Maternal and Child Nursing Lec 1 PDF

1 | MATERNAL AND CHILD NURSING LEC LESSON 1: FRAMEWORK FOR MATERNAL PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSE AND CHILD HEALTH NURSING...

1 | MATERNAL AND CHILD NURSING LEC LESSON 1: FRAMEWORK FOR MATERNAL PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSE AND CHILD HEALTH NURSING 1. Considers the family as a whole and as a partner in care when planning or implementing CASE STUDY or evaluating the effectiveness of care. Anna Chung is a pre- mature neonate who will be 2. Serves as an advocate to protect the rights of transported to a regional center for care about 30 miles all family members, including the fetus. from the hospital where she was born. Her parents, 3. Demonstrates a high degree of independent Melissa and Robert, are worried because their tiny nursing functions because teaching and daughter will be cared for so many miles away from counseling are major interventions. home. 4. Promotes health and disease prevention They’re also concerned about whether they will be able because these protect the health of the next to pay for her special care. Melissa, who is 37 years old, generation. tells you that she feels too old to leave the hospital only 5. Serves as an important resource for families 2 days after having a cesarean birth. She wonders how during childbearing and childrearing as these her first can be extremely stressful times in a life cycle. child, Micko, now 6 years old, will react to having an ill 6. Respects personal, cultural, and spiritual rather than a healthy sister. This chapter discusses attitudes and beliefs as these so strongly standards and philosophies of maternal and child influence the meaning and impact of health care and how these standards and philosophies childbearing and childrearing affect care. 7. Encourages developmental stimulation during QUESTION: both health and illness so children can reach 1. What is some health care issues evident in this their ultimate capacity in adult life. scenario? What is the nursing role here? 8. Assesses families for strengths as well as specific needs or challenges. DEFINITION OF TERMS: 9. Encourages family bonding through rooming-in 1. Childbearing- includes pregnancy, birth, and and family visiting in maternal and child the early nursing period. healthcare settings. 2. Childrearing- came from the Old English 10. Encourages early hospital discharge options to raeran, meaning “to raise”. The bringing up and reunite families as soon as possible to create a taking care of children (often differently seamless, helpful transition process. perceived in our society, and by women 11. Encourages families to reach out to their themselves) community so the family can develop a wealth 3. Obstetrics- the care of woman during of support people they can call on in a time of childbirth, is derived from the Greek word family crisis. obstare, which means “to keep watch” 4. Pediatrics- a word derived from the Greek FAMILY- CENTERED CARE word pais, meaning “child” - Delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical SCOPE OF PRACTICE and psychosocial needs of the family. - Preconceptual health care - It is a cooperative effort of families and other - Care of women during three trimesters of caregivers that recognizes the strength and pregnancy and integrity of the family. - the puerperium (the 6 weeks after childbirth, sometimes termed the fourth trimester of Basic principles of family-centered care: pregnancy) a. Childbirth is considered a normal, healthy event - Care of infants during the perinatal period (6 in the life of a family. weeks be- fore conception to 6 weeks after b. Childbirth affects the entire family, and birth) relationships will change. - Care of children from birth through adolescence c. Families can make decisions about their own - Care in settings as varied as the birthing room, care if given adequate information and the pediatric intensive care unit, and the home professional support. (Price, Noseworthy, & Thornton, 2007) PHILOSOPHY OF MATERNAL AND CHILD HEALTH NURSING 1. Family centered; assessment should always include the family as well as an individual. 2. Community centered; the health of families is both affected by and influences the health of communities. 3. Evidence based; this is the means whereby critical knowledge increases. 4. A challenging role for nurses and a major factor in keeping families well and optimally functioning. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  2 | MATERNAL AND CHILD NURSING LEC TIPS FOR SELECTING A FAMILY-CENTERED HEALTHCARE SETTING Q. Melissa Chung asks you, “With so many healthcare settings available, how do we know which one to choose?" A. When selecting a setting, asking the following questions can help you decide what is best for your family: If the setting is for childcare, are personnel interested in you as well as your child? If the setting is a maternal care site, do they ask about family concerns as well as individual ones? Can the setting be reached easily? (Going for preventive care when well or for continuing care when ill should not be a chore.) Will the staff provide continuity of care, so you'll always see the same primary care provider if MAGNET STATUS possible? - is a credential furnished by the American Does the physical setup of the facility provide Nurses Credentialing Center (ANCC), an for a sense of privacy, yet a sense that affiliate of the American Nurses Association healthcare providers share pertinent - to hospitals that meet a rigorous set of criteria information, so you do not have to repeat your designed to improve the strength and quality of history at each visit? Is the cost of care and the nursing care. number of referrals to specialists explained clearly? Are preventive care and health FIVE MAJOR CATEGORIES: education stressed? (Keeping well is as 1. Transformational leadership important as recovering from illness.) 2. Structural empowerment Is health education done at your learning level? 3. Exemplary professional practice Do healthcare providers respect your opinion 4. New knowledge, innovation, and improvements and ask for your input on healthcare decisions? 5. Empirical quality results Will the facility still be accessible if a family member becomes disabled? FOCUS ON NATIONAL HEALTH GOALS ADVANCES MATERNAL AND CHILD HEALTH GOALS LEADING HEALTH INDICATORS AND STANDARDS 1. Immunization 1. PHYSICAL ACTIVITY 2. New fertility drugs and fertility techniques - Regular physical activity throughout life is 3. Stem cell therapy important for maintaining a healthy body, enhancing psychological well-being, and 2020 NATIONAL HEALTH GOALS preventing premature death. The objectives 1. To increase quality and years of healthy life. selected to measure progress in this area are: 2. To eliminate health disparities. Increase the proportion of adolescents who engage in vigorous physical activity THE GLOBAL HEALTH GOALS (UN AND WHO, 2020) that promotes cardiorespiratory fitness 3 1. To end poverty and hunger or more days per week for 20 or more 2. To achieve universal primary education minutes per occasion. 3. To promote gender equality and empower Increase the proportion of adults who women engage regularly, preferably daily, in 4. Reduce child mortality moderate physical activity for at least 30 5. To improve maternal health minutes per day. 6. To combat HIV/AIDS, malaria, in other diseases 2. OVERWEIGHT AND OBESITY 7. To ensure environmental sustainability - major contributors to many preventable causes 8. To develop global partnership for development of death. The objectives selected to measure progress in this area are: Reduce the proportion of children and adolescents who are overweight or obese. Reduce the proportion of adults who are obese. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  3 | MATERNAL AND CHILD NURSING LEC 3. TOBACCO USE some time during their lives. The objectives - Cigarette smoking is the single most selected to measure progress in this area are: preventable cause of disease and death in the Reduce deaths caused by motor vehicle United States. Smoking results in more deaths crashes. each year in the United States than AIDS, Reduce homicides. alcohol, cocaine, heroin, homicide, suicide, motor vehicle crashes, and fires—combined. 8. ENVIRONMENTAL QUALITY The objectives selected to measure progress in - An estimated 25% of preventable illnesses this area are: worldwide can be attributed to poor Reduce cigarette smoking by environmental quality. In the United States, air adolescents. pollution alone is estimated to be associated Reduce cigarette smoking by adults. with 50,000 premature deaths and an estimated $40 billion to $50 billion in health-related costs 4. SUBSTANCE ABUSE annually. The objectives selected to measure - Alcohol and illicit drug use are associated with progress in this area are: many of this country’s most serious problems, Reduce the proportion of persons including violence, injury, and HIV infection. exposed to air that does not meet the The objectives selected to measure progress in U.S. Environmental Protection Agency’s this area are: health-based standards for ozone. Increase the proportion of adolescents Reduce the proportion of nonsmokers not using alcohol or any illicit drugs during exposed to environmental tobacco the past 30 days. smoke. Reduce the proportion of adults using any illicit drug during the past 30 days. 9. IMMUNIZATION Reduce the proportion of adults or - Vaccines are among the greatest public health adolescents engaging in binge drinking of achievements of the 20th century. alcoholic beverages during the past Immunizations can prevent disability and death month. from infectious diseases for individuals and can help control the spread of infections within 5. RESPONSIBLE SEXUAL BEHAVIOR communities. The objectives selected to - Unintended pregnancies and sexually measure progress in this area are: transmitted infections (STIs), including infection Increase the proportion of young children with the human immunodeficiency virus that who receive all vaccines that have been causes AIDS, can result from unprotected recommended for universal sexual behavior. The objectives selected to administration. measure progress in this area are: Increase the proportion of Increase the proportion of adolescents noninstitutionalized adults who are who abstain from sexual intercourse or vaccinated annually against influenza use condoms if currently sexually active. and ever vaccinated against Increase the proportion of sexually active pneumococcal disease. adults who use condoms. 10. ACCESS TO HEALTH CARE 6. MENTAL HEALTH - Strong predictors of access to quality health - Approximately 20% of the U.S. population is care include having health insurance, a higher affected by mental illness during a given year; income level, and a regular primary care no one is immune. Of all mental illnesses, provider or other source of ongoing health care. depression is the most common disorder. BOX Use of clinical preventive services, such as 1.6 ✽ Focus on National Health Goals More early prenatal care, can serve as indicators of than 19 million adults in the United States suffer access to quality health care services. The from depression. Major depression is the objectives selected to measure progress in this leading cause of disability and is the cause of area are: more than two thirds of suicides each year. The Increase the proportion of persons with objective selected to measure progress in this health insurance. area is to: Increase the proportion of persons who Increase the proportion of adults have a specific source of ongoing care. including postpartum depression who Increase the proportion of pregnant receive treatment. women who begin prenatal care in the first trimester of pregnancy. 7. INJURY AND VIOLENCE - More than 400 Americans die each day from injuries, due primarily to motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons sustain a significant injury at MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  4 | MATERNAL AND CHILD NURSING LEC FRAMEWORK FOR MATERNAL AND CHILD HEALTH LEVEL II: Evidence obtained from well- NURSING designed con- trolled trials without Definitions and Examples of Phases of Health Care randomization, well-designed cohort or case-control analytic studies, or multiple 1. HEALTH PROMOTION time series with or without an intervention. - Educating clients to be aware of good health Evidence obtained from dramatic results in through teaching and role modeling uncontrolled trials might also be regarded - EX. Teaching women the importance of rubella as this type of evidence. immunization before pregnancy; teaching children the importance of safer sex practices LEVEL III: Opinions of respected authorities, based on clinical experience, 2. HEALTH MAINTENANCE descriptive studies, or reports of expert - Intervening to maintain health when risk illness committees (U.S. Preventive Services Task is present Force, 2005). - EX. Encouraging women to come for prenatal of care, teaching parents the importance of NURSING RESEARCH safeguarding their home by childproofing it - The controlled investigation of problems that against poisoning have implications for nursing practice, provides evidence for practice and justification for 3. HEALTH RESTORATION implementing activities for outcome - Promptly diagnosing and treating illness using achievement, ultimately resulting in improved interventions that will return client pregnancy to and cost-effective patient care. wellness most rapidly - Caring for a woman during a complication of a NURSING THEORY pregnancy or a child during an acute illness - Offer helpful ways to view clients so that nursing activities can best meet client needs. 4. HEALTH REHABILITATION 1. One of the requirements of a profession - Preventing further complications from an (together with other critical determinants, such illness; bringing an ill client back to an optimal as member-set standards, monitoring of state of wellness or helping a client to accept practice quality, and participation in research) is inevitable death that the concentration of a discipline’s - Encouraging a woman with gestational knowledge flows from a base of established trophoblastic disease to continue therapy or a theory. child with a renal transplant to continue to take 2. Nursing theorists offer helpful ways to view necessary medications clients so that nursing activities can best meet client needs NURSING PROCESS - Nursing care is designed and implemented in a QSEN: QUALITY & SAFETY EDUCATION FOR NURSES thorough manner, using an organized series of steps, to ensure quality and consistency of care (Carpenito, 2004). - A proven form of problem solving based on the scientific method, serves as the basis for assessing, making a nursing diagnosis, planning, organizing, and evaluating care. - Applicable to all health care settings, from the prenatal clinic to the pediatric intensive care unit, is proof that the method is broad enough to serve as the basis for all nursing care. EVIDENCE-BASED PRACTICE - Evidence-based practice is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of patients (Foxcroft & Cole, 2009). - Evidence can be a combination of research, clinical expertise, and patient preferences when all three combines in decision making. - The worth of evidence is ranked according to: LEVEL I: Evidence obtained from at least one properly de- signed randomized controlled trial. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  5 | MATERNAL AND CHILD NURSING LEC SIGNIFICANT RISE IN MATERNAL DEATHS AND UNINTENDED PREGNANCIES - The Philippines, unfortunately, showed one of the highest rates of adolescent fertility in Asia prior to COVID-19, described as a 'national social emergency' last year. 2020 may end up seeing 18,000 more Filipino teenage girls getting pregnant because of the indirect effects of COVID-19, compared to 2019. - Intimate partner violence is also expected to increase because for instance women and girls are more likely to be stuck with the abusers at home. Although many of such gender-based violence cases will be unreported, the study estimates a 20% increase in intimate partner violence, physical or sexual, in 2020 from 2019. - For this reporting year, the Philippine Statistics Authority (PSA) Maternal Mortality Ratio (MMR19) estimates will be used in the presentation of maternal health outcomes as this data source provided a more recent TRENDS IN MATERNAL AND CHILD HEALTH CARE estimate of MMR, unlike in previous reports AND IMPLICATIONS FOR NURSES where we utilized old surveys conducted from 1. BIRTH RATE- number of births per 1000 1993 to 2017. Nonetheless, while the data population sources show different levels of MMR, these 2. FERTILITY RATE- number of pregnancies per illustrate similar trend across time. 1000 population women of childbearing age. - Analysis of trends showed that the maternal 3. FERTILITY DEATH RATE- number of fetal deaths mortality ratio had been flat for the past years. (weighing more 500g) per 1000 live births. In the 1980s, PSA MMR estimates showed a persistently high maternal mortality ratio at 4. NEONATAL DEATH RATE- number of deaths per 127/100,000 livebirth. 19 Maternal Mortality 1000 live birth occurring at birth or in the first 28 Ratio (MMR is computed as a number of days of life. maternal deaths per 100,000 live births. 5. PERINATAL DEATH RATE- number of fetuses Maternal death is defined as the death of a weighing more than 500g and within the first 28 woman while pregnant or within 42 days of days of life per 1000 live births termination of pregnancy, irrespective of the 6. INFANT MORTALITY RATE- number of deaths per duration and site of the pregnancy, from any 1000 live births occurring at birth or in the first 12 causes related to or aggravated by the months of life. pregnancy or its management but not from 7. MATERNAL MORTALITY RATE- number of accidental or incidental causes (WHO, 2016). maternal deaths per 100,000 live births that occur as a direct result of the reproductive process. 8. CHILDHOOD MORTALITY RATE- number of deaths per 1000 population in children, 1 to 14 years of age. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  6 | MATERNAL AND CHILD NURSING LEC TRENDS IN THE HEALTH CARE ENVIRONMENT STANDARD III: EDUCATION 1. Initiating Cost Containment - The nurse acquires and maintains current 2. Changes in Health Insurance Coverage knowledge in nursing practice. 3. Increasing Alternative Settings and Styles for Health Care STANDARD IV: COLLEGIALITY 4. Increasing Use of Technology - The nurse contributes to the professional 5. Meeting Work Needs of Pregnant and development of peers, colleagues, and others. Breastfeeding Women 6. Regionalizing Intensive Care STANDARD V: ETHICS 7. Increasing Use of Alternative Treatment - The nurse’s decisions and actions on behalf of Modalities patients are determined in an ethical manner. 8. Increasing Reliance on Home Care STANDARD VI: COLLABORATION ALTERNATIVE HEALTH CARE PRACTICES - The nurse collaborates with the patient, - therapy such as: significant others, and health care providers in ✓ acupuncture providing patient care. ✓ homeopathy ✓ therapeutic touch STANDARD VII: RESEARCH ✓ herbalism - The nurse uses research findings in practice. ✓ chiropractic care or nontraditional (tribal medicine or Hispanic herbalists- STANDARD VIII: RESOURCE yerberos or curanderos) - The nurse considers factors related to safely, effectiveness, and cost in planning and HEALTHCARE CONCERNS AND ATTITUDES delivering patient care. 1. Increasing Concern for Quality of Life 2. Increasing Awareness of the Individuality and STANDARD IX: PRACTICE ENVIRONMENT Diversity of Patients - The nurse contributes to the environment of 3. Empowerment of Healthcare Consumers care delivery within the practice settings. LEGAL CONSIDERATIONS OF MATERNAL CHILD STANDARD X: ACCOUNTABILITY PRACTICE - The nurse is professionally and legally 1. Confidentiality accountable for his/her practice. The 2. Quality of individual nursing care and health professional registered nurse may delegate to care team members and supervise qualified personnel who provide 3. Understanding the scope of practice. patient care. 4. Documentation is for justifying actions. 5. Obtaining informed consent. ETHICAL CONSIDERATIONS OF PRACTICE - Conception issues, especially those related to A. WRONGFUL BIRTH- the birth of a disabled child in vitro fertilization, embryo transfer, ownership whose pregnancy the parents would have of frozen oocytes or sperm, cloning, stem cell chosen to end if they had been informed about research, and surrogate mothers the disability during pregnancy - Abortion, particularly partial-birth abortions - Fetal rights versus rights of the mother B. WRONGFUL LIFE- a claim that negligent - Use of fetal tissue for research prenatal testing on the part of a healthcare - Resuscitation (for how long it should be provider resulted in the birth of a disabled child. continued?) - Number of procedures or degree of pain that a C. WRONGFUL CONCEPTION- denotes that a child contraceptive measure failed, allowing an - should be asked to endure to achieve a degree unwanted child to be conceived and born. of better health - Balance between modern technology and STANDARDS OF PROFESSIONAL PERFORMANCE quality of life STANDARD I: QUALITY OF CARE THEORIES RELATED TO MATERNAL AND CHILD - The nurse systematically evaluates the quality NURSING and effectiveness of nursing practice 1. Bonding and Attachment Theory 2. Maternal Role Attainment Theory STANDARD II: PERFORMANCE APPRAISAL 3. Synactive Theory of Infant Development - The nurse evaluates his/her own nursing practice in relation to professional practice standards and relevant statutes and regulations. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  7 | MATERNAL AND CHILD NURSING LEC ADVANCED-PRACTICE ROLES NURSES IN MATERNAL LESSON 2: REPRODUCTIVE AND SEXUAL AND CHILD HEALTH HEALTH 1. CLINICAL NURSE SPECIALIST- capable of acting as consultants in their area of expertise, National Healthy People 2030 Goals as well as serving as role models, researchers, 1. Well-being, including overall life satisfaction and teachers of quality nursing care. 2. Life expectancy in good health, free activity limitations and of disability 2. CASE MANAGER- a graduate-level nurse who 3. Summary mortality and health measures supervises a group of patients from the time they enter a health care setting until they are Goals Related to Maternal and Child Health: discharged from the seamless care system. 1. By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. 3. NURSE PRACTITIONER- nurses educated at the 2. By 2030, end preventable deaths of newborns and master’s or doctoral level. children under 5 years of age. 4. WOMEN’S HEALTH NURSE PRACTITIONER- has 3. By 2030, ensure universal access to sexual and advanced study in the promotion of health and reproductive health care services. prevention of illness in women 4. Achieve universal health coverage. 5. Strengthen the prevention and treatment of 5. PEDIATRIC NURSE PRACTITIONER- or PNP, a substance abuse. nurse prepared with extensive skills in physical 6. By 2030, end the epidemics of AIDS, tuberculosis, assessment, interviewing, and well- child malaria, and neglected tropical diseases and counseling and care. combat hepatitis, water-borne diseases, and other communicable diseases (World Health 6. NEONATAL NURSE PRACTITIONER- an Organization, 2020) advanced-practice role for nurses who are skilled in the care of newborns, both well and ill. FOR PROMOTION OF REPRODUCTIVE AND SEXUAL HEALTH: 7. FAMILY NURSE PRACTITIONER- or FNP, an advanced-practice role that provides health a. Assessment: care not only to women and children but also to - Interview the family. b. Nursing Diagnosis: 8. CERTIFIED NURSE-MIDWIFE- or CNM, an - Health-seeking behaviors related to individual educated in the two disciplines of reproductive functioning nursing and midwifery and li- censed (assisting - Anxiety related to inability to conceive after 6 women with pregnancy and childbearing) months without birth control - Pain related to uterine cramping from menstruation - Disturbance in body image related to early development of secondary sex characteristics Diagnoses relevant to sexuality could include: - Sexual dysfunction related to as-yet-unknown cause - Altered sexuality patterns related to chronic illness - Self-esteem disturbance related to recent reproductive tract surgery - Altered sexuality patterns related to fear of harming the fetus - Anxiety related to fear of contracting an STI - Health-seeking behavior related to learning responsible sexual practices c. Outcome and Identification Planning: - Health teaching - Gender identity/ role behavior - Referral MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  8 | MATERNAL AND CHILD NURSING LEC i. Implementation: responsible for muscular development - Encouraging women over 40 to have physical growth mammograms increase in sebaceous gland secretions that - Explaining to a school-age boy that nocturnal causes typical acne in both boys and girls. emissions are normal. In males, androgenic hormones are produced - Teaching an early adolescent what is normal by the adrenal cortex and the testes, in and abnormal in relation to menstrual function females, by the adrenal cortex and the - Teaching a young adolescent safer sex practice ovaries. - Explaining reproductive physiology to a couple The level of the primary androgenic hormone, who wish to become pregnant testosterone, is low in males until puberty (approximately age 12 to 14 years). At that ii. Outcome Evaluation: time, testosterone levels rise to influence the Examples of expected outcomes include: further development of the testes, scrotum, - Patient states he is taking precautions to penis, prostate, and seminal vesicles; the prevent contracting an STI. appearance of male pubic, axillary, and facial - Patient states she is better able to manage hair; laryngeal enlargement and its symptoms of premenstrual dysphoric accompanying voice change; maturation of syndrome. spermatozoa; and closure of growth in long - Couple state they have achieved a mutually bones. satisfying sexual relationship. - Client states he is ready to tell family about In girls, testosterone influences enlargement MWM gender identity of the labia majora and clitoris and formation of axillary and pubic hair. REPRODUCTIVE DEVELOPMENT - Adrenarche- development of pubic and axillary A. Intrauterine Development hair because of androgen stimulation - Gonad (week 5) 2 undifferentiated ducts ROLE OF ESTROGEN mesonephric duct (week 7 or 8) → - When triggered at puberty by FSH, ovarian primitive testis and formation of follicles in females begin to excrete a high level testosterone develop → into the male of the hormone estrogen. reproductive organs (12th week) - This increase influences the development of Paramesonephric ducts develop into the: female reproductive organs (by week Uterus 10) fallopian tubes - Oocytes vagina; typical female fat distribution; egg cells (ovaries) hair patterns; and breast development. Functions - Closes the epiphyses of long bones - steroid hormone production - THELARCHE- the beginning of breast - gametogenesis development, which usually starts 1 to 2 years - When ovaries form, (cells that will develop into before menstruation. eggs throughout the woman’s mature years) are already present (Edmonds, 2012). SECONDARY SEX CHARACTERISTICS GIRLS: PUBERTAL DEVELOPMENT/CHANGES Growth spurt - Puberty is the stage of life at which secondary Increase in the transverse sex changes begin. diameter of the pelvis - Hypothalamus Gonadotrophin- releasing Breast development hormone (GnRH) → triggers the Anterior Growth of pubic hair pituitary release of follicle-stimulating hormone Onset of menstruation (FSH), luteinizing hormone (LH) Growth of axillary hair - FSH& LH initiate the production of androgen and Vaginal secretions estrogen; initiate secondary sex characteristics BOYS: Increase in weight TESTOSTERONE: THE MALE REPRODUCTIVE HORMONE Growth of testes Gonadal Development: Growth of face, axillary, - begins at 5 to 6 weeks gestation. and pubic hair - Testicular differentiation and testosterone Voice changes production begin at 7 weeks of gestation. Penile growth - This action of testosterone continues throughout Increase in height life (levels decrease as men age), including the Spermatogenesis (production of sperm) development of sperms MALE REPRODUCTIVE SYSTEM Role of Androgen - Andrology is the study of the male reproductive - Andrology: study of male reproductive organs. organs. - Androgenic hormones: - consists of both external and internal divisions MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  9 | MATERNAL AND CHILD NURSING LEC MALE EXTERNAL STRUCTURES MALE INTERNAL STRUCTURES - External genital organs of the male include the - The male internal reproductive organs are the testes (which are encased in the scrotal sac) epididymis, the vas deferens, the seminal and the penis. vesicles, the ejaculatory ducts, the prostate gland, the urethra, and the bulbourethral glands A. SCROTUM Sac-pouch like structure from root of penis, D. EPIDIDYMIS suspended from the perineal region. Soft-like cordlike, coma-shaped Formed of pigmented skin. Located on the superior surface of the testis It is composed of skin and dartos muscles. Over 20 ft. long Sebaceous glands open directly onto scrotum Travels down to the posterior aspect to the secretions with distinct odor. lower pole of the testis leading to the deferent Contraction of dartos and cremasteric muscles duct (vas deferens) shortens scrotum and draws it closer to the body wrinkling its outer surface E. VAS DEFERENS Has two compartments one for each testis. an additional hollow tube surrounded by a rugated, skin-covered, muscular pouch arteries and veins and protected by a thick suspended from the perineum. fibrous coating. to support the testes and help regulate the Carries the sperm to the ejaculatory duct temperature of sperm. Ligated in bilateral vasectomy, a male surgical method of family planning B. TESTES Spermatic cord- carries sperm from the Two small oval male gonads suspended in the epididymis through the inguinal canal into the scrotum abdominal cavity, where it ends at the seminal 4.6 cm to 6 cm long, 2.5 cm wide, 3 cm thick. vesicles and the ejaculatory ducts below the Weighing 10 to 15 g. bladder. Each testis is encased by a protective white fibrous capsule and is F. SEMINAL VESICLES composed of a number of lobules. Each lobule Paired structure, or pouches situated posterior contains interstitial to the bladder cells (Leydig cells) that produce testosterone 5 cm long and pyramid shaped and a seminiferous Secrete a viscous fluid, becomes part of the tubule that produces spermatozoa. ejaculate Contribute to nutrition and activation of sperms, C. PENIS keep sperms alive and motile. - It is elongated and cylindrical, consisting of a G. PROSTATE GLAND body (shaft) and a cone- shaped end (glans). It a chestnut-sized gland lies in front of the scrotum. 4 cm long, 3 cm wide, and 2 cm deep - The penile root lies in the perineum, from where composed of columnar epithelium, a muscular it passes forward below the symphysis pubis layer and enclosed in a firm outer fibrous layer while the lower two-thirds are outside the body capsule. in front of the scrotum and covered in skin. Located below the bladder, surrounds the - Extremely vascular blood spaces fill and urethra and the base of the bladder become distended during sexual excitement Lies between the rectum and the symphysis resulting in penile distension and stiffening pubis. termed erection. Connected to the urethra and ejaculatory ducts Secretes a thin, lubricating milky fluid which Three Columns of Erectile Tissue: enters the urethra through the ducts and helps Corpora Cavernosa (2 columns) in the passage and viability of spermatozoa Corpus Spongiosum (1 column) H. BULBOURETHRAL GLAND/ COWPER’S Main Attachment: GLAND Suspensory ligament Located on each side of the urethra, below the prostate gland. Blood Supply: Secrete small amount of lubricating fluid. Pudendal arteries Supply one more source of alkaline fluid to help Veins ensure the safe passage of spermatozoa. Penile artery I. URETHRA Nerve Supply: Hollow tube leading from the base of the Pudendal nerve bladder Sympathetic fibers 8 inches (18 to 20 cm) long. Parasympathetic fibers it is lined with mucous membrane. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  10 | MATERNAL AND CHILD NURSING LEC SPERM PARTS: OTHER EXTERNAL ORGANS - head 1. Vestibule- flattened, smooth surface inside the - body labia. - mobile tail 2. Clitoris- a small (approximately 1 to 2 cm), Life span: up to 72 hours rounded organ of erectile tissue at the forward junction of the labia minora. It’s covered by a TESTICULAR FUNCTIONS fold of skin, the prepuce; is sensitive to touch a. Endocrine Function and temperature; and is the center of sexual - Hypothalamus arousal and orgasm in a woman. - Anterior Pituitary Gland (APG) 3. Two Skene glands (paraurethral glands)- - Testes located on each side of the urinary meatus; their - Testosterone hormone production ducts open into the urethra. b. Exocrene Function: spermatogenesis 4. Bartholin glands (vulvovaginal glands)- located - Sperm production: on each side of the vaginal opening with ducts Primary spermatogonia that open into the proximal vagina near the labia Spermatogenesis minora and hymen. Spermato-Cytogenesis 5. Fourchette- the ridge of tissue formed by the Spermatogenesis posterior joining of the labia minora and the Spermiogenesis labia majora. Spermiation Process 6. Hymen- a tough but elastic semicircle of tissue that covers the opening to the vagina during TYPES OF SPERM CELLS childhood. ANDOSPERM GYMNOSPERM VULVAR BLOOD SUPPLY Carries Y-sex chromosome Carries X-sex chromosome Blood supply of female external genitalia is Fast-moving Slower mainly from the pudendal artery and a portion is from the inferior rectus artery Smaller, weaker, short-lived Bigger, stronger, long-lived Dies in acid Acid-resistant VULVAR NERVE SUPPLY FEMALE REPRODUCTIVE SYSTEM Anterior portion of the vulva derives its nerve Gynecology- study of the female reproductive organs. supply from the ilioinguinal and genitofemoral consists of both external and internal divisions nerves (L1 level). The posterior portions of the vulva and vagina FEMALE EXTERNAL STRUCTURES are supplied by the pudendal nerve (S3 level). - The structures that form the female external genitalia are termed the vulva (from the Latin FEMALE INTERNAL STRUCTURES word for “covering”) - The structures that include the ovaries, the fallopian tubes, the uterus, and the vagina. A. MONS VENERIS OR MONS PUBIS Soft, rounded fatty pad over the symphysis A. OVARIES pubis Approximately 3 cm long by 2 cm in diameter Grows coarse hair after puberty that thins after and 1.5 cm thick, or the size and shape of menopause almonds. It protects the symphysis pubis They are grayish-white and appear pitted, with minute indentations on the surface. B. LABIA MAJORA Located close to and on both sides of the uterus Also known as the bigger lips in the lower abdomen. Two folds of skin with sparse hair on either side of the vaginal opening B. FALLOPIAN TUBES OR OVIDUCTS With fat Arise from each upper corner of the uterine Contains Bartholin’s glands body and extend outward and backward until It protects the labia minora and vaginal os. each open at its distal end, next to an ovary. Length: 8 to 14 cm (average: 10 cm) C. LABIA MINORA Tubal Parts/Positions: Two thinner folds of delicate tissue within the Interstitial labia majora Isthmus It is hairless Ampulla Anterior ends unite to form the prepuce Infundibulum Posterior ends unite to form the fourchette It protects and obscures the vestibule, urinary meatus and vaginal os. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  11 | MATERNAL AND CHILD NURSING LEC ACCESSORY ORGAN: MAMMARY GLANDS OR BREASTS - Under the skin, over the pectoralis major muscles - Made up of fibrous, adipose, and glandular tissue. - Its glandular tissue is arranged in about 20 lobes. A. Nipple- composed of smooth muscle capable of erection on manual or sucking stimulation. On stimulation, it transmits sensations to the posterior pituitary gland to release oxytocin, which acts to constrict milk glands and push milk forward into the ducts that lead to the C. UTERUS nipple (let-down reflex) A hollow, muscular, pear-shaped organ located B. Areola- skin surrounding the nipples is dark in the lower pelvis, posterior to the bladder and pigmented out to about 4 cm. anterior to the rectum. C. Montgomery tubercles- appears rough on the Uterine Length: surface because it contains may sebaceous Before puberty: from 2.5 to 3.5 cm glands In adult nulliparous women: from 6 to 8 cm BLOOD SUPPLY- BREASTS In multiparous women: from 9 to 10 cm - It is profuse because it is supplied by large Uterine Weight: thoracic branches of the axillary, internal Non-pregnant: 60 g mammary, and intercostal arteries. Pregnant, term: 1000 g Uterine Parts: Fundus Corpus or body Cornua Isthmus Cervix Three Uterine Layers Endometrium Myometrium Perimetrium Abnormalities in Uterine Position: Retroflexion Retroversion Uterine Ligaments: REPRODUCTIVE SYSTEM Broad ligaments Round ligaments 1. UTERUS Ovarian ligaments - Uterine size is increased due to hypertrophy of Cardinal ligaments existing muscles and connective tissues (No formation of new muscle fibers in pregnancy) Uterosacral ligaments - Weight increases from 60 g (non-pregnancy) Pubocervical ligaments to 1000 g (fullterm) Uterine Functions: - Length increases from 7.5 cm to 32 cm, width Menstruation from 4 cm to 24 cm and depth from 2.5 cm to Pregnancy/gestation 22 cm. Labor - Uterine shape charges from globular to OVAL Blood Supply: - New fibroelastic tissues are formed this makes Internal iliac artery up stronger uterine walls - Fundic height changes D. Vagina 12th weeks level of symphysis pubis - Vascular, tubular, musculomebranous structure 13th weeks rising from pelvic cavity, may that extends from the vulva to the uterus be palpable just above the symphysis between the urinary bladder (anteriorly) and pubis rectum (posteriorly). 14th weeks an abdominal content - 3 to 4 inches 20th to 22nd week at umbilical level - Posterior wall: 10 cm long; Anterior wall: 7.5 36th weeks at xiphoid process level cm long, because the upper cervix projects at - Increased vascularity to the pelvic region the right angle into its upper part. (estrogen effect) results MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  12 | MATERNAL AND CHILD NURSING LEC HEGAR’S SIGN: softening of lowering uterine segmen - HPL is the major diabetogenic hormone or called the isthmus easy compressibility of the uterus insulin antagonist in pregnancy – gestational GOODELL’S SIGN: softening of the cervix. Consistency DM or difficulty to control pre-existing DM. of the tip of the nose: non-pregnant cervix. Consistency of ear lobe pregnant cervix (Goodell’s sign). 2. ANTERIOR PITUITARY GLAND (APG) Consistency of whipped butter cervix ripe for labor - No ovulation from increased follicle stimulating CHADWICK’S SIGN: bluish or purplish discoloration of hormone the vaginal mucosa and cervix - Breast is prepared for lactation with increased BRAXTON-HICKS CONTRACTIONS- Intermittent prolactin irregular, painless, abdominal, and false labor contractions felt as abdominal muscle tightening by 3. POSTERIOR PITUITARY GLAND (PPG) about 4 months more pronounced at 8 months. - Oxytocin is produced by hypothalamus stored BALLOTTEMENT: Rebounding of fetal head against and secreted by the PPG examining fingers by 4 to 5 months - Fetal head pressure on the cervix stimulates SECONDARY AMENORRHEA: due to the persistence of FPG to secrete oxytocin the corpus luteum stimulates uterine myometrium – uterine contractions – labor onset (auded by the 2. CERVIX drop in progesterone in late pregnancy. - Shorter thicker, more elastic - With edema and hyperplasia of mucus lining 4. THYROID GLAND there is increased mucus production which - Changes in thyroid activity resulting to elevated makes up the protective mucus plug (week 7) BMR are due to (Cunningham at al, 2001); As it seals the cervix it also prevents bacterial elevated serum estrogen placental effects on contamination of the uterine cavity. thyroid function increased renal clearance of - Increased vascularity causes cervix to be soft iodide or decreased available iodide Goodell’s sign - Increased thyroid activity – increased RMR, any extraordinary growth must be assessed 3. VAGINA (Littleton & Engebretson, 2006) - Hypertrophy and hyperplasia – thickened increased pulse rate vaginal mucosa elevated cardiac output - Leukorrhea: whitish, mucoid, non-foul, non- hear intolerance pruritic vaginal secretions increase as estrogen - The 15th increased in metabolic rate activity by level increases provide increased vaginal 25% returns to normal levels at 6th week acidity, an added protection from bacterial postpartum invasion. - Increased vascularity results to bluish 5. PARATHYROID GLAND discolocation: Chadwick’s sign - enhances calcium and phosphorus metabolism to metabolism to meet fetal needs for increased 4. PERINEUM calcium - Hypertrophy edema and relaxation there is an - the leading cause increase in size - Increased vascularization, changes into deeper 6. PANCREAS color - increased insulin secretion in response to increase metabolism in pregnancy. ENDOCRINE SYSTEM - insulin secreted by pancreas is rendered ineffective by insulin antagonists of pregnancy 1. PLACENTA most importantly human placental lactogen of - Chorion of placenta secretes HCG which human chorionic somatomammotropin (HCS) functions to: Maintain the corpus luteum (most 7. ADRENAL CORTEX important function) - Increased cortisol words at multiple sites Aid in diagnosing pregnancy by its promoting metabolism of macronutrients detection in maternal serum and urine carbohydrates, protein, and fat. Serum blood: As early as 8 to 10 days or - When the gravida needs more energy, cortisol at the time of implantation Urine: As early as 10 to 14 days after the MENSTRUATION missed menstruation - Series of rhythmic reproductive cycle Found elevated in excessive vomiting a. From the onset of menstrual bleeding to the - Mature placenta at 10 to 12 weeks increased day before the next bleeding day. The first placental hormones estrogen progesterone day of the cycle is the day or which HCG and HPL/HCS (human placental menstruation begins. lactogen/Human chorionic b. Characterized by changes in the ovaries somatomammotropin) and uterus c. Influenced by normal hormonal variation mediated by hypothalamus and anterior MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  13 | MATERNAL AND CHILD NURSING LEC pituitary gland (APG) via feedback CHARACTERISTICS OF NORMAL MENSTRUAL mechanism (negative feedback). CYCLES d. Recurring cyclically beginning at puberty 1. Beginning (menarche)- Average age at onset. with the first menstruation called menarche 12.4 yrs; average range, 9-17 yrs and ceasing at menopause. 2. Interval between cycles - Average, 28 days; e. Duration varies and is highly individualized, cycles of 23–35 days not unusual but the average cycle/mean cycle length is 3. Duration- Average flow, 4–6 days; ranges of 2–9 28 days; normal range is 25 to 35 days per days not abnormal cycle; can be as short as 21 days or as long 4. Amount - Difficult to estimate; average 30–80 ml as 40 days. Only one interval is fairly per menstrual period; saturating a pad or tampon constant (almost always 14 or 15 days): the in less than 1 hr is heavy bleeding time from ovulation to the beginning of 5. Color- Dark red; a combination of blood, mucus, menses. (Marieb, 2002) and endometrial cells f. Function of the cycle, preparation for the 6. Odor- Similar to marigolds release of egg, fertilization, and implantation PHYSIOLOGY OF MENSTRUATION STRUCTURES AND HORMONES INVOLVED IN THE MENSTRUAL CYCLE 1. HYPOTHALAMIC HORMONES- secrete gonadotrophin-releasing (GnRF) or inhibiting STRUCTURES HORMONES FUNCTIONS factors (GnIF) that stimulate the pituitary gland Initiates the to secrete or inhibit the secretion of menstrual corresponding gonadotrophin (Gn) Gonadotropin cycle by HYPOTHALAMUS releasing hormone stimulating the 2. ANTERIOR PITUITARY (APG) HORMONES- (GnRH) anterior gonadotrophins (Gn) follicle stimulating pituitary gland to secrete hormone (FSH) and luteinizing hormone (LH) hormones a. Follicle-stimulating Hormone (FSH) Facilitates - secreted by the APG in response to the maturation of Follicle ovarian follicles stimulation of hypothalamic follicle- stimulating Facilitates stimulating hormone releasing factor PITUITARY hormone ovulation (FSHRF) triggered by low blood levels of GLAND (FSH) Enhances estrogen during the first half of the Luteinizing formation of menstrual cycle hormone (LH) corpus luteum Estrogen is at its lowest by 4 to 5 days of the menstrual cycle. Stimulates - stimulates the development of primordial uterine growth follicles (immature follicles) into Graafian Fertile cervical mucus follicles (mature follicles); FSH stimulates Maintains the follicle cells to secrete estrogen. endometrium Decreases the b. Luteinizing Hormone (LH) basal body - also called interstitial cell stimulating Estrogen temperature hormone. OVARIES Progesterone Hormone of - secreted by the APG in response to the ‘womanhood’ stimulation of hypothalamic luteinizing Maintains hormone releasing factor (LHRF) triggered uterine lining by low blood levels of progesterone. for implantation - Progesterone is lowest on the 13th day of of the zygote Prepares the the menstrual cycle. endometrium - because progesterone is responsible for Relaxes the rise in basal body temperature (BBT), the myometrium slight rise in BBT (day 14) that is preceded Increases the by a drop (day 13) is considered a basal body significant sign of ovulation in the regular temperature 28-day cycle. Infertile mucus Hormone of 3. OVARIAN HORMONES pregnancy a. Estrogen - secreted by the ovaries, adrenal cortex; secreted by placenta in pregnancy - responsible sex characteristics and assists in maturation of ovarian follicles MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  14 | MATERNAL AND CHILD NURSING LEC - Inhibits secretion of FSH (negative 4. PROSTAGLANDIN feedback) and stimulates secretion of LH - fatty acids recognized as hormone (positive feedback) secreted by a lot of body organs including - Responsible for the proliferative phase of the endometrium of the uterus. the menstrual cycle Affects menstrual cycle - Responsible for fertile cervical mucus (thin, Stimulates uterine muscles to contract clear, colorless, stingy, stretchable, slippery, lubricative, produces fern-pattern MENSTRUAL CYCLE STAGES/PHASES when dry (positive ferning test)) 1. Menstrual or Bleeding Phase - In pregnancy: increase vascularity, - days 1 to 4; may last for 3 to 5 days maintains the highly specialized - terminal phase endometrium called decidua, stimulates - characterized by vaginal bleeding as the uterine muscles contraction, causes uterine endometrium is shed down to the fatigue, and antagonizes insulin. basal layer along with blood from the capillaries and with the unfertilized ovum. b. Progesterone - menstruation is periodic discharge of blood, - Secreted by corpus luteum in non-pregnant mucus and cellular debris from the uterine state in early part of pregnancy; secreted by mucosa and occurs at regular, cyclic, and the placenta as early as sixth week of predictable intervals from menarche to pregnancy until parturition menopause. - Inhibits secretion of LH (negative feedback) - the menstrual period is the woman’s period - Helps maintain the endometrium by of absolute infertility. facilitating secretory phase of the menstrual - menarche is the first menstruation; occurs cycle preparation for implantation, also between 12 to 13 years; usually called nidation anovulatory, infertile, irregular. - Relaxes smooth muscles including the - duration of menstruation: variable with myometrial muscle of the uterus: usual duration of 3 to 5 days or up to 4 to 6 Progesterone is the hormone that days. maintains pregnancy by maintaining - amount: 25 to 60 ml equivalent to about 0.4 decidua. to 1.0 mg of iron loss for every day of the A drop in progesterone in early cycle. pregnancy may lead to abortion - menstrual blood is incoagulable because A drop in progesterone in late the blood, coagulated as it is shed, is pregnancy may lead to premature promptly liquefied by fibrinolytic activity. labor. Progesterone drop at term is one of 2. Follicular or Proliferative Phase the theories labor onsets so when - days 5 to 14 ending in ovulation; lasts about smooth muscle relaxant 9 days progesterone drops at term, uterine a. Regenerative Phase: the first few days muscles are easily stimulated to of the reformation of the endometrium contract due to rising stimulants to b. Under the control of estrogen contract due to rising stimulants in (principally estradiol) there is regrowth late pregnancy particularly oxytocin and thickening/ proliferation of the and prostaglandin. endometrium up to 8 to 10-fold. - Thermogenic- increases basal body Proliferative changes level off at temperature ovulation. - Has water-retaining, antidiuretic action c. At the completion of the proliferative - Increases fibrinogen level, thus increases phase, the endometrium consists of blood coagulability three layers: - Decreases hemoglobin and hematocrit Basal layer: 1 mm thick, lowest most levels layer lying immediately above the - Responsible for interfile cervical mucus myometrium; contains all the (thick opaque, sticky, non- stretchable, necessary rudimentary structures for produces non-fern-pattern when dry building up new endometrium; never (negative ferning test)) alters during the menstrual cycle. - In pregnancy maintains pregnancy, relaxes Functional layer: 2.5 mm thick; the uterus, and together with estrogen, middle layer, contains tubular glands; human placental lactogen (HPL) and constantly changes according to the cortisol, antagonizes insulin. hormonal influences of the ovary. Cuboidal ciliated epithelium layer: upper most layer; covers the functional layer; dips down to the line the tubular glands. ✓ Ovulation: present in the middle of the cycle: monthly growth and MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  15 | MATERNAL AND CHILD NURSING LEC release of mature, non-fertilized The corpus luteum lives longer and ovum from the ovary secretes progesterone and estrogen in ✓ Usually happens in the middle of early- pregnancy later replace by the menstrual cycle; 13 to 15 days placenta. or an average of 14 days prior to The usual life span of the corpus the next menstruation in regular luteum is two weeks or 10 to 14 days. cycles. If fertilization does not occur, the yellow ✓ Estrogen: high while body corpus luteum function only for progesterone is low about 7 to 8 days after ovulation then Ovulations signs: involutes to becomes a white body, the ✓ Breast tenderness corpus albicans which persist up to 10 ✓ Slight rise in BBT (0.3 to 0.5 C or to 12 days after ovulation. This causes 0.4 to 0.8 F) during ovulation a drop in levels of estrogen and which is preceded by a slight drop progesterone causing endometrial (0.2 F) 24 to 36 hour before. The ischemic or premenstrual phase. most fertile time is 3 to 4 days 4. Ischemic Phase- about day 24 or day 25 before ovulation and 1 to 2 days after (Littleton & Engebretson, 5. Menses Phase- the end of an arbitrarily defined 2006) menstrual cycle ✓ Positive Spinnbarkeit test (with SPECIAL CONCERNS: MENSTRUAL PROBLEMS/ stretchable mucus) DISORDERS Mittelschmerz - left or right lower A. Premenstrual Syndrome (“PMS” quadrant pain corresponding to Syndrome): the rupture of the Graafian - Complex physical signs and behavior follicle. symptoms that occur during the second half Positive Ferning test of the menstrual cycle that resolve with the onset of menses. d. Estimating Ovulation Time: subtract 14 days from the menstrual length B. Amenorrhea: In 28-day cycle, ovulation occurs - Absence of menstruation on the 14th day counting from the ✓ Primary Amenorrhea: menarche has first day of bleeding. never occurred In 30-day cycle, ovulation occurs ✓ Secondary Amenorrhea: cessation of on the 16th day counting from the menses for more than 3 months after first day of bleeding. regular menstrual cycles have been The period when the woman is established most fertile is during ovulation time, the period of absolute C. Dysmenorrhea: fertility. - Painful menstruation: usually corresponds In 28-day cycle, periods of fertility to the secretory phase of the endometrium is from 9 to 17 days and in a 30- indicating the ovulation has occurred; day cycle, periods of fertility is absent when ovulation is suppressed (Kain from 11 to 19 days During these & Hall, 2000) periods, pregnancy is likely to ✓ Primary Dysmenorrhea: occurs in the occur if the woman engages in absence of any underlying anatomic unguarded coitus. abnormality ✓ Secondary Dysmenorrhea: occurs 3. Luteal or Secretory Phase when there is an underlying structural - 15 to 28 days; lasts about 12 days abnormality of the cervix or uterus - Initiated by ovulation in response to a surge (malposition), presence of a foreign in LH that promotes the development of body (IUD), pelvic inflammatory corpus luteum from the ruptured follicle, the disease (PID), endometriosis, or yellow body that secretes high levels of endometritis. progesterone and estrogen. D. Metrorrhagia: - Progesterone stimulates the already - Abnormal bleeding between menses/ proliferated endometrium causing the periods or intercyclic bleeding functional layer to become thicker (3.5 mm thick), more spongy, softer with glands E. Menometrorrhagia: becoming more tortuous as the endometrial - Excessive or prolonged menstrual bleeding capillaries get distended with blood in which may lead to or not cause preparation for reception/ implantation and hypovolemia and anemia nourishment of the fertilized ovum. If fertilization occurs, implantation follows 6 to 9 days or 7 to 10 days (average of 7 days) after fertilization. MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  16 | MATERNAL AND CHILD NURSING LEC F. Menorrhagia: Hot flashes: cluster of symptoms due to - Excessive, profuse menstrual flow; may be vasomotor disturbances related to caused by hormonal imbalance, infection, hormonal changes and cessation of uterine tumors menses Emotional changes as mood swings or G. Oligomenorrhea: emotional liability - Infrequent menses Sleep disturbances Tendency to obesity not because of a H. Polymenorrhea: change in adipose deposits but rather due - Too frequent menses to increased caloric intake Sexual drive may not be diminished; sexual I. Hypomenorrhea: activity and interest may improve as the - Abnormally short menstrual cycle need for contraception disappears. Atrophic changes in the vagina, vulva and J. Hypermenorrhea: urethra and in the trigonal area of the - Abnormally long menstrual cycle bladder. ✓ The vaginal atrophy may result in NURSING IMPLEMENTATION: MENSTRUAL discomfort during intercourse- ABNORMALITIES/ DISORDERS dyspareunia- but may be overcome with 1. Prompt referral for evaluator and diagnosis a lubricating gel or saliva, the most if with: common vaginal lubricant. Excessive menstrual flow, intermenstrual The breasts become pendulous and or post-menopausal bleeding decrease in size and firmness Absence of menarche at age 17 Long-range physical changes may include Severe pre-menstrual tension syndrome osteoporosis associated with: (PMS)- anxiety, depression, irritability, ✓ Low estrogen and androgen levels headache, nausea, abdominal bloating. ✓ Lack of physical exercise ✓ Low dietary intake of calcium 2. Promote relief of discomfort of dysmenorrhea: c) Treatment: for relief of symptoms of Rest menopause treatments include: Mild sedatives I. Estrogen replacement if there is no history Leg lifts of cancer in the family although this External heat to lower abdomen treatment is controversial Hot drinks ✓ Short-term, low dose estrogenic therapy Treatment as ordered: antiemetics and for troublesome vasomotor disturbances prostaglandin inhibitors (hot flashes) ✓ Sustained high-dose estrogen therapy 3. Psychological support: has been reported to predispose women Initial encourage verbalization of fears, to reproductive tract cancer anxieties, problems, and related concerns; ✓ Hormonal vagina creams/ lubricants (K-Y provide and protect privacy. jelly) for painful coitus or dyspareunia II. Vitamins B complex and E for hot flashes MENOPAUSE and other symptoms - Transitional phase for women marketing III. Increased calcium and phosphorus intake the end of their reproductive abilities. for osteoporosis prevention - Menopause is to the climacteric as IV. Support system to provide emotional menarche is to puberty (Olds et al. 1988) support a. Change of lime or climacteric period b. Occurs between 45 to 50 years in 50% FOUR STAGES OF HUMAN SEXUAL RESPONSE of women; can be from 35 to 60 years (MASTERS AND JOHNSON, 1966) with an average of 53 years; not A. Excitement: completed until 2 years since the last physical and psychologic stimulus period stimulation of the genitals c. Ovulation ceases 1 to 2 years prior to arterial dilatation and venous constriction menopause with individual variation. in the genital area Characteristics: B. Plateau: a) Gradual cessation of menstruation: first reached first before orgasm menstruation becomes irregular and then it women: formation of orgasmic platform, ceases altogether increased nipple engorgement b) Presence of physical symptoms due to a drop men: full distention of the penis in estrogen C. Orgasm: discharge of accumulated sexual tension orgasm occurs shortest stage MATERNAL, CHILD, ADOLESCENT LEC BY: CORPUZ, ROCE LEANNE A.  17 | MATERNAL AND CHILD NURSING LEC D. Resolution: LESSON 3: CARE OF THE MOTHER AND THE external and internal organs return to an unaroused state FETUS DURING THE PERINATAL PERIOD generally, takes 30 minutes Nursing Care Planning Based on Healthy People 2030 Goals 1. Reduce the rate of fetal deaths at 20 or more weeks of gestation with a baseline of 5.9 fetal deaths per 1,000 live births. Target is 5.7 fetal deaths per 1,000 live births. 2. Increase the proportion of pregnant people who receive early and adequate prenatal care. The baseline is 76.4% and target is 80.5% (US Department of Health and Human Services, 2020) NURSING PROCESS OVERVIEW - To Help Ensure Fetal Health: I. Assessment: II. Nursing Diagnosis Readiness for education related to usual fetal development. Anxiety related to lack of fetal movement. Knowledge deficiency related to the need for good prenatal care for healthy fetal well- being III. Outcome and Identification Planning: Educate potential parents about teratogens Established for teaching about fetal growth Amniocentesis or ultrasound examination Teaching plan IV. Implementation: Helps them to understand the importance of implementing healthy behaviors (eating well and avoiding substances that may be dangerous to a fetal- recreational drugs). Viewing a sonogram and learning the fetal sex Helping initiate bonding between the parents and the infant.