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NRSG 344 - Nursing of the Family > Lecture 3 > Flashcards

Lecture 3 Flashcards

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1
Q

What are the 5 most common causes of death in infants in the US?

A
  1. Accidents
  2. Birth defects
  3. Preterm birth and low birth weight
  4. Sudden SIDS
  5. Pregnancy complications
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2
Q

What are the 5 most common causes of infant deaths in the world?

A
  1. Neonatal encephalopathy, or problems with brain function after birth. Neonatal encephalopathy usually results from birth trauma or a lack of O2 to the baby during birth
  2. Infections, especially blood infections
  3. Complications of preterm birth
  4. Lower respiratory infections (like the flu and pneumonia)
  5. Diarrheal diseases
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3
Q

What are the 3 assumptions of the Family Systems Theory?

A
  1. The family is a complex emotional unit
  2. The family is emotionally interconnected
  3. Familial, community, and social relationships are reciprocal
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4
Q

What are the 3 definitions of families?

A
  1. Traditional and legal definition
    -> Family members are related by legal ties or genetic relationships
  2. Non-Traditional definition
    -> At least 2 people who say they are a “family” and are bound by
    sharing and emotional closeness
    -> “A family is whoever you say it is”
  3. A family is a functioning group “System”
    -> A family system contains or relates to 2 other systems:
    -> Subsystem (individual family members)
    -> Suprasystem (groups “outside” the family)
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5
Q

What is the family development theory?

A

Family is a developing group that goes through stages
1. Just married couple
2. Children arrive
3. Childrens’ growth and development bring change
4. Young adults leave home
5. Old married couple
6. Death breaks the physical relationship but not the emotional connection

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6
Q

Family Development Theory

A
  • Family members must perform certain time-specific tasks
  • Family role performance at one stage influences behavioral options at the next stage. eg: poor hearing in a young child requires more attention in an older child
  • Disequilibrium is common when entering a new stage, with goal of homeostasis within stages
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7
Q

What are the 3 parts of the Family Systems Theory?

A
  1. Inter-relatedness
    - A family consists of more than just the “sum” of its parts (members)
    - A change in one member affects the whole family (PEDIATRIC CARE)
  2. Interaction
    - Who I am or Who I have become is dependent on family relationships and interactions
    - Is it helpful to blame our families for our problems and issues?
    - We also interact with the environment and community, which also influences who we are
  3. Boundaries
    - Imaginary but real lines btwn family members and also btwn family and the “outside world”
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8
Q

What is the Family Stress Theory?

A
  1. Stress is a definite part of family life
  2. One family’s “crisis” may be another family’s “challenge”
  3. The ability to handle stress depends on 4 factors:
    1. Basic family type or attributes (dysfunctional vs healthy or
      “stable”)
    2. Amount of resources or support the family has
    3. Family’s perception of the stressful event
    4. Family’s “learned coping strategies”
      -> When stressors exceed the family’s ability to cope, crisis occurs
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9
Q

What is the Family Role Theory?

A
  1. Role is defined by culture
  2. Most people assume several roles (student, employee, spouse, etc)
  3. Role expectations - expectations about behaviors and feelings that a role should include
    • New parents and grandparents carry these expectations in
      their heads
  4. Role stress or strain
    • Subjective reaction when trying to meet all role
      expectations
      -> Being “super mom/dad” while employed and in school
      -> Person with role strain knowns he/she has it, but like
      pain, it sometimes can’t be objectively measured, just
      personally recognized
  5. Role transitions
    • Moving in and out of roles (pregnancy to parenting, etc)
    • Usually causes some role stress which can be reduced by
      “anticipatory socialization” such as childbirth and
      parenting classes
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10
Q

What are the 2 family characteristics that may impact health?

A
  1. Cultural beliefs about health
  2. Religious beliefs about health
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11
Q

7 Attributes of a Health Family

A
  1. Commitment to growth of all members
  2. Showing appreciation and stressing the positive
  3. Effort to spend time with family
  4. Basic agreement about important things
  5. Ability to communicate, or at least try
  6. Flexible in problem solving and coping
  7. Balance between external and internal resources
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12
Q

3 layers that make up the myometrium (2nd or middle layer of uterine wall)

A
  1. Longitudinal
  2. Transverse
  3. Oblique

They make a figure 8 pattern to prevent postpartum hemorrhaging

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13
Q

Shape of blood vessels in the uterus when not pregnant vs when pregnant

A

Not pregnant: Coiled
Pregnant: Uncoiled and straighten*

*Unless something like preeclampsia happens or when blood vessels don’t “remodel” correctly, affecting placental perfusion and leading to vasospasm

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14
Q

Hormones in the menstrual cycle and where they come from

A
  1. Hypothalamus
    -> Gonadotropin-releasing hormone (GnRH)
    -> AKA Luteinizing hormone-releasing hormone (LRHR)
    -> GnRH are “sex hormones” for both males and females
  2. Pituitary
    -> Follicle-stimulating hormone (FSH)
    -> Luteinizing hormone (LH)
  3. Ovary
    -> Estrogen
    -> Progesterone (heat-creating hormone)
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15
Q

What are the 3 phases of the uterine cycle that temporarily change the uterus?

A
  1. Menstruation (the period)
  2. Proliferative phase
  3. Secretory (before period bleeding)
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16
Q

What are the 3 phases in the ovarian cycle that temporarily change the ovaries?

A
  1. Follicular (before ovulation)
  2. Ovulation (egg is released from ovary)
  3. Luteal (after ovulation)
17
Q

Phases of Menstrual Cycle

A
  1. Menstruation
    -> The surface of the endometrium sheds off resulting in
    menses
  2. Proliferative phase (Follicular Phase)
    -> Endometrial cells proliferate and the lining thickens
  3. Secretory phase (Luteal Phase)
    -> An egg is expelled from the ovary (ovulation) into the
    pelvic cavity
  4. Premenstrual phase
    -> May begin about 1 week before one’s period. The
    endometrium continues to mature until a sudden drop in
    hormone levels triggers menstruation
18
Q

Breakdown of Menstruation Phase

A

When: From the time vaginal bleeding starts to the time it ends
LMP: Last Menstrual Period start. Used to date pregnancy with Naegele’s rule
Length: 5-6 days, sometimes 8
What is it: Blood and tissue from previous cycle
- The uterine lining, called the endometrium, is thinnest during this phase

Estrogen and progesterone levels are AT THEIR LOWEST during this phase

19
Q

Breakdown of Proliferative phase (Follicular Phase)

A
  • Endometrial cells proliferate and the lining thickens
    When: From the end of the period until ovulation (~7 days)
    What: Proliferative means growing quickly. The uterus builds
    up a thick inner lining while the ovaries prepare eggs for
    release. The uterus thickens so a potential fertilized egg
    can implant and grow
    Hormones: Estrogen is at its highest during this phase (signals
    uterine lining to grow)
20
Q

Breakdown of Secretory Phase (Luteal Phase)

A
  • An egg is expelled from ovary into the pelvic cavity
    When: Last 2 weeks of the cycle (day 14-28)
    What: Endometrial lining continues to thicken in preparation for possible
    fertilized egg
    Hormones: Progesterone it at its highest (“pro gestation”). Stimulates the
    endometrium and corpus luteum
  • PMS may occur in last week
21
Q

Breakdown of Ovarian Cycle

A
  1. Follicular phase (FSH) - Pituitary hormone
    - Nerve cells in the hypothalamus make and release GnRH into blood
    - This stimulates the pituitary gland to make and release FSH/LH
    When: From the start of the period until ovulation
    Hormones: FSH stimulates “graafian follicles”
    - Prepare an egg for ovulation
    - Up to 20 graafian follicles begin to develop, can result in twins/triplets if
    more than one is released and fertilized
    - The dominant follicle produces estrogen as it grows which peaks just
    before ovulation
  2. Ovulation
    - Egg is released into pelvic cavity
    - Fimbriae at ends of fallopian tube bring egg into tube
  3. Luteal phase - Progesterone - Ovarian hormone
    - Empty follicle forms a gland called corpus luteum
    - Corpus luteum produces progesterone
    - If pregnancy occurs, corpus luteum maintains the pregnancy until the
    placenta is mature enough to take over (around 12 weeks gestation)
22
Q

Which forms of Birth Control work “Really, Really Well”? (Less than 1/100)

A

The implant
IUDs
Copper IUD
Sterilization

23
Q

Which forms of Birth Control work “Pretty Well”? (6-9/100)

A

The pill
The patch
The ring
The shot

All the “the’s”

24
Q

Which forms of Birth Control work “Not as Well”? (12-24/100)

A

Pulling out
Fertility Awareness (when are you most fertile)
Internal condom
Condom

25
Q

Types of Emergency Contraception

A

Copper IUD
- Almost 100% effective
- Take within 5 days
- Placed in uterus by health care provider
- Get it from a health care provider

Ella (pill)
- May be less effective if over 195 lbs
- Works better the sooner you take it, up to 5 days
- Remember to use it every time you have unprotected sex
- Get it from a health care provider for future emergencies

Plan B One-Step (or generic)
- May be less effective if over 165 lbs
- Works better the sooner you take it, up to 3 days
- Use it every time you have unprotected sex
- Get it from a health care provider for future emergencies

26
Q

Birth Control Pills (BCP)

A
  • Commonly “combined pills” with both estrogen and progesterone
  • 97-99% effective
  • Suppresses secretion of FSH and LH, inhibiting ovulation
  • Associated risk for cancer*
    -> Cervical cancer (not sure why
    -> Endometrial cancer
    -> Ovarian cancer
  • Breast Cancer: no documented increased risk, but “jury is still out”, especially if hx of breast cancer was classified as estrogen-dependent

Side Effects:
- N/V
- Weight gain
- Breakthrough bleeding d/t progesterone
- Mild hypertension
- Breast tenderness
- Mood changes (or may help stabilize hormones/mood

27
Q

IUDs

A

98-99.2% effective

Types:
1. Copper-containing (Paragard)
2. Progesterone-containing (Skyla, Mirena)

How they work:
1. May damage sperm in transit, prevent fertilization
2. Prevent implantation of fertilized egg through inflammatory response on
endometrium, or decreased endometrial proliferation

Their relatively “local” vs systemic effects make them more appropriate for:
- Heavy smokers over 35 years old
- Hypertension
- Coronary artery disease
- Strong family hx of diabetes with vascular complications

28
Q

How Foams/Jellies/Creams work

A
  • pH of vaginal secretions is more acidic, decreasing sperm survival
  • Sperm flagella are attacked, decreasing motility/movement
  • Helps with prevention of STD spread, except HIV
  • If hx of chronic cervicitis/infection, avoid spermicides
29
Q

Sterilization for Males

A

Considered PERMANENT
- Vasectomy (cut/cauterize vas deferens)
- Patient education is needed to explain that it takes ~15 ejaculations for the swimmers to all be gone
- Use a back up contraceptive method for a while

30
Q

Sterilization for Women

A
  1. Tubal ligation after vaginal birth or with c/s
    • Small abdominal incision around belly button if no c/s
  2. Essure
    • Insertion of small coil in each tube to permanently block tube within 3
      months. Requires back up contraceptive initially
31
Q

Subdermal Implant

A
  • Norplant (2 implants)
  • Implanon and Nexplanon (single rod)

Are effective for 3-5 years
How they work:
-> Prevent some but not all ovulatory cycles
-> Thickens cervical mucous and affects/thins uterine lining

32
Q

Depo-Provera Injections

A

An injectable progesterone with side effects similar to Nexplanon/Implanon, with an additional slight risk of osteoporosis

Dose: IM or SQ injection Q 12 weeks

Massage can decrease length of effectiveness

NRSG 344 - Nursing of the Family (5 decks)

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