NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

TOPIC 1  Fundamentals of Nursing Practice Global Health Goals

A Framework for Maternal and Child Health Nursing  2000 – UN and the WHO established millennium health goals in
2000 in an effort to improve health worldwide
Goals and Philosophies of MCHN  2020 – national Health Goals, these concentrate on improving
 Comprehensive preconception and prenatal care are essential the health of women and children
in ensuring a healthy outcome for mother and earth
 Major Goal of MCHN = Promotion and maintenance of optimal Global Health Goals
family health  To end poverty and hunger
 MCHN extends from preconception to menopause with an  To achieve universal primary education
expansive array of health issues and healthcare providers o  To promote gender equality and empower women
From womb to tomb  To reduce child mortality
 To improve maternal health
Scope of Practice  To combat HIV/AIDS, malaria, and other disease
 Preconception health care  To ensure environmental sustainability
 Care of women during three trimesters of pregnancy and the  To develop a global partnership for development
puerperium
o 1 – 3 months = 1st trimester A Framework of MCHNC
o 4 – 6 months = 2nd trimester  Nursing process
o 7 – 9 months = 3rd trimester  Nursing Theory
 Care of infants during the perinatal period • Care of children  Quality and Safety Education for Nurses (QSEN)
from birth through late adolescent • Care in a variety of hospital
and home care settings 4 Phases of Health Care (P,M,R,R)
 Health promotion – educating parents and children to follow
Family-centered approach sound health practices through teaching and role modeling
 is the preferred focus of nursing care o Providing preteens with info about safer sex
 The health of an individual and their ability to function as a practices well before they are likely to become
member of a family can strongly influence and improve overall sexually active
family functioning o Teaching women the importance of rubella
 Family-centered care enables nurses to better understand immunization before pregnancy
individuals and their effect on others and, in turn, to provide  Health maintenance – intervening to maintain health when risk
more holistic care of illness if present
 Family members are encouraged to provide physical and o Encouraging women to be partners in prenatal
emotional care based on the individual situation and their care
comfort level o Teaching parents the importance of safeguarding
their home by childproofing against poisoning
Maternal and Child Health Goals and Standards
 Health restoration – using conscientious assessment to be
 Healthcare technology has contributed to a number of important
certain that symptoms of illness are identified and interventions
advances in MCH care
are begun to return patient to wellness more rapidly
 New fertility drugs and fertility technologies allows more couples
o Caring for a woman during a complication of
to conceive
pregnancy such as gestational diabetes or a child
o In vitro fertilization (IVF) - is a procedure used
during an acute illness such as pneumonia
to help you get pregnant. a human egg is fertilised  Health rehabilitation – helping prevent complications from
illness; helping a patient with residual effects achieve an optimal
with sperm in a laboratory then implanted into a
state of wellness and independence, helping a patient to accept
uterus. If the fertilised egg (embryo) successfully
inevitable death
implants in the uterus, this will result in pregnancy.
o Encouraging a woman with gestational
 The ability to prevent preterm birth and improve the quality of
life for both preterm and late terms infants has increased trophoblastic disease (abnormal placenta growth)
dramatically to continue therapy or a child with renal transplant
to continue to take necessary medication
 Stem cell therapy may make it possible to replace diseased
cells with new growth cells and cure these illness
Nursing Process
 Nursing care is designed and implemented in a thorough
2020 National Health Goals
manner, nursing organized series of steps
 The two main overarching national health goals are:
 A scientific form of problem solving, serves as the basis for
o To increase quality and years of healthy life
assessing, making a NSG dx (nursing diagnosis), planning,
o To eliminate health disparities
implementing, and evaluating care
 A new objective added in 2010 recommends that 100% of
 It is a process broad enough to serve as the basis for modern
prelicensure programs in nursing include core content on
nursing care
counseling for health promotion and disease prevention, cultural
diversity including for LGBT populations, evaluation of health
Nursing Theory
sciences literature, environmental health, public health systems,
 One of the requirements of a profession (together with other
and global health
critical determinants, such as members who set their own
 Help citizens more easily understand the importance of health
standards, self-monitor their practice quality, and participate, in
promotion and disease prevention and to encourage wide
research) is that a discipline’s knowledge flows from a base of
participation in improving health in the next decade
established theory
 Nursing theories are designed to offer helpful ways to view
5 Areas in Nursing Board Exam
patients so nursing activities can be created to best meet
 Maternal Care
patient needs
 Medical Surgical
 Calista Roy – Adaptation Model
 Community Health Nursing / Community Diseases
 Psychiatric Nursing

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

o An important role of the nurse is to help patients

adapt to change caused by illness or other
stressors
 Dorothea Orem – Self-Care Deficit
o Examining patient’s ability to perform self-care
 Patricia Benner – 5 Levels of Expertise
o Described the way nurses move from novice to TOPIC 3
expert as they become more experienced and The Nursing Role in the Reproductive Health
prepared to give interprofessional care.  Andrology – study of the male (XY) reproductive organs
 Gynecology - study of the female (XX) reproductive organs
Issues  The reproductive systems play an important roles in the
 How nurses should be viewed or what the goals of nursing care development of the structural and functional differences
should be between males and females, influence human behavior, and
 Extensive changes in the scope of MCHN have occurred as produce offspring.
health promotion has become a greater priority in care
 As promoting healthy pregnancies and keeping children well Reproductive Development
protects not only patients at present but also the health of the  Begins at the moment of conception and continue through life
next generations
Intrauterine Development
Quality and Safety Education for Nurses (QSEN)  Gonad is a body organ that produces the cells necessary for
6 Competencies of Quality Care (PC,TC,QI,I,EB,S) reproduction (the ovary in females, the testes in males)
 The overall goal is to address the challenge of preparing future  Approximately 5 weeks of intrauterine life, mesonephric
nurses with the abilities necessary to continuously improve the (wolffian) and paramesonephric (Mullerian) ducts, the tissue
quality and safety of the healthcare systems in which they work that will become ovaries and testes, have already formed
 Patient-centered care  By week 7 or 8, in chromosomal males, this early gonadal
 Teamwork and collaboration tissue begins formation of testosterone
 Quality Improvement  When ovaries form, all the oocytes (cells that will develop into
 Informatics eggs throughout the woman’s mature years) are already
present
 Evidence-based practice
o Importance element of nursing practice prior to the  Women are born with immature egg cells (oocytes)
development of QSEN  At about week 12 of IUL, the external genitals begin to
o The conscientious, explicit, and judicious use of develop.
current best evidence of make decisions about the  In males, penile tissue elongates and the ventral surface of
care of patients the penis closes to form a urethra.
o Combination of research, clinical expertise, and  In females, with no testosterone present, the uterus, labia
patient preferences or values o Output-based minora, and labia majora form.
evidence
The Role of Androgen
 Safety
 Androgenic hormones are the hormones responsible for
A Maternal and Child Health Nurse: muscular development, physical growth, and the increase in
sebaceous gland secretions that cause typical acne in both
 Considers the family as a whole and as partner in care when
boys and girls during adolescence
planning or implementing or evaluating the effectiveness of care
 Androgenic hormones ( adrenal cortex and testes/ovaries)
 Serves as an advocate to protect the rights of all family
members, including the fetus a. To nutrition b. To be cared for  Level of the primary androgenic hormone, testosterone, is low
c. To live in males until puberty (between ages 12 and 14 years) The
reproductive systems play an important role in the
 Demonstrate a high degree of independent nursing functions
development of the Functions of the Reproductive System
because teaching and counseling are major interventions a.
Males
Primigravida – first pregnancy b. Multiparous / multigravida –
had multiple births  Production of sperm cells (sex cells)
 Promotes health and disease prevention because there protects  Sustaining and transfer of the sperm cell to female
the health of the next generation  Production of male sex hormones Females
 Serves as an important resource for families during childbearing  Production of female sex cells
and childrearing as these can be extremely stressful times in a  Fertilization of sperm cell from the male
life cycle a. Childbearing is to have children b. Childrearing is to  Nurturing the development of and providing nourishment for
raise children the new individual
 Respect personal, cultural, and spiritual attitudes and beliefs as  Production of female sex hormones
these so strongly influence the meaning and impact of
childbearing and childrearing Male Reproductive System
 Encourages developmental stimulation during both health and
illness so children can reach their ultimate capacity in adult life
a. 6 months = can crawl
 Assesses families for strengthen as well as specific needs or
challenges
 Encourages family bonding through rooming-in and family
visiting in maternal and child healthcare settings
 Encourages early hospital discharge options to reunite families
ASAP in order to create a seamless, helpful transition process
 Encourages families to reach out to their community so the
family can develop a wealth of support people they can call on
in a time of a family crisis

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

Function called capacitation of sperm cells, occur after

 Production of sperm cells ejaculation.
 Sustaining and transfer of the sperm cells to the female o Responsible for conducting sperm from the testis
 Production of male sex hormones to the vas deferens or storing it
 Vas deferens - this is a thick-walled tube joined to the
epididymis. It carries sperm from the epididymis up to the
prostate gland and urethra.
External structures o • The DUCTUS DEFERENS, or VAS DEFERENS
 Scrotum - this is a loose bag of skin that hangs outside the passes from the epididymis into the abdominal
body, behind the penis. It holds the testes in place. cavity.
o A saclike or pouch-like structure containing the o Carries sperm from the epididymis through the
testes that hangs behind the penis. inguinal canal into the abdominal cavity where it
o Contains two lateral compartment that house the ends at the seminal vesicles into the ejaculatory
testes, epididymis, and the lower portion of the ducts.
spermatic cord.  Ejaculatory ducts - delivers sperm into the urethra, adding
 Penis - the organ used for urination and sexual intercourse. secretions and additives from the prostate necessary for
It has spongy tissue which can fill with blood to cause an sperm function, while providing an interface between the
erection. It contains the urethra, which carries both urine and reproductive and urinary systems in men
semen. o The ejaculatory ducts join the prostatic urethra in
o Is the male organ of copulation/urination and the prostate gland
functions in the transfer of sperm cells from the  Urethra - his is a tube that extends from the bladder to the
male to the female external opening at the end of the penis. The urethra carries
o Consist of the body (shaft) and glans (bulging, both urine and sperm.
sensitive ridge of tissue) o The urethra extends from the urinary bladder
o Contains sensory nerve endings that provide through the penis to the outside of the body. It is
sexual pleasure. about 8 in. (18-20 cm) long
o Consists of erectile tissue; engorgement of this  Seminal vesicle - 2 small glands above the prostate gland
erectile tissue with blood causes the penis to that make up much of the fluid in semen.
enlarge and become firm, a process called o The SEMINAL VESICLES are two pouch-like
ERECTION structure between the lower portion of the bladder
o Based on religious or cultural beliefs, many male and the rectum.
infants have the prepuce tissue removed surgically o The seminal vesicles empty into the ejaculatory
(circumcision) shortly after birth. duct
o The American Academy of Pediatrics (AAP) o Secrete a viscous alkaline portion of the semen
advises that the health benefits of male that aids in spermatozoa motility and metabolism
circumcision outweigh its medical risks, the because the fluid is alkaline and sperm are more
benefits are not strong enough to recommend motile in an alkaline fluid.
every male NB be circumcised.  Prostate glands - this is a walnut-sized gland that sits in the
o Its advantages: Lower rates of UTI, HIV, STIs, and middle of the pelvis. The urethra runs through the middle of it.
penile cancer. It produces the fluid secretions that support and nourish the
o Disadvantages: surgical complications (bleeding & sperm.
pain), reduction in sensation with sexual o The PROSTATE GLAND consists of glandular and
stimulation muscular tissue
o Located just below the bladder and allow the
urethra to past through the center of it.
Internal genitalia
o About the size and shape of a walnut
 Testes - these are a pair of egg-shaped glands that sit in the
 Bulbourethral gland (Cowper’s glands) - contribute to the
scrotum, on the outside of the body. They produce sperm and
final volume of semen by producing a lubricating mucus
testosterone, which is the male sex hormone.
secretion
o Or male gonads, are oval shaped glandular organs
o Bulbourethral glands (Cowper’s glands) are two
(each about 4-5 cm long and 2-3 cm wide), within
pea-sized glands that lie beside the prostate and
the scrotum
empty by shorth ducts into the urethra.
o Each testis is encased by a protective white
o Secrete a thick alkaline fluid that neutralizes acidic
fibrous capsule and is composed of several
secretions in the female reproductive tract.
lobules (containing the seminiferous tubules and
interstitial cells)
Secretions
o Leydig’s cells produce testosterone, Seminiferous
 Semen is a mixture of sperm cells and secretions from the
tubules produces spermatozoa.
male reproductive glands
o During development, the testes pass from the
 The testicular secretions contain sperm cells
abdominal cavity through the inguinal canal to the
scrotum  Seminal vesicle fluid contains nutrients, prostaglandins, and
o Function of the Testes proteins that coagulate
 Prostate fluid contains nutrients and proteolytic enzymes,
- Hormone Production
and it neutralizes the pH of the vagina
- Spermatogenesis the process of sperm
cell development
 Epididymis - this is a highly coiled tube that lies at the back
Types of Sperm Cells
of the testes. All sperm from the testes must pass through the
Androsperm
epididymis, where they mature and start to ‘swim’.
 Carries y-sex chromosome
o The EPIDIDYMIS is a coiled tube system (the
 Fast moving
length totals about 6 m), located on the testes, that
is the site of sperm maturation. Final changes,  Smaller, weaker, short-lived
 Dies in acid

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Mons pubis - is the movement of sperm cells, mucus, prostatic

Gymnosperm secretions and seminal vesicle secretions into the prostatic,
 Carries x-sex chromosome o Slower o Bigger, stronger, long- membranous and spongy urethra
lived  Labia majora - enclose and protect the other external
 Acid-resistance Sex Chromosome (Gender Determination) reproductive organs. During puberty, hair growth occurs on the
 Females inherit X chromosome from the father for a XX skin of the labia majora, which also contain sweat and oil-
genotype secreting glands. (outside part)
 Males inherit Y chromosome from the father for XY genotype o Two thick folds of adipose tissue with fat underneath
 Note: Fathers determine the gender of the child because they o Fused anteriorly but separated posteriorly
have XY chromosomes o Positioned lateral top of the labia minora
o Mothers only pass one of their X chromosomes o Consist of connective tissue, elastic fibers, veins, and
sebaceous glands
Normal Finding  Labia minora - This skin is very delicate and can become
 Volume: 2 to 6 mL easily irritated and swollen. (inside part)
 Viscosity: liquid within 30 minutes (20-3 minutes) o Two thin folds of delicate tissues
 Sperm Count: more than 20 million/mL o Consist of hairless folds of connective tissue, sebaceous
 Morphology: more than 50% mature and normal and sweat glands, nonstriated muscle fibers, nerve
 Motility: more than 40% (or 50%) moving endings, and blood vessels.
o Form an upper fold encircling the clitoris (prepuce) and
Parts of sperm cell unite posteriorly (called the fourchette)
o The internal surface is covered mucous membrane, and
the external surface is covered with skin
 Glands Clitoris - a small, sensitive protrusion that’s
comparable to a penis in men or people assigned male at birth
(AMAB)
o 1 to 2 cm in size, rounded organ of erectile tissue
o Located in the anterior portion of the vulva.
Head o Covered by a fold of skin called the prepuce.
 Where the nucleus is compacted o Made up of erectile tissue, nerves, and blood vessels.
 Made up of chromosomal material o Provide sexual pleasure.
 The top is covered by a cap called acrosome  Vaginal Vestible - Flattened smooth surface inside the labia.
Body o Is the tissue extending from the posterior fourchette
 Mobile tail o Consist of the vaginal orifice, the hymen, the fourchette,
 Used to propel the sperm along Skene’s glands, and Bartholin’s glands.
Male Sexual Behavior and Sexual Act  Hymen
 Testosterone is required for normal sexual behavior o is a piece of tissue covering or surrounding part of your
 Stimulation of the sexual act can be tactile or psychological vaginal opening. It’s formed during development and
 Motor stimulation causes erection, mucus production, emission, present during birth.
and ejaculation  Fourchette
 Emission is the movement of sperm cells, mucus, prostatic o Is the ridge of tissue formed by the posterior joining of the
secretions and seminal vesicle secretions into the prostatic, two labia majora and labia minora.
membranous and spongy urethra o Skene’s glands (paraurethral glands)
 Erection is the first major component of the male sexual act o Are located just lateral to the urinary meatus, on either side
 Ejaculation is the forceful expulsion of the secretions that have • The ducts open into the urethra
accumulated in the urethra o May become infected and produce a discharge and pain.
 Bartolin’s glands (vulvovaginal glands)
Female Reproductive System
o Are two bean-shaped glands on either side of the vagina.
o Secrete mucus along with Skene’s glands during sexual
stimulation.
o May become infected and produce a discharge and pain.
o Its alkaline nature enhances sperm survival.
 Vaginal Orifice
o Also known as introitus is the external opening of the
vagina located just below the urethral meatus
 Perineal Body, or perineal muscle
o Posterior to the fourchette
o Easily stretched during childbirth to allow enlargement of
the vagina and passage of the fetal head.
o Kegel exercises, squatting, and tailor sitting are aimed at
making this area as flexible as it can be to allow for optimal
expansion during birth and to prevent tearing of this tissue.
Function  Urethral Meatus
 production of female sex cells o External opening of the urethra.
 reception of sperm cells from the males o Located 1 to 2.5 cm below the clitoris
 nurturing the development of and providing nourishment for the  Perineum
new individual o Area from the lower border of the vaginal orifice to the
 production of female sex hormones anus.

External Genitalia

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

Internal parts

Uterine Layers (E,M,P)

1. Its cardinal function is as an organ of reproduction
2. Organ of menstruation
3. Uterine contraction to expel the fetus during labor and to seal torn
 Vagina - is a muscular canal that joins the cervix (the lower part blood vessels after delivery of the placenta
of uterus) to the outside of the body. It can widen to  Endometrium - Inner mucous membrane layer of the uterus
accommodate a baby during delivery and then shrink back to o basal portion (closest to the uterine wall) is unaffected
hold something narrow like a tampon. It’s lined with mucous by hormones; inner, or glandular, portion is influenced
membranes that help keep it moist. by estrogen and progesterone.
o Is a hollow, vascularized musculomembranous canal that o The endocervix continues from the endometrium and is
extends from the external genitals to the uterus; located also influence by hormones.
between the bladder and the rectum.  Myometrium
o Expands with pregnancy to function as a birth canal. – o Consists of three interwoven layers of smooth muscle,
o Acts as the organ of intercourse and to convey sperm to arranged in longitudinal, transverse, and oblique
the cervix as well as uterine excretory duct for menses and directions.
other secretions o Constricts the tubal junctions and prevents regurgitation
o Vault - term for the upper end of the vagina. - Where the of the menstrual flow into the fallopian tube.
cervix projects into the vagina, the vault forms a circular o Holds the internal cervical os closed during pregnancy
recess described as four or fornices to prevent a preterm birth.
o Rugae - transverse ridges of mucous membranes lining  Perimetrium
the vagina which allow it to stretch during sexual o Outer serosal layer
intercourse and childbirth o Covers the body of the uterus and part of the cervix.
o Vaginal reaction: ACIDIC with pH 4 to 6 due to the
presence of lactic acid formed by the action of LDB on
glycogen found in the squamous epithelium of the lining.
o The blood supply to the vagina is furnished by the vaginal  Ovaries - Ovaries are small, oval-shaped glands that are
artery, a branch of the internal iliac artery located on either side of your uterus. Your ovaries produce
 Uterus - is a hollow, pear-shaped organ that holds a fetus eggs and hormones.
during pregnancy. Your uterus is divided into two parts: the o Two almond-shaped, dull white sex gland near the
cervix and the corpus. Your corpus is the larger part of your fimbriae, kept in place by ligaments.
uterus that expands during pregnancy. o Their functions is to produce, mature, and discharge ova.
o Hollow pear-shaped fibromuscular organ 3 inches (5-7 cm) o Ova produce estrogen and progesterone and initiate and
long, 2 inches (5 cm) wide, I inch thick and weighing 50-60 regulate the menstrual cycle
grams in a non-pregnant woman. o Ovulation is necessary for maturation of ova and
o Located in the lower pelvis posterior to the bladder and maintenance of secondary sex characteristics.
anterior to the rectum.  Fallopian tube - These are narrow tubes that are attached to
o Never returns to its prepregnant size. 9 cm long, 6 cm the upper part of your uterus and serve as pathways for your
wide, 3 cm thick ang 80 g in weight. egg (ovum) to travel from your ovaries to your uterus.
o Consist of the body, or corpus; the fundus; the Fertilization of an egg by sperm normally occurs in the fallopian
isthmus; and the cervix. tubes. The fertilized egg then moves to the uterus, where it
o Body of the uterus implants into your uterine lining.
- Upper most portion of the uterus
- Forms the bulk of the uterus
- Expands to contain the growing fetus.
o Fundus
- Located between the points of attachment of the
fallopian tubes
o Isthmus
- Short segment between the body of the uterus and
the cervix
o Cervix o Site of normal fertilization; most commonly in the ampullary
- Lower portion of the uterus portion
- Is about one-third the total size of the uterus o Ducts through which ova travel from ovaries to the uterus.
- Half lies above the vagina and half extends into the o Each is about 10 cm long and ¼ inch in diameter in
vagina mature woman.
o Consist of four layers
- Peritoneal
- Subserous
- Muscular
- Mucous

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

o Divided into four portions: interstitial, isthmus, ampulla, and o Causes ovulation
infundibular. - Serves as the site of fertilization.  Follicle-Stimulating Hormone (FSH) – anterior pituitary gland
o Signals the follicle in ovaries to being development
Related Structures  Estrogen – follicles of ovaries
 Female accessory glands: o Affects endometrial lining of the uterus, breasts, regulates
Breast secretions of LH and FSH
 Consist of glandular, fibrous, and adipose tissue.  Progesterone – ovaries
 Grow and developed from stimulation of secretions from the o Affects endometrial lining of uterus, secretions, breasts,
hypothalamus, anterior pituitary, and ovaries. affects
 enhance sexual pleasure.
 Provide nourishment to the infant and transfer maternal Analogous Structure in the Male and Female Reproductive
antibodies. System

Pelvis
 Important in obstetrics because it is the passage through which
the baby passes during birth
 Disproportion between fetus and size of pelvis may make
vaginal delivery difficult or impossible
 4 Bones of the Pelvis o Two innominate bones (Ilium, Ischium,
Pubis)
o Sacrum
- wedge-shaped, forms the upper posterior portion of
the pelvic ring
- consist of 5 fused vertebrae
o Coccyx
- lowest part of the spine; degree of movement
between sacrum and coccyx.
- made up of five very small bones fused together
 Divisions of the Pelvis
o False Pelvis – shallow extended portion above brim that
supports abdominal viscera
o True Pelvis – portion that lies below pelvic brim and
divided into three sections (Inlet, Outlet, Cavity) (I,O,C)
o Inlet – entranceway to the true pelvis. Its transverse
diameter is wider than its anteroposterior diameter.
o Pelvic Cavity – space between the inlet and outlet.
o Outlet – inferior portion of the pelvis, bounded in the back
by the coccyx, on the sides by the ischial tuberosities and Female sexual behavior and sex act
in front by the inferior aspect of the symphysis pubis and
 Female sex drive is partially influenced by the testosterone
the pubic arch.
like hormones and estrogen produced by the ovary
 Autonomic nerves cause erectile tissue to become engorged
o Pelvic inlet (4 main types)
with blood, the vestibular glands to secrete mucus, and the
vagina to produce a lubricating fluid

Related Structures
 Female accessory glands:
 Breast
o Consist of glandular, fibrous, and adipose tissue.
o Grow and developed from stimulation of secretions
from the hypothalamus, anterior pituitary, and
ovaries.
o enhance sexual pleasure.
o Provide nourishment to the infant and transfer
maternal antibodies.

Feedback Mechanism
- Gynecoid – inlet round/blunt, heart shaped (45% of  Physiological regulation system in a living body that works to
women); ideal for childbirth return the body to its normal internal state, or commonly known
- Android – inlet wedge-shaped (15% of women), as homeostasis
male pelvis; least suited for vaginal delivery o A loop system in which the system responds to
- Anthropoid – inlet ovalshaped (35% of women)
perturbation either in the same direction (positive
- Platypelloid – inlet transversely oval-shaped, (5% of
feedback) or in the opposite direction (negative
women) ▪
feedback)
o Mid-pelvis
 It is triggered when the system undergoes a change that causes
o Pelvic outlet
an output
 There are two types of feedback mechanisms; these are
Female Sex Hormones positive and negative feedback mechanisms
 Gonadotropin-releasing hormone – hypothalamus
o Stimulates secretion of LH and FSH Positive Feedback Mechanism
 Luteinizing Hormone (LH) – anterior pituitary gland

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Occur when a change in one direction is followed by another  Decrease renal threshold for lactose and dextrose.
change in the same direction.  Increases fibrinogen levels; decreases hemoglobin and
 A positive feedback system amplifies deviations and causes hematocrit.
output state changes.  Increases body temperature after ovulation. Just before
 Because it moves the body away from homeostasis, positive ovulation, basal body temperature decreases slightly and then
feedback mechanisms are significantly less common than increases slightly a day after ovulation
negative feedback mechanisms.
 An example of a positive feedback loop is the onset of Menstrual Cycle
contractions in childbirth. When a contraction begins, the  refers to the series of changes that occur in sexually mature,
hormone oxytocin is released into the body to stimulate further nonpregnant females and that culminate in menses
contractions.  MENSES is a period of mild hemorrhage during which part of
the endometrium is sloughed and expelled from the uterus
Negative Feedback Mechanism
 When a change in one direction produces a change in the other Phases of Menstrual Cycle (P,S,I,M)
 It is a pathway that is triggered by a deviation in output and  Proliferative - Following the blood loss from the endometrium,
produces changes in output in the opposite direction of the the uterus is restored to normal. During this time the ovarian
initial deviation. follicle is maturing and secreting estrogen and this phase is
 An example is the regulation of blood glucose levels. If blood completed by the rupture of the follicle and liberation of the egg,
glucose levels continue to rise it may result in diabetes. In fact, about 14 days before the next menstrual period begins.
there are many biologic processes that use negative feedback  Secretory – the endometrium increases in thickness, during
to maintain homeostasis or dynamic equilibrium this time the corpus luteum in an ovary is developing and
secreting progesterone and lasts about 15-26 days.
 300,000–400,000 immature oocytes per ovary present at birth  Ischemic – if pregnancy has not occurred, menstruation
 Menarche – first menstruation in girls beginning with the flow of menstrual fluid will occur which may
 Menopause – permanent cessation of menstruation; no more occur by 27 to 28th day.
functioning oocytes in the ovaries  Menstruation – the period of uterine bleeding and shedding of
o Menopause – time when ovaries secrete less the endometrium and lasts an average of 4-5 days.
hormones and number of follicles in ovaries is low
o Menstrual cycle and ovulation are less regular
o Hot flashes, fatigue, irritability may occur
o Estrogen replacement therapy may be used to
decrease side effects
 EDC – expected day of confinement

Associated terms
 Amenorrhea – absence of menstruation
 Dysmenorrhea – pain during menstration
 Oligomenorrhea - irregular and inconsistent menstrual blood
flow in a woman
 Menorrhagia – heavy bleeding, menstrual bleeding that lasts
more than 7 days.
 Metrorrhagia - Excessive, prolonged and/or irregular bleeding
unrelated to menstruation
 Polymenorrhagia – frequent but short menstrual cycles

 Body Structures involved:

o Hypothalamus
o Anterior Pituitary Gland
o Ovary
o Uterus
 Hormones which regulates cyclic activities:
o FSH – follicle stimulating hormone
o Luteinizing Hormone Additional Information
 When the ovary releases the mature ovum on the day of
Effect of Estrogen in the body ovulation, sometimes a certain degree of pain in either the right
 Inhibits production of FSH or left lower quadrant is felt by a woman. (mittelschmerz)
 Causes hypertrophy of the myometrium.  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
 Stimulates growth of the ductile structures of the breast.
– exactly 2 weeks after ovulation, menstruation will occur.
 Increases quantity and pH of cervical mucus, causing it to
 In a 28-day cycle, ovulation takes place on the 14th day. In a
become thin and watery and can be stretched to a distance at
32-day cycle, ovulation takes place on the 18th day. In a 26-day
10-13 cm.
cycle, ovulation takes place on the 12th day
Effects of progesterone in the body:
Teaching about menstrual health exercise
 Inhibits production of LH
 Increases endometrial secretions.
Exercise
 Inhibits uterine motility.  It’s good to continue moderate exercise during menses for a
 Decreases muscle tone of gastrointestinal and urinary tract. general sense of wellbeing.
 Increases musculoskeletal motility.  sustained excessive exercise, such as professional athletes
 Facilitates transport of the fertilized ovum through the fallopian maintain, can cause amenorrhea.
tube.

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

o Day 1 to 5 – Menses (shedding of endometrium)

Sexual relations - Menstrual bleeding (menses)
 not contraindicated during menses (the male should wear a - Estrogen and progesterone levels are low
condom to prevent exposure to body fluid). - Follicle begins to mature
o heightened or decreased sexual arousal may be noticed o Day 6 to 13 – Proliferation (between end of menses
during menses. and ovulation)
o orgasm may increase menstrual flow. - Endometrium rebuilds
- Estrogen levels begin to increase
Activities of daily life - Progesterone levels remain low
 nothing is contraindicated (many people believe incorrectly that - Follicle matures
things like washing hair are harmful). o Day 14 – Ovulation
- Oocyte is released due to LH
Pain relief - Estrogen levels high
 applying local heat may be helpful. - specific drugs are now - Progesterone levels are increasing
available. - Cervical mucus thins
o Day 15 to 28 – Secretory (between ovulation and
Rest next menses)
 more rest may be helpful if dysmenorrhea interferes with sleep - Endometrium is preparing for implantation •
at night. - Estrogen levels decrease (low)
- Progesterone levels high
Nutrition - Cervical mucus thickens
 many women need iron supplement to replace iron lost in
menses (the iron loss in a typical menstrual flow is approx. Conception Fertilization Implantation
11mg;this is enough loss that many women need to take a daily  fertilization
iron supplement to prevent iron depletion during their o The union of the sperm and the mature ovum in the
menstruating years). outer third or outer half of the fallopian tube.
Characteristics of Normal Menstrual Cycle o The fertilized egg is called a ZYGOTE
Beginning  Process of Fertilization
 Average age of onset: 12.4 or 13 years; o During fertilization, the sperm and egg unite in one of
 Interval between cycles average 28 days; cycles of 23 to 35 the fallopian tubes to form a zygote. Then the zygote
days not unusual travels down the fallopian tube, where it becomes a
 Duration of menstrual flow: average flow 4-6 days; ranges of 2 morula. Once it reaches the uterus, the morula
to 9 days not abnormal becomes a blastocyst. The blastocyst then burrows into
 Amount of menstrual flow: difficult to estimate: average 30 to the uterine wall — a process called implantation.
80ml per menstrual period; saturating a pad or tampon in less  Implantation
than an hour is heavy bleeding o Occurs when the cellular wall of the blastocyst (the
 Color: dark red, a combination of blood, mucus, and trophoblast) implants itself in the endometrium of the
endometrial cells anterior or posterior fundal region, 7 to 9 days after
 Odor: marigolds fertilization.
o Primary villi appears within weeks after implantation.
Menstrual Cycle o The trophoblast, in contact with the endometrial lining,
 series of changes that occur in sexually mature nonpregnant proliferates and invades the underlying endometrium bt
females Menses – ttime when endometrium is shed from uterus separating and dissolving endometrial cells
 Average is 28 days and results from cyclical changes that occur  Tracing implantation
in endometrium
 Each cycle can be divided into 3 phrases based on events in
the ovary (ovarian cycle) or in the uterus (uterine cycle)

 Hypothalamic–Pituitary–Ovarian Cycle (HPO)

o a tightly regulated system controlling female

reproduction. HPO axis dysfunction leading to ovulation
disorders can be classified into three categories defined
by the World Health Organization (WHO).
 Ovarian Cycle
o Follicular phase - Ovulation - Luteal phase
o Follicular phase – characterized by menstruation, General Consideration
when the thickened lining of the endometrium is shed  Normal amount of semen per ejaculation = 3- 5 cc or 1
because no egg was fertilized or implanted teaspoon
o Ovulatory phase – estrogen is the hormone produced  Normal number of sperms in an ejaculate = 120 – 150 million /
by the ovaries, which stimulates the maturation of a cc
follicle and thickens the endometrium  Mature ovum is capable of being fertilized for 12 – 24 hours
o Luteal phase – luteal phase follows ovulation and is after ovulation. Sperms are capable of fertilizing even for 3 – 4
characterized by the development of the corps lute, days after ejaculation
secretion of progesterone, preparation of the  Normal lifespan of sperms = 7 days.
endometrium for implantation of a fertilized egg and the  Sperms once deposited in the vagina, will generally reach the
formation of a thick mucus to block the cervix once the cervix within 90 seconds after deposition.
egg passes out of the fallopian tube  Reproductive cells during gametogenosis divide by meiosis
 Uterine Cycle (haploid number of daughter cells); they contain only 23
o Menstruation - Proliferation phase - Secretory chromosomes
phase

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

o Sperms have 22 autosomes and 1X sex chromosome  Amenorhea – the absence of menstruation and can be either
or 1Y sex chromosome primary or secondary. It is considered as primary when
o Ova contain 22 autosomes and 1X sex chromosome. menarche has never occurred.
o The union of an X-carrying sperm and a mature ovum  Dysmenorrhea – is painful menstruation that usually
results in a baby girl (XX) corresponds to the secretory phase of the endometrium,
o The union of a Y-carrying sperm and a mature ovum indicating the ovulation has occurred.
resluts in a baby boy (XY)  Metrorrhagia – abnormal bleeding between menses/periods.
 Menometrorrhagia – is excessive or prolonged menstrual
Essential Procedure in Normal Pregnancies bleeding which could be lead to hypovolemia and anemia.
 Estimating Ovulation Time  Premenstrual Syndrome (PMS) – is describe as “complex
o Estimating the exact time of ovulation in menstrual physical signs and behavioral symptoms that occur during the
cycle is of utmost importance in maternity care. A second half of of the menstrual cycle and resolve with onsetof
thorough knowledge on ovulation estimation can be a menses.
useful tool in determining a woman’s period of fertility  Signs and Symptoms:
and infertility. o Psychologic
o OVULATION usually occurs approximately 14 days o Respiratory
before the first day of the succeeding menstrual o Neurologic
bleeding, corresponding to the life of the corpus o Urinary
lateum. o Gastrointestinal
 Signs and Symptoms of Ovulation o Dermatological
o Abrupt slight rise in basal body temperature (0.3 – o Mammary
0.5˚C or 0.4 – 0.8˚F), which is preceded by sight drop
24 to 36 hours before. The most fertile is 3-4 days TOPIC 4
before ovulation and 1 to 2 days after. Human Sexuality
 Presence of Mittelschmerz
o The sensation of lower abdominal discomfort on the Sexuality
side of the ovary that ovulated.  Sexuality is a multidimensional phenomenon that includes
o The irriation of the peritoneum by follicular or blood feelings, attitudes, and actions.
that escapes from ruptured Graafian follicle at  It encompasses and gives direction to a person's physical,
ovulation cause mittelschmerz. emotional, social, and intellectual responses throughout life
Identification of Fertile Cervicle Mucus  Biologic gender – is the term used to denote a person’s
 Brought about by the influence of he hormone estrogen. Fertile chromosomal sex: male (XY) or female (XX).
cervical mucus is characterized as:  Gender identity – is the inner sense a person has of being
o Clear and Transparent male or female.
o Slippery and Lubricative  Gender role – is the male or female behavior a person exhibits.
o Stringy, Elastic and Stretchable  Development of gender Identity
o Having a positive Fern Test o Infancy
 Ferning capacity or elasticity of cervical mucus increase and o Preschool Period
viscosity decrease as ovulation approaches. The ferning test is o School-Age Child
also used to determine the rupture of amniotic membrane, in o Adolescent
conjunction with nitrating test. o Young Adult
o Middle-Age Adult
Positive Spinnbarkeit Test
o Older Adult
 The ability to of the mucus to be stretched up.
 It exist when the mucus can be streched at a minimum of 5 to 6
Puberty
cm to as long as 12 to 24 cm.
 It encompasses the physiological changes leaving to
 Spinnbarkeit is a sign of Ovulation, the basis of one of the
development of adult reproductive capacity,
fertility awareness based on a natural methods of
 the process includes maturation of the hypothalamus, pituitary
contraceptives called “Billing Method”
gland and gonads. The pituitary secretion of gonadotropin
initiate growth and maturation. It occurs initially during sleep
What to include in Menstrual History
and later in puberty throughout wakefulness.
 Menarche – First menstruation, occurs between 12-13years of
 In most girls, these changes are stimulated when the H
age, characteristically irregular, anovulatory and infertile
synthesizes and releases GnRH, which then triggers the
 Duration of Menses – Duration approximately 2- 4days.
anterior P to release the FSH and LH.
 Intervals between Menses – 28 days, (although 21-35 days is
 FSH and FH are termed gonadotropin (gonad – “ovary”; tropin =
normal range)
”growth”) hormones.
 Characteristic of Menstrual flow – the flow can be describe
 The mechanism that initiates pubertal change is not well
as scanty, normal and heavy. Normal amount of blood lost
understood, but the H apparently serves as a gonadostat or
during menstrual period range from 25-60ml.
regulation mechanism to “turn on” gonad functioning
 Presence of mittleschmerz – or mid-cycle pain.
 Combination of better nutrition and increased obesity, girls are
 Date onset of last menstrual period (LMP) it consider the beginning puberty at earlier ages than ever before (8-11 years
duration and character of LMP, should be normal and not of age).
implantation bleeding, which usually coincides with expected  Studies of female athletes and girls with anorexia nervosa
menstrual flow.
demonstrate that delays or halts in menstruation are r/t the lack
 Date of past/previous menstrual period (PMP) - It usually the of body fat or energy expenditure
same menstrual period before the last is the PMP. It has the
same characteristic as the last menstrual period. Adolescence
 Encompasses the physiologic, social and cognitive changes
Menstrual abnormalities or problems:
leading to the development of adult identity.

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 The process includes individuation achievement of personal

independence and maturation of cognitive reasoning skills.
 Thelarche
o Budding of the breast
 Adrenarche
o Development of axillary of pubic hair

Sexual development

Tanner Staging
 A rating system for pubertal development
 It is the biologic marker of maturity
 It is based on the orderly progressive development of:
 Breast and pubic hair in females
 Genitalia and pubic hair in males

Tanner stages of pubertal development: telarche and genitalia

Sexual cycle response

Human sexual cycle (E,P,O,R,R)

 Excitement
o Occurs with physical and psychological stimulation
(sight, sound, emotion, or thought) that causes
parasympathetic nerve stimulation.
o Vaginal lubrication and vasocongestion of the genitalia
o Penile erection and scrotal thickening and elevation of
the testes due to vasoconstriction
 Plateau
o in women: clitoral prepuce, the lower part of the vagina
becomes extremely congested (formation of orgasmic
platform due to prominent vasoconstriction) and there is
increased breast nipple elevation.
o in men: distention of the penis.
o pre-ejaculatory phase with live spermatozoa
o Generalized muscle tension, hyperventilation, increased
BP, tachycardia in the late plateau phase
Tanner Stages of Pubertal Development: Adrenarche  Orgasm
o Occurs when stimulation proceeds through the plateau
stage to a point at which a vigorous contraction of the
muscles in the pelvic area expels or dissipates blood
and fluid from the area of congestion.
o Strong rhythmic contractions of vagina and uterus
o Muscle contractions surrounding the seminal vessels
and prostate project semen into the proximal urethra.
o Shortest stage in the SC

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

o Usually experienced as intense pleasure affecting the  Sadomasochism – involves inflicting pain (sadism) or
whole body, not just the pelvic area receiving pain (masochism) to achieve sexual satisfaction.
 Resolution  Pedophilia – are individuals who are interested in sexual
o A 30-minutes period during which the external and encounters with children.
internal genital organs return to an unarousable state.  Exhibitionism – is revealing one’s genitals in public
o Rapid decline in pelvic vasocongestion. All organs
return to previous position. Orgasm Disorder
o Men: a refractory period occurs during which further  Erectile Dysfunction – formerly referred to as impotence, is
orgasm is impossible. the inability of a man to produce or maintain erection long
o Women: do not go through this refractory period, so it is enough for vaginal penetration or partner satisfaction.
possible for women who are interested and properly  Premature Ejaculation – is ejaculation before penilevaginal
stimulated to have additional orgasms immediately after contact
the first.
 Refractory phase Pain disorder
o Only in males; the period during which no amount of  Vaginismus – is involuntary contraction of the muscles at the
stimulation can cause another erection. Not manifested outlet of the vagina when coitus is attempted.
in females because females are multi-orgasmic. This  Dyspareunia/Vestibulitis – is pain during coitus. - is
phase lengthens with age inflammation of the vestibule

The Influence of Pregnancy on Sexual Response Types of sexuality (P,A,G)

 LP – there is increased fluid retention and vasocongestion in  Primary Sexuality – Refers to the translation of social and
the woman’s lower pelvis. cultural definition of femaleness and maleness, which will
 Vasocongestion is already present at the beginning of the influence the kind of women or men children will grow up to
excitement stage of the sexual response, women appear to be. ;
reach the plateau stage more quickly and achieve orgasm more  Affective Sexuality – Incorporates all the experiences and
readily during this time. dimensions related to closeness and intimacy with others. – It
 Note Women also may be more interested in initiating sexual ranges from attraction – crushes, infatuation, love – to
relations during this time. relationships – romantic or platonic, marital or live-in
arrangement. Etc
The Influence of the Menstrual Cycle on Sexual Response  Genital Sexuality – A broad range of biologically based
 Pregnancy is another time in life when there is vasocongestion experiences that activate the genital organs and influence
of the lower pelvis because of the blood supply needed by a genital activity.
rapidly growing fetus. o Common issues
 Many women continue to experience increased sexual interest o Masturbation
because the new growth of blood vessels during pregnancy o Wet dreams
lasts for some time and continues to facilitate pelvic o Menstruation
vasocongestion. o Sexual performance anxiety
 Note At a time when a woman may want sexual contact very o orgasm
much , she needs to be free of myths and misconceptions, such o Impotence
as orgasm will cause a spontaneous miscarriage. Increased o Contraceptives
breast engorgement that accompanies pregnancy results in o Pregnancy and abortion
extreme breast sensitivity during coitus.
Note:
 Ultimately, teaching about sexuality should lead to the
cultivation of healthy attitudes toward one’s own person and
Types of sexual orientation (H,H,B,T,C)
another’s as unique women and men.
 Heterosexual – is one who finds sexual fulfillment with a
 Interestingly, no matter how “educated” one is, parents could
member of the opposite gender. (different)
be remiss in this aspect of a child’s development
 Homosexual – is a person who finds sexual fulfillment with a
 It is most alarming at times to witness how parents are
member of his or her own sex (same)
completely ignorant about the way they are affecting their
 Bisexuality – people are bisexual if they achieve sexual children in this aspect.
satisfaction from both homosexual and heterosexual
 husband. A father punishes the son for cross-dressing.
relationship. (both)
 Transsexuality – or transgender person is an individual who, Topic 5
although of one biologic gender, feels as if he or she should be Nursing Care Related to Psychological and Physiological
of the opposite gender. (cross dressing) Changes of Pregnancy
 Celibacy – is abstinence from sexual activity. Masturbation – is
self-stimulation for erotic pleasure; it can also be a mutually Maternal Adaptation to Pregnancy
enjoyable activity for sexual partners. Woman may find
masturbation to orgasm the most satisfying sexual expression Cardiovascular system
and use it more commonly than men. (absence)  Increased in blood volume of 30-50% (1500cc) at 3rd month
contributes to increased cardiac workload.
Types of Sexual Expression (E,F,T,V,S,P,E)
 Mother feels fatigue (lassitude).
 Erotic Stimulation – is the use of visual materials such as
 Epistaxis occurs due to hyperemia of the nasal membrane.
magazines or photographs for sexual arousal.
 Slight hypertrophy of ventricles.
 Fetishism – is sexual arousal resulting from the use of certain
 Heart rate increases 10-15 bpm.
objects or situation.
 Palpitation is also common.
 Transvestism – is an individual who dresses to take on the role
 BP decreases in second trimester, rises to pregnancy level in
of the opposite sex.
third trimester.
 Voyeurism – is obtaining sexual arousal by looking at an
other’s person’s body

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Supine hypotension syndrome: lying supine compresses the  Flatulence- presence of excessive amount of gas in the
vena cava, blood return to the heart decreases. stomach and intestines due to increased progesterone.
 Increased clotting factors, platelets, white blood cells, lipid,  Constipation- a condition in which bowel movements are
Decreased protein level. infrequent or incomplete caused by hypoperistalsis, lack of
 Physiologic Anemia: fluids, poor dietary habits, pressure of the enlarged uterus on
o Occurs as a result of hemodilution of the blood. internal organ, effects of progesterone on muscles and
o 40-50% increase in blood volume expansion, (75% hemorrhoids.
plasma, 25% RBC)  Hemorrhoids- a varicose condition of the external
o Normal values in pregnancy: Hct: 32-42%; Hgb: 10.5-14 hemorrhoidal veins causing painful swelling at the anus. This is
d/dL due to the gravid uterus.
 Pathologic Anemia
o Iron deficiency anemia IDA – most common Renal system
hematologic disorder.  Proximity of the uterus and bladder in early and late pregnancy
o S/Sx: pallor, slowed capillary refill, concave fingernails causes urinary frequency.
(late sign) caused by chronic tissue hypoxia,  Bladder tone is reduced by effects of hormones on smooth
constipation and listlessness. muscles.
o Nutritional instruction: increased iron in diet  Pressure of enlarging uterus and the progesterone effect on
o Parenteral iron thru Z-tack method. smooth muscles cause dilatation of the uterus.
o Oral iron supplements (ferrous sulfate 0.3g, 3x a day)  Kidneys increased in size because of the increase in renal
blood flow
 Edema of the lower is normal but edema in the upper
 ncrIeased UO results is lowered specific gravity.
extremities is a sign of pre-eclampsia
 Glycosuria – determined by Benedict’s test
 Varicosities – can be prevented thru wearing of panty hose or
support stockings. Pain of Vulvar varicosities is relieved thru  Nocturia
positioning (side lying and modified knee-chest) •  Proteinuria – determined by Heat and Acetic Acid test
 Thrombophlebitis or DVT – venous inflammation with
thrombus formation Musculoskeletal system
o S/Sx: (+) Homan’s sign, Milk leg or “Phlagmasia Alba  Lordosis – accentuation of the lumbar curvature of the spine. •
Dolens” – shiny white leg brought by stretching and Softening of all ligaments and joints.
inflammation of the skin.  Waddling Gait – due to relaxin; risk for accidents
 Leg cramps – occur from an imbalance of calcium in the body
Endocrine system and from pressure of the gravid uterus on nerves supplying the
 Elevated HCG levels which reaches peak at third month then lower extremities.
drops.
 Estrogen and progesterone increase and continue to be Integumentary system
secreted from the placenta during the last 6 months of
pregnancy.
 Progesterone acts to inhibit uterine contractions.
 Increase in both hormones leads to sodium and water retention
and muscle relaxation which leads to fatigue.
 Thyroid activity is increased; normal pregnancy may emulate a
mild hyperthyroid state.
 Estriol level increased; sometimes used as an indicator of fetal
well-being.

Respiratory system  Striae Gravidarum (Stretch marks)

 The mother experiences SOB because of enlarging uterus and  Protruding Umbilicus
there is also an increased oxygen demand.  Linea Nigra – brownish-pinkish line running from symphysis
 Hyperventilation occurs due to the mother’s need to blow-off pubis to the umbilicus separating the abdomen into right and left
increased CO2 transferred to her from the fetus. halves.
 Nasal congestion occurs as a response to increased estrogen  Chloasma – melanoderma or melasma, pigmented facial
levels patches “mask of pregnancy”
 Vascular spiders or telangiectasias – small, fiery-red branching
Gastrointestinal system spots)
 Morning sickness – characterized by early morning N/V. 1st  Palmar erythema
trimester morning sickness may be relieved by getting out of  Excretion of wastes through the skin causes diaphoresis
bed slowly after eating a few crackers, eating frequent, small
meals (afternoon nausea), and by avoiding spicy or greasy Reproductive system
foods.  Amenorrhea occurs because the corpus luteum persists and
 Hyperemesis gravidarum ovulation is inhibited by the high levels of circulating estrogen
 Emesis gravidarum and progesterone.
 Heartburn or Pyrosis – can be prevented by eating small  Changes in the uterus are circulatory, hormonal and related to
frequent meals; avoiding fatty and spicy foods; proper body fetal growth.
mechanics; and taking sips of milk.  Chadwick’s sign – bluish to purplish color of the cervix and
 Decreased emptying time of gallbladder may precipitate vaginal mucosa. “Leukorrhea”
development of gallstones.  Goodell’s sign – softening of the cervix
 Food cravings may occur; only significant if substance craved is  Hegar’s sign – softening of the lower uterine segment
unusual (pica).  Uterus enlarges in size
 Ptyalism – increased salivation  Changes in position of the uterus
 Hyperemia and softening of gums with accompanying
hyperacidity of oral secretions result in nonspecific gingivitis.

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Fundic height - the distance from the pubic bone to the top of
the uterus measured in centimeters.
 Ovaries – pregnancy is the rest period for the ovaries.
 Breast changes such as fullness, tingling, soreness, and
darkening of the areola and nipples occurs with an increase in
hormonal levels.

Immune system
 Immunologic competency during pregnancy decreases,
probably to prevent a woman’s body from rejecting the fetus.
 IgG production is partially decreased, which can make a woman
more prone to infection during pregnancy.

Confirmation of pregnancy (3Ps)

 The changes in the various body systems give rise to the signs
and symptoms of pregnancy grouped into presumptive,
probable, and positive signs
 PRESUMPTIVE – signs strongly suggestive of pregnancy ;
“Could Be” signs of pregnancy.
 PROBABLE – “Probably Pregnant”
 POSITIVE – “Definitely Pregnant”

Nursing Diagnosis
 Altered breathing patterns related to respiratory system
changes of pregnancy
 Disturbed body image related to weight gain from pregnancy
 Deficient knowledge related to normal changes of pregnancy
 Imbalanced nutrition, less than body requirements, related to
early morning nausea
 Powerlessness related to unintended pregnancy
 Possible impaired health and prenatal care behaviors
associated with cultural beliefs

Outcomes
 Altered breathing patterns related to respiratory system
changes of pregnancy
Emotional and psychological adaptations in pregnancy  Disturbed body image related to weight gain from pregnancy
 Varied psychological responses due to hormonal changes,  Deficient knowledge related to normal changes of pregnancy
altered body image, anticipation of role changes, emotional  Imbalanced nutrition, less than body requirements, related to
makeup, socio-cultural background, and reaction of family and early morning nausea
friends.  Powerlessness related to unintended pregnancy
 Common response includes ambivalence, grief, narcissism,  Possible impaired health and prenatal care behaviors
introversion, stress and emotional liability. associated with cultural beliefs
 Patient experience mixed feelings (even if the pregnancy was
planned) due to unresolved emotional conflicts between the TOPIC 6
patient and her mother, fear of pending role change or of labor Nursing Care to Promote Fetal and Maternal Health
and delivery and the need to alter career plans.  Exercise Purpose: Exercise during pregnancy strengthen the
 Growing acceptance of the pregnancy as the patient sees her muscles to be used for labor and delivery.
physical appearance change, experience quickness and hear Benefits of Exercise During Pregnancy
fetal heart tones.  Strengthen the muscles to promote their quick return to normal
 Focusing of woman’s attention towards to self-preparation to condition after birth.
birth  Promote circulation, prevent and relieve problems like
 Normal response varicosities and hemorrhoids.
 May strain the relationship if her partner misinterprets  Relieve tension and anxiety
introversion as rejection  Improve posture and appetite.
 Wide mood swing can strain marital or familiar relationships,  Improve metabolic efficiency.
possibly causing the partner of family members to withdraw,
leaving the patient feeling rejected. General Considerations

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Exercise should be performed in moderation, should not cause Employment

fatigue to a woman. The key is “train the body, not strain the  Pregnant women can continue working as long as their job does
body” not involve lifting heavy objects, standing and sitting for long
 Exercise should be individualized and adjusted to the stage of periods of time, excessive physical and emotional strain and
pregnancy. exposure to toxic substance.
 The pregnant woman should not start a new high intensity  Classification of jobs for pregnant women:
exercise regimen during pregnancy. o Standing Job – require standing for the same position
 If a woman has no exercise regimen before pregnancy, she for more than 3 hours a day.
should start slowly and gradually build up. o Active Job – require continuous or intermittent walking.
 If a woman has been exercising before pregnancy, then the o Sedentary Job – require less than an hour of standing
goal should be to maintain the current exercise program with a per day.
few adaptations.
 Walking, prenatal yoga, and swimming or water aerobics are Maternity Clothes
probably the three best exercises for pregnancy.
 When exercising, it is important to always warm-up before and
cool-down after and wear appropriate clothing.
 Instruct women to avoid:
o Exercising in extremely hot weather, cold temperature.
o High intensity exercise.
o Extremes of joint flexion and extension
o Holding of breath while exercising, pointing of toes and
hyperextension of the back.
o Activities such as competitive sports, hang gliding,
horseback riding, scuba diving, sky diving and water
skiing.
o Prolong periods of motionless standing. Bathing
 Instruct woman to stop exercising if she experiences any of the  The woman perspires more heavily because she needs to
following. excrete waste products of her body and that of the fetus.
o Vaginal bleeding  Tub bath is discourage because alteration in the woman’s
o Unusual pain balance makes getting in and out of the bath tub difficult, she
o Dizziness or lightheadedness might slip, fall and hurt herself and the fetus.
o Unusual shortness of breaths  There should be no tub bathing late in pregnancy.
o Racing heartbeats or chest pain  It is alright for the woman to go swimming but no diving.
o Fluid leaking from your vagina
Immunizations
o Uterine contractions.
 Immunizations with vaccines containing live viruses is
contraindicated during pregnancy because of the danger of the
Contraindication
virus crossing the placenta and infecting the fetus.
 Pregnancy Induced Hypertension (PIH)
 PROM - premature rupture of membranes Tetanus Toxoid
 PTL - Preterm labor
 Incompetent cervix
 Vaginal bleeding

Recommended Exercise
 Pelvic Rocking
o Relieve low backache.
o Strengthen the muscles of the lower back.
o Relieves abdominal pressure Travel
 Tailor Sitting  There are usually no travel restrictions during pregnancy, but it
o Stretch and strengthen perineal muscles. is advised that pregnant women avoid long trips on the 3rd
o Improve circulation in the perineum. trimester.
 Abdominal Muscle Contractions  Instruct to wear seatbelts when travelling. The seatbelt should
o Strengthen abdominal muscles in preparation for labor not directly cross the gravid uterus.
pushing.  When travelling:
o Contract and relax the muscles of the abdomen.  A 15 to 20-minute rest period every 2 hours on long rides to
 Squatting move about and empty the bladder.
o The exercise stretches the perineal muscles and  When travelling by air, the plane should pressurized
increase blood flow to the perineum
 Kegel Exercise Maternal Relations/Coitus
o Strengthen pubococcygeal muscles  Changes in normal sexual response are related to physiologic
o Helpful in postpartum period to reduce pain and changes of pregnancy
promote perineal healing  Generally no contraindications except in the presence of
 Calf Stretching PROM, Premature Labor, Hx of abortion, Bleeding, Deeply
o Relieve leg cramps engaged head in late pregnancy, Incompetent cervix
 In healthy, pregnant woman, sexual intercourse, usually does
 Modified Knee Chest
no harm.
o Relieve hemorrhoids, vulvar varicosities, pelvic
pressure, cramps in the thighs or buttocks and low
Sleep and Rest
backache.
 Assess activities to identify need for rest and sleep.

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Average no. of hrs. of sleep = 8 hours Afternoon nap = 1 – 2 - Eat dry toast or crackers before rising from bed.
hours - Eat small frequent meals rather than 3 large
 Plan rest time during the day ones.
 At work, get to stand and walk about for few minutes at least - Ice chips
once in every 2 hours  Frequent Urination
o Because of enlarging uterus on the anterior bladder.
Care of the Teeth o Sensation may last for about 3 months.
 Regular examination of the teeth and gums should be part of o Management:
the prenatal general physical examination. - Limit fluid intake before bedtime.
 Dental carries require prompt management in pregnancy. - Kegel exercise to improve tone of muscle that
 N/V, heartburn, and hyperemia of gums may lead to (POH) and controls urination.
dental carries  Constipation - due to slow peristalsis and the weight of a
growing uterus presses against the bowel.
S-A-D Habits of Pregnancy o Management
Smoking - encourage to evacuate bowels regularly
 Woman who smoke in pregnancy have smaller infants (SGA) - fiber in the diet
than those women who do not. - AVOID ENEMA
 Prenatal tobacco exposure causes learning and attention  Fatigue
problems in children but less consistently than does alcohol o 1st trimester – due to the action of progesterone on the
exposure. sleep centers of the brain. • 2nd & 3rd trimester – due to
 Effects of Tobacco use increased metabolic rate and increased weight of the
o Increased risk of SGA uterus.
o Prematurity o Management:
o infant mortality - Take at least 8 hours of sleep at night and
o Spontaneous abortion frequent rest periods during daytime.
o Placenta previa/ Abruptio placenta - Avoid standing for long periods, work while
seated as much as possible.
o PROM
- Eat well balanced diet to provide enough energy
 Causes of Adverse effects of Smoking
 Heartburn or pyrosis
o Nicotine
o Progesterone slows down gastric motility resulting in
o the increased of CM causes functional inactivation of
reflux of gastric contents into the lower esophagus.
maternal and fetal Hgb
o Management:
o Decreased plasma volume
- Take small frequent diet.
o Reduce appetite, resulting to decreased caloric intake.
- Bend at knees not at waist when picking objects
Alcohol from floor, avoid lying flat.
 Alcohol ingestion by pregnant women is likely to cause fetal  Varicose veins
abnormalities. o Caused largely by hereditary predisposition, advancing
 Alcohol is leading known teratogen in the Western world. age, prolong standing and exaggerated by pregnancy.
 Effects of chronic alcoholism: Fetal Alcohol Syndrome o Apparent during the 2nd & 3rd trimester
(FAS) o Management:
o Retardation/delays: cognitive, motor, attention, and
o LEG VARICOSITIEs
learning deficits
- Periodic rest with elevation of the leg, lie with feet
o Mental retardation: associated with microcephaly, and
against the wall.
seizure disorders - Avoid prolonged sitting or standing, constricting
o Craniofacial defects garters, knee high socks.
o Cardiovascular defects - Wear support hose
o Limb defects o VULVAR VARICOSITIES
o Impaired fine and gross motor function - Rest with pillow under the hips
Drugs - Modified knee chest position.
 Should only be taken by pregnant women when prescribed by o ANAL VARICOSITIES OR HEMORRHOIDS
their physicians. - Sim’s position several times a day.
 No medication is taken during pregnancy unless necessary and - Avoid constipation
prescribed. - Hot sitz bath 15 to 20 minutes
o Intake of illicit drugs in the 1st trimester can cause the - Avoid bearing down
most adverse fetal malformations. - Observe good bowel habits
o The so-called “hard” drugs may cause growth - Use of stool softeners and warm soaks
retardation and drug withdrawal which is associated  Leg cramps
with increased neonatal mortality. o Also known as Charley Horse.
o Illegal drugs carry the risk of acquiring HIV and other o Caused by pressure of the uterus against the nerve
STDs. supplying the lower extremities.
o Herbal supplements being natural, are not always safe o Management:
because of lack of consistent potency in the active - For immediate relief, push toe upward while
ingredient applying pressure on the knee to straighten the
leg.
Discomforts of early Pregnancy - One quart of milk a day to meet calcium needs or
 Nausea and Vomiting oral calcium supplements.
o Also known as morning sickness - Exercise regularly but avoid pointing of toes.
o Commence 6 weeks after the last menstrual period and  Breast Tenderness and Nipple Irritation
disappears by the end of the 1st trimester. o Breast discomforts occurs throughout pregnancy.
o Management: o Tenderness is minimal and transient.

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

o Management:  10 lunar months

- Wash breast with water only, no soaps and
alcohol. Components of prenatal visit
- Wear supportive maternity brassiere.  Personal info
 Leukorrhea o Name, Address, Age, Civil Status, Occupation,
o Whitish, viscous vaginal discharge or an increase in the Religion, Economic Status, and Educational Level
amount of normal vaginal secretions. o History of emotional or psychiatric disorders
o Elevated level of estrogen causes hyperactivity of o Diest practices
cervical glands throughout pregnancy.  Partner’s history
o Management: o Age
- Proper perineal hygiene, flush the perineum with o Genetic or medical disorders
water after voiding. o Alcohol or drug use
- Use of sanitary pad for excessive vaginal  Medical history
discharge. o Childhood Diseases
 Palmar Erythema - palmar pruritus - increased estrogen levels o Surgical Procedures
o Management:
o Medical Problems
- Calamine lotion can be soothing
 Family medical history
o History of multiple birth, congenital diseases, or
Discomforts of Middle to Late Pregnancy
deformities
 Backache
o Significant medical problems
o To maintain balance due to growing uterus.
 Present medical status
o Management:
o Use of prescription and nonprescription drugs
- Wear shoes with low heels.
o Use of alcohol, tobacco, or illegal drugs
- Walk with the pelvis tilted forward.
o Conditions that could negative affect pregnancy.
 Ankle Edema
o Reduced blood circulation in the lower extremities o Presence of disease, such as diabetes or cardiac
(uterine pressure and general fluid retention) disease.
o Management:  Gynecology history
- Rest on the left side-lying position. o Menarche
- Sitting with the legs elevated. o Length of menses cycle
- Avoid wearing constrictive clothing o Duration of menses
 Dyspnea o History of dysmenorrhea
o Pressure of the expanding uterus on the diaphragm. o Gynecologic surgery
o Management: o Contraceptive use
- Sleep upright
- Limit activities during the day Method of Delivery
 Braxton Hicks Contractions - early as the 8th to 12th week of  Normal spontaneous vaginal delivery (NSVD)
pregnancy - uterus periodically contracts and then relaxes.  Cesarean section (CS)
 Headache
o Expanding blood volume puts pressure on the cerebral Indication for past CS
arteries.  Where: At home? In the Hospital?
o Management:  Risk involved: Prematurity? Toxemia?
- Rest with a cold towel on the forehead
Current Pregnancy
TOPIC 7  First day or last menses
Nursing care related to assessment of prenatal care  Abnormal symptoms
 Attitude toward pregnancy
Prenatal care
 Overall health Length of Pregnancy
 Essential for ensuring the overall health of newborn and  267 – 280 days
pregnant woman  9 calendar months
 38-42 wks ave. 40
Reason for assessment  3 trimester
 Establish baseline data  10 lunar months
 Determine gestational age of fetus
 Monitor fetal development and maternal by anticipating and Maternal Attitude and Reaction towards Pregnancy
preventing problems before they occur  Is this a planned or wanted
 Education about, lactation and new born care
Teratogenic Trisomy 21 - down syndrome
Phocomelia – presence of hand and foot without limbs
Schedule of visit Amelia – no extremities. complete absence of one or more limbs
 First visit to 28 wks – every four wks (once a month)
 From 32 wks to 36 wks – every two wks (twice a month ) Fundic height Measurement
 36 weeks = 9 months  To measure gestational age beyond 22 weeks

Length of Pregnancy Mc Donald’s Rule

 267 – 260 days  Determines AOG by measuring the Fundic height (FH) from the
 9 calendar months fundus to symphysis pubis (in cm)
 38-42 wks ave. 40  Length of fundus in cm x 8/7 = AOG In weeks
 3 trimester  Length of fundus in cm x 2/7 = AOG in moths

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NCM107 Lecture: Care of Mother, Child, and Adolescent (well clients )

 Example 1: AOG in months

o FH = 3.5
o 3.5 x 2/7 = 9 months
 Example 2: AOG in moths
o FH= 21 cm
o 21 x 2/7 = 6 months
 Example 3: AOG in weeks
o FH = 21 cm
o 21 x 8/7 = 24 weeks

Bartolomew’s Rule
 Estimate AOG by relative presentation of the uterus in
abdominal cavity
 3 months – just above symphysis pubis
 4 months – midway

Haase’s Rule
 Determine the length of fetus in cm

1st trimester
 Rapid

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