Maternal-and-Child-Health-Nursing-Reviewer NEW PDF

Preview

Summary

Download Maternal-and-Child-Health-Nursing-Reviewer NEW PDF

Description

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN FEMALE REPRODUCTIVE ANATOMY AND PHYSIOLOGY

I.

THE EXTERNAL REPRODUCTIVE ORGANS

A. Mons pubis or mons veneris – pad of fat which lies over the symphysis pubis covered by skin and at puberty by short hairs; protects the surrounding delicate tissues from trauma. B. Labia majora – two folds of skin with fat underneath; contain Bartholin’s glands which are believed to secrete a yellowish mucus which acts as a lubricant during sexual intercourse. The openings of the Bartholin;s glands are located posteriorly on either side of the vaginal orifice. C. Labia minora – two thin folds of delicate tissues; form an upper fold encircling the clitoris )called the prepuce) and unite posteriorly (called the fourchette) which is highly sensitive to manipulation and trauma that is why it is often torn during a woman’s delivery. D. Glans clitoris - small erectile structure at the anterior junction of the labia minora, which is comparable to the penis in its being extremely sensitive. E. Vestibule – narrow speace seen when the labia minora are separated. F. Urethral meatus – external opening of the urethra: slightly behind and to the side are the openings of the Skene’s glands (which are often involved in infections of the external genitalia). G. Vaginal orifice or Introitus – external opening of the vagina covered by a thin membrance (called hymen) in virgins. H. Perinuem – area from the lower border of the vaginal orifice to the anus; contains the muscles (e.g., pubococcoygeal and levator ani muscles) which support the pelvic organs, the arteries that supply blood to the external genitalia and the pudendal nerves which are important during delivery under anesthesia.

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN

II.

THE INTERNAL RERODUCTIVE ORGANS (Figure 2) A. Vagina – a 3-4 inch long dilatable canal located between the bladder and the rectum; contains rugae (which permit considerable stretching without tearing); organ of copulation; passageway for menstrual discharges and fetus. B. Uterus 1. Hollow pear-shaped fibromuscular organ 3 inches lone, 2 inches wide, 1 inch thick and weighing 50-60 gms. In a non-pregnant woman 2. Held in place by broad ligaments (from sides of uterus to pelvic walls; also hold Fallopian tubes and ovaries in place) and round ligaments (from sides of the uterus to the mons pubis) 3. Abundant blood supply from uterine and ovarian arteries 4. Composed of 3 muscle layers: perimetrium, myometrium and endometrium 5. Consists of three parts 5.1 Corpus (body)- upper portion with a triangular part called fundus 5.2 Isthmus – area between corpus and cervix which forms part of the lower uterine segment 5.3 Cervix – lower cylindrical portion. 6. Organ of menstruation; site of implantation, retainment and nourishment of the products of conception.

C. Fallopian Tubes – 4 inches long from each side of the fundus; widest part (called ampulla) spreadsinto fingerlike projections (called fimbriae). Responsible for transport of mature ovum from ovary to uterus; fertilization takes place in its outer third or outer half.

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN D. Ovaries – almond-shaped, dull white sex glands near the fimbriae, kept in plact by ligaments. Produce, mature and expel ova and manufacture estrogen and progesterone.

III. THE PELVIS (Figure 3) – although not a part of the female reproductive system but of the skeletal system, it is a very important body part of pregnant women. A. Structure 1. Two os coxae/innominate bones – made up of: 1.1 Ilium – upper extended part; curved upper border is the iliac crest. 1.2 Ischium – under part; when sitting, the body rests on the ischial tuberosities; ischial spines are important landmarks. 1.3 Pubes – front part; join to form an articulation of the pelvis called the symphysis pubis. 2. Sacrum – wedge-shaped, forms the back part of the pelvis. Consists of 5 fused vertebrae, the first having a prominent upper margin called the sacral promontory. 3. Coccyx – lowest part of the spine; degree of movement between sacrum and coccyx made possible by the third articulation of the pelvis called sacroccygeal joint which allows room for delivery of the fetal head. B. Divisions – set apart by the linea terminalis, an imaginary line from the sacral promontory to the ilia on both sides to the superior portion of the symphysis pubis. 1. False pelvis – superior half formed by the ilia. Offers landmarks for pelvic measurements; supports the growing uterus during pregnancy; and directs the fetus into the true pelvis near the end of gestation. 2. True pelvis – inferior half formed by the pubes in front, the iliac and the ischia on the sides and the sacrum and coccyx behind. Made up of three parts:

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN 2.1 Inlet – entranceway to the true pelvis. Its transverse diameter is wider than its anterosposteior diameter. Thus: 2.1.1 Transverse diameter = 13.5 cm. 2.1.2 Anteroposterior diameter (AP) = 11 cm. 2.1.3 Right and left oblique diameter = 12.75 cm. 2.2 Cavity – space between the inlet and the outlet. Contains the bladder and the rectum, with the uterus between them in an anteflexed position towards the bladder. 2.3 Outlet – inferior portion of the pelvis, bounded on the back by the coccyx, on the sides by the ischial tuberosities and in front by the inferior aspect of the symphysis pubis and the pubic arch. Its AP diameter is wider than its transverse diameter. C. Types/Variations 1. Gynecoid – “normal” female pelvis. Inlet is well rounded forward and back. Most ideal for childbirth. 2. Anthropoid – transverse diameter is narrow, AP diameter is lager than normal. 3. Platypelloid – inlet is oval, AP diameter is shallow 4. Android – “male” pelvis. Intel has a narrow, shallow posterior portion and pointed anterior portion. D. Measurements 1. External – suggestive only of pelvic size: 1.1 Intercristal diameter – distance between the middle points of the iliac crests. Average = 28 cm. 1.2 Interspinous diameter – distance between the anterosuperior iliac spines.

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN Average = 25 cm. 1.3 Intertrochanteric diameter – distance between the trochanters of the femur. Average = 31 cm. 1.4 External conjugate/Baudelocque’s diameter – distance between the anterior aspect of the symphysis pubis and depression below L5. Average = 18-20 cm.

2. Internal – give the actual diameters of the inlet and outlet 2.1 Diagonal conjugate – distance between the sacral promontory and inferior margin of the symphysis pubis. Average = 12.5 cm. 2.2 Important measurement because it is the diameter of the pelvic inlet. Average = 10.5 – 11 cm. 2.3 Bi-ischial diameter/tuberischii – transverse diameter of the pelvic outlet. Is measured at the level of the anus. Average = 11 cm.

Figure 3. The Pelvis

IV. FEEDBACK MECHANISM OF MENSTRUATION A. General Considerations 1. 300, 000 – 400, 000 immature oocytes per ovary are present at birth (were formed during the first 5 months of intrauterine life, a process called oogenesis); many of these oocytes, however, degenerate and atrophy (a process called atresia). Only about 300-400 mature during the entire reproductive cycle of women.

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN 2.

Ushered in by the menarche (very first menstruation in girls) and ends with menopause (permanent cessation of menstruation, i.e., there are no more functioning oocytes in the ovaries); age of onset and termination vary widely depending on heredity, racial background, nutrition and even climate.

3. Normal period (days when there is menstrual flow) lasts for 3-6 days; menstrual cycle (from first day of menstrual period up to the first day of next menstruation period) may be anywhere from 25-35 days, but accepted average length is 28 days. 4. Anovulatory states after menarche are not unusual because of immaturity of feedback mechanism. Anovulatory states also occur in pregnancy, lactation and related disease conditions. 5. Associated terms 5.1 Amenorrhea – temporary cessation of menstrual flow. 5.2 Oligomenorrhea – markedly diminished menstrual flow, nearing amenorrhea 5.3 Menorrhagia – excessive bleeding during regular menstruation. 5.4 Metrorhagia – bleeding at completely irregular intervals. 5.5 Polymenorrhea – frequent menstruation occurring at intervals of less than 3 weeks. 5.6 Oligomenorrhea – markedly diminished menstrual flow. 6. Body structures involved 6.1 Hypothalamus 6.2 Anterior pituitary gland 6.3 Ovary 6.4 Uterus 7. Hormones which regulate cyclic activities

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN 7.1 Follicle-stimulating hormone (FSH) 7.2 Luteinizing hormone (LH) 8. Effects of estrogen in the body 8.1 Inhibits production of FSH 8.2 Causes hypertrophy of the myometrium 8.3 Stimulates growth of the ductile structures of the breasts. 8.4 Increases quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. (Spinnbarkheit test of ovulation). 9. Effects of progesterone in the body 9.1 Inhibits production of LH 9.2 Increases endomentrial tortuosity 9.3 Increases endometrial secretions 9.4 Inhibits uterine motility 9.5 Decreases muscle tone of gastrointestinal and urinary tracts 9.6 Increases musculoskeletal motility 9.7 Facilitates transport of the fertilized ovum through the Fallopian tubes 9.8 Decreases renal threshold of lactose and dextrose 9.9 Increases fibrinogen levels; decreases hemoglobin and hematocrit 9.10 Increases body temperature after ovulation. Just before ovulation basal body temperature decreases slightly (because of low progesterone level in the blood) and then increases slightly a day after ovulation (because of the presence of progesterone)

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN B. Sequential steps of the menstrual cycle 1. On the third day of the menstrual cycle, serum estrogen level is at its lowest. This low estrogen level serves as the stimulus for the hypothalamus to produce the Follicle-Stimulating Hormone Releasing Factor (FSHRF). 2. FSHRF is the one responsible for stimulating the Anterior Pituitary Gland (APG) to produce the first of two hormones which regulate cyclic activities, the Follicle-Stimulating Hormone (FSH). 3. FSH, in turn, will stimulate the growth of an immature oocytes inside a primordial follicle by stimulating production of estrogen by the ovary. Once estrogen is produced, the primordial follicle is now termed as Graafian follicle (The Graafian follicle, therefore, is the structure which contains high amounts of estrogen). 4. Estrogen in the Graafian follicle will cause the cells in the uterine endothelium to proliferate (grow very rapidly), thereby increasing its thickness to about eightfold. This particular phase in the uterine cycle, therefore, is called proliferative phase. In view of the change from primordial to Graafian follicle, it is also called follicular phase. Because of the predominance of estrogen, it is also called the estrogenic phase. And since it comes right after the menstrual period, it is also called postmenstrual phase. And it is also called the pre-ovulatory phase. 5. On the 13th day of the menstrual cycle, there is now a very low level of progesterone in the blood. This low serum progesterone level is the stimulus for the Hypothalamus to produce the Luteinzing Hormone Releasing Factor (LHRF). 6. LHRF is responsible for stimulating the APG to produce the second hormone which regulates cyclic activity, the Luteininzing Hormone (LH). 7. The LH, in turn, is responsible for stimulating the ovary to produce the second hormone produced by the ovaries, progesterone.

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN 8. The increased amounts of both estrogen and progesterone push the new mature ovum to the surface of the ovary until, on the following day (the 14th day of the menstrual cycle), the Graafian follicle ruptures and releases the mature ovum, a process called ovulation. 9. Once ovulation has taken place, the Graafian follicle, because it now contains increasing amounts of progesterone, giving it its yellowish appearance, is termed Corpus Luteum. (Therefore, the structure which contains high amounts of progesterone is the Corpus Luteum). 10. Progesterone causes the glands of the uterine endothelium to become corkscrew or twisted in appearance because of the increasing amount of capillaries. Progesterone, therefore, is said to be the hormone designed to promote pregnancy because it makes the uterus nutritionally abundant with blood in order for the fertilized zygote to survive should conception take place, that is why this phase in the uterine cycle, that is why this phase in the uterine cycle is what we call progestational phase. This phase in the uterine cycle is also called secretory phase because it secretes the most important hormone in pregnancy. In view of the change from Graafian follicle to corpus Luteum, it is called luteal phase. Because it occurs just after ovulation, it is also called the post-ovulatory phase. And, it is also called the pre-menstrual phase. 11. Up until the 24th day of the menstrual cycle, if the mature ovum is not fertilized by a sperm, the amounts of hormones in the corpus Luteum will start to decrease. The corpus Luteum turning white is now called the corpus albicans and in 3-4 days, the thickened lining of the uterus produced by estrogen starts to degenerate and slough off and capillaries rupture. And thus begins another menstrual period. C. Additional Information 1. When the ovary releases the mature ovum on the day of ovulation, sometimes a certain degree of pain in either the right or left lower quadrants is felt by the woman. This sensation is normal and termed mittelschmerz. 2. The first 14 days of the menstrual cycle is a very variable period. The last 14 days of the menstrual cycle is a fixed period – exactly 2 weeks after ovulation,

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN menstruation will occur (unless a pregnancy has taken place) because the corpus Luteum has a life span of only 2 weeks. Implications: when given options regarding the exact date of ovulation, choose two weeks before menstruation. 3. In a 28-day cycle, ovulation takes place on the 14th day. In a 32-day cycle, ovulation takes place on the 18th day. In a 26-day cycle, ovulation takes place on the 12th day (Subtract 14 days from the cycle). 4. Menstruation does not occur during pregnancy because progesterone does not decrease in amount. Corpus Luteum continues to produce progesterone until the placenta takes over production of hormones by the 8th week of pregnancy. 5. Menstruation can occur even without ovulation (as in women taking oral contraceptives). Ovulation can likewise occur even without menstruation (as in lactating mothers).

HUMAN SEXUALITY

I. DEFINITION OF TERMS A. Puberty – encompasses the physiologic changes leading to the development of adult reproductive capacity; the process includes maturation of the hypothalamus, pituitary gland and gonads. The role of the anterior pituitary gland. The pituitary secretion of gonadotropin initiates growth and maturation. It occurs initially during sleep and later in puberty throughout wakefulness. B.

Adolescence – encompasses the physiologic, social, and cognitive changes leading to the development of adult identity. The process includes individual, achievement of personal independence and maturation of cognitive reasoning skills.

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN C.

Thelarche – budding of the breasts

D. Adrenarche – development of axillary and pubic hair

II. SEXUAL DEVELOPMENT (Table 1)

Criteria

Males

Females

1. Start of growth spurt

Around 13 years old

After onset of menses, around 10-12 years old

2. Growth rate

Rapid early growth

Sharp decrease menses occur

3. Growth cessation

Early cessation

1-2 years after onset of menses

4. Order of maturation

after

sexual 6 months later than 6 months earlier than females Completed in 5 males years Completed in 3 years 4.1 Darkening and 4.1 Breast budding thinning of scrotum and enlargement of first visible sign testes and scrotum – 4.2 Increased size of first visible sign pelvis 4.2 Appearance of body 4.3 Appearance of body hair hair 4.2.1 Pubic area

4.3.1 Pubic area

4.2.2 Axilla

4.3.2 Axilla

4.2.3 Upper lip

4.4 Menstruation

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN 4.2.4 Face 4.3 Penis enlarges

4.5 Ovulation grows,

4.4 Nocturnal emissions (wet dreams) - male counterpart of menstruation 4.5 Spermatogenesis

Table 1. Sexual Development

III. TANNER STAGING (Table 2 and Table 3) A. A rating system for pubertal development B. It is the biologic marker of maturity C. It is based on the orderly progressive development of: 1. Breasts and pubic hair – in females 2. Genitalia and pubic hair – in males

Stages I

Males Childhood size of penis, testes, scrotum

Females Prepubertal, no breast tissue

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN II

Enlargement of testes and scrotum Appearance of breast bud

III

Lengthening of the penis Further enlargement of testes and scrotum

Enlargement of the breasts and areola

Deepening pigmentation of scrotal skin IV

Widening and further lengthening of penis Further enlargement of testes and scrotum

Areola and nipple form a mound atop underlying breast tissues

Deepening pigmentation of scrotal skin V

Adult configuration and size of genitalia

Adult configuration and size of genitalia Areola and breasts have smooth contour

Table 2. Tanner Stages of Pubertal Development: Thelarche & Genitalia

Stages

Males

Females

I

Prepubertal, no pubic hair

- same -

II

Sparse, downy hair at the base of the phallus

At the medial aspect of the labia majora

III

Darkening, coarsening, curling of

- same -

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN hair which extend upward and laterally IV

Hair of adult consistency limited to the mons pubis

- same -

V

Hair spreads to the medial aspect of the thighs

- same -

Table 3. Tanner Stages of Pubertal Development: Adrenarche

IV. HUMAN SEXUAL CYCLE

A. Excitement 1. Vaginal lubrication and vasocongestion of the genitalia. 2. Penile erection due to vasocongestion B. Plateau 1. Formation of orgasmic platform due to prominent vasocongestion. 2. Generalized muscle tension, hyperventilation, increased BP, tachycardia in the late plateau phase. 3. Pre-ejaculatory phase with live spermatozoa C. Orgasmic 1. Strong rhythmic contractions of vagina and uterus. 2. In males, vas deferens, seminal vesicle, ejaculatory duct and prostate contract 34 times over a few seconds causing pooling of seminal fluid in the prostatic

MATERNAL AND CHILD HEALTH NURSING REVIEWER Compiled by NURSEHOOMAN urethra. Rhythmic contractions in males occur at 0.8 seconds interval that assist in the propulsion process D. Resolution – rapid decline in pelvic vasocongestion. All organs return to previous position E. Refractory phase – only in males; the period during which no amount of stimulation can cause another erection. Not manifested in females becaus...