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Maternal and Child Health Nursing

Maternal and Child Health Nursing

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Published by naithan

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Published by: naithan on Dec 02, 2009
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Maternal and Child Health Nursing involves care of the woman and familythroughout pregnancy and child birth and the health promotion and illness carefor the children and families.Primary Goal of MCN1The promotion and maintenance of optimal family health to ensurecycles of optimal childbearing and child rearing
1.OvariesoAlmond shapedoProduce, mature and discharge ovaoInitiate and regulate menstrual cycleo4 cm long, 2 cm in diameter, 1.5 cm thickoProduce estrogen and progesterone
Estrogen: promotes breast dev’t & pubic hair distribution prevents osteoporosiskeepskeeps cholesterol levels reduced & so limits effects of atherosclerosis Fallopian tubes..
Approximately 10 cm in lengthConveys ova from ovaries to the uterusSite of fertilizationParts: interstitialisthmus – cut/sealed in BTLampulla – site of fertilizationinfundibulum – most distal segment; covered with fimbria2. UterusHollow muscular pear shaped organ
uterine wall layers: endometrium; myometrium; perimetriumOrgan of menstruationReceives the ovaProvide place for implantation & nourishment during fetal growthProtects growing fetusExpels fetus at maturityHas 3 divisions: corpus – fundus , isthmus (most commonly cut during CS delivery) andcervix 3. Uterine WallEndometrial layer: formed by 2 layers of cells which are as follows:basal layer- closest to the uterine wallglandular layer – inner layer influenced by estrogen and progesterone; thickens and shed off as menstrual flowMyometrium – composed of 3 interwoven layers of smooth muscle; fibers are arranged in longitudinal; transverse andoblique directions giving it extreme strengthVaginaActs as organ of copulationConveys sperm to the cervixExpands to serve as birth canalWall contains many folds or rugae making it very elastic
Fornices – uterine end of the vagina; serve as a place for pooling of semen following coitusBulbocavernosus – circular muscle act as a voluntary sphincter at the external opening to thevagina (target of Kegel’s exercise)
the stage of life at which secondary sex changes beginsthe development and maturation of reproductive organswhich occurs in female 10-13 years old & male at 12-14 yrs old
serve as a
or regulationmechanism set to “
turn on
” gonad
at this age
2. Reproductive Development
Readiness for child bearing
begins during intrauterine lifefull functioning initiated at puberty
releases the
which triggers the APG to form and release FSH and LH 
. (FSH & LH initiates production of androgen and estrogen --->
2° sexualcharacteristics
Role of Androgen
Androgenic hormones – are produced by the testes, ovaries and adrenal cortex which is responsible for:muscular developmentphysical growthinc. sebaceous gland secretions
–primary androgenic hormone
Related terms
a. Adrenarche – the development of pubic and axillary hair (due to androgen stimulation)b. Thelarche – beginning of breast developmentc. Menarche – first menstruation period in girls (early 9 y.o. or late 17 y.o.)d. Tanner StagingIt is a rating system for pubertal developmentIt is the biologic marker of maturityIt is based on the orderly progressive development of:breasts and pubic hair in femalesgenitalia and pubic hair in males
3. Body Structures Involved
HypothalamusAnterior Pituitary GlandOvaryUterus
4. Menstrual Cycle
Female reproductive cycle wherein periodic uterine bleeding occurs in response to cyclic hormonal changesAllows for conception and implantation of a new lifeIts purpose it to bring an ovum to maturity; renew a uterine bed that will be responsive to the growth of a fertilizedovum
5. Menstrual PhasesFirst
: 4-5 days after the menstrual flow; the endometrium is very thin, but begins to proliferate rapidly; thicknessincrease by 8 folds under the influence of increase in estrogen levelalso known as: proliferative; estrogenic; follicular and postmentrual phase
y: after ovulation the corpus luteum produces progesterone which causes the endometrium become twisted inappearance and dilated; capillaries increase in amount (becomes rich, velvety and spongy in appearance also knownas: secretory; progestational; luteal and premenstrual
if no fertilization occurs; corpus luteum regresses after 8 – 10 days causing decrease in progesterone and estrogenlevel leading to endometrial degeneration; capillaries rupture; endometrium sloughs off ; also known as:ishemic
Final phase
: end of the menstrual cycle; the first day mark the beginning of a new cycle; discharges contains blood fromruptured capillaries, mucin from glands, fragments of endometrial tissue and atrophied ovum.
Physiology of Menstruation
About day 14 an upsurge of LH occurs and the graafian follicle ruptures and the ovum is releasedAfter release of ovum and fluid filled follicle cells remain as an empty pit; FSH decrease in Amount; LH increasecontinues to act on follicle cells in ovary to produce lutein which is high in progesterone ( yellow fluid) thus thename corpus luteum or yellow bodyCorpus luteum persists for 16 – 20 weeks with pregnancy but with no fertilization ovum atropies in 4 – 5 days, corpusluteum remains for 8 -10 days regresses and replaced by white fibrous tissue, corpus albicans
Characteristics of Normal Menstruation Period
Menarche – average onset 12 -13 yearsInterval between cycles – average 28 daysCycles 23 – 35 daysDuration – average 2 – 7 days; range 1 – 9 daysAmount – average 30 – 80 ml ; heavy bleeding saturates pad in <1hourColor – dark red; with blood; mucus; and endometrial cells
Associated Terms
1. Amenorrhea - temporary cessation of menstrual flow2. Oligomenorrhea - markedly diminished menstrual flow3. Menorrhagia - excessive bleeding during regular menstruation4. Metrorrhagia - bleeding at completely irregular intervals5. Polymenorrhea - frequent menstruation occurring at intervals of less than 3 weeks 
Occurs approximately the 14th day before the onset of next cycle (2 weeks before)If cycle is 20 days – 14 days before the next cycle is the 6th day, so ovulation is day 6If cycle is 44 days – 14 days, ovulation is day 30.Slight drop in BT (0.5 – 1.0 °F) just before day of ovulation due to low progesterone level then rises 1°F on the dayfollowing ovulation (spinnbarkheit; mittelschmerz)If fertilization occurs, ovum proceeds down the fallopian tube and implants on the endometrium
oMechanism- a transitional phase (period of 1 – 2 years) called
, heralds the onset of menopause.oMonthly menstrual period is less frequent, irregular and with diminished amount.oPeriod may be ovulatory or unovulatory - advised to use Family planning method until menses havebeen absent for 6 continuous monthsoMenopause is has occurred if there had been no period for one year.
Classical signs:
Vasomotor changes due to hormonal imbalancea.hot flushesb.excessive sweating especially at nightc.emotional changesd.insomniae.headachef.palpitationsg.nervousnessh.apprehensioni.depression j.tendency to gain weight more rapidlyk.tendency to lose height because of osteoporosis (dowager hump)l.arthralgias and muscle painsm.loss of skin elasticity and subcutaneous fat in labial folds
 Artificial menopause / surgically induced menopause
a.oophorectomy or irradiation of ovariesb.panhysterectomy
1.physiologic method: oral contraceptives ; natural methods

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