Maternal, Neonatal, and Women’s Health Nursing

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Maternal, Neonatal, and Women’s Health Nursing

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Acknowledging the tremendous changes in the health care system, this book offers a current and fresh perspective on nursing in the 21st century. A departure from the "medical model", its emphasis on client education, shifting delivery of care, and a collaborative approach fosters a practical view of the challenges the student will encounter in the workplace. Core content areas are covered in detail, including pathophysiology, normal and high-risk pregnancy, and women's health across the life-span. The text's integrated, holistic approach incorporates this information within a framework of biological, psychosocial, cultural, and environmental theory in a clear and consistent manner....

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  1. Maternal, Neonatal, and Women’s Health Nursing Lynna Y. Littleton, RNC, PhD and Joan C. Engebretson, RN, DrPH, HNC Delmar / Thompson Learning
  2. B RIEF CONTENTS U N IT I: F OU N DATIONS OF CHAPTER 21: ENVIRONMENTAL RISKS AFFECTING N U RSI NG CAR E 1 FETAL WELL-BEING 605 CHAPTER 1: NURSING IN THE CONTEMPORARY CHAPTER 22: EVALUATION OF FETAL WELL-BEING 643 HEALTH CARE SYSTEM 3 U N IT VI: CH I LDB I RTH 675 CHAPTER 2: ISSUES IN MATERNAL, NEONATAL, CHAPTER 23: PROCESSES OF LABOR AND AND WOMEN’S HEALTH 29 DELIVERY 677 CHAPTER 3: THEORETICAL PERSPECTIVES CHAPTER 24: ANALGESIA AND ANESTHESIA IN ON THE FAMILY 49 LABOR AND DELIVERY 709 CHAPTER 4: COMPLEMENTARY AND ALTERNATIVE CHAPTER 25: INTRAPARTUM NURSING CARE 739 THERAPIES 77 CHAPTER 26: HIGH-RISK BIRTHS CHAPTER 5: ETHICS, LAWS, AND STANDARDS AND OBSTETRIC EMERGENCIES 811 OF CARE 113 CHAPTER 27: BIRTH AND THE FAMILY 851 CHAPTER 6: HOME VISITING PROGRAMS AND PERINATAL NURSING 139 U N IT VI I: P OSTPARTU M H EALTH AN D N U RSI NG CAR E 875 U N IT I I: H EALTH CAR E CHAPTER 28: NORMAL POSTPARTUM OF WOM E N 163 NURSING CARE 877 CHAPTER 7: DEVELOPMENT OF WOMEN ACROSS THE LIFE SPAN 165 CHAPTER 29: POSTPARTUM FAMILY ADJUSTMENT 929 CHAPTER 8: NUTRITION FOR WOMEN CHAPTER 30: LACTATION AND NURSING ACROSS THE LIFE SPAN 185 SUPPORT 955 CHAPTER 9: HEALTH CARE ISSUES U N IT VI I I: N EWBOR N DEVE LOPM E NT FOR WOMEN ACROSS THE LIFE SPAN 221 AN D N U RSI NG CAR E 1009 CHAPTER 10: COMMON CONDITIONS CHAPTER 31: PHYSIOLOGIC AND BEHAVIORAL OF THE REPRODUCTIVE SYSTEM 257 TRANSITION TO EXTRAUTERINE LIFE 1011 CHAPTER 11: VIOLENCE AND ABUSE 297 CHAPTER 32: ASSESSMENT AND CARE OF THE NORMAL NEWBORN 1039 U N IT I I I: H U MAN SEXUALITY CHAPTER 33: NEWBORN NUTRITION 1099 ACROSS TH E LI FE SPAN 327 CHAPTER 12: SEXUAL AND REPRODUCTIVE CHAPTER 34: NEWBORNS AT RISK RELATED TO FUNCTION 329 BIRTH WEIGHT AND PREMATURE DELIVERY 1121 CHAPTER 13: GENETICS AND GENETIC CHAPTER 35: NEWBORNS AT RISK RELATED TO COUNSELING 355 CONGENITAL AND ACQUIRED CONDITIONS 1167 CHAPTER 14: FAMILY PLANNING 383 CHAPTER 36: DEVELOPMENTAL CARE OF THE INFANT AT RISK 1197 U N IT IV: PR EG NANCY 411 CHAPTER 15: NORMAL PREGNANCY 413 U N IT IX: SPECIAL CONSI DE RATIONS 1237 CHAPTER 16: MANAGEMENT AND NURSING CHAPTER 37: GRIEF AND THE FAMILY CARE OF THE PREGNANT WOMAN 453 IN THE PERINATAL EXPERIENCE 1239 CHAPTER 17: CHILDBIRTH PREPARATION CHAPTER 38: COMMUNITY AND HOME HEALTH AND PERINATAL EDUCATION 477 CARE NURSING FOR THE HIGH-RISK INFANT 1269 CHAPTER 18: MANAGEMENT AND NURSING APPENDIX A: STANDARDS OF HOLISTIC NURSING CARE OF THE HIGH-RISK CLIENT 507 PRACTICE 1291 CHAPTER 19: PREGNANCY IN SPECIAL APPENDIX B: ABBREVIATIONS, ACRONYMS, POPULATIONS 541 AND SYMBOLS 1296 U N IT V: ASSESSM E NT GLOSSARY 1301 OF FETAL WE LL-B E I NG 581 INDEX 1313 CHAPTER 20: FETAL DEVELOPMENT 583
  3. Maternal, Neonatal, and Women’s Health Nursing
  4. Maternal, Neonatal, and Women’s Health Nursing Lynna Y. Littleton, RNC, PhD Director of the Women’s Health Care Nurse Practitioner Program Women’s Health Nurse Practitioner Associate Professor of Clinical Nursing University of Texas Health Science Center at Houston Houston, Texas and Joan C. Engebretson, RN, DrPH, HNC Associate Professor Nursing for Target Populations/Head of Division of Women and Childbearing Families University of Texas Health Science Center at Houston Houston, Texas Australia Canada Mexico Singapore Spain United Kingdom United States
  5. Maternal, Neonatal, and Women’s Health Nursing Lynna Y. Littleton, RNC, PhD Joan C. Engebretson, RN, DrPH, HNC Health Care Publishing Director: Executive Marketing Manager: Art/Design Coordinator: William Brottmiller Dawn F. Gerrain Jay Purcell Executive Editor: Production Editor: Editorial Assistant: Cathy L. Esperti James Zayicek Shelly Esposito Acquisitions Editor: Project Editor: Matthew Kane Maureen M. E. Grealish Senior Developmental Editor: Elisabeth F. Williams COPYRIGHT © 2002 by Delmar, a division of Thomson Learning, Inc. For permission to use material from this text or product, contact us by Thomson Learning ™ is a trademark used herein under license. Tel (800) 730-2214 Fax (800) 730-2215 Printed in the United States of America www.thomsonrights.com 1 2 3 4 5 6 XXX 05 04 03 02 01 Library of Congress Cataloging-in-Publication Data For more information contact Delmar, Littleton, Lynna. 3 Columbia Circle, PO Box 15015, Maternal, neonatal, and women’s health nursing/Lynna Littleton and Albany, NY 12212-5015 Joan Engebretson. p. cm. Or find us on the World Wide Web at http://www.delmar.com Includes bibliographical references and index. ISBN 0-7668-0121-7 (alk. paper) ALL RIGHTS RESERVED. No part of this work covered by the copyright 1. Maternity nursing. 2. Infants (Newborn)—Diseases—Nursing. hereon may be reproduced or used in any form or by any means— 3. Infants (Newborn)—Care. 4. Gynecologic nursing. I. Engebretson, graphic, electronic, or mechanical, including photocopying, recording, Joan. II. Title. taping, Web distribution, or information storage and retrieval systems— RG951.L563 2001 610.73′678–dc21 without written permission from the publisher. 2001032460 NOTICE TO THE READER The publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein. The publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities herein and to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions. The publisher makes no representation or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or mer- chantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material.
  6. CONTENTS CONTRIBUTORS xvi Complementary and Alternative Therapies 17 Contemporary Challenges in Health Care REVIEWERS xx Delivery 17 Rapidly Changing Technology 17 PREFACE xxi Changing Demographics 18 Balancing Cost with Best Practice 19 ACKNOWLEDGMENTS xxiv Nursing Implications 19 ABOUT THE AUTHORS xxv Nursing Skills for Professional Practice 20 Cognitive Skills 20 HOW TO USE THIS TEXT xxvi Technical Skills 21 Communication Skills 22 HOW TO USE THE STUDENT ACTIVITY Collaborative Skills 23 SOFTWARE xxix Cultural Competency 23 Economic Expertise 23 Self-Awareness and Reflective Practice 24 U N IT I: F OU N DATIONS OF Development of Intuition 24 N U RSI NG CAR E 1 CHAPTER 1: NURSING IN THE CONTEMPORARY HEALTH CARE SYSTEM 3 CHAPTER 2: ISSUES IN MATERNAL, NEONATAL, Current State of Health Care Delivery 4 AND WOMEN’S HEALTH 29 Technologic Advancement for Diagnosis and Changes in Maternal, Neonatal, and Women’s Treatment 4 Health Care 30 Health Care Expansion 5 Advances in Diagnosis and Treatment 30 Movement of Health Care to the Community 6 Health Indicators 31 Change in Philosophy 7 Risk Assessment and Management 33 Cost Containment 7 Cost 33 Activities to Improve Health 8 Goals and Guidelines 33 Identify Health Indicators 8 Trends in Maternal, Neonatal, and Women’s Establish Health Goals 8 Health Care 34 Address Health Disparities 8 Medicalization and Demedicalization 34 Institute Evidence-Based Practice or Best Practice 9 Decreased Hospital Stay 35 Develop and Publish Guidelines 10 Reduction in Intervention 35 Work Toward Cost Containment 11 Family-Centered Care 35 Develop Collaboration with Multidisciplinary Community-Centered Care 36 Teams 12 Evidence-Based Practice 36 Changing Views in Understanding Health, Illness, Understanding Women’s Health 37 and Disease 13 Biologic Health 37 Biologic Science 13 Behavioral Health 37 Environmental Medicine 14 Environmental Health 37 Behavioral Medicine 15 Social Health 37 Social Aspects of Health 15 Cultural Health 38 Cultural Issues and Health 16 Complementary and Alternative Therapies 39
  7. CONTENTS VI Issues Related to Maternal, Neonatal, Ingested and Applied Substances 87 and Women’s Health Care 39 Energy-Based Therapies 99 Cost Containment 39 Psychologic or Mind-Body Therapies 101 Access to Care 40 Spiritual Healing 102 Reduction of Medical Errors 40 Nursing Implications 103 Ethical Issues 40 Implications for Women’s Health 103 Medical-Legal Issues 40 Implications for Research 103 Philosophy of Care 42 Implications for Practice 103 Nursing Implications 43 Nursing Process 105 Nursing Practice 43 Assessment 105 Nursing Education 44 Nursing Diagnoses 105 Nursing Research 44 Outcome Identification 105 Planning 105 Nursing Intervention 105 CHAPTER 3: THEORETICAL PERSPECTIVES Evaluation 107 ON THE FAMILY 49 Family System of Structure and Function 51 Traditional or Nuclear Family 51 CHAPTER 5: ETHICS, LAWS, AND STANDARDS Childless Dyads 52 OF CARE 113 Extended Family 52 Ethical Issues 115 Communal Family 53 Basic Ethical Perspectives 115 Unmarried Heterosexual (Cohabitation) Family 53 Ethical Principles 119 Homosexual Family 53 Code for Nurses 120 Single-Parent Family 54 Ethical Decision-Making Model 121 Theoretical Frameworks 61 Selected Dilemmas in Maternal-Child Practice 123 Developmental Theories 61 Legal Issues 130 Interactional or Structural-Functional Theory 62 Basic Legal Concepts 130 Role Theory 63 Standards of Care 131 Systems Theory 63 Practicing Safely in Perinatal Settings 131 Cultural Issues that Influence Families 64 Legal Issues in Maternal-Child Practice 134 Lower Birth Rate and Longer Life Span 64 Practice Implications for Maternal-Child Nursing 135 Economics 64 Cultural Diversity 66 CHAPTER 6: HOME VISITING PROGRAMS Choice of Marriage Partner 66 AND PERINATAL NURSING 139 Changing Role of Women 67 Historical Background 140 Provider Models 68 Community Health Concepts 141 Family Dynamics 68 Defining Home Visitation 142 Biopsychosocial Model 70 Site of Service Delivery 142 Resiliency Model of Family Stress, Adjustment, Relationship Building 142 and Adaptation 70 Indications for Home Visitation 143 Proactive Model for Enabling and Empowering Provision of Acute Care 143 Families 71 Health Promotion 144 Nursing Implications 74 Principles of Home Visitation 144 Efficacy of Home Visitation 147 CHAPTER 4: COMPLEMENTARY AND ALTERNATIVE Essential Skills for Home Visiting 148 THERAPIES 77 Nursing Process 150 Contemporary Use of Complementary Therapies 79 Assessment 150 Differentiating Alternative from Complementary Nursing Diagnoses 150 Therapies 81 Outcome Identification 150 Background and Classification of Modalities 82 Planning 150 Systems of Healing 82 Nursing Interventions 151 Healing Approaches Congruent with Self-Healing 85 Evaluation 151 Complementary Modalities 86 Case Management 152 Physical Manipulation 86 Making the Home Visit 152
  8. CONTENTS VII Previsit Preparation 152 Obesity 211 Visiting the Home 155 Heart Disease 211 Postvisit Activities 157 Osteoporosis 213 Challenges of Home Visitation 158 Cancer 213 Meeting Multiple Needs 158 Nursing Implications 214 Fostering Self-sufficiency 158 Physical and Emotional Overload 158 CHAPTER 9: HEALTH CARE ISSUES Responding to Client Diversity 159 FOR WOMEN ACROSS THE LIFE SPAN 221 Cost and Reimbursement 159 Historical Perspective of Women’s Health 222 Terminating the Home Visiting Relationship 159 History of Reproductive Health Care in the U.S. 222 Current View of Women’s Health Care 223 Sociocultural Influences 224 U N IT I I: H EALTH CAR E Women’s Health as a National Priority 225 OF WOM E N 163 National Response to Women’s Health Issues 225 Demographic Data for American Women 227 CHAPTER 7: DEVELOPMENT OF WOMEN Life Expectancy 227 ACROSS THE LIFE SPAN 165 Race and Ethnicity 228 Prenatal through Early Adolescent Years 166 Population Shift 228 Adolescence 167 Employment 228 Physiologic Changes 167 Education 229 Psychosocial Changes 171 Marital Status 229 Cultural Influences 173 Fertility and Birth Rates 229 Self-Care Considerations 173 Birth Rates for Adolescent Mothers 230 Young Adulthood to Perimenopausal Years 174 Birth Rates for Unmarried Women 230 Physiologic Changes 174 Mortality and Morbidity 231 Psychosocial Changes 174 Leading Causes of Death 231 Cultural Influences 175 Cardiovascular Disease 231 Self-Care Considerations 175 Cancer 232 Perimenopausal to Mature Years 175 Chronic Conditions 244 Physiologic Changes 176 Age-Specific Issues 246 Psychosocial Changes 178 Infancy to Young Adulthood 246 Cultural Influences 178 Young Adulthood to Perimenopausal Years 247 Self-Care Considerations 178 Perimenopausal to Mature Years 248 Mature Years 179 Mature Years 249 Physiologic Changes 179 Health Promotion and Disease Prevention 250 Psychosocial Changes 180 Delivery of Preventive Services 251 Cultural Influences 181 Types of Preventive Services 251 Self-Care Considerations 181 Nursing Implications 181 CHAPTER 10: COMMON CONDITIONS OF THE REPRODUCTIVE SYSTEM 257 CHAPTER 8: NUTRITION FOR WOMEN Menstrual Cycle Abnormalities 258 ACROSS THE LIFE SPAN 185 Amenorrhea 258 Nutritional Guidelines 187 Dysfunctional Uterine Bleeding 261 Dietary Guidelines 187 Dysmenorrhea 262 Food Guide Pyramid 187 Endometriosis 262 Culturally Adapted Food Guides 187 Premenstrual Syndrome 263 Nutrition Facts Food Label 190 Nursing Implications 264 Nutritional Needs Across the Life Span 192 Breast Conditions 266 Adolescence 192 Benign Breast Conditions 266 Adulthood and Childbearing Years 194 Malignant Breast Conditions 272 Mature Years 210 Nursing Implications 274 Nutrition-Related Health Concerns 211 Pelvic Conditions 277 Physicial Activity 211 Infectious Conditions 277
  9. CONTENTS VIII Benign Pelvic Conditions 283 CHAPTER 13: GENETICS AND GENETIC Malignant Pelvic Conditions 284 COUNSELING 355 Nursing Implications 286 Chromosomal Basis of Inheritance 357 Menopause 288 Chromosome Number and Structure 357 Vasomotor Instability 288 Patterns of Chromosome Anomalies 358 Urogenital Atrophy 289 Distribution of Chromosomes During Psychologic Conditions 289 Cell Division 359 Long-Term Considerations 289 Gene Structure and Function 361 Nursing Implications 290 Single Gene (Mendelian) Inheritance 362 Dominant Gene Inheritance Pattern 363 CHAPTER 11: VIOLENCE AND ABUSE 297 Recessive Gene Inheritance Pattern 364 Intimate Partner Violence 298 Polygenic and Multifactorial Inheritance 366 Sexual Assault 298 Single-Gene Disorders 367 Violence During Pregnancy 300 Autosomal Dominant Disorders 367 Emergency Department Visits 302 Autosomal Recessive Disorders 369 Primary Care of Abused Women 303 X-Linked Disorders 371 Post-Traumatic Stress Disorder 305 Chromosome Abnormalities 372 Cultural Influences 306 Numerical Abnormalities of the Autosomes 372 Stalking 306 Numerical Abnormalities of the Sex Chromosomes 373 Impact in the Workplace 307 Structural Chromosomal Abnormalities 374 Portrait of an Abuser 308 Genetic Screening 374 Nursing Implications 310 Genetic Counseling 375 The Cycle of Violence 311 Prenatal Diagnosis 376 Violence Against Children 312 Nursing Implications 378 Child Abuse 313 Child Sexual Abuse 314 CHAPTER 14: FAMILY PLANNING 383 Children Witnessing Violence 314 Reproductive Decision-Making 384 Nursing Responsibilities 315 Factors Affecting Reproductive Choices 385 Violence Against Older Persons 317 Readiness for Decision-Making 386 Characteristics 317 Contraceptive Methods 388 Signs 317 Reversible Methods 388 Nursing Responsibilities 318 Permanent Methods 407 Special Case: Female Circumcision 318 Nursing Implications 408 U N IT I I I: H U MAN SEXUSALITY ACROSS TH E LI FE SPAN 327 U N IT IV: PR EG NANCY 411 CHAPTER 12: SEXUAL AND REPRODUCTIVE CHAPTER 15: NORMAL PREGNANCY 413 FUNCTION 329 Signs of Pregnancy 414 Normal Sexual Differentiation 330 Presumptive Signs 414 Female Reproductive Function 331 Probable Signs 415 Male Reproductive Function 334 Positive Signs 416 Sexuality 335 Expected Date of Delivery 416 Human Sexual Response 336 Physiologic Adaptation to Pregnancy 417 American Sexual Practices 337 Reproductive System 417 Sexual Dysfunction 339 Breasts 419 Female Sexual Dysfunction 340 Hematologic System 419 Male Sexual Dysfunction 341 Cardiovascular System 421 Evaluation of Sexual Dysfunction 341 Respiratory System 422 Infertility 343 Gastrointestinal System 424 Factors Affecting Fertility 343 Endocrine System 425 Assessment of the Infertile Couple 345 Changes in Metabolism 427 Nursing Implications 352 Urinary System 428
  10. CONTENTS IX Integumentary System 430 Nursing Diagnoses 472 Musculoskeletal System 431 Outcome Identification 473 Eyes 431 Planning 473 Discomforts of Pregnancy 431 Nursing Intervention 473 Nausea and Vomiting of Pregnancy 433 Evaluation 473 Heartburn 433 Constipation 434 CHAPTER 17: CHILDBIRTH PREPARATION Fatigue 434 AND PERINATAL EDUCATION 477 Frequent Urination 434 From Childbirth Education to Perinatal Epistaxis and Nasal Congestion 434 Education 479 Varicosities 435 History of Childbirth Education 479 Hemorrhoids 435 Methods of Childbirth Preparation 479 Back Pain 436 Lamaze Method of Psychoprophylaxis 480 Leg Cramps 436 Dick-Read Method 480 Health Promotion 436 Bradley Method 481 Psychosocial Adaptations to Pregnancy 438 Kitzinger’s Psychosexual Method 482 Psychologic Responses to Pregnancy 438 Water Immersion 482 Becoming a Mother 439 Theoretical Basis for Childbirth Preparation 483 Becoming a Father 441 Relaxation Theories 483 The Family 442 Pain Management Theories 483 Siblings 443 Research Related to Childbirth Preparation 484 Grandparents 443 Strategies for Labor Management 484 Cultural Caring 444 Relaxation Techniques 484 Complementary Therapies 445 Acupressure 489 Nursing Process 445 Support during Labor 489 Assessment 445 Parenting, Role Transition, and Family Nursing Diagnosis 446 Adaptation 491 Outcome Identification 446 Additional Classes Offered to Childbearing Planning 446 Families 491 Nursing Intervention 446 First Trimester–Early Pregnancy Class 492 Evaluation 446 Pregnancy Exercise Classes 492 Breast-Feeding Classes 492 CHAPTER 16: MANAGEMENT AND NURSING Sibling Classes 494 CARE OF THE PREGNANT WOMAN 453 Grandparent Classes 495 Benefits of Early Care 454 Vaginal Birth after Cesarean Preparation 495 Preconception Care 455 Infant Care Classes 495 Preconception Assessment 455 Preparation for the Educator Role 495 Early Interventions 456 Organizations that Support and Certify Childbirth Prenatal Care 456 Educators 497 Availability and Accessibility of Care 456 Principles of Adult Learning 498 Facilitation of Client Access to Care 456 Group Process 498 Components of Prenatal Care 457 Cultural Considerations in Childbirth The Initial Prenatal Visit 457 Preparation 499 Subsequent Visits 462 Variables Influencing the Need for Childbirth Discomforts of Pregnancy 468 Preparation 500 Urinary Frequency 469 Choice of Provider 501 Nausea and Vomiting 469 Choice of Delivery Setting 501 Indigestion 469 Home Birth 501 Constipation and Hemorrhoids 469 Free-Standing Birth Center 502 Edema of Lower Extremities 469 Birth Center in a Hospital 502 Danger Signs to be Reported 470 Labor, Delivery, and Recovery Unit 502 Nursing Process 472 Labor, Delivery, Recovery, and Postpartum Unit 502 Assessment 472 Nursing Implications 502
  11. CONTENTS X CHAPTER 18: MANAGEMENT AND NURSING Pregnancy in Women over Age 35 571 CARE OF THE HIGH-RISK CLIENT 507 Incidence and Significance 571 Hemorrhagic Disorders 508 The Effects of Age on Reproduction 572 Abortion 508 Nursing Implications 574 Ectopic Pregnancy 510 Placental Abnormalities 510 Placenta Previa 510 U N IT V: ASSESSM E NT Abruptio Placentae 512 OF FETAL WE LL-B E I NG 581 Labor Disorders 514 Incompetent Cervix 514 CHAPTER 20: FETAL DEVELOPMENT 583 Preterm Labor and Premature Rupture of Cell Division 584 Membranes 514 Implantation and Fertilization 584 Postterm Pregnancy 517 Placenta 587 Disorders of Amniotic Fluid Volume 517 Functions of the Placenta 587 Polyhydramnios 517 Placental Circulation 588 Oligohydramnios 518 Fetal Circulation 589 High-Risk Fetal Conditions 518 Newborn Circulation 591 Multiple Gestation 518 Umbilical Cord 592 Rh Isoimmunization and ABO Incompatibility 519 Membranes and Amniotic Fluid 592 Nonimmune Hydrops Fetalis 521 Embryonic and Fetal Development 592 Hypertension 521 Embryonic Stage 592 Endocrine Disorders 524 Fetal Stage 598 Diabetes 524 Hypothyroidism 526 Hyperthyroidism 527 CHAPTER 21: ENVIRONMENTAL RISKS AFFECTING Cardiovascular Disorders 527 FETAL WELL-BEING 605 Clinical Presentation 527 Risks Related to Geographic Location 606 Management 528 Nuclear and Chemical Accidents 607 Nursing Care 529 Pesticides 607 Pulmonary Disorders 529 Industrial Contaminants 608 Asthma 529 Rural or Urban Residence 609 Tuberculosis 530 Warfare and Political Violence 610 Autoimmune Disease 531 Risks Related to Employment 611 Systemic Lupus Erythematosus 531 Heat and Radiation 611 Hematologic Disorders 532 Chemical Exposure 612 Immunological Idiopathic Thrombocytopenic Fatigue and Physical Risks 613 Purpura 532 Stress 614 Sickle-Cell Disease 533 Risks Related to Home Environment Neurologic Disorders 534 and Lifestyle 615 Seizure Disorders 534 Food Additives and Contaminants 615 Nursing Implications 535 Medications 616 Alcohol Use 621 CHAPTER 19: PREGNANCY IN SPECIAL Tobacco Smoking and Passive Smoke 622 POPULATIONS 541 Illicit Drug Use 624 Pregnancy in Adolescence 542 Infections 625 Incidence and Significance 543 Nursing Process 632 Adolescent Psychosocial Development 546 Assessment 633 Issues Related to Adolescent Sexuality, Pregnancy, Nursing Diagnoses and Outcome Identification 633 and Parenting 550 Planning 634 Nursing Implications 557 Nursing Intervention 634 Pregnancy in HIV-Infected Women 562 Evaluation 634 Incidence and Significance 562 Future Directions: Improving Public Awareness Screening, Testing, and Diagnosis 563 and Policies for Pregnancy Safety 634
  12. CONTENTS XI CHAPTER 22: EVALUATION OF FETAL Respiratory System 695 WELL-BEING 643 Renal System 704 Evaluation of Fetal Well-Being 644 Gastrointestinal System 704 Purpose 645 Endocrine System 704 Process 646 Fetal Adaptations to Labor 704 Consequences 648 Fetal Heart Rate 704 Genetic and Biochemical Evaluation 648 Fetal Respiratory System 705 Invasive Fetal Diagnostic Studies 648 Fetal Circulation 705 Maternal Serum Studies 655 Physical and Physiological Surveillance 656 CHAPTER 24: ANALGESIA AND ANESTHESIA IN Fetal Imaging 657 LABOR AND DELIVERY 709 Fetal Heart Rate Monitoring 662 Theories of Pain and Pain Management 711 Fetal Behavior Studies 665 Analgesia and Anesthesia 711 Nursing Process 668 Types of Anesthesia 711 Assessment 668 Types of Anesthesia Providers 712 Nursing Diagnoses 669 Pain in Labor and Delivery 712 Outcome Identification 669 Types of Pain 713 Planning 670 Considerations in Medication for Pain 714 Nursing Intervention 670 Analgesia in Labor 714 Evaluation 672 Nonpharmacologic Methods 714 Future Directions 672 Parenteral Analgesia 714 Regional Analgesia 718 Anesthesia for Delivery 726 Local Infiltration 726 U N IT VI: CH I LDB I RTH 675 Regional Anesthesia 726 General Anesthesia 732 CHAPTER 23: PROCESSES OF LABOR AND Special Considerations for Cesarean Section 734 DELIVERY 677 Postdelivery Care for the Client Receiving Physiology of Labor 678 Anesthesia 735 Theories for the Onset of Labor 679 Local Anesthesia 735 Mechanisms of Labor 679 Regional Anesthesia 735 Signs and Symptoms of Impending Labor 686 General Anesthesia 735 Lightening 686 Cervical Changes 686 Braxton Hicks Contractions 686 CHAPTER 25: INTRAPARTUM NURSING CARE 739 Bloody Show 686 Assessment of the Physiologic Processes Energy Spurt 686 of Labor 741 Gastrointestinal Disturbances 686 Maternal Status 741 Stages of Labor 686 Fetal Status 747 First Stage 687 Labor Status 751 Second Stage 687 General Systems Assessment 756 Third Stage 689 Setting Priorities and Making Decisions 759 Fourth Stage 690 Maternal-Family Support and Interactions 760 Interventions of Labor 690 Psychologic Considerations During the Latent Phase Labor Induction 690 of Labor 760 Cervical Ripening Methods 690 Documentation and Communication 761 Amniotomy 692 Laboratory Tests 761 Augmentation of Labor 692 Nursing Responsibilities During Labor 761 Forceps-Assisted Birth 693 First Stage 762 Vacuum-Assisted Birth 694 Second Stage 776 Cesarean Section 694 Third Stage 790 Maternal Adaptations to Labor 694 Fourth Stage (Recovery) 797 Hematologic System 694 Precipitous Delivery 803 Cardiovascular System 695 Delivery in a Nonhospital Setting 804
  13. CONTENTS XII CHAPTER 26: HIGH-RISK BIRTHS CHAPTER 28: NORMAL POSTPARTUM AND OBSTETRIC EMERGENCIES 811 NURSING CARE 877 Dysfunctional Labor Pattern 813 Postpartum Care 878 Hypertonic Labor 814 Mother-Baby Nursing 878 Hypotonic Labor 818 Infant Security 879 Precipitate Labor 818 Hospital Length of Stay 879 Fetal Malpresentation and Malposition 820 Clinical Assessment 880 Breech Presentation 820 Nursing Approach to Cultural Sensitivity 881 Shoulder Presentation 823 Vital Signs 881 Face Presentation 824 Physical Assessment 883 Malpositions 825 Other Assessments 895 Maternal and Fetal Structural Abnormalities 828 Hemodynamic Status 896 Cephalopelvic Disproportion 828 Integumentary System 896 Macrosomia 829 Musculoskeletal System 896 Multiple Gestation 832 Activity 897 Fetal Distress 834 Exercise 898 Uterine Rupture 835 Weight Loss 899 Placental Abnormalities 837 Sexuality 900 Placenta Previa 837 Contraception 901 Abruptio Placenta 838 Pain Management 902 Other Placental Anomalies 840 Immune System 902 Umbilical Cord Anomalies 840 Family Considerations 904 Amniotic Fluid Abnormalities 842 Documentation 906 Polyhydramnios 842 Postpartum Complications 908 Oligohydramnios 843 Postpartum Hemorrhage 908 Amniotic Fluid Embolism 844 Pelvic Hematoma 911 Postpartum Infections 912 Client Education 917 CHAPTER 27: BIRTH AND THE FAMILY 851 Early Discharge 919 Historical Aspects of Birth and the Family 853 Home Visit Guidelines 920 Cultural Considerations in a Family’s Response Nursing Implications 924 to Birth 853 Theoretical Approaches to the Study CHAPTER 29: POSTPARTUM FAMILY ADJUSTMENT 929 of the Family 854 Maternal-Infant Attachment 930 Systems Theory 854 Maternal Adjustment and Role Attainment 932 Developmental Theory 855 Paternal Adjustment 937 Crisis Theory 855 Infant Behaviors Influencing Attachment 939 Nursing Implications 856 Sibling Adjustment 940 Effect of Birth on the Family 856 Grandparent Adjustment 941 Maternal Adaptation 856 Factors Affecting Role Mastery 942 Paternal Adaptation 862 The Postpartum Adolescent Mother 943 Sibling Adaptation 864 Cultural Considerations 944 Grandparent and Extended Family Adaptation 865 Cultural Assessment 946 Prolonged Labor and Assisted Delivery 866 Nursing Process 946 Cesarean Delivery 867 Assessment 947 Response of the At-Risk Family 867 Nursing Diagnosis 947 Response to Loss at Birth 869 Outcome Identification 947 Loss Through Adoption 870 Planning 947 Loss Through Special Circumstances 870 Nursing Intervention 947 Response of Health Care Professionals 870 Evaluation 948 U N IT VI I: P OSTPARTU M H EALTH CHAPTER 30: LACTATION AND NURSING AN D N U RSI NG CAR E 875 SUPPORT 955
  14. CONTENTS XIII History of Breast-Feeding 957 Complications of Pulmonary System Transition 1030 Epidemiology 957 Complications of Cardiac System Transition 1031 Cultural Values, Beliefs, and Traditions 958 Anticipatory Guidance for Prospective Parents Biology of Lactation 959 of Preterm Neonates 1031 Anatomy of the Breast 960 Resuscitation and Stabilization in the Delivery Physiology of Lactation: Hormones and Processes 961 Room 1031 Mechanics of Lactation 964 Issues Related to Breast-Feeding 967 CHAPTER 32: ASSESSMENT AND CARE Benefits 968 OF THE NORMAL NEWBORN 1039 Barriers to Lactation 973 Assessment After Transition 1041 Biologic Barriers 974 Temperature 1041 Psychologic Barriers 978 Cardiovascular System 1042 Social Barriers 979 Respiratory System 1042 Other Barriers 980 General Nursing Care 1043 Contraindications to Breast-Feeding 982 General Assessment 1046 Maternal Disease 983 Position 1046 Infant Disease 984 Skin Color 1047 Drugs and Medications 984 Body Size 1048 Problems Encountered with Breast-Feeding 985 Reactivity 1048 Maternal Problems 986 Identification 1048 Resources for Breast-Feeding Mothers 992 Physical Examination 1050 Nursing Implications 993 Weight, Measurement, and Vital Signs 1050 Overcoming Barriers 994 Gestational Age Assessment 1060 Facilitating the Process 995 Systems Assessment 1064 Nursing Process 997 Additional Assessment 1088 Assessment of the Nursing Pair 997 Periodic Shift Assessment 1088 Nursing Diagnoses 998 Quick Examination 1088 Outcome Identification 998 Interactional Assessment 1089 Planning 999 Factors that Place the Infant at Risk 1091 Nursing Intervention 999 Physical 1091 Evaluation 999 Psychological 1091 Family 1092 Environment 1092 U N IT VI I I: N EWBOR N DEVE LOPM E NT Illness and Infection 1092 AN D N U RSI NG CAR E 1009 Nursing Implications 1093 Promotion of Physiologic Stability 1093 CHAPTER 31: PHYSIOLOGIC AND BEHAVIORAL Newborn Care 1093 TRANSITION TO EXTRAUTERINE LIFE 1011 Sleep and Activity 1093 Physiologic Transitions of Major Systems 1013 Cord and Skin Care 1094 Pulmonary System Transition 1013 Criteria for Discharge 1094 Cardiac System Transition 1014 Thermoregulation 1016 Metabolic Transition 1020 CHAPTER 33: NEWBORN NUTRITION 1099 Gastrointestinal System Transition 1020 Growth and Development 1100 Neurobehavioral Transition in the First Energy 1102 12 Hours 1020 Protein 1103 First Period of Reactivity 1021 Fat 1103 Period of Decreased Activity 1022 Carbohydrates 1104 Second Period of Reactivity 1022 Water and Electrolytes 1105 Assessment Strategies and Newborn Competencies 1023 Minerals 1105 Complications of Transition 1024 Trace Elements 1106 Common Complications 1024 Water-Soluble Vitamins 1107 Major Pathologies that Affect Transition 1027 Fat-Soluble Vitamins 1108 Transition of the Premature Infant 1030 Breast-Feeding 1109
  15. CONTENTS XIV Commercial Infant Formula 1110 Nursing Diagnosis 1190 Introduction of Solid Foods and Weaning 1114 Outcome Identification 1191 Nursing Implications 1116 Planning 1191 Nursing Interventions 1191 Evaluation 1191 CHAPTER 34: NEWBORNS AT RISK RELATED TO Parents and Family 1194 BIRTH WEIGHT AND PREMATURE DELIVERY 1121 The Small for Gestational Age Infant 1123 Intrauterine Growth Restriction 1123 CHAPTER 36: DEVELOPMENTAL CARE Complications Associated with the SGA Infant 1124 OF THE INFANT AT RISK 1197 The Large for Gestational Age Infant 1126 Historical Development 1198 Associated Factors 1126 Stage 1 1199 Complications 1126 Stage 2 1199 Assessment and Care 1126 Stage 3 1199 The Premature Infant 1126 Theoretical Framework for Developmental Care 1199 Factors Associated with Preterm Delivery 1126 Standards of Care 1200 Assessment of the Preterm Infant 1127 Elements of Developmental Care 1201 Review of Systems 1129 Macro-environment Components 1201 Special Considerations in Caring for the Infant Micro-environment Components 1208 at High Risk 1143 Assessment Strategies in Developmental Care 1223 Parental Anxiety 1144 Research Support for Comprehensive Ethical Considerations 1144 Developmental Care Protocols 1224 Thermoregulation 1145 Families and the High-Risk Infant 1226 Nutrition and Fluid Management 1146 Pain Management in the Neonate 1150 Drug Metabolism and Excretion 1152 U N IT IX: SPECIAL Complementary Therapy 1153 CONSI DE RATIONS 1237 Developmental Care 1153 Therapeutic Touch 1155 CHAPTER 37: GRIEF AND THE FAMILY Co-Bedding of Twins 1156 IN THE PERINATAL EXPERIENCE 1239 Neonatal Transport 1156 Psychology of Loss 1240 Maternal Transport versus Neonatal Transport 1156 Attachment 1241 Neonatal Transport Team 1157 Grief 1242 Back Transport 1157 Loss of a Dream 1244 Discharge Planning 1157 Reproductive Loss 1244 Fetal Death 1244 CHAPTER 35: NEWBORNS AT RISK RELATED TO Loss of the Perfect Baby 1245 CONGENITAL AND ACQUIRED CONDITIONS 1167 Sudden Infant Death 1246 Congenital Anomalies 1169 Relinquishment 1246 Central Nervous System Anomalies 1169 Grief Response 1248 Respiratory System Anomalies 1172 Depression and Grief Work 1248 Cardiovascular System Anomalies 1173 Dysfunctional Grieving 1249 Gastrointestinal System Anomalies 1176 Avoidance 1249 Genitourinary System Anomalies 1179 Prolonged and Exaggerated Grief 1249 Musculoskeletal System Anomalies 1181 Multiple Losses 1250 Acquired Disorders 1183 Chronic Grief 1250 Trauma and Birth Injuries 1183 Isolation 1250 Infants of Diabetic Mothers 1185 Sociocultural Issues 1251 Hyperbilirubinemia 1186 Religious Practices and Spirituality 1251 Neonatal Infections 1189 Creating Memories and Finding Meaning 1251 Sepsis 1189 Effects of Loss on the Family 1252 Family Experiences 1190 Issues of Intimacy and Communication 1253 Nursing Process 1190 Gender Issues Related to the Grief Response 1253 Assessment 1190 Communication 1253
  16. CONTENTS XV Grandparents 1254 The Home Health Care Visit 1279 Siblings 1254 Physical Assessment 1279 Care for the Grieving Family 1256 Developmental Assessment 1279 Bereavement Program 1257 Nutritional Assessment 1280 Care for the Caregivers 1257 Social and Environmental Assessment 1280 Nursing Responses 1258 Laboratory Tests 1281 Supporting the Caregivers 1259 Referrals 1281 Companioning as a Support Technique 1259 Recording the Visit 1281 Staff Education and Support 1259 Programs for the Infant and Family Care Team 1259 with Special Needs 1281 Nursing Process 1261 Home Health Care for the Infant Exposed Assessment 1261 to Drugs 1281 Nursing Diagnosis 1261 CRADLES Integrated Children’s Project 1283 Outcome Identification/Planning 1261 Healthy Families Alexandria 1284 Nursing Intervention 1261 Public Health Programs for Infants Evaluation 1263 and Children 1285 Early Childhood Intervention (Birth to 3 Years) 1285 Women, Infants, and Children (WIC) Nutritional CHAPTER 38: COMMUNITY AND HOME HEALTH Program 1286 CARE NURSING FOR THE HIGH-RISK INFANT 1269 Nursing Implications 1286 Economics and Home Health Care 1270 Multicultural Diversity in Home Health Care 1271 History of Home Care 1272 APPENDIX A: STANDARDS OF HOLISTIC Research on Home Visiting Programs 1272 NURSING PRACTICE 1291 Barnard’s Nursing Model 1274 Multidisciplinary Team Approach APPENDIX B: ABBREVIATIONS, ACRONYMS, to Home Health Care 1274 AND SYMBOLS 1296 Nursing Guidelines and Recommendations for Home Health Care 1275 GLOSSARY 1301 Nursing Role in the Home Health Care of the High-Risk Infant 1276 Home Visit Preparation 1276 INDEX 1319 Transition from Hospital to Home Health Care 1277 Discharge and Home Health Care Planning 1277 Follow-Up Care for the High-Risk Infant 1278
  17. CONTRIBUTORS Janet M. Banks, RN, PhD CPNP Diana Reyna Delgado, RN, MSN Coordinator, Pediatric Nurse Practitioner Program Assistant Professor Assistant Professor, Department of Family Nursing Care Nursing Department University of Texas Health Science Center at San Antonio University of Texas Pan American School of Nursing Edinburg, Texas San Antonio, Texas Chapter 35: Newborns at Risk Related to Congenital and Chapter 32: Assessment and Care of the Normal Newborn Acquired Conditions M. Colleen Brand, RNC, MSN, NNP Judy Freidrichs, RN, MS Clinical Instructor Death Educator and Grief Support Facilitator Neonatal Nurse Practitioner Program Education and Quality Coordinator University of Texas Health Science Center at Houston Rush—Presbyterian—St. Luke’s Medical Center School of Nursing Chicago, Illinois Houston, Texas Chapter 37: Grief and the Family in the Perinatal and Experience Neonatal Nurse Practitioner Patricia G. Grantom, RNC, MS, CNS, NP Neonatal Nurse Practitioner Program Perinatal Nurse Practitioner Texas Children’s Hospital Private Practice Houston, Texas Pasadena, Texas Chapter 34: Newborns at Risk Related to Birth Weight and Chapter 26: High-Risk Births and Obstetric Emergencies Premature Delivery Chris Hawkins, RN, PhD Nancy H. Busen, RN, PhD CFNP Associate Professor and M.S. Program Coordinator Associate Professor College of Nursing—Houston Center University of Texas Health Science Center at Houston Texas Woman’s University School of Nursing Houston, Texas Houston, Texas Chapter 16: Management and Nursing Care of the Chapter 19: Pregnancy in Special Populations Pregnant Woman Kathy Clarke, RNC, MS Judith Headley, RN, PhD Director, Women’s Services Assistant Professor Memorial Hermann Hospital University of Texas Health Science Center at Houston Houston, Texas School of Nursing Chapter 15: Normal Pregnancy Houston, Texas Miguel F. da Cunha, PhD Chapter 4: Complementary and Alternative Therapies Professor University of Texas Health Science Center at Houston School of Nursing Houston, Texas Chapter 13: Genetics and Genetic Counseling
  18. CONTRIBUTORS XVII Lori Hinton, RN, DrPH Lynn L. LeBeck, CRNA, MS Assistant Professor DNSc student, Rush University University of Texas Health Science Center at Houston Chicago, Illinois Houston, Texas and Assistant Director and President Oakland University—Beaumont Hospital American Case Management Graduate Program of Nurse Anesthesia Houston, Texas Royal Oak, Michigan Chapter 9: Health Care Issues for Women Across the Life Chapter 24: Analgesia and Anesthesia in Labor and Span Delivery Nancy M. Hurst, RN, MSN, IBCLC Terry Leicht, MSN, CNS, PNNP Director, Lactation Support Program and Milk Bank, Texas Labor and Delivery Children’s Hospital John Sealy Hospital Instructor in Pediatrics University of Texas Medical Branch at Galveston Baylor College of Medicine Galveston, Texas Houston, Texas Chapter 18: Management and Nursing Care of the Chapter 33: Newborn Nutrition High-Risk Client Margaret H. Kearney, RNC PhD Dorothy Lemmey, RN, PhD Women’s Health Nurse Practitioner Associate Professor of Nursing Lakeland Community College and Associate Professor Kirtland, Ohio Boston College School of Nursing Chapter 11: Violence and Abuse Chestnut Hill, Massachusetts Harriet Linenberger, RNC, PhD Chapter 21: Environmental Risks Affecting Fetal Vice President of Patient Care Sevices Well-Being Memorial Hermann Hospital—Southwest Bonnie Kellogg, RN, DrPH Houston, Texas Professor Chapter 12: Sexual and Reproductive Function California State University—Long Beach Marilyn J. Lotas, RN, PhD Long Beach, California Associate Professor Chapter 20: Fetal Development Frances Payne Bolton School of Nursing Elizabeth King, CNS, PhD Case Western Reserve University Assistant Professor of Clinical Nursing Cleveland, Ohio University of Texas Health Science Center at Houston Chapter 31: Physiologic and Behavioral Transition to School of Nursing Extrauterine Life Houston, Texas Chapter 36: Developmental Care of the Infant at Risk Chapter 25: Intrapartum Nursing Care Jeanne B. Martin, RD, PhD, FADA, LD Karren Kowalski, RN, PhD, FAAN Associate Professor and Director, Dietetic Internship President, Kowalski and Associates University of Texas Health Science Center at Houston Maternal Child and Women’s Health Consultants School of Public Health Castle Rock, Colorado Houston, Texas Chapter 37: Grief and the Family in the Perinatal Chapter 8: Nutrition for Women Across the Life Span Experience

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