Care of the Mother, Child and

Family

Mr. Jhessie Lawaan y Abella, RN, RM, MAN

Course Description/Objective/Outline

Course Description: Principles and techniques of caring for the normal mothers, infants, children and family and the application of principles and concepts on family and family health nursing process.

Course Objective: At the end of the course, given actual or simulated situations/conditions involving the client (normal pregnant woman, mother, and/or newborn baby, children and the family), the student will be able to:

1. Utilize the nursing process in the holistic care of client for the promotion and maintenance of health.1.1 Assess with the client his/her health condition and risk factors affecting health1.2 Identify wellness /at risk nursing diagnosis1.3 Plan with client appropriate interventions for health promotion and

maintenance of health1.4 Implement with client appropriate interventions for health promotion and

health maintenance taking into consideration relevant principles and techniques

1.5 Evaluate with client the progress of one’s health condition and outcomes of care.

. I. The Family and Family HealthII. The Family Health Nursing ProcessIII. Methods of Data GatheringIV. Typology of Nursing Problems in Family Nursing Practice

1. 1st level assessment: identify health threats, foreseeable crisis, health deficits & wellness potential/state2. 2nd level assessment: determining family’s ability to perform the family health tasks on each health threat, health deficit, foreseeable crisis or wellness potentialV. Statement of a Family Health Nursing Problem- health problem and cause/ contributing factors or health condition and factors related with non-performance of family health tasks

VI. Developing the Care PlanVII. Categories of nursing interventions in family nursing practice include:VIII. Categories of health care strategies and interventionIX. EvaluationX. Records in Family Health Nursing PracticeXI. Mother and Child Health

1.Procreative Healtha. Definition and theories related to procreationb. Process of human reproductionc. Risk factors that will lead to genetic disordersd. Common tests for determination of genetic abnormalitiese. Utilization of the nursing process in the prevention of genetic alteration and in the care of clients seeking services before & during conception

XII. Antepartum/ Pregnancy1. Anatomy & physiology of the male and female reproductive system2. Physiology of menstrual cycle3. The process of conception4. Fetal circulation5. Milestones of fetal development6. Estimating the EDC7. Common teratogens and their effects8. Health history: past, present, potential, biographical data, menstrual history, current pregnancy

(EDD, AOG, gravid, para), previous pregnancies & outcomes (TPAL score),gynecologic history, medical history, nutritional status

9. Normal changes during pregnancya. Local & systematic physical changes including vital signs, review of systemsb. Emotional changes including ‘angers in pregnancy’c. Leopold’s maneuver

10. Danger signs of pregnancy11. Normal diagnostic/laboratory findings & deviations Pregnancy test12. Appropriate nursing diagnoses13. Addressing the needs and discomforts of pregnant mothers14. Prenatal exercises15. Preparation for labor and delivery

XIII. Intrapartum (Process of Labor & Delivery)1. Factors affecting labor & delivery process- passenger, passage, power (primary and

secondary) and placenta2. Functional relationships of presenting part3. Theories of labor onset4. Common signs of labor5. Stages of labor & delivery6. Common discomforts of the woman during labor and delivery7. Danger signs during labor & delivery8. Appropriate Nursing Diagnoses9. Care of clients experiencing labor & delivery process10. Physical & psychological preparation of the client:11. Monitoring of progress of labor delivery12. Provision of personal hygiene, safety & comfort measures e.g. perineal care,

management of labor pain, bladder and bowel elimination13. Coping mechanisms of woman’s partner and family of the stresses of pregnancy,

labor and delivery & puerperium14. Preparation of the labor & delivery room15. Preparation of health personnel

XIV. Post Partum1. Definition2. Specific Body Changes on the Mother3. Psychological Changes on the Mother4. Phases of Puerperium

“Taking In” “Taking Hold” “Letting Go”

5. Monitoring of Vital signs, uterine involution, amount & pattern of lochia, emotional responses, responses to drug therapy, episiotomy healing

6. Possible complications during post partum : bleeding & infection7. Appropriate Nursing Diagnoses8. Nursing care of mothers during post partum

a. Safety measures: limitations in movement, protection from falls, provision of adequate clothing, wound care e.g. episiotomy

b. Comfort measures: exercises, initiation of lactation, relief of discomforts like breast engorgement and nipple sores, hygienic measures, maintaining adequate nutrition

c. Measures to prevent complication: ensuring adequate uterine contraction to prevent bleeding, adequate monitoring, early ambulation, prompt referral for complications

d. Support for the psychosocial adjustment of the mothere. Health teaching needs of mother, newborn, familyf. Accurate documentation and reporting as needed

9. Health beliefs & practices of different cultures in pregnancy, labor delivery, puerperium10. Current trends in maternal and child care11. Family planningXV. The Newborn

The Infant and Family The Toddler & the Family The Preschooler and the Family The Schooler and the Family The Adolescent & the Family Adulthood

The Concept and Definition of FAMILY

• The family is a very important social institution • It is generally accepted that the family is the first and oldest social

institution in society. The family is consist of parents and children who interact with one another. Through this socialization process, parents are able to hand down socially accepted cultural practice that serves as initial training for the young to become future responsible citizen in the future.

• Refers to a group of people united by ties of marriage, blood or adoption. As a group, the members of the family live together under one roof and that they constitute a single housekeeping unit.

• It is a universal institution that has the following common characteristics:Associate with one another in their respective roles as husbands

and wife, mother and father, son and daughter or brother ans sisters

As the members of the family enjoy life together playing their different roles, they tend to create a common culture.

• There have been significant changes in the way people regard the family as a social institution. Friedman (1992) defines it as “ Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family”

• Key Points! A clients family includes any person that he/she identifies as a family member.

FIVE UNIVERSAL CHARACTERISTICS OF FAMILYA family is a social systemA family perform certain basic functionA family has structureA family has its own cultural values and rulesA family moves through stages in its life cycle

Key Points! The basic function and task of a family focus on providing physical health, providing for mental health, socializing its members, reproducing, and providing for economic well being.

Functions of the FAMILY Provision of Physical needs: food, shelter, clothing,

safety and healthcare Allocation of Resources: careful planning and use of

family money, material good, space and abilities Division of Labor: assigning the workload, including

responsibility for household income and household management

Socialization: guiding towards acceptable standards of elimination, food intake, sexual drive, respect for others and their possession and sense of spirituality

Reproduction, recruitment and release: bearing or adopting children, adding new members by marriage, and allowing members to leave

Maintenance of Order: interaction and communication oppurtinities, discipline, affection, sexual expression

Assistance with fitting into the larger society: community, schools, spiritual center and organization

Maintenance of motivation and morale: recognition, affection, encouragement, family loyalty, help in meeting crisis, philosophy of life, spirituality

FAMILY STRUCTURESDifferent structures emanates due to changing

family patterns and cultural; variations practiced by

family members in a given society.

Classifications of Family Based on Internal Organization:

o CONJUGAL FAMILYo NUCLEAR FAMILYo EXTENDED FAMILY

Classification of Family Based on Family Descent:

o PATRILINEAL FAMILYo MATRILINEAL FAMILYo BILATERAL FAMILY

FAMILY STRUCTURESClassification of Family Based on Authorityo PATRIARCHAL FAMILYo MATRIARCHAL FAMILYo EGALITARIAN FAMILYo MATRICENTIC FAMILY

Classification of Family Based on Residenceo PATRILOCAL Residenceo MATRILOCAL Residenceo BILOCAL Residenceo NEOLOCAL Residenceo AVUNCULOCAL Residence

FAMILY STRUCTURES

Alternative Families

o Cohabitation refers to the unmarried individuals in a committed partnership living together with or without children. People may live in cohabitation arrangement, before in between or as an alternative to marriage.

o Gay or Lesbian Family intimate partners of the same sex may live together or own property together .

o Communal Family several people together. They often strive to be self-sufficient and minimize contact with the outside society. Members share financial resources, work and child care responsibilities.

o Foster Family children live in temporary arrangement with paid caregivers. These children are meant to return to their family of origin when condition permits or to otherwise be placed for adoption.

CHARACTERISTICS OF A HEALTHY FAMILY

Healthy families maintain a spiritual foundation

Healthy families make the family the top priority

Healthy families ask and give respectHealthy families communicates and

listenHealthy families values service to

othersHealthy families expect and offer

acceptance

STAGES OF FAMILY DEVELOPMENT

Stage One: Single young adults leave homeHere the emotional change is from the reliance on the family to acceptance of emotional and financial responsibility for ourselves. Second-order changes include differentiation of self in relation to family of origin. This means we neither blindly accept what our parents believe or want us to do, nor do we automatically respond negatively to their requests. Our beliefs and behaviors are now part of our own identity, though we will change and refine what we believe throughout our lives. Also, during this period we develop intimate peer relationships on a deeper level than we had previously and become financially independent.

Stage Two: The new couple joins their families through marriage or living togetherThe major emotional transition during this phase is through commitment to the new system. Second-order change involves the formation of a marital system and realignment of relationships with extended families and friends that includes our spouses.

STAGES OF FAMILY DEVELOPMENTStage Three: Families with young childrenEmotionally we must now accept new members into the system. This isn't hard initially because babies come to us in sweet innocent packages that open our hearts. Unfortunately, in the middle of the night we may wonder what we've gotten ourselves into. Nevertheless, we adjust the marital system to make space for our children, juggling childrearing, financial and household tasks. Second-order change also occurs with the realignment of relationships with extended family as it opens to include the parenting and grand parenting roles.

Stage Four: Families with adolescentsEmotional transitions are hard here for the whole family because we need to increase the flexibility of families boundaries to include children's independence and grandparents' frailties. As noted above, second-order change is required in order for the shifting of the parent-child relationship to permit adolescents to move in and out of the system. Now there is a new focus on midlife marital and career issues and the beginning shift toward joint caring for the older generation when both children and aging parents demand our attention, creating what is now called the sandwich generation.

Stage Five: Launching children and moving onThis is one of the transitions that can be most emotionally difficult for parents as they now need to accept a multitude of exits from and entries into the family system. If the choices of the children leaving the nest are compatible with the values and expectations of the parents, the transition can be relatively easy and enjoyable, especially if the parents successfully navigate their second-order changes, such as renegotiation of the marital system as a couple rather than as simply parents.

Stage Six: Families in later lifeWhen Erikson discusses this stage, he focuses on how we as individuals either review our lives with acceptance and a sense of accomplishment or with bitterness and regret. Second-order changes require us to maintain our own interests and functioning as a couple in face of physiological decline. We shift our focus onto the middle generation (the children who are still in stage five) and support them as they launch their own children. In this process the younger generation needs to make room for the wisdom and experience of the elderly, supporting the older generation without over functioning for them. Other second-order change includes dealing with the loss of our spouse, siblings, and others peers and the preparation for our own death and the end of our generation.

OVERVIEW OF MALE AND FEMALE

REPRODUCTIVE SYSTEM

REPRODUCTIVE DEVELOPMENT

• The chromosomal sex or biologic sex is formed at fertilization. Females have XX chromosomes and the male XY chromosomes.

• During early fetal life, primitive germ cells are formed in the 6th and 10th week in the yolk sac. The Gonads is a body organ that produces sex cells. At 5th weeks primitive Gonadal tissue is already formed.

REPRODUCTIVE DEVELOPMENT• At 8th to 10th week, the

human embryo has neutral gonads with two pairs of duct system. The MULLERIAN Ducts (Paramesonephric) and the WOLLFIAN Ducts (Mesonephric) joined at the lower end.

• If the germ cell are XX the gonads become the Ovaries

• If the germ cell is XY the gonads become the testes

REPRODUCTIVE DEVELOPMENT• The internal genitalia forms at

around 13th week from the mullerian (female) and the wollfian (male) ducts.

• If the embryo is XY, the gonads secrets the following hormones:

o Mullerian duct inhibitor which cause mullerian duct to self destruct and disappear a process called as APOPTOSIS.

o Testosterone produced by the Leydig cells which causes Wollfian duct to develop into sperm transport system epididymis, vas deferenses, and seminal vesicle.

REPRODUCTIVE DEVELOPMENT• The conversion of testosterone

to DHT dehydrotestosterone causes development of the prostate gland. DHT is also responsible for the development of the male external genitalia.

• If the embryo is XX, no hormones are released. Mullerian ducts develop into oviducts, uterus, and upper vagina. The Wollfian ducts disappear without stimulation from testosterone .

REPRODUCTIVE DEVELOPMENT

Female MaleClitoral Gland Penile GlandClitoral Shaft Penal ShaftLabia Majora Scrotum

Ovaries TestesSkene’s Gland Prostate

Bartholin’s Gland

Cowper’s Gland

Female and Male Reproductive Homologues

Female and Male Reproductive Homologues

PUBERTY• Is the stage of life at which secondary sex changes

begins. Both boys and girls begin dramatic development and maturation of reproductive organs at approximately 12 to 13 years.

• The hypothalamus apparently serves as gonadostat or is set to “turn on” gonad functioning. It is believed though that the hypothalamus is turned on to release initial trigger hormones when a girl has developed enough body fat or has reached the critical weight that is believed to be around 95 lbs or 43 kgs.

• Under the stimulation hypothalamus the pituitary glands release GONADOTROPIN hormones.

• The first sign of pubescence in females is usually breast bud formation. Puberty ends with menarche which occurs approximately two years after thelarche .

Puberty Changes in Females

o Breast bud formationo Pubic and axillary hair

processo Growth spurtso Increase in body fats as

distributed in the breast, mons pubis, hips and thighs

o Vagina lengthens and become rugated

o Labia majora and minora becomes thickened and rugated

Puberty Changes in Males

o Testicular enlargement o Development of penis and

scrotum to adult size and shape is achieved between 12 to 17

o Deepening of the voice due to hormonal influence to the vocal cords

o Onset of spermatogenesiso Growth spurts

Female External Genitalia

Female External Genitalia• Vulva or Pudenda• Mons Pubis or Mons

Veneris• Labia Majora• Labia Minora• Clitoris• Vestibule• Bartholin’s Glands• Skenes’s Glands• Vaginal Orifice• Hymen• Urethral Meatus

Female External Genitalia

• Vulva or Pudenda refers to the entire female genitalia.

• Mons Pubis is a fold of fats above the symphysis pubis that is an important obstetrical landmark and protects the symphysis pubis from trauma.– It is richly supplied with

sebaceous glands– “Escutcheon” curly hair

Female External Genitalia

o Labia Majora are thick folds of adipose tissues originating from the mons and terminating in the perineum. o Its functions is to provide covering

and protection to the external organs located under it

o Labia Minora are two thin folds of connective tissues that joins anteriorly to form the prepuce and posteriorly to form the fourchetteo It is moist highly vascular, sensitive

and richly supplied with sebaceous glands

Female External Genitalia

• Clitoris is highly sensitive and erectile tissue under the prepuce o “seat of a woman’s sexual arousal

and orgasm”o It is surrounded by many sebaceous

glands that produce a cheese like secretion called “smegma”

o Vestibule triangular space between the labia minora and where the urethral meatus, Bartholin's glands and Skene’s gland are located

o Bartholin’s Gland pair of glands that are also known as “vulvovaginal gland or paravaginal gland”

Female External Genitalia

• Skene’s Gland are a pair of gland also known as “paraurethral and minor vestibular gland”

• Vaginal Orifice or introitus is the external opening of the vagina located just below the urethral meatus.o The Grafenburg or the G Spot is a very

sensitive area located at the inner anterior surface of the vagina.

o Urethral Meatus the external opening of the female urethra is located just below the clitoris

• Hymen is a thin circular membrane made of elastic tissue situated at the vaginal opening that separates the internal organs from the external organs.

• Urethral Meatus the external opening of the urethra is located just below the clitoris.

The NERVE and BLOOD SUPPLY

• The anterior portion’s nerve supply is derived

from L1 and the posterior portion is

derived from S3• Blood supply to the vulva is provided by the pudenda artery and the

inferior rectus artery

THE FEMALE INTERNAL ORGANS

• Vagina is a hollow membranous and muscular canal about 8 to 12 cm located in front of the rectum and behind the bladder

• The external opening of the vagina is encircled by the BULBOCAVENOUS muscle that acts as the voluntary sphincter.

THE FEMALE INTERNAL ORGANS

• Rugae are transverse folds of skin in the vaginal wall

• Vaginal PH before puberty is 6.8 to 7.2. After puberty vaginal PH becomes acidic going down to a PH of 4-5.

• Doderlein Bacilli a bacteria that is normally present in the vaginal mucus into lactic acid.

The UTERUS • The uterus is a hollow muscular, pear shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum.

• With maturity the uterus is approximately 5 to 7cm long, 5 cm wide and in its widest upper part is 2.5cm deep.

The UTERUS

FUNCTIONS OF THE UTERUS

It is the cardinal organ of reproduction

Organ of menstruation

Uterine contraction expel the fetus during labor and to seal torn blood vessels after delivery of the placenta.

The UTERUSPARTS OF THE UTERUS

The CORPUS is the uppermost part and forms the bulk of the uterus. Makes up the 2/3 of the organ. This houses the growing fetus.

The ISTHMUS is the short segment between the isthmus and the cervix

CERVIX considered as the neck of the uterus. The cervix is composed of elastic collage nous tissue and only 10% muscle fibers.

The UTERUSLayers of the UTERUS

PERIMETRIUM the outermost serosal layer attached to the broad ligament

MYOMETRIUM the middle muscular layer responsible for uterine contraction during labor

ENDOMETRIUM the innermost ciliated mucosal layer containing numerous uterine glands.

The UTERUS

UTERINE LIGAMENTS1. CARDINAL LIGAMENTS (2)2. BROAD LIGAMENTS (2)3. ROUND LIGAMENTS (2)4. UTEROSACRAL (2)5. ANTERIOR 6. POASTERIOR

The UTERUS

The large descending AORTA divides to form two iliac arteries, main division of the iliac arteries or hypo gastric arteries.

Ovarian Artery is a direct branch of the aorta.

The FALLOPIAN Tube (OVIDUCTS)

• The oviducts are a pair of tube-like structure originating from the cornua of the uterus.

• Each tube is about four inches long and ¼ inch in diameter.

The FALLOPIAN Tube (OVIDUCTS)

FUNCTIONS OF THE OVIDUCTS Transport ovum from the

ovary to the uterus The site of fertilization Provides nourishment to the

ovum during its journey

The FALLOPIAN Tube (OVIDUCTS)

PARTS OF THE FOLLOPIAN TUBE

INTERSTITIAL/INTAMURAL thick walled located inside the uterus

ISTHMUS the narrowest portion of the FT.

AMPULLA the middle portion and the widest part.

INFUNDIBULUM the most distal portion. It has fingerlike projection called FIMBRA.

OVARIES

OVARIES

The ovaries are almond shape glandular organs located on either side of the uterus.

Before puberty the ovaries are smooth, flat ovoid organs.

Each ovary weighs between 6 to 9 grams, 1.5 to 3 cm wide and 2 to 5 cm long.

OVARIES

FUNCTIONS OF THE OVARIES

OOGENESIS OVULATION HORMONE PRODUCTION

The MAMMARY GLANDS

The MAMMARY GLANDS

The MAMMARY GLANDS

EXTERNAL STRUCTURES NIPPLE OR MAMMARY PAPILAE AREOLA MONTGOMERY TUBERCLES

INTERNAL STRUCTURE LOBES LOBULES ACINI CELLS LACTIFEROUS DUCTS LACTIFEROUS SINUS

The MAMMARY GLANDS

HORMONES THAT INFLUENCE THE MAMMARY GLANDS

ESTROGEN PROGESTERONE HPL OXYTOCIN PROLACTIN

The PELVIS

The PELVIS

For a baby to be delivered vaginally, he/she must be able to pass through the ring of pelvic bone. The pelvic serves to both support and protect the reproductive and the other pelvic organs

The pelvis is divided into three parts: ILIUM forms the upper lateral

portion. ISCHIUM forms the lower portion PUBIS anterior portion of the bone.

The Symphysis Pubis is the junction of the innominate bone at the front of the pelvis

The PELVIS

For obstetrical purposes, the pelvis is further divided into the FALSE Pelvis (superior half) and the TRUE Pelvis (inferior half).

The LINEA TERMINALIS divides the true and the false pelvis.

Male Reproductive System

Male Reproductive System

Male External OrganPenis the male organ of

copulation and urinationComposed of longitudinal erectile tissue: Corposa Cavernosa and Corposa Spongiosum

Male Reproductive System

Male External OrganPARTS OF PENIS: Shaft or body Glans Penis Prepuce or foreskin Urethral Meatus

Male Reproductive System

Male External OrganSCROTUM sac like

structure that contains the testes that hangs behind the penis. The scrotum has no subcutaneous fat because the testes must be kept cool.

Male Reproductive System

TESTES are oval shaped glandular organ lying within the abdominal cavity early fetal life and descend in the scrotum after 28 weeks gestation.

FUNCTIONS: Hormone Production Spermatogenesis

PARTS: Seminiferous Tubules Leydig Cells Sertoli Cells

EPIDIDYMIS is a long coiled tube approximately 20 feet long and at which the sperms travels for 12 to 20 days after it leaves the testis.

VAS DEFERENS it forms the passageway of the sperm cells. The contractile power of the VD propels the sperm to the urethra during ejaculation

SEMINAL VESICLE these are two pouch-like organs consisting of many saclike structure located next to the VD and lying post to bladder and ant to the rectum

EJACULATORY DUCT the two ED pass through the urethra and connect the urethra carrying the secretion of the SV.

PROSTATE GLAND is a walnut shape body lying inf to the bladder surrounding the urethra and the ED. It secretes a thin milky alkaline fluid that enhance the sperm survival.

COWPER’S GLAND these are small glands that are located inf to the PG and secretes an alkaline fluid

SEMEN• Seminal Fluid or

semen is a mixture of secretions from SV, PG, CG,ED and the sperm.

• Emission is the discharge of semen from urethra

• Ejaculation is the forceful expulsion of semen

• It is alkaline in nature and is high in basic sugar and protein, particularly mucin

Stages of Male and Female Sexual

ResponsePhase 1 is the

EXCITEMENTPhase II is the

PLATEAUPhase III is the

ORGASMPhase IV is the

Resolution

EXCITEMENT

• In response to sexual stimuli (whether psychological in the form of sexual thoughts or fantasies, or physical in the form of physical stimulation) the process of vasocongestion occurs, where more blood flows into the penis than is flowing out, and the result will usually be that a man will get an erection. How long this takes, and what the erection feels like will differ from man to man, and for the same man over time. Physical changes may include:

• -There are also changes in the scrotum and testes, with the testes increasing in size and the scrotum elevating, coming closer to the body. -The skin may become flushed; men may experience heightened sensitivity in parts of their body, like the nipples.

• -Some increase in heart rate, blood pressure, and muscle tension.

PLATEAU

• With continued sexual stimulation this phase represents the time between the initial arousal and excitement, up until orgasm. For many men the plateau phase is very short, but this is the phase that men can extend as a way of controlling premature ejaculation. Physical changes during this phase may include:

• -An increase in the size of the head of the penis, and the head may also change color, becoming purplish. -The Cowper's gland secretes fluid, often referred to as pre-cum, which comes out of the tip of the penis. -The testes move further in towards the body, and increase in size. -There may be a sex flush, muscle tension, increase in heart rate and rising blood pressure.

ORGASM

• In the first stage: -Contractions in the vas deferens, seminal vesicles, and the prostate causes seminal fluid ("come" or ejaculate) to collect in a pool at the base of the penis, in the urethra. This collection is usually felt as a "tickling" type sensation.

• In the second stage of the orgasmic phase:-Contractions of muscles occur in a "throbbing" manner around the urethra, and propel ejaculate through the urethra and out of the body. -These contractions (which occur at different speeds, and in different amounts) are usually what are experienced as highly pleasurable feelings of release.

RESOLUTION

• Resolution phase refers to the period of time immediately following an orgasm, when the body begins to return to its "normal" state. This phase includes: -The loss of the erection as the blood flows out of the penis, which happens in two stages over the period of a few minutes. -The scrotum and testes return to normal size. -A general feeling of relaxation.

Menstrual CycleMenstrual Cycle can be defined as periodic uterine bleeding in response to cyclic

hormonal changes.

Menarche is the term applied to the first menstruation period of girls.

Menopause is the cessation of menstrual cycle .

Postmenopausal is the time of life following menopause.

Premenopausal is the time when menopausal changes are occuring.

Characteristics of Normal Menstrual CycleBeginning Ave. Range 12 or 13, 9 to 17

Interval Ave 28 days, cycle of 20 to 45 day is not unusual

Duration Ave. flow; 3-7 days; Range 1-9 daysAmount of flow Difficult to estimate: average of 25 to 50 ml per

menstrual period

Color of menstrual flow

Dark red: a combination of blood, mucus and endometrial cells

Odor of menstrual flow Odor of marigold

Body Structures and Hormones of the Menstrual

Cycle1. Hypothalamus is the ultimate initiator of

the menstrual cycle. (GNRH)2. The Pituitary Gland in response from the

hypothalamus and low serum estrogen and progesterone level APG release the GH (FSH and LH)

3. The Ovaries during the first half of the cycle it produces estrogen and progesterone during the second half of the cycle.

4. The Uterus changes that occur in the uterine endometrial are due to the influence of the ovarian hormone estrogen and progesterone.

Estrogen and ProgesteroneEstrogen

“Hormone of Women” Breast growth Development of the female

reproductive organ Pattern of hair growth Stimulate the proliferation of the

endometrium resulting in endometrial thickening

Causes mucus to be thin, transparent and highly stretchable

Stimulates the growth of the ductile structure of the breast

Estradiol, Estrone, Estriol

Progesterone “Thermogenic Effect” Relaxes uterine muscle Promotes growth of the

acini cells of the breast Causing weight gain by

promoting fluid retention Causes tingling sensation

and feeling of fullness in the breast before menstruation

Pregnanediol

Estrogen and ProgesteroneEstrogen

inhibit production of FSH ( maturation of ovum)

hypertrophy of myometrium

Spinnbarkheit & Ferning ( billings method/ cervical)

development ductile structure of breast

increase osteoblast activities of long bones

increase in height in female

causes early closure of epiphysis of long bones

causes sodium retention

increase sexual desire

Progesterone

inhibit prod of LH (hormone for ovulation)

inhibit motility of GIT

mammary gland development

increase permeability of kidney to lactose & dextrose causing (+) sugar

causes mood swings in moms

increase BBT

Signs of Ovulation

Mittelschmerz refers to the lower abdominal pain felt at the side of the ovary that released the ovum.

Spinnbarkheit is characterized by cervical mucus that is thin, watery or transparent abundant and highly stretchable. When viewed under the microscope the mucus will reveal a fern pattern.

Increased basal body temperaturePeak blood level of LH occurs 24 to 48

hours before ovulation

The primary purpose of menstrual cycle is to prepare the uterus for pregnancy. In healthy women, menstrual cycle continues from puberty to menopause, interrupted only by pregnancy and lactation.

During each reproductive cycle low level of ovarian hormone stimulates the Hypothalamus to release GnRH to stimulate the APG to release FSH that is active early in the cycle and is responsible in the maturation of the ovum and LH that is most active during the midpoint of the cycle and is responsible for ovulation.

Each female reproductive cycle has two components: the OVARIAN cycle and the UTERINE cycle. Ovulation takes place during the 14th day of the 28th day cycle. The 14 days prior to Ovulation is known as Follicular phase, while the 14 days following ovulation is the Luteal Phase. The Ovarian cycle is regulated by changing levels of LH and FSH. Ovulation takes place on the 14 day of the 28 day cycle of the uterine cycle. The 14th day prior to ovulation is subdivided into two; the Menstrual Phase (days 1-5) and the Proliferative phase (6 to 14). The 14 days after ovulation constitute the Secretory Phase. The uterine cycle is controlled by the ovarian hormone Estrogen and Progesterone.

The Follicular Phase is the time before ovulation. It is called follicular phase because the main event at this phase is the formation of the Graafian follicle from Primordial follicles. During the follicular phase FSH stimulate the development of around 30 follicles in each ovary. But among these many developing follicles only one will be selected to reach full maturity and will release the ovum. FSH also stimulates the Graafian follicle to secrete estrogen that is responsible for many body changes during this period.

Around 24-46 hours before ovulation, as serum estrogen levels peaks, there also occurs a surge in production of LH by the APG which causes the follicle to reach full maturity and rupture thereby releasing the ovum within it an event known as Ovulation. The Luteal Phase after ovulation the empty follicles is transformed into a yellowish body called Corpus Luteum that produces large amount of progesterone and some estrogen under the stimulation of LH. Progesterone causes secretory changes in the endometrium in preparation for implantation and other bodily changes different from ones cause by estrogen.

The Corpus Luteum has a lifespan of 7 days only. Eight days after ovulation the corpus Luteum begins to regress resulting in declining serum progesterone level.

• The Menstrual Phase begins on the first day of menses and extends approximately over first 5 days of the 28 day cycle. Menstruation is caused by the corpus Luteum regression and the consequent withdrawal of the progesterone and estrogen. About 2/3 of the endometrium is shed off every menstrual period. Uterine discharge includes mucus and epithelial cells in addition to blood. The average blood los during menstruation ranges from 30 to 80ml. In woman’s lifetime she loss 10 to 20 liters of blood due to menstruations. The average loss of iron during menstruation is between 12 to 29 mg.

• During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3rd day and highest a day before ovulation.

During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8 th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3 rd day and highest a day before ovulation. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8 th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3 rd day and highest a day before ovulation.

• Progesterone causes the blood vessels in the endometrium to dilate and assumes a spiral or corkscrew shape. The corpus Luteum has an average lifespan of about 7 to 8 days.

• If fertilization does not takes place the CL shrivels. Degeneration of the CL results in progesterone withdrawal which effect leads to the formation and released prostaglandin and possibly endothelin-1. These substance causes vasospasm of the spiral arteries and contraction of myometrium.

• Spasm cuts off blood supply to the uterus causing tissues ischemia, necrosis and rupture of blood vessels that eventually leads to endothelial sloughing of the upper two layers of the endometrium.

• Near the end of the secretory phase, just before the start of menstrual flow, regeneration begins from the retained basal layer. Rebuilding the endometrium from the basal layer going upward is responsible for its healing and rejuvenation without scar formation.

During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8 th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3 rd day and highest a day before ovulation. During the Proliferative Phase estrogen promotes the growth of new cells and capillaries in the endometrium. As a result the endometrium thickens by as much as 8 th folds and become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates the cervical glands to produce abundant amount of mucus that is thin watery, stretchable and transparent. Serum estrogen is lowest on the 3 rd day and highest a day before ovulation.

Signs and Symptoms of Menopause

The signs and symptoms of menopause are evident in the parts of the body most affected by the decline in the hormones estrogen and progesterone.

I. Urogenital Tract. Bladder: dysuria, incontinence, urinary frequency and increased

incidence of cystitis Uterus: atrophy of uterus Vagina: decrease mucus production causing dryness and dyspareuniaII. Circulatory System Hot Flashes Increased Cholesterol increased the risk of CVDIII. Mood irritability, loss of sexual desire, depression anxietyIV. Musculoskeletal: Osteoporosis

V. Other signs and Symptoms: Sleep disturbance characterized by unusual dreams and early morning

awakenings Allergies Appearance of facial hair Weight gain Dizziness Loss of breast mass and firmness

Sexuality and Sexual IdentitySexuality “multidimensional phenomenon

that include feelings, attitudes and actions. It has both biological and cultural components. It encompasses and gives direction to a person’s physical, emotional, social and intellectual response throughout life”

Sex is the term used to denote chromosomal sexual development

Gender Identity is the inner sense a person has of being male or female. Sense of femininity or masculinity. 2-4 yrs/3 yrs gender identity develops.

Role Identity attitudes, behaviors and attributes that differentiate roles

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