CARE OF MOTHER, CHILD AND ADOLESCENTS (WELL
CLIENTS)
NCM 107 MOTHER
Course Description:
This course deals with concepts, principles, theories and
techniques in the nursing care of individuals and families during
childbearing and child rearing years toward health promotion,
disease prevention, restoration and maintenance, and
rehabilitation. The learners are expected to provide safe,
appropriate and holistic nursing care to clients utilizing the
nursing process.
Framework for Maternal and Child Health Nursing
A. Goals and Philosophies of Maternal and Child Health
Nursing
The primary goal of both maternal and child health nursing is the
promotion and maintenance of optimal family health.
1. Family centered: assessment should always include the
family as well as an individual.
2. Community centered: the health of families is both
affected and influences the health of communities.
3. Evidenced based: this is the means whereby critical
knowledge increases.
4. A challenging role for nurses and a major factor in
keeping families well and optimally functioning.
B. A maternal and child health nurse:
1) Considers the family as a whole as a partner in care
when planning or implementing or evaluating the
effectiveness of care.
2) Serves as an advocate to protect the rights of all family
member, including the fetus.
3) Demonstrates a high degree of independent nursing
functions because and counseling are major
interventions.
4) Promote health and disease prevention because these
protect the health of the next generation.
5) Serves as an important resource for families during
childbearing and childrearing as these can be extremely
stressful times in a life cycle.
6) Respect personal, cultural, and spiritual attitudes and
beliefs as these so strongly influence the meaning and
impact of childbearing and childrearing.
7) Encourages developmental stimulation during both
health and illness so children can reach their ultimate
capacity in adult life.
8) Assesses families for strengths as well as specific needs
of challenges.
9) Encourages family bonding through rooming-in and
family visiting in MCH setting.
10) Encourages early hospital discharges options to reunite
families as soon as possible in order to create a
seamless, helpful transition process.
11) Encourages families to reach out to their community so
the family can develop a wealth of support people they
can call on in time of family crisis.
MATERNAL AND CHILD HEALTH GOALS AND STANDARDS
2020 NATIONAL HEALTH GOALS
2 Main overarching national health goals are:
1. To increase quality and years of healthy life.
2. To eliminate health disparities.
 2020 National Health Goal are intended to help citizens
more easily understand the importance of health
promotion and disease prevention and encourage wide
participation in improving health in the next decade.
It’s important for nurses:
- To be familiar with these goals because nurses play
such a vital role in helping the nation achieve these
objectives through both practice and research.
- Serve as the basis for grant finding and financing of
evidence-based practice.
GLOBAL HEALTH GOALS
 To end poverty hunger
 To achieve universal primary education
 To promote gender equality and empower women
 To reduce child mortality
 To improve maternal health
 To combat HIV/AIDS, malaria, and other diseases
 To ensure environmental sustainability
 To develop a global partnership for developments
4 Phases of Health Care
1. Health Promotion
2. Health Maintenance
3. Health Restoration
4. Health Rehabilitation
What do maternal child and health nurse do?
• Monitor children's health.
• Support maternal health and wellbeing.
• Identify health and development concerns early.
• Provide intervention and referral when necessary.
• Deliver health promotion and education programs.
• Provide parenting support.
WHO ‘s 17 Sustainable Development Goals
GOAL 1: No Poverty
GOAL 2: Zero Hunger
GOAL 3: Good Health and Well-being
GOAL 4: Quality Education
GOAL 5: Gender Equality
GOAL 6: Clean Water and Sanitation
GOAL 7: Affordable and Clean Energy
GOAL 8: Decent Work and Economic Growth
GOAL 9: Industry, Innovation and Infrastructure
GOAL 10: Reduced Inequality
GOAL 11: Sustainable Cities and Communities
GOAL 12: Responsible Consumption and Production
GOAL 13: Climate Action
GOAL 14: Life Below Water
GOAL 15: Life on Land
GOAL 16: Peace and Justice Strong Institutions
GOAL 17: Partnerships to achieve the Goal
What are Sustainable Development Goals (SDGs)?
• Sustainable Development Goals (SDGs) are the United
Nations global development goals.
• These are bold universal agreements to end poverty in
all its dimensions and craft an equal, just and secure
world.
• SDG has 17 goals and 169 targets and it covers multiple
aspects of growth and development.
• It is also known as a successor of MDGs (Millennium
Development Goals)
• It was adopted by 193 countries of United Nations
General Assembly on 25th September 2015
• SDG is officially known as “Transforming our world: the
2030 Agenda for Sustainable Development.”
• It is built on the principle agreed upon under resolution,
“The Future We Want”.
Reproductive and Sexual Health Responsible parenthood
Joy and challenge.

AIM OF RESPONSIBLE PARENTHOOD:

- To empower families so that the couple can be made
aware of their basic responsibilities as parents, and can
be awaken for taking lifelong commitment towards
their family, community society and nation as a whole.

PARENTING CONSIST OF THREE FACTORS:

1. Time spent with your child
2. Resources utilized for your child
 Procreative Dimension of Conjugal Love 3. Energy like hope, motivation and courage given to the child
 The Inspirable Unitive and Procreative
 Procreation – is the creation of a new human person, PARENTING APPROACH/STYLES
by the act of sexual intercourse, by a man and a woman.
 Creation – is the making of all things from nothing, by
an act of God, at some time in the past- God’s action
could have taken on a second, or 6 days, or a million
years.

HUMAN SEXUALITY
Concepts
 A person’s sexuality encompasses the complex
behaviors, attitudes emotions & preferences that are
related to sexual self & eroticism.
 Sex – basic & dynamic aspect of life
 During reproductive years, the nurse performs as
resource person on human sexuality.

Definitions related to sexuality:

*Gender Identity PARENTING APPROACH/STYLES:

- sense of femininity or masculinity
GIVING ORDERS
*Gender curiosity: 3 y/o AUTHORITARIAN STYLE
• Very rigid and strict
*Role identity • Most often in working class families
- attitudes, behaviors & attributes that differentiate roles GIVING IN
PERMISSIVE OR INDULGENT PARENTING STYLE
*Sex • They set no limits.
- biologic male or female status. Sometimes referred to a specific • A child’s freedom and autonomy are
sexual behavior such as sexual intercourse. overvalued.
• Parents are UNDEMANDING
*Sexuality • Most popular among middle class families
- behavior of being boy or girl, male or female, man/ woman & is
an entity subject to a lifelong dynamic change. Developed at the GIVING CHOICES
moment of conception. AUTHORITATIVE/DEMOCRATIC STYLE
• Most effective style
STAGES OF SEXUAL RESPONSES (EPOR) • It is based on equality and respect
• Give and take atmosphere
Initial responses: UNINVOLVED/NEGLECTFUL STYLE
• Vasocongestion – congestion of blood vessels; • Little or no expectation of the child
• Myotonia – increase muscle tension • Regularly have no communication
• • Not responsive to a child’s need
1. Excitement Phase • If present, they provide what the child needs
- (sign present in both sexes, moderate increase in HR, for survival
RR, BP, sex flush, nipple erection)
- erotic stimuli cause increase sexual tension, lasts Importance of responsible parenthood:
minutes to hours. - Parents are child’s first and most influential teacher
which can’t be replaced by other in his/her life.
2. Plateau Phase - Parents are solely responsible for their child’s well-
- (accelerated V/S) being, health and safety
- increasing & sustained tension nearing orgasm. Lasts - All the things he/she will learn from the parents.
30 seconds to 3 minutes.
3. Orgasm STAGES OF RESPONSIBLE PARENTHOOD
- (involuntary spasm throughout body, peak v/s)
- involuntary release of sexual tension with physiologic or - PARENTING= a process by which parents and children
psychologic release, immeasurable peak of sexual experience grow and develop, each influencing the other
- May last 2 to 10 sec - most affected are is pelvic area. throughout their lives.

4. Resolution - According to GALINSKY 1981, = 6 stages of parenthood.

– (v/s return to normal, genitals return to pre-excitement phase)

Refractory Period – the only period presents in males, wherein

he cannot be restimulated for about 10-15 minutes

RESPONSIBLE PARENTHOOD
- State of being parent is parenthood. = broad concept =
biological and socio-cultural aspect
IMAGE-MAKING STAGE: PREGNANCY RUGAE: Transverse ridges of mucus membranes lining the
- Parents prepare for changes in themselves, for new vagina which allow it to stretch during sexual intercourse and
relationships with each other, and the responsibilities of childbirth. Most numerous in nulliparous women.
this new life
- There are lots of queries in parent’s head The vagina is acidic with pH of 4 to 6. before puberty 6.8 to 7.2
which is alkaline.
What do you think would be the nursing responsibility in
educating human sexuality? FUNCTIONS:
A. Organ of Copulation
Primary reproductive function B. Excretory Canal of the uterus
FEMALE - Production C. Passageway during childbirth
MALE - And
Transport
The uterus
- Hollow, muscular, pear shaped organ; covered partially
by perimetrium or serosa. 50 -70 gms
- After delivery it does not return to its pre-pregnant
condition.

FUNCTIONS:
A. Organ of reproduction
B. Organ of menstruation

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

THE VULVA
A.K.A. the External Genitalia

PARTS:
a. Mons Veneris or Mons Pubis
b. Labia Majora
c. Labia Minora
d. Glans Clitoris
e. Vulvovaginal Glands
f. Paraurethral Glands
g. Urinary Meatus

Mons veneris
Soft, rounded fatty pad over the symphysis pubis.
FUNCTION: Protects the sypmphysis pubis PARTS:

Labia majora A. FUNDUS: convex upper part between the insertion of fallopian
A.K.A. the Bigger Lips tubes; most contractile portion during labor
FUNCTION: Protects the labia minora and vaginal os.
B. CORPUS or BODY: upper, larger, triangular portion
Labia minora
Two thinner folds of delicate tissue within the labia majora C. CORNUA: point from where the oviducts emerge
FUNCTION: Protects and obscures the vestibule, urinary meatus
and vaginal os. D. ISTHMUS: constricted area immediately above the cervix

Glans clitoris E. CERVIX: lower, smaller cylindrical portion, effaced and dilate
A small body of highly erogenous and sensitive tissue protected during labor
by prepuce
FUNCTIONS: Primary site of sexual arousal, excitement and UTERINE LAYERS:
orgasm; serves as guide to female catheterization
A. ENDOMETRIUM: inner layer. This layer undergoes changes in
Vulvovaginal Glands response to the hormones at different phases of the menstrual
A.K.A. the Bartholin’s Glands cycle to prepare the uterus for implantation and pregnancy.
Two small palpable glands situated between the vestibule on B. MYOMETRIUM: middle layer. Thickest at the fundal area of
either side of the vaginal orifice. the uterus. Efferent motor fibers from T5 to T10 are responsible
FUNCTION: for uterine contraction while paparymphatetic fibers from the
Secretes mucus that helps to keep the vaginal introitus sacral nerves are responsible for vasodilation and inhibiting
lubricated. Its alkaline nature enhances sperm survival myometrial contractions.
C. PERIMETRIUM: outer layer, attached to the broad ligaments
Paraurethral glands
A.K.A. the Skene’s Ducts FUNCTIONS:
FUNCTION:  MENSTRUATION
Increases sexual stimulation to provide lubrication to the vagina  PREGNANCY or GESTATION
and facilitate coitus  LABOR

HYMEN UTERINE LIGAMENTS

FUNCTION:
Separates the female internal and external organs.
FEMALE INTERNAL REPRODUCTIVE ORGANS
The Vagina
LENGTH: 3 to 4 inches (8 to 12 cm)
Uterine ligaments – ten ligaments that supports the uterus
permit it to move freely in the anteroposterior plane and enlarge
without difficulty during labor.
1. Cardinal ligament – main support of the uterus.
Damage can cause uterine prolapse.
 2. Broad ligament – support the sides of the uterus, assist Hormone Production:
in holding the uterus in anterversion. - The testes produce the hormone testosterone which
3. Round ligament – gives stability of the uterus during stimulates spermatogenesis and is responsible for the
pregnancy development of secondary male chars.
4. Uterosacral ligament – keep uterus in normal position
by maintaining traction on the cervix. PARTS of the TESTIS
5. Anterior ligament – cystocele (bladder wall drop) 1. Seminiferous tubules. This tube lead to the tightly
6. Posterior ligament – rectocele (herniation of the coiled epididymis where the sperm cells continue their
rectum) travel and maturations.
2. Leydig or interstitial cells produce testosterone, they
The fallopian tubes or oviducts are found around the seminiferous tubules.
- Two muscular canals/tubes. 3. Sertoli cells or supporting cells which plays a role in
- Lined with CILIATED mucous membrane called sperm transport
CILIATED CUBICAL EPITHELIUM
The sperm
TUBAL PARTS/PORTIONS
 Interstitial – thick walled located inside the uterus SPERMATOGENESIS:
 Isthmus – narrowest portion of the uterus and is about The process by which male spermatogonia develop into mature
1 cm located, site of tubal ligation spermatozoa. Beginning puberty, the hypothalamus secretes
 Ampulla- site of fertilization GnRH which stimulates the APG to release FSH which in turn
 Infundibulum – distal portion, finger like structure causes the cell division and development of spermatogonia to
called fimbriae, attach to the ovary to guide ovum to the sperm cells.
oviduct during fertilization.
PARTS of SPERM:
FUNCTIONS: - Head
 Site of normal fertilization - Body
 Transport ovum from the ovary to the uterus - Mobile Tail
 Provides nourishment to the ovum during its journey
LIFESPAN: 36 to 72 hours
The ovaries
FUNCTIONS: SPERM PRODUCTION TIME: testes produce about 176 sperm
 OOGENESIS – the ovaries are responsible for cells a day
development and maturation of ovum
 OVULATION – release of mature ovum from the ovary MATURATION TIME: 64 days
 ENDOCRINE FUNCTION – Hormone production, the
ovaries are the main source of estrogen and Testosterone
progesterone in non-pregnant women. Testosterone is the male reproductive hormone.

Layers of the Ovaries The ducts

1. Tunica albuginea – outermost protective layer
surrounded by a single layer of cuboidal epithelium
called germinal layer of Waldeyer.
2. Cortex – functional layer because it is the site of ovum
formation and maturation. It contains the primordial
follicles, Graafian follicles, Corpus luteum and corpus
albicans. As the follicles decrease the number after each Mammary glands
ovulation, this layer become thinner and more pitted in
appearance. The number of follicles in each ovary
decreases in number as the woman ages.
3. Medulla – this layer contains blood vessels, lymphatics,
nerves and muscle fibers.
- SEMINIFEROUS TUBULES (Seed-Carrying Tubules)
- EPIDIDYMIS (site of sperm maturation)
- SPERMATIC CORD
a. Vas Deferens
b. Testicular Blood Vessels
- Located at each side of the wall
- Each breast has 15 to 20 lobes with clusters of alveoli
- Acinar cells produce milk
- Lactiferous ducts transport milk to the nipple
- Ampulla reservoir for milk

MALE EXTERNAL ORGANS MATERNAL REFLEXES

- Prolactin Reflex (Milk Secretion Reflex)
The penis - Letdown Reflex (Draught Reflex)
- Milk Ejection Reflex
Three Columns of Erectile Tissue:
 CORPORA CAVERNOSA ACCESSORY GLANDS
 CORPUS SPONGIOSUM
MAMMARY GLANDS (Breasts)
FUNCTIONS: Carries the urethra; pathway for both urine and the Composition:
semen it has 15 – 20 opening connected to lactiferous ducts and which
milk flows out
PRIMARY FUNCTION: Deposits sperm in the female vagina for - Size: varies
fertilization of the ovum. - Function: Lactation, maternal antibodies, source of
pleasurable sexual sensation
 EJACULATION
Ejaculation is about 2 to 4 mL of semen. Internal structures
1. Lobes: 15 to 20 lobes are found in each breast that are
The scrotum divided into several lobes
2. Lobules: composed of clusters of acini cells
FUNCTIONS: 3. Acini cells: these are milk secreting cells of the breast
- Saclike structure containing the testes that hangs beside that are stimulated by prolactin hormone
the penis. 4. Lactiferous ducts: ducts that serve as passageway of
- PROTECTION and TEMPERATURE REGULATION milk
5. Lactiferous sinus: dilated portion of the ducts located
The testes behind the nipple that serves as the reservoir of milk.

Functions: Hormones that influence the mammary gland

- Secretion of male sex hormones (androgens) and the 1. Estrogen: stimulates development of the ductile
site of spermatozoa production in the mature male. structures of the breast
 2. Progesterone: stimulates the development of the
acinar structures of the breast.
3. Human placental lactogen: promotes breast
development during pregnancy
4. Oxytocin: let down reflex. This hormone is inhibited by
progesterone
5. Prolactin; stimulates milk production. This hormone is
inhibited by estrogen.
The menstrual cycle
From the onset of menstrual bleeding to the day before the next
bleeding day.
NOTE!
The FIRST DAY of the cycle is the DAY on which
menstruation begins.
MENARCHE
- refers to first menstruation, an event that signifies the
and beginning of the reproductive years of a woman
end of puberty.
- Occurs at 12-13 years of age, but the onset of
menstruation may occur anytime between 9 to 17 years
old depending on many conditions, heredity, race and
nutrition.
PHASES of MENSTRUAL CYCLE:
- Menstrual Phase/Bleeding Phase
- Follicular Phase or Proliferative Phase – time
before ovulation, formation of the Graafian
follicle.
- Luteal or Secretory Phase – period following
ovulation. This period lasts usually 14 days,
(13-15 days)
1. MENSTRUAL PHASE: 1-4 days; estrogen and progesterone are
low; characterized by endometrial bleeding.
* Menstruation: cyclic vaginal discharge of blood and
endometrial fragments (1.5-2 oz); a response to decrease
estrogen and progesterone.
* Menarche: first menstruation; irregular, unovulatory,
infertle; about 10-14 years
* Menopause: cessation of menses; about 45-55 years;
bilateral removal of the ovaries (oophorectomy) induces man-
made menopause.
FOLLICULAR PHASE OR PROLIFERATIVE PHASE
OVULATION SIGNS:
a. Breast Tenderness
b. Slight rise in BBT- progesterone has thermogenic
effect
c. Positive Spinnbarkheit test characterized by
cervical mucus that is thin, water or transparent.
d. Positive Ferning test
e. Mittelschmerz pain abdominal pain felt at the side of
the ovary that release the ovum
2. PROLIFERATIVE PHASE/FOLICULAR PHASE: days 5-14
(ending in Ovulation); endometrium thickens, CELLS
PROLIFERATE because of ESTROGEN (ESTRADIOL= principal
estrogenic hormone) as a result of influence of follicle stimulating
hormone (FSH); a single follicle approaches maturity; leutenizing
hormone (LH) induces ovulation (release of mature ovum by
ruptured mature follicle (Graafian follicle)
3. SECRETORY /LUTEAL PHASE: days 1-28; begins after
ovulaton; LH develops CORPUS LUTEUM (YELLOW
BODY,temporary endocrine gland) from ruptured follicle
resulting increase progesterone and thereby stimulates thick
endometrium to become thicker, secretory, glandular which
increase glycogen-secreting cells for the preparation for
IMPLANTATION;
* without fertilization, it functions for 7-8 days after
ovulation, becomes nonfunctioning CORPUS ALBICANS (WHITE
BODY) up to 10-12 days, then finally dies at 12-14 days (life span of
the corpus luteum: 2 weeks)
* if with fertilization: corpus luteum persist to continue
secreting progesterone to maintain decidua in early pregnancy.
MENSTRUAL CYCLE HORMONES
A. GONADOTROPHIC HORMONES
1. Follicle Stimulating Hormone (FSH) in the first half
of the menstrual cycle
- Develops the primordial (immature) follicles
that will stimulate development of Graafian follicle
- Raises level of estrogen
2. Luteinizing Hormone (LH) – secreted by APG
- Stimulates ovulation
- Develops the CORPUS LUTEUM (yellow body
with life span of 2 weeks) and raises blood level of progesterone.
3. Prolactin Hormone (PH)
- Develops the breasts
B. OVARIAN HORMONES
1. Estrogen: secreted by ovaries and adrenal cortex
during cycle by placenta during pregnancy.
- Thickens endometrium 8X
- Responsible for PROLEFERATIVE phase of
the menstrual cycle
- Inhibits FSH
- Responsible for FERTILE CERVICAL MUCUS:
clear, colorless, slippery, stretchy (+ Spinnbarkeit), stringly, +
Ferning test.
2. Progesterone: secreted by corpus luteum during
cycle and placenta during pregnancy
- Responsible for SECRETORY phase of the
menstrual cycle which maintain uterine lining for IMPLANTATION
- Inhibits LH
- Responsible for rise in the basal body
temperature (BBT) during the menstrual cycle
- Relaxes smooth muscles
OVULATION
A. Monthly release of a mature ovum by the Graafian
Follicle (mature follicle)
B. Usually happens in the middle of the menstrual
cycle
C. Estimating Ovulation
1. SUBTRACT 14 FROM THE MENSTRUAL CYCLE.
Ex. MC = 28 days
- 14
14
* ovulation occurs on the 14th day counting
from the first day of menstrual bleeding in a 28-day cycle.
2. IF THE MENSTRUAL CYCLE DURATION IS NOT
GIVEN, OVULATION OCCURS 14 DAYS BEFORE THE FIRST DAY
OF MENSES. DAY 1 OF MENSES IS THE FIRST DAY OF THE
MENSTRUAL CYCLE.
3. SIGNS OF OVULATION:
* MITTELSCHMERZ: midcycle pain, low
quadrant, unilateral
* + SPINNABARKEIT test: cervical mucus thin
and stretchable up to about 10-12 cm
* Basal Body Temperature (BBT) Method:
slight rise in BBT (0.3-0.6 C) preceded by a slight drop.
D. At ovulation time, the woman is most fertile. If
sexual intercourse occurs during this fertile period,
the ovum could be fertilized by the sperm resulting
to pregnancy.
FERTILIZATION
A. Fertilization is the union of the mature ovum (egg cell)
and sperm; impregnation of the ovum by the sperm.
B. Site: FALLOPIAN TUBE – the most common site,
particularly in the ampulla.
C. Time: The ovum could be fertilized as early as 12-24
hours after ovulation. The life span of the ovum is 24
 hours. The sperm must be in genital tract 4-6 hours IMPLANTATION
before it is able to fertilize an egg cell, the enzyme A.K.A. NIDATION
HYALURONIDASE is activated which dissolves the
cement substance hyaluronic acid for fertilization. TIME: 6 to 7 days after fertilization
SITE:
D. Synonyms: CONCEPTION, impregnation, fecundation A. Normal
B. Abnormal

The placenta
LOCATION: Located in the uterus, anteriorly or posteriorly near
the fundus.

FETAL SIDE: covered with amion.

MATERNAL SIDE: divided into irregular lobes.

PLACENTA is formed by the union of the CHORIONIC VILLI and

DECIDUA BASALIS.

DECIDUA
ENDOMETRIUM OF PREGNANCY.
FERTILIZATION AND FETAL DEVELOPMENT
3 Layers
FERTILIZATION  Decidua Basalis – where implantation takes place,
The union of mature egg cell (ovum) and sperm cell happening in maternal side of the placenta
the AMPULLA (outer third of the fallopian tube)  Decidua Capsularis – enclosed the blastocyst
 Decidua Vera/Parietalis – located under decidua
ZYGOTE basalis
The First Cell of the Human Body

 First cell of the human body formed after fertilization

Contains 46 chromosomes: 44 autosomes and the remaining are

either XX chromosomes if the offspring is female, or XY
chromosomes if the offspring is male.

 The zygote journeys from the fallopian tube to the

uterus for a period of 3-4 days.
 About 24 hours after fertilization, it undergoes its first
cell division. Subsequent cell division occurs after every
22 hours.
 When there are already 16 or more blastomeres, it
becomes morula , it is in the morula form that the
zygote travels from the fallopian tube to the uterus.
 Upon reaching the uterine cavity, the remaining zona
pellucida disintegrates and the morula is transformed
into a blastocyst.

BLASTOCYST
 Composed of inner cell mass called embryonic disc or
blastocele, then trophoblast developed.
 Trophoderm layer gives rise to the placenta, fetal
membrane, umbilical cord and amniotic fluid. The
important function of trophoblast is to:
a. absorb nutrient from the endometrium
b. Secrete the hormone HCG necessary in prolonging the life
of corpus luteum.
 Blastocele gives rise to the 3 Germinal Layer

3 Germinal layer
1. Ectoderm – first germ layer to develop that gives rise to
the skin, hair, nails, sense organs, nervous system,
mucous membrane of the mouth and anus.
2. Entoderm – gives rise to the bladder, lining of the GIT,
tonsils, thyroid gland, and respiratory system.
3. Mesoderm – the last germ layer to develop that gives
rise to the kidney, musculoskeletal system (bones,
muscles), reproductive system and cardiovascular
system (heart and blood vessels)

Aira C. 