JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 2 MODULE I: DEVELOPMENTAL STAGES AND TRANSITIONS. 100% proven pass rate. Graded A+

JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 2 MODULE I: DEVELOPMENTAL STAGES AND TRANSITIONS This module reviews content related to normal growth and development of the infant, child, and adolescent. Normal ...

JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 2 MODULE I: DEVELOPMENTAL STAGES AND TRANSITIONS This module reviews content related to normal growth and development of the infant, child, and adolescent. Normal and expected occurrences during pregnancy, labor and delivery, and postpartum are reviewed. Family systems and dynamics and family planning, including infertility and methods of contraception, are addressed. LESSON 1: INFANT, CHILD AND ADOLESCENT  Theories of Personality Development Age Range Erikson (Psychosocial) Freud (Psychosexual) Piaget (Cognitive) Kohlberg (Moral) Infancy: birth to 1 year Trust vs mistrust Oral gratification Sensorimotor (birth to 2 years) Infant has no awareness of right or wrong Toddler: 1 to 3 years Autonomy vs shame and doubt Anal stage: gains a sense of control over instinctive drives Preoperational (2 to 7 years) Punishment and obedience orientation Preschool: 3 to 6 years Initiative vs guilt Phallic stage: becomes aware of self as sexual being Preoperational (2 to 7 years) Preconventional: conforms to rules to avoid punishment School-age: 6 to 12 years Industry vs inferiority Latency stage: focuses on developing peer relationships Concrete operational (7 to 11 years) Conventional: conforms to rules to please others Adolescent: 12 to 20 years Identity vs role confusion Genital stage: develops relationships with members of the opposite sex, plans life goals, and gains strong sense of personal identity Formal operations (11 years to adulthood) Post conventional: focuses on individual rights and principles of conscience  The Infant o Physical Characteristics  Infant sleeping  Weight has doubled at 5 to 6 months and tripled by 12 months.  By 1 to 2 years of age, head circumference and chest circumference are equal.  Anterior fontanel (soft and flat in a normal infant) closes between 12 and 18 months.  Posterior fontanel (soft and flat in a normal infant) closes after 2 to 3 months.  Lower central incisors erupt after 6 to 8 months.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 3  Eruption of permanent and deciduous teeth: Source: HESI-Saunders 2017, Elsevier Inc.   The infant sleeps most of the time.  Vital signs  Newborn  Infant crawling  Axillary temperature: 97.7° F to 99.5° F  Apical rate: 120 to 160 beats per minute (100 sleeping, 180 crying) Respirations: 30 to 60 (average 40) breaths per minute  Blood pressure: averages 73/55 mm Hg  Year-Old  Axillary temperature: 96.8° F to 99° F  Apical rate: 90 to 130 beats per minute  Respirations: 20 to 40 breaths per minute  Blood pressure: averages 90/56 mm Hg o Nutrition  Infant eatingJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 4  The infant may breastfeed or bottle-feed, depending on the mother's choice.  Human milk is the best food for infants younger than 6 months.  Whole milk should not be introduced to an infant until after 1 year of age.  Skim and low-fat milk should not be given, because the essential fatty acids are inadequate and the solute concentration of protein and electrolytes is too high.  Fluoride supplementation may be needed starting around 6 months of age.  Solid foods are introduced at 5 to 6 months of age.  New foods are introduced one at a time, usually at intervals of 4 to 7 days, as a means of identifying food allergies.  Sequence of introduction of solid foods:  Rice cereal; fruits and vegetables, first yellow and then green; meats; egg yolks, avoiding egg whites (introduce egg white toward the end of the first year); cheese may be used as a substitute for meat and as a finger food.  Avoid solid foods, such as nuts, foods with seeds, raisins, popcorn, grapes, and pieces of hot dog, which put the infant at risk for choking.  Avoid microwaving baby bottles and baby food.  Never mix food or medications with formula.  To help prevent botulism, never add honey or corn syrup to formula, water, or other fluid.  Offer fruit juice from a cup. Rather than a bottle, to prevent bottle-mouth caries. o Skills  2 to 3 Months  Smiles  Turns head from side to side  Cries  Follows objects  Holds head in midline  4 to 5 Months  Grasps objects  Switches objects from hand to hand  Rolls over for first time  Enjoys social interaction  Begins to show memory  Aware of unfamiliar surroundingsJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 5  6 to 7 Months  Creeps  Sits with support  Imitates  Exhibits fear of strangers  Holds arms out  Frequent mood swings  Waves bye-bye  8 to 9 Months  Sits steadily when unsupported  Crawls  May stand while holding on to support  Begins to stand without help  10 to 11 Months  Can move from prone to sitting position  Walks while holding on to furniture  Stands securely  Entertains self for periods  12 to 13 Months  Walks with one hand held  Can take a few steps without falling  14 to 15 Months  Walks alone  Can crawl up stairs  Shows emotions such as anger and affection  Explores away from parent in familiar surrounding o Play  Infant playing  Solitary  Enjoys soft stuffed animals, crib mobiles with contrasting colors, squeeze toys, rattles, musical toys, water toys in the bath, large picture books, and, after beginning to walk, push toys o Safety  The infant and hazardous objectsJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 6  The home should be baby-proofed.  Car safety seats are not placed in the front seats of cars;  The infant could be seriously injured if the passenger air bag is released, because safety seats extend closer to the dashboard.  An airbag could strike a child safety seat and injure an infant  Guard infant on bed or changing table.  Use gates to protect infant from stairs.  Never vigorously shake an infant.  Be sure that bathwater is not hot; do not leave child unattended in bath.  Do not hold infant while drinking or working near hot liquids.  Cool vaporizers should be used instead of steam to help prevent burn injuries.  To help prevent choking, avoid offering food that is round and similar in diameter to the airway.  Be sure that toys have no small pieces.  To help prevent strangulation, hang mobiles and other toys over the crib well out of reach of the infant.  Avoid placing large toys in the crib; an older infant may use them as steps to climb.  Cribs should be positioned away from curtains and blind cords.  Cover electrical outlets.  Remove hazardous objects from low, reachable places.  Remove chemicals, medications, poisons, and plants from the infant's reach.  Keep the poison-control hotline number available.  The Toddler o Physical Characteristics  Height and weight increase in step like fashion, reflecting growth spurts and lags.  Weight gain is slower during this phase than in infancy.  The toddler should see a dentist soon after the first teeth erupt, usually around 1 year of age; a fluoride supplement may be necessary.  A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, or sweetened water because of the risk of bottle-mouth caries.  The toddler typically sleeps through the night and takes one daytime nap; nap is discontinued around age 3.  A consistent bedtime ritual helps prepare the toddler for sleep.  Security objects may also help the toddler get to sleep.  Vital Signs o Axillary temperature: 97.5° F to 98.6° F o Apical rate: 80 to 120 beats per minuteJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 7 o Respirations: 20 to 30 breaths per minute o Blood pressure: averages 92/55 mm Hg  Nutrition o The toddler generally does best eating several small, nutritious meals each day rather than three large meals. o The My Plate for Kids food plan provides dietary guidelines for children as young as 2 years of age. o Offer a limited number of foods at any one time; avoid concentrated sweets and empty calories. o Seat the toddler in a high chair at the family table for meals. o Allow toddler sufficient time to eat but remove food when he or she begins playing with it. o The toddler drinks well from a cup held with both hands. o Toddlers are at risk for aspiration of small foods that are not easily chewed (e.g., nuts, foods with seeds, raisins, popcorn, grapes, and pieces of hot dog).  Skills o Toddler coloring o The toddler begins to walk with one hand held by age 12 to 13 months, runs by 2 years, and walks backward and hops on one foot by 3 years. o Children of this age usually cannot alternate feet when climbing stairs. o Toddlers are beginning to master fine motor skills for building, undressing, and drawing lines. o The young toddler often uses "no," even when he or she means "yes," to assert independence. o The toddler is beginning to use short sentences and has a vocabulary of about 300 words by age 2; tends to ask many "why" questions.  Bowel and Bladder Control o Toilet training o The toddler is beginning to exhibit signs of readiness for toilet training.  Signs of Readiness for Toilet Training  Able to stay dry for 2 hours  Wakes dry from nap  Able to sit, squat, and walk  Able to remove clothing  Recognizes urge to defecate or urinate  Expresses willingness to please parent  Able to sit on toilet for 5 to 10 minutes without fussing or getting off o Bowel control develops before bladder control. o By age 3, the toddler has generally achieved fairly good bowel and bladder controlJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 8  Play o The major socializing mechanism is parallel play; therapeutic play may be started at this age. o A short attention span causes the toddler to change toys often. o The toddler explores body parts of self and others. o Typical toys include push/pull toys, blocks, sand, finger paints, bubbles, large balls, crayons, trucks, dolls, containers, Play-Doh, toy telephones, cloth books, and wooden puzzles.  Safety o Safety measures should be taken to protect toddlers from household hazards o Toddlers are eager to explore the world around them. o The toddler should be supervised at play. o Refer to the American Academy of Pediatrics for information on car safety. o Lock all car doors. o Use back burners on the stove to prepare meals; turn handles inward and toward the middle of the stove to keep pots from being pulled off the stove. o Keep dangling cords from small appliances away from the toddler. o Place inaccessible locks on windows and doors, and keep furniture away from windows. o Secure screens on all windows. o Place gates at stairways. o Do not allow the toddler to sleep or play in an upper bunk. o Never leave a toddler alone near a bathtub, pail, swimming pool, or any other body of water. o Keep toilet lids closed. o Store all medicines, poisons, and other toxic products high and locked out of reach; keep household plants out of reach as well.  The Preschooler o Physical Characteristics  Average height and weight at age 5 are 43 inches and 32 lb., respectively.  The preschooler requires about 12 hours of sleep each day.  A security object and a night light will help the preschooler get to sleep.  At the beginning of the preschool period, the eruption of the deciduous (primary) teeth is complete.  Regular dental care is essential, and the preschooler requires assistance with brushing and flossing of teeth; a fluoride supplement may be necessary. o Vital Signs  Preschooler having her temperature taken  Axillary temperature: 97.5° F to 98.6° FJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 9  Apical rate: 70 to 110 beats per minute  Respirations: 16 to 22 breaths per minute  Blood pressure: average, 95/57 mmHg o Nutrition  Preschooler drinking orange juice  The preschooler exhibits food fads and has strong food and taste preferences.  By 5 years, the preschooler tends to focus on social aspects of eating, table conversation, manners, and willingness to try new foods. o Skills  Preschooler on a bike  The preschooler has good posture.  Fine motor coordination and athletic abilities begin to develop.  Increasing skill is demonstrated in activities that require balance.  The preschooler usually talks in three- or four-word sentences by age 3, five- or six-word sentences by age 4, and longer sentences that contain all parts of speech by age 5.  Speech is easily understood by others, and the preschooler can clearly understand what others are saying. o Play  Preschooler painting  Cooperative  Imaginary playmates  Likes to build and create things  Simple, imaginative play  Understands sharing and is able to interact with peers  Enjoys a large space for running and jumping  Likes dress-up clothes, paints, paper, and crayons for creative expression  Activities such as swimming and sports for growth development  Activities such as puzzles and toys for fine motor development o Safety  Preschooler in a car safety seat  Preschoolers are active and inquisitive magical thinking  Children of this age can learn simple safety practices because they can follow simple and verbal directions and their attention span is longer.  Refer to the American Academy of Pediatrics for information on car safety.  Teach the preschooler basic safety rules to ensure safety when playing in a playground near swings and ladders.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 10  Never allow the preschooler to play with matches or lighters.  The preschooler should be taught what to do in the event of a fire or if clothes catch fire; fire drills should be conducted.  Guns should be stored unloaded and secured under lock and key; the preschooler should be taught to leave an area immediately if a gun is seen and to tell an adult.  The preschooler should be taught never to point a toy gun at another person.  Teach the preschooler that if another person touches his or her body in an inappropriate way, he or she should tell an adult.  Teach the preschooler to avoid speaking to strangers and to never accept a ride, toys, or gifts from a stranger.  Teach the preschooler his or her full name, address, parents' names, and telephone number.  Teach the preschooler how to dial 911 in an emergency situation.  Keep the poison-control hotline number available.  The School-Age Child  Physical Characteristics o Friends at school o Average height and weight at age 12 are 59 inches and 88 lb o The first permanent (secondary) teeth erupt around age 6, and deciduous teeth are gradually lost o Regular dentist visits are necessary, and the school-age child must be supervised while brushing and flossing teeth; fluoride supplements may be necessary o Sleep requirements range from 10 to 12 hours a night  Vital Signs o Taking a child’s temperature o Oral temperature: 97.5° F to 98.6° F o Apical rate: 60 to 100 beats per minute o Respirations: 16 to 20 breaths per minute o Blood pressure: averages 107/64 mmHg  Nutrition o Child eating o Increased growth needs o Feed a balanced diet chosen from foods in the MyPlate food plan.  Skills o Child playing the piano o Refinement of fine motor skills o Continued development of gross motor skillsJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 11 o Increased strength and endurance  Play o Children playing soccer o Play is more competitive. o Rules and rituals are important aspects of play and games. o The school-age child enjoys drawing, collecting items, dolls, pets, guessing games, board games, listening to the radio, TV, reading, and videos and computer games. o Many children of this age participate in team sports. o School-age children also enjoy secret clubs, gang activities, and scouting organizations.  Safety o Child riding a bike o The school-age child experiences less fear in play activities and frequently imitates real life by using tools and household items. o Refer to the American Academy of Pediatrics for information on car safety. o Major causes of injuries include bicycles, skateboards, and team sports as the child's motor abilities and independence increase. o Children should always wear a helmet when riding a bike or using inline skates, skateboards, or other items that could result in falls. o Teach the school-age child water safety rules. o Instruct the school-age child to avoid teasing or playing roughly with animals. o Teach the school-age child traffic safety rules. o See the safety guidelines for the preschooler for additional principles.  The Adolescent o Physical Characteristics  Adolescent friendships  Puberty is the maturational, hormonal, and growth process that occurs when the reproductive organs begin to function and secondary sex characteristics develop.  Body mass increases to adult size.  Menstrual periods begin about 2 ½ years after the onset of puberty.  Oral care, including careful brushing, is important; many adolescents need to wear braces.  Adolescents tend to stay up late and, in an attempt to catch up on missed sleep, sleep late whenever possible; an average of 8 hours per night is recommended. o Vital Signs  Oral temperature: 97.5° F to 98.6° FJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 12  Apical rate: 55 to 90 beats per minute  Respirations: 12 to 20 breaths per minute  Blood pressure: averages 121/70 mmHg o Nutrition  Adolescents preparing dinner  Calcium, zinc, iron, folic acid, and protein are especially important nutritional needs.  Body image is very important to children in this age group.  Eating disorders are a concern in this age group. o Skills  Teenage boy surfing  Gross and fine motor skills are well developed.  Strength and endurance increase. o Play  High school cheerleaders  Games and athletics are the most common forms of play.  Competition and strict rules are important.  Adolescents enjoy such activities as sports, videos, movies, reading, parties, dancing, hobbies, computer and other electronic games or activities, music, and experimenting with makeup and hairstyles.  Friends are important, and adolescents like to gather in small groups. o Safety  Adolescent in a car with a cell phone  Adolescents are risk-takers.  Instruct adolescents in the dangers of cigarette smoking, caffeine ingestion, drugs, and alcohol.  Help adolescents recognize that they have choices when difficult or potentially dangerous situations arise.  Advocate the use of seat belts; discuss the causes of motor vehicle accidents, including the use of cell phones and other electronic devices while driving.  Discuss water safety.  Warn adolescents about the dangers of guns, violence, and gangs.  Instruct adolescents in the complications associated with body piercing, tattooing, and tanning.  Discuss such issues as date rape, sexual relationships, and sexually transmitted infections, and the dangers of the Internet in regard to communicating and setting up meetings (dates) with unknown persons.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 13  MUST KNOW o Human milk is the best food for infants younger than 6 months. o Skim and low-fat milk should not be used for infants because the essential fatty acids are inadequate and the solute concentration of protein and electrolytes is too high. o Fluoride supplementation may be needed starting around 6 months of age, depending on the infant's intake of fluoridated tap water. o Introduce solid foods one at a time, usually at intervals of 4 to 7 days, to identify food allergens. o Avoid giving solid foods that place the child at risk for choking, such as nuts, foods with seeds, raisins, popcorn, grapes, and pieces of hot dog. o Baby-proof the home; hazardous items must be stored out of reach. o Toddlers are eager to explore the world around them. o Preschoolers are active and inquisitive; because of their magical thinking, they may believe that the daring feats seen in cartoons are possible and may attempt them. o Children should always wear a helmet when riding a bike, using inline skates or skateboards, or participating in other activities that may result in falls. o Teach children to avoid speaking to strangers and to never accept a ride, toys, or gifts from a stranger. o Teach children how to dial 911 in an emergency situation. o Teach parents to keep the poison-control hotline number available. o Adolescents are risk-takers. o Discuss such issues as date rape, sexual relationships, and sexually transmitted infections and the dangers of the Internet with regard to communicating and setting up meetings (dates) with unknown persons. Confidence does not come when you have all the answers. But it comes when you are ready to face all the questionsJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 14 LESSON 2: EARLY ADULTHOOD, MIDDLE ADULTHOOD AND LATE ADULTHOOD  Psychosocial Development o According to psychologist Erik Erikson, a human being's life encompasses eight stages of psychosocial development, each presenting a psychosocial crisis. The goal is to integrate physical, maturational, and societal demands to overcome the crisis. Unsuccessful resolution of the crisis results in an emotional handicap. o Early Adulthood  Psychosocial crisis: intimacy versus isolation  Task: establishing intimate bonds of love and friendship  Successful resolution: ability to love deeply and commit oneself to a relationship  Unsuccessful resolution: emotional isolation, egocentricity o Middle Adulthood  Psychosocial crisis: generativity versus stagnation  Task: fulfilling life goals that involve family, career, and society  Successful resolution: ability to give and care for others and guide others  Unsuccessful resolution: self-absorption; inability to grow as a person o Later Adulthood  Psychosocial crisis: integrity versus despair  Task: looking back over one’s life and accepting its meaning  Successful resolution: sense of integrity and fulfillment  Unsuccessful resolution: dissatisfaction with life  Early Adulthood o Young adult o Period between the late teens and the middle to late thirties o Physical Changes o Physical growth is usually complete by age 20. o People in this group are generally quite active. o Severe illnesses are less common than in older groups, but people in early adulthood tend to ignore physical symptoms and postpone seeking health care. o Lifestyle habits such as smoking, stress, lack of exercise, poor personal hygiene, and family history of disease increase the risk of future illness. o Cognitive Changes  Young adult couple  People in this group generally demonstrate rational thinking habits.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 15  Conceptual, problem-solving, and motor skills have improved.  Preferred occupational areas are being identified.  Psychosocial Changes  Young adults are separating from their families of origin.  Much attention is paid to occupational and social pursuits to improve socioeconomic status.  Decisions regarding career, marriage, and parenthood are being made.  Young adults must adapt to new situations. o Sexuality  The emotional maturity needed to engage in mature sexual relationships has developed.  Young adults are at risk for sexually transmitted infections.  Middle Adulthood o Period between the middle to late thirties and the middle sixties o Physical Changes  The changes of aging become evident between 40 and 65 years.  The individual becomes aware that changes in reproductive and physical abilities signify the beginning of another stage in life.  Physiological changes often have an impact on self-concept and body image.  Physiological concerns include stress, level of wellness, and the formation of positive health habits. o Cognitive Changes  People in this group may become interested in learning new skills, possibly through educational or vocational programs for people entering the job market or changing careers. o Psychosocial Changes  Middle-aged adult couple  Changes may include expected events such as children moving away from home (post parental family stage) or unexpected events such as the death of a close friend.  Time and financial demands decrease as children move away from home, and couples face redefinition of their relationships.  People in this group may become grandparents and are achieving generativity. o Sexuality  Many couples renew their relationships and find increased marital and sexual satisfaction.  The onset of menopause and climacteric may affect sexual health.  Stress, health, and medications can affect sexuality.  Later Adulthood o Older adult couple o Period between 65 years and death; also referred to as older adulthoodJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 16  Physiological Changes o Integumentary System  Loss of pigment in hair and skin  Wrinkling of the skin  Thinning of the epidermis and easy bruising and tearing of the skin  Decreased skin turgor, elasticity, and subcutaneous fat  Increased nail thickness and slowed nail growth  Decreased perspiration  Dry, itchy, scaly skin  Seborrheic dermatitis and keratosis formation o Neurological System  Slowed reflexes  Slight tremors and difficulty with fine motor movement  Loss of balance  Increased incidence of awakening after onset of sleep  Increased susceptibility to hypothermia and hyperthermia  Short-term memory may decline (although long-term memory is usually maintained)  These physiological changes place the client at risk for injury. o Musculoskeletal System  Diminished muscle mass and strength and muscle atrophy  Decreased mobility, range of motion, flexibility, coordination, and stability  Change of gait to a shortened step and wider base  Changes in posture and stature resulting in a decrease in height  Increased brittleness of the bones  Deterioration of joint capsule components  Kyphosis of the dorsal spine o Cardiovascular system  Diminished energy and endurance, resulting in decreased tolerance for exercise  Decreased compliance of the heart muscle  Thickening, and increased rigidity of heart valves  Decreased cardiac output, resulting in decreased efficiency of blood return to the heart  Decreased resting heart rate  Weak peripheral pulses  Increased blood pressure but susceptibility to postural hypotensionJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 17  Layers of the heart and pericardium: Source: HESI-Saunders 2017, Elsevier Inc.  o Respiratory System  Reduced stretch and compliance of the chest wall  Reduced strength and function of respiratory muscles  Decreased size and number of alveoli  Decreased depth of respirations and oxygen intake  Diminished ability to cough and expectorate sputum o Hematological System  Hemoglobin and hematocrit levels at the low end of the normal range  Tendency to increased blood clotting o Immune System  Lymphocyte counts tend to be low.  Resistance to infection and disease is decreased.  Confusion is a common sign of infection in the older adult, especially infection of the urinary tract. o Gastrointestinal System  Decreased need for calories  Diminished appetite and thirst and reduced oral intake  Reduced lean body weight  Digestive disturbances  Shortened stomach-emptying time  Reduced absorption of carbohydrates, proteins, fats, and vitamins  Increased tendency to constipation  Increased susceptibility to dehydration  Tooth loss  Difficulty chewing and swallowing food o Renal System  Decreased kidney size, function, and ability to concentrate urine  Decreased glomerular filtration rate  Decreased bladder capacity  Increased residual urine and increased incidence of urinary tract infection  Impaired excretion of medication o Endocrine System  Decreased secretion of hormones, with specific physiological changes related to each hormone's function  Decreased metabolic rateJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 18  Decreased glucose tolerance, with resistance to insulin in peripheral tissues o Reproductive System  Decrease in testosterone production and size of testes  Changes in the prostate gland, sometimes leading to urinary problems  Decreased secretion of hormones with the cessation of menses  Vaginal changes, including decreased muscle tone and lubrication  Impotence or sexual dysfunction in both sexes; variation in sexual function with general physical condition, mental health status, and medications o The Senses  Decreased visual acuity  Decreased accommodation in eyes, requiring increased time for adjustment to changes in light  Decreased peripheral vision and increased sensitivity to glare  Presbyopia and cataract formation  Narrowed and straightened optic blood vessels, opaque gray arteries, and gray or yellow spots of hyaline degeneration, called drusen, near the macula  Possible loss of hearing  Inability to discern taste of food  Diminished smell acuity o Changes in touch sensation  The older client experiences pain, but sensation of pain may be diminished as compared to a younger client.  Pain results from numerous causes, most often degenerative changes in the musculoskeletal system; failure to recognize signs of pain and alleviate pain may lead to functional limitations affecting the older adult’s ability to function independently. o Medications  The nurse should routinely assess the number of prescription and nonprescription medications used by the older client and determine whether any may be eliminated or combined.  The nurse should closely monitor the older client for adverse effects and response to medication therapy because of the increased risk for medication toxicity.  One common sign of an adverse reaction to a medication in the older client is an acute change in mental status. o Psychosocial Concerns  Man with cane  Adjustment to deterioration in physical and mental health and well-being  Threat to independent function and fear of becoming a burden to loved ones  Adjustment to retirement and loss of income  Loss of skills and competencies developed early in lifeJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 19  Coping with changes in role function and social life  Diminished quantity and quality of relationships and coping with loss  Dependence on governmental and social systems  Access to social-support systems  Costs of health care and medications o Mental Health Concerns  Older woman with medications  Isolation: Client is alone and desires contact with others but is unable to make that contact.  Grief: The client perceives loss, including physical, psychological, social, and spiritual aspects.  Depression: The increased dependency that older adults may experience can lead to feelings of hopelessness and helplessness, a diminished sense of self-control, and reduced self-esteem and self-worth; these changes may interfere with daily function and lead to depression.  Suicide: Any suicide threat by an older client should be taken seriously.  MUST KNOW o Aging is a natural process that is common to all individuals. o The young adult tends to ignore physical symptoms and postpone seeking health care. o The task of middle adulthood is to achieve generativity. o Age-related changes can increase the older client’s risk for injury. o Excess bathing may result in dryness, itching, and skin disruption. o Regular exercise helps maintain muscle tone and strength and improves circulation. o The reduced respiratory function associated with aging places the client, particularly the immobile client, at risk for pneumonia. o Age-related decline in immune system function increases the older client’s risk of infection. o Age-related changes can alter the mechanism of medication absorption, putting the client at risk for adverse medication reactions. o One common sign of an adverse reaction to a medication in the older client is an acute change in mental status. o Any suicide threat by an older client should be taken seriously.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 20 LESSON 3: FAMILY SYSTEM AND FAMILY DYNAMICS  Family Structure o A set of relationships among individuals who identify themselves as family members and who influence each other's lives o Types of Family Structures  Nuclear: consists of two partners, heterosexual or homosexual, and perhaps one or more children  Extended: includes relatives such as aunts, uncles, grandparents, and cousins in addition to the nuclear family  Single-parent: formed when one of the parents leaves the nuclear family through death or desertion or when a single person decides to give birth to or adopt a child  Blended: formed when parents bring unrelated children from prior or foster-parenting relationships to a new joint-living situation  Single-adult household: one adult living alone in a household  Multi-adult household: more than one adult living in a household  Grandparent household: grandparent or grandparents caring for grandchildren  Communal groups: various types of families living together  Cohabitating partners: unmarried individuals, heterosexual or homosexual, living together  Family Dynamics That Affect Family Functioning o Financial  Father and son  Many women work outside the home because of the need for additional income.  Managing employment and family life and obtaining adequate child care may be difficult; grandparents may be caring for children while the parents are working.  Fathers may be expected to help fulfill parenting responsibilities.  Family members may need to balance the needs of the family with caring for its older members. o Relationships and Roles  Patterns of relationships form power and role structure within the family.  Relationships among family members may be numerous and complex: For example, a father's relationships may include those of a husband with his wife, a father with his daughter, a father with his son, and an employee with his boss, and each of these relationships may carry different demands or expectations.  Family goals are important for family function and dependent on bonding and communication among family members, goal-setting, caregiving among members, coping mechanisms, conflict resolution, and the appropriate use of internal and external resources.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 21 o Culture and Religion  Depending on cultural and religious beliefs and norms, societal and economic demands may affect the roles of family members.  Cultural and religious beliefs and norms may affect structure, function, health beliefs, values, and the way in which events are perceived.  The nurse must always assess the importance of a family’s religious and cultural beliefs when planning and delivering care.  The nurse must always respect cultural and religious family beliefs and use an appropriate interpreter to help ensure client understanding. o Illness  Hospital room  The family strongly influences the health behaviors of its members.  The health status of each individual influences how the family unit functions and affects its ability to achieve goals.  Illness of a family member affects a family's routines, rituals, and daily practices.  Roles and responsibilities of family members may change in the face of a family member’s illness.  Family members of different ages may subscribe to various folk remedies, healthcare beliefs, and religious remedies. o Adaptation to New Family Members  Introducing a new family member, such as a newborn, may produce stress within the family structure.  Sibling adaptation to a new family member depends on the sibling's age and developmental level. o Adaptation of a Toddler  Pregnant mother  Very young children (2 years and younger) are unaware of maternal changes occurring during pregnancy and are unable to comprehend that a new brother or sister is going to be born.  Because toddlers have little perception of time, many parents delay telling them that a baby is expected until shortly before the birth.  Any household changes that must be made, such as changes in sleeping arrangements, should be made several weeks before the birth so that the toddler does not feel displaced by the new baby.  Until the toddler feels secure in the affection of his or her parents, expecting him or her to welcome a newborn into the family is not realistic; frequent reassurances of parental love and affection are crucial.  A gift “given” to the toddler by the new baby when the infant arrives home from the hospital may help the toddler accept the new family member.  The parents can be taught to accept strong feelings that the toddler expresses, such as anger, jealousy, and frustration, without judgment and to continue reinforcing the toddler's feeling of being loved. o Adaptation of Older Children  Brothers playingJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 22  Older children are more aware of changes in the mother's body that show that a baby is to be born.  Older children look forward to the baby's arrival and expect the infant to be a playmate.  Older children (school age) generally enjoy taking responsibility for the care of a younger sibling.  Children should be encouraged to feel the fetus move and may benefit from sibling classes, which provide an opportunity for children to discuss the changes the new baby will mean for the family. o Adaptation of an Adolescent  Adolescent girl  An adolescent may be embarrassed because the pregnancy confirms the continued sexuality of the parents or repelled by the obvious physical changes in his or her mother.  Some adolescents are immersed in their own developmental tasks and are indifferent to the pregnancy unless it directly affects them or their activities.  Some adolescents become very involved and want to help with preparations for the new baby. o Family Planning  Family planning involves choosing when to have children and, toward this end, selecting contraception and methods of achieving pregnancy.  Because most available contraceptive methods must be used by women, women often choose the type of contraception to be used. o Role of the Nurse  The nurse acts as a counselor and educator.  The focus of contraceptive counseling must meet the needs and feelings of the woman and her partner.  Several factors, including effectiveness, safety, and personal preference, should be considered when a client is choosing a method of birth control.  The woman's preferences are most important, and the nurse must not introduce his or her own biases toward or against specific methods.  Other factors that bear on selection of a contraceptive method include family planning goals, age, frequency of intercourse, the individual's ability to comply with the therapy, and cultural and religious preferences.  If a couple’s family planning goals have already been met, sterilization of either the male or the female partner may be desirable.  For women who frequently engage in coitus, oral contraceptives or a long-term contraceptive method may be considered.  Use of a long-term contraceptive method provides reliable protection if compliance may be a problem.  When sexual activity is limited, use of spermicide, condoms, or a diaphragm may be most appropriate.  Barrier methods combined with spermicides also provide protection against sexually transmitted infections (STIs); such combinations may be appropriate for individuals who have multiple partners.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 23 o Adolescents  Nurse explaining contraceptive use to adolescents  Misinformation and erroneous beliefs cause adolescents to use ineffective methods of contraception or no method at all.  Adolescents are more likely to take risks with sexual activity because they believe that the chance of becoming pregnant is small.  As the nurse counsels an adolescent about sexuality, he or she must be sensitive to the feelings, concerns, and needs of the teenager and should reassure the adolescent about confidentiality.  The adolescent often needs more extensive teaching than an older woman does; contraception is most successful when the adolescent chooses a method that is easy to use.  Condom use should be encouraged to help prevent STIs even when another contraceptive method is being used. o Choosing a Method of Contraception  Personal Preference  The woman makes the final decision about her contraceptive method, and her satisfaction with her choice is crucial.  Consistent use of any method depends on whether it meets the needs of the woman and her partner.  Safety  Some forms of contraception are contraindicated in the presence of certain medical conditions.  The nurse must identify contraindications and side effects clearly when discussing each method.  Effectiveness  The importance of avoiding pregnancy must be considered when a contraceptive method is being chosen.  Methods that are less reliable can sometimes be combined to increase effectiveness (e.g., using a condom with a spermicide).  The effectiveness of the method must be balanced against its acceptability to the couple.  Convenience  If the woman perceives her contraceptive as difficult to use or time consuming, she is unlikely to use it consistently.  Protection from Sexually Transmitted Infections (STIs)  Condom o No contraceptive (other than abstinence) is 100% effective in preventing STIs. o The male condom offers the best protection available and should be used whenever it is possible that one partner has an STI, even when another form of contraception is practiced. o Some methods of contraception, such as condoms, involve very little education, whereas others require one or more teaching sessions to ensure adequate knowledge. o Interference with spontaneity is a factor for some couples: Coitus-related contraceptive methods, such as spermicides and some barrier methods, must be used just before intercourse.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 24  Availability o Condoms and spermicides are readily available without a prescription.  Expense o The costs of various contraceptive methods must be discussed.  Religious, Cultural, and Personal Practices and Beliefs o Religious, cultural, and personal practices and beliefs may influence the use of contraception and the method chosen. o Some religions, such as Roman Catholicism, do not sanction the use of contraceptives other than natural planning methods.  Informed Consent o Because some methods have potentially serious adverse effects, it is important for the woman to sign an informed-consent form to show that she has received and understands information about the risks and benefits.  Sterilization o Methods include tubal ligation and vasectomy; sterilization is used by couples who have completed their families. o Sterilization should always be considered a permanent end to fertility, because reversal surgery is not always successful. o Reversal surgery for tubal ligation increases the risk of ectopic pregnancy. o Complications of sterilization include those of any surgery: hemorrhage, infection, and complications of anesthesia. o The couple must be informed that complete sterilization by means of vasectomy does not occur immediately and that it may take a month or longer after surgery. o The man who has undergone a vasectomy will submit semen specimens for analysis until two successive specimens show that no sperm are present.  Oral Contraceptives o Oral contraceptives (a.k.a. the pill) alter the normal hormonal fluctuations of the menstrual cycle. o There are two main categories of oral contraceptives: those that contain both an estrogen and a progestin, known as combination oral contraceptives; and those that contain only a progestin.  Cautions and Contraindications: Women at Risk o The pill is contraindicated during pregnancy and for women with known or suspected breast carcinoma, known or suspected estrogen-dependent cancers, benign or malignant liver tumors, and undiagnosed abnormal genital bleeding.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 25 o Oral contraceptives should be used with caution by women with diabetes mellitus, smokers, woman who have risk factors for cardiovascular disease (e.g., hypertension, obesity, hypercholesterolemia), and women anticipating elective surgery in which postoperative thrombosis might be expected.  Cautions and Contraindications: Cardiovascular Risks o The use of combination oral contraceptives has been associated with venous and arterial thromboembolism, pulmonary embolism, myocardial infarction, and thrombotic stroke. o The risk of thromboembolism is increased in the presence of other risk factors, especially heavy smoking and a history of thromboembolism, hypertension, cerebrovascular disease, coronary artery disease, myocardial infarction, or surgery in which postoperative thrombosis might be expected. o The pill is contraindicated for women with a history of thrombophlebitis, thromboembolitic disorders, stroke, coronary artery disease, and other risk factors for thrombosis. o Oral contraceptives may be discontinued as long as 4 weeks before surgery in which postoperative thrombosis might be expected. o Women taking oral contraceptives should be informed about the symptoms of thrombosis and thromboembolism (e.g., leg tenderness or pain, sudden chest pain, shortness of breath, severe headache, and sudden visual disturbance) and instructed to stop taking the medication and notify the physician if these symptoms occur. o Blood pressure should be monitored; if hypertension develops, the physician may discontinue use. Blood pressure usually declines to pretreatment levels within a few months after the oral contraceptive has been withdrawn.  Cautions and Contraindications: Possible Effects o By inducing endometrial regression, oral contraceptives may decrease or eliminate menstrual flow during the initial months of use, but breakthrough bleeding and spotting may occur. o If bleeding irregularities persist during use, the possibility of malignancy should be investigated. o If two consecutive periods are missed, the client should be evaluated for pregnancy. o Estrogens and progestin’s can cause birth defects; if pregnancy should occur, oral contraceptives should be discontinued. o After the discontinuation of oral contraceptive use, a period of 1 to 3 months may be required before normal menstruation resumes; in extreme cases, cyclic menses may not return for as long as 1 year. o Estrogen excess causes nausea, breast tenderness, and edema; progestin excess can increase appetite and cause fatigue and depression. o Oral contraceptives enter breast milk and reduce milk production; therefore they should not be taken by women who are breastfeeding.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 26 o The incidence of twin births has been shown to be increased in women who become pregnant shortly after discontinuing oral contraceptives.  Taking Oral Contraceptives o An additional form of birth control (e.g., a condom) is recommended. o Pills should be taken at the same hour each day. o If a dose is missed, that dose should be taken together with the next scheduled dose. o If two doses are missed, two doses should be taken each day on the next 2 days. o If three doses are missed, a new cycle should be initiated, starting 7 days after the last pill was taken; an additional form of birth control should be used during the first two weeks of the new cycle. o A thorough history and physical examination, including blood pressure determination, examination of the breasts and pelvic organs, and a Papanicolaou (Pap) smear should be conducted initially and yearly in any woman taking the pill.  Oral Contraceptives o Birth control pills Medication Interactions o Oral contraceptives should be avoided by women using hepatotoxic medications. o The pill interferes with the activity of Promocriptine Mesylate (Parlodel) and anticoagulants and increase the toxicity of tricyclic antidepressants. o Antibiotics may decrease the absorption and effectiveness of oral contraceptives.  Medications That Diminish the Effects of Oral Contraceptives o The client may require an increased dosage of the oral contraceptive or an alternative form of birth control if a medication that diminishes the effect of oral contraceptives is prescribed. o Medications That Diminish the Effects of Oral Contraceptives  Antitubercular  Rifampin (Rifadin)  Antiviral  Ritonavir (Norvir)  Hypoglycemic  Many oral hypoglycemic  Insulin  Anticonvulsants  Phenytoin (Dilantin)  Carbamazepine (Tegretol)  Phenobarbital (Luminal)JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 27  Primidone (Mysoline)  Topiramate (Topamax)  Antibiotics  Tetracycline  Ampicillin sodium (Omnipen, Polycillin)  Anticoagulants  Warfarin sodium (Coumadin)  Long-Acting Contraceptives  Syringe Depot Medroxyprogesterone Acetate (DMPA or Depo-Provera)  A single intramuscular injection provides safe, effective contraception for 3 months or longer.  When injections are discontinued, an average of 12 months is required for fertility to return.  Menstrual disturbances are common during use; cycles become irregular at first, and, after 6 to 12 months, menstruation may cease entirely.  Adverse effects include abdominal bloating, headache, depression, decreased libido, and osteoporosis.  Intrauterine Devices (IUDs)  The IUD is inserted into the uterus to provide continuous pregnancy protection by preventing fertilization of the egg by sperm, inhibiting tubular transport, and preventing implantation into the endometrium.  The primary concern is pelvic inflammatory disease resulting from STI.  Women who are at risk for STIs (e.g., women who are not in mutually monogamous relationships) should not use IUDs.  The woman who is to use an IUD must be taught about the device’s side effects; the major side effects are cramps and increased menstrual bleeding.  If pregnancy occurs while an IUD is in place, the risk of ectopic pregnancy is increased.  The woman must be taught to check for the presence of the plastic strings, or "tail," extending from the IUD into the vagina, once a week during the first 4 weeks, then monthly after menses and if she detects signs of expulsion (cramping or unexpected bleeding); if the strings become longer or shorter, the client should contact her healthcare provider.  Spermicides  Spermicides, which are dispensed as foams, gels, creams, and suppositories, may be purchased without a prescription.  Used alone, spermicides are only moderately effective; combined use with a diaphragm or condom increases efficacy.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 28  A spermicide must be applied before coitus but no more than 1 hour in advance (when used alone).  Containers for foam preparation must be shaken thoroughly before each use to ensure dispersal of the spermicide.  Suppositories or tablets should be inserted at least 10 to 15 minutes before intercourse to allow time for dissolution.  A spermicide should be reapplied each time intercourse is anticipated.  Douching should be postponed for at least 6 hours after coitus.  Barrier Devices  Various types of contraceptives  Condoms for Men  Condoms are available without a prescription.  Most condoms are made of latex, which is impermeable to bacteria and viruses; therefore, in addition to protecting against pregnancy, latex condoms protect against STIs. (Polyurethane condoms also protect against STIs, but condoms made from lamb intestines are permeable to viruses and do not protect against STIs.)  Allergy to latex may develop in men or women, especially with repeated exposure.  Condoms for Women  The female condom is a pre-lubricated polyurethane pouch that is inserted into the vagina.  Available without a prescription, the female condom provides protection against STIs in addition to pregnancy.  It cannot be combined with a male condom.  The female condom should be used just once and then discarded.  Diaphragm  When in place over the cervical os, the diaphragm blocks access to the cervix.  Because the device does not fit tightly enough to completely block penetration of sperm, it must be filled with spermicidal jelly or cream before insertion. (Spermicide must be reapplied with repeated intercourse.)  The diaphragm may be inserted as long as 6 hours before intercourse but must remain in place for at least 6 hours after intercourse; because of the risk of toxic shock syndrome, however, it should not be left in place for longer than 24 hours.  Cervical Cap  This device fits snugly over the cervix and is held in place by suction.  A cervical cap must be fitted by a healthcare provider, and the user must be taught how to insert it.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 29  The cap, which is filled with spermicidal cream or jelly before use, may be inserted as long as 6 hours before intercourse (there is no need to apply additional spermicide with repeated intercourse); it should remain in place for at least 8 hours after intercourse but no longer than 24 hours.  Contraceptive Sponge  The sponge, which is designed to fit over the cervix, is inserted into the vagina after being moistened with water.  The device provides protection for as long as 24 hours and for repeated instances of sexual intercourse. o Natural Family Planning Methods  Physiological cues are used to predict ovulation, and coitus is avoided when conditions are favorable for fertilization.  Natural family planning can also be used to help women who want to become pregnant.  This method is acceptable to most religious groups and does not involve the use of medications, chemicals, or devices.  The couple must be committed to the method, because they must abstain from intercourse during the time when conditions for fertilization are favorable.  Calendar Method  This method is based on the fact that ovulation occurs approximately 14 days before the onset of menses.  Monitoring of Basal Body Temperature  Basal body temperature may decrease slightly before ovulation and then increase slightly with ovulation.  Cervical Mucus Method  This method involves the monitoring of changes in the cervical mucus caused by increasing estrogen levels during the follicular phase of the menstrual cycle.  The woman assesses her cervical mucus by wiping it from the vaginal orifice with a tissue each day and checking for changes in consistency.  The couple avoids intercourse when the mucus indicates that ovulation is imminent — the mucus becomes clear and slippery and stretches without breaking.  Symptothermal Method  This method combines the calendar method, monitoring of basal body temperature, and cervical mucus monitoring.  The woman makes note of other symptoms that occur around the time of ovulation, such as weight gain, abdominal bloating, Mittelschmerz (pain on ovulation), and increased libido.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 30  Abstinence  The couple refrains from sexual intercourse or, in some cases, all forms of sexual activity.  This method is encouraged for adolescents and endorsed by many religious groups.  When all sexual activity is avoided (practiced perfectly), abstinence prevents pregnancy and STIs.  Coitus Interruptus  In this method, also called "withdrawal coitus," the penis is removed from the vagina before ejaculation.  Fluid that escapes from the penis before ejaculation is not felt by the man or woman and may contain sperm; sperm spilled on the vulva may enter the vagina and cause pregnancy.  Breastfeeding  Women who breastfeed exclusively (at least 10 times in 24 hours with no supplementary feedings) may avoid ovulation and the resumption of menstrual cycles; however, this method alone is not a reliable means of contraception.  Postcoital Emergency Contraception  Often referred to as emergency contraceptive pills or the "morning-after pill," this form of contraception is used to prevent pregnancy after unprotected intercourse.  Use of the emergency contraceptive pill may not be acceptable by some religious groups because it is not a natural family planning method.  The emergency contraceptive pill prevents ovulation and fertilization and possibly post fertilization implantation.  This method may be used after contraceptive failure, such as condom breakage or dislodgment of a diaphragm during intercourse or in other situations when contraceptives were used incorrectly or not at all, including rape.  Infertility  Involuntary inability to conceive when desired  Factors Contributing to Infertility in Men o Abnormalities of the sperm o Abnormal erections o Abnormal ejaculation o Abnormalities of seminal fluid  Factors Contributing to Infertility in Women o Disorders of ovulation o Abnormalities of the fallopian tubes o Abnormalities of the cervixJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 31  Diagnostic Tests in Infertility  Men o Semen analysis o Endocrine function tests o Ultrasonography o Testicular biopsy o Sperm-penetration assay o Hemizona assay  Women o Ovulation prediction o Ultrasonography o Postcoital test o Endocrine function tests o Hysterosalpingography o Endometrial biopsy o Hysteroscopic laparoscopy  Therapies for Infertility  Medications o May be prescribed for the man or the woman o May be prescribed to improve semen quality, improve erections, induce ovulation, prepare the uterine endometrium, or support the pregnancy once it is established  Ovulation Induction o Involves the use of medication to induce ovulation o Increases the risk of multiple births o May cause ovarian hyper stimulation syndrome  Surgical Procedures o Correction of a varicocele o Endoscopic procedures o Laparotomy, laser surgery techniques, and microsurgical techniques to reduce adhesions or correct obstructions o Transcervical balloon tuboplasty to open the fallopian tubes  Therapeutic Insemination o May involve use of the partner's semen or that of a donor to overcome a low sperm countJSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 32 o In intrauterine insemination, direct placement of sperm in the uterus is done  Advanced Techniques o In vitro fertilization o Gamete intrafallopian transfer o Tubal embryo transfer o Microsurgically assisted fertilization o Preimplantation genetic testing  MUST KNOW o The family strongly influences the health behaviors of its members, and the health status of each individual influences how the family unit functions and its ability to achieve goals. o The nurse should identify the family structure and roles of the family members and assess family dynamics to formulate a plan of care. o The nurse must recognize the cultural and religious influences that affect family function. o Until the young toddler feels secure in the affection of his or her parents, expecting the toddler to welcome a newborn infant into the family is not realistic. o Older children often enjoy taking responsibility for the care of a younger sibling. o Adolescents are more likely to take risks with sexual activity because they believe that the chance of becoming pregnant is small. o Several factors, including the need or desire for contraception, personal preference, cultural and religious beliefs and practices, effectiveness, and safety, should be considered in the choice of a method of birth control. o The nurse must identify the expected outcomes for family planning and discuss the contraindications for the chosen method of contraception. o Oral contraceptives are contraindicated in women with a history of thrombophlebitis, thromboembolitic disorders, stroke, or coronary artery disease; other risk factors for thrombosis; known or suspected breast carcinoma; benign or malignant liver tumors; undiagnosed abnormal genital bleeding  contraindicated in pregnant women. o Oral contraceptives should be used with caution by women with diabetes mellitus, women who are smokers, woman who have risk factors for cardiovascular disease (e.g., hypertension, obesity, hypercholesterolemia), and women anticipating elective surgery in which postoperative thrombosis might be expected. o Most condoms are made of latex, which is impermeable to bacteria and viruses; therefore, in addition to protecting against pregnancy, latex condoms protect against STIs. (Polyurethane condoms also protect against STIs, but condoms made from lamb intestines are permeable to viruses and do not protect against STIs.) o Because of the risk of toxic shock syndrome, a diaphragm should not remain in place for more than 24 hours. o Natural family planning methods involve the use of physiological cues to predict ovulation; coitus is avoided when conditions are favorable for fertilization. o Natural family planning methods are acceptable to most religious groups because they do not involve the use of medications, chemicals, or devices.JSPENA: NCLEX – RN MENTORING PROGRAM 3rd EDITION 2017 33 LESSON 4: MATERNITY CLIENT: ANTEPARTUM CARE  Fertilization and Implantation o Fertilization  Occurs in the upper region of the fallopian tubes within 12 hours of ovulation and 2 to 3 days of insemination, the average durations of viability for the ovum and sperm, respectively.  Once the ovum is fertilized, its membrane undergoes changes that prevent the entry of other sperm.  Fertilization: Source: HESI-Saunders 2017, Elsevier Inc.  Sperm carry an X and a Y chromosome: XY is male, XX female.  X and Y chromosomes: Source: HESI-Saunders 2016, Elsevier Inc. o Implantation  The zygote propels itself down the fallopian tube, toward the uterus.  Implantation in the uterine wall occurs 6 to 10 days after ovulation.