NCM107MODULE1INTRODUCTION-TO-MATERNAL-AND-CHILD-NURSINGSTUDENTCOPY.pptx

Registered Nurse, physician (Philippines), nurse practitioner EDWIN DEL ROSARIO, CCRN, ACNP. AGNP.MD (California) Graduated from University of Santo Tomas, BSN , with Honors Graduated from Pamantasan ng Lungsod ng Maynila, Doctor of Medicine, passed Physician boards, 2002 Prac...

Registered Nurse, physician (Philippines), nurse practitioner EDWIN DEL ROSARIO, CCRN, ACNP. AGNP.MD (California) Graduated from University of Santo Tomas, BSN , with Honors Graduated from Pamantasan ng Lungsod ng Maynila, Doctor of Medicine, passed Physician boards, 2002 Practice Medicine 2002-2005 Migrated to the U.S in 2005 Registered Nurse in California, certified Critical Care RN x 17 years Completed my MSN, Nurse practitioner program in Arizona USA Currently practicing as Nurse Practitioner in California and OVERVIEW OF MATERNAL AND CHILD NURSING LESSON 1 MATERNAL AND CHILD NURSING Scope of practice Preconception health care Care of women during three trimesters of pregnancy and puerperium Perinatal acre Care of children from birth through adolescents Philosophies Family centered Community centered Evidence-based Challenging roles for a nurse MCN NURSE ROLES Family oriented Patient advocate Independent nursing role Health promotion and disease prevention Health care resource Respects personal, cultural and spiritual attitudes Encourages developmental stimulation Assesses healthcare needs of the family Encourages family bonding and rooming- in Encourages early hospital discharge Community-oriented ANATOMY AND PHYSIOLOGY LESSON 3 ANATOMY AND PHYSIOLOGY MALE REPRODUCTIVE SYSTEM : EXTERNAL Scrotum  Protection  thermoregulation Testis  Lobules : Leydig cells  Seminiferous tubules Penis  Corpus spongiosum  Corpora cavernosa PENILE ERECTION MALE REPRODUCTIVE SYSTEM : INTERNAL Epididymis  Lies along the posterior border of each testis  Function: responsible for conducting sperm from testis to Vas deferens  Provide nourishment to maturing sperms Vas deferens  Transports sperm from epididymis to ejaculatory ducts Seminal Vesicles  lies on the lower portion of the urinary bladder  Empty into the urethra via ejaculatory duct  Secretes viscous portion of semen MALE REPRODUCTIVE SYSTEM : INTERNAL Ejaculatory ducts Pass through the prostate joins the seminal vesicles to urethra Components: fructose, Ejects sperm and seminal fluid form urethra to the outside cholesterol, Prostate gland CHON, sperm cells Lies below the urinary bladder Urethra passes through its center Functions: Added to the secretion from the seminal vesicles Secretes thin , alkaline fluid Contribute to sperm motility and viability Bulbourethral gland (Cowper's gland) Empties into urethra Secretes an alkaline fluid to counteract the acid secretion of urethra Provide lubrication for sperm passage Urethra Color: white, opalescent Hallow tube from base of bladder--- shaft ----- outside pH: 7.35-7.50 Volume: 3 ml  FEMALE REPRODUCTIVE ORGANS : EXTERNAL Mons Pubis Rounded, soft fullness over the symphysis Covered with pubic hair Labia Majora 2 fatty tissues containing folds of skin Expends from mons pubis to the perineum Labia minora narrow folds of skin, extends from clitoris to fourchette Clitoris Homologous to penis, erectile organ’ Highly sensitive tissue Above urethral meatus FEMALE REPRODUCTIVE ORGANS : EXTERNAL Bulb of vestibule  Located at the sides of vaginal orifice  Paired of elongated masses of erectile tissues Urethral meatus  Pink, reddened slit like opening,  marks the terminal end of urethra Paraurethral glands (Skene’s gland)  Located posterolateral inside the urethral meatus  Secretes vaginal secretions Hymen : membrane that covers the vaginal orifice Perineum  diamond shaped area medial to the thigh and buttocks  Contains external genitalia and anus Vagina INTERNAL FEMALE GENITALIA  Extends form introitus to cervix  Between bladder and rectum  Function: passageway for menses, sperm  copulation Uterus  Hollow muscular organ, pear shaped  Weighs 60 grams  Parts: cervix, isthmus, corpus, fundus  Layers: Perimetrium, myometrium, endometrium  Function: reproduction, menstruation, - nourishment for fetus  INTERNAL FEMALE GENITALIA Fallopian Tubes  Conveys the ovum from the ovaries to uterus  Where fertilization takes place  Parts: Interstitial. Isthmus, ampulla, infundibulum Ovaries  Located at posterior surface of the broad ligaments  Functions  Release of matured ovum (ovulation)  Produces estrogen and progesterone  ACCESSORY FEMALE STRUCTURES Breast  Composed of glandular, fibrous and adipose tissues  Contains acinar cells that produces milk Nipples  erectile tissues which responds to tactile stimulation  contains lactiferous ducts with 15-20 openings Hormones (Lactation) Estrogen Progesterone Oxytocin Prolactin  PELVIS Functions: support and protect the reproductive and other pelvic organ Parts Ilium  Forms upper and lateral portions Ischium  Inferior portion  Ischial tuberosity  Ischial spines Pubis  PELVIS Pubis  anterior portion  Symphysis pubis Sacrum  Forms the upper posterior portion of the pelvic ring  Sacral prominence Coccyx  Composed of five fused vertebrae below the sacrum  Sacrococcygeal joint PELVIS  TRUE VS. FALSE PELVIS FALSE PELVIS TRUE PELVIS Superior half Inferior half Shallow upper part that Has obstetric importance supports uterus during Lower, smaller but deeper pregnancy part of pelvis that must be Aids in directing the fetus adequate for delivery process into the true pelvis Also known as the bony birth cana;  PELVIC INLET VS. OUTLET PELVIC INLET PELVIC OUTLET Entrance to the true pelvis Inferior border of the pelvis Level of linea terminalis AP > transverse Transverse diameter > AP measurements Measurements: True conjugate = 11 cm Obstetric conjugate= 10.5cm Diagonal conjugate = 12 cm PELVIS MENSTRUAL CYCLE LESSON 5 SPERMATOGENESIS  process by which the seminiferous tubules of the testes produce sperm  begins in males at puberty  takes 65-75 days to complete  SPERM 300 million sperm complete the process of spermatogenesis each day.  60 um long  Parts  Head : contains 23 chromosomes  Acrosome: contains enzymes  Nucleus  Tail  Neck  Constricted region, contains centriole  Middle peace  Contains the mitochondria  HORMONAL CONTROL & SEXUAL DEVELOPMENT Androgen  Male sex hormone, produced in testes and adrenal gland  For male sex organ development, spermatogenesis Testosterone  Major androgen  Secreted by Leydig cell of the testis OOGENESIS  Formation of gametes in the ovaries  Begins in females before they are born  Between 5-7 million ova are form in utero  At birth - 2M primary oocytes remain in each ovary  By age 7 – 500,000 are present in each ovary By 22 years – 300,000 are present By menopause – none are left The remainder of the primary oocytes undergo atresia HYPOTHALAMIC PITUITARY-OVARIAN/TESTICULAR AXIS GnRH  Secreted by hypothalamus  Stimulates release of FSH and LH Gonadotropic Hormones FSH : initiates follicular growth LH: stimulate corpus luteum to synthesize progesterone - triggers ovulation Ovarian Hormones Estrogen : secreted by ovarian follicles Progesterone: corpus luteum  MENSTRUATION episodic uterine bleeding in response to cyclic hormonal changes Length/duration: 2 to 7 days, ranges of 1-9 days Average amount blood loss of 30 to 80 ml Color of menstrual flow: Dark red; a combination of blood, mucus and endometrial cells. Odor: Similar to marigolds Menarche 9-17 years old, average 12.4 Normal cycle: 23-35 days, average 28 days  PHASES OF THE FEMALE REPRODUCTIVE CYCLE Four structures involved Hypothalamus Pituitary Ovaries Uterus Four phases Menstrual Preovulatory (proliferative, follicular) Ovulation Postovulatory (secretory, Luteal)  PHASES OF THE FEMALE REPRODUCTIVE CYCLE MENSTRUAL DAY 0-7 Event in the Events in the Hormonal Menstrual phase Ovaries Uterus changes Episodic Under Menstrual flow Decrease uterine influence of from uterus estrogen and bleeding FSH --- progesterone Cyclic monthly primordial levels changes in follicles Stimulate ovaries and develops into prostaglandin endometrium primary --- release Monthly secondary Constrict spiral uterine lining follicles arteries shedding off Oxygen ---- drop of deprivation estrogen and Stratum progesterone functionalis sloughs off  PHASES OF THE FEMALE REPRODUCTIVE CYCLE PROLIFERATIVE/FOLLICULAR DAY 7-14 Preovulatory Events in the Events in the Hormonal (Proliferative) ovaries uterus changes Time between Secondary Endometrial Increase in the end of follicles begins lining start to estrogen level menstruation to secrete proliferate and ovulation estrogen and inhibin Estrogen Dominant secreted by follicles growing ovarian becomes mature follicles (graafian) stimulate repair follicles and of the continue to endometrium enlarge for Stratum basalis ovulation undergo mitosis Ovarian follicles Produces new are growing and  PHASES OF THE FEMALE REPRODUCTIVE CYCLE OVULATION DAY 14 Ovulation Events in the Events in the Hormonal phase ovaries uterus changes Rupture of the Release of Endometrial High level of matured secondary lining estrogen graafian oocytes into proliferates Positive follicles pelvic cavity and thickens feedback Release of the Secrete LH secondary and GnRH oocytes into ovulation pelvic cavity Occurs on day 14 in a 28 day cycle  PHASES OF THE FEMALE REPRODUCTIVE CYCLE SECRETORY/LUTEAL DAY 14-28 Postovulatory Events in the ovaries Events in the Uterus Hormonal chnages (Secretory) Time between After ovulation, the Progesterone and Rise of GnRH, FSH, ovulation and onset mature follicle estrogen produced LH of the next menses collapse by the corpus Most constant part Corpus luteum luteum promotes of the cycle secretes growth and coiling Last 14 days in a progesterone, of endometrial cycle estrogen, relaxin glands Day 15-28 and inhibin under Thickening of the influence of LH endometrium Oocytes is not fertilized--- corpus luteum degenerates into corpus albican If secondary oocyte is fertilized --- begin to divide Corpus luteum produces HcG DAY OF CYCLE STAGE FERTILITY 1-7 Menstruation Least fertile stage 8-9 Post menstruation Possible to conceive 10-14 Ovulation Most Fertile 15-16 Post-ovulation Possible to conceive 17-28 Luteal/secretory Less fertile, unlikely to conceive HUMAN SEXUALITY LESSON 6  SEXUALITY  multidimensional phenomenon that includes feelings, attitudes, and actions  encompasses and gives direction to a person’s physical, emotional, social and intellectual responses throughout life  Biological Gender  chromosomal sexual development  Gender/sexual identity  sex a person thinks of himself  Gender role  male or female behavior a person exhibits  PRENATAL SEX DETERMINATION  DEVELOPMENT OF GENDER IDENTITY 1. amount of testosterone secreted in utero 2. how appealing parents or adult role models portray their gender roles 3. culturally influenced 4. role of women and men in society 5. expectations from the child EXCITEME RESOLUTI PLATEAU ORGASM NT ON HUMAN SEXUAL RESPONSE  FACTORS AFFECTING SEXUAL Menstrual cycle RESPONSE Luteal phase Increase libido -- vasocongestion in the lower pelvis --- ready for plateau and orgasm Pregnancy 1st trimester: decrease in urge due to physiologic changes/stress 2nd trimester: increase in libido due vasocongestion, increase oxytocin 3rd trimester; increase libido Age Male : peak during late teen years Female: on her late 30s THANK YOU “BE INSPIRED”