NCM107 - Care of Mother, Child, Adolescent.pdf

NCM107: CARE OF MOTHER, CHILD, ADOLESCENT NOTES Whischelle D. Ama │BSN2B (Prelims) MATERNAL AND CHILD HEALTH NURSING CARE INTRODUCTION Common Measures to Ensure Family-Centered The care of childbearing and childrearing families is a...

NCM107: CARE OF MOTHER, CHILD, ADOLESCENT NOTES Whischelle D. Ama │BSN2B (Prelims) MATERNAL AND CHILD HEALTH NURSING CARE INTRODUCTION Common Measures to Ensure Family-Centered The care of childbearing and childrearing families is a Maternal and Child Health Care major focus of nursing practice. To have healthy adults, Principles you must have healthy children. It is important to ○ The family is the basic unit of society. promote the health of a childbearing woman and her ○ Families represent racial, ethnic, family from the time before children are born until they cultural, and socioeconomic diversity. reach adulthood. ○ Children grow both individually and as part of a family. Philosophy of Maternal and Child Health Nursing Nursing Interventions Consider the family as a whole as well ❖ Family Centered – assessment data must as its individual members. include family and individual assessment. Encourage families to reach out to their ❖ Community Centered – health of families community so that family members are depends on and influences the health of not isolated from their community or communities. ❖ Research-Oriented – research is the means from each other. whereby critical knowledge increases. Encourage family bonding through ❖ Both Nursing Theory and Evidence-Based rooming-in in both maternal and child Practice – provide foundation for nursing care. health hospital settings. ❖ The Nurse serves as an advocate to protect the rights of all family members including the Participate in early hospital discharge fetus. programs to reunite families as soon as ❖ Teaching and Counseling are frequently required. possible. ❖ Promoting health is an important nursing role – Encourage family and sibling visits in the this protects the health of the next generation. hospital to promote family contacts. ❖ Pregnancy or Childhood Illness can be Assess families for strengths as well as specific stressful – it can affect family life. needs or challenges. ❖ Personal, cultural, and religious attitudes and Respect diversity in families as a unique quality beliefs influence the meaning of illness and its impact on the following. of that family. ❖ Nursing is a challenging role – a major factor in Encourage families to give care to a newborn promoting high-level wellness in families. or ill child. Include developmental stimulation in nursing The family is considered the primary unit of care. care. Share or initiate information on health planning The level of family functioning affects the with family members so that care is healthy status of individuals, because if the family-oriented. family’s level of functioning is low, the emotional, physical, and social health and 4 PHASES OF HEALTH CARE potential of individuals in the family can be affected. ❖ Health Promotion ❖ Health Maintenance ❖ Health Restoration STANDARDS OF MATERNAL AND CHILD HEALTH ❖ Health Rehabilitation NURSING PRACTICE  Whischelle D. Ama | BSN2B | ‘24 - ‘25 2 NURSING THEORY formed in ovaries at week 10 of intrauterine Nursing theorists offer helpful ways to view development. clients so that nursing activities can best meet clients’ needs. At week 12, the external genitals develop. Examples of major concepts of theory: ○ Patricia Benner – Nursing is a caring - Male: penile tissue elongates, ventral surface relationship. Nurses grow from novice closes which forms urethra to expert as they practice in clinical - Female: with the absence of testosterone, settings. the urogenital fold remains open forming the ○ Florence Nightingale – Role of the labia minora nurse is changing or structuring elements of the environment to put the What would be formed as scrotal tissue in the male client into the best opportunity for recovery. becomes the labia majora in the female. ○ Dorothea Orem – Focus of nursing is on the individual, clients are assessed When testosterone is halted it results in a in terms of ability to do self-care. chromosomal male with female-appearing ○ Martha Rogers – The purpose of genitalia. nursing is to move the client toward optimal health, the nurse should view If a woman is prescribed testosterone during the client as a whole. ○ Sister Callista Roy – The role of the pregnancy or due metabolic abnormality, nurse is to aid client to adapt to the produces a high testosterone it results to a changes caused by illness, levels of chromosomal female with male-appearing adaptation depend on the degree of genitalia. environmental change and state of coping ability PUBERTAL DEVELOPMENT Puberty is the stage of life at which secondary sex REPRODUCTIVE DEVELOPMENT changes begin. INTRAUTERINE DEVELOPMENT Intra - inside ROLE OF ANDROGEN: The sex of an individual is determined at the - Androgenic hormones are responsible for moment of conception by the chromosome muscular development, physical growth, and information supplied by the particular ovum the increase in sebaceous gland secretions and sperm that joined to create the new life. that causes acne in both boys and girls. GONAD - body organ that produces the cells - In males, androgenic hormones are produced necessary for reproduction (the ovary for the by the adrenal cortex and the testes. In females and the testis in males). females, by the adrenal cortex and the ovaries. At week 5 of intrauterine life, gonadal tissue is already - Testosterone – the primary androgenic formed. hormone. - two undifferentiated ducts (1) the mesonephric - Testosterone is low in males until (wolffian), and (2) paramesonephric (mullerian) puberty (12-14 years) ducts. - In girls, testosterone influences the enlargement of the labia majora and At week 7 or 8, in chromosomal males this early clitoris and formation of axillary and gonadal differentiates into primitive testes and begins pubic hair. formation of testosterone (from male chromosome). - Adrenarche – term used to describe the - Presence of Testosterone influences the development of pubic and axillary hair. mesonephric duct to develop into male reproductive organs, and the paramesonephric ROLE OF ESTROGEN: duct regresses. - At puberty, ovarian follicles (immature egg - Absence of Testosterone at week 10, the cells) are triggered by FSH and begin to gonadal tissue differentiates into ovaries and excrete a high level of the hormone estrogen. the paramesonephric duct develops into - Estrogen consists of three compounds: female reproductive organs. (estrone [E1], estradiol [E2], and estriol [E3]), but a single substance in terms of action. ALL of the OOCYTES (cells that will develop into eggs - Thelarche - is the term used to describe breast throughout the woman’s mature years) are already development.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 3 SECONDARY CHARACTERISTICS ○ Help regulate the temperature of GIRLS BOYS sperm Testes are two ovoid glands that lie in the ❖ Growth spurt ❖ Increase in weight scrotum ❖ Increase in the ❖ Growth of testes ○ Each lobule contains interstitial cells transverse diameter ❖ Growth of face, (Leydig’s cells) and seminiferous of the pelvis axillary and pubic tubule. Seminiferous tubules produce ❖ Breast development hair spermatozoa. ❖ Growth of pubic hair ❖ Voice changes ❖ Onset of ❖ Penile growth ○ Leydig’s cells are responsible for the menstruation ❖ Increase in height production of testosterone. ❖ Growth of axillary ❖ Spermatogenesis ○ forms in the pelvic cavity; descends at hair (Production of 34th to 38th week (late in pregnancy) ❖ Vaginal secretions sperm) ○ Testes that remain in the pelvic cavity ❖ Menarche (1st ❖ Spermatozoa are may not produce viable sperm and are menstrual period) produced in a occurs at an continuous associated with testicular cancer. average age of 12.4 process. years. Or it may ❖ Sperm production occur as early as continuous from age 9 or as late as puberty throughout age 17. the male’s life. ❖ Menstruation is not dependent on ovulation. GIRLS: Menstruation becomes regular until ovulation occurs consistently with them. It happens 1-2 years after menarche. ○ Sperm production starts when the Ova is produced in a cycle pattern. hypothalamus releases GnRH which in Ova stops to be produced at menopause (the turn influences the APG to release end of the fertile period in females). FSH and LH. FSH releases Androgen-Binding Protein. LH releases ANATOMY AND PHYSIOLOGY OF THE testosterone. And the binding of ABP REPRODUCTIVE SYSTEM and testosterone promotes sperm formation. ○ In most males, one testis is slightly larger than the other and is suspended slightly lower in the scrotum than the other (usually the left one). The Penis is composed of three cylindrical masses of erectile tissue in the penis shaft: two termed the corpus cavernosa, and a third termed the corpus spongiosum. ○ It serves as the outlet for both the urinary and the reproductive tracts in men. ○ Penile erection is stimulated by the parasympathetic nerve innervation. Reproductive structures of the female and male are homologous. They arise from the ○ At the distal end of the is a bulging, same matched embryonic origin. sensitive ridge of tissue – the glans. Gynecology – the study of female Epididymis is the seminiferous tubule of each reproductive organs. testis, and tightly coiled. It is responsible for Andrology – the study of the male conducting sperm from the tubule to the vas reproductive organs. deferens – the next step in the passage to the MALE REPRODUCTIVE SYSTEM outside ○ 20 feet long and some sperm stored in MALE EXTERNAL STRUCTURES the epididymis. Scrotum is a rugated, skin-covered muscular ○ Alkaline fluid, semen or seminal pouch suspended from the perineum. fluid (basic sugar & mucin, a form of  Whischelle D. Ama | BSN2B | ‘24 - ‘25 4 protein) that surrounds sperm at ○ It is approximately 8 in (18 to 20 cm maturity is produced by the cells lining long). of epididymis ○ It is lined with mucous membrane. ○ It takes 12-20 days for the sperm to travel the length of the tube. FEMALE REPRODUCTIVE SYSTEM ○ 64 days for the sperm to mature FEMALE EXTERNAL STRUCTURES ○ Aspermia (absence of sperm) and The Vulva (from the latin word for “covering”) are the Oligospermia (less than 20million structures that form the female EXTERNAL genitalia. sperm/ml) are problems that do not respond to therapy but only after 2 months. Vas Deferens (Ductus Deferens) is a hollow tube surrounded by arteries and veins and protected by a thick fibrous coating. ○ Sperm mature as they pass through the vas deferens. ○ Spermatic cord consists of the blood vessels and the vas deferens. ○ Vasectomy (severing of the vas deferens to prevent passage of sperm). A popular means of male birth control. Mons Veneris is a pad of adipose tissue Seminal Vesicles are two convoluted pouches located over symphysis pubis, the pubic bone that lie along the lower portion of the posterior joint. surface of the bladder and empty into the ○ Purpose is to protect the junction of the urethra by way of the ejaculatory ducts. pubic bone from trauma ○ They secrete a viscous alkaline liquid Labia Minora is just posterior to the mons that has a high sugar, protein, and veneris spreading two hairless folds of prostaglandin content. connective tissue. Ejaculatory Ducts are two ducts that pass ○ BEFORE MENARCHE, these folds are through the prostate gland and join the seminal fairly small. At childbearing age, they vesicles to the urethra. are firm and full. AFTER Prostate Gland is a chestnut-sized gland that MENOPAUSE, they atrophy and again lies just below the bladder. become smaller. ○ Urethra passes through the center o ○ The area is abundant with sebaceous ○ It secretes a thin, alkaline fluid and it glands. further protects sperm from being Labia Majora are two folds of adipose tissue immobilized covered by loose connective tissue and ○ Men develop benign prostate epithelium that are positioned lateral to the hypertrophy – swelling that labia minora. interferes with both fertility and ○ Covered by pubic hair - protection for urination. the external genitalia and the distal Bulbourethral Glands or Cowper’s glands lie urethra and vagina beside the prostate gland and empty via short ducts into the urethra. OTHER EXTERNAL ORGANS ○ secretes alkaline fluid that helps ❖ Vestibule is the flattened, smooth surface counteract the acid secretion of the inside the labia. The openings to the bladder urethra and ensure safe passage of (urethra) and the uterus (the vagina) both arise spermatozoa. from here. ○ Semen, is derived from the prostate ❖ Clitoris is a small (1 to 2 cm), rounded organ gland (60%), the seminal vesicles of erectile tissue at the forward junction of the (30%), the epididymis (5%), and the labia minora. Covered by a fold skin, the bulbourethral glands (5%) prepuce. It is sensitive to touch and Urethra is a hollow tube leading from the base temperature and is the center of sexual arousal of the bladder. After passing the prostate and orgasm in a woman. gland, continues to the outside through the shaft and glans of the penis  Whischelle D. Ama | BSN2B | ‘24 - ‘25 5 ❖ Skene’s glands (parauretral glands) are ○ Anesthesia is administered locally to located lateral to the urinary meatus, one on block the pudendal nerve, eliminating each side. Their ducts open into the urethra. pain at the perineum during childbirth. ❖ Bartholin’s glands (vulvovaginal glands) are located just lateral to the vaginal opening on FEMALE INTERNAL STRUCTURES both sides. Their ducts open into the distal The Internal Organs of the Female are ovaries, vagina. fallopian tubes, uterus and the vagina. Secretions from both of these glands Ovaries are approximately 4 cm long by 2cm help to lubricate the external genitalia in diameter and approximately 1.5 cm thick, or during coitus. the size and shape of almonds. The alkaline pH of their secretions ○ unruptured, glistening, clear, fluid-filled helps to improve sperm survival in the graafian follicle (an ovum to be vagina discharged) or a miniature yellow ❖ The Fourchette is the ridge of tissue formed corpus luteum (the structure left by the posterior joining of the two labia minora behind after the ovum has been and the labia majora. This is the structure that discharged) - it is yellow due to its is sometimes cut (episiotomy) during childbirth richness in progesterone which to enlarge the vaginal opening. prepares the uterus for implantation ❖ Perineal muscle or perineal body is a ○ Ovaries are located close to and on muscular area and it is easily stretched during both sides of the uterus in the lower childbirth to allow enlargement of the vagina abdomen. and passage of the fetal head. ○ Their function (female gonads) is to (Kegel’s, squatting and tailor sitting) produce, mature, and discharge ova make the perineal muscle more flexible (egg cells). ❖ The Hymen is a tough but elastic semicircle ○ They produce estrogen and tissue that covers the opening of the vagina in progesterone and initiate and regulate childhood. menstrual cycles. It is torn during the time of first sexual The estrogen secreted by the intercourse. ovaries is important to prevent Imperforate hymen (does not allow the osteoporosis or weakness of menstrual blood to flow/sexual bones because of withdrawal relations) needed to be incised of calcium from the bones surgically. (happens after menopause). estrogen keeps the cholesterol Vulvar Blood Supply is the blood supply of level reduced thus limiting the external genitalia coming from the atherosclerosis (artery pudendal artery and a portion of the inferior disease). rectus artery. ○ It is rich with blood supply, hence 3 Principal Divisions of Ovary subject to hematomas due to trauma or childbirth. 1. Protective layer of surface epithelium. ○ Blood supply contributes to the rapid 2. Cortex, where the immature (primordial) healing of any tears in the area of oocytes mature into ova and large amounts childbirth. of estrogen and progesterone are produced. Vulvar Nerve Supply is the anterior portion of 3. Central Medulla, which contains the nerves, the vulva that derives its nerve supply from the blood vessels, lymphatic tissue, and some ilioinguinal and genitofemoral nerves (L1 level). smooth muscle tissue. ○ posterior vulva are supplied by the pudendal nerve (S3 level). DIVISION OF REPRODUCTIVE CELLS ○ a rich nerve supply makes the area extremely sensitive to touch, pressure, ➔ At birth, each ovary has 2 million immature pain and temperature. ova (oocytes), formed during the 1st five ○ Normal stretching of the perineum with months of intrauterine life. childbirth causes temporary loss of ➔ These cells contain the usual components of sensation in the area. cells: a cell membrane, an area of clear cytoplasm, and a nucleus containing chromosomes.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 6 ➔ The oocytes, like the sperm, differ from all ○ Composed of mucous membrane – other body cells in the number of contains mucus-secreting and ciliated chromosomes they contain in the nucleus. (hair covered) cells. ○ The muscle layer produces the peristaltic motions that help the ovum travel along the length of the tube. ○ This pathway is susceptible to infection and diseases so clean technique must be used during pelvic examinations or treatment. ○ Sterile technique is done during vaginal examination to ensure no organisms can enter. The Uterus is a hollow, muscular, pear-shaped ➔ Oocytes before ovulation and spermatozoa organ located in the lower pelvis, posterior to before it matures, both will undergo meiosis the bladder and anterior to the rectum. With (reduction division). maturity, the uterus is 5 cm to 7 cm, 5 cm wide, ➔ After reduction division, an ovum has 22 2,5 cm deep. autosomes and an X sex chromosome. A ○ Its function is to receive the ovum from spermatozoon has 22 autosomes and either an the fallopian tube; provide a place for X or a Y sex chromosome. implantation and nourishment; ➔ A new FEMALE individual = union of an ovum furnish protection to a growing fetus, and an X carrying spermatozoon (an XX and at maturity of the fetus, expel it chromosome pattern). from a woman’s body. ➔ A new MALE individual = union of an ovum ○ After pregnancy, the uterus never and a Y carrying spermatozoon (an XY returns to its nonpregnant size (9cm chromosome pattern) long, 6cm wide, 3cm thick). ◆ Male determines the gender of the offspring ❖ The Isthmus is a short segment between the body and the cervix. It is 1-2 min length MATURATION OF OOCYTES This enlarges during pregnancy to aid ➔ Primordial Follicle is a protective sac or thin in accommodating the growing fetus. layer of cells that surrounds oocytes. It is the portion of the uterus that is ➔ Between 5 to 7 million ova form in the utero. most commonly cut when a fetus is ➔ Majority never developed, by birth only 2 born by a cesarean birth. million are present. ❖ The Cervix is the lowest portion of the uterus. ➔ By age 7 years, only approximately 500,000 It is 1/3 of the total size of the uterus (2-5 cm are present in each ovary; by 22 years there long). are approximately 300,000, and by menopause Cervical canal is the central cavity of none are left. the cervix. ➔ Menopause is the point at which no Internal Cervical Os is the opening of functioning oocytes remain in the ovaries. the canal at the junction of the cervix and isthmus. External Cervical Os is the distal Fallopian Tubes arise from each corner of the opening to the vagina. uterine body and extend outward and The level of the external os is at the backward until each opens at its distal end, the level of the ischial spines (an important ovary relationship in estimating the level of ○ It is 10 cm long in a mature woman the fetus at the birth canal). ○ Their function is to convey the ovum from the ovaries to the uterus and to UTERINE AND CERVICAL COATS provide a place for fertilization of the The uterine wall consists of three separate coats of ovum by sperm. layers of tissue: an inner one of mucous membrane ○ The isthmus portion of the tube is cut (the endometrium), a middle one of muscle fibers (the or sealed in a tubal ligation. myometrium), and an outer one of connective tissue ○ The ampulla is where fertilization of an (the perimetrium). ovum occurs.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 7 nerves arise from the T5 through T10 spinal ganglia while afferent nerves at the T11 and T12. UTERINE DEVIATIONS Several uterine deviations (shape and position) may interfere with fertility or pregnancy. As the fetus matures, this septum dissolves, so at birth no remnant of the division remains. A. Anteversion – the entire uterus is tipped far forward. B. Anteflexion – the body of the uterus is bent sharply forward at the junction with the cervix. Endometrium layer is important for menstrual C. Retroversion – entire uterus is tipped forward function. D. Retroflexion – the body is bent sharply back ○ The inner layer of the endometrium is just the cervix. highly sensitive and responsive to hormones estrogen and progesterone. These positions can interfere fertility by blocking the ○ It grows and becomes thick and migration of sperm. capable in supporting a pregnancy ○ When pregnancy does not occur, this *CONTINUATION OF INTERNAL STRUCTURES* layer shed as the menstrual flow Vagina is a hollow, musculomembranous canal located posterior to the bladder and anterior to UTERINE BLOOD SUPPLY the rectum.It extends from the cervix of the uterus to the external vulva. ○ Its function is to act as the organ of intercourse and to convey sperm ○ It expands to serve as the birth canal. ○ Doderlein’s Bacillus is the lactose-fermenting bacteria causing lactic acid to form, making the pH of the vagina acidic detrimental to pathogenic bacteria, preventing vaginal infections. The mammary glands, or breasts remain halted in size and development until a rise of estrogen at puberty. ○ Thelarche - the beginning of adult breast development. ○ Milk glands of the breasts are divided All nerve endings are in the uterus to nourish into approximately 20 lobes. All of the and supply the needs of the placenta (fetus). glands in each lobe produce milk by Because the uterine blood supply is not far ACINAR CELLS and deliver it to the removed from the aorta, it is abundant and nipple through a lactiferous duct. adequate to supply the growing needs of the ○ Montgomery’s Tubercles are the area fetus. that appears rough surfaces because it ○ Urine output is monitored after giving contains many sebaceous glands. birth because ureters is involved The blood vessels that supply the cells and THE PHYSIOLOGY OF MENSTRUATION lining of the uterus are tortuous in nonpregnant MENSTRUATION CYCLE women. As uterus enlarges with pregnancy, the It is a female reproductive cycle that is episodic vessels “unwind” and so can stretch to uterine bleeding in response to cyclic hormonal maintain an adequate blood supply changes. Its purpose is to bring an ovum to maturity and UTERINE NERVE SUPPLY renew a uterine tissue bed that will be The uterus is supplied by efferent (motor) and responsible for the ova’s growth should it be afferent (sensory nerves). The efferent fertilized.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 8 It is the process that allows for conception and - Immediately after a menstrual flow (4 or days implantation of a new life. of cycle), the endometrium or lining of the 28 days uterus is very thin. - Termed interchangeably as proliferative, PHYSIOLOGY OF MENSTRUATION: estrogenic, follicular, or postmenstrual. 1. The Hypothalamus 2. The Pituitary Gland (Anterior) 2nd PHASE of Menstrual Cycle 3. The Ovaries (SECRETORY) 4. The Uterus - After ovulation, the formation of progesterone - All four must contribute their part to complete a in the corpus luteum (under the direction of LH) menstrual cycle causes the glands of the uterine endometrium to become corkscrew or twisted in appearance HYPOTHALAMUS: Initiates the menstrual cycle and dilated with glycogen and protein. - Releases a hormone called Gonadotropin - The lining becomes rich, spongy velvet. Releasing hormone (GnRH) also called as Luteinizing Hormone Releasing Hormone 3rd PHASE of Menstrual Cycle (ISCHEMIC) (LHRH) - it stimulates the anterior pituitary - If fertilization does not occur, the corpus luteum gland. in the ovary begins to regress after 8 to 10 - signals the gland to produce FSH and LH, also days. called Gonadotropic hormones. - The capillaries rupture with minute hemorrhages and it sheds off. PITUITARY GLAND: APG produces two hormones that act on the ovaries to further influence the 4th PHASE of Menstrual Cycle (MENSES) menstrual cycle - Menses or menstrual flow consists of: a. FSH – hormone that is active early in the cycle - Blood from the ruptured capillaries and responsible for maturation of the ovum. - Mucin from the glands b. LH – a hormone that becomes most become at - Fragments of endometrial tissue the midpoint of the cycle is responsible for - The microscopic, atrophied, and ovulation, or release of the mature egg cell unfertilized ovum. from the ovary, and growth of the uterine - It is the end of the menstrual cycle. lining during the second half of the menstrual - It is also used to mark the beginning cycle. day of a new menstrual cycle OVARY: FSH and LH are called gonadotropic GENETIC ASSESSMENT AND COUNSELING hormones because they cause growth (trophy) in the INTRODUCTION gonads (ovaries). Genetics - study of the way such disorders - As the follicle grows, it produces a clear liquid occur that contains a high degree of estrogen (mainly Genes - basic units of heredity that determine estradiol) and some progesterone. both the physical and cognitive characteristics - As the follicle reaches its maximum size, it is of people. propelled toward the surface of the ovary. Genetic Disorder - can be passed from one - At maturity, the ovum is like a clear water generation to the next because they result from blister and like the size of a printed period with some disorder in the gene or chromosome its surrounding follicle membrane and fluid structure. and it is termed as graafian follicle. ○ may occur due to occupational - By day 14 of a menstrual period, the ovum has hazards, toxic substances in the been divided by mitotic division into two environment of workplaces separate bodies. Cytogenetics - study of chromosomes by light - Mitotic division: there’s a primary oocyte, microscopy and the method by which which contains the bulk of the cytoplasm; and a chromosomal aberrations are identified. (Will secondary oocyte, which contains so little check if there are abnormalities, such as same cytoplasm that is not functional. chromosomes) Chromosomes - are threadlike structures of UTERUS: nucleic acids and proteins found in the nucleus 1st PHASE of Menstrual Cycle of most living cells, carrying genetic information (PROLIFERATIVE) in the form of genes.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 9 NATURE OF INHERITANCE Family Planning IVF Surrogate Sperm donor and more THE ASSESSMENT FOR GENETIC DISORDERS HISTORY: obtain information and document diseases in family members for a minimum of three generations. Include half brothers and sisters or anyone related in any way as family. mother’s age, consanguineous, ethnic background child is born dead, parents are advised to have 46 Chromosomes / 23 pairs a chromosomal analysis and autopsy (44 autosomes and 2 sex chromosomes) performed on the infant XX (Male) XY (Female) Age Phenotype - physical characteristics Genotype - actual composition of genes PHYSICAL ASSESSMENT: pay particular attention to certain body areas, MENDELIAN INHERITANCE: DOMINANT AND such as the space between the eyes; the RECESSIVE height, contour, and shape of ears; the number Gregor Mendel- The principles of genetic inheritance of fingers and toes; and the presence of of disease are the same as those that govern genetic webbing because these often suggest inheritance of other physical characteristics structural genetic disorders Dermatoglyphics-the study of surface Two like genes for a trait—two healthy genes = markings of the skin homozygous fingerprints, abnormal palmar creases, hair - two homozygous genes for a dominant trait = whorls, or coloring of hair are also present with homozygous dominant some disorders - two genes for a recessive trait= homozygous close assessment: born at < 35 weeks recessive gestation ; multiple congenital anomalies The genes differ= heterozygous SCREENING AND DIAGNOSTIC TESTING: Before pregnancy: GENETIC COUNSELING AND TESTING DNA analysis or karyotyping Provide concrete, accurate information about the process of inheritance and inherited During pregnancy disorders trimester nuchal translucency Reassure people who are concerned their child hormonal screening may inherit a particular disorder that the cfDNA testing disorder will not occur quadruple test analysis Allow people who are affected by inherited CVS (chorionic villus sampling >35yo / disorders to make informed choices about abnormal genetic testing) future reproduction Amniocentesis (>35yo / abnormal genetic Allow people to pursue potential interventions testing) that may exist such as fetal surgery percutaneous umbilical blood sampling (PUBS) Allow families to begin preparation for a child Sonography with special needs >35yo may be offered a more accurate noninvasive blood test = screen for Chromosomal disorders Couples who are most apt to benefit from a referral for genetic testing or counseling include: Decision making (CVS or Amniocentesis) TERMINATION REPRODUCTIVE ALTERNATIVES Alternative insemination by donor (AID) - an option for couples if the genetic disorder is one inherited by the male partner or is a recessively inherited disorder carried by both partners Amniocentesis - done during the 15th week to check Surrogate embryo transfer - Inherited for abnormalities. problem is one arising from the female partner. Ideal time for discussing whether the possibility of a The Oocyte is donated by a friend or relative or genetic disorder exists is before a first pregnancy at a provided by an anonymous donor, which is preconception health visit then fertilized by the male partner’s sperm in  Whischelle D. Ama | BSN2B | ‘24 - ‘25 10 the laboratory and implanted into a woman’s uterus. Surrogate mother - a woman who agrees to be alternately inseminated, typically by the male partner’s sperm, and bear a child for the couple FUTURE POSSIBILITIES STEM CELL - immature cells from a healthy embryo (stem cells) could be implanted into an embryo with a known abnormal genetic makeup, replacing the abnormal cells or righting the affected child’s genetic composition LEGAL AND ETHICAL ASPECTS OF GENETIC SCREENING AND COUNSELING Always keep in mind several legal responsibilities of genetic testing, counseling, and therapy including: Participation by couples or individuals in genetic screening must be elective. People desiring genetic screening must sign an informed consent for the procedure. Results must be interpreted correctly yet provided to the individuals as quickly as possible. The results must not be withheld from the individuals and must be given only to those persons directly involved. After genetic counseling, persons must not be coerced to undergo procedures such as abortion or sterilization. Any procedure must be a free and individual decision. COMMON CHROMOSOMAL DISORDERS RESULTING IN PHYSICAL OR COGNITIVE DEVELOPMENTAL DISORDERS Cri du Chat Syndrome - caused by the deletion (a missing piece) of genetic material on the small arm (the p arm) of chromosome 5 Turner syndrome - less eating of sodium, at risk for kidney disorders. Klinefelter syndrome - where boys and men are born with an extra X chromosome Down syndrome - thick tongue and white, wider neck, ears lowered, high risk for choking, shortened fingers and toes (A Simian line is when the Head line and the Heart line are joined. ) the size of their head can reach 10-20%, low IQ, risk for stenosis (at risk for cardiovascular disease) risk for strabismus/cataracts, upper respiratory tract infection CHOKING: ○ Proper hygiene ○ Give more time for eating ○ Monitor while eating RESPIRATORY INFECTION: ○ Hand hygiene ○ Face Mask FAMILY PLANNING Natural Family Planning - periodic abstinence methods No chemical/foreign material. 1. Abstinence - refrain from sexual relations 2. Lactation Amenorrhea Method (LAM) - failure rate 1% to 5%. When a woman is  Whischelle D. Ama | BSN2B | ‘24 - ‘25 11 breastfeeding, there is a natural suppression of - Can be used up to 2 yrs both ovulation and menses. - Contraindication: ineffective 3. Coitus Interruptus (withdrawal) - the man (prolapsed, retroflexed or anteflexed to withdraws and spermatozoa are emitted such degree) outside the vagina Oral Contraceptives 4. Postcoital douching - douching following Combination Oral Contraceptives - estrogen acts to intercourse suppress FSH and LH to suppress ovulation, The 5. Fertility Awareness methods progesterone decreases the permeability of cervical a. Calendar (rhythm) method mucus and limits sperm mobility and access to ova. 6. Basal body temperature method (BBT) - at - Can interfere with glucose metabolism the time of ovulation the female’s BBT rises a Transdermal Patch - applied each week for 3 full Fahrenheit of 0.2 C due to the rise in weeks. After menstrual flow progesterone with ovulation. This method is Subdermal Hormone Implants - aka Nexplanon done by waking her temperature each morning can be embedded just under the skin on the immediately after waking before she rises from inside of the upper arm bed or undertakes any activity. She refrains ○ Irregular menstruation, weight gain, from coitus for the next 3 days as soon as she scarring, depression and need for notices any change in the BBT. removal. 7. Cervical Mucus Method (Billing’s) Method - based on the changes in cervical mucus that THE GROWING FETUS occur naturally during the ovulation. Before STAGES OF FETAL DEVELOPMENT ovulation each month, the cervical mucus is In just 38 weeks, a fertilized egg (ovum) thick and does not stretch when pulled matures from a single cell to a fully developed between thumb finger. Just before ovulation, fetus ready to be born mucus secretion increases. Fetal growth and development are typically divided into three periods: pre-embryonic - Day of ovulation - it becomes thin, (first 2 weeks, beginning with fertilization), water and transparent. Feels slippery embryonic (weeks 3 through 8), and fetal like egg white and stretches at least 1 (from week 8 through birth). inch. 8. Two Day Method - if she feels secretions for 2 TERMS TO DENOTE FETAL GROWTH days in a row, avoid coitus that day and Ovum – from ovulation to fertilization Zygote - from fertilization to implantation following day. Embryo – from implantation to 5-8 weeks 9. Symptothermal Method - cervical mucus and Fetus – from 5-8 weeks until term BBT methods Age of viability -The earliest age at which 10. Standard Days Method: Cyclebeans - fetuses could survive if they were born at that designed for women who have menstrual time, generally accepted as 24 weeks, or cycles between 26 - 32 days fetuses weighing more than 400 g 11. Ovulation Detection FERTILIZATION (24-72 HOURS) 12. Marquette Model: Combines Cervical mucus, BBT, cervix position and softness 13. S/E and contraindications for natural planning 14. Natural Planning and effect on pregnancy 15. Natural planning and Effect on Sexual Enjoyment 16. Natural Planning and the Fertilization (also referred to as conception and Adolescent/Premenopausal impregnation) is the union of an ovum and a spermatozoon. Woman/Postpartal Woman This usually occurs in the outer third of a fallopian tube, the ampullary portion Barrier Methods of Contraception - forms of birth Usually only one of a woman’s ova will reach control that place a chemical or latex barrier between maturity each month. Once the mature ovum is cervix and advancing sperm so it cannot each fertilize released, fertilization must occur fairly quickly the ovum. because an ovum is capable of fertilization for 1. Spermicides only 24 hours (48 hours at the most). As the ovum is extruded from the graafian 2. Male and female condoms follicle of an ovary with ovulation, it is 3. Diaphragm or cervical caps - rubber disk that surrounded by a ring of mucopolysaccharide is placed over the cervix before coitus.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 12 fluid (the zona pellucida) and a circle of cells - The touching or implantation point is usually (the corona radiata) high in the uterus, on the posterior surface The ovum and these surrounding cells (which - Occasionally, a small amount of vaginal increase the bulk of the ovum and serve as spotting appears on the day of implantation protective buffers against injury) are propelled - If this happens, the predicted date of birth of into a nearby fallopian tube by currents initiated her baby (based on the time of her last by the fimbriae—the fine, hairlike structures menstrual period) will be calculated 4 weeks that line the openings of the fallopian tubes. late A combination of peristaltic action of the tube - Once implanted, the zygote becomes an and movements of the tube cilia help propel embryo. the ovum along the length of the tube. The mechanism whereby spermatozoa are EMBRYONIC AND FETAL DEVELOPMENT drawn toward an ovum is probably a 1. DECIDUA species-specific reaction, similar to an a. Decidua parietalis antibody–antigen reaction b. Decidua basalis ○ During the first trimester some women c. Decidua capsularis start to bleed due to resectioning of 2. CHORIONIC VILLI embryos that causes miscarriage. 3. PLACENTA Spermatozoa move through the cervix and the 4. UMBILICAL CORD body of the uterus and into the fallopian tubes, 5. AMNIOTIC MEMBRANE toward the waiting ovum by the combination of 6. AMNIOTIC FLUID movement by their flagella (tails) and uterine contractions. EMBRYONIC AND FETAL STRUCTURES Capacitation is a final process that sperm 1. Decidua - - corpus luteum in the ovary must undergo to be ready for fertilization. continues to function because of the influence This process, which happens as the sperm of HCG ( human chorionic gonadotropin = a move toward the ovum, consists of changes in hormone secreted by the trophoblast cells. the plasma membrane of the sperm head, - Endometrium continues to grow in thickness which reveal the sperm-binding receptor sites and vascularity and is now termed DECIDUA All of the spermatozoa that achieve capacitation reach the ovum and cluster 3 Separate Areas: around the protective layer of corona cells. Decidua basalis – part of the endometrium that Hyaluronidase (a proteolytic enzyme) is lies directly under the embryo. released by the spermatozoa and dissolves the Decidua capsularis – the portion of the layer of cells protecting the ovum. endometrium that stretches or encapsulates the portion of the trophoblast. IMPLANTATION Decidua vera- the remaining portion of the - Implantation, or contact between the growing uterine lining. structure and the uterine endometrium, During birth the entire surface of the uterus is occurs approximately 8 to 10 days after stripped away, leaving the organ highly fertilization. susceptible to hemorrhage & infection. - Once fertilization is complete, a zygote migrates over the next 3 to 4 days toward the 2. Chorionic Villi - as early as 11-12th day body of the uterus miniature villi or probing “ fingers” reach out - Trophoblast cells become the placenta into the endometrium. - By the time the zygote reaches the body of the - It is surrounded by a double layer of uterus, it consists of 16 to 50 cells. trophoblast cells. - At this stage, because of its bumpy outward a. The outer layer or the syncytial layer appearance, it is termed a morula (from the = instrumental in the production of hcg, Latin word morus, meaning “mulberry”). somatomammotropin, human placental - The morula continues to multiply as it floats lactogen (hPL), estrogen and free in the uterine cavity for 3 or 4 additional progesterone days. b. Inner layer – cytotrophoblast or the - Large cells tend to collect at the periphery of Langhan’s layer = present as early as the ball, leaving a fluid space surrounding an 12 days’ gestation, to protect the inner cell mass. At this stage, the structure growing embryo and fetus from certain becomes a blastocyst. It is this structure that infectious organisms such as attaches to the uterine endometrium. spirochete or syphilis. - The cells in the outer ring are trophoblast cells. They are the part of the structure that will 3. Placenta - Latin for pancake, which is later form the placenta and membranes. descriptive of its size and appearance at term. - The inner cell mass (embryoblast cells) is - It serves as the fetal lungs, kidneys and the portion of the structure that will form the gastrointestinal tract & as a separate endocrine embryo. organ throughout pregnancy.  Whischelle D. Ama | BSN2B | ‘24 - ‘25 13 4. Umbilical Cord - is formed from the fetal membranes (amnion and chorion) and provides a circulatory pathway that connects the embryo to the chorionic villi of the placenta. - transport oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta. a. Two arteries and one vein. (AVA) 5. Amniotic Membrane a. Chorionic membrane- outermost fetal membrane = offers support to the sac that contains the amniotic fluid. (exchange of nutrients) b. Amniotic membrane or amnion – forms beneath the chorion. It produces Foramen ovale can be seen only in children amniotic fluid and prostaglandins which (should close when babies are delivered) can cause uterine contractions and *butas sa puso* may trigger or initiate labor Ductus Arteriosus needs to be removed too Ductus venosus is a shunt that allows 6. Amniotic Fluid - is constantly being newly oxygenated blood in the umbilical vein to formed by the amniotic membrane. bypass the liver and is essential for normal fetal circulation. DEVELOPMENT OF ORGAN SYSTEMS ○ Should be cleaned because it might Primary Germ Layer – each germ layer develops into affect the liver specific body systems. 3 germ layers All organ systems are complete at 8 weeks gestation. During the early time of organogenesis, the growing structures are most vulnerable. ○ Ecto, Endo and Mesoderm - FIRST TRIMESTER (CRUCIAL) *MAY FORM ABNORMALITIES* IMPORTANT! Heart beats 24 days; Doppler 12th week HR 120-160 bpm (For Fetus) Surfactant formed & excreted by 24th week & reaches normal ratio by 35th week Nervous system develops during 3rd -4 th week; brain waves 8th week Ear responsive to sound & sight is present Meconium forms 16th week, sterile GI tract Mature sucking & swallowing reflex (32 weeks) Fetal movement 11th wk; quickening 18th -20th week (can be seen in ultrasound) Gonads formed by 6th week; testosterone Formation of urine (12th week), excretion (16th week) Skin appears thin and almost translucent until sebaceous fat begins to be deposited (36th week) IgG gives fetus a temporary passive immunity during the 3 rd trimester Whischelle D. Ama | BSN2B | ‘24 - ‘25 14 FETAL WELL BEING 1. Fetal Movement a. Movement should have consistency b. Ask the mother to observe and record the number of movements the fetus makes daily i. Sandovsky method – 2x every 10 minutes/ 10-12/hour ii. Cardiff method – usually 10 movements in 1 hour 2. Fetal Heart Rate a. Should be 120-160 bpm b. Can be heard with Doppler at 12th week i. Rhythm Strip Testing – FHR (20 minutes) ii. Non-stress Testing –FHR increase by 15 bpm for 15 seconds upon movement (reactive) iii. Vibroacoustic Stimulation –Sound to startle and wake the fetus iv. Contractions Stress Testing – 3 contractions with a duration of 40 seconds or more for 10 minutes; FHR does not decelerate (negative) 3. Ultrasound – sound waves displayed as visual image a. Confirm structures, position b. Placental grading c. Amniotic fluid volume (800-1200) d. Biparietal diameter Ensure a full bladder 4. Maternal Serum Alpha-Fetoprotein a. Present in amniotic fluid and maternal serum b. Increase – open spinal or abdominal defect; c. Low –Down’s syndrome  Whischelle D. Ama | BSN2B | ‘24 - ‘25 15 5. Chorionic Villi Sampling PROMOTING FETAL AND MATERNAL HEALTH a. Biopsy and analysis of CV for PROMOTING HEALTH AND COMFORT chromosomal analysis (10-12 weeks). 6. Amniocentesis a. Aspiration of amniotic fluid to test for genetic abnormalities and fetal maturity (12-13 weeks) i. Ask the woman to void ii. Do not ask the client to take a deep breath while the needle is being inserted. iii. Attach monitors and take maternal BP and FHR (baseline) b. Administer Rhogam if the woman is Rhnegative. c. It is used to determine the following: i. Color – water → slight yellow tinge ii. Lecithin/Sphingomyelin ratio – to determine fetal lung maturity (2:1) by a shake test. iii. PSG and Desaturated Phosphatidylcholine – presence in amniotic fluid is the BEST indicator for fetal lung maturity 7. Percutaneous Umbilical Blood Sampling (cordocentesis/funicentesis) a. Aspiration of blood from the umbilical vein for analysis b. Can be subjected to CBC, direct Coomb’s test, blood gases and karyotyping. c. Rhogam is also given to Rh-negative women. d. Fetus is monitored by a non-stress test before and after the procedure. 8. Biophysical Profile/fetal APGAR a. Combination of fetal breathing movement, fetal tone, amniotic fluid volume, placental grading, fetal heart reactivity. b. More accurate in predicting fetal well-being than any single assessment. c. Scores: 8-10 doing well, 4-6 fetus in jeopardy.