Chapter 6 Prenatal Influences on Healthy Development Copyright

Chapter 6 Prenatal Influences on Healthy Development Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Objectives 1. 2. 3. 4. State the goals of the Human Genome Project. Trace the steps of human fertilization and implantation. Discuss the critical periods of fetal development. Compare the similarities and differences among two types of twins. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 2

Objectives (cont. ) 5. 6. 7. Discuss the importance of prenatal health and nutrition as related to the health and life expectancy of the newborn. Discuss the emotional changes that occur during transition to motherhood. Discuss the importance of understanding culture as it affects the care of parents and newborns. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 3

Objectives (cont. ) 8. 9. 10. Discuss bonding and attachment between parents and newborns. Describe the techniques for calming a newborn infant. List the types of toys and activities that foster the growth and development of the neonate. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 4

Key Terms allele Apgar score attachment bonding chromosome dizygotic dominant gene ectopic pregnancy en face engrossment fetal alcohol syndrome fetus gene therapy genetic code genetic counseling Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 5

Key Terms (cont. ) genome gestation monozygotic multifetal mutated neonatal sibling rivalry syndrome viable virus vector Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 6

The Human Genome Project Involved gene mapping, which determined the makeup of human genes The completion of the project in 2001 resulted in the identification of all human genes Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 7

Heredity genome chromosome genetic code allele. dominant gene mutated syndrome Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 8

Genetic Counseling Communication between a geneticist and parents to discuss an infant's risk of inheriting genes that could result in an abnormality Therapeutic genes can repair defective DNA Suicide genes can be programmed to destroy defective genes Pure genes can replace a missing gene Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 9

Critical Thinking Question 1 Today, genetic testing methods can detect the presence of many defective genes before pregnancy or can detect a genetic or congenital disorder early in pregnancy. As a result, the potential exists to completely eliminate the occurrence of certain health problems such as Down syndrome and dwarfism. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 10

Critical Thinking Question 1 (cont. ) What are the moral and ethical ramifications of being able to encourage or even mandate that persons with certain defects not have children or undergo an abortion if the defect already exists in the fetus? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 11

Gene Therapy Placing a therapeutic gene on the back of a virus vector: Virus enters specific cells in the body Ø Carries the new gene into the cell that has a missing or defective gene Ø Ethical, social, and legal aspects Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 12

Screening Procedures and Therapies Screen individual patients for the existence of some specific genetic problems without looking at DNA Some adult-onset diseases can be diagnosed before symptoms appear Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 13

ELSI Ethical, legal, and social implications of gene therapy Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 14

Fetal Development Occurs when sperm penetrates the ovum as it enters the upper portion of the woman's fallopian tube Sperm lives for up to 5 days, but the ovum lives for only 24 hours after ovulation Zygote Ectopic pregnancy Fetus Gestation Viability Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 15

Twins Multifetal Dizygotic Monozygotic Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 16

The Prenatal Phase: Critical Periods Many occur during the first trimester of pregnancy (first 3 months) when basic structures are developing. Inadequate nutrition Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 17

Exercise During Pregnancy Important to maintain levels of health and fitness during pregnancy Benefits include improved energy level, mood, sleep, and muscle tone, as well as decreased risk of gestational diabetes. Simple modifications may be needed Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 18

Critical Thinking Question 2 What are some factors in your community that could pose a risk to normal fetal development? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 19

Toxins Exposure to toxins during fetal development can cause abnormalities, illness, or miscarriage Maternal ingestion of substances such as alcohol can interfere with cell growth in the developing fetus Fetal alcohol syndrome is characterized by mental retardation and abnormal facial features Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 20

Maternal Adaptations During the Prenatal Phase Three phases of parental development Response to discovering that conception has occurred Ø Reality of pregnancy becomes evident with fetal movement and ultrasound Ø Plans for the actual birth of the baby Ø Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 21

The Birth Process Childbirth is a normal physiological process that affects the health of the mother and the fetus Labor and delivery are often a family affair A woman choose to deliver the baby in a traditional hospital setting, in a freestanding private birthing center, or at home Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 22

The Birth Process (cont. ) Dilation and effacement Descent and birth of the baby Birth of the placenta Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 23

The Newborn Infant Physiological changes occur in the infant's body to enable it to adjust to life outside the uterus after the umbilical cord is cut Infant is dried and placed in a pre-warmed bed, and the head is covered to minimize heat loss until the infant can stabilize its own body temperature Bonding and attachment between parents and newborn Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 24

Apgar Score Assessed at 1 minute and minutes after birth A rating of heart rate, respiration, muscle tone, color, and reflex response Score from 0 to 10 estimates the condition of the infant Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 25

Critical Thinking Question 3 How does knowledge about the physical and behavioral characteristics of the neonate facilitate the process of bonding with and attachment to the newborn? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 26

The Transition to Motherhood Hormonal changes, changes in self-image, and reorganization of tasks Mood swings are common; postpartum blues Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 27

Critical Thinking Question 4 The early postpartum period appears to be one of emotional and physical vulnerability for new mothers. What coping strategies could the nurse suggest to help prevent the escalation of “baby blues” into a more serious postpartum depression? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 28

Rubin’s Psychological Changes After Birth Phase 1 - “Taking in. ” Phase 2 - “Taking hold. ” Phase 3 - “Letting go. ” Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 29

Fathers or Significant Others Engrossment Roles and responsibilities may change Changes in sleep patterns and routines and the onset of new financial burdens can be stressful for some fathers or partners Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 30

Siblings Sibling rivalry Initial relationship between a newborn and a sibling is established by the parents’ interaction with each child Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 31

Critical Thinking Question 5 Should children be present during their mother’s labor and subsequent birth of a sibling? If they are, what type of preparation programs should be made available and what criteria should be met for children to be present during childbirth? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 32

Grandparents Culture and physical distance in living arrangements influence the role of grandparents Most helpful if they assume the role of home manager by preparing meals, shopping, and helping with household tasks Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 33

Critical Thinking Question 6 How does the view of aging in our society affect a person’s adjustment to the role of grandparent? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 34

The Influence of Culture Although the beliefs and practices of the family may be different than those of the health-care provider, these differences must be respected and considered. Cultural perception may also affect the accuracy of pain assessment Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 35

Critical Thinking Question 7 Why is it important for nurses to provide pregnant women and their families with prenatal care that is sensitive to cultural beliefs and practices regarding pregnancy? (Or is it important? ) Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 36

Critical Thinking Question 8 How is a nurse’s care management of a laboring woman influenced by the manner in which the woman responds to the pain she is experiencing? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 37

Developmental Tasks and Responses of the Neonate Feeding patterns and habits First trust experience Sleeps 15 to 20 hours daily Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 38

Development of Intelligence involves the ability to learn from experience and to adapt to the environment and its challenges Psychometric variables and complex system variables Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 39

Play Activities and Neonatal Development A developmental task of the neonate is to learn how to focus on and follow objects as they move across the field of vision Piaget's sensorimotor stage of cognitive growth The best time to interact with the neonate is during the quiet-alert state of responsiveness Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. 40