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Family NRSG > Wk 3: Conception, fetal dev., genes, fertility, adoption, surrogacy > Flashcards

Wk 3: Conception, fetal dev., genes, fertility, adoption, surrogacy Flashcards

1
Q

chromosomes

A
  • You have 46 total
  • 23 pairs
  • sex chromosome is the 23rd one
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2
Q

Haploid vs diploid chromosomes

A
  • Haploid = Only sex chromosomes which are called gametes. They have a single set of unpaired chromosomes.
  • Diploid = The presence of two complete sets of chromosomes in an organisms cells. 23 pairs.
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3
Q

Karyotype

A
  • A picture of all a person’s chromosomes
  • Homologous = same genes arranged in the same order
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4
Q

Homologous pairs

A
  • having the same position, value, or structure
  • Chromosomes come in homologous pairs
  • Matching genes = one in each parent
  • Gene for eye color for example
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5
Q

DNA - deoxyribonucleic acid

A
  • Carries genetic info
  • Genes = rungs of the ladder.
  • Give physical characteristics
  • A chromosome has 100 to 1000s of genes
  • More than one gene may be responsible for a trait. ie 3 genes for eye color.
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6
Q

Traits

A
  • Gene is a segment of dna that determines a trait
  • Traits are determined by the genes on the chromosomes
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7
Q

The work of chromosomes

A
  • chromosome 14: Premature birth, slow growth before and after birth, short stature, small hands and feet, early onset of puberty
  • c. 21: intellectual disablity, delayed dev., characteristic facial features such as down syndrome
  • c. 22: Workings of the immune system, CHD, schizophrenia, cancers including leukemia
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8
Q

Allele

A
  • Every trait has at least two alleles
  • ## They are the different possibilities for a given trait
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9
Q

Dominant and recessive genes

A
  • Dominant: prevents recessive from showing
  • Recessive: a gene does not show even thought it is present. Must have two recessives to express gene
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10
Q

Homo vs heterozygous

A
  • Homo: RR or rr (both d or r)
  • Hetero: Rr (combo of D and r)
  • Refers to alleles in this case
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11
Q

Chrome. mutations

A
  • Less common than gene mutations…gene: CF, sickle anemia, celft palate.
  • Chromosome mutations are more drastic: down syndrome, turner syndrome
  • Caused by failure of homologous chromes. to separate during meiosis
  • Pairs no longer look the same
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12
Q

Terms of chromosome mutation

A
  • Deletion
  • Duplication
  • Inversion
  • Translocation
  • Miscarriage may happen in these cases
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13
Q

Examples: down syndrome

A
  • Trisomy 21. 47 chromosomes
  • extra chromosome pair at #21.
  • Flattened nose and face
  • Spacing of the toes, simean crease that goes all along the hand
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14
Q

Mosaicism

A
  1. a condition in which cells within the same person have a different genetic makeup
  2. can affect any type of cell, including:
    - Blood cells
    - egg and sperm cells
    - Skin cells
  3. caused by an error in mitosis very early in dev. of fetus. Ex of mosaicism: turners, or down.
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15
Q

X-linked recessive. Sex linked to mother.

A
  • Means females carry the disorder
  • females have a 50% chance of being a carrier
  • Males have 50% chance of exhibiting the disorder when born to a carrier mother
  • Besides hemophilia A & B, color blindness, and “fragile X syndrome”, are examples of this disorder
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16
Q

Autosomal recessive pattern

A
  • The gene in question is located on one of the numbered, or non-sex, chromosomes
  • Diseases only expressed when 2 copies of the recessive allele are inherited
  • Subsequent pregnancies carry same risk percentage as the first one:
  • transmission not related to gender
  • Marrying blood relative increases risk of this disease: 25% chance child will have it, 50% child is carrier, 25% chance child is neither carrier or diseased
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17
Q

Autosomnal Dominant

A
  • Only one abnormal gene from one paren tis necessary for disease/disorder manifestation
  • The affected parent has 50% chance of having a child with the disorder
  • Occurrence not affected by gender and occurs in each generation
  • Normal or unaffected individual does not transfer/transmit disorder to offspring
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18
Q

Examples of autosomnal dominant diseases

A
  • Huntington disease
  • Polycystic kidney disease
  • Polydactyly
  • Achondroplasia
  • Neurofibromatosis
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19
Q

Genetic counseling is:

A
  • Estimation of risk:
    1. occurrence of risk:
    • parents are known to be at risk for producing a child with disease
      1. Recurrence risk:
    • once they have produced a child with disease
      1. Interpretation of risks
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20
Q

Punnet square

A
  • One parent on top
  • one on the side
  • Each box is 25%
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21
Q

The four symbols of a pedigree

A
  • Circle = female
  • Square = male
  • Triangle = Stillborn
  • Diamond = Miscarriage
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22
Q

Gamete has how many total chromosomes ?

A
  • 23 total chromosomes. Haploid!
  • So each sperm and egg has 23 chromosomes !
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23
Q

Fetal growth and development

A
  • after sperm enters egg, within 38 hours, cell division begins
  • by the 10th day the embryo embeds in the uterus
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24
Q

Know

A
  • zygote is the name of the fertilized egg
  • Morula: 16 cells.
  • Blastocyst: After morula, by 5th or 6th day. bunch o’ cells.
  • Embryo until 8th week
  • then fetus till birth
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25
Q

By which day does the embryo implant in the uterus

A

By the 10th day

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26
Q

Intervillus space in placenta

A
  • where oxygen is absorbed, and baby’s CO2 is offput (gas exchange)
  • Their blood does not mix, but chemicals can pass
  • Spiral arteries involved
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27
Q

Fetal growth chart

A
  • Heart: wk 6 - 8
  • Upper limbs: 6 - 8
  • Eyes: wk 8 and past
  • First 7 - 8 wks: the entire structure of the fetus
  • 12 - 16 wks and after: its formed, and then they grow and mature.
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28
Q

landmark devs. 6, 7, 8th wks

A
  • 6 wks: heart beat
  • 7 wks: essential organs start to form
  • 8 wks: Size of a grape
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29
Q

landmark devs. wk 12, 16, 20:

A
  • 12 wks: 2 1/2 inches long
  • 16 wks: 4 & half inches long
  • 20 wks: 6 inches long, yawns makes faces
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30
Q

landmark dev. wk 24

A
  • 9 inches long
  • Hiccups
  • sucks thumb or toe
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31
Q

Infertility

A
  • Defintion: for women up to age 35, failure to get pregnant within one year of trying
  • After age 35, failure to get pregnant after 6 months of trying
  • Infertility does not include miscarrying or being unable to carry a baby to childbirth
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32
Q

The most common overall cause of female fertility is the…

A
  • ….failure to ovulate, which occurs in 40% of women with fertility issues
  • Not ovulating may be a cause of:
  • Primary ovarian insufficiency
  • Polycystic ovary syndrome
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33
Q

Infertility - male causes

A
  • Male factors: decreased sperm count
  • increased scrotal heat
  • Impaired sperm motility/movement
  • Smoking
  • Steroids, prednisone, antihypertensives
  • Tagamet can affect spermatogenesis
  • Diabetes can cause vascular damage
34
Q

Female factors of infertility

A
  • Age (over age 35 for women or over 40 for men)
  • Anovulation can ocur for many reasons:
    1. Hypothyroidism
    2. Poor health
    3. Consistent strenuous exercise (marathon runner etc)
35
Q

Female factors of infertility (pt. 2)

A
  • PID w/ scarring or adhesions
  • STDs
  • Weight problems
  • Eating disorders
36
Q

Female factors of infertility (pt. 3)

A
  • Uterine problems: fibroids/benign tumors may block fallopian tube entrance or could decrease space available for pregnancy implantation
  • Endometriosis: Implantation of endometrial cells outside of uterus and may block fallopian tubes
  • Cervical problems; Infection can increase mucous decreasing sperm motility. - stenosis
    • cervical polyps
37
Q

Infertility Assessment

A
  • Complete hist for the couple:
    1. previous illnesses
    2. hist, meds, mensrtual hist
    3. Track temp and track ovulation
38
Q

See table 5-1, p. 107 for assessments with infertility

A
39
Q

Medical tx for infertlity

A
  • Laparoscopic or laparotomy to deal with adhesions, fibroids, endometriosis
  • Be familiar with possible fertility meds such as clomid or pergonal which causes over-stimulation of ovaries, so requires close medical observation & frequent ultrasounds
40
Q

NRSG interventions r/t infertility

A
  • Show compassion and willingness to listen
  • Avoid telling couple how they’re supposed to feel
  • Provide emotional support
  • Accept resistance one partner may show
  • Regarding tx options - be clear with pt edu, which should involve spouse/significant other
  • Provide accurate info and avoid false hopes
41
Q

Infertility can negatively impact a marriage

A
  • Blaming who’s at “fault”
  • Refusing to allow for in-vitro fertilization
  • Refusing to adopt
  • Refusing to allow for surrogacy
42
Q

Adoption

A
  • is a lifelong process
  • The process is not a one time event
  • The adoption itself is a one-time event, but the effects of living with adoption are lifelong
43
Q

History

A
  • Informal adoptions prior to 1917
  • Farmers had too many kids. Neighbor offers to take one and raise it for help on their own farm.
  • 1917: closed adoption law
  • 1930: All states formal laws on closed adoption
  • 1960/70s: open adoptions more common
44
Q

Hist. cont. Cultural shift

A
  • Unplanned pregnancy, 1970s, 30% adopted
  • 2000s to the present: 49% abort, 49% keep baby, 1-2% adopt out
45
Q

Adoption today

A
  • Planned adoption
  • Surrogacy:
  • 748 in 2004
  • 1448 in 2010
  • 2,8007 in 2015
  • Gestational carriers (surrogate workers)
  • Out sourcing to foreign countries
  • Unique ethical issues
46
Q

Who is involved?

A
  • Birth mother
  • Agency
  • Social worker
  • Attorney
  • Adopting/intended parent
47
Q

Costs: surrogacy

A
  • $80,000 to $100,000 – own eggs or frozen embryos.
  • Fees to agency, gest. carrier, attorney and social worker
  • Legal and medical costs and money to cover the carrier’s maternity wardrobe and travel expenses
  • Costs of harvesting the egg or embryo
  • Incidentals include paying the gestational surrogate for any lost wages if she is put on bed rest or day care costs for her other children
48
Q

International adoption vs private domestic adoption

A
  • International: $25,000 - $50,000
  • Private domestic adoption: $20,000 - $35,000 –> application fee, agency fee, home visit, background checks, birth mother’s expenses, medical expenses, rematch fee (if baby is declined), termination rights fee, and father’s termination rights fee.
49
Q

Open adoption definition

A
  • Birth mother signs the baby over to the adopting parents, but also signs an agreement about future contact, wether monthly, birthdays, etc.
50
Q

Seven core adoption issues

A
  • Rejection
  • Guilt/shame
  • grief
  • Identity
  • Intimacy
  • Mastery/control
  • Loss
51
Q

Adopted person issue:

A
  • Birth family
  • bio, genetic, cultural hist.
  • Belonging
  • security
52
Q

Birth parent loss

A
  • Child
  • social isolation
  • body and self image
  • future relationships
53
Q

Adoptive parent loss

A
  • “dream” child
  • immortality ….. ?!?!
  • self
54
Q

Adopted person (rejection)

A
  • Not keepable
  • self esteem issues
  • fear of abandonment
  • fear of exclusion
55
Q

Guilt and shame: adopted person

A
  • Tainted
  • A mistake
  • Different
  • Defensive/angry
56
Q

Guilt and shame: birth parent

A
  • a secret
  • How much to share?
  • Who do I tell?
  • Fears judgment
  • Double blind
57
Q

Grief: Adopted issues

A
  • Somatic issues
  • no permission to grieve
  • Depression
  • Acting out
  • Lack of “fit”
58
Q

Intimacy: adopted person

A
  • Fear of getting close
  • Concerns about incest
  • Missed the story of the day they were born
59
Q

Intimacy: Birth parent

A
  • intimacy = loss
  • At risk for multiple relationships
  • Impacts relationship with other children
60
Q

Intimacy: Adoptive parent

A
  • Relationship difficulties
  • Child’s distance triggers fear
  • Missed early opportunities
61
Q

Emotions of affected people in adoption –> not all here, review in slides

A
62
Q

baby belongs to birth mom until relinquished.

A
  • No guarantees this will happen
  • Oregon law protects rights of pregnant women until relinquishment
63
Q

Labor & adoption

A
  • Avoid intake interview with everyone present…I.E. Birth mom, her support person, + adoptive family
  • Best: interview mom in private:
  • Request all visitors to leave
  • “what do you want?”
  • “How can I support you?”
64
Q

Birth plan

A
  • Usually have one. Look at it!
  • Share info with other members of the healthcare team taking care of her
  • Explain when/what is happening
65
Q

Time with baby

A
  • Past was “out of sight, out of mind”
  • Very important for birth mom to have quiet time with baby
  • Encouraged to name baby, or choose together with involved adoptive family
66
Q

Relinquishing

A
  • Cannot make a legal commitment until after delivery
  • Usually at the time of mom’s discharge
  • Formal papers are signed - many variations, dependent on hospital –>
  • Relinquishing forms
  • Hospital forms
  • Wall goes up as placement happens
67
Q

relinquishing cont: Handoff

A
  • Agency or attorney
  • If to family, in the presence of…
  • Requires proper photo ID and paperwork
  • Placement ceremony, entrusting the care for this baby to the adoptive parents
68
Q

After discharge - adoption - coping

A
  • 1 - 3 months usually most difficult
  • Open adoption: see baby if appropriate, call adoptive parents
  • Next few months continue to be difficult: Seeing adoptive family loving and caring for baby, observing baby thrive, personal life shifting back to “normal”
69
Q

Surrogacy

A
  • Traditional surrogacy
  • Gestational carriers (surrogate workers):
  • Rate grew 89% in just 4 years. between 2004 - 2008 from 738 to 1400
  • Income: $12,000 - $25,000 per pregnancy (0.50 per hour)
  • Cost to intended parents: $40,000 - $120,000
  • Many are military wives
70
Q

Outsourcing to foreign countries

A
  • Unique ethical issues: women serving as surrogates come from families of the lowest income brackets - exploitation fo vulnerable women?
71
Q

Surrogacy definition: traditional

A
  • Baby is biologically related
  • Woman’s egg, donated sperm
  • Artificial insemination (AI)
  • She agrees to carry the child to term and thereafter relinquish her parental rights to the child
72
Q

Surrogacy: Gestational carriers

A
  • Baby is not biologically related
  • In-vitro fertilization
73
Q

Know slide 105 definitions!! … IVF:

A
  • In vitro fertilization
  • Removal of one or more eggs from a woman’s ovaries just before ovulation
    -The eggs are then placed with sperm and fertilization takes place
  • The fertilized egg is then transferred to the woman for fertilization
74
Q

TDI

A
  • Therapeutic donor insemination
  • Formerly known as AID
  • This involves the use of donor sperm to fertilize a woman’s egg, typically through artificial insemination
75
Q

GIFT definition

A
  • Gamete intra fallopian transfer
  • This procedure involves removal of the egg just before ovulation, then placement of the egg and sperm together into the woman’s fallopian tube, where fertilization will occur
76
Q

Egg donation

A

a woman donates her eggs for use by another woman in IVF or GIFT procedures

77
Q

Sperm donation

A

A man donates sperm for TDI

78
Q

Legal matters

A
  • This is not an adoption, so we don’t say adoption parents
  • we use “intended parents” when talking about genetic parents
  • Declaratory judgment of parent
  • Gestational carrier’s wishes are primary
  • Unless parent’s have signed a Medical Power of Attorney for Medical decision making
79
Q

ID bands - check your hospital’s policy

A
  • Surrogate: the newborns will be issued one set of ID bands
  • The surrogate will be issued a corresponding ID band
  • The final ID band is to be designated by the surrogate
80
Q

Gestational carrier w/ ID bands

A
  • The newborn(s) will be issued two sets of ID bands
  • One set for the gestational carrier and one set for the intended parents with their surname instead of the gestational carrier’s
81
Q

Birth certificate

A
  • Oregon state law requires the name of the surrogate/gestational carrier on the birth certificate
  • Leave the father’s name blank if the surrogate/gestational is married. If she is not married, the name of the adoptive father is put on the form
82
Q

Pathophysiology Mosaicism

A
  • Mitosis goes bad
  • may miscarriage
  • 50% cells could be abdormal
  • if happens later could be less severe

Family NRSG (8 decks)

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