Nursing Care of Mother and Child Past Paper PDF

BACHELOR OF SCIENCE IN NURSING: CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC): COURSE MODULE COURSE UNIT WEEK 1 5 5...

BACHELOR OF SCIENCE IN NURSING: CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC): COURSE MODULE COURSE UNIT WEEK 1 5 5 General and Specific Problems in Reproduction and Sexuality Read course and unit objectives Comprehend study guide prior to class attendance Read and understand required learning resources; refer to unit terminologies for jargons Proactively participate in online discussions Participate in weekly discussion board (Canvas) Answer and submit course unit tasks At the end of this unit, the students are expected to: Cognitive: 1. Describe common assessments necessary to detect subfertility. 2. Plan nursing interventions to meet the needs of a couple with a diagnosis of subfertility.  3. Implement nursing care associated with the diagnosis of subfertility or measures to promote fertility, such as health teaching. 4. Classify the different type of assisted reproductive techniques. 5. Determine the advantages and disadvantages of assisted reproductive techniques. 6. Identify areas of nursing care related to assisted reproductive techniques that could benefit from additional nursing research or application of evidence-based practice Affective: Listen attentively during class discussions Demonstrate tact and respect when challenging other people’s opinions and ideas Accept comments and reactions of classmates on one’s opinions openly and graciously. Develop heightened interest in studying Maternal and Child Nursing. Psychomotor: 1. Participate actively during online class discussions and group activities 2. Express opinion and thoughts in online classes Adele Pilliteri, JoAnne Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. (8th Ed.). Burney, R. O., Schust, D. J., & Yao, M. W. M. (2007). Infertility. In J. S. Berek (Ed.). Berek & Novak’s gynecology. Philadelphia: Lippincott Williams & Wilkins. 1. INFERTILITY Subfertility exists when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus. In primary subfertility, there have been no previous conceptions; in secondary subfertility, there has been a previous viable pregnancy, but the couple is unable to conceive at present. Sterility is the inability to conceive because of a known condition, such as the absence of a uterus. In about 40% of couples with a subfertility problem, the cause of subfertility is multifactorial; in about 30% of couples, it is the man who is subfertile. In women seen for a fertility concern, 20 % to 25% experience ovulatory failure; another 20% experience ovulatory failure; another 20% experience tubal, vaginal, cervical, or uterine problems. In about 10% of couples, no known cause for the subfertility can be discovered despite all the diagnostic tests currently available. Such couples are categorized as having unexplained subfertility. When engaging in coitus an average of four times per week, 50% of couples will conceive within 6 months, and 85% within 12 months. These periods will be longer if sexual relations are less frequent. Couples who engage is coitus daily may have more difficulty conceiving than those who space coitus to every other day. This is because too-frequent coitus can lower a man’s sperm count to a level below optimal fertility.  The chance of subfertility increases with age. Because of this gradual decline in fertility, women who defer pregnancy to their late 30s are apt to have more difficulty conceiving than their younger counterparts. Women who are using oral, injectable, or implanted hormones for contraception may have difficulty becoming pregnant for several months after discontinuing these medications, because it takes that long for the body to restore normal functioning. A. Male Subfertility Factors Several factors typically lead to male subfertility: Disturbance in spermatogenesis Obstruction in the seminiferous tubules, ducts, or vessels preventing movement of spermatozoa Qualitative or quantitative changes in the seminal fluid preventing sperm motility Development of autoimmunity that immobilizes sperm Problems in ejaculation or deposition preventing spermatozoa from being placed close enough to a woman’s cervix to allow ready penetration and fertilization. 1. Inadequate Sperm Count. The sperm count is the number of sperm in a single ejaculation or in a milliliter of semen. The minimum sperm count considered normal is 20 million/ml of seminal fluid, or 50 million per ejaculation. At least 50% of sperm should be motile, and 30% should be normal in shape and form. Spermatozoa must be produced and maintained at a temperature slightly lower than body temperature to be fully motile. Any condition that significantly increases body temperature such as a chronic infection from tuberculosis or recurrent sinusitis can lower a sperm count. Actions that increase scrotal heat, such as working at desk jobs or driving a great deal everyday may produce lower sperm counts compared with men whose occupations allow them to be ambulatory at least part of each day. Frequent use of hot tubs or saunas may also lower sperm counts appreciably. Congenital abnormalities such as cryptorchidism (undescended testes) may lead to lowered sperm production if surgical repair of this problem was not completed until after puberty or if the spermatic cord became twisted after the surgery. A varicocele or varicosity of the spermatic vein could increase temperature within the testes and slow and disrupt spermatogenesis although whether this actually causes much difference is in doubt. If this is happening, surgery to repair the varicocele has the potential to increase the chance for conception. Other conditions that may inhibit sperm production are trauma to the testes; surgery on or near the testis that results in impaired testicular circulation; and endocrine  imbalances, particularly of the thyroid, pancreas, or pituitary glands. Drug use or excessive alcohol use and environmental factors such as exposure to x-rays or radioactive substances have also been found to negatively affect spermatogenesis. Men who are exposed to radioactive substances in their work environment should be provided adequate protection of the testes. When undergoing pelvic radiography, be certain that men and boys are always furnished with a protective lead testes shield. If sperm are present but the total count is low, a man may be advised to abstain from coitus for 7 to 10 days at a time to increase the count. Ligation of a varicocele (if present) and changes in lifestyle (e.g., wearing looser clothing, avoiding long periods of sitting, avoiding prolonged hot baths) may be helpful to reduce scrotal heat and increase the sperm count. 2. Ejaculation Problems Psychological problems, diseases such as cerebrovascular accident, diabetes, or Parkinson’s disease, and some medications (certain antihypertensive agents) may result in erectile dysfunction (formerly called impotence or the inability to achieve an erection). This condition is primary if the man has never been able to achieve erection and ejaculation in the past but now has difficulty. Erectile dysfunction can be a difficult problem to solve if it is associated with stress, because this is not easily relieved. Solutions to the problem can include psychological or sexual counseling as well as use of a drug such as sildenafil. Premature ejaculation (ejaculation before penetration) is another factor that may interfere with the proper deposition of sperm. It is another problem often attributed to psychological causes. Adolescents may experience it until they become more experienced in sexual techniques. 3. Obstruction or Impaired Sperm Motility Obstruction may occur at any point along the pathway that spermatozoa must travel to reach the outside: the seminiferous tubules, the epididymis, the vas deferens, the ejaculatory duct, or the urethra. Diseases such as mumps orchitis, epididymitis, and tubal infections such as gonorrhea or ascending urethral infection can result in this type of obstruction because adhesions form and occlude sperm transport. Congenital stricture of a spermatic duct may occasionally be seen. Benign hypertrophy of the prostate gland occurs in most men beginning at about 50 years of age. Pressure from the enlarged gland on the vas deferens can interfere with sperm transport. Infection of the prostate, through which the seminal fluid must pass, or infection of the seminal vesicles can change the composition of the seminal fluid enough to reduce sperm motility. Anomalies of the penis, such as hypospadias (urethral opening on the ventral surface of the penis) or epispadias (urethral opening on the dorsal surface), can cause sperm to be deposited too far from the sexual partner’s cervix to allow optimal cervical penetration. Extreme obesity in a male may also interfere with effective penetration and deposition. If sperm are not motile because the vas deferens is obstructed, the obstruction is most likely to be extensive and difficult to relieve by surgery. Sperm can be extracted by syringe from a point proximal to vas deferens blockage and used for intrauterine insemination. If the problem appears to be that sperm are immobilized by vaginal secretions because of an immunologic factor, the response can be reduced by abstinence or condom use for about 6 months. However, to avoid this prolonged time interval, washing of the sperm and  intrauterine insemination may be preferred. The administration of corticosteroids to a woman may have some effect in decreasing sperm immobilization because it reduces her immune response and antibody production. B. Female Subfertility Factors The factors that cause subfertility in women are analogous to those causing subfertility in men: anovulation (faulty or inadequate production on ova), problems of ova transport through the fallopian tubes to the uterus, uterine factors such as tumors or poor endometrial development, and cervical and vaginal factors that immobilize spermatozoa. In addition, nutrition, body weight, and exercise may be responsible. 1. Anovulation This is the most common cause of subfertility in women and may occur from a genetic abnormality such as Turner’s syndrome (hypogonadism) in which there are no ovaries to produce ova. Ovarian tumors may also produce anovulation because of feedback stimulation on the pituitary. Chronic or excessive exposure to x-rays or radioactive substances, general ill health, poor diet, and diet may all contribute to poor ovarian function. When either glucose or insulin levels are too high, they can disrupt the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH) leading to subfertility from ovulation failure. Women should maintain an ideal body weight and height, as represented by a BMI of 20 to 24. Eating slowly digested carbohydrate foods such as brown rice, pasta, dark bread, beans, and fiber-rich vegetables rather than food such as white bread and cold breakfast cereals that have easily digested carbohydrates can not only increase fertility but perhaps prevent gestational diabetes when a woman does become pregnant. It is also important to consume unsaturated fatty acids rather than saturated or trans-fatty acids. Although eating adequate protein is important for fertility, excessive intake of protein may be yet another deterrent to fertility. Exercising 30 minutes a day by walking or doing mild aerobics can help regulate blood glucose levels. Some women ovulate only a few times a year because of polycystic ovary syndrome. This is associated with the metabolic syndrome (a waist circumference of 35 or above in women, a fasting blood glucose >100 mg/dl, serum triglycerides >150 mg/dl, blood pressure >135/85 mmHg, and high-density lipoprotein cholesterol