A Framework for Maternal and Child Health 3.

Research oriented/Evidence Based

Nursing 4. Advocate to protect the rights of all family
members, including the fetus.
Maternal & child health nursing (MCHN) 5. Using high degree of independent nursing
● Involves care of the woman & family throughout functions, because teaching and counseling are
pregnancy & childbirth & the health promotion major interventions.
& illness care for the children & families. 6. Promoting health and disease prevention are
important nursing roles because these protect the
Obstetrics health of the next generation.
● Care of woman during childbirth 7. Serve as important resources for families during
● derived from Greek word “obstare” (to keep childbearing and childrearing as these can be
watch) extremely stressful times in a life cycle.
8. Personal, cultural, and religious attitudes and
Pediatrics beliefs influence the meaning and impact of
● is a word derived from Greek word, “pais” childbearing and childrearing on families.
meaning (child) 9. Health Promotion and Disease Prevention to
protect health of new generation.
Focus of MCN 10. A challenging role for nurses
● Care of: childbearing (nanganganak) &
childrearing families (nagpapalaki) Maternal and Child Health Goals and Standards

Goals of Maternal and Child Health Nursing ● In maternal-child health, standards have been
● Promotion and maintenance of optimal family developed by the:
health to ensure cycles of optimal childbearing
and childrearing.  Division of Maternal-Child Health
Nursing Practice of the American Nurses
● Goals of MCN are broad Because the scope of Association in collaboration with the
practice or range of practice includes the ffg: Society of Pediatric Nurses.

1. Preconceptual Health Care American Nurses Association/Society of Pediatric

Nurses Standards of Care and Professional
2. Care of women during 3 trimesters of pregnancy
Performance
 1st trimester (1st –3rdmonth) (most risky)
 2nd trimester (4th–6thmonth)
Standards of Care
 3rd trimester (7th–9thmonth)
 Comprehensive pediatric nursing care focuses on
3. Care of women during Puerperium or 4th helping children and their families and
Trimester (6 weeks after childbirth) communities achieve their optimum health
4. Care of infants during Perinatal Period (6 wks potentials. This is best achieved within the
before conception & 6 wks afterbirth) framework of family-centered care and the
5. Care of children from birth to adolescence nursing process, including primary, secondary,
 Neonatal (28 days of life); and tertiary care coordinated across health care
 Infancy (1–12 months); and community settings.
 Adolescence (after 18 y/o)
6. Care in settings as varied as the birthing room,  Standard I: Assessment
the PICU, and the home. The pediatric nurse collects patient health data.

Philosophies of MCN  Standard II: Diagnosis

MCN is: The pediatric nurse analyzes the assessment data in
1. Family Centered determining diagnoses.
2. Community Centered
 Standard III: Outcome Identification pediatric health care through the use of research
The pediatric nurse identifies expected outcomes methods and findings.
individualized to the child and the family.
 Standard VIII: Resource Utilization
 Standard IV: Planning The pediatric nurse considers factors related to safety,
The pediatric nurse develops a plan of care that effectiveness, and cost in planning and delivering
prescribes interventions to obtain expected outcomes. patient care.

 Standard V: Implementation Association of Women’s Health, Obstetric, and

The pediatric nurse implements the interventions Neonatal Nurses Standards and Guidelines
identified in the plan of care.
Standards of Professional Performance
 Standard VI: Evaluation
The pediatric nurse evaluates the child’s and family’s  Standard I: Quality of Care
progress toward attainment of outcomes. The nurse systematically evaluates the quality and
effectiveness of nursing practice.
Standards of Professional Performance
 Standard II: Performance Appraisal
 Standard I: Quality of Care The nurse evaluates his/her own nursing practice in
The pediatric nurse systematically evaluates the relation to professional practice standards and
quality and effectiveness of pediatric nursing practice. relevant statutes and regulations.

 Standard II: Performance Appraisal  Standard III: Education

The pediatric nurse evaluates his or her own nursing The nurse acquires and maintains current knowledge
practice in relation to professional practice standards in nursing practice.
and relevant statutes and regulations.
 Standard IV: Collegiality
 Standard III: Education The nurse contributes to the professional
The pediatric nurse acquires and maintains current development of peers, colleagues, and others.
knowledge and competency in pediatric nursing
practice.  Standard V: Ethics
The nurse’s decisions and actions on behalf of
 Standard IV: Collegiality patients are determined in an ethical manner.
The pediatric nurse interacts with and contributes to
the professional development of peers, colleagues,  Standard VI: Collaboration
and other health care providers. The nurse collaborates with the patient, significant
others, and health care providers in providing patient
 Standard V: Ethics care.
The pediatric nurse’s assessment, actions, and
recommendations on behalf of children and their  Standard VII: Research
families are determined in an ethical manner. The nurse uses research findings in practice.

 Standard VI: Collaboration  Standard VIII: Resource Utilization

The pediatric nurse collaborates with the child, The nurse considers factors related to safety,
family, and other health care providers in providing effectiveness, and cost in planning and delivering
client care. patient care.

 Standard VII: Research  Standard IX: Practice Environment

The pediatric nurse contributes to nursing and The nurse contributes to the environment of care
delivery within the practice settings. Human Sexuality
Sex
 Standard X: Accountability ● Act of copulation
The nurse is professionally and legally accountable ● Coitus
for his/her practice. The professional registered nurse
may delegate to and supervise qualified personnel Human Sexual Response
who provide patient care. ● Sexuality has always been a part of human life.
● According to researcher, feelings and attitudes
Theories Related to Maternal and Child Health about sex vary widely:
Nursing - The sexual experience is unique to each
individual, but sexual physiology (i.e., how
 Nursing theorists offer helpful ways to view the body responds to sexual arousal) has
clients so that nursing activities can best meet common features (Baram & Basson, 2007).
client needs—for example:
● by seeing a pregnant woman not simply as a 4 Stages of Sexual Response (EPOR)
physical form but as a dynamic force with Human Sexual Response Cycle
important psychosocial needs, or
● by viewing children as extensions or 1. Excitement
● active members of a family as well as ● Occurs with physical & psychological
independent beings. stimulation that causes parasympathetic nerve
● Only with this broad theoretical focus can stimulation.
nurses appreciate the significant effect on a ● Stimulation of penis
family of a child’s illness or of the ● Arterial dilatation & venous constriction in the
introduction of a new member. genital area

 Another issue most nursing theorists address is Physiological Changes

how nurses should be viewed or what the goals Women
of nursing care should be.
Clitoris increase in Size
Lubrication
 Extensive changes in the scope of maternal and
Vagina Widens
child health nursing have occurred as health
Breast nipples become erect
promotion, or keeping parents and children well,
has become a greater priority. Increase BP, RR, HR
Men
Roles and Responsibilities of a Maternal and Erection
Child Nurse Scrotal Thickening
Elevation of the testes
ROLES Increase BP, RR, HR
● teaching,
● counseling, 2. Plateau
● supporting, and ● Formation of the orgasmic platform.
● advocacy ● Increased HR to 100-175 bpm
● Nurses care for clients who are more critically ill ● Increased RR approximately 40 cycles per
than ever before. minute.
● Because care of women during pregnancy and of ● Reach first before orgasm
children during their developing years helps ● Women: formation of organic platform,
protect not only current health but also the health increased nipple
of the next generation, maternal- child health ● Men: full distention of the penis
nurses fill these expanded roles to a unique and
special degree.
3. Orgasm / Orgasmic 3. Ovaries
● Body suddenly discharges accumulated sexual 4. Uterus
tension.
● Women: 8-15 contractions with interval of 1 PHASES OF MENSTRUAL CYCLE
every 0.8 seconds. 1. Proliferative
● Men: muscle contractions surrounding the ● Occurs during the first 4-5 days of a cycle
seminal vessels & prostate projects semen into ● Ovary begins to produce estrogen which thickens
the proximal urethral ejaculations 3-7 times. endometrial lining by 8th folds
● Shortest stage – experience intense pleasure.
● Orgasm occur 2. Secretory phase
● A rash, or "sex flush" may appear over the entire ● Increase progesterone; capillaries increase in
body. amount until lining appears rich, spongy velvet.

4. Resolution 3. Ischemic phase

● Period during which the external & internal ● If no fertilization occurs, decrease progesterone
genital organs return to an unarousal state. & estrogen, capillaries rupture & endometrium
● Generally takes 30 minutes sloughs off.

Menstrual Cycle and Menarche Menses

● Discharge from the uterus
Menarche  Blood from the rupture capillaries
● Onset or the very 1st menstruation  Mucin from the glands
● An event that signifies the end of puberty & the  Fragments of endometrial tissue
beginning of the reproductive years of a woman  Unfertilized ovum
● Typically occurs bet 9-17 years old (average age
of onset 12 or 13 years) Diagnostic Tests
Fern test
Menstrual cycle  Increased estrogen when cervical mucus forms a
● rhythmic reproductive cycle in females extending fernlike pattern when it is placed on a glass slide
from the onset of a period of uterine bleeding to & allow to dry.
the onset of the next period of bleeding Spinnbarheit test
● Mean cycle length is 28 days  Increased estrogen when cervical mucus
● Normal range is 20 to 45 days per cycle becomes thin & watery & can be stretched into
● the rhythmic menstrual cycles begin at puberty long strands.
and cease at menopause  Increased progesterone when mucus is thick &
● is a monthly pattern of ovulation and viscous state
menstruation
● is a monthly pattern of ovulation and ● Menstruation - the period of uterine bleed &
menstruation shedding of the endometrium & lasts an ave of 4-
● Ovulation - Discharge of a mature ovum from 5 days
the ovary ● Often referred to as menstrual phase,
● bleeding, menses or a period
Menstruation ● Periodic shedding of:
● Periodic uterine bleeding in response to cyclic  Blood
hormonal changes.  Mucus
4 BODY STRUCTURES INVOLVE IN  Epithelial cells from uterus
MENSTRUAL CYCLE: ● Average blood loss is 30-80 mL
1. Hypothalamus
2. Pituitary Gland
Ovaries System responsible for Menstruation
● Produce mature gametes & secrete the ffg ● CNS
hormones: ● Endocrine system
 Estrogen ● Reproductive system
Function
● Hormone of the woman CNS response
● Primary function is the dev’t of 2° sexual ● Hypothalamus
characteristics in female ● Stimulates the anterior pituitary gland “master
● Inhibits production of follicle stimulating clock of the body” (APG) by secreting
hormone (FSH) gonadotropin-releasing hormone (GnRH)
● Responsible for hypertrophy of myometrium ● APG secretes 2 gonadotropins:
● Responsible for spinnbarkeit & ferning (cervical  FSH
mucus or Billing’s ovulation method) - prompts the ovary to develop ovarian
● Spinnbarkeit test follicles
 Clear - The developing follicles secrete estrogen
 Slippery texture (like uncooked egg white w/c feeds back to APG to supress FSH &
 Typical of cervical mucus during ovulation trigger a surge of LH
● Ferning  LH
 Test for the presence of estrogen in the - Acts w/ FSH to cause the ovulation &
cervical mucus enhance corpus luteum formation
 Estrogen causes cervical mucus to dry on a
slide in a fernlike pattern Ovarian response
 In pregnancy testing, the fern pattern does ● An oocyte grow w/in the primodial follicle in 2
not appear phases
● Dev’t of ductile structure of the breast OVARIAN PHASES
● ↑ osteoblastic activity of long bones causing an ↑ 1. Follicular phase
in height - Days 1-14
● At 12 years old, female taller than male - The follicle matures as a result of FSH.
● Early closure of epiphysis of long bones 2. Luteal phase
● ↑ sexual desire in female - days 15-22
● ↑ vaginal lubrication - Corpus luteum develops from ruptured follicle
● Responsible for Na retention therefore causing
wt. gain Endometrial Response (4 PHASES)
1. Menstrual phase
Progesterone - Days 1-5
● Hormone of the Pregnant - Estrogen level is ↓
● 1° function: - Cervical mucus is scanty
 prepares the endometrium for implantation 2. Proliferation (Follicular) phase
of fertilized ovum making it thick. - days 6-14
● 2° function: - Estrogen level is ↑
 inhibits uterine contraction - Endometrium and myometrium thicken
● Inhibits prod’n of Luteinizing hormone (LH) - Cervical mucus changes
● ↓ GIT motility leading to constipation Note: Average Ovulation 14-28 days
● Dev’t of mammary gland 3. Secretory phase
● ↑ permeability of kidney to lactose & dextrose ● Days 14-26
causing (+) 1 sugar in urine. ● After release of the ovum, Estrogen level drops
● ↑ basal body temperature ● Progesterone level ↑
● Mood swing of the woman ● ↑ uterine vascularity
4. Ischemic phase Menstrual Cycle
● days 27-28 ● Female reproductive cycle
● Estrogen & progesterone levels recede ● Periodic uterine bleeding in response to cyclical
● Endometrium prepares to shed hormonal changes
● Menstruation begins
BODY STRUCTURES INVOLVE IN THE
Cervical Response MENSTRUAL CYCLE
 Before ovulation
● Estrogen levels ↑ Hypothalamus
● Causing cervical os dilation ● The ultimate initiator of the menstrual cycle by
● Abundant liquid mucus secreting Gonadotropin Releasing Hormones
● High spinnbarkeit (GnRH) that governs the PG by hormonal
● Excellent sperm penetration pathways, w/c in turn governs the ovary in the
same manner.
 After ovulation
● THE GnRH are:
● Progesterone levels ↑
● Resulting cervical os constriction ● Follicle Stimulating Hormone Releasing
Hormone (FSHRH)
● Scant viscous mucus
- Triggered by ↓ serum estrogen level, it
● Low spinnbarkeit
stimulates the APG to release FSH
● No ferning
● Luteinizing Hormone Releasing Factor (LHRF)
● Poor sperm penetration
- Triggered by ↓ serum progesterone level
 During pregnancy
- Stimulates APG to release Luteinizing hormone
● Cervical circulation (blood supply) increases (LH)
& a protective mucus plug forms
Anterior pituitary gland(APG)
Characteristic Periods and Menopause
● In response to stimulation from the
● Climacteric is a transitional period during w/c hypothalamus and ↓ serum Estrogen and
ovarian fxn & hormones prod’n decline Progesterone levels, the APG releases the
● Menopause refers to woman’s last menstrual following Gonadotropin hormones (GRH)
period
● Ave age 51 with ave range 40-55  Follicle Stimulating Hormones (FSH)
- This is triggered by FSHRF and ↓ E level,
MENSTRUAL DISORDER VOCABULARY it stimulates the development of several
 meno = menstrual related graafian follicles in the ovary and the
 metro = time production of Estrogen.
 oligo = few - It is inhibited by high serum estrogen level
 a = without, none or lack of  Luteinizing Hormone (LH)
 rhagia = excess or abnormal - Triggered by ↓ serum progesterone and
 dys = not or pain LHFH
 rhea = flow - It stimulates the corpus luteum to produce
● Amenorrhea progesterone and some estrogen.
● Dysmenorrhea - Responsible for ovulation
● Metrorrhagia Ovary
● Menorrhagia ● Known as female gonad
● Polymenorrhea ● Produces estrogen during the first half of the
● Hypomenorrhea cycle and progesterone during the second half of
● Hypermenorrhea the cycle.
 Within the cortex of the ovary
 The follicles at the different phases of the
dev’t are found:
Primodial follicles corpus albicantia.
 Formed during intrauterine life
 Most of them regress before birth Hormones of the Ovaries
 Immature follicles inside the ovary that contain Estrogen
immature ova ● FSH stimulates the Graafaian follicle to produce
 During a menstrual cycle, several of these Estrogen
follicles develop under the influence of FSH. ● 3 kinds of Estrogen:
1. Estradiol
Graafian follicles 2. Estrone
 Derived from the name of Regner de Graaf, the 3. Estriol
Dutch anatomist who 1st described it in 1672. ● Estradiol is the most potent
 After puberty, several follicles develop under the ● Estriol is the one found in urine
influence of FSH ● Estrone is metabolized by the liver and excreted
 This developng promodial follicle is termed in the urine
Graafian follicle. ● Effect of Estrogen
 Described as a blister like structure barely visible  inhibits FHS
to the naked eye. As it develops, the oocyte  Known as the “Hormone of Women”
within it matures because it is the hormones that stimulates the
 Secret large amount of estrogen and under the devt of the female 2º characteristics
influence of FSH.  Causes mucus to be thin transparent and
highly stretchable
Corpus luteum/follicles  Stimulates the growth of ductile structure of
 After ovulation, the Graafian follicles undergoes the breasts
certain changes.  Menarche and menstruation
 Cells inside, now empty follicle proliferate and
enlarge until it becomes a dense mass of cells Progesterone
about 1 to 3 mm in diameter that produce a ● LH stimulates the corpus luteum to produce
yellow fluid called lutein. progesterone.
 Lutein fills the space that was once occupied by ● Its by product found in the urine known as
the ovum giving it a yellow coloration. This is pregnanediol
why the follicle is termed corpus luteum after
● Known as the “Hormone of Pregnant Women”
ovulation w/c means yellow body
● Effect of Progesterone
 The primary hormone produced is progesterone,
 Thermogenic effect: body temperature drops
although secret some estrogen.
by 0.5 to 1 º F a day before ovulation
 Has life span of 7-8 days only. After which it
because of the very low progesterone level at
regresses
this time, and rises 1º F once progesterone
 If fertilization occurs, the trophoblast cells of the increase in level
zygote secret HCG w/c prolongs the life of
 Remains elevated for the next 8-10 days.
corpus luteum & stimulates it to continue
 Relaxes uterine muscles
producing progesterone.
 Promotes growth of the acini cells of the
 Not only secrets progesterone during pregnancy
breast
but also, relaxin, activins, inhibins and sometime
oxytocin.  Causes weight gain by promoting fluid
retention
 Produce P until 8 - 12 wks gestation
 Causes tingling sensation and feeling
 It usually regresses after 6 months
fullness in the breast
 Stimulates endometrium glans to secret
Corpus albicans
mucin and glycogen in preparation for
 Complete regression of the corpus luteum occurs implantation.
before menstruation, later it will be seen as a
white fibrous tissue, called corpus albicans or
Uterus 1 Corpus Spongiosum
● Changes occurs in the uterine endometrium are ● The penis supports the urethra as it passes from
due to the influence of the ovarian hormones: the seminal vesicles, through the Corpora
E&P Cavernosa, to the meatus at the glans of the penis.
● 1st half of the cycle, proliferation of the ● At its tip is the glans penis which is the most
endometrial glands and blood vessels is due to sensitive area comparable to that of clitoris in
the influence of estrogen female.
● 2nd half of the cycle, mucin and glycogen
secretion of endometrial glands is due to  Scrotum (Scrotal Sac)
influence of the progesterone. Structure
● Sac- or pouch-like structure hanging below the
Male Reproductive Organ pendulous penis,
● With a median septum dividing it into two sacs,
Male Reproductive System each of which contains testis. It is the cooling
● External Genitalia mechanism of the testes.
● Internal Gentalia ● Composed of skin and dartos muscles
● Sebaceous glands open directly onto scrotum
Andrology secretions with distinct odor.
● The study of the male reproductive organ. ● Contractions of dartos & cremaster muscles
shortens scrotum & draws it closer to the body,
Primary Reproductive Function wrinkling its outer surface.
● Production & transport of sperms through & out  Degree of wrinkling:
of the genital tract into the female tract  Smooth in preterm, wrinkled in full term
newborns
External Genitalia  Greatest wrinkling in young men & at
 Penis cold temperature
Function  Least wrinkling in older men & at warm
temperature.
● copulation & urination
Function
● (Pathway for both urine & semen)
● Scrotum contains the testes & epididymis
Structure
● Protect the testes & the sperm by maintaining
● Elongated & cylindrical
temperature lower than the body.
● Lies in front of the scrotum
 34.4°C enables the production of sperm
● Extremely vascular;
 36.7°C damaging to sperm count
Blood spaces fill & become distended during
● Because the testes are sensitive to touch,
sexual excitement resulting in penile distension
temperature, pressure & pain
& stiffening termed erection
Consist of
Internal Genitalia (also known as gonads)
● Body (shaft)
 Testes or testicles
● Cone-shaped end (glans penis)
Structure
● Meatus
● Contained within the scrotum
Structure
● 2 oval-shaped glandular organs about 5cm long
● Contains of a body or a shaft consisting of 3
& 3cm in diameter
longitudinal columns and erectile tissues
● There are 3 layers
● 3 longitudinal columns of the penis:
 Tunica vasculosa
2 Corpora Cavernosa
- inner layer of connective tissue containing
 2 lateral columns of erectile tissue located on
a fine network of capillaries
either side & in front of the urethra;
 Tunica albuginea
 Made of sponge tissue which is filled with
blood during sexual arousal. - fibrous covering
 - its ingrowths divide the testis into 200-300 attachment
lobules  Drains in the same manner as the ovarian
 Tunica vaginalis veins.
- outer layer  The right testicular vein joins the inferior
- Made of petroleum brought down with vena cava but the left returns its blood to the
descending testis when it migrated from the left renal vein.
lumbar region in fetal life ● Nerves
Function Nerve supply if from the X & XI thoracic nerve.
● Produce & store spermatozoa/sperm (main ● Lymphatic Vessels
reproductive organ responsible for Lymphatic drainage is to the lymph nodes
spermatogenesis) around the aorta.
● Main source of male hormone testosterone ● Vas deferens joins duct of seminal vesicles to
● Testosterone is responsible for secondary sex become ejaculatory ducts
hormones - small muscular ducts that carry the
● Together with follicle stimulating hormone spermatozoa & the seminal fluid to the urethra
(FSH), its also promotes the production of Function
spermatozoa ● Function of the deferent duct is to carry the
sperm to the ejaculatory duct
System Ducts including:
 Vas deferens
 Epididymis  Ejaculatory duct
Structure  Urethra
● Soft, cordlike, comma-shaped
● Located on the superior surface of the testis & Accessory Glands including:
travels down to the posterior aspect to the lower ● Seminal vesicles - Paired structure or pouches
pole of the testis leading to the deferent duct (vas situated posterior to the bladder
deferens)
● Head: attached to top of testis ● Prostate gland - located below the bladder,
● Tail: continuous with vas deferens surrounds the urethra at the base of the bladder,
● Storage House: for maturing spermatozoa lies bet the rectum & the symphysis pubis
 4 cm long, 3 cm wide & 2 cm deep
 Seminiferous tubules (“seed-carrying” tubules)  Composed of columnar
Structure
● Place of sperm production (spermatogenesis) ● Cowper’s gland - located on each side of the
● 3 tubules in each lobule & between the tubules urethra, just below the prostate gland; secrete
are interstitial cells which secrete male hormone small amount of lubricating fluid.
testosterone.
● Tubules join to form a system of channels ● Bulbourethral glands & urethral glands
leading to the epididymis
FEMALE REPRODUCTIVE SYSTEM
 Spermatic Cord
Structure External Genitalia
● Vas Deferens “Vulva” is the collective term of female external
- carries the sperm to the ejaculatory duct genitalia.
- Ligated in bilateral vasectomy “Pudenda” is the term used to denote the external
● Testicular blood vessels : Arteries & Veins genitalia of either sex.
testicular artery:
 branch of abdominal aorta MONS VENERIS
 Supply blood to the testis, scrotum&  also called Mons Pubis meaning Mountain of
 Venus,  Primary significance in obstetrics: serves as
 is a mound of fatty tissues (sebaceous glands) guide to female catheterization
that lies over the symphysis pubis covered by Function
skin  protects the labia minora & vaginal os
 after puberty is it covered by pubic hair (curly
hair) that forms the escutcheon. VESTIBULE
Function  an almond shape area that contains the urinary
 serves as cushion or protection to the symphysis meatus, Skene’s glands, hymen, vaginal orifice
pubis. and Bartholin’s glands.
 Urinary Meatus
LABIA MAJORA - urethral opening for urination
 “large, bigger or greater lips” - The shortness of the urethral predisposes the
 longitudinal fold of pigmented skin that extends female to recurrent urinary tract infection (UTI)
from the symphysis pubis to the perineum.  Skene’s Glands (Paraurethral Glands or
 2 folds of skin with sparse hair on either side of lesser vestibular)
the vaginal opening ● 2 small, palpable glands that open onto the
 With fat posterior urethral wall
 Contains the Bartholin’s glands ● secretes small amounts of mucous which
 Dartus muliebris – responsible for the wrinkle- functions as lubrication during sexual
like appearance of the labia majora. intercourse or coitus.
Function ● most common site of external genital
 protects the labia minora & vaginal os infection in females
 Bartholin’s Glands (Paravaginal or Vulvo-
LABIA MINORA vaginal glands or greater vestibular)
 “nymphae”; 2 thinner, soft longitudinal folds ● 2 small, palpable glands situated the
located in between labia majora vestibule on either side of the vaginal orifice.
 Hairless ● Secretes alkaline substance responsible for
 Anterior ends unite to form the prepuce. neutralizing the acidity of vagina to keep the
 Prepuce - Posterior ends unite to form the sperm alive particularly the androsperms
fourchette. ● Doderleine’s bacillus – responsible for
● Fourchette maintaining the acidic environment of the
- Formed by the posterior joining of the labia vagina.
minora and majora which is very sensitive to  Vaginal orifice
manipulation, often torn during vaginal ● external opening of the vagina.
delivery; common site for episiotomy.  Hymen
Function ● membranous tissue that covers vaginal
 protects & obscure the vestibule, urinary meatus orifice.
& vaginal os ● Thin mucous membrane
● Can be stretched or torn during physical
GLANS CLITORIS activity, tampon insertion, vaginal
 Greek word means “key” of highly erogenous & examination or sexual intercourse
sensitive tissue protected by prepuce  Hymen Myrtiformes carunculae (hymenal
 Small body caruncles)
 pea-shaped composed of erectile tissues and ● term for the residual tags or remnants of the
sensitive nerve endings which is the site of torn hymen post – instrumentation, use of
sexual arousal, excitement, eroticism orgasm in tampons, coitus or vaginal delivery.
females. Function
 Sensitive to touch, pressure & temperature ● protects the opening of the vagina; separates
 Secretes smegma internal from external reproductive organs
PERINEUM stands erect
 area between the vagina & rectum; consists of ● Leans forward & this position is known as
fibromuscular tissue. Most of the support of the anteversion.
perineum is provided by: ● Bends forward on itself producing
anteflexion with the fundus resting on the
 Pelvic diaphragms bladder.
- consists of the levator ani muscles plus the - The normal anteversion & anteflexion of
coccygeous muscles posteriorly. the uterus prevent uterine prolapse.
 Urogenital diaphragms  Weight:
- comprised of the deep transverse peineal  Non-pregnant: 50-60 g
muscles, the constrictor of the urethra & the  Pregnant: 1000 g
internal and external facial coverings ● 4th Stage of Labor: 1000 g
● 2 weeks after delivery:500 g
Internal Genitalia ● 3 weeks after delivery: 300 g
VAGINA ● 5-6 weeks after delivery:50-60 g
 vascular, tubular, musculomembranous structure
that extends from the vulva to the uterus between  Three portions of the Uterus
the urinary bladder and urethra (anteriorly), Fundus
rectum & perineal body (posteriorly), uterus ● uppermost cylindrical/convex portion , most
(superiorly) & external genitalia (inferiorly). muscular area of the uterus
 Length: 3-4 inches; or 8-10 cm long of dilatable ● most contractile portion during labor).
canal containing rugae ● Used for OB landmark
● thick folds of membranous stratified antenatal (Palpation for uterine growth & dev’t)
epithelium which permits considerable
Postpartum (involution)
amount of stretching without tearing.
Ideal site for the implantation of the zygote
Function
Corpus/body
 Female organ for copulation; passageway of
● upper, larger, triangular portion.
menstruation and fetus
● Makes up the 2/3 portion of the uterus
● It houses the fetus during pregnancy
UTERUS
Cornua
 a hollow, pear-shaped organ;
● the point from where the oviducts or the
 thick walled muscular organ designed for the
fallopian tubes emerge
implantation, containment and nourishment of
the developing fetus. It varies in size, shape and Isthmus
weight. Its functions are mainly for menstruation, ● called the “lower uterine segment” during
pregnancy and labor. pregnancy, it is the portion that joins the cervix
 Uterine length: to the corpus
● Before puberty : 2.5-3.5 cm ● upper third of the cervix w/c is very thin
● Adult nulliparous women: 6-8 cm Cervix
● Multiparous women: 9-10cm ● Neck of the uterus
 Uterine shape: ● lower cylindrical layer; lowest and narrowest end
of uterus.
● Non-pregnant: pear shape or inverted
avocado ● 2.5 cm long 2.5 cm in diameter
● Pregnant: ovoid ● Contains sebaceous glands secretes clear viscid
and alkaline mucus.
 Position
● Parts of the Cervix
● uterus is partially mobile organ; as the body
moves, it is free to move in the Internal os - w/c open to the corpus
anteroposterior Cervical canal- bet the internal and external os
● The uterus lies in a position almost External os which opens to vagina
horizontal when a non-pregnant woman
Muscular Layers of the Uterus Mesovarium: supports the ovaries
These three muscle layers make expansion of the
uterus in every direction 3. Round ligaments
● (2) ligaments connects the uterus to the labia
Endometrium majora by extending from the upper outer angle
● the inner mucosal layer; formed where the fallopian tubes join the uterine
● undergoes constant changes in response to corpus (@ the cornua), thru the inguinal canals &
estrogen (proliferation phase) & progesterone ending in the labia majora
(secretory phase) during the menstrual cycle, ● Give stability to the uterus
● it lines the non-pregnant uterus; - Hypertrophy during pregnancy under the
● muscle layer for menstruation; influence of hormones
● sloughs off during menstruation.
● Decidua - it lines the pregnant uterus. 4. Uterosacral Ligament (2)
● hold the uterus in position by maintaining
Myometrium traction on the cervix & connects uterus to
● middle muscular layer, thickest sacrum.
● its smooth muscles are considered to be the - Keep the uterus in its normal position by
“living ligatures” of the body that control maintaining traction to cervix.
bleeding during 3rd stage of labor;
● largest portion of the uterus; “power of labor”; 5. Anterior Ligament (1) (uterovesical or
muscle layer for delivery process, responds to the pubocervical)
stimulation by oxytocic drugs ● provides support to the uterus in connection with
the bladder
Perimetrium - Overstretching of this ligament will cause the
● outermost serosal layer formed by the bladder to “drop” & to herniate into of the
peritoneum (parietal peritoneum) protects the vagina, a condition called cystocele.
entire uterus.
● Attached to the broad ligament 6. Posterior Ligament (1) (uterovesical or
pubocervical)
Uterine ligaments supports the uterus ● Connects the posterior portion of the uterus to
(10 ligaments) the rectum.
● Forms the deep rectouterine pouch also known as
1. Cardinal/Transverse-Cervical/Lateral the cul-de-sac of Douglas w/c is the lowest part
Cervical/Mackenrodt ‘s Ligaments (2) of the abdominal cavity so that the blood, pus or
other drainage in the abdominal area tends to
● the lower portion of the broad ligaments and
collect here.
the upper portion of the posterior ligaments.
- Damage to this will lead to herniation of
● Main support of the uterus
rectum to vagina, a condition called rectocele.
● Damage to this ligament will result to
Functions:
uterine prolapse
● Cardinal function is as an organ of reproduction
● Organ of menstruation
2. Broad Ligaments/Peritoneal Ligaments
● Pregnancy/gestation: houses and nourishes the
● the 2 broad ligaments are double folds of parietal
growing baby
peritoneum extending wing- like from the sides
of the corpus to the lateral pelvic wall. It ● Labor: it propels the products of conception into
supports the sides of the uterus & assists in the vaginal canal in labor
holding the uterus in anteversion.
● 3 PARTS Fallopian Tubes or Oviducts
Mesometrium: supports the corpus ● 2-3 inches long passageway which conveys the
Mesosalphinx: supports the fallopian tubes ova to the uterus.
● Four (4) Significant Segments of the fallopian
 tubes: escaping along with the release ovum during
1. Infundibulum ovulation.
● most distal part which is funnel or trumpet-
shaped. It has fimbria which are finger-like Ovarian functions:
projections that catches the mature ovum.  Process of developing a mature ovum in a
2. Ampulla graafian follicle (oogenesis)
● outer 3rd or 2nd half; or middle portion; common ● When primordial follicles mature &
site for fertilization & ectopic pregnancy. becomes cystic, they are termed Graafian
3. Isthmus follicles
● the narrowest portion of the FT only 1 cm long, ● The ovum is situated at the end of Graafian
common site for female sterilization which is follicle, encircled by a narrow perivitelline
also known as Bilateral Tubal Ligation (BTL). space, surrounded by a clump of cells called
4. Interstitial/intramural discus proligerus w/c radiate outwards to
● most dangerous site for ectopic pregnancy form the corona radiata. The very clear
because of its narrow lumen about 1 mm in innermost cells of corona radiata are referred
diameter. to as zona pellucida.
 Ovulation
OVARIES ● monthly expulsion of a mature ovum from
 2 almond-shaped female sex glands for ovulation the Graafian follicle in the pelvic cavity.
and production of 2 hormones progesterone and  Endocrine functions: (hormone production)
estrogen secretion of female hormones estrogen and
 The cortex of the ovary contains the developing progesterone
follicle and graafian follicle. ● maturing follicles secrete estrogen while
 Ovarian layers: corpus luteum secretes estrogen & primarily
Tunica albuginea progesterone.
● Dense & dull white; ● Ovaries:
● Outermost protective layer - primarily source of estrogen; adrenal
Cortex cortex produces minute amount of estrogen
● Contains the ovarian follicles in different ● Secondary : develops female secondary sex
stages of dev’t characteristics. “Hormone of woman
● Site for ovum formation & maturation ● Progesterone
● Ova, ( primodial follicles, graafian follicles, - “hormone of pregnant”; its effects on the
corpura lutea (corpus luteum ) & corpus decidua allow pregnancy maintenance.
albicans (corpora albicantia) & degenerated
follicles held together by ovarian stroma. ANALOGOUS STRUCTURE IN THE MALE &
● About 200,000 primordial follicles in the FEMALE REPRODUCTIVE SYSTEM
ovarian cortex @ birth MALE FEMALE
Medulla SPERMATOZOA OVUM
● Inner central part GLANS PENIS CLITORIS
● Surrounded by cortex SCROTUM LABIA MAJORA
● Composed of loose connective tissues & PENIS VAGINA
contains nerves, bld vessels & lymphatic TESTES OVARIES
vessels VAS DEFERENCE FALLOPIAN TUBE
● The hilum where these vessels enter lies just PROSTATE GLANDS SKENE’S GLANDS
where the ovary attached to the broad COWPER’S GLAN BARTHOLIN’S GLAND
ligament (this area is called mesovarium)
● The ovaries are incensitive unless they are Accessory Glands
distended & squeezed. The Mammary Glands (breast)
● Mittelschmerz: midcycle pain – caused by ● The female breast are accessory organs of the
irritation of the peritoneum by blood or fluid reproduction meant to provide the infant with the
 most ideal nourishment after birth Function:
● Situated over the pectoralis major muscles bet ● Lactation or milk secretions for nourishment &
the 2nd & 6th ribs maternal antibodies (IgA); source of pleasurable
● Supported by the Cowper’s ligaments sexual sensation

External structure FAMILY PLANNING:

 Nipple or Mammary papillae A SAFE MOTHERHOOD & WOMEN’S
● Located at the center of the anterior surface HEALTH EDUCATION
of each breast. It has 15-20 opening
connected to lactiferous ducts & in w/c milk Family Planning
flows out. ● A national mandated priority public health
 Areola program to attain the country's national health
● pigmented skin surrounding the nipple development: a health intervention program and
● Both the nipple and areola have pigmented an important tool for the improvement of the
& wrinkled health and welfare of mothers, children and other
 MontgomeryTubercle members of the family.
● glands in the areola that secrete an oily
substance that keeps the areola & nipple BASIC PRINCIPLES
lubricated ● Responsible Parenthood which means that each
family has the right and duty to determine the
Internal Structure desired number of children they might have and
 Lobes when they might have them.
15 to 20 lobes are found in each breast that are ● Responsible Parenting which is the proper
divided into several lobules upbringing and education of children so that they
 Lobules grow up to be upright, productive and civic-
minded citizens.
composed of clusters of acini cells
● Respect for Life. The 1987 Constitution states
 Acini cells
that the government protects the sanctity of life.
these are the milk secreting cells of the breasts
● Birth Spacing
that are stimulated by the prolactin hormone.
● Informed Choice that is upholding and ensuring
 Lactiferous Ducts
the rights of couples to determine the number
ducts that serves as the passageways of milk.
and spacing of their children according to their
 Lactiferous sinus life's aspirations and reminding couples that
Dilated portions of the ducts located behind the planning size of their families have a direct
nipple that serves as reservoir of milk. bearing on the quality of their children's and their
own lives.
Hormones that influence the Mammary Glands
Estrogen: TYPES OF FAMILY PLANNING
Stimulates dev’t of the ductile structures of the 1. Natural family planning
breast 2. Artificial contraceptives
Progesterone: ● Mechanical
Stimulates the dev’t of the acinar structure ● Chemical
Human Placental Lactogen: 3. Permanent Method of contraception
Promotes breast dev’t during pregnancy
Oxytocin: NATURAL FAMILY PLANNING
Let-down reflex ● Abstinence
Inhibited by progesterone ● Calendar Method
Prolactin: ● Lactational Amenorrhea
Stimulates milk production ● Basal Body Temperature
Inhibited by estrogen ● Billings Method
● Symptothermal Method ● Length ↑ from 7.5 cm to 32 cm; width from 4cm
● Coitus Interruptus to 24 cm & depth 2.5 cm to 22 cm.
b. Uterine shape
ARTIFICIAL METHOD OF FAMILY ● Changes from globular to OVAL
PLANNING
Chemical: c. FUNDIC HEIGHT CHANGES
● Contraceptive pills ● 12th wk: level of symphysis pubis
● Spermicidals ● 16th wk: 1-2 fingers above the symphysis pubis
● Depo provera ● 20 – 22wk: 2-3 fingers below the umbilicus
● Subdermal Implants ● 24 wk: at the umbilicus level
● Transdermal Patches ● 28 wk: 2-3 fingers above the umbilicus
● 32 wk: midway between the umbilicus and the
● Spermicidals xiphoid process
● The Shot - Depo Provera ● 40 wk: 1-2 fingers below the costal level
● Injectables ● 36 wk: at the level of the costal margin
● Implants
d. Increased vascularity to the pelvic region
MECHANICAL METHOD OF FAMILY (estrogen effect) results:
PLANNING ● Hegar’s sign: softening of the lower uterine
● Condom (Male & Female Condoms) segment
● Diaphragm ● Goodell’s sign: Softening of the cervix in
● Cervical cap pregnancy
● IUD ● Chadwick’s sign: discolorization of vaginal
● Vaginal ring walls from pink to violet or bluish
● Vaginal sponge
e. Braxton-Hicks Contractions:
PERMANENT METHOD OF FAMILY ● Intermittent irregular, painless, erratic uterine
PLANNING contractions false contractions felt as that occur
● VASECTOMY toward the end of pregnancy.
● BILATERAL TUBAL LIGATION (BTL)
f. Ballottement:
PHYSIOLOGIC CHANGES ● the sensation of an object rebounding after being
IN PREGNANCY pushed by an examining hand; used for
A. Reproductive system pregnancy diagnosis
B. Endocrine system
C. Respiratory system g. Secondary amenorrhea:
D. Circulatory system ● Due to the persistence of the corpus luteum
E. Gastrointestinal system
F. Urinary system CERVIX
G. Integumentary system ● a. shorter, thicker more elastic
H. Musculo-skeletal system ● b.with edema & hyperplasia of mucus lining,
there is ↑ mucus production which make up the
A. REPRODUCTIVE SYSTEM protective mucus plug (operculum) (wk 7).
UTERUS ● Seals the cervix, it also prevents bacterial
a. Uterine size contamination of the uterine cavity.
● ↑ due to hypertrophy of existing muscles & ● c. ↑ vascularity causes cervix to be soft:
connective tissues (no formation of new muscle Goodell’s sign
fibers in pregnancy) ● consistency of the tip of the nose: non-pregnant
● Wt ↑ 60 g (non-pregnant) to 1000 g (full term) cervix
● Consistency of earlobe: pregnant cervix ● HPL the major diabetogenic hormone or insulin
(Goodell’s sign) antagonist in pregnancy → gestational DM or
● Consistency of whipped butter: cervix ripe for difficulty to control pre-existing DM
labor ● c. HCG level:
● Peak around 10 wks gestation → 50,000 –
VAGINA 100,000 mIU/mL then ↓ to 10,000 – 20,000
● a. Hypertrophy & hyperplasia mIU/mL by 20 wks gestation
→ thickened vaginal mucosa
● b. Leukorrhea: whitish, mucoid, non-foul, non- ANTERIOR PITUITARY GLAND (APG)
pruritic vaginal secretions ↑ as estrogen level ↑; ● a. No ovulation from ↑ follicle stimulating
provides increased vaginal acidity, an added hormone (FSH)
protection from bacterial invasion. ● b. breast is prepared for lactation with increased
● c. ↑ vascularity results to bluish discoloration: prolactin
Chadwick’s sign
POSTERIOR PITUITARY GLAND (APG)
OVARIES ● a. Oxytocin is produced by hypothalamus
● a. ovum production ceases ● b. Fetal head pressure on the cervix stimulates
● b. corpus luteum persists & takes over hormonal PPG to secrete oxytocin → stimulates uterine
production task in early pregnancy myometrium → uterine contractions → labor
● c. Placenta: major endocrine organ in pregnancy onset (aided by the drop in progesterone in late
● d. Pregnancy is the rest period of the ovaries pregnancy

BREAST THYROID GLAND

● a. ↑ size & firmness ● a. Changes in thyroid activity → BMR
● b. there is tingling sensation in the nipples in 4 Due to:
wks & with breast tenderness  ↑serum estrogen
● c. Enlargement of areola, alveoli duct & alveoli  Placental effects on TF
system  ↑ renal clearance of iodide or ↓ available
● Darkening of areola & skin around it iodide
● Enlargement & prominence of superficial veins ● b. ↑ thyroid activity → BMR; any extraordinary
● Enlargement of Montgomery’s glands growth must be assessed:
 ↑ PR
B. ENDOCRINE SYSTEM  ↑ CO
PLACENTA  Heat intolerance
● a. Chorion of placenta secretes HCG w/c fxns
to: PARATHYROID GLAND
 Maintain the corpus luteum (most impt fxn ● a. enhanced Ca & Phosphorus metabolism to
 Aid in dx pregnancy by its detection in meet fetal needs for ↑ Ca
maternal serum & urine ● b. leading cause of cramps in pregnancy is
● Serum/blood: as early as 8-10 days or as the Ca-Phosphorus imbalance
time of implantations
● Urine: as early as 10-14 day after the missed PANCREAS
menstruation ● a. ↑insulin secretion in response to ↑ metabolism
 Found elevated in excessive vomiting in pregnancy
● b.Insulin secreted by pancreas is rendered
● b. Mature placenta@ the 10-12 wks; ↑ placental ineffective by insulin antagonists of pregnancy
hormones estrogen, progesterone, HCG & most importantly HPL or HCS
HPL/HCS (human placental lactogen/human
chorionic somatomammotropin)
ADRENAL CORTEX ● Nursing care:
● a. ↑cortisol works for promoting metabolism of  ↑ iron intake
Macronutrients  Parenteral iron thru Z-track method – if not
● If needs more energy cortisol activates given properly may cause hematoma
gluconeogenesis converts stored CHON to  Oral iron supplements (ferrous sulfate 0.3 g,
glucose 3x a day) best given 1 hour ac or with empty
● b. ↑aldosterone promotes Na retention & H2O stomach for better absorption, however can
reabsorption lead to GIT irritation, Hence, given on full
stomach but with Vit C to enhance
C. RESPIRATORY SYSTEM absorption.
NOSE Side effects:
● a. ↑ vascularity (estrogen effect) → nasal ● Constipation & black tarry stool
congestion ● Monitor for hemorrhage
● Iron from red meat is better absorbed than iron
RR from other sources
● a. not much change and may ↑ 24 bpm ● Iron is better absorbed when taken with foods
● b. may experience SOB due to enlarging uterus rich in Vitamin C such as orange juice.
& ↑O2 demand; may position the mother to L ● Higher iron intake is recommended since
side lying to promote lateral expansion of the circulating blood volume is ↑ & heme is required
lungs from the production of RBC’s
● c. Hyperventilation to blow-off ↑CO transferred ● Best sources of iron: Liver, lean or red meat,
to her from the fetus; direct effect of legumes, such as munggo and green leafy
progesterone on respiratory center vegetables such as kangkong, ampalaya, spinach
and malunggay.
D. CARDIOVASCULAR SYSTEM
E. GASTROINTESTINAL SYSTEM
● 1. HR ↑ 10-15 bpm in the 2nd & 3rd trimester ● 1. Morning sickness – characterized by early
● 2. Palpitation in early & late pregnacy due to: morning n/v due to ↑ HCG & reduction in HCl
 SNS disturbances (early) secretion
 ↑ intraabdominal pressure (late) ● 1st trimester – getting OOB slowly after eating
● 3. BP changes: a few crackers, eating frequent, small meals
(after nausea) & by avoiding spicy or greasy
 Remains constant, but may drop slightly in
foods.
2nd trimester
● 2. Hyperemesis Gravidarum – excessive
 Supine hypotension syndrome (supine
vomiting during pregnancy. May result to
position) → inferior vena caval compression
metabolic alkalosis.
→ ↓ venous return → ↓ CO →hypotension
● 3. Emesis Gravidarum – vomiting during
 Prevention & mgt:
pregnancy
 Left lateral recumbent (LLR)
● 4. Heartburn or Pyrosis – reflux of stomach
content to the esophagus. Can be prevented by
● 4. 3rd mo. ↑ Bld volume of 30-50% (1500 eating small frequent meals; avoiding fatty &
mL)→ ↑ Cardiac workload to meet the dev’t spicy foods; proper body mechanics: & taking
needs of the fetus sips milk.
● 5. WBC, fibrinogen, & other clotting factors ↑ ● 5. Emptying time decreased
● 6. Physiologic anemia ● 6. Food cravings – may occur; only significant if
 Due to hemodilution substance craved is unusual (pica) ; for example
 S/sx of Pathologic anemia: clay, starch, dirt, soil
 Pallor, slowed CR, concave fingernails (late ● 7. Ptyalism - ↑ salivation caused by ↑HCG
sign) caused by chronic tissue hypoxia ● 8. Hyperemia & softening of gums with
accompanying hyperacidity of oral secretions
 result in nonspecific gingivitis. Nsg care: ↑ vit C or lotion.
intake & regular oral hygiene ● 2. Protruding umbilicus
● 9. Flatulence - excessive amount of gas in the ● 3. Linea Nigra – used to be the linea alba but
stomach & intestine due to ↑ prod’n of changes to the brownish pinkish line running
progesterone. Can be lessened by avoiding intake from symphysis pubis to the umbilicus due to ↑
of gas-forming food such as root crops, beans melanin
● 10. Constipation – due to BM are infrequent or ● 4. Chloasma – melanoderma or melasma
incomplete due to hypoperistalsis, lack of fluids, characterized by the occurrence of extensive
poor dietary habits, pressure of the enlarged brown patches of irregular shape & size on the
uterus on internal organs, effects of progesterone skin of the face & elsewhere; the pigmented
on muscles & hemorrhoids. Mgt: ↑ OFI, eat high facial patches if confluent & also called the
fiber foods like oatmeal, papaya, pineapple, “mask pregnancy” & are associated most
grapes, apple watermelon, regular exercise. commonly w/ pregnancy & use of OC.
● 11. Hemorrhoids – a varicose condition of the
external hemorrhoidal veins causing painful H. MUSCULO-SKELETAL SYSTEM
swellings at the anus due to gravid uterus. Mgt: ● 1. Lordosis – accentuation of the lumbar
warm sitz bath, sit on soft pillows, high fib curvature of the spine. “Pride of Pregnancy”
 High fiber diet & ↑ OFI ● 2. Softening of all ligament & joints, esp.
symphysis & sacroiliac, caused by ↑ hormonal
F. URINARY SYSTEM action of estrogens and relaxin.
● 1. Proximity of the uterus & bladder in early & ● Prevents fall thru wearing of low heeled or flat
late pregnancy causes urinary frequency: shoes
a. 1st tri – frequent urination ● 3. Leg cramps – may occur from an imbalance
b. 2nd tri – normal as bladder is already of Ca in the body & from pressure of the gravid
adjusted uterus on nerves supplying the lower extremities.
c. 3rd tri - ↑ in frequency of urination due to MGT:
pressure of the gravid uterus on urinary bladder. ● Milk – should be limited to 1 pint or 4 cups/day
● 2. Bladder tone is reduced by effects of or 3-4 servings
hormones on smooth muscles ● Calcium-rich foods like anchovies, sardines,
● 3. Pressure of enlarging uterus & the specifically the head of the fish, sea foods,
progesterone effect on smooth muscles cause mussels, cheese, yogurts, broccoli & diary
dilatation of the ureters. The right side dilates products shld be included in the diet
more than the left in most patients ● Put the affected leg in a flat surface & do the
● 4. the kidneys ↑ in size bcoz of ↑ renal blood dorsiflexion
flow. This reverses after the 1st trimester.
● 5. ↑ urinary output results in lowered specific EMOTIONAL / PSYCHOLOGICAL
gravity. ADAPTATIONS IN PREGNANCY
● 6. Glycosuria - increased excretion of sugar
caused by lowered renal threshold FACTORS INFLUENCING A WOMAN’S
● 7. Nocturia - need to get up during the night in RESPONSE TO PREGNANCY
order to urinate, thus interrupting sleep, managed ● Memories of her own childhood
by: ● Cultural background
a. ↓ OFI at least 2 hrs before HS ● Socio-economic conditions
b. side lying or lateral position
● Perceptions of maternal role
● Coping mechanisms
G. INTEGUMENTARY SYSTEM
● Knowledge of pregnancy changes
● 1. Striae Gravidarum or Stretch marks –
caused by enlarging uterus w/c causes
destruction of connective resulting from 1st Trimester:
separation of underlying collagen w/c appears as Establish an acceptance of Pregnancy
irregular scars. Do not scratch instead apply oil ● 1. no tangible s/sx
● 2. feeling of surprise, ambivalence (existence of
2 opposing feelings), emotional lability or mood
swings, money worries, body image changes.
● 3. Focusing on self
● 4. Denial: a sign of maladaptation to pregnancy
● 5. developmental task ;to accept the biological
facts of pregnancy. “ I AM PREGNANT”
● 6. Health teaching/focus: bodily changes,
personal hygiene & nutrition

2nd Trimester:
Continuation of Pregnancy
● 1. with tangible s/sx
● 2. Role identification & heightened sense of time
● 3. mother identifies fetus as a separate entity due
to quickening.
● 4. Mother begins to fantisize the appearance of
the baby
● 5. Developmental Task: To accept the growing
fetus as a baby to be nurtured. “ I AM GOING
TO HAVE A BABY”
● 6. Health teaching/focus: G&D of the fetus

3rd trimester:
Preparation for separation of the baby
● 1. Mother has personal identification of the
appearance of the baby
● 2.Mother has fears due to enlarged abdomen.
Allow her to hear FHT.
● 3. L &D are on the mother’s mind; safe passage
for herself the newborn
● 4. Nesting behaviors: Busy days & restless nights
● 5. Father prepares for birth and his environment
● 6. Developmental Task: To prepare for birth and
parenting of the child. “ I AM GOING TO BE
A MOTHER”
● 7. Health teaching/focus: RP, best time to
prepare for baby layette, shopping & buying
baby’s cloths, Lamaze classes may also be
offered.