TABLE OF CONTENTS-PART III
CONTENT PAGE
IX.Pregnancy at Risk……………… ...... 2
X.Complications of Labor and Delivery ...... 5
XI.Complication of the Puerperium……………………………………………………………………….…...7
XII.Disorders of the Female and Male Reproductive System………………………….……….……9
XIII.Infertility, Genetics, and Care of the Transgender Patient…………………………………….13
IX.PREGNANCY AT RISK
1.OBJECTIVES: At the end of this class the student will be able to:
A.Describe any disorder which may cause bleeding in the first and second trimesters.
B.Explain alterations of the placenta which may cause bleeding in the second and third trimesters of pregnancy.
C.Discuss the risks and interventions used for patients with hyperemesis gravidarum.
D.Describe the pathophysiology, interventions, and risks of the hypertensive disorders of pregnancy.
E.Identify the risks to the fetus and neonate of Rh and ABO incompatibilities.
F.Compare and contrast risks to the fetus and woman with gestational diabetes and preexisting diabetes mellitus.
G.Describe the potential risks to the pregnancy for a woman with preexisting cardiac disease
H.Compare and contrast potential risks to the fetus and pregnant woman who has various types of anemias.
I.Discuss maternal, fetal, and neonatal effects of selected common infections that may occur during pregnancy.
J.Describe the effect of psychosocial problems on the pregnancy, including psychiatric illnesses, physical and emotional abuse, and substance abuse.
K.Discuss the screening process used to identify abused pregnant women.
L.List three key components of abuse interventions
M.Prepare a care plan for a high risk pregnancy patient
2.LECTURE OUTLINE
A.Disorders Causing Bleeding in Early Pregnancy
1.Hemorrhage during pregnancy
2.Spontaneous abortion
3.Induced abortion
4.Ectopic pregnancy
5.Gestational Trophoblastic Disease
B.Disorders Causing Bleeding in Later Pregnancy
1.Placenta previa
2.Abruptio placenta
3.Nursing process for patients experiencing bleeding
C.Hyperemesis gravidarum
1.Risk factors
2.Priority nursing care
D.Hypertensive disorders of pregnancy
1.Background
2.Risk factors
3.Classification/assessment
4.Pathophysiology
5.HELLP syndrome
6.Nursing process
7.Pharmacology and related nursing interventions
E.Maternal-fetal blood incompatibilities (see High Risk Neonate)
F.Diabetes mellitus
1.Classifications
2.Pathophysiology
3.Risk factors
4.Nursing process
5.Gestational diabetes
G.Preexisting cardiac disease
1.Overview
2.Classifications
3.Nursing process
H.Anemias
1.Iron deficiency anemia
2.Folic acid deficiency anemia
3.Thalassemia
4.Sickle cell anemia
I.Maternal infections
1.Classifications/types
2.Risk factors
3.Fetal risks
4.Nursing process
J.Psychosocial problems during pregnancy
1.Pre-existing psychiatric illness
2.Abuse/battering
3.Substance abuse
CRITICAL THINKING EXERCISES FOR A PATIENT WITH AN AT-RISK PREGNANCY
1. A patient is assessed duringa prenatal visit. Her blood pressure is 150/95. What other specific data should the nurse collect at this time?
2. A patient calls theadvice nurse center stating that she is bleeding. What other priorityinformation does the nurse need to know before giving advice?
X.COMPLICATIONS OF LABOR AND DELIVERY
1.OBJECTIVES: At the end of this class the student will be able to:
A.Explain abnormalities that may result in dysfunctional labor and alterations in homeostasis.
B.Compare and contrast dysfunctional labor patterns.
C.Describe how various types of fetal malpositions and malpresentations can affect the labor process.
D.Identify maternal and fetal risks associated with premature rupture of membranes.
E.List factors that increase a woman’s risk for preterm labor.
F.Describe risks to the mother and fetus from a pregnancy lasting beyond 41 weeks.
G.Identify various intrapartum emergent conditions.
H.Describe medical management of intrapartum complications.
I.Apply the nursing process to a woman experiencing intrapartum complications.
J.Explain how the nurse can best intervene with a woman experiencing intrapartum complications.
2.LECTURE OUTLINE
A.Dysfunctional labor/complications/emergencies
1.Alterations in contraction patterns and quality
a.hypertonic labor
b.hypotonic labor
2.Fetal malpositions and malpresentations
3.Pelvic alterations
4.Psychological alterations
5.Alterations in the length of labor
6.Nursing interventions
B.Complications of the labor process
1.PROM-premature rupture of membranes
2.Preterm labor and birth
C.Intrapartum emergencies
1.Placental abnormalities
2.Prolapsed umbilical cord
3.Uterine rupture
4.Uterine inversion
5.Amniotic fluid embolism-Anaphylactoid syndrome of pregnancy
6.Shoulder dystocia
XI.COMPLICATIONS OF THE PUERPERIUM(Postpartum period)
1.OBJECTIVES: At the end of this class the student will be able to:
A.Describe postpartum hemorrhage in terms of risk factors, assessment and priority nursing interventions.
B.Identify complications of postpartum hemorrhage.
C.Explain associated factors, assessment and priority nursing interventions for subinvolution.
D.Compare and contrast thromboembolic disorders in term of predisposing factors, assessment and priority interventions.
E.Discuss puerperal infection in terms of location, risk factors, and priority interventions.
F.Describe major postpartum psychiatric disorders.
G.Apply the nursing process to a patient experiencing complications and alterations in homeostasis during the postpartum period.
2.LECTURE OUTLINE
A.Postpartum hemorrhage
1.Definition/risk factors
2. Early vs. late
3.Complications
4.Care Management
5.Teaching
B.Thromboembolic disorders
1.Classifications
2.Incidence/etiology
3.Clinical manifestations
4.Case management
C.Infections
1.Risk factors
2.Classifications
3.Manifestations
4.Case management
D.Psychiatric disorders
1.Postpartum blues
2.Postpartum depression-PP major mood disorder
3.Postpartum psychosis
E.Loss and Grief
1.Situational life crises
2.Phases of grief
3.Communication and caring
XII.DISORDERS OF THE FEMALE AND MALE REPRODUCTIVE SYSTEMS
1.OBJECTIVES: At the end of this class, the student will be able to:
A.Compare the common benign breast disorders.
B.Describe the diagnostic tests for breast cancer.
C.Develop a plan of care for a woman experiencing breast cancer.
D.Discuss the clinical manifestations and treatment for endometriosis.
E.Describe toxic shock syndrome.
F.Compare the common sexually transmitted diseases with regard to causative organisms, clinical manifestations, treatment and any residual implications.
G.Develop a plan of care for a woman undergoing gynecological surgery
H.Describe the most common gynecological surgical procedures.
I. Compare the various types of reproductive cancers, according to incidence,risk factors, and treatment.
J.Identify nursing interventions for patients experiencing infections of the male reproductive system.
K.Describe testicular cancer, including clinical manifestations, risk factors, and incidence, and management.
2.LECTURE OUTLINE
A.Breast Masses
1.Screening for breast masses
a.Breast self-exam
b.Exam by clinician/mammogram
2.Benign breast disorders
a.Fibroadenoma
b.Fibrocystic breast changes
c.Ductal ectasia
d.Intraductalpapillomas
3.Breast cancer
a.Pathophysiology
b.Etiology/risk factors/incidence
c.Clinical manifestations
d.Nursing diagnoses
e.Management
1.Surgical management
A.lumpectomy
B.modified radical mastectomy
C.sentinel lymph node biopsy
D.reconstructive surgery
2.Adjuvant therapy-radiation
3.Adjuvant therapy-chemotherapy
f.Discharge planning
1.Resources
A.ACS Reach for Recovery program
B.NCCN-National Comprehensive Cancer Network
C.ACS home page
B.Sexually TransmittedDiseases/Infections
1.Infections associated with ulcers
a.Syphilis
b.Herpes simplex
c.Granuloma inguinale
d.Chancroid
2.Infections of epithelial surfaces
a.HPV-human papilloma virus
b.Gonorrhea
c.Chlamydia
d.Trichomoniasis
e.PID-pelvic inflammatory disease
f.HIV-has additional modes of transmission
C.Gynecologic Disorders
1.Postmenopausal bleeding
2.Endometriosis
3.Dysfunctional uterine bleeding/abnormal uterine bleeding (DUB/AUB)
4.Inflammations and infections
a.vaginitis/vulvitis
b.toxic shock syndrome
5.Problems r/t pelvic support structures
a.uterine prolapse
b.cystocele
c.rectocele
6.Common benign neoplasms
a.Types/management
1.ovarian
2. uterine
b.Surgical management
7.Reproductive cancers
a.Endometrial
b.Cervical
c.Ovarian
d.Vulvar
D.Male Reproductive Disorders
1.Testicular Cancer
2.Prostate Cancer
3.Cancer of the Penis
4.Other reproductive disorders
a.Hydrocele
b.Spermatocele
c.Varicocele
d.Scrotal trauma
e.Cryptorchidism
f.Phimosis
g.Priapism
h.Epididymitis
i.Orchitis
j.Prostatitis
XIII.INFERTILITY, GENETICS, and CARE OF TRANSGENDER PATIENTS
1.OBJECTIVES: At the end of this class, the student will be able to:
A.List and define the various diagnostic tests utilized in an infertility workup.
B.Describe the various risk factors and causes for male and female infertility.
C.Identify the nursing role during the diagnostic and treatment phase.
D.Describe the various pharmacological regimes used to treat various aspects of infertility.
E.Define and give examples of the various chromosomal abnormalities.
F.Describe the diagnostic tests utilized in genetic testing.
G.Apply the nursing process to the care of a family undergoing genetic testing.
H.Explain role of the nurse as a leader promoting advocacy for transgender people.
I.Explain major challenges for transgender patients seeking health care.
J.Describe using culturally-sensitive terminology when caring for the transgender patient.
2.LECTURE OUTLINE
A.The Couple Experiencing Infertility
1.Incidence
2.Risk factors
3.Components of fertility
4.Infertility management
a.Psychosocial
b.Nonmedical therapies
c.Medical therapies
d.Surgical treatments
e.Reproductive alternatives
f.Nursing diagnoses
B.The Family Experiencing a Genetic Disorder
1.Chromosomal Abnormalities
2.Patterns of Inheritance
3.Testing
4.Clinical Management/Nursing Roles
C.Caring for Transgender Patients
1.Terminology
2.Health Issues
3.Health care
4.Post-operative care
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