1M - The Pubescent Period (2022) PDF

Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) General Functions of the Human Reproductive Testes / - Primary male gonad...

Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) General Functions of the Human Reproductive Testes / - Primary male gonad System Testicles - Has endocrine and exocrine functions 1. Gametogenesis à production of gametes n Endocrine product = testosterone n Oogenesis in females n Exocrine product = sperm cells n Spermatogenesis in males - Covered by tunica albuginea 2. Fertilization à union of gametes to form a zygote - Septa plunge into the testes, dividing 3. Growth and Nourishment of a New Individual them into sections referred to as 4. Production of the Reproductive Hormones “lobules” n Each lobule contains 1-4 Male Reproductive System “seminiferous tubules” (**sperm forming factories) n There are 2 types of cells found in the STs: 1. Germ cells à differentiate into spermatozoa 2. Sustentacular/Sertoli Cells à nourish germ cells Leydig/Interstitial Cells - Found in the soft CT surrounding the STs - Secrete testosterone (androgens) - Products from the STs travel to the epididymis à rete testis à ductuli External Structures efferentes Penis - Male reproductive organ (copulatory organ) that delivers sperm to the Internal Structures: Duct System female reproductive system - Conveys both0 urine and seminal fluid to Epididymis - Highly coiled tube (6m or 20ft) the outside of the body - Site of sperm maturation External Characteristics: - Temporary storage of sperm cells - Shaft, glans penis, foreskin (prepuce) - During sexual stimulation, the Internal Characteristics: epididymis contracts and expels sperm - Urethra is surrounded by spongy into the vas deferens erectile tissue - Takes ~20 days for the sperm to travel n Fills with blood during periods of the length of the epididymis sexual excitement, leading to erection n Learns to grow and swim during this (enlarged and rigid) time Scrotum - Divided sack of skin that hangs outside Vas - Enclosed by the spermatic cord Deferens (**connective tissue sheath with - the abdominal cavity - Located between the0 legs and at the nerves and blood vessels) Main Function: propel live sperm, allowing -> root of the penis - Hangs loose under normal it to empty into the ejaculatory duct circumstances - Ejaculatory duct receives spermatozoa - Contains, encloses, and protects the and additives to produce seminal fluid testes - Passes through the prostate gland, - Helps maintain consistent temperature merging with the urethra Urethra - Extends from the base of the bladder - for spermatogenesis 3°C below body temperature ↓ Body temperature to the tip of the penis - Viable sperm can’t be produced at BT - Carries urine and semen, but not at the - The scrotum consists of 2 muscles same time responsible for protecting the testes - The sphincter of the bladder constricts - from cold temperatures when semen enters the urethra - Divided into 3 parts: 1. Dartos Muscle à contracts the skin of [ the scrotum 2. Cremaster Muscle à pulls the testes 1. Prostatic urethra 2. Membranous urethra closer to the body 3. Penile urethra Christine Joyce (Magghie) Ellorimo – BSN-2H  Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) Inhibin Produced In: testes Internal Structures: Accessory Glands Target Tissue: anterior pituitary gland **Sperm encounters three accessory glands during its Function: regulates sperm production travel in the urethra by inhibiting the release of FSH Seminal - Connects to the ejaculatory duct Relaxin Produced In: prostate gland Vesicles - Secretes thick, viscous fluid Target Tissue: sperm cells containing nutrients, and Function: increases sperm motility prostaglandins Prostate - Secretes thin, milky, alkaline Spermatogenesis Gland solution that enhances the-motility - Formation of sperm cells that starts during puberty and of the spermatozoa continues throughout life - Near the urethra - Onset is triggered by high levels of FSH released by the n Prostate gland enlargement can anterior pituitary gland lead to urine obstruction (near 1. Sperm cells are formed in the seminiferous tubules, the urethra) begins with the primitive sperm “spermatogonia”, Bulbourethral - Secretes alkaline mucus-like fluid, formed from sperm cells present in either side of (Cowper’s) lubricates the urethra and end of each lobule Gland the penis è Sertoli cells are also present n Neutralizes urine residue 2. Spermatogonia undergo rapid cell division, “mitosis”, (**harmful to the sperm due to to build up the stem cell line, resulting in 2 types of acidity) spermatogonium: è Type A à remains in the tubule to maintain the Semen production of stem cells - The main purposes of semen: è Type B à pushed towards the tubule lumen, 1. Allow transport becomes primary spermatocyte 2. Provide nutrition + protection for sperm 3. Type B cells undergo meiosis 1 + 2 in the gonads, 3. Allows for dilution resulting in the formation of 4 haploid daughter cells - Transport medium for sperm and its accompanying containing the father’s DNA protective chemicals and nutrients 4. Spermatids are non-functional and non-motile, - Semen consists of secretions from accessory glands peristalsis aid in movement towards the epididymis, and sperm cells the site of their 20-day maturation period - NORMAL SPERM CELL COUNT: ~50 million - ~150 5. Going from primary spermatocyte to immature million per mL of semen sperm cell can take ~60-~75 days - NORMAL EJACULATION VALUE: 2.5mL of semen 6. Spermiogenesis, the last phase of maturation, occurs - NORMAL pH: relatively alkaline (7.2-7.6) in the epididymis è Excess cytoplasm is shed off, leaving 3 compacted Male Reproductive Hormones regions: the head, the midpiece, the tail Gonadotropin- Produced In: hypothalamus 7. Mature sperm is referred to as “spermatozoa” Releasing Target Tissue: anterior pituitary gland 8. During contact with the oocyte, the acrosomal Hormone Function: stimulates secretion of LH membrane of the sperm breakdowns, resulting in the (GnRH) and FSH release of enzymes that aid in penetration Luteinizing Produced In: anterior pituitary gland (fertilization) Hormone (LH) Target Tissue: interstitial cells (testes) 9. Once sperm reach the uterus, they undergo the final Function: stimulates synthesis and stage of their maturation, capacitation secretion of testosterone Alternate Name: interstitial cell stimulating hormone (ICSH) Follicle- Produced In: anterior pituitary gland Stimulating Target Tissue: sustentacular cells Hormone (seminiferous tubules) (FSH) Function: supports spermatogenesis Testosterone Produced In: interstitial cells (testes) Target Tissue: testes and body tissue Function: promotes primary and secondary sex characteristics Christine Joyce (Magghie) Ellorimo – BSN-2H  Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) The Female Reproductive System n The oocyte is surrounded by follicle cells n The follicle cells enlarge as the egg matures, turning into graafian follicles (fluid-filled follicles with mature ova) - When developing eggs complete maturity, the follicle ruptures, ejecting the egg as part of ovulation n After ovulation, the graafian follicle turns into a “corpus luteum” è Responsible for progesterone secretion until degeneration - The ovary is secured to the walls of the pelvis, uterus, and peritoneum External Structures through the suspensory, ovarian, and **collective external structures are also referred to as broad ligaments “the vulva” Internal Structures: The Duct System Mons - Fatty rounded area overlying the pubic Pubis symphysis Uterine - Receives oocytes and conveys the - Covered with hair after puberty (Fallopian) developing embryo towards the uterus Tubules - Consist of 3 sections: Labia - Two-elongated skin folds that enclose 1. Infundibulum Majora the vaginal vestibule 2. Ampulla Labia - Protects the external openings of the 3. Isthmus Minora urethra and the vagina - Fimbriae à finger-like projections Vestibular - Secretes fluid that moistens and partially surrounding the ovary, catch Glands lubricates the vaginal vestibule + the ova released during & ovulation opening during sexual arousal and n Creates fluid currents that carry the coitus ovum towards the uterine tube Clitoris - Sensitive erectile tissue makes it the - It is possible for eggs to get lost in the primary site for sexual arousal peritoneal cavity - Richly supplied with sensory nerve - The ampulla = site of fertilization endings n Once fertilization begins, it takes - Perineum à diamond shaped area approx. 3-4 days for the containing labial folds zygote/fertilized egg to travel to the uterus Uterus - Located between the urinary bladder and the rectum - Hollow organ that receives, retains, and nourishes a fertilize egg - Site of implantation - Consists of 3 regions: 1. Fundus 2. Body 3. Cervix - Consists of 3 layers: 1. Perimetrium (outermost) Internal Structures 2. Myometrium Ovaries - The primary female gonad, has è Important during labor, muscular endocrine (estrogen and 3. Endometrium progesterone) and exocrine (oocyte) è Site of implantation, most features vascular layer - Consists of ovarian follicles à tiny sac- - Young embryos travel towards the like structures holding one oocyte uterus, burying themselves in the (immature egg) endometrial lining Christine Joyce (Magghie) Ellorimo – BSN-2H  Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) - If the woman remains unpregnant, the Estrogen, Produced In: ovarian follicles endometrial lining is shed (part of the Estradiol, Target Tissue: uterus, mammary menstrual cycle) Estrone, glands, body tissues Vagina - Receives the erect semen during coitus Estriol Function: - Passageway for uterine secretions - Maintains uterine lining in (menstruation) and the fetus (labor) preparation for possible - Doesn’t share the same passageway fertilization and implantation for urine - Lining is shed off during the - Hymen à thin + highly vascular fold menstrual cycle that partially covers the opening of the Progesterone Produced In: corpus luteum (ovaries) hymen Target Tissue: uterus, mammary n The hymen tends to bleed when glands, body tissues ruptured, especially during intense Function: physical activity/the first sexual - Maintains uterine lining in encounter preparation for possible n Hymen durability varies from woman fertilization to woman – its presence, or lack Hormones Important for Motherhood thereof, is not a reliable sign for Human Produced In: placenta virginity Chorionic Target Tissue: corpus luteum (ovaries) Gonadotropin Function: Mammary Glands (hCG) - Maintains corpus luteum - Found in the breasts anterior to the pectoral muscles - Increases progesterone secretion - Contains milk glands during first trimester - The breasts are divided by connective tissue partitions Oxytocin Produced In: posterior pituitary into ~20 lobules Target Tissue: uterus, mammary glands - Acinar cells à exocrine cells responsible for producing Function: milk - Stimulates uterine contractions - Lactiferous duct à delivers milk to the nipple - Let-down reflex during - Prolactin à hormone responsible for milk production breastfeeding - The “let down reflex” Prolactin Produced In: anterior pituitary gland n During lactation, the ampulla of the lactiferous duct Target Tissue: mammary gland acts as a reservoir for milk Function: n When stimulated, signals are transmitted to the - Development of mammary glands posterior pituitary gland/PPG - Milk production n Release of PPG stimulates oxytocin release, which is responsible for releasing milk from the breast – this is Oogenesis known as the “let-down reflex” - Begins during fatal development - By the fourth month of development, 5 million oogonia Female Reproductive Hormones are produced Female Reproductive Hormones - By birth, oogonia either degenerate OR they complete Gonadotropin- Produced In: hypothalamus mitosis; they also begin meiosis releasing Target Tissue: anterior pituitary gland n Meiosis stops during the first meiotic division Hormone Function: stimulates LSH + FH - Females are born with ~2 million primary oocytes (GnRH) production n It is theorized that this is her lifetime supply of Follicle- Produced In: anterior pituitary gland oocytes stimulating Target Tissue: ovaries n The oocytes become enclosed by a single layer of Hormone Function: cells, forming the primary follicle (FSH) - Promotes the follicle development è These oocytes remain in suspended animation - Increases estrogen secretions until puberty Luteinizing Produced In: anterior pituitary gland - From birth to puberty, the number of primary oocytes Hormone (LH) Target Tissue: ovaries decreases to ~300,000-400,000 Function: - On average, 400 primary oocytes continue - Stimulates follicle maturation development, becoming secondary oocytes (occurs - High levels of LH triggers ovulation every month) n Secondary oocytes are released during ovulation Christine Joyce (Magghie) Ellorimo – BSN-2H  Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) - Ovulated secondary oocytes are surrounded by the Males and Puberty corona radiata, which will be penetrated by the sperm - Increased levels of luteinizing hormone triggers during fertilization increase in testosterone (primary androgenic n Meiosis completes AFTER fertilization, allowing the hormone) production ovum to achieve full maturation - Testosterone influences a variety of characteristics, including: Placental Formation n Muscular development - Presence of hCG (produced by cells surrounding the n Physical growth embryo) after fertilization allows the corpus luteum to n Increase in sebaceous gland secretions continue functioning n Development of reproductive structures - hCG stimulates the ovaries, allowing for continuous - Whilst testosterone is mainly produced in the testis, it production of estrogen and progesterone can also be produced in the adrenal cortex n This prevents shedding of the lining (decidua) during pregnancy Physical Changes in Boys è Decidua à thick modified mucus membrane - Adrenarche à refers to the onset of androgen- layer dependent body changes in males, this includes: - By the 11th/12th week of pregnancy, chorionic villi reach n Increase in height, weight, and muscle mass out from the trophoblast cells of the endometrium n Closure of growth plates in long bones n This marks the beginning of placenta formation n Growth of testes, scrotum, penis, prostate, and è The placenta attaches itself to the uterus, seminal vesicles providing oxygen and nutrients to the growing n Appearance of facial, axillary, leg, and pubic hair fetus, and aiding in waste removal n Voice changes - By the 3rd month, the placenta assumes the role of n Frequent occurrence of erection estrogen and progesterone production, leaving the - It is common for pubescent males to experience ovaries inactive nocturnal emissions n This linked to the onset of spermatogenesis Changes During Puberty (spemarche), which is triggered by an increase of FSH - Puberty is the stage of life where secondary sex levels changes begin è Spermatogenesis is NOT CYCLIC, but rather - It is triggered by release of GnRH from the continuous hypothalamus, which triggers release of FSH and LH è Continues from puberty until the end of life (gonadotropin hormones) from the anterior pituitary - Increase in estrogen due to hormonal imbalance can gland cause gynecomastia n Gonadotropin hormones influence reproductive organs, signaling the beginning of androgen and Concerns of Boys estrogen production - Bodily changes è These hormones are essential for development of n Gynecomastia secondary sex characteristics n Possible acne breakout è In girls, estrogen affects the production of eggs n It is important for boys to be aware that these are and influences the menstrual cycle normal changes - The most prominent theory regarding the onset of - Nocturnal and premature emissions puberty is that it is triggered by attainment of a certain weight Females and Puberty n For girls, this is ~43kg/95lbs - Estrogen influences many aspects of female puberty, n For boys, the onset is still unclear, but it is possibly such as: linked n The development of different reproductive structures, such as the uterus, fallopian tubes, and Sex Characteristics vagina - Primary sex characteristics à changes that are related n Typical female fat distribution to organs of reproduction n Girls also experience a widening of hips n Organs related to reproduction enlarge and mature n Hair and breast development during adolescence n Closure of epiphyseal plates - Secondary sex characteristics à physiological signs of sexual maturation not involving sex organs n Onset for girls: 10-14 n Onset for boys: 12-16 Christine Joyce (Magghie) Ellorimo – BSN-2H  Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) Physical Changes Proliferative/ Day: 6th – 14th - Growth spurt Estrogenic - Occurs immediately after n By 16, most females achieve 98% menstrual flow; endometrial - Increase in transverse pelvic diameter linings are very thin - Thelarche à onset of breast development - GnRh and FSH contribute to n Typically occurs 1-2 years before menstruation development and maturation of begins the ovarian follicle - Menarche à describes the onset of menstruation - The graafian follicle n Usually occurs at ~12.4 (between 9-17 years old) n Secretes estrogen n It is important to remind young girls that an irregular n Decreases FSH and LH (triggers cycle for the first 2 years is normal, as ovulation has ovulation) yet to establish a consistent cycle - The endometrium proliferates - Hormonal fluctuations can lead to an increase of Ovulatory Day: 15th day testosterone (produced in adrenal cortex), this can lead Phase - An increase of LH causes to: rupturing of the graafian follicles n Enlargement of labia majora and clitoris Secretory Day: 15th -28th n Thicker/abundant body hair Phase/ - Endometrium becomes thicker n Increase in sexual drive/libido Pregestational/ and corkscrew in appearance Luteal - Ruptured ovarian follicle transfers Concerns of Girls: into the corpus luteum and begins - Bodily Changes secreting progesterone n Early growth spurt Pre-menstrual/ Day: last 2 days n breast development Ischemic Phase - Absence of pregnancy n Widening of hips n Constriction of the endometrial - Menarche arteries and shrinking of the - Presence of vaginal secretions lining n Regression of the corpus luteum **General: other concerns experienced during puberty è Marked decrease of - Gender identification estrogen and progesterone - Self-esteem and belongingness n Constricted arteries open and - Sex education and sexual health behaviors break off, marking the beginning of menses The Menstrual Cycle Characteristics: The Ovarian Cycle - An average of 28 days between the start of each cycle Follicular - Primordial follicles mature under - Average flow day of 4-6 days Phase the influence of FSH and LH - An average of ~30-~80ml during each period Ovulatory - There is a marked increase of LH 2 - Dark red blood accompanied by mucus endometrial Phase days before ovulation begins, cells leading to the rupture of the Phases of the Endometrial Cycle: ovarian follicle, releasing the egg Proliferative à Ovulatory à Secretory à Pre-menstrual à Luteal Phase - Large amounts of estrogen and Menstruation progesterone secreted released The Endometrial Cycle from the corpus luteum (triggered Menstruation/ Day: 1-5 by LH) allow the endometrium to Menses - 30-80cc, 3-5 days prepare for a fertilized ovum - Menses discharged from the - In cases of degeneration, a uterus contain: decrease of progesterone and n Blood from ruptured capillaries estrogen causes sloughing n Mucin from glands n Fragments of endometrial tissues n Microscopic, atrophied, and unfertilized, ovum - End of the menstrual cycle is used to mark the beginning day of a new menstrual cycle Christine Joyce (Magghie) Ellorimo – BSN-2H  Care of Mother, Child, and Adolescent (Theory) – Midterms 1M – “The Pubescent Period” Christine Joyce R. Ellorimo, BSN-2H (2022) Changes of Menstruation Signs Accompanying Ovulation: - Premenstrual Syndrome à a collection of symptoms or - Subjective sensations women experience because of high n Cervical mucorrhea hormone levels before, and sometimes during, periods n Mittelschmerz à sudden, sharp abdominal pain cause by stretching of the ovary during ovulation Physiologic Changes Experienced in Menstruation Increased, slippery vaginal discharge - Cramps à cause by presence of prostaglandins, 2 - Objective types n Changes in basal temperature 1. Spasmodic cramping à sharp pain n Spinnbarkeit à elasticity of ovulating mucus 2. Congestive cramping à deep, dull ache - Before: Menstrual Health Teachings: n Tension - Maintain good hygiene n Depression - Promote exercise n Irritability - Increase oral fluid intake n “PMS” - Promote rest and sleep n Hostility - Take note of menstrual periods n Head/Backache - Eat a balanced diet to help with food cravings n Hot temper - Have a diet lower in salt to ease bloating - During: - Avoid caffeine and promote social interaction to ease n Food cravings crankiness or anxiety n Mood swings - Promote diversional activities for relaxation n Irritability - Appropriate pain management (OTCs, heating pad, n Feelings of exhaustion safe sex may be practiced) - After: n Relief n Euphoria n Creative energy n More intense orgasms n Release n Feelings of new beginnings n Increased sex drive - Other symptoms: n Bloating n Soreness or swelling in the n breasts n Headaches n Backache n Pain in the inner thighs n Nausea n Diarrhea or constipation n Pimples n Sudden mood changes, such as n sadness or irritability n Depression Conditions Related to Menstruation: - Dysmenorrhea à painful menstruation - Amenorrhea à absence of menstruation - Hypermenorrhea/menorrhagia à uterine bleeding in excess of the normal period, typically caused by carcinoma - Polymenorrhagia à uterine bleeding for more often than intervals of 24-48 days - Metorrhagia à irregular flow at times other than the menstrual period, bleeding in between period cycles - Oligomenorrhea à diminished menstrual flow Christine Joyce (Magghie) Ellorimo – BSN-2H