CMPA411 & NCMB418 Obstetrics Nursing PDF

CMPA411 | Competency Appraisal 1 Prelims 1 LESSON 1 − Dimensions: 3” long x 2” wide x 1” thick OBSTETRICS NURSING − Weight: 50 - 60 gr...

CMPA411 | Competency Appraisal 1 Prelims 1 LESSON 1 − Dimensions: 3” long x 2” wide x 1” thick OBSTETRICS NURSING − Weight: 50 - 60 grams (can get up to 500g or more Female Reproductive System during pregnancy). Internal Structures − Shape: pear-shaped, hollow-muscular organ 1. Vaginal Canal − Location: suspended between the urinary bladder and the rectum. − Position:  anteverted / anteversion (non-pregnant)  retroverted / retroversion (pregnant - 2nd trimester) Layers 1. Perimetrium - Outer 2. Myometrium - Middle, thickest layer, origin of contractions.  3Ms: Myo (means “muscular”), makapal (thick) 3. Endometrium - Inner Parts 1) Fundus − Upper portion, upper uterine segment. − Where you can also find the thickest − with Rugae myometrium. − Depth: 3” - 4” 2) Corpus − Duoderleine Bacilli − Middle portion, lower uterine segment. → normal Flora along the vaginal canal. − Comprising the uterine cavity. → produces lactic acid to maintain normal pH 3) Isthmus between 4 - 5 (acidic). − Lower uterine segment − Weak contractions because it is thin and soft, to Functions accommodate fetal head or presenting part.  Organ of copulation - receives penis & fingers 4) Cervix  Part of birth canal − “Kuwelyo ng matris” / Collar of the Uterus  Passageway of menstrual discharge − 3in. Long, 2in. Wide, 1in. Thick − Opening or mouth of the uterus. 2. Uterus  Parts of the Cervix: a. Internal Os — During L&D, it undergoes cervical effacement (thinning of internal os). b. Cervical Canal — During pregnancy your mucus thickens (mucus plug or operculum) and acts as a seal and prevents ascending infection, therefore protecting the products of conception. c. External Os — During L&D, it undergoes dilatation (widening or opening of external os). How do you measure cervical effacement? ► By percentage (full cervical effacement is 100%). How do you measure cervical dilatation? ► By centimeters (full cervical dilatation is 10cm). How soft is the cervix of a woman? ► Non-pregnant cervix is as soft as the tip of your nose. In early pregnancy, it is soft as an earlobe. In late pregnancy, it is soft as your lips or butter. Which duration of Labor and Delivery is longer, primi or multi? ► Primigravida takes 12 - 16 hrs ► Multipara takes 6 - 8 or an average of 7hrs. Multipara takes shorter duration because of the 1|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 2 pattern of effacement and dilatation. 6:10’55” When pregnant women undergoes Goodell’s - 6:10’15” 6:10’55” — 6:10’15” = 40 seconds Sign: 40 □ Primigravida → Cervical Effacement → Cervical Dilatation □ Multipara → Cervical Dilatation → Cervical Interval Effacement ► answer in seconds □ Multipara → Cervical Dilatation & Effacement ► Increment #2 — Decrement #1 simultaneously 3 70 6:14’55” +60 - 6:10’55” Signs that may appear during pregnancy 3’15” 6:13’70” — 6:10’55” (Chinese General Hospital) (if you borrow 1, you add = 3 minutes 15 seconds Chadwick’s Bluish discoloration of vaginal 60 secs) Sign mucosa. Frequency Goodell’s Sign Softening of cervix. ► answer in seconds Hegar’s Sign Softening of Isthmus. ► Increment #2 — Increment of #1 3 70 6:14’10” +60 Functions - 6:10’15”  Aids in labor and delivery 3’55” 6:13’70” — 6:10’15” ▲ By promoting uterine contractions (if you borrow 1, you add = 3 minutes 55 seconds ▲ relaxation → contraction → relaxation 60 secs)  Site of Implantation ▲ Endometrium − It is also the site of placental development.  upper uterine segment to endometrium − If the implantation is invasive (reaches the Relaxation Contraction myometrium) Increment Acme Decrement  if the placenta attaches to the myometrium, Duration Cycle the placenta becomes part of your uterus I Increment of contraction #1 and it will never separate. D Decrement of contraction #1 − Placenta Accreta i Increment of contraction #2  Deep implantation of Placenta. d Decrement of contraction #2  when the baby has come out and the placenta does not show any signs of 1, 2 Number of cycle separation. Duration ► Beginning to end ○ Management: Hysterectomy (uterus Time from I to D Duration of contraction #1 removal) Time from i to d Duration of contraction #2 − Placenta Previa  when the placenta is placed on the lower Interval ► End to beginning uterine segment instead on the upper. It is (rest period / relaxation) obstructing the birth canal. If the fundus Time from D to i Interval of contraction #1 and #2 contracts, the uterus will push the baby Frequency ► Beginning to beginning down crashing the placenta and causing Time from I to i Frequency continuous bleeding.  Organ of menstruation Computation  Houses and nourishes the products of conception ▲ Baby ▲ Umbilical cord ▲ Placenta ▲ Membrane Uterine Ligaments 1) Broad ligament — keeps the fallopian tube and uterus in place. Duration 2) Round ligament — provides upper support and pulls ► answer in seconds the fundus upward to assume the retroverted position. ► Decrement — Increment of the same contraction 3) Cardinal ligament — provides middle support and the most important ligament because it provides stability to the uterus. 2|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 3 4) Pelvic floor ligament Surgical Sterilization (Tubal Ligation) − Doctor will fold the isthmus (ligate, ligate, ligate What do you use in evaluating the uterine contraction? together). ► Palpation using palm and surface of the fingers. (Surface of fingers is more sensitive because it has many nerve endings, so place your hands over the fundus). Where is the origin of uterine contraction? ► from the myometrium of the fundus, located at the upper uterine segment. 3. Fallopian Tube / Oviduct − Female will still ovulate. − Female will still have menstruation. − There is protection from pregnancy. − There is no protection from STD. − Duration: permanent − Can undergo reconstructive surgery, but not highly recommended because it can accumulate scar formation and ectopic pregnancy due to the narrowed passageway of the FT. 4. Ovaries − Length: 3 - 4 inches Parts 1) Interstitial (inner third) — most dangerous site of ectopic pregnancy. 2) Isthmus (middle third) — most common site of bilateral tubal ligation. 3) Ampulla (outermost third) — most common site of fertilization and ectopic pregnancy. 4) Infundibulum Functions  Site of fertilization  Transports ovum to the uterus.  Site of surgical sterilization — BTL  Transports the fertilized egg from the FT to the uterus. ▲ Fertilized egg remains on the fallopian tube for 3 - 4 days. After 3 - 4 days, estrogen will rise and will encourage contraction. FT will have wave-like motion, the cilia of FT will move, therefore − Is the female gonad. the egg will move inward. − Is responsible for the production of: ▲ The egg cell will take another 3 - 4 days to reach the uterus (Implantation will take 7-10 days after fertilization).  Estrogen  Progesterone 3|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 4  Relaxin narrow. − Is responsible for oogenesis or production of egg cell. ˃ It is an intentional wound, therefore it is ▲ During pregnancy, ovaries are not that active because of the cleaned and controlled. placenta producing progesterone and estrogen. □ Medial - Straight ▲ During pregnancy, progesterone and relaxin relaxes and □ Medio-lateral - loosens the pelvic joints to accommodate the enlarging uterus. Diagonal Divisions When is episiotomy being done? 1. Surface epithelium ► Done at acme (peak), to provide natural anesthesia. 2. Cortex 3. Medulla Female Hormones 1. Estrogen Where is the site of maturation of oocytes? − enlarges the uterus. ► Ovaries − encourages uterine contraction − causes epistaxis (nose bleeding) External Structures: Vulva 2. Progesterone − prevents uterine contraction − hormone of (p)regnancy — because it prevents contraction and provides nourishment to the fetus. − causes poor GI motility − causes pyrosis (heart burn) LESSON 2 OBSTETRICS NURSING Male Reproductive System External Structures ► Upper part of the vulva. 1. Mons Veneris ► Protects the pubic bone. / Pubis ► Protects the symphysis pubis Female landmark for correct 2. Clitoris catheterization. 3. Labia Majora Two thick folds of tissue 4. Labia Minora Thin folds of tissue 1. Penis Spaces between the labia minor − covered by glands skin known as prepuce. (not highly Two obvious openings: mascular) □ Urethral Meatus - For − Size: 4-5 inch average size of fully erect penis 5. Vestibule elimination □ Vaginal Orifice / Function Meatus / Opening - For  Copulation / sexual intercourse / coitus reproduction Fold / ridge below the labia 2. Scrotum 6. Fourchette − a sac of skin that hangs from the body at the front of majora Space between the the pelvis bet. fourchette and the anus − Scrotum of newborn is darker than adult because of Site of episiotomy - Cutting Rugae. 7. Perineum of the perineum. ˃ Usually done with primigravidas because their vaginal canal is still 4|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 5 Internal Structures going to engage sexual intercourse for at least 2 months. □ Sperm cells that are located on your vas deferens are capable of 64 days maturing causing pregnancy. □ To quickly empty the part, you need to ejaculate (35 to 45 ejaculation, there is no guarantee). □ Surest method is you need to test your sperm count. □ 1st result – not sure if the sperm count is zero. □ 2nd result – zero □ 2 consecutive zero sperm count results 1. Testes □ Vasectomy cannot stop the erection − They produce testosterone. and do not prevent spermatogenesis − Gonad / sex gland and can still ejaculate (only that the − Responsible of spermatogenesis (production of sperm seminal fluid has no sperm) in the seminiferous tubule) □ Vasectomy cannot protect the husband from STD. Why is it the testes are found inside the scrotal sac? And scrotal sac is found outside the body? What do you call the fluid that lubricate the sperm? ► Because there are sperms inside the testes. ► Seminal fluid ► Sperm cells are heat sensitive (↑ heat causes death of the sper cells). ▲ During contraction of ejaculatory duct there is forceful What’s temperature diff. bet. the body temp. and scrotal temp? ejaculation so that the sperm will not stay in the acidic vaginal ► 1 degree Fahrenheit canal. ► The body temp is 1 degree Fahrenheit higher than the ▲ Sperm cells will reach the cervix in 90 seconds and fallopian scrotal temperature (vice versa). tube in 5 minutes. ▲ Testes - male sex gland ▲ Testosterone - male sex hormone 2. Epididymis − serving as storage room for growth and maturation for 4. Ampulla the sperms. 5. Seminal vesicle  Sperm Cells ○ made up of protein. 6. Ejaculatory duct ○ Sperrn cells after maturation will die. − where the ampulla and seminal vesicle meet ○ they provide nourishment. connected to the urethra. 3. Vas deferens 7. Urethra − is the conduit bet. − structure connected to this are urinary bladder, − The seminal vesicle and epididymis or the connecting ejaculatory duct, prostate gland, & bulbourethral structure. gland (cowper’s gland). − Site for male surgical sterilitilization (vasectomy - − Length in Male: 5 - 9 inch with average of 7 ligate, ligate, then cut). − Length in Female: 2 - 3 inch (prone in UTI)  Vasectomy is permanent contraception. ○ After vasectomy, there is still a possibility to Dual function for Urethra make the wife pregnant because there are  Passageway of Urine sperm cells left in the deferens.  Passageway of Semen ○ There’s erection ○ There’s spermatogenesis 8. Corpora spongiosum ○ Still ejaculating − came from the word sponge (capable absorbing fluid ○ There is protection from pregnancy / blood). ○ NO protection from STD ○ Duration: permanent but can undergo 4 Structures Producing Seminal Fluid reconstruction surgery 1) Epididymis Nursing Teaching Plan (After vasectomize) 2) Seminal vesicle □ Do not forget that after vasectomy that 3) Prostate gland you need to wear condom if you are 4) Cowper’s gland 5|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 6 How many percent of the seminal fluid will epedidymis produce? 2. Y: Androsperm ► 5% of the seminal fluid comes from epididymis − small head short tail 30% from seminal vesicle ► − fast moving ► 60% from prostate gland – main producer of seminal fluid the male reproductive anatomy − contains less alkaline ► 5% from cowper’s gland − Non-acid resistant During anal intercourse why is it some males ejaculate even without masturbating? ► Because of the vibration of the prostate gland during anal Abnormal Sperm Morphology sex. ▲ Maturation of cells in epididymis – 64 to 75 days (common answer 64 days more than 2 months) ▲ Sperm Cells travels from vas deferens to ampulla – because of the 5% of the seminal fluid produce by the epididymis ▲ Sperm Cells are alkaline in nature because of the fluids (able to survive the acidity of vaginal canal because of alkaline) ▲ Vaginal canal is acidic. Why the vaginal canal is acidic? ► Because of Duoderline Bacilli that produce lactic acid LESSON 3 making the vaginal canal acidic. OBSTETRICS NURSING Breast Mammary Glands Sperm Analysis Result Semen per ejaculation 3 - 5 ml Sperms per mL 20M - 150M 400M Sperms per ejaculation 400M ave. sperm / ejac. and 50% viability so every ejaculation 200M are alive. Lifespan 3 - 5 days or 72 hrs pH level 7-8 Morphology 30% 50% Motility ► are activley moving 50% Viability ► are in normal shapes, normal size Aspermia zero sperm cell is the drug to help increase the Clomid (Clomifene sperm production also helping Citrate) for fertility. Oligospermia low sperm count Who determines the gender of the baby? ► The father because of X and Y chromosome. Father Mother 1 sperm 1 egg cell 23 pairs 23 chromosomes 23 chromosomes 22 pairs 22 autosomes 22 autosomes 1 pair 1 sex cell 1 sex cell 2 Types of Sperms 1. X: Gynosperm − The breast lies in the pectoralis major muscle. − Big head long tail − Lobes of the breast are connected to the lactiferous − slow moving ducts. − contains more alkaline − Acid resistant 6|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 7 Lactiferous Sinuses / Ampulla of the Breast 1. Gynecoid − End of the lactiferous duct. − True female pelvis because this is the most rounded − storage room for the milk. type of pelvis. − It can easily support pregnancy and delivery. lactiferous Lactiferous sinuses / Lobes → → ducts Ampulla opening of lactiferous ↲ 2. Anthropoid − Can also support pregnancy and delivery. Hormones that stimulates the breast to produce milk 3. Android 1. Prolactin − Male pelvis – heart or triangular shape.  What gland produces Prolactin? − It is produced by the Anterior pituitary gland. 4. Platypelloid − Stimulates acini cells (found inside lobes that − The anterior and posterior diameter is short. can produce milk) − Flat pelvis − For milk production − Cannot support pregnancy and delivery. 2. Oxytocin 4 Types of Pelvis  What gland produces Oxytocin? 1. Inlet − It is produced by the Posterior pituitary gland. 2. Cavity − For the release of milk 3. Outlet How will the mother breast feed the baby after delivery? Boundaries of the True Pelvis ► Because of the action of the prolactin and oxytocin. Anterior Posterior Lateral ► Prolactin stimulates the production of milk by acini cells inside the lobes Superior Sacral Inlet Ilium ► Milk ejection reflex or let down reflex of the milk we need Pubis Prominence oxytocin, coming from the posterior pituitary gland. Cavity When is the best time to do self-breast exam? 5-7 days after the mens. Ischial ► Outlet Inferior Pubis Coccyx Spines Pelvis − Supports and protects the reproductive and other Diameter the Pelvis pelvic organs. Anterior - Transverse Obluque − Bony ring structure. Posterior − Inside the pelvic cavity there is female internal Inlet 11cm 13cm 12cm reproductive system including the part of the renal Cavity 12cm 12cm 12cm system the bladder and the digestive system, the Outlet 13cm 11cm 12cm rectum and the anus. Inlet ► transverse is bigger and AP diameter is smaller. Outlet Division of the Pelvis ► transverse is smaller and AP diameter is bigger. 1. False Pelvis The baby needs to rotate while passing the birth − From symphysis pubis going up. canal. − supports growing uterus. 6 Mechanism of Labor 2. True Pelvis D-FIRE-ER-E − From symphysis pubis going down. − serves as the birth canal. 4 Types of Pelvis D Decent F Flexion IR Internal Rotation 7|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 8 E Extension 3 Regions of the Fetal Skull ER External Rotation 1. Face – biggest E Expulsion 2. Brow / Sinciput – big Fetal Skull – Pelvis Relationship 3. Vertex – small − The fetal skull is the most important part of the fetal 4. Occiput – body during the labor and delivery because: smallest  The most frequent presenting part. ○ Because the most common fetal presentation is cephalic presentation. Fetal Presentation  Largest part of the fetal body. 1. Cephalic ○ Since it is the largest part, there may be − headfirst difficulties in passing through the birth canal 2. Breech due to its size. − buttocks first  Least compressible. 3. Transverse ○ When the fetal head passes through the − shoulder first birth canal, it is compressed, a process known as molding. Fetal Skull 3 Main bones 1. Frontal bones 2. Parietal bones 3. Occipital bones Sutures − Cranial joints-like space. 1) Frontal suture – between 2 frontal Compound bones 2) Coronal suture – between 2 parietal and 2 frontal 3) Sagittal suture – between 2 parietal bones Shoulder 4) Lambdoidal suture - between 2 parietal and 1 occipital Breech Presentation Fontanels 1. Anterior fontanel – diamond space (closes within 12-18 mos.). 2. Posterior fontanel – triangular space (closes within 2-3 mos.). All babies that are in cephalic presentation will be delivered Attitudes normally? 1. Flexion ► No, it depends. − most common fetal presentation. ▲ If the presenting part in the vagina is the baby’s face, it can be − the baby's chin is tucked to the chest. dangerous. As the uterus contracts and pushes the baby down, 2. Extension the head extends further, which can increase the risk of cervical spine fractures. − In this presentation, the baby's head is tilted backward, with the face or brow presenting first. Fetal Station True Pelvis False Pelvis ► Positive 1 to 5 ► Negative 1 TO 5 ► Birth Canal ► Above 8|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 9 ► Below symphysis pubis symphysis pubis 2. Transverse Lie 3 Parts ► The head of the − In actual area presentation is the commonly used 1. Inlet – pubic bone baby is located term because it is direct. 2. Cavity above the ischial 3. Outlet – Ischial spine spine (not LESSON 4 “sipit-sipitan” and it is the engaged) OBSTETRICS NURSING land mark of Fetal Station ► The head of the Fetal Position ► One station is equal to 1cm baby is still ► The head of the baby is floating located below the ischial ► With spine (engaged) Ballottement ► Without Ballottement (bouncing of the ► Positive 4 and 5 is baby in aminiotic crowning (head of the fluid) baby) At Level of Ischial Maternal Landmark: Spines = Station 0 Ischial Spines (engaged) -5 +1 -4 +2 -3 +3 -2 +4 -1 +5 Fetal Engagement and Station − Is the relationship of fetal landmark with the maternal pelvic quadrant. ▲ LOA: most common and favorable birthing position. ▲ LOP & ROP: most common malposition and most painful as well. Maternal Pelvic Quadrant − Relationship of the presenting part to the ischial spine and denoted in centimeters. Fetal Lie − Relationship of the long axis of the uterus and long axis of the fetus.  Right Anterior (RA) - Near the Right Abdomen  Right Posterior (RP) - Near the Right Buttock  Left Anterior (LA) - Near the Left Abdomen  Left Posterior (LP) - Near the Left Buttock 1. Longitudinal Lie − if the axis of uterus and baby is parallel to each other.  Two types: Cephalic and breech 9|BUDOL  CMPA411 | Competency Appraisal 1 Prelims 10 Common Fetal Landmark  Right Occiput Transverse (ROT) Side lying position - right Fetus is facing left leg / ischial spines Fetal back is on the right leg / ischial spines  Left Occiput Transverse (LOT) Side lying position - left Fetus is facing the right leg / ischial spines Fetal back is on the left leg / ischial spines  Occiput Anterior (OA) Fully prone position Fetus is facing posterior / buttocks  Occiput Posterior (OP) Fully supine position Fetus is facing the anterior or abdomen  Occiput Near Posterior Fontanelle is nearest to the back.  Face (Mento) Chin is nearest to the chest. Mento-Vertical – biggest diameter involved  Buttocks (Sacro) Sacrum is nearest to the back. What is the common fetal position? ► LOA. 80% of Cephalic presentation is? ► LOA.  Right Mento Anterior (RMA)  Left Occiput Anterior (LOA) Fetus is facing right anterior Semi-prone position Fetal back is on the left posterior Fetus is facing right posterior  Left Mento Anterior (LMA) Fetal back is in left anterior Fetus is facing left anterior  Right Occiput Anterior (ROA) Fetal back is on the right posterior Semi-prone position  Right Mento Posterior (RMP) Fetus is facing left posterior Fetus is facing right posterior Fetal back is on the right anterior Fetal back is on the left anterior  Left Occiput Posterior (LOP)  Left Mento Posterior (LMP) Semi-supine position Fetus is facing left posterior Fetus is facing the right anterior Fetal back is on the right anterior Fetal back is on the left posterior  Right Occiput Posterior (ROP) Semi-supine position Fetus is facing left anterior Fetal back is on the right posterior  Left Sacro Anterior (LSA) Fetus is facing right posterior Fetal back is on the left anterior  Right Sacro Anterior (RSA) 10 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 11 Fetus is facing left posterior □ ROA, ROT, ROP - auscultate on RLQ Fetal back is on the right anterior □ OA, OP - auscultate on Mid LQ Ex. Mento  Left Sacro Posterior (LSP) LMA, LMP - auscultate on the RLQ □ Fetus is facing right anterior □ RMA, RMP - auscultate on the LLQ Fetal back is on the left posterior  If fetus is in Breech presentation  Right Sacro Posterior (RSP) Auscultate on the upper quadrants Ex. Sacrum Fetus is facing left anterior RSA, RSP - auscultate on the RUQ □ Fetal back is on the right posterior □ LSA, LSP - auscultate on the LUQ On what abdominal quadrant of the mother will you auscultate fetal heartbeat?  If fetus is in Cephalic presentation Auscultate on the lower quadrants. Ex. Occiput □ LOA, LOT, LOP - auscultate on LLQ LESSON 5 OBSTETRICS NURSING (F2F Lecture) Homologous Penis copulation Vagina Glans penis excitement Clitoris Scrotum – Labia majora Testes gonads Ovaries Testosterone hormones Estrogen & Progesterone Sperm gametes Egg Vas deferens conduit Fallopian tube Pregnancy must be:  Standard of EINC: 4 Check-ups (once in  Planned every trimester) ○ Timing the pregnancy ► Before the 4th month (1st)  20 - 30yrs old ► 6th month (2nd)  1 year after marriage ► 8th month (3rd)  3 - 6 months weight reduction program ► Final month (4th) ○ Number of children  Standard of NCLEX: 14 Check-ups  2-3 ► First 6 months - once a month ○ Spacing ► 7th to 8th month - twice a month  3 - 5yrs ► 9th month - weekly  Wanted  Supported Oxytoxic Tocolytic ○ Financial These are medications used to These are medications used to ○ Emotional induce or strengthen uterine suppress premature labor by contractions during labor, helping relaxing the uterus, helping to ○ Sexual to speed up the delivery process. delay delivery. ○ Physical ▲ Syntocinon ▲ Duvadilan ▲ Best position during pregnancy: Sims position ▲ Pitocin ▲ Bricanyl (Terbutaline)  Monitored ▲ Oxytocin ▲ Dactyl OB ○ Pre-natal Check-up ▲ Methergine ▲ Yutopar  Facility-based check-ups ► Accessible Primary Health Care ► Available (Health Centers) ► Affordable 11 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 12 Stages of Orgasm Duct will turn into male or female reproductive organ. How? Between the 7th and 8th weeks of pregnancy, if the testosterone levels produced by the primitive testes are high, the mesonephric ducts will develop into the male reproductive organs, while the paramesonephric ducts will regress. This is because the paramesonephric ducts are the precursors to female reproductive organs. ▲ Female Orgasm – 30 contractions / seconds However, if testosterone levels remain low by the 10th week of intrauterine life, the gonadal tissues will develop into ovaries, and the paramesonephric ducts will transform into the Pre-Ejaculation / Pre-Cum female reproductive organs. − Unfelt ejaculation. Ovaries carries XX Ovaries carries XX Contraceptives Chromosomes Chromosomes Withdrawal 80% effective, 20% failure If the sperm that fertilizes Pills 98% effective the egg cell (XX) is Implant 99.9% effective If the sperm that fertilizes carrying a Y chromosome, the egg cell (XX) is then the fetus will become carrying an X ADDITIONAL KNOWLEDGE a Male. (XY) Therefore, if chromosome, then the OBSTETRICS NURSING the combination of the fetus will become a Normal OB chromosomes is XY then Female. (XX). Therefore, Obstetric Nursing the Primitive Testis is the Intrauterine Life − Obstetrics came from from the word obstetric which expected to increase the means “midwife.” production of testosterone. − Takes care of the pregnant client during the antepartal period, intrapartal period, and postpartal period. Pubertal Development − Secondary Sex Changes begin. Reproductive Development  Growth Spurt − So how does the gender of a person develops? ˃ a sudden increase  Gonads ○ Range: 9 - 17 years old ˃ are the male and female reproductive ○ Average: sysytem. 9 -12 (girls) ˃ Sex Glands 12 -14 (boys) ○ Male: Testes (XY) ○ Female: Ovaries (XX) Different Hormones That Caused Pubertal Development 5 Weeks of Intrauterine Life Role of Androgen Hormone − Presence of Primitive Gonadal Tissues  Source:  Mesonephric Duct & Paramesonephric Duct 1. Female – Adrenal Cortex and Ovaries (Master ˃ will be the one that will change so that the clock: Hypothalamus). child or the baby will become a male or ˃ The hypothalamus will trigger the Adrenal female Cortex to start producing the Androgen 7 – 8 Weeks hormone and then, the ovaries will produce ► between the 7th to 8th week of the the Estrogen and Progesterone. pregnancy the fetus is producing 2. Male – Adrenal Cortex and Testis. or developing. ˃ For male, the Adrenal Cortex will produce → Primitive Testis – capable of androgen (by the stimulation of the producing a small amount of hyothalamus) and it will stimulate the testes testosterone. to produce testosterone that is why there will ► Testosterone – the level of be an appearance of the male and female testosterone will be the one to secondary sex characteristics. determine if the Mesonephric Duct or Paramesonephric 12 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 13 Tanner’s Sexual Development ▲ In Christian countries, majority of males are circumcised due to Female Secondary Sex Characteristics (in order) religious practices. A Acceleration in linear growth (growth spurt) ▲ Circumcision advantage: Genital Hygiene but there is no difference when it comes to sexual performance. Broadening of the hips / Increase transverse Scrotum / Scrotal Sack B ▲ diameter of the pelvis → Unequally leveled (Left is longer than the right so that they T Breast development (Thelarche) will not hit one another) → Testicles (inside) Growth of pubic hair and Growth of axillary hair A (Adrenarche) Why is it that the testes are found inside the scrotal sack while ► Pubic before Axillary hair. and scrotal sack is found outside the body? ► Because you can find sperm inside the testes and sperms M Onset of menstruation (Menarche) are heat sensitive. (Scrotal Temperature: 1° Farenheit O Ovulation lower than the Body Temperature). I Increase in Vaginal secretions How long is the average length of the fully erect penis? ► the average length is around 4-5 inches. Chronological Biologic Question  Thelarche  Adrenarche Internal Structures  Menarche  Testes  Ovulation − male sex glands that produces testosterone. − responsible for spermatogenesis  Epididymis What is the earliest sign of female secondary sex development/characteristics? − on top of the testes. a. Increase in height − serving as the storage for growth and maturation b. Breast development for the sperms. Answer: Increase in height (Acceleration in Linear Growth) − 64 to 70 days common maturation date of the sperm cells. − the conduit between the seminal vesicles and the Male Secondary Sex Characteristics (in order) epididymis is Vas Deferens. 1. Increase in weight  Vas Deferens 2. Broadening of shoulders − site for male surgical sterilization (vasectomy). 3. Growth of testes  Ampulla 4. Growth of face, axillary and pubic hair  Ejaculatory Duct 5. Voice changes − where the ampulla and the seminal vesicle meet. 6. Penile growth − Ejaculatory duct is connected to the; 7. Increase in height  Urethra 8. Spermatogenesis − found in the middle of the corpus spongiosum. − 3 Structures that are Connected to the If a 10yr old boy masturbates, will there already be a presence of Urethra: sperm in his ejaculation? 1) Ejaculatory Duct ► None, only seminal fluid but there is still no presence of 2) Prostate Gland – produces alkaline that sperm in his ejaculation. protects the sperm 3) Bulbourethral Gland / Cowper’s Gland – Male Reproductive System produces alkaline that protects the sperm. External Structures  Urinary Bladder  Penis − has many ligaments How will the penis erect? − Inside the Penis ► Sexual Stimulation (blood rush) Corpora Cavernosa ˃ When the male person is sexually stimulated, the penile arteries dilate (more blood rushes toward the Corpora Spongiosum – came from the penis) while the penile vein constricts. word sponge. ► Parasympathetic Stimulation  Shaft Where is the specific site of spermatogenesis?  Glans penis ► In the Seminiferous Tubules − covered by a foreskin called pre-fuse.  Urethra 4 Structures Responsible in Producing Seminal − found on the tip portion of glans penis. Fluid − Length: 5-9 inches and average of 7 inches − Dual Function: 1. Epididymis: 5%  Passage way of urine. (Elimination) 2. Seminal Vesicle: 30%  Passage way of semen. (Reproduction) 3. Prostate Gland: 60% 13 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 14 4. Cowper’s Gland / Bulbourethral Gland: 5% Where is the most ideal site of implantation, Upper Uterine Segment or Lower Uterine Segment? ► Upper Uterine Segment, the site of implantation is the is ▲ When the male person ejaculates, sperm cells will reach the the site of placental development. cervix within 90 seconds and 5 minutes in fallopian tube Implantation should only happen where? a. Endometrium only After undergoing vasectomy, What is the most important Nursing b. Endometrium to Myometrium Health Teaching that you are going to give to your client? Answer: Endometrium only, it should not reach myometrium. Why? ► Sir, you have been vasectomize. Do not forget that after Placenta comes out next after the baby has been delivered, meaning vasectomy, you need to wear condom if you are going to to say, it is superficially implanted on the Endometrium and it will engage in any sexual activities for at least 2 months automatically come out during uterine contraction, but if the because immature sperm cells are capable of maturing for implantation goes deeper (invasive implantation) the placenta mow is 64 days causing pregnancy. attached permanently on the myometrium, this is called Placenta Is there are way to quickly empty the immature sperm? Accreta. If Placenta Accreta happens, the mother will bleed to death. ► Yes, by ejaculating. When will the uterus assume the retroverted position? Will vasectomy prevent spermatogenesis? ► During the 2nd trimester of pregnancy ► No, he will continue to produce sperm. → 1st Trimester - 1 to 3 months → 2nd Trimester - 4 to 6 months → 3rd Trimester - 7 to 9 months Female Reproductive System External Structures  Mons Pubis  Fallopian Tubes − protects the symphysis pubis.  Ovaries  Labia Majora ○ Fimbriae  Labia Minora − finger-like structure.  Clitoris − the site of sexual excitement for female. ▲ Placenta Previa – growth of placenta in the Lower Uterine  Vestibule Segment (obstructs the birth canal which can lead to bleeding). − pear shaped − 2 Obvious Openings What do you call the gland that lubricates the urethra? ► Paraurethral Gland/ Skene’s Gland ○ Urethra – Length: 2 - 3 inches What gland lubricates the vaginal canal? ○ Vaginal orifice / Vaginal meatus ► Bartholin’s Gland  Fourchette − where the labia majora and labia minora meets.  Perineum LESSON 6 OBSTETRICS NURSING − from the fourchette to the anus Menstruation  Episiotomy − Perodic discharge of blood from uterus. − cutting of the perineum of a woman to provide − Occurs during puberty: space for delivery of the head  9-17 y/o ○ Median Episiotomy – straight − menarche happens: ○ Mediolateral Episiotomy – slightly slanted  average of 12 y/o (better than median) Menstrual period VS Menstrual Cycle Internal Structures − Menstrual period are the days where in the woman is  Vaginal Canal menstruating.  Uterus  Average length of the menstrual period: ○ Size: 3” long x 2” wide x 1” thick ○ 3 – 5 days (Maximum: 7 days) ○ Weight: 50-60 grams (minimum of 500 grams for − Menstrual cycle starts from the first day of period to pregnant woman) the first day of next period, average of 28 days/cycle. ○ Shape: pear-shaped  First onset of menstrual cycle is menarche. ○ Location:  Ranges from 23 – 35days (Maximum: 40 days) ► suspended anteriorly in the bladder  Menstrual cycle can be regular or irregular. ► suspended posteriorly in the rectum ○ Position: ► Anteverted / anteversion (non-pregnant) ► Retroverted/retroversion (pregnant - 2nd tri) ˃ Ante-flexion and Retroflexion is abnormal ▲ Placenta Previa – growth of placenta in the Lower Uterine Segment (obstructs the birth canal which can lead to bleeding). 14 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 15 Ovulation − the day that the one of the 2 ovaries of the woman is releasing a mature egg cell. − The woman is fertile when the one of her 2 ovaries is releasing egg cell. − If the woman is fertile and she had sex there is a possibility that the egg will be fertilized by the sperm and get pregnant. Menstruation (Safe) Safe Days How are we going to compute for the day of Fertile Window Ovulation Day Sex Days ovulation? − From the end of the cycle, minus 14. Example: ▲ If the woman is a 28-day cycle, she will ovulate on day 14, granted that the menstrual period of the woman is 1 – 5 days. 28 – 14 = 14 ▲ From the day of ovulation minus 5 (14 – 5 =9) & from the day of  she will be ovulating on day 14 ovulation plus 3 (14 + 3 =17) so days 9 –17 she is fertile.  This is only done by regular. ▲ Therefore days 1 – 8 she is safe but if she wants to engage in sex beyond menstrual period, she is safe from days 6 – 8 and from day 18 – 28. ▲ Hormone estrogen is high on the first half of the cycle. Is she ovulating at day 9? ▲ Hormone progesterone is high on the second half of the cycle. ► No, because day 14 is the ovulation day. The length of the cycle affects the day of the cycle? ▲ Day 9 is 5 days before ovulation, means that if you have sex on ► Yes. day 9 sperm enters the vagina → cervix (w/in 90 sec) → uterine ▲ The day of ovulation is based on the cycle. cavity → fallopian tube (reached w/in 5 min) and; ▲ If the length of the cycle is changing every month, then the day ▲ Starting from day 9, the sperm waits in the ampulla of the of your ovulation every month is also changing, then you are not fallopian tube for the arrival of the egg for up to 5 days (since the regular. lifespan of sperm is 3 – 5 days, it can wait in the ampulla for 5 days). The egg will arrive on the 5th day, exactly on day 14 (ovulation day), in the ampulla of the fallopian tube. Therefore, Fertile Window pregnancy can occur even if intercourse happened 5 days − These are the days the woman is considered fertile. earlier. − If you want to get pregnant have sex during the fertile ▲ Note the sperm lives for 3 – 5 days that is why you have to subtract 5 and add 3 is derived from the life span of the window. ▲ Ovum / egg cell. It is only 1 – 2 days or actually average of 24 − If you don’t want to get pregnant have sex outside the hrs.or 1 day, maximum of 48hrs. or 2 days. Plus 3 kase they window. added 1 day. ▲ If you don’t want to get pregnant, have sex more than 5 days before ovulation—specifically on day 8 or earlier. Example: 5 days of menstruation − For irregular, you must also monitor your menstrual  Days 1 to 5 = menstrual period is safe. cycle at least 6 months. ○ Deduct 5 days from the day of ovulation − You have to identify the month that has longest cycle 14 – 5 = 9 and the shortest cycle. ○ Add 3 days from the day of ovulation − You have to deduct 11 days from the longest cycle 14 + 3 =17 then, deduct 18 days from the shortest cycle. ▲ Day 9 – 17 fertile window, the woman is ▲ We cannot identify exactly the ovulation day but we considered fertile. will know the fertile window. ▲ The woman is considered safe to have Example: sex if she does not want to get pregnant Irregular menstruation beyond the window so less than 9 and a) May (Longest Cycle) above 17. Longest cycle – 38 – 11 = 27 days ▲ Specifically, the woman is safe to have ○ ↑ Considered as the cycle because it is the sex from day 1 – 8 but days 1 – 5 have longest. menstrual period. Therefore, day 6 – 8 b) August (Shortest cycle) and during menstrual period is safe. Shortest cycle – 21 – 18 = 3 days  Day 18 – 28 is also safe × Day 9 – 17 fertile days, not safe Menstruation → Ovulation → Menstruation Day 1 --------- Day 38 15 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 16 4 Dates of Menstrual Cycle 1. ↓ 3rd day − the level of estrogen in the blood of the woman is very low. − Days 1-5, she is menstruating at the beginning menstrual cycle. Menstruation (Safe) Safe Days Fertile Window Sex Days 2. ↑ 13th day No Ovulation Days − the level of estrogen in the blood of the woman is very − 1 – 5 MP: 1 – 2 safe low. − 3 – 27 FW: 28 – 38 safe − Day 5 still menstruating and Day 3 ovulation day (they 3. ↓ 13th day are overlapping). − the level of progesterone in the blood of the woman is very low. 4 Important Structures − That regulate / control the menstrual cycle. 4. ↑ 14th day − the level of progesterone in the blood of the woman is ▲ Hypothalamus gland that starts menstrual cycle. very high. Hypothalamus stimulates what gland? ► Anterior pituitary gland APG stimulates what organ? ► ovaries Ovaries affect what organ? ► uterus 1. Hypothalamus − Producing:  GnRH or Gonadotropic Releasing Hormone − Types of GnRH:  FSHRF or Follicle Stimulating Hormone First Half of Cycle Releasing Factor. 1) Particularly days 1 – 5, on the 3rd day of menstrual  LHRF or Luteinizing Hormone Releasing period the level of estrogen in the blood of the woman Factor. is already very low because she is menstruating. 2) That low level of the estrogen of woman stimulates 2. Anterior Pituitary Gland the hypothalamus to start a new cycle. − Producing: 3) Estrogen stimulate hypothalamus to release FSHRF  FSH or Follicle Stimulating Hormone 4) FSHRF stimulates the APG to release FSH.  LH or Luteinizing Hormone 5) FSH stimulates the ovary to release estrogen. Then, Estrogen will affect the uterus. 3. Ovaries  Once APG release, FSH will develop egg cells. − Producing: ○ 1st Effect of FSH: It will cause the maturation of  Estrogen – dominant on the 1st half of oocytes. (Oocyte – immature egg cells) cycle. ○ 2nd Effect of FSH: FSH stimulates ovaries to  Progesterone – dominant on the 2nd half of release estrogen so once estrogens is release, it cycle. converts the follicle of the ovary into graafian follicle. 4. Uterus  Follicle is the compartment in the ovary where you can find the egg cells and becomes graafian follicle. Estrogen is the hormone that is very high in the graafian follicle. ○ The effect of the estrogen on the uterus is thickening of myometrium and endometrium. ○ Myometrium is also thickening – the uterus will slightly enlarge during menstrual cycle because of the hormone estrogen.  If the woman gets pregnant, the level of estrogen is high, which is why estrogen enlarges the uterus. 16 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 17  The ovary does not produce estrogen and progesterone simultaneously; they are produced one at a time.  Estrogen is partnered with FSH, while progesterone is paired with LH. How ovaries produce progesterone? ► Estrogen levels are low on the 3rd day and high on the 13th day of the menstrual cycle. On the 13th day, the level of estrogen is high, while progesterone is low. When estrogen levels are very high on the 13th day, there will be a feedback effect. ► This high level of estrogen signals the APG to temporarily stop producing FSH. ► Effect: If FSH production stops, the ovary will no longer produce estrogen because it already has a stock of estrogen in the Graafian follicle. What gland that starts menstrual cycle? ▲ Progesterone is then produced by the corpus ► Hypothalamus luteum, which forms from the Graafian follicle after Hypothalamus stimulates? ovulation. ► APG APG stimulates? ► Ovary. Second Half of Cycle Ovary affects?? 1) That is why on the 13th day of the menstrual cycle the ► Uterus. Hormone high in the graafian follicle? level of progesterone is very low stimulating the ► Estrogen hypothalamus to release LHRF. Hormone high in the CL? 2) LFRH stimulates the APG to release LH. ► Progesterone 3) LH stimulates the ovary to release progesterone. What gland stimulate ovary to produce estrogen and progesterone? Then, Progesterone will affect the uterus. ► APG.  When the level of LH is high, LH triggers ovulation. What hormone will stimulate the ovary to produce estrogen?  The high level of progesterone will convert graafian ► FSH. follicle into corpus luteum. (Corpus luteum c What hormone will stimulate the ovary to produce progesterone coming from what gland? yellowish) ► APG, under the egulation of hypothalamus gland.  Progesterone will stimulate uterus, there will be What hormone will stimulate APG to produce LH? increased vascularity on endometrium ► LHRF coming from hypothalamus.  Increase vascularity – building up of temporary What day the level of estrogen is highest? ► 13th capillary. What day the level of progesterone is lowest?  Progesterone builds up temporary capillaries on ► 13th endometrium. What day the level of progesterone is highest?  The blood supply will be high when there’s a build-up ► 14th What day the level of estrogen is lowest in the blood of the of temporary capillary. woman?  If the blood supply in endometrium will become high, it ► 3rd day because she is menstruating increased supply of O2, H20, Glucose, Amino Acid. What hormones trigger ovulation??  Progesterone made the endometrium highly ► LH nourished. LESSON 7 OBSTETRICS NURSING Family Planning and Contraception − Is the use of a range of methods of fertility regulation in order to: Structure Hormones  Avoid unwanted births / pregnancy  Bring about wanted births/pregnancy − If hormones contain “RF” releasing factor it came  Regulate the number of children born (2 – 3 from hypothalamus walang “RF” from APG. recommended) − If the questions are about structures look at the  Regulate intervals between pregnancies / birth middle. spacing (interval 3 – 5 year average of 3 if CS 5) − If the question is about the hormones look at the  Control time at which birth occurs (1 year after outside. getting married) 17 | B U D O L  CMPA411 | Competency Appraisal 1 Prelims 18 2 Components Family Planning – DOH 1. Planning pregnancy − The program is anchored on the following basic  Timing principles.  Number of children 1) Responsible Parenthood  Proper spacing ˃ means that each family has the right and 2. Preventing pregnancy duty to determine the desired number of children they might have and when they Sexual and Reproductive Health might have them. And beyond responsible − Good sexual and reproductive health is a state of parenthood is Responsible Parenting complete physical, mental and social well-being in all which is