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OB Exam one Chapters 1-5

by: Brianne Knight

OB Exam one Chapters 1-5 Nurs 3550

Brianne Knight

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Chapters are very detailed with information thats going to be on the test!
Nursing caring for adult childbearing family
Dr. Lancaster
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This 36 page Study Guide was uploaded by Brianne Knight on Monday February 15, 2016. The Study Guide belongs to Nurs 3550 at Middle Tennessee State University taught by Dr. Lancaster in Winter 2016. Since its upload, it has received 91 views. For similar materials see Nursing caring for adult childbearing family in Women and Gender studies at Middle Tennessee State University.

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Date Created: 02/15/16
Exam 1: Chapters 1-5 Maternal-Newborn and Women’s Health Nursing Chapter 1 Maternity and Women’s Health Care Today Historical Perspectives  Granny Midwives: birth the baby and took care of families ( No physicians)  Preferred attendant for wealthy was a midwife/ homebirth  Maternal and newborn death rates high both home/hospital  Primary causes for a woman: postpartum hemorrhage, Postpartum infection (puerperal sepsis/childbed fever), and toxemia (now known as preeclampsia or gestational hypertension).  Primary causes for newborn: prematurity, dehydration from diarrhea, and contagious disease. Medical Management Arrives th  Late 19 Century: decline on homebirth and increase in physician assisted. (developments that were available to physicians, but not always to midwives)  Discovery by Semmelewis that puerperal infection could be prevented by hygienic practices. o Development of forceps to facilitate birth o Discovery of Chloroform, which was used to control pain during childbirth and was available only to physicians o Use of drugs to start or induce labor and increase uterine contractions (augmentation of labor) o Advances in operative procedures such as cesarean birth with good intentions to prevent infections, hospitals hurried to develop policies and procedures to meet the needs of physicians and take advantage.  By 1960, 90% of births occurred in hospitals  Maternity care became highly regimented for most women. o Physicians managed all antepartum(before onset of labor), intrapartum( time of labor), and postpartum( first 6 weeks after childbirth) care. o The woman’s role on childbirth was seen as passive: The physician “delivered” the infant. o Primary function of Midwife were to assist the physician and follow prescribed medical orders after childbirth.  Unlike homebirths, hospital births hindered bonding between parents and infants.  Despite technologic advances and the move from home to hospital, maternal and infant mortality rates declined slowly. o The slow decline primarily resulted from problems that could have been prevented, such as poor malnutrition, infectious disease, and inadequate prenatal care. Food for Thought  Mary Breckinridge and Florence Nightingale  Mary pioneered the frontier Nursing Services-midwives in 1924-1925. Rural area in Kentucky  Recruited Nurses and taught them the basic concepts  She dropped the infant and mother mortality rate Government Involvement 2  Two concurrent trends, federal government involvement and consumer demands, led to additional changes in maternity care. o Cause of high rates of maternal and infant mortality  Sheppard-Towner Act of 1921, the first federally sponsored program, provide funds for state-managed programs for mothers and children. o Later repealed, it set the stage for future allocation of federal funds.  Ongoing problem of providing health care for women and children with inadequate health care coverage left the door open for pared nurses as certified nurse- midwives(CNMs), nurse practitioners, and clinical nurse specialists. Effects of Consumer Demands on Health Care  In the early 1950s, consumers began to insist on their right to be involved in their own health care. o Pregnant women were no longer willing to accept only what was offered.  Early in the 1950s, Dr. Grantly Dick-Read proposed a method of childbirth that allowed the mother to control her fear and thus control her pain during labor, allowing for birth without pharmacologic intervention.  Consensus among child psychologists and families that babies being away from mothers after birth is not good… dawning of… o Methods such as Lamaze and Bradley also gained favor. Family Centered Care  Families didn’t want the nursery setting 3 o Proven babies do better with mom and dad  Family-centered care describes safe, high-quality care that recognizes and adapts to both the physical and psychosocial needs of the family, including the newborn.  Goal is to foster family unity while maintaining physical safety  Developed in response that families wanted NO NURSERY  Follows the premise that children are usually a normal healthy event in life of a family and that childbirth affects the entire family  Family-Centered care greatly increased the responsibilities of nurses.  Nurses now assume a major role in teaching, counseling, and supporting families in their decisions about childbirth. Hospital vs. Birth Center vs Home  In the past, labor occurred in a functional labor room, similar too small hospital room or an emergency department room. o Move from the labor room to the delivery room just before the birth of the baby was particularly difficult for the mother. o Each move disrupted the family’s time together and often separated the parents and the infant. o Because of these disadvantages, hospitals began to devise settings that were more comfortable and enhanced family participation.  Labor, Delivery, and Recovery Rooms (LDR): the most common location for vaginal birth. o In an LDR room, normal labor, birth, and recovery from birth take place in one setting. 4 o LDR rooms are homelike, often with refrigerators, entertainment media, and soothing lightening. o The mother typically stays in the LDR room for 1-2 hours and then transferred to a postpartum room until her stay. o The healthy infant may remain with the mother throughout her stay in the LDR room, receiving continuing evaluation for adaption to neonatal life.  When the mother is transferred to her postpartum room, the infant may be transferred to the nursery for some mote extensive assessment or may remain with the mother in a mother-baby postpartum room while being assessed.  Some hospitals offer rooms similar to LDR rooms in layout and function, with exception that the mother is not transferred to a postpartum unit after recovery. o She and the infant remain in the Labor, Delivery, Recovery, Postpartum Room until discharge (LDRP)  Free standing Birth centers are designed to provide maternity care to low risk women outside a hospital setting.  Both the mother and the infant continue to receive follow- up care during the first 6 weeks after birth. o This may include help for breastfeeding problems, a postpartum examination at 4 to 6 weeks, family planning information, and examination of the newborn.  Birth Centers are less expensive compared with traditional hospitals, which provide advanced technology that may be unnecessary for low-risk women. 5  Main disadvantage is that most independent birth centers are not equipped for major obstetric emergencies.  Home Birth provides the advantage of keeping the family together in its own familiar environment throughout the childbirth experience.  Women who plan a home birth must be screened carefully to male sure that they have a very low risk for complications.  Need for parents to provide a setting and adequate supplies for the birth.  Moreover, the mother must take care of herself and the infant without the immediate help she would have in a hospital or birth center setting. Complementary and Alternative Medicine(CAM)  Its use is not restricted to recent immigrants to North America, although some techniques originated thousands of years ago in Eastern cultures.  CAM can be defined as those systems, practices, interventions, modalities, professions, therapies, applications, theories, and claims that are currently not an integral part of the conventional medical system in North America.  The therapies may be used alone (alternative therapy), combined with other therapies or used in addition to conventional medical therapy  Massage, chiropractic, acupuncture, herbal, homeopathy, naturopathic, aromatherapy  Safety is a major concern with the use of CAM.  Many people who use these techniques or substances are self-referred. 6  Some CAM therapies are harmful if combined with conventional medications or when taken in excess.  Also, many people may not consider some therapies as alternative because they are considered mainstream in their cultures. Family  Traditional families or nuclear families are headed by a father and mother who view parenting as a major priority in their lives and whose energies are less likely to be depleted by stressful conditions such as poverty, illness or substance abuse.  Nontraditional families are defined by their unique structure and may be single parent, blended, or extended. o Single-parent families: Millions of families are now headed by a single parent, most often the mother, who must function as a homemaker and caregiver and is often the major financial provider for the family’s needs.  Divorce is the most common cause of single parenting, although childbirth among unmarried women is also a factor.  Widowhood of the parent sometimes occurs as well o Blended families: are formed when divorced or widowed parents remarry and bring children from a previous marriage into the new relationship. o Extended families: includes members from at least three generations living under one roof. o This family structure is becoming increasingly common in the US and has given rise to the term boomerang families. 7 o Elderly parents may live with their adult children, or single if married adults with children of their own return to their parents’ home because they either are unable to support their families or want additional support that grandparents provide for grandchildren o Characteristics of a healthy family: communication, flexible, agree on basic principles of parenting, adaptable, mature, ask for help. o High risk families include those that live below poverty level, those headed by a single teenager parent, and those with unanticipated stress such as an infant who is preterm, ill, or handicapped. o In addition to families with lifestyle problems such as alcoholism, substance abuse, and family violence are considered at high risk for problems in providing adequate care for the infant.  May need specialized services that can provide comprehensive care. The most common referrals are to social service agencies for financial assistance, crisis intervention, home visits, and drug rehabilitation programs. Culture perspectives  Culture-sum of the beliefs and values that are learned, shared and transmitted from generation to generation in a particular group  Ethnic-pertains to religious, racial, national or cultural group characteristics such as speech, social customs, and physical characteristics  Transcultural nursing- concerned with the provision of nursing care in a manner that is sensitive to the needs of individuals, families, and groups. 8  Nurse must be aware that culture has visible and invisible layers that could be said to resemble an iceberg.  Observable behaviors can be compared with visible part the top of the iceberg. The history, beliefs, values, and religion are not observed, but they are the hidden foundation on which behaviors are based and can be likened to the large submerged part of the iceberg.  Western: Nursing practice in the US is based largely on Western beliefs.  Asian: Speak softly and avoid prolonged aye contact, which they consider rude, in contrast to the western belief that eye contact denotes honesty and forthrightness.  Hispanic: Usually have a close extended family and place a high value on children. And can not get to the point or directly confront because they take it as being insulted if a problem is addressed directly without taking time for small talk.  African Americans: close extended family. Heads of households are usually women. Use a communication style that may cause conflict when they seek a healthcare provider. Statistics  A country such as the US, which has one of the highest gross national products(GNP) in the world, is expected to have one of the lowest infant mortality rates.  Yet in 2008, the most recent years for the comparative data among countries area available, the infant th mortality rate in the US ranked 27 among developing nations. 9  Cardiovascular disease and the many accompanying problems affect females from adolescence through old age. o CVD is the leading cause of death in the US, and 51% of the deaths occur in women. o The epidemic of obesity contributes to the growing problems of hypertension, high blood cholesterol, and diabetes mellitus. o Poverty not race is an important factor…live below poverty= unlikely good health. o Fastest growing group of homeless is women and children Chapter 2 The Nurse’s role in maternity and women’s health care  Shortages of nurses have been intermittent and brief for many years.  Many current nurses are baby boomers (those born in the years 1946-1964) and they are nearing retirement age or have already retired.  Institute of medicine (2010) 80% of be prepared at the baccalaureate or higher by 2020 yet only 50% meets this challenge.  With inadequate nurse staffing and increasing patient loads as the population ages, nurses face greater work stress and fatigue, leading hours in most acute care facilities may be too much for the aging nurse, but these shifts may also be too demanding for he nurse who is a new parent, caregiver for an older adult, or trying to earn a higher degree while working.  Hospitals earning the “Magnet status” recognition from American Nurses Credentialing Center are often more attractive at acquiring and retaining nurses. 10  AND programs meet the need Advanced Preparation for Nurses  Advanced practice nurses may practice as certified nurse-midwives, nurse practitioners, nurse educators, nurse researchers.  CNM are RN’s who have completed an extensive program of study and clinical experience. o Qualified to take complete health histories and perform physical examinations. o They can provide complete care during pregnancy, childbirth, and postpartum period. o They attend the mother and infant as long as the mother’s progress is normal. o The practice approach of the CNM to childbirth is noninterventionist and supportive.  Nurse practitioners are RNs with advanced preparation that allows them to provide primary care for specific groups of clients. o They can take complete health history, perform physical examinations, order and interpret laboratory and other diagnostic studies, and provide primary care for health maintenance and health promotion. o Most nurse practitioners collaborate with physicians with regard to administering treatments and medications, but depending on their scope of practice and the board of nursing mandates for their practice in their state, they may work independently and prescribe some medications.  The women’s health nurse practitioner (WHNP) provides wellness focused, primary, reproductive, and 11 gynecologic care over a woman’s life span, beginning from adolescence. o Common responsibilities include performing WWE’s screening for sexually transmitted diseases, and providing family planning services. o Hospitals may employ WHNPs to assess and screen women who arrive at an obstetric triage unit. Many of these women have nonobstetric problems during pregnancy.  Family Nurse Practitioner (FNPs) are prepared to provide preventive, holistic care for young as well as older family members. o They may care for women during uncomplicated pregnancies and provide follow-up care to mothers and infants after childbirth. o Unlike CNMs, FNPs do not assist with childbirth.  Neonatal nurse practitioners (NNPs) assist in the care of high-risk newborns in the immediate post-birth care or in a neonatal intensive care unit.  Pediatric Nurse Practitioner(PNPs) provide health maintenance care to infants and children who do not require the services of physicians. o They may see infants at well-baby visits and to provide treatment for common illnesses.  Clinical Nurse Specialists (CNS) include direct care, consultation, systems leadership, collaboration, coaching, research, and ethical decision making. o Unlike nurse Practitioners, clinical nurse specialists do not provide primary care.  All require at minimum a master’s degree…soon to be doctorate 12 Therapeutic Communication  Unlike social communication, therapeutic communication is purposeful, goal directed, and focused. 1. Restful setting that provides privacy 2. Interactions should begin with introductions and clarification of nurse’s role 3. Therapeutic communication should be focused and directed toward meeting the needs expressed by the family. 4. Nonverbal behaviors may communicate more powerful messages than the spoken word 5. Active listening a. Eye contact b. Minimal cues and leads such as nodding, leaning closer, and smiling c. Touch 6. Cultural differences influence communication 7. Clarifying communication 8. Emotions are part of communication  Clarifying: clearing up or following up to understand both content and feelings expressed, to check the accuracy of how the nurse perceives the message.  Paraphrasing: Restating in words other than those used by the woman what she seems to express; a form of clarification  Reflecting: Verbalizing comprehension of what the patient said and what she seems to be feeling…Nurse’s opinion should not be in the reflection  Silence: Waiting and allowing time for the patient to continue. Verbal communication must not be constant 13  Structuring: Creating guidelines or setting priorities  Pinpointing: Calling attention to differences or inconsistence in statements  Questioning: Open ended questions…avoid yes and no  Directing: Using nonverbal responses or succinct comments to encourage the person to continue.  Summarizing: Reviewing the main themes or issues that were discussed. Principles of learning  Real learning depends on the readiness of the individual or the family to learn and the relevance of the content  Active participation increases learning  Repetition of a skill increases retention and feelings of competence  Praise and positive feedback are powerful motivators for learning and are particularly important when the family is trying to master a frustrating task such as breastfeeding and unresponsive infant  Role modeling is an effective method to demonstrate behavior.  Conflict and frustration impede learning  Learning is enhanced when teaching is structured to present simple tasks before more complex material  A variety of teaching methods may maintain interest and illustrate concepts  Retention is greater when material is presented in small segments overtime. Factors that influence learning 14  Developmental level  Language  Culture  Previous Experience  Physical Environment  Organization and kill of the instructor  Nurse’s role as Collaborator: collaborate with other members of the health care team, often coordinating and managing a woman’s or infant’s care.  Nurse’s role as researcher: Evidence-based practice is no longer just an ideal but an expectation of nursing practice. o Nursing generates an answers its own questions based on research of its unique subject matter.  Nurse’s role as Advocate: the nurse considers the family’s wishes in planning and implementing care. o Nurses must be advocate for health promotion of vulnerable groups such as victims of domestic violence or women unable to pay for low-cost preventive care such as yearly well-woman examinations.  Nurse’s role as Manager: May provide less direct care and delegate tasks such as ambulation or taking vital signs to others. o As a result, nurses spend more time teaching women and families and supervising unlicensed personnel.  Critical Thinking: Outcome focused in toward finding solutions for problems. Based on research than preference or prejudice. 15 o The purpose is to help nurses make the best clinical judgments o Steps ABCDEs of critical thinking: assumption, biases, closure, data, evaluation of emotions  Research: Nurses must base their practice on evidence generated by research. Professional journals are the best sources for the latest research. Chapter 3 Ethical, Social, and Legal Issues  The nurse must understand the legal basis for his or her scope of practice to reduce vulnerability to malpractice (negligence by a professional nurse) claims.  Ethics involves determining the best course of action in a certain situation.  Bioethics is the application of ethics to healthcare.  Ethical Behavior for nurses is discussed in codes such as the American Nurses Association Code for Nurses.  Ethical Dilemma is a situation in which no solution is completely satisfactory. o Opposing courses of action may seem equally desirable, or all possible solutions may seem undesirable. o Ethical dilemmas are among the most difficult situations in nursing practice. o To find solutions nurses and other health care personnel must apply ethical theories and principles and determine the burdens and benefits of any course of action. Ethical theories  Three models guide ethical decision making: deontological, utilitarian, and human rights. 16 o Deontological: Determines what is right by applying ethical principles and moral rules.  It does not vary the solution according to individual situations. o Utilitarian: approaches ethical dilemmas by analyzing the benefits and burdens of any course of action to find one that will result in the greatest amount of good.  Concerned more with the consequences of actions than the actions themselves. o Human Rights: belief that each person has human rights is the basis for the human rights model to making ethical decisions. Ethical Principles  Ethical principles or rules are also important for solving ethical dilemmas. Four of the most important principles are beneficence, nonmaleficene, respect for autonomy, and justice.  Other important ethical principles such as accountability, confidentiality, truth, and keeping promises are derived from the four basic principles. o Autonomy: people have the right to self- determination. This includes the right to respect, privacy, and information necessary to make decisions based on their personal values and beliefs. o Beneficence: Make a decision that produces greatest good or the least harm o Nonmaleficence: avoid risking or causing harm to others 17 o Justice: all people should be treated equally and fairly regardless of disease or social or economic status. o Fidelity: keep promises and do make promises that cannot be kept. o Truth (veracity): tell the truth o Confidentiality: keep information private o Accountability: accept responsibility for actions as a heath care professional Ethical Issue in Reproduction  Reproduction issues often involves conflicts in which a woman behaves in way that may cause harm to her fetus or that is disliked by some or more of society  Conflicts between a mother and fetus occur when the mother’s needs, behavior, or wishes may injure the fetus.  The most obvious instances involve abortion, substance abuse, and mother’s refusal to follow advice of caregivers.  Abortion, or elective termination of pregnancy, was a volatile legal, social, and political issue even before the Roe v. Wade decision by the U.S Supreme court in 1973.  Before time, states could outlaw abortion within their boundaries.  Central to political action to keep abortion legal is the conviction that women have the right to make decisions about their own reproductive functions on the basis of their own ethical and moral beliefs and that government has no place in these decisions.  Many people who who support the legality of abortion prefer to call themselves pro-choice rather than pro- 18 abortion because they believe that choice more accurately expresses their philosophic and political position.  Many people believe that legalized abortion condones taking a life and feel morally bound to protect the lives of fetuses. This position is called pro-life.  NURSES: The nursing practice acts of many states allow nurses to refuse to assist with the procedure if it violates their ethical, moral, or religious beliefs. However, nurses are obligated to disclose this information before they are employed in an institution that performs abortion.  Some people believe that mandated contraception is a reasonable way to prevent additional births in case of women who are considered unsuitable parents and to reduce government expenses for dependent children.  Infertility treatment: perinatal technology has found ways for some previously infertile couples to bear children. o Assisted reproductive techniques now allow postmenopausal women to become pregnant  In surrogate parenting, a woman agrees to bear an infant for another woman. Conception may take place outside the body using ova and sperm form the couple who wishes to become parents.  HIPAA (Health Insurance Portability and Accountability Act of 1996 was designed to reduce fraud in the insurance industry and make it easier for people to remain insured if they move from one job to another. Social Issues  Some issues that affect maternity care include poverty, homelessness, access to care, allocation of health care resources, and care versus cure. 19  Poverty remains an underlying factor in problems such as homelessness and inadequate access to health care.  Poverty often breeds poverty.  Changes in Medicaid, Medicare, and Children’s Health Insurance Program to cover children from low-income groups such not already on Medicaid, or addressed within the ACA. Various government programs area available to help the poor. One such program is Temporary Assistance to Needy Families which provides money for basic living cost of indigent children and their families.  Homeless families are often composed of single women and their children, and domestic violence is often part of their history as they to escape the violence.  The United States ranks 27 in infant mortality compared with other developed countries.  Many of these deaths are related to low birth weight, prematurity, and other prenatal factors.  Prenatal care is widely accepted as an important element in a good pregnancy outcome  Lack of access to prenatal care adds to the infant mortality rate and the large number of low birth weight infants born each year in the united states.  Because preterm infants are the largest category of those needing intensive care, millions of dollars could be saved each year by ensuring adequate prenatal care and good maternal age reduces complications and hospital time.  In the United States minority women are more likely to be indigent, less likely to seek prenatal care, and more 20 likely to doe in childbirth when compared with white women.  FACTORS RELATED TO POOR SCCESS TO HEALTHCARE: poverty, unemployment, lack of medical insurance, adolescence, minority group, inner city resident, rural residence, unmarried mother status, less than high school education, inability to speak English.  Medicaid provides health care for indigent persons, older adults, and persons with disabilities. Pregnant women and young children are especially targeted. Medicaid is funded by both federal and individual state governments  Women who do not have private insurance or Medicaid may receive prenatal care at public clinics  Quality and Quantity of care in clinics may be poor because of inadequate funding. Nurses have been instrumental in opening shelters, clinics, and outreach services for the homeless, with NPs often playing a major role. Legal Issues  Three categories of safeguards determine the law’s view of nursing practice: nurse practice act, standard of care, rules and policies set by the institution employing the nurse.  Every state has a nurse practice act that determines the scope of practice of RN in that state.  Nurse Practice Act defines what the nurse is allowed to do when caring for a patient. The act also specifies what the nurse is expected to do when providing care.  Standards of care are set by professional associations and describe the level of care that can be expected from practices. 21  Each healthcare agency sets specific policies, procedures, and protocols that govern nursing care. Malpractice: limiting loss  Negligence is the failure to perform as a reasonable, prudent person of similar background would act in a similar situation. o May consist of doing something that should not be done or filing to do something that should be done.  Malpractice is negligence by professionals such as nurses and physicians in the performance of their duties. o Nurses may be accused of malpractice if they do not perform according to established standards of care and in the manner of a reasonable, prudent nurse with similar education and experience in a similar situation. o Four elements must be present to prove negligence: duty, breach of duty, damage, and proximate cause.  Duty: The nurse must have a duty to act or give care to the patient. It must be part of the nurse’s responsibility.  Breach of duty: a violation of that duty must occur. The nurse fails to conform to established standards in performing that duty.  Damage: an actual injury or harm to the patient as a result of the nurse’s breach of duty  Proximate cause: the nurse’s breach of duty must be proved to be the cause of harm to the patient.  Informed Consent is an ethical concept that has been enacted into law. Patients have the right to decide 22 whether to accept or reject treatment options as part of their right to function autonomy. o Patient’s competence: able to think through a situation and make rational decisions. o Full disclosure of information needed: including details of what the treatment entails, the expected results, and the meaning of those results. The risks, side effects, benefits, and other treatment options must be explained to patients. o Patient’s understanding of information: the person must comprehend information about proposed treatment. o Volunteer Consent: must be allowed to make choices voluntarily without undue influence or coercion from others. o Refusal of care: Patients have the right to refuse care, and they can withdraw agreement to treatment at anytime.  The nurse documents on the chart the patient’s refusal, explanations given to the patient, and notification of the physician.  Patients may be asked to sign forms indicating that they understand the possible results of treatment refusal.  Coercion is illegal and unethical in obtaining consent.  Nurses are expected to meet the standard care, or level of care expected of a professional as determined by laws, professional organizations, and health care agencies.  Documentation is the best evidence that a standard of care has been maintained. 23  Documentation must be specific and complete in perinatal nursing. This careful step is critical because of the long statue of limitations when a newborn is involved.  Documentation must show that nurses assessed the patient appropriately, continually monitored for problems, identified problems and instituted correct interventions, and reported changes in the patient’s condition to the primary care provider.  Nurses are legally and ethically bound to act as the patient’s advocate. o When patient’s best interest are not being served: relaying the problem through the facility’s chain of command. The nurse consults a supervisor and the patient’s physician. If the results are not satisfactory, the nurse continues through administrative channels to the director of nurses, hospital administrator, and chief of the medical staff, if necessary. o The nurse can also reduce malpractice liability by maintaining expertise.  To ensure that nurses maintain expertise in provision of safe care, states require proof of continuing education for renewal of nursing licenses.  Teaching begins at admission  Self care during pregnancy or in women’s health begins at first encounter.  More teaching must occur during pregnancy when the mother’s physical needs do not interfere with her ability to comprehend the new knowledge 24  A printed form, signed by both the patient and the nurse, I placed in the chart with a copy given to the woman for later reference in self-care and care of the baby. Chapter 4 Reproductive Anatomy and Physiology  Sexual development begins at conception when the genetic sex is determined by the union of an ovum and a sperm.  The mother’s ovum carries a single X chromosome.  Each of the father’s spermatozoa carries either an X chromosome or a Y chromosome.  XX: female and XY: Male  The reproductive systems of males and females are similar or sexually undifferentiated, for the first weeks of prenatal care. o The external genitalia continue to look similar umtil the nonth week when these outer structures begin to change. o Differentiation of the external sexual organs is complete at about 12 weeks of gestational age. Childhood  The sex glands of girls and boys are inactive during infancy and childhood.  Gonads: reproductive sex glands Sexual Maturation  Puberty refers to the time during which the reproductive organs become fully functional.  Primary sex characteristics relate to the maturation of those organs directly responsible for reproduction. 25 o EX. Maturation of the ova in the ovaries and production of sperm in the testes  Secondary Sex Characteristics are changes in other systems that differentiate females and males but do not directly relate to the reproduction o EX. Female: development of glandular and ducal systems in the breast. Male: Narrow, upright, and heavier pelvis.  Secretions of the hypothalamus, anterior pituitary, and gonads all play a role. o Hypothalamus stimulates the anterior pituitary gland to produce hormones to stimulate sex hormones production by the gonads. o The level of GnRH increases slowly until it reaches a level adequate to stimulate the anterior pituitary to increase ites production of FSH and LH. Female Puberty Changes  Breast changes: The nipple enlarges and protrudes. The areola surrounding the nipple enlarges and becomes somewhat protuberant, although less so than the nipple. Followed by growth of the glandular and duct tissue. Fat is deposited to give it the round shape.  Body Contours: The pelvis widens and assumes a rounded, base like shape that favors passage of the fetus during childbirth. Fat is deposited in hips as well  Body Hair: Pubic hair first appears downy and becomes thicker as puberty progresses. Axillary hair appears near time of menarche. 26  Skeletal Growth: girls grow taller for several years during early puberty in response to estrogen stimulation. Growth spurt begins about 1 year after menarche.  Reproductive Organs: External Genitalia enlarge as fat is deposited in the mon pubis, labia majora, labia minora.  Menarche: Approx. 2-2 ½ years after the beginning of breast development girls experience their menarche, or first menstrual period.  Amenorrhea: delayed onset of the menstruation. o Older than 16 years old, more than 0ne year passed when mother first started, secondary is absence of menstruation for at least three cycles after regular cycles has been stablished. Male Puberty Changes  Nocturnal Emission: Often called wet dreams, occur commonly in teenagers,  Body Hair: Pubic hair growth begins at the base of the penis. Gradually the hair coarsens and grows upward and in the midline of the abdomen. Chest hair develops and on the back as well.  Body composition: Because of influence of testosterone, men develop a greater average muscle mass compared with women. Exceeds women muscle mass by 50%.  Skeletal Growth: Testosterone cause men to undergo rapid growth spurt, especially in height. Begins 1 year later than women. 27  Voice Changes: Hypertrophy of the laryngeal mucosa and enlargement of the larynx cause the male’s voice to deepen. Decline in Fertility  The Climacteric is a transitional period, which starts a female fertility declines and extends through menopause and the postmenopausal period.  Menopause is the term used to describe the final menstruation period(Permeant)  Post menopause is the day after the final menstrual period.  Men do not experience a distinct marker event like menopause. But production of testosterone and sperm declines, and sexual function decreases in the late forties and fifties Female Reproductive Anatomy  The external Genitalia is known as the vulva: Mon Pubis Labia Majora/minora, clitoris, vestibule, and perineum.  Vagina: Passage way for menstrual flow and female organ for coitus; male penis during coitus, passage way for fetus during birth  Uterus: Houses and nourishes the fetus  Fallopian Tube: passage way for the ovum as it travels from the ovary to the uterus  Ovaries: Secrete Estrogen and Progesterone Support Structures  Pelvis: True pelvis is the lower which is important during childbirth. Structure at the lower end of the spine. 28  Muscles: Paired muscles enclose the lower pelvis and provide support for internal reproductive, urinary, and bowel structures.  Ligaments: Seven pairs of ligaments maintain the intermal reproductive organs and their never and blood supplies in their proper positions with the pelvis.  Blood Supply: The uterine blood supply is carried by the uterine arties, which are branches of the internal iliac artery. AVA(Artery-Vein-Artery)  Nerve Supply: Most function of the reproductive system are under involuntary, or unconscious, control. Reproductive Cycle  AKA the menstrual cycle period  The duration of the cycle is about 28 days, although it may range form 20-45 days. o Significant deviation from the 28 day cycle are associated with reduced fertility.  The first day of the cycle is counted as day one of the woman’s cycle  The female reproductive cycle is further divided into two cycles that reflects changes in the ovaries and uterine endometrium.  Ovarian Cycle o Follicular Phase: Days 1-14(ovum matures) o Ovulatory Phase: Middle of the cycle- occurs 2 days prior to ovulation o Luteal Phase: after ovulation and through day 28  Endometrial Cycle 29 o Proliferative Phase: first half of ovarian cycle – endometrium thin o Secretory Phase- last half of the ovarian cycle- endometrium thicker o Menstrual Phase: approx. 5 days long and is the result of no fertilization-endometrium is thick and sheds. Female Breast  The breasts, or mammary glands, are not directly functional in reproduction, but they secrete milk after childbirth to nourish the infant.  The breasts are inactive until puberty, when rising estrogen levels stimulate growth of the glandular tissue.  Breast size is unrelated to ability of milk production  Prolactin stimulates milk production  Active milk production occurs during baby suckling Male Anatomy  Penis: Conduit for urine form the bladder and male organ of sexual intercourse  Scrotum: houses the testes and keeps the testes cooler than the core body temp.  Cremaster Muscle: attached to each testicle.  Testes: secrete testosterone  Seminiferous tubules: Storage of some sperm  Epididymis: final sperm maturation  Vas Deferens: Storage of sperm  Seminal Vesicle prostate, bulbourethral: Secretion of seminal fluids 30 Chapter 5: Hereditary and Environmental Influence on Childbearing  Hereditary and Environmental forces shape on a person’s development form before conception until death.  Congenital: present at birth and these disorders could be genetic or from environmental including medication  Birth Defects: caused by environmental factors  Genetic Influences can result if too much or too little genetic material is present in the cells and if one more genes are abnormal and provides incorrect directions.  DNA: the building block of genes and chromosomes and directs the manufacture of proteins needed for cell function.  A gene is a segment of DNA that directs the production of a specific product needed for the body structure or function. o We have approx.. 23,000 genes arranged on our chromosomes  Genes that code for the same trait have two more alternate forms called alleles. o Example: ABO blood type  Genes are organized in 46 paired chromosomes in the nucleus of somatic cells.  Each chromosome is composed of varying numbers of genes. A total of 22 chromosomes pairs are autosomes(NON-SEX Chromosome) and the 23 pair is composed of the sex chromosomes. 31  Added, missing, or and structurally abnormal chromosome are usually harmful  When the ovum and the sperm unite at conception, the total is restored to 46 paired chromosomes.  Karyotype: pairs are arranged from largest to smallest with sex chromosomes shown separate.  Inherited Characteristics are passed form parent to child by the gene in each chromosome. o Thus traits are classified according to whether they are dominant or recessive o Also traits are classified according to whether they are on autosomes or sex chromosomes. o Both normal and abnormal hereditary characteristics are transmitted in this fashion  Dominance: describes the way a person’s genotype- genetic composition- is translated into the phenotype, or observable characteristics o Example: ABO blood system- genes for Type A and B are dominant O is recessive  Single gene inheritance is often depicted as a pedigree or a diagram exhibiting the family’s genetic history  Autosomal dominant- 50% chance of transmitting the disorder to each biologic child  Autosomal recessive- many are severe with the individual never living long enough to reproduce. Two healthy parents with this recessive gene have 25% of having a child affected with the disorder caused by the gene o Notable expectations are sickle cell and PKU, Tay Sachs, Cystic Fibrosis 32  Consanguinity- blood relationship of parents, increase the chance for a child with a autosomal recessive disorder because the blood relatives have more genes in common which could include abnormal ones-inbred  One copy of an abnormal xlinked recessive gene is enough to produce the disorder in a male.  Autosomal Dominant: produced by a dominant gene on a non sex chromosome. o Abnormal finding: Huntington Disease and neurofibromatosis  Chromosomal Abnormalities can be numerical or structural  Trisomy: exits when each body cell contains a copy of one chromosome, bringing the total number to 47. Too many, common is Trisomy 21 aka Down Syndrome. o 47 XYY o Characteristics: flat face and occiput, low-set ear, and a protruding tongue, also transvers palm crease and a single crease on the fifth finger  Monosomy: exists when each body cell has a missing chromosome with a total number of 45. Turner Syndrome is the only monosomy that is compatible with life.  Multifactorial Disorders: an interaction of genetic and environmental factors o Typically, present and detectable at birth. o Isolated defects rather than defects that occur with unrelated abnormalities o Examples Include: Many heart defects, Neural tube defects as such as anencephaly (absence of he brain an skull) an d spina bifida, cleft lip and cleft palate, pyloric stenosis 33  Environmental Influences: Nurse must display encouragement for small changes and choices  Good Nutrition including adequate amounts of folic acod  Not known to have a genetic component  Many agents can cross the placenta and affect the fetus.  Teratogens: agents in the fetal environment that either cause or increase the likelihood that a birth defect wil occur o Drugs o Alcohol o Smoking o Infections o Recreational Drugs o Teratogen typically cause more than one defect which differentiates them form multifactorial disorders  Preventing fetal Exposure o Begins before conception o Infections( immunizations) o Drugs and other substances  The categories range form A through D and X. Class A drugs have no demonstrated fetal risk. At the opposite end, pregnancy category X drugs are well established as being harmful. o Radiation o Maternal Hyperthermia( hot tubs, sauna, high fever, caffeine)  Manipulating the Fetal Environment 34 o If diabetic take oral insulin; diet and exercise o If PKU… return to phenylalanine free diet o Take prenatal vitamins daily o Folic acid 0.4 mg daily(prevention of neural tube defect) o Neural defect close appro. The 4 -5 week of pregnancy  Genetic Counseling o Availability(vital for those who undergo testing) o Focus is on the entire family o Testing may be a slow and arduous process o Nurse must be compassionate as parents may react guilty o Important to know the family history/ genetics and any defects  Possible Reasons for Referral to a Genetic Counselor o Women 35 years and older who become pregnant o Men who father children after age 40 o Carriers of autosomal recessive disorders o Women who are carriers of Xlinked disordes o Couples related by blood o Family history of defect sof retardation o Women with multiple spontaneous abortion o Women exposed to teratogens o Abnormal ultrasound findings. ( Oligiohydramnios) 35 To learn more and get OneNote, visit 36


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