Professional Documents
Culture Documents
The primary role of the nurse concerning reproductive anatomy and physiology
is education.
I. ASSESSMENT:
•Gonad- is a body organ that produces sex cell ( ovary for females and testis for
male).
•Week 12:
(+) testosterone
-penile tissue elongates
-Urogenital fold on the ventral surface of the penis
closes to form the urethra
-scrotal tissue
(-) testosterone
-Urogenital fold remains open to form labia minora
-labia majora
REPRODUCTIVE AND SEXUAL HEALTH
PUBERTAL DEVELOPMENT:
DIAGNOSTIC FUNCTION:
•AMNIOCENTESIS – removal of amniotic fluid to diagnose
chromosomal abnormalities.
Before this time corpus luteum which produces the hormones necessary to
maintain pregnancy.
Placenta serves the ff purpose.
•Respiratory system (lungs)
•Circulatory system
•Endocrine system
•3 subtypes of Estrogen:
•Estrone(E1)- post menopausal women
•Estradiol(E2)- non-pregnant
•Estriol(E3)- pregnancy
Conception
The penetration of one ovum (female gamete) by one sperm (male
gamete) resulting in a fertilized ovum (zygote). Each gamete has haploid number
(23). Zygote has a diploid number(46) with one of each pair from each parent.
•Ductus venosus connects umbilical vein and inferior vena cava; bypassing portal
circulation; closes after birth
•Foramen ovale allows blood to flow from right atrium to left atrium, bypassing
lungs. Closes functionally at birth because of increased pressure in left atrium;
anatomic closure may take several weeks to several months.
•Ductus arteriosus allows blood flow from pulmonary artery to aorta, by passing fetal
lungs; closes after delivery.
B. Ovaries:
1. No ovulation during pregnancy
2. Corpus Luteum persists in early pregnancy until development of placenta is
complete.
E. Cervix
–Softens and loosens in preparation for labor and delivery (Goodell’s sign).
–Mucous production increases and plug (Operculum) is formed as bacterial
barricade.
F. Uterus
–Hypertrophy and hyperplasia of muscle cells.
–Development of fibroelastic tissue that increases ability to contract
–Shape changes from pearlike to ovoid
–Rises out of pelvic cavity by 16th week of pregnancy
–Increased vascularity and softening of isthmus (Hegar’s sign)
–Mild contractions (Braxton Hick’s sign) beginning in the fourth month through
end of pregnancy.
PHYSICAL AND PSYCHOLOGIC CHANGES OF PREGNANCY
Reproductive System continue…
G. Breasts
–Increased vascularity; sensitivity and fullness
–Nipples and areola darkens
–Nipples becomes more erectile
–Proliferation of ducts and alveolar tissue evidenced by increased breast size.
–Production of colostrums by the second trimester
PHYSICAL AND PSYCHOLOGIC CHANGES OF PREGNANCY
Cardiovascular System
–Blood volume expands as much as 50% to meet demands of new tissue and
increased needs of all systems.
–Progesterone relaxes smooth muscle, resulting in vasodilatation and
accommodation of increased volume.
–RBC volume increases as much as 30%; may be slight decline in hematocrit as
pregnancy progresses because of this relative imbalance (physiologic anemia).
–Stroke volume and cardiac output increase.
–WBC’s increased.
–Greater tendency to coagulation.
–Blood pressure may drop in early pregnancy; should not rise during last half of
pregnancy.
–Heart rate increases; palpitation possible
–Blood flow to uterus and placenta is maximized by side-lying position.
–Varicosities may occur in vulva and rectum as well as lower extremities.
PHYSICAL AND PSYCHOLOGIC CHANGES OF PREGNANCY
Respiratory System
Renal System
–Possible headache
Neurologic System
–Few changes with a typical pregnancy
–Pressure on sciatic nerve may occur later in pregnancy due to fetal position.
–Pancreas may be stressed due to complete interaction of glucose metabolism, HPL and
cortisol, resulting in diminished effectiveness of insulin and demand for increased
production.
B. Second trimester
–Mother demonstrates growing realization of baby as separate and needing person.
–Fantasizes about unborn child.
C. Third trimester
–“Nesting” activity appears as due date approaches
–Desire to be finished with pregnancy.
–Anxiety over “safe passage” for self and baby through labor and delivery.
–Reactions of father-to-be may parallel those of mother
(e.g ambivalence, anxiety). “COUVAGE SYNDROME”
5. Preparation of siblings varies according to their age and experience.
THE ANTEPARTAL PERIOD
ASSESSMENT
Classification of Pregnancy:
ASSESSMENT
Determination of Pregnancy
Diagnosis of pregnancy is based on pregnancy-related physical and hormonal
changes and are classified as presumptive, probable or positive
ASSESSMENT
Determination of Pregnancy
B. Probable Signs and Symptoms (Objective)
These changes are usually noted by the health care provider but are still not
conclusive for pregnancy.
–Uterine enlargement
–Changes in the uterus and cervix from increase vascularity
–Ballottement: fetus rebounds against the examiner’s hand when pushed gently
upwards.
–Braxton Hick’s contractions: occurs early in pregnancy, although not usually
sensed by the mother until the third trimester
–Laboratory test for pregnancy
–Most tests rely on the presence of HCG in the blood or urine of the woman
–Easy, inexpensive, but may give false readings with any handling error,
medications or detergent residue in laboratory equipment.
ASSESSMENT
Determination of Pregnancy
B. Probable Signs and Symptoms (Objective) continue:
8. Exception is the radioimmunoassay (RIA) which tests for the beta subunit
of HCG and is considered to be so accurate as to be diagnostic for pregnancy
9. Changes in skin pigmentation.
ANALYSIS
–Nursing diagnoses for the antepartal period may include:
–Knowledge deficit: information on the following topics needs to be given and
reinforced
–Alteration in nutrition potential: individualized nutritional information will be
needed
–Activity intolerance: need for additional rest and benefits of a moderate exercise
program
–Anxiety
–Constipation, potential
–Body image disturbance
–Alteration in comfort
–Individual coping, ineffective
–Powerlessness
–Noncompliance
–High risk for fluid volume deficit
–Health-seeking behaviors
THE ANTEPARTAL PERIOD
Interventions
Prenatal care
A. Time frame
–First visit: may be made as soon as woman suspects she is pregnant;
frequently after first missed period.
–Subsequent visit: Every mon. until the 8th mon., qo 2 wks during the 8th mon
and wkly during the 9th mon more frequent visits are scheduled if problem arise
THE ANTEPARTAL PERIOD
Interventions
Prenatal care continue:
1. Extensive collection of data about client in all pertinent areas in order to form
basis for comparison with data collected on subsequent visits and to screen for
any high-risk factors.
a. Menstrual history: menarche, regularity, frequency and duration of flow, last
period.
b. Obstetrical history: all pregnancy, outcome, complications, contraceptive
use, sexual history.
c. Medical history: include past illnesses, surgeries; current use of medication
d. Family history/ psychosocial data
e. Information about the father-to-be may also be significant
f. Current concerns.
THE ANTEPARTAL PERIOD
Interventions
Prenatal care continue:
Interventions
Prenatal care continue:
Interventions
Nutrition during Pregnancy
A. Weight gain
–Variable, but 25 lb usually appropriate for average woman with single
pregnancy
–Woman should have consistent, with only 2-3 lb in first trimester, then average
12 oz gain every week in second and third trimesters.
–Gain mostly reflect maternal tissue in second half of pregnancy
Interventions
Nutrition during Pregnancy
C. Dietary supplements: many health care providers supplement the pregnant
woman’s diet with an iron-fortified multivitamins to ensure essential levels
D. Special concerns
–religious, ethics, and cultural practices that influence selection and preparation
of foods
–Pica (ingestion of non-edible or nonnutritive substances)
–Vegan vegetarians- no meat products, may need B12 supplement
–Adolescence
–Economic deprivation
–Heavy smoking, alcohol consumption, drugs
–Previous reproductive problems
Interventions
–Topics can be grouped into early and late pregnancy, labor an delivery, and post
delivery/newborn care.
Interventions
Determination of Fetal Status and Risk Factors
2. Types
•Chorionic vili sampling (CVS): earliest test possible on fetal cells; sample
obtained by slender catheter passed through cervix to implantation site.
THE ANTEPARTAL PERIOD
Interventions
Determination of Fetal Status and Risk Factors
A. Fetal diagnostic tests
2. Types continue…
Interventions
Determination of Fetal Status and Risk Factors
A. Fetal diagnostic tests
2. Types continue:
•Creatinine level: estimates fetal renal maturity and function, uses amniotic
fluid
Interventions
Determination of Fetal Status and Risk Factors
A. Fetal diagnostic tests
2. Types continue:
–At 35-36 weeks , ratio is 2:1, indicative of mature levels; once ratio of 2:1 is
achieved, newborn less likely to develop respiratory distress syndrome.
Interventions
Determination of Fetal Status and Risk Factors
A. Fetal diagnostic tests
2. Types continue:
Interventions
Determination of Fetal Status and Risk Factors
B. Electronic Monitoring
c. Non-invasive
Interventions
Determination of Fetal Status and Risk Factors
B. Electronic Monitoring
Interventions
Methods of Childbirth
Read method
The so-called “natural” childbirth method. Underlying concept: knowledge
diminishes the fear that is key to pain. Classes include information as well as
practice in relaxation and abdominal breathing techniques for labor.
Lamaze method
Psychoprophylactic method based on utilization of Pavlovian conditioned
respond theory. Classes teach replacement of usual response to pain with new,
learned responses (breathing, effleurage. Relaxation) in order to block
recognition of pain and promote positive sense of control in labor
Bradley method
Husband-coached childbirth. A modification of the Read method emphasizing
working in harmony with the body.
EVALUATION:
•Maternal /fetal assessment data remain within acceptable limits: fetus maintains
growth and development pattern appropriate to gestational age (evidenced by
maternal weight gain, normal increments in fundal heights, fetal activity level, other
antepartal tests).