Critical Concept Review

Learning Objectives Concepts Compare the nutritional value Composition of breast milk: and composition of breast 10% solids consisting of milk and formula carbohydrates, proteins, and fats preparations. 90% is water Breast milk has immunologic and nutritional (biodegradable) properties that make it the optimal food for first year of life. Most common cow milk proteinbased formulas attempt to duplicate the same concentration of carbohydrates, proteins, and fats as 20 kcal/oz breast milk. Advantages of breastfeeding: Discuss the advantages and disadvantages of Provides immunologic protection. breastfeeding and formulaInfant digests and absorbs feeding for both mother and components of breast milk easier. newborn. Provides most vitamins to infant if mothers diet is adequate. Strengthens the mother-infant attachment. No additional cost. Breast milk requires no preparation. Disadvantages of breastfeeding: Many medications pass through to breast milk. Father is unable to participate equally in actual feeding of infant. Mother may have difficulty being separated from infant. Advantages of bottle-feeding: Provides good nutrition to infant. Father can participate in infant feeding activities. Disadvantages of bottle-feeding: May need to try different formulas before finding one that is welltolerated by the infant. Formula must be purchased and

prepared. Proper preparation is necessary for nutritional adequacy. Develop guidelines for helping The breastfeeding mother needs to both breast- and formulaknow: feeding mothers to feed their How breast milk is produced. newborns successfully. How to correctly position the infant for feeding. The procedure for feeding the infant. How to express leaking of milk. How to express and store breast milk. How and when to supplement with formula. How to care for the breasts. Medications that pass through breast milk. Support groups for breastfeeding. The bottle-feeding mother needs to know: Types of formula available and how to prepare each type. The procedure for feeding the infant. How to correctly position the infant for bottle-feeding. How to safely store the formula. How to safely care for bottles and nipples. Nurses must: Recognize the influence of cultural values on infant care, Recognize that cultural values especially feeding practices. influence infant feeding practice. Be sensitive to ethnic backgrounds of minority populations. Understand that the dominant culture in any society defines normal maternal infant feeding interactions. Nursing responsibilities include: Delineate nursing responsibilities for client Teaching signs and symptoms of education about problems the mastitis, cracked nipples, and other breastfeeding mother may breastfeeding concernssee Chapter encounter at home. 32. Reinforcing parents understanding of the supply-demand nature of

breastfeeding. Helping mother to find ways to get adequate rest while breastfeeding. Providing information about who to contact for problems encountered at home. Parents need to know: Incorporate knowledge of newborn nutrition and normal Amount of formula to feed infant at growth patterns into parent each feeding and how often to feed education and infant infant. assessment. Number of times per day the breastfed infant should be put to the breast. The expected weight gain of both formula and breastfed infants. The proper diet for the breastfeeding mother.

Critical Concept Review

Learning Objectives Describe major theories of development as formulated by Freud, Erikson, Piaget, Kohlberg, social learning theorists, and behaviorists. Concepts Freud: Early childhood experiences form the unconscious motivation for action in later life. Erikson: There are eight periods that determine an individuals future social relationships. Piaget: Childs view of the world is influenced largely by age, experience, and maturational ability. Kohlberg: Developed a framework for understanding moral decision making. Social learning theorists: Children learn attitudes, beliefs, and customs through social contact with adults and other children. Behaviorists: Behavior can be elicited by positive

reinforcement and extinguished by negative reinforcement. Plan nursing interventions for Infant: children that are appropriate Encourage parents to hold and stay for the childs developmental with infant. state, based on theoretical Provide opportunities for sucking. frameworks. Provide infant with toys that give comfort or stimulate interest. Toddler: Maintain toilet-training procedures. Encourage appropriate independent behavior. Give short explanations. Provide rewards for appropriate behaviors. Preschooler: Encourage parents to be involved in care of child. Provide safe versions of medical equipment for playtime. Give clear explanations about procedures and illnesses. School-age: Provide for privacy and modesty. Explain treatments and procedures clearly. Encourage continuation of school work. Adolescent: Provide privacy. Interview and examine adolescent without parents present, if possible. Encourage adolescent participation in treatment and decision making. Encourage visitation of peers. Ecologic theory: Explain contemporary developmental approaches Emphasizes the presence of mutual such as temperament theory, interactions between the child (who ecologic theory, and the is unique) and various settings. resilience framework. Temperament theory: All children can be categorized into three patterns of temperament, which can be used to assist in

adaptation of the childs environment and for a better understanding of the child. Resiliency theory: All individuals experience crises that lead to adaptation and development of inner strengths and the ability to handle future crises. Infant: Recognize major developmental milestones for 0 Rolls over. infants, toddlers, 1 Sits up. preschoolers, school-age 2 Stands. children, and adolescents. 3 Able to say one to two words. 4 Uses pincer grasp well. Toddler: 0 Walks up and down stairs. 1 Undresses self. 2 Scribbles on paper. 3 Kicks a ball. 4 Has a vocabulary of 1000 words and uses short sentences. Preschooler: 0 Uses scissors. 1 Rides bicycle with training wheels. 2 Throws a ball. 3 Writes a few letters. 4 All parts of speech welldeveloped. School-age: 0 Possesses reading ability. 1 Rides a two-wheeled bike. 2 Jumps rope. 3 Plays organized sports. 4 Mature use of language. Adolescent: 0 Fine motor skills welldeveloped. 1 Gross motor skills improve due to growth spurts. 2 Able to apply abstract thought and analysis.

Synthesize information from several theoretical approaches to plan assessments of the childs physical growth and developmental milestones.

Describe the role of play in the growth and development of children.

The nurse plans assessments of the childs: Physical growth and development and prenatal influences. Cognitive development. Psychosocial development. Personality and temperament. Communication. Sexuality. Infant: 0 Engages primarily in solitary play, although social interaction enhances play. 1 Learns and matures through feel and sound of activities and objects. 2 As the infant begins to crawl and walk, the sphere of play enlarges and the effect of play on growth and development increases. Toddler: 0 Increased motor skills enable the toddler to engage in new ways of playing. 1 Play becomes more social, and often includes parallel play with other toddlers. 2 Engages in imitative behavior, which teaches them new actions and skills. 3 Increased cognitive abilities enable the toddler to manipulate objects and learn about their qualities. Preschooler: 0 Interacts with others in associative play. 1 Enjoys large motor activities.

Use data collected during developmental assessments to implement activities that promote development of children and adolescents.

Increased manual dexterity is demonstrated in greater complexity of play activities. 3 Fantasy play enhances growth and development. School-age: 0 Increased physical abilities allow greater range and complexity of activities. 1 Engages in cooperative play, which increases social and cognitive skills. Adolescent: 0 Increased maturity leads to new activities and ways to play. 1 The peer groupas the focus of activitiesplays an important role in establishing the adolescents identity. 2 Participate in and learn from social interactions fundamental to adult relationships. Discuss proper nutrition and feeding techniques. Conduct health teachings and screenings that are appropriate for childs age. Encourage family to discover childs personality characteristics and temperament. Instruct parents in expected language skills and refer to appropriate providers for assistance. Give parents information regarding appropriate and normal sexual behavior in young children. Instruct school-age children concerning the expected body changes of puberty. Give adolescent information

concerning birth control and sexually transmitted diseases.

Critical Concept Review

Learning Objectives Delineate recommended levels of weight gain during pregnancy. Concepts Weight gain recommendations are dependent upon the womans prepregnancy weight: Underweight: 2840 lb (12.5 to 18 kg) Normal weight: 2535 lb (11.5 to 16 kg) Overweight: 1525 lb (7 to 11.5 kg) Obese: #15 lb (#7 kg) Identify the role of specific Carbohydrates: the bodys primary nutrients in the diet of the source of energy. Promotes weight gain pregnant woman. and growth of the fetus and placenta. Protein: supplies needed amino acids for growth of tissue. Fat: source of maternal energy; also promotes fetal fat deposits. Calcium and phosphorus: promotes mineralization of fetal bones and teeth. Iodine: promotes fetal thyroid gland function. Sodium: regulates fluid balance and metabolism in the mother. Zinc: promotes growth of fetus and sufficient lactation. Magnesium: promotes cellular metabolism and bone mineralization. Iron: prevents maternal anemia and contributes to fetal and infant stores of iron. Vitamins: maintain good maternal health. Folic acid, taken prior to conception, may prevent neural tube defects in the fetus. Compare nutritional needs During pregnancy and lactation, during pregnancy, the nutritional requirements increase postpartum period, and significantly from nonpregnant lactation with nonpregnant requirements:

requirements.

Plan adequate prenatal vegetarian diets based on the nutritional requirements of pregnancy.

Calories in second and third trimester increase by 300 kcal/day, and during lactation, by another 200 kcal/day. Protein increases by 14 mg to 60 g/day. Calcium requirements for the pregnant or lactating woman increase to 1000 1300 mg/day depending upon the age of the woman. Magnesium increases to 350 mg/day. Iron increases to 27 mg/day. (It is very difficult to eat enough iron-rich foods in the regular diet, so iron supplements are commonly prescribed.) Iodine increases to 220 mcg/day. Zinc increases to 11 mg/day during pregnancy and 12 mg/day during lactation. Vitamin A increases to 770 mcg/day. Vitamin D increases to 5 mcg/day. Vitamin C increases from 75 to 85 mg/day. Thiamine increases from 1.1 mg to 1.4 mg/day. Riboflavin increases from 1.1 mg to 1.4 mg/day. Niacin increases from 14 to 18 mg/day. Pantothenic acid increases to 5 mg/day. Vitamin B12 increases from 2.4 to 2.6 mcg/day. Fluid needs increase to 810 glasses of noncaffeinated beverages/day. For nonbreastfeeding mothers, during the postpartum period, nutritional requirements return to prepregnancy levels. There are different types of vegetarian diets, which differ in the types of animal-based products that are eaten. Vegans do not eat any animal-based products, but can obtain protein from beans, rice, peanut butter, soy products, and seeds. Most vegans need additional supplementation of vitamins

B12 and D, and calcium. Vegetarians daily food requirements are: 0 611 servings of whole grains, cereal, pasta, and rice. 1 24 servings of fruit. 2 35 servings of vegetables. 3 23 servings of legumes, nuts, seeds, and meat alternatives. 4 23 servings of milk products (unless vegan). Nausea, vomiting, constipation, and Describe ways in which various physical, heartburn can limit a womans intake of psychosocial, and cultural nutritional foods especially during the factors can affect first trimester. nutritional intake and Lactose intolerance may cause diarrhea status. or bloating after intake of dairy products. Cultural, ethnic, and religious influences may prohibit use of certain foods that are needed for adequate nutrition. Socioeconomic level may limit amounts of nutritional foods available to the woman. Lack of knowledge about proper nutrition may limit the womans ability to prepare nutritional foods. Clients with eating disorders may have nutritional and electrolyte imbalances due to starvation or vomiting. Pica may result in iron deficiency anemia. Weight gain: add recommended weight Compare recommendations for gain of the adult pregnancy to the weight gain and nutrient expected gain of the adolescent. intakes in the pregnant Nutrient needs: adolescent needs more adolescent with those for iron, calcium, and folic acid than the the mature pregnant adult. adult pregnant woman. Discuss basic factors a nurse should consider when offering nutritional Basic factors to consider: 0 Number of years since adolescent reached

counseling to a pregnant adolescent.

menarche. Whether growth has been completed. 2 Most adolescents have irregular eating patterns. 3 Adolescent may not be the one who regularly prepares meals, so the individual who prepares meals should be included in nutritional counseling. 4 Teens are present, not future, oriented which impacts nutritional counseling. Formula-feeding mothers: Compare nutritional counseling issues for Eat a well-balanced diet. breastfeeding and formulaDietary requirements are the same as feeding mothers. before pregnancy. Weight loss of 12 lb/week is acceptable. Breastfeeding mothers: Calorie requirements increase by 200 kcal/day over needs during pregnancy. Need 25002700 kcal/day. Need 65 g/day of protein. Need 1000 mg/day of calcium. Should avoid foods that irritate the infant. 1

Critical Concept Review

Learning Objectives Concepts Describe actions that the Father: nurse can take to help Provide information about expected maintain the well-being of changes (physical and emotional) during the expectant father and pregnancy. siblings during a familys Encourage the father to express feelings pregnancy. about pregnancy and other related topics such as feeding, ability to parent, and sexual activity. Refer the couple to parenting classes for information about labor and birth. Also provide for support from other couples in

Explain the causes of the common discomforts of pregnancy.

the same situation. Assess fathers intended level of participation during labor and birth. Siblings: Discuss the possible negative feelings of siblings that may take place at the birth of a new child. Teach parents to use open communication during the transition time. In the first trimester: Nausea and vomiting are caused by increased levels of hCG as well as changes in carbohydrate metabolism. Urinary frequency is caused by pressure of the uterus on the bladder. Fatigue may be caused by urinary frequency at night. Breast tenderness is caused by increased estrogen and progesterone. Increased vaginal discharge is caused by cervical hyperplasia and increased production of mucus by the endocervical gland. Nasal stuffiness and epistaxis are caused by increased estrogen levels. In the second and third trimesters: Heartburn is caused by increased levels of progesterone as well as decreased gastric motility, increased relaxation of cardiac sphincter, and increased size of uterus which displaces the stomach. Ankle edema is caused by prolonged sitting or standing, slow venous return, increased capillary permeability, and increased level of sodium. Varicose veins are caused by venous congestion and weight gain. Hemorrhoids are caused by constipation and slow venous return of blood. Constipation is caused by slow peristalsis due to increased level of progesterone. Constipation is also caused by decreased

fluids, decreased exercise, increased level of iron, and pressure of the uterus on the intestines. Backache is caused by increased lumbosacral vertebrae curve due to enlarging uterus. Leg cramps are caused by an imbalance of calcium and phosphorus, fatigue, and poor lower extremity circulation. Faintness is caused by a sudden change of position which precipitates postural hypotension. Dyspnea is caused by decreased vital capacity due to increasing size of uterus. Flatulence is caused by decreased gastric motility and air swallowing. Carpal tunnel syndrome is caused by compression of median nerve precipitated by edema. Identify appropriate relief In the first trimester: measures for the common For nausea and vomiting: avoid odors discomforts of pregnancy. and eat dry crackers before arising in a.m. Drink fluids between meals and avoid greasy foods. For urinary frequency: increase fluid intake during day and decrease in the evening. For fatigue: plan rest periods and ask for help from family or support persons. For breast tenderness: wear a wellsupporting bra. For increased vaginal discharge: bathe daily and wear cotton underwear. For nasal stuffiness and epistaxis: use cool mist vaporizer. In the second and third trimester: For heartburn: eat small, frequent meals, avoid overeating and lying down after eating. For ankle edema: elevate legs while sitting or standing and dorsiflex feet frequently. For varicose veins: elevate legs as much

as possible and wear support hose. For hemorrhoids: avoid constipation, use ice packs or sitz baths as necessary. For constipation: increase fluid and fiber in diet. Develop regular bowel habits. For backache: use good body mechanics and practice pelvic tilt exercises. For leg cramps: apply heat to affected muscles and dorsiflex feet. For faintness: change positions slowly, avoid standing for long periods of time. For dyspnea: use good posture to sit and stand, and sleep in a semi-Fowlers position. For flatulence: chew food completely and avoid gas-forming foods. For carpal tunnel syndrome: avoid repetitive hand movement and elevate arm as needed. Fetal activity monitoring: Discuss the basic information that a nurse 0 Cardiff Count-to-Ten Method: Lie should provide to the quietly in the same position expectant family to enable for 2030 minutes each them to carry out time. Should feel at least 10 appropriate self-care. fetal movements in 3 hours. Breast care: 0 Wear a bra with good support and fit. 1 If breastfeeding, avoid soap on the nipples. Nipple preparation: 0 Go braless to toughen nipples. 1 Roll nipple to prepare for breastfeeding. (Should be avoided in women who have had previous preterm labor.) 2 Have partner orally stimulate the nipple during sexual activity to help prepare nipple. Clothing: 0 Should be loose and nonconstricting. 1 Wear low-heeled, comfortable,

well-fitting shoes. Bathing (be aware of cultural norms): 0 Be careful to avoid falls or feelings of faintness. 1 Shower may be easiest way to bathe in third trimester. Employment: 0 Women with low-risk pregnancy can work until labor begins. 1 Workplace should be assessed for fetotoxic hazards. Travel: 0 Avoid travel if woman has history of complications or has a multiple pregnancy. 1 With car travel, stop every 2 hours and walk. Position the seat belt under the abdomen. Activity and rest: 0 Maintain regular exercise in uncomplicated pregnancy. 1 Avoid supine position. 2 Drink fluids and make sure to eat adequate amount of calories. 3 Avoid exercise during hot and humid weather. 4 Stop exercising with any suspicions of complications. 5 Plan for more sleep and regular rest periods. 6 Instruct in exercises to prepare for childbirth, including the pelvic tilt, partial sit-up, Kegel exercises, and the cross-legged sitting (tailor sit) position. Dental care: 0 Maintain regular dental checkups. 1 Dental work should be done in the second trimester. 2 Delay dental x-rays until after baby is born.

Delineate some of the concerns that an expectant couple might have about sexual activity.

Immunizations: 0 Avoid live virus vaccines. Complementary and alternative therapies: 0 The nurse should develop understanding of most common ones. 1 The nurse should provide printed information about risks and benefits of homeopathic remedies and herbs. Medications: 0 Avoid all OTC medications. 1 Take only medications approved by healthcare provider. Substances to avoid during pregnancy: 0 All of the following should be avoided completely or decrease the amount of substance used: tobacco, alcohol, marijuana, and cocaine. 1 Caffeine has not been proven to impact pregnancy so women should be advised concerning common sources of caffeine and advised to moderate its use. 0 Traditional positions for intercourse may be uncomfortable; consider alternative positions. Sexual desire may change during pregnancy. Partners need to communicate feelings and needs. Intercourse is contraindicated in: 0 Multiple pregnancy. 1 Threatened abortion. 2 Incompetent cervix. 3 Sexually transmitted infection. 4 Miscarriage following orgasm. 5 Rupture of membranes. 6 Preterm labor.

 Medical risks: Summarize the medical risks and special concerns 0 Fetal death risk is increased for of the older expectant all women older than 35. mother and her partner. 1 Mother is more likely to have chronic medical conditions such as diabetes and hypertension that could pose a risk to the fetus. 2 Increased risk for cesarean birth. 3 Increased risk for Down syndrome and all autosomal dominant inherited disorders. Special concerns: 0 Parents ability to meet needs of child. 1 Not doing same things as peers, which could lead to social isolation. 2 Concern that biological clock continues to tick. 3 Fear of own mortality.

Critical Concept Review

Learning Objectives Identify the anatomic and physiologic changes that occur during pregnancy. Concepts Uterus: Increased amounts of estrogen and growing fetus cause enlargement in size and weight, strength, elasticity, and vascularity. Cervix: Hyperplasia occurs (increase in cell number) due to increased estrogen level. Mucous plug forms to prevent organisms from entering uterus. Vagina: Increased thickness of mucosa, increased vaginal secretions to prevent bacterial infections. Connective tissue relaxes. Caused by increased estrogen level. Breasts: Increase in size and number of mammary glands. Nipples more erectile and areolae darken, colostrum produced during third trimester. Caused by increased estrogen and progesterone levels.

Relate these anatomic and physiologic changes to the signs and symptoms that develop in the woman.

Respiratory system: Increasing levels of progesterone cause increased volume of air, deceased airway resistance, increased anteroposterior diameter. Thoracic breathing occurs as uterus enlarges. Cardiovascular system: Cardiac output increases, blood volume increases. Increased size of uterus interferes with blood return from lower extremities. Increased level of red cells to increase oxygen delivery to cells. Clotting factors increase. Caused by increased level of estrogen and progesterone. Gastrointestinal system: Delayed gastric emptying and decreased peristalsis. Caused by increased progesterone levels. Genitourinary system: Glomerular filtration rate and renal tubular reabsorption increase as a result of increased blood volume. Skin and hair: Increased skin pigmentation caused by increased estrogen and progesterone. Musculoskeletal: Relaxation of joints caused by increased estrogen and progesterone. Uterus: Increased strength and elasticity allows uterus to contract and expel fetus during labor. Cervix: Mucous plug expelled as labor begins. Increased vascularity may cause bleeding after vaginal examinations. Vagina: Acid pH increases chance of vaginal yeast infections. Breasts: Increase in size causes soreness. Colostrum may be expressed during the third trimester. Respiratory system: Increased size of uterus may cause shortness of breath. Increased vascularity may cause nasal stuffiness and nosebleeds. Cardiovascular system: Decreased blood return from lower extremities may cause varicose veins and hemorrhoids. Pressure on the vena cava by the enlarged uterus may cause dizziness and decreased blood pressure. Gastrointestinal system: Nausea and vomiting

and constipation caused by increased estrogen level and slow peristalsis and motility. Genitourinary system: Increased size of uterus, pressure on bladder, increased blood volume and glomerular filtration rate cause increased urination. Skin and hair: Increased skin pigmentation causes linea nigra and chloasma (melasma). Compare subjective Subjective (presumptive) changes: (presumptive), Amenorrhea objective (probable), Nausea and vomiting and diagnostic Fatigue (positive) changes of Urinary frequency pregnancy. Breast changes Quickening Objective (probable) changes: Goodells and Chadwicks sign Hegars and McDonalds sign Enlargement of the abdomen Braxton Hicks contractions Uterine souffle Skin pigmentation changes Pregnancy tests Diagnostic (positive) changes: Fetal heartbeat Fetal movement Visualization of the fetus Contrast the various Urine tests: Detect hCG during early types of pregnancy pregnancy. tests. Serum tests: Also may detect hCG but may detect presence earlier than urine tests. Home (OTC) tests: Urine tests designed to detect hCG. Mother: Discuss the emotional and First trimester: Disbelief and ambivalence. psychologic changes Second trimester: Quickening helps mother to that commonly occur view fetus as separate from herself. in a woman, her Third trimester: Anxiety about labor and birth. partner, and her Nesting (bursts of energy) occurs. family during Rubin identified four tasks: Ensuring safe pregnancy. passage through pregnancy, labor, and birth Seeking acceptance of this child by others Seeking commitment and acceptance of

Summarize cultural factors that may influence a familys response to pregnancy.

herself as mother to infant Learning to give of oneself on behalf of ones child Father/partner: First trimester: May feel left out. Disbelief. Second trimester: Begins to decide which behaviors of own father he wants to imitate or discard. Third trimester: Anxiety about labor and birth. Family: Siblings reaction depends upon age of siblings, but preparation is essential. Grandparents are usually supportive and excited about the birth. Cultural assessment should be done to determine the beliefs, wishes, and traditions of the family. Factors such as religious preference, language, and communication style will affect the familys plans for the pregnancy.

Critical Concept Review

Learning Objectives Concepts Mitosis produces cells that cause growth in Compare the differences between the body. Results in daughter cells that are meiotic cellular division an exact copy of the parent cell. They and mitotic cellular contain a full diploid set (46) of division. chromosomes. Meiosis produces cells called gametes that are necessary for reproduction of the species. Results in cells that contain only one half (haploid or 23) of the chromosomes of the parent cell. Ova are present in the female ovary at birth Compare the processes by which but are dominant until puberty. Meiosis ova and sperm are initially produces via oogenesis two haploid produced. cells (secondary oocyte and a minute polar body) that are released at ovulation. At the end of meiosis in the female, there are four haploid cells: the three polar bodies and one ovum.

Sperm are produced in the seminiferous tubules of the testes beginning at puberty. Meiosis in the male creates four haploid sperm able to fertilize the ovum. Two sperm carry the Y chromosome and two sperm contain the X chromosome. Preparation is the first component of Describe the components of the fertilization. process of fertilization. Ovum released into fallopian tubeviable for 24 hr. Sperm deposited into vaginaviable for 48 to 72 hr (highly fertile for 24 hr). Sperm must undergo capacitation and acrosomal reaction. Sperm penetration causes a chemical reaction that blocks more sperm penetration. Moment of fertilization is the second component of fertilization. It occurs in the empulla (outer third) of the fallopian tube. Sperm enters ovum. The nuclei of the ovum and sperm swell, unite and become a diploid zygote. Cellular multiplication: Describe in order of increasing complexity Rapid mitotic division (cleavage). the structures that Blastomeres grow to morula (solid ball of 12 form during the to 16 cells). cellular multiplication Morula divides into a solid mass (blastocyst) and differentiation surrounded by an outer layer of cells stages of intrauterine (trophoblast). development. Implantation occurs in 7 to 10 days. Cellular differentiation: At 10 to 14 days of age, blastocyst differentiates into three primary germ layers (ectoderm, mesoderm, and endoderm) from which all tissues, organs, and organ systems develop. Embryonic membranes form at implantation and include the chorion and the amnion. Amniotic fluid is created when the amnion and chorion grow and connect and form the amniotic sac and produce fluid. Amniotic fluid cushions the fetus against

Describe the development, structure, and functions of the placenta and umbilical cord during intrauterine life.

Identify the differing processes by which fraternal (dizygotic) and identical (monozygotic) twins are formed.

Summarize the significant changes in growth and development of the

mechanical injury, controls the embryos temperature, allows symmetrical growth, permits freedom of movement, and prevents adherence to the amnion. Yolk sac develops as part of the blastocyst and produces primitive red blood cells. It is soon incorporated into the umbilical cord. After implantation, the endometrium is called the deciduas. Decidua capsularis is the portion that covers the blastocyst. Decidua basalis is the portion that is directly under the blastocyst. Umbilical cord: Develops from amnion. Contains two arteries and one vein and is surrounded by Whartons jelly, which protects the vessels. Function is to provide a circulatory pathway to the embryo. Placenta: Develops at site of embryonic attachment to the uterus and is composed of two parts, the maternal side and the fetal side. The placenta is made up of 15 to 20 segments called cotyledons. Serves as endocrine (production of hPL, hCG, estrogen, and progesterone), metabolic and immunologic functions for the fetus. It acts as the fetuss respiratory organ, is an organ of excretion, and aids in the exchange of nutritents. Identical twins: Develop from a single fertilized egg. Both fetuses are same sex with same characteristics. Single placenta. Fraternal twins: Develop from two separate ova fertilized by two separate sperm. Two placentas. 4 weeks: 4 to 6 mm CR, brain formed from anterior neural tube, limb buds seen, heart begins to beat. 6 weeks: 12 mm CR, primitive skeletal

fetus at 4, 6, 12, 16, 20, 24, 28, 36, and 40 weeks gestation.

shape, chambers in heart, respiratory system begins, ear formation begins. 12 weeks: 8 cm CR, ossification of skeleton begins, liver produces red cells, palate complete in mouth, skin pink, thyroid hormone present, and insulin present in pancreas. 16 weeks: 13.5 cm CR, teeth begin to form, meconium begins to collect in intestines, kidneys assume shape, hair present on scalp. Sex can be determined. 20 weeks: 19 cm CR, myelination of spinal cord begins. Suck and swallow begins, lanugo covers body, vernix begins to form. 24 weeks: 23 cm CR, respiratory movement and surfactant production begins, brain appears mature. 28 weeks: 27 cm CR, nervous system begins regulation of some functions, adipose tissue accumulates rapidly. Nails, eyebrows and eyelids are present. Eyes open and close. 36 weeks: 35 cm CR, earlobes soft with little cartilage, few sole creases. 40 weeks: 40 cm CR, adequate surfactant, vernix in skin folds and lanugo on shoulders, earlobes firm, and sex apparent.

Critical Concept Review

Learning Objectives Identify the structures and functions of the female and male reproductive systems. Concepts Female reproductive system: Ovaries Produce female germ cells and female sex hormones. Fallopian tubes Capture the ovum. Allow transport of the ovum to the uterus. Uterus Implantation site for the fertilized ovum. Cervix

Summarize the actions of the hormones that affect reproductive functioning.

Connection between the vagina and the uterus. Protective portal for the body of the uterus. Vagina Passageway from the external genitals to the uterus. Provides for discharge of menstrual products out of the body. Male reproductive system: Testes Produce male germ cells and male sex hormones. Epididymis, vas deferens, and ejaculatory duct Transport spermatozoa outside the body. Accessory glands Produce secretions necessary for sperm nutrition, survival, and transport. Penis Reproductive organ of intercourse. Estrogen: Controls development of female secondary sex characteristics. Assists in the maturation of the ovarian follicles. Causes endometrial mucosa to proliferate following menstruation. Causes uterus to increase in size and weight. Increases myometrial contractility in both the uterus and fallopian tubes. Increases uterine sensitivity to oxytocin. Inhibits FSH production. Stimulates LH production. Progesterone: Decreases uterine motility and contractility.

Causes uterine endometrium to increase its supply of glycogen, arterial blood, secretory glands, amino acids, and water. Vaginal epithelium proliferates. Cervix secretes thick, viscous mucus. Increases breast glandular tissue, both in size and in complexity. Prepares breasts for lactation. Prostaglandins: Necessary for follicular rupture. Follicular phase: Identify the two phases of the ovarian cycle and the changes 0 Primordial follicle matures that occur in each phase. under the influence of FSH and LH until ovulation occurs. Luteal phase: 0 Ovum leaves the follicle. 1 Corpus luteum develops under the influence of LH. 2 Corpus luteum produces high levels of progesterone and low levels of estrogen. Menstrual phase: Describe the phases of the menstrual cycle, their dominant 0 Shedding of the hormones, and the changes that endometrial lining. occur in each phase. 1 Low estrogen levels. Proliferative phase: 0 Enlargement of the endometrial glands under influence of estrogen. 1 Changes in cervical mucus; peak at ovulation. 2 Increasing estrogen levels. Secretory phase: 0 Follows ovulation. 1 Influenced primarily by progesterone.

Increase in vascularity of the uterus to make ready for possible implantation. Ischemic phase: 0 Decreasing levels of estrogen and progesterone. 1 Degeneration of the corpus luteum. 2 Constriction of the spiral arteries. 3 Escape of blood into the stromal cells of the endometrium. Ischial spines: Discuss the significance of specific female reproductive 0 Serve as a reference point structures during childbirth. during labor to evaluate the descent of the fetal head. Pubic arch (symphysis pubis): 0 Fetal head passes under this arch during birth. False pelvis: 0 Serves to support the weight of the enlarged pregnant uterus and direct the presenting fetal part into the true pelvis. True pelvis: 0 Shape and size must be adequate for normal fetal passage. 1 Fetus must change its position to move through the diameter of the true pelvis. Pelvic cavity: 0 Can influence the length of labor. Identify the functions of specific Penis: male reproductive structures for 0 Deposits sperm in the

reproduction.

vagina so fertilization of the ovum can occur. Scrotum: 0 Protects the testes and sperm by maintaining a temperature lower than the body. Testes: 0 Serve as a site for spermatogenesis. 1 Produce testosterone. Epididymis: 0 Provides a reservoir for maturing spermatozoa. Vas deferens: 0 Rapidly squeeze the sperm from their storage sites into the urethra. Ejaculatory duct: 0 Passageway for semen and fluid secreted by the seminal vesicles. Urethra: 0 Passageway for both urine and semen. Seminal fluid: 0 Provides environment favorable to sperm mobility and metabolism. 1 Transports viable and mobile sperm to the female reproductive tract.