NUR 194 MCN SAS 1-23 PDF - Care of Mother, Child, and Adolescent Clients

Care of Mother, Child and Adolescent (Well- Clients) INSTRUCTOR’S GUIDE BS NURSING / SECOND YEAR...

Care of Mother, Child and Adolescent (Well- Clients) INSTRUCTOR’S GUIDE BS NURSING / SECOND YEAR Session # 1 Materials: Book, paper, pen, notebook, and LCD projector LESSON TITLE: FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING AND CONCEPTS OF UNITIVE AND PROCREATIVE HEALTH LEARNING OUTCOMES: At the end of the lesson, the student nurse can: References 1. Identify the Framework and Maternal and Child Health Goals and Standards Pilliteri, Adele and Silbert-Flagg, JoAnne (2018) 2. Describe the theories related to Maternal and Child Health th Maternal and Child Health Nursing, 8 Edition. Nursing USA: Lippincott Williams and Wilkins 3. Define the roles and responsibilities of a Maternal-Child nurse. Sustainable Developmental Goals launch in 2016. 4. Explain the ethico-legal considerations of maternal and child (2015, December 30). practice. https://www.un.org/sustainabledevelopment/blog/ 5. Define “family” in its different contexts. 2015/12/sustainable-development-goals-kick-off- 6. Identify the basic family types and structures with-start-of-new-year/ 7. Enumerate the functions characteristics and tasks of the family United Nations Millennium Developmental Goals. https://www.un.org/millenniumgoals/ SUBJECT ORIENTATION (10 minutes) Activity 1: Getting to Know Each Other The instructor will initiate the activity by greeting the class, saying his/her full name, his/her preferred nickname, statin g an object that best describes him/her, and why. Example: “Hello, everyone! I am (full name). You can call me Sir/Ma’am (nick name). The object that best describes me is a clock because time is so precious and we must mak e each moment count. ” The instructor will then tap the right shoulder of the next person to introduce himself/herself. The process will continue until every student is done. Activity 2: Course Orientation The instructor will introduce the course, Care of Mother, Child and Adolescent Well-Clients)-Lecture. Copies of the course outline will be distributed and discussed accordingly, with emphasis on: o Calendar of activities o Classroom rules and regulations o Computation of grades o Students will then be allowed to ask questions and voice out their expectations. o Election of officers will follow as needed. MAIN LESSON (40 minutes) The instructor should discuss the following topics. Instruct the students to tak e down notes and read their book about this lesson (Chapter 1: A Framework for Maternal and Child Health Nursing page 3). A Framework for Maternal and Child Health Nursing: 1. Primary Goal of Maternal and Child Health Nursing: The promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 11  Maternal and Child Health Nursing Practice Throughout the Childbearing‒Childrearing Continuum  Provision of preconception health care  Provision of nursing care of women throughout pregnancy, birth, and postpartum period  Provision of nursing care of children from birth through adolescence  Provision of nursing care to families in all settings 2. Philosophy of Maternal and Child Health Nursing: o Family-centered o Community-centered o Evidence-based 3. Maternal and Child Health Goals and Standards GLOBAL HEALTH GOALS: a. The United Nations (UN) and the World Health Organization established Millennium Health Goals in 2000 in an effort to improve health worldwide. b. These concentrate on improving the health of women and children because increasing the health in these two populations can have such long-ranging effects on general health. c. These Global Health Goals are: MILLENIUM DEVELOPMENT GOALS- These eight goals, set by the United Nations back in 2000 to eradicate poverty, hunger, illiteracy and disease, expire at 2015. SUSTAINABLE DEVELOPMENT GOALS:  are a collection of 17 global goals set by the United Nations General Assembly in 2015 for the year 2030.  part of a wider 2030 Agenda for Sustainable Development  built on the Millennium Development Goals (MDGs) as framework  In total, 5 million people from across 88 countries in all the world’s regions took part in the consultation, and shared their vision for the world in 2030.  It aims to transform our world and to improve people's lives and prosperity on a healthy planet. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 11   It applies to all countries through partnerships and peace. Countries, regions, cities, the business sector and civil society are actively engaged in implementing the Agenda and the SDGs.  They are mobilizing efforts to end all forms of poverty, fighting inequalities and tackling climate change, while ensuring that no one is left behind. 4. Theories Related to Maternal and Child Health Nursing Nursing theories that are related in promoting healthy pregnancies and keeping the children well are designed to offer helpful ways to view patient so nursing activities can be created to best meet patients ’ needs. Examples: a. Callista Roy’s Adaptation Theory- nurse’s role is to help patients adapt to change caused by illnesses or other stressors b. Dorothea Orem’s Self-Care Theory- involves examining the patient’s ability for self-care c. Patricia Benner’s Novice-Expert Model- describes nurse’s move from novice to expert 5. Roles and responsibilities of a Maternal-Child nurse. 6 Competencies Necessary for Quality Care:  Patient-Centered Care  Teamwork & Collaboration  Evidence-Based Practice  Quality Improvement  Safety  Informatics 6. Legal Considerations of Maternal-Child Practice  Nurses are legally responsible for protecting the rights of their patients, including confidentiality, and are accountable for the quality of their individual nursing care and that of other healthcare team members  Proper documentation is essential for justifying actions. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 11   Nurses need to be conscientious about obtaining informed consent about invasive procedures in children and determining if pregnant women are aware of any risk to the fetus associated with a procedure or test.  Nurses are legally responsible to report inappropriate or insufficient care provided by another practitioner. 7. Ethical Considerations of Practice  Nurses should provide factual, complete information, supportive listening and helping them in clarifying their values without imposing their own. (Chapter 3: Concepts of Unitive and Procreative Health). A. Definitions of Family: D. Family Theory 1. “A group of people related by blood, marriage,  a set of perspectives from the family’s point or adoption living together.” (US Census of view Bureau, 2009)  helps address important issues of 2. “Two or more people who live in the same childbearing and childrearing families. household (usually), share a common  Modern concept of MCN Nursing is based on a family and community standpoint emotional bond, and perform certain interrelated social tasks. (Allender & Spradley, E. Basic Family Types 2008) 1. Family of orientation: the family one is born B. Influence of Family on Its Members into (e.g., oneself, mother, father, and 1. Provides long-lasting emotional ties siblings, if any) 2. Provides a depth of support - refers to the family in which a person is 3. Determines how members relate to people RAISED. 4. Influences what moral values members follow 2. Family of procreation: the family one 5. Molds the members’ basic perspectives on establishes (e.g., oneself, a spouse or the present and future significant other, and children, if any) C. Family Nursing -the family that we CREATE by getting - focus of modern nursing practice married and having children - it is nursing care that considers the family, not the individual F. RECOGNIZED FAMILY STRUCTURES 1. Childfree or childless family 8. Binuclear family -2 people living together without children -A family that is created by divorce or separation when the child is raised in two families -Advantages: Companionship and shared resources 9. Communal Family - group of people who choose to live together as an 2. Cohabitation family extended family -Couples perhaps with children who live together but remain unmarried -motivated by social or religious values rather than kinship 3. Nuclear family -Composed of 2 parents and children. -freedom & free choice rather than those of a traditional family -Advantage: financial and emotional support, genuine affection for each other. -prefer complementary or alternative therapies 4. Extended (multigenerational) family 10. Gay or Lesbian (LGBT) Families -Nuclear family plus grandparents, uncles, aunties, cousins and grandchildren. - individuals of the same sex live together as partners for companionship, financial security and sexual fulfilment -Contains more people to serve as resources during crises and models for behavior and values. -some include children from previous heterosexual relationships, artificial insemination, adoption or surrogate 5. Single-parent family motherhood -PROS: family can offer the child a special parent-child relationship & increased opportunities for self-reliance & -Pros: advantages of a nuclear family independence. -CONS: discrimination -CONS: limited resources 11. Foster Family -foster parents may or may not have children of their own and receive remuneration for their care of the foster child; theoretically temporary until the kids can be returned to This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 11 6. Blended family/Remarriage/Reconstituted Family their own parents -a divorced or widowed person with children marries someone who also has children; -PROS: prevents kids from being raised in large orphanage settings -PROS: increased security and resources, exposure to different customs or culture; -CONS: insecurity & inability to establish meaningful relationships due to frequent moves -CONS: rivalry, each spouse may experience difficulty helping rear the other’s children, financial problems 12. Adoptive Family - type of family structure in which a person from 7. Dyad Family the family assumes the parenting of a child from -2 people living together, usually man & woman (e.g. his/her biological parents through adoption newly-married couple) agencies, international adoption and private adoption -single, young, same-sex adults who live together as a dyad for companionship & financial security 13. Polygamous Family -marriage with multiple spouses -polygyny- (1 man with several wives) -polyandry (1 woman with several husbands) G. 5 Universal Characteristics of a Family H. Characteristics of A Healthy Family 1. Small social system- interrelated; actions of 1 Members: affect the other  interact with each other repeatedly in many 2. Performs certain basic functions: provides for contexts. the physical, spiritual, mental health, socialization  encouraged to grow and develop as of members, provision of economic well-being individuals and members of the family 3. Has structure- who are the members?  enhanced and fulfilled by maintaining 4. Has its own cultural values and roles contacts with a wide range of community 5. Moves through stages in the life cycle groups and organizations  make efforts to master their lives by becoming members of groups, finding information and options, and making decisions. I. 8 Family Tasks: J. Family Life Cycles a. PHYSICAL MAINTENANCE- food, clothing & shelter Stage 1: Marriage Stage 2: The Early Child-bearing Family b. SOCIALIZATION OF FAMILY MEMBERS Stage 3: The Family with a Pre-school Child Stage 4: The Family with a School-age Child c. ALLOCATION OF RESOURCES Stage 5: The Family with an Adolescent Stage 6: The Launching Stage Family Stage7: The Family of Middle Years d. MAINTENANCE OF ORDER Stage 8: The Family in Retirement or Old Age e. DIVISION OF LABOR *BOOMERANG GENERATION- young adults return f. REPRODUCTION, RECRUITMENT AND RELEASE OF home to live with their family after college or a failed FAMILY MEMBERS relationship until they can afford their own apartment or form a new relationship g. PLACEMENT OF MEMBERS INTO THE LARGER SOCIETY * SANDWICH FAMILY- a family that is squeezed into taking care of both aging parents and a returning young h. MAINTENANCE OF MOTIVATION AND MORALE adult. *EMPTY NEST SYNDROME- is a feeling of boredom or grief and loneliness parents may feel when their children leave home for the first time, such as to live on their own or to form families of their own K. ASSESSMENT OF FAMILY STRUCTURE AND FUNCTION This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 11  Family assessment is best done when a family is doing well GENOGRAM- diagram that details family structure, provides info about the family’s history and the roles of various family members over time, usually through several generations; provides a basis for discussion and analysis of family interaction. ECOMAP- to document the fit of a family in their community; a diagram of family and community relationships FAMILY APGAR- a screening tool of the family environment -a Family APGAR form is administered to each family member and their scores are c ompared This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 11 CHECK FOR UNDERSTANDI NG (30 minutes) The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to answer these questions and write the rationale for each question. Multiple Choice (For 1-10 items, please refer to the questions in the Rationalization Activity) RATIONALIZATION ACTIVITY The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss among their classmates. 1. These are primary goals of maternal and child health nursing except: A. Provision of nursing care of women throughout pregnancy, birth, and postpartum period B. Provision of nursing care of children from birth through adolescence C. Provision of quality education D. Provision of nursing care to families in all settings ANSWER: C RATIONALE: Option C is part of the 17 Sustainable Development Goals. A, B and D are goals of maternal and child Health Nursing 2. Maternal and child health nursing is: A. Patient-centered B. Family-centered C. Evidence-based D. All of the above E. None of the above ANSWER: D RATIONALE: A, B and C are part of the philosophy of Maternal and child health nursing. 3. Which of the following is not a Millennium Development Goal? A. Improve maternal health B. Enhance child mortality C. Eradicate extreme poverty and hunger D. Combat HIV, AIDS, malaria and other diseases ANSWER: B This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 11  RATIONALE: The correct statement of MDG number 4 is: Reduce child mortality 4. Which of the Millennium Development Goals does this graphic image represent? A. Eradicate extreme poverty and hunger B. Improve maternal health C. Combat HIV, AIDS, malaria and other diseases D. Achieve universal primary education ANSWER: A st RATIONALE: The graphic image represents the 1 MDG: Eradicate extreme poverty and hunger 5. Fill in the blank. MDG6 is to combat HIV-AIDS, __________ and other diseases A. Tuberculosis B. Malaria C. Diarrhea D. Cholera ANSWER: B RATIONALE: MDG 6 specifically states: Combat HIV/AIDS, MALARIA and other diseases. Tuberculosis, Diarrhea and Cholera are not specifically mentioned. 6. Sustainable Development Goal number 1 is about poverty. What is the aim of this goal? A. Cut poverty in half by 2030 B. Reduce poverty by 75% in 2030 C. End poverty in all its forms everywhere D. Help each nation make progress in ending poverty ANSWER: C RATIONALE: “Leave no one behind” is a k ey message throughout the 2030 Agenda for Sustainable Development. Goal 1 is about ending poverty, in all its forms, everywhere in the world. 7. Sustainable Development Goal 17 is about strengthening the “means of implementation” and revitalizing the “Global Partnership” for realizing all the other Goals. Which of the following is not part of Goal 17? A. Mobilizing the financial resources to achieve the goal B. Creating international sports tournaments and festivals to meet the goal. C. Helping developing countries build the capacities they need in areas such as technology, public policy and data for reporting on progress. D. Enhancing trade, especially to help developing countries increase their exports and grow their economies. ANSWER: B RATIONALE: Option B is not formally part of the sustainable development goals 8. Which of the following is not part of the Sustainable Development Goals? A. Access to sustainable energy for all B. Availability of water and sanitation for all. C. Provision of free internet services for all D. Promotion of decent jobs for all ANSWER: C RATIONALE: Provision of free internet services for all is not part of the SDGs. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 11 9. The nurse’s role is to help patients adapt to change caused by illnesses or other stressors. This is a theory by: A. Florence Nightingale B. Dorothea Orem C. Callista Roy D. Patricia Benner ANSWER: C RATIONALE: Callista Roy’s Adaptation Model states that the nurse’s role is to help patients adapt to change caused by illness or other stressors. 10. These are all competencies necessary for quality care except: A. Patient-centered care B. Experience-based practice C. Safety D. Teamwork and collaboration ANSWER: B RATIONALE: A, C, and D are all competencies necessary for quality care. Evidence- based practice, NOT experience-based practice is part of the competencies. 11. Group of people who choose to live together as an extended family and their relationship is motivated by social or religious rather than kinship A. Nuclear family B. Communal Family C. Adoptive Family D. Multigenerational family ANSWER: B RATIONALE: A communal family is a group of people who choose to live together as an extended family motivated by social or religious values rather than k inship 12. The family that loosens ties to allow freedom and prepares the children to lead their own lives is in the life cycle stage of: A. Stage 8: The Family in Retirement or Old Age B. Stage 5: The Family with an Adolescent C. Stage 5: The Family of Middle Years D. Stage 6: The Launching Stage Family ANSWER: D RATIONALE: The launching stage family has children adult children who are ready to leave home in order to form families of their own or to live independently. Options A and C have children that usually have children that have already left home and are leading their own lives. Option B is a family that is still preparing their child to live independently. 13. The family task that helps maintain a sense of unity and pride in the family is: A. socialization of family members B. maintenance of order C. division of labor D. motivation and morale ANSWER: D RATIONALE: Motivation and boosting of morale brings the family together and cultivates a sense of unity and pride in being a part of the family. Socialization of family members prepares them for creating relationships outside the family and in the bigger community. Maintenance of order and division of labor instills a sense of responsibility and promotes equality. 14. “Empty Nest Syndrome” is: A. When young adults return home to live with their family after college or a failed relationship until they can afford their own apartment or form a new relationship. B. A family that is squeezed into taking care of both aging parents and a returning young adult. C. A feeling of boredom or grief and loneliness parents may feel when their children leave home for the first time, such as to live on their own or to form families of their own D. All of the above ANSWER: C RATIONALE: Option A refers to Boomerang Generation, while Option B refers to a Sandwich Family. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 11 15. The family is: A. A group of people related by blood, marriage, or adoption living together. B. Two or more people who live in the same household (usually), share a common emotional bond, and perform certain interrelated social tasks C. A couple perhaps with children who live together but remain unmarried D. A and B E. All of the above ANSWER: E RATIONALE: Options A, B and C refer to the different definitions of family: Option A is the definition of family by the US Census Bureau, 2009. Option B is the definition of family by Allender & Spradley, 2008. Option C is the definition of a Cohabitation Family 16. What type of family does this image represent? A. Multigenerational Family B. Nuclear Family C. Single-Parent Family D. LGBT Family ANSWER: A RATIONALE: The graphic image represents a multigenerational family comprised of the Nuclear family plus grandparents and probably uncles, aunties, cousins and grandchildren. Option B is Composed of 2 parents and their children, Option C is composed of one parent and his/her child or children. Option C is composed of a couple of the same sex, with or without children. 17. The stage in the family life cycle wherein the nurse serves as a counsellor to a family with teenagers, a step in family growth: A. Family with an adolescent B. Family with young adult C. Family in the middle years D. Family with a Preschool child ANSWER: A RATIONALE: An adolescent is defined as someone between the ages of 10 to 19, inclusive of the teenage years. Options B and C are families with children with ages above the teens, from 20 years of age onwards. Option B describes a family with a child aged 3 to 6 years. 18. A Family assessment tool that consists of a Diagram of family history A. EcoMap B. Genogram C. Family APGAR D. A and B E. A and C ANSWER: B RATIONALE: A Genogram is a diagram that details family structure, provides info about the family’s history and the roles of various family members over time, usually through several generations. An EcoMap is a diagram of family and community relationships. A Family APGAR is a screening tool of the family environment which mak es use of a questionnaire as its tool. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 11 19. The family task that establishes family rules and regulations: A. Physical maintenance B. Reproduction, recruitment and release of family members C. Allocation of resources D. Maintenance of order ANSWER: D RATIONALE: Option D, maintenance of order, is the family task that constitutes of establishing rules and regulations and instilling discipline among its members. Physical maintenance entails provision of basic needs such as food, water and shelter. Allocation of resources refers to the just division and distribution of resources to each family member. 20. It refers to the family one is born into (e.g., oneself, mother, father, and siblings, if any) A. Family of Orientation B. Family of Procreation C. Nuclear family D. Adoptive family ANSWER: A RATIONALE: Family of orientation refers to the family one is born into. Option B refers to the family one establishes or creates. Option C is type of family structure composed of 2 parents and children. Option D is a type of family structure in which a person from the family assumes the parenting of a child from his/her biological parents LESSON WRAP-UP (10 minutes) Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students trac k how much work they have accomplished and how much work there is left to do. This tracker will be part of the student activity sheet. You are done with the session! Let’s track your progress. Period 1 Period 2 Period 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 AL Strategy: Minute Paper 1. Towards the end of the class, students are asked to use index cards or half-sheets of paper to provide written feedback to the following questions: a. What was the most useful or the most meaningful thing you have learned this session? b. What question(s) do you have as we end this session? 2. Collect the responses as or before the students leave. One way is to station yourself at the door and collecting “minute papers” as student file out. 3. Respond to students’ feedback during the next class meeting or as soon as possible This document and the information thereon is the property of PHINMA Education (Department of Nursing) 11 of 11  Care of Mother, Child and Adolescent (Well- Clients) INSTRUCTOR’S GUIDE BS NURSING / SECOND YEAR Session # 2 LESSON TITLE: NURSING ROLE IN REPRODUCTIVE Materials: AND SEXUAL HEALTH: Male and Female Reproductive Book, anatomical models of the male and female System genitalia, paper, pen, notebook, and LCD projector LEARNING TARGETS: At the end of the lesson, the student nurse can: 1. Identify the anatomy and physiology pertinent to reproductive and sexual health 2. Differentiate the male and female physiological Reference changes during puberty 3. Identify the parts and functions of the mammary glands Pilliteri, Adele and Silbert-Flagg, JoAnne (2018) th 4. Identify the parts and functions of the female pelvis Maternal and Child Health Nursing, 8 Edition. USA: Lippincott Williams and Wilkins LESSON REVIEW/PREVIEW (10 minutes) 1. The instructor will start the session by greeting the class, checking attendance and responding to the questions generated by the previous meeting’s 4 Minute Paper and the assigned paper about the family. 2. To introduce the day’s topic, the instructor will distribute anatomical models of the male and female genitalia to the students and initiate a brief recall of the anatomical parts. MAIN LESSON (50 minutes) The instructor should discuss the following topics. Instruct the students to tak e down notes and read their book about this lesson (Chapter 5: The Nursing Role in Reproductive and Sexual Health p.77). I. Definition of Terms: II. REPRODUCTIVE DEVELOPMENT (Intrauterine A. Obstetrics = a branch of medicine that deals with Development) the care of women during pregnancy, labor, and the period of recovery following childbirth.  Sex is determined at the moment of conception a. It is derived from the Greek word obstare, which means “to keep watch”  A GONAD produces sex cells (ovary & testes); by B. Gynecology = is the study of female reproductive week 5 in utero, primitive gonads are formed organs and diseases affecting it. C. Andrology = is the study of the male reproductive  In both sexes, there are 2 undifferentiated ducts, organs the mesonephric (WOLFFIAN) & D. Pediatrics = the branch of medical science paramesonephric (MULLERIAN) duct concerned in children and their illness. a. It is derived from the Greek word pais  Week 7-8 (males)- gonadal tissue differentiates meaning “child”. into primitive testes & begins formation of E. Neonatology =the branch of medicine concerned testosterone with the development and disorders of newborn babies.  Testosterone influences the mesonephric(W) F. Sexual Health = is not just an absence of disease, duct to develop into male reproductive organs dysfunction, or infirmity but a condition of physical, as the paramesonephric(M) duct regresses. emotional and psychological well-being. G. Gonad = is a body organ that produces the cells necessary for reproduction (the ovary in females, the  If testosterone is absent by week 10, gonadal testis in males) tissue differentiates into ovaries & paramesonephric duct(M) develop into female reproductive organs. Oocytes are formed This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 13   Week 12, external genitals begin to be visible.  In males, dt testosterone, penile tissue elongates & the urogenital fold on the ventral surface of the penis closes to form the urethra.  In females with no testosterone, urogenital fold remains open to form the labia minora; what would be formed as scrotal tissue in the male becomes the labia majora in the female. III. PUBERTAL DEVELOPMENT PUBERTY is the stage of life at which secondary sex change C. Secondary Sex Characteristics in Female s: begins; begins at 9 to 12 years old in girls.  Growth spurt  Increase in the transverse diameter of the pelvis  Breast development A. Role of Testosterone:  Growth of pubic hair Responsible for:  Onset of menstruation muscular development physical growth  Growth of axillary hair increase in sebaceous gland secretions that cause  Vaginal secretions typical acne in both boys and girls during adolescence. D. Secondary Sex Characteristics in Males:  Increase in weight  Initiates adrenarche (pubertal changes in testes,  Growth of testes scrotum, penis, prostate, and seminal vesicles; the  Growth of face, axillary, and pubic hair appearance of male pubic, axillary, and facial hair;  Voice changes laryngeal enlargement with its accompanying voice  Penile growth change; and maturation of spermatozoa).  Increase in height  Spermatogenesis - production of sperm  Androgens are produced by the adrenal gland and the testes in males.  Androgens are produced by the adrenal gland and the ovaries in females. B. Role of Estrogen:  Release is triggered by FSH, ovaries in females excrete a high level of estrogen.  Influences the development of uterus, fallopian tubes, and vagina; typical fat distribution; hair patterns; breast development.  Thelarche = the beginning of breast development; which usually starts 1 to 2 years before menstruation.  Menarche = the beginning of menstruation Onset: 9 – 17 years old in females Average: 12.4 years old in females This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 13  II.ANATOMY AND PHYSIOLOGY OF THE MALE REPRODUCTIVE SYSTEM EXTERNAL STRUCTURES 1. SCROTUM 2. TESTES  rugated, skin-covered, muscular, deeply pigmented pouch suspended from the perineum  left scrotum is larger & lower due to longer spermatic cord  Cremaster muscle- responsible for contraction of the scrotum  midline septum- separates each sac  each compartment contains a testis, its epididymis, & a part of the spermatic cord  Functions of the scrotum: supports the testes, helps regulate the temperature of sperm protects the testes from trauma  2 ovoid glands, 2 to 3 cm wide, encased by protective white fibrous capsule  male sex glands, correspond to the ovary in female  composed of lobules, each lobule containing interstitial cells (LEYDIG’S CELLS) & seminiferous tubules  900 coiled seminiferous tubules produce spermatozoa  Interstitial cells (Leydig’s cells) produce testosterone  Functions: manufacture male sex cells (gametes) or spermatozoa produce several steroid hormones primarily testosterone This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 13 3. PENIS  3cylindrical masses of erectile tissue in the penis shaft: 2 CORPUS CAVERNOSA 1 CORPUS SPONGIOSUM  corpus spongiosum contains the urethra which serves as a passage for both sperm and urine  organ of copulation & urination  Penile artery supplies blood to the penis  Erection is innervated by the Peripheral Nervous System  GLANS- bulging, sensitive ridge of tissue at the distal end of the penis; similar in function to the clitoris  PREPUCE/foreskin- retractable casing of skin, protects the glans  PHIMOSIS- condition in which the prepuce is too tight that it interferes with the flow of urine INTERNAL STRUCTURES 1. EPIDIDYMIS 2. VAS DEFERENS/DUCTUS DEFERENS  a tightly coiled tube responsible for conducting sperm  is an additional hollow tube surrounded by arteries from the tubule to the vas deferens. and protected by a thick fibrous coating, which  It is the storage of immature sperm, and a part of the altogether, are referred to as the spermatic cord. alkaline fluid (semen, or seminal fluid that contains a  It carries sperm from the epididymis through the basic sugar and protein) that will surround sperm at inguinal canal into the abdominal cavity, where it maturity is produced by the cells lining the epididymis. ends at the seminal vesicles and the ejaculatory  Sperm are immobile and incapable of fertilization as ducts below the bladder. they pass through or are stored at the epididymis level.  Sperm completely matures as they pass through the  It takes at least 12 to 20 days for them to travel the vas deferens. They are still not mobile at this point. length of the tube, and a total of 65 to 75 days for them  This is the site severed during vasectomy to prevent to reach full maturity. passage of sperm, a popular means of male birth  Sperm is capable of surviving for 72 hours inside the control. woman’s body.  Aspermia = absence of sperm  Oligospermia = fewer than 20 million sperm per milliliter 3. PROSTATE GLAND 5. URETHRA  is a chestnut-size gland that lies just below the bladder  is a hollow tube leading from the base of the and allows the urethra to pass through the center of it, bladder, which, after passing through the prostate like the hole in a doughnut. gland, continues to the outside through the shaft and glans of the penis. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 13   Function: to secrete a thin, alkaline fluid, which, when added to the secretion from the seminal vesicles, further protects sperm by increasing the naturally low pH level of the urethra. 4. BULBOURETHRAL GLAND  or Cowper’s glands lie beside the prostate gland and empty by short ducts into the urethra. They supply one more source of alkaline fluid to help ensure the safe passage of spermatozoa.  SEMEN is derived from the prostate gland (60%), the seminal vesicles (30%), the epididymis (5%), and the bulbourethral glands (5%). II. ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM EXTERNAL STRUCTURES VULVA/PUDENDA This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 13 1. MONS PUBIS or MONS VENERIS 2. LABIA MAJORA (Large lips)  It is a pad of adipose tissue located over the  2 folds of adipose tissue covered by loose symphysis pubis, the pubic bone joint. connective tissue & epithelium  It is covered by a triangle of coarse, curly hairs  Function: protects the external genitalia and inner known as “escutcheon”. vulvar structures  Function: to protect the junction of the pubic bone from trauma. 3. LABIA MINORA (Small lips) 4. VESTIBULE  2 flat hairless, reddish folds of connective tissue  almond-shaped area that is found within the labia located between the labia majora  contains openings to the urethra, vagina, skene’s glands and bartholin’s glands  anteriorly fuse to form the prepuce (hoodlike covering of the clitoris) and the frenulum(fold of 5. GLANS CLITORIS tissue under the clitoris)  a small (1 to 2cm), rounded organ of erectile tissue at the forward junction of the labia minora  posteriorly join to form the FOURCHETTE (torn  site or center of sexual arousal & orgasm in during childbirth & is the site of episiotomy females  Protects and obscures the vestibule, urinary meatus  when the ischiocavernosus muscle surrounding and vaginal os it contracts with sexual arousal, the venous outflow for the clitoris is blocked, leading to clitoral erection.  Secretes smegma 6. SKENE’S GLANDS/ PARAURETHRAL GLANDS 8. PERINEAL MUSCLE/ PERINEAL BODY  Located on each side of the urinary meatus  Located posterior to the fourchette  produce alkaline mucus for lubrication & protection  muscular area easily stretched during childbirth 7. BARTHOLIN’S GLANDS / PARAVAGINAL GLANDS  Located on each side of the vaginal opening  Exercises to strengthen the perineal body: Kegel  secrete an alkaline substance to lubricate the exercises, tailor-sitting, squatting vaginal orifice & neutralize the acidity of the vagina 9. HYMEN  tough but elastic tissue that covers the vagina  Site of Bartholin’s cyst & infection (Bartholinitis)  imperforate hymen- a hymen so complete it does not allow passage of menstrual blood from the vagina or for sexual relations until it is surgically incised INTERNAL STRUCTURES This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 13 1. OVARIES Functions of ESTROGEN (Hormone of the Woman)  approximately 3 cm long by 2 cm in diameter and 1.5 Development of secondary sexual cm thick, or the size and shape of almonds. They are characteristics grayish-white and appear pitted, with minute Inhibits production of FSH indentations on the surface. SPINNBARKEIT formation  Function: to produce, mature, and discharge ova Development of ductile structure of the (egg cells). In the process of producing ova, the breasts ovaries also produce estrogen and progesterone and Increase in height in females initiate and regulate menstrual cycles. Hypertrophy of the uterine lining  Organ of ovulation, oogenesis, and hormone production. Functions of PROGESTERONE (Hormone of the  3 principal divisions/layers Mother) TUNICA ALBUGINEA-protective layer of Inhibits LH production epithelium Inhibits motility if the GIT- decrease in CORTEX- filled with ovarian & graafian peristalsis, increase in H2O reabsorption follicle causing constipation MEDULLA- contains nerves, blood vessels, Mammary gland maturation lymphatics Mood swings  ***At birth, each ovary contains about 2 million Increase in BBT (Basal Body immature ova; by age 7 years, only 500T are Temperature) present per ovary; by 22 years, 300,000 ova; by menopause none are left (atrophied or matured) 2. FALLOPIAN TUBES/OVIDUCTS/UTERINE DUCTS 4 Segments of the FALLOPIAN TUBE: INTERSTITIAL- most proximal, lies within uterine wall (1 cm); most dangerous site for ectopic pregnancy ISTHMUS- next distal portion, extremely narrow; site of sterilization or BTL (Bilateral Tubal Ligation) AMPULLA- 3rd & longest portion (5 cm); site of fertilization INFUNDIBULLUM- most distal, funnel-shaped; rim is covered by fimbriae (small hairs) that help guide the ovum into the FT This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 13   They arise from each upper corner of the uterine body and extend outward and backward until each opens at its distal end, next to an ovary.  The fallopian tubes are approximately 8-10 cm long in a mature woman. Functions: to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum by the sperm 3. UTERUS Isthmus = is a short segment between the body and the cervix. In the nonpregnant uterus, it is only 1 to 2 mm in length.  It is the portion where the incision most commonly is made when a fetus is born by a cesarean birth.  It is considered as “the lower uterine segment” during pregnancy. Cervix = is the lowest portion of the uterus.  It represents about one third of the total uterine size and is approximately 2 to 5 cm long.  It is a hollow, muscular, pear-shaped organ located in  Its central cavity is termed as cervical canal. the lower pelvis, posterior to the bladder and anterior to the rectum  The opening of the canal at the junction of the cervix and isthmus is the internal cervical os;  During childhood it is the size of an olive & reaches its adult size by 17 years-old  the distal opening to the vagina is the external cervical os.  Dimensions: 5-7 cm long, 5 cm wide, 2.5 cm deep and weighs 60 g.  The level of the external os is at the level of the ischial spines  Functions: Uterine and Cervical coats: receive the ovum from the oviduct, implantation & nourishment of the fetus, Endometrium = an inner layer of mucous membrane protection of the fetus, innermost layer expulsion during childbirth Three divisions of the uterus: highly vascular with 3 layers (compact, spongy & basal layers); basal layer is unaffected by hormones & the upper 2 Body of the uterus (corpus) = the uppermost part and forms are sloughed off during menses and are greatly affected by the bulk of the organ. hormones  The lining of the cavity is continuous with the fallopian Myometrium = a middle layer of muscle fibers tube, which enter at its upper aspects (the cornua).  3 interwoven layers of smooth muscle arranged in  The fundus is the uppermost part of the corpus longitudinal, transverse & oblique directions  provides strength to the organ during contractions  During pregnancy, the body of the uterus is the portion of the structure that expands to contain the growing Functions: fetus.  constrict tubal junctions & prevent regurgitation of menstrual blood into the tubes  The fundus is the portion that can be palpated  holds internal os closed during pregnancy; abdominally to determine the amount of uterine growth  limits blood loss during childbirth during pregnancy, to measure the force of uterine contractions during labor, and to assess that the uterus is returning to its nonpregnant state after childbirth. Perimetrium = an outer layer of connective tissue that provides support This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 13  UTERINE LIGAMENTS CARDINAL/ TRANSVERSE-CERVICAL/ MACKENRODT UTEROSACRAL LIGAMENT LIGAMENTS  connects uterus to the sacrum  lower portion of the broad ligaments  main support of the uterus ANTERIOR LIGAMENT  damage to this ligament results to UTERINE  provides support to the uterus in connection with PROLAPSE the bladder. BROAD/PERITONEAL LIGAMENTS  Overstretching will lead to herniation of the ates from the sides of the corpus & extends to the lateral pelvic bladder to the vagina, a condition called CYSTOCELE orts the sides of the uterus & assists in holding the uterus in POSTERIOR LIGAMENT tly tipped forward  It forms the cul-de-sac or pouch of Douglas. ROUND LIGAMENT  connects the uterus to the labia majora and gives  Damage will led to herniation of the rectum to the stability to the uterus vagina, a condition called RECTOCELE UTERINE DEVIATIONS BICORNUATE UTERUS- horns at the junction of the fallopian tubes SEPTUM which divides the uterus DOUBLE UTERUS RETROVERSION- fundus is tipped backward This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 13  ANTEVERSION- fundus is tipped forward ANTEFLEXION- body is bent sharply forward at the junction of the cervix RETROFLEXION- body is bent sharply back just before the cervix 4. VAGINA  FORNICES- recesses at the cervical end of the  it is a hollow, musculomembranous, rugated canal vagina: posterior, anterior & lateral located posterior to the bladder & anterior to the rectum o posterior fornix- site where semen pools  rugae make the vagina elastic & expand during after intercourse childbirth  It is lined with stratified squamous epithelium similar  from the cervix of the uterus to the external vulva to the cervix  FUNCTIONS: organ of intercourse  mucus secretions contain glycogen broken down by and birth canal DODERLEIN’S BACILLUS forming lactic acid making the pH 4 to 5 which is acidic; thus, preventing infections  Low E (menopause, childbirth & lactation) causes dryness & thinness of the vaginal walls and smoothening of the rugae  bulbocavernosus muscle acts as a voluntary sphincter; kegel’s exercise strengthens this muscle ACCESSORY ORGANS 1. MAMMARY GLANDS NIPPLE is composed of smooth muscles capable of erection on manual or sucking stimulation  Nipples project slightly upward & outward, with 15 to 20 small openings; surrounded by a darkly pigmented area of epithelium approximately 4 cm in diameter, termed the AREOLA AREOLA  Areola appears rough due to sebaceous glands called MONTGOMERY’S TUBERCLES  Stimulation leads the APG to secrete OXYTOCIN which makes the myoepithelium to contract, pushing the milk forward into the nipples (LETDOWN Located anterior to the pectoralis major muscle, REFLEX or MILK EJECTION REFLEX) between the sternum & the midaxillary line (between 2nd & 6th ribs), with an extension called the TAIL OF  Increase in P & E 3-4 days before menses increase SPENCE and extends well into the axilla vascularity of the breasts, induce growth of ducts & Composition: acini, promotes H2O retention, resulting in breast  divided into 15 to 20 LOBES divided into LOBULES swelling, tenderness & discomfort. LOBULES -clusters of ACINAR CELLS/ ACINI which are  After menses, regression occurs & H2O is lost & saclike terminal parts of the gland emptying through a narrow reaches minimal alteration levels 5 to 7 days after lumen of duct lined with epithelial cells that secrete MILK & menses. (BEST TIME FOR Breast Self- COLOSTRUM Examination)  below the epithelium is the MYOEPITHELIUM which Hormones that Influence the Mammary Glands contracts to expel milk from the acini into the LACTIFEROUS or MILK DUCTS towards the nipple  ESTROGEN- development of the ductile structure of the breast  As the ducts converge, they dilate to form common  PROGESTERONE- development of the acinar LACTIFEROUS SINUSES or AMPULLA which serve structures of the breast as milk reservoirs. These are located just posterior to the NIPPLE  HUMAN PLACENTAL LACTOGEN (HPL)- breast development during pregnancy  OXYTOCIN- let-down reflex or milk ejection reflex  PROLACTIN- directly stimulates milk production This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 13 2. PELVIS 2 Divisions of the Pelvis: A. Functions:  FALSE PELVIS- upper half which supports the  Support & protect the reproductive & other pelvic uterus during the late months of pregnancy & aids in organs directing the fetus into the true pelvis for birth  Accommodation of the growing fetus  Anchorage of the pelvic support structures  TRUE PELVIS- lower half of the pelvis; long, bony, curved canal divided into 3 parts: B. Composition: o inlet,  Anterior & lateral portion made up of 2 innominate o pelvic cavity hip bones divided into 3 parts (ilium, ischium and o outlet pubis  Posterior portion: sacrum, coccyx  LINEA TERMINALIS or BRIM- imaginary line from the sacral promontory to the superior border of the SP which divides the pelvis into true & false pelves CHECK FOR UNDERSTANDI NG (25 minutes) The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to answer these questions and write the rationale for each question. Multiple Choice (For 1-10 items, please refer to the questions in the Rationalization Activity) RATIONALIZATION ACTIVITY The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss among their classmates. 1. Which term refers to the externally visible structures of the female reproductive system extending from the symphysis pubis to the perineum? A. Mons pubis B. Vulva C. Labia majora D. Clitoris ANSWER: B RATIONALE: Vulva is the collective term referring to the external structures of the female genitalia. Options A, C and D are parts of the vulva 2. Which principal factors causes vaginal pH to be acidic? A. Cervical mucus B. Secretions from the Skene’s glands C. The action of Doderlein bacilli on the vagina D. Secretions from the Bartholin’s glands This document and the information thereon is the property of PHINMA Education (Department of Nursing) 11 of 13  ANSWER: C RATIONALE: Doderlein bacilli present in the vagina converts glycogen to lactic acid, rendering the vaginal secretions acidic. Options A, B and D are alk aline secretions 3. This is the period of life at which no functioning oocytes or ova remain in the uterus A. Puberty B. Andropause C. Menarche D. Menopause ANSWER: D RATIONALE: Option A is the period of adolescence when reproductive sexual changes occur. Option B refers to male menopause. Option C refers to the first menstruation of females 4. These are structures located bilateral to the urinary meatus of females and serve to lubricate the external genitalia and protect the sperm A. Prostate gland B. Cowper’s gland C. Bartholin’s gland D. Skene’s Gland ANSWER: D RATIONALE: Sk ene’s glands are located on each side of the female urinary meatus and secrete alk aline fluid to protect the sperm from the acidic ph of the vagina. 5. When performing a pelvic examination, the nurse observes a red, swollen area on the right side of the c lient’s orifice. The nurse would document this as enlargement of which of the following? A. Clitoris B. Parotid Gland C. Skene’s Gland D. Bartholin’s Gland ANSWER: D RATIONALE: Bartholin’s glands are located on each side of the vaginal orifice. The clitoris is located anterior to the vaginal orifice. Option B is not part of the vulva. Option C is located on each side of the urinary meatus 6. Which of the following is not a function of the vagina? A. It receives the penis during intercourse B. It houses the products of conception C. It is the passageway for menstrual discharges D. It is part of the birth canal during delivery ANSWER: B RATIONALE: It is the uterus that houses the products of conception and not the vagina. Options A, C and D are all functions of the vagina. 7. All are functions of the oviduct except: A. Transports ovum from the ovary to the uterus B. The site of fertilization C. Responsible for oogenesis D. Provides nourishment to the ovum during its journey ANSWER: C RATIONALE: The ovary is responsible for oogenesis. Options A, B and D are function of the fallopian tube 8. It is a long, tightly coiled tube about 20 feet long which is the site of spermatozoa maturatio n A. Epididymis B. Ejaculatory duct C. Vas deferens D. Seminiferous tubules ANSWER: A RATIONALE: The sperm produced in the seminiferous tubules (Option D) travel along the epididymis where they undergo maturation. Options B and Care passageway for mature sperm. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 12 of 13 9. The basal body temperature drops slightly before ovulation and rises by 1F after ovulation. This change in the temperature is due to the influence of what hormone? A. Estrogen B. Progesterone C. Testosterone D. Luteinizing Hormone ANSWER: B RATIONALE: Progesterone is responsible for increasing the basal body temperature during ovulation. Estrogen is responsible for spinnbark eit, a change in the consistency of cervical mucous during ovulation. Testosterone is a male hormone. Luteinizing hormone is responsible for initiating ovulation. 10. These are oval-shaped glands lying within the scrotal sacs and are considered as the male gonads A. Testes B. Prostate gland C. Ovary D. Ejaculatory duct ANSWER: A RATIONALE: Option B is located in the pelvis. Option C is the female gonad. Option D is a tube outside of the scrotum LESSON WRAP-UP (5 minutes) Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students trac k how much work they have accomplished and how much work there is left to do. This tracker will be part of the student activity sheet. You are done with the session! Let’s track your progress. Period 1 Period 2 Period 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 AL STRATEGY: CAT 3-2-1 This closure activity is to evaluate what the students learned after the discussion and the activity. 3-2-1 Three things you learned: 1. __________________________________________________ 2. __________________________________________________ 3. __________________________________________________ Two things that you’d like to learn more about: 1. __________________________________________________ 2. __________________________________________________ One question you still have: 1. ___________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 13 of 13  Care of Mother, Child and Adolescent (Well- Clients) INSTRUCTOR’S GUIDE BS NURSING / SECOND YEAR Session # 3 LESSON TITLE: NURSING ROLE IN REPRODUCTIVE Materials: AND SEXUAL HEALTH: The Menstrual Cycle Book, paper, pen, notebook, and LCD projector LEARNING OUTCOMES: At the end of the lesson, the student nurse can: Reference 1. Describe the anatomy and physiology pertinent to the menstrual cycle Pilliteri, Adele and Silbert-Flagg, JoAnne (2018) 2. Identify the hormones that influence the menstrual th Maternal and Child Health Nursing, 8 Edition. cycle USA: Lippincott Williams and Wilkins 3. Discuss the ovarian phases of the menstrual cycle 4. Discuss the uterine phases of the menstrual cycle LESSON REVIEW/PREVIEW (10 minutes) 1. The instructor will start the session by greeting the class and checking attendance 2. The instructor will conduct a short recitation where 1 student will be asked to answer a question on the previous session’s topic. After answering, the student will choose one of her classmates to answer the next quest ion. MAIN LESSON (50 minutes) The instructor should discuss the following topics. Instruct the students to tak e down notes and read their book about this lesson (Chapter 5: The Nursing Role in Reproductive and Sexual Health-The Menstrual Cycle p.92). I. Characteristics of A Normal Menstrual Cycles: Characteristic Description Beginning (menarche) Average age at onset: 12.4 years Average range: 9 – 17 years Interval between cycles Average: 28 days Cycles of 23 – 35 days not unusual Duration of menstrual flow Average flow: 4 – 6 days Ranges of 2 – 9 days not abnormal Amount of menstrual flow Difficult to estimate; average: 30-80 mL per menstrual period; saturating a pad or tampon in less than 1 hour is heavy bleeding Color of menstrual flow Dark red; a combination of blood mucus, and endometrial cells Odor Similar to marigolds This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 8  II. Physiology of Menstruation: DEFINITION: Menstrual cycle or female reproductive PURPOSE: To bring an ovum to maturity & renew uterine cycle is defined as episodic uterine bleeding in response tissue bed that is responsible for the growth of the to the cyclic hormonal changes fertilized ovum Release is triggered by FSH, ovaries in females excrete a high level of estrogen. A. 4 STRUCTURES INVOLVED IN MENSTRUAL CYCLE This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 8  1. HYPOTHALAMUS  The release of GnRH (also called luteinizing hormone-releasing hormone [LHRH]) from the hypothalamus initiates the menstrual cycle.  GnRH then stimulates the pituitary gland to send gonadotropic hormone to the ovaries to produce estrogen  When the level of estrogen rises, release of GnRH is repressed and no further menstrual cycles will occur (the principle that birth control pills use to eliminate menstrual flows). Excessive levels of pituitary hormones can also inhibit release. 2. PITUITARY GLAND  It is under the influence of GnRH, the anterior lobe of pituitary gland (adenohypophysis) produces two hormones:  Follicle-stimulating hormone (FSH) = is a hormone active early in the cycle that is responsible for maturation of the ovum.  Luteinizing hormone (LH) = is a hormone that becomes most active at the midpoint of the cycle and is responsible for ovulation, or release of mature egg cell from the ovary. It also stimulates growth of the uterine lining during the second half of the menstrual cycle.  FSH and LH are called gonadotropic hormones because they cause growth (trophy) in the gonads (ovaries). 3. OVARIES (OVARIAN CYCLE) B. LUTEAL PHASE – from Day 15 to Day 28 of a 28- day menstrual cycle A. PROLIFERATIVE PHASE –from Day 1 to Day 14 of a 28-day menstrual cycle  After the ovum and the follicular fluid have been discharged from the ovary, the cells of  Every month, one of the ovary’s oocytes is activated the follicle remain in the form of a hollow, by FSH to begin to grow and mature empty pit. The FSH has done its work at this  As the oocyte grows, its cell produce a clear fluid point and now decrease in amount (follicular fluid) that contains a high degree of estrogen and progesterone. As the follicle  The second pituitary hormone, LH, continues surrounding the oocyte grows, it is propelled toward to rise in amount and directs the follicle cells the surface of the ovary as a clear blister (Graafian left behind in the ovary to produce lutein, a follicle). bright-yellow fluid high in progesterone. With  After an upsurge of LH, prostaglandins are released lutein production, the follicle is renamed a and the graafian follicle ruptures (ovulation) corpus luteum (yellow body). th  This happens on the 14 day before the onset of the next cycle (not the midpoint).  If conception (fertilization by a spermatozoon) occurs as the ovum proceeds down a fallopian tube and the fertilized ovum implants on the endometrium of the uterus, the corpus luteum remains throughout the major portion of the pregnancy (to about 16 to 20 weeks).  If conception does not occur, the unfertilized ovum atrophies after 4 to 5 days, and the corpus luteum remains for only 8 to 10 days. As the corpus luteum regresses, it is gradually replaced by white fibrous tissue called corpus albicans (white body).  The basal body temperature of a woman drops O O slightly (by 0.5 to 1 F) just before the day of ovulation because of the extremely low level of progesterone that is present at that time. It O rises by 1 F on the day after ovulation because of the concentration of progesterone, This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 8  which is thermogenic.  The woman’s temperature remains at this level until approximately day 24 of the menstrual cycle, when the progesterone level again decreases. 4. UTERUS (UTERINE CYCLE) = the uterus also changes monthly as a result of stimulation from the estrogen and progesterone produced by the ovaries A. First Phase of the Menstrual Cycle (PROLIFERATIVE B. Second Phase of the Menstrual Cycle (Secretory PHASE) = from day 4 or 5 to day 14 Phase) = Day 14 to 24 of menstrual cycle  Immediately after menstrual flow (MENSTRUAL  After ovulation, the formation of progesterone PHASE from Days 1-4), the endometrium, or the in the corpus luteum causes the glands of the lining of the uterus, is very thin, approximately one uterine endometrium to become corkscrew or cell layer in depth. twisted in appearance.  As the ovary begins to produce estrogen (in the  The capillaries of the endometrium increase in follicular fluid), the endometrium begins to proliferate. amount until the lining takes on the  This growth is very rapid and increases the thickness appearance of rich, spongy velvet. of the endometrium approximately eightfold.  Also known as pregestational, luteal,  This happens from day 5 – 14 premenstrual, or secretory phase  Also known as estrogenic, follicular, or postmenstrual phase C. Third Phase of Menstrual Cycle (Ischemic Phase) = D. Fourth Phase of Menstrual Cycle (Menses or Day 24 to 28 of menstrual cycle Menstrual Phase) = first day of the menstrual flow to 5 days  If fertilization does not occur, the corpus luteum in the ovary begins to regress after 8 – 10 days. Menstrual flow is composed of:  Production of progesterone and estrogen decreases.  Blood from the ruptured capillaries  The endometrium of the uterus begins to degenerate.  Mucin from the glands – protein  Capillaries rupture, with minute hemorrhages, and  Fragments of endometrial tissue the endometrium sloughs off.  Happens approximately on day 24 or 25 of the cycle.  Microscopic, atrophied, and unfertilized ovum B. The Fern Test This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 8   Just before ovulation when estrogen levels are high, the cervical mucus has the ability to form fernlike patterns on a microscope slide when allowed to dry. This pattern is known as arborization or ferning.  When progesterone is the dormant hormone, as it is just after ovulation, this fern pattern is no longer discernible. C. Spinnbarkeit Test  At the height of estrogen secretion, the cervical mucus has the ability to stretch into long strands.  Stretching the mucus at the midpoint of a menstrual cycle is another way to demonstrate that high levels of estrogen are being produced, and that ovulation is about to occur. D. Education for Menstruation Signs and Symptoms of Menopause: Myths during menses: Periods of amenorrhea  Should not plant vegetables or the vegetables will “hot flashes” die.. Vaginal dryness leading to dyspareunia  Should not eat sour foods because this will cause cramping Aid: use a lubricating jelly such as KY jelly prior to sexual intercourse. Menstrual disorders: Osteoporosis (lack of bone mineral density)  Dysmenorrhea = painful menstruation  Menorrhagia = abnormally heavy menstrual flows Urinary incontinence  Metrorrhagia = bleeding between menstrual Aid: practice Kegel exercise to help strengthen periods bladder supports  Amenorrhea = absence of menstrual flow  Menopause = is the cessation of menstrual Hot flashes can be accompanied by heart palpitations and This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 8  cycles can occur up to 20 – 30 episodes a day Perimenopausal = is a term used to denote the period First Aid: sip a cold drink or use a hand fan during which menopausal changes occur. Postmenopausal = describes the time of life following the final menses Age range: 40 – 55 Mean average: 51.3 Women who smoke tend to have earlier menopause CHECK FOR UNDERSTANDI NG (25 minutes) The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to answer these questions and write the rationale for each question. Multiple Choice (For 1-10 items, please refer to the questions in the Rationalization Activity) RATIONALIZATION ACTIVITY The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss among their classmates. 1. It is the endocrine gland responsible for secreting gonadotropin releasing hormone in response to low levels of estrogen and progesterone Mons pubis A. Ovary B. Hypothalamus C. Anterior Pituitary Gland D. Posterior Pituitary Gland ANSWER: B RATIONALE: Option A secretes Estrogen and Progesterone. Option C secretes FSH and LH. Option D secretes oxytocin. 2. The basal body temperature drops slightly before ovulation and rises by 1F after ovulation. This change in the temperature is due to the influence of what hormone? A. Estrogen B. Progesterone C. Testosterone D. Follicle stimulating hormone ANSWER: B RATIONALE: Estrogen is responsible for spinnbark eit. Testosterone is responsible for the growth of pubic and axillary hair FSH is responsible for the maturation of primordial follicles in the ovary and Progesterone increases the basal body temperature after ovulation. 3. Which of the following hormones stimulates the ovary to produce estrogen during the menstrual cycle? A. Follicle Stimulating Hormone (FSH) B. Luteinizing Hormone (LH) C. Gonadotropin Releasing Hormone (GnRH) D. Progesterone ANSWER: A RATIONALE: FSH released by the adenohypophysis stimulates maturation of follicles at the same time stimulating the ovary to produce estrogen. LH initiates ovulation. GnRH stimulates the anterior pituitary gland to produce FSH and LH. Progesterone induces thick ening of the uterine endometrium. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 8 4. It is the phase in the uterine cycle wherein the uterus will thicken, glands become corkscrew and capillaries form: A. Menstrual Phase B. Proliferative Phase C. Secretory Phase D. Ischemic Phase ANSWER: C RATIONALE: During the Secretory phase, because of the influence of Progesterone, the uterine lining will thick en, glands become cork screw and capillaries form. During the menstrual phase, the uterine lining will slough off. During the proliferative phase, the uterine lining will have an eightfold thick ening. During the ischemic phase, the capillaries and glands will degenerate. 5. During the menstrual cycle, ovulation generally occurs at which of the following time? A. 7 days after the last day of menstruation B. 14 days after the last day of menstrual cycle C. 14 days before the beginning of the next menstrual cycle D. 14 days after the last day of menstrual flow ANSWER: C RATIONALE: Every month, one of the ovary’s oocytes is activated by FSH to begin to grow and mature This happens on the 14th day before the onset of the next cycle (not the midpoint). 6. The menstrual cycle prepares the uterus for pregnancy. When pregnancy does not occur, which of the following phenomena will follow? A. Ovulation B. Fertilization C. Nidation or Implantation D. Menstruation ANSWER: D RATIONALE: When pregnancy does not occur, the endometrial lining will begin to slough off leading to menstruation. 7. Once a month, from puberty until menopause, a Graafian follicle ruptures and expels a mature ovum. This process is called: A. Menstruation B. Fertilization C. Ovulation D. Nidation Answer: C Ovulation is the rupture of the Graafian follicle releasing the mature ovum. Menstruation is the sloughing off of the endometrial lining. Nidation is the implantation of the zygote into the uterus 8. Which of the following is not a function of progesterone? A. It prepares the endometrium for pregnancy B. It is responsible for the development of distinctive female characteristics C. It maintains the endometrium during pregnancy D. It is responsible for the growth and development of acinar cells of the mammary gland ANSWER: B RATIONALE: Option B is the function of Estrogen. A, C and D are functions of Progesterone 9. An adolescent client asked what body structure is responsible for the production of Follicle Stimulating Hormone (FSH). Your appropriate response is: A. Testes B. Hypothalamus C. Ovary D. Anterior Pituitary Gland ANSWER: D RATIONALE: Option B is located in the pelvis. Option C is the female gonad. Option D is a tube outside of the scrotum This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 8 10. The increased activity of the endometrial glands during the luteal phase of the female reproductive cycle is stimulated by: A. Progesterone B. Estrogen C. Prolactin D. Follicle Stimulating Hormone ANSWER: A RATIONALE: Progesterone levels are increased during the luteal causing further thick ening of the endometrium, formation of cork screw glands and increase in vasculature. Estrogen is increased during the follicular phase. FSH is increased during the follicular phase LESSON WRAP-UP (5 minutes) Teacher directs the student to mark (enc