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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.

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Welcome to n353 for winter 2005 l.jpg

Welcome to N353 for Winter 2005!!

Joy Haskin, RN, MS

with

Shalise Pollock, RN, MSN &

Maria Rubiolino, RN, MSN


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Review of the Syllabus

  • Date & time

  • Course description

  • Prerequisites/co-requisites

  • Course objectives

  • Teaching methods

  • Required textbooks

  • Student evaluation


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Syllabus Review (cont’d)

  • Student policies

    • Students with disabilities

    • Academic honesty

    • Absentee policy

    • Additional information

  • Guidelines for Formal Paper

  • Class/Reading/Assignment Schedule



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Contemporary Maternity & Women’s Health Care

  • Maternity Nursing

    • focuses on the care of child-bearing women and their families through all stages of pregnancy and childbirth, as well as the first 4 weeks after birth.



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  • Perinatal Nurse

    • nurturer, educator, physical a care provider, critical thinker, support person, counselor, case manager, or researcher


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  • Perinatal Nurse

    • nurturer, educator, physical a care provider, critical thinker, support person, counselor, case manager, or researcher

  • Care providers during perinatal period include:


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  • 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)



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  • Women’s Health Nursing

    • Focuses on physical, psychologic, and social needs of women throughout their lives.

    • Well-being, childbearing & diseases


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  • 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)


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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


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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%)


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Delivery location

  • Hospital

  • Free-standing birthing center

  • Home

  • Delivered by whom?

    • Physician 92%

    • CNM 7%


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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


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Changes in Labor Care (cont’d)

  • Changes in analgesia care

    • No analgesia

    • Epidural

  • Family-centered care

    • Fathers

    • Grandparents

    • Siblings

    • Friends


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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 (labor-deliver-recover-postpartum LDRP)

  • Mother-baby couplets rather than 1 RN for mother and 1/baby

  • 24-48 hour discharge that challenges teaching

  • Newborn security


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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


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Education

  • Classes for

    • Childbirth

    • parenting

  • Parent support groups after birth


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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


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  • 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


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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


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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)


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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


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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


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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


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  • Nursing Outcome Classifications (NOC)

  • Health Care Financing Administration (HCFA)

  • Best practice

  • Benchmarking

  • World Health Organization (WHO)

  • Standard of Care

  • Legal=Policy

  • Ethical issues


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Conception & Fetal Development

  • Conception

    • Union of single egg and sperm

    • Marks the beginning of pregnancy


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Conception & Fetal Development

  • Conception

    • Union of single egg and sperm

    • Marks the beginning of pregnancy

  • Gamete


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Conception & Fetal Development

  • Conception

    • Union of single egg and sperm

    • Marks the beginning of pregnancy

  • Gamete

    • Egg or sperm


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Conception & Fetal Development

  • Conception

    • Union of single egg and sperm

    • Marks the beginning of pregnancy

  • Gamete

    • Egg or sperm

  • Fertilization


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Conception & Fetal Development

  • Conception

    • Union of single egg and sperm

    • Marks the beginning of pregnancy

  • Gamete

    • Egg or sperm

  • Fertilization

    • Union of gametes



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  • Cell Division

    • Mitosis

      • Yields 2 identical cells

    • Meiosis

      • Yields 2 germ cells w/ half the chromosomal number=haploid; 22 autosomes & 1 sex chromosome

  • Gametogenesis


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  • 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


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  • 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)


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  • 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


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Fertilization

  • Takes place in outer third of uterine tube


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Fertilization

  • Takes place in outer third of uterine tube

  • Sperm penetrates membrane of ovum, become enclosed=zona reaction


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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



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  • 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)


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Implantation

  • Zona pellucida degenerates


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Implantation

  • Zona pellucida degenerates

  • 6-10 days p/ conception


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Implantation

  • Zona pellucida degenerates

  • 6-10 days p/ conception Anterior or posterior fundus


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Implantation

  • Zona pellucida degenerates

  • 6-10 days p/ conception Anterior or posterior fundus

  • Trophoblast burrows into endometrium


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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


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Fetal Development

  • Pregnancy lasts 10 lunar mos. or 40 weeks or 280 days


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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


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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


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