Concept: Maternal and Child Nursing Lecturer: Anxel Cariaso, RN Main Concept of MCN 1. Pregnancy a. Menstruation b. Sexuality c.

Prenatal Care d. Genetic Principle 2. Labor and Delivery a. Post Partum b. 4 P s (power, passenger, passageway, pelvis insight) c. Stages of C and D d. Newborn Care e. Maternal 9-12 years old age na nireregla ang babae Hypothalamus stimulates when alam niyang may imbalance sa hormones; minimum of 95 lbs Hypothalamus GnRH Pituitary Gland FSH and LH increase FSH ovary Primordial follicle to graafian follicle development increase estrogen increase progesterone thickening (changes) in endometrium lining increase estrogen increase LH bursting out of mature ovum from graafian follicle ovulation aalis yung matured ovum at magstay sa fallopian tube kaya magthithickening sa endometrium lining for possible implantation Progesterone maintains thickening Estrogen stimulates thickening (If magmimeet ang sperm cell at egg cell mafefertilize ito ) After fertilization fertilized egg stays 3 days sa fallopian tube para mag-implant sa uppermost portion of uterus Menarche typical age: 12 years old - but it happens sa 9-17 years old 28 days - normal average duration of menstrual cycle - can be short as 22-25 days Way how to know if fertile ang babae: (if hindi fixed na 28 days ang menstruation) - subtract 18 sa shortest cycle na naranasan mo - subtract 11 sa longest cycle - e.g. the girl has irregular menstruation cycle. Her shortest count sa isang cycle is 26 days and the longest is 43 days. 26 (shortest) 18 = 8 days 43 (longest) 11 = 32 days Nagkakamens ang babae 3-5 days a week Menstruation nagdedecrease ang amount

- increase amount during 1st to 3rd day - from red, it will turn to pink then to brown then to white (habang nagdedecrease din ang amount nito) Hormone estrogen helps para magkaroon ng secretion Blood loss during menstruation 30-80 ml or average of 60 ml Menstruation combination of blood, endometrial tissue and cervical mucus - 3-5 days before and after, fertile ka na. Menstrual disturbance 1. amenorrhea absence of menstruation - primary cause: never pa nagkaroon ng menstruation; normal before the age of 9 years old; normal before the age of puberty; management: dependent of underlying condition - secondary cause: nagkaroon dati pero huminto dahil may ovaries dysfunction; hindi na mabubuntis 2. dysmenorrhea painful and difficult menstruation - primary: not related to pathologic - secondary: related to pathologic like PID and endometriosis - feel at lower abdominal area hypogastric pain Ischemic phase release of prostaglandin (pain hormone) - shed off - management for pain: 1. warm compress to decrease pain sensation - Warm/ cold massage serotonin blocks the pain receptors - Mydol prostaglandin blockers 2. low dose of ibuprofen and mefenamic acid (NSAID) - take it with means to prevent ulcer formation - gastric lining have protective layes with prostaglandin Management: dysmenorrhea 1. strengthen of abdominal by doing exercise - weakening of abdominal magkakaroon ng dysmenorrheal 3. menorrhagia atypical uterine bleeding - heavy and prolonged bleeding - more than 14 days of menstruation - 1st 7 to 10 days, increase amount - common in near menopause - increase estrogen and walang progesterone that means if madaming estrogen (may thickening sa endometrium) but wala siyang progesterone (walang magmemaintain ng thickening) kasi limited na ang egg cells so walang ovulation - management: progesterone pills

Menopause anovulatory cycle - nagreregla ng walang ovulation

4. metrorrhagia - normal menstruation happens at irregular interval - 3-5 per 7 days ang menstruation (normal) but here, 2 times to 3 times a month - breakthrough bleeding - OC pills - no management to metrorrhagia Pre-menstrual syndrome - combination of physical and behavioral changes during last half of menstrual cycle - cause: unknown (common) - progesterone related ovulation - signs and symptoms: Physical Behavioral - breast fullness - emotional lability (mood swings) - easy fatigue - cyclical nature - low back pain - ptyalism increase appetite - excessive salivation because of increase estrogen - management: none - dapat maging understanding Sexuality multidimensional phenomenon that encompasses feelings, attitude, and behavior 3 Types of Gender: 1. Biologic gender male/ female 46 chromosomes 23 both father and mother - 22 autosomes and 1 sex chromosome from mother - 22 autosomes and 1 sex chromosome from father 44xx female 44xy male Women doesn t produce y Male only have or produce y chromosomes; which means male ang nagdedefine ng biologic gender 2. sexual identity inner sense of being male or female 4 types: a. heterosexual normal - opposite sex finds love, pleasure and satisfaction b. homosexual due to environmental and social factor - same sex needs thin skin condom if they want sex c. bisexual chickboy; identity crisis - they don t know what they want and because they don t know who they are d. transsexual extending homosexual Rectal bleeding signs and symptoms of rectal cancer

Oral sex ngipin can be portal entry of microorganisms - bawal lunukin ang buhok kasi can cause allergic reaction (e.g. cough, white or grayish sputum) 3. gender role a behavior conveys being a male or female

Sexual response cycle 1. excitement period of arousal - physiological and psychological stimulation Lalaki visually stimulated - psychological stimulation Female physiologically stimulated Physiologically and psychologically stimulation increase vital signs (PR, RR, T); increase muscle tension and arterial dilation and venous constriction fluid accumulation on pelvic area (semen and fluid) 6 weeks after attack kapag may Myocardial Infarction (heart attack): - man or woman with heart attack not in dominant or active position - myocardial infarction the more na magheart attack, decrease chance of survival - pumping increase in oxygen demand - sliding lang ang gagawin kapag may Myocardial Infarction (if the patient wants to be in dominant position) 2. plateau - longer: female 30 seconds - shorter: male 3-5 seconds - encourage foreplay to pass the orgasm for female - teach proper technique (pump and slide) - clitoris center stimulation of female 3. orgasm height of sexual pleasure - mas okay kapag sabay mag rgasm - male need 5-30 minutes in refractory phase para mag erect ulit - needs 24 hours (60-70 years old) - once lang mag-oorgasm Geriatric (sex) - position: no pumping; sliding na lang - no extreme position - dyspareunia use water lubrication (water- based like KY jelly) - no to petroleum kasi irritants ito sa body - alternative methods: kissing, masturbating, hugging, carress Females - multiple orgasm 1. clitoral orgasm

2. vaginal orgasm mahirap ireach ang orgasm; increase stimulation if you have increase secretions G spot doesn t exist in the body Pregnancy and menstruation hormones increase progesterone --> cause of precongestion water retention weight gain 4. resolution unaroused stage 5. refractory (for males only) - pahinga muna Different Genetic Principle 1. Fertilization 2. Principle of Genetic Maternal 3. Patterns of Inheritance Fertilization - life span: ovum (24-48 hours) first 24 hours, ovum is fertilized - life span: sperm cell (48-72 hours) but it says that it is alive until 5 days; capacity to fertilized ovum 72 hours - capacitation pagmeet ng sperm and egg cell - structures Male Female - seminal fluid: 3-5 ml and in 1 ml, there is 100 - ovum has protective layers: zona pellucida million sperm cell (external) and corona radiata (internal) - sperm with proteolytic enxyme hyaluronidase and has tail for mobility Zona pellucida hyaluronidase Corona radiata head ovum tail sperm cell

Test to identify kung baog ang isang tao: - female: 1. hormone imbalance 2. uterus infantile uterus 3. vaginal pH increase acidic 4. ovary dysfunction 5. fallopian tube stenosis - male: 1. sperm test sperm analysis Infertility inadequate sperm or ejaculation - less than 20 million per ejaculation - sperm mobility itaas yung pwet ng babae kapag nakasupine position (sinusunod ang law of gravity) para mabuntis ang babae

-management: used fertilitydrugs ordered by doctor: a. drink alcohol or beer it increases mobility - alter CNS affects equilibrium - gastric irritants and allergic irritants Twins 1. monozygotic 1 sperm and 1 egg cell a. identical twins same gender, finger prints and mole b. conjoined twins no total separation c. parasitic twins no total separation and no development; taong may excess organs 2. dizygotic a. fraternal twins 2 sperm and 2 egg cell - at risk of intrauterine growth restriction For pregnant women who have twins: - at risk intrauterine growth restriction - share 1 placenta and 1 membrane Twin transfusion syndrome - 1 payat decrease nourishment - 1 mataba increase nourishment enough Different types of Genetic Maternal 46 - 23 from mother and 23 from father - 22 autosomes and 1 sex chromosome (from one parent) 22x (from mother) + 22x (from father) = 44xx (baby male) 22x (from mother) + 22y (from father) = 44xy (baby female) 22x (from mother) + 22o (from father) = 44xo (no sex chromosomes) - it may indicate: a. turner s syndrome b. incomplete female c. with physical body of male d. they don t have ovary or uterus e. no internal reproductive system 22x (from mother) + 22xy (from father) = 44xxy - indicates: 1. kleinfelter syndrome 2. hermaphrodite (all animals are normally have 2 sexes) 3. with female and male genitalia 4. penis is found in area of clitoris 5. one of the genitals is functional - if the testes is in the abdomen, it normally descent in 7 months 21A21 trisomy 21 - may extra 21 chromosomes - down syndrome - mongoloid kasi parang Mongolian ang face

- low set ears - simian crease - unusual spacing of toes - mental retardation 13A13 trisomy 13 - physical feature of down syndrome - have pigeon chest - increase anterior chest - without mental retardation Autosome5 cri tu chat - crying cat 23+46 chromosomes = 69 - H.mole - walang anak 23+0= 23 - walang anak - blighted ovum Patterns of Inheritance Autosomal no sex preference X linked with sex preference Hemophilia females are only carrier - lalaki lang ang nagkakaroon Condition: 1. dominant strong condition = 1 parent symptomatic 2. recessive weak 2 parents a. heterozygous carrier, no symptoms or signs b. homozygous carrier, with signs and symptoms autosomal dominant condition - 1 affected parent abnormal parent (D) - 1 normal parent normal parent (d) D (ABNORMAL) d Dd (25) d Dd (25) - indicates: a. 50% of their child is sick b. 50% of their child is normal 1. retinoblastoma tumor of retina, poor prognosis - chemotherapy prevent metastasis to normal eye 2. osteogenesis imperfect brittle bone disease - signs and symptoms sees when the child grows up

d dd (25) dd (25)

- prone for pathologic fracture particularly long bones in lower limbs because it holds the weight of the baby - management: ROD insertion femur or long bones - have brittle skull management: helmet 3. achondroplasma normal size of head, normal trunk, maliit ang upper extremities and limbs - e.g. DAGUL Hypopituitarism dwarfism e.g. mahal and mura Autosomal recessive condition - no sex preference - weak - 2 parents - D normal - d abnormal Hetero Homo d - abnormal d - abnormal - 50% - carrier - 50% - sick Hetero Hetero D d - 25% - normal - 50% - carrier - 25% - sick Homo Normal D D - 100% - carrier - 3rd generation condition 1. sickle cell anemia inheritance of a sickle hemoglobin - hemoglobin oxygen carrier - hemoglobin f 1st 6 months then become hGbA - hGbs nagiging ganito kapag may sickle cell anemia; less than 21% oxygen - vasoocclusion can cause hypoxia 2. thalassemia limited lifespan - very fragile RBC -normal life span of RBC: 30-50 days; but on thalassemia, there is accelerated rate of hemolysis d Dd Dd d Dd Dd D DD Dd d Dd dd

D - normal Dd Dd

d - abnormal dd dd

- hemolysis: accelerated rate - spleenomegaly spleenic rupture blood loss hypovolemic shock - spleen reservoir of RBC