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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 • • • • • • • Date & time Course description Prerequisites/co-requisites Course objectives Teaching methods Required textbooks Student evaluation Syllabus Review (cont’d) • Student policies • • • • 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 • • • • 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 • • • • 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 • • • • • • • 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