Analysis of Middle Range Nursing Theory

Integration of Mid-Range Theory and Practice Paper:

MaryKay Livingston Frances Payne Bolton School of Nursing
Case Western Reserve University Dr. Deborah Lindell

The Practice Situation

Complex physiological changes during pregnancy have a significant impact on almost every organ on the body system including the oral cavity -- these changes are due to hormonal changes. Estrogen causes increased blood flow to the oral cavity, making the gums friable and easy to bleed, contributing to gingivitis. Pregnancy-associated gingivitis is highly prevalent. It affects approximately 30%-75% of pregnant women and resolves after delivery. Nausea and vomiting during pregnancy can also increase the risk of extensive erosion (Varney, Kriebs, & Gegor, 2004; Barak, Oettinger, Machetie, Peled, & Ohel, 2003). In addition, changes in diet, such as increased consumption of carbohydrates, increased acid from vomiting, and changes in oral hygiene may increase the risk of tooth decay during pregnancy (Russel & Mayberry, 2008). Current research and evidence shows the importance of maintaining good oral health during pregnancy. Evidence supports that periodontal infections during pregnancy increases the risk of adverse birth outcomes such as premature deliveries, low birth weight, still birth, miscarriage, and pre-eclampsia (Russell & Mayberry, 2008; Jeffcoat, Geurs, Reddy, Cliver, Goldenberg & Hauth, 2001). Preterm birth is a significant public health problem, as the prematurity rate at in the United States was 12.7% in 2007. Preliminary data for 2008 indicates a slight decline to about 12.3% (Martin, Hamilton, Sutton, Ventura, Mathews, Kirmeyer, & Osterman, 2010). Behrman & Butler (2007) reported that annual societal preterm births cost more than $26.2 billion in 2005, or $51,600 per infant born preterm, including maternal delivery, medical care, early intervention services, and loss of

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