Week 1, 2, 3 NCM 107 Care of Mother, Child, Adolescents (Well Clients)

Totipotent stem cells

During the first 4 days of life, zygote cells are termed __________ or cells so undifferentiated they have the potential togrow into any cell in the human body

The primary goal of both maternal and child health nursing is the _______ and ______of optimal family health

promotion maintenance

Maternal and child health nursing is ?

a. Family centered

b. Community centered

c. Evidence based , this is the means whereby critical knowledge is increased.

d. A challenging role for nurses and a major factor in keeping families well and

optimally functioning.

GLOBAL HEALTH GOALS

1. To end poverty and hunger.

2. To achieve universal primary education.

3. To promote gender equality and empower women.

4. To reduce child mortality.

5. To improve maternal health.

6.To combat HIV/AIDS, malaria, and other disease.

7.To ensure environmental sustainability.

8.To develop a global partnership for development.

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.

Maternal and Child Health Goals and Standards

The 2020 National Health Goals are intended to help citizens more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade.

It's important for maternal and child health 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

The goals also serve as the basis for funding and financing of evidence-based practice.

Framework for Maternal and Child Health Nursing Care

Maternal and child health nursing can be visualized within a framework in which nurses use:

Nursing process Nursing theory Quality and Safety Education for Nurses

Health promotion

educating parents and children to follow sound health practices through teaching and role modeling

Health maintenance

intervening to maintain health when risk of illness is present.

Health restoration

using conscientious assessment to be certain that symptoms of illness are identified and interventions are begun to return patient to well ness most rapidly.

Health rehabilitation

helping prevent complications from illness helping a patient with residual effects achieve an optimal state of wellness and independence; helping a patient to accept inevitable death.

Nursing Process

a scientific form of problem solving, serves as the basis for assessing, making a nursing diagnosis, planning, implementing and evaluating care.

Nursing Theory

Nursing theories are designed to offer helpful ways to view patients so nursing activities can be created to best meet patients needs

Nursing Process

It is a process broad enough to serve as the basis for modern nursing care because it is applicable to all healthcare settings, from the home to ambulatory clinics to intensive care units.

Quality and Safety Education for Nurses

a. patient-centered care

b. Teamwork and collaboration

c. Quality improvement

d. Informatics

e. Evidence based practice

f. Safety

Over all goal of QSEN

to prepare future nurses with the abilities

necessary to continuously improve the quality and safety of the

healthcare systems in which they work.

ETHICAL CONSIDERATIONS OF PRACTICE

1. Conception issues, especially those related to in vitro fertilization, embryotransfer, ownership of frozen oocytes or sperm and surrogate motherhood

2. Pregnancy termination

3. Fetal rights versus rights of the mother

4. Stem cell research

5. Resuscitation (and length of its continuation)

6.Number of procedures or degree of pain a child should be asked to endure to achieve a degree of better health

7. Balance between modern technology and quality of life

8. Difficulty maintaining confidentiality of records when there are multiple caregivers.

STRUCTURE AND FUNCTIONEXTERNAL GENITALIA

1.Penis

2.Scrotum

Penis

Male reproductive organ

Freely movable and attached to the pubic arc by ligaments

Scrotum

A thin walled sac suspended below the pubic bone, posterior to the penis

Contains sweat and sebaceous glands and consists of rugae skin and cremaster muscle

Functions of Scrotum

1.Serve as a protective covering for the testes, epididymis and vas deferens

2. Helps to maintain temperature control because the cremaster muscle is sensitive to changes in temperature.

(cremateric reflex) Scrotal skin become wrinkled

The muscle contracts when too cold, raising the scrotum and testes upward toward the body for warmth is called?

Testes

1. Two parts of the scrotum: divided into two by a septum: each part contain one testis

2.Testes are a pair of ovoid-shaped organs similar to the ovaries of woman

3. Size: 3.7 to 5 cm long, 2.5 cm wide 2.5cm deep

4. Each testis is covered by tunica vaginalis which separate the testis from the scrotal wall.

Each testis is covered by _______ which separate the testis from the scrotal wall

Tunica vaginalis

Function of tunica vaginalis

protect the testes from injury because of its double layered and lubricated membrane

Function of testis

to produce spermatozoa and the male sex hormone testosterone

Spermatic Cord

Suspending the scrotum

Contains blood vessels, lymphatic vessels, nerves and the vas deferens (ductus deferens)

The vas deferens is a muscular tube that is continuous with the lower portion of the epididymis

Functions of vas deferens

provides passage for transporting sperm from the testes to the urethra for ejaculation

INGUINAL AREA

Also known as the groin

Area where hernia develops ( hernia is the protrusion of loops of bowel through weak areas of the musculature)

Inguinal area is located between the anterior superior iliac crest spine laterally and the symphysis pubis medially

a. Anal canal

Final segment of the digestive system

Begins at the anal sphincter and ends at the anorectal junction(pectinate line or mucocutaneous junction, dentate line)

Size of the anal canal: 2.5 cm to 4 cm long

Lined with skin that contains no hair or sebaceous glands but with many somatic sensory nerves, making it susceptible to painful stimuli

Anal opening

Or anal verge

Hairless, moist in appearance

There are two sphincters within the anus that hold the anal canal closed except when passing gas and feces

External sphincter

composed of skeletal muscle and is under voluntary control

Internal sphincter

composed of smooth muscle and is under involuntary control by the autonomic nervous system> Above the internal sphincter is the anorectal junction (not palpable but can be visualized during examination)

Rectum

The lowest portion of the large intestine

Size: 12cm long

Extending from the end of the sigmoid colon to the anorectal junction.

Peritoneum

Lines the upper 2/3 of the anterior rectum

rectovesical pouch, rectouterine pouch

Locate dip down, it may be palpated where it forms the________ in men and the __________ in women

INTERNAL GENITALIA

PROSTATE

Prostate gland

Size: 2.5 to 4cm in diameter, surrounding the neck of the bladder and urethra

Lies between the structures and the rectum in male clients

Consists of two lobes separated by a shallow groove called the median sulcus

Median sulcus

Secretes a thin, milky substance that promotes sperm motility and neutralizes female acidic vaginal secretions

This chestnut or heart shaped organ can be palpated through the anterior wall of the rectum

MALE REPRODUCTIVE SYSTEM

Bladder

Urethra

Penis

Seminal Vesicle

Prostate Gland

Vas Deferens

Epididymis

Testicle

EXTERNAL GENITALIA

Can be identified through inspection Sometimes referred to as the vulva or pudendum Extends from the mons pubis to the anal opening

Mons pubis

Fat pad located over the symphysis pubis Covered with pubic hair in a triangular pattern among normal adults

Functions of mons pubis

Absorb force and to protect the symphysis pubis during intercourse( sexual intercourse)

Labia majora

Are two skin folds that extend posteriorly and inferiorly from the mons pubis to the perineum

Skin folds are composed of adipose tissue, sebaceous glands, and sweat glands

The outer surface is covered with pubic hair in the adult, while the inner surface is pink, smooth and moist.

Labia minora

located inside the labia majora

Thin skin folds

Join anteriorly at the clitoris and form a prepuce or hood

Posteriorly the two folds join to form the frenulum

Hairless, and darker pink

Contain numerous sebaceous glands.

Labia minora

Functions: promote lubrication and maintain a moist environment in the vaginal area

Clitoris

Located anteriorly at the end of the labia minora

Small, cylindrical mass of erectile tissue and nerves with three parts:

The glans

visible rounded portion

The corpus

the body

The crura

two bands of fibrous tissue that attach the clitoris to the pelvic bone

Vestibule

A boat shaped area formed by the skin folds of the labia majora and labia minora

Contains several openings:

Urethral meatus

located between the clitoris and the vaginal orifice

Skene's glands

located on either side of the urethral openings and are not usually visible

Vaginal orifice

External opening of the vagina and either has a slit like or irregular circular structure depending on the configuration of a hymen.

Hymen

is a fold of membranous tissue that covers part of the vagina

Bartholin's glands

Located on either side of and slightly posterior to the vaginal orifice (between the vaginal orifice and the labia minora) These glands secrete mucus, which lubricate the area during sexual intercourse They are not visible to the naked eye and sometimes called as the greater vestibular glands.

Female External Reproductive Organs

Clitoris

Mons Pubis

Urethral Orifice

Vaginal Orifice

Labuim majus

Vestibule

Labuim minus

Perineum

Anus

Vagina

A muscular, tubular organ, extends up and slightly back toward the rectum from the vagina orifice (external opening) to the cervix

Lies between the rectum posteriorly and the urethra and bladder anteriorly

Approximately 10 cm long

Functions of vagina

Allows the passage of mentrual flow

Receives the penis during sexual intercourse

Serves as the lower portion of the birth canal during delivery

Outer layer

composed of pink squamous epithelium and connective tissue

Under the direct influence of the hormone estrogen and with many mucus-producing cells

Lies in transverse folds called rugae

These transverse folds allow the vagina to expand during intercourse and to facilitate vaginal delivery of a fetus

Submucosal layer - Second layer

Contains the blood vessels, nerves, and lymphatic channels

Third layer

is composed of smooth muscle

Fourth layer

consists of connective tissue and the vascular network

Normal environment of vagina

acidic; pH 3.8 -4.2

Doderlein's bacili

This environment is maintained because the acidic environment contains ________________ and these bacili act on glycogen to produce lactic acid; this acidic environment helps to prevent vaginal infection

Cervix

Dips down and forms a circular recess that gives rise to areas known as theanterior and posterior fornices

neck of the uterus

The cervix is considered as the

Internal os

The junction of the isthmus and the cervix forms the

external os or ectocervix

The junction of the cervix and the vagina forms the

"os"

The _____ refers to the opening in the center of the cervix

The cervix is composed

Smooth muscle Muscle fibers

Connective tissue

squamocolumnar junction

Red, rough-looking columnar epithelium may be visible around the os the point where the two epithelium meet is called ?

Transformational zone

This migrates toward the cervical os with maturation or with increased estrogen levels

This migration forms an area known as ?

Importance of transformational zone

90% of the neoplasms of the lower genital tract originate in this area.

This is the area from which cells are obtained for cervical cytology or the Papanicolaou smear or Pap smear

Functions of the cervix

1. Allows the entrance of sperm into the uterus

2. Allow the passage of menstrual flow

3. Secretes mucus and prevents the entrance of vaginal bacteria

4. Stretches to allow the passage of fetus during normal delivery

Uterus

pear-shaped muscular organ

Two components

a. The corpus - the body

b. The cervix - the neck

Division of the uterus:

c. Fundus - Upper portion

d. The body - central portion

e. Isthmus - narrow lower portion

Uterus

is located at the forward position above the bladder

Size of Uterus

Size: 7.5cm long, 3cm wide, 2.5 cm thick (non pregnantuterus)

Three layers of the uterine walls

Endometrium

Estrogen and progesterone

Endometrium

inner mucosal layer

Endometrium

Composed of the epithelium, connective tissue and vascular network

Estrogen and progesterone

influence the thickness of this layer

Myometrium

The middle layer

Composed of three layers of smooth muscle fibers that surround blood vessels

Myometrium

Function: to expel the product of conception (fetus)

Peritoneum- outer layer

Covers the uterus and separates it from the abdominal cavity

Forms anterior and posterior pouches around the uterus

recto-uterine pouch or the cul-de-sac of Douglas

The posterior pouch is called the

ovaries

Are a pair of small, oval-shaped organs, each is located on a lateral aspect of the pelvic cavity

Ovaries are connected to the uterus by the ovarian ligament

ovaries

Size: 3 cm long, 2 cm wide, 1 cm deep

Ovaries Functions

Develop and release ova

To produce hormones such as estrogen, progesterone and testosterone

Fallopian tubes

The ovum travels from the ovary to the uterus through the ?

Fallopian tubes

size: 8 to 12 cm

Begin near the ovaries and enter the uterus just beneath the fundus.

fimbriae

The end of the tube near the ovary has finger like extensions or finger like projections called

Adnexia (Latin forappendages)

The ovaries, fallopian tubes and supporting ovarian ligaments are called ?

Anal canal

Final segment of the digestive system

Begins at the anal sphincter and ends at the anorectal junction

Anal canal

Size: 2.5 cm to 4 cm long

Anal canal

Lined with skin that contains no hair or sebaceous glands but contain somatic sensory nerves making it susceptible to painful stimuli

Anal opening

Or anal verge Hairless, moist in appearance

External sphincter

Composed skeletal muscle and is under voluntary control

Internal sphincter

Composed of smooth muscle and is under involuntary control by the autonomic nervous system