NCM 107 Module 1 PDF
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Centro Escolar University
Anna Rubenette P. Ramos
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This document is a presentation on newborn care. It covers essential intrapartum newborn care (EINC) protocols, including drying, skin-to-skin contact, cord clamping, and early breastfeeding. It also details the importance of these practices, related equipment, and procedures.
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NCM 107- CARE OF MOTHER, CHILD AND ADOLESCENTS RELATED LEARNING EXPERIENCE Anna Rubenette P. Ramos, MAN,RN 01 EINC Essential Intrapartum Newborn Care INTRODUCTION Essential Intrapartum and Newborn Care(EINC) are set of practices with It supports the national evidence based comm...
NCM 107- CARE OF MOTHER, CHILD AND ADOLESCENTS RELATED LEARNING EXPERIENCE Anna Rubenette P. Ramos, MAN,RN 01 EINC Essential Intrapartum Newborn Care INTRODUCTION Essential Intrapartum and Newborn Care(EINC) are set of practices with It supports the national evidence based commitment to the United standards that reduce Nations in the Sustainable maternal and newborn Development Goals #3 on mortality rate improving maternal health. Importance of Essential Intrapartum Newborn Care It supports the WHO Millennium Development Goal (MDG) 4 which is to reduce under 5 child mortality rate. It minimizes the risk of illness and maximizes the newborn’s growth and development. It is a simple cost effective intervention that lessens maternal and newborn death. DOH Unang Yakap (Essential Newborn Care: Protocol For New Life) Training video from the Department of Health Unang Yakap Program (unangyakap.doh.gov.ph) FOUR CORE STEPS OF EINC. Immediate and thorough drying of the newborn Immediate and thorough drying for 30 seconds to one minute -warms the newborn and stimulates breathing.. Immediate and thorough drying of the newborn Time band: within the first 30 seconds Intervention: Dry and provide warmth to newborn Actions: Use clean and dry cloth to thoroughly dry the face, eyes, head, front and back body, arms and legs. Remove the wet cloth. Do a quick check of newborn’s breathing while drying.. Immediate and thorough drying of the newborn Note: Do not wipe out vernix caseosa as this will help stabilize the baby’s temperature and will serve as a natural moisturizer on the baby’s skin. Do not wash the baby within the 24hrs of life. Vernix caseosa - protective layer of the skin that is white cheese-like substance which was developed while the baby is in the womb Vernix Caseosa 2. Early skin to skin contact between mother and newborn Early skin to skin contact between mother and newborn and delayed washing for at least 6 hours: This prevents: * Hypothermia * Infection * Hypoglycemia 2. Early skin to skin contact between mother and newborn Time band: within the 1st minute Actions: ❑ Place the newborn in prone position on the mother’s abdomen or chest ❑ Cover the newborn’s back with a blanket and head with a bonnet ❑ Place identification band on ankle 2. Early skin to skin contact between mother and newborn Note: Do not place the newborn in a cold or wet surface. Do not do foot printing. 3. Properly timed cord clamping and cutting. Waiting for the cord pulsation to stop (Between 1 to 3 minutes). Prevents anemia and protects against brain hemorrhage in premature newborn 3. Properly timed cord clamping and cutting. Time band: within the 1 to 3 minutes Actions: Remove the 1st set of gloves Clamp and cut the umbilical cord after the cord pulsation have stopped Clamp the cord around 2 to 5 cm from the base of the baby’s abdomen Cut the cord with sterile scissors. 3. Properly timed cord clamping and cutting. Note: Always observe for oozing of blood After cord clamping, ensure that oxytocin is given to the mother. 4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in Continuous non-separation of newborn and mother for early breastfeeding protects infants from infection. The first feed provides colostrum. 4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in Time band: within the 90 minutes of age Actions: 1. Observe the newborn 2. Counsel mother on positioning and attachment. Advise the mother to: - Make sure that the newborn’s neck is neither flexed nor twisted - Make sure the newborn’s nose is opposite the nipple and the chin touching the breast - Support the newborn’s whole body and not just the neck and shoulder 4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in 3. Hold the newborn’s body close to the mother’s body 4.Wait until the newborn’s mouth is opened wide 5. Move newborn to the mother’s breast aiming the infant’s lower lip well below the nipple Look for the signs of good attachment Mouth wide open Lower lip turned outward Suckle is slow, deep and with pauses **If attachment is not good, try again and reassess. 4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in 4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in Note: Do not throw away colostrum To avoid nipple confusion, do not give bottles or pacifier Overview of Newborn Care Time band: 90 minutes to 6 hours Intervention: Do eye care, give Vitamin K prophylaxis and vaccines, physical examination of the baby and anthropometric measurement Actions: After the newborn has located the breast, administer erythromycin ointment on both eyes of the newborn. This is done to prevent ophthalmia neonatorum Inject a single dose of Vitamin K, 1 mg IM. This is done to prevent neonatal hemorrhage Overview of Newborn Care ❑ Inject Hepatitis B vaccine intramuscular and BCG intradermal. ❑ Measure head, chest and abdominal circumference length and weight the newborn then record. ❑ Thoroughly examine the baby for possible birth injuries and malformations. ❑ Do cord care. Fold the diaper below the stump; Put nothing on the stump; Wash stump with clean water and soap only if it is soiled and dry it thoroughly with a clean cloth. Seek medical care if the umbilicus is red or draining pus EINC PROCEDURES Purposes: Reduce maternal and newborn Safe and quality care of mortality birthing mothers and their newborns, within 48 hours of intrapartum period (labor and delivery) and a week of life for the newborn.. Materials Needed Sterile gloves Plastic Cord Clamp Instrument clamp Dry linens (2) Bandage scissor kidney basins (2) Materials Needed oxytocin injection cotton balls antiseptic solution BCG and Resuscitation set (ambubag, hepatitis B oxygen tubings, stethoscope, Vitamin K injection vaccines plaster). and erythromycin eye ointment ASSESSMENT: UTERINE CONTRACTION INTERVAL DURATION INTENSITY Assess for the Assess for the Check if the contractions that gradual increase in intensity of the occur at regular the duration of contraction intervals and the each contraction becomes stronger interval between and stronger each contraction. ASSESSMENT: DILATATION BLEEDING PAIN Assess if the Assess for the Assess for the cervix vaginal bleeding continuous pain progressively or discomfort at dilating the back of the abdomen PLANNING: Prior to woman’s transfer to the DR: POSITION EAT/DRINK COMMUNICATE Ensure that the Ask mother if she Communicate with mother is in her wishes to eat/ the mother, inform position of choice drink or void. her of progress of when in LABOR.. labor, gave reassurance and encouragement PLANNING: Woman Already in the DR ( Preparing for Delivery RESUSCITATION DR ROOM TEMP DEFAULT POSITION AREA Check temperature in the Ask if the patient is Prepare a clear and clean DR area to be 25 to 28 °C; comfortable in the semi- newborn resuscitation Eliminates air drafts upright area. PRIVACY JEWELRY LINEAR SEQUENCE Ensures woman’s Removes all jewelry and wash privacy hands thoroughly observing Arrange materials in linear the 1-2-3-4-5 procedure sequence PLANNING: PERINEUM Handwashing and Cleanse the perineum gloving with antiseptic solution Wash hands and put on two pairs od sterile gloves aseptically. IMPLEMENTATION At the Time of Delivery 1. Encourage woman to push The primary provider continues as desired. to coach and encourage the woman to push once there is contraction. 2. Drape the clean, dry linen Clean dry linen is spread in the over the mother’s abdomen abdomen of the mother and it is used to dry the baby. or arms in preparation for drying the baby IMPLEMENTATION At the Time of Delivery 3. Applies perineal support As soon as the head of a fetus is and did controlled delivery prominent (approximately 8cm across) at the vaginal opening, one of the head. technique to help the fetus achieve extension and allow the smallest head diameter to present is for the care provider to place a sterile towel over the rectum and press forward of the fetal chin while the other hand presses downward to the occiput (a Ritgen’s maneuver). IMPLEMENTATION At the Time of Delivery 4. Calls out time of birth The time of birth is the precise time and gender of the baby when the entire body is out of the mother, this time should be recorded. In case of multiple birth each birth would be noted in the same way. (Perry et al, 2014). The sex of the baby should be announced together with the time of birth. IMPLEMENTATION At the Time of Delivery 5. Inform mother of the It is important that the mother outcome. will be informed of the outcome through showing the baby to her and let her determine the sex of her baby. This is to make her aware of the sex of the baby. IMPLEMENTATION First 30 minutes 6. Thoroghly dried the Drying the newborn quickly can prevent baby for at least 30 heat loss. Keep the baby at the same seconds, starting from level as the mother’s uterus until the the face and head, going end of the cord stops pulsating. Note: The baby should be kept at the same down to the trunk and level as the mother’s uterus to prevent extremities while his or her blood from flowing to or from performing a quick the placenta and the resultant check for breathing. hypovolemia or hypervolemia. Do not 1-3minutes “milk” the cord. (Perry et al, 2014).. IMPLEMENTATION First 30 minutes 7. Remove the wet cloth This is to prevent hypothermia. 8. Place the baby in skin- Skin-to-skin contact immediately to-skin contact on the after birth and then newborn’s first mother’s abdomen or attempt at breastfeeding further chest. augment maternal oxytocin levels. 9. Cover the baby with the Putting on a stockinet cap dry cloth and the baby’s will further reduce heat loss after head with a bonnet drying. IMPLEMENTATION First 30 minutes 10. Excluded a 2nd baby by This is done to ensure that there is a palpating the abdomen in single pregnancy. preparation for giving oxytocin. 11. Use wet cloth to wipe Oxytocin is for the contraction of the the soiled gloves. Give IM uterus and it decreases bleeding. oxytocin within 1 minute (Perry et al, 2014.). of baby’s birth. Dispose wet cloth properly. IMPLEMENTATION First 30 minutes 12. Removes first set of This aseptic technique is being gloves and observed in preparation of the decontaminates them cutting of the umbilicus. Observation properly (in 0.5% chlorine of decontamination is to prevent the spread of microorganism in order to solution for at least 10 prevent infection. minutes). 13. Palpates umbilical cord Wait for the pulsation to stop before to check for pulsations. cord clamping IMPLEMENTATION First 30 minutes 14. After pulsation stops, Delayed umbilical cord clamping clamp cord using the plastic appears to be beneficial for term and clamp or cord tie 2 cm from preterm infants. In term infants, the base. delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. (American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice , 2017).. IMPLEMENTATION First 30 minutes 15. Places the instrument Drain the cord of blood by stripping clamp 5 cm from the base. away from the baby then apply the second clamp (instrument clamp) at 5cm from the umbilical base (which is 3cm from the first clamp (plastic clamp.) (WHO,2014). Instrument clamp will hold the remaining cord that is still attached to the placenta IMPLEMENTATION First 30 minutes 16. Cut near plastic clamp This is to ensure that the cord stump is (not midway). not too long after the cord clamp. Performs the remaining Active management include steps of the AMTSL (Active administering an oxytocic medication Management of the Third (e.g./ oxytocin/Pitocin) when the Stage of Labor: anterior shoulder is birthed or immediately following the birth of the fetus, clamping and cutting the umbilical cord within 3 minutes after birth IMPLEMENTATION First 30 minutes Waits for strong uterine Wait for the placenta to contractions then applies separate. Do not tug the cord. controlled cord tractions and Inappropriate traction may tear counter traction on the uterus, the cord, separate the placenta, or invert the uterus. signs of continuing until placenta is placental separation include a delivered. slight gush of dark blood from introitus, lengthening of the cord, and change in the uterine contour from a discoid to globular shape. IMPLEMENTATION First 30 minutes Massage the uterus until firm. Gently massage the fundus and demonstrate to the mother how she can massage her own fundus properly. Massage can prevent or minimize hemorrhage. (Perry et al, 2014). IMPLEMENTATION First 30 minutes Inspect the lower vagina and The primary health care perineum for lacerations/tears providers examine the woman and repair lacerations/tears, as for any perineal, vaginal or necessary. cervical lacerations requiring repair. If an episiotomy was performed, it is sutured. Immediate repair promotes healing, limits residual damage and decreases possibility of infection IMPLEMENTATION First 30 minutes Examine the placenta for Whether the placenta first appears completeness and abnormalities. by its shiny fetal surface (Schultze mechanism) or turns to show its dark roughened maternal surface first (Duncan Mechanism) is of no clinical importance. After the placenta and amniotic membranes emerge, the primary health care provider examines them for intactness to ensure that no portion remains in the uterine cavity (Perry et al, 2014). IMPLEMENTATION First 30 minutes Clean the mother; flush perineum This hygienic action will make and applies perineal pad/napkin the mother feel comfortable. or cloth. Check baby color and breathing; Perform a brief assessment of checks that mother is the newborn immediately: Apgar comfortable and uterus is score at 1 and 5 minutes after contracted. birth. (Perry et al, 2014). Check the mother uterus is if it is contracted. IMPLEMENTATION First 30 minutes Dispose the placenta in a leak- This is to prevent the spread of proof container or plastic bag. infection Decontaminate (soaked in 0.5% This is to prevent the spread of chlorine solution) instruments infection. before cleaning; decontaminates 2nd pair of gloves before disposal stating that decontaminations lasts for at least 10 minutes IMPLEMENTATION Advise mother to maintain skin- One of the method for promoting to-skin contact. Baby should be thermoregulation and maternal newborn interaction is to place the prone on mother's chest in naked newborn on the mother’s between the breasts with head bare’s chest and cover both with turns to one side.15-90 MINUTES blanket. Skin to skin contact reduces conductive and radiant heat loss and enhances newborn temperature control and maternal infant interaction. (Brown and Landers, 2011, Perry, 2014). IMPLEMENTATION Advise mother to observe for The mother needs to understand feeding cues and cites example of infant behaviors in relation to feeding cues: breastfeeding and recognize that the baby is ready to feed. Infants exhibit feeding readiness hand-to- mouth or hand-to-hand cues or early signs of hunger. movements suckling motion rooting reflex- IMPLEMENTATION Support mother, instructs her on For the initial feedings it can be positioning and attachment. advantageous to encourage and assist the mother to breastfeed in semi reclining position with the newborn lying prone, skin to skin on mother’s bare chest. Her body supports the baby. (Perry et al 2014). IMPLEMENTATION Wait for FULL BREASTFEED to Milk production is supply meets be completed. demands system. (i.e as milk is removed from the breast, more is produced). Incomplete removal of milk from breasts can lead to decreased milk supply. (Perry et al., 2014) IMPLEMENTATION After a complete breastfeed, administers eye ointment (first), did thorough physical examination, then did Vit. K, hepatitis B and BCG infections, hepatitis B and BCG injections (simultaneously explains purpose of each intervention). IMPLEMENTATION Advises delay bathing of World Health Organization advises delaying the bath for 24 baby (After 24 hours of hours. (Delisle, R. 2016) life). It is important to delay bathing because the vernix, removed during early bathing, contains antimicrobial proteins that are active against group B strep, E. coli and other common perinatal pathogens. (American Journal of Obstetrics & Gynecology). IMPLEMENTATION Advises breastfeeding Breast milk contains vital antibodies that are passed from per demand and about the mother that help protect the danger signs for referral. infant against certain infections. Promoting breastfeeding needs to be a priority of all health care staff caring for both the mother and infant. (Ramos, J. 2014). EVALUATION In the 1st hour: check This is to ensure that the baby is baby's breathing and in good condition and at the color, and check mother's same to check the mother status on hemorrhage. vital signs and massage uterus every 15 minutes. EVALUATION In the 2nd hour: check Constant checking will ensure the good condition of both mother-baby dyad every mother and child. 30 minutes to 1 hour. Complete all records. Documentation served as a monitoring on the condition of the baby and the mother as well as the management given to the patient. VENUS MARS Venus has a beautiful Despite being red, Mars is name, but it’s terribly hot a cold place, not hot NEPTUNE It’s the farthest planet from the Sun SATURN JUPITER Saturn is a gas giant and It’s the biggest planet in has several rings the Solar System 2 LEOPOLD’S MANEUVER Leopold’s Maneuver – systematic method of observation and palpation to determine the fetal DEFINITION: presentation and position. Assessment Review the available prenatal health record of the client and determine Expected Date of Confinement and Age of Gestation Planning Gather all the necessary equipment and materials needed for the procedure: Linen Divider Tape measure Stethoscope Doppler if available Pillow Water- soluble lubricant gel Tissue paper Implementation Introduce self to the client Explain the purpose of the procedure to the client as well as how the procedure will be done. Implementation Instruct client to empty The patient will feel the bladder before doing comfortable and the contour of the fetus is not the procedure. obscured. Perform personal hand hygiene using warm water Implementation Provide privacy for the client by using a divider and draping client with linen just below the hips. Position the client supine with knees slightly flexed. Place a small pillow or towel under her left side. Implementation Expose the women’s abdomen and observe for the longest diameter and where fetal movement is apparent Ask the client to lower down her underwear just below the hips to expose the symphysis pubis. Implementation Using a tape measure, measure the fundic height in centimeters by holding the zero (0) on the tape measure at the top of the pubic bone and follow the curve of her abdomen, and hold the tape at the top of her uterus. Record the fundic height. Implementation Perform the first maneuver. - Stand at the foot of the client, facing hear and place both hands flat on her abdomen. - Palpate the superior portion of the fundus. Determine the consistency, shape and mobility Implementation Perform the 2nd maneuver. Face the patient and place the palms of each hand on either side of the abdomen. Palpate the sides of the uterus. Hold the left hand stationary on the left side of the uterus while the right hand palpates the opposite side of the uterus from top to bottom. Implementation Then hold the right hand steady, and repeat palpation using left hand on the left side. Place the diaphragm of the stethoscope on the side where the fetal back is located and establish the location of the fetal heart tone and count for 1 full minute. Implementation In case a doppler device is available, apply dollop of water soluble gel on the midline. Halfway between the symphysis pubis and the umbilicus. Turn on the Doppler device and set the volume to the halfway mark. Implementation Place the probe on the gel and listen to the fetal heart sounds, adjusting the volume as needed. Compare the audible heart sounds with your patient’s pulse. If the rate is the same, you’re probably hearing the mother’s heart sounds and need to reposition the device. When you locate the fetal heartbeat, count it for a full minute and listen closely for any increases or decreases in rate. Record the fetal heart tone. Perform third maneuver Gently grasp the lower portion of the abdomen just above symphysis pubis between the thumb and index finger, and try to press the thumb and finger together. Determine any movement. Perform 4th maneuver Facing the foot part of the woman. Place the fingers on both sides of the uterus approximately 2 inches above the inguinal ligaments, pressing downward and inward in the direction of the birth canal. Allow fingers to be carried downward. Evaluation Document the findings and immediately notify the health care provider for further assessment of fetal well- being in the following situation: - Absence of FHT. - Any decrease in FHR that doesn’t return to baseline immediately. - The mother reports that she doesn’t feel the baby moving after ( 22 weeks) or she’s having abdominal cramps or vaginal discharge or bleeding. THANKS! CREDITS: This presentation template was created by Slidesgo, Slidesgo including icons by Flaticon, and infographics & images by Freepik Flaticon Freepik Please keep this slide for attribution NCM 107 MODULE 1 Reproductive System and Menstrual Cycle Table of Contents 01 Reproductive System 03 Human Sexuality 02 Menstrual Cycle 01 Reproductive System Introduction The reproductive system is a collection of internal and external organs — in both males and females — responsible for the production and fertilization of gametes (sperm or eggs) and carrying of a fetus. Of the body’s major systems, the reproductive system is the one that differs most between sexes, and the only system that does not function until puberty. Male Reproductive System The male reproductive system is responsible for delivering sperm to the female reproductive system Female Reproductive System The female reproductive system is designed to produce ova, receive the penis during intercourse and the sperm that has been ejaculated, store, contain and nourish a fetus, and feed the newborn after birth with breast milk. Functions of Male Reproductive System ▪ production, maintenance and transport of sperm (the male reproductive cells) ▪ production of the fluid components of semen ▪ ejection of sperm from the penis ▪ production and secretion of the male sex hormones. Male Reproductive System Organ / Component Primary Functions Internal Structure Testes Produce sperm and hormones Accessory Organs Epididymis( 5m) ▪ Acts as site of sperm maturation Ductus Deferens ▪ Thick-walled tube that transports (Sperm Duct ) -45cm sperm cells from epididymis Seminal ▪ Secrete fluid that makes up much vesicles(5cm) of the volume of semen Prostate ▪ Secretes fluid and enzyme Gland(4cm) Male Reproductive System Organ / Component Primary Functions External Genitalia Penis ▪ passageway for excretion of urine as well as the ejaculation of semen. Scrotum ▪ Surrounds the testes and controls their temperature Structures of Male Reproductive System Functions of Female Reproductive System ▪ produces the female egg cells necessary for reproduction called the ova or oocytes. ▪ produces female sex hormones that maintain the reproductive cycle. ▪ designed to transport the ova to the site of fertilization. ▪ site for implantation and fetal development ▪ take on responsibility for the developing human, birth and nourishment. Female Reproductive System Organ / Component Primary Functions Internal Structures Ovaries produce egg cells and hormones Uterus nourish the developing fetus prior to birth. Fallopian tubes(8–14 important passageway for an egg and a cm long) sperm to meet and for a fertilized egg (embryo) to make its way to the uterus. Vagina passage that plays a role in sex, menstruation, pregnancy and childbirth. Internal Structures of Female Reproductive System Female Reproductive System Organ / Component Primary Functions External Genitalia Vulva serves a protective function for both the reproductive and urinary systems. Mons pubis helps cushion the area during sexual intercourse Labia Majora cover the labia minora, clitoris, vulva vestibule, vestibular bulbs, Bartholin’s and Skene’s glands, urethra, and vagina Female Reproductive System Organ / Component Primary Functions External Genitalia Labia Minora smaller lips” of the vulva; protect the vaginal and urethral openings from mechanical irritation, dryness, and infections. Clitoris essential sex organ for women. Vestibular bulbs bulbs are formed of erectile tissue and arise near the back side of the body of the clitoris. Bartholin’s Glands secrete fluid that helps lubricate the vagina. Female Reproductive System Organ / Primary Functions Component External Genitalia Skene’s glands secrete a substance to lubricate the urethra opening. Urethral orifice conducting urine from the bladder to the outside of the body Vaginal opening opening for menstrual flow, sexual intercourse and baby’s birth. External Structures of Female Reproductive System 02 Menstrual Cycle Introduction The menstrual cycle is the time from the first day of a female's period to the day before their next period, the length of a menstrual cycle varies but on average is 28 days and consists of four stages; the menstrual phase, follicular phase, ovulation phase, and luteal phase Menstruation ❑ Is an episodic uterine bleeding in response to cyclic hormonal changes ❑ The purpose is to bring an ovum to maturity and renew a uterine tissue bed that will be responsible for the ova’s growth should it be fertilized ❑ That allows for conception and implantation of a new life Menstruation ❑ Menarche – first menstrual period in girls. ❑ May occur as early as 9 years old or as late as 17 years old. ❑ Average onset at 12.4 years ❑ Normal menstrual Cycle: 23 to 35 days, average of 28 days. Menstruation Length/duration: 2 to 7 days, ranges of 1-9 days Average amount blood loss of 30 to 80 ml Color of menstrual flow: Dark red; a combination of blood, mucus and endometrial cells. Odor: Similar to marigolds. Menstruation Four body structures involved 1. Hypothalamus 2. Pituitary gland 3. Ovaries 4. Uterus Menstruation 4 Phases of Female Reproductive Cycle ❑ Menstrual phase ❑ Preovulatory phase (proliferative) ❑ Ovulation ❑ Postovulatory phase (secretory) Neptune Mars Mercury Venus 2016-2015 2018 2016-2015 2018 Neptune Mars Mercury Venus 2016-2015 2018 2016-2015 2018 Phases of Menstrual Cycle Follicular Phase Events in the Ovary: ❑Under the influence of FSH – primordial follicles develop into primary follicles then into secondary follicles. ❑ Secondary follicles in the ovaries begin to secret estrogen and inhibin. ❑ One dominant follicle becomes the mature (graafian follicle) and continues to enlarge and ready for ovulation. ❑ During the final maturation process, the mature follicle continues to increase its estrogen production. Ovarian follicles are growing and developing. Phases of Menstrual Cycle Proliferating Phase Events in the uterus: Estrogens secreted by the growing ovarian follicle stimulate the repair of the endometrium. Stratum basalis undergo mitosis and produces a new stratum functionalis. The thickness of the endometrium doubles to 4 to 10 mm. Termed as Proliferative phase because the endometrium is proliferating. Phases of Menstrual Cycle Ovulation Phase Events in the ovary ❑ The rupture of the mature (graafian) follicile. Release of the secondary oocyte into the pelvic cavity. ❑ High levels of estrogens during the last part of the preovulatory phase exerts a positive feedback. Secrete LH and GnRH and causes ovulation. ❑ Mittelschmerz – the small amount of blood that leaks into the pelvic cavity from the rupture follicile can cause pain. Phases of Menstrual Cycle Ovulation Phase: Events in the ovary Signs and symptoms of ovulation: ❑ Basal body temperature slightly increase 0.2 to 0.5 ˚C on the day following ovulation preceded by sudden drop. Phases of Menstrual Cycle Ovulation Phase Events in the Ovary Signs and symptoms of ovulation: ❑ Spinnbarkeit Test : Cervical mucus becomes thin and watery and can be stretched into long strands. ❑ Midmenstrual pain ❑ Breast tenderness Phases of Menstrual Cycle Post Ovulatory Phase(Luteal Phase) Events in One Ovary: ❑ After ovulation, the follicle the egg grew in (called a corpus luteum) continues to produce another hormone called progesterone. ❑ Progesterone keeps the endometrium healthy and is required to support the growth of a pregnancy. ❑ But if there is no pregnancy, the corpus luteum stops producing progesterone, and the falling progesterone levels cause the entire lining of the uterus to shed so it can start over again with a new cycle, preparing for another egg. Phases of Menstrual Cycle Post Ovulatory Phase( Secretory) Events in the Uterus: ❑ It is the most constant part of the female reproductive cycle. ❑ Last 14 days in a day cycle, from day 15 to day 28. ❑ Progesterone and estrogens produced by the corpus luteum promote growth and coiling of the endometrial glands. ❑ Vascularization of the endometrium. ❑ Thickening of the endometrium to 12 to 18 mm. Neptune Mars Mercury Venus 2016-2015 2018 2016-2015 2018 Menstrual Cycle Saturn Mars Venus Neptune Jupiter Sun Menstrual Cycle Saturn Mars Venus Neptune Jupiter Sun 03 Human Sexuality Introduction Human sexuality is the way in which we experience and express ourselves as sexual beings (Rathus et al., 1993). It encompasses and gives direction to a person’s physical, emotional, social and intellectual responses throughout life. SEXUALITY BIOLOGIC GENDER - chromosomal sexual development male (XY) and female (XX) GENDER/SEXUAL IDENTITY - inner sense a person has of being a male or a female - sex a person thinks of himself - maybe the same or different from biologic gender -develops throughout the entire lifespan GENDER ROLE ❑ male or female behavior a person exhibits activities of a person undertakes ❑ maybe the same or different from biologic gender or gender identity ❑ culturally influenced ❑ more interchangeable nowadays HUMAN SEXUAL RESPONSE Despite being red, Mars is cold Earth is where we Venus has a all live on beautiful name Jupiter is the biggest planet HUMAN SEXUAL RESPONSE Despite being red, Mars is cold Earth is where we Venus has a all live on beautiful name Jupiter is the biggest planet HUMAN SEXUAL RESPONSE Despite being red, Mars is cold Earth is where we Venus has a all live on beautiful name Jupiter is the biggest planet INFLUENCEOF MENSTRUAL CYCLE ❑ during the luteal phase of menstruation there said to be an increase in since there's vasocongestion in the woman's lower pelvis which makes her more ready for plateau and orgasm. INFLUENCE OF PRENANCY ❑ 1st Trimester - decrease in urge for sex due to the physiologic changes to patient. ❑ 2nd Trimester - increase in libido due to vasocongestion in the lower pelvis and breast, increase in oxytocin. ❑ 3rd Trimester - increase in libido due to preoccupation and fear of labor and delivery.. PEAK SEXUAL RESPONSE ❑ male's sexual response is at peak during his late teen years. ❑ female's peak sexual response is on her late 30s because male are sexually oriented first than female. THANK YOU REFERENCES: Tucker, R. (2020). 2021 Lippincott Pocket Drug Guide for Nurses (9th ed.). Wolters Kluwer. Faan, S. L. P. R. A. (2013). Saunders Comprehensive Review for the NCLEX-RN Examination (Saunders Comprehensive Review for NCLEX-RN) (6th ed.). Saunders. Pillitteri, A. (2017). Maternal and Child Nursing. JoAnne Silbert-Flagg DNP CPNP IBCLC FAAN and Dr. Adele Pillitteri PhD RN PNP.