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TYPES OF SEXUAL ORIENTATION 1. HETEROSEXUALITY: one who finds sexual fulfillment with a member of the opposite sex. Because interest in the opposite sex and sexual relationships may begin as early as the beginning of puberty. (10-12 Yrs old.) , HC providers need to provide information on safe sex practices as early as this age for the information and the knowledge to be most helpful. 2. HOMOSEXUALITY: is finding sexual fulfillment wit a member of his/her own sex. Why homosexual gender identity develops is unknown, although most individuals who are homosexual report a realization that they are “different” even as early as before puberty. It is probably during their adolescence in seeking a sense of identity that they realize that the reason they feel “different “is because they are homosexual. It is important that health care providers be sensitive to their needs in this time of identity formation. There is a higher suicide risk found in gay and lesbian adolescents because of either fear of social stigma, or having the turmoil of identity confusion. 3. BISEXUALITY: people who are bisexual achieve sexual satisfaction from both homosexual and heterosexual relationships. Gay and bisexual men have a higher risk for acquiring STD’s. The role of the HC provider is to ensure that sufficient information and knowledge about HIV and STD’s are given. 4. TRANSSEXUALITY: a transsexual individual is one who, although of 1 biologic gender feels as if he/ she should be of the opposite gender. Such people may undergo sex change so they appear cosmetically as the sex they envision themselves to be. Although the person becomes capable of sexual intercourse in this new role, they are incapable of reproduction. STAGES OF FETAL DEVELOPMENT: fetal growth and development is divided into 3 periods: 1. pre- embryonic- 1st 2 weeks beginning with fertilization 2. embryonic- from weeks 3-8 3. fetal- from week 8 through birth
FERTILIZATION: the union of the ovum and the spermatozoon. Usually occurs in the distal third portion of the fallopian tube. • life span of sperm cell- 48-72 hours • life span of egg cell- 24-42 hours an ejaculation of semen averages 2.5ml of fluid containing 50-200million sperm cells per ml. at the time of ovulation, there is a decrease in the thickness of the cervical mucous making it easier to be penetrated by the sperm cell. Sperm cells deposited in the vagina during intercourse generally reach the cervix within 90 seconds and the outer end of the fallopian tube within 5 minutes after deposition. Sperm cells move by means of their flagella (tails) and with the help of uterine contractions through the cervix, the body of the uterus, to the fallopian tubes, and to the waiting ovum. A proteolytic enzyme (HYALURONIDASE) acts to dissolve the layer protecting the ovum, making it easier to penetrate. Immediately after the penetration of the sperm cell to the ovum, the chromosomal material of the sperm and the ovum fuse. The resulting structure is called the ZYGOTE. Fertilization depends on at least 3 factors: a. maturation of both the sperm and the ovum b. ability of the sperm to reach the ovum c. ability of the sperm to penetrate the ovum
IMPLANTATION: - Once fertilization is complete, the zygote migrates towards the body of the uterus. This usually takes 3-4 days. During this time, mitotic cell division/ cleavage begins. The 1st cleavage occurs about 24 hours. By the time the zygote reaches the body of the uterus, it already consists of 1650 cells. At this stage, because of its bumpy outward appearance, it is termed as the MORULLA (mulberry). - The morulla continues to multiply as it floats free in the uterine cavity for 3-4 more days. At this stage, the structure is called a BLASTOCYST. It is this structure that attaches to the endometrium of the uterus. - Implantation occurs approximately 8-10 days after fertilization. - Then these 3 stages follow: 1. The blastocyst brushes against the endometrium (apposition). 2. it attaches to the surface of the endometrium (adhesion)
Ms. April Anne D. Balanon
thus preventing premature labor. As early as the 11th or 12th day. The decidua has 3 separate areas: a. It protects the umbilical cord from pressure. it shields against pressure or a blow to the mother’s abdomen b. and then settles down into the soft folds of the endomentrium (invasion) The implantation point is usually high in the uterus. Amniotic fluid is slightly alkaline with a pH of about 7. on the posterior surface. FETAL DEVELOPMENT MILESTONES: The length of the pregnancy is generally measured from the first day of the last menstrual period ( GESTATIONAL AGE ) - end of the 4th gestational week 2 GreywolfRed Ms.the placenta (Latin for pancake) arises out of trophoblast tissue. and supports the amniotic fluid. d. implantation happens in the endometrium of the uterus. and may make the delivery of the fetus difficult (PLACENTA PREVIA) EMBRYONIC AND FETAL STRUCTURES 1.the part of the endometrium lying directly under the embryo b. A placenta weighs 400-600g. It can be found in maternal blood and urine as early as the time of the first missed menstrual period until about the 100th day of pregnancy. the growing placenta may occlude the cervix.the amniotic membrane and the chorionic membrane cover the fetal surface of the placenta and give that surface it’s typical shiny appearance. The amniotic membrane produces. progesterone: is essential to maintain the endometrial lining of the uterus during pregnancy. The bulk of the cord is a gelatinous muccopolysaccharide called WHARTON’s JELLY which gives the cord body and prevents pressure on the vein and arteries. 4. It also serves to regulate maternal glucose. chorionic villi. CHON. . decidua basalis. The decidua. It promotes mammary gland growth in preparation for lactation in the mother.once implantation is achieved. c. 3. The umbilical cord has no nerve supply 5. membranes and amniotic fluid. Human placental lactogen: is a hormone with either growth promoting and lactogenic or milk producing properties. This hormone also appears to decrease contractility of the uterine muscles during pregnancy. decidua capsularis. Umbilical cord. It is produced as early as the 6th week of pregnancy.functions to transport oxygen and nutrients to the growing fetus from the placenta and to return the waste products of the fetus to the placenta. A decrease in the amount of the amniotic fluid is termed as OLIGOHYDRAMINOS Normal amount of amniotic fluid is 800-1200ml. because liquid changes temperature more slowly than air. and as a separate endocrine organ throughout pregnancy. Balanon . decidua vera. the layer that thickens in order to cushion the egg does not slide off but instead continues to grow in thickness. This is about 20-21 inches long and 2cm thick.The outer layer of the chorionic villi develops into a separate hormone producing system producing the following: a.2 The amniotic fluid is an important protective mechanism for the fetus: a. gastrointestinal tract. c. The decidua. Placenta. the trophoblastic layer of the cells of the blastocyst begin to mature rapidly. protecting fetal oxygenation. It serves as the fetal lungs. April Anne D.NCM 101 Lecture Notes PRELIMS Handout 4 _____________________ - 3.the portion of the endometrium that stretches or encapsulates the trophoblast c.the remaining portion of the uterine lining 2. It aids in muscular development because it allows free movement of the fetus d. finger like projections or chorionic villi reach out from the single layer of cells into the uterine endometrium. and fat levels so that adequate levels of these are always available to the fetus. HCG (human chorionic gonadotropin) this is the 1st hormone to be produced. If the point of implantation is low in the uterus. It protects the fetus from changes in temperature.after fertilization. estrogen: primarily ESTRIOL contributes to the mother’s mammary gland development in preparation for lactation and it also stimulates uterine growth to accommodate the developing fetus. b. kidneys.
• length is 0. This is a cheesy white substance produced by the sebaceous glands. the sternum. April Anne D. and nose are discernible end of the 8th gestational week • • • • • • • • • • length is 2.5 cm or 1 inch weight is 20g organogenesis is complete the heart with valves and a septum beats rhythmically facial features are discernible extremities have developed external genitalia are present but sex is not distinguishable by simple observation the primitive tail is regressing abdomen appears large as fetal intestines are growing rapidly sonogram shows a gestational sac end of the 12th gestational week ( 1st trimester) • • • • • • • • • • length is 7-9 cm weight is 45g nail beds are forming on hands and toes spontaneous movements are possible although are too faint to be felt by the mother some reflexes such as the babinski reflex are present bone ossification centers are forming tooth buds are present sex is distinguishable by outside appearance kidney secretion has begun. demonstrating an intact but uncoordinated swallowing reflex end of 20th gestational week • • • • • • • • • • length is 25 cm weight is around 223g spontaneous felt movements can be felt by the mother antibody production is possible hair forms including in eyebrows and hair on head meconium is present on upper intestine Brown fat begins to be formed behind the kidneys.NCM 101 Lecture Notes PRELIMS Handout 4 _____________________ At the end of the 4th week of gestation. This aids in thermoregulation at birth fetal heart beat is strong enough to be heard through the abdomen with an ordinary stethoscope vernix caseosa begins to form. and the posterior neck. comprising about 1/3 of the entire structure • the back is bent so that the head almost touches the tip of the tail • the rudimentary heart appears as a prominent bulge on the anterior surface • arms and legs are bud like structures • rudimentary eyes. the human embryo is a rapidly growing formation of cells but does not resemble a human being just yet. Balanon . ears. Definite sleep and activity patterns are distinguishable 3 GreywolfRed Ms. although urine may not be present yet in the amniotic fluid heart beat is audible by a Doppler end of 16th gestational week • • • • • • length is 10-17 cm weight is 55-120 g fetal heart sounds are audible with an ordinary stethoscope lanugo (fine hair on back and arms of the baby which serves as a source for insulation) is well formed liver and pancreas are functioning fetus actively swallows amniotic fluid.75 ti 1 cm • weight is 400mg • the spinal cord is formed and fused at the midpoint • lateral wings that will form the body are folded forward to fuse at the midline • head folds forward and becomes prominent.
This event is termed as LIGTENING. PHYSIOLOGIC CHANGES IN PREGNANCY SKIN: • As the uterus changes in size. At birth. It is a fetal announcement that the 3rd trimester of pregnancy has ended and birth is at hand.hard enough to cause the mother some discomfort Fetal hemoglobin begins its conversion to adult hemoglobin. the abdominal wall must stretch to accommodate it.NCM 101 Lecture Notes PRELIMS Handout 4 _____________________ end of 24th gestational week ( 2nd trimester) • • length is 28-36cm weight is about 550g passive antibody transfer from mother to fetus probably begins as early as the 20th week of gestation meconium is present as far as the rectum active production of lung surfactant begins eyebrows and eyelashes are well defined eyelids previously fused since the 12th week now open pupils are capable of reacting to light • • • • • • end of the 28th gestational week • • • • • length is 35-38cm weight is about 1200g lung alveoli begin to mature and surfactant can be detected in the amniotic fluid testes begin to descend into the scrotal sac from the lower abdominal cavity in males the blood vessels of the retina are highly susceptible to damage from high o2 concentrations end of the 32nd gestational week • length is 38-43cm • • • • • • • weight is about 1600g subcutaneous fat begins to be deposited fetus is aware of the sounds outside the mother’s body active moro reflex is present delivery position ( vertex or breech) may be assumed iron stores that provide iron during the time that the baby will ingest only milk after birth are beginning to develop fingernails grow and reach at the end of the fingertips end of the 36th gestational week • • • • • • • length is 42-49cm Weight is 1900-2700g (5-6lbs. glycogen.) body stores of iron. April Anne D.) fetus kicks actively. This leads to pink or reddish streaks (STRIAE GRAVIDARUM) appearing on the sides of the abdominal wall and sometimes on the thighs. Balanon . about 20% of hemoglobin will be adult in character • vernix caseosa is fully formed • finger nails extend over the fingertips • creases on the soles of the feet cover at least 2/3 of the surface of the foot -in primiparas( 1st time mothers) the fetus often sinks into the birth canal during these last 2 weeks giving the mother a feeling that her load is being lightened. 4 GreywolfRed Ms. This stretching can cause rupture and atrophy of small segments of the connective layer of the skin. calcium and carbohydrates are augmented Additional amounts of subcutaneous fats are deposited.. Sole of the foot has only 1 or 2 creases compared to the full cris cross pattern that will be evident at term Amount of lanugo present begins to diminish Most babies will turn into a vertex position or head down presentation during this month end of the 40th gestational week ( 3rd trimester) • • • • length is 48-52cm weight is about 3000g (7-8lbs.
Darkened areas may also appear on the face particularly on the cheeks and across the nose ( MELASMA) or the ‘mask of pregnancy’ All these are due to the melanocyte stimulating hormones secreted by the pituitary. which slows the circulation to the area. A brown line (LINEA NIGRA) running from the umbilicus to the symphysis pubis may also be present. This hormone level decreases after pregnancy and the once darkened areas again lighten. Balanon . • • BREAST: • • • • • • Breast changes may be one of the first physiologic changes a woman will feel during pregnancy because of the change in the levels of estrogen and progesterone. • To handle the increase in blood volume. • When a woman lies supine. and legumes) to help reduce the risk for neural tube defects in the fetus.5cm to 5/ 7. Extra pigmentation also appears on the abdominal wall. 5 GreywolfRed Ms.NCM 101 Lecture Notes PRELIMS Handout 4 _____________________ • • • • • The umbilicus is also stretched that it becomes obliterated and smooth because it has been pushed so far outward. Iron absorption may be decreased during pregnancy as a result of decreased gastric acidity.) The mother may also complain of ‘stuffiness’ or congestion of the nasopharynx. and varicosities to the rectum. the weight of the uterus presses on the vena cava obstructing the blood flow from the lower extremities. a woman’s cardiac output increases. asparagus. During the 1st trimester. COLOSTRUM or the thin high protein fluid that is the precursor of breast milk can be expelled from the nipples. This is dangerous because it can lead to fetal HYPOXIA. As pregnancy progresses.5cm The sebaceous glands of the areola ( MONTGOMERY”S TUBERCLES) enlarge. The secretions from these help prevent the nipples from cracking and drying. Because as the uterus enlarges. ( Intervention: L side Lying) RESPIRATORY: • Most women would complain of DOB or shortness of breath as the pregnancy progresses. URINARY: • alterations in fluid retention. and during the last 2 weeks of pregnancy to a rate of 10-12 time of voiding per day. This results to a decreased blood flow to the heart and in turn HYPOTENSION. This is normal because of the increase in the levels of estrogen. A feeling of fullness. breast size also increases because of the hyperplasia of the mammary alveoli The areola also darkens in color and its diameter increases from about 3. pressure is put on the diaphragm. and legs. ureter. and bladder function • Urinary frequency is also noted to change. and ultimately on the lungs. Vascular spiders are sometimes seen on the thighs of the woman during pregnancy. April Anne D. • almost all women need iron supplements during pregnancy because of the following reasons: a. c. and renal. • Despite the increase in blood volume in pregnancy (HYPERVOLEMIA) the blood pressure does not normally rise because of the increased heart action. This leads to edema. vulva. By the 16th week of pregnancy. The fetus requires about 350-400mg of iron in order to grow. CARDIOVASCULAR: • Blood loss at a normal vaginal delivery is about 300-400ml whereas blood loss from a caesarean birth is much higher at about 800-1000ml. The hart rate increases by 10 beats per minute • During the 3rd trimester. or tenderness in the breast may be felt because of the increased levels of estrogen. women have a comparatively low iron storage of less than 500mg because of their monthly menstrual loss b. so additional iron is prescribed during pregnancy to prevent anemia. Breathing rate also becomes more rapid during pregnancy (18-20 breaths per min. blood flow to the lower extremities is impaired because of the pressure of the expanding uterus to the arteries and veins of the lower extremities. tingling. This is caused by an increase in the level of estrogen during pregnancy. • Women should also increase their intake of folic acid (spinach.
increase blood volume d. effects of estrogen and progesterone activity b. and melanocyte stimulating hormones. • Morning sickness can be noticed at the time HCG and progesterone levels begin to rise. it displaces the stomach and intestines towards the back of the abdomen. constipation. • Heartburn results from the reflux of the stomach contents into the esophagus as a result of the upward pushing of the uterus to the stomach • Because of RELAXIN. • Adrenal Glands Increase production of aldosterone and corticosteroids which aid in the suppression of inflammatory reaction. heartburn may also be felt • There may also be increased saliva formation (HYPERPTYALISM) because of the increased levels of estrogen. This is caused by RELAXIN.causing skin pigment changes Late in pregnancy. This may be also attributed to the decrease in glucose levels of the mother because the growing fetus utilizes great quantities of glucose as it develops. This pushing pressure may cause a decrease in the peristaltic movement leading to heartburn. • Progesterone also has an effect on smooth muscles (intestines) making them less active.so the woman’s body would not reject the fetus growing in her womb. the posterior pituitary hormone produces OXYTOCIN which will later be needed during labor. • ABDOMINAL WALL AND GIT: • As the uterus continues to grow in size.. This brings about edema especially in the lower extremities. which relaxes the esophageal sphincter.5-22cm width expands from 4-24cm weight increases from60-1000g • Cervix softens during pregnancy turns from pale pink to violet blue in color a tenacious lining of mucous fills the cervical canal ( OPERCULUM) which acts to seal out bacteria during pregnancy and help protect the fetus from infection • Vagina changes in color from light pink to dark violet • Ovary no production of FSH and LH so ovulation does not occur ENDOCRINE: • Placenta production of high levels of HCG. • Because blood is also drawn to the uterus. Balanon . to make ambulation easier. April Anne D. progesterone. Water is retained during pregnancy to aid in the increase in blood volume and to serve as a ready source of nutrients for the fetus.NCM 101 Lecture Notes PRELIMS Handout 4 _____________________ • Changes in the urinary system result from the following: a. • The woman also changes her center of gravity because of the weight of the fetus. (LORDOSIS) REPRODUCTIVE • Uterus length grows from approximately 6.. and flatulence. postural influences Fluid retention is also seen during pregnancy. and relaxin • Pituitary Gland increase levels of growth hormones. a hormone produced by the ovaries. - 6 GreywolfRed Ms. compression of the bladder and ureters by the growing uterus c. SKELETAL • Calcium and phosphorous needs are increased during pregnancy because the fetal skeleton must be built • There is gradual softening of the pelvic ligaments to facilitate the passage of the baby during birth • Wide separation of the symphysis pubis as much as 3-4mm by the 32nd week of pregnancy may occur.5-32cm depth increases from 2. decreased blood supply to the gastrointestinal tract is decreased and may cause a decrease in the gastric motility. estrogen. making the woman walk with difficulty.
(HYPER EMESSIS GRAVIDARUM) vomiting past the 12th week of pregnancy is not normal. April Anne D.NCM 101 Lecture Notes PRELIMS Handout 4 _____________________ Also helps regulate glucose metabolism in the mother DANGER SIGNS OF PREGNANCY: 1. Severe chest or abdominal pain should therefore prompt immediate assessment and intervention. severe continuous headache f. This is dangerous because it depletes the fetus of its nutritional supply. CHILLS AND FEVER.may indicate premature rupture of membranes. swelling of the face and fingers c. However. this may create immediate danger to both. or the fetus is in distress. Balanon .(PIH) this situation needs immediate assessment and requires that the mother be monitored throughout her pregnancy so as not to endanger the life or the life of the baby. INCREASE OR DECEASE IN FETAL MOVEMENT. rapid wt. Assessment is very important to rule out if the spotting needs further evaluation or not. 4. Persistent and frequent vomiting is not normal. - 5. It could be possible that bleeding from hemorrhoids could be misinterpreted as spotting. 3. This may cause the uterine cavity to be open to infxn. The nurse should ask the woman how she discovered her spotting. decrease in urine output 2. or preterm labor. Chest pains may be indicative of pulmonary embolus. so it becomes a threat to both mother and baby.A fetus normally moves more or less the same amount everyday. separation of the placenta. An unusual increase or decrease in this movement suggests either that the fetus responds to the need for oxygen. PREGNANCY INDUCED HYPERTENSION. This may also cause the umbilical cord to prolapse (out from the uterus and into the vaginal canal) if the cord is compressed by the fetal head. PERSISTENT VOMITING.this may be indicative of an intrauterine infection and should be checked immediately SUDDEN ESCAPE OF FLUID FROM THE VAGINA. • signs of PIH include the following: a. which may follow a complication such as thrombophlebitis. 6. dimness or burring of vision e. VAGINAL BLEEDING.1x or 2x of vomiting per day is not uncommon during the 1 st trimester. flashes of light or dots before the eyes d. gain ( over 2lbs per week in the 2nd trimester) b. 7.a woman should report vaginal bleeding no matter how slight. because a lot of the serious bleeding complications arise from slight spotting. 7 GreywolfRed Ms. ABDOMINAL or CHEST PAINS.abdominal pain may be indicative of an ectopic pregnancy.