Contemporary childbirth is characterized by what 3 things ?
1. family - centered childbirth ( including ext.family)
2. increased choices including place, caregiver and experiences (analgesia, position)
3. High -tech birthing
In the US , the majority of those over 65 are insured by ________, while the under 65 and in poverty, they are covered by _________.
Medicare
Medicaid
The two primary functions of HIPAA are :
1. protect the health insurance coverage of employees and their families if they lose or change jobs
2. addresses the privacy and security of health information
What are the requirements for a professional nurse and their scope of maternity practice?
1. graduate of accredited program
2. successful completion of NCLEX
3. current license as an RN
4. general care of maternal/newborn patients
what are the requirements and scope of practice for a Certified Registered Nurse ( RNC) ?
1. RN with specialty expertise in a particular field of nursing
2. succesful completion of a national certification examination in that field
What are the requirements and scope of practice for a Nurse Practioner?
1. RN with specialized education in either a Doctor of Nursing ( DNP) or masters degree program that functions in an expanded role.
2. can provide :
* ambulatory care ( woments health center)
* Acute care settings
3. Focus on physical and psychosocial assessment including:
* health history
* physical examination
* diagnostic tests /procedures
What are the requirements and scope of practice for a Clinical Nurse Specialist ( CNS) ?
1. RN with a masters degree and specialized knowledge ina specific clinical area
2. leadership role to improve patient care both directly and indirectly
What are the requirements and scope of practice for a Certified Nurse-Midwife ?
1. Educated in both Nursing and Midwifery
2. Certified by ACNM ( american college of Nurse-midwives)
3. independently manages the care of women at low risk for complications during pregancy and birth and the care of normal newborns
Name 4 types of Advanced practices nurses ( APN's)
NP
CNS
CRNA ( certified nurse anesthetists
CNM
Nurse researcher ( has a PhD )
Which person is most qualified to provide prenatal, intrapartal, postpartal and newborn care for the low-risk childbearing woman?
a. Acute care clinical specialist
b. CNM
c. lay midwife
d. obstetric NP
The CNM is most qualified as the overall care of this client
What are the 3 areas of focus of Primary care in community setting ??
1. Health promotion
2. Illness prevention
3. Individual responsibility
What are 2 purposes for Home care ?
1. Provides additional support and teaching after discharge from acute care settings
2. Allows people to remain at home with conditions that previously would have required hospitalization
As the main providers of home care services , Nurses play a major role in what 4 areas of care?
1. Assessment and therapeutics
2. Communication and teaching
3. problem solving and organization
4. coordination of care with other providers such as:
* lactation consultants
* physical therapists
* social workers
What is the definition of and 4 elements of Negligence in Nursing practice?
D: omitting or committing an act that a reasonably prudent person would not omit or commit under the same or similar circumstances.
1. there was a duty to provide care
2. the duty was breached
3. Injury occurred
4. the breach of duty caused the injury
What is the difference between breach of duty by ommission vs commission?
breach by ommission:
1. failure to give a medication
2. failure to assess properly
3. failure to notify physician of change in laboring womans condition
Breach by commission:
1. giving the wrong medication
2. placing an infant in the wrong crib
Negligence is determined by comparing the care given to the standard of care. If the standards were not met, then negligence occured.
Name 5 organizations responsible for standards of care in maternal nursing.
ANA ( American nurses assoc)
Council of perinatal nurses
AWHONN ( Assoc of womens health, obstetrics,and neonatal nurses )
AORN ( assoc of operating room nurses )
NANN ( national assoc of neonatal nurses )
Name the 3 major areas of informed consent
1. information is clearly and concisely presented in a manner that is understandable to the patient and must include :
* risks and benefits
* probability of success
* significant treatment alternatives
2. Patient must be told the consequences of receiving No treatment /procedure
3. patient must be told they have the right to refuse a treatment or procedure
Name 4 areas of Maternal-fetal conflict that may arise and pose ethical dilemmas for the nursing staff.
1. termination of pregnancy
2. Embryonic and fetal research
3. reproductive assistance
4. Cord blood banking
Abortion is defined as a pregnancy that is terminated before ______ weeks gestation or if unattainable, a fetus that weighs less than _______ g.
20 weeks or 500 grams
Name 3 types of reproductive assistance.
1. Therapeuitic insemination ( TI )
2. Assisted Reproductive technology ( ART)
3. Surrogate childbearing
How is Therapeutic insemination accomplished?
sperm from a husband, donor , partner is deposited into the woman
Define ART
any fertility treatment where BOTH the egg and sperm are handled
1. invitro fertilization and embryo transfer ( IVF -ET)
What are common complications of ART ?
1. Multifetal pregnancy which increases chances of :
* miscarriage
* preterm birth
* neonatal morbidity
* neonatal mortality
* C -section birth
Birth rate is :
number of live births per 1000 people
Infant mortality rate is :
number of deaths of infants under 1 year of age per 1000 live births in a given population.
Neonoatal mortality rate is:
number of deaths of infants less than 28 days of age per 1000 live births
post neonatal mortality is figured :
number of deaths of infants between the ages of 28 days and 1 year
perinatal mortality is
includes BOTH fetal (death in-utero 20 or more weeks gestation ) and neonatal deaths per 1000 live birhts
Maternal mortality rate is:
the number of deaths from any cause related to , or aggravated by pregnancy or its management during the pregnancy cycle
Statistical data can be used by Nurses to:
1. determine at-risk populations
2. assess the relationship between specific factors
3. establish databases for specific patient populations
4. determine levels of care needed by particular patient populations
5. evaluate the success of specific nursing interventions
6.estimate staffing and equipment needs of units
Evidence based practice is :
Nursing care in which all interventions are supported by current, valid research or other forms of evident such as committee opinions or task force recommendation
What are the 3 basic competencies in evidence based practice for nurses ??
1. recognize which clinical practices are supported by sound evidence, which have conflicting findings and which have no evidence to support their use
2. to use data in their clinical work to evaluate outcomes of care
3. to appraise and integrate scientific bases into practice
Acupuncture is :
technique that uses fine needles to stimulate pressure points
Ayurveda is :
Classic system of Hinu medicine aimed at helping people lead healthy lives
Biofeedback is:
Technique designed to help individuals learn to control their physiologic responses
Chiropractic therapy is:
System that uses concepts of manipulation to address certain health problems
Homeopathy is :
Healing system that uses the concept of like to cure like
Traditional chinese medicine
system of medicine based on the balance of energy or chi
Naturopathy is:
system that uses a variety of natural approaches to preventing and treating problems.
Name 7 types of alternative and complementary therapies
Acupuncture
Ayurveda
Biofeedback
Chiropractic
Homeopathy
Naturopathy
Traditional Chinese medicine
Amenorrhea
Absence of menses
Hypomenorrhea
abnormally short menstrual cycle
Menorrhagia
Excessive menstrual flow
Dysmenorrhea
painful menses
Hypermenorrhea
abnormally long menstrual cycle
Metrorrahagia
Bleeding between periods
Define Family power and how it affects health care decisions
Family power: individual or group who possesses the potential or actual ability to change teh behavior of other family members .
This person/groups attitude may affect how a patient responds to a healcare provider, a diagnosis, treatments , or health teaching.
Culture
beliefs,values, attitudes and practices that are accepted by the population , a community or an individual . It is learned, not genetic
Ethnicity
social identity that is associated with shared behaviors and patterns . They include: family structure, religious affiliation, language, dress ,eating habits , health behaviors
Acculturation
the process by which people adapt to a new cultural norm
Assimilation
when a group completely changes their cultural identity to become part of the majority culture
Complimentary therapy
any procedure or product that is used together with conventional medical treatment
Alternative therapy
used in place of conventional medicine
4 Benefits of alternative therapy:
Emphasis on prevention/wellness
Emphasis on healing vs cure
Noninvasive approaches
cost and access
4 risks of alternative therapy
Lack of regulation and standardization
lack of research
inadequate training and certification
financial and health risks of unproven methods
External genital structures of a fetus are the same for male/female until the end of week _______?
Nine (9)
Differentiation of external genitals is complete by week ______ ?
12
Name 4 signs of female puberty
Broadening of hips
budding of breasts
appearance of pubic and axillary hair
onset of menstruation ( menarche)
name 4 characteristics of male puberty
linear growth spurts
increase in size of genitals
appearance of pubic , axillary and facial hair
deepening of voice
T or F
All oocytes are formed during fetal development and present in full at birth.
True
Puberty is initiated by the maturation of the ________-_______ - ________ complex in addition to the input from the CNS.
Hypothalamic-pituitary-gonad
Puberty is initiated when the CNS stimulates the ________ to synthesize and release _________ ?
Hypothalamus
GnRH ( gonadotropin-releasing hormone)
What is the sequence of events in the onset of puberty ?
CNS stimulates hypothalamus to release GnRH
GnRH is transmitted to the Anterior pituitary where it causes synthesis of LH and FSH
Name 8 hormones that are responsible for puberty and/or development of secondary sex characteristics
GnRH
LH
FSH
ACTH
GH
Thyroid
Estrogen
testosterone
Name 3 hormones that can disrupt the onset of puberty in too high/low levels.
ACTH
TH
GH
Internal and external female reproductive organs develop and mature in response to estrogen and progesterone
Female external genitals are called the _______ ?
Vulva
Vulva:
Mons pubis
labia ( majora and minora)
clitoris
urethral meatus
vaginal vestibule
perineal body
This part of the vulva generally gets cut or tears during vaginal delivery.
Perineal body
the mons pubis is responsible for protection of the pelvic bones, especially during sex
The labia majora :
protection of internal structures
stratified squamous epithelium
contain hair follicles and sebacious glands
merge to form the posterior junction of the perineal skin
The dartos muscle sheath is responsible for the wrinkled appearance of the labia majora as well as sensitivity to heat/cold
the labia minora converge near the anus, forming the fourchette
The labia minora:
* shiny
* no hair follicles
* rich in sebacious glands
* composed of erectile/involuntary muscle tissue
The labia minora secretions serve to:
lubricate and waterproof the vulvar skin
provide bacteriacidal properties
the size of labia minora increase after puberty and decrease after menopause in response to what hormone ?
Estrogen
Clitoris is made of __________ tissue and is partly covered by the fold of skin called the _________
erectile
prepuce ( clitoral hood)
The clitoris is very rich in blood and nerve supplies and is the primary erogenous zone for women.
The clitoris secretes ____________. ( pheremone )
smegma
Urethral meatus is located ___ to _____ cm beneath the clitoris in the midline of the vestibule
1 to 2.5 cm
The paraurethral glands are also called __________ and serve to lubricate the vaginal vestibule to facilitate sexual intercourse
skene's glands
The vaginal opening can also be called the _________ and is the border between the exterior and interior genitals
Introitus
Hymen: thin, elastic collar or semicollar of tissue that surrounds the vaginal opening.
Bartholin's glands ( vulvovaginal glands) are located external to the hymen at the base of the vestibule and secrete a clear, thick, alkaline mucous that facilitates sperm motility
Perineal body is
wedge shaped mass of fibromuscular tissue ( appx 4 x 4 x 4 cm) between the lower part of the vagina and the anus
The superficial part of the perineal body between the vagina and the anus is called the ________
perineum
This tissue is most likely the site of injury, tearing or episiotomy during vaginal delivery
Perineum
The anterior wall of the vagina is appx 2.5 cm shorter than the posterior wall , due to the projection of the cervix into the anterior wall.
the upper part of the vagina is called the _________ ______
vaginal vault
The recess or hollow area around the cervix is called the
vaginal fornix
what 7 structures can be palpated through the thin walls of the vaginal vault?
Uterus
distended bladder
ovaries
appendix
cecum
colon
ureters
The upper fourth of the vagina is separated from the rectum by the _______ __ _________, and is posterior to the cervix
Pouch of douglas
The purpose of the vaginal fornix is ________
allow pooling of semen when woman lies on her back after sex ( increases chances of pregnancy)
the rugae of the vagina have the purpose of _______________
stretching to accomodate birth of baby and during coitis
the principle muscle responsible for closing the vagina is the ________ _____
Levator Ani
The thin band of striated muscle at the lowest extremity of the vagina is the _____ ______
sphincter vaginae
a rich blood supply to the vagina is necessary to maintain a high glycogen content in the epithelial cells and to nourish the underlying musculofascial layer ( where the vaginal vault attaches to cervix )
The normal pH for the vagina ( during reproductive years) is ______ to ______
4 - 5
The acidic environment of the vagina is maintained by a symbiotic relationship between:
Lactic acid producing Bacilli ( Doderlein's bacillus or lactobacillus) and the vaginal epithelial cells that contain glycogen ( which the bacilli break down into lactic acid)
The amount of glycogen available in the vaginal epithelial cells is regulated by the _________ _______
