NURS 2410 Unit 1 Nancy Pares, RN, MSN Metro Community College
Objective 1 and 2 and 3 • Apply basic knowledge of healthy maternal newborn care (recall from PN year) • Describe ethical and legal issues of maternal newborn nursing, current legislation and community resources available. • Demonstrate appropriate therapeutic communication and assessment of high risk pregnancy.
Ethical decision making model • Context • Who is involved, what is the setting • What other information is needed • What personal beliefs of the nurse may impact the situation • Clarification of the issues • What are the ethical issues • Who should decide the issue • Identification of alternatives and potential outcomes
Decision making cont • Ethical reasoning • What ethical theories have bearing on the situation • Should some theories be given greater weight in the decision making process • What legal or social constraints are factors • What obligations might be present in the role of the nurse
Decision making model cont • Resolution • What is the best action in this situation • What strategy should be used to carry out this action • Evaluation • What were the outcomes • Should this same action be used in the future for similar dilemmas
Maternal-Newborn Nursing Roles • Professional Nurse • Certified Registered Nurse • Nurse Practitioner • Clinical Nurse Specialist • Certified Nurse Midwife
Factors Contributing to Family Values • Religion and social beliefs • Presence and influence of the extended family • Socialization within the ethnic group • Communication patterns • Beliefs and understanding about health and illness • Permissible physical contact with strangers • education
Legal Issues • Standards of care: • Minimum criteria for competent, proficient, delivery of nursing care • Institutional policies • Ethical implications • Scope of practice • Defined by state Nurse Practice Act • laws
Negligence • There was a duty to provide care. • The duty was breached. • Injury occurred. • The breach of duty caused the injury (proximate cause).
Maternal-Child Issues • Divergence between rights of mother and rights of fetus: • Mother may refuse fetal intervention. • Fetal intervention may be forced on mother. • Fetal research: • Therapeutic vs. non-therapeutic
Maternal-Child Issues • Intrauterine fetal surgery: • Therapy for anomalies incompatible with life • Health of the mother and fetus is at risk • Surrogate, frozen embryo, • Female circumcision
Maternal-Child Issues • Abortion • Can be performed until point of viability • After viability, if mother’s health in jeopardy • Nursing role • Have right to refuse to assist • Responsible for ensuring a qualified replacement is available
Maternal-Child Issues • Infertility • Human stem cells • Cord blood • Maternal refusal for c/del • Maternal refusal for fetal surgery
Standards of Care • Womens’ health standards by Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) • State Boards • Individual facilities policy
Practicing Safety • A holistic interpersonal approach • Adequate documentation • Communication • Updated and realistic policies and procedures • Appropriate delegation • Question deviations from the standar • Follow chain of command
Benefits ofEvidence-Based Practice • Transforms research findings into clinical practice: • Efficiency improvement • Better outcomes • Quality improvement
Objective 4 and 5 • Identify vulnerable periods during which malformations of various organs may occur and describe the resulting anomalies. • Describe the function and structure of the placenta during intrauterine life. (review PN year)
Cell Division (review A&P) • Mitosis: • Exact copies of original cell • Meiosis: • Production of new organism
Genetic terms • Deletion • Loss of chromosome material • Translocation • Misplacement • Nondisjunction • Chromosomes don’t separate correctly • Karotype • Chromosomal make up of an individual Mosaicism two or more genetically different cell populations in an individual
Mitosis • Interphase • Prophase • Metaphase • Anaphase • Telophase
Meiosis • First division: • Chromosomes replicate, pair, and exchange information. • Chromosome pairs separate, and cell divides. • Second division: • Chromatids separate and move to opposite poles. • Cells divide, forming four daughter cells.
Oogenesis • Ovary gives rise to oogonial cells. • Cells develop into oocytes. • Meiosis begins and stops before birth. • Cell division resumes at puberty. • Development of Graafian follicle.
Spermatogenesis • Production of sperm • First meiotic division: • Primary spermatocyte replicates and divides. • Second meiotic division: • Secondary spermatocytes replicate and divide. • Produce four spermatids.
Figure 11–3 Gametogenesis involves meiosis within the ovary and testis. A, During meiosis, each oogonium produces a single haploid ovum once some cytoplasm moves into the polar bodies. B, Each spermatogonium, in contrast, produces four haploid spermatozoa.
Fertilization • Uniting sperm and ovum form a zygote • Ova are fertile for 12 to 24 hours • Sperm are fertile for 72 hours • Takes place in the ampulla of fallopian tube
Changes in Sperm • Capacitation: • Removal of plasma membrane and glycoprotein coat • Loss of seminal plasma proteins • Acrosomal reaction: • Release of enzymes • Allows entry through corona radiata
Figure 11–4 Sperm penetration of an ovum. A, The sequential steps of oocyte penetration by a sperm are depicted moving from top to bottom. B, Scanning electron micrograph of human sperm surrounding a human oocyte (750ﾗ). The smaller spherical cells are granulosa cells of the corona radiata. SOURCE: Used with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.
After Sperm Entry • Zone pellucida blocks additional sperm from entering • Secondary oocyte completes second meiotic division • Forms nucleus of ovum • Nuclei of ovum and sperm unite • Membranes disappear • Chromosomes pair up
Twins • Fraternal: two ova and two sperm • Identical: single fertilized ovum - Originate at different stages
Pre-embryonic • Cleavage • Blastomeres form morula • Blastocyst: - develops into embryonic disc and amnion • Trophoblast: - develops into chorion
Implantation • Occurs 7 to 10 days after fertilization • Blastocyst burrows into endometrium • Endometrium is now called decidua
Embryonic Development • Primary germ layers: • Ectoderm • Mesoderm • Endoderm
Placenta • Metabolic and nutrient exchange • Maternal portion: • Decidua • Fetal portion: • Chorionic villi • Fetal surface covered by amnion
Placental Development • Chorionic villi form spaces in decidua basalis • Spaces fill with maternal blood. • Chorionic villi differentiate: • Syncytium: outer layer • Cytotrophoblast: inner layer • Anchoring villi form septa
Figure 11–13 Longitudinal section of placental villus. Spaces formed in the maternal decidua are filled withmaternal blood; chorionic villi proliferate into these maternal blood-filled spaces and differentiate into a syncytium layer and a cytotrophoblast layer.
Umbilical Cord • Body stalk fuses with embryonic portion of the placenta • Provides circulatory pathway from chorionic villi to embryo: • One vein • Delivers oxygenated blood to fetus: • Two arteries
Figure 11–14 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
Placental Functions • Nutrition • Excretion • Fetal respiration • Production of fetal nutrients • Production of hormones
Fetal Development: Week 4 • Beginning development of GI tract • Heart is developing • Somites develop—beginning vertebrae • Heart is beating and circulating blood • Eyes and nose begin to form • Arm and leg buds are present
Fetal Development: Week 6 • Trachea is developed • Liver produces blood cells • Trunk is straighter • Digits develop • Tail begins to recede
Fetal Development: Week 12 • Eyelids are closed • Tooth buds appear • Fetal heart tones can be heard • Genitals are well-differentiated • Urine is produced • Spontaneous movement occurs
Fetal Development: Week 16 • Lanugo begins to develop • Blood vessels are clearly developed • Active movements are present • Fetus makes sucking motions • Swallows amniotic fluid • Produces meconium
Fetal Development: Week 20 • Subcutaneous brown fat appears • Quickening is felt by mother • Nipples appear over mammary glands • Fetal heartbeat is heard by fetoscope
Fetal Development: Week 24 • Eyes are structurally complete • Vernix caseosa covers skin • Alveoli are beginning to form
Fetal Development: Week 28 • Testes begin to descend • Lungs are structurally mature
Fetal Development: Week 32 • Rhythmic breathing movements • Ability to partially control temperature • Bones are fully developed but soft and flexible
Fetal Development: Week 36 • Increase in subcutaneous fat • Lanugo begins to disappear
Fetal Development: Week 38 • Skin appears polished • Lanugo has disappeared except in upper arms and shoulders • Hair is now coarse and approximately 1 inch in length • Fetus is flexed
Factors Influencing Development • Quality of sperm or ovum • Genetic code • Adequacy of intrauterine environment • Teratogens