PRELIM - Maternity Concept PDF

GOALS AND PHILOSOPHIES PF MATERNAL AND 4. Both nursing theory and evidence-based practice CHILD HEALTH NURSNG provide a foundation for nursing care. 5...

GOALS AND PHILOSOPHIES PF MATERNAL AND 4. Both nursing theory and evidence-based practice CHILD HEALTH NURSNG provide a foundation for nursing care. 5. A maternal and child health nurse serves as an advocate the rights of all family members, including OUTLINE the FETUS. I. GOALS 6. Maternal and child health nursing includes a high II. PHILOSOPHIES degree of independent nursing functions. III. MATERNAL AND CHILD HEALTH GOALS 7. Promoting health is an important nursing role. AND STANDARD 8. PREGNANCY OR CHILDHOOD ILLNESS can be IV. THEORIES RELATED TO MATERNAL AND stressful and can alter family life in both subtle and CHILD NURSING extensive ways. V. ROLES AND RESPONSIBILITIES OF A MATERIAL CHILD NURSE 9. Personal, cultural, and religious attitudes and VI. THE 17 SUSTAINABLE DEVELOPMENT beliefs influence the meaning of illness and its GOALS (SDGS) TO TRANSFORM OUR impact on the family. WORLD 10. Maternal and child health nursing is a challenging role for a nurse and is a major factor in promoting high-level wellness in families GOALS MATERNAL AND CHILD HEALTH GOALS AND  Primary goals of maternal and child health nursing care can STANDARDS be stated simply as promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and Association of women health’s, obstetrical, and neonatal childrearing. nurse’s standards, and guidelines standards of professional performance. THE GOALS OF MATERNAL AND CHILD HEALTH NURSING CARE ARE NECESSARILY BROAD STANDARD I: QUALITY OF CARE. The nurse BECAUSE THE SCOPE OF PRACTICE IS SO BROAD. systematically evaluates the quality and effectiveness of THE RANGE OF PRACTICE INCLUDES: nursing practice.  PRECONCEPTUAL HEAL CARE STANDARD II: PERFORMANCE APPRAISAL. The nurse  CARE OF WOMEN DURING THREE evaluates his/her own nursing practice in relation to TRIMESTER OF PREGNANCY AND THE professional practice standards and relevant statutes and PUERPERIUM (THE 6 WEEKS AFTER regulations. CHILDBIRTH, SOMETIMES TERMNED THE FOURTH TRIMESTER OF PREGNANCY.  CARE OF CHILDREN DURING THE PERINATAL STANDARD III: EDUCATION. The nurse acquires and PERIOD (6 WEEKS BEFORE CONCEPTION TO maintains current knowledge in nursing practice. 6 WEEKS AFTER BIRTH)  CARE OF CHILDREN FROM BIRTH THROUGH STANDARD IV: COLLEGIALITY. The nurse contributes to ADOLESCENCE the professional development of peers, colleagues, and  CARE IN SETTINGS AS VARIED AS THE others. BIRTHING ROOM, THE PEDIATRIC INTENSIVE CARE UNIT, AND THE HOME IN ALL SETTINGS STANDARD V: ETHICS. The nurse’s decisions and actions AND TYPES OF CARE, KEEPING THE FAMILY on behalf of patients are determined in an ethical manner. AT THE CENTER OF CARE DELIVERY IS AN ESSENTAL GOAL. STANDARD VI: COLLABORATION. The nurse collaborates with the patient, significant others, and health PHILOSOPHIES care providers in providing patient care. 1. Maternal and child health nursing is FAMILY STANDARD VII: RESEARCH. The nurse uses research CENTERED. findings in practice. 2. Maternal and child health nursing is COMMUNITY CENTERED. STANDARD VIII: RESOURCE UTILIZATION. The nurse 3. Maternal and child health nursing is RESEARCH considers factors related to safety, effectiveness, and cost ORIENTED. in planning and delivering the patient care. ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 1  STANDARD IX: PRACTICE ENVIRONMENT. The nurse 10. HILDEGARD PEPLAU contributes to the environment of care delivery within the  The promotion of health is viewed as the forward practice settings. movement of the personality; this is accomplished through an interpersonal process that includes STANDARD X: ACCOUNTABILTY. The nurse is orientation, identification, exploitation, and resolution. professionally and legally accountable for his/her practice. 11. MARTHA ROGERS The professional registered nurse may delegate to and  The purpose of nursing is to move the client toward supervise qualified personnel who provide patient care. optimal health; the nurse should view the client as whole and constantly changing and help people to interact in the best way possible with the environment. A FRAMEWORK FOR MATERNAL AND CHILD 12. SISTER CALLISTA ROY HEALTH NURSING CARE  The role of the nurse is to aid clients to adapt to the change caused by illness; Levels of adaptation depend Maternal and child health nursing can be visualized within a on the degree of environmental change and state of framework in which nurses, using nursing process, nursing coping ability; Full adaptation includes physiologic theory, and evidence-based practice, care for families during interdependence. childbearing and childbearing years through four phases of health care: ROLES AND RESPONSIBILITIES OF A MATERNAL CHILD NURSE  Health Promotion  Health Maintenance 1. CLINICAL NURSE SPECIALIST  Health Restoration 2. CASE MANAGER  Health Rehabilitation 3. WOMEN’S HEALTH NURSE PRACTITIONER 4. FAMILY NURSE PRACTITIONER THEORIES RELATED TO MATERNAL AND CHILD 5. NEONATAL NURSE PRACTITIONER NURSING 6. PEDIATRIC NURSE PRACTITIONER 1. PATRICIA BENNER 7. NURSE-MIDWIFE  Nursing is a caring relationship. Nurses grow from novice to expert as they practice in clinical settings. 17 SUSTAINABLE DEVELOPMENTAL GOALS 2. DOROTHY JOHNSON (SDGS) TO TRANSFORM OUR WORLD  A person compromises subsystems that must remain in balance for optimal functioning. Any actual or potential 1. GOAL 1: NO POVERTY threat to this system balance is a nursing concern. 2. GOAL 2: ZERO HUNGER 3. IMOGENE KING 3. GOAL 3: GOOD HEALTH AND WELL-BEING  Nursing is a process of action, reaction, interaction, and 4. GOAL 4: QUALITY EDUCATION transaction; Needs are identified based on client’s social 5. GOAL 5: GENDER EQUALITY system, perceptions, and health; the role of the nurse is 6. GOAL 6: CLEAN WATER AND SANITATION to help the client achieve goal attainment. 7. GOAL 7: AFFORDABLE AND CLEAN ENERGY 4. MADELIEINE LININGER 8. GOAL 8: DECENT WORK AND ECONOMIC  The essence of nursing is care. To provide transcultural GROWTH care, the nurse focuses on the study and analysis of 9. GOAL9: INDUSTRY, INNOVATION AND different cultures with respect to caring behavior. INFRASTRUCTURE 5. FLORENCE NIGHTINGALE 10. GOAL 10: REDUCED INEQUALITY  The role of the nurse is viewed as changing or structuring 11. GOAL 11: SUSTAINABLE CITIES AND elements of the environment such as ventilation, COMMUNITIES temperature, odors, noise, and light to put the client into 12. GOAL 12: RESPONSIBLE CONSUMPTION AND the best opportunity for recovery. PRODUCTION 6. BETTY NEUMAN 13. GOAL 13: CLIMATE ACTION  A person is a open system that interacts with the 14. GAOL 14: LIFE BELOW WATER environment; Nursing is aimed at reducing stressors 15. GOAL 15: LIFE ON LAND through primary, secondary, and tertiary prevention. 16. GOAL 16: PEACE AND JUSTICE STRONG 7. DOROTHEA OREM INSTITUTIONS  The focus of nursing is on the individual; clients are 17. GOAL 17: PARTNERSHOPS TO ACHIEVE THE assessed in terms of ability to complete self-care. Care GOAL given may be wholly compensatory (Client has no role); partly compensatory (Client participates in care); or supportive-educational (Client performs own care). REFERENCES 8. IDA JEAN ORLANDO  The focus of the nurse is interaction with the client; I. PowerPoint presentation effectiveness of care depends on the client’s behavior and the nurse’s reaction to that behavior. The client should define his or her own needs. 9. ROSEMARIE RIZZO PARSE  Nursing is a human science. Health is a lived experience. Man-living-health as a single unit guides practice. ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 2  SEXUALITY / PREGNANCY - Eye Prophylaxis - Cord Care - Vitamin K OUTLINE CONCEPT OF SEXUALITY 1. SEXUALITY I. Procreative Health Refers to sexual behaviour in all sexual organisms. A II. Antepartum / Pregnancy person’s sexuality encompasses complex emotions, III. Intrapartum attitudes, preferences, and behaviours related to IV. Postpartum expression of the sexual self and eroticism V. The Newborn 2. ASEXUALITY VI. Concept of Sexuality VII. Principles Relevant to Sexuality Absence = no attraction between opposite sex VIII. Sexual Stimulation and Response Patterns Is a general term or a self-designation for people who IX. Patters of Sexual Responses lack sexual attraction or otherwise find sexual behaviour X. Sexual Relationships unappealing 3. AUTOSEXUALITY People are attractive to own self but that doesn’t mean PROCREATIVE HEALTH you’re not attracted to other people Principles of Sexuality and Procreation Prefer masturbation but again, that doesn’t mean you’re not attracted to other people Sexuality Or Autoerocitism is the sexual stimulation of, or sexual Genetics desire towards one’s body Risk Factors that will lead to Genetic Disorders Common Tests for determination of Genetic 4. HUMAN SEXUALITY Abnormalities Refers to the expression of sexual sensation and related intimacy between human beings, as well as the Nursing Process expression of identity through sex Involves social interaction of individual and physical as ANTEPARTUM / PREGNANCY well Anatomy and Physiology of the Reproductive system - Spermatogenesis PRINCIPLES RELEVANT TO SEXUALITY - Oogenesis 1. Human sexuality provides for reproduction (Human Physiology of Menstrual Cycle fertilization) of human species Fertilization - 2 persons are involved in the act, and they should know the purpose of their action and aware of INTRAPARTUM responsibility, family panning should be involved Concept of Labor and Delivery 2. Sexual fulfilments is a basic human need Concepcion - According to Maslow’s hierarchy of needs, Fetal Development physiological need includes sexual fulfilment; use Normal Adaptation in Pregnancy ethics with patients Assessment 3. Sexuality pervades virtually every aspect of life from Theories of Labor birth to death Components of Labor - starts at birth Signs of Labor 4. All human cultures have sanctions, often legal as Stages of Labor well as moral, controlling expressions of sexual drive - Different cultures have different sanctions like in POSTPARTUM certain agreements Puerperium 5. Individuals have strong cultural, religious, ethical convictions regarding the expression of human Family Planning Methods sexuality Legal Implication of MCN 6. Moral values concerning appropriate sexual behaviors have undergone considerable THE NEWBORN liberalizations in most western cultures in recent Profile of the Newborn years - Function and Appearance - According to Max Weber, culturing values are - Apgar score enduring and autonomous influence in the society - Anthropometric Measurements (weight, HC, CC, regarding sex Abdominal C, Body Length) 7. Successful gender identification in early childhood is - Vital Signs, Airway important for an individual’s health and well-being Nursing Care of the Newborn throughout life ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 3  - It is important for emotional and mental stability, a A relationship outside of marriage where an ellicit clear gender will help you develop more romantic or sexual relationship or passionate attachment 8. Actual or potential damage to the integrity of an occurs; kabit. individual’s sex organ poses a considerable threat to 4. NON-TRADITIONAL his self-esteem Can be look in many different ways. They can be non - Prone to suicidal sexual. They can be in a relationship where there’s a large disparity in money or age SEXUAL STIMULATION AND RESPONSE PATTERNS FACTORS AFFECTING SEXUAL FUNCTIONING: A. PHYSICAL STIMULATION 1. BIOLOGICAL Usually consists of touching the erogenous zones or the sexual differentiation, brain mechanisms involved in excitement area of the human body sexual responses, role of sex hormones, sexual effects of Ex. Male→female= nipples, neck, back of ears, clitoris, drugs, sexually transmitted disease lips 2. SOCIAL B. PSYCHOLOGICAL STIMULATION role of parents, social media B1 Visual- pictures of nudity and romantic photo 3. MORAL B2 Auditory- classical music beliefs of each culture regarding sexual functioning B3 Olfactory- perfumes and scented candles 4. PSYCHOLOGICAL the impact of body image, sexual abuse in childhood, and PATTERNS OF SEXUAL RESPONSES mental health history, interpersonal problems 1. DESIRE RESPONSIBLE PARENTHOOD It is a prelude to sexual excitement & sexual activity. It As defined in the directional plan of POPCOM, is the will occurs in the mind rather than the body and may not and ability of parents to respond to the needs and progress to sexual excitement without further physical or mental stimulation. It is communicated between potential aspirations of the family and children. It is a shared sexual partners either verbally or through body language responsibility of the husband and wife to determine and or behavior. achieve the desired number, spacing & timing of their Ex. A woman preparing herself, putting lotion and children according to their own family life and perfume aspirations, taking into account the psychological 2. EXCITEMENT / AROUSAL preparedness, health status, socio cultural, and Is the body’s physical response to desire. A person who economic concerns manifests the physical indications of excitement is termed to be “aroused” or “excited’. It can be communicated PRINCIPLES OF PROCREATION between partners verbally or through body language, 1. Sex is a search for sensual pleasure and satisfaction, behavior, or anybody changes. releasing physical and psychic tensions. 3. PLATEAU 2. Sex is a search for the completion of the human The highest moment of sexual excitement before person through an intimate personal union of love orgasm maybe achieved, lost and regained several times expressed by bodily union for the achievement of a without the occurrence of orgasm more complete humanity During intercourse already, there is excitement 3. Sex is a social necessity for procreation of children and education in the family so as to expand the 4. ORGASM human community and guarantee its future beyond Occurs at the peak of the plateau phase. The sexual death. tension that has been building throughout the body is 4. Sex is a symbolic (sacramental) mystery, somehow released, and the body releases chemical called revealing the cosmic order. In short, this Christian “Endorphins” which causes a sense of wellbeing. This principle is all about pleasure, love, reproduction and can achieve through mental stimulation and fantasy the sacramental meaning of sex. alone, but more commonly is a result of direct physical stimulation or sexual intercourse MECHANISM OF HEREDITY Time where ejaculation of sperm into vagina of female, brings satisfaction OVA SPERM 5. RESOLUTION Is a period following orgasm, during which muscles relax and the body begins to its pre-excitement state 23 23 Relaxation of both reproductive systems CHROMOSOMES CHROMOSOMES SEXUAL RELATIONSHIPS 1. PREMARITAL Is a period for two different person who do not know each other, understand each other and create bonds of love 46 which are necessary to live together before they take CHROMOSOMES decision to marry. 2. POSTMARITAL Occurring, existing, or taking effect after the end of marriage. 22 PAIR 1 PAIR (SEX CHROMOSOME) (23RD PAIR) 3. EXTRAMARITAL (AUTOSOME) ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 4  INHERITANCE SCREENING TEST FOR GENETIC TRAITS AND 1. GENOTYPE DISEASE complete set of inherited traits 1. KARYTYPING 2. PHENOTYPE a visual display of the individual’s actual chromosomes how these traits are expressed pattern. 3. ALLELES 2. HETEROZYGOTE SCREENING are pair of genes the use of specific assays to determine the genetic status - 1 from ovum of individuals already suspected to be at higher risk for an - 1 from sperm inherited disorder caused by family history 4. HOMOZYGOUS 3. MATERNAL SERUM ALPHA the same alleles Fetoprotein made by the baby’s liver also found in the 5. HETEROZYGOUS amniotic fluid) different versions of the trait It is a rare procedure because it is an invasive procedure) 4. TRIPLE SCREENING GENETIC DISORDER analysis of 3 indicators from MSAF (Meconium- stained 1. CHROMOSOMAL INHERITANCE DISORDERS amniotic fluid), Estriol (estrogen), HCG (Human Chrionic A. AUTOSOMAL DOMINANT DISORDER gonadotropin) - (single copy of disease mutationof the genes) - dwarfism HISTORY OF GENETIC DISORDER - huntington’s disease (progressive breakdown of Anencephaly (the baby doesn’t have a skull) nerve cells causing to have problem in the brain that Spina bifida (the spine of the baby is not straight, there is has one copy of defective genes), a curvature at the back the protrude) - marfan’s disease (Affects the connective tissues or Gastroschisis (doesn’t have abdominal wall either on the fibers that supports or anchor the different organs right or left causing the intestine to come out) also this disease will limit the ability to make protein to build a connective tissue.) DIAGNOSTIC TESTS 1. CHRIONIC VILLI SAMPLING B. AUTOSOMAL RECESSIVE DISORDER 5th week of pregnancy (earliest), but mostly done at 8th (Two copies of mutation are needed to cause the to 10th week disease) Prenatal test that involves taking a sample of tissue from - cystic fibrosis (Affecting the lungs as well as the the placenta to test for some chromosomal abnormalities digestive system, produces a thick sticky mucus on certain genetic problem membrane in the lungs thus it has a difficulty to 2. AMNIOCENTESIS (REFER TO THE AMNIOTIC inflate and deflate. This also affects the pancreas regarding its function) FLUID) taking down 2-5 ML to test some abnormalities at 14 and C. X- LINKED DOMINANT DISORDER 16 weeks - fragile x syndrome (A mental retardation or disorder 3. SONOGRAPHY (ULTRASOUND) in which the brain needs more protein. It occurs not an invasive procedure but uses a high waves of because there are some changes in the formation of frequency sound waves the genes.) 4. FETOSCOPY an incision done to the mother D. X-LINKED RECESSIVE DISORDER 3-4 incision - haemophilia (it is a disorder in which the blood doesn’t clot normally) CHRIONIC VILLI SAMPLING - Fabry disease (raising the risk of heart attack, stroke and kidney failure) E. MULTIFACTORIAL INHERITANCE - CLEFT LIP - PALATE 2. CHROMOSOMAL ABNORMALITY DISORDERS A. NUMERIC ABNORMALITY- Klinefelter Syndrome B. STRUCTURAL DISORDER – Translocations RISK FACTORS OF GENETIC DISORDER 1. Age (mother and father) 2. Race 3. Family history of disease 4. OB History of pregnancy issue: like exposure to teratogens (chemicals that affect the growth of the fetus in the mother’s womb) such as radiation, certain drugs, viruses, toxins and chemicals Fig 1. The needle is inserted to the abdomen up to the placenta with the guide of an ultrasound ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 5  AMNIOCENTESIS Fig 2. The needle is inserted to the abdomen up to the amniotic fluid with the guide of an ultrasound. NURSING PROCESS A. ASSESSMENT 1. Health history - genetic history, ethnic background, general medical history and mother’s age 2. Laboratory and diagnostic studies B. NURSING DIAGNOSES 1. Knowledge Deficit 2. Decisional Conflict 3. Anticipatory Grieving C. PLANNING 1. The couple will receive education 2. The couple will receive emotional support D. IMPLEMENTATION 1. Provide education - information about genetic problem; testing required; possible treatment; and available resources 2. Provide emotional support - Counseling healthcare facilities. Assist in coping E. EVALUATION REFERENCES I. PowerPoint presentation ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 6  2. Scrotum - A bag of skin that holds and help to protect THE ANATOMY AND PHYS IOLOGY OF THE the testicles also it provides a proper temperature for REPRODUCTIVE SYSTEM the viable sperm Additional notes: OUTLINE  When the environment is cold the scrotum I. Male Reproductive Organ will retreat up towards the body and will II. Spermatogenesis constrict however if the environment is hot III. Female External Reproductive Organ the scrotum will descend due to the IV. Oogenesis V. Menstruation temperature that maintain the viability of VI. The Menstrual Cycle the sperm. VII. Pregnancy  Cryptorchidism - Failure of the scrotum to VIII. Stages of Pregnancy descend. This is one of the most common endocrine problems in newborn males B. INTERNAL STRUCTUR ES M ALE REPRODUCTIVE SY STEM 1. Testes 2. Epididymis - extend 10-20 ft; 2-4 weeks sperm maturation - Temporary site for immature sperm 3. Vas Deferens - 16 inches  Ampulla of the Vas Deferens 4. Ejaculatory duct 5. Urethra  Three regions of the urethra: - Prostatic Urethra - Membranous Urethra - Penile Urethra C. ACCESSORY GLANDS 1. Seminal vesicles - 2 inches; secrete alkaline fluid and fructose  Aspermia - Lack or absence of the reproduction of the sperm Fig 1. Parts of the Male Reproductive System  Oligospermia - The sperm is fewer than 20 million per ml  The male reproductive system produce, nourish and 2. Prostate gland - walnut transport sperm into the female reproductive system  Prostatic Urethra - Help to control for reproduction. the mixing of the urine into the sperm  It secretes the male sex hormone called testosterone. during the sexual intercourse. 3. Cowper’s gland/ Bulbourethral - 2 pea sized A. EXTERNAL STRUCTURES structure 1. Penis - Transport the semen into the female  secrete an alkaline mucus-like fluid reproductive tract. that helps to counter act the acidity of the urethra and ensure the passage of - Passage of urine the spermatozoa.  Parts of the Penis: - Shaft D. M ALE BREASTS - Glands Penis - Prepuce/ Foreskin ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 7  SPERM ATOGENESIS  The formation of sperm cell that undergo mitotic and meiotic divisions Hypothalamus Gonadotropin Releasing Hormone Fig 2. Parts of the sperm cell Anterior Pituitary Gland FEM ALE EXTERNAL REPRO DUCTIVE FSH (Follicle LH ORG AN Stimulating (Luteinizing Hormone) Hormone) Androgen Binding Protein Testosterone SPERMATOGENESIS SEMEN  60%- Prostate gland Fig 3. External parts of the Female Reproductive system  30%- Seminal Vesicle  5%- Epididymis  Produces the egg cell  5%- Bulbourethral gland  Site for fertilization  3-5 cc (1tsp) per ejaculation  Nourish, Protect the developing fetus inside the mother’s womb SPERM ATOZO A  It produces the hormone Estrogen and Progesterone  Produced by testicles  40-80 million per cc of semen A. EXTERNAL STRUCTURE  300-500 million per ejaculation 1. Mons Veneris/ Mons Pubis  300-500 million per ejaculation 2. Labia Majora - An adipose tissue that helps to protect  12-20 days travel mature after 64 days and cover the inner structure of the female genitalia 3. Labia Minora 4. Clitoris 5. Urethral Meatus 6. Perineum ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 8  4. OVARIES  2 almond shaped glands  Female gonads are located in the superior portion of the pelvic cavity lateral to the uterus  It produces secondary oocytes, discharge secondary oocytes (the process of ovulation) and secretes hormones such as estrogens, progesterone, relaxing and inhibin  Oogenesis begins in the ovaries  Regulate and initiate the menstrual cycle  Within the ovary, it has tiny sac structures  Ovarian follicle = consist of immature egg which we called oocytes  Cells surrounded by oocytes inside which we call as the Fig 4. Internal Parts of the Female Reproductive System follicular cells in which mature and become the ovarian follicle B. INTERNAL STRUCTUR ES  The mature follicle is called graafian follicle which discharge mature ovum from the graafian follicle during 1. VAGINA the ovulation time (time you are “so” fertile)  3-4 inches long 5. CERVIX  Vaginal rugae = become thin because this will be the passageway of the baby during delivery  Cervical os has internal and external os  Passageway for sperm and menstrual flow, the receptacle of the penis during sexual intercourse and the 6. FIMBRIAE inferior portion of birth canal. It is capable of considerable distension  Help catch the sperm during penetration  Is finger-like projection and can be found at the end of 2. UTERUS the fallopian tube  Creates current that acts to carry the oocytes or the  “womb” fertilized egg into the uterine tube where it usually begins  “bahay-bata” its journey towards the uterus  Where the baby develops  The layers of the uterus are an outer perimetrium, 7. BRO AD LIG AM ENT middle myometrium, inner endometrium  Help the uterus in place, no matter what position you 3. FALLOPIAN TUBE  will do during sexual intercourse = “locked” Additional notes:  4 inches  Transport the egg from the ovary to the uterus  If the egg during sexual intercourse/excitement is  Has 3 parts: not fertilized, it will eventually deteriorate and 1. Isthmus = site of fertilization excreted from the body in the form of menstruation 2. Ampulla  The journey from the tube into the uterus of a 3. Infundibulum fertilized is about 4-5 days; the egg is fertilized in  Some mothers have ectopic pregnancy wherein during the tube and implanted in the uterus and fully fertilization it is stuck in the tube and not in the uterus. developed particularly in the endometrium This will cause rupture of the blood vessel in the tube  If there is tubal ligation, it is the isthmus that is resulting bleeding to the pregnant mother surgically cut off ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 9  C. ACCESSORY GLANDS  Has internal os and external os and is expressed in cm (dilation of cervix) 1. BREASTS (M AMM ARY GLAND)  Vaginal canal is rugated and becoming thin during the process of delivery or as labor progresses. It is expressed  Are modified sweat glands lying superficial to the in percentage by the doctor pectoralis major muscles. Their function is to synthesize, secrete and eject milk (lactation) after the FEM ALE INTERNAL REPRODUCTIVE birth of the baby SYSTEM: LATERAL VIEW  Mammary gland development depends on estrogen and progesterone. The milk production is stimulate by hormones such as prolactin, estrogens and progesterone, milk ejection is stimulated by oxytocin 2. BARTHOLIN OR VULVOVAGINAL GLAND  Produces fluid to the stimulation 3. SKENE OR PARAURET HRAL GLAND D. PELVIS  Is NOT an accessory gland  Part of the skeletal system  Involved in the process of delivery INTERNAL PART OF THE UTERU Fig 6. Internal Part of the Uterus in Lateral view  Uterus = overlying into the urinary bladder and rectum  A full bladder and rectum will hinder the passageway of the baby or paglabas ng baby  The pelvic bone plays a role in pregnancy OOGENESIS  This is the process in which there is formation and development of the oocyte or the ovum Fig 5. Internal Part of the Uterus  The layers of the uterus are an outer perimetrium, middle myometrium, inner endometrium (site of implantation) ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 10  Underdeveloped cell  This will provide internal protection for the oocytes PRIMITIVE OOGANIA ZONA PELLUCIDA During proliferation phase, the cells of the  The one that supports the communication between the PRIMORDIAL OR generative layer of the ovary divides to produce oocytes and the follicular cells during the oogenesis PRIMITIVE FOLLICLE  Regulates the ovulated eggs and free-swimming during follicle which is the (before birth) Undergo secondary oocyte and following of fertilization Meiosis I Further develop to HY ALURENIC ACID become the oocytes or the haploid of the  Important part of the extracellular matrix that function in SECONDARY OOCYTES chromosomes = 46 cells during signalization Provides for the MENSTRUATION maturation as well as the release of the fertilized GRAAFIAN FOLLICLE  Shedding of Corpus Luteum oocytes. Forms the corpus luteum (CL)  Periodic discharges of the female which is composed of which promote and blood, mucos, and dead endometrial cells of the uterus maintains the implantation  Blood coming from the ruptured capillaries in the uterus of the embryo. If there is OVUM no fertilization the CL will  Menarch (onset) early as 14 yrs. old some 10, progress its function and menopause (termination) 50 years old and above turns into menstrual cycle.  300,000 - 400,000 oozytes per ovary, they are the If there is ovum, it is the one If there is fertilization, the immature oozytes that is present at birth. It is formed capable of developing a new graafian follicle will during the first month of the intrauterine life. This maybe individual with the sperm being maintain the CL in fertilized preparation for the coming degenerate and be atresia of fertilized ovum  Average cycle is 28 days but, in some cases, it reaches up to 31 days. Duration of 3-5 days however in some books it says up to 7 days  Unovulatory state after menarch OOCYTES / FERTILIZED EGG  Menstrual flow contains 30-80 ml of blood, sometimes more due to intake, problem in hormone, or not properly shed off  Structures involve hypothalamus, APG, ovaries, uterus, vagina (excretion of the menstrual cycle)  Hormones that regulate – FSH and LH  ESTROGEN  PROGESTERONE  Mittelschmerz = abdominal cramping pain that occurs after the time of ovulation. It is different from dysmenorrhea in which is an abdominal cramping pain that occurs during the course of menstruation. ESTROGEN Fig 7. Oocytes / fertilized egg  Inhibits production of FSH  Causes hypertrophy of the myometrium CORONA RADIAT A  Stimulates growth of breasts ducts  Is a follicle cell that surrounds the zona pellucida - Development of the breast is called “Thelarche” ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 11  Increases ph of cervical mucus causing it to become thin B. PHASES OF MENSTRU AL CYCLE and watery (Spinnbarkhelt test), occurs during ovulation  Proliferates the endometrium A. Proliferative/ Preovulatory/ Follicular Phase (16-14 days) PROGESTERONE  In a 28 days cycle → begins with the end of menstruation  Inhibits production of LH  Increases endometrial tortuosity Additional notes:  Increases endometrial secretions  The first day of menstruation is the last day  Inhibits uterine motility of menstrual period.  Facilitate transport of fertilized ovum through fallopian tube  Increases body temperature after ovulation which means you are fertile  levels of estrogen and progesterone  Hypothalamus senses the decrease, thus THE MENSTRUAL CYCLE stimulates the APG to secrete GnRH prompting the release of FSH which stimulates the ovaries to produce follicles A.THE FOUR LEVELS (10-20)  1. CNS RESPONSE- Hypothalamic-pituitary gland  Follicles ripen but only one will mature action (FSH and LH) which is known as the Graafian follicle. -stimulation of the hypothalamus  2. OVARIAN RESPONSE (2 phases)- Proliferative B. Ovulatory Phase (14-15) –Peak phase (1-14 days); Secretory (15-22 days)  ENDOMETRIAL RESPONSE (4 phases)  Graafian follicle ruptures and releases the mature o Menstrual phase (1-5 days) ovum near the fallopian tube. o Proliferative phases (6-14 days)  2 ova matures- both fertilized (Fraternal twins) o Secretory ( 15-26 days)  1 fertilized ovum divides into 2 separate zygotes o Ischemic ( 27-28 days) (Identical twins)  CERVICAL MUCUS RESPONSE (OVULATORY) 15 – 23 days BEFORE OVULATION – Spinnbarkeit/Spinnbarkheit; mittelschmerts AFTER  Hypothalamus senses increase level of estrogen OVULATION. triggers the APG to release LH which acts with FSH to cause OVULATION and enhance Corpus Additional notes: Luteum formation Body structures involved in menstrual cycle:  Hypothalamus C. Secretory / Luteal Phase (16-28)  Anterior Pituitary Gland  Ovary  Corpus luteum secretes Progesterone that  Uterus maintains the vascularity (also the thickness) of the endometrium  Decrease level of estrogen and increase progesterone (hormone of pregnancy) ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 12   Cause glands in the endometrium to secrete  Increased in hormones in preparation for the nutrients to sustain a fertilized ovum that is implanted coming of the fertilized ovum. But if there is no in the uterine wall fertilization the hormones start to decrease  If no implantation- Hypothalamus signal the because there is no pregnancy to maintain. Pituitary gland to stop producing FSH and LH Additional Notes:  Decrease in FSH and LH causes the Corpus luteum to decompose in the ovary and nourishment  Obstetric nursing defined as the art and of the endometrium stops. (THIS WILL HAPPEN 2 science that would take care of the DAYS BEFORE MENSTRUATION) childbearing as well child rearing mothers. Also take care the woman and the unborn baby. Addition notes:  Maternity nursing this is a practice of  Corpus luteum become necrotic and nursing care given to the woman before, ischemic. After 2 days the necrotic will during, and after pregnancy. separate and degenerate from basal layer  Maternal and childcare nursing is branch of of corpus luteum and it turns another nursing that is family centered and that cycle of menstruation would assume responsibility for the whole cycle of the pregnant mother to include the family member or the entire family itself. PREGNANCY D. Menstrual Phase (1-5): an end and a beginning  Normal amount of semen/ ejaculation :3.5 cc  Decrease in estrogen and progesterone  Number of sperm per cc of semen: 40 -80 million  Mature ovum is capable of being fertilized for 12 to  Lining disintegrates and discharges from the body 24 hours after ovulation  Sperm is capable of fertilizing for 3 to 4 days after  MENSTRUAL FLOW ejaculation  Normal lifespan of sperm is 7 days  Sperm can reach ovum in 1 -5 minutes.  Fallopian tube will contract due to estrogen  Sperm must remain in female genital tract for 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 OF PREGNANCY 1. Fertilization ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 13   The Process in which a sperm penetrates outer Additional Notes: layer of the ovum Decidua Casularis – portion of endometrium that Additional Notes: stretches/encapsulates the trophoblast surface  Fertilization – Union of sperm and Decidua Vera – lines the remaining area of the ovum, sperm penetrates layer of uterus ovum. Which then turns into a zygote. Then begins a chain of 1. Amniotic fluid (100 – 2200) division that result in the  -serves as a protective mechanism development of an embryo and of growing fetus usually occurring at the fallopian  -protects fetus from changes of tube. The total time span is about 24 temperature – 48 hr. Mature ovum is surrounded  -aids in muscular development by 2 plasma which binds together  -during delivery it will aid in the and where the sperm needs to descent of the baby penetrate.  -serves as a lubricant  another term for fertilization is Impregnation  -allows the fetus to move freely  Fertilization – occurs during the mid-  -protects umbilical cord from cycle of the menstruation, 14th days pressure after menstruation is the ovulation  -Protects fetus from infection process. The woman is Fertile. Polyhydramnios – too much production of Amniotic fluid Intervention: Less fluid intake 2. Implantation Oligohydramnios – less  when the blastocyst attaches the endometrium (7 – production of Amniotic fluid 9 days after fertilization) Intervention: increase fluid intake Additional Notes: 2. Chorionic villi  Endometrium – where implantation of  -involve in the function the placenta fertilized ovum  -surround trophoblast, and produce  Morola – 6 collection of cells coded hormones that undergone mitotic division, takes about 3 - 4 days. Continues to undergo Hormones: mitosis until the end of the 5th day,  - Human gonadotropin then turn into a blastocyst.  - (Hpnl) Human placental lactogen  Apposition – when blastocyst  -Estrogen reaches/brushes unto the  -Progesterone endometrium  Adhesion – when blastocyst attaches 2. Yolk sac to the endometrium  -Produce RBC, develops sperm or  Invasion – when blastocyst settles in egg cells, Becomes a part of the the soft fold of the endometrium umbilical cord  Decidua – thickening of the  endometrium and also vascularity 3. Allantois 3 separate areas:  -Contribute function of urinary Decidua Basalis – portion where the late trophoblast bladder, blood vessels, but become cells are establishing communication with a part of the umbilical cord maternal blood vessels which forms maternal side of the placenta ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 14  3. Pre-Placental stage  When the endometrium becomes highly vascular (week 2) 4. Placental and Fetal development IMPLANT ATION  50% of zygote never achieve implantation  Small amount of vaginal spotting is occasionally present  Endometrium turned to decidua: decidua Basalis, decidua capsularis, decidua vera  3 Processes: apposition, adhesion, invasion REFERENCES I. Power point presentation II. Notes from Discussion ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 15  PLACENTA FETAL DEVELOPMENT 1. Respiratory System 2. Renal System 3. Gastrointestinal System OUTLINE 4. Endocrine System Human Chorionic gonadotropin (HCG) - I. Umbilical Cord Maintain the corpus luteum to keep producing II. Amniotic Fluid estrogen and progesterone III. Amniotic Membrane IV. Placenta Human Placental Lactogen/ Human Chronic V. Fetal Development Somatomammotropin – Promotes mammary gland necessary for lactation Estrogen - Promote the development of the mammary gland. UMBILICAL CORD Progesterone/ Hormone of pregnancy - 21 inches long from the mother to the placenta Maintains the endometrium lining of the uterus to 2 arteries and 1 vein (AVA) hold the fetus inside. Wharton’s Jelly- White substance that protects the two veins and the artery from any compression Additional notes: Transport oxygen, nutrient, minerals, and waste products If the production of Progesterone is less, thus, there is a tendency that the AMNIOTIC FLUID fetus will draw out inside the mother’s 500-1000 ml inside the amniotic sac (BOW) womb especially if it is not full term. Produced by the amniotic membrane Helps in the contraction of the uterus Shields fetus from pressure or blow during labor and delivery Protects fetus from sudden change in temperature Aids in muscular development 5. Protective function - It inhibits the Passage of Aids in decent bacteria as well as the large molecule to the fetus. Protects umbilical cord from pressure Additional notes: Protects fetus from infection Teratogens - Toxic subs such as ROH drugs, and certain placental membrane and can cause severe birth defects The critical time for brain development 16 weeks of AOG. FETAL DEVELOPMENT Zygote (1st 14 Days) Embryo - 1st 15 days (3rd to 8th Week) - Major organs of the Fig 1. Amniotic membrane embryo are formed during the first 8 weeks Additional notes: The Pregnancy duration has a three Fetus trimester that has 38 weeks or 266 days each. (8th week to birth)-The fetus has a sufficient development inside the mother’s womb. ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 16  Additional notes: Abortion - The fetus is delivered before 9 months or 20 to 22 weeks Preterm/ Premature Delivery - The fetus is delivered in more than 20 to 22 weeks but less than 38 weeks. The fetus is not fully developed Different types of abortion 1. Spontaneous Abortion - Nothing is done to the pregnant mother it just occurs naturally without any artificial interferences that cause some fetal Fig 4. The two arteries and the vein inside the Wharton’s abnormalities Jelly are visible and the formation of the fetus is improving in 2. Induced Abortion - Any abortion that are Cause by which its head is developing and some of its features are some mechanical or artificial means to remove the already visible baby and this is true to any unwanted pregnancy. 3. Therapeutic Abortion - This is performed by a physician or a doctor as a form of treatment to the mother Fig 5. The external feature of the fetus is already in position Fig 2. Bean like Structure During this week the liver is already formed and is a major site of RBC production but after the succeeding months it is already the bone marrow that will produce the RBC For 9-12 weeks there is already urine production Fig 3. During the 4th week of the fetus, some organs are forming and there is an increase in fetal size ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 17  The baby produces Vernix carseosa (a white cheesy like substance that is found all over the body to maintain temp.) Fig 6. Rapid Growth of the Fetus and has a coordinated movement During this week external Reproduction is already visible thus in this week we can already determine the gender of the fetus Fig 9. There is already weight gain in the fetus and the skin becomes pinkish or reddish. Eye movement and growth of fingernails happens in this week Fig 7. There is already osification of the skeleton Fig 10. During this time the lungs of the baby is starting to produce surfactant/ lung surfactant (Substance that decreases the surface tension of alveoli in the lungs which is necessary for survival on the outside world) By this week the bone marrow will take over the production of RBC/ Erethropoiesis (by the spleen) Fig 8. During this week the Growth of the baby is slowing down also in this week there is already quickening (1st movement felt by the mother) as well as some fine hair called lanugo (Fine hair that can be found all over the body except palm, sole and lips) ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 18 Fig 11. The baby already have capillary reflex to light Fig 13. Fullterm baby, the head and the body of the baby is fully proportionate as well as its features. The weight of the baby should be 7.5 pounds which is equal to 3000- 3800 grams and the legnth is about 45- 50 cm Additional notes: if the baby is delivered during his 32 weeks it is called post term baby The baby should be 40-42 weeks inside the mother’s womb When the Placenta starts to regress its function, the baby will be delivered Fig 12. The body of the fetus is already proporional to the head and the subcutaous fats are already deposited in some parts that helps to maintain the temp of the baby after birth REFERENCES Additional notes: I. PowerPoint Presentation For 35 weeks, the baby’s hand is II. Notes from: Mrs. Atillo’s PPT already strong for gripping and has a strong orientation towards light ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN-2D 19  5. Ductus Arteriosus FET AL CIRCULATION  Is between the Pulmonary artery and the Aorta OUTLINE  In some cases, after delivery it will close after 3 months, but in other cases, it will not I. FETAL CIRCULATION close leading to Patent ductus arteriosus II. FOCUS OF FETAL DEVELOPMENT (PDA) = abnormal connection between the III. NORMAL ADAPTATION OF PREGNANCY aorta and the pulmonary artery in the heart Additional notes:  Foramen Ovale, Ductus Venosus, Ductus Arteriosus = will close before delivery but in some cases it will not close (like foramen ovale) it will lead to disorder of a baby  Blue baby syndrome = mix of oxygenated and unoxygenated blood FET AL CIRCULATION FLOW CHART  Refer to the fig_  Oxygenated blood from the placenta returns via the umbilical vein  The umbilical vein distributes Fig 1: Fetal Circulation o 40% of its flow to the liver  Inferior vena cava drains into the right atrium FEATURES IN FETAL CIRCULATION  From the right atrium, the flow splits into right ventricle and left atrium via foramen ovale 1. Umbilical Artery  From the left ventricle, into the aorta  Transport the blood from the baby to the o From the aorta, upper body blood flow placenta going back to the mother (brain and arms) is purely from the left circulation ventricle, whereas lower body blood flow is 2. Umbilical Vein the combined output of the left ventricle and  Transports the blood and nutrients from the right ventricle via the ductus arteriosus mother to the placenta going to the fetus  From the common iliac arteries, via the umbilical  Collection between the mother and fetus arteries to the placenta 3. Foramen Ovale  Septum between the right atrium and the FOCUS OF FET AL DEVELOPMENT left atrium  Like prick of a needle but it will allow the FIRST TRIMESTER shunting of the blood from right to left 4. Ductus Venosus  Organogenesis  Is the one that carries the blood  between the umbilical vein and the inferior SECOND TRIMESTER vena cava that allows the blood bypassing the liver  Period of continued growth and development ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 20  THIRD TRIMESTER o Increase blood flow in cervix or the vagina that causes engorgement of the vagina or the cervix  Period of most rapid growth and development as well, and vulva that produces discoloration  Hegar’s sign (8th week) NORM AL ADAPT ATION OF PREGNANCY o Cause by an increase of secretion of estrogen and progesterone that produces a REPRODUCTIVE SYSTEM cervical softening of cervix o Softening of the lower uterine segment that  Undergoes greatest changes in size as well in its is caused by of pelvic congestion function  Chadwick’s sign (8th to 10th week)  Uterus o One of the earliest signs of pregnancy that o Uterine growth and enlargement the discoloration bluish-purple hue that o Length – 6.5 cms to 32 cms appears on the cervix, vaginal, and vulva o Width – 4 cms to 24 cms o estrogen and progesterone o Depth – 2.5 cms to 22 cms  Ovaries = no ovulation, during pregnancy, the ovary o Weight – 50 gms to 1000 gms stops to produce ova but continues to produce o Volume – 1-2 ml to 1000 ml hormone progesterone  Vagina = more acidic (ph 3.5 to 6) help control the Additional notes: growth of pathogens in the vaginal canal to prevent ascending infections like UTI, Leukorrhea = whitish,  Uterus increases as the baby grows: it can yellowish discharge accommodate  Breasts = as the fetus enlarges in the uterus,  Uterus is under the influence of estrogen and estrogen and progesterone produces number of myometrial cells as well as the muscle fibers, changes to the mammary glands undergoes changes: Hypertrophy, with the process that allows the uterus to enlarge and Additional notes: stretch as the fetus enlarges also  Estrogen = cause hypertrophy of uterus and  Melanotropin = a hormone that is secreted enhance the uterus contractility, prepares the by the pituitary gland that causes the nipple muscles during pregnancy; myometrium contracts become tender and darkening of areola  Progesterone = enables the pregnancy to thrive  Colostrum = whitish, appeared in 3rd the effect by relaxation on a smooth muscle, trimester, it is creamy whitish yellow liquid prevent the labor if the baby is not on full term, help that have antibodies that help create natural in the contractility to expel the baby outside, immunity of the baby; encourages baby to decrease of progesterone - the baby will be  Braxton Hicks Contraction suck the breast of mother to get colostrum expelled o Irregular and painless contraction or fetal movement felt by the mother during the 16 weeks or for 4 months  Becomes globular (4th month) MUSCULOSKELET AL SYST EM o Abdomen, as the baby increase in its size and  This involves the pelvic joint. The pelvis of the mother growth the uterus of the mother becomes during pregnancy normally relaxes causing a waddling globular in shape and seen physically walk (walking like a duck).  Goodell’s sign (4th week) - Waddling walk o Cervix/cervical softening is caused by the - Symphysis pubis may separate slightly stimulation from the hormone estrogen and progesterone CIRCULATORY SYSTEM ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 21  Increased blood volume 40% to 50% - because there - Darkening of neck, under arms, and color changes is a need to increase this amount due to metabolic of the palm which termed as Palmar Erythema. demands of the new tissues of the growing fetus - The breast also darkens especially the areola.  Physiologic anemia- occurs due to hemodilution of the - Abdomen also have a line which is termed as hemoglobin content of the blood volume. There is Linea Negra is the dark streak down midline in the decrease RBC during pregnancy which is term as abdomen PSEUDOANEMIA.  Chloasma/ Melasma  Heart is displaced upward – to the left because of the - darkening of skin especially on the face. growing fetus. - term as “MASK OF PREGNANCY”  Increased cardiac output to 30 % - that is why we ask  Stria Gravidarum – this the stretch mark found the the mother to position to left lateral. abdomen sometimes due to the scratching of the  Supine hypotension mother - if the CO increase to 30 %.  Linea Negra- dark streak down midline in the abdomen - It also causes the mother to have difficulty in  Increased Perspiration- during pregnancy causes the breathing. mother to take bath several times a day. - They experienced due to the enlarging fetus and the location of the inferior vena cava. G ASTROINTESTINAL SYSTEM - The mother has difficulty to lie on supine position because of compression.  Morning Sickness - If the mother is in flat position, it compresses inferior - vomiting in the morning vena cava that causes Cardiac Venous Return that - Caused by the hormone HCG (Human decreases cardiac output and that would lead to chorionic gonadotropin) Supine Hypotension or Vena Cava Syndrome. - An increased salivary secretion because of  Increased WBC enzyme Ptyalin that helps in mastication but also  CR & PR increased to 10 -15 beats/min causes morning sickness due to increase level of HCG, Estrogen, and progesterone  Heartburn - due to the relaxation of the sphincter between the stomach and the esophagus that causing a reflux of the gastric content - Medical term for heartburn is Pyrosis  Constipation - caused by the decrease motility of the gastrointestinal tract which is brought about by increased progesterone. - additional Ferrous sulfate(sulphate) to increase the RBC content of the body and one of the side effects of this constipation. Fig.2 Growth of baby and enlargement of the uterus. INTEGUMENT ARY SYSTEM  Increased pigmentation ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 22  RESPIRATORY SYSTEM  Increased RR: up to 23 RR -Normal: 12-16 RR -Other Factors: Chest Contractions  Dyspnea – Difficulty in breathing -diaphragm is being displaced about 2 cm upward.  Increased tidal volume – amount of air breathe of the mother per minute -Caused by the increase of estrogen and progesterone *Estrogen increase – causes hypertrophy (increased muscle cells) and hyperplasia (increase of cells) of the lung tissue *Progesterone increase – causes relaxation of Fig. 3 Mask of Pregnancy (Melasma or Chloasma) smooth muscle of the bronchi, bronchioles, and alveoli.  Increase vital lung capacity – force of respiration is increased.  Decreased residual volume URINARY SYSTEM  Urinary frequency – compress bladder  Increased GFR (Glomerular Filtration Rate) -Caused by increased progesterone: -Mothers are advised to increase fluid intake during the day -includes relaxation of the sphincter -causes asymptomatic bacteriuria and UTI (urinary tract infection) *Careful during this time if there is glycosuria result. It is the inability of the kidney to reabsorb glucose. ENDOCRINE SYSTEM  Increase metabolism of CHON and ChO -Caused by the pancreas -Pancreas increase insulin during pregnancy  Increased insulin production WEIGHT G AIN  Weight distribution: Fetus - 7lbs Placenta - 1lbs Amniotic fluid - 1.5lbs Uterus - 2lbs Blood Volume - 1lbs ALCORDO, ALINGASA, BULAWAN, CARPIO, QUIMNO BSN 2D 23  Breast - 1.5 – 3lbs Flui