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Welcome to N353 for
Winter 2005!!
Joy Haskin, RN, MS
with
Shalise Pollock, RN, MSN &
Maria Rubiolino, RN, MSN
Review of the Syllabus
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Date & time
Course description
Prerequisites/co-requisites
Course objectives
Teaching methods
Required textbooks
Student evaluation
Syllabus Review
(cont’d)
• Student policies
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Students with disabilities
Academic honesty
Absentee policy
Additional information
• Guidelines for Formal Paper
• Class/Reading/Assignment
Schedule
Contemporary Maternity
& Women’s Health Care
• Maternity Nursing
Contemporary Maternity
& Women’s Health Care
• Maternity Nursing
• focuses on the care of childbearing women and their families
through all stages of pregnancy
and childbirth, as well as the first
4 weeks after birth.
• Perinatal Nurse
• Perinatal Nurse
• nurturer, educator, physical a care
provider, critical thinker, support
person, counselor, case manager,
or researcher
• Perinatal Nurse
• nurturer, educator, physical a care
provider, critical thinker, support
person, counselor, case manager,
or researcher
• Care providers during perinatal
period include:
• Perinatal Nurse
• nurturer, educator, physical a care
provider, critical thinker, support
person, counselor, case manager,
or researcher
• Care providers during perinatal
period include:
• Nurses
• Nurse Practitioners (NPs)
• Certified Nurse Midwives (CNMs)
• Women’s Health Nursing
• Women’s Health Nursing
• Focuses on physical, psychologic,
and social needs of women
throughout their lives.
• Women’s Health Nursing
• Focuses on physical, psychologic,
and social needs of women
throughout their lives.
• Well-being, childbearing &
diseases
• Women’s Health Nursing
• Focuses on physical, psychologic,
and social needs of women
throughout their lives.
• Well-being, childbearing &
diseases
• Reproductive issues, socio-cultural
and occupational factors related
to health problems (poverty, lower
wages, rape, incest, sexual
harassment, and family violence)
(see ICNM Vision)
Contemporary Issues &
Trends
• Health care = 13% national
spending
• Nursing shortage=nurses
leading unlicensed assistive
personnel rather than caregiver
• Integrative care practices of
Eastern and Western healing
practices
Childbirth Practices
• Prenatal care may promote
better pregnancy outcomes by
allowing early risk assessment
and promoting healthy
behaviors, such as improved
nutrition and smoking cessation
• 2000, 83.2% received early PNC
• 3.9% had late (??100%)
Delivery location
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Hospital
Free-standing birthing center
Home
Delivered by whom?
• Physician 92%
• CNM 7%
Changes in Labor Care
• Change in mandatory 2hr
delivery time after complete
dilatation (10 cm)
• Delay pushing
• Conserve mother’s energy
• Decrease episiotomy
• Decrease intervention
Changes in Labor Care
(cont’d)
• Changes in analgesia care
• No analgesia
• Epidural
• Family-centered care
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Fathers
Grandparents
Siblings
Friends
Other Updates in Care
• Some women labor-deliver-recover in the
same room (LDR)
• Some women may stay in the same room
for the entire birth experience (labordeliver-recover-postpartum LDRP)
• Mother-baby couplets rather than 1 RN for
mother and 1/baby
• 24-48 hour discharge that challenges
teaching
• Newborn security
Views of Women
Language we use:
• Incompetent cervix=premature
dilatation of the cervix
• Arrest of labor=fail to progress
• Intrauterine growth
retardation=intrauterine growth
restriction
• Abortion=miscarriage
Education
• Classes for
• Childbirth
• parenting
• Parent support groups after
birth
Breastfeeding in the Workplace
Family leave
International concerns
• Female genital mutilation
• Circumcision
• Infibulation
Health of Women
• Caucasian 80 yrs
• African-American 75 yrs
• Breast CA
• Violence @ 8% in pregnant
women
• Pregnancy and abortion in
adolescents have declined
• Still highest in US of
industrialized nations
• Infants developing AIDS
declined from 8.9/100,000 in
1992 to 2.8/100,000 in 1996.
Universal screening of pregnant
women in 1999
Healthy People 2010
• 28 of 467 objectives focus on
maternal, infant and child
health
• Fertility rate=births/1000
women
• Birth rate=live births/1000
women
Trends in Fertility, Birth,
and Mortality Rates
• Fertility rate 15-44 yrs 67.6 inc.
3% in 2001
• Birth rate 14.8 in 2000 (1997,
55% live births, 29% induced
and 15% spontaneous)
• Low-birth-weight (LBW) infants<2500 gms=7.6% (highest since
1973)
• Infant mortality rate=death < 1
yr = 6.9/1000 live births
• This is an indicator of adequacy of
prenatal care and health of a
nation as a whole
• Disparity between races
• Neonatal mortality rate=death <
28 days
• Perinatal mortality
rate=stillbirths + neonatal
deaths
Maternal Mortality
• 9.8/100,000 live births in US
• 1600 women die each day
world-wide; many preventable
• In US, racial differences
• African-American 4X
• Hispanic 1.7X
• HP2010 goal 3.3/100,000 live birth
Involving the Consumer
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Self-care
Reduce health disparities
High technology care
Community-based care
Increase in hi-risk pregnancies
High cost of health care
Limited access to health care
Trends in Nursing
• Nursing Intervention
Classification (NIC)
• Evidence-based Practice
• Association of Women’s Health,
Obstetrical, and Neonatal
Nurses (AWHONN)
• Cochrane Pregnancy and
Childbirth Database
• Nursing Outcome
Classifications (NOC)
• Health Care Financing
Administration (HCFA)
• Best practice
• Benchmarking
• World Health Organization
(WHO)
• Standard of Care
• Legal=Policy
• Ethical issues
• It’s time for a break!!
• Please return in 15
mins
Conception & Fetal
Development
• Conception:
Conception & Fetal
Development
• Conception
• Union of single egg and sperm
• Marks the beginning of pregnancy
Conception & Fetal
Development
• Conception
• Union of single egg and sperm
• Marks the beginning of pregnancy
• Gamete
Conception & Fetal
Development
• Conception
• Union of single egg and sperm
• Marks the beginning of pregnancy
• Gamete
• Egg or sperm
Conception & Fetal
Development
• Conception
• Union of single egg and sperm
• Marks the beginning of pregnancy
• Gamete
• Egg or sperm
• Fertilization
Conception & Fetal
Development
• Conception
• Union of single egg and sperm
• Marks the beginning of pregnancy
• Gamete
• Egg or sperm
• Fertilization
• Union of gametes
• Cell Division
• Cell Division
• Mitosis
• Cell Division
• Mitosis
• Yields 2 identical cells
• Cell Division
• Mitosis
• Yields 2 identical cells
• Meiosis
• Cell Division
• Mitosis
• Yields 2 identical cells
• Meiosis
• Yields 2 germ cells w/ half the
chromosomal number=haploid; 22
autosomes & 1 sex chromosome
• Gametogenesis
• Cell Division
• Mitosis
• Yields 2 identical cells
• Meiosis
• Yields 2 germ cells w/ half the
chromosomal number=haploid; 22
autosomes & 1 sex chromosome
• Gametogenesis
• Spermatogenesis
• Cell Division
• Mitosis
• Yields 2 identical cells
• Meiosis
• Yields 2 germ cells w/ half the
chromosomal number=haploid; 22
autosomes & 1 sex chromosome
• Gametogenesis
• Spermatogenesis in testes (male)
and oogenesis in ovaries (female)
• Cell Division
• Mitosis
• Yields 2 identical cells
• Meiosis
• Yields 2 germ cells w/ half the
chromosomal number=haploid; 22
autosomes & 1 sex chromosome
• Gametogenesis
• Spermatogenesis in testes (male)
and oogenesis in ovaries (female)
• Fertilization forms zygote
Fertilization
• Takes place in outer third of
uterine tube
Fertilization
• Takes place in outer third of
uterine tube
• Sperm penetrates membrane of
ovum, become enclosed=zona
reaction
Fertilization
• Takes place in outer third of
uterine tube
• Sperm penetrates membrane of
ovum, become enclosed=zona
reaction
• Cleavage=mitotic division
continues as zygote floats down
tube
• Blastomere-smaller cells
formed by this first mitosis
• Blastomere-smaller cells
formed by this first mitosis
• Morula-the ball formed by 16
cells surrounded by a protective
zona pellucida
• Blastomere-smaller cells
formed by this first mitosis
• Morula-the ball formed by 16
cells surrounded by a protective
zona pellucida
• Separates into 2 parts by
fluid=trophoblast (placenta) and
embryoblast (embryo)
• Blastomere-smaller cells
formed by this first mitosis
• Morula-the ball formed by 16
cells surrounded by a protective
zona pellucida
• Separates into 2 parts by
fluid=trophoblast (placenta) and
embryoblast (embryo)
• Blastocyst=cells that give rise
to embryo (source of stem
cells)
Implantation
• Zona pellucida degenerates
Implantation
• Zona pellucida degenerates
• 6-10 days p/ conception
Implantation
• Zona pellucida degenerates
• 6-10 days p/ conception Anterior
or posterior fundus
Implantation
• Zona pellucida degenerates
• 6-10 days p/ conception Anterior
or posterior fundus
• Trophoblast burrows into
endometrium
Implantation
• Zona pellucida degenerates
• 6-10 days p/ conception Anterior or
posterior fundus
• Trophoblast burrows into
endometrium
• Chrorionic villi form finger-like
projections for oxygen and nutrient
provision/CO2 & waste removal
Fetal Development
• Pregnancy lasts 10 lunar mos.
or 40 weeks or 280 days
Fetal Development
• Pregnancy lasts 10 lunar mos.
or 40 weeks or 280 days
• Compute length of pregnancy =
first day of LMP to day of birth
Fetal Development
• Pregnancy lasts 10 lunar mos.
or 40 weeks or 280 days
• Compute length of pregnancy =
first day of LMP to day of birth
• Day of conception is 2 weeks
later, so fetal development is in
post-conceptual age