Fertilization and Conception

Intrauterine life reaches full term 9 calender months, 40 weeks, or 280 days. Fertilization occurs when one sperm penetrates the ovum Fertilization of the ovum takes place in the outer 1/3 of the fallopian tube and occurs within 24 hours of the ovums release. The newly formed organism, known as a zygote, has a 22 pairs of autosomal chromosomes.

 The zygote, has three distinct cell layers - endoderm (inner layer) respiratory, digestive, liver, and the pancreas system - mesoderm ( middle layer) skeleton, connective tissue, cartilage, muscle and the circulatory, lymphoid, reproductive and urinary system. - ectoderm ( outer layer) the brain, spinal cord, nervous, and outer body parts ( skin, hair, and nails)

 The zygote moves through the fallopian tube uterus within 3 to 4 days. Within 3 days a solid ball of cell Morula has formed forms central cavity Blastocyst. Cell at the end of the blastocyst develop into the Embryo, and those at the opposite end will begin to form the placenta. Between days 6 and 10, enzymes are secred that allow the blastocyst to burrow into endometrium and become completely covered Implantation

 Chorionic villi, fingerlike projections, develop to obtain oxygen and nutrition from the maternal blood supply and dispose of carbon dioxide and waste products

 The placenta produces essential hormones that help maintain the pregnancy. The placenta is extremely porous, noxious materials such as viruses and drugs can also pass from mother to child. The effect of noxiuous agent on unborn child depends on the developmental stage; embriyonic stage being the most crucial This is a crucial stage in the development of organ systems and the main external features.

 The period gestation is devided : 1. First trimester 2. Second trimester 3. Thirt trimester

First Trimester
Physical changes - the first 3 calender months: 1. fetal cell continue to differentiate and develop into essential organs system 2. interference with growth can cause the congenital absence of a organ system or extensive structural or functional alterations. 3. disruption of one system often occurs with disruption of others

 At the end of the first trimester, some reflexes are present, kidney secretion begins, the heart beat can be heard by Doppler The sex of the infant is distinguishable by outward appearance

 Health promotion - three risk factors have been possible effect on prenatal development : nutrition, stress, and mothers age 1. Nutrition a. Folic acid intake is encouraged decreasing the incidence of neural tube defects b. Morning sickness, report excessive nausea and vomiting 2. Avoid exposure to teratogenic agents, such as : rubelle or German measles virus, drugs, smoking, alcohol, caffeine

Second Trimester
Physical changes - measurement of the height of the uterus above the symphysis pubis is one indicator of fetal growth - by the end of the 6th month, most system are complete and can function - finger and toes are differentiated, rudimentary kidney function, and the sex of the fetus can be determined - covered with vernix caseosa and lanugo.

fetal heart tones are audible by stethoscope the liver and pancreas are functioning hair forms sleep wake pattern are established lung surfactant is produced eyelibs open.

 Health promotion - include planning for the birth - concern for personal safety - gestational events and appropriate maternal rest - nutrition - dental care - physical activity - posture - employment - infant feeding options

Cont..
- UTI increase the risk of preterm labor discuss proper voiding - Education to recognize potential complications - Prematurity, causes: physiological stresses, poverty, smokers and poor prenatal care; potential: multiple pregnancies and fetal infections; abruptio placentae and placenta plevia

Third Trimester
Physical Changes - the fetus grows to approximately 50 cm in length - subcutaneous fat is stored, and weight increases to between 3.2 dan 3.4 kg. - the skin thickens, lanugo begins to disappear - fetal body becomes rounder and fuller - a tremendous spurt in brain growth - the CNS has established its total number of neurons and connections between neurons, and myelination of nerve fibers prgresses at a rapid rate

- able to make tha transition from intrauterine to extrauterine life. - cardiac system can change its circulation to end bypassing of the lungs - the lungs are capable of maintaining the inflanted state for gas exchange. - temperature maintenance systems, reflexes, and sensory organs are ready for use

 Health promotion - preparing her mind and body for the delivery. - information regarding the childbirth process and breast- feeding - assess the couples strengths and weaknesses. Cognitive changes - periods of diminished oxygen (anoxia) during fetal life are known to cause deficits in later cognitive functioning, - inadequate prenatal nutrition has been associated with lower brain weight

- infant with LBW and VLBW indicates increased risk for learning disorders, school failures, temperament problems, neurological and motor impairment and developmental delay. Psychosocial changes - nutritional deficiencies of the fetus can significantly influence later psychosocial development.

Transition From Intrauterine to Extrauterine Life

Physical Changes - circulatory, pulmonary, and thermal changes nurse maintaining an open airway, stabilizing and maintaining body temperature, and protecting the newborn from infection - assess APGAR Score 1 and 5 minutes after birth nurse monitors the newborns body temperature and other vital signs until they stabilize

 Phychosocial changes - the nurse promotes the parents and newborns need for close physical contact. - assess physical factors ( e.g fatique, hunger, and health ) and emotional factors ( e.g happiness and needs for affection and touch). - bonding occur when parents and newborn elicit reciprocal and complementary behavior. - parental bonding behaviors include attentiveness and physical contact - newborn bonding behavior involves maintenance of contact with the parent.

 Health Risk - nasopharyngeal and oropharyngeal suction are susceptible to heat loss and cold stress - hypothermia see measures to prevent cold stress - prevention of infection : good hand-washing techniques, wearing gloves when touching mucous membranes and when drawing blood - prophylactic treatment againts neisseria gonotthoeae and other infections, which can be transmitted during passage through an infected vaginal canal. - Vit K is administeres SD shortly after birth . - the stump of the moist umbilical cord.

 Measures to prevent cold stress

Mechanism of heat loss Nursing Intervention

Evaporation

Immediately dry newborn after delivery. Wrap in blanket. Delay first bath until temperature and other vital signs are stable
Warm objects that have direct contact with newborn. Covers newborns head Prevent unnecessary exposure to cold Use radiant warmer until temperature stabilizes. Avoid cold drafts

Conduction Convection Radiation