Welcome to N353 for Winter 2005!!

1. Welcome to N353 for Winter 2005!! Joy Haskin, RN, MS with Shalise Pollock, RN, MSN & Maria Rubiolino, RN, MSN

2. Review of the Syllabus • Date & time • Course description • Prerequisites/co-requisites • Course objectives • Teaching methods • Required textbooks • Student evaluation

3. Syllabus Review (cont’d) • Student policies • Students with disabilities • Academic honesty • Absentee policy • Additional information • Guidelines for Formal Paper • Class/Reading/Assignment Schedule

4. Contemporary Maternity & Women’s Health Care • Maternity Nursing

5. 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.

6. Perinatal Nurse

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

8. Perinatal Nurse • nurturer, educator, physical a care provider, critical thinker, support person, counselor, case manager, or researcher • Care providers during perinatal period include:

9. 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)

10. Women’s Health Nursing

11. Women’s Health Nursing • Focuses on physical, psychologic, and social needs of women throughout their lives.

12. Women’s Health Nursing • Focuses on physical, psychologic, and social needs of women throughout their lives. • Well-being, childbearing & diseases

13. 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)

14. 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

15. 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%)

16. Delivery location • Hospital • Free-standing birthing center • Home • Delivered by whom? • Physician 92% • CNM 7%

17. 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

18. Changes in Labor Care (cont’d) • Changes in analgesia care • No analgesia • Epidural • Family-centered care • Fathers • Grandparents • Siblings • Friends

19. 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

20. 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

21. Education • Classes for • Childbirth • parenting • Parent support groups after birth

22. 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

23. 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

24. 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

25. 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)

26. 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

27. 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

28. 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

29. 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

30. Nursing Outcome Classifications (NOC) • Health Care Financing Administration (HCFA) • Best practice • Benchmarking • World Health Organization (WHO) • Standard of Care • Legal=Policy • Ethical issues

31. It’s time for a break!! • Please return in 15 mins

32. Conception & Fetal Development • Conception:

33. Conception & Fetal Development • Conception • Union of single egg and sperm • Marks the beginning of pregnancy

34. Conception & Fetal Development • Conception • Union of single egg and sperm • Marks the beginning of pregnancy • Gamete

35. Conception & Fetal Development • Conception • Union of single egg and sperm • Marks the beginning of pregnancy • Gamete • Egg or sperm

36. Conception & Fetal Development • Conception • Union of single egg and sperm • Marks the beginning of pregnancy • Gamete • Egg or sperm • Fertilization

37. Conception & Fetal Development • Conception • Union of single egg and sperm • Marks the beginning of pregnancy • Gamete • Egg or sperm • Fertilization • Union of gametes

38. Cell Division

39. Cell Division • Mitosis

40. Cell Division • Mitosis • Yields 2 identical cells

41. Cell Division • Mitosis • Yields 2 identical cells • Meiosis

42. Cell Division • Mitosis • Yields 2 identical cells • Meiosis • Yields 2 germ cells w/ half the chromosomal number=haploid; 22 autosomes & 1 sex chromosome • Gametogenesis

43. 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

44. 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)

45. 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

46. Fertilization • Takes place in outer third of uterine tube

47. Fertilization • Takes place in outer third of uterine tube • Sperm penetrates membrane of ovum, become enclosed=zona reaction

48. 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

49. Blastomere-smaller cells formed by this first mitosis

50. Blastomere-smaller cells formed by this first mitosis • Morula-the ball formed by 16 cells surrounded by a protective zona pellucida