Wk 2 Monday slides Flashcards
Number of live births in 1 yr per 1000 pop.
Birth rate
Number of birth per1000 women between ages 15 and 44
Fertility rate
of deaths of infants younger than 28 days of age per 1000 live births
Neonatal mortality rate
Most common causes of neonatal mortality rate
- Preterm birth
- Intrapartum-related complications
- Infections and birth defects
infant at birth showing no signs of life (breathing, HR, voluntary muscles spasms)
still birth
of stillbirths and neonatal death per 1000 live births
perinatal mortality rate
Infant mortality rate
of deaths of infants <1 yr per 1000 live births
Most common causes of infant death in US…
- Birth defects
- Preterm birth and low birth wt
- SIDS Sudden infant death syndrome
- Pregnancy complications
- Accidents (#1)
Most common causes infant death worldwide
- Neonatal encephalopathy, problems w/ brain function. Results from birth trauma or lack of O2 to baby during birth
- Infections, especially blood infections
- Complications of preterm birth
- Lower resp infect (flu, pneumonia)
- Diarrheal diseases
Maternal mortality rate
of maternal deaths from birth and complications from pregnancy, birth, and puerperium, per 100000 live births
Family Systems Theory
Views family as a complex system of interconnected and interdependent individuals
Types of families
Traditional, non-traditional
Traditional and legal family definition:
Family mems are related by legal ties or genetic relationships
Non-traditional family def
2 people who say they are “family” and are bound by emotional ties
Family development theory
Family is a developing group which goes through stages
Fam members must perform certain time specific tasks
Disequilibrium is common when entering a new stage, w/ goal of hemostasis w/I stages
Family systems theory
Inter-relatedness
* A fam consists of more than just the “sum” of its parts-its members
* A change in one mem affects the whole fam
o V important in peds care
Interaction
* ‘Who I am’ or ‘Who I have become’ dependent on fam relationships and interactions
* Is it helpful to blame our fam for our problems and issues
* We also interact w/the environment and community which also influences who we are
Boundaries: Imaginary but real lines between fam mems and also between fam and the “outside world”
Family stress theory
Stress is a definite part of fam life
One fam’s crisis may be another fam’s challenge
The ability to handle stress depends on 4 factors:
* Basic fam type or attributes (dysfunctional vs health/stable
* Amount of resources/support the fam has
* Fam’s perception of the stressful event
* Fam’s learned coping strategies: When stressors exceed the fam ability to cope crisis occurs
Family role theory:
Role is defined by culture
Most ppl assumes several roles (student, employee, spouse. Etc.)
Role expectations: expectations about behaviors and feelings that a role should include
Role stress/strain
* Subjective reaction when trying to meet all role expectations
Role transitions
Myometrium
2nd or middle layer of the uterine wall
* Consists of smooth musc fibers arranged in 3 diff directions
o Longitudinal
o Transverse
o Oblique
Hypothalamus produces
o Gonadotropin-releasing hormone (GnRH)
Aka Luteinizing hormone-releasing hormone (LHRH)
o GnRH are “sex hormone” for both males and females
Pituitary produces:
o Follicle-stimulating hormone (SH)
o Luteinizing hormone (LH)
Ovary produces:
o Estrogen
o Progesterone
When is mensuration
from the time vaginal bleeding starts to the time it ends
LMP
Last mensural period
Length of mensuration
5-6 days
What is menstruation
Blood and tissue from the previous cycle
When is the endometrium thinnest
during the menstruation period
What are hormones like during menstruation period
(estrogen and progesterone) = lowest, causing top layers of the lining to release and leave the body
Order of the uterine cycle
menstruation, proliferation, secretory
Mensuration (when)
from the time vaginal bleeding starts to the time it ends
Menstruation (length)
5-6 days (sometimes 8)
Menstruation (What it is)
Blood and tissue from the previous cycle
Proliferation (when/how long)
From end of period until ovulation: about 7 days
Proliferation (what)
Proliferation = 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.
Proliferation (hormones)
Estrogen is high during this phase. This signals the uterine lining to grow. (Estrogen is like lawn fertilizer, encouraging growth of the uterine lining
Secretory (When)
last 2 wks of cycle (Days 14-28)
Secretory (hormones)
Progesterone increases (“pro-gestation”). Stimulates the endometrium and the corpus luteum.
Corpus luteum
- Empty follicle that releases the egg
- Temporary endocrine structure
- After ovulation, it becomes the corpus luteum
- Secretes large quantities of progesterone and estrogen to sustain a possible fertilized egg
- If no preg occurs, the corpus luteum begins to degenerate, hormone secretion declines and menstruation begins. Scar tissue remains.
PMS
Premenstrual syndrome- may occur in the last wk
3 phases of the ovarian cycle
Follicular -> Ovulation -> Luteal
Which hormone is hight. during the follicular phase
FSH
Where does FSH come from
- Nerve cells in the hypothalamus make and release GnRH into the blood
- This stimulates the pituitary gland to make and release FSH ad LH
When is the follicular phase
From the start of the period until ovulation
What does FSH in the follicular phase do
Follicle stimulating hormone (FSH) stims “Graafian follicles.” This preps the egg for ovulation
What happens during the ovulation phase
o Egg is released into pelvic cavity
o Fimbriae at ends of fallopian tube brings egg into tube
Luteal (what)
- Empty follicle forms a gland called “corpus luteum”
- If preg occurs, will maintain preg until placenta is mature enough to take over- around 12 wks gestation
Luteal phase (hormone)
Corpus luteum produces progesterone
Endometrial development during menstruation
The surface of the endometrium sheds off resulting in menses
Endometrial development during proliferation/follicular phase
Endometrium cells proliferate and the lining thickens
Endometrial development during Secretory/luteal phase
an egg is expelled from the ovary into the pelvic cavity
Endometrial development during premenstrual phase
may begin about a week b4 period. The endometrium continues to mature until a sudden drop in hormone levels trigger menstruation
Fallopian tube (what)
The site where fertilization happens:
* Hallow, muscular ducts that provide passageway for egg and sperm to meet
* Egg waits in the fallopian tube
* Finger-like structures (fimbriae) sweep the egg into the tube
* Conception happens in the outer third of the fallopian tube
* Powerful, muscular movements move the egg towards the uterus for implantation if fertilized
process of conception
ovum -> fertilization -> fusion of egg and sperm pronuclei -> zygote -> cleavage (2, 4, 8 celled) -> morula -> blastocyst -> implanted blastocyst
Chronological order of 4 hormones during menstrual cycle
GnRH -> FSH -> LH -> progesterone
average cycle
28 days
Testosterone
influences the muscular development; physical growth, sebaceous gland activity/acne; sex organ function, sperm maturation in males; and is present in both males and females
Estrogen
Effects bone growth in females, as higher levels help close the epiphyseal lines of long bones around the time of menarche
estriol
thought to have a role in parturition/ onset of labor, by increasing the sensitivity to prostaglandins and oxytocin. Changing levels of this compound are the spit/salivary estriol test to predict PTL risk
Progesterone
- Helps maintain pregnancy and also helps prepare the uterus for pregnancy
- Progesterone elevation occurs after ovulation and spikes at 5-6 days after ovulation.
- Progesterone is thermogenic -> the reason women’s temp is higher following ovulation
Birth control options
*Condoms
*Female condom
*BCP
*Hormonal ring
*IUD
*Injections
*Surgical sterilization
*Subdural implant
*Coitus interruptus
*Calendar rhythm
*Patch
*Diaphragm
*Foams, jellies, creams
Birth control pill (Effectiveness)
97-99%
BCP mech of action
o Suppresses secretion of FSH and LH, inhibiting ovulation
o Actions of progesterone: Thickens cervical mucous and interferes w/ endometrial proliferation
BCP risks
o Risk for cervical CA (not sure why)
o Risk of endometrial and ovarian CA
BCP s/e
N/V, wt gain, possibility of breakthrough bleeding initially, mild HTN, breast tenderness, mood changes
IUD effectivness
98-99.2%
IUD types
copper (paragard), Progesterone-containing (Skyla, Mirena)
IUD mech of action
o May damage sperm in transit, prevent fertilization
o Prevent implantation of fertilized egg through inflammatory response on endometrium, or decreased inflammatory proliferation
IUDs are most appropriate for
o Heavy smokers >35yrs old
o HTN
o Coronary artery disease
o Strong familial hx of DI w/ vascular complications
Cons of injections
Depo-provera injection is an injectable progesterone w/ SE like Nexplanon/implantation, w/ an additional slight risk of osteoporosis
Types of surgical sterilization
tibial ligation and Essure
Tibial ligation
after vaginal birth or c-section, small ABD incision around belly button if no c-section
Essure
insertion of a small coil in each tube to permanently block tube w/I 3 mon. Requires back-up method initially
Subdural implant types
Norplant (2 implants), implanon and Nexplanon (single rod)
How long do implants stay active
3-5 years
what is the mech of action of implants
Thickens cervical mucosa and affects/thins uterine lining
Vasectomy
Cautery of the vas deferens
pt education for vasectomy
need to be aware that it may takes to mons (or 15 ejaculations) to remove all sperm from sperm ducts
