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Childbearing Patient

Developmental Self-Care Requirement

Implantation 1. Blastocyst embeds into endometrium 2. Usually in upper/posterior uterine wall 3. 5-6 days 4. Chronic villi, finger like projections 5. Embryo 6. Germ cell layers developed (ectoderm, mesoderm, endoderm
Blastocyst Embryoblast- inner layer forms: Embryo/amnion Trophoblast- Outter layer forms: Chorion/placenta
Childbearing Patient Components 1. Anterpartum 2. Intrapartum 3. Postpartum 4. Neonate 5. Family
Multifetal Pregnancies Twins: 1 in 43 pregnancies Dizygotic - Fraternal (2 mature ova fertilized by 2 seperate sperm) Monozygotic - Identical (1 fertilized ova splits) Multifetal - usually due to infertility drugs
Maternal/Fetal Heart Rates -Funic Soufflé - fetal heart rate (110-160 is normal) -Uterine Soufflé - mothers blood flow -distinguish the above by the rate
Endocrine Function of the Placenta Human Chorionic Gonadotropin (HCG) Human Placental (hPL) Progesterone Estrogen Relaxin
Umbilical Cord Formed from Amnion Cord's blood is baby's blood (If there is only 1 vein and 1 artery in cord this can indicate cardiac abnormalities that would need to be ruled out.) Normally has 3 vessels (AVA - two arteries and one vein) Wharton's Jelly
Preconception Counseling Physical Exam Dental Exam-women with poor dental hygiene are at higher risk for preterm labor. Nutrition-Should take 400mcg/day of Folic Acid before and during pregnancy. Exercise-continue what you are used to. Teaching
Factors that effect embryonic/fetal development Environmental Teratogens -Maternal health, behaviors -Infectious Agents-TORCH -Chemical, meds, drugs, radiation Chromosomal or genetic -Chromosomal abnormalities -Single Gene Disorder
TORCH T- taxoplasmosis O- Other (gonorrhea, syphilis, Hep B, HIV) R- Rubella (German Measels) C- Cytomegalovirus H- Herpes Symplex
Germ Cell Layers Germ cell layers developed 1. Ectoderm (placenta, nervous system, pituitary). 2. Mesoderm (muscles, bones) 3. Endoderm (Respiratory, digestion, asophogus, lungs, liver, bowel, bladder
Taxoplasmosis -Caused by taxoplasmosis gondii by eating raw or undercooked meat, unpasturized milk, contact with infected cat feces.
Rubella aka German Measels Get maternal blood screened, get vaccinated, MMR vaccine postpartum.
Herpes Simplex Virus Transmitted to baby during vaginal delivery (40% develope HSV within 2-12 days, half of 40% will die). Treatments- Valtrex PO and Acyclivor IV
Progesterone Keeps endometrium healthy and prevents contraction.
Estrogen For uterine and breast enlargement (for breast feeding).
Relaxin Permits pelvis to expan, relaxes muscles in pelvic, helps with cervical softening, works with progesterone to help maintain the pregnancy.
GBS Infection -Bacterial infection colinized in the vagina and rectum. -Screened at 35-37 weeks -GBS + -IV Antibiotics (PCN) at least 4 hours before delivery -Failure to treat can result in sepsis or death Baby needs to be Max: 18 hours after membrane rupt
Stages of Development Pre-embryonic-0-15 days Embryonic- 15 days to 8 weeks Fetal - 9 weeks to delivery (0-8 weeks is most critical)
Safe Vaccines during pregnancy Hep A & B Influenza (inactivated) IM Pneumonococcal (inactivated) Tdap Meningococcal Rabies
Contraindicated Vaccines during pregnancy MMR Influenza (live) Varicella BCG Meningococcal Typhoid HPV
Neonate Abstinence Score (NAS) GI: Poor feeding, excessive sucking, diarrhea. CNS: Hypertonicity, excoriation, tremors, inconsolability. Other: Nasal congestion, sneezing, sweating, fever, tachypnea.
Nursing Care for Neonatal Abstinence -Review maternal history -Toxicology screening for newborn -Assessment for signs of withdrawal
Supportive Newborn Care for Neonatal Absitnence Low stimulus environment Nutritional support Swaddling Non-nutritive sucking Skin Care Pharmocologic treatment based on severity of withdrawal symptoms.
Karyotype Pictoral analysis of chromosomes
Genotype Genetic make-up of gene pairs
Phenotype Visible expression of genes (eye color, hair color, height, etc.)
FDA Classification for Pregnancy Classification A-Vit C B-Penicillin, acetaminophen C-Heparin, Zidovudine, Orinase D-Tetracycline, Lithium, Streptomycin X-Coumadin, Diethylstilbestrol (DES), Accutane (Never give these)
Autosome Abnormalities Down Syndrom-Trisomy 21 Edwards' Syndrom-Trisomy 18 Patau's Syndrom-Trisomy 13 Abnormal Structure- Cri Du Chat (translocation, addition, deletion)
Sex Chromosome Abnormalities Turner Syndrom-femals, Monosomy X Kleinfelter's Syndrom- Males, Trisomy XXY
Autosomal Dominant Inheritance Affected individual has affected parent 50% chance of passing on the gene Males and Femals equally affected Ex: Huntington's Disease, polycystic kidney disease, neurofibromatosis, Achondroplastic dwarfism.
Assessment for fetal well being-genetic screening Amniocentesis and Chorionic villi sampling
Developmental Milestones Embryo/Fetus 4- heart begins to beat 8-body organs and eyes/ears/nose/mouth/digits well-formed 12-sex recognizable 16-mother feels quickening 20-lanugo and vernix appear 24-hearing 28-weak cry/suck reflex; lecithin forms 36-plump/surfactant/myelination of brain
Teratogen Any subs., organism, physical agent of defici. state present during gestation that is capable of inducing abno. postnatal structure or func. interfering with normal embryonic and fetal develop. -greatest effect during embryonic period-16-60 days concept.
Substance Abuse as Teratogen: Neonatal Effects Alcohol-Craniofacial features, developmental delays, cognitive delays Tobacco-LBW, learning problems, SIDS Heroin-withdrawal within 24-72hrs after birth Cocaine-fetal effects are 2nd to maternal effects, growth restriction, behav. issuses, hypertonicit
Substance Abuse as Teratogen: Neonatal Effects Methadone-more severe than heroin withdrawal, usually within 96 hours of birth Methamphetamine-often abuse of other substances
Chromosomes Made of DNA, carry Genes
Genes made of DNA, coded info
Human Cells 23 pairs-homologous, matched 22 pairs of autosomes 1 pair sex chromosomes xx female xy male
Translocation Pieces of chromosomes break off and attach to another chromosome somewhere in a person's genome: Burkitt's lymphoma, CML
Deletion Portion of one chromosome deleted and added to another
Abnormality of Chromosome Structure Cri Du Chat Missing piece in short arm of chromosome 5 Effectes 50-60 children yearly
Patterns of Genetic Transmission-Multifactorial Combination of genetics/environment, mild to severe, familial (cleft lip/palate, pyloric stenosis, neural tube defects).
Patterns of Genetic Transmission-Unifactorial Mendelian Single gene defect -autosomal dominant -autosomal recessive -x-linked recessive -x-linked dominant
Autosomal Dominant Inheritance Affected individual has an affected parent 50% chance of passing on the gene Males and females equally affected Ex: huntington's disease, polycystic kidney disease, neurofibromatosis, achondroplastic dwarfism.
Autosomal Recessive Inheritance Both parents are carriers 25% of passing on abnormal gene 25% of an affected child with each pregnancy 50% chance of having carrier child Males and females equally affected Ex: CF, Tay-Sachs, Sickle Cell, Inborn Errors Metabolism: PKU, Galactosemia
X-Linked Dominant Inheritance Rare, occur in males/heterozygous females, affected females have normal gene, affected males transmit abnormal gene only to their daughters on X chromosome Ex: fragile X syndrome, vitamin D-resistant rickets
X-Linked Recessive Inheritance Abnormal gene carried on X Female carries the abn. gene on one of her two X chromosomes A single abnormal copy of the recessive gene will cause the disease in a male. 50% pass to son affected 50% pass to daughter carrier Ex: Hemophilia, color blindne
Couples Risks Factors Maternal age > 35 + family hx, cpl w/chrom abn. cpl w/a balanced translocation, Fam. hx of known or suspec. Mendelian (single gene) genetic disorder,previous child w/chromo. anomaly or metab.disorder, 2 + 1st tri spont. abortions, ethic groups at ^ r
Couples Risks Continued... Abnormal MSAFP Women with teratogenic risk Maternal pre-existing medical conditions
Promotion of Normalcy Nursing Care: Educative/Supportive Nursing System Prenatal care and teaching Anticipatory guidance emotional support identifies ethical, cultural, legal, and fiscal issues related to genetics Teach about teratogens and genetics and the impact of fetal well-being Support pt/fam in making informed dec
Promotion of Normalcy Nursing Care: Partially Compensatory Nursing System Assist w/prenatal/postnatal diagnostic testing Monitor newborn for deviations-behavior changes, temperature instability, feeding difficulties, respiratory changes Encourage parent-newborn interaction Teach Re: modifications for newborn care, followup c
Promotion of Normalcy for Fetal Development Nursing Dx -risk for disturbed maternal/fetal dyad -risk for impaired parenting Outcomes -verbalize factors that impact fetal well-being -demonstrate behaviors that reduce risk to fetus -participate in screening procedures as indicated
Created by: nglidden