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OB nursing key points, Lecture notes of Nursing

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McKinney: Maternal-Child Nursing, 4th Edition
Chapter 1: Foundations of Maternity, Women’s Health, and Child Health Nursing
Key Points - Print
Maternity and child health nursing has changed dramatically because of increasing
knowledge about the care of women, children, and families; changes in the health care system;
federal involvement; and consumer demands.
Recently, the government, insurance companies, hospitals, and health care providers have
tried to reform health care delivery and control health care costs. This trend has changed where
and how money is spent.
According to the basic principles of family-centered maternity care, childbirth is usually
a normal, healthy event in the life of a family. Childbirth affects the entire family and requires a
restructuring of family relationships. Families are capable of making decisions about care when
they have adequate information and professional support. Family-centered care increases the
responsibilities of nurses.
Prospective payment plans control health care costs by negotiating reduced charges with
providers and restricting patient choice of providers. Prospective payment plans have had major
effects on maternal and infant care, primarily in relation to the length of stay.
Capitated plans allow a predictable amount of money to be budgeted for health care, and
patients do not have unexpected financial burdens from illness. However, patients lose freedom
of choice regarding who will provide their care. Some health care providers and consumers fear
that cost constraints might affect treatment decisions.
In case management, a case manager focuses on both quality of care and cost outcomes
and coordinates patient and family services. Nurses who provide case management evaluate
patient and family needs, establish needs documentation to support reimbursement, and may be
part of long-term care planning in the home or a rehabilitation facility.
Clinical pathways identify patient outcomes, specify timelines to achieve them, direct
appropriate interventions and sequencing of interventions, include interventions from a variety of
disciplines, promote collaboration, and involve a comprehensive approach to care. As in
managed care and case management, the purpose is to provide quality care while controlling
costs.
With advances in portable and wireless technology and monitoring devices, home nursing
care has grown dramatically. Services include telephone calls, home visits, information lines, and
lactation consultations.
Historically, mortality rates among women and infants have been high. With
improvements in the health of the general population, sanitation, and medical knowledge,
mortality rates fell. However, racial inequality of maternal and infant mortality rates continues.
Nurses must be informed about the abortion issue from a legal and ethical standpoint,
know the regulations and laws in their state, and acknowledge the sincere convictions and strong
emotions of people on all sides of the issue.
Maternal-child health nurses must know how to approach the ethical and social issues
that affect families knowledgeably and systematically.
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McKinney: Maternal-Child Nursing, 4th Edition

Chapter 1: Foundations of Maternity, Women’s Health, and Child Health Nursing Key Points - Print

  •  Maternity and child health nursing has changed dramatically because of increasing knowledge about the care of women, children, and families; changes in the health care system; federal involvement; and consumer demands.
  •  Recently, the government, insurance companies, hospitals, and health care providers have tried to reform health care delivery and control health care costs. This trend has changed where and how money is spent.
  •  According to the basic principles of family-centered maternity care, childbirth is usually a normal, healthy event in the life of a family. Childbirth affects the entire family and requires a restructuring of family relationships. Families are capable of making decisions about care when they have adequate information and professional support. Family-centered care increases the responsibilities of nurses.
  •  Prospective payment plans control health care costs by negotiating reduced charges with providers and restricting patient choice of providers. Prospective payment plans have had major effects on maternal and infant care, primarily in relation to the length of stay.
  •  Capitated plans allow a predictable amount of money to be budgeted for health care, and patients do not have unexpected financial burdens from illness. However, patients lose freedom of choice regarding who will provide their care. Some health care providers and consumers fear that cost constraints might affect treatment decisions.
  •  In case management, a case manager focuses on both quality of care and cost outcomes and coordinates patient and family services. Nurses who provide case management evaluate patient and family needs, establish needs documentation to support reimbursement, and may be part of long-term care planning in the home or a rehabilitation facility.
  •  Clinical pathways identify patient outcomes, specify timelines to achieve them, direct appropriate interventions and sequencing of interventions, include interventions from a variety of disciplines, promote collaboration, and involve a comprehensive approach to care. As in managed care and case management, the purpose is to provide quality care while controlling costs.
  •  With advances in portable and wireless technology and monitoring devices, home nursing care has grown dramatically. Services include telephone calls, home visits, information lines, and lactation consultations.
  •  Historically, mortality rates among women and infants have been high. With improvements in the health of the general population, sanitation, and medical knowledge, mortality rates fell. However, racial inequality of maternal and infant mortality rates continues.
  •  Nurses must be informed about the abortion issue from a legal and ethical standpoint, know the regulations and laws in their state, and acknowledge the sincere convictions and strong emotions of people on all sides of the issue.
  •  Maternal-child health nurses must know how to approach the ethical and social issues that affect families knowledgeably and systematically.
  •  Poverty—an underlying factor in problems such as inadequate access to health care and homelessness—is a major predictor of unmet health needs in children and adults.
  •  To provide informed consent, a patient must be able to think through a situation and make rational decisions. Minors are not allowed to give consent. In most states, minority status for informed consent ends at the age of 18 years.
  •  Nursing accountability involves knowing current laws. Accountability in child health nursing requires special consideration because the nurse must be accountable to the family as well as the child.
  •  Nurses can help defend themselves against malpractice judgments by following guidelines for informed consent, refusal of care, and documentation; acting as a patient advocate; working within accepted standards and the policies and procedures of the facility; and maintaining their level of expertise.
  •  Documentation, whether on paper or in electronic media, is the best evidence that a standard of care has been maintained. When documentation is not present, juries tend to assume that care was not given.

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 3: The Childbearing and Child-Rearing Family Key Points - Print

  •  Traditional families, or nuclear families, are headed by two parents who consider parenting their major priority. These families may have one or two incomes. In general, they are motivated to learn all they can about pregnancy, childbirth, and parenting.
  •  Nontraditional families include single-parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, and homosexual parent families.
  •  High-risk families include families experiencing marital conflict and divorce, families with adolescent parents, families affected by violence, families involved with substance abuse, and families with a chronically ill child. Nurses should consider the additional needs of high-risk families.
  •  Dysfunctional families tend to become trapped in patterns that maintain conflicts rather than resolve them. The conflicts create stress.
  •  To provide effective care, nurses must be aware that culture is a significant influence on parenthood, health, illness, and aging.
  •  Nurses must learn to perform a cultural assessment so that they can understand the meanings of health and illness to the cultural groups they encounter.
  •  A nurse caring for a child must know the family structure and the identity of the primary caregiver.
  •  Because communication is an essential component of nursing assessment and teaching, the nurse must understand cultural influences that may form barriers to communicating with people from another culture.
  •  Parenting behaviors that promote social-emotional, cognitive, and language development are warmth, responsiveness, encouragement, and communication.
  •  The child’s physical appearance, sex, and temperament may affect the parent-child relationship.
  •  Internal family coping strategies include family relationship strategies, cognitive strategies, and communication strategies. External strategies include maintaining active community linkages and using social support systems and spiritual strategies.
  •  Patients from other cultures may not share dominant Western cultural values, including democracy, individualism, cleanliness, preoccupation with time, reliance on machines and equipment, the belief that optimal health is a right, and admiration of self-sufficiency and financial success.
  •  More than 100 different ethnocultural groups live in the United States, and these groups observe numerous traditional health beliefs.
  •  The three styles of parenting are authoritarian, authoritative, and permissive. Authoritarian parents expect obedience without any questioning about the reasons behind the rules. Authoritative parents tend to show respect for the opinions of their children by allowing them to be different. Permissive parents have little or no control over the behavior of their children.
  •  Regardless of the primary parenting style, parenting is more effective when parents adjust their parenting techniques according to each child’s developmental level and when parents are involved and interested in their children’s activities and friends.
  •  The nurse can use formal instruction and informal role modeling to help the parent learn how to discipline a child effectively.
  •  Discipline, which is the foundation of self-discipline, is designed to teach a child how to function effectively within society.
  •  Essential components of effective discipline include maintaining a positive, supportive, loving relationship between the parents and the child; using positive reinforcement and encouragement to promote cooperation and desired behaviors; and removing reinforcement or applying punishment to reduce or eliminate undesired behaviors.

McKinney: Maternal-Child Nursing, 4th Edition

Key Points - Print

  •  Genetic sex is determined at conception, but the reproductive systems of males and females are sexually undifferentiated for the first 6 weeks. During the 7th week, differences between males and females appear in internal structures, and at 12 weeks, differentiation of the external sexual organs is complete.
  •  During puberty, the reproductive organs become fully functional, and secondary sex characteristics develop.
  •  Girls are 6 months to 1 year younger than boys when hormonal changes of puberty begin, although a girl’s growth spurt early in puberty makes it seem that she begins puberty about 2 years before boys of the same age.
  •  Increases in height and weight are dramatic during puberty but slow after puberty until the mature height and weight are attained.
  •  Girls often do not ovulate in early menstrual cycles, although they can ovulate even before the first cycle. Therefore, a sexually active girl can become pregnant before her first menstrual period.
  •  The first outward evidence of sexual maturation in boys is the growth of the testes.
  •  During adolescence, boys commonly experience spontaneous ejaculation of seminal fluid during sleep. Boys should be prepared so that they do not feel abnormal or ashamed.
  •  At birth, a girl has all the ova she will ever have. By the time a woman reaches the climacteric, almost all her ova have been released during ovulation or have regressed.
  •  The female reproductive cycle is called the menstrual cycle because menstruation provides a marker for each cycle’s beginning and end if pregnancy does not occur.
  •  Breast size is not related to glandular tissue or the quantity or quality of milk a woman can produce after childbirth. Breast size is primarily related to the amount of fat present.
  •  The scrotum’s main function is to keep the testes cooler than the core body temperature, so normal sperm formation can take place.
  •  Seminal fluids secreted by the seminal vesicles, prostate, and bulbourethral glands nourish and protect the sperm, enhance their motility, and ensure that most sperm are deposited in the vagina.

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 12: Conception and Prenatal Development

Key Points - Print

  •  Gametogenesis produces ova and sperm that have half the full number of chromosomes, or 23 unpaired chromosomes. When an ovum and sperm unite at conception, the number is restored to 46 paired chromosomes.
  •  In oogenesis, one primary oocyte results in a single mature ovum that contains 23 unpaired chromosomes (22 autosomes and 1 X chromosome).
  •  A man can produce new sperm from puberty through the rest of his life, although fertility gradually declines with age.
  •  The gamete from a male determines the sex of the baby. If an X-bearing spermatozoon fertilizes the ovum, the baby is a girl. If a Y-bearing spermatozoon fertilizes the ovum, the baby is a boy.
  •  During the embryonic period, basic structures of all major body organs are completed, although organs are vulnerable to structural damage from teratogens.
  •  The fetal period is one of dramatic growth and refinement of established organ systems. During this period, teratogens are less likely to cause structural damage but may cause major functional damage.
  •  The placenta is a thick, disk-shaped organ that has metabolic and endocrine functions and transfers substances between mother and fetus.
  •  The four mechanisms of placental transfer of substances are simple diffusion, facilitated diffusion, active transport, and pinocytosis.
  •  The fetal membranes contain amniotic fluid, which protects the fetus by cushioning any impact to the maternal abdomen and providing a stable temperature. Amniotic fluid also promotes normal prenatal development by allowing symmetric development of the fetus as body surfaces fold toward the midline, keeping the membranes from adhering to developing fetal parts, and providing room and buoyancy for fetal movement.
  •  The umbilical cord has two arteries that carry deoxygenated blood and other waste products from the fetus to the placenta for transfer to the mother’s blood. One umbilical vein carries oxygenated, nutrient-rich blood from the placenta back to the fetus.
  •  Three fetal circulatory shunts partially bypass the fetal liver and lungs: the ductus venosus, foramen ovale, and ductus arteriosus. These structures close functionally after birth.
  •  Multifetal pregnancy may be monozygotic or dizygotic. Twinning is the most common form of multifetal pregnancy.
  •  Dizygotic twins are more likely in certain families and racial groups. Infertility therapy and advancing maternal age also increase the likelihood of dizygotic twins.

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 13: Adaptations to Pregnancy Key Points - Print

  •  Multifetal pregnancies require more frequent prenatal visits because complications are more common.
  •  Families need information related to self-care, health promotion, and coping with the common discomforts of pregnancy.
  •  The nursing process focuses on identifying each family’s responses to the physiologic changes of pregnancy, determining factors that might interfere with the ability to adapt to changes, and finding solutions to identified problems.
  •  Maternal responses progress during pregnancy from uncertainty and ambivalence to feelings of vulnerability and preparation for the birth of the infant.
  •  During the second trimester, the woman’s major focus becomes producing a healthy infant.
  •  As they become larger, some pregnant women believe their bodies are ugly, and they worry about their partner’s sexual response. Expectant mothers and fathers should be made aware of the normal changes in sexual desire that occur during pregnancy and the importance of communicating their feelings with each other.
  •  Making the transition to the role of mother involves mimicking the behavior of other mothers, fantasizing about the baby, developing a sense of self as mother, and grieving for the loss of previous roles.
  •  The woman’s priority task is seeking safe passage for herself and her baby. Without safety, she cannot move on to other tasks.
  •  Paternal responses change throughout pregnancy and depend on the ability to perceive the fetus as real, gain recognition for the role of parent, and create a role as involved father.
  •  Certain experiences act as catalysts that make the child more real: seeing the fetus on a sonogram, hearing the fetal heartbeat, and feeling the fetus move.
  •  The term couvade refers to pregnancy-related symptoms and behavior in expectant fathers. In primitive cultures, couvade took the form of pregnancy-related rituals performed by the man. Today, the term refers to a cluster of pregnancy-related symptoms experienced by the man.
  •  The response of grandparents to pregnancy depends on their ages, their beliefs about the role of grandparents, and the number and ages of other grandchildren.
  •  The response of siblings to pregnancy depends on their ages and developmental levels.
  •  The developmental tasks of pregnancy are more difficult for multiparas because they have less time, experience more fatigue, and must negotiate a new relationship with the older children.
  •  Socioeconomic status is a major factor in determining health practices during pregnancy.
  •  Cultural differences can cause conflict between health care workers and families during pregnancy. Conflict commonly occurs in the areas of language, time orientation, and health beliefs.

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 14: Nutrition for Childbearing Key Points - Print

  •  During pregnancy and lactation, a pregnant woman must nourish her own body and that of her baby. Nurses can provide education about nutritional needs throughout this period.
  •  Insufficient weight gain during pregnancy is associated with low birth weight, small-for- gestational-age infants, preterm birth, and failure to initiate breastfeeding. Excessive weight gain is associated with macrosomia, cesarean birth, postpartum weight retention, low Apgar scores, hypoglycemia, and overweight children.
  •  For women who begin pregnancy at a normal body mass index, the recommended weight gain during pregnancy is 11.5 to 16 kg (25 to 35 lb).
  •  Women of normal weight before pregnancy should gain 0.5 to 2 kg (1.1 to 4.4 lb) during the first trimester and 0.35 to 0.5 kg (0.8 to 1 lb) per week thereafter.
  •  During the second trimester, daily caloric intake should increase by 340 calories. During the third trimester, it should increase by 452 calories. Calorie increases should be attained with foods high in nutrient density to meet the other needs of pregnancy.
  •  During the second half of pregnancy, a daily protein intake of 71 g is recommended to expand the blood volume and support the growth of maternal and fetal tissues.
  •  Excessive amounts of fat-soluble vitamins (A, D, E, and K) can be toxic. Excessive amounts of water-soluble vitamins (B 6 , B 12 , and C; folic acid; thiamin; riboflavin; and niacin) are excreted in the urine, making toxicity less likely.
  •  In women of childbearing age, dietary intake of iron and calcium may be below recommended levels.
  •  Because of the difficulty of obtaining enough iron in the diet, health care providers often prescribe iron supplements during pregnancy.
  •  Vitamin-mineral supplements may increase the intake of some nutrients to doses that are much higher than recommended. Excessive amounts of some vitamins and minerals may be toxic to the fetus.
  •  Pregnant women should drink 8 to 10 cups of fluids daily, and most of the fluid should be water.
  •  The website http://www.choosemyplate.gov/mypyramidmoms provides an individualized diet plan adapted for pregnant women.
  •  Food can have special cultural meaning during pregnancy. Nurses need to know the habits of a variety of cultures so that they can provide culturally appropriate nutritional counseling.
  •  Low-income women may not have enough money or knowledge to meet the nutrient needs of pregnancy. Nurses should refer them for financial assistance and nutritional counseling.
  •  Before and during pregnancy, adolescents often have diets low in vitamins A, B 6 , and C; folic acid; calcium; iron; zinc; and magnesium, and adolescents may not take prescribed supplements regularly. This combination of poor intake and unreliable supplementation may further deplete nutrient stores and general nutritional status.
  •  Pregnant vegetarians may need help choosing a diet that includes nonanimal sources of energy, protein, iron, calcium, zinc, vitamins B 12 and D, and other nutrients. They also may need vitamin-mineral supplements during pregnancy.
  •  Lactose-intolerant women should increase calcium intake from foods other than milk, such as calcium-rich vegetables.
  •  Ultrasound procedures in obstetrics use real-time scanning in which a rapid sequence of fixed images is displayed on the screen, allowing the observer to detect movement such as fetal heartbeat, fetal breathing activity, and fetal body movement.
  •  Ultrasound is widely used during pregnancy to determine a variety of fetal and placental conditions and to aid in the performance of other tests, such as amniocentesis.
  •  Nondirectional color Doppler imaging uses one color to identify structures, such as the number of vessels in the umbilical cord. Directional color Doppler uses two or more colors to determine the direction and speed of blood flow and pulsations within cardiovascular structures.
  •  Alpha-fetoprotein can be measured in maternal serum and amniotic fluid. Abnormal concentrations of alpha-fetoprotein are associated with serious fetal anomalies, requiring additional testing to determine the cause.
  •  Low levels of serum alpha-fetoprotein are associated with chromosomal anomalies, such as trisomy 21 (Down syndrome). The most common cause of elevated alpha-fetoprotein levels is failure of the embryonic neural tube or anterior body wall to close properly.
  •  Chorionic villus sampling is usually performed between 10 and 13 weeks of gestation to diagnose fetal chromosomal, metabolic, or DNA abnormalities.
  •  The primary purpose of amniocentesis during the second trimester is to examine fetal cells in amniotic fluid to identify chromosomal or biochemical abnormalities. During the third trimester, amniocentesis is used to determine fetal lung maturity or to evaluate fetal hemolytic disease often caused by Rh incompatibility.
  •  Percutaneous umbilical blood sampling involves aspiration of fetal blood from the umbilical cord near the placenta for prenatal diagnosis or therapy.
  •  The goals of antepartum fetal surveillance are to determine fetal health or compromise as accurately as possible, to guide intervention by the obstetric and neonatal teams, and to reduce perinatal morbidity and mortality.
  •  The nonstress test determines whether the fetal heart rate increases when the fetus moves, indicating adequate oxygenation, a healthy neural pathway from the fetal central nervous system to the fetal heart, and the ability of the fetal heart to respond to stimuli.
  •  The contraction stress test evaluates how the fetal heart responds to short, recurrent interruptions in placental blood flow and oxygen supply caused by uterine contractions.
  •  Counting fetal movements is one of the oldest methods for evaluating the condition of the fetus. Several methods for the mother to formally count and record fetal movements have been proposed, but no standard protocol exists.
  •  Perinatal nurses must provide information and support to the woman undergoing diagnostic tests. Nursing support for the family can reduce anxiety.

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 25: Pregnancy-Related Complications Key Points - Print

  •  The most common cause of spontaneous abortion is severe congenital abnormalities that are incompatible with life. Treatment of spontaneous abortion focuses on preventing complications, such as hypovolemic shock, and providing emotional support for grieving.
  •  Since 1970, the incidence of ectopic pregnancy has increased dramatically throughout the world from 4.5 per 1000 pregnancies to 19.7 per 1000 pregnancies. More than 95% of ectopic pregnancies are in the fallopian tube. Medical management is most successful when the fallopian tube is intact, the pregnancy is early, and the fetus is less than 3.5 cm and not living.
  •  Therapeutic management of gestational trophoblastic disease (hydatidiform mole) includes evacuation of the mole and follow-up to detect any malignant changes in remaining trophoblastic tissue.
  •  After 20 weeks of pregnancy, the two major causes of hemorrhage are placenta previa and abruptio placentae.
  •  In missed abortion, the fetus dies during the first half of the pregnancy but is retained in the uterus. Disseminated intravascular coagulation is a serious complication of this type of spontaneous abortion. The priority treatment is to deliver the fetus and placenta to stop the production of thromboplastin, which fuels the process.
  •  The cause of hyperemesis gravidarum is unknown, but the condition is more common among unmarried white women, during first pregnancies, and in multifetal pregnancies. Treatment often consists of the woman attempting to control the nausea with methods used for morning sickness.
  •  Four types of hypertensive disorders occur during pregnancy: gestational hypertension, preeclampsia, eclampsia, and chronic hypertension.
  •  Preeclampsia results from generalized vasospasm that causes impeded blood flow and elevated blood pressure. Thus, circulation to all body organs, including the kidneys, liver, brain, and placenta, is decreased.
  •  Treatment for preeclampsia includes reducing activity and environmental stimuli and administering anticonvulsant medications.
  •  Magnesium sulfate has a long record of safety for mother and baby while preventing maternal seizures. However, the medication can cause central nervous system depression that leads to respiratory depression.
  •  Nurses monitor the woman to determine whether her preeclampsia is improving or deteriorating. Nurses also monitor the woman for signs of magnesium toxicity.
  •  The most common maternal hazard is the development of preeclampsia in pregnant women with chronic hypertension. New-onset proteinuria or a significant rise in preexisting proteinuria identifies the superimposed preeclampsia.
  •  During pregnancy, Rhesus (Rh) factor incompatibility can occur when the expectant mother is Rh-negative and the fetus is Rh-positive.
  •  Rho(D) immune globulin (RhoGAM) prevents the production of anti-Rh antibodies, thereby preventing destruction of Rh-positive red blood cells in subsequent pregnancies.
  •  ABO incompatibility occurs when the expectant mother is blood type O and the fetus is blood type A, B, or AB. These three blood types contain an antigen not present in type O blood. ABO incompatibility may result in uncomplicated hyperbilirubinemia or more severe anemia.
  •  Nurses can help women carefully consider family planning methods and select the one that best meets their needs.
  •  Because certain methods, such as surgical sterilization, hormone injections, implants, and intrauterine devices, have potentially dangerous side effects, the woman may need to sign an informed consent form.
  •  Adolescents may lack knowledge about their own bodies, conception, and methods of contraception. They are likely to learn about contraception from other teenagers, who often pass on incorrect information.
  •  Adolescents are more likely to engage in risk-taking behavior than older women, and such behavior may lead to sexually transmitted disease and pregnancy.
  •  Nurses who counsel adolescents about sexuality must have an accepting attitude and be sensitive to the adolescents’ feelings, concerns, and needs.
  •  For adolescents, the most successful methods of contraception are ones that are easy to use and seem unrelated to coitus. The most popular methods are oral contraceptives and condoms.
  •  Sterilization for men and women is the most widely used contraception in the United States. Vasectomy is less expensive than tubal ligation and can be performed in the physician’s office using local anesthesia.
  •  Intrauterine devices are effective and safe. Once inserted, an intrauterine device provides continuous pregnancy prevention. Fertility returns when the device is removed.
  •  Hormonal contraceptives, which alter the normal hormone fluctuations of the menstrual cycle, may be taken orally or delivered by implant, injection, patch, or vaginal ring.
  •  Emergency contraception, also called the morning-after pill, is a method to prevent pregnancy after unprotected intercourse.
  •  Barrier methods use chemicals or devices to prevent sperm from entering the cervix and provide some protection from sexually transmitted disease. Because these methods are coitus- related, they may reduce spontaneity.
  •  Natural family planning methods involve avoiding coitus when physiologic cues suggest ovulation is likely. This method requires a high level of motivation and extensive education.
  •  Despite examinations and tests, infertility remains unexplained in 10% to 20% of couples who seek care.
  •  Treating infertility is simple with some couples; others require complex evaluation and treatment. Because so many factors contribute to infertility, treatment of an identified problem does not always lead to a pregnancy.
  •  Fertility problems in men can result from sperm, erection, ejaculation, or seminal fluid abnormalities.
  •  Fertility problems in women can result from ovulation disorders, fallopian tube abnormalities, or cervical abnormalities.
  •  A systematic evaluation of both partners identifies therapy that is most likely to be successful and cost-effective.
  •  If a couple does not achieve pregnancy, the man and woman may experience psychological distress and threats to their self-images. In addition, their marital and family relationships may suffer.
  •  Infertile couples must make choices at many points before and during evaluation and therapy. Some major factors that enter into their decisions include social, cultural, and religious values; the difficulty of treatment; the probability of success; and financial concerns.
  •  Infertility therapy may lead to these outcomes: Pregnancy is achieved and then lost. The man and woman become parents biologically or by adoption. The couple decides to remain childless.
  •  Nursing care of an infertile couple may include assisting with communication, increasing the couple’s sense of control, reducing isolation, and promoting a positive self-image.

WEEK 2

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 16: Giving Birth Key Points - Print

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 17: Intrapartum Fetal Surveillance Key Points - Print

  •  Fetal surveillance uses several methods to evaluate the fetal condition during pregnancy.
  •  The low-tech approach to intrapartum fetal assessment uses intermittent auscultation of the fetal heart rate and palpation of uterine activity. The high-tech approach uses electronic fetal monitoring. The routine use of electronic fetal monitoring remains controversial because its benefits to the fetus are not always clear.
  •  Adequate fetal oxygenation requires normal maternal blood flow to the placenta, normal oxygen saturation in maternal blood, an adequate exchange of oxygen and carbon dioxide in the placenta, an open circulatory path between the placenta and the fetus, and normal fetal circulatory and oxygen-carrying functions.
  •  Interpretations of fetal heart rate patterns are divided into three categories to guide interventions: normal (reassuring), indeterminate (equivocal or ambiguous data), and abnormal (nonreassuring).
  •  Sympathetic stimulation increases the fetal heart rate and strengthens myocardial contractions through the release of epinephrine and norepinephrine. Parasympathetic stimulation reduces the fetal heart rate and maintains variability through stimulation of the vagus nerve.
  •  The fetoscope detects actual fetal heart sounds. Unlike the fetoscope, the Doppler transducer cannot reliably detect fetal dysrhythmias.
  •  Electronic fetal monitoring equipment consists of a bedside monitor unit and either internal or external sensors for fetal heart rate and uterine activity. External monitoring is less accurate than internal monitoring, but it is noninvasive and suitable for most women in labor.
  •  The nurse should plan to promote adequate fetal oxygenation, intervene to increase fetal oxygenation if necessary, report nonreassuring patterns to the physician or nurse-midwife, support the woman and her partner if a complication develops, and document assessments and care.

McKinney: Maternal-Child Nursing, 4th Edition

Chapter 18: Pain Management for Childbirth Key Points - Print

  •  Pain is subjective and personal.
  •  Childbirth pain differs from other pain in that it is normal, the woman has time to prepare, and the pain has a foreseeable end.
  •  Pain that exceeds a woman’s tolerance can be harmful to her and the fetus.