Maternal-Child Nursing Anatomy, Physiology, Puberty, and Health Education PDF

MATERNAL-CHILDNURSING : Anatomy , Physiology , Puberty, Health Education 2 Puberty: A Process over Several Years Late Childhood to Adolescence Gonadotropin Releasing Hormone (GnRH) from the hypothalamus stimulates the anterior pituitary > to produce stimulating hormones Follicle Stimulating Hormone...

MATERNAL-CHILDNURSING : Anatomy , Physiology , Puberty, Health Education 2 Puberty: A Process over Several Years Late Childhood to Adolescence Gonadotropin Releasing Hormone (GnRH) from the hypothalamus stimulates the anterior pituitary > to produce stimulating hormones Follicle Stimulating Hormone / (FSH) , and Luteinizing Hormone (LH) > that will stimulate sex hormone production by testes and ovaries ( Testosterone , Estrogen and Progesterone ) Girls : Puberty BODY CONTOURS: Pelvis widens ,Fat in hips HAIR : Pubic hair : downy , then thickens Axillary hair at tie of menarche SKELETON: Growth Spurt about 1 year after breast development EXTERNAL GENITALIA : fat deposited in mons pubis, labia majora, and labia minora Vagina , uterus ,Fallopian tubes larger Ref : McKinney,E, et al , Maternal-Child Nursing , 3rd ed , p 220 Puberty : Girls Tanner Staging ( NOT to be memorized ) BREAST Stage I ( prepubertal ) Elevation of papilla only Stage 2 :Age 9.8 years : Breast Bud Elevation of Breast and papilla as small mound , Areola diameter enlarges Stage3: Age 11.2 years : Breast Elevation:further enlargement Stage 4: Age 12.1 years : Areolar Mound : secondary mound of areola and papilla above the breast Stage 5:Age 14:6years Adult :Recession of areola to contour of breast Ref : Speroff, L & Fritz, M , Clinical Gynecologic Endocrinology and Infertility , 7 ed, p 377-379 PUBIC HAIR Stage I ( prepubertal ) No pubic hair Stage 2:Age 10.5 years :Presexual Hair : sparse ,long pigmented hair along labia majora Stage 3: Age 11.4 years Sexual Hair.Dark, curled sparse hair over mons Stage 4:Age 12years:Mid Escutcheon: Adult type hair , abundant , limited to mons Stage 5:Age 13.7years :Adult type in quantity and distribution Tanner Breast Development Ref : Speroff, L & Fritz, M , Clinical Gynecologic Endocrinology and Infertility , 7 ed, p 377-379 PUBERTY :Female Pubic Hair Ref : Speroff, L & Fritz, M , Clinical Gynecologic Endocrinology and Infertility , 7 ed, p 377-379 Menarche Ages 9-16 Critical Body weight 105 pounds Early menses may be anovulatory Limited progesterone so may bleed heavily or longer PUBERTY BOYS Growth of TESTES - ages 9 ½-17 SCROTAL Skin thickens and darkens Wet Dreams –nocturnal emissions –spontaneous ejaculation of seminal fluid, often with dreams of sexual content BODY HAIR : pubic hair at base of penis then spreads up and toward midline of abdomen facial Hair -fine , downy moustache progresses to beard BODY CONTOUR :Increased muscle mass SKELETEL GROWTH : Growth spurt , 1 year later than girls , but lasts longer ; shoulders broaden VOICE : Deepens ( hypertrophy of laryngeal mucosa ) Ref : McKinney Maternal Child Nursing 3ed , p220 Definitions : Gender Gender Identity- How a person identifies, male, female, both, or neither Gender Expression- How a person expresses their gender through the way they behave, hair style, the way they dress, etc. Gender variant/non-conforming- When a person’s gender expression is different from societal norms Sexual orientation- How a person identifies their physical and emotional attraction to others Gender identity does not equal sexual orientation Intersex- Person born with sexual or reproductive anatomy that is not typical for either male or female Ref : National LGBT Health Education Center Appreciation to Sharon Yardley , NP , DNP Candidate Objective :Gender and Sexuality CPD (I) - Spring 2018 10 CPD SPRING @)!* (I) - Spring 2017 Objective :Gender and Sexuality 11 The Breast A thing of beauty Sexual pleasure Nutrition for baby Bonding for baby Breast Anatomy Breast Anatomy Lymphatics from most of the breast drain towards the axilla. The central nodes are palpable most frequently The four quadrants describe clinical findings and the glandular tissue.The tubuloalveolar glands and ducts form 15 to 20 septated lobes radiating around the nipple. Breast Examination Inspection Palpation Nipple Areola Breast Axilla Lymph nodes Lactation Growth and development of milk secreting apparatus of mammary gland is dependent on Progesterone, Placental lactogen, Cortisol, Estrogen, Prolactin and Insulin. Expulsion of placenta: decrease in estrogen & progesterone -> lactation is initiated. PROLACTIN falls after delivery : suckling triggers rise in PROLACTIN. Breast stimulation curtails release of prolactin inhibiting factors. LET DOWN REFLEX - pulsatile OXYTOCIN from neurohypophysis expresses milk by contraction of myoepithelial cells. The Female Reproductive Organs Anatomy and Physiology : The Vulva , Vagina Cervix VULVA : External Genitalia Mons Pubis Clitoris and clitoral hood Labia Majora ( covered with hair) Labia minora ( thin , inner lips ) Urethra Skene’s peri urethral glands Vagina Bartholin’s Glands ( lateral, lower ) Hymen Perineum Anus Vagina : a distensible tube extending from the external genitalia , approximately 4 inches / 8 cm in length The organ of copulation and exit for menses and secretions Upper vagina encircles the cervix ( lower uterus ) Cervix : round , firm lower portion of the uterus , with small opening for sperm entry , and discharge of menstrual fluid Anatomic Landmarks: Vulva CPD (I) - Spring 2018 Objective : Physical Examination Image via National Cancer Insititue, Accessed online 2015. 18 Inspection — — — — — Inspect external genitalia for lesions and/or swelling Inspect hair distribution Inform patient that you are going to touch and spread the labia for further inspection Inspect labia, clitoris, and urethral meatus Inspect the perineum CPD (I) - Spring 2018 Objective : Pelvic Examination Objective : Normal Pelvic Examination 19 Inspection :Speculum Examination; Vagina and Cervix FOCM (I) - Spring 2017 20 ANATOMY Uterus: a flattened pear shaped organ 6-8 cm in length divided into fundus; body and cervix surrounded by peritoneal folds; broad, uterosacral, round and cardinal ligaments 3 layers; serosa; myometrium; endometrium Ovaries: 2.5 - 5cm (L) aligned with the uterus by utero-ovarian ligament Infundibulopelvic ligament (suspensory ligament of the ovary) extends from ovary to pelvic side wall. ovarian vessels and nerves. Fallopian tubes: 8 - 14 cm (L) extend from uterus to a site near the ovaries mobile Blood supply to uterus: Uterine artery (hypogastric artery) Ovaries: ovarian artery (aorta and anastomosis with the ovarian branch of the uterine artery Lymphatic: drainage of the pelvis: external and internal iliac and paraortic chains Nerve Supply: sympathetic predominantly some parasympathetic S2-S4 21 Uterus, Ovaries, Fallopian Tubes, Pelvic Ligaments 22 Pelvic Anatomy urinary urinary bladder bladder obliterated umbilical vessel round ligament superior vesical artery uterine artery broad ligament uterosacral ligament obdurator artery inferior hemorrhiodal artery and vein ureter external iliac artery ureter passing over iliac vessels mesentery Female Pelvis From Frank Netter Collection ovary internal iliac artery common iliac artery Root of mesentery 23 ANATOMY 24 Ovulatory Cycle Corpus Luteum Corpus Luteum of Pregnancy Mature Graffian Follicle Follicular Growth Involuting Corpus Luteum Prepuberty Atrophy ( menopause) 25 Changes in Menses CPD (I) - Spring 2018 Objective : Nomenclature FSH : stimulates the ovary to develop follicles and select the Dominant Follicle Estrogen from the ovary increases Estrogen exerts positive feedback on LH Midcycle Ovulation occurs Progesterone from the Corpus Luteum increases the endometrium If implantation occurs , progesterone increases the endometrium If pregnancy does not occur , the endometrium sloughs ( menses ) 26 Physiology of Menses FEEDBACK LOOPS Hypothalamus produces Gonadotropin Releasing Factors (GnRH)> which stimulate Pituitary> To Release FSH> which causes ovary to produce Estrogen And LH to cause ovary/ Corpus Luteum> to secrete Progesterone Negative Feedback : When the Estrogen level is high , the FSH decreases When Progesterone is high , LH is low 27 There are Estrogen Receptors in Many Non- Reproductive organs Central nervous system: Brain Ovary: Blood vessels: Bone: Lungs: Urogenital tract: Breast: Liver: Uterus: Course et al. 1997, Shughrue et al. 1996, Arts et al. 1997 28 Male and Female Genitourinary Tract Upper Urinary Tract Lower Urinary Tract Sperm 30 Male Reproductive Anatomy and Physiology The penis The shaft of the penis is formed by three columns of vascular erectile tissue: o The corpus spongiosum, containing the urethra o The two corpora cavernosa The corpus spongiosum forms the bulb of the penis, ending in the cone-shaped glans with its expanded base, or corona The testes The testes are ovoid, somewhat rubbery structures approximately 4.5 cm long The left testis usually lies somewhat lower than the right The testes produce spermatozoa and testosterone Male Reproductive Anatomy and Physiology ( continued ) The testes (cont.) The scrotum is a loose, wrinkled pouch divided into two compartments, each containing a testis Covering the testis, except posteriorly, is the serous membrane of the tunica vaginalis On the posterolateral surface of each testis is the softer commashaped epididymis; the epididymis provides a reservoir for storage, maturation, and transport of sperm The scrotum is a loose, wrinkled pouch divided into two compartments, each containing a testis Covering the testis, except posteriorly, is the serous membrane of the tunica vaginalis On the posterolateral surface of each testis is the softer commashaped epididymis; the epididymis provides a reservoir for storage, maturation, and transport of sperm Male Anatomy and Physiology (cont.) The lower genitourinary tract The vas deferens, a cordlike structure, begins at the tail of the epididymis It ascends within the scrotal sac (as the spermatic cord) and passes through the external inguinal ring on its way to the abdomen and pelvis Behind the bladder, it is joined by the duct from the seminal vesicle and enters the urethra within the prostate gland Anatomy and Physiology (cont.) 35 Physiology of Conception 4 Components: Gametogenesis Fertilization Ovum and blastocyst transport Implantation Somatic cells divide by mitosis: 2 daughter cells same diploid number of chromosomes as parent cell Gametogenesis: requires meiosis chromosomal number decreased to half  haploid gametes (23) diploid state restored at fertilization Meiosis: limited to germ cells long prophase - allows exchange of genetic material 36 Female Reproductive Physiology Oogenesis – Meiosis First Division Second Division Oocyte formation completes first meiotic division which begun before birth Occurs when sperm enters secondary oocyte (haploid) Formation of two daughter cells - 23 chromosomes Divides without chromosome reduction One receives all the cytoplasm of mother cell  secondary oocyte The other: little cytoplasm  First Polar Body ü cast off while still in the ovary secondary polar body (haploid) mature ovum (haploid) Mature ovum contains 25% of original primary oocyte DNA  female pronucleus Female and male pronuclei fuse  zygote Male Reproductive Physiology First Meiotic Division Second Meiotic Division Primitive Sperm cells develop during fetal life Spermatogenesis begins during Puberty when the spermatogonia multiply by mitosis Each spermatogonia has 46 chromosomes and enlarges to Primary Spermatocyte First meiotic division : forms TWO secondary spermatocytes with 23 chromosomes each ( 22 autosomes and X or Y sex chromosome ) Secondary spermatid divides again to form 2 more spermatids each with 22 chromosomes and X or Y Spermatids mature into sperm Gametogenesis 39 Physiology of Reproduction There are 4 Components Gametogenesis ( egg and sperm ) Fertilization Ovum and blastocyst transport Implantation Sperm Fertilization Mid cycle 14 days PRIOR to next period Egg is released from ovary >captured by fimbriated end of tube and enters Fallopian Tube Intercourse / Coitus : Sperm enters the vagina > is propelled by flagella into uterus and into Fallopian tube Fertilization takes place in the Fallopian Tube The fertilized egg ( now 46 chromosomes ) divides > Implants in the uterus approximately Day 6 Human Chorionic Gonadptropin is produced by the dividing embryo ( blastocyst ) and later by the placenta. The Pregnancy test ( B HCG is positive 10 days after implantation – before the period is missed The Corpus Luteum ( site of rupture of that ovum )and later the placenta produces Prigesterone , the major hormone of pregnancy Sperm and Egg 43 Fertilized Ovum 44 8 Cell Stage Embryo 45 Pregnant Uterus 46 Patient Education The Breast Self examination For early detection of breast cancer, the Breast Self Examination is most useful when coupled with regular breast examinations by an experienced clinician nipple and mammography areola breast SEXual EDUCATION Boys and Girls Their Bodies Their Sexuality Sexually transmitted infections Teen Pregnancy Contraception Confidentiality Parental Issues Case A 21 year old recently married woman is concerned as her period is two weeks late. She and her husband have been using condoms for contraception. She has flu like symptoms. She was not planning to be pregnant so soon after marriage. You: A) Reassure her that pregnancy is unlikely B) Suggest that she change to the oral contraceptive C) Suggest she return in 4 weeks for a pregnancy test D) Perform a pregnancy test THANK YOU