Care of Mother and Child at Risk (Acute and Chronic) Module 16 Student Activity Sheet PDF

Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: ___________________...

Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ LESSON TITLE: CARE OF MALE AND FEMALE CLIENTS WITH Materials: GENERAL AND SPECIFIC PROBLEMS IN REPRODUCTION AND SEXUALITY Pen, paper, index card, book, and class List Learning Targets: At the end of the module, students will be able to: References: 1. Describe common causes of difficulty with conception or subfertility in both men and women. Pilliteri, Adele and Silbert-Flagg, JoAnne 2. Integrate common causes of difficulty with conception or (2018) Maternal and Child Health Nursing, 8th subfertility in both men and women in developing nursing Edition. USA: Lippincott Williams and Wilkins process to achieve quality maternal and child health nursing care. A. LESSON PREVIEW/REVIEW Instruction: Enumerate the classifications of thrombophlebitis and discuss each briefly. 1. ______________________________________________________________________________________ 2. ______________________________________________________________________________________ 3. ______________________________________________________________________________________ B. MAIN LESSON DEFINITION OF TERMS STERILITY- inability to conceive because of a known INFERTILITY- old term; inability to conceive a child or condition, such as the absence of a uterus sustain a pregnancy to birth *when engaging in coitus an average of 4x a week, 50% of couples will conceive within 6 months, & 85% SUBFERTILITY- term used more often than infertility within 12 months because most couples have the potential to conceive but are less able to do so without additional help. *too frequent coitus can lower sperm count *chance of subfertility increases with age -when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus. MALE SUBFERTILITY FACTORS  Disturbance in spermatogenesis  PRIMARY SUBFERTILITY- no previous  Obstruction in the seminiferous tubules, ducts or conception vessels  Qualitative & quantitative changes in the seminal  SECONDARY SUBFERTILITY- there has been a fluid preventing sperm motility previous viable pregnancy but the couple has been  autoimmunity that immobilizes sperm unable to conceive at present  Problems in ejaculation or deposition INADEQUATE SPERM COUNT OBSTRUCTION OR IMPAIRED MOTILITY  Sperm count- # of sperm in a single ejaculation or  Mumps orchitis- testicular inflammation & in a milliliter of semen; 33 to 46M/ml or scarring because of mumps virus 50M/ejaculation,  Epididymitis, tubal infections such as gonorrhea  at least 50% should be motile and or urethral infections may cause adhesions  30% should be normal in shape and form occluding sperm transport  Produced and maintained at a temperature lower  Benign hypertrophy of the prostate gland puts than body temp to be fully motile pressure on the vas deferens THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________  Infection of the prostate gland or seminal  CRYPTORCHIDISM (undescended testicles) vesicles may change composition of seminal lowers sperm production if surgical repair was not fluid completed until after puberty or if spermatic cord  Autoimmune reaction that immobilize sperm in becomes twisted after the surgery men who had vasectomies or obstruction of vas deferens  VARICOCELE- varicosity of the spermatic vein  Hypospadias, epispadias can cause sperm to could increase the temp within the testes and slow be deposited too far from the sexual partner’s and disrupt spermatogenesis; surgery is an option cervix Extreme obesity may interfere with penetration and Other conditions: trauma, surgery near the testicles deposition impairing circulation, endocrine imbalance (thyroid, pancreas or pituitary glands), use of alcohol, drugs, xray, radioactive substances EJACULATION PROBLEMS  Psychological problems, CVA, DM, Parkinson’s disease, medications (anti HPN) may cause erectile dysfunction  ERECTILE DYSFUNCTION- formerly called IMPOTENCE; inability to achieve an erection  PRIMARY ERECTILE DYSFUNCTION- never been able to achieve erection and ejaculation  SECONDARY ERECTILE DYSFUNCTION- the man has been able to achieve ejaculation in the past but is now unable to  Solutions: psychological/sexual counseling, sildenafil (VIAGRA)  PREMATURE EJACULATION- ejaculation before penetration FEMALE SUBFERTILITY FACTORS ANOVULATION TUBAL TRANSPORT PROBLEMS  TURNER’S SYNDROME (hypogonadism- no  Scarring in the fallopian tubes ovary), hormonal imbalance due to hypothyroidism,  PELVIC INFLAMMATORY DISEASE- infection ovarian tumors, exposure to xray or radiation, of the pelvic organs: uterus oviducts, ovaries general ill health, poor diet, exercise, stress and their supporting structures initially caused by  Nutrition, body weight and exercise influence an STD most frequently due to Chlamydia or glucose/insulin balance; if either is too high, it gonorrhea disrupts production of FSH & LH  invasion of fallopian tube is usually at the end of  Stress reduces production of GnRH lowering menstruation because menstrual blood is an production of LH & FSH excellent medium for bacterial growth and at this  Decreased body weight or a body/fat ratio of less time there is usually a loss of normal cervical than 10% lowers FSH/LH mucus barrier  Most common cause is the naturally-occurring  -high incidence in IUD users variations in ovulatory patterns or polycystic ovary syndrome in which excess testosterone is produced lowering FSH & LH UTERINE PROBLEMS CERVICAL PROBLEMS  Tumors or fibromas (leiomyomas) may block entrance to  infection or inflammation of cervix may thicken FP or limit space on uterine wall for effective implantation cervical mucus   Stenotic cervical os, polyps prevent sperm  Congenitally deformed uterus penetration   Previous D & C, cervical conical surgery may  Poor secretion from the ovaries may result in inadequate cause scar tissue & tightening of the cervical os endometrium formation (overproduction or underproduction) VAGINAL PROBLEMS   Infection of the vagina can cause pH to become  ENDOMETRIOSIS- occurs when bits of the tissue that acidotic, limiting or destroying motility of sperm THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ lines the uterus (endometrium) grow on other pelvic organs, such as the ovaries or fallopian tubes. UNEXPLAINED SUBFERTILITY   No known cause for subfertility can be  most common sites: pouch of Douglas, ovaries, uterine discovered ligaments, outer surface of the uterus, the bowel  It is usually a combination of several insignificant  in the FP, may cause obstruction, adhesions factors  can be treated medically and surgically FERTILITY ASSESSMENT 1. HEALTH HISTORY 3. FERTILITY TESTING FOR THE MALE a. SEMEN ANALYSIS  General Health  After 2 to 3 days of sexual abstinence the man  Nutrition ejaculates by masturbation into a clean, dry  Alcohol, drug or tobacco use specimen jar.  Congenital health problems such as hypospadias,  The number of sperm are counted and then cryptorchidism examined under a microscope within 1 hour  Illnesses such as mumps, orchitis, UTI, STD  Average ejaculation should produce MINIMUM  General Health 1.4 to 1.7 ml of semen and should contain a  Nutrition minimum of 20M/ml  Alcohol, drug or tobacco use  Analysis may be repeated after 2 to 3 months  Congenital health problems such as hypospadias, because 30-90 days is needed for new sperm to cryptorchidism reach maturity  Illnesses such as mumps, orchitis, UTI, STD  Sperm motility can be tested with a self-test kit  Current illnesses, part. Endocrine illnesses or low- grade infections b. SPERM PENETRATION ASSAY & ANTISPERM  Past & current occupation and work habits (sitting ANTIBODY TESTING all day, exposure to xray or radiation)  Done to test if the sperm can penetrate the  Sexual practices such as the frequency of coitus ovum and masturbation, failure to achieve ejaculation,  With IVF, poorly motile sperm or those with poor premature ejaculation, coital positions, and use of penetration can be injected directly into a lubricants woman’s ovum (INTRACYTOPLASMIC SPERM  Past contraceptive measures, existence of any INJECTION) children produced from a previous relationship  Any complementary alternative therapy such as c. OVULATION MONITORING herbal additives the couple is using (acupuncture,  The least expensive method is to record BBT for herbs) at least 4 months  At the time of ovulation the temp dips slightly FOR THE FEMALES (0.5F) then rises to a level no higher than normal  Current or past reproductive problems such as body temp until 3-4 days before the next infections menstrual flow. The increase in temp ,marks the  Overall health, emphasizing endocrine problems time of ovulation because it occurs immediately such as galactorrhea (breast nipple secretions) or at the beginning of the luteal phase thyroid dysfunction  The temp rise should last approximately 10  Abdominal or pelvic operations that could have days. If not, luteal phase defect is suggested compromised blood flow to the pelvic organs (Progesterone production begins but is not  Past hx of childhood cancer treated with radiation sustained) that might have reduced ovarian function  The use of douches or intravaginal meds or sprays d. OVULATION DETERMINATION BY TEST STRIP that could interfere with vaginal pH  Tests upsurge of LH by dipping a test strip into THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________  Exposure to occupational hazards such as xrays or midmorning urine then comparing the color toxic substances change  Nutrition including an adequate source of folic acid  These are OTC kits easy to use, marks the point and avoidance of trans-fats just before ovulation unlike the BBT and  If she can detect ovulation through such symptoms advantageous for women with irregular work. as breast tenderness, midcycle wetness or lower abdominal pain (mittelschmerz) FERRELL Testing Kit contains both tests for FSH the  Age of menarche 3rd day of the menstrual cycle (abnormally high FSH  Length, regularity and frequency of menstrual indicates that the ovaries are not responding well to periods ovulation) and a sperm motility test for the male;  Amount of flow woman’s result is available in 30 mins and the man’s in  Any difficulties experienced such as premenstrual 10 mins; expensive dysphoric disorder(PDD)  History of contraceptive use e. TUBAL PATENCY  History of any previous pregnancies or abortions  UTZ, XRAY used to determine patency of FT and assess depth and consistency of the 2. PHYSICAL ASSESSMENT endometrial lining For the MALE  SONOHYSTEROGRAPHY/SALINE SOLUTION  Detection of the presence of secondary sexual SONOHYSTEROGRAPHY- uterus is filled with characteristics and genital abnormalities such as sterile saline introduced through a narrow absence of vas deferens, undescended testes or catheter through the cervix then transvaginal varicocele UTZ transducer is inserted into the vagina to For the FEMALE detect abnormalities in the uterus ( septal  Breast and thyroid examination deviation, myoma); can be done anytime during  Secondary sexual characteristics which indicates the cycle maturity and pituitary function  Complete pelvic examination including PAP smear  HYSTEROSALPINGOGRAPHY- done after menstrual flow to avoid reflux of menstrual debris into the FP; iodine-based radiopaque material is introduced into the cervix under pressure; the radiopaque material outlines the uterus & both tubes if the tubes are patent 4. ADVANCED SURGICAL PROCEDURES a. UTERINE ENDOMETRIAL BIOPSY  If biopsy is done during 2nd half of MC, endometrium resembles a corkscrew, then ovulation occurred  At present, biopsies are replaced by serum progesterone level evaluations to detect if ovulation has occurred  Done 2-3 days before expected menstrual flow (Day 25 or 26 of a 28-day cycle)  After paracervical block, a thin probe and biopsy forceps are introduced through the cervix and a specimen is taken from the anterior or posterior wall  Contraindicated if pregnancy is suspected, or if infection (CERVICITIS, PID) is present  Spotting is common after the procedure b. HYSTEROSCOPY  Visual inspection of the uterus through insertion of HYSTEROSCOPE c. LAPAROSCOPY Introduction of a thin, hollow, lighted tube through a small incision in the abdomen just under the umbilicus SUBFERTILITY MANAGEMENT A.FOCUSES ON CORRECTIONOF UNDERLYING B. ASSITED REPRODUCTIVE TECHNIQUES PROBLEM 1. Therapeutic Insemination 1. Increasing Sperm Count and Motility  Instillation of sperm into the female reproductive THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________  Correct obstruction if present. tract to aid conception  If sperm count is low, advise to abstain from coitus  Intracervical Insemination for 7-10 days at a time to increase the count  Intrauterine insemination  Ligation of varicocele  Average of 6 months to achieve conception  Changes in lifestyle- loose underwear, avoiding prolonged periods of sitting and prolonged hot baths 2. Reducing the Presence of Infection 2. In Vitro Fertilization  1 or more oocytes are removed from the ovary 3. Hormone Therapy by laparoscopy and fertilized by exposure to  For disturbance in ovulation GnRH therapy sperm under laboratory conditions outside a  Clomiphene citrate (Clomid, Serophene) may woman’s body. stimulate ovulation  After 40 hours of fertilization, fertilized ova are  Human menopausal gonadotropins inserted into the uterus (Pergonal/MENOTROPINS), combi of FSH & LH  For blocked or damaged FT, oligospermia, lack derived from postmenopausal urine in conjunction of cervical mucus, antisperm antibodies, with administration of hCG is given unexplained subfertility  If increased Prolactin levels are detected,  Donor ovum can be used bromocriptine (Parlodel) is added to the medication regimen to reduce prolactin and allow increase in 3. Gamete Intrafallopian Transfer (GIFT) gonadotropins  Ova are obtained as in IVF then both ova and  Administration of clomiphene or Pergonal may sperm are instilled within a matter of hours, hyperstimulate the ovaries causing multiple ova to using a laparoscopic technique, into the open to mature resulting in multiple births end of a FT  If vaginal secretions are too scant, low-dose  Fertilization the occurs in the tube and moves to estrogen therapy to increase mucus production the uterus for implantation during days 5 to 10;Conjugated estrogen  Contraindicated for blocked FT (Premarin) is a type of estrogen for this purpose 4. Zygote Intrafallopian Transfer (ZIFT) For luteal phase defect, progesterone vaginal suppositories  Oocyte retrieval by transvaginal, UTZ-guided begun on the 3rd day of temp rise and continued for the aspiration, followed by culture and insemination next 6 weeks (if pregnancy occurs) or until menstrual flow of oocytes in the laboratory begins  Within 24 hours, fertilized eggs are transferred by laparoscopic technique into the end of an 4. Surgery open FT  Re-anastomosis of previously ligated FT but the success rate is 70%-80% & increases risk of 5. Surrogate Embryo Transfer ectopic pregnancy  For a woman who does not ovulate  IUI is commonly done  Use of donor oocyte  Myomectomy via hysteroscopic ambulatory  MCs of both donor and recipient are procedure if the tumor is small and adhesions lysed synchronized by administration of gonadotropic by hysteroscopy. Estrogen is give for 3 months to hormones prevent adhesions from reforming and an IUD may  At the time of ovulation, donor’s ovum is be inserted to prevent uterine sides from touching removed by transvaginal. UTZ-guided procedure  Surgery to correct uterine abnormalities  Oocyte is fertilized in the laboratory and placed  For tubal insufficiency from inflammation, diathermy in the recipient woman’s uterus by embryonic or steroids; canalization of FP and plastic surgical transfer repair 6. Preimplantation Genetic Diagnosis  Done to detect congenital abnormalities ALTERNATIVE TO CHILDBIRTH 1. Surrogate Mothers  A woman who has agreed to carry a pregnancy to term for a subfertile couple THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________  The surrogate may provide the ova or ova and sperm may be donated by the couples 2. Adoption  An alternative to subfertile, LGBTQ couple, genetic-health related conditions, conditions that would make pregnancy high risk 3. Child-free Living  For both fertile and subfertile couples who have been through the rigors and frustrations of subfertility testing and unsuccessful treatment regimen. CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. 1. This is the term used more often than infertility because most couples have the potential to conceive but are less able to do so without additional help: A. Subfertility B. Infertility C. Fertility D. Sterility Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. This is the inability to conceive because of a known condition, such as the absence of a uterus: A. Subfertility B. Infertility C. Fertility D. Sterility Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. This is done to test if the sperm can penetrate the ovum: A. Fertility Testing B. Semen Analysis C. Sperm Penetration Assay and Antisperm Antibody Testing D. Ovulation Monitoring E. Ovulation Determination by Test Strip F. Ferrell Testing Kit Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. This tests the upsurge of Luteinizing Hormone by dipping a test strip into midmorning urine then comparing the color change: A. Fertility Testing B. Semen Analysis C. Sperm Penetration Assay and Antisperm Antibody Testing D. Ovulation Monitoring THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 6  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ E. Ovulation Determination by Test Strip F. Ferrell Testing Kit Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. This test contains both tests for FSH the 3rd day of the menstrual cycle and a sperm motility test for the male: A. Fertility Testing B. Semen Analysis C. Sperm Penetration Assay and Antisperm Antibody Testing D. Ovulation Monitoring E. Ovulation Determination by Test Strip F. Ferrell Testing Kit Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. A type of Assisted Reproductive Technique wherein at the time of ovulation, donor’s ovum is removed by transvaginal with ultrasound guided procedure and the oocyte is fertilized in the laboratory and placed in the recipient woman’s uterus: A. Therapeutic Insemination B. In Vitro Fertilization C. Gamete Intrafallopian Transfer (GIFT) D. Zygote Intrafallopian Transfer (ZIFT) E. Surrogate Embryo Transfer Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. A type of Assisted Reproductive Technique wherein instillation of sperm into the female reproductive tract to aid conception: A. Therapeutic Insemination B. In Vitro Fertilization C. Gamete Intrafallopian Transfer (GIFT) D. Zygote Intrafallopian Transfer (ZIFT) E. Surrogate Embryo Transfer Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. A type of Assisted Reproductive Technique in which ova are obtained as in In Vitro Fertilization then both ova and sperm are instilled within a matter of hours, using a laparoscopic technique, into the open end of a fallopian tube: A. Therapeutic Insemination B. In Vitro Fertilization C. Gamete Intrafallopian Transfer (GIFT) D. Zygote Intrafallopian Transfer (ZIFT) E. Surrogate Embryo Transfer Answer: ________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 7  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. A type of Assisted Reproductive Technique wherein oocyte retrieval by transvaginal, ultrasound-guided aspiration, followed by culture and insemination of oocytes in the laboratory: A. Therapeutic Insemination B. In Vitro Fertilization C. Gamete Intrafallopian Transfer (GIFT) D. Zygote Intrafallopian Transfer (ZIFT) E. Surrogate Embryo Transfer Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. A type of Assisted Reproductive Technique is done by one or more oocytes are removed from the ovary by laparoscopy and fertilized by exposure to sperm under laboratory conditions outside a woman’s body: A. Therapeutic Insemination B. In Vitro Fertilization C. Gamete Intrafallopian Transfer (GIFT) D. Zygote Intrafallopian Transfer (ZIFT) E. Surrogate Embryo Transfer Answer: ________ Rationale:________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ C. LESSON WRAP-UP AL Activity: Formative Assessment This strategy focuses on the assessment of your learnings after a lesson. You must answer the following questions, as honest as possible, based on your own understanding. 1. What specific part of the Main Lesson for this session do you find the most confusing? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________________ 2. What makes your answer in #1 confusing? What is the question in your mind? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________________________________________________ 3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic? _________________________________________________________________________________________________ _________________________________________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 8  Care of Mother and Child at Risk or with Problems (Acute and Chronic) Module #16 Student Activity Sheet Name: _________________________________________________________________ Class number: _______ Section: ____________ Schedule: ________________________________________ Date: ________________ _________________________________________________________________________________________________ _____________________________________________________________________ THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 9