Care of Mother, Child, and Adolescent PDF

Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ADVANCED-PRACTICE ROLES FOR NURSES FRAMEWORK FOR MATERNAL AND CHILD IN MATERNAL AND CHILD HEALTH HEALTH NURSING...

Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ADVANCED-PRACTICE ROLES FOR NURSES FRAMEWORK FOR MATERNAL AND CHILD IN MATERNAL AND CHILD HEALTH HEALTH NURSING Clinical nurse specialists STANDARDS OF M/C HEALTH NURSING o Are nurses prepared at the master’s PRACTICE or doctorate degree level who are 1. Health Promotion - Educating clients to be capable of acting as consultants in aware of good health through teaching and their area of expertise role modeling. Neonatal Nurse Specialists 2. Health Maintenance - Intervening to o Manage the care of infants at birth maintain health when risk of illness is and in intensive care settings; present. ensure the newborn remains well. 3. Health Restoration - Promptly diagnosing Childbirth Educators and treating illness using interventions that o Teach families about normal birth will return client to wellness most rapidly. and how to prepare for labor and 4. Health Rehabilitation - Preventing further birth. complications from an illness; bringing an ill Lactation Consultants client back to an optimal state of wellness or o Educate women about helping a client to accept inevitable death breastfeeding and support them while they learn how to do this. STANDARDS OF CARE AND MEASURES OF Genetic Nurse Counselors QUALITY (WHO) o Consult with families about patterns Standard 1: Every woman and newborn of inheritance and offer support to receive routine, evidence-based care and families with a child who has management of complications during labor, inherited a genetic disorder. childbirth and the early postnatal period, Case Manager according to WHO guidelines. o A graduate level nurse who Standard 2: The health information system supervises a group of patients from enables use of data to ensure early, the time they enter a health care appropriate action setting until they are discharged Standard 3: Every woman and newborn with from the setting condition(s) that cannot be dealt with o Case management can be a vastly effectively with the available resources is satisfying nursing role, because if appropriately referred. the healthcare setting is Standard 4: Communication with women “seamless,” or one that follows and their families is effective and responds to people both during an illness and their needs and preferences. on their return to the community. Standard 5: Women and newborns receive Nurse Practitioners care with respect and preservation of their o Are educated at the master’s or dignity. doctoral level. Play pivotal roles in Standard 6: Every woman and her family today’s health care system. are provided with emotional support that is o Recent advances in technology, sensitive to their needs and strengthens the research, and knowledge have woman’s capability. amplified the need for longer and Standard 7: For every woman and newborn, more in-depth education for nurse competent, motivated staff are consistently practitioners as they play pivotal available to provide routine care and roles in today’s health care system. manage complications. Women’s Health Nurse Practitioner Standard 8: The health facility has an o Has advanced study in the appropriate physical environment, with promotion of health and prevention adequate water, sanitation and energy of illness in women. supplies, medicines, supplies and equipment o Such a nurse plays a vital role in for routine maternal and newborn care and educating women about their management of complications. bodies and sharing with them methods to prevent illness; in addition, they care for women with illnesses such as sexually Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT transmitted infections, and offer confidentiality, and are accountable for the information and counsel them about quality of nursing care. reproductive life planning. Understanding the scope of practice and Pediatric Nurse Practitioner (PNP) standards of care can help nurses practice o A nurse prepared with extensive within appropriate legal parameters. skills in physical assessment, Nurses need to be conscientious about interviewing, and well-child obtaining informed consent for invasive counseling and care. procedures and determining that pregnant o In this role, a nurse interviews woman are aware of any risk to the fetus parents as part of an extensive associated with a procedure or test. health history and performs a Documentation is essential for protecting a physical assessment of the child. nurse and justifying his or her actions. Neonatal Nurse Practitioner Adolescents who support themselves or who o is an advanced-practice role for are pregnant are termed “emancipated nurses who are skilled in the care of minors” or “mature minors” and have the newborns, both well and ill. right to sign for their own health care. o NNPs may work in level 1, level 2, Some of the most difficult ethical quandaries or level 3 newborn nurseries, in health care today are those that involve neonatal follow-up clinics, or children and their families. physician groups. Examples are: Conception issues related to in vitro Family Nurse Practitioner (FNP) o provides health care not only to fertilization, embryo transfer, ownership of women and children but also to the frozen oocytes or sperm, cloning, stem cell family as a whole. research, and surrogate mothers o In conjunction with a physician, an Abortion, particularly partial-birth abortions FNP can provide prenatal care for a Fetal rights versus rights of the mother woman with an uncomplicated Use of fetal tissue for research pregnancy. Resuscitation (for how long should it be Certified Nurse Midwife continued?) o an individual educated in the two Number of procedures or degree of pain that disciplines of nursing and midwifery a child should be asked to endure to achieve and licensed. a degree of better health. o Plays an important role in assisting Balance between modern technology and women with pregnancy and quality of life. childbearing. Either independently STATISTICAL TERMS USED TO REPORT or in association with a physician, MATERNAL AND CHILD HEALTH the nurse-midwife assumes full Birth rate: Number of births per 1000 responsibility for the care and population management of women with Fertility rate: Number of pregnancies per uncomplicated pregnancies. 1000 women of childbearing age. Fetal death rate: Number of fetal deaths LEGAL CONSIDERATIONS OF M AND C (weighing more 500 g) per 1000 live births. PRACTICE Neonatal death rate: Number of deaths per Maternal and child health nursing carries 1000 live births occurring at birth or in the some legal concerns that extend above and first 28 days of life. beyond other areas of nursing, care is often Perinatal death rate: Number of deaths of given to an “unseen client”—the fetus—or to fetuses weighing more than 500 g and within clients who are not of legal age for giving the first 28 days of life per 1000 live births. consent for medical procedures. In addition, Maternal mortality rate: Number of labor and birth of a neonate are considered maternal deaths per 100,000 live births that “normal” events, so the risks for a lawsuit are occur as a direct result of the reproductive greater when problems arise (O’Grady et al., process. 2007) Infant mortality rate: Number of deaths per Nurses are legally responsible for protecting 1000 live births occurring at birth or in the the rights of their clients, including first 12 months of life. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT Childhood mortality rate: Number of A maternal and child health nurse serves as deaths per 1000 population in children, 1 to an advocate to protect the rights of all family 14 years of age members, including the fetus. NURSING THEORY Maternal and child health nursing includes a One of the requirements of a profession high degree of independent nursing (together with other critical determinants, functions, because teaching and counseling such as member-set standards, monitoring are major interventions. of practice quality, and participation in Promoting health and disease prevention are research) is that the concentration of a important nursing roles because these discipline’s knowledge flows from a base of protect the health of the next generation. established theory. Maternal and child health nurses serve as Nursing theorists offer helpful ways to view important resources for families during clients so that nursing activities can best childbearing and childrearing as these can meet client needs—for example, by seeing a be extremely stressful times in a life cycle. pregnant woman not simply as a physical Personal, cultural, and religious attitudes and form but as a dynamic force with important beliefs influence the meaning and impact of psychosocial needs, or by viewing children childbearing and childrearing on families. as extensions or active members of a family Circumstances such as illness or pregnancy as well as independent beings. Only with this are meaningful only in the context of a total broad theoretical focus can nurses life. appreciate the significant effect on a family of Maternal and child health nursing is a a child’s illness or of the introduction of a challenging role for nurses and a major new member. factor in keeping families well and optimally Another issue most nursing theorist’s functioning. address is how nurses should be viewed or GOALS OF MATERNAL AND CHILD HEALTH what the goals of nursing care should be. NURSING Extensive changes in the scope of maternal The primary goal of maternal and child and child health nursing have occurred as health nursing care can be stated simply as health promotion, or keeping parents and the promotion and maintenance of optimal children well, has become a greater priority. family health to ensure cycles of optimal With health promotion as a major nursing child- bearing and childrearing. goal, teaching, counseling, supporting, and The goals of maternal and child health advocacy are also common roles nursing care are necessarily broad because (Vonderheid et al., 2007). Nurses care for the scope of practice (the range of services clients who are more critically ill than ever and care that may be provided by a nurse before. Because care of women during based on state requirements) is so broad. pregnancy and of children during their The range of practice includes: developing years helps protect not only o Preconceptual health care current health but also the health of the next o Care of women during three generation, maternal-child health nurses fill trimesters of pregnancy and the these expanded roles to a unique and puerperium (the 6 weeks after special degree. childbirth, sometimes termed the fourth trimester of pregnancy) PHILOSOPHY OF MATERNAL AND CHILD o Care of infants during the perinatal HEALTH NURSING period (6 weeks before conception Maternal and child health nursing is family to 6 weeks after birth) centered; assessment must include both o Care of children from birth through family and individual assessment data. adolescence Maternal and child health nursing is o Care in settings as varied as the community centered; the health of families birthing room, the pediatric depends on and influences the health of intensive care unit, and the home communities. In all settings and types of care, keeping the Maternal and child health nursing is family at the center of care or considering evidence based, because this is the means the family as the primary unit of care is an whereby critical knowledge increases. essential goal. This is because the level of a family’s functioning affects the health status Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT of its members (Vonderheid, Norr, & Handler, HUMAN SEXUALITY 2007). A healthy family, on the other hand, It is a multidimensional concept. establishes an environment conducive to It can be defined broadly by stating that growth and health-promoting behaviors that sexuality integrates the somatic (bodily), sustain family members during crises. emotional, intellectual, & social aspects of Similarly, the health of an individual and his being a human sexual being. or her ability to function strongly influence It involves the anatomy & physiology of the the health of family members and overall human body, as well as one’s attitudes & family functioning. For these reasons, a feelings about oneself. family-centered approach enables nurses to BIOLOGIC GENDER better understand individuals and their effect It is the term used to denote chromosomal on others and, in turn, to provide holistic sexual development: male (XY) or female care. (XX) WHO 17 SUSTAINABLE DEVELOPMENT SEXUAL OR GENDER IDENTITY GOALS It is the inner sense a person has of being male or female. GENDER ROLE It is the behavior a person conveys about being a male or female. SEX VS GENDER Sex and gender are not the same. In general terms, SEX refers to a person’s physical characteristics at birth, and GENDER 1. No Poverty encompasses a person’s identities, 2. Zero Hunger expressions, and societal roles. 3. Good Health and Well-being 4. Quality Education 5. Gender Equality 6. Clean Water and Sanitation 7. Affordable and Clean Energy 8. Decent Work and Economic Growth 9. Industry, Innovation, and Infrastructure 10. Reduced Inequality 11. Sustainable Cities and Communities 12. Responsible Consumption and Production 13. Climate Action COMPONENTS OF SEXUALITY 14. Life Below Water Reproductive Sexuality - involves the 15. Life on Land biological aspects of conception & 16. Peace and Justice Strong Institutions procreation. 17. Partnerships to achieve the Goal Gender Sexuality - deals w/ the social & emotional aspects of being a man or a TERMINOLOGIES woman. Infant Mortality Rate - is the number of Erotic Sexuality - refers to sexual love and deaths among infants from birth to 1 year of arousing sexual desires age per 1000 live births. TYPE OF SEXUAL ORIENTATION Maternal Mortality Rate - is the number of Heterosexuality – one who finds sexual resident maternal deaths within 42 days of fulfillment with a member of opposite gender. pregnancy termination due to complications Homosexuality – person who finds sexual of pregnancy, childbirth, and the puerperium fulfillment with a member of his or her own in a specified geographic area. sex. Maternity Nursing – involves direct o usually, they prefer to be called as personal care to maternity pts and their “gay” for men & “lesbian” for newborn infants or to related activities on women. their behalf during the various phases of the Bisexuality – people are bisexual if they child bearing experience. achieve sexual satisfaction from both REPRODUCTIVE AND SEXUAL HEALTH homosexual and heterosexual relationship. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT Transexuality – is an individual who, although one biologic gender, feels as is he or she should be of the opposite gender o sex change operations (synthetic vagina/penis) HUMAN SEXUAL RESPONSE CYCLE: EXCITEMENT 1. EXCITEMENT occurs with physical and psychological stimulation (sight, sound, emotion or thought) that causes parasympathetic nerve stimulation. This leads to arterial dilation and venous constriction in the genital area ▪ A vigorous contraction of muscles in the The resulting increased blood supply leads pelvic area expels or dissipates blood and to vasocongestion and increasing muscular fluid from the area of congestion. tension. ▪ The average number of contractions for the woman is 8 to 15 contractions at intervals of one every 0.8 seconds. ▪ IN MEN, muscle contractions surrounding the seminal vessels and prostate project semen into the proximal urethra. ▪ contractions are followed immediately by three to seven propulsive ejaculatory contractions, occurring at the same time interval as in the woman, which force semen IN WOMEN, this vasocongestion causes the from the penis. clitoris to increase in size and mucoid fluid to ▪ Shortest stage in sexual response cycle appear on vaginal walls as lubrication. ▪ vagina widens in diameter and increases in length. The nipples become erect. IN MEN, penile erection occurs ▪ as both sexes, there is an increase in heart and respiratory rates and BP. HUMAN SEXUAL RESPONSE CYCLE: PLATEAU 2. PLATEAU In woman, clitoris is drawn forward and retracts under HUMAN SEXUAL RESPONSE CYCLE: the clitoral prepuce RESOLUTION ▪ lower part of the vagina becomes extremely 4. RESOLUTION congested and there is increased nipple ▪ period during which the external and internal elevation. genital organs return to an unaroused state. In men, the vasocongestion leads to distention of the ▪ usually takes 30 minutes for both men and penis. women. ▪ HR - increases to 100 to 175 beats per TYPE OF SEXUAL EXPRESSION minute ▪ CELIBACY – abstinence from sexual ▪ RR - approximately 40 respirations per activity. Ex. Priest minute. HUMAN SEXUAL RESPONSE CYCLE: ORGASM ▪ MASTURBATION – is self-stimulation for 3. ORGASM erotic pleasure. ▪ the body suddenly discharges accumulated sexual tension. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ EROTIC STIMULATION – is the use of ▪ INHIBITED SEXUAL DESIRE – lack of visual materials such as magazines or desire for sexual relations may be a concern photographs - for sexual arousal. of young or middle-aged adults. ▪ Support or a caring sexual partner ▪ FETISHISM – is sexual arousal resulting or relief of the tension causing the from the use of certain objects or situations. stress allows a return to sexual ▪ TRANSVESTISM – an individual who interest. dresses to take on the role of opposite sex. ▪ VOYEURISM – obtaining sexual arousal by looking at another’s person’s body. CASE MAPPING (RLE) CONCEPT MAPPING ▪ SADOMASOCHISM – involves inflicting pain (sadism) or receiving pain (masochism) to achieve sexual satisfaction. ▪ EXHIBITIONISM – revealing one’s genitals in public. ▪ PEDOPHILES – individuals who are interested in sexual encounters with children. DISORDERS OF SEXUAL FUNCTIONING ▪ a visual representation that allows you ▪ Erectile Dysfunction – formerly referred to graphically show the connections between a client’s many problems. as impotence ▪ an effective learning strategy to understand ▪ inability to produce or maintain an the relationship that exist between client erection long enough for vaginal problems. penetration or partner satisfaction. ▪ allows the student to organize and link ▪ Premature Ejaculation – ejaculation before information about a client in unique and penile contact. meaningful ways. ▪ can be unsatisfactory and CONCEPT MAPPING frustrating to both partners APPPLICATION TO NURSING PRACTICE ▪ can be psychological ▪ A concept map allows the student to ▪ FAILURE TO ACHIEVE ORGASM organize and link information about a client (Anorgasmia) in unique and meaningful ways. ▪ can be due to poor sexual ▪ The relationship seen between multiple technique nursing diagnoses allow students to plan ▪ or possible negative attitudes interventions that are therapeutic for more toward sexual relationships than one problem area. ▪ Use of concept maps helps students to ▪ VAGINISMUS – involuntary contraction of reflect and critically think about relationships the muscles at the outlet of the vagina when between clinical information in a way that coitus is attempted. promotes clinical decision making. ▪ muscle contraction prohibits penile ETIOLOGY penetration. ▪ It is defined as the science of finding causes and origins. ▪ DYSPAREUNIA – pain during coitus ▪ can be due to endometriosis ▪ an example of etiology is knowing that some of the causes of high blood pressure are smoking, lack of exercise, stress and a diet high in salt and fats. COMPONENTS OF CONCEPT MAP RISK FACTORS - Are conditions that increase your risk of developing a disease. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT MODIFIABLE RISK FACTORS - meaning you can MEDICAL AND SURGICAL MANAGEMENT take measures to change them. ▪ MEDICAL - A medical condition involves a more systemic, pharmaceutical approach to treatment. ▪ SURGICAL - A surgical disease is one that requires some form of localized intervention such as, of course, surgery, although various vascular interventions and radiation techniques would also fall into this category. SIGNIFICANCE/PERTINENT FINDINGS History and Physical Examination that formulate a ▪ Example: differential diagnosis o Alcohol consumption ▪ For example: if the patient's chief complaint o Overweight and obesity is chest pain, pertinent findings would o Physical activity include things like: o Healthy eating POSITIVE FINDINGS - Clinical significance is essentially a subjective interpretation of research NON–MODIFIABLE RISK FACTOR - which means findings as meaningful for patient under care, and they cannot be changed. therefore likely to influence the behavior of healthcare Examples: provider. ▪ Age according to American Heart NURSING DIAGNOSIS - is a clinical judgment Association computations, about 80 percent concerning human response to health conditions/life of people who die from cardiovascular processes. disease are 65 years and older. EXPECTED OUTCOMES - are forecasted ▪ Gender - heart disease has long been results-relate directly to program goals and objectives. considered to be primarily a men’s disease NURSING INTERVENTIONS - are the actual ▪ Family history treatments and actions that are performed to help the ▪ Race patient to reach the goals that are set for them. TYPES OF NURSING INTERVENTIONS PATHOPHYSIOLOGY - is the study of the physical and biological abnormalities occurring within the body as a result of the disease. MEDICAL DIAGNOSIS - The process of identifying a disease, condition, or injury from its signs and COMPONENTS OF CONCEPT MAP: symptoms. NURSING INTERVENTIONS ▪ A health history, physical exam, and tests, such as blood tests, imaging tests, and HEALTH TEACHING/HEALTH EDUCATION biopsies, may be used to help make a - is a social science that draws from the diagnosis. biological, environmental, psychological, DIAGNOSTIC TEST - is any approach used to gather physical and medical sciences to promote clinical information for the purpose of making a clinical health and prevent disease, disability and decision. premature death. ▪ through education - driven voluntary behavior change activities. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ GOAL: to promote, maintain, and REPRODUCTIVE AND SEXUAL HEALTH improve individual and community DEVELOPMENT OF REPRODUCTIVE SYSTEM health through the educational GONADS refers to the organs in which process. gametogenesis occurs. ▪ a body organ that produces sex cells ▪ EXERCISE - bodily or mental exertion, ▪ female gonad – ovary especially for the sake of training or ▪ male gonad – testis / testes improvement of health ▪ At approximately week 5 of intrauterine life, o Example: Walking is good exercise. primitive gonadal tissue is already formed. ▪ male and female gonads appear as gonadal ▪ DIET - the sum of food consumed by a ridges person. o often implies the use of specific ▪ In both sexes, two undifferentiated ducts, the intake of nutrition for health or mesonephric (wolffian) and weight-management reasons (with paramesonephric (müllerian) ducts, are the two often being related). present. ▪ By week 7 or 8, in chromosomal males, this early gonadal tissue differentiates into ▪ TREATMENT - an act or manner of treating. primitive testes and begins formation of o action or behavior toward a person, testosterone. animal, etc. management in the ▪ Under the influence of testosterone, the application of medicines, surgery, mesonephric duct begins to develop into the etc. male reproductive organs, and the ▪ MEDICATIONS - a substance used in paramesonephric duct regresses. ▪ If testosterone is not present by week 10, the treating disease or relieving pain. gonadal tissue differentiates into ovaries, o the act or process of treating a and the paramesonephric duct develops into person or disease with medicine. female reproductive organs. ▪ ENVIRONMENT - means anything that ▪ All of the oocytes (cells that will develop into surround us. eggs throughout the woman’s mature years) o It includes physical, chemical and are already formed in ovaries at this stage other natural forces. (MacKay, 2009). ▪ SPIRITUALITY - Involves the recognition of a feeling or sense or belief that there is something greater than myself o An opening of the heart is an essential aspect of true spirituality. ▪ DISCHARGE PLANNING - is when the patient, career, family and any staff involved make the necessary arrangements to ensure there is a smooth transition from hospital to home, residential care or somewhere else. o It involves taking into account things like follow-up tests and appointments. o Outpatient follow up - was defined as an office visit with any primary care or specialist physician. At about week 12, the external genitals develop. In males, under the influence of testosterone, penile tissue elongates and the urogenital fold on the ventral surface of the penis closes to form the urethra; Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT In females, with no testosterone present, the urogenital fold remains open to form the labia minora; what would be formed as scrotal tissue in the male becomes the labia majora n the female. FEMALE AND MALE REPRODUCTIVE SYSTEM HOMOLOGUES PUBERTY ▪ It is the stage of life at which secondary sex changes begin. ▪ Girls (estrogen) o Growth Spurt o Increase in the transverse Female diameter of the pelvis 1. Clitoral glans o Breast Development 2. Clitoral shaft 3. Labia majora o Growth of Pubic Hair 4. Ovaries o Onset of Menstruation 5. Skene’s glands o Growth of Axillary Hair 6. Bartholin’s glands o Vaginal Secretions Male 1. Penile glans 2. Penile shaft 3. Scrotum 4. Testes 5. Prostate 6. Cowper’s glands PHYSIOLOGY OF ONSET ▪ Puberty is initiated by hypothalamic pituitary-gonad complex. ▪ sequence of events by which a child is transformed into a young adult ▪ Puberty usually starts in: Girls at 10-13 years old Boys starts at 12-14 years old. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ Boys (testosterone) o GAMETES - reproductive cells that o Increase in weight are produced in the gonads. o Growth of testes 2. Fertilization - enables union of the oocyte o Growth of face, axillary & pubic by the sperm. hair o Voice changes o Penile growth o Increase in height o Spermatogenesis 3. Development and nourishment of a new individual - nurtures the developing fetus in the uterus until birth and provides nourishment (breast milk) after birth ROLE OF ANDROGENS ▪ Androgenic hormones - responsible for muscular development, physical growth ▪ an increase in sebaceous gland secretions causing typical acne in both boys & girls. ▪ produced by adrenal cortex & testes (males) 4. Production of sex hormones - Hormones produced by the reproductive system control its development and the development of the gender-specific body form. MALE REPRODUCTIVE SYSTEM: OVERVIEW FUNCTIONS ▪ consists of THE TESTES, a series of ducts, ▪ REPRODUCTION - is an essential accessory glands, and supporting structures. characteristic of living organisms, and functional male and female reproductive ▪ DUCTS - the epididymis, the ductus systems are necessary for humans to deferens/vas deferens, and the urethra. reproduce. ▪ ACCESSORY GLANDS - the seminal 1. Production of gametes - Gametogenesis - vesicles, the prostate gland, and the is the production of gametes. bulbourethral glands. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ testes descend away from the body, which ▪ Supporting structures - include the lowers their temperature. scrotum and the penis MALE REPRODUCTIVE SYSTEM: TESTIS TESTES - Also called male gonads; oval organs within the scrotum ▪ Seminiferous tubules – where sperm cells develop ▪ Interstitial cells / Leydig cells – endocrine cells that secrete testosterone ▪ Sustentacular cells / Sertoli – are large and nourish the germ cells; produce a number of hormones MALE REPRODUCTIVE SYSTEM: SCROTUM ▪ SCROTUM - Saclike structure containing the testes. ▪ Dartos muscle – layer of Smooth Muscle beneath the skin of the scrotum. ▪ Cremaster muscles – extensions of abdominal muscles into the scrotum. MALE REPRODUCTIVE SYSTEM: ▪ Dartos and Cremaster muscles - BOTH SPERMATOGENESIS regulates the temperature in the testes SPERMATOGENESIS - Formation of sperm cells COLD TEMPERATURES ▪ Spermatogonia – most peripheral germ ▪ DARTOS MUSCLE CONTRACTS, causing cells that divide through mitosis. the skin of the scrotum to become firm and ▪ Primary spermatocytes – other daughter wrinkled and reducing the overall size of the scrotum. cells that divide by meiosis and become sperm cells ▪ CREMASTER MUSCLES CONTRACT, ▪ Secondary spermatocytes – product of first which pulls the testes closer to the body, which increases the testes’ temperature meiotic division ▪ Spermatids – product of secondary meiotic WARM WEATHER OR EXERCISE ▪ dartos and cremaster muscles relax, skin of division the scrotum - loose and thin Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ Sperm cell / Spermatozoon - developed ▪ Efferent ductules – carry sperm cells from spermatid with a head, midpiece, and the testis to the epididymis. flagellum ▪ Capacitation – final changes in sperm cells ▪ ACROSOME – vesicle; anterior to the that occur after ejaculation of semen into the nucleus vagina and prior to fertilization. ▪ contains enzymes that are released ▪ Ductus Deferens / Vas deferens - Emerges during the process of fertilization ▪ necessary for the sperm cell to from the epididymis and ascends along the penetrate the oocyte, or egg cell. posterior side of the testis. ▪ contains smooth muscle, which contracts in peristaltic waves to propel the sperm cells from the epididymis through the ductus deferens. ▪ Spermatic cord – consists of the ductus deferens, testicular artery and veins, lymphatic vessels, and testicular nerve. ▪ Ampulla of the ductus deferens – ductus deferens increases in diameter. ▪ Seminal vesicle – sac-shaped gland ▪ Ejaculatory duct – formed by the ducts from the seminal vesicle and the ampulla of the ductus deferens. ▪ Urethra ▪ about 20 cm long and extends from the urinary bladder to the distal end of the penis. ▪ a passageway for both urine and male reproductive fluids. ▪ Divided into three parts: ▪ Prostatic urethra – passes through the prostate gland. ▪ Membranous urethra – passes through the floor of the pelvis; surrounded by the external urinary sphincter. ▪ Spongy urethra – extends the MALE REPRODUCTIVE SYSTEM: DUCTS length of the penis and opens at its ▪ Epididymis - A tightly coiled series of end. threadlike tubules that form a comma-shaped structure. ▪ Maturation site of sperm cells, developing the capacity to swim and the ability to bind to the oocyte. ▪ Rete testis – each seminiferous tubule empty into tubular networks. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ Prepuce / foreskin – lose fold of skin that covers the glans penis. MALE REPRODUCTIVE SYSTEM: GLANDS ▪ Prostate gland – consists of glandular; MALE REPRODUCTIVE SYSTEM: PENIS PENIS muscular tissue & empties into the urethra ▪ Male organs of copulation ▪ secretes fluid that nourishes and ▪ Functions in transfer of sperm cells from the protects sperm. male to the female ▪ Bulbourethral glands / Cowper glands – a ▪ contains three columns of erectile tissue pair of small, mucus-secreting glands that ▪ Erection – process of the empty into the urethra. engorgement of the erectile tissue with blood that causes the penis to enlarge and become firm. ▪ Corpora cavernosa – two columns of erectile tissue that form the dorsal portion. ▪ Corpus spongiosum – third, small erectile column that occupies the ventral portion of the penis. ▪ Glans penis – a formed cap ▪ External urethra orifice – spongy SECRETIONS urethra that opens to the exterior Semen - is a mixture of sperm cells and secretions part from the male reproductive glands. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT 1. seminal vesicles produce about 60% of the ▪ Inhibin – has a negative-feedback effect on fluid 2. prostate gland contributes approximately FSH secretion (granulosa and theca cells of 30% the ovary and by the Sertoli cells of the 3. testes contribute 5% testis) 4. bulbourethral glands contribute 5%. Mucus has four primary functions: from bulbourethral glands and the mucous glands of the urethra: 1. lubrication of the urethra 2. neutralization of the contents of the normally acidic urethra 3. providing a small amount of lubrication during intercourse 4. reduction of acidity in the vagina Substances include: 1. FRUCTOSE - nourish the sperm cells as they move through the female reproductive tract. 2. COAGULATION PROTEINS - help thicken the semen, which keeps the sperm cells in the vagina for a longer period of time. 3. ENZYMES - destroy abnormal sperm cells. 4. PROSTAGLANDINS - stimulate smooth muscle contractions of the female CLINICAL IMPACT ▪ Erectile dysfunction (ED) – impotence; reproductive tract to propel sperm cells failure to achieve erections infertility in males through the tract. ▪ Common cause is a low sperm cell Secretions of the prostate also have several count functions: Regulate pH ▪ INFERTILITY - is the inability or the reduced ▪ prostate secretions is alkaline. ability to produce offspring. ▪ neutralizes the acidity of the male urethra, the secretions of the testes, the secretions of ▪ OLIGOSPERMIA – low sperm count the seminal vesicles, and the vagina ▪ AZOOSPERMIA - semen contains no sperm Liquefy the coagulated semen ▪ prostate gland secretions contain proteolytic ▪ Artificial insemination – concentrating the enzymes that break down the coagulated proteins; make the semen more liquid. sperm cells and inserting them into the female’s reproductive tract. PHYSIOLOGY OF MALE REPRODUCTION REGULATION OF SEX HORMONE SECRETION ▪ Gonadotropin-releasing hormone (GnRH) – produced in hypothalamus; stimulates release of LH and FSH from the anterior pituitary. ▪ Luteinizing hormone (LH) – stimulates interstitial cells to produce testosterone ▪ Follicle-stimulating hormone (FSH) – binds to sustentacular cells and stimulates spermatogenesis and secretion of inhibin ▪ Testosterone – has a negative-feedback effect on GnRH, LH, and FSH Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT FEMALE REPRODUCTIVE SYSTEM OOGENESIS AND FERTILIZATION ▪ consist of the ovaries, the uterine tubes (or ▪ OOGONIA – the cells form which oocytes fallopian tubes) ▪ uterus, the vagina, the external develop. genitalia, and the mammary glands. ▪ Primary oocyte – oogonia that has stopped ▪ internal reproductive organs of the female in prophase I are located within the pelvis, between the urinary bladder and the rectum. ▪ Secondary oocyte – released when the first ▪ UTERUS AND THE VAGINA are in the meiotic division is complete. midline, with an ovary to each side of the ▪ Ovulation – release of an oocyte from an uterus. ovary. ▪ Fertilization – when a sperm cell penetrates the cytoplasm of a secondary oocyte ▪ Zygote ▪ 23 chromosomes from the sperm ▪ + 23 chromosomes from the female gamete FEMALE REPRODUCTIVE SYSTEM: OVARIES Broad ligament – spreads out on both sides of the uterus and attaches to the ovaries and uterine tubes Ovary - is a small organ suspended in the pelvic cavity by two ligaments ▪ Suspensory ligament – extends from each ovary to the lateral body wall ▪ Ovarian ligament – attaches the ovary to the superior margin of the uterus ▪ Mesovarium – folds of peritoneum Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT FOLLICLE DEVELOPMENT ▪ Primordial follicle – primary oocyte surrounded by granulosa cells (single layer of flat cells) ▪ Primary follicles – oocyte enlarges and the single layer of granulosa cells become enlarged and cuboidal. ▪ Zona pellucida – a layer of clear material that is deposited around the primary oocyte. UTERUS ▪ Secondary follicle – fluid-filled vesicles ▪ Fundus – superior to the entrance of the appear and a theca form around the follicle. uterine tubes ▪ Fluid filled spaces - vesicles ▪ Body – main part of the uterus ▪ Theca – a capsule that forms around the ▪ Cervix – inferiorly, narrower part follicle ▪ the lowest portion of the uterus ▪ represents approximately one third ▪ Antrum – a single, fluid-filled chamber of the total uterus size ▪ cervical canal ▪ Cumulus cells – mass of granulosa cells ▪ Prolapsed uterus – occurs when the uterus ▪ Graafian follicle – mature follicle extends inferiorly into the vagina. ▪ Corpus luteum – remaining cells of the ruptured follicle are transformed into a glandular structure ▪ Human chorionic gonadotropin hormone (hCG) – the corpus luteum enlarges in response to this hormone UTERINE TUBES 1. Fallopian tube or oviduct 2. Receive the secondary oocyte Fimbriae – long, thin processes that surrounds each the opening of each uterine tube. Cilia on fimbriae – sweep the oocyte into the uterine tube. Ampulla – where fertilization usually occurs. Implantation – process wherein the fertilized oocyte embeds itself in the uterine wall. ▪ Perimetrium – outer layer; serous layer of the uterus formed from visceral peritoneum. ▪ Myometrium – middle layer; muscular layer that accounts for the bulk of the uterine wall. ▪ Endometrium – innermost layer; consists of simple columnar epithelial cells with an underlying CT layer. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT UTERINE DEVIATIONS Hymen – thin mucous membrane Ordinarily, the body of the uterus is tipped slightly ▪ inside the opening of the vagina forward. ▪ Rarely, completely close the vaginal A. Anteversion- a condition in which the entire orifice and it must be removed to uterus is tipped far forward. allow menstrual flow. B. Anteflexion -a condition in which the body ▪ More commonly, the hymen is of the uterus is bent sharply forward at the perforated by one or several holes. junction with the cervix. ▪ greatly enlarged during the first C. Retroversion- a condition in which the entire sexual intercourse. uterus is tipped backward. Hymenectomy - is a minor procedure to D. Retroflexion- a condition in which the body surgically remove or open the hymen. is bent sharply back just above the cervix. EXTERNAL GENITALIA ▪ Vulva – pudendum; external female genitalia ▪ Vestibule – the space into which the vagina VAGINA and urethra open VAGINA ▪ Labia minora – longitudinal skin folds 1. female organ of copulation 2. it receives the penis during intercourse ▪ Clitoris – small, erectile structure; well 3. It also allows menstrual flow and childbirth supplied with sensory receptors, made up of smooth muscle + elastic fibers erectile tissue ▪ can increase in size to accommodate the penis during intercourse, and it can stretch ▪ Greater vestibular glands – produce a greatly during childbirth. lubricating fluid that helps maintain the ▪ Ph is acidic due to the action of Doderlein’s moistness of the vestibule bacillus. ▪ Labia majora – prominent, rounded folds of skin Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ Mons pubis – an elevation of tissue over the ▪ Menstrual cycle – series of changes that pubic symphisis occur in sexually mature, non-pregnant females, and that culminate in menses ▪ Pudendal cleft – space bet. the labia majora ▪ Menses – a period of mild hemorrhage; part ▪ Clinical perineum – region bet. the vagina of the endometrium is sloughed and expelled and the anus from the uterus; day 1 – 4: menstrual fluid is ▪ Episiotomy – an incision made in the produced by degeneration of the endometrium. clinical perineum to avoid tearing during childbirth. ▪ AMENORRHEA - absence of a menstrual cycle MAMMARY GLANDS 1. Organs of milk production ▪ Ectopic pregnancy – implantation occurs 2. Located in the breasts anywhere other than in the uterine cavity 3. Modified sweat glands ▪ Areola – a circular, pigmented area that surrounds the nipple ▪ Glandular lobes – covered by adipose HORMONES ESTROGEN & PROGESTERONE ▪ Aid in uterine and mammary gland development and function, external genitalia structure, secondary sexual characteristics, sexual behavior, menstrual cycle. ▪ Estrogen - is the hormone that regulates the tissue; gives the breast its form. menstrual cycle. ▪ Progesterone - is the hormone that ▪ Lactiferous duct – opens independently to supports pregnancy. the surface of the nipple HUMAN CHORIONIC GONADOTROPIN (HCG) ▪ Myoepithelial cells – surround the alveoli ▪ Stimulate production of estrogen & progesterone and contract to expel milk from the alveoli ▪ created by trophoblast tissue, tissue typically ▪ GYNECOMASTIA – occurs when the found in early embryos breasts of a male become permanently ▪ stimulates the corpus luteum to produce enlarged; results from hormonal imbalance progesterone to maintain the pregnancy. and the abuse of anabolic steroids OXYTOCIN ▪ caused by male estrogen levels that ▪ stimulates labor are too high ▪ Increased uterine contractions OTHER TERMS RELATED TO FEMALE ▪ increased milk expulsion from mammary REPRODUCTION glands PROLACTIN ▪ Menarche – first episode of the menstrual ▪ Development of breast during pregnancy bleeding (first occurrence) Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ Stimulates milk prod and prolongs (the adenohypophysis) produces progesterone secretion two hormones that act on the NCMA 217 (RLE) ovaries to further influence the MENSTRUATION menstrual cycle: ◦ monthly discharge of blood from the uterus ◦ FSH, a hormone that is active early occurring from puberty to menopause in the cycle and is responsible for wherein about 30-60 cc of blood, epithelial maturation of the ovum cells and mucus are being discharged ◦ LH, a hormone that becomes most ◦ The purpose of a menstrual cycle is to bring active at the midpoint of the cycle an ovum to maturity and renew a uterine and is responsible for ovulation, or tissue bed that will be responsible for the release of the mature egg cell from ova’s growth should it be fertilized. It is the the ovary, and growth of the uterine process that allows for conception and lining during the second half of the implantation of a new life. menstrual cycle. ◦ The length of menstrual cycles differs from 3. Ovary woman to woman, but the average length is ◦ As it grows, its cells produce a clear 28 days (from the beginning of one fluid (follicular fluid) that contains a menstrual flow to the beginning of the next). high degree of estrogen (mainly ◦ It is not unusual for cycles to be as short as estradiol) and some progesterone. 23 days or as long as 35 days. The length of At this stage of maturation, the the average menstrual flow (termed menses) small ovum (barely visible to the is 4 to 6 days, although women may have naked eye, approximately the size periods as short as 2 days or as long as 7 of a printed period), with its surrounding follicle membrane and fluid, is termed a graafian follicle. ◦ After an upsurge of LH from the pituitary, prostaglandins are released and the graafian follicle ruptures. The ovum is set free from the surface of the ovary, a process termed ovulation. It is swept into the open end of a fallopian tube 4. Uterus - also illustrates uterine changes that occur monthly as a result of stimulation from the hormones produced by the ovaries. days. EFFECTS OF ESTROGEN TO THE BODY PHYSIOLOGY OF MENSTRUATION ⮚ Inhibits production of FSH Four body structures are involved in the physiology of ⮚ Causes hypertrophy and hyperplasia of the menstrual cycle: the hypothalamus, the pituitary myometrium gland, the ovaries, and the uterus. ⮚ Stimulates the growth of ductile structures of 1. Hypothalamus the breast ◦ The release of GnRH (also called ⮚ Increases quantity and pH of cervical mucus luteinizing hormone–releasing causing it to become watery and can be to a hormone, or LHRH) by the distance of 10-13 cm. (Spinnbarkeit test of hypothalamus initiates the dilation). menstrual cycle. EFFECTS OF PROGESTERONE IN THE BODY ◦ GnRH is transmitted from the ⮚ Inhibits production of LH. hypothalamus to the anterior ⮚ Facilitates transport of fertilized ovum pituitary gland and signals the gland through the fallopian tubes. to begin producing the gonadotropic ⮚ Causes fluid retention hormones FSH and LH. Because ⮚ Decreased hemoglobin and hematocrit production of GnRH is cyclic, levels menstrual periods also cycle. ⮚ Increased basal body temperature after 2. Pituitary Gland ovulation because of the presence of ◦ Under the influence of GnRH, the progesterone. anterior lobe of the pituitary gland Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT THE MENSTRUAL CYCLE FERTILIZATION: THE BEGINNING OF 1. On the third day of the menstrual cycle, PREGNANCY serum estrogen level is at lowest which ◦ Fertilization (also referred to as conception stimulates the hypothalamus to produce and impregnation) is the union of an ovum follicle stimulating hormone releasing factor and a spermatozoon. This usually occurs in (FSHRF). the outer third of a fallopian tube, the 2. FSHRF is responsible for stimulating the ampullar portion (Crombleholme, 2009). anterior pituitary gland (APG) to produce the ◦ Usually only one of a woman’s ova will reach FSH which will act on one immature oocyte maturity each month. Once the mature inside. a primordial follicle, stimulating its ovum is released, fertilization must occur growth. fairly quickly because an ovum is capable of 3. In view of the FSH, estrogen is now going to fertilization for only 24 hours (48 hours at the be produced in an increasing amount inside most). the follicle, which is found in the ovary. Once ◦ After that time, it atrophies and becomes estrogen is present, the primordial follicle is nonfunctional. Because the functional life of now termed Graafian follicle. The GF is the a spermatozoon is also about 48 hours, structure therefore that contains high possibly as long as 72 hours, the total critical amounts of estrogen. time span during which sexual relations must 4. Estrogen in the GF will cause the cells in the occur for fertilization to be successful is uterus to proliferate (grow rapidly); about 72 hours (48 hours before ovulation increasing its thickness to about eight-fold. plus 24 hours afterward). This is called Proliferative/follicular phase. ◦ The ovum and these surrounding cells 5. On the 13th day of menstrual cycle, there is (which increase the bulk of the ovum and now a very low level of progesterone in the serve as protective buffers against injury) are blood. This stimulates the hypothalamus to propelled into a nearby fallopian tube by produce Luteinizing Hormone releasing currents initiated by the fimbriae—the fine, factor (LHRF). hairlike structures that line the openings of 6. LHRF is responsible for stimulating the APG the fallopian tubes. A combination of to produce LH. peristaltic action of the tube and movements 7. The LH in turn, is responsible for stimulating of the tube cilia help propel the ovum along the ovary to produce progesterone. The the length of the tube. increased amounts of both estrogen and ◦ At the time of ovulation, there is a reduction progesterone push the new mature ovum to in the viscosity (thickness) of the cervical the surface of the ovary until the following mucus, which makes it easy for spermatozoa day (14th) the GF ruptures and releases the to penetrate it. Sperm transport is so efficient mature ovum. close to ovulation that spermatozoa 8. Once ovulation has taken place, the GF deposited in the vagina generally reach the which contains increased amount of cervix within 90 seconds and the outer end progesterone will turn to Corpus Luteum of a fallopian tube within 5 minutes after which is yellow appearance. deposition. 9. Progesterone causes the gland of the uterine ◦ Spermatozoa move through the cervix and endothelium to become corkscrew or twisted the body of the uterus and into the fallopian in appearance. This is the hormone of tubes, toward the waiting ovum by the pregnancy because it prevents uterine combination of movement by their flagella contractions. Once the fertilized ovum (tails) and uterine contractions. developed finger-like projections called TROPHOBLAST around the blastocyst, the trophoblasts are the ones that will implant high on the anterior or posterior surface of the uterus. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ◦ Capacitation is a final process that sperm occurs approximately 8 to 10 days after must undergo to be ready for fertilization. fertilization. This process, which happens as the sperm ◦ The structure brushes against the rich move toward the ovum, consists of changes uterine endometrium (in the second in the plasma membrane of the sperm head, [secretory] phase of the menstrual cycle), a which reveal the sperm-binding receptor process termed apposition. It attaches to the sites. surface of the endometrium (adhesion) and ◦ Hyaluronidase (a proteolytic enzyme) is settles down into its soft folds (invasion). released by the spermatozoa and dissolves ◦ The blastocyst is able to invade the the layer of cells protecting the ovum. One endometrium because, as the trophoblast reason that an ejaculation contains such a cells on the outside of the structure touch the large number of sperm is probably to provide endometrium, they produce proteolytic sufficient enzymes to dissolve the corona enzymes that dissolve any tissue they touch. cells. Under ordinary circumstances, only This action allows the blastocyst to burrow one spermatozoon is able to penetrate the deeply into the endometrium and receive cell membrane of the ovum. Once it some basic nourishment of glycogen and penetrates the cell, the cell membrane mucoprotein from the endometrial glands. As changes composition to become impervious invasion continues, the structure establishes to other spermatozoa. an effective communication network with the ◦ Immediately after penetration of the ovum, blood system of the endometrium. the chromosomal material of the ovum and spermatozoon fuse to form a zygote. ◦ Because the spermatozoon and ovum each carried 23 chromosomes (22 autosomes and 1 sex chromosome), the fertilized ovum has 46 chromosomes. ◦ If an X-carrying spermatozoon entered the ovum, the resulting child will have two X chromosomes and will be female (XX). ◦ If a Y-carrying spermatozoon fertilized the ovum, the resulting child will have an X and a Y chromosome and will be male (XY). IMPLANTATION ◦ Once fertilization is complete, a zygote migrates over the next 3 to 4 days toward the body of the uterus, aided by the currents initiated by the muscular contractions of the THE FOLLOWING METHOD WILL HELP YOU FIND fallopian tubes. During this time, mitotic cell OUT YOUR FERTILE WINDOW: division, or cleavage, begins. 1. For 8 to 12 months, record the day you start ◦ The first cleavage occurs at about 24 hours; your menstrual period and count the total cleavage divisions continue to occur at a rate number of days in that cycle. Note that the of about one every 22 hours. By the time the first full flow day of your menstrual period is zygote reaches the body of the uterus, it day one. consists of 16 to 50 cells. At this stage, 2. Then write down the longest and shortest because of its bumpy outward appearance, it number of days from your monthly tracking. is termed a morula (from the Latin word 3. Find out the first day of your fertile window morus, meaning “mulberry”). by subtracting 18 days from the length of ◦ Large cells tend to collect at the periphery of your shortest cycle. For example, if your the ball, leaving a fluid space surrounding an shortest cycle was 27 days, subtract 18 from inner cell mass. At this stage, the structure 27, and write down day 9. becomes a blastocyst. It is this structure 4. Find out the last day of your fertile window that attaches to the uterine endometrium. by subtracting 11 from your length of the The cells in the outer ring are trophoblast longest cycle. For example, if it was 30 days, cells. you’d get day 19. ◦ Implantation, or contact between the growing 5. The time between the shortest and longest structure and the uterine endometrium, day is your fertile window. In the above Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT example, it would be between days 9 and 19. If you’re trying to avoid pregnancy, you’d want to avoid having unprotected sex during those days. BARRIER METHODS - work by the placement of a FAMILY PLANNING METHOD barrier between the cervix and advancing sperm so REPRODUCTIVE LIFE PLANNING that sperm cannot enter the uterus or fallopian tubes ▪ includes all the decisions an individual or and fertilize the ovum. couple make about having children. 1. Chemical Barriers - spermicide is an agent that causes the death of spermatozoa before they can enter the cervix. 2. Mechanical Barriers - work by blocking the entrance of sperm into the cervix. HORMONAL METHODS - used of hormones that cause fluctuations in a normal menstrual cycle that ovulation does not occur. SURGICAL METHOD - often called sterilization, include tubal ligation for women and vasectomy for men. NATURAL FAMILY PLANNING 1. Abstinence 2. Lactation Amenorrhea IMPORTANT THINGS TO REMEMBER IN 3. Calendar CHOOSING CONTRACEPTIVES 4. Ovulation method 1. Personal Values – beliefs / religion 5. Symptothermal 2. Ability to use a method correctly 6. Post – ovulation 3. How the method will affect sexual enjoyment 4. Financial factors 1. Abstinence – absolutely no penetration; to 5. Status of a couple’s relationship abstain from sexual intercourse. 6. Prior experiences ▪ the most effective way to protect 7. Future plans against conception and STD. CHARACTERISTICS OF EFFECTIVE ▪ TO BE SUCCESSFUL CONTRACEPTIVES communication between partners is 1. Safe important 2. 100% effective ▪ Requires a couple to abstain from 3. Easily obtainable coitus on the days of a menstrual 4. Affordable cycle when the woman is most 5. Easy to use and acceptable to both user and likely to conceive (3 or 4 days sexual partner before until 3 or 4 days after 6. Free of effects on future pregnancies ovulation) TYPES OF FAMILY PLANNING 2. Calendar (Rhythm) Method - Requires a 1. Natural Family Planning - involves no couple to abstain from coitus on the days of introduction of chemical or foreign material a menstrual cycle when the woman is most into the body. likely to conceive (3 or 4 days before until 3 2. Artificial Family Planning or 4 days after ovulation) has failure rate of ▪ Mechanical Method 9%. ▪ Chemical Method ▪ The process in calculating for the ▪ Surgical Method woman’s safe days is achieved when the woman records her menstrual cycle for six months. 3. Basal Body Temperature Method - the woman takes her temperature each morning immediately after waking, before she undertakes any activity. ▪ at the time of ovulation, the BBT rises full degree because of the influence of progesterone. Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT ▪ as she notices a slight dip in 8. Coitus Interruptus temperature followed by an increase, ▪ man withdraws the penis during the she knows that she has ovulated. ejaculation, thereby emitting the ▪ She refrains from having sex for the spermatozoa outside the vagina. next 3 days ▪ Offers little protection against conception. 4. Cervical Mucus (Billings) Method - To use ▪ one of the oldest methods of contraception. the charges in cervical mucus that occur ▪ Disadvantage: pre-ejaculation fluid that naturally with ovulation. contains a few spermatozoa that may cause ▪ Before ovulation the cervical mucus is fertilization. thick and does not stretch when pulled 9. Postcoital Douching between the thumb and finger ▪ Douching following intercourse, no matter ▪ With ovulation or during the peak day, what solution is used. the cervical mucus: copious, thinned, ▪ Sperm are known to appear in cervical watery and transparent. mucus within a few seconds after ejaculation. ▪ SPINNBARKEIT - it feels ▪ Sperm can reach site of fallopian tube within slippery and stretches at least a short time. 1 inch before the strand breaks ▪ Once sperm cells are in tube, pregnancy can ▪ mucus is copious: result and douching will not prevent this. abstains from sex. ▪ NOT a RELIABLE method HORMONAL METHODS 1. Transdermal patch 2. Vaginal ring 3. IUD (copper T) 4. IUD LNG-IUS Mirena 5. Combination oral contraceptives (COCs) 6. Injectable progesterone (Depo-Provera) 7. Intradermal Patch ARTIFICIAL FAMILY PLANNING 1. Oral Contraception / Birth Control Pills ▪ Commonly known as pills or COCs (combination oral contraceptives) 5. Symptothermal Method ▪ Composed of varying amounts of ▪ Combines the cervical mucus and BBT synthetic estrogen combined with small methods amount synthetic progesterone ▪ couple abstain from intercourse until 3 days (progestin) after the rise in temperature or the fourth day after the peak of mucus change ▪ ESTROGEN ▪ these are the woman’s fertile days. ▪ Suppress follicle stimulating 6. Ovulation Awareness hormone (FSH) and (LH), thereby suppressing ovulation ▪ Uses an OTC ovulation detection kit. ▪ PROGESTERONE ▪ Kit detects the midcycle surge of luteinizing ▪ Decrease in the permeability of hormone (LH) , that can be detected in urine cervical mucus, limiting sperm 12 to 24 hours before ovulation. motility and access to ova. ▪ 98 – 100% accurate ▪ Interfere with tubal transport and ▪ expensive endometrial proliferation to such 7. Lactation Amenorrhea Method degrees that the possibility of ▪ As long as woman is EXCLUSIVELY breast implantation is significantly – feeding an infant, there is some natural decreased suppression of ovulation. ▪ As a rule of thumb, after 6 months of breast-feeding, the woman should be advised to choose another method of contraception Care of Mother, Child, and Adolescent PRELIM EXAM WEEK 1-5 / PPT HOW DOES THE PILL WORK? ARTIFICIAL FAMILY PLANNING ▪ Stops ovulation 2. Estrogen/Progesterone Patch ▪ Thins uterine lining ▪ Transdermal patches - slowly but ▪ Thickens cervical mucus continuously release a combination of estrogen and progesterone. ▪ Applied once a week for 3 weeks ▪ During the week on which the woman is patch free a menstrual flow will occur. ▪ Mild breast discomfort and irritation at the application site ▪ May be applied at: upper outer arm, upper torso (front torso, excluding the breast), abdomen or buttocks CONTRAINDICATIONS TO ORAL CONTRACEPTIVE USE: ▪ Breastfeeding and less than 6 weeks’ postpartum ▪ Age 35 years or older and smoking 15 or 3. Vaginal Rings more cigarettes per day ▪ Silicone ring that surrounds the cervix and ▪ Multiple risk factors for arterial continually releases a combination of cardiovascular disease, such as older age, estrogen and progesterone. smoking, diabetes ▪ It is inserted by the woman and left in place for 3 weeks then removed for 1 week (to ▪ Hypertension - Elevated blood pressure of allow menstrual flow) 160 mm Hg systolic or above or 100 mm Hg ▪ Menstrual bleeding occurs during the ring diastolic or above. free week ▪ Current or history of deep vein thrombosis or ▪ Hormones released are absorbed by the pulmonary embolism vagina, thereby avoiding a “first pass” thru ▪ Major surgery that requires prolonged the liver. immobilization ▪ Current or history of ischemic heart disease ▪ Stroke NOTES TO ORAL CONTRACEPTIVE USE: ▪ Breast-fed infants have lower weight gains because the estrogen content, decrease the woman’s milk supply. ▪ After a woman stops taking a COC, she may 4. Emergency Post Coital Contraception not be able to become pregnant for 1 or 2 ▪ Often referred as” morning after pills” months, possibly 6 to 8 months. ▪ High level of estrogen they contain ▪ The pituitary gland requires a recovery apparently interferes with the production period to begin cyclic gonadotropin of progesterone, thereby prohibiting stimulation again. good implantation. ▪ Two sets of pills taken exactly 12 hours