ob 1: p,p&f: intro to maternity & pediatric nursing

the past

Karl Crede: silver nitrate to prevent blindness via gonorrhea. (silver for infections)

Ignaz Semmelweiss: sepsis can transmit via unwashed hands.

Louis Pasteur: confirmed that fever & infection transmit via unwashed hands.

Joseph Lister: british surgeon. anti-septic theory

• think lister: listerine

obstetrics

physician: called obstetrician

• care of women during pregnancy, childbirth, postpartum

postpartum period: 6 weeks vaginal / 8 weeks c section

empowerment

u.s in the 1900s

birth process in the 60s

organizations w children

UNICEF: United Nations International Children’s Fund

WHO: World Health Organization

government influences in maternity & pediatric care

Shepard Towner Act of 1921: state-managed programs for maternity care

FMLA: allows employees to take 12 weeks of unpaid leave to care for family member. cannot loose benefits/ pay status if they take FMLA

HIPPA: protect pt’s health info. allows pt access to & control their health info. can only access minimum necessary health info.

HITECH

Pt Protection & Affordable Care Act of 2010

• signed by Obama

• expanded health care to millions who were uninsured

nurses must report

• illness that poses hazard to public

• child abuse

• suicidal behavior: ask if they have a plan

the present: family centered care

family involvement. necessary for bonding & support

sections of maternity unity

• labor-delivery

• postpartum

• newborn nursery.

diagnosis-related groups aka DRGs

determine payment for a hospital stay based on the diagnosis

• push for early discharge

• case managers & utilization review nurses

health promotion

preventing illness & disability. cost-effective

• increased need for complex medical care as chronically ill children live well into adulthood

clinical pathway

• expected progress patient

documentation

legal responsibility of the nurse.

facilities differ on charting method.

SBAR

S: situation

b: backround

a: assessment

r: recommendation

puberty ends when

females: menstrual cycle becomes regular

males: mature sperm is formed

male puberty

10 - 16 yo

testosterone: taller. muscular. secondary-sex characteristics. levels are constant, decrease w age.

male external genitalia

testes: manufacture male germ cells aka sperm

testosterone: enhances production of RBC → higher hemoglobin. promotes growth of long bones. increases basal metabolic rate.

epididymis: stores & carries sperm to penis. stores sperm for 2-10 days. sperm matures → vas deferens.

female puberty

11 - 15 yo

first change: development of breasts

first menstrual period: 2 - 2.5 years after

• organs mature to prepare for sexual activity & childbirth

menarche is ?

the first menstrual period

female external genitalia / vulva

forchette aka perineum

episiotomy: cut of perineum during birth if baby is stuck/too big

ovaries

held in place by ovarian & uterine ligaments in the abd cavity

• produce estrogen & progesterone

• born with all ova.

fallopian tubes

outer 3rd of the tube, near the ovary: where egg is fertilized

internal female genitalia / vagina

uterus aka womb: fundus → corpus / body → cervix (narrow tube opening to vagina)

mucosal lining functions

• lubricates vagina

• bacteriostatic agent

• alkaline environment to hold sperm

• produces mucus plug in cervical canal. prevent infection

symphysis pubis

a cartilaginous joint connecting the left and right pubic bones at the front of the pelvis

pelvic widening during childbirth

female pelvis

support & distribute body weight

protect pelvic organs

form birth passageway

most favorable type: gynecoid.

unfavorable type: platypelloid, android.

types of pelvis

true vs false pelvis

true: dictates the bony limits of the birth canal

false: supports the enlarging uterus. guides fetus into true pelvis.

pelvic inlet

pelvic outlet

breasts - mammary glands

produces milk after birth. colostrum first 2-3 days (thick, yellow fluid rich in antibodies & growth factor)

montgomery glands: small sebaceous gland. lubricate& protect breasts during lactation

after fertilization, ovum is called the

zygote

reproductive & menstruation cycle

LH triggers ovulation

egg lives for 25 hours after ovulation

sperm can reach fallopian tube after 5 minutes & can remain viable for 4-5 days

reproductive & menstruation cycle

climacteric

period of years during which the woman’s ability to reproduce gradually declines: 35 +

menopause

after 1 year of no period

body cells

what does folic acid prevent?

neural spine defects

cell division

sex determination

sperm carries either an X or Y chromosome - determines gender of fetus

• pH of reproductive tract influences survival rate of the sperm … speed & motility

XX: female

XY: male

tubal transport of zygote

xygote formed by fertilization

zygote undergoes rapid mitotic divison: cleavage

implantation of zygote

cell differntation

chorion

amnion & amniotic fluid

amniotic fluid: clear, mild odor.

• maintains even temp

• prevents amniotic sac from gluing to fetal sin

• symmetric growth of fetus

• allows fetal movement

• cushion to prevent fetus

amniotic fluid

• maintains even temp

• prevents amniotic sac from gluing to fetal sin

• symmetric growth of fetus

• allows fetal movement

• cushion to prevent fetus

yolk sac

germ layers

ectoderm: outer layer of skin, oil glands, nails and hair, sense organs, mucus membranes

mesoderm: bone and cartilage, muscles, vessels, kidneys & gonads

endoderm: lining of respiratory tract, digestive tract & bladder and urethra

3 stages of prenatal development

placenta

provides oxygen & nutrients. removes waste from baby’s blood

moms side: beefy | fetus side: gray & shiny

connected to baby via umbilical cord

forms in uterus

placental hormones

progesterone: prepares uterus for pregnancy & supports early pregnancy

estrogen: stimulates uterine growth. increased blood flow to uterine vessels. development of breast ducts

human chorionic gonadotropin / hCG: checked for pregnancy. maintains progesterone production, supporting the uterine lining.

human placental lactogen (hPL): increased maternal glucose. supports fetal growth prepares breasts for lactation.

umbilical cord

2 arteries: carries blood away from fetus | 1 vein: returns blood to fetus

normal length: 55 cm / 22 inch

wharton jelly: covers & cushions cord vessels

fetal circulatory shunts

blood is diverted from lungs & liver

foramen ovale: diverts blood from RA to LA, sending oxygenated blood to left side

ductus arteriosus: diverts blood from lungs to systemic circulation

ductus venosus: bipases the liver

circulation before birth

blood enters fetus via umbilical vein

circulation after birth

lung preparation for birth

epi & norepinephrine: activate sodium channels so water & sodium move out the lungs

in C section, this process is limited. can cause wet lungs

ptsd & licorish can cause

ptsd: decreased cortisol, asthma & behavioral problems

licorish: aggression

what is the age of viability?

20 weeks

the point at which the fetus can survive on it’s own

how many weeks is a full term pregnancy?

37 - 42 weeks

go in slides for weeks of pregnancy

vernix

white / cheese-like substance covering fetus

lanugo

hair covering baby

what week is there increased surfactant in lungs?

25

multifetal pregnancy

occur once in every 90 pregnancies.

monozygotic: identical. from a single fertilization. share/ grow up in separate placenta.

dizygotic: fraternal. share ½ genes, like other siblings. two separate fertilizations. have their own placenta.

if embryonic disk does not divide completely, what can occur?

simease/ conjoined twins

complications w twins

uterine distention: not enough room.

placental insufficiency: placenta is not enough for both fetuses

what happens at week 3 of pregnancy?

fetus heart begins to pump blood