Care of Mother, Child and Adolescent (Well Client)

NCM 107A

MODULE NO. : 1A
MODULE TITLE: Mother & Child Health
TOPIC 1 : PROCREATIVE HEALTH

WRITTER: Maria Teresa S. Nicomedes

MODULE INTRODUCTION AND FOCUS QUESTION(S)

 Procreative health is the capability to generate or produce offsprings. This is the innate
ability of man to reproduce and keep our species from dying out. Psalm 123:3 says that
procreation is not only a gift but a natural sexual expression of marriage. Various threats in
the environment and society, challenges this capacity. During the reproductive years, the
nurse performs as a resource person on human sexuality. How would you assist the mother
to avoid these risks and promote safe pregnancy? How would you help them make
pregnancy a rewarding experience?

GENERAL INSTRUCTION:
Module Lessons and ONLINE
Coverage 1. Enroll in the Google Classroom NCM 107
2. Follow the instruction for each activity uploaded in the Google
Classroom
3. Access the learning materials uploaded in the Google
Classroom
4. Submit the requirements posted in the Google classroom on
proper time

OFF-SITE (Modular)
1. Modules will be sent through courier for students who have
no internet access
2. Follow the instructions stated on the modules
3. Comply with assigned readings
4. Submit outputs on time indicated in the modules through mail
or courier.

DISTANCE LEARNING MODULE

FLEXIBLE

Lesson Subtopics LEARNING OUTCOMES Estimated

“I SHOULD BE ABLE TO”… time
1 Definition and theories related to  IDENTIFY the periods when 1.0 hour
procreation the developing body systems
of the fetus are most

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 susceptible to genetic
2 Process of human reproduction disorders. 1.0 hour
 RECOGNIZE environmental
3 Risk factors that will lead to hazards that may predispose 0.5 hour
genetic disorders genetic abnormalities
 COMPARE different theories
of procreation.
4 Common tests for determination 0.5 hour
 CONSTRUCT appropriate
of genetic abnormalities nursing diagnosis and
nursing measures to prevent
5 Prevention of genetic alteration genetic alterations. 01.0 hour
and in the care of clients seeking
services before and during
conception

PRETEST Instruction: Please choose the letter which represents the best answer:
1. The average age at which menarche (first menstruation) occurs
a. 9 years old c. 15 years old
b. 12 years old d. 17 years old
2. The four body structures which plays a major role in the physiology of menstruation
a. Uterus, ovaries, fallopian tubes, vagina
b. Hypothalamus, ovaries, uterus, fallopian tubes
c. Pituitary gland, uterus, fallopian tubes, ovaries
d. Hypothalamus, Pituitary gland, ovaries, uterus
3. Basic units of heredity that determines both the physical and cognitive characteristics of
people
a. Genes c. Sex links
b. Chromosomes d. Gametes
4. The most sensitive period in pregnancy wherein teratogens may cause abnormalities to
the growing fetus
a. First trimester c. Third trimester
b. Second trimester d. All the time
5. The following, except for one are chromosomal syndromes that may result from genetic
abnormalities during pregnancy
a. Down syndrome c. Trisomy 18
b. Twins d. None of them

STUDY
Instruction: Click the link below, watch the video and show your reaction by posting an
emoji

Video link: Race to life (httpswww.youtube.com/watch?v=GyvIf7fV0Po)

ACTIVITY 1: Fertilization myths

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Instruction: Respond to each statement twice. Once before the lesson and again after
reading the discussion of the lesson
 Write YES if you agree with the statement
 Write NO if you disagree with the statement

Response Statement Response After

Before the the Lesson
Lesson
1. Phases of the moon affect menstruation

2. Reproductive hormones need to be ‘in

balance’

3. Lying prone after sex increases chances of

becoming pregnant

4. Women were never meant to go through

menopause

5. The female orgasm can’t just be for pleasure

— it must be related to improving the chance
of pregnancy

6. The human papillomavirus vaccine is

associated with premature ovarian failure

7. Men stay fertile forever

HOOK-UP ACTIVITY
Instruction: Play the nursing game on Birth defects by clicking the link below.
Nursing Game on Birth defects: (https://www.learningnurse.org/games/sl-
birthdefects/story_html5.html)

RESEARCH
( Procreative Health power point presentation )
I Definition and theories related to procreation
Procreation is the physical act of joining a sperm and an egg together to create
another biological being. With procreation, the link between the parent and child is direct in that the
child has genetic make-up based on both parents biological contributions. (Pagliocca et al.1915)
https://www.questia.com >journal
Changing family patterns, development and proliferation of” Ässisted Reproductive
Technology,” its permissibility, and its use to enhance future children or prevent the birth of
children with certain conditions gave rise to the following debates in ethics and political philosophy.

1. Foundation

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 2. Procreative Autonomy
3. The Morality of Procreation ( Assisted Reproduction, Surrogacy and Contractually
Assissted Reproduction, Enhancement)
4. Becoming Parents
5. Being Parents
Parenthood and Procreation, Stanford Encyclopedia of Philosophy, August 2, 2016

II Process of human reproduction

Fundamental concepts: ( Information on Genetics and obstetrics)
1. Each individual is a product of two traits, one coming from the mother and the
other from the father.
2. Deoxyribonucleic acid (DNA) carries genetic information
3. Chromosomes are thread-like strands composed of hereditary materials called
DNA
4. Genes are small segments of DNA.
5. Normal amount of ejaculated sperm is 3-5 cc or 1 tsp.
6. Ovum is capable of being fertilized within 24-36 hours after ovulation
7. Sperm is viable within 48-72 hours or 2-3 days.
8. Spermatogenesis is the process of maturation of sperm, the end product is
sperm.
9. Oogenesis is the process of maturation of ovum; the process by which cells
formed into fetal life develop into primitive eggs known as oocytes.
10. Gametogenesis is the formation of 2 haploids into diploids.

11. Mitosis is the process of cell division resulting in 46 chromosomes.

12. Age of reproductivity for women is 15 to 44 years old.
13. High risk pregnancy is below 18 and above 35 years old.
14. Ideal age of childbearing is 20 to 30 years old.
15. Phenotype will result to physical appearance.
16. Karyotype is the pictorial analysis of individual chromosomes for the purpose of
detecting chromosomal aberrations.
17. Reproductive cells divide by the process of meiosis (Haploid number)
Note: Review Anatomy and Physiology of Reproductive System (Male and
Female)

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The Menstrual Cycle – is the period from the beginning of menstruation to the
period of the beginning of the next menstruation. Average days of
menstrual cycle is 28 days while length of menstruation is 5 days. Normal
blood loss during menstruation is 50 cc or ¼ cup with fibrinolysis which
prevents clot formation.

Related terminologies:

Menarche- the first menstruation which usually occurs as early as 9 years

old to seventeen years old, the average which is 12.5 years of age.

Dysmenorrhea means painful menstruation.

Metrorrhagia is bleeding in between menstruation.

Menorrhagia is heavy or excessive bleeding which can cause anemia.

Amenorrhea is the absence of menstruation.

Menopause is the cessation of menstruation which averages at the age of

51.

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Parts of the body responsible for menstruation:
1. Hypothalamus- initiator of the menstrual cycle; releases gonadotropin-
releasing hormone (FSH-RH, LH-RH)
2. Anterior pituitary gland- releases gonadotropin hormone ( FSH and LH)
3. Uterus- organ from which menstrual discharge is formed
4. Ovaries- site ovulation and source of estrogen and progesterone
Hormones involved in the menstrual cycle:
1. Estrogen- “hormone of the woman,” responsible for the secondary sexual
characteristics in female ( breast growth, pubic and axillary hair growth,
bony pelvis growth, general growth)
2. Progesterone- “hormone of pregnancy,” responsible for increased basal
body temperature, mood swings of the woman, and promotes development
of placenta and mammary gland.
3. Follicle stimulating hormone
4. Luteinizing hormone

5. Androgens- prerecursor of estrogen and inhibits FSH induction of LH

receptors

Phases of Menstrual Cycle

1. Proliferative phase/ Follicular phase- thickening of the uterine lining as
cells proliferate
2. Secretory phase/ Luteal phase- promotes endometrium secretory
activity; endometrium becomes ready for implantation if fertilization occurs
3. Premenstrual phase/ Ischemic phase- occurs by 27th or 28th of the
cycle
The Process of Human Conception
A. Fertilization- union of the sperm cell and egg cell
1. Prostaglandin and Oxytocin- helps the sperm reach ampulla
2. Fornix – where the sperm is deposited after ejaculation
3. Sperm- characterized by short head, long tail, pearly white in color

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 4. Of the half billion deposited sperm, 1000 to 3000 can actually reach the
ampulla, however, only one can penetrate the ovum
5. Capacitation – the ability of the sperm to release proteolytic enzymes and
penetrate the ovum

Hormonal Regulation of Pregnancy

a. Estrogen
b. Progesterone
c. Relaxin
d. Human Chorionic Somatomamotrophin (HCS)
The Process of Human Conception
i. Fertilization
2. Pre-Embryonic Phase
3. Embryonic Phase

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 STAGES OF HUMAN CONCEPTION
B. Pre- embryonic Stage
1. Zygote- is the fertilized ovum; it travels 3-4 days to reach the uterus while
mitotic cell division and sex differentiation begins
2. Fertilization would result 46 chromosomes; 22 pairs of autosomes
responsible
for determining the trait of an individual and 1 pair of sex chromosomes

responsible for the sex of an individual

3. Morula - is the mulberry like ball containing of 16-50 cells; as it reaches the
uterus it continues to float and multiply for 4 days
4. Blastocyst- is the enlarging cell forming a cavity that later becomes the
embryo;
Trophoblast- covering of the blastocyst which will later become placenta
and
membrane.
5. Implantation or Nidation - occurs 7-10 days after fertilization
Site: Upper anterior or posterior of the uterus
Processes of Implantation:
a. Apposition – when blastocyst begins to BRUSH the endometrial lining
b. Adhesion – when blastocyst begins to ATTACH to the endometrial lining
c. Invasion - when blastocyst begins to SETTLE DOWN the endometrial
lining
C. Embryonic Stage - implanted ovum
Decidua - thickened endometrium; a Greek word that means “falling off”
Parts of Decidua:
a. Basalis- part of the endometrium which is located directly under the fetus
where placenta is developed
b. Capsularis - part of the endometrium that encapsulates the fetus
c. Vera- remaining portion of the endometrium
Milestones of Fetal Development
Stages of Fetal Growth and Development
a. Zygote – the cells that results from fertilization of the ovum by the sperm
cell; the fertilized ovum from conception to 2 weeks; fertilization to 14
days

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 b. Blastomere - mitotic division of the zygote gives rise to daughter
cells called blastomeres
c. Morula – the solid ball of cells formed by 16 or more blastomeres
d. Blastocyst – after the morula reaches the uterus, it is termed as
blastocyst
e. Embryo- extends from the 7th day to 7th week postconception (14 days to
2 months)
f. Fetus - from the 8th week (2 months) up to birth
Conceptus – refers to all the products of conception
Chorionic villi – fingerlike projections developed by 10th- 11th day of
pregnancy
Cytotophoblast – “Langhans Layer”; outer layer which protects fetus
against
syphilis and capable of living until 24 weeks or 6 months

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 Fetal Circulation
Fetal cardiovascular system begins to develop at the end of the 3rd week
4th month – the heart starts to be
The critical period of heart development is from day 20 to day 50 after
fertilization
Placenta – attached to the uterus; gas exchange during fetal life
Foramen ovale – connects the left and right atrium so that blood can be
supplied to
brain, heart and kidney, bypassing fetal lungs
Umbilical vein (1) – brings oxygenated blood coming from the placenta to the
heart and liver; becomes ligamentum teres after birth
Umbilical arteries (2) – carry unoxygenated blood from the fetus (descending
aorta) to placenta; become umbilical ligaments after birth
Ductus venosus – carry oxygenated blood from umbilical vein to inferior vena
cava, bypassing fetal liver; becomes ligamentum venosum after birth
Ductus arteriosus – carry oxygenated blood from pulmonary artery to aorta,
bypassing fetal lungs; becomes ligamentum ateriosum after birth

For additional information :Click https://www. Heart.org>health topics

https://www.stanfordchildren.org
IV Common tests for determination of genetic abnormalities
 Molecular genetic tests
 Chromosomal genetic tests
 Biochemical tests
 Newborn screening
 Diagnostic testing
 Carrier testing

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  Prenatal testing
 Carrier testing
 Pre-implantation testing
For more information: Click: https://patient.info>genetic testing
Common Teratogens & their Effects
Teratogens- any factor, chemical or physical, that adversely affects the fertilized
ovum, embryo or fetus. Any drug, virus irradiation, or any harmful
substances, exposure to which may cause damage to the fetus.
Common Teratogens and their Effects
1. Streptomycin/Quinine - Damage to the 8th cranial nerve leads to poor
hearing or deafness
2. Vitamin K - Leads to hemolysis or destruction of RBC and
hyperbilirubinemia
3. Tetracycline - Staining of the tooth enamel and inhibit growth of long bones
4. Iodides - Enlargement of the thyroid gland or goiter
5. Thalidomides - Amelia: absence of extremities
Phocomelia: absence of distal extremities

6. Steroids - Cleft lip and cleft palate and abortion

7. Lithium- Congenital malformations, Ebstein’s anomaly (right heart defect)

8. Dilantin - Fetal hydantoin Syndrome, Intra-Uterine Growth Retardation

(IUGR),

Craniofacial dysmorphism, microcephaly, nail hypoplasia, heart defects

9. Isotretinoin (Accutane) - Congenital deafness, Microtia, CNS defects,

Congenital Heart Disease

10. Alcohol - Low Birth Weight (LBW), Fetal Alcohol , Withdrawal Syndrome

Microcephaly

11. Smoking - Low Birth Weight

12. Caffeine - Low Birth Weight

13. Coccaine - Low Birth Weight, abruption placenta

14. TORCH - Toxoplasmosis, Other infections, Rubella, Cytomegalovirus,

Herpes simpl

(Genital Herpes Infection)

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 Toxoplasmosis- a protozoan infection, spread most commonly through
contact with

uncooked meat , may also be contracted through handling cat stool in soil
or cat

litter Infant may be born with CNS damage, hydrocephalus, microcephaly,

- intracerebral calcification and retinal deformities May lead to increased

bilirubin

levels in the newborn

Management:

a. Sulfonamides

b. Pyrimethamine - an antiprotozoal agent

Other Infections

1. Syphilis - a sexually transmitted infection

Effects on the fetus: a. Intrauterine or congenital syphilis

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 b. Deafness

c. Cognitive challenge

d. Ostoechondritis

e. Fetal death

Effects of Syphilis in Newborn: a. Congenital anomalies

b. Extreme rhinitis (sniffles)

c. Characteristic syphilitic rash

Management: a. 1st trimester - benzathine penicillin

b. serologic screening- VDRL or a rapid plasma reagent

should be

done at first prenatal visit

2. Lyme Disease- a multisystem disease caused by spirochete Borrelia

Burgdorferi

- spread by a bite of a deer. Women anticipating becoming pregnant or

who are

pregnant should avoid areas such as wooded or tall grassy areas where
they are

apt to be bitten by ticks

Treatment: Penicillin

3. Hepatitis B Virus (HBV)

4. Human Immunodeficiency Virus (HIV)

5. Rubella - causes mild rash and mild systematic illness in the mother but
-
teratogenic effect on a fetus can be devastating

Effects on Fetus:

a. Deafness

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 b. Mental and motor challenges

c. Cataracts

d. Cardiac defects (most commonly patent ductus arteriosus &

pulmonary

stenosis)

e. Restricted intrauterine growth (small for gestational age)

f. Thrombocytopenic purpura

g. Dental and facial clefts

h. Cleft lip and palate

6. Cytomegalovirus (CMV)- a member of the herpes virus family

Effects on the fetus:

a. Hydrocephalus

b. Microcephaly

c. Spasticity

d. Eye damage- optic atrophy, chorioretinitis

e. Deafness

f. Chronic liver disease

g. Skin may be covered with large petechiae(“blueberry-muffin” lesions)

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Hydrocephalus

Prevention: a. Thorough handwashing before eating

b. Avoiding crowds of young children at daycare or nursery settings

7. Herpes Simplex Virus - (Genital Herpes Infection)- virus spreads into the

bloodstream (viremia) and crosses the placenta to the fetus

Effects on the Fetus:

1st Trimester a. Severe congenital anomalies

b. Spontaneous miscarriage

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 MICROCEPHALY

Management:

a. Blood Culture and Sensitivity (C&S )Test to women with history of

genital herpes and existing genital lesions

b. Intravenous or oral Acyclovir (Zovirax - can be administered

during

pregnancy

HERPES SIMPLEX LESIONS

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 V Prevention of genetic alteration and in the care of clients seeking services
before

and during conception.

Commit to Healthy Choices to Help Prevent Birth Defects:

1. Plan ahead. Get 400 mcg of Folic acid everyday, a vitamin B

2. Avoid harmful substances. Avoid alcohol at any time during pregnancy.

3. Choose a healthy lifestyle. Keep Diabetes under control.

4. Talk with your health care provider. Talk to health care providers about

taking any medications

https://www.cdc.gov>prevention

4 main causes of genetic problems:

1. Genetic problems- One or more genes might have change or mutation

that hresults in them not working properly such as in Fragile X

syndrome

2. Chromosomal problems

3. Infections

4. Exposure to medications, chemicals or other agents during pregnancy

https://www.nichd.nih.gov>topics

The most common birth defects

 Heart defects

 Cleft lip/palate

 Down syndrome

 Spina bifida

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 Strategies for the Prevention and Treatment of Birth Defects

1. Prevention and prenatal environment

2. Increasing Folic acid intake

3. Limiting exposure to teratogens and mutagens alcohol, cigarette

smoke, certain medications, environmental factors

4. Detection and early treatment of birth defects

www.nature.com>topicage>birth

Basic Reading/Browsing

1. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family [with Study
Guide]
by Adele Pillitteri
2. Nursing Process, Fundamentals of Nursing Practice, Kozier and Erbs
3. https://www.betterhealth.vic.gov.au
4. https://www.eu.m.wikepedia.org.>wiki

ACTIVITY 2- ONLINE QUIZ

Instruction: Answer the posted quiz on the Google classroom NCM 107

ANALYSIS

ACTIVITY 3- Article review

Instruction
 ONLINE: Look for this article in the internet entitled, “Genetic Modification of
Preimplantation Embryo,” and make your analysis on the possibility and morality of
the issue. Also include the benefits and danger of the said procedure. Submit your
output in Google classroom NCM 107 at indicated time.https://www.ncbi.nih.gov>pmc
 OFF-SITE: An article will be included in the module and the student will give their
reaction/ reflections

ACTION
INSTRUCTION: After reading the situation below, design a comprehensive nursing care
plan using the nursing process and outline a detailed health teaching for the client

Scenario: Mrs. Cruz, a 19-year old, came to the health center for prenatal checkup. She is
on her second month of pregnancy and with complaints of frequent vomiting and dizziness.
Although she does not smoke but their clients in the videoke bar does. She also drinks
occasionally when offered by clients. She would not have seek prenatal check-up if not for
her problems. Upon assessment, her BP was 90/60mmHg, RR- 110 bpm and PR 98bpm.

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 With the situation presented, design a comprehensive nursing care plan using the
nursing process and outline a health teachingregimen for her to follow, putting emphasis
on the possibilities of fetal defects if smoking and drinking will continue. Your output as a
nursing student will be presented to your classmates, instructor and health personnel.

G Design a nursing care plan using the nursing process and outline a health
teaching regimen for the client to follow
R Student nurse
A Clinical instructor, classmates, health personnel
S Prenatal check-up of a first time mother
P Nursing care plan and health teaching regimen
S Comprehensive

RUBRICS

INCOMPLETE POOR FAIR GOOD

5 pts 10 pts 15 pts 20 pts
Assessment Assessment Does not include Includes all Includes all
portion is all pertinent data pertinent data pertinent data
incomplete. related to nursing related to nursing related to nursing
Includes diagnosis. May diagnosis, but also diagnosis and
subjective, also include data includes data not does not include
objective and that does not related to nursing data that is not
historical data that relate to nursing diagnosis. related to nursing
support actual or diagnosis. diagnosis.
risk for nursing
diagnosis.
Diagnosis Diagnosis portion Diagnosis is not Diagnosis is Diagnosis is
is incomplete. appropriate for appropriate for appropriate for
patient and ordinal patient and ordinal patient and ordinal
Includes the most level (first level, and level, and
appropriate diagnosis, second diagnosis is diagnosis is
diagnosis for diagnosis, etc). NANDA approved, NANDA approved.
patient and ordinal May also not be but does not Diagnosis also
number that NANDA and may include all parts or includes all parts
includes all not include all information is and information is
appropriate parts parts. listed in wrong listed in correct
(stem, related to part of diagnosis. part of diagnosis.
or R/T, and as
evidenced by AEB
for actual
diagnosis) and is
NANDA approved.
Planning (Goal Goal portion is Goal statement is Goal statement is Goal statement is
Setting) incomplete. not patient or patient or family patient or family
family oriented oriented, and oriented, and
and may not have contains at least contains two
Includes a patient measurable one measurable measurable
or family goal that criteria or a target criteria or a target criteria and a
is most appropriate date or time. date/time. target date or
for the time.

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patient/family and
the nursing
diagnosis. Goal
should be
measurable by at
least two criteria
and have a target
date or time.
Implementation Interventions Interventions Interventions Interventions
(Interventions portion is portion does not portion contains portion contains
incomplete. include adequate adequate number adequate number
number of of interventions to of interventions to
Includes interventions to help patient/family help patient/family
interventions or help patient/family meet goal, but meet goal, and
nursing actions meet goal. interventions may interventions are
that directly relate Interventions may not be specific, specific in action
to the patient's also not be labeled or listed and frequency,
goal, that are specific, labeled or with rationales. labeled with "I" or
specific in action listed with "C" and are listed
and frequency, are rationales. with referenced
labeled "I" for rationales.
independent and
"C" for
collaborative, and
include a
referenced
rationale with page
number (if
applicable).
Number of
interventions
should be
appropriate to help
patient or family
meet their goal.
Evaluation Evaluations Evaluation portion Evaluation portion Evaluation portion
portion is does not contain does contain data does contain data
incomplete. data that is listed that is listed as that is listed as
Includes data that as criteria in goal criteria in goal criteria in goal
is listed as criteria statement. May statement, but statement. Does
in goal statement. also not describe does not describe describe goal as
Based on this data, goal as met, goal as met, met, partially met,
goal is determined partially met, or partially met, or or not met. If goal
to be met, partially not met. May also not met. May also was partially met
met, or not met. If not include not include or not met,
goal was not met revision or new revision or new includes revision
or partially met, evaluation evaluation and/or new
plan of care is date/time. date/time. evaluation
revised or date/time.
continued and a
new evaluation
date/time is set.

CLOSURE:

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 Learning Skills

Perfect! A bit confused

Can’t understand
1. I CAN IDENTIFY the
periods when the
developing body systems of
the fetus are most
susceptible to genetic
disorders.

2. I CAN COMPARE different

theories of procreation.

3. I CAN CONSTRUCT
appropriate nursing
diagnosis and nursing
measures to prevent
genetic alterations.

4. I CAN RECOGNIZE
environmental hazards that
may predispose genetic
abnormalities

POST TEST: Please choose the letter which represents the best answer

1. The first menstruation which occurs during the age of puberty

a. Adrenarche c. Telarche
b. Menarche d. Menorrhea

2. The four body structures which plays a major role in the physiology of
menstruation
a. Uterus, ovaries, fallopian tubes, vagina
b. Hypothalamus, ovaries, uterus, fallopian tubes
c. Pituitary gland, uterus, fallopian tubes, ovaries
d. Hypothalamus, Pituitary gland, ovaries, uterus

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 5. This determines both the physical and cognitive characteristics of people
a. Gametes c. Sex links
b. Chromosomes d. Genes
6. Teratogens may greatly cause abnormalities to the growing fetus during this stage
a. First trimester c. Third trimester
b. Second trimester d. All the time
7. The most common genetic abnormality that may occur during pregnancy is
a. Down syndrome c. Trisomy 18
b. Twins d. None of them

REFERENCES:
1. Gunter, J. (2020). 7 Fertility Myths That Belong in the Past. The New York Times. Retrieved from:
https://www.nytimes.com/2020/04/15/parenting/fertility/trying-to-conceive-myths.html
2. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family [with Study
Guide]
by Adele Pillitteri
3. Nursing Process, Fundamentals of Nursing Practice, Kozier and Erbs
4. Nursing Plan Rubric. Retrieved from: https://www.rcampus.com/rubricshowc.cfm?
code=H5788W&sp=true

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