Maternal and Child Health Nursing Framework PDF

2. Maternal and child health nursing is community centered FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING 3. Maternal and child health nur...

2. Maternal and child health nursing is community centered FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING 3. Maternal and child health nursing is research-oriented Maternal and child health nursing can be 4. Both nursing theory and evidence-based visualized within a framework in which nurses, practice provide a foundation for nursing care using the nursing process, nursing theory, and 5. A maternal and child health nurse serves as an evidence-based practice, care for families advocate to protect the rights of all family during childbearing and childrearing years members, including the fetus through 4 phases of health care 6. Maternal and child health nursing includes a ○ Health promotion -educate to be high degree of independent nursing functions aware of good health 7. Promoting health is an important nursing role ○ Health maintenance -intervene to 8. Pregnancy or childhood illness can be stressful maintain health and can alter family life in both subtle and ○ Health restoration - prompt diagnosis extensive ways and treatment of illness 9. personal, cultural, and religious attitudes and ○ Health rehabilitation - prevent beliefs influence the meaning of illness and its further complications: bringing back an impact on the family optional state of wellness; to accept 10. Maternal and child health nursing is a death challenging role for a nurse and is a major factor in promoting high-level wellness in GOALS AND PHILOSOPHIES OF MATERNAL AND families CHILD HEALTH NURSING MATERNAL AND CHILD HEALTH GOALS AND GOALS STANDARDS Primary goal of maternal and child health Standard I: Quality of Care. The nurse nursing care can be stated simply as the systematically evaluates the quality and promotion and maintenance of optimal family effectiveness of nursing practice health to ensure cycles of optimal childbearing Standard II: Performance Appraisal. The and childrearing. nurse evaluates his/her own nursing practice in Range of practice includes relation to professional practice standards and ○ Pre conceptual health care relevant statutes and regulations. ○ Care of women during three trimesters Standard III: Education. The nurse acquires of pregnancy and the puerperium (the and maintains current knowledge in nursing six weeks after childbirth, sometimes practice. termed the fourth trimester of Standard IV: Collegiality. The nurse pregnancy) contributes to the professional development of ○ Care of children during the prenatal peers, colleagues, and others. period (6 weeks before conception to 6 Standard V: Ethics. The nurse’s decisions and weeks after birth) actions on behalf of patients are determined in ○ Care of children from birth through an ethical manner. adolescence Standard VI: Collaboration. The nurse ○ Care in settings as varied as the birthing collaborates with the patient, significant others, room, the pediatric intensive care unit, and health care providers in providing patient and the home care. Standard VII: Research. The nurse uses research findings in practice. PHILOSOPHIES Standard VIII: Resource Utilization. The nurse considers factors related to safety, 1. Maternal and child health nursing is family effectiveness, and cost in planning and centered delivering patient care  Standard IX: Practice Environment. The nurse participates in care), or supportive contributes to the environment of care delivery education (client performs own care). within the practice settings. Standard X: Accountability. The nurse is Ida Jean Orlando professionally and legally accountable for ○ The focus of the nurse is interaction his/her practice. The professional registered with the client; the effectiveness of care nurse may delegate to and supervise qualified depends on the client’s behavior and the personnel who provide patient care. nurse’s reaction to that behavior. The client should define his or her own needs. THEORIES RELATED TO MATERNAL AND CHILD NURSING Rosemarie Rizzo Parse ○ Nursing is a human science. Health is a Patricia Benner lived experience. Man-living-health as a ○ Nursing is a caring relationship. Nures single unit guides practice grow from novice to expert as they Hildegard Peplau practice in clinical settings ○ The promotion of health is viewed as Dorothy Johnson the forward movement of personality; ○ A person comprises subsystems that this is accomplished through an must remain in balance for optimal interpersonal process that includes functioning. Any actual or potential orientation, identification, exploitation, threat to this system balance is a and resolution nursing concern Martha Rogers Imogene King ○ The purpose of nursing is to move the ○ Nursing is a process of action, reaction, client toward optimal health: the nurse interaction, and transaction: needs are should view the client as a whole and identified based on the client’s social constantly changing and help people to system, perceptions, and health: the interact in the best way possible with role of the nurse us to help the client the environment achieve goal attainment. Sister Callista Roy Madeleine Leininger ○ The role of the nurse is to aid clients to ○ The essence of nursing is care. To adapt to the change caused by illness; provide transcultural care, the nurse levels of adaption depend on the degree focuses on the study and analysis of of environmental change and state of different cultures with respect to caring coping ability; full adaption includes behavior physiologic interdependence Florence Nightingale ○ The role of the nurse is viewed as changing or structuring elements of the ROLES AND RESPONSIBILITIES OF A MATERNAL environment such as ventilation, CHILD NURSE temperature, odor, noise, and light to 1. Clinical nurse specialist put the client into best opportunity for 2. Case manager recovery 3. Women’s health nurse practitioner Betty Neuman 4. Family nurse practitioner ○ A person is an open system that 5. Neonatal nurse practitioner interacts with the environment: nursing 6. Pediatric nurse practitioner is aimed at reducing stressors through 7. Nurse-midwife primary, secondary, and tertiary prevention THE 17 SUSTAINABLE DEVELOPMENT GOALS (SDGs) Dorothea Orem TO TRANSFORM OUR WORLD ○ The focus of nursing is on the individual; GOAL 1: No poverty clients are assessed in terms of ability to GOAL 2: Zero Hunger complete self-care. The care given may GOAL 3: Good health and well-being be wholly compensatory (client  GOAL 4: Quality education PROCESS OF HUMAN REPRODUCTION GOAL 5: Gender equality GOAL 6: Clean water and sanitation Practices and behaviors surrounding human GOAL 7: Affordable and clean energy reproduction vary widely across cultures, but in GOAL 8: Decent work and economic growth every case it involves sperm, an ovum, a uterus and a baby GOAL 9: Industry, innovation, and infrastructure GOAL 10: Reduced inequality MEIOSIS GOAL 11: Sustainable cities and communities Mitosis GOAL 12: Responsible consumption and ○ Identical cell production production ○ Can repair, grow and replace GOAL 13: Climate action Meosis GOAL 14: Life below water ○ Gametes = reproductive cells GOAL 15: Life on land ○ Sperm and egg cell GOAL 16: Peace and justice strong institutions Diploid cell GOAL 17: Partnerships to achieve the goal ○ Parent cell Zygote REPRODUCTIVE AND SEXUAL HEALTH ○ Fertilized cell Sperm cell and Egg cells CONCEPT OF UNITIVE AND PROCREATIVE HEALTH ○ 23 chromosomes which in turn they Unitive and Procreative Health have 46 pairs of chromosomes ○ Unitive - a specific type of physical union, the sexual union of a man and woman in natural intercourse. This type of sexual act is in harmony with and ordered toward procreation ○ Procreation - focuses on the conceiving and bearing of offspring ○ Procreative health - the moral obligation of parents to have the healthiest children through all-natural and artificial means available PRINCIPLES OF PROCREATION Sex is a search for sensual pleasure and satisfaction releasing physical and psychic tensions Sex is a search for the completion of the human person through an intimate personal union of love expressed by the bodily union for the achievement of a more complete humanity Sex is a social necessity for procreation of children and their education in the family is so as to expand the human community and guarantee its future beyond death Note: every chromosome has a like pair, if the 23rd Sex is a symbolic (sacramental) mystery, pair is both XX=female and when it is XY=male somehow revealing the cosmic order “in short, this Christian principle is all about pleasure, love, reproduction, and the sacramental meaning of sex  and chemicals - preganancy category MECHANISM OF HEREDITY drugs When a sperm cell penetrates the ovum;s barrier, its 23 chromosomes fuse with the COMMON TEST FOR DETERMINATION OF GENETIC ABNORMALITIES ovum’s 23 chromosomes, forming a zygote GOALS Enables individuals or couples to make informed reproductive decisions Provides psychological support for decision making Provides clients with information about the defect in question INHERITANCE Cmmunicationss to clients the risk for Genotype transmitting the defect in question to future ○ Complete set of inherited traits children ○ Set of genes - basic unit of heredity GOALS Phenotype ○ How these traits are expressed e.g. blue Karyotyping - a visual display of the eyes individual’s actual chromosome pattern ○ Observable characteristics NORMAL Homozygous ○ Same alleles Heterozygous ○ Different versions of the trait ABNORMAL RISK FACTORS FOR GENETIC DISORDER Age ○ Risks increases with age - wear and tear theory Race/Ethnic Background ○ Certain disorders occur more frequently in some ethnic groups compared to others - incest Family history of disease ○ Including those who hae died as part of the family -undiagnosed chromosomal disease or non compatible of life babies OB History of pregnancy issues ○ like exposure to teratogens such as radiation, certain drugs viruses toxins  Heterozygote screening ○ Is directed at detecting clinically normal carriers of a disease- causing mutant gene particularly in people of ethnic groups with high frequency of the mutant gene under investigation Maternal serum alpha-fetoprotein (MSAFO) ○ Screen is done when an open neural tube is suspected. ○ Alpha-fetoprotein - glycoprotein = fetal It is also used to analyze skin cells, liver, detectable in the maternal blood alpha-fetoprotein, or acetylcholinesterase. It carries during 13-32 weeks of pregnancy ( the only a 0.5% risk of spontaneous abortion safest is 15 weeks) Sonography (Ultrasound) - is a diagnostic ○ If glycoprotein levels go beyond tool that is used to examine structural disorders 10ng/ml -15ng/ml the fetus will be of the internal organs, spine, and limbs. It uses suspected of neural tube disorder sound waves to create a “picture” ○ If glycoprotein levels are low ○ Transabdominal -chromosomal disorder such as trisomy Done through your abdomen 21 (down syndrome) Lie on your back on an exam Triple screening table ○ Analysis of 3 indicators from MSAFP, Technician puts a little bit of gel ESTRIOL, and Human Chorionic on the transducer. The gel helps Gonadotropin the transducer move more ○ Estriol - a type of estrogen smoothly and prevents air from ○ HCG - a hormone produced by the getting between the device and placenta your skin Congenital anomaly scan (CAS) DIAGNOSTIC TEST done through transabdominal ultrasound, this is done for a Chorionic villi sampling - retrieval of more in-depth scan chorionic villi or chromosomal analysis. Done in the 5th week of pregnancy (earliest), but ○ Transvaginal mostly done at the 8th to 10th week. The Also called an endovaginal results of this analysis are extremely accurate ultrasound, is a type of pelvic but it cannot detect all inherited diseases ultrasound used to examine female reproductive organs Including the uterus, fallopian tubes, ovaries, cervix, and vagina. Transvaginal means “ through the vagina” this is an internal examination The very first ultrasound for the first trimester is recommended Amniocentesis - the withdrawal of a sample by doctors due to the fetus being of amniotic fluid (2 to 5ml) transabdominally for very small and difficult to get a genetic analysis. It is usually done with clear image using the ultrasound visualization between 14 and 16 transabdominal ultrasound weeks  may enter maternal circulation TRANSVAGINAL ULTRASOUND after the procedure as a result of oozing at the puncture site PERCUTANEOUS UMBILICAL BLOOD SAMPLING ○ Fetoscopy Involves the insertion into the mother’s uterus of a fiberoptic through a small incision in her abdomen It is used to inspect for fetal Genetic Disorders anomalies or confirm an ultrasound finding, it can also be Chromosomal Inheritance Disorders used to remove fetal skin cells for DNA analysis and used to Chromosomal Inheritance Disorders perform corrective surgery for ○ Autosomal Dominant Disorder (1 gene congenital anomalies defective to cause the desease) Dwarfism FETOSCOPY ○ Autosomal Recessive Disorder (atleast 2 defective genes to cause the disease ○ Percutaneous Umbilical Blood Sampling Cystic fibrosis The removal of blood from the umbilical vein. Blood studies include karyotyping, complete blood count (CBC), direct Coomb’s test, and measurement of blood gases It uses a technique similar to amniocentesis to obtain the blood sample An Rh-negative mother should be given RhoGAM because blood  ○ X-Linked Dominant Disorder Autosoma Recessivel Disorder (ARD) Sickle-cell disease Only 1,500 identified ARDs’ Enzymatic Problems (Internal problems such as organ issues, not visible on the outside) Disease will only occur if there is 2 defective genes Chromosomal Abnormality Disorders Numeric Abnormality ○ Klinefelter Syndrome - a disorder where men are born with an extra X (XXY) chromosome i.e. males with this ○ X-Linked Recessive Disorder disorder will have female characteristics Hemophilia such as ( enlarged breast, reduced body hair, and reduced muscle mass) ○ Turner Syndrome - a disorder that affects females, where one of the X chromosomes is meaning i.e from the normal (XX) it has only one (X). this ○ Multifactorial Inheritance disorder cause a variety of medical and Cleft lip palate developmental problems such as short Note: Most Asians are Rh+, it’s very seldom for height, abnormal physic, undevelop Asians to be RH- ovaries and heart defect (Coarctation of aorta) Autosomal Dominant Disorder (ADD) 1 defective gene (Dominant) = disorder More than 3000 identified autosomal disorder (e.g. dwarfism (very common) but only a few can be seen, because if a baby has 2 or more defective genes, meaning the baby is not compatible of life (DD =X life) Structural Defects ( such undeveloped brain, heart, etc.) Two types ○ Homozygous - 2 defective genes ○ Heterozygous - 1 healthy gene + 1 dominant defective gene  ANATOMY AND PHYSIOLOGY OF THE MALE Structural Disorder REPRODUCTIVE SYSTEM ○ Translocation - a change in location. It Penis often refers to genetics, when part of a ○ Is the male organ of copulation chromosome is transferred to another chromosome. Chromosomes are structures that carry genes, our units of heredity. When this type of translocation occurs, it can cause flaws in chromosomes Nursing Process Assessment ○ Health History - should focus on determining the couple’s risk for having a baby with an inherited disorder: Genetic history Ethnic background General medical history EXTERNAL STRUCTURES Mother’s age The cylindrical shaft consists of the following: ○ Laboratory and Diagnostic studies ○ Corpora cavernosa Diagnosis Two lateral column of erectile ○ Knowledge deficit tissue (corpora cavernosa) ○ Decisional Conflict ○ Corpus spongiosum ○ Anticipatory Grieving A column of erectile tissue on the underside of the penis Planning and outcome Identification (corpus spongiosum) that ○ The couple will receive education about encases the urethra genetic problems that may affect their children including risks for having a child with a problem and treatment options for the particular problem ○ The couple will receive emotional support throughout the genetic screening test Evaluation ○ The couple states that they received adequate information about patterns of inheritance, their risk in having a child with an inherited disorder, information concerning the disorder itself, and information about treatments and available resources ○ The couple demonstrates positive coping skills and states that they are able to make a reasonable choice about the outcome of genetic testing and counseling  ERECT: TRANSVERSE VIEW FLACCID: LATERAL VIEW The cylindrical shaft consists of the following: ○ Glans penis Cone-shaped expansion of the corpus spongiosum that is highly sensitive to sexual stumulus ○ Prepuce or foreskin A skin flap that cover the glans FLACCID: TRANSVERSE VIEW penis in uncercumcised men ERECT: LATERAL VIEW  Scrotum ○ A pouch hanging below the penis that contains the testes. internally, the medical septum divides the scrotum into two sacs each of which contains a testicle Ejaculatory duct ○ Is the canal formed by the union of the vas deferens and the excretory duct of the seminal vesicle. It enters the urethra at the prostate gland INTERNAL STRUCTURES Testes ○ Are two solid ovoid organs 4 to 5cm long, divided into lobes containing seminiferous tubules. The two functions of the testes are the production of testosterone and spermatogenesis (production of sperm) Epididymis Urethra ○ Is a tubular sac located next to each ○ Is the passageway for urine and semen testis that is a reservoir for sperm that extends from the bladder to the storage and maturation. It can extend urethral meatus 10-20ft; 2-4 weeks of sperm maturation Vas deferens ○ Is a duct extending from the epididymis to the ejaculatory duct which provides a passageway for sperm. It extends to 16 inches long ○ This is also where “vasectomy” is done, an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering the urethra and thereby prevent fertilization Seminal vesicles of a female through sexual intercourse. ○ Located behind the bladder and in front of the rectum, deliver secretions to the urethra through the ejaculatory duct. It  is 2 inches: and secretes alkaline fluid and fructose or known as “semen” MALE BREAST Prostate gland Male mammary tissue ○ Surround the base of the urethra and ○ Remains dormant throughout life, but the ejaculatory duct, secrets a clear fluid the breasts are a site of sexual with a slightly acid pH rich in acid excitation and arousal phosphatase, citric acid, zinc, and ○ Although rare (accounting for less than proteolytic enzymes. It is shaped like a 1% of all breast cancers in the United walnut. States), male breast cancer occur when frequently enough to warrant routine inspection of the breasts for dimpling, discharge or nipple inversion Cowper’s gland ○ Also termed as Bulbourethal gland; 2 pea-sized structure that lies at the base of the prostate gland and either side of the membranous urethra. They produce SEMEN a clear alkaline mucinous substance that A thick, whitish fluid ejaculated by the man lubricates the urethra and coats its during orgasm surface Contains spermatozoa (sperm) and fructose-rich nutrients During ejaculation, semen receives contributions of fluid from the seminal vesicles and the prostate gland Alkaline (average pH 7.5) -because when the semen will become acidic, this will kill the sperm cells due to the vagina being acidic Average amount released during ejaculation is 2.5 to 3.5 ml NEUROHORMONAL CONTROL OF THE MALE REPRODUCTIVE SYSTEM Hypothalamus ○ Stimulates the pituitary gland to produce Follicle Stimulation Hormone (FSH) and Luteinizing Hormone (LH)  ○ FSH stimulates germ cells within the Spermatogenesis testes to manufacture sperm -–to ○ “Sperm production” stimulate for production and maturation Occurs continually after puberty, of egg cells (female repro) providing large numbers of ○ LH - stimulates the production of sperm for unlimited ejaculations testosterone in the testes. Although LH during the mature life span. stimulates the Leydig cells to produce ○ Spermatozoa - are released from the testosterone from cholesterol, epithelial wall of the seminiferous testosterone inhibits the secretion of LH tubules. Meiosis occurs during the by the anterior pituitary gland process, and the number of chromosomes in each cell is reduced by one-half (Haploid number) ○ Spermatogenesis is a heat-sensitive process; the 2’ to 3’ F difference between scrotal and abdominal temperatures allows spermatogenesis to proceed in the cooler environment ○ The entire period of spermatogenesis from terminal cell to mature sperm, takes about 75 days Testosterone ○ One of the several androgens (and most SPERM PRODUCTION DIAGRAM potent) produced in the testes, is responsible for the development of secondary sex characteristics at puberty ○ Production occurs in the interstitial Leydig cells in the seminiferous tubules. Leydig cells are abundant in the newborn and pubescent boy, and testosterone is abundant during these periods ○ Testosterone production slows after 40 years of age: by 80 years of age, production is only about one-fifth of peak level Note: Leydig cells - are the primary source of testosterone or androgens in males. This Semen physiology allows them to play a crucial role in ○ 60% - Prostate gland many vital physiological processes in males, ○ 30% - Seminal vesicle including sperm production or spermatogenesis, ○ 5% - Epididymis controlling sexual development, and ○ 5% - Bulbourethral gland maintaining secondary sexual characteristics ○ 3-5cc (1tsp) per ejaculation and behaviors. SPERM PATHWAY  Spermatozoa patient to submit herself for a medical check-up ○ Produced by the testicles for prompt diagnosis of an illness, the following ○ 40-80 million per cc of semen phase of health care applies ○ 300- 500 million per ejaculation a. Health restoration ○ Mature after 64 days 7. Among all the 17 SDGs, MCN belongs to what goal? a. Good health and well-being Evaluate the quality of Quality care nursing practice Evaluate one’s own Performance Appraisal practice Acquires and maintains Eduction knowledge in practice Work effectively with Collaboration patient watchers and other healthcare providers use s research finding in Research practice Consider factors and cost Resource Utilization in delivering patient care Nurses may delegate and Accountability supervise qualified QUIZ 2 personnel 1. Framework, Goals, & Standards of maternal & QUIZ 3 child health nursing –all the following is true except 1. This term refers to the substance which a. MCN Uses evidence-based practice can cause harm/ deformity/ abnormal solely development of the growing fetus if the 2. The range of practice in MCN starts with the mother is exposed during pregnancy care of women before and during the three a. Teratogens trimesters of pregnancy and ends after the birth 2. This refers to the visual display of the of a child individual’s actual chromosome pattern a. False wherein a sample is taken, stained, and 3. In this phase of health care, the nurse should placed under a microscope intervene practice of the patient to maintain a. Karyotyping health 3. A chorionic villi sampling is the retrieval a. Maintenance of chronic villi for chromosomal analysis. 4. The primary goal of MCN is the promotion and It is mostly/ usually done at how many maintenance of optimal family health to ensure wells of pregnancy a. True a. 8 to 10 weeks 5. Which of the following is not included in the 4. This term refers to the different versions roles and responsibilities of a maternal and of a trait child health nurse a. Heterozygous a. Medical doctor 5. As the age of the mother or father 6. A patient is experiencing cough and cold for 5 increases the risk of getting a child with days already. When a nurse encourages a genetic abnormality decreases  a. False 2. All the following are external structures except 6. The following are necessary for human a. Testicle reproduction except 3. Testosterone production slows after the age of 40 a. Penis a. True 7. This term refers to the process of cell 4. The semen has an acidic pH growth, repair, and replacement of a. False worn-out ones 5. This is a cone-shaped expansion of the corpus a. Mitosis spongiosum that is highly sensitive to sexual 8. A child has red hairt like her mother and stimulus blue eyes like her father. This is due to a. Glans penis 6. This refers to the process of producing sperm the complete set of inherited traits or a. Spermatogenesis set genes which are called? 7. A sperm cell is a thick, whitish fluid ejaculated a. Genotype by the man during orgasm 9. This carries only a 0.5% risk of a. False spontaneous abortion a. Amniocentesis Secrete alkaline fluid and Seminal vesicles 10. The following are products of meiosis fructose except for a. Skin cells Passageway for urine Urethra 11. This focuses on the conceiving and Male organ of copulation Penis bearing of offspring a. Procreation Passageway for sperm Vas deferens 12. Humans get 2 copies of every gene from Walnut-shaped that Prostate gland parents and the 2 copies/ alleles should surround the base of the always be identical urethra a. False 13. Sex is a social necessity for the Storage of sperm Epsdidymis procreation of children to expand the Pea-sized lies at the base Bulbourethral gland human community of the prostate a. True Canal formed by the Ejaculatory gland union of vas deferens Dwarfism Autosomal dominant and the excretory duct of disorder seminal vesicle Cystic fibrosis Autosomal recessive disorder FEMALE REPRODUCTIVE SYSTEM Sickle-cell disease X-linked dominant disorder EXTERNAL STRUCTURES Cleft lip Multifactorial inheritance Mons veneris / Mons pubis ○ is a mound of fatty tissue over the Hemophilia X-linked recessive symphysis pubis that cushions and disorder protects the bone Klinefelter syndrome Numeric abnormality Labia majora Turner syndrome Nurmeric abnormality ○ are the longitudinal fold of pigmented skin extending from the mons pubis to the perineum QUIZ 4 ○ Cushion vaginal area ○ Pigmented ○ Serves as a cushion 1. This structure stimulates the pituitary gland to produce FSH and LH a. Hypothalamus  VAGINA Vagina ○ Is the female organ of copulation and also serves as the birth canal. It is a tubular, ○ musculomembranous organ that lies between the rectum and urethra, and bladder ○ It is 3-4 inches long Labia minora ○ Are soft longitudinal skin folds between the labia majora Clitoris ○ Is an erectile tissue located at the upper end of the labia minora. It is the primary site of sexual arousal Urethral meatus (urethral orifice) Uterus (womb) ○ Is a small opening of the urethra. It is ○ Located between the bladder and located between the clitoris and the rectum and consist of regions the vaginal orifice for the purpose of fundus, body (corpus) and cervix urination ○ Is hollow, musculoar organ with three Perimeum ○ Is the area of tissue between the anus muscle layers ( perimetrium, and vagina; an episiotomy is performed myometrium, and endometrium) here i.e. where doctors create an incision during a mother's labor Menstruation is the sloughing away of spongy Vestibule layers of endometrium with bleeding from tourn ○ Is an almond-shaped area between the vessels labia minora containing the vaginal introitus, hymen, Bartholin glands Environment for pregnancy: the meebryo and Hymen fetus develop in the uterus after fertilization ○ Is a membranous tissue ringing the Labor consists of powerful contractions of the vaginal introitus muscular uterin wall that result in expulsion of the fetus –which results to the delivery Uterine ligaments ○ Broad and round ligaments provide upper support for the uterus  Cervix Cardinal, pubocervical, and uterosacral ○ Is a cylinder-shaped neck of tissue that ligaments are suspensory and provide middle connects the vagina and uterus. Located support at the lower most portion of the uterus Pelvic muscular floor ligaments provide lower the cervix is comeposed primarily of support fibromuscular tissue Fallopian tube (oviducts) ○ Extend from the upper out angles of the uterus and end near the ovary. It is 4 inches long. These tubes serve as the passageway fro the ovum to travel from the uterus to the ovary ○ Has three segments Infundibulum - an expanded funnel near the ovary ACCESSORY GLANDS Breast ( mammary gland) Ampulla - middle segment ○ Specialized sebaceous glands that Isthmus - a short segment between produce milk after childbirth (lactation) ampulla and uterine wall VAGINA Ovaries ○ Are 2 almond-shaped female sex glands Nipple located on each side of the uterus. ○ Is a raised, pigmented area of the ○ The two functions are breast ovulation - release of ovum Secretion of hormones Areola -estrogen and progesterone ○ Is a pigmented skin around the nipple  Montgomery tubercles Physical changes in breast size and activity are ○ Are sebaceous glands of the areola at a minimum 5 to 7 days after menstruation stops; this is the best time to detect pathologic changes through breast self examination Bartholin or Vilvovaginal gland ( female counter part of the cowpers glands) ○ Are mucus-secreting glands located on either side of the vaginal orifice Glandular tissue ○ Parenchyma is composed of acini ( milk producing) cells that cluster in groups of 15 to 20 to form the lobes of the breast Lactiferous ducts or sinuses ○ form passageways for the lobes to the nipple ○ Skene or paraurethral glands Fibrous tissue ○ Are small mucus screting glands that ○ Also called cooper ligaments, provide open into the posterior wall of the support to the mammary glands urinary meatus and lubricate the vagina Aduoise and fibrous tissue (stroma) ○ provide the relative size and consistency of the breast Pelvis ○ A bony ring in the lower portion of the The breast change in size and nodularity in the trunk. It consists of three parts (ilium, response to cyclic ovarian hormonal changes, ischium, and pubis) and four bones ( including two innominate bones or hipbones, ○ Estrogen stimulation sacrum, and coccyx) Which produces tenderness ○ Pelvic bones are held together by four ○ Progesterone (Postovulation) which joints (articulations) - symphysis pubis, cause increased tenderness and breast two sacroiliac, and sacrococcygeal. enlardement Fibrocartilage between these joints provides mobility  OOGENESIS The production or development of an ovum Types of pelvis ○ Gynecoid The typical female pelvis with a rounded inlet ○ Antherpoid Is an “apelike” pelvis with an oval inlet ○ Android Normal male pelvis with a heart-shaped inlet ○ Platypeloid Is a flat, female type pelvis with a transverse oval inlet Pelvimetry ○ (The process of measuring the internal Physiology of Menstrual Cycle or external pelvis) ○ Is performed with radiography or by internal examination  Menarche Progesterone - inhibits the ○ Onset of menstruation production of ○ Typically occurs between 10 and 13 Luteinizing hormone ○ inhibits uterine motility years of age ○ facilitate the transport of fertilized Menstrual cycle ovum through fallopian tube ○ Monthly patter of ovulation and ○ increases body temperature after menstruation ovulation Ovulation ○ Stops construction GnR ○ Discharge of a mature ovum from the ovary Prostaglandins - regulate the reproductive process by stimulating the contractility of the ○ Produces 300,000 to 400,000 oocytes uterine and other smooth muscles. per ovary in a lifetime ○ Average cycle is 28 days and a duration of 3 to 5 days Sexual Response Cycle Mittelschmerz Phases of Menstrual Cycle ○ one-sided, lower abdominal pain ○ Proliferative/Preovulatory/Follicular associated with ovulation. It occurs Phase (6-14 days) midway through a menstrual cycle about 14 days before your next menstrual period. It doesn’t require medical attention. Menstruation - ○ periodic shedding of blood, mucus, and epithelial cells from the uterus; average blood loss is 50 ml (1⁄4 cup); the range of 30 to 80 ml of blood. The ovaries produce mature gametes and Ovulatory/Secretory/Luteal/Progestational secrete the following hormones: Phase(14-15 days) – Peak ○ Estrogen - contributes to the characteristics of femaleness( female bodybuilder, breast growth) Increase Estrogen - Thin and watery Decrease Estrogen - Cervical mucus will be thick causes hypertrophy of the myometrium proliferates the endometrium inhibits the production of follicle-stimulating hormone Ischemic Phase ( 16-28 days) (FSH) increases pH of cervical mucus causing it to become thin and watery (Spinnbarkeit test) Progesterone -hormone of pregnancy ○ Production of Luteinizing HormoneLH ○ quiets/ decreases the contractility of the uterus ○ increases endometrial tortuosity ○ increases endometrial secretions  Menstrual Phase (1-5 days) (an end and a Spinnbarkeit Test beginning) Climacteric Period and Menopause ○ Climacteric - a transitional period during which ovarian function and hormonal production decline. ○ Menopause - refers to a woman’s last menstrual period the average age of menopause is 51.4 years. ○ However, it is important to note that women may ovulate after menopause and thus can become pregnant Endometrial cells - buo2 in blood Each ovary release eggs per month (alternate) 4 Level Concept of Sexuality 1. CNS Response – Hypothalamic-pituitary gland SEXUALITY action (FSH and LH) ○ Maleness and femaleness 2. Ovarian Response (2 phases) – Proliferative ○ Physical phase ( 1-14 days); Secretory ( 15-22 days) ○ Emotional 3. Endometrial Response ( 4 phases) ○ Social a. Menstrual phase ( 1- 5 days) ○ Ethical SEXUAL STIMULATION b. Proliferative ( 6 – 14 days) ○ Physical c. Secretory ( 15-26 days) ○ Psychological d. Ischemic ( 27 – 28 days) ○ Visual 4. Cervical Mucus Response ( Ovulatory) 15-23 SEXUAL RESPONSE days ○ Erection/Foreplay a. Before Ovulation – ○ Coitus (sex/sexual intercourse) Spinnbarkeit/Spinnbarkheit; ○ Ejaculation/Orgasm mittelschmerz b. After Ovulation Principles Relevant to Sexuality Different way to know if you are fertile 1. Human sexuality provides for the reproduction ○ Fern Test- Using Cervical Mucus of the human species. 2. Sexual fulfillment is a basic human need. 3. Sexuality pervades virtually every aspect of life from birth to death. 4. All human cultures have sanctions, often legal as well as moral, controlling expressions of sexual drive. 5. Individuals have strong cultural, religious, and ethical convictions regarding the expression of human sexuality. 6. Moral values concerning appropriate sexual 3. Sexual Partner Preference - may be behaviors have undergone considerable HETEROSEXUAL ( opposite sex), HOMOSEXUAL liberalizations in most western cultures in (same sex), or BISEXUAL ( both), person may recent years. vary during a person’s lifetime and is probably 7. Successful gender identification in early shaped by a complex interaction of several childhood is important for an individual’s factors health and well being throughout life. 8. Actual or potential damage to the integrity of SEX an individual’s sex organ poses a considerable threat to his self-esteem. Latin roots “cut of Divide” ○ SEX meanings: ○ Gender: Male or Female ○ Anatomic Structures: sexual organs Principles of Procreations ○ Physical activities/Sexual expression 1. Sex is a search for sensual pleasure and An individual chooses to give and receive satisfaction, releasing physical and psychic physical love and gratification. tensions. One’s culture determines acceptable forms of 2. Sex is a search for the completion of the sexual expression; what’s considered normal human person through an intimate personal may vary greatly among cultures. union of love expressed by the bodily union for Acceptable sexual activity includes the the achievement of more complete humanity. elements of PRIVACY, CONSENT, and LACK OF 3. Sex is a social necessity for the procreation of FORCE children and their education in the family so as to expand the human community and Sexual Orientation guarantee its future beyond death. 4. Sex is a symbolic (sacramental) mystery, Concerns the direction of one’s romantic interests and erratic attractions towards the somehow revealing the cosmic order. In short, same sex, other sex, or both. this Christian principle is all about pleasure, love, reproduction, and the sacramental 1. HETEROSEXUALITY: finds fulfillment meaning of sex. with a member of the opposite gender. 2. HOMOSEXUALITY: finds sexual fulfillment with a member of his or her Human Sexuality own sex. 1. The ways in which we experience and express 3. BISEXUALITY: Bisexual- achieve sexual ourselves as sexual beings. satisfaction from both homosexual and 2. A person's sexuality encompasses the complex heterosexual relationships. of emotions, attitude preferences, and 4. TRANSEXUALITY: an individual who behaviors r/t expression of sexual self and although of one biological gender feels as if he or she should be of the eroticism. opposite gender. 3. Nurses commonly are resource people for Types of Social Interaction clients seeking information r/t human ○ Celibacy - abstinence from sexual sexuality and functioning during the activity reproductive years. 4. Responsible sexuality involves a commitment ○ Masturbation - self-stimulation for to a relationship, responsible reproductive erotic pleasure health care, and rational decisions about childbearing. ○ Erotic Stimulation - Use of visual materials such as magazines or photos Developmental Tasks of Sexual Identity Atypical Sexual Variations 1. Gender Identity- is a person’s sense of his or PARAPHILIA - a diagnostic category used by her masculinity or femininity the American Psychiatric Association to 2. Gender Roles/ Sex Role Standards - are describes typical patterns of sexual arousal or composed of behaviors, attributes, and behavior that become problematic in the eyes attitudes an individual conveys about being of the individual or society. male or female. 1. FETISHISM-Sexual arousal by the use of certain ○ HR and BP begin to increase objects or inanimate objects. ○ Generalized muscle tension increases 2. TRANSVESTISM- an individual who dresses to associated with muscle contractions. take on the role of the PLATEAU PHASE 3. opposite sex 4. VOYEURISM- Sexual arousal by looking at Women: another’s body; watching other people who ○ Decrease internal vaginal diameter are nude, or involved in sexual relations. ○ Labia minora further swell and 5. SADOMASOCHISM- A mutually gratifying darken sexual, interaction between consenting sex ○ Clitoris retracts partners in which sexual arousal is associated ○ Nipple further engorged with infliction and recipient of pain or humiliation ○ Flushing 6. Sadist - inflicting pain or humiliation on others ○ Increase:HR, BP, muscle tension 7. Masochism - received the pain /desire or need Men: for pain ○ Further penile enlargement, with color 8. PEDOPHILIA - desires sexual pleasure from changes children ○ Preorgasmic emission may occur from 9. EXHIBITIONISM - sexual arousal from exposing Cowper glands genitals to strangers 10. usually men in a public place ○ Testes continue to elevate and 11. FROTTEURISM - sexual arousal by touching or rotate rubbing other people in sexual ways without ○ Increases: HR, BP, RR, their consent muscle tension 12. SCATOLOGIA - obscene phone callers and ORGASMIC PHASE makes sexual suggestions or references. Women: Uttering obscenities and sexual provocations to a non-consenting person. ○ Strong muscular contractions outer 13. COPROPHILIA - sexual arousal/gratification ○ 1/3 of the vagina from feces; the person may desire to be ○ Uterine muscles contracts defecated on or to defecate a partner. ○ Flushing 14. UROPHILIA - desire sexual excitement from ○ Increase: RR,BP, HR urine as when doing “GOLDEN SHOWERS” Men: 15. ZOOPHILIA- aroused by fantasies or actual ○ Rhythmic contractions expel semen sexual contact with an animal. 16. NECROPHILIA- fantasies of or actual sexual ○ Testes at maximum elevation, size and contact with a dead person. elevation 17. KLISMAPHILIA- sexual arousal is derived from ○ flushing the use of enemas. ○ increase at its peak: RR, BP, HR a. Enemas - medication for ○ General loss of voluntary control occurs leisure ○ Refractory period begins RESOLUTION PHASE Sexual Response Cycle Women: EXCITEMENT ○ Inner 2/3 of the vagina gradually shrinks Female: ○ Cervix dips into the seminal pool ○ Vaginal lubrication ○ Labia minora and majora return to ○ Engorged labia minora/ minor flatten normal state ○ Nipples become erect, breast size ○ Clitoris protrudes increase ○ Flushing disappears ○ Flushing ○ Muscle relax quickly ○ Overall muscle tension increases Men: Male: ○ More than 50% of the erection is lost ○ penile erection ○ Testes descend and return to normal ○ Thick and congested scrotal skin size ○ Testes elevate to scrotal sac ○ Nipple erection subsides ○ Some nipple erection ○ Flushing disappears ○ Flushing ○ Normal:RR,HR,BP  ○ General muscle relaxation occurs Sexual concerns r/t pregnancy ○ Altered desire for sex ○ Breasts may be painful to touch ○ Increase amount and odor of vaginal discharge can be turned off to some men ○ Other concerns: dyspareunia ○ Other forms of expression: kissing/hugging/ manual genital stimulation Pregnancy Pregnancy - is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus ○ usually lasts about 40 weeks, or just over 9 months, as measured from the last menstrual period to delivery. ○ Normal amount of semen/ejaculation: 3.5cc ○ Number of sperm per cc of semen – 40 – 80 million ○ Number of sperm per ejaculation – 300 –500 million ○ Mature ovum is capable of being fertilized for 12 to 24 hours after ovulation ○ Sperm is capable of fertilizing for 3 to 4 days after ejaculation ○ Normal lifespan of sperm is 7 days ○ Sperm can reach the ovum in 1 – 5 mins. -Fallopian tube will contract due to estrogen ○ Sperm must remain in the female genital tract 4 – 6 hours before they are capable of fertilizing the ovum ○ Sperm have 22 autosomes and 1 X or Y sex chromosomes ○ Ova contains 22 autosomes and 1 X sex chromosomes Stages/ Process of Pregnancy 1. Fertilization - is the process in which a sperm penetrates the outer layer of the ovum. 2. Implantation - when the blastocyst attaches to the endometrium (7 -9 days after fertilization). 3. Pre-placental stage - when the endometrium becomes highly vascular (week 2) 4. Placental and fetal development -A clearer picture of the process  - decidua vera – lines the rest of the uterus ○ It has 3 processes: 1. Apposition 2. Adhesion 3. invasion Human Development Late Blastocyst ○ The cells begin to differentiate into: -Inner cell mass ( embryo) -Trophoblast Cells ( attach to the uterus) Trophoblast cells erode the endometrium of the uterus so that The Blastocyst burrows into the uterine wall Endometrium covers the embryo and the blood supply becomes established - Cell Division Process IMPLANTATION ○ 50% of zygotes never achieve implantation ○ Small amount of vaginal spotting is occasionally present (Implantation breed) ○ Endometrium turned to decidua: - decidua basalis - directly under blastocyst - decidua capsularis – covers blastocyst  Placenta ○ Respiratory system ○ Renal system 3. Gastrointestinal system ○ Endocrine system: Human chorionic gonadotropin (HCG) Human placental lactogen Estrogen Progesterone ○ Protective functions Note: 1st stool of the baby is called “meconium” ->500 -1000ML= Normal volume or level of amniotic Umbilical Cord fluid ○ 21 inches long - Urine of the baby adds to the amniotic fluid ○ 2 arteries and 1 vein (AVA) volume ○ Wharton's jelly (makes the umbilical - Oligohydramnios = below normal levels of cord flexible and “un-kinkable”) amniotic fluid ○ Transport oxygen, nutrients, minerals, - Polyhydramnios = above normal levels of and waste products amniotic fluid -> Fetal kidney need to be develop first before the Amniotic Fluid baby can swallow ○ 500 – 1000 ml inside the amniotic sac -> (BOW=Bag of Water) ○ Produced by the amniotic membrane ○ Shields fetus from pressure or blow Focus of Fetal Development ○ Maternal and Child Health Nursing | 25 Fetal Development ○ Protects fetus from sudden change in ○ ZYGOTE - 1st 14 days ( week2) temperature ○ EMBRYO - 3rd to 8th week ○ Aids in muscular development ○ FETUS - 8th to birth ○ Aids in descent ○ NEWBORN - Delivery; 1st 28 days ○ Protects umbilical cord from pressure ○ INFANT - more than the 1st 28 days ○ Protects fetus from infection First Trimester (1-3months) - organogenesis; highest risk for the baby to develop malformities caused by teratogens Second Trimester (4-6 months) - Period of continued growth and development; Rapid development Third Trimester (7-9 months) - Period of most rapid growth and development - BOW composed of 2 layers - Amnion = Inner layer; produces the amniotic fluid - Chorion = Outer layer  FETAL CIRCULATION - Shunting = these are shortcuts; faster blood circulation for the fetus for faster fetal development - First organs that will experience shunting - Heart - Liver - Kidney - Formen Ovale = opening of 2 atria the right and  ○ Congenital malformations account for left opening ( blood goes through the left opening first) approximately 20% of deaths in the perinatal period We have 3 structures where shunting is most present ○ Approximately 3% of newborn infants -Ductus Venosus ( 1st Shunting) will have major malformations -Foramen Ovale (2nd Shunting) ○ Another 3% will have malformations -Ductus Arteriosus ( 3rd Shunting) detected later in life. What happens when the 3 structure mention above Nicotine doesn't close? - the baby will be at high risk of ○ effect on fetal growth congenital malformations, such as Congenital Heart ○ intrauterine growth restriction Disease (CHD) ○ Heavy cigarette smokers: premature delivery ○ constricts uterine blood vessels and causes decreased uterine blood flow thereby decreasing the supply of oxygen and nutrients available to the embryo ○ compromises cell growth and may have an adverse effect on mental development. Alchohol ○ Common abuse by women of childbearing age. ○ Demonstrate prenatal and postnatal growth deficiency, mental retardation, F= FETAL and other malformations subtle but A= ADULT classical facial features associated with fetal alcohol syndrome including short palpebral fissures, maxillary hypoplasia, Common Teratogens a smooth philtrum, and congenital heart Teratology disease ○ Study of abnormal development in ○ Moderate consumption (2 to 3 oz. of embryos and the causes of congenital hard liquor per day): fetal alcohol effects malformations or birth defects ○ Binge drinking: harmful effect on ○ May be visible on the surface of the embryonic brain developments at all body or internal to the viscera times of gestation.  Tetracycline: Antibacterial ○ Highly teratogenic: inhibit rapidly dividing cells ○ Should be avoided whenever possible but are occasionally used in the third trimester when they are urgently needed to treat the mother. Retinoic Acid: Anti-acne ○ Type of antibiotic ○ Can cross the placental membrane ○ Deposited in the embryo in bones and teeth ○ Exposure can result in yellow staining of the primary or deciduous teeth and diminished growth of the long bones Phenytoin: Anti-compulsive ○ Produce the Fetal Hydantoin Syndrome consisting of intrauterine growth retardation, microcephaly, mental retardation, distal phalangeal hypoplasia, and specific facial features. Antineoplastic Agents: anti-cancer (Attacks fast-growing cells) ○ Vitamin A derivatives ○ Extremely teratogenic ○ Even at very low doses, oral medications ○ such as isotretinoin, used in the treatment of acne, are potent teratogens ○ Critical period of exposure: second to the fifth week of gestation ○ Most common malformations: craniofacial dysmorphisms, cleft palate, thymic aplasia, and neural tube defects.  Congenital Cytomegalovirus Tranquilizer Thalidomide: Hypnotic Agents ○ One of the most famous and notorious teratogens ○ Hypnotic agent - used widely in Europe in 1959, after which an estimated 7000 infants were born with the thalidomide syndrome or meromelia ○ Characteristic features: limb ○ Most common viral infection of the fetus abnormalities that span from the ○ Infection of the early embryo during the absence of the limbs to rudimentary first trimester most commonly results in limbs to abnormally shortened limbs spontaneous termination ○ Also causes malformations of other ○ Exposure later in the pregnancy: organs including the absence of the intrauterine growth retardation, internal and external ears, micromelia, chorioretinitis, blindness, hemangiomas, congenital heart disease, microcephaly, cerebral calcifications, and congenital urinary tract mental retardation, and malformations hepatosplenomegaly ○ The critical period of exposure appears to be 24 to 36 days after fertilization. Ionizing Radiation ○ can injure the developing embryo due to German Measles cell death or chromosome injury ○ severity of damage to the embryo depends on the dose absorbed and the stage of development at which the exposure occurs ○ Study of survivors of the Japanese atomic bombing demonstrated that exposure at 10 to 18 weeks of pregnancy is a period of greatest sensitivity for the developing brain ○ There is no proof that human congenital malformations have been caused by diagnostic levels of radiation. However, ○ Consists of the triad of cataracts, cardiac attempts are made to minimize malformation, and deafness scattered radiation from diagnostic ○ The earlier in the pregnancy that the procedures such as x-rays that are not embryo is exposed to maternal rubella, near the uterus the greater the likelihood that it will be ○ The standard dose of radiation affected associated with a diagnostic x-ray  produces a minuscule risk to the fetus. However, all women of childbearing age are asked if they are pregnant before any exposure to radiation Maternal Medical Conditions ○ also produce teratogenic risks ○ Infants of diabetic mothers have an increased incidence of congenital heart disease, renal, gastrointestinal, and central nervous system malformations such as neural tube defects ○ Tight glycemic control during the third to sixth-week post-conception is critical ○ Infants of mothers with phenylketonuria who are not well controlled and have high levels of phenylalanine have a significant risk of mental retardation, low birth weight, and congenital heart disease Pregnancy Risk Categories Pregnancy Normal Adaptation in Pregnancy Reproductive System Uterus ○ Uterine growth and enlargement Lenght 6.5cms to 32cms Width 4cms to 24cms Depth 2.5 cms to 22 cms Weight 50 gms to 1000gms Volume ( Blood volume) 1-2ml ( Non-pregnant Lightening- the preparation for labor state) to 1000ml Pre-term - 37 and below (pregnancy) Full-term - 38 to 42 weeks Post - term - above 42 weeks ○ Braxton Hicks contraction - practice contractions ( Before labor begins, you might have false labor contractions, also known as Braxton Hicks contractions. These irregular uterine contractions are perfectly normal and might begin in your second or third trimester. A contraction is when your uterus tightens and then relaxes. Contractions are your body's way of getting ready for real labor) ○ Becomes globular (4th month) Reproductive system: Uterus ○ Goodell’s signs ( 4th week) - softening of the cervix ○ Hegar’s sign (8th week) - softening of 12 weeks ( first 3 months) - organogenesis the lower uterine segment ○ Chadwick’s sign ( 8th to 10th week) - discoloration of the cervix, including the vaginal walls; bluish/purplish in color due to the dilation of the blood vessels Ovaries ○ No ovulation Vagina ○ More acidic (ph 3.5 to 6) Breast ○ Enlarged ○ Increased in Size ○ Darken Areola, nipple ○ Blue veins ○ Montgomery tubercle enlarge 12 weeks - symphysis pubis 16 weeks- in between the symphysis pubis and umbilicus 36 weeks - xiphoid process: diaphragm compressed Average growth of the uterus - 1cm per week or 4cm per month  due to the increased production of melanocytes ○ Note: Lactation amenorrhea - prevents ○ chloasma/melasma periods due to lactation mask of pregnancy Musculoskeletal System ○ Striae gravidarum ○ Waddling walk due to the stretching of the ○ Symphysis pubis may separate slightly abdominal skin (stretch marks) ○ Linea nigra Drakens due to pregnancy ○ Increased perspiration The mother sweats more due to the increased activity of the body and increase metabolism Striae Gravidarum - With a growing baby, the mother will appear lordotic (Pride of pregnancy) Linea Nigra Circulatory system ○ Increased blood volume 40% to 50% ○ Physiologic anemia brought about by the rapid increase of blood plasma ○ Heart is displaced upward ○ Increased cardiac output to 30% ○ Supine hypertension ○ Increased WBC ○ CR &PR increased to 10-15 beat/min. ○ Vaaricosities and edema Telangiectasis A - Supine B - Side-lying position Gastrointestinal System Integumentary System ○ Morning Sickness ○ Increased pigmentation HCG levels go up  Hyperemesis gravidarum