Exercise and PMS

Exercise is often recommended as a treatment for PMS, but there is no published study demonstrates its efficacy as the sole intervention. Timonen and Procope surveyed than 700 female college students and reported that premenstrual complaints were less frequent among those who participated in sports. Prior and Vigna compared the effects of exercise on premenstrual symptoms in sedentary women and runners. Increased exercise was associated with improvements in fluid and breast related symptoms, based on daily symptoms reports, as well as premenstrual dysphoria up to 6 months after initiation of an exercise program. No changes in control subjects were observed. In the strongest study design, Lemon evaluated the effect of aerobic training in 32 women with prospectively confirmed PMS. Women were randomly assigned to either a high-intensity aerobic training group or a low-intensity control group. Although the high-intensity aerobic group reported greater reductions, both groups exhibited significantly fewer symptoms as compared with baseline. Further controlled studies are needed to clarify whether exercise can alleviate or mitigate physiologic or psychological symptoms of PMS.

Source:
Debra A. Krummel, Penny M. Kris-Etherthon. Nutrition in Women's Health. Aspen Publishers, 1996.

Ectopic Pregnancy

Ectopic Pregnancy

Ectopic pregnancy occurs whenever the blastocyst implants anywhere except in the endometrium lining the uterine cavity. Possible sites for ectopic pregnancy include the cervix, fallopian tubes, ovaries, and abdomen. Predisposing factors to ectopic pregnancy are given in this section. For a woman with a suspected ectopic pregnancy, the midwife should draw blood for a quantitative human chorionic gonadotropin, obtain an ultrasound, and notify the consulting physician. Early diagnosis and referral to the physician are critical. If a tubal pregnancy can be diagnosed before rupture, microsurgery or medical management with methotrexate is more likely to save the fallopian tube.

Source:

Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.

Postpartum Depression

Postpartum Depression

Postpartum depression starts later, is more intense and devastating, and lasts longer than postpartum after-baby blues. It may start anytime during the first year postpartum. The mother gradually slips deeper and deeper into depression, becomes increasingly incapable functioning, and thinks angry and hurtful thoughts about her baby, which she suppresses because she’s “not supposed to think this way.” She becomes lonely and isolated and feels she has lost control. She is truly suffering.

Beck has identified 11 themes and developed a checklist of 11 symptoms of postpartum depression a mother can experience, to be used by a health care professional in discussion with a mother:

1. Lack of ability to concentrate; feeling “in a fog”
2. Loss of previous interest and goals; feeling empty.
3. Unbearable loneliness; feeling that no one understands.
4. Insecurity and need to be mothered herself.
5. Obsessive thinking about being a bad mother.
6. Lack of positive emotions-perceives herself as going through motions like a robot.
7. Loss of self from fear that normalcy in her life is irretrievable.
8. Loss of control of her emotions.
9. Anxiety attacks; feeling that she is on the edge of insanity.
10. Guilt and fear at thoughts of harming infant.
11. Thoughts of death to end this living nightmare.

Postpartum depression should be differentiated from postpartum psychosis, which is a very confused state of extreme highs and lows, agitation, seeing and hearing things that others don’t (including voices that may “order” the persons to do things she normally would not do), and frightening thoughts of harming herself of her baby. A mother with these symptoms needs immediate psychiatric help. Postpartum depression also must be differentiated from postpartum thyroiditis with its symptoms of extreme fatigue and weight loss, or later, weight gain. Differentiation is difficult because both postpartum depression and postpartum thyroiditis present with overwhelming fatigue, which affects the mother’s activities of daily living and her capacity for taking care of her baby. A thyroid work-up is indicated when a mother’s depression is prolonged, her weight does not stabilize, the onset of her fatigue was rapid, and fatigue is present without physical exertion.

It is most helpful in the midwife’s approach to a mother with postpartum depression to acknowledge what she is experiencing and to tell her it’s ok to express what she may think are socially unacceptable negative feelings. Connecting her with support groups may be useful. Mild forms of depression may be helped with plans for coping such as getting out of the house, doing something for herself each day, having contact with and communicating with adults, talking with a friend about what she feels, doing some form of exercise, and paying attention to nutrition.

Source:

Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.

The Calendar Method (Rhyntm Method)

The Calendar Method (Rhythm Method)

Research in the 1930s led to the development of the earliest of the natural family planning methods,the “rhythm” method, also known as the calendar method. The method was based on this finding, a woman’s fertile period can be identified.

This method has many limitations because of the wide variation in the length of menstrual cycles. Because a fairly regular menstrual cycles. Because a fairly regular menstrual cycle is essential to any reliable estimation of the time ovulation, the following women cannot depend on the calendar method: women with menstrual cycles shorter than 25 days, women with irregular menstrual cycles, women with menstrual cycles that vary in length by 8 days or more, postpartum women, women who are lactating and women in the perimenopause.

The calendar method can only predict the days in a menstrual cycle during which a woman is more likely to get pregnant. This prediction is based on the projected time of ovulation as determined by calendar calculations made from the history of the length of the last 8 to 12 cycles. A woman must keep a record of menstrual cycles to identify the longest and shortest cycles so that all possible fertile days may be projected. The calculations used today allow for a variation factor of +2 days around the approximately 14 days prior to the onset of the next menstrual period, 2 or 3 days for sperm survival, and 1 day for ovum survival, for a minimum total of 9 fertile days.

The woman subtracts 20 days from the length of her shortest cycle to determine her first predicted fertile day and 10 days from the length of her longer cycle to determine her last predicted fertile day. The couple then abstain from sexual intercourse during the projected fertile days to prevent conception.

Although this method may be selected by some couples in United States and is still used in many countries, it has been supplanted by modern natural family planning methods that have proved to be more effective and require fewer days of abstinence. The latter methods differ from the calendar (rhythm) method in that they are based on clinical indicators of hormonal changes and identify the times of fertility and infertility as they occur in each and every cycle. These biological signs can be observed and interpreted by women and their partners.

Source:

Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.

Basic Assumptions of The Neuman Systems Model

Basic Assumptions of The Neuman Systems Model

1. Although each individual client or group as a client system is unique, each system is a composite of common known factors or innate of characteristics within a normal, given range of response contained within a basic structure.
2. May known, unknown, and universal environmental stressors exist. Each differs in its potential for disturbing a clients’ usual stability level, or normal line of defense. The particular interrelationships of client variables-physiological, psychological, sociocultural, developmental, and spiritual-at any point in time can affect the degree to which a vliet is protected by the flexible line of defense against possible reaction to single stressor or a combination of stressors.
3. Each individual client/client systems has evolved a normal range of responses to the environment that is referred to as a normal line of defense, or usual wellness/stability state,. The normal line of defense can be used as a standard from which to measure health deviation.
4. When the cushioning, accordian-like effect of the flexible line of defense is no longer capable of protecting the client/client system against the environmental stressor, the stressor breaks through the normal line of defense. The interrelationships of variables-physiological, psychological, sociocultural, developmental, and spiritual-determine the nature and degree of system reaction or possible reaction to the stressor.
5. The client, whether in a state of wellness or illness, is a dynamic composites of the interrelationships of variables-physiological, psychological, sociocultural, developmental, and spiritual. Wellness is on a continuum of available energy to support the systems in an optimal state of system stability.
6. Implicit within each client system are internal resistance factors known as lines of resistance, which function to stabilize and return the client to the usual wellness state (normal line of defense) or possibly to a higher level of stability following an environmental stressor reaction.
7. Primary prevention relates to general knowledge that is applied in client assessment and intervention in identification and reduction or mitigation of possible or actual risk factors associated with environmental stressors to prevent possible reaction. The goal of health promotion is included in primary prevention.
8. Secondary prevention relates to symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatments to reduce their noxious effects.
9. Tertiary prevention relates to the adjustive processes taking place as reconstitution begins and maintenance factors move the client back in a circular manner toward primary prevention.
10. The client as a system is in dynamic, constant energy exchange with the environment.

Source:

Ann Marriner Tommey, Martha Raile Alligood. Nursing Theorists and Their Work. Mosby: 1998.

Theory of Self-Care

Theory of Self-Care

Self-care is a human regulatory function that individuals must, with deliberation, perform for them-selves or have performed for them to maintain life, health, development, and well-being. Self-care is an action system, the elaboration of the concepts of self-care demand, and self-care agency provide the foundations for understanding the action requirements and action limitations of persons who may benefit from nursing. Self-care as a human regulatory function stands in distinction to other types of regulation of human functioning and development such as neuroendocrine regulation. Self-care must be learned and it must be deliberately performed continuously in time and in conformity with the regulatory requirements of individuals associated, for example with their stages of growth and development, states of health, specific features of health or developmental states, environmental factors, and levels of energy expenditure.

Source:

Ann Marriner Tommey, Martha Raile Alligood. Nursing Theorists and Their Work. Mosby: 1998.

Theory of Self-Care Deficit

Theory of Self-Care Deficit

The central idea of the Theory of Self-Care Deficit is that requirements of persons for nursing are associated with the subjectivity of mature and maturing persons to health-related or helath-care-related action limitations that render them completely or partially unable to know existent and emerging requisities for regulatory care for themselves or their dependents and to engage in the continuing performance of care measures to control performances of care measures to control or in some way factors that are regulatory of their own or their dependents’ fuctioning and develepmont.

Selfcare deficit is a term that expresses the relationship between the action capabilities of individuals and their demands of care. Self-care deficit is an abstract concept that, when expressed in terms of action limitations, provides guides for selection of methods of helping and understanding patient roles in self-care.

Source:

Ann Marriner Tommey, Martha Raile Alligood. Nursing Theorists and Their Work. Mosby: 1998.

Theory of Nursing Systems

The Theory of Nursing Systems proposes that nursing is human action: nursing systems are action systems formed (designed and produced) by nurses through the exercise of their nursing agency for persons with health-derived or health-associated limitations in self acre or dependent-care. Nursing agency includes concepts of deliberate action, including intentionally and operations of diagnosis, prescription, and regulation. Nursing system may be produced for individuals, for persons who constitute a dependent-care unit, for groups whose members have therapeutic self-care demands with similar components or who have similar limitations for engagement in self-care or dependent-care, or for families or other multiperson units.

Source:

Ann Marriner Tommey, Martha Raile Alligood. Nursing Theorists and Their Work. Mosby: 1998.

Abdellah’s Theory of 21 Nursing Problems

1. To Maintain good hygiene and physical comfort.

2. To promote optimal activity: exercise, rest, sleep.

3. To Promote safety through prevention of accident, injury, or other trauma and through the prevention of the

spread of infection.

4. To maintain good body mechanics and prevent and correct deformity.

5. To facilitate the maintenance of a supply of oxygen to all body cells.

6. To facilitate the maintenance of nutrition of all body cells.

7. To facilitate the maintenance of elimination.

8. To facilitate the maintenance of fluid and electrolyte balance.

9. To recognize the physiological responses of the body to disease conditions-pathological, physiological, and compensatory.

10. To facilitate the maintenance of regulatory mechanisms and functions.

11. To facilitate the maintenance of sensory function.

12. To identify and accept positive and negative expressions, feelings, and reactions.

13. To identify and accept interrelatedness of emotions and organic illness.

14. To facilitate the maintenance of effective verbal and nonverbal communication.

15. To promote the development of productive interpersonal relationships.

16. To facilitate progress toward achievement and spiritual goals.

17. To create and/or maintain a therapeutic environment

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs.

19. To accept the optimum possible goals in the light of limitations, physical, and emotional.

20. To use community resources as an aid in resolving problems arising from illness.

21. To understand the role of social problems as influencing factors in the cause of illness.

Source:

Ann Marriner Tommey, Martha Raile Alligood. Nursing Theorists and Their Work. Mosby: 1998.