remediated an exam during this same course, the student is no longer eligible for additional remediation within the specified course. (Students will continue to be eligible for a one-time remediation within another course during the same semester, however.)

• When sitting for a remediation exam, the student is expected to achieve a minimum score of 80% in order


to progress to the next course or to complete the program if the course exists in the final semester.

• Although the student is allowed the opportunity for remediation for the sake of progression, the student’s original exam grade will be posted for final grade calculation purposes.

Students who do not pass the remediation attempt with a minimum score of 80%, or students who have already remediated and do not achieve a minimum score of 70% on a following examination will not be allowed to progress in the course or program. Such students will have the opportunity to apply for readmission to the program during the following program year. LABORATORY AND HOMEWORK EXPECTATIONS:

1. Demonstrations/Simulations, where applicable. Laboratories will be conducted to correspond with presentations, protocols and homework assignments.

2. Each student will create and maintain a protocol booklet of images for early and late OB/Gyn procedures, which will count towards 5% of the final grade.

3. There is an exercise manual that students will complete to correspond to lab and lecture sessions, as part of homework. These are listed in the topic overviews for each section and will count as 5% of the final student grade.

4. Laboratory/simulation scanning participation and multimedia assignments will be graded for a portion of the laboratory grade, which consists as 10% of the student’s final grade.

FIELD WORK: Clinical correlation should be made to all instructional learning, with clinical assignments often given as or related to homework throughout the program. Students may be asked to present cases or bring case information into the classroom setting. HIPAA Regulations must be adhered to in such instances, with the HIPAA Privacy Statement submitted with the case, and the Case Rubric utilized if a full case is assigned by the instructor. These forms are located in your Syllabus following the Syllabus Acknowledgement Statement.

In many instances, you may use a full case work-up in this course as a required clinical case study assignment AFTER it has been presented in class. However, you must bring the cases for this course to your class session with you, so do NOT expect to turn in the same case for clinical requirements during the same class week, as clinical assignments are due on Monday mornings and students should not expect to have them returned. OBJECTIVES: Students will be expected to perform objectives located within the topic overviews for each section INDEPENDENTLY, in addition to other chapter objectives that may also be assigned. These objectives will be turned in prior to each exam that correlates to this material in the student’s dropbox (either online or on campus). Objectives completion directly assists in preparing the student for the assessment on related material, so these MUST be completed. The student should consider these as the “Entrance Ticket” to your exam. The instructor reserves the right to refuse the student entrance to the exam without first submitting these objectives. Note that the student should preferably use the online dropbox and only use the on-campus one if online submission is not available or achievable. (The student should choose only one means or the other of submission; do not duplicate assignment submission into both places, please.) In this course, additional credit may be assigned to a specific topic portion of instructional objectives when a student completes and presents a voluntary case study. Mandatory case studies receive their own grades. OTHER EVALUATION METHODS: Attendance and Participation will be taken into consideration when assigning the final grade, with points being deducted for unexcused absenteesim or tardiness. The instructor reserves the right to adjust grades according to these or other considerations (i.e. participation, disruption, etc.). Attendance and other relevant classroom policies are specifically addressed in the DMS Student Handbook, where the student has previously given signature to an understanding and acceptance of these policies.


COURSE GRADING & GRADING SCALE: EXAM 1 25% EXAM 2 25% EXAM 3 25% LABORATORIES 10% PROTOCOL CARDS 5% WORKBOOK ASSIGNMENTS 5% OBJECTIVES COMPLETION 5% The final grades of A, B, C, D, or F will be assigned on the basis of the numerical average determined by the assignments listed above with the following point ranges: A (90-100) B (80-89) C (70-79) D (65-69) F (64 or less) In the event that a student fails an exam and has exhausted all remediation attempts, the student will NOT be awarded a grade higher than a D, regardless of how the numeric grade would otherwise calculate. Students must successfully complete all work with passing competency grades for each assignment to achieve a minimum of a C in the course, thereby maintaining eligibility for program progression.

SYLLABUS STATEMENTS

STUDENT-INSTRUCTOR COMMUNICATION

All sonography program students are required to set up a TigerMail account and supply this official college email address to the program director at the beginning of the program year. Your director and/or instructor will use your TigerMail account to relay any program-specific information to you. The link to set up this account can be found on the campus TigerWeb home page, which will first require input of your Student campus ID (your “A” number) and setting up your own password.

Any email communications that are course-specific will be addressed by your instructor through the e-Learn (online course platform) email system. Your instructor(s) will demonstrate the use of this tool during your sonography orientation. Please utilize the e-Learn email system within your course when asking a course-specific question or submitting course-specific information to your instructor.

You may email your instructor at his/her Chattanooga State email address (rather than the e-Learn site) or call and leave a message on your instructor’s voice mail when your question or information is either program-specific or your course-specific question has not been answered according to the procedure established in the following paragraph.

It is my goal, as your sonography course instructor, to answer your emails and voice mails within 48 hours during the regular program week (Mon-Fri) and within 72 hours when a weekend is involved. However, please understand that the sonography program requires faculty to travel to clinic sites and other professional events (often for multiple consecutive days) as part of my program duties. I will continue to make reasonable attempts to check my email and/or voice mail within the stipulated timeframe above. However, in an emergency where you have not received an adequate response in a timely manner, please leave a message with our secretary at 423-697-3360, specifically explaining your need, so that she may attempt to reach me or someone else who can assist you immediately. Thank you.

*All Exams will count towards

the Final Grade. (No score will be

dropped.)


ASSIGNMENT GRADING

Students are asked to submit graded documents either within their Dropbox (online) or Inbox (on campus) by the designated due date. Your instructor will have submitted items graded no later than the following class week, where you will either receive confirmation of a grade in your Dropbox Comments (online) or your graded materials will be located in your Outbox (on campus). Your instructor will notify you of any grading delays beyond this standard, along with the anticipated time you may expect to receive your returned graded assignment.

Where instructor dates are provided (on the course online calendar, syllabus, lesson plans and/or in each topic segment), late work will be accepted only under extenuating circumstances and upon completion and submission of the Extension Request Form together with explanation and proof of need for an extension (i.e. doctors certificate, etc.). All accepted late assessment, regardless of cause, may be penalized.

If the course is not completed prior to the end of the term, the student will receive an Incomplete and will have two additional weeks into the following semester to complete the course work (unless the instructor has approved a later date in advance, due to approval of the extension request form). After such time, an Incomplete will be changed to a Failure of the course.

EXTENSION POLICY

Assignments will not be accepted after 2 weeks from the end of the assigned course week. Late assignments can only receive a maximum of 75% of the grade assigned. (Extreme extenuating circumstances, such as a health issue, may receive special consideration.)

ADA STATEMENT Students who have educational, psychological, and/or physical disabilities may be eligible for accommodations that provide equal access to educational programs and activities at Chattanooga State. These students should notify the instructor immediately, and should contact Disabilities Support Services within the first two weeks of the semester in order to discuss individual needs. The student must provide documentation of the disability so that reasonable accommodations can be requested in a timely manner. All students are expected to fulfill essential course requirements in order to receive a passing grade in a class, with or without reasonable accommodations. DISRUPTIVE STUDENTS The term “classroom disruption” means – student behavior that a reasonable person would view as substantially or repeatedly interfering with the activities of a class. A student who persists in disrupting a class will be directed by the faculty member to leave the classroom for the remainder of the class period. The student will be told the reason(s) for such action and given an opportunity to discuss the matter with the faculty member as soon as practical. The faculty member will promptly consult with the division dean and the college judicial officer. If a disruption is serious, and other reasonable measures have failed, the class may be adjourned, and the campus police summoned. Unauthorized use of any electronic device constitutes a disturbance. Also, if a student is concerned about the conduct of another student, he or she should please see the teacher, department head, or division dean. AFFIRMATIVE ACTION Students who feel that he or she has not received equal access to educational programming should contact the college affirmative action officer. ACADEMIC INTEGRITY/ACADEMIC HONESTY In their academic activities, students are expected to maintain high standards of honesty and integrity. Academic dishonesty is prohibited. Such conduct includes, but is not limited to, an attempt by one or more students to use unauthorized information in the taking of an exam, to submit as one's own work, themes, reports, drawings,

10 Rev. 09/10 SACS / jh

laboratory notes, computer programs, or other products prepared by another person, or to knowingly assist another student in obtaining or using unauthorized materials. Plagiarism, cheating, and other forms of academic dishonesty are prohibited. Students guilty of academic misconduct, either directly or indirectly through participation or assistance, are immediately responsible to the instructor of the class. In addition to other possible disciplinary sanctions, which may be imposed through the regular institutional procedures as a result of academic misconduct, the instructor has the authority to assign an "F" or zero for an activity or to assign an "F" for the course. SYLLABUS GUIDELINES STATEMENT

The instructor reserves the right to modify this syllabus in writing anytime during the course of the semester. This course is governed by the policies and procedures as stated in the current: • Chattanooga State Student Handbook • CSTCC Nursing/Allied Health Student Handbook • CSTCC Diagnostic Medical Sonography Student Handbook.

Additional or more specific guidelines may apply. PROGRAM POLICIES: This class is governed by the policies and procedures stated in the current Chattanooga State Diagnostic Medical Sonography Student Handbook. Additional or more specific guidelines may apply. COLLEGE POLICIES: This class is governed by the policies and procedures stated in the current Chattanooga State Student Handbook. Additional or more specific guidelines may apply.

STUDENT ACKNOWLEDGEMENT STATEMENT

By my signature below, I attest that I have received and reviewed the US 212 course syllabus for Spring ___________ . course no. Semester Year I understand the course requirements with regard to attendance, grading, objectives, course policies and procedures, including those regarding my conduct in this course. I agree to be held accountable for my performance and actions according to such requirements and also agree to the provisions of the Syllabus Guidelines Statement as written within the course syllabus. Student Name (Please Print): Student Signature: Date:

11 Rev. 09/10 SACS / jh

Chattanooga State Community College Diagnostic Medical Sonography Program

HIPAA Privacy Statement Related to Sharing of Case Study Information for Educational Purposes

Course #: Semester/Year: Case Study Title: Case Study #: Instructor: The submitted archived images/reports associated with this case study are to be used only by the ChSCC DMS/CVS Programs for case study information, according to the current HIPAA agreement that has been signed by all relevant parties. No portion is to be shared for any other purpose outside of the agreed upon scope to pursue academic knowledge for professional necessity. Any parties viewing such information are within this same instructional scope and also agree that no information about this patient or case will be discussed or used outside of this environment. Any cases remaining with the instructor will be stored in a case file that is either physically locked in the digital imaging room or file room storage facility or digitally stored on a password protected computer that will only be accessed by parties covered within the designated instructional scope OR will be disposed of in the same manner as all privacy records on campus. Any case study records returned to the student MUST be immediately returned to the clinical site from which they were released for use. The Student submitting this case should designate one of the following options, related to the extent of privacy information included:

� Submitted documents and/or images DO NOT contain any recognizable patient identification.

� Submitted documents and/or images DO NOT contain any recognizable facility identification.

� Submitted documents and/or images DO contain information that is recognizable but CANNOT be removed. The Data archiving/PACS system does NOT allow the removal of data or I am NOT provided with any alternate capability to hide patent information.

� The recognizable data is related to patient identification.

� The recognizable data is related to facility identification.

� Students are not permitted to remove Images/reports associated with case studies from this facility. Relevant Data pertaining to this case study must be reviewed on site by ChSCC faculty.

Student Signature: __________________________________Date of Signature:

12 Rev. 09/10 SACS / jh

Chattanooga State Community College Diagnostic Medical Sonography Program

Case Study Assessment Guide

Criteria 17 15 13 11 Points

Indications/ Presenting Symptoms

Completeness of case history to include:

Age, gender, presentation of

symptoms/indications, and prior diagnosis or

problems.

Case history is

complete except one criterion is omitted.

Case history partially complete, two criteria

are omitted.

Limited Case history

included.

Sonographic

Findings

Excellent description of a specific US exam

(with submitted images) to include; US

appearance using appropriate medical

terminology to describe pathology/findings in students’ own words.

Very Good description of US findings and use

of terminology, however, one

abnormality is omitted. Appropriate images are

submitted.

Good description of US findings, however, one abnormality is omitted and/or inappropriate terminology is used.

Only a limited number of images are included.

US findings are limited to a copied radiology report. No images/few images are submitted.

Scanning Problems/

Caveats Involved and How These Were overcome

Scanning

caveats/problems are thoroughly discussed

along with a description of how these were

overcome.

Scanning

caveats/problems are discussed along with a limited description of

how these were overcome.

Scanning

caveats/problems are discussed along with no

description of how these were overcome.

Scanning caveats/ problems and a

description of how these were overcome were not discussed,

only limited entry, such as “no problems”

Applicability to

Present Didactical Studies

Student relates in

excellent detail how this case applies to their

present didactic studies.

Student relates in very good detail how this case applies to their


Student relates in good

detail how this case applies to their present

didactic studies.

Student relates in very limited detail how this case applies to their


New Clinical Applicability

Student relates in

excellent detail how new technology,

instrumentation or other procedures were used to obtain diagnosis for

this case.

Student relates in good

detail how new technology,


this case.

Student relates in

limited detail how new technology,


this case.

Student relates in very limited or no detail how

new technology, instrumentation or other procedures were used to obtain diagnosis for

this case.

Additional

Information

Excellent additional

information is gathered concerning this specific

case or pathology including (if available):

lab results, imaging reports and /or images from other modalities,

surgical notes, pathology reports, and research information

concerning the abnormality/pathology.

Good additional


case or pathology to including (if available):

lab results, imaging reports and /or images from other modalities,

surgical notes, pathology reports, and research information

concerning the abnormality/pathology.

Additional information is

gathered concerning this specific case or

pathology including (if available): lab results,

imaging reports and /or images from other modalities, surgical

notes, pathology reports, and research

information concerning the abnormality

/pathology.

Only limited additional


case or pathology.

Total →

13 Rev. 09/10 SACS / jh

UNIT 1 EMBRYOLOGIC DEVELOPMENT Reading Assignment: Curry & Tempkin text, Ch. 17 Ansert text, Ch. 41 Homework Assignment: Curry & Tempkin workbook, Ch. 17 Instructional Objectives (Due prior to Exam 1 Administration) Related Laboratory: 1st trimester OB protocol; videotape worksheets; -Begin menstrual cycle charts Complications Related to Early Pregnancy Instructional Objectives:

1. List the recommended indications for sonographic examination during the first trimester. (LO 1) 2. Provide a brief differential descriptive of each of the following types of evidence for pregnancy: (LO 1)

a. Presumptive b. Probable c. Positive

3. Provide at least three (3) differing factors of TA to TV scanning considerations. (LO 1) 4. Give the probable time period for blastocyst implantation into the decidua. (LO 2) 5. Identify the typical cause of painless spotting during the first few weeks of pregnancy. (LO 2) 6. Diagram the parts of the decidua during pregnancy. (LO 2) 7. Determine the decidual layers between which the double decidua sign is formed. (LO 2) 8. Differentiate cell components and the common location for each of the following: (LO 2)

a. Zygote b. Morula c. Blastocyst

9. Provide the likely hCG levels associated with normal pregnancy identification on: (LO 1) a. TV sonography b. TA sonography

10. Identify the components of the Gestational (Chorionic) sac. (LO 2) 11. Differentiate chorion frondosum from chorion laeve. (LO 2) 12. Differentiate between the meanings of: (LO 3)

a. Spontaneous AB b. Threatened AB c. Missed AB d. Inevitable AB e. Incomplete AB f. Complete AB g. Septic AB

13. Describe findings associated with an eventful (problematic) subchorionic hemorrhage. (LO 2) 14. Describe potential sonographic findings associated with an abortion in progress. (LO 3) 15. Briefly describe sonography’s usefulness in the diagnosis of cervical incompetence. (LO 4) 16. Define blighted ovum, including its association with the hydatidiform mole. (LO 4) 17. Differentiate the types of molar pregnancies. (LO 4) 18. List the common clinical symptoms associated with Ectopic pregnancy. (LO 5) 19. Provide the mIU/ml as discriminatory findings for: (LO 6)

a. TV sonography b. TA sonography

20. Describe the sonographic findings that must be present for a definitive diagnosis of Ectopic pregnancy. (LO 5) 21. Explain clues for which the sonographer searches to obtain the diagnosis of Interstitial (cornual) Ectopic

pregnancy. (LO 5)

14 Rev. 09/10 SACS / jh

22. Explain why heterotopic pregnancies are now more prevalent than in previous years. (LO 7) 23. Provide the term for the: (LO 7)

a. endometrium during pregnancy b. best sonographic measurement (that we hope to obtain) for dating purposes c. primitive placenta d. reaction creating a thick ring around the gestational sac e. ovarian cysts associated with a hydatidiform mole f. location where most Ectopic pregnancies occur g. fluid in the uterine cavity associated with an Ectopic pregnancy h. Most dangerous type of Ectopic pregnancy i. The differential diagnosis of cervical Ectopic pregnancy j. Embryotoxic treatment for Ectopic pregnancies

A. Fertilization 1. Fallopian tube (ampulla) 2. Morula 3. Blastocyst a. trophoblast (forms placenta) b. inner cell mass (forms embryo) c. blastocyst cavity B. Implantation 1. Attachment of blastocyst 2. Syncytiotrophoblast 3. Decidual reaction a. decidua basalis b. decidua capsularis c. decidua vera 4. Gestational sac a. yolk sac b. embryo c. amnion d. chorion 1. chorion laeve 2. chorion frondosum C. Complications of Implantation 1. Subchorionic hemorrhage 2. Threatened abortion a. missed AB b. incomplete AB 3. Blighted ovum 4. Hydaditiform mole a. causal explanation b. clinical presentation c. sonographic appearance d. related abnormalities 1. theca lutein cysts 2. coexisting twin e. follow-up treatment 5. Ectopic pregnancy a. causal explanation b. incidence of occurrence c. clinical presentation d. sonographic findings 1. pseudogestational sac 2. embryo outside of normal

15 Rev. 09/10 SACS / jh

implantation site 3. tubal damage 4. other findings e. treatment 6. Incompetent cervix

UNIT 2 Sonography in EARLY INTRAUTERINE PREGNANCY Reading Assignment: Hagen-Ansert text, Ch. 43, pp 983-997 Homework Assignment: Hagen-Ansert, Review Questions pg. 607, #1-9 -Bring Ectopic Case Study to Next Scheduled Lab! Sonographic Assessment of Early IUP Instructional Objectives: 1. Contrast the usefulness of imaging early pregnancies with transvaginal (TV) vs. transabdominal (TA) scanning techniques. (LO 8) 2. Explain the cause for occurrence of a corpus luteum cyst. (LO 8) 3. Describe fertilization/development from the point at which the ovum is swept into the tube to implantation. (LO 8) 4. Delineate between ‘menstrual age’ and ‘embryologic (or gestational) age.’ (LO 8) 5. Differentiate formations during the embryonic and fetal periods. (LO 8) 6. Name the three layers which can microscopically be identified in a trilaminar embryo. (LO 9) 7. Associate the beta hCG levels at the stages of visualization for an early gestational sac both transvaginally and transabdominally. (LO 6)

8. Distinguish between normal umbilical herniation from an abdominal wall defect, according to age and appearance. (LO 9) 9. At 9 postmenstrual weeks, name the structures filling the lateral ventricles. (LO 9) 10. Identify the membrane which encircles the embryo/fetus, approximating the timeframe when it joins with the chorion. (LO 9) 11. Recognize the time period that the placenta begins to supply hormones, while the corpus luteum is absorbed. (LO 9) 12. Equate the time period that the following are seen sonographically, utilizing the transabdominal technique: (LO 9) a. gestational sac d. embryo b. fetal pole e. yolk sac c. cardiac activity f. chorion frondosum 13. Explain the cause of the decidual reaction. (LO 8) 14. Name the first identifiable structure of an early gestation. (LO 9) 15. Name the embryologic components of the echogenic ring around the gestational sac. (LO 9) 16. Explain the purpose of the secondary yolk sac. (LO 9) 17. Identify the three(3) primary brain vesicles that develop after the 6th week of pregnancy. (LO 9) A. Guidelines for First Trimester Sonography 1. Review of ACR Guidelines 2. Documentation a. gestational sac 1. location

16 Rev. 09/10 SACS / jh

2. number of gestational sacs 3. size 4. shape 5. internal components a. yolk sac

b. crown-rump length 1. measurement a. dates b. fetal shape 2. accuracy 3. heart activity c. placental component b. uterus and cervix c. adnexal structures 1. ovaries a. location b. corpus luteum cyst 2. incidental findings a. fallopian tubes b. cul-de-sac c. miscellaneous B. Indications for Sonography in First Trimester 1. Establish IUP 2. Evaluate complicated early IUP 3. Detect fetal life 4. Localization of IUD's C. Sonographic Assessment Techniques 1. transabdominal 1. patient preparation 2. caveats 2. Transvaginal 1. visualization a. earlier b. increased resolution 2. patient care a. symptom: vaginal bleeding b. pediatric patient c. patient concerns

UNIT 3 Sonography of ECTOPIC PREGNANCIES Reading Assignment: Hagen-Ansert text, Ch. 44, pp 998-1013 Laboratory Assignment: ECTOPIC CASE STUDY PRESENTATION*. Include a patient history & description of findings. (NOTE: does not have to be an ectopic; may simply have been diagnosed as R/O ectopic) -RETURN MENSTRUAL CYCLE CHARTS. Related Laboratory: Pelvic Review Exam & Scanning; Menstrual Cycle Assessment/ Comparison; Pelvic Muscle Identification

17 Rev. 09/10 SACS / jh

Ectopic Laboratory *(Lab case study) Case Study Objectives: Sonographically identify an ectopic pregnancy, through: (LO 5) 1. clinical symptoms of an ectopic pregnancy (list): 2. beta hCG levels (describe common findings); 3. fluid which may be present in the endometrial cavity with an ectopic pregnancy, often mimicking a gestational sac (name); 4. identification of patients with the highest incidence of ectopic pregnancy; 5. identification of the two most common presenting symptoms of ectopic pregnancy (list these); 6. most common area of salpinx for ectopic pregnancy (name); 7. identification of positive sonographic findings (list these). Additional Instructional Objectives:

1. Sonographically describe the other complications of pregnancy that occur in the first trimester: (LO 4) a. Acrania b. Anencephaly c. Embryonic bradycardia d. Embryonic tachycardia e. Complete abortion f. Incomplete abortion (sonographic and hCG comparison with ectopic) g. Blighted ovum h. Hydaditiform mole (sonographic and hCG comparison with ectopic)

A. Incidence of Ectopic Pregnancies 1. Higher incidence patients a. salpingitis b. previous tubal surgery c. previous ectopic pregnancy d. intrauterine contracept. device use 2. Location of incidence a. 95% in fallopian tube b. highest percentage in ampulla c. very unlikely to be concurrent with IUP (unless on therapy) d. very unlikely in cervix (more likely to be AB in progress) e. most dangerous in interstitium B. Detecting an Ectopic Pregnancy 1. Similarities with an IUP a. decidual cast b. adnexal pain (c.l. cyst vs. e.p.) c. adnexal mass (" " " ") d. spotting e. faintness f. positive beta hCG test 2. Differences from an IUP a. significant lower abdominal pain b. sharp pain from rupture of tube c. syncope with shoulder pain d. pallor or hemorrhagic shock e. numerically low beta hCG C. Suggestive Findings in the Ultrasound Evaluation

18 Rev. 09/10 SACS / jh

1. ONLY One positive/definite diagnosis - gestational sac outside uterus containing: a. live embryo b. dead embryo with definitive yolk sac 2. Other determinations a. empty uterus w/ low beta hCG b. adnexal sac or ring c. adnexal mass, variable in size and morphology d. echogenic pelvic fluid e. pseudogestational sac D. Outcomes of Tubal Ectopic Pregnancies 1. Tubal resorption or abortion 2. Tubal rupture E. Recognizing an Interstitial Ectopic Pregnancy F. Treatment of Tubal Ectopic Pregnancy 1. Emergency laparotomy 2. Salpingostomy 3. In uncertainty, strict monitoring and measuring beta hCG G. Rare Ectopic Pregnancies 1. Heterotopic 3. Abdominal 4. Cervical 5. Ovarian

UNIT 4 NORMAL FETAL ANATOMICAL IMAGING Reading Assignment: Curry & Tempkin text, Ch. 18 Ansert text, Ch. 45, pp. 1015-1055 Homework Assignment: Curry & Tempkin workbook, Ch. 18 Fetal Anatomic Development Instructional Objectives: 1. Identify the echogenic mass within the lateral ventricle in a second trimester fetus. (LO 9) 2. Approximate the timeframe when the fetal kidneys first become sonographically visible. (LO 9) 3. Differentiate the appearance of the fetal kidneys between the second and third trimesters. (LO 9) 4. Define textural variations of the fetal lungs and liver. (LO 9) 5. Name the material which surrounds and supports the umbilical cord. (LO 9) 6. Name the normal component parts of an umbilical cord. (LO 9) 7. Explain the relationship of the amniotic fluid volume to the gastrointestinal and genitourinary tracts. (LO 9) 8. Describe the replacement which occurs when the amnion and chorion fuse. (LO 9) 9. Identify the midline structure of the fetal brain, about the level of the BPD measurement. (LO 9) 10. Discuss the value of real-time imaging for fetal assessment. (LO 9) 11. Describe the regulation process for amniotic fluid volume. (LO 9) 12. Briefly describe the placental grading classifications. (LO 9) 13. Explain the clinical significance of a small amount of fluid within the fetal scrotum. (LO 9) 14. Give the probable variabilities of bladder size, according to abnormal amniotic fluid volume conditions. (LO 9) 15. Supply possible reasons for nonvisualization of the fetal stomach. (LO 9)

19 Rev. 09/10 SACS / jh

16. Approximate the range for a normal fetal heart rate. (LO 9) 17. Describe what happens to the texture of the fetal lung tissue as the pregnancy progresses. 18. Illustrate the normal transverse appearance of the fetal spine. (LO 9) 19. Specify the intracranial anatomy which is present at the level which the biparietal diameter is performed. (LO 9) 20. Distinguish a complete breech from a footling breech. (LO 4) A. Scanning Techniques 1. Intrauterine survey a. fetal life 1. verify first 2. if demise, get second opinion b. fetal position c. number of fetuses d. amount of amniotic fluid e. presence placental masses f. identification of obvious anomalies 2. Extrauterine survey a. uterine masses b. ovarian masses, if visualized c. any surrounding abnormalities B. Fetoplacental Landmarks 1. Cranium a. occipitotransverse position 1. contour 2. intracranial anatomy a. interhemispheric fissure b. lateral ventricles b. caudal tilt of transducer (level of BPD) 1. midline echo complex 2. paired thalamus 3. third ventricle 4. cavum septum pellucidum 5. ant. horns of ventricles 6. area of corpus callosum c. further caudal tilt 1. cerebral peduncles 2. circle of Willis (colorflow) 3. cerebellar hemispheres 4. cisterna magna d. lower scanning level 1. orbital rings 2. nasal bones 3. cranial fossae 4. sphenoid bones 5. sella turcica 2. Face a. profile contour b. coronal plane 1. details of facial bones and soft tissue 2. facial expressions/movements 3. craniofacial anomalies (i.e. cleft lip)

20 Rev. 09/10 SACS / jh

3. Vertebral column a. sagittal plane 1. "railway" sign 2. cross-sect both laminae b. transverse plane 1. echogenic V-configuration 2. look for splaying and absence of posterior ossification ctr. 4. Thorax a. lungs 1. development a. size b. texture 1. early pregnancy - less echogenic 2. late pregnancy - more dense/echo- genetic c. location 2. breathing movements b. heart 1. movement 2. location 3. rate 4. rhythm 5. anatomical survey (chambers) c. bony landmarks of chest cavity 1. ribs 2. scapulae 3. clavicles d. diaphragm 1. contour a. curvilinear interface b. best visualized on rt. 2. demonstr. stomach inferior to e. vascular structures 1. great vessels 2. others 5. Upper abdominal quadrant a. hepatobiliary system 1. umbilical-left portal junction (level of abd. circumference) 2. liver 3. gallbladder, if visible b. great vessels c. spleen, esp. for Rh sensitization 6. Gastrointestinal system a. stomach 1. routinely identified as cystic 2. size variability b. bowel loops 7. Urinary system a. kidneys 1. lack distinctive borders in 2nd trimester 2. small amount of renal pelvis dilatation of no significance

21 Rev. 09/10 SACS / jh

3. appear very developed by 3rd trimester b. adrenals 1. cephalic to kidneys in transverse 2. seen after 20th week c. bladder 1. size variability 2. must be routinely identified 8. Genitalia a. clinical significance 1. sex-linked disorder 2. emotional impact-be careful!!! b. technique 9. Limbs a. movement b. long-bone measurements 1. detect of skeletal dysplasias 2. detect congenital formations c. anatomic configuration 10. Umbilical cord a. one umbilical vein 1. transports oxygenated blood from placenta 2. identify at insertion site b. two umbilical arteries 1. transport deoxygenated blood from fetus 2. one artery can signal anomaly c. surrounding structures 1. amnion 2. Wharton's jelly 11. Placenta a. position b. grade 12. Amniotic fluid a. functions b. volume variability c. regulation d. assessment methods

22 Rev. 09/10 SACS / jh

UNIT 5 FETAL BIOMETRY Reading Assignment: Hagen-Ansert text, Ch. 46 pp 1057-1073 Laboratory Assignment: -Fetal Scanning Assessments; videotape worksheets -Late trimester protocols & biometry Biometric Assessment Instructional Objectives: 1. Name the important rule of measurement of the long bones, having to do with the ossification centers. (LO 9) 2. Explain the main reason that long bone measurements should be taken proximally to the transducer, rather than distally. (LO 10) 3. Explain the inaccuracy of the crown rump length (CRL) after a certain developmental time period, identifying that period. (LO 10) 4. Identify the most commonly accepted fetal head measurement. (LO 10) 5. Describe the anatomic landmarks used to obtain a biparietal diameter and the technique used to accurately measure it. (LO 10) 6. Explain the caveats associated with variants in head shape for determination of fetal age. (LO 10) 7. Identify the head measurement/calculation which overcomes the problem(s) of objective #6. (LO 10) 8. Describe the calculation for determining the normality of fetal head shape. (LO 10) 9. Explain the usefulness of an abdominal circumference measurement. (LO 10) 10. Name the long bone measurement most commonly utilized, as well as its specific bony landmarks. (LO 10) 11. Explain Naegel's rule for determining the EDC. (LO 10) 12. Explain the technique utilized for biometrically analyzing the lateral ventricles for normalcy. (LO 10) 13. Describe the process for determining normal biometric values for fetal measurements. (LO 10) 14. Utilize appropriate fetal measurements according to their minimum/maximum dates (list and identify). (LO 10) 15. Identify the most accurate sonographic measurement used to establish gestational age, explaining why this is so. (LO 10) 16. Explain the usefulness of the head to abdominal circumference ratio. (LO 10) 17. Anatomically describe the proper location for the sonographer to perform an appropriate abdominal circumference measurement. (LO 10) 18. Describe instances where other non-traditional measurements should be used to provide additional clinical information. (LO 10) A. Review of First Trimester Growth Assessment 1. Gestational sac diameter a. begin at approx. 4 weeks b. not very accurate 2. Crown-rump length a. most accurate measurement b. 6-12 weeks 3. Biparietal diameter a. most accepted head measurement b. optimal between 17 and 26 weeks c. level of thalamus & cavum septi pell.

23 Rev. 09/10 SACS / jh

d. outer skull to inner skull 4. Head circumference a. level of BPD b. PPD and OFD - outer to outer; or c. ellipsoid diameter 5. Cephalic index a. overcomes head shape variabilities 1. dolicocephaly 2. brachiocephaly b. C.I. range = 75-85% 6. Long bone measurement - femur length a. accurate, though less than others 1. more measurement variability 2. growth factors b. full length of femur 1. anteriorly, without artifactual bowing 2. posterior shadowing 3. major trochanter to external condyle a. no femur head b. no distal epiphysis 7. Abdominal circumference a. useful as growth parameter b. measure at level of umbilical vein branching into left portal sinus ("J" formation); not at insertion level! c. keep abdomen more circular than oval (reduce compression) d. ellipsoid or AP and lateral outer to outer. 8. Comparison Growth Parameters a. HC/AC ratio b. estimated fetal weight c. FL/AC d. other 9. Specialized measurements a. orbits 1. ocular distance 2. binocular distance a. best predictor of age b. more relation with BPD c. lower plane than BPD d. outer to outer measurement e. useful when other growth parameters are affected 3. intraocular distance b. posterior fosse 1. cerebellum a. more accurate than BPD in certain situations b. measure widest diameter 2. cisterna magna a. measure frontal to occipital b. normal - less than 1 cm 10. Other age parameters a. ossification centers 1. distal femoral epiphysis oss. a. identified after 33 wks. 2. proximal tibial epiphyseal oss

24 Rev. 09/10 SACS / jh

a. identified after 35 wks. 3. look for presence of; no measurement taken b. fetal bowel changes - grading 1. 26-30 wks. - intestine has uniform gray appearance 2. 31-35 wks. - colon exhibits echo-free areas next to kidney 3. 36-37 wks. - transonic areas changing shape w/in abdomen; larger echo-free areas 4. 38+ wks. - colon redundant, w/ haustra; active sm. bowel movement c. amniotic fluid 1. amount 2. appearance d. placental grading

UNIT 6 FETAL GROWTH and BIOPHYSICAL ASSESSMENT Reading Assignment: Curry & Tempkin text, pp. 356-357 Hickey & Goldberg, p. 163 Biophysical Assessment Instructional Objectives: 1. Explain the usefulness/importance of the biophysical profile (BPP). (LO 11) 2. List the five biologic considerations of a BPP. (LO 11) 3. Explain the importance of documenting breathing and muscular movements of the fetus in a sonographic evaluation. (LO 11) 4. List the functions of amniotic fluid. (LO 9)

5. Describe why ultrasound is preferable in the determination of fetal demise over previous techniques. (LO 11)

A. Biophysical Profile 1. Biologic variables a. fetal breathing movement b. fetal motion c. amniotic fluid volume d. fetal tone e. non-stress test 2. Scoring process a. scored 0 to 2 for each (2 is best) b. below six, incr. risk for mortality 3. Utilization a. assess fetal well-being b. plan appropriate delivery time for IUGR/SGA fetus

25 Rev. 09/10 SACS / jh

UNIT 7 Ultrasound for the HIGH RISK PREGNANCY Reading Assignment: Hagen-Ansert text, Chap. 48, pp. 1086-1105 Curry & Tempkin text, Ch. 19 Homework Assignment: Curry & Tempkin workbook, Ch. 19 Related Laboratory: Case Study Impressions, -High Risk Videotape Series worksheets High Risk Pregnancies Instructional Objectives: 1. Complete the “Quiz on Twins.” (LO 13) 2. Identify the following facts about multiple gestations: (LO 13)

a. The most frequent type. b. The term for an intra-uterine pregnancy (IUP) and a co-existent extra-uterine pregnancy (EUP). c. Factors that may influence a multiple gestation. d. The term for a false vanishing twin caused by endometrial fluid. e. The number of placentas present in a di-chorionic gestation. f. The most dangerous chorionicity/amnionicity for a twin gestation.

3. Chart the contrasts of dizygotic and monozygotic pregnancies. (LO 13) 4. Correlate the timing (days) of division with the chorionic and amniotic findings for the monozygotic twin

gestation. (LO 13) 5. Describe the dynamics of the twin-to-twin transfusion syndrome, identifying useful sonographic

parameters of diagnosis. (LO 12) 6. Differentiate the appearance of the dizygotic membrane on sonography to that of the monozygotic

amniotic membrane, also mentioning the ease of distinguishing the difference early in pregnancy versus later in pregnancy. (LO 13)

7. Define sonography’s role as it is specifically related to the diagnosis of multiple gestation. (LO 13) 8. Describe specific Sonographic techniques for imaging twins. (LO 13) 9. Be prepared to identify types of twins based on chorionicity and amnionicity (suggestion: diagram them).

(LO 13) 10. Review White’s Classifications of Diabetes, contrasting types A-C with D and beyond. (LO 12) 11. List the three(3) factors that influence the prognosis of pregnancy in diabetes mellitus. (LO 12) 12. Identify the primary fetal risk of diabetes mellitus. (LO 12) 13. Contrast the fetal risk factors of Types A-C diabetic mothers to those risk factors of Types D and beyond.

(LO 12) 14. Define sonography’s role in the assessment of the diabetic patient during pregnancy. (LO 12) 15. List the three(3) main risk concern categories for hypertension in pregnancy. (LO 12) 16. Differentiate the diagnoses of chronic hypertension with pregnancy-induced hypertension (PIH), also

stating the one(1) exception to the “definitional rule.” (LO 12) 17. Name the three(3) factors present in pre-eclampsia. (LO 12) 18. Provide the absolute, unquestionable gestational age at which delivery WILL occur if the patient presents

with pre-eclampsia at this time period. (LO 12) 19. Explain why fetal lung maturity (FLM) is not as great of a concern for the hypertensive patient. (LO 12) 20. Name the most likely condition that occurs when a pre-eclampsia patient seizures. (LO 12) 21. Describe the structure of the pregnancy that is so greatly affected by complications of hypertension. (LO

12) 22. Describe sonography’s role in the assessment of the hypertensive patient during pregnancy. (LO 12) 23. Describe the physiology of Rh sensitization and the effect of anemia on the fetus. (LO 12)

26 Rev. 09/10 SACS / jh

24. Contrast immune and non-immune hydrops. (LO 12) 25. Describe sonography’s role in the assessment of hydrops. (LO 12) 26. Include a discussion of placental abruption, based on the following descriptors: (LO 12)

a. Clinical symptoms b. Causes c. Consequences d. Sonographic appearance

27. Discuss placenta previa according to its: (LO 12) a. Clinical symptoms (differentiate with the main symptom of abruption) b. Causes c. Consequences d. Sonographic detection considerations

28. Diagram the various types of previa. (LO 14) 29. Provide a definition for the term, PROM. (LO 12) 30. Define the time period associated with premature labor, also giving its occurrence rate and primary

associated fetal risk concerns. (LO 12) 31. Identify the factors most commonly associated with a breech presentation. (LO 12) A. Maternal Diseases of Pregnancy 1. Diabetes a. increased risk factors 1. macrosomia a. uncontrolled glucose levels b. difficult delivery 2. polyhydramnios a. poor glucose control b. noted by overly-enhanced and freely mobile fetus 3. enlarged placenta a. thickness greater- 5 cm b. enlargement due to nonimmunity of growth-enhancing effects of fetal insulin 4. unexplained stillbirth 5. congenital anomalies a. caudal regression syndrome b. heart and neural tube b. types of diabetes 1. insulin-dependent 2. non-insulin dependent 3. gestational 2. Hypertension a. associated findings 1. small placenta a. vascular hypertension b. restricted blood supply to fetus 2. preeclampsia a. high blood pressure b. proteinuria c. edema b. hypertensive states 1. pregnancy-induced 2. chronic 3. Other a. hyperemesis gravidarum

27 Rev. 09/10 SACS / jh

1. dehydration 2. electrolyte imbalance b. urinary tract disease c. physiologic cysts d. uterine fibroids B. Hydrops 1. Immune a. Rh isoimmunization 1. process 2. treatment a. amniocentesis zones b. transfusion methods 1. intraperitoneal 2. intravascular b. signs of hydrops 1. scalp edema 2. fetal ascites 3. effusions (peric. and pleur.) 4. polyhydramnios 5. enlarged placenta 6. increased umb. vein diameter 7. enlarged liver and spleen 2. Nonimmune a. mechanism unknown b. numerous associated disorders c. antibody screen to R/O Rh isoimm. d. cardiac lesions and anemia C. Placental Abnormalities 1. Abruption a. associated causes b. clinical signs 1. painful bleeding! 2. others c. sonographic presentation 1. retroplacental hematoma 2. elevation of membranes (early) 3. look for fetal distress! 2. Previa a. degrees of previa 1. complete 2. partial 3. marginal 4. low-lying placenta b. clinical signs 1. painless bleeding c. treatment options D. Labor and Delivery Factors 1. Premature labor a. common causes 1. premature rupture of membranes (PROM) a. conservative management b. active intervention 2. incompetent cervix 3. all others b. epidemiologic factors c. sonographic assistance 2. Fetal death

28 Rev. 09/10 SACS / jh

a. known causes b. incidence 1. according to trimester 2. according to maternal state a. diabetes b. hypertension c. judgment before advent of ultrasound 1. clinical signs 2. radiologic signs 3. External cephalic version (breech preg.) a. single gestation b. multiple gestation E. Multiple gestations 1. Risk factors a. maternal b. fetal 2. Clinical and sonographic determinations a. 1st trimester b. 2nd (or 3rd!) trimester 3. Types of twins a. monozygotic 1. diamniotic, dichorionic 2. diamniotic, monochorionic 3. monoamniotic, monochorionic a. VERY high risk b. ovum division after 13 days, conjoined b. dizygotic 1. ONLY diamniotic, dichorionic! 2. differentiate by locating membrane 3. demonstrate 2 placentas 4. Twin-to-twin transfusion a. monozygotic b. placental sharing 1. arterial-venous shunt 2. donor twin a. anemic b. growth-retarded c. oligohydramnios 5. Common sonographic findings a. dolicocephaly b. may seem SGA, so concentrate on corroboration of size and dates c. adjacent or fused placentas (should differentiate between 1 and 2) d. membrane! e. often opposite presentations f. pseudotwin g. twin demise 6. Techniques for imaging a. distinction of twins b. verification of multiple gestation c. awareness for abnormalities increase

29 Rev. 09/10 SACS / jh

UNIT 8 Detection and Management of INTRAUTERINE GROWTH RESTRICTION (IUGR)

Reading Assignment: Hagen-Ansert text, Ch. 47, pp 1074-1085 Hickey & Goldberg, p. 164 IUGR Instructional Objectives:

1. Differentiate the types of IUGR according to their growth patterns and characteristics of identification.

(LO 14) 2. Contrast and compare the meanings of the terms, IUGR and SGA. (LO 14) 3. List the three categorical origins (causes) of IUGR. (LO 14) 4. Describe the sonographic assessment parameters utilized in the diagnosis of IUGR. (LO 14) 5. Identify the fetal measurement parameter(s) that are most likely to be inaccurate in asymmetrical IUGR. 6. Differentiate biometric testing from biophysical testing. (LO 14) 7. Label the following components of a spectral Doppler wave signal on a diagram: (LO 14)

• Peak systole • Diastole • Diastolic notch • End diastole

8. Diagram normal Doppler samplings in late 2nd to early 3rd trimesters for the following vasculature: (LO 14) • Umbilical artery • Uterine artery • Fetal aorta • Middle cerebral artery

9. Diagram abnormal Doppler samplings in late 2nd to early 3rd trimesters for the vasculature listed in Objective 6. (A suggestion would be to make a table and demonstrate normal and abnormal for each vessel in a side-by-side comparison.) (LO 14)

10. Provide a written explanation of your abnormal findings, in very general terms. (LO 14) 11. Explain why the Doppler waveforms change from early gestation to later gestation. (LO 14) 12. Differentiate the calculation of a resistive index (RI) versus a pulsatility index (PI). (LO 14) 13. Identify the placental grade that would be of most concern when assessing a fetus for IUGR. (LO 14) 14. Explain the process of performing an AFI, as well as its abnormal measurement. (LO 14) 15. Clarify some of the measurement caveats (pitfalls) in the analysis for IUGR. (LO 14) 16. Contrast the care treatment provided for a patient whose Doppler findings have PED (present end

diastole) vs. AED (absent end diastole). (LO 14) 17. Sketch a growth analysis diagram of an IUGR measurement falling outside of the normal growth range

parameters. (LO 14) A. Types of Intrauterine Growth Restriction 1. Symmetrical a. small in all parameters b. causes may be assoc. with anomalies 2. Asymmetrical a. more common b. head size usually spared c. usually results from placental insufficiency d. begins 2nd to 3rd trimester B. Placental Effects 1. Early maturation 2. Increased ischemic reactions

30 Rev. 09/10 SACS / jh

3. Placental insufficiency C. Other Determining Factors 1. Doppler a. common vasculature studied 1. umbilical artery 2. uterine artery 3. fetal aorta

b. S:D ratios 1. normal fetus a. 6.5 at 16 wks. b. 2.5 at term 2. IUGR or poor risk fetuses a. increased resistance b. increased S:D ratios 2. CAUTION! - single BPD inaccurate for determining 3. Growth parameters very important

DS 212 Syllabus - Chattanooga State Community...

Documents

Transcript of DS 212 Syllabus - Chattanooga State Community...