NUR 128 Final exam blueprint

NUR 128 Final exam blueprint Week 13: Sexuality 19.2 Family Planning o Preconception health promotion ▪ Helping the couple be in the best possible health state so they don’t enter pregnancy with unnecessary health risks. ▪ Stop smoking and limit secondhand smoke. ▪ Avoid or limit caffeine. ▪ No alcohol or drugs ▪ Discuss the use of RX drugs with HCP. This includes prescription & non- prescription drugs. Accutane (acne medication) was mentioned. ▪ If woman has thyroid disorders, seizures, HTN, DM, she should see appropriate specialist to be sure pregnancy is advised and to change meds if needed. ▪ Determine possible environmental hazards such as radiation or chemical expose in their community or at work. o Physical exam ▪ Both parents should have a physical to identify health problems so they can be corrected if possible. ▪ Genetic counseling if woman is over 35 and has a family history of genetic disorders. ▪ Dental exam before pregnancy to avoid x-rays, local anesthetic, and infection during pregnancy ▪ Age less than 16 is also a problem. o Nutrition ▪ Woman should be average weight for build and height. BMI= 18-24 ▪ Underweight women should gain. ▪ Overweight women should lose ▪ Follow nutritious diet rich in essential nutrients: calcium, protein, iron, B- complex, vitamin C, magnesium and folic acid. ▪ Avoid vitamins in excess. They can cause severe fetal problems. ▪ Cultural norms that affect nutritional intake should also be assessed. ▪ Normal weight gain is 25-35lbs. ▪ PICA - eating weird things because you crave them. Example dirt, ass, clay, just weird things in general. o Exercise ▪ Continue present pattern of exercise or begin regular exercise 3 months before pregnancy. ▪ Aerobic exercise and general muscle toning will improve circulation and general health. ▪ 30 min of mod exercise daily. ▪ Don’t start anything during pregnancy that you were not doing before pregnancy. o Immunizations ▪ DO THIS!! ▪ All immunizations should be complete 3 months prior to conception, especially rubella. ▪ flu at anytime during pregnancy o Infertility possible causes and common medications ▪ Infertility- lack of conception despite unprotected sex for 12 months. ▪ Subfertility- both partners have reduced fertility. ▪ Secondary infertility- couples unable to conceive after one or more successful pregnancies or who cannot sustain a pregnancy. (These women can get Progesterone to help maintain pregnancy) ▪ Men – alcohol abuse, tobacco or drugs, exposure to environmental toxins, certain RX drugs, or previous cancer treatment and age (higher risk in women) ▪ Women – excess alcohol intake, tobacco use, stress, poor diet, being under or overweight, athletic training, health problems that affect hormones, STIs, or age. ▪ Women over 35 – smaller # of eggs, eggs left aren’t as healthy, prone to miscarriage. Eggs are old as shit. o Genetics ▪ Abnormal chromosomal number ● Most often caused by nondisjunction, a failure of paired chromosomes to separate properly during cell division. ● If nondisjunction occurs in either the sperm or the egg before fertilization, the zygote will have an abnormal chromosome makeup in all the cells. o Each cell that develops will be monosomic (having only one copy of a particular chromosome). o Or trisomic (having 3 copies of a particular chromosome). ● If nondisjunction occurs after fertilization, the developing zygote will have cells with 2 or more different chromosomal makeups, evolving into 2 or more different cell lines (mosaicism). ● Mosaics have trisomy occurring in some but not all of the cells of the body, in which case the manifestations are not as severe. ● Trisomies – product of the union of a normal gamete with a gamete that contains an extra chromosome. o Down syndrome is the most common trisomy. o Extra chromosome 21. o Common - 21, 18, 13 ● Monosomies – occur when a normal gamete unites with a gamete that is missing a chromosome. o Most common monosomy is Turner Syndrome. o If a fetus with monosomy survives, it is due to mosaicism. ▪ These individuals are sterile females. ▪ Abnormal chromosomal structure ● Involve only parts of the chromosome and occur in 2 forms: o Translocation o Deletions or additions ● Some people with down syndrome have an abnormal rearrangement of chromosomal material known as a translocation o Clinically the 2 types of down syndrome are indistinguishable unless you do a chromosomal analysis. ● Structure abnormality also caused by additions or deletions of chromosomal material. o Depending how much chromosomal material is involved, the clinical effects may be mild or severe. ▪ Abnormal sex chromosome ● In a female, at an early embryonic stage, one the two normal X chromosomes becomes inactive. o The inactive X chromosome forms a dark stain known as the Barr body. o Normal female has one Barr body because one of her two X chromosomes has be inactivated. o The normal male has NO Barr body because he has only one X chromosome. ● Females most common abnormality is Turner syndrome. (XO with no Barr body present) ● Males most common abnormality is Klinefelter syndrome (XXY with one Barr body present) o Modes of inheritance (define) not adding in the mendelian stuff yet ▪ Autosomal dominant ● If the disease trait is the abnormal gene overshadows the normal gene of the pair to produce the trait. ● Remember: o The affected individual generally has an affected parent. Family tree will show multiple generations with the disorder. o Affected individuals have a 50% chance of passing on the abnormal gene to each child. o Males and females are equally affected. o The father can pass abnormal gene to son. o Disorders have varying degrees of presentation. Parent may have a mild form and child have a severe form. ● Examples: huntington disease, polycystic kidney disease, neurofibromatosis, and achondroplastic dwarfism. ▪ Autosomal recessive ● The individual must have two abnormal genes, one from mom and one from dad to be affected. ● Remember: o Affected individual may have clinically normal parents but both parents are carriers of the abnormal gene. o When both parents are carriers, there is a 25% chance that the abnormal gene will be passed on to any child. o If a child of two carrier parents is clinically normal, there is a 50% chance that the child is a carrier of the gene. o Both males and females equally affected. o There is an increased history of consanguineous matings (mating of close relatives) o Use and remember how to do a Punnit Square. ● Examples: CF, phenylketonuria, sickle cell, galactosemia, Tay- Sachs disease, and most metabolic disorders. After testing you are notified through your Pediatrician but ONLY for abnormalities. ▪ X-linked recessive ● AKA sex linked., ● Disorders are those in which the abnormal gene is carried on the X chromosome (sex chromosome) ● Manifested in a male who carried the abnormal gene on his only X chromosome. o His mother is considered to be a carrier when the normal gene on one X chromosome overshadows the abnormal gene on the other X chromosome. ● Remember: o There is no male-to-male transmission. Affected males obtain the abnormal gene through the female line. o There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will thus be affected. o There is a 50% chance that a carrier mother will pass the abnormal gene to each of her daughters, who become carriers. o Fathers affected cannot pass to son, but all daughters become carriers of the disorder. ● Common disorders – hemophilia, Duchenne muscular dystrophy, and color blindness. ▪ X-linked dominant ● Rare, the most common being vitamin D-resistant rickets and fragile X syndrome. ● When this does occur, the pattern is similar to that of X-linked recessive inheritance except that heterozygous females are affected. ● Remember: o There is no male-to-male transmission. o Affected fathers will have affected daughters o No sons will be affected. ▪ Multifactorial ● Traits passed on by the influence of multiple genes. ● Remember: o The malformations may vary from mild to severe. ▪ Ex: spina bifida occulta- mild and myelomeningocele- severe o The more severe the defect, the greater the number of genes present for that defect. o Often sex bias. ▪ Pyloric stenosis is more common in males ▪ Cleft palate is more common in females. ▪ When a member of the less commonly affected sex shows the condition, a greater number of genes must usually be present to cause the defect. o In the presence of environmental influences, fewer genes are needed to manifest the disease in the offspring. o In contrast to single-gene disorders, multifactorial inheritance has an additive effect. ▪ The more family members who have the defect, the greater the risk that the next pregnancy will also be affected. ● Although most congenital malformations are multifactorial, a careful family history should always be taken, because cleft lip and palate, certain congenital heart defects, and other malformations occasionally can be inherited as autosomal dominant or recessive traits. ● Common disorders- cleft palate, heart defects, spina bifida, dislocated hips, clubfoot, and pyloric stenosis. o Others thought to be multifactorial- DM, HTN, some heart diseases and mental illness. o Contraception (How to choose appropriate methods. Risks. Side effects.) ▪ Fertility awareness ● AKA natural planning. ● Take into account the life span of sperm (3-6 days) and the ovum (1-3 days) in the female reproductive tract. ● Max fertility for a woman occurs approx. 6 days before ovulation and decreases rapidly the day after. ● Fertility awareness methods are free, safe, and acceptable to many individuals whose religious beliefs prohibit other methods. ● Require extensive initial counseling to be used effectively. ● Difficult or impossible for women with irregular cycles. ● corpus luteum produces progesterone. o cervical mucus is thick. o maintains pregnancy ● Calendar rhythm method, AKA standard days method, based on the assumption that ovulation tends to occur about 14 days before the start of the next menstrual period. o To use this method, woman must record her cycle for 6 months to identify the shortest and longest cycles. o Fertile phase is calculated from 18 days before the end of the shortest recorded cycle through 11 days from the end of the shortest recorded cycle. o Least reliable of the fertility awareness methods and has largely been replaced by other more scientific approaches ● Basal body temperature (BBT) method requires that a woman take her BBT every morning upon awakening and record the readings on a temp graph. o Use a BBT thermometer which shows tenths of a degree. o Method based on the fact that the temp sometimes drops just before ovulation and almost always rises and remains elevated for several days afterward. o Temp rises in response to the increased progesterone levels that occur in the second half of the cycle. o The couple abstains from sex the day of temp rise and for 3 days afterward. ● Ovulation method, AKA cervical mucus method or the Billings