Exam #1 NUR 238 Topical Study Guide
National safety goals
Increase pregnant women who receive prenatal care from 76% 90%
Improve perinatal services quality care = survival rates
Healthy People 2020/30 initiatives
Reduce unintended / adolescent pregnancy
Decrease infant mortality (highest in pts <16 / >44 yrs) *fertility begins to after age 32
maternal mortality (ANY death related to pregnancy) 42 days – 1 yr post delivery
Increase prenatal care (& healthy weights), reduce c-sections & preterm births
o Reduce/eliminate alcohol/drug/opioid/ cigarette use
Increase screening for PPD
Evidence based practice
Use of current research/avail. data to guide policy/practice decisions (empirical rather than anecdotal
experience) incorporate QSEN competencies:
o QSEN Competencies (6) ‘Quality Safety Education for Nurses’
1. Pt centered care
2. Teamwork/collaboration
3. EBP
4. Quality improvement
5. Safety
6. Informatics
Cultural diversity in healthcare
Nurses to provide culturally competent care respecting behaviors/beliefs of their pts
o Prescriptive behaviors: expected behaviors of the pregnant woman (i.e - sleeping on back to protect
the fetus from harm DO NOT DO!)
o Restrictive behaviors: activities that are limited during pregnancy (i.e. - don’t reach overhead)
o Taboo: cultural restriction believed to have supernatural consequences (i.e. - early baby shower
will invite the ‘evil eye’)
o Cultural relativity: judging a culture/practices based on ones own culture – DO NOT DO!
o Ethnocentrism: the belief that one’s culture is superior to others.
Trends in healthcare
1960’s: natural childbirth, little obstetric interventions, delivery rm cold/sterile, no father present, mother in
‘twilight sleep’ during delivery, infant kept in nursery, 10-day hospital stay.
Today: advanced technology/interventions, mother chooses delivery method, BIRTH PLANS, NVD – 2
days/CS – 3-4 days, family centered care, birth centers
Family centered care
o Developed in the 1970s in response to the ‘depersonalization’ of birth
considers womans philosophy, values, preferences during the birth process (‘physiologic
childbirth’ aka natural childbirth)
o Midwives pivotal re: advocating for pt = fewer unnecessary interventions
, Birthrate declining over past 100 yrs – WHY?
o Contraception, legal abortion, focus on career 1st, economic constraints
o ‘Elderly primps’ – outdated term for women >35 giving birth for 1st time.
Adolescent pregnancy (defined as age 10-19)
RISKS:
o Poverty (doesn’t finish hs, reduced job opps)
o 75% on welfare w/in 5yrs 25% have 2nd child w/in 2 yrs
o Infant mortality increases the younger mom is
o Barely take care of themselves (STDs, BP re: poor nutrition/prenatal care)
Informed consent
o Pregnant adolescent = emancipated and can make decisions about themselves/baby
Pregnancy Terminology
Ovum: Female reproductive cell. Ovulation = mature ovum (‘egg’) released from an ovarian follicle.
Sperm: Male reproductive cell. 200-500 million released @ ejaculation must perforate outer layer of ovum.
Morula: ball of 16 cells (developing zygote).
Zygote: the union of sperm and ovum, the fertilized egg, cells continue to divide.
Embryo: implanted zygote until eight weeks.
Fetus: from 8 weeks until term.
Gravida: woman who is pregnant
Para: related to actual births
Nulligravida: never been pregnant
Nullipara: never given birth to a live child
Primigravida: first pregnancy
Primipara - first time birth
Multigravida: 2< pregnancies (regardless of birth or abortion)
Multipara: 2< viable births
Full term: >37 weeks gestation but before 42nd week
Preterm: >20 weeks but less than 37 weeks
Viability: ability to survive outside of the uterus (20 weeks gestation, 500 grams)
GTPAL
Gravida (# preg.)
Term (# that were born > 38wks)
Preterm (# ending 20-37 weeks)
Abortion (# preg. ending <20wks) *spontaneous miscarriage OR elective abortion
Living (# living)
Two-digit system: gravida(# preg.)/para (# to term)
Five-digit system: GTPAL (gravida, fullterm, preterm, abortion: spontaneous or elective, living)
National safety goals
Increase pregnant women who receive prenatal care from 76% 90%
Improve perinatal services quality care = survival rates
Healthy People 2020/30 initiatives
Reduce unintended / adolescent pregnancy
Decrease infant mortality (highest in pts <16 / >44 yrs) *fertility begins to after age 32
maternal mortality (ANY death related to pregnancy) 42 days – 1 yr post delivery
Increase prenatal care (& healthy weights), reduce c-sections & preterm births
o Reduce/eliminate alcohol/drug/opioid/ cigarette use
Increase screening for PPD
Evidence based practice
Use of current research/avail. data to guide policy/practice decisions (empirical rather than anecdotal
experience) incorporate QSEN competencies:
o QSEN Competencies (6) ‘Quality Safety Education for Nurses’
1. Pt centered care
2. Teamwork/collaboration
3. EBP
4. Quality improvement
5. Safety
6. Informatics
Cultural diversity in healthcare
Nurses to provide culturally competent care respecting behaviors/beliefs of their pts
o Prescriptive behaviors: expected behaviors of the pregnant woman (i.e - sleeping on back to protect
the fetus from harm DO NOT DO!)
o Restrictive behaviors: activities that are limited during pregnancy (i.e. - don’t reach overhead)
o Taboo: cultural restriction believed to have supernatural consequences (i.e. - early baby shower
will invite the ‘evil eye’)
o Cultural relativity: judging a culture/practices based on ones own culture – DO NOT DO!
o Ethnocentrism: the belief that one’s culture is superior to others.
Trends in healthcare
1960’s: natural childbirth, little obstetric interventions, delivery rm cold/sterile, no father present, mother in
‘twilight sleep’ during delivery, infant kept in nursery, 10-day hospital stay.
Today: advanced technology/interventions, mother chooses delivery method, BIRTH PLANS, NVD – 2
days/CS – 3-4 days, family centered care, birth centers
Family centered care
o Developed in the 1970s in response to the ‘depersonalization’ of birth
considers womans philosophy, values, preferences during the birth process (‘physiologic
childbirth’ aka natural childbirth)
o Midwives pivotal re: advocating for pt = fewer unnecessary interventions
, Birthrate declining over past 100 yrs – WHY?
o Contraception, legal abortion, focus on career 1st, economic constraints
o ‘Elderly primps’ – outdated term for women >35 giving birth for 1st time.
Adolescent pregnancy (defined as age 10-19)
RISKS:
o Poverty (doesn’t finish hs, reduced job opps)
o 75% on welfare w/in 5yrs 25% have 2nd child w/in 2 yrs
o Infant mortality increases the younger mom is
o Barely take care of themselves (STDs, BP re: poor nutrition/prenatal care)
Informed consent
o Pregnant adolescent = emancipated and can make decisions about themselves/baby
Pregnancy Terminology
Ovum: Female reproductive cell. Ovulation = mature ovum (‘egg’) released from an ovarian follicle.
Sperm: Male reproductive cell. 200-500 million released @ ejaculation must perforate outer layer of ovum.
Morula: ball of 16 cells (developing zygote).
Zygote: the union of sperm and ovum, the fertilized egg, cells continue to divide.
Embryo: implanted zygote until eight weeks.
Fetus: from 8 weeks until term.
Gravida: woman who is pregnant
Para: related to actual births
Nulligravida: never been pregnant
Nullipara: never given birth to a live child
Primigravida: first pregnancy
Primipara - first time birth
Multigravida: 2< pregnancies (regardless of birth or abortion)
Multipara: 2< viable births
Full term: >37 weeks gestation but before 42nd week
Preterm: >20 weeks but less than 37 weeks
Viability: ability to survive outside of the uterus (20 weeks gestation, 500 grams)
GTPAL
Gravida (# preg.)
Term (# that were born > 38wks)
Preterm (# ending 20-37 weeks)
Abortion (# preg. ending <20wks) *spontaneous miscarriage OR elective abortion
Living (# living)
Two-digit system: gravida(# preg.)/para (# to term)
Five-digit system: GTPAL (gravida, fullterm, preterm, abortion: spontaneous or elective, living)
