NCMA 217A LEC Prelims - Care of Mother, Child & Adolescent (Well Client) PDF

lOMoARcPSD|41766266 NCMA 217A LEC Prelims - Care of Mother, Child & Adolescent (Well Client) Care of Infants and Children (Our Lady of Fatima University) Scan to open on Studocu Studocu is...

lOMoARcPSD|41766266 NCMA 217A LEC Prelims - Care of Mother, Child & Adolescent (Well Client) Care of Infants and Children (Our Lady of Fatima University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Framework for Maternal and Child Health activities for monitoring and improving Nursing performance around the time of childbirth.to improve the care of every woman and newborn. Standards of Maternal and Child Health Nursing Practice Standard 3: Every woman and newborn with condition(s) that cannot be dealt with effectively 1. Health promotion – educating clients to be with the available resources is appropriately referred. aware of good health through teaching and role modeling 3.1 Every woman and newborn is appropriately 2. Health maintenance – intervening to assessed on admission, during labour and in the maintain health when risk of illness is present early postnatal period to determine whether 3. Health restoration – promptly diagnosing referral is required, and the decision to refer is and treating illness using interventions that made without delay. will return client to wellness most rapidly 3.2 For every woman and newborn who requires 4. Health rehabilitation – preventing further referral, the referral follows a pre-established complications from an illness; bringing an ill plan that can be implemented without delay at client back to an optimal state of wellness or any time. helping a client to accept inevitable death 3.3 For every woman and newborn referred within or between health facilities, there is appropriate Standards of Care and Measures of Quality information exchange and feedback to relevant (WHO) health care staff. Standard 1: Every woman and newborn receive Standard 4: Communication with women and their routine, evidence-based care and management of families is effective and responds to their needs and complications during labor, childbirth and the early preferences. postnatal period, according to WHO guidelines. 4.1 All women and their families receive information 1.1 Women are assessed routinely on admission and about the care and have effective interactions during labour and childbirth and are given with staff. timely, appropriate care. 4.2 All women and their families experience 1.2 Newborns receive routine care immediately after coordinated care, with clear, accurate birth. information exchange between relevant health 1.3 Mothers and newborns receive routine postnatal and social care professionals. care. 1.4 Women with pre-eclampsia or eclampsia Standard 5: Women and newborns receive care with promptly receive appropriate interventions, respect and preservation of their dignity. according to WHO guidelines. 5.1 All women and newborns have privacy around 1.5 Women with postpartum hemorrhage promptly the time of labour and childbirth, and their receive appropriate interventions, according to confidentiality is respected WHO guidelines. 5.2 No woman or newborn is subjected to Standard 2: The health information system enables mistreatment, such as physical, sexual or verbal use of data to ensure early, appropriate action abuse, discrimination, neglect, detainment, extortion or denial of services. 2.1 Every woman and newborn have a complete, 5.3 All women have informed choices in the services accurate, standardized medical record during they receive, and the reasons for interventions or labour, childbirth and the early postnatal period. outcomes are clearly explained. 2.2 Every health facility has a mechanism for data collection, analysis and feedback as part of its CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 1 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Standard 6: Every woman and her family are Advanced-Practice Roles for Nurses in Maternal provided with emotional support that is sensitive to and Child Health their needs and strengthens the woman’s capability. Clinical Nurse Specialists 6.1 Every woman is offered the option to experience are nurses prepared at the master’s or labor and childbirth with the companion of her choice. doctorate degree level who are capable of 6.2 Every woman receives support to strengthen her acting as consultants in their area of expertise, as well as serving as role models, capability during childbirth. researchers, and teachers of quality nursing Standard 7: For every woman and newborn, care. competent, motivated staff are consistently available Neonatal nurse specialists - manage the care to provide routine care and manage complications. of infants at birth and in intensive care settings; they provide home follow-up care to 7.1 Every woman and child has access at all times to ensure the newborn remains well. Childbirth at least one skilled birth attendant and support educators teach families about normal birth staff for routine care and management of and how to prepare for labor and birth. complications. 7.2 The skilled birth attendants and support staff Lactation consultants- educate women have appropriate competence and skills mix to about breastfeeding and support them while meet the requirements of labour, childbirth and they learn how to do this. the early postnatal period. Genetic nurse counselors - consult with 7.3 Every health facility has managerial and clinical families about patterns of inheritance and leadership that is collectively responsible for offer support to families with a child who has developing and implementing appropriate inherited a genetic disorder. policies and fosters an environment that supports Case Manager facility staff in continuous quality improvement. a graduate-level nurse who supervises a Standard 8: The health facility has an appropriate group of patients from the time they enter a physical environment, with adequate water, health care setting until they are discharged sanitation and energy supplies, medicines, supplies from the setting. and equipment for routine maternal and newborn Case management can be a vastly satisfying care and management of complications. nursing role, because if the healthcare setting 8.1 Water, energy, sanitation, hand hygiene and is “seamless,” or one that follows people both waste disposal facilities are functional, reliable, during an illness and on their return to the safe and sufficient to meet the needs of staff, community. women and their families. Nurse practitioners 8.2 Areas for labor, childbirth and postnatal care are designed, organized and maintained so that every are nurses educated at the master’s or woman and newborn can be cared for according doctoral level. Recent advances in to their needs in private, to facilitate the technology, research, and knowledge have continuity of care. amplified the need for longer and more in- 8.3 An adequate stock of medicines, supplies and depth education for nurse practitioners as equipment is available for routine care and they play pivotal roles in today’s health care management of complications system. Women’s Health Nurse Practitioner Has advanced study in the promotion of health and prevention of illness in women. CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 2 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Such a nurse plays a vital role in educating Family Nurse Practitioner (FNP) women about their bodies and sharing with them methods to prevent illness; in addition, (FNP) is an advanced-practice role that they care for women with illnesses such as provides health care not only to women and sexually transmitted infections, and offer children but also to the family as a whole. information and counsel them about In conjunction with a physician, an FNP can reproductive life planning. provide prenatal care for a woman with an uncomplicated pregnancy. Pediatric Nurse Practitioner (PNP) Certified Nurse-Midwife is a nurse prepared with extensive skills in physical assessment, interviewing, and well- (CNM) is an individual educated in the two child counseling and care. In this role, a nurse disciplines of nursing and midwifery and interviews parents as part of an extensive licensed. health history and performs a physical Plays an important role in assisting women assessment of the child. with pregnancy and childbearing. Either If the PNP determines that a child has a independently or in association with a common illness (such as iron deficiency physician, the nurse-midwife assumes full anemia), he or she orders the necessary responsibility for the care and management laboratory tests and prescribes appropriate of women with uncomplicated pregnancies. drugs for therapy. Legal Considerations of Maternal-Child Practice If the PNP determines that the child has a major illness (such as congenital subluxated Maternal and child health nursing carries hip, kidney disease, heart disease), he or she some legal concerns that extend above and consults with an associated pediatrician; beyond other areas of nursing, because care together. is often given to an “unseen client”—the fetus—or to clients who are not of legal age Women’s Health Nurse Practitioner for giving consent for medical procedures. In addition, labor and birth of a neonate are has advanced study in the promotion of considered “normal” events, so the risks for a health and prevention of illness in women. lawsuit are greater when problems arise Such a nurse plays a vital role in educating women about their bodies and sharing with (O’Grady et al., 2007) them methods to prevent illness; in addition, Nurses are legally responsible for protecting they care for women with illnesses such as the rights of their clients, including sexually transmitted infections, and offer confidentiality, and are accountable for the information and counsel them about quality of their individual nursing care and reproductive life planning. that of other health care team members. Understanding the scope of practice and Neonatal Nurse Practitioner standards of care can help nurses practice within appropriate legal parameters. is an advanced-practice role for nurses who are skilled in the care of newborns, both well Documentation is essential for protecting a and ill. NNPs may work in level 1, level 2, or nurse and justifying his or her actions. level 3 newborn nurseries, neonatal follow- Nurses need to be conscientious about up clinics, or physician groups. obtaining informed consent for invasive procedures and determining that pregnant CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 3 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 women are aware of any risk to the fetus broad theoretical focus can nurses appreciate associated with a procedure or test. the significant effect on a family of a child’s Adolescents who support themselves or who illness or of the introduction of a new are pregnant are termed “emancipated member. minors” or “mature minors” and have the Another issue most nursing theorist’s address right to sign for their own health care. is how nurses should be viewed or what the goals of nursing care should be. Extensive Ethical Considerations of Practice changes in the scope of maternal and child Some of the most difficult ethical quandaries health nursing have occurred as health in health care today are those that involve children promotion, or keeping parents and children and their families. well, has become a greater priority. With health promotion as a major nursing Examples are: goal, teaching, counseling, supporting, and Conception issues, especially those related to advocacy are also common roles in vitro fertilization, embryo transfer, (Vonderheid et al., 2007). Nurses care for ownership of frozen oocytes or sperm, clients who are more critically ill than ever cloning, stem cell research, and surrogate before. Because care of women during mothers pregnancy and of children during their Abortion, particularly partial-birth abortions developing years helps protect not only Fetal rights versus rights of the mother current health but also the health of the next Use of fetal tissue for research generation, maternal-child health nurses fill Resuscitation (for how long should it be these expanded roles to a unique and special continued?) degree. Number of procedures or degree of pain that Philosophy of Maternal and Child Health a child should be asked to endure to achieve Nursing a degree of better health Balance between modern technology and Maternal and child health nursing is family quality of life centered; assessment must include both family and individual assessment data. Nursing Theory Maternal and child health nursing is community centered; the health of families One of the requirements of a profession depends on and influences the health of (together with other critical determinants, communities. such as member-set standards, monitoring of practice quality, and participation in Maternal and child health nursing is evidence research) is that the concentration of a based, because this is the means whereby discipline’s knowledge flows from a base of critical knowledge increases. established theory. A maternal and child health nurse serves as Nursing theorists offer helpful ways to view an advocate to protect the rights of all family clients so that nursing activities can best meet members, including the fetus. client needs—for example, by seeing a Maternal and child health nursing includes a pregnant woman not simply as a physical high degree of independent nursing form but as a dynamic force with important functions, because teaching and counseling psychosocial needs, or by viewing children as are major interventions. extensions or active members of a family as well as independent beings. Only with this CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 4 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Promoting health and disease prevention are Statistical terms used to Report Maternal and important nursing roles because these protect Child Health the health of the next generation. Birth rate: Number of births per 1000 Maternal and child health nurses serve as population. important resources for families during Fertility rate: Number of pregnancies per childbearing and childrearing as these can be 1000 women of childbearing age. extremely stressful times in a life cycle. Fetal death rate: Number of fetal deaths Personal, cultural, and religious attitudes and (weighing more 500 g) per 1000 live births. beliefs influence the meaning and impact of childbearing and childrearing on families. Neonatal death rate: Number of deaths per 1000 live births occurring at birth or in the Circumstances such as illness or pregnancy first 28 days of life. are meaningful only in the context of a total Perinatal death rate: Number of deaths of life. fetuses weighing more than 500 g and within Maternal and child health nursing is a the first 28 days of life per 1000 live births. challenging role for nurses and a major factor in keeping families well and optimally Maternal mortality rate: Number of maternal deaths per 100,000 live births that functioning. occur as a direct result of the reproductive Goals of Maternal and Child Health Nursing process. Infant mortality rate: Number of deaths per The primary goal of maternal and child health 1000 live births occurring at birth or in the nursing care can be stated simply as the promotion first 12 months of life. and maintenance of optimal family health to ensure cycles of optimal child- bearing and childrearing. Childhood mortality rate: Number of deaths per 1000 population in children, 1 to The goals of maternal and child health nursing care 14 years of age are necessarily broad because the scope of practice (the range of services and care that may be provided Infant mortality rate by a nurse based on state requirements) is so broad. The infant mortality rate for Philippines in The range of practice includes: 2019 was 19.239 deaths per 1000 live births, Preconceptual health care a 2.16% decline from 2018. Care of women during three trimesters of The top three leading causes of infant pregnancy and the puerperium (the 6 weeks mortality were Pneumonia (3,146; 14.3%); after childbirth, sometimes termed the fourth Bacterial sepsis of newborn (2,731; 12.4%); trimester of pregnancy) and Respiratory distress of newborn (2,347; 10.7%). Care of infants during the perinatal period (6 weeks before conception to 6 weeks after birth) Care of children from birth through adolescence Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 5 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Envision 2030 The year 2016 marks the first year of the implementation of the SDGs. At this critical point, #Envision2030 will work to promote the mainstreaming of disability and the implementation of the SDGs throughout its 15-year lifespan with objectives to: Raise awareness of the 2030 Agenda and the achievement of the SDGs for persons with disabilities; Promote an active dialogue among Maternal Mortality Rate stakeholders on the SDGs with a view to create a better world for persons with Philippines maternal mortality ratio was at level of disabilities; and 121 deaths per 100,000 live births in 2017, down Establish an ongoing live web resource on from 124 deaths per 100,000 live births previous each SDG and disability. year, this is a change of 2.42%. The campaign invites all interested parties in sharing their vision of the world in 2030 to be inclusive of persons with disabilities. Goal # 1: No Poverty By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day. Goal 2: Zero Hunger By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to World Health Organization 17 Sustainable safe, nutritious and sufficient food all year development goals round. By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons Goal 3: Good Health and Well-being By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 6 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 By 2030, end preventable deaths of newborns Goal 6: Clean Water and Sanitation and children under 5 years of age, with all By 2030, achieve universal and equitable countries aiming to reduce neonatal mortality access to safe and affordable drinking water to at least as low as 12 per 1,000 live births for all and under-5 mortality to at least as low as 25 per 1,000 live births By 2030, achieve access to adequate and equitable sanitation and hygiene for all and By 2030, end the epidemics of AIDS, end open defecation, paying special attention tuberculosis, malaria and neglected tropical to the needs of women and girls and those in diseases and combat hepatitis, water-borne vulnerable situations diseases and other communicable diseases By 2030, improve water quality by reducing Goal 4: Quality Education pollution, eliminating dumping and minimizing release of hazardous chemicals By 2030, ensure that all girls and boys and materials, halving the proportion of complete free, equitable and quality primary untreated wastewater and substantially and secondary education leading to relevant increasing recycling and safe reuse globally. and Goal-4 effective learning outcomes By 2030, ensure that all girls and boys have Goal 7: Affordable and Clean Energy access to quality early childhood By 2030, ensure universal access to development, care and preprimary education affordable, reliable and modern energy so that they are ready for primary education services By 2030, ensure equal access for all women By 2030, increase substantially the share of and men to affordable and quality technical, renewable energy in the global energy mix vocational and tertiary education, including university By 2030, double the global rate of improvement in energy efficiency By 2030, substantially increase the number of youth and adults who have relevant skills, Goal 8: Decent Work and Economic Growth including technical and vocational skills, for employment, decent jobs and Sustain per capita economic growth in entrepreneurship accordance with national circumstances and, in particular, at least 7 per cent gross Goal 5: Gender Equality domestic product growth per annum in the least developed countries End all forms of discrimination against all women and girls everywhere Achieve higher levels of economic productivity through diversification, Eliminate all forms of violence against all technological upgrading and innovation, women and girls in the public and private including through a focus on high-value spheres, including trafficking and sexual and added and labor-intensive sectors other types of exploitation Protect labour rights and promote safe and Eliminate all harmful practices, such as child, secure working environments for all workers, early and forced marriage and female genital including migrant workers, in particular mutilation women migrants, and those in precarious Ensure women’s full and effective employment. participation and equal opportunities for leadership at all levels of decision making in political, economic and public life CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 7 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Goal 9: Industry, Innovation and Infrastructure situations, women, children, persons with disabilities and older persons Develop quality, reliable, sustainable and Support least developed countries, including resilient infrastructure, including regional through financial and technical assistance, in and transborder infrastructure, to support building sustainable and resilient buildings economic development and human well- utilizing local materials being, with a focus on affordable and equitable access for all Goal 12: Responsible Consumption and Promote inclusive and sustainable Production industrialization and, by 2030, significantly Implement the 10-year framework of raise industry’s share of employment and programmes on sustainable consumption and gross domestic product, in line with national production, all countries taking action, with circumstances, and double its share in least developed countries taking the lead, taking developed countries. into account the development and capabilities Significantly increase access to information of developing countries and communications technology and strive to By 2030, achieve the sustainable provide universal and affordable access to the management and efficient use of natural Internet in least developed countries by 2020 resources Goal 10: Reduce Inequalities By 2030, substantially reduce waste generation through prevention, reduction, By 2030, progressively achieve and sustain recycling and reuse. income growth of the bottom 40 percent of the population at a rate higher than the Goal 13: Climate Action national average Strengthen resilience and adaptive capacity By 2030, empower and promote the social, to climate-related hazards and natural economic and political inclusion of all, disasters in all countries irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or Integrate climate change measures into other status national policies, strategies and planning Ensure equal opportunity and reduce Improve education, awareness-raising and human and institutional capacity on climate inequalities of outcome, including by eliminating discriminatory laws, policies and change mitigation, adaptation, impact reduction and early warning practices and promoting appropriate legislation, policies and action in this regard Goal 14: Life Below Water Goal 11: Sustainable Cities and Communities By 2025, prevent and significantly reduce marine pollution of all kinds, in particular By 2030, ensure access for all to adequate, from land-based activities, including marine safe and affordable housing and basic debris and nutrient pollution services and upgrade slums By 2020, sustainably manage and protect By 2030, provide access to safe, affordable, marine and coastal ecosystems to avoid accessible and sustainable transport systems significant adverse impacts, including by for all, improving road safety, notably by strengthening their resilience, and take action expanding public transport, with special for their restoration in order to achieve attention to the needs of those in vulnerable healthy and productive oceans. CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 8 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Goal 15: Life on Land Terminologies By 2020, ensure the conservation, restoration Infant Mortality rate - is the number of and sustainable use of terrestrial and inland deaths among infants from birth to 1 year of freshwater ecosystems and their services, in age per 1000 live births. particular forests, wetlands, mountains and Maternal Mortality Rate - is the number of drylands, in line with obligations under resident maternal deaths within 42 days of international agreements. pregnancy termination due to complications Take urgent action to end poaching and of pregnancy, childbirth, and the puerperium trafficking of protected species of flora and in a specified geographic area. fauna and address both demand and supply of Maternity Nursing – involves direct illegal wildlife products personal care to maternity pts and their newborn infants or to related activities on Goal 16: Peace, Justice and Strong Institutions their behalf during the various phases of the Significantly reduce all forms of violence and child bearing experience. related death rates everywhere. End abuse, exploitation, trafficking and all forms of violence against and torture of children. Promote the rule of law at the national and international levels and ensure equal access to justice for all. Substantially reduce corruption and bribery in all their forms. Goal 17: Partnerships for the Goals Finance – Strengthen domestic resource mobilization, including through international support to developing countries, to improve domestic capacity for tax and other revenue collection Technology – Fully operationalize the technology bank and science, technology and innovation capacity-building mechanism for least developed countries by 2017 and enhance the of enabling technology, in particular information and communications technology Capacity building – Enhance international support for implementing effective and targeted capacity building in developing countries to support national plans to implement all the sustainable development goals, including through North-South, South- South and triangular cooperation CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 9 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Human Sexuality Types of Sexual orientation is a multidimensional concept Sexual gratification is experienced in several It can be defined broadly by stating that ways. What is considered normal varies greatly sexuality integrates the somatic (bodily), among cultures, although general components of emotional, intellectual, & social aspects of accepted sexual activity are that it is an activity of being a human sexual being. adults and privacy, consent, and lack of force are It involves the anatomy & physiology of the included. human body, as well as one’s attitudes & Heterosexual feelings about oneself is a person who finds sexual fulfillment with Sexuality a member of the opposite gender. is a multidimensional phenomenon that Homosexual includes feelings, attitudes, and actions. It has both biologic and cultural components. It is a person who finds sexual fulfillment with encompasses and gives direction to a a member of his or her own sex. Many person’s physical, emotional, social, and homosexual men prefer to use the term “gay.” intellectual responses throughout life. “Lesbian” refers to a homosexual woman. More recent terms are “men who have sex Biologic gender with men” (abbreviated as “MWM”) and is the term used to denote a person’s “women who have sex with women” chromosomal sex: male (XY) or female (WWW). Many young adults are worried (XX). about the stigma of being labeled homosexual and therefore keep their identity Gender identity secret from heterosexual acquaintances. sexual identity is the inner sense a person has Bisexuality of being male or female, which may be the same as or different from biologic gender. people are said to be bisexual if they achieve sexual satisfaction from both homosexual Gender role and heterosexual relationships. Like men is the male or female behavior a person who have sex with men, bisexual men may be exhibits, which, again, may or may not be the at greater risk for HIV and STIs than are same as biologic gender or gender identity. others. Female partners of bisexual men need to be aware that they are also at increased risk Components of Sexuality for HIV and other STIs. Reproductive Sexuality - involves the Transsexual or transgender biological aspects of conception & procreation. It also includes the sexual person is an individual who, although of one response biologic gender, feels as if he or she is of the Gender Sexuality - deals w/ the social & opposite gender (Jain & Bradbeer, emotional aspects of being a man or a 2007). Such people may have sex change woman. operations so that they appear cosmetically as the gender they feel that they are. Erotic Sexuality - refers to sexual love and arousing sexual desires CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 10 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Types of Sexual expression Transvestite Sexual abstinence (celibacy) is an individual who dresses in the clothes of the opposite sex. Transvestites can be is separation from sexual activity (Ott, heterosexual, homosexual, or bisexual. Many Labbett, & Gold, 2007). It is the avowed are married. Some transvestites, particularly state of certain religious orders. It is also a married heterosexuals, may be under a great way of life for many adults and one that is deal of strain to keep their lifestyle a secret becoming fashionable among a growing from friends and neighbors. number of young adults. It is the main point of many high school sex education classes. Sadomasochism Masturbation involves inflicting pain (sadism) or receiving pain (masochism) to achieve sexual is self-stimulation for erotic pleasure; it can satisfaction. It is a practice generally also be a mutually enjoyable activity for considered to be within the limits of normal sexual partners. It offers sexual release, sexual expression as long as the pain which may be interpreted by the person as involved is minimal and the experience is overall tension or anxiety relief. Masters satisfying to both sexual partners. (1998) reported that women may find masturbation to orgasm the most satisfying Exhibitionism sexual expression and use it more commonly than men. Children between 2 and 6 years of revealing one’s genitals in public. age discover masturbation as an enjoyable Pedophiles activity as they explore their bodies. interested in sexual encounters with children. Erotic stimulation Disorders of Sexual Functioning is the use of visual materials such as magazines or photographs for sexual arousal. Inhibited Sexual desire Although this is thought to be mostly a male Lessened interest in sexual relations is phenomenon, there is increasing interest in normal in some circumstances, such as after centerfold photographs in magazines the death of a family member, a divorce, or a marketed primarily to women. Some parents stressful job change. The support of a caring of adolescents may need to be assured that an sexual partner or relief of the tension causing interest in this type of material is the stress allows a return to sexual interest. developmental and normal. Decreased sexual desire can also be a side Fetishism effect of many medicines. Chronic diseases, such as peptic ulcers or chronic pulmonary is sexual arousal resulting from the use of disorders, that cause frequent pain or certain objects or situations. Leather, rubber, discomfort may interfere with a man’s or a shoes, and feet are frequently perceived to woman’s overall well-being and interest in have erotic qualities. The object of sexual activity. stimulation does not just enhance the Some women experience a decrease in experience; rather, it becomes a focus of sexual desire during perimenopause. arousal and a person may come to require the Administration of androgen (testosterone) to object or situation for stimulation. women may be helpful at that time, because it can improve interest in sexual activity. CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 11 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Failure to Achieve Orgasm as well as serotonergic antidepressants such as Mirtazapine, may be helpful in alleviating The failure of a woman to achieve orgasm the problem. can be a result of poor sexual technique, concentrating too hard on achievement, or Persistent Sexual Arousal Syndrome (PSAS) negative attitudes toward sexual is excessive and unrelenting sexual arousal in relationships. Treatment is aimed at relieving the absence of desire (Mahoney & the underlying cause. It may include Zarate, 2007). It may be triggered by instruction and counseling for the couple medications or psychological factors. When about sexual feelings and needs. assessing someone with the disorder, be Erectile Dysfunction certain to ask if the person is taking any herbal remedies such as Ginkgo biloba Erectile dysfunction (ED), formerly referred because some of these can have arousal to as impotence, is the inability of a man to effects. produce or maintain an erection long enough for vaginal penetration or partner satisfaction Vaginismus (Wessells et al., 2007). Most causes of ED are is involuntary contraction of the muscles at physical, such as aging, atherosclerosis, or the outlet of the vagina when coitus is diabetes, which limit blood supply. It may attempted that prohibits penile penetration also occur as a side effect of certain drugs. (Engman, Wijma, & Wijma, 2007). Examples of drugs prescribed today for ED Vaginismus may occur in women who have are sildenafil (Viagra), tadalafil (Cialis), and been raped. Other causes are unknown, but it vardenafil (Levitra), which are taken up to could also be the result of early learning once a day to stimulate penile erection. a patterns in which sexual relations were surgical implant to aid erection by the use of viewed as bad or sinful. As with other sexual vacuum pressure is a possible alternative problems, sexual or psychological counseling (Hossein, 2007). Testosterone injections may to reduce thisresponse may be necessary. be helpful in some men. Dyspareunia and Vestibulitis Premature Ejaculation Dyspareunia is pain during coitus. This can Premature ejaculation is ejaculation before occur because of endometriosis (abnormal penile–vaginal contact (Docherty, 2007). The placement of endometrial tissue), vestibulitis term also is often used to mean ejaculation (inflammation of the vestibule), vaginal before the sexual partner’s satisfaction has infection, or hormonal changes such as those been achieved. Premature ejaculation can be that occur with menopause and cause vaginal unsatisfactory and frustrating for both drying. A psychological component may be partners. present. The cause, like that of ED, can be Treatment is aimed at the underlying cause. psychological. Masturbating to orgasm (in Encouraging open communication between which orgasm is achieved quickly because of sexual partners can be instrumental in lack of time) may play a role. Other reasons resolving the problem. suggested are doubt about masculinity and fear of impregnating a partner, which prevent the man from sustaining an erection. Sexual counseling for both partners to reduce stress, CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 12 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Human sexual response Orgasm Sexuality has always been a part of human Orgasm occurs when stimulation proceeds life, but it is only in the past few decades that through the plateau stage to a point at which it has been studied scientifically. One the body suddenly discharges accumulated common finding of researchers has been that sexual tension. feelings and attitudes about sex vary widely: A vigorous contraction of muscles in the the sexual experience is unique to each pelvic area expels or dissipates blood and individual, but sexual physiology (i.e., how fluid from the area of congestion. The the body responds to sexual arousal) has average number of contractions for a woman common features. is 8 to 15 contractions at intervals of 1 every 0.8 seconds. Excitement In men, muscle contractions surrounding the occurs with physical and psychological seminal vessels and prostate project semen stimulation (i.e., sight, sound, emotion, or into the proximal urethra. These contractions thought) that causes parasympathetic nerve are followed immediately by three to seven stimulation. This leads to arterial dilation and propulsive ejaculatory contractions, venous constriction in the genital area. The occurring at the same time interval as in the resulting increased blood supply leads to woman, which force semen from the penis. vasocongestion and increasing muscular Resolution tension. In women, this vasocongestion causes the Resolution is a 30-minute period during clitoris to increase in size and mucoid fluid to which the external and internal genital organs appear on vaginal walls as lubrication. The return to an unaroused state. vagina widens in diameter and increases in For the male, a refractory period occurs length. The nipples become erect. during which further orgasm is impossible. In men, penile erection occurs, as well as Women do not go through this refractory scrotal thickening and elevation of the testes. period, so it is possible for women who are In both sexes, there is an increase in heart and interested and properly stimulated to have respiratory rates and blood pressure. additional orgasms immediately after the first. Plateau The plateau stage is reached just before orgasm. In the woman, the clitoris is drawn forward and retracts under the clitoral prepuce; the lower part of the vagina becomes extremely congested (formation of the orgasmic platform), and there is increased nipple elevation. In men, the vasocongestion leads to distention of the penis. Heart rate increases to 100 to 175 beats per minute and respiratory rate to approximately 40 respirations per minute. CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 13 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Terminologies In both sexes, two undifferentiated ducts, the mesonephric (wolffian) and paramesonephric Sexual Orientation - The direction of one’s (müllerian) ducts, are present. romantic and sexual attraction—to either the By week 7 or 8, in chromosomal males, this opposite, the same, or both sexes. Includes early gonadal tissue differentiates into heterosexual, homosexual, and bisexual primitive testes and begins formation of orientations. testosterone. Under the influence of Gender identity is one’s internal sense of testosterone, the mesonephric duct begins to being either male or female, usually but not develop into the male reproductive organs, always the same as one’s biological sex. and the paramesonephric duct regresses. If Sexuality - is about your sexual feelings, testosterone is not present by week 10, the thoughts, attractions and behaviors towards gonadal tissue differentiates into ovaries, and other people. You can find other people the paramesonephric duct develops into physically, sexually or emotionally female reproductive organs attractive, and all those things are a part of your sexuality. Pubertal Development Reproductive System Puberty is the stage of life at which secondary sex changes begin. These changes are The major function of the reproductive stimulated when the hypothalamus system is to ensure survival of the species. An synthesizes and releases gonadotropin- individual may live a long, healthy, and releasing hormone (GnRH), which in turn happy life without producing offspring, but if triggers the anterior pituitary to begin the the species is to continue, at least some release of follicle-stimulating hormone individuals must produce offspring. (FSH) and luteinizing hormone (LH). FSH Within the context of producing offspring, and LH initiate the production of androgen the reproductive system has four functions: and estrogen, which in turn initiate secondary o To produce egg and sperm cells sex characteristics, the visible signs of o To transport and sustain these cells maturity. o To nurture the developing offspring o To produce hormones Role of Androgen Reproductive development Androgenic hormones are the hormones responsible for muscular development, Intrauterine development physical growth, and the increase in The sex of an individual is determined at the sebaceous gland secretions that causes moment of conception by the chromosome typical acne in both boys and girls. In males, information supplied by the particular ovum and androgenic hormones are produced by the sperm that joined to create the new life. adrenal cortex and the testes; in females, by the adrenal cortex and the ovaries. A gonad is a body organ that produces the cells necessary for reproduction (the ovary in Role of Estrogen females, the testis in males). At When triggered at puberty by FSH, ovarian approximately week 5 of intrauterine life, follicles in females begin to excrete a high primitive gonadal tissue is already formed. level of the hormone estrogen. This hormone is actually not one substance but three CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 14 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 compounds (estrone [E1], estradiol [E2], and Testes estriol [E3]). are two ovoid glands, 2 to 3 cm wide, that lie Secondary Sex characteristics in the scrotum. Adolescent sexual development is Surrounded by 2 tunics: o Tunica vaginalis categorized into stages (Tanner, 1990). There is wide ▪ Derived from the parietal variation in the time required for adolescents to move peritoneum. through these developmental stages; however, the o Tunica albuginea sequential order is fairly constant. Each testis is encased by a protective white Secondary sex characteristics of girls (estrogen) fibrous capsule and is composed of several lobules, with each lobule containing Growth spurt interstitial cells (Leydig’s cells) and a Increase in the transverse diameter of the seminiferous tubule. pelvis Seminiferous tubules produce spermatozoa. Breast development Leydig’s cells are responsible for the Growth of pubic hair production of testosterone. Onset of menstruation Testes in a fetus first form in the pelvic Growth of axillary hair cavity. They descend, late in intrauterine life Vaginal secretions (about the 34th to 38th week), into the scrotal Secondary sex characteristics of boys sac. Because this descent occurs so late in (testosterone) usually occur in the order of: pregnancy, many male preterm infants are born with undescended testes. Increase in weight In most males, one testis is slightly larger Growth of testes than the other and is suspended slightly lower Growth of face, axillary, and pubic hair in the scrotum than the other (usually the left Voice changes one). Because of this, testes tend to slide past Penile growth each other more readily on sitting or Increase in height muscular activity, and there is less possibility Spermatogenesis (production of sperm) of trauma to them. Spermatozoa do not survive at a temperature Male Reproductive System as high as that of the body, however, so the A. Male External Structures location of the testes outside the body, where the temperature is approximately 1° F lower Scrotum than body temperature, provides protection is a rugated, skin-covered, muscular pouch for sperm survival (McCance & suspended from the perineum. Its functions Huether, 2007). are to support the testes and to help regulate Penis the temperature of sperm. In very cold weather, the scrotal muscle The penis is composed of three cylindrical contracts to bring the testes closer to the masses of erectile tissue in the penis shaft: body; two termed the corpus cavernosa, and a in very hot weather, or in the presence of third termed the corpus spongiosum. The fever, the muscle relaxes, allowing the testes urethra passes through these layers of erectile to fall away from the body. tissue, making the penis serve as the outlet for CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 15 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 both the urinary and the reproductive tracts in Some sperm are stored in the epididymis, and men. a portion of the alkaline fluid that will At the distal end of the organ is a bulging, surround sperm at maturity (semen, or sensitive ridge of tissue, the glans. A seminal fluid that contains a basic sugar and retractable casing of skin, the prepuce, mucin, a form of protein) is produced by the protects the nerve-sensitive glans at birth. cells lining the epididymis. Tubular structure located above the scrotum, Sperm are immobile and incapable of composed of shaft and glans. fertilization as they pass or are stored at the Half of it is an internal root and half is the epididymis level. external visible shaft. It takes at least 12 to 20 days for them to Soft and flaccid (2.5 to 4 inches). travel the length of the epididymis and a total Erection - blood vessels in the shaft become of 64 days for them to reach maturity. congested, penis become hard and erect (5.5 This is one reason that aspermia (absence to 7 inches) of sperm) and oligospermia (20 million Glans - The distal end of the organ is bulging sperm/mL) are problems that do not appear to sensitive ridge of tissue which has the respond immediately to therapy but rather external urinary meatus at its tip. only 2 months. Corona - The proximal margin of the glans. Vas Deferens (Ductus Deferens) Prepuce - Also called the foreskin. Loose skin attached to the shaft, allowing for is an additional hollow tube surrounded by expansion during erection. Retractable casing arteries and veins and protected by a thick of skin that protects the nerve sensitive glans fibrous coating. It carries sperm from the at birth. epididymis through the inguinal canal into Frenulum - Ventral fold of tissue attaches the abdominal cavity, where it ends at the the skin to the glans. Contains the urethra as seminal vesicles and the ejaculatory ducts. well as 3 erectile bodies: Sperm mature as they pass through the vas o 2 dorsal erectile tissues known as the deferens. corpora cavernosa Vasectomy (severing of the vas deferens to o 1 midventral tissue known as the prevent passage of sperm) is a popular means corpus spongiosum of male birth control (Cook et al., 2009). ▪ Surrounds penile urethra Seminal Vesicles ▪ Expands distally to form the glans penis are two convoluted pouches that lie along the lower portion of the posterior surface of the B. Male Internal Structures bladder and empty into the urethra by way of Epididymis the ejaculatory ducts. These glands secrete a viscous alkaline liquid The seminiferous tubule of each testis leads to a that has a high sugar, protein, and tightly coiled tube, the epididymis, which is prostaglandin content. Sperm become responsible for conducting sperm from the tubule to increasingly motile with this added fluid, the vas deferens, the next step in the passage to the because it surrounds them with nutrients and outside. a more favorable pH. Because each epididymis is so tightly coiled, its length is extremely deceptive: it is actually over 20 ft long. CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 16 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 Ejaculatory Ducts A. Female External structures The two ejaculatory ducts pass through the Mons veneris prostate gland and join the seminal vesicles is a pad of adipose tissue located over the to the urethra. symphysis pubis, the pubic bone joint. Prostate Gland It is covered by a triangle of coarse, curly hairs. is a chestnut-sized gland that lies just below The purpose of the mons veneris is to protect the bladder. The urethra passes through the the junction of the pubic bone from trauma. center of it, like the hole in a doughnut. It contains many nerve ending that makes the the prostate gland secretes a thin, alkaline mons pubis sensitive to touch and pressure fluid. When added to the secretion from the seminal vesicles and the accompanying Labia Minora sperm from the epididymis, this alkaline fluid further protects sperm from being Located posterior to the mons veneris spread immobilized by the naturally low pH level of two hairless folds of connective tissue, the the urethra. labia minora. Before menarche, these folds are fairly small; by childbearing age, they are Bulbourethral Glands firm and full; after menopause, they atrophy and again become much smaller. two bulbourethral or Cowper’s glands lie beside the prostate gland and empty via short Labia Majora ducts into the urethra. Like the prostate gland and seminal vesicles, they secrete an alkaline The labia majora are two folds of adipose fluid that helps counteract the acid secretion tissue covered by loose connective tissue and of the urethra and ensure the safe passage of epithelium that are positioned lateral to the spermatozoa. labia minora. Covered by pubic hair, the labia majora serve as protection for the external Urethra genitalia and the distal urethra and vagina. is a hollow tube leading from the base of the Vestibule bladder, which, after passing through the prostate gland, continues to the outside is the flattened, smooth surface inside the through the shaft and glans of the penis. It is labia. approximately 8 in (18 to 20 cm) long. The openings to the bladder (the urethra) and the uterus (the vagina) both arise from the Functions of the Female reproductive system vestibule It produces the female egg cells necessary for Clitoris reproduction, called the ova or oocytes. It is designed to transport the ova to the site is a small (approximately 1 to 2 cm), rounded of fertilization. organ of erectile tissue at the forward junction of the labia minora. It is covered by If fertilization does not take place, the system is designed to menstruate. a fold of skin, the prepuce. It produces female sex hormone that maintain The clitoris is sensitive to touch and the reproductive cycle. temperature and is the center of sexual arousal and orgasm in a woman. CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENT) – LEC PRELIMS 17 Downloaded by Da Vinci ([email protected])  lOMoARcPSD|41766266 It contains erectile tissue blood vessels and Vaginal orifice / introitus nerves Occupies the lower portion of the vestibule It is made up of erectile tissue which many and varies considerably in size and shape large and small venous channels surrounded The vagina has an abundantly vascular by large amount of involuntary muscle tissue, supply the ischiocarvernosa facilitate erection of the organ. Fourchette o The clitoris measures 5 – 6 mm. long and 6 – 8 mm. across. is the ridge of tissue formed by the posterior o It has very rich blood and n