Lecture 3 Flashcards
What are the 5 most common causes of death in infants in the US?
- Accidents
- Birth defects
- Preterm birth and low birth weight
- Sudden SIDS
- Pregnancy complications
What are the 5 most common causes of infant deaths in the world?
- 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
- Infections, especially blood infections
- Complications of preterm birth
- Lower respiratory infections (like the flu and pneumonia)
- Diarrheal diseases
What are the 3 assumptions of the Family Systems Theory?
- The family is a complex emotional unit
- The family is emotionally interconnected
- Familial, community, and social relationships are reciprocal
What are the 3 definitions of families?
- Traditional and legal definition
-> Family members are related by legal ties or genetic relationships - 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” - 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)
What is the family development theory?
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
Family Development Theory
- 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
What are the 3 parts of the Family Systems Theory?
- 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) - 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 - Boundaries
- Imaginary but real lines btwn family members and also btwn family and the “outside world”
What is the Family Stress Theory?
- Stress is a definite part of family life
- One family’s “crisis” may be another family’s “challenge”
- The ability to handle stress depends on 4 factors:
- Basic family type or attributes (dysfunctional vs healthy or
“stable”) - Amount of resources or support the family has
- Family’s perception of the stressful event
- Family’s “learned coping strategies”
-> When stressors exceed the family’s ability to cope, crisis occurs
- Basic family type or attributes (dysfunctional vs healthy or
What is the Family Role Theory?
- Role is defined by culture
- Most people assume several roles (student, employee, spouse, etc)
- Role expectations - expectations about behaviors and feelings that a role should include
- New parents and grandparents carry these expectations in
their heads
- New parents and grandparents carry these expectations in
- 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
- Subjective reaction when trying to meet all role
- 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
What are the 2 family characteristics that may impact health?
- Cultural beliefs about health
- Religious beliefs about health
7 Attributes of a Health Family
- Commitment to growth of all members
- Showing appreciation and stressing the positive
- Effort to spend time with family
- Basic agreement about important things
- Ability to communicate, or at least try
- Flexible in problem solving and coping
- Balance between external and internal resources
3 layers that make up the myometrium (2nd or middle layer of uterine wall)
- Longitudinal
- Transverse
- Oblique
They make a figure 8 pattern to prevent postpartum hemorrhaging
Shape of blood vessels in the uterus when not pregnant vs when pregnant
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
Hormones in the menstrual cycle and where they come from
- Hypothalamus
-> Gonadotropin-releasing hormone (GnRH)
-> AKA Luteinizing hormone-releasing hormone (LRHR)
-> GnRH are “sex hormones” for both males and females - Pituitary
-> Follicle-stimulating hormone (FSH)
-> Luteinizing hormone (LH) - Ovary
-> Estrogen
-> Progesterone (heat-creating hormone)
What are the 3 phases of the uterine cycle that temporarily change the uterus?
- Menstruation (the period)
- Proliferative phase
- Secretory (before period bleeding)
What are the 3 phases in the ovarian cycle that temporarily change the ovaries?
- Follicular (before ovulation)
- Ovulation (egg is released from ovary)
- Luteal (after ovulation)
Phases of Menstrual Cycle
- Menstruation
-> The surface of the endometrium sheds off resulting in
menses - Proliferative phase (Follicular Phase)
-> Endometrial cells proliferate and the lining thickens - Secretory phase (Luteal Phase)
-> An egg is expelled from the ovary (ovulation) into the
pelvic cavity - 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
Breakdown of Menstruation Phase
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
Breakdown of Proliferative phase (Follicular Phase)
- 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)
Breakdown of Secretory Phase (Luteal Phase)
- 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
Breakdown of Ovarian Cycle
- 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 - Ovulation
- Egg is released into pelvic cavity
- Fimbriae at ends of fallopian tube bring egg into tube - 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)
Which forms of Birth Control work “Really, Really Well”? (Less than 1/100)
The implant
IUDs
Copper IUD
Sterilization
Which forms of Birth Control work “Pretty Well”? (6-9/100)
The pill
The patch
The ring
The shot
All the “the’s”
Which forms of Birth Control work “Not as Well”? (12-24/100)
Pulling out
Fertility Awareness (when are you most fertile)
Internal condom
Condom
Types of Emergency Contraception
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
Birth Control Pills (BCP)
- 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
IUDs
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
How Foams/Jellies/Creams work
- 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
Sterilization for Males
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
Sterilization for Women
- Tubal ligation after vaginal birth or with c/s
- Small abdominal incision around belly button if no c/s
- Essure
- Insertion of small coil in each tube to permanently block tube within 3
months. Requires back up contraceptive initially
- Insertion of small coil in each tube to permanently block tube within 3
Subdermal Implant
- 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
Depo-Provera Injections
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
