NCMA 217 Care Of Mother, Child & Adolescent Prelims PDF

**NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A -- -- **WEEK 1: FRAMEWORK AND MATERAL AND CHILD HEALTH NURSING** **STANDARDS OF MATERNAL AND CHILD HEALTH NURSING PRACTICE** 1. **Health promotion** - Ed...

**NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A -- -- **WEEK 1: FRAMEWORK AND MATERAL AND CHILD HEALTH NURSING** **STANDARDS OF MATERNAL AND CHILD HEALTH NURSING PRACTICE** 1. **Health promotion** - Educating clients to be aware of good health through teaching and role modeling 2. **Health maintenance** - Intervening to maintain health when risk of illness is present 3. **Health restoration** - Promptly diagnosing and treating illness using interventions that will return client to wellness most rapidly. 4. **Health rehabilitation** - Preventing further complications from an illness; bringing an ill client back to an optimal state of wellness or helping a client to accept inevitable death **STANDARDS OF CARE AND MEASURES OF QUALITY (WHO)** **[Standard 1:]** Every woman and newborn receives routine, evidence-based care and management of complications during labor, childbirth and the early postnatal period, according to WHO guidelines. 1. Women are assessed routinely on admission and during labor and childbirth and are given timely, appropriate care. **1.2.** Newborns receive routine care immediately after birth. **[Standard 2:]** The health information system enables use of data to ensure early, appropriate action **2.1.** Every woman and newborn has a complete, accurate, standardized medical record during labor, childbirth and the early postnatal period. **2.2.** Every health facility has a mechanism for data collection, analysis and feedback as part of its activities for monitoring and improving performance around the time of childbirth.to improve the care of every woman and newborn. **[Standard 3:]** Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred. **3.1.** Every woman and newborn is appropriately assessed on admission, during labor and in the early postnatal period to determine whether referral is required, and the decision to refer is made without delay. **3.2.** For every woman and newborn who requires referral, the referral follows a pre-established plan that can be implemented without delay at any time. **3.3.** For every woman and newborn referred within or between health facilities, there is appropriate information exchange and feedback to relevant health care staff. **[Standard 4:]** Communication with women and their families is effective and responds to their needs and preferences. **4.1.** All women and their families receive information about the care and have effective interactions with staff. **4.2.** All women and their families experience coordinated care, with clear, accurate information exchange between relevant health and social care professionals. **[Standard 5:]** Women and newborns receive care with respect and preservation of their dignity. **5.1.** All women and newborns have privacy around the time of labor and childbirth, and their confidentiality is respected **5.2.** No woman or newborn is subjected to mistreatment, such as physical, sexual or verbal abuse, discrimination, neglect, detainment, extortion or denial of services. **5.3**. All women have informed choices in the services they receive, and the reasons for interventions or outcomes are clearly explained. **[Standard 6:]** Every woman and her family are provided with emotional support that is sensitive to their needs and strengthens the woman\'s capability. **6.1.** Every woman is offered the option to experience labor and childbirth with the companion of her choice. **6.2.** Every woman receives support to strengthen her capability during childbirth. **[Standard 7:]** For every woman and newborn, competent, motivated staff are consistently available to provide routine care and manage complications. **7.1** Every woman and child has access at all times to at least one skilled birth attendant and support staff for routine care and management of complications. **7.2** The skilled birth attendants and support staff have appropriate competence and skills mix to meet the requirements of labour, childbirth and the early postnatal period. **7.3** Every health facility has managerial and clinical leadership that is collectively responsible for developing and implementing appropriate policies and fosters an environment that supports facility staff in continuous quality improvement. **[Standard 8:]** The health facility has an appropriate physical environment, with adequate water, sanitation and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications. **8.1** Water, energy, sanitation, hand hygiene and waste disposal facilities are functional, reliable, safe and sufficient to meet the needs of staff, women and their families. **8.2** Areas for labor, childbirth and postnatal care are designed, organized and maintained so that every woman and newborn can be cared for according to their needs in private, to facilitate the continuity of care. **8.3** An adequate stock of medicines, supplies and equipment is available for routine care and management of complications **ADVANCED-PRACTICE ROLES FOR NURSES IN MATERNAL AND CHILD HEALTH** 1. **Clinical nurse specialists** - Are nurses prepared at the master\'s or doctorate degree level who are capable of acting as consultants in their area of expertise, as well as serving as role models, researchers, and teachers of quality nursing care. - **Neonatal nurse specialists** - manage the care of infants at birth and in intensive care settings; they provide home follow-up care to ensure the newborn remains well. - **Childbirth educators** teach families about normal birth and how to prepare for labor and birth. - **Lactation consultants**- educate women about breastfeeding and support them while they learn how to do this. - **Genetic nurse counselors**- consult with families about patterns of inheritance and offer support to families with a child who has inherited a genetic disorder. 2. **Case Manager** - A graduate-level nurse who supervises a group of patients from the time they enter a health care setting until they are discharged from the setting. - Case management can be a vastly satisfying nursing role, because if the healthcare setting is \"seamless,\" or one that follows people both during an illness and on their return to the community, - Nurse practitioners are nurses educated at the master\'s or doctoral level. Recent advances in technology, research, and knowledge have amplified the need for longer and more in-depth education for nurse practitioners as they play pivotal roles in today\'s health care system 3. **Women\'s Health Nurse Practitioner** - Has advanced study in the promotion of health and prevention of illness in women. - Such a nurse plays a vital role in educating women about their bodies and sharing with them methods to prevent illness - They care for women with illnesses such as sexually transmitted infections, and offer information and counsel them about reproductive life planning. 4. **Neonatal Nurse Practitioner** - Is an advanced-practice role for nurses who are skilled in the care of newborns, both well and ill. NNPs may work in level 1, level 2, or level 3 newborn nurseries, neonatal follow-up clinics, or physician groups. 5. **Family Nurse Practitioner (FNP)** - Is an advanced-practice role that provides health care not only to women and children but also to the family as a whole. In conjunction with a physician, an FNP can provide prenatal care for a woman with an uncomplicated pregnancy. 6. **Pediatric Nurse Practitioner (PNP)** - Is a nurse prepared with extensive skills in physical assessment, interviewing and well-child counseling and care. In this role, a nurse interviews parents as part of an extensive health history and performs a physical assessment of the child. - If the PNP determines that a child has a common illness (such as iron deficiency anemia), he or she orders the necessary laboratory tests and prescribes appropriate drugs for therapy. - If the PNP determines that the child has a major illness (such as congenital subluxated hip, kidney disease, heart disease), he or she consults with an associated pediatrician; together. 7. **Certified Nurse-Midwife (CNM)** - Is an individual educated in the two disciplines of nursing and midwifery and licensed. - Plays an important role in assisting women with pregnancy and childbearing. Either independently or in association with a physician, the nurse- midwife assumes full responsibility for the care and management of women with uncomplicated pregnancies. **LEGAL CONSIDERATIONS OF MATERNAL-CHILD PRACTICE** - Care is often given to an **\"unseen client\"**- the fetus-or to clients who are not of legal age for giving consent for medical procedures. - Labor and birth of a neonate are considered \"**normal**\" events, so the risks for a lawsuit are greater when problems arise (O\'Grady et al., 2007) - Nurses are legally responsible - Understanding the scope of practice and standards of care can help nurses practice within appropriate legal parameters. - **Documentation** is essential for protecting a nurse and justifying his or her actions. - Nurses need to be conscientious about obtaining informed consent for invasive procedures and determining that pregnant women are aware of any risk to the fetus associated with a procedure or test. - Adolescents who support themselves or who are pregnant are termed **\"emancipated minors\" or \"mature minors\"** and have the right to sign for their own health care. **ETHICAL CONSIDERATIONS OF PRACTICE** Some of the most difficult ethical quandaries in health care today are those that involve children and their families. Examples are: - Conception issues, especially those related to in vitro fertilization, embryo transfer, ownership of frozen oocytes or sperm, cloning, stem cell research, and surrogate mothers - Abortion - Fetal rights versus rights of the mother - Use of fetal tissue for research - Resuscitation (for how long should it be continued? - Number of procedures or degree of pain that a child should be asked to endure to achieve a degree of better health Balance between modern technology and quality of life **PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSING** - Maternal and child health nursing is family centered. - Maternal and child health nursing is community centered. - Maternal and child health nursing is evidence based. - A maternal and child health nurse serves as an advocate. - Maternal and child health nursing includes a high degree of independent nursing functions. - Promoting health and disease prevention are important nursing roles - Maternal and child health nurses serve as important resources for families during childbearing and childrearing - Personal, cultural, and religious attitudes and beliefs influence the meaning and impact of childbearing and childrearing on families. - Circumstances such as illness or pregnancy are meaningful only in the context of a total life. - Maternal and child health nursing is a challenging role for nurses and a major factor in keeping families well and optimally functioning. **STATISTICAL TERMS USED TO REPORT** **MATERNAL AND CHILD HEALTH** - **Birth rate** - number of individuals live births or born in a population on a given amount of time, per 1000, 15 - 44 years old, not specific to women - **Fertility rate** - total number of children that would be born in the woman if she were to lived to the end in her child bearing years and bear children according to age, live births per 1000 in a given population - **Fetal death rate** - number of fetal deaths weighting more than 500 grams per 1000 live births - **Neonatal death rate** - number of death per 1000 live births occurring in the first 28 days of live (age or weight comparison) - **Perinatal death rate** - weight more than 500 grams - **Maternal mortality rate** - number of maternal deaths per 100,000 from direct reproductive processes - **Infant mortality rate** - number of death per 1000 deaths t births or in the first 12 months in life - **Childhood mortality rate** - probability of dying from age 1 to age 5 **INFANT MORTALITY RATE** - The infant mortality rate for Philippines in 2019 was 19.239 deaths per 1000 live births, a 2.16% decline from 2018. - The top three leading causes of infant mortality were 1. 2. 3. **MATERNAL MORTALITY RATE** - Philippines maternal mortality ratio was at level of 121 deaths per 100,000 live births in 2017, down from 124 deaths per 100,000 live births previous year, this is a change of 2.42%. **ENVISION 2030** - The year 2016 marks the first year of the implementation of the SDGs. At this critical point, \#Envision 2030 will work to promote the mainstreaming of disability and the implementation of the SDGs throughout its 15-year lifespan with objectives to: - - - **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 2: REPRODUCTIVE AND SEXUAL HEALTH** **HUMAN SEXUALITY** - Is a multidimensional concept. - It can be defined broadly by stating that sexuality integrates the somatic (bodily), emotional, intellectual, & social aspects of being a human sexual being. - It involves the anatomy & physiology of the human body, as well as one\'s attitudes & feelings about oneself - **Biologic Gender** - is the term used to denote chromosomal sexual development: male (XY) or female (XX) - **Sexual or Gender identity** - is the inner sense a person has of being male or female - **Gender role** - is the behavior a person conveys about being a male or female. - Sex and gender are not the same. In general terms, **SEX** refers to a person\'s physical characteristics at birth, and **GENDER** encompasses a person\'s identities, expressions, and societal roles. **COMPONENTS OF SEXUALITY** **Reproductive Sexuality** - involves the biological aspects of conception & procreation. - - **TYPES OF SEXUAL ORIENTATION** **Heterosexuality** - one who finds sexual fulfillment with a member of opposite gender. **Homosexuality** - a person who finds sexual fulfillment with a member of his or her own sex. - **Bisexuality** - people are bisexual if they achieve sexual satisfaction from both homosexual and heterosexual relationship. **Transexuality** is an individual who, although one biologic gender, feels as is he or she should be of the opposite gender - **HUMAN SEXUAL RESPONSE CYCLE** I. **EXCITEMENT** - Occurs with physical and psychological stimulation (sight, sound, emotion or thought) that causes parasympathetic nerve stimulation. - This leads to arterial dilation and venous constriction in the genital area. - The resulting increased blood supply leads to vasocongestion and increasing muscular tension.  - **[In woman]**, this vasocongestion causes the clitoris to increase in size and mucoid fluid to appear on vaginal walls as lubrication - - **[In men]**, penile erection occurs as both sexes, there is an increase in heart and respiratory rates and BP. II. **PLATEAU** - **[In woman]** clitoris is drawn forward and retracts under the clitoral prepuce - - **[In men]**, the vasocongestion leads to distention of the penis. - - III. **ORGASM** - The body suddenly discharges accumulated sexual tension. - A vigorous contraction of muscles in the pelvic area expels or dissipates blood and fluid from the area of congestion. - The average number of contractions for the woman is **8 to 15 contractions at intervals of one every 0.8 seconds.** - **[In men]**, muscle contractions surrounding the seminal vessels and prostate project semen into the proximal urethra. - - **Shortest stage** in sexual response cycle IV. **RESOLUTION** - Period during which the external and internal genital organs return to an unaroused state. - Usually takes 30 minutes for both men and women. **TYPES OF SEXUAL EXPRESSION** **CELIBACY** - abstinence from sexual activity. Ex. Priest **MASTURBATION -** is self-stimulation for erotic pleasure. **EROTIC STIMULATION** - is the use of visual materials such as magazines or photographs - for sexual arousal. **FETISHISM** - is sexual arousal resulting from the use of certain objects or situations. **TRANSVESTISM** - an individual who dresses to take on the role of opposite sex. **VOYEURISM** - obtaining sexual arousal by looking at another\'s person\'s body. **SADOMASOCHISM** - involves inflicting pain (sadism) or receiving pain (masochism) to achieve sexual satisfaction. **EXHIBITIONISM** - revealing one\'s genitals in public. **PEDOPHILES** - individuals who are interested in sexual encounters with children. **DISORDERS OF SEXUAL FUNCTIONING** **ERECTILE DYSFUNCTION** - formerly referred to as impotence - Inability to produce or maintain an erection long enough for vaginal penetration or partner satisfaction. **PREMATURE EJACULATION** - ejaculation before penile contact. - - **FAILURE TO ACHIEVE ORGASM (ANORGASMIA)** - can be due to poor sexual technique or possible negative attitudes toward sexual relationships **VAGINISMUS** - Involuntary contraction of the muscles at the outlet of the vagina when coitus is attempted. - Muscle contraction prohibits penile penetration. **DYSPAREUNIA** - Pain during coitus - Can be due to endometriosis **INHIBITED SEXUAL DESIRE** - Lack of desire for sexual relations may be a concern of young or middle-aged adults. - Support or a caring sexual partner or relief of the tension causing the stress allows a return to sexual interest. **DEVELOPMENT OF REPRODUCTIVE SYSTEM** - **GONADS** refers to the organs in which gametogenesis occurs. - - - - - - **In both sexes**, two undifferentiated ducts, the mesonephric (wolffian) and paramesonephric (müllerian) ducts, are present. - **By week 7 or 8**, in chromosomal males, this early gonadal tissue differentiates into primitive testes and begins formation of testosterone. - Under the influence of testosterone, the mesonephric duct begins to develop into the male reproductive organs, and the paramesonephric duct regresses. - **If testosterone is not present by week 10**, the gonadal tissue differentiates into ovaries, and the paramesonephric duct develops into female reproductive organs. - **All of the oocytes** (cells that will develop into eggs throughout the woman\'s mature years) are already formed in ovaries at this stage (MacKay, 2009). - **At about week 12**, the external genitals develop. - 1. 2. - 1. 2. **FEMALE AND MALE REPRODUCTIVE SYSTEM HOMOLOGUES** +-----------------------------------+-----------------------------------+ | **FEMALE** | **MALE** | +-----------------------------------+-----------------------------------+ | 1. Clitoral glans | 1. Penile glans | | | | | 2. Clitoral shaft | 2. Penile shaft | | | | | 3. Labia majora | 3. Scrotum | | | | | 4. Ovaries | 4. Testes | | | | | 5. Skene\'s glands | 5. Prostate | | | | | 6. Bartholin\'s glands | 6. Cowper\'s glands | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ **PHYSIOLOGY OF ONSET** - **Puberty** is initiated by hypothalam pituitary - gonad complex. - - - - - **[Boys (testosterone)]** - - - - - - - **FUNCTIONS** **REPRODUCTION** - is an essential characteristic of living organisms for both functional male and female reproductive systems are necessary for human to reproduce 1. **Production of gametes** - - 2. **Fertilization** - enables union of the oocyte by the sperm.  3. **Development and nourishment of a new individual. -** nurtures the developing fetus in the uterus until birth and provides nourishment (breast milk) after birth 4. **Production of sex hormones** - hormones produced by the reproductive system control its development and the development of the gender-specific body form. **MALE REPRODUCTIVE SYSTEM: OVERVIEW** - Consists of **THE TESTES**, a series of ducts, accessory glands, and supporting structures. - - - - **SCROTUM** - Saclike structure containing the testes - - I. **SCROTUM** - **Dartos and cremaster muscles** - BOTH regulates the temperature in the testes - **[Cold Temperatures]** - - - **[Warm wether or excercise]** - -. II. **TESTIS** - Also called male gonads; oval or within the scrotum - - - III. **SPERMATOGENESIS -** process of making male gametes - **Spermatids** - product of secondary meiotic division - **Sperm cell / Spermatozoon** developed spermatid with a head, midpiece, and flagellum - **Acrosome** - vesicle; anterior to the nucleus - - IV. **DUCTS** - **Epididymis** - A tightly coiled series of threadlike tubules that form a comma-shaped structure - - **Rete testis** - each seminiferous tubule empty into in tubular networks - **Efferent ductules** - carry sperm cells from the testis to the epididymis - - **Seminal Vesicle and Ejaculatory Duct** - - - **Ductus Deferens / Vas deferens** - Emerges from the epididymis and ascends along the posterior side of the testis - - **Spermatic cord** - consists of the ductus deferens, testicular artery and veins, lymphatic vessels, and testicular nerve - **Ampulla of the ductus deferens** - ductus deferens increases in diameter - **Urethra** - - - 1. 2. 3. V. **PENIS** - Male organs of copulation - Functions in transfer of sperm cells from the male to the female - Contains three columns of erectile tissue - **Erection** - process of the engorgement of the erectile tissue with blood that causes the penis to enlarge and become firm - **Prostate gland** - consists of glandular; muscular tissue & empties into the urethra - - **Bulbourethral glands / Cowper glands** - a pair of small, mucus- secreting glands that empty into the urethra - **Corpora cavernosa** - two columns of erectile tissue that form the dorsal portion - **Corpus spongiosum** - third, small erectile column that occupies the ventral portion of the penis - **Glans penis** - a formed cap - **External urethra orifice** - spongy urethra that opens to the exterior part - **Prepuce/foreskin** - lose fold of skin that covers the glans penis **SECRETIONS** **Semen** - is a mixture of sperm cells and secretions from the male reproductive glands. 1. 2. 3. 4. **Mucus has four primary functions:** from - bulbourethral glands and the mucous glands of the urethra 1. 2. 3. 4. **[Substances include:]** 1. 2. 3. 4. **[Secretions of the prostate also have several functions:]** 1. **Regulate pH** - Prostate secretions is alkaline. - Neutralizes the acidity of the male urethra, the secretions of the testes, the secretions of the seminal vesicles, and the vagina 2. **Liquefy the coagulated semen.** - Prostate gland secretions contain proteolytic enzymes that break down the coagulated proteins; make the semen more liquid. **PHYSIOLOGY OF MALE REPRODUCTION** A. **REGULATION OF SEX HORMONE SECRETION** - **Gonadotropin-releasing hormone (GnRH)** - produced in hypothalamus; stimulates release of LH and FSH from the anterior pituitary - **Luteinizing hormone (LH)** - stimulates interstitial cells to produce testosterone - **Follicle-stimulating hormone (FSH)** - binds to sustentacular cells and stimulates spermatogenesis and secretion of inhibin - **Testosterone** - has a negative-feedback effect on GnRH, LH, and FSH - **Inhibin** - has a negative-feedback effect on FSH secretion (granulosa and theca cells of the ovary and by the Sertoli cells of the testis) B. **CLINAL IMPACT** - **Erectile dysfunction (ED)** - impotence; failure to achieve erections Infertility in Males - Common cause is a low sperm cell count - **Infertility** - is the inability or the reduced ability to produce offspring. - **Oligospermia**- low sperm count - **Azoospermia** - semen contains no sperm - **Normospermia** - normal sperm count - **Artificial insemination** - concentrating the sperm cells and inserting them into the female\'s reproductive tract **FEMALE REPRODUCTIVE SYSTEM** - Consist of the ovaries, the uterine tubes (or fallopian tubes), Uterus, the vagina, the external genitalia and the mammary glands - Internal reproductive organs of the female are located within the pelvis, between the urinary bladder and the rectum - **UTERUS AND THE VAGINA** are in the midline, with an ovary to each side of the uterus I. **OVARIES** - **Broad ligament** - spreads out on both sides of the uterus and attaches to the ovaries and uterine tubes - **Ovary** - is a small organ suspended in the pelvic cavity by two ligaments 1. 2. - **Mesovarium** - folds of peritoneum II. **OOGENESIS AND FERTILIZATION** - **Oogonia** - the cells form which oocytes develop - **Primary oocyte** - oogonia that has stopped in prophase I - **Secondary oocyte** - released when the first meiotic division is complete - **Ovulation** - release of an oocyte from an Ovary - **Fertilization** when a sperm cell penetrates the cytoplasm of a secondary oocyte - III. **FOLLICLE DEVELOPMENT** - **Fluid filled spaces** - vesicles - **Theca -** a capsule that forms around the follicle - **Antrum** - a single, fluid-filled chamber - **Cumulus cells** - mass of granulosa cells Graafian follicle - mature follicle - **Corpus luteum** - remaining cells of the ruptured follicle are transformed into a glandular structure - **Human chorionic gonadotropin hormone (hCG)** - the corpus luteum enlarges in response to this hormone IV. **UTERINE TUBES** 1. Fallopian tube or oviduct 2. Receive the secondary oocyte - **Fimbriae** long, thin processes that surrounds each the opening of each uterine tube - **Cilia on fimbriae** - sweep the oocyte into the uterine tube - **Ampulla** - where fertilization usually occurs - **Implantation** - process wherein the fertilized oocyte embeds itself in the uterine wall - **Fundus** - superior to the entrance of the uterine tubes - **Body** - main part of the uterus - **Cervix** - inferiorly, narrower part - - - - **Prolapsed uterus** - occurs when the uterus extends inferior into the vagina - **Perimetrium** - outer layer; serous layer of the uterus formed from visceral peritoneum - **Myometrium** - middle layer; muscular layer that accounts for the bulk of the uterine wall - **Endometrium** - innermost layer; consists of simple columnar epithelial cells with an underlying CT layer V. **VAGINA** - **Hymen** - thin mucous membrane inside the opening of the vagina - - - - **Hymenectomy** is a minor procedure to surgically remove or open the hymen.  VI. **UTERINE DEVIATIONS** - Ordinarily, the body of the uterus is tipped slightly forward. - - - - VII. **EXTERNAL GENITALIA** - **Vulva** - pudendum; external female genitalia - **Vestibule** - the space into which the vagina and urethra open - **Labia minora** - longitudinal skin folds - **Clitoris** - small, erectile structure; well supplied with sensory receptors, made of erectile tissue - **Greater vestibular glands** - produce a lubricating fluid that helps maintain the moistness of the vestibule - **Labia majora** - prominent, rounded folds of skin - **Mons Pubis** - an elevation of tissue over the pubic symphisis - **Pudendal cleft** - space bet. the labia majora - **Clinical perineum** - region bet. the vagina and the anus - **Episiotomy** - an incision made in the clinical perineum to avoid tearing during childbirth VIII. **MAMMARY GLANDS** 1. Organs of milk production 2. Located in the breasts 3. Modified sweat glands - **Areola** - a circular, pigmented area that surrounds the nipple - **Glandular lobes** - covered by adipose tissue; gives the breast its form - **Lactiferous duct** - opens independently to the surface of the nipple - **Myoepithelial cells** - surround the alveoli and contract to expel milk from the alveoli - **GYNECOMASTIA** - occurs when the breasts of a male become permanently enlarged; results from hormonal imbalance and the abuse of anabolic steroids - IX. **OTHER TERMS REL. TO FEMALE REPROD** - **Menarche** - first episode of the menstrual bleeding (first occurrence) - **Menstrual cycle** - series of changes that occur in sexually mature, non-pregnant females, and that culminate in menses - **Menses** - a period of mild hemorrhage; part of the endometrium is sloughed and expelled from the uterus; day 1 - 4: menstrual fluid is produced by degeneration of the endometrium - **AMENORRHEA** - absence of a menstrual cycle - **Ectopic pregnancy** - implantation occurs anywhere other than in the uterine cavity **HORMONES** **ESTROGEN & PROGESTERONE** - Aid in uterine and mammary gland development and function, external genitalia structure, secondary sexual characteristics, sexual behavior, menstrual cycle - **Estrogen** is the hormone that regulates the menstrual cycle - **Progesterone** - is the hormone that supports pregnancy. **OXYTOCIN** - Stimulates labor - Increased uterine contractions - Increased milk expulsion from mammary glands **PROLACTIN** - Development of breast during pregnancy - Stimulates milk prod and prolongs progesterone secretion **MENSTRUATION** - The menstrual cycle is measured from the first day of menstrual bleeding, Day 1, up to Day 1 of your next menstrual bleeding. - A teen\'s cycles tend to be long **(up to 42 days)**, growing shorter over several years. - The average menstrual period is 5 days. - The amount of blood loss every menstrual period is 30 to 80 ml. - The normal color of the menses is dark red that contains mucus and endometrial cells. **MENSTRUAL CYCLE** - The menstrual cycle is measured from the first day of menstrual bleeding, Day 1, up to Day 1 of your next menstrual bleeding. - A teen\'s cycles tend to be long (up to 42 days), growing shorter over several years. The average menstrual period is 5 days. The amount of blood loss every menstrual period is 30 to 80 ml. - The normal color of the menses is dark red that contains mucus and endometrial cells. **ORGANS INVOLVED IN MENSTRUATION** - **HYPOTHALAMUS -** Stimulates anterior pituitary gland to begin production of gonadotropic hormones. - **PITUITARY GLAND -** under the influence of LHRH, the anterior pituitary gland produces 2 hormones that act on the ovaries to further influence menstruation. - **FSH -** a hormone that is active early in a cycle & is responsible for maturation of the ovum - **LH:** a hormone that becomes most active at the midpoint of the cycle & is responsible for ovulation or release of the mature egg cell from the ovary, and growth of uterine lining - **Ovaries** -one ovum matures in one or the other ovary & is discharge from it each month - **Uterus** - stimulation from the hormones produced by the Ovaries causes specific monthly effects on the uterus **ESTROGEN (HORMONE FOR WOMAN)** 1. Stimulate the growth, development, and maintenance of female reproductive structures, secondary sex characteristics and the breast. 2. They help regulate fluid and electrolyte balance. 3. They stimulate protein synthesis 4. They lower blood cholesterol levels 5. Spinnbarkeit and ferning 6. Thickening of the endometrium A. **The Follicular Phase** - Days 1 through 13 - In response to follicle stimulating hormone (FSH) released from the pituitary gland in the brain, ultimately one egg matures. B. **Ovulation** - Day 14 - At about day 14, in response to a surge of Luteinizing hormone, the egg is released from the ovary. - The egg travels through the fallopian tube toward the uterus. C. **The Luteal Phase** - Days 14 through 28 - The remains of the follicle become the corpus luteum which releases progesterone D. **Proliferative Phase** - Days 5-14 - The uterine lining increases rapidly in thickness, and the uterine glands proliferate and grow. E. **Secretory Phase** - Days 14 through 28 - When an egg is not fertilized, the corpus luteum gradually disappears, estrogen and progesterone levels drop, and the thickened uterine lining is shed. This is menses (your period). **SIGNS AND SYMPTOMS OF OVULATION** - **Mittelschmerz** - abdominal tenderness on left/rightiliac regions, brought about by peritoneal irritation due to blood coming out from the graafian follicle. - **Spinnbarkeit** - vaginal secretion is clear & transparent - Change in vaginal mucus - Goodel\'s sign - Mood changes - Breast tenderness - Increased levels of Progesterone - Change in basal body temperature **ANTEPARTAL PERIOD** - **Ovum** - from ovulation to fertilization - **Zygote** - from fertilization to implantation - **Embryo** - from implantation to 5-8 weeks - **Fetus** - from 5-8 weeks until term - **Conceptus** - Developing embryo or fetus and placental structure throughout pregnancy **PROCESS OF FERTILIZATION** **Fertilization (Conception, Fecundation)** - Is the union of an ovum and a spermatozoon. This usually occurs in the outer third of fallopian tube. **Capacitation** is a final process that sperm must undergo to be ready for fertilization. - **Hyaluronidase (a proteolytic enzyme)** is released by the spermatoz and dissolves the layer of cells protecting the ovum. - - **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT RLE - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 1: FRAMEWORK AND MATERAL AND CHILD HEALTH NURSING** **CONCEPT MAPPING** - A visual representation that allows you graphically show the connections between a client\'s many problems. - - - **Application to Nursing Practice** - - - **ETIOLOGY** - Is defined as the science of finding causes and origins. - An example of etiology is knowing that some of the causes of high blood pressure are smoking, lack of exercise, stress and a diet high in salt and fats. **COMPONENTS OF CONCEPT MAP** 1. **RISK FACTORS** - Are conditions that increase your risk of developing a disease. a. **Examples:** - - - - b. **Examples:** - - - - 2. **PATHOPHYSIOLOGY** - is the study of the physical and biological abnormalities occurring within the body as a result of the disease.  3. **MEDICAL DIAGNOSIS** - The process of identifying a disease, condition, or injury from its signs and symptoms. - 4. **DIAGNOSTIC TEST** - is any approach used to gather clinical information for the purpose of making a clinical decision. 5. **MEDICAL AND SURGICAL MANAGEMENT** - - 6. **NURSING DIAGNOSIS** is a clinical judgment concerning human response to health conditions/life processes 7. **EXPECTED OUTCOMES** - are forecasted results-relate directly to program goals and objectives. 8. **NURSING INTERVENTIONS** - are the actual treatments and actions that are performed to help the patient to reach the goals -that are set for them. **TYPES OF NURSING INTERVENTIONS** +-----------------------+-----------------------+-----------------------+ | **INDEPENDENT** | **DEPENDENT** | **COLLABORATIVE** | +-----------------------+-----------------------+-----------------------+ | Auscultate apical | Administer IV | Refer to dietitian | | pulse, assess heart | solutions, | for counseling | | rate, rhythm. | restricting total | specific to | | Document dysrhythmia | amount as indicated. | individual dietary | | if telemetry is | | customs. | | available. | | | | | | | | Administer diuretics | | | | as indicated. | | | +-----------------------+-----------------------+-----------------------+ **COMPONENTS OF CONCEPT MAPS: NURSING INTERVENTION** 1. **Health Teaching/Health education** - is a social science that draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability and premature death. - - 2. **EXERCISE** - bodily or mental exertion, especially for the sake of training or improvement of health - 3. **DIET** - the sum of food consumed by a person. often implies the use of specific intake of nutrition for health or weight-management reasons (with the two often being related). 4. **TREATMENT** - an act or manner of treating. - 5. **MEDICATIONS** -a substance used in treating disease or relieving pain the act or process of treating a person or disease with medicine. 6. **ENVIRONMENT** - means anything that surround us. - 7. **SPIRITUALITY** - Involves the recognition of a feeling or sense or belief that there is something greater than myself - 8. **DISCHARGE PLANNING** - is when the patient. career, family and any staff involved make the necessary arrangements to ensure there is a smooth transition from hospital to home, residential care or somewhere else. - - 1. **Spider Mapping -** Sub entities connecting to the main entity 2. **Hierarchy Mapping -** Main entity at the top and the sub entities in the following hierarchy 3. **Flowchart Mapping** - Related entities in a linear format 4. **System Mapping** - All the related entities with relationships, inputs, and outputs   **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 3: HUMAN GENETICS PART 1** **DEFINITION** - **Inherited or genetic disorders** are disorders that can be passed from one generation to the next. - - **Genetics** is the study of the way such disorders occur. - **Cytogenetics** is the study of chromosomes by light microscopy and the method by which chromosomal aberrations are identified. - **[Most human cells contain 46 chromosomes:]** - - - - - **[Upon fertilization]:** sex of the baby is determined by the sperm cell. The baby is: - - **GENETIC DISORDERS:** 1. **Phenotype** - is a person\'s outward appearance. 2. **Genotype** - refers to the actual gene composition. 3. **Karyotype** is a graphic representation of the chromosomes that are present. **NATURE OF INHERITANCE** - A person\'s genome is the complete set of genes present (about 50,000 to 100,000). - A **[normal genome]** is abbreviated as **46XX or 46XY** (designation of the total number of chromosomes plus a graphic description of the sex chromosomes present). - If a chromosomal aberration exists, it is listed after the sex chromosome pattern. - - The abbreviation **46XX5p**, for example, is the abbreviation for a female with 46 total chromosomes but with the short arm of chromosome 5 missing **[(cri-du-chat syndrome)]**. - In **[Down syndrome]**, the person has an extra chromosome 21, which is abbreviated as **47XX21+ or 47XY21+** **TERATOGEN SEVERITY OF DAMAGE TO THE** **UNBORN DEPENDS ON:** - Dose - Length of exposure - Time of exposure - **Critical period:** a fixed time period during which certain experiences or events can have a long-lasting effect on development 1. **TERATOGEN: ALCOHOL** - No alcohol consumption during pregnancy is safe to fetus - **Fetal alcohol syndrome:** - - Facial deformities - Defective limbs, face, heart - Most have below-average intelligence; some are **mentally retarded**  2. **TERATOGEN: PRESCRIPTION AND NON - PRESCRIPTION DRUGS** ----------------------------------------------------- ---------------- Sulfonamides Aminoglycoside Antibacterial Fluoroquinolones Antibacterial Erythromycin Metronidazole Anti protozoal Tetracyclines Ribavirin Anti viral Griseofulvin Anti fungal Chloramphenicol & Clarithromycin **SAFE M**oms **T**ake **R**eally **G**ood **C**are ----------------------------------------------------- ---------------- 3. **TERATOGEN: NICOTINE** - **Maternal smoking** can negatively influence prenatal development, birth, and postnatal development - **[Associated with:]** - - - - - 4. **TERATOGEN: ILLEGAL DRUGS** **[Cocaine I Methamphetamine I Marijuana I Heroin ]** - **A mother taking illegal drugs** during pregnancy increases her risk for anemia, blood and heart infections, skin infections, hepatitis, and other infectious diseases. - **Marijuana** use during pregnancy may be linked to cognitive and behavioral problems in the baby. - **Cocaine** use can lead to miscarriage, preterm delivery of the fetus, premature detachment of the placenta, high blood pressure, and stillbirth **MATERNAL STRESS** - Cortisol can pass through the **placenta** to the fetus. - **High levels of maternal stress hormones** during a pregnancy have been associated with a slower growth rate in the fetus and lower birth weight and with temperamental difficulties in infants **CAFFEINE** - Small risk of miscarriage and low birth weight for those consuming more than 200 mg. daily - Increased risk of fetal death for those consuming more than 300 mg. daily **ENVIRONMENTAL HAZARDS** - Radiation - Environmental pollutants and toxic wastes **TRISOMY 13 SYNDROME (47XY13 OR 47XX13)** - **Trisomy 13 syndrome (Patau syndrome)**, the child has an extra chromosome 13 and is severely cognitively challenged. - Midline body disorders such as cleft lip and palate, heart defects, particularly ventricular septal defects, and abnormal genitalia are present - Other common findings include microcephaly with abnormalities of the forebrain and forehead; eyes that are smaller than normal (microphthalmos) or absent; and low-set ears. - Most of these children do not survive beyond early childhood  **TRISOMY 18 SYNDROME (47XY18 OR 47XX18)** - Children with trisomy 18 syndrome have three copies of chromosome 18. - Children are severely cognitively challenged and tend to be small for gestational age at birth, have markedly low-set ears, a small jaw, congenital heart defects, and usually misshapen fingers and toes (the index finger deviates or crosses over other fingers). - Also, the soles of their feet are often rounded instead of flat (rocker-bottom feet). As in trisomy 13 syndrome, most of these children **do not survive beyond early infancy** **CRI-DU-CHAT SYNDROME (46XX5P OR 46XY5P)** - Cri-du-chat syndrome is the result of a **missing portion of chromosome 5.** - In addition to an abnormal cry, which sounds much more like the sound of a **cat than a human infant\'s cry**, children with cri-du-chat syndrome tend to have a small head, wide-set eyes, and a downward slant to the palpebral fissure of the eye. - They are severely cognitively challenged **TURNER SYNDROME (45X0)** - **Child with Turner syndrome (gonadal dysgenesis)** has only one functional X chromosome. - Hairline at the nape of the neck is low set, and the neck may appear to be webbed and short. - A newborn may have appreciable edema of the hands and feet and a number of congenital anomalies, most frequently coarctation (stricture) of the aorta and kidney disorders. - The disorder can be identified with an ultrasound during pregnancy because of the increased neck folds. - The child is short in stature and has only streak (small and nonfunctional) ovaries. - She is sterile and with the exception of pubic hair, secondary sex characteristics do not develop at puberty. **KLINEFELTER SYNDROME (47XXY)** - Infants with Klinefelter syndrome are males with an **extra X chromosome.** - Characteristics of the syndrome may not be noticeable at birth. - At puberty, secondary sex characteristics do not develop; the child has small testes that produce ineffective sperm - Affected individuals tend to develop gynecomastia (increased breast size) and have an increased risk of male breast cancer **FRAGILE X SYNDROME** - They may be identified by the presence of a large head, a long face with a high forehead, a prominent lower jaw, and large protruding ears. - Hyperextensive joints and cardiac disorders may also be present. - After puberty, enlarged testicles may become evident. Affected individuals are fertile and can reproduce. - - Intellectual function from the syndrome cannot be improved  **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 3: REPRODUCTIVE LIFE** **REPRODUCTIVE LIFE PLANNING** - Includes all the decisions an individual or couple make about having children. **IMPORTANT THINGS TO REMEMBER IN CHOSSING CONTRACEPTIVES:** 1. Personal Values - beliefs / religion 2. Ability to use a method correctly 3. How the method will affect sexual enjoyment 4. Financial factors 5. Status of a couple\'s relationship 6. Prior experiences 7. Future plans **CHARACTERISTICS OF EFFECTIVE CONTRACEPTIVES:** 1. Safe 2. 100% effective 3. Easily obtainable 4. Affordable 5. Easy to use and acceptable to both user and sexual partner 6. Free of effects on future pregnancies **TYPES OF FAMILY PLANNING** 1. **BARRIER METHODS** - work by the placement of a barrier between the cervix and advancing sperm so that sperm cannot enter the uterus or fallopian tubes and fertilize the ovum. a. b. 2. **HORMONAL METHODS** - used of hormones that cause fluctuations in a normal menstrual cycle that ovulation does not occur. 3. **SURGICAL METHOD** - often called **sterilization**, include tubal ligation for women and vasectomy for men. **NATURAL FAMILY PLANNING** 1. **ABSTINENCE**- absolutely no penetration; to abstain from sexual intercourse. - The most effective way to protect against conception and STD. - TO BE SUCCESSFUL communication between partners is important - Requires a couple to abstain from coitus on the days of a menstrual cycle when the woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation) 2. **CALENDAR (RHYTHM) METHOD** - **CALENDAR METHOD** - Requires a couple to abstain from coitus on the days of a menstrual cycle when the woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation) - - 3. **BASAL BODY TEMPERATURE METHOD** - **Basal Body Temperature Method** - the woman takes her temperature each morning immediately after waking, before she undertakes any activity - - -  4. **CERVICAL MUCUS (BILLINGS) METHOD** - **Cervical Mucus (Billings) Method** - To use the charges in cervical mucus that occur naturally with ovulation - Before ovulation the cervical mucus is thick and does not stretch when pulled between the thumb and finger - With ovulation or during the peak day, the cervical mucus: copious, thinned, watery and transparent. - **SPINNBARKEIT** - it feels slippery and stretches at least 1 inch before the strand breaks - Mucus is copious: abstains from sex. 5. **SYMPTOTHERMAL METHOD** - Combines the cervical mucus and BBT methods - Couple abstain from intercourse until 3 days after the rise in temperature or the fourth day after the peak of mucus change - 6. **OVULATION AWARENESS** - Uses an OTC ovulation detection kit. - Kit detects the midcycle surge of luteinizing hormone (LH), that can be detected in urine 12 to 24 hours before ovulation. - - 7. **LACTATION AMENORRHEA METHOD** - As long as woman is EXCLUSIVELY breast-feeding an infant, there is some natural suppression of ovulation. - As a rule of thumb, after 6 months of breast-feeding, the woman should be advised to choose another method of contraception  8. **COITUS INTERRUPTUS** - **Coitus Interruptus** - man withdraws the penis during the ejaculation, thereby emitting the spermatozoa outside the vagina. - - - **Disadvantage:** pre-ejaculation fluid that contains a few spermatozoa that may cause fertilization. 9. **POSTCOITAL DOUCHING** - Douching following intercourse, no matter what solution is used - - - - NOT a RELIABLE method **HORMONAL METHODS** 1. Transdermal patch 2. Vaginal ring 3. IUD (copper T) 4. IUD LNG-IUS Mirena 5. Combination oral contraceptives(COCs) 6. Injectable progesterone (Depo-Provera) 7. Intradermal Patch **ARTIFICIAL FAMILY PLANNING** 1. **ORAL CONTRACEPTIONS/BIRTH CONTROL PILLS** - Commonly known as pills or COCs (combination oral contraceptives) - Composed of varying amounts of synthetic estrogen combined with small amount synthetic progesterone (progestin) - **ESTROGEN** - - **PROGESTERONE** - -  **CONTRAINDICATIONS TO ORAL CONTRACEPTIVES USE** - Breastfeeding and less than 6 weeks\' postpartum - Age 35 years or older and smoking 15 or more cigarettes per day - Multiple risk factors for arterial cardiovascular disease, such as older age, smoking, diabetes - **Hypertension** - Elevated blood pressure of 160 mm Hg systolic or above or 100 mm Hg diastolic or above - Current or history of deep vein thrombosis or pulmonary embolism - Major surgery that requires prolonged immobilization - Current or history of ischemic heart disease - Stroke **NOTES TO ORAL CONTRACEPTIVE USE** - Breast-fed infants have lower weight gains because the estrogen content, decrease the woman\'s milk supply. - After a woman stops taking a COC, she may not be able to become pregnant for 1 or 2 months, possibly 6 to 8 months. - The pituitary gland requires a recovery period to begin cyclic gonodotropin stimulation again. 2. **EMERGENCY POST COITAL CONTRACEPTION** - Often referred as **\"morning after pills\"** - High level of estrogen they contain apparently interferes with the production of progesterone, thereby prohibiting good implantation - Two sets of pills taken exactly 12 hours apart - Must be taken within 72 hours of the act of unprotected intercourse - 75 84% effective 3. **INTRAMUSCULAR INJECTIONS** **Medroxyprogesterone Acetate (Depoprovera)** - Birth control shot given once every three months to prevent pregnancy - Given every 12 weeks or injections of Lunelle given every 30 days - 99.7% effective preventing pregnancy - No daily pills to remember - **S/E:** irregular menstrual cycle, headache, weight gain, depression, risk for osteoporosis **SIDE EFFECTS OF DEPO - PROVERA** - Extremely irregular menstrual bleeding and spotting for 3-6 months! - NO PERIOD after 3-6 months - Weight change - Breast tenderness - Mood change - NOT EVERY WOMAN HAS SIDE EFFECTS 4. **INTRAUTERINE DEVICES (UID)** - T-shaped object placed in the uterus to prevent pregnancy ▪ Must be on period during insertion - A Natural childbirth required to use IUD - Extremely effective without using hormones \> 97 % - Must be in monogamous relationship  **3 COMMON TYPES:** - Progestasert changed yearly - Mirena effective for 5 years - Copper T380 Effective for 10 years Screenshot 2024-09-05 005621 **WARNING SIGNS:NECESSITATE THE REMOVAL OF UID** **P- Period Late (Pregnant)**, abnormal spotting or bleeding **A - Abdominal Pain** during intercourse **I - Infection exposure** (watch out for vaginal discharge **N - No string (missing),** shorter, or longer than usually felt +-----------------------------------+-----------------------------------+ | **COPPER - T** | **PROGESTASERT** | +-----------------------------------+-----------------------------------+ | - 10 YEARS | - 1 YEAR | | | | | - 99.2 % effective | - 98% effective | | | | | - Copper on IUD acts as | - T shaped plastic that | | spermicide, IUD blocks egg | releases hormones over a | | from implanting | one-year time frame Thickens | | | mucus, blocking egg | | - Must check string before sex | | | and after shedding of uterine | - Check string before sex & | | lining. | after shedding of uterine | | | lining. | +-----------------------------------+-----------------------------------+ |  | | +-----------------------------------+-----------------------------------+ **BARRIER METHODS** 1. **VAGINALLY - INSERTED SPERMICIDAL PRODUCT** - Cause the death of spermatozoa before they can enter the cervix - Change the vaginal pH to a strong acid level, a condition not conducive to sperm survival. (creams, gel, suppositories, foams, tablets)  **SPERMICIDES** - Chemicals kill sperm in the vagina - **Different forms:** 1. 2. 3. 4. - Some work instantly, others require pre-insertion - Only 76% effective (used alone), should be used in combination with another method i.e., condoms 2. **DIAPHRAGMS** - **Diaphragms** - a circular rubber that is placed over cervix before intercourse - Forms a barricade against the entrance of sperm - Kept in place for at least 6 hours after coitus - May be left in place for as long as 24 hours Wash after use last for 2-3 year  3. **CERVICAL CAPS** - Made of rubber shaped like a thimble - Fit snugly over the uterine cervix - Caps tend to dislodge more readily than diaphragms - filled with spermicide and self- inserted over the cervix prior to intercourse. - Device is left in place several hours after intercourse. 4. **VAGINAL RING (NUVARING)** - **NuvaRing** is a flexible plastic (ethylene-vinyl acetate copolymer) ring that releases a low dose of a progestin and an estrogen over 3 weeks. - - - -  5. **MALE CONDOM** - **CONDOM** is a latex rubber or synthetic sheath that is placed over the erect penis before coitus to trap sperm - Ideal failure rate of 2% and a typical - failure rate of about 15%, because breakage or spillage occurs in up to 15% of uses - **Advantage:** one of the few \"male responsibility\" birth control measures available - 6. **FEMALE CONDOMS** - **CONDOMS FOR FEMALES** are latex sheaths made of polyurethane and pre- lubricated with a spermicide. - - -  **SURGICAL METHODS OF REPRODUCTIVE LIFE PLANNING** **[How Long Does Complete Sterility Take After a Vasectomy?]** - Vasectomy recovery typically takes a week - The first 5 to 20 ejaculations after the procedure will still contain active sperm - It can take between 8 to 16 weeks for complete sterility Screenshot 2024-09-05 012231 **TUBAL LIGATION** -- a minor surgery whereby fallopian tubes are occluded by cautery, crushing, clamping or blocking thereby preventing passage of both sperm and ova. - **Fimbriectomy** - removal of the fimbria at the distal end of the tubes, is another possible but little used technique. - Sterilization of women could include removal of the uterus or ovaries (hysterectomy) - Most common operation: **laparoscopy** woman may return to having coitus as soon as 2 to 3 days after the procedure.  **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 4: PRENATAL PERIOD: THE GROWING FETUS** **FETUS** - Slow but sure development - **[Fetal development]** - critical stage of responsibility over her children - Role of the mother not only the time the baby is born but mos especially when she decides that [she wants to conceive an offspring] Male sperm + Female egg = zygote = embryo = baby **THE GROWING FETUS** - 38 weeks, from a single cell to a developed fetus - **[3 periods:]** 1. 2. 3. **TERMINOLOGIES** **OVUM** - Ovulation - Fertilization **ZYGOTE** - Fertilization - Implantation **EMBRYO** - Implantation - 5 to 8 weeks **FETUS** - 5 - 8 weeks until term **CONCEPTUS** - developing embryo, placental structure throughout pregnancy **AGE OF VARIABILITY** - earliest stage which they can survive outside the uterus, accepted [24 weeks (6 months)] or [weight more than 400 grams] "considered the capability of the lungs: - - - **FERTILIZATION** **FERTILIZATION** - referred the conception and impregnation **KANGAROO HUG** - when covered in linen, when the baby is good, the mother breaths for the baby - - - - - - - - - - - - - - The average time of the sperm can reach the cervix within [90 sec] and can reach the Fallopian tube within [5 min] - if the ovum has already penetrated by a spermatozoan. It changes is composition so that its becomes impermeable to other spermatozoan - After penetration, the chromosomal materials of the both ovum and the spermatozoan combine to form a **zygote** - **[3 factors determining certainty of fertilization]** 1. 2. 3. **IMPLANTATION** **IMPLANTATION** - Contact between the growing structure and the uterine endometrium, occurs [8 to 10 days after fertilization ] - [50%] of the zygote never achieve it - Occasionally, [small amount of vaginal spotting] appears on the day of implantation - capillaries **ECTOPIC PREGNANCY** - fertilization occurs outside of the uterus - Migration of the zygote to uterus takes 3 to 5 days via muscular - Mitotic cell after 24 hrs - Role of cleaving is every 24 hrs **MOLULA** - 15 to 50 cells Molula - Blastocyst - Endometrium (called implantation which takes 8 to 10 days after fertilization) **[PARTS OF BLASTOCYST]** 1. **TROPHOBLAST** - cells outer ring 2. **EMBRYOBLAST CELS** - inner cell mass, portion to form the embryo 3. **MOLAR PREGNANCY** - grape like structure, excessive hcg **LOKIA** - excessive blood **RUBRA** - 1 to 3 days, bright red color **SEROSA** - 3 to 5 days, fluid **ALPHA** - brownish, 10 days max **[2 TYPES OF PLACENTA]** 1. **DUNKEN** - sabog, difference cotyledons, have depressions and blood in the uterus, flat when pulled out 2. **SCHULTZ** - smooth, curved/fold when pulled out **FETAL CIRCULATION** - opposite function of a human - **Vein** - oxygenation - **Arteries** - deplete oxygen - Has 2 small arteries and 1 big vein - **Corpus luteum** - first 3 months of producer of hormone - **Placenta** - after end of the 3^rd^ month Blood sugar of the mommy is high = Blood sugar of the baby is also high Baby heart normally contains water The umbilical cord has no nerve endings **MEASLES** - can cause blindness to the baby **IMPLANTATION** - **Adhesion** occurs afterwards as the blastocyst attaches to the surface of the endometrium, then invasion, as it settles into the folds of the endometrium. - On the day of implantation, the woman may experience a small amount of vaginal spotting as the capillaries by the implanting blastocyst. - **EMBRYONIC AND FETAL DEVELOPMENT** - The **placenta**, which will [serve as the fetal lungs, kidneys, and digestive tract] in utero, begins growth in early pregnancy in coordination with embryo growth **FETAL STRUCTRE** - Uterine endometrium continues to thicken because of the corpus luteum that is influenced by hCG, and instead of sloughing off in a usual menstrual cycle, it becomes the **DECIDUAS**. - Endometrium is now termed the **DECIDUA** (the Latin word for [\"falling off\"]), because it will be discarded after the birth of the child. **DECIDUA HAS THREE SEPARATE AREA** - **Decidua basalis** - part of the endometrium that lies directly under the embryo (or the portion where the trophoblast cells establish communication with maternal blood vessels) innermost portion of the layer - **Decidua capsularis** - the portion of the endometrium that stretches or encapsulates the surface of the trophoblast - **Decidua vera** - becomes the remaining portion of the uterine lining, and sheds as the lochias. - **CHORIONIC VILLI** - On the **11th or 12th day**, the chorionic villi start to form from the miniature villi that protrude from a single layer of cells to start the formation of placenta. - - **Syncytiotrophoblast or the syncytial layer** outer of the two covering layers - - **CYTOTROPHOBLAST OR LANGHANS\' LAYER** - middle layer, present as early as 12 days\' gestation. - - **PLACENTA** **PLACENTA** is a Latin term for **\"pancake\"** for its appearance came from the trophoblast tissues lot of functions that benefit the fetus. - Using the umbilical cord as its conduit, the flattened, disk-shaped placenta [provides nutrients and removes wastes from the fetus] from the [third month of pregnancy until birth]. - formed from the chorion, its chorionic villi, and the adjacent decidua basalis. - **[Placenta Contains Two Highly Specialized Circulatory Systems:]** 1. **FETOPLACENTAL CIRCULATION** transports oxygen-depleted blood from the fetus to the chorionic villi by the **UMBILICAL ARTERIES** and returns oxygenated blood to the fetus through the **UMBILICAL VEIN**. Blood enters the intervillous spaces from **UTERINE ARTERIES** that penetrate the basal part of the placenta; it leaves the **INTERVILLOUS SPACES** and flows back into the maternal circulation through **VEINS** in the basal part of the placenta near the arteries. **[PLACENTA: Hormones]** - For the first 3 months of pregnancy - **CORPUS LUTEUM** - By the end of the third month - **PLACENTA** - Hormones in the rise - **ESTROGEN** stimulates uterine development to provide a suitable environment for the fetus. - **PROGESTERONE** - synthesized by the placenta from maternal cholesterol, reduces uterine muscle irritability and prevents spontaneous abortion of the fetus. - **HUMAN PLACENTAL LACTOGEN (HPL),** which resembles growth hormone - stimulates maternal protein and fat metabolism to ensure a sufficient supply of amino acids and fatty acids for the mother and fetus **[Mechanism by which nutrients cross the placenta]** **DIFFUSION** - higher concentration to the area of lower concentration. Oxygen, carbon dioxide, sodium, and chloride. **FACILITATED DIFFUSION** - substances cross the placenta guided by a carrier - So move more rapidly or easily substance that crosses by this process: **Glucose** **ACTIVE TRANSPORT** - process requires the action of an enzyme to facilitate transport. - Amino acids and water-soluble vitamins **PINOCYTOSIS** - absorption by the cellular membrane of microdroplets of plasma and dissolved substances. - Gamma globulin, lipoproteins, and phospholipids - Viruses that then infect the fetus can also cross in this manner. **AMNIOTIC MEMBRANES** **CHORIONIC MEMBRANE (CHORION)** - the outermost fetal membrane. - Its purpose is to form the sac that contains the amniotic fluid. **AMNIOTIC MEMBRANE (AMNION)** - second membrane lining the chorionic membrane, forms beneath the chorion - These membranes seem as [one at term]. - Covering the fetal surface of the placenta, giving that surface its typically [shiny appearance]. - Is no nerve supply, so when they spontaneously rupture at term or are artificially ruptured, [neither woman nor child experiences any pain] - Not only [offers support to amniotic fluid] but also actually **produces the fluid**. - It produces a [phospholipid] that initiates the f[ormation of prostaglandins] **AMNIOTIC FLUID** - [Clear, yellowish fluid] surrounding the developing fetus. - Average amount is [1000 ml]. - Having \< 300ml - **Oligohydramnios**, associated with [fetal renal abnormalities]. - Having 2 L - **Hydramnios**, associated with [GI and other malformations]. - Protects Fetus - Controls Temperature - Supports Symmetrical Growth - Prevents Adherence to amnion - Allows Movement - \"Source of oral fluid - Acts as a excretion - collection repository **UMBILICAL CORD** - Formed from the fetal membranes [(amnion and chorion)] - Connecting [link between fetus and placenta]. - Transports [oxygen and nutrients] to fetus from the placenta and [returns waste products] from the fetus to the placenta. - Contains: **2 arteries and 1 vein** supported by mucoid material **(wharton\'s jelly)** to prevent kinking and knotting. - Contains NO pain receptors. **ORIGIN & DEVELOPMENT OF ORGAN SYSTEMS** **STEM CELLS** - During the first 4 days of life, cells are [termed **totipotent** stem cells, or cells] that are so undifferentiated they have the potential to form a complete human being. - In **another 4 days**, as the [structure implants and becomes an embryo], cells begin to show differentiation and lose their ability to become any body cell. **ZYGOTE GROWTH** - From the beginning of fetal growth, development proceeds in a cephalocaudal (head-to-tail) direction; head development occurs first and is followed by development of the middle and, finally, the lower body parts. - **Organogenesis** - organ formation -  **CARDIOVASCULAR SYSTEM** - 1st System to function - **SEPTUM** that divides the heart into chambers develops during the sixth or seventh week. - **HEART VALVES** begin to develop in the seventh week. - FHR 120 - 160/Min - Can hear FHR with doppler at **10 - 12 Weeks - Day 21**. **FETAL CIRCULATION** - **As early as the third week of intrauterine life**, fetal blood begins to [exchange nutrients with the maternal circulation] across the chorionic villi. - Fetal circulation differs from extrauterine circulation because the [fetus derives oxygen and excretes carbon dioxide] not from gas exchange in the lung but from [gas exchange in the placenta] **RESPIRATORY SYSTEM** - **At the third week** of intrauterine life, the respiratory and digestive tracts exist as a [single tube]. - Initially this forms as a solid structure, which then canalizes (hollows out). - **By the end of the fourth week**, a [septum begins to divide the esophagus from the trachea]. - At the same time, [lung buds] appear on the trachea. - **Surfactant** - - - **NEUROLOGICAL SYSTEM** - Formed from the ectoderm during the 3rd week ---------------------------------- ------------ **Controlles by Nervous System** Respiratory effort 18 1/2 WKS Swallowing 12 1/2 WKS Sucking 29 WKS Fetal movement felt (Quickening) 16-20 WKS ---------------------------------- ------------ **NERVOUS SYSTEM** - Begins to develop [extremely early in pregnancy]. - **Third and fourth weeks** of intrauterine life, possibly before the woman even realizes she is pregnant, [active formation of the nervous system and sense organs] has already begun. - **Spinal cord disorders** such as meningocele - occur because of [lack of folic acid] (contained in green leafy vegetables and pregnancy vitamins) **DIGESTIVE SYSTEM** - Forms during **4th week** - [Sterile] before birth. - **Vitamin** K is synthesized by the action of bacteria in the intestines, vitamin K levels are [low in the newborn]. - **Sucking and swallowing reflexes** are not mature until the fetus is at about [32 weeks\' gestation or weighs 1500 g]. - **Meconium** is [sticky in consistency] and appears [black or dark green] (obtaining its color from bile pigment). **RENAL SYSTEM** - Kidneys form in **5th week** and begin to [function 4 weeks later.] - At term, fetal urine is being excreted at the rate of **500 mL/day.** - Voiding [into amniotic fluid] - [Low volume] can show renal dysfunction - Renal malformation can be diagnosed in utero. - [GFR is low at birth] **[E]NDOCRINE SYSTEM** - Thyroid gland 1st to develop - Insulin produced at **20 weeks** **IMMUNE SYSTEM** - Immunoglobulin G (IgG) maternal antibodies cross the placenta into the fetus - **20 - 24 week** of intrauterine life to give [a fetus temporary passive immunity] against diseases for which the mother has antibodies. **INTEGUMENTARY SYSTEM** - Skin [thin and almost translucent] until subcutaneous [fat] begins to be deposited at about **36 weeks**. - **Lanugo** - Skin is covered by [soft downy hairs] to preserve warmth in utero - **Vernix Caseosa** - a [cream cheese-like substance] for lubrication and for keeping the skin from macerating in utero. - **10th week** - Fingernails, toenails **VIABILITY** - Capability of fetus to [survive outside uterus] at the earliest gestational age **22-24 weeks** - **[Survival depends on:]** - - **FIRST TRIMESTER** **1 MONTH** At the end of four weeks: - Baby is [1/4 inch in length] - Heart, digestive system, backbone and spinal cord begin to form - **Placenta** (sometimes called **\"afterbirth\"**) begins to develop - Single fertilized egg is now [10,000 times] larger than size at conception **2 MONTH** At the end of 8 weeks: - Baby is [1-1/8 inches long] - Heart is functioning - Eyes, nose, lips, tongue, ears and teeth are forming - Penis begins to appear in boys - [Baby is moving], although the mother [can not yet feel movement] **3 MONTH** At the end of 12 weeks: - Baby is [2 1/2 to 3 inches] long - Weight is about [1/2 to 1 ounce] - Baby develops [recognizable form]. Nails start to develop and earlobes are formed - Arms, hands, fingers, legs, feet and toes are fully formed - Eyes are almost fully developed - Baby has [developed most of his/her organs and tissues] - Baby\'s heart rate [can be heard at 10 weeks] with a special instrument called a **Doppler** **SECOND TRIMESTER** **4 MONTH** At the end of 4 months: - Baby is 6 1/2 to 7 inches long - Weight is about 6 to 7 ounces - Baby is developing reflexes, such as sucking and swallowing and may begin sucking his/her thumb - Tooth buds are developing **5 MONTHS** At the end of 5 months: - Baby is [8 to 10 inches long] - Weight is about [1 pound] - Hair begins to grow on baby\'s head - Soft woolly hair called **lanugo** will cover its body. Some may remain until a week after birth, when it is shed. - Mother [begins to feel fetal movement] - Internal [organs are maturing] - Eyebrows, eyelids and eyelashes appear **6 MONTHS** At the end of 6 months: - Baby is [11 to 14 inches long ] - Weight is about [1 & 3/4 to 2 pounds] - [Eyelids begin to part and eyes open sometimes] for short periods of time - Skin is [covered with protective coating] called **vernix** - Baby is [able to hiccup] **THIRD TRIMESTER** **7 MONTHS** At the end of 7 months: - Baby is [14 to 16 inches long ] - Weight is about [2 1/2 to 3 1/2 pounds] - [Taste buds] have developed - [Fat layers are forming ] - Organs are [maturing] - Skin is still [wrinkled and red] - If born at this time, baby will be considered a premature baby and require special care **8 MONTHS** At the end of 8 months: - Baby is [16 1/2 to 18 inches long ] - Weight is about [4 to 6 pounds ] - [Overall growth is rapid] this month - [Tremendous brain growth] occurs at this time - Most body organs are [now developed with the exception of the lungs ] - **Movements or \"kicks**\" are [strong enough to be visible from the outside] - Kidneys are [mature] - Skin is [less wrinkled] - Fingernails now extend beyond fingertips **9 MONTHS** At the end of 9 months: - Baby is [19 to 20 inches long] - Weight is about [7 to 7 1/2 pounds] - The [lungs are mature] - Baby is now [fully developed] and [can survive outside the mother\'s body] - Skin is [pink and smooth] - Baby settles down lower in the abdomen in preparation for birth and may seem less active **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 5: CARE OF THE MOTHER DURING THE PERINATAL PERIOD** **PRENATAL CARE** I. **OBSTETRIC DATA** **GRAVIDA** - Number of pregnancy regardless of duration as long as the mother becomes pregnant even abnormal. **PARA/PARITY** - number of viable pregnancy or the total number of pregnancies in which the fetus has reached the age of viability and subsequently delivered whether dead or alive at birth. **VIABILITY** - Ability of the fetus to live outside the uterus at the earliest possible gestational age. **PRIMIGRAVIDA** - - Woman who is pregnant for the first time **PRIMIPARA** - Woman who has given birth to one child past age of viability; woman who has completed one pregnancy to age of viability and subsequently delivered the fetus, whether alive or dead at birth. **MULTIGRAVIDA** - Woman who has been pregnant previously; 2 or more pregnancy **GRANDMULTIGRAVIDA** - woman who has had six or more pregnancies **MULTIPARA** - Woman who has carried two or more pregnancies to viability; woman who has carried two or more pregnancies of stage of viability and subsequently born alive or dead. **NULLIGRAVIDA** - Woman who has never been and is not currently pregnant **PRINCIPLES IN IDENTIFYING PARITY** 1. Number of pregnancies is counted and not the number of fetuses. 2. Abortion is not included in parity count 3. Live birth or stillbirth is counted in parity count. **OB SCORING** **T** - Term: Number of full-term infants born 37 weeks **P** - Preterm: Number of preterm infants born 20 - 36 weeks **A** - Abortion: termination of pregnancy before the age of viability (less than 20 weeks) **L** - Number of Currently Living Children **M** - Multiple Pregnancy **EXAMPLE**: Gravida - 4 Parity - 3 = G4P3 T3 P1 A0 L3 **NAGELE\'S RULE** - Use to determine expected date of delivery (EDD or EDB). It is important to determine the mother\'s LMP. - - **MC DONALD\'S RULE** - Use to determine age of gestation in weeks using FUNDIC HEIGHT - **FORMULA:** - - **BARTHOLOMEW\'S RULE** - Use to determine age of gestation by proper location of fundus at abdominal cavity - - - - - - **PHYSIOLOGICAL CHANGES** - **GRIEF** - may arise from the [realization that one\'s roles] would be changed permanently. - **MOOD SWINGS** - Also known as **emotional lability**, caused by two factors: 1. 2. - - **FIRST TRIMESTER** - experience a decrease in libido mainly because of breast tenderness, nausea, and fatigue. **SECOND TRIMESTER** - sexual libido may rise because of increased blood flow to the pelvic area that supplies the placenta. **THIRD TRIMESTER** - might bring an increase or decrease in sexual libido due to an increase in the abdominal size or difficulty in finding a comfortable position. Estrogen increase may also affect sexual libido as it may bring a loss of desire. - - **Self-centeredness (narcissism)** - generally an early reaction to pregnancy. - A woman who previously was barely conscious of her body, who dressed in the morning with little thought about what to wear, who was unconcerned about her posture or her weight, suddenly begins to concentrate on these aspects of her life. - - [**Pregnancy** is a major change] in roles that could cause stress. - Stress that a pregnant woman feels [might affect her ability to decide]. - [Discomforts] that she may feel could also add up to the stress she is experiencing. - **BODY IMAGE AND BOUNDARY BODY IMAHE** **BODY IMAGE** - way your body [appears to yourself] **BODY BOUNDARY** - a [zone of separation] you perceive between yourself - Change during pregnancy as a woman [begins to envision herself as a mother.] - **COUVADE SYNDROME** - Many men experience physical symptoms such as nausea, vomiting, and backache [to the same degree or even more intensely] than their partners during a pregnancy. - Symptoms apparently result from [stress, anxiety, and empathy for the pregnant woman]. **PSYCHOLOGICAL TASKS OF PREGNANCY** 1. Both the woman and her husband walk through a tangle of emotions during pregnancy. 2. Accepting that a new life would be born out of your blood is not as easy as others may think. 3. There are several stages that both should undergo, the psychological way. **[First Trimester - Accepting the Pregnancy]** - **SHOCK OF LEARNING ABOUT A NEW PREGNANCY** is [sometimes too heavy for a couple], so it is just proper for the both of them to spend some time recovering [from this major life-altering situation and avoid overwhelming themselves at first]. - One of the most common reactions of a couple who would be having a baby for the first time i[s ambivalence or feeling both pleased and unhappy about the pregnancy]. **[Second Trimester: Accepting the Baby]** - Woman and her partner will start to [merge into the role of novice parents] as second trimester closes in. - Emotions such as [narcissism and introversion are commonly] present at this stage. - [Role playing and increased dreaming] are activities that help the couple embrace their roles as parents. - At this stage, the woman and her partner must start to [concentrate on what it will feel like to be parents]. **[THIRD TRIMESTER: Preparing for the Baby]** - Couple starts to [grow impatient as birth nears]. - Preparations for the [baby, both small and big], takes place during this stage. - [Baby\'s clothing and sleeping arrangements] are set and the couple is excited for his arrival. - **DIAGNOSIS OF PREGNANCY** 1. The Diagnosis of Pregnancy - - - 2\. Reproductive System Changes 3\. Breast Changes 4\. Systemic Changes - - - - - - - - **Uterine enlargemen**t - uterus can be palpated over symphysis pubis **Quickening** - fetal movement felt by woman **Linea Nigra** - line of dark pigment forms on the abdomen **Melasma** - dark pigmentation on face **Striae Gravidarum** - red streaks forms on abdomen - **CHADWICK\'S SIGN** - a change in the color of the vagina from pink to violet **GOODELL\'S SIGN** - softening of the cervix. **HEGAR\'S SIGN** - softening of the lower uterine segment. **BALLOTTEMENT** - rise of the fetus felt through the abdominal wall when the uterine segment is tapped on a bi manual examination. **GESTATIONAL SAC** found during ultrasound **BRAXTON - HICKS CONTRACTIONS** periodic uterine tightening and contractions. **FETAL OUTLINE** can also be now palpated by the examiner through the abdomen. **Laboratory Tests** - blood serum and urine specimen to detect the presence of human chorionic gonadotrophin (hCG) a. b. c. **[PHYSIOLOGIC CHANGES THAT Occur During Pregnancy]** **LOCAL** - confined to the reproductive organs **SYSTEMIC** - affecting the entire body. - Both symptoms (subjective findings) and signs (objective findings) of the physiologic changes of pregnancy are used to diagnose and mark the progress of pregnancy. **REPRODUCTIVE SYSTEM CHANGES** - **Amenorrhea** - suppression of follicle-stimulating hormone (FSH) by rising estrogen levels. - **Cervix** undergoes a more vascular and edematous appearance owing to the increased level of estrogen. - **Uterus increases** in length, depth, width, weight, wall thickness, and volume. 1. 2. 3. 4. - **Cervical changes** - becomes more vascular and edematous - **Vaginal Changes** - increase vascularity of the vagina - **Ovarian Changes** - active production of estrogen and progesterone - - **[BREAST changes]** - **Feeling of fullness**, tingling or tenderness because of increased estrogen level - **Breast size increase** because of the growth in mammary alveoli and in fat deposit - Areola of the **nipple darkens** and the diameter increases from about 3.5 cm (1.5 inches) to 5cm or 7 cm (2 or 3 inches) **ENDOCRINE SYSTEM CHANGES** - **FSH and LH** - decreases causing anovulation. - **PROLACTIN** - prepare the breasts for lactation, increases in production of milk. - **Melanocyte** - stimulating Hormones causes increase in skin pigment. - **Human growth hormone** - increase to aid the fetus in growing. - **THYROID AND PARATHYROID GLAND** - [slight enlargement; increases the basal metabolic rate] of a pregnant woman and for better consumption of calcium and vitamin D. - - **INSULIN** produced from the pancreas [decreases EARLY in the pregnancy], thereby [increasing glucose available] for the fetus. - [Increase in insulin] occurs in the first trimester [because estrogen, progesterone and HPL] have insulin antagonistic properties. **CARDIOVASCULAR SYSTEM CHANGES** - Changes in the circulatory system are extremely significant to the health of the fetus - [adequate placental and fetal circulation] - - - - - **RESPIRATORY SYSTEM CHANGES** - **Shortness of breath** is also a common discomfort of pregnancy as the pregnant uterus pushes the diaphragm upward. - The total oxygen consumption of a pregnant woman **increases by 20%.** - **congestion, or "stuffiness," of the nasopharynx** - response to increased estrogen levels. **GASTROINTESTINAL CHANGES** - [Slow emptying time] of the stomach - **Nausea and vomiting** - high levels of estrogen and human chorionic gonadotropin - **Hyperemesis gravidarum** - severe nausea and excessive vomiting during pregnancy (abnormal) - [Decreased pH] of the saliva - **CONSTIPATION** - high level of progesterone during pregnancy [slows the automatic waves of muscular contractions] in the intestine - **Hemorrhoids** - common due to constipation, [pressure of the uterus, slow peristalsis] **MUSCULOSKELETAL SYSTEM** - **Calcium and phosphorus needs are increased** during pregnancy, because the fetal skeleton must be built. - gradual softening of a woman\'s pelvic ligaments and joints to facilitate passage of the baby through the pelvis at birth. - Symphysis pubis widens for 3 to 4 mm. - **\'pride of pregnancy\'** or commonly **\'lordosis\'** occurs - backache - **Muscle cramps** are caused by [decreased serum calcium levels] **IMMUNE SYSTEM CHANGES** - **Immunologic competency** during pregnancy apparently decreases - to prevent a woman\'s body from rejecting the fetus - **Immunoglobulin G (IgG) production decreased**, which can make a woman more prone to infection - **Increase in the white blood cell count** may help to counteract the decrease in IgG response. **NCMA 217: CARE OF MOTHER, CHILD & ADOLESCENT - PRELIMS** **LECTURER: DOROTHY INOT SY 2024 - 2025** STEVEN VALENCIA, SN LEVEL 2 - M10A **WEEK 5: NORMAL DIAGNOSTIC LABORATORY FINDINGS AND DEVIATION** A **medical diagnosis of pregnancy** serves to date when the birth will occur and also helps predict the existence of high-risk status. - With advancements in science and technology, pregnancy tests today are commercially available and can be performed by the trained personnel that are highly accurate and precise, if done with the correct technique. **PREGNANCY TESTING** - relies on the detection of an antibody to the hormone **human chorionic gonadotropin (hCG)** or a subunit in the urine or serum **HUMAN CHORIONIC GONADOTROPHIN** - the first placental hormone produced and can be found shortly after implantation **[Specimens:]** 1. **Urine** - test to yield accurate results and it should be done 10 to 14 days after the missed menstrual period. This period guarantee level of hCG and prevents false negative results. a. b. - **[Urine Tests: (hCG)]** - - - - - - 2. **BLOOD** - with sensitive assays hCG can be detected in maternal blood at 7 days after conception and are accurate close to 100% of the time 3. **PROGESTERONE WITHDRAWAL TESTA CONTRACEPTIVE PILL** is taken OD or TID (3xdays) - If menstruation occurs within 10-15 days, the woman is not pregnant. - If corpus luteum produces enough hormones to neutralize the effect of withdrawn synthetic progesterone and no bleeding occurs, the woman is pregnant 4. **ULTRASOUND IMAGING** - (Ultrasound scanning or Scanning) involves exposing a part of the body to high frequency sound waves to produce pictures of the inside of the body - It is a popular and safe diagnostic tool in the care of the pregnant woman and her fetus. - It provides the physician, and other members of the health team the ability to approach the developing fetus as a separate patient with an identifiable set of reflexes reactions to outside stimuli and activity patterns. - 7-11 wks. if the date of LMP is unknown, between 16-20 wks. gestation to verify fetal structures and gender **TYPES OF PELVIC ULTRASOUND** 1. **Abdominal or Transabdominal** - with the woman in supine position, the sonographer/radiologist applies the transducer on the lower abdomen 2. **Vaginal or transvaginal** - with the woman in lithotomy position, the sonographer/radiologist inserts into the vagina 2-3 inches of the vaginal transducer\'s end with the protective cover and lubricating gel - **[Purpose:]** 1. 2. 3. 4. 5. **ULTRASONOGRAPHY** 1. **Biparietal diameter** - used to predict fetal maturity. a. Measurement of fetal head (8.5 cm. or greater) b. Weight. 2500 g (5.5 lb.) 2. **Doppler Umbilical Velocimetry** - measures the velocity at which RBC in the uterine and fetal vessels to assess blood flow 3. **Placental grading for maturity** - graded based on the amount of calcium deposits present in the base of the placenta - **[Placental grading for maturity]** - - - - **LATERAL PELVIMETRY** - In suspected cephalopelvic disproportion (CPD) with a danger sign of absence of lightening in a primigravida in active labor - **[Indications for lateral Pelvimetry]** - - - - - **LABORATORY ASSESSMENT** a. Urinalysis - tested for proteinuria, glycosuria, nitrates, pyuria b. Complete blood count c. Genetic screen (G6PD glucose6phosphate dehydrogenase) d. VDRL serologic test for syphilis e. Blood typing (Rh factor) f. Maternal serum a-fetoprotein - done between 16-18 wks. of pregnancy g. Combs test-determination of whether Rh antibodies are present in an Rh (-) woman h. HIV screening i. Serum antibody titers for rubella, hepatitis, varicella j. Blood Serum Studies k. Tuberculosis Screening (Mantoux Test) **FETAL BIOPHYSICAL PROFILE** - Is a noninvasive method of assessing the general well being of the fetus and the fetal assessment. - BPP may be used as early as 26-28 weeks for the surveillance of high risk pregnancy. - The test requires the use of an ultrasound and the electronic fetal monitor and the observation time takes about 30 minutes. - **[Indications:]** 1. 2. 3. 4. **[Five Parameters:]** 1\. Fetal reactivity 2\. Fetal breathing movements 3\. Fetal body movements 4\. Fetal tone 5\. Amniotic fluid volume **[Results:]** 8 -10 fetus is considered to be doing well 6 - is considered suspicious 4- denotes a fetus probably in jeopardy **BIOPHYSICAL PROFILE SCORING** 1. **Fetal breathing** - at least one episode of 30secs. of sustained breathing movement w/in 30mins 2. **Fetal movement** - at least 3 episodes of fetal limb or trunk movement w/in 30mins. 3. **Fetal tone** - Observation must extend and then flex extremities or spine at least once in 30 mins. 4. **Fetal heart reactivity** - 2 or more heart accelerations at least 15 beats/min 5. **Amniotic fluid volume** - A range of amniotic fluid between 5 and 25 cm must be present **[Fetal Heart Rate]** Fetal heart sounds a\. 10-11 wks. - ultrasound b\. 10 wks. - Doppler **[Daily fetal Movement Count]** (Kicks Count) a\. 18-20 wks. - quickening felt by the mother b\. 28-38 wks. - 10x/hr. peaks in intensity **RHYTHM STRIP TESTING** - use for assessment of the fetal heart rate **Average FHR** - 130 beats/min. **Average fetal moves** - twice every 10 mins. - causes heart rate to increase **VIBROACOUSTIC STIMULATION** - for acoustic (sound) stimulation - Acoustic stimulator applied to the mother\'s abdomen to produce sharp sound (80 db.), startling and waking the fetus **[Purposes of Amniotic Fluid Analysis]** 1. Detection of fetal abnormalities early in pregnancy 2. To determine fetal lung maturity 3. Lecithin/Sphingomyelin ratio 4. Lung Profile 5. Amniotic Fluid Bilirubin 6. Rh incompatibility 7. For detection of certain infections **AMINIOCENTESIS** - Amnion for sac and kentesis for puncture. Scheduled between the 14th and 16th week - Amniocentesis is the removal of fluid from the amniotic cavity by needle puncture. An ultrasound is performed first to determine the safe site where the needle can be inserted. - During the procedure, the fetus is continuously monitored by ultrasound to ensure its wellbeing. - Complications includes hemorrhage from the penetration of the placenta, infection of the amniotic fluid and puncture of the fetus **[Nursing Care during Amniocentesis]** 1. Assist client to empty her bladder before the procedure 2. Place in supine position and drape properly 3. Put rolled towel under right hip to tip body to the left and remove pressure of uterus on vena cava 4. Instruct not to take a deep breath and hold it while the needle is being inserted as it will shift the uterus and needle may hit placenta or fetus. 5. Inform the patient that it is not painful because anesthesia will be applied at the insertion site. She may experience pressure sensation during the insertion of the needle. 6. Monitor FHT before, during and in 30 minutes after the test. 7. Instruct patient to observe for: - Infection - Uterine cramping - Vaginal bleeding **CHORIONIC VILLI SAMPLING** - Is a transcervical or transabdominal insertion of a needle into the fetal portion of the placenta, at the area of the chorion frondosum - CVS is performed at 8-12 weeks gestation under ultrasound guidance to ensure that the fetus is unharmed. - Chorionic villi cells are examined to detect chromosome abnormalities such as Down syndrome and genetic disorders such as cystic fibrosis - Is a biopsy & analysis of chorionic villi for chromosomal analysis done at 8 to 10 weeks of pregnancy chorion cells are located by ultrasound - A thin catheter is inserted vaginally or needle biopsy is inserted intravaginally or inserted abdominally, and a number of chorionic cells are removed chromosone analysis (genetic defect) 1. Instruct the client to report bleeding, infection or leakage of fluid after procedure 2. Some instances of limb reduction syndrome 3. Less than 1% risk leading to excessive bleeding or pregnancy loss 4. Reportable signs and symptoms: - Chills or fever (infection) - Uterine contraction or vaginal bleeding (threatened miscarriage) **AFP/TRIPLE SCREEN** - This test involves measurement of AFP, estriol and HCG in maternal serum at 15-20 weeks of gestation to screen for fetal structural & chromosomal abnormalities. Alpha-feto protein is a substance produced by the liver that is present in amniotic fluid and maternal serum. - Estriol is initially tested. If the result is abnormal, the woman is next referred for ultrasound to confirm gestational age and to evaluate for neural tube defects (NTD) and other structural abnormalities. - A low estriol, elevated HCG, and low AFP finding is often associated with Trisomy 21 (Down syndrome). - High in the maternal serum (MSAFP) if the fetus has an open spinal or abdominal defect. **NON - STRESS TEST (NST)** - An assessment of fetal well-being that analyses the response of the fetal heart to fetal movement - When the fetus has adequate oxygenation and intact CNS, the are accelerations of FHR with fetal movement. - The baby\'s heart rate should accelerate, by 15 beats for at least 15 seconds, twice in a twenty minute period. This is called a reactive NST and is a good sign that the fetus is healthy. - A reactive NST indicates intrauterine survival for one week. The doctor may order a CST if the NST is nonreactive. The usual preparation is to feed the mother with food or fluids before the test to stimulate fetal movements **[CONTRACTION STRESS TEST]** - Assess the ability of the fetus to withstand the stress of uterine contraction done during labor - CST is a means of evaluating the respiratory function of the placenta. - Induced or spontaneous contraction decrease transport of 02 to the fetus. A healthy fetus maintains a steady heart rate. - If placental reserve is insufficient, fetal hypoxia and decrease in FHR occur. - Testing is initiated when 3 contractions in every 10 minutes are attained. The test takes about 60-90 minutes to perform. **PERIODIC CHANGES** a. **Accelerations** - temporary normal increases in FHR caused by fetal movement or compression of the umbilical vein during contraction b. **Early Decelerations** - periodic decreases in FHR resulting from pressure of the fetal head during contractions. - - c. **Late Decelerations** - delayed decelerations until 30 to 40 seconds after the onset of a contraction and continue beyond the end of the contraction - - - - - - - d. **Variable Decelerations** - Decelerations that occur at unpredictable times in relations to c