Maternal and Child Health Nursing PDF

MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Primary Goal of Maternal and Child Health Nursing: INTRODUCTION The promo...

MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Primary Goal of Maternal and Child Health Nursing: INTRODUCTION The promotion and maintenance of optimal family health Maternal and child health (MCH) programs focus on to ensure cycles of optimal childbearing and childrearing health issues concerning women, children and families, such as access to recommended prenatal and well-child care, infant and maternal mortality prevention, maternal and child mental health, newborn screening, child immunizations, child nutrition and services for children with special health care needs. States invest in healthy children and families to strengthen communities and avoid unnecessary health care cost. Maternal and Child Health Nursing Practice Throughout the Childbearing-Childrearing OBJECTIVES: Continuum View the areas of maternal and child health as Provision of preconception health care a continuum with a seamless flow between Provision of nursing care of women throughout the two areas pregnancy birth and postpartum period Identify the specific goals and philosophies of Provision of nursing care of children from birth maternal and child health nursing and apply through adolescence these to nursing practice Provision of nursing care to families in all Identify 2030 National Health Goals as an settings important guide to understanding the health of the nation and goals that nurses can help the Philosophy of Maternal and Child Health Nursing nation achieve Includes the following concepts: Using the nursing process, plan nursing care Family-centered plan that includes the six competencies of Community-centered Quality & Safety Education for Nurses Evidence-based (QSEN): Patient Centered Care, Teamwork & A challenging role for nurses and a major factor Collaboration, Evidence-Based Practice in keeping families well and optimally functioning (EBP), Quality Improvement (QI), Safety, and Informatics Maternal and child health nurse: Considers the family as a whole and as a Key Words partner in care when planning or implementing Evidence-based practice or evaluating the effectiveness of care Fertility rate Serves as an advocate to protect the rights of all Infant mortality rate family members, including the fetus Maternal and child health nursing Demonstrates a high degree of independent nursing functions because teaching and counseling are major interventions Promotes health and disease prevention because these protect the health of the next generation Serves as an important resource for families during childbearing and childrearing, as these can be extremely stressful times in a life cycle 1 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Quality Improvement Respects personal, cultural and spiritual Safety attitudes and beliefs as these so strongly Informatics influence the meaning and impact of childbearing and childrearing Legal Considerations Specific to Maternal-Child Encourages developmental stimulation during Nursing Practice both health and illness so children can reach Informed consent related to fetal well-being their ultimate capacity in adult life Informed consent and legal guardianship for Assess families for strengths as well as specific procedures performed on children needs or challenges Length of time between healthcare incident and Encourages family bonding through rooming-in child’s ability to bring lawsuit and family visiting in maternal and child Identifying and reporting suspected child abuse healthcare settings Concepts of “wrongful life” and “wrongful Encourages early hospital discharge options to conception” reunite families as soon as possible in order to Acupuncture create a seamless, helpful transition process A system of integrative medicine that involves Encourages families to reach out to their pricking the skin or tissues with needles, used to community so the family can develop a wealth of alleviate pain and to treat various physical, mental and support people they can call on in a time of emotional conditions. Originating in ancient China, family crisis acupuncture is now widely practiced in the West National Health Goals Homeopathy Increase quality and years of healthy life Is a medical philosophy and practice based on Eliminate health disparities the idea that the body has the ability to heal itself. Objective recommends that all pre licensure Homeopathy was founded in the late 1700s in programs in nursing include core content on Germany and has been widely practiced throughout Counseling for health promotion and disease Europe prevention Cultural diversity Therapeutic touch Evaluation of health sciences literature Is a pseudoscientific energy therapy which Environmental health practitioners claim promotes healing and reduces pain Public health systems and anxiety Global health Chiropractic care Framework for Maternal and Child Health Nursing Use hands-on spinal manipulation and other Care alternative treatments. The theory is that proper Phases of health care alignment of the body’s musculoskeletal structure, Health promotion particularly the spine, will enable the body to heal itself Health maintenance without surgery or medication Health restoration Health rehabilitation Herbalism The practice of making or prescribing plant Quality & Safety Education for Nurses (QSEN) based herbal remedies for medical conditions. Patient-centered care Practitioners of herbalism may be licensed MDs, Teamwork & Collaboration naturopaths or osteopaths Evidence-Based Practice 2 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Statistics Related to the Measurements of Maternal and Child Health Birth rate Fertility rate Fetal death rate Neonatal health rate Perinatal death rate Maternal mortality rate Infant mortality rate Childhood mortality rate Childhood morbidity rate Trends Impacting Maternal and Child Health Nursing Families contain fewer members The number of single parents is increasing Ninety percent of women work outside the home; many are the primary wage earner The number of homeless women and children is increasing Families are becoming more mobile Child and intimate partner violence is increasing Balancing quality and cost containment in health care is an increasing initiative MORATALITY - death MORBIDITY - disease 3 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Reproductive and Sexual Spermatic cord Health Male Reproductive System INTRODUCTION The ability to reproduce is one of the properties distinguishing living from non-living matter. The more primitive the animal, the simpler the process of reproduction. In mammals, including humans, the process is one of sexual reproduction in which the male and female organs differ anatomically and physiologically, and the new individual develops from the fusion of two different sec cells (gametes) Objectives 28 1. Describe anatomy and physiology pertinent to 27 reproductive sexual health 26 2. Assess a couple for anatomic and physiologic 25 24 health and readiness for childbearing 23 3. Asses a couple for reproductive planning and 22 sexual health needs related to sexual 21 20 orientation and gender identity if pertinent 19 4. Formulate nursing diagnoses related to 18 reproductive and sexual health 17 16 15 14 Terminologies 13 Adrenache Gonad 12 11 10 Andrology: infertility or Gynecology 9 impotence in male repro 8 7 Anteflexion: bending Gynecomastia 6 forward of an organ 5 4 Anteversion: leaning Laparoscopy 3 2 forward 1 1 Aspermia: absence of Menarche 2 semen 3 4 Bicornuate uterus Oocyte 5 6 Culdoscopy Puberty 7 8 9 Cystocele Retroflexion 10 11 Rectocele Retroversion 12 4 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A 13 Delivery of spermatozoa in semen into the 14 female reproductive tract 15 16 17 Scrotum 18 19 - Is a pouch of pigmented skin, fibrous and 20 connective tissue and smooth muscle 21 - It is divided into two compartments, each of 22 23 which contains one testis, one epididymis and 24 the testicular end of a spermatic cord 25 26 27 The male gametes are called spermatozoa Testes The testes are the male reproductive glands and The female gametes are called ova are the equivalent of the ovaries in the female. They are about 4.5 cm long, 2.5 cm wide and 3 cm thick and are suspended in the scrotum by the spermatic cords They are surrounded by three layers of tissue 1. Tunica vaginalis 2. Tunica albuginea 3. Tunica vasculosa Structure - In each testis are 200-300 lobules, and within each lobule are 1-4 convoluted loops of germinal epithelial cells called seminiferous tubules - Between the tubules are groups of interstitial cells (of Leydig) that secrete the hormone testosterone after puberty The functions of the male reproductive organs are Functions Production, maturation and storage of - Spermatozoa (sperm) are produced in the spermatozoa seminiferous tubules of the testes 5 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Spermatic cords The spermatic cords suspend the testes in the scrotum. Each cord contain a testicular artery, testicular veins, lymphatics Seminal vesicles is a 5 cm long tube that joins with the deferent duct to form the common ejaculatory duct Functions - The seminal vesicles contract and expel their stored contents, seminal fluid, during ejaculation. Seminal fluid, which forms 60% of the volume of semen Ejaculatory ducts The ejaculatory ducts are two tubes about 2 cm long, each formed by the union of the duct from a seminal vesicle and a deferent duct They pass through the prostate and join the prostatic urethra, carrying seminal fluid and spermatozoa to the urethra 100 million spermatozoa per mL. If not ejaculated, sperm gradually lose their fertility after several months and are reabsorbed by the epididymis Anatomy and Physiology of the Reproductive System: The Female Gynecology: study of the female reproductive system An anterior view of female reproductive organs showing Urethra the relationship of the fallopian tubes and body of the 19-20 cm long uterus Prostatic urethra Membranous urethra Penile urethra Two sphincter 6 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A At puberty, hair grows on the mons pubis and on the lateral surfaces of the labia majora Labia minora These are two smaller folds of skin between the labia majora, containing numerous sebaceous and eccrine sweat glands Or “lesser lips” are the thin hairless ridges at the The functions of the female reproductive system entrance of the vagina, which joins behind and Formation of ova in front Reception of spermatozoa In front they split to enclose the clitoris Provision of suitable environments for Clitoris fertilization and fetal development parturition - The clitoris corresponds to the penis in the male (childbirth) lactation, and the production of and contains sensory nerve endings and erectile breast milk, which provides complete tissue nourishment for the baby in its early life - The clitoris is a small pea-shaped structure - It plays an important part in sexual excitement External genitalia (vulva) The external genitalia are known collectively as the vulva, and consist of the - Labia majora and labia minora - The clitoris - The vaginal orifice - The vestibule - The hymen - Vestibular glands (Bartholin’s glands) Vestibular glands - The vestibular glands (Bartholin’s glands) are situated one on each side near the vaginal opening. They are about the size of a pea and their ducts open into the vestibule immediately lateral to the attachment of the hymen - They secrete mucus that keeps the vulva moist Labia majora These are the two folds forming the boundary of the vulva They are composed of skin, fibrous tissue and fat and contain large numbers of sebaceous and eccrine sweat glands Labia majora or “greater lips” is the part around the vagina containing two glands (Bartholin’s glands), which helps lubrication during intercourse Blood supply, lymph drainage and nerve supply 7 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Arterial supply – this is by branches from the internal pudendal arteries that branch from the internal iliac arteries and by external pudendal arteries that branch from the femoral arteries Venous drainage – this forms a large plexus, which eventually drains into the internal iliac veins Lymph drainage – this is through the superficial inguinal nodes Nerve supply – this is by branches from pudendal nerves Perineum Structure of the vagina The perineum is roughly triangular area The vaginal wall has three layers: extending from the base of the labia minora to An outer covering of areolar tissue the anal canal A middle layer of smooth muscle It consists of connective tissue, muscle and fat And an inner lining of stratified squamous It gives attachment to the muscles of the pelvic epithelium that forms ridges or rugae. It has no floor secretory glands but the surface is kept moist by cervical secretions Internal genitalia Vagina Lactobacillus acidophilus Uterus - Bacteria that secrete lactic acid, are normally Two uterine tubes present maintaining the pH between 1.9 and 3.5. Two ovaries The acidity inhibits the growths of most other micro-organisms that may enter the vagina from Vagina the perineum or during sexual intercourse The vagina is a fibromuscular tube lined with stratified squamous epithelium Blood supply, lymph drainage and nerve supply It runs obliquely upwards and backwards at an Arterial supply – an arterial plexus is formed angle of about 45 ° between the bladder in front round the vagina, derived from the uterine and vaginal arteries, which are branches of the internal iliac arteries and rectum and anus behind Venous drainage – A venous plexus, situated in In the adult, the anterior wall is about 7.5 cm the muscular wall, drains into the internal iliac veins long and the posterior wall is about 9 cm long. Lymph drainage – this is through the deep and The difference is due to the angle of insertion of superficial iliac glands the cervix through the anterior wall Functions of the vagina The vagina acts as the receptacle for the penis Hymen during sexual intercourse (coitus) The hymen is a thin layer of mucous membrane that Provides an elastic passageway through which partially occludes the opening of the vagina the baby passes during childbirth It is normally incomplete to allow for passage of Parts of the uterus (FBC) menstrual flow and is stretched or completely Fundus torn away by sexual intercourse, insertion of a - This is the dome-shaped part of the uterus tampon or childbirth above the openings of the uterine Body 8 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A - this is the main part. It is narrowest inferiorly at The uterus is supported in the pelvic cavity by the internal os where it is continuous with the surrounding organs, muscles of the pelvic floor cervix and ligaments that suspend it from the walls of Cervix (‘neck’ of the uterus) the pelvis - This protrudes through the anterior wall of the Broad ligaments – These are formed by a vagina, opening into it at the external os double fold of peritoneum, one on each side of the uterus Round ligaments – these are bands of fibrous tissue between the two layers of broad ligament. Uterosacral ligaments – these originate from the posterior walls of the cervix and vagina and extend backwards, one on each side of the rectum, to the sacrum Transverse cervical (cardinal) ligaments – these extend one from each side of the cervix and vagina to the side walls of the pelvis Perimetrium This is the peritoneum, which is distributed Uterine Tubes differently on the various surfaces of the uterus The uterine (Fallopian) tubes are about 10 cm Anteriorly, it lies over the fundus and the body, long and extend from the sides of the uterus where it is folded onto the upper surface of the between the body and the fundus urinary bladder. This fold of peritoneum forms They lie in the upper free border of the broad the vesicouterine pouch ligament and their trumpet-shaped lateral ends Posteriorly the peritoneum covers the fundus, penetrate the posterior wall, opening into the the body and the cervix, then it folds back on the peritoneal cavity close to the ovaries rectum to form the rectouterine pouch (of The end of each tube has fingerlike, projections Douglas) called fimbriae Myometrium The longest of these is the ovarian fimbria, This is the thickest layer of tissue in the uterine which is in close association with the ovary wall Structure It is a mass of smooth muscle fibres interlaced The uterine tubes are covered with peritoneum with areolar tissue, blood vessels and nerves (broad ligament) Endometrium Have a middle layer of smooth muscle and are Made up of the Columnar epithelial cells lined with ciliated epithelium Consists mucous secreting tubular glands Blood and nerve supply and lymphatic drainage Endometrium are as for the uterus Blood supply, lymph drainage and nerve supply Functions Arterial supply – this is by the uterine arteries, The uterine tubes propel the ovum from the branches of the internal iliac arteries ovary to the uterus by peristalsis and ciliary Venous drainage – internal iliac vein movement Lymph drainage – deep and superficial lymph The secretions of the uterine tube nourish both vessels drain lymph from the uterus and the uterine the ovum and spermatozoa tubes to the aortic lymph nodes and groups of nodes Fertilization of the ovum usually takes place in associated with the iliac blood vessels the uterine tube, and the zygote is propelled into Supporting structures to the uterus the uterus for implantation 9 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Ovaries The ovaries are the female gonads (glands producing sex hormones and ova), and they lie in a shallow fossa on the lateral walls of the pelvis They are 2.5-3.5 cm long, 2cm wide and 1 cm thick. Each is attached to the upper part of the uterus by the ovarian ligament and to the back of the broad ligament by a broad band of tissue, the mesovarium Blood vessels and nerves pass to the ovary The nipple through the mesovarium This is a small conical eminence at the centre of Structure the breast surrounded by a pigmented area, the The ovaries have two layers of tissue. areola A. Medulla – This lies in the centre and consists of On the surface of the areola are numerous fibrous tissue, blood vessels and nerves sebaceous glands (Montgomery’s tubercles), B. Cortex – this surrounds the medulla. It has a which lubricate the nipple during lactation framework of connective tissue or stroma, covered by germinal epithelium. It contains ovarian follicles in various stages of maturity, each of which contains an ovum Functions The ovary is the organ in which the female gametes are stored and develop prior to ovulation Blood supply, lymph drainage and nerve supply Their maturation is controlled by the Arterial supply – the breasts are supplied with hypothalamus and the anterior pituitary gland blood from the thoracic branches of the axillary arteries and from the internal mammary and intercostal arteries Breast Venous drainage – this is formed by an The breasts or mammary glands are accessory anastomotic circle round the base of the nipple from glands of the female reproductive system which branches carry the venous blood to the They exist also in the male, but in only a circumference and end in the axillary and mammary rudimentary form veins Structure The mammary glands or breasts consist of Reproductive Development varying amounts of glandular tissue responsible Reproductive development begins at the for milk moment of conception and continues through life Intrauterine Development Sex assigned at birth is generally determined at the moment of conception by chromosome information, which is supplied by the sperm that joins with the ovum to create new life - A gonad is a body organ that produces the cells necessary for reproduction (ovary in females, the testis in males) 10 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A At approximately week 5 of intrauterine life, secretions that cause typical acne in both boys mesonephric (Wolffian) and paramesonephric and girls during adolescence (Mullerian) ducts, the tissue that will become - In males, androgenic hormones are produced by ovaries and testes, have already formed the adrenal cortex and the testes By week 7 or 8, in chromosomal males, this - In females, by the adrenal cortex and the early gonadal tissue begins the formation of ovaries testosterone. Under the influence of The level of the primary androgenic hormone, testosterone, the mesonephric duct develops testosterone, is low in males until puberty into male reproductive organs, and the (between ages 12 and 14 years) when it rises to paramesonephric duct regresses. influence pubertal changes in the testes, If testosterone is not present by week 10, the scrotum, penis, prostate, and seminal vesicles, paramesonephric duct becomes dominant and the appearance of male pubic and axillary. And develops into female reproductive organs. When facial hair; laryngeal enlargement with its ovaries form, all of the oocytes (cells that will accompanying voice change; maturation of develop into eggs throughout the woman’s spermatozoa; and closure of growth plates in mature years) are already present long bones (termed adrenarche) At about week 12 of intrauterine life, the external In girls, testosterone influences the enlargement genitals begin to develop of labia majora and clitoris and the formation of In males, penile tissue elongates and the axillary and pubic hair ventral surface of the penis closes to form a urethra The Role of Estrogen In females, with no testosterone present, the When triggered at puberty by FSH, ovarian uterus, labia minora and labia majora form follicles in females begin to excrete a high level of the hormone estrogen Pubertal Development This increase influences the development of the Puberty is the stage of life t which secondary uterus, fallopian tubes, and vagina; typical sex changes begin female fat distribution; hair patterns; and breast - In most girls, these changes are stimulated development when the hypothalamus synthesizes and It also closes the epiphyses of long bones in releases gonadotropin-releasing hormone girls the same way testosterone closes the (GnRH), which then triggers the anterior pituitary growth plate in boys. The beginning of breast to release follicle-stimulating hormone (FSH) development is termed thelarche, which usually and luteinizing hormone (LH) starts 1 to 2 years before menstruation FSH and LH are termed gonadotrophin (gonad = “ovary”, tropin = “growth”) hormones not only Sexual Health because they begin the production of androgen Sexuality and estrogen, which in turn initiate secondary - Is a multidimensional phenomenon that includes sex characteristics, but also because they feelings, attitudes, and actions. It has both continue to cause the production of eggs and biological and cultural diversity components influence menstrual cycles throughout women’s - It encompasses and gives direction to a person’s lives (Eggers, Ohnesorg & Sinclair, 2014) physical, emotional, social and intellectual responses throughout life The Role of Androgen Androgenic hormones are the hormones The Sexual Response Cycle responsible for muscular development, physical Two of the earliest researchers of sexual growth and the increase in sebaceous gland response were Masters and Johnson. In 1966, 11 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A they published the results of a major study based on more than 10,000 episodes of sexual activity among more than 600 men and women (Masters, Johnson & Kolodny, 1998) In this study, they described the human sexual response as a cycle with four discrete stages: excitement, plateau, orgasm, and resolution. Whether stages are felt as separate steps this way or blended into one smooth process of desire, arousal, and orgasm is individualized. Progesterone is a hormone that maintains pregnancy 12 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Fertility Assessment ❖ Health history (both partners) FAMILY HAVING General health Nutrition DIFFICULTY CONCEIVING Alcohol, drug or tobacco use General health A CHILD Nutrition Alcohol, drug or tobacco use Congenital problems of reproductive Subfertility is said to exist when a pregnancy has not tract, past STDs or genital tract occurred after at least 1 year of engaging in surgery unprotected coitus (Hamilton, 2012) Current illnesses Contraceptive history and Primary subfertility, there have been no previous pregnancies in previous relationships conceptions: in secondary subfertility, there has been a previous viable pregnancy but the couple is Occupational/lifestyle hazards unable to conceive at present ❖ Health History (female partner) Past pregnancies, miscarriages, Sterility is the inability to conceive because of a abortions known conditions, such as the absence of a uterus Menstrual history Current or past reproductive tract Infertility: inability to conceive a child or sustain a problem pregnancy to birth Radiation to pelvis (cancer treatment, Infertile couple: one who has not become pregnant occupational exposure, diagnostic after at least 1 year of unprotected coitus X-rays) Use of douches or intravaginal Male Subfertility Factors medications or sprays Disturbance in spermatogenesis; inadequate Detection of ovulation through FSH and LH production symptomatology Seminiferous tubule, duct, or vessel obstruction; Female circumcision seminal fluid changes prevent sperm motility Fertility Assessment: Physical Assessment Development of autoimmunity, ejaculation Male partner problems ▪ Secondary sex characteristic Chronic or excessive exposure to X-rays or ▪ Genital abnormalities radioactive substances, general ill health, poor Female partner diet and stress ▪ Secondary sex characteristics ▪ Genital abnormalities Female Subfertility Factors ▪ Breast and thyroid examination Inadequate FSH or LH production Anovulation Fertility Testing: Answering the Three Basic Problems of ova transport through the fallopian Questions tubes to the uterus 1. Is there sperm of good quality, number and Uterine factors motility available? Cervical and vaginal factors ▪ Semen analysis Poor nutrition, increased body weight, lack of 2. Are ova available? exercise ▪ Ovulation monitoring 13 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A 3. Structural abnormalities—the shape or motility of 3. Can sperm and ovum meet in a receptive the sperm is affected, preventing the sperm from environment? either swimming to or binding with the egg. ▪ Assessment of fallopian tube potency 4. Age-aged males have a lower sperm count and Fertility Testing: Semen Analysis motility rate. Number of sperm In female Appearance of sperm 1. Ovulation disorders - PCOS (polycystic ovarian Motility of sperm syndrome) Sperm penetration 2. Tubal blockage - prevents ovum and sperm meeting. Fertility Testing: Ovulation Monitoring 3. Advanced maternal age - quality of woman's ❖ Ovulation monitoring ovum decrease with age and can limit her ability ▪ Measurement of woman’s serum to conceive. progesterone level during luteal 4. Quality of uterine lining - e.g. endometriosis, in phase of menstrual cycle which womb tissues invades and damages ▪ Recording of basal body temperature neighboring reproductive tissues ▪ Measurements of urine LH upsurge (urine test strip) Assisted Reproductive Technique - Defined as the technology to achieve pregnancy Fertility: Tubal Transport Tubal Patency by means of procedures Sonohysterosalpinogogram a. Artificial insemination Hysterosalpinogogram b. In vitro fertilization Transvaginal hydrolaparoscopy c. Surrogacy Fertility Testing: Uterine Concerns Hysteroscopy Artificial Insemination Uterine endometrial biopsy Laparoscopy a. Introduction of sperm into the female’s uterus or cervix for the purpose of achieving pregnancy through in vitro fertilization other Assisted Reproductive Technique than sexual intercourse Definition WHO Types of Artificial Insemination Infertility: inability to conceive after more than one year of intercourse without contraception ▪ Intracervical Insemination It can be both female and male - It involves injection of unwashed or raw semen into the cervix with the needleless Causes of Infertility syringe In male - A vaginal speculum is used to hold open the 1. Sperm production/sperm count disorder vagina so that cervix may be observed and ▪ Azospermia – no sperm cell produced then syringe is inserted the plunger is pushed ▪ Oligospermia – few sperm cell forward and semen is emptied deep in the produced vagina 2. Eractile or ejaculation deficiency – failure or impotence ▪ Intrauterine Insemination - The seminal vesicle is prepared in the laboratory (washed with special media). 14 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Injected inside the uterus with catheter after organs located between the vaginal wall and stimulating the ovaries to produce more eggs the ovary per cycle - The other end of the needle is attached to the suction device ▪ Intratubal Insemination - Then the follicular fluid and cellular material is - It involves injection of the washed sperm into suctioned with the needle the fallopian tube - The procedure will last 10-20 minutes - It should not be confused with the GIFT, where both the eggs are mixed outside the III. Sperm retrieval wash sperm woman’s body and then immediately inserted - Three hour before the procedure, a semen into the fallopian tube sample from the male donor is obtained - Less used than IUI - The sperm is washed and prepared for loading into the same catheter together with the females best eggs In Vitro Fertilization - The eggs are obtained by transvaginal aspiration/ultrasound The uniting of egg and sperm in the lab. The embryos are transferred into the uterus IV. Fertilization through the cervix and pregnancy begins - After retrieval of sperm and egg, they are Letting fertilization of male and female brought together in a laboratory glass dish to gametes occur outside the female body allow the sperm to fertilize the eggs, called standard insemination, once fertilization takes STEPS OF IN VITRO FERTILIZATION place one or more healthy embryo will be There are generally five major steps in the transferred to the uterus process of IVF V. Embryo transfer I. Ovary Stimulation TUBAL EMBRYO TRANSFER (TET) - Different hormones are given to female in It combines IVF with tubal transfer order stimulate formation of more than one Embryos are placed into the women’s ovum fallopian tube - Formation of more than one ovum for multiple The embryos to make their way to the uterus zygote or embryos to increase the probabilty for implantation for getting a healthy embryo It is advantage over ZIFT is that it allow for the - Drugs or hormone like Clomiphene (clomid) assessment of fertilization and embryo quality bMG (pergonal), FSH (metrodin), GnRH Success rate higher than ZIFT agonist (lupron) FSH/LH first promoted, then inhibited nCG acts like LH GAMETE INTRE FALLOPIAN TRANSFER II. Oocyte retrieval (GIFT) - Technique used to remove oocyte from the - it is a tool of assisted reproductive technology ovary of the female to have fertilization against infertility. Eggs are removed from a outside the body woman’s ovaries, and placed in one of fallopian Procedure tubes, along with the man’s sperm With the ultrasound guidance a needle is - the first attempt was made by Steptoe and inserted into the vaginal wall and into the Edwards ovarian follicle, taking care not to injure - it takes on average four to six weeks to complete the cycle of GIFT 15 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Advantages known as artificial insemination. The there is no much human intervention in the surrogate mother uses an insemination kit to actual fertilization of the eggs became pregnant using an intended father’s because fertilization takes place within the semen fallopian tube, GIFT offers an option for people whose religious beliefs prohibit conception 2. Gestational surrogacy: it is physically more outside the body complicated and more expensive. Here both fertilization can be confirmed before they are the eggs and sperm are taken from intended implanted into the fallopian tube father and mother allow a developing embryo to travel into the uterus on its own, which may be important to those who wish their baby as naturally as NEGATIVE ASPECT OF ART possible - Due to administration of hormone and drugs, Disadvantages ovarian hyperstimulation syndrome (OHSS) can can be performed if woman have at least one occur normal fallopian tube - Risks associated with pregnancy GIFT does not allow for visual confirmation of - Multiple pregnancy fertilization - Increased risk of premature labor, etc. GIFT involves laparoscopic surgery - Can cause premature menopause It is more expensive than GIFT - Increased risk of ovarian cancer, atleast by a times when compared to normal women INTRA CYTOPLASMIC SPERM INJECTION (ICSI) - Sperm is injected directly into the eggs in a RECENT TRENDS laboratory - Innovative design of IVF equipment (PloS ONE, - Used if infertility originates from the male such June 2012) as: - A novel system for processing embryos during o Low number of sperm IVF treatment has been shown to significantly o Low sperm motility improve the chances of pregnancy by 27% - Single spermatozoan is directly injected into the - Pioneered by a Newcastle team of fertility cytoplasm of the oocyte through the experts within the University and NHS, the micropuncture of zona pellucida innovative design of interlinked incubators provides a totally enclosed and controlled environment within which every step of the IVF Surrogacy process can be performed Surrogacy is when another woman carries CONCLUSION and gives birth to a baby for the couple who - ART has been the answer for many childless want to have a child couples, resulting in successful pregnancies and It is the carrying of a pregnancy for intended childbirth parents - Today there is a range of infertile treatment that In this a woman agrees to became pregnant aims to ensure a healthy sustainable pregnancy and deliver a child for a contracted party - But there are still risks, stress and high cost Types associated with ART - With the advent of new technologies, it is hoped 1. Traditional surrogacy: it is the simplest and that these shortcomings would be overcome in least expensive form of surrogacy and is also 16 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A the near future and every infertile couple would Metrorrhagia: Irregular menstrual intervals, have the privilege of parenthood excessive flow and duration Oligomenorrhea: Menstrual interval greater than 35 days Anovulation/anovulatory: Menstrual cycle MENSTRUAL CYCLE without ovulation Dysmenorrhea: Menstrual cramping/pain - Cyclic changes in a woman’s body going through menstruation Normal Features of Menstruation 1. Follicular phase 1. Duration of menstrual flow 2. Ovulation Last from 3 to 7 days 3. Luteal phase The exact duration varies from woman 4. Menstruation to woman Most women do not experience cycle-to-cycle changes more than 1 or 2 MENSTRUATION days The process in a woman of discharging blood It is unusual for the same woman to and other material from the lining of the have wide swings, such as 3 days uterus(endometrium) at intervals of about one lunar duration in one cycle and 7 days in month (28 days) from puberty until the menopause, another except during pregnancy 2. Quality of the menstruum Menstrual blood is normally bright or Significance light red in color like the bleeding that 1. Cycle of natural changes that occurs in the occur after a knife cut or similar injury uterus and ovary as an essential part of It could look brown in some few women making sexual reproduction possible and still be normal menstruation 2. Essential for the production of eggs It must not have a foul odor 3. Preparation of the uterus for pregnancy Small clots may be a normal part of 4. Fertile period of a woman’s life between menstrual blood menarche and menopause 3. Amount of blood loss Terms The average blood loss during normal Menarche: Age at onset of menstruation menstruation is about 35 ml, with a Primary amenorrhea: Absence of range of 10 to 80 ml menstruation despite signs of puberty Usually understood from the number of Secondary amenorrhea: Absence of pads soaked menstruation for 3-6 months in a woman who 4. The flow pattern previously menstruated The amount of blood loss seems to Dysfunctional uterine bleeding: Irregular increase gradually until it attains a bleeding due to anovulation or anovulatory maximum and then starts diminishing as cycle the ends of the flow draws near Menarche age 12 9 years 16 years This pattern is described as crescendo – Menorrhagia: Regular menstrual intervals, decrescendo pattern excessive flow and duration 5. Associated symptoms Breast fullness Mild lower abdominal pain 17 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Irritability Progesterone levels drop, uterine lining Fluid retention detaches menstruation can begin tissue, blood, Cramping unfertilized egg all discharge Mood swings Can take from 3-7 days Weight gain Breast tenderness Hormone Secreted From Function Diarrhea Constipation FSH Anterior pituitary - Stimulate (follicle follicular growth stimulating - Stimulates hormone) estrogen secretion (from developing follicles) Estrogen Ovaries - Development (developing of endometrium follicle) - Stimulates LH secretion (follicular phase) - Inhibits LH and FSH (luteal phase) Follicular LH Anterior pituitary - Surge causes (luteinizing ovulation Begins when estrogen levels are low hormone) - Development Anterior pituitary secretes FSH and LH, of corpus stimulating follicle to develop luteum Cells around egg enlarge, releasing estrogen - Stimulates This causes this uterine lining to thicken progesterone Progesterone Ovaries (corpus - Thickening Ovulation luteum) endometrium LH and FSH still released for another 3-4 days - Inhibits LH and Follicle ruptures, releasing ova into the fallopian FSH (luteal tubes phase) Lutheal Hormonal Regulation of Menstruation Empty follicle changes to a yellow color, WITHOUT ESTROGEN AND becomes PROGESTERONE, ENDOMETRIUM BREAKS Continues to secrete estrogen, but new beings DOWN—MENSTRUATION OCCURS to release progesterone further develops uterine lining If pregnant, embryo will release hormones to preserve corpus luteum Menstruation If no embryos, the corpus begins to disintegrate 18 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Genetic disorders may occur due to GENETICS ASSESSMENT occupational hazards, such as toxic substances in the environment of workplaces AND COUNSELING (Kiku, Voronin & Golokvhast, 2015) Key Terms Cultural Diversity Blood disorder β – thalassemia Alleles Genetics a. Occurs most frequently in families of Greek Chromosomes Genome or Mediterranean heritage α – thalassemia occurs most often in persons Cytogenetics Genotype from the Philippines or Southeast Asia Sickle-cell anemia occurs most often in people Dermatoglyphics Heterozygous with an African ancestry Tay-Sachs disease, a deterioration of muscle Genes Homozygous and mental facilities, occurs most often in people karyotype of eastern Jewish ancestry. phenotype Genetic disorders occur at the moment an ovum and sperm fuse or even earlier, in the OBJECTIVES meiotic division phase of the ovum and sperm 1. Assess a family for adjustment to the probability when the chromosome count is halved from 46 of inheriting a genetic disorder to 23 2. Formulate nursing diagnoses related to genetic Cytogenetics is the study of chromosomes by disorders light microscopy and the method by which 3. Implement nursing care such as counseling a chromosomal aberrations are identified. family with a genetic disorder 4. Evaluate expected outcomes for achievement NATURE OF INHERITANCE and effectiveness of care Inheritance – the passing of familial elements from one generation to the next Genes are the basic units of heredity that Genetics – introduced by Bateson in 1906, derived determine both the physical and cognitive from the Greek word “gene” which means “to become” characteristics of people or “to grow into” Composed of segment of DNA, they are woven - Branch of science that studies genes and the into strands in the nucleus of all bod cells to pattern of inheritance of particular diseases form chromosomes - Concerned with the transmission of In humans, each cell, with the exception of the characteristics from parents to offspring sperm and ovum, contains 46 chromosomes - George Mendel – father of genetics (44 autosomes and 2 sec chromosomes) Genetic Disorders For each chromosome in a sperm cell, there is Disorders that can be passed from one a like chromosome of similar size, shape, and generation to the next because they result function in the ovum. from some disorder in the gene or The one chromosome that does not have a chromosome structure mirror match is the chromosome for determining Occur in some ethnic groups more than sex others because people tend to marry within their own cultural group ❖ Gene – basic unit of genetic information. Determines the inherited characteristics 19 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A ❖ Chromosomes – storage unit genes, A the options open to them in management and structure within the cell that deliver the genetic family planning in order to prevent or avoid it materials as DNA Process of helping people understand and ❖ DNA – a nucleic acid that contains the genetic adapt to the medical, psychological and instructions specifying the biological familial implications of genetic contributions to development of all cellular forms of life molecule disease encodes the genetic information ❖ Genome – the collection of genetic information Genetic Counselor https://medlineplus.gov/genetics/understanding/basics/g - Are healthcare professionals who work with ene/ individuals,families, communities and other healthcare professionals to empower them to Gregor Mendel – The basic laws of heredity were first understand how genetic information impacts formed during the mid-1800s by an Austrian botanist their lives or the lives of their patients monk named Gregor Mendel. Because his work laid the foundation to the study of heredity, Mendel is referred to As a genetic counselor you can: as “The Father of Genetics” Educate individuals, families, health MEDELIAN INHERITANCE: DOMINANT AND professionals and communities about family RECESSIVE PATTERNS health history, inheritance, genetic testing, Homozygous – person who has two like genes management, prevention, resources and for a trait – two healthy genes, for example research (one from the mother and one from the father) Collect family health history and provide Heterozygous – if the genes differ (a healthy disease risk assessment gene from the mother and an unhealthy gene Provide psychosocial support and counseling from the father, or vice versa) to individuals, family and groups to promote Homozygous dominant – individual with two informed choices and adaptation to risks or homozygous genes for a dominant trait conditions Homozygous recessive – an individual with two genes for a recessive trait Aims in genetic counseling Genome - is the complete set of genetic Promotes informed decisions by involved information in an organism. It provides all of the family members information the organism requires to function Clarifying the family’s options available Alleles - is one of a pair of genes that appear at treatment and prognosis a particular location on a particular chromosome Explains alternatives to reduce the risk of and control the same characteristic, such as genetic disorders blood type or color blindness. Alleles are also Decrease the incidence of genetic disorders called allelomorphs. Your blood type is Reducing the impact of disorders determined by the alleles you inherit from your parents. Indications for genetic counseling Heredity disease in a family Birth defects GENETIC COUNSELING Mental retardation A process by which patients or relatives at risk Advanced maternal age of an inherited disorder are advised of the Early onset of cancer consequences and nature of the disorder, the Miscarriages probability of developing or transmitting it and Malformations Tendency to develop a neurologic conditions 20 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Informations in genetic counseling 6. Tends to advise, make decisions, be coercive, 1. Magnitude risk of recurrence or occurrence persuasive, influencing, directing and 2. Impact of disease on patient and family controlling 3. Modification of disease impact and risk 7. Communicates enables, explores, 4. Anticipated future development encourages, informs, offers choices, discusses, promotes autonomy emphatic, Steps in genetic counseling non-judgemental and respectful to clients 1. Assessment 2. Diagnosis Nurse as a genetic counselor 3. Prognosis 1. Play an important role in follow up clarifying 4. Treatment information, providing continuous support to the grieving process as appropriate As a genetic counselor, you have many career 2. Helps to decrease the risk of transmitting the options, including: disorder Clinical: Prenatal: Provide genetic counseling services Types of genetic screening to pregnant women, couples planning a 1. Carrier identification pregnancy, couples who are at risk for having 2. Prenatal diagnosis a baby with a genetic condition, or women 3. Newborn screening who have experienced pregnancy loss among 4. Forensic screening (paternity test) other Adult: Provide genetic counseling services to Carrier testing is a type of genetic testing that is used individuals with medical and genetic to determine whether a person is carrier for specific conditions, or a family history of a condition autosomal recessive diseases such as cancer, cardiovascular disease, This kind of testing is used most often by Huntington disease or Alzheimer disease couples who are considering becoming pregnant to determine the risks of their child Role of genetic counselors inheriting one of these genetic disorders 1. Provide genetic information, with their ability to emphatically connect with their patients, Diagnosis tests that can identify Down syndrome that leads to demand for their skills include: 2. Must have strength to make their clients have a. Chorionic villus sampling (CVS). In CVS, cells their most interest and foremost priority and are taken from the placenta and used to keenly attuned to complex professional and analyze the fetal chromosomes ethical challenges b. This test is typically performed in the first 3. Uses non-directive counseling methods to trimester, between 10 and 13 weeks of provide the best service to those who need pregnancy them 4. Develop mutual relationship with the client, to Newborn screening refers to a set of special tests, understand her or him, to relieve including blood, hearing and heart screening, done to psychological distress, promote a sense of one to two day old infants, usually before they leave control, and help find a solution to a problem the hospital 5. Assess the client’s strengths, values and This is to check for any serious health needs; provide an individual and flexible style disorders that do not show signs at birth of counseling based on the client's needs 21 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A So babies can begin treatment as soon as possible-before the disease even turn serious or so early interventions can be made TRISOMY 13 SYNDROME - Trisomy 13 syndrome (Patau syndrome), the child has an chromosome 13 and severely cognitively challenged a. Midline body disorders such as cleft lip and palate, heart disorders (particularly ventricular septal defects) and abnormal genitalia are present 22 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Nursing Care Related to Psychological Changes Description Psychological and First trimester task: Partners both spend time Physiologic Changes of Accepting the pregnancy recovering from the surprise of learning they are pregnant and Pregnancy concentrate on what it feels like to be pregnant. A common reaction is Pregnancy ambivalence, or feeling - It is a physiological state of a female which is both pleased and not produced due to the implantation of the fertilized pleased about the ovum in the uterine endometrium and ultimately pregnancy giving rise to a fetus Second trimester task: Partners move through Accepting the fetus emotions such as narcissism and Psychological Changes introversions as they concentrate on what it Social feel like to be a parent. Role playing and The pregnant person went alone to a physician's increased dreaming are office for care; at the time of birth, they were common separated from their family, hospitalized, in seclusion from visitors and even from the new baby for 1 week Third trimester task: Partners prepare clothing afterwards so the newborn could be fed by nurses Preparing for the baby and sleeping and end of pregnancy arrangements for the Cultural baby but also grow impatient as they ready A person's cultural background may strongly themselves for birth influence how active a role they want to take in their pregnancy because certain beliefs and taboos can Emotional Responses place restrictions on their behavior and activities (Tradukunda, 2020) Grief - The thought that grief can be associated Family with what many consider a positive process seems at first incongruent. But The family in which a pregnant person was raised before a parent can take on a parenting can be influential to their beliefs about pregnancy role, they have to give up or alter their because it is part of the cultural environment present role as they will never be the Personal Influences person they have been in exactly the same way again. A person’s ability to cope with or adapt to stress Narcissism plays a major role in how they can resolve any conflict - Self-centeredness (narcissism) may be about becoming a parent. early reaction to pregnancy. A person who previously perhaps was barely Psychological Tasks conscious of their body, who dressed in TABLE 10.1: Common Psychological Changes That the morning with little thought about Occur With Pregnancy 23 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A what to wear, suddenly begins to - Mood changes occur frequently in a concentrate on these aspects of their life pregnant person, partly as a symptom of Introversion versus extroversion narcissism (i.e., their feelings are easily - Introversion, or turning inward to hurt by remarks that would have been concentrate on oneself and one’s body, laughed off before) and partly because is a common finding during pregnancy. of hormonal changes, particularly the Some people, however, react in an sustained increase of estrogen and entirely opposite fashion and become progesterone. more extroverted. Changes in sexual desire Body image and boundary - Most pregnant people report their sexual - Body image (i.e., the way your body desire changes, at least to some appears to yourself) and body boundary degree, during pregnancy. People who (i.e., a zone of separation your perceive formerly were worried about becoming between yourself and objects or other pregnant might truly enjoy sexual people) both change during pregnancy relations for first time during pregnancy as a person begins to envision Changes in expectant family themselves as a parent or becoming - Most parent are aware that their older “bigger” in many different ways. children need preparation when a new Stress baby is on the ebay; however, knowing - Because pregnancy brings with it such a preparation is needed and being major role change, it can be extreme prepared to explain where babies come stress in a person who was not planning from are two different things. to be pregnant or if they find their TABLE 10.3 TIMETABLE FOR PHYSIOLOGIC lifestyle changing dramatically after CHANGES OF PREGNANCY (last page of this topic) becoming pregnant Physiologic Changes Depression Reproductive system changes - A feeling of sadness marked by loss of Uterine changes interest in usual things, feelings of guilt - The most obvious alteration in the body or low self-worth, disturbed sleep, low during pregnancy is the increase in size energy and poor concentration - is a of the uterus to accommodate the common finding in late adolescents. growing fetus. Over the 10 lunar months Depression causes as many as 15% of of pregnancy, the uterus increases in people to enter pregnancy feeling length, depth, width, weight, wall depressed; others grow depressed thickness, and volume during pregnancy, especially if they lack Amenorrhea a meaningful support person (Lie et al., - (i.e., an absence of a menstrual flow) 2017) occurs with pregnancy because of the Couvade syndrome suppression of follicle-stimulating - Many partners experience physical hormone (FSH) by rising estrogen levels symptoms such as nausea, vomiting Cervical changes and backache to the same degree or - In response to the increased level of even more intensely than their partner circulating estrogen produced by the during pregnancy; some begin to gain placenta during pregnancy, the cervix of weight along with their partner. the uterus becomes more vascular and Emotional lability edematous than usual. 24 MATERNAL AND CHILD HEALTH NURSING Prof. Ruffina Salvador | Vanessa Gwen M. Samar | BSN 2A Vaginal Changes luteum (the temperature, which increases at - Under the influence of estrogen, the ovulation, remains elevated vaginal epithelium and underlying tissues increase in size as they become TABLE 10.5 RESPIRATORY CHANGES DURING enriched with glycogen. Muscle fibers PREGNANCY loosen from their connective tissue base in preparation for great distention at Variable Change birth Ovarian Changes Vital capacity No change - Ovarian stops with pregnancy because of the active feedback mechanism of Tidal volume Increased by 30%-40% estrogen and progesterone produced Respiratory rate Increased by 1 or 2 early in pregnancy by the corpus luteum breaths/min and late in pregnancy by the placenta, Changes in breasts Residual volume Decreased by 20% - Subtle changes in the breast may be one of the first physiologic changes of Plasma PCO2 Decreased to about pregnancy a person notices (at about 6 27-32 mm Hg weeks) Plasma pH Increased to 7.40-7.45 Systemic Changes Endocrine system - almost all aspects of the Plasma PO2 Increased to 104-108 mm endocrine system increase during pregnancy in Hg order to support the fetal growth - Placenta Respiratory minute Increased by 40% - Pituitary gland volume - Thyroid and parathyroid glands Expiratory reserve Decreased by 20% - Adrenal glands - Pancreas Immune system - immunologic competency Cardiovascular system during pregnancy decreases, probably to - Blood volume prevent a pregnant person’s body from rejecting - Iron, folic acid, and vitamin needs the fetus as if it were a transplanted organ. - Heart - Competency decreases - Blood pressure - IgG is decreased - Peripheral blood flow - Increase in WBC - Supine hypotension syndrome Integumentary system - as the uterus - Blood constitution increases in size, the abdominal wall must Gastrointestinal system stretch to accommodate it. (Striae) Urinary system Respiratory system - a local change that often - Fluid retention occurs in the respiratory system is marked - Renal function congestion, or “stuffiness” of the nasopharynx, a - Ureter and bladder function response, again to increased estrogen levels. Temperature - early in pregnancy body TABLE 10.7 URINARY TRACT CHANGES DURING temperature increases slightly because of the PREGNANCY secretion of progesterone from the corpus