OB NURSING PDF S.Y. 2024 - 2025

OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS – SEM 1 Q1 WEEK # – - Is a rugated, skin-covered, muscular pouch suspended from the...

OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS – SEM 1 Q1 WEEK # – - Is a rugated, skin-covered, muscular pouch suspended from the perineum. - protects the nerves from urinating or - IMPORTANT NOTES have an erection [@] – my notes - -Function: to support the testes and help [-]- end of my notes regulate the temperature of sperm. [-] 1.0 MALE REPRODUCTIVE SYSTEM Testes (testicles)- male sex organs 1. Manufacture testosterone ( male sex MALE REPRODUCTIVE SYSTEM hormone) 2. Produce sperm (male reproductive cells) Two ovoid glands, 2-3 cm wide, lie in the scrotum. Each is encased by a protective white fibrous capsule composed of lobules, with each lobule (seminiferous tubules which develops germ cells) containing the following: ○ Interstitial cells or Leydig’s Cells – responsible for the production of testosterone ○ Seminiferous tubules – responsible for the production of spermatozoa Functions of the male reproductive system: Spermatozoa: male sex Production of sperm cells. hormone that carries genetic Sustaining and transfer of the sperm cells to material the female reproductive organ Production of male sex hormones. PENIS Glans (head) – located at the distal end, a External Male Reproductive Organs bulging and sensitive ridge of tissue. Scrotum Prepuce – a retractable skin casing that Testes protects the nerve-sensitive glans at birth. Penis Composed of three cylindrical mass of erectile tissue Internal Male Reproductive Organs in the shaft where the urethra passes: Epididymis 2 Corpus cavernosa- surrounds the urethra Vas Deferens 1 corpus spongiosum- either side of ureter Ejaculatory Duct Organ for copulation (sexual intercourse) and urination Accessory Organs Seminal Vesicle EJACULATORY DUCT- connects the seminal vesicles Prostate Gland to the urethra Cowper’s/ Bulbourethral Gland moves through prostate and pick up prostatic Seminal Fluid or semen fluid to add semen Scrotum 1.1 ACCESSORY ORGANS 1. loose sac of skin that hangs outside the body 2. holds the testes 3. Helps regulate the temperature of sperm SEMINAL VESICLE 2 pouch like organ consisting of many saclike To produce sperm, the temperature of the structures located next to the ductus deferens testes must be a few degrees lower than the and lying behind the bladder an in front of the normal body temperature of 98.6 degrees F rectum 4cm long, has low pH and contain nutrients [@] that nourish the sperms PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 1 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS Its secretions contain prostaglandins that are thought to cause contractions of the female 2.0 FEMALE REPRODUCTIVE SYSTEM reproductive tract to help transport the sperm cells. ○ Sperm become increasingly motile because this added fluid surrounds them with a more favorable pH environment PROSTATE GLAND A walnut- shape (conical)/chestnut-sized gland body lying below the bladder surrounding the urethra and the 2 ejaculatory ducts which secretes a thin milky alkaline fluid that enters the urethra to neutralize the acidic secretions of the testes, seminal vesicles and vagina and also nourish the sperm cell Purpose: Secrete a thin alkaline fluid COWPER’S / BULBOURETHRAL GLAND FEMALE REPRODUCTIVE ORGAN 2 small glands located below the prostate secrete an alkaline fluid before ejaculation EXTERNAL GENITALIA which help neutralize the acidic nature of urethra 1. Mons Pubis/ Mons Veneris ○ provides lubrication during intercourse 2. Labia Majora 3. Labia Minora 4. Clitoris 5. Fossa Navicularis 6. Vestibule 7. Bartholin’s Glands 8. Skene’s Glands 9. Vaginal Orifice 10. Hymen 11. Urethral Meatus INTERNAL GENITALIA 1. Vagina 2. Uterus 3. Fallopian tubes SEMINAL FLUID OR SEMEN 4. Ovaries mixture of secretions from the seminal vesicles (60%); prostate gland ( 30%); testes ( 5%); Cowper’s gland (5%); ejaculatory duct and sperm cells. ○ 2 to 5 ml normal volume of semen ○ 1 ml = about 100 million sperm cells - sperm count below 20 million is abnormal and usually result in sterility PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 2 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS 4. CLITORIS highly sensitive and erectile tissue situated under the prepuce of the labia minora Highly sensitive to touch and temperature Composed of two erectile tissue called corpora cavernosa (connected to the bone) Supplied with many sebaceous glands that produce a cheese-like secretion (smegma) it is the guide in female catheterization ○ during sexual arousal the ischiocavernosus muscle surrounding it contracts blocking blood flow resulting in clitorial congestion and erection 5. FOSSA NAVICULARIS The space between the fourchette and vaginal introitus. Usually obliterated during childbirth 6. VESTIBULE Is a triangular space located between the labia minora containing the following openings: 2.1 EXTERNAL GENITALIA ○ vaginal introitus ○ urethral meatus ○ Bartholin’s glands VULVA OR PUDENDA- refers to the entire female ○ Skene’s glands external genitalia 7. BARTHOLIN'S GLANDS 1.MONS PUBIS/ MONS VENERIS Also known as vulvovaginal gland, paravaginal Pad of flat above symphysis pubis that is an and major vestibular glands. important obstetrical landmark and protects A pair of glands located at each inner side of the symphysis from trauma the vagina that secretes alkaline mucus which it is richly supplied with sebaceous glands helps to keep the vaginal introitus lubricated during childhood it is hairless and smooth, but and enhance sperm survival by puberty it becomes covered by curly hair called escutcheon 8. SKENE’S GLANDS hair pattern in female is triangular with base Also known as paraurethral and minor up and in male it assumes a diamond-shaped vestibular glands. pattern A pair of glands situated at each inner side of the urethral meatus 2. LABIA MAJORA Its secretions increases with sexual two elongated, hair-covered fatty skin folds stimulation to lubricate the vagina and its main function is to provide covering and facilitate coitus protection to the external organs located under it 9. VAGINAL ORIFICE External opening of vagina below the urethral 3. LABIA MINORA meatus two thin hair-free folds covered with mucosa & the G- spot or Grafenberg is a very sensitive sebaceous glands lower portion is called area located at the inner anterior surface of frenulum being very fragile it is usually torn the vagina during vaginal delivery ○ In nulliparous women, the labia minora 10. HYMEN covers the vaginal introitus, vestibule A thin circular membrane made of elastic and urethra tissue situated at the vaginal opening and which is torn during the first sexual intercourse and childbirth PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 3 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS separates the internal organ and external hollow, thick-walled organ that functions to organs receive, retain, & nourish a fertilized egg and ○ Imperforate hymen- a hymen that developing baby completely cover the vaginal introitus Thickens if fertilized(zygote). preventing passage of menstrual Breaks down and sheds if not fertilized discharge and sexual intercourse (menstruation) ○ hymenotomy or hymenectomy- is the surgical incision of an imperforate hymen 11. Urethral Meatus External opening of the female urethra located below the clitoris the shortness of urethral meatus makes women more prone to infection 2.2 INTERNAL GENITALIA VAGINA hallow, membranous and muscular canal about 8- 12 cm long Located in front of rectum and behind the bladder Functions: Organ for copulation discharges menstrual flow -Birth canal DODERLEIN BACILLI bacteria normally present in vagina ○ Vaginal pH before puberty- 6.8-7.2 (ALkaline) ○ Vaginal pH after puberty- 4-5(Acidic) Note: mas nagiging Acidic kapag tumatanda UTERUS Muscular pear shaped organ PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 4 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS the longest fimbria, called fimbria ovarica is 2.3 FALLOPIAN TUBE attached to the ovary to guide the ovum to the oviduct during ovulation FALLOPIAN TUBE (OVIDUCTS) pair of tube–like structures originating from the cornua of the uterus with distal ends located near the ovaries Each tube is about 4 inches (10 cm) long and 1⁄4 inch in diameter ○ Its blood suply is derived from the ovarian artery and grainage is via ovarian and uterine arteries ○ Part of it is cut during Tubal ligation FUNCTIONS: 1. Transport of ovum from ovary to the uterus 2. The site of fertilization 3. Provides nourishment to the ovum during journey 2.4 OVARY OVARIES Almond shape glandular organs located either side of the uterus each ovary weighs between 6 to 9 g, 1,5 to 3 cm wide and 2-5 cm long FUNCTIONS: 1. Oogenesis for development and maturation of ovum PARTS OF THE FALLOPIAN TUBE 2. Ovulation release of ovum from the ovary 1. INTERSTITIAL/ INTRAMURAL thick walled, located inside the uterus andis 3. Hormone production about 1 cm long it produces estrogen and progesterone 2. ISTHMUS the narrowest portion of the uterus and is Houses eggs(ova). about 1cm long. Only 400-500 eggs of potential 700,000 are released site for tubal ligation during a lifetime. Produces female sex hormones. 3. AMPULLA the middle portion and the widest part. LAYERS OF OVARY site for fertilization 1. Tunica Albuginea 4. INFUNDIBULUM 2. Cortex the most distal portion. 3. Medulla it has fingerlike projections called fimbriae PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 5 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS LAYERS OF THE OVARY: 1. TUNICA ALBUGINEA the outermost protective layer surrounded by a single layer of cuboidal epithelium called germinal layer of Waldeyer 2. CORTEX the functional layer which is the site of ovum formation and maturation. It contains primordial follicles, Graafian follicles, corpus luteum and corpus albicans. as the follicles decrease in number after each ovulation, this layer become thinner with advancing age 2 mos. Intrauterine- 600,000 oogonia 5 mos intrauterine- 6,800,000 At birth - 2 million oocytes Puberty/ childhood- 300,000- 400,0000 36 yrs. Old - 30,000- 40,000 Menopause - absent 3. MEDULLA layer which contains blood vessels, lymphatics, nerves and muscle fibers. Blood supply is derived from ovarian artery PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 6 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS ○ MENARCHE ○ Typical female fat distribution & hair 3.0 PUBERTAL DEVELOPMENT pattern ○ Breast development (THELARCHE) Puberty ○ Increase diameter of pelvic bone - Stage of life at which secondary sex changes ○ Closes the epiphyses of long bones begin ○ Oogenesis ○ Girls mature earlier than boys Girls --- 9 – 12 yo SECONDARY SEX CHARACTERISTICS Boys --- 12 – 14 yo GIRLS 1. Growth spurt 2. Increase in the transverse diameter of the pelvis 3.1 HORMONES SIGNIFICANT DURING 3. Breast development PUBERTY 4. Growth of Pubic hair 5. Menarche 1. Androgen (Testosterone) 6. Growth of Axillary Hair 2. Estrogen 7. Vaginal secretions ANDROGEN BOYS 1. Increase in weight Hormone responsible for muscular 2. Growth of testes development, physical growth, and the 3. Growth of facial, axillary and pubic hair increase in sebaceous gland secretions 4. Voice changes Causes acne 5. Penile growth 6. Growth Spurt TESTOSTERONE 7. Spermatogenesis Males : primary androgenic hormone are low until puberty 3.2 MENSTRUAL CYCLE Influences development ○ testes MENSTRUATION ○ scrotum ○ penis the periodic discharge of blood, mucus, and ○ Prostate epithelial cells from the uterus in response to ○ seminal vesicles hormonal changes ○ Male pubic, axillary and facial hair Allows for conception and implantation of a ○ Laryngeal enlargement new life ○ voice change Brings an ovum to maturity and renews a ○ Maturation of spermatozoa uterine tissue bed (spermatogenesis) ○ Closure of growth in long bones Girls : influences Enlargement of the labia majora and clitoris Adrenarche ESTROGEN Estrone (E1), estradiol (E2), estriol (E3) Secreted at high levels during puberty by the ovarian follicles ○ Development of the uterus, fallopian tubes & vagina PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 7 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS ○ Corpus Luteum – high content of 3.3 HORMONES Progesterone and some Estrogen HYPOTHALAMUS LHRH – Luteinizing Hormone Releasing Hormone GnRH – Gonadotropin Releasing Hormone ANTERIOR PITUITARY HORMONE - FSH – Follicle Stimulating Hormone Active during the 1st half of the menstrual cycle Function : Maturation of the ovum LH – Luteinizing Hormone ○ Most active during the midpoint of the menstrual cycle Ovulation Growth of the uterine lining during the 2nd half of the cycle ESTROGEN PROGESTERONE 3.5 UTERINE CYCLE PROLIFERATIVE PHASE (Estrogenic, Post-menstrual) 3.4 OVARIAN CYCLE First phase of cycle Estrogen Endometrium proliferates after menstrual flow FOLLICULAR PHASE First half of the menstrual cycle SECRETORY PHASE (Progestational, Pre-menstrual) From Day 1 of menses to ovulation Second phase of the cycle Progesterone FSH Dilated uterine glands and capillaries ○ Follicle - high content of Estrogen (Estradiol) and some Progesterone MENSTRUAL PHASE Progesterone and Estrogen decrease LUTEAL PHASE Endometrium degenerate and sloughs off; Second half of the menstrual cycle capillaries rupture From ovulation to just before Day 1 of next cycle LH PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 8 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS PRIMIPARA - a woman who has delivered only 3.6 CONTENTS OF MENSTRUAL FLOW once a fetus or fetuses that reached viability MULTIPARA - a woman who has completed 2 Blood or more pregnancies to viability Mucin PARTURIENT – a woman in labor Endometrial Tissue PUERPERA – a woman who has just given Unfertilized Ovum birth 3.7 MENSTRUAL DISORDERS 4.2 THE DIAGNOSIS OF PREGNANCY Dysmenorrhea – painful menstruation Menorrhagia – heavy menstruation Metrorrhagia – bleeding between periods 4.2.1 PRESUMPTIVE SIGNS Pre-menstrual syndrome Hypomenorrhea – decreased amount of bleeding PRESUMPTIVE SIGNS Oligomenorrhea - > 35 days interval Are least indicative of pregnancy Polymenorrhea - < 23 days interval Subjective Documented by the examiner Not yet true diagnostics findings of pregnancy 3.8 HEALTH TEACHING SYMPTOMS: Nausea and/or vomiting Moderate exercise Frequent urination Sexual relations Fatigue ○ Not contraindicated Quickening ○ Orgasm may increase flow Breast tenderness and tingling sensation Activities of daily life Pain relief SIGNS: Rest Amenorrhea Nutrition Anatomical breast changes Thermal changes Abdominal enlargement Skin changes 4.0 DIAGNOSIS OF PREGNANCY Linea negra Melasma Striae gravidarum 4.1 DEFINITIONS 4.2.2 PROBABLE SIGNS GRAVID – woman who is or has been pregnant irrespective of the pregnancy outcome Serum laboratory tests PRIMIGRAVIDA – establishment of first Chadwick’s sign pregnancy Goodell’s sign MULTIGRAVIDA – successive pregnancies Hegar’s sign PARITY - pregnancy that is completed at age UTZ evidence of gestational sac of viability Ballottement ○ Number of pregnancy reaching Braxton Hick’s contraction viability not the number of fetuses Fetal outline by the examiner delivered NULLIPARA - a woman who has never 4.2.3 POSITIVE SIGNS completed a pregnancy beyond the stage of viability UTZ evidence of fetal outline PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 9 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS Audible fetal heartbeat conditions apart from pregnancy Fetal movement felt by examiner Bleeding may occur after conception Less in amount and paler in color Implantation bleeding 4.3 PRESUMPTIVE SIGNS CHANGES IN URINARY SYSTEM Direct pressure of enlarging uterus on urinary Thermal changes Week 1 bladder 1st trimester and 3rd trimester Breast changes Week 2 Irritability, dribbling, nocturia Frequent UTI Nausea, vomiting Week 2 Urinalysis to R/O UTI in pregnancy Amenorrhea Week 2 FATIGUE Frequent urination Week 3 Easy fatigability First few weeks of pregnancy and 3rd Fatigue Week 12 ⬆️ trimester metabolism Uterine enlargement Week 12 ABDOMINAL ENLARGEMENT Quickening Week 18 Position = 12, 16, 20, 36 weeks FUNDAL HEIGHT = Linear measurement from Skin pigmentation Week 24 symphysis pubis to fundus of uterus; correlates with AOG from 16 – 32 weeks Abdominal enlargement more pronounced, THERMAL CHANGES more lax, flaccid and pendulous in Elevation of temperature (0.3 – 0.5oC) for multigravida longer than 3 weeks Thermogenic effect of progesterone PISKACEK'S SIGN Asymmetrical enlargement of a pregnant BREAST CHANGES uterus 6 weeks AOG Fullness, tingling sensation, breast tenderness QUICKENING Increased breast size Perception of fetal movement Darkened areola Slight flutter or brisk movement Secondary areola 16 – 20 weeks Bluish vascularity May be mistaken for intestinal peristalsis or Protuberant Montgomery’s tubercles spasm of the GIT Colostrum (16th week) SKIN PIGMENTATION CHANGES NAUSEA AND VOMITING Chloasma / melasma First 2 – 3 months Linea negra Peculiar distaste for food Striae gravidarum Morning sickness or late afternoon Spider telangiectasia Correlates with the amount of circulating hCG Palmar erythema Extreme n/v due to hyperplacentosis Hyperemesis gravidarum → DHN and ketonuria MGT: frequent small feedings, avoid fatty 4.4 PROBABLE SIGNS foods, ice chips, emotional support, Antacids, hospitalization Serum laboratory tests Week 1 AMENORRHEA Absence of menstruation Chadwick’s sign Week 6 Suppression of FSH Presumptive because can mean other Goodell’s sign Week 6 PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 10 @france  OB NURSING S.Y. ‘24 - ‘25 | SEM 1 | FARC WEEK #: PRELIMS Hegar’s sign Week 6 Audible fetal heartbeat Week 10-12 UTZ evidence of Week 6 Fetal movement felt by Week 20 gestational sac examiner Ballottement Week 18 FETAL OUTLINE BY UTZ Braxton Hicks Week 20 8th week AOG contraction Fetal outline within the gestational sac Number of fetuses, placental placement Fetal outline by Week 20 examiner FETAL HEARTBEAT Differentiate FHB from maternal HR 120 – 160 bpm LABORATORY TESTS (hCG) 5 – 6 weeks by echocardiogram Urine 12 weeks by Doppler Radioimmunoassay 18 – 20 weeks by stethoscope Enzyme-linked immunosorbent assay Radio receptor assay Other sounds heard other than FHB Funic souffle or umbilical cord souffle 7 – 9 days AOG : 50 mIU/ml Uterine souffle 60 – 80 days AOG : 100 mIU/ml Sound from movement of fetus 100 – 120 days : plateau Maternal pulse Gurgling gas in mother’s GIT CHANGES IN REPRODUCTIVE ANATOMY Hegar’s sign FETAL MOVEMENT FELT BY EXAMINER Goodell’s sign 20 – 24 weeks AOG Chadwick’s sign GESTATIONAL SAC on UTZ Characteristic ring seen as early as 4 – 6 wks AOG BALLOTTEMENT Bouncing of fetus in utero when the examiner moves the uterus from side to side or during IE 16th week, volume of fetus is small compared to amniotic fluid BRAXTON-HICKS CONTRACTION Painless, irregular contractions which may be both palpable and visible as the pregnancy progress Perceivable at 20th week OUTLINING OF THE FETUS On Leopold’s maneuver Fetal head can be mistaken for myomas or ovarian new growth 4.5 POSITIVE SIGNS UTZ evidence of fetal Week 8 outline PPT | LECTURE | BSN 2-2 OB SEM1 REVIEWER PAGE 11 @france