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MATERNAL NCM 103 PRELIMS – 1ST SEM W1: INTRODUCTION TO MCHN Primary Goal of MCHN: - Promotion and Maintenance of OPTIMAL FAMILY HEALTH, ensuring cycles of optimal Childbearing and Childrearing. PROVISION...

MATERNAL NCM 103 PRELIMS – 1ST SEM W1: INTRODUCTION TO MCHN Primary Goal of MCHN: - Promotion and Maintenance of OPTIMAL FAMILY HEALTH, ensuring cycles of optimal Childbearing and Childrearing. PROVISIONS: Preconception Women THEORIES RELATED TO MCHN: Children Families SISTER CALISTA ROY: ADAPTATION THEORY DOROTHEA OREM: SELF-CARE HEALTHY FAMILIES CYCLE: THEORY PATRICIA BENNER: NOVICE TO EXPERT MODEL ROLES AND RESPONSIBILITIES OF A MATERNAL-CHILD NURSE: Philippine Nursing Act of 2002 (RA 9173 - Article 6) holistic approach collaborator of care provider of health care education nurse educator evidence-based practice (nurse PHASES OF HEALTHCARE: researcher) Health Promotion Health Maintenance Health Restoration COMPETENCIES FOR QUALITY Health Rehabilitation CARE: Patient-Centered Care Teamwork and Collaboration PHILOSOPHY OF MCHN: Evidence-Based Practice Family-centered Quality Improvement Community-centered Safety Evidence-based Informatics MCHN HEALTH GOALS AND STANDARDS LEGAL CONSIDERATIONS OF PRACTICE GLOBAL HEALTH GOALS: - Protect the rights of the patients - UNITED NATIONS AND WORLD (confidentiality and accountability) HEALTH ORGANIZATION - Proper documentation - Improve the health of women and children. - Conscientious about informed consent (invasive procedure - risk awareness) - Reporting inappropriate or insufficient BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM BASIC FAMILY TYPES: - Family of Orientation - Family of Procreation ETHICAL CONSIDERATIONS OF PRACTICE FAMILY THEORY: - based on family and community standpoint - Factual, complete information, supportive - Sets of perspectives listening, clarifying their value. - Addresses important issues PROVISIONS: FAMILY LIFE CYCLE: Preconception Boomerang Generation: young Women adults returning home. Children Sandwich Family: both aging parents and returning young adults. Families Empty Nest Syndrome: children leaves home for the first time. DEFINITIONS OF FAMILY: US CENCUS - A group of ASSESSMENT OF FAMILY STRUCTURE BUREAU, 2009 people related AND FUNCTIONS: by blood, marriage, or Genogram: details family structure, adoption living family history, roles of family members together (over time), basis and analysis of family interactions. ALLENDER & - Two or more Ecomap: how the family fits in the SPRADLEY, 2008 people who live community. Family and community in the same relationships. household, share a common RECOGNIZED FAMILY STRUCTURES: emotional Childfree or Childless Family bond, perform certain Cohabitation Family interrelated Nuclear Family social tasks. Extended (multigenerational) Family Single-Parent Family Blended Family/Remarriage/Reconstituted Family Dyad Family Binuclear Family INFLUENCE OF FAMILY ON ITS Communal Family MEMBERS: Gay or Lesbian (LGBT) Families emotional ties Foster Family depth of support Adoptive Family relations to others moral values basic perspectives CHARACTERISTICS OF A HEALTHY FAMILY: interacts with each other encourages growth and development FAMILY NURSING: enhanced and fulfilled - focus of modern nursing master their lives - family and not as an individual BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM - Women: heightened sexual tension, further engorgement - Men: further penile/testicular changes FAMILY APGAR: screening tool of the family - Both: generalized muscular tension. environment. A: Adaptation P: Partnership ORGASM G: Growth A: Affect - Intense desire for sexual release. R: Resolve - Increased heart rate, blood pressure, respiration. - Muscular contractions in reproductive HUMAN SEXUALITY organs. - Multidimensional concept encompassing sexual nature, activity, and interest. RESOLUTION - Influenced by ethical, spiritual, cultural, and moral factors. - Overall release of muscular tension. - Important component of women's - Feeling of warmth and relaxation. - Women may experience brief refractory period. COMMUNITY-BASED WOMEN’S HEALTH - Women capable of multiple orgasms. Recognizes each person's autonomy. Provides holistic care. SEXUAL ORIENTATIONS Sensitive to physical, emotional, sociocultural, and situational needs. Heterosexual: attraction to opposite sex/gender. THE HUMAN SEXUAL RESPONSE Homosexual: attraction to same - Researched by Masters and Johnson sex/gender. in 1960s Bisexual: attraction to both - Defined sexuality as natural component of healthy personality - Gave insights into physical components of pleasure and orgasm. SEXUAL & REPRODUCTIVE HEALTH - a complex, multifaceted topic encompasses physical, emotional, and relational aspects. PHASES OF SEXUAL RESPONSE - Nurses play a crucial role in promoting women's health in this area. EXCITEMENT NOTE: Basson's model (2002) emphasizes complexity of women's sexual response - Physiological responses to internal/external cues - Women: vaginal lubrication, SEXUAL DYSFUNCTION (WOMEN) engorgement, increased heart/respiratory - Any sexual situation causing distress for the woman ratex herself. - Men: penile engorgement, scrotal changes - Can manifest as pain, arousal disorder, orgasmic disorder, or desire disorder. - Emphasis on individual experience and perception. PLATEAU BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM MEDICATION-FREE METHODS - Taken daily at the same time - Natural family planning (NFP) - 95% effective with typical use - Fertility awareness methods (FAM) - Many non-contraceptive benefits (e.g. - Coitus interruptus (withdrawal) reduced menstrual cramps) - Lactational amenorrhea method - Not suitable for some women (e.g. (breastfeeding) smokers over 35) MALE CONDOMS - Thin sheath worn over penis during intercourse PROGESTIN-ONLY PILLS: - 85% effective with typical use - "Mini-pill" - contains only progestin - Taken daily without breaks FEMALE CONDOMS - Good option for those who can't take estrogen - Polyurethane sheath inserted into vagina - 92% effective with typical use - Can be inserted up to 8 hours before intercourse - May cause irregular bleeding NOTE: Pain with intercourse (dyspareunia) DIAPHRAGMS & CERVICAL CAPS CONTRACEPTIVE PATCH - Adhesive patch worn on skin, changed - Shallow silicone cups inserted into vagina to cover weekly cervix - Releases hormones through skin into - 84% effective for diaphragms, 74% for cervical bloodstream caps with typical use - 99% effective when used correctly - May be less effective for women over 198 pounds SPERMICIDES - Chemical agents that immobilize or kill sperm - 71% effective with typical use when used alone VAGINAL RING - Flexible ring inserted into vagina for 3 weeks at a time HORMONAL METHODS - Releases low dose of hormones - 98% effective with perfect use - Use synthetic hormones to prevent - May cause vaginal irritation in some pregnancy. users - Work by preventing ovulation and - Requires comfort with inserting and thickening cervical mucus. removing from vagina INJECTABLE CONTRACEPTIVES - Depo-Provera: Injection given every 12-13 weeks - Contains progestin only - 98-99% effective - May cause irregular bleeding and weight gain - Return to fertility may be delayed after stopping CONTRACEPTIVES CONTRACEPTIVE IMPLANT COMBINED ORAL - Small rod inserted under skin of upper CONTRACEPTIVES: arm - The Pill - contains estrogen and - Releases progestin for up to 3 years progestin - Over 99% effective BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM - Can use partner or donor sperm - Requires minor procedure for insertion - Often combined with ovulation induction - and removal - Sperm washing improves motility and reduces side - May cause irregular bleeding effects GAMETE INTRAFALLOPIAN TRANSFER NOTE: FSH (follicle stimulating hormone) LSH (luteinizing (GIFT): hormone) - Involves laparoscopy and ovulation induction - Harvest 3-5 oocytes from ovary - Combine with washed sperm in catheter - Inject into fallopian tubes or at least one. IN VITRO FERTILIZATION (IVF) INTRAUTERINE DEVICES (IUDs) - Retrieve oocytes from ovaries - Small T-shaped device inserted into - Combine with sperm in laboratory uterus - Transfer developing embryos to uterus - Two types: copper and hormonal - Success depends on factors like woman's age - Over 99% effective - Multiple cycles may be needed - Can last 3-10 years depending on type - May cause heavier periods (copper) or lighter/no periods (hormonal) MALE REPRODUCTIVE SYSTEM: ANATOMY & FUNCTION - Consists of external and internal structures EMERGENCY CONTRACEPTION - Arises from same embryonic origin as female - after unprotected sex to prevent system pregnancy - Andrology is the study of male reproductive - Options: pills or copper IUD insertion organs - Most effective when used as soon as possible (within 72 hours) - Not intended for regular use - Does not terminate existing pregnancy STERILIZATION - Permanent surgical methods of contraception - Female: Tubal ligation - fallopian tubes cut or blocked - Male: Vasectomy - vas deferens cut or blocked EXTERNAL MALE STRUCTURES - Over 99% effective - Should be considered irreversible SCROTUM: - Rugated, muscular pouch that holds testes - Regulates temperature of testes/sperm - Contracts in cold, relaxes in heat INTRODUCTION TO INFERTILITY TESTES: - Two ovoid glands, 2-3 cm wide, in scrotum - Infertility: Failure to conceive after 12 - Produce sperm in seminiferous tubules months of trying - Leydig cells produce testosterone - Affects 10-15% of couples in the US - One testis usually slightly larger/lower - Causes: 40% female factors, 40% male PENIS: - Composed of erectile tissue factors, 20% combined/unknown - Corpus cavernosa and corpus spongiosum - Increasing number of people seeking - Glans at distal end covered by prepuce fertility assistance - Urethra passes through center SURGICAL OPTIONS INTERNAL MALE STRUCTURES THERAPEUTIC INSEMINATION: EPIDIDYMIS: - Place sperm at cervix or in uterus mechanically - Tightly coiled tube, over 20 ft long - Conducts/stores sperm from testes BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM - Sperm immobile and immature here NOTE: GnRH (Gonadotropin-releasing hormone) - Takes 64 days for sperm to mature VAS DEFERENS: - Carries sperm from epididymis ERECTION PHYSIOLOGY - Sperm mature as they pass through - Triggered by sexual excitement - Part of spermatic cord with blood vessels - Nitric oxide release causes vasodilation - Site of vasectomy for contraception - Increased blood flow to penis - Ischiocavernosus muscle contracts to maintain - Parasympathetic nervous system involved SEMINAL VESICLES: - Two pouches by bladder COMMON DISORDERS - Secrete alkaline, nutrient-rich fluid - Increases sperm motility - Benign prostatic hyperplasia EJACULATORY DUCTS: - Prostate cancer - Connect seminal vesicles to urethra - Testicular cancer - Pass through prostate gland - Erectile dysfunction - Conduct seminal fluid during ejaculation - Varicocele PROSTATE GLAND: - Chestnut-sized gland below bladder FEMALE REPRODUCTIVE SYSTEM - Secretes thin alkaline fluid - Urethra passes through center - Consists of internal and external structures - Can enlarge with age (benign prostatic hyperplasia) - Responsible for reproduction and hormone BULBOURETHRAL GLANDS: production - Also called Cowper's glands - Develops and matures during puberty - Located beside prostate gland - Secrete alkaline fluid into urethra - Neutralizes urethra acidity for sperm EXTERNAL FEMALE GENITALIA URETHRA - Tube from bladder through penis - Collectively known as the vulva - About 8 inches (20 cm) long - Includes mons pubis, labia, clitoris, vestibule - Lined with mucous membrane - Protects internal structures - Conducts both urine and semen - Facilitates sexual arousal and intercourse COMPOSITION OF SEMEN - Fluid that carries sperm during ejaculation Components: - 60% from prostate gland - 30% from seminal vesicles - 5% from epididymis - 5% from bulbourethral gland MONS PUBIS & LABIA - Mons pubis: fatty pad over pubic bone SPERM PRODUCTION & MATURATION - Labia majora: outer folds of tissue - Labia minora: inner folds of tissue - Produced in seminiferous tubules of testes - Provide protection and lubrication - Stored and begin maturation in epididymis CLITORIS & VESTIBULE - Complete maturation in vas deferens - Clitoris: highly sensitive organ for sexual pleasure - Process takes about 64 days total - Vestibule: area between labia minora - Contains urethral and vaginal openings HORMONAL CONTROL GLANDS OF THE EXTERNAL GENITALIA - Skene's glands: near urethra, produce lubricating - Hypothalamus produces GnRH mucus - Anterior pituitary produces FSH and LH - Bartholin's glands: near vaginal opening, - Testes produce testosterone provide lubrication BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM INTERNAL FEMALE GENITALIA - Ovaries: produce eggs and hormones - Fallopian tubes: transport eggs - Uterus: supports fetal development - Vagina: passageway for menstruation and childbirth INTERNAL FEMALE GENITALIA HORMONAL REGULATION: - Hypothalamus produces GnRH - Pituitary releases FSH and LH - Ovaries produce estrogen and progesterone PUBERTY & REPRODUCTIVE LIFESPAN: Puberty: development of secondary sex characteristics Menarche: first menstrual period FALLOPIAN TUBES: Reproductive years: typically ages 12-51 - Connect ovaries to uterus Menopause: cessation of menstrual - Site of fertilization - Transport fertilized egg to uterus COMMON DISORDERS UTERUS: Endometriosis - Menstruation Polycystic ovary syndrome (PCOS) - Implantation site for fertilized egg Uterine fibroids - Fetal development and protection Cervical cancer - Labor contractions for childbirth CERVIX: - Lower portion of uterus PELVIC BONES & LIGAMENTS - Connects uterus to vagina - Produces cervical mucus - The pelvis is composed of 4 bones: sacrum, coccyx, - Dilates during childbirth and two innominate bones VAGINA: - Innominate bones formed by fusion of ilium, - Muscular canal connecting uterus to outside of body ischium, and pubis - Passageway for menstrual flow and childbirth - Ligaments provide support and flexibility - Self-cleaning organ with acidic pH MENSTRUAL CYCLE OVERVIEW - Monthly cycle of hormonal changes - Prepares uterus for potential pregnancy - Consists of follicular, ovulatory, and luteal phases TRUE VS FALSE PELVIS False pelvis: superior to linea terminalis, supports gravid uterus True pelvis: inferior to linea terminalis, critical for childbearing BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM True pelvis divided into inlet, midpelvis, and outlet - Prolactin stimulates milk production after birth EXTERNAL BREAST ANATOMY Nipples: contain pores for milk secretion, erectile tissue aids infant latch Areola: pigmented area surrounding nipple, 1-3.9 inches in diameter Montgomery tubercles: secrete lubricating substance HYPOTHALAMIC HORMONES: Gonadotropin-releasing hormone (GnRH): PELVIC MEASUREMENT: stimulates FSH and LH release - Pelvimetry used to assess adequacy for vaginal Corticotropin-releasing hormone (CRH): birth. regulates ACTH secretion Growth hormone-releasing hormone (GH-RH): stimulates GH production Thyrotropin-releasing hormone (TRH): regulates PELVIC TYPES thyroid hormones Gynecoid: most favorable for childbirth (50% of women) ANTERIOR PITUITARY HORMONES: Android: triangular inlet, narrow subpubic arch - Thyroid-stimulating hormone (TSH) (23%) - Adrenocorticotropic hormone (ACTH) Anthropoid: oval inlet, slightly narrow subpubic - Prolactin (PRL) arch (24%) - Growth hormone (GH) Platypelloid: flat, wide laterally (3%) - Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) POSTERIOR PITUITARY HORMONES: - Stimulates uterine contractions - Promotes milk ejection during breastfeeding - Synthetic form used to induce labor and prevent postpartum hemorrhage GONADAL HORMONES: - Estrogen: primary female sex hormone - Progesterone: prepares uterus for implantation - Testosterone: present in both sexes, higher in males PROSTAGLANDINS BREAST ANATOMY Found in high concentrations in female reproductive tract Affect ovulation, fertility, and cervical mucus Involved in premenstrual syndrome (PMS) Play a role in initiating labor RELAXIN Produced primarily by corpus luteum Detectable by first missed period Softens and lengthens cervix Promotes uterine - Development controlled by estrogen and INTRODUCTION TO PUBERTY progesterone at puberty - Primary function: lactation (milk production) - Puberty is the transition from childhood to - Hormonal changes during pregnancy prepare adulthood breasts for lactation BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM - Characterized by physical changes leading to sexual maturity ALLELES & TRAIT EXPRESSION - Typically occurs between ages 8-14 for girls, - Alleles: Different versions of the same gene 9-15 for boys - Produce variations in characteristics (e.g., eye color, - Triggered by hormonal changes in the body blood type) PRECOCIOUS PUBERTY: - Dominant vs. recessive alleles - Onset of puberty before age 8 in girls, 9 in boys MULTIFACTORIAL INHERITANCE - Can be caused by hormonal imbalances or tumors - Involves multiple genes and environmental factors - May lead to short adult height if untreated - Examples: cleft lip, neural tube defects, congenital - Treatment aims to pause puberty until appropriate heart disease age - Severity can vary based on genetic and ADRENARCHE: THE OTHER PUBERTY: environmental influences - Maturation of the adrenal glands UNIFACTORIAL (SINGLE-GENE) INHERITANCE: - Occurs before gonadarche (activation of - Trait or disorder controlled by a single gene ovaries/testes) - Includes autosomal dominant, autosomal recessive, - Leads to production of weak androgens and X-linked inheritance - Causes body odor, oily skin, and pubic hair growth - Many genetic disorders follow this pattern INTRODUCTION TO GENETICS AUTOSOMAL DOMINANT INHERITANCE - Genetics is the study of heredity and variation in living organisms. - Caused by a single altered gene on an autosome - Key concepts: DNA, genes, chromosomes, - Only one copy of the altered gene needed to express and inheritance the trait - The Human Genome Project revolutionized - 50% chance of passing to offspring - Examples: Huntington's disease, neurofibromatosis our understanding of genetics. AUTOSOMAL RECESSIVE INHERITANCE THE HUMAN GENOME PROJECT - Both copies of the gene must be altered to express the trait - Began in 1990 to identify human DNA - Parents are usually unaffected carriers sequences and genes - 25% chance of passing to offspring if both parents - Enabled scientists to read the complete are carriers human genetic blueprint - Examples: cystic fibrosis, sickle cell anemia - Goal: New methods for diagnosing, treating, and preventing diseases. X-LINKED DOMINANT INHERITANCE DNA: the blueprint of life - Altered gene located on X chromosome - DEOXYRIBONUCLEIC ACID - More common in females (who have two X - Carries instructions for making proteins and - chromosomes) passing on genetic information - Affected males pass to all daughters, none to sons - Located in cell nucleus, packaged into - Examples: vitamin D-resistant rickets chromosomes X-LINKED RECESSIVE INHERITANCE GENES: The basic Units of Heredity - More common in males (who have only one X - Genes are segments of DNA that contain chromosome) information for protein production - Females can be carriers without showing symptoms - Located on chromosomes at specific positions called - Examples: hemophilia, color blindness loci - - Come in pairs, one copy inherited from each parent CHROMOSOMES: Packages of Genetic Material COMMON GENETIC DISEASES - Threadlike structures composed of DNA and proteins CYSTIC FIBROSIS - Humans have 23 pairs of chromosomes (46 total) - Autosomal recessive disorder - 22 pairs of autosomes + 1 pair of sex chromosomes - Most common in people of European ancestry BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM - Affects respiratory and digestive systems - Opioids: Withdrawal, growth problems, birth HUNTINGTON’S DISEASE defects - Autosomal dominant disorder - Marijuana: Possible effects on brain development, - Progressive neurological disease behavior - Symptoms usually appear between ages 30-50 - Amphetamines: Preterm birth, growth restriction, heart defects CAFFEINE CONSUMPTION INTRODUCTION TO EMBRYONIC & FETAL - Found in coffee, tea, soda, chocolate, some DEVELOPMENT medications - Crosses placenta and stimulates fetus - Embryonic period: First 8 weeks after - High intake may increase risk of miscarriage, low fertilization birth weight - Fetal period: 9 weeks until birth - Moderation recommended - limit to 200 mg/day - Critical periods of development when RADIATION EXPOSURE embryo/fetus most vulnerable - High levels can damage chromosomes and - Many factors can potentially disrupt normal embryonic cells development - Risks: Growth problems, brain abnormalities, cancer later in life - Fetus most vulnerable in first trimester - Medical x-rays generally safe if abdomen protected - GENETIC FACTORS COMMON GENETIC DISEASES - About 1/3 of birth defects caused by genetic factors - Can be inherited from parents or occur SICKLE CELL ANEMIA spontaneously - Autosomal recessive disorder - Chromosomal abnormalities (e.g. Down syndrome) - Most common in people of African ancestry - Single gene disorders - Causes abnormal, sickle-shaped red blood cells - Multifactorial inheritance TORCH INFECTIONS - Toxoplasmosis, Other (syphilis, varicella, etc.), ENVIRONMENTAL TERATOGENS Rubella, Cytomegalovirus, Herpes - Teratogens: Agents that can cause birth defects - Can cross placenta and infect fetus - Include drugs, chemicals, radiation, infections - May cause miscarriage, birth defects, - Timing, dose, and duration of exposure matters developmental problems - Embryo most vulnerable during organogenesis - Prevention: Good hygiene, avoiding high-risk (weeks 3-8) foods/exposures MATERNAL MEDICATIONS MATERNAL AGE - 82% of women 18-44 use at least one medication - Advanced maternal age (35+) increases risk of - Many medications can cross placenta and affect chromosomal abnormalities fetus - Down syndrome risk increases with age - Known teratogens: Some anticonvulsants, retinoids, - But 80% of Down syndrome births are to mothers etc. under 35 ALCOHOL EXPOSURE - Risks also associated with very young maternal age - No safe level of alcohol use during pregnancy CHROMOSOMAL ABNORMALITIES - Can cause fetal alcohol spectrum disorders (FASDs) - Trisomies: Extra chromosome (e.g. Down - Effects: Growth problems, facial abnormalities, syndrome - trisomy 21) brain damage - Deletions: Missing chromosome segment - 100% preventable by avoiding alcohol during - Translocations: Chromosome segment in wrong pregnancy location TOBACCO USE: - Can cause birth - About 25% of pregnant women smoke GENETIC TESTING OPTIONS - Increases risk of low birth weight, preterm birth, birth defects - Nicotine and carbon monoxide reduce oxygen to - Karyotyping: Examines number and fetus structure of chromosomes - Quitting, even late in pregnancy, has benefits - DNA/RNA analysis: Looks for specific ILLICIT DRUG USE gene mutations - Cocaine: Growth restriction, birth defects, - Biochemical testing: Analyzes protein developmental issues BERLYN DG – BSN 2-9  MATERNAL NCM 103 PRELIMS – 1ST SEM products of genes - Preconception, prenatal, and newborn screening available BERLYN DG – BSN 2-9