MCN1 - Module1B PDF

MCN 1 – M1B: THE NURSING ROLE IN PREPARING FAMILIES FOR CHILDBEARING AND CHILDREARING The Nursing Role in Reproductive and Sexual Health Assessing & Meeting Reproductive Concerns Unitive and Procreate Marriage → When a man and woman “unite as one flesh”...

MCN 1 – M1B: THE NURSING ROLE IN PREPARING FAMILIES FOR CHILDBEARING AND CHILDREARING The Nursing Role in Reproductive and Sexual Health Assessing & Meeting Reproductive Concerns Unitive and Procreate Marriage → When a man and woman “unite as one flesh” (sex is unitive) → The marital meaning is only present when the natural sexual act occurs between a man and a woman married to each other. Marriage is open of the possibility of having children. (sex is procreation) Unitive → The unitive meaning is a specific type of physical union, the sexual union of a man and a woman in natural intercourse. This type of sexual act is in harmony with, and ordered toward, the other meanings:  marital and procreative Procreative → The procreative meaning is found only in natural intercourse. This type of sexual act is inherently ordered toward the creation of new human life. Even if each natural sexual act does not produce new life, its ordering toward new life is necessary to have the good moral object of the procreative meaning. Marital, Unitive, Procreative → Every sexual act is marital unitive, and procreative is an inherently good type of sexual act. However, the other two fonts of morality—intention and circumstances—must also be good for the couple to avoid sin. Reproductive Development INTRAUTERINE DEVELOPMENT Sex Determination Occurs at conception based on chromosome information from sperm and ovum Gonadal Formation Gonads (ovaries/testes) form by week 5 Presence of two undifferentiated ducts: o Mesonephric (Wolffian) duct → male reproductive organs (if testosterone is present)  o Paramesonephric (Mullerian) duct → female reproductive organs (if testosterone is absent) Oocytes form in ovaries by week 10 External Genital Development (week 12) Testosterone influences male genital formation Absence of testosterone leads to female genital formation Hormonal imbalances can cause ambiguous genitalia THE MALE REPRODUCTIVE SYSTEM Physiology of the Male Reproductive System  The function of the male reproductive system depends on hormonal and neural mechanisms  Andrology → study of the male reproductive organs Male Reproductive System  Male External Reproductive Structures Scrotum Structure rugated, skin-covered, muscular pouch suspended from the perineum Functions supports the testes regulates sperm temperature through muscle contraction and relaxation Testes Structure Two ovoid glands (2-3cm wide) resting in the scrotum Encased in a protective white fibrous capsule Contain: o Leydig cells – produce testosterone o Seminiferous tubules – produce spermatozoa Development Form in the pelvic cavity; descend into the scrotum between 34-38 weeks of gestation Preterm infants may have undescended testes (cryptorchidism), increasing the risk of infertility and testicular cancer Hormonal Regulation Hypothalamus releases GnRH → stimulates pituitary to release FSH & LH o FSH – triggers androgen-binding protein (ABP) protein o LH – stimulates testosterone release  o Testosterone + ABP – promote sperm formation o Negative feedback regulates hormone production Testicular Positioning One testis (typically the left) is lower than the other to prevent trauma External position keeps sperm temperature ~1oF lower than body temp. for survival Penis Structure Composed of three cylindrical masses of erectile tissue Contains the urethra, serving as an outlet for both urinary and reproductive systems Erection Mechanism Nitric Oxide release → arterial blood flow increases Ischiocavernosus muscle contracts → traps blood, leading to erection Glans and Prepuce Glans – bulging, sensitive ridge at the distal end Prepuce – retractable skin casing protecting the glans Circumcision Surgical removal of the prepuce, often for cultural or religious reasons  Male Internal Reproductive Structures Epididymis Structure Tightly coiled tube (~20ft long) connected to the seminiferous tubules Function Conducts sperm from the testes to the vas deferens store sperm and produces part of the alkaline seminal fluid sperm take 12-10 days to pass through the epididymis and 65-75 days to fully mature sperm are immobile and incapable of fertilization at this stage Vas Deferens Structure Hollow tube surrounded by arteries, veins, and a thick fibrous coating (spermatic cord) Function  Carries sperm from the epididymis through the inguinal canal into the abdominal cavity Connects to the seminal vesicles and ejaculatory ducts bellow the bladder Sperm complete maturation but remain due to acidic semen Seminal Vesicles Structure Two convoluted poches along the lower bladder Function Secretes a viscous alkaline fluid rich in sugar, protein, and prostaglandins Helps sperm motility by providing a more favorable pH environment Ejaculatory ducts Structure Pass through the prostate gland and join the seminal vesicles to the urethra Function Prostate gland Structure Chestnut-sized gland located below the bladder, surrounding the urethra Function Secretes a thin, alkaline fluid to neutralize the acidic urethra Enhances sperm survival and mobility Bulbourethral (Cowper) glands Structure Two small glands beside the prostate  Function Secretes additional alkaline fluid to protect sperm during passage Contributes 5% of semen volume Semen is from prostate gland (60%), seminal vesicles (30%), epididymis (5%), and bulbourethral glands (5%) Urethra Structure Hollow tube (8 in/18-20cm long) passing from the bladder through the prostate and penis Lined with mucous membrane Function Serves as the outlet for urine and semen Secondary Sex Characteristics In boys, production of spermatozoa doesn't begin before birth like the production of eggs in girls. Also, unlike the cyclical release of eggs in females, sperm production in males is a continuous process. Sperm production continues from puberty throughout the male’s life. Secondary sex characteristics of boys usually occur in the order of: 1. Increase in weight 2. Growth of testes 3. Growth of face, axillary, and pubic hair 4. Voice changes 5. Penile growth 6. Increase in height 7. Spermatogenesis (production of sperm) Regulation of sex hormone secretion  GnRH stimulates LH and FSH release from the anterior pituitary o LH → stimulates the interstitial cells to produce testosterone o FSH → stimulates the sperm cell formulation o Inhibin → produced by sustentacular cells; Inhibits FSH secretion During Puberty  Before: small amounts of testosterone inhibit GnRH release  During: testosterone completely suppresses GnRH release, resulting- Role of Androgen  Produced by adrenal cortex and testes → affects genital growth, hair patterns, voice deepening, and bone growth Effects of Testosterone  Hair growth stimulation and inhibition  Increased skin thickness and melanin and sebum production  Enlargement of the larynx and deepening of the voice  Increased protein synthesis (muscle), bone growth, blood cell synthesis, blood volume  Metabolic rate increases Male Sexual Behavior and The Male Sexual Act  Testosterone is required  Male sexual acts includes erection, emission, ejaculation, orgasm, and resolution  Stimulation of sexual acts can be psychic or tactile Sexual Response Cycle (???) 1. Orgasm 2. Excitement 3. Plateau 4. Resolution  THE FEMALE REPRODUCTIVE SYSTEM Physiology of the Female Reproductive System  Role of estrogen → When triggered at puberty by FSH, ovarian follicles in females begin to excrete a high level of hormone estrogen → This hormone is not one substance but three compounds ▪ E1 – Estrone ▪ E2 – Estradiol ▪ E3 – Estriol  Increase in estrogen levels in the female at puberty influences the development of the uterus _____  Adrenarche → development of pubic and axillary hair because of androgen stimulation  Thelarche → beginning of breast development  Gynecology → study of the female reproductive organs Female Reproductive System Female External Reproductive Structures The structures that form the female external genitals are termed the vulva (Latin = covering). Mons Veneris Structure Pad of adipose tissue over the symphysis pubis Covered with coarse, curly pubic hair Function Protects the pubic bone junction from trauma Labia Minora Structure Two hairless folds of connective tissue Changes in size and thickness with age (thin before menarche, thick in childbearing year, atrophied after menopause) Function Contains sebaceous glands, which can develop cysts Plays a role in vulvar examination for infections or abnormalities Labia Majora Structure Two folds of loose connective tissue covered by epithelium and pubic hair Fused anteriorly, separated posteriorly Function Protects the external genitalia, shields urethral and vaginal openings Susceptible to trauma-induced swelling (e.g., from childbirth or S.A.) Other External Organs a. Vestibule Structure Flattened, smooth surface inside the labia minora Contains openings for: Urethra (bladder outlet); Vagina (uterus outlet) b. Clitoris Structure Small (1-2 cm) rounded organ of erectile tissue Covered by a fold of skin (prepuce) Internal components (clitoral crura) extend laterally along corpus cavernosum Function Center of sexual arousal and orgasm Becomes engorged with blood during stimulation due to ischiocavernosus muscle contraction Subject to female genital cutting in some cultures c. Skene Glands (Paraurethral Glands) Structure  Located on each side of the urinary meatus Secretes lubricating fluid during intercourse d. Bartholin Glands (Vulvovaginal Glands) Structure Located on each side of the vaginal opening Secretes alkaline mucus to enhance sperm survival Prone to infection and swelling, leading to Bartholin cysts e. Fourchette Structure Ridge of tissue where the labia minora and majora meet posteriorly Function May tear or be cut (episiotomy) during childbirth to widen the vaginal opening f. Perineal Body (Perineal Muscle) Structure Muscular area between the vagina and anus Function Stretches during childbirth to allow fetal passage Exercises like Kegels improve flexibility and prevent tearing g. Hymen Structure Elastic semicircle of tissue covering the vaginal opening Can be torn by sexual activity, tampon use, or sports Vulvar Blood Supply Major Blood Vessels  Pudendal artery (primary supply) Inferior rectus artery (additional supply) Clinical Significance Venous pressure from pregnancy may cause varicosities in the labia majora and legs Rich blood supply aids rapid healing but also increases risk of hematomas Vulva Nerve Supply Structure Anterior Vulva – supplied by ilioinguinal and genitofemoral nerves (L1 level) Posterior Vulva and Vagina – supplied by pudendal nerve (S3 level) Function Highly sensitive to touch, pressure, pain and temperature Temporary numbness occurs in the perineum during childbirth, reducing pain sensation  Female Internal Reproductive Structures Ovaries Almond-shaped organs (3 cm long, 2 cm diameter, 1.5 cm thick) Located bilaterally in the lower abdomen near the uterus Functions: o Produce, mature, and release ova (egg cells) o Secrete estrogen and progesterone o Regulate menstrual cycles Suspended by three strong ligaments, allowing mobility Unique in lacking peritoneal covering, enabling direct release of ova into the fallopian tubes Susceptible to tumor growth due to mobility, making ovarian cancer difficult to detect early The Division of Reproductive Cells (Gametes) At birth: ~2 million oocytes per ovary (formed during intrauterine life) Chromosome number: o Normal human cells: 46 chromosomes (22 pairs of autosomes, 1 pair of sex chromosomes) o Reproductive cells (ova & sperm): 23 chromosomes Oocytes undergo mitotic division in utero, halting until puberty Meiosis (cell reduction division) resumes at ovulation Fertilization determines sex (XX = female, XY = male) The Maturation of Oocytes Initial oocyte count (~7 million in utero) declines over time: o Birth: ~2 million per ovary o Age 7: ~500,000 per ovary o Age 22: ~300,000 per ovary o Menopause: Depletion of functional oocytes Fallopian Tubes Arise from the uterine body, extending outward (10 cm long) Functions: o Transport ova from ovaries to uterus o Site of fertilization  Anatomical divisions: 1. Interstitial portion (1 cm long, within uterine wall) 2. Isthmus (2 cm long, site of tubal ligation) 3. Ampulla (5 cm long, common fertilization site) 4. Infundibulum (2 cm long, fimbria assist ovum capture) Lined with mucous-secreting and ciliated cells, aiding ovum movement Open pathway can allow peritonitis if infection spreads Uterus Hollow, muscular, pear-shaped organ (5-7 cm long, 5 cm wide) Located in the lower pelvis (posterior to bladder, anterior to rectum) Functions:  o Receive and nourish fertilized ovum o Protect and support fetal growth o Expel fetus at term Divisions: 1. Body (Corpus) - Largest section, expands during pregnancy 2. Isthmus - Narrow region connecting corpus and cervix 3. Cervix - Lower third, contains the cervical canal Uterine layers: 1. Endometrium - Inner mucous membrane (hormone- sensitive, sheds during menstruation) 2. Myometrium - Middle muscular layer (facilitates contractions, supports pregnancy) 3. Perimetrium - Outer connective tissue layer (provides strength and support) Uterine blood supply: o Derived from iliac arteries via uterine and ovarian arteries o Expands to accommodate fetal needs Uterine nerve supply: o Motor nerves (T5-T10), sensory nerves (T11-T12) – relevant for labor pain management Uterine support structures: o Broad ligaments (cover uterus, extend to pelvic walls)  o Round ligaments (stabilize position, can cause pain if stretched in pregnancy) o Posterior ligament (forms Douglas’ pouch, potential site for fluid accumulation) Uterine deviations: o Anteversion: the entire uterus tips far forward o Anteflexion: the body of the uterus is bent sharply forward at the junction with the cervix o Retroversion: the entire uterus tips far back o Retroflexion: the body of the uterus is bent sharply back just above the cervix Vagina A hollow, musculomembranous canal.  Positioned posterior to the bladder and anterior to the rectum. Extends from the cervix of the uterus to the external vulva. Functions o Serves as the organ of intercourse. o Acts as a conduit for sperm to the cervix. o Expands to function as the birth canal during childbirth. Orientation & Dimensions Position in the body: When lying on the back (e.g., during a pelvic exam), the vagina is inward and downward. Length: o Anterior wall: ~6 to 7 cm o Posterior wall: ~8 to 9 cm Anatomical Features Fornices (recesses around the cervix): o Posterior fornix: Collects semen post-coitus, aiding sperm migration. o Anterior & lateral fornices: Allow for palpation of surrounding structures (e.g., bladder, ovaries, rectum). Vaginal walls:  o Lined with stratified squamous epithelium (same as the cervix). o Consist of three layers: 1. Epithelial layer (produces glycogen-rich mucus). 2. Middle connective tissue layer. 3. Muscular wall (strong & elastic). o Contain rugae (folds) that allow for expansion (e.g., during childbirth). Bulbocavernosus muscle: o Acts as an external voluntary sphincter. o Strengthened by Kegel exercises, helping with birth preparation and postnatal recovery. Blood Supply Supplied by the vaginal artery (a branch of the internal iliac artery). Rich blood supply facilitates rapid healing but also causes profuse bleeding in case of trauma (e.g., childbirth tears). Nervous Innervation Sympathetic & parasympathetic innervation from S1 to S3 levels. Despite this, the vagina is not highly sensitive; sexual excitement is mainly a clitoral function.  pH & Protection Against Infection Vaginal mucus is rich in glycogen. Döderlein bacillus (lactose-fermenting bacteria) breaks down glycogen into lactic acid, creating an acidic pH. The acidic environment prevents bacterial infections. Hygiene recommendation: Avoid douches, sprays, and wipes, as they disrupt the natural protective acidity. Support Structures of the Female Reproductive System Pelvis Composed of: o Right and left innominate bones o Sacrum o Coccyx Forms the bony passage for childbirth. The relationship between pelvic size/shape and fetal size can impact labor and vaginal delivery. Symphysis Pubis The junction of the innominate bones at the front of the pelvis. Pelvic Measurements Used to assess the size of the birth canal and determine the likelihood of a safe vaginal delivery. Key Pelvic Measurements: 1. True Conjugate o From upper margin of symphysis pubis to sacral promontory. o Minimum length: 11 cm. o Measured via X-ray or ultrasound.  2. Diagonal Conjugate (Oblique Conjugate) o From lower border of symphysis pubis to sacral promontory. o Normal range: 12.5–13 cm. o Measured via vaginal examination. 3. Obstetric Conjugate o From inner surface of the symphysis pubis (slightly below the upper border) to the sacral promontory. o Most important pelvic measurement for labor. o Estimated by subtracting 1.5–2 cm from the diagonal conjugate. Pelvic Shapes 1. Android – Narrow, heart-shaped (male-type pelvis). 2. Anthropoid – Narrow, oval-shaped (resembles ape pelvis).  3. Gynecoid – Classic female pelvis, wide and well-rounded (ideal for childbirth). 4. Platypelloid – Wide but flat, may still allow vaginal delivery. Pelvic Divisions 1. False (Greater) Pelvis o The upper portion of the pelvis. o Supports the enlarging uterus, but not directly involved in childbirth. 2. Linea Terminalis o Dividing line between the false pelvis (upper) and true pelvis (lower). 3. True Pelvis o The lower half of the pelvis, composed of: ▪ Pubes (front) ▪ Ilia and ischia (sides) ▪ Sacrum and coccyx (back)  o Includes: ▪ Pelvic inlet ▪ Pelvic cavity ▪ Pelvic outlet o Pelvic measurements influence labor and delivery. Pelvic Divisions in Detail Inlet – Entrance to the true pelvis. o Transverse diameter: 13.5 cm o Anteroposterior diameter: 11 cm o Oblique diameters: 12.75 cm Cavity – Space between the inlet and outlet. Outlet – Inferior portion of the pelvis. o Bounded by: ▪ Coccyx (back) ▪ Ischial tuberosities (sides)  ▪ Inferior symphysis pubis & pubic arch (front) o Anteroposterior diameter is wider than the transverse diameter. Breasts (Mammary Glands) Develop from ectodermic tissue during fetal development. Remain undeveloped until puberty, when estrogen stimulates growth. Growth is due to: o Increase in connective tissue o Fat deposition Glandular tissue fully develops during first pregnancy. Development in Males Gynecomastia: Temporary breast enlargement during puberty. More noticeable in obese boys. Anatomy of the Breast Located anterior to the pectoral muscle. Breast tissue extends into the axilla. Breast self-examinations are no longer routinely recommended, but annual clinical exams are advised. During breast exams, the axillary region must be palpated to avoid missing tissue abnormalities. Milk Production & Lactation Milk glands (lobes) are divided by connective tissue partitions. Each breast contains ~20 lobes. Milk production occurs in acinar cells, which deliver milk to the nipple via lactiferous ducts. The nipple contains ~20 small openings for milk secretion. Ampulla (a reservoir behind the nipple) stores milk before breastfeeding. Nipple Function Composed of smooth muscle. Becomes erect with manual stimulation or sucking. Oxytocin release (from the posterior pituitary) causes milk ejection. Areola & Montgomery’s Tubercles Areola: Dark-pigmented skin around the nipple (~4 cm). Contains sebaceous glands (Montgomery’s tubercles), which lubricate the nipple. Blood Supply Supplied by branches of the: o Axillary artery o Internal mammary artery o Intercostal arteries  Rich blood supply ensures efficient milk production for breastfeeding. Secondary Sex Characteristics In girls, pubertal changes typically are manifest as: 1. Growth spurt 2. Increase in the transverse diameter of the pelvis 3. Breast development 4. Growth of pubic hair 5. Onset of menstruation 6. Growth of axillary hair 7. Vaginal secretion Menstrual Period Menarche → first menstrual period o Occurs at an average age of 12.4 years o It may occur as early as age 9 or as late as age 17 Irregular menstrual periods are the rule rather than the exception for the first year Menstrual periods do not become regular until ovulation consistently occurs with them this does not happen until 1-2 yrs after the menarche During Puberty  Menarche → first puberty  Begins when GnRH, FSH, LH, estrogen, and progesterone promote the development of the female primary and secondary sexual characteristics  Typically enters puberty at 9-12 yrs of age  A weight of ~95 lbs or body fat percentage may trigger puberty in girls  Female athletes or those with anorexia may experience delayed puberty Role of Androgen  Produced by adrenal cortex and ovaries → influences pubic/axillary hair growth (adrenarche) Female Sexual Behavior and the Female Sexual Act  Female sex drive is usually a series of events: 1. The erectile tissue of clitoris and the bulbs of the vestibule become filled with blood 2. The vestibular glands secrete mucus, and the vagina extrudes a mucus like substance 3. Orgasm and resolution occur Sexual Response Cycle 1. Unaroused 2. Excitement Phase 3. Plateau Phase 4. Orgasm 5. Resolution Phase  FERTILIZATION  It must take place 5 days before to 1 day after ovulation if fertilization is to occur  Sperm cell transport to the ampulla depends on the ability of the sperm cells to swim and possibly contradictions of __  Ampulla → site of fertilization MENOPAUSE  Cessation of menstruation cycle  Perimenopause → the time between the beginning of irregular menstrual cycles and menopause MENSTRUAL CYCLE Sexual Health